Positive Iron Balance Research Articles

Effect of Eculizumab on Iron Metabolism in Transfusion-independent Patients With Paroxysmal Nocturnal Hemoglobinuria

Effect of Eculizumab on Iron Metabolism in Transfusion-independent Patients With Paroxysmal Nocturnal Hemoglobinuria

Assessment of positive iron balance in end-stage renal disease: Could hepcidin-25 be useful?

The aim of our study was to examine the relationship of hepcidin-25 with red blood cell and reticulocyte indices and to evaluate the diagnostic properties of hepcidin-25 in the assessment of positive iron balance in end-stage renal disease (ESRD) patients. Eighty anemic ESRD patients (hemoglobin<110g/L) were classified as having iron deficiency (ID, N=20), iron sufficiency (IS, N=29), and positive iron balance (PB, N=31) using the conventional biomarkers for iron status evaluation. Hepcidin-25 was determined by a chemiluminescent direct ELISA. Hepcidin-25 was significantly negatively correlated with the proportion of hypochromic erythrocytes (%HYPO) (P=.034) and immature reticulocyte fraction (P=.010) in ID and with the absolute reticulocyte concentration in ID (P=.048) and PB (P=.040). In multivariate models, hepcidin-25 was independently negatively associated with the mean reticulocyte hemoglobin content (CHr; β=-0.493, P=.004) and red blood cell size factor (RSf) (β=-0.334, P=.036) only in the PB group. The best hepcidin-25 value to exclude PB was 66.13µg/L, showing a sensitivity of 61.3%, a specificity of 75.5%, and an AUC of 0.808. Our results suggest that hepcidin-25 levels are independently negatively associated with the iron demand for the most recent erythropoiesis only in PB. Hepcidin-25 performed acceptable in discriminating anemic ESRD patients with positive iron balance and may prove to be a useful additional tool in the evaluation of iron status.

Urinary iron excretion for evaluating iron chelation efficacy in children with thalassemia major

BackgroundIn patients with thalassemia major, examination routinely used for the evaluation of iron load in Indonesia is serum ferritin, but it is strongly influenced by other factors such as infections, inflammation and vitamin C levels. Evaluation of urinary iron excretion is an important and easy method to indicate iron chelation efficacy. ObjectiveTo determine the efficacy of iron chelation therapy by urinary iron examination and to evaluate its correlation with the time of transfusion, serum ferritin level, transferrin saturation and T2* MRI. MethodsProspective cohort study was conducted in children with thalassemia major aged 7–<18 years old who received DFP therapy. Twenty-four-hour urine collections were examined through inductively coupled plasma – mass spectrometry (ICP-MS). Patient's serum ferritin, transferrin saturation, peripheral blood, differential count and T2* MRI was documented during the study. Data analysis is based on urine iron level, body iron balance and the correlation between urine iron level, serum ferritin, transferrin saturation and T2* MRI and dosage of DFP. ResultsThirty (55%) subjects showed a higher urine iron level on the day prior to transfusion (mean: 12,828 SD ±12,801 μg/24 h) in comparison to post transfusion (mean: 10,985 SD ±10,023 μg/24 h). All subjects had positive iron balance (mean 524 SD ±230 mg). There were positive correlation between urine iron level and transferrin saturation (r = 0.559, p = 0.01) and serum ferritin (r = 0.291, p = 0.03), no correlation found with T2* MRI results. ConclusionsThere is a relationship to urinary iron excretion in response to chelation therapy and the degree of iron load.

Positive Iron Balance in Chronic Kidney Disease: How Much is Too Much and How to Tell?

Background: Regulation of body iron occurs at cellular, tissue, and systemic levels. In healthy individuals, iron absorption and losses are minimal, creating a virtually closed system. In the setting of chronic kidney disease and hemodialysis (HD), increased iron losses, reduced iron absorption, and limited iron availability lead to iron deficiency. Intravenous (IV) iron therapy is frequently prescribed to replace lost iron, but determining an individual’s iron balance and stores can be challenging and imprecise, contributing to uncertainty about the long-term safety of IV iron therapy. Summary: Patients on HD receiving judicious doses of IV iron are likely to be in a state of positive iron balance, yet this does not appear to confer an overt risk for clinically relevant iron toxicity. The concomitant use of iron with erythropoiesis-stimulating agents, the use of maintenance iron dosing regimens, and the reticuloendothelial distribution of hepatic iron deposition likely minimize the potential for iron toxicity in patients on HD. Key Messages: Because no single diagnostic test can, at present, accurately assess iron status and risk for toxicity, clinicians need to take an integrative approach to avoid iron doses that impose excessive exposure while ensuring sufficient replenishment of iron stores capable of overcoming hepcidin blockade and allowing for effective erythropoiesis.

