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Iron stores:

Serum ferritin
Indicates the iron store status and decreased serum ferritin is the first, most
sensitive and specific test for iron deficiency. The levels <15 g/L indicate
depletion of iron stores (normal levels 15-300 g/L) and is diagnostic of iron
deficiency.
Because ferritin is an acute phase reactant protein, it is not reliable in the
presence of infection, inflammation, hemolysis and neoplasia. In those situations
serum ferritin may be normal or high despite tissue iron depletion.
Reduced iron stores inhibit hepcidin synthesis and its serum levels are
decreased.

b. Tissue iron supply


Serum iron: Reduced to 10-15 g/dL (normal 50-150 g/dL).
Serum transferrin saturation: Transferrin is the major physiological transport
protein
for iron in the blood, which transports iron to cells. Transferrin saturation is
the
proportion of available sites on transferrin for iron binding that is occupied by
iron atoms
and is expressed as percentage. Normally, only 33% (normal 30-40%) of transferrin
is
saturated. Low serum iron with increased iron-binding capacity results in a
reduction
of transferrin saturation levels to below 15%.
Total plasma iron-binding capacity (TIBC): Transferrin has the capacity to bind
approximately 300 g/dL (normal 310-340 g/dL) of iron. This value is known as
total
plasma iron-binding capacity. This is increased to 350-450 g/dL.

Table 3.4: Serum iron profile in IDA


Normal range Value in IDA Observation
Serum ferritin 15-300 g/L <15g/L Decreased
Serum iron 50-150 g/dL 10-15 g/dL Decreased
Serum transferrin saturation 30-40% <15% Decreased
Total plasma iron-binding capacity (TIBC) 310-340 g/dL 350-450 g/dL Increased
Serum transferrin receptor (TFR) 0.57-2.8 g/L 3.5-7.1 g/L Increased
Red cell protoporphyrin 30-50 g/dL >200 g/dL Increased5:50 PM 3/29/2017

Serum transferrin receptor (TfR) assays: Serum transferrin receptor protein


levels are
increased in iron deficiency anemia and helps in differentiating it from anemia of
chronic
disorders in which it is in the normal range of 4-8 g/L.
Red cell protoporphyrin: Reduced heme synthesis leads to elevation of free
erythrocyte
protoporphyrin to >200 g/dL (Normal 30-50 g/dL).

c. Functional iron: Decreased functional iron results in reduced Hb, MCV and MCH.
Other Causes of Microcytic Hypochromic Anemia
Thalassemia major: Presents with features of hemolytic anemia and
hepatosplenomegaly.
The iron stores are increased.
Anemia of chronic disorders: Clinical features of underlying chronic disorders
are present
and iron stores are either normal or increased.
Other causes: These include alcohol, lead poisoning and drugs.
Essentials in Hematology and Clinical Pathology - Jaypee Brothers Medical
Publishers (P) Ltd

Ramadas Nayak, Sharada Rai, Astha Gupta