115 Prognostic significance of iron deficiency status in chronic inflammatory cardiomyopathy

Abstract Aims Iron deficiency (ID) and associated anaemia (IDA) represent major comorbidities in chronic diseases. However, their prevalence and prognostic significance have never been investigated in chronic inflammatory cardiomyopathy (CIC). Methods and results This is a single-centre, prospective study, on consecutive adult patients with CIC (symptom onset > 3 months, endomyocardial biopsy-proven chronic myocarditis) undergoing iron status assessment (enrollment: January 2014–January 2019). ID was defined as either serum ferritin < 100 µg/l or transferrin saturation < 20%. IDA was defined as haemoglobin < 12 g/dl in women, < 13 g/dl in men. The primary endpoint was the occurrence of heart failure events (HFE) and/or arrhythmic events (AE). The study cohort is composed by 219 CIC patients (mean age 46 ± 15 y, 71% males, mean LVEF 50 ± 14%). Diagnosis was furtherly supported by cardiac magnetic resonance in 194 cases (89%). Baseline characteristics of patients with IDA (n = 48), ID (n = 70), and non-ID controls (n = 101) were largely comparable. We found that median in-hospital stay length was 13 days (IQR: 6–20) in IDA patients vs. 8 (IQR: 5–11) in the remaining groups (P = 0.002), and was inversely correlated with haemoglobin values on admission. By 3.9 ± 1.8 year prospective follow-up, events occurred in 86 patients (39%). For the composite endpoint, the only factors associated with events were ID status (HR: 6.3, 95% CI: 2.1–19.5, P = 0.001) and male gender (HR: 5.4, 95% CI: 1.2–24.9, P = 0.030). In detail, HFE occurred in 48 patients (40/118 IDA or ID vs. 8/101 controls, P < 0.001), and AE in 51 (34/118 IDA or ID vs. 17/101 controls, P = 0.039). All cardiac deaths (n = 7) occurred in ID or IDA patients (P = 0.016; n = 1 and 6, respectively). Conclusions ID and IDA are common among CIC patients, and may bare a negative prognostic value. Our findings suggest a careful evaluation of haemoglobin levels and iron status, and call for further investigation on both pathophysiological and prognostic implications of ID and IDA among CIC patients.

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Iron status of adolescent girls from two boarding schools in southern Benin

Public Health Nutrition ◽

10.1017/s1368980008001833 ◽

2008 ◽

Vol 11 (7) ◽

pp. 737-746 ◽

Cited By ~ 9

Author(s):

Halimatou Alaofè ◽

John Zee ◽

Romain Dossa ◽

Huguette Turgeon O’Brien

Keyword(s):

Iron Deficiency ◽

Vitamin C ◽

Adolescent Girls ◽

Binding Capacity ◽

Iron Status ◽

Transferrin Saturation ◽

Meat Consumption ◽

Boarding Schools ◽

Important Health ◽

Iron Binding Capacity

AbstractIron deficiency (ID) is the most prevalent micronutrient deficiency in the world, particularly in developing countries. Blood samples and a qualitative FFQ on Fe- and vitamin C-rich foods were obtained in 180 adolescent girls aged 12 to 17 years living in two boarding schools from south Benin. ID, defined as serum ferritin either <20μg/l or 20–50μg/l, plus two of the following parameters: serum Fe<11μmol/l, total iron-binding capacity>73μmol/l or transferrin saturation<20%, was found in 32% of subjects. Anaemia (Hb<120g/l) was found in 51% of adolescents, while 24% suffered from iron-deficiency anaemia (IDA) (ID and Hb<20g/l). After adjusting for confounding factors (age, mother's and father's occupation, household size) in a logistic regression equation, subjects having a low meat consumption (beef, mutton, pork) (<4 times/week) were more than twice as likely to suffer from ID (OR=2·43; 95% CI 1·72, 3·35;P=0·04). Adolescents consuming less fruits (<4 times/week) also had a higher likelihood of suffering from ID (OR=1·53; 95% CI 1·31, 2·80;P=0·03). Finally, subjects whose meat consumption was low were twice as likely to suffer from IDA (OR=2·24; 95% CI 1·01, 4·96;P=0·04). The prevalence of ID represents an important health problem in these Beninese adolescent girls. A higher consumption of Fe-rich foods and of promoters of Fe absorption (meat factor and vitamin C) is recommended to prevent ID deficiency in these subjects.

