Accumulation of storage iron in patients treated for iron-deficiency anaemia.

The repletion of iron stores after treatment was studied in 38 patients with uncomplicated iron-deficiency anaemia. The serum ferritin concentration rose significantly when oral treatment was continued for two months after the attainment of a normal haemoglobin concentration. Patients treated with a total-dose infusion of iron dextran had thehighest final serum levels, which were significantly greater than in patients given Ferro-Gradumet. Oral ferrous sulphate was almost as effective as parenteral iron in producing iron stores.     

Utilization of Iron Dextran

The utilization of iron dextran was investigated in normal subjects, in patients with iron-deficiency anaemia, and in anaemias associated with rheumatoid arthritis, reticulosis, and uraemia. Utilization of iron for haemoglobin formation at 14 days was found to be depressed in patients with rheumatoid arthritis, reticulosis, and uraemia, but when a concomitant iron-deficiency anaemia was present utilization was significantly increased. When iron dextran is used to treat anaemias in such conditions an optimum therapeutic response will be obtained only when bone marrow iron stores are absent.     

Humoral immune response in children with iron-deficiency anaemia.

The humoral immune response (as shown by plasma immunoglobulin concentrations and antibody response to diphtheria and tetanus toxoids) was evaluated in 14 children with iron-deficiency anaemia and in 24 normal controls. Mean concentrations of haemoglobin and serum iron and mean transferrin saturation were significantly lower in children with iron-deficiency anaemia than in controls. Serum immunoglobulin concentrations were within the normal range in both groups. Two weeks after immunisation with diphtheria and tetanus toxoids the concentrations of IgG increased significantly in both groups. Antibody titres in iron-deficient children were similar to those of controls before and after immunisation. The mean T-lymphocyte count was significantly lower in iron-deficient children than that in controls, but the mean B-lymphocyte counts were similar in the two groups. These observations suggest that humoral immunity in children is not affected by iron deficiency and that conventional immunisation programmes would be effective in children with iron-deficiency anaemia.     

Effect of iron supplementation on oxidative stress and antioxidant status in iron-deficiency anemia

This study was designed to measure the effect of iron supplementation on antioxidant status in iron-deficient anemia, including the time for hemoglobin normalization and at the time of filling of iron body stores. The extent of plasma lipid peroxidation was evaluated by measuring the levels of malondialdehyde and glutathione peroxidase (GSH-Px), and the activities of superoxide dismutase (SOD) and catalase in 63 patients with iron-deficiency anemia before and after 6 wk of iron supplementation and at the time when body iron stores are saturated. After 6 wk of iron supplementation, a significant decrease of oxidative stress was observed in the treated subjects relative to controls (p<0.05). No significant differences existed between treated patients at 6 wk and at the end of the study. The erythrocyte levels of catalase, SOD, and GSH-Px were significantly lower in treated patients relative to controls (p<0.05). These levels increased after 6 wk of supplementation (p<0.05) and showed no significant differences with those at the end of the study.     

Iron-deficiency anaemia enhances red blood cell oxidative stress

Oxidative stress associated with iron deficiency anaemia in a murine model was studied feeding an iron-deficient diet. Anaemia was monitored by a decrease in hematocrit and haemoglobin. For the 9 week study an increase in total iron binding capacity was also demonstrated. Anaemia resulted in an increase in red blood cells (RBC) oxidative stress as indicated by increased levels of fluorescent heme degradation products (1.24-fold after 5 weeks; 2.1-fold after 9 weeks). The increase in oxidative stress was further confirmed by elevated levels of methemoglobin for mice fed an iron-deficient diet. Increased haemoglobin autoxidation and subsequent generation of ROS can account for the shorter RBC lifespan and other pathological changes associated with iron-deficiency anaemia.     

Antenatal Iron Supplementation Regimens for Pregnant Women in Rural Vietnam and Subsequent Haemoglobin Concentration and Anaemia among Their Infants

Background

Little evidence about the effects of antenatal iron supplementation on infant anaemia is available. The aim was to compare effects on six-month-old infants’ Haemoglobin (Hb) concentration and anaemia of daily iron–folic acid (IFA), twice-weekly IFA with or without other micronutrients (MMN) and usual antenatal care in rural Vietnam.

