SOLUBLE TRANSFERRIN RECEPTOR AND SOLUBLE TRANSFERRIN RECEPTOR-FERRITIN INDEX FOR EVALUATION OF THE IRON DEFICIENCY IN CIRRHOTIC PATIENTS

Objective: lion delivery to erythroblast is mediated by the interaction of plasma transferrin with the cell surface transferrin receptors. Measurement of serum soluble transferrin receptor (sTfR) has been introduced as a promising new index for iron depletion. Our aim is to evaluate the value of sTfR concentration and soluble transferrin receptor-ferritin index (TfFI) in the diagnosis of iron deficiency anemia (IDA) in cirrhotic patients. Material and Method: Thirty-five Grade A (Child Pugh) cirrhotic patients and 29 healthy subjects were enrolled into this study. Complete blood cell count and biochemical analysis including sTfR were performed in all patients and control subjects. Transferrin saturation (TS) was calculated by using the formula 100x serum iror. concentration/total iron binding capacity, and TfFI was estimated with sTfR concentration/log ferritin. IDA was diagnosed when TS was below 15% together with a concordant peripheral blood smear. Results: IDA group had higher sTfR and TfFI levels when compared to cirrhotic patients with anemia of chronic disease (ACD) (sTfR; 7.77 +/- 4.00 vs 3.70 +/- 0.98 mg/l, p < 0.001, z=3.495, TfFI; 5.98 +/- 3.14 vs 1.59 +/- 0.48 g/l, p < 0.001, z=3.550) and healthy subjects (sTfR; 7.77 +/- 4.00 vs 2.99 +/- 0.78 mg/l, p < 0.001, z=4.503, TfFI; 5.98 +/- 3.14 vs 1.87 +/- 0.78 g/l, p < 0.001, z=3.699). Patients in IDA group had lower scrum ferritin levels when compared to ACD group (93 +/- 64 vs 290 +/- 122, p=0.002, z=-3.051). Sensitivity, specificity and diagnostic values of sTfR and TfFI were 90% vs 90%, 87% vs 94% and 88 vs 92 respectively. Conclusion: Scrum sTfR and TfFI may be used together to distinguish the iron deficiency state in cirrhotic patients.