Reduced Frequency of Iron Deficiency Anaemia in Sickle Cell Trait

IntroductionSickle cell disease (SCD) is the most common inherited disease worldwide. The greatest disease burden is seen in sub-Saharan Africa. Early diagnosis and improved care of people living with SCD have led to an increase in the number of women with SCD reaching the reproductive age. Iron deficiency anaemia remains the most common cause of anaemia in pregnancy, affecting 51%–63% of pregnancies in Africa. However, the unavailability of guidelines on supplementation of iron in this pregnant subpopulation often leaves clinicians in a fix. We propose to conduct the first systematic review and possibly a meta-analysis on the prevalence, associated factors and maternal/fetal outcomes of iron deficiency anaemia among pregnant women with SCD.Methods and analysisWe will search the following electronic databases for studies on the iron status of pregnant women with SCD: PubMed, MEDLINE, EMBASE, Google Scholar, African Journals Online, African Index Medicus, Popline and the Cochrane Library. After the selection of eligible studies from the search output, review of full text, data extraction and data synthesis will be performed. Studies obtained from the review shall be evaluated for quality, risk of bias and heterogeneity. Appropriate statistical methods shall be used to pool prevalence estimates for matching studies globally and in subpopulations. This protocol has been reported as per the 2015 guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols.Ethics and disseminationThere is no requirement for ethical approval as the proposed study will use published data. The findings of this study will be published in a peer-reviewed journal and will be presented at conferences.Trial registration numberCRD42018109803.

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Iron stores in pregnant women with sickle cell disease: a systematic review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03326-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Desmond Aroke ◽

Benjamin Momo Kadia ◽

Tsi Njim

Keyword(s):

Systematic Review ◽

Sickle Cell Disease ◽

Iron Deficiency ◽

Quality Assessment ◽

Sickle Cell ◽

Iron Deficiency Anaemia ◽

Iron Status ◽

Cell Disease ◽

Deficiency Anaemia ◽

Factors Associated

Abstract Background Gradual improvements in the management of sickle cell disease (SCD), have led to an increase in the number of women with SCD who reach the age of procreation. However, evidence on the iron status of pregnant women with sickle cell disease (PWSCD) remains inconclusive. We conducted the first systematic review on the prevalence, determinants and maternal/foetal outcomes of iron deficiency anaemia among PWSCD. Methods We searched MEDLINE, EMBASE, Global Health, Africa Index Medicus, the Cochrane library databases and reference lists of retrieved publications for studies describing the iron status of PWSCD. The literature search was done over a period of 1 month, with no language or date restrictions applied. Data were extracted on a Microsoft excel sheet. Two authors assessed all included studies for methodological quality and risk of bias. Results A total of 710 reports were identified for title and article screening. Five retained studies were conducted before or during the 90s and included 67 participants. After quality assessment, the observational studies were designated to have a “fair” quality assessment while the randomised control trial had an “unclear” quality assessment. The prevalence of iron deficiency anaemia among PWSCD varied by study design and diagnostic method. The overall prevalence ranged from 6.67–83.33%. None of the studies provided evidence on factors associated with iron deficiency anaemia and the randomized trial reported no difference in outcomes between PWSCD who had iron supplementation and those who did not. Conclusion Evidence on factors associated with iron deficiency anaemia among PWSCD and maternal/foetal outcomes in PWSCD who have iron deficiency anaemia is poor. The studies included in this review suggests that iron deficiency anaemia may be highly prevalent in PWSCD but due to the very small sample sizes and varied study designs, this evidence is inconclusive. The review shows that there is a need for more studies with robust designs and adequate sample sizes to assess the disease burden of iron deficiency anaemia in PWSCD.

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IRON-DEFICIENCY ANÆMIA AND SICKLE-CELL DISEASE : A HYPOTHESIS

The Lancet ◽

10.1016/s0140-6736(73)93163-2 ◽

1973 ◽

Vol 302 (7823) ◽

pp. 260-261 ◽

Cited By ~ 15

Author(s):

ThomasL. Lincoln ◽

Jerome Aroesty ◽

Paul Morrison

Keyword(s):

Sickle Cell Disease ◽

Iron Deficiency ◽

Sickle Cell ◽

Iron Deficiency Anaemia ◽

Cell Disease ◽

Deficiency Anaemia

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Iron deficiency anaemia in Jamaican children, aged 1-5 years, with sickle cell disease

West Indian Medical Journal ◽

10.1590/s0043-31442005000500004 ◽

2005 ◽

Vol 54 (5) ◽

Cited By ~ 5

Author(s):

L King ◽

M Reid ◽

TE Forrester

Keyword(s):

Sickle Cell Disease ◽

Iron Deficiency ◽

Sickle Cell ◽

Iron Deficiency Anaemia ◽

Cell Disease ◽

Deficiency Anaemia

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Determination of Red Cell Indices Cut-off for Identifying Iron Deficiency Anaemia among Pre-school Children with Sickle Cell Anaemia

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp.145 ◽

2020 ◽

pp. 357-364

Author(s):

OS Akodu ◽

FA Adekanmbi ◽

TA Ogunlesi

Keyword(s):

Iron Deficiency ◽

Sickle Cell ◽

School Children ◽

Iron Deficiency Anaemia ◽

Sickle Cell Anaemia ◽

Red Cell ◽

Predictive Values ◽

Deficiency Anaemia ◽

Red Cell Indices ◽

Discriminatory Performance

Nigerian pre-school children have a high risk of developing iron deficiency and there is no consistent evidence that patients with sickle cell anaemia are protected from iron deficiency anaemia. The objective is to explore red cell indices cut-off values useful as surrogate for detecting iron deficiency in children with sickle cell anaemia. Ninety-seven children with sickle cell anaemia were recruited from Children Outpatient. Reference intervals were developed using the 2.5th – 97.5th, 3.0rd – 97.0th, 5 – 95th, and 10th – 90th percentile intervals for MCV and MCH. The discriminatory performance of the proposed red cell indices criterion was assessed by use of sensitivity, specificity, accuracy, likelihood ratio and predictive values. The 2.5th, 3rd, 5th, 10th, 90th, 95th, 97th, and 97.5th percentile values were: MCV (62.7, 63.6, 66.5, 69.6, 86.3, 87.7, 89.5, and 90.1fl), and MCH (19.0, 19.5, 20.8, 21.4, 28.2, 29.1, 29.5 and 29.7pg). The various calculated cut-off points for the MCV and MCH had lower sensitivity but a higher specificity for detecting iron deficiency than the standard reference values for the general population. The calculated cut-off point for the study subjects below the 10th percentiles had the best discriminatory performance. The cut-off for iron deficiency was 69.6fl for MCV and 21.4pg for MCH either use singly or in combination. In conclusion, standard reference cut-offs of MCV and MCH based on results from western individuals without sickle cell anaemia of the same age are not in agreement with the estimated values for children with sickle cell anaemia in Nigeria.

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