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Conventional and novel peripheral blood iron markers compared against bone marrow in Malawian children.

Jonker, Femkje A M, Boele van Hensbroek, Michael, Leenstra, Tjalling, Vet, Raymond J W M, Brabin, Bernard, Maseko, Nelson, Gushu, Montfort B, Emana, Mercy, Kraaijenhagen, Rob, Tjalsma, Harold, Swinkels, Dorine W and Calis, Job C J (2014) 'Conventional and novel peripheral blood iron markers compared against bone marrow in Malawian children.'. Journal of Clinical Pathology, Vol 67, Issue 8, pp. 717-723.

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Iron deficiency is an important child health problem. Its diagnosis in areas of high infection exposure remains complicated as inflammation may interfere with the accuracy of peripheral iron markers. With this study, we aimed to validate the conventional iron markers and two novel iron markers, hepcidin and Red blood cell Size Factor (RSf), against the reference standard of iron status, bone marrow iron, in children living in an infectious setting.


We compared ferritin, soluble transferrin receptor, Soluble Transferrin Log-Ferritin Index (sTfR-F), mean cellular volume, mean cellular haemoglobin concentration, hepcidin and RSf, against bone marrow iron in 87 healthy Malawian children (6-66 months) scheduled for elective surgery.


Of all children, 44.8% had depleted bone marrow iron stores. Using optimised cut-offs, ferritin (<18 µg/L) and sTfR-F (>1.85) best predicted depleted iron stores with a sensitivity/specificity of 73.7%/77.1% and 72.5%/75.0%, respectively. Hepcidin (<1.4 nmol/L) was a moderate sensitive marker (73.0%) although specificity was 54.2%; RSf poorly predicted depleted iron stores.


We provide the first bone marrow-validated data on peripheral iron markers in African children, and showed ferritin and sTfR-F best predicted iron status. Using appropriately defined cut-offs, these indicators can be applied in surveillance and research. As their accuracy is limited for clinical purposes, more reliable iron biomarkers are still required in African children.

Item Type: Article
Subjects: QV Pharmacology > Hematologic Agents > QV 183 Iron. Iron compounds
WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Nutrition Disorders > WD 105 Deficiency diseases
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 380 Bone marrow
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 300 Hemic and lymphatic system
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Julie Franco
Date Deposited: 04 Sep 2014 09:55
Last Modified: 06 Feb 2018 13:07


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