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Monitoring of iron status in patients with heart failure

European Heart Journal Supplements ◽

10.1093/eurheartj/suz231 ◽

2019 ◽

Vol 21 (Supplement_M) ◽

pp. M32-M35 ◽

Cited By ~ 2

Author(s):

Ewa A Jankowska ◽

Michał Tkaczyszyn ◽

Marcin Drozd ◽

Piotr Ponikowski

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Serum Ferritin Level ◽

Iron Status ◽

Ferritin Level ◽

Transferrin Saturation ◽

Intravenous Iron ◽

Accurate Method ◽

Separate Entity ◽

Patients With Heart Failure

Abstract The 2016 ESC/HFA heart failure (HF) guidelines emphasize the importance of identifying and treating iron deficiency (ID) in patients with HF. Iron deficiency can occur in half or more of HF sufferers, depending on age and the phase of the disease. Iron deficiency can be a cause of anaemia, but it is also common even without anaemia, meaning that ID is a separate entity, which should be screened for within the HF population. Although assessment of iron stores in bone marrow samples is the most accurate method to investigate iron status, it is not practical in most HF patients. Levels of circulating iron biomarkers are an easily available alternative; especially, ferritin and transferrin saturation (Tsat). In patients with HF serum ferritin level <100 µg/L (regardless of Tsat value) or between 100 and 299 µg/L with Tsat <20% are considered as recommended criteria for the diagnosis of ID, criteria which have been used in the clinical trials in HF that have led to a recommendation to treat ID with intravenous iron. We discuss the optimal measures of iron biomarkers in patients with HF in order to screen and monitor iron status and introduce some novel ways to assess iron status.

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Prevalence and pattern of Iron deficiency in patient with heart failure with reduced ejection fraction

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v7i2.30689 ◽

2019 ◽

Vol 7 (2) ◽

pp. 10-16

Author(s):

Aditya Mahaseth ◽

Jay Narayan Shah ◽

Bikash Nepal ◽

Biplave Karki ◽

Jeet Ghimire ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Ejection Fraction ◽

Serum Ferritin ◽

Iron Status ◽

Transferrin Saturation ◽

Functional Iron Deficiency ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Absolute Iron Deficiency

Background and Objectives: Iron Deficiency is the commonest nutritional deficiency worldwide, affecting more than one-third of the population, its association with Heart Failure with or without anemia is of growing interest. As iron supplementation improves prognosis in patients with Heart Failure, Iron Deficiency is an attractive therapeutic target – a hypothesis that has recently been tested in clinical studies. This study is designed to estimate the prevalence and pattern of iron deficiency (ID) in heart failure (HF) with reduced ejection fraction patients with or without anemia. Material and methods: It was a single center hospital based cross sectional observational study. A total of 60 male and female patients with diagnosis of heart failure based on the Framingham Criteria, who gave consent for the study were included. They underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin saturation percentage, serum ferritin, total iron binding capacity. Serum ferritin <100 μg/l was used to diagnose absolute ID. Functional ID was defined as a serum ferritin level of 100–300 μg/l and a transferrin saturation of <20 %. Anemia was defined as hemoglobin (Hb) <13 g/dl for males and <12 g/dl for females, based on World Health Organization definition. Results: Using the above definitions iron deficiency was found in 28 (46.67%) patients. 36.67% patients had absolute iron deficiency and 10% patients had functional iron deficiency. Females had a higher non statistically significant iron deficiency than males 63.16% vs 39.02%. 15 patients (48.38%) with iron deficiency did not have anemia, and 11 (35.5%) of those patients had absolute iron deficiency. Conclusion: Iron deficiency is prevalent in patients with heart failure and reduced ejection fraction irrespective of anemia and hemoglobin levels. Many of those patients can have functional iron deficiency. Measurement of iron status should be a routine during workup of heart failure patients and further studies are needed to determine the prognostic value of iron status measurement and the influences of treatment of iron deficiency in heart failure patients. Many such trials are now underway.

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Increased Serum Transferrin Saturation Is Associated with Lower Serum Transferrin Receptor Concentration

Clinical Chemistry ◽

10.1093/clinchem/45.12.2191 ◽

1999 ◽

Vol 45 (12) ◽

pp. 2191-2199 ◽

Cited By ~ 16

Author(s):

Anne C Looker ◽

Mark Loyevsky ◽

Victor R Gordeuk

Keyword(s):

