Effect of Eradication of Helicobacter pylori and Iron Supplementation on the Iron Status of Children with Iron Deficiency

2010 ◽  
Vol 41 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Ximena Duque ◽  
Segundo Moran ◽  
Robertino Mera ◽  
Mayela Medina ◽  
Homero Martinez ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Iron Deficiency ◽  
Iron Supplementation ◽  
Iron Status

scholarly journals A Randomized Controlled Trial of Daily and Weekly Iron Supplementations for Improving Iron Status in the Infants

2021 ◽  
Author(s):  
Nalinee Pattrakornkul ◽  
Parichaya Ngamcherdtrakul ◽  
Warawut Kriangburapa ◽  
Siriporn Tangjaturonrasme ◽  
Ramorn Yampratoom
Keyword(s):  
Randomized Controlled Trial ◽  
Iron Deficiency ◽  
Iron Supplementation ◽  
Iron Status ◽  
Controlled Trial ◽  
Daily Group ◽  
Randomized Controlled ◽  
The Mean ◽  
Mean Differences ◽  
Weekly Group

Abstract Background: Iron deficiency anemia screening and iron supplementation in infants aged 6-12 months are recommended in the Guideline in Child Health Supervision. This study aims to evaluate the effectiveness of weekly iron supplementation compared with daily supplementation in improving the iron status in infants.Methods: A single-blind randomized controlled trial was conducted in infants aged 6 months visiting the Well Child Clinic between May 2019 and November 2020 at Burapha University Hospital, Chonburi, Thailand. The intervention consisted of either daily or weekly iron supplementation combined with iron-rich complementary food promotion for six months. The outcomes were the differences of serum ferritin and hematological variables before and after being iron supplemented. Results: Sixty-nine six-month-old healthy infants were randomized to receive either 10 mg Fe/day (daily group) or 30 mg Fe/week (weekly group). Forty-five infants (daily group; n = 24 and weekly group; n = 21) completed the intervention. After the six-month period of iron supplementation, the mean differences of serum ferritin in the daily and the weekly group were 8.78±37.21 and -13.05 ±17.53 ng/mL, respectively (95%CI: 4.54, 39.12; P=0.015). The mean differences of hemoglobin in the daily and the weekly group were 0.58±0.82 and 0.08±0.59 g/dL, respectively (95%CI: 0.06, 0.93; P=0.026). Daily supplementation could prevent iron deficiency more than weekly supplementation significantly (P=0.029), particularly in the exclusive breastfeeding subgroup (P=0.032).Conclusions: Daily iron supplementation is more effective than weekly iron supplementation in improving iron status and hemoglobin level in infants, especially in the exclusively breast-feds.Trial registration: TCTR20191107001, November 7th, 2019. Retrospectively registered, http://www.thaiclinicaltrials.org

Resolution of Unexplained Iron Deficiency Following Successful Eradication of Helicobacter Pylori in Children

2021 ◽  
Author(s):  
Osama Tanous ◽  
Carina Levin ◽  
Parminder S.Suchdev ◽  
Hanqi Luo ◽  
Firas Rinawi
Keyword(s):  
Helicobacter Pylori ◽  
Iron Deficiency ◽  
Iron Status ◽  
Older Age ◽  
Deficiency Anemia ◽  
Reactive Protein ◽  
Gi Symptoms ◽  
Supplement Therapy ◽  
Upper Gastrointestinal ◽  
Baseline Hemoglobin

