Diagnostic utility of zinc protoporphyrin to detect iron deficiency in Kenyan pregnant women

BMC Medicine

Hans Verhoef¹  Ayşe Y Demir²  Huub FJ Savelkoul⁴  Barend van Lagen⁶  Han Zuilhof⁶  Alice M Mwangi³  Laura Trijsburg⁴  Johanna M Roth⁴  Noel K Shinali⁵  Pauline EA Andang’o⁵  Sumi Maskey⁴  Martin N Mwangi⁴ 

[1] MRC Keneba, Private Bag, London, The Gambia, UK;Meander Medical Centre, Laboratory for Clinical Chemistry, Maatweg 3, Amersfoort, 3813 TZ, The Netherlands;Department of Food Technology and Nutrition, University of Nairobi, College of Agriculture and Veterinary Sciences, Applied Nutrition Programme, Uthiru, Nairobi, Kenya;Wageningen University, Cell Biology and Immunology Group, Wageningen, 6700 AH, The Netherlands;Maseno University, School of Public Health and Community Development, Private Bag, Maseno, Kenya;Wageningen University, Laboratory for Organic Chemistry, Dreijenplein 8, Wageningen, 6703 HB, The Netherlands

关键词: Zinc protoporphyrin;    Pregnancy;    Plasmodium;    Malaria;    Kenya;    Iron deficiency;    Erythrocyte protoporphyrin;   

Others  :  1118156
DOI  :  10.1186/s12916-014-0229-8

 received in 2014-07-21, accepted in 2014-11-06,  发布年份 2014

【 摘 要 】

Background

Iron-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).

Methods

Single 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.

Results

Individually, 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.

Conclusions

Erythrocyte 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 registration

NCT01308112 webcite (2 March 2011).

【 授权许可】

   
2014 Mwangi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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