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Conventional and novel peripheral blood iron markers compared against bone marrow in Malawian children
  1. Femkje A M Jonker1,
  2. Michael Boele van Hensbroek1,
  3. Tjalling Leenstra2,
  4. Raymond J W M Vet3,
  5. Bernard J Brabin4,
  6. Nelson Maseko5,
  7. Montfort B Gushu5,
  8. Mercy Emana5,
  9. Rob Kraaijenhagen6,
  10. Harold Tjalsma7,8,
  11. Dorine W Swinkels7,8,
  12. Job C J Calis1
  1. 1Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
  2. 2Department of Infectious Diseases, Division of Internal Medicine, Centre for Tropical Medicine and Travel Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
  3. 3Department of Specialized Hematology, Academic Medical Centre, Amsterdam, The Netherlands
  4. 4Liverpool School of Tropical Medicine, University of Liverpool, United Kingdom,
  5. 5Community Health Department, College of Medicine, Blantyre, Malawi
  6. 6Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
  7., Nijmegen, The Netherlands
  8. 8Laboratory of Genetic, Endocrine and Metabolic diseases, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Dr Femkje A M Jonker, Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, Tk S0-227, 1105 AZ Amsterdam, The Netherlands; femkje.jonker{at}


Aim Iron deficiency is an important child health problem. Its diagnosis in areas of high infection exposure remains complicated as inflammation may interfere with the accuracy of peripheral iron markers. With this study, we aimed to validate the conventional iron markers and two novel iron markers, hepcidin and Red blood cell Size Factor (RSf), against the reference standard of iron status, bone marrow iron, in children living in an infectious setting.

Methods We compared ferritin, soluble transferrin receptor, Soluble Transferrin Log-Ferritin Index (sTfR-F), mean cellular volume, mean cellular haemoglobin concentration, hepcidin and RSf, against bone marrow iron in 87 healthy Malawian children (6–66 months) scheduled for elective surgery.

Results Of all children, 44.8% had depleted bone marrow iron stores. Using optimised cut-offs, ferritin (<18 µg/L) and sTfR-F (>1.85) best predicted depleted iron stores with a sensitivity/specificity of 73.7%/77.1% and 72.5%/75.0%, respectively. Hepcidin (<1.4 nmol/L) was a moderate sensitive marker (73.0%) although specificity was 54.2%; RSf poorly predicted depleted iron stores.

Conclusions We provide the first bone marrow-validated data on peripheral iron markers in African children, and showed ferritin and sTfR-F best predicted iron status. Using appropriately defined cut-offs, these indicators can be applied in surveillance and research. As their accuracy is limited for clinical purposes, more reliable iron biomarkers are still required in African children.

  • IRON

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  • Abstract in Dutch

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