TY  - JOUR
A1  - Füllenbach, Christoph
A1  - Stein, Philipp
A1  - Glaser, Patricia
A1  - Triphaus, Chris
A1  - Lindau, Simone
A1  - Choorapoikayil, Suma
A1  - Schmitt, Elke
A1  - Zacharowski, Kai
A1  - Hintereder, Gudrun
A1  - Hennig, Georg
A1  - Homann, Christian
A1  - Stepp, Herbert
A1  - Spahn, Gabriela H.
A1  - Kaserer, Alexander
A1  - Schedler, Andreas
A1  - Meybohm, Patrick
A1  - Spahn, Donat Rudolf
T1  - Screening for iron deficiency in surgical patients based on noninvasive zinc protoporphyrin measurements
T2  - Transfusion
N2  - Background: 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.
Study design and methods: 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.
Results: 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.
Conclusion: 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.
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/52548
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-525482
SN  - 1537-2995
SN  - 0041-1132
N1  - This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
VL  - 60
IS  - 1
SP  - 62
EP  - 72
PB  - Wiley-Blackwell
CY  - Oxford [u. a.]
ER  -