Serum transferrin receptor concentration indicates increased erythropoiesis in Kenyan children with asymptomatic malaria

Background: Serum transferrin receptor concentrations indicate both erythro poietic activity and the deficit of functional iron in the erythron. In con trast with serum ferritin concentrations, serum transferrin receptor concen trations are not or are only marginally influenced by the inflammatory resp onse to infection. Objective. We assessed iron status and examined the relation between serum transferrin receptor concentrations and malaria in children aged 2-36 mo wh o were asymptomatic for malaria. Design: This was a community-based cluster survey (n = 318). Results: Prevalences of malaria, anemia (hemoglobin concentration < 110 g/L ), iron deficiency (serum ferritin concentration < 12 pg), and iron deficie ncy anemia were 18%, 69%, 53%, and 46%, respectively. Malaria was associate d with lower mean hemoglobin concentrations (92.7 compared with 104.1 g/L; P = 0.0001) and higher geometric mean serum concentrations of transferrin r eceptor (11.4 compared with 7.8 mg/L; P = 0.005), ferritin (21.6 compared w ith 11.9 mug/L; P = 0.05), and C-reactive protein (12.5 compared with 6.8 m g/L; P = 0.004). There was no evidence for an association between serum con centrations of C-reactive protein and transferrin receptor. Children with m alaria had higher serum transferrin receptor concentrations than expected f or the degree of anemia, even after adjustment for inflammation indicated b y serum C-reactive protein concentration quartiles. (P = 0.02). Conclusions: Our findings are consistent with the notion that malaria-induc ed hemolysis is accompanied by increased erythropoiesis. Serum transferrin receptor concentration is not useful for detecting iron deficiency in indiv iduals with malaria. Individuals with high concentrations of serum C-reacti ve protein or similar acute phase reactants should be excluded from analysi s if serum ferritin concentrations < 12 mug/L are to be used to measure iro n deficiency in malaria-endemic areas.