Non-anemic Individuals Research Articles

Pre-operative Anemia as a Risk Factor of Morbidity and Mortality in Valvular Surgeries

Pre-operative anemia can be a hindrance to speedy recovery and will increase blood transfusion intraoperative and post operatively. Objective: To find a correlation between preoperative anemia and the subsequent morbidity and mortality rates in patients undergoing valvular surgeries. Methods: A retrospective observational study, involving 493 valvular surgeries’ patients. All patients had the same anesthetic and surgical techniques. According to the WHO, anemia is a hemoglobin level < 13 g/dl for men and <12 g/dl for women. Clinical variables were compared using chi-square and independent t-test. Results: The patients received cardiac surgery for valvular heart disorders and had an average age of 42.2±14.1 years, with 60.9% being male. Most patients exhibited NYHA III (48.9%) and CCS III (36.5%) functional class symptoms. Highest comorbidity was hypertension (35.1%), followed by diabetes (14.4%) and dyslipidemia (6.5%). 43.2% were anemic and older than non-anemic individuals (P=0.02). Anemic people had a significantly greater incidence of HTN (P 0.02) and DM (P < 0.001). Both groups exhibited identical perfusion and cross-clamp periods (P=0.4 vs. P=0.3). Though not statistically significant (P=0.08), non-anemic patients needed more intraoperative blood or blood product transfusions. Patients with anemia have worse outcomes, including increased rates of in-hospital mortality (P=0.03), extended artificial breathing (P=0.04), and postoperative blood/product transfusion (P<0.001). 44.8% of anemic individuals needed RCC, 41.9% FFP, and 41.4% platelets. Conclusions: anemia is associated with the poorest post-operative results. There is conflicting information about the impact of preoperative anemia, particularly iron deficiency anemia, on valvular surgery.

Interaction between anemia and renal dysfunction in relation to long-term survival following acute myocardial infarction.

Anemia and chronic kidney disease (CKD) adversely affect prognosis following acute myocardial infarction (AMI). We aimed to assess their interaction regarding long-term survival post-AMI. This is a single-center, retrospective analysis of consecutive AMI survivors. Stratified by admission-time anemia status and CKD grade, as determined by hemoglobin and creatinine levels, the cohort was evaluated for all-cause mortality at 10 years after hospital discharge. A total of 11,395 patients (69.1% males, mean age 65.8 ± 13.9 years, 49.6% with ST elevation MI) were included, of whom 29.9% had anemia and 15.9% -grade 3b or higher CKD. CKD was more advanced among anemic patients and the prevalence of anemia rose as CKD grade increased (p for trend < 0.001). At 10 years, 47.8% of patients died. Notwithstanding differences in baseline characteristics, presentation, and treatment between those with various anemia status and CKD grades, anemia presence (HR 1.40, 95% CI 1.32-1.49, p < 0.001) and increasing CKD grade (HR 1.10, 95% CI 1.02-1.20, p for trend < 0.001) were independently associated with a higher mortality risk. The incremental hazard imposed by either anemia or more advanced CKD was limited to patients with normal renal function and up to grade 3a (in the total cohort and the conservative treatment subgroup) or 4 (in the invasive revascularization subgroup) CKD. The added risk associated with increasing CKD grade also affected non-anemic individuals irrespective of the specific CKD grade. Anemia and more advanced CKD are associated with reduced long-term survival post-AMI, inflicting higher risk when conjoined in lower-grade CKD.

Serum Hepcidin Is an Early Predictor of Iron Depletion in Non-Anemic Blood Donors

