Clinical thresholds for diagnosing iron deficiency: comparison of functional assessment of serum ferritin to population based centiles

Abstract 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 reach 10 µg/L, and are largely similar between genders and age groups. In comparison, centiles (2.5%) presented with lower limits overall, with varying levels depending on age and gender. Functionally-derived limits better reflects the underlying physiology of a patient, and may provide a basis for deriving a threshold related to treatment of iron deficiency and any other biomarker with functional outcomes.

Download Full-text

Effect of Maternal Iron Deficiency Anemia on the Iron Store of Newborns in Ethiopia

Anemia ◽

10.1155/2015/808204 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Betelihem Terefe ◽

Asaye Birhanu ◽

Paulos Nigussie ◽

Aster Tsegaye

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Complete Blood Count ◽

Iron Status ◽

Hemoglobin Concentration ◽

Deficiency Anemia ◽

Iron Store ◽

Cross Sectional ◽

Iron Deficient

Iron deficiency anemia among pregnant women is a widespread problem in developing countries including Ethiopia, though its influence on neonatal iron status was inconsistently reported in literature. This cross-sectional study was conducted to compare hematologic profiles and iron status of newborns from mothers with different anemia status and determine correlation between maternal and neonatal hematologic profiles and iron status in Ethiopian context. We included 89 mothers and their respective newborns and performed complete blood count and assessed serum ferritin and C-reactive protein levels from blood samples collected from study participants. Maternal median hemoglobin and serum ferritin levels were 12.2 g/dL and 47.0 ng/mL, respectively. The median hemoglobin and serum ferritin levels for the newborns were 16.2 g/dL and 187.6 ng/mL, respectively. The mothers were classified into two groups based on hemoglobin and serum ferritin levels as iron deficient anemic (IDA) and nonanemic (NA) and newborns of IDA mothers had significantly lower levels of serum ferritin (P=0.017) and hemoglobin concentration (P=0.024). Besides, newborns’ ferritin and hemoglobin levels showed significant correlation with maternal hemoglobin (P=0.018;P=0.039) and ferritin (P=0.000;P=0.008) levels. We concluded that maternal IDA may have an effect on the iron stores of newborns.

Download Full-text

Correlation of red cell indices and hemoglobin concentration with serum ferritin among iron deficiency anemia patients

Biomedicine ◽

10.51248/.v39i2.194 ◽

2020 ◽

Vol 39 (2) ◽

pp. 268-273

Author(s):

N. L Sharanya Raj ◽

U Ajay Sharma ◽

M. L Revathi Devi ◽

S. M Purushothama ◽

S. N Manjunath ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Hemoglobin Concentration ◽

Developed Countries ◽

Deficiency Anemia ◽

Mean Corpuscular Hemoglobin ◽

Red Cell ◽

Distribution Width ◽

Red Cell Indices

Introduction and Aim: Iron deficiency anemia is the commonest cause of anemia in developing country like India in all age groups. It is most easy to prevent as well as to treat. Its diagnosis and treatment are based on serum ferritin levels in developed countries which is not possible in India at primary healthcare setting. This study was undertaken to explore if red cell indices could replace serum ferritin in detecting iron deficiency. Materials and Methods: Study of association of red cell indices like Mean Corpuscular Volume (MCV), Mean Corpuscular hemoglobin (MCH), Mean Corpuscular hemoglobin Concentration (MCHC), Red cell Distribution Width (RDW) and Hemoglobin concentration (Hb%) with iron deficiency anemia and the correlation of these Red cell indices and Hb% with serum ferritin was done in 220 anemia patients of all age groups with Hb% <12g/dL. Results: Descriptive data showed skewed distribution of serum ferritin. Statistically significant reduction in all red cell indices values among iron deficiency anemia patients and statistically significant correlation of all red cell indices values except red cell distribution width with serum ferritin was found. Conclusion: Unlike developed countries we can use simple estimation of hemoglobin concentration along with red cell indices for diagnosing iron deficiency anemia in primary healthcare setting of India.

Download Full-text

The Role of α-Thalassemia and Iron Deficiency in the Difference between Hemoglobin Levels of African-Americans (AA) and Whites.

