S-ferritin Levels Research Articles

Effects of iron supplementation to iron depleted and iron replete pregnant Danish women: Defining criteria for identification of women who can manage without supplements. A randomized, placebo-controlled study.

To define criteria based on iron status parameters for the identification of healthy women who do need/do not need iron supplementation during normal pregnancy. Randomized, double-blind, placebo-controlled study of 113 women (62 iron-, 51 placebo treated) and their newborns. Iron dose was 66 mg elemental iron as ferrous fumarate daily from 14-18 weeks gestation to delivery. Hemoglobin (Hb), serum (S)-ferritin, S-transferrin saturation percentage, and S-erythropoietin were measured during gestation, prepartum, one week and 8 weeks postpartum. The women were divided in groups according to S-ferritin levels at inclusion:<30,≥30,≥40,≥50 and≥60μg/L. Iron deficiency (ID) was defined as S-ferritin < 15μg/L; iron deficiency anemia (IDA) as S-ferritin < 15μg/L and Hb < 110 g/L. Placebo treated women with S-ferritin levels < 30μg/L at inclusion had a much higher incidence of ID/IDA than placebo treated women with S-ferritin levels≥30,≥40,≥50, and≥60μg/L. S-ferritin levels≥40μg/L were associated with a very low risk of ID/IDA and none of the women with levels≥50 and≥60μg/L displayed ID/IDA. Women having S-ferritin < 30μg/L in early pregnancy, have a high risk of ID/IDA and should be recommended ferrous iron supplements in appropriate doses. With increasing iron reserves, i.e., increasing S-ferritin, the need for iron supplements diminishes, and placebo treated women having S-ferritin ≥40μg/L seldom develop IDA. Women with S-ferritin levels≥50 and≥60μg/L or higher, have adequate iron reserves and do not need routine iron prophylaxis in pregnancy. The results support the arguments for an individual iron supplementation guided by iron status, to avoid unwanted side effects of unnecessary iron intake.

Relationship between iron deficiency and expression of genes involved in iron metabolism in human myocardium and skeletal muscle

BackgroundIron deficiency (ID) is associated with adverse prognosis in patients with heart failure. This study aims to investigate the relationship between ID and expression of genes involved in iron metabolism in human myocardium and skeletal muscle, focusing on Transferrin 1 receptor (TfR1), the main pathway of cellular iron uptake. MethodsPatients undergoing elective CABG were assessed prior to surgery with echocardiography and serum iron parameters. Core needle biopsies were collected from the left and right ventricle (LV, RV), the right atrium and intercostal skeletal muscle (SM). Gene expression analyses were done by mRNA sequencing. ResultsOf 69 patients (median age 69 years, 91% men), 28% had ID. 26% had HFrEF, 25% had HFpEF physiology according to echocardiographic findings and NT-proBNP levels, and 49% had normal LV function. The expression of TfR1 was increased in patients with ID compared to patients without ID in ventricular tissue (p = 0.04) and in intercostal SM (p = 0.01). The increase in TfR1 expression in LV and RV was more pronounced when analysing patients with absolute ID (S-Ferritin<100 μg/L). Analysing the correlation between various iron parameters, S-Ferritin levels showed the strongest correlation with TfR1 expression. There was no correlation with NT-proBNP levels and no difference in TfR1 expression between different HF phenotypes. ConclusionsIn patients undergoing elective CABG we found an association between ID and increased TfR1 expression in myocardium regardless of LV function, indicating physiologically upregulated TfR1 expression in the presence of ID to restore intracellular iron needs.Clinical Trial Registration:Clinicaltrials.govNCT03671122

Iron supplementation in pregnant Danish women revisited: Effects on prepartum and postpartum iron deficiency, anemia, serum erythropoietin; including iron status, erythropoietin and anthropometrics in newborns. A randomized, placebo-controlled study.

