Median S-ferritin Research Articles

Pediatric Crohn's disease, iron deficiency anemia and intravenous iron treatment: a follow-up study

Background and aims: Increasing evidence in adults demonstrates efficacy and safety of IV iron in inflammatory Bowel disease (IBD) associated iron deficiency anemia; however, evidence in pediatric patients is yet scarce and no previous study has included a long follow-up. This study aimed to evaluate safety and efficacy of IV iron (primary end point), and the need of re-treatment (secondary end point), in this setting.Methods: Prospective recruitment (40 months); PCDAI determined before and after treatment; anemia defined according to WHO criteria; IV iron treatment included iron sucrose and ferric carboxymaltose. Primary and secondary endpoints included hemoglobin, serum ferritin, transferrin saturation at baseline and 4-6 weeks after treatment; and the need of re-treatment during the median follow-up period (18 months), respectively.Results: Nineteen patients (median age: 15.5 years) with remissive/mild disease were included. At recruitment, the median hemoglobin was 10.5 g/dl, (median s-ferritin: 20.1 ug/l, median transferrin saturation; 6%) and 4-6 weeks after treatment was 12.7 g/dl. Median hemoglobin according to age groups before vs. after treatment: <12 years:11 vs. 12.0 g/dl; females ≥12 years:9.9 vs. 12.6 g/dl; and males ≥12 years:11.1 vs. 13.3 g/dl. Patients with remissive vs. mild disease had median Hb of 10.5 g/dl vs. 10.6 g/dl, and median s-ferritin: 6.8 ug/dl vs. 43.3 ug/dl, respectively). Nine patients were treated with iron sucrose (median dose 672.6 mg/dl) and 10 patients with ferric carboxymaltose (median dose 811.5 mg/dl). No major adverse reactions occurred. Six patients needed re-treatment after a median 15.5 months period.Conclusions: Our prospective study, concerning pediatric IBD anemia patients with remission/mild disease and a significant follow-up, emphasizes efficacy and safety of IV-iron and the importance of long-term follow-up of iron status.Summary: In pediatric IBD iron anemia, the evidence supporting the efficacy and safety of IV-iron is scare. This prospective study aims to evaluate the safety and efficacy (short and long term) of IV-iron in these patients. Nineteen pediatric CD patients were evaluated before and after IV iron treatment (40-month period).The median Hb before and after IV iron was 10.5 and 12.7 g/dl, respectively. No major adverse reactions were documented. Six patients needed re-treatment (median period of 15.5 months). This study further demonstrates the efficacy and safety of IV iron. It reinforces the importance of long-term follow-up of the iron status in pediatric CD patients.

Tumour Necrosis Factor Alpha and Its Promoter Polymorphisms' Role in the Phenotypic Expression of Hemochromatosis

Background: The majority of hemochromatosis patients are homozygous for the HFE-C282Y mutation. However, less than half of C282Y homozygous subjects identified by population screening studies actually develop the disease. The cytokine TNF- ! is implicated in the regulation of iron metabolism at different levels. Our aim was to study the role of TNF- ! and its promoter polymorphisms in the phenotypic expression of hemochromatosis in individuals with and without the C282Y mutation. Methods: We studied 4 groups of 10 subjects each: ( 1 ) C282Y homozygotes without clinical hemochromatosis; ( 2 ) C282Y homozygotes with hemochromatosis; ( 3 ) secondary hemochromatosis (without C282Y mutation); and ( 4 ) controls. Groups were age-matched and sex-matched. Peripheral blood mononuclear cells (PBMC) were stimulated with lipopolysaccharide (LPS) and the release of TNF- ! was measured. Additionally, the G/A polymorphisms at position -238 and -308 of the TNF- ! gene were determined by PCR and RFLP analysis in 178 hemochromatosis patients and 41 controls. Results: TNF- ! production from PBMC at 8 and 24 r h after increasing concentrations of LPS stimulation were similar in the four groups. The prevalence of TNF- ! polymorphisms was similar in patients and controls. The prevalences of cirrhosis, siderosis, median s-ferritin and median ALT values were similar in patients with and without the TNF- ! polymorphisms. Conclusions: Neither TNF- ! released from PBMC nor the presence of TNF- ! polymorphisms seem to be associated with disease manifestation in hemochromatosis.

Raised serum ferritin predicts non-response to interferon and ribavirin treatment in patients with chronic hepatitis C infection.