Regulatory Mechanisms for Iron Homeostasis Are Present in Small Preterm Newborns

▪Iron, an essential micronutrient, plays an important role in cellular functions. To prevent deficiency, iron supplementation is universally recommended for preterm infants; nevertheless, assessment of newborn iron stores is not currently recommended. Both iron deficiency and iron excess early in life can have adverse effects on neurodevelopment and outcomes, and therefore sensitive and specific methods for evaluating iron status and determining optimal iron supplementation are essential. The current study aimed to evaluate iron status and iron-supplementation efficacy/toxicity in preterm infants using new laboratory methods, and to correlate iron status with clinical, nutritional, laboratory and therapeutic factors, and the amount of blood extracted and transfused.We evaluated 50 very low birth weight (VLBW) preterm infants treated under standard protocols at the Emek Medical Center NICU, 26 (54%) male. Iron supplementation was administered enterally from 4 wk of age (4 mg elemental iron/kg body weight daily). Laboratory studies included CBC, reticulocyte count, reticulocyte hemoglobin (Hb) content, iron, transferrin, transferrin saturation, ferritin, erythropoietin, hepcidin, CRP and non-transferrin-bound iron (NTBI) (Aferrix, Israel). Samples were obtained at 3 different times during hospitalization: (-0) before starting oral iron supplementation, (-1) on d 4-7 of supplementation, and (-2) after at least 2 wk of supplementation. To better understand iron metabolism, the analyzed preterm population was divided into subgroups for comparison: infants who did not require blood transfusion (No-BT) vs. those who received one or more transfusions (BT); infants who did not show abnormal NTBI levels (≤0.19 μmol/L; No-NTBI) vs. those with abnormal NTBI levels (≥ 0.2 μmol/L in one or more samples; NTBI).Mean birth weight of the studied infants was 1264.5 ± 342 g, gestational age 29.1 ± 2.5 wk, age at hospital discharge 57.6 ± 20 d and weight at discharge, 2412 ± 421 g. The BT group included 35 (70%) infants. The mean birth weight was lower in the BT vs. No-BT group (1199 ± 351 g vs. 1416±273 g, P = 0.04). Mean red blood cell, Hb, and hematocrit were higher in the BT vs. No-BT group. Conversely, mean platelet count, reticulocyte count, and erythropoietin were higher in the No-BT vs. BT group, suggesting an erythropoietic response to lower Hb levels and utilization of iron through effective erythropoiesis. In the BT group, mean serum iron, ferritin, transferrin saturation and hepcidin were higher, whereas transferrin was lower than in the No-BT group. This reflects increased iron burden induced by the transfusions, making NTBI more likely to develop with potential toxicity. Regarding NTBI, 34 (68%) of the infants were in the No-NTBI group, and 16 (32%) showed increased NTBI levels. The Δiron (sum of iron from diet, supplementation and transfusion minus iron output via blood extractions) before starting supplementation was significantly higher in the NTBI vs. No-NTBI group. Mean transferrin saturation at -0 was higher, whereas transferrin at -2 was lower in the NTBI vs. No-NTBI group, demonstrating a higher iron burden in NTBI infants. The odds of developing NTBI rose 7.2% for each percent increment in transferrin saturation at -0 (O.R. 1.072, 95% CI, 1.005-1.143, P = 0.036), and a cutoff of 26% at -0 gave 80% sensitivity and 41% specificity for the presence of NTBI (AUC 0.68).Thus VLBW infants show evidence of regulatory mechanisms for iron homeostasis and iron utilization for erythropoiesis; however, the protective responses are not developed enough to limit the appearance of circulating free iron with potential toxic effects. Neither adverse effects nor presence of NTBI were associated with enteral iron supplementation. Premature infants who received blood transfusions had a positive iron balance, higher Hb and ferritin levels, and reduced erythropoiesis. Consequently, these babies are more likely to develop free iron. Conventional biomarkers are effective for evaluating iron status in VLBW infants. Transferrin saturation seems to be the most reliable and "physiological" biomarker, and a potential predictor of abnormal NTBI levels. These findings support an individualized approach to iron supplementation based on the characteristics of the specific preterm infant while taking into consideration past need for blood transfusion and the infant's iron status. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The human immunodeficiency virus infection is associated with positive iron balance among subjects in Nnewi, South East Nigeria

