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      Iron deficiency without anemia – a clinical challenge

      case-report
      Author(s): 1 ,
      Publication date (Electronic):
      Journal: Clinical Case Reports
      Publisher: John Wiley and Sons Inc.
      Keywords: Anemia, ferritin, hemoglobin, iron deficiency

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          Key Clinical Message

          One should always consider iron deficiency (without anemia) as the cause of persisting, unexplained unspecific, often severe, symptoms, regardless of the primary underlying disease. The symptoms of iron deficiency may arise from the metabolic systems where many proteins are iron containing. Long‐standing iron deficiency may be challenging to treat.

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          Most cited references19

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          Detection, evaluation, and management of iron-restricted erythropoiesis.

          Lawrence Goodnough, Tomas Ganz, Elizabeta Nemeth (2010)
          Progress in our understanding of iron-restricted erythropoiesis has been made possible by important advances in defining the molecular mechanisms of iron homeostasis. The detection and diagnostic classification of iron-restricted erythropoiesis can be a challenging process for the clinician. Newer assays for markers of inflammation may allow more targeted management of the anemia in these conditions. The availability of new intravenous iron preparations provides new options for the treatment of iron-restricted erythropoiesis. This review summarizes recent advances regarding the detection, evaluation, and management of iron-restricted erythropoiesis.
          Article 0 comments Cited 121 times – based on 0 reviews     Review now
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            Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency.

            Kari Punnonen, Kerttu Irjala, Allan Rajamäki (1997)
            The objective of the study was to evaluate the diagnostic efficiency of laboratory tests, including serum transferrin receptor (TfR) measurements, in the diagnosis of iron depletion. The patient population consisted of 129 consecutive anemic patients at the University Hospital of Turku who were given a bone marrow examination. Of these patients, 48 had iron deficiency anemia (IDA), 64 anemia of chronic disease (ACD), and 17 patients had depleted iron stores and an infectious or an inflammatory condition (COMBI). Depletion of iron stores was defined as a complete absence of stainable iron in the bone marrow examination. Serum TfR concentrations were elevated in the vast majority of the IDA and COMBI patients, while in the ACD patients, the levels were within the reference limits reported earlier for healthy subjects. TfR measurement thus provided a reliable diagnosis of iron deficiency anemia (AUC(ROC) 0.98). Serum ferritin measurement also distinguished between IDA patients and ACD patients. However, the optimal decision limit for evaluation of ferritin measurements was considerably above the conventional lower reference limits, complicating the interpretation of this parameter. Calculation of the ratio TfR/log ferritin (TfR-F Index) is a way of combining TfR and ferritin results. This ratio provided an outstanding parameter for the identification of patients with depleted iron stores (AUC(ROC) 1.00). In anemic patients, TfR measurement is a valuable noninvasive tool for the diagnosis of iron depletion, and offers an attractive alternative to more conventional laboratory tests in the detection of depleted iron stores.
            Article 0 comments Cited 91 times – based on 0 reviews     Review now
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              Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration.

              Christian Breymann, Georg Schulthess, J Furrer … (2011)
              This is the first study to investigate the efficacy of intravenous iron in treating fatigue in nonanemic patients with low serum ferritin concentration. In a randomized, double-blinded, placebo-controlled study, 90 premenopausal women presenting with fatigue, serum ferritin ≤ 50 ng/mL, and hemoglobin ≥ 120 g/L were randomized to receive either 800 mg of intravenous iron (III)-hydroxide sucrose or intravenous placebo. Fatigue and serum iron status were assessed at baseline and after 6 and 12 weeks. Median fatigue at baseline was 4.5 (on a 0-10 scale). Fatigue decreased during the initial 6 weeks by 1.1 in the iron group compared with 0.7 in the placebo group (P = .07). Efficacy of iron was bound to depleted iron stores: In patients with baseline serum ferritin ≤ 15 ng/mL, fatigue decreased by 1.8 in the iron group compared with 0.4 in the placebo group (P = .005), and 82% of iron-treated compared with 47% of placebo-treated patients reported improved fatigue (P = .03). Drug-associated adverse events were observed in 21% of iron-treated patients and in 7% of placebo-treated patients (P = .05); none of these events was serious. Intravenous administration of iron improved fatigue in iron-deficient, nonanemic women with a good safety and tolerability profile. The efficacy of intravenous iron was bound to a serum ferritin concentration ≤ 15 ng/mL. This study was registered at the International Standard Randomized Controlled Trial Number Register (www.isrctn.org) as ISRCTN78430425.
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                Author and article information

                Contributors
                Esa T. Soppi:
                ORCID: http://orcid.org/0000-0003-2498-0675
                esa.soppi@eiransairaala.fi
                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (doi): 10.1002/(ISSN)2050-0904
                Journal ID (publisher-id): CCR3
                Title: Clinical Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2050-0904
                Publication date (Electronic): 17 April 2018
                Publication date Collection: June 2018
                Volume: 6
                Issue: 6 ( doiID: 10.1002/ccr3.2018.6.issue-6 )
                Pages: 1082-1086
                Affiliations
                [ 1 ] Outpatient clinic Eira Hospital Laivurinkatu 29 Helsinki 00150 Finland
                Author notes
                [*] [* ] Correspondence

                Esa T. Soppi, Outpatient clinic, Eira Hospital, Laivurinkatu 29, Helsinki 00150, Finland.

                Tel: +35891620570; Fax: +35891620579;

                E‐mail: esa.soppi@ 123456eiransairaala.fi

                Author information
                http://orcid.org/0000-0003-2498-0675
                Article
                Publisher ID: CCR31529
                DOI: 10.1002/ccr3.1529
                PMC ID: 5986027
                PubMed ID: 29881569
                SO-VID: dc021450-1069-4ea6-bfb5-b30e3154665d
                Copyright © © 2018 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 January 2018
                Date revision received : 11 March 2018
                Date accepted : 12 March 2018
                Page count
                Figures: 2, Tables: 0, Pages: 5, Words: 3201
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                component-id ccr31529
                cover-date June 2018
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.0 mode:remove_FC converted:04.06.2018

                Keywords: anemia,ferritin,hemoglobin,iron deficiency
                Data availability:
                Keywords: anemia, ferritin, hemoglobin, iron deficiency

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