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Centre for Evidence-
Based Medicine

Anaemia: Diagnosis of iron deficiency anemia in the elderly

Clinical Bottom Line

In community dwelling elderly medical patients in whom iron deficiency anaemia is suspected, serum ferritin is a valid, precise diagnostic test.


Guyatt GH, Patterson CH, Ali M. Diagnosis of iron-deficiency anemia in the elderly. Am J Med 1990;88:205-9.

Clinical Question

In a patient with anaemia can a low serum ferritin be used to diagnose iron deficiency?

Search Terms

"ferritin" and "sensitivity and specificity" in MEDLINE

The Study

  1. Gold Standard - bone marrow aspiration
  2. Study setting - consecutive pts over the age of 65 yr. who were admitted with anaemia to a university-affiliated hospital in Canada.

The Evidence

Ferritin Iron Deficiency No Iron Deficiency Likelihood Ratio
≤ 45 70/85 15/150 8.2
> 45 ≤ 100 7/85 27/150 0.44
> 100 8/85 108/150 0.13
Totals 85 150


  1. Excluded pts from institutions and pts who were "too ill" or had "severe dementia" although these were not defined.
  2. Weighted kappa for bone marrow interpretation by 2 haematologists was 0.84.
  3. Low values can SpPin, and high values can SnNout.
  4. Also see the meta-analysis in J Gen Intern Med 1992;7:145-53. (with a correction on page 423).

Appraised By

S. Straus, 1996

Expiry Date