ASSESSMENT OF IRON

STATUS
Dr Sukma Sahreni, M.Gizi

SukmaS2Gizi/2012
 Function of iron
 Total iron : 2.5-4 g elemental iron,
 70% in the hemoglobin(Hb)
 4 % in myoglobin
 Trace amount : electron transport and several enzymes
 25% present as storage iron(>>> liver,<<< RES of
the bone marrow and spleen)
 Ion storage : 2/3 Ferritin

sukma/S2Gizi/2012
Iron metabolism

sukma/S2Gizi/2012
 Deficiency of iron in Human
 Prevalent in : Infant, young children and pregnant
women
 Cause : * intake <<
*poor absorption
*Losses >>>
 Physical manifestation:
Anemia, angular stomatitis, glossitis, dysphagia,
hypochlorhidria and spoon nails
 Less specific: Fatigue, anorexia, tiredness, impaired
exercise or work performance, development delay,
cognitive impairment

sukma/S2Gizi/2012
 Development of iron deficiency anemia
1. Iron depletion( the first stage)
storage iron (liver)
-Transport iron and Hb N
- Ferritin
2. Iron deficient erythropoiesis (the second stage)
Exhaustion iron stores, Iron deficiency without anemia
-Iron supply
-Serum transferin Receptor and Erythrocyte protophorphyrin ,
- Hb slightly /N
3. Iron Deficiency anemia ( third stage)
Exhaustion iron stores, circulating iron
-Microcytic hypochromic anemia
-Hb

sukma/S2Gizi/2012
 HEMOGLOBIN
 >>> used for IDA(be careful)
 not be single used for measure iron status
 Factor affecting Hb concentration
*Biological variation: evening < morning
*Age and Sex
*Pregnancy
*Race
*Higher altitudes
*Iron deficiency anemia
*Certain other micronutrient deficiency
*Parasitic Infection
*Certain disease states
*Cigarette smoking
 Reference limit ?, NHANES, INACG
 WHO, adult : men <13, women <12, pregnant women < 11 g/dl
 CDC : pregnant women T I : 11g/dl, T II : 10,5g/dl, TIII : 11 g/dl

sukma/S2Gizi/2012
 Measurment of Hemoglobin
1. Best determinant : venous blood (EDTA)
2. Alternative : Capillary blood : heel, ear, finger
pricks (heparinized capillary tube)
3. Best methods : Cyanmethemoglobin
(converting OxyHb, MethHb and Carboxy Hb
to cyanmethHb)
4. Blood spots (filter paper)
5. Automated counter
6. Hemocue (portable Hb photometer)
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 SERUM IRON, TIBC and TRANSFERRIN
SATURATION
Very useful for differentiating between nutritional iron def and anemia arising
from chronic infections, inflamation or neoplastic

 Serum iron = iron in transit from RES to bone marrow

 TIBC (Total iron Binding Capacity) =The sum of all unfilled iron binding
sites of transferrin

serum iron (µ mol/L)

 transferrin sat=----------------------------x100%
TIBC( µ mol/L)

Transferrin sat < 16 % = Iron def erythropoiesis (adult)

sukma/S2Gizi/2012
 Red cell distribution width
 Is: measure of the variation in red cell size
 Automated electronic counter
 High value : Iron def anemia
Folate and B12 def anemia
etc

sukma/S2Gizi/2012
 Measurement of serum iron and
TIBC
SERUM IRON
 Clinical chemistry autoanalyzer

 Colorimetric

 Atomic absorbtion spectrofotometry

TIBC
 Spectrometric

 Colorimetric

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 SERUM FERRITIN
 The concentration of ferritin parallels the total amount
of storage iron
 Sex : male>female
 Iron def :
 Iron overload :
 Measurement:
-IRMA(Immunoradiomatric A)
-Elisa( Enzym-linked Immuno sorbent assay )
 Samples : Venous blood , capillary blood, blood spot

sukma/S2Gizi/2012
 Serum transferrin receptor
(sTfR)

• Is an iron- related protein that regulate the uptake

of transferrin into all body cell
• The surface of the cells express sTfR in proportion to their
requirement for iron

sukma/S2Gizi/2012
 sensitive indicator of the degree of tissue iron def
 In mild iron def when iron availability to tissue is
compromised because iron stores are depleted , sTfR
expression by cell
 Main advantages using sTfR is that unlike serum ferritin
, concentration are not significantly affected by the
anemia of chronic disease

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 Interpretive criteria : depend on age
 Measurement : Elisa

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