Ferritin Transferrin Receptor Research Articles

Imbalance of Iron Availability and Demand in Patients With Acute and Chronic HeartFailure.

Iron deficiency (ID) is a frequent comorbidity in patients with acute (AHF) and chronic heart failure (CHF) associated with morbidity and death. We aimed to better characterize iron homeostasis in patients with heart failure applying different biomarkers and to evaluate the accuracy of current ID definition by the European Society of Cardiology/American College of Cardiology/American Heart Association to indicate tissue iron availability and demand. We performed a retrospective cohort study investigating 277 patients with AHF and 476 patients with CHF between February 2021 and May 2022. Patients with AHF had more advanced ID than patients with CHF, reflected by increased soluble transferrin receptor and soluble transferrin receptor-ferritin index, and lower ferritin, serum iron, transferrin saturation, hepcidin, and reticulocyte hemoglobin. Decreased iron availability or increased tissue iron demand, reflected by increased soluble transferrin receptor-ferritin index and decreased reticulocyte hemoglobin, was found in 84.1% (AHF) and 28.0% (CHF) with absolute ID and in 50.0% (AHF) and 10.5% (CHF) with combined ID according to the current European Society of Cardiology/American College of Cardiology/American Heart Association-based ID definition. Low hepcidin expression as an indicator of systemic ID was found in 91.1% (AHF) and 80.4% (CHF) of patients with absolute ID and in 32.3% (AHF) and 18.8% (CHF) of patients with combined ID. ID definitions with higher specificity reduce the need for iron supplementation by 25.5% in patients with AHF and by 65.6% in patients with CHF. Our results suggest that the current European Society of Cardiology/American College of Cardiology/American Heart Association-based ID definition might overestimate true ID, particularly in CHF. More stringent thresholds for ID could more accurately identify patients with heart failure with reduced tissue iron availability who benefit from intravenous iron supplementation.

Diagnostic importance of hepcidin, soluble transferrin receptor (sTfR) and TfR-F index in monitoring the iron status of female hockey players

Latent iron deficiency is highly prevalent among female athletes compared to the sedentary population. The present study is designed to assess whether the subnormal ferritin levels observed in female hockey players were due to true iron deficiency or due to exercise-induced metabolic adaptations. Twenty-six female field hockey players were selected for this study, after assessing the iron profile parameters they were divided into two groups namely the low ferritin group (LFG) and normal ferritin group (NFG) based on their ferritin levels (cut-off value -12ng/ml). Hepcidin, soluble transferrin receptor (sTfR), soluble transferrin receptor-ferritin index (TfR-F Index), levels were compared between groups. Though there was no significant difference in TfR levels, significant differences were observed in hepcidin, TfR-F Index, serum iron, TIBC, and TS levels between both the groups, indicating the incidence of depletion of stored iron in female players during the training cycle.

Study of the role of soluble transferrin receptor/ferritin index in the assessment of anemia in inflammatory bowel disease patients

Abstract Background Idiopathic inflammatory bowel disease (IBD) includes those conditions characterized by a tendency for chronic or relapsing immune activation and inflammation within the gastrointestinal tract, Crohn’s disease (CD) and ulcerative colitis (UC) are the two major forms of idiopathic IBD. Aim of the Work The aim of this study is to evaluate the clinical usefulness of the soluble transferrin receptor-Ferritin index in the evaluation of anemia in patients with IBD and especially for differentiation between iron deficiency anemia and anemia of chronic disease. Patients and Methods This study included fifty patients with established diagnosis of IBD either Ulcerative Colitis or Crohn’s disease. They were collected at Internal Medicine and Gastroenterology outpatient clinics and inpatient wards at Ain Shams University hospitals as well at New Cairo hospital in the period from March 2017 to September 2017. They were classified into 2 groups: group I 25 patients with Crohn’s disease and anemia with active or inactive disease, group II 25 patients with ulcerative colitis and anemia with active or inactive disease, group III 25 healthy controls with no significant medical or family history of IBD. Results In the current study there was no significant difference between the different study groups regarding the demographic data except for the disease localization as there was significant difference between ulcerative and crohn’s disease. Conclusion The results of the current study stated that the sTfR and sTfR-F index seems to be very efficient in the detection and diagnosis of IDA, among patients with IBD. Its detection rate is higher using sTfR/F index than sTfR alone and of course higher than the other existing markers. It is essential to mention that the clinical use of this sTfR/F index rather adds to the value of other established markers, such as ferritin, transferrin and Tsat, than replaces them in the diagnosis of IDA. Therefore, sTfR-F index could be proposed as an additional parameter, which can improve the diagnosis of iron deficiency anemia in patients with IBD. This remains to be confirmed with other larger studies.

