The importance of serum transferrin receptor level in the diagnosis of functional iron deficiency due to recombinant human erythropoietin treatment in haemodialysis patients

1998 ◽  
Vol 30 (5) ◽  
pp. 645-651 ◽  
Author(s):  
H. Z. Tonbul ◽  
H. Kaya ◽  
N. Y. Selçuk ◽  
S. B. Tekin ◽  
A. San ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Recombinant Human Erythropoietin ◽  
Serum Transferrin ◽  
Functional Iron Deficiency ◽  
Receptor Level ◽  
Serum Transferrin Receptor ◽  
Human Erythropoietin ◽  
Erythropoietin Treatment

scholarly journals Early prediction of response to recombinant human erythropoietin in patients with the anemia of renal failure by serum transferrin receptor and fibrinogen

Blood ◽  
1993 ◽  
Vol 82 (7) ◽  
pp. 2010-2016 ◽  
Author(s):  
Y Beguin ◽  
M Loo ◽  
S R'Zik ◽  
B Sautois ◽  
F Lejeune ◽  
...  
Keyword(s):  
Renal Failure ◽  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Recombinant Human Erythropoietin ◽  
Response Rate ◽  
Serum Transferrin ◽  
Subclinical Inflammation ◽  
Functional Iron Deficiency ◽  
Serum Transferrin Receptor ◽  
Human Erythropoietin

Abstract Recombinant human erythropoietin (rHuEpo) has been shown to be effective in correcting the anemia of chronic renal failure, but the dose needed may be variable. The reason for this variation is not known, but several factors could be involved, such as iron deficiency, inflammation, aluminum intoxication, hyperparathyroidism, blood losses, or marrow dysfunction. Treatment with rHuEpo was given intravenously thrice weekly after hemodialysis to 64 consecutive unselected patients with the anemia of chronic renal failure. The starting dose was 50 U/kg/dose, which was increased to 75 and 100 U/kg/dose if no response was observed after 1 and 2 months of treatment. After a minimum follow- up of 6 months, response was evaluated as early (hematocrit [Hct] > or = 30% before 3 months) or late (Hct > or = 30% after 3 months) response, or failure (target Hct not attained). We examined the value of various laboratory parameters (baseline values and early changes) as predictors of response to rHuEpo. The best prediction by pretreatment parameters only was obtained with baseline serum transferrin receptor (TfR) (< or > or = 3,500 ng/mL) and fibrinogen (< or > or = 4 g/L): 100% response rate when both parameters were low, versus only 29% when they were both high, and versus 67% when one was low and the other high. When the 2-week TfR increment was greater than 20%, the response rate was 96%. When TfR increment was less than 20%, the response rate was 100% when baseline TfR and fibrinogen were low, 12% when fibrinogen was elevated, and 62% when fibrinogen was low but baseline TfR high. The predictive value of baseline TfR and fibrinogen and of the 2-week increment of TfR was confirmed by life table analysis and stepwise discriminant analysis. Major reasons for failure or late response were identified and included subclinical inflammation, iron deficiency, functional iron deficiency, marrow disorders, hemolysis, bleeding, and low Epo dose. We conclude that response to rHuEpo can be predicted early by pretreatment fibrinogen and TfR, together with early changes of TfR levels. These prognostic factors illustrate the importance of the early erythropoietic response, subclinical inflammation, and functional iron deficiency. Early recognition of a low probability of response in a given patient could help identify and correct specific causes of treatment failure to hasten clinical improvement and avoid prolonged ineffective use of an expensive medication.

scholarly journals Early prediction of response to recombinant human erythropoietin in patients with the anemia of renal failure by serum transferrin receptor and fibrinogen

Blood ◽  
1993 ◽  
Vol 82 (7) ◽  
pp. 2010-2016
Author(s):  
Y Beguin ◽  
M Loo ◽  
S R'Zik ◽  
B Sautois ◽  
F Lejeune ◽  
...  
Keyword(s):  
Renal Failure ◽  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Recombinant Human Erythropoietin ◽  
Response Rate ◽  
Serum Transferrin ◽  
Subclinical Inflammation ◽  
Functional Iron Deficiency ◽  
Serum Transferrin Receptor ◽  
Human Erythropoietin

Recombinant human erythropoietin (rHuEpo) has been shown to be effective in correcting the anemia of chronic renal failure, but the dose needed may be variable. The reason for this variation is not known, but several factors could be involved, such as iron deficiency, inflammation, aluminum intoxication, hyperparathyroidism, blood losses, or marrow dysfunction. Treatment with rHuEpo was given intravenously thrice weekly after hemodialysis to 64 consecutive unselected patients with the anemia of chronic renal failure. The starting dose was 50 U/kg/dose, which was increased to 75 and 100 U/kg/dose if no response was observed after 1 and 2 months of treatment. After a minimum follow- up of 6 months, response was evaluated as early (hematocrit [Hct] > or = 30% before 3 months) or late (Hct > or = 30% after 3 months) response, or failure (target Hct not attained). We examined the value of various laboratory parameters (baseline values and early changes) as predictors of response to rHuEpo. The best prediction by pretreatment parameters only was obtained with baseline serum transferrin receptor (TfR) (< or > or = 3,500 ng/mL) and fibrinogen (< or > or = 4 g/L): 100% response rate when both parameters were low, versus only 29% when they were both high, and versus 67% when one was low and the other high. When the 2-week TfR increment was greater than 20%, the response rate was 96%. When TfR increment was less than 20%, the response rate was 100% when baseline TfR and fibrinogen were low, 12% when fibrinogen was elevated, and 62% when fibrinogen was low but baseline TfR high. The predictive value of baseline TfR and fibrinogen and of the 2-week increment of TfR was confirmed by life table analysis and stepwise discriminant analysis. Major reasons for failure or late response were identified and included subclinical inflammation, iron deficiency, functional iron deficiency, marrow disorders, hemolysis, bleeding, and low Epo dose. We conclude that response to rHuEpo can be predicted early by pretreatment fibrinogen and TfR, together with early changes of TfR levels. These prognostic factors illustrate the importance of the early erythropoietic response, subclinical inflammation, and functional iron deficiency. Early recognition of a low probability of response in a given patient could help identify and correct specific causes of treatment failure to hasten clinical improvement and avoid prolonged ineffective use of an expensive medication.

