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American Journal of Clinical Nutrition, Vol. 74, No. 6, 767-775, December 2001
© 2001 American Society for Clinical Nutrition

Original Research Communication

Serum transferrin receptor concentration indicates increased erythropoiesis in Kenyan children with asymptomatic malaria1,2,3,4,5

Hans Verhoef, Clive E West, Paul Ndeto, Jan Burema, Yves Beguin and Frans J Kok

1 From the Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, Netherlands; the African Medical and Research Foundation, Nairobi, Kenya; the Department of Gastroenterology, Nijmegen University Medical Centre, Nijmegen, Netherlands; the Ministry of Health, Kibwezi Rural Health Centre, Kibwezi, Kenya; and the Department of Medicine, Division of Hematology, University of Liège, Liège, Belgium.

Background: Serum transferrin receptor concentrations indicate both erythropoietic activity and the deficit of functional iron in the erythron. In contrast with serum ferritin concentrations, serum transferrin receptor concentrations are not or are only marginally influenced by the inflammatory response to infection.

Objective: We assessed iron status and examined the relation between serum transferrin receptor concentrations and malaria in children aged 2–36 mo who 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 µg/L), and iron deficiency anemia were 18%, 69%, 53%, and 46%, respectively. Malaria was associated with lower mean hemoglobin concentrations (92.7 compared with 104.1 g/L; P = 0.0001) and higher geometric mean serum concentrations of transferrin receptor (11.4 compared with 7.8 mg/L; P = 0.005), ferritin (21.6 compared with 11.9 µg/L; P = 0.05), and C-reactive protein (12.5 compared with 6.8 mg/L; P = 0.004). There was no evidence for an association between serum concentrations of C-reactive protein and transferrin receptor. Children with malaria had higher serum transferrin receptor concentrations than expected for the degree of anemia, even after adjustment for inflammation indicated by serum C-reactive protein concentration quartiles (P = 0.02).

Conclusions: Our findings are consistent with the notion that malaria-induced hemolysis is accompanied by increased erythropoiesis. Serum transferrin receptor concentration is not useful for detecting iron deficiency in individuals with malaria. Individuals with high concentrations of serum C-reactive protein or similar acute phase reactants should be excluded from analysis if serum ferritin concentrations <12 µg/L are to be used to measure iron deficiency in malaria-endemic areas.

Key Words: Iron deficiency • anemia • ferritin • transferrin receptors • C-reactive protein • falciparum malaria • helminthiasis • preschool children • Kenya • community survey




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