Serum Soluble Transferrin Receptor-Ferritin Indices in Diagnosing and Differentiating Iron Deficiency Anemia from Anemia of Chronic Disease among Patients with Chronic Kidney Disease

Background: Anemia is common in patients with chronic kidney disease (CKD) and this is generally anemia of chronic disease (ACD), but iron deficiency anemia (IDA) is also common. Soluble transferrin receptor (sTfR) is a useful marker for IDA. Present study was undertaken to assess the utility of sTfR as a marker of IDA and to differentiate ACD from IDA in selected group of Bangladeshi patients with CKD.
 Methods: This cross-sectional study was conducted in the Department of Nephrology, BSMMU, Dhaka, Bangladesh from January 2013 to December 2014. Patients with anemia admitted in Nephrology Department, whether on hemodialysis or not and Medicine Department of BSMMU were taken for study. The study population was further divided into two groups; Group A, patients (30) who were having IDA and Group B, patients (40) with ACD and a control group was also selected. Data were collected by face to face interview and laboratory investigations with a self-administered questionnaire.
 Results: The mean age of the patients in Group A and Group B were 38.40±13.23 and 34.85±10.52 years respectively and male-female ratio were 0.5:1 and 1:0.5. Mean sTfR level was higher (4.81± 1.64 μg/ml) in patients with IDA than (2.89±1.40 μg/ml) in patients with ACD (p <0.0001). Mean ferritin level was 599.59± 449.15μg/L in ACD patients whereas 101.23±119.42 in IDA patients (p<0.0001). Total iron binding capacity (TIBC) was more in ACD patients with sTfRe”3μg/ml as compared to ACD patients with sTfR<3μg/ml. Transferrin saturation (TSAT) level was significantly decreased in ACD patients with sTfRe”3μg/ml as compared to ACD patients with sTfR<3μg/ml. sTfR and ferritin indices between group A (IDA) and group B (ACD) shows mean sTfR:logSF level was significantly (P<0.001) high in group A (2.71±1.13) in comparison to group B (1.08±0.54). Mean log sTFR:SF was also significantly higher (P<0.05) in group A (0.001±0.0008) compared to group B (0.013±0.012).
 Conclusion: sTfR level has a comparable ability to serum ferritin in diagnosing IDA and ACD. However, sTfR and serum ferritin alone cannot definitely exclude coexisting iron deficiency in ACD. Log sTfR/ ferritin index has role in identifying development of iron deficiency in ACD whereas sTfR/ log SF ratio can differentiate pure IDA from ACD with or without iron deficiency. Thus, it is important to estimate both serum sTfR and sTfRferritin indices to be able to differentiate pure IDA, ACD and ACD with co-existing iron deficiency thus providing a non-invasive alternative to bone marrow iron.
 Birdem Med J 2019; 9(2): 151-156

The Value of Soluble Transferrin Receptor and Soluble Transferrin Receptor-ferritin Index in Discriminating Iron Deficiency Anaemia from Anaemia of Chronic Disease in Patients With Rheumatoid Arthritis

Background:Anaemia is a common extra-articular manifestation of rheumatoid arthritis (RA) where anaemia of chronic disease (ACD) and iron deficiency anaemia (IDA) are the two most frequent types. The distinction between these two types of anaemia has always been challenging requiring sophisticated techniques. Serum transferrin receptor (sTfR) a truncated soluble form of the transferrin receptor is one of the parameters that is influenced by the Iron content and supply to the erythrons and is not affected by inflammatory status and therefore the use of the sTfR/log ferritin (sTfR-F) index can be a reliable indicator of functional iron deficiency.Aim of the study:This study aims to evaluate the usefulness of sTfR and sTfR-F index in discriminating the most common types of anaemia in patients with RA.Patients and methods:The study included 50 patients with RA and 30 healthy subjects as a control group. Complete blood picture, C-reactive protein, serum Iron, unsaturated iron binding capacity, sTfR and serum ferritin were tested.Results and Conclusion:anaemia was present in 34/50 patients; 19 patients had ACD, 9 had ACD/IDA and only 6 patients had IDA. Both the sTfR and the sTfR-F index showed a significant difference between anaemia groups (P values = 0.037 and 0.001, respectively). sTfR-F index has shown to be a very useful parameter that can discriminate efficiently between IDA and ACD and between ACD and ACD/IDA in patients with RA.

