Predictors Of Iron Deficiency Research Articles

Diagnostic accuracy of mean corpuscular volume in detecting coexisting iron deficiency in patients of sickle cell disorders: A hospital-based study.

Co-existing iron deficiency in patients of sickle cell disease (SCD) and trait may worsen anemia, and adversely affect neuro-cognitive development and growth. Determining a cut-off below which Mean corpuscular Volume (MCV) can predict iron deficiency in SCD patients can preclude use of more expensive test serum ferritin. This study was conducted to determine the diagnostic accuracy of low MCV in detecting iron deficiency compared to serum ferritin levels in patients with SCD. 60 consecutive patients with SS or AS pattern on hemoglobin electrophoresis were enrolled. The index test (MCV) and the reference standard test (serum ferritin) were performed in a blind and independent manner. The measures of diagnostic accuracy were calculated and the precision of the point estimates were expressed by 95% confidence intervals. As MCV is a continuous variable, we also used multi-level likelihood ratios to compute diagnostic accuracy of MCV at several cut-points. The sensitivity of low MCV in detecting iron deficiency was 40.0% (95% CI-20.0-63.6), the specificity was 78.4% (95% CI-61.3-89.6) using serum ferritin as a reference standard. The sensitivity and specificity of predicting coexisting iron deficiency at this point was 60.9% (CI-38.6-80.3%) and 75.7% (CI-58.8-88.2%) respectively. The low sensitivity (40%) of microcytosis in detecting iron deficiency indicates that many cases will be missed if MCV alone is used to detect co-existing iron deficiency anemia in SCD patients. No single test is good enough to detect co-existing iron deficiency and a combination of tests might be useful.

Iron deficiency in new onset heart failure: association with clinical factors and quality of life.

The prevalence of iron deficiency (ID) in newly diagnosed heart failure (HF) and the progression of ID in patients after initiation of HF therapy are unknown. We aimed to describe the natural trajectory of ID in patients with new onset HF during the first year after HF diagnosis, assessing associations between ID, clinical factors, and quality of life (QoL). A prospective cohort of patients with new onset HF in hospitals or outpatient clinics at five major hospitals in Stockholm, Sweden, during 2015-2018 were analysed with clinical assessment, electrocardiogram, blood samples including iron levels, Minnesota living with heart failure questionnaire (MLHFQ), and echocardiogram at baseline and after 12months. Of 547 patients with new-onset HF, 482 (88%) had complete iron data at baseline. Mean age was 70years (interquartile range 61-77) and 311 (65%) were men; 55% of patients had ejection fraction (EF)≤40%, 19% had EF 41-49%, and 26% had HF with preserved EF (HFpEF). At baseline, 163 patients (34%) had ID defined as ferritin <100μg/L or ferritin 100-299μg/L and transferrin saturation <20%. After 12months of follow-up, 119 (32%) had ID of the 368 patients who had complete iron data both at baseline and after 12months and did not receive intravenous (i.v.) iron during follow-up. During the first year after HF diagnosis, 19% had persistent ID, 13% developed ID, 11% resolved ID, and 57% never had ID, consequently 24% changed their classification. Anaemia at baseline was the strongest independent predictor of ID 1year after diagnosis [odds ratio (OR) 3.91, 95% confidence interval (CI) 1.88-8.13, P<0.001], followed by HF hospitalization (OR 2.21, 95% CI 1.24-3.95, P<0.01), female sex (OR 2.04, 95% CI 1.25-3.32, P<0.01), HFpEF (OR 1.96, 95% CI 1.13-3.39, P<0.05), and diabetes mellitus (OR 1.92, 95% CI 1.06-3.48, P<0.05). ID was associated with low QoL at baseline (MLHFQ score mean difference 7.4 points, 95% CI 3.1-11.7, P<0.001), but not at follow-up. About one third of patients with new onset HF had ID both at the time of HF diagnosis and after 1year, though a quarter of the patients changed their ID status. Patients with anaemia, HF hospitalization, female gender, HFpEF, or diabetes mellitus at baseline were more likely to have ID after 1year implying that these should be carefully screened for ID to find those in need of i.v. iron treatment.

