Ferritin, železo a hemoglobin: jak poznat nedostatek železa
Nedostatek \u017eeleza je nej\u010dast\u011bj\u0161\u00ed nutri\u010dn\u00ed deficit na sv\u011bt\u011b. Ferritin, s\u00e9rov\u00e9 \u017eelezo a hemoglobin hodnot\u00ed t\u0159i r\u016fzn\u00e9 aspekty t\u00e9ho\u017e syst\u00e9mu \u2014 z\u00e1soby, transport a funkci. P\u0159i interpretaci v\u00fdsledk\u016f je kl\u00ed\u010dov\u00e9 ch\u00e1pat, kter\u00e1 hodnota se m\u011bn\u00ed jako prvn\u00ed a pro\u010d norm\u00e1ln\u00ed hemoglobin nevylu\u010duje deficit \u017eeleza.
Obsah článku
P\u0159ehled hodnot a norem
| Hodnota | Co m\u011b\u0159\u00ed | Norma (\u017eeny) | Norma (mu\u017ei) | Podrobn\u00fd \u010dl\u00e1nek |
|---|---|---|---|---|
| Ferritin | Z\u00e1soby \u017eeleza | 12\u2013150 \u03bcg/l | 20\u2013300 \u03bcg/l | Ferritin norma |
| Sider\u00e9mie (\u017eelezo) | Transport \u2014 \u017eelezo na transferinu | 9\u201330 \u03bcmol/l | 11\u201332 \u03bcmol/l | \u2014 |
| TIBC / transferin | Kapacita p\u0159epravy (stoup\u00e1 p\u0159i sideropenii) | 45\u201380 \u03bcmol/l | 45\u201380 \u03bcmol/l | \u2014 |
| Hemoglobin | Funkce \u2014 obsah Hb v erytrocytech | 120\u2013160 g/l | 135\u2013175 g/l | Hemoglobin norma |
| MCV | Velikost erytrocyt\u016f (kles\u00e1 pozd\u011b) | 80\u2013100 fl | 80\u2013100 fl | MCV norma |
T\u0159i st\u00e1dia deficitu \u017eeleza \u2014 co se kdy m\u011bn\u00ed
| St\u00e1dium | Ferritin | Sider\u00e9mie / TIBC | Hemoglobin | MCV / MCH | P\u0159\u00edznaky |
|---|---|---|---|---|---|
| 1. Prelatentn\u00ed deficit | \u2193 (pod 30 \u03bcg/l) | Norm\u00e1ln\u00ed | Norm\u00e1ln\u00ed | Norm\u00e1ln\u00ed | M\u00edrn\u00e1 \u00fanava, \u017e\u00e1dn\u00e9 nebo slab\u00e9 |
| 2. Latentn\u00ed (funk\u010dn\u00ed) deficit | \u2193\u2193 (pod 12 \u03bcg/l) | \u2193 sider\u00e9mie, \u2191 TIBC | Norm\u00e1ln\u00ed nebo m\u00edrn\u011b \u2193 | Norm\u00e1ln\u00ed | \u00danava, pad\u00e1n\u00ed vlas\u016f, pica |
| 3. Sideropenick\u00e1 an\u00e9mie | \u2193\u2193 velmi n\u00edzk\u00fd | \u2193\u2193 sider\u00e9mie, \u2191\u2191 TIBC | \u2193\u2193 (pod normu) | \u2193 mikrocyt\u00f3za, hypochromie | V\u00fdrazn\u00e1 \u00fanava, du\u0161nost, bledost |
Pro\u010d ferritin klesl, ale hemoglobin je norm\u00e1ln\u00ed
T\u011blo chr\u00e1n\u00ed hemoglobin za ka\u017edou cenu \u2014 nejprve vy\u010derp\u00e1 z\u00e1soby (ferritin), pak transport (sider\u00e9mie), a teprve nakonec, kdy z\u00e1soby jsou vy\u010derp\u00e1ny, hemoglobin klesne. Proto norm\u00e1ln\u00ed hemoglobin nevylu\u010duje sideropeni\u00ed \u2014 jen \u0159\u00edk\u00e1, \u017ee jsme je\u0161t\u011b v prvn\u00edch dvou st\u00e1di\u00edch. Ferritin odhal\u00ed deficit d\u0159\u00edve a je proto screeningov\u00fdm parametrem prvn\u00ed volby.
Ferritin zv\u00fd\u0161en\u00fd \u2014 jak vylou\u010dit fale\u0161n\u00fd n\u00e1lez
Ferritin je reaktant akutn\u00ed f\u00e1ze \u2014 stoup\u00e1 p\u0159i z\u00e1n\u011btu, infekci, n\u00e1dorech a jatern\u00edm po\u0161kozen\u00ed. Zv\u00fd\u0161en\u00fd ferritin p\u0159i zv\u00fd\u0161en\u00e9m CRP m\u016f\u017ee maskovat sideropeni\u00ed. V takov\u00e9 situaci je t\u0159eba doplnit:
- Saturaci transferinu \u2014 pod 16 % sv\u011bd\u010d\u00ed pro sideropeni\u00ed bez ohledu na ferritin
- Retikulocyt\u00e1rn\u00ed hemoglobin (CHr) \u2014 nejcitliv\u011bj\u0161\u00ed marker funk\u010dn\u00edho deficitu Fe
- CRP \u2014 pokud je zv\u00fd\u0161en\u00e9, ferritin interpretujeme opatrn\u011b
Nej\u010dast\u011bj\u0161\u00ed skupiny s rizikem nedostatku \u017eeleza
- \u017deny v reproduk\u010dn\u00edm v\u011bku \u2014 menstrua\u010dn\u00ed ztr\u00e1ty. Podrobn\u011bji: Ferritin u \u017een
- T\u011bhotn\u00e9 \u017eeny \u2014 plod \u010derp\u00e1 Fe z matky; suplementace Fe od 2. trimestru
- Vegetari\u00e1ni a vegani \u2014 neh-emov\u00e9 \u017eelezo se vst\u0159eb\u00e1v\u00e1 h\u016f\u0159e; pot\u0159eba vitam\u00ednu C
- Sportovci \u2014 hemol\u00fdza z n\u00e1razu chodidla, ztr\u00e1ty potem, hepcidinov\u00e1 blok\u00e1da absorpce
- Senio\u0159i \u2014 malabsorpce, chronick\u00e1 z\u00e1n\u011btliv\u00e1 onemocn\u011bn\u00ed, GI krv\u00e1cen\u00ed (NSAID)
- Pacienti s celiaki\u00ed, IBD \u2014 malabsorpce nebo ztr\u00e1ty krv\u00e1cen\u00edm
Informace maj\u00ed eduka\u010dn\u00ed charakter. Odbornou garanci zaji\u0161\u0165uje MUDr. Pavel Both.
\u2192 P\u0159ehled laboratorn\u00edch hodnot | Ferritin norma | Ferritin u \u017een | Hemoglobin norma | MCV norma