Iron deficiency anemia laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]

Overview

Iron status can be assessed through several laboratory tests. Since, each test assesses a different aspect of iron metabolism, results of one test may not always agree with results of other tests. Hematological tests based on characteristics of red blood cells (i.e., Hb concentration, hematocrit, mean cell volume, and red blood cell distribution width) are generally more available and less expensive than are biochemical tests. Biochemical tests (i.e., erythrocyte protoporphyrin concentration, serum ferritin concentration, and transferrin saturation), however, detect earlier changes in iron status. Except for Total iron binding capacity TIBC, transferrin saturation, and soluble transferrin receptor all other components of iron study are decreased in iron deficiency anemia. The soluble transferrin receptor test is a newer test and is found useful in distinguishing iron deficiency anemia from anemia of chronic disease.

Laboratory Findings

• Complete blood count- Hb <10.5mg/dl and MCV <95fL.
• Microcytic and hypochromic anemia on peripheral blood film.
• Red cell distribution width increased.
• Reticulocyte count is low.
• Iron studies:
  • Iron stain (prussian blue staining) of erythroid precursors (sideroblasts) on marrow spicules shows ack of stainable iron in erythroid precursors.
  • Serum ferittin levels < 30ng/ml, and serum ferritin <41 ng/mL in a patient with anemia and comorbidities (chronic diseases/inflammation)
  • Serum iron <60 mcg/dL.
  • Total iron binding capacity/ serum transferrin- TIBC is calculated by multiplying serum transferrin by 1.389. It is increased in iron deficiency anemia and decreased in anemia of chronic disease. TIBC>350 to 400 mcg/dL is diagnostic of iron deficiency.
  • Transferrin saturation (TSAT) is the ratio of serum iron to TIBC: (serum iron  ÷  TIBC  x  100). It is <15% in iron deficiency (normal is 25-40%).
• Elevated erythrocyte (RBC) zinc protoporphyrin (eg, >80 mcg/dL).
• Decreased iron stain on eryhtroid precursors.

Change in lab values in iron deficiency anemia

Change	Parameter
Decrease	ferritin, hemoglobin, MCV
Increase	TIBC, transferrin, RDW