The soluble transferrin receptor (sTfR)-ferritin index is a potential predictor of celiac disease in children with refractory iron deficiency anemia

Abstract

The soluble transferrin receptor (sTfR) distinguishes iron deficiency anemia from other types of anemia. Refractory iron deficiency anemia is often the onset symptom in malabsorption-induced celiac disease. We evaluated whether sTfR levels distinguish celiac disease-associated iron deficiency anemia from iron deficiency anemia of other origin. To this aim we measured sTfR and ferritin levels and their ratio (the sTfR/ferritin index) and other hematological parameters in 42 anemic children (20 with and 22 without celiac disease) vs. 22 non-anemic children with celiac disease and 31 healthy controls (age range 4-12 years). Hemoglobin parameters, mean cell volume, and serum iron and ferritin levels were decreased to a similar extent in the anemic patients (celiac and non-celiac). The sTfR level in non-anemic celiac patients was similar to that of normal controls (1.7+/-0.35 mg/L), whereas it was significantly increased in non-celiac and celiac anemic patients (2.2+/-0.5 mg/L, p<0.05 and 2.7+/-1.2 mg/L, p<0.001, respectively). The sTfR/ferritin index was also increased more in the anemic celiac patients (mean 4.4, range 1.5-12.0) than in anemic non-celiac children (mean 2.6, range 1.4-4.0) compared with non-anemic children (mean 1.2, range 0.7-2.0). Differences were more pronounced when ferritin was <5 ng/mL. Thus, the sTfR/ferritin index may be a predictive measure in discriminating anemic patients with celiac disease from those without celiac disease.

Refractory iron-deficiency anemia and gluten intolerance: Response to gluten-free diet

“…Anemia is characterized by low hemoglobin levels and usually microcytic and hypochromic RBCs. Patients with ferropenic anemia usually present with reduced circulating iron levels, low transferrin saturation index, and depleted body iron deposits, which translates into severely decreased serum ferritin levels (29).…”

A case of anemia caused by combined vitamin B12 and iron deficiency manifesting as short stature and delayed puberty

“…Although typically presenting as a nutritional anemia, IDA may occur as part of a complex medical problem that includes gastrointestinal blood loss, malabsorption syndromes, and chronic inflammatory diseases9). IDA is also a confounding finding in anemia associated with chronic disease.…”

Hematologic manifestations of celiac disease

“…24 Measurements of soluble transferrin receptors (sTfRs) can also be valuable in the evaluation of IDA, and the ratio of sTfR to ferritin may indicate CD in children with refractory IDA. 25,26 Iron deficiency that is refractory to therapy can be the sole manifestation of CD, especially in pediatric patients. [27][28][29] The prevalence of CD in patients with refractory IDA may be as high as 20%.…”