Body iron store and prevalence of iron deficiency In Mongolian children aged 6-59 months / Монголын Анагаах Ухаан

Background@#Iron is an essential mineral needed for physical and cognitive development with iron needs greatest during pregnancy, infancy, childhood, and adolescence. Iron is vital throughout the lifespan as it is a component of haemoglobin, the protein responsible for transporting oxygen from the lungs to body cells for energy production. Iron deficiency results from a depletion of body iron stores due to increased iron needs, inadequate dietary iron intake, reduced iron absorption, or loss of iron from infections caused by malaria, hookworms, and other intestinal parasites. In advanced stages, iron deficiency leads to iron deficiency anaemia, a condition of low red blood cells and reduced oxygen-carrying capacity.@*Goal@#This study aimed to determine body iron stores in Mongolian children aged 6-59 months, and estimate prevalence of iron deficiency among of studied children. @*Materials and Methods@#In this study were used materials that collected during the fifth national nutrition survey conducted in 21 provinces of 4 economic regions and 8 districts of Ulaanbaatar city of Mongolia. The fifth national nutrition survey was household based survey; therefore sampling unit was household with 5 year-old child. We had used demographic information collected by interview methods and laboratory examination results on ferritin, soluble transferrin (sTfR), C reactive protein (CRP) and α1-acid glycoprotein (AFP) in serum samples collected from 6 to 59 months old children, pregnant women and 15–49 year-old men living in child’s households. Serum Ferritin and soluble transferrin (sTfR) were used as a biomarker for iron store and iron deficiency and C reactive protein (CRP) and AFG were used as indicators for acute and chronic infection. The determination of iron status is challenging when concomitant infection and inflammation are present because of confounding effects of the acute-phase response on the interpretation of most iron indicators. Effects of C reactive protein (CRP) and AGP concentrations on estimates of ID according to serum ferritin (SF) and soluble transferrin receptor (sTfR) were considered in the study. @*Ethical considerations @#The survey protocol was discussed at the scientific committee of the Public health institute and approved by director of scientific committee of PHI on June 28, 2016. Ethical approval for conducting the survey, including obtaining biological samples was obtained from the Medical ethics committee under the Ministry of Health of Mongolia on July 7, 2016. Participation in the survey was voluntary, oral and written informed consent was obtained from each participants and adult caregivers of under 5 year-old children. @*Results@#Biomarkers of iron status were adjusted with inflammation indicators and estimated iron deficiency (ID) and total body iron store in 1732 children 6-59 month-olds. The study findings showed that adjusted mean concentration of serum ferritin and soluble transferrin receptor was 33.7 µg/l and 8.8 mg/l in children age of 6-59 months, respectively. The calculated total body iron store by using adjusted SF and soluble transferrin receptor was 2.8 mg/kg among surveyed children. Iron deficiency was estimated by using 2 different biomarkers among selected population group. The prevalence of iron deficiency estimated by using SF was 20.7% in children 6-59 months. Iron deficiency in children defined by using serum soluble transferrin receptor was 27.7%.@*Conclusions@#</br> 1. The average serum ferritin and soluble transferrin receptor concentrations was 33.7 µg/l and 8.8 mg/l in children age of 6-59 months, respectively. Total body iron store estimated by using SF and soluble transferrin was 2.8 mg/kg among surveyed children. </br>2. The prevalence of iron deficiency estimated by using SF and sTfR was 20.7% and 27.7% in children 6-59 months, respectively. According to the WHO recommendation, prevalence of iron deficiency among Mongolian children aged 6-59 months is classified as “prevalent”. </br>3. Overall proportion of children with low body iron store was 22.4%. The prevalence of iron depletion is relatively common in boys, young children aged 6–23 months, and rural children aged 6-59 months.

