Diagnosing Absolute Iron-Deficiency Anemia in Patients on Hemodialysis in a Tertiary Care Centre: A Retrospective Chart Review

Introduction: The gold standard for the diagnosis of absolute iron-deficiency anemia (IDA) in hemodialysis patients is a bone marrow aspirate with iron staining. Many clinicians use peripheral iron indices instead because they are non-invasive. Previous studies suggested that a serum ferritin < 200 ng/mL was a reliable indicator of absolute iron deficiency in the hemodialysis population. However, the sensitivity of serum ferritin for the diagnosis of IDA in hemodialysis patients is poor. Methods: The primary objective of this study was to identify the optimal ferritin value to diagnose patients with absolute iron deficiency, as assessed on bone marrow aspiration, in the renal dialysis population. Secondary endpoints included the rate of clinically relevant findings on gastrointestinal investigation according to iron status. Research Ethics Board approval was obtained from Queen's University for this retrospective chart review. Hematopathology laboratory records were used to determine all individuals who had bone marrow examination at Kingston Health Sciences tertiary referral center between 2008 January 1 and 2018 August 21. This list was cross-referenced with the Nephrology dialysis database to identify the pre-specified study cohort; those who were receiving concurrent hemodialysis or peritoneal dialysis. Iron deficiency was defined as reduced or absent iron stores on bone marrow aspirate with Perl's Prussian blue stain. Anemia was defined as hemoglobin <130 g/L in males and <120 g/L in females. Additional parameters collected included ferritin (normal range 22 - 275 ng/mL male and 4 - 205 ng/mL female), transferrin saturation (TSAT, normal range 20-55%), vitamin B12, folate, albumin, CRP and thyroid function tests. Peripheral iron indices over six months were analyzed; statistical analysis was performed with t-tests and Mann-Whitney U tests. ROC curves were generated to determine the sensitivity and specificity of various threshold values for serum ferritin and TSAT. Results: Between 2008 January 1 and 2018 August 21, 4234 patients underwent bone marrow examination, of whom 28 had received renal dialysis replacement therapy at some point. Fifteen patients concurrently at the time of bone marrow testing receiving hemodialysis form the study population (Table 1). Among these fifteen patients, 6 (40%) were female, median age was 70.5 (range 39 - 80) years and all were anemic (Hb range 73 - 110 g/L). Four of these individuals were absolutely iron-deficient with reduced or absent iron stores by bone marrow evaluation. The mean ferritin and TSAT values for individuals with absolute iron deficiency by bone marrow aspiration was 273.5 ng/mL (n=4; median 224.5 ng/mL; range 158-539 ng/mL) and 22.0% (n=3; median 20%; range 20-26%), respectively. All four commenced erythropoietin stimulating agents; two received oral iron supplementation. Eight patients, including two of those determined to be absolutely iron deficient on bone marrow, had endoscopic investigation. Two were identified to have sources of gastrointestinal bleeding, both with ferritin values in the 100-200 range (106 and 189 ng/mL). With the limited sample size, the sensitivity and specificity of ferritin to identify absolute iron deficiency in this hemodialysis population was 50% and 85%, respectively, at a threshold of 198 ng/mL. Discussion: Ferritin and TSAT are not sensitive markers for absolute iron deficiency in hemodialysis patients. Bone marrow examination is performed in a minority. The small sample size in this study precludes definitive determination of an optimal ferritin cut-off to diagnose iron deficiency in the dialysis population. Uncertainty about actual iron status may result in alternative invasive testing, such as colonoscopy, to investigate the cause of their anemia. Newer tests such as reticulocyte hemoglobin content and percent hypochromic red blood cells are more accurate and may guide diagnosis and management of IDA in hemodialysis patients. However they are not always routinely available. Further studies are needed to compare the utility of these peripheral iron indices to the gold standard bone marrow examination in a larger population, to allow identification of patients with absolute or functional IDA, and minimize invasive and potentially unnecessary investigation. Disclosures Hay: AbbVie: Research Funding; Kite: Research Funding; Janssen: Research Funding; Seattle Genetics: Research Funding; Celgene: Research Funding; MorphoSys: Research Funding; Roche: Research Funding; Novartis: Research Funding; Gilead: Research Funding; Takeda: Research Funding.

