J. Tancabelic et al., Serum transferrin receptor as a marker of erythropoiesis suppression in patients on chronic transfusion, AM J HEMAT, 60(2), 1999, pp. 121-125
In the management of patients requiring chronic transfusion, various parame
ters may be used to evaluate the degree of erythroid marrow suppression. Th
e aim of our study was to assess which of these parameters provide the most
useful assessment of erythropoiesis. We studied 27 chronically transfused
patients, 19 with sickle cell disease (SS patients) and 8 with thalassemia.
Thirty-one nonchronically transfused SS patients and 74 healthy children s
erved as controls. We measured serum transferrin receptor levels, reticuloc
yte counts, hemoglobin (Hb) concentrations and erythropoietin levels. The s
erum transferrin receptor levels were very elevated in control SS patients
and remained significantly elevated in those on transfusion therapy, but we
re normal in thalassemia patients, indicating a more complete suppression o
f erythropoiesis. The reticulocyte counts were elevated in all SS patients,
even when on chronic transfusion, but were in the normal range in patients
with thalassemia, Erythropoietin levels were elevated in patients with tha
lassemia and in all the SS patients. Hb levels negatively correlated with s
erum transferrin receptor and erythropoietin in all SS patients, In the tra
nsfused SS patients, a higher HbS level correlated with higher reticulocyte
counts, transferrin receptor, and erythropoietin levels, In thalassemia pa
tients, erythropoiesis was more completely suppressed, as reflected both by
normal reticulocyte counts and near-normal transferrin receptor levels. Th
ough the reticulocyte counts were not significantly different in the transf
used SS patients, the serum transferrin receptor levels were less elevated
than in SS patients not on transfusion, The serum transferrin receptor leve
l appears to be the most useful marker of marrow erythropoietic activity in
chronically transfused SS patients. We recommend that reticulocyte counts
be integrated with periodic measurements of serum transferrin receptor leve
ls. (C) 1999 Wiley-Liss, Inc.