To assess effects of iron supplementation, 66 mg elemental iron daily as ferrous fumarate, on iron status markers during normal pregnancies. Randomized, double-blind, placebo-controlled study of 119 women (62 iron-, 57 placebo -treated) and their newborns. Hemoglobin (Hb), serum (S)-ferritin, S-transferrin saturation percentage (TSAT) and S-erythropoietin (S-EPO) were measured at 14-18, 24-27 weeks of gestation, prepartum, 1 and 8 weeks postpartum. From 24-27 weeks gestation to 8 weeks postpartum, the iron group had higher Hb, S-ferritin and TSAT than the placebo group; prepartum, 11% had iron deficiency (ID) and 0% iron deficiency anemia (IDA) in the iron group, vs 60% and 18% in the placebo group; 8 weeks postpartum 1.6% in the iron group had ID and 1.6% IDA vs 14% and 7% in the placebo group. S-EPO levels in the iron group were lower than in the placebo group (p < 0.001). Mothers prepartum S-EPO values were correlated to newborns cord S-EPO values (p < 0.001). Newborns to iron treated mothers had higher cord S-ferritin levels than those to placebo treated mothers (p = 0.02). Newborn girls had higher cord S-ferritin levels than boys (p < 0.01). There was no impact of iron supplementation on the length of gestation, placental weight, or newborns birth weight. Birth weight was correlated only with mothers' body weight, length of gestation and placental weight. Iron supplementation had a "positive" impact on iron status and Hb both during pregnancy and postpartum, with a low frequency of ID/IDA and also a "positive" influence on newborns iron status.

P-416 Low serum ferritin level might be associated with an increased risk of miscarriages in infertility patietns

Abstract Study question Does infertility patients with low serum ferritin have a increased risk of miscarriages and can it be amended by ferric carboxymaltose infusion prior to treatment Summary answer The miscarriage rate is higher in patients with low S-Ferrit and can be reduced by correcting the iron deposits with ferric carboxymaltose infusion What is known already Iron deficiency is common in fertile age women and seen in around 25 % of women in industrialized countries and up to 50 % in women from developing countries. There are very few studies on the relationship between low iron deposits and infertility. A recent Danish study shows that the lower serum Ferritin levels are, the higher is the risk for repeated miscarriages (Georgsen et al, Fertility &amp; Sterility 2020). A person’s iron deposits are considered empty if S-Ferrit is &amp;lt; 30 ug/l. Study design, size, duration We wanted to see how common iron deficiency is in our patient population, defined as S-Ferrit &amp;lt; 30 ug/l, measured in 858 consecutive infertility patients during years 2015-2019. Thereafter the iron deposits were filled in those with low ferritin and a wish for i.v. ferric carboxymaltose infusion. The patients were followed up in a retrospective manner for their reproductive history both before and after the infusion especially regarding the miscarriage rate and live birth rate. Participants/materials, setting, methods This is an interim analysis of the first 215 patients with infertility and age younger than 43 years. All patients had a S-Ferrit &amp;lt; 30 ug/l prior to ferric carboxymaltose infusion of 500 mg i.v. The infusions were done from December 2015 to December 2019. Patients with any other indication than history of infertility and S-Ferrit &amp;lt; 30ug/l were excluded from the study. All patients were treated at one private infertility clinic in Helsinki. Main results and the role of chance In our 858 patients, the mean S-Ferrit was 41 ug/l and 373 of these patients (43,5 %) had a S-Ferrit &amp;lt; 30 ug/l. In the first 215 patients included in this analysis, who received a ferric carboxymaltose infusion, the mean age was 36,6 years, the mean duration of infertility was 3 years and 5 months, BMI 23,8 and AMH 2,10 ug/l. The cause for infertility was unexplained in 28 %. The mean S-Ferrit was 16,4 ug/l before infusion and 82,4 ug/l on average 3 months after the infusion. Before the infusion, 45,5% of patients had experienced one or more miscarriages, whereas only 20,0% after the infusion (p &amp;lt; 0.001, McNemar’s test). On the contrary, 36,3% of the patients had live birth prior to infusion, and 58,2% after the infusion (p &amp;lt; 0.001). In the group of patients with unexplained infertility, the differences were even greater than in the whole material. Limitations, reasons for caution The study is retrospective in nature, where the patient is her own control, before and after infusion. With increasing number of infertility treatments patients tend to use more PGT-A and donor oocytes which might favour the results after infusion. Wider implications of the findings The study underlines the importance of measuring the S-Ferritin levels in patients seeking help for their infertility problem. The S-Ferrit measurement should be included in the initial workup of the patients, as it might be one explanation for (unexplained) infertility and miscarriages. Trial registration number Findata THL.7013.14.02.00.2020.

