¿Puede usarse el receptor soluble de transferrina para diagnosticar anemia ferropénica y evaluar la respuesta al hierro en lactantes con desnutrición aguda moderada? / Can soluble transferrin receptor be used in diagnosing iron deficiency anemia and assessing iron response in infants with moderate acute malnutrition?

Objetivo. Evaluar la eficacia del receptor soluble de transferrina (RST) en el diagnóstico de la anemia ferropénica (AF) y en la evaluación de la respuesta al hierro en los lactantes con desnutrición aguda moderada (DAM). Población y métodos. Se reclutó a lactantes con valores de hemoglobina (Hb) inferiores a los valores umbrales de anemia para su edad y con anemia hipocrómica/microcítica observada en el frotis de sangre periférica. La DAM se definió como un puntaje Z de peso/estatura de entre < -2 y -3. Se compararon los valores del hemograma, los parámetros férricos y el RST entre 41 lactantes con DAM y anemia (grupo DA), 32 lactantes con anemia sin DAM (grupo A) y controles saludables (n= 30). Una vez completado el tratamiento de la anemia y la desnutrición, se repitieron las evaluaciones. Resultados. Además de los índices hematológicos compatibles con AF, los valores de hierro sérico (Fe) y saturación de transferrina (ST) eran significativamente menores, mientras que el valor de transferrina era significativamente mayor en los grupos DA y A en comparación con los controles (p < 0,001). Los valores de ferritina y proteína C-reactiva (PCR) eran significativamente más elevados en el grupo DA (p < 0,05 para la ferritina, p < 0,01 para la PCR). El valor medio del RST fue similar en ambos grupos (DA y A) (p > 0,05) y significativamente mayor que en los controles (p < 0,001). Después del tratamiento con hierro, el RST disminuyó en los grupos DA y A (p < 0,001) a valores similares a los observados en los controles. El RST se correlacionó negativamente con la Hb durante todo el estudio (grupo DA: r= -0,350, p < 0,05; grupo A: r= -0,683, p < 0,01). Conclusiones. Dado que los valores del RST en los grupos DA y A disminuyeron después del tratamiento con hierro, consideramos que este parámetro no estuvo afectado por la DAM ni la inflamación y puede usarse, por sí solo, para detectar la AF y supervisar la respuesta al tratamiento en los lactantes con DAM.

Objective. To evaluate the efficacy of soluble transferrin receptor (sTfR) in diagnosing iron deficiency anemia (IDA) and evaluating iron response in infants with moderate acute malnutrition (MAM). Population and methods. Infants withhemoglobin (Hb) levels lower than threshold values for anemia for their ages and hypochromic/ microcytic anemia on peripheral smear were recruited. MAM was defined as weight/height z score < -2 to -3. Complete blood count (CBC), iron parameters and sTfR were compared among 41 infants with MAM and anemia (MA group), 32 infants with anemia without MAM (group A), and healthy controls (n= 30). Following anemia and malnutrition treatment, tests were repeated. Results. Besides hematological indices compatible with IDA, serum iron (Fe) and transferrin saturation (TS) were significantly lower, while transferrin was significantly higher in MA and A groups compared to controls (p <0.001). Ferritin and C-reactive protein (CRP) were significantly higher in MA group (p <0.05 ferritin, p <0.01 for CRP). Mean sTfR was similar in both MA and A groups (p >0.05) and significantly higher than controls (p <0.001). Following iron treatment, sTfR decreased inboth MA and A groups (p <0.001) to similar values as controls. sTfR was negatively correlated to Hb throughout the study (for MA group, r= -0.350, p <0.05; for A group, r= -0.683, p <0.01). Conclusions. As sTfR values in both MA and A groups decreased following iron treatment, we believe that this parameter was not influenced by MAM or inflammation; and it alone can be used to detect IDA and monitor treatment response in infants with MAM.

