Journal of General Internal Medicine

, Volume 7, Issue 2, pp 145–153 | Cite as

Laboratory diagnosis of iron-deficiency anemia

An overview
  • Gordon H. Guyatt
  • Andrew D. Oxman
  • Mahmoud Ali
  • Andrew Willan
  • William McIlroy
  • Christopher Patterson
Original Articles


Background and methods:To determine the diagnostic values of laboratory tests used in the diagnosis of iron-deficiency anemia, the authors conducted a systematic over-view of the relevant literature. Computerized searches of the MEDLINE database yielded 1,179 potentially relevant citations. Fifty-five studies included the results of laboratory tests and histologic examination of the bone marrow for at least 50% of an identifiable patient group. In these 55 studies, quality was assessed and descriptive information concerning the study populations, the tests conducted, and the results was extracted, all in duplicate.

Results:Serum ferritin radioimmunoassay was by far the most powerful test, with an area under the receiver operating characteristic curve of 0.95. Test properties differed for populations of patients with inflammatory, liver, or neoplastic disease and patients without these conditions. Likelihood ratio lines, which allow precise interpretation of results across the entire range of ferritin concentration values, were constructed for the individual populations.

Conclusion:Serum ferritin radioimmunoassay is an extremely powerful test for the diagnosis of iron-deficiency anemia and, appropriately interpreted, can be applied to the complete range of patients.

Key words

anemia iron deficiency likelihood ratios meta-analysis serum ferritin radioimmunoassay diagnostic tests 


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Copyright information

© Society of General Internal Medicine 1992

Authors and Affiliations

  • Gordon H. Guyatt
    • 1
    • 2
  • Andrew D. Oxman
    • 2
    • 3
  • Mahmoud Ali
    • 1
  • Andrew Willan
    • 2
  • William McIlroy
    • 2
  • Christopher Patterson
    • 1
  1. 1.the Department of Medicine, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  2. 2.the Department of Clinical Epidemiology and Biostatistics, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  3. 3.the Department of Family Medicine, Faculty of Health SciencesMcMaster UniversityHamiltonCanada

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