Serum transferrin receptor as a marker of erythropoiesis suppression in patients on chronic transfusion

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.