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Clinical Chemistry 48: 981-982, 2002;
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(Clinical Chemistry. 2002;48:981-982.)
© 2002 American Association for Clinical Chemistry, Inc.

Editorial

A Hematologic "Gold Standard" for Iron-deficient States?1

Carlo Brugnara1a

1 Children’s Hospital Boston, Department of Laboratory Medicine, 300 Longwood Ave., Boston, MA 02115

aFax 617-713-4347, E-mail carlo.brugnara@tch.harvard.edu

The first 300 words of the full text of this article appear below.

In this issue of the Journal, Thomas and Thomas (1) provide a novel approach to the diagnosis of iron-deficient states. Traditionally, iron deficiency studies have used various biochemical indicators of iron metabolism to establish the absence or presence of biochemical iron deficiency and to assess the performance of a potentially novel biochemical or hematologic marker. Biochemical indicators have included serum iron, serum transferrin, transferrin saturation, serum ferritin, and serum circulating transferrin receptor (TfR) as well as various ratios of these variables. Hematologic indices that have been used to establish the presence of iron deficiency anemia have included, in addition to hemoglobin (Hb) or hematocrit (Hct), abnormal erythrocytes or reticulocyte indices that identify the presence of hypochromic and microcytic cells. Additional variables that have been investigated include zinc protoporphyrin and erythrocyte ferritin. Studies on the diagnosis of iron-deficient states have been complicated by the absence of a clear reference method to detect biochemical iron deficiency. Iron staining of bone marrow biopsy is widely quoted as a gold standard, but the invasive nature of this procedure severely limits its use. A less invasive standard for iron deficiency is based on the hematologic response to iron replacement therapy: an increase of the reticulocyte count or reticulocyte index after oral or intravenous iron replacement therapy reveals the presence of iron deficiency.

The use of biochemical markers to diagnose iron-deficient states is problematic in clinical conditions such as the anemia of chronic disease (ACD). When a disturbed iron metabolism is associated with acute or chronic phase inflammatory responses, serum ferritin and transferrin concentrations are affected and not informative. Biochemical markers are also less effective in diagnosing functional iron deficiency, a transient discrepancy between iron supply and utilization that is mostly seen in individuals treated with recombinant human erythropoietin (r-HuEPO).

In their report, Thomas . . . [Full Text of this Article]




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