The ratio of serum transferrin receptor and serum ferritin in the diagnosis of iron status

Malope, Babatyi I; Macphail, A. P.; Alberts, Marianne; Hiss, Donavon C

doi:10.1046/j.1365-2141.2001.03063.x

Cited by 102 publications

(74 citation statements)

References 30 publications

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“…This is particularly problematic when attempting to assess whether iron deficiency plays a (15,27), no population-based studies have validated its use in the tropics. The usefulness of different iron status measures in a tropical setting has been evaluated in several recent studies, but most of these are difficult to interpret due to the lack of a gold standard definition of iron deficiency.…”

Section: Discussionmentioning

confidence: 99%

Schistosoma japonicum Reinfection after Praziquantel Treatment Causes Anemia Associated with Inflammation

et al. 2006

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There is a relationship between schistosomiasis and anemia, although the magnitude and exact mechanisms involved are unclear. In a cohort of 580 Schistosoma japonicum-infected 7-to 30-year-old patients from Leyte, The Philippines, we evaluated the impact of reinfection with S. japonicum after treatment with praziquantel on the mean hemoglobin level, iron-deficiency (IDA) and non-iron-deficiency anemia (NIDA), and inflammatory markers. All participants were treated at baseline and followed up every 3 months for a total of 18 months. At each follow-up, participants provided stools to quantify reinfection and venous blood samples for hemograms and measures of iron status and inflammation. After 18 months, reinfection with S. japonicum was associated with a lower mean hemoglobin level (؊0.39 g/dl; 95% confidence interval [95% CI], ؊0.63 to ؊0.16) and 1.70 (95% CI, 1.10 to 2.61) times higher odds of all-cause anemia than those without reinfection. Reinfection was associated with IDA for high reinfection intensities only. Conversely, reinfection was associated with NIDA for all infection intensities. Reinfection was associated with serum interleukin-6 responses (P < 0.01), and these responses were associated with NIDA (P ‫؍‬ 0.019) but not with IDA (P ‫؍‬ 0.29). Our results provide strong evidence for the causal relationship between S. japonicum infection and anemia. Rapidly reinfected individuals did not have the positive treatment effect on hemoglobin seen in nonreinfected individuals. The principle mechanism involved in S. japonicum-associated anemia is that of proinflammatory cytokine-mediated anemia, with iron deficiency playing a role in high-intensity infections. Based on the proposed mechanism, anemia is unlikely to be ameliorated by iron therapy alone.

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Section: Discussionmentioning

confidence: 99%

Schistosoma japonicum Reinfection after Praziquantel Treatment Causes Anemia Associated with Inflammation

et al. 2006

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“…Because of the reciprocal relationship between serum sTfR and ferritin measurements, the ratio of sTfR/ferritin describes a perfect log-linear relationship to body iron over a wide range of normal and depleted iron stores [67]. This can also be obtained by the log of the ratio of sTfR to ferritin [68] or by the sTfR-ferritin index, the ratio of sTfR to log ferritin [61,69]. These ratios increase the sensitivity of sTfR in detecting latent iron deficiency.…”

Section: Soluble Tfr and Iron Statusmentioning

confidence: 99%

“…However, the combined use of sTfR and ferritin or the use of TfR/ferritin or TfR/log ferritin ratios may increase the efficacy of sTfR in identifying iron deficiency in patients with chronic inflammation [61,87,88,94,103]. In particular, the log (sTfR/ferritin) ratio may prove superior to the sTfR/log ferritin index [68]. Table 2 Differential diagnosis between iron deficiency anemia (IDA), anemia of chronic disorder (ACD) and the combination of ACD + IDA Hb Serum iron Ferritin sTfR sTfR/ferritin…”

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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“…Because SF levels can be increased during inflammation, they have limitations in accurately predicting the mechanism of anemia in anemic persons with intermediate ferritin levels. 14,23 When the available iron for erythropoiesis is low (in the context of true iron deficiency), membrane transferrin receptors are released and sTfR levels are increased. 19,23 Although sTfR levels are increased during iron deficiency, they are not appreciably affected by inflammation.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16][17][18][19][20][21] Serum ferritin directly correlates with total iron storage in the body and low levels are indicative of true IDA when hemoglobin (Hb) levels are reduced. 13,18 When a person has reduced Hb levels and high SF levels, the patient is iron replete.…”

Section: Introductionmentioning

confidence: 99%

Mechanism of Anemia in Schistosoma mansoni–Infected School Children in Western Kenya

Butler¹,

Muok²,

Montgomery³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. A better understanding of the mechanism of anemia associated with Schistosoma mansoni infection might provide useful information on how treatment programs are implemented to minimize schistosomiasis-associated morbidity and maximize treatment impact. We used a cross-sectional study with serum samples from 206 Kenyan school children to determine the mechanisms in S. mansoni-associated anemia. Serum ferritin and soluble transferrin receptor levels were measured by using an enzyme-linked immunosorbent assay. Results suggest that S. mansoni-infected persons are more likely (odds ratio = 3.68, 95% confidence interval = 1.33-10.1) to have levels of serum ferritin ( 100 ng/mL) that are associated with anemia of inflammation (AI) than S. mansoni-uninfected children. Our results suggest that AI is the most common form of anemia in S. mansoni infections. In contrast, the mechanism of anemia in S. mansoni-uninfected children was iron deficiency. Moreover, the prevalence of AI in the study participants demonstrated a significant trend with S. mansoni infection intensity (P 0.001). Our results are consistent with those observed in S. japonicum-associated anemia.

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The ratio of serum transferrin receptor and serum ferritin in the diagnosis of iron status

Cited by 102 publications

References 30 publications

Schistosoma japonicum Reinfection after Praziquantel Treatment Causes Anemia Associated with Inflammation

Schistosoma japonicum Reinfection after Praziquantel Treatment Causes Anemia Associated with Inflammation

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

Mechanism of Anemia in Schistosoma mansoni–Infected School Children in Western Kenya

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