Study of serum soluble transferrin receptors and Reticulocyte Hemoglobin content in patients with Juvenile Rheumatoid Arthritis

Objectives: The present study was conducted to evaluate the levels of serum soluble transferrin receptors [sTfR] and reticulocyte hemoglobin content [CHr] in patients with juvenile idiopathic arthritis [JIA] attending the pediatric rheumatology outpatient clinic of Alexandria University Children's Hospital [AUCH]

Study design: Forty three JIA patients whose age ranged from 3 to 16 years were enrolled in the study as well as 20 healthy children of matched age and sex as a control group. Complete blood count with CHr, iron profile, acute phase response parameters and sTfR levels were done in all patients and controls

Results: From the total 43 patients with JIA, 22 patients [51.2%] were anemic and 21 [48.8%] were non anemic. Hemoglobin level had negative correlation with illness duration in the anemic group [p=0.007]. No significant difference was found between these 2 groups as regards to any of the medications taken, The anemic group had significantly higher levels of CBC parameters of inflammation, acute phase response parameters and disease activity score than the non-anemic group [p=<0.001]. In the non-anemic group, these parameters showed no significant difference from the controls. Anemic group had significantly higher ferritin level and sTfR. than the non anemic and the controls [p.0.001]. CHr was significantly lower in anemic group than the other 2 groups [p=0.001]

Conclusion: Anemia in JIA is associated with high levels of ferritin and sTfR. with lower CHr. Serum ferritin, being an acute phase reactant, is not reliable in diagnosing anemia in case of chronic disease necessitating the use of other markers as: sTfR. and CHr

Soluble transferrin receptors in Malaria

To determine the concentration of soluble transferrin receptors [sTfR] in patients with malaria. Cross-sectional, analytical study. Baqai Institute of Haematology, Baqai Medical University, Karachi, from December 2009 to April 2010. Twenty samples from normal male and female subjects each were drawn for establishing the reference range while 38 from patients with malaria [with or without anaemia] sTfR centration was determined. Descriptive statistics were used for data analysis. Out of 38 patients, 4 had iron deficiency anaemia while 34 patients were without anaemia. Mean sTfR level in the control group was 33.53 +/- 4.38 nmol/l. In patients with malaria without iron deficiency anaemia, mean sTfR concentration was 30.84 +/- 5.40 nmol/l. Patients with malaria and concomitant iron deficiency anaemia had mean sTfR level of 101.67 +/- 11.69 nmol/l. Comparison of sTfR in normal subjects and in patients with malaria showed no statistically significant difference [p = 0.208]. Statistically significant difference [p < 0.001] was observed in patients with malaria and concomitant IDA as compared to normal control group. Malaria without concomitant iron deficiency anaemia had near normal sTfR levels. While those with concomitant iron deficiency anaemia had significant higher level of sTfR. This concludes that these receptors are not affected in malaria alone

Evaluation of serum transferrin receptor and sTfR ferritin indices in diagnosing and differentiating iron deficiency anemia from anemia of chronic disease.

Objective. The present study was conducted to assess the utility of serum transferrin receptor (sTfR) and sTfR ferritin indices to differentiate ACD from IDA and also to diagnose coexisting IDA and ACD. Methods. The study group comprised of 30 IDA patients, 30 cases of ACD and 30 age and sex matched controls. Complete hemogram with peripheral smear examination, markers of ACD, iron profile including serum ferritin and serum transferrin receptor levels were done in all patients and controls. Serum TfR and ferritin indices were calculated. Results. sTfR levels were significantly higher in the IDA group compared to ACD group (p<0.001). ACD group was further subdivided into two groups on the basis of sTfR levels (B1<3 μg/ml and B2 ≥ μg/ml), suggesting coexisting IDA in group B2. sTfR/log ferritin index was > 1.5 in all cases of IDA and ACD with coexisting IDA while all pure ACD cases and control subjects had sTfR/log ferritin index < 1.5. All case in IDA group had log sTfR/serum ferritin index > 2.55 and all patients with ACD with or without associated iron deficiency had log sTfR/serum ferritin ratio < 2.55. Conclusion. The sTfR levels along with the above mentioned indices can be very useful in differentiating pure IDA, ACD and ACD with coexisting iron deficiency, thus providing a noninvasive alternative to bone marrow iron.

