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BMC Medicine

, 12:229

Medicine for Global Health

Abstract

BackgroundIron-deficient erythropoiesis results in excess formation of zinc protoporphyrin ZPP, which can be measured instantly and at low assay cost using portable haematofluorometers. ZPP is used as a screening marker of iron deficiency in individual pregnant women and children, but also to assess population iron status in combination with haemoglobin concentration. We examined associations between ZPP and disorders that are common in Africa. In addition, we assessed the diagnostic utility of ZPP measured in whole blood and erythrocytes, alone or in combination with haemoglobin concentration, in detecting iron deficiency plasma ferritin concentration <15 μg-L.

MethodsSingle blood samples were collected from a population sample of 470 rural Kenyan women with singleton pregnancies, gestational age 13 to 23 weeks, and haemoglobin concentration ≥90 g-L. We used linear regression analysis to assess associations between ZPP and iron markers including anaemia, factors known or suspected to be associated with iron status, inflammation markers plasma concentrations of C-reactive protein and α1-acid glycoprotein, infections Plasmodium infection, HIV infection, and other disorders α-thalassaemia, plasma concentrations of total bilirubin, and lactate dehydrogenase. Subsequently, in those without inflammation, Plasmodium infection, or HIV infection, we used logistic discriminant analysis and examined receiver operating characteristics curves with corresponding area-under-the-curve to assess diagnostic performance of ZPP, alone and in combination with haemoglobin concentration.

ResultsIndividually, whole blood ZPP, erythrocyte ZPP, and erythrocyte protoporphyrin had limited ability to discriminate between women with and without iron deficiency. Combining each of these markers with haemoglobin concentration had no additional diagnostic value. Conventional cut off points for whole blood ZPP >70 μmol-mol haem resulted in gross overestimates of the prevalence of iron deficiency.

ConclusionsErythrocyte ZPP has limited value to rule out iron deficiency when used for screening in conditions with a low prevalence e.g., 10%. ZPP is of unreliable diagnostic utility when discriminating between pregnant women with and without iron deficiency. Based on these findings, guidelines on the use of ZPP to assess iron status in individuals or populations of pregnant women need review.

Trial registrationNCT01308112 2 March 2011.

KeywordsErythrocyte protoporphyrin Iron deficiency Kenya Malaria Plasmodium Pregnancy Zinc protoporphyrin AbbreviationsAGPα1-acid glycoprotein

AUCArea-under-the-curve

CRPC-reactive protein

EPErythrocyte protoporphyrin

FEPFree erythrocyte protoporphyrin

HRP2Histidine-rich protein-2

IPTIntermittent preventive treatment

pLDHPlasmodium lactate dehydrogenase

ROCReceiver operating characteristics

WHOWorld health organization

ZPPZinc protoporphyrin

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-014-0229-8 contains supplementary material, which is available to authorized users.

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Autor: Martin N Mwangi - Sumi Maskey - Pauline EA Andang’o - Noel K Shinali - Johanna M Roth - Laura Trijsburg - Alice M Mw

Fuente: https://link.springer.com/



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