Iron deficiency anaemia revisited

Function of hematopoiesis and bone marrow niche in inflammation and non-hematopoietic diseases

Hematopoiesis and the behavior of hematopoietic stem and progenitor cells (HSPCs) are regulated by the bone marrow niche. Here, we introduce the major niche cell types in bone marrow and their response to stress condition. We highlight the hematopoietic response and bone marrow niche adaptation to inflammatory condition and non-hematopoietic diseases, which are not systematically summarized. These emerging data suggest targeting hematopoiesis and bone marrow niche may provide novel therapeutic target to precisely control the progression of the diseases.

Iron metabolism and ferroptosis in health and diseases: The crucial role of mitochondria in metabolically active tissues

Iron is essential in various physiological processes, but its accumulation leads to oxidative stress and cell damage, thus iron homeostasis has to be tightly regulated. Ferroptosis is an iron-dependent non-apoptotic regulated cell death characterized by iron overload and reactive oxygen species accumulation. Mitochondria are organelles playing a crucial role in iron metabolism and involved in ferroptosis. MitoNEET, a protein of mitochondrial outer membrane, is a key element in this process. Ferroptosis, altering iron levels in several metabolically active organs, is linked to several non-communicable diseases. For example, iron overload in the liver leads to hepatic fibrosis and cirrhosis, accelerating non-alcholic fatty liver diseases progression, in the muscle cells contributes to oxidative damage leading to sarcopenia, and in the brain is associated to neurodegeneration. The aim of this review is to investigate the intricate balance of iron regulation focusing on the role of mitochondria and oxidative stress, and analyzing the ferroptosis implications in health and disease.

Association between Neutrophil Percentage-to-Albumin ratio and anemia risk: a population-based study

Anemia remains a significant global health challenge, driven by complex inflammatory mechanisms. This study investigated the association between neutrophil percentage-to-albumin ratio (NPAR) and anemia risk, utilizing data from 24,938 participants in the National Health and Nutrition Examination Survey (2005-2018). Multivariable logistic regression analysis revealed a significant association between NPAR and anemia risk (OR = 1.16; 95% CI 1.13-1.18, p < 0.0001). Two-piecewise regression analysis identified a nonlinear relationship with a threshold at NPAR 11.96: below this threshold, an inverse association was observed (OR = 0.88; 95% CI 0.79-0.98, p = 0.0249), while above it, a positive association was evident (OR = 1.21; 95% CI 1.18-1.25, p < 0.0001). Subgroup analyses demonstrated stronger associations in males, non-Hispanic Whites, diabetic patients, and individuals who were married or living with a partner. These findings highlight the potential of NPAR as a novel biomarker for assessing anemia risk in clinical practice.

Fluorescent sensor based on collagen fiber-derived carbon quantum dots and carboxymethylated nanocellulose for Fe3+ detection

Detection of Fe3+ is essential for environmental and food safety monitoring. However, conventional detection methods often require costly equipment and lengthy processes, limiting their on-site applications. To address these challenges, a fluorescent sensor was developed using carboxymethylated nanocellulose (CMCNF) and collagen fiber-based carbon quantum dots (CCQDs). The CCQDs, with a fluorescence quantum yield of 25.04 %, were synthesized via a microwave hydrothermal method using secondary collagen fibers. A selective and sensitive CMCNF/CCQDs sensor was fabricated by incorporating CCQDs into a CMCNF matrix through a simple solution-casting method. The CMCNF matrix ensured uniform dispersion and stability of the CCQDs, optimizing sensor performance. The sensor exhibited a linear detection range for Fe3+ between 0 μM and 180 μM, with a corresponding linear equation of y=0.6496+0.3532xR2=0.9932. The limit of detection (LOD) for Fe3+ was determined to be 3.84 μM. Excellent detection performance was demonstrated in real water samples, achieving recoveries from 99.45 % to 105.23 % and an RSD below 2 %. The fluorescence quenching mechanism underlying CCQDs and Fe3+ interactions was systematically explored. This study provides a sustainable strategy for the high-value utilization of biomass waste and offers a portable approach for Fe3+ detection.

Causal associations between iron deficiency anemia and digestive system cancers: evidence from a bidirectional two-sample Mendelian randomization study

BACKGROUND & AIMS

Iron deficiency anemia (IDA) is associated with digestive system cancers (DSCs), but the causal relationship is poorly understood. This two-sample bidirectional Mendelian randomization (MR) study investigated the causal association between IDA and five types of DSCs.

METHODS

This study pooled data from a genome-wide association study of IDA (6,087 cases and 211,115 controls of European ancestry) and DSCs. IVW, weighted median, weighted mode, and MR-Egger regression were used to assess causal associations between IDA and DSCs. Sensitivity analysis included Cochran's Q test for heterogeneity, MR-PRESSO for pleiotropy, and leave-one-out method for robustness.

RESULTS

The MR analysis used 12 single-nucleotide polymorphisms (SNPs) associated with IDA as instrumental variables (IVs). In contrast, the reverse MR analysis used 20 SNPs associated with the five types of DSC as IVs. Genetic predictions revealed no significant association between IDA and the risk of DSCs: (odds ratio [OR]: 1.00; 95% confidence interval [CI] [0.76, 1.31]; P = 0.979), esophageal (OR: 0.94; 95% CI [0.67, 1.31]; P = 0.699), pancreatic (OR: 1.14; 95% CI [0.68, 1.92]; P = 0.615), liver (OR: 1.12; 95% CI [0.51, 2.47]; P = 0.776), and stomach (OR: 1.04; 95% CI [0.71, 1.54]; P = 0.830) cancers. Reverse MR also indicated no causal association between DSC and IDA. MR-Egger regression showed minimal heterogeneity impact except for colorectal cancer (heterogeneity P = 0.002). MR-PRESSO identified no outliers.

CONCLUSION

The present MR analysis shows no causal associations between IDA and the risk of DSCs.

