scholarly journals Laboratory tests of iron status: correlation or common sense?

1996 ◽  
Vol 42 (5) ◽  
pp. 718-724 ◽  
Author(s):  
J Hastka ◽  
J J Lasserre ◽  
A Schwarzbeck ◽  
A Reiter ◽  
R Hehlmann
Keyword(s):  
Iron Deficiency ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Deficiency Anemia ◽  
Zinc Protoporphyrin ◽  
Iron Supply ◽  
Iron Deficient ◽  
Red Cell Indices ◽  
Total Body

Abstract We demonstrate that simple correlation between the various tests of iron status is not sufficient for examining their value in diagnosing iron deficiency (ID). Three degrees of ID are recognized: Iron depletion (ID grade I) is defined by decreased total body iron and normal iron support to erythropoiesis, as diagnosed by decreased storage iron, decreased ferritin, normal sideroblast count, normal zinc protoporphyrin (ZPP), and transferrin saturation >15%. When the iron supply to erythropoiesis becomes insufficient, as diagnosed by transferrin saturation < or = 15%, increased ZPP, and decreased sideroblast count, iron-deficient erythropoiesis (ID grade II) occurs. When finally hemoglobin is below its normal range, iron-deficiency anemia (ID grade III) results. The various tests for ID cannot be compared without taking into account the severity of the deficiency. Depending on the grade of ID examined, the correlation of markers seen in our patients' data varied considerably. We conclude that a "best" marker of ID does not exist. However, the different tests efficiently complement each other by detecting different stages and individually show the clinical extent of ID. Ferritin reflects the iron stores. ZPP indicates whether the ID in a given patient is clinically relevant or not. Finally, the extent of a clinically relevant ID can be assessed by the measured ZPP, hemoglobin concentration, and red cell indices.

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

Anemia ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
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.

Washing Erythrocytes to Remove Interferents in Measurements of Zinc Protoporphyrin by Front-Face Hematofluorometry

1992 ◽  
Vol 38 (11) ◽  
pp. 2184-2189 ◽  
Author(s):  
J Hastka ◽  
J J Lasserre ◽  
A Schwarzbeck ◽  
M Strauch ◽  
R Hehlmann
Keyword(s):  
Iron Deficiency ◽  
Blood Donors ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Hospitalized Patients ◽  
Front Face ◽  
Zinc Protoporphyrin ◽  
Iron Deficient ◽  
Validation Tests

Abstract Zinc protoporphyrin (ZPP) is determined by hematofluorometry of whole blood to detect iron deficiency in blood donors. In hospitalized patients, ZPP did not correlate with established markers of iron status. We performed 4500 ZPP measurements with the Aviv front-face hematofluorometer in samples from 475 patients and measured ferritin, transferrin saturation, hemoglobin, and erythrocyte indices. We found that the fluorometric determination is affected by substances dissolved in plasma but that this interference can be eliminated by using washed erythrocytes. In validation tests the within-day variation was < 3.5%; the day-to-day variation was < 6.8%. In 130 healthy persons without iron deficiency, ZPP was < or = 40 mumol/mol heme, which we consider a normal value. Mean ZPP in 46 iron-deficient patients was 256 (SD 105) mumol/mol heme (correlation with ferritin: -0.73; with hemoglobin: -0.85; P < 0.001). When washed erythrocytes are used, the hematofluorometric determination of ZPP is sensitive and specific for detecting iron deficiency in otherwise healthy individuals and hospitalized patients.

The diagnosis of iron deficiency anemia in sickle cell disease

Blood ◽  
1981 ◽  
Vol 58 (5) ◽  
pp. 963-968 ◽  
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.

