Iron Deficiency: What Are the Future Trends in Diagnostics and Therapeutics?

Abstract

A review of currently available diagnostic and therapeutic modalities for the laboratory assessment of iron deficiencies has identified a need for novel markers to complement the traditional serum iron, ferritin, and transferrin measurements and to improve the assessment of the best therapeutic options for treating these disorders. Newer markers, such as serum transferrin receptor and reticulocyte hemoglobin (Hb)7 content, have not ended up being integrated into clinical practice. This experience thus provides a cautionary tale about the translation of promising research findings into clinical practice. Measurements of serum hepcidin appear to be promising and worth pursuing in larger diagnostic and therapeutic trials. When intravenous (IV) iron replacement therapy is indicated, the availability of several different preparations can present challenges in selecting the most appropriate agent and in assessing their risk/benefit ratios. The relative safety of IV iron preparations needs assessment by prospective, blinded, controlled trials. In this Q&A article, leading experts in the field of diagnosis and treatment of iron-deficient states present their opinions on the advantages and disadvantages of current and future laboratory assessments of iron deficiencies and the therapeutic options currently available to treat these conditions. In a majority of patients, iron deficiency is identified with simple and traditional hematological and biochemical markers that have remained essentially unchanged for decades. Is there a need to add any other biomarker for the diagnosis of nutritional iron deficiency or iron deficiency due to blood loss? From your perspective, what are the requirements for ideal biomarker(s) for monitoring individualized therapy with iron and erythropoiesis-stimulating agents, especially as applied to anemia of chronic disease and chronic kidney disease (CKD) patients treated with dialysis? John Adamson: This is a very complex question. I don't look for biomarkers to try to sort out the various contributors to anemia [iron vs erythropoietin (EPO)]. Nutritional …