Serum Ferritin Levels Research Articles

Association between Iron deficiency and hypothyroxinemia in first-trimester pregnant women: A study from a tertiary care hospital

ABSTRACT Background: Iron deficiency (ID) is a common nutritional concern worldwide. Hypothyroidism during pregnancy also has harmful effects on both mother and child, such as post-partum hemorrhage, pre-eclampsia, low-birth weight, pre-term labour and abruptio placenta. Few articles have shown an association between ID and hypothyroidism. Aims: To evaluate the association between hypothyroidism, hypotriiodothyroninemia and ID in pregnant women. Materials and Methods: This cross-sectional study was conducted between January 2017 and June 2019 at JSS Hospital, a Tertiary Care Teaching and Research Hospital attached to JSS Medical College in Mysuru City, South India. Five hundred consecutive pregnant women aged 18–45 years in the first trimester of pregnancy were recruited. A venous blood sample of approximately 5 mL was drawn and sent for analysis of haemoglobin, thyroid-stimulating hormone (TSH), T3, T4, anti-thyroid peroxidase (TPO) antibodies and serum ferritin. T3, T4, TSH, anti-TPO antibody and serum ferritin levels were measured by chemiluminescence for all pregnant women. Correlation and linear regression analyses were performed to determine the association between ID and T3, T4 and TSH levels. Results: Out of 500 women, nine were excluded because of pre-analytical errors; hence, there were 491 pregnant women in the first trimester. Mean values of T3, T4, TSH and ferritin in the study were 1.45 ± 0.72, 9.29 ± 2.53, 2.37 ± 3.17 and 31.54 ± 30.28. There was a positive correlation between serum ferritin and T4 levels, with a correlation coefficient of 0.135. The scatter plot also showed a linear relationship between serum ferritin and T4 levels. There was no significant correlation between serum ferritin, T3 and TSH levels. Linear regression analysis also showed an association between ferritin and T4 levels, with a significance of 0.003. Linear regression analysis was insignificant for TSH, T3 and serum ferritin levels. Conclusion: ID anaemia (IDA) is associated with hypothyroxinemia in pregnant women. Further extensive studies are needed to evaluate the causal association between hypothyroidism and IDA. Iron therapy might improve thyroid parameters in patients with subclinical hypothyroidism and ID without thyroxine, which requires further research.

Correlation between Serum Ferritin and Thyroid Hormones Level in Children with Thalassemia

Background: Thalassemia is a group of hereditary blood disorder characterized by reduced or absent globin chain synthesis resulting in transfusion dependent anaemia and iron overload. Due to regular blood transfusion and inadequate chelation therapy patient develop multiorgan dysfunction. Objectives: To find any correlation between serum ferritin and thyroid hormones level in children with transfusion dependent thalassemia. Methods: This cross-sectional study was carried out in the department of Paediatrics and department of Medicine, Sylhet MAG Osmani Medical College Hospital between June, 2021 to May, 2022, on one hundred children with transfusion dependent thalassemia who were on more than 12 times blood transfusion but did not take any chelation therapy and whose serum ferritin level were > 1000 ng/ml. Assessment of their thyroid hormones level and statistically its correlation with serum ferritin were done. Result: A total of 53 (53%) male and 47 (47%) female were included in this study. The mean age of the patients was 9.47 ±3.63 years. Mean serum ferritin was 1980±1126.19 ng/ml, mean serum TSH was 3.55±2.08 µIU/ml, mean serum free T4 was 1.10±0.18 ng/ml, mean serum free T3 was 3.64±0.37 pg/ml. Subclinical hypothyroidism and euthyroid were found in 20 patients (20%) and 80 patients (80%) respectively. No overt hypothyroidism or hyperthyroidism were found. Mean serum ferritin in subclinical hypothyroid and euthyroid were 2407±995.37 ng/ml and 1875.59±1131.18 ng/ml respectively which difference was statistically significant (P value <0.05). Scattered diagram was done and it showed linear correlation between serum ferritin and serum TSH of subclinical hypothyroid group. No linear correlation was found between serum ferritin and F.T3 and F.T4 on scattered diagram. Positive (Pearson) correlation was found between serum ferritin and serum TSH of subclinical hypothyroid group and strong positive (Pearson) correlation (r=0.74, P=0.02) was found between them. Conclusion: This study showed that good percentages of children with transfusion dependent thalassemia are suffering from subclinical hypothyroidism. There is positive correlation between serum ferritin level and subclinical hypothyroidism.

