Effect of maternal hemoglobin and iron status on fetal hemoglobin, iron status, growth and maturity

Background: Iron deficiency anemia during pregnancy is a major health issue in India. However, the status of iron stores in infants born to iron depleted mothers remains controversial and inadequately investigated. The present study is therefore an attempt to understand whether maternal anemia and iron stores have any significant effect on iron status and growth of fetus.Methods: This is a prospective, cross-sectional, hospital based study conducted at Mata Chanan Devi Hosital, Janakpuri, New Delhi. Hemoglobin and iron profile of 100 newborns and their mothers were taken. Mothers were divided into anemic and non anemic group to see the effect of maternal anemia on fetus.Results: A total of 100 newborns and their mothers were analysed. Cord hemoglobin and iron profile was significantly reduced in anemic compared to non anemic group. Birth weight of newborn was significantly reduced only in moderately anemic group as compared to non anemic group but there was no difference seen in length and head circumference.Conclusions: Maternal serum ferritin levels should be measured for the diagnosis of occult iron deficiency in the fetus so that timely measures can be taken to prevent iron deficiency anemia in the newborn.

The Relationship between Iron Deficiency Anemia and Dental caries

Background Iron deficiency anemia and dental caries are among the most prevalent diseases in some developing countries. However, few studies have been conducted to assess the association between Iron deficiency anemia (IDA) and early childhood caries (ECC). Objectives The aim of the study was to assess the association between IDA and ECC. Methods 40 children with proved iron deficiency anemia (using iron profile panel done initially) and another 40 healthy age and sex-matched children were examined by one trained and calibrated dentist where the oral status of all enrolled children was assessed in terms of the Decayed, Missing, Filled (DMF) index and gingival health using Gingival index of Loe and Sillness. Results Children with anemia had a significantly higher DMF index (4.37±4.44) than children without anemia (0.50±0.90) (P < 0.001). It was found that there was a negative significant correlation between DMF index and the presence of anemia (r= -0.60, P < 0.001), hemoglobin level (r= -0.454, P < 0.001) and MCH level (r= -0.380, P = 0.001). The multiple regression model statistically significantly predicted DMF index (P = 0.001), (R2=0.34) and only the presence of anemia was found to add significantly to the model (P = 0.027). Conclusion Children with iron deficiency anemia have increased risk for development of dental caries than children without anemia. Any children with significant dental caries should be investigated for IDA and anemia should be treated if present.

Evaluation of serum Hepcidin level and Iron profile among Sudanese patients with anemia of end stage kidney disease

ackground: Anemia of chronic disease is anemia found in certain chronic disease state, is typically marked by the disturbance of iron homeostasis or hypoferremia. This condition leads to shortage of iron for hemoglobin synthesis but the iron storage in bone morrow is left undisturbed. Patients with chronic kidney disease are usually anemic because of defective erythropoeisis and inflammation. Materials and methods: Some of red blood cell profile (Hb, PCV, RBCs count and RBCs indices) were determined by the automated Hematology Analyzer and Cobas e 411 was used to determine the levels of serum iron, ferritin, TIBC, and transferrin saturation percentage. Enzyme – Linked immunoassay (ELISA) was used to determine the level of hepcidin. Results: The results show the mean of the RBCS profile (RBCs count, Hb, PCV) (3.353±88cell/l, 10.62±2.4g/dl, 32.59±6.82%) in patients with ACKD Vs (4.048±0.47cell/l, 12.52±1.57g/dl, 37.92±4.79%) in control groups P.value (0.000, 0.000, and 0.000) respectively. Serum hepcidin levels higher in patients with ACKD compared with healthy controls mean (161.55±29.8ng/ml Vs 82.05±13.4ng/ml. P. value (0.000). The mean value of the iron profile, S. iron, S. ferritin and TS % (61.353±29,8ug/dl, 195.3.62±19.4ng/ml, 21.59±12.82%) in patients with ACKD Vs (82.048±0.47ug/dl, 80.52±1.57ng/ml, 28.92±4.79%) in control groups P.value (0.000, 0.000, and 0.000) respectively. Conclusion: In the present study there is significant association between CKD and RBCS profile (RBCs count, Hb, PCV). The hepcidin levels were significantly higher in patients with ACKD compared with healthy controls. The Statistical significant differences showed in the comparison between the study variables (RBCs profile, Iron profile, hepcidin level) and the end stage of CKD (dialysis dependent), in the RBCs count, Hb, PCV, S. iron, S.ferritin, TIBC. TS %, hepcidin level.

716A study of clinical and trichoscopic evaluation of diffuse hair loss in adult females

Background Hair fall is a major concern to the patient leading to angst, psychological distress and decrease in quality of life style, more so in female. The aim of the study is to evaluate diffuse hair loss (DHL) in adult females & find the underlying causes. Methods This was an observational, prospective time bound hospital-based study including clinical and trichoscopic evaluation of DHL in women. 222 adult women who had DHL of 4 or more weeks were studied. Detailed history was taken and clinical examination was performed. Laboratory investigations like Hb, Iron Profile, Thyroid Panel was also noted. Trichogram, trichoscopy was performed for perfect visualization of hairs. Results Among the subjects, 95 women were diagnosed as having female pattern hair loss (FPHL), 89 as telogen effluvium, 24 as chronic telogen effluvium (CTE) while 14 had FPHL and TE both. Mean age of females was 33.92 ± 5.46 years. Majority, 145 (65.3%) of the patients were in the age group of 31-40 years. Stress (18%) and PCOD (15%) were the most common precipitating factors. Majority (75.3 %) females with TE have positive hair pull test. Brown peripilar sign (PPS) and white PPS was present in 15.8% and 8.1% women respectively. Conclusions The common causes for DHL are FPHL, TE, CTE and FPHL with TE. Key messages Along with definitive treatment, understanding of the cause of hair loss by the patient goes a long way in appropriate beneficial lifestyle modification and holistic management.

STUDY OF ANAEMIA & IRON PROFILE IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS ON MAINTENANCE DIALYSIS AND ITS CORRELATION WITH DIABETES MELLITUS

Most patients with chronic kidney disease (CKD) have anaemia, the cause of which is erythropoietin and iron deciency. Anaemia in patients on haemodialysis is associated with poor patient outcomes. Diabetes remains one of the predominant aetiologies of CKD all over the world. The study was undertaken to study the iron prole in haemodialyzed patients and its corelation with diabetes mellitus. Sixty-six patients were enrolled in the study with the aim to study the prevalence of anaemia and diabetes in haemodialyzed patients as well as the iron prole in these patients. Patients were studied as a single group as well as divided into two groups, a non-diabetic group comprising of 36 patients and a diabetic group comprising of 30 patients. Anaemia was found to be prevalent in 56(84.84%) patients out of which 28(50%) were diabetics. Also, diabetics comprised of 45.45% of the study group. Various parameters like haemoglobin with blood indices and iron prole was studied and compared in both groups. There was no signicant difference in the various parameters in both groups except a signicantly low MCH and MCHC and signicantly high ferritin levels in the diabetic group. We concluded that the low MCH and MCHC might be suggestive of an increased cardiovascular risk in diabetic patients while higher levels of serum ferritin may suggest sub-clinical inammation rather than iron overload. In conclusion diabetes remains to be the single most important aetiology for the causation of end stage renal disease and appropriate management of anaemia in terms of EPO and iron therapy remains the mainstay of therapy in haemodialyzed patients.

Correlation of Iron Profile with Different Stages of Chronic Kidney Disease in Children Presenting at a Tertiary Care Hospital

Aim: To determine correlation of iron profile in children with different stages of chronic kidney disease (CKD) presenting to tertiary care hospital. Methodology: A total of 81 children with chronic kidney disease stage having glomerular filtration rate (GFR) less than 90 (ml/min/m2) aged 1 – 14 years of either sex were included. Three ml serum sample was taken in vial by hospital duty doctor for serum ferritin level, serum iron, transferrin saturation and total iron binding capacity. The sample was sent to hospital laboratory for reporting. Iron profiling was done evaluating hemoglobin (g/dl), serum iron (ug/dl), serum ferritin (ng/ml), transferrin saturation (%) and total iron binding capacity (ug/dl) while iron load was defined as serum ferritin levels above 300 ng/ml. Correlation of iron profile with different stages of CKD was determined applying one-way analysis of variance (ANOVA). Results: In a total 81 children, 46 (56.8%) were boys while overall mean age was 7.79±2.30 years. Mean duration on hemodialysis was 11.52 ± 9.97 months. Iron overload was observed in 26 (32.1%) children. Significant association of age above 7 years (p=0.031) and residential status as rural (p=0.017) was noted with iron overload whereas iron overload was increasing with increase in stages of CKD (p=0.002). Hemoglobin levels decreased significantly with increase in stages of CKD (p<0.001). Serum iron levels increased significantly with increase in the CKD stages (p=0.039). Serum ferritin levels were increasing significantly with the increase in CKD stages (p=0.031). Transferrin saturation also increased significant with increase in CKD stages (p=0.027). Conclusion: High frequency of iron overload was noted in children with CKD on maintenance hemodialysis and there was linear relationship with stages of CKD and iron overload. Significant correlation of hemoglobin, serum iron, serum ferritin and transferrin saturation was observed with different stages of CKD. Keywords: Iron overload, maintenance hemodialysis, ferritin level.

Loss of erythroblasts in acute myeloid leukemia causes iron redistribution with clinical implications

Acute myeloid leukemia (AML) is a heterogeneous disease with poor prognosis and limited treatment strategies. Determining the role of cell-extrinsic regulators of leukemic cells is vital to gain clinical insights into the biology of AML. Iron is a key extrinsic regulator of cancer, but its systemic regulation remains poorly explored in AML. To address this question, we studied iron metabolism in patients with AML at diagnosis and explored the mechanisms involved using the syngeneic MLL-AF9–induced AML mouse model. We found that AML is a disorder with a unique iron profile, not associated with inflammation or transfusion, characterized by high ferritin, low transferrin, high transferrin saturation (TSAT), and high hepcidin. The increased TSAT in particular, contrasts with observations in other cancer types and in anemia of inflammation. Using the MLL-AF9 mouse model of AML, we demonstrated that the AML-induced loss of erythroblasts is responsible for iron redistribution and increased TSAT. We also show that AML progression is delayed in mouse models of systemic iron overload and that elevated TSAT at diagnosis is independently associated with increased overall survival in AML. We suggest that TSAT may be a relevant prognostic marker in AML.