The American Journal of Digestive Diseases

, Volume 23, Issue 8, pp 705–709 | Cite as

Iron deficiency in inflammatory bowel disease

Diagnostic efficacy of serum ferritin
  • A. B. R. Thomson
  • R. Brust
  • M. A. M. Ali
  • M. J. Mant
  • L. S. Valberg
Original Articles


The prevalence of iron-deficiency anemia was defined in 105 patients with inflammatory bowel disease and an appraisal made of the diagnostic value of serum ferritin for the assessment of iron stores. Iron deficiency, defined by the absence of bone-marrow hemosiderin was found with anemia in 36% of 41 patients with ulcerative colitis (UC) and 22% of 64 patients with Crohn's disease (CD). Iron deficiency without impaired erythropoiesis was detected in an additional 32% of patients with UC and 2% with CD. Anemia with plentiful bone-marrow iron was present in 33 (51%) of patients with CD, only one of whom had vitamin B12 deficiency. Red blood cell morphology, RBC indices, serum iron, and percent transferrin saturation correlated poorly with stainable marrow iron. Serum ferritin, assayed in samples from 45 patients, was <18 ng/ml in 4/12 with iron-deficiency anemia and 0/5 with absent marrow iron and a normal hemoglobin level; values >55 ng/ml were invariably associated with the presence of marrow hemosiderin. Based on a lower normal limit of 18 ng/ml, the serum ferritin had an excellent predictive value (100%) but a high predictive error (32%) in the diagnosis of iron deficiency in inflammatory bowel disease. Serum ferritin >55 ng/ml ruled out iron deficiency as the basis for anemia.


Inflammatory Bowel Disease Ulcerative Colitis Iron Deficiency Serum Ferritin Transferrin Saturation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Hoffbrand AV, Stewart JS, Booth CC, Mollin DL: Folate deficiency in Crohn's disease: Incidence, pathogenesis, and treatment. Br Med J 2:71–75, 1968Google Scholar
  2. 2.
    Dyer NH, Child JA, Mollin DL, Dawson AM: Anaemia in Crohn's disease. Q J Med 41:419–436, 1972Google Scholar
  3. 3.
    Child JA, Brozovic B, Dyer NH, Mollin DL, Dawson AM: The diagnosis of iron deficiency in patients with Crohn's disease. Gut 14:642–648, 1973Google Scholar
  4. 4.
    Barr M, Delava S, Zetterstrom R: Studies of the anaemia in ulcerative colitis with special reference to the iron metabolism. Acta Paediatr 44:62–72, 1975Google Scholar
  5. 5.
    Beal RW, Skyring AP, McRae J, Firkin BG: The anaemia of ulcerative colitis. Gastroenterology 45:589–603, 1963Google Scholar
  6. 6.
    Edwards FC, Truelove SC: The course and prognosis of ulcerative colitis. Gut 5:1–15, 1964Google Scholar
  7. 7.
    Ormerod TP: Measurement of fecal bleeding in active chronic ulcerative colitis. Am J Dig Dis 12:1095–1101, 1967Google Scholar
  8. 8.
    Ormerod TP: Observations on the incidence and cause of anaemia in ulcerative colitis. Gut 8:107–114, 1967Google Scholar
  9. 9.
    Ormerod TP: Radio-iron (59 Fe) studies in acute ulcerative colitis. Scand J Gastroenterol 3:189–192, 1967Google Scholar
  10. 10.
    Ormerod TP: Anaemia in ulcerative colitis. Proc R Soc Med 61:931, 1968Google Scholar
  11. 11.
    Bothwell TH: The diagnosis of iron deficiency. NZ Med J 65:880–883, 1966Google Scholar
  12. 12.
    Scott DE, Pritchard JA: Iron deficiency in healthy young college women. JAMA 199:897–900, 1967Google Scholar
  13. 13.
    Walters GO, Miller FM, Worwood M: Serum ferritin concentrations and iron stores in normal subjects. J Clin Pathol 26:770–772, 1973Google Scholar
  14. 14.
    Cook JD, Lipshitz DA, Miles LEM, Finch CA: Serum ferritin as a measure of iron stores in normal subjects. Am J Clin Nutr 27:681–687, 1974Google Scholar
  15. 15.
    Lipschitz DA, Cook JD, Finch CA: A clinical evaluation of serum ferritin as an index of iron stores. N Engl J Med 290:1213–1216, 1974Google Scholar
  16. 16.
    Jacobs A, Worwood M: Ferritin in serum: Clinical and biochemical implications. N Engl J Med 292:951–956, 1975Google Scholar
  17. 17.
    Valberg LS, Sorbie J, Ludwig J, Pelletier D: Serum ferritin and the iron status of Canadians. Can Med Assoc J 114:417–421, 1976Google Scholar
  18. 18.
    Jacobs A, Slater A, Whittaker JA, Canellas G, Wiernik PH: Serum ferritin concentration in untreated Hodgkin's disease. Br J Cancer 34:162–166, 1976Google Scholar
  19. 19.
    Bentley DP, Williams P: Serum ferritin concentration as an index of storage iron in rheumatoid arthritis. J Clin Pathol 27:786–788, 1974Google Scholar
  20. 20.
    Lennard-Jones JE, Lockhart-Mummay HE, Morson BC: Clinical and pathological differentiation of Crohn's disease and proctocolitis. Gastroenterology 54:1162–1170, 1968Google Scholar
  21. 21.
    Zak B, Epstein E: Automated determination of serum iron. Clin Chem 11:641–644, 1965Google Scholar
  22. 22.
    Baker H, Herbert V, Frank O, Fasher I, Hutner SH, Wasserman LR, Sobotka H: A microbiologic method for detecting folic acid deficiency in man. Clin Chem 5:275–280, 1959Google Scholar
  23. 23.
    Ross GIM: Vitamin B12 assay in body fluids usingEuglenia gracilis. J Clin Pathol 5:250–256, 1952Google Scholar
  24. 24.
    Luxton AW, Walker WHC, Gauldie J, Ali MAM, Pelletier, C: A radioimmunoassay for serum ferritin. Clin Chem 23:683–689, 1977Google Scholar
  25. 25.
    Best WR, Becktel JM, Singleton JW, Kern F: Development of a Crohn's disease activity index. Gastroenterology 70:439–444, 1976Google Scholar
  26. 26.
    Gambino SR, Galen RS: Beyond Normality. The Predictive Value and Efficiency of Medical Diagnoses, Chapter 5. New York, WileyGoogle Scholar
  27. 27.
    Jones PAE, Miller FM, Worwood M, Jacobs A: Ferritin-anaemia in leukaemia and Hodgkin's disease. Br J Cancer 27:212–217, 1973Google Scholar
  28. 28.
    Whorwell PJ, Baldwin RC, Wright R: Ferritin in Crohn's disease tissue: Detection by electron microscopy. Gut 17:696–699, 1976Google Scholar

Copyright information

© Digestive Disease Systems, Inc. 1978

Authors and Affiliations

  • A. B. R. Thomson
    • 1
    • 2
    • 3
  • R. Brust
    • 1
    • 2
    • 3
  • M. A. M. Ali
    • 1
    • 2
    • 3
  • M. J. Mant
    • 1
    • 2
    • 3
  • L. S. Valberg
    • 1
    • 2
    • 3
  1. 1.Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.McMaster UniversityHamilton
  3. 3.University of Western OntarioLondon

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