DIAGNOSTIC ACCURACY OF SERUM FERRITIN AND SOLUBLE SERUM TRANSFERRIN RECEPTOR, TAKING BONE MARROW IRON STAIN AS A GOLD STANDARD FOR IRON DEFICIENCY ANEMIA IN HETEROGENOUS GROUP OF PATIENTS

Objective: To determine the diagnostic accuracy of serum ferritin and soluble serum transferrin receptor (sTfR), taking bone marrow iron stain as a gold standard for iron deficiency anaemia in heterogeneous group of patients. Study Design: Cross-sectional diagnostic accuracy study. Place and Duration of Study: Department of Diagnostic, Combined Military Hospital Lahore, from Mar to Aug 2020. Methodology: A total of 55 adult patients, of both genders, undergoing bone marrow examination for any reason were enrolled. Patients with known hemolytic condition (sickle cell anemia, megaloblastic anemia), taking erythropoietin/iron supplements, transfused red cell concentrate (RCC) recently or undergoing chemotherapy were excluded. Age, gender, clinical history and results of bone marrow examination, complete blood count (CBC), serum Ferritin and C-reactive protein (CRP) were recorded. Results: Serum ferritin was found to be less sensitive (28%) but more specific (100%) for reflecting reduced bone marrow iron stores as compared to sTfR (sensitivity: 60%, specificity: 96.6%). sTfR had highest likelihood ratio (15) and diagnostic accuracy (80%). On Receiver Operator Characteristic (ROC) graph Transferrin index (AUC=0.908) showed maximum accuracy, followed by Ferritin (AUC=0.884) and sTfR (AUC=0.879). Conclusion: Serum soluble transferring receptor (sTfR) and transferrin index has advantage over serum ferritin alone in predicting the bone marrow iron stores and differentiating iron deficiency anemia from anemia of chronic disease.

The correlation of intake phytate and tannin on serum transferrin receptor and hemoglobin in stunted overweight adolescents

Stunted overweight teenagers are at risk of having iron deficiency. Iron deficiency is caused by various factors including the high food absorption inhibitors of iron such as phytate and tannins. Phytate and tannin contain polyphenol compounds which have a strong ability to bind iron so that it inhibits iron absorption in the intestine. This study aims to analyze the correlation between phytate, tannin intake and serum transferrin receptor (sTfR) and hemoglobin in stunted overweight adolescents. The research method was a cross-sectional study of 64 stunted overweight adolescents selected by consecutive sampling in four high schools/vocational high schools in Banyumanik District, Semarang City. Phytate and tannin intake data using SQ-FFQ method. The serum transferrin receptor examination uses the ELISA method and the hemoglobin level uses the Cyanomethemoglobin method. The results of the study, most of the respondents had high phytate and tannin intake of 96.9% and 89.1%. Respondents with low serum transferrin receptor were 7.8% and low hemoglobin levels were 7.8%. There was no correlation between phytate intake with serum transferrin receptor or hemoglobin (p1 = 0.937 r1 = -0.010, p2 = 0.192 r2 = 0.165). Tannins were significantly correlated with serum transferrin receptor and hemoglobin (p1 = 0.005 r1 = 0.344, p2 = 0.002 r2 = -0.374). Based on multivariate analysis, tannin is a determinant of hemoglobin (R2 = 0.257). Conclusion is that tannin is positively correlated with serum transferrin receptor and hemoglobin in stunted overweight adolescents. Excessive tannin intake can cause deficiency in stunted overweight adolescents.

Bioavailability of Iron Supplement Formulations by Bariatric Surgery Type: A Pilot Study (P23-013-19)

Objectives Our previous research demonstrated that ferrous sulfate, the gold standard iron supplement treats iron deficiency in bariatric surgery patients but wasn't well tolerated. We also found that the bioavailability of iron supplements, assessed by a serum iron absorption test, predicts treatment response. The objective of the current study is to determine whether bariatric surgery type (gastric bypass [GB] and sleeve gastrectomy [SG]) or iron formulation type (inorganic ferrous sulfate versus and an organic, slow-release form of iron, called AspironTM) predicts iron supplement bioavailability. Methods Iron-deficient GB and SG females, ages 18–65 years, who had surgery at least 6 months previously, participated in an 8-hour iron absorption test. Participants were considered iron deficient if two of the following values were abnormal: serum transferrin receptor greater than 2012 mcg/L, ferritin below 30 mcg/L, total iron binding capacity above 370 mcg/dL, and a serum transferrin receptor: ferritin ratio greater than 500. Participants received a low-iron breakfast with a 65 mg iron supplement. We assessed serum iron every 30 minutes for 8 hours following the supplementation using a calorimetric assay (South Bend Medical Foundation, South Bend, IN). Results We report our preliminary findings to date; the study is ongoing. Out of the 10 participants, 8 had GB and 2 had SG. Six of the GB patients and both SG patients received AspironTM, and two of the GB patients received ferrous sulfate. In GB participants, following ferrous sulfate, serum iron increased 80.5 ± 6.4 mcg/dL compared to baseline, whereas following AspironTM, serum iron increased 6.7 ± 4.6 mcg/dL compared to baseline (P = 0.000). Compared to the GB group, serum iron increased 58.5 ± 57.3 mcg/dL in the SG group following AspironTM supplementation (P = 0.037). Conclusions Our preliminary findings suggest that AspironTM is not as bioavailable as ferrous sulfate in GB patients. AspironTM may be better absorbed in SG patients, indicating that it could be an effective treatment to reverse iron deficiency in the SG population. Funding Sources Cura Global Health Inc.

Is Iron Supplementation Influenced by Sub-Clinical Inflammation?: A Randomized Controlled Trial Among Adolescent Schoolgirls in Myanmar

Iron absorption was impaired in the presence of sub-clinical inflammation (SCI) and might hamper the effect of iron supplementation. The purpose of the study was to identify the influence of SCI on iron supplementation. A randomized, double-blinded, placebo-controlled experimental study was conducted among anaemic adolescent schoolgirls in Ayeyarwady region, Myanmar. A total of 402 schoolgirls were recruited from six schools screened from 1269 girls who were assigned into one of four groups: Folate group (2.5 mg of folate), Vitamin A group (15,000 IU of vitamin), Iron folate group (60 mg elemental iron and folate) and Iron, and vitamin A and folate group. Supplementation was done once a week for 12 weeks. Iron, vitamin A and inflammation were measured at the baseline, middle and endline. Changes in serum ferritin and body iron were significantly higher in the IFA and IFA + vitA among those without SCI. There was interaction between vitamin A and SCI on Hb changes. Analysis of GLM repeated measure showed interactions between treatment and SCI for hemoglobin and serum transferrin receptor. Those treated with vitamin A had better outcomes when there was SCI. Inflammation accompanied a negative effect on iron supplementation and vitamin A improved efficacy of iron supplementation in the presence of SCI.