Serum Ferritin: Deceptively Simple or Simply Deceptive? Lessons Learned From Iron Therapy in Patients With Chronic Kidney Disease

2008 ◽  
Vol 21 (6) ◽  
pp. 411-419 ◽  
Author(s):  
Csaba P. Kovesdy ◽  
Grace H. Lee ◽  
Kamyar Kalantar-Zadeh
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Therapeutic Benefit ◽  
Lessons Learned ◽  
Diagnostic Tools ◽  
Ongoing Debate ◽  
Iron Stores ◽  
Anemia Management ◽  
The Right ◽  
Iron Replacement

Iron is an essential micronutrient that is indispensable for erythropoesis. Correct assessment of iron stores is needed both for the diagnosis of iron deficiency and to direct iron replacement therapies. Serum ferritin is a commonly employed measure to assess iron stores, yet there are caveats that influence its accuracy as a diagnostic tool. While low ferritin levels are specific for iron deficiency, high levels can be the result of inflammation, liver disease, or malignancies and could be independent of iron stores. Optimal anemia management involves administration of adequate amounts of iron. The right dose of iron that allows optimal erythropoesis yet avoids oxidative stress is a matter of ongoing debate, especially when using imperfect diagnostic tools such as serum ferritin to direct therapy. Data from hemodialysis patients are presented to illustrate the challenges one faces when trying to achieve the best possible therapeutic benefit from iron-replacement therapy.

Effect of Nutrition Education and Diet Modification in Iron Depleted Preschool Children in Nurseries in Tehran: a Pilot Study

2004 ◽  
Vol 74 (4) ◽  
pp. 264-268 ◽  
Author(s):  
Khoshnevisan ◽  
Kimiagar ◽  
Kalantaree ◽  
Valaee ◽  
Shaheedee
Keyword(s):  
Preschool Children ◽  
Iron Deficiency ◽  
Nutrition Education ◽  
Serum Ferritin ◽  
Fruit Juice ◽  
Dietary Modification ◽  
Iron Stores ◽  
Diet Modification ◽  
Before And After ◽  
Education Groups

In view of the high prevalence of iron deficiency in preschool children and its consequences, this study was carried out to examine the effect of nutrition education and dietary modification on 438 two- to six-year-old nursery school children in Tehran in 1999. Sixty-two children who were judged anemic, iron-depleted, or having low iron stores were randomly allocated to "control", "dietary modification" (consuming one additional citrus fruit after lunch), and "nutrition education" (teaching the mothers proper eating patterns based on the food pyramid) groups. Food habits were surveyed, including 24-hour dietary recall and food frequency, as well as timing of consumption of special items; this survey was carried out for each child before and after intervention. After three months, blood samples were taken from the subjects. The prevalence of anemia, iron depletion, and low iron stores was 11.4, 62.8, and 15.1% respectively, with no significant differences observed in hemoglobin and percent transferrin saturation (%TS) between the groups. Mean ± SD serum ferritin concentrations in "control", "diet modification", and "nutrition education" groups were 8.9 ± 3.1, 9.5 ± 3.7, and 6.9 ± 2.3 mug/dL. The same figures at the end of intervention were 6.9 ± 3.5, 11.2 ± 5, and 10.7 ± 5.9 mug/dL, respectively. Analysis of variance showed ferritin concentrations to be significantly different, in that there was a reduction in the control and elevation in the nutrition education groups. There was no significant difference in %TS before and after the intervention. During three months of intervention, changes in frequency of fruit and fruit juice intake after the meals in nutrition education and diet modification groups were significantly correlated to serum ferritin alteration. Frequency of fruit juice intake (rich in vitamin C) after meals (at least five times a week) can significantly increase serum ferritin within three months. Therefore, educating mothers of iron-deficient children while increasing the iron stores in children can prevent the recurrence of iron deficiency and result in general child wellbeing.

