Distinguish Iron Deficiency Anemia Research Articles

Distinguishing Iron Deficiency Anemia From Beta-Thalassemia Trait: Comparative Analysis of CRUISE Index and Other Traditional Diagnostic Indices.

Introduction Iron deficiency anemia and beta-thalassemia trait are two common and important differentials of microcytic hypochromic anemia. Various discrimination indices using two or more common complete blood cell count (CBC) parameters have been used to distinguish between the two since1973. Recently, a new discriminant index, the CRUISE index, was proposed in the year 2019. The efficacy of various older indices along with the CRUISE index was evaluated for patients in our geographical area. Materials and method Ours was a laboratory-based, cross-sectional study where 100 patients, based on inclusion and exclusion criteria, with microcytic hypochromic anemia were evaluated for CBC parameters along with serum ferritin and hemoglobin-high performance liquid chromatography (Hb HPLC). A total of eight discrimination indices namely, Mentzer, Srivastava, Shine & Lal, Green & King, RDWI, England & Fraser, Kerman I and CRUISE index were used and evaluated for their diagnostic efficacy using different statistical parameters. ROC curves were obtained and a new cut-off value was proposed for our population. Data was analysed using Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and SPSS v29.0.2.0 (20) (IBM Corp., Armonk, NY, USA). Results Out of the total 100 cases, 39 were beta-thalassemia trait and 61 were iron deficiency anemia cases. The average age was 36.7 (±12.7 SD) years. Among the 73 females, 43 were diagnosed as iron deficiency anemia (IDA) and 30 as beta-thalassemia trait (BTT) cases. Among the 27 males, 18 were diagnosed as IDA and nine as BTT cases. The mean values were significantly lower in IDA patients for mean corpuscular volume (MCV) (p=.008), mean corpuscular haemoglobin (MCH) (p=.003), and mean corpuscular haemoglobin concentration (MCHC) (p=.003) and significantly higher for red cell distribution width (RDW) (p=.020). The mean ferritin levels in cases of IDA were 7.61 (±3.75) mcg/L and in BTT were 87.09 (±66.77 SD) mcg/L. The mean HbA2 levels in IDA cases were 2.75% (±0.41% SD) and BTT cases were 5.57% (±0.73% SD). CRUISEindex revealed the highest AUC (0.934), YI (76.21) and accuracy (90%) followed by the Mentzer index with a diagnostic accuracy of 81%. Shine & Lal index revealed the lowest AUC (0.710), YI (3.28) and accuracy (41%). Conclusion CRUISE index, which was recently proposed, was ranked 1st in terms of AUC, YI, and accuracy and was considered 2nd best in terms of sensitivity for differentially diagnosing the two conditions. Mentzer index, a commonly used index, also revealed a high diagnostic accuracy in our study for differentiating BTT from IDA. CRUISE index being a novel index, more research work needs to be carried out in various other geographical setups to evaluate the efficacy of this index.

A Novel Discriminating Tool for Microcytic Anemia in Childhood.

Accurate and timely interpretation of microcytic anemia can be diagnostically challenging in the primary care setting. We sought to develop a novel model for distinguishing iron-deficiency anemia from thalassemia trait in the modern pediatric population. Demographic history and red blood cell indices were retrospectively characterized for 76 children referred to our pediatric hematology clinic for evaluation of microcytic anemia. Statistically significant variables were sequentially added into a logistic regression model to develop the final model. The final discriminating model incorporates red cell distribution width, mean corpuscular hemoglobin concentration, and red blood cell values. Favorable predictive performance is seen in the initial (sensitivity 89.2%, specificity 92.3%) and external validation cohort (sensitivity 84.4%, specificity 88.9%). This novel tool may aid in determining the cause of hypochromic, microcytic anemia in the primary care setting. Finally, the study cohort reflects an underrepresented group in the development of screening tools, and thus offers generalizability.

Diagnostic test performance of the Mentzer index in evaluating Saudi children with microcytosis.

