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Clin Chem Lab Med. 2012 Feb 11;50(8):1343-9. doi: 10.1515/cclm-2011-0594.

The transferrin/log(ferritin) ratio: a new tool for the diagnosis of iron deficiency anemia.

Author information

1
Department of Clinical Chemistry and Hematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands. r.castel@asz.nl

Abstract

BACKGROUND:

Serum ferritin is the best single laboratory test to diagnose iron deficiency anemia (IDA). Ferritin levels <20 μg/L are highly specific for IDA, and ferritin levels >100 μg/L usually exclude IDA. However, ferritin concentrations between 20 and 100 μg/L are often inconclusive. The objective of this study was to improve the diagnosis of IDA when ferritin levels are inconclusive.

METHODS:

We evaluated the predictive performance of classic (ferritin, mean corpuscular volume, transferrin and serum iron) and modern [reticulocyte hemoglobin content, serum transferrin receptor and soluble transferrin receptor (sTfR)/log(ferr)] iron status parameters to diagnose IDA in 2084 anemic, non-hospitalized patients. The results were validated in an independent cohort of 274 anemic patients.

RESULTS:

In our study population, 29% (595 patients) of the patients had a ferritin level between 20 and 100 μg/L, hampering diagnosis of IDA. None of the classic or modern parameters was capable of completely separating the IDA population from the non-IDA population. However, using a new parameter, the transferrin/log(ferritin) ratio, the IDA and non-IDA populations can be completely separated. At a cut-off value of 1.70, the transferrin/log(ferritin) ratio indicates IDA in 29% of the patients with inconclusive ferritin levels.

CONCLUSIONS:

The transferrin/log(ferritin) ratio is a practical new tool that improves diagnosis of iron deficiency when ferritin levels are inconclusive.

PMID:
22868798
DOI:
10.1515/cclm-2011-0594
[Indexed for MEDLINE]

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