Hemoglobin Iron Research Articles

Ziltivekimab for anemia and atherosclerosis in chronic kidney disease: a new hope?

Anemia of chronic kidney disease is a multifactorial condition secondary to various etiologies, including nutritional deficiencies, chronic inflammation, erythropoietin deficiency or resistance, bone marrow suppression, iron deficiency and adverse drug effects. The major therapeutic intervention for anemia among chronic kidney disease patients is erythropoiesis-stimulating agents. However, a limitation of erythropoiesis-stimulating agents is the risk for thromboembolic events, hypertension, seizures, solid organ malignancies and hyporesponsiveness. A novel interleukin-6 monoclonal antibody, ziltivekimab, has been evaluated for managing anemia in chronic kidney disease patients in pilot clinical trials with promising outcomes, including an improvement in hemoglobin levels and reduction of inflammatory parameters. These trials have shown that ziltivekimab does not increase the risk for cytopenia or infectious complications as has been described for other interleukin-6-targeting monoclonal antibodies, like tocilizumab. Furthermore, potentially beneficial effects on serum lipid profile have been reported, leading to the hypothesis of a favorable impact of the drug on atherosclerotic complications. In addition, ziltivekimab has shown efficacy in improving anemia parameters, including hemoglobin levels and iron studies. Ziltivekimab deserves full scale clinical development, and to this aim, large-scale clinical trials are under way.

Hepcidin, GDF-15 and their Impact on Iron Metabolism in CKD

Background Anemia is an important complication in chronic kidney disease (CKD). We studied the diagnostic accuracy of hepcidin and growth differentiation factor-15 (GDF-15) as early markers of iron deficiency anemia (IDA) in non-dialysis (ND-CKD) patients. Materials and Methods This was a cross-sectional, case-control study comprising 100 cases of CKD (newly diagnosed and non-dialyzed) and 40 healthy controls. Serum levels of hepcidin and GDF-15 were estimated using ELISA-based assays. Receiver operator characteristics were used to evaluate the diagnostic validity of hepcidin and GDF-15 for absolute and functional iron deficiency anemia. Results About 33% of the cases were females with a mean age of 47.64 (± 13.68) years. The predictive value of hepcidin for diagnosing functional IDA in CKD was found to be 69.1% (95% CI: 52.5% to 82.7%), and that of GDF-15 was found to be 68.8% (95% CI: 52.6% to 82.1%). Hepcidin significantly correlated with hemoglobin (r = 0.278, p = 0.005) and serum iron (r = 0.222; p = 0.025). GDF-15 positively correlated with ferritin (r = 0.346, p < 0.0001) and hsCRP (r = 0.223, p = 0.0088) and negatively correlated with eGFR (r = -0.462, p < 000001), Hb (r = -0.481, p < 0.00001) and TIBC (r = -0.353, p < 0.0001). Conclusion Hepcidin and GDF-15 could predict functional IDA in our patients but not absolute IDA.

Streamlined Preoperative Iron Deficiency Screening and IV Treatment for Colorectal Cancer Patients beyond Clinical Trials

Background/objectives: Iron deficiency anemia is common in patients with colorectal cancer and affects postoperative outcomes. Preoperative intravenous iron supplementation corrects anemia effectively; however, the effect on the postoperative clinical course is unclear. The aim of this study was to investigate the effects of implementing a screening program for iron deficiency anemia and correction in patients with colorectal cancer. Methods: This was a retrospective single-institutional quality-assurance study that included patients undergoing elective surgery for colorectal cancer between January 2019 and December 2021. On 1 March 2020, screening for iron deficiency was implemented. Anemia was corrected by intravenous ferricarboyxmaltose. Patients with hemoglobin <7mmol/L and ferritin <30 µg/L or ferritin 30–100 µg/L and TSAT < 0.2 were divided into iron- and non-iron groups. The primary outcome was a change in hemoglobin concentration, and secondary outcomes included blood transfusion, complications, length of stay, mortality, and implementation efficacy. Data from the patients were extracted from digital patient charts and entered into a database. Results: A total of 532 patients were included, of which 177 patients (33.3%) were anemic, 63 were in the iron group, and 114 were in the non-iron group. Adherence to the screening program was 86.3%. Hemoglobin (iron group) increased from a mean of 5.7 mmol/L (SD 0.8) to 6.9 (0.8) mmol/L, p < 0.001. Iron treatment decreased transfusion rates from 27.7% to 9.1%, p = 0.007, and increased the rate of patients without complications from 53.2% to 79.6%, p < 0.001, which held true after controlling for confounding. In addition, 90-day mortality was lower in the iron group; however, this was not significant. Conclusions: Administration of intravenous iron increased hemoglobin, leading to reduced use of blood transfusion and fewer complications.