Real-world evaluation of an intravenous iron service for the treatment of iron deficiency with or without anemia

Intravenous (IV) iron is a guideline-recommended treatment for iron deficiency when oral iron is contraindicated, ineffective, or not tolerated, or when rapid iron delivery is necessary. However, evidence suggests that some patients receive less IV iron than needed. This retrospective audit assessed the effectiveness and safety of ferric derisomaltose (FDI), a high-dose IV iron, in 2,468 patients. Efficacy outcomes assessed at 4-12 weeks post-infusion included changes in hemoglobin (Hb) and ferritin, proportion of courses (a course was defined as the treatment episode required to administer one total dose) after which patients were non-anemic (Hb ≥ 130 g/L [men] or ≥ 120 g/L [women]), and response rate (proportion of courses after which patients were non-anemic or Hb increased by ≥ 20 g/L). Safety was assessed through adverse events. Across 2,775 FDI courses, the mean dose was 1,244 mg, but mean estimated iron need was 1,580 mg. At follow-up, mean Hb had increased by 20.9 g/L and mean ferritin by 188.8 µg/L. Patients were non-anemic after 33.4% (n = 494/1,478) of courses and responded after 65.1% (n = 962/1,478) of courses. One patient (n = 1/2,468; 0.04%) had a serious allergic reaction. Patients remained anemic after > 65% of courses, demonstrating the need to optimize dosing based on iron need.

PTPN2 Regulates Iron Handling Protein Expression in Inflammatory Bowel Disease Patients and Prevents Iron Deficiency in Mice

Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Iron deficiency is the most frequent cause of anemia in IBD; however, the mechanisms involved are still poorly understood. Here, we investigated the role of the IBD risk gene, protein tyrosine phosphatase non-receptor type 2 (PTPN2), in regulating iron homeostasis. Proteomic analyses were performed on serum from IBD patients genotyped for the IBD-associated loss-of-function rs1893217 PTPN2 variant. Constitutive Ptpn2 wild type (WT), heterozygous (Het), and knockout (KO) mice were analyzed for iron content, blood parameters, and expression of iron handling proteins. Iron absorption was assessed through radiotracer assays. Serum proteomic analyses revealed that the "iron homeostasis signaling pathway" was the main pathway downregulated in Crohn's disease (CD) patients carrying the PTPN2 risk allele, independent of disease activity. Ptpn2-KO mice showed characteristics of anemia, including reduced hemoglobin concentrations along with serum and tissue iron deficiency and elevated serum hepcidin levels vs. Ptpn2-WT and Het mice. 55Fe absorption via oral gavage was significantly impaired in Ptpn2-KO mice. Correspondingly, Ptpn2-KO mice showed reduced apical membrane expression of the iron transporter DMT1. CD patients with the PTPN2 loss-of-function rs1893217 variant display alterations in serum iron handling proteins. Loss of Ptpn2 in mice caused features of anemia, including iron deficiency associated with reduced apical membrane expression of DMT1. These findings identify an important role for PTPN2 in regulating systemic iron homeostasis.

Boosting nutritional value: the role of iron fortification in meat and meat products

Iron deficiency is a widespread nutritional problem affecting millions of people globally, leading to various health issues including anemia. Iron fortification of meat and meat products has emerged as an effective strategy to combat this issue. This review explores the process and benefits of iron fortification, focusing on the types of iron compounds suitable for fortification, such as ferrous sulfate and ferric pyrophosphate, their bioavailability, and their impact on the sensory and nutritional qualities of meat products. Technological challenges and solutions, including encapsulation, chelation, and microencapsulation techniques, have been examined to minimize their negative impacts on sensory qualities. This review also discusses the regulatory framework governing iron fortification and consumer acceptance. Analytical methods for determining iron content, such as spectrophotometric and colorimetric detection, are discussed. Although iron-fortified meat products offer health benefits, sensory aspects and consumer acceptance are important considerations. This review provides a comprehensive understanding of the role and significance of iron fortification in meat products as a public health intervention to address iron deficiency.

Iron Status and Risk of Periodontitis and Dental Caries: A Mendelian Randomization Study

BACKGROUND

Previous studies have indicated a potential relationship between iron status and oral health outcomes, specifically periodontitis and dental caries. This study employed Mendelian randomization (MR) to investigate the causal effects of iron status on these oral health conditions. The focus of this study was on key iron biomarkers, namely serum iron, ferritin, transferrin saturation (TSAT), and total iron-binding capacity (TIBC).

METHODS

This two-sample MR analysis employed genome-wide association study (GWAS) data. The instrumental variables (IVs) were selected based on their genome-wide significance and independence from confounders. The statistical analyses employed the inverse variance weighted (IVW) method, MR-Egger regression, weighted median, and weighted mode. Additionally, sensitivity analyses were conducted to verify the reliability of the causal association results.

RESULTS

The MR analysis indicated a suggestive negative causal relationship between TIBC and periodontitis, with an odds ratios of 0.875 and a 95% CI of 0.766-0.998, with a P-value of .047. No significant other associations were found. The results of sensitivity analyses demonstrated the robustness of these findings.

CONCLUSION

This MR study suggested a potential negative association between TIBC and periodontitis, highlighting the importance of considering iron status in the clinical management of chronic periodontitis. However, more standardized, multi-population studies are needed to confirm this causality.

Prevalence and patterns of testing for anaemia in primary care in England: a cohort study using an electronic health records database

BACKGROUND

Despite epidemiological data on anaemia being available on a global scale, the prevalence of anaemia in the UK is not well described.

AIM

To describe anaemia prevalence and testing patterns for haemoglobin and other blood parameters.

DESIGN AND SETTING

This study was a descriptive population-based cohort study using data drawn from the Clinical Practice Research Datalink Aurum database in 2019.

METHOD

Demographic data were extracted for each person who was registered at their current practice during 2019, including linked data on Index of Multiple Deprivation. Anaemia prevalence in 2019 was calculated based on World Health Organization-specified age and gender thresholds for haemoglobin. Anaemia was classified based on mean corpuscular volume and ferritin. People with anaemia were followed up for up to 1 year to investigate longitudinal testing patterns for haemoglobin.

RESULTS

The cohort contained 14 million people. Anaemia prevalence in England in 2019 was 4.1% (583 847/14 207 841) (5.1% [363 438/7 121 614] females and 3.1% [220 409/7 086 227] males). Prevalence was higher in people aged >65 years, people of Black and Asian ethnicities, and people living in areas with higher social deprivation. Only half of people with anaemia and a mean corpuscular volume of ≤100 fL had an accompanying ferritin value recorded. About half of people with anaemia had a follow-up haemoglobin test within 1 year, most of which still indicated anaemia.

