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Letters |

Improved Detection of Early Iron Deficiency-Reply

Suzanne McClure, MD, PhD; Edward Custer, PhD; J. David Bessman, MD
JAMA. 1985;254(9):1174-1175. doi:10.1001/jama.1985.03360090064016.
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In Reply.—  Dr Becker describes the difficulty involved in using transferrin saturation to assess body stores. We agree that interpretation may be difficult in patients with the anemia of chronic disease, although our experience has been closer to Wintrobe's1 than Christensen's.2 However, in our study there were no anemic patients, so this difficulty is unlikely to be a factor. In contrast, the ferritin assay often is falsely elevated in acute inflammation,3 a common problem in our subjects. Therefore, we chose the transferrin saturation as less likely to have artifacts in our study. None of our subjects had bone marrow examination, which, despite its own technical difficulties, is the gold standard for iron assay. However, of the 37 patients in the last year without Prussian bluestainable marrow iron, 35 had elevated red blood cell distribution width (RDW). Certainly the bone marrow examination will reveal the earliest phase of


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