Serum Transferrin Receptor Concentrations Research Articles

Source and level of dietary iron influence semen quality by affecting inflammation, oxidative stress and iron utilization levels in boars

BackgroundBoars fed a mixed form of inorganic and organic iron in excess of the NRC recommended levels still develop anemia, which suggested that the current level and form of iron supplementation in boar diets may be inappropriate. Therefore, 56 healthy Topeka E line boars aged 15–21 months were randomly divided into 5 groups: basal diet supplemented with 96 mg/kg ferrous sulfate (FeSO4) and 54 mg/kg glycine chelated iron (Gly-Fe, control); 80 mg/kg or 115 mg/kg Gly-Fe; 80 mg/kg or 115 mg/kg methionine hydroxyl analogue chelated iron (MHA-Fe, from Calimet-Fe) for 16 weeks. The effects of dietary iron supplementation with different sources and levels on semen quality in boars were investigated.Results1) Serum Fe and hemoglobin concentrations were not affected by reduced dietary iron levels in the 80 mg/kg or 115 mg/kg Gly-Fe and MHA-Fe groups compared with the control group (P > 0.05). 2) Serum interleukin-6 (IL-6) and sperm malondialdehyde (MDA) levels in the 80 mg/kg or 115 mg/kg MHA-Fe groups were lower than those in the control group (P < 0.05), and higher serum superoxide dismutase levels and lower MDA levels in the 115 mg/kg MHA-Fe group (P < 0.05). 3) Boars in the 80 mg/kg or 115 mg/kg Gly-Fe and MHA-Fe groups had lower serum hepcidin (P < 0.01), ferritin (P < 0.05), and transferrin receptor (P < 0.01) concentrations, and boars in the 115 mg/kg MHA-Fe group had higher seminal plasma Fe concentrations compared with the control group. 4) Boars in the 80 mg/kg and 115 mg/kg MHA-Fe groups had lower abnormal sperm rate and in situ oscillating sperm ratio compared to the control group at weeks 12 and/or 16 of the trial. However, the effect of Gly-Fe on improving semen quality in boars was not evident. 5) Serum IL-6 level was positively correlated with hepcidin concentration (P < 0.05), which in turn was significantly positively correlated with abnormal sperm rate (P < 0.05). Furthermore, significant correlations were also found between indicators of iron status and oxidative stress and semen quality parameters.ConclusionsDietary supplementation with 80 mg/kg or 115 mg/kg MHA-Fe did not induce iron deficiency, but rather reduced serum inflammatory levels and hepcidin concentration, alleviated oxidative stress, increased body iron utilization, and improved semen quality in adult boars.

Factors associated with anaemia status and haemoglobin concentrations in infants 6-11 months in Mbala district, northern province, Zambia

This paper presents information on the factors associated with anaemia status and haemoglobin concentrations in infants 6-11 months old in Mbala District, Northern Province, Zambia. The information is drawn from the baseline data collection of a study involving 631 caregiver-child pairs. The data presented here includes anthropometry, malaria parasitism, concentrations of haemoglobin (Hb) and serum transferrin receptor (STfR), and information on household characteristics, infant and young child feeding (IYCF) practices, and morbidity, gathered via questionnaire. It was found that 57% of the sample was anaemic (Hb 8.3 mg/L) and 53% had iron deficiency anaemia. Overall, 30% of the infants in the sample were stunted, 2% were wasted, and 16% were underweight, and 22%, 56% and 18% of infants were meeting minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, respectively, and 28% consumed iron rich foods in the previous 24 hours. Infants who had achieved a minimum dietary diversity score (OR = 0.44; 95% CI: 0.30-0.65), who had consumed iron rich foods in the previous 24 hours (OR = 0.56; 95% CI: 0.40-0.80), or were female (OR = 0.69; 95% CI: 0.50-0.94), had significantly lower risks of being anaemic. Infants that tested positive for malaria parasitism (OR = 4.33; 95% CI: 2.16- 8.70), as well as those having a fever (OR = 1.88; 95% CI: 1.36-2.59) in the previous two weeks had significantly greater odds of being anaemic. Despite these associations, whether or not a child slept under a mosquito net was not related to their risk of being anaemic. Infants in households that treated their water to make it safer to consume had average haemoglobin concentrations 3 g/L higher than those who did not (p = 0.021), but this did not translate into a significant difference in the odds of being anaemic. These results shed light on the specific causes of anaemia in the Zambian context, and illustrate the importance of improving dietary quality, specifically the intake of iron, and reducing the prevalence of diseases including malaria in order to reduce the prevalence of anaemia.

Subclinical inflammation influences the association between vitamin A- and iron status among schoolchildren in Ghana.

Background and objectiveIn resource-poor settings, micronutrient deficiencies such as vitamin A deficiency may co-exist with iron-deficiency. In this study we assessed the iron and vitamin A status of schoolchildren and the association between vitamin A and iron status.MethodsA cross-sectional design using the baseline data of a dietary intervention trial conducted among randomly selected 5–12 years old schoolchildren (n = 224) from 2 rural schools in northern Ghana. Hemoglobin (Hb), serum ferritin (SF) and serum transferrin receptor (sTfR) concentrations were used as measures of iron status. Retinol binding protein (RBP) was used as a measure of vitamin A status. Subclinical inflammation (SCI) was measured using C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations. We examined the cross-sectional association between vitamin A and iron status biomarkers with multiple linear regressions.ResultsThe proportions of schoolchildren with anemia (WHO criteria), iron-deficiency (ID, SF <15μg/l and/or sTfR >8.5mg/l) and iron-deficiency anemia (IDA, concurrent anemia and ID) were 63.8%, 68.3% and 46.4% respectively. Low or marginal vitamin A status (0.70 μmol/l ≤ RBP < 1.05μmol/l) was present in 48.2% while 37.5% of the schoolchildren had vitamin A deficiency (VAD, RBP <0.70 μmol/l). The prevalence of SCI as well as concurrent VAD and ID were 48.7% and 25% respectively. RBP was associated with Hb (β = 7.2, P = 0.05) but not SF (β = 20.7, P = 0.33) and sTfR concentration (β = 12.0, P = 0.63). In the presence of SCI, RBP was not associated with hemoglobin status but a significant positive association was observed among children without SCI.ConclusionsThe study shows that RBP is significantly associated with Hb concentration but not with SF and sTfR. The observed relationship between RBP and Hb is only significant in the absence of SCI.

The effect of daily consumption of the small fish Amblypharyngodon mola or added vitamin A on iron status: a randomised controlled trial among Bangladeshi children with marginal vitamin A status.

Mola (Amblypharyngodon mola) is a nutrient-rich, small fish found in ponds and rice fields in Bangladesh. The aim of the present intervention was to assess the effect of mola consumption on iron status in children with marginal vitamin A status. Bangladeshi children (n=196), aged 3-7 years, with marginal vitamin A status were randomly allocated to one of three intervention groups served different fish curries: mola curry (experimental group); rui (Labeo rohita) curry with added retinyl palmitate (positive control group); or rui curry (negative control group). The intervention meals were served 6 days/week for 9 weeks. The experimental and positive control meals were designed to contain similar amounts of retinol activity equivalents per portion. The mola curry contained four times more iron compared to the rui curries due to different iron content in the two fish species. Haemoglobin, ferritin, serum transferrin receptor and Creactive protein were measured at screening and endpoint. In the experimental group receiving mola, serum transferrin receptor concentration declined 0.73 mg/L (95% CI 0.17, 1.28, p=0.01) compared to the positive control group, while there were no differences between groups in ferritin or haemoglobin. Consumption of mola instead of rui has potentially an effect on iron status in children with marginal vitamin A status, seen as a decrease in serum transferrin receptor concentration.

Erratum to: Inter-ethnic differences in genetic variants within the transmembrane protease, serine 6 (TMPRSS6) gene associated with iron status indicators: a systematic review with meta-analyses.

