Soluble transferrin receptor levels among pregnant women in Port Harcourt, Nigeria
DOI:
https://doi.org/10.18203/2320-6012.ijrms20194290Keywords:
Anaemia, Port Harcourt, Pregnancy, Soluble transferrin receptorAbstract
Background: Anaemia in pregnancy is one of the medical problems that affect pregnant women in developing countries. It contributes considerably to the morbidity and mortality in pregnancy especially in areas where malaria is endemic. The concentration of soluble transferrin receptor is a reflection of body iron status. It is therefore, a valuable tool for assessing bone marrow erythropoetic activity and can also be a marker of iron deficiency.
Methods: This study evaluated the levels of soluble transferrin receptor in pregnant subjects. A total of 275 pregnant subjects of age 20 to 45 years and 88 age-matched apparently healthy control subjects were involved in this study. Individuals who had severe anaemia, HIV infection, sickle cell disease or Hookworm infestation were excluded from this study. Five millilitres (5ml) of blood were collected from each consenting subject for the analysis of soluble transferrin receptor, haematological parameters and iron parameters using appropriate methods.
Results: The mean value of parameters for the study subjects were sTfR( 21.16±9.11 nmol/L), Hb(9.05±1.22 g/dl), TIBC(332.61±80.87 µg/dl), Serum Iron(97.91±39.44 µg/dl), LIBC(239.36±80.52 µg/dl), TS(30.24±11.00 %) while for control subjects were sTfR(18.21±3.77 nmol/L), Hb(12.19±0.66 g/dl), TIBC(261.94±52.49µg/dl), Serum Iron(107.10±34.77 µg/dl), LIBC(155.52±61.25 µg/dl), TS(42.81±18.03 %). The mean sTfR levels in pregnant women was significantly lower (p<0.001) than in control subjects. The pregnant women also had significantly lower values of Hb (p<0.001), serum iron (p=0.038) and TS( p<0.001) values, and significantly higher values of TIBC(p<0.0001) and LIBC(p<0.0001). There were also increases in soluble transferrin receptor levels from first to third trimesters. The sensitivity of sTfR as against Serum iron parameters from this study was 76% while the specificity was 50%. The positive predictive value was 60% while the negative predictive value was 50%.
Conclusions: sTfR may be a useful supplementary diagnostic tool in the management of anaemia in pregnancy.
References
Ndukwu GU, Dienye PO. Prevalence and socio-demographic factors associated with anaemia in pregnancy in a primary health centre in Rivers State, Nigeria. Afric J Primary Health Care Family Med. 2012;4(1):1-7.
Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011 Dec 17;378(9809):2123-35.
World Health Organization. Haemoglobin concentration for the diagnosis of anaemia and assessment of severity, 2011. Available at: WHO/NMD/NHD/MNM/11.1. Accessed on 25 March 2017.
Boon N.A, Colledge, N.R, Walker B.R. Davidson’s Principles and Practice of Medicine. 20th Ed. Edinburg. Churchill Livingstone Elsevier. 2006; 1023-1030.
Gwarzo MY, Ugwa EA. The pattern of anaemia in northern Nigerian pregnant women. Journal of Medicine and Medical Sciences. 2013 Aug 1;4(8):319-23.
WHO/UNICEF/UNO. IDA: prevention, assessment and control. Report of a WHO/UNICEF/UNO consultation. Geneva. 1998.
Infusino I, Braga F, Dolci A, Panteghini M. Soluble transferrin receptor (sTfR) and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia a meta-analysis. Am J Clin Pathol. 2012 Nov 1;138(5):642-9.
Speeckaert MM, Speeckaert R, Delanghe JR. Biological and clinical aspects of soluble transferrin receptor. Crit Reviews Clin Laborat Scie. 2010 Dec 1;47(5-6):213-28.
Skikne BS. Serum transferrin receptor. Am J Hematol. 2008 Nov;83(11):872-5.
Beguin Y. Soluble transferrin receptor for the evaluation of erythropoiesis and iron status. Clinica chimica acta. 2003 Mar 1;329(1-2):9-22.
Asif N, Tariq W, Mateen Y. Iron status in non-anemic pregnant females during the Third Trimester. Ann Pak Inst Med Sci. 2008;4(2):88-91.
Fairbanks VJ, Brandhagen DJ. Disorders of iron storage and transport. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, Sellgsohn Y, Eds. Withams Haematology. New York. McGraw-Hill; 2008; 435-460.
Okafor IM, Okpokam DC, Antai AB, Usanga EA. Soluble transferrin receptor as a marker in the diagnosis of iron deficiency anaemia, a study in Calabar. Inter J Biomed Laborat Scie. 2014;3:41-7.
Breymann C. Iron deficiency anaemia in pregnancy: modern aspects of diagnosis and therapy. Blood Cells, Molecules, and Dis. 2002;29(3):506-17.
Ma A, Chen X, Zheng M, Wang Y, Xu R, Li J. Iron status and dietary intake of Chinese pregnant women with anaemia in the third trimester. Asia Pacific J Clinical Nutrition. 2002 Sep;11(3):171-5.
De Block CE, Van Campenhout CM, De Leeuw IH, Keenoy BM, Martin M, Van Hoof V, et al. Soluble transferrin receptor level: a new marker of iron deficiency anemia, a common manifestation of gastric autoimmunity in type 1 diabetes. Diabetes Care. 2000 Sep 1;23(9):1384-8.
Raza N, Sarwar I, Munazza B, Ayub M, Suleman M. Assessment of iron deficiency in pregnant women by determining iron status. J Ayub Med Col Abbottabad. 2011 Jun 1;23(2):36-40.
Dale JC, Burritt MF, Zinsmeister AR. Diurnal variation of serum iron, iron-binding capacity, transferrin saturation, and ferritin levels. Am J Clin Pathol. 2002 May 1;117(5):802-8.
Rzik S, Beguin Y. Serum soluble transferrin receptor concentration is an accurate estimate of the mass of tissue receptors. Exp Haematol. 2001;29(6):677-82.
Chandra I, Sun LZ. Iron status and choice of iron therapy during pregnancy: Advantages and disadvantages. Int J Reprod Contraception Obstet Gynecol. 2015 Oct;4:1264-71.
Choi JW, Im MW, Pai SH. Serum transferrin receptor concentrations during normal pregnancy. Clin Chem. 2000;46(5):725-7.
Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutrit. 2000 Jul 1;72(1):257S-64S.
Miller EM. The reproductive ecology of iron in women. Am J Phys Anthropol. 2016 Jan;159:172-95.
Dogan S, Turkoglu I. Iron-deficiency anemia detection from hematology parameters by using decision trees. Inter J Scie Technol. 2008;3(1):85-92.
Wians Jr FH, Urban JE, Keffer JH, Kroft SH. Discriminating between iron deficiency anemia and anemia of chronic disease using traditional indices of iron status vs transferrin receptor concentration. Am J Clin Pathol. 2001 Jan 1;115(1):112-8.
