Serum Ferritin Measurements Research Articles

Diagnostic Accuracy of Combined Measurement of Serum Homocysteine, C-Reactive Protein, and Serum Ferritin in Mild Cognitive Impairments and Alzheimer's Disease.

Evaluation of the diagnostic accuracy of combined detection of serum homocysteine (Hcy), C-reactive protein (CRP), and serum ferritin (SF) levels in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Descriptive study. Place and Duration of the Study: Clinical Laboratory Section, Affiliated Hospital of Hebei University, Baoding, Heibei, China, from May 2022 to June 2023. Data of 120 patients with memory decline were retrospectively collected. They were divided into an MCI group and an AD group. A further 50 healthy participants were used as a normal control (NC) group. Differences in the Hcy, CRP, and SF levels between the three groups were evaluated. The specificity, accuracy, and sensitivity of these three indices in the combined or single diagnosis of AD and MCI were compared. Their associations with the severity of AD and MCI were also compared. The AD group had the highest levels of Hcy, CRP, and SF (18.79 ± 4.50, 6.35 ± 2.04, and 355.69 ± 120.36), followed by MCI (16.75 ± 3.06, 4.58 ± 2.31, and 203.48 ± 12.76), and NC group (14.32 ± 2.06, 2.06 ± 0.76, and 98.46 ± 5.06), with statistically significant differences (all p <0.001). The diagnostic efficacy of AD for CRP was 98.50%, sensitivity was 96.00%, and specificity was 94.00%, which was higher than Hcy and SF. Tested together, the area under the ROC curve was 99.90%, specificity was 98.00%, and sensitivity was 98.00%. The diagnostic efficacy of SF for MCI had sensitivity of 100.00%, and specificity of 100.00%, which was higher than that of Hcy and CRP. When the three were combined for detection, the area under the curve of SF was 100.00%, sensitivity of 100.00%, and specificity of 100.00%. The levels of Hcy, CRP, and SF were positively correlated with the severity of AD (p <0.01), while negatively correlated with the mini-mental state examination (MMSE) score (p <0.01). The combined detection of Hcy, CRP, and SF improved the diagnostic accuracy of comorbid AD and MCI. Homocysteine, C-reactive protein, Cognitive impairment, Serum ferritin, Alzheimer's disease.

Absolute and Functional Iron Deficiency in the US, 2017-2020

The prevalence of absolute and functional iron deficiency among adults in the US is unknown. To estimate the prevalence of absolute and iron deficiency and iron supplement use in the US across age, sex, and comorbidity categories. This cross-sectional study analyzed data from the National Health and Nutritional Examination Survey (NHANES) 2017 to 2020 prepandemic cycle. Participants included noninstitutionalized, civilian women and men aged 18 years or older who had available serum ferritin, iron, and unsaturated iron binding capacity measurements. Data analysis was performed from March 21, 2023, to July 5, 2024. Absolute iron deficiency and functional iron deficiency. Absolute iron deficiency was defined as serum ferritin less than 30 ng/mL regardless of transferrin saturation. Functional iron deficiency was defined as serum ferritin greater than or equal to 30 ng/mL with transferrin saturation less than 20%. The prevalence of absolute and functional iron deficiency was estimated among all adults in the US and separately among women and men according to age category (>18 years to <50 years, 50-65 years, and ≥65 years) using recommended sample weights and sampling design factors to provide estimates representative of the national, noninstitutionalized civilian population. The 95% CIs were calculated using the Korn-Graubard method. A total of 8021 US adults (mean age, 48 years; 95% CI, 47-49 years; 52% [95% CI, 50%-53%] female) were included in this analysis. An estimated 14% (95% CI, 13%-15%) of adults in the US met the criteria for absolute iron deficiency, and an estimated 15% (95% CI, 14%-17%) met the criteria for functional iron deficiency. Among US adults without anemia, heart failure, chronic kidney disease, or current pregnancy, the estimated prevalence of absolute iron deficiency was 11% (95% CI, 10%-11%), and that of functional iron deficiency was 15% (95% CI, 14%-17%). The prevalence of functional iron deficiency exceeded that of absolute iron deficiency in all US adults except women younger than 50 years. Iron supplement use ranged from 22% (95% CI, 12%-37%) to 35% (95% CI, 29%-42%) of women with iron deficiency and 12% (95% CI, 5%-21%) to 18% (95% CI, 8%-32%) of men with iron deficiency depending on age. These findings suggest that absolute and functional iron deficiency affect a large proportion of American adults even in the absence of anemia, heart failure, or chronic kidney disease. Further research on the role of functional iron deficiency in adverse health outcomes and on iron deficiency screening strategies is needed.