Comparison of iron stores in healthy individuals and patients with ischemic heart disease

Excess body iron has been linked to atherosclerosis owing to its pro-oxidative properties. However, inconsistent results have emerged from the epidemiological studies linking iron status and the risk of cardiovascular diseases [CVD]. Objective of the present study is to compare iron stores of healthy individuals and patients with ischaemic heart disease [IHD]. A total of 137 subjects were included in the study, 90 patients of IHD and 47 healthy subjects with no history of IHD as controls. We compared body iron stores of patients and controls. Serum ferritin, serum transferrin receptor [sTfR] and sTfR/ferritin ratio were used as measures of body iron stores. Our results revealed that mean serum ferritin concentration of cases was significantly higher than controls. Moreover, mean sTfR and sTfR/ferritin ratio of controls was significantly higher than the patients. We conclude from our results that IHD patients have higher iron stores than healthy subjects suggesting a possible association between high iron stores and the risk of IHD

Serum transferrin receptor-ferritin index shows concomitant iron deficiency anemia and anemia of chronic disease is common in patients with rheumatoid arthritis in north India.

Anemia is a frequent cause of morbidity in patients with rheumatoid arthritis (RA). We studied the prevalence of anemia of chronic disorders (ACD) and ACD with coexistent iron deficiency anemia (IDA) in patients with RA using sTfR/log ferritin ratio (sTfR - F index). Complete blood counts, percent transferrin saturation, serum ferritin, sTfR, sTfR-F index measurements were carried out in 100 anemic RA patients. Twenty-five IDA subjects without any other illness and 25 age- and sex-matched normal controls were studied. Prevalence of anemia in RA patients was 50.5%. Patients with sTfR-F index value < 1.5 were classified as pure ACD and patients with sTfR-F index value> 1.5 were classified as ACD with coexistent IDA. Using these criteria, 20% patients were found to have pure ACD and 80% patients had coexistent ACD and IDA. In the normal control group, sTfR-F index was found to be 0.16-1.8. We found that sTfR-F index can clearly distinguish IDA control cases and normal subjects with no overlap in the range of sTfR-F index.

Circulating soluble transferrin receptor and ferritin in polycystic ovary syndrome

The aim of this study was to determine serum ferritin and soluble transferrin receptor [sTfR] concentrations in poiycystic ovary syndrome [PCOS] women and to clarify their relationship to insulin resistance and metabolic features of PCOS. This cross-sectional study consisted of 20 obese patients with PCOS, 15 obese, normally menstruating, age and BMI matched women, and 10 healthy, age matched, lean women as control groups. Serum ferritin and soluble transferrin receptor levels were measured using an enzyme-linked immunosorbent assay. Additionally, participants were subjected to hormonal assays, lipid profile, fasting glucose, iron, total iron binding capacity and serum insulin levels as well as transvaginal ultrasonography. The homeostasis model assessment of insulin resistance [HOMA-IR], Free Androgen Index [FAI], Body mass index [BMI] and Waist to hip ratio [WHR] were also calculated for each participant. Serum ferritin level was significantly higher in obese PCOS patients compared to both obese and lean control subjects Also, serum ferritin level was significantly higher in obese compared to lean control subjects. On the other hand, serum sTfR level was significantly lower in obese PCOS patients compared to both obese and lean subjects. While, no significant difference was observed between obese and lean subjects as regard sTfR level, the fasting insulin level and HOMA-IR were significantly higher in obese PCOS patients compared to both obese and lean control subjects. In addition, obese subjects had significantly higher fasting insulin level and HOMA-IR compared to lean control subjects. Serum ferritin levels showed a significant inverse correlation with soluble transferrin receptor level in all of the studied groups. Obese PCOS women have lower soluble transferrin receptor levels compared to obese and normal controls. sTfR is highly correlated with ferritin. Furthermore, sTfR could serve as a sensitive marker for iron overload in obese, PCOS patients, or metabolic syndrome

Change of serum transferrin receptor due to malarial infection, an experiment in Plasmodium gallinaceum infected chicken model.

BACKGROUND & OBJECTIVES: The serum transferrin receptor (sTfR) concentration in an individual reflects the extent of erythropoietic activity and is considered as an useful marker of iron deficiency independent of concurrent inflammation or infection. However, data on the impact of malaria on this parameter are ambiguous. METHODS: Here we performed an animal experiment to study the chronological change of serum transferrin receptor due to infection of Plasmodium gallinaceum. In this pilot study, we performed control experimental infection of P. gallinaceum to four newborn chicken from the same batch. We collected the venous blood samples from all chicken on Day 7 and 14. All samples were analysed for sTfR level by the immunoturbidimetric assay. RESULTS: The average level of sTfR level of the control chicken was 1.24 +/- 1.58 mg/L (range 0.18 to 3.52 mg/L). The average level of sTfR level of the experimental chicken on Day 7 was 5.42 +/- 2.19 mg/L (range 3.22 to13.94 mg/L). CONCLUSION: Although the trend of increase was observed but no significance was observed (p > 0.05). The results from this pilot study can be a good basic data for the further study in this area.

Las disferritinemias, algoritmo de orientación diagnóstica / The disferritinemias, diagnostic orientation algorithm

Las disferritinemias se observan frecuentemente en el laboratorio de análisis clínicos. Se describen los principales exámenes etiológicos. La hipoferritinemia esencialmente manifista una carencia marcial. En la práctica habitual, la hiperferritinemia puede ser de origen inflamatorio, citolítico (cánceres, síndrome metabólico, hepatopatías, hemólisis) o poner de manifiesto sobrecargas de hierro secundarias o primarias (tranfusiones, anomalías de la hemoglobina, hemocromatosis).

Role of serum transferrin receptor and transferrin/ ferritin index in differentiation between true and functional iron deficincy anemia in rheumatiod arthritis

Anemia is the most common extraarticular manifestations of rheumatoid arthritis [RA] in which, differentiating iron deficiency anemia from anemia of chronic disease may be difficult because of similarities in presentation. The study was performed to elucidate the use of serum transferrin receptor [sT f R] and s T f R / log ferritin as non-invasive laboratory indices to distinguish between iron deficiency anemia [IDA] and anemia of chronic disease [ACD]. Also, to establish a method to identify functional iron deficiency in RA patients with anemia. The study compromised 30 RA patients with anemia diagnosed according to American Collage of Rheumatology Revised Criteria for diagnosis of RA. The patients were divided into two groups after bone marrow aspiration and staining for iron [Group [I], including 17 patients with normal iron store [ACD]; Group [II], including 13 patients with depletion iron store [IDA]]. All patients were subjected to the following investigations: [CBCs and RBCs indices, ESR, CRP, rheumatoid factor and iron status study]. RBCs study showed a significant difference between two groups as regards; HB, [p<0.05]; PCV, [p<0.05] and RDW, [p<0.01], but no significant differences between two groups were found as regards; MCH, MCHC, serum iron and serum ferritin. Our results demonstrated a significant differences between two groups as regard to total iron binding capacity [TIBC], [p<0.01]; sT f R, [p<0.01]; sTfR / ferritin index, [p<0.01] and highly significant in sTfR / log ferritin index, [p<0.001]. s T f R could be introduced as a new tool for diagnosis of iron depletion, also sTfR/log ferritin index along with TIBC alone or TIBC and RDW have much more value in differentiation between IDA and ACD in RA patients

Evaluation of serum transferrin recceptor concentration in diagnosing and differentiating Iron deficiency anaemia from anaemia of chronic disorders

To diagnose and differentiate iron deficiency anaemia [IDA] from anaemia of chronic disorders [ACD] using serum concentration of soluble transferrin receptors [sTfR]. One hundred and seventy six adult anaemic patients were diagnosed on bone marrow examination as IDA and ACD in the Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi from November 2001 to May 2003. They were further evaluated with sTfR, serum iron, total iron binding capacity [TIBC] and serum ferritin. These biochemical investigations were compared with results of bone marrow iron status, which served as gold standard. Absence of stainable iron in the bone marrow was diagnostic of iron deficiency, whereas abundance of iron along with decreased siderocytes and sideroblasts was considered diagnostic of ACD. Data was collected on a proforma and analysed using software SPSS [version 11.0] and t-test was used to test the statistical significance. Specificity, sensitivity positive and negative predictive value of the sTfR test was calculated. Out of 176 patients studied, 90 [51.1%] were diagnosed as ACD whereas 86 [48.8%] as IDA. The mean + SD sTfR levels in IDA patients was 9.68 + 2.48 mg/l, whereas mean + SD sTfR levels in ACD patients was 2.96 + 1.28 mg/l, thus clearly separating the two categories of anaemic patients. Both the sensitivity and specificity of sTfR in IDA was found to be 100%, whereas in ACD, these were 66.6% and 100% respectively. The positive and negative predictive value, in case of IDA was 100%, whereas in ACD it was 100% and 74.1% respectively. The results of serum iron, TIBC and serum ferritin correlated well in IDA, with a fall in serum iron, raised TIBC and decreased serum ferritin, except in few cases in which concomitant inflammatory conditions resulted in falsely high serum ferritin level. Serum iron and TIBC were not useful in cases of ACD. However, the serum ferritin cutoff level of 90 ng/ml was evaluated which virtually excludes IDA, and found this highly effective in cases of IDA alongwith chronic inflammatory conditions. The results show that in case of simple IDA, sTfR concentration is significantly raised and it has a very high test efficiency in this condition. However in case of ACD the positive predictive value is high [100%] but the negative predictive value is compromised [74.1%]. It is therefore a reliable laboratory index of IDA and in distinguishing IDA from ACD

