Iron Deficiency Anemia Research Articles

Endoscopic Tunnel Dissection of an Oesophageal Bronchogenic Cyst: A Case Report

Introduction: A bronchogenic cyst is a very rare congenital malformation typically found in the middle and superior mediastinum. Infrequently, it can be located in the pericar-dium, diaphragm, oesophagus, and stomach. Intramural oesophageal bronchogenic cysts are highly uncommon, and because of this, they have not been extensively studied. They are gen-erally asymptomatic; however, due to their potential to cause complications, such as evolution into malignancy, the removal of these cysts is recommended. Routinely, techniques, including thoracotomy and thoracoscopy, have been adopted for excision. This case report details our success in performing a complete resection of an intramural oesophageal bronchogenic cyst via a novel approach of Submucosal Tunneling Endoscopic Resection (STER). Case Presentation: A 62-year-old woman was referred for an outpatient gastroscopy and co-lonoscopy for further investigation of her unexplained iron deficiency anaemia, abdominal pain, diarrhoea, and weight loss. A single oesophageal nodule was found on gastroscopy, which was further characterized and deemed to be benign on upper endoscopic ultrasound. The lesion was removed via the STER technique. During the procedure, submucosal fibres were dissected and a full-thickness myotomy was performed to completely remove the lesion. Histologically, the lesion showed a cyst lining comprising ciliated columnar epithelium, a finding consistent with a bronchogenic cyst. The patient maintained a normal diet and re-mained asymptomatic throughout the follow-up period. Conclusion: This report documents the successful resection of an oesophageal bronchogenic cyst via the STER technique. This novel approach appears to be a valuable tool with negligible invasiveness. It provides a feasible option for patients.

Comparison of Problem-based Learning and Didactic Lecture as a Teaching–Learning Method among Undergraduate Medical Students: An Interventional Study

Background Didactic lecture (DL) is a teaching method that has been there for a long time in our educational system, but student involvement is minimal. Problem-based learning (PBL) differs in that it involves students in the learning process. Various skills are learned, such as self-learning, group discussion, communication skills, teamwork and knowledge retention. Critical thinking, analysis and the ability to solve real problems are some benefits of PBL, which can help medical students understand clinical scenarios and analyse, interpret and come up with possible solutions based on sound knowledge. Thus, there is a need to assess the effectiveness of PBL in recall, interpretation and problem-solving skills as compared to the traditional lecture method, as there are very few Indian studies related to PBL in Indian medical students. Materials and Methods A non-randomised interventional study was carried out in the Department of Pharmacology at East Point Medical College, Bengaluru. Groups A and B, each with 60 medical students, participated in PBL and DL for either of the two competencies (myocardial infarction and iron deficiency anaemia). After the completion of the DL and PBL sessions, 20 multiple-choice questions (MCQs) were given to the students. The effectiveness of the teaching method was determined by comparing the mean scores of MCQs of both groups. Results The group scores were compared using an independent sample t-test and expressed as mean ± standard deviation. The total mean score of PBL for the topic myocardial infarction (11.00 ± 2.64, p value = .001) was statistically significant compared with the total mean score in the DL group (9.38 ± 2.52), and the total mean score of PBL for the topic iron deficiency anaemia (15.28 ± 3.53, p value = .001) was significant compared to the total mean score in the DL group (12.98 ± 3.61), respectively. The mean score for recall and problem-solving for the topic of myocardial infarction was statistically significant in the PBL group compared to the DL group. The mean score for recall, interpretation and problem-solving for the topic of iron deficiency anaemia was statistically significant in the PBL group compared with the DL group. Conclusion PBL showed marked improvement in recall, interpretation and problem-solving abilities compared with DL. So, including PBL as a teaching–learning method can promote active and student-centered learning.

Inconsistency in ferritin reference intervals across laboratories: a major concern for clinical decision making.