CONCLUSION

Anaemia is prevalent in the UK with large disparities between levels of demographic variables. Investigation and follow-up of anaemia is suboptimal in many patients. Health interventions aimed at improving anaemia investigation and treatment are needed, particularly in the most at-risk groups.

Micro-nutrient sufficiency in mothers and babies: management of deficiencies while avoiding overload during pregnancy

Pregnancy is a period characterized by extensive physiological changes in both the mother and fetus. During this period, the nutritional status of the mother has a profound and irreversible impact on her health and the growth and development of the fetus. The fetus depends exclusively on the mother and drives nutrients through the placenta. Therefore, mothers must be provided with a well-balanced diet that is adequate in both macro- and micronutrients. Most pregnant women generally manage to get adequate macronutrients; however, many women fail to get micronutrients up to the recommended dietary allowance. Micronutrients such as vitamins and minerals are necessary for preventing congenital abnormalities and the optimal development of the brain and body of the fetus. Their inadequacy can lead to complications like anemia, hypertension, pre-eclampsia, maternal and fetal hypothyroidism, premature infants, intrauterine growth restriction, stillbirth, and other negative pregnancy outcomes. New studies recommend the use of prenatal micronutrient supplements to prevent birth defects and health issues caused by deficiencies in folic acid, iron, iodine, and calcium during pregnancy. This is especially important in developing nations where deficiencies are prevalent. Also while using these supplements, their upper limits (UL) must be considered to avoid overload. In this review, we provide an overview of the four most critical micronutrients during pregnancy: iron, folic acid, iodine, and calcium. We provide insight into their sources, RDAs, deficiency consequences, and the need for supplementation while considering the risk of micronutrient overload. To maximize the potential benefits while minimizing the risk of nutrient overload, although knowledge gaps remain.

Lack of association between the TMPRSS6 gene polymorphism (rs855791) and anemia: a comprehensive meta-analysis

BACKGROUND

Anemia affects around 1.6 billion people worldwide and presents a significant challenge for healthcare providers. Despite the hemoglobin concentration being commonly used for diagnosis, identifying underlying causes remains challenging, particularly in vulnerable groups like children under five and pregnant women. Genetic factors, notably variations in the TMPRSS6 gene, are implicated in iron deficiency anemia, yet the precise relationship with anemia remains unclear.

METHODS

A thorough literature search was conducted across databases, including Embase, Google Scholar, and PubMed, focusing on studies investigating TMPRSS6 gene polymorphisms and anemia. Thirteen eligible studies, comprising 2082 cases and 2684 controls, underwent meta-analysis using Review Manager 5.4 software. Various genetic models were assessed, including allelic, homozygous, heterozygous, dominant, and recessive, with no significant relationship found between the TMPRSS6 rs855791 polymorphism and anemia.

CONCLUSION

This meta-analysis provides robust evidence suggesting no significant association between the TMPRSS6 rs855791gene polymorphism and anemia. These findings underscore the complexity of genetic factors contributing to anemia and emphasize the importance of the further investigation to unravel the mechanisms underlying this relationship for improved diagnostic and therapeutic approaches.

Selective detection of Fe3+ via fluorescent in real sample using aminoanthraquinone resorcin[4]arene-based receptors with logic gate application

Resorcin[4]arene based fluorescent sensors RES-AAQ containing eight anthraquinone groups as binding sites, were developed for very accurate and sensitive detection of Fe3+ metal ion. The motivation for this study lies in the need for advanced sensing techniques for precisely identifying Fe3+ ions. Due to its unique redox properties, Fe3+ plays a crucial role in biological processes, environmental remediation, medical diagnostics, and advanced detection methods. The sensors were extensively characterized using FT-IR, 1H NMR, 13C NMR, and ESI-MS techniques. The absorption spectra revealed significant interactions between RES-AAQ and Fe3+ ions. Fluorescence quenching was observed due to Photoinduced electron transfer (PET). The quenching process was systematically analyzed using Stern-Volmer analysis. Each sensor (L1, L2, L3, L4) demonstrated remarkable detection limits for Fe3+ ions (10.51 nM, 10.48 nM, 10.49 nM, 10.47 nM, respectively) along with substantial binding affinities (binding constants: 9.07x109 M-1, 1.19x109 M-1, 1.49x109 M-1 and 1.03x109 M-1 for L1, L2, L3, and L4, respectively). Traditional, Fe3+ detection methods often suffer from limitations such as complexity, lack of sensitivity, or interference from other metal ions. This research offers highly sensitive fluorescent sensors for Fe3+ detection with potential applications in human blood serum and tap water. Molecular docking, DFT studies, and ESI-MS investigation have been employed to gain insights into the binding interactions between the molecules. The low detection limits, high binding affinity, and real-world applicability highlight the significant advantages of developed sensors compared to existing methods. Additionally, a combinatorial logic gate was constructed to facilitate a proper understanding of the working principle of RES-AAQ.

Understanding and Managing Infusion Reactions and Hypophosphataemia With Intravenous Iron-A Nurses' Consensus Paper

AIM

To provide evidence-based guidance on practical aspects and potential safety concerns (infusion reactions and hypophosphataemia) related to the use of intravenous iron from a nursing perspective.

DESIGN

A modified Delphi consensus method.

METHODS

Literature searches were conducted and used to support the development of 16 consensus statements. Six nurses with expertise in the field of gastroenterology and experience with the administration of intravenous iron participated in a modified Delphi process to develop a final set of statements.

RESULTS

Overall, 16 statements achieved consensus and covered the practicalities of administration, infusion reactions and hypophosphataemia. Patient preparation is a key step in the administration of intravenous iron, but information should be communicated carefully to prevent undue anxiety. Highlighting the nurse's confidence in the management of any reactions may help to reduce anxiety. The patient should be observed during the first 5-10 min of an infusion to allow prompt management of immediate infusion reactions, although severe hypersensitivity reactions are rare. Nurses should be vigilant for symptoms of hypophosphataemia (such as fatigue, weakness and muscle/bone pain), which can develop following treatment with ferric carboxymaltose, saccharated ferric oxide and iron polymaltose. Serum phosphate levels should be measured in patients receiving ferric carboxymaltose who are at risk of low phosphate.

IMPACT

Infusion reactions and hypophosphataemia with intravenous iron are documented in the literature, but existing publications do not approach these topics from a nursing perspective. This consensus paper highlights the importance of patient preparation, monitoring and prompt management when administering intravenous iron to ensure patient safety. Considering that nurses have a central role in the administration of intravenous iron, the availability of evidence-based guidance is essential for both nurse confidence and patient safety.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was involved in the consensus process.

