Iron Binding Capacity Research Articles

High Ferritin and Low Total Iron-Binding Capacity in Plasma Predict All-Cause Mortality During the First 3 Years of Hemodialysis in Patients with End-Stage Chronic Kidney Disease.

To determine all-cause mortality rate and the predictive value of plasma ferritin and total iron-binding capacity (TIBC) concentrations for mortality during the first 3 years of hemodialysis in patients with end-stage chronic renal disease (ESRD). We conducted a study on 174 ESRD patients (estimated Glomerular Filtration Rate < 15 mL/min/1.73m2). The plasma TIBC level was quantified by the ELISA method in all patients at the time before hemodialysis. Based on TIBC concentration, patients were divided equally into 2 groups. Each group had 87 patients. Patients were initiated on hemodialysis, and patients who died from any cause during the first 3 years of hemodialysis were recorded. The all-cause mortality rate of ESRD patients in the first 3 years of maintenance hemodialysis was 22.9%. Plasma high hs-CRP, high ferritin, and low TIBC concentrations were independent factors associated with all-cause mortality in the patients. Plasma ferritin (cut-off value = 454.2 ng/L) and TIBC (cut-off value = 39.84 µmol/L) were predictors of all-cause mortality, AUC is: 0.772; 0.723, p < 0.001. Plasma ferritin and TIBC were good predictors of all-cause mortality in ESRD patients during the first 3 years of hemodialysis.

Assessment of haematological values and iron profile in dogs with iron deficiency, iron deficiency anaemia and anaemia without iron deficiency

Iron deficiency (ID) has important effects on both animals and humans, causing illness and non-specific signs. The blood changes associated with ID develop as a decrease in some erythrocyte parameters and microcytic anaemia. In this study, 175 blood samples from dogs were obtained for the measurement of complete blood count (CBC), copper, and iron profiles that included serum iron, total iron binding capacity (TIBC), transferrin saturation (TS%), unbound iron binding capacity (UIBC), and canine ferritin. The cut-off values for serum iron and TS% were found using the receiver operator characteristic (ROC) curve test. The estimated cutoffs for the diagnosis of iron deficiency in the dogs were 115.74 mg/dL (serum iron) and 34.07% (TS%). The dogs with serum iron ≤ 115.74 mg/dL and TS% ≤ 34.07 were iron deficient. The dogs were divided into three groups based on the ROC curve results: iron deficiency (ID), iron deficiency anaemia (IDA), and non-iron deficiency anaemia (NIDA). The iron concentration and TS% of ID and IDA dogs were significantly lower than those of NIDA dogs, while the TIBC, UIBC, and ferritin did not differ among groups. The serum copper was not significantly lower in dogs with ID, but in the ID group (85.85±11.30 mg/dL) was less than levels in IDA and NIDA dogs (98.46±15.92 and 78.69±11.77, respectively). The study concluded that the ROC curve and area under the curve provided guidelines for the diagnostic accuracy of tests and the diagnosis of iron deficiency in dogs. The coefficient of variation of red blood cell distribution width (RDWc) was significantly higher when iron deficiency anaemia developed, as indicated by red blood cell (RBC) anisocytosis. The decreases in serum iron and TS% were considered "golden tests" for the diagnosis of IDA in dogs

Evaluation of Iron Status in Children Presenting with Febrile Seizure in a Tertiary Health-care Facility

Abstract Introduction: The aim of this study was to investigate the relationship between iron deficiency anemia (IDA) and febrile seizures (FS) in children. Materials and Methods: The study included 100 cases of FS in children between the ages of 6 and 60 months, including both simple and complex FS. Children in the same age range who had a fever but no seizures made up the control group. The various hematological parameters reflecting the iron status, including hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red-cell distribution width (RDW), serum ferritin, and total iron-binding capacity (TIBC), were evaluated in both groups to ascertain the relationship between the iron status and the FS. Results: Male-female ratio in children with and without FS were 1.2:1 and 1.3:1, with a mean age of 25.16 ± 11.75 and 24.37 ± 11.75 months, respectively. Age and gender distribution were comparable between the two groups (P = 0.719 and P = 0.851, respectively). The mean values for Hb, MCV, MCHC, RDW, ferritin, and TIBC among children who had FS were 11.030.98 g/dL, 66.1810.97 fl, 32.421.38 pg/L, 14.881.13, 46.5432.64 ng/mL, and 419.7672.49 g/dL, respectively. In contrast, the readings for the control group’s children were 11.91 0.78, 67.94 11.06 fl, 32.80 0.60 pg/L, 14.16 1.01, 59.20 27.52 ng/mL, and 378.65 60.87 g/dL, respectively. Except for the mean MCV, each of these variances was statistically significant. Conclusions: Our results suggest that IDA is a major risk factor for FS since it was more common in the case group than in the control group.

