Serum Ferritin Assay Research Articles

Clinical Application of Reticulocyte Maturity Indices in Early Diagnosis of Iron Deficiency Anemia in the First Trimester of Pregnancy

Background: Iron deficiency anemia (IDA) is a prevalent global health issue, particularly affecting pregnant females due to increased iron demands during pregnancy. In Pakistan, IDA remains a significant concern, posing challenges to maternal and child health. Early detection and management of iron deficiency are crucial for improving pregnancy outcomes.
 Objective: This study aims to investigate the iron status and associated hematological parameters among pregnant females during the first trimester in Islamabad, Pakistan.
 Methodology : This cross-sectional study, conducted in collaboration with the Pakistan Atomic Energy Commission (PAEC) and the Pakistan Institute of Medical Sciences (PIMS), aimed to investigate the iron status among first-trimester pregnant females in Islamabad, Pakistan.Laboratory investigations encompassed hemoglobin and serum ferritin assays, reticulocyte counts, and other red blood cell parameters. Participants were categorized into distinct iron status groups based on these evaluations. Utilizing SPSS version 25, statistical analysis followed ethical protocols, striving to uncover discrepancies in hematological parameters across the various iron status groups.
 Results : Among 340 first-trimester pregnant women, three iron status groups were identified. Group 1 (n = 102) had low ferritin despite normal Hb, with elevated immature reticulocytes. Group 2 (n = 150) showed normal iron parameters, while Group 3 (n = 88) had high reticulocyte counts. Group 2 exhibited superior erythrocyte indices and higher ferritin levels than Groups 1 and 3. Group 3 displayed the poorest indices and elevated immature reticulocytes. These findings highlight variations in iron status and reticulocyte maturation among pregnant women.
 Conclusion: This study underscores the high prevalence of iron deficiency anemia among first-trimester pregnant females in Islamabad, Pakistan. Variations in red blood cell parameters and serum ferritin levels highlight the importance of early iron status assessment for optimizing maternal and foetal health outcomes.

Importance of the reticulocyte hemoglobin equivalent in the exclusion of latent iron deficiency.

Iron deficiency is an underdiagnosed public health problem, especially in developing countries, that can conceal serious underlying illnesses. Early diagnosis and treatment of latent iron deficiency (LID) is crucial. Reticulocyte hemoglobin equivalent (RET-He), was reported to be a cost-effective tool that reflects the iron availability at erythropoiesis. The aims of this study were to evaluate the RET-He in the exclusion of LID. Transversal study was carried out in the laboratory of clinical biology of Ben Arous regional hospital, it included volunteers in apparently good health. We performed a complete blood count and a serum ferritin assay. Participants with normal hemoglobin were divided into two groups: Control group G1: normal ferritin (≥15ng/mL)/LID group G2: low ferritin (<15ng/mL). We compared the blood count parameters of the two groups. We selected 108 participants (G1: 88 (81.5%), G2: 20 (18.5%)), mean age =36 years, gender-ratio =0.92. We noted, in G2, significantly lower rates for hemoglobin Hb (p <0.001), hematocrit (p <0.001), mean corpuscular hemoglobin MCH (p =0.026), reticulocyte count (p =0.039) and RET-He (p <0.001) and significantly higher rate for RDW/CV (p =0.009). RET-He averages were 29.1pg in G2 and 31.1pg in G1. In multivariate analysis, only RET-He showed a significant difference between the two groups. Area under the curve was 0.872, the cutoff =30.9 (sensitivity 100%, specificity 61%, PPV 37%, NPV 100%). RET-He is an accessible and affordable parameter of the iron status, with an excellent NPV. It would be interesting to evaluate our results on a larger sample to define reference values in our population.

