scholarly journals DIAGNOSTIC ACCURACY OF SERUM FERRITIN AND SOLUBLE SERUM TRANSFERRIN RECEPTOR, TAKING BONE MARROW IRON STAIN AS A GOLD STANDARD FOR IRON DEFICIENCY ANEMIA IN HETEROGENOUS GROUP OF PATIENTS

2021 ◽  
Vol 71 (6) ◽  
pp. 1920-24
Author(s):  
Tayyaba Ashiq ◽  
Ammara Hafeez ◽  
Abdus Sattar ◽  
Nasiruddin . ◽  
Naureen Saeed ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Diagnostic Accuracy ◽  
Serum Ferritin ◽  
Transferrin Receptor ◽  
Gold Standard ◽  
Bone Marrow Examination ◽  
Deficiency Anemia ◽  
Serum Transferrin Receptor ◽  
Bone Marrow Iron

Objective: To determine the diagnostic accuracy of serum ferritin and soluble serum transferrin receptor (sTfR), taking bone marrow iron stain as a gold standard for iron deficiency anaemia in heterogeneous group of patients. Study Design: Cross-sectional diagnostic accuracy study. Place and Duration of Study: Department of Diagnostic, Combined Military Hospital Lahore, from Mar to Aug 2020. Methodology: A total of 55 adult patients, of both genders, undergoing bone marrow examination for any reason were enrolled. Patients with known hemolytic condition (sickle cell anemia, megaloblastic anemia), taking erythropoietin/iron supplements, transfused red cell concentrate (RCC) recently or undergoing chemotherapy were excluded. Age, gender, clinical history and results of bone marrow examination, complete blood count (CBC), serum Ferritin and C-reactive protein (CRP) were recorded. Results: Serum ferritin was found to be less sensitive (28%) but more specific (100%) for reflecting reduced bone marrow iron stores as compared to sTfR (sensitivity: 60%, specificity: 96.6%). sTfR had highest likelihood ratio (15) and diagnostic accuracy (80%). On Receiver Operator Characteristic (ROC) graph Transferrin index (AUC=0.908) showed maximum accuracy, followed by Ferritin (AUC=0.884) and sTfR (AUC=0.879). Conclusion: Serum soluble transferring receptor (sTfR) and transferrin index has advantage over serum ferritin alone in predicting the bone marrow iron stores and differentiating iron deficiency anemia from anemia of chronic disease.

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

Blood ◽  
1997 ◽  
Vol 89 (3) ◽  
pp. 1052-1057 ◽  
Author(s):  
Kari Punnonen ◽  
Kerttu Irjala ◽  
Allan Rajamäki
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Laboratory Tests ◽  
Bone Marrow Examination ◽  
Deficiency Anemia ◽  
Serum Transferrin ◽  
Iron Stores ◽  
Serum Transferrin Receptor ◽  
Reference Limits

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.

scholarly journals Diagnosing Absolute Iron-Deficiency Anemia in Patients on Hemodialysis in a Tertiary Care Centre: A Retrospective Chart Review

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4814-4814
Author(s):  
Robert C. Clayden ◽  
Wilma Hopman ◽  
Frances Macleod ◽  
David Good ◽  
Jocelyn Garland ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Serum Ferritin ◽  
Research Funding ◽  
Iron Status ◽  
Bone Marrow Examination ◽  
Hemodialysis Patients ◽  
Deficiency Anemia ◽  
Iron Deficient ◽  
Absolute Iron Deficiency