Iron deficiency anemia is a significant global health concern, diagnosed by measuring hemoglobin concentrations in combination with plasma ferritin concentration. This study investigated the variability in ferritin reference intervals among laboratories in the Netherlands and examined how this affects the identification of iron-related disorders. Ferritin reference intervals from 52 Dutch ISO15189-certified medical laboratories were collected. Ferritin, hemoglobin and mean corpuscular volume data of non-anemic apparently healthy primary care patients, measured by four laboratory platforms (Beckman, Abbott, Siemens, and Roche), were collected (n=397,548). Median ferritin levels were determined per platform, stratified by sex and age. The proportion of ferritin measurements outside of the reference interval was calculated using the reference intervals from the 52 laboratories (using a total of n=1,093,442 ferritin measurements). Lastly, ferritin data from 3,699 patients as captured in general practitioner (GP) data from the PHARMO Data Network were used to assess the variation of abnormal ferritin measurements per GP. Median plasma ferritin concentrations were approximately four times higher in men and twice as high in postmenopausal women compared to premenopausal women. Moreover, there are substantial differences in the median plasma ferritin concentration between the four platforms. However, even among laboratories using the same platform, ferritin reference intervals differ widely. This leads to significant differences in the percentages of measurements classified as abnormal, with the percentage of ferritin measurements below the reference limit in premenopausal women ranging from 11 to 53 %, in postmenopausal women from 3 to 37 %, and in men from 2 to 19 %. The percentage of ferritin measurements above the reference limit in premenopausal women ranged from 0.2 to 11 %, in postmenopausal women from 3 to 36 % and in men from 7 to 32 %. The lack of harmonization in ferritin measurement and the disagreement in plasma ferritin reference intervals significantly impact the interpretation of the iron status of patients and thereby the number of iron disorder diagnoses made. Standardization or harmonization of the ferritin assays and establishing uniform reference intervals and medical decision limits are essential to reduce the substantial variability in clinical interpretations of ferritin results.

Prevalence of iron deficiency anemia in exclusively breastfed infants after a 5-month iron supplementation

Iron deficiency anemia (IDA) is prevalent in exclusively breastfed (EBF) Thai infants. However, in Thailand, iron supplementation guidelines for EBF infants are not available. This prospective open-label study aimed to estimate the prevalence of IDA in 9-month-old EBF infants after receiving iron supplementation from 4 months of age until they consumed adequate iron-rich food. Forty-seven healthy, 4-month-old EBF infants were prescribed 1 mg/kg/day ferrous sulfate. Their complementary food records from 6 to 9 months were calculated for daily iron intake. Complete blood count and iron study were performed at 9 months of age. The results showed that the prevalence of IDA at 9 months was 6.4%. An employed caregiver and the male sex of the baby were significantly associated with iron deficiency. The food record revealed that the median daily iron intake was less than the Thai dietary reference intake recommendation. In summary, the prevalence of IDA in infants with 9 months of exclusive breastfeeding who received iron supplementation was lower than the background rate (25.7%) when iron was not prescribed. Most infants did not have adequate iron in complementary foods. Iron supplementation should be prescribed routinely during 4–9 months of age in healthy Thai EBF infants.

Risk of Intestinal Complications, Extraintestinal Morbidity, and Mortality in Patients with Crohn’s Disease and Ocular Involvement

ABSTRACT Purpose Patients with Crohn’s disease (CD) and subsequent ocular manifestations may have worse outcomes when compared to matched patients with CD without ocular disease. Methods In this retrospective cohort study, an aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with CD stratified by the presence or absence of ocular involvement with at least 1 year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities. Results Patients with CD with ocular disease showed a greater risk of undergoing bowel resections (RR: 2.06, 95% CI: 1.48–2.85, p < 0.001), developing other CD-related gastrointestinal complications (RR: 1.31, CI: 1.15–1.49, p < 0.001), or acquiring Clostridioides difficile infections (RR: 2.19, CI: 1.89–2.54, p < 0.001). Further, patients with CD with ocular sequelae had a greater risk of developing NASH (RR: 1.43, CI: 1.31–1.56, p < 0.001), CD-related nutrient deficiencies (RR: 1.38, CI: 1.29–1.49, p < 0.001), iron deficiency anemia (RR: 1.41, CI: 1.33–1.50, p < 0.001), CD-related dermatological disease (RR: 1.84, CI: 1.65–2.05, p < 0.001), osteoporosis (RR: 1.49, CI: 1.37–1.64, p < 0.001) and primary sclerosing cholangitis (RR: 1.63, CI: 1.11–2.38, p = 0.011). Among patients with CD with ocular involvement, there was an elevated risk of MI (RR: 1.36, CI: 1.14–1.63, p < 0.001), stroke (RR: 1.42, CI: 1.18–1.70, p < 0.001), VTE (RR: 1.37, CI: 1.22–1.54, p < 0.001), and sepsis (RR: 1.53, CI: 1.37–1.71, p < 0.001). Conclusions Patients who have CD and subsequent ocular involvement have an increased risk of local intestinal complications, extraintestinal morbidity, and cardiovascular complications when compared to patients with CD without ocular involvement.

