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

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

Zeitschrift für Naturforschung C ◽

10.1515/znc-1977-11-1227 ◽

1977 ◽

Vol 32 (11-12) ◽

pp. 1023-1025 ◽

Cited By ~ 20

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.

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Sideroblastic Changes Can Be Recognized in the Erythrogram.

Blood ◽

10.1182/blood.v106.11.4909.4909 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4909-4909

Author(s):

Alicia Rovó ◽

Jakob R. Passweg ◽

Geneviève Favre ◽

Dominik Heim ◽

Sandrine Meyer-Monard ◽

...

Keyword(s):

Bone Marrow ◽

Iron Deficiency ◽

Predictive Value ◽

Statistical Significance ◽

Diagnostic Approach ◽

Distribution Width ◽

Rbc Indices ◽

Scatter Plots ◽

Bone Marrow Iron ◽

Cell Counter

Abstract The scatter plots of red blood cells (RBC), called erythrogram produced by the ADVIA® 2120 cell counter gives a visual representation of RBC characteristics. Using a pair of threshold gates on each axis, nine areas are defined according to the cell volume and the hemoglobin (Hb) content. Normal RBC are distributed in the central quadrant. In diseases such as iron deficiency and thalassemia the erythrogram shows a characteristic pattern commonly used for diagnostic approach. We observed in patients, mainly with myeloid diseases with ringed sideroblasts (RS) in the bone marrow a particular erythrogram pattern with a broad distribution of the RBC and a marked variation in RBC size and hemoglobinization. From the central quadrant an abnormal RBC population shifts on an imaginary axis to the lower-left quadrant representing a tail advancing into the microcytic and hypochromic quadrants (Fig1). To confirm whether this particular erythrogram was predictive for bone marrow sideroblastic changes; we compared retrospectively the erythrogram of patients with RS to a group of myeloid diseases without RS. Between January 2004 and August 2005, 33 of 1973 cases with more than 15% of RS in the marrow were identified, 21/33 patients were evaluable (AML=2, MDS=13, MPS=1, MDS/MPS=3, non neoplasia=2). These patients were compared to 30 consecutive cases with myeloid diseases without RS (No RS) (AML=16, MDS=11, MPS=2, MDS/MPS=1). In addition to the erythrogram pattern, Hb, RBC indices, and bone marrow iron staining were analyzed in both groups. We defined two types of erythrogram pattern in respect of sideroblastic changes: a) typical (fig1) b) non typical: any other pattern (i.e. macrocytosis, fig 2). The erythrogram was typical in 17/21 patients with RS and in 0/30 patients with No RS (p<0.0001). The positive predictive value for sideroblastic changes was 100% and the negative predictive value was 88%. Despite the RBC indices comparison showed statistical significance in some variables, they were not specific enough to identify sideroblastic changes. In the group with RS, mean cell Hb was lower (median 30.8 versus 33.6pg), RBC distribution width was higher (19.3 versus 16.5%), the % of hypochromic RBC was higher (5.3 versus 0.9%) and Hb content of reticulocyte was lower (33 versus 37 pg) compared to No RS patients (p<0.05). This last index was particularly useful to rule out iron deficiency in RS group as a cause of hypochromic RBC changes, since in contrast to iron deficiency it was not decreased. In conclusion: sideroblastic changes can be recognized in the erythrogram. Indeed, despite myeloid diseases with RS are a heterogeneous group of diseases they have a common pattern of RBC distribution that can be considered as a kind of fingerprinting for sideroblastic changes with a high predictive value allowing a straightforward diagnostic approach in clinical practice. Figure 1 Figure 1. Figure 2 Figure 2.

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Screening for Iron Deficiency: Can We Continue To Avoid Ferritin?.

Blood ◽

10.1182/blood.v108.11.3351.3351 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3351-3351

Author(s):

Maria E. Montoya ◽

Peter R. Van Delden ◽

M. Tarek Elghetany ◽

J. David Bessman

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Blood Count ◽

Roc Curves ◽

Screening Tools ◽

Distribution Width ◽

Males And Females ◽

Relative Utility ◽

Multiple Receiver

Abstract Detection of iron deficiency remains poorly understood and costly due to inappropriate screening. Low ferritin is a definitive diagnosis of iron deficiency, but screening with ferritin is not allowed. Therefore surrogates in the blood count have been used to justify obtaining the serum ferritin. The purpose of this research was to analyze the role of Hemoglobin (Hgb), Mean Corpuscular Volume (MCV), and RBC Distribution Width (RDW) as surrogates in screening for iron deficiency. All 2,563 patients with serum ferritin levels gathered over 12 months were reviewed. The relative utility of Hgb, MCV, and RDW in screening for low ferritin levels was shown through multiple Receiver Operator Characteristic (ROC) curves. 264 patients had a ferritin less than 10 ng/ml and 210 between 11 to 20 ng/ml. Results indicate that when viewed independently MCV correlates most closely to low ferritin as seen in Figure 1. RDW and Hgb in both males and females demonstrate a weaker association though remains of value. Table1 lists the values at which the three screening tools were 95% and 100% sensitive for detecting ferritin levels of 10 ng/ml and below. In contrast the data indicate that for ferritin levels from 11 to 20 ng/ml all three screening variables have poor sensitivity and specificity. This is demonstrated clearly in Figure 2. The data suggest that the most severe iron deficiency (ferritin under 10 ng/ml) can be well predicted by abnormalities in the blood count; however less severe iron deficiency (ferritin 10 to 20 ng/ml) cannot be anticipated from the blood count. The blood count does not appear to be a practical alternative to ferritin for screening for iron deficiency. Table 1: Sreening Variable Sensitivities* 100% Sensitivity 95% Sensitivity *values for ferritin less than 11 ng/ml MCV >98.2 >90.0 RDW <12.2 <13.1 Hgb Males >15.0 >13.7 Hgb Females >14.2 >12.6 Figure 1 Figure 1. Figure 2 Figure 2.

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