Iron Deficiency ◽

Iron Overload ◽

Transferrin Receptor ◽

Iron Status ◽

Transferrin Saturation ◽

Reference Interval ◽

Serum Transferrin ◽

Reactive Protein ◽

Serum Transferrin Receptor ◽

Health And Nutrition

Abstract Background: Serum transferrin receptor (sTfR) concentrations are increased in iron deficiency. We wished to examine whether they are decreased in the presence of potential iron-loading conditions, as reflected by increased transferrin saturation (TS) on a single occasion. Methods: We compared sTfR concentrations between 570 controls with normal iron status and 189 cases with increased serum TS on a single occasion; these latter individuals may be potential cases of iron overload. Cases and controls were selected from adults who had been examined in the third National Health and Nutrition Examination Survey (1988–1994) and for whom excess sera were available to perform sTfR measurements after the survey’s completion. Increased TS was defined as >60% for men and >55% for women; normal iron status was defined as having no evidence of iron deficiency, iron overload, or inflammation indicated by serum ferritin, TS, erythrocyte protoporphyrin, and C-reactive protein. Results: Mean sTfR and mean log sTfR:ferritin were ∼10% and 24% lower, respectively, in cases than in controls (P <0.002). Cases were significantly more likely to have an sTfR value <2.9 mg/L, the lower limit of the reference interval, than were controls (odds ratio = 1.8; 95% confidence interval, 1.04–2.37). Conclusion: Our results support previous studies that suggested that sTfR may be useful for assessing high iron status in populations.

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Impact of Iron Status on Thyroid Function: A Community Based Cross-Sectional Study in Eastern Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v15i1.21022 ◽

2019 ◽

Vol 15 (1) ◽

pp. 18-21 ◽

Cited By ~ 1

Author(s):

Saroj Thapa ◽

Madhab Lamsal ◽

Sanjay Kumar Sah ◽

Rajendra Kumar Chaudhari ◽

Basanta Gelal ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Status ◽

Transferrin Saturation ◽

Cross Sectional Study ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Hormone Profile ◽

Iron Deficient ◽

The Mean

Background: Iron deficiency is the most common nutritional deficiency in the world. The relation between thyroid hormones and iron status is bidirectional. The aim of this study was to assess iron nutrition status and evaluate its relationship with thyroid hormone profile among children of Eastern Nepal. Methods: A community based cross-sectional study was conducted in eastern Nepal. A total of 200 school children aged 6-12 years were recruited after taking informed consent from their guardians. Blood samples were collected and assayed for free thyroid hormones (fT3 and fT4), thyroid stimulating hormone (TSH), serum iron, total iron binding capacity (TIBC) concentration and percentage transferrin saturation was calculated. Results: The mean serum iron and TIBC was 74.04 µg/dl and 389.38 µg/dl respectively. The median transferring saturation was 19.21%. The overall prevalence of iron deficiency (Transferrin saturation < 16%) was 34% (n=68). The mean concentration of fT3 and fT4 was 2.87 pg/ml and 1.21 ng/dl respectively, while the median TSH concentration was 3.03 mIU/L. Median TSH concentration in iron deficient group (3.11 µg/dl) and iron sufficient group (2.91 µg/dl) was not significantly different. Among iron deficient children 5.9% had subclinical hypothyroidism (n=4). Iron status indicators were not significantly correlated with thyroid profile parameters in the study population. Conclusions: The prevalence of iron deficiency is high and iron deficiency does not significantly alter the thyroid hormone profile in the study region.

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Iron Status in Hypogammaglobulinemia

Journal of the Royal Society of Medicine ◽

10.1177/014107688507801009 ◽

1985 ◽

Vol 78 (10) ◽

pp. 838-841

Author(s):

Hasan I Atrah

Keyword(s):

Iron Deficiency ◽

General Population ◽

Intravenous Immunoglobulin ◽

Serum Ferritin ◽

Iron Status ◽

Transferrin Saturation ◽

The State ◽

Serum Samples ◽

Serum Igg

Iron, transferrin and ferritin were measured in serum samples from 16 patients with primary hypogammaglobulinemia. Transferrin saturation was low in 12 patients (75%) and serum ferritin was low in 9 patients (56.25%). Both parameters were low, confirming the state of iron deficiency, in 6 patients (37.5%). These figures are highly significant ( P < 0.01) when compared with the prevalence of iron deficiency in the general population. Eight patients were maintained on intravenous immunoglobulin infusions and the rest on intramuscular immunoglobulin injections, their mean serum IgG being 4.4 g/l and 2.6 g/l respectively. There was no difference in the prevalence of iron deficiency between the two groups.

