Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 6)

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Table 98-3 Iron Store Measurements Iron Stores 4+ Marrow Iron Stain, 0– µg/L Serum Ferritin, 0 0 150 Iron overload — 500–1000 Red Cell Protoporphyrin Levels Protoporphyrin is an intermediate in the pathway to heme synthesis. Under conditions in which heme synthesis is impaired, protoporphyrin accumulates within the red cell.

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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 6) Table 98-3 Iron Store Measurements Iron Stores Marrow Iron Stain, 0– Serum Ferritin, 4+ µg/L 0 0
800–1000 3+ 60–150 mg 1–2 g 4+ >150 Iron overload — >500–1000 Red Cell Protoporphyrin Levels Protoporphyrin is an intermediate in the pathway to heme synthesis. Under conditions in which heme synthesis is impaired, protoporphyrin accumulates within the red cell. This reflects an inadequate iron supply to erythroid precursors to support hemoglobin synthesis. Normal values are
(TRP) is released by cells into the circulation, serum levels of TRP reflect the total erythroid marrow mass. Another condition in which TRP levels are elevated is absolute iron deficiency. Normal values are 4–9 µg/L determined by immunoassay. This laboratory test is becoming increasingly available and, along with the serum ferritin, has been proposed to distinguish between iron deficiency and the anemia of chronic inflammation (see below). Differential Diagnosis Other than iron deficiency, only three conditions need to be considered in the differential diagnosis of a hypochromic microcytic anemia (Table 98-4). The first is an inherited defect in globin chain synthesis: the thalassemias. These are differentiated from iron deficiency most readily by serum iron values; normal or increased serum iron levels and transferrin saturation are characteristic of the thalassemias. Table 98-4 Diagnosis of Microcytic Anemia Tests Iron Inflamma Thalasse Siderobl Deficiency tion mia astic Anemia Smear Micro/h Normal Micro/hy Variable
ypo micro/hypo po with targeting SI