Transferrin Saturation Coefficient Research Articles

#1078 Prevalence of iron deficiency in patients admitted to a geriatric unit: analysis according to the stages of chronic kidney disease

Abstract Background and Aims Iron deficiency (ID) is a poor prognostic factor in chronic diseases such as chronic kidney disease (CKD). Indeed, independently of anemia, ID is associated with more rapid clinical worsening of CKD and is a risk factor for mortality in this condition. In older patients, CKD is common and often associated with other comorbidities. Method The CARENFER PA study is a national multicenter study designed to evaluate ID in older patients (>75 years) newly hospitalized in a geriatric unit. The primary endpoint was the prevalence of ID, defined as serum ferritin < 100 µg/L and/or transferrin saturation coefficient (TSAT) <20%. Absolute ID was defined as serum ferritin < 100 µg/L and functional ID as serum ferritin ≥ 100 µg/L and TSAT < 20%. In this analysis, we explored ID prevalence according to the degree of CKD. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death). Results 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were analyzed. Stages of CKD were: stage I, 3.8%; II, 53.2%; IIIa, 22.3%; IIIb, 13.3%; IV, 6.0% and V, 1.4%. ID prevalence in the entire cohort was 57.6% (495/859). When present, ID was absolute in 56.2% (278/495) of cases and functional in 43.8% (217/495). ID prevalence was 54.3% (265/488) in patients with stages I-II, and 61.9% (227/367) in patients with stages III-V (p = 0.0271). In the subgroup of anemic patients, ID prevalence was 58.9% (112/190) and 65.9% (147/223), respectively (p = 0.14). We assessed, according to the stages of CKD, various factors likely to affect or be associated with ID. Thus, in patients with at least three comorbidities, ID prevalence was 56.9% (74/130) in patients with stages I-II and 64.8% (142/219) with stages III-V (p = 0.14); in patients with heart failure, ID was present in 63.2% (36/57) and 60.3% (76/126), respectively (p = 0.71). If patients received treatments with possible effect on ID/anemia (e.g., anticoagulant, proton pump inhibitors, platelet antiaggregant), ID prevalence was 58.4% (192/329) for stages I-II and 62.7% (188/300) for stages III-V (p = 0.27). In patients with CRP ≥ 12 mg/L, ID prevalence was 73.8% (96/130) and 72.2% (117/162), respectively (p = 0.76). In univariate analysis of the entire cohort, degree of CKD (stages III-V vs. I-II), at least three comorbidities, CRP ≥ 12 mg/L, anemia and low serum albumin were significantly associated with ID. In multivariate analysis, CRP ≥ 12 mg was the only independent predictor of ID (odds ratio, 2.78; 95% CI, 1.92–4.08; p < 0.0001). In patients with stages I-II, physical performances were poor (SPPB score 0-6) in 44.5% (77/173) of patients without ID and 57.5% (119/207) with ID; in patients with stages III-V, SPPB scores were low in 55.6% (60/108) of patients without ID and 63.5% (106/167) with ID. Conclusion ID prevalence is high (over half of patients) in older patients admitted to a geriatric unit—particularly those with CKD—and is associated with inflammation and a low SPPB score. These new data underline the importance of more systematic screening for ID in older patients. Future randomized controlled trials should evaluate the efficacy of iron supplementation on the outcome of older patients with ID.

Prevalence of iron deficiency in patients admitted to a geriatric unit: a multicenter cross-sectional study

BackgroundIron deficiency (ID) is often associated with other comorbidities in older patients and is a factor of morbimortality. However, the prevalence of ID remains poorly documented in this population.MethodsThe CARENFER PA study was a French multicenter cross-sectional study whose objective was to evaluate ID in patients (> 75 years) admitted to a geriatric unit. The primary endpoint was the ID prevalence defined as: serum ferritin < 100 µg/L and/or transferrin saturation coefficient (TSAT) < 20%. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death).ResultsA total of 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were included from October 2022 to December 2022. The prevalence of ID was 57.6% (95% CI, 54.3–60.9) in the cohort of older patients (62.6% in anemic and 53.3% in non-anemic patients; p = 0.0062). ID prevalence increased significantly with the presence of more than three comorbidities (65.6% vs. 55.9%; p = 0.0274), CRP ≥ 12 mg/L (73.0% vs. 49.3%; p < 0.001) and treatment that may influence ID/anemia (60.5% vs. 49.6%; p = 0.0042). In multivariate analysis, only CRP ≥ 12 mg/L was an independent predictive factor of ID (odds ratio, 2.78; 95% CI, 1.92–4.08; p < 0.001). SPPB scores were low (0–6) in 60.5% of patients with ID versus 48.6% of patients without ID (p = 0.0076).ConclusionMore than half of older patients had ID, including non-anemic patients. ID was associated with the presence of inflammation and a low SPPB score.Trial registrationNCT05514951.

Comparison of cytokine secretion and study of their effect on erythropoiesis in patients with malignant neoplasms with anemia of chronic disease, iron deficiency anemia, and their combination

Aim. To compare the secretion of interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) in cancer patients with anemia of chronic disease (ACD), iron deficiency anemia (IDA) and a combination of these two anemia types. To assess the effect of the studied cytokines on erythropoiesis in patients with malignant neoplasms separately for each type of anemia studied.Materials and methods. 106 patients with stage II–IV of solid malignant neoplasms were examined: 84 with anemia (55 men, 29 women, 67.1 ± 9.9 years), 22 without anemia (17 men, 5 women, mean age 60.2 ± 14.9 years). In accordance with Van Santen and Worwood criteria, by determining the transferrin saturation coefficient, ferritin concentrations, C-reactive protein, patients were divided into 4 groups: group 1 – patients with ACD, 31 (20 / 11 patients), 2 group – ACD / IDA, 28 (18 / 10 patients), group 3 – IDA, 25 (17 / 8 patients), group 4 (control) – 22 patients without anemia. In all patients, the number of erythrocytes, the concentration of hemoglobin, ferritin, C-reactive protein, transferrin saturation coefficient, IL-6, TNF-α, IL-10 were determined. For quantitative indicators, the arithmetic mean and interquartile range (IQR) were calculated. Significance of differences between several unrelated groups was determined using the Kruskal–Wallis test. To assess the relationship between variables, the Spearman correlation coefficient (r) was calculated.Results. In the ACD group, the maximum IL-6 concentration was 73.3 (IQR 6.2–51), TNF-α – 24.4 (IQR 15.3–60.7) and IL-10 – 8.7 (IQR 4.7–12.1) compared with the ACH3 / IDA group (IL-6 – 9.3 [IQR 4.4–13.2], TNF-α – 7.2 [IQR 4.5–9.6] and IL-10 – 6.7 [IQR 4.1–11.4]), and the IDA group (IL-6 – 3.4 [IQR 1.4–5.9], TNF-α – 4.6 [IQR 3.7–6] and IL-10 – 2.5 [IQR 0–5]) (p &lt;0.05). In the ACD group, the highest correlation coefficients were found between IL-6 and erythrocytes (r = –0.74) and hemoglobin (r = –0.88), between TNF-α and erythrocytes (r = –0.66) and hemoglobin (r = –0.77), between IL-10 and erythrocytes (r = –0.36) and hemoglobin (r = –0.63). In the IDA group, the correlation coefficients between cytokines, erythrocytes, and hemoglobin are low or absent.Conclusion. In cancer patients, ACD, IDA, as well as their combination can occur. Increased cytokine secretion in ACD group patients is important due to the proven strong negative effect of cytokines on erythropoiesis. Further study of ACD pathogenesis is needed in order to improve treatment.

Évaluation du fer sérique comme facteur prédictif d’une réponse de l’hémoglobine au traitement par fer injectable chez les patients hémodialysés chroniques

BackgroundThe detection and correction of iron deficiency are essential for the treatment of anemia in chronic hemodialysis patients. The aim of our study was to assess the ability of serum iron to predict hemoglobin response to intravenous iron supplementation in hemodialysis patients. MethodsIt is a retrospective study in 91 hemodialysis patients during 2016 at Clermont-Ferrand University Hospital for whom intravenous iron supplementation had been started. A responder patient was defined as an increase in hemoglobin greater than or equal to 1 g/dL/month and/or a decrease in the dose of erythropoiesis stimulating agent after two months of iron supplementation. ResultsIn responding patients, serum iron was significantly lower (6.7 ± 2.7 μmol/L) compared to non-responding patients (8.9±2.9 μmol/L; P<0.001). The positive response to iron supplementation was significantly associated with low serum iron (odds ratio = 0.58 [0.42–0.81]; P=0.002) in a logistic regression model taking into account ferritin, transferrin saturation coefficient, dose variation monthly iron and erythropoiesis stimulating agent and the duration of dialysis. The area under the receiver operating characteristic curve of serum iron, ferritin and transferrin saturation coefficient to predict the response to iron supplementation were 0.72, 0.51 and 0.64, respectively (serum iron versus ferritin [P=0.006] and serum iron versus transferrin saturation coefficient [P=0.04]). The sensitivity for serum iron below 7.5 μmol/L was better than that for ferritin below 86 ng/mL (P<0.001) and the specificity for serum iron below 7.5 μmol/L was better than that for TSC less than 19% (P=0.02). ConclusionSerum iron below 7.5 μmol/L can predict the success of the response to iron supplementation in chronic hemodialysis patients.

Neglected Comorbidity of Chronic Heart Failure: Iron Deficiency.

Iron deficiency is a significant comorbidity of heart failure (HF), defined as the inability of the myocardium to provide sufficient blood flow. However, iron deficiency remains insufficiently detected. Iron-deficiency anemia, defined as a decrease in hemoglobin caused by iron deficiency, is a late consequence of iron deficiency, and the symptoms of iron deficiency, which are not specific, are often confused with those of HF or comorbidities. HF patients with iron deficiency are often rehospitalized and present reduced survival. The correction of iron deficiency in HF patients is associated with improved functional capacity, quality of life, and rehospitalization rates. Because of the inflammation associated with chronic HF, which complicates the picture of nutritional deficiency, only the parenteral route can bypass the tissue sequestration of iron and the inhibition of intestinal iron absorption. Given the negative impact of iron deficiency on HF progression, the frequency and financial implications of rehospitalizations due to decompensation episodes, and the efficacy of this supplementation, screening for this frequent comorbidity should be part of routine testing in all HF patients. Indeed, recent European guidelines recommend screening for iron deficiency (serum ferritin and transferrin saturation coefficient) in all patients with suspected HF, regular iron parameters assessment in all patients with HF, and intravenous iron supplementation in symptomatic patients with proven deficiency. We thus aim to summarize all currently available data regarding this common and easily improvable comorbidity.

Erythrocyte blood indices and state of iron metabolism in children with juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is a systemic chronic disease. One of the extra-articular manifestations of JIA are hematological changes. The most common is anemia. The aim of the study was to explore the indicators of the red blood cells and the state of iron metabolism in children with JIA, depending on the form and duration of the disease. A retrospective analysis of the medical history of patients was carried out. The study of the indicators of the red blood cells consisted in determining the number of erythrocytes, the amount of hemoglobin, the ratio of the number of erythrocytes to blood volume, the average volume of erythrocytes, the average hemoglobin content in the erythrocyte, the average concentration of hemoglobin in the erythrocyte, as well as the distribution of red blood cells along the length in the form of the difference between the largest and smallest size of red blood cells and the deviation of the volume of red blood cells from the average value. The state of iron metabolism was represented by such indicators as the content of serum iron, ferritin, transferrin, latent iron-binding capacity of blood serum, total iron-binding capacity of serum, transferrin saturation coefficient with iron. In 18.7 % of children with JIA, a decrease in hemoglobin of less than 120 g/l was noted. There was a significant (p &lt; 0.001) decrease in the average hemoglobin content in the erythrocyte in 37.9 % of patients. As a result of the study, it was found that the decrease in the iron content in the blood serum is due not only to the true iron deficiency state, but also to the redistribution of iron reserves against the background of chronic autoimmune inflammation. In the systemic form of the disease, changes in the latent iron deficiency state are more pronounced. With a long course of the disease, normalization of red blood cell parameters occurs. The duration of the disease has no effect on ferrokinetics, which is due to the development of iron deficiency compensation against the background of ongoing treatment.

Impact of Iron-Deficiency Management on Quality of Life in Patients with Cancer: A Prospective Cohort Study (CAMARA Study)

BackgroundIron deficiency (ID) is very common in patients with solid tumors and may cause symptoms such as fatigue. However, its impact on clinical outcomes is poorly described. The aim of this prospective monocentric cohort study was to evaluate the evolution of quality of life (QoL) of these patients after iron supplementation.MethodsWe included patients treated for a solid tumor, which were diagnosed with a functional (ferritin <800 ng/mL) or absolute (ferritin <300 ng/mL) ID (transferrin saturation coefficient <20%). The primary endpoint was patients’ QoL evolution between baseline and intermediate visit, 15-30 days after initial intravenous iron supplementation, assessed by the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale. Secondary endpoints were the same assessment between baseline, intermediate, and final visit at 6 months and the evolution of functional capacities.ResultsFrom 02/2014 to 12/2016, 248 patients were enrolled, of whom 186 were included in the analyses, including 140/186 (75.3%) with absolute ID. Anemia was detected in 141/174 (81.0%) patients at baseline. The FACT-An scores improved significantly between inclusion and intermediate visit (P = .001) and also between the 3 times of evaluation (P < .001). The most improved dimensions were those assessing physical, emotional well-being, and fatigue. Patients who performed the functional tests in all 3 phases had a significant improvement in performance on the majority of tests.ConclusionThe supplementation of ID was associated with an improvement of the QoL and functional capacities in patients with cancer. A randomized control trial is necessary to confirm our results. Our findings underline the importance of supportive care, including screening for ID, in oncology.Clinical trial registration numberNCT03625661.

