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Serum transferrin receptor in children with respiratory infections
P Bhaskaram1, K Madhavan Nair, N Balakrishna
1Division of Pediatrics, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India. pbhask@yahoo.com
Insights
Severe respiratory infections in children can impair iron status and erythropoiesis. While serum transferrin receptor (sTfR) levels may initially rise, they may not accurately reflect true iron status during severe infections.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Nutritional Biochemistry
Background:
- Respiratory infections are common in children and can affect nutritional status.
- Iron deficiency is a prevalent cause of anemia in children worldwide.
- Assessing iron status during infection is complex due to altered biochemical markers.
Purpose of the Study:
- To investigate the impact of acute, mild, and severe respiratory infections on iron status in children.
- To determine the nature of anemia associated with infection using serum transferrin receptor (sTfR) levels.
- To evaluate the utility of sTfR in assessing iron status during infectious conditions.
Main Methods:
- A study involving 43 healthy children (controls) and 115 children with respiratory infections (mild URI or acute pneumonia).
- Measurements included hemoglobin (Hb), serum ferritin, and sTfR at diagnosis and on days 15 and 30 post-infection.
- Comparison of iron status markers between control and experimental groups, and over time within the infected group.
Main Results:
- Mild upper respiratory infection elevated serum ferritin but did not affect Hb or sTfR.
- Eighty-three percent of children with pneumonia had low Hb and elevated sTfR at diagnosis.
- sTfR levels in pneumonia fluctuated, showing a decline by day 15 and a subsequent rise by day 30; serum ferritin remained elevated initially then declined.
Conclusions:
- Severe lower respiratory infections can exacerbate iron-deficient erythropoiesis by hindering iron release from stores.
- Serum transferrin receptor (sTfR) may not be a reliable indicator of true iron status in children experiencing severe infections.
- The study highlights the complex interplay between infection, iron metabolism, and anemia in pediatric populations.
Objective:
To study the effect of infection on iron status in children suffering from acute, mild or severe respiratory infections and to determine the nature of anemia in infection using serum transferrin receptor (sTfR) levels.
Design:
Forty-three children aged between 3 and 5 y with no evidence of infection and receiving iron supplements in the preceding 100 days served as controls. Twenty-one children with mild upper respiratory infection and 94 children hospitalized for acute pneumonia constituted the experimental group. Hemoglobin (Hb), sTfR and serum ferritin were estimated in all the children at the time of diagnosis and again on the 15th and 30th days after the infection in those who were available for follow-up.
Results:
Mean (95% CI) sTfR was 6.08 (5.1-7.1) mg/l in healthy non-anemic children. Upper respiratory infection had no impact on Hb or sTfR but it significantly elevated serum ferritin levels. Eighty-three percent of the children with pneumonia had Hb less than 110 g/l at the time of diagnosis and had elevated mean sTfR, 18.0 (15.7-20.3) mg/l. There was a decline in mean sTfR by the 15th day of infection to 14.3 (11.3-17.4) mg/l with further rise to 22.9 (13.0-31.9) mg/l by 30 days. Serum ferritin was significantly elevated at the time of diagnosis (85.9; 71.1-100.8 micro g/l) as well as at 15 days (89.1; 68-110.1 micro g/l) with a decline by 30 days.
Conclusions:
Severe lower respiratory infection exaggerates iron-deficient erythropoiesis by blocking release of iron from the storage pools. sTfR may not be a sensitive and specific tool of assessing true iron status of children exposed to severe infections.