Soluble Transferrin Receptor (sTfR) Identifies Iron Deficiency Anemia (IDA) in Pulmonary Tuberculosis Patients

Authors

  • Tri Ratnaningsih Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  • Novi W Sukirto Department of Internal Medicine, Faculty of Medicine, Ahmad Dahlan University, Yogyakarta, Indonesia
  • Arum Tri Wahyuningsih Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

Keywords:

sTfR, anemia, iron deficiency, pulmonary tuberculosis, chronic disease

Abstract

Background: iron deficiency in pulmonary tuberculosis (TB) patients may weaken their immune system, causing difficulty in overcoming the infection. Accurate diagnosis of iron deficiency anemia (IDA) in pulmonary TB patients is essential. In order to prove the iron deficient state, diagnosis should focus on inflammatory factors, which could highly affect the outcome of iron status, such as measurement of serum ferritin (SF). Soluble Transferrin Receptor (sTfR) is the best parameter to diagnose iron deficiency in the inflammatory condition. This study aimed to understand the role of sTfR to identify IDA in TB patients. Methods: cross-sectional study were applied to 3 study groups: anemic pulmonary TB (68 subjects), IDA (7 subjects), and non-anemic pulmonary TB (15 subjects). The test averages and correlations between sTfR, SF, and other hematological parameters were measured and analyzed. Results: significant differences of sTfR were found in the anemic TB group compared to the IDA group and also between the IDA and non-anemic TB groups (p<0.0001). However, there was no significant difference (p>0.05) between TB anemic and non-anemic groups. We also found no significant difference between the TB anemic sub-group with normal levels of sTfR compared with the non-anemic group. There was no significant difference of sTfR levels between sub-group of increasing sTfR and group IDA (p>0.05). However, there was strong correlation between sTfR and SF in the IDA group (r=-0.89; p=0.007). Conclusion: the findings suggest verifying the sTfR amount in anemic patients with pulmonary TB suffering from inflammation, so that the iron deficiency could be more accurately identified and properly treated.

References

World Health Organisation. Global tuberculosis report 2018. 2018. Available from: http://www.who.int/tb/publications/global_report/en/.

Departemen Kesehatan Republik Indonesia. Available from: www.depkes.go.id. Accessed: June 18th 2017.

Abay F, Yalew A, Shibabaw A, Enawgaw B. Hematological abnormalities of pulmonary tuberculosis patients with and without HIV at the University of Gondar Hospital, Northwest Ethiopia: A comparative cross-sectional study. Hindawi Tuberculosis Res Treat. 2018;2018:6. Article ID 5740951. doi: 10.1155/2018/5740951.

Barzegari S, Afshari M, Movahednia M, Moosazadeh M. Prevalence of anemia among patients with tuberculosis: A systematic review and meta-analysis. Indian J Tuberculosis. 2019;66:299-307.

Lee GR. Anemia: a diagnostic strategy. In: Lee GR, Foerster J, Lukens J, et al, editors. Wintrobe’s clinical hematology. 13th ed. Baltimore: Williams and Wilkins; 2015.

Suega K, Kandarini Y, Tubung J. Role of soluble transferrin receptor and transferrin receptor- ferritin index to detect iron deficiency anemia in regular hemodialysis patients. Open Access Maced J Med Sci. 2019;7(1):97-102. https://doi.org/10.3889/oamjms.2019.012.

Hoffbrand AV, Pettit JE, editors. Essential hematology. 7th edition. London: Blackwell Science Ltd; 2015.

Vázquez-López MA., López-Ruzafa E., Ibáñez-Alcalde M., et al. The usefulness of reticulocyte haemoglobin content, serum transferrin receptor and the sTfR-ferritin index to identify iron deficiency in healthy children aged 1–16 years. Eur J Pediatr. 2019;178(1):41-9. doi: 10.1007/s00431-018-3257-0.

Rodak BF. Hematology clinical principles and application, 5th edition. WB Saunders Company; 2016.

Suominen P, Mottonen T, Rajamaki A, Irjala K. Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia. Arthritis Rheum. 2000;43:1016-20.

Gangat N, Wolanskyj AP. Anemia of Chronic Disease. Seminars in Hematology. 2013;50(3):232–238. doi: 10.1053/j.seminhematol.2013.06.006.

Kim A, Nemeth E. New insights into iron regulation and erythropoiesis. Curr Opin Hematol. 2015;22(3):199–205. doi:10.1097/MOH.0000000000000132.

