siblings were predicted to carry 2 mutant TMPRSS6 alleles. Thus, in many cases, it is highly likely that clinically affected individuals with 1 TMPRSS6 pathogenic variant possess a second occult mutant allele. While this manuscript was in preparation, another group of investigators also studied the utility of normalizing plasma hepcidin to the TfSat in patients with IRIDA. 6 In particular, they compared the TfSat:hepcidin ratio in TMPRSS6-mutated patients who had 1 or 2 mutated alleles and found that, in general, those individuals with a single detectable allele had a milder biochemical phenotype than those with 2 mutated alleles. We suggest that most patients with a severe clinical phenotype likely have biallelic TMPRSS6 mutations and that, in some cases, the second allele is genetically occult. One goal of this study was to elaborate a biochemical method that might predict which patients in a group of individuals with cID/A were most likely to have biallelic TMPRSS6 mutations. The study group included only those who were poorly responsive to oral iron and had a TfSat #15%, that is to say, those who had a higher pretest probability of having IRIDA as a result of TMPRSS6 mutations than an unselected group with ID/A and TfSat #15%. Application of these tests in a broader iron-deficient population would likely result in a lower specificity. Nonetheless, one might argue that, regardless of whether or not an individual with cID/A has TMPRSS6 mutations, a relative hepcidin excess, as indicated by the normalized hepcidin or ferritin ratios or multivariable model would indicate that they would benefit from early initiation of parenteral iron therapy.