Introduction Iron deficiency is one of the major concerns in repeated whole blood donors. Although taking iron supplementation, frequent whole blood donors sometimes suffer from iron depletion which contributes to adverse impact on donor's health and may reduce the donor blood pool. Laboratory parameters identifying iron depleted status could help early recognize donors at risk of iron deficiency. Hepcidin is a key iron regulator, which blocks ferroportin to inhibit iron absorption and iron release from hepatocytes. In iron depletion, hepcidin down regulates to encourage iron absorption. Previous data reported that serum hepcidin at less than 10 ng/mL was significantly associated with iron deficiency. According to the biological function and physiological response of hepcidin, we hypothesize that hepcidin could be an early predictor of iron deficiency status in non-anemic individuals. Methods This cross-sectional study was conducted at the Blood Bank Center at Chiang Mai University Hospital, Chiang Mai, Thailand in May 2023. After the informed consent was obtained, ninety-seven healthy repeated whole blood donors who had donated blood at least twice in the past year were recruited. The medical records were reviewed. Basic characteristics and laboratories including complete blood count, reticulocyte indices, iron parameters, and serum hepcidin were evaluated. Donors who had serum ferritin level less than 30 and 30-100 ng/mL were categorized as iron deficiency, and low ferritin group, respectively. Those who had ferritin more than 100 ng/mL were the control group. Logistic regression analysis was done to determine the value of serum hepcidin in predicting iron deficiency status in each group. Results The total of 97 repeated whole blood donors were recruited, 48 (49.5%) were women. Mean age was 34.6 ± 10.7 years. There were 8 donors in the iron deficiency group, 38 in the low ferritin group, and 51 donors in the control group. Mean hemoglobin levels were 13.4 ± 1.1, 13.8 ± 1.2, and 14.2 ± 1.2 g/dL in the iron deficiency, low ferritin group and control, respectively, (p = 0.796). White blood cell and platelet count were not different in these groups. Similarly, red cell indices including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and reticulocyte indices showed no difference among groups. Serum hepcidin had a significant difference between the three groups. Median levels of hepcidin were 2.61 (1.37, 3.4) and 12.35 (10.12, 15.57) ng/mL in the iron deficiency and the low ferritin group, respectively, compared to 26.01 (21.36, 39.08) ng/mL in the control group, (p &amp;lt; 0.001). Low serum hepcidin (less than 10 ng/mL) were found in 14 (36.8 %) donors who had ferritin levels less than 100 ng/mL, compared to only 1 (2.4%) donor in the control group, (p &amp;lt; 0.001). In addition, serum hepcidin showed a strong correlation with ferritin levels (r = 0.779). Logistic regression model showed that only female sex (OR: 2.87; 95% CI: 1.26, 6.56) and hepcidin (OR: 0.76; 95% CI: 0.66, 0.86) were significant predictors of repeated donors who were at risk of iron depletion and had the ferritin levels less than 100 ng/mL. Conclusions Frequent blood donors are at risk of iron depletion. Serum hepcidin was a significant predictor of iron depleted status in non-anemic donors. Serum hepcidin also showed a significant correlation with ferritin levels. The downregulation of serum hepcidin was detected prior to the changes of red blood cell indices and reticulocyte responses. Early recognition and identification of donors at risk of iron depletion and prompt iron restoration are the key to ensuring the donor safety and preserving adequate blood donor pool.

Synergism of Carbamoylated Erythropoietin and Insulin-like Growth Factor-1 in Immediate Early Gene Expression.

Trophic factors are secreted proteins that can modulate neuronal integrity, structure, and function. Previous preclinical studies have shown synergistic effects on decreasing apoptosis and improving behavioral performance after stroke when combining two such trophic factors, erythropoietin (EPO) and insulin-like growth factor-1 (IGF-1). However, EPO can elevate the hematocrit level, which can be life-threatening for non-anemic individuals. A chemically engineered derivative of EPO, carbamoylated EPO (CEPO), does not impact hematological parameters but retains neurotrophic effects similar to EPO. To obtain insight into CEPO and IGF-1 combination signaling, we examined immediate early gene (IEG) expression after treatment with CEPO, IGF-1, or CEPO + IGF-1 in rat pheochromocytoma (PC-12) cells and found that combining CEPO and IGF-1 produced a synergistic increase in IEG expression. An in vivo increase in the protein expression of Npas4 and Nptx2 was also observed in the rat hippocampus. We also examined which kinase signaling pathways might be mediating these effects and found that while AKT inhibition did not alter the pattern of IEG expression, both ERK and JAK2 inhibition significantly decreased IEG expression. These results begin to define the molecular effects of combining CEPO and IGF-1 and indicate the potential for these trophic factors to produce positive, synergistic effects.

Reticulocyte Hemoglobin as a Screening Test for Iron Deficiency Anemia: A New Cut-Off.

Latent iron deficiency (LID), in which iron stores in the body are depleted without incidental anemia, poses a key diagnostic challenge. Reticulocyte hemoglobin content (Ret-Hb) is directly correlated with the functionally available iron for heme synthesis in erythroblasts. Consequently, Ret-Hb has been proposed as an efficient iron status marker. To assess the importance of Ret-Hb in detecting latent iron deficiency as well as its use in screening for iron deficiency anemia. A study involving 108 individuals was conducted at Najran University Hospital, 64 of whom had iron deficiency anemia (IDA) and 44 of whom had normal hemoglobin levels. All patients were subjected to complete blood count (CBC), reticulocyte percentage, Ret-Hb, serum iron, total iron binding capacity (TIBC), and serum ferritin measurements. A significant decrease in Ret-Hb level was observed in IDA patients compared to non-anemic individuals, with a cut-off value of 21.2 pg (a value below which indicates IDA). The measurement of Ret-Hb, in addition to CBC parameters and indices, provides an accessible predictive marker for both iron deficiency (ID) and IDA. Lowering the Ret-Hb cut-off could better allow for its use as a screening parameter for IDA.

