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PubMed1999

Anaemia and iron deficiency disease in children.

Iron deficiency is the single most common nutritional disorder world-wide and the main cause of anaemia in infancy, childhood and pregnancy. It is prevalent in most of the developing world and it is probably the only nutritional deficiency of consideration in industrialised countries. In the developing world the prevalence of iron deficiency is high, and is due mainly to a low intake of bioavailable iron. However, in this setting, iron deficiency often co-exists with other conditions such as, malnutrition, vitamin A deficiency, folate deficiency, and infection. In tropical regions, parasitic infestation and haemoglobinopathies are also a common cause of anaemia. In the developed world iron deficiency is mainly a single nutritional problem. The conditions previously mentioned might contribute to the development of iron deficiency or they present difficulties in the laboratory diagnosis of iron deficiency.

Anemia, Iron-Deficiency↗

PubMed2003

Patients over 45 years with iron deficiency require investigation.

BACKGROUND: Iron deficiency anaemia (IDA) that occurs in patients above the age of 45 years is often caused by gastrointestinal blood loss, and guidelines on the appropriate investigation of these patients have been published. There are few data regarding patients with iron deficiency who are not anaemic and it is not clear how these patients should be managed. OBJECTIVES: We set out to investigate the hypothesis that similar pathologies are likely to underlie iron deficiency and IDA, and to assess whether IDA was being investigated according to the guidelines published by the British Society of Gastroenterology (BSG). METHODS: The pathology computer identified 153 consecutive patients over the age of 45 years who had serum ferritin levels below 20 microg/dl (normal range 20-200 microg/dl) in a 2 month period (i.e., October and November 2000). Medical records were examined and we recorded all investigations, the diagnoses reached, and the investigating specialty. The results were compared using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The study shows that the causes of iron deficiency and IDA are similar, but IDA is investigated more thoroughly than iron deficiency, OR 2.07 (CI 1.08-3.97). Ten patients with iron deficiency without anaemia were found to have coeliac disease, a significant result, OR 6.71 (CI 1.38-32.6). The majority of patients with IDA are not under the care of a gastroenterologist and this group are significantly less likely to be investigated according to the BSG guidelines, OR 0.15 (0.04-0.6). CONCLUSIONS: The study shows that the yield of investigation of iron deficiency is high and, hence, it should be investigated in all patients over the age of 45 years. Despite guidelines published by the BSG, IDA is investigated sub-optimally and measures other than the issuing of guidelines are needed to change practice.

Age Factors↗

PubMed1987

Iron deficiency. Misunderstood, misdiagnosed and mistreated.

Iron deficiency is a common medical problem that may present in a variety of ways to the general practitioner or the specialist. An understanding of iron physiology is relevant to diagnosis and treatment of iron deficiency. Human iron metabolism is a system based on conservation. For this reason, the most common cause of iron deficiency is loss of the normal conservation of iron and this usually means blood loss. The important implication is that the search for the cause of iron deficiency will usually focus on the gastrointestinal tract in males and non-pregnant, non-menstruating females. Iron deficiency is commonly misdiagnosed. The usual error is misinterpretation of the laboratory features of the anaemia of chronic disease. The serum iron is low, but the iron binding capacity is normal and ferritin is normal or high. There are problems and exceptions involved in interpretation of iron indices. Treatment of iron deficiency requires an understanding of iron absorption and the ability of the marrow to respond. In most circumstances, iron deficiency will respond to adequate doses of oral iron; however, there are a few situations when oral iron is unsuitable and parenteral iron is required. An inadequate response to iron may indicate inadequate supply of iron to the bone marrow (e.g. malabsorption, non-compliance) or failure of the marrow to respond (e.g. concomitant folate deficiency). Pregnancy is a special situation in which conservation of iron is overcome by fetal iron requirements and in which application of the knowledge of iron physiology should be applied to prevent and treat iron deficiency.

Acute-Phase Reaction↗

PubMed1983

Diagnosis of iron deficiency: mean corpuscular hemoglobin (MCH) as a predictor of iron deficiency in infants.

Hematologic variables were measured in 240 apparently healthy infants ranging from 1-12 months of age attending a well baby clinic. There were 20 infants for each month of age. Hematologic parameters were measured in each infant by Coulter Counter Model S. Serum iron, total iron binding capacity, free erythrocyte protoporphyrin (FEP) and serum ferritin levels were measured in most infants. Their weights together with their serum iron, total iron binding capacity, and serum ferritin were judged to be independent variables of iron status, whereas the hematologic variables were considered to be response variables indicative of iron status. The correlation coefficients among these variables, after excluding redundant variables and transforming to logarithms, were computed. Canonical correlation analysis was applied to the matrix of correlation coefficients to yield the linear function of the independent variables most highly correlated with a linear function of the response variables. The linear function of the response variables was found to be well approximated by the logarithm of the mean corpuscular haemoglobin, which was highly correlated with each of the independent variables.

Anemia, Hypochromic↗

PubMed1980

Comparative effects of iron deficiency induced by bleeding and a low-iron diet on the intestinal absorptive interactions of iron, cobalt, manganese, zinc, lead and cadmium.

Dietary iron deficiency enhances the absorption of iron, cobalt, manganese, zinc, cadmium and lead, whereas, iron deficiency due to bleeding increases the absorption of iron, cobalt and perhaps manganese. To determine whether the response to bleeding is qualitatively different from that induced by dietary iron deficiency, metal absorption was studied in mice fed either a high-iron diet (120 ppm Fe) and bled (0.5 ml) or fed a low-iron diet (< 3 ppm Fe). Iron absorption from an intragastric dose was increased by the loss of 0.5 ml of blood; smaller losses of blood had no effect. Also, iron absorption was increased more by dietary iron deficiency than by bleeding. In perfusion experiments, bleeding increased the duodenal absorption of only iron and cobalt, whereas dietary iron deficiency enhanced the absorption of all the metals except cadmium. The patterns of absorptive inhibition of the metals by each other were similar in bled mice and in mice with dietary iron deficiency except that interactions among metals with lower affinities for the iron absorption mechanism--manganese, zinc, cadmium and lead--were more obvious in mice fed the low-iron diet. We concluded that bleeding only partially activates the iron absorptive mechanism and that the lack of a bleeding effect on the absorption of manganese, zinc, cadmium and lead results from the weaker interactions of these metals, with a partly-activated absorption process.

Animals↗

PubMed1991

A review of iron deficiency and replacement.

Iron deficiency is very common throughout the world. It is by far the most common cause of anemia, but even states of storage iron depletion and tissue iron deficiencies need iron replacement therapy. The effectivity of the therapy depends on the daily dose administered and on the duration of the therapy. Because of an optimal absorption and minimal side-effects slow-release oral iron preparations seem to solve this very important problem.

Administration, Oral↗

PubMed1984

A small-dose iron tolerance test as an indicator of mild iron deficiency.

Small doses of iron (5 to 20 mg) were used to study absorption in normal and mildly iron-deficient men. Plasma iron concentration was measured before and at frequent intervals after ingestion of iron. Men with normal iron stores showed little change in plasma iron levels, while mildly iron-deficient men showed large increases. This consistent observation of increases in plasma iron levels indicates that the iron tolerance test using small doses of iron is a sensitive indicator of iron deficiency. It provides a means of studying iron absorption without the use of radioactive tracers.

Adolescent↗

PubMed2000

Localisation of divalent metal transporter 1 (DMT1) to the microvillus membrane of rat duodenal enterocytes in iron deficiency, but to hepatocytes in iron overload.

BACKGROUND: The mechanism of iron absorption by the intestine and its transfer to the main iron storage site, the liver, is poorly understood. Recently an iron carrier was cloned and named DMT1 (divalent metal transporter 1). AIMS: To determine the level of DMT1 gene expression and protein distribution in duodenum and liver. METHODS: A DMT1 cRNA and antibody were produced and used in in situ hybridisation and immunohistochemistry, respectively, in rats in which the iron stores were altered by feeding diets with normal, low, and high iron content. RESULTS: Duodenal DMT1 mRNA was low in crypts and increased at the crypt-villus junction in iron deficient and control rats; it fell in the iron loaded state. Staining for DMT1 protein was not detected in crypts. In villus enterocytes, protein staining was localised to the microvillus membrane in iron deficiency, in the cytoplasm and to a lesser extent in the membrane in controls, and entirely in the cytoplasm of iron loaded animals. Liver DMT1 mRNA was distributed evenly across hepatocytes. DMT1 protein staining was observed on hepatocyte plasma membranes, with highest values in the iron loaded state, lower values in control animals, and none after iron depletion. CONCLUSIONS: Results are consistent with a role for DMT1 in the transmembrane transport of non-transferrin bound iron from the intestinal lumen and from the portal blood.

Animals↗

PubMed2005

Diurnal variations in qualitative composition of breast milk in women with iron deficiency.

