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[The urinary elimination of cobalt 57 in iron-deficiency anemia and in iron-overload states].

The authors used the 57 Co urinary excretion test to assess the intestinal absorption of iron in anemia associated with hypoferrinemia and in iron overload states. Among the anemia associated with hypoferrinemia, a high elimination of 57 Co had been found in all patients (15) with post-haemorrhagic iron deficiency anemia. Conversely, this elimination was very low in all 10 patients with anemia due to chronic inflammatory diseases. Moreover the test detected few iron deficiency anemia due to a decreased intestinal absorption of iron. In the iron overload states, the test had been performed in 2 subgroups of patients : chronic anemic patients with transfusional iron overload and hemochromatosis without anemia. In the transfusional iron overload group, 19 patients with thalassemia major who are routinely transfused have a moderate decrease of the 57 Co excretion. This finding probably reflects a continuing intestinal absorption of iron. On the other hand, 6 patients with acquired idiopathic sideroblastic anemia have a very low excretion. In the non anemic hemochromatosis, a high urinary level of 57 Co was present in 5 patients with idiopathic hemochromatosis when it was lower and variable in 6 patients with alcoholic siderosis. Using Wilcoxon, Mann and Whitney's non parametric test, there is a significant difference between the results of both groups. So, in idiopathic hemochromatosis, the high urinary level of 57 Co reflects an inappropriately high absorption of iron in spite of the iron overload and the test may be of value in detecting asymptomatic carriers of the disease.

Adolescent↗

Reticulocyte hemoglobin content to diagnose iron deficiency in children.

CONTEXT: Early identification of iron deficiency in children is essential to prevent the damaging long-term consequences of this disease. However, it is not clear which indices should be included in a diagnostic panel for iron deficiency and iron deficiency anemia in children. OBJECTIVE: To develop an effective approach for the diagnosis of iron deficiency and iron deficiency anemia in young children. DESIGN AND SETTING: Retrospective laboratory analysis, carried out over 7 weeks in 1996, using blood samples ordered by pediatricians and sent to a large metropolitan hospital for analysis. PATIENTS: A total of 210 children (mean [SD] age, 2.9 [2.0] years; 120 were male) who had a lead screening test (complete blood cell count and plasma lead level) ordered by a primary care pediatrician. MAIN OUTCOME MEASURES: Levels of hemoglobin (Hb), iron, transferrin, transferrin saturation (Tfsat), ferritin, and circulating transferrin receptor and reticulocyte Hb content (CHr) among patients with and without iron deficiency, defined as Tfsat of less than 20%, and iron deficiency anemia, defined as Tfsat of less than 20% and Hb level of less than 110 g/L. RESULTS: Of the 210 subjects, 43 (20.5%) were iron deficient; 24 of these had iron deficiency anemia. Reticulocyte Hb content and Hb levels were the only significant predictors of iron deficiency (likelihood ratio test [LRT] = 15.96; P<.001 for CHr, and LRT = 6.59; P = .01 for Hb), and CHr was the only significant multivariate predictor of iron deficiency anemia (LRT = 30.43; P<.001). Plasma ferritin level had no predictive value (P = .97). Subjects with CHr of less than 26 pg (optimal cutoff value based on sensitivity/specificity analysis) had lower Hb level, mean corpuscular volume, mean corpuscular Hb level, serum iron level, and Tfsat, and increased red blood cell distribution width vs those with CHr of 26 pg or more (P<.001 for all). CONCLUSIONS: Reticulocyte Hb content level was the strongest predictor of iron deficiency and iron deficiency anemia in children. It holds promise as an alternative to biochemical iron studies in diagnosis.

Anemia, Iron-Deficiency↗

Transferrin saturation studies in male adults showing high prevalence of iron deficiency.

Estimation of serum iron, total iron binding capacity (TIBC) and transferrin saturation was performed in 62 apparently healthy male medical students. All had haemoglobin over 140 g/1. Low serum iron, elevated level of TIBC and transferrin saturation under 20% indicating iron deficiency state was found in 2 subjects. Elevated values of TIBC was found in 25 (40.32%) students as evidence of latent iron deficiency. Such high prevalence of iron deficiency in an affluent group indicates widespread iron deficiency in the general population.