The Effectiveness of Anemia Treatment with Injectable Iron within 48 to 72 Hours before Coronary Artery Bypass Surgery on Cardiac Function and Postoperative Outcome: A Randomized Clinical Trial

Background: Anemia is considered as one of the risk factors affecting the outcomes after cardiac surgery. Accordingly, the improvement of iron deficiency anemia through injection or oral may be associated with the improvement of post-procedure results, especially the improvement of cardiovascular function. This study was aimed at investigating the effectiveness of iron treatment shortly before surgery in reducing the need for blood transfusion and improving myocardial performance parameters (left ventricular ejection fraction) in coronary bypass surgery patients. Methods: This study was a single-blind randomized clinical trial. In total, 60 candidates for coronary bypass surgery having iron deficiency anemia before the operation were randomly divided into two groups treated with injectable iron supplement (iron sucrose at a dose of 200 mg/200 ml of normal saline injected in 30 minutes) 48 to 72 hours before surgery or without therapeutic intervention. The patients were examined during and after the operation in terms of surgical outcomes. Results: Treatment with injectable iron before surgery was associated with improvement in serum hemoglobin level after surgery and a significant reduction in the need for intraoperative and postoperative transfusions. Preoperative treatment of iron deficiency was associated with a reduction in the length of hospitalization of the patients after surgery. Conclusion: Treatment of iron deficiency anemia within 48 to 72 hours before surgery will improve the condition of patients’ anemia and compensate serum hemoglobin, reduce the need for blood transfusion during surgery and the length of hospitalization of the patients after surgery.

Utility of Reticulocyte Hemoglobin Equivalent in Screening for Iron Deficiency in Pregnancy.

Ferritin, commonly used for diagnosing iron deficiency (ID) in pregnancy, is limited by high cost and false elevations during inflammation. Reticulocyte hemoglobin equivalent (Ret-He), an alternative marker for ID, is unaffected by inflammation and analyzed on the same collection tube as the standard complete blood count (CBC). We aimed to determine the accuracy of Ret-He in detecting ID in pregnancy compared to ferritin in a U.S. This prospective cohort study enrolled 200 pregnant participants, recruited in any trimester if a CBC was drawn as part of routine prenatal care. For those who agreed to participate, Ret-He and ferritin were collected concurrently with the CBC. ID was defined as ferritin level below 30 ng/mL. Patients were classified into three groups based on hemoglobin and ferritin results to determine the severity of ID: no ID, ID alone, and ID anemia (IDA). Four participants with anemia but normal ferritin were excluded. Receiver operating curve analysis, including the area under the curve (AUC), was performed to assess the accuracy of Ret-He in detecting ID. A one-way ANOVA (analysis of variance) with post-hoc analysis was used to compare differences in Ret-He between the three groups of ID severity. The prevalence of ID in our cohort was 82% (161/196). The AUC for Ret-He was 0.65 (95% confidence interval: 0.55-0.75), indicating suboptimal discrimination between patients with and without ID. Ret-He was significantly different among the three groups (p < 0.001). In post-hoc analysis, Ret-He was significantly lower in the IDA group compared to the ID group (p < 0.001) but there was only a trend of lower Ret-He in the ID group compared to the non-ID group (p = 0.38). Ret-He has low accuracy in diagnosing ID in pregnancy. It may be useful in detecting severe ID resulting in anemia but not a mild iron-deficient state resulting in ID only. · The prevalence of ID in our cohort was 82%.. · Ret-He has low accuracy in diagnosing ID in pregnancy.. · Ferritin is preferable when readily available..

