most sensitive hemochromatosis test? nbme 7 spoiler

[knuckles]

A girl with thalassemia had excessive blood transfusions, and they wanted to know what the sensitive test was for detecting secondary hemochromatosis.

Choices were ferritin, transferrin, iron saturation, prealbumin, and haptoglobin.

I remember ferritin being most sensitive for iron deficiency anemia, but is it for hemochromatosis as well?

is it always ferritin, or do different iron diseases have different tests that are best, like what is the most sensitive for anemia of chronic disease? thanks

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[sswang00]

I remember from somewhere that its the transferrin/transferrin saturation.
Don't remember the source but I'm relatively sure that's the answer.

If you think about it, none of the other diseases they usually test us on have increased transferrin saturation...so im assuming that would make it the most sensitive test (more TP, very low FN)

iron dieficiency: low iron, low ferritin, high TIBC ............. low transferrin sat
anemia chronic dz: low iron, high ferritin, low TIBC ..........normal transferrin sat
thallasemias:normal

iron overload: high iron, high ferritin, low TIBC................ increased transferrin sat


Was % transferrin saturation one of the choices? If anything I would pick transferrin.

 

[knuckles]

transferrin is the same thing as tibc. not sure if that's right. In first aid , there is a primary next to serum iron for iron defic and hemochromatosis. does that mean its the first and most sensitive sign?

I had iron sat and that was wrong, so it's either ferritin or transferrin. If the question had been referring to iron defic anemia, do you think it would have been ferritin?

 

[vkhullar]

transferrin is the same thing as tibc. not sure if that's right. In first aid , there is a primary next to serum iron for iron defic and hemochromatosis. does that mean its the first and most sensitive sign?

I had iron sat and that was wrong, so it's either ferritin or transferrin. If the question had been referring to iron defic anemia, do you think it would have been ferritin?

Correct answer is Ferritin. I got it right on NBME 7.

 

[Richter915]

pretty sure i put ferritin and it was right. Acc to one of my heme-onc professors, whenever you're questioned about hemoglobinopathies or iron levels on the floors/boards, ALWAYS get a serum ferritin before anything else.

 

[sswang00]

well then, OOPS!

disregard my elaborate attempted explanation

 

[DC DOC]

transferrin is the same thing as tibc. not sure if that's right. In first aid , there is a primary next to serum iron for iron defic and hemochromatosis. does that mean its the first and most sensitive sign?

I had iron sat and that was wrong, so it's either ferritin or transferrin. If the question had been referring to iron defic anemia, do you think it would have been ferritin?

A serum fasting transferrin level has the highest sensitivity and specificity in diagnosing secondary iron overload, unless they are having ineffective erythroposeisis as in this case, then ferritin would be the best option. Iron deficiency is diagnosed with serum ferritin levels because it is the stores of iron you are wanting to measure, but this can change in an inflammatory state as it is an acute phase reactant and can be falsely elevated when indeed there is a deficiency.

 

[knuckles]

ok so quick and dirty first test should always be ferritin to rule out. thanks