Blood Iron Research Articles

Effect of obesity and hypothyroidism on hepcidin concentration in pregnancy - a pilot study using maternal and umbilical cord blood at delivery day.

Hepcidin is a primary regulator of iron metabolism in the human body. By promoting ferroportin degradation, hepcidin reduces intestinal iron absorption and its release from intracellular stores. In the course of pregnancy, gradually declining hepcidin concentrations encourage placental iron transfer, thereby providing the appropriate amount of iron for fetal development. Hence, we aimed to investigate changes in maternal and cord blood hepcidin and iron metabolism parameters in normal-weight (n=17) and obese (n=17) gestating women, as well as gravid women with a history of hypothyroidism following the restoration of euthyroidism (n=17). All blood samples were taken on the day of delivery, and ELISA kits were used for measurements. A significant increase in maternal hepcidin concentration was observed in obese pregnant women, compared to normal-weight controls (29.53±4.20 ng/mL vs. 25.69±5.70 ng/mL; P<0.05). However, only a slight, insignificant tendency for lower hepcidin was noted in the hypothyroid group, compared to the healthy controls (23.10±6.00 ng/mL vs. 25.69±5.70 ng/mL; P=NS). Moreover, decreased maternal free triiodothyronine, triiodothyronine, free thyroxine, and ferritin levels were revealed in the hypothyroid group, compared to the normal-weight individuals (P<0.05). Furthermore, positive correlations between maternal hepcidin and the majority of maternal thyroid hormones were found, with a most potent relation to FT3 (r=0.40; P<0.01). Interestingly, no alterations of thyroid hormones and iron metabolism parameters were noticed in cord blood in any of the subgroups. In summary, pre-pregnancy obesity is associated with elevated maternal hepcidin, albeit no signs of lowered cord blood iron status were shown. Medical history of hypothyroidism following the restoration of euthyroidism does not substantially influence maternal nor cord blood hepcidin concentration, as well as fetal iron homeostasis, even though free thyroid hormone levels correlate with maternal hepcidin.

S2963 Congenital Riedel’s Lobe of the Liver: A Case Report

Introduction: Riedel lobe of the liver is a rare anatomical variation with a reported incidence to be between 3.3% and 14.5%. We report a case of a 43-year-old female with an incidental finding of non-palpable Riedel’s lobe. Case Description/Methods: A 43-year-old female was referred for evaluation of hepatomegaly, which was revealed on MRI and CT scan dating back to 2016. Medical history notable for Irritable Bowel Syndrome (IBS), uterine fibroids, and a history of a tumor removal from her right breast. Patient denies any history of alcohol, illicit drugs, hepatotoxic medications, or pre-existing liver disease. Physical exam was unremarkable and abdominal exam did not reveal any mass or abnormalities. Routine blood examination, including LFTs and iron studies, was within normal limits. Hepatitis panel (A, B, C), anti-smooth muscle antibody, and LKM-1 IgG antibody was negative. ANA, alpha-1 antitrypsin, and tissue transglutaminase were all negative. The only lab abnormality was an elevated IgG mitochondrial M2 antibody 54.5 (normal less than 20 units). CT abdomen was significant for an enlarged liver with the right lobe extending into the pelvis and ‘not completely included in the study’. MRI abdomen revealed a markedly enlarged liver measuring up to 23.8cm in its craniocaudal dimension with extension into the pelvis with the pancreas deviated to the left, likely secondary to the prominent hepatomegaly. Venous duplex significant for normal directional flow in the portal and hepatic veins with no evidence of portal hypertension. Liver biopsy revealed signs of sinusoidal dilatation nonspecific for veno-occlusive outflow obstruction with no signs of inflammation, steatosis, or fibrosis. The patient was diagnosed with Riedel’s lobe of the liver. She was discharged from the hospital without treatment with a recommendation to repeat an MRI in 1 year, as torsion is a reported complication of Riedel’s lobe over time. Patient will be recommended to repeat LFTs and anti-mitochondrial antibody to determine progression/significance prior to follow up in 6 months. Discussion: Riedel’s lobe of the liver is a rare anatomical variant that is often incidentally found on imaging or the presence of hepatomegaly on physical exam. Although patients are usually asymptomatic, its presentation can vary, ranging from nonspecific symptoms to more severe symptoms such as torsion, obstruction, rupture, and bleeding. The range of symptoms highlights its importance in diagnosis and surveillance in this patient population.Figure 1.: (A) CT of the abdomen/pelvis from 2016. Liver measuring up to 197.3mm in the sagittal plane. (B) CT of the abdomen/pelvis from 2020. Liver measuring up to 215.4mm in the sagittal plane.