Transmembrane protease, serine 6 (TMPRSS6), is likely to be involved in iron metabolism through its pleiotropic effect on hepcidin concentrations. Recently, genome-wide association studies have identified common variants in the TMPRSS6 gene to be linked to anaemia and low iron status. To get a more precise evaluation of identified TMPRSS6 single nucleotide polymorphism associations with iron status in cohorts of differing continental ancestry, we conducted a systematic review with meta-analyses. We searched the literature using HuGE Navigator, Pubmed and Scopus databases for primarily genome-wide association studies using TMPRSS6 as a free term. Fixed-effects meta-analysis was used to obtain summary estimates of associations. Eleven studies comprised Caucasian populations, four included an Asian population and one study included an African-American population. Differences in minor allele frequencies of 8 TMPRSS6 SNPs (rs855791, rs4820268, rs2111833, rs1421312, rs228921, rs228918, rs228919 and rs575620) across ethnic groups were observed, with the MAF of rs855791 significantly higher in Asian populations than in Caucasians (0.55 vs 0.42, P < 0.0001). In the meta-analysis, the A allele of rs855791 was associated with lower Hb and ferritin concentrations in all populations. This allele was also associated with increased serum transferrin receptor and transferrin concentrations. We observed similar associations for the G allele in rs4820268. Clear disparities in associations were found for the African-American population, although not statistically significant. Associations between TMPRSS6 SNPs and anaemia are consistent across Caucasian and Asian populations. This study highlights the need to conduct studies in African populations where iron deficiency is of utmost public health significance.

Inter-ethnic differences in genetic variants within the transmembrane protease, serine 6 (TMPRSS6) gene associated with iron status indicators: a systematic review with meta-analyses.

Transmembrane protease, serine 6 (TMPRSS6), is likely to be involved in iron metabolism through its pleiotropic effect on hepcidin concentrations. Recently, genome-wide association studies have identified common variants in the TMPRSS6 gene to be linked to anaemia and low iron status. To get a more precise evaluation of identified TMPRSS6 single nucleotide polymorphism associations with iron status in cohorts of differing continental ancestry, we conducted a systematic review with meta-analyses. We searched the literature using HuGE Navigator, Pubmed and Scopus databases for primarily genome-wide association studies using TMPRSS6 as a free term. Fixed-effects meta-analysis was used to obtain summary estimates of associations. Eleven studies comprised Caucasian populations, four included an Asian population and one study included an African-American population. Differences in minor allele frequencies of 8 TMPRSS6 SNPs (rs855791, rs4820268, rs2111833, rs1421312, rs228921, rs228918, rs228919 and rs575620) across ethnic groups were observed, with the MAF of rs855791 significantly higher in Asian populations than in Caucasians (0.55 vs 0.42, P<0.0001). In the meta-analysis, the A allele of rs855791 was associated with lower Hb and ferritin concentrations in all populations. This allele was also associated with increased serum transferrin receptor and transferrin concentrations. We observed similar associations for the G allele in rs4820268. Clear disparities in associations were found for the African-American population, although not statistically significant. Associations between TMPRSS6 SNPs and anaemia are consistent across Caucasian and Asian populations. This study highlights the need to conduct studies in African populations where iron deficiency is of utmost public health significance.

Iron Deficiency in Pediatric Patients in Long-Term Risperidone Treatment

Atypical antipsychotics, increasingly used in children and adolescents, modulate brain dopamine. Iron plays a critical role in dopaminergic signaling. Therefore, we explored whether body iron status is related to psychiatric symptom severity, treatment response, and tolerability following extended antipsychotic therapy. Between November 2005 and August 2009, medically healthy 7-17-year-old risperidone-treated participants enrolled in a cross-sectional study examining the long-term safety of this antipsychotic. Anthropometric measurements were obtained. Psychiatric symptom severity and dietary intake were assessed. Serum ferritin, transferrin receptor, and prolactin concentrations were measured. Linear multivariable regression analysis tested the association among body iron, symptom severity, the dose of risperidone and psychostimulants, and serum prolactin concentration. The sample consisted of 115 patients (87% males) with a mean (±SD) age of 11.6 (±2.8) years. The majority had externalizing disorders, and they had taken risperidone for 2.4 (±1.7) years. Body iron was low, with 45% having iron depletion and 14% having iron deficiency. Iron status was inversely associated with weight gain during risperidone treatment and with interleukin-6. Body iron was neither associated with psychiatric symptom severity nor with the daily dose of risperidone and psychostimulants. It was, however, inversely associated with prolactin concentration, which was nearly 50% higher in the iron-deficient group. Iron depletion and deficiency are prevalent in children and adolescents chronically treated with risperidone. Iron deficiency accentuates the antipsychotic-induced elevation in prolactin. Future studies should confirm this finding and investigate the potential benefit of iron supplementation in antipsychotic-treated patients.