A neglected comorbidity of chronic heart failure: iron deficiency

The functioning of the heart muscle is particularly sensitive to iron deficiency, the easily curable comorbidity most frequently associated with heart failure. Iron-deficient heart failure patients are more often rehospitalized and have reduced survival. Heart muscle function is particularly susceptible to martial deficiency. Recent randomized studies have shown that exogenous iron intake is accompanied by improved functional capacity (walking test), quality of life, and re-hospitalization rate in these patients. The symptoms of iron deficiency are not very specific and often confused with those of heart failure or other comorbidities, which explains why management is often too late. Anemia is only a late consequence of this iron deficiency. Due to the inflammatory state associated with chronic heart failure, only the parenteral route can bypass the macrophage tissue sequestration of iron and inhibit its intestinal absorption. Recent European guidelines recommend screening for iron deficiency (serum ferritin and transferrin saturation coefficient) in all patients with suspected heart failure, routine iron parameters assessment in all patients with heart failure, and intravenous iron supplementation in case of deficiency in symptomatic patients. Given the pejorative nature of iron deficiency on disease progression, the frequency and financial impact of hospitalizations linked to episodes of decompensation, as well as the effectiveness of simple supplementation, screening for this comorbidity, screening for this frequent comorbidity should now be part of routine testing in all heart failure patients.

State of enteral parallel microbiota in chronic duodenal insuffi ciency

Objective. To study the state of the enteral parietal microbiota and to assess the conjugacy of its changes with motor-evacuation disorder of the gastrointestinal tract (gastrointestinal tract) in chronic duodenal insufficiency.Materials and methods. The study included 40 patients with chronic duodenal insufficiency (CDN). Of these, 21 (52.5%) were women, 19 (47.5%) were men, the average age was 37.1± 13.8 years. CDN was diagnosed using anamnestic and physical data, X-ray and endoscopic examinations, intracavitary manometry. Enzyme immunoassay determined vitamin B12, 25-OH Vitamin D, transferrin. The study of the motor function of the gastrointestinal tract was carried out using the gastroenteromonitor “Gastroscan-GEM”. The method of gas chromatography with mass spectrometry was used to study the enteral wall microbiota.The results of the study. The blood showed a decrease in fat-soluble vitamins B12 and 25-OH vitamin D in relation to control. There was a decrease in the transferrin saturation coefficient (13.2%) compared to the control group (34.7%, p=0.04). Gastroenteromonitoring on the device “Gastroscan-GEM” showed a decrease in the coefficients of rhythmicity in the stomach and DPC in the fasting and postprandial periods. Chromass spectrometric analysis of resident microflora in patients with CDN revealed a significant decrease in Lactobacillus spp 1245.3± 0.21 cl/g x 10^3 and Bifidobacterium spp 1453.2± 0.18cl/g x 10^3 against the background of pronounced growth of bacteria of the genus Clostridium, Eggerthella lenta 412.3± 0.84cl/g x 10^3, Propionibacterium acnes 58.6± 0.32cl /g x 10^3, Propionibacterium freudenreichii 2388.7± 0.62 cl/g x 10^3, Propionibacterium jenseni 146.6±0.32 cl/g x 10^3, Staphylococcus spp 658.4± 0.28 cl/g x 10^3, Streptococcus mutans (anaerobic) 494.3±0.74 cl/g x 10^3, Streptomyces spp. 305.3±0.26 cl/g x 10^3. It was shown that the increased growth of pathogenic microflora was associated with a violation of the rhythm of duodenal motility.Conclusion. In patients with chronic duodenal insufficiency, a pronounced growth of parietal pathogenic microflora was detected, depending on the state of motor activity of the duodenum.

EFFECT OF IRON ON BONE TISSUE METABOLISM AND THYROID FUNCTION IN CHILDREN LIVING ON RADIOLOGICALLY CONTAMINATED TERRITORIES SINCE THE ChNPP ACCIDENT.

