title: Soluble transferrin receptor and its ratio to erythroblasts in bone marrow may be a new diagnostic tool to distinguish between aplastic and refractory anemia.
abstract: Myelodysplastic syndromes (MDS), especially refractory anemia (RA) are very heterogeneous diseases regarding their morphological, biological and clinical features. One important clinical problem is the difficulty of diagnosis. Soluble transferrin receptors (sTfRs) reflect the erythropoietic activity in the bone marrow (BM). To establish whether determination of serum sTfR could be useful for the differential diagnosis between RA and aplastic anemia (AA), we measured the serum sTfR concentrations, BM cellularity and BM erythroblast percentages in 14 untreated AA and 7 untreated RA patients. The serum sTfR levels of the RA patients (820.1 +/- 402.8 ng/ml) were significantly higher than those of the AA patients (491.1 +/- 195.2 ng/ml; p = 0.0207). However, the serum sTfR values of RA and AA patients also overlapped. A new index, the 'sTfR-E index' [the ratio of serum sTfR level (ng/ml) to BM cellularity (%) x BM erythroblasts (%)] is proposed, which is expected to reflect the number of transferrin receptors (TfR) on the cell membrane per BM erythroblast. The sTfR-E index values of the 7 RA patients (0.395 +/- 0.234) were significantly lower than those of the 14 AA patients (2.669 +/- 1.633; p = 0.0003). The sTfR-E index values of AA and RA patients overlapped only marginally. In conclusion, the sTfR-E index may be a useful new diagnostic tool to distinguish between AA and RA patients.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Saitama Medical School, Moroyama, Japan. amatsu@saitama-med.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Matsuda
authors.forename: Motohiro
authors.initials: M
authors.lastname: Misumi
authors.forename: Tsuneyuki
authors.initials: T
authors.lastname: Shimada
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yoshida
authors.forename: Fumiharu
authors.initials: F
authors.lastname: Yagasaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Kawai
authors.forename: Ikuo
authors.initials: I
authors.lastname: Murohashi
authors.forename: Kunitake
authors.initials: K
authors.lastname: Hirashima
authors.forename: Masami
authors.initials: M
authors.lastname: Bessho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000741:Anemia, Aplastic / Q000175:diagnosis*; D000753:Anemia, Refractory / Q000175:diagnosis*; D001854:Bone Marrow Cells; D003937:Diagnosis, Differential; D004900:Erythroblasts / Q000166:cytology*; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011990:Receptors, Transferrin / Q000097:blood*; D012995:Solubility
chemical_list: D011990:Receptors, Transferrin