Early Detection Of Iron Deficiency Research Articles

Leading with dysphagia… An unusual view of a common symptom.

Plummer-Vinson syndrome (PVS) is characterized by the classic triad of post-cricoid dysphagia, iron-deficiency anemia and esophageal webs. PVS is commonly found in women of middle age especially in the fourth and fifth decade of life. The prevalence of PVS has decreased due to early detection of iron deficiency and repletion of iron stores. We report a case of a 81-year-old female patient who had a classic presentation of PVS, treated successfully with endoscopic procedure. To our knowledge, the current case is the fourth case of dysphagia related to Plummer-Vinson syndrome reported in an octogenarian in the literature so far. Iron supplementation can resolve dysphagia in many patients, but dilation of esophageal webs may sometimes be required. PVS should be part of the differential diagnosis of sideropenic dysphagia, especially due the risk of pharyngeal and esophageal epidermoid neoplasia.

Prognostic Performance of Hematological and Serum Iron and Metabolite Indices for Detection of Early Iron Deficiency Induced Metabolic Brain Dysfunction in Infant Rhesus Monkeys

BackgroundThe current pediatric practice of monitoring for infantile iron deficiency (ID) via hemoglobin (Hgb) screening at one y of age does not identify preanemic ID nor protect against later neurocognitive deficits. ObjectivesTo identify biomarkers of iron-related metabolic alterations in the serum and brain and determine the sensitivity of conventional iron and heme indices for predicting risk of brain metabolic dysfunction using a nonhuman primate model of infantile ID. MethodsSimultaneous serum iron and RBC indices, and serum and cerebrospinal fluid (CSF) metabolomic profiles were determined in 20 rhesus infants, comparing iron sufficient (IS; N = 10) and ID (N = 10) infants at 2 and 4 mo of age. ResultsReticulocyte hemoglobin (RET-He) was lower at 2 wk in the ID group. Significant IS compared with ID differences in serum iron indices were present at 2 mo, but Hgb and RBC indices differed only at 4 mo (P < 0.05). Serum and CSF metabolomic profiles of the ID and IS groups differed at 2 and 4 mo (P < 0.05). Key metabolites, including homostachydrine and stachydrine (4-5-fold lower at 4 mo in ID group, P < 0.05), were altered in both serum and CSF. Iron indices and RET-He at 2 mo, but not Hgb or other RBC indices, were correlated with altered CSF metabolic profile at 4 mo and had comparable predictive accuracy (area under the receiver operating characteristic curve scores, 0.75–0.80). ConclusionsPreanemic ID at 2 mo was associated with metabolic alterations in serum and CSF in infant monkeys. Among the RBC indices, only RET-He predicted the future risk of abnormal CSF metabolic profile with a predictive accuracy comparable to serum iron indices. The concordance of homostachydrine and stachydrine changes in serum and CSF indicates their potential use as early biomarkers of brain metabolic dysfunction in infantile ID.

