Materiały źródłowe

• #1 Iron Deficiency Anemia: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0115/p98.html

  Iron deficiency is the most common nutritional disorder worldwide and accounts for approximately one-half of anemia cases. The diagnosis of iron deficiency anemia is confirmed by the findings of low iron stores and a hemoglobin level two standard deviations below normal. […] Diagnosis of iron deficiency anemia requires laboratory-confirmed evidence of anemia, as well as evidence of low iron stores. Anemia is defined as a hemoglobin level two standard deviations below normal for age and sex. […] A serum ferritin level should be obtained in patients with anemia and a mean corpuscular volume less than 95 m3. Ferritin reflects iron stores and is the most accurate test to diagnose iron deficiency anemia. […] Although levels below 15 ng per mL (33.70 pmol per L) are consistent with a diagnosis of iron deficiency anemia, using a cutoff of 30 ng per mL (67.41 pmol per L) improves sensitivity from 25 to 92 percent, and specificity remains high at 98 percent.

• #2 A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2754511/

  Iron deficiency (ID), with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. […] Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. […] After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. […] If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs.

• #3 Anemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anemia/diagnosis-treatment/drc-20351366

  To diagnose anemia, your health care provider is likely to ask you about your medical and family history, do a physical exam, and order blood tests. Tests might include: […] A CBC is used to count the number of blood cells in a sample of blood. For anemia, the test measures the amount of the red blood cells in the blood, called hematocrit, and the level of hemoglobin in the blood. […] If you get a diagnosis of anemia, you might need more tests to find the cause. Sometimes, it can be necessary to study a sample of bone marrow to diagnose anemia.

• #4 Iron-Deficiency Anemia – Hematology.org

  https://www.hematology.org/education/patients/anemia/iron-deficiency

  Iron-deficiency anemia is diagnosed by blood tests that should include a complete blood count (CBC). Additional tests may be ordered to evaluate the levels of serum ferritin, iron, total iron-binding capacity, and/or transferrin. In an individual who is anemic from iron deficiency, these tests usually show the following results: […] The peripheral smear or blood slide may show small, oval-shaped cells with pale centers. In severe iron deficiency, the white blood count (WBC) may be low and the platelet count may be high or low. […] Your doctor will decide if other tests are necessary. Iron deficiency is common in menstruating and pregnant women, children, and others with a diet history of excessive cow’s milk or low iron-containing foods. By talking with your doctor about your diet and medical history, your doctor may gain enough information to determine whether additional testing is needed.

• #5 Anemia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/3929-anemia

  Your healthcare provider will ask questions about your symptoms. As anemia happens when you dont have enough healthy red blood cells, theyll do blood tests, including: […] Complete blood count (CBC): Healthcare providers use this test to check on all of your blood cells, with a focus on your red blood cells. Medical pathologists examine blood samples to count your red blood cells. They also examine your red blood cells size and shape. Healthcare providers may use this test to check on your vitamin B12 or B9 levels. […] Hemoglobin test: Hemoglobin is the main component of red blood cells. The test is often used to detect anemia. […] Hematocrit test: This test measures the percentage of red blood cells in your blood. […] Peripheral blood smear: Healthcare providers examine your red blood cells under a microscope to assess blood cell size and shape.

• #6 How is Iron-Deficiency Anemia Diagnosed? | Hematology-Oncology Associates of CNY

  https://www.hoacny.com/patient-resources/blood-disorders/what-iron-deficiency-anemia/how-iron-deficiency-anemia-diagnosed

  Your doctor will diagnose iron-deficiency anemia based on your medical history, a physical exam, and the results from tests and procedures. […] Many tests and procedures are used to diagnose iron-deficiency anemia. They can help confirm a diagnosis, look for a cause, and find out how severe the condition is. […] Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many parts of your blood. […] If the CBC results confirm you have anemia, you may need other blood tests to find out what’s causing the condition, how severe it is, and the best way to treat it. […] To check whether internal bleeding is causing your iron-deficiency anemia, your doctor may suggest a fecal occult blood test. This test looks for blood in the stools and can detect bleeding in the intestines.

• #7 Diagnosis and management of iron deficiency anaemia: a clinical update | The Medical Journal of Australia

  https://www.mja.com.au/journal/2010/193/9/diagnosis-and-management-iron-deficiency-anaemia-clinical-update

  Iron deficiency anaemia (IDA) may be effectively diagnosed in most cases by full blood examination and serum ferritin level. […] Patients without a clear physiological explanation for iron deficiency (especially men and postmenopausal women) should be evaluated by gastroscopy/colonoscopy to exclude a source of gastrointestinal bleeding, particularly a malignant lesion. […] Patients with suspected iron deficiency should have iron studies performed and the results correlated with red cell indices. […] The serum ferritin level is the most readily available and useful index of iron deficiency. In an anaemic adult, a ferritin level below 15 g/L is diagnostic of iron deficiency, and levels between 15 and 30 g/L are highly suggestive. […] Iron deficiency should be distinguished from other causes of anaemia because of its associations with underlying conditions that mandate specific investigation, and because treatment is simple, safe and effective.

• #8 Iron Deficiency Anemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p671.html

  The most accurate initial diagnostic test for IDA is the serum ferritin measurement. Serum ferritin values greater than 100 ng per mL (100 mcg per L) indicate adequate iron stores and a low likelihood of IDA. […] Another laboratory change that occurs in patients with IDA is an increase in the iron-carrying protein transferrin. The amount of iron available to bind to this molecule is reduced, causing a decrease in the transferrin saturation and an increase in the total iron-binding capacity. […] The choice of a ferritin level of less than 45 ng per mL (45 mcg per L) is to allow for a higher sensitivity, despite the fact that most laboratories’ normal range for ferritin includes 45 ng per mL. […] The general approach is to separate groups by risk of underlying disease. Patients with a high risk of underlying disease (e.g., men of all ages and postmenopausal women) should be evaluated endoscopically for occult bleeding unless the history and physical examination strongly indicate a known benign cause for IDA.

