Lower Total Iron Binding Capacity Research Articles

New insights into the mechanisms of iron absorption: Iron dextran uptake in the intestines of weaned pigs through glucose transporter 5 (GLUT5) and divalent metal transporter 1 (DMT1) transporters

The purpose of this study was to gain insight into the mechanism of iron dextran (DexFe) absorption in the intestines. A total of 72 piglets (average BW = 7.12 ± 0.75 kg, male to female ratio = 1:1) weaned at 28 d of age were randomly divided into two treatment groups with six replicates for each group. The experimental diets included the basal diet supplemented with 100 mg/kg iron dextran (DexFe group) and the basal diet supplemented with 100 mg/kg FeSO4•H2O (CON group). The experiment lasted for 28 d. The piglets' intestinal iron transport was measured in vitro using an Ussing chamber. Porcine intestinal epithelial cell line (IPEC-J2) cells were used to develop a monolayer cell model that explored the molecular mechanism of DexFe absorption. Results showed that compared to the CON group, the ADG of pigs in the DexFe group was improved (P = 0.022), while the F/G was decreased (P = 0.015). The serum iron concentration, apparent iron digestibility, and iron deposition in the duodenum, jejunum, and ileum were increased (P < 0.05) by dietary DexFe supplementation. Piglets in the DexFe group had higher serum red blood count, hemoglobin, serum iron content, serum ferritin and transferrin levels and lower total iron binding capacity (P < 0.05). In the Ussing chamber test, the iron absorption rate of the DexFe group was greater (P < 0.001) than the CON group, and there was no significant difference between the DexFe group and the glucose group (P > 0.05). Furthermore, when compared to the CON group, DexFe administration improved (P < 0.05) SLC2A5 gene and glucose transporter 5 (GLUT5) protein expression but had no effect (P > 0.05) on SLC11A2 gene or divalent metal transporter 1 (DMT1) protein expression. Once the GLUT5 protein was suppressed, the iron transport rate and apparent permeability coefficient were decreased (P < 0.05) in IPEC-J2 monolayer cell models. The findings suggest the effectiveness of DexFe application in weaned piglets and revealed for the first time that DexFe absorption in the intestine is closely related to the glucose transporter GLUT5 protein channel.

Iron Status in Male Type 2 Diabetic Patients and Its Association with Their Glycemic Status

Background &amp; objective: Alteration in iron metabolism may occur in diabetic patients especially those who have poor glycemic control. Serum iron is involved in free radical formation associated with hyperglycemia and causes diabetic complications. The present study was undertaken to observe the iron status and its relation with glycemic control in male type 2 diabetic patients. Methods: This cross-sectional analytical study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka from July 2017 to June 2018. A total of 48 diagnosed male type 2 diabetic patients (cases) were recruited from the Out-patient Department (OPD) of Endocrinology based on predefined eligibility criteria. Of them, 24 had good glycemic control (HbA1c level &lt; 7%) (Group B1) and 24 had poor glycemic control (HbA1c level ≥ 7%) (Group B2). To compare the outcome (serum iron status) of these diabetic patients, another 48 age- and BMI-matched healthy non-diabetic male subjects were selected from personal contact as control. While diabetes and glycemic status (fasting blood glucose level, and HbA1c) of the diabetic patients were exposure variables, serum iron, serum total iron binding capacity (TIBC), transferrin saturation, and serum ferritin were the outcome variables. Results: The mean age of the subjects of either study group was around 43 and there was no significant difference between the groups concerning age (p = 0.610). The distribution of BMI and serum creatinine between groups was also similar (p = 0.135 and p = 0.134 respectively). The cases had a significantly higher level of serum iron, transferrin saturation, and an insignificantly lower total iron binding capacity (TIBC) than their non-diabetic peers (p = 0.045, p = 0.036, and p = 0.061 respectively). A comparison of outcome variables among the three groups shows that the groups were significantly heterogeneous in terms of serum iron, TIBC, transferrin saturation, haemoglobin level (p = 0.032, p = 0.012, p = 0.008 and p = 0.018 respectively). The associations were more conspicuous in patients with poor glycemic status. Correlation analyses revealed that while there was a significant linear correlation between serum iron and HbA1c (r = + 0.376, p &lt; 0.01), it was negatively correlated with serum TIBC (r = -0.478, p &lt; 0.001). The glycemic status (HbA1c) was also found to be linearly correlated with serum ferritin and transferrin saturation (r = + 0.354, p = 0.013 and r = + 0.462, p &lt; 0.001 respectively). Conclusion: The study concluded that type 2 diabetic patients have a significantly higher level of serum iron, transferrin saturation, and a lower total iron binding capacity (TIBC) than the non-diabetic healthy subjects, all of which may lead to reduced synthesis of hemoglobin. The compromised iron metabolism is even more evident as the hyperglycemia aggravates. Ibrahim Card Med J 2023; 13 (1&amp;2): 32-39

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

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

Association of iron homeostasis biomarkers in type 2 diabetes and glycaemic traits: a bidirectional two-sample Mendelian randomization study.

Mendelian randomization (MR) studies show iron positively associated with type 2 diabetes (T2D) but included potentially biasing hereditary haemochromatosis variants and did not assess reverse causality. We assessed the relation of iron homeostasis with T2D and glycaemic traits bidirectionally, using genome-wide association studies (GWAS) of iron homeostasis biomarkers [ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation (TSAT) (n ≤ 246 139)], T2D (DIAMANTE n = 933 970 and FinnGen n = 300 483), and glycaemic traits [fasting glucose (FG), 2-h glucose, glycated haemoglobin (HbA1c) and fasting insulin (FI) (n ≤ 209 605)]. Inverse variance weighting (IVW) was the main analysis, supplemented with sensitivity analyses and assessment of mediation by hepcidin. Iron homeostasis biomarkers were largely unrelated to T2D, although serum iron was potentially associated with higher T2D [odds ratio: 1.07 per standard deviation; 95% confidence interval (CI): 0.99 to 1.16; P-value: 0.078) in DIAMANTE only. Higher ferritin, serum iron, TSAT and lower TIBC likely decreased HbA1c, but were not associated with other glycaemic traits. Liability to T2D likely increased TIBC (0.03 per log odds; 95% CI: 0.01 to 0.05; P-value: 0.005), FI likely increased ferritin (0.29 per log pmol/L; 95% CI: 0.12 to 0.47; P-value: 8.72 x 10-4). FG likely increased serum iron (0.06 per mmol/L; 95% CI: 0.001 to 0.12; P-value: 0.046). Hepcidin did not mediate these associations. It is unlikely that ferritin, TSAT and TIBC cause T2D although an association for serum iron could not be excluded. Glycaemic traits and liability to T2D may affect iron homeostasis, but mediation by hepcidin is unlikely. Corresponding mechanistic studies are warranted.

Comparison of Haematological Variables in Helicobacter Pylori-Infected Patients with Ulcer and without Ulcer: A Cross-sectional Study

Introduction: Helicobacter pylori (H. pylori) is predominantly responsible for acute and chronic progressive gastroduodenal inflammation. Symptoms of gastric diseases vary from dyspepsia to altered bowel movements, leading to ulcers and potential gastrointestinal bleeding. Consequently, H. pylori can have a variable effect on the gastrointestinal tract and other organs. Ongoing research has shown associations between H. pylori and haematological manifestations. Recent studies have reported a 90% incidence of duodenal ulcers and an 80% incidence of gastric ulcers in patients with H. pylori infection. Aim: To investigate haematological manifestations in H. pyloriinfected patients with and without ulcers, and to compare the haematological variables. Materials and Methods: This cross-sectional study was conducted in the Department of Gastroenterology at King George’s Medical University in Lucknow, India, from October 2021 to October 2022. One hundred patients diagnosed with H. pylori-positive biopsy through endoscopy were enrolled in the study. Among these patients, 51% had ulcers with H. pylori infection (enrolled as cases), while 49% were H. pylori infected but without ulcers (enrolled as controls). Samples were analysed for Haemoglobin (Hb) levels, Red Blood Cell (RBC) count, Reticulocyte Count (RetC), serum iron, serum ferritin, Total Iron Binding Capacity (TIBC), serum vitamin B12, and Homocysteine (HCy) levels. Statistical analysis involved independent sample t-tests to compare continuous data and chi-square tests to compare categorical data. Results: The majority of patients included in the study, both with ulcers (70.6%) and without ulcers (59.2%), were males with mean±Standard Deviation (SD) ages of 32.39±7.25 years and 29.86±7.66 years, respectively. In the present study, low reticulocyte count, anaemia, deranged RBC count, low serum iron, high TIBC, and low ferritin were observed in 9%, 22%, 61%, 11%, 12%, and 8% of the patients, respectively. Vitamin B12 deficiency and hyperhomocysteinemia were observed in 6% and 1% of the cases, respectively. Among patients with ulcers, the strongest correlation was found between serum iron and serum ferritin (r-value=0.901), while the weakest correlation was found between vitamin B12 and RetC (r-value=0.206). Among patients without ulcers, the strongest correlation was found between serum iron and Hb (r-value=0.884), while the weakest correlation was found between TIBC and HCy (r-value=0.270). Conclusion: The present study demonstrates a significant association between H. pylori infection-induced ulcers and decreased mean reticulocyte count, serum iron, and serum ferritin levels. Recognising these haematological derangements and including them as indications for H. pylori eradication may lead to a remarkable improvement in the management regime.

