Evaluation of Iron Status in Patients on Chronic Hemodialysis: Relative Usefulness of Bone Marrow Hemosiderin, Serum Ferritin, Transferrin Saturation, Mean Corpuscular Volume and Red Cell Protoporphyrin

Nephron ◽  
1983 ◽  
Vol 35 (3) ◽  
pp. 196-200 ◽  
Author(s):  
J. Moreb ◽  
M.M. Popovtzer ◽  
M.M. Friedlaender ◽  
A.M. Konijn ◽  
C. Hershko
Keyword(s):  
Bone Marrow ◽  
Serum Ferritin ◽  
Mean Corpuscular Volume ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Chronic Hemodialysis ◽  
Red Cell ◽  
Corpuscular Volume

scholarly journals Evaluation of the iron status of a population

Blood ◽  
1976 ◽  
Vol 48 (3) ◽  
pp. 449-455 ◽  
Author(s):  
JD Cook ◽  
CA Finch ◽  
NJ Smith
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Red Cell ◽  
Adult Males ◽  
Packed Red Blood Cells ◽  
Iron Deficient ◽  
Menstruating Women ◽  
Prevalence Of Anemia

Abstract The iron status of a population of 1564 subjects living in the northwestern United States was evaluated by measurements of transferrin saturation, red cell protoporphyrin, and serum ferritin. The frequency distribution of these parameters showed no distinct separation between normal and iron-deficient subjects. When only one of these three parameters was abnormal (transferrin saturation below 15%, red cell protoporphyrin above 100 mug/ml packed red blood cells, serum ferritin below 12 ng/ml), the prevalence of anemia was only slightly greater (10.9%) than in the entire sample (8.3%). The prevalence of anemia was increased to 28% in individuals with two or more abnormal parameters, and to 63% when all three parameters were abnormal. As defined by the presence of at least two abnormal parameters, the prevalence of iron deficiency in various populations separated on the basis of age and sex ranged from 3% in adolescent and adult males to 20% in menstruating women. It is concluded that the accuracy of detecting iron deficiency in population surveys can be substantially improved by employing a battery of laboratory measurements of the iron status.

scholarly journals Effects of Iron Fortification in a School Feeding Scheme and Anthelmintic Therapy on the Iron Status and Growth of Six- to Eight-Year-Old Schoolchildren

1996 ◽  
Vol 17 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Marita Kruger ◽  
Chad J. Badenhorst ◽  
Erna P. G. Mansvelt ◽  
Jacoba A. Laubscher ◽  
A. J. Spinnler Benadé
Keyword(s):  
Serum Ferritin ◽  
Mean Corpuscular Volume ◽  
Iron Status ◽  
Corpuscular Volume ◽  
Iron Fortification ◽  
Iron Stores ◽  
Positive Effects ◽  
School Feeding ◽  
Z Scores ◽  
Height For Age

The effect of iron fortification of soup in a school feeding scheme (20 mg iron and 100 mg vitamin C per portion) and anthelmintic therapy on haematological and iron status and on growth was studied in 179 schoolchildren age six to eight years. Measurements were performed before and at the end of a six-month intervention and repeated five months later. In children with low baseline iron stores (serum ferritin <20 μg/L), iron fortification was associated with increases in haemoglobin (p <.05), mean corpuscular volume (p <.01), and serum ferritin (p<.0001), compared with children who received unfortified soup. Significant positive effects of the anthelmintic therapy on haemoglobin concentrations (p < .05) and height-for-age Z scores (p<.01) were found. Children with adequate baseline iron stores showed smaller but similar changes.

scholarly journals Management of iron deficiency anemia in hemodialysis patients based on mean corpuscular volume

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kumiko Onda ◽  
Teruo Koyama ◽  
Sanae Kobayashi ◽  
Yoji Ishii ◽  
Kazuo Ohashi
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Mean Corpuscular Volume ◽  
Iron Supplementation ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
Intravenous Iron ◽  
Deficiency Anemia ◽  
Corpuscular Volume ◽  
Current Standard

