Iron Deficiency Anemia Subjects Research Articles

Prevalence of Anemia, Iron Deficiency Anemia and its Socio-Demographic Factors among Pregnant Women in Garmian Province, Kurdistan region of Iraq

Anemia is the most common hematologic abnormality in pregnancy. Maternal anemia is associated with adverse fetal, neonatal, and childhood outcomes. This study aims to determine the prevalence of anemia, and iron deficiency anemia (IDA), the severity of the condition, and study the effect of some socio-demographic factors on pregnant women in Garmian province. The study was conducted among 157 pregnant women in Garmian province between 17 and 49 years old. Participants completed a questionnaire that included sociodemographic characteristics, disease, and gestational age. A hematological evaluation, including a complete blood count (CBC) and serum for ferritin testing. Results of this study have shown that the prevalence of anemia and IDA were 34.4% and 15.3%, respectively. Almost three-quarters of the pregnant women had mild anemia, while 31 % of the subjects had moderate anemia, and about 60% of the participants were diagnosed with normocytic anemia. The second trimester had the highest prevalence, with 51.9% for the anemic and 45.8% for IDA subjects, while the first trimester showed the lowest prevalence, with 14.8 % for anemic and 12.5% for IDA subjects. Age, occupation, gravidity with anemia, and iron deficiency anemia did not make a significant difference. Moreover, there was no significant difference in blood indices between anemic and IDA participants. The serum ferritin level was unaffected by the pregnancy trimesters.

A Study to Assess the Levels of Salivary Ferritin in Iron Deficiency Anemia Subjects and Healthy Subjects.

Introduction: Iron deficiency anemia is one of the most widespread disorders in humans. Early diagnosis of iron deficiency anemia is challenged by assessing serum ferritin levels. However, studies across the globe have concluded that ferritin is present in quantifiable amounts in saliva. Thus, in the study, the scope of using salivary ferritin as a diagnostic biomarker in detecting iron deficiency anemia is studied.Methods: Levels of salivary ferritin in patients with iron deficiency anemia (test group, n=15) and non-anemic subjects (control group, n=15) were assessed by an automated chemilumesent method with a total sample size of 30 volunteers.Results: The mean level of salivary ferritin in subjects with iron deficiency anemia was 139.37±47.90 µg/dl, which was significantly higher when compared to the level in non-anemic subjects, 94.18±62.90 µg/dl, which was contradictory when compared to the levels of serum ferritin.Conclusion: The raise in the levels of salivary ferritin in subjects with iron deficiency anemia can be attributed to the iron-dependent enzymatic function of saliva. Thus, salivary ferritin can become a biomarker that helps in the diagnosis of iron deficiency anemia; however, more research is needed for devising a more standard cutoff value for diagnosing iron deficiency anemia.

Risk of migraine in iron deficiency anemia patients with or without iron supplementation usage: a nationwide database analysis

IntroductionThis study evaluated the association between iron deficiency anemia (IDA) and migraine and investigated the effects of iron supplementation, and comorbid conditions, including cardiovascular, respiratory, hepatic, endocrine, metabolic, and other diseases on migraine development.Material and methodsAll study subjects aged ≥20 years with newly diagnosed IDA in the Taiwan National Health Insurance Database during 2000–2012 were enrolled. We matched IDA and non-IDA subjects according to age and sex at a 1:2 ratio. Our primary outcome was diagnosis of migraine, and the patients were monitored until the end of 2013. A Cox proportional hazards regression model was used to evaluate the risk of migraine events in IDA.ResultsThe cumulative incidence of migraine in patients with IDA was 5.82 per 1,000 person-years, which was higher than that in the comparison group (3.99 per 1,000 person-years) during the follow-up period (log-rank test, p < 0.001). After controlling for potentially confounding factors, the risk of migraine was higher in the IDA group compared with the non-IDA group (the adjusted hazard ratio = 1.68, 95% CI = 1.51−1.87, p < 0.001). Female and ≤50 year-old IDA patients with or without iron supplementation use had an increased incidence of migraine (p < 0.05).ConclusionsOur study provided additional evidence of an increased risk of migraine in patients with IDA. We also found that females and ≤50 year-old IDA patients with or without iron supplementation use had an increased risk of migraines.

