Measuring Serum Ferritin Levels Research Articles

Association between Body Iron Status and Cognitive Task Performance in a Nationally Representative Sample of Older Adults.

Iron is an essential micronutrient that is necessary for proper cognitive function. However, the dose-response relationship between body iron status and cognitive function remains unclear. The objective of this study was to investigate the association between serum ferritin concentrations, an indicator of body iron status, and cognitive function in older adults. Based on the National Health and Nutrition Examination Survey (NHANES) 1999 -2002 in the United States, nationally representative data was collected from 2,567 adults aged 60 years and older who had objectively measured serum ferritin levels and cognitive performance. High ferritin levels were defined as a serum ferritin level >200 ng/mL in women and >300 ng/mL in men. Low ferritin levels were defined as a serum ferritin level <30 ng/mL. The digit symbol substitution test (DSST) was employed to assess cognitive function. Multivariable logistic regression analyses with survey weights were performed after the DSST was dichotomized at the median score. The weighted prevalence of adults with normal, low, and high serum ferritin levels were 73.98%, 9.12%, and 16.91%, respectively. A U-shaped association between serum ferritin concentrations and cognitive task performance was observed. After adjusting for demographic, socioeconomic, lifestyle, and C-reactive protein factors, the odds ratio (95% confidence intervals) for lower cognitive performance was 1.39 (1.11, 1.74) in adults with high ferritin levels and 1.38 (0.86, 2.22) in adults with low ferritin levels, compared with those with normal ferritin levels. The association between serum ferritin levels and lower cognitive performance was stronger in adults aged 60 to 69 years old than those aged 70 years and older. In conclusion, in a nationally representative sample of older adults in the United States, a high serum ferritin level was significantly associated with worse cognitive task performance. Thus, the relationship between low serum ferritin concentrations and cognitive task performance warrants further investigation.

Serum ferritin level is an effective prognostic factor for lung cancer immunotherapy

ABSTRACT Immunotherapy of lung cancer has achieved promising clinical results. However, it is urgent to develop predictive biomarkers for effective immunotherapy. While ferroptosis plays a critical role in immunotherapy efficacy, ferritin is an important regulatory factor. We, therefore, hypothesize that basal serum ferritin levels before immunotherapy and their corresponding changes during immunotherapy can be useful predictors of immunotherapy response in patients with lung cancer. We measured serum ferritin levels in 107 patients with lung cancer before and during immune checkpoint blockade treatments and studied the correlation between ferritin levels, response rate, and survival. Moreover, the correlation between basal ferritin and PD-L1 expression, tumor stages and pathological types was also analyzed. Patients with lower basal serum ferritin levels before immunotherapy had longer progression-free survival (PFS) (median 7 vs 4 months, P = .023) and higher disease control rate (DCR) (X2 = 4.837, P = .028), those with downregulated serum ferritin levels during immunotherapy correlated with longer PFS (median 9.5 vs 4 months, P < .001) and higher DCR (X2 = 6.475, P = .011). However, the “integrated factor”, which was calculated as the combination of lower basal serum ferritin levels before immunotherapy and downregulated serum ferritin levels during immunotherapy, correlated with prolonged PFS (P < .001). Multivariate analyses revealed that the basal serum ferritin levels before immunotherapy and the corresponding changes during immunotherapy were both strong independent prognostic factors (hazard ratio (HR) = 1.60, P = .041; HR = 2.65, P = .001). These findings suggest that serum ferritin levels can be used as a prognostic biomarker for lung cancer in predicting immunotherapy efficacy.

RISK OF GESTATIONAL DIABETES MELLITUS AND ITS ASSOCIATION WITH SERUM FERRITIN LEVELS

Background: The high prevalence of GDM in Indian women necessitates early detection. GDM problems can be avoided if screening and diagnosis are done early. Serum ferritin is utilized as an inammatory marker, and its levels are tested in early pregnancy to predict the likelihood of developing GDM, making it a tool for early detection of GDM. Aims And Objectives: To know the association between serum ferritin levels in rst trimester and risk of GDM. To measure Serum Ferritin levels in First trimester and to know the association between elevated serum ferritin levels and risk of GDM by measuring the Glucose levels. Methods: 100 women attending the antenatal clinic in 11-14 weeks of gestation were enrolled in the study. Data was collected from the study participants after explaining about the study to them and getting their informed consent. Venous blood samples were obtained from the patient between11 to 14 weeks' gestation to measure serum ferritin level . Serum Ferritin levels measured are grouped in quantiles. Results: In this study, of 100 pregnant women, 28 had serum ferritin values &lt;30ng/dl, 42 had 31-60 ng/ml., 15 had 61 -90 ng/ml and 15 women had serum ferritin above 90 ng/ml. This also implies that majority of the population studied randomly had low serum ferritin levels. 6 out of 15women with high BMI had increased serum ferritin levels. This shows a clear correlation between obesity and insulin resistance and serum ferritin levels on higher range,with risk of developing GDM. Conclusion: Hyperinsulinemia and insulin resistance association with serum ferritin levels had been highlightened by this observation. Possible mechanisms involving elevated serum ferritin levels and risk of GDM was excess iron stores hypothesis and inammation hypothesis

A Comparative Study for Measuring Serum Ferritin Levels with Three Different Laboratory Methods: Enzyme-Linked Immunosorbent Assay versus Cobas e411 and Cobas Integra 400 Methods.

