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Editor's Correspondence |

Serum Ferritin vs Transferrin Receptor–Ferritin Index

Steven A. Dosh, MD, MS
Arch Intern Med. 2002;162(15):1782-1783. doi:.
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Rimon et al1 studied the transferrin receptor–ferritin index (TR-F index) in the evaluation of iron deficiency anemia (IDA) in the elderly. The authors concluded that "routine blood tests [have] a very low sensitivity" and that "the TR-F index is much more sensitive." Furthermore, they suggested that a positive TR-F index can eliminate the need for bone marrow evaluation.

Including the serum ferritin with multiple "routine laboratory tests" for IDA caused the authors to come to an erroneous conclusion. Table 1 of the article reveals that the mean ± SD serum ferritin level was 13.7 ± 5.2 ng/mL among patients with anemia and those without anemia had a mean ± SD serum ferritin level of 363.9 ± 222.2 ng/mL. A serum ferritin level of less than 19 ng/mL virtually established the diagnosis of IDA in the study group. In a study by Guyatt et al,2 the authors demonstrated that a serum ferritin level of 18 µg/L or less had a positive likelihood ratio of 41.47. Rimon et al1 found a sensitivity of 87.8% and specificity of 92.9% for the TR-F index. Using these data, the likelihood ratio for a TR-F index greater than 1.5 would be 8.78.

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