Mean Serum Ferritin Concentration Research Articles

The iron status of rural Nigerian women in the second and third trimesters of pregnancy: implications for the iron endowment and subsequent dietary iron needs of their babies.

The aim of the study was to determine the iron status of rural-dwelling pregnant Nigerian women in the second and third trimesters, and to predict their risk of giving birth to babies with suboptimal iron endowment. This was a prospective cohort study conducted between April and August 2021. A total of 174 consecutive and consenting pregnant rural dwellers, who met the inclusion criteria, were recruited by convenience sampling from the antenatal clinic of a public hospital in Nsukka, a semirural town in south-east Nigeria. The study participants were aged 21-40 years, and their iron status was determined by measuring blood haemoglobin (Hb) and serum ferritin (SF) concentration. Hb concentration was determined by the cyanmethemoglobin method and the SF concentration was determined by enzyme immunoassay method. Almost half (47.7%) of the participants had Hb concentrations below 11 g/dL, while about two out of every five (40.8%) had SF concentrations less than 15 µg/L. The prevalence of iron deficiency, iron deficiency anaemia (IDA) and non-iron deficiency anaemia were 40.8%, 23.6% and 24.7%, respectively. The mean SF levels varied with maternal age, gestation stage, pregnancy intervals and the intake of iron supplements. The mean SF concentration was higher in the second trimester than in the third. The mean SF concentration ± standard deviation (37.10±3.02 µg/L) was higher in the group that took iron supplements than in the group that did not (20.76±2.11 µg/L). However, two out of five participants in both groups had SF concentrations less than 15.0 µg/L. The prevalence of IDA was quite high among the participants in both trimesters even with the widespread intake of the recommended oral iron supplements. About four out of 10 of the participants had SF concentrations of less than 15 µg/L and were thus judged at risk of giving birth to babies with poor iron deposits. Therefore, more effective strategies are needed to monitor and prevent IDA among pregnant women in rural populations of Nigeria and, by inference, other parts of tropical Africa.

RESULTS OF IRON SUPPLEMENTATION FOR REGULAR VOLUNTARY NON-REMUNERATED BLOOD DONORS AT NATIONAL INSTITUTE OF HEMATOLOGY AND BLOOD TRANSFUSION

Objective: To evaluate the results of iron supplementation for RRVBD at the National Institute of Hematology and Blood Transfusion (NIHBT). Subjects and methods: Including 279 RRVBD with serum ferritin below 26 ng/ml taking iron tablets containing 35 mg of elemental iron. Methods: Cross-sectional description, prospective study. Results: The average age of RRVBD taking iron tablets is 27.8 years old, the average number of blood donations is 11 times, the average time of re-testing is 169.5 days. The proportion of RRVBD taking iron tablets and testing on time is 43.4%, the proportion of RRVBD not taking iron tablets or not taking enough iron tablets is 18.3%, the proportion of RRVBD taking enough iron tablets and not coming to the test on time is 18.6%. The proportion of RRVBD dropping out of the study is 19.7%. Hematological parameters (red blood cell count, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean serum iron concentration) of RRVBD taking iron tablets are within the normal range, the serum ferritin concentration of RRVBD recovered after taking iron tablets is: in the group of blood donors taking enough iron tablets and testing on time, the mean serum ferritin concentration before taking iron tablets is 15.8 ± 5.5 ng/ml and after taking iron tablets is 24.7 ± 14.9 ng/ml, the proportion of blood donors with ferritin returning to normal range after taking iron tablets is 39.7%. In group of blood donors not taking iron tablets or not taking enough iron tablets, serum ferritin before iron intake is 18.1 ± 5.3 ng/ml and after iron intake is 14.2 ± 10.9 ng/ml, the proportion of blood donors having serum ferritin returning to normal range after iron intake is 7.8%. In group of RRVBD taking enough iron tablets and not coming to the test on time, the mean serum ferritin concentration before iron intake is 16.5 ± 5.9 ng/ml and after iron intake is 28.8 ± 17.1 ng/ml, the proportion of blood donors with serum ferritin concentration returning to normal range after blood donation is 51.9%. Conclusion: The proportion of regularly repeated voluntary blood donors taking enough iron tablets and testing on time is 43.4%, the proportion of regularly repeated voluntary blood donors not taking iron tablets or not taking enough iron tablets is 18.3%, the proportion of regularly repeated voluntary blood donors taking enough iron tablets and not coming to the test on time is 18.6%, the proportion of regularly repeated voluntary blood donors not taking iron tablets and not testing is 19.7%. Hematological parameters (red blood cell count, Hb, MCV, MCH and mean serum iron concentration) of regularly repeated voluntary blood donors taking iron tablets before and after iron intake are within the normal range. The proportion of blood donors with serum ferritin concentration after iron intake returning to the normal range: blood donors taking enough iron tablets and testing on time is 39.7%, blood donors not taking iron tablets or not taking enough iron tablets is 7.8% and blood donors taking enough iron tablets and not coming to the test on time is 51.9%.