Association Between Serum Ferritin Level and Liver Function Tests in Children with Beta-Thalassemia (Thalassemia Center of Kut Hospital, Iraq)

Background: Thalassemia represents a heterogeneous autosomal recessive hereditary anemia.Ferritin is a 450 KDa soluble protein. It can be found in all of the body's cells, but it's particularly abundant in marrow macrophages, spleen, and liver.Objective: In patients with β thalassemia major and β thalassemia Intermedia, serum ferritin levels are measured, and their correlation with bilirubin levels, liver enzymes AST (aspartate transaminase) and ALT (alanine transaminase), in beta-thalassemia major and β thalassemia Intermedia.Patients and Methods: A cross-section study that involved 90 patientsincluded 50 Thalassemia Major (TM) and 40 Thalassemia intermediate(TI). Patients who were randomly chosen for this study would be gathered from the Kut Hospital Thalassemia Center. Every patient's are kid, aged 5 to 17, regardless of gender. Abbott C4000 Architect Additionally, the TSB, ALT, AST, and serum ferritin were determined using the Cobas c 111 analyzer.Results: The studies include both genders 52.9% of the females had B-thalassemia major and 47.1% had β-thalassemia intermediate, whereas 57.1% of the men had βTM and 42.9% had βTI. There were 37.8% of females and 62.2% of males in the sample.Patients with severe thalassemia exhibited a statistically significant increase in the mean± SD of serum ferritin (4016.54 ± 2500.81 ng/ml) compared to the mean ± SD of β-thalassemia intermedia (1629.48 ± 1235.33 ng/ml), with a p-value of 0.000. Patients with major β-thalassemia had a mean TSB level that was statistically significantly lower (1.32 ± 0.69 mg/dl) than the mean level of β-thalassemia intermedia (2.10 ± 0.86 mg/dl), with a p-value of 0.000. In the B-thalassemia major group, serum hepcidin did not exhibit a statistically significant association with serum ferritin (r=-0.04), while in the B-thalassemia intermedia group, serum ferritin exhibited a statistically significant moderate negative correlation with TSB (r=-0.38), p-value. 0.01.Conclusions: Ferritin levels may be useful in thalassemia syndrome diagnosis and prognosis determination.

Profile of Micronutrients in Patients Presenting with Pityriasis Alba in a Tertiary Care Center: A Case–control Study

Abstract Background: Pityriasis alba (PA) is a common, self-limiting skin disease of childhood. Several micronutrient deficiencies have been attributed to causing PA. Few studies have found a decreased level of serum zinc to be associated with PA, whereas other studies have found a deficiency of serum copper, magnesium, ferritin, and Vitamin D3 to be associated with PA. Aims and Objectives: The objective of the study was to estimate the serum levels of micronutrients (zinc, copper, magnesium, and ferritin), hemoglobin (Hb), serum albumin, and Vitamin D3 in patients of PA and compare the same with that of controls. Materials and Methods: A total of 36 patients with PA and 36 controls were enrolled in the study. Five milliliters of venous blood will be obtained from both cases and controls to conduct the investigations. The serum levels of zinc, ferritin, magnesium, copper, Vitamin D3, hemoglobin, and serum albumin levels were detected. The data were analyzed statistically. Results: In this study, we observed a low serum level of zinc associated with PA patients, when compared to healthy controls with P < 0.042. The serum levels of magnesium in cases were significantly low compared to controls with P < 0.002, which was statistically significant. Vitamin D and Hb levels were also significantly reduced in the PA patients. However, we did not find statistical significance between serum levels of copper, albumin, and ferritin in cases and controls with P = 0.408, P = 0.055, and P = 0.082, respectively. Conclusion: PA is a multifactorial etiological condition, in which micronutrient deficiency is an important cause and supplementation of micronutrients among these patients may be beneficial.

