DOCSLIB.ORG

Interpreting Raised Serum Ferritin Levels • Link to This Article Online for CPD/CME Credits Marianna Koperdanova, Jonathan O Cullis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Interpreting Raised Serum Ferritin Levels • Link to This Article Online for CPD/CME Credits Marianna Koperdanova, Jonathan O Cullis EDUCATION PRACTICE EDUCATION PRACTICE RATIONAL TESTING Interpreting raised serum ferritin levels • Link to this article online for CPD/CME credits Marianna Koperdanova, Jonathan O Cullis Salisbury District Hospital, Salisbury A 60 year old businessman attended his general practi- Raised ferritin due to iron overload SP2 8BJ, UK tioner after an insurance medical examination at which Iron overload occurs when there is increased absorption Correspondence to: J O Cullis abnormal liver function tests had been noted (alanine of dietary iron, or after administration of iron or via blood [email protected] aminotransferase 70 IU/L (normal range 10-40 IU/L) transfusion. Cite this as: BMJ 2015;351:h3692 doi: 10.1136/bmj.h3692 and γ-glutamyltransferase 120 IU/L (normal range 0-37 Secondary iron overload—This may follow repeated IU/L)). He was otherwise fit and well and not taking blood transfusions, multiple infusions of intravenous iron This series of occasional articles regular medication. His general practitioner noted that (such as in people with renal failure and cancer patients provides an update on the best use of key diagnostic tests in the his full blood count and renal function were normal, and who have been treated with repeated parenteral iron), or initial investigation of common or requested hepatitis B and C serology (which were nega- prolonged ingestion of iron supplements. It may occur in important clinical presentations. tive) and serum ferritin level, which was 567 µg/L (nor- chronic anaemias with ineffective erythropoeisis (such The series advisers are Steve Atkin, professor of medicine, Weill mal range 24-300 µg/L). as thalassaemia intermedia, sideroblastic anaemias, and Cornell Medical College Qatar; chronic haemolytic anaemias). In such cases, those who and Eric Kilpatrick, honorary What is the next investigation? have received >20 transfusions (for example, patients with professor, department of clinical biochemistry, Hull Royal Infirmary, Ferritin is an intracellular iron storage protein and a sickle cell disease, β thalassaemia major, aplastic anae- Hull York Medical School. To marker of iron stores. Normal serum ferritin levels vary mia, or myelodysplasia) are at risk of iron overload and in suggest a topic for this series, between laboratories but generally concentrations the long term may develop cardiac, hepatic, or endocrine please email us at [email protected]. >300 µg/L in men and postmenopausal women and dysfunction. Secondary iron overload may also be due to >200 µg/L in premenopausal women are regarded as porphyria cutanea tarda, a hepatic porphyria presenting elevated.1 Low ferritin values provide absolute evidence with cutaneous photosensitivity and liver dysfunction due of iron deficiency.2 Raised levels often indicate iron to hepatic iron deposition. overload, but they are not specific, as ferritin is an acute Primary iron overload (hereditary haemochromatosis)— phase protein and is also released from damaged hepato- This is iron accumulation due to inheritance of mutations cytes; thus levels are elevated in inflammatory disorders, in the HFE gene on chromosome 6. This autosomal reces- liver disease, alcohol excess, or malignancy.3 4 Raised sive disorder is the commonest single gene disorder in ferritin levels therefore require further investigation in northern European populations (estimated prevalence primary care to determine if they truly represent iron 0.4%), but is far less common in other populations.6 It overload. It is critical to consider two broad categories causes excessive absorption of dietary iron, but is often of causes: asymptomatic and unrecognised in primary care.9 10 • Raised ferritin without iron overload Associated morbidities (hepatic, endocrine, cardiac) are • Raised ferritin due to iron overload. serious and preventable: timely diagnosis and treatment These can usually be distinguished through clinical are important. assessment and measurement of serum transferrin saturation.5 Clinical assessment in primary care Initial clinical assessment of any patient with hyperfer- Raised ferritin without iron overload ritinaemia should first consider reactive causes (box 2); Most patients (90%) with hyperferritinaemia will not have if these are clearly