Classic and emergent indicators for the assessment of human iron status

Abstract

Iron deficiency is the leading cause of anemia, a significant global public health problem. Different methods exist for assessing iron nutritional status, including laboratory tests that focus on storage, transportation, and iron functional compartment parameters. Classical markers such as bone marrow, serum iron, ferritin, hemoglobin, erythrocyte parameters, transferrin, transferrin receptors, and zinc protoporphyrin are discussed in this review. Additional parameters calculated from these indicators, including transferrin saturation, ferritin index and Thomas plot, and some emergent parameters such as hepcidin, erythroferrone, and low hemoglobin density are also discussed. There is no a single indicator for assessing iron nutritional status. Therefore, the use of more than one indicator may be the best practice to obtain the correct diagnosis, also considering the influence of inflammation/infection on many of these indicators. The constant validation of the current parameters, the improvement of assessment methods, and the identification of new indicators will be the key to refine the assessment of iron nutritional status and the right choice of treatment for its improvement.

KEYWORDS:

• Anemia
• hepcidin
• iron deficiency
• iron replacement therapy
• iron status

Declaration of interest

The authors declare no known conflicts of interest associated with this publication.

Additional information

Funding

Mauricio Restrepo-Gallego (M.R.G.) thanks Universidad de La Sabana's Grant System (grant ING-174-2016) and the Colombian Department of Science, the Ministry of Science, Technology, and Innovation (Minciencias) for its support through a national doctoral fellowship (grant 567 2012).