Previous studies have indicated that response to interferon therapy is inversely proportional to the amount of body iron stores. We have studied the relationship between serum ferritin, transferrin saturation, liver iron, presence of HFE-C282Y gene mutation and response to treatment in patients with chronic hepatitis C infection. Two hundred and fifty-six naive, HCV-RNA positive patients (60% males, median age 38 years, range 21-70) were treated with interferon and ribavirin for 6 months. Iron indices and the presence of the C282Y mutation were measured. In 242 (94%) patients iron deposition were determined by Perls staining method. Patients with negative HCV-RNA at 6 months after the end of treatment were defined as sustained viral responders. Non-responders (n = 127) had significantly higher median s-ferritin values compared with sustained viral responders (130 microg/L vs. 75 microg/L P < 0.001). There was no difference in transferrin saturation among the two response groups. Only 23% (4/7) of patients with Perls grade 1 in liver biopsies responded to treatment vs. 54% (122/225) patients without iron deposition (P = 0.02), however, 10/13-non-responders had HCV genotype one. Two patients (0.8%) were homozygous for the C282Y mutation, 36 patients were heterozygous (14%). Among mutation carriers 26/38 achieved sustained response compared with 102/216 non-carriers (68% vs. 48%, P = 0.02). In a multivariate analysis s-ferritin (P = 0.030) and C282Y carrier status (P = 0.012) remained independent predict of sustained response. Raised s-ferritin values predicate non-response to interferon-ribavirin therapy in hepatitis C patients. Response rate in C282Y mutation carriers seems greater than in non-carriers.

Raised serum ferritin predicts non-response to interferon and ribavirin treatment in patients with chronic hepatitis C infection

: Background/Aim: Previous studies have indicated that response to interferon therapy is inversely proportional to the amount of body iron stores. We have studied the relationship between serum ferritin, transferrin saturation, liver iron, presence of HFE-C282Y gene mutation and response to treatment in patients with chronic hepatitis C infection. Methods: Two hundred and fifty-six naive, HCV-RNA positive patients (60% males, median age 38 years, range 21–70) were treated with interferon and ribavirin for 6 months. Iron indices and the presence of the C282Y mutation were measured. In 242 (94%) patients iron deposition were determined by Perls staining method. Patients with negative HCV-RNA at 6 months after the end of treatment were defined as sustained viral responders. Results: Non-responders (n = 127) had significantly higher median s-ferritin values compared with sustained viral responders (130 µg/L vs. 75 µg/L P < 0.001). There was no difference in transferrin saturation among the two response groups. Only 23% (4/7) of patients with Perls grade 1 in liver biopsies responded to treatment vs. 54% (122/225) patients without iron deposition (P = 0.02), however, 10/13-non-responders had HCV genotype one. Two patients (0.8%) were homozygous for the C282Y mutation, 36 patients were heterozygous (14%). Among mutation carriers 26/38 achieved sustained response compared with 102/216 non-carriers (68% vs. 48%, P = 0.02). In a multivariate analysis s-ferritin (P = 0.030) and C282Y carrier status (P = 0.012) remained independent predict of sustained response. Conclusions: Raised s-ferritin values predicate non-response to interferon-ribavirin therapy in hepatitis C patients. Response rate in C282Y mutation carriers seems greater than in non-carriers.

Iron stores in 70-year-old Danish men and women. Evaluation in 469 individuals by serum ferritin and hemoglobin.

Iron status, including serum (S-) ferritin and hemoglobin (Hb) was assessed in a population survey of 469 old subjects (70 years of age; 254 men, 215 women); 7.9% of the participants had abnormal laboratory tests indicating diseases which might be connected with inappropriately high S-ferritin levels. Men had a median S-ferritin of 114 micrograms/L, 5-95 percentile 28-373 micrograms/L; 2.4% had values < 15 micrograms/L (i.e., depleted iron stores), 3.5% values from 15-30 micrograms/L (i.e., small iron stores), and 94.1% values > 30 micrograms/L (e.g., replete iron stores); 74.4% had values from 61-300 micrograms/L, and 8.7% values > 300 micrograms/L. Median Hb was 142 g/L (8.8 mmol/L), 5-95 percentile 124-158 g/L (7.7-9.8 mmol/L); Hb values < 129 g/L (8.0 mmol/L) were observed in 7.5%. Iron deficiency anemia (i.e., S-ferritin < 15 micrograms/L and Hb < 129 g/L) was seen in 0.39% of the men. Women had lower S-ferritin than men (p < 0.0001), median 81 micrograms/L, 5-95 percentile 20-273 micrograms/L; 3.3% had values < 15 micrograms/L, 9.3% values from 15-30 micrograms/L, and 87.4% values > 30 micrograms/L; 63.2% had values from 61-300 micrograms/L, and 3.7% values > 300 micrograms/L. Hb was lower in women than in men (p < 0.0001), median 132 g/L (8.2 mmol/L), 5-95 percentile 118-145 g/L (7.3-9.0 mmol/L); Hb values < 121 g/L (7.5 mmol/L) were seen in 6.5%. None of the women had iron deficiency anemia (i.e., S-ferritin < 15 micrograms/L and Hb < 121 g/L).