Vitamin C-rich guava consumed with mungbean dal reduces anemia and increases hemoglobin but not iron stores: a randomized controlled trial of food-to-food fortification in Indian children.

BackgroundAdding vitamin C-rich fruit to staples containing iron could be an effective strategy to improve iron bioavailability and thereby reduce iron-deficiency anemia in children. ObjectiveWe aimed to assess the effect of consuming a mungbean-based meal with or without guava fruit on body iron stores, hemoglobin concentration, and anemia of children as part of a school feeding program. MethodsWe conducted a 7-month randomized, controlled trial with 6 to 10-year-old school children (n=200; 46% anemic, 71% iron-deficient) from a rural community in Haryana, North India. Children were assigned to two treatment groups to daily receive either a meal of mungbean dal only (3.0 mg of iron; vitamin C:iron molar ratio ∼0.5:1), or mungbean dal with fresh guava (3.2 mg of iron; ∼170 mg of vitamin C; molar ratio ∼18:1). Meals were served every school day under supervision. The primary outcome was body iron stores, while concentrations of hemoglobin and other iron indicators were secondary outcomes. ResultsDaily consumption of mungbean dal along with guava did not result in an overall improvement of body iron stores (mean treatment effect: 0.65 mg/kg body weight; 95% CI: −0.34, 1.63; P=0.197). However, compared to children who consumed mungbean dal only, children in the guava group showed a larger increase in hemoglobin concentration (3.7 g/L; 95% CI: 1.6, 5.6; P=0.001), and a larger drop in the prevalence of anemia (−51%; 95% CIs: −74, −10; P= 0.022) and iron-deficiency anemia (−56%, 95% CI: −83, 13; P=0.087). These effects were more pronounced in children who were iron-deficient at study start. ConclusionsAddition of guava to a mungbean-based meal containing a moderate amount of iron increased hemoglobin and reduced anemia but did not provide enough additional absorbed iron to also increase body iron stores. Food-to-food fortification by inclusion of vitamin C rich fruits in iron-containing school meals may help alleviate the burden of anemia in children.This trial was registered at https://clinicaltrials.gov/ct2/show/NCT01191463.

Type 2 Diabetes Mellitus and Helicobacter pylori Gastritis in Patients Referred for Endoscopy-A Single-Center Romanian Study.

Type 2 diabetes mellitus (T2DM) affects up to 10% of adults globally, and its complications can mask the risk of gastrointestinal bleeding or malignancy. Our study enrolled 633 endoscopic patients stratified according to T2DM presence (4:1 ratio in favor of the control group). T2DM patients referred for endoscopy experienced lower prevalence of epigastric pain and heartburn (OR = 0.637/OR = 0.346, p < 0.05). Often being anemic (OR = 2.23, p < 0.001), they had significantly lower hemoglobin (p = 0.001) and serum iron (p = 0.02), but serum cholesterol was higher in non-diabetics. Ulcers, erosions and mucosal hemorrhages were comparable between groups (p < 0.05), although low-dose aspirin use was more prevalent in diabetics (p = 0.000, OR = 2.34). T2DM was associated with the increased frequency of antro-corporal active gastritis (OR = 1.451/OR 1.501), with smokers presenting a higher frequency of active H. pylori infection (OR = 3.37). T2DM predicted anemia (adjusted OR = 1.70) and the absence of gastroesophageal reflux symptoms (adjusted OR = 0.37), but not active H. pylori gastritis or premalignant lesions. In an endoscopic population, patients with T2DM had lower hemoglobin and serum iron levels. There was an inverse correlation between T2DM and heartburn. H. pylori gastritis and premalignant lesions occurred more frequently in diabetic patients (predominantly pangastritis) before adjusting for age or associated comorbidities, with smoking increasing the risk for active infection.