Anemia is a global public health concern, affecting both developing and industrialized countries at a rate of 39.8%. It is defined by low hemoglobin concentration, and anemia varies in severity based on age: <11 g/dL (6-59 months), <11.5 g/dL (5-11 years), and < 12 g/dL (12-14 years). This study evaluates the Mentzer index's reliability in differentiating iron deficiency anemia from the thalassemia trait. A total of 434 children (≤16 years) with hemoglobin electrophoresis previously screened for microcytosis (MCV <80 FL) and an iron profile were included. Children with other hematological conditions were excluded. Out of 434 children, 181 were diagnosed with thalassemia, and 345 had iron deficiency anemia. The Mentzer index showed 74% sensitivity and 63% specificity for the beta-thalassemia trait, with 61% sensitivity and 36% specificity for iron deficiency anemia. The beta-thalassemia trait group had the highest negative predictive value (98%), while iron deficiency anemia had the highest positive predictive value (79%). Our study, which is consistent with previous literature, suggests that the Mentzer index is not highly reliable in distinguishing iron deficiency anemia from the thalassemia trait among children in Saudi Arabia.

Distinguishing Iron Deficiency Anemia from Anemia of Chronic Disease Using Hematological Measures

Anemia is a serious public health concern in today’s world which is particularly affecting young children, pregnant women, menstruating adolescent girls and women. The two most common causes of anemia are iron deficiency anemia (IDA) and anemia of chronic disease (ACD), often known as anemia of inflammation. This study aim was to assess the levels of certain hematological parameters, including Hemoglobin Estimation, Mean Corpuscular Volume (MCV), Serum Ferritin, Serum TIBC, Erythrocyte Sedimentation Rate and C - reactive protein to clearly differentiate between iron deficiency anemia and anemia of chronic disease. The study was conducted in Department of Medical Lab Technology, Riphah International University, Islamabad from September 01, 2023 to January 01, 2024. A total of 109 samples with 59 of iron deficiency anemia patients and 50 patients of Anemia of chronic disease were assessed for differentiation be these two diseases. The significant level was selected with p-value less than 0.05. Hemoglobin estimation, TIBC, and ESR were significant in our investigation as their p-values were less than 0.05. Hence, it concluded that Hemoglobin estimation, total Iron Binding Capacity and Erythrocyte Sedimentation Rate were Hematological parameters that distinguished between Iron Deficiency Anemia and Anemia of Chronic Disease.

Diagnóstico y tratamiento de la anemia ferropénica en la asistencia primaria de España

Background and objective: Iron deficiency anemia is a frequent cause of consultation in routine medical practice. Knowing how it is diagnosed and treated in Primary Care can allow us to detect if there is any area for improvement.Method: Descriptive multicenter survey-type study with 12 questions to find out the aspects of greater variability in the management of iron deficiency anemia. The population under study are physicians from Primary Care Centers nationwide who treat these patients.Results: 732 physicians answered the form. 51.8% consider iron deficiency anemia a serious disease. To make the diagnosis, 80.7% check the ferritin and only 27.2% the transferrin saturation index (IST). 71.6% performed control tests every 3 months. 57.9% prescribe iron only for 3 months. 47% end treatment when Hb normalizes. When the patient is referred, the majority do so to the digestive service, followed by hematology, internal medicine, and gynecology.Conclusions: Despite the fact that almost 52% of those surveyed consider iron deficiency anemia a serious disease and that ferritin is the most useful biochemical determination for its diagnosis, around 20% do not use it. On the other hand, the IST, which can often help distinguish iron-deficiency anemia from inflammatory anemia, is only requested by slightly more than 27%, which can lead to diagnostic errors. On the other hand, on some occasions, the treatment is insufficient since the majority treat the patients for only 3 months and 47% finish the treatment when the Hb normalizes without taking into account the ferritin result. Although the diagnosis and treatment of iron-deficiency anemia in Primary Care has improved, it is likely that many patients would benefit from greater use of ferritin and IST and from longer-lasting treatments.

