Role of Ferritin and Soluble Transferrin Receptor Levels in Diagnosis of Iron Deficiency Anemia in Inflammatory Conditions. A Cross-sectional Study

• MAMOONA SHUJA

  Author

• MANAL TARIQ

  Author

• MUHAMMAD NASIR SHAHBAZ

  Author

• M. NAUMAN SHAHID

  Author

Background: Iron deficiency anemia (IDA) is a very popular disease in the world, and it is often combined with chronic inflammatory diseases, which makes the correct diagnosis difficult. The serum ferritin is commonly utilized in determining the iron status, although under the inflammatory condition, being an acute-phase reactant, reduces its reliability in determining iron status. In such cases, soluble transferrin receptor (sTfR) is suggested to be a more precise biomarker of iron deficiency. This paper critically analyzes the use of ferritin and sTfR in the diagnostics of IDA in the chronic inflamed patients.

Objective: To compare the diagnostic usage of serum ferritin and soluble transferrin receptor levels in diagnosing iron deficiency anemia in patients with inflammatory disorders.

Methodology:

The work was a cross-sectional study of 100 anemic patients with inflammatory diseases thereof. Measurement of complete blood count, serum ferritin, sTfR, ESR and CRP levels were taken. Iron deficiency was identified with the help of low ferritin (below 30 ng/mL) or high sTfR levels. Sensitivity, specificity and diagnostic accuracy of ferritin and sTfR were compared and the index of sTfR/log ferritin was obtained.

 Results: The average age of the participants was 45.85 age with the SD of 13.2 years; 58 percent were women. The most common ones were chronic kidney disease (32%), and rheumatoid arthritis (28%). The sTfR had higher sensitivity and specificity (89 and 82) than ferritin (56 and 74) even with anemia as 62 and 71 percent of the patients were found to have higher levels of ferritin. The sTfR/log ferritin index was the best in diagnostic use with 92% sensitivity or 85% specificity.

Conclusion: Soluble transferrin receptor is a better predictor of iron deficiency anemia in chronic inflammatory disease patients when compared to serum ferritin. The sTfR /log ferritin index further increases the accuracy of diagnosis. The use of sTfR testing as a part of regular assessment of inflammatory anemic patients can enhance the earlier identification and treatment of iron deficiency.

1. Busti F, Campostrini N, Malerba G, et al. The soluble transferrin receptor (sTfR)-ferritin index is a very efficient marker for the diagnosis of iron deficiency anaemia in patients with IBD. Inflamm Bowel Dis. 2011;17(12):E158-E159. doi:10.1002/ibd.21881.

2. Punnonen K, Irjala K, Rajamäki A. Ferritin and iron transferrin receptor in the assessment of iron deficiency. Blood. 1994;83(1):165-171. doi:10.1182/blood.V83.1.165.

3. Koulaouzidis A, Siau K. How to diagnose iron deficiency in chronic disease: A review of new‐and old‐iron biomarkers. Eur J Med Res. 2022;27(1):32. doi:10.1186/s40001-022-00922-6.

4. Lam W, et al. Soluble transferrin receptor and soluble transferrin receptor/log ferritin index in children with IBD: superior diagnostic utility. Eur J Pediatr. 2018;177(5):727-735. doi:10.1007/s00431-018-3171-9.

5. Mast AE, Blinder MA, Gronowski AM. Clinical utility of the soluble transferrin receptor and comparison with other tests of iron status. Clin Chem. 2000;46(8 Pt 1):1264-1273. doi:10.1093/clinchem/46.8.1264.

6. Pasricha SR, Flecknoe-Bell KL, Allen DA, et al. Adjusting soluble transferrin receptor concentrations for inflammation. Br J Nutr. 2014;112(7):1195-1203. doi:10.1017/S0007114514001810.

7. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-1023. doi:10.1056/NEJMra041809.

8. Elwood PC, et al. Reticulocyte haemoglobin content vs soluble transferrin receptor-ferritin index in the diagnosis of iron deficiency anaemia. Br J Haematol. 2007;138(6):761-767. doi:10.1111/j.1365-2141.2007.06624.x.

9. Ganz T. Iron metabolism: from molecular mechanisms to clinical consequences. Blood. 2013;122(4):394-402. doi:10.1182/blood-2013-05-498569.

10. Girelli D, Nemeth E, Swinkels DW. Hepcidin in the diagnosis of iron disorders: Consensus and controversies. Haematologica. 2016;101(11):1164-1173. doi:10.3324/haematol.2016.152170.

11. Mast AE, Blinder MA, Gronowski AM. Clinical utility of the soluble transferrin receptor and comparison with other tests of iron status. Clin Chem. 2000;46(8 Pt 1):1264-1273. doi:10.1093/clinchem/46.8.1264

12. Pasricha SR, Flecknoe-Bell KL, Allen DA, et al. Adjusting soluble transferrin receptor concentrations for inflammation. Br J Nutr. 2014;112(7):1195-1203. doi:10.1017/S0007114514001810

13. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-1023. doi:10.1056/NEJMra041809

14. Elwood PC, et al. Reticulocyte haemoglobin content vs soluble transferrin receptor–ferritin index in the diagnosis of iron deficiency anaemia. Br J Haematol. 2007;138(6):761-767. doi:10.1111/j.1365-2141.2007.06624.x

15. Ganz T. Iron metabolism: from molecular mechanisms to clinical consequences. Blood. 2013;122(4):394-402. doi:10.1182/blood-2013-05-498569

16. Girelli D, Nemeth E, Swinkels DW. Hepcidin in the diagnosis of iron disorders: Consensus and controversies. Haematologica. 2016;101(11):1164-1173. doi:10.3324/haematol.2016.152170

17. Oustamanolakis P, Koutroubakis IE. Soluble transferrin receptor-ferritin index is the most efficient marker for the diagnosis of iron deficiency anemia in patients with IBD. Inflamm Bowel Dis. 2011;17(12):E158-E159. doi:10.1002/ibd.21881

18. Meta-analysis: Soluble transferrin receptor and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia (sTfR-logF) — (authors not specified here). Am J Clin Pathol. 2012;138(5):642-657. doi:10.1093/ajcp/138.5.642

19. Turgeon O’Brien H, Blanchet R, Gagné D, Lauzière J, Vézina C. Serum soluble transferrin receptor levels are independently associated with homeostasis in preschool Inuit children: using sTfR and inflammation-adjusted ferritin to diagnose iron deficiency. Arch Med Sci. 2016;12(4):643-651. doi:10.5114/aoms.2016.64302

20. Hematology review: Diagnosis and management of iron deficiency in chronic disease. Hematology Am Soc Hematol Educ Program. 2020;2020(1):478-484. doi:10.1182/hematology.2020.000145

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