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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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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.

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DIAGNOSTIC ACCURACY OF SERUM FERRITIN AND SOLUBLE SERUM TRANSFERRIN RECEPTOR, TAKING BONE MARROW IRON STAIN AS A GOLD STANDARD FOR IRON DEFICIENCY ANEMIA IN HETEROGENOUS GROUP OF PATIENTS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v6i6.6855 ◽

2021 ◽

Vol 71 (6) ◽

pp. 1920-24

Author(s):

Tayyaba Ashiq ◽

Ammara Hafeez ◽

Abdus Sattar ◽

Nasiruddin . ◽

Naureen Saeed ◽

...

Keyword(s):

Bone Marrow ◽

Iron Deficiency ◽

Diagnostic Accuracy ◽

Serum Ferritin ◽

Transferrin Receptor ◽

Gold Standard ◽

Bone Marrow Examination ◽

Deficiency Anemia ◽

Serum Transferrin Receptor ◽

Bone Marrow Iron

Objective: To determine the diagnostic accuracy of serum ferritin and soluble serum transferrin receptor (sTfR), taking bone marrow iron stain as a gold standard for iron deficiency anaemia in heterogeneous group of patients. Study Design: Cross-sectional diagnostic accuracy study. Place and Duration of Study: Department of Diagnostic, Combined Military Hospital Lahore, from Mar to Aug 2020. Methodology: A total of 55 adult patients, of both genders, undergoing bone marrow examination for any reason were enrolled. Patients with known hemolytic condition (sickle cell anemia, megaloblastic anemia), taking erythropoietin/iron supplements, transfused red cell concentrate (RCC) recently or undergoing chemotherapy were excluded. Age, gender, clinical history and results of bone marrow examination, complete blood count (CBC), serum Ferritin and C-reactive protein (CRP) were recorded. Results: Serum ferritin was found to be less sensitive (28%) but more specific (100%) for reflecting reduced bone marrow iron stores as compared to sTfR (sensitivity: 60%, specificity: 96.6%). sTfR had highest likelihood ratio (15) and diagnostic accuracy (80%). On Receiver Operator Characteristic (ROC) graph Transferrin index (AUC=0.908) showed maximum accuracy, followed by Ferritin (AUC=0.884) and sTfR (AUC=0.879). Conclusion: Serum soluble transferring receptor (sTfR) and transferrin index has advantage over serum ferritin alone in predicting the bone marrow iron stores and differentiating iron deficiency anemia from anemia of chronic disease.

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Iron Supplementation Improves Energetic Efficiency During Submaximal Exercise in Iron Deficient Non-anemic Women (P24-042-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz044.p24-042-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Joanna Fiddler ◽