present, further investigation may iron overload.6 7 Many conditions are associated with “reac- be unnecessary. An alcohol history is mandatory, as is tive” high ferritin levels (box 1), and these may coexist assessment for liver disease. Check body mass index and (such as inflammation and hepatitis).8 blood pressure, as elevated ferritin levels in absence of THE BOTTOM LINE Box 1 | Causes of high ferritin without iron overload • Elevated ferritin levels are usually due to causes such as acute or chronic Common inflammation, chronic alcohol consumption, liver disease, renal failure, • Liver disease (such as non-alcoholic steatohepatitis or viral metabolic syndrome, or malignancy rather than iron overload hepatitis) • Exclude these causes clinically or with initial tests such as full blood count, • Alcohol excess liver and renal function, and inflammatory markers (C reactive protein or • Acute and chronic inflammatory conditions erythrocyte sedimentation rate) • Infections • A normal serum transferrin saturation (ideally fasting) usually excludes iron • Malignancy overload (where it is raised) and suggests a reactive cause for raised ferritin • Renal failure • Unexplained serum ferritin values >1000 μg/L warrant referral for further • Metabolic syndrome investigation Less common • Consider HFE mutation screen for hereditary haemochromatosis in individuals • Thyrotoxicosis with elevated ferritin and a raised transferrin saturation >45% • Acute myocardial infarction the bmj | 8 August 2015 31 EDUCATION PRACTICE iron overload are increasingly recognised in patients with thebmj.com Box 2 | Causes to be considered at first encounter with a Previous articles in this metabolic syndrome (obesity, type 2 diabetes, dyslipidae- 11 12 patient with raised ferritin series mia, and hypertension). Box 2 outlines other causes • Tests to predict to be excluded. Causes without iron overload imminent delivery in • Recent illness (such as acute infection) threatened preterm First line tests • Alcohol intake These include: labour • Abnormal liver function, chronic liver disease, cirrhosis— • Blood count and inflammatory markers (C reactive (BMJ 2015;350:h2183) Check liver function tests, consider liver ultrasound scan protein or erythrocyte sedimentation rate) to detect • Viral hepatitis—Serology for hepatitis B and C • Investigating occult inflammatory disorders • Acute or chronic inflammatory conditions—Erythrocyte intracerebral Serum creatinine and electrolytes for renal function • sedimentation rate or C reactive protein, or both haemorrhage • Liver function tests—Abnormal results should • Metabolic syndrome (obesity, type 2 diabetes, (BMJ 2015;350:h2484) prompt consideration of viral hepatitis screening and dyslipidaemia, hypertension)—Check body mass index, Screening tests for • abdominal ultrasonography blood pressure, blood glucose, lipid studies tuberculosis before Blood glucose and lipid studies. • • Renal failure—Check renal function starting biological • Malignancy (for example, weight loss, anorexia)—Imaging Transferrin saturation therapy as appropriate (BMJ 2015;350:h1060) If the cause of hyperferritinaemia is unclear, the most use- • Investigating young ful test to aid differentiation of true iron overload from Causes with iron overload adults with chronic other causes is the serum transferrin saturation. • Iron supplements, intravenous iron, transfusion history diarrhoea in primary care • Anaemia or known haematological conditions—Full blood (BMJ 2015;350:h573) Normal transferrin saturation count, blood film, haemoglobinopathy studies • Investigating sepsis In patients with unexplained hyperferritinaemia, normal • Hereditary haemochromatosis (fatigue, lethargy, transferrin saturation (<45% in females, <50% in males) with biomarkers arthralgia, diabetes, loss of libido, impotence, usually excludes conditions of iron overload, and reac- amenorrhoea, right upper quadrant abdominal pain, (BMJ 2015;350:h254) 1 4 tive causes should be reconsidered. Ideally, transfer- hepatomegaly, cirrhosis, chondrocalcinosis, skin rin saturation should be measured on a fasting morning hyperpigmentation, heart failure) sample, as serum iron levels undergo diurnal variation, • Family history of iron overload and may rise with recent food ingestion, temporarily • Porphyria cutanea tarda (cutaneous photosensitivity) increasing transferrin saturation.13 Patients should also not be tested during acute illness, when iron levels may – Refer to a hepatologist, as this degree of elevation fall and misleadingly lower transferrin saturation. is more likely