Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Serum transferrin receptor in children with respiratory infections

European Journal of Clinical Nutrition volume 57, pages 75–80 (2003)Cite this article

Abstract

Objective: To study the effect of infection on iron status in children suffering from acute, mild or severe respiratory infections and to determine the nature of anemia in infection using serum transferrin receptor (sTfR) levels.

Design: Forty-three children aged between 3 and 5 y with no evidence of infection and receiving iron supplements in the preceding 100 days served as controls. Twenty-one children with mild upper respiratory infection and 94 children hospitalized for acute pneumonia constituted the experimental group. Hemoglobin (Hb), sTfR and serum ferritin were estimated in all the children at the time of diagnosis and again on the 15th and 30th days after the infection in those who were available for follow-up.

Results: Mean (95% CI) sTfR was 6.08 (5.1–7.1) mg/l in healthy non-anemic children. Upper respiratory infection had no impact on Hb or sTfR but it significantly elevated serum ferritin levels. Eighty-three percent of the children with pneumonia had Hb less than 110 g/l at the time of diagnosis and had elevated mean sTfR, 18.0 (15.7–20.3) mg/l. There was a decline in mean sTfR by the 15th day of infection to 14.3 (11.3–17.4) mg/l with further rise to 22.9 (13.0–31.9) mg/l by 30 days. Serum ferritin was significantly elevated at the time of diagnosis (85.9; 71.1–100.8 µg/l) as well as at 15 days (89.1; 68–110.1 µg/l) with a decline by 30 days.

Conclusion: Severe lower respiratory infection exaggerates iron-deficient erythropoiesis by blocking release of iron from the storage pools. sTfR may not be a sensitive and specific tool of assessing true iron status of children exposed to severe infections.

Sponsorship: Funding from the Department of Science and Technology (DST no. SP/SO/B-29/96), Government of India, New Delhi, India.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  • Adelekan, DA & Thurnham, DI (1990). Plasma ferritin concentration in anemic children: relative importance of malaria, riboflavin deficiency and other infections. Am. J. Clin. Nutr., 51, 453–456.

    Article  CAS  Google Scholar 

  • Akenami, FOT, Vaheri, A, Koskiniemi, M, Kivi Vuori, S, Ekanem, EE, Bolarin, DM & Smiles, MA (1997). Severe malnutrition is associated with decreased levels of plasma transferrin receptor. Br. J. Nutr., 77, 391–397.

    Article  CAS  Google Scholar 

  • Basta, S & Churchill, A (1974). Iron deficiency anemia and the productivity of adult males in Indonesia, pp1–49, World Bank Staff working paper 175 Washington, DC: World Bank

    Google Scholar 

  • Beisel, WR (1976). Trace elements in infectious processes. Med. Clin. N. Am., 60, 831–849.

    Article  CAS  Google Scholar 

  • Beisel, WR, Pekarek, RS & Wannemacher, RW Jr (1974). The impact of infectious disease on trace element metabolism in the host. In:Trace element metabolism in animals-2, ed. WG Hoekstra, JW Suttie, HE Ganther & W Mertz, pp217–240, Baltimore, MD: University Park Press

    Google Scholar 

  • Beresford, CH, Neale, RJ & Brooks, OG (1971). Iron absorption and pyrexia. Lancet, 1, 568–572.

    Article  CAS  Google Scholar 

  • Bhaskaram, P (1988). Immunology of iron deficient subjects. In:Contemporary issues in Clinical Nutrition, Nutrition and Immunology, ed. RK Chandra, Vol II, pp149–164, New York: Liss

    Google Scholar 

  • Bhaskaram, P (2001). Immunology of mild-moderate micronutrient deficiency. Br. J. Nutr., 85, (Suppl) S75–S80.

    Article  CAS  Google Scholar 

  • Cartwright, GE & Lee, GR (1971). The anemia of chronic disorders. Br. J. Haematol., 21, 147–152.

    Article  CAS  Google Scholar 

  • Chandra, RK & Grace, A (1985). Goldsmith award lecture. Trace element regulation of immunity and infection. J. Am. Coll. Nutr., 4, 5–16.

    Article  CAS  Google Scholar 

  • Dimitriou, H, Stiakaki, E, Markaki, EA, Bolonaki, I, Giannakopoulou, C & Kalmanti, M (2000). Soluble transferrin receptor levels and soluble transferrin receptor/log ferritin index in the evaluation of erythropoletic status in childhood infections and malignancy. Acta Paediatr, 89, 1169–1173.

    Article  CAS  Google Scholar 

  • Ferguson, BJ, Skikne, BS, Simpson, KM, Baynes, RD & Cook, JD (1992). Serum transferrin receptor distinguishes the anemia of chronic disease from iron deficiency anemia. J. Lab. Clin. Med., 119, 385–390.

