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Reference intervals and percentiles for soluble transferrin receptor and sTfR/log ferritin index in healthy children and adolescents

  • Freerk Prenzel ORCID logo EMAIL logo , Thorsten Kaiser ORCID logo , Anja Willenberg , Maike vom Hove , Gunter Flemming , Lars Fischer , Jürgen Kratzsch , Wieland Kiess and Mandy Vogel
Published/Copyright: July 8, 2024
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 63 Issue 1

Abstract

Objectives

Soluble transferrin receptor (sTfR) is a marker of both erythropoiesis and iron status and is considered useful for detecting iron deficiency, especially in inflammatory conditions, but reference intervals covering the entire pediatric age spectrum are lacking.

Methods

We studied 1,064 (48.5 % female) healthy children of the entire pediatric age spectrum to determine reference values and percentiles for sTfR and the ratio of sTfR to log-ferritin (sTfR-F index) using a standard immunoturbidimetric assay.

Results

Soluble TfR levels were highly age-specific, with a peak in infancy and a decline in adulthood, whereas the sTfR-F index was a rather constant parameter. There were positive linear relationships for sTfR with hemoglobin (Hb) (p=0.008) and transferrin (females p<0.001; males p=0.003). A negative association was observed between sTfR and ferritin in females (p<0.0001) and for transferrin saturation and mean corpuscular volume (MCV) in both sexes (both p<0.0001). We found a positive relationship between sTfR and body height, body mass index (BMI) and inflammatory markers (CrP p<0.0001; WBC p=0.0172), while sTfR-F index was not affected by inflammation.

Conclusions

Soluble TfR values appear to reflect the activity of infant erythropoiesis and to be modulated by inflammation and iron deficiency even in a healthy cohort.

Keywords: reference values; iron deficiency; iron metabolism; erythropoiesis
Corresponding author: Freerk Prenzel, MD, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstr. 20a, 04103 Leipzig, Germany, E-mail:

Funding source: Freistaat Sachsen

Funding source: Europäischer Sozialfonds

Funding source: European Union

Funding source: European Regional Development Fund

Acknowledgments

We kindly thank all participants and their families, the LIFE study teams, and the laboratory team from the Institute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics at Leipzig University for their contributions. We are grateful to Roche Diagnostics Germany and IDS Germany for a grant to analyze samples to determine sTfR reference ranges free of charge.

  1. Research ethics: LIFE Child was approved by the Ethics Committee of the University of Leipzig (Reg. No. 264-10-19042010).

  2. Informed consent: Written informed consent was obtained from all participants and/or their legal guardians.

  3. Author contributions: Wieland Kiess, Jürgen Kratzsch, Mandy Vogel, and Freerk Prenzel were involved in conception and design. Freerk Prenzel and Mandy Vogel wrote the first draft of the paper. All authors were involved in provision of study materials or patients and collection and assembly of data, in data analysis and interpretation, manuscript editing, final approval of manuscript and accountable for all aspects of the work.

  4. Competing interests: None declared.

  5. Research funding: This publication is supported by LIFE – Leipzig Research Centre for Civilization Diseases, University of Leipzig, with funding from the European Union, the European Social Fund (ESF), the European Regional Development Fund (ERDF), and the Free State of Saxony within the framework of the excellence initiative.

  6. Data availability: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Researchers interested in accessing data from the LIFE Child study may contact the study by writing to .

  7. Clinical trial registration: NCT study number 02550236.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2024-0369).

Received: 2023-12-18
Accepted: 2024-06-11
Published Online: 2024-07-08
Published in Print: 2025-01-29

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2024-0369
Keywords for this article
reference values; iron deficiency; iron metabolism; erythropoiesis

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Blood self-sampling: friend or foe?
  4. Reviews
  5. Blood self-sampling devices: innovation, interpretation and implementation in total lab automation
  6. Salivary fatty acids in humans: a comprehensive literature review
  7. Opinion Papers
  8. EFLM Task Force Preparation of Labs for Emergencies (TF-PLE) recommendations for reinforcing cyber-security and managing cyber-attacks in medical laboratories
  9. Point-of-care testing: state-of-the art and perspectives
  10. A standard to report biological variation data studies – based on an expert opinion
  11. Ethical Checklists for Clinical Research Projects and Laboratory Medicine: two tools to evaluate compliance with bioethical principles in different settings
  12. Guidelines and Recommendations
  13. Assessment of cardiovascular risk and physical activity: the role of cardiac-specific biomarkers in the general population and athletes
  14. Genetics and Molecular Diagnostics
  15. Clinical utility of regions of homozygosity (ROH) identified in exome sequencing: when to pursue confirmatory uniparental disomy testing for imprinting disorders?
  16. An ultrasensitive DNA-enhanced amplification method for detecting cfDNA drug-resistant mutations in non-small cell lung cancer with selective FEN-assisted degradation of dominant somatic fragments
  17. General Clinical Chemistry and Laboratory Medicine
  18. The biological variation of insulin resistance markers: data from the European Biological Variation Study (EuBIVAS)
  19. The surveys on quality indicators for the total testing process in clinical laboratories of Fujian Province in China from 2018 to 2023
  20. Preservation of urine specimens for metabolic evaluation of recurrent urinary stone formers
  21. Performance evaluation of a smartphone-based home test for fecal calprotection
  22. Implications of monoclonal gammopathy and isoelectric focusing pattern 5 on the free light chain kappa diagnostics in cerebrospinal fluid
  23. Development and validation of a novel 7α-hydroxy-4-cholesten-3-one (C4) liquid chromatography tandem mass spectrometry method and its utility to assess pre-analytical stability
  24. Establishment of ELISA-comparable moderate and high thresholds for anticardiolipin and anti-β2 glycoprotein I chemiluminescent immunoassays according to the 2023 ACR/EULAR APS classification criteria and evaluation of their diagnostic performance
  25. Reference Values and Biological Variations
  26. Capillary blood parameters are gestational age, birthweight, delivery mode and gender dependent in healthy preterm and term infants
  27. Reference intervals and percentiles for soluble transferrin receptor and sTfR/log ferritin index in healthy children and adolescents
  28. Cancer Diagnostics
  29. Detection of serum CC16 by a rapid and ultrasensitive magnetic chemiluminescence immunoassay for lung disease diagnosis
  30. Cardiovascular Diseases
  31. The role of functional vitamin D deficiency and low vitamin D reservoirs in relation to cardiovascular health and mortality
  32. Annual Reviewer Acknowledgment
  33. Reviewer Acknowledgment
  34. Letters to the Editor
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  36. Comment on Lippi et al.: EFLM Task Force Preparation of Labs for Emergencies (TF-PLE) recommendations for reinforcing cyber-security and managing cyber-attacks in medical laboratories
  37. Six Sigma in laboratory medicine: the unfinished symphony
  38. Navigating complexities in vitamin D and cardiovascular health: a call for comprehensive analysis
  39. Simplified preanalytical laboratory procedures for therapeutic drug monitoring (TDM) in patients treated with high-dose methotrexate (HD-MTX) and glucarpidase
  40. New generation of Abbott enzyme assays: imprecision, methods comparison, and impact on patients’ results
  41. Correction of negative-interference from calcium dobesilate in the Roche sarcosine oxidase creatinine assay using CuO
  42. Two cases of MTHFR C677T polymorphism typing failure by Taqman system due to MTHFR 679 GA heterozygous mutation
  43. A falsely elevated blood alcohol concentration (BAC) related to an intravenous administration of phenytoin sodium
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