Frequency and biochemical expression of hemochromatosis [HFE] gene mutations in 1029 blood donors in Iran

There are no data on the frequency and biochemical expression of the hemochromatosis associated mutations, C282Y and H63D, in Iranian adult population. This is the first study among Iranians that may advocate a screening program. We investigated the frequency of the C282Y/H63D HFE gene mutations in a group of 1029 randomly selected Iranian blood donors as well as transferrin saturation [TS], serum iron and serum ferritin levels. DNA extraction with salting-out method was performed on blood samples and the analysis of HFE gene mutations was performed by PCR amplification followed by digestion with RsaI and BclI restriction enzymes. The mean age of donors was 40 +/- 11 years and 92.7% were male. No homozygosity was detected for the C282Y mutation. Heterozygosity for the C282Y mutation was 0.2%, while homozygosity and heterozygosity for the H63D mutation were 1.6% and 19.6%, respectively. There was no compound heterozygote for the C282Y/H63D mutation. These data resulted in allele frequencies of 0.1% and 11.3% for C282Y and H63D mutations, respectively. Serum iron and TS were not influenced by the type of C282Y and H63D mutation. There was no difference in ferritin levels according to type of HFE mutations among blood donors. This study shows low allele frequency for C282Y and H63D mutations in Iran. These results also suggest that there is not any association between HFE gene mutations and iron, TS and ferritin level among Iranian population. The genetic screening for the HFE gene mutation in Iran is not recommended until the true prevalence of other mutations in all hemochromatosis genes could be established

Factors associated with iron deficiency anemia in Brazilian preschool children

OBJETIVO: Avaliar fatores determinantes de anemia e deficiência de ferro em crianças de duas creches da cidade de Pontal, sudeste do Brasil. MÉTODOS: Estudo transversal foi realizado avaliando-se 192 crianças com idades entre 12 e 72 meses. Dados pessoais (idade, sexo, uso de ferro medicamentoso, duração do aleitamento materno, tipo de parto, cuidados pré-natais, peso e estatura) e dados socioeconômicos (número de co-habitantes, escolaridade dos pais e renda per capita familiar) foram obtidos e correlacionados com hemoglobina, receptores de transferrina, ferritina e anemia ferropriva. RESULTADOS: A idade foi a variável mais afetada pelo estado nutricional de ferro, correlacionando-se com maiores valores de hemoglobina e ferritina e menores valores de receptor de transferrina, sendo que menos anemia ferropriva foi detectada quanto maior a idade. As outras variáveis estudadas não apresentaram correlação com o estado nutricional de ferro. CONCLUSAO: Os dados sugerem que as estratégias de controle para essa população de crianças pré-escolares devem ser direcionadas especialmente para aquelas de menor idade.