An investigation on prevalence of Anemia in relation to BMI and nutrient intake among adult rural population of West Bengal, India

&#x0D; Background: Anemia is now globally recognized major public health problem. The present study was undertaken to investigate the prevalence of anemia and interrelationship of anemia with BMI among adult rural population of West Bengal state, India.&#x0D; Method: Anthropometric measures, nutritional parameters, heart rate and hemoglobin were measured from 310 adult subjects by using standard technique.&#x0D; Results: The prevalence of anemia was high among both sexes and more than the global prevalence. The anemic individuals consumed nutritionally deficient diet than the non-anemic individuals. The prevalence of anemia was significantly high in underweight and normal groups. The Odds ratios became significantly higher in underweight group than normal and overweight/obese groups of both sexes.&#x0D; Conclusions: The prevalence of anemia in the adult rural population might be related to dietary deficiency and poor dietary patterns. The present study was hypothesized that the subjects with low BMI would have a higher risk of anemia compared to normal or overweight subjects.&#x0D;

Retinal vascular caliber in patients with newly diagnosed iron deficiency anemia

BackgroundTo evaluate the retinal vascular caliber using fundus photography in patients with newly diagnosed iron deficiency anemia (IDA). MethodsThis study included 56 eyes of 28 female patients with IDA and the 56 eyes of 28 age- and sex-matched healthy participants. Retinal vascular calibers were measured using image analysis software from fundus photographs. The central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE) and arteriole-to-venule ratio (AVR) were compared between groups. Linear regression analysis was used to quantify the relative impact of hemoglobin level on CRAE, CRVE, and AVR. ResultsThe CRAE was significantly narrower in patients with IDA. However, no such difference appeared between groups in CRVE. AVR was significantly lower among patients with IDA than in the control group. Linear regression analysis revealed that in patients with IDA, hemoglobin level was associated with CRAE and CRVE but not with AVR. Among non-anemic individuals, there was also no association between hemoglobin level and CRAE, CRVE, or AVR. ConclusionsOur results showing that the CRAE is significantly narrower in patients with IDA than in healthy non-anemic individuals suggests that vascular caliber may reflect early microvascular alterations resulting from IDA. Added to that, hemoglobin level was associated with CRAE and CRVE in our linear regression analysis of patients with IDA. Certain changes in retinal vascular caliber are also clearly associated with high blood pressure, cardiovascular risk, and mortality. It may be critical to identify all alterations in retinal vascular caliber in order to prevent potential ocular and systemic disorders in patients with IDA.

Mild anemia and 11- to 15-year mortality risk in young-old and old-old: Results from two population-based cohort studies.

Mild anemia is a frequent although often overlooked finding in old age. Nevertheless, in recent years anemia has been linked to several adverse outcomes in the elderly population. Objective of the study was to investigate the association of mild anemia (hemoglobin concentrations: 10.0-11.9/12.9 g/dL in women/men) with all-cause mortality over 11-15 years and the effect of change in anemia status on mortality in young-old (65-84 years) and old-old (80+ years). The Health and Anemia and Monzino 80-plus are two door-to-door, prospective population-based studies that included residents aged 65-plus years in Biella municipality and 80-plus years in Varese province, Italy. No exclusion criteria were used. Among 4,494 young-old and 1,842 old-old, mortality risk over 15/11 years was significantly higher in individuals with mild anemia compared with those without (young-old: fully-adjusted HR: 1.35, 95%CI, 1.15-1.58; old-old: fully-adjusted HR: 1.28, 95%CI, 1.14-1.44). Results were similar in the disease-free subpopulation (age, sex, education, smoking history, and alcohol consumption adjusted HR: 1.54, 95%CI, 1.02-2.34). Both age groups showed a dose-response relationship between anemia severity and mortality (P for trend <0.0001). Mortality risk was significantly associated with chronic disease and chronic kidney disease mild anemia in both age groups, and with vitamin B12/folate deficiency and unexplained mild anemia in young-old. In participants with two hemoglobin determinations, seven-year mortality risk was significantly higher in incident and persistent anemic cases compared to constant non-anemic individuals in both age groups. In participants without anemia at baseline also hemoglobin decline was significantly associated with an increased mortality risk over seven years in both young-old and old-old. Limited to the Monzino 80-plus study, the association remained significant also when the risk was further adjusted also for time-varying covariates and time-varying anemia status over time. Findings from these two large prospective population-based studies consistently suggest an independent, long-term impact of mild anemia on survival at older ages.