Serum Ferritin as an Indicator of Neonatal Anaemia

Introduction: Haemoglobin levels are usually used to diagnose neonatal anaemia. By the time haemoglobin levels drop, body iron is depleted. Serum ferritin is the standard measure for assessment of iron levels in neonates and detects iron deficiency earlier than haemoglobin levels.&#x0D; Aims: To determine the prevalence of low haemoglobin and ferritin levels amongst term and preterm newborn babies. To determine the value of serum ferritin in the diagnosis of low iron stores amongst term and preterm newborns.&#x0D; Methodology: This was a cross sectional descriptive study carried out at the Neonatal Intensive Care Unit of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria between June and December 2014. The study included 140 newborns of all birth weights delivered at the UNTH. These were categorized into preterm (gestational age &lt;37 completed weeks) and term (gestational age ≥37 completed weeks. Babies with C-reactive protein levels &gt; 10mg/dl, who were intra-uterine growth restricted, and whose mothers had conditions associated with low iron stores were excluded from the study. Anthropometric measurements were done for all subjects. Haemoglobin estimation and ferritin assay were carried out and the prevalence of neonatal anaemia was determined using each of these.&#x0D; Results: The range of haemoglobin concentration in the study population was 12.22g/gl – 22.80g/dl. The mean serum haemoglobin concentrations were 15.69mg/dl ± 1.58 and 16.45 ± 1.92 in the preterm and term babies respectively (t = 2.557, P = .0116). The prevalence of low haemoglobin concentrations amongst both preterm and term babies was zero= .024). The range of serum ferritin level in the study population was 20.6µg/l - 296µg/l. The mean serum ferritin levels were 63.13µg/l ± 23.93 and 133.67µg/l ± 50.14 in the preterm and term babies respectively (t = 10.623, P &lt; .001). The prevalence of low serum ferritin in the study population was 22.14%, but was higher in preterm than term babies 35.7% vs 8.6%: (OR – 5.926, 95% C.I OR = 2.248 – 15.619)(P&lt;.001).&#x0D; Conclusion: Serum ferritin assay is more useful than haemoglobin as an indicator of anaemia during the neonatal period.

ROLE OF RETICULOCYTE HEMOGLOBIN CONTENT IN DIAGNOSIS OF IRON DEFICIENCY ANEMIA

Objectives: Anemia is a global problem of immense health significance affecting persons of all ages and economic groups. Iron deficiency anemia (IDA) is the most common type of anemia met with in clinical practice. For IDA diagnosis, estimation and treatment, many indices such as serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF), and soluble transferrin receptor assay are used. But reticulocyte hemoglobin content (CHr) is called as the gold standard for diagnosing IDA as it is the most valuable screening tool for identifying IDA with a sensitivity of 94% and specificity 80% and differentiates IDA from anemia of systemic disease. The present study was undertaken to evaluate CHr as a most efficient marker in diagnosing IDA. Methods: This prospective observational study was carried out in the Department of General Medicine of M.K.C.G. Medical College and hospital, Berhampur, Odisha, India, from October 2017 to October 2019. Sixty microcytic hypochromic patients of either sex &gt;18 years of age admitted in the medicine ward fulfilling the inclusion and exclusion criteria were included in this study. After taking detailed history and clinical examination, laboratory investigations including complete blood count, SI, serum, ferritin, serum transferrin saturation, TIBC, CHr, and bone marrow aspiration with iron stain were done in all patients. Results: In the study group of 60 patients, 10 (16.66%) patients had mild anemia, 17 (28.33%) had moderate anemia, and 33 (55%) had severe anemia. Mean hemoglobin of the patients was 6.86 g/dL and SD was 1.95 g/dL. Nineteen (31.66% patients) had TIBC in the range of 351–400 μg/dl. Mean±SD of serum TIBC was 333.91±67.26 μg/dL. Thirty-nine patients (65%) had transferrin saturation in the range of 0.1–10%. The mean±SD of the study group was 13.68±3.22%. Fifty (83.33%) patients had SF in the range of 0–100 μg/dL. Twenty-three patients (38.33%) had CHr concentration between 15.1 and 20 pg followed by 19 (31.66%) between 20.1 and 25 pg and 18 (30%) between 25.1 and 30 pg. The mean±SD of this study was 22.14 pg±3.92. Conclusion: CHr is found to be a potential biomarker that can be used to differentiate IDA from other causes of anemia.

Iron stores in steady-state sickle cell disease children accessing care at a sickle cell disease clinic in Kumasi, Ghana: A cross-sectional study.

Children with sickle cell disease (SCD) have an increased risk of multiple hemotransfusions and this can predispose them to elevated iron stores. The objectives of the study were to determine the extent of elevated iron stores and the associated risk factors in a population of steady-state SCD children in Ghana. This cross-sectional study was conducted at the pediatric sickle cell clinic at the Komfo Anokye Teaching Hospital. Complete blood count and serum ferritin assay were performed for (n = 178) steady-state SCD children. Descriptive and multivariate logistic regression analysis were performed. Elevated iron stores were defined as serum ferritin levels >300 ng/ml. Statistical significance was considered at p < 0.05. The mean (standard deviation) age of the participants was 9.61 (±4.34) years, and 51% of them were males. About 17% of SCD children had elevated iron stores and receiving at least three hemotransfusions during the last 12 months was strongly associated with elevated iron stores (p < 0.001). History of chronic hemotransfusion increased the odds of having elevated iron store (adjusted odds ratio [aOR] = 11.41; 95% confidence interval [CI] = 3.11-30.85; p < 0.001) but SCD patients on hydroxyurea treatment had reduced-odds of having elevated iron stores (aOR = 0.18; 95% CI = 0.06-0.602; p = 0.006). Moreover, red blood cell (Coef. = -0.84; 95% CI = -0.37, -1.32; p = 0.001), hemoglobin (Coef. = -0.83; 95% CI = -0.05, -1.61; p = 0.04), hematocrit (Coef. = -0.85; 95% CI = -0.08, -1.63; p = 0.03), mean cell volume (Coef. = 0.02; 95% CI = 0.01, 0.03; p = 0.001) and mean cell hemoglobin (Coef. = 0.04; 95% CI = 0.01, 0.07; p = 0.002) could significantly predict serum ferritin levels. The magnitude of elevated iron stores was high among children with SCD in steady-state. Red cell indices could provide invaluable information regarding the risk of elevated iron stores. SCD children who have a history of chronic hemotransfusion or had received at least three hemotransfusions in a year should be monitored for elevated iron stores.

Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric Hematology-Oncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics

Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.

Assessment of iron status in regular blood donors in a tertiary care hospital in Southern India.

Regular blood donation depletes iron stores. The assertion is that the vulnerable donor population requires a predictive standard operative procedure for early detection of iron store depletion, preventing them from developing iron-deficiency anemia. This study aims to study the potential effects of blood donation in the regular donor group using hematological and biochemical estimation of iron status parameters. This was a prospective cross-sectional study on regular blood donors, defined as those who have donated at least 3 times, the last donation being within the last 12 months and continues to donate at least once a year, at a tertiary care teaching hospital in Southern India. The complete blood count (CBC) was performed on the Sysmex coulter, and the red cell indices were calculated. The ferritin and the soluble transferrin receptor (sTfR) assays were performed using Enzyme Immunoassays. The comparison of CBC, serum ferritin, and sTfR assay with donation frequency and time since the last donation was carried out using an independent student's t-test for two groups. The statistical analysis was performed using SPSS for Windows version 20. A total of 323 regular blood donors (6 were females) were included in the study of which they were categorized into three, 211 donors with less than or equal to 10 donations, 84 those who had donated between 11 and 20 times and 28 who had donated more than 20 times. The red cell indices were reduced and different in the groups but not statistically significant except for mean corpuscular volume. About 15% of the study population had a transferrin level of <15 ng/ml. The Ferritin levels showed a statistically significant negative correlation with the number of donations, the correlation coefficient being -0.27. Logarithmic ratios of sTfR/ferritin also correlated with a coefficient of 0.156 with the number of donations and were statistically significant. Our study found that regular blood donors had low iron stores, as shown by ferritin levels and other iron indicators. Using the current guidelines (hemoglobin >12.5 g/dL) for donation, or the red cell indices alone do not reflect the donor's actual iron status.

Establishment of normal reference range of serum hepcidin in Indian blood donors.

