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1
Latif, Abdul, Farhana Hoque, Muhammad Rafiqul Alam, Asia Khanam, Sarwar Iqbal, Muhammad Abdur Rahim, Md Mostarshid Billah, Md Obaidur Rahman, and Tufayel Ahmed Chowdhury. "Serum Soluble Transferrin Receptor-Ferritin Indices in Diagnosing and Differentiating Iron Deficiency Anemia from Anemia of Chronic Disease among Patients with Chronic Kidney Disease." BIRDEM Medical Journal 9, no. 2 (May 5, 2019): 151–56. http://dx.doi.org/10.3329/birdem.v9i2.41282.
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Background: Anemia is common in patients with chronic kidney disease (CKD) and this is generally anemia of chronic disease (ACD), but iron deficiency anemia (IDA) is also common. Soluble transferrin receptor (sTfR) is a useful marker for IDA. Present study was undertaken to assess the utility of sTfR as a marker of IDA and to differentiate ACD from IDA in selected group of Bangladeshi patients with CKD.
Methods: This cross-sectional study was conducted in the Department of Nephrology, BSMMU, Dhaka, Bangladesh from January 2013 to December 2014. Patients with anemia admitted in Nephrology Department, whether on hemodialysis or not and Medicine Department of BSMMU were taken for study. The study population was further divided into two groups; Group A, patients (30) who were having IDA and Group B, patients (40) with ACD and a control group was also selected. Data were collected by face to face interview and laboratory investigations with a self-administered questionnaire.
Results: The mean age of the patients in Group A and Group B were 38.40±13.23 and 34.85±10.52 years respectively and male-female ratio were 0.5:1 and 1:0.5. Mean sTfR level was higher (4.81± 1.64 μg/ml) in patients with IDA than (2.89±1.40 μg/ml) in patients with ACD (p <0.0001). Mean ferritin level was 599.59± 449.15μg/L in ACD patients whereas 101.23±119.42 in IDA patients (p<0.0001). Total iron binding capacity (TIBC) was more in ACD patients with sTfRe”3μg/ml as compared to ACD patients with sTfR<3μg/ml. Transferrin saturation (TSAT) level was significantly decreased in ACD patients with sTfRe”3μg/ml as compared to ACD patients with sTfR<3μg/ml. sTfR and ferritin indices between group A (IDA) and group B (ACD) shows mean sTfR:logSF level was significantly (P<0.001) high in group A (2.71±1.13) in comparison to group B (1.08±0.54). Mean log sTFR:SF was also significantly higher (P<0.05) in group A (0.001±0.0008) compared to group B (0.013±0.012).
Conclusion: sTfR level has a comparable ability to serum ferritin in diagnosing IDA and ACD. However, sTfR and serum ferritin alone cannot definitely exclude coexisting iron deficiency in ACD. Log sTfR/ ferritin index has role in identifying development of iron deficiency in ACD whereas sTfR/ log SF ratio can differentiate pure IDA from ACD with or without iron deficiency. Thus, it is important to estimate both serum sTfR and sTfRferritin indices to be able to differentiate pure IDA, ACD and ACD with co-existing iron deficiency thus providing a non-invasive alternative to bone marrow iron.
Birdem Med J 2019; 9(2): 151-156
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Latif, Abdul, Muhammad Rafiqul Alam, Asia Khanam, Farhana Hoque, Muhammad Abdur Rahim, and Rafi Nazrul Islam. "Role of Serum Transferrin Receptor in Diagnosing and Differentiating Iron Deficiency Anemia from Anemia of Chronic Disease in Patients with Chronic Kidney Disease." BIRDEM Medical Journal 7, no. 2 (May 4, 2017): 132–37. http://dx.doi.org/10.3329/birdem.v7i2.32451.
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Background: Anemia is common in patients with chronic kidney disease (CKD) and this is generally anemia of chronic disease, but iron deficiency anemia (IDA) is also common. Soluble transferrin receptor (sTfR) is a useful marker for IDA. Present study was undertaken to assess the utility of sTfR as a marker of IDA in selected group of Bangladeshi patients with CKD.Methods: This cross-sectional study was conducted in the Department of Nephrology, BSMMU, Dhaka, Bangladesh from January 2013 to December 2014. Patients with anemia admitted in nephrology department whether on hemodialysis or not and medicine department of BSMMU were taken for study. The study population was further divided into two groups; Group A, patients who are having IDA and Group B, patients with ACD and a control group was also selected. Data were collected by face to face interview and laboratory investigations with a self-administered questionnaire.Results: The mean age of the patients in two study groups were 38.40±13.23 and 34.85±10.52 years respectively and male-female ratio were 0.5:1 and 1:0.5. Mean sTfR level was higher (4.81± 1.64 ?g/ml) in patients with IDA than (2.89±1.40 ?g/ml) in patients with ACD (p <0.0001). In our study mean ferritin level was 599.59± 449.15?g/L in ACD patients whereas 101.23±119.42 in IDA patients (p<0.0001). Total iron binding capacity (TIBC) was more in ACD patients with sTfRe3?g/ml as compared to ACD patients with sTfR<3?g/ml. Transferrin saturation (TSAT) level was significantly decreased in ACD patients with sTfR ?3?g/ml as compared to ACD patients with sTfR<3?g/ml.Conclusion: sTfR has a comparable ability to S. ferritin in diagnosing IDA and ACD. However, sTfR and serum ferritin alone cannot definitely exclude co-existing iron deficiency in ACD. As sTfR is not affected by infection and/or inflammation, thus providing a non-invasive alternative to bone marrow study.Birdem Med J 2017; 7(2): 132-137
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Lin, Xiao-Ming, Juan Zhang, Zhi-Yong Zou, Zhu Long, and Wei Tian. "Evaluation of serum transferrin receptor for iron deficiency in women of child-bearing age." British Journal of Nutrition 100, no. 5 (November 2008): 1104–8. http://dx.doi.org/10.1017/s0007114508966101.
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The objective was to study the evaluation of serum transferrin receptor (sTfR) for Fe deficiency in women of child-bearing age. Primary screening was performed in 942 women ranging in child-bearing age. Serum ferritin (SF), Zn protoporphyrin (ZPP) and Hb were determined. Then the subjects were divided into four groups: normal, Fe store depletion (IDs), Fe-deficiency erythropoiesis and Fe-deficiency anaemia. sTfR was determined and sTfR/SF (sTfR/logSF and log(sTfR/SF)) was calculated. Changes of sTfR in women of different Fe status were observed. A receiver-operating characteristic (ROC) curve was used to evaluate whether sTfR had proper diagnostic efficacy for functional Fe deficiency. The levels of sTfR increased significantly along with the aggravation of Fe deficiency. Increase of STfR/SF along with the aggravation of Fe deficiency was more significant than that of sTfR. STfR had a significant negative correlation with SF and Hb, while it had a significant positive correlation with ZPP. The ROC curve showed that the diagnostic effective rate of sTfR for Fe deficiency could reach 83 %. At this point, the sensitivity was 79 % and the specificity was 63 %. Log(sTfR/SF) could be considered to have the highest effective ratio in detecting IDs, since it reached 99 %. STfR and sTfR/SF could both reflect body Fe-deficiency status specifically. They could be used as reliable indicators for evaluating Fe status and diagnosing Fe deficiency in women of child-bearing age.
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Gujjarlapaudi, Deepika, Namburu Veeraiah, Syed Hassan Naveed, and Duvvuru Nageswara Reddy. "Serum transferrin receptor-ferritin index as a marker of iron deficiency anemia in active inflammatory bowel disease patients in Indian population." International Journal of Research in Medical Sciences 9, no. 9 (August 25, 2021): 2796. http://dx.doi.org/10.18203/2320-6012.ijrms20213425.
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Background: Anemia is most common complication in IBD (inflammatory bowel disease). The aim of the study was to assess the sTfR-F (soluble transferrin receptor-ferritin) index as early marker of IDA (iron deficiency anaemia) in IBD.Methods: Retrospective cross sectional study has 480 cases of IBD (group I ) with controls 220 (group II), CBP, serum hsCRP, serum iron, TIBC (total iron binding capacity), sTfR, ferritin, fecal calprotectin, vitamin B12, folic acid were assessed.Results: In study I, group I was compared with group II showed (66.5%) patients had active disease and in that 65.0% of UC, 32.1% of CD and 2.9% others colitis had anemia. In study II, subgroup I 56.4% had IDA subgroup II 7.3% had ferritin between 30-100 ng/ml combi subgroup III 23.3% had ferritin>100 ng/ml (ACD, anaemia of chronic disease) subgroup IV 5.6% had vitamin B12 and folic acid deficiency excluding sTfR-F analysis. In study III, subdivided to identify IDA with sTfR-F index as group A 60.8% had sTfR-F index>2, group B 32.6% had sTfR-F index=1-2 and group C 3 (6.2%) had sTfR-F index<1. Intially diagnosed IDA was 56.4%, in addition with group A, IDA has increased by 66.5%. In study IV, in IDA, sensitivity of sTfR-F index was100%, sTfR 89% and SF 85%. Specificity of sTfR and sTfR-F index were 80.60% and SF has low specificity 73.90%. In study V, a statistical significance was seen more in female than male and in children than in adults with sTfR-F index in IDA.Conclusions: sTfR-F index as an early diagnostic marker, in differentiating IDA, ACD and combi in IBD patients.
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Kandarini, Yenny, Gede Wira Mahadita, Sianny Herawati, Anak Agung Wiradewi Lestari, Ketut Suega, and I. Gde Raka Widiana. "Soluble Transferrin Receptor and Soluble Transferrin Receptor/Log Ferritin Ratio are Correlated with Iron Status in Regular Hemodialysis Patients." Indonesian Biomedical Journal 13, no. 2 (June 14, 2021): 201–7. http://dx.doi.org/10.18585/inabj.v13i2.1412.
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BACKGROUND: Monitoring of iron status in chronic kidney disease patients is important, however inflammation may hinder its monitoring. Soluble transferrin receptor (sTfR) is an alternative parameter to overcome this issue, whereas ferritin play a part in the inflammation process. Hence, the correlation between the sTfR ratio and the sTfR/log ferritin ratio with conventional iron status parameters in regular hemodialysis patients is necessary to be evaluated.METHODS: A cross-sectional was conducted in the current study. As many as 5 mL of blood (2 mL for sTfR and 3 mL for serum iron and ferritin levels) was collected. sTfR level was the blood-soluble transferrin receptor level measured by the enzyme-linked immunosorbent assay (ELISA). The amount of ferritin and serum iron was determined using the immunochemiluminescent process. To evaluate the correlation, the Pearson correlation test was used.RESULTS: A total of 80 subjects was included in this study. The mean of hemoglobin was 10.25±1.66 g/dL, serum iron was 58.19±26.56 g/dL, and the median ferritin was 520.4 (49.9-3606) ng/mL. The sTfR was significantly associated only with serum iron levels with a correlation coefficient of r=-0.242; p=0.031. The sTfR/log ferritin was significantly associated with serum iron l evels (InSI)(r=-0.255, p=0.022); and transferrin saturation (r=-0.295; p=0.008).CONCLUSION: sTfR/log ferritin has a negative and significant correlation with serum iron levels and transferrin saturation, while sTfR negatively correlated with serum iron levels. sTfR and sTfR/log ferritin may be considered as an alternative iron marker in inflammation setting such as CKD.KEYWORDS: sTfR/log ferritin, iron status, serum iron, ferritin, chronic kidney disease, hemodialysis
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Ragab, L., H. A. Ibrahim, A. S. Eid, T. Kotb, and M. F. Konsowa. "Suitability of soluble transferrin receptor for the clinical diagnosis of different types of anaemia in children." Eastern Mediterranean Health Journal 8, no. 2-3 (June 15, 2002): 298–307. http://dx.doi.org/10.26719/2002.8.2-3.298.
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We evaluated the ability of serum transferrin receptor [sTFR] to identify different types of anaemia in children. Thus 150 Egyptian children suffering from anaemia [iron deficiency anaemia, anaemia of chronic disease and beta-thalassaemia] were enrolled, together with 50 controls. There was a significant increase in the mean levels of sTFR in the groups with iron deficiency anaemia and thalassaemia, and a significant decrease in mean sTFR levels in the group with anaemia of chronic disease. Serum ferritin levels were significantly higher in all patient groups except the group with iron deficiency anaemia. There were also significant correlations between the sTFR and sTFR/log ferritin ratio [sTFR-F index] and different indices of iron status and of erythropoiesis. The sTFR-F index could be used as a diagnostic or screening tool for iron deficiency anaemia, anaemia of chronic disease and thalassaemia.
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Safarova, K., and A. Rebrov. "AB0720 SOLUBLE TRANSFERRIN RECEPTOR IN DIAGNOSIS OF IRON DEFICIENCY ANEMIA IN PATIENTS WITH SPONDYLOARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1655.1–1655. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3608.