Залізодефіцитна анемія під час вагітності та наслідки, пов'язані з нею

Анотація: у статті узагальнено аргументи та контраргументи в рамках наукової дискусії щодо питання механізмів розвитку залізодефіцитної анемії. Основна мета цього дослідження це узагальнення інформації про вплив залізодефіцитної анемії під час вагітності та наслідків, пов’язаних з нею. Завдяки детальному вивченню літературних джерел, їхній систематизації та підходів до вирішення проблеми, було виявлено, що антенатальна анемія є фактором ризику материнської та перинатальної смертності, передчасних пологів, новонароджених з низькою масою тіла та післяпологових кровотеч. Анемія матері також може бути пов’язана з поганими результатами розвитку нервової системи дитини. Останні досягнення системного та плацентарного гомеостазу заліза можуть покращити терапевтичну ефективність шляхом зміни дози та частоти перорального прийому заліза. А внутрішньовенне введення заліза є безпечним засобом для швидкої корекції анемії матері. Актуальність дослідження даної патології полягає в тому, що вона багато в чому визначає перинатальну та материнську захворюваність. Однак, на сьогодні немає чіткого уявлення про особливості молекулярних та судинних механізмів залізодефіцитної анемії, тому це призводить до суперечностей у лікуванні таких вагітних жінок, що перешкоджає своєчасному, адекватному лікуванню та профілактиці. У дослідженні були використані методи бібліографічного та контент-аналізу літератури, семантичного групування, а також порівняльного підходу та синтезу відносно питань нових досліджень по особливостям механізмів розвитку залізодефіцитної анемії, гомеостазу заліза та поточних визначень ЗДА під час вагітності, несприятливі наслідки для матері та новонародженого, пов’язані з анемією, а також останні рекомендації щодо лікування ЗДА під час вагітності та післяпологового періоду. Офіційні документи, знайдені на веб-сайтах, були проаналізовані, а відповідна інформація згрупована та порівняна. В статті представлено результати досліджень, які засвідчили, що залізо відіграє ключову роль у нормальному і патологічному перебігу вагітності та впливає на розвиток новонародженого. Поглинання і метаболізм заліза суворо регулюються, і повне вивчення метаболізму заліза під час вагітності представляє інтерес для запобігання ускладнень у матері та плода. У цій роботі підкреслюється необхідність раннього виявлення дефіциту заліза. Крім того, є важливим лікувати дефіцит для забезпечення оптимального розвитку новонароджених. Наразі такі заходи, як пероральне або внутрішньовенне введення заліза, схоже, не працюють у масштабах, необхідних для досягнення цілей ВООЗ знизити поширеність анемії у жінок репродуктивного віку на 50%. Частково це може бути пов’язано з невизначеністю щодо того, як найкраще досліджувати, запобігати та лікувати материнську анемію. Розвиток нашого розуміння фізіології заліза привів до можливості значного покращення шляхом зміни стратегії дозування перорального заліза. Нові лабораторні показники заліза, такі як гепсидин, можуть в кінцевому підсумку допомогти керувати терапією дефіциту заліза, але нещодавнє дослідження не виявило жодної переваги від використання підходу скринінгу та лікування на основі гепсидину в порівнянні з рекомендованою схемою ВООЗ. Тому необхідні подальші дослідження щодо результатів, орієнтованих на пацієнта та економічної ефективності. Результати проведеного дослідження можуть бути корисними для лікарів первинної ланки, гінекологів, терапевтів.

Cut off Value of Red Cell Distribution Width (RDW) in Screening and Diagnosis of Iron Deficiency Anemia and b Thalassemia Trait

Background: The most concerning consequences of iron deficiency in children are the alterations of cognitive, motor, and behavioral performance. Persistent neurocognitive changes despite iron repletion have increased the importance of prevention and early detection of iron deficiency.&#x0D; Objectives: To evaluate the cut off value of red cell distribution width (RWD) in the screening and diagnosis of iron deficiency anemia (IDA) and â thalassemia trait (BTT).&#x0D; Methods: It is a cross sectional study performed at Dhaka Shishu (Children) Hospital from July 2006 to July 2008. Total 52 patients, age ranged from 1-12 years were included in the study. Among them 27 cases were IDA and 25 cases were BTT. Complete blood count (CBC), serum ferritin and hemoglobin (HB) electrophoresis were measured. The sensitivity, specificity, positive and negative predictive value of differential and cutoff value for RDW discrimination index in differentiation between IDA and BTT were performed.&#x0D; Results: Age ranged from 1-12 years. In IDA group male were found 16(59%), female were 11(41%) and in BTT group male were 15(60%), female were 10(40%). The Hb% value in IDA group was significantly (p&lt;0.0001) lower than value for BTT. An elevation of RBC distribution width (&gt;14.6) in IDA had a sensitivity of 81%, specificity of 84%, positive predictive value (PPV) of 85% and negative predictive value (NPV) of 81%; value of RBC distribution width (&lt;14.6) in BTT had a sensitivity of 84%, specificity of 81%, positive predictive value (PPV) of 81% and negative predictive value (NPV) of 85%. An elevation of RBC distribution width (&gt;16) had a sensitivity of 67%, specificity of 92%, and positive predictive value (PPV) of 90% in distinguishing iron deficiency anemia from thalassemia trait. Moreover, eleven (11) of 27 patients with iron deficiency had RBC distribution width values greater than 18 compared to one (1) of the patients with thalassemia trait. An elevation of RBC distribution width ³18 specificity of 96% and positive predictive value (PPV) of 92%.&#x0D; Conclusion: The rersult of the study, in patients with microcytic hypochromic anemia, RDW value e³14.6% and Hb level&lt; 10gm/dl, iron deficiency is the most likely diagnosis. RDW value (&gt;16) is a reliable diagnostic tool in differentiation between IDA and BTT. Red cell distribution width (RDW) above 16% is the best index of IDA.&#x0D; DS (Child) H J 2021; 37(1): 51-58

Utility of reticulocyte haemoglobin content and immature reticulocyte fraction in early diagnosis of latent iron deficiency in whole blood donors.