Establishment of an animal model of immune-related adverse events induced by immune checkpoint inhibitors.

Immunotherapy, specifically immune checkpoint inhibitors (ICIs), has revolutionized cancer treatment. However, it can also cause immune-related adverse events (irAEs). This study aimed to develop a clinically practical animal model of irAEs using BALB/c mice. Subcutaneous tumors of mouse breast cancer 4T1 cells were generated in inbred BALB/c mice. The mice were treated with programmed death-1 (PD-1) and cytotoxic t-lymphocyte antigen 4 (CTLA-4) inhibitors once every 3 days for five consecutive administration cycles. Changes in tumor volume and body weight were recorded. Lung computed tomography (CT) scans were conducted. The liver, lungs, heart, and colon tissues of the mice were stained with hematoxylin-eosin (H&E) staining to observe inflammatory infiltration and were scored. Serum samples were collected, and enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of ferritin, glutamic-pyruvic transaminase (ALT), tumor necrosis factor-α (TNF-α), interferon-gamma (IFN-γ), and interleukin-6 (IL-6). Mouse liver and lung cell suspensions were prepared, and changes in macrophages, T cells, myeloid-derived suppressor cells (MDSCs), and regulatory (Treg) cells were detected by flow cytometry. Mice treated with PD-1 and CTLA-4 inhibitors showed significant reductions in tumor volume and body weight. The tissue inflammatory scores in the experimental group were significantly higher than those in the control group. Lung CT scans of mice in the experimental group showed obvious inflammatory spots. Serum levels of ferritin, IL-6, TNF-α, IFN-γ, and ALT were significantly elevated in the experimental group. Flow cytometry analysis revealed a substantial increase in CD3+T cells, Treg cells, and macrophages in the liver and lung tissues of mice in the experimental group compared with the control group, and the change trend of MDSCs was opposite. The irAE-related animal model was successfully established in BALB/c mice using a combination of PD-1 and CTLA-4 inhibitors through multiple administrations with clinical translational value and practical. This model offers valuable insights into irAE mechanisms for further investigation.

Iron Deficiency and Hearing Problems in Adult Patients: Sample of Iraqi Patients

Abstract Background: Anemia causes insufficient oxygenation of various organs, which leads to impairment of cognitive function as well as behavioral dysfunction, and there is a possibility of iron effects on the inner ear system by inducing pathologic insults. Objectives: The aim of this article is to investigate the association of tinnitus and hearing loss with iron deficiency and iron deficiency anemia. Materials and Methods: A descriptive cross-sectional study included patients suffering from tinnitus who were tested by pure tone audiometry and categorized according to hearing status into those with normal hearing and those with hearing loss. A blood sample was taken from each one for performing a complete blood count and serum ferritin level measurements in order to show the presence of iron deficiency and/or iron deficiency anemia. Results: One hundred patients with tinnitus were enrolled, 62 patients of them have hearing loss, while 38 patients have normal hearing. Forty-eight percent of tinnitus patients have iron deficiency anemia and 13% have only iron deficiency. There is a significant association between sensorineural hearing loss and iron deficiency anemia in patients with tinnitus (P value is 0.00283, P value is significant if <0.05). The proportion of subjects with low ferritin and hearing loss is significantly higher than those with low ferritin and normal hearing (P value is 0.000106. The result is significant at P < 0.05). Conclusion: Tinnitus and sensorineural hearing loss are significantly associated with iron deficiency and iron deficiency anemia.

