Measurements of serum ferritin used to predict concentrations of iron in bone marrow in anemia of chronic disease

Abstract 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.

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Correlation between serum ferritin and bone marrow iron stores

Tropical Doctor ◽

10.1177/0049475516678478 ◽

2016 ◽

Vol 47 (3) ◽

pp. 217-221 ◽

Cited By ~ 1

Author(s):

Anupama K V ◽

Purnima S Rao ◽

Sushma Adappa ◽

Prashantha Balanthimogru ◽

Chakrapani Mahabala

Keyword(s):

Bone Marrow ◽

Correlation Coefficient ◽

Serum Ferritin ◽

Characteristic Curve ◽

Iron Store ◽

Cross Sectional ◽

Cutoff Value ◽

Iron Stores ◽

Bone Marrow Iron ◽

Spearman’S Correlation

Bone marrow aspirate examination is a gold standard to assess bone marrow iron stores. The correlation between serum ferritin and bone marrow iron has not been established in detail, as the cutoff value for iron stores have not been uniformly established. Ours was a cross-sectional study. Perl’s Prussian blue stain was used to stain bone marrow, assessed by Gale’s grading. Receiver operating characteristic curve analysis and Spearman’s correlation coefficient calculated. Gale’s grading revealed iron store deficiency in 26 and sufficiency in 13. Spearman’s correlation coefficient of 0.90 showed a significant relation between serum ferritin and bone marrow iron stores. A serum ferritin of 228 pmol/L had high sensitivity and specificity for iron deficiency; our study suggests that this level be taken as the cutoff value to predict iron store deficiency in bone marrow.

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Study of RBC Indices and Bone Marrow Iron Stores in Anaemia of Chronic Disease and comparison with Serum Ferritin

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v5i7.40 ◽

2017 ◽

Vol 5 (7) ◽

Author(s):

Dr Manisha Kakkar ◽

Keyword(s):

Bone Marrow ◽

Chronic Disease ◽

Serum Ferritin ◽

Iron Stores ◽

Anaemia Of Chronic Disease ◽

Rbc Indices ◽

Bone Marrow Iron

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Role of intensive method of bone marrow iron assessment and serum Ferritin in prediction of iron deficiency: a study of 143 patients

Indian Journal of Pathology and Oncology ◽

10.18231/2394-6792.2018.0131 ◽

2018 ◽

Vol 5 (4) ◽

pp. 686-691

Author(s):

Mayank Singh ◽

Swati Raj ◽

Dwijendra Nath ◽

Pallavi Agrawal ◽

Sufiya Ahmed

Keyword(s):

Bone Marrow ◽

Iron Deficiency ◽

Serum Ferritin ◽

Bone Marrow Iron

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Anemia: Production Defects Generally Associated with a Normal or Largely Normal Bone Marrow

10.2310/im.1338 ◽

2017 ◽

Author(s):

Nancy Berliner ◽

John M Gansner

Keyword(s):

Bone Marrow ◽

Differential Diagnosis ◽

Chronic Disease ◽

Blood Cells ◽

Deficiency Anemia ◽

Normal Bone Marrow ◽

Peripheral Smear ◽

Anemia Of Chronic Disease ◽

Normal Bone ◽

Anemia Of Inflammation

This review focuses on anemia resulting from production defects generally associated with a normal or largely normal bone marrow. The definition, epidemiology, etiology, pathogenesis, diagnosis, differential diagnosis, management, complications, and prognosis of the following production defects are discussed: Anemia of inflammation (AI; formerly known as anemia of chronic disease), and anemia in kidney disease, as well as anemia secondary to other conditions such as alchohol abuse and starvation. Iron deficiency anemia (IDA) is discussed elsewhere in this publication. A figure depicts peripheral smear changes in the size and shape of red blood cells seen in starvation. A table lists the differential diagnoses of hypochromic anemias. This review contains 1 figure; 1 table; 79 references

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Anemia of Chronic Disease: Epidemiology and Pathophysiological Mechanisms – Literature Review

Global Journal of Medical Therapeutics ◽

10.46982/gjmt.2020.109 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Abdulrahman Ismaiel ◽

Nahlah Al Srouji

Keyword(s):

Bone Marrow ◽

Chronic Disease ◽

Iron Absorption ◽

Solid Organ Transplantation ◽

Future Research ◽

Solid Organ ◽

Chronic Infections ◽

Anemia Of Chronic Disease ◽

Erythroid Progenitor ◽

Pathophysiological Mechanisms

Anemia of chronic disease (ACD), also known as anemia of inflammation (AI), is the term used to describe the hypoproliferative anemia. ACD was demonstrated in several conditions including systemic inflammation, acute and chronic infections of bacterial, viral, parasitic or fungal etiologies, cancer and hematological malignancies, chronic diseases such as chronic kidney disease and congestive heart failure, in addition to ageing, graft versus host disease after solid-organ transplantation, critical illness, and obesity. As a result of the possible different etiologies, the pathogenesis of ACD is complex with multiple pathways. Although the relationship between anemia, chronic inflammation and iron was discovered decades ago, only recently did research describe the role of several pro-inflammatory cytokines, in addition to molecular pathways and the type II acute-phase protein hepcidin involving iron absorption and metabolism, helping in the understanding of new pathophysiological mechanisms which were not previously understood that can lead to ACD. Hence, our understanding of the molecular mechanism related to intestinal iron absorption and metabolism has improved significantly. The pathophysiology of ACD is thought to be due to three main processes including a decreased erythrocyte survival that creates a demand for a mild increase in bone marrow production of erythrocytes, inability of the bone marrow to respond to the required increased demand due to an altered erythropoietin production or impaired ability to respond to erythropoietin by erythroid progenitor cells and alteration in iron stores’ mobilization through increased uptake and retention of iron in cells of the reticuloendothelial system. Lately, research advances including hepcidin’s discovery contributed to our understanding regarding iron metabolism and pathophysiological mechanisms in ACD. However, future research remains essential in order to find potential therapeutic strategies, possibly targeting genes coding cytokines to discover optimal therapies in treating ACD more efficiently.

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