Different laboratory methods are used to measure serum ferritin levels as a marker of iron status in the general population. This study aimed to compare serum ferritin levels using enzyme-linked immunosorbent assay (ELISA) versus immunochemiluminescence (Cobas e411) and immunoturbidimetric (Cobas Integra 400) methods in terms of sensitivity, specificity and accuracy, and whether they can be used interchangeably. A comparative cross-sectional study enrolled one hundred and six adult Yemeni patients (33 males and 73 females) aged 18–55 years, recruited from the dermatology and cosmetic center of Hadhramout Modern Hospital, Mukalla, Yemen. Serum ferritin levels were measured using ELISA, Cobas e411, and Cobas Integra 400 methods. For method comparison, a paired-sample t-test was used. For the consistency between the three methods, they were analyzed with regression and Pearson correlation coefficient. For determining accuracy, a receiver operating curve (ROC) was used. Bias error between the methods was determined through a Bland–Altman plot analysis. Our results did not show any significant statistical difference between ELISA and Cobas e411 (52.55 ± 7.4 µg/L vs. 52.58 ± 7.5 µg/L, p = 0.967), while there were significantly higher values from Cobas Integra 400 results than Cobas e411 (56.31 ± 7.8 µg/L vs. 52.58 ± 7.5 µg/L, p < 0.001) and ELISA (52.55 ± 7.4 µg/L vs. 56.31 ± 7.8 µg/L, p < 0.001). According to the correlation coefficient and linear regression analysis, a strong association between ELISA with Cobas e411 (r = 0.993, p < 0.001) and Cobas Integra 400 results (r = 0.994, p < 0.001) were revealed. For determining accuracy, Cobas e411 and Cobas Integra 400 results showed higher sensitivity (92.0%; 90.0%) and specificity (97.7%; 99.9%) respectively. Additionally, the Bland–Altman plot analysis showed a high agreement between the ELISA and Cobas e411 methods (bias: −0.035). In contrast, there was a low agreement between the ELISA and Cobas Integra 400 methods (bias: −3.75). Similarly, the agreement between Cobas e411 and Cobas Integra 400 methods was low (bias: −3.72). Serum ferritin levels were measured by Cobas e411, and Cobas Integra 400 methods were strongly correlated with the ELISA results, with higher sensitivity, specificity, and accuracy. However, further investigations with larger samples are required for improved accuracy and more precise results, and to determine whether they can be used interchangeably.

A study of association of serum ferritin as a prognostic marker in acute cerebrovascular accident

Cerebrovascular disease (CVD) is the third leading cause of death in developed countries and is now emerging as the commonest preventable life-threatening neurological problem worldwide. It makes an important contribution to morbidity and mortality in developed as well as developing countries. The prognosis of acute stroke is determined by a series of factors some of which may be used in the early stages of stroke to predict prognosis and mortality. However, the role of inflammatory markers in predicting functional outcome in stroke remains controversial, Iron and ferritin are known to have an important role in stroke as well as in other disorders. Serum ferritin which is considered as an acute phase reactant has also been used for assessing the severity and prognosis of stroke. Therefore, testing of serum ferritin is useful in identifying high risk patients.1: To study the effect of level of serum ferritin with early neurological deterioration and the outcome in patients of acute stroke. 2: Association of serum ferritin in ischemic and haemorrhagic stroke.50 patients with acute stroke were selected based on inclusion and exclusion criteria. Appropriate questionnaire was used to collect the data of patients. Diagnosis of stroke was confirmed by CT or MRI scan of brain and examination was done by Canadian stroke scale at the time of admission. About 5ml of venous blood Sample from cubital vein was collected for measuring serum ferritin levels, it was performed within 48hrs of onset of symptoms by using CLIA method. Neurological assessment was repeated on the day of discharge to assess the clinical improvement and prognosis of the stroke patients.Totally 50 patients of acute stroke were included in our study, majority of the patients are males 35 (70%), and females are 15(30%). Approximately 36% were in the age group of 51-60 years. In this study ischemic stroke was seen in 45 (90%) of the patients and 5 (10%) had hemorrhagic stroke. The serum ferritin levels are normal in 41(82%) and high in 9(18%) of the patients. Canadian stroke scale interpretation on the day of discharge showed 20% of the patient are deteriorated, 66% are in the same status and 14% of the patients are improved clinically. The patients with haemorrhagic stroke had high serum ferritin level 60.0% and ischemic stroke are 13.3%. Those patients with high serum ferritin levels had higher deterioration in Canadian stroke scale (p&amp;#60;0.001). The mean serum ferritin levels are higher in deteriorated patients 199.29% when compared to other status group in Canadian stroke scale.High levels of serum ferritin correlates well with early neurological deterioration of stroke patients. Based on this study finding, that high serum ferritin level within 48 hours after the onset of symptoms of stroke helps to predict the early prognosis. Therefore, testing of serum ferritin is useful in identifying high risk patients.

