Hypoferritinemia without Anemia the Possible Diagnostic Thought

Abstract Hypoferritinemia Without Anemia The Possible Diagnostic Thought Hassan Al-Jafar , Saud Al-Fadli , Fatma Al-Thelab , Mubark Al-Aqeel Introduction : Iron metabolism still an active area in research work which provide more knowledge of aetiology and pathogenesis of the diseases and provide new treatment methods based on the new research results . HWA is one of the metabolic disorders where all the investigations are withen normal reference ranges . HWA patients could have long standing complain , while few HWA patients have no complains . The normal all results make HWA a hidden disease with lack in the exact underling cause . Iron deficiency anemia ( IDA ) and latent iron deficiency anemia ( LIDA ) are easy to diagnose from the clinical and the laboratory results , where IDA has anemia and LIDA has at least one paremeter in complete blood count that indicate a stage of pre-iron deficiency anemia . HWA desease has normal results except low ferritin level , ehat make pre-pre-IDA or pre-LIDA with normal transferrin saturation a stutus which was not described before . In the letreture serum ferritin found to be low in canins due to autoantibodies , also there could be another factors which not yet known that may affect iron metabolism and causing HWA . Aim: This research project is looking for interpretation for HWA to treat it by methods other than iron or iron infusion as many unpleasant and side effects accompanied both oral and intravenous iron treatment. Methodology and tools: From our hospital data and from the outpatient department 75 Patients 36 male and 39 females were reviewed to detect the variations of complete blood count parameters in comparison with iron status. Tools: Complete blood count (CBC), HPLC, serum iron, serum ferritin, transferrin. Including criteria: Adult male and female patients, normal HPLC results. Excluding criteria: Abnormal HPLC, Family history of hemoglobinopathy disorders for patients investigated prospectively, patients on iron treatment excluded from this study. Results: In IDA group usually all the parameters indicate IDA. In LIDA group at least one parameter or more indicate iron deficiency. In HWA group only, ferritin is low and transferrin saturation is normal while it is expected to be low if HWA underling aetiology is iron deficiency. Table [ 1] Conclusion: IDA and LIDA are easly diagnosed , while HWA has only low serum ferritin which is not routinely done. In HWA the results are not going with the usual parameters of iron metabolism and homeostasis, when low ferritin found with normal transferrin saturation in the same sampling days. HWA could be just an early pre- LIDA or may be a low ferritin reference range in some countries especially when the patient has no complains, or the body could have another unknow storage mechanisms other than ferritin. HWA also might be hormonal deficiency which reduce acute reactive proteins which could affect serum ferritin level or HWA could be an antibody against ferritin which has no influence on serum iron, but it renders serum ferritin lower than normal. HWA is important from many aspects , first it is a hidden disorder which need to be known by the physicians for diagnosis and treatment and it is important from academic point of view to answer to its indecisive aetiology and pathogenesis especially when it has a controversy in low ferritin and normal transferrin saturation . Adding more research tools as hepcidin test could provide more information to understand HWA disorder better. References: 1-Wei Wang , Mary Knovich , Lan G.Coffman Frank M, Torti , Suzy V. Torti , Serum ferritin :Past , Present and future Biochim Biophys acta , 2010 August ; 1800 (8) : 760-769 2-Hassan Al-Jafar, HWA: Hypoferritinemia without a hidden hematology disorder, journal of family medicine and primary care 2017, volume: 6, issue: 1 p 69-72 Disclosures No relevant conflicts of interest to declare.

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Iron deficiency in preschool non-anemic Egyptian children

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-021-00081-z ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Osama M. El-Asheer ◽

Mary S. Naeem ◽

Fardos A. Abdel-Hafez ◽

Madleen A. A. Abdou ◽

Khalil A. Mohamed

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Complete Blood Count ◽

Binding Capacity ◽

Iron Status ◽

Ferritin Level ◽

Transferrin Saturation ◽

Deficiency Anemia ◽

Healthy Children ◽

Egyptian Children

Abstract Background Iron deficiency anemia remains a common cause of anemia in young children. The term iron deficiency without anemia, or the so-called latent iron deficiency, has become increasingly significant as it is not only difficult to identify this condition in non-anemic children, but it also adversely affects neurocognitive development, and unfortunately, some of these effects may be irreversible and not respond to treatment. This cross-sectional study was conducted to evaluate iron status in 68 apparently healthy, non-anemic Egyptian children aged 1–6 years. They were subjected to detailed history-taking, physical examination, complete blood count, and tests for serum iron, total iron binding capacity, serum ferritin, and transferrin saturation. Results Low serum ferritin level and low transferrin saturation were detected in 41.2% and 47% of the children, respectively. Iron deficiency parameters were significantly affected among toddlers aged “1” to “3” years compared with preschool children, and boys were found to be more affected than girls of the same age group. Conclusions A normal hemoglobin level does not exclude iron deficiency, which should be screened in healthy children to prevent the possible long-term effects of iron deficiency on their cognition and mental development.