Cut off Value of Red Cell Distribution Width (RDW) in Screening and Diagnosis of Iron Deficiency Anemia and b Thalassemia Trait

Background: The most concerning consequences of iron deficiency in children are the alterations of cognitive, motor, and behavioral performance. Persistent neurocognitive changes despite iron repletion have increased the importance of prevention and early detection of iron deficiency.&#x0D; Objectives: To evaluate the cut off value of red cell distribution width (RWD) in the screening and diagnosis of iron deficiency anemia (IDA) and â thalassemia trait (BTT).&#x0D; Methods: It is a cross sectional study performed at Dhaka Shishu (Children) Hospital from July 2006 to July 2008. Total 52 patients, age ranged from 1-12 years were included in the study. Among them 27 cases were IDA and 25 cases were BTT. Complete blood count (CBC), serum ferritin and hemoglobin (HB) electrophoresis were measured. The sensitivity, specificity, positive and negative predictive value of differential and cutoff value for RDW discrimination index in differentiation between IDA and BTT were performed.&#x0D; Results: Age ranged from 1-12 years. In IDA group male were found 16(59%), female were 11(41%) and in BTT group male were 15(60%), female were 10(40%). The Hb% value in IDA group was significantly (p&lt;0.0001) lower than value for BTT. An elevation of RBC distribution width (&gt;14.6) in IDA had a sensitivity of 81%, specificity of 84%, positive predictive value (PPV) of 85% and negative predictive value (NPV) of 81%; value of RBC distribution width (&lt;14.6) in BTT had a sensitivity of 84%, specificity of 81%, positive predictive value (PPV) of 81% and negative predictive value (NPV) of 85%. An elevation of RBC distribution width (&gt;16) had a sensitivity of 67%, specificity of 92%, and positive predictive value (PPV) of 90% in distinguishing iron deficiency anemia from thalassemia trait. Moreover, eleven (11) of 27 patients with iron deficiency had RBC distribution width values greater than 18 compared to one (1) of the patients with thalassemia trait. An elevation of RBC distribution width ³18 specificity of 96% and positive predictive value (PPV) of 92%.&#x0D; Conclusion: The rersult of the study, in patients with microcytic hypochromic anemia, RDW value e³14.6% and Hb level&lt; 10gm/dl, iron deficiency is the most likely diagnosis. RDW value (&gt;16) is a reliable diagnostic tool in differentiation between IDA and BTT. Red cell distribution width (RDW) above 16% is the best index of IDA.&#x0D; DS (Child) H J 2021; 37(1): 51-58

The diagnostic potential of the iron-regulatory hormone hepcidin.

The diagnostic potential of the iron-regulatory hormone hepcidin.

Distinguishing iron deficiency anemia from thalassemia by the red blood cell lifespan with a simple CO breath test: a pilot study

Background: Extant indices for distinguishing between iron deficiency anemia (IDA) and thalassemia (Thal) have substantial practical limitations. The aim of this pilot study was to assess the predictive value of red blood cell lifespan (RBCLS), as determined by an automated CO breath test analysis approach, in the differential diagnosis of these two common forms of microcytic hypochromic anemia (MHA). Methods: RBCLS measurements were conducted in 35 healthy controls (HCs) and 114 patients diagnosed with MHA (IDA, N = 59; and Thal, N = 55) with ELS TESTER that provides a direct RBCLS value read-out. RBCLS between IDA and Thal was compared and evaluated by referring to normal cut-off from the instrument. Results: Compared with that in HCs, RBCLS in IDA and Thal groups was shortened; and median RBCLS was shorter in the Thal group than that in IDA group (33 d versus 79 d, p < 0.001). The median RBCLS in IDA patients with chronic gastrointestinal (GI) bleeding was shorter than that those without GI bleeding (38 d versus 100 d, p < 0.001). Using 75 d as a cut-off, RBCLS had a sensitivity of 96.4% and a specificity of 50.8% for detecting Thal. When GI bleeding patients were excluded from the IDA group, discriminant efficiency of RBCLS was further improved. Conclusions: MHA with a normal RBCLS is suggestive of IDA, whereas MHA with a significantly shortened RBCLS without signs of chronic GI bleeding is suggestive of Thal.