• #9 Which tests can diagnose iron deficiency anemia?

  https://www.medicalnewstoday.com/articles/iron-deficiency-anemia-test

  Various tests can help diagnose iron deficiency anemia. […] Doctors may use a number of tests to help diagnose iron deficiency anemia, checking for various levels in the blood as well as markers of other underlying factors. […] A low RBC count may be a sign of iron deficiency anemia. […] A serum iron test measures how much iron is in the blood. Low levels of serum iron may indicate iron deficiency. […] Levels of ferritin can help doctors understand how much iron is in the body’s stores. Low ferritin levels indicate low iron stores and iron deficiency. […] If TIBC levels are high, it may indicate low iron in the blood due to iron deficiency anemia. […] High levels of transferrin may be a sign of iron deficiency anemia, and doctors can use a soluble transferrin receptor (sTfR) test to check for these levels.

• #10 Anemia – Iron-Deficiency Anemia | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia

  How is iron-deficiency anemia diagnosed? To help diagnose iron-deficiency anemia, your doctor will order a blood test to check your complete blood count (CBC), hemoglobin levels, blood iron levels, and ferritin levels. Your doctor may tell you that the iron level in your blood is low. Your doctor may also tell you that you have anemia with the iron deficiency. […] Different tests help your doctor diagnose iron-deficiency anemia. In iron-deficiency anemia, blood levels of iron will be low, or less than 10 micromoles per liter (mol/L) for both men and women. Normal levels are 10 to 30 mol/L. Levels of ferritin will also be low, or less than 10 micrograms per liter (g/L) for both men and women. Normal levels are 40 to 300 for men and 20 to 200 for women.

• #11 Iron Deficiency Anemia Workup: Approach Considerations, Complete Blood Count, Peripheral Smear

  https://emedicine.medscape.com/article/202333-workup

  The CBC documents the severity of the anemia. […] In chronic iron deficiency anemia, the cellular indices show a microcytic and hypochromic erythropoiesis that is, both the mean corpuscular volume (MCV) and the mean corpuscular hemoglobin concentration (MCHC) have values below the normal range for the laboratory performing the test. […] Examination of the peripheral smear is an important part of the workup of patients with anemia. […] In iron deficiency anemia, unlike thalassemia, target cells usually are not present, and anisocytosis and poikilocytosis are not marked. […] Low serum iron and ferritin levels with an elevated TIBC are diagnostic of iron deficiency. […] While a low serum ferritin is virtually diagnostic of iron deficiency, a normal serum ferritin can be seen in patients who are deficient in iron and have coexistent diseases (eg, hepatitis or anemia of chronic disorders).

• #12 Anemia- Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anemia-diagnosis/

  Anemia- Diagnosis […] Characterizing the anemia as microcytic, normocytic, or macrocytic using the MCV helps to guide further investigations and management. […] Diagnostic Criteria: […] Adult non-pregnant females: Hgb < 120 g/L or Hct < 36% (0.36) [...] Adult pregnant females: [...] 1st trimester: Hgb < 110 g/L [...] 2nd trimester: Hgb < 105 g/L [...] 3rd trimester: Hgb < 110 g/L [...] Adult males: < 130 g/L or Hct < 41% (0.41) [...] Children and Adolescents: [...] Birth (term infant): < 135 g/L [...] 1 month: < 107g/L [...] 2 months: < 94 g/L [...] 3 – 6 months: < 95 g/L [...] 6 months – 2 yrs: < 105 g/L [...] 2 – 12 yrs: < 115 g/L [...] 12 – 18 years: [...] Males: < 130 g/L [...] Females: <120 g/L [...] General laboratory Investigations [...] CBC: [...] Hemoglobin [...] Hematocrit

• #13 Diagnosis and investigation of iron deficiency anaemia | Lifeblood

  https://www.lifeblood.com.au/health-professionals/clinical-practice/clinical-indications/iron-deficiency-anaemia/diagnosis-investigation

  Iron deficiency anaemia is diagnosed by a full blood examination and iron studies, particularly serum ferritin levels. Serum iron levels should not be used to diagnose iron deficiency. […] A constellation of the following findings on full blood count is highly suggestive of iron deficiency anaemia, but MCV and MCH can be normal in early stages of iron deficiency: anaemia, microcytosis (low MCV), hypochromia (low MCH). […] Iron deficiency can occur without anaemia, and ferritin is required to confirm diagnosis. […] Ferritin is the diagnostic test of choice. […] Iron deficiency is diagnosed when ferritin is 30g/L in adults and 20g/L in children. […] Elevated transferrin and low transferrin saturation are suggestive of iron deficiency even in the presence of a normal or elevated ferritin. […] Additional tests, such as soluble transferrin receptor and bone marrow biopsy, may be considered when the clinical features and haematology profile are suggestive of iron deficiency, but ferritin is normal.

• #14 Iron Deficiency – Diagnosis and Management – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/iron-deficiency

  This guideline provides recommendations for the diagnosis, investigation and management of iron deficiency in patients of all ages. […] Ferritin is the test of choice for the diagnosis of iron deficiency. […] Serum iron, iron binding capacity, and transferrin saturation/fraction saturation are not routinely useful for investigating iron deficiency anemia. […] The recommended initial tests for iron deficiency and for IDA, in otherwise well patients, should usually be limited to serum ferritin and complete blood count (CBC). […] Ferritin 12 ug/L is diagnostic of iron deficiency. […] Serum ferritin below 50 ug/L should be investigated for iron deficiency in the elderly. […] The diagnosis of absolute iron deficiency is challenging in the elderly. […] Testing for malabsorption is recommended if small bowel disease is clinically suspected, or if oral iron supplementation results in inadequate response despite compliance.