Abstract Background: Evidence is needed to inform whether Helicobacter pylori (HP) treatment is beneficial in children with refractory iron deficiency. We aimed to assess association between successful HP eradication and resolution of unexplained iron deficiency. Methods: Medical records of children diagnosed with HP infection (based on histopathology) and without significant upper gastrointestinal source of blood loss, were retrospectively reviewed for presence of iron deficiency. Among those with non-anemic iron deficiency (NAID) or iron deficiency anemia (IDA), hemoglobin, ferritin and C-reactive protein (CRP) levels were compared prior and 6-9 months’ post successful HP eradication. Patients with overt bleeding or subsequent iron supplement therapy post HP diagnosis were excluded. Predictors of resolution of iron deficiency following HP eradication were assessed. Results: Among 60 included children (median age 14.8, IQR12.3-16; 62% males), symptoms of anemia were observed in 20%. A total of 21 (35%) had IDA while the remainder 65% had NAID. Following successful HP eradication, 60% of these 60 patients normalized their iron status. There were significant improvements in both hemoglobin and ferritin following HP eradication with hemoglobin increasing from 12.3g/dL to 13.0 g/dL (P<0.001), and ferritin increasing from 6.3μg/l to 15.1 μg/l (P<0.001). In multivariate logistic regression that assessed sex, ethnicity, baseline hemoglobin, anemia or GI symptoms, previous iron therapy, and time from diagnosis to eradication, older age was the only factor associated with resolution of anemia following HP eradication: (OR 1.65, 95% CI 1.16-2.35, P = 0.005).Conclusion: Successful HP eradication could be helpful in improving iron status among children with refractory NAID or IDA. Older age may predict this outcome. Screening for HP should be considered in the workup of refractory IDA or NAID.

No Difference Between Iron Supplementation Only and Iron Supplementation with Synbiotic Fermented Milk on Iron Status, Growth, and Gut Microbiota Profile in Elementary School Children with Iron Deficiency

2020 ◽  
Vol 16 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Siti Helmyati ◽  
Endang Sutriswati Rahayu ◽  
Bernadette Josephine Istiti Kandarina ◽  
Mohammad Juffrie
Keyword(s):  
Iron Deficiency ◽  
Gut Microbiota ◽  
School Children ◽  
Elementary School Children ◽  
Iron Supplementation ◽  
Iron Status ◽  
Body Height ◽  
Fermented Milk ◽  
The Body ◽  
Iron Deficient

Background: Iron deficiency may inhibit the height increase and weight gain of children. On the other hand, the supplementation of iron causes gut microbiota imbalance which leads to inflammation and diarrhea. The addition of synbiotic fermented milk is expected to have beneficial effects on iron supplementation. This study aimed to determine the effects of iron supplementation only and its administration with synbiotic fermented milk on iron status, body height and weight, and gut microbiota profile of iron deficient elementary school children. Methods: This research was an experimental study with pre and post test conducted on 59 irondeficient children. Subjects were given iron supplementation in syrups (IS group) or given iron supplementation in syrup with fermented milk (containing synbiotic Lactobacillus plantarum Dad 13 and fructo-oligosaccharide) (ISFM group) for 3 months. The body weight and height, hemoglobin and serum ferritin levels, and total number of Lactobacilli, Enterobacteria, Bifidobacteria, and Escherichia coli were measured at the beginning and the end of the study. Results: The body height in the ISFM group increased significantly than that in IS group after the intervention (1.67 vs. 2.42, p<0.05). The hemoglobin and serum ferritin levels in IS and ISFM groups were improved significantly (p<0.05) although the difference between the two groups was not significant (p>0.05). The results showed no significant difference of gut microbiota profile between the IS and ISFM groups (p>0.05). Conclusion: There is no difference on the iron status, height, weight, and gut microbiota profile of iron-deficient primary school children received iron supplementation only or iron supplementation with synbiotic fermented milk.

Effects of Iron Status and Iron Supplementation on Salmonella Typhimurium and Plasmodium Yoelii Infection In Mice

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2052-2052
Author(s):  
Eldad A. Hod ◽  
Eric H. Ekland ◽  
Shruti Sharma ◽  
Boguslaw S. Wojczyk ◽  
David A. Fidock ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Salmonella Typhimurium ◽  
Median Survival ◽  
Iron Supplementation ◽  
Iron Status ◽  
Plasmodium Yoelii ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Iron Deficient ◽  
Deficient Mice

