Soluble Transferrin Receptor

Anemia

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No Fasting Required

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Marker of iron deficiency.

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Soluble Transferrin Receptor Test Information Guide

Why is it done?
- Measures the level of soluble transferrin receptors in the blood, which reflect the body's iron status and erythropoietic activity
- Distinguishes between iron deficiency anemia and anemia of chronic disease
- Evaluates iron metabolism and iron stores in patients with suspected iron deficiency
- Assesses bone marrow function and erythroid activity in various hematologic disorders
- Monitors iron status in patients with chronic kidney disease on dialysis
- Evaluates response to iron therapy and erythropoiesis-stimulating agents
- Ordered when patients present with symptoms of anemia such as fatigue, weakness, or dyspnea
Normal Range
- Normal Values: 0.9 - 2.8 mg/L (micrograms/L) or 9.0 - 28.0 nmol/L, depending on laboratory and methodology
- Units of Measurement: mg/L, nmol/L, or µg/L depending on laboratory reporting
- Normal Range Interpretation: Values within this range generally indicate adequate iron stores and normal erythroid activity
- Elevated Values: >2.8 mg/L indicates iron deficiency or increased erythropoietic demand
- Low Values: <0.9 mg/L may indicate iron overload or suppressed erythropoiesis
- Important Note: Reference ranges vary by laboratory; consult your lab's specific values for accurate interpretation
Interpretation
- Elevated sTfR with Low Ferritin: Consistent with iron deficiency anemia; indicates increased iron demand for red blood cell production
- Elevated sTfR with Normal/High Ferritin: Suggests increased erythropoietic activity or may indicate iron deficiency coexisting with anemia of chronic disease or inflammation
- Normal/Low sTfR with Elevated Ferritin: Suggests anemia of chronic disease or iron overload; ferritin is acting as an acute phase reactant
- sTfR Index Calculation: sTfR/Log(ferritin) ratio >2 highly specific for iron deficiency; ratio <1 suggests anemia of chronic disease
- Low sTfR: May indicate secondary hemochromatosis, iron overload, suppressed erythropoiesis, or aplastic anemia
- Factors Affecting Results: Inflammation, infection, malignancy, and chronic kidney disease can elevate ferritin independently; sTfR is less affected by these conditions making it superior for assessing iron status in these scenarios
- Clinical Significance: sTfR directly reflects the body's need for iron and is superior to ferritin alone for iron status assessment, particularly in patients with concurrent inflammatory conditions or chronic diseases
Associated Organs
- Primary Organ Systems: Bone marrow (erythropoiesis), gastrointestinal tract (iron absorption), liver (iron storage and transferrin production), kidneys (erythropoietin production)
- Diseases Associated with Elevated sTfR: Iron deficiency anemia, hemolytic anemia, polycythemia vera, thalassemia, hereditary spherocytosis, sickle cell disease, and myelodysplastic syndromes
- Conditions with Normal/Low sTfR: Anemia of chronic disease, aplastic anemia, hemochromatosis, iron overload, hypothyroidism, and suppressed erythropoiesis
- Chronic Kidney Disease: Elevated sTfR may persist in dialysis patients despite low ferritin, indicating true iron deficiency requiring intervention
- Gastrointestinal Disorders: Celiac disease, Crohn's disease, ulcerative colitis, and malabsorption syndromes result in elevated sTfR due to decreased iron absorption
- Potential Complications: Untreated iron deficiency can lead to severe anemia, impaired cognitive development, decreased immune function, and increased cardiovascular risk; iron overload causes organ damage including cirrhosis, cardiomyopathy, and diabetes
Follow-up Tests
- Recommended Complementary Tests: Serum ferritin, serum iron, total iron-binding capacity (TIBC), complete blood count (CBC) with differential, peripheral blood smear
- Iron Metabolism Panel: If abnormal sTfR, order complete iron panel to assess transferrin saturation and calculate sTfR index for better differentiation
- Assessment of Anemia Etiology: Reticulocyte count, hemoglobin electrophoresis, vitamin B12 and folate levels, thyroid function tests, inflammatory markers (CRP, ESR)
- Renal Function Assessment: Creatinine, blood urea nitrogen (BUN), glomerular filtration rate (GFR) if chronic kidney disease is suspected
- Gastrointestinal Evaluation: Tissue transglutaminase (tTG-IgA) for celiac disease, fecal occult blood test for GI bleeding if iron deficiency suspected
- Monitoring During Treatment: Repeat sTfR measurement 2-4 weeks after initiating iron therapy to assess response; CBC monitoring every 2-4 weeks during treatment
- Long-term Surveillance: Annual sTfR and iron panel assessment in patients with chronic conditions affecting iron metabolism; quarterly monitoring for dialysis patients
- Genetic Testing: HFE gene testing if hereditary hemochromatosis is suspected based on elevated iron studies
Fasting Required?
- Fasting Requirement: No, fasting is not required for soluble transferrin receptor testing
- Timing Considerations: Blood can be drawn at any time of day; however, consistency in timing is recommended for serial monitoring to reduce biological variation
- Sample Collection: Standard venipuncture into serum separator tube (SST) or EDTA tube depending on laboratory protocol; no special handling required
- Medications to Note: Inform phlebotomist of current iron supplements or medications; sTfR is not significantly affected by iron therapy but ferritin may be, requiring interpretation context
- Pre-test Instructions: No special preparation required; patient may eat and drink normally; wear comfortable clothing for blood draw
- Test Processing: Most laboratories can process samples same-day with results available within 24-48 hours; specialized testing may require referral to reference laboratory

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