Iron Deficiency State Research Articles

Serum ferritin levels and Diffuse hair loss—A correlation

Iron deficiency leads to disruption of hair follicle as elemental Iron is involved in various physiological processes within the hair follicle.The aim of this study is to evaluate if a correlation exists between decreased serum ferritin levels and the most common causes of diffuse hair fall.'This was a cross sectional study conducted at a teaching hospital and research center. 60 female patients aged between 15-45 years complaining of diffuse hair loss are taken into consideration. A significant correlation was found between decreased body iron stores (as measured by serum ferritin levels) and diffuse hair loss. 65% of the subjects were found to be in iron deficient state, 20% in iron depleted state, 8.33% with adequate serum ferritin levels but lower than the required for normal hair cycle, and 3.66% with normal ferritin levels.Diffuse hair loss was found to be associated with significantly decreased serum ferritin levels.

Evaluation of Serum Ferritin and Anti-Thyroid Peroxidase Antibody Status in Newly Diagnosed Subclinical Cases of Hypothyroidism.

Serum ferritin concentrations are altered in hypothyroidism, but there is no available literature regarding the status of serum ferritin in anti-thyroid peroxidase (anti-TPO) positive hypothyroidism. The objectives of our study were to evaluate the titer of anti-TPO and serum ferritin in newly diagnosed hypothyroid patients and to find out any difference in serum ferritin concentration between antibody-positive and antibody-negative patients. A total of 143 subjects above the age of 18 years were recruited, and serum Thyroid Stimulating Hormone (TSH), free T3, free T4, anti-TPO, and ferritin were assayed by chemiluminescence method. According to their serum analysis findings, three groups were made as Group 1 of 49 subjects with hypothyroidism and anti-TPO positive, Group 2 of 47 subjects with hypothyroidism and anti-TPO negative, and Group 3 of 47 euthyroid and anti-TPO negative controls. Kruskal Wallis H test was applied, and the difference in concentration of TSH, FT3, FT4, Ferritin, anti-TPO amongst the three groups was found to be significant. The relationship between anti-TPO levels and serum ferritin concentration was further studied by multinomial logistic regression. We have found that there is a significant difference between the concentrations of ferritin; hence, it is highly likely that those with a high level of anti-TPO antibody shall have a higher concentration of serum ferritin. Ferritin concentrations were decreased in anti-TPO negative hypothyroidism, but in the case of anti-TPO positive hypothyroidism the ferritin concentrations are raised. Hence, hypothyroidism should not always be considered as an iron deficiency state.

FOR A FEW STEPS TO..., OR HOW TO AVOID FOR IRON DEFICIENCY AT PREGNANCY. LITERATURE REVIEW

The article presents modern data on the etiology, pathogenesis, diagnosis, prevention and treatment of iron deficiency anemia (IDA) and anemia of chronic disease, as well as their combination on the eve of and during pregnancy. The emphasis is made on the role of iron deficiency of any etiology in the development of obstetric and perinatal complications, especially its impact on the central nervous system formation and further psychophysical child development. Need for prevention of iron deficiency states in risk groups which includes all women of reproductive age who have menstruation is shown based on evidence-based medicine data. Effectiveness and safety of modern drugs containing iron in oral and parenteral forms has analyzed. The paper presents data on the safety and effectiveness of an innovative form of ferric iron in the form of liposomal iron, which differs in the mechanism of action, digestibility and the absence of side effects typical for this group of drugs. According to various authors the frequency of IDA in pregnant women ranges up to 80%, in puerperas up to 40%. It is unimpossible to stop IDA without iron supplementation only with an iron-rich diet. Two main groups of iron preparations are used to correct iron deficiency differing in the valence of iron atoms – bivalent iron salts and trivalent complexes. These drugs differ in the tolerability and bioavailability of atomic iron. Liposomal iron is a new drug for treatment of iron deficiency and IDA today; it has an innovative way of iron delivery to the body. Liposomal iron has advantages for the prevention of anemia in patients with anemia of chronic disease or its combination with IDA (inflammatory bowel diseases, obesity, after resection of the stomach and intestines, etc.). An innovative form of liposomal iron in Ukraine is represented by a dietary supplement Ferroview containing 30 mg of elemental iron, that is corresponds to the average prophylactic dose recommended in WHO documents.

Anaemia in patients with type 2 diabetes mellitus without nephropathy is related to iron deficiency

Background and aimsIron deficiency anaemia, although well reported in diabetic nephropathy, has not been well studied in type 2 diabetes patients in the absence of nephropathy. We studied the prevalence of anaemia and iron deficiency in type 2 diabetes patients without nephropathy. Material and methodsA total of 89 patients were selected for this study. 24 h urine protein less than 500 mg was used as the criteria to rule out diabetic nephropathy. Complete hemogram, iron profile and high sensitivity C reactive protein (hs CRP) levels were performed in each patient.Functional iron deficiency (FID) was defined as serum ferritin more than 100 μg/l with serum transferrin less than 20% and total iron deficiency state was defined as serum ferritin less than 100 μg/l. ResultsFifteen patients (16.8%)had anaemia out of which 13 had total iron deficiency and one each had functional iron deficiency and normal iron status respectively. Assessment of the iron status overall showed that 49 patients had TID (55.05%), 16 had FID (17.9%)and 24 (27.05%) had normal iron status. The hs-CRP was significantly higher in those with iron deficiency. ConclusionsThe present study found a high prevalence of iron deficiency anaemia in type 2 diabetic patients even in the absence of nephropathy. Most of the diabetic subjects also displayed an iron deficiency state the cause of which needs further investigation.

The Efficacy and Safety of Using a Combined Iron Supplement in Children with Iron Deficiency Conditions (Literature Review, Own Research)

The article summarizes our own data and presents a scientific review of the medical literature, which is devoted to the analysis of the problem of treatment of iron deficiency with iron supplements in children. At present, there is a high prevalence of iron deficiency in children. In the article we characterized clinic of iron deficiency states and also we analyzed their interrelation with other deficiency syndromes, such as copper and manganese deficiency. We shown the role of the copper and manganese deficiency in the development of iron deficiency. We analyzed the possibilities of using a combined drug – iron gluconate combined with manganese gluconate and copper gluconate because of the polydeficiency in iron deficiency in children. The use of such combination drug improves the results of the treatment of iron deficiency conditions at what blood parameters and iron content normalize faster compared to the use of other iron mono-drugs. Also are given the personal data on the treatment of iron deficiency combined with pathology of the biliary tract in children.

Non-Epileptic Paroxysmal Events in Infants: stucture, manifestation and risk factors

During 3 years we observed in specialized neurological department of St. Olga Children’s City Hospital 708 babies aged up to 42 months with different paroxysmal disorders. Non-epileptic paroxysmal events (NEPE) were diagnosed in 98 cases. These disorders were qualified (according to ILAE criteria) as differentiated and undifferentiated NEPE. In most cases neurophysiological assessment data, neurovisualization data, and neurological status of infants with NEPE and babies from comparison group varied marginally. It was shown that NEPE development correlated with perinatal factors, and with infants’ developmental diseases (functional gastrointestinal disorders, iron deficiency states, chronic or persistent infections). The obtained data was interpreted according to the developmental neurology principles (optimality concept, in particular).

Dietary Iron Repletion Stimulates Hepatic Mobilization of Vitamin A in Previously Iron-Deficient Rats as Determined by Model-Based Compartmental Analysis