To assess the metabolic processes in bone tissue and state of thyroid gland depending on iron metabolism parameters in children of pre-pubertal, pubertal and post-pubertal age, living on radiologically contaminated territories after the ChNPP accident. Children (n = 119) aged 6 to 18 years were examined and the 4 study groups were formed, featuring the childhood, pre-pubertal, pubertal and post-pubertal life periods. Clinical symptoms, iron metabolism parameters (serum iron (SI) and ferritin (SF) content, transferrin saturation coefficient), parameters of bone tissue metabolism (serum creatinine and alkaline phosphatase (APh)), and amino acid content in urine were taken into account. Functional state of thyroid, titers of antibodies to thyroperoxidase (TPOAb) and thyroglobulin (TgAb) were assayed. Results and their discussion are presented depending on the age of children, biochemical parameters of blood, iron metabolism findings, thyroid gland function and individualized radiation doses. In 13.4 % of pubertal and post-pubertal children an elevated content of SI and SF was observed. APh levels were increased in 20.2 % of children (758.9 ± 16.3 U/l) being directly correlated with SI levels (rs = 0.50; р < 0.01). In 16.3 % of children of pubertal and post-pubertal age, in whom the level of SI was above 27 μmol/l, a direct correlation with serum thyroid-stimulating hormone (TSH) level was established in case of the hormone content above 2.5 mU/l (rs = 0.50; р < 0.05). Serum creatinine level directly correlated with glycine content in urine (rs = 0.70), which is a part of collagen, and inversely correlated with serum APh (rs = -0.47), (р < 0.05). Under the levels of SI higher than (15.1 ± 1.2) μmol/l and SF higher than (87.5 ± 6.4) ng/ml, the TPOAb titer was higher than at lower iron concentrations (U-test = 64.5, р < 0.05). The TgAb titer directly correlated with SI (rs = 0.39) and TSH (rs = 0.81) levels (р < 0.01). The average effective radiation dose in children was (0.75 ± 0.10) mSv. A direct correlation was established between the child's radiation dose and age (rs = 0.33; р < 0.05). Bone metabolism depends on the age of children, characteristics of pubertal period, excess of iron in the body, and functional state of thyroid system, which is involved in collagen formation and protein metabolism.

Chronic hepatitis B in children carried out of the hemochromatosis gene HFE

Purpose: to establish the frequency and clinical significance of mutant variations of the HFE gene polymorphism in chronic hepatitis B (CHB) in children with iron overload syndrome (IOS).Materials and methods: 60 children with chronic hepatitis B with iron overload syndrome (IOS) were examined. When distributing children into groups, we took into account the criteria we developed for assessing the degree of life expectancy in children with CHB: CST&gt;0.5 – mild degree of life expectancy (43,3% of children), CST˃0.5 – mild degree of life expectancy (43,3% of children), CST˂0,5 – moderate severity of life expectancy (31,7% of children) and CST˂0,2 – severe degree of SPL (25,0%). Virological verification of HBV was performed by ELISA and PCR. Using PCR Real Time and molecular genetic analysis, HFE gene C282Y, H63D, S65C mutations were detected from amplified DNA using the PRONTO Hemochromatosis reagent kit (Israel). The transferrin saturation coefficient (CST) was calculated using the formula CST = sTfR / log10.Ft. Results:Results: The study of the hemochromatosis gene HFE showed that the overwhelming majority (84,0%) of children with CHB with IOS were carriers of heterozygous, phenotypically different, mutant types. And only 16,0% of sick children were homozites of the wild (normal) HFE gene. Analysis of the phenotypic polymorphism of the hemochromatosis gene HFE revealed the presence of three point heterozygous mutations: H63D, S65C and combined variations in H63D / S65C, the latter of which is associated with severe forms of CHB and severe IOS.Conclusion. Children with CHB with IOS are characterized by a high incidence of heterozygous mutations in the HFE gene, the phenotypic manifestations of which were S65C, H63D, H63D / S65C. The comparability of the heterozygous combined mutation H63D / S65C with severe forms of CHB and a severe degree of IOS gives grounds to consider this phenotype of the HFE gene as a factor in the progression of the disease.

THE MAIN PARAMETERS OF IRON METABOLISM IN PATIENTS WITH UROTELIAL BLADDER CANCER AT DIFFERENT DEVELOPMENT STAGES OF MALIGNANT NEOPLASM ANEMIA

The article presents information about the protein responsible for the iron depot in the body – ferritin. Its physiological role and clinical significance are demonstrated. A batophenanthroline method was used to determine the range of iron in the blood serum and the range of the total iron-binding capacity of the blood serum. The range of unsaturated iron-binding capacity of blood serum was calculated as the difference between total iron-binding capacity in blood serum and the range of iron in blood serum. The transferrin saturation coefficient of iron was defined as the ratio of the content of iron in blood serum to the total iron-binding capacity in blood serum. The range of transferrin was determined by the rate of the total iron-binding capacity in blood serum, and ferritin using the radiometric method. The dynamics of changes in ferritin content in malignant neoplasm anemia in patients with bladder cancer has been demonstrated. The conclusion about the importance of this parameter for laboratory diagnosis of iron deficiency and anemia of malignant neoplasms is made.