Iron Deficiency Anemia among Sanitation Workers in a Tertiary Care Hospital: A Cross-sectional Study

ABSTRACT Background: Iron deficiency anemia (IDA) has been the main cause of the health burden in India over the past decade. The aim of the present study was to examine the iron status and prevalence of iron deficiency anemia using biochemical markers among sanitation workers working at a tertiary healthcare center. Methodology: This hospital-based cross-sectional observational study was conducted on 80 sanitation workers for a period of 18 months (age 31–40 years). Dietary intake patterns were collected through the structured questionnaires. Blood samples were analyzed for complete blood count, serum iron level and unsaturated iron binding capacity, and ferritin. Total iron binding capacity and percentage transferrin saturation were calculated. Stool samples were screened for intestinal helminthic ova and cysts of intestinal protozoa. Results: Of the 80 sanitation workers, IDA was found in 38.7%; out of this, mild anemia was found in 16 (20%) participants, while 11.3% and 7.5% participants had moderate and severe anemia, respectively. Higher plasma sTfR levels were observed in women with severe iron depletion than in those with iron sufficiency (median 17.6 versus 15.5 nmol/L; P = 0.001). A statistically significant positive correlation between hemoglobin and serum iron, serum ferritin, and transferrin saturation was found. Hemoglobin was positively correlated with white blood cells, red blood cells, hematocrit, and mean corpuscular hemoglobin. Conclusion: This study highlights the presence of mild IDA among sanitary workers and lower levels of iron intake than the recommended dietary allowance.

An Electrolytic Elemental Iron Powder Effectively Regenerates Hemoglobin in Anemic Rats and Is Relatively Well Absorbed When Compared to Ferrous Sulfate Monohydrate.

Elemental iron powders are used as food fortificants to reduce the incidence of iron deficiency anemia. However, many commercially available iron powders are relatively untested in vivo. The purpose of this study was to determine the hemoglobin regeneration efficiency (HRE) and relative iron bioavailability (RBV) of an electrolytic elemental iron powder (EIP), by treating anemic rats with 14 d iron repletion diets fortified with four different concentrations (12, 24, 36, or 48 mg iron/kg diet) of EIP and bakery-grade ferrous sulfate monohydrate (FS; FeSO4•H2O), or no added iron (control); n = 9-12/group. The HRE of FS was significantly higher (p ≤ 0.05) than EIP at each concentration of dietary iron tested. For EIP, the HREs (ratios) of diets containing 12, 24, 36, and 48 mg iron/kg were 0.356, 0.205, 0.197, and 0.163, respectively. For both EIP and FS, HRE was inversely associated with increasing dietary iron. The RBVs (%) of iron from EIP in diets at 12, 24, 36, and 48 mg iron/kg as compared to FS were 64.5, 59.1, 50.6, and 54.3%, respectively. Overall, findings show that at the concentrations of iron tested, EIP has RBVs greater than 50% and is an effective fortification agent to replenish hemoglobin and correct iron deficiency anemia.

Iron status and anemia as predictors for acute bronchiolitis severity

BackgroundThe aim of this study was to determine the effect of iron deficiency anemia (IDA) on the severity of symptoms in infants hospitalized for acute bronchiolitis.MethodsThis is a case–control study, which was carried out on 80 infants from November 2022 to April 2023. The study involved 60 infants ranging in age from 2 months to 2 years, who were admitted to the Pediatric Pulmonology Unit and met the diagnostic criteria for acute bronchiolitis. Furthermore, a control group of 20 apparently healthy infants was incorporated into the study.ResultsThis study showed that patients with moderate and severe bronchiolitis exhibited notably reduced levels of hemoglobin, HCT, MCV, MCH, and MCHC. Concerning the iron status, a substantial decrease in serum iron and increase in TIBC in the severe group (P = 0.012, 0.001, respectively). No substantial correlation was detected between the severity of acute bronchiolitis and serum ferritin levels. Hemoglobin and serum iron were found to be independent predictors of the severity of acute bronchiolitis.ConclusionsInfants suffering from IDA exhibit increased vulnerability to acute bronchiolitis. The low levels of hemoglobin and serum iron may function as prognostic indicators for the severity of the condition in infants with acute bronchiolitis.

