Predicting Bone Marrow Iron Stores in Anemic Patients in a Community Hospital Using Ferritin and Erythrocyte Sedimentation Rate

Witte, David L.; Angstadt, Debbie S.; Davis, Sue H.; Schrantz, Robert D.

doi:10.1093/ajcp/90.1.85

Cited by 31 publications

(17 citation statements)

References 7 publications

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“…[28][29][30][31][32]36,37 Six of these included assessment of bone marrow iron. [28][29][30][31][32]36 Five of these studies were in hospitalized patients, and one appears to have included both inpatients and outpatients. 28 Sensitivity and specificity of serum ferritin level was provided or could be calculated from the data provided in five of these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Our study also included both inpatients and outpatients, and our subjects were almost entirely male. Witte et al attempted to adjust the serum ferritin level cutoff for iron deficiency according to the erythrocyte sedimentation rate in 43 hospitalized patients, 36 but subsequent studies found this prediction model invalid. 26,27 Transferrin saturation Յ20% was more sensitive (76.5%-92.9%) for iron deficiency in three studies that investigated this parameter in unselected hospitalized patients, [29][30][31] compared with our study, which found a transferrin saturation of Յ20% to be only 60.5% sensitive.…”

Section: Discussionmentioning

confidence: 99%

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Detecting iron deficiency in anemic patients with concomitant medical problems

Kis

Carnes

1998

J Gen Intern Med

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OBJECTIVE:To determine the sensitivity and specificity of mean corpuscular volume, transferrin saturation, total ironbinding capacity, and ferritin level in determining iron deficiency in a population of anemic veterans with a wide variety of general medical diagnoses. DESIGN: MEASUREMENTS AND MAIN RESULTS:Using the presence or absence of bone marrow hemosiderin as the reference standard, the sensitivity and specificity of the following serum iron indicators were calculated: mean corpuscular volume, transferrin saturation, total iron-binding capacity, and ferritin level. Of these patients, 41 (40.6%) were categorized as iron deficient, with no stainable bone marrow hemosiderin. A serum ferritin level Յ 100 g/L provided the best sensitivity (64.9%) and specificity (96.1%) for evaluating iron stores in this patient population. When performed within 24 hours of bone marrow examination, a serum ferritin level Յ 100 g/L was 100% accurate in separating iron-deficient from iron-sufficient patients. None of the other serum iron indicators alone or in combination performed better than ferritin level alone. CONCLUSIONS:In a population of anemic veterans with a wide variety of concomitant medical problems, a serum ferritin level Յ 100 g/L was optimal for determining iron deficiency. This is higher than the ferritin level of Յ 50 g/L cited in standard textbooks as evidence of iron deficiency in patients with inflammation, infection, or malignancy.KEY WORDS: iron deficiency; anemia; ferritin; total ironbinding capacity; transferrin saturation. J GEN INTERN MED 1998;13:455-461.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Detecting iron deficiency in anemic patients with concomitant medical problems

Kis

Carnes

1998

J Gen Intern Med

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“…Although many studies have evaluated the diagnostic properties of SF in comparison with bone marrow iron stores, most of these studies were conducted in populations at high risk of inflammation, for example, in hospital populations (36)(37)(38). Such studies would likely distort the identified SF cutoff (likely raising it) because of the high prevalence of inflammation in these persons.…”

Section: Evidence For Current Sf Cutoffsmentioning

confidence: 99%

Serum ferritin as an indicator of iron status: what do we need to know?

Daru

Colman

Stanworth

et al. 2017

The American Journal of Clinical Nutrition

171

124

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Determination of iron status in pregnancy and in young children is essential for both clinical and public health practice. Clinical diagnosis of iron deficiency (ID) through sampling of bone marrow to identify the absence of body iron stores is impractical in most cases. Serum ferritin (SF) concentrations are the most commonly deployed indicator for determining ID, and low SF concentrations reflect a state of iron depletion. However, there is considerable variation in SF cutoffs recommended by different expert groups to diagnose ID. Moreover, the cutoffs used in different clinical laboratories are heterogeneous. There are few studies of diagnostic test accuracy to establish the sensitivity and specificity of SF compared with key gold standards (such as absent bone marrow iron stores, increased intestinal iron absorption, and hemoglobin response to SF) among noninflamed, outpatient populations. The limited data available suggest the commonly recommended SF cutoff of ,15 mg/L is a specific but not sensitive cutoff, although evidence is limited. Data from women during pregnancy or from young children are especially uncommon. Most data are from studies conducted .30 y ago, do not reflect ethnic or geographic diversity, and were performed in an era for which laboratory methods no longer reflect present practice. Future studies to define the appropriate SF cutoffs are urgently needed and would also provide an opportunity to compare this indicator with other established and emerging iron indexes. In addition, future work would benefit from a focus on elucidating cutoffs and indexes relevant to iron adequacy.Am J Clin Nutr 2017;106 (Suppl):1634S-9S.

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“…ESR is a particularly useful measure for distinguishing iron deficiency anemia from the anemia of chronic disease/inflammation (Beganovic, 1987;Charache et al, 1987;Jansson et al, 1986;Witte et al, 1987). Elevated ESR levels occur in concert with other indicators of the anemia of chronic disease/ infections because ESR is a n indirect indicator of disease.…”

Section: Discussionmentioning

confidence: 99%

Anemia and the transition of nomadic hunter-gatherers to a sedentary life-style: Follow-up study of a Kalahari community

Kent

Dunn

1996

Am. J. Phys. Anthropol.

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Iron profiles of communities of hunter-gatherers and former hunter-gatherers conducted between 1969 and 1987 at Dobe in the Kalahari Desert of Botswana exhibited pronounced differences during periods of rapid culture change. The loss of good health and particularly the increase in anemia through time was attributed to notable changes in diet, although changes in mobility patterns were considered a secondary cause. In 1988 and 1989, studies were conducted at Kutse, also in the Kalahari Desert of Botswana, to ascertain the frequency of anemia at a recently sedentary community in which residents still relied primarily on wild animals for meat. Although not identical, the hematological presentation in 1989 was similar to that in 1988. The studies together suggest that our findings characterize the pattern of health and disease at Kutse, which is unrelated to any specific year or to diet. Additional measures of disease, specifically ESR (erythrocyte sedimentation rate) and oral temperatures, support an interpretation of anemia of chronic disease as the cause of hypoferremia at Kutse. Morbidity is high, in spite of adequate diets, because the residents are transitional from a nomadic to a sedentary lifestyle and from a relatively dispersed to an aggregated settlement pattern. These changes have introduced new health problems.

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Predicting Bone Marrow Iron Stores in Anemic Patients in a Community Hospital Using Ferritin and Erythrocyte Sedimentation Rate

Cited by 31 publications

References 7 publications

Detecting iron deficiency in anemic patients with concomitant medical problems

Detecting iron deficiency in anemic patients with concomitant medical problems

Serum ferritin as an indicator of iron status: what do we need to know?

Anemia and the transition of nomadic hunter-gatherers to a sedentary life-style: Follow-up study of a Kalahari community

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