Decreased Iron Stores Research Articles

Iron stores in maternal and cord blood.

AbstractSerum ferritin concentration was measured in 206 paired maternal and newborn (Umbilical cord sample) blood specimens taken during delivery. Iron deficiency (assessed by serum ferritin assay) was found in 38% pregnant women. The mean serum ferritin was significantly low in pregnant mothers compared to non‐pregnant women, indicating depleted iron stores at term.Serum ferritin levels in cord blood were higher than those in the maternal blood, indicating that the mother is in a state of iron deficiency with low serum ferritin and the fetus in a state of iron sufficiency with high serum ferritin.Maternal ferritin had no correlation with cord ferritin and babies born to iron deficient mothers had low but not statistically significant serum ferritin levels. This suggests that iron storage in the mother and iron metabolism in the fetus are not directly related. However, there seemed to be a level of maternal iron stores below which the newborn was endowed with decreased iron stores.

Adult Celiac Sprue

We report the clinical, laboratory, and pathological findings in a series of 52 consecutive patients with adult celiac sprue observed over a 20-year period. The frequency of that diagnosis increased from an average of 0.7 case/year during the period 1966-1975 to 5.8 cases/year during the period 1981-1985. Apart from two patients with dermatitis herpetiformis, nonclassical clinical presentations were observed in 16 of 50 (32%) patients overall and in 13 of 28 (46%) patients diagnosed since 1981. Diarrhea was the most common complaint leading to the diagnosis; since 1981, hematologic abnormalities warranted investigation in 38% of the patients. Decreased iron stores (88%), decreased red cell folate (82%), or both (74%), and abnormal radiographic studies of the small bowel (83%) were the most sensitive tests in the diagnostic investigation. We conclude that atypical or nonclassical presentations of adult celiac sprue, mostly with hematologic abnormalities, are not uncommon.

EFFECT OF AGE, ON THE PREVALENCE OF ANEMIA IN INFANTS

The requerimcnt for iron in infancy is proportional to the growth velocity. The recommended dietary allowance (RDA; NAS/NRC) for iron is 15mg/day from age 6 to 36 months, even though growth velocity decreases during this period. Conversely, if an infant develops an iron deficiency anemia daring the first year of life, iron therapy is necessary to regain a normal hemoglobin. We have demonstrated a significant inverse relationship between the prevalence of anemia and infant's age in the anemia prevalence studies performed in Buenos Aires and Misiones (x2 = 17.4; p 24 months) respectively. The difference in hemoglobin concentration was highly significant (paired t test 4.68, p <0.001). Decreased iron stores as assayed by serum ferritin < 12 ug/l were more prevalent in the young group: 64.3% and 19.0% respectively with a highly significant difference in iron stores (paired t test 5.36, p <0.001). We conclude that these data are consistent with a relative improvement in the anemia with increasing iron intake.

Iron stores in male blood donors evaluated by serum ferritin.

Iron stores were evaluated by serum ferritin measurements in 1348 male blood donors. Blood donation was associated with a decrease in serum ferritin concentrations. First-time donors (n = 21) had a geometric mean serum ferritin concentration of 52 micrograms per l, and multiple-time donors (n = 1327) of 36 micrograms per l (p less than 0.01). In the donating population, 6.0 percent had serum ferritin values less than 15 micrograms per l (i.e., depleted iron stores), 33.9 percent had values from 15 to 30 micrograms per l (i.e., reduced iron stores), 52.5 percent had values from 31 to 90 micrograms per l, and 7.6 percent had values greater than 90 micrograms per l (i.e., normal iron stores). The frequency of donations per year was more predictive of decreased iron stores than the number of lifetime donations. Serum ferritin showed a moderate fall up to the fourth donation (p less than 0.001); thereafter serum ferritin levels showed only minor insignificant changes. An increase in donation frequency was accompanied by a significant decrease in serum ferritin; values less than 15 micrograms per l were found in 1.3 percent of donors bled two times per year, in 6.0 percent bled three times per year, and in 7.9 percent bled four times per year. Regular monitoring of iron stores by serum ferritin in blood donors seems justified in order to identify those with depleted iron stores who will benefit from iron supplementation.

Plasma cell iron--clinical and morphologic features.