The present study was planned to assess the clinical utility of reticulocyte haemoglobin content (CHr) and immature reticulocyte fraction (IRF) in the early detection of latent iron deficiency in blood donors. The prospective longitudinal observational study was conducted using the purposive sampling method. Written informed consent was obtained and donors were allocated into the first-time (FTD) and regular donor (RD) group. The enrolled blood donors (n= 205 in each group) were followed up for two subsequent whole blood donations. Haemoglobin (Hb), CHr, IRF and serum ferritin values were recorded at enrolment and two follow-ups. The sensitivity of CHr in detecting iron-deficient erythropoiesis (serum ferritin values ≤ 26 μg/dl) was 45% and 56.7%, specificity 96.7%, positive predictive value (PPV) 85.6% and 90.8% and negative predictive value (NPV) 80.1% and 78.7%, respectively in FTD and RD cohorts. The sensitivity of IRF was 45.1% and 44.8%, specificity 93.4% and 97.1%, PPV 74.8% and 90.4% and NPV 79.6% and 74.5%, respectively in both the cohorts. The sensitivity of CHr in detecting absent iron stores (serum ferritin values ≤ 15 μg/dl) was 66.2% and 74.4%, specificity 92% and 90.6%, PPV 56.7% and 68.7% and NPV 94.5% and 92.8% among FTD and RD cohort, respectively. The sensitivity of IRF was 72.7% and 65.3%, specificity 90.3% and 94.3%, PPV 54.4% and 76% and NPV 95.4% and 90.8%, respectively in both the cohorts. Reticulocyte hemoglobin content and IRF can be used along with complete blood count for early detection of iron deficiency in blood donors using the same blood sample at no extra cost.

Iron deficiency during the first 1000 days of life: are we doing enough to protect the developing brain?

Iron is essential for the functioning of all cells and organs, most critically for the developing brain in the fundamental neuronal processes of myelination, energy and neurotransmitter metabolism. Iron deficiency, especially in the first 1000 days of life, can result in long-lasting, irreversible deficits in cognition, motor function and behaviour. Pregnant women, infants and young children are most vulnerable to iron deficiency, due to their high requirements to support growth and development, coupled with a frequently inadequate dietary supply. An unrecognised problem is that even if iron intake is adequate, common pregnancy-related and lifestyle factors can affect maternal-fetal iron supply in utero, resulting in an increased risk of deficiency for the mother and her fetus. Although preterm birth, gestational diabetes mellitus and intrauterine growth restriction are known risk factors, more recent evidence suggests that maternal obesity and delivery by caesarean section further increase the risk of iron deficiency in the newborn infant, which can persist into early childhood. Despite the considerable threat that early-life iron deficiency poses to long-term neurological development, life chances and a country's overall social and economic progress, strategies to tackle the issue are non-existent, too limited or totally inappropriate. Prevention strategies, focused on improving the health and nutritional status of women of reproductive age are required. Delayed cord clamping should be considered a priority. Better screening strategies to enable the early detection of iron deficiency during pregnancy and early-life should be prioritised, with intervention strategies to protect maternal health and the developing brain.

Hematology and Iron Status Evaluation Based on Donation Characteristics in Dr. Sardjito Hospital, Yogyakarta

Blood donation will reduce iron storage in the body. A high frequency of donations and short interval inter-donations may increase the risk of iron deficiency. In Indonesia, detection of iron deficiency in blood donors is not a routine procedure. Therefore, the comparison of hematology and iron status based on donor characteristics is not widely known. For a month, this study was a cross-sectional study conducted at the Blood Transfusion Service Unit, Dr. Sardjito Hospital. Subjects were routine blood donors who met the criteria for donor selection; however, subjects were excluded if the CRP level was &gt; 10 g/L and had a history of iron supplementation. Subjects were divided based on donation frequency and blood donation interval. The Kruskal-Wallis test was used to compare variables among groups with a statistical significance of p &lt; 0.05. This study involved 145 subjects who met the criteria. Blood donations more than 20 times showed the lowest ferritin levels and iron saturation (16.9 ng/mL and 15.08%). Ferritin levels were also increased in line with the donation interval (35.5 ng/mL; 75.3 ng/mL; 92.7 ng/mL every three months). However, the hematological parameters and iron saturation did not differ significantly based on the donation interval. Hematological parameters are easy and fast procedures but have limitations in the early detection of iron deficiency. Serum ferritin has higher specificity, but its level is affected by inflammatory conditions. Ferritin levels were consistently at the lowest level in the subjects with the highest risk of iron deficiency compared to hematologic and iron saturation parameters.

