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Higher concentrations of serum transferrin receptor in children than in adults
M A Virtanen1, L U Viinikka, M K Virtanen
1Department of Clinical Chemistry and Hospital for Children and Adolescents, University of Helsinki, Finland. marita.virtanen@huch.fi
Insights
Serum transferrin receptor (TfR) levels are higher in children, especially infants, reflecting lower iron stores. Age-specific reference ranges for TfR are needed for accurate iron status assessment in pediatric populations.
Area of Science:
- Pediatric Nutrition
- Iron Metabolism
- Biomarker Research
Background:
- Serum transferrin receptor (TfR) is a sensitive indicator of iron depletion in adults.
- TfR and serum ferritin together assess iron status from deficiency to overload.
- Limited data exists on TfR concentrations in pediatric populations.
Purpose of the Study:
- Compare serum TfR and ferritin concentrations in infants, children, and adults.
- Evaluate TfR-ferritin ratios across different age groups.
- Correlate TfR concentrations with other iron status markers.
Main Methods:
- Study included healthy 1-year-old infants (n=36), 11-12-year-old prepubertal boys (n=35), and 20-39-year-old men (n=40).
- Serum TfR and ferritin concentrations were measured.
- Multiple linear regression analysis was used to identify predictors of TfR concentration.
Main Results:
- Infants had higher TfR concentrations and TfR-ferritin ratios than prepubertal boys and men.
- Prepubertal boys had higher TfR concentrations and ratios than men.
- Serum iron and log serum ferritin were inverse predictors of TfR concentration (R2=0.32).
Conclusions:
- Low serum ferritin and iron, even within normal ranges, elevate TfR concentrations.
- Higher TfR in children, particularly infants, indicates physiologically low iron stores.
- Age-specific reference concentrations for TfR are necessary for accurate interpretation in children.
Background:
The serum transferrin receptor (TfR) concentration in adults is suggested to provide a sensitive measure of iron depletion and together with the serum ferritin concentration to indicate the entire range of iron status, from iron deficiency to iron overload. However, little is known about TfR concentrations in children.
Objective:
Our objective was to compare serum TfR and ferritin concentrations and their ratios in children and adults and look for correlations between TfR concentrations and other measures of iron status.
Design:
Our study groups were healthy 1-y-old infants (n = 36), 11-12-y-old prepubertal boys (n = 35), and 20-39-y-old men (n = 40).
Results:
TfR concentrations were higher in infants (x; 95% reference interval: 7.8 mg/L; 4.5, 11.1) than in prepubertal boys (7.0 mg/L; 4.7, 9.2) and higher in prepubertal boys than in men (5.8 mg/L; 3.1, 8.5). Geometric mean TfR-ferritin ratios were higher in infants (316; 95% reference interval: 94, 1059) than in prepubertal boys (219; 78, 614) and higher in prepubertal boys than in men (72; 23, 223). By multiple linear regression analysis, the best predictors of TfR concentration were serum iron (P = 0.004) and log serum ferritin (P < 0.0001), both being inverse correlations (R2 = 0.32). Mean corpuscular volume, blood hemoglobin, transferrin iron saturation, transferrin, and even age seemed to not have an influence on the TfR concentration and erythropoiesis was not a determinant of TfR concentration.
Conclusions:
Low serum ferritin and iron concentrations, even within the normal physiologic range, result in high TfR concentrations. The lower the iron stores, the stronger the influence of ferritin on TfR. A high TfR concentration in children, especially in infants, is a response to physiologically low iron stores. Age-specific reference concentrations for TfR are needed.