These are available on modern analysers and most UK laboratories would be able to run these tests relatively easily. Blood filmĪ blood film can be helpful if there is diagnostic uncertainty and can show morphological changes, which might support the conclusion that a patient is iron deficient.īlood film features which make iron deficiency more likely include anisocytosis, microcytosis, hypochromia, pencil cells, target cells, and elliptocytes. There is no strong evidence for a diagnostic threshold, but the BSH consensus guidelines suggest levels <16% as supportive of a diagnosis of iron deficiency if initial tests are inconclusive. In an iron-deficient state, the body produces more transferrin to increase the total iron-binding capacity and so acquire more iron for its cells. Transferrin is the primary serum iron transporter molecule in the body. Transferrin saturation is the ratio of total serum iron (or the total iron-binding capacity) to transferrin expressed as a percentage. If the first screening tests are inconclusive, but the suspicion remains that a patient might be iron deficient, BSH suggest requesting secondary investigations which are listed below. Therefore, CRP is suggested as part of the initial screening test, as serum ferritin within the normal range cannot exclude iron deficiency if a patient has raised inflammatory markers or a history of acute or chronic illness.įigure 1. The British Society for Haematology (BSH) guidelines suggest a serum ferritin level of 5 years.Ī level of <150 μg/l should act as a trigger to consider further investigations for potential iron deficiency if a patient has a concurrent inflammatory condition (acute or chronic) or renal impairment. However, serum ferritin is an acute-phase protein, and so increases in inflammatory states, chronic kidney disease, liver disease, and malignancy. There is a direct correlation between serum ferritin levels and overall iron stores in health. Small amounts of ferritin are released into the serum to transport and absorb excess iron and therefore act as a surrogate serum marker for body iron storage. Serum ferritinįerritin is an intracellular protein complex that binds iron and is responsible for most iron storage in the body. These findings are non-specific and may not be present in all iron-deficient patients.įor more information, see the Geeky Medics guide to full blood count interpretation. These may be low in iron deficiency, while red cell distribution width (RDW) may be elevated. To gain more information about iron status, review the mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). Although these measures do not provide any direct information about iron stores. These tests allow the identification and quantification of anaemia by measuring the haemoglobin (Hb) and haematocrit (Hct) which is typically seen in iron deficiency. If iron deficiency anaemia is suspected, initial screening investigations should include:įull blood count (FBC) and red cell parameters
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