Blood ◽

10.1182/blood.v104.11.3706.3706 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3706-3706

Author(s):

Ernest Beutler ◽

Carol West

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Gene Frequency ◽

Ferritin Level ◽

Transferrin Saturation ◽

Hemoglobin Concentration ◽

Iron Deficient ◽

High Prevalence ◽

Hardy Weinberg Equilibrium ◽

The Difference

Abstract The fact that the average hemoglobin concentration (Hb) of AA is lower than that of whites has been documented extensively. Several investigations have shown that this difference of approximately 0.8 g/dL is due neither to iron deficiency nor to socioeconomic status. Its cause remains unknown. We compared the Hb of 1,493 AA and 31,029 white anonymized patients attending a Health Appraisal Clinic and confirmed the known difference in Hb, both for females and males (0.79 and 0.47 g/dL) respectively. The difference persisted when a subset of the subjects were paired by age and narrowed slightly in females when those with serum ferritin levels of <10 ng/ml or transferrin saturations of <16% were excluded (difference in females 0.59 g/dL; males 0.47). We determined the α-thalassemia −3.7 genotype of 298 AA. The gene frequency was found to be 0.17, and the distribution of genotypes fit the Hardy-Weinberg equilibrium. However, in a sample of 155 white subjects only one α-thalassemia allele was found (gene frequency=0.003). Among the AA subjects, the Hb and MCV values were lower in homozygotes (−a/−a) and heterozygotes (aa/−a) for α-thalassemia than in the aa/aa subjects. The table presents data for AA and white subjects after excluding all who did not have a documented serum ferritin level of >9 ng/ml and a transferrin saturation of >16%. Excluding subjects with sickle trait had no effect. Ethnic Group Genotype n Mean Hb SE Hb Mean MCV SE MCV −a/−a 3 11.87 0.418 72.23 2.32 F AA aa/−a 20 12.69 0.202 85.22 0.86 aa/aa 65 13.17 0.127 90.43 0.61 White 2917 13.60 0.016 90.85 0.07 −a/−a 2 13.85 0.550 83.05 1.65 M AA aa/−a 36 14.37 0.161 85.81 0.78 aa/aa 86 14.75 0.123 89.78 0.53 White 5335 15.09 0.013 90.35 0.06 As shown in the table, the average Hb of non-iron deficient AA females and males who had 4 normal α loci (aa/aa) was 0.43 and 0.34 g/dL lower respectively than those of whites, the difference being significant with p<0.01. We conclude that one cause of the lower Hb of AA compared to white subjects is the high prevalence of α-thalassemia in the AA population, but that it accounts for only about one-quarter of the difference after iron deficiency has been excluded. There are other, as yet undefined, causes that play a role. These may include the lower ATP (Biochem. Genet.1:25, 1967) and higher 2,3 BPG (Transfusion18:108, 1978) levels that have been documented in the red cells of AA subjects.

Download Full-text

Effect of Vitamin D Replacement on Hemoglobin Concentration in Subjects with Concurrent Iron-Deficiency Anemia and Vitamin D Deficiency: A Randomized, Single-Blinded, Placebo-Controlled Trial

Acta Haematologica ◽

10.1159/000357104 ◽

2014 ◽

Vol 133 (1) ◽

pp. 31-35 ◽

Cited By ~ 16

Author(s):

Basavraj Sooragonda ◽

Sanjay Kumar Bhadada ◽

Viral N. Shah ◽

Pankaj Malhotra ◽

Jasmina Ahluwalia ◽

...

Keyword(s):

Vitamin D ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Controlled Trial ◽

Hemoglobin Concentration ◽

Deficiency Anemia ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Hb Concentration