Soluble transferrin receptor levels among pregnant women in Port Harcourt, Nigeria

Background: Anaemia in pregnancy is one of the medical problems that affect pregnant women in developing countries. It contributes considerably to the morbidity and mortality in pregnancy especially in areas where malaria is endemic. The concentration of soluble transferrin receptor is a reflection of body iron status. It is therefore, a valuable tool for assessing bone marrow erythropoetic activity and can also be a marker of iron deficiency.Methods: This study evaluated the levels of soluble transferrin receptor in pregnant subjects. A total of 275 pregnant subjects of age 20 to 45 years and 88 age-matched apparently healthy control subjects were involved in this study. Individuals who had severe anaemia, HIV infection, sickle cell disease or Hookworm infestation were excluded from this study. Five millilitres (5ml) of blood were collected from each consenting subject for the analysis of soluble transferrin receptor, haematological parameters and iron parameters using appropriate methods.Results: The mean value of parameters for the study subjects were sTfR( 21.16±9.11 nmol/L), Hb(9.05±1.22 g/dl), TIBC(332.61±80.87 µg/dl), Serum Iron(97.91±39.44 µg/dl), LIBC(239.36±80.52 µg/dl), TS(30.24±11.00 %) while for control subjects were sTfR(18.21±3.77 nmol/L), Hb(12.19±0.66 g/dl), TIBC(261.94±52.49µg/dl), Serum Iron(107.10±34.77 µg/dl), LIBC(155.52±61.25 µg/dl), TS(42.81±18.03 %). The mean sTfR levels in pregnant women was significantly lower (p<0.001) than in control subjects. The pregnant women also had significantly lower values of Hb (p<0.001), serum iron (p=0.038) and TS( p<0.001) values, and significantly higher values of TIBC(p<0.0001) and LIBC(p<0.0001). There were also increases in soluble transferrin receptor levels from first to third trimesters. The sensitivity of sTfR as against Serum iron parameters from this study was 76% while the specificity was 50%. The positive predictive value was 60% while the negative predictive value was 50%.Conclusions: sTfR may be a useful supplementary diagnostic tool in the management of anaemia in pregnancy.

Cognitive function observation and clinical features of 100 cases of elderly patients with non-alcoholic fatty liver disease / 中华消化杂志

Objective To observe the changes of cognitive function,clinical characteristics and hippocampal structure in elderly patients with non-alcoholic fatty liver disease (NAFLD).Methods From December 2014 to June 2016,at Department of Geriatrics,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,169 elderly hospitalized patients who underwent health checkups were enrolled and divided into NAFLD group and non-NAFLD group.The clinical data of two groups were collected,and the Montreal cognitive assessment scale (MoCA) was used for cognitive function assessment.The serum level of soluble transferrin receptor (sTfR) was detected,the liver-spleen ratio was measured and hippocampal proton magnetic resonance spectroscopy (1H-MRS) was performed.T test and linear regression analysis were used for statistical analysis.Results Among the 169 elderly patients,100 were NAFLD and 69 were non-NAFLD.The body mass index(BMI) and waist-to-hip ratio(WHR) of patients in NAFLD group were (25.9 ± 3.4) kg/m2 and 1.03 ± 0.13,respectively,which were higher than those in non-NAFLD group ((24.2 ± 3.7) kg/m2 and 0.95 ± 0.06),and the differences were statistically significant (t =-2.714 and-3.605,both P ＜0.01).MoCA score of the patients in NAFLD group was 20.1 ± 5.8,which was lower than that in non-NAFLD group (22.1 ± 4.4),and the difference was statistically significant(t =2.154,P =0.033).The serum sTfR level and liver-spleen computed tomography(CT) ratio of NAFLD group were (8.78 ± 4.31) mg/L and 0.97 ± 0.12,respectively,which were lower than those of non-NAFLD group ((12.66 ± 3.93) mg/L and 1.19 ± 0.15),and the differences were statistically significant(t =3.765 and 6.142,both P ＜ 0.01).The CT ratio of liver to spleen (β=7.597,95％ confidence interval(CI):2.938 to 12.935) and sTfR (β =0.552,95％ CI:0.304 to 0.787) were positively correlated with cognitive function in elderly patients (both P ＜ 0.01).The height of right hippocampus of NAFLD group was (0.410 ± 0.074) mm,which was lower than that of non-NAFLD group ((0.453 ± 0.086) ram),and the difference was statistically significant (t =2.078,P =0.042).Conclusion Cognitive impairment in elderly NAFLD patients is closely related to iron load and liver fat.

