TESTS AND DIAGNOSIS
OF IRON DEFICIENCY
Tests and lab findings for iron deficiency:
- Peripheral smear (microcytosis, hypochromasia widening of the central pallor accounting for >1/3 of the total RBC diameter, anistocytosis)
-
Red cell indices
a. Mean corpuscular volume (MCV) : measurement of the average size of a single red blood cell (↓ MCV <80 fl)
b. Mean corpuscular hemoglobin (MCH) : calculation of the average amount of hemoglobin inside a single red blood cell (↓ MCH)
c. ↑ Red cell distribution width (RDW) (anisocytosis), platelets
d. ↓ Mean corpuscular hemoglobin concentration - MCHC (<32g/dL), RBC, Hb, Hct
- Serum ferritin (↓ ferritin)
- Serum iron/transferrin = iron saturation (↓ iron saturation <20%)
- Soluble transferrin receptor (sTfR) (facilitates intracellular import of iron; ID induces the expression and release of the transferrin receptor to the circulation)
- Bone marrow iron stain (Prussian blue)
Accepted Definition for ID in HF: ↓ Ferritin < 100 ug/L OR 100-300 ug/L and TSAT < 20 %
Guideline
Criteria
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
Ferritin <100 ng/ml or ferritin 100-300 ng/ml if TSAT < 20%
2021 ESC Guidelines for Diagnosis and Treatment of Acute and Chronic HF
It is recommended that all patients with HF be regularly screened for anemia and iron deficiency with a full blood count, serum ferritin concentration, and TSAT
(Ferritin <100ng/ml or ferritin 100-300ng/ml if TSAT <20%)
Algorithm for Screening, Diagnosis and Treatment Decision for Iron deficiency in Patients with Heart Failure
Algorithm for Screening, Diagnosis and Treatment Decision for Iron deficiency in Patients with Heart Failure
Check iron deficiency status
Ferritin
<100μg/L
Or
Ferritin
100-299μg/L, when TSAT<20%
Check anemia status
Male HB<13g/dL
Female HB<13g/dL
Check iron deficiency status
NO
YES
Exclude other causes for anaemia depending on clinical status:
Occult bleeding (e.g. GI, malignancies
Renal insufficiency (erythropoietin)
Other deficiencies (e.g. Bit B12, folic acid)
Other haemoglobinopathies (e.g. thalassemia, sickle cell anaemia)
No Other Cause
Iron Deficiency Treatment
Note: if Hb >15 g/dL do not administer IV iron
Hb = hemoglobin, Hct = hematocrit, HFrEF = heart failure with reduced ejection fraction,
NYHA = New York Heart Association HF functional classification, RBC = red blod cell, TSAT = transferrin saturation
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REFERENCES:
McDonagh, Theresa, et al. “Screening, diagnosis and treatment of iron deficiency in chronic heart failure: putting the 2016 European Society of Cardiology heart failure guidelines into clinical practice.” European journal of heart failure 20.12 (2018): 1664-1672.
Heidenreich, Paul A., et al. “2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.” Journal of the American College of Cardiology 79.17 (2022): e263-e421.
Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.” Journal of the American College of Cardiology 70.6 (2017): 776-803.
McDonagh, Theresa A., et al. “2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.” European heart journal (2021): ehab368.