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Evaluation of the iron status of a population

Blood ◽

10.1182/blood.v48.3.449.449 ◽

1976 ◽

Vol 48 (3) ◽

pp. 449-455 ◽

Cited By ~ 293

Author(s):

JD Cook ◽

CA Finch ◽

NJ Smith

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Status ◽

Transferrin Saturation ◽

Red Cell ◽

Adult Males ◽

Packed Red Blood Cells ◽

Iron Deficient ◽

Menstruating Women ◽

Prevalence Of Anemia

Abstract The iron status of a population of 1564 subjects living in the northwestern United States was evaluated by measurements of transferrin saturation, red cell protoporphyrin, and serum ferritin. The frequency distribution of these parameters showed no distinct separation between normal and iron-deficient subjects. When only one of these three parameters was abnormal (transferrin saturation below 15%, red cell protoporphyrin above 100 mug/ml packed red blood cells, serum ferritin below 12 ng/ml), the prevalence of anemia was only slightly greater (10.9%) than in the entire sample (8.3%). The prevalence of anemia was increased to 28% in individuals with two or more abnormal parameters, and to 63% when all three parameters were abnormal. As defined by the presence of at least two abnormal parameters, the prevalence of iron deficiency in various populations separated on the basis of age and sex ranged from 3% in adolescent and adult males to 20% in menstruating women. It is concluded that the accuracy of detecting iron deficiency in population surveys can be substantially improved by employing a battery of laboratory measurements of the iron status.

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Inherited microcytic anemias

Hematology ◽

10.1182/hematology.2020000158 ◽

2020 ◽

Vol 2020 (1) ◽

pp. 465-470

Author(s):

Maria Domenica Cappellini ◽

Roberta Russo ◽

Immacolata Andolfo ◽

Achille Iolascon

Keyword(s):

Iron Deficiency ◽

Blood Cell ◽

Iron Metabolism ◽

Red Blood Cell ◽

Iron Status ◽

Transferrin Saturation ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Mean Corpuscular Hemoglobin ◽

Distribution Width

Abstract Inherited microcytic anemias can be broadly classified into 3 subgroups: (1) defects in globin chains (hemoglobinopathies or thalassemias), (2) defects in heme synthesis, and (3) defects in iron availability or iron acquisition by the erythroid precursors. These conditions are characterized by a decreased availability of hemoglobin (Hb) components (globins, iron, and heme) that in turn causes a reduced Hb content in red cell precursors with subsequent delayed erythroid differentiation. Iron metabolism alterations remain central to the diagnosis of microcytic anemia, and, in general, the iron status has to be evaluated in cases of microcytosis. Besides the very common microcytic anemia due to acquired iron deficiency, a range of hereditary abnormalities that result in actual or functional iron deficiency are now being recognized. Atransferrinemia, DMT1 deficiency, ferroportin disease, and iron-refractory iron deficiency anemia are hereditary disorders due to iron metabolism abnormalities, some of which are associated with iron overload. Because causes of microcytosis other than iron deficiency should be considered, it is important to evaluate several other red blood cell and iron parameters in patients with a reduced mean corpuscular volume (MCV), including mean corpuscular hemoglobin, red blood cell distribution width, reticulocyte hemoglobin content, serum iron and serum ferritin levels, total iron-binding capacity, transferrin saturation, hemoglobin electrophoresis, and sometimes reticulocyte count. From the epidemiological perspective, hemoglobinopathies/thalassemias are the most common forms of hereditary microcytic anemia, ranging from inconsequential changes in MCV to severe anemia syndromes.

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Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

Open Heart ◽

10.1136/openhrt-2018-000901 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000901

Author(s):

Anette Borger Kvaslerud ◽

Amjad Iqbal Hussain ◽

Andreas Auensen ◽

Thor Ueland ◽

Annika E Michelsen ◽

...

Keyword(s):

Iron Deficiency ◽

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Iron Status ◽

Transferrin Saturation ◽

Short Term ◽

Prognostic Implication ◽

Wide Range ◽

One Year

ObjectiveThe aim of this study was to evaluate the prevalence and prognostic implication of iron deficiency (ID) and anaemia in patients with severe aortic stenosis (AS).MethodsIn an observational study of consecutive patients referred for aortic valve replacement (AVR), we assessed a wide range of biomarkers of iron status, including the definition of ID commonly applied in patients with chronic heart failure (ferritin <100 µg/L or ferritin 100–299 µg/L with a transferrin saturation <20%). The endpoints were short-term (one-year) and long-term (median 4.7 years, IQR: 3.8–5.5) mortality and major adverse cardiovascular events (MACE) within the first year after inclusion.Results464 patients were included in this substudy. 91 patients (20%) received conservative treatment and 373 patients (80%) received AVR. ID was detected in 246 patients (53%). 94 patients (20%) had anaemia. Patients with ID had an overall worse clinical profile than patients without ID. During follow-up, 129 patients (28%) died. Neither ID as defined above, soluble transferrin receptor nor hepcidin were associated with short-term or long-term mortality or MACE independent on treatment allocation. Anaemia was associated with one-year mortality in conservatively treated patients.ConclusionsID and anaemia are prevalent in patients with severe AS. In our cohort, ID did not provide independent prognostic information on top of conventional risk factors. More studies are required to determine how to correctly diagnose ID in patients with AS.Trial registration numberNCT01794832.

