| [ Summary ] |
In cases of both iron deficiency and iron overload, as advances in therapy and knowledge, diagnosis is necessary to make subtle judgments on conditions which do not lead to disease levels. We should consider absolute iron deficiency to exist in cases where serum ferritin< 100 ng/mL or TSAT<20 %. And further, serum ferritin <50 % or serum ferritin<100 ng/mL and TSAT<20 % are specific predictors of its presence. When the expected effect of ESA is not achieved, confirmation of response to iron supplementation may be used in order to diagnose relative iron deficiency. This is true even when serum ferritin level is 100 ng/mL or higher. At present, since there is not sufficient evidence, the cut-off value is determined by considering various factors, in the range of less than 200 ng/mL serum ferritin values. However, in these cases, supplementation should be stopped immediately if improvements on the effects of ESA are not observed. Iron overload is defined in terms of safety margins for iron supplementation. However, there is not sufficient evidence, it is considered serum ferritin levels of<250 ng/mL is appropriate at this time. In order not to induce iron overload, without missing relative iron deficiency, iron replacement must be performed minimally under comprehensive diagnosis. |