Iron deficiency can result in hyporetinolemia and hepatic vitamin A (VA) sequestration. We used model-based compartmental analysis to determine the impact of iron repletion on VA metabolism and kinetics in iron-deficient rats. At weaning, Sprague-Dawley rats were assigned to either a VA-marginal diet (0.35mg retinol equivalent/kg) with adequate iron (35ppm, control group [CN]) or reduced iron (3ppm, iron-deficient group [ID-]), with an equivalent average body weight for each group. After 5 wk, n=4 rats from each group were euthanized for baseline measurements of VA and iron indices, and the remaining rats (n=6 CN, n=10 ID-) received an intravenous injection of 3H-labeled retinol in an emulsion as tracer to initiate the kinetic study. On day 21 after dosing, half of the ID- rats were switched to the CN diet to initiate iron repletion, referred to as the iron-repletion group (ID+). From the time of dosing, 34 serial blood samples were collected from each rat over a 92-d time course. Plasma tracer and tissue tracee data were fitted to 6- and 4-compartment models, respectively, to analyze the kinetic behavior of VA in all groups. Our mathematical model indicated that ID- rats exhibited a nearly 6-fold decrease in liver VA secretion and >4-fold reduction in whole-body VA utilization, compared with CN rats, whereas these perturbed kinetic behaviors were notably corrected in ID+rats, close to those from the CN group. Iron repletion can remove the inhibitory effect that iron deficiency exerts on hepatic mobilization of VA and restore retinol kinetic parameters to values similar to that of never-deficient CN rats. Together with improvements in iron and VA indices, our results suggest that restoration of an iron-adequate diet is sufficient to improve VA kinetics after a previous state of iron deficiency.

Evaluation of Reticulated Haemoglobin (CHr) as a diagnostic parameter in Iron Deficiency Anemia

Introduction: Iron deficiency anemia (IDA) is the commonest nutritional deficiency in all parts of the world. In developing countries, the commonest cause is inadequate dietary intake [1]. The red cell indices raise the suspicion of iron deficiency state due to the microcytic, hypochromic changes and the wide red cell distribution width. The iron studies are confirmatory of an iron deficiency state, but are not accurate in the presence of infection, inflammation or malignancy as they are acute phase proteins and are affected in these states making the serum iron studies unreliable under these conditions. The reticulocyte haemoglobin content (CHr) indicates the iron available in the marrow for the production of Hb and are not affected by the above-mentioned situations and therefore has been recommended as a reliable marker of iron status in the body. The value for CHr given in the literature was 25pg [3].
 Objectives: General objective was to evaluate the significance of CHr in the diagnosis of IDA. The Specific objectives were to compare CHr with the other conventional iron parameters including serum iron, serum ferritin, TS and TIBC and evaluate any significance of CHr with RBC indices (MCV, MCH and MCHC) and age.
 Methodology: A retrospective analytical study performed at the Department of Haematology of a Tertiary care hospital in Sri Lanka. Data was obtained from the patient records of those referred to the Haematology department for management of iron deficiency during the period of 9 months commencing from April 2019 to January 2020. Data from 178 adult patients both males and females (16 to 84 years) diagnosed with IDA (S. Ferritin < 20ng/ml) (Hb < 12g/dl in men and Hb <11.5g/dl in women) were randomly selected. In pregnant females the S. Ferritin level considered was <30ng/ml and the Hb level was <11g/dl in the first trimester and 10.5g/dl in the 2nd and third trimester [4]. Blood count and CHr was analyzed using Mindray fully automated analyzer BC 6800, Serum iron and TIBC was measured with Mindray BS 480 and Serum ferritin with Advia Centaur Xp. TS was calculated by dividing serum iron by TIBC and multiplying by 100. A data extraction sheet was used to enter the investigations with the results.
 Statistical Analysis: Data were double entered and were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistical methods were used to calculate the median and the mean ± standard deviation of Hb, serum iron, serum ferritin, TIBC, TS, MCV, MCH, MCHC and CHr. Pearson’s correlation was used to evaluate the correlation between variables. Coefficient of determination (R Sq) was used to a statistical measure of how close the data are to the fitted regression line. P < 0.05 was considered significant.
 Conclusion: Significant positive correlations were observed between the CHr and haematological parameters such as Hb, MCV, MCH, and MCHC and biochemical parameters including serum iron, serum ferritin, and TS (p value < 0.001). Negative correlation was seen between the CHr and TIBC and there was no correlation with age. The mean value of CHr was 22.4 ±4.16pg and median was 22.2 pg.

