Journal of General Internal Medicine

, Volume 13, Issue 7, pp 455–461

Detecting iron deficiency in anemic patients with concomitant medical problems

  • Anne M. Kis
  • Molly Carnes
Original Articles

DOI: 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 deficiencyanemiaferitintotal iron-binding capacitytransferrin saturation

Copyright information

© Society of General Internal Medicine 1998

Authors and Affiliations

  • Anne M. Kis
  • Molly Carnes
    • 1
  1. 1.GRECC (11G)William S. Middleton Veterans HospitalMadison