#1078 Prevalence of iron deficiency in patients admitted to a geriatric unit: analysis according to the stages of chronic kidney disease

Abstract Background and Aims Iron deficiency (ID) is a poor prognostic factor in chronic diseases such as chronic kidney disease (CKD). Indeed, independently of anemia, ID is associated with more rapid clinical worsening of CKD and is a risk factor for mortality in this condition. In older patients, CKD is common and often associated with other comorbidities. Method The CARENFER PA study is a national multicenter study designed to evaluate ID in older patients (&amp;gt;75 years) newly hospitalized in a geriatric unit. The primary endpoint was the prevalence of ID, defined as serum ferritin &amp;lt; 100 µg/L and/or transferrin saturation coefficient (TSAT) &amp;lt;20%. Absolute ID was defined as serum ferritin &amp;lt; 100 µg/L and functional ID as serum ferritin ≥ 100 µg/L and TSAT &amp;lt; 20%. In this analysis, we explored ID prevalence according to the degree of CKD. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death). Results 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were analyzed. Stages of CKD were: stage I, 3.8%; II, 53.2%; IIIa, 22.3%; IIIb, 13.3%; IV, 6.0% and V, 1.4%. ID prevalence in the entire cohort was 57.6% (495/859). When present, ID was absolute in 56.2% (278/495) of cases and functional in 43.8% (217/495). ID prevalence was 54.3% (265/488) in patients with stages I-II, and 61.9% (227/367) in patients with stages III-V (p = 0.0271). In the subgroup of anemic patients, ID prevalence was 58.9% (112/190) and 65.9% (147/223), respectively (p = 0.14). We assessed, according to the stages of CKD, various factors likely to affect or be associated with ID. Thus, in patients with at least three comorbidities, ID prevalence was 56.9% (74/130) in patients with stages I-II and 64.8% (142/219) with stages III-V (p = 0.14); in patients with heart failure, ID was present in 63.2% (36/57) and 60.3% (76/126), respectively (p = 0.71). If patients received treatments with possible effect on ID/anemia (e.g., anticoagulant, proton pump inhibitors, platelet antiaggregant), ID prevalence was 58.4% (192/329) for stages I-II and 62.7% (188/300) for stages III-V (p = 0.27). In patients with CRP ≥ 12 mg/L, ID prevalence was 73.8% (96/130) and 72.2% (117/162), respectively (p = 0.76). In univariate analysis of the entire cohort, degree of CKD (stages III-V vs. I-II), at least three comorbidities, CRP ≥ 12 mg/L, anemia and low serum albumin were significantly associated with ID. In multivariate analysis, CRP ≥ 12 mg was the only independent predictor of ID (odds ratio, 2.78; 95% CI, 1.92–4.08; p &amp;lt; 0.0001). In patients with stages I-II, physical performances were poor (SPPB score 0-6) in 44.5% (77/173) of patients without ID and 57.5% (119/207) with ID; in patients with stages III-V, SPPB scores were low in 55.6% (60/108) of patients without ID and 63.5% (106/167) with ID. Conclusion ID prevalence is high (over half of patients) in older patients admitted to a geriatric unit—particularly those with CKD—and is associated with inflammation and a low SPPB score. These new data underline the importance of more systematic screening for ID in older patients. Future randomized controlled trials should evaluate the efficacy of iron supplementation on the outcome of older patients with ID.

Validity of Mentzer Index in Predicting Iron Deficiency Anaemia

Objective: To determine the diagnostic accuracy of the Mentzer index as a screening tool for iron deficiency anaemia, using an iron profile as the gold standard in patients presenting with hypochromic microcytic anaemia. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pediatrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to May 2022. Methodology: Data was collected from 163 patients with hypochromic microcytic anaemia. Red cell indices were noted for each patient and recorded on a defined proforma. Results: The mean age of the patients was 8.23±3.57 years. 85(52.1%) patients were males and 78(47.9%) were females. Moreover, out of 163 patients, the specificity, sensitivity, negative predictive value, positive predictive value, and diagnostic accuracy of the Mentzer index for the diagnosis of iron deficiency anaemia were 90.1%, 90.1%, 84.6%, 93.8%, and 90.8%, respectively. Conclusion: The cell-count-based indices, especially the Mentzer index, are reliable and available methods for diagnosing iron deficiency anaemia. They have an accurate discrimination ability.

