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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

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Volume 50, Issue 8


The transferrin/log(ferritin) ratio: a new tool for the diagnosis of iron deficiency anemia

Rob Castel
  • Corresponding author
  • Department of Clinical Chemistry and Hematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Martine G.H.M. Tax
  • Department of Clinical Chemistry and Hematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jolanda Droogendijk / Math P.G. Leers
  • Department of Clinical Chemistry and Hematology, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ruud Beukers / Mark-David Levin / Pieter Sonneveld / Paul B. Berendes
  • Department of Clinical Chemistry and Hematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2012-02-11 | DOI: https://doi.org/10.1515/cclm-2011-0594


Background: Serum ferritin is the best single laboratory test to diagnose iron deficiency anemia (IDA). Ferritin levels <20 μg/L are highly specific for IDA, and ferritin levels >100 μg/L usually exclude IDA. However, ferritin concentrations between 20 and 100 μg/L are often inconclusive. The objective of this study was to improve the diagnosis of IDA when ferritin levels are inconclusive.

Methods: We evaluated the predictive performance of classic (ferritin, mean corpuscular volume, transferrin and serum iron) and modern [reticulocyte hemoglobin content, serum transferrin receptor and soluble transferrin receptor (sTfR)/log(ferr)] iron status parameters to diagnose IDA in 2084 anemic, non-hospitalized patients. The results were validated in an independent cohort of 274 anemic patients.

Results: In our study population, 29% (595 patients) of the patients had a ferritin level between 20 and 100 μg/L, hampering diagnosis of IDA. None of the classic or modern parameters was capable of completely separating the IDA population from the non-IDA population. However, using a new parameter, the transferrin/log(ferritin) ratio, the IDA and non-IDA populations can be completely separated. At a cut-off value of 1.70, the transferrin/log(ferritin) ratio indicates IDA in 29% of the patients with inconclusive ferritin levels.

Conclusions: The transferrin/log(ferritin) ratio is a practical new tool that improves diagnosis of iron deficiency when ferritin levels are inconclusive.

Keywords: anemia analysis; iron deficiency anemia; iron status parameters

About the article

Corresponding author: Rob Castel, Department of Clinical Chemistry, Room F-3127, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands Phone: +31-786523548, Fax: +31-786523156

Received: 2011-08-30

Accepted: 2012-01-15

Published Online: 2012-02-11

Published in Print: 2012-08-01

Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 50, Issue 8, Pages 1343–1349, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2011-0594.

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