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Background:Anemia is a frequent hematological disorder in patients with rheumatic diseases. The main pathogenetic variants of anemia are anemia of chronic disease (ACD), iron deficiency anemia (IDA), and anemia of chronic disease with iron deficiency (ACD/IDA). The presence of systemic inflammation hinders to diagnose absolute iron deficiency, because standard tests of iron status are affected by it. Soluble transferrin receptors (sTfR) measurement and the calculation of the sTfR/ log ferritin index (sTfR index) are recommended, but data about diagnostically significant levels of these indicators in patients with spondyloarthritis (SpA) is currently limited.Objectives:To assess the diagnostic significance of sTfR and the sTfR index for detecting absolute iron deficiency in patients with SpA and anemia.Methods:Complete blood count, standart iron metabolism parameters, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were evaluated in 68 patients with SpA. Serum concentration of sTfR was measured with enzyme-linked immunosorbent assay (ELISA) using sTfR ELISA kit («Monobind Inc.», USA). The sTfR index was calculated by the formula sTfR/log10ferritin. Anemia was defined using the World Health Organization criteria. Depending on the serum ferritin concentration, transferrin saturation, and CRP level, ACD, IDA, or combined anemia (ACD/IDA) were diagnosed. Disease activity was determined by the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score based on CRP) scales. Receiver operating characteristic (ROC) analysis was performed with MedCalc.Results:Anemia was found in 48 of 68 (70,6%) SpA patients. 16 (33,3%) patients had ACD and 32 (66,7%) had ACD/IDA. Hemoglobin level in ACD was 118 [112; 123] g/L, in ACD/IDA – 110 [106; 120] g/L, in non-anemic patients – 133 [129; 145] g/L (p<0.001 for all groups). CRP and ESR values were higher in ACD compared to ACD/IDA patients (31.5 [20.3; 46.4] mg/L and 27.0 [16.0; 35.5] mm/h versus 9.8 [5.6; 16.9] mg/L and 15.5 [12.0; 22.5] mm/h, respectively [p=0.00 and p=0.038]). No statistically significant difference was found between all groups in BASDAI and ASDAS-CRP scores.ACD/IDA patients had significant increases in serum sTfR levels (1.7 [1.4; 2.2] mg/L) compared to ACD (1.5 [1.1; 1.7] mg/L, p=0,04) and to non-anemic patients (1,3 [1,1; 1,6] mg/L, p=0,003). The sTfR index was significantly higher in ACD/IDA (0.93 [0.82; 1.24]) compared to patients with ACD (0.64 [0.48; 0.75], p<0.001) and without anemia (0.67 [0.56; 0.81], p<0.001).The areas under the curves (AUCs) for distinguishing between ACD/IDA and ACD were 0.85 for sTfR index (p<0,001), 0.72 for sTfR (p<0,001). The sTfR index (cutoff >0.83) and sTfR (cutoff >1.39 mg/L) had sensitivities of 75% and 53%, and specificities of 83% and 81%, respectively.Conclusion:According to obtained data, serum concentration of sTfR >1.39 mg/L and the sTfR index >0.83 point to the presence of iron deficiency component in the structure of anemic syndrome in patients with SpA.References:Management of patients with SpA requires constant monitoring of side effects of therapy, in particular induced by the non-steroidal anti-inflammatory drugs. Use of sTfR and the sTfR index can improve the detection of IDA. A significant advantage of these indicators is their independence from systemic inflammation.Disclosure of Interests:None declared
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Al-Rubaie, Haithem A., Israa M. Al-Bayaa, and Yassmin A. Al-Amiri. "The Value of Soluble Transferrin Receptor and Soluble Transferrin Receptor-ferritin Index in Discriminating Iron Deficiency Anaemia from Anaemia of Chronic Disease in Patients With Rheumatoid Arthritis." Open Rheumatology Journal 13, no. 1 (February 28, 2019): 9–14. http://dx.doi.org/10.2174/1874312901913010009.
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Background:Anaemia is a common extra-articular manifestation of rheumatoid arthritis (RA) where anaemia of chronic disease (ACD) and iron deficiency anaemia (IDA) are the two most frequent types. The distinction between these two types of anaemia has always been challenging requiring sophisticated techniques. Serum transferrin receptor (sTfR) a truncated soluble form of the transferrin receptor is one of the parameters that is influenced by the Iron content and supply to the erythrons and is not affected by inflammatory status and therefore the use of the sTfR/log ferritin (sTfR-F) index can be a reliable indicator of functional iron deficiency.Aim of the study:This study aims to evaluate the usefulness of sTfR and sTfR-F index in discriminating the most common types of anaemia in patients with RA.Patients and methods:The study included 50 patients with RA and 30 healthy subjects as a control group. Complete blood picture, C-reactive protein, serum Iron, unsaturated iron binding capacity, sTfR and serum ferritin were tested.Results and Conclusion:anaemia was present in 34/50 patients; 19 patients had ACD, 9 had ACD/IDA and only 6 patients had IDA. Both the sTfR and the sTfR-F index showed a significant difference between anaemia groups (P values = 0.037 and 0.001, respectively). sTfR-F index has shown to be a very useful parameter that can discriminate efficiently between IDA and ACD and between ACD and ACD/IDA in patients with RA.
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Iriani, Anggraini, Endah Purnamasari, and Riadi Wirawan. "NILAI RUJUKAN SOLUBLE TRANSFERRIN RECEPTOR (sTfR)." INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY 21, no. 3 (September 13, 2016): 211. http://dx.doi.org/10.24293/ijcpml.v21i3.720.
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Iron in plasma is carried by transferrin delivered to cells through the interaction with a specific membrane receptor, namely transferrin receptor. The soluble transferrin receptor (sTfR) is a transferrin receptor monomer which lost its first 100 amino acids, and circulates in the form of transferrin and its receptor complex. Erythroblasts and reticulocytes are the main source of serum TfR The concentration of sTfR in serum is useful to diagnose iron deficiency, especially for patient with chronic disease. A new parameter sTfR is reported to be a surrogate marker of bone marrow iron store. The sTfR concentration can describe the functional iron status while ferritin reflects the iron storage status. The aim of this study was to know a reference interval of sTfR in normal adults by provision. Subjects were 157 healthy adults from clinical medical check up who had met the inclusion criteria and were willing to participate as research subjects. Soluble Transferrin Receptor (sTfR) examination was performed using reagents from Roche. The statistical calculations were performed by SPSS 22. The results showed that there was no significant difference between sTfR levels in men and women as well as in the age group ≤40 years and >40 years. The STfR reference value in this study was calculated based on 95% CI (X±2SD), is 0.197–0.598 mg/dL. It can be concluded that the sTfR reference value is 0.197–0.598 mg/dL
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Сахин, В. Т., М. А. Григорьев, Е. В. Крюков, С. П. Казаков, and О. А. Рукавицын. "Influence of Hepcidin and Soluble Transferrin Receptor on the Development of Anemia of Chronic Diseasesin Rheumatic Patients." Гематология. Трансфузиология. Восточная Европа, no. 3 (November 10, 2020): 311–18. http://dx.doi.org/10.34883/pi.2020.6.3.016.
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Цель. Оценить взаимосвязь между гепцидином, растворимым рецептором трансферрина (sTfR) и показателями обмена железа, концентрацией гемоглобина и числом эритроцитов у ревматических пациентов.Материалы и методы. Обследованы 63 пациента ревматологического профиля: 26 мужчин (45 (36–54,9) лет), 37 женщин (49 (38–60) лет). Пациенты разделены на две группы: 1-я группа – 41 пациент с анемией, 2-я группа (контрольная) – 22 пациента без анемии. Выполнен сравнительный анализ показателей гемограммы, обмена железа (железо, ферритин, трансферрин, общая железосвязывающая способность сыворотки крови – ОЖСС, коэффициент насыщения трансферрина железом – КНТ), гепцидина, растворимого рецептора трансферрина (sTfR), С-реактивного белка (СРБ). Выполнен корреляционный анализ между гепцидином, sTfR и показателями гемограммы и обмена железом.Результаты. У пациентов с анемией в сравнении с контрольной группой выше концентрации гепцидина (504,9 (23,5–916,5) и 232(0,0–858) нг/мл), sTfR (8,6 (3,9–7,1) и 2,2 (1,5–3,1) нмоль/л),а также ферритина (292,7 (146,1–335,1) и 78,5 (36–90,7) мкг/л), СРБ (59,4 (10,9–100,2)и 4,6 (1,2–5,8) мг/л). Для железа, ОЖСС, КНТ, трансферрина не выявлено межгрупповых различий (p>0,05). Выявлена корреляция между числом эритроцитов и гепцидином (r=–0,5), sTfR (r=–0,5). Выявлена корреляция между концентрацией гемоглобина и гепцидином (r=–0,7), sTfR (r=–0,7). Для концентрации гепцидина установлена прямая взаимосвязь с ферритином (r=0,6) и СРБ (r=0,3) и обратная взаимосвязь с ОЖСС (r=–0,6) и трансферрином (r=–0,6). Не выявлено взаимосвязи между гепцидином и железом, КНТ. В отношении концентрации sTfR установлена прямая корреляционная связь с ферритином (r=0,4) и СРБ (r=0,3) и обратная корреляционная связь с железом (r=–0,6) и КНТ (r=–0,5). Не выявлено взаимосвязи между sTfR и ОЖСС, трансферрином.Влияние гепцидина и растворимого рецептора трансферринана развитие анемии хронических заболеваний у ревматических пациентов. Заключение. Показан многокомпонентный генез анемии у ревматических пациентов. Установлено значение увеличения секреции гепцидина, sTfR, нарушений в обмене железа на развитие анемии. Установлено супрессорное влияние гепцидина на выработку клеток эритрона. Доказано слабое влияние воспаления на концентрацию sTfR. Purpose. To assess the relationship between hepcidin, soluble transferrin receptor (sTfR), and indicators of iron metabolism, hemoglobin concentration, and erythrocyte number in rheumatic patients.Materials and Methods. The study involved 63 rheumatic patients: 26 men (45 (36–54.9) years old), 37 women (49 (38–60) years old). The patients were divided into two groups: group 1 – 41 patients with anemia, group 2 (control) – 22 patients without anemia. Comparative analysis of hemogram parameters, iron metabolism (iron, ferritin, transferrin, total iron-binding capacity of blood serum – TIBC, iron transferrin saturation index (TSI), hepcidin, soluble transferrin receptor (sTfR), C-reactive protein (CRP) was performed. Correlation analysis was performed between hepcidin, sTfR, and hemogram and iron metabolism parameters.Results. In patients with anemia, the concentration of hepcidin (504.9 (23.5–916.5) and 232 (0.0–858) ng/ml), sTfR (8.6 (3.9–7.1) and 2.2 (1.5–3.1) nmol/L), ferritin (292.7(146.1–335.1) and78.5(36–90.7) μg/L), CRP (59.4 (10.9–100.2) and 4.6 (1.2–5.8) mg/L) is higher in comparison with the control group. There were no intergroup differences for iron, TIBS, CST, transferrin (p>0.05). The correlation was found between the number of erythrocytes and hepcidin (r=–0.5), sTfR (r=–0.5). The correlation was found between the concentration of hemoglobin and hepcidin (r=–0.7), sTfR (r=–0.7). For the concentration of hepcidin, a direct relationship with ferritin (r=0.6) and CRP (r=0.3) and the inverse relationship with TIBC (r=–0.6) and transferrin (r=–0.6) were revealed. No relationship was found between hepcidin and iron, TSI. In relation to the concentration of sTfR, a direct correlation was revealed with ferritin (r=0.4) and CRP (r=0.3) and the inverse correlation with iron (r=–0.6) and CST (r=–0.5). No relationship was found between sTfR and TIBC, transferrin Conclusion. There was showed the multicomponent genesis of anemia in rheumatic patients. The significance of the increase of the secretion of hepcidin, sTfR, disorders of iron metabolism for the development of anemia was revealed. The suppressive effect of hepcidin on the production of erythron cells was also revealed. A weak effect of inflammation on the concentration of sTfR was proved.
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Iriani, Anggraini, Endah Purnamasari, and Riadi Wirawan. "NILAI RUJUKAN SOLUBLE TRANSFERRIN RECEPTOR (sTfR) {(Soluble Transferrin Receptor Refence Value (sTfR)}." INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY 21, no. 3 (April 18, 2018): 211. http://dx.doi.org/10.24293/ijcpml.v21i3.1268.
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Iron in plasma is carried by transferrin delivered to cells through the interaction with a specific membrane receptor, namelytransferrin receptor. The soluble transferrin receptor (sTfR) is a transferrin receptor monomer which lost its first 100 amino acids, andcirculates in the form of transferrin and its receptor complex. Erythroblasts and reticulocytes are the main source of serum TfR Theconcentration of sTfR in serum is useful to diagnose iron deficiency, especially for patient with chronic disease. A new parameter sTfRis reported to be a surrogate marker of bone marrow iron store. The sTfR concentration can describe the functional iron status whileferritin reflects the iron storage status. The aim of this study was to know a reference interval of sTfR in normal adults by provision.Subjects were 157 healthy adults from clinical medical check up who had met the inclusion criteria and were willing to participate asresearch subjects. Soluble Transferrin Receptor (sTfR) examination was performed using reagents from Roche. The statistical calculationswere performed by SPSS 22. The results showed that there was no significant difference between sTfR levels in men and women as wellas in the age group ≤40 years and >40 years. The STfR reference value in this study was calculated based on 95% CI (X±2SD), is0.197–0.598 mg/dL. It can be concluded that the sTfR reference value is 0.197–0.598 mg/dL.
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Judistiani, Raden Tina Dewi, Sefty Mariany Samosir, Setyorini Irianti, Benny Hasan Purwara, Budi Setiabudiawan, Johannes Cornelius Mose, and Budi Handono. "Correlation of Maternal Serum Hepcidin, Soluble Transferrin Receptor (sTfR) and Cholecalciferol with Third Trimester Anemia: Findings from A Nested Case-control Study on A Pregnancy Cohort." Indonesian Biomedical Journal 12, no. 4 (December 2, 2020): 361–67. http://dx.doi.org/10.18585/inabj.v12i4.1252.