Nutritional assessment of birth outcomes of gestational diabetic mothers in Gaza Strip, Palestine

Introduction: Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy. Numerous studies have dealt with risk factors of GDM, while others studied the health complications associated with GDM. This study aimed to investigate the association between GDM and nutritional birth outcomes in Gaza Strip, Palestine. Materials and Methods: The study utilized the case−control design where 44 GDM mothers and 44 non-GDM mothers were recruited. The study was conducted at the obstetric departments at Al-Shifa Maternity Hospital in Gaza and Mubarak Maternity Hospital in Khan Yunis. Data collection included anthropometric measurement and hematological indicators and other pertinent information through a structured questionnaire. Results: The result reported that the mean age of GDM pregnant women and non-GDM was 31 ± 11.5 and 23 ± 6.75 years, respectively. 13.6% had anemia, 20.5% had previous delivery of macrosomic baby, 15.9% had hypertension, and 11.4% were obese. In addition, 63.6% of GDM mothers had a family history of diabetes and 18.2% had a family history of GDM. 43.2% of GDM mothers delivered by cesarean section (CS) and 13.6% of GDM mothers had a premature delivery. Assessment of dietary intake indicated that 40.9% of GDM mothers have breakfast regularly. The neonatal median birth weight was 3.22 kg for babies of GDM mothers and 3.30 kg for babies of non-GDM mothers, and the median length was 52 cm versus 50 cm; 6.8% of neonates of GDM mothers had low Apgar score. Neonates of GDM mothers expressed significantly lower blood sugar (P = 0.039), lower albumin (P = 0.037), and higher soluble surface receptors – surface transferrin receptor (P = 0.017), but there were no statistically significant differences in the other hematological parameters. Conclusion: The study reflected a significant association between GDM and lower blood glucose, serum albumin, and iron status. Furthermore, the study reflected a significant association between GDM and CS delivery and neonatal hypoglycemia. The study emphasized the need to integrate clinical nutrition services in maternity departments and antenatal clinics and encourage physical activities during pregnancy. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge.

Role of serum hepcidin as a biochemical marker in children with Beta-thalassemia of iron status in Wasit Province Iraq

β-thalassemia is characterized by anemia and depending on the severity of the anemia. Hepcidin is a 25-amino-acid peptide generated by the liver, based on hypoxia, anemia, and iron storage. controls blood iron concentration and tissue distribution and regulates the body's iron hemostasis. To evaluate the usefulness of Serum Hepcidin level as a biochemical marker of iron status in children with β thalassemia major, β thalassemia Intermedia and its relation with serum ferritin level. A cross-section study which will involve 90 included 50 Thalassemia Major (TM) and 40 Thalassemia Intermedia (TI). Patients will be collected from the thalassemia center in Kut Hospital for Gynecology and Pediatrics, were randomly selected for this study. All patients child in both gender from (5-17 years). Enzyme-linked immunosorbent assay [ELISA] used for determination of Hepcidin, Abbott Architect C4000 And cobas c 111 analyzer used for the determination of Ferritin, Iron and Hemoglobin was measured by Sysmex XP-300. The study included both gender 62.2% were male and 37.8% were females, regarding male gender 57.1% had βTM and 42.9% had βTI while female gender 52.9% had B-thalassemia major and 47.1% had β-thalassemia Intermedia.