Efficacy of Iron Therapy on Fatigue and Work Capacity in Non-Anemic Iron Deficient Adults: A Systematic Review of Randomized Controlled Trials

INTRODUCTION: Iron supplementation in iron deficiency anemia is standard practice, but the benefits of iron supplementation in iron deficient non-anemic (IDNA) individuals remains controversial. We conducted a systematic review and meta-analysis to identify the effects of iron therapy on fatigue and work capacity in iron deficient non-anemic adults.METHODS: We included randomized controlled trials of adults (≥18 years) who were iron deficient but non-anemic. Interventions included oral, intramuscular or intravenous iron supplementation; all therapy doses, frequencies and durations were included. We included trials that evaluated outcomes at least 1 month from the initiation of iron therapy. Comparators included placebo or active therapy. Our primary outcome measures were self-reported fatigue and objective measures of work capacity. Secondary outcomes included the incidence of anemia, change in hemoglobin concentration and serum ferritin, and the incidence of adverse outcomes including iron toxicity, constipation, diarrhea, gastrointestinal intolerance and nausea. We searched Medline, Embase, CENTRAL, CINAHL, SportDiscus, and CAB Abstracts from inception to October 31, 2016. We searched the World Health Organization's ICTRP for relevant ongoing trials and performed forward searches of included trials and relevant reviews in Web of Science. We assessed internal validity of included trials using the Cochrane Risk of Bias tool, and the external validity using the GRADE methodology.RESULTS: From 11580 citations we included 18 unique trials, and 2 companion papers enrolling 1162 patients (Table 1). Trials were published between 1989 and 2015, and all trials were published in peer-reviewed journals. Exclusively healthy females (aged 17 to 55 years old) with varying levels of fitness (sedentary to well-trained) were enrolled in all but three studies. Iron interventions consisted of iron supplementation administered orally, intramuscularly or intravenously. Of the trials evaluating oral supplements, all but one used ferrous sulfate (13 trials, 721 participants). Intravenous iron was administered in three trials (395 participants), and intramuscular iron in one trial (16 participants). In trials using oral iron, the mean daily elemental iron dose was 86.9mg (± 49.1mg; range: 16 to 200mg). In trials reporting intravenous iron, the mean daily elemental iron dose was 566mg (± 330mg; range 200 to 1000mg) and mean total elemental iron dose 767mg (± 206mg; range 500 to 1000mg). Among all studies, the mean duration of iron therapy was 46 days (± 30 days; range 1 to 112 days), and mean duration of follow-up was 57 days (± 24 days; range 28 to 112 days). Fatigue was evaluated in four trials enrolling 714 participants. Iron supplementation was associated with a reduction in subjective measures of fatigue when assessed by either the Piper Fatigue Scale (PFS), the Current and Past Psychological State scale (CAPPS), visual analog scale or Brief Fatigue Inventory questionnaire (BFI) (SMD -0.38; 95% CI -0.52 to -0.23; I2 0%). Work capacity was reported in 10 trials (291 participants); all but one of the trials employed at least one of three common aerobic tests of work capacity: time trial, time to exhaustion, or VO2 max performance from a graded exercise test. In two trials (79 participants) that used 15 km time trials, iron supplementation was not associated with improved exercise capacity (SMD -0.09; 95% CI -0.53 to 0.35; I2 0%). In four trials (69 participants) that used time-to-exhaustion tests, iron supplementation did not significantly improve exercise capacity (SMD 0.25; 95% CI -0.22 to 0.73; I2 0%). Nine trials (235 participants) reported VO2 max as a surrogate measure of work capacity. Iron supplementation did not increase VO2 max (SMD 0.11; 95% CI -0.15 to 0.37; I2 0%).CONCLUSION: In iron deficient non-anemic adults, iron supplementation is associated with reduced subjective measures of fatigue, but not with objective improvements in work capacity. Given the global prevalence of both iron deficiency and fatigue, patients and practitioners could consider a course of iron supplementation to improve symptoms of fatigue in presence or absence of documented anemia. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Project nEU-Med. The Contribution of Isotopic Analysis in the Differential Diagnosis of Anemia, the Case of the Medieval Cemetery of Vetricella (Scarlino, GR) in Tuscany

