Clinical Assessment of Iron Status

With adequate iron status, there is sufficient iron to meet all of iron's functional roles and a small reserve of storage iron that can be mobilized when needed (Figure 5). Excessive body iron, stored in liver and bone marrow, is marked by elevated serum ferritin and also serum iron and transferrin saturation. Ferritin in plasma corresponds well with body iron stores, but its use as an indicator is limited under inflammatory conditions. Iron deficiency occurs when iron stores are depleted and the iron transported for physiological function is reduced. Iron deficiency without anemia is commonly detected from abnormal values for two out of three blood indices, usually serum ferritin, transferrin saturation, and free erythrocyte protoporphyrin (Figure 5). As iron deficiency becomes more severe, iron deficiency anemia results, with small, pale erythocytes and reduced blood hemoglobin and hematocrit. Measurement of hemoglobin in reticulocytes, or immature red blood cells, is a possible new tool to assess developing anemias. The ratio of serum transferrin receptor to serum ferritin provides a single, sensitive indicator of iron status across the full range of body iron status, except under conditions of inflammatory stress.

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