Interaction of Iron Deficiency and Lead and the Hematologic Findings in Children With Severe Lead Poisoning

PEDIATRICS ◽  
1988 ◽  
Vol 81 (2) ◽  
pp. 247-254
Author(s):  
Margaret Clark ◽  
Joyce Royal ◽  
Ruth Seeler
Keyword(s):  
Iron Deficiency ◽  
Lead Poisoning ◽  
Iron Status ◽  
Lead Level ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Microcytic Anemia ◽  
Cook County ◽  
Cook County Hospital ◽  
Zinc Protoporphyrin

Microcytic anemia, long considered an effect of lead poisoning, may in fact result from coexisting iron deficiency. In this study, how RBC size, hemoglobin, and zinc protoporphyrin vary as a function of iron status in a group of children with high lead levels was examined. Charts of all children (N = 51) admitted to Cook County Hospital for treatment of lead poisoning in 1981 to 1983 were reviewed for data on age, blood lead level, hemoglobin concentration, MCV, transferrin saturation and zinc protoporphyrin level. The mean lead level was 86 µg/dL and the range was 63 to 190 µg/dL. Children with transferrin saturation values less than 7% had a mean MCV of 56 pµL, hemoglobin of 8.9 g/dL, and zinc protoporphyrin of 693 µg/dL; for those with saturations of 7% to 16%, the values were 61 µL, 10.1 g/dL, and 581 µg/dL, respectively; the children with saturations greater than 16% had normal mean MCVs and hemoglobin concentrations (74 µL and 11.4 g/dL) and a mean zinc protoporphyrin value of 240 µg/dL (P < .0005). Multiple linear regression was used to correct for effect of age, and transferrin saturation remained the most important predictor of MCV, hemoglobin, and zinc protoporphyrin levels; the addition of lead did not improve the models. Results of this study suggest that iron deficiency is strongly associated with some of the observed toxicities of lead. Also, lead poisoning can exist without producing microcytosis or anemia, and zinc protoporphyrin concentration may not be a sensitive indicator of lead level in the absence of iron deficiency.

scholarly journals Estimates of iron sufficiency in the US population

Blood ◽  
1986 ◽  
Vol 68 (3) ◽  
pp. 726-731 ◽  
Author(s):  
JD Cook ◽  
BS Skikne ◽  
SR Lynch ◽  
ME Reusser
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Adult Population ◽  
Hereditary Hemochromatosis ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Deficiency Anemia ◽  
Body Iron ◽  
The Us

Traditionally the iron status of a population is assessed by estimating the prevalence of iron deficiency anemia. This approach is inadequate in countries where the diet is heavily fortified with iron because it conveys no information about the iron-replete segment of the population. In the present study iron status of a US adult population was evaluated using data collected in the second National Health and Nutrition Examination Survey (NHANES II). Body iron was estimated in each of 2,829 individuals from measurements of hemoglobin concentration, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin. When individuals between 18 and 64 years of age were divided on the basis of sex and menstrual status, body iron reserves were normally distributed and averaged 309 mg in women 18 to 44 years, 608 mg in women 45 to 64 years, and 776 mg in men 18 to 64 years. The dispersion of storage iron in these groups was similar, with standard deviations of 346, 372, and 313 mg, respectively. The prevalence of iron deficiency anemia was surprisingly low, ranging from only 0.2% in adult men to 2.6% and 1.9% in pre- and postmenopausal women, respectively. Epidemiologic methods that examine iron status in the entire population assume importance in light of evidence that in certain segments of the US population, iron deficiency anemia is now less common than the homozygous state for hereditary hemochromatosis.

scholarly journals Estimates of iron sufficiency in the US population

Blood ◽  
1986 ◽  
Vol 68 (3) ◽  
pp. 726-731 ◽  
Author(s):  
JD Cook ◽  
BS Skikne ◽  
SR Lynch ◽  
ME Reusser
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Adult Population ◽  
Hereditary Hemochromatosis ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Deficiency Anemia ◽  
Body Iron ◽  
The Us