Relationship of Red Cell Distribution Width (RDW) To the Results Total Iron Binding Capacity (TIBC) In Chronic Kidney Failure Patients with Anemia

Chronic kidney failure is caused by the body's inability to maintain metabolism and fluid balance due to progressive kidney function disorders that will trigger anemia. The cause of anemia in kidney failure is inflammation, which causes inhibition of iron release, resulting in a decrease in iron in the body. Signs of iron deficiency in chronic kidney failure are low levels of Total Iron Binding Capacity (TIBC) and in complete blood count; there is an increase in levels of Red Cell Distribution Width (RDW). This study aims to determine the relationship between Red Cell Distribution Width (RDW) and the results of Total Iron Binding Capacity (TIBC) in patients with chronic kidney failure with anemia. This study was conducted in January-April 2022, using a cross sectional method on 30 samples of patients with chronic kidney failure with anemia by examining a sample of patients at the Haji Regional General Hospital Surabaya. Most of the research results of the research subjects were male (n =16; 53,3%). The normal RDW is 33,3% (10/30), the high RDW is 66,7% (20/30), the low TIBC is 76,7% (23/30), and the normal TIBC is 23,3% (7/30). As much as 53,3% (16/30) for high RDW values with low TIBC. The result of the Pearson correlation test between RDW and TIBC was r = 0.014 (p = 0.940). Therefore, there is no significant relationship between RDW and TIBC in CKD patients with anemia at the Haji Surabaya Hospital.

The interaction analysis between advanced age and longer dialysis vintage on the survival of patients receiving maintenance hemodialysis.

ObjectiveTo compare the all-cause mortality of aged and younger patients undergoing maintenance hemodialysis (MHD) over the long or short term, and to identify independent risk factors.MethodsWe performed a retrospective cohort study using the medical records of 181 patients undergoing MHD. We compared the clinical characteristics and laboratory data of survivors and participants who died, according to their age and the duration of MHD. Binary stepwise logistic regression was used to identify independent risk factors for all-cause mortality.ResultsCardiovascular and cerebrovascular diseases were the principal causes of mortality. The number of aged participants with hypertensive nephropathy as their primary kidney disease was significantly higher than the number of younger participants. The proportion with chronic glomerulonephritis was significantly higher for participants undergoing long-term MHD. Logistic regression analysis revealed that low body mass index, single-pool Kt/V, serum albumin, platelet count, and total iron-binding capacity; and high intact parathyroid hormone and N terminal pro B type natriuretic peptide were independent risk factors for all-cause mortality.ConclusionsAged patients are more susceptible to hypertensive nephropathy than younger patients. In addition, the survival of patients with chronic glomerulonephritis undergoing MHD is superior to that of those with hypertensive or diabetic nephropathy.

Evaluation of iron status in metabolic syndrome

Background: Metabolic syndrome (MetS) is a cluster of interconnected risk factors that adversely affects all the organs of the body. Oxidative stress resulting from excess tissue iron causing insulin resistance, tissue damage and other complications are observed in MetS. Objectives: To assess iron status by serum iron, ferritin, total iron binding capacity (TIBC) and transferrin saturation (TS) levels in female MetS patients. Method: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March, 2019 to February, 2020 on total thirty female MetS patients aged 25 to 45 years. Thirty (30) age matched apperantly healthy female subjects were enrolled as control. Serum iron, ferritin levels, TIBC and TS were measured by standard biochemical methods. Data were expressed as mean ± SD. Statistical analysis was done by Independent sample ‘t’ test. Results: In this study, mean serum ferritin was significantly higher (p&lt;0.001) and mean serum TIBC was significantly lower (p&lt;0.05) in patients than that of controls In addition, 43.3% of MetS patients had excess ferritin and 26.67% patients had low TIBC whereas no control subjects had abnormal ferritin or TIBC and the difference between MetS and control was statistically significant. Conclusion: From the results of this study it can be concluded that higher iron status may be associated with metabolic syndrome. J Bngladesh Soc Physiol 2021;16(1): 82-87