Platelet Parameters in Children with Iron Deficiency Anemia before and After Treatment

Background In iron deficiency anemia (IDA), several changes in platelets indices have been reported in a number of studies. The aim of this study was to evaluate the platelet parameters in children with iron deficiency anemia before and after treatment. Materials and Methods: This cross-sectional study was conducted over a period of 18 months. A total of 110 IDA subjects were selected from those who referred to the pediatric hematology clinic, Zahedan, Iran, during the study period. Age range was 12 months to 16 years were selected.Children in the study were given a 3 month course of oral iron as ferrous sulfate with a daily dose of 4mg/kg/day in 2 divided doses. Platelet parameters including platelet count and mean platelet volume (MPV) were measured before and after treatment. The obtained data were analyzed using SPSS software version 20.0. Results: The mean age of the boys and girls was 4.30±4.55 years and 2.46±3.21 years, respectively. The results of the paired t- test showed that platelet means were 409±120 103 /mm3 and 384±99 103 /mm3 before and after treatment (p<0.001), respectively. The means of MPV increased from 8.07±1.01 fL before treatment to 8.86±1.05 fL after treatment (p<0.001), respectively. Conclusion The result of this study showed that treatment of iron deficiency anemia leads to decreased platelet count and increased MPV.

Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: a nationwide database analysis

BackgroundIt has been shown that iron deficiency anemia (IDA) is associated with psychosocial consequences and psychiatric morbidity. However, the association between adults with IDA and psychiatric disorders has not been clarified. The purpose of this study was to investigate the psychiatric disorder morbidity of an IDA group in comparison with a non-IDA group and to examine the risk of psychiatric disorders in IDA patients treated with iron supplementation.MethodsAll study subjects were 20 years of age or over with newly diagnosed IDA enrolled in the Taiwan National Health Insurance Database from 2000 to 2012. We matched IDA and non-IDA subjects according to age and gender in a 1:2 ratio. Our primary outcome was diagnosis of psychiatric disorders and the patients were monitored until the end of 2013. A multivariate Cox proportional hazards regression model was used to explore the risk of psychiatric disorders in patients with IDA after adjustment for confounders, including demographic characteristics and comorbidities.ResultsThe adjusted hazard ratios (aHRs) of psychiatric disorders was 1.52 (95% CI = 1.45–1.59) in the IDA group compared with the non-IDA group. Among the different types of psychiatric disorders, the IDA group was associated with significantly higher incidence and risks of anxiety disorders, depression, sleep disorders, and psychotic disorders (p < 0.05). Furthermore, iron supplementation in IDA subjects was associated with a significantly lower risk of psychiatric disorders compared to non-iron supplementation in IDA patients.ConclusionsOur study indicates that IDA subjects had an increased risk of psychiatric disorders, regardless of other confounders. In IDA patients, iron supplementation was associated with a decreased risk of psychiatric disorders. Moreover, IDA patients receiving iron supplementation also had a lower risk of sleep disorders.

Association of iron deficiency anemia with tuberculosis in Taiwan: A nationwide population-based study.

BackgroundIron deficiency is associated with decreased cellular immunity, which may predispose patients with iron deficiency anemia (IDA) to increased risk of developing tuberculosis (TB). This study investigated the relationship between newly diagnosed IDA and TB infection in Taiwan.MethodsThe study included data on 21,946 patients with incident IDA and 87,555 non-IDA controls from a national database covering the period 2000–2012. IDA and non-IDA subjects were matched 1:4 on age, gender, and index year. The follow-up period was defined as the time from the initial IDA diagnosis to the date of developing TB or 31 December 2013. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, with the control group as the reference.ResultsThe adjusted hazard ratio of TB for the IDA group was 1.99 (95% confidence interval, 1.77–2.25) compared with the control group. The subgroup analysis showed that for both genders, all age groups, and patients with diabetes mellitus, hyperlipidemia, hypertension, cancer, chronic obstructive pulmonary disease, and hepatitis B virus infection, the IDA group had significantly higher TB incidence. The association was significantly stronger within the 5 years after new IDA diagnosis for both genders and all age groups.ConclusionsHigher TB incidence was discovered in the IDA group, especially for patients with comorbidities.