Serum ferritin measurements differ according to assay used: implications for iron therapy in restless legs syndrome.

Serum ferritin levels are used to determine the need for iron supplementation in patients with RLS. The purpose of the study was to determine whether immunoassay measurement of serum ferritin yields varying levels according to different manufacturer assays, with resultant variation in cut off values. We compared serum ferritin levels using 116 clinical samples assessed by the Beckman and Roche methods. While there was a high correlation between results obtained from the 2 methods (R2 = 0,99), the absolute values differed. The equivalent ferritin measures determined by Beckman, Roche were: 50 mcg/dL, 83 mcg/dL; 75 mcg/dL, 121 mcg/dL; 100 mcg/dL, 158 mcg/dL; and 300 mcg/dL, 457 mcg/dL. It is uncertain which assays were used to measure serum ferritin in the seminal studies on which current guidelines for iron therapy for RLS are based. In view of this uncertainty, as well as the limited data on which current recommendations are based, clinicians should be flexible in using recommended serum ferritin cut off values, also utilizing percentage transferrin saturation. Assuming that Beckman or equivalent assays were used, centers using the Roche method need to adjust the cut offs for administration of oral iron and intravenous iron recommended by current practice guidelines to avoid withholding treatment for RLS patients who might benefit from iron supplementation.

Comparative Analysis of Serum and Saliva Iron, Ferritin, and TIBC in Women with Iron Deficiency Anemia: Highlighting Saliva's Screening Potential

Background: Iron deficiency anemia is a prevalent form of anemia, particularly among women. Diagnosing and tracking this condition typically requires various measurements of serum iron, ferritin, and total iron-binding capacity (TIBC) through blood testing. Objectives: This study aims to evaluate the utility of saliva as a predictive marker for monitoring iron levels in iron deficiency anemia by comparing and correlating iron, ferritin, and TIBC levels in the serum and saliva of anemic and healthy women. Methods: In this comparative analysis, 40 women aged 20 - 40 with a similar periodontal status (anemic subjects = 20 and healthy subjects = 20) were examined. After a complete hematological and oral examination, salivary samples were collected using the spitting method, and iron, ferritin, and TIBC levels were measured and compared to the serum levels. Data were analyzed using SPSS 24. Results: The study results showed that the differences in saliva iron and ferritin levels were insignificant between the two groups (P-value = 0.07 and 0.26, respectively), but those were statistically significant in the serum (P-value = 0.0001 and 0.0001, respectively). Additionally, a significant difference was found in the saliva TIBC level (P-value = 0.001), which was negligible in the serum (P-value = 0.118). Conclusions: The results underscore the efficacy of integrating both serum and saliva analyses for comprehending iron-related parameters. While saliva analysis cannot entirely substitute for serum analysis, it represents a convenient approach that may serve as an initial step or be employed in large-scale anemia screenings.

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&lt;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&lt;0.0001). Conclusions A serum ferritin level elevated above 1,830 μg/L might improve the specificity for HLH diagnosis in Chinese children.

Ceruloplasmin levels in β-thalassaemia major: therapeutic insights and implications for iron homeostasis

Ceruloplasmin (CP) is an enzyme that has ferroxidase activity and is important in maintaining iron homeostasis and serving as a copper-transporter in the bloodstream. Beta-thalassemia major (BTM), a common hereditary disorder in Iraq, can affect CP activity in patients with iron overload resulting from frequent blood transfusions in order to sustain haemoglobin levels. The current study is a single-center observational research. CP activity was measured in 304 patients (120 females and 184 males). Anthropometric indices were recorded and the iron load status was determined by measuring serum ferritin. Ninety-two healthy individuals were also included as a control group. Our findings re¬vealed no relationship between age, body mass index, or plasma ferritin and CP activity in BTM patients. No significant influence of sex on CP activity was observed. The outcomes provide insight into assumed pathways regulating CP, and add to the growing body of research on CP’s contribution to iron metabolism in BTM patients. To our knowledge, this work is the only study of its kind in Iraq, provides the groundwork for upcoming studies and potential therapeutic lines by generating insightful data on the multifaceted relationships between iron homeostasis, CP, and BTM.

Epidemiological investigation of iron deficiency among preschool children in 10 provinces, autonomous regions, or municipalities in China

Objective: To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China. Methods: A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test. Results: A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region (χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference (χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) (χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant (χ2=0.51, P=0.476). Conclusions: There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

A Comprehensive Review on Serum Ferritin as a Prognostic Marker in Intensive Care Units: Insights Into Ischemic Heart Disease.

Serum ferritin has garnered considerable attention as a prognostic marker in intensive care units (ICUs), offering valuable insights into patient outcomes and clinical management strategies. This comprehensive review examines the role of serum ferritin in predicting outcomes among critically ill patients, with a particular focus on its implications for ischemic heart disease (IHD). Elevated serum ferritin levels have consistently been associated with adverse outcomes in ICU settings, including increased mortality, prolonged hospital stays, and higher morbidity rates. Furthermore, the relationship between serum ferritin levels and IHD underscores its potential as a biomarker for cardiovascular risk assessment in critically ill populations. The review synthesizes existing literature to highlight the predictive value of serum ferritin in assessing illness severity and guiding clinical decision-making in the ICUs. It also explores potential mechanisms linking serum ferritin to adverse outcomes and discusses implications for clinical practice. Integrating serum ferritin measurements into routine assessments could enhance prognostication and risk stratification in ICU patients, while further research is needed to elucidate optimal management strategies and therapeutic targets. Collaborative efforts between clinicians and researchers are essential to advance our understanding of serum ferritin's prognostic value in the ICUs and translate this knowledge into improved patient care and outcomes.

Association between Body Iron Status and Cognitive Task Performance in a Nationally Representative Sample of Older Adults.

Iron is an essential micronutrient that is necessary for proper cognitive function. However, the dose-response relationship between body iron status and cognitive function remains unclear. The objective of this study was to investigate the association between serum ferritin concentrations, an indicator of body iron status, and cognitive function in older adults. Based on the National Health and Nutrition Examination Survey (NHANES) 1999 -2002 in the United States, nationally representative data was collected from 2,567 adults aged 60 years and older who had objectively measured serum ferritin levels and cognitive performance. High ferritin levels were defined as a serum ferritin level >200 ng/mL in women and >300 ng/mL in men. Low ferritin levels were defined as a serum ferritin level <30 ng/mL. The digit symbol substitution test (DSST) was employed to assess cognitive function. Multivariable logistic regression analyses with survey weights were performed after the DSST was dichotomized at the median score. The weighted prevalence of adults with normal, low, and high serum ferritin levels were 73.98%, 9.12%, and 16.91%, respectively. A U-shaped association between serum ferritin concentrations and cognitive task performance was observed. After adjusting for demographic, socioeconomic, lifestyle, and C-reactive protein factors, the odds ratio (95% confidence intervals) for lower cognitive performance was 1.39 (1.11, 1.74) in adults with high ferritin levels and 1.38 (0.86, 2.22) in adults with low ferritin levels, compared with those with normal ferritin levels. The association between serum ferritin levels and lower cognitive performance was stronger in adults aged 60 to 69 years old than those aged 70 years and older. In conclusion, in a nationally representative sample of older adults in the United States, a high serum ferritin level was significantly associated with worse cognitive task performance. Thus, the relationship between low serum ferritin concentrations and cognitive task performance warrants further investigation.