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Serum Soluble Transferrin Receptor in Heterozygous β-Thalassaemia: Application in the Diagnosis of Iron Deficiency and as Hematologic Marker of Erythroid Activity According to Thalassaemic Genotypes (β0 vs β+).

Blood ◽

10.1182/blood.v108.11.3828.3828 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3828-3828

Author(s):

Jose Manuel Calvo-Villas ◽

María Francisca Zapata ◽

Ivan Alvarez ◽

Silvia de la Iglesia ◽

Jorge Cuesta ◽

...

Keyword(s):

Iron Deficiency ◽

Transferrin Receptor ◽

Biochemical Parameters ◽

Iron Status ◽

Direct Sequencing ◽

Saturation Index ◽

Transferrin Saturation ◽

Soluble Transferrin Receptor ◽

Iron Deficient ◽

Significant Difference

Abstract Although an increased level of serum soluble transferrin receptor (sTfR) have been found in both heterozygous β-thalassaemia patients with iron deficiency and in those with more severe genotype (β0), it is not a useful marker of iron deficiency status associated to β-thalassaemia. The aim of this study was to analyse the use of two biochemical parameters (sTfR and sTfR/log of ferritin ratio) to determine the iron status and to evaluate the degree of erythropoietic activity in a group of 221 β-thalassaemic heterozigotes patients (155 β0 and 66 β+). Serum ferritin and transferrin saturation index were measured in order to establish the iron status. Of the whole group, 51 patients were iron defficient (βthal-ID) while the remaining 170 were iron sufficient (βthal-IS). Based on the combination of β-thalassaemia genotype and iron status, patients were classified into four subgroups: β0thalassaemia and iron-sufficient (β0thal-IS) (n=124); β0thalassaemia and iron-deficient (β0thal-ID) (n=31); β+thalassaemia and iron-sufficient (β+thal-IS) (n=46); β+thalassaemia and iron-deficient (β+thal-ID) (n=20). 258 healthy and 56 iron-deficient individuals were used as controls. All the haematological parameters were measured by using analyzer Coulter® GEN-S™. Haemoglobins A2 (Hb A2) and F (HbF) were analysed by high performance liquid chromatography and molecular analysis was performed by real-time PCR and direct sequencing techniques. Chemical, inmunoturbidimetrical and nephelometric methods were used to measure iron status as well as sTfR. Comparison of haemalogical and biochemical parameters between subgroups was performed by using the t-student test and correlation analysis was calculated by using least-squares regression model. Mean sTfR level obtained was 2.63 ± 0.8 mg/dL and 2.57 ± 1.1 mg/dL in βthal-ID and βthal-IS patients respectively (p=0.783). Soluble transferrin receptor showed a positive correlation with HbA2, HbF and reticulocyte count values in βthal-IS patients (r=0.208 [p<0.05], r=0.440 [p<0.0001] and r=0.393 [p<0.00001] respectively) while it did not reach a significant correlation in βthal-ID patients. Mean sTfR/log sFt ratio was 2.75 ± 1.6 and 1.34 ± 0.5 in βthal-ID and βthal-IS patients (p<0.001). Interestingly, sTfR level was significantly higher in β0thal-IS patients when compared with β+thal-IS patients (2.76 ± 0.9 vs 1.42 ± 0.4) (p<0.001) as a result of an increased globin chains imbalance related to the β0 genotype. In the other hand, in the comparison between β0thal-ID and β+thal-ID subgroups neither sTfr level (2.71 ± 0.7 vs 2.40 ± 1.1) (p=0.417) nor sTfR/log sFt ratio (2.93 ± 1.7 vs 2.24 ± 1.3) (p=0.371) showed significant difference. In summary, sTfR/log sFt ratio is a valid parameter for diagnosis of iron deficiency associated to heterozygous β-thalassaemia. Unlike the findings observed in β-thalassaemic heterozigotes with normal iron status, sTfR level is not useful to evaluate the genotype severity in those with iron deficiency. Consequently, iron status should be determined before using sTfR as a parameter to provide a reliable estimation of the ineffective erythropoiesis related to the severity of β-thalassaemia genotypes.

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