Attention-Deficit/Hyperactivity Disorder Patients May Have Undiagnosed Narcolepsy.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) patients have many comorbidities. Narcoleptic patients have a big prevalence of ADHD (15%-30%). Both groups suffer from similar symptoms and benefit from the same class of medications. As such, narcolepsy could be masked in ADHD patients. Low serum ferritin has been found both in ADHD patients as well as in patients with narcolepsy.Materials & methodsWe enrolled 26 participants (14 ADHD patients and 12 controls). They answered several questionnaires, and blood samples were obtained from 20 participants. We had clear exclusion criteria.ResultsUsing the Ullanlinna Narcolepsy Scale (UNS), we identified three possible narcolepsy patients within the ADHD group and no suspects in the control group. There was a statistically significant negative correlation between serum iron levels and ADHD symptom severity. No correlation was found measuring serum ferritin levels.ConclusionsNarcolepsy may be more common within ADHD patients than in the general population. Some of these patients could benefit from a change in medication. Low serum iron and ferritin levels could be relevant in ADHD pathophysiology. This requires further exploratory research.

Effectiveness of Deferasirox in Pediatric Thalassemia Patients: Experience from a Tertiary Care Hospital of Odisha.

BACKGROUND AND OBJECTIVES:Patients with beta-thalassemia require lifelong blood transfusions, leading to chronic iron overload, which can lead to growth retardation, as well as hinder sexual development during the adolescent period and dysfunction of organs such as heart, pancreas, and endocrine glands. These patients are in need of lifelong transfusion therapy and hence lifelong iron chelation therapy as well. Hence, this study was aimed to assess the effectiveness of deferasirox for iron chelation in pediatric thalassemia cases in a tertiary care hospital of Eastern India.SUBJECTS AND METHODS:This prospective, observational, hospital-based study was conducted from June 2015 to December 2016. Two hundred and fifty patients were assessed for eligibility, of which 174 were included. Effectiveness of deferasirox was observed by measuring serum ferritin levels which were monitored at the end of every 3 months till 1 year. We also evaluated the compliance with deferasirox therapy in the same study cohort.RESULTS:The serum ferritin level reduced significantly at the end of 12 months in comparison to baseline (P = 0.04). There was a mean absolute decrease in serum ferritin only in the dose range of 21–30 mg/kg/day. Approximately 90% of the patients had 100% compliance with deferasirox therapy.CONCLUSIONS:Deferasirox is an effective iron chelator when started at an optimum time and with optimum dose. At least 1 year of deferasirox therapy is needed for a significant lowering of serum ferritin levels of pediatric thalassemia patients on multiple blood transfusions.

A study of prevalence of iron deficiency anaemia in infants and toddlers (6-24 months) by measuring serum ferritin levels

Background: Nutritional anemia is a worldwide problem with the highest prevalence in the developing countries. One of the most vulnerable groups is 6-24 months of age. NFHS-3 survey shows that the incidence of anemia in children aged 6-35 months is 79.2% with 72.7% in urban areas and 81.2% in rural areas. First stage of iron deficiency is depletion of iron stores, which is reflected by decreased serum ferritin levels and increased total iron binding capacity (TIBC) levels. The objective of this study was to detect presence of iron deficiency in children even before clinical appearance of anemia by measuring serum ferritin levels.Methods: The study was conducted from March 2017 to November 2017 in the Department of Pediatrics of Sir Sayajirao Gaekwad General Hospital, a tertiary level hospital and government medical college, Vadodara. A cross sectional study was done in which a total of 111 asymptomatic infants and toddlers in age group of 6-24 months presenting to well-baby clinic were enrolled randomly. Haemoglobin, RBC indices and serum ferritin levels were estimated. The children were classified into mild, moderate and severe anaemia according to their haemoglobin levels. Correlation with their serum ferritin levels was carried out by using statistical analysis.Results: Prevalence of anaemia (Hb &lt;11gm/dl) was 84.14% in 6-12 months age group, 81.25% in 13-18 months age group and 84.61% in case of 19-24 months age group. Overall 83.78% of infants and toddlers were found to be anemic among 6-24 months age group. 55 infants (49.54%) among 111 infants had mild anaemia, 29 infants (26.12%) had moderate anaemia, 9 infants (8.1%) had severe anaemia. Majority of children (87 of 111 infants) had microcytic and hypochromic RBCs in their peripheral smear examination. 78 infants (72.07%)) had low serum Ferritin levels while only 31 infants had normal ferritin levels which is statistically significant (p=0.0084). Out of these, 4 infants had normal hemoglobin level.Conclusions: Anaemia is highly prevalent in the age group of 6 to 24 months even in otherwise healthy infants. Serum ferritin level is a good indicator of iron deficiency in children.

