Serum ferritin as an indicator of iron status: what do we need to know?

Determination of iron status in pregnancy and in young children is essential for both clinical and public health practice. Clinical diagnosis of iron deficiency (ID) through sampling of bone marrow to identify the absence of body iron stores is impractical in most cases. Serum ferritin (SF) concentr...

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Bibliographic Details
Published in:The American journal of clinical nutrition 2017-12, Vol.106 (suppl_6), p.1634S-1639S
Main Authors: Daru, Jahnavi, Colman, Katherine, Stanworth, Simon J, De La Salle, Barbara, Wood, Erica M, Pasricha, Sant-Rayn
Format: Article
Language:English
Subjects:
Anemia, Iron-Deficiency - blood
Anemia, Iron-Deficiency - diagnosis
Child, Preschool
cutoffs
diagnostic test
Female
ferritin
Ferritins - blood
Hemoglobins - metabolism
hepcidin
Humans
Iron - blood
iron deficiency
iron deficiency anemia
iron status
Nutritional Status
Pregnancy
Receptors, Transferrin - blood
Sensitivity and Specificity
Supplement—Iron Screening and Supplementation in Iron-Replete Pregnant Women and Young Children
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Summary:Determination of iron status in pregnancy and in young children is essential for both clinical and public health practice. Clinical diagnosis of iron deficiency (ID) through sampling of bone marrow to identify the absence of body iron stores is impractical in most cases. Serum ferritin (SF) concentrations are the most commonly deployed indicator for determining ID, and low SF concentrations reflect a state of iron depletion. However, there is considerable variation in SF cutoffs recommended by different expert groups to diagnose ID. Moreover, the cutoffs used in different clinical laboratories are heterogeneous. There are few studies of diagnostic test accuracy to establish the sensitivity and specificity of SF compared with key gold standards (such as absent bone marrow iron stores, increased intestinal iron absorption, and hemoglobin response to SF) among noninflamed, outpatient populations. The limited data available suggest the commonly recommended SF cutoff of 30 y ago, do not reflect ethnic or geographic diversity, and were performed in an era for which laboratory methods no longer reflect present practice. Future studies to define the appropriate SF cutoffs are urgently needed and would also provide an opportunity to compare this indicator with other established and emerging iron indexes. In addition, future work would benefit from a focus on elucidating cutoffs and indexes relevant to iron adequacy.
ISSN:0002-9165
1938-3207
DOI:10.3945/ajcn.117.155960