Electrochemical oxidation of Fe (II) using chlorpromazine drug at boron-doped diamond electrode: application to in vivo mechanism study interaction of chlorpromazine on hemoglobin iron and evaluation of some biomolecules

In this study, the electrochemical properties of aqueous chlorpromazine hydrochloride (CPZ) in the presence of Fe (II) were investigated by cyclic voltammetry at a boron-doped diamond (BDD) electrode. The results showed that an EC′ reaction mechanism occurs, where electrochemically generated CPZ species (cation radical) are reduced by Fe (II) back to the parent CPZ, and Fe (II) is oxidized to Fe (III). The detection limit, sensitivity, and dynamic concentration ranges were 2.8 μM, 0.0188 μA μM−1 and 10–166 μM. Based on the electrochemical results, the interaction of chlorpromazine (CPZ), a widely used antipsychotic tranquillizer, with the allosteric protein, hemoglobin, has been studied. First, four groups of six female rats weighing 400–450 g were selected. The rats were injected with different concentrations of chlorpromazine over a 3-week period, and the concentrations of hemoglobin, methemoglobin, red blood cells (RBCs), and hematocrit (HCT) were analyzed in the blood of each rat. After injection of different concentrations of the drug, the amount of hemoglobin) as a source of Fe (II)) decreased, but the amount of methemoglobin (as a source of Fe (III) increased. In addition, UV spectroscopic measurements in the range of 200–700 nm indicate the conversion of hemoglobin to methemoglobin in chlorpromazine-treated rats compared to the normal sample, and there was a direct relationship between the increasing methemoglobin concentration of chlorpromazine. Furthermore, the amount of RBC and HCT was measured. The results showed that RBC (21.05%–56.52%) and HCT (10.04%–53.19%) decreased. Finally, this study demonstrates a new mechanism for the effects of CPZ on hemoglobin iron in rat blood based on electrochemical results.

Hemoglobin Regeneration Efficiency and Relative Iron Bioavailability of Four Elemental Iron Powders in Rats.

Effective food fortification strategies using elemental iron powders (EIPs) are needed to combat iron deficiency anemia. The purpose of this study was to determine hemoglobin regeneration efficiency (HRE) and relative iron bioavailability (RBV) of four food-grade EIPs (El-Lyte (EL), Hi-Sol (HS), H-325 (H3), and A-131 (A1)) by treating anemic rats with 14 d iron repletion diets (uncooked and cooked), fortified with a 12, 24, or 36 mg iron/kg diet of the EIPs, ferrous sulfate monohydrate (FS, FeSO4•H2O), or no added iron (control), n = 9-12/group. The ability of EL and HS to maintain hemoglobin for 6 weeks on the 6 mg iron/kg diet was also studied. The dissolution rate of iron from the EIPs was measured in hydrochloric acid at pH 1.0. Compared to FS, the EL, HS, and A1 EIPs had >50% overall RBV, with the following order: HS > A1 > EL > H3 (p ≤ 0.05); the effect of cooking was not significant (p > 0.05). Dissolution testing revealed that the mean RBV of the EIPs was positively associated with the percentage of iron solubility. In the 6-week maintenance study, EL and HS maintained hemoglobin as well as FS. Overall, the findings show that at the concentrations of iron tested, these EIPs are effective fortification agents to replenish hemoglobin and correct iron deficiency anemia.

Association of NRAMP1 Gene Polymorphism with Hemoglobin and Iron Parameters in Patients with β-Thalassemia Major

Abstract BACKGROUND: Thalassemia is an inherited disorder that is also called mediterranean anemia and is described by a lack of hemoglobin synthesis. β-thalassemia is more common in people of certain origins, particularly those from the Mediterranean region and Arabian Peninsula. The NRAMP1 protein in membranes catalyzes the exit of divalent metal ions from phagolysosomes and their entry into the cytoplasm, including iron and manganese. AIMS: To investigate the possible link between beta-thalassemia major (β-TM) illness and the single-nucleotide polymorphism (3′ untranslated region) rs3 of the NRAMP1 gene. MATERIALS AND METHODS: To investigate the relationship between the condition β-TM and the NRAMP1 gene, the study used restriction fragment length polymorphisms-polymerase chain reaction. The enzyme-linked fluorescent assay was used to quantify the ferritin level. A hematology analyzer was used to quantify hemoglobin concentration. A spectrophotometer technique was used to assess the serum iron, serum total iron-binding capacity (TIBC), and serum unsaturated iron-binding capacity. RESULTS: The results showed a difference in hemoglobin and serum iron levels, serum unbound iron-binding capacity, serum TIBC, and ferritin concentration between individuals suffering from β-thalassemia and healthy groups. In NRAMP1 gene polymorphism, a highly significant difference was observed between the distribution of two alleles (TG− 244 bp, and TG+ 211 bp). CONCLUSION: During an investigation of NRAMP1 gene polymorphism, a significant variance was observed between β-thalassemia and control groups. Those who carried the (244 bp −TG) allele were found to have a 3.6 times higher risk of developing complications of β-TM than those who carried the (211 bp −TG+) allele.

Impact of a single blood donation on hemoglobin mass, iron stores, and maximum oxygen uptake in pre-menopausal women-A pilot study.

During whole blood donation (BD), 500 mL of blood is drawn. The time interval between two BDs is at least 8-12 weeks. This period might be insufficient for restoring hemoglobin mass (Hbmass) and iron especially in women, who generally have lower Hbmass and iron availability. Since both variables influence physical performance, this pilot study aimed to monitor Hbmass, iron status, and maximum oxygen uptake (V̇O2max) recovery in women after a single BD. In 10 women (24.7 ± 1.7 years), Hbmass, hemoglobin concentration [Hb], iron status, and V̇O2max were assessed before and up to 12 weeks after a single BD. BD reduced Hbmass from 562 ± 70 g to 499 ± 64 g (p < .001). Although after 8 weeks no significant mean difference was detected, 7 women had not returned to baseline after 12 weeks. [Hb] did not return to initial values (13.4 ± 0.7 g/dL) after 12 weeks (12.9 ± 0.7 g/dL, p < .01). Ferritin decreased from baseline until week 6 (40.9 ± 34.2 ng/mL vs. 12.1 ± 6.9 ng/mL, p < .05) and was not restored after 12 weeks (18.4 ± 12.7 ng/mL, p < .05), with 6 out of 10 women exhibiting iron deficiency (ferritin <15 ng/mL). V̇O2max was reduced by 213 ± 47 mL/min (7.2 ± 1.2%; p < .001) and remained below baseline after 12 weeks (3.2 ± 1.4%, p < .01). For most pre-menopausal women, 12 weeks were not sufficient to recover from BD and achieve baseline Hbmass and iron stores resulting in prolonged reduction of aerobic capacity. A subsequent BD might lead to a severe anemia.

Effectiveness of ferritin-guided donation intervals in whole-blood donors in the Netherlands (FIND'EM): a stepped-wedge cluster-randomised trial

Whole-blood donors are at increased risk for iron deficiency and anaemia. The current standard of haemoglobin monitoring is insufficient to ensure the maintenance of proper iron reserves and donor health. We aimed to determine the effects of ferritin-guided donation intervals for blood donor health and blood supply in the Netherlands. In this stepped-wedge cluster-randomised trial (FIND'EM), the 138 fixed and mobile donation centres in the Netherlands are organised into 29 geographical clusters and the clusters were randomly assigned to four treatment groups, with two groups being further split into two per a protocol amendment. Eligible donors were whole-blood donors who consented for use of their leftover material in the study. Each group was sequentially crossed over from the existing policy (haemoglobin-based screening; control) to a ferritin-guided donation interval policy over a 3-year period. In the intervention groups, in addition to the existing haemoglobin screening, ferritin was measured in all new donors and at every fifth donation in repeat donors. Subsequent donation intervals were extended to 6 months if ferritin concentrations were 15-30 ng/mL and to 12 months if they were less than 15 ng/mL. Outcomes were measured cross-sectionally across all donation centres at four timepoints. Primary outcomes were ferritin and haemoglobin concentrations, iron deficiency, and haemoglobin-based deferrals. We assessed all outcomes by sex and menopausal status and significance for primary outcomes was indicated by a p value of less than 0·0125. This trial is registered in the Dutch trial registry, NTR6738, and is complete. Between Sept 11, 2017, and Nov 27, 2020, 412 888 whole-blood donors visited a donation centre, and we did measurements on samples from 37 621 donations from 36 099 donors. Over 38 months, ferritin-guided donation intervals increased mean ferritin concentrations (by 0·18 log10 ng/mL [95% CI 0·15-0·22; p<0·0001] in male donors, 0·10 log10 ng/mL [0·06-0·15; p<0·0001] in premenopausal female donors, and 0·17 log10 ng/mL [0·12-0·21; p<0·0001] in postmenopausal female donors) and mean haemoglobin concentrations (by 0·30 g/dL [95% CI 0·22-0·38; p<0·0001] in male donors, 0·12 g/dL [0·03-0·20; p<0·0074] in premenopausal female donors, and 0·16 g/dL [0·05-0·27; p<0·0044] in postmenopausal female donors). Iron deficiency decreased by 36-38 months (odds ratio [OR] 0·24 [95% CI 0·18-0·31; p<0·0001] for male donors, 0·49 [0·37-0·64; p<0·0001] for premenopausal female donors, and 0·24 [0·15-0·37; p<0·0001] for postmenopausal female donors). At 36-38 months, haemoglobin-based deferral decreased significantly in male donors (OR at 36-38 months 0·21 [95% CI 0·10-0·40, p<0·0001]) but not significantly in premenopausal or postmenopausal female donors (0·81 [0·54-1·20; p=0·29] and 0·50 [95% CI 0·25-0·98; p=0·051], respectively). Ferritin-guided donation intervals significantly improved haemoglobin and ferritin concentrations and significantly decreased iron deficiency over the study period. Haemoglobin-based deferrals decreased significantly for male donors, but not female donors. Although this intervention is overall beneficial for maintenance of iron and haemoglobin concentrations in donors, increased efforts are needed to recruit and retain donors. The Sanquin Research Programming Committee.