Detection of serum ferritin in patients with idiopathic inflammatory myopathies and its clinical significance

Objective To determine serum ferritin levels in patients with idiopathic inflammatory myopathies(IIM), including dermatomyositis(DM), clinical amyopathic dermatomyositis(CADM)and polymyositis(PM), and to evaluate their association with disease activity, especially with interstitial lung disease(ILD). Methods Clinical data and laboratory results were collected from 120 patients with IIM. A double-site enzyme immunoassay was conducted to measure serum ferritin levels in 120 patients with IIM and 63 healthy human controls. Statistical analysis was carried out to assess the relationship of serum ferritin levels with inflammatory biomarkers, autoantibodies, serum muscle enzymes, and severity of ILD in patients with IIM. Results Serum ferritin levels were elevated in 36 out of the 120 patients, but normal in the other 84 patients. Compared with patients with normal serum ferritin levels, those with elevated serum ferritin levels showed increased levels of C-reactive protein(14.1 ± 6.5 vs. 3.6 ± 1.7 mg/L, P < 0.01), aspartate aminotransferase(111.8 ± 44.6 vs. 46.0 ± 9.0 U/L, P< 0.01), lactate dehydrogenase(388.6 ± 81.5 vs. 260.7 ± 29.1 U/L, P< 0.01), as well as erythrocyte sedimentation rate(34.8 ± 8.2 vs. 15.4 ± 2.7 mm/h, P< 0.01). However, no significant difference was observed in the level of creatine kinase between patients with elevated and normal serum ferritin levels. Moreover, serum ferritin levels were significantly higher in both IIM patients complicated with acute/subacute interstitial pneumonia(A/SIP, 650.5 ± 268.5 ng/ml)and those with chronic interstitial pneumonia(CIP, 489.9 ± 157.3 ng/ml)than in those without ILD(155.7 ± 90.8 ng/ml)and those with imageological changes but no clinical symptoms of ILD(193.3 ± 62.1 ng/ml)(all P < 0.01). Moreover, compared with patients with normal serum ferritin levels, those with elevated serum ferritin levels showed a significant increase in the incidence of CIP(52.8% vs. 25.9%, P < 0.01), A/SIP(22.2% vs. 3.5%, P < 0.01), as well as appearance of ground-glass opacity(67.6% vs. 43.4%, P < 0.05)and honeycomb-like changes(14.7% vs. 2.6%, P < 0.05)on high-resolution CT scans. Conclusion Serum ferritin levels are highly correlated with erythrocyte sedimentation rate, C-reactive protein, aspartate aminotransferase, lactate dehydrogenase, ILD and high-resolution CT findings, and may be of great clinical significance for the evaluation of disease activity, especially the severity of ILD. Key words: Myositis; Dermatomyositis; Ferritins; Lung diseases, interstitial; Idiopathic interstitial pneumonias

Acquired Hypogonadotropic Hypogonadism (AHH) in Thalassaemia Major Patients: An Underdiagnosed Condition?

IntroductionIn males, acquired hypogonadotropic hypogonadism (AHH) includes all disorders that damage or alter the function of gonadotropin-releasing hormone (GnRH) neurons and/or pituitary gonadotroph cells. The clinical characteristics of AHH are androgen deficiency and lack, delay or halt of pubertal sexual maturation. AHH lead to decreased libido, impaired erectile function, and strength, a worsened sense of well-being and degraded quality of life (QOL).Patients and methodsWe studied 11 adult men with thalassemia major (TM) aged between 26 to 54 years (mean ± SD: 34.3 ± 8.8 years) with AHH. Twelve age- and sex-matched TM patients with normal pubertal development were used as a control group. All patients were on regular transfusions and iron chelation therapy. Fasting venous blood samples were collected two weeks after transfusion to measure serum concentrations of IGF-1, free thyroxine (FT4), thyrotropin (TSH), cortisol, luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone (TT), prolactin and estradiol (E2), glucose, urea, creatinine and electrolytes (including calcium and phosphate). Liver functions and screening for hepatitis C virus seropositivity (HCVab and HCV-RNA) were performed. Iron status was assessed by measuring serum ferritin levels, and evaluation of iron concentrations in the liver (LIC) and heart using MRI- T2*. Bone mineral density was measured at the lumbar spine (L1–L4) for all patients with AHH by dual energy X-ray absorptiometry (DXA) using Hologic QDR 4000 machine.ResultsThe mean basal serum LH and FSH concentrations in AHH patients were 2.4 ± 2.2 IU/L and 1.2 ± 0.9 IU/L respectively; these, values were significantly lower compared to the control group. Semen analysis in 5 patients with AHH showed azoospermia in 3 and oligoasthenozoospermia in 2. The percentage of patients with serum ferritin level >2000 ng/ml (severe iron load) was significantly higher in AHH patients compared to controls, 5/11 (45.4 %) versus1/12 (8.3%), p=0.043. Heart iron concentrations (T2* values) were significantly lower in AHH patients compared to controls (p=0.004). Magnetic resonance imaging in the 3 azoospermic patients revealed volume loss and reduction of pituitary signal intensity. Heart T2* values were significantly reduced in the AHH group vs. the controls (p=0.004). On the other hand, liver iron concentration (mg/g dry weight) was not different between the two groups of TM patients. Using DXA, 63.6 % (7/11) of patients with AHH were osteoporotic, and 36.3 % (4/11) were osteopenic.ConclusionsIn this cohort of thalassemic patients iron overload and chronic liver disease appear to play a role in the development of AHH. Treatment of AHH in TM patients is a vital and dynamic field for improving their health and QOL. Early identification and management of AHH are very crucial to avoid long-term morbidity, including sexual dysfunction and infertility. Therapy aims to restore serum testosterone levels to the mid–normal range. Many exciting opportunities remain for further research and therapeutic development.

