Screening for iron deficiency: an analysis based on bone‐marrow examinations and serum ferritin determinations in a population sample of women

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Abstract
SummaryEfficacy of different methods in screening for iron deficiency was re‐examined in a randomly selected sample of 38‐year‐old women (n= 203) with known iron status based on absence/presence of stainable iron in bone‐marrow smears. The study was made in 1968–69. Serum ferritin (SF) was determined in 1978 in frozen sera using the Kamco IRMA and, in 1992, samples were re‐analysed using a RIA calibrated with the International Standard 80/602 for SF determination. The effect of storage on SF was calculated from a previously established relationship (courtesy of Dr Mark Worwood. Cardiff) between the results obtained with the Ramco assay and assays calibrated with IS 80/602. The distributions in iron replete and iron deficient women showed less overlap (diagnostic efficiency 91%) for SF than for other haematological parameters. The best discrimination was obtained at SF<16 μg/l (specificity 98%: sensitivity 75%). Absence of iron stores was associated with signs of an iron deficient erythropoiesis. starting already at SF 25–40 μg/l. Use of multiple criteria to diagnose iron deficiency falsely reduces prevalence figures for iron deficiency.