Uncomplicated Iron Deficiency Research Articles

Characterizing Outpatient Classical Hematology Referrals at an Academic Healthcare System

BACKGROUND: Healthcare systems and delivery networks are experiencing an overwhelming number of Classical Hematology (CH) referrals. In our network, patients referred for CH consultation are facing increasing wait times and a shortage of available clinicians. In response to these workforce challenges, our institution is collaborating with advanced practice providers (APPs) to evaluate new patients using a tiered system that matches consults with corresponding years of clinical experience. This model is in use at one clinical site but its potential benefit when implemented across the entire network is unknown. To better inform this initiative, we sought to identify the most common diagnoses for outpatient CH referrals, determine the complexity level of these consults, and identify opportunities for alternative patient scheduling workflows. METHODS: A list of all new outpatient CH referrals evaluated in the Yale Smilow Cancer Network in Connecticut from 2019-2021 was compiled. ICD-10 codes assigned from each new patient encounter were combined into general diagnosis categories including iron deficiency anemia, other anemias, and thrombosis. After the 3 most common diagnoses were identified, 30 new patients evaluated in 2021 were randomly selected from each diagnosis group for manual chart review. Manual review focused on the details of each patient case and assigned a diagnosis level (Table 1). Diagnosis levels were matched with APP years of experience, ranging from level 1 (consults that could be evaluated within the first few years of practice) to level 3 (cases requiring more extensive experience or physician evaluation). These levels were predetermined by a committee of senior level CH physicians in the Smilow network. RESULTS: Based on grouped ICD diagnosis codes, the 3 most common CH referrals to our network from 2019-2021 were anemia (excluding iron deficiency, with an average of 22.4% of all new referrals), iron deficiency anemia (21.2%), and thrombosis (13.2%). Combined, these 3 diagnoses accounted for 56.8% of all incoming new referrals. Manual chart review of the anemia group showed that 3 patients had iron deficiency anemia with a diagnosis level of 1. After excluding these 3 patients, 1/27 (3.7%) anemia patients were level 1, 9/27 (33.3%) were level 2, and 17/27 (63.0%) patients were level 3 (Figure 1). In the iron deficiency group, after accounting for the 3 additional patients transferred from the anemia group, 16/33 (48.5%) were level 1, 7/33 (21.2%) were level 2, and 10/33 (30.3%) were level 3. In the thrombosis group, 12/30 (40.0%) patients were level 2, and 18/30 (60.0%) were level 3. 18.9% of all reviewed charts were level 1, 31.1% were level 2, and 50.0% were level 3. CONCLUSIONS: Manual chart review of the most common CH referrals (anemia, iron deficiency anemia, thrombosis) showed heterogeneity in diagnosis level. Thrombosis and anemia (excluding iron deficiency) had a higher proportion of more complex cases. In contrast, iron deficiency anemia contained a substantial number of level 1 cases (approximately 50% of all iron deficiency referrals). At one of our clinical sites, CH trained APPs have been evaluating new consults using the tiered system described within this study. Patients are then seen in follow-up by a collaborating physician. Manual chart review showed that 50% of consults in the 3 most common referral categories were either level 1 or 2, representing a substantial patient population that could be evaluated by an APP for initial consultation. In addition to increasing trainee and physician recruitment, implementing this model on a network-wide scale may be an invaluable strategy to address the current CH workforce shortage. Our study also identified that iron deficiency contained a large proportion of level 1 cases. This may be a consult population that is particularly amenable to non-traditional triage and evaluation algorithms. Strategies to consider include eConsultations to facilitate faster evaluation and iron infusions when indicated, or specialized provider and clinic creation. Our institution is piloting the use of triage algorithms to identify these uncomplicated iron deficiency cases and further optimize consult workflows.

Ներերակայի՞ն, թե՞ ներքին ընդունում. ո՞րն ընտրել: Երկաթպակասորդային սակավարյունության բուժման նորագույն մոտեցումները

Regardless of the presence of symptoms, all patients with iron deficiency anemia and most patients with iron deficiency without anemia should be treated. Generally the patients who have uncomplicated iron deficiency anemia are treated with oral iron due to the ease of administration. IV iron is often used when treating pregnant women and individuals with inflammatory bowel disease, gastric surgery, or chronic kidney disease, ongoing blood loss, physiologic or anatomic abnormality and intolerable gastrointestinal side effects of oral iron. True allergic reactions are exceedingly rare and vastly overestimated. Routine premedication is not needed prior to IV iron and the use of diphenhydramine should also be avoided.

