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Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: a prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index.
Am J Hematol. 2011 Nov; 86(11):923-7.AJ

Abstract

Anemia of chronic disease (ACD) and iron deficiency anemia (IDA) are the most prevalent forms of anemia and often occur concurrently. Standard tests of iron status used in differential diagnosis are affected by inflammation, hindering clinical interpretation. In contrast, soluble transferrin receptor (sTfR) indicates iron deficiency and is unaffected by inflammation. Objectives of this prospective multicenter clinical trial were to evaluate and compare the diagnostic accuracy of sTfR and the sTfR/log ferritin index (sTfR Index) for differential diagnosis using the automated Access(®) sTfR assay (Beckman Coulter) and sTfR Index. We consecutively enrolled 145 anemic patients with common disorders associated with IDA and ACD. Subjects with IDA or ACD + IDA had significantly higher sTfR and sTfR Index values than subjects with ACD (P < 0.0001). ROC curves produced the following cutoffs for sTfR: 21 nmol/L (or 1.55 mg/L), and the sTfR Index: 14 (using nmol/L) (or 1.03 using mg/L). The sTfR Index was superior to sTfR (AUC 0.87 vs. 0.74, P < 0.0001). Use of all three parameters in combination more than doubled the detection of IDA, from 41% (ferritin alone) to 92% (ferritin, sTfR, sTfR Index). Use of sTfR and the sTfR Index improves detection of IDA, particularly in situations where routine markers provide equivocal results. Findings demonstrate a significant advantage in the simultaneous determination of ferritin, sTfR and sTfR Index. Obtaining a ferritin level alone may delay diagnosis of combined IDA and ACD.

Authors+Show Affiliations

Division of Hematology, University of Kansas Medical Center, Kansas City, USA. bskikne@celgene.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study

Language

eng

PubMed ID

21812017

Citation

Skikne, Barry S., et al. "Improved Differential Diagnosis of Anemia of Chronic Disease and Iron Deficiency Anemia: a Prospective Multicenter Evaluation of Soluble Transferrin Receptor and the sTfR/log Ferritin Index." American Journal of Hematology, vol. 86, no. 11, 2011, pp. 923-7.
Skikne BS, Punnonen K, Caldron PH, et al. Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: a prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index. Am J Hematol. 2011;86(11):923-7.
Skikne, B. S., Punnonen, K., Caldron, P. H., Bennett, M. T., Rehu, M., Gasior, G. H., Chamberlin, J. S., Sullivan, L. A., Bray, K. R., & Southwick, P. C. (2011). Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: a prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index. American Journal of Hematology, 86(11), 923-7. https://doi.org/10.1002/ajh.22108
Skikne BS, et al. Improved Differential Diagnosis of Anemia of Chronic Disease and Iron Deficiency Anemia: a Prospective Multicenter Evaluation of Soluble Transferrin Receptor and the sTfR/log Ferritin Index. Am J Hematol. 2011;86(11):923-7. PubMed PMID: 21812017.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved differential diagnosis of anemia of chronic disease and iron deficiency anemia: a prospective multicenter evaluation of soluble transferrin receptor and the sTfR/log ferritin index. AU - Skikne,Barry S, AU - Punnonen,Kari, AU - Caldron,Paul H, AU - Bennett,Michael T, AU - Rehu,Mari, AU - Gasior,Gail H, AU - Chamberlin,Janna S, AU - Sullivan,Linda A, AU - Bray,Kurtis R, AU - Southwick,Paula C, Y1 - 2011/08/02/ PY - 2011/03/07/received PY - 2011/06/02/revised PY - 2011/06/03/accepted PY - 2011/8/4/entrez PY - 2011/8/4/pubmed PY - 2011/12/14/medline SP - 923 EP - 7 JF - American journal of hematology JO - Am. J. Hematol. VL - 86 IS - 11 N2 - Anemia of chronic disease (ACD) and iron deficiency anemia (IDA) are the most prevalent forms of anemia and often occur concurrently. Standard tests of iron status used in differential diagnosis are affected by inflammation, hindering clinical interpretation. In contrast, soluble transferrin receptor (sTfR) indicates iron deficiency and is unaffected by inflammation. Objectives of this prospective multicenter clinical trial were to evaluate and compare the diagnostic accuracy of sTfR and the sTfR/log ferritin index (sTfR Index) for differential diagnosis using the automated Access(®) sTfR assay (Beckman Coulter) and sTfR Index. We consecutively enrolled 145 anemic patients with common disorders associated with IDA and ACD. Subjects with IDA or ACD + IDA had significantly higher sTfR and sTfR Index values than subjects with ACD (P < 0.0001). ROC curves produced the following cutoffs for sTfR: 21 nmol/L (or 1.55 mg/L), and the sTfR Index: 14 (using nmol/L) (or 1.03 using mg/L). The sTfR Index was superior to sTfR (AUC 0.87 vs. 0.74, P < 0.0001). Use of all three parameters in combination more than doubled the detection of IDA, from 41% (ferritin alone) to 92% (ferritin, sTfR, sTfR Index). Use of sTfR and the sTfR Index improves detection of IDA, particularly in situations where routine markers provide equivocal results. Findings demonstrate a significant advantage in the simultaneous determination of ferritin, sTfR and sTfR Index. Obtaining a ferritin level alone may delay diagnosis of combined IDA and ACD. SN - 1096-8652 UR - https://www.unboundmedicine.com/medline/citation/21812017/Improved_differential_diagnosis_of_anemia_of_chronic_disease_and_iron_deficiency_anemia:_a_prospective_multicenter_evaluation_of_soluble_transferrin_receptor_and_the_sTfR/log_ferritin_index_ L2 - https://doi.org/10.1002/ajh.22108 DB - PRIME DP - Unbound Medicine ER -