BACKGROUND: The human immunodeficiency virus (HIV) infection is associated with a number of metabolic derangements which have a remarkable impact on disease mortality and morbidity. OBJECTIVE: To evaluate the effect of HIV infection on iron status in apparently healthy seropositive adult subjects seen at a tertiary hospital in South East Nigeria. SUBJECTS AND METHODS: A total of eighty subjects were recruited for the study which comprised of randomly selected forty HIV seropositive and seronegative individuals, respectively. Each participant had 5 ml of blood collected for serum ferritin, iron, total binding capacity (TIBC), and percentage saturation of transferrin estimation. Ferritin was determined using the enzyme-linked immunosorbent assay technique while iron and TIBC were measured by spectrophotometry; percentage transferrin saturation was calculated using the standard formula. Statistical analysis was performed using SPSS (version 20), the Student's t -test was used for the comparison of means while the level of statistical significance was set at P RESULTS: The means of serum ferritin and transferrin saturation were significantly higher (164.30 ± 138.52 ng/ml vs. 88.10 ± 57.75 ng/ml; P = 0.002 and 44.67 ± 12.95% vs. 32.42 ± 4.67%; P P = 0.004, respectively) in test subjects compared with controls. Serum iron was not significantly different in the two populations of study subjects ( P = 0.30). CONCLUSION: Infection with the HIV is associated with significant tissue iron loading; this could have important implications on disease course and morbidity.

Postdischarge Iron Requirements of the Preterm Infant

T he preterm infant has a far wider range of iron status than the typical term infant, which makes it difficult to estimate postdischarge iron requirements. Preterm infants typically are born with lower absolute iron stores than term infants and are subjected to multiple factors in the neonatal intensive care unit (NICU) that can influence iron balance positively and negatively. As a result, preterm infants can be in neutral, positive, or negative iron balance at the time of hospital discharge. It is from this base that their postdischarge iron requirements must be calculated. One must also consider variations in postdischarge growth rates because rapid growth increases iron requirements. The preterm infant at discharge may have a 40% higher growth rate than a similarly postconceptionally aged term infant as they catch up from the almost inevitable growth restriction that occurs in the NICU. An important aspect of any postdischarge iron management plan is monitoring iron status in the first year of postnatal life.

Impact of dietary intervention with a functional food supplement to combat anemia - the blood iron metabolic disorder among the coffee plantation laborers

