Iron deficiency anemia criteria
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Diagnostic Criteria for Iron Deficiency Anemia
Introduction to Iron Deficiency Anemia
Iron deficiency anemia (IDA) is the most common nutritional disorder worldwide, affecting various age groups and populations. It is characterized by a lack of sufficient iron to form healthy red blood cells, leading to symptoms such as fatigue, pallor, and reduced cognitive function 249. The diagnostic criteria for IDA vary depending on the population and underlying conditions, necessitating a nuanced approach to diagnosis and management.
Diagnostic Criteria in Infants
In infants, the criteria for diagnosing iron deficiency and IDA are not well-defined and require reevaluation. Key indicators include hemoglobin (Hb), plasma ferritin, erythrocyte mean cell volume (MCV), zinc protoporphyrin (ZPP), and soluble transferrin receptors (TfR). For exclusively breast-fed infants, the following cut-off values are suggested: Hb <105 g/L at 4-6 months and <100 g/L at 9 months; ZPP >75 micromol/mol heme at 4-6 months and >90 micromol/mol heme at 9 months; ferritin <20 microg/L at 4 months, <9 microg/L at 6 months, and <5 microg/L at 9 months; and TfR >11 mg/L at 4-9 months .
Diagnostic Criteria in Children and Adolescents
Iron deficiency anemia is prevalent among children aged nine months to three years and during adolescence. The diagnosis is typically confirmed by low hemoglobin levels and a peripheral blood film showing hypochromia, microcytosis, and marked anisocytosis. A low serum ferritin level is also a key diagnostic marker. The American Academy of Pediatrics recommends universal screening for IDA at approximately one year of age .
Diagnostic Criteria in Adults
In adults, the diagnostic criteria for IDA include a combination of low hemoglobin levels and low iron stores. For women, anemia is defined as a hemoglobin value <12 g/dL, and for men, <13 g/dL. Serum ferritin is the most frequently used diagnostic parameter, although its concentration can increase with age and in the presence of inflammatory diseases. Other useful tests include transferrin saturation and soluble transferrin receptor levels 56.
Diagnostic Criteria in Chronic Kidney Disease (CKD) Patients
In patients with chronic kidney disease (CKD), IDA is a common complication. Absolute iron deficiency is defined by transferrin saturation (TSAT) ≤20% and serum ferritin concentration ≤100 ng/mL in predialysis and peritoneal dialysis patients, or ≤200 ng/mL in hemodialysis patients. Functional iron deficiency, characterized by adequate iron stores but insufficient iron availability, is indicated by TSAT ≤20% and elevated ferritin levels .
Diagnostic Criteria in Older Adults
For older adults, anemia is defined as a hemoglobin value <12 g/dL for women and <13 g/dL for men. The diagnosis of absolute iron deficiency anemia involves the combination of anemia and the absence of total body iron. Serum ferritin is commonly used, but its interpretation can be complicated by age-related increases and inflammatory conditions. Additional tests such as transferrin saturation and soluble transferrin receptor levels may provide further diagnostic clarity 57.
Conclusion
Iron deficiency anemia remains a significant global health issue with varying diagnostic criteria based on age, underlying conditions, and specific populations. Accurate diagnosis involves a combination of hemoglobin levels, serum ferritin, and other iron-related markers. Tailored diagnostic approaches are essential for effective management and treatment of IDA across different demographic groups.
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