to be due to serious underlying pathology.8 Elevated transferrin saturation • Patients with positive HFE mutation results In healthy adults, transferrin saturation >45% has a sen- – Refer for further assessment and therapy. sitivity of 94% and a positive predictive value of 6% for Venesection is the mainstay of management hereditary haemochromatosis.6 If the elevation is slight, in patients with iron overload, aiming to reach consider repeating measurement on a fasting sample to and maintain ferritin concentrations <50 µg/L.14 eliminate effects of recent food. Generally, genetic muta- Combined genetic testing and iron studies would tion screening (for C282Y and H63D polymorphisms) also be offered to siblings.15
Load more

Recommended publications
  • Evaluation of Iron Profile in Type II Diabetes Mellitus Cases
    International Journal of Biotechnology and Biochemistry ISSN 0973-2691 Volume 15, Number 1 (2019) pp. 27-37 © Research India Publications http://www.ripublication.com Evaluation of Iron Profile in Type II Diabetes Mellitus Cases Dr. Sayantaann Saha*, Dr. Roopa Murgod Department of Biochemistry Vydehi Institute of Medical Sciences and Research Centre, EPIP Area, Whitefield, Bangalore 560066, India. ABSTRACT Introduction: Type 2 diabetes mellitus is the most common metabolic disorder, characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Iron, a transitional metal has been shown to play a major role in pathogenesis of T2DM with a bi-directional relationship where iron affects glucose metabolism, and glucose metabolism in turn impinges on several iron metabolic pathways. Aims or Objectives: To estimate and compare the parameters related to iron metabolism viz. Serum Iron (Fe), Serum Ferritin, Serum TIBC (Total Iron Binding Capacity), Serum Transferrin and Transferrin Saturation with Fasting Blood Sugar (FBS) between T2DM patients and healthy controls and correlation of FBS with the above iron parameters. Material and methods: A case control study was conducted between 41 cases of confirmed T2DM patients and 40 age & sex matched healthy controls. Iron profile parameters & FBS were estimated in both the groups and compared. Iron parameters were also correlated with FBS. * Corresponding author(Dr. Sayantaann Saha), Email id: [email protected] 28 Dr. Sayantaann Saha, Dr. Roopa Murgod Results: Serum ferritin, Serum iron & serum transferrin saturation were found to be significantly higher in patients with T2DM compared to control group (P<0.001). Serum transferrin & serum TIBC were found to be slightly lower in cases as compared to controls (P<0.001).
    [Show full text]
  • Emerging and Dynamic Biomedical Uses of Ferritin
    pharmaceuticals Review Emerging and Dynamic Biomedical Uses of Ferritin Brian Chiou and James R. Connor * Department of Neurosurgery, Penn State College of Medicine, Hershey, PA 17033, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-717-531-4541 Received: 24 October 2018; Accepted: 12 November 2018; Published: 13 November 2018 Abstract: Ferritin, a ubiquitously expressed protein, has classically been considered the main iron cellular storage molecule in the body. Owing to the ferroxidase activity of the H-subunit and the nucleation ability of the L-subunit, ferritin can store a large amount of iron within its mineral core. However, recent evidence has demonstrated a range of abilities of ferritin that extends well beyond the scope of iron storage. This review aims to discuss novel functions and biomedical uses of ferritin in the processes of iron delivery, delivery of biologics such as chemotherapies and contrast agents, and the utility of ferritin as a biomarker in a number of neurological diseases. Keywords: ferritin; iron; iron delivery; nanotechnology; nanocage; drug delivery; inflammation; serum biomarker 1. Ferritin Introduction Ferritin, a protein originally identified in 1937 by Vilém Laufberger [1], is a ubiquitously expressed iron storage protein most commonly characterized by its ability to accumulate and store up to 4500 atoms of iron [2]. Ferritin consists of 24 subunits, typically comprised of different ratios of the H and L chain subunit. The ratios vary by organ and even by cell type. Importantly, the different subunits have divergent functions—H-ferritin utilizes ferroxidase activity that is necessary for the oxidation of ferrous (Fe2+) to ferric (Fe3+) iron while L-ferritin contains acidic residues on the surface cavity of the protein that facilitate ferroxidase turnover and are crucial for the nucleation of ferric iron within the core of the fully formed protein.