Education to Prevent Anemia in Pregnancy

Anemia in pregnant women can increase the risk of maternal and infant mortality. Pregnant women really need tablets to increase blood (iron) to avoid anemia. Prevention of anemia in pregnancy starts from adolescence and when it is declared pregnant by consuming iron and folic acid supplements. People who have the potential to experience anemia are women. Educational activities for the prevention of pregnancy anemia were held on Sunday, July 17, 2022 at the RT Kembangan Regency Gresik hall which was attended by cadres, local residents, and pregnant women. The method used is providing counseling, handouts, picture and video slides and questions and answers about anemia. After this counseling, it is hoped that all pregnant women will understand about preventing anemia in pregnancy and how to prevent it.

Determinants of Response at 2 Months of Treatment in a Cohort of Pakistani Patients with Pulmonary Tuberculosis.

Mycobacterium tuberculosis infection continues to be a major global challenge. All patients with pulmonary tuberculosis are treated with a standard 6-month treatment regimen. Historical data suggest that even with shortened treatment, most patients achieve long-term remission. Risk stratification is a goal for reducing potentially toxic prolonged treatment. This study aimed to determine the factors associated with the early clearance of sputum acid-fast bacilli (AFB). A total of 297 freshly diagnosed patients with pulmonary tuberculosis were included and enrolled in this study. Information related to their ethno-demographic and anthropometric characteristics was collected. We also assessed their complete blood counts, and blood iron, folate, and vitamin B12 levels. We found that the presence of higher levels of acid-fast bacilli (AFB) in diagnostic sputum microscopy was the single most significant prognostic factor associated with early clearance of sputum AFB after 2 months of treatment. All of our patients achieved treatment success after 6 months of treatment and were disease free. Our results support the data obtained from previous studies indicating that AFB clearance at 2 months is unlikely to be a clinically useful biomarker or indicator for therapeutic stratification. Furthermore, demographic, anthropometric, and nutritional factors are not clinically useful biomarkers.

Perinatal exposure to a glyphosate pesticide formulation induces offspring liver damage

The present study investigated the effects of perinatal exposure to glyphosate-based herbicide (GBH) in offspring's liver. Pregnant Wistar rats were exposed to GBH (70 mg glyphosate/Kg body weight/day) in drinking water from gestation day 5 to postnatal day 15. The perinatal exposure to GBH increased 45Ca2+ influx in offspring's liver. Pharmacological tools indicated a role played by oxidative stress, phospholipase C (PLC) and Akt pathways, as well as voltage-dependent Ca2+ channel modulation on GBH-induced Ca2+ influx in offspring's liver. In addition, changes in the enzymatic antioxidant defense system, decreased GSH content, lipid peroxidation and protein carbonylation suggest a connection between GBH-induced hepatotoxic mechanism and redox imbalance. The perinatal exposure to GBH also increased the enzymatic activities of transaminases and gamma-glutamyl transferase in offspring's liver and blood, suggesting a pesticide-induced liver injury. Moreover, we detected increased iron levels in liver, blood and bone marrow of GBH-exposed rats, which were accompanied by increased transferrin saturation and decreased transferrin levels in blood. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were increased in the liver of rats perinatally exposed to GBH, which were associated with. Increased phospho-p65NFκB immunocontent. Therefore, we propose that excessive amounts of iron in offspring's liver, blood and bone marrow induced by perinatal exposure to GBH may account for iron-driven hepatotoxicity, which was associated with Ca2+ influx, oxidative damage and inflammation. Further studies will clarify whether these events can ultimately impact on liver function.

Chronic High-Altitude Hypoxia Alters Iron and Nitric Oxide Homeostasis in Fetal and Maternal Sheep Blood and Aorta.

The mammalian fetus thrives at oxygen tensions much lower than those of adults. Gestation at high altitude superimposes hypoxic stresses on the fetus resulting in increased erythropoiesis. We hypothesized that chronic hypoxia at high altitude alters the homeostasis of iron and bioactive nitric oxide metabolites (NOx) in gestation. To test for this, electron paramagnetic resonance was used to provide unique measurements of iron, metalloproteins, and free radicals in the blood and aorta of fetal and maternal sheep from either high or low altitudes (3801 or 300 m). Using ozone-based chemiluminescence with selectivity for various NOx species, we determined the NOx levels in these samples immediately after collection. These experiments demonstrated a systemic redistribution of iron in high altitude fetuses as manifested by a decrease in both chelatable and total iron in the aorta and an increase in non-transferrin bound iron and total iron in plasma. Likewise, high altitude altered the redox status diversely in fetal blood and aorta. This study also found significant increases in blood and aortic tissue NOx in fetuses and mothers at high altitude. In addition, gradients in NOx concentrations observed between fetus and mother, umbilical artery and vein, and plasma and RBCs demonstrated complex dynamic homeostasis of NOx among these circulatory compartments, such as placental generation and efflux as well as fetal consumption of iron-nitrosyls in RBCs, probably HbNO. In conclusion, these results may suggest the utilization of iron from non-hematopoietic tissues iron for erythropoiesis in the fetus and increased NO bioavailability in response to chronic hypoxic stress at high altitude during gestation.

First and Second Level Haemoglobinopathies Diagnosis: Best Practices of the Italian Society of Thalassemia and Haemoglobinopathies (SITE).

The purpose of this best practice paper is to review the current recommendations for the identification and prenatal diagnosis of hemoglobinopathies. Methods: The management committee of SITE selected and gathered a multidisciplinary team in order to formulate recommendations based on the available scientific evidence integrated with the opinions of experts, with the purpose of supporting clinicians. Results: We provide recommendations for first level tests (complete blood count, hemoglobin separation and iron balance), second level tests (molecular diagnosis) and prenatal diagnosis. Five Italian experts in hemoglobinopathies were consulted regarding the orientation of prenatal diagnosis, and for each indication, the degree of agreement among the experts has been specified. Conclusions: Best practice recommendations are the final outcome of this translational research and allow transfer to daily clinical practice.

Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts.

Gastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limited supplies in blood banks. Nowadays, all patients should benefit from a patient blood management (PBM) program that aims to minimize blood loss, optimize hematopoiesis (mainly by using iron replacement therapy), maximize tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM into healthcare management reduces patient mortality and morbidity and supports a restrictive RBC transfusion approach by reducing transfusion rates. The European Commission has outlined strategies to support hospitals with the implementation of PBM, but it is vital that these initiatives are translated into clinical practice. To help optimize management of anemia and iron deficiency in adults with acute or chronic GI bleeding, we developed a protocol under the auspices of the Spanish Association of Gastroenterology, in collaboration with healthcare professionals from 16 hospitals across Spain, including expert advice from different specialties involved in PBM strategies, such as internal medicine physicians, intensive care specialists, and hematologists. Recommendations include how to identify patients who have anemia (or iron deficiency) requiring oral/intravenous iron replacement therapy and/or RBC transfusion (using a restrictive approach to transfusion), and transfusing RBC units 1 unit at a time, with assessment of patients after each given unit (i.e., “don’t give two without review”). The advantages and limitations of oral versus intravenous iron and guidance on the safe and effective use of intravenous iron are also described. Implementation of a PBM strategy and clinical decision-making support, including early treatment of anemia with iron supplementation in patients with GI bleeding, may improve patient outcomes and lower hospital costs.

Intravenous versus oral iron for iron deficiency anaemia in pregnant Nigerian women (IVON): study protocol for a randomised hybrid effectiveness-implementation trial