Background: The effect of vitamin D replacement on hemoglobin (Hb) concentration in subjects with concurrent deficiencies of vitamin D and iron is not known. Methods: We report on an investigator-initiated, randomized, single-blinded, placebo-controlled, 12-week interventional trial. Thirty subjects with iron-deficiency anemia (serum ferritin <15 µg/l) were randomized to an intervention arm (cholecalciferol, i.e. vitamin D3, 0.6 million units i.m. once) or placebo. In all subjects, iron deficiency was corrected with parental iron. Other causes of anemia were excluded with appropriate investigation. The primary end point was a rise in Hb concentration. Results: Baseline parameters of age, BMI, hemogram values and levels of serum ferritin, 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) were similar in the 2 arms. Twelve weeks after vitamin D replacement, there was a significant increase in 25 (OH)D levels (57.7 ± 20.5 vs. 14.1 ± 6.2 ng/ml, p < 0.0001) and a decrease in PTH levels (32.4 ± 16.4 vs. 52.9 ± 18.4 pg/ml, p = 0.003) in subjects in the intervention arm when compared to the placebo arm. However, the increments in serum ferritin and Hb concentration in the intervention and placebo arm did not differ. Conclusion: Vitamin D replacement in subjects with iron-deficiency anemia after iron correction does not improve Hb concentration further.

Download Full-text

Role of red cell distribution width (RDW) in the detection of iron deficiency anaemia in pregnancy within the first 20 weeks of gestation

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v37i3.9122 ◽

1970 ◽

Vol 37 (3) ◽

pp. 102-105 ◽

Cited By ~ 11

Author(s):

GS Sultana ◽

SA Haque ◽

T Sultana ◽

Q Rahman ◽

ANN Ahmed

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Red Cell Distribution Width ◽

Deficiency Anemia ◽

Mean Corpuscular Hemoglobin ◽

Red Cell ◽

Cell Distribution ◽

Corpuscular Hemoglobin ◽

Distribution Width ◽

Iron Deficient

Iron deficiency anemia is common problem during pregnancy. Red cell size variation (anisocytosis) is the earliest morphologic changes in iron deficiency anemia. Red cell distribution width is a quantitative measure of red cell size variation and it can give the idea of early iron deficiency before other test to become positive.190 pregnant women were included in this study. Red cell distribution width was compared between iron deficient & non-iron deficient pregnant women. Red cell distribution width also compared with Hb level, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and peripheral blood film in prelatent iron deficiency, latent iron deficiency, mild and moderate iron deficiency anemia. Red cell distribution width had sensitivity 82.3% and specificity 97.4%. Whereas Hb level, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and peripheral blood film all had 56.6%, 29.2%, 68.1%, 15% and 38.9% sensitivity but specificity was 90.9%, 98.7%, 83.1%, 96.1% and 98.7% in the detection of iron deficiency. Red cell distribution width appears to be a reliable and useful parameter for detection of iron deficiency during pregnancy. DOI: http://dx.doi.org/10.3329/bmrcb.v37i3.9122 BMRCB 2011; 37(3): 102-105

Download Full-text

Scoping into Non Iron Deficiency Anemia: Reflection from the Rural India

10.1101/2021.02.10.21251472 ◽

2021 ◽

Author(s):

Somen Saha ◽

Tapasvi Puwar ◽

Deepak Saxena ◽

Komal Shah ◽

Apurva kumar Pandya ◽

...

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Status ◽

Treatment Protocol ◽

Haemoglobin Concentration ◽

Deficiency Anemia ◽

Iron Storage ◽

Iron Deficient ◽

Postnatal Women ◽

Automated Immunoassay

AbstractIntroductionAnaemia is one of the leading public health problems. India accounts for the highest prevalence of anaemia in the world. Anaemia programs in India focus on screening and management of anaemia based on haemoglobin estimation, treatment is being given irrespective of status of iron as well as other micronutrient storage. The present study assesses the prevalence of anaemia and iron deficiency (ID) based on low serum ferritin status among antenatal and postnatal women in Devbhoomi Dwarka District of Gujarat.MethodsA total of 258 pregnant (AN) and postnatal (PN) women drawn from 27 primary health centres were studied. Anaemia was evaluated based on haemoglobin concentration obtained from venous whole blood, using auto-analyser. Serum ferritin was used to evaluate iron status in the study. Serum ferritin was assessed using the direct chemiluminescence method using MINI VIDAS which is a compact automated immunoassay system based on the Enzyme Linked Fluorescent Assay (ELFA) principles.ResultsOverall, Anaemia (low Hb) and ID (low s. ferritin) was observed in 65.9% and 27.1% respectively. Out of anaemic participants, about 38.2% reported ID while the remaining 61.8% had normal s. ferritin (i.e. non-iron deficient anaemia). Anaemia was reported 69.1% in AN women and 57.1% in PN women. The ID was reported higher (30.9%) in AN woman than PN women (17.1%). However, the prevalence of anaemia, as well as IDA decreased from the first to the third trimester.ConclusionTwo out of every three women were anaemic; one out of four were anaemic with depleted iron storage. Importantly, two out of five women had anaemia but iron storage was sufficient. Strategy to prevent and correct anaemia must include screening for iron and non-iron deficiency anaemia and follow appropriate treatment protocol for both types of anaemia.

