Predicting bone marrow iron stores in anemic patients in a community hospital using ferritin and erythrocyte sedimentation rate

Forty-three consecutive cases from a community hospital with concomitant bone marrow iron stain, serum ferritin, and erythrocyte sedimentation rate (ESR) were reviewed. Cases were classified as iron present or absent by the bone marrow iron stain. A two-dimensional linear graphic relationship between ferritin and ESR correctly identified six of nine iron-deficient patients and 32 of 34 iron-present patients. Four cases yielded indeterminate results. One complex iron-deficient case was incorrectly classified. This graphic method developed with data from tertiary care patients was correct in 88.4% of cases, incorrect in 2.3%, and indeterminate in 9.3%. When absent iron stores were graphically predicted, the predictive value was 100%. When iron deficiency was graphically excluded, the predictive value was 97%. The authors conclude the graphic method is useful in a community hospital practice for the confirmation or exclusion of iron deficiency.