Comparison of Diagnostic Performance of Soluble Transferrin Receptor and Soluble Transferrin Receptor-Ferritin Index Tests in the Diagnosis of Iron Deficiency Anemia
In this research article, a comprehensive analysis is performed to compare the diagnostic performance of soluble transferrin receptor (sTfR) and sTfR/log ferritin index tests in the differential diagnosis of iron deficiency anemia (IDA) and anemia of chronic disease (ACD). The analysis is performed for both sTfR and sTfR/log ferritin index using a set of 11 studies. The overall odds ratios for sTfR and sTfR/log ferritin index were 36.79 and 119.32 respectively, using 95% confidence interval. The relative sensitivity, specificity. positive likelihood ratio (LR) and negative LR values for sTfR in relation to sTfR/log ferritin index were 81% vs 85%, 84% vs 93%, 6.31 vs 13.95 and 0.18 vs 0.14 respectively. The summary receiver operating characteristic (SROC) curves are also plotted for both sTfR and sTfR/log ferritin index. The area under SROC curves for sTfR and sTfR/log ferritin index was found to be 0.9296 and 0.9825 respectively. Although both tests are useful, the sTfR/log ferritin index seems to be more effective when compared with sTfR.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1315999Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 396
 S. S. Barry, P. Kari, and H. C. Paul 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, vol. 86, pp. 923–927, 2011.
 W. Guenter, and T.G. Lawrence, “Anemia of chronic disease,” N Engl J Med, vol. 352, pp. 1011–1023, 2005.
 I. Ilenia, B. Federica, and D. Alberto et al., “Soluble transferrin receptor (stfr) and stfr/log ferritin index for the diagnosis of iron-deficiency anemia a meta-analysis,” Am J Clin Pathol, vol. 138, pp. 642–649, 2013.
 A. B. Carl, R. A. Edward, and E. B. David, “Tietz textbook of clinical chemistry and molecular diagnostics,” Elsevier Health Sciences, 2012.
 F. G. Andrew, W. J. Martin, and S. M. Alistair et al., “Guidelines for the management of iron deficiency anaemia,” Gut 2011; gut–2010.
 M. Manuel, A. G. Jose, and R. Francisco, “Disorders of iron metabolism. Part ii: iron deficiency and iron overload,” J. Clin. Pathol, vol. 64, pp. 287–296, 2011.
 J. F. Beverly, S. Barry, and M. Karen et al., “Serum transferrin receptor distinguishes the anemia of chronic disease from iron deficiency anemia,” J Lab Clin Med, vol. 119, pp. 385–390, 1992.
 J. E. ALLAN, “Anemia of chronic disease,” fifth ed., McGraw-Hill, New York, 1995.
 N. N. Alan, N. D. Emmanuel, and B. K. Sanford, “The pathogenesis of anemia in rheumatoid arthritis: a clinical and laboratory analysis,” In Seminars in arthritis and rheumatism, vol. 19, pp. 209–223, 1990.
 P. Kari, I. Kerttu, and R. Allan, “Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency,” Blood, vol. 89, pp. 1052– 1057, 1997.
 B. Fernando, and G. Santiago et al., “A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases,” World J Gastroenterol, vol. 15, pp. 4638–4643, 2009.
 B. Z. Michael, “Methods to assess iron and iodine status,” Br. J. Nutr, vol. 99, pp. S2–S9, 2008.
 A. B. Beth, D. H. James, and T. Ayalew, “A bone marrow report of absent stainable iron is not diagnostic of iron deficiency,” Ann Hematol, vol. 80, pp. 166–169, 2001.
 M. S. Marijn, S. Reinhart, and R. D. Joris, “Biological and clinical aspects of soluble transferrin receptor,” Crit. Rev. Clin. Lab. Sci, vol. 47, pp. 213–228, 2010.
 S. Barry, “Serum transferrin receptor,” Am J Hematol, vol. 83, pp. 872–875, 2008.
 T. Ketil, and R. Inge, “The transferrin receptor: its diagnostic value and its potential as therapeutic target,” Scand J Clin Lab Invest, vol. 53, pp. 113–120, 1993.
 K. Yutaka, N. Yoshiro, and K. Hitoshi et al., “Serum transferrin receptor as a new index of erythropoiesis,” Blood, vol. 70, pp. 1955–1958, 1987.
 A. Namanjeet, J. L. Carol, and B. Robert et al., “Iron deficiency and anemia of chronic disease in elderly women: a discriminant analysis approach for differentiation,” Am J Clin Nutr, vol. 61, pp. 590–596, 1995.
 C. H. Flowers, B. S. Skikne, and A. M. Covell et al., “The clinical measurement of serum transferrin receptor,” J Lab Clin Med, vol. 114, pp. 368–377, 1989.
