Serum Total Iron Binding Capacity Research Articles

#406 High ferritin is not needed in hemodialysis patients: a retrospective study of total body iron and oral iron replacement therapy

Abstract Background and Aims In vivo iron levels can be adjusted through intestinal iron absorption to be maintained at a suitable level; however, optimal iron levels in hemodialysis (HD) patients are unclear. Although serum ferritin is useful as an indicator of iron stores, it does not necessarily reflect body iron levels in HD patients with unstable hematopoiesis since iron metabolism is a semi-closed system in vivo. In this study, we investigated total body iron (TBI), new index calculated as the sum of red blood cell (RBC) iron and iron stores, during courses of low-dose oral iron replacement therapy, and evaluated in vivo iron sufficiency and its indicators in HD patients. Method We analyzed data on 105 courses of low-dose iron replacement therapy (50–120 mg of iron daily) administered to 83 patients with serum ferritin <60 ng/mL and Hb <12 g/dL undergoing maintenance hemodialysis at our institution. Low-dose oral iron replacement therapy was initiated between August 2016 and June 2023 and continued for at least seven months. All blood samples were collected at the start of hemodialysis at the beginning of the week. Blood examinations were performed twice a month, and patients were given darbepoetin alfa (DA), long-acting ESAs to maintain Hb at the target level of 10–12 g/dL, in accordance with the guidelines of the Japanese Society for Dialysis Therapy. Iron-related parameters were determined based on blood samples collected once a month, with TSAT calculated from serum iron (Fe) and total iron-binding capacity (TIBC), using the following equation. TSAT=Fe/TIBC × 100. We evaluated changes in TBI, RBC iron, and iron stores from the initiation of treatment to month 7, in two groups of patients, namely, iron-therapy responders and non-responders. Furthermore, we investigated factors associated with steady-state TBI. TBI was regarded as achieving a steady state during the course of therapy when the trend shifted from an increase and the difference from the value at one month was less than or equal to zero. TBI was calculated using the formula proposed by Cable et al (Transfusion. 2016, 56, 2005). Results Mean age was 68.1±12.6 years and median time on hemodialysis was 6.6 years. Of the 105 courses of therapy, 75 were delivered to men and 30 to women, and 66.7% of the patients had diabetic nephropathy. The patients had a mean Hb level of 10.4±0.7 g/dL, a mean serum ferritin level of 27.3±12.5 ng/mL, mean transferrin saturation (TSAT) of 18.1%±5.9%, and a median C-reactive protein level of 0.1 mg/dL at the start of each course. TBI showed significant increases until month 4 and plateaued thereafter in iron-therapy responders, and tended to increase and then reached a similar plateau in non-responders (month 7: 1900±447 vs. 1900±408 mg, Fig. 1). As for RBC iron, iron-therapy responders showed significant monthly increases up to month 3, whereas non-responders showed constant values. Regarding iron stores, iron-therapy responders showed significant monthly increases up to month 5, while non-responders showed a significant increase only at month 1. DA per body weight showed a significant decrease at month 3 and 4 in the effective group, but a slight increase in the non-responder group. Steady-state TBI did not correlate with Hb or serum ferritin, but was strongly correlated with body surface area (BSA) using the Du Bois formula [TBI=−791.914 + 1628.606 × BSA (m2); R2=0.88, p<0.001, Fig. 2]. Conclusion This study showed that hemodialysis patients can increase their body iron levels during oral iron replacement therapy and maintain them at the same level after sufficiency has been achieved, suggesting activation of a “mucosal block.” Furthermore, this result also suggests that determining iron sufficiency based on serum ferritin alone is difficult in HD patients with fluctuations in Hb. However, regression equations using steady-state TBI and BSA showed a high degree of fit. Therefore, BSA might potentially be used in estimations of TBI sufficiency, which may be useful for avoiding excessive iron dosage.

Association among attention-deficit hyperactivity disorder, restless legs syndrome, and peripheral iron status: a two-sample Mendelian randomization study.