Abstract Background To manage the anemic status in hemodialysis (HD) patients, a well-balanced combination therapy based on the use of erythropoiesis-stimulating agents (ESAs) and iron supplementation is essential. Serum ferritin level and transferrin saturation rate (TSAT) are the current standard tests for screening iron deficiency status. However, these are not included in frequently checked regular blood measurements in many HD centers. Other parameters that could predict a hemoglobin (Hb) increase response from iron supplementation have yet to be established. To determine a frequently checked and regularly measured biomarker for predicting iron deficiency status, this study investigated the value of mean corpuscular volume (MCV) as a clinical parameter for HD patients receiving intravenous iron supplementation (Fe-IV) therapy. Methods and results One hundred thirty four HD patients, 88 non-HD patients with anemia, and 50 HD patients on Fe-IV therapy from the Nozatomon clinic were assessed. Comparison of MCV values of anemic HD patients and anemic non-chronic kidney disease (CKD) patients showed that anemic HD patients had significantly higher MCV values (93.9 ± 7.3 fL) compared with anemic non-CKD patients (82.8 ± 8.8fL). Fifty HD patients, who received Fe-IV therapy at ten consecutive HD sessions (inclusion criteria: Hb ≤ 12.0 g/dL, TSAT < 20%, and serum ferritin < 100 ng/mL) showed a rapid increase during the Fe-IV period in MCV, Hb, and TSAT levels. After the completion of the Fe-IV therapy, MCV persisted at the increased levels, whereas Hb levels further increased and peaked at 1 month with a gradual decline after, largely influenced by ESA dosage reductions. The 50 patients were divided into three groups according to the MCV levels obtained immediately prior to the Fe-IV therapy (MCV ≤ 85 fL, 85 fL < MCV ≤ 90 fL, MCV > 90 fL), and Hb changes at 50 days after the initiation of the Fe-IV therapy were compared. All the patients in the MCV ≤ 85 fL group and most of the patients in the 85 fL < MCV ≤ 90 fL group showed linear and consistent Hb increase during the 50-day period. In marked contrast, patients in the MCV > 90 fL group showed dispersed trends in their Hb increase. The present study also revealed that successful ESA dosage reduction could be achieved after the Fe-IV therapy in both the MCV ≤ 85 fL and 85 fL < MCV ≤ 90 fL groups. Conclusions The present study underscored the value of MCV in perceiving iron deficiency status as well as predicting iron-based therapeutic response in HD patients.

scholarly journals MO911ALTERED CIRCULATING OMENTIN-1 LEVELS REFLECT IRON DEFICIENCY IN CHRONIC HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Davide Bolignano ◽  
Pierangela Presta ◽  
Giuseppina Crugliano ◽  
Marta Greco ◽  
Francesco Dragone ◽  
...  
Keyword(s):  
Pilot Study ◽  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Serum Levels ◽  
Chronic Hemodialysis ◽  
Serum Samples ◽  
Discriminatory Capacity ◽  
Better Than

