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Published on: August 17, 2022
Bone marrow iron depletion is common in patients with coronary artery disease
Ewa A Jankowska1, Katarzyna Wojtas2, Monika Kasztura3
1Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
Insights
Nearly half of patients with stable coronary artery disease (CAD) have iron deficiency (ID). Serum soluble transferrin receptor accurately detects this non-invasively, aiding diagnosis and treatment.
Area of Science:
- Cardiology
- Hematology
- Clinical Diagnostics
Background:
- Iron deficiency (ID) is a potential comorbidity in cardiovascular diseases, but its diagnosis in these patients is uncertain.
- Bone marrow aspirates are the gold standard for diagnosing ID.
Purpose of the Study:
- To investigate the diagnostic accuracy of blood tests for ID in patients with stable coronary artery disease (CAD).
- To compare blood test results with bone marrow iron stores.
Main Methods:
- Bone marrow aspirates were collected from 65 stable CAD patients and 10 controls.
- ID was defined by low iron stores (Gale scale 0-1) and minimal iron in erythroblasts (≤10%).
Main Results:
- 48% of CAD patients had bone marrow ID, compared to 0% of controls.
- Serum soluble transferrin receptor showed the strongest association with bone marrow ID (AUC: 0.876), with high sensitivity (67%) and specificity (97%) at a cutoff of ≥1.32mg/L.
Conclusions:
- Profound bone marrow iron depletion is common in stable CAD patients.
- Serum soluble transferrin receptor offers an accurate, non-invasive method for assessing iron stores in these patients.
Background/Objectives:
Iron deficiency (ID) may be an important, treatable co-morbidity complicating cardiovascular diseases, but considerable uncertainty exists about the diagnostic accuracy of blood tests. Accordingly, we investigated the relationship between blood tests for ID and iron stores in bone marrow aspirates, the diagnostic gold-standard for ID, in patients with stable coronary artery disease (CAD).
Methods:
Bone marrow aspirates were obtained from 65 patients with stable CAD undergoing cardiac surgery and 10 healthy controls. ID was defined as depleted extracellular iron stores (0-1 grade according to Gale scale) accompanied by ≤10% of erythroblasts containing iron.
Results:
Bone marrow ID was found in 31 (48%) patients with CAD but in none of the controls (p<0.01). Amongst patients with CAD, ID was present in 10 of 16 (63%) with and 21 of 49 (43%) without anaemia (p=0.17). The clinical profiles of patients with and without ID were similar. Of circulating biomarkers of ID, serum soluble transferrin receptor had the strongest association with bone marrow ID (area under curve: 0.876±0.048, 95% confidence interval: 0.762-0.948, for cut-off of ≥1.32mg/L-sensitivity: 67%, specificity: 97%).
Conclusions:
Almost half of patients with stable CAD have profound bone marrow iron depletion that can be accurately assessed non-invasively using serum soluble transferrin receptor.
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