Abstract
The serum ferritin assay is the best single blood test for the diagnosis of iron deficiency. Previous studies with elderly anemic patients have suggested that ferritin level less than 45 μg/L is indicative of iron deficiency. The subjects of these studies were hospitalized patients with anemia, however. We thus conducted a prospective study to determine the normal minimum level of serum ferritin of community-dwelling older adults by assessing the ratio of serum transferrin receptor to the log ferritin level (sTfR-F index). We conducted the anemia survey between October and November 2002. A total of 1,254 apparently healthy older adults, aged between 60 and 95 years, from three urban community dwellings participated in the survey. Among these individuals, 156 subjects who were anemic or whose serum ferritin level was less than 100 μg/L were selected. The soluble transferrin receptor assay was performed and the sTfR-F index was calculated. The receiver operating characteristic curve analysis was performed. Based on the data, serum ferritin level of 22 μg/L was selected as the cutoff value for the diagnosis of iron deficiency in community-dwelling older adults. Applying the serum ferritin cutoff of 22 μg/L and the sTfR-F index cutoff of 1.5, the sensitivity of the assay was 89.5% (34 of 38) and the specificity was 89.0% (105 of 118). In conclusion, for the diagnosis of iron deficiency of community-residing older adults, we suggest the serum ferritin cutoff value of 22 μg/L obtained by use of the sTfR-F index. The value is lower than the previous value established for hospitalized and anemic older adults.
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References
Andrews NC (2003) Disorders of iron metabolism. In: Handin RI, Lux SE, Stossel TP (eds) Blood principles and practice of hematology, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, pp 1410–1412
Ania BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton LJ III (1997) Incidence of anemia in older people: an epidemiologic study in a well-defined population. J Am Geriatr Soc 45:825–831
Balducci L (2003) Epidemiology of anemia in the elderly: information on diagnostic evaluation. J Am Geriatr Soc 51:S2–S9
Casale G, Bonora C, Migliavacca A, Zurita IE, de Nicola P (1981) Serum ferritin and aging. Age Ageing 10:119–122
Cermak J, Brabec V (1998) Transferrin receptor–ferritin ratio: a useful parameter in differential diagnosis of iron deficiency and hyperplastic erythropoiesis [letter]. Eur J Haematol 61:210–212
Fletcher RH, Fletcher SW, Wagner EH (1996) Clinical epidemiology: the essentials. Williams and Wilkins, Baltimore
Flowers CH, Skikne BS, Covell AM, Cook JD (1989) The clinical measurement of transferrin receptor. J Lab Clin Med 114:368–377
Guyatt GH, Patterson C, Ali M, Singer J, Levine M, Turpie I, Meyer R (1990) Diagnosis of iron-deficiency anemia in the elderly. Am J Med 88:205–209
Holyoake TL, Stott DJ, McKay PJ, Hendry A, MacDonald JB, Lucie NP (1993) Use of plasma ferritin concentration to diagnose iron deficiency in elderly patients. J Clin Pathol 46:857–860
Huebers HA, Finch CA (1987) The physiology of transferrin and transferrin receptors. Physiol Rev 67:520–582
Jacobs A, Worwood M (1975) Ferritin in serum. Clinical and biochemical implications. N Engl J Med 292:951–956
Joosten E, Pelemans W, Hiele M, Noyen J, Verhaeghe R, Boogaerts MA (1992) Prevalence and causes of anaemia in a geriatric hospitalized population. Gerontology 38:111–117
Kohgo Y, Niitsu Y, Kondo H, Kato J, Tsushima N, Sasaki K, Hirayama M, Numata T, Nishisato T, Urushizaki I (1987) Serum transferrin receptor as a new index of erythropoiesis. Blood 70:1955–1958
Krause JR, Stolc V (1980) Serum ferritin and bone marrow biopsy iron stores, II: correlation with low serum iron and Fe/TIBC ratio less than 15%. Am J Clin Pathol 74:461–464
Lipschitz DA, Cook JD, Finch CA (1974) A clinical evaluation of serum ferritin as an index of iron stores. N Engl J Med 290:1213–1216
Loria A, Hershko C, Konijin AM (1979) Serum ferritin in an elderly population. J Gerontol 34:521–524
Means RT Jr, Allen J, Sears DA, Schuster SJ (1999) Serum soluble transferrin receptor and the prediction of marrow aspirate iron results in a heterogeneous group of patients. Clin Lab Haem 21:161–167
Patterson C, Turpie ID, Benger AM (1985) Assessment of iron stores in anemic geriatric patients. J Am Geriatr Soc 33:746–767
Punnonen K, Irjala K, Rajamaki A (1997) Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89:1052–1057
Rimon E, Levy S, Sapir A, Gelzer G, Peled R, Ergas D, Sthoeger ZM (2002) Diagnosis of iron deficiency anemia in the elderly by transferrin receptor–ferritin index. Arch Intern Med 162:445–449
Skikne BS, Flowers CH, Cook JD (1990) Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood 75:1870–1876
Suominen P, Punnonen K, Rajamaki A, Irjala K (1998) Serum transferrin receptor and transferrin receptor–ferritin index identify healthy subjects with subclinical iron deficits. Blood 92:2934–2939
Witte DL (1991) Can serum ferritin be effectively interpreted in the presence of the acute-phase response? Clin Chem 37:484–485
Zacharski LR, Ornstein DL, Woloshin S, Schwartz LM (2000) Association of age, sex, and race with body iron stores in adults: analysis of NHANES III data. Am Heart J 140:98–104
Acknowledgements
This study was supported by the Brain Korea 21 Project in 2003. The corresponding author (J. Lee)’s research was supported by the grant from the Medical Research Center for Environmental Toxicogenomics and Proteomics, funded by Korea Science and Engeneering Foundations and Ministry of Science and Technology.
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Choi, C.W., Cho, W.R., Park, K.H. et al. The cutoff value of serum ferritin for the diagnosis of iron deficiency in community-residing older persons. Ann Hematol 84, 358–361 (2005). https://doi.org/10.1007/s00277-005-1033-5
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DOI: https://doi.org/10.1007/s00277-005-1033-5