Adult↗

Iron-deficiency anaemia.

Iron-deficiency anaemia (IDA) is a common clinical problem throughout the world and an enormous public health problem in developing countries. The cornerstone of the laboratory identification of IDA is a low haemoglobin and serum ferritin concentration although a normal serum ferritin does exclude IDA. When the serum ferritin is normal in an anaemic patient with iron-deficient erythropoiesis, it is common practise to perform a bone marrow examination to diagnose IDA. The recent introduction of serum transferrin receptor measurements is a useful alternative for distinguishing IDA from the anaemia of chronic disease because the serum receptor concentration is usually elevated in patients with IDA but normal in patients with anaemia due to inflammation or neoplasia. It is helpful for the clinican to be aware of the causes of physiological IDA. The most important are increased rate of body growth, excessive menstrual blood loss, pregnancy, regular blood donation, intensive endurance training, chronic aspirin use and a vegetarian diet. Without these, a careful search for unsuspected gastrointestinal blood loss must be made and even when the suspicion of physiological IDA is high, it is prudent to screen for fecal occult blood. In most patients, IDA responds promptly to oral iron therapy. Patients who experience troublesome side-effects with oral iron might benefit from a gastric delivery system for oral iron which eliminates nausea and vomiting and improves iron absorption when given with food.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Absorption of low and therapeutic doses of ferric maltol, a novel ferric iron compound, in iron deficient subjects using a single dose iron absorption test.

Ferric maltol is a novel ferric iron compound with potential use as an oral therapy for iron deficiency anaemia. Using a single, low dose iron absorption test we compared absorption of ferric maltol with absorption of ferrous sulphate in 21 iron deficient subjects. Absorption of 10 mg of ferric maltol as either aqueous solution or a single tablet compared favourably with that of an equivalent dose of ferrous sulphate. At a higher, more therapeutic dose of 60 mg elemental iron as tablets, absorption of ferric maltol appeared to be both more rapid and total absorption greater, than that seen with ferrous sulphate. We conclude that iron from ferric maltol, both at low dose and higher, more therapeutic doses, is at least as well absorbed as from ferrous sulphate. Ferric maltol is the first ferric iron formulation to be absorbed to a degree equivalent to that of ferrous iron salts and may represent a viable form of administration for ferric iron in the treatment of iron deficiency anaemia.

Adult↗

[Iron deficiency in domestic animals].

Iron is essential for the organism. In ionized forms (Fe++, Fe ), it constitutes an integrated part of a lot of different functional proteins (Figure 1). The most important functions are participation in oxygen transport in blood, oxygen storage in muscle tissues and oxidation of nutrients in the mitochondria. Iron is an essential part of cytochrome C and alpha-glycerolphosphate dehydrogenase, and early stages of iron deficiency may, therefore, cause disturbances in tissue metabolism before development of anaemia. Thus, haemoglobin determinations is not very suitable for diagnosing early iron deficiency. The content of iron in roughages, apart from root crops (Table II), is usually sufficient to cover the requirement of domestic animals (Table III), which is met by about 50 mg per kg feed dry matter. Iron deficiency is very often caused by a reduced absorption in the intestinal tract because of components in the feed forming complexes with iron of very low solubility or inhibitors reducing the absorption processes. The immune status of the organism and its resistance against infections depends on the iron supply. Iron deficiency inhibits the myeloperoxidase activity and thus decreases the bacteriocide effect of the leucocytes. In spite of this, when exposed to infections the physiological mechanisms reduce the blood concentration of available iron. By this mode of action, invading pathogens, needing iron like the host animals, will be restrained. The low content of iron in milk (Table II) combined with a high content of iron binding lactoferrin, is ideal to protect newborn and milk fed young animals against intestinal infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗

Electrophysiologic abnormalities of heart in iron deficiency anemia. Effect of iron therapy.