Diagnostic and prognostic value of serum hepcidin concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage

The aim of the study was to evaluate the diagnostic and prognostic value of serum hepcidin concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage (SSICH). Materials and methods. Prospective cohort study of 88 patients with acute SSICH receiving the conservative therapy was conducted. Level of neurological deficit was evaluated using the Full Outline of UnResponsiveness Scale, the Glasgow Coma Scale and the National Institute of Health Stroke Scale. Computed tomography was performed to detect an intracerebral hemorrhage volume (ICHV), secondary intraventricular hemorrhage volume (SIVHV) and total volume of intracranial hemorrhage (TVICH). Laboratory blood samples were taken within 24 hours of hospitalization. Hepcidin levels, serum iron concentrations and total iron-binding capacity were determined, followed by calculations of transferrin saturation coefficient. Early neurological deterioration (END) and unfavorable variants of the acute period of SSICH (lethal outcome, modified Rankin score 4-5 on the 21st day of the disease) were considered as endpoints. Statistical processing of the obtained results included a correlation analysis, logistic regression analysis and ROC-analysis. Results. It was identified, that serum hepcidin level in the patients with SSICH was correlated with ICHV (R = 0.44, P ˂ 0.01), SIVHV (R = 0.45, P ˂ 0.01) and TVICH (R = 0.57, P ˂ 0.01). Hepcidin serum concentrations in the patients with ICHV &gt;30 ml exceeded the value of those in cases of ICHV ≤30 ml by 69.0 % (P ˂ 0.0001). Serum levels of hepcidin were significantly higher in the patients with an unfavorable course and outcome of the disease in the acute period on the 1st day of admission (P ˂ 0.0001). Informative multipredictor models were developed via multiple logistic regression analysis, which include hepcidin values coupled with clinical and neurovisualization findings and are predictive of lethal and unfavorable acute period functional outcomes (AUC = 0,93, P ˂ 0.0001). Conclusions. The level of serum hepcidin in patients with acute SSICH is associated with the severity of cerebral lesions. The integration of serum hepcidin concentration with clinical and neuroimaging findings in the structure of multipredictor logistic regression models allows to determine the vital and functional prognosis of the acute period of SSICH with an accuracy of &gt;85 %

Correction of Postoperative Anemia in Patients undergoing Mitral Valve Replacement through Blood Saving Technology

The aim. To investigate anemia of chronic disease (ACD) in patients with mitral valvular disease, to provide preoperative correction in these patients and to determine the level of postoperative anemia after mitral valve replacement (MVR) through blood saving technology (BST) under artificial circulation (AC).Materials and methods. This is a study of 104 patients operated due to acquired mitral heart defects under AC. According to the baseline Hb, Ht, serum iron (SI) as well as the use of BST during MVR, all the patients were divided into 3 groups. Group A included 47 patients with normal Hb concentration, Ht and SI, who underwent the surgical intervention without BST with blood transfusion. Group B included 35 patients without ACD who were operated without blood transfusion with the use of BST. The group C included 22 patients with preoperative ACD with low Hb, Ht, and SI. A week before surgery the patients of group C underwent preoperative correction of SI and erythropoiesis stimulation using erythropoietin. The patients of group C were operated using BST. Preoperative correction of anemia and the use of blood and BST during surgery in groups A, B, C were compared. The effect of preoperative ACD correction and erythropoiesis stimulation on the level of postoperative anemia in patients operated due to mitral heart disease through BST in group C and with or without correction in group B was studied.Results. The presented research results show that in group A, in order to sufficiently stabilize the level of Hb and Ht during the operation, donated blood components (590.0 ± 83.0 ml of packed red blood cells and 563.0 ± 68.0 ml of fresh frozen plasma) were used. The use of BST in the group B reduced the level of Hb by 17.4%, Ht by 15.8%, thrombocyties by 20.5%, and the intervention could be performed without donated blood transfusion. Preoperative correction of SI and administration of erythropoietin in patients with ACD resulted in 8.6-fold increase in SI, 5.5-fold increase in ferritin and increase in Hb by 8.1% before the intervention. The use of BST and hematopoietic technology during MVR in patients of group C stabilized SI, Hb and platelets in the operative period, which facilitates operations under AC without transfusion of donated blood components.Conclusions.1. In patients of group A, donor blood components (590.0 ± 83.0 ml of packed red blood cells and 563.0 ± 68.0 ml of fresh frozen plasma) were used to stabilize Hb and Ht during MVR without the use of BST.2. ACD correction in patients of group C with mitral heart disease has led to a 8.6-fold increase in SI (p˂0.05), increase in transferrin saturation coefficient by 36.8% (p˂0.05), and 5.5-fold increase in ferritin activity (p˂0.05).3. The use of BST in patients of group B undergoing MVR reduces the level of Hb by 17.4% (* p˂0.05) and platelets by 20.5% (* p˂0.05).4. Preoperative correction of SI with iron (III) hydroxide and hemapoiesis stimulation by erythropoietin in patients of group C with MVR using BST reduces anemia by 10.7% and thrombocytopenia by 5%.

