What is the iron deficiency pattern in a patient with chronic anemia, characterized by low iron (Hypoferritinemia) levels, elevated Total Iron-Binding Capacity (TIBC), low iron saturation index, and normal Ferritin levels?

From the Guidelines

This laboratory pattern reflects iron deficiency anemia despite the normal ferritin level, as indicated by the low serum iron, normal total iron binding capacity (TIBC), and particularly the low transferrin saturation index of 0.13 (13%). The low serum iron (6 umol/L) and low transferrin saturation index are classic findings in iron deficiency, as noted in the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1. While ferritin is typically low in iron deficiency, it can appear normal in the setting of chronic inflammation or certain comorbidities as it's an acute phase reactant, as discussed in the second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations 1.

Key Findings

• Low serum iron (6 umol/L)
• Normal TIBC (46 umol/L)
• Low transferrin saturation index (0.13 or 13%)
• Normal ferritin level (90)

Diagnosis and Treatment

According to the ESPEN guideline: clinical nutrition in inflammatory bowel disease 1, iron supplementation is recommended in all patients with iron-deficiency anaemia. Treatment should include oral iron supplementation, typically ferrous sulfate 325 mg three times daily or ferrous gluconate 300 mg twice daily, taken between meals with vitamin C to enhance absorption. Therapy should continue for 3-6 months even after hemoglobin normalizes to replenish iron stores. If oral therapy is ineffective or poorly tolerated, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be necessary.

Underlying Cause Investigation

Additionally, the underlying cause of iron deficiency should be investigated, particularly focusing on sources of blood loss such as gastrointestinal bleeding or heavy menstrual bleeding in women of reproductive age, as recommended by the British Society of Gastroenterology guidelines 1. The ESPEN guideline also suggests that all patients with inflammatory bowel disease (IBD) should be assessed for the presence of anaemia, and that iron supplementation should be considered in patients with clinically active IBD, with previous intolerance to oral iron, with haemoglobin below 100 g/L, and in patients who need erythropoiesis-stimulating agents 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Iron Deficiency Anemia Diagnosis

The patient's iron level is 6 umol/L, TIBC 46 umol/L, and iron saturation index 0.13, with a normal ferritin level of 90. To determine the pattern this reflects, we need to consider the diagnosis of iron deficiency anemia.

• The patient's iron level is low, which could indicate iron deficiency anemia 2.
• The TIBC is within the normal range, but the iron saturation index is low, which suggests that the patient's iron stores are depleted 3.
• The normal ferritin level suggests that the patient's iron stores are not severely depleted, but the low iron level and low iron saturation index suggest that the patient may have iron deficiency anemia 4.

Patterns of Iron Deficiency Anemia

There are several patterns of iron deficiency anemia, including:

• Absolute iron deficiency, which is characterized by low iron stores and low hemoglobin levels 2.
• Iron-deficiency anemia, which is characterized by low hemoglobin levels due to low iron stores 2.
• Non-anemic iron deficiency, which is characterized by low iron stores without low hemoglobin levels 2.

Diagnosis and Interpretation

Based on the patient's laboratory results, it appears that they may have iron deficiency anemia, characterized by low iron levels and low iron saturation index, despite a normal ferritin level. However, the diagnosis of iron deficiency anemia should be confirmed by a healthcare professional, taking into account the patient's medical history, physical examination, and other laboratory results 3, 4.

• The patient's low iron level and low iron saturation index suggest that they may have iron deficiency anemia, but the normal ferritin level suggests that their iron stores are not severely depleted 4.
• The patient's TIBC is within the normal range, which suggests that their iron-binding capacity is normal 3.

It is essential to consider the patient's overall clinical presentation and laboratory results to determine the underlying cause of their iron deficiency anemia and to develop an appropriate treatment plan 2, 3, 4.