Methods and Findings

Secondary data analysis from: a prospective population-based observational study (OS) which examined effects of antenatal psychosocial factors, anaemia and iron deficiency on infant development and health; and a three-arm cluster randomised trial (CRT) of different antenatal iron supplementation regimens. In the OS 497 women (<20 weeks gestation) from 50 randomly-selected communes participated, and in the CRT 1,258 pregnant women (<16 weeks gestation) in 104 communes were allocated randomly to trial arms. The main outcome was six-month-old infant Hb concentration. Baseline data included women’s socio-demographic characteristics, reproductive health, Hb and serum ferritin. Mean differences in infant Hb and odds ratios of infant anaemia between CRT arms and OS were calculated by multivariable regression models, controlling for baseline differences and clustering, using robust standard errors.Infant anaemia prevalence was 68.6% in the OS, 47.2% daily IFA, 53.5% weekly IFA, and 50.3% MMN conditions. After adjustment, mean infant haemoglobin levels in daily IFA (mean difference = 0.95 g/dL; 95%CI 0.7-11.18); weekly IFA (0.91; 95%CI 0.69-1.12) and MMN (1.04; 95%CI 0.8-1.27) were higher than in the OS. After adjustment there were lower odds ratios of anaemia among infants in the daily IFA (OR = 0.31; 95% CI 0.22-0.43), weekly IFA (0.38; 95%CI 0.26-0.54) and MMN (0.33; 95%CI 0.23-0.48) groups than in the OS.

Conclusions

Infant anaemia is a public health problem in Vietnam and other resource-constrained countries. All supplementation regimens could have clinically significant benefits for Hb and reduce anaemia risk among six-month-old infants. Universal provision of free intermittent iron supplements is warranted.     

Effects of trace element levels on platelet aggregation

Platelet aggregation was measured by an optical method in 32 patients with iron-deficiency anemia at the time of diagnosis and after a period of supplementation with iron. Epinephrine- and adenosine diphosphate-induced platelet aggregation were lower in anemic patients than in the controls (p<0.05). After iron-supplementation therapy, these values showed no significant differences. If induced by collagen or ristocetin, platelet aggregation was the same for patients and controls, but increased after treatment of patients (p<0.05). The plasma zinc values did not show significant differences among the subjects included in this study. These results show that iron is involved in the enzymatic systems that regulate platelet aggregation. The exact nature of this interaction is still to be determined.     

Serum iron and transferrin during an exhaustive session of interval training

Conflicting data have been reported on "sports anaemia" and anaemia during physical training. Most of these results are of studies at rest before or after training. The aim of this investigation was to further study the profiles of serum iron (Se Fe) and transferrin (Se Tr), in 14 physically trained men (28 +/- 6 years) during an exhaustive interval training session. The 45 min Square-Wave Endurance Exercise Test (SWEET) was performed on a cycle ergometer. To the SWEET base, established as a % of individual VO2max, a peak of 1 min at VO2max was added every 5 minutes. Arterial blood samples were taken at rest, during the SWEET at the 14th, 15th, 29th, 30th, 44th and 45th minutes, just before and after the peaks, and at the 15th min of recovery. Lactate, acidity [H+], PaCO2, PaO2, Haematocrit (Hct), Haemoglobin (Hb), Se Fe and Se Tr were measured. After the SWEET, weight loss was 0.89 +/- 0.15 kg. Lactate and serum iron rose progressively at the base levels and at the peaks, while PaCO2 and bicarbonate fell progressively. Hct, [Hb], serum transferrin and [H+] increased significantly at the 14th min of SWEET and thereafter no change was observed. At the 45th min with respect to the value at rest, Se Fe increased as much as +32%, Se Tr +13% and [Hb] +8%. Haemoconcentration could explain the changes in Se Tr but not the total significant increase in Se, Fe, which moreover is not explained by acidosis [H+].(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of Green Tea Supplementation on Elements, Total Antioxidants, Lipids, and Glucose Values in the Serum of Obese Patients

