Does the ESR-adjusted serum ferritin concentration predict iron deficiency better?

There has always been a need to develop simple and accurate techniques to improve the predictive value of the serum ferritin concentration (sFC) in patients with systemic inflammation and malignancies. This prospective study examined the impact of adjusting sFC for acute phase reactants with the erythrocyte sedimentation rate (ESR), using the bone marrow aspirate Perl’s stain as a gold standard for comparison. Sixty patients (male/female = 35/25), with a mean age of 44 ± 4 years were recruited. Thirty-four of the patients had HIV infection, twenty had haematologic malignancies, four had unexplained severe anaemia, while two had hyperreactive malarial splenomegaly. Haematologic parameters including ESR, ELISA-based serum ferritin concentration (sFC) and bone marrow aspiration (and trephine biopsy, if aspirate was aparticulate) were examined. The effect of ESR-adjustment of the sFC on the iron status predictive value was studied. The difference in the sFC of bone marrow aspirate (BMA)-negative and BMA-positive patients was significant, and was further enhanced with ESR adjustment of the sFC. This study has shown clearly that the predictive value of sFC for assessing iron status can be enhanced using the ESR, in patients with chronic inflammatory conditions and malignancies.