Epidemiological evidence indicates a high correlation and comorbidity between Attention Deficit Hyperactivity Disorder (ADHD) and Restless Legs Syndrome (RLS). We aimed to investigate the causal relationship and shared genetic architecture between ADHD and RLS, as well as explore potential causal associations between both disorders and peripheral iron status. We performed two-sample Mendelian randomization (MR) analyses using summary statistics from genome-wide meta-analyses of ADHD, RLS, and peripheral iron status (serum iron, ferritin, transferrin saturation, and total iron binding capacity). Additionally, we employed linkage disequilibrium score regression (LDSC) to assess genetic correlations between ADHD and RLS using genetic data. Our MR results supports a causal effect from ADHD (as exposure) to RLS (as outcome) (inverse variance weighted OR = 1.20, 95% CI: 1.08-1.34, p = 0.001). Conversely, we found no a causal association from RLS to ADHD (inverse variance weighted OR = 1.04, 95% CI: 0.99-1.09, p = 0.11). LDSC analysis did not detect a significant genetic correlation between RLS and ADHD (Rg = 0.3, SE = 0.16, p = 0.068). Furthermore, no evidence supported a causal relationship between peripheral iron deficiency and the RLS or ADHD onset. However, RLS may have been associated with a genetic predisposition to reduced serum ferritin levels (OR = 1.20, 95% CI: 1.00-1.04, p = 0.047). This study suggests that ADHD is an independent risk factor for RLS, while RLS may confer a genetic predisposition to reduced serum ferritin levels. The GWAS summary data utilized originated from populations of European ancestry, limiting the generalizability of conclusions to other populations. The potential co-occurrence of RLS in individuals with ADHD should be considered during diagnosis and treatment. Moreover, iron supplementation may be beneficial for alleviating RLS symptoms.

Serum iron level is independently associated with sarcopenia: a retrospective study

Sarcopenia greatly reduces the quality of life of the elderly, and iron metabolism plays an important role in muscle loss. This study aimed to investigate the association between iron status and sarcopenia. A total of 286 adult patients hospitalized between 2019 and 2021 were included in this study, of which 117 were diagnosed with sarcopenia. Serum iron, total iron binding capacity (TIBC), transferrin, and transferrin saturation levels were compared between groups with and without sarcopenia and were included in the logistic analyses, with significant variables further included in the logistic regression model for the prediction of sarcopenia. Serum iron, TIBC, and transferrin levels decreased significantly in the sarcopenia group (p < 0.05), and were negatively associated with handgrip strength, relative skeletal muscle index, and multiple test performances (p < 0.05). Multivariate logistic analysis showed that sex, age, body mass index (BMI), and serum iron level were independent risk factors for sarcopenia. In the final logistic regression model, male sex (odds ratio [OR] 3.65, 95% confidence interval [CI] 1.67–7.98), age > 65 years (OR 5.40, 95% CI 2.25–12.95), BMI < 24 kg/m2 (OR 0.17, 95% CI 0.08–0.36), and serum iron < 10.95 μmol/L (OR 0.39, 95% CI 0.16–0.93) were included. Our study supported the impact of iron metabolism on muscle strength and performance.

Role of blood hepcidin alteration as a biomarker in β-thalassemia patients’ diagnosis

The objective of this research was to determine the change in hepcidin levels and other biochemical markers, including total iron binding capacity (TIBC), serum iron, testosterone, and specific vitamins in the blood of individuals with β-Thalassemia. Here, 140 participants were involved in the study, of whom 110 were affected by β-thalassemia and 30 were healthy. The samples were obtained from Baqubah Teaching Hospital, the blood bank and blood donation center. The study was carried out from May 2022 to August 2022, and the patients were housed in Diyala Provence, Baquba City and its suburbs. The participants in this investigation were split into three groups: A: 55 male patients with β-thalassemia; B: 55 female patients with β-thalassemia; and C: 30 healthy individuals that were set as a control group. The findings of the study showed that the levels of HbA1 in males and females were 93.44 ± 0.71 and 93.53 ± 0.91, respectively, while the levels of HbA2 in males and females were 4.99 ± 0.59 and 5.29 ± 0.72, respectively. In contrast, the control group had HbA1 levels of 97.33 ± 0.40 in males and 97.66 ± 0.46 in females, but HbA2 levels were 2.32 ± 0.33 in males and 2.24 ± 0.24 in females. The study revealed remarkable differences (P &lt; 0.05) between these variables. Hematological measures, such as hemoglobin concentration and percentages of mean corpuscular volume (MCV), packed cell volume (PCV), and mean corpuscular hemoglobin (MCH) were substantially reduced (P &lt; 0.05) in β-thalassemia patients when compared to the controls. Serum iron and TIBC were significantly increased (P &lt; 0.05), while Hepcidin levels were markedly decreased (P &lt; 0.05) in the serum of β-thalassemia patients compared to controls. Therefore, as a conclusion the reduction of hepcidin levels and increase in iron levels are correlated with β-thalassemia and can be used as a biomarkers in monitoring β-thalassemia disease.