Role of Soluble Transferrin Receptor and Transferrin Receptor-Ferritin Index to Detect Iron Deficiency Anemia in Regular Hemodialysis Patients.

BACKGROUND:Several iron indicators can be used to detect iron deficiency anaemia (IDA) where confounding comorbidities occurred such as patients with regular hemodialysis.AIM:This study was aimed to determine the diagnostic value of serum transferrin receptor (sTfR) and transferrin receptor-transferrin index (TfR-F index) and to combine these two markers in detecting IDA in regular hemodialysis anaemic patients.METHODS:There were 70 patients recruited consecutively. IDA was diagnosed based on TS < 20% and ferritin level < 200 ng/L and functional iron deficiency when TS < 20% and ferritin > 200 ng/L. TfR-F index calculated as sTfR/log ferritin.RESULTS:Correlation of ferritin to iron level was changed when its correlation adjusted by confounding inflammation (CRP level > 10). The correlation strength of ferritin to iron serum before adjusted was r = 0.37 with p = 0.02 but became r = 0.65 with p = 0.023 after adjusted to CRP > 10. In inflammation (CRP > 10), ferritin mild-moderately correlated with iron but became moderately strong when there was no inflammation (CRP < 10). AUC for sTfR was 0.77 with p = 0.028 (95% CI 0.55-0.99), and for TfR-F index has larger AUC 0.85% with p = 0.004 (95%CI 0.69-1.00), hence TfR-F index more superior than sTfR. sTfR and sTfR-F index were not correlated with CRP with p > 0.05, and sTfR and TfR-F index mean level was different between IDA and ACD patients although not statistically significant.CONCLUSION:When sTfR and the TfR-F index used in combination to detect IDA, we found the largest AUC on ROC 0.98 (95% CI 0.94-1.00).

Inflammatory bowel disease and anemia: intravenous iron treatment

Objectives: The main objective of our study was to determinate the effectiveness of intravenous iron treatment with ferric carboxymaltose in inflammatory bowel disease (IBD) patients. Our other objectives were to study parameters that would predict a good response to the treatment and to chart out possible side-effects of the treatment.Materials and methods: In our retrospective chart review study we collected clinical data and laboratory results related to IBD from medical records of 87 IBD patients who were treated with ferric carboxymaltose in Helsinki University Hospital between 2014 and 2016.Results: The mean increase in hemoglobin levels of the patients was 24.6 g/l (+ 24%) after one month, 27.6 g/l (+ 27%) after three months and 26.0 g/l (+ 27%) after six months. Nine out of 87 treated patients (10.3%) reported side-effects during the iron infusion. A linear regression model assessing the change in hemoglobin levels after six months demonstrated close correlation with transferrin receptor count (p = .004) and ferritin (p = .016) with an adjusted R square of 0.463.Conclusion: Ferric carboxymaltose was found to be an effective and well tolerated treatment for iron deficiency anemia in patients with IBD. The results of our study further strengthen the current knowledge of the effectiveness and safety of the treatment.

Soluble Serum Transferrin Receptor (STFR) Levels in Hemodialysis Patients

&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Anemia is a frequent disorder in patients with end stage renal disease. Erythropoietin is advised in these patients; however, this therapy is not effective in patients who are iron deficient. So, diagnosis of iron deficiency which is traditionally based on ferritin and other iron parameters becomes difficult in these patients, as chronic kidney disease is a chronic inflammatory condition which affects these markers and masks the iron deficiency. In present study, we assessed the reliability of another indicator of body iron supply; serum transferrin receptor, in hemodialysis patients. It is not affected in case of inflammation unlike other markers of iron status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;Eighty Patients with end&lt;/p&gt;&lt;p&gt;stage renal disease, 20 to 60 years of age and both sexes were included. All cases were examined for complete blood count, serum iron, serum ferritin, serum total iron binding capacity, transferrin saturation and serum soluble transferrin receptor. Data was analysed by using independent sample &lt;em&gt;t&lt;/em&gt; test and Pearson’ correlation. A &lt;em&gt;p &lt;/em&gt;value of ≤ 0.05 was considered as significant.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results of our research showed that mean values of serum soluble transferrin receptor and serum ferritin were 3.28 ± 0.83 µg/ml and 286.31 ± 165 ng/ml respectively which were significantly higher than the upper normal limit (&lt;em&gt;p &lt;/em&gt;&amp;lt; 0.001). Levels of sTfR were statistically different (&lt;em&gt;p &lt;/em&gt;= 0.002) between iron replete group (SF &amp;gt; 100 ng/ml) and iron deplete group (SF &amp;lt; 100 ng/ml). Additionally, there was negative and significant correlation between sTfR and Hemoglobin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Levels of serum soluble transferrin receptor can be used as a reliable marker of iron defi-ciency in hemodialysis patients.&lt;/p&gt;

