Anaemia: iron-deficiency: liver cirrhosis: ferritin was a useful test.

Clinical bottom line (level 1b)

  1. About 40% of patients with liver cirrhosis and anaemia had iron-deficiency anaemia.
  2. Patients with a ferritin level 200 or less were more likely to have iron-deficiency anaemia (LR+4.3) .
Intragumtornchai et al: Journal of Internal Medicine 1998; 243: 233-241
Expires December 2002

The study

Setting: university hospital, Thailand

72 patients (aged range 21 to 74 years; median 49, 65% female) liver cirrhosis with anaemia (Hb <13 in men, <12 in women). Liver cirrhosis diagnosed by:
  • characteristic clinical features (jaundice, ascites, encephalopathy, low serum albumin, raised transaminase levels and a PT level not corrected by vitamin K)
  • ultrasound scan liver- irregular hepatic echogenicity without focal lesions


Excluded if
  • <15 years old
  • hepatic space-occupying lesion suggestive of malignancy on ultrasound
  • concomitant renal impairment (creatinine >2.0 mg/dl)
  • symptomatic thalassaemia or other underlying haematological disorder
  • received blood transfusion, folate or vitamin B within one month
  • active gastrointestinal bleeding within one month



    • Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
    Reference standard:
    • iron stores on bone marrow aspirate
    Diagnostic test: ferritin concentration- positive if 200 µ g or less

    The evidence

    pre-test probability of iron-deficiency anaemia: 40%, (95% CI: 29% to 52%)

    diagnostic test iron-deficiency anaemia no anaemia LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    ferritin concentration 23 8 4.3
    (2.3 to 8.2)     		74% 0.22
    (0.10 to 0.49)     		13%
    total 28 42

    Comments

    1. There are too few patients to create meaningful likelihood ratios for multiple levels.
    2. Note that the ferritin levels are much higher than those used to detect iron-deficiency anaemia in well patients.

    Citation

    1. Intragumtornchai T, Rojnukkarin P, Swasdikul D, et al: The role of serum ferritin in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis. Journal of Internal Medicine 1998; 243: 233-241
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    Contributor: Chris Ball and Clare Wotton, June 2000
    Reviewer:

    Clinical Question.
    Patient liver cirrhosis
    Intervention or Exposure ferritin concentration
    Comparison iron stores on bone marrow aspirate
    Outcome diagnosis of iron deficiency anaemia