ABSTRACT Pathological conditions in skeletal remains, such as cribra orbitalia and porotic hyperostosis, can be caused by etiologically different forms of anemia: hereditary hemolytic anemias, iron deficiency anemias, megaloblastic anemias, etc. Though not always simple to apply, differential diagnosis of cases of anemia found in the archaeological record is essential to correlate the pathology with the wider environmental and socio-cultural context. Anthropological analysis of the skeletal sample from the archaeological site of Vetricella showed a very high prevalence of cribra orbitalia and porotic hyperostosis. The differential diagnosis between acquired and congenital anemia is essential in the study of this condition, especially considering the presence of Plasmodium falciparum in this area and its role in the possible subsequent spread of the thalassaemia gene, which was widespread until a few decades ago. Carbon and nitrogen stable isotope analysis was carried out on a large subset of the skeletal sample, including both anemic and non-anemic individuals, to investigate the nutritional patterns of the Vetricella population in order to verify whether the widespread traces of anemia might be of dietary origin. Isotope results allowed for the exclusion of the hypothesis of nutritional-deficiency anemia and supported the hypothesis of congenital anemia.

Branched-chain amino acids are linked with iron metabolism.

BackgroundThe branched-chain amino acids (BCAAs) valine, leucine and isoleucine are reported to influence erythropoiesis and the human iron status. Large study cohorts encompassing biomarkers of iron metabolism and BCAAs are still lacking.MethodsWe investigated potential interactions between blood concentrations of all three BCAAs valine, leucine and isoleucine and biomarkers of iron metabolism [i.e., hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), iron, transferrin, ferritin, transferrin saturation, soluble transferrin receptor (sTfR)] in 430 outpatients referred for a medical health check-up. Linear regression models were performed to assess possible associations between variables.ResultsAll three BCAAs were positively correlated with Hb, ferritin and the sTfR (r-values: 0.145–0.382; P values: <0.001–0.003). The strongest correlation was observed between valine and Hb (r=0.382; P value <0.001). Linear regression models showed a statistically significant influence of all three BCAAs on Hb and ferritin (β-coefficients: 0.173–0.351; all P values: <0.001). Seventeen patients with anemia (4%) were found with significantly lower serum BCAA concentrations compared to 413 non-anemic individuals (P<0.05).ConclusionsThese data indicate a pathophysiological link between the three BCAAs valine, leucine and isoleucine and the human iron indicators Hb and ferritin. Further studies are needed to clarify the exact causal mechanisms of these findings.

Interactions of Anemia, FGF-23, and Bone in Healthy Adults-Results From the Study of Health in Pomerania (SHIP).

Osteoporosis and anemia are among the most common diseases in the aging population with an increasing prevalence worldwide. As the bone-derived hormone fibroblast growth factor 23 (FGF-23) was recently reported to regulate erythropoiesis, we examined age-related associations between hemoglobin levels and bone quality, bone turnover, and FGF-23 concentrations. We used data from more than 5000 adult subjects who participated in the population-based cohorts of the Study of Health in Pomerania (SHIP and SHIP-Trend). Bone quality was assessed by quantitative ultrasound at the heel, bone turnover by measurement of carboxy-terminal telopeptide of type I collagen (CTX), and intact amino-terminal propeptide of type I procollagen (P1NP) serum concentrations, respectively. Anemia was defined as hemoglobin <13 g/dL in men and <12 g/dL in women. Carboxy-terminal FGF-23 levels were measured in plasma in a subset of 852 subjects. Anemic subjects had poorer bone quality, higher fracture risk, and lower serum levels of P1NP than nonanemic individuals. Linear regression models revealed positive associations between hemoglobin and bone quality in subjects aged 40 or above and inverse associations with CTX in subjects aged 60 or above. Hemoglobin and FGF-23 concentrations were inversely associated, while FGF-23 was not related to bone quality or turnover. Our data corroborate a close link between FGF-23 and anemia, which is related to poor bone quality in elderly people. We observed no direct association of FGF-23 with bone parameters. Further studies are needed clarifying the role of FGF-23 on bone and red blood cell production.

Anemia is associated with the risk of Crohn's disease, not ulcerative colitis: A nationwide population-based cohort study.