The role of lipid peroxidation products in the development of iron deficiency anemia in cytomegalovirus infection in pregnant women of the first trimester

Aim. To establish the role of lipid peroxidation (LPO) products in the development of iron deficiency anemia in pregnant women of the first trimester during exacerbation of cytomegalovirus infection. Materials and methods . A prospective case-control study included 60 women in the first trimester of pregnancy (8-12 weeks), of which 35 were cytomegalovirus-positive with mild iron deficiency anemia (main group) and 25 - cytomegalovirus-seronegative (control group). Antibodies of IgM and IgG to CMV, low avid IgG (avidity index), and serum ferritin concentration were determined by enzyme-linked immunosorbent assay. In order to assess the intensity of LPO processes in blood serum spectrophoto-metric method was used to measure the levels of molecular products of oxidation: diene conjugates and active products of thiobarbituric acid. The concentration of arachidonic acid in blood serum was analyzed by means of the method of capillary gas-liquid chromatography. The concentration of total hemoglobin in red blood cells was measured by photometry. The study of iron metabolism included: evaluation of serum iron by spectrophotometric method, the total iron binding capacity of serum using commercial kits of the company “Lachema” (Czech Republic), transferrin saturation coefficient by means of calculation method. Results . Activation of LPO processes was noted in women of the main group, as evidenced by an increase in the concentration of diene conjugates by 1.54 times (p<0.001), active products of thiobarbituric acid by 2.4 times (p<0.001) and arachidonic acid by 1.3 times (p<0.001) compared with similar indicators of the control group. It has been found that hemoglobin levels were reduced by 1.2 times (p<0.001), serum iron and ferritin, respectively, by 1.4 (p<0.001) and 2 times (p<0.001), in the setting of an increase in the total iron binding capacity of serum while reducing the coefficient of iron saturation with transferrin. Conclusion . The data obtained indicate the important role of LPO products in the pathogenesis of iron deficiency anemia during exacerbation of cytomegalovirus infection in the first trimester of gestation.

Characteristics of the metabolic status of children of the first year of life with protein-energy deficiency depending on the gestational age at birth.

Comparative analysis of energy-plastic exchange indicators in mature and premature children of the first year of life in the development of protein-energy malnutrition (PEM) was carried out. Unidirectional changes are revealed, including an increase in creatinine, lactate and creatine phosphokinase activity levels, suggesting a n increasing muscle mass deficit against the background of glucose anaerobic oxidation activation. In preterm infants, glucose and triacylglicerine levels decrease, which reflects uncompensated insufficiency of energy substrates and, accordingly, ATP level. Multidirectional deviations in metabolism are pyruvate and ATP content: increase in full-term infants and decrease in preterm infants, that should be taken into account when monitoring condition of children with PEM. A significant decrease of pyruvic acid in preterm infants against the background of the levels of total protein, albumin, hemoglobin, and transferrin, not exceeding reference values, can obviously testify to the active use of this integral metabolite to maintain the fund of substituted amino acids. Development of this pathology in both mature and premature infants creates a pre-morbid background for iron deficiency anemia-diagnostic panel, which should be supplemented by calculation of transferrin saturation coefficient. Regardless of gestational age in childbirth during the formation of PEM, the lipid spectrum is rearranged according to atherogenic type: at normal values of total cholesterol, there is a significant increase in low and very low density lipoproteins with an increase in the atherogenicity coefficient. This singles out children with the pathology in question as a risk group for the development of the atherosclerotic process later, which justifies the recommendation to control the lipid profile in children of the first year of life.