Biorhythms of iron metabolism in healthy women and patients with iron deficiency were studied during lactation. Healthy nursing women were characterized by circadian variations in the concentrations of iron, alpha-tocopherol, and malonic dialdehyde in breast milk. Diurnal variations in iron concentration, antioxidant potential, and lipid peroxidation in breast milk depended on iron metabolism in nursing women. Iron deficiency was accompanied by a decrease in the concentrations of alpha-tocopherol and iron, increase in malonic dialdehyde content, and suppression of circadian variations in these parameters in breast milk.

Adult↗

PubMed1997

Strategies for the prevention of iron deficiency through foods in the household.

Iron deficiency can be caused not only by diets deficient in iron but by poor absorption of available dietary iron. Extrinsically tagging foods with radioiron allows the exact measurement of iron absorbed from heme and nonheme iron foods. It has furthered the study of the effect of enhancers and inhibitors of iron absorption. As a result, we have a greater understanding of why iron deficiency and iron deficiency anemia are prevalent in populations of low socioeconomic status and of which food vehicles and iron compounds are most suitable for iron fortification.

Absorption↗

PubMed1983

Acquired iron-deficiency anaemia due to impaired iron transport.

A previously healthy 39-year-old woman presented with severe iron-deficiency anaemia, but she had lost no blood and her serum iron level was high. Her bone marrow was hypercellular with a predominance of erythroid elements and had no stainable iron deposits, but it also showed dyserythropoiesis and an excess of apparently normal plasma cells. IgM was demonstrated on her bone-marrow erythrocytes and their precursors. On azathioprine and prednisone therapy she had a complete clinical and haematological remission. The impaired iron transport and the associated dyserythropoiesis were probably due to an IgM-mediated autoimmune process. Diabetes mellitus, which first appeared during her anaemic illness, could also have been due to an autoimmune process. This is the first report of an iron-deficiency anaemia caused by a naturally acquired impairment of iron transport.

Adult↗

PubMed1997

Prevalence and risk factors in iron deficiency and anemia.

Iron deficiency anemia is nowadays the world most prevalent nutritional problem. Several studies concerning anemia prevalence were carried out in Brazil with pregnant women and children aged less than 5 years, restricted mainly to northeast and southeast regions of the country. More recently, groups other than those of pregnant women and children aged less than 5 years, such as school children and adolescents, have become the target of those concerned with the issue. The differences found out among the groups and the diversity of methodologies employed, prevent us from reaching an evolutionary profile concerning nutritional anemia in Brazil. However, the high rates of prevalence verified by the various studies carried out are enough for justifying the general interest in controlling and/or eradicating the disease. This paper presents a model of causal determination of anemia, that points out the diet as the principal immediate factor. The typical Brazilian diet is poor in bioavailable iron. The two foods--meat and beans--responsible for the totality of this mineral in the habitual Brazilian diet have been registering a decreasing intake in the last decades. Iron deficiency is also observed in the food practice of infants and children aged less than 5 years. This situation justifying the urgency in finding an effective intervention to control this relevant nutritional problem.

Anemia↗

PubMedDate not supplied

[Management, prevention and control of anaemia secondary to iron deficiency].

Anemia secondary to iron deficiency is the most frequent anaemia in our environment, the first cause of consultation in Haematology and the most common nutritional problem. It is characterized by a diminution or absence of iron deposits. The ultimate test that confirms the diagnosis of anaemia secondary to iron deficiency is a low serum level of ferritin, which indicates iron depletion. Other parameters do not allow to distinguish iron deficiency anaemia from other chronic derangements. Diet is of utmost importance in anaemia. There is not a single food product with sufficient concentration of iron capable of restoring iron deficiency situations. Therefore, treatment of iron deficiency must be made orally with iron preparates, mainly in the form of iron sulphate in order to guarantee a better absorption. The initial recommended doses are 150-200 mg of elemental iron per day split in three ingestions (in children 3-5 mg/Kg/day).

Administration, Oral↗

PubMed1995

True absorption and retention of supplemental iron is more efficient when iron is administered every three days rather than daily to iron-normal and iron-deficient rats.

