{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:12:27Z","timestamp":1791526347332,"version":"4.3.4"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T00:00:00Z","timestamp":1573430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Approximately every third surgical patient is anemic. The most common form, iron deficiency anemia, results from persisting iron\u2010deficient erythropoiesis (IDE). Zinc protoporphyrin (ZnPP) is a promising parameter for diagnosing IDE, hitherto requiring blood drawing and laboratory workup.<\/jats:p><\/jats:sec><jats:sec><jats:title>STUDY DESIGN AND METHODS<\/jats:title><jats:p>Noninvasive ZnPP (ZnPP\u2010NI) measurements are compared to ZnPP reference determination of the ZnPP\/heme ratio by high\u2010performance liquid chromatography (ZnPP\u2010HPLC) and the analytical performance in detecting IDE is evaluated against traditional iron status parameters (ferritin, transferrin saturation [TSAT], soluble transferrin receptor\u2013ferritin index [sTfR\u2010F], soluble transferrin receptor [sTfR]), likewise measured in blood. The study was conducted at the University Hospitals of Frankfurt and Zurich.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Limits of agreement between ZnPP\u2010NI and ZnPP\u2010HPLC measurements for 584 cardiac and noncardiac surgical patients equaled 19.7 \u03bcmol\/mol heme (95% confidence interval, 18.0\u201321.3; acceptance criteria, 23.2 \u03bcmol\/mol heme; absolute bias, 0 \u03bcmol\/mol heme). Analytical performance for detecting IDE (inferred from area under the curve receiver operating characteristics) of parameters measured in blood was: ZnPP\u2010HPLC (0.95), sTfR (0.92), sTfR\u2010F (0.89), TSAT (0.87), and ferritin (0.67). Noninvasively measured ZnPP\u2010NI yielded results of 0.90.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>ZnPP\u2010NI 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\u2010NI values of 40\u2009\u03bcmol\/mol heme or less allows exclusion of IDE, whereas for 65\u2009\u03bcmol\/mol heme or greater, IDE is very likely if other causes of increased values are excluded. In these cases (77% of our patients) ZnPP\u2010NI may suffice for a diagnosis, while values in between require analyses of additional iron status parameters.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.15577","type":"journal-article","created":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T13:00:04Z","timestamp":1573477204000},"page":"62-72","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Screening for iron deficiency in surgical patients based on noninvasive zinc protoporphyrin measurements"],"prefix":"10.1111","volume":"60","author":[{"given":"Christoph","family":"F\u00fcllenbach","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt Goethe University  Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Stein","sequence":"additional","affiliation":[{"name":"Institute 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