Analysis of how Serum Ferritin and the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) are correlated to Hepatic MRI T2* Findings in Children with Beta-Thalassemia Major

Background: Iron overload is a major complication in patients with beta-thalassemia major. Excessive iron accumulation leads to organ dysfunction. The regular assessment of iron is crucial to effectively manage iron overload in these patients. This study evaluated the correlation between serum ferritin levels, the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI), and hepatic MRI T2* findings in children with beta-thalassemia major. Materials and Methods: This retrospective analytical study was conducted at Shahid Sadoughi Hospital in Yazd in 2023. The research population comprised all the children under the age of 15 with beta-thalassemia major who had undergone multiple blood transfusions (at least ten units of blood). Results: The participants in this study were 70 children with beta-thalassemia major, including 35 males and 35 females. Their mean age was 3.52 ± 10.76 years. The mean relaxation time of liver MRI T2* was 4.42 ± 4.91 ms. The participants also had the APRI score of 0.55 ± 1.90, the aspartate aminotransferase (AST) level of 23.82 ± 36.29, and the serum ferritin level of 285.01 ± 3244.04 (ng/mL). Based on MRI T2* results, 30% of the patients had a severe liver iron overload, 27.1% had a moderate overload, 21.4% had a severe overload, 18.6% had a mild overload, and 2.9% had near-normal iron levels.The AST level demonstrated a significant association with the type of chelation treatment (P = 0.003). The duration of blood transfusion (in years) showed a strong positive correlation with the patients' age (Pearson's coefficient = 0.996). Conclusion: This study indicates the elevated serum ferritin levels and APRI scores in patients with beta-thalassemia major, most of whom have abnormal MRI T2* findings. However, no significant correlation was observed between the APRI score, serum ferritin level, and MRI T2* results.

Biomarkers of hemorrhagic transformation of acute ischemic stroke – A cross-sectional study

Background. Hemorrhagic transformation (HT) is a serious complication that can arise in individuals experiencing acute ischemic stroke (AIS), whether it occurs spontaneously or following thrombolytic therapy, resulting in considerable morbidity and mortality. Hemorrhagic changes are associated with several risk factors, including excessive blood sugar levels, hypertension, the severity of a stroke, and reperfusion. Aim. To assess the commonly available blood parameters such as lipid profile, serum magnesium, and serum ferritin as tools to identify patients who are at risk of hemorrhagic transformation after an acute ischemic stroke. Materials and methods. The study was conducted at the Saveetha Medical College, Chennai, Tamil Nadu, in India, as a cross-sectional study, and a total of 142 patients diagnosed with acute ischemic stroke were enrolled for this study from January 2023 to January 2024. Results. Among the 32 patients who had a hemorrhagic transformation, all 32 (100%) patients had elevated serum ferritin levels and the remaining 110 patients who had no hemorrhagic transformation were found to have normal serum ferritin levels and the difference was statically significant (p<0.001). Total cholesterol, serum LDL, serum HDL, and serum triglycerides had no statistically significant association with hemorrhagic transformation among the patients. Conclusion. The present study concludes that people with lower serum magnesium on admission and higher serum ferritin were found to be at risk. Serum lipid profile had no statistically significant association with hemorrhagic transformation among the patients.

PREVALENCE OF MALARIA, THE EFFECT OF PARASITAEMIA ON BLOOD PARAMETERS AND IRON LEVEL OF INFECTED CHILDREN UNDER FIVE YEARS OF AGE IN ITU, SOUTH-SOUTH, NIGERIA

Malaria is a devastating public health concern in Itu with varied haematological and biochemical implications. This study seeks to crystalize the prevalence of malaria, the effect of parasitaemia on some haematological parameters, and serum iron level of infected children under 5 in Itu Local Government Area, Nigeria. The study adopted a cross-sectional study involving 430 children. Blood samples were obtained from consented caregivers. Malaria prevalence and parasitaemia level were diagnosed microscopically. Haematology auto-analyzer was used to determine haematological parameters. Malaria prevalence of 41.08% was recorded in the study. The highest prevalence (42.86%) was reported among the female subjects. The difference in the infection rate between males and females was statistically significant (p<0.05). The infected children tended to have significantly lower mean haemoglobin, packed cell volume, red blood cell level, lymphocyte, monocytes, and eosinophil count, (p < 0.005) and a higher mean neutrophil, as well as white blood cell count (p < 0.05) compared to the non-infected subjects respectively. A weak correlation between the level of parasitaemia and Hb (r= 0.108), PCV(r=0.247), RBC (r= o.074), and a weak negative with WBC (r = -0.063) was also reported. The study also recorded a higher mean serum ferritin level (648 ng/ml) compared to non-infected, lower mean serum transferrin (6.41 ng/ml) compared to normal, and mean serum iron (54.40 ng/ml) was higher than normal. It is essential to pay keen attention to the evaluation of haematological and biochemical parameters in the management of malaria infection in children living in malaria-endemic areas.