Objective: To assess the nutritional status and other nutrition related problems of the workers. To design, implement and evaluate the impact of dietary intervention for the nutritional metabolic disorder which is directly related to productivity.Background: Indian economy greatly relies on agriculture. Agriculture is set to play a more dynamic role in the economy. The present study focuses on the nutritional status with special reference to the blood iron profile of manual coffee plantation laborers belonging to Kodaikannal, Tamil Nadu, India. The outcome of this study on the dietary intervention, based on nutritional picture of coffee plantation laborers, will have a nationwide application because of the simplified, stable coffee plantation operations throughout India.Method: Experiments were carried out in three phases. In the first phase, the personal background of the laborers was assessed. In the second phase, the nutritional and health status of the laborers, through dietary survey comprising 24 Hour Food Recall record and weighment of cooked food consumed for three consecutive days, clinical and biochemical profile were studied. The serum iron was measured with the total iron binding capacity, from which the transferrin saturation was calculated. In the third phase, dietary intervention was implemented with a nutrient rich nutraceutical food supplement - spirulina incorporated soup. The supplementation was extended for a period of 120 days. The subjects were grouped into control and the experimental group. The control group was given plain soup and the experimental group was administered with soup incorporated with spirulina. The impact of intervention on the biochemical and nutritional profile of the laborers was reassessed in similar working conditions.Results: A deficit of 0.1 mg to 0.3 mg of iron intake per kg body weight in the male and female laborers was observed when compared to their RDA. The clinical pictures reveal that 94 percent suffered from anemia, 56 percent showed anemic signs of spooning of nails (koilonychyia), 36 percent of the subjects had glossitis (mouth ulcer), 16 percent suffered from bleeding gums, 4 percent had cheilosis (ulceration of tongue) and 28 percent had angular stomatitis. The average hemoglobin level was 8.6 ± 1.12g/dl for men and 8.1±1.01g/dl for women which are 28 and 37 percent less than normal respectively. Dietary intervention of 5g of spirulina in 150 ml of soup had significantly improved the blood iron profile. Among the male laborers, 10 percent who suffered from severe anemia with 7.9 g.dl-1 hemoglobin before intervention were shifted to moderate levels of 9.4 g.dl-1, 30 percent who suffered from mild anemia were shifted to normal ones and among 60 percent of male laborers who were moderately anemic, 50 percent reverted to normalcy.Conclusion: In the present study it was observed that the habitual dietary intake showed deficiency in consumption of iron rich foods and the clinical picture revealed the signs and symptoms of anemia The blood iron profile - Hemoglobin (Hb), Serum Iron, Transferrin Saturation, Serum Ferritin, Total Iron Binding Capacity (TIBC) and Unsaturated Iron Binding Capacity (UIBC) were greatly influenced by dietary intervention with the functional food Spirulina incorporated soup The blood hemoglobin content increased by 21 percent i.e from 10.9 to 13.3g.dl-1. Serum iron, serum ferritin and transferrin levels showed a consistent and progressive rise while TIBC and UIBC reduced resulting in a positive iron balance. Keywords: Dietary intervention, functional food, Spirulina, hemoglobin, anemia

From perpetual haemosiderinuria to possible iron overload: iron redistribution in paroxysmal nocturnal haemoglobinuria patients on eculizumab by magnetic resonance imaging

From perpetual haemosiderinuria to possible iron overload: iron redistribution in paroxysmal nocturnal haemoglobinuria patients on eculizumab by magnetic resonance imaging

Iron-related parameters in Spanish mares during pregnancy

During pregnancy, metabolic adjustments occur in the mare to preserve iron stores in order to have adequate amounts for the growth and development of the equine fetus. The aim of this study was to analyze the evolution of hematocrit, iron, and ferritin in Spanish Purebred mares during pregnancy. A total of 31 Spanish broodmares aged 4–17 years old were studied during three similar periods of pregnancy (I, II, and III). Hematocrit (packed cell volume, PCV) was determined by microhematocrit and iron and ferritin concentrations were analyzed using spectrophotometry and turbidimetric methods, respectively. Pregnancy in the Spanish mare was characterized by a progressive increase in PCV and serum iron and ferritin concentrations. The physiological state of pregnancy significantly modifies iron status in these animals. In comparison with the first period, the increase in iron stores during the second and third periods indicates a positive iron balance, suggesting that the fetus can tolerate iron levels compatible with the mothers during the entire fetal development process.

Ubiquitination of lysine-331 by Kaposi's sarcoma-associated herpesvirus protein K5 targets HFE for lysosomal degradation

The nonclassical MHC class I-related (MHC-I) molecule HFE controls cellular iron homeostasis by a mechanism that has not been fully elucidated. We examined the regulation of HFE by K5, the E3 ubiquitin ligase encoded by Kaposi's sarcoma-associated herpesvirus (KSHV/HHV8), that is known to down-regulate classical MHC-I. K5 down-regulated HFE efficiently, using polyubiquitination of the membrane proximal lysine in the HFE cytoplasmic tail (K331), to target the molecule for degradation via ESCRT1/TSG101-dependent sorting from endosomes to multivesicular bodies (MVBs)/lysosomes. In the primary effusion lymphoma cell line BC-3, which carries latent KSHV, HFE was degraded rapidly upon virus reactivation. HFE was ubiquitinated on lysine-331 in unactivated BC-3 cells, conditions where K5 was not detectable, consistent with an endogenous E3 ubiquitin ligase controlling HFE expression. The results show regulated expression of HFE by ubiquitination, consistent with a role in cellular iron homeostasis, a molecular mechanism targeted by KSHV to achieve a positive iron balance.