Serum ferritin level is inversely related to number of previous pregnancy losses in women with recurrent pregnancy loss

To study whether low serum ferritin (s-ferritin) levels are associated with recurrent pregnancy loss (RPL), and whether low s-ferritin predicts the risk of another pregnancy loss or the ability to conceive. Cohort study. Fertility clinic at a university hospital. Eighty-four women referred to the RPL Unit and 153 women of reproductive age with no known fertility problem. s-Ferritin levels were measured in serum samples taken before pregnancy attempt. None. s-Ferritin levels were correlated to pregnancy history, ability to conceive, and time to conception during the first 2 years after sampling. Furthermore, s-ferritin levels were correlated to outcome of the first pregnancy after referral for RPL. Women with RPL had lower s-ferritin than the comparison group, 39.9 μg/L versus 62.2 μg/L, and had a higher prevalence of low iron stores (s-ferritin <30 μg/L), 35.7% versus 13.7%. We found an inverse relationship between s-ferritin level and number of pregnancy losses before referral. We did not find s-ferritin level to be associated with ability to conceive or time to pregnancy in either group. Nor did s-ferritin level predict the risk of losing the first pregnancy after referral for RPL. The inverse relationship between s-ferritin levels and previous pregnancy losses suggests that low s-ferritin is associated with a more severe reproductive disturbance in women with RPL. Whether low s-ferritin is causally related to RPL and if such women could benefit from iron supplementation to achieve a live birth warrants further investigation.

Intravenous iron preparations transiently generate non-transferrin-bound iron from two proposed pathways

Intravenous iron-carbohydrate complex preparations (IVIP) are noninterchangeable pro-drugs: their pharmacokinetics (PK) varies determined by semi-crystalline iron core and carbohydrate shell structures, influences pharmacodynamics (PD) and thus efficacy and safety. Examining PK/PD relationships of three IVIP we identify a two-pathway model of transient non-transferrin-bound iron (NTBI) generation following single dose administration. Twenty-eight hypoferremic non-anemic patients randomized to 200 mg iron as ferric carboxymaltose (Fe-carboxymaltose), iron sucrose (Fe-sucrose), iron isomaltoside 1000 (Fe-isomaltoside- 1000), n=8/arm, or placebo, n=4, on a 2-week PK/PD study, had samples analysed for total serum iron, IVIP-iron, transferrin-bound iron (TBI) by high-performance liquid chromatography in combination with inductively coupled plasma mass spectrometry (HPLC-ICP-MS), transferrin saturation (TSAT), serum ferritin (s-Ferritin) by standard methods, NTBI and hepcidin as published before. IVIP-dependent increases in these parameters returned to baseline in 48-150 hours (h), except for s-Ferritin and TSAT. NTBI was low with Fe-isomaltoside-1000 (0.13 μM at 8 h), rapidly increased with Fe-sucrose (0.8 μM at 2 h, 1.25 μM at 4 h), and delayed for Fe-carboxymaltose (0.57 μM at 24 h). NTBI area-under-curve (AUC) were 7-fold greater for Fe-carboxymaltose and Fe-sucrose than for Fe-isomaltoside-1000. Hepcidin peak time varied, but not AUC or mean levels. s-Ferritin levels and AUC were highest for Fe-carboxymaltose and greater than placebo for all IVIP. We propose two mechanisms for the observed NTBI kinetics: rapid and delayed NTBI appearance consistent with direct (circulating IVIP-to-plasma) and indirect (IVIP-to-macrophage-to-plasma) iron release based on IVIP plasma half-life and s-Ferritin dynamics. IVIP generate different, broadly stability- and PK-dependent, NTBI and s-Ferritin signatures, which may influence iron bioavailability, efficacy and safety. Longer-term studies should link NTBI exposure to subsequent safety and efficacy parameters and potential clinical consequences.

Serum ferritin and obstructive sleep apnea-epidemiological study.