Relationship study of blood serum visfatin and iron metabolism in newly diagnosed type 2 diabetes mellitus / 重庆医学

Objective To determine the concentration of blood serum visfatin and some iron metabolism‐related indicators:Ser‐um ferritin、hepcidin、serum transferring receptor(sTfR)level in newly diagnosed type 2 diabetes patients and explore the inter‐rela‐tionship between blood serum visfatin and iron metabolism .Methods Eighty‐five patients with newly diagnosed type 2 diabetes mellitus were selected and divided into 2 groups including 43 patients with normal weight (the normal weight of diabetic group , group B)and 42 obese patients (the obese diabetic group ,group D) .Meanwhile ,86 healthy examinees were selected and divided into 2 groups including 43 cases with normal weight (the control group ,group A)and 43 cases with obese (simple obesity group ,group C) .Serum visfatin ,ferritin ,hepcidin ,serum transferring receptor level and other clinical parameters of all groups were determined . Results Blood serum visfatin concentration was not found to be associated with ferritin ,hepcidin ,serum transferring receptor in all the groups(r=0 .111 ,P>0 .05) .Conclusion Blood serum visfatin may be not associated with ferritin ,hepcidin ,serum transferring receptor in newly diagnosed type 2 diabetes patients .

Serum Soluble Transferrin Receptor Concentration as a Biomarker of Erythropoietic Activity: Surrogate Marker of Adequate Transfusion in Adult Beta-Thalassaemia Intermedia Patients

Management of Beta (β)-thalassaemia intermedia in contrast to β-thalassaemia major patients has no clear guidelines as to indicators of adequate transfusion. Regular blood transfusion suppresses bone marrow erythropoietic activity. Serum soluble transferrin receptor (sTfR) concentration is a marker for erythropoietic activity, with increased sTfR being associated with functional iron defi ciency and increased erythropoietic activity. This study aimed to determine the use of sTfR as an indicator of adequate transfusion in adult β-thalassaemia intermedia patients. A cross-sectional study was conducted at Hospital Ampang, Malaysia, for six months. Patient group included six β-thalassaemia intermedia and 34 HbE-β-thalassaemia transfused patients. None of the patients were on regular monthly blood transfusions as in β-thalassaemia major. The control group comprised of 16 healthy subjects with normal haematological parameters. Haemoglobin (Hb) analysis, sTfR and ferritin assays were performed. Hb and HbA percentages (%) were found to be signifi cantly lower in patients compared to the controls, while HbE%, HbF%, sTfR and ferritin were signifi cantly higher in patients. An inverse relationship was found in the controls between HbF% with Hb (r = -0.515, p < 0.05) and HbA% (r = -0.534, p < 0.05). In patients, sTfR showed an inverse relationship with HbA% (r = -0.618, p = 0.000) and a positive correlation with HbE% (r = 0.418, p = 0.007) and HbF% (r = 0.469, p = 0.002). Multivariate analysis showed that HbA% (r = 2.875, p = 0.048), HbE% (r = 2.872, p = 0.020) and HbF% (r = 2.436, p = 0.013) best predicted sTfR independently in patients. Thus, sTfR is a useful marker for erythropoiesis. The elevated sTfR in these patients indicate that the transfusion regimen used was inadequate to suppress ineffective erythropoiesis. Hb levels may not be the best target for monitoring transfusion treatment in β-thalassaemia intermedia patients, but the use of sTfR is helpful in individualising transfusion regimens.