    [Show full text]
  • Cold Type Autoimmune Hemolytic Anemia- a Rare Manifestation Of
    Dematapitiya et al. BMC Infectious Diseases (2019) 19:68 https://doi.org/10.1186/s12879-019-3722-z CASE REPORT Open Access Cold type autoimmune hemolytic anemia- a rare manifestation of infectious mononucleosis; serum ferritin as an important biomarker Chinthana Dematapitiya1*, Chiara Perera2, Wajira Chinthaka1, Solith Senanayaka1, Deshani Tennakoon1, Anfas Ameer1, Dinesh Ranasinghe1, Ushani Warriyapperuma1, Suneth Weerarathna1 and Ravindra Satharasinghe1 Abstract Background: Infectious mononucleosis is one of the main manifestations of Epstein – Barr virus, which is characterized by fever, tonsillar-pharyngitis, lymphadenopathy and atypical lymphocytes. Although 60% of patients with IMN develop cold type antibodies, clinically significant hemolytic anemia with a high ferritin level is very rare and validity of serum ferritin as an important biomarker has not been used frequently. Case presentation: 18-year-old girl presented with fever, malaise and sore throat with asymptomatic anemia, generalized lymphadenopathy, splenomegaly and mild hepatitis. Investigations revealed that she had cold type autoimmune hemolysis, significantly elevated serum ferritin, elevated serum lactate dehydrogenase level with serological evidence of recent Epstein Barr infection. She was managed conservatively and her hemoglobin and serum ferritin levels normalized without any intervention following two weeks of the acute infection. Conclusion: Cold type autoimmune hemolytic anemia is a rare manifestation of infectious mononucleosis and serum ferritin is used very rarely as an important biomarker. Management of cold type anemia is mainly supportive and elevated serum ferritin indicates severe viral disease. Keywords: Infectious mononucleosis (IMN), Hemolytic anemia, Ferritin Background mainly Mycoplasma pneumoniae and infectious mono- Epstein – Barr virus is one of the most ubiquitous human nucleosis (IMN). Diagnosis of cold type AIHA due to viruses, infecting more than 95% the adult population IMN is confirmed by demonstrating red cell aggregates in worldwide.
    [Show full text]
  • K392-100 Total Iron-Binding Capacity (TIBC) and Serum Iron Assay Kit (Colorimetric)
    FOR RESEARCH USE ONLY! Total Iron-Binding Capacity (TIBC) and Serum Iron Assay Kit (Colorimetric) rev 08/19 (Catalog # K392-100; 100 assays; Store at -20°C) I. Introduction: BioVision’s TIBC and Serum Iron Assay Kit measures both Total iron-binding capacity (TIBC) and Serum iron. Those values indicate the requisite iron for transferrin saturation and Serum Iron respectively. In humans, Transferrin is a blood protein that binds and transports iron throughout the body. Iron bound to transferrin and not bound are reflected in the following: 1) Total Iron Binding Capacity, 2) Unbound Iron, 3) Transferrin Saturation Bound Iron, and 4) Free Iron. Those measurements can be used for to detect and monito transferrin saturation and also iron-deficiency anemia and chronic inflammatory diseases. Part A: TIBC Part B: Serum Iron 1 1 2 2 3 3 4 II. Application: Determination of TIBC, Unbound Iron, Transferrin Saturation, Serum Iron III. Sample Type: Serum or plasma. Serum-off-the clot is preferable to normal serum. IV. Kit Contents: Components K392-100 Cap Code Part Number TIBC Assay Buffer 25 ml WM K392-100-1 Iron Solution 100 µl Blue K392-100-2 TIBC Detector 2 x 1.5 ml Brown K392-100-3 TIBC Developer 5 ml NM K392-100-4 Iron Standard (100 mM) 100 µl Yellow K392-100-5 V. User Supplied Reagents and Equipment: • 96-well plate clear plate with flat bottom • Microplate reader capable of absorbance reading VI. Storage Conditions and Reagent Preparation: Store kit at -20°C, protected from light. Briefly centrifuge small vials prior to opening.
