Red cell ferritin content: a re-evaluation of indices for iron deficiency in the anaemia of rheumatoid arthritis.

Davidson, Anne; Weyden, Martin B Van Der; Fong, H.; Breidahl, Margot J.; Ryan, P. F. J.

doi:10.1136/bmj.289.6446.648

Cited by 14 publications

(5 citation statements)

References 17 publications

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“…Clinical and biological studies suggested that eryth roblast ferritin synthesis depends on the balance between iron supply to the erythroblast and its utilization for Hb production [12][13][14], Previous studies have shown that in some pathological conditions, such as rheumatoid arthri tis and liver disease, EF could be more useful than other parameters to assess the body iron status [15,16], In this study we showed that in CHD patients both EF and SF were scattered over a wide range. A little group of CHD patients (table 1, group 3) had a consensual increase of EF and SF values in comparison with nonnephropathic sub jects: they had been frequently transfused or treated with parenteral iron in the past and an iron overload was likely to be present.…”

Section: Discussionmentioning

confidence: 82%

“…For these reasons, EF may be a useful parameter to disclose the real iron need in patients with increased or reduced red cell turnover. Moreover, EF seems to be scarcely influenced by those factors such as liver cell necrosis [15] or inflammatory diseases [16] that may specifically increase SF levels [7], To our knowl edge, no data on EF behavior in CHD patients are pres ently available. In this study, we evaluated EF levels in 35 patients on CHD with different body iron stores assessed according to SF levels.…”

Section: Introductionmentioning

confidence: 99%

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Erythrocyte Ferritin in Patients on Chronic Hemodialysis Treatment

Brunati¹,

Piperno²,

Guastoni³

et al. 1990

Nephron

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Serum ferritin (SF) and erythrocyte ferritin (EF) were evaluated in 35 patients on chronic hemodialysis treatment (CHD), in 45 healthy subjects and in 22 nonnephropathic females with iron deficiency anemia. Twenty-five CHD patients with basal SF < 500 μg/l were treated orally with 200 mg of Fe²⁺ for 2 months and the positive (hemoglobin increase > 1 g/dl) or negative response to the therapy was correlated to the basal levels of SF and EF. Three groups of CHD patients could be defined on the basis of their basal SF levels (hypo-, normo- or hyperferritinemic). Nine patients with increased SF levels had also EF levels significantly higher than the other CHD patients and controls since they were probably iron-overloaded. In the other 2 groups of CHD patients, EF levels were significantly higher than in controls for each level of SF probably because of the reduced utilization of iron by uremic bone marrow. Among the 25 treated CHD patients, only 5 responded to the therapy: 3 were hypoferritinemic while the other 2 responders had basal SF within the normal range. Four hypoferritinemic patients did not respond to the therapy. Four out of five responders had the lowest EF levels among CHD patients. EF measurement could be an important and useful test in detecting the presence of an iron deficiency erythropoiesis in CHD patients.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Erythrocyte Ferritin in Patients on Chronic Hemodialysis Treatment

Brunati¹,

Piperno²,

Guastoni³

et al. 1990

Nephron

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“…It has been suggested that the usual lower limits of normal for this assay (12-15 ng/ml) should be adjusted in these settings to compensate for this recognized difference. Recommended adjusted cutoff levels for SERFER have vaned from 50 to 110 ng/ml [6,9,22,23]. In spite of such modifications, the evaluation of iron stores in these common clinical states continues to be difficult.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that the basic (hepatic/spleen type) ferritin fraction remains unchanged throughout the red cell lifespan [ 101. For this reason it has been proposed that a RBCFER measurement may represent a stable protein and thus may be a more effective tool in assessing iron stores in chronic disease [ 141, rheumatoid arthritis [22], and liver disease [13,24].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of bone marrow iron stores in anemia associated with chronic disease: A comparative study of serum and red cell ferritin

et al. 1993

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The serum ferritin (SERFER) may be elevated and misleading in the setting of chronic disease (chronic inflammation, liver disease, and neoplasm). The red cell ferritin (RBCFER) may be more stable in clinical situations that affect the SERFER. We compared the ability of SERFER and RBCFER to assess iron stores in these settings. Iron stores were defined by bone marrow aspirate staining. We studied 120 anemic (Hb < 14 g/dl) male patients. Twenty-eight (23%) were iron deficient based on the absence of marrow iron. The SERFER correlation with marrow iron stores (r = 0.58; P < 0.001) was better than the RBCFER (r = 0.36; P < 0.001). Cutoff values for the diagnosis of iron deficiency were determined by chi-square analysis (SERFER < 70 ng/ml; RBCFER < or = 4 ag/RBC). The sensitivity for detecting iron deficiency with SERFER (0.60) was less than RBCFER (0.82). The specificity of SERFER (0.90) was slightly better than RBCFER (0.83). Neither difference reached statistical significance (P > 0.05). The positive predictive value between the two assays was the same (SERFER 0.65 vs. RBCFER 0.59). The combination of SERFER < 70 ng/ml with RBCFER < or = 4 ag/RBC was more specific (0.97) when compared with the SERFER alone (0.90) (P = 0.04). In addition, the potential of this combination to predict iron deficiency (0.82) was higher than that seen with either SERFER (0.65) or the RBCFER (0.59). Our findings show that the RBCFER as a single assay is not anymore accurate than the SERFER. However, we find that the RBCFER can effectively complement the SERFER to either predict iron depletion or confirm the presence of bone marrow iron.

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“…The concentration tends to vary inversely with the red cell protoporphyrin concentration (107). Thus in patients with rheumatoid arthritis and anaemia, a low concentration is found in those with microcytosis, and a low serum iron concentration is observed regardless of the serum ferritin concentration (109). The red cell ferritin concentration does not therefore necessarily indicate the concentration of iron in storage.…”

Section: Red Cell Ferritin and Its Diagnostic Usementioning

confidence: 97%