To survey on the components of metabolic syndrome and determine the serum ferritin levels in patients with metabolic syndrome

Background: Metabolic syndrome is one of the most common public health concerns in the 21st century. Several studies in the world have shown a link between elevated serum ferritin and metabolic syndrome as well as the risk of metabolic syndrome, the study provides a number of conclusions argues that ferritin may be considered as an early predictor of metabolic syndrome. For that reason, we conducted this study with the objective: “To survey on the components of metabolic syndrome and determine the serum ferritin levels in patients with metabolic syndrome”. Methods: A descriptive, cross-sectional study on 207 patients who were treated at the General Internal Medicine-Geriatric Department, Hue Central Hospital from 5/2016 to 8/2017. Patients were divided into two groups: study group (104 patients with metabolic syndrome) and control group (103 patients without metabolic syndrome and no serum ferritin-mediated disease). The metabolic syndrome was diagnosed by joint interim statement of the International Diabetes Federation/American Heart Association/ National Heart, Lung, and Blood Institute/ World Heart Federation/ International Atherosclerosis Society/ International Association for the Study of Obesity 2009. Results: The most common combination of metabolic syndrome components was: hypertriglyceridemia - hypertension - hyperglycemia (15.1%). In the metabolic syndrome group, mean serum ferritin concentration was 391.62±181.97ng/ml (Increased ferritin concentration accounted for 86.54%). In men, mean serum ferritin concentration was 453.064 ± 161.75ng/ml (Increased ferritin concentration accounted for 96.15%). In women, mean serum ferritin concentration was 330.17 ± 181.71 ng/ml (Increased ferritin concentration accounted for 86.54%). Conclusion: In the group of patients with metabolic syndrome, the serum ferritin levels increases and the rate of Increased ferritin concentration was high.

Serum Iron Profile in Type 2 Diabetes Mellitus

Background: Type 2 diabetes Mellitus is a major growing health issue worldwide. There is a strong relation between iron parameters and type 2 diabetes mellitus. Iron metabolism can directly or indirectly affect the occurrence and development of type 2 diabetes. Objectives: To observe serum levels in Type 2 Diabetes Mellitus patients. Methods: This cross sectional study was conducted from to in the Department of Physiology, Rangpur Medical College, Rangpur. For this study, total number of 150 subjects were selected among them 75 non-diabetic healthy subjects were included in group-A and 75 Type 2 Diabetes Mellitus patients were included in group-B. The subjects of group-A were selected from surrounding community of Rangpur district and subjects of Group-B were selected from Diabetic Association and from Outdoor of Endocrinology Department, Rangpur Medical College and Hospital, Rangpur. For statistical analysis independent sample “t”test was performed by computer based software SPSS- 23.0 version for windows. Results: Mean serum free iron concentration in Group A and Group B were 12.29±3.1 μmol/l and 15.24±6.8 respectively. Mean TIBC in Group A and Group B were 68.06±7.3 μmol/l and 56.89 ± 8.6 respectively. Mean serum ferritin concentration were 131±12.90 mg/ml and 170.50±15.1 respectively. The difference between serum iron, TIBC and ferritin between Group A and Group B were highly significant ( p _ 001 ). Conclusion: The results obtained from this study suggests that serum iron and serum ferritin were increased and TIBC was decreased in T2DM patients as compared to healthy control. J Rang Med Col. September 2023; Vol. 8, No. 2: 40-43

Comparison of Total Iron Binding Capacities between Type 2 Diabetes Mellitus Patients and Healthy Individuals

Background: Worldwide, diabetes mellitus (DM) is a leading cause of death and disability. Iron overload is increasingly being connected to insulin resistance in patients with type 2 diabetes mellitus (T2DM). Free iron causes the assembly of reactive oxygen species that invariably steer the body’s homeostasis toward oxidative stress-mediated diabetic complications. We have very limited research-based data regarding the total iron binding capacities in type 2 diabetes mellitus patients. Aim of the study: The aim of the study was to compare the total iron binding capacities (TIBC) between type 2 diabetes mellitus patients and healthy individuals. Methods: This cross-sectional study was conducted in the Department of Biochemistry, Dhaka Medical College (DMC), Dhaka, Bangladesh from July 2015 to June 2016. In total 100 participants were enrolled in 2 groups as the study subjects. In group A, in total 50 diagnosed patients with type 2 diabetes mellitus (T2DM) were included. On the other hand, in group B, 50 age and sex-matched healthy individuals were included. Properly written consent was taken from all the participants before data collection. All the demographic and clinical information of the participants was recorded. All data were processed, analyzed and disseminated by using MS Excel and SPSS version 23.0 program as per necessity. Results: In this study, the mean serum iron in group A and group B were 112.7 μg/dl and 87.6 μg/dl respectively. The mean serum ferritin concentration in group A and group B were 199.3 μg/dl and 107.0 μg/dl respectively. There was a statistically significant increase in serum iron and serum ferritin concentrations in group A compared to group B. Both serum ferritin and serum iron levels showed strong positive correlations with HbA1C ((r=0.724, p<0.001, r=0.724, p<0.001) and FPG (r=0.724, p<0.001, r= 0.724, p<0.001). The mean TIBC level was found 184 μg/dl in group A and 318.8 μg/dl in group B. In analyzing the total iron binding capacities (TIBC) between the groups we observe that the TIBC (µg/dl) levels in group A and group B were 184.0±79.5 and 318.8 ± 14.0 µg/dl respectively. The TIBC levels were significantly lower in group A than in group B (<0.001). Conclusion: The total iron binding capacity level is significantly lower in type 2 diabetes mellitus (T2DM) patients than that in healthy individuals. Routine screening for iron status along with glycemic control in diabetic patients might help prevent complications in such patients.

