Physiologically based serum ferritin thresholds for iron deficiency in women of reproductive age who are blood donors

Abstract

Our objective is to develop a physiologically based method to determine serum ferritin thresholds for iron deficiency in healthy individuals. The current World Health Organization threshold of <15 µg/L for iron deficiency in women is based on expert opinion. We examined the relationship between serum ferritin and 2 independently measured indicators of iron-deficient erythropoiesis, soluble transferrin receptor (sTfR) and hemoglobin, in baseline data from 286 women, 20 to 49 years, who were first-time or reactivated donors in the Retrovirus Epidemiology Donor Study-II Donor Iron Status Evaluation (REDS-RISE) study. At lower serum ferritin concentrations, median sTfR increased as hemoglobin decreased. Using restricted cubic spline regression analysis to determine thresholds for iron-deficient erythropoiesis, the thresholds identified by sTfR (serum ferritin < 25.4 µg/L) and hemoglobin (serum ferritin < 25.3 µg/L) did not differ significantly. The thresholds found in the REDS-RISE study do not differ from those identified by sTfR (serum ferritin < 25.5 µg/L) and hemoglobin (serum ferritin < 26.6 µg/L) in a previous study of 5442 women, 20 to 49 years, in the US National Health and Nutrition Examination Survey 2003 to 2018 (P = .98 and 0.83, respectively). Although international comparisons are needed, these results with US data provide additional evidence for the potential usefulness of a physiologically based method to identify serum ferritin thresholds for iron deficiency.

Figure 1.

Concentration curve of serum ferritin against hemoglobin, and soluble transferrin receptor in a sample of women who are blood donors. (A) Restricted cubic spline (RCS) regression fit with 5 knots of serum ferritin against Hb; vertical line denotes SF threshold calculated at the first plateau identified by differential equation. (B) RCS fit with 5 knots of serum ferritin against sTfR; vertical line denotes SF threshold calculated at the first minimum identified by differential equations in a healthy sample of US nonpregnant women aged 20 to 49 years from REDS-RISE.