Ability of serum ferritin to diagnose iron deficiency anemia in an elderly cohort

Abstract

BackgroundDiagnosis and treatment of iron deficiency anemia in older subjects improves their quality of life. Serum ferritin as a marker of iron stores is an acute phase protein. In older subjects who usually have many concomitant chronic medical conditions, serum ferritin may increase in response to inflammatory processes irrespective of iron stores. This study was performed to determine the diagnostic properties of serum ferritin in the diagnosis of iron deficiency anemia in older subjects.MethodsThis case–control study included all the inhabitants of Amirkola town who participated in the Amirkola Health and Aging Project. Diagnosis of anemia was confirmed based on a hemoglobin level <13 g/dL in men and <12 g/dL in women and iron deficiency anemia by percent transferrin saturation <15%. A receiver operating characteristic curve was constructed to determine an optimal serum ferritin cutoff value to differentiate patients with and without iron deficiency anemia at the highest sensitivity and specificity.ResultsEighty patients with iron deficiency anemia and 160 cases of anemia without iron deficiency (mean age: 72.9 ± 8 and 71.6 ± 7.6 years, respectively; p-value = 0.37) were analyzed. In iron deficiency anemia, the mean serum ferritin was significantly lower (p-value = 0.036) compared to patients without iron deficiency anemia. Serum ferritin with a cutoff level of 100 ng/mL differentiated patients with and without iron deficiency anemia with a sensitivity of 60% and specificity of 59% and area under the receiver operating characteristic curve of 0.615 ± 0.040 (95% confidence interval: 0.536–0.694; p-value = 0.004).ConclusionThese findings indicate that in elderly subjects, iron deficiency anemia may develop with higher levels of serum ferritin. Hence, the conventional cutoff of serum ferritin for the diagnosis of iron deficiency anemia in young adults is not appropriate for the elderly population.

Iron status in the elderly: A review of recent evidence

“…ID was responsible for approximately 4% of anemias for women as well as for men (Contreras-Manzano, Cruz and Villalpando, 2015). Similar to the Austrian study (Bach et al, 2014), the incidence of ID increased with age and reached 7% for men and women above 80 years. The authors concluded that the main reason for anemia in this group of elderly was not ID but kidney failure.…”

“…A Brazilian group (Bosco et al, 2013) reported that anemia was present in 30% of their hospitalised patients (n=709, aged 60 years and over). In an Austrian hospital cohort of 19,758 patients aged 64-104 years, 24% of men and 19% of women were anemic (Bach et al, 2014). A significant increase in the incidence of anemia was observed with age, reaching 31% and 38% for over 80 and over 90 years respectively.…”

“…The main reasons for anemia in this study were identified as: mild, moderate and severe kidney failure (56% of anemic patients), absolute and functional iron deficiency in 14% and 28% respectively, folate and B12 deficiency in 7% and 2% respectively. Macrocytic anemia was diagnosed in 16% of participants and could not be explained by vitamin B12 or folate insufficiency (Bach et al, 2014). Further, C-reactive protein (CRP) was negatively correlated with Hb.…”

“…Babaei et al (Babaei et al, 2017) investigated the use of ferritin to differentiate between participants with and without iron deficiency anemia (WHO cut-offs). IDA was diagnosed when transferrin saturation <15%.…”

Pre and Post Iron Therapy Absolute Reticulocyte Count- A Reliable Test With Early Response to Treatment in Iron Deficiency Anaemia

“…people with coexisting morbidities revealed that IDA can develop even with normal or higher Serum Ferritin. (21) Therefore, even though serum ferritin can consistently predict the response to iron therapy, it may not be valid in the presence of underlying inflammation, whereas ARC is not affected by the same. Van Santen et al (22) conducted a study to predict response to oral iron therapy in patients with chronic inflammation.…”