Microcytic anaemia with low transferrin saturation, increased serum hepcidin and non-synonymousTMPRSS6variants: not always iron-refractory iron deficiency anaemia

2014 ◽  
Vol 169 (1) ◽  
pp. 150-151 ◽  
Author(s):  
Albertine E. Donker ◽  
Paul P. T. Brons ◽  
Dorine W. Swinkels
2019 ◽  
Vol 7 (1) ◽  
pp. 132
Author(s):  
Gaurav Mohan ◽  
Gurinder Mohan ◽  
Manish Chandey ◽  
Avneet Kaur ◽  
Trimaan Singh Sikand ◽  
...  

Background: To study the prevalence and pattern of iron deficiency (ID)in heart failure (HF) patients with or without anaemia.Methods: This is a single-centre observational study, conducted at a tertiary care hospital of Punjab. Patients were selected based on validated clinical criteria-Framingham criteria. The iron parameters were done during the study including serum iron, serum ferritin, total iron binding capacity, and transferrin saturation (TSAT), to diagnose iron deficiency anaemia. Anaemia was defined as haemoglobin (Hb) < 13g/dl in males and <12 g/dL in females, based on WHO definition. Absolute iron deficiency is defined as serum ferritin < 100 mg/L and functional ID was defined as normal serum ferritin (100–300 mg/L) with low TSAT (<20%).Results: A total of 120 patients of Heart Failure (54% males and 46% females) were studied. Most of the patients were of high-functional NYHA class (Class IV NYHA n=45). Iron Deficiency was present in 60% patients with 31.66% patients having absolute and 28.33% patients having functional ID. Nearly one-fifth of the patients were having ID but without anemia, signifying importance of workup of Iron deficiency other than haemoglobin levels.Conclusions: Study highlights the neglected burden of ID in HF patients in India. This study suggests further large-scale studies to better characterize this easily treatable condition and considering routine testing in future Indian guidelines.


Author(s):  
Sabeen Khan ◽  
Sahira Aaraj ◽  
Syeda Namayah Fatima Hussain

Abstract Objective: To study the frequency and types of haemoglobinopathies in children with microcytic anaemia. Method: The prospective study was conducted at the Paediatric Out-patient Department of Shifa Falahi Community Health Centre, Islamabad, Pakistan, from July to December, 2018, and comprised patients aged from 3 months to 14 years who had haemoglobin <10mg/dl and mean corpuscular volume <70fL. Serum ferritin and haemoglobin electrophoresis were done to check for iron deficiency anemia and haemoglobinopathies. Data was analysed using SPSS 23. Results: Of 175 subjects, 33(18.9%) had haemoglobinopathies and 142(81.1%) had iron deficiency anaemia. Thalassemia trait 18(10.3%) was the leading cause amongst haemoglobinopathies, followed by thalassemia major 8(4.6 %) and intermedia 5(2.9%). There were 2(1.1%) patients with haemoglobin D. Conclusion: The prevalence of hemoglobinopathies was high. Identification of haemoglobinopathies is important for proper treatment, antenatal screening and future genetic counselling. Key Words: Haemoglobinopathy, Iron deficiency anaemia, Microcytic, MCV, IDA.


2005 ◽  
Vol 8 (5) ◽  
pp. 451-460
Author(s):  
Fiona Barr ◽  
Loretta Brabin ◽  
Shola Agbaje ◽  
Feikumo Buseri ◽  
John Ikimalo ◽  
...  

AbstractObjectiveMenstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to make the problems. We investigated the prevelance of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia.SettingRural village in south-east Nigeria.DesignCross-sectional survey.SubjectsThe studdy included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village.MethodsA field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (HB), serum iron, transferin saturation and protoporphyrin levels (ZPP) were also measured.Results307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml);. median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (p = 0.048), and had longer duration of meneses (p < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status.ConclusionsThe level of menorrhagia detected (12%) may be an ‘expected’ level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.


