Iron Deficiency Anemia Thresholds

For an anemic patient in whom iron deficiency is plausible, obtain serum ferritin with serum iron, transferrin or total iron-binding capacity (TIBC), and calculate transferrin saturation (TSAT). Ferritin reflects total body iron stores, but conventional iron studies are substantially affected by acute-phase responses; interpretation must therefore incorporate concurrent inflammatory, infectious, malignant, renal, and obesity-related conditions. acpjournals+2acpjournalsIron Deficiency Anemia : Annals of Internal Medicine - In the ClinicASHIron deficiency: new insights into diagnosis and treatment | Hematology, ASH Education Program | American Society of HematologyASHSerum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency | Blood | American Society of Hematology

Use ferritin <45 ng/mL as the diagnostic cutoff for iron deficiency in patients with anemia undergoing evaluation for a gastrointestinal source. This threshold is preferred over ferritin <15 ng/mL by the American Gastroenterological Association for this clinical context. A ferritin above 45 ng/mL does not independently exclude iron deficiency when acute-phase elevation is likely. Gastroenterology+1GastroenterologyAGA Clinical Practice Guidelines on the Gastrointestinal Evaluation ...ASHSerum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency | Blood | American Society of Hematology

Do not use a single serum iron value as a standalone rule-in or rule-out test. Serum iron, TIBC/transferrin, TSAT, and ferritin can all be distorted by an acute-phase response; a discordant profile should trigger assessment for inflammation and consideration of soluble transferrin receptor testing rather than premature classification as isolated anemia of chronic disease. ASHASHSerum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency | Blood | American Society of Hematology

Anemia of chronic kidney disease can combine dialysis-related blood loss, increased hepcidin from both increased production and reduced clearance, and erythropoiesis-stimulating agent–driven demand. This combination can produce functional iron deficiency: iron stores may be present but insufficiently mobilized to support erythropoiesis. ASHASHIron deficiency: new insights into diagnosis and treatment | Hematology, ASH Education Program | American Society of Hematology

Inflammatory states, chronic infection, malignancy, and severe obesity can raise hepcidin and reduce intestinal iron absorption or iron release from stores. Therefore, a ferritin result that is not below the usual deficiency cutoff is not decisive in these settings, particularly if the clinical phenotype and TSAT suggest limited circulating iron availability. ASH+1ASHIron deficiency: new insights into diagnosis and treatment | Hematology, ASH Education Program | American Society of HematologyASHSerum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency | Blood | American Society of Hematology

When standard studies are equivocal, obtain soluble serum transferrin receptor (sTfR), if locally available. In comparative data, sTfR identified iron deficiency despite concurrent inflammation or infection and more effectively differentiated combined iron deficiency plus anemia of chronic disease from anemia of chronic disease alone than ferritin. ASHASHSerum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency | Blood | American Society of Hematology

In adult men and postmenopausal women, chronic gastrointestinal blood loss is a common mechanism of iron deficiency anemia; potential causes include peptic ulcer disease, gastritis, inflammatory bowel disease, vascular lesions, and gastrointestinal cancer. Unexplained iron deficiency anemia warrants extensive gastrointestinal investigation because ulcers and malignant tumors are important potential sources. ScienceDirect+1ScienceDirectIron Deficiency Anemia - an overview | ScienceDirect TopicsASHSerum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency | Blood | American Society of Hematology

In menstruating patients, quantify menstrual blood loss but do not assume it fully explains persistent, severe, recurrent, or treatment-unresponsive deficiency. Heavy menstrual bleeding, bariatric surgery, inflammatory bowel disease, celiac disease, Helicobacter pylori gastritis, and autoimmune gastritis are clinically relevant causes of inadequate iron absorption or ongoing loss. Wiley+1WileyOptimizing diagnosis and treatment of iron deficiency and iron ...ScienceDirectPathogenesis and Management of Iron Deficiency Anemia: Emerging Role of Celiac Disease, Helicobacter pylori, and Autoimmune Gastritis

If bidirectional gastrointestinal evaluation does not establish a cause, reassess for impaired absorption. Celiac disease, autoimmune gastritis, and H. pylori infection are recognized acquired explanations for otherwise unexplained iron deficiency; treating celiac disease with a gluten-free diet or eradicating H. pylori can correct the anemia when these conditions are causal. ScienceDirectScienceDirectPathogenesis and Management of Iron Deficiency Anemia: Emerging Role of Celiac Disease, Helicobacter pylori, and Autoimmune Gastritis

Monitor hemoglobin and hematocrit together with iron storage parameters during parenteral iron replacement. With iron dextran, serum iron, TIBC, and TSAT are specified monitoring measures; iron storage parameters can improve before hematologic parameters, and ferritin may not accurately reflect body stores in chronic dialysis. dailymed nlm nihdailymed nlm nih[PDF] INFED- iron dextran injection Actavis Pharma, Inc. - DailyMed

Failure to obtain an expected clinical or hematologic response should prompt reassessment of adherence and tolerability with oral iron, continued bleeding, malabsorption, inflammation-associated iron restriction, CKD-related functional deficiency, or iron-refractory iron deficiency anemia. Oral iron commonly causes gastrointestinal adverse effects that can compromise adherence; intravenous iron is preferred when oral iron is intolerable, ineffective, or inappropriate, including after bariatric surgery or in inflammatory bowel disease. Wiley+2WileyOptimizing diagnosis and treatment of iron deficiency and iron ...ScienceDirectPathogenesis and Management of Iron Deficiency Anemia: Emerging Role of Celiac Disease, Helicobacter pylori, and Autoimmune GastritisASHIron deficiency: new insights into diagnosis and treatment | Hematology, ASH Education Program | American Society of Hematology

Do not use early ferritin improvement as proof that anemia has corrected. For parenteral iron, storage indices may improve before hemoglobin and hematocrit; continue monitoring until both anemia and iron replacement goals are addressed while concurrently treating the loss or absorption disorder. dailymed nlm nih+1dailymed nlm nih[PDF] INFED- iron dextran injection Actavis Pharma, Inc. - DailyMedScienceDirectPathogenesis and Management of Iron Deficiency Anemia: Emerging Role of Celiac Disease, Helicobacter pylori, and Autoimmune Gastritis