Iron preparations for children

1966 ◽  
Vol 4 (3) ◽  
pp. 9-11
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Blood Smear ◽  
Binding Capacity ◽  
Iron Binding ◽  
Iron Stores ◽  
Plasma Iron ◽  
Hypochromic Anaemia ◽  
Iron Binding Capacity

We have discussed iron preparations for adults in earlier articles;1 much of the information applies equally to children. Iron is not a ‘tonic’ and should be given only to prevent or correct iron deficiency. Estimation of the haemoglobin and inspection of a blood smear are the minimum investigations necessary before iron is prescribed in therapy. When deficiency is suspected in the absence of hypochromic anaemia, plasma iron and iron-binding capacity should be estimated and/or the bone marrow examined for haemosiderin crystals which disappear when iron stores are depleted.

Lab Indicators of Iron Level in Bone Marrow Aspirate of Patients Diagnosed with Multiple Myeloma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5397-5397
Author(s):  
Ankit Mangla ◽  
Sriman Swarup ◽  
Muhammad Umair Mushtaq ◽  
Hussein Hamad ◽  
Sharad Khurana ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Iron Deficiency ◽  
Bone Marrow Aspirate ◽  
Binding Capacity ◽  
Iron Level ◽  
Iron Binding ◽  
Iron Stores ◽  
Bone Marrow Iron ◽  
Iron Binding Capacity

Abstract Introduction Iron plays a critical role in patients with multiple myeloma (MM). The limited availability of iron to the developing erythroid precursors results in the characteristic anemia so frequently seen in these patients. Moreover, iron is also a determinant in growth of the malignant plasma cells that makes it one of the critical factors in progression of the disease. Iron is a key component in success of erythropoietin (EPO) therapy that is often used to maintain hemoglobin (Hb) level of >10g/dL in patients with MM. International Myeloma working group (2011) advised transfusing IV iron to aid in success of EPO therapy. However, apart from determining the iron stores on bone marraow aspirate, there is hardly any reliable clinical or lab indicator of the iron stores in the body. The utility of various iron indices in determining the bone marrow iron stores remains anecdotal. In this study we aim to determine the relation between iron indices and iron level in the bone marrow of patients diagnosed with multiple myeloma. Methods A total of 268 multiple myeloma patients, diagnosed from 2004 to 2015, were identified from tumor registry of John H. Stroger Jr. Hospital of Cook County, Chicago. Accuracy of ferritin, iron level, total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC) and transferrin saturation (TSAT) was evaluated using receiver operating characteristic curves (ROC). Out of sampled patients, 167 patients had a concurrent bone marrow biopsy and aspirate, serum ferritin and iron panel, and were included in ROC analyses. Results The study population consisted of 57% African-Americans, 18% Caucasians and 16% Hispanics. Median age was 61 years and 51% were females. Past history was significant for hypertension (48%), diabetes (31%), co-existing inflammatory conditions (18%), smoking (25%), alcohol abuse (17%) and illicit drug abuse (8%). Median hemoglobin, mean corpuscular volume (MCV), leukocytes and platelets were 10g/dL, 90.3fL, 6,200/mcL and 219,500/mcL respectively. Bone marrow aspirates for iron were rated as absent (37%), mild/moderate (18%) and adequate/normal (45%). Anemia was found in 79% of males (Hb <12.9g/dL) and 76% of females (Hb<11.7 g/dL). Of the patients with anemia, 36% of males and 39% of females had absent iron stores (determined by prussian blue staining method) on bone marrow aspirate. MCV was not significantly related with iron deficiency. Iron level, TIBC, UIBC and TSAT were not significantly associated with bone marrow iron (P>0.05). Only ferritin was significant predictor of iron deficiency and presence of iron in bone marrow (AUC 0.64, 95%CI 0.55-0.74, P=0.002). Ferritin levels of ≤15mcg/L (positive LR 3.77, sensitivity 3.4%, specificity 99.1%), ≤30mcg/L (positive LR 2.59, sensitivity 11.9%, specificity 95.4%) and ≤50mcg/L (positive LR 4.35, sensitivity 32.2%, specificity 92.6%) predicted iron deficiency. Ferritin levels of ≥100mcg/L (positive LR 1.47, sensitivity 76.9%, specificity 47.5%), ≥200mcg/L (positive LR 1.46, sensitivity 54.6%, specificity 62.7%) and ≥500mcg/L (positive LR 1.94, sensitivity 23.1%, specificity 88.1%) ruled out iron deficiency. Conclusion Of all the indices predicting iron deficiency, only ferritin was significantly associated with absent iron in bone marrow aspirates. In MM patients, iron supplementation should be considered with ferritin levels of ≤50mcg/L and can be deferred with ferritin levels of ≥500mcg/L. Further studies are needed to explore the association. Disclosures No relevant conflicts of interest to declare.

