Diagnosis of iron-deficiency anemia in the elderly (original) (raw)
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Diagnosis of iron-deficiency anemia in the elderly1
American Journal of Medicine, 1990
PURPOSE: To determine the value of serum ferritin, mean cell volume, transferrin saturation, and free erythrocyte protoporphyrin in the diagnosis of iron-deficiency anemia in the elderly.
Ability of serum ferritin to diagnose iron deficiency anemia in an elderly cohort
Revista Brasileira de Hematologia e Hemoterapia, 2017
Background: Diagnosis and treatment of iron deficiency anemia in older subjects improves their quality of life. Serum ferritin as a marker of iron stores is an acute phase protein. In older subjects who usually have many concomitant chronic medical conditions, serum ferritin may increase in response to inflammatory processes irrespective of iron stores. This study was performed to determine the diagnostic properties of serum ferritin in the diagnosis of iron deficiency anemia in older subjects. Methods: This case-control study included all the inhabitants of Amirkola town who participated in the Amirkola Health and Aging Project. Diagnosis of anemia was confirmed based on a hemoglobin level <13 g/dL in men and <12 g/dL in women and iron deficiency anemia by percent transferrin saturation <15%. A receiver operating characteristic curve was constructed to determine an optimal serum ferritin cutoff value to differentiate patients with and without iron deficiency anemia at the highest sensitivity and specificity. Results: Eighty patients with iron deficiency anemia and 160 cases of anemia without iron deficiency (mean age: 72.9 ± 8 and 71.6 ± 7.6 years, respectively; p-value = 0.37) were analyzed. In iron deficiency anemia, the mean serum ferritin was significantly lower (p-value = 0.036) compared to patients without iron deficiency anemia. Serum ferritin with a cutoff level of 100 ng/mL differentiated patients with and without iron deficiency anemia with a sensitivity of 60% and specificity of 59% and area under the receiver operating characteristic curve of 0.615 ± 0.040 (95% confidence interval: 0.536-0.694; p-value = 0.004). Conclusion: These findings indicate that in elderly subjects, iron deficiency anemia may develop with higher levels of serum ferritin. Hence, the conventional cutoff of serum ferritin for the diagnosis of iron deficiency anemia in young adults is not appropriate for the elderly population.
Annals of Hematology, 2005
The serum ferritin assay is the best single blood test for the diagnosis of iron deficiency. Previous studies with elderly anemic patients have suggested that ferritin level less than 45 μg/L is indicative of iron deficiency. The subjects of these studies were hospitalized patients with anemia, however. We thus conducted a prospective study to determine the normal minimum level of serum ferritin of community-dwelling older adults by assessing the ratio of serum transferrin receptor to the log ferritin level (sTfR-F index). We conducted the anemia survey between October and November 2002. A total of 1,254 apparently healthy older adults, aged between 60 and 95 years, from three urban community dwellings participated in the survey. Among these individuals, 156 subjects who were anemic or whose serum ferritin level was less than 100 μg/L were selected. The soluble transferrin receptor assay was performed and the sTfR-F index was calculated. The receiver operating characteristic curve analysis was performed. Based on the data, serum ferritin level of 22 μg/L was selected as the cutoff value for the diagnosis of iron deficiency in community-dwelling older adults. Applying the serum ferritin cutoff of 22 μg/L and the sTfR-F index cutoff of 1.5, the sensitivity of the assay was 89.5% (34 of 38) and the specificity was 89.0% (105 of 118). In conclusion, for the diagnosis of iron deficiency of community-residing older adults, we suggest the serum ferritin cutoff value of 22 μg/L obtained by use of the sTfR-F index. The value is lower than the previous value established for hospitalized and anemic older adults.
A ferritin level >50 μg/L is frequently consistent with iron deficiency
European Journal of Internal Medicine, 2009
Background: The British Society of Gastroenterology (BSG) suggests that a serum ferritin level ≤ 50 μg/L is still consistent with iron deficiency in the presence of coexistent pathology (inflammation, infection or malignancy), by implication excluding iron deficiency above this level. We aim to examine the validity of this cut-off level in three different groups of patients. Methods: We used the soluble transferrin receptor/Log 10 ferritin ratio (sTfR-F Index or Index) as a determinant of body iron stores. If the Index was equal or more than 2, the patients were considered iron deficient. Patients were considered iron replete if Index was ≤1. The data was prospectively collected over a period of 3 years. All patients had normocytic anaemia. Results: We collected data for 198 patients. Ninety-three had a sTfR-F Index ≥2 and 17 had Index ≤1. If a ferritin level ≤50 μg/L was used as the cut-off value for iron deficiency, the negative predictive value (NPV) of ferritin test was 22% and the positive predictive value (PPV) 100%; if the level is raised to 100 μg/L the NPV of ferritin test rose to 34.8% and the PPV was 97%. Conclusion: Patients with normocytic anaemia who have ferritin levels above 50 μg/L should not automatically be considered to have adequate iron stores. We suggest that the integration of sTfR-F Index in the diagnostic workup of these patients can improve patient care.
Clinical chemistry, 1991
We determined serum ferritin, C-reactive protein (CRP), fibrinogen, and the erythrocyte sedimentation rate (ESR) in 73 patients with anemia of chronic disease. Nomograms of CRP, ESR, or fibrinogen vs ferritin concentrations were constructed and used to estimate the iron store in bone marrow. Iron stores estimated from the nomograms were compared with the results of staining cytological bone marrow smears for iron, the reference method for evaluating iron in bone marrow. In contrast to the results of Witte et al. (Clin Chem 1985;31:1011; Am J Clin Pathol 1986;85:202-6 and 1988;90:85-7), we observed that nomograms of CRP, fibrinogen, or ESR (i.e., acute-phase reactants not influenced by changes in iron metabolism) vs ferritin are not suitable to correct for the acute-phase component of changes in ferritin concentrations. For ferritin concentrations less than 70 micrograms/L, we found that iron deficiency, as judged from bone marrow iron stain, apparently was always present.