Anemia in infancy is associated with alterations in systemic metabolism and microbial structure and function in a sex-specific manner: an observational study

Anemia is a term that describes low hemoglobin concentrations and can result from micronutrient deficiencies, infection, or low birth weight. Early-life anemia, particularly iron-deficiency anemia (IDA) is associated with several negative metabolic, developmental, and cognitive outcomes, some of which persist into adulthood. The aim of this study was to investigate alterations in systemic metabolism and fecal microbial diversity and functionality associated with anemia and IDA in male and female infants from Iquitos, Peru. Cross-sectional stool and serum samples were collected from 95 infants (53 boys and 42 girls) at 12 mo of age. The fecal microbiome was assessed by using 16S ribosomal RNA gene sequencing, and the fecal and serum metabolomes were quantified using 1H-nuclear magnetic resonance. The prevalence of anemia was 64%, with a greater proportion of anemia in male infants attributed to iron deficiency. Metabolically, anemia was associated with decreased concentrations of tricarboxylic acid cycle metabolites in both sexes (males: succinate, P=0.031; females: fumarate, P=0.028). In addition, anemic male infants exhibited significantly lower serum concentrations of several amino acids compared with nonanemic male infants. Although no specific structural or functional differences in the microbiota were observed with anemia in general, likely due the heterogeneity of its etiology, IDA affected the microbiome both structurally and functionally. Specifically, the abundance of butyrate-producing bacteria was lower in IDA subjects of both sexes than in nonanemic, non-iron-deficient subjects of the same sex (females: Butyricicoccus, P=0.041; males: Coprococcus, P=0.010; Roseburia, P=0.027). IDA male infants had higher concentrations of 4-hydroxyphenyllactate (P<0.001) and putrescine (P=0.042) than those without IDA, whereas IDA female infants exhibited higher concentrations of leucine (P=0.011) and valine (P=0.003). Sexually dimorphic differences associated with anemia and IDA are suggestive of greater mitochondrial dysfunction and oxidative stress in male infants compared with female infants, and alterations in microbial structure and function may further contribute. Differences in metabolic pathways associated with anemia and IDA in each sex point to potential mechanisms for the associated lasting cognitive deficits. This trial is registered at clinicaltrials.gov as NCT03377777.

Iron profiles of preterm infants at two months of chronological age

Background Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, repeated phlebotomy, and the body’s increased demand for iron during growth. The risk of ID increases at 2 months of age, when hemoglobin (Hb) levels start to decrease. Adequacy of body iron level is assessed by ferritin, serum iron (SI), transferrin saturation (Tfsat), total iron-binding capacity (TIBC), and Hb measurements.Objective To describe iron profiles in preterm infants at 2 months of chronological age (CA).Methods This cross-sectional study was conducted in 2-month-old infants, born at 32-36 weeks of gestational age, and who visited the Growth and Development Clinics at Cipto Mangunkusumo, Fatmawati, or Budi Kemuliaan Hospitals. Parental interviews and medical record reviews were done during the clinic visits. Complete blood count, blood smear, SI, TIBC, Tfsat, and ferritin level tests were performed.Results Eighty-three subjects were enrolled in this study. Most subjects were male (51%) and born to mothers &gt;20 years of age (93%). Subjects’ birth weights ranged from 1,180 g to 2,550 g. The prevalence of iron deficiency anemia (IDA) was 6% and that of ID was 10%. The lowest Hb level found in IDA infants was 6.8 g/dL, while the lowest ferritin level was 8.6 ng/mL. Median values for the other tests were as follows: SI 48 µg/dL, TIBC 329µg/dL, and Tfsat 17%. Subjects with IDA were all male (5/5), mostly achieved more than twice their birth weight (4/5), were non-iron supplemented (3/5), born to mothers with low educational background (3/5), and of low socioeconomic status (3/5).Conclusion The prevalence of IDA is 6% and that of ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat, and low ferritin level. Most of the all-male IDA subjects weigh more than twice their birth weight, are non-iron supplemented, and born to mothers with low educational background and low socioeconomic status.