Iron Deficiency Anemia in Children and Adolescents with Type I Diabetes, Is it a Real Problem?

Abstract Background: Iron deficiency anemia (IDA) in children with type I diabetes (T1D) represents a significant burden. Aim of Study: To asses iron status in children and adoles-cent with T1D of and to correlate it with glycemic control and diabetic vascular complications. Patients and Methods: Two hundred children with T1D recruited from Pediatrics and Adolescent Diabetes Unit (PADU), Ain Shams University in the period from December 2019 to July 2020. They were 123 males (61.5%) and 77 females (38.5%) aged 10.97±3.93 years (Range: 2-18 years). History taking, fundus examination and general examination were done stressing on anthropometric measurements. Labo-ratory evaluation including complete blood count, glycosylated haemoglobin (HbA1c), urinary albumin/creatinine ratio (ACR), lipid profile and patients with microcytic hypochromic anaemia underwent Serum iron, total iron-binding capacity (TIBC), serum ferritin, Hepcidin, Anti-tissue transglutaminase (IgA), Occult blood in stool and H-pylori antigen in stool. Results: Seventy two of diabetic children were anemic (36%) and fifty one had IDA (25.5). IDA was more prevalent in males. Children with T1D and IDA experienced more clinically significant hypoglycemic attacks, more DKA attacks, high fatigue severity scale and history of menorrhagia. Low body weight, low BMI, low mean corpuscular volume (MCV), high TIBC and low hepcidin level were present in diabetic children with IDA. They also had high HbA1c, neuropathy, high triglycerides and high level of low density lipoprotein (LDL cholesterol). Conclusions: IDA is a significant morbidity among chil-dren with T1D and it should be screened. Serum hepcidin levels are significantly associated with iron status in children, and could be useful indicators of ID.

Maternal anemia and preterm birth among women living with HIV in the United States

Women living with HIV (WLHIV) have a higher prevalence of anemia than women without HIV, possibly related to the effects of HIV and antiretroviral medications. To estimate the prevalence of anemia in the third trimester of pregnancy and the effect of anemia on preterm births in WLHIV in the longitudinal, US-based Pediatric HIV/AIDS Cohort Study (PHACS). During the third trimester, we obtained up to three 24-hour dietary recalls to estimate daily intakes of nutrients and measured serum concentrations of iron, vitamin B6, vitamin B12, zinc, folate, ferritin, total iron-binding capacity (TIBC), and high sensitivity C-reactive protein. Third trimester anemia was defined as hemoglobin<11 g/d and iron-deficiency anemia (IDA) was defined as low ferritin, high TIBC, and low transferrin saturation. A preterm birth was defined as birth at<37 completed weeks of gestation, regardless of etiology. We fit separate modified Poisson regression models for each outcome (anemia, preterm birth) and each main exposure, adjusted for confounders, and report adjusted prevalence ratios (aPR) and 95% CIs. Of the 267 WLHIV, 50% were anemic in the third trimester, of whom 43.5% (n=57/131) had IDA. On average, women with anemia were younger, were more likely to be black, started antiretroviral medications in the second trimester, had a low CD4 count (<200 cells/mm3) early in pregnancy, and were less likely to meet recommended intakes for iron, B6, and folate. The prevalence of anemia was greater in WLHIV with a low CD4 count (aPR=1.65; 95% CI: 1.20-2.27) and high HIV viral load (>10,000 copies/mL; aPR=1.38; 95% CI: 1.02-1.87). In total, 16% of women delivered preterm. Anemia was associated with a 2-fold (aPR=2.04; 95% CI: 1.12-3.71) higher prevalence of preterm births. Anemia is common in pregnant WLHIV, highlighting the need to address the underlying factors and clinical outcomes of anemia in this population.