Iron status in Danish women aged 35-65 years. Relation to menstruation and method of contraception.

Iron status was assessed by serum (S-) ferritin and hemoglobin (Hb) in a population survey comprising 883 non-gravid Danish women in age cohorts of 35, 45, 55, and 65 years. Premenopausal women (n = 676) had lower S-ferritin, median 42 micrograms/l, than postmenopausal women (n = 207), median 80 micrograms/l (p < 0.0001). Of premenopausal women, 12.1% had S-ferritin < or = 20 micrograms/l (i.e. depleted iron stores), and 35.6% S-ferritin of 21-40 micrograms/l (i.e. small iron stores). Corresponding figures in postmenopausal women were 0.5% and 13.2%. Premenopausal blood donors (n = 88) had lower S-ferritin than non-donors (p < 0.001). In premenopausal women, S-ferritin levels were strongly dependent on the duration of menstrual bleeding (p < 0.0001), which in turn was related to the method of contraception. Women (n = 64) using hormonal contraceptives (the pill) had menstrual bleeding of shorter duration than those (n = 511) not using pills or intrauterine devices (IUD), who in turn had bleeding of shorter duration than those (n = 101) using IUD. Median S-ferritin in pill users was 62 micrograms/l, in those not using pills or IUD 42 micrograms/l, and in IUD users 36 micrograms/l. S-ferritin values < 40 micrograms/l (i.e. small and depleted iron stores) were seen in 25% of pill users, in 48% of those not using pills or IUD, and in 61% of IUD users.(ABSTRACT TRUNCATED AT 250 WORDS)

BONE-MARROW HEMOSIDERIN IRON AND SERUM IRON STATUS MARKERS IN SMALL-CELL CARCINOMA OF THE LUNG

Bone marrow haemosiderin iron grade and serum (S-) iron status markers (haemoglobin (Hb), S-iron, S-transferrin, transferrin saturation, S-ferritin) were measured in 31 patients with newly discovered small cell cancer of the lung (SCCL), and compared to the values in 53 healthy control subjects. Among SCCL patients, 2 had grade 0 (absent), 5 grade (1+) (trace), 8 grade 1+ (normal), and 16 grade 2+ (increased) marrow haemosiderin iron. Median S-ferritin values in the respective groups were 38 mug/l, 243 mug/l, 384 mug/l and 433 mug/l. There was no correlation between Hb, S-iron, S-transferrin or transferrin saturation and marrow iron grade. S-ferritin displayed a correlation with marrow iron grade (r(s) = 0.40, p <0.05) but there was marked overlap between the groups. Among the controls, 5 had grade 0, 11 grade (1+), and 37 grade 1+ marrow iron. Median S-ferritin values in the respective groups were 14 mug/l, 26 mug/l and 57 mug/l. Hb, S-iron, S-transferrin, transferrin saturation and S-ferritin were all significantly correlated to marrow iron grade; S-ferritin, r(s) = 0.64, p <0.0001. In conclusion, SCCL patients have inappropriately high S-ferritin values. In SCCL, serum iron status markers, including S-ferritin, are poor indicators of marrow haemosiderin iron and thus body iron stores. Therefore, estimation of marrow haemosiderin iron or histochemical/chemical liver iron content remains the only reliable way of assessing iron stores in SCCL.