55 patients with iron deficiency anemia (IDA) and 55 age- and sex-matched control subjects were given exercise test on a treadmill to observe the effect on ST segment of the electrocardiogram. 14 IDA patients showed significant ST segment depression compared to only 1 in the control group, the difference being highly significant (p less than 0.001). Test was repeated 2-3 days later in 12 IDA cases and it showed significant ST depression as on previous occasions showing the reproducibility of the results. 11 of these patients received total dose i.v. iron-dextran and the exercise test was repeated 2-3 days later before any significant rise in the hemoglobin level; in 10 cases there was no significant ST segment depression. Response to iron therapy was highly significant (p less than 0.003). Correction of electrophysiological abnormalities of the heart in IDA patients by iron therapy, before the rise of hemoglobin, may be the result of the effect of iron at the tissue level.

Adolescent↗

Iron deficiency in Europe.

In Europe, iron deficiency is considered to be one of the main nutritional deficiency disorders affecting large fractions of the population, particularly such physiological groups as children, menstruating women and pregnant women. Some factors such as type of contraception in women, blood donation or minor pathological blood loss (haemorrhoids, gynaecological bleeding...) considerably increase the difficulty of covering iron needs. Moreover, women, especially adolescents consuming low-energy diets, vegetarians and vegans are at high risk of iron deficiency. Although there is no evidence that an absence of iron stores has any adverse consequences, it does indicate that iron nutrition is borderline, since any further reduction in body iron is associated with a decrease in the level of functional compounds such as haemoglobin. The prevalence of iron-deficient anaemia has slightly decreased in infants and menstruating women. Some positive factors may have contributed to reducing the prevalence of iron-deficiency anaemia in some groups of population: the use of iron-fortified formulas and iron-fortified cereals; the use of oral contraceptives and increased enrichment of iron in several countries; and the use of iron supplements during pregnancy in some European countries. It is possible to prevent and control iron deficiency by counseling individuals and families about sound iron nutrition during infancy and beyond, and about iron supplementation during pregnancy, by screening persons on the basis of their risk for iron deficiency, and by treating and following up persons with presumptive iron deficiency. This may help to reduce manifestations of iron deficiency and thus improve public health. Evidence linking iron status with risk of cardiovascular disease or cancer is unconvincing and does not justify changes in food fortification or medical practice, particularly because the benefits of assuring adequate iron intake during growth and development are well established. But stronger evidence is needed before rejecting the hypothesis that greater iron stores increase the incidence of CVD or cancer. At present, currently available data do not support radical changes in dietary recommendations. They include all means for increasing the content of dietary factors enhancing iron absorption or reducing the content of factors inhibiting iron absorption. Increased knowledge and increased information about factors may be important tools in the prevention of iron deficiency in Europe.

Adolescent↗

sIgA- and IgM-containing cells in the intestinal mucosa of iron-deficient rats.

The effect of iron deficiency on the jejunal mucosa was studied in postweaning rats that had received a 3-wk regimen of either iron-deficient or iron-sufficient diet (iron content 6 and 50 mg/kg diet) and in rats given the iron-sufficient diet for 1 wk after the initial 3-wk iron-deficient diet. Morphometric analysis showed little difference in villous height but a significant decrease in mitotic index of the crypt epithelial cells in the iron-deficient group. Direct immunoperoxidase studies showed that iron-deficient rats had substantially fewer sIgA- and IgM-containing cells than iron-sufficient rats. This abnormality was reversed after a 1-wk iron-sufficient diet. We conclude that iron deficiency may impair local immunity in the intestinal mucosa, sensitizing the surface epithelial cells to damage by noxious agents. Similar changes might lead to the syndrome of iron-deficiency anemia and hypoproteinemia in children.

Anemia, Hypochromic↗

Prevalence of iron deficiency in the United States.