Anemia is a common manifestation of inflammatory bowel disease (IBD), but it remains unclear whether anemia is associated with the development of IBD. We assessed the risk of developing IBD in anemic patients, and stratified the results with respect to their hemoglobin concentrations. A population-based study was conducted using the National Healthcare Insurance Service database in South Korea. We included individuals over 20 years’ old who participated in the national health screening program in 2009 (n = 9,962,064). Anemia was defined as a hemoglobin level less than 13 g/dL in men and less than 12 g/dL in women. We compared the rate of newly diagnosed IBD in anemic patients and non-anemic individuals. Newly diagnosed IBD was identified using both the ICD-10 medical code and specialized V codes for rare intractable diseases in South Korea. During the mean follow-up period of 7.3 years, the incidences of CD and UC in anemic patients were 2.89 and 6.88 per 100,000 person-years, respectively. The risk of CD was significantly higher in anemic patients than in non-anemic individuals [adjusted hazard ratio (aHR), 2.084; 95% confidence interval (CI), 1.769–2.455]. The risk of CD development was inversely proportional to the hemoglobin concentration. A J-curve relationship was observed between age and the risk of CD in anemic patients. The risk of CD in male anemic patients was significantly higher than that in female anemic patients (aHR, 1.432 vs. 1.240, respectively). By contrast, there was no statistically significant difference in the risk of developing UC in anemic and non-anemic individuals (aHR, 0.972; 95% CI, 0.880–1.073). This work indicates that anemia is related to the development of CD, and this risk was inversely proportional to the hemoglobin concentration.

3068 – LINK BETWEEN BRANCHED-CHAIN AMINO ACIDS, IRON METABOLISM AND ANEMIA – A NEW PATHOPHYSIOLOGICAL CONCEPT

<h3>Background</h3> Branched-chain amino acids (BCAAs) are reported to influence erythropoiesis and the human iron status. This study is aimed at investigating potential interactions between blood concentrations of all three BCAAs valine, leucine and isoleucine and indicators of human iron status. <h3>Methods</h3> Overall, 430 outpatients referred for a medical health check-up were included in this study. They underwent investigation of valine, leucine and isoleucine and biomarkers of iron metabolism (i.e., hemoglobin [Hb], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], iron, transferrin, ferritin, transferrin saturation, soluble transferrin receptor [sTfR]). Linear regression models were performed to assess possible associations between variables. <h3>Results</h3> All three BCAAs were positively correlated with Hb, ferritin and the sTfR (r-values: 0.145 – 0.382; P-values: <0.001 – 0.003). The strongest correlation was observed between valine and Hb (r = 0.382; P-value < 0.001). Linear regression models showed a statistically significant influence of all three BCAAs on Hb and ferritin (ß-coefficients: 0.173 – 0.351; all P-values: < 0.001). Seventeen patients with anemia (4%) were found with significantly lower serum BCAA concentrations compared to 413 non-anemic individuals (P < 0.05). <h3>Conclusions</h3> These data indicate a pathophysiological link between the three BCAAs valine, leucine and isoleucine and the human iron indicators hemoglobin and ferritin. Anemic individuals had significantly lowered serum BCAA concentrations compared to non-anemic subjects and lowered BCAA concentrations were observed with lowered ferritin levels.

Iron deficiency in non-anemic individuals: a retrospective analysis of Libyan population

Iron deficiency may be severe despite a normal hemoglobin and full blood count. Since iron losses not met iron intake, iron stores depleted and non-anemic iron deficiency (NAID), occurs preceding iron deficiency anemia (IDA). NAID is a diagnostic challenge. Ferritin concentration is the most sensitive and specific test used for identification of iron deficiency. The study designed to determine the prevalence of Non-anemic iron deficiency (NAID). In addition, the correlation between serum ferritin with iron and hemoglobin levels in NAID. The study included (35 males and 110 females) non-anemic patients, recruited from the Al Akeed laboratory after completed a questionnaire to obtain clinical information and analyzed through SPSS version 24. Blood samples collected and analyzed for iron variables (Serum iron, total iron binding capacity (TIBC), transferrin saturation, ferritin, and hemoglobin (Hb). Based on ferritin levels non-anemic patients divided into two groups, the proportion of Normo-ferritin was 47.6% with normal iron level (96.7±50.8), Hb (13.5±2.0) UIBC (250.4±103.3) and TIBC, (342.0±94.9). Hemoglobin had significant correlation with MCHC, MCH, and MCV in this group. Low-ferritin level were 11.8±7.1 ng/mL in 76 cases suggesting the prevalence of sub-clinical iron deficiency in 52.4% cases. The levels of iron, Hemoglobin were normal. Ferritin had positive correlation with iron levels, Hemoglobin and MCH, and a highly significant but negative correlation with UIBC and TIBC. The ferritin level can be helpful in early recognition and diagnosis of IDA with appropriate interpretation of IDA. A direct relationship of iron, ferritin and transferrin with hemoglobin in non-anemic. Iron deficiency.