Amino Acid Chelated Iron Versus Ferric Ammonium Citrate on Iron Status in Egyptian Children with Iron Deficiency Anemia: A Randomized Controlled Study

Few studies have compared the relative effectiveness of different iron compounds on iron status in school-age children with iron deficiency anemia. The objective of this study was to compare the effect of iron amino acid chelated (AACI) preparation versus ferric ammonium citrate (FAC) in treatment of iron deficiency anemia.

PATIENTS AND METHODS

A randomized, clinical study was conducted on one hundred and sixty children aged 5-13 years old proved to have iron deficiency according to guide lines of WHO, 2001. All included children were subjected to the following laboratory investigations: CBC, reticulocytic count, CRP, serum iron, total iron binding capacity (TIBC), serum ferritin (SF), and serum hepcidin. Patients were assigned to two treatment regimens on randomized base 1:1 either to supplement with (AACI) or (FAC) once daily at bedtime. The subjects were followed up for eight weeks.

RESULTS

At the end of the study, group 1 who received AACI had increase in: Hb from 9.9 ± 1.1to 11.5 ± 0.3 gm/l(p = 0.01), MCV(fl) from 63.57.7 ± to 69 ± 6.3 (p = 0.05), serum iron from 49.5 ± 5.8 to 87 ± 12.7ug/dl(p = 0.001), serum ferritin from26.2 ± 10.5to 116.4 ± 19.7ng/ml(p = 0.001) while in group 2 who received FAC, there was increase in: HB from10.1 ± 1.7 to 11.2 ± 0.8, (p = 0.1), MCV from 64.5 ± 8.02 to 73.2 ± 8.9 (p = 0.01), serum iron from 48.2 ± 3.5to74 .3 ± 15 ug/dl (p = 0.01) and serum ferritin from 28.1 ± 9.3 to 84.3 ± 15.2 ng/ml (p = 0.006).

CONCLUSION

Our study showed much improvement in iron status indices in AACI preparation with no significant statistically difference between it and FAC.

Lactoferrin-A Regulator of Iron Homeostasis and Its Implications in Cancer

Cancer is a global health challenge, and its development is closely linked to iron metabolism. Cancer cells have an increased demand for this element, which promotes their proliferation, invasion, and metastasis. Excess iron catalyzes the formation of reactive oxygen species (ROS), which can both induce ferroptosis and initiate oncogenic signaling pathways. The deregulation of iron metabolism in cancer patients leads to anemia or toxic iron overload and also affects the gut microbiota. Lactoferrin (LF), a glycoprotein with strong iron chelating properties, can regulate its availability to cancer cells, thereby limiting their growth and progression. By chelating free Fe ions, LF reduces oxidative stress and inhibits the mechanisms that promote carcinogenesis. Additionally, it exhibits immunomodulatory and anti-inflammatory effects and may enhance the body's anti-tumor response. This review analyses the mechanisms of action of lactoferrin in the context of cancer, with a particular focus on its chelating, antioxidant, and immunomodulatory properties. The multidirectional effects of LF make it a promising component of preventive and therapeutic strategies, requiring further clinical studies.

Evaluation of Different Polysaccharide-Iron Complex Preparations In Vitro and In Vivo

Objectives: Iron-deficiency anemia is one of the most common nutritional deficiencies worldwide. Polysaccharide-iron complexes (PICs), as novel organic iron supplements, have garnered increasing attention due to their high bioavailability, minimal gastrointestinal irritation, and favorable tolerability. However, different formulations of PICs can show significant variations in their physicochemical properties and bioavailability. These factors are crucial for clinical efficacy and safety. Methods: This study selected two formulations of polysaccharide-iron complexes: Formulation A (PIC-coated pellets) and Formulation B (PIC powders), with ferrous succinate tablets (Formulation C) used as a control. The focus was on evaluating the molecular weight of the polysaccharides, the levels of free iron, and the dissolution across various dissolution media. Physicochemical properties were compared through particle size analysis, dissolution rate testing, and free iron content determination. Additionally, the pharmacokinetic properties of the two PIC formulations were assessed in a beagle dog model of iron-deficiency anemia. Results: Significant differences were observed in particle appearance and content structure between the two PIC formulations. Formulation A, prepared using pellet technology, exhibited a uniform particle size distribution. Its dissolution rate in acidic environments was significantly lower than that of Formulation B. In simulated gastric fluid, the cumulative iron dissolution rate of Formulation A was less than 15% within two hours, while that of Formulation B exceeded 50%, with substantial batch-to-batch variability. In various dissolution media, Formulation A released 12% of its dissolved iron content in gastric fluid within two hours. In contrast, the absolute free iron content of Formulation B was 8.5 times higher than that of Formulation A in simulated gastric fluid. In the beagle dog model of iron-deficiency anemia, Formulation A showed significantly higher bioavailability, which suggests that the pellet preparation technology improves both the acid resistance and bioavailability of the PIC formulation. Conclusions: The study revealed that Formulation A, prepared using pellet technology, possesses unique quality characteristics. This technology significantly reduces the release of free iron from PICs due to gastric acid action, potentially minimizing gastrointestinal irritation. Moreover, the pellet preparation process improves the acid resistance and bioavailability of PIC formulations, offering a more effective therapeutic option for iron-deficiency anemia. Future research may further explore the potential applications of pellet technology in other iron supplement formulations.

Persistent impact of antenatal maternal anaemia on child brain structure at 6-7 years of age: a South African child health study

BACKGROUND

This study aimed to determine whether associations of antenatal maternal anaemia with smaller corpus callosum, caudate nucleus, and putamen volumes previously described in children at age 2-3 years persisted to age 6-7 years in the Drakenstein Child Health Study (DCHS).

METHODS

This neuroimaging sub-study was nested within the DCHS, a South African population-based birth cohort. Pregnant women were enrolled (2012-2015) and mother-child dyads were followed prospectively. A sub-group of children had magnetic resonance imaging at 6-7 years of age (2018-2022). Mothers had haemoglobin measurements during pregnancy and a proportion of children were tested postnatally. Maternal anaemia (haemoglobin < 11 g/dL) and child anaemia were classified using WHO and local guidelines. Linear modeling was used to investigate associations between antenatal maternal anaemia status, maternal haemoglobin concentrations, and regional child brain volumes. Models included potential confounders and were conducted with and without child anaemia to assess the relative roles of antenatal versus postnatal anaemia.

