What is the clinical significance of a 56-year-old male patient's laboratory results, which showed hypoferritinemia (FERRITIN 84) and iron deficiency (Iron 45, Iron % Saturation 16), while being treated with Requip (Ropinirole) 1 mg and Duloxetine (Cymbalta) 60 mg?

From the Guidelines

I strongly recommend initiating oral iron supplementation for this 56-year-old male patient due to his low serum iron level and iron saturation percentage. Ferrous sulfate 325 mg once or twice daily between meals would be appropriate. The patient should take iron supplements with vitamin C (such as orange juice) to enhance absorption and avoid taking them with calcium-containing foods, tea, coffee, or dairy products which can reduce absorption. Treatment should continue for 3-6 months with follow-up labs in 2-3 months to assess response. This recommendation is based on the patient's laboratory values showing iron deficiency (serum iron 45 μg/dL, iron saturation 16%), though ferritin remains within normal range at 84 ng/mL 1. The current medications (Requip 1 mg and duloxetine 60 mg) are not likely causing the iron deficiency, but it would be important to evaluate for potential causes of iron deficiency in this patient, including occult gastrointestinal blood loss, poor dietary intake, or malabsorption issues, particularly in the prison setting where dietary options may be limited. According to the British Society of Gastroenterology guidelines, iron deficiency should be confirmed by iron studies prior to investigation, and serum ferritin is the single most useful marker of IDA 1. However, in the presence of inflammation, a serum ferritin up to 100 mg/L may still be consistent with iron deficiency, as suggested by the ESPEN guideline on clinical nutrition in inflammatory bowel disease 1. Given the patient's ferritin level of 84 ng/mL, which is below 100 mg/L, and his low serum iron and iron saturation, initiating oral iron supplementation is a reasonable approach to address his iron deficiency and improve his quality of life. It is also important to note that iron supplementation is recommended in patients with iron-deficiency anaemia, and quality of life improves with correction of anaemia, as stated in the ESPEN guideline 1. Therefore, oral iron supplementation should be initiated promptly to address the patient's iron deficiency and improve his overall health outcomes.

From the Research

Patient's Iron Levels and Medication

• The patient is taking Requip 1 mg and Duloxetine 60 mg, and has the following iron levels: Iron 45, Iron % Sat 16, Ferritin 84.
• These levels indicate that the patient may have iron deficiency anemia, as the ferritin level is below the normal range 2.
• However, the patient's iron levels are not severely low, and the ferritin level is still within a range that may not require immediate iron supplementation 3.

Diagnosis and Treatment of Iron Deficiency Anemia

• Iron deficiency anemia is typically diagnosed by measuring biomarkers of iron stores, such as serum ferritin and transferrin saturation 4.
• Oral supplementation with ferrous sulphate is an effective therapy for iron deficiency anemia, but gastrointestinal side effects may impair treatment compliance 4, 5.
• The patient's current medication regimen does not include iron supplements, and it is unclear whether iron supplementation would be beneficial for this patient.

Interpretation of Biochemical and Haematological Findings

• The measurement of ferritin is the most important analysis in the study of iron deficiency, but there is no consensus on the diagnostic cut-off 2.
• A ferritin level of < 12-20 μg/L is commonly used as a diagnostic cut-off, but this may not be sensitive enough to detect iron deficiency in all patients 2.
• The patient's ferritin level of 84 is above this range, but it is still important to consider the patient's overall clinical picture and other laboratory findings when interpreting these results 3.

Comparison of Iron Supplements

• Ferrous sulfate is the most commonly prescribed oral iron supplement, but iron polysaccharide complex may be better tolerated in some patients 6.
• A study comparing ferrous sulfate with iron polysaccharide complex found that ferrous sulfate resulted in a greater increase in hemoglobin concentration at 12 weeks 6.
• However, the patient's current medication regimen and iron levels do not necessarily indicate a need for iron supplementation, and the choice of supplement would depend on individual patient factors 5.