[Investigation of iron deficiency status in the newborns of gestational diabetes mellitus women]

OBJECTIVE

To investigate the iron status in the newborns of maternal gestational diabetes mellitus (GDM) women, and explore the mechanism of iron deficiency in these newborns.

METHODS

From June 2008 to October 2011, 64 GDM women (GDM group) and 71 healthy pregnant women (control group) who delivered in the Second Affiliated Hospital of Wenzhou Medical College and their newborns were studied prospectively. Serum ferritin (SF), serum transferrin receptor (sTfR), erythropoietin (Epo), haemoglobin (Hb), serum level of insulin and plasma glucose in cord blood was measured. The neonatal birth weight (BW) and birth weight Z Score (WAZ) was recorded. The concentrations of serum fasting insulin (FINS), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) were tested for all the women before delivery.

RESULTS

In the GDM group, the cord blood sTfR, Epo and serum level of insulin was (42 ± 10) nmol/L, (56 ± 41) U/L and (18 ± 5) U/L, respectively. While in the control group, these were (35 ± 8) nmol/L, (41 ± 43) U/L and (10 ± 5) U/L, respectively. The cord blood sTfR, Epo and serum level of insulin in the GDM group were significantly higher than those in the control group (P < 0.05). The cord blood SF in the GDM group [(60 ± 36) µg/L] was significantly lower than that of the control group [(146 ± 38) µg/L, P < 0.01]. The neonatal BW and WAZ in the GDM group [(3615 ± 538) g and 0.558] were significantly higher than those in the control group [(3449 ± 423) g and 0.224, P < 0.05]. No significant difference was found in the cord blood plasma glucose and Hb between the GDM group [(3.3 ± 1.0) mmol/L and (181 ± 18) g/L] and the control group [(3.0 ± 0.8) mmol/L and (176 ± 16) g/L, P > 0.05]. The FINS and HbA1c of the GDM group [(12.5 ± 5.0) U/L and (6.5 ± 0.7)%] were significantly higher than those in the control group [(10.9 ± 4.3) U/L and (5.3 ± 0.7)%, P < 0.05]. The FPG of the GDM group and the control group were (5.3 ± 1.2) and (5.0 ± 1.0) mmol/L, respectively, with no statistically significant difference (P > 0.05).

CONCLUSION

Maternal GDM may related to the iron deficiency of the newborns.

Study to establish the role of JAK2 and SMAD1/5/8 pathways in the inhibition of hepcidin by polysaccharides from Angelica sinensis

ETHNOPHARMACOLOGICAL RELEVANCE

Angelica sinensis polysaccharide (ASP) is one of the major active ingredients in Angelica sinensis (Oliv.) Diels. This traditional Chinese medicine has been used for thousands of years for treating gynecological diseases.

AIM OF THE STUDY

Previous studies have suggested that ASP from the roots of Angelica sinensis (Oliv.) Diels suppresses hepcidin expression, but the underlying molecular mechanisms are not known. The present study was designed to establish the role of the janus-kinases 2 (JAK2) and son of mothers against decapentaplegic 1/5/8 (SMAD1/5/8) pathways in the inhibition of hepcidin by polysaccharides from Angelica sinensis in normal rats.

MATERIALS AND METHODS

ASP was administered orally (0.3, 0.6 and 1.2g/kg body weight) to male Sprague-Dawley rats every day for 20 days. Intraperitoneal injections of recombinant human erythropoietin (rhEPO; 800 and 2000U/kg body weight) were given to the positive control group every day for 3 days. After administration, hepcidin levels, blood parameters, serum iron status and non-heme iron concentrations in the liver were examined. Western blot analyses were used to investigate the expression of five relevant signaling proteins in the liver.

RESULTS

RhEPO injection significantly stimulated erythropoiesis and expression of the serum transferrin receptor (sTfR), and decreased serum iron status and non-heme iron concentrations in the liver. However, blood parameters barely changed in the ASP groups. sTfR, serum iron, and liver iron levels altered only in the ASP high-dose group (1.2g/kg body weight). rhEPO and ASP significantly reduced hepcidin expression by inhibiting the expression of phospho-SMAD1/5/8 and JAK2 in the liver, but not through transmembrane protease serine 6 (TMPRSS6) and extracellular signal-regulated kinase 1/2 (ERK1/2).

CONCLUSIONS

These data suggested that ASP can interrupt the JAK2 and SMAD1/5/8 pathways, which eventually results in lower expression of hepcidin.

Anemia in heart failure: association of hepcidin levels to iron deficiency in stable outpatients

BACKGROUND

Anemia is a prevalent condition in heart failure with multiple potential causes. The complex interaction between iron stores, hepcidin, inflammation and anemia is poorly comprehended. We tested the hypothesis that, in stable heart failure patients with anemia, hepcidin is associated with iron deficiency status irrespective of inflammation.

METHODS AND RESULTS

Stable systolic heart failure outpatients with and without anemia underwent a complete iron panel, erythropoietin, hepcidin and tumor necrosis factor (TNF)-α assessment. Sixty outpatients were studied. Anemic patients (n = 38, mean hemoglobin 11.4 ± 1 g/dl) were older (69.6 ± 9.6 vs. 58 ± 10.8 years old, p < 0.01) compared with nonanemic patients (n = 22, mean hemoglobin 13.8 ± 1.1 g/dl). Iron deficiency was present in 42% of patients with anemia. TNF-α and hepcidin were 29 and 21% higher in patients with anemia, respectively, compared to nonanemic patients; however, no correlations were found between hepcidin and TNF-α levels. Hepcidin levels in the lower tertile (<31.7 ng/ml) were strongly associated with iron deficiency (OR 16.5, 95% CI 2.2-121.2; p < 0.01).

CONCLUSION

In stable heart failure patients with anemia, hepcidin levels may be more importantly regulated by patients' iron stores than by inflammation.

Body iron stores and risk of type 2 diabetes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study

AIMS/HYPOTHESIS

The aim of this study was to prospectively examine the association between body iron stores and risk of type 2 diabetes.

METHODS

We designed a case-cohort study among 27,548 individuals within the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. During 7 years of follow-up, 849 incident cases of type 2 diabetes were identified. Of these, 607 remained for analyses after exclusion of participants with missing data or abnormal glucose levels at baseline. A sub-cohort of 2,500 individuals was randomly selected from the full cohort, comprising 1,969 individuals after applying the same exclusion criteria.

RESULTS

After adjustment for age, sex, BMI, waist circumference, sports activity, bicycling, education, occupational activity, smoking habit, alcohol consumption and circulating levels of γ-glutamyltransferase, alanine aminotransferase, fetuin-A, high-sensitivity C-reactive protein, adiponectin, HDL-cholesterol and triacylglycerol, higher serum ferritin concentrations were associated with a higher risk of type 2 diabetes (RR in the highest vs lowest quintile, 1.73; 95% CI 1.15, 2.61; p(trend) = 0.002). No significant association was observed for soluble transferrin receptor (RR 1.33; 95% CI 0.85, 2.09; p(trend) = 0.50). The soluble transferrin receptor-to-ferritin ratio was significantly inversely related to risk (RR 0.61; 95% CI 0.41, 0.91; p(trend) = 0.02).

CONCLUSIONS/INTERPRETATION

High ferritin levels are associated with higher risk of type 2 diabetes independently of established diabetes risk factors and a range of diabetes biomarkers whereas soluble transferrin receptor concentrations are not related to risk. These results support the hypothesis that higher iron stores below the level of haemochromatosis are associated with risk of type 2 diabetes.

Study on the method of quantitative analysis of serum ferritin and soluble transferrin receptor with protein microarray technology

OBJECTIVE

To establish and evaluate a protein microarray method for combined measurement of serum ferritin (SF) and soluble transferrin receptor (sTfR).

METHODS

Microarrayer was used to print both anti-SF antibodies I and anti-sTfR antibodies I on each protein microarray. Anti-SF antibodies II and anti-sTfR antibodies II were used as detection antibodies and goat antibodies coupled to Cy3 were used as antibodies III. The detection conditions of the quantitative analysis method for simultaneous measurement of SF and sTfR with protein microarray were optimized and evaluated. The protein microarray was compared with commercially available traditional tests with 26 serum samples.

RESULTS

By comparison experiment, mouse monoclonal antibodies were chosen as the probes and contact printing was chosen as the printing method. The concentrations of SF and sTfR probes were 0.5 mg/mL and 0.5 mg/mL respectively, while those of SF and sTfR detection antibodies were 5 μg/mL and 0.36 μg/mL respectively. Intra- and inter-assay variability was between 3.26% and 18.38% for all tests. The regression coefficients comparing protein microarray with traditional test assays were better than 0.81 for SF and sTfR.

CONCLUSION

The present study has established a protein microarray method for combined measurement of SF and sTfR.

[The algorithm of modern laboratory diagnostics of anemic syndrome in oncologic patients]

The algorithm of analysis of blood of oncologic patients with anemic syndrome was elaborated using large clinical sampling (n = 284). It is established that 72% of oncologic patients developed anemia by kind of chronic diseases anemia. However in some patients the anemic syndrome was caused by the iron deficiency The cases of B12 deficient, autoimmune hemolytic anemia were registered and inefficient erythropoiesis under metastatic lesion of bone marrow and myelodysplasia syndromes as well. The high importance of methods of objective evaluation of iron resources (level of ferritin and soluble receptors of transferrin), erythropoietic activity of bone marrow (reticulocytes and reticulocyte indices) and adequate response to anemia degree (level of endogenic erythropoietin). The possibility to detect the concentration of hemoglobin in reticulocytes makes it possible to monitor the restoration of hemoglobin content on early stages of treatment of patient with iron deficiency anemia.

Soluble transferrin receptors in malaria

OBJECTIVE

To determine the concentration of soluble transferrin receptors (sTfR) in patients with malaria.

STUDY DESIGN

Cross-sectional, analytical study.

PLACE AND DURATION OF STUDY

Baqai Institute of Haematology, Baqai Medical University, Karachi, from December 2009 to April 2010.

METHODOLOGY

Twenty samples from normal male and female subjects each were drawn for establishing the reference range while 38 from patients with malaria (with or without anaemia) sTfR centration was determined. Descriptive statistics were used for data analysis.

RESULTS

Out of 38 patients, 4 had iron deficiency anaemia while 34 patients were without anaemia. Mean sTfR level in the control group was 33.53 ± 4.38 nmol/l. In patients with malaria without iron deficiency anaemia, mean sTfR concentration was 30.84 ± 5.40 nmol/l. Patients with malaria and concomitant iron deficiency anaemia had mean sTfR level of 101.67 ± 11.69 nmol/l. Comparison of sTfR in normal subjects and in patients with malaria showed no statistically significant difference (p = 0.208). Statistically significant difference (p < 0.001) was observed in patients with malaria and concomitant IDA as compared to normal control group.

CONCLUSION

Malaria without concomitant iron deficiency anaemia had near normal sTfR levels. While those with concomitant iron deficiency anaemia had significant higher level of sTfR. This concludes that these receptors are not affected in malaria alone.

Serum soluble transferrin receptor concentrations in US preschool children and non-pregnant women of childbearing age from the National Health and Nutrition Examination Survey 2003-2010

BACKGROUND

Serum soluble transferrin receptor (sTfR) is recommended as a sensitive and accurate measure of iron deficiency (ID) in populations when only a single indicator can be used. The lack of assay standardization and of representative data on the distribution of sTfR in at-risk populations currently limits its utility.

METHODS

Using data from NHANES 2003-2010, we examined the distribution of sTfR and developed assay-specific cutoff values for defining elevated sTfR in 2 US populations groups: children aged 1-5 y (n=2820) and non-pregnant women aged 15-49 y (n=6575).

RESULTS

On average, children had higher geometric mean sTfR concentrations (4.09 mg/l; 95% CI: 4.04-4.14) than non-pregnant women (3.31 mg/l; 95% CI: 3.26-3.35) (p<0.001). Among children, those aged 1-2 y (compared to those aged 3-5 y), boys (compared to girls), and non-Hispanic black (NHB) children (compared to non-Hispanic white (NHW) and Mexican-American (MA) children) had higher sTfR concentrations. Among non-pregnant women, adolescents (15-19 y) had higher sTfR concentrations than adults aged 20-34 y but not compared to adults aged 35-49 y; NHB women (compared to NHW and MA women) and multiparous women (compared to nulliparous women) had higher sTfR concentrations. The derived cutoff values (97.5th percentile in a defined healthy reference population) for defining elevated sTfR in the US were 6.00 mg/l for children 1-5 y and 5.33 mg/l for non-pregnant women 15-49 y.

CONCLUSIONS

A different sTfR cutoff value may be needed in children and non-pregnant women to define ID.

The ratio of sTfR/ferritin is associated with the expression level of TfR in rat bone marrow cells after endurance exercise

Currently, it is unclear which index of haematological parameters could be used to most easily monitor iron deficiency during endurance training. To address this question, 16 male Wistar rats were randomly assigned to two groups: a sedentary group (n = 8) and an exercised group (n = 8). Initially, animals in the exercise group started running on a treadmill at a rate of 30 m/min, on a 0% grade, for 1 min/session. Running time was gradually increased by 2 min/day. The training plan was one session per day during the initial 2 weeks and two sessions per day during the third to ninth week. At the end of the 9-week experiment, we analysed the blood of the experimental animals for haemoglobin levels, erythrocyte numbers, haematocrit, serum iron levels, total iron binding capacity, transferrin saturation, serum ferritin levels and soluble transferrin receptor (sTfR) levels, and we calculated the ratio of sTfR/ferritin. Erythrocyte numbers, haemoglobin levels and haematocrit values were decreased after 9 weeks of exercise, but sTfR and sTfR/ferritin values were increased (P < 0.01 or P < 0.05). The training regime significantly increased TfR mRNA levels in the bone marrow cells of the exercised rats compared with the sedentary group (1.8 ± 0.5 vs. 1.1 ± 0.2, P < 0.01). These results revealed a significant correlation between TfR levels in the bone marrow cells and the ratio of sTfR/ferritin (r = 0.517; P < 0.01) and sTfR levels (r = 0.206; P < 0.05) in sedentary and exercised rats. In conclusion, we show that sTfR indices and the ratio of sTfR/ferritin could be useful indicators for monitoring iron deficiency during endurance training.

Underlying factors associated with anemia in Amazonian children: a population-based, cross-sectional study

Background

Although iron deficiency is considered to be the main cause of anemia in children worldwide, other contributors to childhood anemia remain little studied in developing countries. We estimated the relative contributions of different factors to anemia in a population-based, cross-sectional survey.

Methodology

We obtained venous blood samples from 1111 children aged 6 months to 10 years living in the frontier town of Acrelândia, northwest Brazil, to estimate the prevalence of anemia and iron deficiency by measuring hemoglobin, erythrocyte indices, ferritin, soluble transferrin receptor, and C-reactive protein concentrations. Children were simultaneously screened for vitamin A, vitamin B₁₂, and folate deficiencies; intestinal parasite infections; glucose-6-phosphate dehydrogenase deficiency; and sickle cell trait carriage. Multiple Poisson regression and adjusted prevalence ratios (aPR) were used to describe associations between anemia and the independent variables.

Principal Findings

The prevalence of anemia, iron deficiency, and iron-deficiency anemia were 13.6%, 45.4%, and 10.3%, respectively. Children whose families were in the highest income quartile, compared with the lowest, had a lower risk of anemia (aPR, 0.60; 95%CI, 0.37–0.98). Child age (<24 months, 2.90; 2.01–4.20) and maternal parity (>2 pregnancies, 2.01; 1.40–2.87) were positively associated with anemia. Other associated correlates were iron deficiency (2.1; 1.4–3.0), vitamin B₁₂ (1.4; 1.0–2.2), and folate (2.0; 1.3–3.1) deficiencies, and C-reactive protein concentrations (>5 mg/L, 1.5; 1.1–2.2).

Conclusions

Addressing morbidities and multiple nutritional deficiencies in children and mothers and improving the purchasing power of poorer families are potentially important interventions to reduce the burden of anemia.

Increased yet iron-restricted erythropoiesis in postpartum mothers

Iron deficiency in the postpartum period is common and associated with impaired quality of life. Interpretation of ordinary laboratory parameters is considered to be simple in postpartum women, as normalization of pregnancy induced physiological changes is assumed to take place in the early postpartum period. We have studied changes in erythrocyte and iron parameters during the first 11 postpartum months. Erythrocyte parameters and iron markers, serum ferritin, and soluble transferrin receptor (sTfR), and an inflammation marker, neopterin, were investigated in healthy mothers 6 weeks (n = 104), 4 months (n = 100), and 11 months (n = 43) after giving birth to a term infant. Healthy nonpregnant and nonlactating women (n = 61) were included as controls. The hemoglobin level increased throughout the first 11 postpartum months and was significantly higher from 4 months on, compared to control women. At all time points, the mothers had significantly lower mean corpuscular volume (MCV) and higher erythrocyte count and percentage of hypochromic erythrocytes. sTfR levels were significantly higher over the whole serum ferritin distribution during the first 4 postpartum months compared to the controls, indicative of an increased cell production. At 6 weeks, postpartum mothers had higher neopterin levels and this was associated with markers of a low iron status, not including sTfR. Substantial changes in erythrocyte and iron parameters were observed in the postpartum period, consistent with an increased, but iron restricted erythropoiesis. The increased erythropoietic activity was reflected in higher sTfR concentrations. Given the vital role for iron in both mothers and infants, further studies are warranted for establishing proper cut off levels for sTfR as an iron marker in postpartum women.

Credibility of the measurement of serum ferritin and transferrin receptor as indicators of iron deficiency anemia in hemodialysis patients

BACKGROUND AND OBJECTIVES

Anemia is a common complication in uremic patients. Erythropoietin therapy is prescribed in these cases; however, this treatment is not successful in iron deficient patients. Ferritin-based diagnosis of iron deficiency in these patients is a challenging task, as serum ferritin level may be high due to chronic inflammation and mask iron deficiency. In the current study we evaluated the credibility of another indicator of body iron supply, serum transferrin receptor, in hemodialysis patients in two University-based Hospitals in North of Iran.

MATERIALS AND METHODS

In a cross-sectional study, 53 hemodialysis patients with a mean age of 56 +/- 18.7 years and 30 persons with iron deficiency and normal renal function with a mean age of 20.1 +/- 14.4 years were examined. All hemodialysis patients were on hemodialysis 2-3 times per week for 3-4 hours. All cases were examined for blood hemoglobin content, serum iron, CRP, serum ferritin and serum transferrin receptor levels. The reference ranges introduced by manufacturers were considered as standard ranges for analysis of the results. Using one sample T-test and Fisher's exact test, data were analyzed. p<0.05 was considered as significant.

RESULTS

Hemodialysis patients had blood hemoglobin content below normal range (p<0.05 for men, p<0.001 for women) and CRP levels above normal range (p<0.001). In hemodialysis patients, serum ferritin level was significantly higher than control group (p<0.001), whilst serum transferrin receptor levels in the two groups were not significantly different (p=0.69), and both were above defined normal upper limit (p<0.001 for iron deficient patients; p<0.05 for hemodialysis patients).

DISCUSSION

This study showed measurement of serum ferritin in the presence of chronic inflammation induced by renal failure cannot be a credible indicator of body iron supply, while under this certain condition serum transferrin receptor can more appropriately reflect the amount of body iron supply.

Iron deficiency and Helicobacter pylori infection in children

AIM

To examine the relationship between iron deficiency (ID) and Helicobacter pylori infection in school-aged children.

METHODS

Altogether 363 children from ambulatory admission were consecutively enrolled in the study. Haemoglobin (Hb), soluble transferrin receptor (sTfR), IgG against H. pylori and IgA against tissue transglutaminase were measured. The criteria for ID were sTfR > 5.7 mg/L in children aged 7-12 years and sTfR > 4.5 mg/L in older children, for anaemia Hb < 115 g/L in the younger group and Hb < 130 g/L for older boys and Hb < 120 g/L for girls.

RESULTS

Iron deficiency was found in 17% of the children, 5% had also anaemia. H. pylori colonization was detected in 27% and serum markers for coeliac disease in 0.6% of the children. The prevalence of ID and H. pylori seropositivity was higher in older children (23% and 29%, vs 9% and 22%, respectively). Children with H. pylori were significantly shorter [length SDS 1.0 (0.98-1.01) vs 0.98 (0.97-0.99)]. Older children had risk for ID (OR 1.1, 95% CI 1.0-1.3, p = 0.03). Although the prevalence of H. pylori seropositivity was higher in the ID group, it was not significantly associated with ID in multivariate analysis.

CONCLUSION

Helicobacter pylori seropositivity was not associated with ID. The associated factor for ID was age.

Serum transferrin receptor, serum ferritin and serum transferrin receptor-ferritin index in adults with iron deficiency anaemia

BACKGROUND

Serum Ferritin (SF) and iron both show acute phase responses to inflammation, so iron may fall and ferritin rise independent of the marrow iron store. Bone marrow iron store has been considered the gold standard, but is invasive, painful and expensive and not suitable for everyone. Serum transferrin receptor (sTfR) which is the concentration of the soluble fragment of transferrin receptor in serum, is an important new haematological parameter. The ratio of sTfR to log SF is known as sTfR-SF index. This study was conducted to evaluate sTfR, Ferritin and sTfR-F Index in diagnosing and differentiating iron deficiency anaemia (IDA) from anaemia of chronic disease (ACD).

