Cook James D
Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
Best Pract Res Clin Haematol. 2005 Jun;18(2):319-32. doi: 10.1016/j.beha.2004.08.022.
Anaemia is typically the first clue to iron deficiency, but an isolated haemoglobin measurement has both low specificity and low sensitivity. The latter can be improved by including measures of iron-deficient erythropoiesis such as the transferrin iron saturation, mean corpuscular haemoglobin concentration, erythrocyte zinc protoporphyrin, percentage of hypochromic erythrocytes or reticulocyte haemoglobin concentration. However, the changes in these measurements with iron deficiency are indistinguishable from those seen in patients with the anaemia of chronic disease. The optimal diagnostic approach is to measure the serum ferritin as an index of iron stores and the serum transferrin receptor as a index of tissue iron deficiency. The treatment of iron deficiency should always be initiated with oral iron. When this fails because of large blood losses, iron malabsorption, or intolerance to oral iron, parenteral iron can be given using iron dextran, iron gluconate or iron sucrose.
贫血通常是缺铁的首要线索，但单纯的血红蛋白测量特异性和敏感性均较低。通过纳入缺铁性红细胞生成的指标，如转铁蛋白铁饱和度、平均红细胞血红蛋白浓度、红细胞锌原卟啉、低色素红细胞百分比或网织红细胞血红蛋白浓度，可提高敏感性。然而，这些测量指标因缺铁而发生的变化与慢性病贫血患者所见的变化难以区分。最佳诊断方法是测量血清铁蛋白作为铁储备指标，以及血清转铁蛋白受体作为组织缺铁指标。缺铁的治疗应始终从口服铁剂开始。当因大量失血、铁吸收不良或对口服铁剂不耐受而治疗失败时，可使用右旋糖酐铁、葡萄糖酸铁或蔗糖铁给予胃肠外铁剂。