Download Full-text

Zinc protoporphyrin as screening test in female blood donors

Clinical Chemistry ◽

10.1093/clinchem/44.4.800 ◽

1998 ◽

Vol 44 (4) ◽

pp. 800-804 ◽

Cited By ~ 14

Author(s):

Else J Harthoorn-Lasthuizen ◽

Jan Lindemans ◽

Mart M A C Langenhuijsen

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Blood Donors ◽

Deficiency Anemia ◽

Zinc Protoporphyrin ◽

Ferritin Concentration ◽

Iron Deficient ◽

Serum Ferritin Concentration ◽

Low Serum

Abstract Erythrocyte zinc protoporphyrin (ZPP) was measured in 102 women blood donors to evaluate its usefulness in screening for evolving iron deficiency anemia, a reason for the deferral of donors. The results were compared with serum ferritin determinations. Five women were deferred before their first donation and eight women were deferred after one or two donations. Women with increased ZPP values all had low serum ferritin concentrations, indicating iron-deficient erythropoiesis that was caused by iron depletion. The positive predictive value of an increased ZPP in predicting deferral of the donor after one or two donations was 75%, whereas a serum ferritin concentration ≤12 μg/L predicted deferral in 26% of the donors. The results indicate that the ZPP test can be recommended as a feasible and inexpensive predonation test to determine a subset of donors with iron-deficient erythropoiesis at risk of developing iron deficiency anemia.

Download Full-text

The diagnosis of iron deficiency anemia in sickle cell disease

Blood ◽

10.1182/blood.v58.5.963.963 ◽

1981 ◽

Vol 58 (5) ◽

pp. 963-968 ◽

Cited By ~ 35

Author(s):

E Vichinsky ◽

K Kleman ◽

S Embury ◽

B Lubin

Keyword(s):

Sickle Cell Disease ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Sickle Cell ◽

Serum Ferritin ◽

Transferrin Saturation ◽

Deficiency Anemia ◽

Zinc Protoporphyrin ◽

Cell Disease ◽

Iron Deficient

Abstract We determined the prevalence and optimal methods for laboratory diagnosis of iron deficiency anemia in patients with sickle cell disease. Laboratory investigations of 38 nontransfused and 32 transfused patients included transferrin saturation, serum ferritin, mean corpuscular volume (MCV), and free erythrocyte protoporphyrin (FEP). Response to iron supplementation confirmed the diagnosis of iron deficiency anemia in 16% of the nontransfused patients. None of the transfused patients were iron deficient. All iron-deficient patients (mean age 2.4 yr) had a low MCV, serum ferritin less than 25 ng/ml, transferrin saturation less than 15%, and FEP less than 90 micrograms/dl RBC. Following therapy, all parameters improved and the hemoglobin concentration increased greater than 2 g/dl. A serum ferritin below 25 ng/ml was the most reliable screening test for iron deficiency. There were 13% false positive results with transferrin saturation, 3% with MCV, and 62% with FEP. FEP values correlated strongly with reticulocyte counts. The high FEP was in part due to protoporphyrin IX and not completely due to zinc protoporphyrin, which is elevated in iron deficiency. We conclude that iron deficiency anemia is a potential problem in young nontransfused sickle cell patients. Serum ferritin below 25 ng/ml and low MCV are the most useful screening tests.