Jane Seymour ◽

Sonia Hernandez-Cordero ◽

Ismael Campos ◽

Jere Haas

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Status ◽

Work Capacity ◽

Submaximal Exercise ◽

Deficiency Anemia ◽

Physical Work ◽

Physical Work Capacity ◽

Mexican Women ◽

Iron Deficient

Abstract Objectives It has been estimated that 37–50% of anemia in non-pregnant women of reproductive age (WRA) is associated with iron deficiency (ID). Some of the highest rates of anemia associated with ID have been found in Latin American and Caribbean countries including Mexico. It has been well established that iron deficiency anemia (IDA), characterized by a reduced concentration of hemoglobin, results in a decline in muscular work capacity exhibited by a decrease in aerobic capacity and the ability to perform physical exercise. There is conflicting evidence on the impairment of physical work capacity in the iron deficient non-anemic (IDNA) state that is characterized by low serum ferritin but normal hemoglobin. The purpose of this study was to determine if iron status influences physical work capacity during submaximal exercise in Mexican women 18- to 45-year-old who are marginally iron depleted but not anemic. Methods Thirty-three iron-depleted (serum ferritin < 20 µg/L), non-anemic (hemoglobin > 120 g/L) women (age: 26.5 ± 6.4 yr) received either 10 mg elemental iron as FeSO4 daily (Fe: iron-supplement group, n = 18) or an identical placebo capsule (P: placebo group, n = 15) for 6 wk in a randomized, double-blind controlled trial. The energy cost of performing work during cycle ergometry at 25 and 50 watts were determined from indirect calorimetry at baseline and following the supplementation period. Results We observed increased serum ferritin (P = 0.035) and total body iron (P = 0.001), and decreased serum transferrin receptor (P = 0.028) in the Fe group compared with the P group. Based on mixed model ANOVA for a time-by treatment interaction, at end line participants in the Fe group performed work at both 25 and 50 W with lower mean energy expenditures (EE) compared to the P group (difference in EE at 25 W = 0.28 kcal/min, P = 0.036; difference in EE at 50 W = 0.41 kcal/min; P = 0.017). Conclusions Findings suggest that marginally iron depleted but non-anemic Mexican women improved their iron status and physical work efficiency following the consumption of supplemental iron. These results are important for WRA whose social, economic and dietary circumstances increase their risk for IDNA and suggest that a large proportion of these women who rely on physical labor as a livelihood may be working harder to achieve the same amount of work output as individuals with normal iron levels. Funding Sources Funding provided by The College of Human Ecology and Agricultural & Life Sciences, Cornell University.

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Consumption of a Double-Fortified Salt Affects Perceptual, Attentional, and Mnemonic Functioning in Women in a Randomized Controlled Trial in India

Journal of Nutrition ◽

10.3945/jn.117.251587 ◽

2017 ◽

Vol 147 (12) ◽

pp. 2297-2308 ◽

Cited By ~ 6

Author(s):

Michael J Wenger ◽

Laura E Murray-Kolb ◽

Julie EH Nevins ◽

Sudha Venkatramanan ◽

Gregory A Reinhart ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Status ◽

Controlled Trial ◽

Reproductive Age ◽

Deficiency Anemia ◽

Control Group ◽

Attention And Memory ◽

Double Blind ◽

Iron Deficient ◽

Mnemonic Function

Abstract Background: Iron deficiency and iron deficiency anemia have been shown to have negative effects on aspects of perception, attention, and memory. Objective: The purpose of this investigation was to assess the extent to which increases in dietary iron consumption are related to improvements in behavioral measures of perceptual, attentional, and mnemonic function. Methods: Women were selected from a randomized, double-blind, controlled food-fortification trial involving ad libitum consumption of either a double-fortified salt (DFS) containing 47 mg potassium iodate/kg and 3.3 mg microencapsulated ferrous fumarate/g (1.1 mg elemental Fe/g) or a control iodized salt. Participants' blood iron status (primary outcomes) and cognitive functioning (secondary outcomes) were assessed at baseline and after 10 mo at endline. The study was performed on a tea plantation in the Darjeeling district of India. Participants (n = 126; 66% iron deficient and 49% anemic at baseline) were otherwise healthy women of reproductive age, 18–55 y. Results: Significant improvements were documented for iron status and for perceptual, attentional, and mnemonic function in the DFS group (percentage of variance accounted for: 16.5%) compared with the control group. In addition, the amount of change in perceptual and cognitive performance was significantly (P < 0.05) related to the amount of change in blood iron markers (mean percentage of variance accounted for: 16.0%) and baseline concentrations of blood iron markers (mean percentage of variance accounted for: 25.0%). Overall, there was evidence that the strongest effects of change in iron status were obtained for perceptual and low-level attentional function. Conclusion: DFS produced measurable and significant improvements in the perceptual, attentional, and mnemonic performance of Indian female tea pickers of reproductive age. This trial was registered at clinicaltrials.gov as NCT01032005.

