A 79-year-old woman was referred to an internist by her general practitioner with complaints of fatigue and exercise intolerance. Physical examination showed no abnormalities. Laboratory tests showed reduced concentrations of iron, ferritin and reduced transferrin saturation. Another patient, a 48-year-old man with a microcytic anaemia was referred to an internist by a rheumatologist. This patient suffered from active rheumatoid arthritis and was receiving treatment with immunosuppresives and infliximab. Laboratory tests showed reduced concentrations of iron, transferrin, reduced transferrin saturation and increased ferritin concentration. In order to make the correct diagnosis in anaemia, the most important laboratory tests are Hb, MCV and ferritin. As ferritin is an acute phase protein, a CRP should always be ordered concomitantly.
Conflict of interests: none reported. Financial support: D.W. Swinkels is a consultant on the use of hepcidine for a number of companies; the institute for which D.W. Swinkels works receives financial support for this. D.W. Swinkels and the institute at which D.W. Swinkels works receive financial support in connection with a patent in respect to a hepcidine-immuno-assay. D.W. Swinkels receives financial support for delivering presentations on hepcidine and related subjects. D.W. Swinkels is the medical director of www.hepcidinanalysis.com; the institute for which D.W. Swinkels works receives financial support for this.