RT Journal Article
SR Electronic
T1 Conventional and novel peripheral blood iron markers compared against bone marrow in Malawian children
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 717
OP 723
DO 10.1136/jclinpath-2014-202291
VO 67
IS 8
A1 Jonker, Femkje A M
A1 Boele van Hensbroek, Michael
A1 Leenstra, Tjalling
A1 Vet, Raymond J W M
A1 Brabin, Bernard J
A1 Maseko, Nelson
A1 Gushu, Montfort B
A1 Emana, Mercy
A1 Kraaijenhagen, Rob
A1 Tjalsma, Harold
A1 Swinkels, Dorine W
A1 Calis, Job C J
YR 2014
UL http://jcp.bmj.com/content/67/8/717.abstract
AB 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.