Bridging the Knowledge Gap on Iron Deficiency Anemia Among Nursing Students

Background: Iron deficiency anemia (IDA) is a prevalent nutritional disorder characterized by a significant reduction in the body’s iron stores, affecting oxygen transport and leading to various health complications. Specific Background: The understanding of IDA among nursing students is underdeveloped, especially regarding the differences between morning and evening study cohorts. Knowledge Gap: Understanding nursing students' knowledge of IDA is critical for enhancing educational strategies and improving patient care, yet limited studies have assessed this demographic's awareness of the condition and its management. Aims: This study aims to evaluate nursing students' knowledge about IDA and to compare the levels of knowledge between morning and evening students at the College of Nursing, University of Basrah, over a six-month period from November 2023 to March 2024. Results: A descriptive cross-sectional study was conducted involving 145 students (72 morning and 73 evening) who completed a questionnaire. Results indicated that 40.2% of morning students and 53.4% of evening students suffered from iron deficiency. While 86.1% of morning students had prior knowledge of IDA compared to 67.1% of evening students, the mean knowledge levels were deemed good for both groups, with no significant statistical difference between them. Novelty: This research contributes to the existing literature by highlighting knowledge levels of IDA among nursing students in Iraq, revealing that both morning and evening cohorts possess substantial understanding yet exhibit slight discrepancies. Implications: The findings underscore the necessity for targeted educational interventions to bridge the knowledge gap regarding IDA, ultimately enhancing nursing students' competencies in managing this condition in clinical settings. Highlights: IDA Prevalence: 40.2% morning students and 53.4% evening students affected. Knowledge Difference: 86.1% morning vs. 67.1% evening students aware of IDA. Educational Need: Targeted interventions required for improved IDA management in nursing education. Keywords: Iron deficiency anemia, nursing students, knowledge assessment, educational interventions, Iraq

Streamlined Preoperative Iron Deficiency Screening and IV Treatment for Colorectal Cancer Patients beyond Clinical Trials

Background/objectives: Iron deficiency anemia is common in patients with colorectal cancer and affects postoperative outcomes. Preoperative intravenous iron supplementation corrects anemia effectively; however, the effect on the postoperative clinical course is unclear. The aim of this study was to investigate the effects of implementing a screening program for iron deficiency anemia and correction in patients with colorectal cancer. Methods: This was a retrospective single-institutional quality-assurance study that included patients undergoing elective surgery for colorectal cancer between January 2019 and December 2021. On 1 March 2020, screening for iron deficiency was implemented. Anemia was corrected by intravenous ferricarboyxmaltose. Patients with hemoglobin &lt;7mmol/L and ferritin &lt;30 µg/L or ferritin 30–100 µg/L and TSAT &lt; 0.2 were divided into iron- and non-iron groups. The primary outcome was a change in hemoglobin concentration, and secondary outcomes included blood transfusion, complications, length of stay, mortality, and implementation efficacy. Data from the patients were extracted from digital patient charts and entered into a database. Results: A total of 532 patients were included, of which 177 patients (33.3%) were anemic, 63 were in the iron group, and 114 were in the non-iron group. Adherence to the screening program was 86.3%. Hemoglobin (iron group) increased from a mean of 5.7 mmol/L (SD 0.8) to 6.9 (0.8) mmol/L, p &lt; 0.001. Iron treatment decreased transfusion rates from 27.7% to 9.1%, p = 0.007, and increased the rate of patients without complications from 53.2% to 79.6%, p &lt; 0.001, which held true after controlling for confounding. In addition, 90-day mortality was lower in the iron group; however, this was not significant. Conclusions: Administration of intravenous iron increased hemoglobin, leading to reduced use of blood transfusion and fewer complications.

Chemical Composition of Clay Soil Analysis and Potential Health Risks: Experimental Study in Tshwane District, Gauteng Province

The practise of geophagy is common amongst women of childbearing age from different geographic locations, including South Africa, regardless of their social and economic status such as their level of education, race, marital status, income or occupation. This study aimed to examine the women of childbearing age in Tshwane District, Gauteng Province, South Africa. An experimental study was conducted at the laboratory to examine the chemical composition of clay soil ingested by geophagic women of childbearing age. Thirty-nine clay soil samples were collected from study participants attending antenatal care services and family planning at public healthcare facilities of Tshwane District, Gauteng Province, and subjected to geochemical analysis. The concentrations of vanadium, manganese, chromium, and barium were detected in quantities exceeding 100 mg/kg in almost all samples. Cadmium, mercury and silver were detected in low concentrations below 1 mg/kg in all samples. The practice of geophagy amongst women of childbearing age has been reported to be associated with detrimental health outcomes and risks such as iron deficiency anaemia, constipation, shortness of breath, maternal and childhood mortalities and morbidities, neurological and central nervous system disorder, death, appendicitis, cancers, teratogenic risks, and ulcers. The chemical composition of clay soil eaten by geophagic women of childbearing age contains potentially harmful substances, thus the practise of geophagy is toxic and should be discouraged to protect public health.