The consumption of green tea has been associated with cardiovascular and metabolic diseases. There have been some studies on the influence of green tea on the mineral status of obese subjects, but they have not yielded conclusive results. The aim of the present study is to examine the effects of green tea extract on the mineral, body mass, lipid profile, glucose, and antioxidant status of obese patients. A randomized, double-blind, placebo-controlled study was conducted. Forty-six obese patients were randomly assigned to receive either 379?mg of green tea extract, or a placebo, daily for 3?months. At baseline, and after 3?months of treatment, the anthropometric parameters, blood pressure, and total antioxidant status were assessed, as were the levels of plasma lipids, glucose, calcium, magnesium, iron, zinc, and copper. We found that 3?months of green tea extract supplementation resulted in decreases in body mass index, waist circumference, and levels of total cholesterol, low-density cholesterol, and triglyceride. Increases in total antioxidant level and in zinc concentration in serum were also observed. Glucose and iron levels were lower in the green tea extract group than in the control, although HDL-cholesterol and magnesium were higher in the green tea extract group than in the placebo group. At baseline, a positive correlation was found between calcium and body mass index, as was a negative correlation between copper and triglycerides. After 3?months, a positive correlation between iron and body mass index and between magnesium and HDL-cholesterol, as well as a negative correlation between magnesium and glucose, were observed. The present findings demonstrate that green tea influences the body's mineral status. Moreover, the results of this study confirm the beneficial effects of green tea extract supplementation on body mass index, lipid profile, and total antioxidant status in patients with obesity.     

Erythrocyte CuZn superoxide dismutase activity is decreased in iron-deficiency anemia

Iron and copper and essential microminerals that are intimately related. The present study was performed to determine the effect of iron-deficiency anemia (IDA) and treatment with iron on laboratory indicators of copper status. Hemoglobin, mean corpuscular volume erythrocyte Zn protoporphyrin, serum ferritin, serum copper, serum ceruloplasmin, and erythrocyte CuZn-superoxide dismutase (SOD) activity were studied in 12 adult women with IDA before and after iron treatment for 60–90 d (100 mg/d Fe, as ferric polymaltose) and in 27 women with normal iron status. Prior to treatment with iron, serum copper and ceruloplasmin were not different between the groups and treatment with iron did not affect these measures. IDA women, before and after treatment with iron, presented a 2.9- and 2-fold decrease in erythrocyte CuZn-SOD activity compared to women with normal iron status (p <0.001). Treatment with iron increased erythrocyte CuZn-SOD activity of the IDA group; however, this change was not statistically significant. in conclusion, CuZn-SOD activity is decreased in IDA. Measurement of this enzyme activity is not useful for evaluating copper nutrition in iron-deficient subjects.     

Randomized Placebo-Controlled Trial of Helicobacter pylori Eradication for Iron-Deficiency Anemia in Preadolescent Children and Adolescents

Background. A few cases relating H. pylori infection to iron-deficiency anemia have been described recently. We investigated the role of H. pylori infection in iron-deficiency anemia in preadolescent children and adolescents.
Patients and Methods. We conducted a double-blind, placebo-controlled therapeutic trial in 43 subjects (mean age, 15.4 years) with iron-deficiency anemia. Endoscopy was performed, and biopsy specimens were examined by urease test and histological analysis. Twenty-two of 25 H. pylori –positive patients were assigned randomly to three groups. Group A patients were given oral ferrous sulfate and a 2-week course of bismuth subcitrate, amoxicillin, and metronidazole. Group B patients were given placebo for iron and a 2-week course of triple therapy. Group C patients were given oral ferrous sulfate and a 2-week course of placebo. Iron status was reassessed 4 weeks and 8 weeks after the 2-week regimen ended.
Results. Of the 43 subjects with iron-deficiency anemia, 25 (58.1%) had H. pylori in the antrum. Group A and B subjects, who received eradication therapy, showed a significant increase in hemoglobin level as compared with group C subjects at 8 weeks after therapy ( p = .0086).
Conclusions. Treatment of H. pylori infection was associated with more rapid response to oral iron therapy as compared with the use of iron therapy alone. Such treatment also led to enhanced iron absorption even in those subjects who did not receive oral iron therapy.     

Geophagia sideropenica]

The authors describe two cases of geophagia (45 years old mother and her 25 years old daughter). Both suffered from an anaemia of medium degree only (case 1: 3.77 million of erythrocytes, Hb 8.5 g%; case 2: 3.34 million of erythrocytes, Hb 10 g%), there was a serious iron deficiency (46 and 35 microgram % respectively of serum iron). Both were blood donors, the mother 7 times and the daughter 31 times. In both cases the iron deficiency existed before geophagia. The desire for eating argillacecous earth already disappeared after the application of some ampules of Ferrlecit injected intravenously, even before the values of the serum iron and the number of erythrocytes had changed. The number of erythrocytes, the Hb value and that of haematocrit as well as the values of the serum iron normalized completely. EEG changes were observed in both cases, which could be influenced by the ferrotherapy. The authors recommend the serum iron estimation in all blood donors as well as the introduction of their routine treatment with iron preparations.     

低频交变磁场刺激对缺铁性贫血大鼠贫血改善的作用研究

目的:明确低频正弦波交变电磁场对缺铁性贫血大鼠贫血改善的作用效果,为其未来的临床应用提供实验依据。方法:雄性断乳的SPF级Sprague-Dawley(SD)大鼠,共36只,随机的等分为空白对照组(n=12)、缺铁性贫血组(n=12)和缺铁性贫血+电磁场刺激组(n=12)。缺铁性贫血组和缺铁性贫血+电磁场刺激组的大鼠饲养以低铁饲料和去离子水,每周尾静脉放血1 m L。空白对照组大鼠饲养以常规饲料和普通蒸馏水,且不予尾静脉放血。对缺铁性贫血+电磁场刺激组的12只大鼠施加全身低频交变电磁场刺激,每天刺激2小时,连续刺激10周。实验结束后提取大鼠血液样本,使用氰化高铁血红蛋白法进行测定全血血红蛋白含量,使用专用试剂盒测定血清铁和总铁结合力;提取肝脏和脾脏组织,对肝脏铁和脾脏铁含量进行测定。结果:全身暴露低频交变电磁场刺激显著提高了缺铁性贫血大鼠体重(P0.05),提升了其血清铁含量(P0.05),显著提高全血血红蛋白含量(P0.05),并显著降低了缺铁性贫血大鼠血清总铁结合力(P0.05);同时,电磁刺激也显著提高了缺铁性贫血大鼠肝脏铁和脾脏铁含量(P0.05)。结论:交变电磁场作为一种经济、安全、无创的物理作用方式,具有较为显著的缺铁性贫血的改善效果。     

左卡尼汀联合蔗糖铁对血液透析患者肾性贫血及氧化应激的影响

目的:探讨左卡尼汀联合蔗糖铁对血透患者肾性贫血及氧化应激的影响。方法:抽选我院2010年3月-2013年5月行维持血透治疗的肾性贫血患者79例,采用数字表法分为对照组(39例)和观察组(40例),对照组采用促红细胞生成素(EPO)、单用蔗糖铁及常规对症治疗,观察组在对照组基础上联用左卡尼汀治疗。比较两组患者治疗前、治疗6个月后血红蛋白(Hb)、血细胞比容(Hct)、血浆铁蛋白(SF)、转铁蛋白饱和度(TSAT)、晚期蛋白质氧化产物(AOPP)及血丙二醛(MDA)水平,并对两组治疗开始时、治疗3、6个月时EPO使用剂量进行比较。结果:治疗6个月后,观察组患者Hb、Hct、SF、TSAT明显高于对照组(P0.05),AOPP、MDA明显低于对照组(P0.05);对照组从治疗开始到治疗6个月时一直维持较高的EPO使用剂量,而观察组EPO用量依次递减,至治疗6个月时EPO用量显著低于对照组(P0.05)。结论:左卡尼汀能联合蔗糖铁治疗肾性贫血的疗效显著,能有效缓解氧化应激反应,降低EPO用量,值得临床推广。     

Long-term weekly iron-folic acid and de-worming is associated with stabilised haemoglobin and increasing iron stores in non-pregnant women in Vietnam

Background

The prevalence of anaemia and iron deficiency in women remains high worldwide. WHO recommends weekly iron-folic acid supplementation where anaemia rates in non-pregnant women of reproductive age are higher than 20%. In 2006, a demonstration project consisting of weekly iron-folic acid supplementation and regular de-worming was set up in two districts in a northern province in Vietnam where anaemia and hookworm rates were 38% and 76% respectively. In 2008 the project was expanded to all districts in the province, targeting some 250,000 women. The objectives of this study were to: 1) examine changes in haemoglobin, iron stores and soil transmitted helminth infection prevalence over three years and 2) assess women''s access to and compliance with the intervention.

