Serum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency

Abstract

The objective of the study was to evaluate the diagnostic efficiency of laboratory tests, including serum transferrin receptor (TfR) measurements, in the diagnosis of iron depletion. The patient population consisted of 129 consecutive anemic patients at the University Hospital of Turku who were given a bone marrow examination. Of these patients, 48 had iron deficiency anemia (IDA), 64 anemia of chronic disease (ACD), and 17 patients had depleted iron stores and an infectious or an inflammatory condition (COMBI). Depletion of iron stores was defined as a complete absence of stainable iron in the bone marrow examination. Serum TfR concentrations were elevated in the vast majority of the IDA and COMBI patients, while in the ACD patients, the levels were within the reference limits reported earlier for healthy subjects. TfR measurement thus provided a reliable diagnosis of iron deficiency anemia (AUCROC 0.98). Serum ferritin measurement also distinguished between IDA patients and ACD patients. However, the optimal decision limit for evaluation of ferritin measurements was considerably above the conventional lower reference limits, complicating the interpretation of this parameter. Calculation of the ratio TfR/log ferritin (TfR-F Index) is a way of combining TfR and ferritin results. This ratio provided an outstanding parameter for the identification of patients with depleted iron stores (AUCROC 1.00). In anemic patients, TfR measurement is a valuable noninvasive tool for the diagnosis of iron depletion, and offers an attractive alternative to more conventional laboratory tests in the detection of depleted iron stores.

Non‐anaemic iron deficiency – a disease looking for recognition of diagnosis: a systematic review

“…There has been conflicting data on the effect of NAID on childhood growth and development (6)(7)(8)(9), cognitive function (10)(11)(12)(13), work capacity (14)(15)(16)(17)(18)(19)(20)(21), pregnancy (22)(23)(24) and fatigue (25)(26)(27)(28). There are few consistent clinical symptoms or signs of iron deficiency (29,30). Serum ferritin is an indirect measure of iron stores where each microgram per litre is approximately equivalent to 8 mg of stored iron (31).…”

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

“…Lab. Haem., 21, 161-167 matoid arthritis (Pettersson, Kivivuori & Siimes 1994;Fitzsimons et al 1997;Punnonen, Irjala & Rajamaki 1997), a model for chronic inflammatory disease. Since patients seen by a physician do not often fall into such clear categories, it is essential that a new diagnostic test be effective in a diverse group of patients.…”

Anaemia in the critically ill patient: monitoring of erythropoietin therapy

“…Ret-Hb provides direct real-time evaluation of the bone marrow activity, reflecting the balance between iron availability and erythropoiesis. As an indicator for proliferation and iron availability to the bone marrow, the ratio of serum soluble transferrin receptor (sTfR) concentration to the logarithm of serum ferritin concentration (sTfR/log ferritin = ferritin index) is a valuable tool [9]. In healthy subjects, Ret-Hb is 28-35 pg and the ferritin index is < 1.5 [10].…”