Although ongoing research in hepcidin testing is promising, there is no standardized or approved hepcidin assay, and this testing is not currently recommended for diagnosis of ACD/AI. Serum and urine hepcidin levels may be increased in ACD/AI.
MCHC, mean corpuscular hemoglobin concentration RDW, red blood cell distribution width Tsat, transferrin saturationĮrythrocyte protoporphyrin is increased in ACD/AI, but not in conditions of abnormal heme synthesis, and thus may be useful in distinguishing ACD/AI from diseases such as thalassemia minor. Laboratory Testing to Distinguish Between ACD/AI and IDA Parameter IDA and ACD/AI may occur together, complicating diagnosis. Soluble transferrin receptor testing may also be useful. Serum iron indices are complicated in ACD/AI: iron is sequestered, leading to ample stores, but is not made available for erythropoiesis. Serum ferritin and total iron binding capacity (TIBC) are first-line tests to evaluate iron stores.
Patients with anemia, a normal or low MCV, and a low corrected reticulocyte count or reticulocyte production index should be evaluated for ACD/AI. A reticulocyte count is also recommended to assess bone marrow response to anemia and rule out conditions in which this response is elevated, such as hemolytic anemia. In general, ACD/AI presents as a normocytic anemia (cells have a normal mean corpuscular volume ), but may be microcytic in up to 25% of cases. Once anemia is confirmed, red blood cell (RBC) counts and morphology from a CBC can be used to further classify anemia. Conditions in which ACD/AI is common include chronic infection, autoimmune disease, cancer, acute infection, chronic pulmonary obstructive disease, pulmonary arterial hypertension, obesity, chronic liver disease, and certain forms of heart disease. Patients with hemoglobin (Hb) levels at least 2 standard deviations below the mean for age and sex (see Anemia) and a chronic or inflammatory condition should be evaluated for ACD/AI.
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