Pulmonary dysfunction in children with beta thalassemia major in relation with iron overload - a cross sectional hospital based study

Background: Previously many patients with thalassemia major died from severe anemia during first decade, but with modern transfusion therapy many now survive beyond childhood. Because of such therapy, however excessive iron deposition occurs in lungs and causing respiratory dysfunction. Respiratory impairment occurs because of defective chelation and repeated transfusions. Objectives: To a) study pattern of respiratory impairment using spirometry, b) estimate iron overload by measuring serum ferritin levels, c) correlate a&amp;b. Methodology:Thalassemia children &gt;7year, on regular blood transfusion were included in the study after getting institutional ethical clearance .Standardised pulmonary function test was done using spirometry. Iron overload was assessed using serum ferritin levels. Severity of pulmonary dysfunction was correlated with serum ferritin levels. Results:Total of 42 children were included 62% were males and 38% were females (with median age 12yrs). By spirometry 95% had restrictive pattern of respiratory dysfunction. Mean ferritin value was 4152. Out of them10 (23.8%) mild, 25(59%) moderate and 5(12%) severe dysfunction based on FEV1 and FVC. The mean ferritin values in severe respiratory dysfunction is 6275 which is significantly higher when compared to moderate (4249) and mild (3066) pattern of respiratory dysfunction. None of the children had evidence of CCF. Significant correlation (p value=0.003) was found between severity of pulmonary dysfunction with ferritin values and also with weight of the child (p value=0.007). No other significant correlation found between severity pattern and transfusion index, age or height. Conclusion:Restrictive pattern is most common pulmonary dysfunction seen in chronic iron overloaded thalassemia major children. Regular blood transfusions with adequate chelation decrease incidence of pulmonary dysfunction. Screening of all thalassemia children using spirometry is need of the hour. DOI: http://dx.doi.org/10.3126/ajms.v6i5.11782Asian Journal of Medical Sciences Vol.6(5) 2015 47-50

Serum ferritin is elevated in amyotrophic lateral sclerosis patients

Our objective was to measure serum ferritin levels, which reflect iron metabolism, in ALS patients versus healthy and disease controls, and determine whether serum ferritin levels correlate with survival. We retrospectively analyzed data from 138 ALS patients, 152 healthy controls, and 82 disease controls. Gender, age, site of onset, and dates of symptom onset and death were recorded. Survival was defined as the time from symptom onset to death. Serum ferritin levels were measured using immunoassay. ANOVA and Pearson's correlation were used to compare ferritin levels between groups and test the association between ferritin levels and age and survival. Ferritin levels were categorized into high and low groups, and Kaplan-Meier analysis performed. Results showed that gender proportions differed between ALS patients versus healthy and disease controls, and gender affected serum ferritin levels. Ferritin comparisons were stratified for gender. In both males and females, ferritin levels were higher in ALS patients versus healthy and disease controls. However, ferritin levels were unrelated to survival in either gender, by tests of association or survival analysis. In conclusion, ALS patients have altered iron metabolism that is not simply due to the presence of neurological disease. Serum ferritin levels alone are not sufficient to predict survival.

