Transferrin, Acute-Phase Protein

What sample is needed for Transferrin?

1. The patient’s blood is needed to prepare serum.
2. Try to analyze the fresh sample.
3. Can store at 4 °C for <72 hours.
4. When stored at -20 °C, it is stable for 6 months.

What are the precautions for Transferrin?

1. Avoid hemolysis because the RBC contains iron.
2. Avoid lipemic serum.

What are the indications for Transferrin?

1. Differential diagnosis of anemia.
2. Monitoring of treatment of iron deficiency anemia.
3. As acute phase protein.

What is the role of Transferrin as an acute-phase protein?

How will you define transferrin as an acute-phase protein?

1. During infections or inflammation, transferrin is considered a negative acute-phase protein.
2. Its concentration changes in the blood in response to the body’s immune status.

What is the mechanism of transferrin as an acute-phase protein?

1. There is the release of inflammatory cytokines:
   1. Interleukin-6.
   2. Tumor necrosis factor-alpha.
2. It leads to the activation and enhanced functions of the immune cells.
3. Stimulate more synthesis of transferrin.
4. Iron is needed for the host defense.
5. It can bind to bacteria and viruses and prevent their growth.
6. It helps in clearance by the immune system.

What is the role of Transferrin as an acute-phase protein?

1. This is decreased in acute inflammation and raised in chronic conditions.
   1. This acts as an acute-phase protein.
2. Its high level relates to the ability of the body to fight against the infection.

Pathophysiology of Transferrin

1. Transferrin is a major beta-globulin (glycoprotein). This is an iron-carrying protein.
   1. This is also called siderophilin.

2. The transferrin transports the Ferric ion (Fe+++); normally, there is 20% to 30% saturation, increasing in iron-deficiency anemia.
   1. One molecule of transferrin binds two ions of iron.
   2. Ferrous ions bind more rapidly than ferric ions.
   3. It changes in color from colorless to pink.

3. The liver synthesizes the transferrin, and this will bind the iron.
4. This is synthesized in the liver and depends on its demands in anemia.

5. Transferrin can be lost in the urine because of its small molecular size.
   1. More loss in severe proteinuria.
6. CSF also contains a small amount of transferrin.
   1. Its function in the CSF is not known.
   2. This can be used as a marker in the case of CSF leakage.
7. RBC has a receptor for transferrin. These receptors are also present in the lymphocytes.

What is the effect of Transferrin in various conditions?

1. In the case of iron deficiency anemia, the transferrin level increases.
2. There is a low level of transferrin in the case of malignancy and inflammation.

What is the function of Transferrin?

1. This transports iron.
2. It regulates the absorption of iron.
3. It protects against the toxic effects of iron.

Transferrin saturation is a better index of iron saturation.

1. 1. Transferrin saturation % = serum iron x 100 / TIBC

Normal  Transferrin level

• o to 4 days           =  130 to 275 mg/dL
• 3 months to 16 years = 203 to 360 mg/dL
• 16 to 60 years     =
  •  male         = 215 to 365 mg/dL
  •   female     =  250 to 380 mg/dL
• 60 to 90 years    =  190 to 375 mg/dL
• >90 years = 186 to 347 mg/dL
• Another source
  • Male = 215 to 365 mg/dL
  • Female = 250 to 380 mg/dL
  • Newborn = 130 to 275 mg/dL
  • Child = 203 to 360 mg/dL
• Source 4
  • Adult = 250 to 425 mg/dL  (2.5 to 4.2 g/L)
  • Children = 203 to 360 mg/dL (2.0 to 3.6 g/L)
  • Newborn = 130 to 275 mg/dL (1.3 to 2.7 g/L)
• Transferrin saturation:
  • Male = 20% to 50%.
  • Female = 15% to 50%

What causes an increase in the Transferrin level?

1. Iron deficiency anemia.
2. In pregnancy.
3. Use of oral contraceptives or estrogen therapy.

What causes a decrease in the Transferrin level?

1. In protein malnutrition.
2. In protein loss from burns.
3. In iron overload diseases (hemochromatosis).
4. In acute and chronic diseases.
5. Acute liver diseases.
6. Renal diseases like nephrosis.
7. The absence of transferrin is seen in the genetic disorder called Atransferrinemia.
   1. It is characterized by anemia and hemosiderosis.
   2. Hemosiderosis is seen in the liver and heart.

Value for the layman:

• Transferrin is advised when the patient has anemia (decreased hemoglobin).
• This is a better test for evaluating anemia, iron deficiency, thalassemia, sideroblastic anemia, and hemochromatosis.

Questions and answers: