Guideline for the laboratory diagnosis of functional iron deficiency

Thomas, Dafydd; Hinchliffe, R F; Briggs, Carol; Macdougall, Iain C.; Littlewood, Tim; Cavill, I.

doi:10.1111/bjh.12311

Cited by 311 publications

(311 citation statements)

References 68 publications

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“…It is perhaps unsurprising that those with a lower initial haemoglobin mount the most significant response to iron; this is in keeping with previous findings [23] that responders to oral iron therapy had a lower baseline haemoglobin (91 vs 98 g/L). Additionally, these patients tended to be younger and had a lower Body Mass Index (BMI) (27.9 vs 31.1kg/m 2 ).…”

Section: Discussionsupporting

confidence: 85%

Targeting, Monitoring and Effect of Oral Iron Therapy on Haemoglobin Levels in Older Patients Discharged to Primary Care from Inpatient Rehabilitation: A Cohort Study Using Routinely Collected Data

2016

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Targeting, monitoring and effect of oral iron therapy on haemoglobin levels in older patients discharged to primary care from inpatient rehabilitation Thomson, Zach; Hands, Katherine J.; Witham, Miles , & Witham, M. (2016). Targeting, monitoring and effect of oral iron therapy on haemoglobin levels in older patients discharged to primary care from inpatient rehabilitation: a cohort study using routinely collected data. Drugs & Aging, 33(8), 603-610. DOI: 10.1007/s40266-016-0385-y General rightsCopyright and moral rights for the publications made accessible in Discovery Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from Discovery Research Portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain.• You may freely distribute the URL identifying the publication in the public portal. Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract BackgroundOral iron is commonly prescribed to older patients with suspected or confirmed iron deficiency anaemia, however few studies have examined the effectiveness of oral iron therapy in the real world in this population. We therefore determined the prevalence of iron deficiency in older people prescribed oral iron, examined the response mounted to therapy and ascertained predictors of response to oral iron. MethodsWe analysed a routinely collected, linked dataset from older patients who had undergone inpatient rehabilitation between 1999 and 2011. An initial analysis examined patients within this cohort who were prescribed iron after rehabilitation and derived three groups based upon their ferritin and transferrin indices; probably, possibly and not iron deficient. A second analysis compared pre-and post-treatment haemoglobin to determine the degree of response to iron therapy across each category of deficiency. Finally, patient demographics, linked biochemistry data and comorbid disease based on International Statistical Classification of Disease (ICD-10) codes from previous hospital admissions were used in regression modelling to evaluate factors affecting response to therapy. Results490 patients were prescribed oral iron within 90 days of rehabilitation discharge. 413/490 (84%) had iron indices performed; 94 (23%) were possibly deficient, 224 (54%) were probably deficient, and 95 (23%) were not deficient. 360/490 patients had both pre and post treatment haemoglobin data and iron indices; probably deficient patients mounted a slightly greater response to oral iron (17g/L vs 12g/L for not deficient; p<0.05). Only pre-treatment haemoglobin, mean cell volume (MCV) and lower gastrointestinal pathology were significant predictors ...

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Section: Discussionsupporting

confidence: 85%

Targeting, Monitoring and Effect of Oral Iron Therapy on Haemoglobin Levels in Older Patients Discharged to Primary Care from Inpatient Rehabilitation: A Cohort Study Using Routinely Collected Data

2016

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“…3,4 According to the literature, it only takes hours for human serum iron concentrations to decrease in the presence of an acute phase response. 5 Increased erythropoiesis, for instance following acute bleeding or external erythropoietin administration, can cause rapid changes in serum iron concentrations as well. 6 The total iron-binding capacity (TIBC) indirectly reflects the total serum transferrin concentration.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of reticulocyte hemoglobin content (RET‐He) in the diagnosis of iron‐deficient erythropoiesis in dogs

