Non-anemic Women Research Articles

Facts and Artifacts About Anemia and Preterm Delivery-Reply

In Reply.— We appreciate the opportunity to respond to the thoughtful criticisms by Lieberman et al. These criticisms involve our interpretation of the literature, the age of the Collaborative Perinatal Project, potential nonindependence of the observations, and the possibility that women who have repeated hematocrits are different from the general population. We address each of these concerns. Our purpose in citing Nilsen et al 1 was to provide supporting evidence for our contention that hematocrit rises during the third trimester of a normal pregnancy, not to address the relationship between anemia and preterm birth. These investigators demonstrated that in normal pregnancies to nonsmoking, nonanemic women, the hemoglobin level rose approximately 5 g/L between 25 to 30 weeks and term. Taylor and Lind, 2 who studied unselected British women, noted that among those who received iron, the mean hematocrit increased from 33 percent at 26 to 30 weeks to 36 percent at

Serum perritin as a measure of iron stores in normal indian subjects and pregnant women

Serum ferritin has been estimated by ELISA (double antibody sandwich technique) in 225 normal and anaemic subjects as well as pregnant women. It was log-normally distributed with a geometric mean of 58.9 ng/ml in 60 normal males and 31.6 ng/ml in 58 normal females. In 75 nonanaemic pregnant women, it was 21.9 ng/ml in the first trimester, 19.5 ng/ml in the second trimester and 14.4 ng/ml in the third trimester of pregnancy. In 32 nonpregnant anaemic women, it was 9.0 ng/ml. There was no correlation between serum ferritin and serum iron or transferrin saturation. In 46.8% of anaemic women, serum ferritin was elevated in the face of anaemia and low transferrin saturation, limiting the value of serum ferritin as a universal tool for the assessment of iron deficiency, at least in this geographic region where iron deficient states are often complicated by infections.

Serum ferritin, folate and cobalamin levels and their correlation with anemia in normal full-term pregnant women

Serum ferritin, folate, cobalamin and hemoglobin concentrations were determined by radioimmunoassay, radioisotopic assay, radioassay and an automated hematology analyser respectively, and then analysed in 221 normal full-term pregnant women in order to evaluate the incidence and the prevalence of nutritional anemia in pregnancy. None of them had received any hematonic during their pregnancy. Their mean age was 27.68 years and the mean duration of pregnancy was 39.51 weeks. Twenty-three (10.41%) of these previously non-anemic pregnant women had clinical anemia after full-term pregnancy. Of the 23 women, 11 (47.83%) had iron-deficiency anemia, with serum ferritin less than 12 μg/l; another 11 women had some degree of iron depletion, with serum ferritin less than 20 μg/l. So in 22 of the 23 anemic women (95.65%) the cause of anemia may correlate to iron depletion. The remaining one had folate-deficiency anemia. No pure cobalamin deficiency anemia was found in this study. Among the 198 non-anemic normal full-term pregnant women, 92 (46.46%) had iron depletion (serum ferritin < 20 μg/l), of whom 35 (17.68%) had severe iron deficiency, with serum ferritin less than 12 μg/l. Another 3 had folate deficiency and 3 had cobalamin deficiency. By including all the anemic and non-anemic pregnant women, 114 (51.58%) of them had some degree of iron depletion. In other words, pregnancy can produce a considerable degree of iron depletion in more than half of the previously non-anemic women.

Correlation between 2,3-diphosphoglycerate and red cell mass in the third trimester of pregnancy.

In 30 non-anemic, and in 7 non-thalassemic, anemic pregnant women the red cell mass (RCM) was determined at 32-36 weeks of pregnancy, using isotopes, and was correlated with red cell 2,3-DPG, using the method of Keitt. The increase in 2,3-DPG in pregnant women with low RCM was in the same range as in those with increased RCM. Thus, 2,3-DPG can not be used to diagnose a RCM deficit in pregnancy. The relationship between 2,3-DPG and RCM in the third trimester was complex: in the 7 anemic women there was an inverse relationship, which failed to reach statistical significance, probably because of the small number of cases; in the 30 non-anemic women there was a significant, positive correlation between 2,3-DPG and RCM. The cause of this positive relationship needs further investigation.

