Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia

Suominen, Pauli; Möttönen, Timo; Rajamäki, Allan; Irjala, Kerttu

doi:10.1002/1529-0131(200005)43:5<1016::aid-anr9>3.0.co;2-3

Cited by 78 publications

(62 citation statements)

References 16 publications

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“…Prior studies have suggested that the sTfR Index may improve the ability to accurately classify anemia in diseases with active inflammation [5,[15][16][17][18]. However, these studies involved single institutions with a limited number of subjects reflecting the specialized patient population at that center, which can introduce possible bias in study outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The sTfR Index thus takes advantage of the reciprocal relationship between two variables influenced by iron deficiency, an increase in sTfR and a decrease in the ferritin concentration. While sTfR and ferritin measurements are useful in the diagnosis of iron deficiency and in the differential diagnosis of various types of anemia, some reports have suggested that the combination of sTfR and ferritin measurements and the calculation of the sTfR Index improves the ability to accurately classify anemia, particularly in anemia accompanying diseases with active inflammation [5,[15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: A prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index

et al. 2011

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Anemia of chronic disease (ACD) and iron deficiency anemia (IDA) are the most prevalent forms of anemia and often occur concurrently. Standard tests of iron status used in differential diagnosis are affected by inflammation, hindering clinical interpretation. In contrast, soluble transferrin receptor (sTfR) indicates iron deficiency and is unaffected by inflammation. Objectives of this prospective multicenter clinical trial were to evaluate and compare the diagnostic accuracy of sTfR and the sTfR/log ferritin index (sTfR Index) for differential diagnosis using the automated Access® sTfR assay (Beckman Coulter) and sTfR Index. We consecutively enrolled 145 anemic patients with common disorders associated with IDA and ACD. Subjects with IDA or ACD + IDA had significantly higher sTfR and sTfR Index values than subjects with ACD (P < 0.0001). ROC curves produced the following cutoffs for sTfR: 21 nmol/L (or 1.55 mg/L), and the sTfR Index: 14 (using nmol/L) (or 1.03 using mg/L). The sTfR Index was superior to sTfR (AUC 0.87 vs. 0.74, P < 0.0001). Use of all three parameters in combination more than doubled the detection of IDA, from 41% (ferritin alone) to 92% (ferritin, sTfR, sTfR Index). Use of sTfR and the sTfR Index improves detection of IDA, particularly in situations where routine markers provide equivocal results. Findings demonstrate a significant advantage in the simultaneous determination of ferritin, sTfR and sTfR Index. Obtaining a ferritin level alone may delay diagnosis of combined IDA and ACD. Am. J. Hematol., 2011. © 2011 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: A prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index

et al. 2011

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“…Several investigators have reported that mean sTfR levels were uninfluenced by conditions of chronic inflammatory diseases in adults, thus reflecting the true iron status of the individual (Ferguson et al, 1992;Suominen et al, 2000). In parasitic infections like malaria, Kuvibidila et al (1995) found sTfR levels to reflect the true iron status of the individual.…”

Section: Discussionmentioning

confidence: 99%

Serum transferrin receptor in children with respiratory infections

et al. 2003

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Objective: To study the effect of infection on iron status in children suffering from acute, mild or severe respiratory infections and to determine the nature of anemia in infection using serum transferrin receptor (sTfR) levels. Design: Forty-three children aged between 3 and 5 y with no evidence of infection and receiving iron supplements in the preceding 100 days served as controls. Twenty-one children with mild upper respiratory infection and 94 children hospitalized for acute pneumonia constituted the experimental group. Hemoglobin (Hb), sTfR and serum ferritin were estimated in all the children at the time of diagnosis and again on the 15th and 30th days after the infection in those who were available for followup. Results: Mean (95% CI) sTfR was 6.08 (5.1 -7.1) mg=l in healthy non-anemic children. Upper respiratory infection had no impact on Hb or sTfR but it significantly elevated serum ferritin levels. Eighty-three percent of the children with pneumonia had Hb less than 110 g=l at the time of diagnosis and had elevated mean sTfR, 18.0 (15.7 -20.3) mg=l. There was a decline in mean sTfR by the 15th day of infection to 14.3 (11.3 -17.4) mg=l with further rise to 22.9 (13.0 -31.9) mg=l by 30 days. Serum ferritin was significantly elevated at the time of diagnosis (85.9; 71.1 -100.8 mg=l) as well as at 15 days (89.1; 68 -110.1 mg=l) with a decline by 30 days. Conclusions: Severe lower respiratory infection exaggerates iron-deficient erythropoiesis by blocking release of iron from the storage pools. sTfR may not be a sensitive and specific tool of assessing true iron status of children exposed to severe infections.

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“…Values of sTfR decrease after adequate iron supplementation, independently of marrow iron stores, indicating that they are good indicators of functional iron deficiency [90]. Contrarily to serum ferritin, sTfR may thus prove to be a diagnostic test of iron deficiency in patients with inflammation.…”

Section: Soluble Tfr and Inflammationmentioning

confidence: 99%

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

Béguin

2003

Clinica Chimica Acta

395

316

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Iron transport in the plasma is carried out by transferrin, which donates iron to cells through its interaction with a specific membrane receptor, the transferrin receptor (TfR). A soluble form of the TfR (sTfR) has been identified in animal and human serum. Soluble TfR is a truncated monomer of tissue receptor, lacking its first 100 amino acids, which circulates in the form of a complex of transferrin and its receptor. The erythroblasts rather than reticulocytes are the main source of serum sTfR. Serum sTfR levels average 5.0 F 1.0 mg/l in normal subjects but the various commercial assays give disparate values because of the lack of an international standard. The most important determinant of sTfR levels appears to be marrow erythropoietic activity which can cause variations up to 8 times below and up to 20 times above average normal values. Soluble TfR levels are decreased in situations characterized by diminished erythropoietic activity, and are increased when erythropoiesis is stimulated by hemolysis or ineffective erythropoiesis. Measurements of sTfR are very helpful to investigate the pathophysiology of anemia, quantitatively evaluating the absolute rate of erythropoiesis and the adequacy of marrow proliferative capacity for any given degree of anemia, and to monitor the erythropoietic response to various forms of therapy, in particular allowing to predict response early when changes in hemoglobin are not yet apparent. Iron status also influences sTfR levels, which are considerably elevated in iron deficiency anemia but remain normal in the anemia of inflammation, and thus may be of considerable help in the differential diagnosis of microcytic anemia. This is particularly useful to identify concomitant iron deficiency in a patient with inflammation because ferritin values are then generally normal. Elevated sTfR levels are also the characteristic feature of functional iron deficiency, a situation defined by tissue iron deficiency despite adequate iron stores. The sTfR/ferritin ratio can thus describe iron availability over a wide range of iron stores. With the exception of chronic lymphocytic leukemia (CLL) and high-grade non-Hodgkin's lymphoma and possibly hepatocellular carcinoma, sTfR levels are not increased in patients with malignancies. We conclude that soluble TfR represents a valuable quantitative assay of marrow erythropoietic activity as well as a marker of tissue iron deficiency. D

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Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia

Abstract: The results of this study elucidate the roles of sTfR and the TfR-F Index in the differential diagnosis between IDA and ACD and provide direct evidence that these parameters are useful in detecting FID, irrespective of the concurrent iron storage status.

Cited by 78 publications

References 16 publications

Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: A prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index

Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: A prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index

Serum transferrin receptor in children with respiratory infections

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

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