Pre- and Postnatal Vitamin A Deficiency Impairs Motor Skills without a Consistent Effect on Trace Mineral Status in Young Mice

Pregnant women and children are vulnerable to vitamin A deficiency (VAD), which is often compounded by concurrent deficiencies in other micronutrients, particularly iron and zinc, in developing countries. The study investigated the effects of early-life VAD on motor and cognitive development and trace mineral status in a mouse model. C57BL/6J dams were fed either a vitamin A-adequate (VR) or -deficient (VD) diet across two consecutive gestations and lactations. Offspring from both gestations (G1 and G2) continued the same diets until 6 or 9 weeks of age. Behavioral assays were conducted to evaluate motor coordination, grip strength, spatial cognition, and anxiety. Hepatic trace minerals were analyzed. A VD diet depleted hepatic retinoids and reduced plasma retinol across all ages and gestations. Retracted rear legs and abnormal gait were the most common clinical manifestations observed in VD offspring from both gestations at 9 weeks. Poor performance on the Rotarod test further confirmed their motor dysfunction. VAD didn’t affect hemoglobin levels and had no consistent effect on hepatic trace mineral concentrations. These findings highlight the critical role of vitamin A in motor development. There was no clear evidence that VAD alters the risk of iron deficiency anemia or trace minerals.

Treatment of iron deficiency and iron deficiency anaemia in menstruating women

Iron deficiency and anaemia affect premenopausal women’s quality of life. Daily oral iron supplements are standard treatment, causing gastrointestinal side effects, which could be overcome by an alternate-day dosing regimen. In this review, we compare dosing strengths and frequencies in trials: Twice-daily doses of 160 mg of elemental iron increases the ferritin- but not the haemoglobin level significantly and is poorly tolerated compared to 60-80 mg elemental iron taken daily or every other day, in mild to moderate anemia, although evidence for severe anaemia is limited.

The response of Intravenous Iron sucrose in children with Iron Deficiency Anaemia unresponsive to Oral Iron Therapy.

Objective: To evaluates the efficacy and safety of intravenous iron sucrose in paediatric patients with IDA who have not responded to or tolerated oral iron therapy.Methodology: This observational study was conducted at Department of Paediatrics, Pakistan aeronautical complex (PAC) Hospital Kamra, from October 2023 to April 2024. Iron sucrose (Venofer®) was administered at a dose of 0.35 ml/kg, providing 100 to 200 mg of elemental iron per dose, on alternate days for three doses. Haemoglobin (Hb) and serum ferritin levels were measured 4 weeks post-treatment to evaluate response.Results: Among the participants, 70 (70%) were male and 30 (30%) were female, with a mean age of 34.23 ±19.54 months. Results showed a significant increase in mean Hb from 7.92 ± 0.74 g/dl before treatment to 10.46 ± 0.94 g/dl after treatment (p = 0.001)Conclusion: Clinicians should consider intravenous iron therapy to enhance patient outcomes, improve quality of life, and potentially reduce healthcare costs. Keywords: Iron Deficiency Anaemia (IDA), Anaemia, Haemoglobin (Hb), Oral Iron, Intravenous Iron.

