Letter to the Editor

Response to “Predictors of Endoscopic and Laboratory Evaluation of Iron Deficiency Anemia in Hospitalized Patients”

Authors: Oscar M. P. Jolobe, MRCP (UK)

Abstract

To the Editor:


The original article by Ioannou, Spector, and Rockey published in October's issue of this Journal could have been improved slightly. The prediction of iron deficiency could have been potentially enhanced by incorporating, in the screening protocol, not only the mean cell volume (MCV),1 but also the mean cell hemoglobin (MCH). This method was useful, for example, in a prospective study where 201 subjects were identified with iron deficiency anemia, the criterion for iron deficiency being a serum ferritin of less than 18 μg/L.2 Although the majority had MCV <80 fL as well as MCH <26 pg, the proportion of those with MCH <26 pg, on its own, was significantly greater than the proportion of those with MCV <80 fL on its own (P < 0.001).2

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References

1. Ioannou GN, Spector J, Rockey DC. Predictors of endoscopic and laboratory evaluation of iron deficiency anemia in hospitalized patients. South Med J 2007;100:976–984.
 
2. Jolobe OMP. Prevalence of hypochromia (without microcytosis) vs microcytosis (without hypochromia) in iron deficiency. Clin Lab Haematol 2000;22:79–80.
 
3. Francis J, Sheridan D, Samanta A, et al. Iron deficiency anemia in chronic inflammatory rheumatic diseases: low mean cell hemoglobin is a better marker than low mean cell volume. Ann Rheum Dis 2005;64:787–788.
 
4. Kivivouri SM, Pelkonen P, Ylijoki H, et al. Elevated serum transferrin receptor concentration in children with juvenile chronic arthritis as evidence of iron deficiency. Rheumatology 2000;39:193–197.
 
5. Brugnara C, Chambers LA, Malynn E, et al. Red blood cell regeneration induced by subcutaneous recombinant erythropoietin: iron deficient erythropoiesis in iron replete subjects. Blood 1993;81:956–964.