Ferritin is an intracellular iron storage protein and a marker of inflammation. Studies have shown that subjects with obstructive sleep apnea (OSA) have higher levels of circulating pro-inflammatory cytokines, but little is known about the association between ferritin and OSA. The aims of the study were to evaluate serum ferritin (S-Ferritin) levels in OSA patients compared to levels in the general population and also examine the effect of obesity level and treatment with positive airway pressure (PAP) on S-Ferritin levels. The OSA subjects (n = 796) were part of the Icelandic Sleep Apnea Cohort. The control subjects (n = 637) were randomly chosen Icelanders who participated in an epidemiological study. Propensity score (PS) methodologies were employed to minimize selection bias and strengthen causal inferences when comparing non-randomized groups. S-Ferritin levels were measured and all participants answered the same detailed questionnaire about sleep and health. Only OSA patients underwent a sleep study and were re-invited for a 2-year follow-up. S-Ferritin levels were significantly higher in OSA males than controls (213.3 vs. 197.3μg/L, p = 0.007). However, after adjusting for confounders and using our PS methodology, no significant difference was found. S-Ferritin levels were not correlated with severity of OSA, obesity level, or clinical symptoms. Also, no significant change in S-Ferritin levels was found with 2years of PAP treatment. S-Ferritin levels are comparable in OSA patients and controls and do not change consistently with obesity level or PAP treatment in our sample.

Ferritinemia and serum inflammatory cytokines in Swedish adults with Gaucher disease type 1

BackgroundThe storage of glucosylceramide in macrophages produces an inflammatory response in Gaucher disease type 1 (GD1) resulting in iron metabolism dysregulation and cytokine release. Patients and methodsThe study included 16 adults with GD1 aged 20–86years. All but one patient carried at least one allele with the c.1226A>G (N370S) mutation in the GBA1 gene. Ferritinemia, iron metabolism profiles including hepcidin, and inflammatory cytokine concentrations were assessed in GD1 patients in Sweden. ResultsHyperferritinemia was present in 81% of patients. There was no correlation between hyperferritinemia and patient's gender, spleen status, or clinical status. Hepcidin was discrepantly low in relation to ferritin levels. TNF-α was moderately increased in 5 of 11 patients; 2 patients with the highest TNF-α concentrations showed mildly elevated IL-6 levels. The concentrations of IL-1β, IL-8, and IL-10 were normal in all patients. Upon treatment, ferritinemia ameliorated but S-ferritin levels did not normalize. The increased TNF-α level however, normalized in all treated patients, reaching the lowest values after 2years of therapy and continued to be stable during the remaining 2years of follow-up. ConclusionsHyperferritinemia is a frequent finding in GD1 in Sweden. The relatively low hepcidin levels reveal a distorted relationship between hepcidin and ferritin in GD1. Therapy has the potential to not only ameliorate hyperferritinemia but to also normalize the serum TNF-α concentration in GD1.

Prognostic Value and Clinical Implication of Serum Ferritin Levels following Allogeneic Hematopoietic Cell Transplantation

Little research has been done on changes in serum ferritin (s-ferritin) levels and clinical implications following allogeneic hematopoietic cell transplantation (HCT). We retrospectively evaluated the correlation of s-ferritin levels after HCT with survival in 203 patients. The s-ferritin level was significantly elevated, with 75% of the patients showing peak levels 90 days after HCT. The level was >10,000 ng/ml in a total of 43% of the patients, a finding that was associated with febrile neutropenia or infection. The s-ferritin level at day 30 and at 1 year after HCT was significantly associated with prognosis. However, this statistically significant relationship was lost after adjusting for acute-phase reactants. We conclude that hyperferritinemia is very common and the degree of influence of a red blood cell transfusion will vary depending on the phase after HCT. A prospective study is needed to determine if iron load in and of itself contributes to a worse prognosis after HCT. © 2014 S. Karger AG, Basel

Deferasirox improves hematologic and hepatic function with effective reduction of serum ferritin and liver iron concentration in transfusional iron overload patients with myelodysplastic syndrome or aplastic anemia

Transfusional iron overload and its consequences are challenges in chronically transfused patients with myelodysplastic syndromes (MDSs) or aplastic anemia (AA). This was a prospective, multicenter, open-label study to investigate the efficacy of deferasirox (DFX) by serial measurement of serum ferritin (S-ferritin) level, liver iron concentration (LIC) level using relaxation rates magnetic resonance imaging, and other laboratory variables in patients with MDS or AA. A total of 96 patients showing S-ferritin level of at least 1000 ng/mL received daily DFX for up to 1 year. At the end of the study, S-ferritin level was significantly decreased in MDS (p=0.02366) and AA (p=0.0009). LIC level was also significantly reduced by more than 6.7 mg Fe/g dry weight from baseline. Hemoglobin level and platelet counts were significantly increased from baseline (p=0.002 and p=0.025, respectively) for patients showing significant anemia or thrombocytopenia. Elevated alanine aminotransferase was also significantly decreased from baseline. This study shows that DFX is effective in reducing S-ferritin and LIC level in transfusional iron overload patients with MDS or AA and is well tolerated. In addition, positive effects in hematologic and hepatic function can be expected with DFX. Iron chelation treatment should be considered in transfused patients with MDS and AA when transfusion-related iron overload is documented.