    [Show full text]
  • Gamma-Glutamyltransferase: a Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk
    Hindawi Publishing Corporation Disease Markers Volume 2015, Article ID 818570, 18 pages http://dx.doi.org/10.1155/2015/818570 Review Article Gamma-Glutamyltransferase: A Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk Gerald Koenig1,2 and Stephanie Seneff3 1 Health-e-Iron, LLC, 2800 Waymaker Way, No. 12, Austin, TX 78746, USA 2Iron Disorders Institute, Greenville, SC 29615, USA 3Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA 02139, USA Correspondence should be addressed to Gerald Koenig; [email protected] Received 2 July 2015; Accepted 20 September 2015 Academic Editor: Ralf Lichtinghagen Copyright © 2015 G. Koenig and S. Seneff. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gamma-glutamyltransferase (GGT) is a well-established serum marker for alcohol-related liver disease. However, GGT’s predictive utility applies well beyond liver disease: elevated GGT is linked to increased risk to a multitude of diseases and conditions, including cardiovascular disease, diabetes, metabolic syndrome (MetS), and all-cause mortality. The literature from multiple population groups worldwide consistently shows strong predictive power for GGT, even across different gender and ethnic categories. Here, we examine the relationship of GGT to other serum markers such as serum ferritin (SF) levels, and we suggest a link to exposure to environmental and endogenous toxins, resulting in oxidative and nitrosative stress. We observe a general upward trend in population levels of GGT over time, particularly in the US and Korea. Since the late 1970s, both GGT and incident MetS and its related disorders have risen in virtual lockstep.
    [Show full text]
  • Understanding Your Blood Test Lab Results
    Understanding Your Blood Test Lab Results A comprehensive "Health Panel" has been designed specifically to screen for general abnormalities in the blood. This panel includes: General Chemistry Screen or (SMAC), Complete Blood Count or (CBC), and Lipid examination. A 12 hour fast from all food and drink (water is allowed) is required to facilitate accurate results for some of the tests in this panel. Below, is a breakdown of all the components and a brief explanation of each test. Abnormal results do not necessarily indicate the presence of disease. However, it is very important that these results are interpreted by your doctor so that he/she can accurately interpret the findings in conjunction with your medical history and order any follow-up testing if needed. The Bernards Township Health Department and the testing laboratory cannot interpret these results for you. You must speak to your doctor! 262 South Finley Avenue Basking Ridge, NJ 07920 www.bernardshealth.org Phone: 908-204-2520 Fax: 908-204-3075 1 Chemistry Screen Components Albumin: A major protein of the blood, albumin plays an important role in maintaining the osmotic pressure spleen or water in the blood vessels. It is made in the liver and is an indicator of liver disease and nutritional status. A/G Ratio: A calculated ratio of the levels of Albumin and Globulin, 2 serum proteins. Low A/G ratios can be associated with certain liver diseases, kidney disease, myeloma and other disorders. ALT: Also know as SGPT, ALT is an enzyme produced by the liver and is useful in detecting liver disorders.
    [Show full text]
  • Increasing Ferritin Predicts Early Death in Adult Hemophagocytic Lymphohistiocytosis
    Henry Ford Health System Henry Ford Health System Scholarly Commons Pathology Articles Pathology 2-17-2021 Increasing ferritin predicts early death in adult hemophagocytic lymphohistiocytosis Rand Abou Shaar Charles S. Eby Suzanne van Dorp Theo de Witte Zaher K. Otrock Follow this and additional works at: https://scholarlycommons.henryford.com/pathology_articles Received: 13 November 2020 | Accepted: 29 January 2021 DOI: 10.1111/ijlh.13489 ORIGINAL ARTICLE Increasing ferritin predicts early death in adult hemophagocytic lymphohistiocytosis Rand Abou Shaar1 | Charles S. Eby2 | Suzanne van Dorp3 | Theo de Witte3 | Zaher K. Otrock1 1Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, Abstract USA Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of 2 Department of Pathology and