S remains elusive. The use of the ratio of soluble transferrin

S remains elusive. The use of the ratio of soluble transferrin receptor to log ferritin concentrations (sTfR/log ferritin index) has been advocated to assess iron status [18]. However, this index is also limited because its parameters are influenced by the erythropoietic activity and inflammation [19,20]. Moreover, we found that malaria infection was associated with a significant increase in sTfR plasma levels, even higher than those observed in IDA, thus questioning the role of sTfR levels in the diagnosis of IDA in individuals 23388095 exposed to malaria [16]. Until now, the microscopic examination of Perl’s Prussian blue stained bone marrow aspirate remains the “gold standard” for the 1113-59-3 biological activity assessment of iron stores [21]. However, this is an invasiveprocedure and not logistically feasible in most settings where the diagnosis of ID is both most needed and problematic. A previous study among severely anaemic Malawian children comparing various iron markers against bone marrow iron content found that TfR-F index was the best predictor of bone marrow iron stores deficiency (sensitivity 74 and specificity 73 ) [22]. However, even using this index as a proxy for ID, a significant number of iron deficient children would not be diagnosed and thus receive adequate treatment. On the other hand, evaluation of the performances of iron markers in other well defined populations from highly infectious settings is needed to know if they could be extrapolated. In order to contribute to improving the diagnosis of ID in children exposed to high infection pressure, we have evaluated the sensitivity and specificity of currently used iron markers using bone marrow iron content as the “gold standard” in Mozambican children with several degrees of anaemia.Materials and Methods Ethics StatementThe study protocol was approved by the order Tunicamycin National Mozambican ?Ethics Committee and the Hospital Clinic of Barcelona Ethics Review Committee. Parents-guardians were informed of the goals, procedures, benefits and risks of taking a bone marrow sample from their child, and it was never offered to them any financial or material inducement to agree on it. They were also given the choice of consenting to the participation of their child in theIron Deficiency Diagnosis and InfectionsTable 3. Sensitivity, specificity and accuracy of internationally accepted cut-off values of iron markers to identify iron stores deficiency using bone marrow iron content as “gold standard”.Table 4. AUCROC values for iron markers to identify children with iron 1326631 stores deficiency*.Iron marker Iron marker True False Accuracy ( ) 32 29 21 76 52 71 66 20 73 34 55 49 Ferritin sTfR TfR-F index Plasma iron Ferritin (ng/ 21 ml) Ferritin (ng/ 15 ml) 1 Ferritin (ng/ 1 ml) 2 sTfR TfR-F index TfR-F index Plasma iron Transferrin Transferrin saturation TIBC MCHC MCV4Area under ROC curve 0.70 0.75 0.76 0.64 0.(95 CI) (0.61, 0.79) (0.66, 0.84) (0.68, 0.85) (0.53, 0.75) (0.61, 0.81) (0.60, 0.80) (0.61, 0.81) (0.49, 0.70) (0.43, 0.66)p-value 0.0268 0.0059 0.0024 0.1584 0.0298 0.0326 0.028 0.3382 0.Sensitivity Specificity Pos Neg Pos Neg ( ) ( ) 35 35 35 0 0 0 17 3 15 16 0 21 0 10 18 117 123 137 22 75 32 43 140 27 117 68 71 15 11 1 83 42 75 70 1 81 17 51 49 100 100 100 50 91 56 54 100 40 100 71TransferrinTransferrin saturation 0.70 TIBC MCHC MCV 0.71 0.59 0.107 17 54 97 98 1 31 19 19*This analysis includes only children with results for all iron markers (n = 159). Abbreviations: CI, confidence interval; MCHC, mean cell haemo.S remains elusive. The use of the ratio of soluble transferrin receptor to log ferritin concentrations (sTfR/log ferritin index) has been advocated to assess iron status [18]. However, this index is also limited because its parameters are influenced by the erythropoietic activity and inflammation [19,20]. Moreover, we found that malaria infection was associated with a significant increase in sTfR plasma levels, even higher than those observed in IDA, thus questioning the role of sTfR levels in the diagnosis of IDA in individuals 23388095 exposed to malaria [16]. Until now, the microscopic examination of Perl’s Prussian blue stained bone marrow aspirate remains the “gold standard” for the assessment of iron stores [21]. However, this is an invasiveprocedure and not logistically feasible in most settings where the diagnosis of ID is both most needed and problematic. A previous study among severely anaemic Malawian children comparing various iron markers against bone marrow iron content found that TfR-F index was the best predictor of bone marrow iron stores deficiency (sensitivity 74 and specificity 73 ) [22]. However, even using this index as a proxy for ID, a significant number of iron deficient children would not be diagnosed and thus receive adequate treatment. On the other hand, evaluation of the performances of iron markers in other well defined populations from highly infectious settings is needed to know if they could be extrapolated. In order to contribute to improving the diagnosis of ID in children exposed to high infection pressure, we have evaluated the sensitivity and specificity of currently used iron markers using bone marrow iron content as the “gold standard” in Mozambican children with several degrees of anaemia.Materials and Methods Ethics StatementThe study protocol was approved by the National Mozambican ?Ethics Committee and the Hospital Clinic of Barcelona Ethics Review Committee. Parents-guardians were informed of the goals, procedures, benefits and risks of taking a bone marrow sample from their child, and it was never offered to them any financial or material inducement to agree on it. They were also given the choice of consenting to the participation of their child in theIron Deficiency Diagnosis and InfectionsTable 3. Sensitivity, specificity and accuracy of internationally accepted cut-off values of iron markers to identify iron stores deficiency using bone marrow iron content as “gold standard”.Table 4. AUCROC values for iron markers to identify children with iron 1326631 stores deficiency*.Iron marker Iron marker True False Accuracy ( ) 32 29 21 76 52 71 66 20 73 34 55 49 Ferritin sTfR TfR-F index Plasma iron Ferritin (ng/ 21 ml) Ferritin (ng/ 15 ml) 1 Ferritin (ng/ 1 ml) 2 sTfR TfR-F index TfR-F index Plasma iron Transferrin Transferrin saturation TIBC MCHC MCV4Area under ROC curve 0.70 0.75 0.76 0.64 0.(95 CI) (0.61, 0.79) (0.66, 0.84) (0.68, 0.85) (0.53, 0.75) (0.61, 0.81) (0.60, 0.80) (0.61, 0.81) (0.49, 0.70) (0.43, 0.66)p-value 0.0268 0.0059 0.0024 0.1584 0.0298 0.0326 0.028 0.3382 0.Sensitivity Specificity Pos Neg Pos Neg ( ) ( ) 35 35 35 0 0 0 17 3 15 16 0 21 0 10 18 117 123 137 22 75 32 43 140 27 117 68 71 15 11 1 83 42 75 70 1 81 17 51 49 100 100 100 50 91 56 54 100 40 100 71TransferrinTransferrin saturation 0.70 TIBC MCHC MCV 0.71 0.59 0.107 17 54 97 98 1 31 19 19*This analysis includes only children with results for all iron markers (n = 159). Abbreviations: CI, confidence interval; MCHC, mean cell haemo.