42 Trakia Journal of Sciences, Vol. 12, Suppl. 1, 2014 Trakia Journal of Sciences, Vol. 12, Suppl. 1, pp 42-45, 2014 Copyright © 2014 Trakia University Available online at: http://www.uni-sz.bg ISSN 1313-7050 (print) ISSN 1313-3551 (online) SOLUBLE TRANSFERRIN RECEPTOR-FERRITIN INDEX IN THE DIAGNOSIS OF ANEMIA OF CHRONIC DISEASE IN PATIENTS WITH DIABETES G. Delcheva 1* , K. Stefanova 1 , A. Maneva 1 , D. Iliev 2 , T. Deneva 3 , M. Orbetzova 2 1 Department of Chemistry and Biochemistry, Faculty of Pharmacy, Medical University, Plovdiv, Bulgaria 2 Second Department of Internal Medicine, Section of Endocrinology, Medical University, Plovdiv, Bulgaria 3 Department of Clinical Laboratory, Faculty of Pharmacy, Medical University, Plovdiv, Bulgaria ABSTRACT The aim of the present research is to investigate the efficiency of sTfR, ferritin and the ratio sTfR/log ferritin (sTfR-ferritin index) in the diagnosis of anemia of chronic disease (ACD) in patients with diabetes mellitus and healthy controls. The patientsʼ blood samples were taken from the University Hospital of the Medical University – Plovdiv. The serum levels of sTfR and ferritin were determined with commercially available ELISA kits. The measurements of sTfR and ferritin are reliable markers of iron deficiency anemia (IDA) and the calculation of the ratio sTfR/log ferritin can be used also to evaluate ACD. In diabetic patients sTfR is 0.866 (0.694 ÷ 1.201) and in healthy controls is 0.781 (0.585 ÷ 0.914), (p = 0.017) while ferritin is 125.76 (16.2 ÷ 358.85) and 31.21 (17.9 ÷ 54.2), (p = 0.014) respectively. The sTfR-ferritin index in diabetic patients is 0.423 (0.275 ÷ 0.638) and in the healthy controls it is 0.4 99 (0.378 ÷ 0.602), (p = 0.222). The same parameters are investigated separating the patients according to the CRP level. In the group with increased CRP (>8) the concentration of ferritin is significantly higher (p = 0.03). In this group the sTfR-ferritin index is with 27 % higher than the group with normal CRP (≤8). In contrast to rheumatoid arthritis occuring with acute inflammation where this index can be used for parameter confirming IDA, in diabetes we didn’t find significant difference between the gr oup with normal and increased CRP. Possible explanation of this fact is the low inflammation activity in diabetes where the determination of sTfR is more informative as a parameter for pure iron deficiency. Key words: anemia of chronic disease, sTfR, ferritin, sTfR/log ferritin, diabetes, CRP INTRODUCTION Iron deficiency anemia can be caused both by decreased dietary intake or by iron malabsorption (1). Ferritin and sTfR are reliable and used markers for evaluation of iron deficiency. sTfR is a truncated form of the tissue receptor and exists as a transferrin – receptor complex (1, 2). Increased synthesis of TfR reflects iron requirement and iron depletion results in its induction. Insulin is known to cause a rapid iron uptake by fat cells, redistributing TfRs from the intracellular environment to the ___________________________ *Correspondence to: Ginka Delcheva, Medical University, Plovdiv, 15A Vassil Aprilov blvd., Tel: 032 602 538, ginkaaivazova@yahoo.com cell surface (1, 2). Insulin also stimulates the liver iron transport and accumulation that results in increased ferritin biosynthesis (3). The synthesis of ferritin and TfR is regulated reciprocally at posttranscriptional level according to the cellular iron status (4). The levels of sTfR are proportional to: the cellular iron status, the cellular expression of the membrane TfR and the concentration of sTfR is related to cellular iron demands – the higher ferritin level, the lower is the sTfR concentration (2, 4, 5). Iron plays a significant role in the development of diabetes and its complications (6). The purpose of the present research is to evaluate the efficiency the efficiency of sTfR,