scholarly journals Hepcidin and conventional markers to detect iron deficiency in severely anaemic HIV-infected patients in Malawi

2019 ◽  
Author(s):  
Minke HW Huibers ◽  
Job C Calis ◽  
Theresa J Allain ◽  
Sarah E. Coupland ◽  
Chimota Phiri ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Supplementation ◽  
Haemoglobin Concentration ◽  
Area Under The Curve ◽  
Severe Anaemia ◽  
Middle Income ◽  
Middle Income Countries ◽  
Bone Marrow Iron ◽  
Roc Area ◽  
Queen Elizabeth Central Hospital

AbstractIntroductionIron deficiency is a treatable cause of severe anaemia in low-and-middle-income-countries (LMIC). Diagnosing it remains challenging as peripheral blood markers poorly reflect bone-marrow iron deficiency (BM-ID), especially in the context of HIV-infection.MethodsSevere anaemic (haemoglobin ≤70g/l) HIV-infected adults were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. BM-ID was evaluated. Accuracy of blood markers including hepcidin alongside mean corpuscular volume, mean cellular haemoglobin concentration, serum iron, serum ferritin, soluble transferrin receptor (sTfR), sTfR -index, sTfR–ratio to detect BM-ID was valued by ROC area under the curve (AUCROC).ResultsSeventy-three patients were enrolled and 35 (48.0%) had BM-ID. Hepcidin and MCV performed best; AUCROCof 0.593 and 0.545. Other markers performed poorly (ROC<0.5). The AUCROCof hepcidin in males was 0.767 (sensitivity 80%, specificity 78%) and in women 0.490 (sensitivity 60%, specificity 61%).ConclusionBM-ID deficiency was common in severely anaemic HIV-infected patients and is an important and potential treatable contributor to severe anaemia. Hepcidin was the best, though still suboptimal, marker of BM-ID. Hepcidin, which is directly linked to iron absorption, is a very promising marker to guide curative iron supplementation policies in severely anaemic HIV-infected patients.

scholarly journals Control of iron deficiency anemia in low- and middle-income countries

Blood ◽  
2013 ◽  
Vol 121 (14) ◽  
pp. 2607-2617 ◽  
Author(s):  
Sant-Rayn Pasricha ◽  
Hal Drakesmith ◽  
James Black ◽  
David Hipgrave ◽  
Beverley-Ann Biggs
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Supplementation ◽  
World Health ◽  
Scientific Development ◽  
Deficiency Anemia ◽  
Current Evidence ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Despite worldwide economic and scientific development, more than a quarter of the world’s population remains anemic, and about half of this burden is a result of iron deficiency anemia (IDA). IDA is most prevalent among preschool children and women. Among women, iron supplementation improves physical and cognitive performance, work productivity, and well-being, and iron during pregnancy improves maternal, neonatal, infant, and even long-term child outcomes. Among children, iron may improve cognitive, psychomotor, and physical development, but the evidence for this is more limited. Strategies to control IDA include daily and intermittent iron supplementation, home fortification with micronutrient powders, fortification of staple foods and condiments, and activities to improve food security and dietary diversity. The safety of routine iron supplementation in settings where infectious diseases, particularly malaria, are endemic remains uncertain. The World Health Organization is revising global guidelines for controlling IDA. Implementation of anemia control programs in developing countries requires careful baseline epidemiologic evaluation, selection of appropriate interventions that suit the population, and ongoing monitoring to ensure safety and effectiveness. This review provides an overview and an approach for the implementation of public health interventions for controlling IDA in low- and middle-income countries, with an emphasis on current evidence-based recommendations.

scholarly journals Prevalence and determinants of anaemia among children aged 0–59 months in a rural region of Armenia: a case–control study

2015 ◽  
Vol 19 (7) ◽  
pp. 1260-1269 ◽  
Author(s):  
Anahit Demirchyan ◽  
Varduhi Petrosyan ◽  
Viktoria Sargsyan ◽  
Kim Hekimian
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Regression Models ◽  
Severe Anaemia ◽  
Linear Regression Models ◽  
Middle Income ◽  
Middle Income Countries ◽  
Daily Diet ◽  
Younger Age ◽  
Low Middle Income Countries