Iron chelation therapy for patients with sickle cell disease and iron overload

A 21-year-old male with sickle cell disease (SCD) presented with severe pallor. He had received a total of 100 red blood cell (RBC) units in his lifetime, had a mean serum ferritin level of 3133 ng/ml, and liver iron concentration (LIC) of 12 mg Fe/g dry weight (dw). He was started on subcutaneous deferoxamine (DFO) infusions at a dose of 56 mg/kg/d, five days a week (equivalent to 40 mg/kg/d, seven days a week) and continued to receive 8–10 RBC units/year as treatment for pain. During the first six months of chelation therapy, his serum ferritin levels fell by around 50% of the pretreatment value, but then started to increase back up to the baseline values. The patient was noncompliant with DFO therapy. He experienced pain at the site of injection, could not sleep and was concerned about carrying a pump and not being accepted by his peers. He dropped out of college and abstained from all social activities. He was referred to a psychologist; however, this failed to improve compliance and he opted to stop DFO therapy altogether.

Relationships of alcohol intake with biological health outcomes in an African population in transition: the Transition and Health during Urbanisation in South Africa (THUSA) study

Objective: Because present recommendations on alcohol intake are based mainly on evidence of beneficial effects in populations of developed countries, this study examines biological effects of alcohol consumption in an African population in transition to assess whether these recommendations are also valid for Africans.Design: A cross-sectional, comparative, population-based study.Setting: Thirty-seven randomly selected sites in the North West province of South Africa, representing both rural and urban areas.Subjects: A total of 1 854 apparently healthy men and women older than 15 years volunteered to participate. Complete data of 1 757 participants were available for analysis. Pregnant and lactating women as well as subjects taking any form of chronic medication, those with oral temperatures above 37 °C and those who were inebriated were excluded.Outcome measures: A validated, quantitative food frequency questionnaire was used to measure dietary intake, including alcoholic beverages, expressed as absolute alcohol in grams per day. Anthropometric measurements and blood pressure were taken in triplicate using standardised equipment and procedures. Fasting blood samples were used to determine biochemical variables related to nutritional status and health. Serum gamma glutamyl transferase was used to examine the reliability of reported alcohol intake. The SPSS package was used to relate alcohol intake to blood pressure and biochemical variables, controlling for age, body mass index and blood glucose. Data from men and women, as well as drinkers and non-drinkers, were analysed separately and compared.Results: In total, 61.5% of the men and 25.2% of the women reported that they consumed alcoholic beverages. The mean alcohol intake of men (30.2 ± 47.8 g/day) exceeded the recommend value of 21 g/day. The women had a mean intake of 11.4 ± 18.8 g/day, falling within the 12 to 15 g/day recommendation. Older drinkers (> 40 years) and those infected with HIV drank more. The level of urbanisation had little effect on amounts consumed. Drinkers had significantly higher HDL cholesterol (HDL-C), serum triglycerides, blood pressure and iron status variables than non-drinkers. These effects represent some beneficial but mostly detrimental consequences of alcohol consumption. When serum ferritin was used to classify subjects into those in negative iron balance (< 12 µg/L), ‘normal’ iron balance (12–150 µg/L) and positive iron balance (> 150 µg/L), it became evident that alcohol intake almost doubled the proportion of subjects in positive iron balance (in men from 25 to 46%; in women from 11 to 23%).Conclusion: Although the beneficial effect of alcohol consumption on HDL-C was seen in this population, the effects on iron status and balance are of concern and should be researched in more detail.

Intravenous versus Oral Iron Supplementation in Peritoneal Dialysis Patients

Iron supplementation is required in a preponderance of peritoneal dialysis (PD) patients treated with erythropoietic stimulatory agents (ESAs). Although many authors and clinical practice guidelines recommend primary oral iron supplementation in ESA-treated PD patients, numerous studies have clearly demonstrated that, because of a combination of poor bioavailability of oral iron, gastrointestinal intolerance, and noncompliance, oral iron supplementation is insufficient for maintaining a positive iron balance in these patients over time. Controlled trials have demonstrated that, in iron-deficient and iron-replete PD patients alike, intravenous (IV) iron supplementation results in superior iron stores and hemoglobin levels with fewer side effects than oral iron produces. Careful monitoring of iron stores in patients receiving IV iron supplementation is important in view of conflicting epidemiologic links between IV iron loading and infection and cardiovascular disease. Emerging new iron therapies such as heme iron polypeptide and ferumoxytol may further enhance the tolerability, efficacy, and ease of administration of iron in PD patients.