Absorption of daily iron supplements is inefficient. Detailed absorption patterns of FeSO4 supplements simulating World Health Organization-recommended doses were studied in iron-deficient and iron-normal male Sprague-Dawley rats. For 12 d after weaning, the rats were fed a premeal containing < 20 (iron-deficient group) or 400 micrograms Fe (iron-normal group) twice daily followed by iron-free AIN-76 diet for 1 h. Then, both groups (iron-deficient and -normal) were divided in three groups, one continuing without change and two receiving 4000 micrograms of premeal Fe either daily or every 3 d to match intestinal mucosa renewal time. Food intake, growth, hemoglobin concentration and periodic 59Fe-labeled iron absorption and rate of loss were determined. Iron-deficient rats became anemic, and ate and grew less. Iron absorption was stable in normal (34.2%), deficient (89.7%) and normal, intermittently supplemented (9.5%) groups. Absorption decreased logarithmically in daily supplemented rats, whereas in iron-deficient, intermittently supplemented rats absorption decreased slowly and linearly. Rates of iron loss were significantly accelerated in daily supplemented rats. Thirteen-day total iron retention in intermittently supplemented normal and deficient rats was 62 and 86%, respectively, of that of daily supplemented rats. Iron supplementation timed to match mucosal renewal is more efficient.

Absorption↗

PubMed2002

Iron deficiency--United States, 1999-2000.

Iron deficiency, the most common nutritional deficiency worldwide, has negative effects on work capacity and on motor and mental development in infants, children, and adolescents, and maternal iron deficiency anemia might cause low birthweight and preterm delivery. Although iron deficiency is more common in developing countries, a significant prevalence was observed in the United States during the early 1990s among certain populations, such as toddlers and females of childbearing age. One of the national health objectives for 2010 is to reduce iron deficiency in these vulnerable populations by 3-4 percentage points (objective no. 19-12). CDC has published recommendations to prevent iron deficiency in the United States. To characterize the iron status of persons in the United States, CDC calculated the prevalence of iron deficiency and iron deficiency anemia by applying a multiple-indicator model to data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES 1999-2000). These values were compared with those observed in the third National Health and Nutrition Examination Survey (NHANES III [1988-1994]) using the same multiple-indicator model. This report summarizes the results of this analysis, which indicate that iron deficiency remains 2-5 percentage points above the 2010 national health objectives. To prevent iron deficiency, vulnerable populations should be encouraged to eat iron-rich foods and breast-feed or use iron-fortified formula for infants.

Adolescent↗

PubMedDate not supplied

Iron deficiency anemia and hearing.

Iron deficiency anemia is a frequently occurring clinical disorder. Despite the suggested association with hearing loss in the literature, cochlear sequelae of iron deficiency have yielded conflicting results in experimental studies. Auditory function was tested in iron-deficient and normal male Wistar albino rats using distortion product otoacoustic emissions and auditory brainstem response audiometry for the clarification of the opposing results in the literature. Hemoglobin, hematocrit, serum iron and albumin levels were monitored to verify iron deficiency. Although dramatic differences in weight gain and blood test parameters were noted, no significant change in auditory function due to iron deficiency was detected.

Anemia, Iron-Deficiency↗

PubMed2002

Parenteral iron supplementation for the treatment of iron deficiency anemia in children.

Iron-deficiency anemia impairs growth and intellectual development in children, which can be reversed only by early diagnosis and iron supplementation. Oral supplementation can efficiently replace stores, but in many cases parenteral iron is needed. Unfortunately some adverse reactions have limited its use in children. We compared the efficacy and safety of intramuscular and intravenous administration in 33 evaluable children with severe iron deficiency and/or iron-deficiency anemia who failed to respond to oral iron supplementation. Nineteen children received intravenous infusion and 14 intramuscular injections. All children showed recovery from iron-deficiency anemia, with statistically similar improvement in hemoglobin levels. The duration of treatment was longer in those receiving intramuscular injection. Parenteral iron therapy for the treatment of iron-deficiency anemia is a rapid, easy, and definitive solution to a long-troubling situation. We suggest the use of parenteral iron, in particular intravenous iron, in children who do not recover from severe iron-deficiency anemia after oral therapy. We should consider the physical and neuropsychological sequelae of long-lasting iron deficiency in children and the fact that oral supplementation is less likely to replace iron stores.

Anemia, Iron-Deficiency↗

PubMed1989

Iron deficiency: does it matter?

Iron deficiency causes different abnormalities in the three major population groups that are at risk. In pregnant women, epidemiological studies suggest that anaemia, presumably due mainly to iron deficiency, is associated with an increased risk of low birth weight, prematurity, and perinatal mortality. In iron-deficient infants and children, there is convincing evidence of impaired psychomotor development and cognitive performance. Finally, iron-deficient women during the childbearing years (and iron-deficient men) have a decreased work capacity and less efficient response to exercise. These symptoms provide ample justification for preventing and treating a common and easily correctable nutritional disorder.

Anemia, Hypochromic↗