The comparison of effects of iron supplementation since pre-pregnant and during pregnant period on reducing iron deficiency anemia in pregnant women with mild anemia in Bali

Introduction: Iron deficiency anemia (IDA) is still a problem of pregnant women's health related to its high prevalence and its negative effects on health. Prevention efforts have been carried out through administration of oral iron tablets to women during their pregnancy; however, the expected results have not been satisfied yet. This failure is probably due to the assumption that, especially in developing countries, the iron store in pre-pregnant women is very low or may be empty, so that iron supplementation during pregnancy is not enough to prevent IDA. The aim of study is to know the difference of effect of iron supplementation in treated and control groups in terms of hemoglobin concentration, serum ferritin level and prevalence of IDA. Method: A quasi-experimental study was conducted on 99 non-pregnant new couple women. Iron tablets were administered to the treated group from the beginning of pre-pregnant period, continuing until the first 3 months of pregnancy, while in the control group iron tablets were only given during the first 3 months of pregnancy. IDA was measured by serum ferritin and hemoglobin concentration using WHO’s criteria, the benefit of iron tablet was measured by BCR technique. Result: The administration of an oral iron tablet from the prepregnant period (treated group) could decrease prevalence of IDA higher than the administration of oral iron tablet during pregnancy only (control group) (0% vs 38.46%, p<0.05). A significant difference was also observed on mean serum ferritin concentration at the end of observation (the third month of pregnancy) 33.45±14.12 µg/dL in the treated group, and 19.65±8.99 µg/dL in the control group. This difference was statistically significant (p<0.05). Meanwhile, the hemoglobin concentration was 12.25±1.20 g/dL in the treated group and 10.91±0.67 g/dL in the control group. This difference was also statistically significant (p<0.05). Benefit analysis showed that administration of an oral iron tablet starting from pre-pregnancy is more advantageous (BCR >1) compared to oral administration of iron tablet during the pregnancy period only. There were no significant differences in side effects and compliance of the patient to consume iron pills in both treated and control groups. Conclusion: The administration of oral iron tablets (iron supplementation) to pregnant women starting from pre-pregnant period results in a better effect compared to oral iron supplementation during pregnancy only. This program is feasible to be implemented in a community setting because its compliance is good.

S272: SAFETY AND PRELIMINARY PHARMACODYNAMIC EFFECTS OF THE FERROPORTIN INHIBITOR VAMIFEPORT (VIT-2763) IN PATIENTS WITH NON-TRANSFUSION-DEPENDENT BETA THALASSEMIA (NTDT): RESULTS FROM A PHASE 2A STUDY

Background: NTDT is characterized by an imbalanced α/β-globin chain ratio, ineffective erythropoiesis, increased intestinal iron absorption and iron overload. Vamifeport inhibits ferroportin-mediated iron export into plasma and has been shown to decrease serum iron and transferrin saturation (TSAT) levels in relevant animal disease models and healthy volunteers. Aims: The primary objective of this multicenter, Phase 2a, double-blind, randomized, placebo-controlled study (NCT04364269) was to assess the safety and tolerability of vamifeport (given once [QD] or twice [BID] daily) versus placebo in patients with NTDT over a 12-week treatment period. A secondary objective was to assess preliminary efficacy of vamifeport versus placebo with respect to pharmacodynamic effects on iron parameters (serum iron, ferritin, hepcidin and TSAT) in these patients. Methods: Adults (18–65 years) with documented NTDT (including β-thalassemia intermedia) who provided informed consent, were included. NTDT was defined as receipt of <5 units of red blood cells during the 24 weeks prior to randomization. Patients also required a mean baseline hemoglobin of ≤11 g/dL on two consecutive measurements ≥1 week apart within 6 weeks prior to randomization. Use of iron chelation therapy (ICT) within 4 weeks prior to randomization was not permitted; patients with TSAT <30%, serum ferritin <150 ng/mL and/or liver iron content ≤1 mg/g (<300 ng/mL/3 mg/g, respectively, for those recently on ICT) were also excluded. Patients received vamifeport at a dose of 60 mg if their body weight was 40–59 kg or 120 mg if their weight was 60–100 kg. Results: Twenty-five patients were included (vamifeport QD n=9, BID n=12, placebo n=4; median age 42.0, 31.0 and 40.5 [range 18–61] years, respectively). Overall, 64% were male, 56% had a body weight <60 kg and 16% had received prior ICT. At baseline, mean (standard deviation [SD]) serum iron concentrations were 27.2 (11.6) µmol/L and mean TSAT was 76.2 (27.6)% for the population as a whole. Mean (SD) serum ferritin concentrations were 746.7 (1431.7) µg/L. There were no differences between groups in treatment-emergent adverse event (TEAE) rates (vamifeport QD 66%, BID 58%; placebo 75%). All TEAEs were mild or moderate intensity, and each was reported only once. There were no deaths or serious AEs (1 patient receiving vamifeport QD had an acute hemolytic event); one TEAE (increased creatine kinase and transaminase levels, not drug-related) led to drug discontinuation in the vamifeport BID group. There were also no clinically relevant changes in any assessed safety parameter. Serum iron concentrations decreased 3 h after first vamifeport dose (Day 1) in all vamifeport-treated patients (mean [SD] decrease: QD -11.3 [7.2] µmol/L; BID -17.0 [9.6] µmol/L) and were maintained below baseline levels at 3–4 h post vamifeport administration at each visit throughout the remaining treatment period. Mean (SD) TSAT also decreased at Day 1 (3 h post dose; QD -32.6 [19.6]%; BID -46.8 [22.6]%) and were below baseline levels 3–4 h post-dose at each subsequent visit in the vamifeport groups (Figure). There were no clinically meaningful changes from baseline in serum iron or TSAT levels in the placebo group, or in ferritin or hepcidin levels in any treatment group. Image:Summary/Conclusion: In this 12-week Phase 2a study, vamifeport had a favorable safety and tolerability profile and showed promising target engagement and pharmacodynamic effects on serum iron and TSAT levels versus placebo in adults with NTDT.