AbstractObjectiveDespite the trend of increasing prevalence of childhood anaemia in Armenia, no studies exploring its risk factors have been conducted in the country. The present study aimed to investigate the prevalence and determinants of childhood anaemia in rural Armenia.DesignBlood Hb level was measured among a representative sample of children using the HemoCue Hb201+ analyser. The revealed cases with anaemia were compared with randomly selected non-anaemic controls. Mothers of cases and controls were interviewed. Logistic and linear regression models were fitted to identify the risk factors of anaemia and low Hb level, respectively.SettingTalin communities, Aragatsotn Province, Armenia.SubjectsChildren under 5 years of age in Talin region.ResultsOf the 729 studied children, 32·4 % were anaemic with 14·7 % having moderate/severe anaemia. Infants were the most affected group with 51·1 % being anaemic before 6 months and 67·9 % at 6–12 months of age. Fitted regression models identified the following predictors of anaemia: younger age, male gender, shorter birth length, anaemia during pregnancy, lower meal frequency per day, lack of meat in the diet, using dung cakes for heating and living in a community that received an incomplete set of nutrition interventions.ConclusionsThe study identified several modifiable risk factors that could be targeted to reduce childhood anaemia in rural Armenia and, possibly, in rural areas in other low-/middle-income countries. The suggested interventions include prevention and treatment of anaemia during pregnancy, provision of adequate complementary feeding to children with inclusion of meat in their daily diet and reduction of their exposure to biomass fuel smoke.

Iron Supplementation for Infants

PEDIATRICS ◽  
1976 ◽  
Vol 58 (5) ◽  
pp. 765-768 ◽  
Author(s):  
Keyword(s):  
Iron Deficiency ◽  
Animal Studies ◽  
Iron Supplementation ◽  
Low Birthweight ◽  
Economic Status ◽  
Human Infant ◽  
Deficiency Anemia ◽  
Term Infants ◽  
Middle Income ◽  
Lower Socioeconomic

Iron deficiency remains the most common cause of anemia in infants and children despite the increasing availability of iron-fortified foods during the past three decades. The Committee on Nutrition published a review in 1969 of the iron requirements for infants, along with recommendations for several ways of meeting these.1 In 1971, the Committee issued another statement recommending the use of iron-fortified formulas until at least 12 months of age.2 Developments since that time indicate that there are various means for fulfilling iron needs and that a broader set of recommendations is warranted. The risk of iron deficiency is greatest when neonatal iron stores have been depleted, after about two months in small, preterm infants and after four to six months in term infants.3 Previous Committee statements have made no distinction between socioeconomic groups, but recent surveys among infants and children4-6 indicate that the highest incidence of anemia, which is a late manifestation of iron deficiency, is found in lower socioeconomic populations. Possibly this reflects poor compliance with recommended feeding practices and overdependence on fresh cow's milk in the diet. Most children in middle-income families have little or no anemia.5,6 Infants of low birthweight are more likely to develop iron deficiency regardless of economic status.1 Thus, recommendations for iron supplementation in infancy must be flexible and should emphasize the needs of low-birthweight infants and of normal-birthweight infants in lower socioeconomic populations. Although there is no evidence that iron deficiency without anemia has a permanent effect on human infant growth and development, animal studies indicate that iron deficiency anemia early in postnatal development results in biochemical abnormalities of some organs (e.g., the brain) that persist long after anemia has been corrected.7

scholarly journals Anaemia and iron deficiency during pregnancy in rural Bangladesh

2004 ◽  
Vol 7 (8) ◽  
pp. 1065-1070 ◽  
Author(s):  
SM Ziauddin Hyder ◽  
Lars-Åke Persson ◽  
Mushtaque Chowdhury ◽  
Bo Lönnerdal ◽  
Eva-Charlotte Ekström
Keyword(s):  
Iron Deficiency ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Economic Status ◽  
Venous Blood ◽  
Haemoglobin Concentration ◽  
Severe Anaemia ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cross Sectional Survey ◽  
Cross Sectional