Abstract Abstract 2052 To clarify the interactions between iron status, oral iron supplementation, and bacterial and malarial infections, we examined iron-replete mice and mice with dietary iron deficiency infected with Salmonella typhimurium, Plasmodium yoelii, or both, with and without oral iron administration. These studies were designed to identify potential mechanisms underlying the increased risk of severe illness and death in children in a malaria-endemic region who received routine iron and folic acid supplementation during a randomized, controlled trial in Pemba, Tanzania (Sazawal et al. Lancet 2006;367:133-43). To this end, weanling C57BL/6 female mice were fed an iron-replete or an iron-deficient diet, the latter of which resulted in severe iron deficiency anemia. Groups of mice were then infected by intraperitoneal injection of Salmonella typhimurium strain LT2, Plasmodium yoelii strain 17X parasites, or both. With Salmonella infection alone, iron-deficient mice had a median survival (7.5 days, N=8) approximately half that of iron-replete mice (13 days, N=10, p<0.0001). At death, the mean level of bacteremia was significantly higher in infected iron-deficient mice. In blood cultures performed at death, all iron-deficient mice were bacteremic, but bacteria were detected in only 4 of 10 iron-replete mice. Both iron-deficient and iron-replete Salmonella-infected mice had gross hepatosplenomegaly with hepatitis, distorted hepatic and splenic architecture, massive expansion of the splenic red pulp with inflammatory cells, and Gram-negative bacilli by tissue Gram stain. With P. yoelii infection alone, iron-deficient and iron-replete mice cleared the infection at similar rates (by ~13 days following infection, N=5 in each group) and no deaths due to parasitemia occurred. With Salmonella and P. yoelii co-infection, death was earlier than with Salmonella alone in iron-replete mice (median survival of 10 vs. 13 days; N=10 in each group; p=0.005), but not in iron-deficient mice (median survival of 7 vs. 7.5 days; N=10 and 8, respectively; p=0.8). To examine the effect of short-term oral iron supplementation with Salmonella infection alone, mice received daily iron (ferrous sulfate, 1 mg/kg) by gavage for 4 days before infection with Salmonella, and supplementation continued for a total of 10 days. After gavage, plasma non-transferrin-bound iron (NTBI) appeared at 1–2 hours with a mean peak level of approximately 5 μM. In iron-deficient mice, short-term oral iron supplementation did not fully correct the iron deficiency anemia or replenish iron stores. Oral iron supplementation reduced the median survival of both iron-deficient and iron-replete Salmonella-infected mice by approximately 1 day; the difference was significant only in the iron-replete group (N=5, p<0.05). In summary, these results indicate that iron deficiency decreases the survival of Salmonella-infected mice; the median survival of iron-deficient mice was approximately half that of those that were iron replete. These observations are similar to those in the Pemba sub-study in which iron-deficient children given placebo had a 200% increase in the risk of adverse events relative to iron-replete children. Iron deficiency had no apparent effect on the course of infection with P. yoelii but further studies with more virulent Plasmodium species are needed. Co-infection with Salmonella and Plasmodium significantly increased mortality as compared to single infections, but only in iron-replete mice. Oral iron supplementation of Salmonella-infected mice significantly decreased the median survival, but only of iron-replete animals; however, our study may have had insufficient power to detect an effect on iron-deficient mice. Systematic examination in mice of the effect of iron supplements on the severity of malarial and bacterial infection in iron-replete and iron-deficient states may ultimately help guide the safe and effective use of iron interventions in humans in areas with endemic malaria. Disclosures: No relevant conflicts of interest to declare.

High Prevalence of Iron Deficiency In Anemic and Non Anemic Patients with Various Types of Cancer

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5145-5145
Author(s):  
Heinz Ludwig ◽  
Georg Endler ◽  
Brigitte Klement ◽  
Wolfgang Hüubl ◽  
Tim Cushway
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Multiple Testing ◽  
Serum Iron ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Clinical Symptoms ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Patients With Cancer