Hepcidin-25, a polypeptide hormone, plays a major role in iron metabolism and is found to be reduced during iron deficiency; therefore, testing for hepcidin can be utilized as an indicator of bioavailability of iron. Globally, reference range values for hepcidin have been established in different communities. The aim of the present study was to establish the normal reference range values of serum hepcidin in Indian blood donors to fathom the baseline and reference point of hepcidin. A total of 90 donors fulfilling the eligibility criteria were recruited in the study consisting of 28 males and 62 females. Blood samples collected were used to execute hemoglobin (Hb), serum ferritin, and hepcidin assays. Serum hepcidin-25 isoform was detected by a commercial competitive enzyme-linked immunosorbent assay kit according to the manufacturer's instructions. Hb and ferritin were evaluated by the standard methods. The mean ± standard deviation (SD) of Hb level in males was 14.62 ± 1.34 g/dL and females was 13.33 ± 0.76 g/dL. The mean ± SD of ferritin level in males was 113 ± 56.12 ng/mL and females was 62.65 ± 40.8 ng/mL. Similarly, the mean ± SD of hepcidin level in male donors was 22.18 ± 12.17 ng/mL and female donors was 10.95 ± 6.06 ng/mL. The established reference range values of Hepcidin were 6.32-46.06 ng/mL for males and 3.44-24.78 for females. These findings suggest that further studies with larger groups of donors are mandatory to produce reference values of hepcidin that can be précised to the whole populace in India.

Prevalence of Iron Deficiency Anemia among Adolescent School Children of Manipur, India

Background: Iron deficiency anemia (IDA), one of the most common types of nutritional anemia worldwide is considered a major public health problem in developing countries. Prevalence in India remains alarmingly high. Population of Manipur, a small state in the north-eastern part of India, is different with distinct race, culture, socio-demographic pattern and dietary habits. Therefore, this cross-sectional study was conducted to determine the prevalence and risk factors of IDA among apparently healthy school children of Manipur, India.&#x0D; Methods: Three hundred and seventy-nine blood samples (163 males and 216 females) were collected randomly from urban and rural school children in the age group of 13 to 19 years from Imphal west and Thoubal districts of Manipur respectively. Eligible participants were subjected to haemoglobin (Hb) estimation and serum ferritin (SF) assay. Moreover, a questionnaire was designed to collect demographics, food and drink habits, hygienic practices and socioeconomic status. BMI of the students were also recorded.&#x0D; Results: The overall prevalence of IDA was 23.2% (n = 88), of whom 81.81% were females (n = 72) and 18.18% were males (n = 16). Prevalence of IDA among the males and females was higher in the rural compared to urban schools but not statistically significant. Correlation between BMI and Hb was significant (p &lt; 0.05) but not with serum ferritin status. Students belonging to the middle income group had the highest prevalence of ferritin deficiency followed by the high income group and low income group respectively. Both the Hb and serum ferritin levels of students who do hand wash before meals were significantly higher than those who do not. Both hemoglobin and serum ferritin levels do not differ significantly among students who prefer home-made traditional food and junk food.&#x0D; Conclusion: This study revealed that the majority of the students, especially females, have IDA that might become worse by malnutrition, lifestyle habits, and lack of awareness. Our results suggest that IDA can be prevented by providing proper knowledge on the healthful diet, improved lifestyle, and harmful effect of IDA to the students.

Ferritin and transferrin levels of the elderly population at Lagos State university teaching hospital, Ikeja, Lagos, Nigeria

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The elderly have limited regenerative abilities thus predisposing them to various diseases. Measuring both serum ferritin and transferrin serve as biomarkers of iron deficiency. This study, using enzyme-linked immunosorbent assay (ELISA) determined the serum levels of ferritin and transferrin in the elderly. Full blood count was also done and correlated with serum ferritin and transferrin levels of every participant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a cross-sectional study at the Geriatric Clinic of Lagos State University Teaching Hospital (LASUTH). Following receipt of written consents from ninety (90) elderly participants, venous samples were drawn for full blood count (FBC) and samples for serum ferritin and transferrin ELISA assay collected and stored at -40&lt;sup&gt;o&lt;/sup&gt;C until the required sample size was obtained. Data were analyzed using SPSS version 23.0 (Statistical Package for Social Sciences, Inc., Chicago, Ill). The Pearson chi-square test was used for statistical analysis. P value was considered to be statistically significant when &amp;lt;0.05. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Participants consisted of 50 (55.6%) females and 40 (44.4%) males. The mean age of all participants was 71.31±7.38 years. The Majority, 90% (36 of 40) of the males had haemoglobin values lower than 13 gm/dl, while 66% (33 of 50) of females had haemoglobin values lower than 12 gm/dl. The mean ferritin concentration of all participants was 196.19 ±121.21ng/ml. The overall mean serum transferrin was 0.187±0.157 ng/ml with a minimum of 0.03 ng/ml and a maximum of 1.18 ng/ml.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Anaemia in the elderly is very common using the World Health Organization (WHO) haemoglobin cut-off values, however, iron deficiency anaemia prevalence is low.&lt;/p&gt;