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.

Serum ferritin/C-reactive protein ratio is a simple and effective biomarker for diagnosing iron deficiency in the context of systemic inflammation.

Diagnosing iron deficiency is challenging in the presence of systemic inflammation. To investigate the relationship between plasma C-reactive protein (CRP), serum ferritin (SF) and transferrin saturation (TS), with the objective of establishing a straightforward ratio applicable in the presence of inflammatory syndrome. Test prospective cohort and validation retrospective cohort. A prospective cohort of inpatients (n = 140) assessed the correlation between CRP and SF/TS levels. The diagnostic performance of a determined ratio was evaluated for identifying iron deficiency (ID) using different definitions and in the presence of inflammation and/or chronic heart and/or kidney failure. A large validation cohort (n = 795) further assessed the predictive power of this ratio. In a training cohort (median age 76 years [57-84]), a linear relation was observed between SF (µg/l) and CRP (mg/l), unlike with TS. The SF/CRP ratio accurately predicted ID, with receiver operating characteristic-area under the curve (ROC-AUC) values ranging from 0.85 to 0.92 for different ID definitions. A threshold of ≤6 demonstrated the highest Youden index (0.61). In the validation cohort (age 72 years [57-84]), the SF/CRP ratio exhibited an ROC-AUC of 0.88 [95% CI: 0.85-0.90], with an odds ratio of 37.9 [95% CI: 20.3-68.9] for the threshold of ≤6. In this study, we demonstrated that the SF/CRP ratio, with a threshold of ≤6, is a simple and effective biomarker for ID, even in the presence of systemic inflammation or comorbidities. This ratio could potentially replace the complex set of criteria currently recommended by learned societies.

Iron Status of Preadolescents Without Clinical Pallor Attending a Tertiary Care Hospital in South India- A Cross-Sectional Analytical Study.

To determine the prevalence of Iron Deficiency (ID) in children without clinical pallor using serum ferritin and the new parameters, soluble transferrin receptor (sTfR) & the ratio of sTfR/log10 serum ferritin (sTfR-F index), as suggested by WHO. Also to assess whether these new parameters could individually predict the presence of ID. Consecutive 230 healthy children aged 9-11 y without clinical pallor underwent estimation of Hemoglobin (Hb), C-Reactive Protein (CRP), serum ferritin, sTfR, and sTfR-F index levels in their blood. The abilities of the sTfR and sTfR-F index in predicting ID were determined by comparing with the gold standard (normal CRP and less serum ferritin), plotting Receiver-operating characteristic (ROC) curve, and noting the area under the curve (AUC). The blood reports of 114 boys and 106 girls (total=220) were available for analysis. Overall, 57 (31 girls, 26 boys) children had ID; among children with low CRP, 45 had ID, as suggested by low serum ferritin levels. Among children with high CRP, 12 had evidence of ID as evidenced by elevated sTfR and/or sTfR-F index. The positive predictive values of both sTfR and sTfR-F were low (32.9% and 35.9%, respectively) than the negative predictive values (85.6% and 95.3%, respectively). The proportion of children identified to have ID using serum ferritin, sTfR, and sTfR-index was 25.9%. sTfRand/or sTfR-F index are unlikely to be ideal individual predictors of ID.

A study of iron status in children with cyanotic congenital heart disease

Background: Iron deficiency is a common problem in patients with cyanotic congenital heart disease (CCHD), but it is often underdiagnosed. Cyanotic patients with iron deficiency will experience higher morbidity due to symptoms of hyper viscosity. The consequences of iron deficiency anemia in cyanotic heart disease may manifest either in infancy or later. The tendency to develop metabolic acidosis and hyper-cyanotic attacks is exacerbated by relative iron deficiency anemia. This study was performed to identify the prevalence of iron deficiency in children with CCHD based on definitive tests like serum ferritin. Methods: We included 100 patients with congenital cyanotic heart diseases between 3 months to 18 years. Baseline characteristics were noted in specific proforma. Data from the blood tests were collected and analysed statistically to find out the prevalence of iron deficiency, along with tests that best predict the presence of iron deficiency. Results: Serum ferritin-based prevalence of iron deficiency in CCHD was 46%. Iron status based on haemoglobin, MCV values with the serum ferritin, and the strength of agreement were almost perfect. The strength of agreement for PCV, MCH, RDW, and peripheral smear was substantially significant. The strength of agreement for MCHC was moderate significance (Kappa value 0.41-0.60). Red cell distribution width (RDW) was an independent predictor of iron deficiency in logistic regression analysis. Conclusions: RDW seems to be a good indicator for predicting iron deficiency in children with congenital cyanotic heart diseases.