Download Full-text

STUDY OF IRON DEFICIENCY IN INFANTS BY MEASURING SERUM FERRETIN LEVELS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i11.731 ◽

2019 ◽

Vol 3 (11) ◽

Author(s):

Dr. Neeraj Jauhri

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Motor Development ◽

Ferritin Level ◽

Age Groups ◽

Severe Anaemia ◽

Age Group ◽

Iron Deficient ◽

Mild Anaemia ◽

Low Serum

Introduction: In human body for many metabolic processes to take place as a mineral iron is necessary element. It is a part of haemoglobin which is important and essential for the delivery of oxygen to the cells of body. Worldwide especially in developing countries Nutritional anaemia is problem with the highest prevalence. When the hemoglobin and/or hematocrit are two standard deviations below the mean for that particular age and sex then a child is said to be anemic. This national problem of iron deficiency (ID) without anemia is worldwide concern which lead to long term neurodevelopment and behavior disorders that may be irreversible. Anaemia is consider as serious condition because it impair in behavioral and motor development, impairments in cognitive performance, coordination, language development, and scholastic achievement as well as increased morbidity from infectious diseases. This is most endangered in age group of 6- 24 months of age. Aim: The main objective of this study is to prevalence of iron deficiency in infants by measuring serum ferretin levels. Material and Method: Total 70 patients with various age groups from 1 month to 24 months of age group attending to Pediatrics department of this college were included for study. For each patient various physical examinations were carried out to rule out other causes of anaemia like hemolytic anaemia, anaemia of chronic disease etc. laboratory investigations like CBC, Hb indices and peripheral smear carried out. In all the patients Serum ferritin levels were estimated. Result: Prevalence of anaemia (Hb<11gm/dl) in 1- 12 months age group was 82.3%, in 13- 18 months age group was 79.5% and in case of 19-24 months age group was 85.4%. Overall, 82.7% of infants were found to be anemic. Amont the total anaemic patients 45 infants (64.3%) among 70 infants had mild anaemia, 19 infants (27.1%) had moderate anaemia, 6 infants (8.6%) had severe anaemia. 48 (68.6%) out of 70 patients had low serum ferritin levels and only 21(30%) had normal levels. Out of 70 patients 48 had low serum ferritin levels. However though not all infants having low MCV had iron deficiency but all iron deficient infants have low MCV value. 2 of 70 infants had serum ferritin level >400ng/ml. Conclusion: In this study there is significantly Association between iron deficiency and low MCV. This study emphasis need for iron supplementation aim all healthy infants as early as 6 months. More and more studies on a larger population of children should be carried out to determine the role of other factors is needed. Keywords: Infants, iron deficiency, serum ferretin, Haemoglobin level, MCV

Download Full-text

Serum Ferritin and Anemia in Trained Female Athletes

International Journal of Sport Nutrition ◽

10.1123/ijsn.8.3.223 ◽

1998 ◽

Vol 8 (3) ◽

pp. 223-229 ◽

Cited By ~ 17

Author(s):

Michael J. Ashenden ◽

David T. Martin ◽

Geoffrey P. Dobson ◽

Colin Mackintosh ◽

Allan G. Hahn

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Female Athletes ◽

Weight Bearing ◽

Hemoglobin Concentration ◽

Background Information ◽

Deficiency Anemia ◽

Mean Corpuscular Hemoglobin ◽

Ferritin Concentration

The aim of this study was to establish whether extremely low serum ferritin values in female athletes were associated with indications of iron deficiency anemia and whether serum ferritin values were influenced by the type of training or participants' body size. Hematological data collected during 6 years at the Australian Institute of Sport were reviewed to quantify changes in serum ferritin concentration associated with training and to establish whether decrements in serum ferritin were associated with any change in hemoglobin concentration, mean corpuscular volume, or mean corpuscular hemoglobin concentration. Mean serum ferritin concentrations of 7.5 μg ⋅ L−1 were not associated with any indication of iron-deficiency anemia. Serum ferritin declined by approximately 25% with the onset of rigorous daily training (p <.01) whether training was predominantly weight-bearing or non-weight-bearing. Rowers had significantly higher ferritin concentrations than basketball players of similar stature (p = .02). We conclude that considerable background information such as the stage of training, specific sport, and previous blood results should be sought when interpreting serum ferritin concentrations in female athletes.

Download Full-text