Serum transferrin receptor concentration indicates increased erythropoiesis in Kenyan children with asymptomatic malaria12345

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ABSTRACT

Background:

Serum transferrin receptor concentrations indicate both erythropoietic activity and the deficit of functional iron in the erythron. In contrast with serum ferritin concentrations, serum transferrin receptor concentrations are not or are only marginally influenced by the inflammatory response to infection.

Objective:

We assessed iron status and examined the relation between serum transferrin receptor concentrations and malaria in children aged 2–36 mo who were asymptomatic for malaria.

Design:

This was a community-based cluster survey ( n = 318).

Results:

Prevalences of malaria, anemia (hemoglobin concentration <110 g/L), iron deficiency (serum ferritin concentration <12 μg/L), and iron deficiency anemia were 18%, 69%, 53%, and 46%, respectively. Malaria was associated with lower mean hemoglobin concentrations (92.7 compared with 104.1 g/L; P = 0.0001) and higher geometric mean serum concentrations of transferrin receptor (11.4 compared with 7.8 mg/L; P = 0.005), ferritin (21.6 compared with 11.9 μg/L; P = 0.05), and C-reactive protein (12.5 compared with 6.8 mg/L; P = 0.004). There was no evidence for an association between serum concentrations of C-reactive protein and transferrin receptor. Children with malaria had higher serum transferrin receptor concentrations than expected for the degree of anemia, even after adjustment for inflammation indicated by serum C-reactive protein concentration quartiles ( P = 0.02).

Conclusions:

Our findings are consistent with the notion that malaria-induced hemolysis is accompanied by increased erythropoiesis. Serum transferrin receptor concentration is not useful for detecting iron deficiency in individuals with malaria. Individuals with high concentrations of serum C-reactive protein or similar acute phase reactants should be excluded from analysis if serum ferritin concentrations <12 μg/L are to be used to measure iron deficiency in malaria-endemic areas.

KEY WORDS

Iron deficiency
anemia
ferritin
transferrin receptors
C-reactive protein
falciparum malaria
helminthiasis
preschool children
Kenya
community survey

Cited by (0)

1

From the Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, Netherlands; the African Medical and Research Foundation, Nairobi, Kenya; the Department of Gastroenterology, Nijmegen University Medical Centre, Nijmegen, Netherlands; the Ministry of Health, Kibwezi Rural Health Centre, Kibwezi, Kenya; and the Department of Medicine, Division of Hematology, University of Liège, Liège, Belgium.

2

HV, CEW, and FJK were responsible for the study design and interpretation of results; HV was responsible for data collection and analysis; PN assisted in detailed planning of the field work and data collection; JB advised on statistical analyses; and YB conducted the biochemical analyses and assisted in the interpretation of those results.

3

YB is a Research Director of the National Fund for Scientific Research (Belgium).

4

Supported by the Netherlands Foundation for the Advancement of Tropical Research (NWO/WOTRO; grant WV93-273).

5

Reprints not available. Address correspondences to CE West, Division of Human Nutrition and Epidemiology, Wageningen University, PO Box 8129, 6700 EV Wageningen, Netherlands. E-mail: [email protected].