No genetic causal association between iron status and pulmonary artery hypertension: Insights from a two‐sample Mendelian randomization

AbstractTo explore the genetic causal association between pulmonary artery hypertension (PAH) and iron status through Mendelian randomization (MR), we conducted MR analysis using publicly available genome‐wide association study (GWAS) summary data. Five indicators related to iron status (serum iron, ferritin, total iron binding capacity (TIBC), soluble transferrin receptor (sTfR), and transferrin saturation) served as exposures, while PAH was the outcome. The genetic causal association between these iron status indicators and PAH was assessed using the inverse variance weighted (IVW) method. Cochran's Q statistic was employed to evaluate heterogeneity. We assessed pleiotropy using MR‐Egger regression and MR‐Presso test. Additionally, we validated our results using the Weighted median, Simple mode, and Weighted mode methods. Based on the IVW method, we found no causal association between iron status (serum iron, ferritin, TIBC, sTfR, and transferrin saturation) and PAH (pβ &gt; 0.05). The Weighted median, Simple mode, and Weighted mode methods showed no potential genetic causal association (pβ &gt; 0.05 in the three analyses). Additionally, no heterogeneity or horizontal pleiotropy was detected in any of the analyses. Our results show that there are no genetic causal association between iron status and PAH.

Serum Ferritin Level and Total Iron Binding Capacity Relationship with Iron Deficiency Anemia During Pregnancy and Labour

Background: Iron deficiency anemia (IDA) is a prevalent condition globally, impacting maternal and fetal health outcomes significantly. The condition is especially concerning during pregnancy, given its association with complications such as preterm labor and increased maternal and neonatal morbidity and mortality rates. Objective: The study aimed to assess the prevalence of IDA among pregnant women and its correlation with fetal-maternal complications, as well as to evaluate the effectiveness of current healthcare interventions in managing the condition. Methods: A cross-sectional study was conducted at Shikhzayad Women Hospital, Larkana, over six months from January 1, 2022, to July 1, 2022. Fifty pregnant women with IDA at various gestational stages were selected and evaluated for serum ferritin and total iron-binding capacity (TIBC). The severity of anemia and its correlation with feto-maternal complications were analyzed using SPSS version 25. Results: Out of the 50 women studied, 6 had mild anemia, 37 had moderate anemia, and 7 had severe anemia. Serum ferritin levels showed that 10 participants had levels between 5-10 mg/L, 20 had levels between 10-50 mg/L, 10 had levels between 50-150 mg/L, and 10 had normal levels (150-300 mg/L). Elevated TIBC levels (400-600 ug/ml) were observed in 30 women. Feto-maternal complications included emergency cesarean sections (28 cases), postpartum hemorrhage (8 cases), disseminated intravascular coagulation (6 cases), cardiac failure (4 cases), and maternal death (4 cases). Pregnancy outcomes were reported as 5 first-trimester abortions, 2 second-trimester abortions, 4 preterm deliveries, 15 cases of intrauterine growth restriction (IUGR), 9 intrauterine deaths (IUD), and 5 neonatal deaths (NND). Conclusion: IDA remains a significant determinant of adverse maternal and neonatal outcomes. This study underscores the urgent need for enhanced preventive strategies, including iron supplementation and dietary education. Further large-scale research is required for a comprehensive understanding of IDA's impact and the development of targeted interventions.

Relationship between Iron Saturation Indices and Psychiatric Disorders among Persons Seeking Care at Selected Psychiatry Health Facilities in Ghana