Anemia in children: a pediatrician’s view

Anemia is defined as a hemoglobin level that is two standard deviations below the mean for age. After children reach the age of 12, the hemoglobin norm can be further divided into gender-specific ranges. When a patient presents with anemia, it is important to establish whether the abnormality is isolated to a single cell line [red blood cells (RBC) only] or whether it is part of a multiple cell line abnormality. In children, anemia is usually caused by decreased RBC production or increased RBC turnover. Anemia is usually classified based on the size of RBC (microcytosis, normocytosis, or macrocytosis) as measured by the mean corpuscular volume. Although iron deficiency anemia is usually microcytic, some patients may have normocytic blood cells. From a practical point of view, it is better to use in children the etiologic classification of anemia which includes impaired red cell formation, blood loss and hemolytic anemia. Most children with anemia are asymptomatic, and the condition is detected on screening laboratory evaluation. Iron deficiency can be treated with oral iron, intravenous iron, and/or blood transfusion, depending on the patient`s hemoglobin levels, tolerance and co-morbidity. Oral iron salts are usually the first line of treatment for uncomplicated iron deficiency, but are poorly absorbed and lead to gastrointestinal side effects. In some cases, iron refractory iron deficiency anemia (IRIDA), a hereditary recessive anemia refractory to oral iron, occurs. IRIDA shows a slow response to intravenous iron and partial correction of anemia.

Comparative Study of Intravenous Iron Sucrose Vs Oral Ferrous Sulfate Therapy for Uncomplicated Iron Deficiency Anemia

Background: Iron deficiency anemia (IDA) is one of the most frequent nutritional deficiency leading to morbidity and mortality in whole world. Oral iron therapy as well as intravenous (IV) iron therapy can be given to treat the IDA patients.
 Objective: To compare the efficacy and hematological changes of Oral and IV iron preparation in patients with uncomplicated iron deficiency anemia.
 Method: An interventional, prospective study in patients with uncomplicated IDA anemia receiving IV iron sucrose and Oral iron ferrous sulfate were included. Clinical history, baseline hemoglobin, anemia indices data were recorded in a case record form. A total number of 80 patients were enrolled in this study. 40 patients (Group A) were treated with IV iron sucrose and another 40 patients (Group B) were treated with oral iron ferrous sulfate. After therapy Hemoglobin level, RBC indices and adverse drug reactions (ADRs) were observed.
 Place and period of Study: Study was carried out in the Department of Hematology at Dhaka Medical College Hospital (DMCH), from July 2015 to June 2016.
 Results: The mean age of total participants was 35.77 ± 16.08 (range of 13 – 75 years). In this study female (72.5%) is predominant than male (27.5%). Oral and IV iron preparations significantly (P<0.0001) improved mean hemoglobin, anemia indices at the end of study. However, mean increase in hemoglobin were significant (P<0.0001) with IV iron sucrose (7.6 ± 2.9) gm/dl, as compared to Oral ferrous sulfate (6.4± 2.2)gm/dl, after 2 months of therapy. In this study Hemoglobin increases in group A (IV iron arm) almost 1mg/kg/week and in group B (oral iron arm) 0.8 mg/dl/week).Surprisingly, ADRs were more in patients treated with oral ferrous sulfate (38%) compared to iron sucrose (26%).
 Conclusion: IV iron sucrose improves hemoglobin, anemia indices and replenish iron stores rapidly and is well tolerated than oral iron preparations.
 J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 175-181

Iron Absorption in Iron-Deficient Women, Who Received 65 mg Fe with an Indonesian Breakfast, Is Much Better from NaFe(III)EDTA than from Fe(II)SO₄, with an Acceptable Increase of Plasma NTBI. A Randomized Clinical Trial.

