Deranged Iron Status Evidenced by Iron Deficiency Characterizes Patients with Hidradenitis Suppurativa

Dermatology ◽  
2020 ◽  
Vol 236 (1) ◽  
pp. 52-58
Author(s):  
Malgorzata Ponikowska ◽  
Lukasz Matusiak ◽  
Monika Kasztura ◽  
Ewa A. Jankowska ◽  
Jacek C. Szepietowski
Keyword(s):  
Iron Deficiency ◽  
Disease Severity ◽  
Transferrin Receptor ◽  
Hidradenitis Suppurativa ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Severity Index ◽  
Soluble Transferrin Receptor ◽  
Serum Concentrations ◽  
Autoimmune Processes

Background: Proinflammatory activation and autoimmune processes underlie the pathophysiology of hidradenitis suppurativa (HS). Iron deficiency (ID) is frequently present in inflammation-mediated chronic diseases, irrespective of anemia. Objectives: We aimed to characterize iron status in patients with HS. Methods: Serum concentrations of ferritin, transferrin saturation (Tsat), soluble transferrin receptor and hepcidin were assessed as the biomarkers of iron status in 74 patients with HS and 44 healthy subjects. ID was defined as ferritin <100 µg/L or ferritin 100–299 µg/L with Tsat <20% (following the definition used in the other studies in chronic disease). Results: Compared with controls, patients with HS demonstrated a deranged iron status as evidenced by decreased levels of ferritin (91 ± 87 vs. 157 ± 99 µg/L), Tsat (21.5 ± 10.8 vs. 42.2 ± 11.7%) and hepcidin (31.3 ± 25.9 vs. 44.2 ± 22.0 ng/mL) (all p < 0.05 vs. controls). There was also a trend toward higher values of soluble transferrin receptor (1.23 ± 0.35 vs. 1.12 ± 0.19 mg/L) (p = 0.09 vs. controls). Disease severity (assessed with the Hidradenitis Suppurativa Severity Index and the 3-degree Hurley scale) did not differentiate iron status biomarkers. ID was present in 75% of HS patients, and its prevalence was not related with disease severity (Hurley I/II/III – 82 vs. 73 vs. 67%). In HS, none of the iron status biomarkers correlated with the levels of interleukin-6 (a marker of proinflammatory activation). Conclusions: The majority of HS patients demonstrate derangements in iron status typical of ID. These abnormalities are neither related to proinflammatory activation nor associated with disease severity. Whether it may have a therapeutic impact needs to be further studied.

Serum Soluble Transferrin Receptor in Heterozygous β-Thalassaemia: Application in the Diagnosis of Iron Deficiency and as Hematologic Marker of Erythroid Activity According to Thalassaemic Genotypes (β0 vs β+).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3828-3828
Author(s):  
Jose Manuel Calvo-Villas ◽  
María Francisca Zapata ◽  
Ivan Alvarez ◽  
Silvia de la Iglesia ◽  
Jorge Cuesta ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Biochemical Parameters ◽  
Iron Status ◽  
Direct Sequencing ◽  
Saturation Index ◽  
Transferrin Saturation ◽  
Soluble Transferrin Receptor ◽  
Iron Deficient ◽  
Significant Difference

