Detecting iron deficiency in anemic patients with concomitant medical problems
10.1046/j.1525-1497.1998.00134.x Cite this article as: Kis, A.M. & Carnes, M. J GEN INTERN MED (1998) 13: 455. doi:10.1046/j.1525-1497.1998.00134.x Abstract OBJECTIVE: To determine the sensitivity and specificity of mean corpuscular volume, transferrin saturation, total iron-binding capacity, and ferritin level in determining iron deficiency in a population of anemic veterans with a wide variety of general medical diagnoses. DESIGN: Retrospective chart review. SETTING: Hospitals of the Department of Veterans Affairs in Madison and Milwaukee, Wisconsin. PARTICIPANTS: One hundred one anemic veterans with any medical condition who underwent bone marrow aspiration and serum iron studies. MEASUREMENTS AND MAIN RESULTS: Using the presence or absence of bone marrow hemosiderin as the reference standard, the sensitivity and specificity of the following serum iron indicators were calculated: mean corpuscular volume, transferrin saturation, total iron-binding capacity, and ferritin level. Of these patients, 41 (40.6%) were categorized as iron deficient, with no stainable bone marrow hemosiderin. A serum ferritin level ≤ 100 µg/L provided the best sensitivity (64.9%) and specificity (96.1%) for evaluating iron stores in this patient population. When performed within 24 hours of bone marrow examination, a serum ferritin level ≤ 100 µg/L was 100% accurate in separating iron-deficient from iron-sufficient patients. None of the other serum iron indicators alone or in combination performed better than ferritin level alone. CONCLUSIONS: In a population of anemic veterans with a wide variety of concomitant medical problems, a serum ferritin level ≤ 100 µg/L was optimal for determining iron deficiency. This is higher than the ferritin level of ≤ 50 µg/L cited in standard textbooks as evidence of iron deficiency in patients with inflammation, infection, or malignancy. Key words iron deficiency anemia feritin total iron-binding capacity transferrin saturation
Received from the University of Wisconsin Department of Medicine, Section of Geriatrics and Gerontology, and the Department of Veterans Affairs Geriatric Research, Education, and Clinical Center, Madison, Wis.
Dr. Carnes is a professor in the Department of Medicine and Director of Women’s Health at the William S. Middleton Veterans Hospital, and Dr. Kis was an internal medicine resident at the University of Wisconsin at the time this work was performed.
This work was supported by the Madison Geriatric Research Education and Clinical Center (GRECC) and the University of Wisconsin Department of Medicine.
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