title: Iron deficiency anaemia in hospitalised patients: value of various laboratory parameters. Differentiation between IDA and ACD.
abstract: BACKGROUND
  for the diagnostic evaluation of microcytic or normocytic anaemia in a heterogeneous group of patients, the value of newer parameters, such as zinc protoporphyrin (ZPP), plasma transferrin receptor (PtrfR) and PtrfR/ferritin ratio is not clear. We have performed a prospective study to determine the predictive value of these parameters and ferritin, for diagnosing iron deficiency anaemia (IDA).
  
  
  METHODS
  sixty-two patients with Hb<8.2 (men) or <7.0 (women) and mean cell volume (MCV)<96 fl were included. Exclusion criteria were: known haematological disease, pregnancy, bone marrow suppression or iron therapy within the previous 7 days. Bone marrow examination was used as a golden standard to discriminate between IDA and non-IDA.
  
  
  RESULTS
  twenty-four patients had depleted iron stores. We found that the reticulocyte response on iron supplementation correlated well with the iron-status of the bone marrow. Univariate analysis showed that ferritin, PtrfR/ferritin ratio, ZPP and PtrfR have significant predictive values for differentiating IDA from non-IDA. Interestingly, multivariate analysis revealed that ferritin was the only significant, independent predictor of IDA, with a cut-off point of 32 microg/l (sensitivity 79.2%, specificity 96.9%).
  
  
  CONCLUSIONS
  the low sensitivity and specificity of ZPP, PtrfR and PtrfR/ferritin ratio render them insufficient to be used as a single 'best' test for the identification IDA in a non-selected group of anaemic patients and do not even add to the prediction if the value of ferritin is known.
authors.affiliation: Department of Internal Medicine, St. Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands. avantellingrn@worldmail.nl
authors.forename: A
authors.initials: A
authors.lastname: van Tellingen
authors.forename: J C
authors.initials: JC
authors.lastname: Kuenen
authors.forename: W
authors.initials: W
authors.lastname: de Kieviet
authors.forename: H
authors.initials: H
authors.lastname: van Tinteren
authors.forename: M L
authors.initials: ML
authors.lastname: Kooi
authors.forename: W L
authors.initials: WL
authors.lastname: Vasmel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers