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Role of Serum Transferrin Receptor in Diagnosis of Iron Deficiency Anemia:Report of 130 Cases in West of Algeria

Beddek Fatima and Abbassia Demmouche

Introduction: Anemia is one of the most common disorders in pregnancy. The most common cause is iron deficiency. Iron deficiency anemia is relatively easy to diagnose using a serum ferritin of <15 ng/ml. However, because ferritin is an acute phase reactant, the diagnosis of iron deficiency anemia in hospitalised or ill patients may be difficult, since serum ferritin may be normal or raised, even in the face of iron deficiency. Soluble transferrin receptor assay (sT-fR) may be useful in these situations because it reflects the degree of iron requirement in relation to supply, and it is not an acute phase reactant.

Aim: The aims of our study are to affirm the value and specificity of sT-fR and integrate it in the list of routine parameters of iron status in the differential diagnosis of anemia in our laboratories in Algeria.

Patients and Method: Our study included 130 patients divided into three groups: control group with 40 healthy adult (22 men and 18 women). Group 2, with 30 patients (11 men and 19 women) hospitalized at the hematology department of the University Hospital “Abdelkader Hassani” of Sidi Bel Abbes, which represents the group of subjects with purely iron deficiency anemia without any associated disease (IDA) having rates of C-reactive protein (CRP <10 mg/L), and the third group with 60 anemic patients with anemia of chronic disease (ACD) (36 men and 24 women) hospitalized at the department of Internal Medicine of the University Hospital of Sidi Bel Abbes. Each patient underwent a complete blood count, an iron status, and the sT-fR assays, and inflammatory balance (CRP). All these examinations were performed immediately on fresh plasma and serum; assays were performed by immunoturbidimetric method. Statistical analyzes of the data (mean and standard deviation, correlation coefficients, tests for normality and comparison of means) were performed using the software Statview (1998). A P-value (P<0.05) was considered statistically significant, all P values are calculated by the t-test function using bilateral distribution.

Results: The control group (healthy subjects) has a normal iron status. All parameters with levels in normal ranges in both sexes for 100% of subjects. The outcome of the second group is in perfect agreement with IDA for all of its parameters, it has a very disturbed iron status representative of this anemia: anemia (Hb <120 g/L); microcytosis (MCV <80 fl); circulating pool (serum iron decreased high transferrinemia); reserves depleted (ferritin <30 μg/L) and erythropoietic needs high iron (high sT-fR). In the third group it's difficult to interpret ferritin levels (very higher), it's in contradiction with the other parameters, which leads us to discuss the homogeneity of this group. Because there is gender effect on key parameters of our study (hemoglobin, ferritin and sT-fR are heterogeneous in both sexes (P<0.001), the results were analyzed separately between men and women. Analyses of results were done for discussing the sensitivity of the sT-fR on iron status and the informative contribution of each parameter to the specific diagnosis of anemia.

Conclusion: This study has allowed us to recommend for the use of sT-fR assays, because it is very promising for the exploration of erythropoiesis and the differential diagnosis of anemia in adults, with a normal range of: 2.65 to 4.39 mg/L in men and postmenopausal women and 2.03 to 3.69 mg/L in premenopausal women, in the hope of establishing an international range of reference values.