METHODS

One hundred and sixteen (116) adult subjects (80 anaemic and 36 controls) who already had their bone marrow examination done for various reasons were included in the study. sTfR, SF, and their index were measured and compared with bone marrow iron stores. Absence of iron stores denoted IDA whereas increased macrophage iron with decreased siderocytes and sideroblasts was diagnostic of ACD.

RESULTS

Out of 80 anaemic patients, 47 were diagnosed as IDA while 33 were diagnosed as ACD. In case of IDA the diagnostic accuracy of index was 91.57%, sTfR had accuracy of 85.54% while SF had accuracy of 75.90%. In case of ACD, the diagnostic accuracy of sTfR was 91.30%, index 89.86%, while SF had accuracy of 79.71%.

CONCLUSION

sTfR-SF index is a better parameter than sTfR or ferritin alone but should only be used when the results of these parameters seem altered or a bone marrow aspiration is mandatory for diagnosis of ACD. The estimation of sTfR or index may offer a simple non invasive method that may enable more accurate assessments of iron status in such patients.

[Value of soluble transferrin receptor in the diagnosis of iron deficiency in children]

OBJECTIVE

To study the prevalence of iron deficiency in children between 6 months and 7 years and to study the diagnostic value of soluble transferrin receptor (sTfR) for iron deficiency in the children.

METHODS

A total of 502 healthy children between 6 months and 7 years from Hangzhou City of Zhejiang Province were enrolled. Serum sTfR, serum ferritin (SF), serum iron (SI), total iron blinding capacity (TIBC), zinc protoporphyrin (ZPP), Hb, MCV and CRP levels were measured.

RESULTS

The prevalence rate of iron deficiency was 19.5% in children at ages of 6 months to 7 years. The prevalence rate of iron deficiency was the highest in infants (≤1 year old; 34.7%), followed by in toddlers (1-3 years old; 19.4%) and preschoolers (3-7 years old; 14.0%). The mean serum sTfR level in infants (2.02±0.73 mg/L) was significantly higher than that in toddlers (1.68±0.40 mg/L) and preschoolers (1.67±0.29 mg/L) (P<0.05).The best cut-off value of serum sTfR for the diagnosis of iron deficiency was 2.02 mg/L in infants (sensitivity: 70.3%, specificity: 82.2%). The best cut-off value was 1.85 mg/L in toddlers (sensitivity: 71.7%; specificity: 86.4%), and that was 1.85 mg/L in preschoolers (sensitivity: 77.8%; specificity: 88.6%). Serum sTfR was correlated with SF (r=0.107, P<0.05), TIBC (r=0.276, P<0.01), TS (r=-0.139, P<0.05), ZPP (r=0.175, P<0.01) and MCV (r=-0.140, P<0.01).

CONCLUSIONS

Iron deficiency is more prevalent in infants ≤1 year old. The mean serum level and the cut-off value of sTfR in infants are higher than in toddlers and preschoolers. Serum sTfR is an effective index for the diagnosis of iron deficiency in children, especially in infants≤ 1 year old.

Soluble transferrin receptor: a differentiating marker between iron deficiency anaemia and anaemia of chronic disorders

BACKGROUND

Iron deficiency anaemia and anaemia of chronic disorders are the two major causes of microcytic and hypochromic anaemia. Many times the diagnosis of these conditions becomes difficult through conventional laboratory tests. Determination of soluble transferrin receptors is a helpful laboratory test for the differential diagnosis of these conditions. The study was conducted to evaluate the role of soluble transferrin receptors in the differential diagnosis between iron deficiency anaemia and anaemia of chronic disorders.

METHODS

A total of 80 blood samples were evaluated, i.e., 20 samples from normal adult male, 20 samples from normal adult female, 20 samples from iron deficiency anaemia group and 20 samples from patients with anaemia of chronic disorders. Soluble transferrin receptors were determined by ELISA technique using Quantikine IVD kit (R and D Systems).

RESULTS

There was significant difference in the levels of sTfR in iron deficiency anaemia and anaemia of chronic disorders. Statistically non-significant difference was observed between the levels of sTfR in patients with anaemia of chronic disorders as compared to normal control group.