Relationship between iron homeostasis and prognosis in patients with heart failure: a retrospective study based on the MIMIC-IV database.

The role of iron homeostasis has become increasingly recognized as a key factor in determining a prognosis of patients with heart failure (HF). Disruptions in iron balance, encompassing deficiency and overload, can affect patient prognosis, and therefore, significantly impact treatment and management strategies. The study investigated possible associations between iron homeostasis-related indicators and long‑term mortality as well as first‑admission mortality in individuals with HF. Data on 3483 HF patients from the MIMIC‑IV database were retrospectively analyzed. The relationship between iron homeostasis-related indicators (ferritin, serum iron, transferrin, and total iron binding capacity [TIBC]) and the first-admission and long-term mortality of HF patients was discerned utilizing the Cox proportional hazards model and the Kaplan-Meier survival analysis. Additionally, the predictive capability of these indicators for patient prognosis was assessed using the receiver operating characteristic curve. Fourth quartile levels of ferritin and serum iron were obviously associated with poor long‑term outcomes in HF patients. Conversely, fourth quartile levels of transferrin and TIBC served as protective factors and were associated with a lower mortality. Additionally, iron homeostasis indicators exhibited a certain predictive value for both long‑term mortality and first‑admission mortality in HF patients. This study underscores a significant association between iron homeostasis indicators and the prognosis of HF patients, providing valuable insights into risk stratification and clinical decision‑making for this population. Future studies should focus on dynamic fluctuations in iron homeostasis and explore interventions to improve the prognosis of HF patients.

Interaction between systemic iron parameters and left ventricular structure and function in the preserved ejection fraction population: a two-sample bidirectional Mendelian randomization study.

Left ventricular (LV) remodeling and diastolic function in people with heart failure (HF) are correlated with iron status; however, the causality is uncertain. This Mendelian randomization (MR) study investigated the bidirectional causal relationship between systemic iron parameters and LV structure and function in a preserved ejection fraction population. Transferrin saturation (TSAT), total iron binding capacity (TIBC), and serum iron and ferritin levels were extracted as instrumental variables for iron parameters from meta-analyses of public genome-wide association studies. Individuals without myocardial infarction history, HF, or LV ejection fraction (LVEF) < 50% (n = 16,923) in the UK Biobank Cardiovascular Magnetic Resonance Imaging Study constituted the outcome dataset. The dataset included LV end-diastolic volume, LV end-systolic volume, LV mass (LVM), and LVM-to-end-diastolic volume ratio (LVMVR). We used a two-sample bidirectional MR study with inverse variance weighting (IVW) as the primary analysis method and estimation methods using different algorithms to improve the robustness of the results. In the IVW analysis, one standard deviation (SD) increased in TSAT significantly correlated with decreased LVMVR (β = -0.1365; 95% confidence interval [CI]: -0.2092 to -0.0638; P = 0.0002) after Bonferroni adjustment. Conversely, no significant relationships were observed between other iron and LV parameters. After Bonferroni correction, reverse MR analysis showed that one SD increase in LVEF significantly correlated with decreased TSAT (β = -0.0699; 95% CI: -0.1087 to -0.0311; P = 0.0004). No heterogeneity or pleiotropic effects evidence was observed in the analysis. We demonstrated a causal relationship between TSAT and LV remodeling and function in a preserved ejection fraction population.

Therapeutic and toxicological assessment of hydroethanolic leaf extracts of Jatropha carcus and Justicia carnea in apparently healthy Sprague Dawley rats.

The study aimed at evaluating the effects of hydroethanolic leaf extracts of Justicia carnea and Jatropha carcus on the biochemical, hematological, and histological parameters of apparently healthy rats. Thirty adult rats (n = 30) with an average weight of 153 g were randomly divided into six groups (A-F). Group A: negative control; Group B: positive control; Group C: Jatropha curcas (low dose); Group D: Jatropha curcas (high dose); Group E: Justicia carnea (low dose); and Group F: Justicia carnea (high dose). Standard and scientifically approved methods were used for sacrifice and laboratory diagnosis. The study shows a significant increase in body weight across groups administered with the leaf extracts. Elevated levels of serum creatinine were recorded in rats administered with both extracts, indicating nephrotoxicity. The study also observed an increase in alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase across groups, indicating hepatotoxicity. Both extracts caused an increase in white blood cell count and hemoglobin concentration, a significant reduction in bleeding time, increased prothrombin time, and partial thromboplastin time at high dosages. Total iron binding capacity and serum ferritin values were increased in high doses and were statistically significant at P<0.05. Histomorphology of both extracts shows hepatorenal toxicity at high concentrations and none in the lungs or heart. Oral administration of Justicia carnea and Jatropha carcus extracts at high concentrations is not safe for the liver and kidneys. Biochemical parameters should be monitored regularly in humans exposed to both plants. Therefore, this study scientifically confirms and supports the traditional use of the leaves of Jatropha carcus and Justicia carnea to enhance hematological parameters.

Evaluation of the influence of pre-analytical factors on serum iron levels, total iron binding capacity, transferrin saturation index and ferritin

Evaluation of the influence of pre-analytical factors on serum iron levels, total iron binding capacity, transferrin saturation index and ferritin

Impact of ultrastructural and molecular identified Babesiosoma spp. in both Egyptian freshwater fishes (common carp and African catfish): Hematological, biochemical, and histopathological findings.

Babesiosomes are apicomplexan parasites of both marine and freshwater fish species. In this study, we recorded the prevalence of Babesiosoma spp in two Egyptian freshwater fish species; the common carp and the African catfish with full pathological evaluation of the diseased condition, hematological and biochemical analysis of some parameters with exact recognition of the parasite with different methods. Two hundred and forty fish blood samples from Al-Sharqiya and Al-Ismailia governorates from August 2022 to January 2023 followed by blood film examinations, performing electron microscopy and molecular detection of the parasite via polymerase chain reaction. The total infection prevalence was 63.75% with a higher prevalence observed among African catfish (42.5%) than Common carp (21.25%). Regarding hematologic parameters, the obtained results showed a significant decrease in the hematocrit values and a significant increase in the total leukocyte and lymphocyte values in both infected fish species. The serum ferritin, superoxide dismutase, and glutathione peroxidase were also significantly increased. However, the total iron binding capacity was significantly decreased. There was also a significant increase in the total serum bilirubin in the examined fish, all at (p < 0.001). Histopathologically, the lesions were more intense in the African catfish than the common carp but generally, the infected fish showed many changes with the gills being severely affected with pronounced hyperplasia of secondary lamellae with fusion and telangiectasis. The spleen, heart, and kidney are also affected. Serious adverse effects on the health status of previously examined fishes infected with Babesia spp. were observed and detected by several diagnostic and descriptive tools. Histopathological, hematological, and biochemical studies give an idea of the extent of these changes which are largely fatal affecting the economic system depending on the fish industry.

Can ferritin be a surrogate marker for CD4 cells in human immunodeficiency virus patients? A cross-sectional study of association of serum ferritin levels with immunological staging of human immunodeficiency virus patients.

The human immunodeficiency virus (HIV)/AIDS in India came into public view in 1986 with the detection of the first case of HIV in Chennai, Tamil Nadu, and the first AIDS case in Mumbai, Maharashtra in 1987. In acute phase response, iron distribution occurs in the liver and mononuclear phagocytic system. A high prevalence of elevated serum ferritin levels is reported in HIV infection and serum ferritin levels increase with the clinical worsening of infection and with decreasing CD4 lymphocyte counts. This study is designed to find the role of acute phase reactant serum ferritin in the progression of the disease of HIV which is complicated by opportunistic infections, by finding the correlation of serum ferritin with immunological stages of HIV. This cross-sectional study was conducted on 75 patients admitted to various wards of the Department of Medicine or attending medicine outdoor or ART Centre, Maharana Bhupal Government Hospital, RNT Medical College Udaipur. Serum ferritin, total iron binding capacity, and total serum iron were analyzed in Cobas® analyzer. CD4 cells are measured using the flow cytometry technique. The results were tabulated and subjected to statistical analysis. There was a negative correlation among serum ferritin and CD4 cells with r = -0.195 which was statistically significant (P < 0.05). As the CD4 cell count decreased incidence of serum ferritin increased. Elevation of serum ferritin levels is associated with a low count of the CD4+ in HIV-diagnosed patients. In a patient diagnosed with HIV, elevated serum ferritin indicates underlying inflammatory pathology. Serum ferritin can be used as a guide to further evaluation of underlying disease in HIV patients.

Evaluation of the relationship of digital phototrichogram findings of patients with diffuse hair loss with blood TSH, ferritin and vitamin B12 levels.

Telogen effluvium (TE) is a type of alopecia that is frequently seen in women. Among factors resulting in hair loss, many reasons such as endocrine diseases, nutrition disorders, stress, anemia, low ferritin levels, vitamin B12 deficiency, and thyroid diseases are found. A digital phototrichogram is one of the non-invasive methods of diagnosis in the evaluation of alopecia. In this study, it was aimed to compare biochemical parameters of female patients with diffuse hair loss with phototrichogram findings. 108 female patients with diffuse hair loss were included in the study. Patients were divided into two groups: acute and chronic TE, and a hair pull test was applied. Total blood count, blood biochemistry, iron, iron binding capacity, ferritin, thyroid stimulating hormone (TSH), sT3, sT4, folic acid, and vitamin B12 levels were examined. The telogen/anagen ratios and hair densities of patients were determined with a phototrichogram. The serum biochemical parameters (aspartate aminotransferase, alanine aminotransferase, urea, creatinine), TSH, sT3, sT4, and folic acid levels of patients were within normal limits. Telogen ratio, anagen ratio, hair density, number of shed hairs, family history, blood ferritin, TSH, and vitamin B12 levels were found to be similar between groups having acute and chronic TE. In our study, while mean anagen and telogen ratios with trichoscan were similar to literature data, no statistically significant correlation was determined between patients' ages and examined trichoscan findings (p>0.05). The hair pull test positivity of patients with chronic TE was higher compared to patients with acute TE (p<0.05). In patients with positive hair pull tests, the telogen ratio and hair density were found to be higher. In the group with <40 ng/mL ferritin level, the mean telogen ratio was detected to be significantly higher than the mean anagen ratio (p<0.05). No significant correlation was determined between vitamin B12 and TSH levels in patients and phototrichogram findings (p>0.05). The findings of this study showed that ferritin has an important role in diffuse hair loss, and the phototrichogram method is an auxiliary method for the physician in the diagnosis of TE.

Factors associated with the malnutrition inflammation score (MIS) among hemodialysis patients in Dhaka city: a cross-sectional study in tertiary care hospitals.

Chronic kidney disease (CKD) is a progressive disease that leads to end-stage renal disease (ESRD). Malnutrition increases the risk of mortality among patients with ESRD. This study aimed to determine malnutrition prevalence and associated factors among twice-weekly (n = 94/120) and thrice-weekly (n = 26/120) hemodialysis patients/HDP. A cross-sectional study was conducted at two tertiary-level public hospitals in Dhaka city using a consecutive sampling technique from April to June 2021. Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Multivariable ordinal logistic regression was performed to determine which socioeconomic, clinical, anthropometric, biochemical, and dietary factors are associated with MIS. The prevalence of malnutrition was very high among HDP (severe 15.5%, mild/moderate 56.7%) with an average dialysis vintage of 28.7 months. Comorbidities (80.8%) and gastrointestinal symptoms/GIS (68.3%) were ubiquitous, and "dialysis frequencies" were not associated with MIS in bivariate analysis. Multivariable ordinal regression showed that anthropometric factors like mid-upper arm circumference/MUAC (adjusted odds ratio/AOR = 0.978), post-dialysis body mass index/BMI (AOR = 0.957), and biochemical parameters like albumin (AOR = 0.733) and TIBC/total iron binding capacity (AOR = 0.996) negatively (P < .05) associated with MIS. Moreover, having "no GIS" (AOR = 0.672, P < .001) was 33.0% less likely to be associated with MIS. Contrarily, as the month of dialysis increases, MIS increases by 22.0% (AOR = 1.22). Significant associations of clinical, anthropometric, and biochemical characteristics with MIS indicate the importance of routine screening of the nutritional status of patients with CKD to improve health status and prevent protein-energy wasting. The MIS could be a simple, noninvasive tool for testing nutritional status in patients with CKD.

A dual colorimetric-electrochemical microfluidic paper-based analytical device for point-of-care testing of ischemic strokes.

A novel microfluidic paper-based analytical device with dual colorimetric and electrochemical detection (dual μPAD) was developed for the assessment of transferrin saturation (TSAT) in samples from ischemic stroke patients. TSAT was calculated from the ratio between transferrin-bound iron, which was colorimetrically measured, and the total iron-binding capacity, which was electrochemically measured. To this end, a μPAD was smartly designed, which integrated both colorimetric and electrochemical detection reservoirs, communicating via a microchannel acting as a chemical reactor, and with preloading/storing capabilities (reagent-free device). This approach allowed the dual and simultaneous determination of both parameters, providing an improvement in the reliability of the results due to an independent signal principle and processing. The μPADs were validated by analyzing a certified reference material, showing excellent accuracy (Er ≤ 5%) and precision (RSD ≤ 2%). Then they were applied to the analysis of diagnosed serum samples from ischemic stroke patients. The results were compared to those provided by a free-interference method (urea-PAGE). Impressively, both methods exhibited a good correlation (r = 0.96, p < 0.05) and no significant differences were found between them (slope 1.0 ± 0.1 and the intercept 1 ± 4, p < 0.05), demonstrating the excellent accuracy of our approach during the analysis of complex samples from ischemic stroke patients, using just 90 μL of clinical samples and taking less than 90 min in comparison with the 18 hours required by the urea-PAGE approach. The developed fully integrated colorimetric-electrochemical μPAD is a promising ready to use reagent-free device for the point-of-care testing of TSAT, which can be used to assist physicians in the fast diagnosis and prognosis of ischemic strokes, where the decision-time is crucial for the patient's survival.

Transferrin receptor 1 rs3817672 variant genotyping in Egyptian children diagnosed with iron-deficiency anemia: a case–control study

Background Cell surface transferrin receptor 1 (TFR1) is a gatekeeper controling cellular iron uptake. The association of iron-deficiency anemia (IDA) in humans with TFR1 variants was not extensively studied. Among these variants is TFR1 rs3817672, an exonic missense variation that may affect the TFR1 protein structure. This is the first study in Egypt and the second worldwide that genotype TFR1 rs3817672 variant in IDA pediatric patients. Aim The aim of the current study was to investigate the association between TFR1 rs3817672 variant with susceptibility risk for IDA. Patients and methods The study was conducted on 50 IDA Egyptian pediatric patients and 50 healthy controls. Complete blood count, iron profile, and TFR1 rs3817672 variant genotyping were performed for all participants. Results TT genotype was associated with a high risk of IDA among cases compared to controls in the recessive model (odds ratio 24, 95% confidence interval 5.253–109.650, P≤0.001) with the predominance of T allele (odds ratio 7.3187, 95% confidence interval 3.919–13.669, P≤0.001). TT genotype was associated with a significant decrease in serum iron (P=0.001 and 0.003) and transferrin saturation (P=0.003 and 0.005) compared to CT genotype and CC+CT genotypes in the recessive model, respectively. In IDA patients, serum iron had a significant positive correlation with transferrin saturation (r=0.984, P≤0.001) and a significant negative correlation with total iron-binding capacity (r=−0.555, P≤0.001). Conclusion TT genotype was the predominant genotype among Egyptian pediatric IDA patients. TFR1 rs3817672 genotyping might be used as a potential screening test for IDA risk susceptibility in pediatrics.

A review of the biological activities of lactoferrin: mechanisms and potential applications.

Lactoferrin, a multifunctional iron-binding protein found in milk and other body fluids, possesses numerous biological activities. The functional activity of lactoferrin lies not only in its iron-binding capacity but also in the molecular mechanisms by which it can affect important chemical components in the host. However, the molecular mechanisms underlying these activities remain unelucidated. In this paper, we review the structure, properties, and contents of different lactoferrin milk sources. The different biological activities, namely antibacterial, antiviral, immunomodulatory, anti-inflammatory, bone regeneration, and improved metabolic disorder bioactivities, and the associated potential mechanisms of lactoferrin are summarized with the aim of providing a reference for the development of lactoferrin-related products.

On the evolutionary trail of MagRs.

Magnetic sense, or termed magnetoreception, has evolved in a broad range of taxa within the animal kingdom to facilitate orientation and navigation. MagRs, highly conserved A-type iron-sulfur proteins, are widely distributed across all phyla and play essential roles in both magnetoreception and iron-sulfur cluster biogenesis. However, the evolutionary origins and functional diversification of MagRs from their prokaryotic ancestor remain unclear. In this study, MagR sequences from 131 species, ranging from bacteria to humans, were selected for analysis, with 23 representative sequences covering species from prokaryotes to Mollusca, Arthropoda, Osteichthyes, Reptilia, Aves, and mammals chosen for protein expression and purification. Biochemical studies revealed a gradual increase in total iron content in MagRs during evolution. Three types of MagRs were identified, each with distinct iron and/or iron-sulfur cluster binding capacity and protein stability, indicating continuous expansion of the functional roles of MagRs during speciation and evolution. This evolutionary biochemical study provides valuable insights into how evolution shapes the physical and chemical properties of biological molecules such as MagRs and how these properties influence the evolutionary trajectories of MagRs.

Roxadustat on Renal Anemia with Macroinflammation: A Retrospective Cohort Study

Introduction: Roxadustat, the first-in-class drug for the treatment of renal anemia, has demonstrated efficacy in renal anemia with microinflammation. Additional data are needed regarding the efficacy of roxadustat on renal anemia with systemic macroinflammation. Methods: Three cohorts of renal anemia based on the basic level of high-sensitivity CRP were included. Patients with hsCRP ≤2 mg/L were selected as non-inflammation (NI) group; 2< hsCRP ≤10 mg/L as microinflammation (MI) group; hsCRP≥10 mg/L as macroinflammation (MA) group. Patients received oral roxadustat three times per week for 52 weeks. The primary end point was the hemoglobin level over weeks 12–52. The second end point was the cumulative proportion of patients achieving hemoglobin response by the end of week 12. Results: A total of 107 patients with chronic kidney diseases (CKDs) were enrolled. Overall, the baseline hemoglobin level of patients was 79.99 ± 11.20 g/L. Roxadustat could significantly increase the hemoglobin level in all of the three groups and did not show any significant difference (p > 0.05, respectively). Meanwhile, compared with that of the NI group, there was no significant difference in hemoglobin response rate in the MA group both at week 12 (p = 0.06; 95% confidence interval [CI], 0.9531–13.75) and week 52 (p = 0.37; 95% CI, 0.5080–7.937). Moreover, the hemoglobin response was independent of baseline hsCRP level (p = 0.72, 95% CI, −0.1139 to 0.0794). More importantly, roxadustat significantly reduced ferritin and serum iron levels and increased total iron-binding capacity in the three groups, which showed no significant differences among the three groups (p > 0.05, respectively). Conclusion: Roxadustat significantly improves anemia in CKD patients with systemic macroinflammation.