Receptores solubles de transferrina como mejor indicador bioquímico para definir deficiencia de hierro / Soluble transferrin receptors as best biochemical test for iron deficiency / Receptores solúveis de transferrina como o melhor indicador bioquímico para definir deficiência de ferro

Con el propósito de valorar el mejor análisis bioquímico como indicador del perfil de hierro en niños preescolares sin anemia se analizaron 149 muestras de niños y niñas con una edad promedio de 4 años de una comunidad urbana marginal y otra rural de Costa Rica a los que se les realizó análisis de hemoglobina, ferritina, receptores solubles de transferrina, protoporfirina eritrocitaria y proteína C reactiva. El 42% de las muestras presentaron un perfil de hierro dentro de los intervalos de referencia. Sin embargo, se detectó deficiencia de hierro en el 30,8% utilizando receptores solubles de transferrina, en un 14% utilizando la protoporfirina zinc eritrocitaria y en un 10% mediante la ferritina sérica. Además, el 16,8% de las muestras mostraron una elevación inespecífica de la ferritina debido a un proceso infeccioso o inflamatorio agudo y el 5% elevación de la protoporfirina zinc eritrocitaria. Se puede concluir que si se cuantifica únicamente ferritina sérica para evaluar perfil de hierro se estaría diagnosticando mal a una proporción importante de la población (16,8%). Si se considera únicamente la protoporfirina eritrocitaria aumentarían en un 19% las muestras deficientes en hierro pero con un 5% de falsas disminuciones. En cambio, si se evalúan los receptores solubles de transferrina se estaría detectando un número mayor de muestras, un 30,8% con perfil bajo de hierro. Por lo tanto, en la experiencia de estos autores resultó de mayor utilidad usar los receptores solubles de tranferrina como mejor indicador bioquímico para valorar perfil de hierro, ya que la ferritina y la protoporfirina eritrocítica son sensibles a los cambios circadianos y a la presencia de procesos agudos inespecíficos. Asimismo, de acuerdo a los datos obtenidos, no se consideró necesario utilizar intervalos de referencia según sexo y lugar de residencia en niños y niñas de 4 años ya que no hubo diferencia estadísticamente significativa entre sexo y zona urbana marginal y rural para ningún análisis estudiado.

With the aim to evaluate the best biochemical analysis of iron status in preschool children without anemia, a hundred and fortynine samples of boys and girls with an average age of 4 years from an urban marginal community and a rural área from Costa Rica hemoglobin, ferrítin, soluble receptors oí transferrin, erythrocyte protoporphyrln and C reactive proteln were analysed. Forty-two per cent oí the samples presented iron status between the reference interval. Nevertheless, iron deficiency was detected in 30.8% oí the cases using soluble transferrin receptor, 14% with erythrocyte protoporphyrln and 10% with serie ferrítin. In addition, 16.8% of the samples had an unspecified increase in ferrítin due to acute infectious or inflammatory process, and 5% of erythrocyte protoporphyrín. It can be concluded that if serum ferrítin is quantified solely to evalúate iron status, an ímportant portíon of the population (16.8%) would be wrongly díagnosed. If erythrocyte protoporphyrln was considered alone, it would increase the iron deficient samples by 19%, but with 5% of false reductions. However, evaluating the soluble receptors of transferrin we would be detecting a greater number of samples-30.8% with low iron status. In the experience of the authors, it was of major utility use to use the soluble receptors of tranferrin as better biochemical indicators to assess iron status, since ferrítin and erythrocyte protoporphyrln are sensible to circadian changes and to the presence of unspecific acute processes. Because of the data obtained, it was not considered necessary to use different reference valúes for sex or place of residence in four year-old boys and girís because there are no significant statistical differences between sex or resideney for any analysis studied.

Maternal serum iron-related parameters in severe preeclampsia / 대한산부인과학회지

OBJECTIVE: Based on the pathophysiology of preeclampsia and the hypothesis that the iron was a catalyzer of the oxidative stress and lipid peroxidation and that the ferritin and soluble transferrin receptors (sTfR) were the good iron status parameters, this study was performed to investigate the alteration of these parameters in preeclampsia. METHODS: Predelivery and 72 hour postpartum venous blood were collected from 12 healthy pregnant women and 20 pregnant women with severe preeclampsia at 34 week to 40 weeks of gestation. Serum ferritin, and sTfR were measured using the commercial kits, respectively. RESULTS: Predelivery serum ferritin concentration was significantly higher in patients with preeclampsia than in healthy pregnant women (p=0.01). Predelivery serum sTfR concentration in patients with preeclmapsia was not significantly different from that in healthy pregnant women (p=0.22). Postdelivery serum ferritin concentration was significantly higher in preeclamptic patients than in healthy pregnant women (p=0.04). Postdelivery serum sTfR concentration was significantly lower in preeclamptic patients than in healthy pregnant women (p=0.02). There was a significant negative correlation between postdelivery serum ferritin concentration and sTfR concentration in all subjects including healthy and preeclamptic patients (r=-0.37, p=0.04). CONCLUSION: The serum ferritin was the best sensitive marker of the iron status parameters reflecting the preeclampsia. And the result may support the role of iron as a catalyzer of oxidative stress and lipid peroxidation in preeclampsia pathophysiology.

