Abstract
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.
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References
Shali T, Singh C, Goindi G. Prevalence of anemia amongst pregnant mothers and children in Delhi. Indian J Pediatr 2004; 71: 946.
Bentley DP. Anemia and chronic disease. Clin Hematol 1982; 11:465.
Cartwright GE. The anemia of chronic disorders. Semin Hematol 1966; 3: 351.
Lee GR. The anemia of chronic disorders. Semin Hematol 1983; 20: 61–80.
Baynes RD, Shih YJ, Hudson BG, Cook JD. Production of serum form of transferrin receptor by a cell membrane associated serine protease. Proc Sec Exp Biol Med 1993; 204: 65–69.
Petterson T, Kivivuori SM, Siimes MA. Is serum transferrin receptor useful for detecting iron deficiency inn anemic patients with chronic inflammatory disease. Br J Rheumatol 1994; 33: 740–744.
Rimon E, Levy S, Sapir A. Diagnosis of iron deficiency anemia in elderly by transferrin receptor-ferritin index. Arch Intern Med 2002; 162: 445–449.
Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem 2002; 48: 1066–1076.
Goyal R, Das R, Bambery P, Garewal G. Serum transferrin receptorferritin index shows concomitant iron deficiency anemia and anemia of chronic disease is common in patients with rheumatoid arthritis in north India. Indian J Pathol Microbiol 2008; 51:102–104.
Malope BL, Macphail AP, Albert M, Hiss DC. The ratio of serum transferrin receptor and serum ferritin in diagnosis of iron status. Br J Haematol 2001; 115: 84–89.
Punnomen K, Irjala K, Rajamaki A. Iron deficiency anemia is associated with high concentration of transferring receptor in serum. Clin Chem 1994; 40: 774–776.
Coenen JLLM, Van Dieyen-Visser MP, Van Pelt J. Measurement of serum ferritin used to predict concentrations of iron in bone marrow in anemia of chronic disease. Clin Chem 1991; 37: 560–563.
Baynes RD. Assessment of iron status. Clin Biochem 1996; 29: 209–215. (Review).
Worwood M. Serum transferrin receptor assays and their application. Ann Clin Biochem 2002; 39: 221–230.
Dimitrou H, Stiakaki E, Markaki EA. Soluble transferrin receptor levels and soluble transferrin receptor/ log ferritin index in the evaluation of erythropoietic status in childhood infections and malignancy. Acta Paediatr 2000; 89: 1169–1173.
Angeles Vazquez Lopez M, Molonis FL, Carmona ML, Morales AC, Munoz Vico FJ, Munoz JL et al. Serum transferrin receptor in children: usefulness for determining the nature of anemia in children. J Pediatr Hematol Oncol 2006; 28: 809–815.
Hanif E, Ayyub M, Anwar M, Ali W, Bashir M. Evaluation of serum transferrin receptor concentration in diagnosis and differentiating iron deficiency anemia from anem ia of chronic disorders. J Pak Med Assoc 2005; 55: 13–16.
Markovic M, Majkic-Singh N, Subota V. Usefulness of soluble transferrin receptor and ferritin in iron deficiency and chronic disease. Scand J Clin Lab Invest 2005; 65: 571–576.
Revel-Vilk S, Tamary H, Broide E. Serum transferrin receptor in children and adolescents with inflammatory bowel disease. Eur J Pediatr 2000; 159: 585–589.
Das Gupta A, Abbi A. High serum transferrin receptor level in anemia of chronic disorders indicates coexistent iron deficiency. Am J Hematol 2003; 72: 158–161.
Chua E, Clague JE, Sharma AK. Serum transferrin receptor assay in iron deficiency anaemia and anaemia of chronic disease in the elderly. QJM 1999; 92: 587–594.
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Jain, S., Narayan, S., Chandra, J. et al. Evaluation of serum transferrin receptor and sTfR ferritin indices in diagnosing and differentiating iron deficiency anemia from anemia of chronic disease. Indian J Pediatr 77, 179–183 (2010). https://doi.org/10.1007/s12098-009-0302-z
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DOI: https://doi.org/10.1007/s12098-009-0302-z