Fishbane S, Maesaka J
Factors predictive of suboptimal iron stores in hemodialysis patients with normal iron indices
Am Soc Nephrol
J Am Soc Nephrol (abstract) (Nov) 6:520 1995

This study by my group was based on our finding of improved erythropoiesis in hemodialysis patients with "normal" TSATs and ferritins after treatment with iv iron. This suggested that currently accepted normal levels of TSAT and ferritin may underdiagnose suboptimal iron stores. In this study we administered iv iron to HD patients with ferritin greater than 100 and TSAT greater than 15%. We then used receiver operator curves to define the utility of several diagnostic tests for iron stores. Our primary finding was that no test of iron stores offered a very strong utility for diagnosis in this population. The single test with the greatest utility was the TSAT at a level of 21%. The combination of a TSAT of less than 25% and a serum ferritin of less than 200 offered relatively high sensitivity and specificity for the detection of patients with suboptimal iron stores. (Fishbane)

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Am Soc Nephrol
CRF by problem area : Anemia/Erythropoietin/Iron


IS THERE A LEVEL OF TSAT OR FERRITIN AT WHICH IV IRON-DEXTRAN IS CONTRAINDICATED? IT APPEARS THAT THE "INDICATED" LEVELS CONTINUE TO RISE.
LEWIS I SCHAINUCK,MD (lisaspen@aol)
LAKEWOOD, CA USA-Monday, September 23, 1996 at 20:29:48 (CDT)

Generally we will not administer iron to patients with a serum ferritin above 1000 ng/ml. I believe that there is little risk for parenchymal iron deposition below this value. An older study of liver biopsy found the risk of parenchymal iron deposition was low with a serum ferritin of < 2,000 ng/ml. Some investigators in Europe use this value as a cutoff for iron administration. You should be aware, however, that there are also studies which have found that the serum ferritin concentration cannot accurately rule out the possibility of iron overload.
Steven Fishbane (steveb930@aol.com)
Mineola, NY USA-Tuesday, September 24, 1996 at 07:09:40 (CDT)

When are we going to see the recommendations on Iron management forn the D.O.Q.I anemia pannel?
Sergio R. Vega MD
Atlanta, GA USA-Wednesday, March 05, 1997 at 11:51:45 (PST)