Efficacy of ferric carboxymaltose therapy in celiac patients

Aims: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA can be caused by reduced iron intake, impaired iron absorption or losses. Celiac disease can cause iron malabsorption by decreasing the surface absorption area in the duodenum and consequently can cause IDA. Oral or intravenous iron preparations are used in the treatment of IDA. In this study, we wanted to investigate the efficacy of ferric carboxymaltose (FCM) in celiac patients with RIA. Methods: Twenty-three patients who were followed up in the gastroenterology outpatient clinic of İnönü University Medical Faculty Hospital Turgut Özal Medical Center with the diagnosis of CD and who received FCM were included in the study. The hemogram, ferritin, iron and iron binding levels of the patients were retrospectively screened through the hospital medical record system. Results: Of the 23 patients included in the study, 3 (13.05%) were male and 20 (86.95%) were female. Hemoglobin concentration, iron and iron binding capacity before and after treatment showed a significant increase in all parameters after treatment. Ferritin value increased, although not significantly. Conclusion: In our study, we found that FCM is an effective and safe treatment modality in the treatment of IDA in celiac patients.

#3019 Hepcidin and erythropoietin along with iron indices to asses anemia in lupus nephritis population

Abstract Background and Aims There is a broad spectrum of hematologic manifestations in SLE including lymphopenia, anemia, thrombocytopenia, or pancytopenia. lymphadenopathy and splenomegaly are also identified especially with high disease activity. Anemia of chronic disease, representing approximately one third of the cases in patients with SLE. Santacruz et al, also reported that iron deficiency anemia is also a common cause, usually caused by blood loss. serum hepcidin levels are high in patients with CKD, and are associated with erythropoiesis stimulating agent resistant anemia due to the inability of stored iron to be accessed for erythropoiesis, they are also high in autoimmune diseases as SLE. we evaluated anaemia in lupus nephrites population by assessing the level of hepcidin, erythropoietin along with iron study Method in this observational study We identified 100 patients with SLE and diagnosed as lupus nephritis by means of renal biopsy ISN/RPS classification 2004 with some missed data about biopsy details, the patients assessed for anaemia by haemoglobin level, iron study (TSAT, ferritin), hepcidin (10-120 μg/L) and erythropoietin level (3-36 IU/L). Demographics, disease characteristics and comorbidities were ascertained and adjusted for. Results 52 % of patients with SLE, LN (mean age 37.85 (9.40) years, 94 % female,) had Hgb&amp;lt;12 g/dl. The two groups of patient were comparable in disease duration but anemia had higher disease activity than patients with normal Hgb (p. value 0.9, 0.001 ). Furthermore, incidence of DM and HTN wasn't have statical significant, laboratory investigation showed anemia is microcytic hypochromic with low TSAT, hepcidin is almost high in 72% of all patients but wasn't significantly different between the two groups but erythropoietin level was normal in 100% of patients in both groups. Conclusion Patients with SLE and LN have an increased prevalence of anemia due to different factors. Our data suggest that iron deficiency anaemia was prevalent in the study group which may be due to high hepcidin level in those group of patient or blood loses especially the majority were females, erythropoietin level as marker of anaemia in lupus nephritis patient had been found to be not an indicator, its receptor resistance or antibodies found in SLE patients.

Use of Different Iron Preparations for Prophylaxis and Effects on Iron Status in Infancy.

