From the Guidelines
This patient does not have iron deficiency anemia despite low serum iron, as indicated by a ferritin level of 409, which is significantly above the threshold for iron deficiency, suggesting anemia of chronic disease. The patient's laboratory results show a hemoglobin of 7.97 g/dL, MCV 94, MCHC 31, HCT 25, TIBC 27, iron 9.3, ferritin 409, and vit B12 1219 1. According to the British Society of Gastroenterology guidelines for the management of iron deficiency anemia in adults, a serum ferritin level above 150 μg/L is unlikely to occur with absolute iron deficiency, even in the presence of inflammation 1. Given the patient's ferritin level is significantly elevated, the diagnosis of iron deficiency anemia is unlikely. The patient's anemia is more likely due to anemia of chronic disease, which is common in patients with multiple comorbidities like diabetes, hypertension, and stroke history. Key considerations in the management of this patient include:
- Evaluating the cause of anemia, considering chronic disease and potential gastrointestinal blood loss
- Monitoring kidney function due to the increased risk of chronic kidney disease associated with diabetes, hypertension, and previous stroke
- Assessing the need for blood transfusion if the patient is symptomatic with this degree of anemia
- Considering alternative treatments for anemia of chronic disease, such as erythropoiesis-stimulating agents, if necessary.
From the Research
Patient's Condition
The patient is a 61-year-old with a known case of diabetes mellitus (DM), hypertension (HTN), and stroke for 2 years. The patient's laboratory results show:
- Hemoglobin (Hgb): 7.97 g/dL
- Mean Corpuscular Volume (MCV): 94 fL
- Mean Corpuscular Hemoglobin Concentration (MCHC): 31 g/dL
- Hematocrit (HCT): 25%
- Total Iron-Binding Capacity (TIBC): 27 μg/dL
- Iron: 9.3 μg/dL
- Ferritin: 409 ng/mL
- Vitamin B12: 1219 pg/mL
Iron Deficiency and Anemia
According to the study 2, iron deficiency and iron-deficiency anemia are common conditions that may cause symptoms such as fatigue, exercise intolerance, and difficulty concentrating. The patient's ferritin level is 409 ng/mL, which is above the normal range, indicating that the patient does not have iron deficiency anemia. However, the patient's hemoglobin level is low, which may indicate anemia due to other causes.
Diagnosis and Treatment of Iron Deficiency
The study 3 suggests that the diagnosis of iron deficiency is based on decreased levels of serum ferritin and transferrin saturation. The patient's ferritin level is elevated, which may indicate an inflammatory condition rather than iron deficiency. The study 4 recommends that treatment targets for iron deficiency include an increase in hemoglobin concentrations to 10-12 g/dL or normalization and serum ferritin >100 μg/L or 200 μg/L.
Clinical Management of Iron Deficiency Anemia
The study 5 suggests that serum ferritin and transferrin saturation are the key tests in the early decision-making process to identify iron deficiency anemia. The study also recommends that treatment is based on iron supplementation, and infusion route should be preferentially considered in frail patients, especially in the view of new iron available formulations.
Relationship to Stroke
The study 6 investigated the relationship between electrocardiogram (ECG) abnormalities and stroke. The study found that patients with stroke had an increased frequency of ECG abnormalities, including QT prolongation, ischemic changes, and arrhythmias. However, this study does not provide direct evidence related to the patient's condition, as it focuses on ECG abnormalities rather than iron deficiency or anemia.
Key Points
- The patient's ferritin level is elevated, indicating that the patient does not have iron deficiency anemia.
- The patient's hemoglobin level is low, which may indicate anemia due to other causes.
- The patient's laboratory results and medical history should be further evaluated to determine the underlying cause of anemia.
- Treatment targets for iron deficiency include an increase in hemoglobin concentrations to 10-12 g/dL or normalization and serum ferritin >100 μg/L or 200 μg/L, as recommended by the study 4.