Iron Status and Its Determinants in a Nationally Representative Sample of Pregnant Women

Iron-deficiency anemia is associated with adverse neonatal health outcomes. Iron status and its determinants were assessed in a representative sample of Belgian pregnant women. Blood samples were collected and a questionnaire was completed face-to-face. Hemoglobin (Hb) and mean cell volume were measured using a Beckman Coulter Hematology Analyzer and serum ferritin (SF) and transferrin receptor (sTfr) concentrations by immunoassay. In total, 55 obstetric clinics and 1,311 pregnant women were included. Approximately 40% of third-trimester and 6% of first-trimester women had SF levels less than 15 μg/L. Approximately 21% of third-trimester and 4% of first-trimester women had anemia (Hb <110 g/L). Of the third-trimester women, 23% were iron-deficient nonanemic (SF <15 μg/L and Hb ≥110 g/L), 16% had iron-deficiency anemia (SF <15 μg/L and Hb <110 g/L), and approximately 7% had tissue iron deficiency (sTfr >8.5 mg/L). The median body iron stores were 8.1 mg/kg among first-trimester women, but only 3.6 mg/kg among third-trimester women. SF levels were significantly positively associated with age and education level, and were higher among nulliparous women and lower among North-African women. sTfr concentrations were significantly negatively associated with age and were lower among smokers, nulliparous women, and women who planned their pregnancy. Despite the fact that two thirds of Belgian pregnant women took iron-containing supplements, iron deficiency and iron-deficiency anemia were frequent in third-trimester women. The World Health Organization regards this as a moderate public health problem. National iron supplementation guidelines are needed in Belgium to optimize iron status during pregnancy.

751 Are Infants of Diabetic Mothers More Prone to Iron Deficiency?

BackgroundIron deficiency during the fetal and neonatal (perinatal) period can result in dysfunction of multiple organ systems, some of which might not recover despite iron rehabilitation. The aim of the...

Pharmacokinetics, safety and tolerability of intravenous ferric carboxymaltose: a dose-escalation study in volunteers with mild iron-deficiency anaemia

Iron-deficiency anaemia (IDA) represents a major burden to public health worldwide. The therapeutic aim for patients with IDA is to return iron stores and haemoglobin (Hb) levels to within the normal range using supplemental iron therapy and erythropoiesis-stimulating agents. Oral and previous intravenous (i.v.) iron formulations have a number of disadvantages, including immunogenic reactions, oxidative stress, low dosages, long administration times and the requirement for a test dose. Ferric carboxymaltose (FCM, Ferinject) is a novel, next-generation i.v. iron formulation with the potential to overcome these limitations. In this single-centre, randomized, double-blind, placebo-controlled study, the pharmacokinetics (PK), pharmacodynamics (PD), safety and tolerability of single, escalating doses of FCM were investigated. Four ascending doses were investigated in a total of 24 patients with mild IDA (defined as serum ferritin < 20 microg/l and transferrin saturation [TfS] < 16%): 100 mg iron as FCM given as an i.v. bolus injection, and 500, 800 and 1000 mg iron as FCM given as an i.v. infusion over 15 min. At each dose level six patients received FCM and two received placebo. The decision to escalate to the next dose was based on evaluation of safety and tolerability data from the previous dose. The maximum duration of the study was 5 weeks from screening to final assessment. Assessments were made of PK iron-status parameters up to 168 h post-dose. Safety assessments included incidence of adverse events (AEs), clinical laboratory parameters and vital signs. PK and PD parameters were analysed using descriptive statistics. All analyses were performed on the safety population, which included all patients who received > or = 1 dose of study medication. Seventy-seven patients were screened and, of these, 32 male and female patients with pre-study Hb between 9.2 and 11.9 g/dl and serum ferritin < 20 microg/l were included in the study. Two patients had TfS > 16% (19.2% and 17.2%); both patients were considered by the investigator to be eligible for inclusion. Compared with placebo, a rapid, dose-dependent increase in total serum iron was observed across all dose groups. Mean (standard deviation) maximum total serum iron levels ranged between 36.9 (4.4) and 317.9 (42.3) microg/ml in the 100 and 1000 mg groups. Concentration-time curves of total serum iron continuously declined for up to 24 and 72 h post-dose in the 100 and 500-1000 mg groups, respectively. Non-compartmental analysis of PK parameters was truncated at 24 h (100 mg) and 72 h (500-1000 mg doses). A dose-dependent, but not dose-linear, increase in serum ferritin was seen in all treatment groups compared with placebo, with peak levels of a 23-210-fold increase above baseline occurring 48-120 h postdose. Iron-binding capacity was transiently almost fully utilized after doses of 500, 800 and 1000 mg (TfS > 95%). No meaningful changes in serum transferrin or serum transferrin receptor concentrations were observed during this study. The elimination pattern for FCM appeared to be mono-exponential; FCM was cleared from serum with a terminal halflife of approximately 7.4-12.1 h. The percentage of FCM excreted in urine was negligible (0.0005%). FCM was well tolerated; a total of 19 AEs were reported by 8/32 patients (25%), of which three were considered by the investigator to be related to FCM: nausea and vomiting (one patient [100 mg]), and headache (one patient [1000 mg]). The incidence of AEs did not increase with dose. No severe or serious AEs, or deaths occurred. FCM had no significant effect on laboratory safety parameters or vital signs. This study satisfactorily characterized the PK/PD parameters of single doses of 100, 500, 800 and 1000 mg iron as FCM. The majority of FCM was utilized or eliminated within 24 h of administration of a 100 mg dose and within 72 h of a 500-1000 mg dose. FCM was generally well tolerated across all doses in patients with mild IDA.