Low serum iron is associated with anemia in CKD stage 1\u20134 patients with normal transferrin saturations

Low transferrin saturation (TSAT), calculated by serum iron divided by total iron-binding capacity (TIBC), indicates iron deficiency. Because malnutrition and inflammation are associated with low TIBC in chronic kidney disease (CKD), TSAT might not reflect iron status or risk for anemia. We examined whether low serum iron was a risk factor for anemia in CKD patients with normal TSAT. Thus we compare the risk for anemia in 2500 CKD stage 1–4 patients divided by TSAT (cutoff: 20%) and serum iron (cutoff: 70 μg/dL in men, 60 μg/dL in women). Our results confirmed low TIBC (< 200 μg/dL) was associated with hypoalbuminemia and high C-reactive protein. In fully-adjusted logistic regression, both “normal TSAT low iron” and “low TSAT low iron” groups were associated with baseline anemia (hemoglobin < 11 g/dL) (odds ratios (OR) 1.56; 95% confidence interval (CI) 1.13–2.16 and OR 2.36; 95% CI 1.76–3.18, respectively) compared with the reference group (normal TSAT normal iron). Sensitivity tests with different cutoffs for TSAT and iron also showed similar results. In patients without anemia, both groups were associated with anemia after 1 year (OR 1.69; 95% CI 1.00–2.83 and OR 1.94; 95% CI 1.11–3.40, respectively). In conclusion, CKD stage 1–4 patients with normal TSAT but low serum iron are still at risk for anemia.

Inflammatory diets are associated with lower total iron binding capacity in sera of young adults.

Chronic, systemic inflammation, which is associated with obesity and numerous other diseases, impairs iron status by increasing hepcidin concentration. Inflammation also decreases the concentration of transferrin, the main iron transport protein and a negative acute phase protein, which is indirectly assessed by measuring total iron binding capacity (TIBC). However, the contribution of diet-induced inflammation has not been studied. Data from two studies, namely Diet and Inflammation and Selenium and Inflammation Studies (total n=98) were used to assess the associations among Dietary Inflammatory Index (DII®) scores derived from three-day dietary records, body mass index (BMI=weight[kg]/height[m]2), inflammatory and hematological markers among young adults with normal-weight, overweight or obesity. Subjects' diets were also categorized as less inflammatory diets (LID) and inflammatory diets (ID) using cluster analysis. Independent t-test and regression analyses were used to assess associations in the data. Intakes of iron, proteins, fat, fiber, and calories were higher in the LID group compared to the ID group (p<0.05). Demographic characteristics and concentrations of C-reactive protein (CRP) and iron status biomarkers did not differ significantly between the two groups (p>0.05). Higher DII score was associated with increasing CRP (β+SE=0.23+0.07, p=0.002) and lower TIBC (β+SE=-8.46+3.44, p=0.02), independent of BMI category. The LID diet was associated with higher TIBC (β+SE=29.87+10.75, p=0.007) compared to the ID diet. In conclusion, inflammatory diets may impair iron status by reducing the iron binding capacity of transferrin.

Background: Iron Deficiency Anemia (IDA) and beta-thalassemia trait (&amp;beta;-TT) are the two most prevalent causes of microcytic hypochromic anemia. The current study aimed to assess the accuracy of the various indices to distinguish these two conditions. Material &amp;amp; Methods: A total of 40 patients were studied retrospectively by calculating six discrimination indices. The patients were assessed according to the Mentzer,

Background Iron Deficiency Anemia IDA and beta-thalassemia trait beta-TT are the two most prevalent causes of microcytic hypochromic anemia. The current study aimed to assess the accuracy of the various indices to distinguish these two conditions.Material amp Methods A total of 40 patients were studied retrospectively by calculating six discrimination indices. The patients were assessed according to the Mentzer Shine amp Lal England amp Fraser Green amp King Red Cell Distribution Width Index RDWI and Srivastava indices. The study included 19 beta-TT cases based on low Hb and mean cell volume MCV levels normal serum iron and raised levels of HbA2 gt3.5 and 21 IDA cases with low hemoglobin low serum iron low ferritin high total iron-binding capacity and normal electrophoresis. The accurately diagnosed cases were identified and their sensitivity specificity positive and negative predictive value and Youdenrsquos index of the indices were calculated.Results None of the indices showed a sensitivity and specificity of 100. The percentage correctly diagnosed was highest for RDWI 97.5 followed by Green and King 95. Youdenrsquos index was also highest for RDWI 95 followed by Green and King 90 and Mentzer 84.7.Conclusion RDWI Green amp King and Mentzer are readily available and the most stable indices in differentiating between IDA and beta-TT.