Iron deficiency in non-anemic individuals: a retrospective analysis of Libyan population

Iron deficiency in non-anemic individuals: a retrospective analysis of Libyan population

Association of ferritin levels with depression, anxiety, sleep quality, and physical functioning in patients with fibromyalgia syndrome: a cross-sectional study

AimTo determine the frequency of ferritin deficiency in individuals with fibromyalgia syndrome (FMS) and to evaluate the association of ferritin level with depression, anxiety, sleep quality, and physical functioning.MethodsThis cross-sectional study, conducted from 2016 to 2017, compared the frequency of ferritin deficiency between 100 non-anemic fibromyalgia patients and 100 non-anemic individuals without FMS. Serum ferritin level of <30 ng/mL indicated iron deficiency. FMS patients filled out demographic questionnaire, Fibromyalgia Impact Questionnaire, Beck Anxiety Inventory, Beck Depression Inventory, and Pittsburg Sleep Quality Index.ResultsMedian serum ferritin level was 20.95 ng/mL. A total of 64% of patients and 42% of controls had iron deficiency. Beck Anxiety Inventory, Beck Depression Inventory, and Pittsburgh Sleep Quality Index scores were not associated with ferritin levels. FMS patients with poor sleep quality had significantly higher Beck Depression Inventory, Beck Anxiety Inventory, and Fibromyalgia Impact Questionnaire scores (P < 0.05). In individuals with poor sleep quality, lower ferritin levels also correlated with higher Beck Depression Inventory scores (r = -0.277, P < 0.05). Sleep quality was not significantly associated with age, body mass index, duration of diagnosis, and serum ferritin levels.ConclusionsPatients with fibromyalgia syndrome have a rather high prevalence of non-anemic iron deficiency. No associations were found between serum ferritin level and anxiety, depression, sleep quality, and physical functioning.ClinicalTrials.gov identifier: NCT03825393.

Subclinical Iron Deficiency in Non-Anemic Individuals: A Retrospective Analysis of Korean Health Examinees

Objectives: Non-anemic individuals may have undetected subclinical iron deficiency (SID). The aims of this study were to determine the prevalence of SID and identify the associated factors for SID. In addition, the screening performance of red blood cell (RBC) indices for SID in health check-ups was assessed. Methods: This study was conducted with 16,485 non-anemic health examinees (3,567 males and 12,918 females) who underwent tests for iron variables (serum iron, total iron-binding capacity, ferritin, and iron saturation) at 16 health-promotion centers in 13 cities in Korea between January 2017 and June 2018. SID was defined as a decreased ferritin level (<24 µg/L in males and <15 µg/L in females) and either a decreased serum iron level (<44 µg/dL in males and <29 µg/dL in females) or a transferrin saturation of <20%. Results: The prevalence rates of SID were 0.6 and 3.3% in males and females, respectively. In terms of age and sex, SID was most prevalent in males aged ≥70 years (7.8%) and females aged 15–49 years (7.6%). There were significant differences in the hemoglobin (Hb) level, white blood cell count, platelet count, mean corpuscular volume, mean corpuscular Hb (MCH), and RBC distribution width (RDW) between the SID and non-SID groups (p < 0.001). The factors associated with SID in males were older age (odds ratio, OR, 1.069, 95% confidence interval, CI, 1.03–1.109, p = 0.004), lower Hb (OR 0.58, 95% CI 0.345–0.976, p = 0.04), lower MCH (OR 0.433, 95% CI 0.298–0.629, p < 0.001), and higher RDW (OR 1.374, 95% CI 1.001–1.887, p = 0.049), while in females they were lower body mass index (BMI; OR 0.929, 95% CI 0.895–0.963, p < 0.001) and younger age (OR 0.954, 95% CI 0.945–0.963, p < 0.001), as well as lower Hb, lower MCH, and higher RDW. The AUC for the MCH (0.877, 95% CI 0.793–0.960 in males; 0.872, 95% CI 0.853–0.890 in females) indicates that the MCH at cut-offs of 29.2 and 29.3 pg are the best discriminators of SID in males and females, respectively (p < 0.001). Conclusions: Reproductive-age females with a lower BMI and elderly males are high-risk groups for SID. MCH is a reliable RBC index for the screening of SID. For the population with defined risk factors, including females with lower BMI and elderly males, screening for SID is needed to prevent the development of anemia.