P2-351 Iron status and cardiovascular disease risk in black South African women: the pure study

ObjectiveTo examine the associations between measures of iron status and cardiovascular disease (CVD) risk factors in South African women.DesignThe study was cross-sectional in design. Demographic information and health history were...

Laboratory assessment of iron status in pregnancy

Efforts to improve maternal nutrition during pregnancy prompted an observational study of the occurrence of maternal iron deficiency and its laboratory diagnosis in almost 500 pregnancies. In this longitudinal study, the biochemical and haematological iron indices of women (n=492) attending a prenatal clinic in a Dublin maternity hospital were assessed at first booking (mean 15.9 weeks), and after 24 weeks, and 36 weeks of gestation. Full blood counts were measured. Serum ferritin (SF), zinc protoporphyrin (ZPP), and transferrin receptor (sTfR) concentrations were assayed and transferrin receptor index (sTfR-Index) was calculated. The occurrence of low values and their diagnostic values were considered. A high occurrence iron deficiency (ID) at first booking (SF<12 μg/L) had increased over six-fold by 24 weeks, and all biochemical iron indices reflected progressive iron depletion right up to term. The WHO recommended anaemia "cut-off" (Hb<110 g/L) was insensitive to biochemical iron deficiency at booking, missing over 90% of the low SF values (SF<12 μg/L) which were mostly associated with much higher Hb levels. This study stresses the importance of including a biochemical index of iron status in prenatal screening and supports SF as the best indicator of biochemical ID overall. sTfR was insensitive to iron deficiency in early pregnancy, whereas the sTfR-Index, as a ratio, has the potential to distinguish between ID and physiological anaemia, and may offer stability in the assessment of iron stores from early pregnancy to full term. A policy of early screening of both Hb and SF concentrations is recommended as the minimum requirement for surveillance of maternal iron status in pregnancy.

Serum hepcidin at mid‐gestation is not associated with neonatal hepcidin or maternal obesity among pregnant adolescents

Hepcidin is a systemic regulator of iron (Fe) homeostasis whose synthesis is increased in inflammatory conditions such as obesity. To assess determinants of hepcidin in pregnant adolescents, maternal and cord blood were obtained from a group of 93 pregnant teens (17.1 ± 1.1 y with prepregnancy BMI from 17.0 – 41.5 kg/m2). Serum ferritin (SF), transferrin receptor (sTfR) and hepcidin concentrations (by C-ELISA) were measured at mid-gestation (26.3 ± 3.5 wks) and in cord blood at delivery (39.8 ± 1.3 wks). Maternal weight gain across pregnancy averaged 17.4 ± 7.3 kg and ranged from −2.2 – 39.5 kg. Maternal hepcidin was significantly lower than neonatal hepcidin (32.1 ± 28.3 vs.132 ± 95.9 ng/mL, p<0.0001) but the two were not significantly correlated. Maternal hepcidin was significantly lower in adolescents with tissue Fe depletion (sTfR >8.5 mg/dL; p=0.009, n=78) and depleted Fe stores (ferritin < 20 ug/L; p=0.01, n=77) at mid-gestation. Unlike observations among non-pregnant women, no significant relationship was evident between maternal hepcidin and prepregnancy BMI or between those with a BMI < 30 vs.> 30 kg/m2 at term. The high iron demands of the pregnant adolescent and her developing fetus may override the effect of inflammation on hepcidin during pregnancy. USDA: 2005–35200 & 2008–0857