Serum Ferritin and Procalcitonin as Diagnostic Biomarkers for Sepsis in an Emergency Department: A Clinical Study

Abstract Background and Aim: Sepsis, a life-threatening condition, presents diagnostic challenges due to its heterogeneous nature. Early and accurate diagnosis is essential for timely intervention. Serum biomarkers, such as ferritin and procalcitonin (PCT), have been explored for their potential in sepsis diagnosis, but the outcomes are inconclusive. The current study was an attempt to further explore the usefulness of ferritin and PCT as sepsis biomarkers. Material and Methods: A prospective study involving 149 patients assessed serum ferritin and PCT levels in those with features suggestive of sepsis. Patients were categorized into sepsis and nonsepsis groups based on the clinical judgment of the emergency physicians. Statistical analyses, including the Mann–Whitney U test and receiver operating characteristic (ROC) curves, were conducted to evaluate the diagnostic utility of these biomarkers. Results: Serum ferritin levels did not exhibit a statistically significant difference between sepsis and nonsepsis groups (P = 0.698). In contrast, PCT levels were significantly higher in sepsis cases (P = 0.011). ROC analysis identified an optimal PCT cutoff value of 0.085, offering high sensitivity (92.5) but lower specificity (16.7). Conclusion: PCT proved valuable as a diagnostic marker for sepsis. Serum ferritin, on the other hand, did not demonstrate statistical significance as a diagnostic marker for sepsis, its potential role in specific septic conditions and disease severity monitoring warrants further investigation.

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.

Serum Ferritin Level as a Predictor for Intra Uterine Growth Restriction

Background: Maternal serum ferritin is being explored as a potential predictor for Intrauterine Growth Restriction (IUGR). Early detection of IUGR is crucial for improving perinatal outcomes and reducing associated mortality and morbidity. Objective: To evaluate the role of elevated maternal serum ferritin in predicting the risk of developing IUGR. Patients and Methods: A prospective case-control study was conducted at Al-Batool Teaching Hospital, Diyala, involving 51 pregnant women divided into two groups based on pregnancy status. Demographic data, obstetric history, and risk factors for IUGR were collected through a questionnaire, and blood samples were taken to measure hemoglobin and serum ferritin levels. Results: The study found that the mean serum ferritin level was significantly higher in the patient group (209.89±50.95 ng/ml) compared to the control group (66.91±37.49 ng/ml), with a p-value of <0.001. The mean birth weight was significantly lower in the patient group (1873.81±425.62 g) compared to the control group (3078.67±415.56 g), also with a p-value of <0.001. There were no significant differences in age and hemoglobin levels between the two groups. Conclusion: Elevated maternal serum ferritin levels may suggest an increased risk of IUGR, emphasizing the need for further research to validate its role as a predictive marker.