Plasma immunoreactive erythropoietin in normal women studied sequentially during and after pregnancy

Six healthy, nonanemic women with uncomplicated singleton pregnancies were sequentially studied for plasma immunoreactive erythropoietin levels, hematologic indices, and human placental lactogen. Mean group levels of erythropoietin as well as human placental lactogen were significantly increased (p < 0.01) after 18 weeks' gestation compared to nonpregnant values (20 to 30 weeks post partum). However, individual responses of erythropoietin during pregnancy were found to be highly variable. There was a direct correlation of both maternal plasma erythropoietin and human placental lactogen with gestational age (p < 0.001) but no detectable relation of erythropoietin with human placental lactogen levels. We speculate that the increase in erythropoietin levels during pregnancy acts as a trophic stimulus for effecting an increase in maternal red blood cell mass presumably to meet the increased metabolic (oxygen) demands of pregnancy.

Prevalences of anemia and iron deficiency anemia in Black and White women in the United States estimated by two methods.

Prevalences of anemia were estimated by two methods for 742 Black and 3,074 White nonpregnant women of childbearing age drawn from a large probability sample of the United States civilian noninstitutionalized population (NHANES I). One method defines the prevalence of anemia as the proportion of women with hemoglobin levels below a 12 g/dl "cut-off". The second method defines the prevalence of anemia as the proportion of women whose hemoglobin values are shifted downwards relative to a distribution of hemoglobin values of non-anemic women. Estimates produced by both methods suggest a higher prevalence of anemia in Black than in White women. Estimates produced by the "cut-off" method, however, are higher than those from the "distribution" method for both racial groups, probably because the "cut-off" method results in large overestimates in populations where anemia prevalence is low. The "distribution" method is further used to estimate the contribution of iron deficiency to anemia. Essentially all anemia in White women and a high proportion of anemia in Black women is associated with iron deficiency in the US civilian noninstitutionalized population. Iron supplementation trials are needed in order to define the magnitude of the problem accurately and plan appropriate public health programs.

Influence of thyroid status on hemoglobin A2 expression.

We studied the electrophoretic pattern of hemoglobin (Hb) and red blood cell indices in 128 women divided into four groups: group I, 36 nonanemic hyperthyroid women, divided in two subgroups: 36 with untreated hyperthyroidism (subgroup IA) and 9 made euthyroid by antithyroid drug therapy (subgroup IB); group II, 12 nonanemic women with untreated hypothyroidism; group III, 30 women known to be heterozygous for beta-thalassemia; and group IV, 50 healthy women. The mean (+/- SEM) HbA2 level was higher (P less than 0.001) in subgroup IA (3.21 +/- 0.06%) than in subgroup IB (2.42 +/- 0.09%) and group IV (2.48 +/- 0.04%), but lower (P less than 0.001) than in group III (5.26 +/- 0.12%). The mean HbA2 level was lower (P less than 0.001) in group II (1.99 +/- 0.08%) than in group IV. Hb fetal was detectable in eight patients of subgroup IA and undetectable in subgroup IB and groups II and IV. The mean cellular volume was lower (P less than 0.001) in subgroup IA than in other nonanemic groups. The mean cellular volume was higher (P less than 0.001) in group II than in group IV. Follow-up of nine patients who became euthyroid with treatment showed the normalization of these erythrocyte parameters. These results suggest that thyroid hormones can modulate the synthesis of delta- and gamma-globin chains.

Haemoconcentration in Severe Pre-eclampsia

The last maternal haemoglobin (Hb) concentration before delivery was related to the perinatal outcome in 87 non-anaemic women suffering from severe pre-eclampsia. Abnormally high Hb concentrations were found in most women with evidence of placental dysfunction. An inverse correlation was found between the centile weight of the newborn and the maternal Hb. Significantly higher Hb levels were found in pregnancies complicated by fetal growth retardation and perinatal distress compared with those in pregnancies with good outcomes. Particularly high levels were found in pregnancies that ended in perinatal deaths. The hypothesis is put forward that raised haemoconcentration during severe pre-eclampsia causes increased blood viscosity which predisposes to placental pathology and initiates a vicious circle.