In order to identify the major clinical features and laboratory findings in patients with plasma cell iron, the authors reviewed the medical records and marrow aspirates of 53 consecutive patients with plasma cell iron hospitalized at Nashville Veterans Administration Hospital over a seven-year period. Plasma cell iron was associated most commonly with alcoholism and occurred in marrows with increased, normal, and decreased iron stores. In patients with decreased marrow iron, plasma cells were the major site of stainable iron. Plasma cell iron was found in patients without other morphologic changes of alcoholism such as megaloblastosis, erythroid vacuolization, and ringed sideroblasts. Plasma cell iron could be demonstrated in biopsy and autopsy material from extra-marrow sites. Ultrastructural studies showed iron always was located in membrane bound lysosomal vesicles of plasma cells.

Serum ferritin and bone marrow iron in patients undergoing continuous ambulatory peritoneal dialysis

In 20 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), serum ferritin concentration (radioimmunoassay) was compared with bone marrow iron stores (graded semiquantitatively). A close correlation between the two parameters was found. Patients with decreased iron stores (8/20) had serum ferritin concentrations below 70 ng/mL; those with normal or increased iron stores had concentrations above 96 ng/mL. It is concluded that serum ferritin concentrations adequately reflect bone marrow iron stores and are useful as a guide to iron-replacement therapy in patients undergoing CAPD. (<i>JAMA</i>1983;250:3317-3319)

Serum Ferritin and Bone Marrow Iron in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

In 20 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), serum ferritin concentration (radioimmunoassay) was compared with bone marrow iron stores (graded semiquantitatively). A close correlation between the two parameters was found. Patients with decreased iron stores (8/20) had serum ferritin concentrations below 70 ng/mL; those with normal or increased iron stores had concentrations above 96 ng/mL. It is concluded that serum ferritin concentrations adequately reflect bone marrow iron stores and are useful as a guide to iron-replacement therapy in patients undergoing CAPD.

Iron Stores in Blood Donors

A high frequency of donations by some blood donors has prompted concern about iron depletion. Five hundred sixteen female and 505 male donors were examined by measurements of hemoglobin, hematocrit, plasma iron, total iron-binding capacity, and ferritin values and detailed histories of iron ingestion, pregnancy and menstrual status, and past blood donations. Hemoglobin, hematocrit, and serum iron studies, unlike ferritin values, were not sensitive indicators of body iron depletion. Reduced iron stores were found in 8% of male and 23% of female donors. Menstruation significantly lowered iron stores in women. The total number of lifetime donations was not as predictive of decreased iron stores as frequency of donations per year. Even casual iron supplementation reduced the impact of donations on iron stores. Administration of iron to donors, especially menstruating women, should be studied by blood programs.

Serum Ferritin as an Early Determinant of Decreased Iron Stores in Pregnant Women

Serum ferritin has been shown to be an excellent determinant of iron stores. In a consecutive group of women registering at the regular prenatal clinic, we measured serum ferritin, iron, iron-binding capacity, and hemoglobin to determine their hematologic status as to anemia. It was found that serum ferritin is the most sensitive determinant of depleted iron stores, with serum iron being next in sensitivity. This assay is a rapid, economic, sensitive measure of iron stores, and results are not altered significantly by other types of anemia or oral iron therapy.

Ferritin as an index of bone marrow iron stores.

We examined the relationship of serum ferritin to bone marrow iron stores in 73 anemic male medical inpatients with liver disease, alcoholism, chronic inflammatory disease, and malignancies. A correlation of r = 0.75 (P less than .00005) was found between serum ferritin and bone marrow iron stores (BMIS) for the entire group. Liver disease as manifested clinically or by increased levels of serum glutamic-oxaloacetic transaminase did not appear to significantly affect this relationship. Patients with folic acid deficiency did tend to have a disproportionate increase in ferritin in relation to BMIS, but this did not seem to destroy the usefulness of ferritin levels. A useful clinical rule seems to be that serum ferritin of greater than 100 ng/ml tends to exclude iron deficiency, and a level of less than 30 ng/ml tends to confirm decreased iron stores.

IRON STORES IN PREGNANCY

Summary. Serum ferritin concentration has been measured during the course of pregnancy in 154 women. There was a rapid decrease in iron stores during early pregnancy irrespective of any iron therapy. Oral iron did, however, prevent the stores reaching iron deficient levels during the second half of pregnancy. The results suggest that maternal erythroid activity starts early in pregnancy and may exhaust the iron stores before the fetal demands for iron can be met.

Iron Stores in Pregnancy

Serum ferritin concentration has been measured during the course of pregnancy in 154 women. There was a rapid decrease in iron stores during early pregnancy irrespective of any iron therapy. Oral iron did, however, prevent the stores reaching iron deficient levels during the second half of pregnancy. The results suggest that maternal erythroid activity starts early in pregnancy and may exhaust the iron stores before the fetal demands for iron can be met.