Shin DH., Kim HS., Park MJ., et al. Utility of access soluble transferrin receptor (stfr) and stfr/log ferritin index in diagnosing iron deficiency anemia. Annals of Clinical & Laboratory Science. 2015;45(4):396-402.

F. Alam, S. S. Fatima, S. Noor, et al. Stages of chronic kidney disease and soluble Transferrin Receptor (sTfR), Ferritin, ratio. J Pak Med Assoc. 2017;67(6):848-51.

Suominen P, Mottonen T, Rajamaki A, Irjala K. Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia. Arthritis Rheum. 2000;43:1016-20.

Krawiec P, Pac-Koz ̇uchowska E. Soluble transferrin receptor and soluble transferrin receptor/log ferritin index in diagnosis of iron deficiency anaemia in paediatric inflammatory bowel disease. Dig Liver Dis. 2018. doi: 10.1016/j.dld.2018.11.012.

Roque ME, Sandoval MJ, Aggio MC. Serum erythropoietin and its relation with soluble transferrin receptor in patients with different types of anemia in a locally defined reference population. Clin Lab Haem. 2001;23:291-5.

Pfeiffer CM, Looker AC. Laboratory methodologies for indicators of iron status: strengths, limitations, and analytical challenges. Am J Clin Nutr 2017;106(Suppl):1606S–14S.

Sebastiani G, Pantopoulos K. Disorders associated with systemic or local iron overload: from pathophysiology to clinical practice. Metallomics. 2011;3:971–986. doi: 10.1039/c1mt00082a.

Sysmex SE-9500 Operator’s manual. Sysmex Corporation, Japan. 1999.

Ferritin, Tina-quant. Soluble transferrin receptor (sTfR). Roche Diagnostics GmbH. Germany. 2010.

Chua E, Clague JE, Sharma AK, Horan MA, Lombard M. Serum transferrin receptor assay in iron deficiency anemia and of anemia of chronic disease in the elderly. Q J Med. 1999;92:587-94.

Lee SW, Kim DK, Ko DS, Yoo CG, Han SK, Shim YS, Yim JJ, Kim YW. Prevalence and evolution of anemia in patients with tuberculosis. Chest Journal. 2004.

Higgins C. Science review: anemia of chronic disease. Accessed: June 18th 2017.

Hoffbrand AV, Pettit JE. Essential hematology, 6th ed. Oxford: Blackwell Science; 2011.

Muñoz M, Gómez-Ramírez S, Besser M, et al. Current misconceptions in diagnosis and management of iron deficiency. Blood Transfus. 2017;15:422-37. doi: 10.2450/2017.0113-17.

Camaschella C, Longo DL (editor). Iron-deficiency anemia. N Engl J Med. 2015;372:1832-43. doi: 10.1056/NEJMra1401038.

Dosumu EA. Pattern of some hematological indices in newly diagnosed pulmonary tuberculosis cases in Iwo, Nigeria: diagnostic and therapeutic implications. Niger J Med. 2001;10:18-20.

Voloshina VV, Fomicheva NI. Efficiency treatment of new cases of destructive pulmonary tuberculosis in the presence of concurrent iron deficiency anemia. Probl Tuberk. 2002;10-2.

Mast AE, Blinder MA, Gronowski AM, Chumley C. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clinical Chemistry. 1998;44:145–51.

Ong KH, Tan HL, Lai HC, Kuperan P. Accuracy of various iron parameters in the prediction of iron deficiency in an acute care hospital. Ann Acad Med Singapore. 2005;34:437-40.

Abedin MY, Saleh MT, El Wakkad AS, Fathy GA, Awadallah ZE. Serum transferrin receptor and transferrin receptor/ferritin ratio distinguish iron deficiency in anemia of chronic disorders in children. Egypt Med J. N RC. 2003;2(2):75-92.

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Published

2020-12-28

How to Cite

Ratnaningsih, T., Sukirto, N. W., & Wahyuningsih, A. T. (2020). Soluble Transferrin Receptor (sTfR) Identifies Iron Deficiency Anemia (IDA) in Pulmonary Tuberculosis Patients. Acta Medica Indonesiana, 52(4), 334. Retrieved from http://www.actamedindones.org/index.php/ijim/article/view/1262

Issue

Vol. 52 No. 4 (2020): Acta Medica Indonesiana

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ORIGINAL ARTICLE

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