Serum Transferrin Receptor Level in the Diagnosis of Iron Deficiency due to Erythropoietin Treatment

Nephron ◽  
1998 ◽  
Vol 80 (2) ◽  
pp. 241-241 ◽  
Author(s):  
H. Zeki Tonbul ◽  
H. Kaya ◽  
Y. Selçuk ◽  
A. San ◽  
F. Akçay ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Serum Transferrin ◽  
Receptor Level ◽  
Serum Transferrin Receptor ◽  
Erythropoietin Treatment

scholarly journals Serum transferrin receptor: a quantitative measure of tissue iron deficiency

Blood ◽  
1990 ◽  
Vol 75 (9) ◽  
pp. 1870-1876 ◽  
Author(s):  
BS Skikne ◽  
CH Flowers ◽  
JD Cook
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Transferrin Receptor ◽  
Iron Status ◽  
Serum Transferrin ◽  
Mean Cell Volume ◽  
Functional Iron Deficiency ◽  
Iron Stores ◽  
Serum Transferrin Receptor ◽  
Tissue Iron

Abstract This study was undertaken to evaluate the role of serum transferrin receptor measurements in the assessment of iron status. Repeated phlebotomies were performed in 14 normal volunteer subjects to obtain varying degrees of iron deficiency. Serial measurements of serum iron, total iron-binding capacity, mean cell volume (MCV), free erythrocyte protoporphyrin (FEP), red cell mean index, serum ferritin, and serum transferrin receptor were performed throughout the phlebotomy program. There was no change in receptor levels during the phase of storage iron depletion. When the serum ferritin level reached subnormal values there was an increase in serum receptor levels, which continued throughout the phlebotomy program. Functional iron deficiency was defined as a reduction in body iron beyond the point of depleted iron stores. The serum receptor level was a more sensitive and reliable guide to the degree of functional iron deficiency than either the FEP or MCV. Our studies indicate that the serum receptor measurement is of particular value in identifying mild iron deficiency of recent onset. The iron status of a population can be fully assessed by using serum ferritin as a measure of iron stores, serum receptor as a measure of mild tissue iron deficiency, and hemoglobin concentration as a measure of advanced iron deficiency.

scholarly journals Significance of serum transferrin receptor level as an index of iron deficiency in patients undergoing chronic hemodialysis.

1996 ◽  
Vol 29 (10) ◽  
pp. 1379-1386 ◽  
Author(s):  
Takashi Mizuguchi ◽  
Jun Minakuchi ◽  
Kazuhiko Kawahara ◽  
Yasuo Ishii ◽  
Kayoko Sone ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Chronic Hemodialysis ◽  
Serum Transferrin ◽  
Receptor Level ◽  
Serum Transferrin Receptor

scholarly journals Serum transferrin receptor: a quantitative measure of tissue iron deficiency

Blood ◽  
1990 ◽  
Vol 75 (9) ◽  
pp. 1870-1876 ◽  
Author(s):  
BS Skikne ◽  
CH Flowers ◽  
JD Cook
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Transferrin Receptor ◽  
Iron Status ◽  
Serum Transferrin ◽  
Mean Cell Volume ◽  
Functional Iron Deficiency ◽  
Iron Stores ◽  
Serum Transferrin Receptor ◽  
Tissue Iron

This study was undertaken to evaluate the role of serum transferrin receptor measurements in the assessment of iron status. Repeated phlebotomies were performed in 14 normal volunteer subjects to obtain varying degrees of iron deficiency. Serial measurements of serum iron, total iron-binding capacity, mean cell volume (MCV), free erythrocyte protoporphyrin (FEP), red cell mean index, serum ferritin, and serum transferrin receptor were performed throughout the phlebotomy program. There was no change in receptor levels during the phase of storage iron depletion. When the serum ferritin level reached subnormal values there was an increase in serum receptor levels, which continued throughout the phlebotomy program. Functional iron deficiency was defined as a reduction in body iron beyond the point of depleted iron stores. The serum receptor level was a more sensitive and reliable guide to the degree of functional iron deficiency than either the FEP or MCV. Our studies indicate that the serum receptor measurement is of particular value in identifying mild iron deficiency of recent onset. The iron status of a population can be fully assessed by using serum ferritin as a measure of iron stores, serum receptor as a measure of mild tissue iron deficiency, and hemoglobin concentration as a measure of advanced iron deficiency.

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