title: Early detection of iron deficiency in elite athletes: could microcytic anemia factor (Maf) be useful?
abstract: BACKGROUND
  The aim of this study was to establish the sensitivity and specificity of the microcytic anemia factor (Maf(®)), which is generated by the Coulter LH 750 analyzer in the evaluation of iron depletion and iron-deficient erythropoiesis in athletes.
  
  
  METHODS
  A total of 142 athletes were divided into three groups: with iron depletion, with iron-deficient erythropoiesis, and controls. The following parameters were measured: RBCs (red blood cells), Hb (hemoglobin), Hct (hematocrit), MCV (mean cellular volume), MCH (mean cell hemoglobin), MCHC (mean cell hemoglobin corpuscular), RDW (red cell distribution width), Maf(®), Reticulocytes, Ferritin, sTfR (soluble transferrin receptor), Transferrin, Haptoglobin, IL- 6 (Interleukin-6), hs-CRP (high-sensitivity C-reactive protein).
  
  
  RESULTS
  The best Maf(®) value to exclude iron depletion in athletes was 130.3, showing a sensitivity of 72.6% and a specificity of 57.3%. The AUC was 0.690 (CI 95% 0.607-0.765, P < 0.001). ROC curve analysis for Maf(®) in the diagnosis of iron-deficient erythropoiesis indicates sensitivity of 61.5%, and specificity of 93.0%, with AUC = 0.826 (CI 95% 0.754-0.885, P < 0.001) and on cutoff value 114.
  
  
  CONCLUSIONS
  This study shows that Maf(®) generated by the Coulter LH 700 Series hematology analyzers, performs very well in discriminating healthy athletes and those with different stages of iron deficiency. Also, in cost/benefit terms, monitoring of Maf(®) is justified as a low cost, effective screening parameter for determining iron status in athletes.
authors.affiliation: Faculty of Pharmacy, Department of Medical Biochemistry, University of Belgrade, Belgrade, Serbia.|Center of Medical Biochemistry, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: V
authors.initials: V
authors.lastname: Dopsaj
authors.affiliation: Health Center Rakovica, Laboratory Department, Belgrade, Serbia.
authors.forename: J
authors.initials: J
authors.lastname: Martinovic
authors.affiliation: Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia.
authors.forename: M
authors.initials: M
authors.lastname: Dopsaj
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis*; D056352:Athletes; D002097:C-Reactive Protein / Q000378:metabolism; D004906:Erythrocyte Count; D004909:Erythrocyte Indices; D004912:Erythrocytes / Q000378:metabolism* / Q000473:pathology; D004920:Erythropoiesis; D005260:Female; D005293:Ferritins / Q000097:blood; D006242:Haptoglobins / Q000378:metabolism; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007501:Iron / Q000097:blood; D008297:Male; D012680:Sensitivity and Specificity; D014168:Transferrin / Q000378:metabolism
chemical_list: D006242:Haptoglobins; D006454:Hemoglobins; C508600:IL6 protein, human; D015850:Interleukin-6; D014168:Transferrin; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron
keywords: Iron deficiency; anemia; athletes; exercise; ferritin; transferrin saturation