The Value of Serum Ferritin in the Prediction of Iron Deficiency in Patients with Lymphoid Neoplasms | ||
| Kerbala Journal of Medicine | ||
| Article 1, Volume 6, Issue 2, December 2013, Pages 1668-1674 PDF (0 K) | ||
| Authors | ||
| Ahmed I. Shuk; Yassmin .Ali abdul-kareem AL-Amiri; Yassmin .Ali abdul-kareem AL-Amiri Mahmood R. Al-Rubaye; Zakaa N. Al-Nidawy; Israa M. Al-Bayaa | ||
| Abstract | ||
| background:- anemia is a well-known complication of patients with lymphoid neoplasm and many factors are involved in its pathogenesis including defective iron utilization and diagnosing iron deficiency in the context of malignancy or chronic illness can be very challenging as many of the parameters used are acute phase markers and can be misinterpreted in the presence of chronic illness .bone marrow iron is the gold standard mean for assessing marrow iron but it is an invasive and a laborious procedure ,on the other hand serum ferritin has been used as the most relevant indicator of iron deficiency in the general population but it has the drawback of being increased in the presence of an acute response. Objectives:- evaluate the ability of serum ferritin at different cutoff levels and in combination with other parameters to identify iron deficiency in patients with lymphoid neoplasms. Patients and methods:- 39 anemic patients with different types of lymphoid neoplasm attending the hematology unit in Baghdad hospital were enrolled in the study ,exclusion criteria included history of blood transfusion and iron therapy in the past 2 months .for all patients bone marrow iron study was carried out and accordingly patients were classified into 2 groups the iron depleted group (with absent marrow iron) and the iron replete group (with present iron stores).from all patients peripheral blood was taken for the evaluation of complete blood picture and ESR and serum ferritin by enzyme Linked immunosorbant assay method (ELISA). Results:- the mean serum ferritin for the iron depleted group was 78.31ng/dl while for the iron replete group it was 202.77ng/dl there was a highly significant difference for serum ferittin between the 2 groups (p value .005),a less significant difference was found also for the mean cell volume(p value .05) while the other parameters showed no difference, the lowest cutoff level for serum ferittin that could accurately identify iron deficiency with a high sensitivity 96% and a high specifity 80% was 66.7ng/dl . Logistic regression analysis was done for serum ferritin and ESR to test for the effect of these parameters on the predictive power of bone marrow iron stores. The logistic equation was: Log (p)=0.163 + .0621*ESR -0.026*ferritin Using this equation with ferritin and ESR gave a prediction power of about 74% to identify the iron bone marrow store however using ferittin alone gave a 69% prediction power. Conclusion: - serum ferritin at a cutoff value of 66.7ng/dl can be used with high accuracy for the identification of iron deficiency in patients with lymphoid neoplasm and can be used as a suitable alternative for bone marrow iron, correction of serum ferritin for the acute phase response did not enhance much its predictive power in identifying iron deficiency in those patients. | ||
| Keywords | ||
| ferritin; ESR; lymphoid neoplasm; marrow iron stores; Anemia | ||
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