IRON METABOLISM

PEDIATRICS ◽  
1956 ◽  
Vol 18 (2) ◽  
pp. 267-298
Author(s):  
Phillip Sturgeon
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Intestinal Mucosa ◽  
Rapid Growth ◽  
Iron Content ◽  
Serum Iron ◽  
Binding Capacity ◽  
Total Iron ◽  
Iron Binding ◽  
Iron Binding Capacity

The infant has no route or organ for the physiologic excretion of iron. Clinically insignificant quantities are lost through the skin and gastrointestinal tract. Assimilation of iron by the adult does not exceed 10 per cent of that ingested in the food; natural foods have a relatively low content of iron. There is evidence from balance studies that at least some infants may have a greater capacity to absorb iron than adults; confirmatory studies using isotopic labeled iron in naturally occurring food, especially milk, would be most helpful in considering and re-evaluating this phase of iron nutrition in the infant. The intestinal mucosa tends to act as a barrier to the rapid entrance of iron into the circulation (mucosal block). Iron in serum is transported bound to a serum globulin (siderophilin); the latter is present in a two- to threefold excess of the concentration of iron in the serum (this represents the serum iron-binding capacity). Relative to adults, many normal infants have a reduced concentration of serum iron and increased iron-binding capacity. Similar changes are seen in iron deficiency states. Storage iron is found primarily in the liver and spleen in 2 chemical forms. One, ferritin, is detectable only by chemical means, and the other, hemosiderin, is visible microscopically and takes iron stains. The content of the latter in bone marrow is reduced in iron deficiency states. Also, hemosiderin is not found in the bone marrow of normal infants. The time required for the assimilation of iron, including metabolic transport across the intestinal mucosa, through the serum iron pool, into the bone marrow and out into the circulating erythrocytes, is very short; as little as 4 hours. The vast majority of iron metabolized internally comes from the daily breakdown of hemoglobin and, to a lesser extent, from other iron compounds such as myoglobin, cytochrome and ferritin. The dietary iron assimilated constitutes only a small percentage of the daily total iron turnover. Studies of iron turnover rates (ferro-kinetics) have not been performed in infants; the magnitude and significance of the additional factor created by rapid growth in such considerations is not known at present. The phyisologic anemia of late infancy is associated with evidence of depletion of iron in the various iron compartments: hemoglobin, serum iron, iron-binding capacity and iron stores. In view of recent data on the blood volume and concentration of hemoglobin of the newborn infant, considerable reduction in estimates of the total amount of iron present at birth are in order: A mean value of 200 mg. for a 3-kg. infant is consistent with these data, and is also consistent with studies of total iron content of stillborn fetuses over 3 kg. A relatively wide range in values, 120 to 320 mg. for total body iron are well within the limit's of normal. Calculations are presented to show that those infants endowed with the smaller quantities of iron at birth and a relatively rapid growth factor will have to assimilate iron at 3 times the rate of other normal infants. In the normal infant with reduced iron content at birth, the drain of iron from hemoglobin by growth of muscle and myoglobin mass may constitute a significant factor contributing to a profound degree of anemia. Preliminary studies on the prophylactic use of intramuscular iron indicate that many of the manifestations of iron deficiency in normal infancy can be altered. A statistically significant higher mean concentration of hemoglobin (0.7 gm./100 ml.) was achieved. Infants, so treated, with values for hemoglobin less than 11.0 gm./ 100 ml. were not observed, whereas 20 per cent of normal infants at 1 year of age had values for hemoglobin ranging from 9.4 to 11 gm./100 ml. Highly significant reductions in the total iron-binding capacity, serum copper and free erythrocyte protoporphyrin were achieved. Increases in the concentration of serum iron and mean erythrocyte hemoglobin concentration were also significant. The average mean corpuscular volume in the treated group was 78.9 µm.; this was not significantly different from the value of 77.2 in the control group. In previous studies using oral iron in large doses, the only one of the above manifestations of iron deficiency which was altered significantly was the concentration of hemoglobin. Except for staining of the skin, the intramuscular iron preparation employed gave no reactions. The iron requirement for the first year of life was given in 3 injections of 1 to 2 ml. without difficulty.

PLASMA IRON AND IRON-BINDING CAPACITY

The Lancet ◽  
1975 ◽  
Vol 305 (7919) ◽  
pp. 1293
Author(s):  
Terry Hamblin
Keyword(s):  
Binding Capacity ◽  
Iron Binding ◽  
Plasma Iron ◽  
Iron Binding Capacity

Plasma iron and transferrin iron-binding capacity evaluated by colorimetric and immunoprecipitation methods.