Effect of single-dose albendazole and vitamin A supplementation on the iron status of pre-school children in Sichuan, China.

The aim of this study was to explore the effect of single-dose albendazole and vitamin A intervention on the anaemic status and Fe metabolism of pre-school children. This study was a randomised, placebo-controlled and double-blinded intervention trial. All eligible anaemic pre-school children were randomly divided into three groups: group 1 received no intervention, which served as the control group, group 2 received 400 mg single-dose albendazole administration and group 3 received a 60000 μg vitamin A capsule combined with 400 mg single-dose albendazole at the beginning of the study. The follow-up period was for 6 months. Anthropometry and biochemical index about Fe metabolism were measured before and after intervention. A total of 209 pre-school anaemic children were randomly divided into three intervention groups (sixty-four, sixty-two and sixty for groups 1, 2 and 3, respectively). The mean age of the children in the study was 4·4 (sd 0·7) years and 50·5 % of the children were female (94/186). After a follow-up period of 6 months, the levels of serum retinol, ferritin, transferrin receptor-ferritin index and body total Fe content of children in group 3 were significantly higher compared with children in groups 1 and 2 (P<0·05). Moreover, the proportion of vitamin A deficiency, marginal vitamin A deficiency and Fe deficiency among children in group 3 were markedly lower compared with children in groups 1 and 2 (P<0·05). Albendazole plus vitamin A administration showed more efficacy on the improvement of serum retinol and Fe metabolic status.

An exploratory study of the associations between maternal iron status in pregnancy and childhood wheeze and atopy.

Maternal nutritional status during pregnancy has been reported to be associated with childhood asthma and atopic disease. The Avon Longitudinal Study of Parents and Children has reported associations between reduced umbilical cord Fe status and childhood wheeze and eczema; however, follow-up was short and lung function was not measured. In the present study, the associations between maternal Fe status during pregnancy and childhood outcomes in the first 10 years of life were investigated in a subgroup of 157 mother-child pairs from a birth cohort with complete maternal, fetal ultrasound, blood and child follow-up data. Maternal Fe intake was assessed using FFQ at 32 weeks of gestation and Hb concentrations and serum Fe status (ferritin, soluble transferrin receptor and TfR-F (transferrin receptor:ferritin) index) were measured at 11 weeks of gestation and at delivery. Maternal Fe intake, Hb concentrations and serum Fe status were found to be not associated with fetal or birth measurements. Unit increases in first-trimester maternal serum TfR concentrations (OR 1.44, 95% CI 1.05, 1.99) and TfR-F index (OR 1.42, 95% CI 1.10, 1.82) (i.e. decreasing Fe status) were found to be associated with an increased risk of wheeze, while unit increases in serum ferritin concentrations (i.e., increasing Fe status) were found to be associated with increases in standardised mean peak expiratory flow (PEF) (β 0.25, 95% CI 0.09, 0.42) and forced expiratory volume in the first second (FEV1) (β 0.20, 95% CI 0.08, 0.32) up to 10 years of age. Increasing maternal serum TfR-F index at delivery was found to be associated with an increased risk of atopic sensitisation (OR 1.35, 95% CI 1.02, 1.79). The results of the present study suggest that reduced maternal Fe status during pregnancy is adversely associated with childhood wheeze, lung function and atopic sensitisation, justifying further studies on maternal Fe status and childhood asthma and atopic disease.