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Prevalence of Iron Depletion and Anemia in Top-level Basketball Players

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.14.1.30 ◽

2004 ◽

Vol 14 (1) ◽

pp. 30-37 ◽

Cited By ~ 50

Author(s):

Gal Dubnov ◽

Naama W. Constantini

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Blood Count ◽

Complete Blood Count ◽

Iron Status ◽

Transferrin Saturation ◽

Deficiency Anemia ◽

Iron Store ◽

Basketball Players ◽

Iron Depletion

Iron depletion, with or without anemia, may have a negative effect on physical and mental performance. Even with current recognition of the problem, its incidence among athletes remains high. Most studies describe iron status in endurance athletes. This study examined the prevalence of iron depletion and anemia among male and female top-level basketball players. Adolescents and adults (N = 103) from 8 national basketball teams were screened for anemia and iron stores status, which included a complete blood count and levels of plasma ferritin, transferrin, and serum iron. Iron depletion, defined by a ferritin level below 20 μg/L, was found among 22% of study participants (15% in males vs. 35% in females, p = .019). Anemia was found among 25% of athletes (18% in males vs. 38% in females, p = .028). Iron deficiency anemia, defined by the presence of anemia, ferritin levels below 12 μg/L, and transferrin saturation below 16%, was found among 7% of players (3% in males vs. 14% in females, p = .043). In summary, a high prevalence of iron depletion, anemia, and iron deficiency anemia was found among basketball players of both genders. We recommend screening ballgame players for blood count and iron store status, and providing nutritional counseling and iron supplementation when necessary.

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The Prevalence and Risk Factors of Iron Deficiency Anemia in Thai Infants by Complete Blood Count at 9-Month-Old

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.09.10904 ◽

2020 ◽

Vol 103 (9) ◽

pp. 891-896

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Exclusive Breastfeeding ◽

Blood Count ◽

Complete Blood Count ◽

Deficiency Anemia ◽

Iron Treatment ◽

Baby Clinic

Background: Infants are the most at risk from iron deficiency (ID) and iron deficiency anemia (IDA), but the prevalence of the latter in this group is unclear. Estimation as to the prevalence of IDA using Hb of less than 11 g/dL may have been exaggerated due to thalassemia and hemoglobinopathies. On the other hand, iron studies are costly and not routinely available in low resource settings. In the present research, the authors estimated the prevalence of IDA in 9-month-old infants at the authors’ well-baby clinic by improving the post-iron-treatment criteria of Hb and defined the risk factors of IDA in infants. Objective: To estimate the prevalence of IDA in 9-month-old infants at the well-baby clinic and to define the risk factors of IDA. Materials and Methods: A retrospective cohort study of 391 children who had complete blood count (CBC) screening at 9-month-old at the well-baby clinic. Anemia was defined according to the WHO criteria (hemoglobin of 11 g/dL or less for children aged six months to five years). IDA was defined as an increase of at least Hb 1 g/dL after receiving iron treatment for one to two months. Mean levels of hematological parameters were compared between groups using independent samples t-test. The characteristics with potential risk factors for IDA were compared with iron non-responder and normal group. Multivariable adjusted odd ratios and 95% confidence intervals (CIs) of IDA were calculated using multinomial logistic regression with control for risk factors. Results: One hundred fourteen children (29.1%) were anemic. There was no difference between anemic and non-anemic children in baseline characteristics. Seventy children in the anemic group were diagnosed with IDA. The prevalence of IDA in the present study was 17.9%. The IDA group showed significant improvement in Hb, Hct, MCV, MCH after receiving iron treatment, but there were no significant changes in the iron non-responder group. The risk factor for IDA was exclusive breastfeeding for at least six months (odds ratio 3.14, 95% CI 1.67 to 5.90, p<0.001). Conclusion: The prevalence of IDA and anemia in the present study was 17.9% and 29.1%, respectively. The risk factor for IDA was exclusive breastfeeding for at least six months. Keywords: Anemia, Iron deficiency anemia, Prevalence of anemia in infants, Complete blood count screening, Thai infants

