Endoscopic gastrointestinal workup fails to establish the cause of iron deficiency anemia (IDA) in a substantial proportion of patients. In patients referred for hematologic evaluation with unexplained or refractory IDA, screening for celiac disease, autoimmune gastritis, Helicobacter pylori, and hereditary forms of IDA is recommended. About 4% to 6% of patients with obscure refractory IDA have celiac disease, and autoimmune gastritis is encountered in 20% to 27% of patients.
326 BLOOD, 16 JANUARY 2014 x VOLUME 123, NUMBER 3
A complete blood cell count (CBC) is a frequent test sent to aid in the diagnostic evaluation of ill patients. Not uncommonly hematologic abnormalities may be the first sign of an underlying systemic disorder. The astute clinician needs to understand how systemic disease can affect the CBC to direct further diagnostic investigations. This
article focuses on the 2 most common acquired anemias including iron deficiency
and anemia of inflammation (AI) as well as disseminated intravascular coagulation
Pediatr Clin N Am 60 (2013) 1337–1348, http://dx.doi.org/10.1016/j.pcl.2013.08.012
Functional iron deficiency (FID) is a state in which there is insufficient iron incorporation into erythroid precursors in the face of apparently adequate body iron stores, as defined by the presence of stainable iron in the bone marrow together with a serum ferritin value within normal limits (Macdougall et al, 1989). In its broadest sense this definition encompasses the partial block in iron transport to the erythroid marrow seen in subjects
with infectious, inflammatory and malignant diseases, and is a major component of the anaemia of chronic disease (ACD).
British Journal of Haematology, 2013, 161, 639–648 doi:10.1111/bjh.12311
Diabetes mellitus and cardiomyopathy are common in chronically transfused thalassemia major patients, occurring in the second and third decades of life.
We postulated that pancreatic iron deposition would precede cardiac iron loading, representing an environment favorable for extrahepatic iron deposition. To test this hypothesis, we examined pancreatic and cardiac iron in 131 thalassemia major patients over a 4-year period.
BLOOD, 5 NOVEMBER 2009 VOLUME 114, NUMBER 19
Ferritin has a central role in iron homeostasis since it binds and sequesters intracellular iron. It is a spheric shell with a central cavity where up to 4,500 atoms of iron are oxidized and stored. Ferritin is a multimer composed of 24 H (heavy) and L (light) subunits in variable proportions in different tissues. The two subunits are highly conserved during evolution, but only the H subunit has ferroxidase activity.1 Ferritin is also released in the circulation prevalently as L-ferritin or G-(glycosylated)-subunit through a largely unknown process. Since over recent years serum ferritin measurement has become a routine laboratory test, elevated serum ferritin is a common finding in clinical practice. High serum ferritin is found in a large spectrum of conditions both genetic and acquired, associated or not with iron overload. For this reason a precise diagnosis of hyperferritinemia requires a strategy that includes family and personal medical history, biochemical and eventually genetic or other tests, especially those related to tissue iron measurement.
Haematologica March 2009 94: 307-309; Doi:10.3324/haematol.2008.005405