Abstract Although an increased level of serum soluble transferrin receptor (sTfR) have been found in both heterozygous β-thalassaemia patients with iron deficiency and in those with more severe genotype (β0), it is not a useful marker of iron deficiency status associated to β-thalassaemia. The aim of this study was to analyse the use of two biochemical parameters (sTfR and sTfR/log of ferritin ratio) to determine the iron status and to evaluate the degree of erythropoietic activity in a group of 221 β-thalassaemic heterozigotes patients (155 β0 and 66 β+). Serum ferritin and transferrin saturation index were measured in order to establish the iron status. Of the whole group, 51 patients were iron defficient (βthal-ID) while the remaining 170 were iron sufficient (βthal-IS). Based on the combination of β-thalassaemia genotype and iron status, patients were classified into four subgroups: β0thalassaemia and iron-sufficient (β0thal-IS) (n=124); β0thalassaemia and iron-deficient (β0thal-ID) (n=31); β+thalassaemia and iron-sufficient (β+thal-IS) (n=46); β+thalassaemia and iron-deficient (β+thal-ID) (n=20). 258 healthy and 56 iron-deficient individuals were used as controls. All the haematological parameters were measured by using analyzer Coulter® GEN-S™. Haemoglobins A2 (Hb A2) and F (HbF) were analysed by high performance liquid chromatography and molecular analysis was performed by real-time PCR and direct sequencing techniques. Chemical, inmunoturbidimetrical and nephelometric methods were used to measure iron status as well as sTfR. Comparison of haemalogical and biochemical parameters between subgroups was performed by using the t-student test and correlation analysis was calculated by using least-squares regression model. Mean sTfR level obtained was 2.63 ± 0.8 mg/dL and 2.57 ± 1.1 mg/dL in βthal-ID and βthal-IS patients respectively (p=0.783). Soluble transferrin receptor showed a positive correlation with HbA2, HbF and reticulocyte count values in βthal-IS patients (r=0.208 [p<0.05], r=0.440 [p<0.0001] and r=0.393 [p<0.00001] respectively) while it did not reach a significant correlation in βthal-ID patients. Mean sTfR/log sFt ratio was 2.75 ± 1.6 and 1.34 ± 0.5 in βthal-ID and βthal-IS patients (p<0.001). Interestingly, sTfR level was significantly higher in β0thal-IS patients when compared with β+thal-IS patients (2.76 ± 0.9 vs 1.42 ± 0.4) (p<0.001) as a result of an increased globin chains imbalance related to the β0 genotype. In the other hand, in the comparison between β0thal-ID and β+thal-ID subgroups neither sTfr level (2.71 ± 0.7 vs 2.40 ± 1.1) (p=0.417) nor sTfR/log sFt ratio (2.93 ± 1.7 vs 2.24 ± 1.3) (p=0.371) showed significant difference. In summary, sTfR/log sFt ratio is a valid parameter for diagnosis of iron deficiency associated to heterozygous β-thalassaemia. Unlike the findings observed in β-thalassaemic heterozigotes with normal iron status, sTfR level is not useful to evaluate the genotype severity in those with iron deficiency. Consequently, iron status should be determined before using sTfR as a parameter to provide a reliable estimation of the ineffective erythropoiesis related to the severity of β-thalassaemia genotypes.

scholarly journals Using Soluble Transferrin Receptor and Taking Inflammation into Account When Defining Serum Ferritin Cutoffs Improved the Diagnosis of Iron Deficiency in a Group of Canadian Preschool Inuit Children from Nunavik

Anemia ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Huguette Turgeon O’Brien ◽  
Rosanne Blanchet ◽  
Doris Gagné ◽  
Julie Lauzière ◽  
Carole Vézina
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Binding Capacity ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Deficiency Anemia ◽  
Soluble Transferrin Receptor ◽  
Iron Depletion ◽  
Reactive Protein ◽  
Iron Deficient

The prevalence of iron depletion, iron deficient erythropoiesis (IDE), and iron deficiency anemia (IDA) was assessed in preschool Inuit children using soluble transferrin receptor (sTfR) and traditional indicators of iron status while disregarding or taking inflammation into account when defining SF cutoffs. Iron depletion was defined as follows: (1) SF < 15 μg/L regardless of the C-reactive protein (CRP) level and (2) SF < 15 or <50 μg/L with CRP ≤ 5 or >5 mg/L, respectively. IDE corresponded to iron depletion combined with total iron binding capacity > 72 μmol/L and/or transferrin saturation < 16%. Iron depletion and IDE affected almost half of the children when accounting for inflammation, compared to one-third when the SF cutoff was defined regardless of CRP level (P<0.0001). The prevalence of IDE adjusted for inflammation (45.1%) was very similar to the prevalence observed when sTfR was used as a sole marker of IDE (47.4%). The prevalence of anemia was 15%. The prevalence of IDA (IDE + hemoglobin < 110 g/L) was higher when accounting for than when disregarding inflammation (8.0% versus 6.2%,P=0.083). Using sTfR and different SF cutoffs for children with versus without inflammation improved the diagnosis of iron depletion and IDE. Our results confirm that Inuit children are at particularly high risk for iron deficiency.

scholarly journals Increased Serum Transferrin Saturation Is Associated with Lower Serum Transferrin Receptor Concentration

1999 ◽  
Vol 45 (12) ◽  
pp. 2191-2199 ◽  
Author(s):  
Anne C Looker ◽  
Mark Loyevsky ◽  
Victor R Gordeuk
Keyword(s):  
Iron Deficiency ◽  
Iron Overload ◽  
Transferrin Receptor ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Reference Interval ◽  
Serum Transferrin ◽  
Reactive Protein ◽  
Serum Transferrin Receptor ◽  
Health And Nutrition

