Annals of Hematology

, Volume 84, Issue 6, pp 358–361 | Cite as

The cutoff value of serum ferritin for the diagnosis of iron deficiency in community-residing older persons

  • Chul Won Choi
  • Woo Ri Cho
  • Kyong Hwa Park
  • In Keun Choi
  • Jae Hong Seo
  • Byung Soo Kim
  • Sang Won Shin
  • Yeul Hong Kim
  • Jun Suk Kim
  • Juneyoung Lee
Original Article

Abstract

The serum ferritin assay is the best single blood test for the diagnosis of iron deficiency. Previous studies with elderly anemic patients have suggested that ferritin level less than 45 μg/L is indicative of iron deficiency. The subjects of these studies were hospitalized patients with anemia, however. We thus conducted a prospective study to determine the normal minimum level of serum ferritin of community-dwelling older adults by assessing the ratio of serum transferrin receptor to the log ferritin level (sTfR-F index). We conducted the anemia survey between October and November 2002. A total of 1,254 apparently healthy older adults, aged between 60 and 95 years, from three urban community dwellings participated in the survey. Among these individuals, 156 subjects who were anemic or whose serum ferritin level was less than 100 μg/L were selected. The soluble transferrin receptor assay was performed and the sTfR-F index was calculated. The receiver operating characteristic curve analysis was performed. Based on the data, serum ferritin level of 22 μg/L was selected as the cutoff value for the diagnosis of iron deficiency in community-dwelling older adults. Applying the serum ferritin cutoff of 22 μg/L and the sTfR-F index cutoff of 1.5, the sensitivity of the assay was 89.5% (34 of 38) and the specificity was 89.0% (105 of 118). In conclusion, for the diagnosis of iron deficiency of community-residing older adults, we suggest the serum ferritin cutoff value of 22 μg/L obtained by use of the sTfR-F index. The value is lower than the previous value established for hospitalized and anemic older adults.

Keywords

Iron Aged Ferritin Transferrin receptor 

References

  1. 1.
    Andrews NC (2003) Disorders of iron metabolism. In: Handin RI, Lux SE, Stossel TP (eds) Blood principles and practice of hematology, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, pp 1410–1412Google Scholar
  2. 2.
    Ania BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton LJ III (1997) Incidence of anemia in older people: an epidemiologic study in a well-defined population. J Am Geriatr Soc 45:825–831Google Scholar
  3. 3.
    Balducci L (2003) Epidemiology of anemia in the elderly: information on diagnostic evaluation. J Am Geriatr Soc 51:S2–S9Google Scholar
  4. 4.
    Casale G, Bonora C, Migliavacca A, Zurita IE, de Nicola P (1981) Serum ferritin and aging. Age Ageing 10:119–122Google Scholar
  5. 5.
    Cermak J, Brabec V (1998) Transferrin receptor–ferritin ratio: a useful parameter in differential diagnosis of iron deficiency and hyperplastic erythropoiesis [letter]. Eur J Haematol 61:210–212Google Scholar
  6. 6.
    Fletcher RH, Fletcher SW, Wagner EH (1996) Clinical epidemiology: the essentials. Williams and Wilkins, BaltimoreGoogle Scholar
  7. 7.
    Flowers CH, Skikne BS, Covell AM, Cook JD (1989) The clinical measurement of transferrin receptor. J Lab Clin Med 114:368–377Google Scholar
  8. 8.
    Guyatt GH, Patterson C, Ali M, Singer J, Levine M, Turpie I, Meyer R (1990) Diagnosis of iron-deficiency anemia in the elderly. Am J Med 88:205–209Google Scholar
  9. 9.
    Holyoake TL, Stott DJ, McKay PJ, Hendry A, MacDonald JB, Lucie NP (1993) Use of plasma ferritin concentration to diagnose iron deficiency in elderly patients. J Clin Pathol 46:857–860Google Scholar
  10. 10.
    Huebers HA, Finch CA (1987) The physiology of transferrin and transferrin receptors. Physiol Rev 67:520–582Google Scholar
  11. 11.
    Jacobs A, Worwood M (1975) Ferritin in serum. Clinical and biochemical implications. N Engl J Med 292:951–956Google Scholar
  12. 12.
    Joosten E, Pelemans W, Hiele M, Noyen J, Verhaeghe R, Boogaerts MA (1992) Prevalence and causes of anaemia in a geriatric hospitalized population. Gerontology 38:111–117Google Scholar
  13. 13.
    Kohgo Y, Niitsu Y, Kondo H, Kato J, Tsushima N, Sasaki K, Hirayama M, Numata T, Nishisato T, Urushizaki I (1987) Serum transferrin receptor as a new index of erythropoiesis. Blood 70:1955–1958Google Scholar
  14. 14.
    Krause JR, Stolc V (1980) Serum ferritin and bone marrow biopsy iron stores, II: correlation with low serum iron and Fe/TIBC ratio less than 15%. Am J Clin Pathol 74:461–464Google Scholar
  15. 15.
    Lipschitz DA, Cook JD, Finch CA (1974) A clinical evaluation of serum ferritin as an index of iron stores. N Engl J Med 290:1213–1216Google Scholar
  16. 16.
    Loria A, Hershko C, Konijin AM (1979) Serum ferritin in an elderly population. J Gerontol 34:521–524Google Scholar
  17. 17.
    Means RT Jr, Allen J, Sears DA, Schuster SJ (1999) Serum soluble transferrin receptor and the prediction of marrow aspirate iron results in a heterogeneous group of patients. Clin Lab Haem 21:161–167Google Scholar
  18. 18.
    Patterson C, Turpie ID, Benger AM (1985) Assessment of iron stores in anemic geriatric patients. J Am Geriatr Soc 33:746–767Google Scholar
  19. 19.
    Punnonen K, Irjala K, Rajamaki A (1997) Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89:1052–1057Google Scholar
  20. 20.
    Rimon E, Levy S, Sapir A, Gelzer G, Peled R, Ergas D, Sthoeger ZM (2002) Diagnosis of iron deficiency anemia in the elderly by transferrin receptor–ferritin index. Arch Intern Med 162:445–449Google Scholar
  21. 21.
    Skikne BS, Flowers CH, Cook JD (1990) Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood 75:1870–1876Google Scholar
  22. 22.
    Suominen P, Punnonen K, Rajamaki A, Irjala K (1998) Serum transferrin receptor and transferrin receptor–ferritin index identify healthy subjects with subclinical iron deficits. Blood 92:2934–2939Google Scholar
  23. 23.
    Witte DL (1991) Can serum ferritin be effectively interpreted in the presence of the acute-phase response? Clin Chem 37:484–485Google Scholar
  24. 24.
    Zacharski LR, Ornstein DL, Woloshin S, Schwartz LM (2000) Association of age, sex, and race with body iron stores in adults: analysis of NHANES III data. Am Heart J 140:98–104Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Chul Won Choi
    • 1
  • Woo Ri Cho
    • 1
  • Kyong Hwa Park
    • 1
  • In Keun Choi
    • 1
  • Jae Hong Seo
    • 1
  • Byung Soo Kim
    • 1
  • Sang Won Shin
    • 1
  • Yeul Hong Kim
    • 1
  • Jun Suk Kim
    • 1
  • Juneyoung Lee
    • 2
  1. 1.Division of Oncology–Hematology, Department of Internal MedicineKorea University Medical CenterSeoulSouth Korea
  2. 2.Department of Preventive MedicineCollege of Medicine, Korea UniversitySeoulSouth Korea

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