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검사정보의 이해를 통한 철결핍빈혈과 만성질환빈혈의 감별진단

Differential Diagnosis between Iron Deficiency Anemia and Anemia of Chronic Disease by Understanding Laboratory Results

이석준
한국보건정보통계학회 (The Korean Society of Health informatics statistics)|2019.11|보건정보통계학회지 (Journal of Health Informatics and Statistics)|제44권 제4호|pp. 331-338|DOI https://doi.org/10.21032/jhis.2019.44.4.331

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키워드

Iron deficiency anemiaAnemia of chronic diseaseHepcidinIron metabolismSoluble transferrin receptor

초록

Objectives: The purpose of this study is to provide availability of laboratory results in differential diagnosis of iron deficiency anemia (IDA) and anemia of chronic disease (ACD). Methods: This study was based on a systematic review of related to iron metabolism, IDA and ACD. We searched the published articles from 1992 to 2019 in Earticle, KISS, NDSL, RISS, DBpia and PubMed. Results: IDA accounts for more than 50% of all anemia patients, followed by ACD. Differential diagnosis is needed between IDA and ACD, which usually shows microcytic, hypochromic anemia. The standard for differential diagno￾sis is the bone marrow iron stain. However, bone marrow study is invasive, expensive so that it cannot be routinely performed. Consequently, the mea￾surement of serum ferritin is the first level test for differential diagnosis. Serum ferritin level is good indicators of storage iron; decreased levels in IDA and normal to increased levels in ACD. However, serum ferritin level may increase irrespective of iron stores in cases of chronic disease. Therefore, it is difficult to diagnose IDA coexisting with ACD. Another available biomarker is soluble transferrin receptor (sTfR). The sTfR level is not affected by chronic disease; it is elevated in IDA but not in ACD. Additionally, the sTfR/log ferritin index is suggested as a good biomarker for identifying coexisting IDA and CAD. Con￾clusions: This review introduces the etiology and differential diagnosis of IDA and ACD based on an understanding of iron metabolism. Understanding the interrelationship of the various laboratory results may be helpful in the accurate diagnosis and treatment of IDA and ACD.

Abstract

Objectives: The purpose of this study is to provide availability of laboratory results in differential diagnosis of iron deficiency anemia (IDA) and anemia of chronic disease (ACD). Methods: This study was based on a systematic review of related to iron metabolism, IDA and ACD. We searched the published articles from 1992 to 2019 in Earticle, KISS, NDSL, RISS, DBpia and PubMed. Results: IDA accounts for more than 50% of all anemia patients, followed by ACD. Differential diagnosis is needed between IDA and ACD, which usually shows microcytic, hypochromic anemia. The standard for differential diagno￾sis is the bone marrow iron stain. However, bone marrow study is invasive, expensive so that it cannot be routinely performed. Consequently, the mea￾surement of serum ferritin is the first level test for differential diagnosis. Serum ferritin level is good indicators of storage iron; decreased levels in IDA and normal to increased levels in ACD. However, serum ferritin level may increase irrespective of iron stores in cases of chronic disease. Therefore, it is difficult to diagnose IDA coexisting with ACD. Another available biomarker is soluble transferrin receptor (sTfR). The sTfR level is not affected by chronic disease; it is elevated in IDA but not in ACD. Additionally, the sTfR/log ferritin index is suggested as a good biomarker for identifying coexisting IDA and CAD. Con￾clusions: This review introduces the etiology and differential diagnosis of IDA and ACD based on an understanding of iron metabolism. Understanding the interrelationship of the various laboratory results may be helpful in the accurate diagnosis and treatment of IDA and ACD.

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