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Prevalence of Iron Deficiency Anemia in Anemic Patients: A Hospital Based Study

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v6i2.22494 ◽

2018 ◽

Vol 6 (2) ◽

pp. 41-45 ◽

Cited By ~ 1

Author(s):

Satyendra Kumar Mishra ◽

Surendra Marasini ◽

Badri Kumar Gupta ◽

Krishna Kumar Agrawal ◽

Narayan Gautam

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Ferritin ◽

Iron Status ◽

Macrocytic Anemia ◽

High Rate ◽

Deficiency Anemia ◽

Peripheral Smear ◽

Significant Difference ◽

Detailed Medical History

Introduction: In developing countries like Nepal, iron deficiency anemia (IDA) is one of the major concern. The high rate incidence has been related to insufficient iron intake, accompanied by chronic intestinal blood loss due to parasitic and malarial infections. Therefore, a study was conducted to evaluate the prevalence of IDA in anemic patients of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), South Western region, Nepal. Material and Method It was a hospital based cross sectional study comprised of 100 anemic patients. Their detailed medical history and lab investigations, focusing on hematological parameters were documented. Peripheral smear examination and serum ferritin estimation were done to observe red cell morphology and iron status respectively. Results: This study revealed that out of 100 anemic patients, 35% were that of IDA. The most affected age group was 21-40 years with frequency 42.55%. IDA was more common in females (42.85%) than in male (21.62%). Out of 100 anemic patients, microcytic hypochromic anemia was predominant in 47% followed by macrocytic anemia (31%) and then normocytic normochromic anemia (22%). Out of 47 microcytic hypochromic anemic patients, 12 had normal serum ferritin. There was a statistical significant difference in Hb (p=0.011), MCV (p=0.0001), MCH (p=0.0001), MCHC (p=0.0001) and serum ferritin (p=0.0001) among all types of anemia. There was a statistical significant positive correlation of ferritin with Hemoglobin (0.257, p= 0.01), MCV (0.772, p= 0.0001), MCH (0.741, p=0.0001) and MCHC (0.494, p=0.0001). Conclusion: The peripheral smear in conjunction with serum ferritin estimation needs to be included for susceptible individuals to screen the IDA and other types of anemia.

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Prevalence and pattern of Iron deficiency in patient with heart failure with reduced ejection fraction

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v7i2.30689 ◽

2019 ◽

Vol 7 (2) ◽

pp. 10-16

Author(s):

Aditya Mahaseth ◽

Jay Narayan Shah ◽

Bikash Nepal ◽

Biplave Karki ◽

Jeet Ghimire ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Ejection Fraction ◽

Serum Ferritin ◽

Iron Status ◽

Transferrin Saturation ◽

Functional Iron Deficiency ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Absolute Iron Deficiency

Background and Objectives: Iron Deficiency is the commonest nutritional deficiency worldwide, affecting more than one-third of the population, its association with Heart Failure with or without anemia is of growing interest. As iron supplementation improves prognosis in patients with Heart Failure, Iron Deficiency is an attractive therapeutic target – a hypothesis that has recently been tested in clinical studies. This study is designed to estimate the prevalence and pattern of iron deficiency (ID) in heart failure (HF) with reduced ejection fraction patients with or without anemia. Material and methods: It was a single center hospital based cross sectional observational study. A total of 60 male and female patients with diagnosis of heart failure based on the Framingham Criteria, who gave consent for the study were included. They underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin saturation percentage, serum ferritin, total iron binding capacity. Serum ferritin <100 μg/l was used to diagnose absolute ID. Functional ID was defined as a serum ferritin level of 100–300 μg/l and a transferrin saturation of <20 %. Anemia was defined as hemoglobin (Hb) <13 g/dl for males and <12 g/dl for females, based on World Health Organization definition. Results: Using the above definitions iron deficiency was found in 28 (46.67%) patients. 36.67% patients had absolute iron deficiency and 10% patients had functional iron deficiency. Females had a higher non statistically significant iron deficiency than males 63.16% vs 39.02%. 15 patients (48.38%) with iron deficiency did not have anemia, and 11 (35.5%) of those patients had absolute iron deficiency. Conclusion: Iron deficiency is prevalent in patients with heart failure and reduced ejection fraction irrespective of anemia and hemoglobin levels. Many of those patients can have functional iron deficiency. Measurement of iron status should be a routine during workup of heart failure patients and further studies are needed to determine the prognostic value of iron status measurement and the influences of treatment of iron deficiency in heart failure patients. Many such trials are now underway.