OBJECTIVE: To determine the prevalence of iron deficiency and iron deficiency anemia in the US population. DESIGN: Nationally representative cross-sectional health examination survey that included venous blood measurements of iron status. MAIN OUTCOME MEASURES: Iron deficiency, defined as having an abnormal value for at least 2 of 3 laboratory tests of iron status (erythrocyte protoporphyrin, transferrin saturation, or serum ferritin); and iron deficiency anemia, defined as iron deficiency plus low hemoglobin. PARTICIPANTS: A total of 24,894 persons aged 1 year and older examined in the third National Health and Nutrition Examination Survey (1988-1994). RESULTS: Nine percent of toddlers aged 1 to 2 years and 9% to 11% of adolescent girls and women of childbearing age were iron deficient; of these, iron deficiency anemia was found in 3% and 2% to 5%, respectively. These prevalences correspond to approximately 700,000 toddlers and 7.8 million women with iron deficiency; of these, approximately 240,000 toddlers and 3.3 million women have iron deficiency anemia. Iron deficiency occurred in no more than 7% of older children or those older than 50 years, and in no more than 1% of teenage boys and young men. Among women of childbearing age, iron deficiency was more likely in those who are minority, low income, and multiparous. CONCLUSION: Iron deficiency and iron deficiency anemia are still relatively common in toddlers, adolescent girls, and women of childbearing age.

Adolescent↗

Ferric trimaltol corrects iron deficiency anaemia in patients intolerant of iron.

BACKGROUND: Oral iron supplements, which are usually in the form of ferrous (Fe2+) salts, are toxic to the gastrointestinal mucosa, and so intolerance is common, resulting in poor compliance and failure of treatment. The sugar derivative maltol strongly chelates iron, rendering it available for absorption and stabilized in the less toxic ferric (Fe3+) form. AIM: To test whether ferric trimaltol could correct iron deficiency anaemia in patients intolerant of ferrous sulphate. METHODS: Twenty-three patients were recruited from gastroenterology clinics, of whom 1 5 had inflammatory bowel disease, a group often difficult to treat with oral iron. Patients with iron deficiency anaemia and documented intolerance to ferrous sulphate were given 3 months of treatment with ferric trimaltol. RESULTS: Nineteen of 23 patients completed the treatment and anaemia was fully corrected in 14 of these, mean haemoglobin increased from 106 +/- 15 to 126 +/- 16 g/L, and there was a particularly low incidence of side-effects. Of 11 patients with inflammatory bowel disease who completed the study, nine fully corrected their anaemia. CONCLUSION: The results demonstrate that in patients intolerant of ferrous compounds, ferric trimaltol corrects iron deficiency and has a low incidence of side-effects.

Anemia, Iron-Deficiency↗

Growth in iron-deficient rats.

Poor growth in iron deficiency is commonly observed in animal studies. Previous studies from our laboratory showed that iron-deficient rats are metabolically inefficient and have less body fat than controls and proposed that iron deficiency was related to increased metabolic rates and heat loss. To examine these points more completely, we examined growth and metabolic rate of iron-deficient rats at two environmental temperatures, 25 degrees C and 32 degrees C, and feed efficiency in separate groups of rats during a period of rapid growth. Iron deficiency (hemoglobin [Hb] approximately 60 g/liter) was associated with a systematic elevation of metabolic rate over the 24-hr day with animals at 25 degrees C. This did not occur in animals living in thermoneutrality. Iron deficiency affected growth of animals at 25 degrees C but not at 32 degrees C. Feed efficiency (kcal retained/kcal absorbed) was 25 +/- 4.2 and 31 +/- 4.9 kcal (P < 0.0001), respectively, in iron deficient rats and animals were not anorexic. Use of food-restricted animals allowed the direct calculation that iron deficiency was associated with a 10%-15% increase requirement for growth. We conclude that iron deficiency anemia is associated with a poor feed efficiency and that it is attenuated when nonshivering thermogenesis is minimized by a thermoneutral environment.

Anemia, Iron-Deficiency↗

Evaluation of cardiac function in iron deficiency anemia before and after total dose iron therapy.