BackgroundAnaemia in pregnancy is highly prevalent in African countries. High-dose oral iron is the current recommended treatment for pregnancy-related iron deficiency anaemia (IDA) in Nigeria and other African countries. This oral regimen is often poorly tolerated and has several side effects. Parenteral iron preparations are now available for the treatment of IDA in pregnancy but not widely used in Africa.The IVON trial is investigating the comparative effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate standard-of-care for pregnancy-related IDA in Nigeria. We will also measure the implementation outcomes of acceptability, feasibility, fidelity, and cost-effectiveness for intravenous ferric carboxymaltose.MethodsThis is an open-label randomised controlled trial with a hybrid type 1 effectiveness-implementation design, conducted at 10 health facilities in Kano (Northern) and Lagos (Southern) states in Nigeria. A total of 1056 pregnant women at 20–32 weeks’ gestational age with moderate or severe anaemia (Hb < 10g/dl) will be randomised 1:1 into two groups. The interventional treatment is one 1000-mg dose of intravenous ferric carboxymaltose at enrolment; the control treatment is thrice daily oral ferrous sulphate (195 mg elemental iron daily), from enrolment till 6 weeks postpartum.Primary outcome measures are (1) the prevalence of maternal anaemia at 36 weeks and (2) infant preterm birth (<37 weeks’ gestation) and will be analysed by intention-to-treat. Maternal full blood count and iron panel will be assayed at 4 weeks post-enrolment, 36 weeks’ gestation, delivery, and 6 weeks postpartum. Implementation outcomes of acceptability, feasibility, fidelity, and cost will be assessed with structured questionnaires, key informant interviews, and focus group discussions.DiscussionThe IVON trial could provide both effectiveness and implementation evidence to guide policy for integration and uptake of intravenous iron for treating anaemia in pregnancy in Nigeria and similar resource-limited, high-burden settings. If found effective, further studies exploring different intravenous iron doses are planned.Trial registration ISRCTN registry ISRCTN63484804. Registered on 10 December 2020Clinicaltrials.govNCT04976179. Registered on 26 July 2021The current protocol version is version 2.1 (080/080/2021).

Screening of Anemia in Patients with Coronary Heart Disease in Outpatient Practice Using a Computer Monitoring System

The aim of this study was to assess the prevalence, structure, and influence of anemic syndrome on the main health indicators of patients with coronary heart disease (CHD), including the main QOL parameters. Methods and Results: The study included 1210 patients (309 men and 901 women) with an average age of 67.57±9.35 years who were registered at the dispensary with CHD (angina pectoris CCSA classes II-IV) in 2 Regional Hospitals. With the help of the computer program “Monitoring system for patients with anemia syndrome,” medical records from 2 randomly selected primary care areas were analyzed. The data directly related to anemia, comorbid pathology, and previous treatment formed the main part of the statistical data. The QOL was evaluated using the 36-Item Short Form Survey (SF-36) questionnaire. The FACT-An questionnaire was used to account for the characteristic symptoms, and their severity, accompanying anemia. Our findings indicate the presence of anemia in 500(41.3%) patients (355/71% women and 145/29% men). The average age of the patients with diagnosed anemia was 65.34±6.37 years in men and 63.49±7.05 years in women. Anemia of mild severity was observed in 410(82%) patients, moderate severity in 75(15%) patients, and severe anemia in 15(3%) patients. IDA was detected in 467(93.4%) cases and B12-deficiency anemia in 33(6.6%) cases. We found a negative correlation between the blood iron level and age (r=-0.56, P&lt;0.05), which can indirectly indicate the progression of latent iron deficiency with age in CHD patients. All 500 CHD patients with anemia were included in Group 1. Group 2 included 710 CHD patients without anemia. In Groups 1 and 2, angina severity according to CCSA classification was as follows: CCSA class II - 186(37.2%) and 456(64.2%) cases (P=0.000), CCSA class III – 248(49.6%) and 196(27.6%) cases (P=0.000), and CCSA class IV - 66(13.2%) and 58(8.2%) cases (P=0.005), respectively. Group 1 patients, in contrast to Group 2 patients, had the following characteristic clinical features: palpitation (48.2% vs. 35.0%, P=0.000), higher HR (81±9.5 bpm vs. 71.8±8.7 bpm, P=0.000) and respiratory rate (18.9±1.1 vs 18.3±1.2 per minute, P=0.000). The assessment of the impact of anemia on QOL by FACT-An revealed a statistically lower score in Group 1 than in Group 2 (32.0±5.7 vs. 44.0±6.5, P=0.000). We found a positive correlation between the Hb level and the average FACT-An score (r=0.54, P&lt;0.05) Patients in Group 1 demonstrated a low level of QOL in the physical and mental domains, according to SF-36, in comparison with Group 2. Correlation analysis revealed a direct relationship between the Hb level and the average score of the PF (physical functioning) scale (r=0.52, P&lt;0.05)) and PCS (physical component summary) (r=0.38, P&lt;0.05)) of the SF-36 questionnaire. The observed high incidence of anemic syndrome in CHD patients with angina pectoris (CCSA class II-IV) requires special attention due to the high impact on the QOL of patients and aggravation of the course of the underlying disease.