Abstract Abstract 5145 Introduction and aims: Iron deficiency as a major component in the pathogenesis of anemia in cancer is not acknowledged by most oncologists, possibly except when arising from GI blood loss. Iron deficiency is associated with clinical symptoms such as cognitive impairment, fatigue, and reduced exercise performance. New iron formulations are available that allow rapid iron supplementation with single infusions. This treatment could ameliorate symptoms of iron deficiency and correct anemia. Here, we studied iron parameters and their correlation with erythropoiesis and inflammatory markers in a large unselected cohort of patients with cancer. In addition, we investigated the suitability of serum ferritin and transferrin saturation (TSAT) as parameter for assessment of the iron status. Patients and methods: Data from 1627 patients (median age: 66.4 years, range: 20–97 years) presenting sequentially at the Center for Oncology and Hematology, Wilhelminenspital, Vienna between October 01, 2009 and January 26, 2010, have retrospectively been analyzed. Patients were at different stages of their disease or may not have had an established diagnosis at the time of testing. In patients with multiple testing during this period only the first sample taken was included. TSAT (n=1516), serum ferritin (n=887), serum iron, CRP, and complete blood count, were determined by using standard techniques. Commonly used definitions for absolute iron deficiency (AID), [TSAT <20% and serum ferritin <30ng/ml, in case serum ferritin was not available TSAT <10%] and for functional iron deficiency (FID), [TSAT <20% and serum ferritin ≥30ng/ml, in case serum ferritin was not available TSAT between 10 and 20%] have been applied. Fisher's exact test was used for comparison of frequencies and Pearson's product moment correlation coefficient for evaluation of correlation. Results: Table 1 shows the distribution of TSAT and serum ferritin categories in 1627 patients with cancer. AID was found in 116 patients (7.7%) of the 1516 patients for whom TSAT was available. Eighty-three (72%) of the AID patients presented with anemia (defined by hemoglobin <12g/dl). AID was most common in patients with colorectal and pancreatic cancer (12% and 11%, respectively), and not present in patients with testicular and prostate cancer (p=0.013). FID was diagnosed in 530 patients (35%) and 222 (42%) of them were found to be also anemic. Multivariate analysis revealed a statistically significant correlation between TSAT and serum ferritin (R=0.286, p<0.001), serum iron (R=0.874, p<0.001), hemoglobin (R=0.201, p<0.001) and CRP (R=-0.205, p<0.001) (figure 1). Serum ferritin, in contrast, did not correlate with serum iron (R=0.051, p=0.132), but correlated with hemoglobin (R=-0.259, p<0.001), TSAT (R=0.286, p<0.001), and CRP (R=0.396, p<0.001). Conclusion: AID (7.7%) and even more so FID (35%) are frequent co-morbidities in patients with various types of cancer. Seventy-two percent of patients with AID and 42% with FID presented with overt anemia. TSAT correlated closely with serum iron and hemoglobin levels and seems to be the preferred parameter for assessment of iron status in patients with chronic diseases often complicated by increased inflammation. Serum ferritin was found to be an inadequate parameter for assessment and monitoring of iron status. As iron deficiency has been linked with various symptoms, the question arises whether iron supplementation would benefit patients with FID without overt anemia. Future studies should evaluate the role of novel intravenous iron preparations in ameliorating the symptoms of iron deficiency with or without anemia. Disclosures: Klement: Vifor Pharma Ltd: Employment. Cushway:Vifor Pharma Ltd.: Employment.

Epoetin Alfa Biosimilar Treatment for Chemotherapy-Induced Anemia in Current Oncology and Hematology Practice: An Iron Supplementation Subanalysis of the Synergy Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3363-3363
Author(s):  
Florian Scotté ◽  
Kamel Laribi ◽  
Christian Gisselbrecht ◽  
Dominique Spaeth ◽  
Emna Kasdaghli ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Iron Deficiency ◽  
Clin Oncol ◽  
Treatment Response ◽  
Research Funding ◽  
Iron Supplementation ◽  
Iron Status ◽  
Epoetin Alfa ◽  
Iv Iron ◽  
Absolute Iron Deficiency

