Kalantar-Zadeh K, Hofftken B, Wunsch H, Find H, Kleiner M,
Diagnosis of iron deficiency anemia in renal failure patients
in the post-erythropoietin era
Am J Kidney Dis
(Aug) 26:292-299 1995
Bone marrow iron stores were assessed in a gemisch of renal
failure patients (16 HD, 4 CAPD, 5 CRF of which 2 had allografts). 23
had received EPO. All had normochromic normocytic anemia with Hgb <
11.0 g/dl. Bone marrow iron stores (BMI) were rated 0-5+, with 5+
signifying overload, 3-4+ normal, 2+ relative iron deficiency, and 0-1+
definite iron deficiency. A serum ferritin <200 ng/ml was highly
selective, in that it never occurred in patients with 3-4+ BMI stores.
However, sensitivity was only 40-50%, reflecting frequent occurrence of
high ferritins in patients with low BMI stores. TSAT < 20% had a
high sensitivity (88-90%) and not very good selectivity (40-60%).
Sensitivity of the TSAT increased to 100% and selectivity to 80% when
patients with transferrin values
<150 ng/dL (i.e., those with hypoproteinemia) were excluded. The
results suggest that combining TSAT with ferritin, and excluding
patients with low transferrin levels, is a good diagnostic approach.
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