Reduced levels of hepcidin associated with lower ferritin concentration and increased number of previous donations in periodic blood donors: a pilot study.

Hepcidin is one of the major negative regulators of iron balance. Periodic blood donors are highly susceptible to have iron deficiency. Our goal was to evaluate the possible association between serum hepcidin levels and iron homeostasis parameters in periodic blood donors. We enrolled a total of n=39 periodic healthy blood donors (n=24 M and n=15 F). A solid phase enzyme-linked immunosorbent assay (ELISA) was used to measure endogenous hepcidin-25 levels in serum biospecimens collected from each study participant. Statistical analysis was performed to evaluate possible associations between hepcidin levels and ferritin, transferrin, total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC), transferrin saturation (TSAT), and number of previous donations. Reduced serum hepcidin levels significantly correlated with reduced serum ferritin concentration (r = 0.56, IC95%: 0.51-0.60, p < 0.01). A multiple linear regression analysis showed that hepcidin levels were independently and negatively correlated with ferritin (p < 0.01). In addition, the number of previous blood donations was significantly associated with reduced hepcidin levels, independently of the other covariates (p < 0.01). Reduced serum hepcidin levels were significantly associated with reduced levels of ferritin and with increased number of previous donations suggesting its possible clinical role as non-invasive "point-of-care" in predicting iron deficiency among periodic blood donors.

Predicting iron deficiency and oxidative stress in Glycine max through Fourier transform infrared spectroscopy in a time-course experiment

AimsThe excessive use of fertilizers is a problem in current agricultural systems, and sustainable farming practices, including precision agriculture, demand the use of new technologies to manage plant stress at an early stage. To sustainably manage iron (Fe) fertilization in agricultural fields, it is urgent to develop early detection methods for Fe deficiency, and linked oxidative stress, in plant leaves. Herein, the potential of using Fourier Transform Infrared (FTIR) spectroscopy for Fe deficiency and oxidative stress detection in soybean plants was evaluated.MethodsAfter a period of two weeks of hydroponic growth under optimum conditions, soybean plants were grown under Fe-sufficient (Fe+) and Fe-deficient (Fe–) hydroponic conditions for four weeks. Sampling occurred every week, infrared (IR) spectra were acquired and biological parameters (total chlorophyll, anthocyanins and carotenoids concentration, and ABTS and DPPH free radical scavenging ability), mineral concentrations, and the Fe-related genes’ expression - FRO2- and IRT1-like - were evaluated.ResultsTwo weeks after imposing Fe deficiency, plants displayed decreased antioxidant activity, and increased expression levels of FRO2- and IRT1-like genes. Regarding the PLS models developed to estimate the biological parameters and mineral concentrations, satisfactory calibration models were globally obtained with R2C from 0.93 to 0.99. FTIR spectroscopy was also able to discriminate between Fe + and Fe– plants from an early stage of stress induction with 96.3% of correct assignments.ConclusionHigh reproducibility was observed among the different spectra of each sample and FTIR spectroscopy may be an early, non-invasive, cheap, and environmentally friendly technique for IDC management.

