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- Title
Screening for iron deficiency in surgical patients based on noninvasive zinc protoporphyrin measurements.
- Authors
Füllenbach, Christoph; Stein, Philipp; Glaser, Patricia; Triphaus, Chris; Lindau, Simone; Choorapoikayil, Suma; Schmitt, Elke; Zacharowski, Kai; Hintereder, Gudrun; Hennig, Georg; Homann, Christian; Stepp, Herbert; Spahn, Gabriela H.; Kaserer, Alexander; Schedler, Andreas; Meybohm, Patrick; Spahn, Donat R.
- Abstract
<bold>Background: </bold>Approximately every third surgical patient is anemic. The most common form, iron deficiency anemia, results from persisting iron-deficient erythropoiesis (IDE). Zinc protoporphyrin (ZnPP) is a promising parameter for diagnosing IDE, hitherto requiring blood drawing and laboratory workup.<bold>Study Design and Methods: </bold>Noninvasive ZnPP (ZnPP-NI) measurements are compared to ZnPP reference determination of the ZnPP/heme ratio by high-performance liquid chromatography (ZnPP-HPLC) and the analytical performance in detecting IDE is evaluated against traditional iron status parameters (ferritin, transferrin saturation [TSAT], soluble transferrin receptor-ferritin index [sTfR-F], soluble transferrin receptor [sTfR]), likewise measured in blood. The study was conducted at the University Hospitals of Frankfurt and Zurich.<bold>Results: </bold>Limits of agreement between ZnPP-NI and ZnPP-HPLC measurements for 584 cardiac and noncardiac surgical patients equaled 19.7 μmol/mol heme (95% confidence interval, 18.0-21.3; acceptance criteria, 23.2 μmol/mol heme; absolute bias, 0 μmol/mol heme). Analytical performance for detecting IDE (inferred from area under the curve receiver operating characteristics) of parameters measured in blood was: ZnPP-HPLC (0.95), sTfR (0.92), sTfR-F (0.89), TSAT (0.87), and ferritin (0.67). Noninvasively measured ZnPP-NI yielded results of 0.90.<bold>Conclusion: </bold>ZnPP-NI appears well suited for an initial IDE screening, informing on the state of erythropoiesis at the point of care without blood drawing and laboratory analysis. Comparison with a multiparameter IDE test revealed that ZnPP-NI values of 40 μmol/mol heme or less allows exclusion of IDE, whereas for 65 μmol/mol heme or greater, IDE is very likely if other causes of increased values are excluded. In these cases (77% of our patients) ZnPP-NI may suffice for a diagnosis, while values in between require analyses of additional iron status parameters.
- Subjects
FRANKFURT am Main (Germany); IRON deficiency; IRON deficiency anemia; TRANSFERRIN receptors; RECEIVER operating characteristic curves; HIGH performance liquid chromatography; REVERSE phase liquid chromatography; PHLEBOTOMY; CELL receptors; COMPARATIVE studies; ERYTHROPOIESIS; FERRITIN; CARDIAC surgery; IRON; RESEARCH methodology; MEDICAL cooperation; PORPHYRINS; PREOPERATIVE care; RESEARCH; ELECTIVE surgery; TRANSFERRIN; EVALUATION research; BLOOD
- Publication
Transfusion, 2020, Vol 60, Issue 1, p62
- ISSN
0041-1132
- Publication type
journal article
- DOI
10.1111/trf.15577