Effect of iron deficiency anemia and iron supplementation on HbA1c levels - Implications for diagnosis of prediabetes and diabetes mellitus in Asian Indians

BackgroundWe investigated the effect of iron deficiency anemia (IDA) on levels of glycated hemoglobin (HbA1c) and to compare its levels before and after iron supplementations. MethodsAge and sex matched subjects were enrolled and clustered in 2 groups: IDA (n=62) and healthy controls (HC; n=60). HbA1c levels were estimated by HPLC. Hemogram were estimated by hematology analyser. Serum ferritin (ELISA) and other parameters of iron profile were measured by standard guidelines of ICSH. HbA1c values and iron studies were repeated after 3months of iron supplementation to determine the effect of iron therapy on HbA1c levels. ResultsSignificantly higher HbA1c levels were observed in IDA subjects compared to HC (5.51±0.696 v/s 4.85±0.461%, p<0.001). A significant negative correlation was observed between HbA1c and hemoglobin, hematocrit, RBC count, MCH, MCHC and serum ferritin in IDA subjects (r=−0.632, −0.652, −0.384, −0.236, −0.192 and −0.441). Significant decline was noticed in HbA1c levels in IDA subjects after iron supplementation (5.51±0.696 before treatment v/s 5.044±0.603 post-treatment; p<0.001). Post treatment, 70% subjects (14/20) with HbA1c in pre-diabetes range normalised to normal glucose tolerance (NGT) range and out of 6 patients with pre-treatment HbA1c in diabetes range, 5 reverted to pre-diabetes range while 1 of them reverted to the NGT range. ConclusionsCaution must be exercised in interpreting the results of HbA1c in patients of IDA and iron deficiency must be corrected before diagnosing diabetes and pre-diabetes solely on the basis of HbA1c criteria.

Comparative behavior of red blood cells indices in iron deficiency anemia and β-thalassemia trait

Background: β-thalassemia trait (β-TT) is an important differential diagnosis of iron deficiency anemia (IDA). It is important to distinguish between the above conditions to avoid unnecessary iron therapy. IDA and β-TT are the two most common causes of microcytic hypochromic anemia. Red blood cells (RBCs) indices are a simple, easy, and cost-effective method to get a primary and valuable information regarding the diagnosis of IDA and β-TT. Objectives: This study was focused on the comparison of RBC indices behavior: hemoglobin (Hb), hematocrit (Hct), RBC count, mean cell volume (MCV), mean cell hemoglobin (MCH), MCH concentration (MCHC), and red cell distribution width (RDW) in IDA and β-TT. Patients and Methods: Fifty subjects with IDA (12 males and 38 females, age range: 18-65 years) and fifty subjects with β-TT (twenty male and thirty females with age range: 17-66 years) were chosen. Both groups were investigated for RBC indices by automated hematology analyzer. Results: RBC count, Hb, and Hct were significantly lower with (P Conclusion: The study showed that RBC count, Hb, Hct, MCH, and MCHC were significantly lower in IDA subjects than in β-TT subjects, whereas RDW was significantly higher in IDA subjects than in β-TT subjects. There was no significant difference regarding MCV between IDA subjects and β-TT subjects.

Reticulocyte parameters of delta beta thalassaemia trait, beta thalassaemia trait and iron deficiency anaemia

AimsTo analyse the differences in reticulocyte indices between delta beta thalassaemia trait (δβ-TT), beta thalassaemia trait (β-TT) and iron deficiency anaemia (IDA), and to correlate those differences with the physiopathological...

The role of TMPRSS6 polymorphisms in iron deficiency anemia partially responsive to oral iron treatment

Iron refractory iron deficiency anemia (IRIDA) is a rare hereditary disease caused by mutations in TMPRSS6 gene encoding Matriptase-2, a negative regulator of hepcidin transcription. Up to now, 53 IRIDA patients from 35 families with different ethnic origins have been reported and 41 TMPRSS6 mutations have been identified. TMPRSS6 polymorphisms are more frequent than mutations, and have been associated with variation in iron and hematologic parameters. Our study evaluated their presence in 113 subjects with iron deficiency anemia (IDA) partially responsive to oral iron therapy and in 50 healthy blood donors. Thalassemic trait was diagnosed in 38 patients. Sequencing analysis of TMPRSS6 gene revealed that the frequency of several polymorphisms was markedly different between IDA subjects and controls. In particular, the V736A TMPRSS6 polymorphism was associated to moderately lower hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin levels, and in thalassemia carriers with marked anemia and microcytosis. A new variant-H448R- and two uncommon polymorphisms -A719T and V795I- were also identified. These results indicate that TMPRSS6 polymorphisms are more frequent in subjects with persistent IDA than in healthy controls, and in thalassemia carriers V736A variant may account for lower hemoglobin and MCV levels. Further studies in larger court of patients are necessary to identify potential haplotypes and polymorphisms responsible for low response to oral iron treatment and may be useful for planning a correct iron supplementation.