Assessment of analytical bias in ferritin assays and impact on functional reference limits

Serum ferritin is currently the recommended laboratory test to investigate iron deficiency. There have been efforts to standardise serum ferritin assays with implementation of traceability to the World Health Organization reference standard. We evaluate the analytical bias among five widely used commercial ferritin assays in Australia. The relationship between serum ferritin and erythrocyte parameters was recently explored to derive functional reference limits. Residual patient serum specimens were analysed by five participating laboratories that utilised a different ferritin assay, Abbott, Beckman Coulter, Roche, Siemens, and Ortho. Using data mining approach, functional reference limits for Siemens, Abbott, and Ortho serum ferritin methods were derived and compared. At clinically relevant ferritin decision points, compared to the Beckman method, the Roche assay showed higher results ranging from 6 μg/L (31%) at the lowest decision point to 575 μg/L (57%) at the highest decision point. In contrast, the Ortho method underestimated ferritin results at lower decision points of 20 and 30 μg/L, with estimated ferritin results of 16 μg/L (-19%) and 27 μg/L (-12%), respectively. The Abbott and Siemens assays showed a positive bias which was introduced at differing decision points. The comparison of the Siemens and Ortho methods presents similar inflection points between the two assays in the establishment of functional reference limits for serum ferritin. There remain significant biases among some of the commonly used commercial ferritin assays in Australia. More studies are needed to assess if functional reference limits are a way to overcome method commutability issues.

Assessment of molecular and clinical characteristics in blood transfusion dependent HbE/β-thalassemia patients

Hb E/β-thalassemia is one of the most common forms of hemoglobinopathies worldwide. This life-threatening genetic disorder is not completely curable. This study aims to investigate the correlation of mutations with clinical manifestations among the transfusion dependent Hb E/β- thalassemia patients using molecular, hematological and biochemical methods. A total of 60 blood samples were collected from regular blood transfusion-dependent HbE/β-thalassemia patients. Mutations within HBB gene were analysed by Sanger sequencing, BLAST 2.0, HbVar database and Alibaba 2.1. Clinical data were analysed based on CBC, Hemoglobin Electrophoresis and Serum Ferritin assay. Results demonstrate that a total of three mutationsdeletion of A (+23bp in HBB promoter region), c.9 T&gt;C and c.79 G&gt;A were detected among the study population, where deletion of A (+23bp in HBB promoter region) is a novel mutation. A total of three (USF, AP-1 and GATA-1) important putative binding sites were identified within the mutated region of HBB gene. Hematological analysis also showed remarkable correlation between the mutations and clinical manifestations in the patients. Reduced levels of RBC, Hb, MCV and MCH were found among the patients than the normal. Highly increased level of serum ferritin was also found among the patients due to the frequent destruction of RBCs. In conclusion, the findings of this study will be helpful to understand the mutational and hematological status of HbE/β-thalassemia patients. And this study will also be beneficial for effective molecular drug designing, drug response and other therapeutic approach for HbE/β-thalassemia patients.&#x0D; Jahangirnagar University J. Biol. Sci. 9(1 &amp; 2): 109-121, 2020 (June &amp; December)

Estimation of serum ferritin and TSH levels in thalassemia patients undergoing iron chelation therapy