Correlation of Iron Levels with Asthma and Lung Function in Pediatric Patients with Sickle Cell Anemia

Introduction:Significant morbidity and mortality in patients with sickle cell disease (SCD) is attributed to the pulmonary sequalae of the disease. Patients with SCD often suffer airway hyper-reactivity, acute chest syndrome (ACS), chronic lung disease, pulmonary hypertension (PHTN), and obstructive sleep apnea (OSA). Recent literature has provided evidence supporting the strong association between asthma and airway hyper-reactivity in SCD. One of the factors linked to chronic inflammation and asthma is iron status. The present study examined whether iron levels are associated with pulmonary complications in pediatric patients with SCD. Method:Through retrospective review of electronic medical records (EMR) we evaluated patients with diagnosis of asthma and SCD. All patients with available PFT (3/21/2013-3/11/2020) and iron studies were included in the analysis. Chi square and ANOVA tests were used to explore relationships of respiratory conditions with lab data and relevant medical history. Results:The analysis reviewed information of 100 patients with SCD -- 56 males and 44 females The sample population had the following genotypes: 63% Hemoglobin (Hb) SS, 23% Hb SC, 2% Hb S Beta Zero Thalassemia, and 12% Hb S Beta Thalassemia. 38% of these patients were receiving treatment via hydroxyurea. The results generated found that patients with a large airway obstruction (LAO) had a marginally statistically significantly higher serum iron level than those with no LAO (p=0.067.) Patients with homozygous Hb S disease were four times as likely to have a history of ACS (p=0.004) than those without and were marginally significantly more likely to be SS and SB0Thal (p=0.052). Patients with history of ACS had a significantly higher mean iron saturation and lower total iron binding capacity (TIBC.) Patients with PHTN had significantly higher serum iron levels (p=0.029). Conclusion:Our findings reveal that while iron might play a more significant role in the development of PHTN and ACS in patients with SCD, the role in asthma is borderline in our sample. These findings, although of borderline statistical significance p=0.067, are clinically noteworthy. These results may open a new window for therapy targeted at maintaining iron in normal physiologic ranges to decrease pulmonary complications in patients with sickle cell anemia. Further studies with larger samples are necessary to clarify the meaning of our marginally significant findings. Disclosures No relevant conflicts of interest to declare.

Impact of Intravenous Iron on Oxidative Stress and Mitochondrial Function in Experimental Chronic Kidney Disease.

Background: Mitochondrial dysfunction is observed in chronic kidney disease (CKD). Iron deficiency anaemia (IDA), a common complication in CKD, is associated with poor clinical outcomes affecting mitochondrial function and exacerbating oxidative stress. Intravenous (iv) iron, that is used to treat anaemia, may lead to acute systemic oxidative stress. This study evaluated the impact of iv iron on mitochondrial function and oxidative stress. Methods: Uraemia was induced surgically in male Sprague-Dawley rats and studies were carried out 12 weeks later in two groups sham operated and uraemic (5/6 nephrectomy) rats not exposed to i.v. iron versus sham operated and uraemic rats with iv iron. Results: Induction of uraemia resulted in reduced iron availability (serum iron: 31.1 ± 1.8 versus 46.4 ± 1.4 µM), low total iron binding capacity (26.4 ± 0.7 versus 29.5 ± 0.8 µM), anaemia (haematocrit: 42.5 ± 3.0 versus 55.0 ± 3.0%), cardiac hypertrophy, reduced systemic glutathione peroxidase activity (1.12 ± 0.11 versus 1.48 ± 0.12 U/mL), tissue oxidative stress (oxidised glutathione: 0.50 ± 0.03 versus 0.36 ± 0.04 nmol/mg of tissue), renal mitochondrial dysfunction (proton/electron leak: 61.8 ± 8.0 versus 22.7 ± 5.77) and complex I respiration (134.6 ± 31.4 versus 267.6 ± 26.4 pmol/min/µg). Iron therapy had no effect on renal function and cardiac hypertrophy but improved anaemia and systemic glutathione peroxidase (GPx) activity. There was increased renal iron content and complex II and complex IV dysfunction. Conclusion: Iron therapy improved iron deficiency anaemia in CKD without significant impact on renal function or oxidant status.

