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Value of Serum Ferritin Determination in Hemodialysis Patients

One of the reversible components of anemia in chronic dialysis patients is iron deficiency caused by external blood loss associated with the procedure itself, frequent laboratory tests, and hemorrhagic complications of intermittent or long-term anticoagulation therapy. Its detection and adequate treatment constitutes an important aspect of the management of chronic renal failure. Primary iron deficiency anemia can be readily diagnosed by determining serum iron, iron binding capacity, transferrin saturation, and by bone marrow examination. Eschbach, et al (3), however, have shown that the serum iron and iron binding capacity do not provide a reliable index for the diagnosis of iron deficiency in hemodialysis patients. Fong, et al (4) have suggested that serial bone marrow aspiration is a reliable test for determination of iron deficiency in chronic hemodialysis patients. Although this may be true, the procedure is uncomfortable and impractical for long-term and repeated use. Ferritin, a high-molecular-weight iron-containing protein, functions as the iron-storage compound in the body. Normally, trace amount of ferritin can be detected in the plasma. Using a sensitive radio-immunoassay method, Addison, et al (1) showed that serum ferritin can accurately estimate total body iron stores in iron deficiency, iron overload and normal physiologic state. Mean serum ferritin levels in non-anemic normal individuals reported by Siimes et al (10) were 140 and 39 ng/ml for males and females respectively. Jacobs et al (6) reported that serum ferritin ranged between 6 to 186 ng/ml (Mean: 69 ± 5) in the normal male and 3 to 162 ng/ml, (Mean: 35 ± 5) in the normal female, while iron deficient anemic patients had serum ferritin levels of 1-12 ng/ml (Mean: 5 ± 0.6). According to Walters, et al (11), the total body iron stores amount to 0-340 mg (mean: 210 mg) in females and 140-1390 mg (mean: 690 mg) in males. He reported that every 1 ng/ml serum ferritin represents 8 mg of storage iron. Hussein, et al (5) showed that serum ferritin correlated well with the bone marrow iron stores in