Iron deficiency anemia in the clinical laboratory
DOI:
https://doi.org/10.35954/SM2020.39.1.4Abstract
Iron deficiency or ferropenia is the most common cause of anemia and is usually secondary to blood loss; malabsorption is a less frequent cause. The symptoms are usually nonspecific. Red blood cells tend to be microcytic and hypochromic, and iron deposits are low, as shown by decreased serum ferritin and low serum iron concentrations with high total iron-binding capacity. In recent years, the clinical laboratory has added new biomarkers to those traditionally used, in order to improve their contribution to the diagnosis and monitoring of ferropenia. Thus, there is currently a set of tools in the laboratory for this purpose, among which the following stand out: morphological diagnosis of peripheral blood, haemometric indices, and plasma concentrations of transferrin together with the indices calculated from it, ferritin, soluble receptor of transferrin and haemoglobin. At the time of diagnosis, occult blood loss should be suspected until proven otherwise.
Treatment consists of iron replacement and treatment of the cause of bleeding.
The present work is a bibliographic review on iron deficiency anemia, focused mainly on studies carried out in the laboratory for its diagnosis and follow-up, with the aim of making an updated contribution on the subject.
Downloads
References
(1) Pérez Surribas D, Gella Concustell A, Cruz Iglesias E, Hermoso Durán S, Urrechaga Igartua E, Alcaide Martín MJ, et al. Estudio de la ferropenia en el laboratorio clínico. Revista del Laboratorio Clínico 2019; 12(4):e34-e53. doi:10.1016/j.labcli.2019.01.004
(2) Vives Corrons JL, Altés A. Anemia ferropénica y trastornos del metabolismo del hierro. En: Sans-Sabrafen J, Besses Raebel L, Vives Corrons JL. Hematología Clínica. 5a.ed. Madrid : Elsevier, 2006. p. 127-161.
(3) Del Castillo Busto ME, Montes-Bayón M, Sanz-Medel A. The potential of mass spectrometry to study iron-containing proteins used in clinical diagnosis. Anal Chim Acta 2009; 634(1):1-14. doi: 10.1016/j.aca.2008.12.014
(4) Moya Arnao M, Blanquer M, Moraleda Jiménez JM. Anemias carenciales. Medicine 2016; 12(20):1136-1147. doi:10.1016/j.med.2016.10.002
(5) Nemeth E, Tuttle MS, Powelson J, Vaughn MB, Donovan A, Ward DM, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science 2004; 306(5704):2090-3. doi: 10.1126/science.1104742
(6) González de Villambrosia S, Núñez J, González Mesones B, Insunza A. Trastornos del metabolismo del hierro y anemia ferropénica. Medicine 2012; 11(20):1202-11. doi: 10.1016/S0304-5412(12)70471-7
(7) Braunstein EM. Anemia ferropénica (Anemia por hemorragia crónica, clorosis) [Sitio Web]. Kenilworth, NJ., USA; [actualizada noviembre de 2016; acceso 4 de julio de 2019]. Disponible en: https://www.msdmanuals.com/es/professional/hematolog%C3%ADa-y-oncolog%C3%ADa/anemias-causadas-por-deficiencia-de-la-eritropoyesis/anemia-ferrop%C3%A9nica.
(8) Jett M, Jamieson GA, DeBernardo SL. The carbohydrate sequence of the glycopeptide chains of human transferrin. J Biol Chem 1971; 246(11):3686-93.
(9) Ramsay WN. The determination of the total iron-binding capacity of serum. 1957. Clin Chim Acta 1997; 259(1-2):25-30. doi: 10.1016/s0009-8981(96)06489-3
(10)Worwood M. The laboratory assessment of iron status--an update. Clin Chim Acta 1997; 259(1-2):3-23. doi: 10.1016/s0009-8981(96)06488-1
(11) Cook J, Baynes R, Skikne B. Iron deficiency and the measurement of iron status. Nutr Res Rev 1992; 5(1):198-202. doi: 10.1079/NRR19920014
(12) Flemming RE, Bacon BR. Orchestration of iron homeostasis. N Engl J Med 2005; 352(17):1741-4. doi: 10.1056/NEJMp048363
(13) Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood 2003; 102(3):783-8. doi: 10.1182/blood-2003-03-0672
(14) Vernet M. Le récepteur de la transferrine: rôledans le metabolism du fer et intérêt en biologieclinique. Ann Biol Clin 1999; 57(1):9-17.