Aim: This study investigated the relationship between iron metabolism and psychiatric disorder and whether iron saturation indices could predict disease severity.&#x0D; Study Design: The study was a case-control study.&#x0D; Place and Duration of Study: The study was conducted between December 2020 to March 2022 in some selected psychiatric facilities in Ghana.&#x0D; Methodology: Venous blood was collected and serum iron, TIBC, ferritin, transferrin and full blood count were quantified to calculate intraindividual variation and to assess the relationships of these iron saturation indices to severity of psychiatric disorders.&#x0D; Results: Serum iron (38.98±14.55 µmol/L), ferritin (100.23±84.98 ng/mL) and transferrin saturation (44.35±14.6%) were significantly (p&lt;0.05) higher in group with psychiatric disorders compared with the controls (29.25±8.0 µmol/L; 75.25±42.71 ng/mL and 28.66±7.1%). However, total iron binding capacity (TIBC) (102.47±15.01 µmol/L), UIBC (73.22±13.12 µmol/L) and transferrin (4.08±0.6 g/L) concentrations were considerably greater in control group than in the case subjects (88.95±19.73 µmol/L; 49.97±18.32 µmol/L and 3.54±0.79 g/L). One unit increase in BMI is associated with 1.27 (aOR=1.27, p&lt;0.001) times risk of psychiatric disorders and males are 6 (aOR=5.87, p&lt;0.005) times at risk of disorders. At a cut off of ≤65.79 µmol/L, UIBC can distinguish psychiatric disorders from controls.&#x0D; Conclusion: Serum iron and transferrin saturation appears to be good prognostic markers of diseases severity but serum iron at cut off of &gt;35.23 µmol/L better classified individuals of severe form of psychiatric disorder.

Evaluation of Iron Profiles and Coagulation Profiles in Ischemic Heart Diseases Patients in Elmek Nimir Hospital, Sudan

Background: Ischemic heart disease (IHD) is a constellation of diseases that includes stable angina, unstable angina, myocardial infarction, and sudden cardiac death. It belongs to the group of cardiovascular diseases and is the most common type among them. Iron is an essential trace element. It plays an important role in maintaining various cellular functions and enzymatic reactions. On the other hand, excessive intake of iron is known to be a risk factor for the progression of atherosclerosis. Abnormal iron deposition in the heart causes hemochromatosis and dilated cardiomyopathy, which leads to ischemic heart disease. Objective: This study aims to investigate the role of serum iron, serum ferritin, total iron-binding capacity (TIBC), PT, and PTT in ischemic heart disease (IHD) and their relationship with other risk factors for IHD. Methods: This is a prospective, case-control, cross-sectional analytical study conducted at Elmek Nimir University Hospital, Shendi City, to assess the iron profile and coagulation profile of patients with ischemic heart disease. The study included (30) patients diagnosed with ischemic heart disease and the study group was compared with the mean of the control group (20). Serum iron, ferritin, and TIBC were estimated using a spectrophotometer, and PT and PTT were estimated using manual methods. Data were collected using a structured personal questionnaire and the program (SPSS) version (11.5) was used for data analysis. Results: In this study, patients with ischemic heart disease were (40%) male and (60%) female. In this study, iron averaged (41.0) ug/dl (P. value 0.010), ferritin averaged (233.0) ug/dl (P. value 0.000), and TIBC averaged (44.0) µg/dl. Was shown. (P. value 0.000) compared to mean controls (27.0), (162.0), (56.0). A significant difference was found between the iron profile and his IHD. This study showed the mean PT, PTT for cases (13.4), (40.4) (P-value 0.024), (P. value 0.009) compared with the mean for controls (12.0), (35.1). A significant difference was found between the coagulation profile and IHD. Conclusions: This study concluded that serum levels of iron, ferritin, TIBC, PT, and PTT may be associated with Ischemic heart disease.

The use of hepcidin as a marker for diagnosing the type of anemia in patients with high activity of rheumatoid arthritis

