title: Serum transferrin receptor concentration indicates increased erythropoiesis in Kenyan children with asymptomatic malaria.
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.
  
  
  METHODS
  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 microg/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 microg/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 microg/L are to be used to measure iron deficiency in malaria-endemic areas.
authors.affiliation: Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Verhoef
authors.forename: C E
authors.initials: CE
authors.lastname: West
authors.forename: P
authors.initials: P
authors.lastname: Ndeto
authors.forename: J
authors.initials: J
authors.lastname: Burema
authors.forename: Y
authors.initials: Y
authors.lastname: Beguin
authors.forename: F J
authors.initials: FJ
authors.lastname: Kok
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D002675:Child, Preschool; D016000:Cluster Analysis; D004920:Erythropoiesis; D005260:Female; D005293:Ferritins / Q000097:blood; D006306:Health Surveys; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood*; D000090463:Iron Deficiencies; D007630:Kenya; D008288:Malaria / Q000097:blood* / Q000150:complications; D008297:Male; D015995:Prevalence; D011990:Receptors, Transferrin / Q000097:blood* / Q000378:metabolism; D012044:Regression Analysis; D012423:Rural Health; D014168:Transferrin / Q000032:analysis
chemical_list: D006454:Hemoglobins; D011990:Receptors, Transferrin; D014168:Transferrin; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron