Iron Anemia Research Articles

El modelo de la frecuencia cardíaca fetal en embarazadas con diagnóstico de anemia ferropénica

Summary Iron anaemia during pregnancy affects both the mother and the foetus and increases materno-foetal morbidity and mortality. Two different patterns of Foetal Heart Rate (FHR), normal and pathological, have been described but neither is specific for pregnant women with iron deficiency anaemia. A sample of 63 pregnant women was divided into two groups: patients with iron deficiency anaemia (haemoglobin of 10,7 g/dl) and «normal pregnan-cies». The first group was of 43 patients with an age range of 15-38 years, with a mean and standard variation of 24.4 ± 6.1694 years. The second group was of 20 patients, whose age had a mean and standard variation of 27.45 ± 5.69 years. Anaemic patients group: the pregnancy age had a mean and standard variation of 33.97 ± 4.48 weeks. Normal pregnancy group: the pregnancy group had a mean and standard deviation of 33.25 ± 3.11 weeks. The Uterine Contractility and Foetal Heart Rate (FHR) registers were obtained using a HP monitor Model 1350, 50XM serie during a period of 90-120 minutes. The FHR values which appear later are in the mean range. In the anaemia patients group, the basal FHR had a mean value of 142.81 beats per minute, and the normal group had a mean of 135.5 beats per minute. The difference between means was significant, p = 0.0000. In the FHR trace different segments were observed: 1.Period of small accelerations: the duration was 50.19 minutes and the amplitude of the accelerations was 21.47 beats. The amplitude of the type I dips was 21.19 beats, and of the type II dips 22.61 beats. The amplitude of the accelerations of the groups were compared: anaemic pregnancies 21.47 beats vs normal pregnancies 24.18 beats; the difference between means was significant, p = 0.0000. 2. First period of stability: the duration was 28.51 minutes. There were 28 accelerations with an amplitude of 28.10 beats. The amplitude of the type I dips was 21.69 beats and of the type II dips was 23.67 beats. A comparison between the amplitude of accelerations was made: anaemic group 21.10 vs control group 24.81. The difference between means was significant p = 0.0126. 3. Period of large accelerations «Saw Tooth»: the duration was 50.90 minutes and the amplitude was 29.02 beats. The amplitude of the type I dips was 20.76 beats and of the type II dips was 28.86 beats. The amplitude of the large accelerations were compared: anaemic patients group 29.02 vs control group 24.81. The difference between means was significant p = 0.0000. 4. Second period of stability: the duration was of 16.33 minutes, and there were 5 accelerations with an amplitude of 24.60 beats and one type II dip was registered, with an amplitude of 30 beats. Finally, an analysis was made on the amplitude of accelerations between the anaemic and control groups. On both groups the amplitude value was similar, the difference between means was not significant. All the patients had live newborns who were evaluated according to their Apgar score, during the first minute this was in the range of 7-9, and after five minutes was in the range of 7-9 also.

High Prevalence of Iron Deficiency and Anemia Among Female Injection Drug Users With and Without HIV Infection

High Prevalence of Iron Deficiency and Anemia Among Female Injection Drug Users With and Without HIV Infection

The effect of prolonged treatment with haemin on pluripotent haemopoietic progenitors of normal and hereditarily anaemic Belgrade laboratory (b/b) rats

The Belgrade laboratory (b/b) rat has an intracellular iron and haem deficiency-induced anaemia, due to a mutation affecting intracellular iron transport. Many disturbances in haemopoiesis of the b/b rat have been described, including impaired proliferation and a decreased number of pluripotent and committed progenitor cells in bone marrow as well as expanded granulocytic and erythroid progenitor cell populations in the spleen. In this study, the effects of prolonged treatment with haemin were evaluated on femoral and splenic pluripotent progenitors (spleen colony formingunits day 8, CFU-Sd8) in normal (+/+) and anaemic (b/b) rats. The treatment of b/b rats with haemin did not correct their severe anaemia. However, the abrogation of the proliferative block and an increased proliferative activity of the bone marrow CFU-Sd8 were found, demonstrating that the proliferative block of the b/b rat bone marrow CFU-Sd8 was induced by intracellular iron deficiency, rather than by severe hypoxia. Accordingly, the initially very low number of CFU-Sd8 per femur had increased. The results also revealed an enormously expanded population of splenic CFU-Sd8 in b/b rats, whereas after the haemin treatment a significant decrease in the number of these cells was found. The treatment of +/+ rats with haemin resulted in a significant decrease in the number of femoral CFU-Sd8, but the cycling status of these cells was not affected. In the spleen, the initially low number of CFU-Sd8 was modestly increased after the same treatment. These results imply that the effects of haemin treatment are different in a steady state than in a state of impaired medullar haemopoiesis. It is also evident that for both +/+ and b/b rats there exists an inverse number of CFU-Sd8 in the bone marrow and spleen.

Iron deficiency and anemia in vegetarian mothers and their newborns

Blood haemoglobin, serum iron, iron binding capacity, transferrin saturation and ferritin levels were determined in two groups of mothers as well as their cords—strict vegetarians (lactovegetarians) and non-vegetarians (omnivores), closely comparable in age, weight, parity and gestation period but differing in their diet and food habits. All these parameters, except total iron binding capacity, were found to be significantly lower in vegetarian mothers and their cords as compared to nonvegetarian mothers and their cords, respectively, despite receiving supplemental iron for six months. Further, there was a greater incidence of anemia and iron deficiency in mothers consuming only vegetarian diet. Moreover, a significant correlation existed between mother's ferritin to cord ferritin confirming that maternal iron deficiency does affect neonatal iron status. All these observations suggest that strict vegetarian mothers as well as their newborns have a greater incidence and risk of anemia and iron deficiency.

Nutrition and the Physically Active Female

Muscle glycogen is the primary source of energy during high intensity exercise. Increasing the carbohydrate content of the diet allows more glycogen to be stored. Some adolescent female athletes (gymnasts, dancers) do not consume adequate amounts of vitamin B6, folacin, and E. Many women have low dietary intakes of calcium and iron. Low calcium intake and physical inactivity are factors associated with the development of osteoporosis. Low iron intake is associated with the development of iron deficiency and anemia. Low ferritin levels (an index of body iron stores) are commonly observed in female athletes.

IUD use and endometrial bleeding

Bleeding disturbances account for 41-52% of all IUD discontinuations. These bleeding disturbances include an increase in menstrual blood loss (MBL) intermenstrual bleedings (IMBs) and prolonged duration of menstruation. IUD users experience an increase of MBL of 50-75% which continues throughout the duration of IUD use. MBL decreases after insertion of a progestin-releasing IUD. A progestin-releasing IUD can treat women suffering from excessive bleeding during menstruation. MBL of at least 60-80 ml causes iron deficiency and anemia. Since due to infections and malnutrition iron balance is especially important in women from developing countries copper T IUD use threatens their health. IMBs are most frequent during the first months following IUD insertion. IMBs differ with the IUD type. IMB generally results in minimal blood loss (4-5 ml) which has no negative health effects in IUD users. IUD-induced IMB may keep many women from using the IUD in cultures where irregular bleeding is unacceptable. The copper T IUD prolongs menstruation by about 1 day while the progestogen-releasing IUD prolongs it by about 2 days. Prolongation of menses rarely contributes to discontinuation. Ways to manage bleeding disturbances other than removal include counseling before insertion and when disturbances occur; in cases of heavy blood losses antifibrinolytic agents nonsteroidal anti-inflammatory drugs and iron supplementation; and in cases of IMB changing either the IUD or its location. The most important way to minimize the consequences of IUD-related bleeding problems and increase IUD acceptability is good counseling from professionals with experience confidence and adequate knowledge of the effect of the IUD on bleeding patterns.

Management of suspected iron deficiency a cost-effectiveness model

Iron deficiency is frequent among physically active women. Several diagnostic and therapeutic strategies have been advocated. We determined how women's preferences for care varied with their risk of iron deficiency and/or anemia. The women's strength of feelings (utilities) and management costs were used to assess: 1) no evaluation or therapy; treatment based on a 2) complete blood count (CBC) or 3) ferritin level; and 4) empiric iron therapy. The analysis was applied to groups with differing iron deficiency prevalence. Women (N = 22) were adverse to the risk of both anemia and iron deficiency without anemia, and their preferences did not correlate with age, running mileage, years of running, or vitamin supplement use. Because of women's desire to avoid undiagnosed deficiency, the benefits of no evaluation, complete blood count assessment, and, to a less extent, serum ferritin decreased as the prevalence of iron deficiency increased. Ferritin level was more effective per cost than a CBC. However, empiric therapy had the highest effectiveness per cost. These results suggest a strategy that combines both patient concerns and the clinical suspicion of disease in choosing management for physically active women at risk for iron deficiency.

Reduced Hemoglobin Values in Children and Young Adults With Hemophilia

Mild leukopenia and thrombocytopenia are common in multitransfused hemophiliacs. Because little attention has previously been directed to measurements of erythropoiesis in these patients, we prospectively examined hemoglobin concentration and RBC indices in 94 children and young adults with hemophilia during comprehensive clinic visits. Additional studies performed in many included serum transferrin saturation, ferritin, haptoglobin, and free erythrocyte protoporphyrin measurements. Hemoglobin concentrations were recorded as age-related percentile values. Hemophiliacs of all ages and degrees of severity often had lower than average values for hemoglobin; 31% had values less than the third percentile, 46% less than the tenth percentile, and 83% less than the mean value. Reduced hemoglobin percentile values were unrelated to age, severity of disease, or human immunodeficiency virus antibody status. Only five patients had an obvious cause for anemia. Serum ferritin, transferrin saturation, and erythrocyte protoporphyrin values were usually normal, indicating that iron deficiency and anemia of chronic disease were uncommon. Although serum haptoglobin was reduced in 44% of the patients, reticulocyte count was infrequently increased. We conclude that hemoglobin values are frequently less than the mean normal values for age in hemophiliacs. Although frank anemia is common, it is usually mild and without obvious cause. Hemophiliac individuals with slightly reduced hemoglobin values probably do not routinely require detailed investigation for occult blood loss, iron deficiency, or inflammation.

Red blood cell zinc protoporphyrin to evaluate anemia risk in deferred blood donors.

A large proportion of potential blood donors who are deferred are inappropriate to be donors because of unreliable predonation anemia screening methods. In this study, venous hemoglobin concentrations were within acceptable limits in 71% of 275 anemia deferrals. Red blood cell zinc protoporphyrin (RBC ZP) was evaluated as a screening test to improve the accuracy of detecting anemia in prospective blood donors. The frequency of abnormally low venous hemoglobin concentrations in anemia deferrals having fingerstick capillary microhematocrit (MH) values within 3% of the minimum requirement, together with normal RBC ZP levels (less than 53 micrograms/dL [0.943 mumol/L] RBC), was 2%, and not significantly different from the prevalence of venous anemia observed in eligible blood donors. Anemia deferrals with elevated RBC ZP results had a significantly increased rate of iron depletion and anemia. Capillary RBC ZP measurements in combination with the MH test have the potential to safely decrease inappropriate anemia deferrals.

Improvement of Iron Utilization and Anemia in Uremic Patients Switched from Hemodialysis to Continuous Ambulatory Peritoneal Dialysis

Serum ferritin, hematocrit (Ht) and hemoglobin (Hb) were studied in seven patients treated with hemodialysis (HD) who later switched to continuous ambulatory peritoneal dialysis (CAPD). No iron supplements were given during the study. During the whole observation period (12 months on HD and 12 months on CAPD), there was a progressive decrease in serum ferritin during HD, accompanied by a progressive drop in Hb and Ht; on the contrary, on CAPD, Hb and Ht showed a sharp increase despite further ferritin reduction. The CAPD ferritin drop was not due to peritoneal loss of iron or ferritin, which appeared negligible. We propose that the increase in both Ht and Hb in CAPD is due to the removal of toxic factor(s) inhibiting erythropoiesis, which allow(s) increased iron utilization, and consequently a reduction in serum-ferritin levels. Anemia of chronic renal failure is a complex event to which many factors may contribute -reduced erythrocyte survival, hemolysis, iron losses from gastrointestinal leakage, reduced erythropoiesis, presence of inhibitors of erythropoiesis (1).

Study of nutritional anemia in male residents of a chronic care facility

Fifty male residents of a chronic care facility were evaluated for evidence of anemia and/or nutritional deficiencies of folate, B 12, or iron. Anemia was present in 16%, of which 88% were≥80 years of age. Hemoglobin (=14.2 g/dl), serum iron (=64 ug/dl), and total iron binding capacity (=210 ug/dl) in all residents were significantly lower than age and sex-matched controls, while serum ferritin in the non-anemic residents (=89 ng/dl) was comparable to age-matched controls. Serum ferritin was significantly lower in the anemic compared to the non-anemic in whom a clinical or laboratory diagnosis was unclear. There was no evidence of folate or B 12 deficiency.

Cerebral function in iron deficiency: a review.

Studies in many parts of the world have shown that children with iron deficiency and anaemia show minor defects of cerebral function such as poor attentiveness, poor coordination and slightly impaired scores on developmental assessment. The patients improve rapidly after treatment with iron--too quickly for their anaemia to have been corrected. Such changes have not been detected in children with anaemia from other causes, nor in patients with iron deficiency too slight to cause anaemia. The possibility that these changes are due in some way to some other aspect of malnutrition has not been excluded. Fortunately they are minimal, easily reversible and potentially preventable.

Micromethod for zinc protoporphyrin in erythrocytes: Including new data on the absorptivity of zinc protoporphyrin and new observations in neonates and sickle cell disease

Millimolar absorptivity of ZnPROTO in pyridine, 221, and acetone containing 8.2% of 0.5-mole aqueous acetic acid per liter, 211, has been determined on a sample characterized by chromatography, fluorescence spectroscopy, nuclear magnetic resonance spectroscopy, and elemental analysis. These values are substantially higher than previously reported values. A quantitative fluorometric micromethod specific for ZnPROTO in blood is reported. This method gives results equivalent to an FEP method when ZnPROTO is the only species of porphyrin present. If PROTO is also present, the FEP method which measures both, gives a high result. The fraction of PROTO may be calculated from the difference between the FEP and ZnPROTO. In healthy young children with ZnPROTO only, PbB ⪯ 26 and hematocrit ⪰ 36%, the following average values were found: ZnPROTO, 1.28 μ m per liter of erythrocytes; FEP, 1.24 μ m per liter of erythrocytes. Observations in patients show that protoporphyrin is not the only condition in which the concentration of PROTO in erythrocytes is elevated. Increase in PROTO has been found in sickle cell (SS) disease, cord blood from newborns, and in anemic iron deficient children with and without increased lead absorption. Density gradient studies in human cord blood show that PROTO is found in the reticulocyte-rich fraction, as has been reported by others in studies of patients with iron deficiency anemia. The quantitative micromethod for ZnPROTO described here, if used in conjunction with both a standard FEP method and spectrophoto-fluorometry, may prove useful in exploring the significance of elevations in PROTO in these varied clinical conditions.

Biochemical Skeletal Muscle and Hematological Profiles of Moderate and Severely Iron Deficient and Anemic Adult Rats

The time course of the effects of moderate and iron anemia on tissue biochemistry of adult male rats was studied. Nine groups of adult male Sprague-Dawley rats were killed; eight of which had approximately 8 g hemoglobin (Hb)/dl (moderately anemic) for 3 to 360 days and one group which had approximately 4 g Hb/dl (severely anemic) for 30 days. Plasma iron was depressed in the mod erately and severely anemic groups at all times relative to nonanemic control rats. Moderately anemic rats at 360 days had a low mean corpuscu lar Hb and mean corpuscular volume and severely anemic rats at 210 days had a low mean corpuscular Hb, and elevated mean corpuscular Hb concen tration. Cytochrome oxidase activity of the white vastus lateralis, red vastus lateralis and soleus muscles were not different between the moderately anemic groups and their respective control groups at any time, but was significantly lower after 30 days of iron anemia. The myoglobin content and phosphofructokinase activity of these muscles showed no significant group differences with moderate or iron de ficiency. It is concluded that: 1) moderate iron anemia imposed no stimulus for alterations of the oxidative or glycolytic capacity of skeletal muscle, whereas iron anemia induced rapid select changes in a mitochondrial component of skeletal muscle, 2) the blood profiles in conjunction with the muscle biochemistry data in the moderately anemic group suggest a hypochromic, microcytic, manifest iron deficiency anemia, while those of the severely anemic group suggest a hypochromic, normo- cytic, severe iron deficiency anemia. J. Nutr. 108: 1306-1314, 1978.

THE EARLY ANEMIA OF PREMATURITY. PLASMA LEVELS OF TRANSFERRIN, IRON, FERRITIN, AND CERULOPLASMIN

As indicative of the iron status during the early anemia of prematurity, transferrin, iron, and ferritin levels of plasma were followed in infants with birth weight less than 1500 g. Ceruloplasmin, thought to act as ferroxidase, was also studied. Oral iron therapy was started at the age of four weeks.Transferrin concentration rose steadily from a mean value of 1.58 g/1 at 1 week of age to 2.17 g/1 at 8 weeks of age. Plasma iron concentration at 1 week of age was 15.6 ± 5.5 umol/1 and did not change significantly during the 8 week period. Ferritin in cord blood of full term infants was within the range of normal adult males, while the levels in cord blood from 10 infants with birth weight less than 2000 g were lower. Ferritin levels during the course of the early anemia will be discussed. Ceruloplasmin showed a more variable course than transferrin, but after 4 weeks a progressive rise occured. Mean value at 1 week of age was 0.11 g/1, at 6 weeks 0.13 g/1, and 0.15 g/1 at 8 weeks.The plasma iron levels observed are within the normal range for full term infants. However, whether they provide suffient available iron for the accelerated erythropoiesis of this period is unclear. The progressive rise in transferrin suggests that in this period the level more reflects the increase in general protein synthesizing capacity than the iron status. Ferritin concentration, on the other hand, seems to reflect iron stores.

Iron-Deficiency Pruritus

To the Editor.— Lewiecki and Rahman recently reported what they described as the first report of pruritus as a manifestation of iron deficiency (236:2319, 1976). This is an association that has been studied for several years by C. F. H. Vickers, and he has presented findings at numerous scientific meetings. I am aware of only one published report from his findings; it is a summary of 14 years of experience1in which 59 patients with iron deficiency and itching are described. Of particular importance are the following: (1) in many of the patients there was no anemia, but serum iron levels were low, (2) in men with low iron levels, anemia, and pruritus, 12 of 13 were subsequently found to have underlying neoplasia or reticulosis. His number of cases has doubled since that report, and the findings are holding up. I have examined serum iron levels in several patients with

Anaemia in Crohn's Disease

Sixty-three patients admitted to hospital with an exacerbation of Crohn's disease were investigated. Anaemia was found in 79 per cent of males and 54 per cent of females. Low levels of serum iron (65 per cent), total iron-binding capacity (22 per cent), serum vitamin B12, (16 per cent), serum folate (64 per cent), and red-cell folate (35 per cent) were also present. With the exception of the serum vitamin B12, these levels were directly related to the severity of the disease and were less reduced in patients with post-operative recurrences. There was a poor correlation with the site of disease. The serum iron, iron-binding capacity, and transferrin saturation were unreliable in the diagnosis of iron deficiency. An increased TIBC usually indicated iron deficiency and a subnormal TIBC suggested chronic inflammation but did not exclude iron deficiency. Based on the examination of bone marrow iron stores, evidence of iron deficiency was found in 18 (39 per cent) of 46 patients. The incidence of iron deficiency may have been over emphasized in the past because bone marrow iron stores have not always been examined. Of the 46 patients who had bone marrow aspirated, 18 (39 per cent) were megaloblastic. Folate deficiency was implicated as the underlying cause in 11 and vitamin B12 deficiency in six patients; one patient had both deficiencies. Vitamin B12, deficiency was usually associated with ileal resection, while folate deficiency was probably due to dietary deficiency and/or increased folate requirements. Vitamin B12, or folate deficiency should not be implicated as the cause of anaemia on the basis of serum levels alone. Moreover, the finding of megaloblastic change in the marrow should not obscure the importance of coexisting iron deficiency or the effects of the inflammatory disease process on erythropoiesis. When there is clear evidence of iron, folate, or B12-deficiency anaemia this should be treated with appropriate haematinics, although the response may be suboptimal until the inflammatory process is suppressed. As the disease process itself aggravates the severity of the anaemia, there will probably be a partial response to any treatment which reduces the activity of the disease.

Skin clearance of iron in normal and iron deficient subjects.

SUMMARY.— 59Fe-ferric citrate was injected into the skin of 23, normal subjects and 6 iron deficient patients. Iron clearance, measured by external scintillation counting, could be resolved into 3 exponential components. The first, rapid component resulted from the removal of unbound iron by the blood stream. A lymphatic component, t1/2 23·9 hr., accounted for; the clearance of two-thirds of the transferrin bound iron from the skin of normal subjects; the remaining one-third was taken up by the epidermal cells arid cleared only slowly (t1/2 67 days) from the injection site; This pattern was not altered by binding the iron to plasma before injection but in the anaemic iron, deficient patients over half of the transferrin bound iron was taken up by the cells. The possible causes of the increase in the epidermal component in iron deficiency are discussed.

MILK-INDUCED GASTROINTESTINAL BLEEDING IN INFANTS WITH HYPOCHROMIC MICROCYTIC ANEMIA.

SEVERAL FACTORS are known to contribute to the development of hypochromic microcytic anemia in infants, eg, prematurity, multiple births, and inadequate dietary iron. Recently attention has focused on the possible etiological role of occult gastrointestinal bleeding in certain infants. Although a greater fecal blood loss has been demonstrated in infants with hypochromic microcytic anemia than in controls, using radioisotopic techniques, the cause of this phenomenon has not been elucidated. 1,2 On the basis of previous studies 3 which demonstrated a high incidence of positive guaiac tests on stools, increased concentrations of plasma proteins in gastric juice, and multiple precipitins in high titer to whole cow's milk, it was postulated that the ingestion of whole cow's milk could be responsible for these signs of gastrointestinal dysfunction. It was further speculated that a mechanism of milk-induced gastrointestinal blood loss might lead to hypochromic microcytic anemia in some subjects. The present study was

Pathogenesis of Anemia in a Case of Nontropical Sprue

Summary In a case of nontropical sprue encountered at the Mayo Clinic the outstanding clinical manifestations were anemia and skeletal pains secondary to osteomalacia. Hematologic studies revealed severe hypochromic microcytic anemia with scattered macrocytes. The vitamin B 12 -cobalt 60 tracer tests showed greatly decreased absorption of vitamin B 12 . Radiochromium studies demonstrated that the erythrocyte survival was normal but that the patient episodically lost a significant amount of blood from the gastrointestinal tract, probably from internal hemorrhoids. The depletion of iron in the body, evidenced by hypochromic anemia and low concentration of iron in the serum, was shown to be due, at least partially, to gastrointestinal bleeding with hemorrhoids as the possible source. Deficient iron absorption, which is common in idiopathic steatorrhea, 10 probably was a factor in the pathogenesis of the patient's anemia. In combination with vitamin B 12 therapy the parenteral administration of iron produced a satisfactory reticulocyte response and apparently helped to maintain a hematologic remission originally established with the aid of blood transfusions.