Fuchs

Moritz

Grußendorf³

et al. 2017

Veterinary Clinical Pathol

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Abstract:Background: Reticulocyte hemoglobin content provided by the Siemens ADVIA (CHr) is an established marker of iron deficiency. The IDEXX ProCyte Dx hematology analyzer now provides a similar variable, reticulocyte hemoglobin equivalent (RET-He). Objectives: The objective was to evaluate RET-He and its diagnostic utility in dogs, and to calculate a cutoff value for diagnosing iron-deficient erythropoiesis (IDE). Furthermore, the prevalence of RET-He values below this cutoff value was established. Methods: One hundred and seventy-one CBCs of healthy dogs were used to establish a RI. Stability of RET-He was evaluated by repeated measurements over 48 hours (n = 10). The 25-run coefficient of variation (CV) was calculated, and correlation and bias between measurements of RET-He and CHr were assessed (n = 190). A cutoff value for diagnosing IDE was calculated. The utility of RET-He in the detection of IDE was evaluated in 123 dogs. The prevalence of low RET-He values was assessed retrospectively in a multicenter study (2012)(2013)(2014) under participation of 7 veterinary clinics. Results: Reticulocyte hemoglobin equivalent with an RI of 22.2 to 28.6 pg was statistically stable over 48 hours (P = .10). The CV was 1.8%. A fair correlation (q = 0.74) between RET-He and CHr with a small bias of À0.6 pg was found. The cutoff value for diagnosing IDE was 20.9 pg (sensitivity: 85%; specificity: 99%).

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“…There are current guidelines on identifying FID [8] but no consensus on diagnosing or treating FID. A large study of 1528 patients with stage I-IV cancer found FID to comprise 81.9% of those with any sign of iron deficiency combined with haemoglobin ≤120g/l [2].…”

Section: Introductionmentioning

confidence: 99%

Estimating prevalence of functional iron deficiency anaemia in advanced cancer

Neoh

Stanworth

Pasricha

et al. 2016

Support Care Cancer

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PurposeAnaemia is a common complication of cancer causing symptoms including fatigue. It is also associated with shorter survival. Cancer causes systemic inflammation which interrupts iron metabolism leading to a functional iron deficiency (FID). There are few data on prevalence or aetiology of anaemia in those with advanced cancer. We aimed to establish the prevalence of anaemia and estimate extent of FID anaemia in patients with advanced cancer. MethodsAll patients with advanced cancer referred to two UK specialist palliative care services over one year were identified. Demographic and clinical data were linked with routinely collected haematological and biochemical profiles. We assessed the numbers of patients with abnormal values for haemoglobin, %hypochromic red cells (>5% indicates iron restricted erythropoiesis) and CRP (>10 indicates systemic inflammation). We judged that FID anaemia was likely when patients had all three abnormalities and ferritin 30-800ng/ml. Results 1797/2416 patients had a cancer diagnosis and laboratory data available. Mean haemoglobin was 116g/L. 63% of patients were anaemic; mild 25%, moderate 35% and severe 3%. Women had significantly higher mean haemoglobin than men and there was wide variation in anaemia prevalence across tumour sites. Thirty nine percent of patients' who had all four parameters checked met our criteria for FID anaemia. There were significant relationships between haemoglobin, %hypochromic red cells and CRP (p=0.0001). ConclusionsAnaemia was common in this population and we estimate this was caused by FID in 66% of anaemic patients. Further research is needed to validate our diagnostic criteria before this approach can be used in clinical practice.

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Guideline for the laboratory diagnosis of functional iron deficiency

Cited by 311 publications

References 68 publications

Targeting, Monitoring and Effect of Oral Iron Therapy on Haemoglobin Levels in Older Patients Discharged to Primary Care from Inpatient Rehabilitation: A Cohort Study Using Routinely Collected Data

Targeting, Monitoring and Effect of Oral Iron Therapy on Haemoglobin Levels in Older Patients Discharged to Primary Care from Inpatient Rehabilitation: A Cohort Study Using Routinely Collected Data

Evaluation of reticulocyte hemoglobin content (RET‐He) in the diagnosis of iron‐deficient erythropoiesis in dogs

Estimating prevalence of functional iron deficiency anaemia in advanced cancer

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