Iron status and cardiovascular disease risk in black South African women: the PURE study

Objective: To examine the associations between measures of iron status and cardiovascular disease (CVD) risk factors in South African women.Method: In a cross-sectional study, demographic information and health history were obtained during individual interviews using validated questionnaires in the North West Province, South Africa. Anthropometric indices, iron indices, blood pressure, blood glucose and lipid profiles were measured using standard procedures in 1 262 apparently healthy black South African women aged 35 years or older. Iron status was assessed using serum concentrations of ferritin, transferrin receptor (TfR) and TfR:ferritin ratio.Results: Associations between iron status parameters and CVD risk factors were generally weak (r < 0.3, p < 0.01) and were not retained when adjustment was made for age, body mass index, smoking, alcohol consumption and C-reactive protein in the analysis. Waist circumference (WC) and waist:hip ratio (WHR) were higher in the fourth quartile of serum ferritin than in the third quartile, and also in the third quartile compared to the second quartile (P < 0.05). Based on WC and WHR respectively, 31% and 52% of the women had excess abdominal obesity. The mean (95% confidence interval) serum TfR concentration was high, at 9.09 µg/ml (8.77, 9.44), indicating risk of iron deficiency. The mean (95% confidence interval) concentrations of lipids [total cholesterol 4.78 mmol/l (4.64, 4.93), high-density lipoprotein cholesterol 1.45 mmol/l (1.39, 1.52), low-density lipoprotein cholesterol 1.65 mmol/l (1.53, 1.78), triglyceride 1.12 mmol/l (1.07, 1.18)] were within reference ranges.Conclusion: No significant association was found between iron status parameters and established CVD risk factors. However, excessive abdominal adiposity indicated by high WC and WHR contributes significantly to increased serum ferritin concentration in this population.

Utilization of Iron from an Animal-Based Iron Source Is Greater Than That of Ferrous Sulfate in Pregnant and Nonpregnant Women1–3

Heme iron absorption during pregnancy and the role of hepcidin in regulating dietary heme iron absorption remains largely unexplored. The objective of this research was to examine relative differences in heme (animal based) and nonheme (ferrous sulfate) iron utilization. This study was undertaken in 18 pregnant (ages 16–32 y; wk 32–35 of gestation) and 11 nonpregnant women (ages 18–27 y). Women were randomly assigned to receive both an animal-based heme meal (intrinsically labeled 58Fe pork) and labeled ferrous sulfate (57Fe) fed on alternate days. Blood samples obtained 2 wk postdosing were used to assess iron status indicators and serum hepcidin and iron utilization based on RBC incorporation of iron isotopes. Heme iron utilization was significantly greater than nonheme iron utilization in the pregnant (47.7 ± 14.4 vs. 40.4 ± 13.2%) and nonpregnant women (50.1 ± 14.8 vs. 15.3 ± 9.7%). Among pregnant women, utilization of nonheme iron was associated with iron status, as assessed by the serum transferrin receptor concentration (P = 0.003; r2 = 0.43). In contrast, heme iron utilization was not influenced by maternal iron status. In the group as a whole, women with undetectable serum hepcidin had greater nonheme iron utilization compared with women with detectable serum hepcidin (P = 0.02; n = 29); however, there were no significant differences in heme iron utilization. Our study suggests that iron utilization from an animal-based food provides a highly bioavailable source of dietary iron for pregnant and nonpregnant women that is not as sensitive to hepcidin concentrations or iron stores compared with ferrous sulfate.

Iron status during anti-TNF therapy in children with juvenile idiopathic arthritis

Patients with active juvenile idiopathic arthritis (JIA) have frequently low haemoglobin (Hgb) due to inflammation and/or iron deficiency. The aim of the study was to evaluate the effect of anti-tumor necrosis factor (TNF) therapy on their iron status. Twenty children with JIA were treated with either etanercept (n = 8) or infliximab (n = 12) for 12months. Iron status was assessed during anti-TNF treatment by Hgb, mean corpuscular volume of red blood cells (MCV), serum iron (sFe), ferritin, percent transferrin saturation (sTrfesat) and serum transferrin receptor concentration (sTfR). The sTfR/log ferritin index (TfR/logF) was also used. Prior to the therapy, Hgb and MCV were 118 ± 15.5g/L and 79 ± 7.7fl in the infliximab group, and 113 ± 12.5g/L and 78 ± 5.8fl in the etanercept group, respectively. In the whole group of patients, sFe was 6.3 ± 4.1μmol/L and sTrfesat was 9% ± 6%. During anti-TNF therapy, Hgb and MCV improved significantly without use of iron supplementation, and sFe and sTrfesat increased from low to normal levels while inflammation markers decreased, except in one patient, in whom sTfR stayed elevated and the TfR/logF index value was high. In patients with active JIA associated with anaemia, low levels of sFe and sTrfesat cannot be used as markers for iron deficiency. In such patients, sTfR together with TfR/logF seem to be useful in assessing iron deficiency.