Iron Status and Inflammation in Early Stages of Chronic Kidney Disease

Background/Aims: One of the most common causes of anemia of chronic disease (ACD) is chronic kidney disease. The main pathomechanism responsible for ACD is subclinical inflammation. The key element involved in iron metabolism is hepcidin, however, studies on new indices of iron status are in progress.The aim of the study was to assess the iron status in patients in early stages of chronic kidney disease, iron correlation with inflammation parameters and novel biomarkers of iron metabolism. Methods: The study included 69 patients. Standard laboratory measurements were used to measure the iron status, complete blood count, fibrinogen, prothrombin index, C-reactive protein concentration (CRP), creatinine, urea, uric acid. Commercially available kits were used to measure high-sensitivity CRP, interleukin 6 (IL-6), hepcidin-25, hemojuvelin, soluble transferrin receptor (sTfR), growth differentiation factor-15 (GDF-15) and zonulin. Results: Absolute iron deficiency was present in 17% of the patients, functional iron deficiency was present in 12% of the patients. Functional iron deficiency was associated with significantly higher serum levels of fibrinogen, ferritin, transferrin saturation, total iron binding capacity, hepcidin and older age relative to patients with absolute iron deficiency. In comparison with patients without iron deficiency, patients with functional iron deficiency were older, with lower prothrombin index, higher fibrinogen, CRP, hsCRP, sTfR, GDF-15, urea and lower eGFR. Hepcidin was predicted by markers of inflammation:ferritin, fibrinogen and IL-6. Conclusion: Inflammation is correlated with iron status. Novel biomarkers of iron metabolism might be useful to distinguish iron deficiency anemia connected with inflammation and absolute iron deficiency.

The utility of reticulocyte indices in distinguishing iron deficiency anemia from anemia of inflammatory disease, portosystemic shunting, and breed-associated microcytosis in dogs.

Indices of reticulocyte cell size and hemoglobin content show promise for diagnosing iron deficiency (FeDef), but have not been evaluated in other causes of canine anemia or microcytosis. The aims of this study were to establish reference intervals (RI) for reticulocyte indices in dogs, and to compare results from dogs with FeDef anemia to dogs with 3 conditions that may mimic FeDef on hematologic and biochemical testing, including anemia of inflammatory disease (AID), portosystemic shunting (PSS), or breed-associated microcytosis (BAM). Reticulocyte indices were measured using the ADVIA 2120. Reference intervals were determined prospectively in 122 healthy dogs, and retrospectively compared between dogs with FeDef (n=11), AID (n=12), PSS (n=12), and BAM (n=7). Almost all dogs had at least one reticulocyte index outside the RI. The most discriminating reticulocyte indices were reticulocyte hemoglobin concentration (CHCMr) (FeDef≤26g/dL, AID≥26g/dL, PSS≥24.1g/dL, and BAM≥27.7g/dL), reticulocyte hemoglobin content (CHr) (FeDef≤20.1pg, AID≥21.8pg, PSS≥19.2pg, BAM≥21pg), percentage of reticulocytes with low CHCMr (%Hypo-r) (FeDef≥74.2%, AID≤80.1%, PSS≤91.5%, BAM≤61.6%,), and percentage of reticulocytes with low CHr (%LowCHr) (FeDef≥50.7%, AID≤31.3%, PSS≤63.2%, BAM≤34.1%). Reticulocyte indices can be altered in dogs with various conditions, and are not specific for FeDef. Dogs with CHCMr, CHr, %Hypo-r, and %LowCHr beyond the above cutoffs are suspicious for FeDef. Dogs with AID, PSS, or BAM with reticulocyte indices altered beyond the ranges reported for those subgroups warrant evaluation for concurrent iron deficiency.