Iron stores in 1359, 30- to 60-year-old Danish women: Evaluation by serum ferritin and hemoglobin

Iron status, including serum (S-)ferritin and hemoglobin (Hb), was assessed in a population survey comprising 1359 nonpregnant Danish women in age cohorts of 30, 40, 50, and 60 years. S-ferritin levels were similar in 30- and 40-year-old women; they displayed a significant increase in 50-year-old women and a further significant increase in 60-year-old women. In the 30- and 40-year-old women, median S-ferritin was 38 micrograms/l, 5-95 percentile 6-135 micrograms/l; 17.2% had values less than 15 micrograms/l (i.e., depleted iron stores), 22.7% values from 15 to 30 micrograms/l (i.e., small iron stores), and 60.1% values greater than 30 micrograms/l (i.e., replete iron stores). In the 50-year-old women, median S-ferritin was 54 micrograms/l, 5-95 percentile 10-164 micrograms/l; 10.3% had values less than 15 micrograms/l, 16.5% values from 15 to 30 micrograms/l, and 73.2% values greater than 30 micrograms/l. For the 60-year-old women, median S-ferritin was 84 micrograms/l, 5-95 percentile 25-249 micrograms/l; 1.6% had values less than 15 micrograms/l, 8.6% values from 15 to 30 micrograms/l, and 89.8% values greater than 30 micrograms/l. Blood donors (n = 180) had lower S-ferritin than nondonors in all age-groups (p less than 0.001). In the entire series, Hb levels were similar in 30- and 40-year-old women, median 137 milligrams (8.5 mmol/l), 5-95 percentile 121-152 milligrams (7.5-9.4 mmol/l), and higher in 50- and 60-year-old women, median 140 milligrams (8.7 mmol/l), 5-95 percentile 123-158 milligrams (7.6-9.8 mmol/l) (p less than 0.0001). Hb values less than 121 milligrams (7.5 mmol/l) were observed in 3.8% of the women. Women with S-ferritin less than 15 micrograms/l (n = 161) had lower Hb, median 134 milligrams (8.3 mmol/l), than those with S-ferritin greater than or equal to 15 micrograms/l, median 139 milligrams (8.6 mmol/l) (p less than 0.001). Iron deficiency anemia (S-ferritin less than 15 micrograms/l and Hb less than 121 milligrams) was seen in 2.3% of 30- and 40-year-old women, and in 1.1% of 50- and 60-year-old women.

The influence of blood donation on iron stores assessed by serum ferritin and hemoglobin in a population survey of 1359 Danish women

The general impact of blood donation on iron status was studied in a population survey comprising 1359 nonpregnant Danish women in age cohorts of 30, 40, 50, and 60 years; 809 were premenopausal and 550 postmenopausal; 180 (13%) were blood donors. Iron stores were assessed by serum (S)-ferritin and hemoglobin (Hb). Hb levels were not significantly different in donors: mean 137 +/- 10 (SD) g/l (8.5 +/- 0.6 mmol/l) compared with nondonors, 139 +/- 11 g/l (8.6 +/- 0.7 mmol/l). Values less than 121 g/l (7.5 mmol/l) were observed in 3.3% of donors vs 3.8% of nondonors. Correlations between S-ferritin and Hb were without practical relevance: rs = 0.29, p less than 0.0001 in donors vs rs = 0.22, p less than 0.0001 in nondonors. Blood donation had a profound influence on iron status, especially in the premenopausal women population. Donors had lower S-ferritin than nondonors in all age-groups and in pre- and postmenopausal groups (p less than 0.001 in all groups). Premenopausal donors had a median S-ferritin of 31 micrograms/l vs 39 micrograms/l in nondonors, postmenopausal donors of 47 micrograms/l vs 72 micrograms/l in nondonors. S-ferritin values less than 15 micrograms/l (i.e., depleted iron stores) were observed in 31.7% of premenopausal donors vs 15.2% of nondonors, and in 7.0% of postmenopausal donors vs 2.9% of nondonors. Iron deficiency anemia (i.e., S-ferritin less than 15 micrograms/l and Hb less than 121 g/l) was seen in 2.8% of donors vs 1.5% of nondonors. Donors using oral contraceptives had higher S-ferritin, median 33 micrograms/l compared with nonusers, 22 micrograms/l, and a lower frequency of depleted iron stores, 29% vs 39%. Ideally, the frequency of phlebotomy should be adjusted according to S-ferritin as well as Hb levels. If Hb is used as single criterion for donation, only donors with predonation values greater than or equal to 124-125 g/l should be allowed to undergo phlebotomy.