Soluble Transferrin Receptor - A Marker For Iron Deficiency; A Review

Parameters for measuring iron deficiency have been established for decades and have served clinicians in the management of this nutritional disorder. The bone marrow still remains the gold standard in the final diagnosis of iron deficiency. However, researchers have been able to identify the dominating role of the transferrin transferrin receptor complex in the internalization of iron, subsequent to its transport and utilization. The serum transferrin are shed into the blood and its level has been found to correlate with the level of iron stores and thereby the degree of erythropoietic activity. The aim of this literature review is to explore the physical properties of the serum transferrin receptor and its usefulness in the detection of iron deficiency. Literature on the subject was researched using manual library search, articles in journals, internet search such as pubmed, medscape and as well as conference abstracts. Serum transferrin receptor was found to be a reliable marker in the detection of iron deficiency in early pregnancy and other conditions such as patients with chronic renal failure undergoing haemodialysis. Many of the parameters currently being used as markers for iron deficiency have draw backs especially in anaemia that is complicated with other conditions. It has been shown that the concentration of serum transferrin receptors are unaffected by the acute phase reaction seen in many inflammatory conditions. The serum transferrin receptor concentration has been found to correlate well with bone marrow iron stores and red cell indices. However the serum transferrin receptor has not yet been in clinical use in Nigeria and has been mainly in the realms of experiment despite the obvious advantages it presents over the bone marrow aspiration procedure. The procedure for the determination of the serum transferrin receptor concentration is quite easy to understand, the introduction of its estimation into clinical practice will enhance early diagnosis and management of iron deficiency and other related conditions. Key words: Iron deficiency anaemia, soluble transferrin, serum ferritin

A preliminary investigation of nutritional status and attentional performance of 3‐month‐old infants

The present study investigated the statistical predictive utility of indicators of nutritional status on heart‐rate‐defined phases of attention in 3‐month‐old infants. The former included infant anthropometric variables; maternal blood cadmium, lead, and hemoglobin concentrations; and maternal serum transferrin receptor concentrations. A multiple regression analysis using indicators of nutritional status as predictors and attentional performance as the criterion was statistically significant (R = 0.69, p = 0.04). Maternal cadmium concentrations were the only statistically significant individual predictor (partial r = 0.66, p &lt; 0.001). Additional t–tests demonstrated significant differences in attentional performance between those with the highest quartile of cadmium concentrations versus all other infants (t(36) = 3.00, p &lt; 0.005), which was not attenuated by high iron status (t(36) = 2.40, p = 0.02). This supports the use of maternal nutritional status variables to statistically predict early infant attention abilities. This research was supported by National Research Initiative Grant 2008‐35200‐18779 from the USDA National Institute for Food and Agriculture.Grant Funding Source: National Research Initiative Grant 2008‐35200‐18779 from the USDA National Institute for Food and Agriculture

Features of diagnosis and treatment of anemic syndrome in patients with rheumatoid arthritis