Serum ferritin as a new prognostic factor in hepatocellular carcinoma patients treated with radiofrequency ablation

Hepatic iron accumulation is considered to be a cofactor that influences liver injury and hepatocarcinogenesis. Aim of this study is to determine whether serum ferritin (SF) levels relate to overall survival (OS) and time to recurrence (TTR) in hepatocellular carcinoma (HCC) patients treated with percutaneous radiofrequency ablation (RFA). We measured SF levels in 103 HCC patients (median age 70, M/F = 82.5%/17.5%) who underwent RFA between 2005 and 2010. Correlation between SF and other prognostic factors at baseline was analyzed. SF levels were entered into a Cox model and their influence on OS and TTR was evaluated in univariate and multivariate analyses. SF did not correlate with α-fetoprotein (rho: -0.12, P = 0.22), neutrophil/lymphocyte ratio (rho: -0.1020, P = 0.30), Model for End-Stage Liver Disease (rho: 0.18, P = 0.06), Child-Pugh score (P = 0.5), or Barcelona Cancer of the Liver Clinic stage (P = 0.16). A log-rank test found the value of 244 ng/mL as the optimal prognostic cut-off point for SF. Median OS was 62 months (54-78) and survival rate was 97%, 65%, and 52% at 1, 4, and 5 years, respectively. Performance status and SF were the only predictors of OS at multivariate analysis. Median TTR was 38 months (34-49) with a recurrence-free survival rate of 82.5%, 26.2%, and 23.3% at 1, 4, and 5 years, respectively, while SF and age were the only predictors of TTR. SF level, possibly reflecting the degree of hepatic inflammation and fibrosis, is a negative risk factor for survival and recurrence after percutaneous RFA in HCC patients.

Mentzer index as a screening tool for iron deficiency anemia in 6-12-year-old children

Background There is a high prevalence of iron deficiency anemia (IDA) in Indonesia. Iron deficiency anemia impairs the growth and development process in children. The reference standard to diagnose IDA is serum ferritin level. Since this test is expensive and rare not widely available, an inexpensive, simpler testis needed. The Mentzer index (mean corpuscular volume/red blood cell or MCV JRBC) has been used to identitY hypochromic-microcytic anemia with good validity.Objective To assess the validity of the Mentzer index for diagnosing IDA by comparing Mentzer indexes to serum ferritin and to define an optimal Mentzer index cut off point with good sensitivity and specificity.Methods The study was a diagnostic test with cross-sectional design. Subjects were collected by multistage, random sampling, from April to May 2013 at 18 elementary schools in Palembang. The study had a survey phase and diagnostic test phase. Subjects were aged 6-12 years with hypochromic-microcytic anemia. We examined complete blood counts to diagnose hypochromic-microcytic anemia, calculated Mentzer indexes, and measured serum ferritin levels of our subjects. We analyzed the validity of Mentzer index compared to serum ferritin level for diagnosing IDA.Results There were 100 children in our study, consisting of 51boys and 49 girls with a mean age of 9.1 (SD 2.02) years. From the receiver-operator curve (ROC) curve analysis, the area under the curve (AUC) was 91.5)010 for a Mentzer index cutoff point of 13.51. Diagnostic test analysis revealed a sensitivity of93%, specificity 84 %, and accuracy 90%.Conclusion Mentzer index has good validity as an inexpensive and simple screen for IDA in 6-12-year-old children with hypochromic-microcytic anemia.

Hyperferritinemia in Dogs with Splenic Hemangiosarcoma

ABSTRACTSerum ferritin concentration increases in dogs in association with various diseases. In this study, we measured serum ferritin levels in dogs with splenic masses, using a sandwich ELISA assay. Eleven dogs with hemangiosarcoma (HSA), six with hematoma, 1 with hemangioma and 3 with lymphoma were enrolled. All dogs with HSA had serum ferritin concentrations above the normal limit (1,357 ng/ml, mean + 2× standard deviation of normal). Increased serum ferritin concentrations have also been observed in few cases of hematoma, hemangioma and lymphoma. Therefore, hyperferritinemia is not specific for splenic HSA, but may have clinical usefulness as a sensitive test for the disease. Further evaluation of serum ferritin concentrations in dogs with splenic HSA is needed.

The efficacy and safety of current intravenous iron preparations for the management of iron-deficiency anaemia: a review

