Diseases (67)

Diagnostic Testing (44)

Note:

Note:

Rule out iron liver disease.


Note:

Rule out iron deficiency.


Note:

Evaluate for possible iron deficiency secondary to achlorhydria. Especially if anemia is present.


Note:

Rule out liver disease due to iron overload, hemochromatosis.


Note:

If anemia is present, esp. if microcytic/hypochromic.


Note:

Rule out hemochromatosis.


Note:

Note:

Rule out hemochromatosis.


Note:

If patient is diagnosed with folate or Vit. B12 deficiency but the MCV is normal or low


Note:

To rule out hemochromatosis


Note:

Rule out iron load, hemochromatosis.


Note:

Rule out iron deficiency anemia.


Note:

Rule out hemochromatosis.


Note:

If anemia present.


Note:

To evaluate and monitor anemia.

Disease Management Testing (20)

Note:

To monitor iron related therapy in iron related deficiency anemia.


Note:

If patient has been previously shown to have concommitant iron deficiency


Note:

If anemia is seen.


Note:

Rule out iron deficiency if anemia is present.


Note:

If chronic liver disease cased by iron overload.


Note:

If abnormally low?

Overview

Iron is a structural part of hemoglobin, which functions to transport oxygen. Ingested iron is mainly absorbed in the form of Fe2 + in the duodenum and upper jejunum. Absorbed iron is then transported in blood plasma by transferrin-iron complexes. A maximum of 2 Fe2 + ions per transferrin molecule can be transported. Serum iron is almost completely bound to transferrin.

Testing for iron (non-heme) levels is used in the diagnosis and treatment of diseases such as iron deficiency anemia and hemochromatosis. Hemochromatosis is a disease associated with iron deposits in tissues, usually deposited in the form of iron-containing pigments such as hemosiderin and hemofuscin. Disease is characterized by pigmentation of the skin and chronic renal disease. In addition, iron testing can be useful in the diagnosis and monitoring of microcytic anemias (e.g. due to iron metabolism disorders and hemoglobinopathies), macrocytic anemias (e.g. due to vitamin B12 deficiency, folic acid deficiency, and drug-induced metabolic disorders of unknown origin), normocytic anemias such as anemia of chronic renal disease (erythropoetin deficiency), hemolytic anemia, bone marrow disease, and toxic bone marrow damage. Percent iron saturation should also be obtained because it is more helpful than serum iron in estimating iron stores and evaluating for iron deficiency anemia.

Clinical Utility

  • Differential diagnosis of anemia, especially with hypochromia and/or low red blood cell MCV
  • As an aid in diagnosis of thalassemia and sideroblastic anemia
  • As an aid in diagnosis of hemochromatosis
  • Diagnosis of iron deficiency

Interpretation

Increased in:

  • Hemosiderosis due to increased iron uptake
  • Multiple transfusions
  • Hemolytic anemia
  • Pernicious anemia
  • Aplastic or hypoplastic anemia
  • Viral hepatitis
  • Lead poisoning
  • Thalassemias
  • Some drugs: estrogens, ethanol, oral contraceptives

Decreased in:

  • Iron deficiency
  • Nephrotic syndrome
  • Chronic renal failure
  • Many infections
  • Active hematopoiesis
  • Remission of pernicious anemia
  • Some malignancies (some carcinomas)
  • Gastrectomy
  • Nutritional (children and premenopausal women)
  • Pregnancy
  • Chronic blood loss due to bleeding

Reference Ranges

  mcg/dL umol/L
Newborn:  100-250  [17.9-44.8]
Infant: 40-100  [7.2-17.9]
Child:  50-120  [9.0-21.5]
Adult    
M:  65-175  [11.6-31.3]
F:  50-170  [9.0-30.4]
Intoxicated child: 280-2550  [50.1-456.5]
Fatally poisoned child:  1800  [322.2]


 

 

Methodology

Timed Endpoint Spectroscopy Method.

Specimen Collection

Serum (SST) or Plasma Heparin (Green)

Draw blood before other specimens that require anticoagulated tubes. Reject hemolyzed samples.

Stability:

  • Ambient: 14 days
  • Refrigerated: 14 days
  • Frozen: 28 days
  • Separate serum of Plasma within 45 minutes of collection.

Additional Testing

Complete Blood Count with RBC Indices, Vitamin B12, Folate, Ferritin, TIBC, Transferrin, Transferrin Receptor, Erythropoietin, Hemochromatosis Mutation, Lead Level, Occult Blood, Porphyrins Urine.

Turnaround Time

1-3 days.

CPT

83540

LOINC

ICD10

A51.32Syphilitic alopecia
B17.1Acute hepatitis C
B18.2Chronic viral hepatitis C
B19.2Unspecified viral hepatitis C
B19.20Unspecified viral hepatitis C without hepatic coma
B19.21Unspecified viral hepatitis C with hepatic coma
C22.0Liver cell carcinoma
C22.8Malignant neoplasm of liver, primary, unspecified as to type
C22.9Malignant neoplasm of liver, not specified as primary or secondary
C92Myeloid leukemia
C92.1Chronic myeloid leukemia, BCR/ABL-positive
C92.2Atypical chronic myeloid leukemia, BCR/ABL-negative
C92.9Myeloid leukemia, unspecified
C93.1Chronic myelomonocytic leukemia
C93.10Chronic myelomonocytic leukemia not having achieved remission
C93.11Chronic myelomonocytic leukemia, in remission
C93.12Chronic myelomonocytic leukemia, in relapse
D45Polycythemia vera
D46Myelodysplastic syndromes
D46.0Refractory anemia without ring sideroblasts, so stated
D46.9Myelodysplastic syndrome, unspecified
D46.ZOther myelodysplastic syndromes
D47.1Chronic myeloproliferative disease
D47.3Essential (hemorrhagic) thrombocythemia
D50Iron deficiency anemia
D50.0Iron deficiency anemia secondary to blood loss (chronic)
D50.1Sideropenic dysphagia
D50.8Other iron deficiency anemias
D50.9Iron deficiency anemia, unspecified
D51Vitamin B12 deficiency anemia
D51.0Vitamin B12 deficiency anemia due to intrinsic factor deficiency
D52Folate deficiency anemia
D53.1Other megaloblastic anemias, not elsewhere classified
D55Anemia due to enzyme disorders
D55.1Anemia due to other disorders of glutathione metabolism
D56Thalassemia
D56.0Alpha thalassemia
D56.1Beta thalassemia
D56.8Other thalassemias
D56.9Thalassemia, unspecified
D57Sickle-cell disorders
D57.1Sickle-cell disease without crisis
D57.3Sickle-cell trait
D57.8Other sickle-cell disorders
D58Other hereditary hemolytic anemias
D58.8Other specified hereditary hemolytic anemias
D59Acquired hemolytic anemia
D59.0Drug-induced autoimmune hemolytic anemia
D59.1Other autoimmune hemolytic anemias
D59.5Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]
D59.8Other acquired hemolytic anemias
D59.9Acquired hemolytic anemia, unspecified
D62Acute posthemorrhagic anemia
D63Anemia in chronic diseases classified elsewhere
D63.0Anemia in neoplastic disease
D63.1Anemia in chronic kidney disease
D63.8Anemia in other chronic diseases classified elsewhere
D64Other anemias
D64.9Anemia, unspecified
D69.6Thrombocytopenia, unspecified
D72.820Lymphocytosis (symptomatic)
D72.824Basophilia
D75.1Secondary polycythemia
E44Protein-calorie malnutrition of moderate and mild degree
E44.0Moderate protein-calorie malnutrition
E44.1Mild protein-calorie malnutrition
E50Vitamin A deficiency
E50.9Vitamin A deficiency, unspecified
E61Deficiency of other nutrient elements
E61.1Iron deficiency
E64.1Sequelae of vitamin A deficiency
E67.0Hypervitaminosis A
E67.1Hypercarotenemia
E75.22Gaucher disease
E80Disorders of porphyrin and bilirubin metabolism
E80.0Hereditary erythropoietic porphyria
E80.1Porphyria cutanea tarda
