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Interpreting tests for iron deficiency among adults in a high HIV prevalence African setting: routine tests may lead to misdiagnosis

Lewis, D. K., Whitty, C. J. M., Epino, H., Letsky, E. A., Mukiibi, J. M. and Van Den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2007) 'Interpreting tests for iron deficiency among adults in a high HIV prevalence African setting: routine tests may lead to misdiagnosis'. Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol 101, Issue 6, pp. 613-617.

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Abstract

We evaluated peripheral blood tests to diagnose iron deficiency on medical wards in Blantyre, Malawi, where infection and HIV are prevalent. We compared full blood count, ferritin and serum transferrin receptor (TfR) levels with an estimation of iron in bone marrow. aspirates. Of consecutive adults admitted with severe anaemia (haemoglobin <7 g/dl), 81 had satisfactory bone marrow aspirates. The main outcome measures were the validity of each test (sensitivity, specificity, and positive and negative predictive values) and likelihood ratios (LR) for iron deficiency. Twenty patients (25%) were iron deficient and 64 (79%) were HIV-positive. Iron deficiency was more common in HIV-negative compared with HIV-positive patients (59% vs. 16%; P < 0.001). In HIV-positive patients, the optimal ferritin cut-off was 150 mu g/l (sensitivity 20%, specificity 93%, LR 2.7), but no test was accurate enough to be clinically useful. In HIV-negative patients, ferritin was the single most accurate test (cut-off <70 mu g/l., 100% specificity, 90% sensitive, LR if positive infinity, LR if negative 10). TfR measurement did not improve the accuracy. Mean cell volume was not a good predictor of iron status except in HIV-negative patients (cut-off <85 fl, specificity 71%, sensitivity 90%). In populations with high Levels of infection and HIV, an HIV test is necessary to interpret any tests of iron deficiency. In HIV-negative patients, ferritin is the best blood test for iron deficiency, using a higher cut-off than usual. For HIV-positive patients, it is difficult to diagnose iron deficiency without bone marrow aspirates. (C) 2006 Royal Society of Tropical. Medicine and Hygiene. Published by Etsevier Ltd. All rights reserved.

Item Type: Article
Uncontrolled Keywords: hiv iron deficiency anaemia bone marrow diagnosis malawi sub-saharan africa serum transferrin receptor anemia ferritin diagnosis blantyre malawi differentiation indicators disease women
Subjects: QY Clinical Pathology > Blood. Blood Chemistry > QY 400 General works
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 160 Hypochromic anemia
Faculty: Department: Groups (2002 - 2012) > Child & Reproductive Health Group
Digital Object Identifer (DOI): https://doi.org/10.1016/j.trstmh.2006.11.004
Depositing User: Users 19 not found.
Date Deposited: 15 Nov 2010 10:05
Last Modified: 06 Feb 2018 13:01
URI: http://archive.lstmed.ac.uk/id/eprint/1231

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