Correlation between Diagnostic 59Fe2+-Absorption and Serum Ferritin Concentration in Man

1977 ◽  
Vol 32 (11-12) ◽  
pp. 1023-1025 ◽  
Author(s):  
H. C. Heinrich ◽  
J. Brüggemann ◽  
E. E. Gabbe ◽  
M. Gläser ◽  
Fatima Icagic ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Correlation Coefficient ◽  
Serum Ferritin ◽  
Inverse Relationship ◽  
Sensitive Indicator ◽  
Ferritin Concentration ◽  
Iron Stores ◽  
Serum Ferritin Concentration ◽  
The Relationship

Abstract A high correlation coefficient r = -0.832 (Pr≠0 <0.0001) was estimated in man for the inverse relationship between the diagnostic 59Fe2+-absorption and the serum ferritin concentration which is very close to the correlation r = - 0.88 as described for the relationship between the diagnostic 59Fe2+-absorption and the diffuse cytoplasmic storage iron in the bone marrow macrophages. The increase of the diagnostic 59Fe2+-absorption seems to be an earlier and more sensitive indicator of depleted iron stores whereas the serum ferritin decreases somewhat later during the development of iron deficiency.

scholarly journals Enzyme-linked Immunosorbent Assay to Measure Serum Ferritin and the Relationship between Serum Ferritin and Nonheme Iron Stores in Cats

1994 ◽  
Vol 31 (6) ◽  
pp. 674-678 ◽  
Author(s):  
G. A. Andrews ◽  
P. S. Chavey ◽  
J. E. Smith
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Immunosorbent Assay ◽  
Serum Iron ◽  
Nonheme Iron ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ferritin Concentration ◽  
Iron Stores ◽  
Tissue Iron ◽  
Serum Ferritin Concentration

Serum ferritin concentration correlates with tissue iron stores in humans, horses, calves, dogs, and pigs but not in rats. Because serum iron and total iron-binding capacity can be affected by disorders unrelated to iron adequacy (such as hypoproteinemia, chronic infection, hemolytic anemia, hypothyroidism, and renal disease), serum ferritin is probably the most reliable indicator of total body iron stores in larger species. To test the hypothesis that serum ferritin might be correlated with tissue iron levels in cats, we developed a quantitative enzyme-linked immunosorbent assay that uses two monoclonal antibodies in a sandwich arrangement to measure feline serum ferritin. The recovery of purified ferritin added to feline sera ranged from 94% to 104%; the within-assay coefficient of variability was 8.4%, and the assay-to-assay variability was 13.2%. Mean serum ferritin from 40 apparently healthy cats was 76 ng ml (SD = 24 ng/ml). Serum ferritin concentration was significantly correlated ( P < 0.001, n = 101, r = 0.365) with the nonheme iron in the liver and spleen (expressed as milligrams of iron per kilogram of body weight), as determined by Pearson product-moment correlation analysis. Because serum iron can decrease in diseases other than iron deficiency, the combination of serum iron and serum ferritin should provide sufficient evidence to differentiate anemia of chronic inflammation from anemia of iron deficiency in the cat.

Relationship Between Iron Indices and Iron Responsiveness Following IV Ferumoxytol or Oral Iron In Patients with CKD Not on Dialysis

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5149-5149
Author(s):  
John Adamson ◽  
Zhu Li ◽  
Paul Miller ◽  
Annamaria Kausz
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Status ◽  
Oral Iron ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Functional Iron Deficiency ◽  
Iron Stores ◽  
Iv Iron ◽  
Definition Of