S1946 Plummer-Vinson Syndrome: A Rare Cause of Dysphagia in an Octogenarian

INTRODUCTION: Plummer-Vinson syndrome (PVS) is a rare disease that presents with iron deficiency anemia, dysphagia, and esophageal webs. It usually occurs in middle aged women of Caucasian ethnicity and increases the risk for esophageal cancer. Prevalence of PVS has decreased due to early detection of iron deficiency and repletion of iron stores. While PVS has also been commonly described in children and adolescents, it is seldom reported in the elderly population. CASE DESCRIPTION/METHODS: An 88-year-old female with a history of mild cognitive impairment, allergic rhinitis, and GERD presented with dysphagia to solid foods along with a decreased appetite and a ten pound weight loss during the past one year. Physical exam showed bilateral mild erythema of the angle of the mouth. Routine lab work revealed a normal WBC count, platelet count, basic metabolic profile but did have iron deficiency anemia (Hb 11.9 g/dL, iron saturation 11% and ferritin of 8 ng/ml). She was prescribed 324 mg daily dose of ferrous gluconate. Three months later, she presented to the ER with food impaction and underwent EGD to remove a food bolus in the cervical esophagus. Localized erythematous mucosa with erosions was noted in the esophagus at the site of food impaction. Normal oropharyngeal function was found during speech pathology evaluation while a video fluoroscopic barium swallow showed localized narrowing in the cervical esophagus along with transient pill retention (Image 1). New labs indicated good response to iron replacement (hemoglobin 14 g/dL, iron saturation 23%, and ferritin of 26 ng/ml). An EGD was repeated three weeks later which demonstrated normal appearance of pharynx and upper esophageal sphincter. Upon careful inspection, an upper esophageal web, 18 cm from the incisors, was noted and dilated using controlled radial expansion (CRE) balloon (Image 2). Biopsy was taken from the upper and lower esophagus which revealed normal mucosa. On follow up, patient reported resolution of difficulty swallowing. DISCUSSION: Dysphagia is reported in up to 10% of the elderly population. It commonly causes malnutrition, and is associated with increased mortality. The usual etiologies include cognitive dysfunction, neurological diseases and/or esophageal disorders. To our knowledge, this is the third case of PVS related dysphagia reported in an octogenarian in the literature. Iron replacement can help resolve dysphagia in PVS but, occasionally, dilation of esophageal webs may be required.Image 1.: Video fluoroscopic barium swallow shows cervical esophagus narrowing (arrow).Image 2.: Esophageal web located 18 cm from the incisors (A). CRE balloon dilation of esophageal web (B) resulting in mucosal tear and disruption on the web (C &D).

Graphene-Based Biosensor for Early Detection of Iron Deficiency.

Iron deficiency (ID) is the most prevalent and severe nutritional disorder globally and is the leading cause of iron deficiency anemia (IDA). IDA often progresses subtly symptomatic in children, whereas prolonged deficiency may permanently impair development. Early detection and frequent screening are, therefore, essential to avoid the consequences of IDA. In order to reduce the production cost and complexities involved in building advanced ID sensors, the devices were fabricated using a home-built patterning procedure that was developed and used for this work instead of lithography, which allows for fast prototyping of dimensions. In this article, we report the development of graphene-based field-effect transistors (GFETs) functionalized with anti-ferritin antibodies through a linker molecule (1-pyrenebutanoic acid, succinimidyl ester), to facilitate specific conjugation with ferritin antigen. The resulting biosensors feature an unprecedented ferritin detection limit of 10 fM, indicating a tremendous potential for non-invasive (e.g., saliva) ferritin detection.

