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Are Current Serum and Plasma Ferritin Cut-offs for Iron Deficiency and Overload Accurate and Reflecting Iron Status? A Systematic Review.
Arch Med Res. 2018 08; 49(6):405-417.AM

Abstract

BACKGROUND

Serum or plasma ferritin concentration is recommended by WHO as a biomarker to assess iron status in individuals and populations.

METHODS

A systematic review was undertaken to summarise the evidence for ferritin reflecting iron status and to assess the cut-off points in different populations. Electronic databases were searched for studies evaluating ferritin concentrations compared against bone marrow aspirates for iron deficiency and to liver biopsies for risk of iron overload.

RESULTS

From 18822 records, 298 studies were assessed in full-text, including 72 studies on iron deficiency and 36 on iron overload in the quantitative analysis. All studies were observational. For iron deficiency, the mean ferritin concentration in healthy individuals was 15.1 μg/L (9 studies, 390 participants) when bone marrow iron content was 0, and 70.4 μg/L (3 studies, 151 participants) when bone marrow iron was 1+ or higher. In non-healthy populations, mean ferritin concentrations were 82.43 μg/L for iron depletion (38 studies, 1023 participants) and 381.61 μg/L for iron sufficiency (38 studies, 1549 participants) with wide variations depending on the pathology. For iron overload the results point out to a cut-off close to 500 μg/L although the data was very limited.

CONCLUSION

Ferritin concentration is low in iron deficient individuals and high in iron-loaded individuals, regardless of confounding clinical conditions. Current WHO thresholds for healthy populations appear valid but the data is limited for different age groups or physiological conditions. For iron overload, ferritin concentration would only help in the presumptive diagnosis and guide the need for further assessment.

Authors+Show Affiliations

Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland. Electronic address: mngarciacasal@gmail.com.Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland.Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland.Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Systematic Review

Language

eng

PubMed ID

30573199

Citation

Garcia-Casal, Maria Nieves, et al. "Are Current Serum and Plasma Ferritin Cut-offs for Iron Deficiency and Overload Accurate and Reflecting Iron Status? a Systematic Review." Archives of Medical Research, vol. 49, no. 6, 2018, pp. 405-417.
Garcia-Casal MN, Pasricha SR, Martinez RX, et al. Are Current Serum and Plasma Ferritin Cut-offs for Iron Deficiency and Overload Accurate and Reflecting Iron Status? A Systematic Review. Arch Med Res. 2018;49(6):405-417.
Garcia-Casal, M. N., Pasricha, S. R., Martinez, R. X., Lopez-Perez, L., & Peña-Rosas, J. P. (2018). Are Current Serum and Plasma Ferritin Cut-offs for Iron Deficiency and Overload Accurate and Reflecting Iron Status? A Systematic Review. Archives of Medical Research, 49(6), 405-417. https://doi.org/10.1016/j.arcmed.2018.12.005
Garcia-Casal MN, et al. Are Current Serum and Plasma Ferritin Cut-offs for Iron Deficiency and Overload Accurate and Reflecting Iron Status? a Systematic Review. Arch Med Res. 2018;49(6):405-417. PubMed PMID: 30573199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are Current Serum and Plasma Ferritin Cut-offs for Iron Deficiency and Overload Accurate and Reflecting Iron Status? A Systematic Review. AU - Garcia-Casal,Maria Nieves, AU - Pasricha,Sant-Rayn, AU - Martinez,Ricardo X, AU - Lopez-Perez,Lucero, AU - Peña-Rosas,Juan Pablo, Y1 - 2018/12/17/ PY - 2018/11/27/received PY - 2018/12/06/accepted PY - 2018/12/24/pubmed PY - 2019/8/14/medline PY - 2018/12/22/entrez KW - Bone marrow KW - Cut offs KW - Ferritin KW - Iron deficiency KW - Liver biopsy KW - Risk of iron overload SP - 405 EP - 417 JF - Archives of medical research JO - Arch. Med. Res. VL - 49 IS - 6 N2 - BACKGROUND: Serum or plasma ferritin concentration is recommended by WHO as a biomarker to assess iron status in individuals and populations. METHODS: A systematic review was undertaken to summarise the evidence for ferritin reflecting iron status and to assess the cut-off points in different populations. Electronic databases were searched for studies evaluating ferritin concentrations compared against bone marrow aspirates for iron deficiency and to liver biopsies for risk of iron overload. RESULTS: From 18822 records, 298 studies were assessed in full-text, including 72 studies on iron deficiency and 36 on iron overload in the quantitative analysis. All studies were observational. For iron deficiency, the mean ferritin concentration in healthy individuals was 15.1 μg/L (9 studies, 390 participants) when bone marrow iron content was 0, and 70.4 μg/L (3 studies, 151 participants) when bone marrow iron was 1+ or higher. In non-healthy populations, mean ferritin concentrations were 82.43 μg/L for iron depletion (38 studies, 1023 participants) and 381.61 μg/L for iron sufficiency (38 studies, 1549 participants) with wide variations depending on the pathology. For iron overload the results point out to a cut-off close to 500 μg/L although the data was very limited. CONCLUSION: Ferritin concentration is low in iron deficient individuals and high in iron-loaded individuals, regardless of confounding clinical conditions. Current WHO thresholds for healthy populations appear valid but the data is limited for different age groups or physiological conditions. For iron overload, ferritin concentration would only help in the presumptive diagnosis and guide the need for further assessment. SN - 1873-5487 UR - https://www.unboundmedicine.com/medline/citation/30573199/Are_Current_Serum_and_Plasma_Ferritin_Cut_offs_for_Iron_Deficiency_and_Overload_Accurate_and_Reflecting_Iron_Status_A_Systematic_Review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0188-4409(18)30827-0 DB - PRIME DP - Unbound Medicine ER -