Pattern of iron profile in type 2 diabetes mellitus patients: experience from outpatient department of Bangladesh Diabetic Network

Background: Worldwide diabetes mellitus (DM) has been recognized as the most prevalent endocrine disorder. Excess iron has been implicated in the pathogenesis of diabetes and its complications. Iron is a transitional metal and a potential catalyst in cellular reaction that produces reactive oxygen species. Free iron causes the assembly of reactive oxygen species that invariably steer the body’s homeostasis towards oxidative stress-mediated diabetic complications. On the other hand, ferritin is an index of body iron stores and acts as an iron overload marker. Elevated iron indices are more common in patients with diabetes. Excess iron may have a role in the development of diabetes and subsequently in glycemic control. In this context, this study was aimed to assess the pattern of plasma iron profile in type 2 DM patients and compare with healthy controls.&#x0D; Methods: This cross-sectional study included 284 subjects attending the outpatient department of Endocrinology of Bangladesh Diabetic Network Ltd. (BDN) from January 2021 to June 2021. This study was done to evaluate the serum iron, total iron binding capacity (TIBC) and ferritin of 284 subjects divided into two groups (I and II) of 182 Type 2 DM patients constituted Group I and Group II consisted of 182 healthy individuals (controls).&#x0D; Results: Mean serum free iron concentration in Group I and Group II were 14.24± 6.7 and 11.29±4.1 ìmol/ l respectively. Mean TIBC in Group I and Group II were 54.19 ±9.8 and 64.08±7.5 ìmol/l respectively. However, mean serum ferritin concentration were 169.50±15.1and 121.29±11.9 mg/ml respectively. The difference between serum iron, TIBC and ferritin between Group I and Group II were highly significant with the p values 0.003, 0.016 and 0.042 respectively. In Group I, glycated hemoglobin (HbA1c) and fasting blood glucose levels both increased. However In this investigation, HbA1c levels were found to have a substantial relationship with serum iron levels and TIBC. However, there was no significant link between serum ferritin and HbA1c.&#x0D; Conclusion: The results obtained from this study suggests that serum iron and serum ferritin were increased and TIBC was decreased in T2DM patients as compared to healthy control. In patients with T2DM, there was a potentiated disparity in the readings. The findings suggest that these micronutrient levels can be employed as biomarkers for T2DM patients.&#x0D; BIRDEM Med J 2022; 12(2): 124-128

A Cross-Sectional Study of Serum Ferritin Levels in Vietnamese Adults with Metabolic Syndrome.

BackgroundMetabolic syndrome is one of the most common public health concerns in the 21st century. Several previous studies have shown an association between increased serum ferritin levels and other components of metabolic syndrome and the risk of metabolic syndrome. They conclude that ferritin can be viewed as a predictor of metabolic syndrome risk. This study investigates some main features of metabolic syndrome and the serum ferritin levels in a Vietnamese adult cohort with metabolic syndrome.MethodsA descriptive cross-sectional study was conducted on 207 patients who were treated at the General Internal Medicine-Geriatric Department, Hue Central Hospital, from May 2018 to August 2020. Patients were divided into two groups: the study group (104 patients with metabolic syndrome) and the control group (103 patients without metabolic syndrome and no serum ferritin-mediated disease). The metabolic syndrome was diagnosed by a joint interim statement of the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute/World Heart Federation/International Atherosclerosis Society/International Association for the Study of Obesity in 2009.ResultsHypertriglyceridemia–hypertension–hyperglycemia (50.9%) is the most common combination of metabolic syndrome components. The mean serum ferritin concentration was 391.62±181.97ng/mL and 124.55±63.95ng/mL in the metabolic syndrome and control groups, respectively. In the metabolic syndrome group, increased ferritin concentration accounted for 86.54% for men, the mean serum ferritin concentration was 453.064 ± 161.75ng/mL (increased ferritin concentration accounted for 96.15%) for women; the mean serum ferritin concentration was 330.17 ± 181.71 ng/mL (increased ferritin concentration accounted for 86.54%).ConclusionThe serum ferritin level is significantly increased in Vietnamese patients with metabolic syndrome.

Ceruloplasmin and Alpha-1-Acid Glycoprotein, but not C-Reactive Protein, Correlate With Serum Ferritin During Various Postpartum/Lactation Periods in Congolese Females.

