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Iron deficiency detected by estimation of body iron in a primary care population

Iron deficiency (ID), although prevalent in women, is considered a relatively uncommon disorder among men and usually is associated with blood loss. We screened veterans attending primary care clinics at a VA medical center by measuring serum transferrin receptor (TfR) and serum ferritin (SF) concentrations. Body iron (Fe) was assessed from the TfR/SF ratio calibrated by quantitative phlebotomy. In this approach, body Fe is expressed as a positive value when stores are present and negatively with tissue Fe deficiency. A body Fe < −4 mg/kg body weight represents a deficit severe enough to produce anemia. A total of 2,225 participants (Pts), 2,099 male (M) and 126 female (F) were enrolled. ID was detected in 79 Pts (3.6%; 68 M and 11 F, ages 38–88 yr, median 65.9 yr) based on a negative body Fe value. The diagnosis of ID was not previously suspected in the majority of cases (N=62, 78%). A likely etiology of ID was apparent in 15 (19%), including 10 with blood loss and 5 with probable malabsorption. The average tissue Fe deficit in men was −2.2 mg/kg (range −7.9 mg/kg to −0.01 mg/kg). Only 30 (44%) of the men with ID were anemic, based on blood hemoglobin (Hb) concentration. The results indicate an unexpectedly high prevalence of ID in this predominantly adult male population and demonstrate that measurement of Hb fails to detect many cases. Thus, assessment of iron status is important to identify affected persons who may require diagnostic evaluation to determine the etiology of ID.