Unbiased Phenome-Wide Association Studies of Red Cell Distribution Width Identifies Key Associations with Pulmonary Hypertension.

Rationale: Red cell distribution width (RDW) is a prognostic factor in many diseases; however, its clinical utility remains limited because the relative value of RDW as a biomarker across disease states has not been established. Objectives: To establish an unbiased RDW disease hierarchy to guide the clinical use of RDW and to assess its relationship to cardiovascular hemodynamic and structural parameters. Methods: We performed phenome-wide association studies for RDW in discovery and replication cohorts derived from a deidentified electronic health record in nonanemic individuals. RDW values obtained within 30 days of echocardiogram or right heart catheterization were tested for association with structural and hemodynamic variables. Results: RDW was associated with 263 phenotypes in both men and women in the discovery cohort (n = 121,530), 48 of which replicated in an independent cohort (n = 2,039). The strongest associations were observed with pulmonary arterial hypertension (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.9-2.3), chronic pulmonary heart disease (OR, 2.0; 95% CI, 1.9-2.2), and congestive heart failure (OR, 1.9; 95% CI, 1.8-2.0); P < 1 × 10-74 for all. By echocardiography, RDW was higher in the setting of right ventricular dysfunction than left ventricular dysfunction (P < 0.001). Measured invasively, mean pulmonary arterial pressure was associated with RDW (21 vs. 33 mm Hg at 25th vs. 75th percentile RDW; P < 1 × 10-7) and remained strongly significant even when controlling for mean pulmonary capillary wedge pressure (21 vs. 29 mm Hg at 25th vs. 75th percentile RDW; P < 1 × 10-7). Conclusions: Among 1,364 coded medical conditions, increased RDW was strongly associated with pulmonary hypertension and heart failure. Hemodynamic and echocardiographic phenotyping confirmed these associations and underscored that the most clinically relevant phenotype associated with RDW was pulmonary hypertension. These hypothesis-generating findings highlight the potential shared pathophysiology of pulmonary hypertension and elevated RDW. Elevated RDW in the absence of anemia should alert clinicians to the potential for underlying cardiopulmonary disease.

Food taboo among pregnant Ethiopian women: magnitude, drivers, and association with anemia

BackgroundThere are pervasive pregnancy-related food taboos and myths (PRFT) in Ethiopia. The evidence, however, is limited on whether PRFT contributes to the burden of maternal anemia. Thus, this study was aimed to determine the magnitude of PRFT, the reasons for adherence to PRFT, and the association of adherence to PRFT with anemia, among pregnant Ethiopian women.MethodsThe study was case-control in design and recruited a sample of 592 pregnant women attending antenatal care in four health facilities in Addis Ababa, Ethiopia. Participants were classified into anemic cases (n = 187) and non-anemic controls (n = 405) based on their hemoglobin level. PRFT was assessed by the participants’ subjective reporting of avoidance of certain food items during the current pregnancy due to taboo reasons. The specific types of food items avoided and the underlying reasons for the avoidance were also assessed. The relation of PRFT with anemia was evaluated by multiple logistic regression analysis, controlling for covariate factors.ResultAlmost a fifth of the study participants (18.2%) avoided one or more food items due to PRFT. Adherence to PRFT was 26.2 and 14.6% among the anemic and the non-anemic individuals, respectively. The food items most avoided due to adherence to PRFT were green chili pepper, organ meat, and dark green leafy vegetables like spinach, lettuce, kale, and broccoli. The underlying reasons for the adherence to PRFT were largely traditionally held beliefs and misconceptions. After controlling for covariates, PRFT was significantly and independently associated with a higher odds of anemia [adjusted odds ratio (AOR) = 2.12, 95% confidence interval (CI) = 1.32–3.42, P = 0.002].ConclusionPRFT might be contributing to the burden of maternal anemia in Ethiopia. It is time for public health authorities in Ethiopia to recognize PRFT as a public health risk, strengthen maternal nutrition counseling, and create public awareness of the consequences of PRFT.Trial registrationClinicalTrials.gov (NCT03251664), 16 August 2017.