Elevated soluble transferrin receptor levels reflect increased erythropoietic drive rather than iron deficiency in pediatric sickle cell disease

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Abstract

Background. The prevalence of iron deficiency in pediatric sickle cell disease (SCD) is difficult to describe because standard markers of iron metabolism are altered in this inflammatory state. Soluble transferrin receptor (sTfR) is an alternative marker of iron utilization. Our primary objective was to evaluate the utility of sTfR as a biomarker of hemolysis and erythropoietic drive versus iron metabolism in SCD. Procedure. In a prospective cohort study, we screened 51 children with SCD at steady state with markers of iron status and sTfR. Iron deficient patients were treated with ferrous sulfate for 6 weeks, followed by repeat testing. Results. At baseline, there was stronger correlation between sTfR and markers of hemolysis and erythropoietic drive, including hemoglobin (Spearman's r=-0.67, P≤0.001) and reticulocyte count (Spearman's r=0.59, P≤0.001), than with markers of iron metabolism, such as transferrin saturation (TS; Spearman's r=0.33, P=0.02) and ferritin (Spearman's r=0.17, P=0.26). Eleven (21%) of the 51 children were identified as iron deficient. For treated patients, response to iron therapy was variable, although all patients had a significant increase (mean 11±3.9%, P=0.001) in TS. Conclusions. sTfR activity is a stronger biomarker of hemolysis and erythropoietic drive than of iron-restricted erythropoiesis in pediatric SCD. Low TS was most suggestive of iron deficiency and an increase in TS represented the most consistent indicator of response to iron supplementation.

Original languageEnglish (US)
Pages (from-to)141-144
Number of pages4
JournalPediatric Blood and Cancer
Volume55
Issue number1
DOIs
StatePublished - Jul 15 2010

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Transferrin Receptors
Sickle Cell Anemia
Iron
Pediatrics
Hemolysis
ferrous sulfate
Biomarkers
Reticulocyte Count
Erythropoiesis
Transferrin
Ferritins
Hemoglobins
Cohort Studies

Keywords

  • Iron deficiency
  • Pediatric
  • Sickle cell disease
  • Soluble transferrin receptor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

@article{89d936b62b6742b3994d4d284edcd2d4,
title = "Elevated soluble transferrin receptor levels reflect increased erythropoietic drive rather than iron deficiency in pediatric sickle cell disease",
abstract = "Background. The prevalence of iron deficiency in pediatric sickle cell disease (SCD) is difficult to describe because standard markers of iron metabolism are altered in this inflammatory state. Soluble transferrin receptor (sTfR) is an alternative marker of iron utilization. Our primary objective was to evaluate the utility of sTfR as a biomarker of hemolysis and erythropoietic drive versus iron metabolism in SCD. Procedure. In a prospective cohort study, we screened 51 children with SCD at steady state with markers of iron status and sTfR. Iron deficient patients were treated with ferrous sulfate for 6 weeks, followed by repeat testing. Results. At baseline, there was stronger correlation between sTfR and markers of hemolysis and erythropoietic drive, including hemoglobin (Spearman's r=-0.67, P≤0.001) and reticulocyte count (Spearman's r=0.59, P≤0.001), than with markers of iron metabolism, such as transferrin saturation (TS; Spearman's r=0.33, P=0.02) and ferritin (Spearman's r=0.17, P=0.26). Eleven (21{\%}) of the 51 children were identified as iron deficient. For treated patients, response to iron therapy was variable, although all patients had a significant increase (mean 11±3.9{\%}, P=0.001) in TS. Conclusions. sTfR activity is a stronger biomarker of hemolysis and erythropoietic drive than of iron-restricted erythropoiesis in pediatric SCD. Low TS was most suggestive of iron deficiency and an increase in TS represented the most consistent indicator of response to iron supplementation.",
keywords = "Iron deficiency, Pediatric, Sickle cell disease, Soluble transferrin receptor",
author = "Lulla, {Rishi R} and Thompson, {Alexis A} and Liem, {Robert I}",
year = "2010",
month = "7",
day = "15",
doi = "10.1002/pbc.22471",
language = "English (US)",
volume = "55",
pages = "141--144",
journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
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number = "1",

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TY - JOUR

T1 - Elevated soluble transferrin receptor levels reflect increased erythropoietic drive rather than iron deficiency in pediatric sickle cell disease

AU - Lulla, Rishi R

AU - Thompson, Alexis A

AU - Liem, Robert I

PY - 2010/7/15

Y1 - 2010/7/15

N2 - Background. The prevalence of iron deficiency in pediatric sickle cell disease (SCD) is difficult to describe because standard markers of iron metabolism are altered in this inflammatory state. Soluble transferrin receptor (sTfR) is an alternative marker of iron utilization. Our primary objective was to evaluate the utility of sTfR as a biomarker of hemolysis and erythropoietic drive versus iron metabolism in SCD. Procedure. In a prospective cohort study, we screened 51 children with SCD at steady state with markers of iron status and sTfR. Iron deficient patients were treated with ferrous sulfate for 6 weeks, followed by repeat testing. Results. At baseline, there was stronger correlation between sTfR and markers of hemolysis and erythropoietic drive, including hemoglobin (Spearman's r=-0.67, P≤0.001) and reticulocyte count (Spearman's r=0.59, P≤0.001), than with markers of iron metabolism, such as transferrin saturation (TS; Spearman's r=0.33, P=0.02) and ferritin (Spearman's r=0.17, P=0.26). Eleven (21%) of the 51 children were identified as iron deficient. For treated patients, response to iron therapy was variable, although all patients had a significant increase (mean 11±3.9%, P=0.001) in TS. Conclusions. sTfR activity is a stronger biomarker of hemolysis and erythropoietic drive than of iron-restricted erythropoiesis in pediatric SCD. Low TS was most suggestive of iron deficiency and an increase in TS represented the most consistent indicator of response to iron supplementation.

AB - Background. The prevalence of iron deficiency in pediatric sickle cell disease (SCD) is difficult to describe because standard markers of iron metabolism are altered in this inflammatory state. Soluble transferrin receptor (sTfR) is an alternative marker of iron utilization. Our primary objective was to evaluate the utility of sTfR as a biomarker of hemolysis and erythropoietic drive versus iron metabolism in SCD. Procedure. In a prospective cohort study, we screened 51 children with SCD at steady state with markers of iron status and sTfR. Iron deficient patients were treated with ferrous sulfate for 6 weeks, followed by repeat testing. Results. At baseline, there was stronger correlation between sTfR and markers of hemolysis and erythropoietic drive, including hemoglobin (Spearman's r=-0.67, P≤0.001) and reticulocyte count (Spearman's r=0.59, P≤0.001), than with markers of iron metabolism, such as transferrin saturation (TS; Spearman's r=0.33, P=0.02) and ferritin (Spearman's r=0.17, P=0.26). Eleven (21%) of the 51 children were identified as iron deficient. For treated patients, response to iron therapy was variable, although all patients had a significant increase (mean 11±3.9%, P=0.001) in TS. Conclusions. sTfR activity is a stronger biomarker of hemolysis and erythropoietic drive than of iron-restricted erythropoiesis in pediatric SCD. Low TS was most suggestive of iron deficiency and an increase in TS represented the most consistent indicator of response to iron supplementation.

KW - Iron deficiency

KW - Pediatric

KW - Sickle cell disease

KW - Soluble transferrin receptor

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