Serum ferritin level is an effective prognostic factor for lung cancer immunotherapy

ABSTRACT Immunotherapy of lung cancer has achieved promising clinical results. However, it is urgent to develop predictive biomarkers for effective immunotherapy. While ferroptosis plays a critical role in immunotherapy efficacy, ferritin is an important regulatory factor. We, therefore, hypothesize that basal serum ferritin levels before immunotherapy and their corresponding changes during immunotherapy can be useful predictors of immunotherapy response in patients with lung cancer. We measured serum ferritin levels in 107 patients with lung cancer before and during immune checkpoint blockade treatments and studied the correlation between ferritin levels, response rate, and survival. Moreover, the correlation between basal ferritin and PD-L1 expression, tumor stages and pathological types was also analyzed. Patients with lower basal serum ferritin levels before immunotherapy had longer progression-free survival (PFS) (median 7 vs 4 months, P = .023) and higher disease control rate (DCR) (X2 = 4.837, P = .028), those with downregulated serum ferritin levels during immunotherapy correlated with longer PFS (median 9.5 vs 4 months, P < .001) and higher DCR (X2 = 6.475, P = .011). However, the “integrated factor”, which was calculated as the combination of lower basal serum ferritin levels before immunotherapy and downregulated serum ferritin levels during immunotherapy, correlated with prolonged PFS (P < .001). Multivariate analyses revealed that the basal serum ferritin levels before immunotherapy and the corresponding changes during immunotherapy were both strong independent prognostic factors (hazard ratio (HR) = 1.60, P = .041; HR = 2.65, P = .001). These findings suggest that serum ferritin levels can be used as a prognostic biomarker for lung cancer in predicting immunotherapy efficacy.

Treatment of Congenital Hypotransferrinemia Patients with Human Apotransferrin Resolves Anemia and Reduces Iron Accumulation

Introduction Congenital hypotransferrinemia is a very rare inherited and life-threatening disorder (MIM#209300) characterized by systemic iron overload and anemia. The deficiency of serum transferrin leads to inadequate iron supply to erythroid bone marrow, resulting in microcytic hypochromic anemia. This triggers hepcidin downregulation, causing increased iron absorption and production of non-transferrin bound iron (NTBI), leading to iron overload in various organs and tissues. Currently, there is no targeted therapy for this disease. Method In an open-label phase II/III study, four children (age 0-7 years) and one adult (20 years) with congenital hypotransferrinaemia were treated with purified plasma-fractionated human apotransferrin for nearly 10 years. All patients received an initial intravenous dose of 75 mg/kg every 8 weeks for 6 months, followed by 75 mg/kg every 4 weeks for additional 6 months, and in the subsequent years apotransferrin was administered every 4 weeks but the dose was adjusted to 75-150 mg/kg based on clinical judgement of physician according to patient condition. Prior to the start of the study two patients already received replacement therapy, i.e., human apotransferrin or plasma. Serum transferrin and serum iron were determined before every infusion. Primary objective was to investigate the effect of apotransferrin treatment on anemia and iron overload. Hemoglobin, hematocrit, and erythrocytes as markers of anemia were measured every 8 weeks. Iron overload was monitored by measuring serum ferritin every 8 weeks and yearly iron quantification in liver and heart through MRI. Labile Plasma Iron (LPI) was measured before and after infusion (starting after 2 years of treatment). The need for additional treatment for anemia or iron overload was defined as a secondary outcome. Safety and clinical tolerance were evaluated by adverse event surveillance and laboratory measurements. Results Baseline serum transferrin levels were significantly below the normal range in all patients (&amp;lt;10-189 mg/L; normal range: 1800-3500 mg/L). Treatment with human apotransferrin increased serum transferrin and serum iron levels in all patients. Fifteen minutes after the first infusion, transferrin levels ranged from 1340-2415 mg/L, but declined to values just above baseline before the next infusion (dosing interval 8 weeks). During the study period serum transferrin concentrations were affected by dose adjustments; however, trough levels of transferrin remained below the normal range throughout the study (range 200-800 mg/L). Despite subnormal trough levels, apotransferrin infusion led to rapid increase of hemoglobin (Figure 1), hematocrit, and erythrocyte levels up to normal values. The two patients who were already treated before the study, showed normal levels at baseline that were maintained. In all patients hematologic parameters remained stable throughout the study. Ferritin levels were elevated at baseline and decreased to normal ranges in 1.2 to 7.3 years, with a maximum decrease ranging from 82% to 97% of baseline. MRI examinations revealed liver iron overload at baseline which normalized in all patients after apotransferrin treatment, in most cases after 3 to 4 years (Figure 2). No myocardial iron overload was observed at baseline and during the follow-up. Pre-infusion LPI was found in all five patients, however in three patients the values were undetectable on most occasions. Immediately after infusion with apotransferrin, in none of the patients LPI was present anymore. Throughout the study no additional use of plasma/blood products or iron chelators was needed. Apotransferrin infusions were well tolerated. No serious adverse events were reported. No loss of clinical response to treatment was detected over time. Conclusion Treatment with human apotransferrin in patients with congenital hypotransferrinemia demonstrated good long-term clinical efficacy. Apotransferrin infusions increased hematopoiesis, reduced iron overload in organs, and eliminated the need for additional medication. The therapy was well-tolerated and showed good clinical safety. Human apotransferrin holds promise as the mainstay treatment option for congenital hypotransferrinemia.