Iron deficiency without anemia is associated with anger and fatigue in young Japanese women.

Iron deficiency without anemia (IDNA), the most prevalent nutritional deficiency worldwide, affects young women of reproductive age. This study aimed to elucidate the relationship between IDNA and mental and somatic symptoms including anger and fatigue using the Japanese version of the Cornell Medical Index Health Questionnaire (CMI-J). Data regarding demographic characteristics, anthropometry, hematological, and biochemical indices of the iron status, frequencies of selected food intakes assessed by self-administered food frequency questionnaires (FFQs), frequencies of nonspecific symptoms, and grades of neurotic tendencies assessed by CMI-J were collected from 76 young women aged 18-22 years living in the metropolitan area of Tokyo, Japan. The subjects were classified as having IDNA (hemoglobin (Hb)≥12 g/dL and serum ferritin<20 ng/mL; n=29), having iron deficiency anemia (IDA) (Hb<12 g/dL and serum ferritin<20 ng/mL; n=10), or having a normal iron status (Hb≥12 g/dL and serum ferritin≥20 ng/mL; n=36). One subject was excluded from the analyses because of Hb<12 g/dL and serum ferritin≥20 ng/mL. Fisher's protected least significant difference and the Dwass-Steel-Chritchlow-Fligner multiple comparison tests were used to compare the data of the three groups. P values<0.05 were considered significant. Sections M-R (mental complaints) were significantly higher in the IDNA subjects than in the normal subjects. No significant difference in CMI scores was found between the normal and IDA subjects. Sections I (fatigability), Q (anger), and R (tension) were significantly higher in the IDNA subjects than in the normal subjects, regardless of no significant differences between the normal and IDA subjects in those sections. Young women with IDNA demonstrated a significantly higher proportion of neurotic tendencies (grades II-IV). The intake frequency score of canned or bottled green tea fortified with vitamin C was significantly higher in the IDNA subjects than the IDA subjects. The findings suggest that IDNA may be a risk factor for anger, fatigue, and tension in women of childbearing age.

TMPRSS6 rs855791 polymorphism influences the susceptibility to iron deficiency anemia in women at reproductive age.

Background: Genome-wide-association studies have identified the TMPRSS6 polymorphism rs855791 has the strongest association with red blood cell indices or iron parameters in general population. Whether this genetic variant influences the susceptibility of iron deficiency anemia (IDA) in women with menstruation has not been well studied.Methods: In this case-control study, we enrolled 67 women with IDA and 107 healthy volunteers, and analyzed their complete blood counts, rs855791 genotypes, and menstrual amounts. Menstrual blood loss was evaluated with a pictorial blood-loss assessment chart.Results: There were significantly fewer rs855791 C homozygotes in the IDA group than in the healthy group (11.9% vs. 25.2%, p = 0.03). The odds ratio (OR) of C homozygotes having IDA versus non-CC subjects having IDA was 0.4 (95% CI, 0.17 - 0.95, p = 0.04). When the analysis was confined to study subjects with menorrhagia, this difference became more prominent (9.6% vs. 28.6%, p = 0.01; OR, 0.27, 95% CI, 0.09 - 0.77, p = 0.01). For women with non-CC genotypes, there was an inverse correlation between hemoglobin levels and menstrual loss (p < 0.001); however, this association was not found for those with genotypes CC (p = 0.15).Conclusions: Our study suggests homozygosity for TMPRSS6 rs855791 C genotype has a protective role against IDA in women at reproductive age, especially in those with menorrhagia.