Low-dose continuous iron therapy leads to a positive iron balance and decreased serum transferrin levels in chronic haemodialysis patients.

Iron balance is critical for adequate erythropoiesis, but its optimal therapeutic regimen remains to be defined. Continuous maintenance therapy with iron has been proposed for dialysis patients on recombinant human erythropoietin (rHuEpo) in the hope that the regimen is adequate and safe. We determined serum ferritin, transferrin, transferrin saturation (TSAT), serum transferrin receptors, albumin and C-reactive protein (CRP) in a 3-year prospective study in 30 chronic haemodialysis patients on dialysis treatment for 132+/-111 months (18 males, 12 females; mean age 56+/-14 years). Beginning in the year 2000, they regularly received low-dose maintenance iron supplementation (i.v. iron gluconate 31.25 mg/week) for 12 months (Period 1 or first treatment phase), followed by a 6-month withdrawal (Period 2 or stop phase) and then by continuous maintenance iron therapy (i.v. iron gluconate 31.25 mg/week) for another 9 months (Period 3 or re-challenge phase). A significant increase in serum ferritin and TSAT was observed, with values exceeding 500 ng/ml and 50% in 10/30 (33%) and 7/30 (23%) of subjects, respectively, in Period 1, and in 11 and 5% in Period 3. A significant decrease in serum transferrin was documented during Period 1, followed by an increase in Period 2 and a decrease in Period 3. Serum albumin remained stable. Serum transferrin was always negatively correlated with ferritin (r = -0.41, P<0.001) and weakly correlated with serum transferrin receptors (r = 0.178, P<0.05), but was not correlated with serum albumin or CRP. Regression equations based on pre-treatment serum ferritin values were developed for predicting the value of serum ferritin at any time following the beginning of continuous iron supplementation. They fitted a linear relationship for males (y = 81 + 21.5 x time) and for females (y = 65 + 22 x time). Percentile charts for quantitative tracking of serum ferritin increases and decreases in patients have also been developed from values measured at different times. These charts show box-plot distributions of expected ferritin against time. Even continuous low-dose maintenance iron therapy, with only 31.25 mg weekly over 1 year, cannot prevent the risk of iron overload in patients with moderate anaemia. Furthermore, this treatment is responsible for decreases in serum transferrin, unrelated to changes in serum albumin, possibly of concern for hypo-transferrinaemia as an independent risk factor for iron toxicity.

Oral versus Intravenous Iron Supplementation in Peritoneal Dialysis Patients

The vast majority of erythropoietin (EPO)-treated peritoneal dialysis (PD) patients require iron supplementation. Most authors and clinical practice guidelines recommend primary oral iron supplementation in PD patients because it is more practical and less expensive. However, numerous studies have clearly demonstrated that oral iron therapy is unable to maintain EPO-treated PD patients in positive iron balance. Once patients become iron-deficient, intravenous iron administration has been found to more effectively augment iron stores and hematologic response than does oral therapy. We recently performed a prospective, cross-over trial in 28 iron-replete PD patients and showed that twice-monthly outpatient iron polymaltose infusions (200 mg) were a practical and safe alternative to oral iron. That treatment produced significant increases in hemoglobin concentration and body iron stores. The additional expense of intravenous iron therapy was completely offset by reductions in EPO dosage. Careful monitoring of iron stores is important in patients receiving intravenous iron supplementation in view of epidemiologic links with infection and cardiovascular disease. Nevertheless, a growing body of evidence suggests that, as has been found for hemodialysis patients, intravenous iron therapy is superior to oral iron supplementation in EPO-treated PD patients.

Could Long-Term Alimentary Iron Overload Have an Impact on the Parameters of Oxidative Stress?

The effects of long-term alimentary (drinking water) iron overload on the parameters of oxidative stress were evaluated. The study group (n = 35) from a village in southern Estonia was 37.1 ± 13.3 years old, and the mean period of drinking water iron overload was 20.6 ± 9.3 years. The serum iron content was significantly higher than normal. The total iron-binding capacity of serum tended to be lowered. There was no change in the transferrin content. The parameters of lipid peroxidation like conjugated dienes and thiobarbituric acid reactive substances showed also significant differences. In addition, the red blood cell glutathione content was also decreased. The total antioxidant capacity of serum was not changed. It can be concluded from our results that a long-term alimentary iron overload results in a positive serum iron balance, which, in turn, yields an increased oxidative stress.

