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Editor's Correspondence
August 12/26, 2002

Serum Ferritin vs Transferrin Receptor–Ferritin Index—Reply

Arch Intern Med. 2002;162(15):1782-1783. doi:

In reply

We appreciate the comments from Dr Dosh and agree that low levels of serum ferritin (<24 ng/mL for men and <15 ng/mL for women) are specific markers for IDA in the elderly. In our study, all the patients with low levels of serum ferritin had bone marrow–proven IDA.1 However, in our study, low ferritin levels were observed in only 10 (20%) of the 49 IDA patients. In all the other 39 patients with bone marrow–proven IDA, serum ferritin levels were high (Table 1 of our article). Thus, serum ferritin assay is highly specific but has a very low sensitivity for the diagnosis of IDA in the elderly. Similar results were reported by Guyatt et al.2 In the later study of anemic patients older than 65 years, low serum ferritin levels led to the diagnosis of IDA in only 21% of their patients. As discussed in our study, serum ferritin assay is not a sensitive test for the diagnosis of IDA in the elderly since more than half of the patients have high levels due to concomitant illnesses.1,35

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