Abstract Background Recommendations on erythropoiesis-stimulating agents (ESAs) for the management of chemotherapy-induced anemia (CIA) are well established (Schrijvers D et al. Ann Oncol 2010;21[suppl 5]:v244-7). Iron supplementation can further improve treatment response of CIA, particularly in the case of iron deficiency (Pedrazzoli P et al. J Clin Oncol 2008;26:1619-25; Auerbach M et al. J Clin Oncol 2004;22:1301-7), but is under-used. Objective To evaluate the effect of epoetin alfa biosimilar, with or without iron, on CIA in current oncology and hematology practice. Methods SYNERGY was an observational, longitudinal, prospective, multicenter study conducted in France, from a representative, random sample of oncologists and hematologists. Patients of these clinicians were aged ≥18 years with solid tumors, lymphoma and/or myeloma and CIA, eligible for treatment with epoetin alfa biosimilar and followed for 12-16 weeks. A subanalysis describing the treatment response to epoetin alfa biosimilar in patients with/without iron supplementation and their target hemoglobin (Hb) levels is presented here. Results Overall, 2167 patients were enrolled by 195 French oncologists/hematologists during June 2012-December 2014. The analysis included 2076 patients, of whom half were male. At inclusion, mean age ± standard deviation (SD) was 67±12 years and 75.7% (n=1517) of patients had a World Health Organization performance status of 0 or 1. Most patients had not received any blood transfusions (90.0%, n=1867) or ESAs (93.1%, n=1932) in the year before the inclusion visit. A total of 31.6% (n=655) patients received iron supplementation, of whom 58.9% (n=386) received intravenous (IV) iron, 40.5% (n=265) had oral iron and 0.6% (n=4) were prescribed both oral and IV iron. An iron status assessment was more common in patients who were given iron supplementation, while over a third of patients who did not have an iron status were prescribed iron (Table). At follow-up, over 70% of patients had a maximum Hb level above 11 g/dL, regardless of iron status (Table). For patients with and without added iron, the mean change in Hb level was 2.26 g/dL and 2.22 g/dL at maximum during the study and 1.71±1.52 g/dL and 1.59±1.60 g/dL at final visit, respectively. Iron status results were used to define patients as having absolute iron deficiency (coefficient of saturation of transferrin [CST] <20% and ferritin <100 μg/100 mL), functional iron deficiency (CST <20% and ferritin ≥100 µg/100 mL) or no deficiency (CST ≥20%). The majority of patients with no iron supplementation had no deficiency compared with a minority of patients with iron supplementation (Table). Patients with absolute iron deficiency given iron supplementation responded better to epoetin alfa biosimilar (increase of ≥1 g/dL since enrollment or increase of ≥2 g/dL, in the absence of transfusion in the 3 previous weeks) than those not given iron supplementation (74.5% vs 65.5%, p=0.403). Similar results were observed for patients with added IV iron. Table 1.Iron supplementationNo iron supplementationIron status assessed; n (%) No Yesn=655 259 (39.5) 396 (60.5)n=1421 743 (52.3) 678 (47.7)Hb levels (g/dL) at inclusion; mean ± SDn=655 9.57±0.7n=1421 9.62±0.7Maximum Hb value (g/dL) reached during study in patients who completed the study; n (%)n=593n=1280≤9 g/dL13 (2.2)16 (1.3)9-11 g/dL157 (26.5)340 (26.5)≥11 g/dL423 (71.4)924 (72.2)Maximum change in Hb value; mean g/dL ± SD, in patients who completed studyn=593 2.22±1.4n=1280 2.26±1.4Association of epoetin alfa biosimilar use* and iron deficiency; n (%)Absolute iron deficiency49 (62.0)30 (38.0)Functional iron deficiency182 (56.5)140 (43.5)No iron deficiency88 (18.6)384 (81.4)Responder to epoetin alfa biosimilar*; n (%)Absolute iron deficiency35 (74.5; p=0.403)19 (65.5)Functional iron deficiency109 (68.1; p=0.958)78 (67.8)No iron deficiency56 (69.1; p=0.489)251 (73.0)*During the first or second chemotherapy cycle after inclusionHb, hemoglobin; SD, standard deviation Conclusions Overall, these results provide real-life evidence that epoetin alfa biosimilar was effective in treating anemia. Iron supplementation improved the response to epoetin alfa biosimilar in patients with an absolute iron deficiency, suggesting that iron status can be used to optimize treatment of patients with CIA with ESAs and iron supplementation. Disclosures Scotté: Hospira SAS: Research Funding. Laribi:Hospira SAS: Research Funding. Gisselbrecht:Bertram Glass: Research Funding; Chugai Pharmaceutical: Research Funding; Baxter: Research Funding; Roche: Consultancy, Research Funding; Hospira SAS: Research Funding. Spaeth:Hospira SAS: Research Funding. Kasdaghli:Hospira: Employment. Albrand:Hospira: Employment. Leutenegger:GECEM: Employment; Hospira SAS: Research Funding. Ray-Coquard:PharmaMar: Consultancy, Other: Paid instructor; Roche: Consultancy, Other: Paid instructor; Amgen: Consultancy, Other: Paid instructor; Hospira SAS: Research Funding.

