Ferritin in iron deficiency anemia
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Ferritin in Iron Deficiency Anemia: Insights and Implications
Ferritin as a Biomarker for Iron Deficiency Anemia
Ferritin is a crucial biomarker for assessing iron status in the body. It stores iron and releases it in a controlled fashion, making it a reliable indicator of iron reserves. However, its levels can be influenced by various factors, including inflammation and infection, which complicates its interpretation in diagnosing iron deficiency anemia (IDA).
Adjusting Ferritin Levels for Inflammation
Inflammation can significantly affect ferritin levels, leading to potential misdiagnosis of iron deficiency. Research from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project highlights the need for adjusting ferritin concentrations to account for inflammation. The study suggests several methods, such as increasing the ferritin cutoff, excluding individuals with high C-reactive protein (CRP) or α-1-acid glycoprotein (AGP) levels, and applying arithmetic or regression correction factors. These adjustments can provide a more accurate estimate of iron deficiency in populations with prevalent inflammation.
Ferritin and Iron Supplementation Strategies
Intravenous vs. Oral Iron Therapy
In cases of IDA, especially in chronic kidney disease (CKD) and pregnancy, intravenous (IV) iron therapy has shown superior efficacy compared to oral iron supplements. Studies indicate that IV iron preparations, such as ferric carboxymaltose (FCM) and ferric citrate, significantly improve hemoglobin and ferritin levels more rapidly and effectively than oral iron . For instance, a randomized controlled trial demonstrated that a single IV infusion of FCM was more effective and better tolerated than oral ferrous sulfate in pregnant women with IDA.
Plant Ferritin as a Dietary Supplement
Plant ferritin, found in legume seeds, offers a promising alternative for iron supplementation. It encapsulates iron ions within a protein shell, preventing oxidative changes in food and reducing gastrointestinal side effects. Although bioavailability studies are promising, the concentration of ferritin in natural sources is often insufficient for effective food fortification. Therefore, biofortification of edible plants to overexpress ferritin is being explored to enhance dietary iron intake.
Diagnostic Tools and Guidelines
Soluble Transferrin Receptor (sTfR) and sTfR/log Ferritin Index
To distinguish between iron deficiency anemia and anemia of chronic disease, the soluble transferrin receptor (sTfR) and the sTfR/log ferritin index are valuable diagnostic tools. Meta-analyses have shown that these markers have high sensitivity and specificity, making them reliable for diagnosing IDA in complex cases where inflammation is present.
Global Guidelines on Iron Deficiency
A systematic review of global guidelines reveals a consensus on using serum ferritin as the primary diagnostic marker for iron deficiency, with a recommended cutoff of 100 µg/L in most conditions. However, transferrin saturation (TSAT) is also suggested as a complementary test. For treatment, oral iron is preferred, especially in children and women, unless contraindicated, in which case IV iron is recommended.
Conclusion
Ferritin remains a cornerstone in diagnosing and managing iron deficiency anemia, but its interpretation must consider the impact of inflammation. Adjusting ferritin levels for inflammatory markers, utilizing advanced diagnostic tools like sTfR, and choosing appropriate iron supplementation strategies are essential for effective management. Continued research and updated guidelines will further refine these approaches, improving outcomes for individuals with IDA.
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