Original Research

An audit of the iron status of patients at Chris Hani Baragwanath Academic Hospital, in Johannesburg, South Africa

Jurette S. Grove, Siyabonga Khoza, Dineo V. Mabuza, Shaida B. Khan
African Journal of Laboratory Medicine | Vol 13, No 1 | a2509 | DOI: https://doi.org/10.4102/ajlm.v13i1.2509 | © 2024 Jurette S. Grove, Siyabonga Khoza, Dineo V. Mabuza, Shaida B. Khan | This work is licensed under CC Attribution 4.0
Submitted: 24 May 2024 | Published: 18 October 2024

About the author(s)

Jurette S. Grove, Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, National Health Laboratory Service, Johannesburg, South Africa
Siyabonga Khoza, Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, National Health Laboratory Service, Johannesburg, South Africa
Dineo V. Mabuza, Department of Chemical Pathology, Faculty of Pathology, PathCare Laboratories, Johannesburg, South Africa
Shaida B. Khan, Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, National Health Laboratory Service, Johannesburg, South Africa

Abstract

Background: Iron deficiency is a common disorder, especially in developing countries. Accurately assessing iron status remains challenging, particularly for patients with chronic diseases such as HIV and chronic kidney disease, prevalent in South Africa.

Objective: This study aimed to determine how ferritin cut-offs affect iron status classification in adult patients treated at a tertiary hospital in South Africa. Additionally, it assessed the frequency of these conditions and the impact of age and gender on iron status.

Methods: This retrospective study analysed iron profiles in adult patients from 01 October 2020 to 31 March 2021. Iron status was categorised into five groups: iron deficiency anaemia (IDA), anaemia of chronic disease, IDA with anaemia of chronic disease, iron deficiency without anaemia, and iron replete based on haemoglobin, transferrin saturation, and ferritin levels. The impact of using two different ferritin cut-off values (15 µg/L and 30 µg/L) was investigated.

Results: The study included 3221 complete iron profiles. There was a predominance of female patients (2.2:1 ratio). Anaemia of chronic disease was the most prevalent iron disorder (39%), regardless of ferritin cut-off. Using a higher ferritin cut-off of 30 µg/L significantly increased the detection rates of both IDA and iron deficiency without anaemia (p < 0.001).

Conclusion: This study suggests that a higher ferritin threshold (30 µg/L) might improve diagnosis of iron disorders in settings with high inflammatory diseases. Further studies are needed to refine thresholds. Local guidelines should be adjusted to consider higher ferritin cut-offs, and longitudinal studies are recommended to evaluate long-term outcomes.

What this study adds: This study confirms the use of higher ferritin cut-offs for enhanced detection of iron deficiency states. The findings also emphasise the ongoing need for establishing simple, standardised, and accurate methods for iron status classification.


Keywords

Iron; iron status; ferritin; ferritin diagnostic threshold; iron deficiency; iron deficiency anaemia; anaemia of chronic disease

Sustainable Development Goal

Goal 3: Good health and well-being

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