Serum transferrin receptor assay in iron deficiency anaemia and anaemia ofchronic disease in the elderly

The most common cause of anaemia in the elderly is anaemia of chronic disea se (ACD). However, iron deficiency anaemia (IDA) may coexist, and can be di fficult to diagnose. The serum transferrin receptor (sTfR) blood test may b e a better indicator of iron status as it is not affected by inflammation n or by advancing age. We evaluated it in four groups (10 males, 10 females e ach):'young' controls,'elderly' controls, IDA and ACD. All patients in the IDA group had elevated sTfR levels (mean +/- SD 65.2 +/- 17.7 nmol/l). All 'young' controls had normal sTfR (22.3 +/- 7.3 nmol/l) and ferritin levels (92.7 +/- 61.1 mu g/l). Although all ferritin levels subjects in the 'elder ly' controls and CD group had normal, and raised or normal serum: ferritin; respectively (88 +/- 62.3 mu g/l; 631.2 +/- 509.5 mu g/l), three (15%) 'el derly' controls and four (20%) ACD patients had raised sTfR levels, suggest ing depleted iron stores. Bone-marrow aspirates were available in 3/4 ACD p atients with raised sTfR. Haemosiderin was absent in two. The sTfR blood te st is comparable to serum ferritin in diagnosing IDA in the elderly but; al so seems capable of differentiating ACD from IDA. Its potential as a non-in vasive test Of iron status, especially in elderly anaemic patients, deserve s further evaluation.