Serum Iron Parameters Research Articles

Recommendations of EASL clinical practice guidelines on haemochromatosis

Haemochromatosis is characterised by elevated transferrin saturation (TSAT) and progressive iron loading that mainly affects the liver. Early diagnosis and treatment by phlebotomy can prevent cirrhosis, hepatocellular carcinoma, diabetes, arthropathy and other complications. In patients homozygous for p.Cys282Tyr in HFE, provisional iron overload based on serum iron parameters (TSAT >45% and ferritin >200 μg/L in females and TSAT >50% and ferritin >300 μg/L in males and postmenopausal women) is sufficient to diagnose haemochromatosis. In patients with high TSAT and elevated ferritin but other HFE genotypes, diagnosis requires the presence of hepatic iron overload on MRI or liver biopsy. The stage of liver fibrosis and other end-organ damage should be carefully assessed at diagnosis because they determine disease management. Patients with advanced fibrosis should be included in a screening programme for hepatocellular carcinoma. Treatment targets for phlebotomy are ferritin <50 μg/L during the induction phase and <100 μg/L during the maintenance phase.

Impact of preoperative anemia, iron-deficiency and inflammation on survival after colorectal surgery-A retrospective cohort study.

BackgroundAnemia is present in up to two-thirds of patients undergoing colorectal surgery mainly caused by iron deficiency and inflammation. As anemia is associated with increased risk of perioperative death, diagnosis and treatment of preoperative anemia according to etiology have been recommended.ObjectiveThe aim of the present study was to assess if the association between anemia and survival in patients undergoing colorectal surgery was determined by the severity of anemia alone or also by anemia etiology.MethodsTo determine the prevalence of anemia and etiology, preoperative hematological parameters, C-reactive protein, ferritin and transferrin saturation were retrospectively assessed and correlated with outcome in a cohort of patients undergoing colorectal surgery between 2005 and 2019 at the University Hospital of Innsbruck. Anemia was defined as hemoglobin <120 g/L in females and <130 g/L in males. The etiology of anemia was classified on the basis of serum iron parameters, as iron deficiency anemia, anemia of inflammation or other anemia etiologies.ResultsPreoperative anemia was present in 54% (1316/2458) of all patients. Anemia was associated with iron deficiency in 45% (134/299) and classified as anemia of inflammation in 32% (97/299) of patients with available serum iron parameters. The etiology of anemia was a strong and independent predictor of survival, where iron deficiency and anemia of inflammation were associated with better postoperative survival than other anemia etiologies. One year survival rates were 84.3%, 77.3% and 69.1% for patients with iron deficiency anemia, anemia of inflammation and other anemia types. Inflammation indicated by high C-reactive protein is a strong negative predictor of overall survival.ConclusionsAnemia has a high prevalence among patients undergoing colorectal surgery and rational treatment requires early assessment of serum iron parameters and C-reactive protein.

Platelet Count in Adults with Iron Deficiency Anemia and Its Correlation with Serum Iron Parameters: An Observational Study at a Tertiary Care Center in Northwestern India

Background: Iron deficiency anemia (IDA) is the most common and potentially treatable nutritional anemia in the world. The platelet count is often unpredictable in IDA. It may lead to reactive thrombocytosis and rarely thrombocytopenia. In children with IDA, abnormal platelet counts were seen in several studies. However, studies evaluating abnormalities of platelet count in adults with IDA are scarce. Objectives: This study was aimed to evaluate platelet count abnormalities in adults with IDA and to correlate platelet count with serum iron parameters. Material and Methods: This was a prospective observational study conducted on 294 adults (age ranged from 18 to 85 years) with newly diagnosed IDA attending outdoor and indoor at a large tertiary care center in Northwestern India, from the April 2018 to March 2020. All patients were subjected to evaluation by meticulous history, thorough clinical examination, and hematological investigations including platelet count and serum iron parameters. Results: IDA was more common in females (63.9%). The initial platelet counts were normal in 176 (59.9%) patients. Thrombocytosis and thrombocytopenia were detected in 99 (33.7%) and 19 (6.4%) patients, respectively Majority of thrombocytosis cases (48.5%) were associated with moderate IDA. Mild thrombocytosis was the most common category (60.6%), followed by moderate (28.3%), severe (8.1%) and profound (3%) thrombocytosis. Majority of thrombocytopenia cases were mild (57.9%), and all cases of severe thrombocytopenia were observed in severe IDA. Platelet count had a significant negative correlation with serum iron and transferrin saturation (p˂0.01) while a significant positive correlation was obtained with total iron‑binding capacity (p&lt;0.05). Conclusion: This study showed that thrombocytosis was a common platelet abnormality in adults with IDA. In addition, mild thrombocytopenia was not so rare in these patients. Furthermore, serum iron, transferrin saturation and total iron‑bind

0506 Clinical efficacy of intravenous ferric carboxymaltose for restless legs symptoms and low serum ferritin in children with autism spectrum disorder

Abstract Introduction Restless legs syndrome (RLS) may be underdiagnosed in children with autism spectrum disorder (ASD) due to difficulty expressing the symptoms in their own words. In addition, administration of oral iron may be particularly difficult in ASD children. Methods Retrospective case series of children with ASD, restless legs (RL) symptoms, and serum ferritin &amp;lt;30 μg/L treated with intravenous (IV) ferric carboxymaltose (FCM). Patients received a single dose of IV FCM, 15 mg/kg if weighting &amp;lt;50 kg or 750 mg if weighting &amp;gt;50 kg. Data collected included presenting symptoms, serum ferritin, iron profile, and Clinical Global Impression Scale (CGI-Severity pre-infusion and CGI-Improvement post-infusion). Results Nineteen subjects, 4-11 years old (12 male, median age 6, interquartile range (IQR) were included. Thirteen children took melatonin, median dose 3 mg (IQR 1-6). Full RLS diagnostic criteria were identified in 6 verbal children (31.6%). RL symptoms in the 13 other children occurred at night and began or worsened during periods of rest or inactivity and included: need for a parent to rub or massage legs (5), fidgeting (2), wiggling (2), kicking (2), pacing (1), and discomfort (1), but improvement of symptoms with movement was difficult to determine. Baseline median values were ferritin 10 µg/L (IQR 10-16), iron 66.5 μg/dL (IQR 57-96), TIBC 382 μg/dL (IQR 360-411) and transferrin 19 mg/dL (IQR 14-28). Median CGI-S was 4 (moderate symptoms) (IQR 3-4). After IV FCM all measures improved and were statistically significant at the Wilcoxon test for paired datasets. Median ferritin was 68 µg/L (IQR 62.5-109, p&amp;lt;0.00045). The median CGI-I was 1 (very much improved) (IQR 1-2). All children meeting full RLS criteria improved. Three children in the RL symptom group did not improve. Children meeting the full RLS criteria had lower baseline ferritin levels than those with a suspected diagnosis (9 µg/L, IQR 9-10 vs. 13 µg/L, IQR 10-16, Mann-Whitney test p&amp;lt;0.045). Conclusion The majority of children (84.2%) with ASD and RL symptoms had clinical improvement after IV FCM. All serum iron parameters improved significantly after a single IV infusion. Support (If Any) None

Effects of a locally available dietary interventions counselling on the community-based management of anaemia in children under five years in Ghana: Kumbungu cluster randomized controlled trial protocol

Anaemia in children under five years remains a significant cause of mortality and morbidity in low-middle income countries. Globally, 27% of the world's population is anaemic, of which developing countries account for more than 89%. The global prevalence is worse in Africa and Asia. Anaemia has the potential of maintaining the cycle of poverty, as it prevents children from attaining their full development potential. An important part of anaemia in children under-five years are preventable. Locally available dietary (LAD) interventions may be the sustainable interventions to address the high prevalence of anaemia in our communities. The aim of the study is to determine the effect of counselling on Locally Available Diet, on anaemia among children aged 6-59 months in the Kumbungu District of the Northern Region, Ghana. This study will be a community-based cluster randomized, controlled trial, with two parallel arms; Iron + Folic Acid (IFA arm) hereby referred to as the Standard care arm and Iron + Folic Acid + Counselling on Locally available dietary intervention (IFA+LAD arm) referred to as the Standard Plus arm. Study participants are children between the ages of 6 to 56 months. All study participants would receive iron plus folic acid. The minimum number of children per arm is 330 and the number of community clusters is 10 (5 per study arm). Also, considering this study proposes two parallel arms, the total minimum study sample size of children under five years is 496, the minimum total number of community clusters is 10 and a minimum of 25 households per community cluster, 124 households per study arm and 248 households for the study. Randomization is at the level of the clusters (selected communities). The intervention group receives counselling on LAD at a household level aimed at promoting the intake of locally available iron, folate and vitamin B12 rich foods. Also encourage the intake of food rich in enhancers of iron absorption and discouraging the intake of food rich in inhibitors of iron absorption. The primary outcome is mean haemoglobin levels in study arms. Secondary outcomes would include measurement of weight, height/length, mid upper arm circumference, dietary record, serum iron, ferritin, and other parameters of full blood count. Ethical clearance has been obtained and trial registered with Pan African Trial Registry (www.pactr.org) PACTR201906918438423.

IRE-dependent Regulation of Intestinal Dmt1 Prevails During Chronic Dietary Iron Deficiency but is Dispensable in Conditions of Acute Erythropoietic Stress.

IRE-dependent Regulation of Intestinal Dmt1 Prevails During Chronic Dietary Iron Deficiency but is Dispensable in Conditions of Acute Erythropoietic Stress.

Iron and Ferritin as novel screening markers of Acute Myocardial Infarction

Introduction: Cardiovascular disease is a public health problem globally. In India, the prevalence of Acute Myocardial Infarction (AMI) was 6.43%. Several causes lead to AMI, among which excess serum Iron and Ferritin is responsible for an increase in the generation of free radicals, thus accelerate atherogenesis through oxidation of Low-density lipoprotein – cholesterol (LDL-C). Assess serum Iron and Ferritin status and compare them with the cardic marker (CK-MB) among patients with AMI. Methods: The study was performed in a tertiary care centre in TamilNadu, India. This casecontrol study was conducted on 25 patients diagnosed with AMI and 25 age and sex-matched healthy participants as control group. Iron, Ferritin, CK-MB and lipid profile parameters were analyzed in serum samples of the participants. Result: The mean levels of serum Iron, Ferritin, CK-MB and lipid profile parameters were increased significantly among the cases when compared to the control group. CK-MB had a strong positive correlation with serum Iron and Ferritin. Serum Iron and Ferritin also had a positive correlation with total cholesterol and LDL-C, and a negative correlation with Highdensity lipoprotein – cholesterol. The odds of developing AMI in those with serum Iron &gt;51.5µg/dl and Ferritin &gt;137ng/dl were 36 and 61.7 times at higher risk respectively. Conclusion: Higher levels of serum Iron and Ferritin seem to be stronger risk factors for AMI, and shall be considered as early screening cardiac markers for AMI.

Comparative Effects between Oral Lactoferrin and Ferrous Sulfate Supplementation on Iron-Deficiency Anemia: A Comprehensive Review and Meta-Analysis of Clinical Trials.

Ferrous sulfate is a commonly used iron supplement for the correction of iron-deficiency anemia but with frequent gastrointestinal side effects. Milk-derived iron-binding glycoprotein lactoferrin possesses well gastrointestinal tolerance and fewer side effects caused by the intake of high-dose iron. However, the underlying mechanism of the iron-enhancing effect of lactoferrin remains unclear. In addition, the comparative efficacies between lactoferrin and ferrous sulfate are also remained to be determined. We conducted a systematic review and meta-analysis on published intervention studies to investigate how lactoferrin modulate iron metabolism and evaluate the comparative effects between lactoferrin and ferrous sulfate supplementation on iron absorption, iron storage, erythropoiesis and inflammation. Lactoferrin supplementation had better effects on serum iron (WMD: 41.44 ug/dL; p < 0.00001), ferritin (WMD: 13.60 ng/mL; p = 0.003) and hemoglobin concentration (11.80 g/dL; p < 0.00001), but a reducing effect on fractional iron absorption (WMD: −2.08%; p = 0.02) and IL-6 levels (WMD: −45.59 pg/mL; p < 0.00001) compared with ferrous sulfate. In conclusion, this study supports lactoferrin as a superior supplement to ferrous sulfate regarding the improvement in serum iron parameters and hemoglobin levels. Considering the weak influence of lactoferrin on iron absorption, the anti-inflammation effect of lactoferrin may be the potential mechanism to explain its efficacy on iron status and erythropoiesis.

Interplay of serum hepcidin with female sex hormones, metabolic syndrome, and abdominal fat distribution among premenopausal and postmenopausal women

Background and purposeHepcidin is the central regulatory molecule of systemic iron homeostasis. Serum ferritin, insulin resistance (IR) and metabolic syndrome (MetS), female sex hormones, and abdominal fat distribution are related to each other and all are linked to menopausal state. Our study was the first to assess the impact of these parameters on hepcidin level among premenopausal women (group I) during the early follicular phase (group I-F) and mid-luteal-phase (group I-L) of the same reproductive cycle and among postmenopausal women (group II). Serum iron parameters, estrogen, progesterone and hepcidin, and plasma insulin were assessed. Abdominal subcutaneous fat (SCF) and peritoneal visceral fat (PVF) thickness were measured by unenhanced- CT. Group I and group II were divided into MetS and non-MetS subgroups.ResultsThe entire group II and MetS-stratified subgroups had significant higher hepcidin level than corresponding group I-F and group I-L. Group I-L had significant higher hepcidin than group I-F. Among group I-F, group I-L, and group II, MetS subgroups had higher hepcidin but not hepcidin/ ferritin ratio (H/F) than corresponding non-MetS; and hepcidin had positive correlations with ferritin, insulin, IR, and SCF. In group I-F and group II, hepcidin had positive correlations with estrogen and progesterone; hepcidin levels increase significantly and linearly with increasing number of MetS features; and cut off values of hepcidin for prediction of MetS were 5.8 ≥ and ≥ 10.3 ng/ml respectively. Main contributors to hepcidin were iron and ferritin in all groups, SCF and progesterone in group I-F, and insulin, progesterone, and MetS in group II. H/F ratio was higher in group II.ConclusionPostmenopausal state (postMS), MetS, and luteal phase are independently associated with high hepcidin level. Serum iron parameters (iron and ferritin) as main regulators of hepcidin are preserved regardless of menopausal state. Its regulation differs based on menopausal state: IR, MetS, and progesterone in postMS meanwhile abdominal SCF and progesterone in premenopausal states. Despite positive associations of estrogen and progesterone with hepcidin, they do not explain its higher level in postMS. Hepcidin levels linearly increase with number of Mets feature and it had high sensitivity for diagnosis of MetS.

Study of serum iron parameters in chronic liver disease

Background: Liver is a complex organ, essential for iron metabolism in the body and is recognised as the primary site for the synthesis of iron-related plasma proteins. Liver also regulates iron concentrations in an effective manner and identifies changes in systemic iron requirements. Haematological abnormalities are often associated with chronic liver diseases. Raised iron stores shows high response to infection of hepatitis C, resistance to interferon, therapy & development of CLDs.Objective: This study intends to assess the association of iron parameters with liver enzymes in patients of CLD and to compare these parameters with healthy controls.Material and Methods: This study was carried out from January to December 2021 in Department of Biochemistry, Teerthanker Mahaveer Hospital. A total of 100 individuals, out of which 50 were chronic liver disease patients and 50 as healthy controls were selected. Serum iron parameters were measured using automated method. Results: Findings of this study reveals that serum iron and serum transferrin saturation levels were significantly increased (p

Study of serum iron parameters in chronic liver disease

Background: Liver is a complex organ, essential for iron metabolism in the body and is recognised as the primary site for the synthesis of iron-related plasma proteins. Liver also regulates iron concentrations in an effective manner and identifies changes in systemic iron requirements. Haematological abnormalities are often associated with chronic liver diseases. Raised iron stores shows high response to infection of hepatitis C, resistance to interferon, therapy & development of CLDs.Objective: This study intends to assess the association of iron parameters with liver enzymes in patients of CLD and to compare these parameters with healthy controls.Material and Methods: This study was carried out from January to December 2021 in Department of Biochemistry, Teerthanker Mahaveer Hospital. A total of 100 individuals, out of which 50 were chronic liver disease patients and 50 as healthy controls were selected. Serum iron parameters were measured using automated method. Results: Findings of this study reveals that serum iron and serum transferrin saturation levels were significantly increased (p< 0.001), while serum UIBC and TIBC levels were significantly decreased (p< 0.001) when compared with healthy controls.Conclusion: Based on our data we demonstrate that these findings will provide a fair framework for the prognosis of liver diseases and are also likely to be informative for reducing the risk of complications associated with liver diseases.

The Role of Gene Variants in the Iron Metabolism of Anemic Adolescent Girls.

Background and objectivesIron deficiency anemia (IDA) and the role of genetic variants in determining the iron status in adolescent girls are not yet well-understood. This study aims to investigate the association of the rs602662, rs1049296, rs1805051, rs855791, rs224589, and rs11568350 genes with IDA and iron bio-status parameters.MethodsThis study consisted of 132 patients (IDA group) and 110 healthy controls. The genotype was analyzed through polymerase chain reaction-restriction fragment length polymorphism.ResultsNo differences were noted in the distribution of genotype and allele frequency single nucleotide polymorphism between the IDA and control group. In the IDA group, the GA carriers of rs602662 had a higher hemoglobin concentration (P=0.02) and packed cell volume (P=0.007), whereas transferrin saturation was increased in AA (P=0.02). The genetic variants rs1049296, rs1805051, rs224589, and rs855791 had a non-statistical significance on hematological parameters. Both the GT and TT carriers of the rs11568350 gene showed a low hemoglobin concentration (P=0.02 and <0.001) and mean corpuscular hemoglobin in GT carrier (P=0.01), whereas the TT risk of this gene showed a decreased packed cell volume (P=0.01). In the control patients, no association was observed with serum iron and hematological parameters.ConclusionOf these genetic variants, the GG and GA genotype frequency in rs602662 and the GG, GT, and TT in rs11568350 were associated with low iron status in anemic patients compared to the control patients.

The Relationship between Serum Hepcidin Level and Serum Iron Parameters in Chronic Hepatitis C Virus Hemodialysis Patients

The Relationship between Serum Hepcidin Level and Serum Iron Parameters in Chronic Hepatitis C Virus Hemodialysis Patients

A Monoclonal Antibody Targeting ALK2 As a Potential Therapeutic Agent for Anemia of Inflammation

Background: Iron homeostasis is primarily regulated by hepcidin, a hormone predominantly expressed in the liver. Hepcidin activates the degradation of the transmembrane iron exporter ferroportin, thereby downregulating the release of iron from cells. Hepcidin expression is, at least partly, regulated in response to signaling of the type I TGF-β receptor ALK2, via SMAD2/3 phosphorylation. IL-6, which is commonly elevated in chronic kidney disease (CKD) and other inflammatory conditions, upregulates hepcidin expression and reduces serum iron bioavailability. As a result, chronic inflammatory conditions are often accompanied by secondary anemia of inflammation (AI).We have previously demonstrated that ALK2 inhibition suppressed hepcidin expression in rodents, monkeys and healthy humans. We further described that administration of a selective small molecule ALK2 kinase inhibitor (KTI-2338) reversed changes in hepcidin and iron in a mouse model of CKD, supporting the potential benefit of ALK2 inhibition in AI. Another approach to targeting ALK2 signaling is use of a neutralizing antibody. KTI-018 is a neutralizing ALK2 antibody with high affinity and selectivity for ALK2. This biologic has been demonstrated to reduce serum hepcidin and increase serum iron in healthy non-human primates.Aims: To further elucidate the specific contribution of ALK2 signaling as a driver in AI, and to determine the therapeutic potential of the antibody in this type of anemia, we assessed the effect of KTI-018 in the CKD mouse model.Methods: The study was conducted with 6-week-old male C57Bl/6 mice. Mice in the CKD cohort (CKD) were treated with once daily oral administration of adenine, a compound that metabolizes to 2,8-dihydroxyadenine, forming crystals in the proximal tubular epithelia and causing inflammation and fibrosis in the kidneys. Mice in the control cohort (healthy) received once daily oral administration of vehicle.Upon confirmation of disease, the CKD cohort was subdivided into two groups. The treatment group received twice weekly intraperitoneal treatment with KTI-018 (CKD-KTI-018), and the control group received tris-buffered saline (CKD-TBS). Healthy mice received TBS only. All mice were maintained on their assigned daily adenine or vehicle regimen. At day 53, the study was terminated and hematologic parameters, serum hepcidin, iron, and IL-6 levels were assessed.Results: After 42 days of adenine or vehicle administration, serum hepcidin, serum iron, and hematologic parameters were assessed in representative cohorts of CKD-TBS and healthy mice. The CKD-TBS cohort experienced changes associated with anemia of inflammation as compared to the healthy mice, including increased hepcidin, decreased serum iron, and decreased hematologic parameters. The differences between the healthy and CKD-TBS groups were maintained through the duration of the study.At study termination, CKD-TBS mice had increased serum IL-6 levels (218%), elevated serum hepcidin (149%), and reduced serum iron (-30%) as compared to the healthy mice. Laboratory findings characteristic of anemia were present in the CKD-TBS group, including decreased red blood cells (-6.1%), hemoglobin (-13.2%), and reticulocyte hemoglobin content (-9.3%) as compared to healthy mice.In contrast, CKD-KTI-018 mice had decreased serum hepcidin (-25%) and increased serum iron (59%) as compared to CKD-TBS mice. This restoration of serum iron corresponded to improvements in red blood cells, hemoglobin, and reticulocyte hemoglobin content, which were increased by 7.6%, 9.6%, and 6.7%, respectively, in the CKD-KTI-018 mice as compared to the CKD-TBS mice. These results demonstrate that, by decreasing serum hepcidin, KTI-018 increased the bioavailability of iron, which led to the restoration of hematologic parameters and appeared to reverse AI in mice.Discussion: In this study, a neutralizing ALK2 antibody decreased serum hepcidin, increased serum iron and consequently reversed AI in a mouse model of CKD. These results support the role of ALK2 signaling in AI and suggest that inhibition of ALK2 may be a potential treatment approach for anemia resulting from CKD and other chronic inflammatory diseases. Future studies will explore if ALK2 inhibition may prevent or treat progression of CKD itself, and the role that ALK2 inhibition may play in other chronic inflammatory conditions associated with elevated hepcidin. DisclosuresMedeiros: Keros Therapeutics: Current Employment, Current equity holder in publicly-traded company. Backus: Keros Therapeutics: Current Employment, Current equity holder in publicly-traded company. Materna: Keros Therapeutics: Current Employment, Current equity holder in publicly-traded company. Fisher: Keros Therapeutics: Current Employment, Current equity holder in publicly-traded company. Lachey: Keros Therapeutics: Current Employment, Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees. Seehra: Keros Therapeutics: Current Employment, Current equity holder in publicly-traded company.

Causes of Anemia in Polish Older Population-Results from the PolSenior Study.

Vitamin B12, folate, iron deficiency (IDA), chronic kidney disease (CKD), and anemia of inflammation (AI) are among the main causes of anemia in the elderly. WHO criteria of nutritional deficiencies neglect aging-related changes in absorption, metabolism, and utilization of nutrients. Age-specific criteria for the diagnosis of functional nutritional deficiency related to anemia are necessary. We examined the nationally representative sample of Polish seniors. Complete blood count, serum iron, ferritin, vitamin B12, folate, and renal parameters were assessed in 3452 (1632 women, 1820 men) participants aged above 64. Cut-off points for nutritional deficiencies were determined based on the WHO criteria (method-A), lower 2.5 percentile of the studied population (method-B), and receiver operating characteristic (ROC) analysis (method-C). Method-A leads to an overestimation of the prevalence of vitamin B12 and folate deficiency, while method-B to their underestimation with over 50% of unexplained anemia. Based on method-C, anemia was classified as nutritional in 55.9%. In 22.3% of cases, reasons for anemia remained unexplained, the other 21.8% were related to CKD or AI. Mild cases were less common in IDA, and more common in non-deficiency anemia. Serum folate had an insignificant impact on anemia. It is necessary to adopt the age-specific criteria for nutrient deficiency in an old population.

