Cook J D
Semin Hematol. 1982 Jan;19(1):6-18.
While the prevalence of iron deficiency has remained relatively constant, there has been continuing refinement in its laboratory recognition, especially with the recent introduction of serum ferritin and FEP measurements. It is helpful to classify iron deficiency into three stages. Storage iron depletion is identified by marrow examination or serum ferritin, iron deficient erythropoiesis by TS, FEP, or MCV, and iron deficiency anemia by hemoglobin concentration or therapeutic iron trial. Combinations of these measurements have been used in prevalence studies to obtain a quantitative measure of body iron stores. The optimal laboratory approach to diagnosing iron deficiency depends on the clinical setting. In the office or outpatient clinic, iron depletion is best recognized by the serum ferritin, although the TS, FEP, and MCV are helpful in gauging its severity. In hospitalized patients with overt anemia, the TS, FEP, and MCV are much less helpful because similar changes are seen in the anemia of chronic disease. Examination of marrow iron remains the method of choice, especially in patients with infection, chronic disease, malignancy, or liver disease, although in many clinical situations the same information can be obtained from a serum ferritin. Serial measurements of serum ferritin have been particularly useful in monitoring patients at high risk of iron deficiency such as those with rheumatoid arthritis, chronic inflammatory bowel disease, or chronic renal failure.
虽然缺铁的患病率一直相对稳定，但其实验室诊断方法却在不断完善，尤其是最近血清铁蛋白和FEP检测方法的引入。将缺铁分为三个阶段会有所帮助。储存铁耗竭可通过骨髓检查或血清铁蛋白来确定，缺铁性红细胞生成可通过转铁蛋白饱和度（TS）、FEP或平均红细胞体积（MCV）来确定，缺铁性贫血可通过血红蛋白浓度或铁治疗试验来确定。这些检测方法的组合已用于患病率研究，以获得体内铁储存的定量指标。诊断缺铁的最佳实验室方法取决于临床情况。在办公室或门诊诊所，血清铁蛋白最有助于识别铁耗竭，尽管TS、FEP和MCV有助于评估其严重程度。在患有明显贫血的住院患者中，TS、FEP和MCV的帮助要小得多，因为在慢性病贫血中也会出现类似变化。骨髓铁检查仍然是首选方法，尤其是在感染、慢性病、恶性肿瘤或肝病患者中，尽管在许多临床情况下，从血清铁蛋白中也能获得相同信息。血清铁蛋白的系列检测在监测缺铁高危患者（如类风湿性关节炎、慢性炎症性肠病或慢性肾衰竭患者）方面特别有用。