Methods and Findings

The study was a semi-cross-sectional, semi-longitudinal panel design with a baseline survey, three impact surveys at three-, twelve- and thirty months after commencement of the intervention, and three compliance surveys after ten weeks, eighteen and thirty six months.

Results

After thirty months, mean haemoglobin stabilised at 130.3 g/L, an increase of 8.2 g/L from baseline, and mean serum ferritin rose from 23.9 µg/L to 52 µg/L. Hookworm prevalence fell from 76% to 22% over the same period. After thirty six months, 81% of the target population were receiving supplements and 87% were taking 75% or more of the supplements they received.

Conclusions

Weekly iron-folic acid supplementation and regular de-worming was effective in significantly and sustainably reducing the prevalence of anaemia and soil transmitted helminth infections and high compliance rates were maintained over three years.     

Non-anemic iron deficiency,oral iron supplementation,and oxidative damage in college-aged females

Oxidative damage, as indicated by protein carbonyl and lipid hydroperoxide concentrations, was assessed in the plasma of college-aged females with adequate iron status and with non-anemic iron deficiency before and after eight weeks of iron supplementation. At baseline, the mean serum ferritin, iron, transferrin saturation, and total iron binding capacity of the iron deficient group (n = 13) was significantly different from the iron adequate controls (n = 24). Mean plasma lipid hydroperoxide and protein carbonyl concentrations did not differ between groups at baseline. Following eight weeks of iron supplementation, the mean serum ferritin, iron, and transferrin saturation significantly increased and the total iron binding capacity significantly decreased in the iron deficient group. No significant differences in plasma lipid hydroperoxide or protein carbonyl concentrations were found between groups at the end of the study period. When plasma lipid hydroperoxide and protein carbonyl concentrations of subjects within groups were compared at the start versus at the end of the study, no significant differences were found for either group. Neither non-anemic iron deficiency nor its treatment with oral iron supplements is associated with oxidative damage in the plasma of college-aged females.     

Consequences of 6 weeks of strength training on red cell O2 transport and iron status

Effects of endurance training on O2 transport and on iron status are well documented in the literature. Only a few data are available concerning the consequences of strenuous anaerobic muscular exercise on red cell function. This study was performed to test the influence of strength training alone on parameters of red cell O2 transport and iron status. Twelve healthy untrained males participated in a strength-training programme of 2-h sessions four times a week lasting 6 weeks. After 6 weeks a small but significant reduction of haemoglobin (Hb; -5.4 g.l-1) was found (p less than 0.05). Mean red cell volume did not change, but a pronounced decrease of mean cell Hb concentration (from 329.2 g.l-1, SE 2.5 to 309.8 g.l-1, SE 1.2; p less than 0.001) and mean corpuscular Hb (from 29.6 pg, SE 0.4 to 27.7 pg, SE 0.3; p less than 0.01) was observed. Serum ferritin decreased significantly by 35% (p less than 0.01); transferrin, serum iron and iron saturation of transferrin were unaltered. Serum haptoglobin concentration was diminished significantly by 30.5% (p less than 0.01). The reticulocyte count had already increased after 3 weeks of training (p less than 0.05) and remained elevated during the following weeks. Strength training had no significant influence on the O2 partial pressure at which Hb under standard conditions was 50% saturated, red cell 2,3-diphosphoglycerate and ATP concentration as well as on erythrocytic glutamate-oxalacetate transaminase activity. The data demonstrate that mechanical stress of red cells due to the activation of large muscle masses led to increased intravascular haemolysis, accompanied by a slightly elevated erythropoiesis, which had no detectable influence on Hb-O2 affinity. Training caused an initial depletion of body iron stores (prelatent iron deficiency). Although Hb had decreased by the end of the training phase a true "sports anaemia" could not be detected.     