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BACKGROUND: Cholecalciferol, hepcidin, and soluble transferrin receptor (sTfR) interaction play an essential role in iron hemostasis. Anemia in pregnancy contributes to morbidity and mortality both for the mother and baby. In this study, we assessed the correlation between hepcidin, sTfR and cholecalciferol in third trimester maternal anemia. We aimed to find the cut-off for hepcidin and sTfR.METHODS: A case-control study involving 56 pregnant women in each anemia and healthy group was nested on a previous larger cohort study in Indonesia. Serum hepcidin, sTfR and cholecalciferol level were measured by enzyme-linked immunosorbent assay (ELISA) method.RESULTS: Serum hepcidin and sTfR level were significantly higher in case group, while serum cholecalciferol level has no difference between the two groups. New cut-off points were found for hepcidin (<15.93 ng/mL) and sTfR level (>2234.45 ng/mL). Low level of hepcidin (OR=5.32) and high level of sTfR (OR=8.28) increase the risk of anemia. High level of sTfR (adjusted OR=4.725; CI 95%=1.730-12.904; p=0.02) was the most important factor contributes to anemia, followed by the low level of hepcidin (adjusted OR=3.677; CI 95%=1.363-9917; p=0.01).CONCLUSION: The high level of sTfR is the most important factor related to anemia in the third trimester, followed by the low level of hepcidin. Low cholecalciferol level tends to favor the incident of anemia. The new cut-off point of third trimester sTfR and third trimester hepcidin were established in this study and may be useful for risk assessment and treatment monitoring for anemia in pregnancy.KEYWORDS: anemia, cholecalciferol, hepcidin, pregnancy, soluble transferrin receptor
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Сахин, В. Т., М. А. Григорьев, Е. В. Крюков, С. П. Казаков, and О. А. Рукавицын. "Possibility of Using Soluble Transferrin Receptor as a Marker of Anemia of Chronic Diseases in Rheumatic Patients." Гематология. Трансфузиология. Восточная Европа, no. 4 (January 4, 2021): 457–66. http://dx.doi.org/10.34883/pi.2020.6.4.003.
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Цель. Изучить особенности секреции растворимого рецептора трансферрина (sTfR) у пациентов с ревматической патологией с анемией хронических заболеваний и железодефицитной анемией. Оценить влияние интерлейкина-6 (ИЛ-6), интерлейкина-10 (ИЛ-10), интерлейкина-1β (ИЛ-1β), интерферона гамма (ИФН-γ), фактора некроза опухоли-альфа (ФНО-α) на sTfR. Изучить возможность использования sTfR в качестве маркера для дифференциальной диагностики анемии хронических заболеваний и железодефицитной анемии у пациентов ревматического профиля.Материалы и методы. Обследованы 126 ревматических пациентов: 34 мужчины (45,8 (36–54,9) года), 92 женщины (49,5 (38–60) года). В 1-ю группу вошел 41 пациент с анемией хронических заболеваний (АХЗ), во 2-ю – 34 с железодефицитной анемией (ЖДА), в 3-ю – 29 с сочетанием АХЗ и ЖДА, в контрольную группу – 22 без анемии. Выполнен сравнительный анализ между группами с анемией и без нее показателей гемограммы, обмена железа, С-реактивного белка (СРБ). Выполнен корреляционный анализ между sTfR, показателями гемограммы, ИЛ-6, ИЛ-1β, ИЛ-10, ИНФ-γ, ФНО-α.Результаты. В группе АХЗ повышены концентрации ферритина, СРБ в сравнении с другими группами. У пациентов с АХЗ, АХЗ/ЖДА и ЖДА выявлена более высокая концентрация sTfR в сравнении с пациентами без анемии (p<0,05). У пациентов трех групп с анемией не выявлено межгрупповых различий в концентрации sTfR (p>0,05). Выявлена отрицательная корреляционная связь между концентрацией sTfR и гемоглобина (r=–0,5) и числом эритроцитов (r=–0,7). Доказана взаимосвязь между концентрациями sTfR и ИЛ-6 (r=0,4), ИЛ-10 (r=0,6), ИНФ-γ (r=0,4) и ИЛ-1β (r=0,3).Заключение. У пациентов ревматического профиля с АХЗ и ЖДА не выявлено значимых различий в концентрации растворимого рецептора трансферрина, при обоих типах анемии концентрации этого рецептора повышаются. Таким образом, у пациентов с ревматическойпатологией использование sTfR для дифференциальной диагностики АХЗ и ЖДА нецелесообразно. Выявленные корреляционные связи между sTfR и цитокинами свидетельствуют об их влиянии на синтез этого рецептора. Необходимы дальнейшие исследования возможных маркеров для дифференциальной диагностики АХЗ и ЖДА, в том числе у ревматических пациентов. Purpose. To study the features of secretion of soluble transferrin receptor (sTfR) in patients with rheumatic pathology with anemia of chronic diseases and iron deficiency anemia. To assess the effect of interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1β (IL-1β), interferon gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α) on sTfR. To study the possibility of using sTfR as a marker for differential diagnosis of anemia of chronic diseases and iron deficiency anemia in rheumatic patients.Materials and Methods. 126 rheumatic patients, 34 men (45.8 (36–54.9) years old), 92 women (49.5 (38–60) years old) were examined. Group 1 consisted of 41 patients with ACD, group 2 – 34 patients with iron deficiency anemia (IDA), group 3 – 29 patients with a combination of ACD and IDA, the control group – 22 patients without anemia. A comparative analysis was performed between the groups with and without anemia on the hemogram parameters, iron metabolism, and C-reactive protein (CRP). Correlation analysis was performed between the sTfR, hemogram indicators, interleukin-6 (IL-6), IL-1β, IL-10, interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α).Results. In the ACD group, the concentrations of ferritin and CRP are increased in comparison with other groups. In patients with ACD, ACD / IDA, and IDA, a higher concentration of sTfR was found in comparison with patients without anemia (p<0.05). In patients of three groups with anemia, there were no intergroup differences in the concentration of sTfR (p>0.05). There was revealed the negative correlation between the concentration of sTfR and hemoglobin (r=–0.5) and the number of erythrocytes (r =–0.7). The relationship between the concentrations of sTfR and IL-6 (r=0.4), IL-10 (r=0.6), INF-γ (r=0.4) and IL-1β (r=0.3) was proved.Conclusion. In rheumatic patients with ACD and IDA, no significant differences were found in the concentration of the soluble transferrin receptor; in both types of anemia, the concentrations of this receptor increase. Thus, in patients with rheumatic pathology, the use of sTfR for differential diagnosis of ACD and IDA is inappropriate. The revealed correlations between sTfR and cytokines indicate their influence on the synthesis of this receptor. Further studies of possible markers for the differential diagnosis of ACD and IDA are needed, including in rheumatic patients.
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Lin, Xiao-Ming, Cheng-Ye Ji, Wen-Jing Liu, Zhu Long, and Xiao-Yi Shen. "Levels of serum transferrin receptor and its response to Fe-supplement in Fe-deficient children." British Journal of Nutrition 96, no. 6 (December 2006): 1134–39. http://dx.doi.org/10.1017/bjn20061954.
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The object of the present study was to investigate the levels of serum transferrin receptor (sTfR) and its response to Fe supplementation in Fe-deficient children and the role of sTfR in detecting Fe deficiency and assessing the efficacy of Fe supplementation. According to the diagnostic standard, 1006 children, aged 6–14 years in Fangshan district, Beijing, Peoples Republic of China, were divided into four groups: normal; Fe store depletion (IDs); Fe deficiency erythropoiesis (IDE); Fe deficiency anaemia (IDA). sTfR was determined and transferrin receptor-ferritin (TfR-F) index was calculated in 238 children, sixty-four normal and 174 Fe deficient. Children were administered a NaFeEDTA capsule containing 60 mg Fe once per week for the IDs and IDE groups and three times per week for the IDA group for nine consecutive weeks. The parameters reflecting Fe status and sTfR were determined before and after Fe supplementation. The levels of sTfR and TfR-F index in Fe-deficient children were significantly higher than those in the normal group. The receiver operating characteristic curve showed that sTfR has proper diagnostic efficacy for functional Fe deficiency. After Fe supplementation, the level of sTfR was significantly decreased in children with IDs, but not in children with IDE and IDA, while TfR-F index was significantly decreased in Fe-deficient children. sTfR is a reliable indicator for detecting functional Fe deficiency, and TfR-F index is a sensitive parameter for assessing the efficacy of Fe supplementation.
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Krawiec, Paulina, and Elżbieta Pac-Kożuchowska. "Biomarkers and Hematological Indices in the Diagnosis of Iron Deficiency in Children with Inflammatory Bowel Disease." Nutrients 12, no. 5 (May 9, 2020): 1358. http://dx.doi.org/10.3390/nu12051358.
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Inflammation may affect many routinely available parameters of iron homeostasis. Thus, the recognition of iron deficiency in inflammatory bowel disease (IBD) remains a diagnostic challenge in a clinical routine. The aim of the study was to detect the most efficient marker of iron deficiency in IBD children. In a group of 75 IBD children, we evaluated the sensitivity, specificity, accuracy, and positive and negative predictive values of erythrocytes’ indices, including MCV, MCH, MCHC and RDW, and biochemical markers, including iron, transferrin, sTfR and sTfR/log ferritin, for identifying iron deficiency. Receiver operating characteristic (ROC) analysis was used to compare the ability of these parameters to detect iron deficiency. The best predictors of iron deficiency were sTfR/log ferritin, with accuracy 0.86, sensitivity 0.98, specificity 0.63, positive predictive value 0.83 and negative predictive value 0.94, and sTfR, with accuracy 0.77, sensitivity 0.82, specificity 0.67, positive predictive value 0.82 and negative predictive value 0.67. Moreover, sTfR/log ferritin exhibited the largest area under ROC (0.922), followed by sTfR (0.755) and MCH (0.720). The sTfR/log ferritin index appears to be the most efficient marker of iron depletion in pediatric IBD, and it may give an added value in the management of IBD patients.
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Delcheva, Ginka, Ana Maneva, Tanya Deneva, and Anelia Bivolarska. "ASSOCIATION BETWEEN IRON AND THYROID STATUS IN PREGNANT WOMEN." Journal of IMAB - Annual Proceeding (Scientific Papers) 28, no. 1 (January 20, 2022): 4194–201. http://dx.doi.org/10.5272/jimab.2022281.4194.
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Purpose: Pregnancy is often complicated by iron deficiency, affecting negatively thyroid gland physiology. The aim of our study is to investigate parameters of iron and thyroid status during І, ІІ and ІІІ trimester of pregnancy in order to establish potential correlations in their dynamics. Materials and methods: The study involved 61 pregnant women and 43 controls. Their iron and thyroid status was determined by measuring hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (sTfR), thyroxine (FT4) and thyroid-stimulating hormone (TSH). Results: Significant differences between pregnant women and the control group were found, indicating an iron deficiency risk: sTfR level was higher, while Hb, ferritin and FT4 levels were lower in pregnant women. Thyroxine correlated positively with Hb (p = 0.016) and ferritin (p = 0.003) in pregnant women. In the I trimester, there was a negative association between sTfR and FT4 (p = 0.013), and in the III trimester, there was a positive association between sTfR and TSH (p < 0.0001). Conclusions: sTfR represented the relationship between iron and thyroid status in the I and III trimester. Iron deficiency was expressed in the III trimester with a positive association between sTfR and TSH. The increased maternal iron requirement (sTfR) correlated with increased TSH secretion induced by decreased thyroxine.
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Woolf, Kathleen, Megan M. St. Thomas, Nicole Hahn, Linda A. Vaughan, Amanda G. Carlson, and Pamela Hinton. "Iron Status in Highly Active and Sedentary Young Women." International Journal of Sport Nutrition and Exercise Metabolism 19, no. 5 (October 2009): 519–35. http://dx.doi.org/10.1123/ijsnem.19.5.519.
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This study examined iron status and nutrient intake in highly active (n = 28; 20 ± 2 yr, ≥12 hr purposeful physical activity per week [PPA/wk]) and sedentary (n = 28; 24 ± 3 yr, ≤2 hr PPA/wk) women. Participants completed a 7-day weighed-food record (energy, protein, fiber, alcohol, and micronutrients), 7-day pedometer/activity log, and fasting blood draw (hemoglobin, hematocrit, red blood cell indices, C-reactive protein, serum iron, percent transferrin saturation, total iron-binding capacity, ferritin, transferrin receptor [sTfR], and sTfR index). Independent-sample t tests and the Mann–Whitney nonparametric test compared mean values between groups. Lower serum ferritin (p = .01) and mean cell hemoglobin (p < .01) concentrations were found in active than in sedentary women. Higher mean sTfR (p = .01) and sTfR index (p < .01) values were found in the active women. No significant differences were found between groups for the other blood markers. Serum ferritin concentrations (storage iron) indicated iron depletion (Stage I) in 21% of active and 18% of sedentary participants. Nonetheless, 50% of active and 18% of sedentary participants were iron depleted as evidenced by the sTfR index (ratio of functional-to-storage iron). Elevated sTfR concentrations (functional iron) were observed in 25% of active and 3% of sedentary participants. Although the active women reported greater iron (p < .01) but similar heme iron intakes, they had higher mean sTfR, higher sTfR index, and lower serum ferritin concentrations than the sedentary women. Assessment of iron status may require measures not commonly used in routine assessments.
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Wen, Jiexia, Sumin Pan, Shuang Liang, Zhenyu Zhong, Ying He, Hongyu Lin, Wenyan Li, Liyue Wang, Xiujin Li, and Fei Zhong. "Soluble Form of Canine Transferrin Receptor Inhibits Canine Parvovirus InfectionIn VitroandIn Vivo." BioMed Research International 2013 (2013): 1–8. http://dx.doi.org/10.1155/2013/172479.