Iron-deficiency anaemia (IDA) is a major health problem worldwide, but responds well to iron supplementation. New approaches are leading to more effective management of this condition. Iron deficiency (ID) is usually suspected in at-risk patients with declining haemoglobin (Hb) levels and then confirmed by measuring serum ferritin levels and transferrin saturation. However, regular monitoring of these iron indicators and other laboratory parameters in susceptible individuals may lead to early recognition of falling iron stores and facilitate pre-emptive therapeutic intervention before anaemia develops. Patients with ID are commonly prescribed oral iron preparations because of convenience and low cost. However, the efficacy of these agents is limited by their reduced absorption rate and gastrointestinal side-effects. Alternatively, treatment of IDA in patients requiring erythropoiesis-stimulating agents (ESAs) is more predictably achieved by use of intravenous (i.v.) iron. Unfortunately, the development of serious adverse events (SAEs) from high molecular-weight iron dextran has led to reluctance to use i.v. iron in the treatment of IDA. Similarly, but to a much lesser extent, low molecular-weight iron dextran is associated with a number of SAEs, including allergic or anaphylactic reactions. The introduction of second-generation i.v. iron formulations, including iron sucrose and ferric gluconate, was clearly an improvement over i.v. iron dextran. These formulations proved to be effective in the management of IDA and are not associated with the serious allergic reactions encountered with i.v. iron dextran. For these reasons, use of these preparations became more widespread in the treatment of IDA across a wide range of clinical conditions. An important advantage of i.v. iron over oral iron is that it may bypass hepcidin actions by directly loading transferrin and making iron available to macrophages. Despite a reduction in the short-term risks, there is still concern about the potential for long-term toxicity of i.v. iron use (e. g. atherosclerosis development, infection and increased mortality). The association of atherosclerosis with iron overload remains unclear. Alternatively, the relative risk for mortality or hospitalization from infection in patients undergoing haemodialysis (HD) who received i.v. iron was shown not to be higher than that observed in the overall HD population. Indeed, doses of i.v. iron up to 400 mg/month were associated with improved patient survival. Second-generation i.v. iron formulations are more frequently used for treating IDA than i.v. iron-dextran in patients with various chronic conditions including those with chronic kidney disease. In the latter, IDA should be corrected before initiation of ESA therapy, as iron deficiency can lead to hyporesponsiveness to ESA. However, a major limitation of the second-generation i.v. iron agents is that they cannot be administered in large doses and the typical 1000 mg therapy requires several clinic visits. Thus, there is a need for an i.v. iron agent that can be safely administered in a single dose of 1000 mg of iron and therefore requires less frequent clinic visits. This limitation has now been overcome with the introduction of newer i.v. iron preparations. Ferric carboxymaltose offers effective and rapid correction of IDA by overcoming the limitations observed with previous i.v. iron preparations. This agent has been shown to be effective and well tolerated in a number of randomized controlled trials in a variety of chronic conditions.

The prognostic value of changes in serum ferritin levels during therapy for hepatitis C virus infection

An increase in serum ferritin levels during combined interferon-ribavirin treatment in chronic patients infected with hepatitis C virus (HCV) can occur. A study was conducted to determine whether observing the kinetics of serum ferritin levels during antiviral therapy, may assist in predicting the rate of sustained virological response. The kinetics of serum ferritin levels during antiviral therapy in treatment-naive, adherent patients with chronic HCV who had early virological response were characterized. Thirteen patients achieved sustained virological response (group 1) while eight patients did not (group 2). Pre-treatment serum ferritin levels were higher in group 2 patients. During antiviral therapy, serum ferritin levels increased in both groups. On treatment, the median increase (compared to baseline) and the calculated rate of the increase in serum ferritin levels was higher in group 1 patients (874% vs. 272%, P < 0.05, 63%/week vs. 13%/week, P = 0.024, respectively). Red blood cell lysis did not contribute to the increase in serum ferritin level. Post-treatment (1st month) serum ferritin levels in group 1 patients were lower than in group 2 patients. In addition, the degree of decline in the 1st month serum ferritin levels (from peak levels) in group 1 patients was higher (76% vs. 49%, P = 0.039). Measuring serum ferritin levels during antiviral therapy in HCV patients who had an early virological response may assist in predicting sustained virological response.

Deferasirox effectively decreases iron burden in patients with double heterozygous HbS/β-thalassemia

Iron overload is present in several cases of double heterozygous sickle-cell/beta-thalassemia (HbS/β-thal). Deferasirox is an orally administered iron chelator which is effective on iron overloaded patients with transfusion-dependent anemia. The aim of this study was to investigate the efficacy and safety of deferasirox on HbS/β-thal patients with iron overload. We evaluated 31 adult patients with HbS/β-thal (14M/17F; median age 41 years) who had serum ferritin levels >1,000 ng/mL and who were sporadically transfused. Total iron burden was monitored by measuring serum ferritin levels before and monthly after starting deferasirox, while liver iron concentration and cardiac iron burden were measured by magnetic resonance imaging (MRI) T2 and T2* parameters at baseline and 12 months after deferasirox treatment. Deferasirox managed to reduce the mean serum ferritin levels after 12 months of treatment from 1,989 ± 923 to 1,008 ± 776 ng/mL (P < 0.001). This reduction was accompanied by a significant improvement on MRI T2* of the liver (from 3.9 ± 3.2 to 5.8 ± 3.1 ms; P < 0.01) and by a comparable improvement of biochemical parameters of liver function. Mild nausea and diarrhea of grade 1/2 were reported in 25% of patients within the first month of treatment, but did not re-occur. These data indicate that deferasirox provided effective control of iron levels (mainly of the liver) in minimally transfused patients with HbS/β-thal, without significant adverse events, at similar doses to those studied widely for the treatment of patients with thalassemia syndromes.

