title: Detection of iron-deficiency anemia in hospitalized patients by zinc protoporphyrin.
abstract: The diagnostic value of zinc protoporphyrin (ZPP) as an indicator of iron-deficient anemia (IDA) in hospitalized patients is assessed in this study. ZPP was measured using an AVIV hematofluorometer with a coefficient of variation (CV) less than 5% and a recovery of greater than 97%. A reference range of 53-70 mu mol/mol heme was determined for ZPP in non-anemic patients in a hospital population. Hospitalized patients (221) with low hemoglobin (< 120 g/l) were evaluated for their iron status. ZPP and other anemia tests were performed. Macrocytic patients with mean corpuscular volume (MCV) greater than 98 fl) were excluded from the study. Seventy-four microcytic patients (MCV < 80 fl) were determined as having IDA according to a diagnostic algorithm. A distribution study of these microcytic patients showed that there was a significant overlap of values between the IDA and non-IDA patients for all serum anemia tests. A receiver-operator curve analysis revealed that ZPP has a relatively high degree of diagnostic efficiency better than iron and ferritin for this patient population. At a cutoff value > 170 mu mol/mol heme, ZPP has a sensitivity of 93% and a specificity of 90%. In addition, ZPP is also elevated in normocytic patients (MCV = 80-98 fl) with low ferritin values, who may have iron depletion. From these data, it is proposed that ZPP may be used as a screening tool for IDA in hospitalized patients.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston 77030, USA. wong@casper.med.uth.med.edu
authors.forename: S S
authors.initials: SS
authors.lastname: Wong
authors.forename: A S
authors.initials: AS
authors.lastname: Qutishat
authors.forename: J
authors.initials: J
authors.lastname: Lange
authors.forename: T G
authors.initials: TG
authors.lastname: Gornet
authors.forename: L M
authors.initials: LM
authors.lastname: Buja
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis*; D004911:Erythrocyte Volume; D005260:Female; D005470:Fluorometry / Q000592:standards; D006801:Humans; D008297:Male; D010343:Patient Admission; D011524:Protoporphyrins / Q000097:blood*; D012016:Reference Values; D012680:Sensitivity and Specificity
chemical_list: D011524:Protoporphyrins; C017803:zinc protoporphyrin