Lower hemoglobin with lower ferritin: It is not just a question of anemia

Aim. To study the association between blood hemoglobin concentration (b-hemoglobin) and serum ferritin concentration (s-ferritin) in an ambulant patient population without inflammation and with normal kidney function. Methods. In ambulant, adult patients with normal values of s-CRP and s-creatinine, median b-hemoglobin and the fraction with anemia was compared in groups with lower s-ferritin from a level of 100 μg/L. The 10, 50 and 90 percentiles of b-hemoglobin were modelled as functions of s-ferritin using quantile regression. Results. Among 3206 women the entire b-hemoglobin distribution was shifted downwards in patients with s-ferritin less than 20 μg/L. Accordingly, the median b-hemoglobin was statistically significantly lower and the fraction with anemia was higher. In 1246 men the findings were similar, except that the turning point toward lower b-hemoglobin was at a s-ferritin level of 30 μg/L. Conclusions. Low s-ferritin is associated with decreased b-hemoglobin in many more subjects than those labelled anemic.

Risk factors affecting cardiac left-ventricular hypertrophy and systolic and diastolic function in the chronic phase of allogeneic hematopoietic cell transplantation

Chronic impairment of cardiac function can be an important health risk and impair the quality of life, and may even be life-threatening for long-term survivors of allogeneic hematopoietic cell transplantation (HCT). However, risk factors for and/or the underlying mechanism of cardiac dysfunction in the chronic phase of HCT are still not fully understood. We retrospectively investigated factors affecting cardiac function and left-ventricular hypertrophy (LVH) in the chronic phase of HCT. Sixty-three recipients who survived for >1 year after receiving HCT were evaluated using echocardiography. Based on simple linear regression models, high-dose TBI-based conditioning was significantly associated with a decrease in left-ventricular ejection fraction and the early peak flow velocity/atrial peak flow velocity ratio, following HCT (coefficient=-5.550, P=0.02 and coefficient=-0.268, P=0.02, respectively). These associations remained significant with the use of multiple linear regression models. Additionally, the serum ferritin (s-ferritin) level before HCT was found to be a significant risk factor for LVH on multivariable logistic analysis (P=0.03). In conclusion, our study demonstrated that a myeloablative regimen, especially one that involved high-dose TBI, impaired cardiac function, and that a high s-ferritin level might be associated with the development of LVH in the chronic phase of HCT.

Iron stores in relation to dietary patterns in a multiethnic population: the SAMINOR study

We evaluated the association between serum ferritin (s-ferritin), transferrin saturation and dietary patterns, in connection with ethnicity, geographical settlement and lifestyle factors. In 2003-2004, a cross-sectional study of health and living conditions was carried out in northern Norway. A questionnaire explored, among other factors, ethnicity and food consumption habits. Principal component analysis was used to assess the association between variables. Seven principal components were then used as input to a cluster analysis. To characterise food consumptions, five dietary patterns were identified and used to assess the effect of food consumption habits on Fe stores. A total of 16 323 men and women between the ages of 36 and 79 years participated. Participants who frequently consumed reindeer meat had higher levels of s-ferritin (P < 0.0001) than did individuals with other dietary patterns. This pattern was highly represented by subjects with three generations of Sami language (Sami I). Further, mean transferrin saturation in the reindeer group was higher compared with the other dietary clusters for men (P < 0.04) and women (P < 0.02). However, the reindeer pattern individuals also had the highest proportion of subjects with overweight and obesity. Obesity was positively associated with s-ferritin in both men and women (P < 0.0001). The differences in Fe status described earlier between inland Sami and non-Sami can be explained by several factors such as food habits, age and obesity. High level of s-ferritin may reflect high intake of reindeer meat. Being overweight and obese is also associated with s-ferritin levels.

Efficacy of ICT with Deferasirox in Transfusional Iron Overloaded Patients with MDS or AA.

