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Iron Studies
1 Serum Iron:
◦ Decreased: due to the body’s iron sequestration
2 Total Iron Binding Capacity (TIBC):
◦ Decreased to Normal:. This is due to decreased liver production of transferrin
3 Transferrin Saturation:
◦ Normal to Low: correlating with reduced serum iron levels and iron sequestration.
4 Serum Ferritin:
◦ Normal to Increased: Inflammatory cytokines increase ferritin synthesis as an acute-phase reactant, so ferritin levels do not accurately reflect iron availability in ACD.
5 Zinc Protoporphyrin (ZPP):
◦ Increased: Zinc is incorporated into protoporphyrin as a substitute for iron
6 Soluble Transferrin Receptor (sTfR):
◦ Normal:
7 sTfR-Ferritin Index:
◦ Decreased: The sTfR-ferritin index, calculated as the ratio of sTfR to ferritin, is low in ACD. This finding helps differentiate ACD from iron deficiency anemia, where the index would be elevated.
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A mild anemia (Hb not <9 g/dl, HCT<27).
Erythrocytes are usually normocytic (MCV785 fL) and
normochromic but can present as normocytic hypochromic or
in long standing cases microcytic hypochromic.
- Reticulocyte production index is < 2.
- White blood cell count and platelet count are normal unless
they are altered due to the primary disease state.
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- Signs and symptoms of ACD are usually those associated
with the underlying disorder, rarely severe and the degree of
the anemia roughly correlates with the activity of the
underlying disease.
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Reason for decreased erythrocyte life span is unknown but
several mechanisms have been suggested including
nonspecific macrophage activation, hemolytic factors
elaborated by tumors, vascular factors and the presence of
bacterial toxins capable of hemolyzing erythrocytes