CONCLUSION

The sTfR determination can be used as a reliable differentiating marker in the diagnosis of iron deficiency anaemia and anaemia of chronic disorders.

[Clinical utility of reticulocyte hemoglobin content for the diagnosis of iron deficiency anemia in children]

OBJECTIVE

To study the clinical utility of measuring reticulocyte hemoglobin content (CHr) in the diagnosis of iron deficiency anemia (IDA) in children.

METHODS

One hundred children with IDA at ages of 1 to 6 years and 50 healthy children were enrolled. Red blood cell parameters, CHr, hemoglobin (Hb), red blood count (RBC) and mean corpusular volume (MCV), were determined using the Blood Cell Analyzer. Serum ferritin (SF) levels were determined using radioimmunoassay double antibody techique. Soluble serum transferrin (sTfR) levels were determined using ELISA.

RESULTS

The values of Hb (100 ± 6 g/L vs 126 ± 8 g/L) and CHr (18 ± 5 pg vs 31 ± 3 pg) in the IDA group were significantly lower than normal controls (P<0.01). SF levels (11 ± 4 μg/L) in the IDA group were also lower than normal controls (59 ± 36 μg/L) (P<0.01). In contrast, the values of sTfR in the IDA group were significantly higher than normal controls (4.8 ± 2.1 mg/L vs 1.4 ± 0.6 mg/L; P<0.01). In both groups, there was a positive correlation between the values of CHr and Hb [r=0.540 (control group), r=0.734 (IDA group); P<0.01]. In the IDA group, CHr was positively correlated with SF(r=0.464; P<0.01) and negatively correlated with sTfR(r=-0.450; P<0.01). When the cut-off value of CHr was 27.8 pg, the sensitivity and specificity for the diagnosis of IDA were 88.0% and 90.0%, respectively and the area under the ROC curve was 0.948.

CONCLUSIONS

CHr can be used as an index for the diagnosis of IDA in children.

Soluble transferrin receptor as a diagnostic laboratory test for detection of iron deficiency anemia in acute illness of hospitalized patients

BACKGROUND

Many patients in the internal medicine ward have anemia. The etiology for the anemia may be multifactorial and, in the setting of inflammatory process when the ferritin is increased, it is difficult to diagnose iron deficiency anemia. Soluble transferrin receptor (sTfR) had been suggested as an indicator for iron deficiency. No study has investigated the meaning of high sTfR as the only positive marker of iron deficiency anemia (IDA) caused by gastrointestinal tract (GIT) bleeding in hospitalized patients.

OBJECTIVES

To demonstrate the importance of high levels of sTfR as a marker for further GIT investigation in cases of anemia where the level of ferritin was normal or increased.

METHODS

We retrospectively assessed all patients in an internal medicine ward in our facility who had anemia, high sTfR levels (> 5.0 mg/L) and normal or high ferritin levels and who underwent esophagogastroduodenoscopy and colonoscopy.

RESULTS

Of 32 patients with anemia and normal or high ferritin levels and high sTfR, 22 patients (68%) had findings that explained IDA (in some patients more than one finding). Those findings were colonic polyps (n=9), carcinoma of colon (n=4), duodenal ulcer (n=4), carcinoma of stomach (n=3), colitis (n=3), atrophic gastritis (n=1), erosive gastritis (n=1) and angiodysplasia (n=1).

CONCLUSIONS

High sTfR may be a good indicator of IDA caused by GIT bleeding when the ferritin level is normal or high. GIT investigation is warranted in such cases.

[Optimizing the detection of soluble transferrin receptor with protein microarray]

OBJECTIVE

To optimize the conditions of protein microarray assay for soluble transferrin receptor (sTfR).

METHODS

A microarrayer was used for printing anti-sTfR as antibody I on each protein microarray; anti-sTfR antibody was used as detection antibody II and goat antibody coupled to Cy3 was used as antibody III. The standard sTfR was detected by double antibody sandwich technique.

RESULTS

Mouse monoclon sTfR antibody was chosen as a probe and contact printing as the printing method. A better homogenicity was appeared after pre-printing for 40 spots. The concentration of sTfR probes was 0.25 mg/ml. The concentration of sTfR detection antibody was 0.18 microg/ml. 3% skim milk powder and goat anti rabbit antibody made by GE was chosen as blocking buffer and secondary antibody. The lowest detection limits and the biological detection limits of sTfR were 0.253 ng/ml and 0.78 ng/ml respectively. The best fitting models and standard curve were established for sTfR (r = 0.99699).