Introduction: The gold standard for the diagnosis of absolute iron-deficiency anemia (IDA) in hemodialysis patients is a bone marrow aspirate with iron staining. Many clinicians use peripheral iron indices instead because they are non-invasive. Previous studies suggested that a serum ferritin < 200 ng/mL was a reliable indicator of absolute iron deficiency in the hemodialysis population. However, the sensitivity of serum ferritin for the diagnosis of IDA in hemodialysis patients is poor. Methods: The primary objective of this study was to identify the optimal ferritin value to diagnose patients with absolute iron deficiency, as assessed on bone marrow aspiration, in the renal dialysis population. Secondary endpoints included the rate of clinically relevant findings on gastrointestinal investigation according to iron status. Research Ethics Board approval was obtained from Queen's University for this retrospective chart review. Hematopathology laboratory records were used to determine all individuals who had bone marrow examination at Kingston Health Sciences tertiary referral center between 2008 January 1 and 2018 August 21. This list was cross-referenced with the Nephrology dialysis database to identify the pre-specified study cohort; those who were receiving concurrent hemodialysis or peritoneal dialysis. Iron deficiency was defined as reduced or absent iron stores on bone marrow aspirate with Perl's Prussian blue stain. Anemia was defined as hemoglobin <130 g/L in males and <120 g/L in females. Additional parameters collected included ferritin (normal range 22 - 275 ng/mL male and 4 - 205 ng/mL female), transferrin saturation (TSAT, normal range 20-55%), vitamin B12, folate, albumin, CRP and thyroid function tests. Peripheral iron indices over six months were analyzed; statistical analysis was performed with t-tests and Mann-Whitney U tests. ROC curves were generated to determine the sensitivity and specificity of various threshold values for serum ferritin and TSAT. Results: Between 2008 January 1 and 2018 August 21, 4234 patients underwent bone marrow examination, of whom 28 had received renal dialysis replacement therapy at some point. Fifteen patients concurrently at the time of bone marrow testing receiving hemodialysis form the study population (Table 1). Among these fifteen patients, 6 (40%) were female, median age was 70.5 (range 39 - 80) years and all were anemic (Hb range 73 - 110 g/L). Four of these individuals were absolutely iron-deficient with reduced or absent iron stores by bone marrow evaluation. The mean ferritin and TSAT values for individuals with absolute iron deficiency by bone marrow aspiration was 273.5 ng/mL (n=4; median 224.5 ng/mL; range 158-539 ng/mL) and 22.0% (n=3; median 20%; range 20-26%), respectively. All four commenced erythropoietin stimulating agents; two received oral iron supplementation. Eight patients, including two of those determined to be absolutely iron deficient on bone marrow, had endoscopic investigation. Two were identified to have sources of gastrointestinal bleeding, both with ferritin values in the 100-200 range (106 and 189 ng/mL). With the limited sample size, the sensitivity and specificity of ferritin to identify absolute iron deficiency in this hemodialysis population was 50% and 85%, respectively, at a threshold of 198 ng/mL. Discussion: Ferritin and TSAT are not sensitive markers for absolute iron deficiency in hemodialysis patients. Bone marrow examination is performed in a minority. The small sample size in this study precludes definitive determination of an optimal ferritin cut-off to diagnose iron deficiency in the dialysis population. Uncertainty about actual iron status may result in alternative invasive testing, such as colonoscopy, to investigate the cause of their anemia. Newer tests such as reticulocyte hemoglobin content and percent hypochromic red blood cells are more accurate and may guide diagnosis and management of IDA in hemodialysis patients. However they are not always routinely available. Further studies are needed to compare the utility of these peripheral iron indices to the gold standard bone marrow examination in a larger population, to allow identification of patients with absolute or functional IDA, and minimize invasive and potentially unnecessary investigation. Disclosures Hay: AbbVie: Research Funding; Kite: Research Funding; Janssen: Research Funding; Seattle Genetics: Research Funding; Celgene: Research Funding; MorphoSys: Research Funding; Roche: Research Funding; Novartis: Research Funding; Gilead: Research Funding; Takeda: Research Funding.

scholarly journals Role of intensive method of bone marrow iron assessment and serum Ferritin in prediction of iron deficiency: a study of 143 patients

2018 ◽  
Vol 5 (4) ◽  
pp. 686-691
Author(s):  
Mayank Singh ◽  
Swati Raj ◽  
Dwijendra Nath ◽  
Pallavi Agrawal ◽  
Sufiya Ahmed
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Serum Ferritin ◽  
Bone Marrow Iron

scholarly journals Serum transferrin receptor: a quantitative measure of tissue iron deficiency