Background: Serum ferritin usually correlates positively with acute phase proteins (APPs), but limited information is available on this association during various postpartum/lactation periods. The objective of this study was to assess the association between serum ferritin and APPs in Congolese females during different postpartum/lactation periods.Methods: Serum ferritin, C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), ceruloplasmin (Cp), and transferrin saturation (TS) were measured during various postpartum/lactation periods (0.5 to 6, 6.1 to 12, 12.1 to 18, and 18.1 to 24 months) in 131 Congolese females aged 15 to 45 years.Results: Mean serum ferritin concentrations were lower in females in the 0.5- to 6-month postpartum/lactation subgroup than in the other 3 subgroups (P<0.05). Mean concentrations of hemoglobin, APPs, and TS were not different among the 4 subgroups. While serum ferritin concentrations correlated with Cp (r=0.514) and AGP (r=0.795) during the 0.5- to 6-month and the 6.1- to 12-month postpartum/lactation periods, respectively (P<0.05), they did not correlate with CRP. Multiple regression analysis suggested that Cp explained 25% of serum ferritin variance in the 0.5- to 6-month postpartum/lactation period (39.3% at 0.5 to 4 months) and AGP explained 60.5% of the variance in the 6.1- to 12-month period (3.7% at 0.5 to 4 months). CRP explained <5% of the serum ferritin variance at these postpartum/lactation periods. APPs explained ≤15.1% of serum ferritin variance at postpartum/lactation periods >12 months.Conclusion: Data suggest that the association between serum ferritin and inflammation is dependent on APP type and lactation time. This association may affect the diagnosis of iron deficiency in lactating females. The positive association between serum ferritin and Cp at 0.5 to 6 months postpartum may be necessary to increase liver iron release and erythropoiesis after childbirth.

Single Dose of Intravenous Ferric Carboxymaltose Prevents Anemia for 6 Months among Moderately or Severely Anemic Postpartum Women: A Case Study from India.

ABSTRACTThe effectiveness of intravenous ferric carboxymaltose (FCM) in quickly increasing normal hemoglobin concentration and replenishing body iron reserves up to 6–12 wk is known; however, its long-term effectiveness is unknown. In this study conducted in northern India during August 2018 to February 2019, 100 postpartum women within 48 h of delivery with a hemoglobin concentration between 5.0 and 9.9 g/dL were included. A single dose of intravenous FCM was administered. The hemoglobin and serum ferritin concentrations were measured at baseline and at 6 mo. Out of 100 women recruited, 57 (57%) returned for the follow-up visit at 6 mo. The mean (± SD) hemoglobin and serum ferritin concentrations at baseline were 8.6 ± 1.1 g/dL and 15.8 ± 17.2 ng/mL, respectively, and at 6 months were 12.5 ± 1.2 g/dL and 72.0 ± 52.0 ng/mL, respectively. The mean increase in hemoglobin concentration was 3.9 (95% CI: 3.5, 4.3) g/dL (P < 0.001) and for serum ferritin was 53.8 (95% CI: 41.8, 65.8) ng/mL (P < 0.001).The study was registered prospectively in the Clinical Trials Registry–India (CTRI) as CTRI/2018/06/014332.

Clinical characteristics of endocrinopathies in Chinese patients with hereditary haemochromatosis.

Hereditary haemochromatosis (HH) is a genetic disorder characterised by systemic iron overload and can lead to end-organ failure. However, very few data on this disorder, especially those on endocrine gland involvement in Chinese populations, are currently available. This study aimed to analyse the clinical features of endocrinopathies in patients with HH to generate concern among endocrinologists and improve the management of this disorder. Chinese patients with HH-related endocrine dysfunction were enrolled at Peking Union Medical College Hospital from January 2010 to December 2018. All clinical data were analysed and summarised. A total of six patients were enrolled in this study, comprising five men and one woman; the average age was 36.5±13.3 years. Mean serum ferritin concentration was 4508.8±1074.3ng/ml, and median transferrin saturation was 97.9% (96.6%-110.0%). Endocrine gland involvement associated with HH included the pancreas (5/6 patients), the adenohypophysis (5/6 patients) and the bones (1/6 patients); secondary endocrinopathies consisted of diabetes mellitus, hypogonadism, adrenal insufficiency and osteoporosis. Based on phlebotomy and iron chelation therapy, five patients were treated with exogenous insulin preparations, and three patients were treated with exogenous sex hormone replacement therapy. The clinical symptoms of five patients improved, although one patient died of hepatic encephalopathy and multiple organ failure. HH can cause multiple endocrinopathies. The possibility of HH should be carefully considered in patients with endocrine gland dysfunctions and concomitant elevated serum ferritin levels. Endocrine gland function should also be assessed and followed up in patients with a clear diagnosis of HH.