Features of diagnostics and course of anemic syndrome in rheumatoid arthritis patients Objective. To study features of anemic syndrome in rheumatoid arthritis (RA) pts, to estimate influence of disease modifying anti – rheumatic drug therapy efficacy on the course of anemic syndrome. Material and methods. 62 pts with definite RA and level of hemoglobin less than 130g\l for men and less than 120g\l for women were examined. Research of hemoglobin, red cells count, mean corpuscular volume (MCV), mean concentration of hemoglobin (MCH), serum iron and ferritin was carried out. In a part of pts serum transferrin receptor and erythropoietin concentrations was defined. 30 pts were examined after 6 month of disease modifying therapy. Results. In 49(79 %) of the pts the anemia was an easy degree of weight, MCH decreased in 33(53 %) of the pts and 15(24 %) pts had decreased values for MCV. Deficiency of iron in 16(26%) of pts has been established at research of concentration a ferritin, sTfR and an index sTfR \log ferritin. At the dynamic research after 6 month of disease modifying therapy the authentic gain levels of hemoglobin, red cells count and serum iron significantly increased in the pts with good and satisfactory effect of therapy. Сonclusion. Definition of MCH, MCV and ferrokinetic data for assessment of iron defi- ciency in the RА pts is necessary. sTfR and sTfR\log ferritin may be study for pts with normal and increased ferritin levels. The major factor influencing on the course of anemia of chronic disease in the rheumatoid arthritis pts is the course rheumatoid arthritis, that efficacy disease modifying treatment to control.

Renal Dysfunction in Thalassemia.

Abstract 2008Poster Board I-1030 BACKGROUND:Renal function is generally thought to be normal in patients with thalassemia, but it has not been studied in detail. There are recent reports of renal tubular defects in both thalassemia intermedia and major. The cause is unclear, but both iron toxicity and iron chelation therapy have been suggested. The study of renal function in thalassemia is timely, because the new oral iron chelator, deferasirox, may increase creatinine concentration and cause proteinuria. Pre-existing, thalassemia-related renal function abnormalities could be a risk factor for deferasirox-related nephropathy. Therefore, it is critical to know how thalassemia affects the kidney. We aimed to determine the prevalence of renal function abnormalities in patients with thalassemia before deferasirox was widely clinically available and to evaluate associations between renal abnormalities and genetic factors, environmental factors, and transfusion regimens. METHODS:We studied patients who participated in the Low Bone Mass Cross-sectional Observational Study (LBMCOS) of the NIH Thalassemia Clinical Research Network. We included all LBMCOS patients (≥6 years of age) with a creatinine clearance (CCr) and calcium to creatinine ratio (Ca:Cr) measured by 24-hour urine collection. We only included patients whose urinary creatinine excretion rate was appropriate for age and gender, indicating a complete urine collection. Notably, none of these patients was treated with deferasirox; nearly all were treated with deferoxamine. We used multivariable models to determine significant predictors of CCr and Ca:Cr. Potential predictors included age, gender, diagnosis, transfusion status, serum transferrin receptor concentration, serum ferritin, and the presence of a variety of clinical complications. RESULTS:This cohort included 216 patients [51.4% female, mean age 12.6 years (range 6.1 – 75.4)]. 188 had beta thalassemia, 14 had Hb H disease or Hb H-Constant Spring, 13 had Hb E-beta-thalassemia, and 1 had homozygous alpha thalassemia major. 180 subjects were regularly transfused (≥8/yr) and 36 were not. Among all patients, 7.8% had a low CCr, 71.3% had a normal CCr, and 20.8% had a high CCr (adjusted for age, gender and body surface area). Regularly transfused patients had significantly lower mean CCr than those not regularly transfused [143.8 ± 54.3 (mean ± SD) mL/min/1.73 m2 vs. 173.4 ± 65; P=0.004]. Among all patients, 71.3% had a normal Ca:Cr, whereas 28.7% had a high Ca:Cr. Regularly transfused patients had significantly higher mean Ca:Cr than those not regularly transfused (0.18 ± 0.10 vs. 0.10 ± 0.08; P<0.0001). Multivariable models showed that the only significant predictors of CCr were regular transfusion status [Odds Ratio (OR) 0.39, 0.17-0.88] and serum transferrin receptor concentration (OR 1.03, 1.01-1.05). Likewise, the only significant predictors of Ca:Cr were regular transfusion status (OR 3.72, 1.24-11.2) and serum transferrin receptor concentration (OR 0.98, 0.95-0.99). CONCLUSIONS:Renal hyperfiltration is common in thalassemia patients, especially those who are not regularly transfused. Hyperfiltration could be the consequence of chronic anemia. Regularly transfused thalassemia patients have a lower CCr and are more likely to have hypercalciuria than patients who are not regularly transfused. This transfusion-related effect could represent iron-mediated tubular and glomerular injury. Awareness of underlying renal dysfunction in thalassemia patients could inform decisions about the use and monitoring of potentially nephrotoxic agents, such as deferasirox. Further studies are needed to better understand renal function in patients with thalassemia. Disclosures:No relevant conflicts of interest to declare.