Abstract 3810Poster Board III-746 PURPOSETransfusion-related iron overload and its consequences are emerging challenges in chronically transfused patients with myelodysplastic syndromes (MDS) or aplastic anemia (AA). The clinical data on specific benefits of deferasirox in transfusion-related iron overload patients with MDS or AA has been limited. METHODS: We have prospectively investigated the efficacy of deferasirox by serial measurement of s-ferritin level and LIC by R2-MRI in transfusional iron overload patients with MDS or AA. RESULTS: A total of 79 patients with de novo MDS (n = 29) or idiopathic AA (n = 50) showing serum ferritin level over 1,000ng/ml were enrolled from 23 institutes. Mean value of s-ferritin level in enrolled patients was 4,788 ng/ml in MDS and 4,188 ng/ml in AA at the time of deferasirox initiation. Mean value of LIC was 24.4 mg Fe/g dry weight in MDS and 22.4 mg Fe/g dry weight in AA. Deferasirox was given orally at a dose of 20 mg/kg/day for at least 6 months to all patients and was withheld If the s-ferritin falls below 500 ng/ml. Over the study period, patients with MDS or AA received a mean of 3.7 and 2.7 units RBC per month, respectively. After 12 months of medication, s-ferritin level significantly decreased by 1824.0 ng/ml form baseline values, a reduction of 38.1% for patients with MDS (p<0.0001) and significantly decreased by 3559.1 ng/ml (85.0%) for patients with AA (p<0.0001). LIC decreased by 11.2 mg Fe/g dry weight, a reduction of 35.7% for patients with MDS, and significantly decreased by 8.1 mg Fe/g dry weight, a reduction of 27.6% for patients with AA (p=0.0028). The patients with lower transfusional requirements (<4 units/month) during the study showed significantly more reduction of LIC level than those with higher requirements (≥4 units/month) (35.7% vs. 2.8%; p<0.0001). The most common drug-related adverse events (AE) were gastrointestinal disturbances and non-progressive increase in s-creatinine, however, AE were transient and mild-to-moderate in severity. All death was ascribed to disease-related causes including cytopenia in nine (11.4%) and disease progression in one (1.3%). CONCLUSION: Deferasirox is effective in reducing LIC and s-ferritin level in transfusional iron overload patients with MDS or AA, even with ongoing transfusion requirement, and well tolerated. Disclosures:No relevant conflicts of interest to declare.

Intravenous iron sucrose is superior to oral iron sulphate for correcting anaemia and restoring iron stores in IBD patients: A randomized, controlled, evaluator-blind, multicentre study

Objective. Patients with inflammatory bowel disease (IBD) often have low iron stores or anaemia. There is controversy about whether iron should be supplemented orally or intravenously (i.v.). The purpose of this study was to investigate whether treatment with intravenous iron is superior to treatment with oral iron. The primary end-points were response and remaining anaemia at the end of treatment (EOT). Material and methods. Ninety-one patients with IBD and anaemia (B-Hb <115 g/L) were randomized to oral iron sulphate (n=46) or intravenous iron sucrose (n=45) treatment for 20 weeks. Results. Forty-three patients in the intravenous iron group completed the study compared to 35 patients in the oral iron group (p=0.0009). Only 22 patients (48%) tolerated the prescribed oral dose, and 52% reduced the dose or withdrew from treatment because of poor tolerance. At EOT, 47% patients in the oral iron group increased their B-Hb by ≥20 g/L, compared with 66% in the intravenous iron group (p=0.07). In the oral iron group, 41% still had anaemia versus 16% of the patients in the intravenous iron group (p=0.007), and 22% versus 42% reached their reference B-Hb level (p=0.04). Treatment with intravenous iron sucrose improved iron stores faster and more effectively than oral iron (p=0.002). Under treatment with intravenous iron, 74% of the patients had no anaemia and normal S-ferritin levels (>25 µg/L) at EOT compared with 48% of patients receiving oral iron (p=0.013). Conclusions. Treatment with intravenous iron sucrose is effective, safe, well tolerated and superior to oral iron in correcting haemoglobin and iron stores in patients with IBD.

