title: Serum transferrin receptor is a marker of iron deficiency in patients included in programs for preoperative autologous blood donation.
abstract: Recently programs for preoperative autologous blood donation (PABD) have expanded to reduce the need for allogenic blood transfusion. Nevertheless, the ability of the patients's bone marrow to replace the red blood cells (RBCs) mass reduced by phlebotomies determines the efficacy of PABD. In mild anemia, known as iron-deficient erythropoiesis (IDE) or iron deficiency without anemia, precipitated by PABD, the marrow response is suboptimal and needs adjuvant therapy. The aim of this study was to evaluate the use of the serum transferrin receptor (sTfR) for the assessment of IDE in patients undergoing PABD.
  
  
  METHODS
  Two autologous blood units from 50 consecutive patients scheduled for elective orthopedic surgery were collected preoperatively. Serial measurements of RBCs, haematocrit (Hct), haemoglobin (Hb), serum iron, serum ferritin, reticulocyte count, reticulocyte maturity index (RMI), endogenous erythropoietin (EPO) and sTfR were performed throughout the phlebotomy program.
  
  
  RESULTS
  RBC, Hct, Hb and serum iron significantly decreased although within the normal range. There was no change in serum ferritin levels. Reticulocytes, RMI and EPO significantly increased as did sTfR which significantly exceeds the normal range.
  
  
  CONCLUSIONS
  These results demonstrate that the sTfR is a reliable laboratory marker for detecting mild anemia or IDE. In patients undergoing PABD increased sTfR levels may suggest a treatment with recombinant human EPO (rh-EPO) or iron to improve the bone marrow performance.
authors.affiliation: Blood Transfusion Service, Azienda Ospedaliera Policlinico, C.R.C.C., Piazza Giulio Cesare 11, Bari 70123, Italy. crccpuglia@libero.it
authors.forename: Donato
authors.initials: D
authors.lastname: Dimonte
authors.forename: Maria
authors.initials: M
authors.lastname: Pepe
authors.forename: Immacolata
authors.initials: I
authors.lastname: Silletti
authors.forename: Luciano
authors.initials: L
authors.lastname: Cazzato
authors.forename: Rosa
authors.initials: R
authors.lastname: Fiore
mesh_terms: D000328:Adult; D000368:Aged; D000747:Anemia, Hypochromic / Q000097:blood* / Q000188:drug therapy; D015415:Biomarkers; D001804:Blood Transfusion, Autologous; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D018962:Phlebotomy / Q000009:adverse effects; D011300:Preoperative Care; D011990:Receptors, Transferrin / Q000097:blood*; D011994:Recombinant Proteins
chemical_list: D015415:Biomarkers; D011990:Receptors, Transferrin; D011994:Recombinant Proteins; D004921:Erythropoietin