Department of Clinical Chemistry & Hematology, Atrium Medical Center Parkstad, The Netherlands.
Int J Lab Hematol. 2010 Dec;32(6 Pt 2):572-81. doi: 10.1111/j.1751-553X.2010.01221.x.
In patients with inflammatory conditions, diagnosing classic iron deficiency or anemia of chronic disease is challenging. In this study, we assessed the diagnostic value of the so-called Thomas'-plot [soluble transferrin receptor (sTfR)/log ferritin (sTfr/log Ferr) and the reticulocyte hemoglobin equivalent (Ret-HE)] in the anemia work up of patients referred by general practitioners. During July 2008-March 2009, 337 consecutive patients were included because of lowered Hb values. The laboratory results of the first 133 consecutive patients were used to determine the cut-off values for the diagnostic plot. The laboratory results of these patients were assessed and interpreted independently by two investigators, blinded from sTfR/log Ferr and Ret-HE values. The following 204 patients were used to test the plot in practice. In 32% of the first 133 patients, no indication of the cause of anemia could be found. However, when using the diagnostic plot in the following 204 patients, this fraction decreased to 14%. The 'Thomas'-plot is of diagnostic value for distinguishing functional iron deficiency from classic iron deficiency in a patient population referred by general practitioners.
在炎症性疾病患者中，诊断典型缺铁或慢性病贫血具有挑战性。在这项研究中，我们评估了所谓的托马斯图（可溶性转铁蛋白受体（sTfR）/log 铁蛋白（sTfr/log Ferr）和网织红细胞血红蛋白当量（Ret-HE））在全科医生转介的贫血患者中的诊断价值。2008 年 7 月至 2009 年 3 月，连续纳入了 337 例因 Hb 值降低的患者。前 133 例连续患者的实验室结果用于确定诊断图的截止值。这些患者的实验室结果由两位研究人员进行评估和解释，他们对 sTfR/log Ferr 和 Ret-HE 值不知情。随后的 204 例患者用于实际测试该图。在最初的 133 例患者中，有 32%的患者找不到贫血的原因。然而，当在随后的 204 例患者中使用诊断图时，这一比例下降到 14%。“托马斯图”对于区分全科医生转介的患者人群中的功能性缺铁和典型缺铁具有诊断价值。