Decreased Total Iron Binding Capacity May Correlate with Ruptured Intracranial Aneurysms

Iron and its derivatives play a significant role in various physiological and biochemical pathways, and are influenced by a wide variety of inflammatory, infectious, and immunological disorders. We hypothesized that iron and its related factors play a role in intracranial aneurysm pathophysiology and investigated if serum iron values are associated with ruptured intracranial aneurysms. 4,701 patients with 6,411 intracranial aneurysms, including 1201 prospective patients, who were diagnosed at the Massachusetts General Hospital and Brigham and Women’s Hospital between 1990 and 2016 were evaluated. A total of 366 patients with available serum iron, ferritin and total iron binding capacity (TIBC) values were ultimately included in the analysis. 89% of included patients had anemia. Patients were categorized into ruptured and non-ruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the association between ruptured aneurysms and iron, ferritin, and TIBC. TIBC values (10−3 g/L) within 1 year of diagnosis (OR 0.41, 95% CI 0.28–0.59) and between 1 and 3 years from diagnosis (OR 0.52, 95% CI 0.29–0.93) were significantly and inversely associated with intracranial aneurysm rupture. In contrast, serum iron and ferritin were not significant. In this case-control study, low TIBC was significantly associated with ruptured aneurysms, both in the short- and long term. However, this association may not apply to the general population as there may be a selection bias as iron studies were done in a subset of patients only.

Thyroid Function in Egyptian Children with Sickle Cell Anemia in Correlation with Iron Load.

Sickle Cell Disease (SCD) is characterized by defective hemoglobin synthesis, hemolytic anemia, frequent thrombosis and chronic organ damage including endocrine organs. To assess thyroid function in children with SCD in correlation and iron load. This study was conducted on 40 children with SCD with iron overload (serum ferritin more than 1000 ng/ml) including 22 males and 18 females with their ages ranging from 11-14 years and mean age value of 11.63±1.36 years and 40 healthy children of matched age and sex as a control group. For all patients; complete blood count, hemoglobin electrophoresis, serum ferritin, serum iron, iron binding capacity and thyroid function including Free Thyroxine (FT4), Free Triiodothyronine (FT3), Thyroid Stimulating Hormone (TSH), Thyroid Peroxidase Antibody (TPOAb) and Thyroglobulin Antibody (TgAb) were done. Significantly higher serum ferritin and iron and significantly lower Total Iron Binding Capacity (TIBC) were found in patients compared with controls (mean serum ferritin was 1665.2±1387.65ng/ml in patients versus 192.55±107.2ng/ml in controls with p-value of 0. 007, mean serum iron was 164±83.9 ug/dl in patients versus 89.5±4.5ug/dl in controls with p-value of 0.039, mean TIBC was 238±44.5ug/dl in patients versus 308±11ug/dl in controls with p-value of 0.001). Significantly higher serum TSH and significantly lower Free T3 and Free T4 were found in patients compared with controls with no significant correlation between thyroid hormones and serum ferritin (mean serum TSH was 4.61±1.2 µIU/mL in patients versus 2.11 ± 0.54 µIU /mL in controls with p-value of 0. 045, mean serum FT3 was 2.61 ±1.3 pg/mL versus 3.93±0.47pg/mL in controls with p-value of 0.027, mean serum FT4 was 0.91±0.174 ng/dL versus 1.44± 0.164 ng/dLin controls with p-value of 0.047, r = - 0. 008 and p-value was 0. 973 for correlation between free T4 and serum ferritin, r = -0. 028 and p-value was 0. 9 for correlation between TSH and serum ferritin and r= - 0.259 and p-value was 0.27 for correlation betweenT3 and serum ferritin). There were no significant differences between patients and controls regarding thyroid peroxidase antibody and thyroglobulin antibody (mean serum thyroid peroxidase antibody was 22.45± 4.32 in patients versus 22.45 ± 3.21 in controls with p-value of 0.98 while mean serum thyroglobulin antibody was 12.32 ± 2.65 in patients versus 12.99 ± 2.34 in controls with p-value of 0.76. Thyroid hormones deficiency may occur in some patients with SCD. Regular assessment of thyroid function in children with SCD may be recommended as they are more vulnerable to develop hypothyroidism and may require replacement therapy.