Aim: To evaluate using different iron preparations for iron deficiency and/or iron deficiency anemia prophylaxis in infants and their iron status. Methods: In this study, we retrospectively evaluated the electronic patient records of 651 healthy children aged 9 to 13 months who met the inclusion criteria and who were followed up in pediatric follow-up outpatient clinics between January 2023 and June 2023. Results: A total of 651 children with a mean age of 11.2 ± 1.4 months, 54.7% of whom were boys, who met the inclusion criteria were included in the study; 56.5% of the children were using Fe + 3 salt and the others were using Fe + 2 salt, microencapsulated iron, or sucrosomial iron drops. After the fifth month of prophylaxis, when the effects of the iron preparations used on the mean laboratory values were evaluated, it was found that hemoglobin, serum iron, and ferritin levels were lower in sucrosomial iron and microencapsulated iron users compared to other preparations (p = 0.001). When statistically pairwise comparisons were made between the groups, hemoglobin and serum iron values were found to be lower in the group using sucrosomial iron compared to the groups using Fe + 2 and Fe + 3 salts (p < 0.0001). Hemoglobin and ferritin levels were higher in the group using Fe + 2 salt compared to both sucrosomial iron and microencapsulated iron groups (p < 0.0001). When the infants were evaluated according to iron status, it was found that 208 (31.9%) had iron deficiency. Iron deficiency was found to be less in infants of families who defined their economic status as rich and in infants who used iron regularly (p-values 0.044 and 0.001, respectively). Iron deficiency/iron deficiency anemia was observed at a higher rate in the group using sucrosomial iron and microencapsulated iron prophylaxis (p = 0.001). Conclusions: To prevent iron deficiency, it is very important to use appropriate iron preparations for prophylaxis and to feed foods with high iron content. Although we found that families were willing to use different iron preparations other than iron salts for their infants, the results presented herein indicate that the rate of iron deficiency was lower in patients using iron salts. However, randomized controlled studies are needed to determine whether these preparations are effective in iron prophylaxis in infants.

A Review of Key Regulators of Steady-State and Ineffective Erythropoiesis.

Erythropoiesis is initiated with the transformation of multipotent hematopoietic stem cells into committed erythroid progenitor cells in the erythroblastic islands of the bone marrow in adults. These cells undergo several stages of differentiation, including erythroblast formation, normoblast formation, and finally, the expulsion of the nucleus to form mature red blood cells. The erythropoietin (EPO) pathway, which is activated by hypoxia, induces stimulation of the erythroid progenitor cells and the promotion of their proliferation and survival as well as maturation and hemoglobin synthesis. The regulation of erythropoiesis is a complex and dynamic interaction of a myriad of factors, such as transcription factors (GATA-1, STAT5), cytokines (IL-3, IL-6, IL-11), iron metabolism and cell cycle regulators. Multiple microRNAs are involved in erythropoiesis, mediating cell growth and development, regulating oxidative stress, erythrocyte maturation and differentiation, hemoglobin synthesis, transferrin function and iron homeostasis. This review aims to explore the physiology of steady-state erythropoiesis and to outline key mechanisms involved in ineffective erythropoiesis linked to anemia, chronic inflammation, stress, and hematological malignancies. Studying aberrations in erythropoiesis in various diseases allows a more in-depth understanding of the heterogeneity within erythroid populations and the development of gene therapies to treat hematological disorders.

Comparison of Three Methods of Umbilical Cord Management in Late Preterm and Term Newborns on Hemoglobin and Ferritin Levels at Six Weeks of Age: A Randomized Controlled Trial.

Umbilical cord milking (UCM) and delayed cord clamping (DCC) are strategies that improve the hemodynamic condition of the newborn and also increase the storage of iron. This study aimed to compare the effects of DCC with or without milking in late preterm and term neonates at different time intervals after birth (60, 120, and 180 seconds) on hematological and hemodynamic parameters in neonates at six weeks of age. In this double-arm, parallel-group, triple-blind, and active-controlled trial, all 150 eligible neonates were randomized with allocation concealment into three groups: Group A (DCC with UCM at 60 seconds), Group B (DCC with UCM at 120 seconds), and Group C (only DCC for 180 seconds). Hemodynamic parameters were recorded and compared during the first 48 hours, and hematological parameters were compared at six weeks of age. At six weeks, a significant difference in hemoglobin levels was noted between Groups A, B, and C (p<0.001). The difference in serum ferritin values at six weeks was also statistically significant in comparisons across all three groups (p=0.003). Regarding secondary outcomes examined, hemodynamic parameters and the incidence of neonatal hyperbilirubinemia were found to be comparable at 48 hours after birth. DCC followed by UCM at 120 seconds and DCC till 180 seconds proves superior to DCC with UCM at 60 seconds in preserving elevated hemoglobin levels and iron stores in neonates at six weeks of age. DCC for 180 seconds yielded comparable results, followed by UCM at 120 seconds. All three methods are considered safe and effective without compromising the neonate's hemodynamics.