Anemia is still one of the most common comorbidities that affects the prognosis of the underlying disease and the quality of life of patients.Objective: to evaluate the value of serum hepcidin level determination for the differential diagnosis of anemia of chronic disease/inflammation (ACD) in patients with active rheumatoid arthritis (RA).Material and methods. The study included 47 patients with RA with anemia consecutively admitted to V.A. Nasonova Research Institute of Rheumatology for inpatient treatment. According to WHO recommendations, the criterion for anemia was a decrease in hemoglobin level ˂ 120 g/l in women and ˂ 130 g/l in men. The control group consisted of 29 patients without anemia. In all patients, the DAS28 index was determined, and clinical and biochemical blood parameters were examined: serum iron, total iron-binding capacity of serum, hepcidin, cytokines, including interleukin (IL) 6 and tumor necrosis factor α (TNFα).Results and discussion. Of 47 patients with active RA and anemia, only 13 (28%) were diagnosed with isolated ACD. Iron deficiency anemia (IDA) was found in 17 (36%), the remaining 17 patients had a mixed genesis of anemia (ACD + IDA). Patients with isolated ACD had a statistically significant higher level of hepcidin(120.3±56.1 pg/ml) compared to the control group (90.3±37.9 pg/ml) and to patients with RA + IDA. In isolated ACD, the levels of IL6, TNFα, rheumatoid factor and antibodies to cyclic citrullinated peptide were 2 times higher (p&lt;0.05) than in RA with iron deficiency (both in IDA and in mixed genesis of anemia). Only in isolated ACD did the hepcidin level correlate with the IL6 concentrations (r=0.8); no such correlation was found in patients with IDA and anemia of mixed origin or in patients without anemia. No correlation with TNFα levels was found in any subgroup. Conclusion. Hepcidin levels are an informative indicator for the differential diagnosis of the type of anemia during active inflammation. In RA patients with ACD, the maximum hepcidin concentration in blood serum was determined, and in IDA it was found to be lower than the reference values. The importance of the hepcidin – IL6 axis and the lack of influence of the proinflammatory cytokine TNFα on iron metabolism were demonstrated. Keywords: hepcidin; anemia; difficult-to-treat patient; rheumatoid arthritis&gt; ˂ 0.05) than in RA with iron deficiency (both in IDA and in mixed genesis of anemia). Only in isolated ACD did the hepcidin level correlate with the IL6 concentrations (r=0.8); no such correlation was found in patients with IDA and anemia of mixed origin or in patients without anemia. No correlation with TNFα levels was found in any subgroup.Conclusion. Hepcidin levels are an informative indicator for the differential diagnosis of the type of anemia during active inflammation. In RA patients with ACD, the maximum hepcidin concentration in blood serum was determined, and in IDA it was found to be lower than the reference values. The importance of the hepcidin – IL6 axis and the lack of influence of the proinflammatory cytokine TNFα on iron metabolism were demonstrated.

Exploring systemic inflammation in children with chronic kidney disease: correlates of interleukin 6.

Systemic inflammation (SI) is linked to chronic kidney disease (CKD) progression and multiple complications. Data regarding SI biomarkers in pediatric patients are scarce. This case-control and cross-sectional study investigates the correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), total iron binding capacity (TIBC) and serum albumin to serum interleukin-6 (IL-6). NLR and PLR were measured in 53 patients (median age: 12.9years), including 17 on dialysis and 36 with a median glomerular filtration rate of 39ml/min/1.73m2, and in 25 age and sex-matched healthy controls. Iron profile, serum albumin and IL-6 were measured in the patient group. IL-6 levels > 3rd quartile were classified as high. Patients presented higher NLR and PLR and particularly those on dialysis (p < 0.001 and p = 0.001). We observed a significant correlation between natural logarithm (ln) of IL-6 (lnIL-6) and NLR (rs = 0.344, p = 0.014), serum albumin (rs = -0.350, p = 0.011) and TIBC (rs = -0.345, p = 0.012) after adjustment for CKD stage, while the correlation between lnIL-6 and PLR was not significant (rs = 0.206, p = 0.151). Combination of NLR, serum albumin and TIBC predicted high IL-6 (13 patients) with an AUC of 0.771 (95% CI 0.608-0.943). Pairing of NLR ≥ 1.7 and TIBC ≤ 300μg/dL exhibited the highest sensitivity (76.9%), while incorporating serum albumin ≤ 3.8g/dL along with them achieved the highest specificity (95%) for detecting high IL-6 levels. Both NLR and PLR levels increase in CKD, especially in patients on chronic dialysis. NLR, rather than PLR, along with TIBC and serum albumin, are associated with IL-6 in pediatric CKD.

Ferritin Reference Ranges in an Adult Population of Working-Age Adults without Anemia