8623 Atypical VHL Genetic Variant Causing Paraganglioma

Abstract Disclosure: G. Mangu: None. J.J. Faria Briceno: None. R. Yatavelli: None. Abstract: Pheochromocytomas and paragangliomas (PPGLs) are rare chromaffin cell tumors that originate from the adrenal medulla and extra-adrenal paraganglia respectively. Previous studies have shown that incidental PPGLs are seen in older patients with mild symptoms. They have lower levels of plasma catecholamines and lower incidence of malignancy than patients with nonincidental PPGLs. We report a case of an incidental paraganglioma in a young female with atypical pathogenic variant in the VHL gene which is known to cause familial erythrocytosis but NOT VHL syndrome or PPGL. Case Presentation: A 33-year-old African American female with no significant medical history presented to the emergency room with the chief complaint of right lower quadrant pain for 2 days, which started with her menstruation. The vitals were BP 128/67, pulse 67 and physical examination was unremarkable. CT showed a 4.0 x 3.0 cm heterogenous enhancing left adrenal mass and MRI with adrenal protocol revealed 3.4 x 3.1 cm mass consistent with pheochromocytoma. Labs revealed elevated plasma nor metanephrines and 24-hour urine normetanephrines were 1020 mcg. She was asymptomatic without hypertension, palpitations, or chest pain. She underwent laparoscopic left adrenalectomy after appropriate alpha blockade. The pathology report showed left periadrenal paraganglioma with immunohistochemistry staining significant for Carbonic anhydrase IX (CAIX) membranous expression which is mostly seen in paragangliomas associated with von Hippel-Lindau syndrome. Clinically, she did not have any stigmata for hereditary PPGL syndrome. Her genetic testing revealed a pathogenic heterozygous variant in the VHL gene, Exon 3, c.598C.T (pArg200Trp), which is a missense variant expected to disrupt VHL protein function. Although she has a germline mutation in VHL, it is not the garden variant which is associated with classic VHL syndrome. It has been reported to cause autosomal recessive erythrocytosis but not PPGL. Conclusion: The pathogenic heterozygous variant in VHL gene, Exon 3, c.598C.T (pArg200Trp) is known to cause autosomal recessive familial erythrocytosis type 2 in the Chuvash population, termed as Chuvash Polycythemia. Our patient did not have polycythemia but had iron deficiency anemia from menorrhagia. Several studies have reported that this variant does not cause VHL syndrome, however it has been reported in a single family with VHL syndrome but WITHOUT pheochromocytoma. To our knowledge, incidental adrenergic paraganglioma associated with this mutation has not been reported in the literature. Presentation: 6/3/2024

6572 Acute Adrenal Crisis Secondary To Undiagnosed Addison's Disease

Abstract Disclosure: J.M. Deirmenjian: None. H. Nickowitz: None. T. Kavafyan: None. Addison’s disease, also known as primary adrenal insufficiency, is when the adrenal gland has a defect in making cortisol. Signs and symptoms of Addison’s disease include nausea, vomiting, diarrhea, fatigue, dizziness, hyperpigmentation, and mood changes. Acute Adrenal Crisis can occur as a result of Addison’s disease when patients experience acute physiologic stress such as acute illness. Patient is a 35- year-old woman with a PMHx of iron deficiency anemia presenting with intractable nausea and vomiting for 10 days and a single witnessed syncopal episode two days prior to presentation. She was also had intermittent dizziness. Patient initially presented to urgent care where she was found to be hyponatremic and then was sent to the ED. She had no seizure like activity or rashes prior to admission. On initial physical exam, her skin was warm and dry with skin discoloration and hyperpigmentation. She was awake, alert, and oriented to person, place, time, and situation. Patient had no neurological deficits and no lateral or vertical nystagmus on initial assessment. On admission, patient was hyponatremic to 114 mEq/L, potassium was 5.0 mEq/L, and glucose level was 79 mg/dL. Despite receiving a 500 cc NS bolus, 1L NS bolus, 25 grams of albumin, and D5-0.45 NS at 50 cc/hr, the hyponatremia was difficult to correct. Her sodium initially corrected to 120 mEq/L but the sodium later decreased to 117 mEq/L. The morning after admission, patient became hypotensive and hypoglycemic. Random cortisol was measured and found to be 2.2 mcg/dL, raising concern for acute adrenal crisis as a result of undiagnosed Addison’s Disease. ACTH level was 17 pg/mL. Endocrinology was consulted and she was treated with IV 100 mg Hydrocortisone in addition to IV hydrocortisone 50 mg IV q6h. Patient was able to be transitioned to PO hydrocortisone 15 mg qAM and 5 mg qPM and was started on PO fludrocortisone 0.1 mg daily. On day of discharge, sodium improved to 127 mEq/L. CT Abdomen with contrast was completed to evaluate the adrenal glands and it showed a normal appearance of the adrenal glands. The etiology of the patient’s acute adrenal crisis was secondary to undiagnosed Addison’s Disease. It is interesting to note that patient was not hypoglycemic on admission but later became hypoglycemic during her hospital course. Adrenal crisis is a possible fatal complication of undiagnosed Addison’s disease. Therefore, a possible Addison’s Disease diagnosis is important to consider when patients are presenting with symptoms such as nausea, vomiting, dizziness, and electrolyte derangements including hyponatremia. If patient’s present with hyponatremia, ruling out possible adrenal insufficiency by checking a cortisol level may change the course of patient’s care. After discharge, she was able to establish care with Endocrinology and remain stable on treatment with PO hydrocortisone and PO fludrocortisone. Presentation: 6/3/2024

