The diagnosis of iron deficiency anaemia is not always straightforward.
Ferritin is an iron storage protein and ferritin levels generally correlate with total iron stores. A low serum ferritin provides evidence of iron deficiency. Ferritin is an acute phase protein so levels may be normal or elevated in inflammatory conditions even if there is coexisting iron deficiency. For this reason, using ferritin to identify iron deficiency in the presence of inflammation will miss iron deficiency. Ferritin may be checked with inflammatory markers such as CRP to determine if there is an acute phase response that might confound interpretation. If identification of iron deficiency anaemia can wait, the easiest way to proceed is rechecking ferritin when inflammation has resolved. In those with chronic inflammatory diseases though consideration of further 'iron studies' can be useful.
Serum iron correlated poorly with total iron stores and is subject to significant fluctuation. In severe iron deficiency, serum iron will be low but this is a late finding and low serum iron levels area again associated with acute infection, trauma and inflammation.
Examination of iron stores within the bone marrow may be useful in complex cases.
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Laboratory Investigation
Result
Treatment
Management of iron deficiency anaemia should accomplish two aims: 1) Identify the cause and manage appropriately 2) Replace iron