Abstract Background: Serum transferrin receptor (sTfR) concentrations are increased in iron deficiency. We wished to examine whether they are decreased in the presence of potential iron-loading conditions, as reflected by increased transferrin saturation (TS) on a single occasion. Methods: We compared sTfR concentrations between 570 controls with normal iron status and 189 cases with increased serum TS on a single occasion; these latter individuals may be potential cases of iron overload. Cases and controls were selected from adults who had been examined in the third National Health and Nutrition Examination Survey (1988–1994) and for whom excess sera were available to perform sTfR measurements after the survey’s completion. Increased TS was defined as &gt;60% for men and &gt;55% for women; normal iron status was defined as having no evidence of iron deficiency, iron overload, or inflammation indicated by serum ferritin, TS, erythrocyte protoporphyrin, and C-reactive protein. Results: Mean sTfR and mean log sTfR:ferritin were ∼10% and 24% lower, respectively, in cases than in controls (P &lt;0.002). Cases were significantly more likely to have an sTfR value &lt;2.9 mg/L, the lower limit of the reference interval, than were controls (odds ratio = 1.8; 95% confidence interval, 1.04–2.37). Conclusion: Our results support previous studies that suggested that sTfR may be useful for assessing high iron status in populations.

scholarly journals Evaluation of new immunoenzymometric assay for measuring soluble transferrin receptor to detect iron deficiency in anemic patients

1997 ◽  
Vol 43 (9) ◽  
pp. 1641-1646 ◽  
Author(s):  
Pauli Suominen ◽  
Kari Punnonen ◽  
Allan Rajamäki ◽  
Kerttu Irjala
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Bone Marrow Aspirate ◽  
Clinical Performance ◽  
Iron Status ◽  
Clinical Work ◽  
Analytical Performance ◽  
Soluble Transferrin Receptor ◽  
Commercial Test ◽  
Clinical Applicability

Abstract During the last few years the measurement of serum-soluble transferrin receptor (sTfR) has been introduced as a tool to detect iron deficiency and as an analyte to differentiate between anemia caused by iron deficiency (IDA) and that caused by chronic disease (ACD). Commercially available methods have emerged to make diagnostics by sTfR more readily accessible. We documented the analytical performance of a newly introduced IDeATM sTfR immunoenzymometric assay (IEMA) by Orion Diagnostica. We also evaluated its clinical performance in 98 consecutive anemic patients, with information derived from bone marrow aspirate samples as the reference for iron status. The clinical usefulness of two other commercially available sTfR assays was assessed for comparison. The analytical performance and clinical applicability of the IDeA were sufficient to support reliable clinical work. We conclude that IDA and iron deficiency in the presence of inflammatory states can be differentiated efficiently from ACD with this new commercial test to measure sTfR.

scholarly journals Soluble Transferrin Receptor and Soluble Transferrin Receptor/Log Ferritin Ratio are Correlated with Iron Status in Regular Hemodialysis Patients

2021 ◽  
Vol 13 (2) ◽  
pp. 201-7
Author(s):  
Yenny Kandarini ◽  
Gede Wira Mahadita ◽  
Sianny Herawati ◽  
Anak Agung Wiradewi Lestari ◽  
Ketut Suega ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Transferrin Receptor ◽  
Serum Iron ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Hemodialysis Patients ◽  
Enzyme Linked Immunosorbent Assay ◽  
Soluble Transferrin Receptor ◽  
Regular Hemodialysis

BACKGROUND: Monitoring of iron status in chronic kidney disease patients is important, however inflammation may hinder its monitoring. Soluble transferrin receptor (sTfR) is an alternative parameter to overcome this issue, whereas ferritin play a part in the inflammation process. Hence, the correlation between the sTfR ratio and the sTfR/log ferritin ratio with conventional iron status parameters in regular hemodialysis patients is necessary to be evaluated.METHODS: A cross-sectional was conducted in the current study. As many as 5 mL of blood (2 mL for sTfR and 3 mL for serum iron and ferritin levels) was collected. sTfR level was the blood-soluble transferrin receptor level measured by the enzyme-linked immunosorbent assay (ELISA). The amount of ferritin and serum iron was determined using the immunochemiluminescent process. To evaluate the correlation, the Pearson correlation test was used.RESULTS: A total of 80 subjects was included in this study. The mean of hemoglobin was 10.25±1.66 g/dL, serum iron was 58.19±26.56 g/dL, and the median ferritin was 520.4 (49.9-3606) ng/mL. The sTfR was significantly associated only with serum iron levels with a correlation coefficient of r=-0.242; p=0.031. The sTfR/log ferritin was significantly associated with serum iron l evels (InSI)(r=-0.255, p=0.022); and transferrin saturation (r=-0.295; p=0.008).CONCLUSION: sTfR/log ferritin has a negative and significant correlation with serum iron levels and transferrin saturation, while sTfR negatively correlated with serum iron levels. sTfR and sTfR/log ferritin may be considered as an alternative iron marker in inflammation setting such as CKD.KEYWORDS: sTfR/log ferritin, iron status, serum iron, ferritin, chronic kidney disease, hemodialysis

