Serum transferrin receptor concentration indicates increased erythropoiesis in Kenyan children with asymptomatic malaria

Verhoef, Hans; West, C.E.; Ndeto, Paul; Burema, J.; Béguin, Yves; Kok, F.J.

doi:10.1093/ajcn/74.6.767

Cited by 96 publications

(85 citation statements)

References 37 publications

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“…Mean sTfR concentration obtained in the current study compares well with findings from studies that have used the Ramco sTfR kit (42)(43)(44)(45) . Serum sTfR concentration does not appear to be affected by infectious or inflammatory conditions (46) except for malaria, which in some studies has been observed to increase sTfR levels (47)(48)(49) while in at least one other study caused a decrease in sTfR (50) . We did not find any difference in sTfR levels by malaria status or by infection/ inflammation (data not shown).…”

Section: Discussionmentioning

confidence: 99%

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

Baingana

Enyaru

Tjalsma

et al. 2014

Public Health Nutr.

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Objective: To describe the aetiology of anaemia in pregnant Ugandan women and explore Fe deficiency and common infections as contributors to anaemia in this population. Design: Cross-sectional study in which Hb, ferritin, transferrin receptor (sTfR), C-reactive protein, α-1 acid glycoprotein, hepcidin, malaria, hookworm infestation, syphilis and Helicobacter pylori infection were assessed. Setting: Antenatal care clinic at Kawempe Health Centre, Kampala, Uganda. Subjects: HIV-negative women (n 151) in their first or second pregnancy at 10-16 weeks' gestation. Results: The prevalence of anaemia was 29·1 %. Fe deficiency was 40·4 % and 14·6 % based on ferritin <30 μg/l and on adjusted ferritin <12 μg/l respectively, and 6·6 % based on sTfR >8·3 μg/ml. The prevalence of Fe-deficiency anaemia was 9·3 % based on ferritin <30 μg/l, 6·6 % based on adjusted ferritin <12 μg/l and 4·3 % based on sTfR >8·3 μg/ml. Hepcidin concentration was positively correlated with ferritin concentration (n 151, r = 0·578, P < 0·00001). H. pylori infection was highly prevalent (70 %) while malaria, hookworm infestation and syphilis were not common. Of all women, 60·3 % had α-1 acid glycoprotein >1 g/l and/or C-reactive protein >5 mg/l. Malaria parasitaemia (OR = 6·85; 95 % CI 1·25, 37·41, P = 0·026) and Fe deficiency defined using sTfR (OR = 5·58; 95 % CI 1·26, 24·80, P = 0·024) were independently and positively associated with anaemia. Populationattributable risk factors for anaemia for raised C-reactive protein, Fe deficiency defined by sTfR >8·3 μg/ml and presence of malaria parasites were 41·6 (95 % CI 11·1, 72·2) %, 13·5 (95 % CI 2·0, 25·0) % and 12·0 (95 % CI 1·4, 22·6) %, respectively. Conclusions: Infections and inflammation are of greater significance than Fe deficiency in the aetiology of anaemia in pregnant Ugandan women during the first trimester. Keywords Anaemia Iron status Pregnancy Infection UgandaNearly 25 % of the world's population suffers from anaemia, with pregnant women and children of pre-school age the most affected (1) . In Uganda, anaemia is the third leading cause of in-patient mortality (2) . In 2011, 49 % of under-fives, 23 % of women of child-bearing age and 31 % of pregnant women in Uganda had anaemia (3) . Anaemia in developing countries has a multifactorial aetiology which includes Fe deficiency (ID) due to dependence on predominantly plant-based diets from which adequate Fe cannot be absorbed (4,5) . Infections such as malaria and hookworm infestation also contribute significantly to the high prevalence of anaemia in many settings (6) . Additionally, infection and inflammation defined by raised biomarkers contribute to anaemia as was demonstrated in a study in Malawi in which C-reactive protein (CRP) was elevated in 73·5 % of anaemic pregnant women who were Fe-replete by bone marrow assessment (7) . Hinderaker et al. (8) also found an association between elevated CRP and anaemia in pregnant women in rural Tanzania. More recently, Helicobacter pylori, the most common infection globally, has been

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Section: Discussionmentioning

confidence: 99%

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

Baingana

Enyaru

Tjalsma

et al. 2014

Public Health Nutr.