Author(s):  
LF Mogongoa

Background: Iron deficiency anaemia is the most commonly encountered form of anaemia in females worldwide. This form of anaemia is, amongst others, associated with geophagia that is defined as the consumption of soil. The two main reasons for the association of geophagia with anaemia are that soil is thought to supplement mineral deficiency and geophagia is seen as a symptom of the anaemia. However, it is hypothesised that soil consumption interferes with iron absorption instead of supplementing it. The first line of therapy for iron deficiency anaemia is oral iron. Therefore, if soil consumption interferes with iron absorption it could interfere with oral iron therapy leading to patients being burdened with symptoms of anaemia as treatment is not effective. The aim of the study was to evaluate the efficacy of oral iron therapy in female participants afflicted with iron deficiency anaemia associated with geophagia. Methods: In this prospective randomised intervention study, 84 geophagic women with iron deficiency anaemia were divided into two groups. One group continued with soil consumption while the other stopped consumption. Oral iron therapy was administered for ten weeks at increasing therapy doses for both groups. Red cell and iron study parameters were evaluated at different time intervals to ascertain the efficacy of iron replacement therapy. Results: The group that stopped soil consumption showed a statistically significant change in haemoglobin (9.4 to 10.0 g/dL, p = 0.029), mean corpuscular volume (73.6 to 75.7 fl), mean corpuscular haemoglobin (23.7 to 24.6 pg), serum iron (22.5 to 28 μg/dL, p < 0.001, transferrin saturation (4.8 to 6.9%, p < 0.001) and total iron-binding capacity (467 to 441 μg/L, p = 0.001). These findings were contrary to the group that continued with consumption, where the statistical changes were only observed for the iron study parameters (serum iron: 21 to 28 μg/dL, p = 0.038; transferrin saturation: 4.3 to 6.9%, p = 0.011; total iron-binding capacity: 496 to 421 μg/L, p = 0.002). Nevertheless, the changes for both groups were clinically insignificant. Oral iron therapy did not correct the anaemia in geophagic females of both groups, this could be explained by two hypotheses where soil affected the gastrointestinal lining and soil directly interfered with therapy iron absorption. This is evidenced by the group that continued with consumption showing fewer changes than the group that abstained from soil consumption. These results were consistent with a case study where oral iron therapy was implemented. Conclusion: Oral iron therapy was not effective in geophagia cases of iron deficiency anaemia.


Author(s):  
Ghulam Abbas Memon ◽  
Tooba Jawed Khan ◽  
Shabnam Abbas ◽  
Ghulam Abbas Shaikh ◽  
Nusrat Shah ◽  
...  

Background: Iron deficiency anaemia (IDA) is the prevalent form of anaemia which has become a major public health problem, globally. Women in the reproductive age group (15–49 years of age) are at increased risk, especially in the South Asian population. It is of paramount importance to identify these micronutrient deficiencies in this age group as it adversely affects the birth outcomes, but the mother and the child at risk of morbidity and mortality during pregnancy.  Methods: A cross-sectional study was conducted at Civil Hospital, Karachi for 12 months i.e. October, 2018 to December, 2019. Data was prospectively collected from patients after obtaining written informed consent. 377 patients were included who met the diagnostic criteria. Descriptive statistics were used and qualitative data analysis; mean, standard deviation, frequency, and percentages were respectively calculated. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. For post-stratification, the chi-square test was applied with a p value of≤0.05.Results: A total of 377 patients with microcytic anaemia were enrolled from Civil Hospital, Karachi. Mean age, duration of anaemia, haemoglobin, height, weight and BMI in our study was 29.28±6.14 years, 1.41±0.26 months, 9.27±0.86 mg/dl, 26.72±1.56 kg/m2, 138±7.28 cm and 78.7±9.87 kg. Out of 377 patients with microcytic anaemia, 144 (38.2%) and 233 (61.8%) had and did not have iron deficiency anaemia.  Conclusions: IDA is frequently found in microcytic anaemia patients. Thus, it is important to screen premenopausal in female patients for iron deficiency presenting with microcytic anaemia to prevent adverse outcomes.  


1983 ◽  
Vol 17 (3) ◽  
pp. 210-212 ◽  
Author(s):  
A. W. Ranasinghe ◽  
N. W. Johnson ◽  
R. Rountree

An animal model was developed in which the effect of iron deficiency on the oral mucosa could be studied. Iron deficiency was induced by feeding hamsters a low-iron powdered diet together with withdrawal of 0·5 ml of blood weekly, for a period of 9 weeks. At the end of this period the mean haematological values for control animals were, Hb 15·9 g/dl, plasma iron 40·3 μmol/l, TIBC 90·5 μmol/l and transferrin saturation 44·5%, compared with 7·4, 7·2, 111·4 and 6·5 respectively for experimental animals. These results were reproducible in successive groups of animals and indicate that this is a useful model for the study of iron deficiency anaemia.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Pablo Pergola ◽  
Diogo Belo ◽  
Paul Crawford ◽  
Moustafa Moustafa ◽  
Dennis Vargo ◽  
...  