(15) Skikne BS, Flowers CH, Cook JD. Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood 1990; 75(9):1870-6.
(16) Suominen P, Punnonen K, Rajamäki A, Irjala K. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood 1998; 92(8):2934-9.
(17) Sherwood RA, Pippard MJ, Peters TJ. Iron homeostasis and the assessment of iron status. Ann Clin Biochem 1998; 35(Pt 6):693-708. doi: 10.1177/000456329803500601
(18) Punnonen K, Irjala K, Rajamäki A. Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 1997; 89(3):1052-7.
(19) World Health Organization. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia.1998. Rebecca J. Stoltzfus, Michele L. Dreyfuss, Eds. Available from: https://www.who.int/nutrition/publications/micronutrients/guidelines_for_Iron_supplementation.pdf?ua=1 [Consulted 12/06/2019]
(20) Urrechaga E, Borque L, Escanero JF. Review Biomarkers of hypochromia: the contemporary assessment of Iron status anderythropoiesis. Biomed Res Int 2013; 603-786. doi: 10.1155/2013/603786
(21) Piva E, Brugnara C, Chiandetti L, Plebani M. Automated reticulocyte counting: state of the art and clinical applications in the evaluation of erythropoiesis. Clin Chem Lab Med 2010; 48(10):1369-80. doi: 10.1515/CCLM.2010.292
(22) Buttarello M, Bulian P, Farina G, Petris MG, Temporin V, Toffolo L. Five fully automated methods for performing immature reticulocyte fraction: comparison in diagnosis of bone marrow aplasia. Am J Clin Pathol 2002; 117(6):871-9. doi: 10.1309/VJAA-L52P-FGRM-QGRU
(23) Buttarello M. Laboratory diagnosis of anemia: are the old and new red cell parameters useful in classification and treatment, how? Int J Lab Hematol 2016; 38 Suppl 1:123-32. doi: 10.1111/ijlh.12500
(24) Thomas W, Hinchliffe R, Briggs C, Macdougall I, Littlewood T, Cavill I. Guideline for the laboratory diagnosis of functional iron deficiency. Br J Haematol 2013; 161(5):639-48. doi: 10.1111/bjh.12311
(25) Camaschella C. Iron-deficiency anemia. N Engl J Med 2015; 372(19):1832-43. doi: 10.1056/NEJMra1401038
Published
How to Cite
Issue
Section
License
Until 2024 we use the Creative Commons Attribution/NonCommercial Attribution 4.0 International License https://creativecommons.org/licenses/by-nc/4.0/deed.es. Which states that: you are free to share, copy and redistribute the material in any medium or format, as well as to adapt, remix, transform and build upon the material. Under the following terms:
Attribution: you must give proper credit , provide a link to the license, and indicate if changes have been made . You may do so in any reasonable manner, but not in such a way as to suggest that you or your use is endorsed by the licensor.
NonCommercial: you may not use the material for commercial purposes.
As of 2025 authors retain their copyright and assign to the journal the right of first publication of their work, which shall simultaneously be subject to the license https://creativecommons.org/licenses/by-nc-sa/4.0/deed.es that permits sharing, copying and redistribution of the material in any medium or format provided that initial publication in this journal is indicated. Adapt, remix, transform and build upon the material. If you remix, transform, or build from the material, you must distribute your contribution under the same license as the original and may not make use of the material for commercial purposes.
Under the following terms:
1. Attribution: you must give proper credit, provide a link to the license, and indicate whether changes have been made. You may do so in any reasonable manner, but not in such a way as to suggest that you or your use is endorsed by the licensor.
2. NonCommercial: you may not use the material for commercial purposes.
3. ShareAlike: if you remix, transform or build upon the material, you must distribute your contribution under the same license as the original.
PlumX Metrics