Abstract Abstract 5149 BACKGROUND Iron deficiency anemia (IDA) is associated with reduced physical functioning, cardiovascular disease, and poor quality of life. The measurement of body iron stores is essential to the management of IDA, and the indices most commonly used to assess iron status are transferrin saturation (TSAT) and serum ferritin. Unfortunately, serum ferritin is not a reliable indicator of iron status, particularly in patients with chronic kidney disease (CKD), because it is an acute phase reactant and may be elevated in patients with iron deficiency in the presence of inflammation. Recent clinical trials have shown that patients with iron indices above a strict definition of iron deficiency (TSAT >15%, serum ferritin >100 ng/mL), do have a significant increase in hemoglobin (Hgb) when treated with iron. These results are consistent with recent changes to the National Cancer Comprehensive Network (NCCN) guidelines, which have expanded the definition of functional iron deficiency (relative iron deficiency) to include a serum ferritin <800 ng/mL; previously, the serum ferritin threshold was <300 ng/mL. Additionally, for patients who meet this expanded definition of functional iron deficiency (TSAT <20%, ferritin <800 ng/mL), it is now recommended that iron replacement therapy be considered in addition to erythropoiesis-stimulating agent (ESA) therapy. Ferumoxytol (Feraheme®) Injection, a novel IV iron therapeutic agent, is indicated for the treatment of IDA in adult patients with CKD. Ferumoxytol is composed of an iron oxide with a unique carbohydrate coating (polyglucose sorbitol carboxymethylether), is isotonic, has a neutral pH, and evidence of lower free iron than other IV irons. Ferumoxytol is administered as two IV injections of 510 mg (17 mL) 3 to 8 days apart for a total cumulative dose of 1.02 g; each IV injection can be administered at a rate up to 1 mL/sec, allowing for administration of a 510 mg dose in less than 1 minute. METHODS Data were combined from 2 identically designed and executed Phase III randomized, active-controlled, open-label studies conducted in 606 patients with CKD stages 1–5 not on dialysis. Patients were randomly assigned in a 3:1 ratio to receive a course of either 1.02 g IV ferumoxytol (n=453) administered as 2 doses of 510 mg each within 5±3 days or 200 mg of oral elemental iron (n=153) daily for 21 days. The main IDA inclusion criteria included a Hgb ≤11.0 g/dL, TSAT ≤30%, and serum ferritin ≤600 ng/mL. The mean baseline Hgb was approximately 10 g/dL, and ESAs were use by approximately 40% of patients. To further evaluate the relationship between baseline markers of iron stores and response to iron therapy, data from these trials were summarized by baseline TSAT and serum ferritin levels. RESULTS Overall, results from these two pooled trials show that ferumoxytol resulted in a statistically significant greater mean increase in Hgb relative to oral iron. When evaluated across the baseline iron indices examined, statistically significant (p<0.05) increases in Hgb at Day 35 were observed following ferumoxytol administration, even for subjects with baseline iron indices above levels traditionally used to define iron deficiency. Additionally, at each level of baseline iron indices, ferumoxytol produced a larger change in Hgb relative to oral iron. These data suggest that patients with CKD not on dialysis with a wide range of iron indices at baseline respond to IV iron therapy with an increase in Hgb. Additionally, ferumoxytol consistently resulted in larger increases in Hgb relative to oral iron across all levels of baseline iron indices examined. Disclosures: Adamson: VA Medical Center MC 111E: Honoraria, Membership on an entity's Board of Directors or advisory committees. Li:AMAG Pharmaceuticals, Inc.: Employment. Miller:AMAG Pharmaceuticals, Inc.: Employment. Kausz:AMAG Pharmaceuticals, Inc.: Employment.

scholarly journals Measuring Reticulocyte Hemoglobin Content As a Marker for Iron Deficiency and Response to Therapy Represents a Paradigm Shift in Care

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 42-43
Author(s):  
Michael Auerbach ◽  
Carlo Brugnara ◽  
Steve Staffa
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Biochemical Markers ◽  
Roc Analysis ◽  
Transferrin Saturation ◽  
Iron Administration ◽  
Iron Deficient ◽  
Ferritin Iron ◽  
Iv Iron ◽  
Iron Replacement