Su1293 Diagnosis of Iron Deficiency in Inflammatory Bowel Diseases by Transferrin Receptor-Ferritin Index

course and intestinal surgery. There is a lack of data regarding diagnostic delay in pediatric IBD patients. We aimed to assess the diagnostic delay in pediatric CD and UC patients and to identifiy risk factors for long diagnostic delay. Methods: Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (68%), regional hospitals (14%), and private practices (18%). Data on diagnostic delay was provided by parents and physician questionnaires. Diagnostic delay was further divided into the time interval from first symptoms to the first consultation with the physician (patient-related interval) and the interval from first physician consultation until IBD diagnosis was established (physician related interval). Long diagnostic delay was defined as delay lying above the 75th percentile. Non-normal data are presented as median, interquartile range [IQR] and range. Results: A total of 100 pediatric CD (37% females) patients and 75 pediatric UC patients (56% females) were included. Age at disease onset was 12 [10 14] years in CD and 11 [7 13] years in UC patients. Diagnostic delay in CD was 4 [2 8] (range 0 82) months with the interval from first symptoms to physician visit of 1 [0 3] (range 0 24) months and from physician visit to diagnosis of 3 [1 9] (range 0 82) months. In UC patients the median diagnostic delay was 2 [1 7] (range 0 52) months with an interval from first symptom onset to physician visit of 0 [0 3] (range 0 36) months and from physician visit to diagnosis of 2 [1 4] (range 0 20) months. Diagnostic delay in CD patients was significantly longer than in UC patients (median 4 vs. 2 months, p = 0.011). Long diagnostic delay was defined as period >8 months in CD and >7 months in UC patients. Neither gender, age at diagnosis, disease location, positive IBD family history, nor provenience (rural vs. non-rural) were associated with long diagnostic delay. Conclusions: The median diagnostic delay in pediatric CD and UC patients in Switzerland is 4 and 2 months, respectively. However, one fourth of pediatric CD patients needs >8 months and one fourth of pediatric UC patients needs >7 months from first symptom onset to IBD diagnosis.

P240 Diagnosis of iron deficiency in inflammatory bowel diseases by transferrin receptor-ferritin index

P240 Diagnosis of iron deficiency in inflammatory bowel diseases by transferrin receptor-ferritin index

Impact of diet and weight loss on iron and zinc status in overweight and obese young women.

Young overweight women are at risk of iron and zinc deficiency. This study assessed iron, zinc and inflammatory status during a 12-month weight loss trial in young women (18-25 y; BMI >=27.5 kg/m2) randomised to a higher-protein (HP: 32% protein; 12.2 mg/day iron; 11.7 mg/day zinc) or lower-protein (LP: 20%; 9.9 mg/day; 7.6 mg/day respectively) diet with contrasting haem iron and zinc content. In completers (HP: n=21; LP: n=15), HP participants showed higher median ferritin (52.0 vs 39.0 μg/L; p=0.021) and lower median soluble transferrin receptor-ferritin index (sTfR-F; 0.89 vs 1.05; p=0.024) although concentrations remained within normal range for both diets. Median C-reactive protein (CRP; HP: 3.54; LP: 4.63 mg/L) and hepcidin (HP: 5.70; LP: 8.25 ng/mL) were not elevated at baseline, and no longitudinal between-diet differences were observed for zinc and CRP. Compared to those with <5% weight loss, HP participants losing >=10% weight showed lower median sTfR-F (0.76 vs 1.03; p=0.019) at six months. Impact of >=10% weight loss on iron was more apparent in LP participants who exhibited greater mean serum iron (20.0 vs 13.5 μmol/L; p=0.002), transferrin saturation (29.8% vs 19.4%; p=0.001) and lower sTfR (1.24 vs 1.92 mg/L; p=0.034) at 12 months. Results show normal iron and zinc status can be maintained during 12 months of energy restriction. In the absence of elevated baseline inflammation and hepcidin, a more favourable iron profile in those with >=10% weight loss may reflect stronger compliance or the potential influence of iron regulatory mechanisms unrelated to inflammatory hepcidin reduction.