• #15 Iron deficiency anemia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/94

  Iron deficiency anemia (IDA) is the most common form of anemia. […] Diagnosis of IDA requires investigation of the underlying cause. […] Blood tests reveal microcytic, hypochromic anemia; low reticulocyte count. […] Other laboratory findings include low serum iron, increased total iron-binding capacity (TIBC), less than 16% transferrin saturation, and low serum ferritin. […] Key diagnostic factors include fatigue, dyspnea on exertion, and pica. […] 1st tests to order include hemoglobin and hematocrit, platelet count, MCV, MCH, MCHC, red cell distribution width, peripheral blood smear, reticulocyte count, serum iron, total iron-binding capacity, transferrin saturation, serum ferritin, celiac serology, urinalysis, and Helicobacter pylori testing. […] Tests to consider include hemoglobin electrophoresis, urease breath test, autoimmune gastritis testing, upper gastrointestinal endoscopy, small-bowel biopsy, lower gastrointestinal endoscopy, CT colonography, transferrin receptor-ferritin index, bone marrow biopsy, monitored trial of iron, and fecal occult blood tests. […] Emerging tests include urinary hepcidin, percentage of hypochromic erythrocytes, reticulocyte hemoglobin content, and erythrocyte protoporphyrin.

• #16 How to diagnose iron deficiency in chronic disease: A review of current methods and potential marker for the outcome | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00922-6

  Routine surveillance of iron status in these groups of patients with chronic conditions is advisable to detect ID early. […] Depending on the inflammatory state, TSAT 20% may be the more accurate diagnostic marker of ID than ferritin. […] The gold standard to determine ID is to determine iron content of the bone marrow. However, this is not feasible in routine clinical practice. […] Therefore, different non-invasive biochemical markers are widely used to determine ID. […] TSAT provides information about iron availability. […] In ID, TSAT usually falls below 20%. […] TSAT as a reliable diagnostic maker for ID is often used in clinical practice and recommended in several guidelines and studies with high sensitivity and specificity. […] Diagnosis of ID in quiescent IBD can be made by serum ferritin level 30 g/L and in active IBD by serum ferritin 100 g/L or TSAT 20%.

• #17 Iron deficiency anemia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/diagnosis-treatment/drc-20355040

  To diagnose iron deficiency anemia, your doctor may run tests to look for: […] Lower than normal hemoglobin levels indicate anemia. […] A low level of ferritin usually indicates a low level of stored iron. […] If your bloodwork indicates iron deficiency anemia, your doctor may order additional tests to identify an underlying cause, such as: […] If iron supplements don’t increase your blood-iron levels, it’s likely the anemia is due to a source of bleeding or an iron-absorption problem that your doctor will need to investigate and treat. […] If you’re diagnosed with iron deficiency anemia, you may need tests to look for a source of blood loss, including tests to examine your gastrointestinal tract.

• #18 A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2754511/

  Once the diagnosis of IDA or ID without anemia has been established, it is necessary to investigate its origin, because it can be caused by very serious diseases. […] The initial studies should include laboratory tests, with an elementary analysis of urine. […] In most patients, a dilemma will arise; is it necessary or mandatory to perform a gastroscopy, a colonoscopy or both? […] Gastrointestinal endoscopies (gastroscopy and colonoscopy) might be performed in the same session or sequentially, according to clinical history (or serologic data). […] The combination of gastroscopy and colonoscopy is highly sensitive and specific for locating gastrointestinal lesions that produce anemia. […] If examinations are normal, the anemia is not severe and symptoms do not suggest significant disease. […] If the results are still normal, it is necessary to investigate the existence of lesions in the small bowel by using capsule endoscopy. […] With all the diagnostic means available nowadays, very few IDAs should be left without a diagnosis.

• #19 Iron Deficiency Anemia: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0115/p98.html

  The soluble transferrin receptor level is an indirect measure of erythropoiesis and is increased in patients with iron deficiency anemia. […] If other tests are indeterminate and suspicion for iron deficiency anemia persists, the absence of stainable iron in a bone marrow biopsy is considered the diagnostic standard.

• #20 A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2754511/

  In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. […] The main techniques in this case are capsule endoscopy, followed by enteroscopy. […] The diagnosis of anemia is simple and objective: the World Health Organization defines it as the decline in blood hemoglobin to a concentration below 13 g/dL in men and 12 g/dL in women. […] However, to confirm that ID is the origin of the anemia is not always easy. […] A typical pattern is a decrease in sideremia, plasma ferritin, and transferrin saturation. […] A low serum ferritin ( 30 ng/L) unequivocally means ID, whether accompanied by anemia or not. […] The soluble transferrin receptor is one of the most useful as it is the least influenced by the presence of inflammation and it correlates well with concentration of transferrin receptor in the cell plasma membrane.

• #21 Improved Diagnosis of Iron Deficiency Anemia in the Critically Ill via Fluorescence Flowcytometric Hemoglobin Biomarkers

  https://www.mdpi.com/2073-4409/12/1/140

  Conclusions: Determination of RET-He and Delta-He allows for the increased precision and sensitivity of iron-deficient anemia in the ICU. […] Anemia remains a common phenomenon in critically ill patients treated in intensive care, with a mean prevalence up to 65% of all patients at the time of admission and nearly 97% after a length of stay of 8 days. Both absolute and functional iron deficiency (ID) require a sensitive and timely diagnosis to optimize anemia therapy. The ability of the recommended serological parameter serum ferritin and transferrin saturation in assessing the iron status in the critically ill is frequently limited due to influences of present inflammatory conditions. […] The quantitative reticulocyte parameters reticulocyte hemoglobin content (RET-He) and Delta-hemoglobin equivalent (Delta-He) directly assess the current iron supply to erythropoiesis independent of body iron storages. RET-He reflects the mean hemoglobin value (Hb) of the newly formed immature reticulocytes. The measured values of RET-He are independent from simultaneous inflammatory conditions, show quick response to changes in iron availability, and depict the functional availability of iron for erythropoiesis within a clinically relevant period from 1 to 2 days.

