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Additional tests may be considered when the clinical features and haematology profile are suggestive of iron deficiency, but ferritin is normal. Consider consulting with a pathologist or haematologist before ordering these additional tests.
The following table summarises additional tests which may be of assistance in diagnosis of iron deficiency:
| Additional tests for the Diagnosis of Iron Deficiency Anaemia |
||
|
Investigation |
Application |
Notes |
|
Iron Binding Capacity Transferrin saturation
Note: serum iron is often reported but only reflects recent intake and is not useful in the diagnosis of iron deficiency |
- high iron binding capacity and - low transferrin saturation are suggestive of iron deficiency (even in the presence of a normal ferritin) |
These tests are recommended when serum ferritin is reported as normal or high and:
|
|
Soluble transferrin receptor (sTfR) |
- elevated in tissue iron deficiency | - not sensitive to inflammation - sTfR/log ferritin ratio is highly correlated with body iron stores - sTfR estimation is limited by variability in interassay cut-offs, availability and slow turnaround in some laboratories - sTfR is not routinely available |
|
Bone marrow examination |
- investigation of IDA in complex cases | |
|
Monitored therapeutic trial of iron |
- may be both diagnostic and therapeutic in patients with probable iron deficiency anaemia | - unreliable in iron malabsorption or ongoing blood loss - reliant on compliance - increase in haemoglobin of 10–20 g/L in 2–4 weeks is diagnostic of iron deficiency |
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