The transferrin saturation is also an informative measure, calculated as follows: transferrin saturation (%) = serum iron/total iron binding capacity X 100. Iron deficiency is diagnosed by measurement of the following blood tests: serum iron concentration, total iron binding capacity (TIBC, a measurement of the amount of transferrin in the blood), and the serum ferritin. Diagnostic Confirmation: Are you sure your patient has Iron Deficiency? Dermal manifestations may involve cheilosis, spoon nail deformity (koilonychia), and hair loss. In severe iron deficiency, the gastrointestinal tract is particularly susceptible, with the possible development of glossitis, stomatitis, esophageal webs, and chronic gastritis and resultant malabsorption. Tissue iron deficiency may manifest as abnormalities in host immunity, work performance, and neurological function. Iron deficiency is usually identified through the anemia that results from advanced iron deficiency, however, every living cell requires iron, and deficiency has been linked to a spectrum of signs and symptoms, not all of which clearly relate to decreased circulating hemoglobin. Gastrointestinal blood loss, possibly due to gastric or colonic carcinoma or peptic ulcerative disease relating to NSAID use, and malabsorption of dietary iron due to celiac disease are the most important causes to consider and evaluate. Iron deficiency is common, with resultant anemia in 2-5% of adult men and postmenopausal women in the developed world. As such, consideration of occult bleeding should be undertaken in adult men and post menopausal women in whom iron deficiency is discovered. Isolated reduction of serum iron is of dubious significance given the wide variability of serum iron concentrations.There is no active excretory mechanism to remove iron from the body – it is only lost through the shedding of cells via desquamation (dermal, intestinal, and genitourinary) and bleeding. As for non-pregnant individuals, ferritin concentrations in the 30-100 µg/L range could indicate iron deficiency in the presence of co-existing inflammatory disease. However, a ferritin concentration <30 µg/L is still considered diagnostic of iron deficiency at any stage of pregnancy. This reflects transfer of organic iron from mother to fetus, rather than any change in iron metabolism. Serum ferritin concentrations typically fall in the last 4 weeks of normal pregnancy. A raised percentage transferrin saturation in isolation may be the earliest indicator of iron overload. In these cases the ratio of ferritin to soluble transferrin receptors gives better discrimination.Īn elevated ferritin concentration above the method-related upper reference limit may be due to concurrent inflammatory disease, liver disease or iron overload (Hereditary haemochromatosis and Haemosiderosis). Serum ferritin levels of 30-100 µg/L in an anaemic adult may represent iron deficiency if there is coexisting inflammatory disease. Serum ferritin levels of 20-60 µg/L in an anaemic pre-pubescent child may represent iron deficiency if there is coexisting inflammatory disease. Serum ferritin levels ≥30 µg/L up to the method-related upper reference limit demonstrates healthy iron stores as long as co-existing inflammatory disease or hepatocellular damage are not present.Ī serum ferritin level ≤20 µg/L for pre-pubescent children (with or without anaemia) is diagnostic of iron deficiency.Ī serum ferritin level <30 µg/L for an adult is diagnostic of iron deficiency. An alternative approach to the patient with suspected iron deficiency and/or chronic inflammatory disease is to assess the haemoglobin response to iron therapy.
Soluble transferrin receptor levels are not affected in an acute phase response levels are normal in anaemia of chronic disease uncomplicated by iron deficiency. In general, serum ferritin is the preferred test for the assessment of iron deficiency, however levels may be normal (up to 100 µg/L) when iron deficiency coexists with an acute phase response. The assessment of iron deficiency or overload may be complicated by the presence of an acute phase response or hepatocellular disease. Suspected iron deficiency, iron overload, acute iron poisoning (see Iron toxicity). See Ferritin, Soluble transferrin receptor. 5 mL blood in lithium heparin or plain tube.
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