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Serum transferrin receptor and its ratio to serum ferritin in the diagnosis
of iron deficiency
K Punnonen, K Irjala and A Rajamaki
Department of Clinical Chemistry, University Hospital of Turku, Finland.
The objective of the study was to evaluate the diagnostic efficiency of
laboratory tests, including serum transferrin receptor (TfR) measurements,
in the diagnosis of iron depletion. The patient population consisted of 129
consecutive anemic patients at the University Hospital of Turku who were
given a bone marrow examination. Of these patients, 48 had iron deficiency
anemia (IDA), 64 anemia of chronic disease (ACD), and 17 patients had
depleted iron stores and an infectious or an inflammatory condition
(COMBI). Depletion of iron stores was defined as a complete absence of
stainable iron in the bone marrow examination. Serum TfR concentrations
were elevated in the vast majority of the IDA and COMBI patients, while in
the ACD patients, the levels were within the reference limits reported
earlier for healthy subjects. TfR measurement thus provided a reliable
diagnosis of iron deficiency anemia (AUC(ROC) 0.98). Serum ferritin
measurement also distinguished between IDA patients and ACD patients.
However, the optimal decision limit for evaluation of ferritin measurements
was considerably above the conventional lower reference limits,
complicating the interpretation of this parameter. Calculation of the ratio
TfR/log ferritin (TfR-F Index) is a way of combining TfR and ferritin
results. This ratio provided an outstanding parameter for the
identification of patients with depleted iron stores (AUC(ROC) 1.00). In
anemic patients, TfR measurement is a valuable noninvasive tool for the
diagnosis of iron depletion, and offers an attractive alternative to more
conventional laboratory tests in the detection of depleted iron stores.
Volume 89,
Issue 3,
pp. 1052-1057,
02/01/1997
Copyright © 1997 by The American Society of Hematology
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