Utility of plasma transferrin receptor, ferritin and inflammatory markers in children with sickle cell disease

A.-W. M. Al-Saqladi, H. A. Bin-Gadeem, B. J. Brabin

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Background: Soluble transferrin receptor (sTfR) is generally unaffected by inflammatory status, whereas ferritin increases along with acute-phase proteins. The utility of these iron biomarkers in relation to inflammatory markers in children with sickle cell disease (SCD) with differing grades of severity is unclear. Objectives: To describe iron biomarker profiles and inflammatory responses in relation to disease severity in children with SCD. Methods: This cross-sectional study describes plasma levels of sTfR, ferritin, C-reactive protein (CRP) and serum amyloid A (SAA) among 102 Yemeni children with SCD in relation to clinical profiles and disease severity. Results: Median (IQR) sTfR was 58.5 mg/L (38-81), and concentration was positively correlated with reticulocyte count (r=+0.31, P=0.002) and splenic enlargement (r=+0.20, P=0.04), and was negatively correlated with Hb (r=-0.28, P=0.004). Subcategories of children in a steady state were identified using ferritin and CRP cut-off values to discriminate iron status. In children in a steady state, the prevalence of iron deficiency was 25%, iron repletion 48% and marginal or normal status 27%. Ferritin concentration correlated positively with Hb and 23% of iron-deficient children had severe anaemia. CRP and SAA were increased in the steady state and were higher with acute disease complications (P <0.05 and <0.001, respectively). There was no association between sTfR or sTfR-ferritin index and inflammatory markers or disease severity score. Conclusion: In SCD, elevated sTfR is related to hypererythropoietic activity and does not correlate with inflammatory status or disease severity. Iron deficiency prevalence was estimated to be 25%. A classification of iron status is proposed
Original languageEnglish
Pages (from-to)27-34
JournalPaediatrics and international child health
Issue number1
Publication statusPublished - 2012

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