Hematological Assessments of Children with Oral Aphthous Ulcer in Diyala Governorate, Iraq

Abstract: BACKGROUND: Although the terms “aphthous ulcers” and “aphthous stomatitis” have been used interchangeably in the past, the latter is now preferable. It is a widespread illness that affects 20% of the general population and 9% of children, according to estimates. Due to the high prevalence, pediatric patients who complain of mouth ulcers frequently present to medical and dental specialists. OBJECTIVES: Hematological assessments of patients with oral aphthous ulcer and comparison with healthy control. MATERIALS AND METHODS: A case–control study of 120 kids was conducted. The study included 100 patients with oral aphthous ulcer (56 male and 44 female) and a group of 20 healthy controls (10 males and 10 females). Data were collected using questionnaires. The questionnaires had two sections. The first section involved personal information. The second section is related to hematological examinations, such as hemoglobin level, serum iron level, folic acid level, Vitamin B12 level, and mean corpuscular volume. Statistical analysis was carried out using the t-test, and the LSD was employed to significantly compare the means. RESULTS: The level of hemoglobin in the control group was statistically highly significantly increased when compared with patients with mean ± standard error (SE) (13.14 ± 0.20) versus mean ± SE (10.39 ± 0.19). Serum iron showed an increased level in the control group compared to patients with statistically showed highly significant correlation with mean ± SE (71.77 ± 5.14) versus mean ± SE (46.76 ± 2.79). A highly significant correlation existed when compared the control group and patients concerning Vitamin B12 levels with mean ± SE (517.02 ± 28.11) versus mean ± SE (367.32 ± 21.25). CONCLUSIONS: Hemoglobin, serum iron, and Vitamin B12 levels of patients are higher than that of controls. It is very important to observe the hemoglobin, folic acid, Vitamin B12, and serum iron levels in patients with oral ulcer before it starts to suggest treatments for oral ulcer.

Iron Fortification and Inulin Supplementation in Early Infancy: Evaluating the Impact on Iron Metabolism and Trace Mineral Status in a Piglet Model

BackgroundInfant formula in the United States contains abundant iron, raising health concerns about excess iron intake in early infancy. ObjectivesUsing a piglet model, we explored the impact of high iron fortification and prebiotic or synbiotic supplementation on iron homeostasis and trace mineral bioavailability. MethodsTwenty-four piglets were stratified and randomly assigned to treatments on postnatal day 2. Piglets were individually housed and received an iron-adequate milk diet (AI), a high-iron milk diet (HI), HI supplemented with 5% inulin (HI with a prebiotic [HIP]), or HIP with an oral gavage of Ligilactobacillus agilis YZ050, an inulin-fermenting strain, every third day (HI with synbiotic [HIS]). Milk was provided in 14 meals daily, mimicking formula feeding in infants. Fecal consistency score and body weight were recorded daily or every other day. Blood and feces were sampled weekly, and tissues collected on postnatal day 29. Data were analyzed using mixed model analysis of variance with repeated measures whenever necessary. ResultsDiet did not affect growth. HI increased hemoglobin, hematocrit, and serum iron compared to AI. Despite marginal adequacy, AI upregulated iron transporter genes and maintained satisfactory iron status in most pigs. HI upregulated hepcidin gene expression in liver, caused pronounced tissue iron deposition, and markedly increased colonic and fecal iron. Inulin supplementation, regardless of L. agilis YZ050, not only attenuated hepatic iron overload but also decreased colonic and fecal iron without altering pH or the expression of iron regulatory genes. HI lowered zinc (Zn) and copper (Cu) in the duodenum and liver compared to AI, whereas HIP and HIS further decreased Zn and Cu in the liver and diminished colonic and fecal trace minerals. ConclusionsEarly-infancy excessive iron fortification causes iron overload and compromises Zn and Cu absorption. Inulin decreases trace mineral absorption likely by enhancing gut peristalsis and stool frequency.