• #22 Improved Diagnosis of Iron Deficiency Anemia in the Critically Ill via Fluorescence Flowcytometric Hemoglobin Biomarkers

  https://www.mdpi.com/2073-4409/12/1/140

  We hypothesized that the repeated determination of RET-He and Delta-He enables a more sensitive and accurate detection of iron-deficient anemia types. This would simplify adjusted therapy administration for patients treated in the intensive care unit (ICU), allowing us to detect all types of ID, not just IDA. […] The primary endpoint of the study was to investigate the ability of RET-He and Delta-He to diagnose iron-deficient anemia types in critically ill patients and whether these biomarkers provide a better sensitivity or area under curve (AUC) in receiver operating characteristic (ROC) analysis in diagnosing IDA and FID than the traditionally used serological biomarkers, namely serum iron, serum ferritin, and TSAT. […] RET-He and Delta-He showed significant differences between the iron-deficient groups (IDA and FID) and every other group. The median values for the IDA and FID groups were, in total, lower than for the non-ID groups. This suggests the diagnostic suitability of both parameters in detecting iron-deficient anemia types and differentiating these anemia types from a non-ID status.

• #23

  https://haematologica.org/article/view/8688

  The measurement of hepcidin, unlike other tests used for evaluating iron status, is a direct reflection of the mechanism controlling iron homeostasis. […] Its future development into a widely available diagnostic tool may offer a major advantage in our drive to understand the nature of iron deficiency diseases and their optimal management.

• #23

  https://haematologica.org/article/view/8688

  Traditionally, the diagnosis of iron deficiency anemia (IDA) rests on simple measurements of serum iron, transferrin and ferritin in subjects with microcytic hypochromic anemia. […] The diagnostic performance of the biomarkers was estimated by analyzing receiver operating characteristic (ROC) curves to determine cut-off values with an optimal likelihood ratio for IDA. […] A ZPP/H ratio cut-off 90mol/mol heme in children and 107mol/mol heme in women was associated with a high likelihood of IDA at diagnosis. […] The authors conclude that erythrocyte ZPP/H ratio is a valid point-of-care (POC) biomarker to diagnose IDA, and that the ZPP and hepcidin reference ranges and cut-off values identified in this study may guide clinicians to utilize these tests for the diagnosis of IDA in women and children.

• #24 SciELO Brazil – Iron deficiency anemia in women: pathophysiological, diagnosis, and practical management Iron deficiency anemia in women: pathophysiological, diagnosis, and practical management

  https://www.scielo.br/j/ramb/a/xXQFftPGTMTqGFwQdKgDnFg/

  Ferritin is an intracellular iron storage protein that correlates with the body’s iron stores in the absence of threshold of ferritin 30 mg/L, achieves a higher sensitivity (92%), while maintaining a high 98% specificity for the diagnosis, and is thus commonly used. […] The diagnosis of ID becomes more challenging with concomitant inflammatory conditions because ferritin is an acute-phase reactant that increases with inflammation. […] Hepcidin is the main protein that controls plasma iron transit through its binding to ferroportin, the only iron-exporting protein present in the cell membrane of macrophages, enterocytes, hepatocytes, and placental syncytiotrophoblasts.

• #25 Iron Deficiency Anemia Workup: Approach Considerations, Complete Blood Count, Peripheral Smear

  https://emedicine.medscape.com/article/202333-workup

  A bone marrow aspirate can be diagnostic of iron deficiency. […] The absence of stainable iron in a bone marrow aspirate that contains spicules and a simultaneous control specimen containing stainable iron permit establishment of a diagnosis of iron deficiency without other laboratory tests. […] The absence of stainable iron in body tissues, including the bone marrow and liver, is the most useful histologic finding in individuals who are iron deficient.

• #26 Iron Deficiency Anemia – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/anemias-caused-by-deficient-erythropoiesis/iron-deficiency-anemia

  Iron deficiency anemia is suspected in patients with chronic blood loss or microcytic anemia, particularly if pica is present. […] A CBC, serum iron and iron-binding capacity, and serum ferritin and reticulocyte count are obtained. […] Iron and iron-binding capacity (and transferrin saturation) are measured because their relationship is important. […] Serum ferritin levels closely correlate with total body iron stores. […] The reticulocyte count is low in iron deficiency. […] The most sensitive and specific criterion for iron-deficient erythropoiesis is absent bone marrow stores of iron, although a bone marrow examination is rarely needed. […] Diagnosis of iron deficiency anemia prompts consideration of its cause, usually bleeding. […] Iron deficiency typically causes low serum iron, high iron-binding capacity, and low serum ferritin levels. […] Always seek a cause of iron deficiency, even when anemia is mild.

• #27 Iron-Deficiency Anemia – Hematology.org

  https://www.hematology.org/education/patients/anemia/iron-deficiency

  Sometimes it is difficult to diagnose the cause of iron deficiency, or your doctor may be concerned that there is a problem other than iron deficiency causing the anemia. These may include inherited blood disorders called thalassemias in which red blood cells also appear small and pale, hemoglobinopathies such as sickle cell disease (but not sickle cell trait alone), or other blood disorders.

• #28 Iron Deficiency Anemia Differential Diagnoses

  https://emedicine.medscape.com/article/202333-differential

  In a meta-analysis of indices for discriminating between iron deficiency anemia and thalassemia trait in subjects with microcytic red blood cells (RBCs), the ratio of microcytic to hypochromic RBCs (M/H ratio) showed the best performance. An M/H ratio 6.4 was strongly indicative of thalassemia. The authors concluded that the sensitivity and specificity of the M/H ratio are not high enough for making a definitive diagnosis, but the ratio can be valuable for identifying patients with microcytic RBC who should undergo diagnostic tests for confirming thalassemia. […] The sequence of events (left to right) that occur with gradual depletion of body stores of iron. Serum ferritin and stainable iron in tissue stores are the most sensitive laboratory indicators of mild iron deficiency and are particularly useful in differentiating iron deficiency from the anemia of chronic disorders. The percentage saturation of transferrin with iron and free erythrocyte protoporphyrin values do not become abnormal until tissue stores are depleted of iron. Subsequently, a decrease in the hemoglobin concentration occurs because iron is unavailable for heme synthesis. Red blood cell indices do not become abnormal for several months after tissue stores are depleted of iron.