Reticulocyte Hemoglobin Equivalent has Comparable Predictive Accuracy as Conventional Serum Iron Indices for Predicting Iron Deficiency and Anemia in a Nonhuman Primate model of Infantile Iron Deficiency

BackgroundInfantile iron deficiency (ID) causes anemia and compromises neurodevelopment. Current screening relies on hemoglobin (Hgb) determination at 1 year of age, which lacks sensitivity and specificity for timely detection of infantile ID. Low reticulocyte Hgb equivalent (RET-He) indicates ID, but its predictive accuracy relative to conventional serum iron indices is unknown. ObjectivesThe objective was to compare diagnostic accuracies of iron indices, red blood cell (RBC) indices, and RET-He for predicting the risk of ID and IDA in a nonhuman primate model of infantile ID. MethodsSerum iron, total iron binding capacity, unsaturated iron binding capacity, transferrin saturation (TSAT), Hgb, RET-He, and other RBC indices were determined at 2 wk and 2, 4, and 6 mo in breastfed male and female rhesus infants (N = 54). The diagnostic accuracies of RET-He, iron, and RBC indices for predicting the development of ID (TSAT < 20%) and IDA (Hgb < 10 g/dL + TSAT < 20%) were determined using t tests, area under the receiver operating characteristic curve (AUC) analysis, and multiple regression models. ResultsTwenty-three (42.6%) infants developed ID and 16 (29.6%) progressed to IDA. All 4 iron indices and RET-He, but not Hgb or RBC indices, predicted future risk of ID and IDA (P < 0.001). The predictive accuracy of RET-He (AUC = 0.78, SE = 0.07; P = 0.003) for IDA was comparable to that of the iron indices (AUC = 0.77–0.83, SE = 0.07; P ≤ 0.002). A RET-He threshold of 25.5 pg strongly correlated with TSAT < 20% and correctly predicted IDA in 10 of 16 infants (sensitivity: 62.5%) and falsely predicted possibility of IDA in only 4 of 38 unaffected infants (specificity: 89.5%). ConclusionsRET-He is a biomarker of impending ID/IDA in rhesus infants and can be used as a hematological parameter to screen for infantile ID.

Iron deficiency, anemia and association with refugee camp exposure among recently resettled refugees: A Canadian retrospective cohort study.

Malnutrition and poor health are common among recently resettled refugees and may be differentially associated with pre-migration exposure to refugee camp versus non-camp dwelling. We aimed to investigate the associations of iron deficiency (ID), anemia, and ID anemia (IDA) with pre-migration refugee camp exposure among recently arrived refugees to Canada. To this end, we conducted a retrospective cohort study of 1032 adult refugees who received care between January 1, 2011, and December 31, 2015, within a specialized refugee health clinic in Calgary, Canada. We evaluated the prevalence, severity, and predictors of ID, anemia, and IDA, stratified by sex. Using multivariable logistic regression, we estimated the association of refugee camp exposure with these outcomes, adjusting for age, months in Canada prior to investigations, global region of origin, and parity. Among female refugees, the prevalence of ID, anemia, and IDA was 25% (134/534), 21% (110/534), and 14% (76/534), respectively; among males, 0.8% (4/494), 1.8% (9/494), and 0% (0/494), respectively. Anemia was mild, moderate, and severe in 55% (60/110), 44% (48/110) and 1.8% (2/110) of anemic females. Refugee camp exposure was not associated with ID, anemia, or IDA while age by year (ID OR = 0.96, 95% CI 0.93-0.98; anemia OR = 0.98, 95% CI 0.96-1.00; IDA OR = 0.96, 95% CI 0.94-0.99) and months in Canada prior to investigations (ID OR = 0.85, 95% CI 0.72-1.01; anemia OR = 0.81, 95% CI 0.67-0.97; IDA OR = 0.80, 95% CI 0.64-1.00) were inversely correlated with these outcomes. ID, anemia, and IDA are common among recently arrived refugee women irrespective of refugee camp exposure. Our findings suggest these outcomes likely improve after resettlement; however, given proportionally few refugees are resettled globally, likely millions of refugee women and girls are affected.

