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Clinical Chemistry, Vol 42, 718-724, Copyright © 1996 by American Association for Clinical Chemistry
J Hastka, JJ Lasserre, A Schwarzbeck, A Reiter and R Hehlmann
III. Med. Klinik Mannheim, Klinikum Mannheim der Universitat Heidelberg, Germany.
We demonstrate that simple correlation between the various tests of iron status is not sufficient for examining their value in diagnosing iron deficiency (ID). Three degrees of ID are recognized: Iron depletion (ID grade I) is defined by decreased total body iron and normal iron support to erythropoiesis, as diagnosed by decreased storage iron, decreased ferritin, normal sideroblast count, normal zinc protoporphyrin (ZPP), and transferrin saturation >15%. When the iron supply to erythropoiesis becomes insufficient, as diagnosed by transferrin saturation < or = 15%, increased ZPP, and decreased sideroblast count, iron-deficient erythropoiesis (ID grade II) occurs. When finally hemoglobin is below its normal range, iron-deficiency anemia (ID grade III) results. The various tests for ID cannot be compared without taking into account the severity of the deficiency. Depending on the grade of ID examined, the correlation of markers seen in our patients' data varied considerably. We conclude that a "best" marker of ID does not exist. However, the different tests efficiently complement each other by detecting different stages and individually show the clinical extent of ID. Ferritin reflects the iron stores. ZPP indicates whether the ID in a given patient is clinically relevant or not. Finally, the extent of a clinically relevant ID can be assessed by the measured ZPP, hemoglobin concentration, and red cell indices.
The following articles in journals at HighWire Press have cited this article:
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  C. Ullrich, A. Wu, C. Armsby, S. Rieber, S. Wingerter, C. Brugnara, D. Shapiro, and H. Bernstein Screening Healthy Infants for Iron Deficiency Using Reticulocyte Hemoglobin Content JAMA, August 24, 2005; 294(8): 924 - 930. [Abstract] [Full Text] [PDF]
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 I J Griffin, M M Reid, K P B McCormick, and R J Cooke Zinc protoporphyrin/haem ratio and plasma ferritin in preterm infants Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2002; 87(1): F49 - 51. [Abstract] [Full Text] [PDF]
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 L. T. Goodnough, B. Skikne, and C. Brugnara Erythropoietin, iron, and erythropoiesis Blood, August 1, 2000; 96(3): 823 - 833. [Abstract] [Full Text] [PDF]
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E. J. Harthoorn-Lasthuizen, P. vant Sant, J. Lindemans, and M. M.A.C. Langenhuijsen Serum Transferrin Receptor and Erythrocyte Zinc Protoporphyrin in Patients with Anemia, Clin. Chem., May 1, 2000; 46(5): 719 - 722. [Full Text] [PDF]
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P. Suominen, K. Punnonen, A. Rajamaki, and K. Irjala Serum Transferrin Receptor and Transferrin Receptor-Ferritin Index Identify Healthy Subjects With Subclinical Iron Deficits Blood, October 15, 1998; 92(8): 2934 - 2939. [Abstract] [Full Text] [PDF]
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