A Study of Ocular Side Effects of Blood Transfusions and Iron Chelators in Thalassemia Patients

Aim: To determine the ocular changes and importance of ophthalmic consults in thalassemia patients on iron chelating agents and regular blood transfusions. Settings and Design: A cross-sectional study was conducted among thalassemia patients who were on regular blood transfusion and iron chelators. Materials and Methods: A detailed history was obtained from 50 thalassemia patients included in the study including birth history, family history, and treatment history which was taken from the parents. Ophthalmic examination performed included visual acuity test for distant and near vision with Snellen chart, color vision obtained with Ishihara plates, contrast sensitivity performed with Pelli–Robson charts, Schirmer test conducted with Whatman strip, intraocular pressure obtained with Perkins tonometer, detailed anterior segment performed with Appasamy Slit Lamp biomicroscope and posterior segment examination with the aid of 90D lenses, and indirect ophthalmoscopy with 20D lenses performed after dilatation. Fundus photograph was taken for all the patients with ZEISS fundus camera. The findings were recorded and documented. Statistical Package AQ6 for the Social Sciences software was used to analyze data obtained. Results: Study group included 26 males (52%) and 24 females (48%) of varying age from 4 years up to 18 years of age. Presence of thalassemia disorder was noted in the family of 10 patients (20%). Five (10%) patients had mild visual impairment for distant vision. While, 18 patients (36%) had mild dry eye disease. Fundus abnormalities were seen in 14 patients as arteriovenous tortuosity, tessellated fundus, and desferrioxamine retinopathy. Decreased visual acuity, dry eye, and fundus abnormalities were seen in patients with serum ferritin levels &gt;1000 ng/mL. Fundus abnormalities were seen in patients with higher serum ferritin levels (&gt;1000 ng/mL) and longer duration of treatment. In total, ocular changes were seen in 31 patients (62%). Conclusion: Regular ophthalmic consult is necessary for all thalassemia patients on regular blood transfusion and chelation therapy to unmask ocular changes at an early stage and provide optimum visual care.

An Improved Method for Quick Quantification of Unsaturated Transferrin.

Blood iron levels play a vital role in oxygen metabolism and energy generation whilst transporter protein, transferrin, binds and delivers iron to the transferrin receptor of endosomal compartments of cells. Consequently, the iron-binding capacity of transferrin is an important indicator for many diseases, and its measurements are used in the diagnosis and treatment of anaemias. Various assays, including Total Iron Binding Capacity (TIBC), Unsaturated Iron-Binding Capacity (UIBC) and Transferrin Saturation (TS), were developed to assess the iron-binding capacity of transferrin. Clinically, UIBC is measured in serum by a multi-step liquid ferrozine method and subjected to interference from conditions such as haemolysis and lipemia. Here, we report a quick method that directly measures the concentration of apotransferrin in EDTA-treated plasma, theoretically equivalent to UIBC. Importantly, this supramolecular assembly-based method is more time-efficient, cost-effective and insensitive to serum cation fluctuations. With additional colorimetric property, this method also provides a visual indicator for abnormal health conditions with extreme transferrin statuses such as those found in cancers. Its minimal requirement for equipment would be particularly useful for diagnosis in remote and under-developed regions.