• #29 Diagnosis and management of iron deficiency anemia in patients with IBD | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2010.151

  Anemia is the most prevalent extraintestinal complication of IBD. […] Although there are several causes of anemia in IBD, iron deficiency anemia (IDA) is the most common. […] Common biochemical values are insufficient for assessing the iron status of patients who have an inflammatory condition, such as IBD. […] The major goal of therapy for IDA is to supply sufficient iron to increase hemoglobin levels by 2 g/dl or increase them to normal values within 4 weeks, and to replenish iron stores. […] Iron supplementation should be administered intravenously to patients with IBD, even though many will respond to oral administration of iron. […] Compared with oral iron therapy, in patients with IBD intravenous iron replenishes iron stores more effectively and overcomes the block to intestinal iron absorption induced by hepcidin.

• #30 Iron-Refractory Iron Deficiency Anemia (IRIDA) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/irida

  How is iron-refractory iron deficiency anemia (IRIDA) diagnosed in children? The first step in treating your child is providing an accurate and complete diagnosis. General iron deficiency anemia can be identified through a complete blood count, an analysis that involves measuring the size, number and maturity of different blood cells within a set volume of blood. […] If your child is determined to have iron deficiency anemia, doctors will want to rule out possible causes of acquired iron deficiency, such as gastrointestinal blood loss; causes of small red blood cells (microcytosis), such as thalassemias or lead toxicity; or chronic inflammatory disorders or intestinal malabsorption, such as celiac disease. […] In order to distinguish IRIDA from other, more common forms of iron deficiency anemia, doctors will look for these key features: Lifelong anemia (hemoglobin 6-9 g/dL), Very low red blood cell size (microcytic), with a mean corpuscular volume (MCV) of 45-65 fL, Very low iron levels in the blood (transferrin saturation 5%), Abnormal oral iron absorption: no response to oral iron supplements or failure of an oral iron challenge, Abnormal iron utilization: a slow, incomplete, and transient response to parenteral iron (iron injected intravenously), Other affected family members with an autosomal recessive inheritance pattern.

• #31 Diagnosis and management of iron deficiency anaemia: a clinical update | The Medical Journal of Australia

  https://www.mja.com.au/journal/2010/193/9/diagnosis-and-management-iron-deficiency-anaemia-clinical-update

  A strategy for assessment and management of IDA is outlined in Box 2. […] Functional iron deficiency (FID) exists when, despite adequate stores, iron cannot be mobilised for erythropoiesis, mediated by elevated hepcidin. […] Bone marrow examination remains the gold-standard investigation of IDA in complex cases, although it can usually be avoided. […] The underlying cause must be established in all patients. […] In men and postmenopausal women with IDA, and also in some premenopausal women, evaluation for benign or malignant GI lesions, inflammatory conditions (such as inflammatory bowel disease) and peptic ulceration is indicated. […] IDA may be diagnosed using age-specific cut-off values of iron indices or by demonstrating a Hb improvement with a therapeutic trial of iron.

• #32 Iron-deficiency Anaemia: Symptoms and Treatment | Doctor

  https://patient.info/doctor/iron-deficiency-anaemia-pro

  Iron-deficiency anaemia (IDA) occurs when the body has insufficient iron to support red blood cell production. […] Failure to investigate IDA appropriately in primary care can cause significant delay in final diagnosis, with associated morbidity. […] IDA can be diagnosed in most cases by FBC and serum ferritin level. […] FBC: shows a hypochromic microcytic anaemia (although there may be a mixed picture with co-existent B12 or folate deficiency). […] Serum ferritin: should be measured to confirm iron deficiency. […] A cut-off ferritin level varies between 12-15 mcg/L to confirm iron deficiency. […] Urine should be tested in all patients. […] All male and postmenopausal females should be considered for upper and/or lower GI investigations. […] All patients should be screened for coeliac disease.

• #33 A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

  https://www.wjgnet.com/1007-9327/full/v15/i37/4638.htm

  Gastrointestinal endoscopies (gastroscopy and colonoscopy) might be performed in the same session or sequentially, according to clinical history (or serologic data). […] However, the combination of both endoscopic techniques only determines the final cause of anemia in a little more than half of the patients. […] If examinations are normal, the anemia is not severe and symptoms do not suggest significant disease. […] The next step might be clinical follow-up, oral iron treatment and cessation of any NSAIDs or aspirin consumption. […] In those cases in which repeated endoscopic examinations are all negative, we should investigate the small bowel as the source of anemia. […] The best initial approach is probably a capsule endoscopy, reserving enteroscopy for cases in which it is necessary to apply a treatment or to obtain biopsies of lesions localized by the capsule.

• #34 Iron Deficiency Anemia: Diagnosis, Symptoms, Causes & Treatment

  https://resources.healthgrades.com/right-care/blood-conditions/iron-deficiency-anemia

  Ferritin and iron. Ferritin is a protein that contains and stores excess iron inside cells. The test measures the amount of ferritin in the blood. […] Peripheral smear. This test examines red blood cells under a microscope. RBCs will be paler and smaller than normal with iron deficiency anemia. […] Reticulocyte count: These are young red blood cells. A lower number is a sign of iron deficiency anemia. […] Diagnostic tests to determine the underlying cause of iron deficiency anemia include: Blood tests to check for bleeding disorders. […] Imaging exams, such as ultrasound and endoscopy, to determine the source of bleeding or to diagnose Crohn’s or celiac disease. […] Tests for nutritional deficiency.