Adherence to ECCO Guidelines for Management of Iron Deficiency and Anemia in Inflammatory Bowel Diseases Among Israeli Adult and Pediatric Gastroenterologists.

The consensus guidelines of the European Crohn's and Colitis Organization (ECCO) for the diagnosis and treatment of iron deficiency anemia (IDA) were published in 2015. We examined the management practices of both adult gastroenterologists (AGs) and pediatric gastroenterologists (PGs) in Israel in treating ID among patients with inflammatory bowel disease (IBD). An 18-question multiple-choice anonymous questionnaire was electronically delivered to AGs and PGs. Questions explored 3 areas of interest: physician demographics, adherence to ECCO guidelines, and management practices of IDA in patients with IBD. Completed questionnaires were returned by 72 AGs and 89 PGs. Practice setting and years of practice were similar. A large majority of AGs and PGs (89% and 92%, respectively) measure complete blood count (CBC) and serum ferritin (S-Fr) at least every 3 months in outpatients with active IBD, as recommended by the ECCO guidelines. In contrast, in IBD patients in remission, only 53% and 26% of AGs and PGs, respectively ( P < 0.001), reported adherence to ECCO guidelines, measuring CBC and S-Fr every 6 months. The ECCO treatment guidelines recommend that intravenous (IV) iron should be considered the first-line treatment in patients with clinically active IBD, with previous oral iron intolerance and those with a hemoglobin level <10 g/dL. Study results indicate that only 43% of AGs recommend IV iron for these indications, compared to 54% of PGs ( P > 0.1). In this study we have demonstrated a relatively low level of adherence to ECCO guideline recommendations among both AGs and PGs, regarding the management of IDA in patients with IBD.

Serum Levels of Ferritin, Iron, and Total Iron Binding Capacity in Cerebral Venous Sinus Thrombosis

Background: Cerebral venous sinus thrombosis (CVST) is a potentially life-threatening condition with a wide range of clinical presentations, from localized headache (the most common symptom) to mental status disturbances, seizures, and coma. Objectives: The main purpose of this study was to evaluate serum levels of ferritin, iron, and total iron binding capacity (TIBC) and their possible relationship with different parameters in CVST patients. Methods: Thirty patients with a definitive diagnosis of CVST based on brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) results participated in the study. During the first 24 hours after admission, 5 cc of blood sample was collected from each patient and delivered to the laboratory to measure serum ferritin, iron, and TIBC levels. Results: Twenty-four women and six men (mean age: 42.6 ± 16.33 years) participated in the study. The mean levels of serum iron, TIBC, and ferritin were within normal ranges (99.40 ± 29.97 mg/dL, 324.50 ± 49.57 mg/dL, and 87.36 ± 88.84 ng/mL, respectively). There were no significant relationships between serum ferritin, iron, TIBC levels, oral contraceptive pills consumption, history of CVST or cerebrovascular accident (CVA), underlying diseases, and the involved sinus. Conclusions: The current study showed no possible benefits of using serum ferritin, iron, and TIBC indices in CVST patients.