Iron stores in 1433, 30- to 60-year-old Danish males. Evaluation by serum ferritin and haemoglobin

Iron status including S-ferritin and haemoglobin (Hb) was assessed in a population survey comprising 1433 Danish males in age cohorts of 30, 40, 50 and 60 years. There was no significant difference in S-ferritin levels between the age groups. In the entire series, median S-ferritin was 126 micrograms 1-1, 5-95% tile 31-378 micrograms 1-1, range 5-3600 micrograms 1-1; 1.2% had values less than 15 micrograms 1-1 (i.e. depleted iron stores), 3.7% values from 15-30 micrograms 1-1 (i.e. small iron stores), and 95.1% values greater than 30 micrograms 1-1 (i.e. replete iron stores); 73.8% had values from 61-300 micrograms 1-1, and 9.5% values greater than 300 micrograms 1-1. Blood donors had lower S-ferritin than non-donors and a higher frequency of depleted iron stores (p less than 0.0001). Hb values showed no age variation; median values was 155 g 1-1 (9.6 mmol 1-1), 5-95% tile 137-171 g 1-1 (8.5-10.6 mmol 1-1). Hb values less than 129 g 1-1 (8.0 mmol 1-1) were observed in 1.7%, and values less than 121 g 1-1 (7.5 mmol 1-1) in 0.8%. Males with S-ferritin less than 15 micrograms 1-1 (n = 17) had lower Hb, median 148 g 1-1 (9.2 mmol 1-1), than those with S-ferritin greater than or equal to 15 micrograms 1-1, median 155 g 1-1 (9.6 mmol 1-1) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Serum ferritin, iron status and plasma ascorbic acid in 40- to 49-year-old males in the Faroe Islands

Iron status (haemoglobin, S-ferritin, S-iron, S-transferrin, and transferrin saturation) was evaluated in an epidemiological survey comprising a representative sample of 118 (4%) of the 40- to 49-year-old Faroese male population. All had normal haemoglobin, (mean +/- SD 153 +/- 9 g/l; 9.5 +/- 0.6 mmol/l). Median S-ferritin was 151 micrograms/l, 5-95 percentile 46-588 micrograms/l, observed range 33-1166 micrograms/l. None had depleted iron stores (S-ferritin less than or equal to 20 micrograms/l), 2.5% had 'small' iron stores (S-ferritin 21-40 micrograms/l), 80.5% had 'normal' iron stores (S-ferritin 41-300 micrograms/l) and 17% had 'increased' iron stores (S-ferritin greater than 300 micrograms/l). Transferrin saturation values were greater than 16% in all males; high values greater than 50% were found in 9.3%, and the combination of high transferrin saturation and S-ferritin greater than 300 micrograms/l was found in 3.4% of the males. Median P-ascorbic acid was 26 mumol/l, 5-95 percentile 7-67 mumol/l; significantly higher in subjects taking vitamin supplements (n = 35, median 50 mumol/l) than in those not taking supplements (n = 81, median 23 mumol/l) (p less than 0.0001). There was no correlation between P-ascorbic acid and iron status markers. The results indicate a high frequency of ample iron reserves in the Faroese male population.

Serum ferritin and iron status in mothers and newborn infants.

Iron status, including hemoglobin, S-ferritin, S-iron, S-transferrin, transferrin saturation and the erythrocyte zinc protoporphyrin/hemoglobin (ZPP:Hb) ratio, was evaluated in 85 healthy iron-supplemented mothers at parturition and in 74 of their term newborn infants. Of the mothers, 17% had a S-ferritin level less than 15 micrograms/l (i.e. depleted iron stores), 9.9% had S-ferritin less than 15 micrograms/l and transferrin saturation less than 15% (i.e. latent iron deficiency), and 2.4% had S-ferritin less than 15 micrograms/l, transferrin saturation less than 15% and Hb less than 120 g/l (i.e. iron deficiency anemia). Newborn infants had higher S-ferritin than mothers: median 128 micrograms/l versus 21 micrograms/l (p less than 0.0001), higher transferrin saturation: 48% vs. 21% (p less than 0.0001), and higher ZPP:Hb ratio: 74 mumol/mol Hb vs. 41 mumol/mol Hb (p less than 0.0001). During the first 5 post-natal days, median S-ferritin rose from 128 to 236 micrograms/l (p less than 0.0001). S-ferritin appeared to be the best single indicator of maternal iron status. Ferritin levels in newborn infants were correlated to levels in mothers (rs = 0.36, p less than 0.01), indicating that fetal iron reserves are dependent on maternal iron stores.