Introduction Considerable controversy has surrounded the creation of reference intervals for ferritin within tested populations. This is particularly true for women and has been attributed to a high prevalence of nonanemic iron deficiency due to physiologic blood loss during menses and physiologic iron transfer during pregnancy. The Quest Blueprint for Wellness (BFW) program is an annual health screening that provides a range of testing to Quest employees and families. Using deidentified data on 24,812 individuals (55% female; age range 18-80 years old) collected as part of this program, we studied the relationship between serum ferritin and characteristics of the study population, red blood cell parameters, and iron saturation in order to better define normal reference ranges for serum ferritin. Methods Test results of participants in the annual BFW screening program conducted between January 2022 and May 2023 were identified (26,535 [53% female]); tests included hematocrit, hemoglobin, RBC indices (including RDW), total serum iron and total iron binding capacity and CRP. Individuals with abnormalities of hemoglobin, hematocrit or RBC indices (including RDW); serum iron or serum TIBC; or elevated CRP were successively excluded, leaving 24,812 participants (55% female). None of these remaining individuals had a personal history of anemia or an identified ICD-10 code associated with anemia or other RBC disorder. This study population was used in subsequent analyses. Multimodal decomposition (MMD) in R (version 4.2.2) was used to calculate reference intervals based on the distribution of results associated with the healthy study subpopulation that was defined. To address the possibility that the TIBC saturation initially employed (20%) was too low, reference intervals were also determined when varying TIBC saturations from 20%-25%. Results As shown in Table 1, the lower limits of the ranges identified did not vary significantly as the TIBC saturation percent was increased from 20% to 25%. The lower limit for women below 50 years of age ranged from 11-13 ng/mL, which was substantially lower than the lower limits for men of the same age. Over the age of 50, the lower limit of the ferritin reference ranges for women increased, approaching but not equaling or exceeding the values observed for men until ages greater than 70. This may reflect the end of menses and the gradual repletion of iron stores. In contrast, the lower limits of the reference ranges for serum ferritin for men increased at ages 30-40 and then declined and fell below that of women in the eighth decade. Conclusions Comparing the lower range of ferritin values between men and women, these data suggest that iron deficiency may be present in a large proportion of working age women in the absence of anemia or abnormal RBC indices. These data also suggest that normal ferritin values are age dependent for both men and women. These conclusions are tempered by the unavailability of a physiologic reference standard able to demonstrate that iron deficiency is in fact present. The lower limit of the ferritin range for women under the age of 60 and for men over the age of 70 approximates the ferritin values associated with the absence of stainable bone marrow iron. While this test is the traditional “gold standard” it is rarely performed for the evaluation of iron status. The evaluation of iron deficiency at present lacks a physiologic indicator, analogous to the relationship between parathyroid hormone and calcium levels which permitted the definition of blood levels of 25 hydroxyvitamin D that represented sufficiency, or methylmalonic acid concentration in B12 deficiency. The broader availability of measures to assess the functional status of reticuloendothelial iron stores available to support erythropoiesis, such as measurements of hepcidin, would facilitate such an assessment.

Serum Copper, Iron, and Total Iron Binding Capacity in Hypothyroidism: A Case Control Study

Background: Thyroid hormone metabolism is linked to iron metabolism. Thyroperoxidase, a key enzyme in the biosynthesis of thyroid hormones, is iron-dependent. Thus, iron deficiency might be the primary cause of hypothyroidism. Copper is another trace element that has been linked to thyroid status. Copper regulates excessive thyroxine (T4) absorption and reduces cell damage during thyroid hormone synthesis. The present study clarified the possible correlations between iron and copper levels as well as total iron binding capacity (TIBC) and triiodothyronine (T3), T4, as well as thyroid-stimulating hormone (TSH) levels in healthy and hypothyroid subjects.Materials and methods: Thirty-five healthy subjects and 35 hypothyroid subjects were included in this study. Serum T3, T4, and TSH levels were measured using the enzyme linked fluorescence assay. Serum iron levels and TIBC were estimated using ferrozine/magnesium carbonate method, while serum copper levels were estimated using colorimetric method.Results: Copper levels were not significantly different between healthy and hypothyroid subjects. Iron and T4 levels were significantly lower in hypothyroid subjects compared with those in healthy subjects, while TIBC and TSH levels were significantly higher. There was no significant correlation between copper levels and T3, T4, and TSH levels.Conclusion: There were inverse correlations between TIBC and T4 as well as iron levels, and there was no significant correlation between copper levels and all thyroid function parameters. Routine examination of iron levels and thyroid function is highly recommended for early diagnosis and therapy of hypothyroidism.Keywords: total iron binding capacity, iron, copper, hypothyroidism

Sonneratia apetala (Buch.-Ham.) Fruit Extracts Ameliorate Iron Overload and Iron-Induced Oxidative Stress in Mice.