REACTIVE TRHOMBOCYTOSIS IN CHILDREN

Thrombocytosis is a condition which the platelet count exceeds 450,000/mm3. Thrombocytosis was classified as: mild (450,000-700,000/mm3), moderate (700,000-900,000/mm3), severe (900,000-1,000,000/mm3) and extreme (1,000,000/mm3). Functionally, thrombocytosis is divided into primary (essential) and secondary (reactive). The novelty of this study due to examining reactive thrombocytosis in children. The purpose of this study was to look at reactive thrombocytosis in children. Essential thrombocytosis is a myeloproliferative disorder due to monoclonal or polyclonal abnormalities of hematopoietic cells or biologic abnormalities of thrombopoietin (Tpo) in the primary regulation of megakaryopoiesis. Meanwhile, reactive thrombocytosis occurs temporarily due to stimulation of megakaryopoiesis with haematological or non-haematological abnormalities. Reactive thrombocytosis is an increase in thrombopoiesis due to reactive process due to infection, chronic inflammation, malignancy, and splenectomy surgery. Bacterial or viral infections are the most common cause (about 37-78%) at any age during childhood. Reactive thrombocytosis are asymptomatic and is usually found incidentally. Based on the guidelines the British Society for Haematology recommends three initial investigations: (1) Peripheral blood smear, (2) Inflammatory markers, and (3) Iron status. Management of reactive thrombocytosis by threated the main diseases, then platelet count returns to normal after the underlying disease is resolved. The overall prognosis depends on the underlying causative condition, approximately 8% of patients with acute infection examined have mild, transient thrombocytosis and show no infectious complications. However, these patients had an increased acute-phase response, prolonged length of stay, more bacteraemia and increased mortality although it only affected a minority of patients. This distinction between essential and reactive thrombocytosis is important because it implies evaluation, prognosis and treatment.Keywords: Reactive Thrombocytosis; Secondary Thrombocytosis; Transient.

The amino acid sensor GCN2 controls red blood cell clearance and iron metabolism through regulation of liver macrophages

GCN2 (general control nonderepressible 2) is a serine/threonine-protein kinase that controls messenger RNA translation in response to amino acid availability and ribosome stalling. Here, we show that GCN2 controls erythrocyte clearance and iron recycling during stress. Our data highlight the importance of liver macrophages as the primary cell type mediating these effects. During different stress conditions, such as hemolysis, amino acid deficiency or hypoxia, GCN2 knockout (GCN2-/-) mice displayed resistance to anemia compared with wild-type (GCN2+/+) mice. GCN2-/- liver macrophages exhibited defective erythrophagocytosis and lysosome maturation. Molecular analysis of GCN2-/- cells demonstrated that the ATF4-NRF2 pathway is a critical downstream mediator of GCN2 in regulating red blood cell clearance and iron recycling.

Luspatercept in patients with non-transfusion dependent β-thalassaemia

Ineffective erythropoiesis leads to the development of chronic anaemia and iron overload in patients with non-transfusion dependent β-thalassemia, which is associated with significant morbidity, risk of mortality, and loss of health-related quality of life (HRQoL) especially in patients who have haemoglobin concentrations lower than 10 g/dL.1 There are no approved drugs directed at the management of anaemia in patients with non-transfusion dependent β-thalassemia, leaving supportive care with occasional red blood cell transfusions and iron chelation as the only approved therapeutic options for these patients.

Blood Trace Element Status in Camels: A Review.

Simple SummaryTrace elements are required in small quantities for all species, and their role in many biological functions is essential. Additionally, their deficiency or excess can have important consequences for metabolism and health. Although camels live in ecosystems dominated by minerals, they are also subject to such imbalances. To investigate the trace element status of camels, as for other animals, blood sampling is preferred. The present paper gives a large overview of the values observed in camel blood samples under different physiological and health conditions, as well as some data regarding the symptoms in deficiency or excess situations. The main trace elements involved are copper, zinc, iron, selenium, manganese, cobalt, iodine, fluorine and molybdenum. In addition, some data regarding bromide and nickel, due to their specific mention in the literature, are included. Although the status of sulfur is regarded as intermediary between the main and trace elements, it is added due to its role in polluted areas. Finally, some specificities of camel trace elements are discussed.Trace minerals play an important role in animal health and productivity. They are involved also in many physiological activities, and their deficiency causes a variety of pathological problems and metabolic defects, reducing consequently the animal productivity. The demand for animal products in semi-arid areas is rapidly increasing, and the supply is still below the required level, partially due to low animal productivity. Camels (Camelus dromedarius and Camelus bactrianus) are considered one of the main sources of healthy, high-quality meat and milk for human consumption within most of the countries in the semi-arid regions. Despite their efficient adaptation to their environment, camels can suffer from the growth retardation of newborns, low feed efficiency, anemia, poor fertility, poor reproduction and many other metabolic disorders. It is well known that trace mineral deficiencies and trace mineral toxicities can influence camels’ production and reproductive efficiency, as well as many aspects of their growth and metabolism. Evaluating the trace minerals status of camels and their variability is an obvious step toward improving camels’ productivity and health. Thus, the present article reviews the data regarding the status of trace minerals (copper, zinc, iron, selenium, manganese, cobalt, iodine, fluorine, molybdenum, sulfur, bromide and nickel) in camel blood and their physiological variability, with a focus on their deficiency and toxicity effects.