Objectives &amp; introduction: Thalassemia, heterogenous group of disorders of haemoglobin,characterised by reduced or absent production of one or more of globin chains.Regular redcell transfusion with chelation therapy for iron overload are cornerstones of therapy for ßthalassemia major. Serum ferritin assay is widely available, relatively inexpensive methodfor assessing body iron burden and monitoring response to chelation process which in turnalso improves TSH levels in thalassemic subjects .The objective of this study was to assessprechelation and postchelation levels of serum ferritin and TSH and correlating post chelationlevels of serum ferritin and TSH in thalassemic patients &gt;6yrs undergoing chelation therapy.&#x0D; Materials &amp; methods: Serum TSH measured by Enzyme linked fluorescent assay and serumferritin measured by enzyme linked immunosorbent assay.&#x0D; Results: Amongst 500 participants,47% were males &amp; 53% females. Mean age was 9.04 yrs ;prechelation ferritin and TSH levelswere 2995.78ng/ml with SD of 802.53 and 5.07 μU/ml with SD of 2.52. The postchelationferritin and TSH levels were 2168.80 ng/ml with SD of 1335.89 and 4.51μU/ml with SD of4.76. Paired t test with respect to pre and postchelation ferritin and TSH levels showed 2 tailed pas 0.000 and t&gt;3, both of which considered significant. While correlating post chelation ferritinwith TSH levels; they showed a linear correlation ( Pearson coefficient of .836).&#x0D; Conclusion:Serum ferritin and TSH estimation in prechelation and postchelation periods give an estimateof iron overload with effect of chelation on it. Both levels decrease post chelation presenting alinear correlation between the two.&#x0D; Bangladesh Journal of Medical Science Vol.20(1) 2021 p.130-135

Role of intensive method of bone marrow iron assessment and serum Ferritin in prediction of iron deficiency: a study of 143 patients

Introduction: Iron deficiency anemia is a major health problem in developing countries like India. The situation is even more grim in economically backward areas of our country like Bundelkhand region. The increasing prevalence of co-existence of iron deficiency anemia with chronic diseases makes the use of biochemical markers like serum ferritin, challenging in diagnosing cases of inflammation and functional iron deficiency. Microscopic evaluation is the “gold standard” method for assessment of iron stores. In this study, we tried to correlate the marrow iron stores with serum ferritin so as to facilitate the distinction of iron store deficiency from functional iron deficiency. Materials and Methods: We selected 143 adult patients with anemia. In all the patients diagnostic bone marrow examination was done. Serum ferritin assay, CBC and peripheral blood smear examination was also performed. Assessment of bone marrow iron was done by both Gale’s method and the intensive method and was correlated with serum ferritin. Results: The Conventional Gale’s grading revealed hypoferremic state in 46.85% cases and normal iron stores in 53.15% cases. The new Intensive method of grading, classifies anemias according to iron status. It showed that most common was combined deficiency (functional & iron stores) (43.36%), followed by normal stores, functional iron deficiency and lastly iron stores deficiency in Bundelkhand region. We also found a positive correlation of microcytic hypochromic blood picture with S.Ferritin and iron deficiency anemia (Spearman’s Rho correlation, p value=0.0001). The proposed cutoff value of S.ferritin as a surrogate marker for iron deficiency used in our study is Conclusion: The new Intensive Bone Marrow Grading Method has greatly improved iron assessment because it provides a useful iron status classification which is of high clinical importance, especially in areas with high prevalence of inflammatory conditions co-existing with iron deficiency anemia, like Bundelkhand region and remains the gold standard method. Keywords: Anemia, Ferritin, Iron, Bone marrow.

Prevalence and foetomaternal effects of iron deficiency anaemia among pregnant women in Lagos, Nigeria.