6970 Severe Symptomatic Hypophosphatemia After Intravenous Iron Therapy: An Under-recognized Adverse Reaction

Abstract Disclosure: A. Morvant: None. O. Olajide: None. Introduction: Iron deficiency is a common condition that is often treated with intravenous preparations of iron supplementation. It has been documented in the literature that ferric carboxymaltose is the form of intravenous iron supplementation that is associated with the highest incidence of hypophosphatemia, when compared to other formulations of intravenous iron therapy. This case highlights a severe case of hypophosphatemia after ferric carboxymaltose therapy that led to multiple hospitalizations and required several months of oral and intravenous phosphorus repletion. Clinical Case A 36-year-old woman presented to the ED with severe diffuse arthralgias, generalized muscle weakness, and fatigue. Laboratory analysis revealed the following: phosphorus 1.2 mg/dL (2.3-4.7 mg/dL), 25-hydroxyvitamin D 13 ng/mL (25-80 ng/mL), parathyroid hormone 220 pg/mL (16-77 pg/mL), and calcium 8.5 mg/dL (8.4-10.5 mg/dL). She was admitted and started on intravenous and oral phosphorus repletion as well as oral ergocalciferol. She was subsequently discharged home on oral phosphorus and ergocalciferol supplementation, with a phosphorus level of 1.8 mg/dL. She was readmitted one day later with persistent arthralgias, myalgias, and severe fatigue, and found to have a phosphorus level of 1.1 mg/dL. Additional laboratory studies revealed the following: FGF23 41 pg/mL (&amp;lt;59 pg/mL) and 24-hour urine phosphorus 2191 mg/24hr (400-1300 mg/24hr). The patient notably had a history of chronic severe iron deficiency anemia due to menorrhagia and had been treated with intravenous iron sucrose infusions 7 months prior to her presentation. Due to adverse reactions to iron sucrose, this was switched to ferric carboxymaltose, and she had received two doses; one month and two weeks prior to her initial presentation. She was treated again with intravenous and oral phosphorus repletion and ergocalciferol and discharged after two weeks on oral phosphorus and ergocalciferol as well as thrice-weekly intravenous phosphorus infusions in the outpatient setting. She continued intravenous phosphorus infusions for about three months, and this was subsequently discontinued without recurrent hypophosphatemia. She is currently on low doses of oral phosphorus with normophosphatemia. Conclusion: Intravenous ferric carboxymaltose therapy can lead to severe and long-lasting, treatment-resistant hypophosphatemia due to increased urinary phosphate excretion. An increased awareness about this is needed by clinicians in treating patients who receive ferric carboxymaltose and monitoring phosphorous levels is crucial.

Study on Prevalence of Iron Deficiency Anaemia in Children of 6 Months - 12 Years of Age in Barabanki District, Uttar Pradesh

Study on Prevalence of Iron Deficiency Anaemia in Children of 6 Months - 12 Years of Age in Barabanki District, Uttar Pradesh

Iron status, anemia, and birth outcomes among pregnant women in urban Bloemfontein, South Africa: the NuEMI study