Профилактика и лечение железодефицитных состояний при беременности

Профилактика и лечение железодефицитных состояний при беременности

THE RISK ASSOCIATED WITH IRON DEFICIENCY ANEMIA FOR SIMPLE FEBRILE SEIZURES IN CHILDREN: A CASE–CONTROL STUDY

Background: Studies have postulated iron deficiency state to be a risk factor for febrile convulsions as it changes the threshold of neurons excitation which may lower the threshold for seizures in children. However, many other studies have reported a protective role for febrile convulsions by increasing the neuronal threshold. Objective: The objective of the study was to evaluate the association of iron deficiency anemia (IDA) as a risk factor for the occurrence of simple febrile seizures (FS) in children. Material and Methods: A case-control study was conducted in a tertiary teaching hospital from September 2015 to February 2017. A total of 240 cases with fever and simple FS were enrolled according to the inclusion and exclusion criteria. Another 100 cases of children without seizure but with short duration of fever were enrolled as controls. Blood samples were then taken for assessing the hematological indices of these patients. The results were statistically analyzed. Results: Incidence of IDA was found to be more in children with simple FS than controls but was not statistically significant (p=0.35). Furthermore, no association was found with other hematological indices with FS occurrence. Conclusion: We could not find any association of IDA as a risk factor for a simple FS.

A Novel Approach for Iron Deficiency Anaemia with Liposomal Iron: Concept to Clinic

Iron deficiency anaemia is the most common nutritional deficiency disorder, contributing to 50 percent of all the anaemias in the world. Dietary changes alone are insufficient for the correction and management of iron deficiency anaemia. Hence, iron supplementation is necessary. Conventional oral iron therapy is limited in many patients because of dose dependent side effects, insufficient absorption, lack of compliance and limitation in various inflammatory conditions. Liposomal iron is a technologically designed, innovative form of iron which due to its differential delivery system ensures higher absorption and bioavailability, greater tolerability and least gastro-intestinal side effects unlike conventional oral iron preparations. This review provides a critical discussion and a comprehensive view based on the author’s review of the medical literature concerning the technology of liposomal iron preparation, mechanism of its absorption, its advantage over conventional iron preparations and clinical evidence on its usage in iron deficient states in pregnancy and certain inflammatory conditions.

Study of Iron Profile and Effect of Oral Iron Supplementation in Patients of Attention Deficit Hyperactivity Disorder: A Case Series

Attention Deficit Hyperactivity Disorder (ADHD) is a neuropsychiatric condition affecting the preschoolers, children, adolescents and adults globally. Dopamine synthesis is dependent on availability of iron in the body and dopamine deficit theory is the widely accepted ADHD causation theory. So, serum iron levels are important to watch out for in patients suffering from ADHD. This article describes six cases to emphasise the importance of diagnosing and treating underlying Iron Deficiency (ID) state with oral iron supplementation for effective management of patients suffering from ADHD. All the six cases which were given oral iron supplementation along with methylphenidate had shown improvement in inattentive domain and in hyperactivity-impulsivity domain at both home as well as school settings. They were given doses of methylphenidate and oral iron supplement as per the recommended body weight. Their parents and teachers were asked to mark the responses on Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) 26 item parent and teacher rating scale respectively. Scores on SNAP-IV were recorded at the first visit and after three months of treatment. Scores were then evaluated on both occasions for evidence of improvement in ADHD symptoms.

