What is the role of serum ferritin testing in the workup of anemia after a significant hemorrhage?

Updated: Nov 26, 2019
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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If hemorrhage was sufficient to deplete iron stores (1-2 L of blood, 500-1000 mg of iron), newly formed erythrocytes are microcytic and hypochromic and gradually replace normal erythrocytes in the circulation that were produced prior to the induction of iron deficiency. Because RBCs normally survive for 120 days in circulation, maximal changes in the MCV and MCHC are not observed until that time. Iron deficiency and the depletion of iron stores can be detected several weeks after bleeding by measurements of the serum iron level and the TIBC (the patient has low serum iron levels and an elevated TIBC) and/or special stains of bone marrow specimens showing an absence of storage iron. A low serum ferritin level provides confirmation of the diagnosis of iron deficiency anemia. The presence of microcytosis and hypochromia is helpful but not diagnostic.

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