Abstract Background and Aims Ferric citrate (FC) is approved in the US as oral iron replacement for the treatment of iron deficiency anaemia (IDA) in adult patients with non-dialysis dependent (NDD) chronic kidney disease (CKD) and for the treatment of hyperphosphatemia in adult patients with dialysis dependent CKD. For IDA, a starting dose FC of 1 tablet three times daily (TID) is recommended with titration to maintain haemoglobin (Hb) at goal. This study was designed to investigate the possibility of dosing FC twice daily (BID) for flexibility in clinical practice. The efficacy and safety of different FC dosing regimens for the treatment of IDA were examined in adults with NDD-CKD. Method In this 48-wk, Phase 4, randomized, open-label, multicentre study, subjects with IDA of NDD-CKD (stage 3-5) were randomized 1:1 to receive 1 FC tablet (1gm containing 210mg ferric iron) TID or 2 tablets BID. At wk 12, subjects whose Hb increased &lt;0.5 g/dL from baseline (BL) or was &lt;10 g/dL had their dose increased to either 2 tablets TID or 3 tablets BID consistent with their original dosing regimen. This prespecified analysis reports data through wk 24. The primary endpoint was mean change in Hb from BL to wk 24. Secondary endpoints included mean change in transferrin saturation (TSAT), ferritin, and phosphate to wk 24. Results 206 subjects were randomized, 183 were included in this analysis after completing the 24-wk dose titration period. Groups were well matched with mean age of 69.5 +/- 10.32 years, 64% female and 54% had diabetes as a cause of CKD. Mean BL eGFR was 33.6 +/- 10.85 ml/min/1.73m2 and Hb 10.45 +/-0.744 g/dL. In subjects who did not require an increase in the FC dose at wk 12, mean changes in Hb at wk 24 were 1.05 and 1.24 g/dL in the 1 tablet TID and 2 tablet BID dosage groups, respectively. In subjects who required an increase in the FC dose at wk 12, mean changes in Hb at wk 24 were 0.41 and 0.13 g/dL in the 2 tablet TID and 3 tablet BID groups, respectively. Mean changes in TSAT, ferritin and phosphate are presented in the Table. The incidence of TEAEs was 78.2% and 75.0% in the BID and TID groups, respectively. The most common AEs reported were diarrhoea, stool discoloration and constipation. The incidence of SAEs was 13.9% and 17.3% in the BID and TID groups, respectively. Five deaths were reported, none were deemed related to FC per the investigator. Conclusion FC was effective and generally well tolerated in the treatment of IDA in this NDD-CKD population. Subjects who had per protocol FC dose increases at wk 12 had less pronounced iron deficiency at BL and smaller increases in Hb suggesting an additional underlying cause of anaemia. Mean changes in Hb, TSAT, ferritin, and phosphate and AE profiles were similar in the BID and TID regimens as well as in 3 g/day and 4 g/day dosing groups supporting the potential for dosing flexibility with FC. Clinicaltrials.gov identifier NCT03236246 Funding provided by Akebia Therapeutics, Inc.


2018 ◽  
Vol 9 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Ephraim Chikwanda ◽  
Victor Daka ◽  
Marah Simakando ◽  
Sumbukeni Kowa ◽  
Trevor Kaile

Background: Anaemia affects approximately 1.62 billion people globally corresponding to 24.8% of the world’s population. Iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are the most common forms of anaemia. A hormone produced by the liver, hepcidin, is the primary regulator of iron homeostasis and its production increases in ACD and decreases in IDA. Usually, ACD and IDA coexist and sometimes look identical on peripheral blood smears.Aims and Objectives: The current study aims to evaluate the diagnostic value of hepcidin to predict ACD from IDA as well as the diagnostic value of hepcidin to predict ACD from a combination of IDA and ACD.Materials and Methods: Specimens presenting with haematological indices suggestive of IDA and/or ACD following World Health Organisation (WHO) standard case definitions were identified among samples coming to the Haematology laboratory for routine investigations. Serum hepcidin, serum ferritin, serum iron and total iron binding capacity (TIBC) were assessed. Demographic data was obtained from specimen requisition forms.Results: Of the 66 participants, 62.1% (n = 41) were females. IDA was more common among females (36.4%) than males (6.1%) while ACD was more common in males (19.7%) than females (12.1%). Iron Deficiency Anaemia participants had significantly lower hepcidin levels than ACD (p<0.001). There was a significant positive correlation between serum hepcidin and serum ferritin levels (p < 0.001).Conclusion: We found that IDA participants had significantly lower hepcidin levels than ACD and IDA/ACD combined. Therefore, serum hepcidin could be considered in diagnosing and distinguishing ACD from IDA or IDA/ACD as it also had high diagnostic sensitivity and specificity compared to other markers.Asian Journal of Medical Sciences Vol.9(1) 2018 15-20


1998 ◽  
Vol 1 (4) ◽  
pp. 249-257 ◽  
Author(s):  
Fiona Barr ◽  
Loretta Brabin ◽  
Shola Agbaje ◽  
Fiekumo Buseri ◽  
John Ikimalo ◽  
...  

AbstractObjective:Menstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to mask the problems. We investigated the prevalence of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia.Setting:Rural village in south-east Nigeria.Design:Cross-sectional survey.Subjects:The study included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village.Methods:A field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (Hb), serum iron, transferrin saturation and protoporphyrin levels (ZPP) were also measured.Results:307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml); median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (P = 0.048), and had longer duration of menses (P < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status.Conclusions:The level of menorrhagia detected (12%) may be an ‘expected’ level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders, and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.


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