TF and malnutrition: It is important to acknowledge that TSAT is a ratio of serum iron to transferrin or total iron binding capacity, and is therefore susceptible to variations in either of these parameters.32 Serum iron levels are strongly influenced by dietary consumption and show pronounced diurnal fluctuations, while conditions such as chronic illness and malnutrition suppress the synthesis of transferrin.33 This is supported by evidence from research conducted in 2022 on Kenyan patients that TSAT (< 20%) shows a relatively low predictive value (31.5%) in identifying IDWA.34