Disparity between dietary iron intake and iron status of children aged 10-12 years

Iron status was assessed in a representative sample of 188 adolescents living in a medium-sized city in Poland. Dietary intakes were evaluated using records of diet over a period of seven consecutive days. Subjects were considered to be iron deficient when two or more of the following parameters were abnormal: serum ferritin, transferrin saturation or mean corpuscular haemoglobin concentration. Based on this definition, the prevalence of iron deficiency in the investigated sample of children aged from ten to twelve years was 12.7%. Iron deficiency anaemia was defined using the following criteria: haemoglobin values less than 12.0 g. dl (-1) in girls or less than 12.2 g. dl(-1) in boys, combined with an iron deficiency. With such a definition, the prevalence of iron deficiency anaemia in all subjects was 6.3%. Four boys (3.9%) and six girls (6.8%) were diagnosed as anaemic. The values for Hb in the anaemic boys ranged from 10.9 to 12.2 g. dl (-1) and in anaemic girls from 8.7 to 12.0 g. (-1). It was found that the majority of the individuals studied had a dietary haem-iron intake lower than that recommended. No relationship was found between the level of serum ferritin and total iron and vitamin C dietary intake, but there was positive correlation between serum ferritin and intake of haem iron. A seven-day dietary history questionnaire correctly identified children at risk of iron deficiency anaemia.     

Long-term zinc and iron supplementation in children of short stature: effect of growth and on trace element content in tissues.

We evaluated the effect of one year of supplementation with iron plus zinc (12 mg/day of Fe+++ and 12.5 mg/day of Zn++), zinc alone (12.5 mg/day of Zn++) and placebo on growth and on the iron, zinc, copper and selenium tissue contents in 30 well-selected children of short stature (16 M and 14 F; 4-11 years old). Before and after supplementation, we measured the concentrations of iron, transferrin, ferritin, zinc and copper in serum, of zinc in erythrocytes and leukocytes, and of zinc, copper and selenium in hair, as well as glutathione peroxidase activity in erythrocytes. Before supplementation, ferritin and serum, erythrocyte and hair zinc contents were significantly lower than in age-matched controls, while the other measured indices were in the normal range. Iron plus zinc supplementation caused an improvement in growth rate in all subjects, i.e., the median Z-score increased from -2.22 +/- 0.45 to -0.64 +/- 0.55; (p < 0.01). In the zinc-supplemented group, only the subjects whose ferritin levels were higher than 20 ng/L before supplementation showed a similar improvement of growth rate. Iron plus zinc supplementation could be a reasonable treatment in short, prepubertal children affected by marginal zinc and iron deficiency.     

Genotyping of alpha-thalassemia in microcytic hypochromic anemia patients from North India

Microcytic hypochromic anemia is a common condition in clinical practice and alpha-thalassemia has to be considered as a differential diagnosis. Molecular diagnosis of alpha-thalassemia is possible by polymerase chain reaction. The aim of this study was to evaluate the frequency of alpha-gene numbers in subjects with microcytosis. In total, 276 subjects with microcytic hypochromic anemia [MCV<80fl; MCH<27pg] were studied. These include 125 with thalassemia trait, 48 with thalassemia major, 26 with sickle-cell thalassemia, 15 with E beta-thalassemia, 40 with iron-deficiency anemia, 8 with another hemolytic anemia, and 14 patients with no definite diagnosis. Genotyping for -alpha3.7 deletion, -alpha4.2 deletion, Hb Constant Spring, and a-triplications was done with polymerase chain reaction. The overall frequency of -alpha3.7 deletion in 276 individuals is 12.7%. The calculated allele frequency for a-thalassemia is 0.09. The subgroup analysis showed that co-inheritance of a-deletion is more frequent with the sickle-cell mutation than in other groups. We were able to diagnose 1/3 of unexplained cases of microcytosis as a-thalassemia carriers. The a-gene mutation is quite common in the Indian subcontinent. Molecular genotyping of a-thalassemia helps to diagnose unexplained microcytosis, and thus prevents unnecessary iron supplementation.