AbstractObjective:To study the prevalence of anaemia and its association with measures of iron deficiency (ID) among a group of pregnant women.Design:Cross-sectional survey.Setting:Pregnant women identified through house-to-house visits and participating in community-based antenatal care activities in a rural location of Mymensingh, Bangladesh.Subjects:The estimates are based on 214 reportedly healthy pregnant women in their second trimester. Information on socio-economic status and reproductive history were obtained through home visits and venous blood samples were collected at antenatal care centres. Haemoglobin concentration (Hb) was measured by HemoCue, serum ferritin (sFt) by radioimmunoassay and serum transferrin receptor (sTfR) by enzyme-linked immunosorbent assay methods. ID was defined as presence of either low sFt (<12 μg l−1) or high sTfR (>8.5 mg l−1).Results:The prevalence of anaemia (Hb <110 g l−1) was 50%, but severe anaemia (Hb >70 g l−1) was absent. Low sFt was observed in 42%, high sTfR in 25%, either low sFt or high TfR in 54% and both low sFt and high TfR in 13% of the pregnant women. Two out of three anaemic women had an indication of ID, which was present in 80% of women with moderate (Hb 70–99 g l−1) and 50% with mild (Hb 100–109 g l−1) anaemia. Four out of 10 non-anaemic women (Hb >110 g l−1) also had ID, but the prevalence was significantly lower than that observed in anaemic women (P=0.001).Conclusions:Despite the high prevalence of anaemia, severe cases were absent. The prevalence of ID increased at lower Hb. However, an increased prevalence was also found among women in the highest category of Hb.

Haemoglobin Mass in an Anaemic Female Endurance Runner Before and After Iron Supplementation

2011 ◽  
Vol 6 (1) ◽  
pp. 137-140 ◽  
Author(s):  
Laura A. Garvican ◽  
Louisa Lobigs ◽  
Richard Telford ◽  
Kieran Fallon ◽  
Christopher J. Gore
Keyword(s):  
Carbon Monoxide ◽  
Iron Deficiency ◽  
Iron Supplementation ◽  
Endurance Athlete ◽  
Haemoglobin Concentration ◽  
Deficiency Anemia ◽  
Endurance Runner ◽  
Before And After ◽  
Haemoglobin Mass ◽  
Rebreathing Method

Haemoglobin mass in a female endurance athlete was measured via carbon monoxide rebreathing upon diagnosis of iron-deficiency anemia (haemoglobin concentration = 8.8 g/dL, ferritin = 9.9 ng/mL) and regularly during treatment thereafter. Haemoglobin mass increased by 49% in the 2 wk following an intramuscular iron injection and continued to increase with oral iron supplementation for 15 wk. The presented case illustrates that haemoglobin mass is readily responsive to iron supplementation in a severely iron-defcient anemic athlete and that changes can be tracked efficiently using the CO-rebreathing method.

scholarly journals The Importance of Iron Status for Young Children in Low- and Middle-Income Countries: A Narrative Review

2019 ◽  
Vol 12 (2) ◽  
pp. 59 ◽  
Author(s):  
Andrew E. Armitage ◽  
Diego Moretti
Keyword(s):  
Early Childhood ◽  
Iron Deficiency ◽  
Young Children ◽  
Iron Status ◽  
Tissue Growth ◽  
Narrative Review ◽  
Gastrointestinal Infections ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Early childhood is characterised by high physiological iron demand to support processes including blood volume expansion, brain development and tissue growth. Iron is also required for other essential functions including the generation of effective immune responses. Adequate iron status is therefore a prerequisite for optimal child development, yet nutritional iron deficiency and inflammation-related iron restriction are widespread amongst young children in low- and middle-income countries (LMICs), meaning iron demands are frequently not met. Consequently, therapeutic iron interventions are commonly recommended. However, iron also influences infection pathogenesis: iron deficiency reduces the risk of malaria, while therapeutic iron may increase susceptibility to malaria, respiratory and gastrointestinal infections, besides reshaping the intestinal microbiome. This means caution should be employed in administering iron interventions to young children in LMIC settings with high infection burdens. In this narrative review, we first examine demand and supply of iron during early childhood, in relation to the molecular understanding of systemic iron control. We then evaluate the importance of iron for distinct aspects of physiology and development, particularly focusing on young LMIC children. We finally discuss the implications and potential for interventions aimed at improving iron status whilst minimising infection-related risks in such settings. Optimal iron intervention strategies will likely need to be individually or setting-specifically adapted according to iron deficiency, inflammation status and infection risk, while maximising iron bioavailability and considering the trade-offs between benefits and risks for different aspects of physiology. The effectiveness of alternative approaches not centred around nutritional iron interventions for children should also be thoroughly evaluated: these include direct targeting of common causes of infection/inflammation, and maternal iron administration during pregnancy.

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