Anaemia in pregnancy is a major health problem and an important cause of adverse foetomaternal outcomes in developing countries. Iron deficiency is the cause of the overwhelming majority of the cases of anaemia in pregnancy. Iron deficiency anaemia (IDA) has been linked with adverse foetal and maternal outcomes. This study investigated the prevalence of IDA and evaluated its effects on foetomaternal outcomes among parturients in Lagos, Nigeria. This was a cross-sectional study that enrolled 220 women aged 15–49 years with singleton gestation at term, between May 1, 2016, and March 31, 2017. Participants were selected by systematic sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure haemoglobin and serum ferritin concentrations, and the associations between IDA (defined as anaemia and iron deficiency) and pregnancy outcomes were examined. A P-value <0.05 was considered as statistically significant. The prevalence of IDA was 12.3%. Routine antenatal iron supplementation (adjusted odds ratio 0.18, 95% confidence interval 0.07–0.46; P = 0.001) and interpregnancy interval of at least 2 years (adjusted odds ratio 0.20, 95% confidence interval 0.05–0.97; P = 0.021) have significant association with IDA. Iron deficiency anaemia was not significantly associated with adverse perinatal outcomes but there were significant associations with increased risk of blood transfusion (P = 0.001) and maternal infectious morbidities such as puerperal pyrexia (P = 0.041) and wound infection (P = 0.020). IDA is still a fairly common condition among parturients in Lagos and it’s mostly associated with maternal peripartum morbidities. Adequate pregnancy spacing through the use of effective contraception and routine antenatal iron supplementations in pregnancy is a recommended preventive measure against IDA and its adverse sequelae. Future studies should adopt the use of transferrin saturation (TSAT) in compliment with serum ferritin assay as a more sensitive marker of iron deficiency.

Association of frequency of hereditary hemochromatosis (HFE) gene mutations (H63D and C282Y) with iron overload in beta-thalassemia major patients in Pakistan.

Objectives:To evaluate any association between the frequency of hereditary hemochromatosis (HFE) gene mutation (H63D and C282Y) and iron overload in beta-thalassemia major (BTM) patients.Methods:The case-control study was conducted from June 2016 to February 2018. Blood samples from 204 BTM patients and 204 normal controls were taken from the Sundas Foundation Blood Bank.These samples were analyzed for serum ferritin assay and HFE mutation. Ferritin level was measured on the ARCHITECT 1000SR. Both patient and control samples were analyzed for mutations using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).Results:Serum ferritin levels for all patients were >1000ng/mL. The p.H63D mutation was observed in 23 (11.3%) cases, out of which 19 cases were heterozygous for p.H63D and 4 cases were homozygous. In control samples, 4 cases (2%) were found heterozygous for the p.H63D, and no homozygous mutation was found. Significantly high serum ferritin levels were found in BTM patients with the H63D mutation (p=0.00). In the case of p.C282Y, neither homozygous nor heterozygous mutation was found in patients or in controls.Conclusion:H63D polymorphism is associated with iron overload in BTM patients. Larger-scale research is required to give an elaborated view of the association of the HFE mutation with iron overload in these patients and to confirm our conclusion.

Magnitude of elevated iron stores and risk associated in steady state sickle cell anemia Congolese children: a cross sectional study

BackgroundThe serum ferritin assay is recommended in Sickle Cell Anemia (SCA) patients receiving regular transfusions. According to several authors, elevated iron stores indicating iron chelation corresponds to hyperferritinemia ≥500 ng/ml, and becomes detectable after twenty blood transfusions. The objectives of the study were to determine the prevalence of elevated iron stores and identify associated risk factors in a case series of Steady state SCA Congolese children.Material and methodsSerum ferritin was assayed in Steady state SCA children followed in 2 specialized hospitals in Kinshasa. Elevated iron stores was defined as serum ferritin level ≥ 500 ng/ml, and the associated risk factors were identified using univariate analysis.ResultsSeventy patients (median age 9 years, 56% boys, 53% receiving hydroxyurea) were selected in the study. Serum ferritin levels ranged from 24 to 2584 ng / ml with 21.4% of children having elevated iron stores. Mean levels of LDH, indirect bilirubin, plasma free Hb and CRP were similar between the 2 groups whereas history of polytransfusions (> 3 during the last year) was more frequent among patients with elevated iron stores (73% vs. 44%, p = 0.078). Receiving > 3 transfusions in a year vs. 0 was the main risk factor associated with elevated iron stores [OR 6.17 (95% CI: 1.81–20.96)].ConclusionIn SCA children, hyperferritinemia requiring iron chelation is most strongly related to blood transfusion. This situation concerned almost one in five children in present study; this shows the magnitude of the problem which is underestimated.

