《2011BSG缺铁性贫血诊治指南》内容预览

Modern automated cell counters provide measurements of the changes in red cells that accompany iron deficiency: reduced mean cell Hb (MCH) hypochromia and increased percentage of hypochromic red cells and reduced mean cell volume (MCV) microcytosis.The MCH is probably the more reliable because it is less influenced by the counting machine used and by storage.Both microcytosis and hypochromia are sensitive indicators of iron deficiency in the absence of chronic disease or coexistent vitamin B or folate deficiency.An increased red cell distribu-tion width will often indicate coexistent vitamin B or folate deficiency. Microcytosis and hypochromia are also present in many haemoglobinopathies (such as thalassaemia, when the MCV is often out of proportion to the level of anaemia compared with iron deficiency), in sideroblastic anaemia and in some cases of anaemia of chronic disease. Hb electrophoresis is recommended when microcytosis is present in patients of appropriate ethnic background to prevent unnecessary GI investigation (C). The serum markers of iron deficiency include low ferritin, low transferrin saturation, low iron, raised total iron-binding capacity, raised red cell zinc protoporphyrin, and increased serum transferrin receptor (sTfR). Serum ferritin is the most powerful test for iron deficiency in the absence of inflammation (A). The cut-off concentration of ferritin that is diagnostic varies between 12 and 15 mg/l.This only holds for patients without coexistent inflammatory disease. Where there is inflammatory disease, a concentration of 50 mg/l or even more may still be consistent with iron deficiency.The sTfR concen-tration is said to be a good marker of iron deficiency in healthy subjects,but its utility in the clinical setting remains to be proven. Several studies have shown that the sTfR/log serum ferritin ratio provides superior discrimination to either test on its own, particularly in chronic disease.

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