Utilidad en el post parto de la determinacion de protoporfirina eritrocitaria y su relacion con el receptor soluble de transferrina / Usefulness of erythrocyte protoporphyrin test in the puerperium compared to the soluble transferrin receptor

Se estudió, en 77 puérperas, la relación entre la protoporfirina eritrocitaria (PE), la ferritina sérica(FS) el receptor soluble de transferrina (RsT) y los indicadores hematológicos utilizados en la rutina clínica. En sangre venosa se determinó: Hematocrito (Hto), Hemoglobina (Hb), recuento de glóbulos rojos (GR) yglóbulos blancos (GB) (contador electrónico MEGA); PE (Piomelli); en suero: Rst (ELISA, Orion Diagnostica), FS (ELISA, IMx Ferritina, Abbott) y Proteína C-Reactiva (PCR-Látex, Wiener lab.) Se analizaron sensibilidad (S), especificidad (E) y puntos de corte medienate el modelo ROC (Receiver Operating Characteristics), considerando como gold standard el RsT. Los resultados (media mayor o menor DE) fueron: Hto (%) 35 mayor o menor; Hb (g/l) 113 mayor o menor 18; GRx10 103/mm3 3,893 mayor o menor 489; VCM (fL) 90 mayor o menor 6; GB/mm3 9,543 mayor o menor 2,669; PE (microg/dl GR) 46 mayor o menor 39; RsT (mg/l) 4.7 mayor o menor 2.8; FS (microg/l) 26 mayor o menor 31; PCR (Pos/Neg) 72/5. La PE no correlacionó con FS, pero sí con el RsT (r=0.323, p=0.007). La S y E de la FS fueron de 83% y 63 %, respectivamente, para un punto de corte de 25 (microg/l); para la PE la S fue de 38% y la E de 90% para un punto de corte de 53 (microg/l) GR. Estos resultados sugieren que ese punto de corte en el puerperio, permitiría detectar con un bajo costo un mayor porcentaje de mujeres (16% en nuestro estudio) que presentan deficiencia de Fe pese a sus valores normales de hemoglobina.

Contribution of iron deficiency to anemia in chronic renal failure.

Prevalence of iron deficiency in anemia of chronic renal failure (CRF) has long been the subject of interest, because the patients of CRF with coexistent iron deficiency anemia need to be treated with iron preparations before starting erythropoietin therapy. Prevalence of iron deficiency in CRF is higher in Indian patients as compared to the West. Diagnosis of iron deficiency in patients with CRF is difficult. Bone marrow iron which is considered to be the gold standard is a painful and invasive procedure. In the present study we used serum transferrin receptor and serum ferritin levels, since not much Indian data is available on this.

Assessment of erythropoiesis in renal anemia using soluble transferrin receptors

To evaluate the clinical usefulness of soluble transferrin receptors [sTFR], 42 patients were enrolled in this study representing four groups. Group I included 10 end stage renal disease [ESRD] patients on HD, EPO and i.v. iron twice-thrice/week [their age ranged from 6 to 12 years with a mean of 7 years]. Group II included 18 ESRD patients on conservative management without regular HD nor erythropoietin, they received maintenance oral iron deficiency anemia with normal kidney functions [their mean age was 6.5 years], they were on iron therapy. Group IV included 13 healthy children with normal Hb level and normal kidney functions [they were age and sex matched as a control group and their mean age was 7 years]. Three parameters for the assessment of erythropoiesis were used in all groups [Hb, sTER and serum ferritin]. Kidney function tests were also determined

Serum transferrin receptor and transferrin receptor/ferritin ratio distinguish iron deficiency in anemia of chronic disorders in children

This study included 44 anemic children: 20 children were iron deficiency anemia [group I], 14 children suffering from iron deficiency anemia in the presence of acute infection [group II] and 10 children had anemia of chronic disorders [group III]. In addition, 20 healthy children were included as a control group. Complete blood count, serum iron, total iron binding capacity, serum ferritin and serum transferrin receptor [sTfR] were assayed in all patients groups. It was concluded that the increase in sTfR among patients with anemia of chronic disease reflects the increased demand for iron in the erythroid cells; thus sTfR level can be used in distinguishing the coexistence of iron deficiency anemia in anemia of chronic inflammatory diseases

Defective Erythropoiesis in Bone Marrow is a Mechanism of Anemia in Children with Cancer