Haemoconcentration in severe pre-eclampsia.

The last maternal haemoglobin (Hb) concentration before delivery was related to the perinatal outcome in 87 non-anaemic women suffering from severe pre-eclampsia. Abnormally high Hb concentrations were found in most women with evidence of placental dysfunction. An inverse correlation was found between the centile weight of the newborn and the maternal Hb. Significantly higher Hb levels were found in pregnancies complicated by fetal growth retardation and perinatal distress compared with those in pregnancies with good outcomes. Particularly high levels were found in pregnancies that ended in perinatal deaths. The hypothesis is put forward that raised haemoconcentration during severe pre-eclampsia causes increased blood viscosity which predisposes to placental pathology and initiates a vicious circle.

Anemia of pregnancy: evaluation of the effectiveness of routine dietary supplementation program in an Israeli community.

Of 514 Israeli women 4-5 months pregnant, 200 who were non-anemic (Hb 11 gm/100 ml or higher) took a daily supplement of ferrous sulfate (100 mg elemental iron). The 160 who remained on this regimen showed, as a group significantly less reduction in hemoglobin levels than 180 non-anemic women who did not wish to take the supplement. Forty of the 200 women either dropped out or were shifted to other treatment regimens because they developed anemia after the fifth month.

Fetal growth retardation associated with inadequate haemodilution in otherwise uncomplicated pregnancy

The Hb level during pregnancy was followed in 113 non-anaemic women with uncomplicated pregnancy and birth weight of the baby above the 2.5th percentile. There was an inverse correlation close to statistical significance between the birth weight of the baby and the lowest Hb level reached during pregnancy as well as the Hb level in late pregnancy (38th week). A group of seven non-anaemic women with birth weight of the baby below the 2.5th percentile had a significantly higher (p less than 0.001) Hb level in late pregnancy than the normal group. Four of these cases had a statistically significant higher Hb level already in the second trimester. Trends in the reproductive history, complaints in the present pregnancy as well as results of hormone assays and the condition of the baby indicated that the seven cases represented a pathological group with fetal growth retardation. None of the women in the two groups were treated with diuretics. All had iron supplementation in high doses.

Iron deficiency in pregnant women in Ibarapa District of Western Nigeria.

Ninety-nine pregnant women with anaemia (haematocrit less than 0.30) were detected by antenatal screening in Ibarapa District. Studies on 23 anaemic women and 17 non-anaemic women from the same clinic on the same day showed that eight out of 23 anaemic women had a transferrin saturation of less than 15%. The mean level (19.5%) for the anaemic patients was significantly less than that found in the nonanaemic controls; mean 33.0% (P less than 0.01). Bone marrow studies on 32 anaemic women revealed megaloblastic change and absent iron in 27 of the 32 patients. In a trial of parenteral iron treatment in 66 patients the mean haematocrit of Imferon treated patients rose from 0.27 to 0.32 in 6 weeks but remained at 0.28 or less in the controls. There was a significant difference between the iron-treated group and the comparable group receiving no imferon (P less than 0.001 at 6 weeks). The method of using parenteral iron treatment to make a diagnosis of iron deficiency anaemia is discussed together with the possible advantages and disadvantages of giving iron.

Nutritional studies on food intake and blood contents of anemic and non-anemic women in a farm village.

To account for the high incidence of anemia among women living in farm villages, studies were made on the state of the nutritional intake in relation to blood contents of anemic women living in a farm village of the north-eastern district of Japan, and the results were compared with similar values of non-anemic women.It was found that anemic women generally had a small intake of vitamin B1, energy and protein, especially vitamin B1 intake of anemic women showed a significant low level and their energy intake on the average showed to be about 150 Cal insufficient compared with non-anemic women. Calculated amount of iron intake seemed to be sufficient, but estimated values were considerably lower and this point requires further examinations. From the blood contents, hemoglobin showed a significant positive correlation not only with serum iron but also serum cholesterol and serum protein, in both anemic and non-anemic women.From these findings, it is suggested that the amount of energy intake in the daily diet, including intakes of fat and protein, should be taken into consideration, in addition to the increase in the intake of iron and animal protein, for improving anemia which was found to occur very frequently in the farm village women.