CONCLUSION

Conditions of a quantitative analysis system for measurement of sTfR with protein microarray were optimized.

Commentary: Iron deficiency and hair loss: problems with measurement of iron

Iron is involved in many critical physiologic processes within the hair follicle, suggesting that iron deficiency could disrupt hair synthesis. However, studies of iron as a cause of hair loss have produced conflicting results. Some of the discrepancies may relate to limitations of assays for iron deficiency. This commentary discusses the sensitivity and specificity of available tests for iron deficiency and presents practical guidelines for testing and supplementation.

Decreased serum hepcidin and improved functional iron status 6 months after restrictive bariatric surgery

Excess adiposity is associated with low-grade inflammation and decreased iron status. Iron depletion in obesity is thought to be mediated by an inflammation-induced increase in the body's main regulator of iron homeostasis, hepcidin. Elevated hepcidin can result in iron depletion as it prevents the release of dietary iron absorbed into the enterocytes, limiting replenishment of body iron losses. Weight reduction is associated with decreased inflammation; however, the impact of reduced inflammation on iron status and systemic hepcidin in obese individuals remains unknown. We determined prospectively the impact of weight loss on iron status parameters, serum hepcidin, inflammation, and dietary iron in 20 obese premenopausal females 6 months after restrictive bariatric surgery. At baseline, the presence of iron depletion was high with 45% of the women having serum transferrin receptor (sTfR) >28.1 nmol/l. Differences between baseline and 6 months after surgery for BMI (47.56 vs. 39.55 kg/m(2); P < 0.0001), C-reactive protein (CRP) (10.83 vs. 5.71 mg/l; P < 0.0001), sTfR (29.97 vs. 23.08 nmol/l; P = 0.001), and serum hepcidin (111.25 vs. 31.35 ng/ml; P < 0.0001) were significantly lower, whereas hemoglobin (Hb) (12.10 vs. 13.30 g/dl; P < 0.0001) and hematocrit (Hct) (36.58 vs. 38.78%; P = 0.001) were significantly higher. Ferritin and transferrin saturation (Tsat) showed minimal improvement at follow-up. At baseline, hepcidin was not correlated with sTfR (r = 0.02); however, at follow-up, significant correlations were found (r = -0.58). Change in interleukin-6 (IL-6) from baseline was marginally associated with decreased log serum hepcidin (Δ IL-6: β = -0.22; P = 0.15), whereas change in BMI or weight was not. No significant difference in dietary iron was noted after surgery. Weight loss in obese premenopausal women is associated with reduced serum hepcidin and inflammation. Reduction in inflammation and hepcidin likely allow for enhanced dietary iron absorption resulting in an improved functional iron profile.

[Status of iron metabolism and erythropoietic proliferation in children with various genotypes of thalassemia]

OBJECTIVE

To study the status of iron metabolism and erythropoietic proliferation in children with various genotypes of thalassemia.

METHODS

Serum concentrations of ferritin (SF), transferrin receptor (sTfR) and erythropoietin (EPO) were measured in 158 children with thalassemia. The differences in the concentrations of the three indices among children with different genotypes of thalassemia were compared. The correlations of the hemoglobin level with sereum SF, sTfR and EPO levels were assessed.

RESULTS

Among the 158 children with thalassemia, 52(32.9%) were diagnosed with alpha-thalassemia minor, 27(17.1%) with HbH disease, 59(37.4%) with beta-thalassemia minor, 13(8.2%) with beta-thalassemia major, and 7(4.4%) with combining alpha beta thalassemia. The SF levels in children with HbH disease or beta-thalassemia major were significantly higher than those in the other thalassemia groups (P<0.01). The sTfR levels in children with beta-thalassemia major were the highest when compared with those in the other thalassemia groups (P<0.05). The EPO levels in children with beta-thalassemia major were also the highest when compared with those in the other thalassemia groups (P<0.01). There was a negative correlation between hemoglobin and EPO levels in children with HbH disease (r=-0.656, P<0.01) and beta-thalassemia major (r=-0.641; P<0.05).

CONCLUSIONS

The status of iron metabolism and erythropoietic proliferation is different in children with different genotypes of thalassemia. A combined measurement of SF, sTfR and EPO may reflect the status of erythropoietic proliferation.