• #35 Iron-deficiency Anaemia: Symptoms and Treatment | Doctor

  https://patient.info/doctor/iron-deficiency-anaemia-pro

  If oesophagogastroduodenoscopy (OGD) is the initial investigation, lower GI endoscopy should also be performed unless advanced gastric cancer or coeliac disease is found. […] If the patient has recurrent IDA and normal OGD and colonoscopy, testing for (and subsequent eradication of) H. pylori is advised. […] Treatment for the iron deficiency should be started before the results of the investigations. […] Iron salts should be given by mouth unless there are good reasons for using another route. […] Parenteral iron is generally reserved for use when oral therapy is unsuccessful because the patient cannot tolerate oral iron or does not take it reliably, if there is continuing blood loss, or in malabsorption. […] FBC should be checked 2-4 weeks after treatment has started.

• #36

  https://journals.lww.com/pbj/fulltext/2020/08000/diagnosis,_treatment,_and_work_impact_of_iron.8.aspx

  Most patients with anemia are not being adequately evaluated and a major proportion does not undergo treatment or has subtherapeutic doses of iron. […] An effort to adapt to the established recommendations is urged, to minimize the consequences of this disease. […] The General Directorate of Health recommends ID screening, regardless the clinical condition, for pregnant women, infants, and preschool children with poor social-economic conditions, institutionalized elderly, at hospital admission, and at preoperative period. […] The most common method of screening ID involves determining the prevalence of anemia by measuring blood hemoglobin or hematocrit levels. […] Of the 10,387 patients with analytically proven anemia, the majority (87.8%) had no serum iron and/or ferritin quantified during the study period, which may reflect an insufficient diagnostic investigation of the anemia cases found in all subgroups analyzed.

• #37 Diagnosis of anemia in pregnancy – Al-Khaffaf – Journal of Laboratory and Precision Medicine

  https://jlpm.amegroups.org/article/view/5248/html

  Iron deficiency accounts for 75% of cases of non-physiologic anemia in pregnancy, and the incidence of iron deficiency anemia during pregnancy world-wide is about 41.8%. The laboratory diagnosis of iron deficiency anemia is based on a complete cell blood count. Additional tests include the determination of the levels of serum ferritin, iron, total iron-binding capacity, and/or transferrin. In an individual who is anemic from iron deficiency, these tests usually show the following results: low hemoglobin and hematocrit, low mean cellular volume, low serum ferritin levels, low serum iron, high transferrin or total iron-binding capacity and low iron saturation. […] Current recommendations suggest that pregnant patients receive 15-30 mg daily of supplemental elemental iron, although studies examining the efficacy of iron supplementation during pregnancy have not shown a clear benefit to pregnancy outcomes. […] In conclusion, for the management of pregnant women, daily 15-30 mg elemental iron is recommended. For those not able to tolerate oral iron, parenteral iron is preferred, but it could be considered safe from the second trimester.

• #38 Iron-deficiency anemia – Wikipedia

  https://en.wikipedia.org/wiki/Iron-deficiency_anemia

  Iron-deficiency anemia is confirmed by tests that include serum ferritin, serum iron level, serum transferrin, and total iron binding capacity. […] Further testing may be necessary to differentiate iron-deficiency anemia from other disorders, such as thalassemia minor. […] It is unclear if screening pregnant women for iron-deficiency anemia during pregnancy improves outcomes in the United States. […] Screening is done with either a hemoglobin or hematocrit lab test.

• #39 Iron-Deficiency Anemia in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/i/iron-deficiency-anemia-in-children.html

  Anemia is a common health problem in children. The most common cause of anemia is not getting enough iron. […] In most cases, anemia is diagnosed with simple blood tests. Routine anemia screening is done because anemia is common in children and they often have no symptoms. […] The AAP recommends anemia screening with a hemoglobin blood test for all infants at 12 months. The screening should also include a risk assessment. This is a group of questions to find risk factors for iron-deficiency anemia. Risk factors include feeding problems, poor growth, and special healthcare needs. […] If the hemoglobin level is low, more blood tests are done. […] Blood tests for anemia may also be done during routine physical exam or checkups in children of any age. […] Most anemia in children is diagnosed with these blood tests: Hemoglobin and hematocrit. This is often the first screening test for anemia in children. It measures the amount of hemoglobin and red blood cells in the blood.

• #40 Iron Deficiency Anemia | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/i/iron-anemia

  Iron deficiency anemia may be suspected based on diet, symptoms of anemia, and a physical exam. Iron deficiency anemia can be confirmed by the following tests: […] A Complete Blood Count (CBC): […] Checks the amount of red blood cells and hemoglobin in the blood. […] Blood Smear: […] Looks at the red blood cells with a microscope. The red blood cells in iron deficiency anemia can be small and have less color. […] Iron studies: […] Checks the amount of iron in the blood and the amount of iron stored in the body (ferritin). […] Additional tests may be needed to find the cause of iron deficiency anemia. Stool tests to check for hidden blood may be needed. Most stool tests are collected at home and returned to the outpatient lab. Families will receive instructions on how to collect these tests.

• #41 Anemia- Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anemia-diagnosis/

  Complete WBC count […] Differential WBC count […] Platelet count […] MCV […] Mean corpuscular hemoglobin concentration (MCHC) […] RDW (RBC distribution width) […] Reticulocyte count […] Peripheral blood smear […] Characterize the Anemia […] Microcytic = MCV <80 fL [...] Ddx: [...] Iron deficiency [...] Most common [...] Bleeding is the leading cause [...] Additional Labs: [...] Serum iron [...] Total iron binding capacity (TIBC) [...] Transferrin Saturation [...] Serum ferritin [...] Adults (ug/L): [...] < 15 = diagnostic of iron deficiency [...] 15-30 = probable [...] >30 = unlikely […] >100 = normal […] ≥600 = consider iron overload […] Children (ug/L): […] < 12 diagnostic of iron deficiency [...] 12-20 possible iron deficiency [...] [...] [...] Quality Of Evidence?

