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The transferrin/log(ferritin) ratio: a new tool for the diagnosis of iron deficiency anemia

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Published/Copyright: February 11, 2012
Clinical Chemistry and Laboratory Medicine
From the journal Clinical Chemistry and Laboratory Medicine Volume 50 Issue 8

Abstract

Background: Serum ferritin is the best single laboratory test to diagnose iron deficiency anemia (IDA). Ferritin levels <20 μg/L are highly specific for IDA, and ferritin levels >100 μg/L usually exclude IDA. However, ferritin concentrations between 20 and 100 μg/L are often inconclusive. The objective of this study was to improve the diagnosis of IDA when ferritin levels are inconclusive.

Methods: We evaluated the predictive performance of classic (ferritin, mean corpuscular volume, transferrin and serum iron) and modern [reticulocyte hemoglobin content, serum transferrin receptor and soluble transferrin receptor (sTfR)/log(ferr)] iron status parameters to diagnose IDA in 2084 anemic, non-hospitalized patients. The results were validated in an independent cohort of 274 anemic patients.

Results: In our study population, 29% (595 patients) of the patients had a ferritin level between 20 and 100 μg/L, hampering diagnosis of IDA. None of the classic or modern parameters was capable of completely separating the IDA population from the non-IDA population. However, using a new parameter, the transferrin/log(ferritin) ratio, the IDA and non-IDA populations can be completely separated. At a cut-off value of 1.70, the transferrin/log(ferritin) ratio indicates IDA in 29% of the patients with inconclusive ferritin levels.

Conclusions: The transferrin/log(ferritin) ratio is a practical new tool that improves diagnosis of iron deficiency when ferritin levels are inconclusive.

Keywords: anemia analysis; iron deficiency anemia; iron status parameters
Corresponding author: Rob Castel, Department of Clinical Chemistry, Room F-3127, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands Phone: +31-786523548, Fax: +31-786523156
Received: 2011-8-30
Accepted: 2012-1-15
Published Online: 2012-02-11
Published in Print: 2012-08-01

©2012 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/cclm-2011-0594
Keywords for this article
anemia analysis; iron deficiency anemia; iron status parameters

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Editorial
  4. EDTA-dependent pseudothrombocytopenia: further insights and recommendations for prevention of a clinically threatening artifact
  5. Reviews
  6. Mitochondria as sources and targets of damage in cellular aging
  7. Application of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in Alzheimer’s disease
  8. Opinion Papers
  9. The intellectual contribution of laboratory medicine professionals to research papers on laboratory medicine topics published in high-impact general medicine journals
  10. Laboratory medicine and sports: between Scylla and Charybdis
  11. Guidelines and Recommendations
  12. The EC4 European Syllabus for Post-Graduate Training in Clinical Chemistry and Laboratory Medicine: version 4 – 2012
  13. Genetics And Molecular Diagnostics
  14. Assessing the utility of whole genome amplified DNA as a template for DMET Plus array
  15. General Clinical Chemistry And Laboratory Medicine
  16. Effect of acceleration forces during transport through a pneumatic tube system on ROTEM® analysis
  17. The transferrin/log(ferritin) ratio: a new tool for the diagnosis of iron deficiency anemia
  18. Instructions on laboratory monitoring in 200 drug labels
  19. Lipid peroxidation markers in Crohn’s disease: the associations and diagnostic value
  20. Impact of asthmatic control status on serum cystatin C concentrations
  21. Elevated levels of Nɛ-homocysteinyl-lysine isopeptide in patients on long-term hemodialysis
  22. Interleukin-1α gene variants influence bone mineral density and the risk of osteoporotic hip fractures in elderly Slovenian people
  23. Novel method to dissociate platelet clumps in EDTA-dependent pseudothrombocytopenia based on the pathophysiological mechanism
  24. Proficiency testing/external quality assurance for the PFA-100®
  25. Interference of selected flavonoid aglycons in platelet aggregation assays
  26. Infectious Diseases
  27. Monocyte chemoattractant protein-1 and paraoxonase-1 and 3 levels in patients with sepsis treated in an intensive care unit: a preliminary report
  28. Association between ischemia-modified albumin, homocysteine, vitamin B12 and folic acid in patients with severe sepsis
  29. Evidence for serum miR-15a and miR-16 levels as biomarkers that distinguish sepsis from systemic inflammatory response syndrome in human subjects
  30. The predictive value of immature granulocyte count and immature myeloid information in the diagnosis of neonatal sepsis
  31. Hypophosphatemia, fever and prolonged length of hospital stay in seronegative PCR positive patients as compared to seropositive patients with early acute Q fever pneumonia
  32. Cancer Diagnostics
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