Aim: Iron deficiency anemia (IDA) is a common medical condition, yet there is still some diagnostic uncertainty in this respect. The aim of this study was to compare the clinical significance of biomarkers of iron deficiency (ID) in diagnosing IDA and iron-deficient erythropoiesis in anemic patients. Materials and methods: A total of 103 untreated patients with non-hemolytic anemia were included. Blood count, reticulocyte hemoglobin content (CHr), iron, transferrin saturation (TSAT), ferritin (Ferr), soluble transferrin receptor (sTfR) and sTfR/logFerr index (sTfR-F index) were determined in the patients. Results: TSAT<16% diagnosed 79 patients with IDA (76.6%), Ferr<30 µg/l - 50 patients with IDA (48.5%). Thomas-plot analysis found 76 patients with ID (73.8%) and 56 of them were with iron-restricted erythropoiesis and IDA (54.4%). Biomarkers of ID were significantly different in anemic patients with iron-deficient erythropoiesis (CHr<28 pg) compared with patients with normal hemoglobinisation (p<0.001). With regard to the predictive value of the parameters of ID for iron-deficient erythropoiesis in anemia, their mutually controlled influence proved sTfR-F index only as independent statistically significant (p=0.011). The optimal cut-off value of sTfR-F index from the ROC curve analysis for detecting iron-deficient erythropoiesis in anemia (CHr<28 pg) was 1.35, with sensitivity of 82.1% and specificity of 80.9% (AUC 0.866; p<0.001). Conclusions: Diagnosis of IDA depends on the applied biomarkers of ID, and TSAT or ferritin when used alone may lead to diagnostic difficulties. Combining sTfR-F index and CHr to evaluate iron-deficient erythropoiesis in patients with anemia in addition to ferritin and TSAT could contribute to improving the diagnosis of IDA in clinical practice.

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Background: Iron accumulation occurs in MDS patients by upregulated iron absorption due to ineffective erythropoiesis with decreased hepcidin levels (Santini et al, 2011) and by chronic blood transfusion therapy. Elevated liver iron concentration (LIC) is regularly found in transfusion dependent patients. Abnormal cardiac iron (50-1) was observed in few studies and severe cardiac iron overload was almost not present although cardiac death appeared in 8% of deceased patients (Nachtkamp et al, 2016). Little is known about corresponding pancreatic iron and iron accumulation in the bone marrow. The release of NTBI in the bone marrow may directly affect hematopoiesis by oxidative stress (Porter et al, 2016). Aims: To compare the relationship of iron concentration and fat content in different organs in low -risk MDS patients. Methods: We studied the iron accumulation in bone marrow, liver, spleen, pancreas and septal heart muscle in 14 mainly low-risk MDS patients (age 39-87 y), partly transfused and chelated. Tissue iron concentration and fat content were assessed by magnetic resonance imaging (MRI -R2 * ) with 3D data acquisition at 3 Tesla using chemical shift relaxometry (Pfeifer et al, 2015). Results: About 50% of patients showed iron overload in the spleen, pancreas and vertebral bone marrow (VBM). Mean LIC (±SD) was found as 1.709 ± 0.914 mg/g liver (10.3 ± 5.5 mg/g dry weight ). Patients with iron overload in the pancreas showed as well abnormal pancreatic fat contents (11-32%) and fasting glucose values (101-186 mg/dL). As expected, septal cardiac iron was normal for all patients. Bone marrow (VBM) iron was elevated in 8/14 patients (R2 * = 149-330 s −1 ) with the highest R2 * in a non-chelated patient. Summary/Conclusion: The feasibility of multi-organ iron and fat measurements by MRI in heart, liver, spleen, pancreas and bone marrow was shown in a small group of elderly MDS patients within a reasonable scan time (30 min). The iron concentration and fat content in different organs will contribute further information about disease process in low -risk MDS patients, as well as success of iron chelation therapy.