The soluble transferrin receptor in dysplastic erythropoiesis in myelodysplastic syndrome

Objectives: In individuals without iron deficiency, the soluble transferrin receptor (sTfR) directly reflects the erythropoietic activity. This study investigated sTfR concentrations in ineffective, dysplastic erythropoiesis in myelodysplastic syndrome (MDS). Methods: To exclude influences of other myeloid cells on sTfR, only patients with refractory anemia (RA), refractory anemia with ringed sideroblasts (BARS) and 5q(-) syndrome were included. sTfR was measured nephelometrically (normal range 0.81-1.75 mg/L). Results: Thirty-four untreated MDS patients (RA = 14, BARS = 10, 5q(-) syndrome = 10) were enrolled and analysed. The mean sTfR value of all MDS patients (1.30 +/- 0.8 mg/L, range 0.2-3.8) did not differ from our control group. In 5q(-) syndrome, the mean sTfR concentration (0.80 +/- 0.5 mg/L) was significantly lower than in RA (1.32 +/- 0.4 mg/L, P = 0.02) and BARS (1.75 +/- 1.1 mg/L, P = 0.03). Subdividing MDS according to their amount of erythroid mass in bone marrow a significant difference of sTfR between patients with decreased (0.70 +/- 0.4 mg/L), normal (1.32 0.4 mg/L) and increased (2.06 +/- 0.9 mg/L) erythropoiesis was observed. MDS patients with sTfR values below the reference range of 0.81 mg/L required transfusions in 90% of cases and showed higher erythropoietin levels compared to MDS patients with sTfR levels >= 0.81 mg/L (P = 0.01). There was a good agreement between sTfR and the amount of polychromatic erythroblasts observed (r = 0.68, P < 0.001). Conclusion: In conclusion, the serum concentration of sTfR reflects erythropoietic activity in MDS, but it is in particular determined by the degree of erythroid maturation and the severity of ineffective erythropoiesis. Low sTfR values in MDS are associated with a reduced, poorly differentiated erythropoiesis and requirement of blood transfusions.