• #42 Diagnosis of Iron Deficiency and Iron Deficiency Anemia with Reticulocyte Hemoglobin Content among Children Aged 6-18 Years – Iranian Journal of Blood and Cancer

  https://ijbc.ir/article-1-898-en.html

  Diagnosis of Iron Deficiency and Iron Deficiency Anemia with Reticulocyte Hemoglobin Content among Children Aged 6-18 Years. […] The American Academy of Pediatrics recommended reticulocyte hemoglobin content (Ret-He) as an alternative laboratory examination to screen and detect ID. […] Ret-He can not be used to detect iron depletion with the cut-off value of 30.3 pg with 100% sensitivity, 19.7% specificity, 100% negative predictive value (NPV), and 5.4% positive predictive value (PPV). […] A Ret-He cut-off value of 28.9 pg was established as optimal to identify ID (78.9% sensitivity, 56.2% specificity, 92.2% NPV, and 28.9% PPV) and 27 pg to detect IDA (75% sensitivity, 80% specificity, 98.1% NPV, and 18.7% PPV). […] Ret-He can be used as an alternative screening parameter to detect ID and IDA in children aged 6-18 years. Screening for IDA with Ret-He has to be done with other parameters, such as Hb examination.

• #43 How to diagnose iron deficiency in chronic disease: A review of current methods and potential marker for the outcome | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00922-6

  Iron deficiency (ID) is the most common nutritional disorder worldwide. […] The aim of this review is to provide an overview about the role of ID in chronic diseases (HF, CKD, IBD, cancer) regarding their current definitions and clinical relevance; diagnostic accuracy of iron parameters in chronic inflammatory conditions and its potential as prognostic markers. […] Due to different definitions and guideline recommendations of ID, various laboratory parameters for ID diagnostic exist and there is no general consensus about the definition of ID and its treatment. […] The most commonly used threshold values for the diagnosis of ID are TSAT of 20% and serum ferritin of 100-300 g/L. […] Studies showed that TSAT is less affected by inflammatory processes and may therefore be more accurate and reliable than serum ferritin, particularly in conditions with elevated inflammatory state.

• #44 A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

  https://www.wjgnet.com/1007-9327/full/v15/i37/4638.htm

  Serum ferritin, in the absence of inflammation (usually defined as a normal C-reactive protein level), reflects total body iron deposits. […] Thus, a low serum ferritin ( 30 ng/L) unequivocally means ID, whether accompanied by anemia or not. […] However, as serum ferritin is an acute phase reactant, a normal or even elevated ferritinemia does not exclude the presence of ID. […] In some cases, even taking into account all these determinations, ID can be difficult to diagnose. […] Once the diagnosis of IDA or ID without anemia has been established, it is necessary to investigate its origin, because it can be caused by very serious diseases. […] The initial studies should include laboratory tests, with an elementary analysis of urine. […] In patients over 50 years old, a colonoscopy is preferred to gastroscopy, and on the other hand, many of the patients under study for ID might have an indication of preventive colonoscopy screening.

• #45 How to diagnose iron deficiency in chronic disease: A review of current methods and potential marker for the outcome | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00922-6

  Routine surveillance of iron status in these groups of patients with chronic conditions is advisable to detect ID early. […] Depending on the inflammatory state, TSAT 20% may be the more accurate diagnostic marker of ID than ferritin. […] The gold standard to determine ID is to determine iron content of the bone marrow. However, this is not feasible in routine clinical practice. […] Therefore, different non-invasive biochemical markers are widely used to determine ID. […] TSAT provides information about iron availability. […] In ID, TSAT usually falls below 20%. […] TSAT as a reliable diagnostic maker for ID is often used in clinical practice and recommended in several guidelines and studies with high sensitivity and specificity. […] Diagnosis of ID in quiescent IBD can be made by serum ferritin level 30 g/L and in active IBD by serum ferritin 100 g/L or TSAT 20%.

• #46 Diagnosis and Management of Iron Deficiency Anemia in Inflammatory Bowel Disease

  https://www.ajmc.com/view/diagnosis-and-management-of-iron-deficiency-anemia-in-inflammatory-bowel-disease

  Anemia is one of the most common concerns. […] IDA in IBD is often underdiagnosed and undertreated. […] Laboratory evaluation is necessary to establish iron deficiency as the cause of anemia. […] Serum ferritin, the storage molecule for iron, is less than 30 g/L in patients with isolated iron deficiency. […] TSAT below 20% is required for the diagnosis of IDA. […] If findings indicative of inflammation are present (eg, elevated C-reactive protein), the threshold for IDA is a ferritin less than 100 g/L. […] Once a patient receives a diagnosis of IDA, appropriate treatment strategies must be selected. […] The goals of IDA treatment include normalization of Hb and iron stores and improving quality of life. […] An algorithm from Niepel and colleagues provides some guidance for screening and treatment of patients with IDA in IBD based on the 2015 European Consensus Guidelines.

• #47 Iron Deficiency – Diagnosis and Management – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/iron-deficiency

  Once iron deficiency/IDA is diagnosed, the etiology must be identified. […] The objective of treatment is to replenish iron stores: normalize hemoglobin levels and ferritin. […] Iron replacement therapy should begin as soon as iron deficiency is detected, whether or not anemia is also present. […] Oral iron replacement is almost always preferred to intravenous (IV) therapy. […] IV iron should not be considered a routine treatment. […] Iron supplementation is recommended if serum ferritin is 75 ug/L.