Soluble transferrin receptor-ferritin index is the most efficient marker for the diagnosis of iron deficiency anemia in patients with IBD

Soluble transferrin receptor-ferritin index is the most efficient marker for the diagnosis of iron deficiency anemia in patients with IBD

Detección de deficiencias subclínicas de hierro a partir del índice receptor soluble de transferrina-ferritina en niños sanos de 1 a 10 años de edad residentes en alturas de 300 y 2600 msnm

La medición de la hemoglobina dentro de los rangos considerados normales no determina el depósito de hierro funcional. El objetivo de este estudio consistió en la descripción hematológica del comportamiento de la ferritina sérica, el receptor soluble de transferrina y el índice receptor soluble de transferrina-ferritina, frente a la concentración de hemoglobina para detectar los estadios subclínicos I y II en 92 niños y 81 niñas entre los 1 y 10 años de edad en poblaciones colombianas ubicadas a diferentes niveles sobre el nivel del mar. Para el análisis estadístico se utilizaron análisis de tipo descriptivo. También se utilizó la prueba no paramétrica de Kruskal – Wallis.El software de apoyo para el análisis de los resultados es SPSS 15.0. Un P valor menor de 0.05 en las pruebas se consideró significativo. La concentración de hemoglobina estuvo dentro de los valores de referencia, sin embargo, el índice receptor soluble de transferrina-ferritina detectó el 9% de los niños estudiados con estado subclínico grado I, II; el 3% con enfermedad crónica; el 2% con anemia de la enfermedad crónica acompañada de anemia ferropénica, el 14% de los niños presentó proceso infeccioso agudo o crónico sin anemia y el 76% presentaron adecuados depósitos de hierro. Los resultados para ferritina sérica, para el receptor soluble de transferrina y para el índice receptor soluble de transferrina-ferritina mostraron un comportamiento similar en niños y niñas independientemente de la altura sobre el nivel del mar. Lo anterior fue confirmado mediante el uso de pruebas estadísticas, permitiendo concluir que la determinación del índice receptor soluble de transferrina-ferritina, es una excelente herramienta para la detección de deficiencias subclínicas de hierro.

Soluble transferrin receptor-ferritin index and estimated body iron in iron-deficiency anemia in “select” chronic diseases

Dear Editor, This paper reports valuable parameters, soluble transferrin receptor-ferritin index (sTfR-F) and estimated body iron (EBI), to make the diagnosis of iron deficiency anemia (IDA) in chronic diseases. Based on the textbook definition [1], anemia of chronic diseases do not include anemia caused by bone marrow replacement, blood loss, renal failure, hepatic diseases, hemolysis, and endocrine deficiencies and so those diseases were excluded in this study. In addition, to obtain a high efficiency in detecting IDA from chronic diseases, the patients were limited to those with “select” chronic diseases excluding pernicious anemia, parvovirus B19, and hematologic malignancies. The “select” chronic diseases were arbitrary made for this study. Those patients were admitted to Chosun University Hospital. One hundred seventy-seven patients with select chronic diseases, including 27 patients with chronic infections, 71 patients with chronic diseases, and 79 patients with non-hematologic malignancies, were studied. The male– female ratio was variable and the ages ranged from 18– 81 years. All patients were divided into three disease groups according to the criteria for anemia and IDA (below described). Thus, there were 48 patients with non-anemic state in select chronic diseases (NAsCD group), 110 patients with anemia of select chronic diseases (AsCD group), and 19 patients with IDA in select chronic diseases (IDA-sCD group). The criterion for anemia was a hemoglobin 17%, and concurrent microcytic hypochromic RBC with anisocytosis on the peripheral blood smear. The patients were further divided into four iron status groups according to the grade of iron granules in bone marrow particles as follows: increased iron group showing many iron granules, adequate iron group showing some iron granules, decreased iron group showing a few iron granules, and deficient iron group showing no iron granules. The numbers of patients in the deficient iron group were three (6.25%) of 48 patients in NAsCD, 11 (10.0%) of 110 patients in AsCD, and 18 (94.74%) of 19 patients in IDA-AsCD (Table 1). Hematologic parameters (Hb and CHr), serum ferritin, and sTfR were determined on an ADVIA 120 automated hematology analyzer (Siemens, Tarrytown, NY, USA), an Axsym analyzer (Abbott Laboratories, Abbott Park, IL, USA), and a BNII nephelometer (Dade Behring, Marburg, Germany), Ann Hematol (2009) 88:913–915 DOI 10.1007/s00277-008-0668-4

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.