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Canine parvovirus (CPV) disease is an acute, highly infectious disease threatening the dog-raising industry. So far there are no effective therapeutic strategies to control this disease. Although the canine transferrin receptor (TfR) was identified as a receptor for CPV infection, whether extracellular domain of TfR (called soluble TfR (sTfR)) possesses anti-CPV activities remains elusive. Here, we used the recombinant sTfR prepared from HEK293T cells with codon-optimized gene structure to investigate its anti-CPV activity bothin vitroandin vivo. Our results indicated that codon optimization could significantly improve sTfR expression in HEK293T cells. The prepared recombinant sTfR possessed a binding activity to both CPV and CPV VP2 capsid proteins and significantly inhibited CPV infection of cultured feline F81 cells and decreased the mortality of CPV-infected dogs, which indicates that the sTfR has the anti-CPV activity bothin vitroandin vivo.
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Enko, Dietmar, Helga Wagner, Gernot Kriegshäuser, Julia Wögerer, Gabriele Halwachs-Baumann, Wolfgang J. Schnedl, Sieglinde Zelzer, et al. "Iron status determination in individuals with Helicobacter pylori infection: conventional vs. new laboratory biomarkers." Clinical Chemistry and Laboratory Medicine (CCLM) 57, no. 7 (June 26, 2019): 982–89. http://dx.doi.org/10.1515/cclm-2018-1182.
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Abstract Background Helicobacter pylori has been associated with iron deficiency (ID). This study is aimed at investigating ID with conventional (ferritin, transferrin saturation [TSAT]) and new biomarkers (soluble transferrin receptor [sTfR], sTfR/log ferritin, reticulocyte hemoglobin content [CHr], hepcidin-25) in patients sub-grouped by the presence or absence of H. pylori infection. Methods In total, 200 consecutive outpatients, who were referred for the H. pylori 13C-urea breath test (13C-UBT), underwent blood testing for ID. Additionally, Thomas-plot (TP)-analyses (sTfR/log ferritin, CHr) were calculated. Results Fifty-three and 147 individuals were found with and without H. pylori infection, respectively. Patients with H. pylori infection showed a higher sTfR concentration (p<0.02) and a higher sTfR/log ferritin ratio (p<0.05). Based on a ferritin <30 μg/L and/or a TSAT <20%, 25/53 (47.2%) patients with H. pylori infection and 63/147 (42.9%) without H. pylori infection showed ID. Based on TP-analyses, 10/53 (18.9%) patients with and 17/147 (11.6%) without H. pylori infection were identified with ID. Completed eradication therapy tended to be associated with functional ID. Conclusions Helicobacter pylori infection was associated with significantly higher plasma sTfR concentrations and sTfR/log ferritin ratios. Patients with H. pylori eradication therapy were more often detected with functional ID compared to patients without eradication therapy, when using the new biomarkers.
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Sandvik, Krystyna. "Jernnivå og plasma sTfR." Tidsskrift for Den norske legeforening 133, no. 6 (2013): 609. http://dx.doi.org/10.4045/tidsskr.13.0255.
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Lee, Young Soo, Chul Soo Kim, and Jong Weon Choi. "Serum Transferrin Receptor Value as a Universal Indicator of Erythropoietic Activity." Blood 104, no. 11 (November 16, 2004): 3682. http://dx.doi.org/10.1182/blood.v104.11.3682.3682.
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Abstract The serum transferrin receptor (sTfR) is thought a sensitive and quantitative parameter of tissue iron deficiency as well as an indicator of erythropoietic activity. This study was aimed at the verification of a hypothesis that sTfR is a general indicator of erythropoiesis regardless whatever the cause is. A total of 173 patients in heterogeneous diseases who underwent bone marrow study as a workup for anemia were measured for sTfR, reticulocyte maturity index (RMI), erythroid element proportion of bone marrow cells, and other hematologic parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red cell distribution width, absolute reticulocyte count). By immunoenzymometric method sTfR was measured using IDeATMcTfR kids (Orion Diagnostica, Orion, Finland). Reticulocyte count and proportion was measured manually by one expert examiner after standard blood smear and stain. Reticulocyte subpopulation was automatically analyzed by flow cytometry using R-3000 TM (Sysmex, TOA, Japan). RMI was calculated from the equation of (medium fluorescent reticulocyte fraction + high fluorescent reticulocyte fraction) X 100 / low fluorescent reticulocyte fraction. Correlation analysis was done among the variables including sTfR, RMI, erythroid element proportion of bone marrow cells, and other hematologic parameters using SAS 6.12 soft ware. The analysis was carried out for the whole 173 patients to see the general trends and repeated for 4 groups of disease category, arbitrarily divided to group 1 (n=33, iron deficiency or or disease with no predisposition to anemia of chronic disease), group 2 (n=53, hematologic malignancies), group 3 (n=44, solid tumors), and group 4 (n=43, chronic or infectious disease) to see if the trends may be affected by specific diseases. The results showed a solid correlation of sTfR with RMI as well as erythroid precursors in bone marrow, not only in the whole patient population (e.g. sTfR vs RMI, R=0.587, p=0.0001) but also in individual groups (e.g. sTfR vs RMI, R=0.48, p=0.005 in group 1, R=0.69, p=0.0001 in group 2, R=0.58, p=0.0001 in group 3, R=0.81, p=0.0001 in group 4). These findings indicated the significance of sTfR is valid under any clinical setting as a universal indicator of hematopoietic activity. The sTfR can be used as a useful parameter for monitoring of erythropoiesis in a variety disease.
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Günther, Florian, Rainer H. Straub, Wolfgang Hartung, Martin Fleck, Boris Ehrenstein, and Louisa Schminke. "Usefulness of Soluble Transferrin Receptor in the Diagnosis of Iron Deficiency Anemia in Rheumatoid Arthritis Patients in Clinical Practice." International Journal of Rheumatology 2022 (October 12, 2022): 1–9. http://dx.doi.org/10.1155/2022/7067262.
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Aim. We analyzed the added value of sTfR measurement in routine clinical practice to standard parameters (SP) of iron deficiency in the detection of iron deficiency anemia (IDA) in patients with rheumatoid arthritis (RA). Methods. Blood samples from 116 patients with RA were analyzed in a prospective study. Based on biochemical parameters, patients were classified as having IDA, anemia of chronic disease (ACD), IDA with concomitant ACD (ACD/IDA), or “other anemia.” Sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of sTfR and SP of iron status alone and in combination were calculated for the diagnosis of IDA in general, i.e., IDA or ACD/IDA. Results. In the whole sample, with regard to the diagnosis of iron deficiency (IDA or ACD/IDA), sTfR had a higher sensitivity compared both to the combined use of SP and to the combination of SP with sTfR (80.9% versus 66.7/54.8%). Specificity, PPV and NPV did not differ substantially. When patients were stratified in groups with high (CRP levels above the median, i.e., 24.1 mg/l) and low (CRP levels less or equal to the median) inflammation, the diagnostic superiority of sTfR was restricted to patients with high inflammation. In this group, the diagnostic performance of sTfR was superior both to the combined use of SP and the combination of SP with sTfR with higher sensitivity (100% versus 52.4%) and NPV (100% versus 77.7/76.7%) and comparable specificity and PPV. Conclusion. For the detection of iron depletion (IDA or ACD/IDA) in anemic RA patients, sTfR is superior to SP of iron deficiency only in highly inflammatory states.
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Suega, Ketut, Yenny Kandarini, and Jemi Tubung. "Role of Soluble Transferrin Receptor and Transferrin Receptor-Ferritin Index to Detect Iron Deficiency Anemia in Regular Hemodialysis Patients." Open Access Macedonian Journal of Medical Sciences 7, no. 1 (January 13, 2019): 97–102. http://dx.doi.org/10.3889/oamjms.2019.012.
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BACKGROUND: Several iron indicators can be used to detect iron deficiency anaemia (IDA) where confounding comorbidities occurred such as patients with regular hemodialysis.
AIM: This study was aimed to determine the diagnostic value of serum transferrin receptor (sTfR) and transferrin receptor-transferrin index (TfR-F index) and to combine these two markers in detecting IDA in regular hemodialysis anaemic patients.
METHODS: There were 70 patients recruited consecutively. IDA was diagnosed based on TS < 20% and ferritin level < 200 ng/L and functional iron deficiency when TS < 20% and ferritin > 200 ng/L. TfR-F index calculated as sTfR/log ferritin.
RESULTS: Correlation of ferritin to iron level was changed when its correlation adjusted by confounding inflammation (CRP level > 10). The correlation strength of ferritin to iron serum before adjusted was r = 0.37 with p = 0.02 but became r = 0.65 with p = 0.023 after adjusted to CRP > 10. In inflammation (CRP > 10), ferritin mild-moderately correlated with iron but became moderately strong when there was no inflammation (CRP < 10). AUC for sTfR was 0.77 with p = 0.028 (95% CI 0.55-0.99), and for TfR-F index has larger AUC 0.85% with p = 0.004 (95%CI 0.69-1.00), hence TfR-F index more superior than sTfR. sTfR and sTfR-F index were not correlated with CRP with p > 0.05, and sTfR and TfR-F index mean level was different between IDA and ACD patients although not statistically significant.
CONCLUSION: When sTfR and the TfR-F index used in combination to detect IDA, we found the largest AUC on ROC 0.98 (95% CI 0.94-1.00).
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Allen, Jean, Kristin R. Backstrom, Jeffrey A. Cooper, MaryAnne C. Cooper, Thomas C. Detwiler, David W. Essex, Rose P. Fritz, et al. "Measurement of soluble transferrin receptor in serum of healthy adults." Clinical Chemistry 44, no. 1 (January 1, 1998): 35–39. http://dx.doi.org/10.1093/clinchem/44.1.35.
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Abstract The concentration of soluble transferrin receptor (sTfR) in serum is reported to be useful in the diagnosis of iron deficiency, especially for patients with concurrent chronic disease, where routine tests of iron status are compromised by the inflammatory condition. A new diagnostic assay for sTfR is calibrated against natural plasma sTfR, thus minimizing calibration discrepancies that result from differences between the analyte and the cellular transferrin receptor used in other assays. Use of the new assay to measure sTfR concentrations in 225 healthy, hematologically normal adults provided a reference interval against which pathological samples could be compared. There was no difference in the reference intervals for men and women and no correlation of [sTfR] with the age of the subject. Black subjects had significantly higher concentrations than nonblacks, and people living at high altitude had higher concentrations than those living closer to sea level. These differences were additive.
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Yang, Mindy M., Mary Ann, Dawn E. Riordan, Min Fu, Victor Moyo, and Richard C. Woodman. "Iron Deficiency Is Common in Anemic Elderly Patients: Results with sTfr Index." Blood 106, no. 11 (November 16, 2005): 3763. http://dx.doi.org/10.1182/blood.v106.11.3763.3763.
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Abstract Chronic anemia is common in the elderly (≥65) with a prevalence often exceeding 10%. Multiple comorbidities and multiple causes of anemia complicate anemia diagnosis in the elderly. Iron deficiency anemia (IDA) and anemia of chronic inflammation (ACI) both commonly occur in the elderly. Distinguishing ACI from the combination of IDA and ACI is difficult with conventional tests (serum iron, TIBC, TSAT, and ferritin), especially in elderly patients or those with multiple comorbidities. Recently, the serum transferrin receptor (sTfr) has been recommended to assess iron stores, although there is limited data in the elderly. Unlike ferritin, TIBC, or TSAT, sTfr Index (sTfr(mg/L)/[log10ferritin]) is not influenced by pro-inflammatory cytokines and may provide a more precise classification of iron status. Purpose: To determine the occurrence of iron deficiency alone or in combination with ACI in the elderly using the sTfr Index. Methods: The results of the sTfr Index were compared to ferritin, as well as serum iron, TIBC, and TSAT to determine the presence of iron deficiency alone or in combination with ACI. An sTfr Index of ≥2.0 was used to define iron deficiency. Data were obtained from ambulatory, community-dwelling elderly screened for three clinical trials for treatment of chronic anemia (Hb≤11g/dL x >3 months) using epoetin alfa. No patients had a history of GI bleeding, active cancer, or recent infections. At the time of evaluation, no patients were receiving iron therapy. GFR was calculated using the Modification of Diet for Renal Disease (MDRD) Equation. Results: A total of 81 patients (mean age 75±6, range 66–89 years; 68 women and 13 men) were studied. Of these patients, 43 patients had a history of rheumatoid arthritis. 32% were African-American, 64% Caucasian, and 4% Hispanic/American-Indian. For the entire cohort, mean Hb was 10.3±0.9 g/dL; ferritin 148.0±180.9ng/mL; iron 61±33mcg/mL; TIBC 311±69mcg/dL (n=80); TSAT 19.7±11.0%; GFR 59.2±28.0mL/min/1.73m2 (n=78); sTfr Index was 3.02±3.16. There was no statistically significant difference in the severity of anemia between patients with and without iron deficiency (sTfr Index ≥2.0, Hb 10.3±0.8 vs. sTfr Index <2.0, Hb 10.4±1.0g/dL). The following table summarizes the distribution of sTfr Index stratified by ferritin concentration. Twenty-six of 35 (74%) patients with a ferritin 30–100 ng/mL had sTfr Index ≥2.0 consistent with iron deficiency. However, using conventional iron tests (meeting 2 of 3 criteria: TIBC >450mcg/dL, iron <60mcg/dL, TSAT <15%), only 19 of the 26 patients would have been identified as having IDA. Surprisingly, 9 of 33 (27%) patients with ferritin >100ng/mL also had sTfr Index ≥2.0 suggesting functional iron deficiency in combination with ACI. Among all patients included in this analysis, compared to conventional iron tests, an univariate logistic regression analysis showed that with each unit increase in sTfr Index, the odds of being iron deficient, identified by conventional tests, significantly increased 3.4-fold (p<0.0001, 95% CI: 1.8–6.1). Conclusions: Results with the sTfr Index suggest that iron deficiency in the elderly may be more common than reported with conventional iron tests. In community-dwelling elderly patients with ferritin levels consistent with ACI (>100ng/mL) may have concomitant functional iron deficiency. The use of sTfr in older adults with milder anemia (Hb>11g/dL) should also be evaluated. Ferritin (ng/mL) sTfr Index < 30 30–100 > 100 < 2.0 0 9 24 2.0 – 3.0 1 17 5 >3.0 12 9 4 Total 13 35 33
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Mast, Alan E., Morey A. Blinder, Ann M. Gronowski, Cara Chumley, and Mitchell G. Scott. "Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations." Clinical Chemistry 44, no. 1 (January 1, 1998): 45–51. http://dx.doi.org/10.1093/clinchem/44.1.45.