The effect of early and delayed umbilical cord clamping on ferritin levels in term infants at six months of life: a randomized, controlled trial

Delayed umbilical cord clamping could increase iron stores and prevent iron deficiency in infants. To test this hypothesis we measured serum ferritin and hemoglobin levels at six months of age in term infants who had participated in a randomized controlled trial, assessing the effect of cord clamping timing on neonatal hematocrit values and clinical outcome. Main outcome measure. Serum ferritin level at six months of age. Out of the 276 mothers and their infants that participated in the initial study, 255 (92.4%) were followed up to six months and included in this study. Of these, 86 had their cords clamped within the first 15 seconds (early clamping), 83 at one minute, and 83 at three minutes. The pediatricians in charge of the evaluations during the follow-up period and personnel in charge of the biochemical tests were blinded to the assignment group. In all but 3 infants the ferritin levels and hemoglobin levels were measured at six months of age. Mothers and infants in the three groups had similar baseline characteristics. Serum ferritin levels were significantly higher in the infants of the three minutes group than in the infants of the early group: 33.2 microg/L vs. 20.9 microg/L (geometric mean ratio: 1.6; 95% CI: 1.2 to 2.11) but no difference was observed in one minute group (25.5 microg/L) vs. early group. There were no significant differences in mean hemoglobin values, 10.6 g/dl (SD 1,1); 10.8 g/dl (SD 0.9) and 10.7 g/dl (SD 1.0) between groups early, one minute, and three minutes, respectively. Although there were no significant differences between groups, the prevalence of iron deficiency anemia (hemoglobin < 10.5 g/dl and ferritin < 9 microg/L) was 3 times more frequent in early clampling group (7.2%) than in three minutes group (2.4%) (RR: 0.30; IC 95%: 0.10-1.60). Delayed umbilical cord clamping at three minutes significantly increases serum ferritin levels in infants at 6 months of age. No significant differences were found between groups in mean hemoglobin levels.

Ferritin levels, inflammatory biomarkers, and mortality in peripheral arterial disease: A substudy of the Iron (Fe) and Atherosclerosis Study (FeAST) Trial

This study delineated correlations between ferritin, inflammatory biomarkers, and mortality in a cohort of 100 cancer-free patients with peripheral arterial disease (PAD) participating in the Veterans Affairs (VA) Cooperative Study #410, the Iron (Fe) and Atherosclerosis Study (FeAST). FeAST, a prospective, randomized, single-blind clinical trial, tested the hypothesis that reduction of iron stores using phlebotomy would influence clinical outcomes in 1227 PAD patients randomized to iron reduction or control groups. The effects of statin administration were also examined in the Sierra Nevada Health Care (SNHC) cohort by measuring serum ferritin levels at entry and during the 6-year study period. No difference was documented between treatment groups in all-cause mortality and secondary outcomes of death plus nonfatal myocardial infarction and stroke. Iron reduction in the main study caused a significant age-related improvement in cardiovascular disease outcomes, new cancer diagnoses, and cancer-specific death. Tumor necrosis factor (TNF)-alpha, TNF-alpha receptors 1 and 2, interleukin (IL)-2, IL-6, IL-10, and high-sensitivity C reactive protein (hs-CRP) were measured at entry and at 6-month intervals for 6 years. Average levels of ferritin and lipids at entry and at the end of the study were compared. The clinical course and ferritin levels of 23 participants who died during the study were reviewed. At entry, mean age of entry was 67 +/- 9 years for the SNHCS cohort, comparable to FeAST and clinical and laboratory parameters were equivalent in substudy participants randomized to iron reduction (n = 51) or control (n = 49). At baseline, 53 participants on statins had slightly lower mean entry-level ferritin values (114.06 ng/mL; 95% confidence interval [CI] 93.43-134.69) vs the 47 off statins (127.62 ng/mL; 95% CI, 103.21-152.02). Longitudinal analysis of follow-up data, after adjusting for the phlebotomy treatment effect, showed that statin use was associated with significantly lower ferritin levels (-29.78 ng/mL; Cohen effect size, -0.47 [t(df, 134) = 2.33, P = .02]). Mean follow-up average ferritin levels were higher in 23 participants who died (132.5 ng/mL; 95% CI, 79.36-185.66) vs 77 survivors (83.6 ng/mL; 95% CI, 70.34-96.90; Wilcoxon P = .05). Mean follow-up IL-6 levels were higher in dead participants (21.68 ng/mL; 95% CI, 13.71-29.66) vs survivors (12.61 ng/mL; 95% CI, 10.72-14.50; Wilcoxon P = .018). Ferritin levels correlated (Pearson) with average IL-6 levels (r = 0.1845; P = .002) and hsCRP levels (r = .1175; P = .04) during the study. These data demonstrate statistical correlations between levels of ferritin, inflammatory biomarkers, and mortality in this subset of patients with PAD.