The role of soluble transferrin receptor levels in the differential diagnosis of iron deficiency anemia and anemia of chronic disease in patients with gastrointestinal malignancy

Abstract

Aim: Anemia is a common complication in patients with gastrointestinal malignancies. This study aimed to investigate the role of serum soluble transferrin receptor (sTfR), sTfR/log ferritin index, and hepcidin levels in the differential diagnosis of iron deficiency anemia (IDA) and anemia of chronic disease (ACD) in anemic patients with gastrointestinal malignancies. Material and Methods: The study included 126 anemic patients with gastrointestinal malignancies followed at Ankara Numune Training and Research Hospital. Serum iron, total iron-binding capacity, ferritin, vitamin B12, folic acid, sTfR, and hepcidin levels were measured, and the sTfR/log ferritin index was calculated. Based on transferrin saturation, patients were classified into two groups: IDA (transferrin saturation ≤20%) and ACD (transferrin saturation >20%). The diagnostic performance of sTfR and sTfR/log ferritin index was assessed using ROC analysis. Results:The sTfR level and sTfR/log ferritin index were significantly higher in the IDA group compared to the ACD group (p < 0.001). The sensitivity and specificity of sTfR for identifying IDA were 77.1% and 67.9%, respectively, with a cutoff value of 1.65 mg/L. Ferritin showed lower sensitivity (57.1%) but higher specificity (76.8%). No significant difference was found in hepcidin levels between the two groups. Conclusion: sTfR and the sTfR/log ferritin index are useful parameters for distinguishing IDA from ACD in patients with gastrointestinal malignancies. Hepcidin levels may not be effective due to their acute-phase reactant properties. Standardization of sTfR measurement and further large-scale studies are needed to determine optimal cutoff values for different patient populations.

Keywords

• Soluble transferrin receptor (sTfR)
• sTfR/log ferritin index
• Hepcidin
• Gastrointestinal ma-lignancy

Gastrointestinal sistem maligniteli hastalarda demir eksikliği ve kronik hastalık anemisi ayırıcı tanısında soluble transferrin reseptör düzeylerinin yeri

Abstract

Amaç: Anemi, gastrointestinal malignite hastalarında sık görülen bir komplikasyondur. Bu çalışma, anemik gastrointestinal maligniteli hastalarda serum soluble transferrin reseptör (sTfR), sTfR/log ferritin indeksi ve hepsidin seviyelerinin demir eksikliği anemisi (DEA) ile kronik hastalık anemisi (KHA) ayırıcı tanısındaki rolünü araştırmayı amaçladı. Gereç ve Yöntemler: Çalışmaya Ankara Numune Eğitim ve Araştırma Hastanesi’nde takip edilen gastrointestinal maligniteli 126 anemik hasta dahil edildi. Serum demir, total demir bağlama kapasitesi, ferritin, vitamin B12, folik asit, sTfR ve hepsidin seviyeleri ölçüldü ve sTfR/log ferritin indeksi hesaplandı. Transferrin saturasyonuna göre hastalar DEA (transferrin saturasyonu ≤ %20) ve KHA (transferrin saturasyonu > %20) olarak iki gruba ayrıldı. sTfR ve sTfR/log ferritin indeksinin tanısal performansı ROC analizi ile değerlendirildi. Bulgular: sTfR düzeyi ve sTfR/log ferritin indeksi DEA grubunda KHA grubuna kıyasla anlamlı derecede yüksekti (p < 0,001). sTfR'nin DEA’yı belirlemede duyarlılığı %77,1 ve özgüllüğü %67,9 olarak bulundu (1,65 mg/L kesim noktası). Ferritin için duyarlılık %57,1, özgüllük ise %76,8 olarak hesaplandı. Hepsidin düzeyleri açısından iki grup arasında anlamlı fark bulunmadı. Sonuç: sTfR ve sTfR/log ferritin indeksi, gastrointestinal maligniteli hastalarda DEA ile KHA ayırıcı tanısında faydalı parametrelerdir. Hepsidin seviyeleri, akut faz reaktanı özelliği nedeniyle ayırıcı tanıda etkili olmayabilir. sTfR ölçümünün standardizasyonu ve farklı hasta grupları için optimal kesim noktalarının belirlenmesi amacıyla daha geniş çaplı çalışmalara ihtiyaç vardır.

Keywords

• Soluble transferrin receptor (sTfR)
• sTfR/log ferritin index
• Hepcidin
• Gastrointestinal ma-lignancy

Supporting Institution

Araştırmacıların herhangi bir çıkar ilişkisi bulunmamaktadır.

Ethical Statement

Bu çalışma için, Ankara Numune Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu tarafından 27.07.2011 tarih ve 211/2011 karar numarası ile onay verilmiştir.

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