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Abstract Soluble transferrin receptor (sTfR) and ferritin concentrations were measured in a variety of clinical settings to compare the ability of these two tests to identify iron deficiency. Among 62 anemic patients who either had a bone marrow aspirate performed or had a documented response to iron therapy, the diagnostic sensitivity and specificity of sTfR (at a diagnostic cutoff of >2.8 mg/L) were 92% and 84%, respectively, with a positive predictive value of 42% in this population. Ferritin (≤12 μg/L) had a sensitivity of 25% and a specificity of 98%. However, the sensitivity and specificity of ferritin could be improved to 92% and 98%, respectively, by using a diagnostic cutoff value of ≤30 μg/L, resulting in a positive predictive value of 92%. Ferritin and sTfR were also measured in 267 outpatient samples and 112 medical students. In the outpatient group, the two tests agreed in 73% of the samples; however, 25% of the samples had ferritin values >12 μg/L and increased sTfR. Among the medical students, there was 91% agreement between the two tests, but 7% of the samples had ferritin ≤12 μg/L and normal sTfR. Together, these data suggest that measurement of sTfR does not provide sufficient additional information to ferritin to warrant routine use. However, sTfR may be useful as an adjunct in the evaluation of anemic patients, whose ferritin values may be increased as the result of an acute-phase reaction.
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Fischer, Christina M., Ming Zhang, Maya R. Sternberg, Maria E. Jefferds, Ralph D. Whitehead, Zuguo Mei, Naveen Paudyal, et al. "The VitMin Lab Sandwich-ELISA Assays for Iron and Inflammation Markers Compared Well with Clinical Analyzer Reference-Type Assays in Subsamples of the Nepal National Micronutrient Status Survey." Journal of Nutrition 152, no. 1 (October 4, 2021): 350–59. http://dx.doi.org/10.1093/jn/nxab355.
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ABSTRACT Background The low cost and small specimen volume of the VitMin Lab ELISA assays for serum ferritin (Fer), soluble transferrin receptor (sTfR), C-reactive protein (CRP), and α-1-acid glycoprotein (AGP) have allowed their application to micronutrient surveys conducted in low-resource countries for ∼2 decades. Objectives We conducted a comparison between the ELISA and reference-type assays used in the US NHANES. Methods Using the Roche clinical analyzer as a reference, we measured random subsets of the 2016 Nepal National Micronutrient Status Survey (200 serum samples from children aged 6–59 mo; 100 serum samples from nonpregnant women) for Fer, sTfR, CRP, and AGP. We compared the combined data sets with the ELISA survey results using descriptive analyses. Results The Lin's concordance coefficients between the 2 assays were ≥0.89 except for sTfR (Lin's ρ = 0.58). The median relative difference to the reference was as follows: Fer, −8.5%; sTfR, 71.2%; CRP, −19.5%; and AGP, −8.2%. The percentage of VitMin samples agreeing within ±30% of the reference was as follows: Fer, 88.5%; sTfR, 1.70%; CRP, 74.9%; and AGP, 92.9%. The prevalence of abnormal results was comparable between the 2 assays for Fer, CRP, and AGP, and for sTfR after adjusting to the Roche assay. Continued biannual performance (2007–2019) of the VitMin assays in CDC's external quality assessment program (6 samples/y) demonstrated generally acceptable performance. Conclusions Using samples from the Nepal survey, the VitMin ELISA assays produced mostly comparable results to the Roche reference-type assays for Fer, CRP, and AGP. The lack of sTfR assay standardization to a common reference material explains the large systematic difference observed for sTfR, which could be corrected by an adjustment equation pending further validation. This snapshot comparison together with the long-term external quality assessment links the survey data generated by the VitMin Lab to the Roche assays used in NHANES.
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Mani, La, Siti Fatimah-Muis, and Apoina Kartini. "Korelasi kadar hepcidin dan asupan makanan dengan serum transferrin reseptor dan hemoglobin pada remaja stunted overweight." Jurnal Gizi Indonesia 8, no. 1 (February 6, 2020): 51. http://dx.doi.org/10.14710/jgi.8.1.51-59.
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Background: Stunted overweight is associated with mild chronic inflammation. The state of inflammation will increase the expression of hepcidin, which affects the iron status of the body, besides the intake of protein, iron, and vitamin C.Objective: To analyze the correlation of hepcidin levels and food intake (protein, iron, vitamin C) with serum transferrin receptors (sTfR) and hemoglobin in stunted overweight adolescents.Method: The design of research was cross-sectional. The subjects were 64 adolescents stunted overweight aged 15-18 years in four high/vocational schools in the Banyumanik District, Semarang City. Measurement the level of hepcidin and sTfR was using the ELISA method and haemoglobin was using Cyanomethemoglobin method. Data on protein, iron, vitamin C intake was using the SQ-FFQ method. Bivariate analysis was using Pearson and Spearman correlation test then followed by multiple linear regression analysis.Results: The result showed that 89.1% subjects had adequate intake of protein, 54.7% subjects had low intake of vitamin C, 76.6% subjects had low intake of iron. Hepcidin levels in all subjects were 100% normal. There were 7.8% subjects with a low sTfR and 7.8% with a low haemoglobin level. Statistic test showed there was correlation between hepcidin with haemoglobin and sTfR (p1 = 0,010 r1 = -0,319, p2 = 0,001, r2 = 0,569). From food intake, only intake iron was correlated with haemoglobin but not with sTfR. There was significant difference between the mean of haemoglobin and sTfR among girls and boys. Further analysis, showed that only hepcidin was a weak negative determinant for sTfR (R2 = 0,120). The determinant factors for haemoglobin were gender (p=0,001) and hepcidin (p =0,004) with the value of R2 = 0,577.Conclusion: Hepcidin correlated with sTfR and haemoglobin while iron intake only correlated with hemoglobin.
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Suominen, Pauli, Kari Punnonen, Allan Rajamäki, and Kerttu Irjala. "Evaluation of new immunoenzymometric assay for measuring soluble transferrin receptor to detect iron deficiency in anemic patients." Clinical Chemistry 43, no. 9 (September 1, 1997): 1641–46. http://dx.doi.org/10.1093/clinchem/43.9.1641.
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Abstract During the last few years the measurement of serum-soluble transferrin receptor (sTfR) has been introduced as a tool to detect iron deficiency and as an analyte to differentiate between anemia caused by iron deficiency (IDA) and that caused by chronic disease (ACD). Commercially available methods have emerged to make diagnostics by sTfR more readily accessible. We documented the analytical performance of a newly introduced IDeATM sTfR immunoenzymometric assay (IEMA) by Orion Diagnostica. We also evaluated its clinical performance in 98 consecutive anemic patients, with information derived from bone marrow aspirate samples as the reference for iron status. The clinical usefulness of two other commercially available sTfR assays was assessed for comparison. The analytical performance and clinical applicability of the IDeA were sufficient to support reliable clinical work. We conclude that IDA and iron deficiency in the presence of inflammatory states can be differentiated efficiently from ACD with this new commercial test to measure sTfR.
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Tri Kusumastuti, Fajar Diah, Sutaryo Sutaryo, and Sri Mulatsih. "Correlations between hemoglobin, serum ferritin, and soluble transferrin receptor levels in children aged 6-59 months." Paediatrica Indonesiana 54, no. 2 (April 30, 2014): 122. http://dx.doi.org/10.14238/pi54.2.2014.122-6.
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Background Early detection of iron deficiency is important in young children to prevent iron deficiency anemia, which may cause permanent neurocognitive development disorders. Hemoglobin level is an insensitive tool for detecting iron deficiency without anemia, while serum ferritin levels may be influenced by infection and inflammation. However, soluble transferrin receptor (sTfR) is a sensitive marker for detecting iron deficiency, yet not widely used in daily practice.Objective To assess for correlations between hemoglobin, serum ferritin, and soluble transferrin receptor levels in children aged 6-59 months.Methods We performed a cross-sectional study in the Yogyakarta and Bantul Districts involving 85 children aged 6-59 months who visited integrated health posts (posyandu) and who met the inclusion criteria. Subjects were chosen by cluster random sampling. Blood specimens were collected to examine hemoglobin, serum ferritin, and sTfR levels.Results Spearman’s correlation test revealed weak negative correlations between hemoglobin and serum ferritin levels, as well as between hemoglobin and sTfR levels, with coefficient correlations of r = -0.220, (P=0.043) and r = -0.317, (P=0.003), respectively. There was no correlation between serum ferritin and sTfR levels (r = -0.033; P=0.767).Conclusion Hemoglobin levels has weak negative correlations with serum ferritin and sTfR, but serum ferritin does not correlate with sTfR. [Paediatr Indones. 2014;54:122-6.]
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Grotto, Helena Zerlotti Wolf, Elza Miyuki Kimura, and Márcia Victor Carneiro. "Soluble transferrin receptor in sickle cell diseases: correlation with spleen function." Sao Paulo Medical Journal 117, no. 4 (July 1999): 145–50. http://dx.doi.org/10.1590/s1516-31801999000400002.
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OBJECTIVE: To correlate spleen function with soluble transferrin receptor (sTfR) levels and red cell ferritin (RCF) values in patients with sickle cell diseases. DESIGN: Prospective study. LOCATION: University Hospital, School of Medical Sciences, State University of Campinas; a tertiary hospital. PARTICIPANTS: 60 patients with sickle cell diseases, in a steady state, who had not received blood transfusions for 3 months; 28 normal individuals with no clinical or laboratory signs of anemia. MEASUREMENTS: Determination of serum iron, transferrin iron-binding capacity, serum ferritin, RCF and sTfR. Evaluation of spleen function: erythrocytes with pits were quantified. RESULTS: Patients with sickle cell anemia had sTfR levels significantly higher than in normal individuals or those with HbSC (p=0.0001) and there was an inverse correlation between sTfR and fetal Hb (p=0.0016). RCF values were significantly higher in sickle cell anemia patients than in normal individuals or those with HbSC (p=0.0001), and there was a correlation between RCF and pitted erythrocytes (p=0.0512). CONCLUSION: The association between sTfR and fetal Hb confirms the contribution of fetal Hb to improving the hemolytic state by minimizing the consequent reactive erythrocyte expansion. High sTfR levels are not related to the degree of spleen function deficiency seen in sickle cell disease patients. The deficiency in the exocytosis process of the spleen occurring in sickle cell anemia patients may contribute to their accumulation of RCF.
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Sfagos, Constantinos, Alexandros C. Makis, Aristeidis Chaidos, Eleftheria C. Hatzimichael, Androniki Dalamaga, Katerina Kosma, and Konstantinos L. Bourantas. "Serum ferritin, transferrin and soluble transferrin receptor levels in multiple sclerosis patients." Multiple Sclerosis Journal 11, no. 3 (June 2005): 272–75. http://dx.doi.org/10.1191/1352458505ms1171oa.
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Over the last few years, increased evidence has supported the role of iron dysregulation in the pathogenesis of multiple sclerosis (MS), as iron is essential for myelin formation and oxidative phosphorylation. We studied indices of iron metabolism, such as serum iron, ferritin, transferrin and soluble transferrin receptor (sTFR) levels in 27 MS patients. Seven patients had chronic progressive active disease (CP-A), six had chronic progressive stable (CP-S), ten had relapsing—remitting active (RR-A) and four had relapsing—remitting stable (RR-S) disease. sTFR levels were found to be significantly higher in CP-A (P=0.021) and RR-A (P= 0.004) patients than in controls. sTFR levels were also elevated in CP-S patients but did not reach significance (P=0.064). sTFR values in RR-S patients were comparable to those found in controls (P=0.31). Ferritin levels were significantly elevated only in CP-A patients (P= 0.002). Patients of the CP group had significantly higher ferritin values than the RR patients (P= 0.004). Haemoglobin values as well as iron and transferrin levels were within normal limits in all patients. In conclusion, the increased serum sTFR and ferritin levels in nonanaemic MS patients with active disease reflect the increased iron turnover. The mild elevation of sTFR levels in CP-S patients may indicate active inflammation with ongoing oxidative damage that is not detectable by history or examination.
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Looker, Anne C., Mark Loyevsky, and Victor R. Gordeuk. "Increased Serum Transferrin Saturation Is Associated with Lower Serum Transferrin Receptor Concentration." Clinical Chemistry 45, no. 12 (December 1, 1999): 2191–99. http://dx.doi.org/10.1093/clinchem/45.12.2191.