RESULTS

Overall, 157 children (Mean [SD] age of 75.54 [4.77] months; 84 [53.50%] male) were born to mothers with antenatal haemoglobin data. The prevalence of maternal anaemia during pregnancy was 31.85% (50/157). In adjusted models, maternal anaemia status was associated with smaller volumes of the total corpus callosum (adjusted percentage difference, - 6.77%; p = 0.003), left caudate nucleus (adjusted percentage difference, - 5.98%, p = 0.005), and right caudate nucleus (adjusted percentage difference, - 6.12%; p = 0.003). Continuous maternal haemoglobin was positively associated with total corpus callosum (β = 0.239 [CI 0.10 to 0.38]; p < 0.001) and caudate nucleus (β = 0.165 [CI 0.02 to 0.31]; p = 0.027) volumes. In a sub-group (n = 89) with child haemoglobin data (Mean [SD] age of 76.06 [4.84]), the prevalence of antenatal maternal anaemia and postnatal child anaemia was 38.20% (34/89) and 47.19% (42/89), respectively. There was no association between maternal and child anaemia (χ2 = 0.799; p = 0.372), and child anaemia did not contribute to regional brain volume differences associated with maternal anaemia.

CONCLUSIONS

Associations between maternal anaemia and regional child brain volumes previously reported at 2-3 years of age were consistent and persisted to 6-7 years of age. Findings support the importance of optimising antenatal maternal health and reinforce these brain regions as a future research focus.

Gut microbiota and risk of iron deficiency anemia: A two-sample Mendelian randomization study

Previous studies have suggested a link between gut microbiota and iron-deficiency anemia (IDA). However, interpreting these findings is difficult due to various factors that influence microbiome composition and the limitations of observational studies, such as confounding variables and reverse causation. This study aims to explore the causal relationship between gut microbiota and IDA using Mendelian randomization (MR) to overcome these limitations. We conducted a 2-sample MR analysis using data from genome-wide association studies from the MiBioGen Consortium and the UK Biobank. The gut microbiome data included 211 genus-level microbes linked to single-nucleotide polymorphisms from 18,340 participants in the MiBioGen Consortium. The outcome data for IDA were obtained from 484,598 participants in the UK Biobank, with 2941 cases and 481,657 controls. We assessed causal relationships using various MR techniques, primarily inverse variance weighting, and performed sensitivity analyses to confirm the robustness of our results. Nine genus-level gut microbes were significantly associated with IDA (P < .05). Protective factors included Clostridia, Actinomycetaceae, Pasteurellaceae, Oscillospira, Prevotella, and Roseburia, while risk factors included Ruminococcus gnavus group, Hungatella, and Parasutterella. Sensitivity analyses showed the reliability of these findings without significant variability. This study provides evidence for a causal relationship between specific gut bacteria and IDA risk, identifying potential targets for therapies aimed at improving outcomes for those with IDA. Further research is needed to clarify the bacteria involved.

Prevalence and determinants of anaemia in South Asian diaspora women residing in Hong Kong: An exploratory cross-sectional study

Background

Anaemia has been a significant public health challenge for the South Asian community, in particular women and migrant populations. Despite abundant research in developed Western settings, evidence in urbanized Asian settings is extremely scarce for comparisons. This study aims to assess the prevalence and social determinants of anaemia in South Asian women residing in Hong Kong, an advanced economy in Asia.

Methods

Between June 2022 and December 2023, 675 non-pregnant South Asian adult women were recruited through territory-wide outreach health assessments for anthropometric and biomedical measurements, in addition to a survey on self-reported sociodemographic, lifestyle, and health factors. Multivariable ordinal logistic regression was employed to identify the predictors of anaemia severity.

Results

The observed prevalence of mild and moderate/severe anaemia (haemoglobin level <12 g/dL) were 26.8 % and 31.4 %, respectively. Findings supported the independent protective role of better diet quality against anaemia severity (aOR=0.40 [95 % CI = 0.22, 0.73] for high diet quality compared to poor diet quality), and that women of reproductive age (aOR=2.36 [1.03, 5.44] for the 35-44 age group compared to the youngest group), having a larger household size (aOR=1.11 [1.01,1.21] per person increase), and staying for a longer period in Hong Kong (aOR=1.83 [1.07, 3.13] for > 7 years compared to < 3 years) were associated with more severe anaemia.

Conclusion

The high prevalence of anaemia in our sampled South Asian women in Hong Kong, especially those of reproductive age, was partly attributable to nutrition, acculturation, and cultural preference on larger family size, beyond potential genetic predisposition.

[Comparison of a portable hemoglobinometer (Verio Q Red) with clinical laboratory results in routine clinical practice]

OBJECTIVE

To analyze the concordance between a hemoglobinometer with capillary blood sample and the clinical laboratory with a venous blood sample.

DESIGN

Cross-sectional concordance study.

LOCATION

Care Centre Primary Bufalà-Canyet Primary and Care Centre Primary Dalt la Vila Primary Care Center, Badalona, Barcelona.

PARTICIPANTS

Random selection of participants who attended routine blood tests. Over 18years old. No abandonment or loss was obtained.

MAIN INTERVENTIONS AND MEASUREMENTS

Sex, age, and reason for the blood test were collected from the medical history. Venous blood is drawn, and simultaneously, capillary blood is collected.

RESULTS

120 individuals are included, with an average age of 58.9years. The Bland-Almant graph showed differences within the confidence intervals for hemoglobin and hematocrit. The mean differences between the values of the Verio Q Red hemoglobinometer and those of the clinical laboratory were -0.42mg/dl for hemoglobin and -1.25% for hematocrit. The intraclass correlation coefficient showed excellent correlation for hemoglobin and hematocrit between the Verio Q Red hemoglobinometer and the clinical laboratory. Pearson's correlation for hemoglobin was 0.737 and for hematocrit 0.787.

CONCLUSIONS

The Verio Q hemoglobinometer is a valid tool for the early diagnosis of anemias and can be very useful in primary care consultations.