Assessment of Bone Density by DXA in Poorly Controlled Children With β-Thalassemia: Correction for Hepatic Iron Overload by Manual Analysis

Introduction: Beta thalassemia major (BTM) is characterized by anemia and iron overload, especially with inadequate chelation therapy. Dual energy x-ray absorptiometry software (DXA) may misanalyse bone measurements due to iron deposition in organs such as the liver. Our objective was to study difference between the posterior-anterior spine measurements of bone mineral content (BMC), area (BA) and density (BMD) in poorly chelated beta thalassemia patients with and without inclusion of the liver in the DXA analysis. Methods: We studied hemoglobin and serum ferritin concentrations in 208 patients with BTM (children n = 177, young adults n = 31). Posteroanterior spine measurements BMC, BA and areal BMD were performed using a GE iDXA. Using the tissue point typing feature (EnCore software, version 16), analysis was carried out including and excluding (manually) the iron overloaded liver. Machine generated Z-scores of L1-L4 BMD were used for analysis. Results: The mean age of the study group was 12.9 ± 5.4 yr. Mean hemoglobin and serum ferritin concentrations were 8.0 ± 1.7 g/dl and 2256.9 ± 1978.0 ng/ml, respectively. The mean BMC, BA, and aBMD at the lumbar spine were 23.2 ± 11.4 g, 29.9 ± 8.5 cm2 and 0.736 ± 0.173 g/cm2 respectively with inclusion of liver that is standard machine analysis. After the liver was excluded from the analysis, the mean BMC, BA, and aBMD were 23.9 ± 11.6 g, 30.0 ± 8.6 cm2 and 0.757 ±0.173 g/cm2, respectively and the BMC and aBMD were significantly greater (p < 0.05). Mean BMD Z-score was −1.5 ± 1.2, which significantly (p < 0.05) improved to −1.3 ± 1.2 after exclusion of the liver from the analysis. Conclusion: In poorly chelated patients with thalassemia, inclusion of the iron-overloaded liver in the tissue analysis may exaggerate the deficit in bone parameters. Iron overloaded tissues need to be manually excluded during analysis of the PA spine.

Effect of Maternal Vitamin D Supplementation on Iron Status During Pregnancy

Abstract Objectives Vitamin D may have an adjunctive role in the prevention and treatment of iron deficiency (ID) through its proposed role in the regulation of erythropoiesis and circulating hepcidin concentrations. Observational studies have shown associations between low vitamin D and iron status; however, there are few data from intervention trials. In participants of the Maternal Vitamin D for Infant Growth Trial (MDIG; NCT01924013), among whom the baseline prevalence of vitamin D deficiency was 64%, we examined the effect of prenatal vitamin D supplementation on iron status during pregnancy by testing the effect of vitamin D supplementation on serum ferritin concentrations. Methods In this double-blind, dose-response, randomized trial in Dhaka, Bangladesh, women were recruited at 17–24 weeks’ gestation and randomly assigned to receive a prenatal vitamin D3 dose of 4200, 16,800, 28,000 IU/week or placebo. Serum ferritin was quantified using an electro-chemiluminescence immunoassay. Plasma C-reactive protein (CRP) was analysed by enzyme-linked immunoassay. Linear regression was used to test the hypothesized effect of vitamin D supplementation on serum ferritin (n = 1011 of 1300 enrolled). In a sensitivity analysis, we adjusted for concurrent CRP to correct for inflammation (n = 920). Regression correction was used to generate an inflammation-corrected estimate of the prevalence of ID (n = 920). Results Prevalence of ID (serum ferritin &amp;lt;15 µg/L) was high overall (27% corrected for inflammation; 12% uncorrected). Geometric mean (95% confidence interval) serum ferritin concentrations were lower in each of the vitamin D supplementation groups [43.1 (38.1, 48.7), 44.8 (40.4, 49.7) and 45.1 (41.5, 49.1) µg/L in the 4200, 16,800 and 28,000 IU/week groups, respectively] compared to the placebo group [50.3 µg/L (45.0, 56.2)], although none of the pairwise differences between each vitamin D group and placebo were statistically significant at the P &amp;lt; 0.05 threshold. Adjusting for CRP did not change the inferences. Conclusions In a population with concurrently high prevalence rates of iron and vitamin D deficiency, prenatal vitamin D supplementation did not lead to improvements in iron status by late gestation. The possibility of a negative effect of vitamin D supplementation on iron status should be further explored. Funding Sources The Bill and Melinda Gates Foundation.

Pharmacokinetic, Pharmacodynamic, and Safety Profiles of Ferric Carboxymaltose in Chinese Patients with Iron-deficiency Anemia

PurposeIron deficiency (ID) is one of the most commonly known nutritional deficiencies and is considered the primary cause of anemia (iron-deficiency anemia). Ferric carboxymaltose (FCM), an intravenous iron preparation, has been widely used for >10 years for iron-deficiency anemia treatment worldwide because of its many advantages. MethodsThis single-center, open-label, single dose escalation study in Chinese subjects was designed to assess the pharmacokinetic/pharmacodynamic parameters and safety of FCM in this population. The first 12 subjects received a 500-mg dose; after assessing safety data from the first 6 subjects in this cohort, another 12 subjects were assigned to the 1000-mg dose cohort. FindingsAfter an infusion of FCM over 15 min, a rapid dose-dependent increase in total serum iron levels was observed with a median Tmax of 30 min following the start of the infusion for both cohorts. The Cmax and AUC for the 1000-mg dose were ~1.8-fold (p = 0.2929) and 2.3-fold (p = 0.0318) those associated with the 500-mg dose, respectively. Mean terminal t1/2 values were 12.3 and 10.5 h for the 2 cohorts. The renal elimination of FCM was negligible (<0.1%). Increase in mean serum iron levels and ferritin concentrations showed dose dependency. Iron-binding capacity was transiently well utilized after dosing, as indicated by transferrin saturation >88% with 500-mg FCM and >90% with 1000-mg FCM. Hemoglobin levels did not show significant changes during the 7-day observation period, whereas mean reticulocyte counts significantly increased in both cohorts, suggesting activation of the hematopoietic system. FCM was well tolerated in these Chinese subjects. No new or unexpected treatment-emergent adverse events were attributable to FCM. ImplicationsThe pharmacokinetic/pharmacodynamic and safety profiles in Chinese subjects seemed comparable to those in white and Japanese populations. ChinaDrugTrials.org.cn identifier: CTR20160863