Blood ◽  
1990 ◽  
Vol 75 (9) ◽  
pp. 1870-1876 ◽  
Author(s):  
BS Skikne ◽  
CH Flowers ◽  
JD Cook
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Transferrin Receptor ◽  
Iron Status ◽  
Serum Transferrin ◽  
Mean Cell Volume ◽  
Functional Iron Deficiency ◽  
Iron Stores ◽  
Serum Transferrin Receptor ◽  
Tissue Iron

Abstract This study was undertaken to evaluate the role of serum transferrin receptor measurements in the assessment of iron status. Repeated phlebotomies were performed in 14 normal volunteer subjects to obtain varying degrees of iron deficiency. Serial measurements of serum iron, total iron-binding capacity, mean cell volume (MCV), free erythrocyte protoporphyrin (FEP), red cell mean index, serum ferritin, and serum transferrin receptor were performed throughout the phlebotomy program. There was no change in receptor levels during the phase of storage iron depletion. When the serum ferritin level reached subnormal values there was an increase in serum receptor levels, which continued throughout the phlebotomy program. Functional iron deficiency was defined as a reduction in body iron beyond the point of depleted iron stores. The serum receptor level was a more sensitive and reliable guide to the degree of functional iron deficiency than either the FEP or MCV. Our studies indicate that the serum receptor measurement is of particular value in identifying mild iron deficiency of recent onset. The iron status of a population can be fully assessed by using serum ferritin as a measure of iron stores, serum receptor as a measure of mild tissue iron deficiency, and hemoglobin concentration as a measure of advanced iron deficiency.

scholarly journals Soluble Serum Transferrin Receptor (STFR) Levels in Hemodialysis Patients

2016 ◽  
Vol 22 (4) ◽  
Author(s):  
Ayesha Majeed ◽  
Aisha Hameed ◽  
Iram Aftab ◽  
Muhammad Anees ◽  
Shahida Mohsin ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Renal Disease ◽  
Serum Ferritin ◽  
Transferrin Receptor ◽  
Hemodialysis Patients ◽  
Serum Transferrin ◽  
Soluble Transferrin Receptor ◽  
Serum Transferrin Receptor ◽  
Iron Deficient ◽  
Stage Renal Disease

<p><strong>Objectives:  </strong>Anemia is a frequent disorder in patients with end stage renal disease. Erythropoietin is advised in these patients; however, this therapy is not effective in patients who are iron deficient. So, diagnosis of iron deficiency which is traditionally based on ferritin and other iron parameters becomes difficult in these patients, as chronic kidney disease is a chronic inflammatory condition which affects these markers and masks the iron deficiency. In present study, we assessed the reliability of another indicator of body iron supply; serum transferrin receptor, in hemodialysis patients. It is not affected in case of inflammation unlike other markers of iron status.</p><p><strong>Patients and Methods:</strong><strong>  </strong>Eighty Patients with end</p><p>stage renal disease, 20 to 60 years of age and both sexes were included. All cases were examined for complete blood count, serum iron, serum ferritin, serum total iron binding capacity, transferrin saturation and serum soluble transferrin receptor. Data was analysed by using independent sample <em>t</em> test and Pearson’ correlation. A <em>p </em>value of ≤ 0.05 was considered as significant.<strong></strong></p><p><strong>Results:  </strong>The results of our research showed that mean values of serum soluble transferrin receptor and serum ferritin were 3.28 ± 0.83 µg/ml and 286.31 ± 165 ng/ml respectively which were significantly higher than the upper normal limit (<em>p </em>&lt; 0.001). Levels of sTfR were statistically different (<em>p </em>= 0.002) between iron replete group (SF &gt; 100 ng/ml) and iron deplete group (SF &lt; 100 ng/ml). Additionally, there was negative and significant correlation between sTfR and Hemoglobin.</p><p><strong>Conclusions:  </strong>Levels of serum soluble transferrin receptor can be used as a reliable marker of iron defi-ciency in hemodialysis patients.</p>