A NIR fluorescent probe based on carbamoyl oxime with high specificity for detecting ferrous ions in food and in vivo

Ferrous ions (Fe2+), the primary form of iron in cells, play a crucial role in various biological processes. The presence and absorption of Fe2+ in food has an important impact on human health. Proper dietary intake and iron supplementation are conducive to prevent and treat iron-related diseases. Therefore, it is of great value to develop tools that can specifically and sensitively detect Fe2+ in foods and organisms. Near-infrared (NIR) fluorescent probes have attracted much attention due to their advantages including deep tissue penetration and lower background fluorescence. Herein, a NIR fluorescent probe DICO-Fe(II) with a new recognition mechanism was constructed. DICO-Fe(II) achieves the highly specific recognition of Fe2+ through its carbamoyl oxime recognition site and exhibits high sensitivity with a limit of detection of 47 nM. DICO-Fe(II) can quantitatively detect Fe2+ with the naked eye through RGB values. It was also successfully applied to detect Fe2+ in food samples, cells, zebrafish, and mice tissues, confirming its potential as a modern analytical tool for the detection of Fe2+ in food and biological organisms.

From the marrow to the blood: optimising the diagnosis of iron deficiency in the setting of inflammation

Iron deficiency (ID) is a common condition with readily available treatment but can be challenging to diagnose. Traditional biomarkers of ID are acute-phase reactants, which complicate diagnosis in patients with co-existent inflammation. This study aimed to establish optimal biomarker diagnostic thresholds for ID diagnosis using bone marrow (BM) iron stores as the gold standard and the C-reactive protein (CRP) as an inflammatory marker. A cross-sectional study was carried out in the haematology department of a tertiary academic hospital. Patients undergoing BM biopsies for any reason were recruited for inclusion. Retrospective case finding was used to enrich the data for cases with confirmed BM ID. Laboratory markers including red cell indices, reticulocyte haemoglobin and iron studies were evaluated to establish optimal cut-offs for ID diagnosis. A CRP of >5 mg/L was used as a marker of inflammation. The study included 139 patients. Forty-two had BM ID, with a median serum ferritin (SF) of 48.5 μg/L. Ninety-six of 134 (72%) had inflammation with a CRP >5 mg/L. An SF of <80 μg/L had optimal sensitivity (69%) and specificity (94%) for ID diagnosis in the whole group (odds ratio 23.5; 95% confidence interval 4.3-129). In patients without inflammation, an SF cut-off of 80 μg/L had high sensitivity (93%) and specificity (96%). An SF <200 μg/L indicated ID in those with inflammation (sensitivity 78%, specificity 74%). A transferrin saturation of <13% in those with inflammation increased the diagnostic specificity (92%). The reticulocyte haemoglobin was unhelpful in diagnosing ID in this setting. In this hospital population, SF was the best parameter to diagnose ID, even in the presence of inflammation. The CRP was useful to identify populations with inflammation in whom higher SF thresholds could be used together with the transferrin saturation to accurately diagnose ID.

Reference intervals and percentiles for soluble transferrin receptor and sTfR/log ferritin index in healthy children and adolescents

OBJECTIVES

Soluble transferrin receptor (sTfR) is a marker of both erythropoiesis and iron status and is considered useful for detecting iron deficiency, especially in inflammatory conditions, but reference intervals covering the entire pediatric age spectrum are lacking.

METHODS

We studied 1,064 (48.5 % female) healthy children of the entire pediatric age spectrum to determine reference values and percentiles for sTfR and the ratio of sTfR to log-ferritin (sTfR-F index) using a standard immunoturbidimetric assay.

RESULTS

Soluble TfR levels were highly age-specific, with a peak in infancy and a decline in adulthood, whereas the sTfR-F index was a rather constant parameter. There were positive linear relationships for sTfR with hemoglobin (Hb) (p=0.008) and transferrin (females p<0.001; males p=0.003). A negative association was observed between sTfR and ferritin in females (p<0.0001) and for transferrin saturation and mean corpuscular volume (MCV) in both sexes (both p<0.0001). We found a positive relationship between sTfR and body height, body mass index (BMI) and inflammatory markers (CrP p<0.0001; WBC p=0.0172), while sTfR-F index was not affected by inflammation.

CONCLUSIONS

Soluble TfR values appear to reflect the activity of infant erythropoiesis and to be modulated by inflammation and iron deficiency even in a healthy cohort.

Association between occupational exposure to gasoline and anemia: a retrospective cohort study in China

BACKGROUND

Anemia is a major global burden, and occupational gasoline exposure is a common occupational hazard factor. Although previous studies have shown that there is a potential relationship between occupational gasoline exposure and the increase of anemia prevalence, this relationship has not been fully explored. The current cohort study aimed to investigate the association between occupational exposure to gasoline and anemia, and the effect of gasoline concentration on hemoglobin (Hb) levels.

METHODS

This retrospective cohort study collected baseline data from 1451 workers, including 605 exposed to gasoline and 846 not exposed to gasoline. Participants were enrolled in 2013-2015, and follow-up in 2019. Anemia was diagnosed according to WHO guidelines on hemoglobin cutoffs to define anemia in individuals and populations. Occupational exposure concentration of gasoline was measured based on the Chinese national standard (GBZ-T300.62-2017). Logistic regression was conducted to analyze the associations of occupational exposure to gasoline and anemia.

RESULTS

The incidence of anemia among workers exposed to gasoline was significantly higher than that among non-exposed workers (relative risk [RR] = 11.03, 95% confidence interval [CI]: 9.45-12.53). The risks of anemia were significantly higher among participants exposed to gasoline concentrations ≥ 43.20 mg/m³ (RR = 13.92, 95%CI: 12.25-15.28), 18.01-43.19 mg/m³ (RR = 12.93, 95%CI: 11.07-14.51), and 0.01-18.00 mg/m³ (RR = 5.49, 95%CI: 3.96-7.32) compared with the control non-exposed group. The risk of anemia was significantly higher among exposed workers, after adjusting for all confounding factors. There was also a significant negative correlation between gasoline exposure concentration and hemoglobin level.

CONCLUSIONS

Occupational exposure to gasoline is associated with an increased incidence of anemia, with a positive correlation between occupational gasoline exposure levels and the severity of anemia. The incidence and severity of anemia increase while hemoglobin levels decrease in line with increasing gasoline exposure concentrations. These findings emphasize the importance of assessing anemia in workers exposed to gasoline.