E80.2Other and unspecified porphyria
E80.29Other porphyria
E80.7Disorder of bilirubin metabolism, unspecified
E83.11Hemochromatosis
E83.110Hereditary hemochromatosis
E83.111Hemochromatosis due to repeated red blood cell transfusions
E83.118Other hemochromatosis
E83.119Hemochromatosis, unspecified
G25.81Restless legs syndrome
G32.8Other specified degenerative disorders of nervous system in diseases classified elsewhere
I12Hypertensive chronic kidney disease
I13Hypertensive heart and chronic kidney disease
I42Cardiomyopathy
I42.0Dilated cardiomyopathy
I42.1Obstructive hypertrophic cardiomyopathy
I42.2Other hypertrophic cardiomyopathy
I42.5Other restrictive cardiomyopathy
I42.8Other cardiomyopathies
I42.9Cardiomyopathy, unspecified
I50Heart failure
I50.20Unspecified systolic (congestive) heart failure
I50.21Acute systolic (congestive) heart failure
I50.22Chronic systolic (congestive) heart failure
I50.23Acute on chronic systolic (congestive) heart failure
I50.30Unspecified diastolic (congestive) heart failure
I50.31Acute diastolic (congestive) heart failure
I50.32Chronic diastolic (congestive) heart failure
I50.33Acute on chronic diastolic (congestive) heart failure
I50.40Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.9Heart failure, unspecified
I78.0Hereditary hemorrhagic telangiectasia
I82.0Budd-Chiari syndrome
I85.01Esophageal varices with bleeding
K25Gastric ulcer
K25.4Chronic or unspecified gastric ulcer with hemorrhage
K25.6Chronic or unspecified gastric ulcer with both hemorrhage and perforation
K25.7Chronic gastric ulcer without hemorrhage or perforation
K27Peptic ulcer, site unspecified
K27.7Chronic peptic ulcer, site unspecified, without hemorrhage or perforation
K29.01Acute gastritis with bleeding
K29.3Chronic superficial gastritis
K29.31Chronic superficial gastritis with bleeding
K29.4Chronic atrophic gastritis
K29.5Unspecified chronic gastritis
K29.6Other gastritis
K29.61Other gastritis with bleeding
K29.7Gastritis, unspecified
K50Crohn's disease [regional enteritis]
K50.0Crohn's disease of small intestine
K50.1Crohn's disease of large intestine
K50.80Crohn's disease of both small and large intestine without complications
K50.811Crohn's disease of both small and large intestine with rectal bleeding
K50.812Crohn's disease of both small and large intestine with intestinal obstruction
K50.813Crohn's disease of both small and large intestine with fistula
K50.814Crohn's disease of both small and large intestine with abscess
K50.818Crohn's disease of both small and large intestine with other complication
K50.819Crohn's disease of both small and large intestine with unspecified complications
K50.9Crohn's disease, unspecified
K51Ulcerative colitis
K51.00Ulcerative (chronic) pancolitis without complications
K51.01Ulcerative (chronic) pancolitis with complications
K51.8Other ulcerative colitis
K52Other and unspecified noninfective gastroenteritis and colitis
K58Irritable bowel syndrome
K58.0Irritable bowel syndrome with diarrhea
K58.9Irritable bowel syndrome without diarrhea
K70Alcoholic liver disease
K70.0Alcoholic fatty liver
K70.1Alcoholic hepatitis
K70.3Alcoholic cirrhosis of liver
K70.30Alcoholic cirrhosis of liver without ascites
K70.31Alcoholic cirrhosis of liver with ascites
K70.4Alcoholic hepatic failure
K71Toxic liver disease
K71.3Toxic liver disease with chronic persistent hepatitis
K72Hepatic failure, not elsewhere classified
K72.00Acute and subacute hepatic failure without coma
K72.01Acute and subacute hepatic failure with coma
