Serum soluble transferrin receptor and the prediction of marrow aspirate iron results in a heterogeneous group of patients

Abstract

Serum soluble transferrin receptor (sTfR) concentration has been evaluated in the diagnosis of iron deficiency in otherwise healthy individuals and in patients with rheumatoid arthritis, but has not been studied in a general population of patients with complicated clinical presentations. In this study, 145 anaemic patients with a variety of medical conditions undergoing diagnostic bone marrow aspiration for any reason were tested by a complete blood count, a panel of biochemical tests to evaluate iron status, bone-marrow aspirate iron stain, and serum sTfR concentration. Sixteen per cent lacked stainable iron in the marrow aspirate. All biochemical parameters differed significantly between patients with or without stainable marrow iron. The sTfR assay was significantly more sensitive but less specific than other iron status assays in identifying the absence of stainable iron. Logistic regression analysis demonstrated that only sTfR and ferritin contributed independently to the prediction of marrow iron status. Serum ferritin alone was highly specific but insensitive. A decision algorithm combining serum ferritin and sTfR was as sensitive as TfR and as specific as serum ferritin. The measurement of serum sTfR, especially in conjunction with serum ferritin, is a valuable addition to the existing methods for predicting the results of marrow aspirate iron stains.

The Content of Reticulocyte Hemoglobin and Serum Concentration of the Soluble Transferrin Receptor for Diagnostics of Anemia in Chronically Hemodialyzed Patients

“…The results of research conducted by other authors confirm the usefulness of an assessment of soluble transferrin receptor in diagnosing iron deficiencies [18][19][20][21]. Those authors recommend sTfR as a reliable index which makes it possible to assess the assimilability of iron during the treatment of its systemic deficiencies [19].…”

“…Those authors recommend sTfR as a reliable index which makes it possible to assess the assimilability of iron during the treatment of its systemic deficiencies [19]. The usefulness of sTfR assessment in the identification of anemia type was confirmed by, among others, Tarng and Huang.…”

Serum transferrin receptor in the evaluation of the iron status in elderly hospitalized patients with anemia

“…In a heterogeneous group of anemic patients, the sensitivity and speci®city were, respectively, 71% and 74% for sTfR and 25% and 99% for serum ferritin with respect to diagnosis of absence of stainable iron in bone marrow [9]. To explain the relatively poor performance of the sTfR assay, Means et al postulated that in iron de®ciency, tissue iron stores can become depleted while iron supply from the circulation is still adequate to sustain near-normal erythropoiesis [9]. Therefore, synthesis of cellular TfR levels may still be relatively normal and the sTfR level may not increase but still be lower then expected in view of the low tissue iron stores and the correspondingly low ferritin levels.…”

“…Additional authors found that sTfR was not superior to serum ferritin for the routine clinical evaluation of patients with IDA versus ACD [17,19]. In a heterogeneous group of anemic patients, the sensitivity and speci®city were, respectively, 71% and 74% for sTfR and 25% and 99% for serum ferritin with respect to diagnosis of absence of stainable iron in bone marrow [9]. To explain the relatively poor performance of the sTfR assay, Means et al postulated that in iron de®ciency, tissue iron stores can become depleted while iron supply from the circulation is still adequate to sustain near-normal erythropoiesis [9].…”

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

“…In unselected populations of patients with a variety of diagnoses, the specificity and positive predictive value of an elevated sTfR level for the diagnosis of iron deficiency is low because many patients have other reasons (predominantly increased erythropoiesis) for it [65]. Combining sTfR and ferritin measurements may increase specificity but not sensitivity for the diagnosis of iron deficiency in such a population [108].…”