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Serum transferrin receptors: Distribution and diagnostic performance in pre-school children
Giorgos L Chouliaras1, Evangelos Premetis, George Tsiftis
1First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital Athens, Greece.
Insights
Soluble transferrin receptor (sTfR) levels vary in preschool children with anemias. While sTfR correlates with age and certain conditions, its accuracy in diagnosing iron deficiency alone is limited, suggesting combined markers are better.
Area of Science:
- Pediatric Hematology
- Diagnostic Biomarkers
- Anemia Research
Background:
- Soluble transferrin receptors (sTfR) are increasingly used for anemia diagnosis.
- Reference ranges for sTfR assays vary significantly by method.
- Understanding sTfR distribution and performance in pediatric populations is crucial.
Purpose of the Study:
- To investigate the distribution and diagnostic utility of sTfR in preschool children.
- To compare sTfR levels in healthy children versus those with beta-thalassemia trait, iron deficiency (ID), and iron deficiency anemia (IDA).
- To evaluate the correlation of sTfR with age and other hematological/biochemical markers.
Main Methods:
- Quantification of circulating sTfR, biochemical, and hematological indices in 521 preschool children.
- Formation of four groups: normal, beta-thalassemia trait, ID, and IDA.
- Statistical analysis of sTfR distribution, age correlation, and diagnostic performance.
Main Results:
- sTfR distribution significantly differed among the four groups (p<0.001), with lower levels in normal children.
- A negative correlation between sTfR and age was observed in normal and ID groups.
- sTfR showed limited diagnostic performance (AUC=0.63, sensitivity=70.5%, specificity=50%) for distinguishing normal from ID children.
Conclusions:
- sTfR levels are influenced by age and dyserythropoietic conditions like beta-thalassemia, ID, and IDA.
- The diagnostic accuracy of sTfR alone for iron deficiency in preschool children is limited.
- Combining sTfR with ferritin may offer greater diagnostic value, pending standardization.
Abstract:
Soluble transferrin receptors have gained interest in the field of diagnosing anemias. Reference ranges differ according to the method used for the quantification of sTfR. We aim to explore the distributional properties and diagnostic performance of sTfR in pre-school healthy children as well as in children with beta-thalassemia carriers, iron deficiency with normal hematological phenotype (ID) and iron deficiency anemia (IDA). Circulating sTfR as well as biochemical and hematological indices were determined in 521 pre-school children and four groups (normal children, beta-thalassemia traits, ID and IDA) were formed. Diagnostic performance and distribution of sTfR according to age and in relation to several parameters were evaluated in every group. Three hundred eighty one children (261 normal, 60 beta-thalassemia traits, 44 ID and 16 IDA) aged 1-6 years were included. We found that distribution of sTfR differed significantly among the four groups (Kruskal Wallis p<0.001) with children in the normal group exhibiting lower concentrations compared to all other. A negative correlation between sTfR and age occurred in the normal (beta=-0.12, p<0.001) and the ID groups (beta=-0.13, p=0.035). In the beta-thal and IDA groups sTfR is correlated to HbA(2) (beta=0.34, p=0.001) and ferritin (Spearman's rho=-0.6, p=0.014) respectively. An area under the curve equal to 0.63 was achieved by sTfR in distinguishing between normal and ID children. Sensitivity and specificity were 70.5% and 50% respectively at a cut-off of 2.5 mg/l. Levels of sTfR are negatively correlated to age in pre-school children while dyserythropoietic procedures like beta-thal, ID, and IDA significantly affect them. These findings indicated that the accuracy of sTfR in diagnosing ID from normal children is limited. Standardization will allow the use of formulas that combine sTfR and ferritin which are of greater diagnostic value than sTfR alone.
