Document Detail

The transferrin/log(ferritin) ratio: a new tool for the diagnosis of iron deficiency anemia.
MedLine Citation:
PMID:  22868798     Owner:  NLM     Status:  MEDLINE    
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.
Rob Castel; Martine G H M Tax; Jolanda Droogendijk; Math P G Leers; Ruud Beukers; Mark-David Levin; Pieter Sonneveld; Paul B Berendes
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Publication Detail:
Type:  Journal Article     Date:  2012-02-11
Journal Detail:
Title:  Clinical chemistry and laboratory medicine : CCLM / FESCC     Volume:  50     ISSN:  1434-6621     ISO Abbreviation:  Clin. Chem. Lab. Med.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-07     Completed Date:  2013-03-14     Revised Date:  2013-06-18    
Medline Journal Info:
Nlm Unique ID:  9806306     Medline TA:  Clin Chem Lab Med     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1343-9     Citation Subset:  IM    
Department of Clinical Chemistry and Hematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
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MeSH Terms
Anemia, Iron-Deficiency / blood,  diagnosis*
Ferritins / analysis,  blood*
Hemoglobins / metabolism
Iron / blood,  deficiency
Middle Aged
Reproducibility of Results
Transferrin / analysis,  metabolism*
Young Adult
Reg. No./Substance:
0/Hemoglobins; 0/Transferrin; 7439-89-6/Iron; 9007-73-2/Ferritins
Comment In:
Clin Chem Lab Med. 2013 May;51(5):e85-6   [PMID:  23152417 ]
Clin Chem Lab Med. 2013 May;51(5):e87-8   [PMID:  23454714 ]

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