Serum Ferritin Level

Seventeen patients without renal failure and 14 patients receiving longterm hemodialysis were studied. Serum and bone marrow ferritin determinations were made at the time of bone marrow aspiration. A good correlation was found between serum ferritin levels and bone marrow iron stores, as well as between bone marrow ferritin levels and iron stores. Serum ferritin determinations appear to give an accurate estimation of bone marrow iron stores, thereby providing a reliable guide for iron replacement therapy and reducing the need for repeated bone marrow aspirations. Serum ferritin levels of less than 105 ng/ml suggest decreased iron stores, and values greater than 120 ng/ml indicate adequate or increased iron stores. Preliminary data also suggest that bone marrow ferritin determinations may be useful in quantitating bone marrow iron stores. ( JAMA 238:601-603, 1977)

Serum ferritin level. Determinant of iron requirement in hemodialysis patients.

Seventeen patients without renal failure and 14 patients receiving long-term hemodialysis were studied. Serum and bone marrow ferritin determinations were made at the time of bone marrow aspiration. A good correlation was found between serum ferritin levels and bone marrow iron stores, as well as between bone marrow ferritin levels and iron stores. Serum ferritin determinations appear to give an accurate estimation of bone marrow iron stores, thereby providing a reliable guide for iron replacement therapy and reducing the need for repeated bone marrow aspirations. Serum ferritin levels of less than 105 ng/ml suggest decreased iron stores, and values greater than 120 ng/ml indicate adequate or increased iron stores. Preliminary data also suggest that bone marrow ferritin determinations may be useful in quantitating bone marrow iron stores.

The Interrelation of Renin and Iron Binding Capacity

When rats are subjected to hypoxia, an increase in serum angiotensinogen concentration occurs which is accompanied by the appearance of serum erythropoietin (EP) during the first 24 h. Subsequent increases in EP reach maximum values 24 to 48 h after increases in packed cell volume (PCV) and serum renin levels. The current experiments were designed to determine if a decrease in iron stores is the stimulus for renin production when rats are rapidly expanding their red cell volume in a hypoxic environment. Young rats fed McCall's low iron diet were paired with rats fed the same diet supplemented with ferric citrate (6 g/kg diet). After two weeks at ambient pressure, they were subjected to hypoxia (0.48 atm) for 1 to 10 days. After 5 days at the reduced pressure, a fraction of the rats on the low iron diet were fed the iron-supplemented diet. At the time of sacrifice, serum was assayed for total iron binding capacity (TIBC) and renin. Rats that were fed the low iron diet showed an increase in TIBC, an increase in serum renin and a positive correlation between serum renin and TIBC. Rats that were fed a normal iron diet under the same conditions had lower TIBC, lower serum renin and no correlation between serum renin and TIBC. When low iron diet rats were supplemented with iron, TIBC and serum renin decreased. These experiments may have a clinical counterpart. The total iron binding capacity, renin and angiotensinogen were measured in the serum of women during the first 19 weeks of pregnancy. Women during early pregnancy showed an increase in TIBC, an increase of renin and angiotensinogen in the serum and a positive correlation between TIBC and renin concentration. It is suggested that the increased concentration of renin in the serum of women during the first 19 weeks of pregnancy and in the serum of rats that are rapidly expanding their red cell volume are related to a decrease in iron stores.

Mucosal Iron Retention and Plasma Iron Absorption in the Duodenum and Jejunum of Dogs

Two groups of non-anemic dogs, one with normal tissue iron stores and one with decreased tissue iron stores, underwent a surgical construction of two equal segments of duodenum and jejunum. A solution of 0.1 mg ferrous sulfate and 1 mg ascorbic acid was injected into the lumen of each segment. The solution for the duodenal segment contained 30 muc of iron59, for the jejunum segment 60 muc of iron55. The solutions were left in the segments for 2 1/2 hours before washout. On the 14th postoperative day, iron59 and iron55 radioactivity per ml/RBC was measured, and iron uptake by segments determined in two ways. Bone marrow, liver, and spleen were histologically assessed of iron stores. In dogs with normal iron stores, percent iron retained was slightly higher in jejunum that duodenum. In dogs with decreased iron stores percent retention was always higher in duodenum; in this group iron retained was about four times higher than in dogs with normal iron stores. This indicates that mucosal uptake of iron from lumen and mucosal transfer of iron from plasma vary inversely with body iron stores, but compared to mucosal uptake, mucosal transfer is more restricted to duodenum, more affected by body iron stores, more limited, and more crucial to regulation of iron absorption.