Dietary therapy for iron deficiency states

Dietary therapy for iron deficiency states

Clinical and biochemical profile of patients with Iron deficiency anemia at a tertiary care hospital

Introduction: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide, especially in adolescent girls, women of reproductive age group, and young children. The clinical presentation and the other biochemical parameters differ in a different age, sex, and geographical group. A study to evaluate the clinical and biochemical profile of patients with IDA at a tertiary care hospital. Materials and Methods: One hundred and two Cases of IDA were taken from the outpatient department (OPD) and ward. After taking consent, the workup was done. Complete history and physical examination were done, and patients were evaluated for signs and symptoms of IDA. Laboratory investigations such as complete blood count with differential count, reticulocyte count, peripheral blood smears, serum iron, total iron binding capacity, serum ferritin, lactic dehydrogenase, stool for occult blood and ova, cysts, liver and renal function were done in all the patients. Results: One hundred and two patients of IDA were enrolled from OPD and ward. The majority of the patients were from the 21 to 30 years age group (25.5%). 37.3% were male and 62.7% were female patients. The main presenting complaint was weakness and easy fatigability (91%). Among the associated comorbidities, the most common were hypertension (13.7%). The majority of the patients had severe pallor (54.9%). Icterus was found in 1.9%. Splenomegaly was found in 4.9%. General blood pictures showed 97.1% had microcytes, 96.1% had hypochromasia and 97.1% had Anisocytosis, which is characteristic of IDA. Conclusion: The majority of patients came to the hospital after developing clinical features due to severe anemia. Therefore, a population based study to evaluate the mild form of IDA or to evaluate a preanemic iron deficiency state can help in the early diagnosis of these patients before they develop severe form.

The pattern of iron deficiency with and without anemia among medical college girl students in high altitude southern Saudi Arabia.

Introduction:The prevalence of iron deficiency, latent and symptomatic, is heterogeneous worldwide. In this study, we aim to explore the prevalence of iron deficiency, with and without anemia, among medical college females at the high Altitude Aseer region of Southwestern Saudi Arabia.Methodology:200 female medical students were randomly sampled, between the ages of 19 and 27 years. Blood samples were collected for complete blood count (CBC) values and serum ferritin determination. Questionnaires were completed in order to collect demographics, medical history, and socioeconomic information of the participants.Results:Prevalence of overall iron deficiency was high (63%, serum ferritin <20 μg/L, 52.5%, ferritin <15 μg/L). Anemia, adjusted for high altitude (defined as less than 13 g/dL was present in 41 participants (20.5%) and 12 (6.5%) have Hb <12 g/dL. Iron-deficiency anemia (Hb <13 g/dL and serum ferritin <15 μg/L) was present in 35 (17.5%). Personal and family history of anemia and poor animal product containing meals were positively correlated with the presence of iron deficiency state. Neither symptoms of anemia, nor the presence of menorrhagia correlate with the presence of iron deficiency anemia.Conclusion:Iron deficiency with and without anemia is a very common and condition in young females’ population at high altitude. Implementing a lab method to screen for anemia on vulnerable populations is needed. Frequently asymptomatic, the primary care providers should maintain a high degree of suspicion in order to initiate screening for iron status.

EXTREMELY LOW BIRTH WEIGHT – LIFE QUALITY FOLLOW-UP

Follow-up of extremely low birth weight infants (&lt;1000 g) at 18 months of corrected age with the definition of parameters of physical, psychomotor development and morbidity has made it possible to establish the incidence of poor outcomes (cerebral palsy, blindness, deafness, psychomotor retardation) among these children which amounted 59,2%. The main problems of "relatively healthy" children were iron deficiency and osteopenia states, nutritional difficulties and atopy.

Recent update in the pathogenesis and treatment of chemotherapy and cancer induced anemia.

Cancer and chemotherapy-induced anemia (CIA) is commonly encountered among patients undergoing active chemotherapy with or without radiation therapy. Its pathogenesis is complex and is often difficult to identify. Symptoms related to CIA may have a negative impact on quality of life and may influence treatment efficacy, disease progression and even survival. The recent major setback of erythropoietin-stimulating agents (ESAs) and the reluctance to transfuse cancer patients with mild and even moderate anemia, had resulted in significant under-treatment of CIA. The discovery of hepcidin and its role in iron homeostasis has revolutionized our understanding of the pathogenesis of iron deficiency and iron overload states. In the present review we examine the multifactorial pathogenesis of CIA, addressing the main mechanisms by which the tumor and immune system affect anemia. Additionally, we discuss the treatment options with more focus on the utilization of the new intravenous iron formulations for this indication.