Special issue in honour of Prof. Reto J. Strasser - Structural and functional response of photosynthetic apparatus of radish plants to iron deficiency

In this work, we tried to identify some specific chlorophyll a fluorescence (ChlF) parameters, that could enable detection of iron deficiency (Fedef) in radish plants (Raphanus sativus L.), before any visual symptoms appear. Changes in ChlF kinetics, JIP-test parameters, and chlorophyll content revealed that iron deficiency negatively affected PSII activity mainly via disruption of light absorption in light-harvesting complexes and by decreasing the activity of the primary quinone acceptor of PSII (QA). Iron deficiency was clearly reflected in the changes of some JIP-test parameters, such as time to reach maximal fluorescence (FM), Area, normalized total area under the OJIP curve, and number of QA redox turnovers until FM is reached. The visible symptoms of Fedef appeared after 7 d of stress application, while ChlF measurements allowed us to detect iron deficiency during 1-3 d. Our results suggest that analysis of ChlF signals has a high potential for early detection of iron deficiency in radish plants.

Long-lasting behavioural consequences of neonatal iron deficiency in high-risk children

AbstractLittle consideration has been given to the long-term consequences of iron deficiency in new-born infants. Fetal iron accretion is compromised by multiple pregnancy complications including preterm birth, gestational diabetes mellitus and fetal growth restriction, while our work has identified increased risks from maternal lifestyle factors such as smoking and obesity for low iron stores at birth. Early-life events, including C-section delivery, also add to this cumulative risk of neonatal iron deficiency, predisposing infants to iron deficiency later in infancy and early childhood. This study aimed to investigate the effect of neonatal iron deficiency on neurological development up to 5 years of age in term-born participants of a maternal-infant birth cohort in Ireland. In the Cork BASELINE Birth Cohort, 697 maternal-infant dyads with prospectively collected lifestyle and clinical data from 15 weeks’ gestation had umbilical cord serum ferritin concentrations measured. Neurological assessments were performed at 2 (Bayley Scales of Infant Development and Child Behaviour Checklist [CBCL]) and 5 (Kaufman Brief Intelligence Test and CBCL) years of age. In the cohort, median [IQR] cord ferritin concentrations were 200.9 [139.0,265.8] μg/L; 7.5% had neonatal iron deficiency (&lt; 76μg/L). Using the risk factors for neonatal iron deficiency that we previously identified (smoking, obesity, C-section delivery, SGA) in this cohort, as selection criteria, we conducted an a priori sensitivity analysis in 306 children. Of the 306 children identified as high-risk, 12.4% had neonatal iron deficiency. Those with neonatal iron deficiency had higher median [IQR] CBCL internal (9.0 [5.3,12.0] vs. 5.0 [3.0,10.0]), external (7.5 [4.0,14.8] vs. 5.0 [2.0,10.0]) and total problem (24.5 [15.3,40.8] vs. 16.0 [10.0,30.0], all P &lt; 0.05) scores at 5 years compared to those without neonatal deficiency. This adverse effect was especially apparent in children of obese mothers (n = 85) who were iron deficient at birth, with a total problem score at 5 years of 42.0 [24.5,54.5] compared to 16.0 [8.8,29.3] in those not deficient (P = 0.008). Associations were robust to adjustment for confounding factors. No effect on cognition or intelligence at 2 or 5 years was observed in this cohort. This study has identified behavioural consequences of neonatal iron deficiency. Interventions targeting the fetal/neonatal period could, therefore, represent a key opportunity for prevention of iron deficiency and its associated long-term neurological consequences. A dual approach is required, comprising public health strategies targeting prevention, through improving nutrition and health in women, and the development of screening strategies for early detection of iron deficiency in new-borns.

The neonatal period: A missed opportunity for the prevention of iron deficiency and its associated neurological consequences?

AbstractIron deficiency is the most common micronutrient deficiency worldwide. Iron is essential for the development of multiple organ systems, most especially the developing brain. Iron deficiency, particularly during sensitive periods of brain development, such as in early childhood, is associated with long‐lasting adverse consequences for cognition, motor function and behaviour. Little consideration has been given to iron deficiency in newborn infants and its potential health consequences. Fetal iron accretion is compromised by pregnancy complications such as pre‐term birth and gestational diabetes mellitus, and our work has identified an increased risk of low iron stores at birth from maternal lifestyle factors such as smoking and obesity. Early‐life events, including Caesarean section delivery, further add to the cumulative risk of neonatal iron deficiency, which can persist throughout infancy into early childhood. While investigations into the long‐term neurological consequences of neonatal iron deficiency are limited, there is evidence of poorer memory, motor function and language ability in children born iron deficient. Recently, we also identified significant behavioural consequences of neonatal deficiency persisting from 2 to 5 years of age, with effects particularly apparent in ‘high‐risk’ children born to obese or smoking mothers or delivered by Caesarean section. Interventions targeting the fetal/neonatal period could therefore represent a key opportunity for the prevention of iron deficiency and its associated long‐term health consequences. A dual approach is required, comprising public health strategies targeting prevention, to improve health in women of reproductive age, and the development of screening strategies for the early detection of iron deficiency in newborn infants.