Abstract Traditionally the iron status of a population is assessed by estimating the prevalence of iron deficiency anemia. This approach is inadequate in countries where the diet is heavily fortified with iron because it conveys no information about the iron-replete segment of the population. In the present study iron status of a US adult population was evaluated using data collected in the second National Health and Nutrition Examination Survey (NHANES II). Body iron was estimated in each of 2,829 individuals from measurements of hemoglobin concentration, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin. When individuals between 18 and 64 years of age were divided on the basis of sex and menstrual status, body iron reserves were normally distributed and averaged 309 mg in women 18 to 44 years, 608 mg in women 45 to 64 years, and 776 mg in men 18 to 64 years. The dispersion of storage iron in these groups was similar, with standard deviations of 346, 372, and 313 mg, respectively. The prevalence of iron deficiency anemia was surprisingly low, ranging from only 0.2% in adult men to 2.6% and 1.9% in pre- and postmenopausal women, respectively. Epidemiologic methods that examine iron status in the entire population assume importance in light of evidence that in certain segments of the US population, iron deficiency anemia is now less common than the homozygous state for hereditary hemochromatosis.

scholarly journals Low prevalence of iron deficiency anemia between 1981 and 2010 in Chilean women of childbearing age

2013 ◽  
Vol 55 (5) ◽  
pp. 478 ◽  
Author(s):  
Israel Ríos-Castillo ◽  
Alex Brito ◽  
Manuel Olivares ◽  
Daniel López-de Romaña ◽  
Fernando Pizarro
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Deficiency Anemia ◽  
Zinc Protoporphyrin ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Prevalence Of Anemia ◽  
Chilean Women

Objective. To determine the prevalence of anemia and iron status among Chilean women of childbearing age between 1981 and 2010. Materials and methods. Calculation of the prevalence of anemia and iron status was based on multiple cross-sectional iron absorption studies performed in 888 women during this period of time. All studies included measurements of hemoglobin, mean corpuscular volume, zinc protoporphyrin, percentage of transferrin saturation and serum ferritin. Data were grouped by decade (1981-1990, 1991-2000, and 2001-2010). Results. Prevalence of anemia for these decades was 9, 6 and 10%, respectively (p=NS). Iron deficiency anemia was the main cause of anemia in all periods (55, 85 and 75%, respectively; p=NS). A high prevalence of women with normal iron status was observed for all periods (64, 69, and 67, respectively; p=NS). Prevalence of iron deficiency without anemia in 1981-1990, 1991-2000 and 2001-2010 was 7, 20 and 12%, respectively (p<0.05). Finally, prevalence of iron depleted stores was 20, 6 and 10%, respectively (p<0.05). Conclusions. Prevalence of iron deficiency anemia in Chilean women of childbearing age was mild between 1981 and 2010. More than 60% of childbearing age women presented normal iron status in all periods. However, prevalence of iron depleted stores was moderate during 1981-1990, and was mild during 1991-2000 and 2001-2010.

scholarly journals The diagnosis of iron deficiency anemia in sickle cell disease

Blood ◽  
1981 ◽  
Vol 58 (5) ◽  
pp. 963-968 ◽  
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

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.

scholarly journals Using Soluble Transferrin Receptor and Taking Inflammation into Account When Defining Serum Ferritin Cutoffs Improved the Diagnosis of Iron Deficiency in a Group of Canadian Preschool Inuit Children from Nunavik

Anemia ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Huguette Turgeon O’Brien ◽  
Rosanne Blanchet ◽  
Doris Gagné ◽  
Julie Lauzière ◽  
Carole Vézina
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Binding Capacity ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Deficiency Anemia ◽  
Soluble Transferrin Receptor ◽  
Iron Depletion ◽  
Reactive Protein ◽  
Iron Deficient

