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Centre for Evidence-
Based Medicine

Anaemia: Diagnosis of iron deficiency anemia in the elderly

Clinical Bottom Line

Acute Cholecystitis - Lap chole may be as safe as open chole


Guyatt GH, Patterson C, Ali M, Singer J, Levine M, Turpie I, Meyer R: 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

  • Gold Standard - bone marrow aspiration
  • 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 patients from institutions and patients 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

Straus, 1996, Reviewed 1998

Expiry Date