    CAS  PubMed  Google Scholar 

  • Flowers, CH, Skikne, BS, Covell, AM & Cook, JD (1989). The clinical measurement of serum transferrin receptror. J. Lab. Clin. Med., 114, 368–377.

    CAS  PubMed  Google Scholar 

  • Heilmeyer, L & Wohler, F (1961). Iron uptake in inflammed tissues. Geriat. Med., 6, 313–316.

    Google Scholar 

  • Kohgo, Y, Nishisato, T, Kondo, H, Tsushima, N, Niitsu, Y & Urushizaki, I (1986). Circulating transferrin receptor in human serum. Br. J. Haematol., 64, 277–281.

    Article  CAS  Google Scholar 

  • Kohgo, Y, Niitsu, Y, Nishisato, T, Kato, J, Kondo, H, Sasaki, K & Urushizaki, I (1988). Quantitation and characterization of serum transferrin receptor in-patients with anemias and polycythemias. Jpn. J. Med., 27, 64–70.

    Article  CAS  Google Scholar 

  • Konijn, AM & Hershko, C (1977). Ferritin synthesis in inflammation. I. Pathogenesis of impaired iron release. Br. J. Haematol., 37, 7–16.

    CAS  PubMed  Google Scholar 

  • Konijn, AM, Carmel, N, Levy, R & Hershko, C (1981). Ferritin synthesis in inflammation: mechanism of increased ferritin synthesis. Br. J. of Haematol., 49, 361–370.

    Article  CAS  Google Scholar 

  • Kuvibidila, S, Mark, JA, Warner, RP, Yu, L, Ode, D & Tshefu, KA (1995). Soluble transferrin receptor as an index of iron status in Zairian children with malaria. J. Trop. Med. Hyg., 98, 373–378.

    CAS  PubMed  Google Scholar 

  • Kuvibidila, S, Warner, RP, Ode, D, Yu, L & Tshefu, KA (1999). Lack of differences in iron status assessed by soluble transferrin receptor between children with cerebral malaria and those with non-cerebral malaria. J. Trop. Paediatr., 45, 166–167.

    Article  Google Scholar 

  • Lee, GR (1983). The anemia of chronic disease. Clin. Hematol., 20, 61–80.

    CAS  Google Scholar 

  • Pawashe, AB, Raman, L, Nair, KM & Sarma, MKJ (1987). Validity of using capillary blood for the measurement of plasma ferritin. Clin. Chim. Acta, 163, 119–120.

    Article  CAS  Google Scholar 

  • Skikne, BS, Flowers, CH & Cook, JD (1990). Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood, 75, 1870–1876.

    CAS  PubMed  Google Scholar 

  • Suominen, P, Mottonen, T, Rajamaki, A & Irjala, K (2000). Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia. Arthritis Rheum., 43, 1016–1020.

    Article  CAS  Google Scholar 

  • Walter, T, Olivares, M, Pizarro, F & Munoz, C (1997). Iron, anemia and infection. Nutr. Rev., 55, 111–124.

    Article  CAS  Google Scholar 

  • Weinberg, ED (1978). Iron and infection. Microbiol. Rev., 42, 45–46.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Zahringer, J, Baliga, BS & Munro, HN (1976). Novel mechanisms for translational control in regulation of ferritin synthesis by iron. Proc. Natl Acad. Sci. USA, 73, 857–861.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Dr Kamala Krishnaswamy, Director, National Institute of Nutrition, for her keen interest in the study and Mr EP Ramachandran for his skillful technical assistance.

Author information

Author notes

  1. P Bhaskaram and K Madhavan Nair: Guarantors: P Bhaskaram and K Madhavan Nair.

  2. P Bhaskaram, K Madhavan Nair, N Balakrishna, P Ravinder and B Sesikeran: Contributors: PB the principal contributor is responsible for study design, recruitment, follow-up of patients, data interpretation and manuscript preparation; KMN contributed to the study design, data analysis and manuscript preparation; PR contributed to the analysis of iron status parameters. NB carried out statistical analysis of the data and BS contributed to the hematological investigations. All the investigators contributed to the writing of the paper.

Authors and Affiliations

  1. Division of Pediatrics, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India

    P Bhaskaram

  2. Division of Biophysics, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India

    K Madhavan Nair & P Ravinder

  3. Division of Statistics, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India

    N Balakrishna

  4. Division of Pathology, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India

    B Sesikeran

Authors
  1. P Bhaskaram
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Madhavan Nair
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N Balakrishna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P Ravinder
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B Sesikeran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Bhaskaram.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bhaskaram, P., Madhavan Nair, K., Balakrishna, N. et al. Serum transferrin receptor in children with respiratory infections. Eur J Clin Nutr 57, 75–80 (2003). https://doi.org/10.1038/sj.ejcn.1601496

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601496

Keywords

This article is cited by

Search

Advanced search

Quick links