title: Utility of plasma transferrin receptor, ferritin and inflammatory markers in children with sickle cell disease.
abstract: BACKGROUND
  Soluble transferrin receptor (sTfR) is generally unaffected by inflammatory status, whereas ferritin increases along with acute-phase proteins. The utility of these iron biomarkers in relation to inflammatory markers in children with sickle cell  disease (SCD) with differing grades of severity is unclear.
  
  
  OBJECTIVE
  To describe iron biomarker profiles and inflammatory responses in relation to disease severity in children with SCD.
  
  
  METHODS
  This cross-sectional study describes plasma levels of sTfR, ferritin, C-reactive  protein (CRP) and serum amyloid A (SAA) among 102 Yemeni children with SCD in relation to clinical profiles and disease severity.
  
  
  RESULTS
  Median (IQR) sTfR was 58·5 mg/L (38-81), and concentration was positively correlated with reticulocyte count (r = +0·31,  P = 0·002) and splenic enlargement (r = +0·20, P = 0·04), and was negatively correlated with Hb (r = -0·28, P = 0·004). Subcategories of children in a steady state  were identified using ferritin and CRP cut-off values to discriminate iron status. In children in a steady state, the prevalence of iron deficiency was 25%, iron repletion 48% and marginal or normal status 27%. Ferritin concentration correlated positively with Hb and 23% of iron-deficient  children had severe anaemia. CRP and SAA were increased in the steady state and were higher with acute disease complications (P<0·05 and <0·001, respectively). There was no association between sTfR or sTfR-ferritin index and inflammatory markers or disease severity  score.
  
  
  CONCLUSIONS
  In SCD, elevated sTfR is related to hypererythropoietic activity and does not correlate with inflammatory status or disease severity. Iron deficiency prevalence was estimated to be 25%. A classification of iron status is proposed.
authors.affiliation: Faculty of Medicine & Health Sciences, Aden University, Yemen.
authors.forename: A-W M
authors.initials: AW
authors.lastname: Al-Saqladi
authors.forename: H A
authors.initials: HA
authors.lastname: Bin-Gadeem
authors.forename: B J
authors.initials: BJ
authors.lastname: Brabin
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000378:metabolism / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000378:metabolism*; D008297:Male; D011990:Receptors, Transferrin / Q000097:blood*; D000685:Serum Amyloid A Protein / Q000378:metabolism; D012720:Severity of Illness Index; D012995:Solubility; D015006:Yemen
chemical_list: D015415:Biomarkers; D011990:Receptors, Transferrin; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein; D005293:Ferritins