Challenges in the diagnosis of iron deficiency anemia in aged people☆

good indicator of IDA in patients with chronic diseases, but it n this issue of the Brazilian Journal of Hematology and emotherapy, Babaei et al.1 investigated the cut-off level for erum ferritin that would better discriminate between elderly atients with and without iron deficiency anemia (IDA). IDA is a common manifestation among the elderly populaion. It has often been associated to gastrointestinal bleeding aused by esophagitis, gastritis, peptic ulcer, cancer, and ntestinal polyps.2–5Although a bone marrow examination is he gold standard test to assess iron stores, it is an invasive ethod with no practical applicability.6,7 A recent systematic eview showed that all guidelines recommend the measureent of serum ferritin to diagnose IDA.8 Serum ferritin is onsidered a first-line diagnostic tool not only due to its availbility, but also because its plasmatic levels accurately reflect verall iron storage, with 1 ng of ferritin per mL indicating pproximately 10 mg of total iron stores.1,9 While serum ferritin under 10–15 ng/mL has 99% of specicity in the diagnosis of IDA, normal or elevated ferritin levels o not exclude IDA, since ferritin is an acute phase proein and may increase during inflammation, cancer, and with ging.8,10 Hence, some studies provide data supporting the se of higher ferritin thresholds for diagnosis, such as 30 or 00 ng/mL.11,12 Elderly people often have many morbidities some of which an potentially lead to anemia, making the diagnosis of IDA articularly challenging in this population.13 Moreover, in ndividuals with chronic diseases, anemia of inflammation