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

Scientific Reports ◽

10.1038/s41598-020-75435-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Gorkem Sezgin ◽

Paul Monagle ◽

Tze Ping Loh ◽

Vera Ignjatovic ◽

Monsurul Hoq ◽

...

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Age Groups ◽

Hemoglobin Concentration ◽

Population Based ◽

Reference Intervals ◽

Deficiency Anemia ◽

Distribution Width ◽

Iron Deficient ◽

Lower Limits

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.

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Effects of Iron Deficiency Anemia and Its Rapid Correction on the Serum Metabolomic Profile of Rhesus Infants

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_142 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1070-1070

Author(s):

Brian Sandri ◽

Gabriele Lubach ◽

Eric Lock ◽

Michael Georgieff ◽

Pamela Kling ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Acid Production ◽

Iron Status ◽

Deficiency Anemia ◽

Iron Dextran ◽

Metabolomic Profile ◽

Intramuscular Injections ◽

Iron Deficient ◽

Rapid Correction

Abstract Objectives To determine whether rapid correction of iron deficiency using intramuscular iron dextran normalizes serum metabolomic changes in a nonhuman primate model of iron deficiency anemia (IDA). Methods Blood was collected from naturally iron-sufficient (IS; n = 10) and IDA (n = 12) male and female infant rhesus monkeys (Macaca mulatta) at 6 months of age. IDA infants were treated with intramuscular injections of iron dextran, 10 mg/weekly for 4–8 weeks. Iron status was reevaluated following treatment using hematological measurements and sera were metabolically profiled using HPLC/MS with isobaric standards for identification and quantification. Results Early-life iron deficiency anemia negatively affects many cellular metabolic processes, including energy production, electron transport, and oxidative degradation of toxins. Slow iron repletion with dietary supplementation restores iron deficient monkeys from a hematological perspective, but the serum metabolomic profile remains differed from monkeys that had been iron sufficient their entire life. Whether rapid iron restoration through intramuscular injections of iron dextran normalizes serum metabolomic profile is not known. A total of 654 metabolites were measured with differences in 53 metabolites identified between IS and IDA monkeys at 6 months (P 0.05). Pathway analyses provided evidence of altered liver function, hypometabolic state, differential essential fatty acid production, irregular inosine and guanosine metabolism, and atypical bile acid production in IDA infants. After treatment, iron-related hematological parameters had recovered, but the formerly IDA infants remained metabolically distinct from the IS infants, with 225 metabolites differentially expressed between the groups. Conclusions As with slow iron repletion, rapid iron repletion does not normalize the altered serum metabolomic profile in rhesus infants with IDA, suggesting the need for iron supplementation in the pre-anemic stage. Funding Sources National Institutes of Health.

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Evaluation of the iron status of a population

Blood ◽

10.1182/blood.v48.3.449.449 ◽

1976 ◽

Vol 48 (3) ◽

pp. 449-455 ◽

Cited By ~ 293

Author(s):

JD Cook ◽

CA Finch ◽

NJ Smith

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Status ◽

Transferrin Saturation ◽

Red Cell ◽

Adult Males ◽

Packed Red Blood Cells ◽

Iron Deficient ◽

Menstruating Women ◽

Prevalence Of Anemia

Abstract The iron status of a population of 1564 subjects living in the northwestern United States was evaluated by measurements of transferrin saturation, red cell protoporphyrin, and serum ferritin. The frequency distribution of these parameters showed no distinct separation between normal and iron-deficient subjects. When only one of these three parameters was abnormal (transferrin saturation below 15%, red cell protoporphyrin above 100 mug/ml packed red blood cells, serum ferritin below 12 ng/ml), the prevalence of anemia was only slightly greater (10.9%) than in the entire sample (8.3%). The prevalence of anemia was increased to 28% in individuals with two or more abnormal parameters, and to 63% when all three parameters were abnormal. As defined by the presence of at least two abnormal parameters, the prevalence of iron deficiency in various populations separated on the basis of age and sex ranged from 3% in adolescent and adult males to 20% in menstruating women. It is concluded that the accuracy of detecting iron deficiency in population surveys can be substantially improved by employing a battery of laboratory measurements of the iron status.

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