Serum Ferritin Level as a Predictor for Intra Uterine Growth Restriction

Background: Maternal serum ferritin is being explored as a potential predictor for Intrauterine Growth Restriction (IUGR). Early detection of IUGR is crucial for improving perinatal outcomes and reducing associated mortality and morbidity. Objective: To evaluate the role of elevated maternal serum ferritin in predicting the risk of developing IUGR. Patients and Methods: A prospective case-control study was conducted at Al-Batool Teaching Hospital, Diyala, involving 51 pregnant women divided into two groups based on pregnancy status. Demographic data, obstetric history, and risk factors for IUGR were collected through a questionnaire, and blood samples were taken to measure hemoglobin and serum ferritin levels. Results: The study found that the mean serum ferritin level was significantly higher in the patient group (209.89±50.95 ng/ml) compared to the control group (66.91±37.49 ng/ml), with a p-value of <0.001. The mean birth weight was significantly lower in the patient group (1873.81±425.62 g) compared to the control group (3078.67±415.56 g), also with a p-value of <0.001. There were no significant differences in age and hemoglobin levels between the two groups. Conclusion: Elevated maternal serum ferritin levels may suggest an increased risk of IUGR, emphasizing the need for further research to validate its role as a predictive marker. Keywords: Intrauterine Growth Restriction (IUGR), Serum Ferritin, Pregnancy, Predictive Marker, Perinatal Outcomes.

A Comparison between Serum 25-Hydroxyvitamin D3 Levels and Serum Ferritin in Children and Adolescents with Iron Deficiency Anemia, Thalassemia Minor, Thalassemia Major and Healthy People

Background: We aimed to determine the level of serum vitamin D and serum ferritin in four groups’ children and adolescents. Methods: This descriptive/analytical study was conducted in 2019 on children and adolescents with thalassemia aged 7-18 years in Ahvaz, Iran. Overall, 160 patients with the target inclusion and exclusion criteria were assigned into four groups (n=40) of people with thalassemia minor, thalassemia major, iron deficiency anemia and healthy individuals. The level of ferritin and vitamin D was assessed. Mann-Whitney test, Wilcoxon test and Spearman's correlation test were used as well as SPSS Statistics V21. Results: The mean age of the participants was 13.07 ± 3.82 yr and 100 people (62.5%) were male. In terms of vitamin D deficiency, 16 people (40%) had severe deficiency in iron deficiency group. The highest level of ferritin was found in thalassemia major group and the lowest in iron deficiency group. Regarding the level of vitamin D and ferritin in the healthy group, there was a statistically significant difference between mean vitamin D and serum ferritin levels (P=0.027). In iron deficiency group, this level of ferritin was observed with mild deficiency (P=0.017). In thalassemia major group, the increase in ferritin was associated with severe vitamin D deficiency (P=0.05. Conclusion: Severe vitamin D is seen in thalassemia major due to the increase in ferritin, but moderate deficiency of this vitamin in healthy people and mild deficiency in iron deficiency anemia group was observed considering the normal levels of ferritin.

Characteristics of markers of ovarian reserve in women with transfusion-dependent beta thalassaemia major with a successful pregnancy outcome

Objective: Spontaneous fertility and successful pregnancies have been reported in well-chelated and transfused women with beta thalassaemia major (BTM) however majority of women are sub fertile due to hypogonadotropic hypogonadism (HH) and lack of ovulation. Little is known about the effect of iron overload on ovarian follicles and whether ovarian reserve is affected by the condition or treatment. The predictive value of markers of ovarian reserve in relation to live birth in this group of women remains unclear. The aim of this study was to characterize the markers of ovarian reserve in women with transfusion-dependent beta thalassaemia major who had at least one successful live birth. Study design: This is a retrospective study in which we collected data from 12 women with transfusion-dependent BTM and at least one successful live birth from our thalassaemia clinic between July 2007 to June 2022. Patient demographics, medical history, menstrual history, hormonal parameters (serum levels of FSH, oestradiol, TSH and AMH) and antral follicle count were recorded. Serum levels of ferritin, cardiac T2*, liver iron concentration and thyroid function results were recorded from clinic visit prior to either natural conception or assisted conception treatments. Results: There was a wide variation in serum levels of AMH and antral follicle counts amongst women with BTM who had a successful live birth. Low serum AMH levels were noted in 4 women with HH with a background of BTM (33.3%) as compared to the established normal ranges for women of similar age. Also, low AFC counts were noted in 7 women (out of which 6 had HH) with BTM (58.3%) as compared to the established normal ranges for women of similar age. Conclusion: Levels of serum AMH and antral follicle counts appeared lower in up to half the women with BTM and hypogonadotropic hypogonadism with a successful live birth as compared to established normal ranges for women of similar age suggesting that these markers may not accurately reflect the ovarian reserve for all in this group of women. There are limited data about the predictive value of contemporary markers ovarian reserve such as serum AMH and AFC levels in predicting successful fertility or pregnancy outcomes in women with transfusion dependent BTM and larger studies are needed.

