Grove Jurette S, Khoza Siyabonga, Mabuza Dineo V, Khan Shaida B
Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
National Health Laboratory Service, Johannesburg, South Africa.
Afr J Lab Med. 2024 Oct 18;13(1):2509. doi: 10.4102/ajlm.v13i1.2509. eCollection 2024.
Iron deficiency is a common disorder, especially in developing countries. Accurately assessing iron status remains challenging, particularly for patients with chronic diseases such as HIV and chronic kidney disease, prevalent in South Africa.
This study aimed to determine how ferritin cut-offs affect iron status classification in adult patients treated at a tertiary hospital in South Africa. Additionally, it assessed the frequency of these conditions and the impact of age and gender on iron status.
This retrospective study analysed iron profiles in adult patients from 01 October 2020 to 31 March 2021. Iron status was categorised into five groups: iron deficiency anaemia (IDA), anaemia of chronic disease, IDA with anaemia of chronic disease, iron deficiency without anaemia, and iron replete based on haemoglobin, transferrin saturation, and ferritin levels. The impact of using two different ferritin cut-off values (15 µg/L and 30 µg/L) was investigated.
The study included 3221 complete iron profiles. There was a predominance of female patients (2.2:1 ratio). Anaemia of chronic disease was the most prevalent iron disorder (39%), regardless of ferritin cut-off. Using a higher ferritin cut-off of 30 µg/L significantly increased the detection rates of both IDA and iron deficiency without anaemia ( < 0.001).
This study suggests that a higher ferritin threshold (30 µg/L) might improve diagnosis of iron disorders in settings with high inflammatory diseases. Further studies are needed to refine thresholds. Local guidelines should be adjusted to consider higher ferritin cut-offs, and longitudinal studies are recommended to evaluate long-term outcomes.
This study confirms the use of higher ferritin cut-offs for enhanced detection of iron deficiency states. The findings also emphasise the ongoing need for establishing simple, standardised, and accurate methods for iron status classification.
缺铁是一种常见疾病，在发展中国家尤为如此。准确评估铁状态仍然具有挑战性，特别是对于南非普遍存在的患有如艾滋病毒和慢性肾病等慢性病的患者。
本研究旨在确定铁蛋白临界值如何影响在南非一家三级医院接受治疗的成年患者的铁状态分类。此外，还评估了这些病症的发生频率以及年龄和性别对铁状态的影响。
这项回顾性研究分析了2020年10月1日至2021年3月31日期间成年患者的铁指标。根据血红蛋白、转铁蛋白饱和度和铁蛋白水平，将铁状态分为五组：缺铁性贫血（IDA）、慢性病贫血、合并慢性病贫血的IDA、无贫血的缺铁以及铁储备充足。研究了使用两种不同铁蛋白临界值（15μg/L和30μg/L）的影响。
该研究纳入了3221份完整的铁指标。女性患者占主导（比例为2.2:1）。无论铁蛋白临界值如何，慢性病贫血都是最常见的铁紊乱疾病（39%）。使用30μg/L的较高铁蛋白临界值显著提高了IDA和无贫血缺铁的检出率（<0.001）。
本研究表明，在炎症性疾病高发的环境中，较高的铁蛋白阈值（30μg/L）可能会改善铁紊乱疾病的诊断。需要进一步研究以完善阈值。应调整当地指南以考虑更高的铁蛋白临界值，建议进行纵向研究以评估长期结果。
本研究证实使用较高的铁蛋白临界值可增强对缺铁状态的检测。研究结果还强调了持续需要建立简单、标准化和准确的铁状态分类方法。