The prevalence of iron depletion, iron deficient erythropoiesis (IDE), and iron deficiency anemia (IDA) was assessed in preschool Inuit children using soluble transferrin receptor (sTfR) and traditional indicators of iron status while disregarding or taking inflammation into account when defining SF cutoffs. Iron depletion was defined as follows: (1) SF < 15 μg/L regardless of the C-reactive protein (CRP) level and (2) SF < 15 or <50 μg/L with CRP ≤ 5 or >5 mg/L, respectively. IDE corresponded to iron depletion combined with total iron binding capacity > 72 μmol/L and/or transferrin saturation < 16%. Iron depletion and IDE affected almost half of the children when accounting for inflammation, compared to one-third when the SF cutoff was defined regardless of CRP level (P<0.0001). The prevalence of IDE adjusted for inflammation (45.1%) was very similar to the prevalence observed when sTfR was used as a sole marker of IDE (47.4%). The prevalence of anemia was 15%. The prevalence of IDA (IDE + hemoglobin < 110 g/L) was higher when accounting for than when disregarding inflammation (8.0% versus 6.2%,P=0.083). Using sTfR and different SF cutoffs for children with versus without inflammation improved the diagnosis of iron depletion and IDE. Our results confirm that Inuit children are at particularly high risk for iron deficiency.

scholarly journals Prenatal Iron Deficiency and Replete Iron Status Are Associated with Adverse Birth Outcomes, but Associations Differ in Ghana and Malawi

2019 ◽  
Vol 149 (3) ◽  
pp. 513-521 ◽  
Author(s):  
Brietta M Oaks ◽  
Josh M Jorgensen ◽  
Lacey M Baldiviez ◽  
Seth Adu-Afarwuah ◽  
Ken Maleta ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Birth Outcomes ◽  
Regression Models ◽  
Iron Status ◽  
Secondary Data ◽  
Hemoglobin Concentration ◽  
Late Pregnancy ◽  
Zinc Protoporphyrin ◽  
Adverse Birth Outcomes ◽  
Soluble Transferrin Receptor

ABSTRACTBackgroundPrevious literature suggests a U-shaped relation between hemoglobin concentration and adverse birth outcomes. There is less evidence on associations between iron status and birth outcomes.ObjectiveOur objective was to determine the associations of maternal hemoglobin concentration and iron status with birth outcomes.MethodsWe conducted a secondary data analysis of data from 2 cohorts of pregnant women receiving iron-containing nutritional supplements (20–60 mg ferrous sulfate) in Ghana (n = 1137) and Malawi (n = 1243). Hemoglobin concentration and 2 markers of iron status [zinc protoporphyrin and soluble transferrin receptor (sTfR)] were measured at ≤20 weeks and 36 weeks of gestation. We used linear and Poisson regression models and birth outcomes included preterm birth (PTB), newborn stunting, low birth weight (LBW), and small-for-gestational-age.ResultsPrevalence of iron deficiency (sTfR >6.0 mg/L) at enrollment was 9% in Ghana and 20% in Malawi. In early pregnancy, iron deficiency was associated with PTB (9% compared with 17%, adjusted RR: 1.63; 95% CI: 1.14, 2.33) and stunting (15% compared with 23%, adjusted RR: 1.44; 95% CI: 1.09, 1.94) in Malawi but not Ghana, and was not associated with LBW in either country; replete iron status (sTfR <10th percentile) was associated with stunting (9% compared with 15%, adjusted RR: 1.71; 95% CI: 1.06, 2.77) in Ghana, but not PTB or LBW, and was not associated with any birth outcomes in Malawi. In late pregnancy, iron deficiency was not related to birth outcomes in either country and iron-replete status was associated with higher risk of LBW (8% compared with 16%, adjusted RR: 1.90; 95% CI: 1.17, 3.09) and stunting (6% compared with 13%, adjusted RR: 2.14; 95% CI: 1.21, 3.77) in Ghana, but was not associated with birth outcomes in Malawi.ConclusionsThe associations of low or replete iron status with birth outcomes are population specific. Research to replicate and extend these findings would be beneficial. These trials were registered at clinicaltrials.gov as NCT00970866 (Ghana) and NCT01239693 (Malawi).

Sign in / Sign up

Export Citation Format

Share Document