Impact of obesity on iron metabolism and the effect of intravenous iron supplementation in obese patients with absolute iron deficiency

Obesity and iron deficiency (ID) are widespread health issues, with subclinical inflammation in obesity potentially contributing to ID through unclear mechanisms. The aim of the present work was to elucidate how obesity-associated inflammation disturb iron metabolism and to investigate the effect of intravenous (IV) iron supplementation on absolute iron deficient pre-obese (BMI 25.0-29.9 kg/m2) and obese (BMI > 30 kg/m2) individuals compared to healthy weight (HW) group (BMI 18.5-24.9 kg/m2). Iron-related, hematological and inflammatory biomarkers along with erythropoietin (EPO) were studied based on body mass index (BMI) in a Spanish cohort of non-anemic participants (n = 721; 67% women; median age of 48 years [IQR: 39-57]) and in a subgroup of subjects (n = 110) with absolute ID (ferritin < 50 ng/mL) after completing an IV iron therapy. Obese group exhibited higher levels of ferritin, hemoglobin (Hb), soluble transferrin receptor (sTfR) and hepcidin compared to HW group. Elevated BMI was independently associated with increased sTfR levels. While no statistical differences were found in EPO among groups, obese showed increased levels that inversely correlated with Hb only in pre-obese and obese groups. IV iron therapy on obese participants had significant improvements on iron-related parameters and Hb levels. Notable obesity-associated disturbances in iron metabolism are described and indicate a mixed ID among both, women and men. These findings highlight the importance of tailored interventions to correctly address ID in obese population.

Iron deficiency anemia in patients with heavy menstrual bleeding: The patients' perspective from diagnosis to treatment

BACKGROUND

Heavy menstrual bleeding (HMB) associated with iron deficiency anemia (IDA) negatively affects quality of life (QoL). Management of IDA usually begins with oral iron supplementation or, if ineffective/poorly tolerated, then intravenous iron (IVI) is given; however, no guidance exists on transitioning from oral to IVI in patients with HMB. While various IVI products exist, safety profiles and distinct properties affecting treatment logistics make product choice important.

OBJECTIVES

Assess the IVI treatment journey for patients with HMB and IDA.

DESIGN

A survey was designed to assess multiple aspects of IVI treatment to evaluate patient perspectives.

METHODS

Patients (⩾18 years) from the United States with IDA currently prescribed IVI completed a survey conducted by The Harris Poll in 2023. Questions covered symptoms, time to diagnosis/treatment, IVI appointment logistics, IVI infusion experience, impact on daily activities, and patient preferences.

RESULTS

Of 323 respondents, 71 (22.0%) were prescribed IVI for HMB and received ⩾2 IVI infusions monthly. The mean age for these patients was 33.5 years; they experienced a mean of 2.9 years from symptom onset until IDA diagnosis, and 1.4 years between diagnosis and IVI treatment. Most patients agreed that navigating IVI treatment logistics interfered with productivity and social commitments, and felt they must schedule their life around treatment. Patients who were also diagnosed with hypophosphatemia following IVI (12/71; 16.9%) reported a mean of 8.2 additional hospital visits. Furthermore, 36.6% of patients missed an IVI dose; of these, 80.8% preferred single-dose IVI.

CONCLUSION

Patients with IDA and HMB experienced substantial delays from symptom onset to subsequent IVI treatment, demonstrating a gap in management. Therefore, oral iron may not be an appropriate first-line treatment for some of these patients. Multiple-dose IVI and associated appointment logistics can negatively impact patients' perspectives on treatment. Single-dose IVI preferences should be considered to improve patients' adherence and QoL.

Injury-Associated Anemia in Orthopaedic Trauma: A Comprehensive Review

» Anemia is a common comorbidity in orthopaedic trauma patients with important clinical consequences, significantly negatively affecting a patient's course following orthopaedic trauma.» Anemia remains relatively understudied in the orthopaedic trauma population with a large amount of current literature focused solely on geriatric hip fracture patients.» Greater investigation into alternatives to blood transfusions such as iron therapy or cell salvaging for treatment of anemia in the orthopaedic trauma population is needed.

Targeting ferroptosis in the neurovascular unit: A promising approach for treating diabetic cognitive impairment

The cognitive decline associated with chronic metabolic disease diabetes has garnered extensive scrutiny, yet its pathogenesis remains incompletely understood, and the advancement of targeted therapeutics has posed a persistent challenge. Ferroptosis, a novel form of cell death characterized by intracellular lipid peroxidation and iron overload, has recently emerged as a significant factor. Numerous contemporary studies have corroborated that ferroptosis within the neurovascular unit is intimately associated with the onset of diabetes-induced cognitive impairment. Numerous contemporary studies have corroborated that ferroptosis within the neurovascular unit is intimately associated with the onset of diabetic cognitive impairment (DCI). This article initially conducts a profound analysis of the mechanism of ferroptosis, followed by a detailed elucidation of the specific manifestations of neurovascular unit ferroptosis in the context of diabetic cognitive function impairment. Furthermore, an exhaustive review of pertinent literature from April 2020 to March 2024 has been undertaken, resulting in the selection of 31 documents of significant reference value. These documents encompass studies on 11 distinct drugs, all of which are centered around investigating methods to inhibit the ferroptosis pathway as a potential treatment for DCI. Simultaneously, we conducted a review of 12 supplementary literary sources that presented 10 pharmacological agents with anti-ferroptosis properties in other neurodegenerative disorders. This article critically examines the potential influence of neurovascular unit ferroptosis on the progression of cognitive impairment in diabetes, from the three aforementioned perspectives, and organizes the existing and potential therapeutic drugs. It is our aspiration that this article will serve as a theoretical foundation for scholars in related disciplines when conceptualizing, investigating, and developing novel clinical drugs for DCI.

The Association of Anemia With Survival Among People With HIV Following Antiretroviral Initiation in the NA-ACCORD 2007-2016

BACKGROUND

Anemia is an independent predictor of mortality, which may be utilized as a signal of deteriorating health. We estimated the association between anemia severity categories and mortality following the initiation of antiretroviral therapy (ART) among people with HIV (PWH) in North America.