SOLUBLE TRANSFERRIN RECEPTOR IS A PROMISING MARKER of IRON DEFICIENCY ANEMIA IN PREVALENT HEMODIALYSIS PATIENTS

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Abou seif ◽  
Hussien Sayed Hussien ◽  
Shaimaa Abdelmegied ◽  
Marwa Abdulhady
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Transferrin Receptor ◽  
Iron Status ◽  
Hemodialysis Patients ◽  
Deficiency Anemia ◽  
P Value ◽  
Soluble Transferrin Receptor ◽  
Significant Difference ◽  
And Control

Abstract: Background Diagnosis of iron deficiency is traditionally based on ferritin and other iron parameters becomes difficult in end stage renal disease patients due to the inflammatory condition which affects these markers and masks the iron deficiency. Serum soluble transferrin receptor (sTfR) is able to be a reliable indicator for assessing iron status, as it is not affected by inflammatory procedures. Aim To evaluate the usefulness of serum soluble transferrin receptors in iron deficiency anemia detection in comparison to the classic markers of iron status in prevalent hemodialysis patients. Methods This case-control study assessed sTfR in 80 prevalent ESRD patients on regular hemodialysis in 2 groups. Group A (N = 40): CRP &gt;10 and group B (N = 40):CRP &lt;10 and apparently healthy 8 control subjects. Results The cut of value of STFRs in hemodialysis patients was 12.5 mg\l. The prevalence of STFRs in patients with CRP&lt;10 was 85%, while in patients with CRP&gt;10 was 92.5% (P-value 0.288). STFRs have high sensitivity 88.75, specificity 100, PPV100% and NPV 47.1%. The hemodialysis patients who have elevated STFRs have risk 1.22 times to have iron deficiency anemia if CRP &lt;10 (odds ratio: 1.22) and 3.14 times if CRP&gt;10 (odds ratio: 3.14). There was significant difference on comparing patients with CRP&lt;10, CRP&gt;10 and control as regard Hb and STFR with P-value 0.0001 and 0.0001 respectively. Post Hoc analysis showed significant difference in both between the patients with CRP&lt;10 and control also in patients with CRP&gt;10 and control (p value &lt;0.0001). while on comparing patients with CRP&lt;10 with patients with CRP&gt;10 there was significant difference in STFRs p value 0.0001 despite no significant difference in hemoglobin (p value 0.642) and classic marker of iron deficiency (s.iron, TIBC, TSAT) with p value 0.701,0.192,0.382 respectively. Serum STFRs was negatively correlated with s.iron and Kt\v (r -0.372, P-value 0.018) and (r-0.416, p value 0.008) respectively in patients with CRP &lt;10. Conclusion Serum soluble transferrin receptor is highly sensitive and specific marker for iron deficiency in hemodialysis patients especially in patients with high CRP level.

scholarly journals Iron metabolism in patients with rheumatoid arthritis

2020 ◽  
Author(s):  
Wojciech Tański ◽  
Mariusz Chabowski ◽  
Beata Jankowska-Polańska ◽  
Ewa Anita Jankowska
Keyword(s):  
Iron Deficiency ◽  
Disease Activity ◽  
Transferrin Receptor ◽  
Transferrin Saturation ◽  
Female Gender ◽  
Control Group ◽  
Soluble Transferrin Receptor ◽  
Platelet Counts ◽  
Das 28 ◽  
Younger Age