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CORRELATION BETWEEN MEAN PLATELET VOLUME AND IRON DEFICIENCY ANEMIA

Journal of Biomedical and Pharmaceutical Research ◽

10.32553/jbpr.v8i4.638 ◽

2019 ◽

Vol 8 (4) ◽

Author(s):

Himanshu Dagor

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Peripheral Blood ◽

Mean Platelet Volume ◽

Ferritin Level ◽

Transferrin Saturation ◽

Deficiency Anemia ◽

Platelet Volume ◽

Iron Treatment ◽

The Mean

Background: Iron inhibits megakaryopoiesis so iron deficiency anemia (IDA) leads to microthrombosis. Iron therapy ameliorates thrombocytosis. In this study, we investigated whether young, active, and large platelets are released into peripheral blood during iron treatment. Mean platelet volume (MPV) was measured as an indicator for the presence of these platelets. Materials and Methods: A total of 80 patients (10 males and 70 females) with IDA were included in this retrospective study. IDA was defined as ferritin level <50 ng/mL with a transferrin saturation <20% or ferritin <15 ng/mL. Daily ferrous sulfate (270 mg iron II sulfate and 80 mg of elemental iron) was given orally to patients. We evaluated retrospectively the hematologic and biochemical parameters prior to and 1 month after iron treatment. Results: the mean ferritin level of the pretreatment group was 6.5 ± 4.0 ng/mL, MPV was 7.9 ± 1.5 fL, hemoglobin (Hb) was 9.8 ± 1.5 g/dL and the mean cellular volume (MCV) was 71.2 ± 7.2 fL. The mean ferritin level of the posttreatment group was 40.3 ± 15.2 ng/mL, MPV was 8.6 ± 2.0 fL, Hb was 12.5 ± 6.6 g/dL, and MCV was 77.6 ± 5.4 fL. The levels of ferritin (P < 0.001), MPV (P < 0.001), MCV (P < 0.001), and Hb (P < 0.001) were significantly higher in the posttreatment group compared to the pretreatment group. Conclusion: There may be an increase in thrombotic events due to hypercoagulability related to microthrombosis during IDA. Even though thrombosis is corrected during iron treatment, the therapy increases the release of large and active thrombocytes into the peripheral blood. Keywords: Iron, iron deficiency anemia, mean platelet volume, thrombocytosis, thrombosis

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An Effective and Efficient Testing Protocol for Diagnosing Iron-deficiency Anemia Preoperatively

Anesthesiology ◽

10.1097/aln.0000000000003263 ◽

2020 ◽

Vol 133 (1) ◽

pp. 109-118 ◽

Cited By ~ 1

Author(s):

Obianuju Okocha ◽

Hardik Dand ◽

Michael J. Avram ◽

BobbieJean Sweitzer

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Blood Count ◽

Complete Blood Count ◽

Transferrin Saturation ◽

Deficiency Anemia ◽

Patient Visit ◽

Single Patient ◽

Traditional Practice ◽

Ferritin Concentration

Background Iron-deficiency anemia is a common perioperative condition and increases perioperative morbidity and mortality. Timely diagnosis and treatment are important. This retrospective cohort study tested the hypothesis that a newly developed preprocedure evaluation protocol diagnoses more patients with iron-deficiency anemia than the traditional practice of obtaining a complete blood count followed by iron studies. Methods The preprocedure anemia evaluation is an order for a complete blood count and reflex anemia testing, which can be completed with a single patient visit. A hemoglobin concentration of 12 g/dl or less with serum ferritin concentration less than 30 ng/ml or transferrin saturation less than 20% defined iron-deficiency anemia. Northwestern Medicine’s database was queried for preoperative clinic patients, age 16 to 89 yr, before (2015 to 2016) and after (2017 to 2018) protocol implementation. The proportion of patients diagnosed with iron-deficiency anemia before and after the preprocedure anemia evaluation implementation was compared. Results Before implementing the protocol, 8,816 patients were screened with a traditional complete blood count. Subsequent iron studies at the providers’ discretion diagnosed 107 (1.2%) patients with iron-deficiency anemia. Some patients were still screened with a complete blood count after implementing the protocol; 154 of 4,629 (3.3%) patients screened with a complete blood count and 738 of 2,828 (26.1%) patients screened with the preprocedure anemia evaluation were diagnosed with iron-deficiency anemia. The preprocedure anemia evaluation identified a far larger proportion of patients with iron-deficiency anemia than did the traditional complete blood count when compared both before (relative risk [95% CI], 21.5 (17.6 to 26.2); P < 0.0001) and after (7.8 [6.6 to 9.3]; P < 0.0001) its implementation. Conclusions The preprocedure anemia evaluation improved identification of iron-deficiency anemia preoperatively. It is more effective and efficient, allowing anemia evaluation with a single patient visit. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Using Reticulocyte Hemoglobin Equivalent (RET- He) in Diagnosis of Iron Deficiency Anemia