Plasma non-transferrin-bound iron (NTBI) is potentially harmful due to the generation of free radicals that cause tissue damage in vascular and other diseases. Studies in iron-replete and iron-deficient subjects, receiving a single oral test dose of Fe(II)SO4 or NaFe(III)EDTA with water, revealed that FeSO4 was well absorbed when compared with NaFeEDTA, while only the Fe(II) compound showed a remarkable increase of NTBI. As NaFeEDTA is successfully used for food fortification, a double-blind randomized cross-over trial was conducted in 11 healthy women with uncomplicated iron deficiency. All subjects received a placebo, 6.5 mg FeSO4, 65 mg FeSO4, 6.5 mg NaFeEDTA, and 65 mg NaFeEDTA with a traditional Indonesian breakfast in one-week intervals. Blood tests were carried out every 60 min for five hours. NTBI detection was performed using the fluorescein-labeled apotransferrin method. Plasma iron values were highly increased after 65 mg NaFeEDTA, twice as high as after FeSO4. A similar pattern was seen for NTBI. After 6.5 mg of NaFeEDTA and FeSO4, NTBI was hardly detectable. NaFeEDTA was highly effective for the treatment of iron deficiency if given with a meal, inhibiting the formation of nonabsorbable Fe-complexes, while NTBI did not exceed the range of normal values for iron-replete subjects.

Adolescent fatigue: Is intravenous iron a better solution?

Adolescent fatigue: Is intravenous iron a better solution?

Serum prohepcidin concentrations in rheumatoid arthritis

Hepcidin, a recently identified peptide, acts as a central regulator of iron metabolism. It is regarded as a factor regulating the uptake of dietary iron and its mobilisation from macrophages and hepatic stores. It is considered as a mediator of anaemia of inflammation. The aim of this study was to assess whether serum prohepcidin concentration is able to distinguish iron deficiency from anaemia of inflammation in patients with rheumatoid arthritis (RA). Blood samples were obtained from 20 healthy blood donors, 30 RA patients who presented with anaemia and 30 patients who had pure iron deficiency anaemia (IDA). The samples were analysed for full blood count, iron, ferritin, transferrin, soluble transferrin receptor and prohepcidin. The mean prohepcidin level in the control subjects was 256 microg/L. The prohepcidin level was significantly lower in IDA patients (100 microg/L; p < 0.0001) but not significantly different from that of control in RA patients (250 microg/L; p > 0.05). Higher serum soluble transferrin receptor (sTfR) levels were observed in IDA (p < 0.0001) but not in RA compared with that of control (p > 0.05). RA patients were divided into iron depleted and iron repleted subgroups based on the ferritin level. Prohepcidin in the iron depleted group was significantly lower than the iron repleted group and the control (p < 0.0001) and higher levels were observed in the iron repleted group (p < 0.01). sTfR levels in the iron depleted group were significantly higher than the control and the iron repleted patients (p < 0.001). In the iron repleted group, sTfR level was not statistically different from that of control (p > 0.05). Serum prohepcidin is clearly reduced in uncomplicated iron deficiency anaemia. The reduced prohepcidin levels in the iron depleted RA patients suggests that there may be conflicting signals regulating hepcidin production in RA patients. In RA patients who have reduced hepcidin in the iron depleted group (ferritin <60 microg/L) where sTfR levels are increased suggests that these patients are iron deficient. Further studies with a larger cohort of patients are required to substantiate this point.

Circulating erythropoietin in microalbuminuric type 2 diabetic patients with normal renal function: a pilot study

To verify the hypothesis of an early impairment of erythropoietin (Epo) production and to assess the adequacy of its circulating levels in diabetic nephropathy, we investigated Epo values in 18 microalbuminuric type 2 diabetic patients with normal renal function (7 anaemic and 11 nonanaemic), 24 subjects with uncomplicated iron-deficiency anaemia, and 15 healthy controls comparable for sex and age. Mean±S.D. plasma Epo level was 56.4±12.7 mU/mL in iron-deficient patients and 9.3±2.6 mU/mL in controls. In diabetic groups, mean±S.D. Epo level was 11.38±3.65 mU/mL in nonanaemic and 49.12±6.44 mU/mL in anaemic subjects. No significant difference ( P>.05) in Epo values was found between controls and nonanaemic diabetic patients. Anaemic diabetics and iron-deficient subjects had significantly higher values than the nonanaemic groups ( P>.001). An inverse significant relation between Epo levels and Hb concentration resulted in both anaemic diabetics ( r=−.44, P>.05) and iron-deficient patients ( r=−.61, P=.001). Analysis of covariance ( P>.05) and comparison of the two regression lines ( t=0.4, df=29, P>.05) did not show any significant difference between diabetic patients with anaemia and iron-deficient patients. These results suggest that normochromic anaemia observed in microalbuminuric diabetic patients with normal renal function is not due to Epo deficiency, and circulating levels of this hormone are suitably increased with regard to Hb concentration.