Immunology, pathologic immune activation. Most studies on adult HLH have evaluated prognostic Washington University School of Medicine, St. Louis, MO, USA factors for overall survival; factors predicting early mortality have not been suffi- 3Radboud University Medical Center, ciently investigated. Nijmegen, Netherlands Methods: This was a collaborative study between Henry Ford Hospital and Barnes- Correspondence Jewish Hospital. We identified all adult HLH patients with at least 2 ferritin levels Zaher K. Otrock, Transfusion Medicine Division, Department of Pathology and within 30 days from admission. Laboratory Medicine, Henry Ford Hospital, Results: One- hundred twenty- four patients were identified. There were
    [Show full text]
  • Importance of Serum Ferritin Level for Early Diagnosis and Differentiation in Patients with Kawasaki Disease with Macrophage Activation Syndrome
    children Article Importance of Serum Ferritin Level for Early Diagnosis and Differentiation in Patients with Kawasaki Disease with Macrophage Activation Syndrome Da Eun Roh 1,2, Jung Eun Kwon 1,2 , Hee Joung Choi 3 and Yeo Hyang Kim 1,2,* 1 Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41405, Korea; [email protected] (D.E.R.); [email protected] (J.E.K.) 2 Division of Pediatric Cardiology, Kyungpook National University Children’s Hospital, Daegu 41404, Korea 3 Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Korea; [email protected] * Correspondence: [email protected]; Tel.: +82-53-200-2747 Abstract: We aimed to evaluate the utility of the serum ferritin level as an early screening test of Kawasaki disease with macrophage activation syndrome (KD-MAS). We analyzed the serum ferritin levels on the first day of admission and the clinical progress of patients diagnosed with complete or incomplete KD. Of the 158 patients, 5 were diagnosed with KD-MAS. Conjunctival injection was significantly more frequent in KD group (p = 0.035), although there were no significant differences in other clinical features. On the first day of admission, the serum ferritin level in the KD-MAS group was >500 ng/mL, which was higher than that in the KD group (p = 0.001). In the KD-MAS group, total bilirubin, triglyceride, and lactate dehydrogenase (LDH) were significantly higher, and erythrocyte sedimentation rate (ESR), total protein, albumin, and fibrinogen were significantly lower Citation: Roh, D.E.; Kwon, J.E.; Choi, than the KD group (p < 0.05).
    [Show full text]
  • Ionized Calcium: Analytical Challenges and Clinical Relevance
    16 Review Article Page 1 of 16 Ionized calcium: analytical challenges and clinical relevance Aghilès Hamroun1, Jean-David Pekar2, Arnaud Lionet1, Amjad Ghulam3, Patrice Maboudou2, Ambroise Mercier2, Thierry Brousseau2, Guillaume Grzych3,4, François Glowacki1,5 1CHU Lille, Service de Néphrologie, F-59000, Lille, France; 2CHU Lille, Biochimie Automatisée (UF-8832), Pôle de Biologie Pathologie Génétique, F-59000, Lille, France; 3CHU Lille, Service « Hormonologie, Métabolisme, Nutrition, Oncologie », Pôle de Biologie Pathologie Génétique, Lille, France; 4INSERM, U1011-EGID, Institut Pasteur de Lille, F-59000, Lille, France; 5EA 4483-IMPECS-IMPact of Environmental Chemicals on Human Health, Research Department, 59045, Lille, France Contributions: (I) Conception and design: G Grzych, JD Pekar, A Hamroun; (II) Administrative support: G Grzych, JD Pekar, A Hamroun; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: G Grzych, JD Pekar, A Hamroun; (V) Data analysis and interpretation: G Grzych, JD Pekar, A Hamroun; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Dr. Guillaume Grzych, MD, MSc. Laboratory of Biochemistry, Biology and Pathology Center, Lille University Hospital, Pr J. Leclercq Boulevard, 59037 Lille, France. Email: [email protected]. Abstract: Calcium is a central electrolyte involved in many physiological functions commonly measured in clinical practice. Abnormal calcium levels are frequently found, and could have serious clinical consequences. The free form of calcium, also called ionized calcium, plays a determining role in the human body. Its measurement still remains limited by technical, analytical and financial constraints. To overcome these limits, many formulas have been developed to estimate the ionized calcium value.