Iron status in a multiethnic population (age 36–80 yr) in northern Norway: the SAMINOR study

Northern Norway consists of a multiethnic population of Sámi and non-Sámi. We evaluated iron status in these two groups with respect to gender, age and residence. In 2002-2004, a cross-sectional study of health and living conditions in areas with both Sámi and Norwegian populations, SAMINOR, was performed in northern Norway. In total, 16,538 men and women between the age of 36 and 79 yr, participated. Response rate was 60.9%. Information about ethnic belonging, s-ferritin and transferrin saturation were available in 14,873 persons (54.8% of the invited sample). A questionnaire delivered at attendance had several questions on family background language and self-perceived ethnicity. Sámi men and women living in the inland areas had significantly higher mean s-ferritin than non-Sámi living in the same area (P < 0.0001). The inland Sámi also had significantly higher s-ferritin than the coastal Sámi and non-Sámi populations, both genders (P < 0.013). S-ferritin increased with increasing age for all women, while the opposite was true for men. Lifestyle factors had impact on s-ferritin level. Also mean transferrin saturation was higher at the inland residents but significant only for the male participants. The results from our analyses indicate that individuals living at the inland areas have higher s-ferritin and transferrin saturation than the coastal population. There were also differences in iron levels between Sámi and non-Sámi groups at the inland areas. Iron levels are influenced by lifestyle factors. The observed differences in iron levels might therefore be explained by nutritional habits.

Serum levels of iron in Sør-Varanger northern Norway - An iron mining municipality

Objectives. The purpose of this study was to investigate iron status in a population with a high proportion of miners in the northernmost part of Norway.Study Design. Cross-sectional, population-based study performed in order to investigate possible health effects of pollution in the population living on both sides of the Norwegian-Russian border.Methods. All individuals living in the community of Sør-Varanger were invited for screening in 1994. In 2000, blood samples from 2949 participants (response rate 66.8 %), age range 30–69 years, were defrosted. S-ferritin and transferrin saturation were analysed in samples from 1548 women and 1401 men. About 30 % (n = 893) were employed in the iron mining industry, 476 of whom were miners and 417 had other tasks in the company. Type and duration of employment and time since last day of work at the company were used as indicators of exposure.Results. Both s-ferritin levels and transferrin saturation were higher in men than in women. S-ferritin increased with increasing age in women, while the opposite was true for men. Iron deficiency occurred with higher frequencies in women (16 %) than in men (4 %). Iron overload was uncommon in both sexes. Adjustment for smoking and self-reported pulmonary diseases did not show any effect on iron levels. Miners had non-significant higher mean s-ferritin and transferrin saturation than non-miners. Neither duration, nor time since employment in the mine, had any impact on iron status.Conclusions. Our analyses did not show any associations between being a miner in the iron mining industry and serum iron levels compared to the general population.(Int J Circumpolar Health 2006;65(5):432–442.)

Functional Iron Deficiency Effectively Overcome by Adjuvant IV Iron during Epoetin Treatment.

Background: 30–40% of anemic cancer patients don’t respond to epoetin treatment. New insights in iron regulation have indicated that one reason for lack of response may be functional iron deficiency (FID), in which an upregulation of hepcidin by imflammatory cytokines impairs the ferroportin-mediated iron export from macrophages. Aims: To assess whether adjuvant IV iron therapy would overcome the iron restriction of FID as well as that of exhaustion of iron stores during epoetin treatment of anemia in patients with lymphoproliferative disorders (LPD) and proven iron presence in the bone marrow. Methods: 67 patients with indolent lymphoid malignancy (19 NHL, 23 CLL and 25 MM), Hb ≥9 to ≤11 g/dl and a positive bone marrow iron staining were randomized to receive epoetin-beta, (NeoRecormon®) 30 000 IU QW or this treatment plus IV iron sucrose, (Venofer®) 100 mg QW, during week 0–6, 100 mg Q2W week 7–16 with dose modifications of epoetin according to the label. 60 patients completed the study. Three patients received transfusion and/or chemotherapy and thus 57 were evaluable. Results: The Hb response rate was superior in the iron-treated group, 91% vs 54%, the time to response (&gt;2 g/dL) half as long, 6 w vs 12 w and the Hb level was 1.2 g/dL higher at the end of study(1). In both groups, the mean transferrin saturation (Tsat) was low at baseline, 22%, and the mean S-ferritin was around 200 ug/L. During treatment, several indicators showed that iron availability was superior in the iron-treated group. In the non-iron group Tsat declined from baseline to &lt;20% in 26 out of 30 patients for the duration of the study, and S-ferritin fell rapidly during the first week and then steadily declined from a baseline value of 191 to 112 ug/L at the end of study. (EOS). The mean soluble transferrin receptor (sTfR) level increased from normal to a maximum of 3.7 mg/L in week 8. In the iron-treated group (n=27) Tsat increased from baseline and stabilized at 30%. S-Ferritin showed no initial fall and continued to increase from 210 at baseline to 398 ug/L at EOS. Discussion. Iron restriction may be present in epoetin treatment of cancer anaemia by two different mechanisms. Iron deposits may be small and become depleted, and secondly iron may be trapped in the macrophages due to FID. In these patients, FID was common, as indicated by the presence of bone marrow iron and the low mean Tsat at baseline. In some patients, small iron deposits were exhausted by the increased erythropoiesis in the non-iron group, as shown by subnormal S-ferritin levels. The fact that the mean Tsat and S-ferritin increased in the iron-treated group indicated that iron availability was constantly better in this group and the reason for the superior Hb response. Conclusions - Functional iron deficiency (low Tsat and iron-restricted erytropoiesis in spite of proven iron stores) is common in patients with anaemia of haematological malignancies. - FID is a common and important reason for lack fo response to epoetin treatment - IV iron treatment improves epoetin response both by overcoming FID and by avoiding iron depletion casued by increased erythropoiesis.

