The transferrin/log(ferritin) ratio: a new tool for the diagnosis of iron deficiency anemia

Authors:
  • MTMartine G.H.M. Tax
    Martine G.H.M. Tax
  • JDJolanda Droogendijk
    Jolanda Droogendijk
  • MLMath P.G. Leers
    Math P.G. Leers
  • RBRuud Beukers
    Ruud Beukers
  • MLMark-David Levin
    Mark-David Levin
  • PSPieter Sonneveld
    Pieter Sonneveld
  • PBPaul B. Berendes
    Paul B. Berendes
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Abstract
Serum ferritin is the best single laboratory test to diagnose iron deficiency anemia (IDA). Ferritin levels 100 μg/L usually exclude IDA. However, ferritin concentrations between 20 and 100 μg/L are often inconclusive. The objective of this study was to improve the diagnosis of IDA when ferritin levels are inconclusive. We evaluated the predictive performance of classic (ferritin, mean corpuscular volume, transferrin and serum iron) and modern [reticulocyte hemoglobin content, serum transferrin receptor and soluble transferrin receptor (sTfR)/log(ferr)] iron status parameters to diagnose IDA in 2084 anemic, non-hospitalized patients. The results were validated in an independent cohort of 274 anemic patients. In our study population, 29% (595 patients) of the patients had a ferritin level between 20 and 100 μg/L, hampering diagnosis of IDA. None of the classic or modern parameters was capable of completely separating the IDA population from the non-IDA population. However, using a new parameter, the transferrin/log(ferritin) ratio, the IDA and non-IDA populations can be completely separated. At a cut-off value of 1.70, the transferrin/log(ferritin) ratio indicates IDA in 29% of the patients with inconclusive ferritin levels. The transferrin/log(ferritin) ratio is a practical new tool that improves diagnosis of iron deficiency when ferritin levels are inconclusive.