The role of haematological indices in predicting early iron deficiency among pregnant women in an urban area of Sri Lanka

BackgroundEarly detection and treatment of iron deficiency during pregnancy is crucial for optimum pregnancy outcomes. Anaemia is a late indictor of iron deficiency measured as Hb < 11 g/dL, and is widely used as a proxy for iron deficiency. We aimed to evaluate the role of red cell indices as a screening tool for early detection of iron deficiency among pregnant women in an urban area of Sri Lanka.MethodA cross-sectional study was conducted among 110 apparently healthy pregnant women ≤12 weeks of gestation attending antenatal clinics in Colombo, Sri Lanka. Women already on nutritional supplements were excluded. Full blood count, serum ferritin (SF) and high sensitive C-reactive protein (hs-CRP) assessments were performed. The women with evidence of inflammation as indicated by hs-CRP > 10 mg/L were excluded (N = 20) from data analysis. Anaemia (Hb < 11 g/dL) and iron deficiency (SF < 30 μg/L) were defined according to WHO guidelines. Receiver operating characteristics curves were used to derive red blood cell indices that showed the optimal cut-offs in detecting early iron deficiency.ResultsOf the 90 women, 63 (70.0%) were iron deficient (SF < 30 μg/L), out of whom 10 (15.9%) were identified as having iron deficiency anaemia (Hb < 11 g/dL). A high sensitivity (> 70%) in the prediction of iron deficiency was obtained for the optimal cut-off values of Hb < 12.2 g/dL, MCV < 83.2 fl, MCH < 26.9 pg and MCHC 33.2 g/dL while maintaining a specificity > 40%.ConclusionIron deficiency can be predicted in early stages using Hb and red cell indices, which is much less expensive. This could be a useful method in areas with limited resources and a high prevalence of iron deficiency.

Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor.

BACKGROUND:Two new parameters low hemoglobin density (LHD) and microcytic anemia factor (Maf) have been used by Beckman–Coulter LH series analyzers as an easy screening tool for the early detection of iron deficiency. The main objective of this study was to assess if LHD and Maf could be used for assessment of iron status in blood donors and also to establish a cut-off for these two parameters at which a tentative iron deficiency could be reported conclusively.MATERIALS AND METHODS:LHD% and Maf could be calculated by knowing mean cell hemoglobin (Hb) concentration, Hb, and mean cellular volume and we used SPSS in calculating LHD and Maf from these parameters.Results: Significant differences were detected in LHD% and Maf values when iron deficient and iron-depleted donors were compared with control donors, while these were insignificant for iron reduced donors. LHD and Maf were able to differentiate between iron deficient and iron-depleted donors from normal donors. A cutoff of 9.18% for LHD% was able to differentiate iron deficient and depleted state from normal iron states with a sensitivity and specificity of 91.9% and 71% respectively. Similarly, a cutoff of 10.16 and10.71 for Maf was able to differentiate between iron-deficient and iron-depleted donors from normal donors, respectively.Conclusion: LHD% and Maf in the screening of blood donors raise the possibility of early detection of iron deficiency, without the need of extra cost and blood sampling.

Ranges for Reticulocyte Fractions and Reticulocyte Hemoglobin of Mongolian Donors