Symptom panorama in upper secondary school students and symptoms related to iron deficiencyScreening with laboratory tests, questionnaire and interventional treatment with iron

ObjectiveTo study symptom panorama in students, to identify undiagnosed iron deficiency, and to evaluate any changes in symptoms and laboratory test results after treatment with iron supplementation. DesignDescriptive and prospective, interventional study. SettingHealthcare in upper secondary school. InterventionTreatment with iron supplementation for a period of 3 months. SubjectsStudents in the first grade of one upper secondary school. Main outcome measuresFrequency of iron deficiency related to symptoms measured by a questionnaire (30 questions) on symptoms related to quality of life and 9 questions about diet and exercise. ResultsIron deficiency was diagnosed in 12% of the students (two or more abnormal laboratory tests) and in 61% of the students one or more laboratory tests were abnormal. Symptoms of vertigo/dizziness were significantly more common in students with iron deficiency. After iron supplementation there was a significant increase in s-ferritin levels and a decrease in s-transferrin levels, with an accompanying significant reduction of the symptom scores of vertigo/dizziness, irritability, depressive symptoms, and indisposition. ConclusionsSymptoms of vertigo/dizziness were significantly more common in students with iron deficiency. Iron supplementation reduced the symptoms of vertigo/dizziness, irritability, depressive symptoms, and indisposition.

Iron status in 268 Danish women aged 18-30 years: influence of menstruation, contraceptive method, and iron supplementation.

The aim of the present study was to evaluate the influence of menstruation, method of contraception, and iron supplementation on iron status in young Danish women, and to assess whether iron deficiency could be predicted from the pattern of menstruation. Iron status was examined by measuring serum (S-) ferritin and hemoglobin (Hb) in 268 randomly selected, healthy, menstruating, nonpregnant Danish women aged 18-30 years. Iron deficiency (S-ferritin <16 microg/l) was observed in 9.7%, of the women, iron deficiency anemia (S-ferritin < 13 microg/l and Hb < 121 g/l) in 2.2%. Iron supplementation, predominantly as vitamin-mineral tablets containing 14-20 mg of ferrous iron was used by 35.1%. The median serum ferritin was similar in non-iron users and in iron users, whereas the prevalence of iron deficiency was 12.6% in nonusers vs. 4.3% in users, the prevalence of iron deficiency anemia 3.4% in nonusers vs. 0%, in users (p=0.17) In non-iron-supplemented women, S-ferritin levels were inversely correlated with the duration of menstrual bleeding (rs= -0.25, p<0.001) and with the women's assessment of the intensity of menstrual bleeding (r(s)= -0.27, p<0.001), whereas no such correlations were found in iron-supplemented women. The results demonstrate that even moderate daily doses of ferrous iron can influence iron status in women with small iron stores. Women using hormonal contraceptives had menstrual bleeding of significantly shorter duration than those using intrauterine devices (IUD) or other methods. There was a high prevalence of small and absent body iron stores in young women, suggesting that preventive measures should be focused on those women whose menstruation lasts 5 days or longer, who have menstrual bleeding of strong intensity, who use an IUD without gestagen, and who are blood donors.