Clinical application of low hemoglobin density in screening for iron deficiency and the differential diagnosis of anemia

To investigate the clinical usefulness of the low hemoglobin density (LHD) and other red blood cell parameters in screening for iron deficiency (ID) and distinguishing iron deficiency anemia (IDA) from other kinds of anemia. Whole blood count (CBC) and parameters of iron metabolism of the patients with ID (n = 251), IDA(n = 155), anemia of chronic disease(n = 90), renal anemia(n = 184), acute hemorrhagic anemia(n = 27) and non-anemia subjects(n = 82) were analysed by Advia 2120 hematology analyzer, Hitachi 7180 automatic biochemical analyzer, Beckman-Coulter DxI 800 immunoassay analyzer. SPSS 13.0 software was applied to anylyze data. The sensitivity of LHD in screening for ID was 67.2%, which was significantly higher than MCHC (38.8%) . There was a sensitivity of 91.2% for ID screening by combination of LHD and RDW. LHD only increased greatly in IDA (14.9%) group, while had no increase in other anemia. LHD is a reliable new marker with certain clinical usefulness. Combination of LHD and RDW is more suitable for screening ID. LHD is also a useful marker to distinguish IDA from other kinds of anemia.

Serum hepcidin-25 in comparison to biochemical markers and hematological indices for the differentiation of iron-restricted erythropoiesis

Biochemical markers have problems in distinguishing iron deficiency anemia (IDA) from anemia of chronic disease (ACD), and the combined state of iron-restricted erythropoiesis (IRE) with ACD (ACD/IRE). We investigated the extent to which hepcidin-25, a potential marker for the evaluation of iron metabolism, enables the differentiation of the states above, and to assess its correlation with convential markers of iron deficiency. One hundred and fifty-five patients with anemia were classified as having IDA, ACD or ACD/IRE using clinical findings, biochemical markers and hematological indices. The diagnostic performance of hepcidin-25 alone or in combination with the reticulocyte hemoglobin content (CHr) was evaluated using receiver-operating characteristic curve analysis and multivariate analysis. Hepcidin-25 was determined using an isotope-dilution micro-HPLC-tandem mass spectrometry method. Hepcidin-25 correlated with biochemical markers of iron deficiency but not with hematological indices. Use of a hepcidin-25 cut-off of ≤ 4 nmol/L allowed the differentiation of IDA from ACD and ACD/IRE, but not the discrimination of ACD from ACD/IRE in patients with severe inflammation. Furthermore, the discrimination of ACD/IRE from ACD required the combination with CHr. Hepcidin-25 is primarily an indicator for decreased body iron levels, but not for IRE. The combination of hepcidin-25 with CHr in a diagnostic plot (hepcidin-25 plot) might be useful for the differentiation of ACD from ACD/IRE and IDA.

Correlaton between soluble transferrin receptor concentration and inflammatory markers

Purpose: The concentration of soluble transferrin receptor (sTfR) is estimated as an iron parameter to evaluate erythropoiesis and iron status. The aim of our study is to evaluate the correlation between sTfR concentration and inflammatory parameters and to distinguish iron deficiency anemia from anemia of inflammation. Methods: One hundred and forty-four infants younger than two years of age who visited Gyeongsang University Hospital for 7 years from 2000 to 2006 were enrolled. Patients who had hemoglobin (Hb) <11 g/dL and ferritin <12 mg/L were excluded. Routine hematologic lab, serum ferritin, sTfR, and inflammatory markers [C-reactive protein(CRP), interleukin-6(IL-6), and absolute neutrophil count (ANC)] were investigated. Results: In all patients, the sTfR concentration showed a correlation with Hb, ferritin, MCV, and ANC, but not with CRP and IL-6. In multiple regression models, positive correlations were found between sTfR concentration and IL-6 (r=0.078, P=0.043), and negative correlations were found between sTfR concentration and ANC (r=-0.117, P=0.033) and MCV (r=-0.027, P=0.009). Conclusion: sTfR concentration was influenced by inflammatory parameters. Therefore, sTfR does not appear to be a useful parameter for discriminating between iron deficiency anemia and anemia of inflammation in infants. (Korean J Pediatr 2009;52:435-440)

Ret-Y a measure of reticulocyte size: a sensitive indicator of iron deficiency anemia

