title: Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review.
abstract: BACKGROUND
  Guidelines on the diagnosis and treatment of iron deficiency (ID) vary widely across indications.
  
  
  OBJECTIVE
  We reviewed all available guidelines on the management of ID worldwide.
  
  
  METHODS
  A literature search was conducted in PubMed, Cochrane, and EMBASE and in main professional association websites, limited to documents published between 1 January 2004 and 30 June 2014.
  
  
  RESULTS
  Of 127 guidelines identified, 29 were selected, involving 29 professional associations and issued from the United States (n = 8), Europe (n = 6), Britain (n = 4), Canada (n = 3), international organizations (n = 2), France (n = 2), Poland (n = 1), Australia (n = 1), Mexico (n = 1), and Japan (n = 1). A total of 22 and 27 guidelines provided recommendations on diagnosis and treatment of ID, respectively. To define ID, all guidelines recommended a concentration for serum ferritin. One-half of them (10 of 22) proposed transferrin saturation (TSAT) as an alternative or complementary diagnostic test. To treat ID, most of the guidelines (18 of 27) recommended preferentially the oral route if possible, particularly in children and in women in the pre- or postpregnancy period. Iron supplementation should be administered intravenously according to 13 of 27 guidelines, particularly in patients with chronic kidney disease (CKD) (n = 7) and chemotherapy-induced anemia (n = 5). Treatment targets for ID included an increase in hemoglobin concentrations to 10-12 g/dL or normalization (n = 8) and serum ferritin >100 μg/L (n = 7) or 200 μg/L (n = 4). For the latter, in some situations, such as CKD, ferritin concentrations should not exceed 500 μg/L (n = 5) or 800 μg/L (n = 5). Only 9 guidelines recommended TSAT as a target, proposing various thresholds ranging from 20% to 50%.
  
  
  CONCLUSIONS
  It appears that for the diagnosis of ID, a cutoff of 100 μg/L for serum ferritin concentration should be considered in most conditions and 20% for TSAT, except in particular situations, including young healthy women with heavy menstrual flow. New indications of intravenous iron supplementation are emerging.
authors.affiliation: National Institute of Health and Medical Research, U954, and Hepato-Gastroenterology Department of Lorraine University, Vandoeuvre-les-Nancy, France; peyrinbiroulet@gmail.com.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: National Institute of Health and Medical Research, U954, and Hepato-Gastroenterology Department of Lorraine University, Vandoeuvre-les-Nancy, France;
authors.forename: Nicolas
authors.initials: N
authors.lastname: Williet
authors.affiliation: Sorbonne University and Inflammation-Immunopathology-Biotherapy Department, Paris, France; National Institute of Health and Medical Research, UMR_S 959, Paris, France; National Scientific Research Center, FRE3632, Paris, France; and Department of Internal Medicine and Clinical Immunology, Salpetriere Hospital, Paris, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
mesh_terms: D061605:Administration, Intravenous; D000465:Algorithms; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D019587:Dietary Supplements / Q000009:adverse effects; D015536:Down-Regulation / Q000187:drug effects; D005290:Ferric Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood*; D014943:Global Health; D006397:Hematinics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D019190:Iron Overload / Q000209:etiology / Q000517:prevention & control; D019266:Iron, Dietary / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012955:Societies, Medical
chemical_list: D015415:Biomarkers; D005290:Ferric Compounds; D006397:Hematinics; D019266:Iron, Dietary; D005293:Ferritins
keywords: TSAT; diagnosis; ferritin; guidelines; iron deficiency; management systematic review