Abstract 12537: Iron Deficiency in Korean Patients With Heart Failure

Introduction: Although iron deficiency (ID) is an important and treatable risk factor for heart failure (HF), data on ID are scarce in Asian patients with HF. Therefore, we sought to determine the prevalence and clinical characteristics of ID in hospitalized Korean patients with HF. Methods: In this prospective, multicenter cohort study, 461 patients with acute HF seen at five centers from January to November 2019 in Korea were enrolled. ID was defined as serum ferritin &lt;100 μg/L or ferritin 100-299 μg/L in combination with transferrin saturation &lt;20%. Results: The patients’ mean age was 67.6±14.9 years, and 61.8% were male. Overall, 53.8% had ID. In a multivariable logistic regression analysis, the independent predictors of ID were female sex (odds ratio [OR], 2.18; 91% confidence interval [CI], 1.46-3.26), higher heart rate (OR, 1.01; 95% CI, 1.00-1.02), anemia (OR, 1.80; 95% CI, 1.21-2.67), and the use of clopidogrel (OR, 1.67; 95% CI 1.07-2.06). Among women, the prevalence of ID did not differ between younger and older women (&lt;65 years: 73.7% vs. ≥65 years: 63.0%, P=0.222), those with low and high body mass index (BMI&lt;25 kg/m2: 66.2% vs. BMI≥25 kg/m2: 69.6%, P=0.703), and those with low and high natriuretic peptide (NP) levels (NP &lt;median: 69.8% vs. NP ≥median: 61.1%, P=0.295). Only 0.2% received intravenous iron supplementation. Conclusions: The prevalence of ID is high in hospitalized Korean patients with HF. Because ID cannot solely be diagnosed by clinical parameters, routine laboratory examinations are necessary to identify patients with ID. Efforts should be made to overcome the low use of intravenous iron supplementation in Korea.

Evaluation of Predicting the Value of the Reticulocyte Hemoglobin Equivalent for Iron Deficiency in Chronic Kidney Disease Patients

Background: Iron management is essential for anemia treatment in chronic kidney disease. The reticulocyte hemoglobin equivalent (RET-He) is a reticulocyte parameter that reflects hemoglobin synthesis of newly formed erythrocytes in the bone marrow in real-time. Objectives: This study aims to evaluate the role of reticulocyte hemoglobin equivalent (RET-He) in predicting iron deficiency in chronic kidney disease (CKD) patients. Methods: Following a descriptive cross-sectional observational design, this study was conducted on 131 adult patients with CKD stages 3 - 5. Laboratory indices, including complete blood count, some biochemical indices, iron status, and reticulocyte indices (including RET-He), were measured. Iron deficiency (ID) was defined as TSAT &lt; 20%, where serum ferritin level &gt; 100 ng/mL was defined as functional ID, while serum ferritin level

Assessment of sociodemographic predictors of iron deficiency among secondary school students in Misau LGA, Bauchi State, Northeastern Nigeria

Background: Iron is an essential micronutrient found in red meat, vegetables, and dairy products. Iron deficiency (ID) is associated with poor growth and impaired cognitive development, lowered immunity with increased risk to infectious diseases, and reduced productivity. Objective: We determined some sociodemographic predictors of ID among secondary school students in Bauchi State, Northeastern Nigeria. Materials and Methods: This was a cross-sectional study of secondary school students in Bauchi State, Northeastern Nigeria. Four hundred and twenty (420) secondary school students were enrolled using stratified sampling with proportional allocation. Data on age, gender, and sociodemographic parameters were collated. Body mass indices (BMIs) were computed while blood was taken for hemoglobin concentration and iron status determination. Collated data were analyzed using JASP 0.11.1.0. Multiple logistic regression analyses were used to adjust for possible confounders in the observed significant relationships. Level of significance was set at P ≤ 0.05. Results: The mean age of the students was 16.5 ± 1.9 years with females constituting 210 (50.0%). Median (interquartile range) monthly incomes for fathers and mothers were 150 (100, 200) USD and 50 (30, 70) USD, respectively. Median BMI and hemoglobin concentration (Hb) were 17.9 (16.4, 19.6) kg/m2 and 13.7 (12.7, 14.7) g/dL, respectively. Anemia was present in 62 (14.8%) participants, whereas ID was present in 213 (50.71%) participants. There was a statistically significant relationship between reduced intake of meat together with gender and iron status with females having a higher risk of having ID compared with males (P < 0.05). Conclusion: Female gender and decreased daily intake of meat are important predictors of ID among secondary school students in Bauchi State, Nigeria.

Prevalence and Predictors of Iron Deficiency in Adolescent and Young Adult Outpatients: Implications for Screening.