Potential Association of Serum Hepcidin, hs-CRP and Iron Status Levels in Hemodialytic Patients

Patients on hemodialysis (HD) are usually anemic because of defective erythropoiesis. Hepcidin is a polypeptide that regulates iron homeostasis and could indicate functional iron deficiency in patients with end-stage renal disease (ESRD); this may also aid in assessing a patient's response to erythropoietin (EPO). The present study was directed to investigate serum levels of hepcidin, iron status, and inflammation markers such as C-reactive protein (CRP) in patients with ESRD on maintenance HD and to observe the correlation of serum hepcidin with conventional iron and inflammatory markers. Forty-two patients of both sexes on maintenance HD and EPO therapy were enrolled; 42 age and sex-matched healthy subjects were included as controls. Laboratory tests were performed, including complete blood count, serum hepcidin, total iron binding capacity (TIBC), serum ferritin, serum iron, and CRP. Serum hepcidin levels were significantly higher in patients with ESRD than in the control group (18.2 \(\pm\) 2.8 ng/mL and 8.5 \(\pm\) 2.3 ng/mL, respectively P = 0.000). The hemoglobin, hematocrit, serum iron, TIBC, and transferrin saturation levels in the patient group were significantly lower than in the control group. Higher hepcidin levels were found in EPO non-responders (19.6 (\pm) 2.4 ng/mL), while lower levels (16.9 \(\pm\) 2.5 ng/mL) were seen in responders (P = 0.001). A positive and significant correlation was observed between the values of serum hepcidin and CRP. Our study indicates that higher hepcidin levels are found in ESRD patients on HD and in those not responding to EPO. Our findings suggest that hepcidin might play a role in the pathophysiology of anemia associated with chronic diseases and EPO resistance.

Distinguishing Iron Deficiency Anemia from Anemia of Chronic Disease Using Hematological Measures

Anemia is a serious public health concern in today’s world which is particularly affecting young children, pregnant women, menstruating adolescent girls and women. The two most common causes of anemia are iron deficiency anemia (IDA) and anemia of chronic disease (ACD), often known as anemia of inflammation. This study aim was to assess the levels of certain hematological parameters, including Hemoglobin Estimation, Mean Corpuscular Volume (MCV), Serum Ferritin, Serum TIBC, Erythrocyte Sedimentation Rate and C - reactive protein to clearly differentiate between iron deficiency anemia and anemia of chronic disease. The study was conducted in Department of Medical Lab Technology, Riphah International University, Islamabad from September 01, 2023 to January 01, 2024. A total of 109 samples with 59 of iron deficiency anemia patients and 50 patients of Anemia of chronic disease were assessed for differentiation be these two diseases. The significant level was selected with p-value less than 0.05. Hemoglobin estimation, TIBC, and ESR were significant in our investigation as their p-values were less than 0.05. Hence, it concluded that Hemoglobin estimation, total Iron Binding Capacity and Erythrocyte Sedimentation Rate were Hematological parameters that distinguished between Iron Deficiency Anemia and Anemia of Chronic Disease.

Red cell parameters, iron, vitamin B12 and folate levels of pulmonary tuberculosis patients attending clinic at General Hospital, Akamkpa, Cross River State, Nigeria