Serum ferritin as an indicator of body iron stores in anemic patients
International Journal of Clinical and Diagnostic Pathology, 2019
Serum ferritin concentrations have been documented to give an accurate indication of the amount of storage iron not only in healthy individuals but also in cases of iron deficiency or iron over load. A low serum ferritin is highly indicative of deficient iron stores. Values less than 15ng/ml are indicative of negative iron balance or decreased stores. In cases of anemia of chronic diseases, serum ferritin levels are increased as serum ferritin is an acute phase reactant. Thus, in patients of anemia of chronic diseases with concomitant iron deficiency, serum ferritin may not be below 15ng/ml and serum ferritin may not give a true picture of deficiency in these patients. In the present study, we determined the role of serum ferritin as an indicator of body iron stores along with the cutoff value for serum ferritin to detect hypoferremia in patients of anemia of chronic diseases.
American Journal of Hematology, 2008
How often elevated serum ferritin in primary-care patients reflects increased iron stores (normally 0.8 g in men, 0.4 g in women) is not known. The Hereditary Hemochromatosis and Iron Overload Screening (HEIRS) study screened 101,168 primary-care participants (44% Caucasians, 27% African-Americans, 14% Asians/Pacific Islanders, 13% Hispanics, 2% others). Follow-up clinical evaluation was performed in 302 of 333 HFE C282Y homozygotes regardless of iron measures and 1,375 of 1,920 nonhomozygotes with serum ferritin >300 g/L (men), >200 g/L (women) and transferrin saturation >50% (men), >45% (women). Quantitative phlebotomy was conducted in 122 of 175 C282Y homozygotes and 122 of 1,102 nonhomozygotes with non-transfusional serum ferritin elevation at evaluation. The estimated prevalence in the Caucasian population of C282Y homozygotes with serum ferritin >900 g/L at evaluation was 20 per 10,000 men and 4 per 10,000 women; this constellation was predictive of iron stores >4 g in men and >2 g in women. The estimated prevalence per 10,000 of non-C282Y homozygotes with serum ferritin >900 g/L at evaluation was 7 among Caucasians, 13 among Hispanics, 20 among African Americans, and 38 among Asians and Pacific Islanders, and this constellation was predictive of iron stores >2 g but <4 g. In conclusion, serum ferritin >900 g/L after initial elevations of both serum ferritin and transferrin saturation is predictive of mildly increased iron stores in multiple
Scientific Reports
Low serum ferritin is diagnostic of iron deficiency, yet its published lower cut-off values are highly variable, particularly for pediatric populations. Lower cut-off values are commonly reported as 2.5th percentiles, and is based on the variation of ferritin values in the population. Our objective was to determine whether a functional approach based on iron deficient erythropoiesis could provide a better alternative. Utilizing 64,443 ferritin test results from pediatric electronic health records, we conducted various statistical techniques to derive 2.5th percentiles, and also derived functional reference limits through the association between ferritin and erythrocyte parameters: hemoglobin, mean corpuscular volume, mean cell hemoglobin concentration, and red cell distribution width. We find that lower limits of reference intervals derived as centiles are too low for clinical interpretation. Functional limits indicate iron deficiency anemia starts to occur when ferritin levels reac...
Archives of Medical Research, 2018
Background. Serum or plasma ferritin concentration is recommended by WHO as a biomarker to assess iron status in individuals and populations. Methods. A systematic review was undertaken to summarise the evidence for ferritin reflecting iron status and to assess the cutoff points in different populations. Electronic databases were searched for studies evaluating ferritin concentrations compared against bone marrow aspirates for iron deficiency and to liver biopsies for risk of iron overload. Results. From 18822 records, 298 studies were assessed in full-text, including 72 studies on iron deficiency and 36 on iron overload in the quantitative analysis. All studies were observational. For iron deficiency, the mean ferritin concentration in healthy individuals was 15.1 mg/L (9 studies, 390 participants) when bone marrow iron content was 0, and 70.4 mg/L (3 studies, 151 participants) when bone marrow iron was 1þ or higher. In non-healthy populations, mean ferritin concentrations were 82.43 mg/L for iron depletion (38 studies, 1023 participants) and 381.61 mg/L for iron sufficiency (38 studies, 1549 participants) with wide variations depending on the pathology. For iron overload the results point out to a cutoff close to 500 mg/L although the data was very limited. Conclusion. Ferritin concentration is low in iron deficient individuals and high in ironloaded individuals, regardless of confounding clinical conditions. Current WHO thresholds for healthy populations appear valid but the data is limited for different age groups or physiological conditions. For iron overload, ferritin concentration would only help in the presumptive diagnosis and guide the need for further assessment.
The Iron Content of Serum Ferritin: Physiological Importance and Diagnostic Value
Clinical Chemistry and Laboratory Medicine, 2000
In this paper we present a method for determining the iron saturation of ferritin as a possible independent predictor of iron stores. Serum ferritin was purified by immunochemical precipitation, and could be completely recovered from serum without any contamination from transferrin. The iron content of the precipitated ferritin was determined by flameless atomic absorption spectrophotometry (FAAS) and the ferritin-iron saturation was calculated using the original serum ferritin concentration. The intra-and inter-assay variation coefficients were 4.2% and 13.4% respectively.