Quantitative ultrasound elastography and serum ferritin level in dogs with liver tumors.

Objective:The objective of this study was to assess the serum ferritin level and quantitate ultrasound elastography as a marker to distinguish dogs with benign and malignant liver tumors.Materials and Methods:Twenty-eight dogs were determined the serum ferritin and ultrasound elastography by using fine-needle aspiration biopsy.Results:Our results demonstrated that dogs with malignant liver tumors had significantly higher mean serum ferritin concentrations than those with benign liver tumors (p = 0.004). The mean intensity of blue and red colors from elastography was greater in the malignant than those in the benign group, especially for the blue color, meaning that lesions showed more hard tissue. Additionally, histograms of blue color in the malignant tended to be higher than the benign group.Conclusion:We suggested that quantitative ultrasound elastography and serum ferritin concentration comprise an alternative and non-invasive diagnostic method that could be used to predict the type of liver tumors in dogs.

The Effect of Chronic Viral Hepatitis on Serum Ferritin Level in Thalassemia Patients

Background: Serum ferritin is widely used as a marker of iron overload in thalassemia patients. However, the ferritin level is affected by active infections or inflammation. The association between viral hepatitis and serum ferritin level in thalassemia patients is still unclear. This study aimed to determine the effect of chronic viral hepatitis on serum ferritin level in thalassemia patients. Methods: This was a cross-sectional study in thalassemia patients aged ≥15 years-old at Chiang Mai University hospital. We expected that thalassemic patients in our clinic have a mean serum ferritin of 767 ng/mL with a standard deviation of 210 ng/mL. As a result, we have to enroll a total of 28 patients to demonstrate 30% difference of mean serum ferritin when the power was set at 80% with alpha level of 0.05. Information on chronic viral hepatitis, mean serum ferritin and liver iron concentration (LIC) as measured by T2* MRI were collected. Chronic viral hepatitis status was confirmed by either HBV DNA or HCV RNA testing. Patients were categorized to hepatitis and non-hepatitis group. Serum ferritin levels were compared between two groups. LIC measurement was used as a gold standard for iron overload. Subgroup analysis was performed according to iron overload and transfusion requirement status. Categorical and continuous variables were compared using the Chi-squared test and T-test, respectively. The correlation between viral loads and mean serum ferritin levels was analyzed by Pearson's correlation. Result: Of 32 thalassemia patients (25 non-transfusion dependent [NTDT] and 7 transfusion dependents [TDT]), 13 patients had chronic viral hepatitis (7 with hepatitis B and 6 with hepatitis C infections). The LIC between hepatitis and non-hepatitis groups were not significantly different (7.28 [SD 4.7] vs 9.08 [SD 5.2] mg Fe/g, p=0.19). In the higher LIC group (≥ 5 mg Fe/g), the mean serum ferritin level was higher in the hepatitis group than non-hepatitis group (1,776 [SD 488] vs 967 [SD 860] ng/mL, p=0.03). For the lower LIC group (&lt;5 mg Fe/g), the mean ferritin levels were not significantly different between the hepatitis and non-hepatitis groups (646 [SD 224] vs 459 [SD 205] ng/mL, p=0.22). The correlation between the viral load and mean ferritin level in NTDT group showed a significant linear correlation with R=0.7 (p=0.04). Conclusions: We observe a higher serum ferritin level among thalassemia patients who concurrently have chronic viral hepatitis. Chronic viral hepatitis is a possible cause of a falsely high ferritin level in these patient population. Furthermore, the viral load is positively correlated with serum ferritin level. Disclosures No relevant conflicts of interest to declare.

Effect of routine iron-folic acid supplementation among rural pregnant women living in low- and high-groundwater-iron areas in Bangladesh.