Introduction: Tuberculosis caused by Mycobacterium tuberculosis, is a disease of public health importance, characterized by a chronic granulomatous inflammation in humans. In this study, red cell and iron parameters as well as vitamin B12 and folate levels were assessed with a view to investigate the presence or absence of iron deficiency and/or vitamin B12 and folate deficiency in tuberculosis disease Methods: Fifty (50) male and female tuberculosis patients within the ages of 15-60 years and attending clinic at the General Hospital, Akamkpa were enrolled in this study. Fifty apparently healthy and mantoux-negative subjects who were age and gender matched and resident in Akamkpa served as control. Ethical approval and informed consent were obtained from the Cross-River State Ministry of Health and all participants. Demographic information was obtained by face-to-face interview. Diagnosis of TB was by the Ziehl-Neelsen technique. Red cell and iron parameters, vitamin B12 and folate levels were determined by standard methods. Data were analyzed using student t-test on statistical package for social sciences version 21and a P value less than or equal to 0.05 is considered significant. Results: The mean age of TB patients (34.7±10.4 years) is comparable to that of the control (32.4±8.6 years) with more males (56%) affected than females (44%). Fifteen (30%) of the TB patients have primary level of education with 31 (62%) and 4 (8%) having attained secondary and tertiary levels. The level of education for the control was 12 (24%), 22 (44%) and 16 (32%) for primary, secondary and tertiary respectively. The TB patients were farmers 20 (40%), traders 15 (30%), students 9 (18%) and civil servants 6 (12%) while the controls consisted of 14 (28%) farmers, 16 (32%) traders, 12 (24%) students and 8 (16%) civil servants. The packed cell volume and haemoglobin concentration of TB patients (0.34±0.05 L/L and 121.4±11.3 g/L) was significantly lower (p &lt; 0.05) than 0.41±0.04 L/L and 145.2±13.1 g/L for the control. The red cell count and mean cell volume of TB patients (4.55±0.73 x 10 12/L and 79.21±2.40 fl) was comparable (p &gt; 0.05) to control values (4.84±0.54 x 10 12/L and 80.18±1.30 fl). Mean cell haemoglobin and mean cell haemoglobin concentration of TB patients was 27.58±2.12 pg and 34.37±1.43 g/dl, which was significantly lower than 29.72±2.24 pg and 35.73±1.38 g/dl obtained for control. The serum iron of TB patients (47.90±6.25µg/dl) was significantly lower (p = 0.001) than control value 109.03±8.56µg/dl. The total iron binding capacity (188.05±33.01µg/dl) and transferrin saturation with iron (28.00±4.54 %) were significantly lower (p = 0.001) for TB patients versus control (252.28±36.30µg/dl and 42.46±6.23%). Serum ferritin of TB patients (345.30±82.61 ng/ml) was significantly higher (p = 0.001) when compared to the value for control (108.62±28.50 ng/ml). Vitamin B12 and folate levels (245.37±39.62 ng/L and 353.34±57.06 µg/l) were significantly lower (p = 0.001) for TB patients when compared with control (550.20±82.33 ng/L and 681.93±97.36µg/l) though within the reference values. Conclusions: This study has shown a lower packed cell volume and haemoglobin concentration in tuberculosis disease indicating the presence of anaemia. An alteration in iron metabolism and increased iron stores has also been demonstrated ruling out iron deficiency anaemia. Vitamin B12 and folate levels though lower for TB patients, are within the reference range thus excluding megaloblastic anaemia. Tuberculosis shows a normocytic normochromic anaemia which is typical of anaemia of chronic disease and inflammation.

An Investigation of the Effectiveness of Distance Learning on Nutrition Quality of Hemodialysis Patients during the COVID-19 Pandemic: A Single-Blind Randomized Clinical Trial.

The COVID-19 pandemic has limited hemodialysis patient's attendance in healthcare centers and receiving diet education. This study was conducted to investigate the effectiveness of distance learning on the nutrition quality of hemodialysis patients during the COVID-19 pandemic. In the single-blind randomized clinical trial, 60 patients undergoing hemodialysis were randomly divided into control (n=30) and experimental (n=30) groups. Before and after the intervention, Dialysis Malnutrition Score (DMS), Malnutrition-Inflammation Score (MIS) (primary outcome), albumin, the total iron-binding capacity of the blood (TIBC), and body mass index (BMI) (Secondary outcome) were investigated. The experimental group received educational content through social networks for three months, whereas the control group received routine care and training. There was no significant difference between the two groups in terms of the mean of DMS, MIS, albumin, and TIBC before the intervention. Pre-test BMI had a confounding effect; therefore, an analysis of covariance was performed to eliminate that effect. This analysis showed significant differences in the post-test mean DMS, MIS, TIBC, and BMI between the two groups. In the control group, significant differences were observed in MIS and BMI toward deterioration. The results also indicated a significant relationship between education level and age with TIBC and between marital status and albumin index. Distance learning can be considered by healthcare managers and police makers as a suitable alternative to the classic face-to-face learning method to enhance hemodialysis patients' nutrition quality during the COVID-19 pandemic.