Assessment of the Risk of Hemochromatosis in Polytransfused Sickle Cell Patients at the Abidjan Transfusion Therapy Unit

In Cote d'Ivoire, sickle cell disease affects 14% of the population. It is responsible for significant morbidity and mortality. Transfusion is a significant element in the management of major sickle cell anemia, which exposes them to post-transfusion hemochromatosis. The biological diagnosis is based on the determination of serum iron and the transferrin saturation coefficient (CST). As the determination of the CST was not available in our exercise context in Cote d'Ivoire, we determined only the ferritinemia. The interest of this work lies in the therapeutic implication linked to the identification of patients at risk of hemochromatosis because chelators are difficult to access for most patients. This was a prospective, descriptive and analytical study, on polytransfused sickle cell patients, followed at the transfusion therapy unit (UTT) of the CNTS of Abidjan, from 2010 to 2018. We included 78 sickle cell patients, all ages and genders who have received at least ten transfusions. The ferritinemia assay was carried out by ELISA. Transfusion exchange, with 59% of cases, was the most used mode of transfusion. The mean ferritinemia was 1719.19 ng / ml. Hyperferritinemia was found in 63% of patients. Most of the patients were on a long-term transfusion program with an average of 27.5 bags of red blood cell concentrates. Thirty-two patients had received at least 20 bags of red blood cell concentrates. We noted 21 patients treated, including 3 with deferoxamine and 18 treated with oral deferasirox. We have identified 33 sickle cell anemia patients at risk for hemochromatosis. The determinants of the risk of hemochromatosis were the high number of blood bags and the method of transfusion.

Transferrin Saturation Coefficient and Ferritinemia in Diagnosis of Iron Deficiency

Transferrin Saturation Coefficient and Ferritinemia in Diagnosis of Iron Deficiency

What do we learn about the “Anemia Module” of the French language Peritoneal Dialysis ? Interest and Results

Background: Anemia is commonly observed in patients with chronic kidney disease (CKD) as soon as the glomerular filtration rate falls below than 30 ml/min. CKD patients frequently have iron deficiency. The use of both erythropoiesis-stimulating agents (ESA) and iron therapy is the backbone of anemia management in CKD. For this reason, an adequate iron supply is mandatory to achieve the optimal therapeutic benefit of erythropoiesis stimulating agents (ESAs). Many groups agree that anemia in peritoneal dialysis (PD) patients is less severe than in hemodialysis (HD) patients and that there are important differences in treatment practices for anemia between PD and HD patients.&#x0D; Methods: Analysis of the Anemia module of the French Language Peritoneal Dialysis Registry (RDPLF) register from the database set up in 2005 with a study of the period 2010-2017.&#x0D; Results: Data from 568 patients who participated in the Anemia module were analysed during the 2010-2017 follow-up period. Their median age were 71 years, 42% were female, median dialysis vintage was 13 months, 40,5% of patients had diabetes mellitus, 74% of patients were treated with ESA, 23% were on oral iron and only 11% have received intravenous iron. In terms of biological assessment, the average hemoglobin level was close to 12 g/dl and median CRP was close to 5 mg/l. For the iron balance, ferritin reached an average level of 270 µg/l in 2013 and stabilized in 2017 at 200 µg/l. The transferrin saturation coefficient always fluctuated between 23 % and 25 % from year 2010 to year 2017.&#x0D; Conclusion: The results of the Anemia module of RDPLF register appear to be in line with the target values of the ERA-EDTA latest European guideline on anemia (ERBP 2013) and show the low use of intravenous iron in PD (usually as second line therapy).

Evaluation of the Hematological and Biochemical Markers of Iron Metabolism in Pulmonary Multidrug-Resistant Tuberculosis (MDR-TB)

Medical management of Multidrug-Resistant Tuberculosis (MDR-TB) has become a major public health issue. The outbreak of this form of tuberculosis is partly due to anemia observed in patients with (MDR-TB). In order to improve the medical management of these patients, it is therefore necessary to define the characteristics of this anemia. The main objective of this study was to investigate the biochemical and haematological parameters related to the anemia observed in patients with Multi-Drug Resistant Tuberculosis (MDR-TB). Thus, 100 (MDR-TB) patients and 100 non-tuberculous patients as many women than men and between 18 and 55 years of age were selected. The hematological markers were assayed with the Sysmex Kobe automate, Japan, while the biochemical parameters such as ferritin and transferrin were performed using Cobas C311 from Roche Diagnostic, France and as for the serum iron, an Atomic Absorption Spectrometer (AAS) of the Varian Spectr AA-20 Victoria® type, Australia was used. Results showed that 32% of women and 18% of men had mixed (iron deficiency and inflammatory) anemia, while the remaining 68% of women and 82% of men had inflammatory anemia. Keywords: Abidjan; Anemia; MDR-TB; Micronutrients Abbreviations : MCV: Mean Cell Volume; MCHC: Mean Corpuscular Hemoglobin Concentration; RMCH: Rates of Mean Corpuscular Hemoglobin; TBC: Total Iron Binding Capacity; TSC: Transferrin Saturation Coefficient