PubMed · 8669408
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A R Walker. 1996. Iron deficiency, development, and cognitive function.. https://doi.org/10.1093/ajcn%2F64.1.120
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The description by Ramsay in 1957 of a practical way of determining the total iron binding capacity of serum (a measure of transferrin concentration) provided a diagnostic test for both iron deficiency and iron overload. Since 1957 the introduction of the assay for serum ferritin (in 1972) has made it possible to assess the levels of storage iron in normal subjects and assays for free erythrocyte protoporphyrin and the circulating transferrin receptor methods to evaluate iron supply for erythropoiesis. In 1957 iron metabolism in man was already well understood but its evaluation relied on measurement of tissue iron concentrations and the use of radioisotopes of iron to measure rates of erythropoiesis. The evaluation can now be carried out using the various blood assays along with the measurement of haemoglobin concentration but interpretation of the measurements in disease still requires an understanding of the way in which these measures are influenced by pathological processes.
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Normal haemoglobin concentration in the trimesters of pregnancy can be considered to be 11-13 g/100 ml, 10-13 g/100 ml and 11-14 g/100 ml, respectively. High and low haemoglobin levels both indicate important pathophysiological changes. The authors discuss the use of serum-ferritin (S-ferritin), mean corpuscular volume (MCV) and erythrocyte protoporphyrin as diagnostic tools. S-ferritin, which is a reliable indicator of the iron status in the first trimester, becomes less reliable after the 20th week due to the physiological dilution of the plasma and a concurrent fall in haemoglobin and S-ferritin. Erythrocyte protoporphyrin is not influenced by the plasma dilution and can be used as a supplement to S-ferritin to assess iron deficiency. MCV can also be used to characterise the iron status. Decreases in MCV take time, however, which makes clinical interpretation difficult. S-ferritin measurement early in pregnancy is a reliable parameter for judging whether iron supplementation is necessary. Even if S-ferritin is influenced by the plasma dilution, a concentration below 15 microgram/l indicates iron deficiency in all stages of pregnancy.