1987 ◽  
Vol 33 (2) ◽  
pp. 273-277 ◽  
Author(s):  
H A Huebers ◽  
M J Eng ◽  
B M Josephson ◽  
N Ekpoom ◽  
R L Rettmer ◽  
...  
Keyword(s):  
Isotope Dilution ◽  
Binding Capacity ◽  
Colorimetric Method ◽  
Isotope Dilution Method ◽  
Dilution Method ◽  
Iron Binding ◽  
Plasma Iron ◽  
Excess Iron ◽  
Iron Deficient ◽  
Iron Binding Capacity

Abstract We evaluated plasma iron (PI) and total iron-binding capacity (TIBC) or transferrin in normal individuals and in patients with iron imbalance. The standard colorimetric measurements of PI and TIBC and the standard isotope-dilution measurement of TIBC were compared with an immunoprecipitation method and also with immunoelectrophoresis of transferrin. PI concentrations as measured by the standard and immunoprecipitation methods agreed closely for all individuals except those with saturated transferrin, where nontransferrin iron increased the results in the standard assay. This excess iron in saturated plasma may be derived from either free iron or iron-bearing ferritin. There were also differences in TIBC between the two methods. Iron-deficient sera gave higher values for transferrin when measured by immunoelectrophoresis. Unsaturated iron-binding capacity was increased in the isotope-dilution method in some iron-saturated plasma, compounding errors when added to erroneously high PI values to compute TIBC. Perhaps some exchange of iron occurred between added iron and transferrin iron in the isotope-dilution method. These measurements confirm the accuracy of the standard colorimetric method of measuring PI and TIBC except in iron-saturated plasma. However, the greater specificity of a polyclonal immunoprecipitation method of measuring PI and TIBC makes it particularly useful in differentiating transferrin-bound iron from nontransferrin iron.

Serum iron and total iron-binding capacity compared with serum ferritin in assessment of iron deficiency.

1981 ◽  
Vol 27 (2) ◽  
pp. 276-279 ◽  
Author(s):  
F Peter ◽  
S Wang
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Binding Capacity ◽  
Transferrin Saturation ◽  
Total Iron ◽  
Iron Binding ◽  
Total Iron Binding Capacity ◽  
Iron Deficient ◽  
Iron Binding Capacity

Abstract Ferritin values for 250 selected sera were compared with values for iron, total iron-binding capacity (TIBC), and transferrin saturation, to assess the potential of the ferritin assay for the detection of latent iron deficiency. The specimens were grouped (50 in each group) according to their values for iron and TIBC. In Group 1 (low iron, high TIBC) the saturation and ferritin values both indicated iron deficiency in all but one. In the 100 specimens of Groups 2 (normal iron, high TIBC) and 4 (normal iron, high normal TIBC), the saturation values revealed 16 iron-deficient cases, the ferritin test 55. For Groups 3 (low iron, normal TIBC) and 5 (low iron, low TIBC), the ferritin test revealed fewer cases of iron deficiency than did the saturation values (37 cases vs 51 cases, in the 100 specimens). Evidently the ferritin test detects iron deficiency in many cases for whom the serum iron and TIBC tests are not positively indicative. The correlation of serum ferritin with iron, TIBC, and transferrin saturation in the five groups was good only in the case of specimens for which the TIBC was normal; if it was abnormal the correlation was very poor.

Immunological Measurement of Transferrin Compared with Chemical Measurement of Total Iron-Binding Capacity

1975 ◽  
Vol 21 (8) ◽  
pp. 1063-1066 ◽  
Author(s):  
Swei H Tsung ◽  
Waldemar A Rosenthal ◽  
Karen A Milewski
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Binding Capacity ◽  
Total Iron ◽  
Deficiency Anemia ◽  
Iron Binding ◽  
Total Iron Binding Capacity ◽  
Chronic Disorders ◽  
Birth Control Pills ◽  
Iron Binding Capacity

Abstract Because of uncertainty as to the molecular weight of transferrin, a previous comparison [Von der Heul et al., Clin. Chim. Acta 38, 347 (1972)] between transferrin content of serum and total iron-binding capacity cannot be definitive. We found a conversion factor for expressing transferrin as iron-binding capacity by measuring the maximum amount of iron bound by 1 mg of transferrin. We compared the resulting calculated value with values obtained by three other methods for measuring total iron-binding capacity. We agree with the previous observation that the latter, as measured radioisotopically, give higher results than would be judged from the transferrin content but the same as those for two chemical methods. The diffusion rate of transferrin in agar was the same irrespective of the degree of iron saturation. Serum transferrin concentrations were low in patients with anemia resulting from malignancy, chronic disorders, and cirrhosis of the liver, and high or normal in patients with iron deficiency anemia and in pregnant women or women who were taking birth-control pills. Measurement of transferrin concentration can be used to distinguish iron deficiency anemia from anemia resulting from chronic disorders, but offers no advantages over existing methods for estimating total ironbinding capacity.

Sign in / Sign up

Export Citation Format

Share Document