Hypoferritinemia without Anemia the Possible Diagnostic Thought
Authors: Al-Jafar Hassan A. , Al-Fadhli S , F Althallab , Al Ageeli Mubark 
Published: October 2019

Abstract
Hypoferritinemia Without Anemia The Possible Diagnostic Thought
Hassan Al-Jafar , Saud Al-Fadli , Fatma Al-Thelab , Mubark Al-Aqeel
Introduction : Iron metabolism still an active area in research work which provide more knowledge of aetiology and pathogenesis of the diseases and provide new treatment methods based on the new research results . HWA is one of the metabolic disorders where all the investigations are withen normal reference ranges . HWA patients could have long standing complain , while few HWA patients have no complains . The normal all results make HWA a hidden disease with lack in the exact underling cause . Iron deficiency anemia ( IDA ) and latent iron deficiency anemia
( LIDA ) are easy to diagnose from the clinical and the laboratory results , where IDA has anemia and LIDA has at least one paremeter in complete blood count that indicate a stage of pre-iron deficiency anemia . HWA desease has normal results except low ferritin level , ehat make pre-pre-IDA or pre-LIDA with normal transferrin saturation a stutus which was not described before . In the letreture serum ferritin found to be low in canins due to autoantibodies , also there could be another factors which not yet known that may affect iron metabolism and causing HWA .
Aim: This research project is looking for interpretation for HWA to treat it by methods other than iron or iron infusion as many unpleasant and side effects accompanied both oral and intravenous iron treatment.
Methodology and tools: From our hospital data and from the outpatient department 75 Patients 36 male and 39 females were reviewed to detect the variations of complete blood count parameters in comparison with iron status.
Tools: Complete blood count (CBC), HPLC, serum iron, serum ferritin, transferrin. Including criteria: Adult male and female patients, normal HPLC results. Excluding criteria: Abnormal HPLC, Family history of hemoglobinopathy disorders for patients investigated prospectively, patients on iron treatment excluded from this study.
Results:
In IDA group usually all the parameters indicate IDA. In LIDA group at least one parameter or more indicate iron deficiency. In HWA group only, ferritin is low and transferrin saturation is normal while it is expected to be low if HWA underling aetiology is iron deficiency. Table [ 1]
Conclusion:
IDA and LIDA are easly diagnosed , while HWA has only low serum ferritin which is not routinely done. In HWA the results are not going with the usual parameters of iron metabolism and homeostasis, when low ferritin found with normal transferrin saturation in the same sampling days. HWA could be just an early pre- LIDA or may be a low ferritin reference range in some countries especially when the patient has no complains, or the body could have another unknow storage mechanisms other than ferritin. HWA also might be hormonal deficiency which reduce acute reactive proteins which could affect serum ferritin level or HWA could be an antibody against ferritin which has no influence on serum iron, but it renders serum ferritin lower than normal. HWA is important from many aspects , first it is a hidden disorder which need to be known by the physicians for diagnosis and treatment and it is important from academic point of view to answer to its indecisive aetiology and pathogenesis especially when it has a controversy in low ferritin and normal transferrin saturation . Adding more research tools as hepcidin test could provide more information to understand HWA disorder better.
References:
1-Wei Wang , Mary Knovich , Lan G.Coffman Frank M, Torti , Suzy V. Torti , Serum ferritin :Past , Present and future
Biochim Biophys acta , 2010 August ; 1800 (8) : 760-769
2-Hassan Al-Jafar, HWA: Hypoferritinemia without a hidden hematology disorder, journal of family medicine and primary care 2017, volume: 6, issue: 1 p 69-72

Disclosures
No relevant conflicts of interest to declare.