0717 Restless sleep associated with low ferritin levels: A Retrospective Study in a Pediatric Sleep Center

Abstract Introduction A significant challenge in diagnosing Restless Leg Syndrome in children is the child’s inability to verbally describe their symptoms. In our pediatric sleep clinic, it has been recognized that restless sleep is a routine element of the clinical history for children presenting with a wide range of sleep disturbances. A literature review showed substantial literature about the prevalence and characteristics of restless sleep in children, but there is little showing the effect of ferrous sulfate on symptoms in children. A deficiency of brain iron stores results in a reduction of dopamine production and the clinical expression of RLS. Brain iron stores cannot be directly quantified for clinical purposes but can be evaluated indirectly by measuring serum ferritin. In the clinical framework of RLS, it is generally accepted that a serum ferritin &amp;lt; 50 ng/ml is too low, despite still being considered within normal range for most reference labs and replacing this with oral elemental iron should be considered the first line treatment. Methods A retrospective chart review was performed of patients seen in the Sleep Clinic at Arkansas Children's Hospital from 2018-2021 who had a report of restless sleep and a serum ferritin drawn. If the ferritin was lower than 50 ng/ml, they were treated with ferrous sulfate for a minimum of three months. After three months, patient’s symptoms were reevaluated, and ferritin levels drawn to determine if improvement had occurred. Results In total, 1,000 charts were reviewed. Ferritin levels &amp;lt; 50 ng/ml were found in 75.2% of the patients. Of the patients with a serum ferritin &amp;gt;50 ng/ml after treatment with ferrous sulfate, 62.8% reported an improvement in restless sleep and 37.2% reported no change in symptoms. Conclusion Low ferritin levels were found in a large number of our pediatric patients with restless sleep. The administration of ferrous sulfate in the patient population showed an improvement in symptoms of restless sleep in a majority of patients. Support (if any)

Efficacy and safety of early ferric carboxymaltose treatment in patients with acute decompensated heart failure

BACKGROUND: The efficacy of intravenous ferric carboxymaltose (FCM) therapy in heart failure (HF) with low ejection fraction with iron deficiency (ID) or ID anemia is known. The aim of this study was to determine the efficacy and safety of intravenous FCM therapy in the early decompensated period in acute decompensated HF with low ejection fraction with ID or ID anemia.METHODS: Patients with acute decompensated HF with low ejection fraction (EF<40%) with ID or ID anemia were included in the study. ID was diagnosed according to serum ferritin and transferrin saturation (TSAT) measurement at admission in 26 patients and before discharge in 26 patients, and intravenous FCM treatment was given at the same time. ID was defined as serum ferritin <100 μg/L (absolute ID) or ferritin 100-299 μg/L with a TSAT<20% (functional ID). Cox regression analysis was used to determine the relationship between the time of intravenous iron therapy and the risk of 30-day hospitalization and 6-month rehospitalization and mortality and Linear regression analysis was used for N-terminal pro-brain natriuretic peptide (NT-proBNP) change at 30 days.RESULTS: All patients have either ID or ID anemia. The mean age was 67.0±13.0 years, 58% female. Anemia was more prevalent at admission blood samples than before discharge (P<0.001), and absolute and functional iron deficiency rates were similar (P=0.38 and P=0.19, respectively). 30-day rehospitalization (Hazar ratio [HR]= 0.80, confidence interval [CI] 0.22-2.98, P=0.74) Sixth-month rehospitalization (HR=0.89, CI 0.36-2.20, P=0.80) and Sixth-month mortality (HR=0.51, CI 0.05-5.56, P=0.58) were similar between treatment groups. There was no significant relationship between the time of administration of FCM treatment and the change in pro-BNP levels measured at baseline and 30-day (P=0.90).CONCLUSIONS: In patients with acute decompensated HF with low ejection fraction and ID or ID anemia, the efficacy and safety of intravenous iron therapy applied at admission are similar to before discharge.

