Laboratory findings of iron deficiency anemia
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Laboratory Findings of Iron Deficiency Anemia
Serum Ferritin: The Gold Standard
Serum Ferritin is widely recognized as the most powerful test for diagnosing iron deficiency anemia (IDA). It has a high diagnostic accuracy, with an area under the receiver operating characteristic curve of 0.95, making it a reliable indicator of iron stores in the body. However, its effectiveness can be influenced by conditions such as inflammation, liver disease, or malignancy, which can elevate ferritin levels independently of iron status . Despite these limitations, a serum ferritin level below 25 ng/ml is considered a strong indicator of iron deficiency.
Hemoglobin and Red Cell Indices
Hemoglobin (Hb) levels are typically the first clue to anemia, but they have low specificity and sensitivity when used alone. To improve diagnostic accuracy, Hb measurements are often combined with red cell indices such as mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). These indices help identify microcytic (small cell) and hypochromic (low hemoglobin content) red blood cells, which are characteristic of IDA . MCV and MCH are particularly useful in pediatric populations, where they show high sensitivity and specificity for diagnosing iron deficiency.
Transferrin Saturation and Total Iron-Binding Capacity
Transferrin Saturation (TSAT) and Total Iron-Binding Capacity (TIBC) are also commonly used in diagnosing IDA. TSAT measures the percentage of transferrin (a blood protein that transports iron) that is saturated with iron. Low TSAT levels are indicative of iron deficiency . TIBC, on the other hand, measures the blood's capacity to bind iron with transferrin. Elevated TIBC levels can indicate iron deficiency, as the body increases transferrin production to capture more iron .
Erythrocyte Protoporphyrin and Reticulocyte Hemoglobin
Erythrocyte Protoporphyrin (EPP) and Reticulocyte Hemoglobin Equivalent (RET-He) are newer parameters that reflect iron availability for erythropoiesis (red blood cell production). EPP levels increase when iron is deficient, as protoporphyrin accumulates in red blood cells . RET-He provides real-time information on the functional availability of iron for hemoglobin synthesis and has shown promise as a rapid diagnostic tool for IDA, with a shorter turnaround time compared to traditional biochemical markers .
Age-Related Variations
Laboratory values for diagnosing IDA can vary significantly with age and sex. For instance, hemoglobin, hematocrit, and red cell indices show age-related changes that must be considered to optimize the identification of iron deficiency. These variations highlight the importance of age-specific reference ranges in the accurate diagnosis of IDA.
Conclusion
In summary, the diagnosis of iron deficiency anemia relies on a combination of laboratory tests, with serum ferritin being the most reliable indicator of iron stores. Hemoglobin levels, red cell indices, transferrin saturation, and total iron-binding capacity provide additional diagnostic information. Newer parameters like erythrocyte protoporphyrin and reticulocyte hemoglobin equivalent offer promising rapid diagnostic capabilities. Age-related variations in these laboratory values must also be considered to ensure accurate diagnosis.
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