Iron Absorption During Epoetin Alfa Therapy for Chemotherapy-Associated Anaemia

Absorption of a physiological dose of ferrous iron was studied in 18 patients with solid malignancy receiving epoetin therapy for mild chemotherapy-associated anemia. The historical control group consisted of 25 iron replete volunteers (iron absorption 20 ± 11% in males and 26 ± 13% in females) and 21 patients with uncomplicated iron deficiency (iron absorption 71 ± 19%). Iron absorption was increased in the majority of the cancer patients (iron absorption 59 ± 35%). There were no significant differences in iron absorption between cancer patients who were iron replete or iron deficient according to current clinical practice guidelines (iron deficiency: transferrin saturation < 20% and/or serum ferritin < 100 ng/mL). Red cell iron incorporation was not disturbed in the majority (89%) of patients.

The Platelet Count/Mean Corpuscular Hemoglobin Ratio Distinguishes Combined Iron and Vitamin B 12 Deficiency from Uncomplicated Iron Deficiency

Combined deficiencies of iron and cobalamin are common. The aims of this study were to investigate the significance of the parameters of the complete blood count (CBC) in differentiating microcytic anemia due to pure iron deficiency anemia (IDA) from anemia due to combined deficiencies of vitamin B(12) and iron (IDA-B12). The study was carried out with 122 patients (100 female) who had microcytic red blood cell indices with IDA-B12 and 105 patients (95 female) with IDA. Group IDA-B12 patients had decreased hemoglobin levels, mean corpuscular volumes, mean corpuscular hemoglobin (MCH) levels, and MCH concentrations but had increased platelet counts (PLT). Using these parameters, we developed a PLT/MCH ratio parameter that has high values when IDA is accompanied by cobalamin deficiency. The cutoff value of >12.00, with a 74.6% sensitivity and a 41.9% specificity, appears to be the most convenient value for screening. We advise measuring the levels of cobalamin in patients with IDA associated with a high PLT/MCH ratio.

Comparison of a Combination Ferrous Fumarate Product and a Polysaccharide Iron Complex as Oral Treatments of Iron Deficiency Anemia: A Taiwanese Study

Despite efforts to improve iron supplements for iron deficiency anemia, there is no consensus on products that balance efficacy, safety and tolerability, and cost. Ferrous products are effective, but they are associated with more gastrointestinal side effects than ferric products. Ferric products tend to have lower absorption. We present results from a 12-week study that randomized 72 people with uncomplicated iron deficiency anemia to receive a ferrous iron supplement (Ferall, a combination of ferrous fumarate with ascorbic acid, folic acid, and cyanocobalamin) or a ferric iron polysaccharide complex (Niferex, ferro-glycine sulfate) plus ascorbic acid. The ferrous product was significantly more effective, the primary and secondary endpoints including changes in levels of hemoglobin and serum ferritin. There was a slightly higher frequency of gastrointestinal side effects in patients taking the ferrous product, but both supplements were well tolerated. No participant withdrew from the study because of side effects. We concluded that the ferrous product is safe and effective for use in uncomplicated iron deficiency anemia. The lack of direct comparison between single-agent ferrous fumarate and the combination ferrous product limited interpretation of results in terms of possible effects due to other components, such as ascorbic acid.

Analytical and Clinical Implications of Soluble Transferrin Receptors in Serum

In this study the analytical performances of two recently introduced assays for soluble transferrin receptors in serum were tested. The Ramco transferrin assay was compared with the Eurogenetics assay. In a small clinical study serum samples from patients with anaemia of chronic disease, iron deficiency and myelodysplastic syndrome were analysed, as well as sera from healthy volunteers. The analytical performances of the Ramco assay were found to be acceptable. In the Eurogenetics test however, inter-assay imprecision and the end of run drift were unacceptably high. We were able to confirm that in patients with uncomplicated iron deficiency the concentration of soluble transferrin receptors is higher than in healthy volunteers. In cases of anaemia of chronic and inflammatory disease, the levels of soluble transferrin receptors in serum are slightly, but not significantly, higher than in normal subjects. Measurement of soluble transferrin receptors in serum provides a good differentiation between anaemia of chronic disease and iron deficiency.