Effect of iron-enriched bean-based diet on body weight, exercise performance and iron biomarkers in young adult BALB/c mice

Iron deficiency contributes to the global burden of disease, affecting children, premenopausal women, and population from low-income and middle-income countries. To manage the deficit of iron on diet, biofortified crops can be obtained from conventionally plant-based foods. BIO102 bean is a biofortified crop with higher iron and protein content when compared to conventional beans. Therefore, this study aimed to determine the effect of BIO102 food on body weight, exercise performance, and iron biomarkers in young adult BALB/c mice. To achieve this, 24 BALC/c mice were randomly assigned to each of the following groups (n=6 per group): Control diet (conventional diet 5010 Diet; CTRL), bean-based biofortified diet (BIO102), bean-based non-biofortified diet (NB), and corn-based diet (CD). The following parameters were assessed weekly from baseline to 8 weeks: body weight, food intake, endurance capacity, and limbs strength. Baseline blood glucose and hemoglobin measurements were made at the first, three, and eighth weeks of tail blood, and serum ferritin, hepcidin, C-reactive protein, and testosterone measurements were made at the end of 8 weeks of whole blood.During the initial week of housing (acclimatization), there were no differences among groups on neither food intake nor body weight ( p&gt;0.05) (Figure 1). A significant difference in body weight from the second week of feeding with the natural diets was found (Figure 1). Due to signs of stress after three weeks of feeding, all the groups that took the natural diets, received 1 g of 5010Diet food as supplementation up to the end of the experiment. Both CTRL and BIO102 groups showed higher body weight gain when compared to NB and CD groups. Regarding exercise performance, no significant differences were found among groups (Figure 2). As for the iron biomarkers, no differences were determined for hemoglobin concentration and blood glucose in acclimatization (Figure 3). Interestingly, at three weeks, bean-based diet groups were significant different from CTRL group for Blood glucose concentration ( p&lt;0.05) (Figure 3). Moreover, at 8 weeks, only CD group showed a statically significant increase in ferritin (Table 1). In summary, our results suggest that bean-based biofortified diet (BIO102) has a higher nutritional value than common crops such as conventional beans and corn, when compared with a control diet. This suggestion is because the mice feed with BIO102 diet kept body weight gain like those in CTRL group. In addition, BIO102 reduced fasting blood glucose, maintaining both endurance capacity and strength, as well as biomarkers of iron regulation. This work was funded by the following: Pontificia Universidad Javeriana Cali-Colombia, El Centro Internacional de Agricultura Tropical (CIAT) y la Fundación Banco de la República. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Reticulocyte Hemoglobin as a Screening Test for Iron Deficiency Anemia: A New Cut-Off.

Latent iron deficiency (LID), in which iron stores in the body are depleted without incidental anemia, poses a key diagnostic challenge. Reticulocyte hemoglobin content (Ret-Hb) is directly correlated with the functionally available iron for heme synthesis in erythroblasts. Consequently, Ret-Hb has been proposed as an efficient iron status marker. To assess the importance of Ret-Hb in detecting latent iron deficiency as well as its use in screening for iron deficiency anemia. A study involving 108 individuals was conducted at Najran University Hospital, 64 of whom had iron deficiency anemia (IDA) and 44 of whom had normal hemoglobin levels. All patients were subjected to complete blood count (CBC), reticulocyte percentage, Ret-Hb, serum iron, total iron binding capacity (TIBC), and serum ferritin measurements. A significant decrease in Ret-Hb level was observed in IDA patients compared to non-anemic individuals, with a cut-off value of 21.2 pg (a value below which indicates IDA). The measurement of Ret-Hb, in addition to CBC parameters and indices, provides an accessible predictive marker for both iron deficiency (ID) and IDA. Lowering the Ret-Hb cut-off could better allow for its use as a screening parameter for IDA.