K72.11Chronic hepatic failure with coma
K72.90Hepatic failure, unspecified without coma
K72.91Hepatic failure, unspecified with coma
K73Chronic hepatitis, not elsewhere classified
K73.9Chronic hepatitis, unspecified
K74Fibrosis and cirrhosis of liver
K74.0Hepatic fibrosis
K74.69Other cirrhosis of liver
K75Other inflammatory liver diseases
K75.0Abscess of liver
K75.81Nonalcoholic steatohepatitis (NASH)
K76Other diseases of liver
K76.0Fatty (change of) liver, not elsewhere classified
K76.3Infarction of liver
K76.89Other specified diseases of liver
K76.9Liver disease, unspecified
K77Liver disorders in diseases classified elsewhere
K90Intestinal malabsorption
K90.0Celiac disease
K90.8Other intestinal malabsorption
K90.89Other intestinal malabsorption
K90.9Intestinal malabsorption, unspecified
K91.2Postsurgical malabsorption, not elsewhere classified
K92.0Hematemesis
K92.1Melena
K92.2Gastrointestinal hemorrhage, unspecified
L63Alopecia areata
L63.0Alopecia (capitis) totalis
L63.1Alopecia universalis
L63.8Other alopecia areata
L63.9Alopecia areata, unspecified
L64Androgenic alopecia
L64.0Drug-induced androgenic alopecia
L64.8Other androgenic alopecia
L64.9Androgenic alopecia, unspecified
L65Other nonscarring hair loss
L65.2Alopecia mucinosa
L66Cicatricial alopecia [scarring hair loss]
L66.8Other cicatricial alopecia
L66.9Cicatricial alopecia, unspecified
M07Enteropathic arthropathies
N13Obstructive and reflux uropathy
N18Chronic kidney disease (CKD)
N18.9Chronic kidney disease, unspecified
N23Unspecified renal colic
N26.9Renal sclerosis, unspecified
O09Supervision of high risk pregnancy
O09.3Supervision of pregnancy with insufficient antenatal care
O26Maternal care for other conditions predominantly related to pregnancy
O28Abnormal findings on antenatal screening of mother
O28.9Unspecified abnormal findings on antenatal screening of mother
O36.01Maternal care for anti-D [Rh] antibodies
O99.01Anemia complicating pregnancy
O99.280Endocrine, nutritional and metabolic diseases complicating pregnancy, unspecified trimester
P54.3Other neonatal gastrointestinal hemorrhage
P58Neonatal jaundice due to other excessive hemolysis
P59.0Neonatal jaundice associated with preterm delivery
P59.9Neonatal jaundice, unspecified
Q24.9Congenital malformation of heart, unspecified
Q84.0Congenital alopecia
R17Unspecified jaundice
R58Hemorrhage, not elsewhere classified
R71Abnormality of red blood cells
R74.0Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]
R77Other abnormalities of plasma proteins
R94Abnormal results of function studies
R94.4Abnormal results of kidney function studies
R94.5Abnormal results of liver function studies
Z01.83Encounter for blood typing
Z01.84Encounter for antibody response examination
Z14Genetic carrier
Z20.5Contact with and (suspected) exposure to viral hepatitis
Z31.430Encounter of female for testing for genetic disease carrier status for procreative management
Z31.440Encounter of male for testing for genetic disease carrier status for procreative management
Z32.0Encounter for pregnancy test
Z34Encounter for supervision of normal pregnancy
Z34.8Encounter for supervision of other normal pregnancy
Z34.9Encounter for supervision of normal pregnancy, unspecified
Z34.90Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
Z36Encounter for antenatal screening of mother
Z67Blood type
Z84Family history of other conditions
Z84.81Family history of carrier of genetic disease
Z85Personal history of malignant neoplasm
Z85.05Personal history of malignant neoplasm of liver

References