Pathogenesis, Diagnosis, and Clinical Implications of Hereditary Hemochromatosis—The Cardiological Point of View

Hereditary hemochromatosis (HH) is a genetic disease leading to excessive iron absorption, its accumulation, and oxidative stress induction causing different organ damage, including the heart. The process of cardiac involvement is slow and lasts for years. Cardiac pathology manifests as an impaired diastolic function and cardiac hypertrophy at first and as dilatative cardiomyopathy and heart failure with time. From the moment of heart failure appearance, the prognosis is poor. Therefore, it is crucial to prevent those lesions by upfront therapy at the preclinical phase of the disease. The most useful diagnostic tool for detecting cardiac involvement is echocardiography. However, during an early phase of the disease, when patients do not present severe abnormalities in serum iron parameters and severe symptoms of other organ involvement, heart damage may be overlooked due to the lack of evident signs of cardiac dysfunction. Considerable advancement in echocardiography, with particular attention to speckle tracking echocardiography, allows detecting discrete myocardial abnormalities and planning strategy for further clinical management before the occurrence of substantial heart damage. The review aims to present the current state of knowledge concerning cardiac involvement in HH. In addition, it could help cardiologists and other physicians in their everyday practice with HH patients.

The relationship between nutritional status, anthropometric measurements and hemogram parameters in preobese and obese women before and after menopause

Objectives: In this study, we aimed to reveal the extent to which they meet their daily energy and nutrient needs and the relationship with the development of anemia by examining the dietary records of women in the premenopausal and postmenopausal periods. Material and Methods: Obese women participating in the study were divided into two groups according to premenopause (36-45 years old) and postmenopause (46-73 years old). Anthropometric measurements and nutritional status were evaluated. Serum glucose, BUN, creatinine, lipid profile, AST/ALT, iron, ferritin, vitamin B12, TSH, free T4, vitamin D and hemogram parameters of all participants were recorded. Results: The waist circumference of 67.5% of the women in the premenopausal group and 75% of the women in the postmenopausal group were above 88 cm. The BUN and HDL levels of premenopausal women were found to be lower than those in the postmenopausal period (BUN:10.6±3.51 vs 15.06±4.96 mg/dL and HDL:54.1±9.1 vs 59.3±13.5 m/dL, P&amp;lt;0.05, respectively). Premenopausal women had lower blood ferritin levels and higher total-iron binding capacity (TIBC) compared to postmenopausal women (Ferritin:15.8±11.5 ng/mL vs 33.5±25.4 and TIBC:311.12±61.7 vs 287.50±41.93 μg/dL; P&amp;lt;0.05). One of the important results of the study was the higher levels for vitamin D, AST and ALT in women in the post-menopausal period (P&amp;lt;0.05). Conclusion: It was determined that obese women in the premenopausal period did not receive enough iron and vitamin D to meet their needs. For this reason, daily dietary consumption should be adjusted accordingly, and lifestyle changes should be made to acquire healthy eating habits.

Does Iron Deficiency Affect the Heart in Children?

It is well known that serum iron parameters are closely related to cardiovascular health. Iron deficiency may lead to significant cardiac problems, such as atrioventricular conduction abnormalities, and systolic and/or diastolic dysfunction. Studies related to the effect of iron deficiency on cardiac functions are limited in children. Therefore, the aim of this study was to evaluate the effect of low iron stores on cardiac repolarization parameters which are used to predict arrhythmia and cardiac functions. Onehundred thirty-five children 2 to 18 years of age without structural heart disease who were referred to the Pediatric Cardiology Department for various reasons such as chest pain, heart murmur, or evaluation before sports participation were evaluated prospectively. The cases were separated into 3 groups according to ferritin levels (group 1: ferritin <15 ng/mL [n=48], group 2: ferritin 15 to 25 ng/mL [n=51], and group 3: ferritin >25 ng/mL [n=36]). Evaluations were made with detailed 12-lead surface electrocardiography (ECG) and transthoracic echocardiogram. Cardiac repolarization parameters were measured from surface ECG and systolic functions, left ventricular wall diameters were evaluated from transthoracic echocardiogram. Eighty-four (62.2%) girls and 51 (37.8%) boys are included in the study. The average age of the groups was similar. In children with low ferritin levels (group 1); Pw, Pw max, and Pw dis; QT, QTc, and QTc dis; Tp-Te, Tp-Te dis, Tp-Te/QT, and Tp-Te/QTc were significantly longer compared with the group 3 (P<0.05). There was a negative correlation between ferritin level and Pw, P max, and Pw dis; QT, QT dis, QTc, and QTc dis; Tp-Te, Tp-Te dis, Tp-Te/QT, and Tp-Te/QTc (P<0.05). No correlation was found between ferritin level and Pw min. There was no difference between the groups in respect of ejection phase indices, heart wall measurements, and end-diastolic diameter measurements. Iron deficiency may be related to the tendency of arrhythmias in children without structural heart disease. Therefore, careful evaluation of ECG parameters of healthy children with low iron stores, and follow up with intermittent monitoring is highly important.