Abstract Background and Aims Iron deficiency is pervasive among hemodialysis (HD) patients; however, although transferrin saturation (TSAT) of &lt;20% and/or serum ferritin of &lt;200 ng/mL should express iron scarcity, in HD patients high ferritin levels could be related to inflammation rather than reflecting optimal iron stores. Omentin-1 is an anti-inflammatory adipokine that is also involved in regulation of iron metabolism through binding with lactoferrin. In this pilot study, we aimed at evaluating serum levels of Omentin-1 in a small HD population, in order to determine its possible relationships with iron status. Method Omentin-1 was measured by ELISA in serum samples of 33 chronic HD patients before a single mid-week HD session and at 1h, 2h and 3h after dialysis start. Common biochemical and clinical parameters were also recorded. Results Serum omentin-1 levels were statistically higher in HD patients than in matched healthy controls (763 [367-1423] vs. 371 [228-868] ng/mL; p=0.03). Omentin-1 levels were broken down after the first hour of HD (reduction ratio: 45±5%) and tended to get back to baseline after the third hour (p=0.04). Correlation analyses showed omentin-1 levels to be directly associated with serum iron (R=0.380; p=0.03), ferritin (R=0.843; p&lt;0.001), TSAT (R=0.661; p&lt;0.001), serum amylase (R=0.454; p=0.01), ALT (R=0.380; p=0.03) and inversely with serum phosphate (R=-0.403; p=0.02), troponin (R=-0.443; p=0.01) and transferrin (R=-0.390;p=0.04). At ROC analyses, Omentin-1 levels showed a remarkable capacity to discriminate HD patients with iron deficiency (TSAT&lt;20%) with an AUC of 0.830 (95%CI 0.658 to 1.000; p=0.002. best cut-off value: ≤478.8 ng/mL; sens. 75%; spec. 85%). Of note, such discriminatory capacity was even better than that of serum ferritin (AUC 0.739; 95%CI 0.528 to 0.950; p for differences between AUCs=0.04; Figure 1) Conclusion Findings from this pilot study demonstrate that HD patients have altered Omentin-1 values probably because this protein is involved in the maintenance of iron equilibrium. Larger studies are needed to confirm whether Omentin-1 might be proposed as a new tool in the assessment of iron deficiency and in the management of iron therapy for HD patients.

scholarly journals CORRELATION BETWEEN THE MEAN CORPUSCULAR VOLUME AND RETICULOCYTOSIS IN PHENYLHYDRAZINE ANEMIA IN SWINE

Blood ◽  
1949 ◽  
Vol 4 (11) ◽  
pp. 1256-1263 ◽  
Author(s):  
F. DOUGLAS LAWRASON ◽  
D. C. ELTZHOLTZ ◽  
C. R. SIPE ◽  
P. K. SCHORK
Keyword(s):  
Bone Marrow ◽  
Body Weight ◽  
Mean Corpuscular Volume ◽  
Red Cell ◽  
Corpuscular Volume ◽  
Phenylhydrazine Hydrochloride ◽  
Similar Dose ◽  
Usual Manner ◽  
The Mean ◽  
Progressive Anemia

Abstract 1. Six adult swine were given phenylhydrazine hydrochloride orally and intravenously. Hematologic observations, which included periodic bone marrow studies were made before, during, and after the administration of the drug. 2. Five swine responded to the drug in the usual manner with progressive anemia, reticulocytosis, and erythrocytic hyperplasia of the bone marrow. Three animals died between the thirty-ninth and fiftieth day of the experiment after receiving a total dose of 0.30 to 0.35 Gm. per kilogram of body weight. Two swine survived and recovered after receiving a similar dose. 3. One animal died on the fourteenth day of the experiment and exhibited a course which closely resembled that of benzol poisoning. Rapid and progressive granulocytopenia, anemia, and extreme universal hypoplasia of the bone marrow were observed. 4. A direct correlation between the mean corpuscular volume of the red cell and the per cent reticulocytes was found within the limits of 0 to 80 per cent reticulocytosis. With each increment of 10 per cent in the reticulocytes the mean corpuscular volume increased approximately 6.8 cubic microns.

scholarly journals Evaluation of the iron status of a population

Blood ◽  
1976 ◽  
Vol 48 (3) ◽  
pp. 449-455 ◽  
Author(s):  
JD Cook ◽  
CA Finch ◽  
NJ Smith
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Red Cell ◽  
Adult Males ◽  
Packed Red Blood Cells ◽  
Iron Deficient ◽  
Menstruating Women ◽  
Prevalence Of Anemia