QJM ◽

10.1093/qjmed/hcaa044.005 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R A R Ahmed ◽

M H A Fayek ◽

D A D Salem

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Complete Blood Count ◽

Area Under The Curve ◽

Deficiency Anemia ◽

Control Group ◽

Chronic Disorder ◽

Evaluation Of Parameters

Abstract Background Anemia is a significant worldwide health problem. Approximately one third of the world's population suffers from anemia, half of which is due to iron deficiency (ID). Evaluation of parameters relating to serum ferritin and iron is critically important in the diagnosis of iron deficiency anemia (IDA). The recent development of automated systems for hematology analysis has made it possible to measure reticulocyte hemoglobin equivalent (RET-He), which is thought to reflect iron content in reticulocytes, in the same sample used for complete blood count tests. Aim of the work We aimed to assess the role of RET- He in diagnosis of iron deficiency anemia. Subjects and Methods Blood samples were obtained from 102 subjects. Patients were classified into three groups: IDA, ID, and anemia of chronic disorder (ACD). In addition 20 age and sex matched healthy volunteers were enrolled as control. RET- He was assessed by Sysmex XN1000 hematology analyzer. Results Patients in the IDA group had significantly lower RET-He levels than those in the control group. RET-He was correlated with serum ferritin in the IDA and ID groups. The area under the curve for RET-He was 0.883. The cut-off value of RET- He for detecting IDA was ≤ 26.5 pg with 80% sensitivity and 90% specificity. Conclusion RET-He facilitates the diagnosis of IDA with high accuracy and may be a clinically useful marker for determining IDA.

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Lactoferrin Levels in the Gastric Tissue ofHelicobacter pylori-Positive and -Negative Patients and Its Effect on Anemia

Mediators of Inflammation ◽

10.1155/2012/214581 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Yaşar Doğan ◽

Tülay Erkan ◽

Zerrin Önal ◽

Merve Usta ◽

Gülen Doğusoy ◽

...

Keyword(s):

Helicobacter Pylori ◽

Abdominal Pain ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Ferritin Level ◽

Deficiency Anemia ◽

Antral Mucosa ◽

Gastric Tissue ◽

Negative Controls

Aim. To determine gastric tissue lactoferrin (Lf) levels ofHelicobacter pylori-(Hp-) positive and -negative patients and its effect on anemia.Methods. Cases in which initial presentation was of abdominal pain and that were Hp-positive at endoscopy were included. Hp-positive cases and -negative controls were divided into two groups.Results. The study included 64 cases (average: years, 39 male and 25 female). Lf levels were subsequently studied on 61 cases. 45 (73.8%) of these were Hp-positive, while 16 (22.2%) were Hp-negative. In Hp-positive cases, mean staining percentages and density of glands in the antral mucosa were % and , respectively. Hp-negative cases showed significantly different values of % and , respectively. Hemoglobin and serum ferritin values of Hp-positive cases were /dL and /mL, but these were comparable with Hp-negative cases (/dL and /mL).Conclusions.Tissue Lf was significantly higher in Hp-positive cases compared to Hp-negative cases, but no difference was observed between the two groups with regards to hemoglobin and ferritin level. As a result, it is difficult to say that this rise in Lf plays a role in the development of iron deficiency anemia in Hp-positive patients.

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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.

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Usefulness of Reticulocyte Hemoglobin Equivalent for Diagnosis of Iron Deficiency

Blood ◽

10.1182/blood.v128.22.3621.3621 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3621-3621

Author(s):

Yasumichi Toki ◽

Katsuya Ikuta ◽

Masayo Yamamoto ◽

Mayumi Hatayama ◽

Motohiro Shindo ◽

...