Iron incorporation in red blood cells of pediatric sickle cell anemia: a stable isotope pilot investigation.

Sickle cell anemia (SCA) is marked by hypoxia, inflammation, and secondary iron overload (IO), which potentially modulate hepcidin, the pivotal hormone governing iron homeostasis. The aim was to evaluate the iron incorporation in red blood cells (RBC) in SCA pediatric patients, considering the presence or absence of IO. SCA children (n = 12; SCAtotal) ingested an oral stable iron isotope (57Fe) and iron incorporation in RBC was measured after 14 days. Patients with ≥1000 ng/mL serum ferritin were considered to present IO (SCAio+; n = 4) while the others were classified as being without IO (SCAio-; n = 8). Liver iron concentration (LIC) was determined by Magnetic Resonance Imaging (MRI) T2* method. The SCAio+ group had lower iron incorporation (mean ± SD: 0.166 ± 0.04 mg; 3.33 ± 0.757%) than SCAio- patients (0.746 ± 0.303 mg; 14.9 ± 6.05%) (p = 0.024). Hepcidin was not different between groups. Iron incorporation was inversely associated with serum ferritin level (SCAtotal group: r = -0.775, p = 0.041; SCAio- group: r = -0.982; p = 0.018) and sickle hemoglobin (HbS) presented positive correlation with iron incorporation (r = 0.991; p = 0.009) in SCAio- group. LIC was positively associated with ferritin (SCAtotal: r = 0.921; p = 0.026) and C reactive protein (SCAio+: r = 0.999; p = 0.020). SCAio+ group had lower iron incorporation in RBC than SCAio- group, suggesting that they may not need to reduce their intake of iron-rich food, as usually recommended. Conversely, a high percentage of HbS may indirectly exacerbate hypoxia and seems to increase iron incorporation in RBC. This trial was registered at www.ensaiosclinicos.gov.br . Identifier RBR-4b7v8pt.

Iron deficiency anemia in relation to pinch strength and hand dexterity in preschool children: a cross-sectional study

BackgroundIron deficiency anemia (IDA) constitutes a considerable nutritional problem in Egyptian preschool children. Moreover, IDA limits physical activity performance and interferes with children's development. Accordingly, we aim to investigate the correlation between IDA and hand dexterity and pinch grip strength in preschool children.ResultsThis observational cross-sectional study encompassed the participation of 87 children, comprising both genders, with an age range of 5–6 years. The cohort was initially stratified into three distinct groups: Group A comprised 36 non-anemic children, group B included 25 children with mild iron-deficiency anemia (IDA), and group C consisted of 26 children with moderate IDA. After group delineation, comprehensive laboratory analyses were performed on all participants to assess for IDA, involving a thorough examination of their complete blood picture, hemoglobin (Hb) levels, serum iron levels, and serum ferritin levels. The evaluative metrics employed in this study encompassed the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2) and the Baseline Mechanical Pinch Gauge. These instruments were utilized to assess manual dexterity and pinch strength, specifically tip-to-tip and tripod strength. This investigation revealed a positive correlation between Hb, serum iron, and serum ferritin levels with both manual dexterity and pinch strength across all three groups.ConclusionThis study highlights that IDA negatively affects hand dexterity and pinch grip strength in preschool children. Managing IDA early is crucial for improving their physical performance and overall development.