Pharmacokinetics and Pharmacodynamics of Unfractionated Heparin and Ferric Pyrophosphate Citrate Co-administration during Hemodialysis: No DrugDrug Interaction

Background: Ferric Pyrophosphate Citrate (FPC) for intravenous administration is approved to maintain hemoglobin in patients receiving Chronic Hemodialysis (HD). The aim of this study is to investigate the coadministration of intravenous (IV) FPC with Unfractionated Heparin (UFH) as an admixture via the HD-machine syringe pump. Methods: Open-label, randomized, 3-period crossover study. Three (3) treatments in randomized sequence: Treatment A: FPC 6.75 mg IV via the post dialyzer blood line and continuous infusion of UFH pre-dialyzer via the HD-machine infusion pump; Treatment B: FPC 6.75 mg IV mixed with UFH via the pre dialyzer heparin line; Treatment C; IV UFH via the on machine syringe pump x 3 h. anti-Xa activity, activated prothrombin time (aPTT), Thrombin time (TT) and serum iron parameters were measured. Pharmacokinetics and dynamics were determined using non-compartmental methods and comparisons of Cmax and AUC were calculated using a standard bioequivalence approach. Results: Mean anti-Xa, aPTT, and TT concentrations were comparable across all timepoints at baseline, and throughout the study. The concentration-time profiles for iron and TSAT were the same between the FPC/UFH admixture and FPC/UFH administered by separate routes. Results on the visual clotting scale were similar across all treatments. FPC and UFH were well tolerated with no reported adverse events. Conclusion: No clinically relevant drug-drug interaction between FPC and UFH on the anticoagulation effects of UFH (as assessed by anti-Xa activity, aPTT, and TT) or on the ability of FPC to deliver iron when these agents are coadministered as a single admixture. No new safety concerns were identified.

Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment

Objective:There are a limited number of studies evaluating iron overload in childhood leukemia by magnetic resonance imaging (MRI). The aim of this study was to determine liver iron content (LIC) by MRI in children with acute lymphoblastic leukemia (ALL) who had completed treatment and to compare those values with serum iron parameters.Materials and Methods:A total of 30 patients between the ages of 7 and 18 who had completed ALL treatment were included in the study. Serum iron parameters (serum iron, serum ferritin [SF], and total iron-binding capacity) and liver function tests were studied. R2 MRI was performed for determining LIC.Results:Normal LIC was detected in 22 (63.4%) of the cases. Seven (23.3%) had mild and 1 (3.3%) had moderate liver iron deposition. In contrast, severe iron overload was not detected in any of the cases. LIC levels were correlated with the numbers of packed red blood cell (pRBC) transfusions (r=0.637, p<0.001), pRBC transfusion volume (r=0.449, p<0.013), SF levels (r=0.561, p=0.001), and transferrin saturation (r=0.353, p=0.044). In addition, a positive correlation was found between the number of pRBC transfusions and SF levels (r=0.595, p<0.001).Conclusion: We showed that the frequency of liver iron deposition was low and clinically less significant after the end of treatment in childhood ALL patients. LIC was demonstrated to be related to SF and transfusion history. These findings support that SF and transfusion history may be used as references for monitoring iron accumulation or identifying cases for further examinations such as MRI.