Comparative efficacy of two parenteral iron-containing preparations, iron gleptoferron and iron dextran, for the prevention of anaemia in suckling piglets

Iron-deficiency anaemia (IDA) is a serious health problem in neonatal piglets and is controlled by routine application of iron in various formulations. The efficacy and safety of two iron-containing products...

Clinical, functional and molecular characteristics of anemia with comorbid chronic obstructive pulmonary disease

The aim was to investigate an impact of different COPD phenotypes on clinical course of anemic syndrome. Methods. This was a single-center prospective observational cohort study. Patients with stable COPD and anemia were involved (n = 215). COPD was diagnosed according to GOLD criteria and anemia was diagnosed according to WHO criteria. The control group included 90 healthy subjects. COPD patients with anemia were stratified according to pathogenic variants of anemia and serum erythropoietin level. COPD symptoms, exacerbations, lung function, pulmonary hemodynamics, the type of airway inflammation, hematology parameters, serum erythropoietin, hepcidin 25, vitamin B12, folate, and iron homeostasis were assessed. Statistical analysis was performed using SPSS 24 software. The groups were compared using chi square test for nominal variables and Kruskal-Wallis test for continuous variables. Logistic regression was used to explore the relationships between variables. Results. Anemia was diagnosed in 63 (29.3%) of patients including common pathogenetic variants of anemia in 12 (19.0 %) of patients: iron deficiency 9 (14.3%) and vitamin B12 deficiency 3 (4.8%). This anemia variants were associated with shorter duration of respiratory symptoms and was not related to COPD phenotype. The clinical course of anemia was modified due to comorbid COPD in 51 (81.0%) of patients. Anemia with normal / high erythropoietin level was found in 31 (49.2%) of COPD patients and was hypochromic, microcytic and hyperregeneratory. Those patients had low serum levels of iron, vitamin B12, and folate, low total and latent iron-binding capacity of serum, and high levels of ferritin and hepcidine. This type of anemia was associated with frequent COPD exacerbations. Anemia with low erythropoietin level 20 (31.7%) was normochromic, normocytic, and normoregeneratory, with normal serum iron and ferritin levels, low iron-binding capacity of serum, and low hepcidine level. This type of anemia was associated with combined pulmonary fibrosis and emphysema and with pulmonary hypertension. Conclusion. Anemic syndrome in COPD patients is associated with COPD phenotype.

Total iron-binding capacity is a novel prognostic marker after curative gastrectomy for gastric cancer.

Patients with gastric cancer (GC) are affected by changes in iron status. Before surgery, GC patients are likely to have iron-deficiency anemia; and after gastrectomy, patients suffer from low nutritional status and low iron. This study investigated preoperative iron status associated with prognosis after curative gastrectomy for gastric cancer. We evaluated preoperative serum hemoglobin (Hgb), Fe and total iron-binding capacity (TIBC) in 298 patients who underwent curative gastrectomy for GC without preoperative chemotherapy, and analyzed these factors' associations with prognosis after surgery. Of the 298 patients, 129 (43.2%) had low Hgb levels, and 33 (11.1%) had low TIBC (< 260µg/dl) that was not associated with Hgb or Fe level. Patients with low TIBC were significantly associated with older age (≥ 65years old; P = 0.0085), low albumin (< 3.9g/dl; P = 0.0388) and high CRP (≥ 0.15mg/dl; P = 0.0018) in multivariate analysis. Low Fe (< 60µg/dl) was not associated with disease-free survival (DFS) or overall survival (OS); however, low Fe was associated with longer cancer-specific survival in Stage III GC patients (P = 0.0333). Both low Hgb and low TIBC were significantly associated with shorter DFS (Hgb: P = 0.0433; TIBC: P < 0.0001) and shorter OS (Hgb: P = 0.0352; TIBC: P < 0.0001). Low TIBC were significantly associated with shorter DFS (HR 2.167, 95% CI 1.231-3.639, P = 0.0086) and shorter OS (HR 2.065, 95% CI 1.144-3.570, P = 0.0173) in multivariate Cox hazard regression analysis. Preoperative serum TIBC level of GC patients who undergo curative gastrectomy is a novel prognostic marker in univariate and multivariate analyses.