BackgroundDespite routine iron supplementation for pregnant women in South Africa, anaemia and iron deficiency (ID) in pregnancy remain a public health concern.ObjectiveTo determine the associations between iron status and birth outcomes of pregnant women attending antenatal clinic at a regional hospital in Bloemfontein.MethodsIn this cross-sectional study of 427 pregnant women, blood was taken to analyze biomarkers of anaemia (haemoglobin), iron status (ferritin and soluble transferrin receptor) and inflammation (C-reactive protein and α-1-acid glycoprotein). A questionnaire was used to collect information about birth outcomes (birth weight and gestational age at birth), HIV exposure, sociodemographics, iron supplement intake, and maternal dietary iron intake using a validated quantified food frequency questionnaire.ResultsThe median (Q1, Q3) weeks of gestation of participants was 32 (26, 36) at enrolment. Anaemia, iron deficiency (ID), ID anaemia (IDA) and ID erythropoiesis (IDE) were present in 42%, 31%, 19% and 9.8% of participants, respectively. Median (Q1, Q3) dietary and supplemental iron intake during pregnancy was 16.8 (12.7, 20.5) mg/d and 65 (65, 65) mg/d, respectively. The median (max-min) total iron intake (diet and supplements) was 81 (8.8-101.8) mg/d, with 88% of participants having a daily intake above the tolerable upper intake level of 45 mg/d. No significant associations of anaemia and iron status with low birth weight and prematurity were observed. However, infants born to participants in the third hemoglobin (Hb) quartile (Hb > 11.3–12.2 g/dL) had a shorter gestation by 1 week than those in the fourth Hb quartile (Hb > 12.2 g/dL) (p = 0.009). Compared to pregnant women without HIV, women with HIV had increased odds of being anaemic (OR:2.14, 95%CI: 1.41, 3.247), having ID (OR:2.19, 95%CI: 1.42, 3.37), IDA (OR:2.23, 95%CI: 1.36, 3.67), IDE (OR:2.22, 95%CI: 1.16, 4.22) and delivering prematurely (OR:2.39, 95%CI: 1.01, 5.64).ConclusionIn conclusion, anaemia, ID, and IDA were prevalent in this sample of pregnant women, despite the reported intake of prescribed iron supplements, with HIV-infected participants more likely to be iron deficient and anaemic. Research focusing on the best formulation and dosage of iron supplementation to enhance iron absorption and status, and compliance to supplementation is recommended, especially for those living with HIV infection.Graphical

Expression of Serum and Salivary Levels of Obestatin in Periodontitis Patients with and without Iron Deficiency Anemia

Expression of Serum and Salivary Levels of Obestatin in Periodontitis Patients with and without Iron Deficiency Anemia

A-159 Re-evaluating Ferritin Cutoffs for the Diagnosis of Iron Deficiency and Iron Deficiency Anemia

Abstract Background Iron deficiency (ID) is the most common nutrient deficiency in the world and iron deficiency anemia (IDA) is estimated to affect 1.24 billion people. Serum ferritin is an iron storage protein commonly used as a biomarker for ID and IDA. The ferritin lower limit of normal (LLN) defined in many clinical laboratories is lower than evidence-based cutoffs and may not detect ID and IDA with adequate sensitivity, particularly when sex-based reference intervals (RIs) are used. This may be due in part to the use of asymptomatic, iron-depleted individuals for RI studies. Recent efforts have been made to increase the LLN for ferritin to at least 30 ng/mL and re-evaluate sex based RIs to improve diagnosis of ID and IDA. In this study, we aimed to investigate LLN ferritin cutoffs for ID and IDA in our patient population. Methods Patient data from June 2022-May 2023 were collected with approval from the Institutional Review Board (IRB), including age, sex, and values for ferritin, iron, transferrin saturation, and hemoglobin. Patients were classified as iron replete (IR), ID, or IDA based on measurements for iron, transferrin saturation, and hemoglobin. IR patients were defined as having iron and transferrin saturation values within current RIs, while those below the cutoff were grouped as ID. ID and IDA were further classified based on hemoglobin values. A range of ferritin concentrations between 1 and 100 ng/mL were used to calculate true and false positive rates (TPR and FPR) and diagnostic accuracy (DA). Receiver operator characteristic (ROC) curve and J index analysis were used to define optimal ferritin cutoffs for ID and IDA. Results Data from 26,455 patients (65% female) were used in this study. Conclusions These findings highlight the need to re-examine ferritin RIs in the context of ID/IDA, especially for those patients assigned female at birth.