Evaluation of the mechanism of anemia in cancer patients might help to select patients for the more efficient use of erythropoietin (EPO, a growth factor for erythroid precursor cells). For this, we investigated whether the production of EPO responds to anemia and the bone marrow responds to EPO appropriately, and whether chronic inflammation is inhibitory to erythropoiesis in anemic cancer children. Serum levels of EPO, soluble transferrin receptor (sTfR), tumor necrosis factor (TNF)-alpha, and erythrocyte sedimentation rate (ESR) in anemic cancer children were measured by enzyme-linked immunosorbent assay and then the correlation coefficients between those parameters and hemoglobin (Hb) were determined. Both in leukemia and in solid tumor patients, there were significant inverse correlations between Hb and EPO (leukemia: tau=-0.547, p<0.0001; solid tumor: tau=-0.591, p<0.0001), and between sTfR and EPO (leukemia: tau=-0.223, p<0.05; solid tumor: tau=-0.401, p<0.05). In contrast, sTfR showed a correlation with Hb in leukemia (tau=0.216, p<0.05) but not in solid tumor patients. sTfR was suppressed in 53% of anemic episodes of leukemia and 78% of those of solid tumor patients. Our results suggest that in cancer children, the EPO production is not defective and chronic inflammation is not inhibitory to erythropoiesis. Rather, the defective erythropoiesis itself is thought to be responsible for the anemia.

Soluble transferrin receptor in sickle cell diseases: correlation with spleen function

OBJECTIVE: To correlate spleen function with soluble transferrin receptor (sTfR) levels and red cell ferritin (RCF) values in patients with sickle cell diseases. DESIGN: Prospective study. LOCATION: University Hospital, School of Medical Sciences, State University of Campinas; a tertiary hospital. PARTICIPANTS: 60 patients with sickle cell diseases, in a steady state, who had not received blood transfusions for 3 months; 28 normal individuals with no clinical or laboratory signs of anemia. MEASUREMENTS: Determination of serum iron, transferrin iron-binding capacity, serum ferritin, RCF and sTfR. Evaluation of spleen function: erythrocytes with pits were quantified. RESULTS: Patients with sickle cell anemia had sTfR levels significantly higher than in normal individuals or those with HbSC (p=0.0001) and there was an inverse correlation between sTfR and fetal Hb (p=0.0016). RCF values were significantly higher in sickle cell anemia patients than in normal individuals or those with HbSC (p=0.0001), and there was a correlation between RCF and pitted erythrocytes (p=0.0512). CONCLUSION: The association between sTfR and fetal Hb confirms the contribution of fetal Hb to improving the hemolytic state by minimizing the consequent reactive erythrocyte expansion. High sTfR levels are not related to the degree of spleen function deficiency seen in sickle cell disease patients. The deficiency in the exocytosis process of the spleen occurring in sickle cell anemia patients may contribute to their accumulation of RCF

Analisis multiparametricos para el diagnostico de la anemia ferropriva / Multiparametric analysis for the diagnosis of deficiency anemia

Se evaluó al receptor de transferrina (RsT) como marcador de hierro funcional en dos grupos: 1) controles (50 adultos sanos de ambos sexos residentes a nivel del mar); 2) 50 anémicos ferroprivos por alteraciones nutricionales, gastrointestinales o ginecológicas (AFP). El valor medio en los controles fue 16.6 nmol/l (8.8 a 26.2 nmol/l), sin diferencias significativas por edad y sexo. En el grupo AFP, el valor medio fue 66.3 nmol/l (16.1 a 148.4 nmol/l). El análisis estadístico (características del operador receptor, ROC) estableció un intervalo de referencia óptimo de 8.8 a 25.8 nmol/l, Los valores predictivos, positivo (VPP) y negativo (VPN), del RsT como prueba diagnóstica fueron 97.5 y 97.7 por ciento, respectivamente, y la eficiencia diagnóstica (ED) fue 97.7 por ciento. Tanto en los controles como en los AFP se observó: 1) concentraciones inversas entre el RsT y la ferritina (F) (tendencia potencial entre las variables (p<0.001) con un coeficiente de determinación del 72 por ciento); 2) ampilas variaciones del RsT para concentraciones de hemoglobina (Hb) inferiores a 100 g/l (tendencia exponencial (p < 0.001) con un coeficiente de determinación del 71 por ciento); 3) valores de la relación RsT/log ferritina (índice RsT/F) sensiblemente mayores en AFP (75.8) que en los controles (9.6). La administración de hierro normalizó los niveles del RsT en pacientes ferroprivos, sin cambiar significativamente las concentraciones de ferritina sérica. Nuestros estudios demuestran que el RsT mide con alta especificidad y sensibilidad el hierro funcional.