It is estimated anemia affects over 30% of the world's population, with iron deficiency (ID) the overwhelmingly most common cause. Whether absolute due to blood loss and/or iron sequestration to underlying morbidity, the need for repletion especially in females, is a formidable medical issue. The diagnosis of iron deficient erythropoiesis has been traditionally based on the biochemical parameters ferritin and percent transferrin saturation (TSAT), mean cell volume and hemoglobin (Hb) concentration. In recent years, reticulocyte Hb content has emerged as a parameter helpful in identifying iron deficient erythropoiesis and informing a need, or lack thereof, for replacement. 556 consecutive, non-selected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of reticulocyte hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. CBC, serum ferritin, iron and TSAT were performed as clinically indicated. RET-He was measured with a Sysmex XN-450 analyzer on the residual CBC sample. 556 patients were studied at baseline and 150 were subsequently treated with intravenous (IV) iron. 240/556 were seen at follow-up, with 57 treated and 183 not treated with IV iron. At baseline, ret-He, positively correlated with Hb (Spearman correlation (rho)=0.365, P &lt; 0.001), MCV (rho=0.576, P &lt; 0.001), MCH (rho=0.777, P &lt; 0.001), serum iron (rho=0.526, P &lt; 0.001) and TSAT (rho=0.492, P &lt; 0.001). Serum iron, and TSAT (but not serum ferritin or MCV, or absolute reticulocyte count) positively correlated with Hb concentrations. Based on either a serum ferritin &lt;30 ng/ml and/or a TSAT&lt; 20%, 241/556 (43.4%) patients were diagnosed as iron deficient. Anemia was present in 64/241 of the iron deficient patients (26.6%). Despite the limitations of the biochemical markers outlined above, we performed ROC analysis assessing the value of RET-He in identifying iron deficiency as defined by serum ferritin &lt;30 ng/mL or transferrin saturation &lt;20%. ROC analysis demonstrates a reasonable performance for RET-He (AUC= 0.733, 95% CI: 0.692, 0.775), with a cut-off value of &lt;30.7 pg yielding 68.2% sensitivity and 69.7% specificity. Using both Hb and RET-He in a multivariable ROC analysis does not provide an improved AUC, as compared to just using RET-He (AUC=0.605 vs.0.733). IV iron administration was associated with significant increases in Hb, MCV, MCH, RET-He, serum ferritin, iron and TSAT, whereas in the no-IV iron cohort, there was a small reduction in RET-He and small increases in MCV and MCH, with no significant variations in Hb and in the other parameters. Serum ferritin was below 30 ng/mL in 18/57 (32%) of the patients requiring IV iron and in 19/183 (10.4%) of those not requiring iron at visit 1. These values changed to 4/57 (7%) (P=0.002) and 23/183 (13%) (P=0.623) at visit 2, respectively. Regression analysis for Hb response following IV iron showed that baseline RET-He values are predictive of Hb response, with every unitary increase in RET-He corresponding to a blunting of the Hb change by -0.19 g/dl (95% CI: -0.27, -0.11; P &lt; 0.001). Changes in RE-He associated with IV iron administration are also predictive of the Hb response, with every additional unit increase in RET-He corresponding to a 0.21 g/dL increase in Hb (95% CI: 0.13, 0.28; P &lt; 0.009). ROC analysis for the capability to predict Hb response among the 57 patients receiving IV iron shows that a value of baseline RET-He &lt; 28.5 pg together with a baseline Hb value &lt; 10.3 g/dL provide the highest Youden's index for predicting Hb response &gt; 1.0 g/dl, with sensitivity of 84% and specificity of 78%. The Figure presents data for the 21/57 patients who had RET-He &lt; 28.5 pg and Hb &lt; 10.3 g/dL vs the 36/57 who did not. The present data show that an abnormally low ret-He value (&lt; 28.5 pg) identifies patients who will respond to iron replacement, obviating delays to obtain standard iron parameters. Baseline and changes in ret-He also associate with Hb response. Given the enormous prevalence of ID in the general population the use of the ret-He, which is available with the CBC on the autoanalyzer, informs need for iron replacement, or lack thereof, represents an increase in convenience for patient and physician, decreases costs, streamlines care and represents an improvement in the treatment paradigm of one of the commonest maladies on the planet. Figure 1 Disclosures Auerbach: AMAG: Research Funding; Sysmex: Research Funding. Brugnara:American Journal of Hematology: Other; Sysmex America Inc.: Consultancy.

scholarly journals Comparative study of efficacy and safety of parenteral iron sucrose versus ferric carboxymaltose in treatment of postpartum iron deficiency anaemia

2021 ◽  
Vol 11 (1) ◽  
pp. 100
Author(s):  
Ganesh N. Dakhle ◽  
Mrunalini V. Kalikar ◽  
Rujuta P. Fuke ◽  
Anisha S. Parmarthi ◽  
Mrunalini K. Chokhandre
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Deficiency Anaemia ◽  
Maximum Dose ◽  
Iron Sucrose ◽  
Ferric Carboxymaltose ◽  
Care Hospital ◽  
Deficiency Anaemia ◽  
Iron Stores ◽  
Parenteral Iron