Abstract Background. The most common haematological manifestation in RA is anaemia (30-60%). The aim of the study was the assessment of the prevalence of iron deficiency in RA patients using standard parameters and new biomarkers.Material and methods. The study was conducted on 62 RA patients, aged 52±15, treated at the Department of Internal Medicine of the 4th Military Teaching Hospital in Wrocław between 2016 and 2017. The control group comprised 58 healthy individuals, aged 56±9. The following tests were carried out: DAS-28, complete blood count, creatinine, uric acid, AspAT, ALAT, GGT, bilirubin, TSH, lipid profile, iron, TIBC, transferrin saturation, ferritin, soluble transferrin receptor, hepcidin, and IL-6.Results. A higher percentage of RA patients compared with the control group had TSAT values below 20%, ferritin levels below the reference range, soluble transferrin receptor levels above 1.59mg/l and hepcidin levels below 14.5 ng/ml. 60% of RA patients had iron deficiency. The correlations between reduced ferritin levels and younger age, female gender, lower GGT levels and increased platelet counts was shown. The correlations were found between iron deficiency and younger age, female gender, reduced haemoglobin levels, increased platelet counts, increased GFR, reduced GGT levels, lower disease activity and less frequent use of sulfasalazineConclusions. Iron deficiency is common in RA patients with high disease activity. RA patients had lower transferrin saturation, lower ferritin and hepcidin levels and higher serum sTfR levels. The increased DAS-28 scores and reduced haemoglobin levels were the two strongest determinants of iron deficiency in RA patients.

scholarly journals P309 Ferritin or transferrin saturation vs. soluble transferrin receptor for iron deficiency diagnosis in inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S309-S309
Author(s):  
S DAUDE ◽  
T Remen ◽  
T Chateau ◽  
S Danese ◽  
I Gastin ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Iron Deficiency ◽  
Bowel Disease ◽  
Transferrin Receptor ◽  
Diagnostic Performance ◽  
Transferrin Saturation ◽  
Added Value ◽  
Routine Practice ◽  
Soluble Transferrin Receptor ◽  
Inflammatory Bowel

Abstract Background Iron deficiency is common in inflammatory bowel disease (IBD) and can negatively affect the quality of life even in the absence of anaemia. Diagnosis of iron deficiency is based on ferritin and transferrin saturation (TfS) in routine practice, yet guideline thresholds are not evidence-based. Serum levels of soluble transferrin receptor (sTfR) are the best non-invasive test as it is not influenced by inflammation, but the test is costly with low availability. Thus, the aim of this study was to evaluate for the first time the accuracy of ferritin and/or TfS for diagnosing iron deficiency in IBD and identify the optimal thresholds of these parameters using sTfR as the gold standard. Methods Serum samples were collected from IBD patients (n = 2,072) receiving a biologic in routine practice. Diagnostic accuracy was assessed using receiver operating characteristic curves for ferritin and TfS levels separately or combined. Results No ferritin or TfS threshold had good diagnostic performance in CD patients. In UC patients with CRP &lt;10 mg/l, optimal iron deficiency diagnostic performances were observed with ferritin and TfS thresholds of 65 µg/l and 16%, respectively. For UC patients with CRP &gt;10 mg/l, the thresholds with the best diagnostic performance were 80 µg/l for ferritin and 11% for TfS. There was no added value for combined ferritin and TfS. Conclusion In conclusion, we found that ferritin and TfS are reliable parameters for iron deficiency diagnosis only in UC patients, at thresholds different from current guidelines. In CD patients, sTfR should be used given the poor diagnostic performance of ferritin and TfS.

scholarly journals Comparative Evaluation of the Reticulocyte Hemoglobin Content Assay When Screening for Iron Deficiency in Elderly Anemic Patients

Anemia ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Torbjörn Karlsson
Keyword(s):  
Iron Deficiency ◽  
Sensitivity And Specificity ◽  
Transferrin Receptor ◽  
Transferrin Saturation ◽  
Deficiency Anemia ◽  
Mean Corpuscular Hemoglobin ◽  
Soluble Transferrin Receptor ◽  
Hemoglobin Content ◽  
Iron Parameters ◽  
Reticulocyte Hemoglobin Content

The aim of this study was to evaluate sensitivity and specificity for reticulocyte hemoglobin content (CHr) compared to other hematimetric and biochemical iron parameters, in particular, mean corpuscular hemoglobin (MCH), when screening for iron deficiency in elderly anemic patients. Bone marrow staining negative for iron was used as the gold standard criterion for iron deficiency anemia (IDA). Sensitivity and specificity for CHr, soluble transferrin receptor (sTfR), soluble transferrin receptor/log ferritin (TfR-F index), ferritin, MCH, and transferrin saturation were determined. The best cut-off point for CHr was 30.5 pg corresponding to a sensitivity and specificity of 93% and 69% for IDA, respectively. For MCH, a sensitivity of 93% and a specificity of 86%, respectively, correspond to an optimal cut-off of 28.5 pg. Analysis of CHr was not superior to MCH with respect to sensitivity and specificity when screening for IDA in elderly anemic patients.

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