Objectives: The goal of this study was to determine the performance of reticulocyte fractions and reticulocyte hemoglobin for early detection of iron deficiency and iron deficiency anemia among Mongolian blood donors. Methods: Blood samples were collected before and after blood donations and analyzed using a Sysmex XN- 2000 analyzer. Iron levels (Umol/L) and Ferritin levels (µmol/L) were measured using a COBAS E601 (ROCHE, Japan). Results: Anemia was diagnosed in 3.2% all of the donors. In donors with anemia the results were: HGB 10.6±0.6 g/dl, serum ferritin 5.5 (4; 9) µmol, serum iron 5.7 (4; 7) µmol and Ret-He 26.5 (23; 28) pg. The mean value of reticulocyte was 1.2±0.3 and 1.1±0.3 within a reference range of 0.5-2%. The mean values of IRF before and after blood donations were 6.3±2.6 and 5.9±2.7 respectively with range of 1.1 - 15.9%. There were no clear differences in reticulocyte count and its fractions among donors before and after blood donation. The mean Ret-He was 32.1+1.7 pg before blood donation; 31.2+2.2 pg 28 days after donation and 31.7+ 1.6 pg within 2-3 months after the first blood donation. There are significant differences in RET-He between the before and after blood donations. Conclusion: IRF and Ret-He are very useful parameters for estimating hematopoiesis, monitoring for iron treatment and early detection of iron deficiency.

Study of serum transferrin and serum ferritin during pregnancy and their correlation with pregnancy outcome

Background: Iron deficiency is more prevalent in young children and women of reproductive age group. Iron deficiency is generally slow to develop and often remain undetected until clinical picture arises due to its deficiency. Thus, early detection of iron deficiency is beneficial before the anemia sets in. The maternal iron level is important for the growth of growing fetus and is always required to have markers which can detect iron deficiency in early stage. The timely implementation of intervention to correct maternal iron status will improve the maternal outcome. Objectives: To study levels of serum transferrin and serum ferritin during pregnancy and their correlation with outcome of pregnancy. Materials and Methods: Longitudinal study was conducted on pregnant women reporting antenatal clinic in first trimester. Data in each trimester of 57 women was collected. Birth weight of new born delivered was recorded and statistical analysis was done by paired t-test. Result: 57 pregnant women were divided into two groups according to weight of delivered babies. 46 delivered low birth and 11 delivered normal birth weight babies. Serum transferrin was significantly higher (p < 0.05) in third trimester in group I subjects as compared to first and second trimester. Also it was significantly higher (p < 0.001) in third trimester in group I subjects as compared to third trimester level of group II subjects. The same comparison does not hold true when serum ferritin levels were compared. Conclusion: The finding of the present study suggests that serum transferrin levels measurement could be a better parameter for predicting pregnancy outcome and can be advised along with other routine hematological investigations.

Red Blood Cell Distribution Width and the Platelet Count in Iron-deficient Children Aged 0.5–3 Years

Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is important to prevent impaired neurodevelopment. Unfortunately, many biomarkers of ID are influenced by infection, thus limiting their usefulness. The aim of this study was to investigate the value of red blood cell distribution width (RDW) and the platelet count for detecting ID(A) among otherwise healthy children. A multicenter prospective observational study was conducted in the Netherlands to investigate the prevalence of ID(A) in 400 healthy children aged 0.5–3 years. ID was defined as serum ferritin (SF) <12 μg/L in the absence of infection (C-reactive protein [CRP] <5 mg/L) and IDA as hemoglobin <110 g/L combined with ID. RDW (%) and the platelet count were determined in the complete blood cell count. RDW was inversely correlated with SF and not associated with CRP. Calculated cutoff values for RDW to detect ID and IDA gave a relatively low sensitivity (53.1% and 57.1%, respectively) and specificity (64.7% and 69.9%, respectively). Anemic children with a RDW >14.3% had a 2.7 higher odds (95% confidence interval [CI]: 1.2–6.3) to be iron deficient, compared with anemic children with a RDW <14.3%. The platelet count showed a large range in both ID and non-ID children. In conclusion, RDW can be helpful for identifying ID as the cause of anemia in 0.5- to 3-year-old children, but not as primary biomarker of ID(A). RDW values are not influenced by the presence of infection. There appears to be no role for the platelet count in diagnosing ID(A) in this group of children.

Monitoring recovery from iron deficiency using total hemoglobin mass.

