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Underdiagnosis of iron deficiency anaemia in HIV-infected individuals: a pilot study using soluble transferrin receptors and intensive bone marrow iron stores to improve the diagnosis
  1. Mahlatse Mankgele1,
  2. Ebrahim Variava2,
  3. Tumelo Moloantoa3,
  4. Kennedy Otwombe3,4,
  5. Khuthadzo Hlongwane3,
  6. Dineo Disenyane5,
  7. Meshack Bida5,
  8. Raylton Chikwati6,
  9. Tracy Snyman6,
  10. Neil Martinson3,
  11. Johnny Mahlangu7
  1. 1Division of Internal Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
  2. 2Department of Internal Medicine, Klerksdorp Tshepong Academic Hospital Complex and the University of the Witwatersrand, Johannesburg, South Africa
  3. 3Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
  4. 4School of Public health, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
  5. 5Anatomical Pathology, University of Pretoria, Pretoria, South Africa
  6. 6Division of Chemical Pathology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
  7. 7Molecular Medicine and Haematology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
  1. Correspondence to Dr Mahlatse Mankgele, Division of Internal Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg 2000, South Africa; Mahlatsemankgele55{at}gmail.com

Abstract

Aim We compared soluble transferrin receptors (sTfR), serum ferritin, mean cell volume (MCV) of red cells and the sTfR-ferritin index with the intensive method bone marrow trephine (BMT) iron stores in the diagnosis of iron deficiency anaemia (IDA) in Human Immunodeficiency Virus (HIV)-positive hospitalised participants.

Methods In this cross-sectional study, we recruited hospitalised HIV-positive and coronavirus of 2019 (COVID-19)-negative adults with anaemia who required a bone marrow examination as part of their diagnostic workup. We measured the full blood count, ferritin, sTfR and assessed iron using the intensive method in Haemotoxylin and Eosin (H&E)-stained BMT core biopsies of consenting participants.

Results Of the 60 enrolled participants, 57 were evaluable. Thirteen (22.80%) had IDA on H&E BMT iron stores assessment, and 44 (77.19%) had anaemia of chronic diseases (ACD). The sTfR and the sTfR-ferritin index had sensitivities of 61.54% and 53.85%, respectively, for IDA diagnosis. The sensitivity and specificity of ferritin was 7.69% and 92.31%, respectively. The sTfR and sTfR-ferritin index’s diagnostic specificity was relatively low at 46.15% and 38.46%, respectively.

Conclusion In this pilot study in HIV-positive participants, the prevalence of iron deficiency using the BMT assessment was low. Both the sTfR and the sTfR-ferritin index had a better quantitative correlation to bone marrow iron stores when compared with the MCV and ferritin and, may be more accurate surrogate markers of IDA.

  • DIAGNOSIS
  • IRON
  • HIV Infections
  • BONE MARROW
  • Iron Metabolism Disorders

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Handling editor Tahir S Pillay.

  • Contributors MM conceived the project, wrote protocol, obtained approvals, collected data, analysed the data and wrote the paper. EV, NM and JM supervised the project, critically evaluated data and wrote the paper, DD and MB coordinated and analysed the trephine core biopsies iron assessments, KH and KO did the statistical analyses, RC and TS set up the sTfR assay and result analyses. MM was the guarantor for the project. All authors approved the final version of the manuscript.

  • Funding The authors would like to thank the National Health Laboratory Service at the Charlotte Maxeke Johannesburg Academic Hospital and the Steve Biko Academic Hospital for providing the facilities for the conduct of this study. The reagents for the sTfR analyses were an unrestricted donation from Roche, South Africa.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.