Iron storage is further compounded by increased iron absorption from food as a way to combat anemia. There are several methods of iron assessment. The easiest, most affordable, least reliable and most common method is a serum ferritin test. This involves drawing a small sample of blood and testing for its ferritin content, which is an important iron-storage protein. Ferritin tests are useful for measuring gross iron overload or dramatic reduction in iron levels, but are limited when attempting to finely measure actual organ storage of iron.
Ferritin tests remain an approximation rather than an accurate indicator of iron stores.
A second method of measuring body iron burden is the liver biopsy, a direct sampling of burdened tissue, during which a small piece of liver tissue is removed and examined for iron fall between storage. The method is an invasive procedure, sometimes involving a short hospital stay. As a result, many patients are reluctant to get a liver biopsy and are worried about its safety. However, a recent study from Italy, where thalassemia is extremely prevalent, showed that of 1000 patients biopsied over 5 years, no complications occurred. This is due in part to improved ultrasound technology which allows physicians to see the liver before the procedure.