The Significance of sTfR and Tf in Serum in Diagnosing Children of Acute Infection with Iron Deficiency / 医学研究杂志

Objective To explore the changes of sTfR and Tf in serum in children of acute infection with iron deficiency,and their significance in diagnosing. Methods To detect the level of sTfR, Tf and SF in serum by velocity scatter immune turbidimetry, volunteers were divided into groups as IDAI before and after treatment,IDA and the healthy controlled.While iron in bone marrow was observed by iron staining. Results The sTfR and Tf levels in serum in IDAI and IDA groups were significantly higher than that in the controlled group(P0.05).After the treatment,Hb in IDAI group,though was still abnormal comparing with the controlled group(P0.05) .Conclusions sTfR and Tf in serum were specific and sensitive in diagnosing the iron deficiency, and the results would not change if infected.So they are reliable indexes in diagnosing iron deficiency and monitoring the treating effect in the children of anemia with infection.Therefore the two indexes should be higher valued than SF or Iron in the bone marrow.

Anemia of Chronic Disease

Although anemia of chronic disease (ACD) is the most prevalent form of anemia next to iron deficiency anemia, its significance has been overridden by the dominant manifestation of the underlying diseases, i.e. chronic inflammation, infection, organ failure, or malignancy. As the treatment of ACD is being recognized to be important for the restoration of life quality, clinicians should be aware of how to detect, how to discriminate, and how to treat the disease. The key pathophysiology of ACD lies on the trapping of iron in the reticuloendothelial system by pro-inflammatory cytokines. The best treatment of ACD is the treatment of underlying disease per se, which is unfeasible in a substantial portion of the cases. Blood transfusion is occasionally harmful without altering the natural course of underlying disease. The benefit of erythropoietin (EPO) was already established in chronic renal disease. EPO has emerged as an important palliative measure for anemia in a variety of cancers. Augmented supplement of EPO may overcome the blunted response to physiologic EPO in anemia secondary to chronic infection or inflammation. Functional or absolute iron deficiency in ACD is manageable using EPO in conjunction with parenteral iron supplement. The iron deficiency in ACD can be identified by low ferritin value (2). Further studies are required for the elucidation of molecular pathogenesis, more accurate diagnosis and new treatment to mobilize trapped iron into active erythropoiesis. The judicious use of therapeutic options currently available can result in palliation of ACD in a majority of the patients, and every single clinician should be fully aware of the principles behind the palliative measures.

Utilidad de la ferritina sérica para evaluar depósitos de hierro maternos en el post parto inmediato / Usefulness of serum ferritin to assess maternal iron stores in the early postpartum period

La ferritina sérica (FS), indicadora de depósitos de hierro (Fe), es cuestionable en el puerperio, mientras que el receptor soluble de transferrina (RsT) parecería más confiable. Por ello, se estudió la FS en las 24 h post parto en 88 mujeres atendidas en el Hospital Diego Paroissien. Se determinó: Hematocrito (Hto), Hemoglobina (Hb), recuento de glóbulos rojos (GR) y blancos (GB); en suero: RsT, FS y Proteína C-Reactiva. Se analizó sensibilidad y especificidad de FS mediante el modelo del operador-receptor (ROC), considerando al RsT como "estándar de oro". Los valores (media ± DE y rangos) fueron: Hto (%) 35 ± 5 (22 - 47); Hb (g/L) 112 ± 17 (61 - 150); GR x 103/mm3 3.843 ± 530 (2.500 - 5.300); GB/mm3 9.644 ± 2.599 (5.300 - 21.000); RsT (mg/L) 4,93 ± 2,93 (0,54 - 14,77); FS (µg/L) 33 ± 39 (0 - 210); PCR (+) en 92,4% de los casos. FS evidenció un área bajo la curva de 0,795 con elevada sensibilidad (83%) y especificidad de 63% para un punto de corte de 25 µg/L. Además, FS correlacionó con RsT (r = -0,436) y con el cociente RsT/FS (r = -0,919). Estos resultados sugieren que FS sería de utilidad en el post parto inmediato, siendo aconsejable utilizar el punto de corte de 25 µg/L.