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Abstract Background: Serum transferrin receptor (sTfR) concentrations are increased in iron deficiency. We wished to examine whether they are decreased in the presence of potential iron-loading conditions, as reflected by increased transferrin saturation (TS) on a single occasion. Methods: We compared sTfR concentrations between 570 controls with normal iron status and 189 cases with increased serum TS on a single occasion; these latter individuals may be potential cases of iron overload. Cases and controls were selected from adults who had been examined in the third National Health and Nutrition Examination Survey (1988–1994) and for whom excess sera were available to perform sTfR measurements after the survey’s completion. Increased TS was defined as >60% for men and >55% for women; normal iron status was defined as having no evidence of iron deficiency, iron overload, or inflammation indicated by serum ferritin, TS, erythrocyte protoporphyrin, and C-reactive protein. Results: Mean sTfR and mean log sTfR:ferritin were ∼10% and 24% lower, respectively, in cases than in controls (P <0.002). Cases were significantly more likely to have an sTfR value <2.9 mg/L, the lower limit of the reference interval, than were controls (odds ratio = 1.8; 95% confidence interval, 1.04–2.37). Conclusion: Our results support previous studies that suggested that sTfR may be useful for assessing high iron status in populations.
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Calvo-Villas, Jose Manuel, María Francisca Zapata, Ivan Alvarez, Silvia de la Iglesia, Jorge Cuesta, Elena Carreter, and Francisco Sicilia. "Serum Soluble Transferrin Receptor in Heterozygous β-Thalassaemia: Application in the Diagnosis of Iron Deficiency and as Hematologic Marker of Erythroid Activity According to Thalassaemic Genotypes (β0 vs β+)." Blood 108, no. 11 (November 16, 2006): 3828. http://dx.doi.org/10.1182/blood.v108.11.3828.3828.
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Abstract Although an increased level of serum soluble transferrin receptor (sTfR) have been found in both heterozygous β-thalassaemia patients with iron deficiency and in those with more severe genotype (β0), it is not a useful marker of iron deficiency status associated to β-thalassaemia. The aim of this study was to analyse the use of two biochemical parameters (sTfR and sTfR/log of ferritin ratio) to determine the iron status and to evaluate the degree of erythropoietic activity in a group of 221 β-thalassaemic heterozigotes patients (155 β0 and 66 β+). Serum ferritin and transferrin saturation index were measured in order to establish the iron status. Of the whole group, 51 patients were iron defficient (βthal-ID) while the remaining 170 were iron sufficient (βthal-IS). Based on the combination of β-thalassaemia genotype and iron status, patients were classified into four subgroups: β0thalassaemia and iron-sufficient (β0thal-IS) (n=124); β0thalassaemia and iron-deficient (β0thal-ID) (n=31); β+thalassaemia and iron-sufficient (β+thal-IS) (n=46); β+thalassaemia and iron-deficient (β+thal-ID) (n=20). 258 healthy and 56 iron-deficient individuals were used as controls. All the haematological parameters were measured by using analyzer Coulter® GEN-S™. Haemoglobins A2 (Hb A2) and F (HbF) were analysed by high performance liquid chromatography and molecular analysis was performed by real-time PCR and direct sequencing techniques. Chemical, inmunoturbidimetrical and nephelometric methods were used to measure iron status as well as sTfR. Comparison of haemalogical and biochemical parameters between subgroups was performed by using the t-student test and correlation analysis was calculated by using least-squares regression model. Mean sTfR level obtained was 2.63 ± 0.8 mg/dL and 2.57 ± 1.1 mg/dL in βthal-ID and βthal-IS patients respectively (p=0.783). Soluble transferrin receptor showed a positive correlation with HbA2, HbF and reticulocyte count values in βthal-IS patients (r=0.208 [p<0.05], r=0.440 [p<0.0001] and r=0.393 [p<0.00001] respectively) while it did not reach a significant correlation in βthal-ID patients. Mean sTfR/log sFt ratio was 2.75 ± 1.6 and 1.34 ± 0.5 in βthal-ID and βthal-IS patients (p<0.001). Interestingly, sTfR level was significantly higher in β0thal-IS patients when compared with β+thal-IS patients (2.76 ± 0.9 vs 1.42 ± 0.4) (p<0.001) as a result of an increased globin chains imbalance related to the β0 genotype. In the other hand, in the comparison between β0thal-ID and β+thal-ID subgroups neither sTfr level (2.71 ± 0.7 vs 2.40 ± 1.1) (p=0.417) nor sTfR/log sFt ratio (2.93 ± 1.7 vs 2.24 ± 1.3) (p=0.371) showed significant difference. In summary, sTfR/log sFt ratio is a valid parameter for diagnosis of iron deficiency associated to heterozygous β-thalassaemia. Unlike the findings observed in β-thalassaemic heterozigotes with normal iron status, sTfR level is not useful to evaluate the genotype severity in those with iron deficiency. Consequently, iron status should be determined before using sTfR as a parameter to provide a reliable estimation of the ineffective erythropoiesis related to the severity of β-thalassaemia genotypes.
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Drakou, Athina, Christos Poziopoulos, Alexandra Margeli, Ioannis Papassotiriou, and Demetrios Vlahakos. "Assessment of Serum Bioactive Hepcidin-25, Soluble Transferrin Receptor and Their Ratio in Predialysis Patients: Correlation with the Response to Intravenous Ferric Carboxymaltose Administration." Blood 126, no. 23 (December 3, 2015): 949. http://dx.doi.org/10.1182/blood.v126.23.949.949.
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Abstract Background: No reliable biomarker exists to predict responsiveness to intravenous (IV) iron (Fe) in iron deficient patients with chronic kidney disease (CKD). Our aim was to investigate if Hepcidin-25 (Hepc25) and soluble Transferrin Receptor (sTfR) and their Ratio sTfR/Hepc25 ratio prior to treatment can make a distinction between those predialysis patients with and those without adequate erythropoiesis after administration of IV ferric carboxymaltose (FCM). Patients and methods: In this prospective study we enrolled 78 stable stage III-IV CKD patients with iron deficiency (serum ferritin levels lower than 100µg/L) treated with IV FCM 1000mg/100ml NaCl-0.9% and infused over a period of 20min. Patients were divided in two groups according to hemoglobin (Hb) increase within a month after treatment. The responders (Group R, n=40), showed above 1g/dL increase in Hb concentration. The non-responders (Group NR, n=38) had no such a favorable reaction. Patient data, clinical information and blood samples were collected prior to IV iron administration. Hematologic analysis was performed using a hematogy analyzer. Blood chemistry, including measurements of renal, nutrition and inflammation markers along with measurements of Hepc25, IL-6 and sTfR were performed using appropriate techniques. Receiver Operating Curve (ROC) analysis was applied in order to evaluate the diagnostic potential of Hepc25 and sTfR/Hepc25 ratio and conclusions about the specificity and sensitivity were drawn. Results: As shown in Table 1, there were no significant differences at baseline between responders and non-responders in demographic and clinical parameters. No significant differences were revealed for serum creatinine, e-GFR, folic acid (FA), vitamin B12, hs-CRP and IL-6, with the notable exception of ferritin and Hepc25 levels that were lower and sTfR and sTfR/Hepc25 ratio that were higher in the responders as compared to non-responders (Table 1). Diagnostic efficacy was analyzed by ROC analysis. Cut off point of 1.49 for Hepc25 had sensitivity 84% and specificity 48%, and cut off point of 1.21 for sTfR/Hepc25 ratio had sensitivity 82% and specificity 52% to predict correctly response to Fe therapy (Table 2). Conclusions: These results suggest that lower Hepc25 and ferritin levels, as well as higher sTfR and sTfR/Hepc25 ratio were significant predictors of favorable hemoglobin response within a month after IV administration of FCM in CKD patients. Further in vitro and in vivo experiments and clinical studies in a larger population of patients are needed to better elucidate the role of Hepc25 and sTfR/Hepc25 ratio in iron deficiency anemia in CKD. Table 1. Demographic, clinical and biochemical parameters in responders vs non-responders. Group R (n=40 Group NR (n=38) Age (years) 72.7±11.2 74.5±10.3 NS Gender (M /F) 27:13 25:13 NS Medications -RAS inhibitors 21(27%) 19(24%) NS rh EPO 1(27%) 20(26%) NS CCB 10(13%) ) 11(14% NS BMI (Κg/m2) 25.5±3.3 25.1±3.4 NS Comorbidities -Cardiovascular Disease 17(22%) 15(19%) NS -Μechanical valve heart 2(2%) 2(2%) NS -Diabetes Mellitus 20(26%) 17(22%) NS -Polycystic Kidney Disease 2(1%) 1(1%) NS Hemoglobin (g/dL) 10.9±1.6 11.1±1.3 NS Creatinine (mg/dL) 2.4±1.1 2.5±1.1 NS eGFR(mL/min/1.73 m2) 35.2±16.9 30.0±13.4 NS B12 (pg/mL) 512.0±369.0 655.0±414.0 NS hs-CRP (mg/L) 3.9±5.9 3.7± 4.9 NS IL-6 (pg/mL) 6.2±5.3 5.78±4.5 NS sTfR (mg/L) 2.27±0.99 1.76±0.76 0.014 Log (1+Hepc25) 0.552±0.343 0.728±0.348 0.027 sTfR/Hepc25 1.91±1.53 0.80±0.72 0.002 Table 2. Sensitivity and specificity of Hepcidin and sTfR/H as predictors of responsiveness to IV FCM AUC 95%C.I. P-value Cut-off Point Sensitivity Specificity Hepc25 0.648 0.52-0.77 0.025 1.49 84% 48% sTfR/Hepc25 0.680 0.56-0.80 0.006 1.21 82% 52% Disclosures No relevant conflicts of interest to declare.
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Canals, Carmen, Pilar Sardà, Jose María Piazuelo, and Ángel F. Remacha. "The “Thomas Plot”: Its Usefulness in the Assessment of Iron Status in Anemia." Blood 106, no. 11 (November 16, 2005): 3737. http://dx.doi.org/10.1182/blood.v106.11.3737.3737.
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Abstract A diagnostic plot to assess iron status in anemia of chronic disorders (ACD) has recently been developed (Thomas C, Thomas L. Lab Hematol 2005). The plot is based on the relation between the ratio of the soluble transferrin receptor value to the logarithm of the ferritin value (sTfR/log sFt) and the RET-He parameter -reticulocyte hemoglobin equivalent-. A different cut-off point for sTfR/log sFt is proposed for patients with a CRP ≤5mg/L or with a CRP >5mg/L. The main aim of our study was to validate the usefulness of the “Thomas Plot” in assessing iron status. We also ascertained whether a modification on the sTfR/log sFt cut-off point improved the results. CRP was determined in 306 patients, 198 with iron deficiency (ID) and 108 with ACD. All of them were anemia cases studied in accordance with our standard protocol. RET-He, sTfR and sTfR/log sFt were calculated in all samples. The Thomas Plot was applied to all the cases and the results were compared. A discrepancy was considered relevant when it implied a change in patient treatment. Using logistic regression analysis, we investigated the optimum cut-off point of sTfR/log sFt in our series. Overall, the Thomas Plot correctly classified 223/306 patients (73%). There were clinically relevant discrepancies in 29 patients (9.5%), in 5 patients with CRP ≤5mg/L (5%) and in 24 patients with CRP >5mg/L (12%). It failed to identify ID in 12/198 patients (6%) but classified 17 cases with ACD (16%) as latent ID or IDA. The optimum sTfR/log sFt cut-off point in our series was 2.4 for patients with CRP ≤5mg/L and 2.39 for patients with CRP>5mg/L. As a consequence, we investigated a modified “Thomas Plot” using a sTfR/log sFt cut-off point of 2.4 for all the patients. The modified algorithm correctly classified 77% of the patients. There were clinical relevant discrepancies only in 17 patients (5%). It failed to identify ID in 12/198 patients (6%) and only classified 5 cases with ACD as latent ID or IDA (4.6%). The sensitivity of the Thomas Plot to identify ID was very high but the specificity was lower. A cut-off point of 2.4 for sTfR/log sFt is useful for patients with or without inflammatory traits and yields more accurate results.
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AR, Indrati, Van Crevel R, Sumantri R, and Wisaksana R. "KADAR PENERIMA TRANSFERIN TERLARUT (sTFR) DI PENDERITA HIV/AIDS DENGAN ANEMIA." INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY 15, no. 3 (March 16, 2018): 105. http://dx.doi.org/10.24293/ijcpml.v15i3.963.
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Anemia is the most common hematologic abnormality associated with HIV which affecting 60 to 80 percent of patients in the latestage of the disease. The presence of anemia is associated with increased of morbidity and mortality in patients with HIV infection. Irondeficiency, chronic inflammation and antiretroviral treatment (ACT) may cause HIV associated anemia. The differentiation of irondeficiency anemia from chronic disease anemia is a diagnostic challenge. Maybe it is helpful in soluble transferrin receptor (sTfR), thecleaving of the extra cellular domain related to transferrin receptor. Because the elevated sTfR concentration is a marker of tissue irondeficiency and increased marrow erythropoietin activity. The aim of this study was to examine the diagnostic value of soluble transferrinreceptor level in anemia patients with HIV/AIDS. The Study was the part of the IMPACT (Integrated Management for Prevention, Controland Treatment of HIV/AIDS) baseline and cohort study. The study started since September 2007 in RSUP Hasan Sadikin Bandung.There were 179 HIV/AIDS patients with anemia included in this study. Complete blood count, reticulocytes, feritin, soluble transferringreceptor and hsCRP were tested in these patients. It was found that the mean of sTfR in HIV patients with anemia were 1238.42U/mL(304.5-30435). sTfR had a low correlation with MCV (r -0.174), feritin (r -0.65) and absolute reticulocyte counting (r 0.172). Feritinhad moderate and significant correlation with hsCRP (r:0.429; p 0.00). There was no significant difference of sTfR level between thepatients without ART, with Zidovudin and d4T (p 0.81). There was no significance difference of sTfR concentration between the low andnormal MCV level (p 0.341). sTfR can not differentiate the source of anemia in patients with HIV/AIDS. It can be concluded so far thatchronic disease and inflammation as reflected by the elevated hsCRP level and use of zidovudine are the main cause of anemia.