Using hemoglobin concentration ([Hb]) to diagnose borderline iron deficiency and monitor the progress of its treatment is difficult because of the confounding effects of plasma volume. Because hemoglobin mass (Hbmass) is not affected by plasma volume, it may be a more sensitive parameter. The aim of this study was to monitor Hbmass, iron storage, and maximal oxygen consumption (V˙O2max) during and after oral iron therapy in subjects with severe and moderate iron deficiency. Three groups of female recreational athletes were monitored for at least 22 wk, as follows: 1) severe iron deficiency group (SID) (n = 8; ferritin, ≤12 ng·mL), 2) moderate iron deficiency group (MID) (n = 14; ferritin, ≤25 ng·mL), and 3) control group (n = 8; ferritin, >25 ng·mL). Hbmass and iron status were determined before, during, and up to 12 wk after at least 10 wk of oral iron supplementation. In total, five V˙O2max tests were performed before, during, and after the supplementation period. Hbmass increased markedly in the SID group (15.6% ± 11.0%, P < 0.001) and slightly in the MID group (2.2% ± 3.7%, P < 0.05) by the end of the supplementation period and remained at this level for the following 12 wk. [Hb] and Hbmass were similarly affected, but Hbmass was more closely related to mean corpuscular volume and mean corpuscular hemoglobin than [Hb]. The SID group incorporated 534 ± 127 mg of iron into ferritin and hemoglobin, whereas the MID group incorporated 282 ± 68 mg of iron. V˙O2max increased only in the SID group by 0.20 ± 0.18 L·min (P < 0.05) and was closely related to Hbmass (P < 0.01). Hbmass is a sensitive tool for monitoring recovery from iron deficiency anemia and assessing the effectiveness of iron supplementation in individuals with severe or moderate iron deficiency.

Correlations between hemoglobin, serum ferritin, and soluble transferrin receptor levels in children aged 6-59 months

Background Early detection of iron deficiency is important in young children to prevent iron deficiency anemia, which may cause permanent neurocognitive development disorders. Hemoglobin level is an insensitive tool for detecting iron deficiency without anemia, while serum ferritin levels may be influenced by infection and inflammation. However, soluble transferrin receptor (sTfR) is a sensitive marker for detecting iron deficiency, yet not widely used in daily practice.Objective To assess for correlations between hemoglobin, serum ferritin, and soluble transferrin receptor levels in children aged 6-59 months.Methods We performed a cross-sectional study in the Yogyakarta and Bantul Districts involving 85 children aged 6-59 months who visited integrated health posts (posyandu) and who met the inclusion criteria. Subjects were chosen by cluster random sampling. Blood specimens were collected to examine hemoglobin, serum ferritin, and sTfR levels.Results Spearman’s correlation test revealed weak negative correlations between hemoglobin and serum ferritin levels, as well as between hemoglobin and sTfR levels, with coefficient correlations of r = -0.220, (P=0.043) and r = -0.317, (P=0.003), respectively. There was no correlation between serum ferritin and sTfR levels (r = -0.033; P=0.767).Conclusion Hemoglobin levels has weak negative correlations with serum ferritin and sTfR, but serum ferritin does not correlate with sTfR. [Paediatr Indones. 2014;54:122-6.]

Early detection of iron deficiency in elite athletes: could microcytic anemia factor (Maf) be useful?

The aim of this study was to establish the sensitivity and specificity of the microcytic anemia factor (Maf(®)), which is generated by the Coulter LH 750 analyzer in the evaluation of iron depletion and iron-deficient erythropoiesis in athletes. A total of 142 athletes were divided into three groups: with iron depletion, with iron-deficient erythropoiesis, and controls. The following parameters were measured: RBCs (red blood cells), Hb (hemoglobin), Hct (hematocrit), MCV (mean cellular volume), MCH (mean cell hemoglobin), MCHC (mean cell hemoglobin corpuscular), RDW (red cell distribution width), Maf(®), Reticulocytes, Ferritin, sTfR (soluble transferrin receptor), Transferrin, Haptoglobin, IL- 6 (Interleukin-6), hs-CRP (high-sensitivity C-reactive protein). The best Maf(®) value to exclude iron depletion in athletes was 130.3, showing a sensitivity of 72.6% and a specificity of 57.3%. The AUC was 0.690 (CI 95% 0.607-0.765, P < 0.001). ROC curve analysis for Maf(®) in the diagnosis of iron-deficient erythropoiesis indicates sensitivity of 61.5%, and specificity of 93.0%, with AUC = 0.826 (CI 95% 0.754-0.885, P < 0.001) and on cutoff value 114. This study shows that Maf(®) generated by the Coulter LH 700 Series hematology analyzers, performs very well in discriminating healthy athletes and those with different stages of iron deficiency. Also, in cost/benefit terms, monitoring of Maf(®) is justified as a low cost, effective screening parameter for determining iron status in athletes.