Serum ferritin (SF) may not be a reliable indicator of iron (Fe) stores during the puerperium. Therefore, it was compared to the soluble transferrin receptor (sTfR) in 24 h post partum women (n = 88), assisted at Diego Paroissien Hospital (Buenos Aires, Argentina). Hematocrit (Hct), hemoglobin (Hb), red blood cells (RBC) and white blood cells (WBC) were determined in fasting blood samples using an electronic counter (Mega); SF by ELISA (IMx Ferritina, Abbott); sTfR by ELISA (Orion Diagnostica) and C-Reactive Protein (PCR-Latex, Wiener lab). Statistical analysis (Receiver Operating Characteristics, ROC) were performed using the sTfR as "gold standard". Results: (mean ± SD) (range): Hct (%) 35 + 5 (22 - 47); Hb (g/L) 112 ± 17 (61 - 150); RBC x 103/mm3 3843 ± 530 (2500-5300); WBC/mm3 9644±2599 (5300 -21000); sTfR (mg/L) 4.93 ± 2.93 (0.54 - 14.77); SF(µg/L) 33 ± 39 (0 - 210); PCR (+) in 92.4%. Sensitivity and specificity of SF were, respectively: 83% and 63% for a cut-off point of 25 µg /L (area under ROC plot 0.795, 95% reference interval: 0.694 - 0.897). SF correlated inversely with sTfR (r = -0.436) and with the sTfR/SF ratio (r = -0.919). These results suggest that SF may be a useful indicator of maternal Fe stores during the early perinatal period, although its cost may limit rutinary laboratory use.

Diagnostic Availability of the Soluble Transferrin Receptor in Old Patients with Iron Deficiency Anemia and Anemia of Chronic Renal Failure / 대한진단검사의학회지

BACKGROUND: The diagnostic efficiency of soluble transferrin receptor (sTfR) was investigated to detect iron deficiency among old patients with iron deficiency anemia (IDA) and anemia of chronic renal failure (CRF). METHODS: Twenty five patients with uncomplicated IDA [mean corpuscular volume (MCV) or =23.8 g/L, group II, n=5 ; MCV > or =80 fL, ferritin or =80 fL, ferritin > or =23.8 g/L, group IV], and 20 normal controls were included in the study. The levels of sTfR, hemoglobin (Hb), MCV, serum ferritin, serum iron (Fe), total iron binding capacity (TIBC), c-reactive protein (CRP) and calculated transferrin saturation (% sat) of each group were compared. The correlations between iron parameters and the sTfR levels were investigated in each group. RESULTS: The mean values of sTfR were significantly higher in group I (5.3+/-3.5 mg/L), group II, (2.6+/-1.1 mg/L) and group III (2.0+/-0.9 mg/L) than in normal controls (1.2+/-0.3 mg/L) and group IV (1.2+/-0.7 mg/L). The proportion of patients with sTfR level higher than the upper normal limit (1.74 mg/L) was 37.4% (100% of group I, 80% of group II, 56% of group III, and 13% of group IV), and that with ferritin level lower than 23.8 g/L was 31.3% (41/131). The proportion of patients with normal sTfR and decreased ferritin was 5.3% (7/131) and that with normal ferritin and increased sTfR was 11.5% (15/131) A good correlation (r>0.800) was observed between Fe and % sat in all patients, microcytic anemic patients, and patients with anemia of CRF; between ferritin and CRP in microcytic anemia patients (r=0.800); and between serum iron and MCV in all patients (r=0.615). A good inverse correlation was observed between ferritin and TIBC (r=-0.649) and between CRP and TIBC (r=-0.614) in microcytic anemic patients only. CONCLUSIONS: Because the sTfR level was significantly higher in microcytic anemic patients and anemic patients with a relatively low ferritin than in anemic patients of CRF and normal controls, especially in more advanced IDA, and because the sTfR detected more IDA patients than ferritin did, thesTfR is the most useful marker expressing functional iron deficiency without being affected by CRP.