Background: Postpartum anaemia often leads to multiple clinical complications in mother as well as infant and iron supplementation with parenteral iron is the preferred treatment modality. The present study was planned to compare the efficacy and tolerability of IV iron sucrose and IV ferric carboxymaltose in treatment of postpartum iron deficiency anaemia.Methods: This randomized, parallel, open label, prospective 4-weeks study was conducted from June 2019 to December 2020 in women with postpartum anaemia admitted to obstetrics and gynaecology inpatient department of a tertiary care hospital. Women with postpartum iron deficiency anaemia (N=60) were randomly divided into two groups; receiving Injection iron sucrose (N=30, maximum dose 500 mg) or Injection ferric carboxymaltose (N=30, maximum dose 500 mg). Change in haemoglobin and serum ferritin levels from baseline to the end of 2 and 4 weeks of treatment were evaluated.Results: The results showed early, sustained and significant increase in the haemoglobin levels in both the groups. However, the difference was not significant between groups (p=0.2). Evaluation of replenishment of iron stores (serum ferritin) showed improvement in both the groups, however in FCM group the rise was found to be significant (p<0.05).Conclusions: FCM in a lower dose of 500mg was found to be safe and effective in significantly improving haemoglobin concentration as well as in replenishing iron stores in patients with postpartum anaemia.

scholarly journals Effect of blood donation on iron stores as evaluated by serum ferritin

Blood ◽  
1977 ◽  
Vol 50 (3) ◽  
pp. 441-447 ◽  
Author(s):  
CA Finch ◽  
JD Cook ◽  
RF Labbe ◽  
M Culala
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Blood Donors ◽  
Serum Ferritin Level ◽  
Blood Donation ◽  
Ferritin Level ◽  
Geometric Mean ◽  
Iron Stores ◽  
High Incidence ◽  
First Time

Serum ferritin was measured in 2982 blood donors. First-time male donors had a geometric mean of 127 microgram/liter and female donors 46 microgram/liter. While values were essentially constant in the women between the ages of 18 and 45, there was a rapid increase in the men between 18 and 30 years of age consistent with the establishment of iron stores during that time. Blood donation was associated with a decrease in serum ferritin. One unit per year, equivalent to an increased requirement of 0.65 mg/day, halved the serum ferritin level in the male. More frequent donations were associated with further decreases. From the data obtained it would appear that male donors, while depleting their iron stores, were able to donate 2–3 U/yr without an appreciable incidence of iron deficiency. Women could donate only about half that amount, and more frequent donations were associated with a high incidence of iron deficiency and donor dropout. These data have provided information on the effect of graded amounts of iron loss through bleeding on iron balance.

scholarly journals Serum transferrin receptor: a quantitative measure of tissue iron deficiency

Blood ◽  
1990 ◽  
Vol 75 (9) ◽  
pp. 1870-1876 ◽  
Author(s):  
BS Skikne ◽  
CH Flowers ◽  
JD Cook
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Transferrin Receptor ◽  
Iron Status ◽  
Serum Transferrin ◽  
Mean Cell Volume ◽  
Functional Iron Deficiency ◽  
Iron Stores ◽  
Serum Transferrin Receptor ◽  
Tissue Iron

Abstract This study was undertaken to evaluate the role of serum transferrin receptor measurements in the assessment of iron status. Repeated phlebotomies were performed in 14 normal volunteer subjects to obtain varying degrees of iron deficiency. Serial measurements of serum iron, total iron-binding capacity, mean cell volume (MCV), free erythrocyte protoporphyrin (FEP), red cell mean index, serum ferritin, and serum transferrin receptor were performed throughout the phlebotomy program. There was no change in receptor levels during the phase of storage iron depletion. When the serum ferritin level reached subnormal values there was an increase in serum receptor levels, which continued throughout the phlebotomy program. Functional iron deficiency was defined as a reduction in body iron beyond the point of depleted iron stores. The serum receptor level was a more sensitive and reliable guide to the degree of functional iron deficiency than either the FEP or MCV. Our studies indicate that the serum receptor measurement is of particular value in identifying mild iron deficiency of recent onset. The iron status of a population can be fully assessed by using serum ferritin as a measure of iron stores, serum receptor as a measure of mild tissue iron deficiency, and hemoglobin concentration as a measure of advanced iron deficiency.