    [Show full text]
  • Differentiation of Iron Deficiency and the Anemia of Chronic Disease
    Differentiation of Iron Deficiency and the Anemia of Chronic Disease Danis J. Christensen, MD Salt Lake City, Utah The predictive value positive of serum iron studies and eryth­ rocyte indices in differentiating between iron deficiency ane­ mia and the anemia of chronic disease (ACD) were determined in 82 hospitalized patients with an iron-binding saturation of 15 percent or less. Iron deficiency, determined by serum ferritin of 20 ng/mL or less, was present in only 31 percent of patients with a serum iron level of 10 p-g/dL or less; 39 percent of patients with a transferrin saturation of 5 percent or less, and 54 percent of patients with a total iron-binding capacity (TIBC) of 350 /zg/dL or greater; conversely, iron deficiency was pres­ ent in only 3 percent of patients with a TIBC of 250 p,g/dL or less. Iron deficiency was present in 83 percent of patients with a mean corpuscular volume (MCV) of 75 /xm3 or less, but only 2 percent of patients with an MCV of 86 p,m3 or greater. It is concluded that the MCV has strong predictive value positive (and negative) when below (or above) the values just cited, but that serum iron studies do not have sufficient predictive value to justify their use in the routine differentiation between iron deficiency anemia and the ACD in hospitalized patients when no other cause for anemia is likely. One of the most frequent problems in the diag­ parameters commonly used to differentiate be­ nosis of anemia is the differentiation between tween the two conditions.
    [Show full text]
  • Protein Expression Profiles in Pancreatic Adenocarcinoma
    [CANCER RESEARCH 64, 9018–9026, December 15, 2004] Protein Expression Profiles in Pancreatic Adenocarcinoma Compared with Normal Pancreatic Tissue and Tissue Affected by Pancreatitis as Detected by Two- Dimensional Gel Electrophoresis and Mass Spectrometry Jianjun Shen,1 Maria D. Person,2 Jijiang Zhu,3 James L. Abbruzzese,3 and Donghui Li3 1Department of Carcinogenesis, Science Park-Research Division, The University of Texas M. D. Anderson Cancer Center, Smithville, Texas; 2Division of Pharmacology and Toxicology, The University of Texas, Austin, Texas; and 3Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas ABSTRACT revealed a large number of differentially expressed genes but little overlap of identified genes among various gene expression ap- Pancreatic cancer is a rapidly fatal disease, and there is an urgent need proaches. Furthermore, although genetic mutation and/or errant gene for early detection markers and novel therapeutic targets. The current expression may underlie a disease, the biochemical bases for most study has used a proteomic approach of two-dimensional (2D) gel elec- trophoresis and mass spectrometry (MS) to identify differentially ex- diseases are caused by protein defects. Therefore, profiling differen- pressed proteins in six cases of pancreatic adenocarcinoma, two normal tially expressed proteins is perhaps the most important and useful adjacent tissues, seven cases of pancreatitis, and six normal pancreatic approach in development of diagnostic screening and therapeutic tissues. Protein extracts of individual sample and pooled samples of each techniques. type of tissues were separated on 2D gels using two different pH ranges. The proteomic approach has offered many opportunities and chal- Differentially expressed protein spots were in-gel digested and identified lenges in identifying new tumor markers and therapeutic targets and in by MS.
    [Show full text]
  • Medical Tests
    Waldenstrom’s Macroglobulinemia Medical Tests WALDENSTROM’S MACROGLOBULINEMIA MEDICAL TESTS The IWMF Vision Statement A World Without WM (Waldenstrom's macroglobulinemia). The IWMF Mission Statement Support and educate everyone affected by Waldenstrom's macroglobulinemia (WM) while advancing the search for a cure. To accomplish this vision, the IWMF offers WM patients, caregivers, family members, and friends six invaluable services: • Information from our website and our publications written in a patient-friendly way to promote understanding of our rare disease • Education at our annual Educational Forum to help patients and caregivers learn about our disease from WM researchers and clinicians • On-going updates about WM and the IWMF sent through our quarterly IWMF Torch magazine and our NEWS releases • Peer support from others who’ve been where you are • Information for medical professionals who may have limited experience with our rare disease • Research directed to better treatments while we search for a cure Since WM is a rare disease, the IWMF relies upon individuals for financial support and upon volunteers to do much of its work. Published by the International Waldenstrom’s Macroglobulinemia Foundation (IWMF) This information has been provided by the IWMF at no cost to you. Please consider Joining and/or contributing to the IWMF to enable us to continue to provide materials like this to support research toward better treatments and a cure for Waldenstrom’s macroglobulinemia. You may Join and/or contribute at our website, www.iwmf.com, or you may mail your contribution to: 6144 Clark Center Avenue, Sarasota, FL 34238. IWMF is a 501(c)(3) Tax Exempt Non-Profit Organization, Fed ID #54-1784426.
    [Show full text]