Comparison between Soluble Transferrin Receptor, Serum Ferritin and Trans-ferrin Saturation in Chronic Renal Failure Patients / 대한진단검사의학회지

BACKGROUND: In chronic renal failure (CRF) patients, iron deficiency is a common problem and a primary cause of resistance to recombinant human erythropoietin (rHuEPO) therapy. Serum ferritin and transferrin saturation (TS) are most commonly used parameters of iron status in CRF patients but may be influenced by the presence of inflammation and malnutrition. Recently soluble transfer-rin receptor (sTfR) has been advocated as a useful parameter of iron deficiency. We evaluated sTfR as an iron deficient marker in CRF patients. METHODS: Included in this study were 73 CRF patients, 30 uncomplicated iron deficiency anemia (IDA) patients, and 55 normal control. Serum sTfR, serum ferritin, TS, and complete blood count were measured. The CRF patients were classified as absolute iron deficient, functional iron deficient, non-iron deficient, and iron overload groups according to National Kidney Foundation Kidney Disease and Dialysis Outcome Quality Initiative (NKF-K/DOQI) guideline. RESULTS: The sTfR concentrations were significantly higher in uncomplicated IDA patients (3.9 +/-1.5 mg/L) and significantly lower in CRF patients (1.1 +/-0.4 mg/L) than in normal controls (1.4 +/-0.4mg/L). In uncomplicated IDA patients, sTfR was inversely correlated with MCV, MCH, and MCHC. In CRF patients, sTfR had a weak inverse correlation with TS and MCHC, but not significantly different between the four groups. The sTfR was not significantly different between the CRF patients with the normal CRP and those with an increased CRP. CONCLUSIONS: The sTfR is useful for diagnosis of uncomplicated IDA, but not for the detection of iron deficiency in CRF patients. Further studies are needed for the evaluation of sTfR as an erythro-poietic marker with rHuEPO therapy.

Iron Parameters and Soluble Transferrin Receptor in Neonates

PURPOSE: Serum soluble transferrin receptor (sTfR) is a marker of iron deficiency and erythropoiesis. The purpose of this study is to evaluate the changes of iron parameters and sTfR in neonates by gestation; and to determine whether cord blood parameters for iron status and erythropoiesis are influenced by maternal iron deficiency or anemia. METHODS: Cord sTfR, iron and ferritin concentrations, hemoglobin (Hb), reticulocyte counts and total iron binding capacity were analyzed in 20 preterm and 60 term newborns. In term neonates, maternal iron status was classified by Hb and serum ferritin as anemic group (n=18; Hb or = 11 g/dl and ferritin < 12 microgram/l) and control (n=21, non anemic and non iron deficient). RESULTS: 1) Cord serum iron of preterm neonates was significantly lower than that of fullterm and the reticulocytes were significantly higher in preterm neonates. 2) The concentrations of cord serum iron were correlated positively with the gestational age, but other iron parameters and sTfR concentrations were not related to gestational age. The sTfR concentrations were correlated positively with cord blood hemoglobin. 3) Cord sTfR concentrations were significantly lower in newborns of anemic group compared with those of non-anemic group (P=0.03), or control (P=0.02). CONCLUSION: Cord sTfR was influenced by maternal iron deficiency aenmia, but not by maternal iron deficiency alone. Since sTfR reflects fetal erythropoietic activity, we speculate that low sTfR in newborns of iron deficiency anemic mother could suggest decreased fetal erythropoiesis by maternal anemia caused by iron depletion.