Iron overload results in oxidative damage to various biomolecules including DNA, proteins and lipids which ultimately leads to cell death. The Sonneratia apetala fruit contains a high content of antioxidants and displays several bioactive properties. Therefore, the powder of the S. apetala fruit was successively fractionated into n-hexane (Hex), chloroform (Chl), and methanol (Met) fractions to evaluate their efficiency in ameliorating iron overload. In vitro, a colorimetric method was used to assess the Fe-chelating activity of the fractions using ferrozine. The fractions were also used in vivo to examine their efficacy in ameliorating iron overload and iron-induced oxidative stress in mice induced by intraperitoneal injection of ferric carboxymaltose at 100 mg/kg body weight (bw). Among the fractions, Met showed the highest Fe-chelation ability with an inhibitory concentration 50 of 165 μg/mL followed by Hex (270 μg/mL), and Chl (418 μg/mL). In vivo, the results showed a significantly (P<0.05) lower iron profile (iron and ferritin concentrations in serum and liver tissue and total iron-binding capacity of serum) in the Met and the Hex treated mice groups than in the iron-overloaded group. Met at 1,000 μg/kg bw completely ameliorated iron overload in the blood and the liver tissue of mice. At this concentration, Met also prevented iron-induced oxidative stress in the liver tissue of iron-overloaded mice by restoring reducing power, total antioxidant capacity, and total protein. Thus, the S. apetala fruit, especially its Met fraction can be used in treating iron overload and associated toxicity.

Assessment of erythroferrone levels in children with chronic kidney disease on regular hemodialysis

Anemia is a common comorbidity in children with chronic kidney disease (CKD) and is associated with adverse outcomes. Erythroferrone (ERFE) is a hepcidin inhibitor whose synthesis is stimulated by erythropoietin, which increases iron absorption and mobilization. Aim of the study: to assess the levels of ERFE hormone in children with CKD on regular hemodialysis. This case–control study was carried out at Menoufia University Hospital and included 70 subjects: 38 healthy individuals (controls) and 32 children with CKD on regular dialysis (cases). The study was approved by the Faculty of Medicine Ethics Committee at Menoufia University. All children were subjected to full history taking, complete clinical examination, blood tests such as complete blood count, reticulocyte count, serum iron, ferritin, and total iron binding capacity, liver and renal function tests, and an immunoassay to measure human ERFE. There was a statistically significant difference in the levels of ERFE between the cases and controls (p &lt; 0.001). There was a significant, strong correlation between the levels of hemoglobin and serum iron and the level of ERFE (r = –0.655, p &lt; 0.001). There was no significant correlation between the administered dose of exogenous erythropoietin and the level of ERFE (p = 0.460). Serum ERFE levels in the children with CKD on regular hemodialysis were significantly higher than in the controls and were negatively correlated with hemoglobin and iron levels. There was no significant correlation between ERFE levels and both serum ferritin and total iron binding capacity levels.

Iron Parameters in Patients Treated with Roxadustat for Anemia of Chronic Kidney Disease.

Roxadustat is a novel agent with a distinct mechanism of action compared to erythropoiesis-stimulating agents (ESAs) and a potentially different combination of effects on iron parameters. This narrative review describes the effects of roxadustat on iron parameters and on hemoglobin levels in the context of iron supplementation in patients with anemia of non-dialysis-dependent (NDD) or dialysis-dependent (DD) chronic kidney disease (CKD). Roxadustat use was associated with a greater reduction in serum ferritin levels than seen with ESAs and an increase in serum iron levels compared to a decrease with ESAs. Decreases in transferrin saturation in patients treated with roxadustat were relatively small and, in the case of patients with NDD CKD, not observed by Week 52. These changes reflect the concomitant increases in both serum iron and total iron-binding capacity. Compared to placebo and an ESA, roxadustat improved iron availability and increased erythropoiesis while requiring less intravenous iron use. Hepcidin levels generally decreased in patients who received roxadustat compared to baseline values in all CKD populations; these decreases appear to be more robust with roxadustat than with an ESA or placebo. The mechanisms behind the effects of roxadustat and ESAs on iron availability and stores and erythropoiesis appear to differ and should be considered holistically when treating anemia of CKD.