Current screening guidelines may not be adequate to identify iron deficiency (ID) and iron deficiency anemia (IDA) in adolescent and young adults. Adolescent and young adult outpatients from 4 hospital-based clinics (N = 493) reported on diet, health, and bleeding, and had phlebotomy for iron and hematologic tests. We examined sex-specific factors associated with ID and IDA and ability of universal and risk factor-based screening using hemoglobin and hemoglobin plus ferritin to detect ID and IDA. Among females (n = 350), 34.6% had ID and 6.3% had IDA. Nearly 1 in 3 females with ID had no risk factors. Among males, 12.6% had ID; none had IDA. More than 1 in 3 males with ID did not have risk factors. Current screening approaches would have missed ID in 47% to 82% of females and 95% to 100% of males. ID was prevalent in both male and female adolescents and young adult outpatients. New approaches to screening for ID are needed to accurately evaluate iron status in this population.

El hemograma como factor predictivo de déficit de hierro y/o transfusión en paciente pendiente de artroplastia

IntroductionAnemia and iron deficiency predispose to an increased risk of transfusion with a consequent increase in morbidity and mortality. The study analyzes whether blood cell count parameters in addition to detecting anemia can predict iron deficiency and/or transfusional risk in patients undergoing mostly to scheduled primary hip and knee arthroplasty. ObjectiveTo analyze how blood cell count parameters predict iron deficiency and/or transfusional risk in patients undergoing programmed arthroplasty. Material and methodsThe analytical and transfusion results of 522 patients undergoing arthroplasty have been prospectively collected between 2013 and 2019 and the discriminative and predictive capacity of the basic parameters of the red cells have been analyzed; hemoglobin (Hb), mean cell volume, mean cell hemoglobin (HCM) and red blood cell distribution width (RDW) for the identification of presurgical iron deficiency and postsurgical transfusion. ResultsAnaemia was detected in 6.6%, “suboptim” Hb (<13g/dL) in 14.5% and iron deficiency in 32.4%. Anemia detects only 13.8% of ID.After logistic regression analysis, the multivariate model significantly related Hb (p=.004), mean corpuscular hemoglobin (MCH) (p=.026), and the red cell distribution width (RDW) (p=.001) with ID; but mean corpuscular volume (MCV) is not significant.Hb, age and transferrin saturation index have been the only risk factors for transfusional risk of the parameters analyzed. ConclusionsThe hemogram contains parameters that correlate with iron deficiency, however, mean cell volume, so widely used for the orientation of iron deficiency, is not valid as a discriminator of iron deficiency in this group of patients.Low Hb and transferrin saturation index are modifiable predictors for transfusion risk.

Anthropometric Markers and Iron Status of 6-12-Year-Old Thai Children: Associations and Predictors.

Introduction Obesity may be associated with poor iron status. The objective of this study was to investigate the association between different indices of iron status and anthropometric measurements in Thai children. Materials and Methods Anthropometry (weight, height, waist circumference (WC), and body composition assessed by bioelectrical impedance analysis) and iron indices were measured in 336 Thai children aged 6–12 years. Iron deficiency (ID) was defined using two or more of the following: (1) %transferrin saturation (%Tsat) < 16%; (2) serum ferritin (SF) < 15 μg/mL; and (3) soluble transferrin receptor (sTfR) > 5 mg/L. Iron deficiency anaemia (IDA) was defined as haemoglobin < WHO age cutoff combined with ID. Overweight and obesity were defined as body mass index (BMI) standard deviation score (SDS) ≥ +1 SDS or +2 SDS, respectively (WHO growth reference). Results BMI SDS was significantly positively correlated with sTfR and SF (sTfR, r: 0.209, p < 0.001; SF, r: 0.214, p < 0.001) and negatively correlated with %Tsat (r: −0.132, p = 0.013). Correlations between WC SDS and %fat mass and each iron marker were similar. The percentage with low SF was significantly lower than that using other individual markers. ID prevalence was not significantly different between normal-weight and overweight/obesity groups although a significantly higher proportion of overweight/obese children had sTfR >5 mg/L. Puberty and menarche were significant predictors of ID (puberty adjusted OR: 2.20, 95% CI: 0.43, 11.25; menarche adjusted OR: 6.11, 95% CI: 1.21, 30.94). Conclusion Greater adiposity was associated with poorer iron status. However, SF may not be a good indicator of iron status in Thai children, particularly in those who are overweight/obese, whereas sTfR merits further investigation.