Quantitative Estimation of Marrow Non-heme Iron in Alcoholics

The non-heme iron of the bone marrow aspirates of two groups of alcoholics (totalling 107 subjects) was quantitatively estimated. About 14% of the patients had markedly decreased iron stores; 78% fell within the normal range, and only 8% displayed modest increases, none comparable with levels found in hemochromatosis. About half of the patients with elevated marrow iron values had clinically overt infection. Significant iron overload is not common in the alcoholic; iron lack is not infrequent.

CHRONIC MUCO-CUTANEOUS CANDIDIASIS: ASSOCIATED ABNORMALITIES OF IRON METABOLISM

Summary.— Forty-six patients with chronic muco-cutaneous candidiasis were ascertained and classified into 4 groups on a clinico-genetic basis. One of these groups contains a newly described entity called familial chronic muco-cutaneous candidiasis. Tests of specific immune responses, related to lymphocyte function, gave abnormal results in over half the patients investigated, but the range of disturbance of function could not be precisely related to the clinico-genetic classification. Twenty-three out of 31 patients fully investigated showed evidence of iron deficiency as judged by low serum iron and decreased iron stores. Eight had hypochromic anaemia, including all 6 patients in the severely affected group. Nine out of 11 patients treated with iron showed significant clinical improvement and this effect was confirmed by a small controlled trial irrespective of the presence of varied abnormal immunological responses. The possibility is considered that the disturbance of iron metabolism might be the fundamental aetiological factor in many of these patients and that the other abnormalities, such as those of specific immune responses, may be secondary. The hypothesis of a possible link between nutritional factors and the immune response is outlined.

Significance of Alterations in Iron Absorption in Patients with Portal Cirrhosis

Increased iron absorption has been a frequent finding in portal cirrhosis and liver disease has been implicated as a common cause of raised iron absorption. In most studies iron stores have not been adequately assessed and iron deficiency has not been excluded as a cause of the increased iron absorption. The present investigation was designed primarily to assess the importance of iron deficiency and the rate of erythropoiesis in the production of increased iron absorption in cirrhosis. Iron stores were assessed by both bone marrow aspiration and liver biopsy. The absorption of a test dose of inorganic iron in 9 patients with portal cirrhosis and 6 with alcoholic fatty liver associated with normal iron stores was similar to the absorption in 12 control subjects with comparable iron stores. An appropriate increase in iron absorption was found in 8 patients with cirrhosis associated with depleted iron stores and an appropriate decrease was present in a patient with cirrhosis and increased iron stores due to blood transfusions. In contrast an inappropriate increase in absorption was detected in 2 patients with portal cirrhosis complicated by iron overload and in 2 patients with cirrhosis in whom it was not clear whether the liver disease or the iron overload was the primary event. No relationship was found between the level of iron absorption and the rate of erythropoiesis, the concentration of either serum folate or serum vitamin B12, the severity of the liver disease, or the presence or absence of a portacaval shunt. The results indicate that increased iron absorption in portal cirrhosis is usually the result of decreased iron stores which in some patients is only evident upon examination of the bone marrow. In a small number of cirrhotic patients with normal or increased iron stores the normal system for excluding unwanted iron breaks down and an inappropriate increase in iron absorption occurs, but the cause of this remains obscure.

Studies of Iron Transport in Portal and Systemic Circulation

Abstract Simultaneous 59Fe absorption curves in portal and systemic venous blood showed different rates of entry of the isotope into the portal (and systemic) circulation: the most rapid entry was seen in two patients with decreased iron stores, whereas negligible counts were obtained in two patients with increased iron stores. These data, combined with 59Fe excretion data, indicate a barrier function of the intestinal mucosa for the passage of iron in two iron-sufficient patients, with evidence of prolonged excretion of 59Fe into the bowel in one of these. The data support a two-step mechanism of absorption of inorganic ferrous iron in humans, the first step being uptake of iron by the intestinal mucosa; the second step transfer of mucosal iron to the portal circulation. In the two patients with decreased iron stores the shape of the absorption curves ruled out significant hepatic deposition of isotope; the amount of isotope transported in the systemic circulation correlated closely with that utilized for hemoglobin synthesis. Different rates of absorption of inorganic ferrous iron and folic acid were demonstrated in one patient.