Reticulocyte haemoglobin content vs. soluble transferrin receptor and ferritin index in iron deficiency anaemia accompanied with inflammation

Ferritin concentration, as a parameter of iron status that is commonly used in the diagnosis of iron deficiency anaemia (IDA), often has limited values if the iron deficiency is accompanied by inflammatory disease. This study evaluated the value of reticulocyte haemoglobin content (CHr) and soluble transferrin receptor-ferritin index (sTfR/F) in the diagnosis of IDA and differential diagnosis of IDA and anaemia of chronic disease. The study included 66 nonanaemic individuals as controls, 86 patients with IDA divided into noninflammatory and inflammatory subgroups, and 32 patients with anaemia of chronic disease. Blood count, iron, transferrin saturation, total iron binding capacity, ferritin, C-reactive protein, sTfR and CHr were determined. Receiver operator characteristic curve analysis showed very high discriminating power for CHr, soluble transferrin receptor (sTfR) and sTfR/F in the diagnosis of IDA. In patients with anaemia of chronic disease these parameters showed no significant difference from the control. CHr and sTfR enabled recognition of iron deficiency and were not affected by acute phase reaction. They are sensitive markers of body iron status with additional value to conventional tests for the detection of iron deficiency.

Levels of serum transferrin receptor and its response to Fe-supplement in Fe-deficient children

The object of the present study was to investigate the levels of serum transferrin receptor (sTfR) and its response to Fe supplementation in Fe-deficient children and the role of sTfR in detecting Fe deficiency and assessing the efficacy of Fe supplementation. According to the diagnostic standard, 1006 children, aged 6-14 years in Fangshan district, Beijing, Peoples Republic of China, were divided into four groups: normal; Fe store depletion (IDs); Fe deficiency erythropoiesis (IDE); Fe deficiency anaemia (IDA). sTfR was determined and transferrin receptor-ferritin (TfR-F) index was calculated in 238 children, sixty-four normal and 174 Fe deficient. Children were administered a NaFeEDTA capsule containing 60 mg Fe once per week for the IDs and IDE groups and three times per week for the IDA group for nine consecutive weeks. The parameters reflecting Fe status and sTfR were determined before and after Fe supplementation. The levels of sTfR and TfR-F index in Fe-deficient children were significantly higher than those in the normal group. The receiver operating characteristic curve showed that sTfR has proper diagnostic efficacy for functional Fe deficiency. After Fe supplementation, the level of sTfR was significantly decreased in children with IDs, but not in children with IDE and IDA, while TfR-F index was significantly decreased in Fe-deficient children. sTfR is a reliable indicator for detecting functional Fe deficiency, and TfR-F index is a sensitive parameter for assessing the efficacy of Fe supplementation.

Association Between Transferrin Receptor–Ferritin Index and Conventional Measures of Iron Responsiveness in Hemodialysis Patients

The diagnostic power of the transferrin receptor-ferritin (TfR-F) index for identification of iron responsiveness in long-term hemodialysis (HD) patients compared with the routine markers recommended by the current US and European guidelines was appraised. Initially, 121 long-term HD patients with a serum ferritin level less than 800 microg/L and on recombinant erythropoietin (rHuEPO) therapy for longer than 6 months were enrolled for intravenous iron (IVFE) supplementation (100 mg of iron polymaltose 3 times/wk for 4 weeks, then 100 mg every 2 weeks for 5 months). Routine iron tests (ie, serum ferritin and transferrin saturation [TSAT]), TfR-F index calculated by the ratio of soluble TfR to log ferritin level, hematocrit, hemoglobin, red blood cell count, and serum high-sensitive C-reactive protein were examined at baseline. Hematocrit and hemoglobin were followed up every 2 weeks during the study period. One hundred patients (52 men, 48 women; mean age, 59 years) completed this study. Fifty-two patients were IVFE responders, defined as an increase in hematocrit greater than 3% and/or a decrease in rHuEPO dose greater than 30% of baseline values at the end of the study, and 48 nonresponders did not fulfill these criteria. Of 52 responders, only 14 patients (27%) could be recognized for iron deficiency by means of routine iron tests (ferritin < 100 microg/L and/or TSAT < 20%). Thirty-three responders (63%) could be further identified for iron deficiency by using TfR-F index (> 0.6), but 5 (10%) still could not by either method. Analyses by using receiver operating characteristic (ROC) curves showed that a cutoff value greater than 0.6 for TfR-F index had greater sensitivity (90%) for the detection of iron deficiency than ferritin level less than 100 microg/L (29%) and TSAT less than 20% (6%). TfR-F index showed a greater area under the ROC curve than ferritin level (P < 0.05) and TSAT (P < 0.001). TfR-F index is superior to routine tests for predicting response to IVFE supplementation in long-term HD patients. Our study indicates that TfR-F index is a new and surrogate marker to estimate body iron stores and guide IVFE therapy for long-term HD patients.