The iron status of a population of 1564 subjects living in the northwestern United States was evaluated by measurements of transferrin saturation, red cell protoporphyrin, and serum ferritin. The frequency distribution of these parameters showed no distinct separation between normal and iron-deficient subjects. When only one of these three parameters was abnormal (transferrin saturation below 15%, red cell protoporphyrin above 100 mug/ml packed red blood cells, serum ferritin below 12 ng/ml), the prevalence of anemia was only slightly greater (10.9%) than in the entire sample (8.3%). The prevalence of anemia was increased to 28% in individuals with two or more abnormal parameters, and to 63% when all three parameters were abnormal. As defined by the presence of at least two abnormal parameters, the prevalence of iron deficiency in various populations separated on the basis of age and sex ranged from 3% in adolescent and adult males to 20% in menstruating women. It is concluded that the accuracy of detecting iron deficiency in population surveys can be substantially improved by employing a battery of laboratory measurements of the iron status.

P1407LIVER, HEART AND BONE: THE PATH OF IRON OVERLOAD IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lucas Acatauassu Nunes ◽  
Luciene Reis ◽  
Hanna Machado ◽  
Rosse Osório ◽  
Rosa Moyses ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Remodeling ◽  
Serum Ferritin ◽  
Bone Biopsy ◽  
Saturation Index ◽  
Transferrin Saturation ◽  
Hemodialysis Patients ◽  
High Serum ◽  
Cross Sectional ◽  
Osteoblast Activity

Abstract Background Chronic kidney disease (CKD) is associated with several comorbidities, including anemia, since with decreased renal function there is a decrease in erythropoietin (EPO) production and changes in iron (Fe) metabolism. In hemodialysis patients, prescription of Fe is indicated to supplement the needs of this element by maintaining ferritin levels above 100 mg/dl and transferrin saturation greater than 20%. However, the excess of Fe can generate free Fe not bound to transferrin, and deposit in organs such as liver, heart, and bone marrow, with consequent impairment of their function. In hemodialysis patients, the diagnosis of Fe overload, its clinical significance and therapeutic decision have been poorly studied, unlike thalassemia patients. Aims To assess whether hemodialysis patients with ferritin levels equal to or greater than 1000 mg/l also have Fe overload in liver, heart, and bone marrow, as well as compromise bone density and remodeling. Method This is a cross-sectional analysis that included 28 adult patients on regular conventional hemodialysis. Inclusion criteria were serum levels of ferritin ≥ 1000 mg/l, and ESRD treated by regular hemodialysis for at least 6 months. We excluded patients with HIV, cancer, hepatic disease, patients who received desferroxamine in the latest year, and those previously submitted to a kidney transplant. All patients underwent dual-energy X-ray absorptiometry (DXA), serum ferritin, transferrin saturation index (STI), Fe, C reactive protein (CRP), Calcium(Ca), phosphorus (P), parathyroid hormone (PTH) and alkaline phosphatase (AP) levels were recorded. T2* image acquisition of Magnetic Resonance Imaging (MRI) 1,5 Tesla, were used for the assessment of Fe of liver, and heart. R2* and R2* Water were used of liver and bone (iliac crest). Bone biopsy was also performed. Results We evaluated 28 hemodialysis patients with a mean age of 55.8±13.1, hemodialysis time of 42.5±26.5 and iron use in the year prior to study enrollment of 311.5±179.8 mg/month. Biochemical analysis showed 3 patients with Hb below 9.0 mg/dl and 14 with values above 11.5 mg/dl; 6 patients with SatFe &lt;30% and 12 patients with ferritin &gt;1500mg/dl; 16 patients with PTH &lt;300pg/ml and eight with &gt;600pg/dl. MRI revealed Fe overload in the liver and bone tissue (figure 1) of all patients but not in the heart. Serum ferritin levels correlated with liver and bone overload (figure 2). Densitometry and bone biopsy results were not affected by Fe overload, however, serum Fe levels were associated with lower bone remodeling and mineralization suggesting an effect of this element on osteoblast activity. Conclusion High serum ferritin is associated with liver and bone marrow Fe overload, but not heart, as well as with low bone remodeling and mineralization. We must be aware of these side effects of high doses of Fe that are commonly used in these patients.

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