Endogenous Lactoferrin in the Assessment of Ferrokinetics in Children with Iron Deficiency States

Objective: to study the concentration of endogenous lactoferrin in children with iron deficiency states before and during the treatment. Material and methods . The clinical and laboratory data of 31 patients with iron deficiency states (24 patients with iron deficiency anemia and 7 with latent iron deficiency) aged 0-17 (the median age was 9.7) and 7 healthy children (the median age was 12.4) who made up the control group have been analyzed. Hemogram and biochemical blood test were done according to the standard method. The concentration of endogenous LF in the blood serum was determined by the method of enzyme immunoassay using commercial test systems for the quantitative determination of human LF in the biological fluids (Elabscience) on the universal VICTOR2TM analyzer (Perkin Elmer, USA). Results . The study of ferrokinetics and LF concentration in the blood serum of the children with iron deficiency states has been performed. It has been shown that the children with iron deficiency reveal an increased LF level in the blood serum, which has variable values depending on age. The highest levels of the serum LF content are characteristic of patients under the age of three months, which is associated with the physiological mechanisms of the adaptation process of the hematopoietic system in newborns and infants. The LF concentration in the blood serum associated with ferrotherapy is increased compared to the corresponding indices before the treatment. Conclusion . From the results of the study its follows that the content of LF in the blood serum increases in iron deficiency and is associated with ferrotherapy. The obtained results will be used in further research aimed at the diagnosis of iron deficiency and prediction of the response to iron therapy.

Exclusive Cow’s milk intake and asymptomatic Anaemia

It is a strong tradition to introduce cow’s milk (CM) early in infancy. There are reports of various deleterious health effects of CM in infancy. We describe an asymptomatic, well-thriving infant who was exclusively fed with CM and had severe iron deficiency anemia. An eleven-months-old infant during the consultation for fever was found to have severe pallor. Except for systolic murmur, she had a normal systemic examination. Hemoglobin was 2.2 gm/dl, her RBC count, volume and hemoglobin concentration were low. Iron studies done showed a severe iron deficiency state. She was given packed cell transfusions; iron supplements were initiated. Introduction of complementary foods rich in iron is imperative as iron stores begin to deplete at four to six months of age. Initiation of CM early in infant feeding can lead to very severe anemia which can be mitigated by CM fortification, iron supplementation in infants.

Drug Treatment of Restless Legs Syndrome in Older Adults.

Restless legs syndrome (RLS) has a high prevalence in the elderly and can impact sleep quality and sleep quantity, reduce quality of life (QoL), and increase the risk of falls during episodes of night-time ambulation. In patients unable to verbalize their sensory symptoms, certain behavioral cues may help with the diagnosis. A state of brain iron deficiency could play a central role in the pathophysiology of RLS and be upstream to a series of dysfunctions that are not limited to the dopaminergic system. Management should initially emphasize lifestyle modifications and reduction of all possible iatrogenic contributors while maintaining a state of normal-high peripheral iron stores. Oral iron, in patients with ferritin levels < 75μg/dL, appears to be effective, although iron infusions should be considered when more immediate benefit or oral iron have not been effective. When other attempts fail and patients continue to experience chronic RLS symptoms substantially interfering with QoL, pharmacological agents may present a favorable benefit versus risk profile. Such agents may include α-2-δ drugs or dopaminergic agents, after careful consideration of the risk of RLS augmentation with the latter class. In patients with established RLS augmentation from the use of dopaminergic drugs, the addition of α-2-δ agents or low-dose opioids, with subsequent slow tapering of dopaminergic agents, is recommended. With any of these agents, caution should be made with regard to the risk of drug-drug interactions and altered pharmacokinetics in this fragile population. Although showing excellent long-term safety data in non-elderly adults with RLS, studies are needed to ascertain that such treatments are effective and well tolerated in older adults.