The Ratio of Serum Transferrin Receptor and Serum Ferritin in the Diagnosis of Iron Deficiency Anaemia in Young Children

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3746-3746
Author(s):  
EunSil Park ◽  
In-Suk Kim ◽  
JiHyun Seo ◽  
JaeYoung Lim ◽  
ChanHoo Park ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Transferrin Receptor ◽  
Iron Deficiency Anaemia ◽  
Normal Group ◽  
Growth Spurt ◽  
Serum Transferrin ◽  
Deficiency Anaemia ◽  
Serum Transferrin Receptor ◽  
The Mean

Abstract The incidence of iron deficiency anaemia in 6∼24 month old infants due to increase in iron demand for growth spurt is reported ranged 10 to 40%. However this age group has a common acute illness such as urinary tract infection, pneumonia, and other viral infections. The aim of this study is to evaluate that iron parameter and acute phase reactant are useful parameters in differentiating anaemia by infection from anemia by iron deficiency and the mixed anaemia of these. Among 6–24 months of the infants who visited Gyeongsang Univeristy Hospital for 7 years from 2000 to 2006, 131 infants were enrolled. Hemoglobin(Hb), serum ferritin(SF), serum transferrin receptor(STfR), C reactive protein(CRP), interleukin-6(IL-6), prohepcidine were checked. The subgroup of anaemia of inflammation(AI) was defined as Hb &lt;11 g/dL and SF &gt;50 μg/L, the subgroup of iron deficiency anaemia(IDA) as Hb &lt;11 g/dL and SF &lt;12 μg/L and the normal group as Hb ≥11 and SF ≥12 μg/L. The mean STfR in the subgroup of AI, IDA and normal was 3.89(±2.64), 10.6(±4.95) and 3.96(±1.24), respectively. The mean STfR/Log SF of subgroup was 1.87(±1.55), 36.11(±71.5), 2.31(±0.97), respectively. The mean Log(STfR/SF) was statistically significant between 3 subgroup. All IDA group had Log(STfR/SF) &gt;2.55 whereas in all subjects classified as AI it was &lt;2.55, thus clearly separating two. The mean IL-6 of AI was significantly higher than IDA subgroup and the mean prohepcidine of AI was significantly lower than the normal group. Calculating Log(STfR/SF) is a useful criteria in classification of the iron status. Prohepcine has nothing to do with AI. Iron signal predominant over inflammatory signal in AI. The Mean(±SD) of STfR, STfR/LogSF, Log (TfR/SF), CRP, IL-6 and Prohepcidine in Subgroups. AI IDA Normal Same letters mean that are not significantly different (P &lt;0.05) AI, anaemia of inflammation; IDA, iron deficiency anaemia Subgroup(%) 33(25) 29(22) 69(53) Hg(g/dL) &lt;11 &lt;11 ≥11 SF(μg/L) &gt;50 &lt;12 ≥12 STfR mean(±SD) 3.89(2.64)a 10.6(4.95) b 3.96(1.24) a STfR/LogSF mean (±SD) 1.87(1.55) a 36.11(71.5) b 2.31(0.97) a Log (TfR/SF) mean(±SD) 1.30(0.56) a 3.29(0.43) b 1.76(0.43) c CRP mean(±SD) 28(39.2) a 7.6(9.6) b 17(28.0) a IL-6 mean(±SD) 6.1(10.5) a 2.0(6.3) b 4.78(11.3) c Prohepcidine mean(±SD) 204(70.5) a 234(144) a 301(120.6) b Fig.1. Log(TfR/SF) in the subgroup. AI, anaemia of inflammation; IDA, Iron deficiency anaemia. Dotted lines indicate the cut-off value at Log(TfR/SF)=2.55 Fig.1. Log(TfR/SF) in the subgroup. AI, anaemia of inflammation; IDA, Iron deficiency anaemia. Dotted lines indicate the cut-off value at Log(TfR/SF)=2.55

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