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Pasricha, Sant-Rayn S., Zoe McQuilten, Mark Westerman, Anthony Keller, Elizabeta Nemeth, Tomas Ganz, and Erica M. Wood. "Is Serum Hepcidin a Useful Diagnostic Test for Iron Deficiency?" Blood 116, no. 21 (November 19, 2010): 2056. http://dx.doi.org/10.1182/blood.v116.21.2056.2056.
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Abstract Abstract 2056 Introduction: Iron deficiency remains the commonest blood disorder worldwide. Hepcidin is a key regulator of iron homeostasis. In iron depletion, decreased hepcidin facilitates increased iron absorption and recycling. Hepcidin is detectable in whole blood, serum & urine, and although assays have been developed, the utility and clinically appropriate cutoffs for diagnosis of iron deficiency remain to be established. Blood donors are at particular risk of iron deficiency, yet early diagnosis remains challenging in this setting; thus donors are an ideal population in which to evaluate a new diagnostic test of iron deficiency. We evaluated hepcidin as a diagnostic test of iron deficiency in female blood donors. Methods: Subjects: Premenopausal, non-anemic females accepted for whole blood donation by the Australian Red Cross Blood Service, not taking iron supplements and with no history of hemochromatosis. Iron status assessment: Serum ferritin (chemiluminescence), soluble transferrin receptor (sTfR) (immunoturbidometry) and serum hepcidin (competitive ELISA). Analysis: Diagnostic utility of hepcidin, compared with ‘gold standards’ ferritin, sTfR and sTfR/log(ferritin) index, was evaluated by Area under Receiver Operating Characteristic curves (AUCROC). Potential hepcidin cutoffs were identified, and their sensitivities and specificities evaluated. Results: We recruited 261 donors: 22.6% had ferritin<15ng/mL, 10.3% had sTfR>4.4mg/mL, and 20.3% had sTfR/log(ferritin) index>3.2. The 95% range of hepcidin values was <5.4-175.0ng/mL (overall); 9.3–203.0ng/mL (if ferritin≥15ng/mL); and 8.1–198.5ng/mL (if sTfR/log(ferritin)index≤3.2). By linear regression, log(hepcidin) was associated with log(ferritin) (coefficient +1.08, P<0.001); log(sTfR) (coefficient -2.02, P<-0.001) and log(sTfR/ferritin index) (coefficient -1.58, P<0.001). The AUCROC for hepcidin, compared with sTfR/log(ferritin) index>3.2 was 0.89, compared with ferritin<15ng/mL was 0.87 and compared with sTfR>4.4mg/mL was 0.81. An undetectable hepcidin (<5.4ng/mL) had sensitivity and specificity of 32.2% and 99.9% respectively for identification of sTfR/log(ferritin) index>3.2; hepcidin<8.1ng/mL had sensitivity and specificity of 41.5% and 97.5% respectively, and hepcidin<20ng/mL had sensitivity and specificity 74.6% and 83.2% respectively. Conclusions: Hepcidin shows promise as a diagnostic test for iron deficiency. Further work is needed to select suitable cutoffs for this assay, however a cutoff of <8.1ng/mL seems to accurately identify normal subjects, whilst <20ng/mL offers a balance between appropriate identification of cases and normal subjects. Hepcidin may become a valuable clinical index of iron status. Rapid diagnosis of iron deficiency with point of care whole blood or urine hepcidin assays may be achievable and useful in various settings, including blood donation. Prevention of donor iron deficiency is a high priority for the Australian Red Cross Blood Service and is being addressed through a comprehensive strategy. Disclosures: Westerman: Intrinsic Life Sciences: Employment, Membership on an entity's Board of Directors or advisory committees. Nemeth:Intrinsic Life Sciences: Employment, Membership on an entity's Board of Directors or advisory committees. Ganz:Intrinsic Life Sciences: Employment, Membership on an entity's Board of Directors or advisory committees.
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Stefanova, Katya I., Ginka T. Delcheva, Ana I. Maneva, Anastas Z. Batalov, Mariela G. Geneva-Popova, Rositza V. Karalilova, and Kiril K. Simitchiev. "Pathobiochemical Mechanisms Relating Iron Homeostasis to Parameters of Inflammatory Activity and Autoimmune Disorders in Rheumatoid Arthritis." Folia Medica 58, no. 4 (December 1, 2016): 257–63. http://dx.doi.org/10.1515/folmed-2016-0040.
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Abstract Aim: To find the correlations between the parameters of iron homeostasis, inflammatory activity and autoimmune disorders in rheumatoid arthritis (RA). Materials and methods: The present study included 114 patients with RA and 42 healthy controls. We determined the parameters of iron homeostasis: serum iron, total iron binding capacity (TIBC), ferritin and soluble transferrin receptor (sTfR), the parameters of inflammatory activity: C-reactive protein (CRP), interleukin-6 (IL-6) and prohepcidin, and the parameters of autoimmune disorders: rheumatoid factor (RF), anti-cyclic citrullinated peptide (antiCCP) antibodies, and DAS 28. Results: The levels of sTfR, CRP, IL-6 and prohepcidin were significantly higher in RA patients than those in the controls and the level of serum iron was significantly lower in RA than that in the control group. Unlike the controls, in RA, there was a significant positive correlation of sTfR with the parameters of inflammatory activity (IL-6, prohepcidin, ESR) and with the parameters of autoimmune disorders (DAS 28, RF, antiCCP). A negative correlation of serum iron with sTfR was found only in RA patients. Prohepcidin positively correlated with the parameters of inflammation (CRP, ESR) and with the parameters for evaluation of autoimmune disorders (DAS 28 and RF) in the RA group. Conclusion: Our study shows that the simultaneous determination of the two parameters sTfR and prohepcidin is most informative in evaluating the changes in iron homeostasis in RA. The increase of both parameters provides information for tissue iron deficiency (assessed by the level of sTfR), caused by the inflammation when prohepcidin is expressed.
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Stefanova, Katya I., Ginka T. Delcheva, Ana I. Maneva, Anastas Z. Batalov, Mariela G. Geneva-Popova, Rositza V. Karalilova, and Kiril K. Simitchiev. "Pathobiochemical Mechanisms Relating Iron Homeostasis with Parameters of Inflammatory Activity and Autoimmune Disorders in Rheumatoid Arthritis." Folia Medica 60, no. 1 (March 1, 2018): 124–32. http://dx.doi.org/10.1515/folmed-2017-0068.
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Abstract Aim: To find the correlations between the parameters of iron homeostasis, inflammatory activity and autoimmune disorders in rheumatoid arthritis (RA). Materials and methods: The present study included 114 patients with RA and 42 healthy controls. We determined the parameters of iron homeostasis: serum iron, total iron binding capacity (TIBC), ferritin and soluble transferrin receptor (sTfR), the parameters of inflammatory activity: C-reactive protein (CRP), interleukin-6 (IL-6) and prohepcidin, and the parameters of autoimmune disorders: rheumatoid factor (RF), anti-cyclic citrullinated peptide (antiCCP) antibodies and DAS 28. Results: The levels of sTfR, CRP, IL-6 and prohepcidin were significantly higher in RA patients than those in the controls and the level of serum iron was significantly lower in RA than that in the control group. Unlike the controls, in RA, there was a significant positive correlation of sTfR with the parameters of inflammatory activity (IL-6, prohepcidin, ESR) and with the parameters of autoimmune disorders (DAS 28, RF, antiCCP). A negative correlation of serum iron with sTfR was found only in RA patients. Prohepcidin positively correlated with the parameters of inflammation (CRP, ESR) and with the parameters for evaluation of autoimmune disorders (DAS 28 and RF) in the RA group. Conclusion: Our study shows that the simultaneous determination of the two parameters sTfR and prohepcidin is most informative for evaluation of the changes in iron homeostasis in RA. The increase of both parameters provides information for tissue iron deficiency (assessed by the level of sTfR), caused by the inflammation when prohepcidin is expressed.
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Salma, Salma, Rita Arifin, Erial Bahar, and Rini Purnamasari. "Soluble transferrin receptor as an indicator of iron deficiency and febrile seizures." Paediatrica Indonesiana 55, no. 2 (April 30, 2015): 95. http://dx.doi.org/10.14238/pi55.2.2015.95-100.
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Background Iron deficiency (ID) has a high incidence inIndonesia, and is a risk factor for febrile seizures. The most suitableassay to detect iron deficiency in the presence of inflammationhas not yet been defined. An indicator of ID unaffected byinflammation is needed, soluble transferrin receptor (sTfR) maybe such an indicator.Objective To evaluate ID as a risk factor for febrile seizures inchildren with inflammation by sTfR measurements.Method We conducted an age-matched, case-control study,focused on children experiencing on acute illnesses at the time.Subjects were 80 children matched by age (40 in the case groupwith febrile seizures, and 40 in the control group who were febrilewithout seizures) aged 3 months to 5 years in Mohammad HoesinHospital, Palembang from February to August 2013. Subjects’clinical data and sTfR levels were recorded. Risk factors wereanalyzed with odd ratios and 95% confident intervals. ThesTfR level cut-off point as a predictor of febrile seizures was alsodefined. Other risk factors were analyzed with multivariate logisticregression test.Results Mean sTfR levels were 41.36 (SD 2.04) nmol/L in thecase group and 33.09 (SD 1.02) nmol/L in the control group.Multivariate analysis revealed ID and iron deficient anemia(IDA), as measured by sTfR levels, to be risk factors for febrileseizures (adjusted OR=3.9; 95%CI 1.41 to 10.8; P=0.007 andOR 3.27; 95%CI 1.21 to 8.84; P=0.017, respectively). The sTfRlevel cut-off point that could be used as a predictor of febrileseizures was 37nmol/L.Conclusion Iron deficiency as measured by increased sTfR isa risk factor for febrile seizures in children.
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Lin, Xiao-Ming, Wei Tian, Le Ma, Zhu Long, Juan Zhang, Xiao-Yi Shen, and Xiao-Peng Zhang. "The responses of serum transferrin receptors to iron supplements in subjects with iron-deficiency erythropoiesis and iron-deficiency anaemia." British Journal of Nutrition 99, no. 2 (February 2008): 416–20. http://dx.doi.org/10.1017/s0007114507797040.
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We aimed to study the response of serum transferrin receptors (sTfR) to Fe supplementation in women of childbearing age with Fe-deficiency erythropoiesis (IDE) and Fe-deficiency anaemia (IDA). Primary screening was performed in 942 women ranging in age from 18 to 45 years. After Fe-related biochemical indices such as serum ferritin, Zn protoporphyrin and Hb were determined, the subjects were divided into four groups: normal, Fe store depletion, IDE and IDA. A total of 131 women were randomly selected from the normal, IDE and IDA groups. Subsequently, seventy-six women with IDE and IDA were given various doses of Fe (14 mg/d for IDE; 28 mg/d for IDA) with ferrousl-threonate capsules for twelve consecutive weeks. After receiving Fe supplements, the levels of Fe and sTfR were determined at weeks 0, 3, 6, 9 and 12.The levels of sTfR in women of childbearing age with IDE and IDA were significantly higher than those in the normal group. After receiving Fe supplements, the levels of sTfR were significantly decreased in women of childbearing age with IDE and IDA, while the levels of serum ferritin were significantly increased. In conclusion, STfR can be used as a reliable indicator for assessing the efficacy of Fe supplements.
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Zikidou, Panagiota, Christina Tsigalou, Gregorios Trypsianis, Alexandros Karvelas, Aggelos Tsalkidis, and Elpis Mantadakis. "PREVALENCE OF ANEMIA, IRON DEFICIENCY, AND IRON DEFICIENCY ANEMIA AND DIAGNOSTIC PERFORMANCE OF HEMATOLOGIC AND BIOCHEMICAL MARKERS OF SIDEROPENIA IN 1- TO 5-YEAR-OLD CHILDREN IN THRACE GREECE." Mediterranean Journal of Hematology and Infectious Diseases 14, no. 1 (June 29, 2022): e2022054. http://dx.doi.org/10.4084/mjhid.2022.054.
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Background and Objectives: Iron deficiency (ID) is a major public health problem with high prevalence in early childhood. We assessed the prevalence of anemia, ID, and iron deficiency anemia (IDA) in healthy children of Thrace, Greece, its correlation with dietary factors, and evaluated the diagnostic performance of hematologic and biochemical markers of sideropenia.
Patients and Methods: For 202 healthy children 1-5 years old, a questionnaire was filled out describing their nutritional habits during infancy and early childhood. Venous hemograms along with serum ferritin, TIBC, %TS, and CRP were obtained from all studied children. In a subset of 156 children, the concentration of sTfR was also determined.