Folic acid and folate binding protein in pregnancy.

Folic acid and folate binding protein (FABP) concentrations were determined in 208 pregnant women as well as in 50 non-pregnant women. Serum folate levels in pregnant women were significantly lower than those of the non-pregnant group. Anaemic pregnant women also had lower serum folate concentrations than those of the non-anaemic pregnant women. Ninetyeight of 208 (47.1%) pregnant women had serum folate levels of less than 4ng/ml. No significant difference in red cell folate concentration between the pregnant and non-pregnant groups was demonstrated, and only 5 of 206 (2.4%) of pregnant women had red cell folate levels of less than 200ng/ml. Serum FABP levels in preg-nant women were also found to be significantly higher (p<0.001) than those of the non-pregnant women. These levels were also found to be higher in the anaemic pregnant group and in pregnant women with serum folate concentration less than 4ng/ml than those of the non-anaemic pregnant women and pregnant women with serum folate concentration higher than 4ng/ml, respectively. There was a direct relationship between the serum FABP levels and the gestation period. As the period of pregnancy advanced higher serum FABP levels were demonstrated. No correlation between the gravida and the serum FABP levels was found in this study.

RETICULOCYTES IN HEALTHY PREGNANCY

High reticulocyte counts are commonly found during pregnancy in non-anaemic Greek and Italian women, whereas in Anglo-Saxon women counts rarely rise above 2-0%. In this study, the Greek and Italian groups had peak mean values of 2-9%, although it occurred some weeks earlier in the Italian group. The Anglo-Saxon group's peak mean value was only 1-5%. The differences between the Anglo-Saxon and other groups are statistically highly significant and should be recognized when assessing haematological profiles in apparently normal women.

Prevention of folate deficiency by food fortification. IV. Identification of target groups in addition to pregnant women in an adult rural population

In a rural Negro population subsisting on a predominantly maize meal diet, the incidence of folate deficiency was 43.8% in nonanaemic women in late pregnancy, 32.1% in nonpregnant women, and 18.6% in adult males. More than one-third of all subjects older than 60 were deficient. No instance of unequivocal vitamin B12 deficiency was revealed in 431 subjects sampled, and it is considered that the hazards of giving a small daily dose of folic acid in this population are negligible. These findings warrant food fortification with folic acid in this and similar population groups.

Hematological responses to oral administration of iron polymoltose complex in anemic and normal pregnant women: A comparative study

Anemia is a common medical disorder affecting a lot of women in pregnancy in the developing countries. Daily oral iron supplementation during pregnancy reduces the prevalence of anemia. In the present study we have compared the hematological responses to oral iron therapy using the formulation of iron poly maltose complex in anemic and normal pregnant women. The haemoglobin (Hb) level and other blood parameters were studied in anemic and non-anemic pregnant women both before and after oral iron therapy. Hemoglobin, iron indicators improved significantly with oral iron therapy and appear to have good compliance and efficacy. This helps us to assess the varied comparative responses in both the categories. The study will be indicative about the rational use of iron in iron deficiency anemia. Key words: Anemia; blood; hemoglobin; deficiency. DOI: 10.3126/jcmsn.v6i3.4067Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.1-7

Storage iron depletion in male blood donors: its significance for iron status in women.

Among 24 male blood donors without anaemia who had been giving a mean of 2.2 donations per year involving a mean blood loss of about 900 ml a year, 10 (41%) were found to be depleted of storage iron. This is somewhat higher but similar to the previously recorded findings in healthy women without anaemia. The results may well support a policy of limiting blood donation to twice a year in men and to once a year in women. Both men and women blood donors require medicinal iron after each donation. It is considered that storage iron depletion in non-anaemic women is not in the main related to pathological levels of menstrual loss but rather to inadequate dietary iron. Food iron in present-day diets should be supplemented.