Bone remodelling is reduced by recovery from iron-deficiency anaemia in premenopausal women

Iron-deficiency anaemia (IDA), one of the most common and widespread health disorders worldwide, affects fundamental metabolic functions and has been associated with deleterious effects on bone. Our aim was to know whether there are differences in bone remodelling between a group of premenopausal IDA women and a healthy group, and whether recovery of iron status has an effect on bone turnover markers. Thirty-five IDA women and 38 healthy women (control group) were recruited throughout the year. IDA women received pharmacological iron treatment. Iron biomarkers, aminoterminal telopeptide of collagen I (NTx), procollagen type 1 N-terminal propeptide (P1NP), 25-hydroxyvitamin D, and parathormone (PTH) were determined at baseline for both groups and after treatment with pharmacological iron for the IDA group. IDA subjects were classified as recovered (R) or non-recovered (nR) from IDA after treatment. NTx levels were significantly higher (p <0.001), and P1NP levels tended to be lower in IDA women than controls after adjusting for age and body mass index (BMI), with no differences in 25-hydroxyvitamin D or PTH. After treatment, the R group had significantly lower NTx and P1NP levels compared to baseline (p <0.05 and p <0.001 respectively), whilst no significant changes were seen in the nR group. No changes were seen in 25-hydroxyvitamin D or PTH for either group. IDA is related to higher bone resorption independent of age and BMI. Recovery from IDA has a concomitant beneficial effect on bone remodelling in premenopausal women, decreasing both bone resorption and formation.

Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle-cell disease and sickle-cell thalassemia

In Tunisia, thalassemia and sickle cell disease represent the most prevalent monogenic hemoglobin disorders with 2.21% and 1.89% of carriers, respectively. This study aims to evaluate the diagnosis reliability of a series of red blood cell indices and parameters in differentiation of beta-thalassemia trait (β-TT) from iron deficiency anemia (IDA) and between homozygous sickle cell disease (SS) and sickle cell-thalassemia (ST). The study covered 384 patients divided into three groups. The first one is composed of 145 control group, the second consists of 57 β-TT and 52 IDA subjects and the last one with 88 SS and 42 ST patients. We calculated sensitivity, specificity, positive-predictive values, negative-predictive values, percentage of correctly identified patients and Youden's index for each indice. We also established new cut-off values by receiver operating characteristic curves for each indice. An evaluation study was performed on another population composed of 106 β-TT, 125 IDA, 31 SS and 17 ST patients. Srivastava Index, mean corpuscular hemoglobin, red blood cell, Mentzer Index (MI) and mean corpuscular hemoglobin concentration show the highest reliability in discriminating β-TT from IDA with new cut-offs slightly different from those described in literature. Ehsani Index, mean corpuscular volume, MI, Shine and Lal Index and Sirdah Index are the most powerful in the differentiation between SS and ST. The effectiveness and the simplicity of calculation of these indices make them acceptable and easy to use for differential diagnosis.

Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle cell disease and sickle cell thalassemia

In Tunisia, thalassemia and sickle cell disease (SS) represent the most prevalent monogenic hemoglobin disorders with 2.21% and 1.89% of carriers, respectively. This study aims to evaluate the diagnosis reliability of 12 red blood cell (RBC) indices in differentiation of β-thalassemia trait (β-TT) from iron deficiency anemia (IDA) and between homozygous SS and sickle cell thalassemia (ST). The study covered 384 patients divided into three groups. The first one is composed of 145 control group, the second consists of 57 β-TT and 52 IDA subjects and the last one with 88 SS and 42 ST patients. We calculated sensitivity, specificity, positive-predictive values, negative-predictive values, percentage of correctly identified patients and Youden's Index (YI) for each indice. We also established new cut-off values by receiver operating characteristic curves for each indice. An evaluation study was performed on another population composed of 106 β-TT, 125 IDA, 31 SS, and 17 ST patients. Srivastava Index (SI) shows the highest reliability in discriminating β-TT from IDA at 5.17 as a cut-off and also SS from ST with 7.7 as another threshold. Mentzer Index (MI) and RBC appear also useful in both groups with new cut-offs slightly different from those described in literature for β-TT and IDA. The effectiveness and the simplicity of calculation of these indices make them acceptable and easy to use. They can be relied on for differential diagnosis and even for diagnosis of β-TT with atypical HbA₂ levels.