Results: Children with ID and IDA had significantly lower beef consumption than children without sideropenia (p=0.044). Using the WHO cut-off values of Hb <11g/dl and ferritin <12μg/l, the prevalence of anemia, ID, and IDA was 9.41%, 6.44%. and 3.47%, respectively. If Hb <12g/dl and ferritin<18μg/l were used as cut-offs, the prevalence of anemia, ID, and IDA was 26.73%, 16.33%, and 5.94%, respectively. ROC analysis revealed that at ferritin <12μg/l, sTfR had the highest specificity and PPV but the lowest sensitivity for ID (93%, 47.4%, and 69.2%, respectively), while sTfR/Fer index had the highest sensitivity and NPV (100%).
Conclusions: The prevalence of ID and IDA in children 1-5 years old in Thrace is like in other developed countries. sTfR and sTfR/Fer index have the highest accuracy to diagnose ID, with the sTfR/Fer index being superior irrespective of the ferritin cut-off value used to define ID.
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Bhuiyan, Mohammed Nuruzzaman, Susane Giti, Mahbuba Akhter, Md Mizanur Rahman, Lubna Naznin, Mohammad Shameem Montasir Hossen, Md Moshiur Rahman, and Tasnim Tabassum Tory. "Role of Soluble Transferrin Receptor in Diagnostic Work Up for The Assessment of Iron Status and Iron Deficiency." Haematology Journal of Bangladesh 6, no. 02 (July 25, 2022): 13–19. http://dx.doi.org/10.37545/haematoljbd202294.
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Background: Iron deficiency anaemia (IDA) is the most frequent form of anaemia in human population. For diagnosing IDA usually conventional laboratory tests such as serum iron, serum ferritin and transferrin saturation are used. However, both ferritin and transferrin proteins are markedly influenced by inflammation, behaving as acute-phase reactants and making it difficult to diagnosis iron-deficiency anemia (IDA) when it is combined with any inflammatory condition. Soluble transferrin receptor (sTfR) is a truncated extracellular form of the membrane transferrin receptor produced by proteolysis. Concentrations of serum sTfR are related to iron status and erythropoiesis in the body. Serum transferrin receptor (sTfR) levels are raised in iron deficiency but are not influenced by inflammatory changes.
Aim: The aim of this study is to evaluate the significance of soluble transferrin receptors in diagnostic work up of iron deficiency.
Materials and Methods: It was a prospective observational study carried out from June 2021 to November 2021 at the Department of Haematology and Biochemistry of Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment. A total of 50 blood sample were collected and subjected to diagnose as microcytic hypochromic anaemia through complete blood count (CBC) and peripheral blood film (PBF). Then serum iron profile and serum sTfR was done by automated analyzer to evaluate differentials of microcytic hypochromic anaemia.
Results: Among 50 cases 5 (10%) were male and 45 (90%) were female. Most of the patients were between 31-40 years age group (34%). Out of 50 patients 42 (84%) showed mild anaemia,6 (12%) showed moderately anaemia and 2(4%) showed severely anaemia according to reference range. Then serum iron profile was done. Among 50 samples 37 (74 %) had low serum iron, 18 (36 %) had high TIBC and 45 (90%) had low serum ferritin in comparison with reference range. Also this study revealed high serum sTfR than normal in 48 (96%) patients. While evaluating the frequency of sTfR level in perspective of both male and female anaemic patients, p-value was found < 0.0001 which was statistically significant.
Conclusion: This study demonstrates that sTfR level in conjunction with other biochemical markers of iron deficiency anaemia is very useful in evaluating iron status. Serum sTfR is a new diagnostic tool for evaluating of iron deficiency anemia when it is associated with other inflammatory condition.
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Ashiq, Tayyaba, Ammara Hafeez, Abdus Sattar, Nasiruddin ., Naureen Saeed, and Faiza Mushtaq. "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." PAFMJ 71, no. 6 (December 30, 2021): 1920–24. http://dx.doi.org/10.51253/pafmj.v6i6.6855.
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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.
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Ford, SJ, MR Bedford, W. Pang, A. Wood, T. Iqbal, C. Tselepis, and O. Tucker. "A comparative study of the iron status of patients with oesophageal adenocarcinoma to determine suitability for a clinical trial of iron chelation therapy." Annals of The Royal College of Surgeons of England 96, no. 4 (May 2014): 275–78. http://dx.doi.org/10.1308/003588414x13946184900282.
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Introduction The incidence of oesophageal adenocarcinoma (OAC) is rising dramatically and overall survival remains extremely poor. Iron has been shown to potentiate tumourigenesis in OAC, and iron chelation therapy demonstrates promise in vivo as an adjunct to neoadjuvant and palliative chemotherapy. OAC, however, has traditionally been associated with iron deficiency anaemia. The aim of this study was therefore to formally quantify the iron status of OAC patients in order to guide the design of future clinical trials involving iron chelation therapy. Methods Demographic and cancer specific data were collected prospectively from all patients presenting with OAC and gastric adenocarcinoma (GAC). Patients had haemoglobin, serum iron, serum ferritin and serum transferrin receptor (sTfR) levels measured to assess systemic iron status. In addition, the sTfR/log ferritin (sTfR-F) index was calculated. Results Average haemoglobin, serum iron, serum ferritin, sTfR and sTfR-F index values for all patients presenting with OAC were within normal sex specific reference ranges. No statistical difference in iron status was observed between OAC patients presenting with resectable and advanced OAC. Patients with OAC are relatively iron replete compared with those presenting with GAC. Iron parameters were not significantly altered by standard neoadjuvant chemotherapy. Conclusions Patients presenting with resectable or advanced OAC could be considered as candidates for a clinical trial of iron chelation therapy as an addition to standard neoadjuvant or palliative treatments.
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Bevers MD, N., G. M. C. Adriaans, A. Aliu, A. Rezazadeh Ardabili, A. C. E. Vreugdenhil, R. de Almeida, P. F. van Rheenen, and M. J. Pierik. "P129 Hepcidin and ferritin index can help to differentiate between different types of anaemia: an exploratory study." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i215—i216. http://dx.doi.org/10.1093/ecco-jcc/jjab232.257.
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Abstract Background Anaemia is frequent in patients with IBD. Iron deficiency anaemia [IDA] and anaemia of chronic disease [ACD] are the most common subtypes and warrant a different treatment approach. The ESPGHAN/ NASHGAN position paper on Anaemia in Children with IBD describes cut-off values on ferritin, transferrin saturation [TSAT] and ferritin index (soluble transferrin receptor/log10(ferritin)) [sTfR-F], to distinguish between IDA and ACD. However, cut-off values for sTfR-F and hepcidin are based on adult data. In this exploratory study we used a data driven approach to define different anaemia groups, using hepcidin and sTfR-F and studied differences between groups and their response to iron suppletion therapy. Insights contribute to a better description of ACD and IDA in a pediatric population. Methods Data from the multi-centre prospective POPEYE study (NTR4487) consisting of a paediatric IBD population was used. Subjects with anaemia (haemoglobin [Hb] < 2 standard deviations [SD] below the mean of a healthy age reference group) with baseline ferritin, TSAT, hepcidin, sTfR-F and erythrocyte sedimentation rate [ESR] values were selected. Summary statistics of these biomarkers were generated for the data-driven groups and compared with existing characteristics for IDA and ACD groups. At baseline subjects received oral or intravenous iron repletion therapy, Hb was determined at baseline and 1 month after iron therapy. Kmeans was used, an unsupervised clustering algorithm using Euclidean distance, to divide data points into k clusters based on sTfR-F and hepcidin. Results Mean age was 13.6 (2.5 SD) years, and mean standardized Hb value -3.2 at baseline for 47 subjects. Data driven groupings using Kmeans (k=3) were based on baseline hepcidin and sTfR-F (figure 1). Group 1 shows characteristics indicative for IDA, with mean ferritin <15µg/l, TSAT < 20% and sTfR-F > 2. Group 2 shows signs suggestive for inflammation since ferritin, hepcidin and ESR were increased (mean ESR 28,5 mm/h [23,2 SD]); this group could be characterized as ACD. Group 3 could not be related to a specific anaemia type. Mean standardized Hb increase 1 month after iron repletion for 37 patients, was 2,9 (SD 0,8), 0,8 (0,7 SD), 1,3 (1,1 SD), for group 1, 2 and 3 respectively. Conclusion Explorative data-driven analysis of a real-world data set showed that hepcidin and sTfR-F can be used to characterize groups that relate to ACD and IDA in a paediatric population. Children with high sTfR-F and low hepcidin possibly benefit more from iron repletion therapy (group 1), compared to when hepcidin is high (group 2). If validated in a larger patient population this determination could contribute to the development of diagnostic algorithms that support targeted therapy.
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Park, EunSil, In-Suk Kim, JiHyun Seo, JaeYoung Lim, ChanHoo Park, HyangOk Woo, and HeeShang Youn. "The Ratio of Serum Transferrin Receptor and Serum Ferritin in the Diagnosis of Iron Deficiency Anaemia in Young Children." Blood 110, no. 11 (November 16, 2007): 3746. http://dx.doi.org/10.1182/blood.v110.11.3746.3746.
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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 <11 g/dL and SF >50 μg/L, the subgroup of iron deficiency anaemia(IDA) as Hb <11 g/dL and SF <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) >2.55 whereas in all subjects classified as AI it was <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 <0.05) AI, anaemia of inflammation; IDA, iron deficiency anaemia Subgroup(%) 33(25) 29(22) 69(53) Hg(g/dL) <11 <11 ≥11 SF(μg/L) >50 <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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V Nipanal, Akkamahadevi, Madhu Kumar M H, and Ashok M L. "Utility of sTFR/Ferritin index to differentiate iron deficiency anaemia and anaemia of chronic disease." IP Journal of Nutrition, Metabolism and Health Science 3, no. 4 (February 15, 2021): 119–23. http://dx.doi.org/10.18231/j.ijnmhs.2020.024.
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Iron deficiency is a common condition that is usually diagnosed using conventional laboratory tests of iron status, such as serum ferritin and transferrin saturation. However, both ferritin and transferrin proteins are markedly influenced by inflammation, behaving as acute-phase reactants and making it difficult to differentiate between iron-deficiency anemia (IDA) and anemia of chronic disease (ACD). To assess the utility of sTfR/ Log ferritin Index to differentiate Iron deficiency anaemia and Anaemia of chronic disease. A cross-sectional study was conducted in the Department of Medicine, Victoria hospital and Bowring and Lady Curzon hospital, Bangalore Medical College and Research institute, Bangalore. A total of 150 blood samples were evaluated, i.e., 50 samples from iron deficiency anaemia group and 50 samples from patients with anaemia of chronic disorders & 50 samples from healthy normal individual. In present study, samples are age matched with mean age of control 45.66±10.23, ACD 50.68±18.03, IDA 48.14±18.47. Hb, MCV, MCHC & MCH were decreased in both the groups. However, the decrease in Hb & MCV was much more in IDA as compared to ACD. Microcytosis was seen in 92% cases of IDA while it was observed in only 11% cases of ACD. sTfR/ log ferritin index was >1.5 in 80% of IDA. 90% of ACD and control subjects had sTfR/log ferritin index <1.5. sTfR levels were significantly higher in IDA (7.7± 5.8) as compared to the ACD cases (1.6 ±0.89) (p<0.001). sTfR/Log ferritin index is significantly higher in patients with Iron deficiency anemia (9.34±10.25) as compared to ACD (0.76±0.52) (p<0.001). sTFR/Log ferritin index indices is very useful in differentiating pure IDA, ACD and ACD with coexisting iron deficiency, thus providing a non-invasive alternative to bone marrow iron.
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Petkova, Nina Y., Julian I. Raynov, Daniela Y. Petrova, Zorka N. Ramsheva, and Borislav A. Petrov. "Diagnostic Significance of Biomarkers of Iron Deficiency for Anemia in Clinical Practice." Folia Medica 61, no. 2 (June 1, 2019): 223–30. http://dx.doi.org/10.2478/folmed-2018-0065.
Full textAbstract:
Abstract Aim: Iron deficiency anemia (IDA) is a common medical condition, yet there is still some diagnostic uncertainty in this respect. The aim of this study was to compare the clinical significance of biomarkers of iron deficiency (ID) in diagnosing IDA and iron-deficient erythropoiesis in anemic patients. Materials and methods: A total of 103 untreated patients with non-hemolytic anemia were included. Blood count, reticulocyte hemoglobin content (CHr), iron, transferrin saturation (TSAT), ferritin (Ferr), soluble transferrin receptor (sTfR) and sTfR/logFerr index (sTfR-F index) were determined in the patients. Results: TSAT<16% diagnosed 79 patients with IDA (76.6%), Ferr<30 µg/l - 50 patients with IDA (48.5%). Thomas-plot analysis found 76 patients with ID (73.8%) and 56 of them were with iron-restricted erythropoiesis and IDA (54.4%). Biomarkers of ID were significantly different in anemic patients with iron-deficient erythropoiesis (CHr<28 pg) compared with patients with normal hemoglobinisation (p<0.001). With regard to the predictive value of the parameters of ID for iron-deficient erythropoiesis in anemia, their mutually controlled influence proved sTfR-F index only as independent statistically significant (p=0.011). The optimal cut-off value of sTfR-F index from the ROC curve analysis for detecting iron-deficient erythropoiesis in anemia (CHr<28 pg) was 1.35, with sensitivity of 82.1% and specificity of 80.9% (AUC 0.866; p<0.001). Conclusions: Diagnosis of IDA depends on the applied biomarkers of ID, and TSAT or ferritin when used alone may lead to diagnostic difficulties. Combining sTfR-F index and CHr to evaluate iron-deficient erythropoiesis in patients with anemia in addition to ferritin and TSAT could contribute to improving the diagnosis of IDA in clinical practice.