IRON PROFILE STATUS IN PSORIASIS PATIENTS AND THEIR CORRELATION WITH THE DEGREE OF SEVERITY OF DISEASE

Objectives: (1) The objective of the study was to evaluate and compare the levels of ferritin, iron, total iron binding capacity (TIBC), and hemoglobin (Hb) in cases and controls (2) and to correlate these parameters with the severity of psoriasis. Methods: Iron-profile including serum ferritin, iron, TIBC, and Hb was evaluated in 100 subjects, 50 cases (psoriatic) and 50 controls (normal healthy individuals). A preformed pro forma was filled for each patient after taking written consent. Ferritin was evaluated using fully automated chemistry analyzer, iron, and TIBC were evaluated by semi-autoanalyzer and Hb by Automated Hematology Cell Counter. Results: In our study, a lower level of serum ferritin, iron, and Hb was found in cases than controls, whereas the levels of TIBC were found higher in cases than controls. (p&lt;0.05) We found a negative correlation of ferritin and a positive correlation of hemoglobin with psoriasis area and severity index. Conclusion: We conclude that iron profile should be done early in the course of disease to improve dietary advices and treatment modalities.

Iron Deficiency and Iron Storage Markers in Different Pregnancy Stages in Sudanese Women of Different Age

Background: The aim of this study was to evaluate the ID and iron storage markers in pregnant women suffering from anemia during various trimesters attending Omdurman Maternity Hospital in Sudan. Methods and Results: This cross-sectional study included 205 pregnant women aged 15 to 45 in various trimesters who attended Omdurman Maternity Hospital (Sudan) between May 2022 and January 2023. All pregnant women were divided into two groups: the case group included 159 pregnant women with anemia, and the control group included 46 apparently healthy pregnant women. The blood test parameters were measured using a Sysmex XT-1800i Automated Hematology Analyzer (Japan). The levels of serum iron (SI) and total iron-binding capacity (TIBC) were measured using a Vitrous-350 Chemistry Analyzer (USA). The serum ferritin (SF) levels were measured by electrochemiluminescence immunoassay on the Cobas e411 analyzer (Roche). Among anemic pregnant women, 33(20.8%) were in the first trimester of pregnancy, 68(42.8%) in the second trimester, and 58(36.5%) in the third. In the case group, more than six deliveries were found in 50.3% of cases, compared to 23.9% in the control group (P=0.0015). The blood levels of Hb and SF were significantly lower in all trimesters in the case group than in the control group. The SI level showed a significantly low level only in the third trimester in the case group, compared to the control group (P&lt;0.05). In the case group, TIBС levels increased from trimester to trimester, reaching maximum values in the third trimester, indicating a low iron level in the blood. In the case group, in the first trimester, the levels of Hb and ferritin did not differ between the age groups of 15-25 years and &gt;26 years. However, in the second trimester, the SF level was statistically lower in the age group of &gt;26 years than in the age group of 15-25 years (45.83±5.0 vs. 49.02±3.71 ng/mL, P=0.0038), but in the third trimester, there was the opposite (37.50±4.9 vs. 26.9±4.5ng/mL, P=0.000), which indicated a presence of IDA in the age subgroup of 15-25 years. Conclusion: Pregnant women are at high risk of developing or worsening ID. Every pregnant Sudanese woman should be screened for IDA.

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.

Evaluation of Iron Profiles and Coagulation Profiles in Ischemic Heart Diseases Patients in Elmer Nimr Hospital, Sudan

Back ground chemic heart disease (IHD) isa constellation of diseases that includes stableangina,unstableangina,myocardialinfarction,andsuddencardiacdeath.It belongs to the group of cardiovascular diseases and is the most common type among them. Iron is an essential trace element .it plays an important role in maintaining various cellular function and enzymatic reactions. On the other hand, excessive intake of iron is known to be a risk factor for the progression of atherosclerosis. Abnormal iron deposition in the heart causes hem chromatists and dilated cardiomyopathy, which leads to is chemic heart disease .Objectives :This study aims to investigate the role of serum iron ,serum ferritin ,total iron-binding capacity(TIBC), PT, and PTT in is chemic heart disease(IHD)and their relationship with other risk factors for IHD This is a prospective, case-control, cross-sectional analytical study conducted at Elmer Narmer University Hospital, Shendi City, to assess their on profile and coagulation profile of patients with is chemic heart disease. The study included (30) patients diagnosed with is chemic hear the diseases and the study group was compared with the mean of the control group (20). Serum iron ,ferritin ,and TIBC were estimated using a Spectro photo meter ,and PT and PTT were estimated using manual methods. Data were collected using a structured personal questionnaire and the program (SPSS) version(11.5)was used for data analysis

ROLE OF RETICULOCYTE HEMOGLOBIN CONTENT IN DIAGNOSIS OF IRON DEFICIENCY ANEMIA

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