In this study the size of reticulocytes was measured, reticulocyte-Y (Ret-Y), to distinguish iron deficiency anemia from the anemia of chronic disease using a Sysmex XE2100 cell counter. We evaluated this parameter prospectively in 100 patients seen for the evaluation of anemia. A clinical diagnosis of iron deficiency anemia or anemia of chronic disease was made on the basis of a complete blood count, examination of the peripheral smear, and serum ferritin along with a history and physical examination. We analyzed the sensitivity and specificity of the Ret-Y in relationship to the clinical diagnosis. We also measured serum transferrin receptor levels to use as the gold standard laboratory test for iron deficiency against which we compared the Ret-Y. In 40 normal individuals with normal serum ferritin and transferrin receptor levels the mean Ret-Y was 1874 +/- 178 (1 SD). The mean Ret-Y in the anemia of chronic disease group (n=62) was 1722 +/- 162, not significantly different from normal. The mean Ret-Y value among iron-deficient patients (n=38), was 1407 +/- 136 (P <0.01 vs. the anemia of chronic disease group's Ret-Y value). Receiver operator curves showed that Ret-Y correlated closely to the serum transferrin receptor and was superior to the mean corpuscular volume, and ferritin level, in differentiating the type of anemia. The Ret-Y parameter has the highest overall sensitivity and specificity of the panel of tests routinely used in differentiating iron deficiency anemia from anemia of chronic disease.

High serum transferrin receptor level in anemia of chronic disorders indicates coexistent iron deficiency.

Blood transferrin receptor (TR) level is largely determined by the quantum of erythropoiesis and by intracellular iron content of the cells of the erythroid lineage. Hence, a high serum TR level has been found to be useful in distinguishing iron deficiency anemia (IDA) from anemia of chronic disorders (ACD). In order to examine its potential role in the diagnosis of concomitant iron deficiency in ACD, we determined serum TR levels in 130 cases of ACD, in 25 cases of IDA, and in 40 normal adults. As expected, all patients of IDA had significantly higher serum TR levels compared to the normal subjects (4.2-19.2 microg/dL vs. 1.3-3.0 microg/dL) (P < 0.002). In 11/25 cases of IDA, the total iron-binding capacity (TIBC) was in the normal range although bone marrow iron store was absent and serum TR levels were high, thereby highlighting the superiority of TR level in the diagnosis of iron deficiency compared to TIBC. Although 54% (70/130) patients of ACD had normal or low serum TR levels (0.9-3.0 microg/dL) as expected, in 46% (60/130) of ACD patients, serum TR levels were high (3.2-11.0 microg/dL). Mean corpuscular volume, red cell distribution width, and transferrin saturation were significantly lower (P < 0.001) in the latter group of patients compared to the former, and these parameters resembled those in IDA patients. Also, serum iron was lower and TIBC was higher in this group of ACD patients compared to those with normal or low serum TR. All these features point to an "IDA-like" profile of ACD patients with high TR and support the possibility of co-existent iron deficiency in this subgroup of ACD patients. In light of these observations it would be prudent to treat ACD patients with high serum TR levels with iron replacement therapy.

Soluble transferrin receptor and immature reticulocytes are not useful for distinguishing iron-deficiency anemia from heterozygous beta-thalassemia.

Iron deficiency and heterozygous beta-thalassemia are important causes of hypochromic-microcytic anemia. Two laboratory parameters are suggested for the differentiation of such anemia. High-fluorescence reticulocyte counts and soluble transferrin receptor levels were determined in iron-deficiency anemia patients (n = 49) and heterozygous beta-thalassemia patients (n = 43). There was no significant difference in high-fluorescence reticulocyte and soluble transferrin receptor values between the two groups, but a correlation was observed between high-fluorescence reticulocytes and soluble transferrin receptors in iron-deficiency anemia, probably due to increased receptor synthesis as a response to decreased iron content in erythrocytes.

Current issues in iron deficiency.