SLC40A1-related hemochromatosis associated with a p.Y333H mutation in mainland China: a pedigree report and literature review

BackgroundHaemochromatosis is a genetic disease characterized by the excessive deposition of iron in various tissues and organs, eventually results in organ damage including cirrhosis, diabetes, cardiomyopathy, etc. SLC40A1-related haemochromatosis is associated with gain-of-function mutations in the SLC40A1 gene, which encodes ferroportin. While sporadic reports of this condition exist in mainland China, the understanding of the phenotype and genetic pattern associated with the SLC40A1 p.Y333H mutation remains incomplete.Case presentationWe report a pedigree with heterozygous p.Y333H mutation in Chinese Han population. The proband is a 64-year-old man complaining of persistent abnormality of liver enzyme levels for 1 year, with a history of knee joint pain, diabetes and skin pigmentation. He displayed markedly elevated serum ferritin level and transferrin saturation. Magnetic resonance imaging showed iron deposition in the liver, spleen, and pancreas, along with cirrhosis and splenomegaly. Whole exome sequencing identified a heterozygous allelic variant c.997T > C (p.Y333H). Genetic screening of family members identified four first-degree relatives and three second-degree relatives having the same mutation. Additional cases with this mutation from two published studies were included. Among the probands and screened relatives, all eight males aged over 30 y had ferritin level > 1000 µg/L, transferrin saturation > 90%. Four patients with organ damage in the present study received therapeutic phlebotomy, alleviating clinical symptoms and improving in transferrin saturation and serum ferritin.ConclusionsThis study reports the largest pedigree with heterozygous SLC40A1 p.Y333H mutation in the Chinese population to date. In Chinese families, males over 30 years old with hemochromatosis due to SLC40A1 p.Y333H mutation exhibit severe iron overload phenotypes.

Analysis of erythrocyte and iron study data among plateletpheresis donors in Hangzhou, China

BackgroundThe purpose of this study is to obtain the iron parameters level of blood donors and the population who need to pay attention to iron parameters level in this area. MethodsA total of 993 plateletpheresis donors were included in this study, including 798 males and 195 females. The results of erythrocyte and iron parameters of blood donors were compared and analyzed in different groups according to the gender, age and number of blood donations. ResultThe proportion of men and women with low serum ferritin (SF) levels was 10.8 % and 27.7 %, respectively. The mean levels of serum iron (SI), SF, transferrin saturation (Tfs), hemoglobin (Hb) and hematocrit (HCT) of male blood donors decreased with the increase of age groups, but there was no significant statistical difference between the results of female blood donors. The level of SI, SF, Tfs, Hb and HCT of male donors decreased with the increase of blood donations in the past year, while TRF and TIBC increased. The level of Hb, HCT and SF of female donors showed no significant downward trend, while the levels of TRF increased with increasing donations in the past year, excluding first-time donors. The SI of female donors trended down, and TIBC trended up with increasing donations. ConclusionBlood collection institutions need to focus on iron parameters levels in older and frequent male donors, and young fertile female donors.

Identification of a high threshold value of serum ferritin in the diagnosis of hemophagocytic lymphohistiocytosis in hospitalized children in China

Abstract Objectives To explore and identify an optimal serum ferritin (SF) threshold level in diagnosing hemophagocytic lymphohistiocytosis (HLH) in Chinese children. Methods We conducted a retrospective study of 74 children with HLH admitted to Guangdong Women and Children Hospital between January 2015 and May 2021. Children in-hospital not diagnosed with HLH between January 2021 and May 2021 with a measurement of SF were enrolled as the non-HLH group. Patient charts were reviewed for SF levels upon admission and during hospitalization. A receiver operating characteristic (ROC) curve was utilized to determine the optimal cutoff value of SF for diagnosing childhood HLH. Results This study included a total of 74 children with HLH and 302 children with non-HLH diseases. The difference in SF values between the HLH and non-HLH groups was statistically significant (8,975 μg/L vs. 165.5 μg/L, p<0.001). An optimal SF cutoff value of 1,830 μg/L provided a sensitivity of 88 % and specificity of 79 % in confirming childhood HLH. The area under the curve (AUC) is 0.91 (95 % confidence interval 0.88–0.94, p<0.0001). Conclusions A serum ferritin level elevated above 1,830 μg/L might improve the specificity for HLH diagnosis in Chinese children.