Serum Transferrin Receptor and Transferrin Receptor-Ferritin Index Identify Healthy Subjects With Subclinical Iron Deficits

Blood ◽  
1998 ◽  
Vol 92 (8) ◽  
pp. 2934-2939 ◽  
Author(s):  
Pauli Suominen ◽  
Kari Punnonen ◽  
Allan Rajamäki ◽  
Kerttu Irjala
Keyword(s):  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Iron Supplementation ◽  
Iron Status ◽  
Serum Transferrin ◽  
Serum Transferrin Receptor ◽  
Iron Deficient ◽  
American Society ◽  
Induced Changes ◽  
Apparently Healthy

Despite the established utility of serum transferrin receptor (sTfR), serum ferritin, and the sTfR/log ferritin ratio (TfR-F Index) in the diagnosis of iron deficiency (ID) anemia, the numeric values of these parameters, which are indicative of subclinical ID, remain to be clearly defined. In this study, 65 apparently healthy nonanemic adults (22 men and 43 women) were treated with 3 months of oral iron supplementation to evaluate its effect on parameters reflecting iron status and to determine the prevalence of subclinical iron deficiency in apparently healthy adults. Significant supplementation-induced changes were observed in sTfR, ferritin, and TfR-F Index values in women, whereas in men, none of the studied parameters showed any significant change. Iron-deficient erythropoiesis (IDE) was not observed in men, but was found in 17 women (40%). Although individuals with a compromised iron status may be represented in substantial numbers in conventional reference populations, they can be readily identified using sTfR, ferritin, and TfR-F Index determinations. © 1998 by The American Society of Hematology.

scholarly journals Justification of Universal Iron Supplementation for Infants 6-12 months in Regions with a High Prevalence of Thalassemia

2021 ◽  
Author(s):  
Phakatip Sinlapamongkolkul ◽  
Pacharapan Surapolchai ◽  
Vip Viprakasit
Keyword(s):  
Iron Deficiency ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Iron Status ◽  
Transferrin Saturation ◽  
University Hospital ◽  
Deficiency Anemia ◽  
Increased Risk ◽  
Thalassemia Minor ◽  
Hb E

Abstract Background Many clinicians hesitate adopting a universal infant iron supplementation program due to the risk of increased iron absorption for those with thalassemia. We aimed to determine thalassemia prevalence in 6- to 12-month old infants, along with the iron status of those with and without thalassemia. Procedures: We performed a cross-sectional descriptive study of infants attending the Well Baby Clinic at Thammasat University Hospital for routine checkups. Complete blood count, hemoglobin electrophoresis, iron parameters, and molecular genetics for common α- and β-thalassemia were evaluated. Results Overall, 97 of 206 (47%) participants had thalassemia minor, the majority having Hb E traits. None had thalassemia intermedia or major. Familial history of anemia or thalassemia presented an increased risk of detecting thalassemia minor in offspring (OR 5.18; 95% CI 2.60-10.33, p = 0.001). There were no statistical differences in transferrin saturation, serum ferritin and hepcidin between iron-replete infants with thalassemia minor and those without. However, one-third of infants with thalassemia minor (31/97) also had iron deficiency anemia (IDA), with a similar risk of having iron deficiency to infants without thalassemia. There was no hepcidin suppression in our infants with thalassemia minor as compared to controls. Conclusions Both thalassemia and IDA are endemic to Southeast Asia. Infants with thalassemia minor, particularly with Hb E and α-thalassemia traits, are at risk of IDA. Our short-term universal iron supplementation program for 6 to 12-month old infants does not appear to increase the risk of those with thalassemia minor developing iron overload in the future.

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