Clinical Prediction of Iron Deficiency at Age 2 Years: A National Cross-sectional Study in France

To assess the diagnostic accuracy of existing clinical criteria and to develop prediction tools for iron deficiency in 2-year-old children. In a national cross-sectional study conducted in primary care pediatricians' practices throughout France, 2-year-old children were consecutively included (2016-2017). Multivariable logistic regression modeling and bootstrapping were used to develop several clinical models to predict iron deficiency (serum ferritin <12μg/L). These models used the best criteria and combinations among the American Academy of Pediatrics' (AAP) criteria adapted to the European context (n=10), then all potential predictors (n=19). One model was then simplified into a simple prediction tool. Among 568 included infants, 38 had iron deficiency (6.7%). In univariable analyses, no significant association with iron deficiency was observed for 8 of the 10 adapted AAP criteria. Three criteria (both parents born outside the European Union, low weight at 1year old, and weaning to cow's milk without supplemental iron) were retained in the AAP model, which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.62 (95% CI, 0.58-0.67), 30% (95% CI, 22%-39%), and 95% (95% CI, 92%-97%), respectively. Four criteria were retained in a newly derived simple prediction tool (≥1 criterion among the 3 previous plus duration of iron-rich formula consumption <12months), which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72 (95% CI, 0.65-0.79), 63% (95% CI, 47%-80%), and 81% (95% CI, 70%-91%), respectively. All prediction tools achieved acceptable diagnostic accuracy. The newly derived simple prediction tool offered potential ease of use. ClinicalTrials.gov NCT02484274.

Management of iron deficiency anemia in hemodialysis patients based on mean corpuscular volume

BackgroundTo manage the anemic status in hemodialysis (HD) patients, a well-balanced combination therapy based on the use of erythropoiesis-stimulating agents (ESAs) and iron supplementation is essential. Serum ferritin level and transferrin saturation rate (TSAT) are the current standard tests for screening iron deficiency status. However, these are not included in frequently checked regular blood measurements in many HD centers. Other parameters that could predict a hemoglobin (Hb) increase response from iron supplementation have yet to be established. To determine a frequently checked and regularly measured biomarker for predicting iron deficiency status, this study investigated the value of mean corpuscular volume (MCV) as a clinical parameter for HD patients receiving intravenous iron supplementation (Fe-IV) therapy.Methods and resultsOne hundred thirty four HD patients, 88 non-HD patients with anemia, and 50 HD patients on Fe-IV therapy from the Nozatomon clinic were assessed. Comparison of MCV values of anemic HD patients and anemic non-chronic kidney disease (CKD) patients showed that anemic HD patients had significantly higher MCV values (93.9 ± 7.3 fL) compared with anemic non-CKD patients (82.8 ± 8.8fL). Fifty HD patients, who received Fe-IV therapy at ten consecutive HD sessions (inclusion criteria: Hb ≤ 12.0 g/dL, TSAT < 20%, and serum ferritin < 100 ng/mL) showed a rapid increase during the Fe-IV period in MCV, Hb, and TSAT levels. After the completion of the Fe-IV therapy, MCV persisted at the increased levels, whereas Hb levels further increased and peaked at 1 month with a gradual decline after, largely influenced by ESA dosage reductions. The 50 patients were divided into three groups according to the MCV levels obtained immediately prior to the Fe-IV therapy (MCV ≤ 85 fL, 85 fL < MCV ≤ 90 fL, MCV > 90 fL), and Hb changes at 50 days after the initiation of the Fe-IV therapy were compared. All the patients in the MCV ≤ 85 fL group and most of the patients in the 85 fL < MCV ≤ 90 fL group showed linear and consistent Hb increase during the 50-day period. In marked contrast, patients in the MCV > 90 fL group showed dispersed trends in their Hb increase. The present study also revealed that successful ESA dosage reduction could be achieved after the Fe-IV therapy in both the MCV ≤ 85 fL and 85 fL < MCV ≤ 90 fL groups.ConclusionsThe present study underscored the value of MCV in perceiving iron deficiency status as well as predicting iron-based therapeutic response in HD patients.