The present study investigated the risks and benefits of routine Fe-folic acid (IFA) supplementation in pregnant women living in low- and high-groundwater-Fe areas in Bangladesh. A case-controlled prospective longitudinal study design was used to compare the effect of daily Fe (60mg) and folic acid (400 μg) supplementation for 3·5 months. A rural community in Bangladesh. Pregnant women living in low-groundwater-Fe areas (n 260) and high-groundwater-Fe areas (n 262). Mean Hb and serum ferritin concentrations at baseline were significantly higher in pregnant women in the high-groundwater-Fe areas. After supplementation, the mean change in Hb concentration in the women in the low-groundwater-Fe areas (0·10 g/dl) was higher than that in the pregnant women in the high-groundwater-Fe areas (-0·08 g/dl; P = 0·052). No significant changes in the prevalence of anaemia or Fe deficiency (ID) in either group were observed after IFA supplementation; however, the prevalence of Fe-deficiency anaemia (IDA) decreased significantly in the women in the low-groundwater-Fe areas. The risk of anaemia, ID and IDA after supplementation did not differ significantly between the groups. None of the participants had Fe overload. However, a significant proportion of the women in the high- and low-groundwater-Fe areas remained anaemic and Fe-deficient after supplementation. IFA supplementation significantly increased the Hb concentration in pregnant women living in the low-groundwater-Fe areas. Routine supplementation with 60 mg Fe and 400 μg folic acid does not pose any significant risk of haemoconcentration or Fe overload. Further research to identify other nutritional and non-nutritional contributors to anaemia is warranted to prevent and treat anaemia.

Assessment of Iron Status in a Sample of Infants Aged 6-12 Months in Jerash Governorate, Jordan

This study aimed at investigating the relationship between iron status and the type of milk and weaning solid foods in a group of infants aged 6 - 12 months in Sakeb Health Center in Jerash Governorate, Jordan. In this cross-sectional study, a sample of 119 infants (59 females, 60 males), were recruited , A special questionnaire was used to collect socioeconomic data for the infants’ families, and three- day food recall was also used to collect infants dietary intake data. Body weight, length and head circumference were measured, and z-score was calculated for evaluating the anthropometric status. Hemoglobin (Hb), mean cell volume (MCV) and serum ferritin concentrations (SF) were measured on nonfasting venipuncture blood samples. The studied sample was divided into three groups according to type of feeding: exclusively breastfed group (n=41), formula-fed group (n=49) and mixed-fed group (n=29).The results showed that among infants with Hb &lt;110 g/l, MCV&lt;70fl and SF &lt;12 µg/l, 10.1% had iron deficiency anemia (IDA). Anemia was found in 36.9% when hemoglobin cutoff was taken to be &lt;110 g/l, and depleted iron stores were found in 27.7% using a ferritin cutoff &lt;12 µg/l. Among the breastfed group, incidence of IDA, anemia and depleted iron stores were the highest compared to the other two groups. No significant differences for Hb, MCV, and SF values existed between males and females although female infants tended to have higher hemoglobin, MCV, and serum ferritin values than male infants.Mean intake of iron was the highest among infants of formula-fed group (7.82 mg/day), as compared with breastfed and mixed-fed groups (2.75 and 4.23 mg/day respectively).No significant differences were observed between infants in any of the anthropometric measurements. Based on z-score, 1.7% of infants in breastfed group and formula-fed group were stunted compared with 0.8% in the mixed-fed group, whereas 2.5% of infants were overweight in the formula-fed group.It could be concluded that iron deficiency is common in infants in Jerash Governorate, since up to 10% of the recruited infants developed IDA, 37% developed anemia, and 28% had depleted iron stores. Keywords: iron, iron deficiency, anemia, breastfeeding, formula feeding DOI : 10.7176/JHMN/59-05

INVESTIGATION OF FACTORS POTENTIALLY ASSOCIATED WITH SERUM FERRITIN CONCENTRATIONS IN THE BLACK RHINOCEROS ( DICEROS BICORNIS) USING A VALIDATED RHINOCEROS-SPECIFIC ASSAY.

Iron overload disorder (IOD) can lead to organ dysfunction and may exacerbate other diseases in the critically endangered black rhinoceros ( Diceros bicornis). It is important to develop methods for monitoring the progression of iron storage (hemosiderosis), diagnosing the disease, and evaluating treatments in this species. Traditionally, an equine enzyme immunoassay (EIA) was used to measure rhinoceros ferritin, a serum protein correlated to iron stores. The goal of this study was to validate a rhinoceros-specific assay and investigate factors potentially associated with ferritin concentrations in black rhinoceros. A ferritin EIA developed for Sumatran rhinoceros was validated for black rhinoceros via Western blot analysis of liver ferritin and confirmed parallelism of serum samples to the EIA standard curve and used to analyze serum samples ( n = 943) collected from 36 black rhinoceros (<1-33 yr) at 14 U.S. institutions. Mean (±SEM) serum ferritin concentration was 6,738 ± 518 ng/ml (range: 85-168,451 ng/ml). Concentrations differed among individuals with eastern black rhinoceros (7,444 ± 1,130 ng/ml) having a higher mean ferritin than southern black rhinoceros (6,317 ± 505 ng/ml; P < 0.05) and higher mean values in wild-born (11,110 ± 1,111 ng/ml) than captive-born individuals (3,487 ± 293 ng/ml; P < 0.05). Ferritin concentrations did not differ between young rhinoceros (<5 yr old; 2,163 ± 254 ng/ml) and adults (7,623 ± 610 ng/ml) and were not correlated with age ( r = 0.143) or time in captivity ( r = 0.146, wild born; r = 0.104, all animals). Ferritin concentration was not impacted by sex (female: 2,086 ± 190 ng/ml; male: 8,684 ± 717 ng/ml), date, month, or season of collection ( P > 0.05). Data indicate ferritin concentrations are variable and not necessarily associated with IOD; ferritin is not recommended for diagnosing or monitoring IOD in black rhinoceros.