• #48 Anemia Diagnosis and Treatment

  https://www.webmd.com/a-to-z-guides/understanding-anemia-treatment

  To diagnose anemia, your doctor will likely ask you about your medical history, perform a physical exam, and order blood tests. […] Blood tests will not only confirm the diagnosis of anemia, but also help point to the underlying condition. Tests might include: Complete blood count (CBC), which determines the number, size, volume, and hemoglobin content of red blood cells; Blood iron level and your serum ferritin level, the best indicators of your body’s total iron stores; Levels of vitamin B12 and folate, vitamins necessary for red blood cell production; Special blood tests to detect rare causes of anemia, such as an immune attack on your red blood cells, red blood cell fragility, and defects of enzymes, hemoglobin, and clotting; Reticulocyte count, bilirubin, and other blood and urine tests to determine how quickly your blood cells are being made or if you have a hemolytic anemia, where your red blood cells have a shortened life span. […] Your doctor will monitor your red blood cell counts, including hematocrit, hemoglobin, and ferritin levels, during treatment. If your anemia doesn’t improve with iron supplements, your doctor will look for some other underlying cause.

• #49 Iron deficiency anaemia: symptoms, diagnosis and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/iron-deficiency-anaemia-symptoms-diagnosis-and-management

  Very low ferritin is a reliable predictor for IDA, whereas normal, or elevated, ferritin is not a reliable predictor for iron repletion when there is concurrent inflammation. […] Deficiency of iron, vitamin B12 and folate can occur in the presence of small bowel disease and therefore all should be checked and corrected.

• #50 Iron Deficiency Anemia | Choose the Right Test

  https://arupconsult.com/content/iron-deficiency-anemia

  An increase in Hb of 1 g/dL after 1 month of oral iron treatment confirms the diagnosis of IDA and indicates responsiveness to treatment. […] Patients considering gastric bypass should be evaluated for IDA prior to surgery. […] Patients with chronic kidney disease should be tested for IDA every 3 months, or more often if receiving hemodialysis, intravenous iron, or an erythropoietin stimulating agent. […] Anemia of inflammation is the most common complication of inflammatory bowel disease (IBD).

• #51 Diagnosis and Management of Anemia and Iron Deficiency in Heart Failure

  https://practicingclinicians.com/the-exchange/diagnosis-and-management-of-anemia-and-iron-deficiency-in-heart-failure

  Reassessment of ferritin and/or TSAT should be performed 3 months after initiation of IV iron treatment. If iron deficiency is still present, another course of IV iron can be administered. […] There are contraindications to administering IV iron, the most important of which is the presence of an active infection.

• #52 Diagnosis and Management of Iron Deficiency Anemia in Inflammatory Bowel Disease

  https://www.ajmc.com/view/diagnosis-and-management-of-iron-deficiency-anemia-in-inflammatory-bowel-disease

  IDA relapse in IBD is common, occurring in more than 50% of patients within 10 to 12 months. […] Therefore, Hb indices and iron status should be monitored every 3 months for a minimum of 1 year after anemia correction and then every 6 to 12 months once Hb normalization and replenishment of iron stores occur. […] If rapid recurrence of IDA occurs after anemia correction, the patient should be further evaluated for subclinical inflammation. […] IDA refractory to IV iron should similarly be evaluated for other etiologies or ongoing inflammation. […] In summary, IDA is the most common extraintestinal manifestation of IBD, and it is underdiagnosed and undertreated.

• #53 Iron-Deficiency Anemia: Symptoms, Causes, and More

  https://www.healthline.com/health/iron-deficiency-anemia

  Your doctor might order additional blood tests to determine how severe your anemia is and help determine treatments. […] If your doctor is concerned that internal bleeding is causing your anemia, additional tests may be needed. […] These tests can help identify sources of gastrointestinal bleeding. […] If you suspect you have an iron deficiency, see a doctor. They can diagnose anemia with blood tests. […] Don’t try to diagnose and treat iron-deficiency anemia by yourself.

• #54 A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

  https://www.wjgnet.com/1007-9327/full/v15/i37/4638.htm

  In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. […] The main techniques in this case are capsule endoscopy, followed by enteroscopy. […] The diagnosis of anemia is simple and objective: the World Health Organization defines it as the decline in blood hemoglobin to a concentration below 13 g/dL in men and 12 g/dL in women. […] However, to confirm that ID is the origin of the anemia is not always easy. […] A typical pattern is a decrease in sideremia, plasma ferritin, and transferrin saturation. […] However, this is not the usual case. […] The least reliable parameter for diagnosis of ID is probably the determination of sideremia, because it could be detected as an artefact of contamination of laboratory equipment, it has a nocturnal rhythm and it can normalize hours after ingestion.

• #55

  https://link.springer.com/article/10.1007/BF02598003

  Background and methods: To determine the diagnostic values of laboratory tests used in the diagnosis of iron-deficiency anemia, the authors conducted a systematic over-view of the relevant literature. […] Results: Serum ferritin radioimmunoassay was by far the most powerful test, with an area under the receiver operating characteristic curve of 0.95. […] Conclusion: Serum ferritin radioimmunoassay is an extremely powerful test for the diagnosis of iron-deficiency anemia and, appropriately interpreted, can be applied to the complete range of patients.

• #56 Iron deficiency anaemia

  https://www.nhs.uk/conditions/iron-deficiency-anaemia/

  Your GP may carry out repeat blood tests over the next few months to check that your iron level is getting back to normal. […] If your diet is partly causing your iron deficiency anaemia, your GP will tell you what foods are rich in iron so you can eat more of them. […] Heavy periods and pregnancy are very common causes of iron deficiency anaemia. […] Bleeding in the stomach and intestines is another common cause of iron deficiency anaemia. […] Any other conditions or actions that cause blood loss could also lead to iron deficiency anaemia. […] Untreated iron deficiency anaemia can make you more at risk of illness and infection a lack of iron affects the immune system.

• #57 Anemia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/3929-anemia

  Reticulocyte count: Reticulocytes are immature red blood cells. This test checks if your bone marrow is producing enough healthy red blood cells. […] Chronic anemia can cause serious medical issues like heart attack, heart failure and organ damage. Chronic anemia is anemia that healthcare providers dont diagnose and treat or that continues despite treatment.

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