Associations between red blood cell indices and iron status and neurocognitive function in young adults: Evidence from memory and executive function tests and event-related potentials.

Cognitive impairment has been associated with anemia and iron deficiency; however, brain electrophysiological studies correlating red blood cell (RBC) indices and iron status to cognition in adulthood are scarce. We aimed to assess neurocognitive function in young adults of the general population and its correlation with RBC indices and iron status. Neurocognitive function was investigated using scalp-recorded event-related potentials (ERPs) within the context of a task-switching paradigm. ERPs and test performance were also compared across groups of "high"/"low" RBC and iron indices. Working memory was examined using the digit span test, in which mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), and ferritin were found to be significant predictors of test performance, with higher MCH/MCV/ferritin being associated with better test scores. In the switching task, MCH, MCV, and ferritin were found to be significant predictors of task performance, with higher MCH/MCV/ferritin levels associated with a lower percentage of errors. Electrophysiological results showed that MCH and MCV were significant predictors of ERPs amplitude, with lower MCH/MCV levels associated with greater amplitude, which may reflect compensatory processes. P1, N1, P2, and P3 were greater for the low MCH/MCV groups. This is the first evidence of association between levels of MCH/MCV and brain function while engaged in an executive function task; possibly reflecting brain iron availability.

Polymorphisms of haptoglobin modify the relationship between dietary iron and the risk of gestational iron-deficiency anemia.

To assess whether polymorphisms of haptoglobin (Hp) modify the relationship between dietary iron and the risk of gestational iron-deficiency anemia (IDA). This study analyzed 1430 singleton pregnant women aged 20 ~ ≤ 48years from the 2017-2019 National Nutrition and Health Survey of Pregnant Women in Taiwan. Sociodemographic, blood biochemical, Hp phenotype, and 24-h dietary recall data were collected. Erythropoiesis-related total prenatal supplementation was defined as the reported use of multivitamins and minerals, vitamin B complex, folate, and iron. Distributions of the Hp 1-1, Hp 2-1, and Hp 2-2 phenotypes were 13.6, 39.8, and 46.5%, respectively. Women with the Hp 1-1 phenotype had the lowest mean levels of serum ferritin (p-trend = 0.017), the highest prevalence of gestational ID (p-trend = 0.033) as well as the highest prevalence of gestational IDA (did not reach statistical differences, p-trend = 0.086). A gene-diet interaction on serum ferritin was observed between the Hp 1 and Hp 2 (2-1/2-2) alleles (p < 0.001). An adjusted multivariate logistic regression showed that compared to those with a normal blood iron status and who reported using erythropoiesis-related total prenatal supplements, those who did not had a 4.05-fold [odds ratio (OR) = 4.05 (95% confidence interval (CI) 2.63-6.24), p < 0.001] increased risk of gestational IDA. The corresponding ORs for carriers of the Hp 1 and Hp 2 alleles were 4.78 (95% CI 1.43-15.99) and 3.79 (95% CI 2.37-6.06), respectively. Pregnant women who are Hp 1 carriers are at increased risk for developing IDA if they do not meet the recommended dietary allowance for iron or use erythropoiesis-related prenatal supplements.