Guideline for the laboratory diagnosis of iron deficiency in adults (excluding pregnancy) and children

Abstract

This Good Practice Paper was compiled according to the British Society for Haematology (BSH) process at: https://b-s-h. org.uk/media/16732/bsh-guidance-development-process-dec-5-18.pdf. The BSH produces 'Good Practice Papers' to recommend good practice in areas where there is a limited evidence base but for which a degree of consensus or uniformity is likely to be beneficial to patient care. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org. Literature review detailsUp to June 2020 MEDLINE and PUBMED were searched systematically for publications in English from 1966 to 2020, with additional ad hoc searches up to June 2021 for any new evidence using key words: iron deficiency, anaemia and each of the parameters discussed. Review of the manuscriptReview of the manuscript was performed by the BSH Guidelines Committee General Haematology Task Force, the BSH Guidelines Committee and the General Haematology sounding board of the BSH. It was made available on the members' section of the BSH website for comment.

Daily versus every other day oral iron supplementation in patients with iron deficiency anemia (DEODO): study protocol for a phase 3 multicentered, pragmatic, open-label, pilot randomized controlled trial

“…The authors will define anemia using hemoglobin thresholds that consider physiological differences in sex in a future definitive RCT. In addition, other indices of iron deficiency such as the reticulocyte hemoglobin will be considered in the future [ 48 ].…”

Laboratory diagnosis of iron deficiency: look out for the ‘PITTs’

“…What about thalassaemia trait? The authors of the current BSH guidelines acknowledge that thalassaemia trait is a confounder, stating ‘in the absence of a thalassaemia mean corpuscular volume (MCV)’, values below the normal range require further investigation 1 . In actual practice, there is no clear MCV that is diagnostic of thalassaemia trait, whether alpha or beta subtype.…”

“…In the current age of increasing intricacy of medical diagnosis, for instance using molecular methods, the diagnosis of the simple condition of iron deficiency can be very challenging. It is therefore very commendable that the British Society of Haematology (BSH) has published a set of guidelines to aid in the diagnosis of this highly prevalent condition 1 . The reasons that diagnosing iron deficiency is problematic are multiple, including: (i) iron deficiency is a continuum of states ranging from asymptomatic absent iron stores to overt iron deficiency anaemia 2 ; (ii) there is no pathognomonic test for iron deficiency 1 ; (iii) iron deficiency frequently co‐exists with other conditions that obscure its diagnosis, which can be remembered by the acronym ‘PITTs’ (Pregnancy, Inflammation, and Thalassaemia Trait).…”

“…It is therefore very commendable that the British Society of Haematology (BSH) has published a set of guidelines to aid in the diagnosis of this highly prevalent condition 1 . The reasons that diagnosing iron deficiency is problematic are multiple, including: (i) iron deficiency is a continuum of states ranging from asymptomatic absent iron stores to overt iron deficiency anaemia 2 ; (ii) there is no pathognomonic test for iron deficiency 1 ; (iii) iron deficiency frequently co‐exists with other conditions that obscure its diagnosis, which can be remembered by the acronym ‘PITTs’ (Pregnancy, Inflammation, and Thalassaemia Trait). The authors of these BSH guidelines start out by excluding pregnancy, which is itself a dynamic condition with increasing demands for iron during the entire duration of gestation 3 .…”

“…The authors of the current BSH guidelines acknowledge that thalassaemia trait is a confounder, stating 'in the absence of a thalassaemia mean corpuscular volume (MCV)', values below the normal range require further investigation. 1 In actual practice, there is no clear MCV that is diagnostic of thalassaemia trait, whether alpha or beta subtype. Alpha thalassaemia trait most commonly results (worldwide) from deletion of one or two of the normal complement of four alpha globin genes, although nondeletional forms exist as well.…”