Serum iron, total iron-binding capacity, and percentage saturation of transferrin have classically been used to demonstrate a hypoferremic state; however, these tests may not discriminate between depleted iron stores and conditions associated with defective reticuloendothelial release of iron. Estimation of stainable iron in the bone marrow biopsy specimen is then the most practical way to assess body iron stores. With the availability of a radioimmunoassay procedure for serum ferritin, we undertook a prospective study to determine whether serum ferritin concentrations might replace assessment of the marrow biopsy iron stores as an indicator of hypoferremia. Iron stores were absent from bone marrow biopsy specimens from 104 patients. A good correlation between low serum ferritin levels and absence of iron stores in biopsy specimens was found for 91 patients (87.5%). Thirteen (12.5%) had normal serum ferritin concentrations with absence of biopsy iron. These individuals had hematopoietic malignancies or active hepatic disease, or were receiving iron therapy. In this group, a bone marrow biopsy would still be necessary for evaluation of a hypoferremic state, even though the serum ferritin concentration might be normal.
[Show abstract][Hide abstract] ABSTRACT: We report our observations on day-to-day variation in serum ferritin, serum iron, total iron-binding capacity, and percent saturation of binding proteins with iron in 13 ostensibly healthy subjects during five weeks. The average intrasubject coefficients of variation were 14.5, 28.5, 4.8, and 28.0%, respectively. Precision studies on control samples showed greater within-assay and between-assay analytical variation for serum ferritin than for serum iron or total iron-binding capacity. Evidently, serum ferritin varies less in a given individual from day to day than do serum iron and percent iron saturation. Thus, a single measurement of serum ferritin may be a more reliable index of iron stores than an isolated determination of either serum iron or percent iron saturation.
[Show abstract][Hide abstract] ABSTRACT: Multivariate analysis was applied to iron deficiency anemia to generate an efficient sequence of diagnostic laboratory tests. A three step diagnostic system--serum ferritin level and mean corpuscular volume as a screen in all patients, followed by serum iron level and total iron binding capacity in some patients, and by erythrocyte sedimentation rate in a few patients--was constructed using a previously validated data reduction system. When compared to bone marrow iron stores, this system was found to have 96 per cent accuracy. In one year of clinical trial the "iron screen" classified 396 of 416 patients in a hospital setting. This sequential strategy shows how clinical laboratory data can be utilized to render diagnoses of defined probability.
Human Pathlogy 03/1981; 12(2):118-26. DOI:10.1016/S0046-8177(81)80099-8 · 2.77 Impact Factor
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