Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Infectious Diseases, Division of Internal Medicine, Centre for Tropical Medicine and Travel Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands.
J Clin Pathol. 2014 Aug;67(8):717-23. doi: 10.1136/jclinpath-2014-202291. Epub 2014 Jun 10.
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.
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.
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.
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.
铁缺乏是一个重要的儿童健康问题。在高感染暴露地区，其诊断仍然很复杂，因为炎症可能会干扰外周铁标志物的准确性。本研究旨在验证常规铁标志物和两种新型铁标志物——铁调素和红细胞大小因子（RSf），针对骨髓铁作为铁状态的参考标准，在生活在感染环境中的儿童中进行验证。
我们比较了 87 名健康马拉维儿童（6-66 个月）的铁蛋白、可溶性转铁蛋白受体、可溶性转铁蛋白受体-铁蛋白指数（sTfR-F）、平均细胞体积、平均细胞血红蛋白浓度、铁调素和 RSf 与骨髓铁之间的关系。这些儿童计划接受择期手术。
所有儿童中有 44.8%的骨髓铁储备耗尽。使用优化的截断值，铁蛋白（<18μg/L）和 sTfR-F（>1.85）对铁储备不足的预测具有最佳的敏感性/特异性，分别为 73.7%/77.1%和 72.5%/75.0%。铁调素（<1.4nmol/L）是一种中度敏感的标志物（73.0%），但特异性为 54.2%；RSf 对铁储备不足的预测能力较差。
我们提供了非洲儿童外周铁标志物与骨髓铁验证的首批数据，并表明铁蛋白和 sTfR-F 最能预测铁状态。使用适当定义的截断值，这些指标可用于监测和研究。由于其在临床应用中的准确性有限，因此非洲儿童仍需要更可靠的铁生物标志物。
