diagnosis of iron deficiency
The diagnosis of iron deficiency can be made when a person has both a low hemoglobin/hematocrit and low serum ferritin. Serum iron and, transferrin-iron saturation percentage (TS%) will also be low in a person who is iron deficient. Iron deficiency without anemia is when a person has a normal hemoglobin, but below normal serum ferritin. Iron deficiency with anemia is when a person has low values of both serum ferritin and hemoglobin.
Serum ferritin is a very important test because it helps distinguish between iron deficiency anemia where you may need iron supplements and anemia of chronic disease (also called anemia of inflammatory response) where iron supplements are not helpful.could be harmful.
Ferritin is a ubiquitous intracellular protein that stores iron and releases it in a controlled fashion. The amount of ferritin stored reflects the amount of iron stored. it acts as a buffer against iron deficiency and iron overload.
iron is stored in a protein complex as ferritin or hemosiderin. Apoferritin binds to free ferrous iron and stores it in the ferric state.
Anemia of chronic disease, also referred to as anemia of inflammatory response or ACD, is a form of anemia seen in chronic illness, e.g. from chronic infection, chronic immune activation, or malignancy.In response to inflammatory cytokines, increasingly IL-6, the liver produces increased amounts of hepcidin. Hepcidin in turn stops ferroportin from releasing iron stores. Inflammatory cytokines also appear to affect other important elements of iron metabolism, including decreasing ferroportin expression, that decreasing the ability of the bone marrow to respond to erythropoietin.
Anemia of chronic disease may also be due to the neoplastic disorder and non infectious inflammmatory diseases. Neoplastic disorder include Hodgkin’s disease lung and breast carcinoma and non infectious inflammmatory diseases include Rheumatoid arthritis and systemic lupus erythematosus.
- In anemia of chronic disease without iron deficiency, ferritin levels should be normal or high, reflecting the fact that iron is stored within cells, and ferritin is being produced as an acute phase reactant but the cells are not releasing their iron.
- ferritin levels may be artificially high in cases of anemia of chronic disease where ferritin is elevated in its capacity as an acute phase protein and not as a marker for iron overload.
- TIBC should be low or normal in anemia of chronic disease.
- In iron deficiency anemia ferritin should be low.
- TIBC should be high in genuine iron deficiency, reflecting efforts by the body to produce more transferrin and bind up as much iron as possible
ملخص الحدوتة : ان الفرتين دة بروتين بيفرزة الكبد عشان يخزن الحديد لما الجسم يعوز حديد يفرز حديد فى الدم لما يبقى فى زيادة حديد فى الدم الفرتين يخزنة ولكن وجدوا ان فى حالات العدوى المزمنة والاتهابات والانترلوكينزا 6 يجعل الحديد لا يخرج من الخلايا المخزنة ولذلك يلاحظ نقص الحديد والفرتين طبيعى
عشان كدة ناخد بالنا من نقص الحديد فى الدم لو كان معاه نقص فى الفرتين يبقى دة انيميا نقص الحديد ويبقى المريض محتاج اقراص حديد اما اذا كان الفريتين زيادة دة معناة نقص حديد من مرض مزمن او التهاب وفى الحالة ديت ميخدش المريض حديد بل يعالج المرض نفسة