Cystic Fibrosis Study Questioned

PEDIATRICS ◽  
1984 ◽  
Vol 74 (1) ◽  
pp. 169-169
Author(s):  
JOANN ATER
Keyword(s):  
Cystic Fibrosis ◽  
Iron Deficiency ◽  
Serum Ferritin ◽  
Plasma Volume ◽  
Clinical Observation ◽  
Good Evidence ◽  
Iron Therapy ◽  
Iron Stores ◽  
Oral Iron Therapy ◽  
Low Serum

In Reply.— Wagener and colleagues make a valid point that increase in plasma volume can be an appropriate response to hypoxia, without the development of polycythemia. This probably is a factor contributing to the inappropriately low hemoglobin values we found in our patients with cystic fibrosis. However, as in anything in medicine, there is rarely a single reason for any clinical observation. Our finding that some of our patients with low iron stores, as reflected by low serum ferritin values, had a significant increase in hemoglobin values with oral iron therapy, provides good evidence that iron deficiency may be one factor limiting the development of polycythemia in these patients.

Serum Ferritin Is Not Sensitive or Specific for the Diagnosis of Iron Deficiency in Patients with Normocytic Anemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 955-955 ◽  
Author(s):  
Justin CL Ho ◽  
Ivan Stevic ◽  
Anthony Chan ◽  
Keith KH Lau ◽  
Howard H.W. Chan
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Status ◽  
Iron Therapy ◽  
Normocytic Anemia ◽  
Therapeutic Trial ◽  
Retrospective Case ◽  
The Mean ◽  
Pre Treatment ◽  
Iron Replacement

Introduction: Following the seminal study by Guyatt et al., serum ferritin has been widely accepted as the most accurate surrogate marker for iron deficiency, particularly if ferritin levels are < 45 mg/L. However, as an acute-phase reactant, ferritin levels rise with a number of conditions, including obesity, age, liver disorders, and inflammation. Elevated ferritin levels due to these concomitant clinical conditions may mask the underlying iron deficiency, thus rendering serum ferritin an unreliable marker for iron status. Therefore, the aim of this study is to evaluate the sensitivity and specificity of ferritin for the diagnosis of iron deficiency in patients presenting with normocytic anemia, when response to iron replacement was used as the gold standard for the diagnosis of iron deficiency. Methods: This study is a retrospective case review involving patients referred to an academic hematology clinic from 2003 to 2015 for further evaluation of chronic normocytic anemia without other cell lines abnormalities. Following initial workup to ensure the absence of 1) mixed microcytic-macrocytic anemia, 2) reticulocytosis suggesting acute blood loss or hemolysis, and 3) suboptimally low erythropoietin level, 59 patients received a therapeutic trial of oral ferrous gluconate. Intravenous iron sucrose was provided if patients could not tolerate or were refractory to oral iron therapy. All 59 patients (median age: 71 years, range: 24-93, male:female ratio 23:36) underwent a complete review of records before and after iron therapy for changes in haematological parameters and iron indexes. An increase of Hb ≥ 10.0 g/L from baseline was defined as a response to iron therapy, according to the WHO criteria. Results: The mean pre-treatment ferritin level of the cohort was 110 μg/L (median: 61 μg/L), which was higher than the generally accepted cut-off for iron deficiency. Following iron replacement therapy, the mean ferritin concentration of the cohort was raised to 257 μg/L, thus confirming the efficacy of iron therapy. Overall, 33 patients (56%) responded to iron therapy, experiencing an increase in Hb ≥ 10.0 g/L. Interestingly, 19 (58%) of these 33 patients had a pre-treatment ferritin value > 45 μg/L. Receiver operating characteristic (ROC) analysis of response rates to iron therapy and pre-treatment ferritin levels revealed an area under the curve (AUC) of only 0.492, indicating poor performance of ferritin tests in predicting the response to iron therapy. As such, serum ferritin is inadequate in predicting response to iron therapy in patients presenting with normocytic anemia. Conclusion: Despite the prevailing notion that low ferritin levels are diagnostic of iron deficiency, this retrospective case study exhibited the shortcomings of using ferritin as the sole determinant of iron status. Consequently, patients with normocytic anemia having a normal or high ferritin should not be excluded from a therapeutic trial of iron therapy. Disclosures No relevant conflicts of interest to declare.

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