Serum Ferritin Iron, a New Test, Measures Human Body Iron Stores Unconfounded by Inflammation

Serum ferritin protein is an acute phase reactant. We hypothesized that serum ferritin protein generated in response to an inflammatory process would have much less iron (Fe) in it than would "normal" ferritin protein, and therefore measuring serum ferritin iron would assess human body iron status unconfounded by inflammation. We measured serum ferritin iron in 140 clinical samples obtained from the serum banks of Bronx VA Medical Center Hematology and Nutrition Laboratory (Bronx, NY), the CDC Nutritional Biochemistry serum sample bank (Atlanta, GA), and the sample bank from patients with thalassemia and iron overload treated at New York Hospital (New York, NY). Each was analyzed for three conventional criteria of iron status: serum iron, percentage of transferrin saturation and ferritin protein. In addition, tests for inflammation were also performed: C-reactive protein, WBC and transaminases. Seventy-seven patients' sera from 140 screened met each of three consistent criteria for stages of iron status. Serum ferritin was immobilized by immunoprecipitation with rabbit antihuman polyclonal antibody bound to agarose and separated from other iron-containing proteins, digested with 0.2 ml of 3N nitric acid and analyzed for iron content by atomic absorption spectroscopy. Serum ferritin iron ranged in normal controls from 10 ng to 35 ng Fe/ml. The patients with iron deficiency (4/4) and those in negative iron balance (5/6) had values < or = 10 ng. Positive iron balance (8/9) and iron overload (22/22) values were > 35 ng/ml, in contrast to 11/19 with inflammation. Seventeen of twenty-two with overload had values > 100 ng/ml while only 1/19 with inflammation had such a value. Ferritin iron in ferritin protein was > 15% by weight in 14/22 with iron overload but in 0/19 with inflammation. Serum ferritin iron is a simple, direct measure of iron stores that we propose, in conjunction with measuring serum ferritin protein, as a minimally invasive screening procedure for accurately assessing the whole range of human body iron status, unconfounded by inflammation.

Serum ferritin levels in carriers of beta-thalassaemia trait.

Hypochromic and microcytic red cell morphology is the most commonly encountered abnormality in a clinical laboratory. Most of such cases have iron deficiency anaemia. However, in Pakistan about 5% of the individuals with a hypochromic and microcytic blood picture have the beta-thalassaemia trait. These individuals are more than often in a positive iron balance. However iron deficiency (being common) may be associated with the beta-thalassaemia trait. This study of serum ferritin levels was carried out on 135 confirmed cases of the beta-thalassaemia trait. A ferritin assay was done by a radioimmunoassay technique. The results show that the level of serum ferritin in 100 (74%) cases was within normal limits, in 17 (12.6%) cases it was above the normal range, whereas in 18 (13.4%) cases the level was lower than normal. The importance of serum ferritin estimation in carriers of the beta-thalassaemia trait is highlighted.

Zinc and iron utilization in young women consuming a beef-based diet

The purpose of this study was to determine the utilization of zinc in young adult women fed diets containing varying amounts of lean ground beef. A secondary objective was to determine the utilization of iron. The 28-day study was divided into one 7-day preexperimental period, during which a vegetarian diet was fed, and three randomly arranged 7-day experimental periods. During the experimental periods, the diets contained 3, 6, or 9 oz of beef, supplying varying levels of zinc and iron. Complete collections of urine and fecal samples were obtained from each subject. All the diets resulted in positive zinc balance; however, mean zinc balances were significantly higher when subjects consumed the experimental diets containing beef. When data for all diets containing beef were combined, mean values for apparent zinc absorption and zinc retention were not significantly higher than values that resulted from the vegetarian diet. Consumption of all diets resulted in a positive iron balance; however, mean iron balances were significantly higher for diets containing beef. As the amount of beef in the diet increased, the bioavailability of iron increased. We found that zinc and iron utilization was enhanced after consumption of a diet including lean ground beef. Results of this study also suggest that little increase in zinc and iron utilization is realized by including more than 3 oz beef per day in the diet.