RISK OF GESTATIONAL DIABETES MELLITUS AND ITS ASSOCIATION WITH SERUM FERRITIN LEVELS

Background: The high prevalence of GDM in Indian women necessitates early detection. GDM problems can be avoided if screening and diagnosis are done early. Serum ferritin is utilized as an inammatory marker, and its levels are tested in early pregnancy to predict the likelihood of developing GDM, making it a tool for early detection of GDM. Aims And Objectives: To know the association between serum ferritin levels in rst trimester and risk of GDM. To measure Serum Ferritin levels in First trimester and to know the association between elevated serum ferritin levels and risk of GDM by measuring the Glucose levels. Methods: 100 women attending the antenatal clinic in 11-14 weeks of gestation were enrolled in the study. Data was collected from the study participants after explaining about the study to them and getting their informed consent. Venous blood samples were obtained from the patient between11 to 14 weeks' gestation to measure serum ferritin level . Serum Ferritin levels measured are grouped in quantiles. Results: In this study, of 100 pregnant women, 28 had serum ferritin values &lt;30ng/dl, 42 had 31-60 ng/ml., 15 had 61 -90 ng/ml and 15 women had serum ferritin above 90 ng/ml. This also implies that majority of the population studied randomly had low serum ferritin levels. 6 out of 15women with high BMI had increased serum ferritin levels. This shows a clear correlation between obesity and insulin resistance and serum ferritin levels on higher range,with risk of developing GDM. Conclusion: Hyperinsulinemia and insulin resistance association with serum ferritin levels had been highlightened by this observation. Possible mechanisms involving elevated serum ferritin levels and risk of GDM was excess iron stores hypothesis and inammation hypothesis

Correlation of serum ferritin level in transfusion-dependant thalassemia major patients: a study at a medical college affiliated hospital in Gujarat region

Background: Beta thalassemia is one of the most common causes of inherited disorder in the world. In India, around 65000-70000 cases of thalassemia are present currently and every years around 9000-10000 new cases are added. Measurement of serum ferritin level gives an idea about when to start iron chelation therapy, which will reduce the concentration of iron in the serum and thereby prevents the multiple organ damages. Methods: A prospective hospital based study was conducted on 100 children having beta thalassemia major. These children were regularly transfused at our hospital and their serum ferritin level were measured by ELISA based assay. Detailed transfusion history and demographic profile were recorded and compared with serum ferritin level. Results were analyzed with SPSS software and Microsoft Excels. Results: In present study, mean serum ferritin level in 0-5 year age group was1262 µg/l, in 6-10 years age group was 1963.44µg/l and in 11-18 years age group was 2387.43µg/l. On applying ANOVA test, it was evident that there was a statistically significant correlation between increased serum ferritin level with increasing age of the patient as well as with increasing number of a total blood transfusion. Conclusions: High serum ferritin level in beta thalassemia is associated with increasing age of children as well as with increasing transfusion dependency. Serum ferritin measurement at regular interval helps in determining the ideal timing to start iron chelation therapy in transfusion dependant thalassemic patients.

Clinico-Etiopathogenesis of Vitamin B12, Folic Acid and Iron Deficiency in Severe Acute Malnutrition Children: A Tertiary Care Hospital Experience from Central India.

In severe acute malnutrition, micronutrient deficiency as well as protein energy malnutrition is a major obstacle to growth & development. Iron deficiency dominates the spectrum of nutritional anemia. After taking informed consent, 211 SAM children and 211 age-and sex-matched healthy children with normal nutritional status were enrolled for the study. MUAC was used to diagnose SAM. A 5-part automated hematoanalyzer was used to measure the complete blood count and red cell indices, and the peripheral smear method to determine the red cell morphology. We measured serum ferritin, Vitamin B12, and folic acid using the ELISA method. Compared to controls, children with SAM had significantly lower red cell indices, platelet counts, and white cell counts. The most common clinical symptoms seen in SAM children were diarrhea, pneumonia, acute gastroenteritis, and acute respiratory infection. Children with SAM are more likely to suffer from iron deficiency and B12 deficiency. Severe vitamin B12 deficiency was more frequently associated with severe anemia. The severe anemia in SAM children constantly changes the body's defense mechanism, affecting the haematopoiesis. In this study, haematological indices are recommended for predicting severity of anemia, and hematopoietic changes are described, in order to improve anticipatory care and outcome in children with SAM.