Combined cobalamin and iron deficiency anemia: a diagnostic approach using a model based on age and homocysteine assessment

Macrocytosis, the hallmark of cobalamin/folate deficiency anemia, is frequently absent. Clinicians have to be aware of coexisting conditions that can mask the macrocytosis expression of megaloblastic anemia, especially iron deficiency. The objective of this work was to investigate the degree of overlap between iron deficiency anemia (IDA) and cobalamin deficiency and to develop a predictive model for differentiating IDA from combined deficiency. A prospective case and control study was carried out to investigate vitamin B12 and folate status in iron deficiency anemia. A total of 658 patients were recruited, 41 of whom (6.2%) were excluded. The remaining 617 subjects consisted of 130 controls and 487 with IDA. Low vitamin B12 (LB12) was considered when serum vitamin B12 was ≤200pmol/L. High serum homocysteine (Hcy) was defined by Hcy >17μM/L. A multivariate analysis (including a logistic regression) was performed to develop a diagnostic model. Low vitamin B12 levels were found in 17.8% of IDA subjects. Ten out of 11 subjects (91%) with IDA and serum vitamin B12 (B12) ≤100pmol/L showed vitamin B12 deficiency. Moreover, vitamin B12 deficiency was demonstrated in 48% of cases with IDA and B12 between 101 and 150pmol/L and in 40% with IDA and B12 between 151 and 200pmol/, respectively. As a result of multivariate logistic analysis, neutrophil counts and age predicted subjects with vitamin B12 ≤200 and Hcy >17μmol/L, [Formula: see text]. Using the age of 60 as a cutoff, sensitivity was 91% (39 out of the 43 patients with vitamin B12 deficiency and IDA were identified). In summary, low vitamin B12 was found in 18% of patients with IDA. Vitamin B12 deficiency was demonstrated in many patients with LB12 and IDA. Age over 60years was used to separate patients with combined deficiency (sensitivity 91%). Therefore, for a diagnostic purpose, serum vitamin B12 should be evaluated in IDA patients over 60years. This diagnostic model needs to be validated in a different population.

Genotoxicity assessment in iron deficiency anemia patients using sister chromatid exchanges and chromosomal aberrations assays

Previous studies have shown that iron deficiency anemia is associated with oxidative stress produced by a decrease in antioxidant enzyme activities and/or a high level of oxidants. Because oxidative stress induces DNA damage, we investigated genotoxicity in lymphocytes from patients with iron deficiency anemia (IDA) using chromosomal aberrations (CAs) and sister chromatid exchanges (SCEs) assays. Eighteen IDA subjects and a similar number of age-matched healthy controls were included in the study. The results demonstrated that IDA was associated with a slight increase in the frequency of spontaneous CAs and a decrease in the frequency of SCEs (P<0.05). In addition, the level of SCEs was positively correlated with both the ferritin concentration (r=0.485, P<0.05) and hemoglobin content (r=0.514, P<0.05) in subjects. Moreover, vitamin E treatment reduced the frequency of SCEs in IDA patients and control subjects by the same percentage (∼30%) without affecting the magnitude of the difference in the levels of SCEs between the two groups. In conclusion, our results demonstrated that IDA has a differential effect on the frequency of spontaneous CAs and SCEs.

Growth differentiation factor 15 in anaemia of chronic disease, iron deficiency anaemia and mixed type anaemia

Recently, the iron and erythropoiesis-controlled growth differentiation factor 15 (GDF15) has been shown to inhibit the expression of hepcidin in beta-thalassaemia patients, thereby increasing iron absorption despite iron overload. To access the diagnostic and pathogenic impact of GDF15 in inflammatory anaemia the association of GDF15 expression with serum iron parameters and hepcidin was studied in patients suffering from iron deficiency anaemia (IDA), anaemia of chronic disease (ACD) and ACD subjects with true iron deficiency (ACD/IDA). GDF15 was significantly increased in both ACD and ACD/IDA, but not in IDA subjects as compared to controls. In contrast, hepcidin levels were significantly lower in IDA and ACD/IDA subjects than in ACD patients. IDA and ACD/IDA, but not ACD, showed an association between GDF15 and soluble transferrin receptor, an indicator of iron requirement for erythropoiesis. However, GDF15 did not correlate to hepcidin in either patient group. While GDF15 levels were linked to the needs for erythropoiesis and iron homeostasis in IDA, the immunity-driven increase of GDF15 may not primarily affect iron homeostasis and hepcidin expression. This indicates that other ACD-related factors may overcome the regulatory effects of GDF15 on hepcidin expression during inflammation.