Diagnostic availability of the soluble transferrin receptor in iron deficiency anemia and anemia of chronic disease / 대한임상병리학회지

BACKGROUND: In diagnoses of iron deficiency anemia(IDA) and anemia of chronic disease(ACD), bone marrow examinations, the gold standard, are too invasive. Iron parameters such as serum ferritin, iron, and total iron binding capacity(TIBC), may be altered by perturbations as varied as infection, inflammation, and malignancy. Clinically, IDA may be the initial manifestation of an occult carcinoma of the gastrointestinal tract, thus noninvasive methods with high sensitivity are now required in detecting tissue iron deficiency. In this study, we investigated the diagnostic availability of the soluble transferrin receptor(sTfR) in differential diagnosis of IDA and ACD. SUBJECTS AND METHODS: Thirty eight patients with uncomplicated IDA(ferritin or =60.0 microgram/L), 7 patients with combined anemia(IDA+ACD, 12.0 microgram/L< OR = ferritin <60.0 microgram/L), and 20 normal controls were included in the study. The blood levels of sTfR, hemoglobin(Hb), RBC indices, serum ferritin, serum iron, and TIBC were measured and the transferrin saturation was calculated. The sTfR levels were compared with each other group. The correlations between iron parameters and the sTfR levels were investigated in each group. RESULTS: The sTfR receptor levels were significantly higher in uncomplicated IDA patients(56.2+/-19.8 nmol/L) than in normal controls(17.9+/-3.9 nmol/L) and uncomplicated ACD patients(15.3+/-7.5 nmol/L). No difference of the sTfR concentrations was observed between ACD patients and normal controls. In combined group, four of the 7 cases showed higher sTfR values than that of normal controls. Good inverse correlation was observed between Hb and sTfR levels in uncomplicated IDA group. There were no correlations between iron parameters and sTfR levels in the other groups. CONCLUSION: Because the sTfR level was not elevated in ACD and was significantly higher in IDA, blood determination of the sTfR levels may be a useful method in differential diagnosis of IDA and ACD. The sTfR is the most useful marker expressing the functional iron deficiency without being affected by chronic diseases. Because the sTfR levels were inversely correlated with Hb in IDA patients, the combined use of two parameters, ferritin and sTfR which are the indices of storage iron and functional iron respectively, may allow accurate definition of the entire range of body iron status.

Diagnostic Availability of the Soluble Transferrin Receptor in RA Patients / 대한임상병리학회지

BACKGROUND: The transferrin receptor (TfR) is expressed on almost all cellular surfaces and is shedded into the blood to form the soluble transferrin receptor (sTfR). The sTfR has been known to be a good marker to reflect cellular iron status and to differentiate between iron deficiency anemia (IDA) and anemia of chronic disease (ACD) without the need for a bone marrow aspiration in rheumatoid arthritis (RA) patients. So we aimed to evaluate the diagnostic availability of sTfR in patients with RA and degenerative joint disease (DJD). METHODS: Eighty-seven outpatients visiting the Department of Rheumatology at HYUH were studied and divided into anemic and non-anemic groups according to their Hb levels (female< 12 g/dL, male< 14 g/dL). The sTfR was measured by ELISA method (Quantikine IVDTM, R&D system). To differentiate whether the anemia was due to iron deficiency or other causes, we used the RBC parameters and a discriminant index which was calculated from serum iron, ferritin and TIBC instead of a bone marrow aspiration, an invasive procedure of which interpretation can be subjective. RESULTS: The median was higher (31.09 nM) than the normal reference values (9-28 nM) only in the anemic group of RA. The medians were within normal limit in all the other groups. sTfR levels were high in 15 of the 28 RA anemic patients which were composed of 10 patients with IDA, 4 with non-anemic RA and 1 with non-anemic RA & DJD. CONCLUSIONS: In the present study, sTfR was increased not only in IDA but also in ACD of RA patients and also in non-anemic patients, which showed that sTfR cannot be used to differentiate these two types of anemia by itself and the further tests are needed. We conclude that the expression of TfR in RA patients was dependent not only on iron deficiency but also on the disease itself.