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Research Funding ◽

Serum Iron ◽

Blood Count ◽

Complete Blood Count ◽

Deficiency Anemia ◽

Enzyme Linked Immunosorbent Assay ◽

Iron Administration ◽

Significant Difference

Abstract Background: Anemia is a significant worldwide health problem, and approximately 30% of world people suffer from anemia, the half of which is iron deficiency (ID). The diagnosis of anemia requires the confirmation of a decrease in hemoglobin (Hb) concentration. For the diagnosis of iron deficiency anemia (IDA), the determinations of serum ferritin and iron related parameters must be necessary even if microcytic hypochromic anemia is confirmed. With recent technological advances, the Hb content of reticulocytes can be quantified by flow cytometry. Reticulocytes exist for 1-2 days in the peripheral blood and its Hb levels might be a good index of ID.There are several markers for the assessment of Hb content in reticulocytes, including reticulocyte Hb equivalent (RET-He) and reticulocyte Hb content (CHr). RET-He, which can be measured in the same sample used for complete blood count tests by the latest automated hematology analyzers, is considered to reflect iron content in reticulocytes. If RET-He is capable of evaluating ID, it must be useful for immediate diagnosis of IDA. Therefore, we evaluated the usefulness of RET-He for determining of ID. Methods: This prospective study was approved by the ethics committee of Asahikawa Medical University (authorization numbers 1356, 1679, and 1356-3). Blood samples were obtained from 211 patients (63 males and 148 females) from 14 to 91 years old. RET-He levels were determined using an automated hematology analyzer (XN-3000® or XE-5000®, Sysmex, Kobe, Japan). Serum iron, total iron binding capacity (TIBC), serum ferritin, and biochemical data were measured using an automated chemical analyzer. Soluble transferrin receptor (sTfR) was measured by an enzyme-linked immunosorbent assay. Anemia was defined as Hb level of <12 g/dL. ID state was defined as serum ferritin level of <12 ng/mL. Patients were classified into four groups which are IDA, ID, control, and anemia without ID groups according to their Hb and serum ferritin levels (Table 1). Laboratory parameters were compared among four groups. The changes of RET-He during oral iron administration were also determined for 21 IDA patients. Results: There were 72 (14 males and 58 females), 28 (12 males and 16 females), 67 (23 males and 44 females), and 44 (14 males and 30 females) patients in the IDA, ID, control, and anemia without ID groups, respectively. As shown in Table 1, The median RET-He levels were 22.3 pg (15.1-35.6 pg), 29.7 pg (19.2-34.9 pg), 34.0 pg (25.9-38.0 pg), and 32.5 pg (19.1-46.3 pg) in the IDA, ID, control, and anemia without ID groups, respectively. Patients in not only IDA but ID groups had significantly lower RET-He levels than those in control group (p < 0.001) while there was no significant difference in RET-He levels between anemia without ID and control. RET-He correlated positively with serum iron (r = 0.654) and transferrin saturation (TSAT) (r = 0.666), and correlated negatively with TIBC (r = -0.617) and sTfR (r = -0.655). There was no correlation between RET-He and serum ferritin when all patients were included in the analysis (r = 0.287); however, analysis of groups according to their iron status revealed a positive correlation between RET-He and serum ferritin in the IDA and ID groups (r = 0.604). The area under the ROC curve (AUC) detecting ID for RET-He was 0.902, whereas AUC for serum iron, TIBC, TSAT, and sTfR were 0.889, 0.879, 0.922 and 0.821, respectively. The cutoff value of RET-He with maximal sensitivity and specificity was 30.9 pg, and the cutoff RET-He value of 28.5 pg had a specificity of >90% (sensitivity, 68%; specificity 91%). Among patients receiving iron treatments, the Hb levels increased in 14 patients, whereas Hb values decreased or did not change in 7 patients. Serum ferritin and RET-He values seemed to change in parallel with changes in Hb levels. Conclusions: In the present study, our data showed the efficacy of RET-He for diagnosis of IDA and the usefulness for monitoring drug iron administration. Because other parameters related to ID such as iron and ferritin should be measured biochemically in serum, it takes a longer time to measure serum iron and ferritin levels when compared with complete blood count tests. We would therefore suggest that measurement of RET-He might be useful to diagnose IDA because its assessment is rapid, fully automated, and can be measured in same sample used for complete blood count test. Disclosures Toki: Sysmex Corporation: Research Funding. Ikuta:Sysmex Corporation: Research Funding. Yamamoto:Sysmex Corporation: Research Funding. Hatayama:Sysmex Corporation: Research Funding. Shindo:Sysmex Corporation: Research Funding. Fujiya:Sysmex Corporation: Research Funding. Okumura:Sysmex Corporation: Research Funding.

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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.

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