This brief review of developments relating to iron deficiency during the past year covers three main areas: iron supplementation, the regulation of iron absorption, and the use of the serum transferrin receptor for the assessment of iron status. The intermittent administration of iron supplement once or twice weekly rather than daily has been advocated by international health agencies in recent years, but radioiron absorption studies in human subjects have failed to demonstrate any absorptive advantage of the intermittent schedule. The value of prophylactic iron supplementation in elderly blood donors was evaluated and shown to offer limited benefit in maintaining donation frequency. A recent model of the regulation of iron absorption involving erythropoietic and store regulators is discussed and a recent article indicating a potential non-hematopoietic effect of hematopoietic growth factors on iron absorption by the gastrointestinal mucosal cell is reviewed. A new measure of functional iron deficiency, namely the serum transferrin receptor, is discussed, with particular reference to its mechanism of production and its great value in distinguishing iron deficiency anemia from the anemia of chronic disease.

Anemia en infecciones agudas febriles leves

This study was designed to furtrer characterize anemia associated to mild infections in children. Thirteen infants and children aged 4 months to 10 years end with an acute febrile illness, all from an outpatient clinic, were included in this study. A blood sampe was ootained at diagnosis and 30 days later, for comple'e blood count, serum iron, total iron binding capacity, transferrin saturation, free erythrocyle orotoporphyrin, serun fe ' r i in, erythrocyte sedimentation rate ana C reactive protein. During the acute infection there was a significant reduction of blood hemoglobin [ 1 1 . 5 ± : .2 vs. '2.0 ± 1.6 g/l; E> < 0.02), -eticulocyte count index [0.3 ± 0.2 vs. 0.7 ± 0.4; p < 0.02], serum iron [36.6 ± 20.6 vs. 73.8 ± 34.8 pg/d ; p<0.001), transferrin saturation ( 1 1 . 1 ± 7.1% vs. 20.8 ± 12.0 % , p < 0.001) crd a significant rise in mean red blood cell volume [80 ± 5 vs. 77 ± 5 fl; p < 0.01) and serum erritr (mean 26, range 8 to 86 vs. 10, range ^ a 21 ng/l; p < 0.004). Three children had a fall in hemoglobin greater tr.an • g/dl. This anemia was likely causec by reduced red cell output due to blockage of iron release and in some cases associated to hemo.ysis. Free erythocyle potoporphyrin was useful to distinguish iron deficiency anemia from anemia due to he acute infection. C reactve protein activity was also useul because all patients had more than 6 me/I during the acute phase of infection.

The Transferrin Receptor: Its Diagnostic Value and its Potential as Therapeutic Target

Transferrin receptors are present on almost all mammalian cells. The receptor participates in the cellular acquisition of iron from transferrin by receptor-mediated endocytosis. Receptor abundancy is generally regulated by two factors: i) cellular iron status and ii) cell growth. These two factors form the basis for the utilization of transferrin receptor determination as a diagnostic tool. In the assessment of body iron status and erythropoietic activity the measurement of circulating transferrin receptor has proved to be of value as a measure of mild tissue iron deficiency, to distinguish iron deficiency anemia from the anemias of chronic disease, and as a sensitive index of iron deficiency during pregnancy. Histochemical analysis of the presence and abundancy of the transferrin receptor will continue to serve as an additional tool in special cases to distinguish between malignant and normal cell growth, and to provide additional information about the biological behaviour of tumor cells. Finally, the transferrin receptor holds a potential as a target for direct and indirect drug delivery in the therapy of malignant cell growth.

Iron deficiency anemia

The prevalence of iron deficiency anemia has decreased in recent years because of improved dietary habits. Yet, iron deficiency anemia is still the most common anemia. Among mature adults, anemia of chronic disease is probably more common. Mean corpuscular volume and red cell distribution width, along with a peripheral smear examination, can often distinguish iron deficiency anemia from other common microcytic anemias, such as thalassemia minor. A normal serum iron level excludes iron deficiency anemia and indicates other causes for microcytic anemia. Often, a low serum iron level and total iron-binding capacity are due to chronic disease, and measurement of serum ferritin or a bone marrow stain for hemosiderin will be necessary to diagnose iron deficiency. Iron therapy to restore the red cell mass should be continued until iron stores are replenished.