Iron deficiency indicators

Shirley, NY) sodium ferric gluconate (Ferrlecit by Watson Pharmaceuticals, Inc., Corona, CA) and iron sucrose (Venofer by American Reagent, Inc., Shirley, NY). Initiation of IV iron should be based on evaluation of iron stores. A serum ferritin level less than 100 ng/mL in conjunction with a TSAT level less than 20% indicates absolute iron deficiency and is a clear indication for the need for iron replacement.31 When TSAT is less than 20% in conjunction with normal or elevated serum ferritin levels, treatment should be based on the clinical picture of the patient, as serum ferritin is an acute phase reactant, which may become elevated with inflammation and stress. Iron supplementation may be indicated if Hgb levels are below the goal level. 

Transferrin saturation (serum iron/TIBC)—indicates the amount of transferrin that is bound with iron it is lower in iron-deficiency anemia. 

A dose-related elevation of EP or ZPP in lead workers has been documented extensively (Herber 1980 Matte et al. 1989). Correlations between PbB levels and log EP or ZPP indicate an apparent threshold for EP elevation in male workers at 25-35 pg/dL (Grandjean and Lintrup 1978 Roels et al. 1975) for FEP and a threshold of 30-40 pg/dL for EP (Roels and Lauwerys 1987 Roels et al. 1979). The threshold for EP elevation appears to be somewhat lower (20-30 pg/dL) in women than in men (Roels and Lauwerys 1987 Roels etal. 1975, 1976, 1979 Stuik 1974), regardless of whether exposure is primarily by inhalation (occupational) or oral (nonoccupational). These studies were controlled for possible confounding factors such as iron deficiency or age, both of which increase erythrocyte ZPP. 

The earliest and most sensitive laboratory change for iron-deficiency anemia is decreased serum ferritin (storage iron), which should be interpreted in conjunction with decreased transferrin saturation and increased total iron-binding capacity (TIBC). Hb, hematocrit, and RBC indices usually remain normal until later stages of iron-deficiency anemia. 

Indication Iron deficiency anemia in Patients with docu- Iron deficiency anemia... 

The parenteral use of complexes of iron and carbohydrates has resulted in anaphylactic-type reactions. Deaths associated with such administration have been reported therefore, use iron dextran injection only in those patients in whom the indications have been clearly established and laboratory investigations confirm an iron-deficient state not amenable to oral iron therapy. Because fatal anaphylactic reactions have been reported after administration of iron dextran injection, administer the drug only when resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available. 

Chromatographic determination of protoporphyrins in erythrocytes has the same indications as the spectrophotometric one. In addition, the method enables the differentiation between zinc-protoporphyrin and (metal-)free protoporphyrin. The first is elevated in iron deficiency and lead intoxication, the second in erythropoietic protoporphyria. 

Commonly, achlorhydria may not be accompanied by other diseases, but in some cases theie is a connection. F01 example, achloihydiia is an abnormality that sometimes occurs with severe iron deficiency. Histalog-fast achlorhydria, resulting from intrinsic factor deficiency in gastric juice, may be an indication of pernicious anemia. Hyperplastic polyps are often found in association with achlorhydria. 

For mild anemia, the determination of red cell indices has some value in diagnosis however, it should be realized that these indices may appear to be entirely normal and that they are subject to errors. Patients with statistically normal hemoglobin values may show a positive hemoglobin response to iron therapy. A woman with hemoglobin concentration of 13g (100 ml)-1 may be iron deficient through excessive menstrual flow for her a hemoglobin concentration of 15g (100 ml)-1... 

The only clinical indication for the use of iron preparations is the treatment or prevention of iron deficiency anemia. Iron deficiency is commonly seen in populations with increased iron... 

There is an association between iron deficiency anemia and RLS thus patients should be screened with complete blood count indices and for serum ferritin level. The iron deficit will not be found using normal parameters such as a complete blood count and iron level. A serum ferritin level of <50 is associated with RLS. 

Most patients with Al intoxication develop an erythropoietin-resistant microcytic anemia in the absence of iron deficiency, and this may be a useful early indication of Al toxicity [41,93,254,255]. The chemical similarity between Fe3+ and Al3+ suggest that both elements will have similar metabolic effects, suggesting that iron and Al compete during erythropoiesis, resulting from a reversible block in heme synthesis due either to a defect in porphyrin synthesis or to impaired iron utilization. It was also suggested that the main mechanisms for Al toxicity in the erythropoietic system are the interference of Al in the uptake and utilization of iron and an interaction of Al with cellular membrane components, affecting not only their structures but also their functions [256]. 

Perhaps the most dramatic indication of the indispensable role of transferrin as an iron donor, however, is provided by an experiment of nature. Individuals afflicted with atransferrinemia, a genetic inability to synthesize transferrin, suffer from a paradoxical co-existence of iron deficiency anemia and generalized iron overload (68, 69). Without transferrin, neither the delivery of iron to hemoglobin-synthesizing cells nor its mobilization from stores is successfully regulated. 

Mild to moderate iron-deficiency anaemia is treated by iron supplementation with ferrous sulphate or ferrous gluconate. Vitamin C can aid iron absorption. A diagnosis of iron deficiency may indicate other potential sources of iron loss, such as gastrointestinal bleeding from ulcers or colon cancer. 

Fig. 7. Cartoon depicting the functional and epistatic relationship between copper and iron uptake and trafficking in yeast. The handling of iron hy eukaryotic cells is ultimately dependent on a copper ferroxidase. In yeast, either copper deficiency or loss of function in any of the copper-handling proteins indicated in the cartoon causes an iron deficiency that is correctable readily by extranutritional copper but not by iron. Loss of function in FetSp or Ftrlp, however, is correctable by neither metal ion.

Anemia is frequently associated with scurvy, and may be either macrocytic, indicative of folate deficiency, or hypochromic, indicative of iron deficiency. 

---