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ARTICLE |

Improved Detection of Early Iron Deficiency in Nonanemic Subjects FREE

Suzanne McClure, MD, PhD; Edward Custer, PhD; J. David Bessman, MD
[+] Author Affiliations

Presented in part at the annual meeting of the American Society for Clinical Investigation, Washington, DC, May 1984.

Reprint requests to John Sealy Hospital, MW 404, University of Texas Medical Branch, Galveston, TX 77550 (Dr Bessman).


JAMA. 1985;253(7):1021-1023. doi:10.1001/jama.1985.03350310103035
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We measured the complete blood cell count, including the index of RBC size heterogeneity (RBC distribution width [RDW]), in 181 subjects without anemia to determine whether RDW became abnormal earlier in the development of iron deficiency than did other variables. In 163 subjects selected only for otherwise normal blood cell counts, an increased RDW was 66% specific (48/73) and 100% sensitive (48/48) for decreased serum iron saturation. Stool guaiac testing was equally specific but less sensitive. In 13 subjects with polycythemia, as iron deficiency developed, RDW increased a minimum of four weeks before mean cell volume changed. In one apparently normal young woman, an abrupt isolated rise in RDW revealed a newly developed low serum transferrin saturation; all values remained normal during serial testing of four other normal subjects. We conclude that RDW is the part of the routine blood cell count that first becomes abnormal during the development of iron deficiency.

(JAMA 1985;253:1021-1023)

REFERENCES

Beutler E:  The red cell indices in the diagnosis of iron-deficiency anemia . Ann Intern Med 1959;;50:313-322.
Conrad ME, Crosby WH:  The natural history of iron deficiency induced by phlebotomy . Blood 1962;;20:173-185.
Beutler E, Robson MJ, Buttenwieser E:  A comparison of the plasma iron, iron-binding capacity, sternal marrow iron, and other methods in the clinical evaluation of iron stores . Ann Intern Med 1958;;48:60-66.
Bessman JD:  Microcytic polycythemia: Frequency of nonthalassemic causes . JAMA 1977;; 238:2391-2392.
Bessman JD, Feinstein DI:  Quantitative anisocytosis as a discriminant between iron deficiency and thalassemia minor . Blood 1979;; 53:288-293.
Bessman JD, Gilmer PR, Gardner FH:  Improved classification of anemias by MCV and RDW . Am J Clin Pathol 1983;;80:242-246.
Finch CA:  Review: Erythropoiesis, erythropoietin, and iron . Blood 1982;;59:1241-1246.
Johnson CS, Tegos C, Beuler E:  Thalassemia minor: Routine erythrocyte measurements and differentiation from iron deficiency . Am J Clin Pathol 1983;;80:31-36.
Kaye FJ, Alter BP:  Red cell size distribution analysis: A noninvasive evaluation of microcytosis, abstracted . Blood 1982;;60( (suppl) ):36.
Crosby WH, O'Neil-Cutting MA:  A smalldose iron tolerance test as an indicator of mild iron deficiency . JAMA 1984;;251:1986-1987.

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Beutler E:  The red cell indices in the diagnosis of iron-deficiency anemia . Ann Intern Med 1959;;50:313-322.
Conrad ME, Crosby WH:  The natural history of iron deficiency induced by phlebotomy . Blood 1962;;20:173-185.
Beutler E, Robson MJ, Buttenwieser E:  A comparison of the plasma iron, iron-binding capacity, sternal marrow iron, and other methods in the clinical evaluation of iron stores . Ann Intern Med 1958;;48:60-66.
Bessman JD:  Microcytic polycythemia: Frequency of nonthalassemic causes . JAMA 1977;; 238:2391-2392.
Bessman JD, Feinstein DI:  Quantitative anisocytosis as a discriminant between iron deficiency and thalassemia minor . Blood 1979;; 53:288-293.
Bessman JD, Gilmer PR, Gardner FH:  Improved classification of anemias by MCV and RDW . Am J Clin Pathol 1983;;80:242-246.
Finch CA:  Review: Erythropoiesis, erythropoietin, and iron . Blood 1982;;59:1241-1246.
Johnson CS, Tegos C, Beuler E:  Thalassemia minor: Routine erythrocyte measurements and differentiation from iron deficiency . Am J Clin Pathol 1983;;80:31-36.
Kaye FJ, Alter BP:  Red cell size distribution analysis: A noninvasive evaluation of microcytosis, abstracted . Blood 1982;;60( (suppl) ):36.
Crosby WH, O'Neil-Cutting MA:  A smalldose iron tolerance test as an indicator of mild iron deficiency . JAMA 1984;;251:1986-1987.
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