A comparative study on selected iron status assessment assays among secondary school students in Bauchi State, Nigeria

Iron deficiency anemia (IDA) is the most common form of anemia worldwide, with highest burden in developing countries. The assays used in detecting iron deficiency comprise of red blood cell indices such as Mean Corpuscular Hemoglobin and Mean Corpuscular Volume, serum ferritin, soluble transferrin receptor (STfR) and STfRL-index. Each of these assessment tools has its drawback(s). This study was conducted to assess IDA diagnostic inter-rater agreements between red cell indices, serum ferritin, STfR and STfLF-Index. A cross sectional descriptive study using systematic random sampling of eligible secondary school students in Misau LGA, Bauchi State, Nigeria. Complete Blood Count with cellular indices, serum ferritin and STfR assays were conducted. Data was analyzed using SPSS version 23.0. Proportions were compared using Z-tests of proportions. Cohen’s Un-weighted kappa analyses were used to assess pairwise agreements in the ability of STfLF-Index, serum ferritin, STfR and red cell indices to classify participants into IDA and non-IDA. Level of significance was set at P≤0.05. A total of 210 participants were enrolled in the study with females constituting 153 (72.9%). STfLF-Index, STfR, serum ferritin levels and red cell indices revealed that 130/210 (61.9%), 160/210(76.2%), 7/210 (3.3%) and 112/210 (53.3%) respectively had iron deficiency. STfR revealed a significantly higher percentage of students with iron deficiency compared to serum ferritin, STfLF-Index and red cell indices. Assessment of iron deficiency showed concurrence between STfR and STfLF-Index. STfR and STfLF-Index have similar ability in classifying iron status.

Study of Serum ferritin levels in β-Thalassemia major children

Background: Thalassemiais one ofthe most commoninherited single-gene disorder in the world. Every year approximately 100,000 thalassemia major children are born all over the world, and there are about 65, 000-67,000β thalassemia major patients in India, with around 9,000-10,000 cases being added every year. Measurement of serum ferritin level can give idea regarding starting of Iron chelation therapy, which will reduce the concentration of serum ferritin and effective in preventing iron induced tissue injury and prolonging life expectancy. Method: This study was conducted on 60 children between 3 to 17 years, being regularly transfused at department of Pediatrics, Kamala Raja Hospital, Gajra Raja Medical College, Gwalior, for period of 1 year from 2011 to 2012, after taking the informed consent from the parents and explaining them the purpose of study. Detailed history weretaken and serum ferritin level weremeasured by ELIS Abased serum ferritin assay kit. Results: Serum ferritin level was found to be elevated in all the patients of betathalassemiamajorwithrange from 1050 to 5029 µg/l and with a mean value of 3879µg/l. Out of 60 patients, 30 (50%) patients had serum ferritin level below 2000μg/l,20 (33.3%) patients had serum ferritin value between 2001 to 4000 μg/l and rest 10 (17.7%) patients had values above 4000 μg/l. Mean value of serum ferritin was found to be higher in patients who received frequent blood transfusion. Conclusion: Majority of the patients had very high ferritin levels, with a mean value of 3879 µg/l. 50% patients had serum ferritin levels more than 2000μg/l. This cut off value reflect either inadequate chelation therapy or non-affordability of parents to purchase oral chelation therapy.

Ferritin: Diversity and Management of Ferritin Measurement Methods.

Serum ferritin is one of the most important and widely used markers of iron metabolism, and is a recommended standard index of iron dynamics in guidelines for renal anemia in many countries. However, serum ferritin measurement has several disadvantages. For example, it is prone to being influenced by underlying disease, and there is considerable systematic bias among different methods of measurement. Systematic bias affects not only the measurement results, but also the therapeutic strategy to be used in accordance with the relevant guidelines, and consequently the cost of medical treatment. Key Messages: Manufacturers should reduce variability in their serum ferritin assay kits. Researchers should take into account propagation of error in the analysis of measurement values, and clinicians should evaluate laboratory data with care.