Peripheral CD71+ erythroid cells as markers of ineffective erythropoiesis in β-thalassemia major

Abstract: BACKGROUND: Transferrin receptor 1, commonly referred to as cluster of differentiation 71 (CD71), is a crucial glycoprotein that mediates the cellular uptake of iron, avails as a substantial index of erythroid growth and iron metabolism, and typically exists in erythroid lineage cells within the bone marrow. We investigated the expression of CD71 in the peripheral blood of patients with transfusion-dependent beta-thalassemia major (βTM). OBJECTIVES: This study examines the distinct role of CD71 in erythropoiesis, particularly in the context of βTM, and highlights its relevance in studying peripheral blood CD71 levels and their association with clinical and demographic criteria in Iraqi patients with βTM. MATERIALS AND METHODS: This case–control study consisted of 60 βTM patients and 28 healthy controls (matched for age and sex), and they were evaluated. Samples of peripheral blood were examined by flow cytometry using anti-CD71 and anti-CD235a. Complete blood count, serum ferritin (SF), and liver function tests were assessed for all participants. Statistical associations with demographic, clinical, and laboratory parameters were examined. RESULTS: The CD71 expression range was notably greater in patients (0.17%–18.20%) compared to controls (0.08%–0.19%), with a statistically significant difference ( P = 0.0001). Thirty percent of patients exhibited <1% expression. Higher levels were found in splenectomized patients compared to splenomegaly patients, and in males compared to females. Positive correlations were identified with white blood cells, platelets, and liver transaminase enzymes. No correlations were found with hemoglobin, red blood cells, alkaline phosphatase, total serum bilirubin, or SF. CONCLUSIONS: CD71 expression is a critical marker of ineffective erythropoiesis in βTM, affected by splenic status, gender, adherence to blood transfusion schedules, and correlates with various hematological and liver parameters. Incorporating CD71 into routine assessment may enhance the evaluation of disease activity and guide individualized prognosis and management in transfusion-dependent thalassemia patients.