Impaired Erythropoietin Response to Anemia After Bone Marrow Transplantation

AbstractDelayed erythroid recovery is common after bone marrow transplantation (BMT), with some patients continuing to require red blood cell (RBC) transfusion support for as long as 1 year. While the etiology is multifactorial, inadequate stimulation of erythroid progenitors by the erythroid growth factor, erythropoietin, may play a role. In this study, the erythropoietin response to anemia of 70 consecutive patients undergoing BMT at the Johns Hopkins Oncology Center was compared with the erythropoietin response in uncomplicated iron deficiency anemia. Erythropoietin levels were elevated for the degree of anemia early after BMT; however, at the time of marrow recovery, erythropoietin levels were significantly suppressed in both allogeneic and autologous BMT patients compared with the iron-deficient patients. Patients with acute graft-versus-host disease (GVHD) had a more marked suppression of the erythropoietin response to anemia. In the patients who remained anemic for extended periods of time (up to 12 months after BMT), an inadequate erythropoietin response to anemia persisted. Delayed erythroid recovery after BMT is associated with inadequate erythropoietin levels. Therefore, recombinant human erythropoietin may be useful in the treatment of the anemia associated with both autologous and allogeneic BMT.

Impaired erythropoietin response to anemia after bone marrow transplantation

Delayed erythroid recovery is common after bone marrow transplantation (BMT), with some patients continuing to require red blood cell (RBC) transfusion support for as long as 1 year. While the etiology is multifactorial, inadequate stimulation of erythroid progenitors by the erythroid growth factor, erythropoietin, may play a role. In this study, the erythropoietin response to anemia of 70 consecutive patients undergoing BMT at the Johns Hopkins Oncology Center was compared with the erythropoietin response in uncomplicated iron deficiency anemia. Erythropoietin levels were elevated for the degree of anemia early after BMT; however, at the time of marrow recovery, erythropoietin levels were significantly suppressed in both allogeneic and autologous BMT patients compared with the iron-deficient patients. Patients with acute graft-versus-host disease (GVHD) had a more marked suppression of the erythropoietin response to anemia. In the patients who remained anemic for extended periods of time (up to 12 months after BMT), an inadequate erythropoietin response to anemia persisted. Delayed erythroid recovery after BMT is associated with inadequate erythropoietin levels. Therefore, recombinant human erythropoietin may be useful in the treatment of the anemia associated with both autologous and allogeneic BMT.

Erythropoietin deficiency in the anaemia of chronic disorders

Defective iron metabolism, mild haemolysis and impaired erythropoiesis contribute to the anaemia of chronic disorders (ACD), but evidence for a deficiency of circulating erythropoietin (Epo) is equivocal. We have examined serum Epo in moderately anaemic patients with Hb less than 10 g/dl--41 patients with ACD (23 associated with rheumatoid disease and 18 with malignancy), 17 with uncomplicated iron-deficiency anaemia and 33 with chronic renal failure (CRF). In ACD the serum Epo (mean (confidence limits] results of 41 (31, 54) mU/ml for the rheumatoid group and 63 (49, 80) mU/ml for the malignancy group, were significantly lower than the Epo of 104 (78, 136) mU/ml for the iron-deficiency group. The CRF group with more severe anaemia had serum Epo of 27 (19, 35) mU/ml. Thus, recombinant human erythropoietin (rHu Epo) should be considered for the treatment of ACD associated with rheumatoid disease and malignancy.

Serum Immunoreactive Erythropoietin in HIV-Infected Patients

Serum immunoreactive erythropoietin (SIE) and hemoglobin levels were measured in 152 patients infected with the human immunodeficiency virus. Anemia was present in 18% of asymptomatic patients who tested positive for the human immunodeficiency virus, 50% of patients with a condition related to the acquired immunodeficiency syndrome (AIDS), and 75% of patients with AIDS. The mean SIE level for untreated AIDS patients (26.2 +/- 2.4 mU/mL) was greater than for patients who tested positive for human immunodeficiency virus or patients with an AIDS-related condition but not outside the normal range for SIE (4 to 26 mU/mL), and the incremental increase in SIE level for a given decline in hemoglobin level was much less in AIDS patients than in patients with uncomplicated iron deficiency anemia. Forty-two patients were treated with zidovudine, and the hemoglobin level fell 10 g/L or more in 48%. In contrast to the untreated patients, however, the mean SIE level rose 10-fold to 214 mU/mL, and the incremental change in SIE level for a given decline in hemoglobin level was markedly increased. In the zidovudine-treated patients, erythrocyte mean corpuscular volume also rose significantly from a mean of 88.1 fL to 102 fL. However, in only 1 patient was there a corresponding increase in reticulocytes and in none was there amelioration of anemia. The data indicate that SIE level is inappropriately low in anemic AIDS patients. The ability of these patients to produce erythropoietin is intact and can be expressed with zidovudine therapy. However, even very high levels of SIE fail to stimulate erythropoiesis adequately.

Decreased iron absorption in patients with active rheumatoid arthritis, with and without iron deficiency.

Mucosal uptake, mucosal transfer, and retention of a physiological dose of ferrous iron were studied in women with active rheumatoid arthritis (RA): 19 with normal and 17 with depleted bone marrow iron stores. Control subjects were 26 normal women and 20 women with uncomplicated iron deficiency. Iron absorption was measured with 59Fe as a tracer and by whole body counting. Compared with controls, final iron retention was considerably decreased in both groups of patients with RA. Analysis of the two sequential steps of iron absorption showed that mucosal uptake was normal in iron replete patients with RA but was significantly lower in patients with RA with depleted iron stores compared with iron deficient controls. Mucosal transfer of iron was considerably decreased in patients with RA with normal iron stores. The impaired absorption of iron in patients with active RA may delay the correction of the haemoglobin concentration when anaemia of chronic disease is complicated by iron deficiency.

Hematologic and iron-related measurements in rheumatoid arthritis.

The hematologic status of 265 patients with rheumatoid arthritis was assessed. In the group as a whole, a mild depression in the hemoglobin concentration and mean cell volume (MCV) was associated with an increase in the red blood cell distribution width (RDW), erythrocyte sedimentation rate (ESR), and platelet count. Bone marrow trephine biopsies and further measurements of iron status and disease activity were done in [a further] 38 more anemic patients, and the findings in those with absent marrow iron (iron deficiency) were compared with those having stainable stores (anemia of chronic disorders). The RDW was raised in both, and there was no significant difference between the two groups. The concentrations of nonheme iron in the marrow and of serum ferritin were significantly lower in the iron-deficient group, but the geometric mean serum ferritin of 34 micrograms/L was still a good deal higher than that associated with uncomplicated iron deficiency. This was presumably because of the fact that the serum ferritin, which was significantly correlated with the ESR (r 0.55; P less than 0.0004) and C-reactive protein (CRP) r 0.41; P less than 0.01), was also functioning as an acute phase protein. While there was a weak correlation (r 0.37; P less than 0.04) between the marrow nonheme iron and the serum ferritin concentrations, it disappeared when nonactive patients with normal CRP concentrations were excluded. The absence of a correlation is unlike the findings that have previously been noted in other chronic inflammatory conditions and in neoplasia. This raises the possibility that serum ferritin concentrations in rheumatoid arthritis may reflect, in part at least, another store of iron located in affected joints.

Three commercial methods for serum ferritin compared and the high-dose "hook effect" eliminated.

We evaluated four commercial kits for measuring serum ferritin, based on three techniques: immunoradiometric assay, radioimmunoassay, and enzyme immunoassay. The kits evaluated were those manufactured by Abbott Laboratories, Clinical Assays, Corning Medical, and Ramco. Two of the immunoradiometric kits showed satisfactory results with respect to sensitivity and precision; they should be useful in diagnosing individuals with uncomplicated iron-deficiency anemia. One of the immunoradiometric assay kits, however, showed a high-dose "hook effect," beginning at 10 mg of ferritin per liter. We modified this kit to eliminate this effect, at least to ferritin concentrations of 33 mg/L. (We observed a ferritin value as high as 47 mg/L in one patient.) Results with all these kits did not inter-compare well for ferritin concentrations greater than 300 micrograms/L, a finding that casts further doubt on the controversial use of serum ferritin measurement in cases of iron overload.

Mucosal uptake, mucosal transfer and retention of iron, measured by whole-body counting.

A method is described which enables simple and accurate measurement of the separate steps of iron absorption. A double isotope technique was used with 59Fe as a tracer and 51Cr (as CrCl3) as an inert, not absorbable indicator. With a whole-body counter it was possible not only to measure initial mucosal uptake and retention but also to calculate mucosal transfer of iron. Thus faeces collection for determination of mucosal uptake of iron was no longer necessary. Absorption of a physiological dose of inorganic iron was studied in 25 normal subjects (15 males and 10 females), in 21 patients with uncomplicated iron deficiency and in 8 patients with idiopathic haemosiderosis. A significant difference was demonstrated between normals and patients with iron deficiency and in idiopathic haemosiderosis with respect to the various steps of iron absorption. The method provides a simple tool for the study of the regulation of iron absorption at the luminal and intracellular site of the intestinal mucosal cell.