 M. Basora, R. Deulofeu, and F. Salazar et al., “Improved preoperative iron status assessment by soluble transferrin receptor in elderly patients undergoing knee and hip replacement,” Clinical & Laboratory Haematology, vol. 28, pp. 370–375, 2006.
 J. D. Cook, B. S. Skikne, and R. D. Baynes, “Serum transferrin receptor,” Annu Rev Med, vol. 44, pp. 63–74, 1993.
 K. Punnonen, K. Irjala, and A. Rajama¨ki, “Iron-deficiency anemia is associated with high concentrations of transferrin receptor in serum,” Clin. Chem. vol. 40, pp. 774–776, 1994.
 B. S. Skikne, C. H. Flowers, and J. D. Cook, “Serum transferrin receptor: a quantitative measure of tissue iron deficiency,” Blood, vol. 75, pp. 1870–1876, 1990.
 F. J. Baillie, A.E. Morrison, and I. Fergus, “Soluble transferrin receptor: a discriminating assay for iron deficiency,” Clinical & Laboratory Haematology, vol. 25, pp. 353–357, 2003.
 T. Berlin, A. Meyer, and P. Rotman et al., “Soluble transferrin receptor as a diagnostic laboratory test for detection of iron deficiency anaemia in hospitalized patients with acute illness,” Isr Med Assoc J, vol. 13, pp. 96–108, 2011.
 B. Yves, “Soluble transferrin receptor for the evaluation of erythropoiesis and iron status,” Clinica Chimica Acta, vol. 329, pp. 9–22, 2003.
 M. Sandra, F. Dragica, and K. Marina et al., “Soluble transferrin receptor and transferrin receptor-ferritin index in iron deficiency anemia and anemia in rheumatoid arthritis,” Clin. Chem. Lab. Med, vol. 43, pp. 326–331, 2005.
 S. Pauli, M. Timo, and R. ALLAN et al., “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 & Rheumatism, vol. 43, pp. 1016, 2000.
 M. Akira, B. Masami, and M. Shigehisa et al., “Diagnostic significance of serum soluble transferrin receptors in various anemic diseases: the first multi-institutional joint study in japan,” Haematologia, vol. 32, pp. 225–238, 2002.
 Z. Javier, A. Victor, and M. Alfonso et al., “Meta-disc: a software for meta-analysis of test accuracy data,” BMC Med Res Methodol, vol. 6 , pp. 31, 2006.
 J.B. Brad et al., “Comparing diagnostic tests: a simple graphic using likelihood ratios,” Stat. Med, vol. 19, pp. 649–663, 2000.
 M. Markovic, S. Majkic, and V. Subota, “Usefulness of soluble transferrin receptor and ferritin in iron deficiency and chronic disease,” Scand J Clin Lab Invest, vol. 65, pp. 571–576, 2005.
 G. Sema, E. Nilgun, and A. K. Mehmet et al., “Soluble transferrin receptor and soluble transferrin receptor-ferritin index for evaluation of the iron status in elderly patients,” Tohoku J Exp Med, vol. 202, pp. 135–142, 2004.
 J. L. Eun, O. E. Eun, and P. Yeon-Joon et al., “Soluble transferrin receptor (stfr), ferritin, and stfr/log ferritin index in anemic patients with nonhematologic malignancy and chronic inflammation,” Clin. Chem, vol. 48, pp. 1118–1121, 2002.
 O. Pantelis, E. K. Ioannis, and M. Ippokratis et al., “Soluble transferrin receptor-ferritin index in the evaluation of anemia in inflammatory bowel disease: a case-control study,” Ann Gastroenterol, vol. 24, pp. 108–114, 2011.
 L. Vazquez, C. Amparo, L. Francisco et al., “The usefulness of serum transferrin receptor for discriminating iron deficiency without anemia in children,” Haematologica, vol. 91,pp. 264–265, 2006.
 P. Geon, P. Young, and J. Sook et al., “Soluble transferrin receptor-ferritin index and estimated body iron in iron-deficiency anemia in select chronic diseases,” Ann Hematol, vol. 88, pp. 913–915, 2009.
 M. Markovic, S. Majkic, and S. Ignjatovic et al., “Reticulocyte haemoglobin content vs. soluble transferrin receptor and ferritin index in iron deficiency anaemia accompanied with inflammation,” International journal of laboratory hematology, vol. 29, pp. 341–346, 2007.
 M. P. Leers, J. F. Keuren, and W. P. Oosterhuis, “The value of the thomas-plot in the diagnostic work up of anemic patients referred by general practitioners,” International journal of laboratory hematology, vol. 32, pp. 572–581, 2010.