Dried plasma spot measurements of ferritin and transferrin receptor for assessing iron status

Efforts to reduce the high global prevalence of nutritional anemia require the use of both reliable laboratory assays to distinguish iron deficiency from other causes of anemia and cost-effective methods for collection of blood specimens under field conditions. The suitability of using small plasma samples spotted and dried on filter paper for measurements of plasma ferritin and transferrin receptor was evaluated in the present study.

Blood specimens obtained from 73 male and 83 female subjects (19-40 years) representing a wide range of iron status were used to perform parallel measurements of plasma ferritin and transferrin receptor on whole plasma and spotted plasma samples.

Ratio plots, evaluating the acceptability and precision of the spot method in ferritin and transferrin receptor assays, showed the expected proportion of data points within the 95% prediction interval. In the composite group of 156 subjects, both the whole plasma and plasma spot methods gave a geometric mean transferrin receptor/ferritin ratio of 18. The regression equation for the ratio was logy = 1.045 logx - 0.05126; r = 0.986; P <0.0001. The ratio of transferrin receptor/ferritin determined from plasma spots correctly identified all 12 subjects with iron deficiency anemia compared with 11 of the 12 for whole plasma measurements.

Measurements of ferritin and transferrin receptor on plasma spotted and dried on filter paper are comparable to whole plasma values for the identification of iron deficiency anemia. The use of dried plasma spots will facilitate the collection, storage, and transport of samples in epidemiological studies of anemia prevalence.