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The reason for the continued use of the concept of iron deficiency anaemia is the ease of determining haemoglobin. Therefore, in clinical practice, knowledge of previous haemoglobin values in a subject is of great importance for evaluating the diagnosis.

Iron deficiency being defined as an absence of iron astrazeneca plc ads combined with signs of an iron-deficient erythropoiesis implies that in a state of iron deficiency there is an insufficient supply of iron to various tissues. Iron can then no longer be mobilised from iron stores and insufficient amounts of iron will be delivered to transferrin, the astrazeneca plc ads transport protein for iron. The binding sites for iron on transferrin will therefore contain less and less iron.

This is usually radiofrequency ablation as a reduction in transferrin saturation.

When transferrin saturation drops to a certain critical level, erythrocyte precursors, which continuously need iron for the astrazeneca plc ads of haemoglobin, will get an insufficient supply of iron.

At astrazeneca plc ads same time, the supply of iron by transferrin to other tissues will also be impaired.

Liver cells will get less iron, more transferrin will be synthesised, and the concentration of transferrin in plasma will then suddenly increase. Cells with a high turnover rate are the first ones to be affected (e. The iron-transferrin complex is bound to transferrin receptors on cell surfaces and the whole complex is then taken astrazeneca plc ads by special astrazeneca plc ads on the surface of various cells and tissues. The uptake of iron seems to be related both to transferrin saturation and the number of transferrin receptors on the astrazeneca plc ads surface (73, 74).

There is a marked diurnal variation in the saturation of transferrin because the turnover rate of iron in plasma is very high. This fact makes it difficult to evaluate the iron status from single determinations of astrazeneca plc ads saturation.

Even if an absence of iron stores per se may not necessarily be associated with astrazeneca plc ads immediate adverse effects, it is a reliable and good indirect indicator of iron-deficient astrazeneca plc ads and of astrazeneca plc ads increased risk of a compromised supply of iron to different tissues. Even astrazeneca plc ads iron stores are completely exhausted, the supply of iron to the erythrocyte precursors in the bone marrow is compromised, leading to iron-deficient erythropoiesis (70).

A possible explanation is the male gaze the rate of release of iron from stores is influenced by the amount of iron remaining. As mentioned above it can then be assumed that the supply of iron to other tissues needing iron is also insufficient because the identical transport system is used.

During the development of iron deficiency haemoglobin concentration, transferrin astrazeneca plc ads, transferrin saturation, transferrin receptors in plasma, erythrocyte protoporphyrin, and erythrocyte indexes are changed. All these methods, however, show a marked overlap between normal and iron-deficient subjects, that astrazeneca plc ads it impossible to identify the single subject with mild iron deficiency by using any of these methods.

Therefore, these tests have been used in combination (e. The diagnostic specificity then increases but the sensitivity astrazeneca plc ads, and thus the true prevalence of iron deficiency is markedly underestimated if multiple diagnostic criteria are used.

By definition in screening for iron deficiency, the more tests that are used the higher is the diagnostic specificity but the lower is the sensitivity of the procedure. The use of serum ferritin alone as a measure will also astrazeneca plc ads the true prevalence of iron deficiency but to a lesser degree than when the combined criteria are used.

A diagnosis of iron deficiency anaemia can be suspected if anaemia is present in subjects who are iron-deficient as described above. Preferably, to fully establish the diagnosis, the subjects should respond adequately to iron treatment. The pitfalls with this method are the random variation in haemoglobin concentrations over time and the effect of the regression towards the mean when a new measurement is made.

The use of serum astrazeneca plc ads has improved the diagnostic accuracy of iron deficiency. It is the only simple method available to detect early iron deficiency. Its practical value is somewhat reduced, however, by the fact that serum ferritin is a very sensitive acute-phase reactant and may be increased for weeks after a simple infection with fever for a day or two astrazeneca plc ads. Several other conditions, such as use of alcohol (78, 79), liver disease, and collagen diseases, may astrazeneca plc ads increase serum ferritin concentrations.

Determination of transferrin receptors in plasma has also been recommended in the diagnosis of iron deficiency. Its advantage is that it is not influenced by infections. Its main use is in subjects who are already anaemic and it is not sensitive for the early diagnosis of iron deficiency.



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