View full text Add to dashboard Cite

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“…Higher TfR concentrations among people infected with malaria (Mockenhaupt et al, 1999;Stoltzfus et al, 2000;Menendez et al, 2001;Verhoef et al, 2001) have led investigators to suggest that the high TfR reflects increased erythropoeisis resulting from malaria induced hemolysis. Others, however, have reported lower TfR concentrations during malaria suggestive of blunted erythropoeisis (Williams et al, 1999;Beesley et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Influence of inflammation as measured by α-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women

et al. 2008

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“…The area has been described in more detail elsewhere. 23,26 Clinical records of outpatient and inpatient attendance and fever incidence in Kibwezi Rural Health Centre, located at a distance of 40 km, show that malaria transmission is highly seasonal, and follows 2 annual peaks in rainfall distribution in October through January and March through May. Children were recruited at the start of the rainy seasons in the period 1998 to 2000.…”

Section: Area and Populationmentioning

confidence: 99%

“…[16][17][18] Studies from Zaire, however, failed to show an effect on sTfR concentrations of malaria, 19,20 whereas reports from cross-sectional studies among nonhospitalized Africans give support to increased sTfR concentration in malaria. [21][22][23] Erythroid hyperplasia with dyserythropoiesis may also occur in malaria, and appears more common in patients with severe anemia and low-grade parasitemia than in those with acute malaria. 12 We used longitudinal data to investigate whether malaria and iron deficiency in asymptomatic Kenyan children independently cause increased erythropoiesis.…”

Section: Introductionmentioning

confidence: 99%

Malarial anemia leads to adequately increased erythropoiesis in asymptomatic Kenyan children

Verhoef

West

Kraaijenhagen

et al. 2002

Blood

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Malarial anemia is associated with a shift in iron distribution from functional to storage compartments. This suggests a relative deficit in erythropoietin production or action similar to that observed in other infections. Our study in Kenyan children with asymptomatic malaria aimed at investigating whether malaria causes increased erythropoiesis, and whether the erythropoietic response appeared appropriate for the degree of resulting anemia. Longitudinal and baseline data were used from a trial with a 2 ؋ 2 factorial design, in which 328 anemic Kenyan children were randomly assigned to receive either iron or placebo, and sulfadoxinepyrimethamine or placebo. Erythropoiesis was evaluated by serum concentrations of erythropoietin and soluble transferrin receptor. Prospectively collected data showed that malarial infection resulted in decreased hemoglobin concentrations, and increased serum concentrations of erythropoietin and transferrin receptor. Conversely, disappearance of malarial antigenemia resulted in increased hemoglobin concentrations, and decreased concentrations of these serum indicators. Additionally, our baseline data showed that current or recent malarial infection is associated with increased serum concentrations of erythropoietin and transferrin receptor, and that these were as high as or perhaps even higher than values of children without malarial infection and without inflammation. Our findings indicate that in asymptomatic malaria, the erythropoietic response is adequate for the degree of anemia, and that inflammation probably plays no or only a minor role in the pathogenesis of the resulting anemia. Further research is needed to demonstrate the role of deficient erythropoietin production or action in the pathogenesis of the anemia of symptomatic malaria. (Blood. 2002;100: 3489-3494)

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Serum transferrin receptor concentration indicates increased erythropoiesis in Kenyan children with asymptomatic malaria

Cited by 96 publications

References 37 publications

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

Influence of inflammation as measured by α-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women

Malarial anemia leads to adequately increased erythropoiesis in asymptomatic Kenyan children

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