Diagnosing iron deficiency: Controversies and novel metrics.

Jody A Rusch, Diederick J van der Westhuizen, Robert S Gill, Vernon J Louw

Journal: Best practice & research. Clinical anaesthesiology 2025;37(4):451-467

PMID: 39764832

Abstract

Iron deficiency, a pervasive global health issue, necessitates precise and reliable diagnostic methods, especially in clinical and surgical settings. This review examines an array of established markers of iron status, encapsulating parameters such as serum iron, ferritin, transferrin, and transferrin saturation alongside novel biomarkers like soluble transferrin receptor, zinc protoporphyrin, and hepcidin. We further scrutinise the potential and limitations of routine and novel diagnostic tools and strategies in distinguishing different anaemic conditions, such as iron deficiency anaemia, iron-restricted erythropoiesis, and anaemia of inflammation. Through a critical lens, we elucidate the current paradigms and pressing questions surrounding the diagnostic criteria and clinical ramifications of iron metabolism. By weaving together the nuances and diverging perspectives within the domain of iron deficiency diagnosis and management, this review aspires to foster a clearer understanding that can steer improved patient care and shape the trajectory of future research in this vital field.

Copyright © 2023 The Author. Published by Elsevier Ltd.. All rights reserved.

Address: Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa. Electronic address: [email protected].; Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.; Department of Medicine, J-floor, Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, South Africa.; Division of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
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