OBJECTIVE: To evaluate the cardiac function before and after the total dose iron therapy (TDI) and to correlate the myocardial function to the rise in haemoglobin after TDI in patients of iron deficiency anemia. METHODS: The study included 30 patients of iron deficiency anemia who presented to our institution in the last one year. There were 11 men and 19 women with the mean age of 30 years. Parameters compared before and after TDI infusion included clinical features, haemoglobin, electrocardiogram (ECG), treadmill stress test (TST) and 2 dimensional echocardiogram (2D echo). RESULTS: During the study period 30 patients (11 men and 19 women) were included for TDI. The mean haemoglobin level increased from 5 gm/dl to 5.7 gm/dl 4 days after TDI. The congestive cardiac failure disappeared in four out of eight patients after TDI. The mean heart rate on the ECG pretherapy was 102.66 +/- 14.9 and post therapy 93.4 +/- 14.9 (p = 0.011). The TST results showed improvement in effort tolerance in 17 out of 24 patients (p = 0.0012) and it improved much before there was a significant rise in haemoglobin. CONCLUSION: Impaired ventricular performance is observed in patients with iron deficiency anemia. After TDI the left ventricular function improved before there was a significant rise in haemoglobin level proving the theory that correction of the electrophysiological abnormalities of the heart in iron deficiency patient by TDI may be the result of correction of iron at the tissue level.

Adolescent↗

Iron deficiency anemia and depleted body iron reserves are prevalent among pregnant African-American adolescents.

Anemia is prevalent among pregnant adolescents, but few data exist on biochemical indicators of iron status in this group. We hypothesized that among an at-risk population of African-American, pregnant adolescents, the degree of iron depletion and deficiency would be marked, and that iron deficiency anemia would comprise the majority of the observed anemia. To examine this, blood samples were collected from 80 girls (< or =18 y old) attending an inner city maternity clinic, 23 of whom were studied longitudinally in the 2nd and 3rd trimesters depending on contact at the clinic. Sample sizes for the biomarkers varied according to the blood volume available at the time the assays were completed. Descriptive statistics were applied to characterize iron status, and multivariate regression and logistic analyses were used to identify significant determinants of iron status. Depleted iron stores (ferritin < or = 15 microg/L) were indicated for 25% (n = 44) and 61% (n = 59) of adolescents during the 2nd and 3rd trimesters, respectively. Serum folate (39.3 +/- 15.4 nmol/L, n = 60), RBC folate (2378 +/- 971 nmol/L, n = 60), and serum vitamin B-12 concentrations (313 +/- 163 pmol/L, n = 60) were within normal ranges. Adolescents with serum transferrin receptor:serum ferritin ratios (R:F ratio) > 300 during the 2nd trimester were 12.5 times (95% CI 2.83, 55.25) more likely to be classified with iron deficiency anemia during the 3rd trimester (P = 0.0002) than those with lower ratios. Estimates of body iron were lower in those tested after wk 26 of gestation (P < 0.0001), and reserves were depleted in 5.0% vs. 31.3% of the 2nd (n = 40) and 3rd (n = 48) trimester cohorts, respectively. In conclusion, iron-deficiency anemia was prevalent among these pregnant minority adolescents. Targeted screening and interventions to improve diet and compliance with prenatal iron supplementation are warranted for this at-risk group.

Adolescent↗

Red cell distribution width in the detection of iron deficiency in maintenance hemodialysis patients.

Iron deficiency is a frequent complication in maintenance hemodialysis patients. Red cell distribution width (RDW) was recently used as an indicator in early detection of iron deficiency. One hundred and thirty nine patients maintained on hemodialysis were studied for the usefulness of RDW in detection of iron deficiency. Serum ferritin less than 30 ug/dl was defined as iron deficiency in these patients. Another 69 patients with iron deficiency not entering hemodialysis were chosen as a control group. The sensitivity of RDW elevation to detect iron deficiency in chronic hemodialysis patients was only 36.7% which was much lower than that of the control group (62.3%). However, it was still more sensitive than microcytosis in the detection of iron deficiency in chronic hemodialysis patients because none of them showed microcytosis. The specificity and positive predictive value of RDW elevation in respect to iron deficiency were 62.4% and 9.6% respectively. This study demonstrated that the use of RDW in the detection of iron deficiency in chronic hemodialysis patients was superior to mean corpuscular volume but still limited.

Erythrocyte Count↗