METHODS

Within the NA-ACCORD, annual median hemoglobin measurements between January 01, 2007, and December 31, 2016, were categorized using World Health Organization criteria into mild (11.0-12.9 g/dL men, 11.0-11.9 g/dL women), moderate (8.0-10.9 g/dL men/women), and severe (<8.0 g/dL men/women) anemia. Discrete time-to-event analyses using complementary log-log link models estimated mortality hazard ratios adjusted for demographics, comorbidities, and HIV clinical markers with 95% confidence intervals for the association between anemia and mortality.

RESULTS

Among 67,228 PWH contributing a total of 320,261 annual median hemoglobin measurements, 257,293 (80%) demonstrated no anemia, 44,041 (14%) mild, 18,259 (6%) moderate, and 668 (0.2%) severe anemia during follow-up. Mortality risk was 5.6-fold higher among PWH with (vs. without) anemia. The association was greater among men (adjusted hazard ratios = 5.8 [5.4, 6.2]) versus women (adjusted hazard ratios = 4.1 [3.2, 5.4]). Mortality risk was 3.8-fold higher among PWH with mild anemia, 13.7-fold higher with moderate anemia, and 34.5-fold higher with severe anemia (vs. no anemia). Median hemoglobin levels decreased significantly in the 4 years before death, with a maximum decrease in the year before death. Macrocytic anemia was associated with an increased mortality risk and microcytic anemia was associated with a decreased mortality risk (vs. normocytic anemia).

CONCLUSIONS

Anemia among PWH who have initiated ART is an important predictive marker for mortality with macrocytic anemia having an increased association and microcytic anemia having a decreased association with mortality compared with normocytic anemia.

In situ detection of ferric reductase activity in the intestinal lumen of an insect

The rise of atmospheric oxygen as a result of photosynthesis in cyanobacteria and chloroplasts has transformed most environmental iron into the ferric state. In contrast, cells within organisms maintain a reducing internal milieu and utilize predominantly ferrous iron. Ferric reductases are enzymes that transfer electrons to ferric ions, either extracellularly or within endocytic vesicles, enabling cellular ferrous iron uptake through Divalent Metal Transporter 1. In mammals, duodenal cytochrome b is a ferric reductase of the intestinal epithelium, but how insects reduce and absorb dietary iron remains unknown. Here we provide indirect evidence of extracellular ferric reductase activity in a small subset of Drosophila melanogaster intestinal epithelial cells, positioned at the neck of the midgut's anterior region. Dietary-supplemented bathophenanthroline sulphate (BPS) captures locally generated ferrous iron and precipitates into pink granules, whose chemical identity was probed combining in situ X-ray absorption near edge structure and electron paramagnetic resonance spectroscopies. An increased presence of manganese ions upon BPS feeding was also found. Control animals were fed with ferric ammonium citrate, which is accumulated into ferritin iron in distinct intestinal subregions suggesting iron trafficking between different cells inside the animal. Spectroscopic signals from the biological samples were compared to purified Drosophila and horse spleen ferritin and to chemically synthesized BPS-iron and BPS-manganese complexes. The results corroborated the presence of BPS-iron in a newly identified ferric iron reductase region of the intestine, which we propose constitutes the major site of iron absorption in this organism.

Comprehensive insight into the alterations in the gut microbiome and the intestinal barrier as a consequence of iron deficiency anaemia

BACKGROUND

Iron deficiency is the top leading cause of anaemia, whose treatment has been shown to deteriorate gut health. However, a comprehensive analysis of the intestinal barrier and the gut microbiome during iron deficiency anemia (IDA) has not been performed to date. This study aims to delve further into the analysis of these two aspects, which will mean a step forward minimising the negative impact of iron supplements on intestinal health.

METHODS

IDA was experimentally induced in an animal model. Shotgun sequencing was used to analyse the gut microbiome in the colonic region, while the intestinal barrier was studied through histological analyses, mRNA sequencing (RNA-Seq), qPCR and immunofluorescence assays. Determinations of lipopolysaccharide (LPS) and bacteria-specific immunoglobulins were performed to assess microbial translocation.

RESULTS

Microbial metabolism in the colon shifted towards an increased production of certain amino acids, short chain fatty acids and nucleotides, with Clostridium species being enriched during IDA. Structural alterations of the colonic epithelium were shown by histological analysis. RNA-Seq revealed a downregulation of extracellular matrix-associated genes and proteins and an overall underdeveloped epithelium. Increased levels of serum LPS and an increased immune response against dysbiotic bacteria support an impairment in the integrity of the gut barrier during IDA.

CONCLUSIONS

IDA negatively impacts the gut microbiome and the intestinal barrier, triggering an increased microbial translocation. This study emphasizes the deterioration of gut health during IDA and the fact that it should be addressed when treating the disease.

High internal phase Pickering emulsions co-loaded with astaxanthin and ferrous gluconate improve iron deficiency anemia in mice and their applications in 3D printing

Iron deficiency anemia (IDA) is a prevalent and serious nutritional health issue that can be mitigated through dietary iron supplementation. However, only ferrous ions, prone to oxidation, can be absorbed in the gastrointestinal tract. In the current work, the effects of high internal phase Pickering emulsions (HIPPEs) co-loaded with astaxanthin (ASTA) and ferrous gluconate on Fe2+ oxidation, IDA management, and their 3D printing performance were investigated. The results demonstrated that the HIPPEs co-loaded with ASTA and ferrous gluconate effectively reduced the oxidation rate of Fe2+ during storage. Animal studies also revealed that HIPPE co-loaded with ASTA and ferrous gluconate had a therapeutic effect on IDA symptoms in mice. HIPPE co-loaded with ASTA and 400 mg/L ferrous gluconate demonstrated superior efficacy in restoring hemoglobin (Hb) levels, organ coefficients, and histological parameters in mice with IDA. Moreover, the evaluation of the adaptability of HIPPEs co-loaded with ASTA and ferrous gluconate for food 3D printing indicated a slight reduction in printing resolution. Overall printing performance was found to be acceptable and satisfactory. Co-loading ASTA and ferrous gluconate in HIPPEs offers an efficient way to address the oxidation challenge of ferrous ion supplementation, enabling customization and flexibility in the production of iron-fortified foods to mitigate IDA.

Coffee Consumption in Association with Serum Iron Levels: A Cross-sectional Study

This study determines the association between adult Saudi Arabian coffee consumption and serum iron levels. The extensive Saudi Arabian population, including both sexes - male and female, participated in this cross-sectional community-based study from 1 October 2020 to 31 June 2022. The participants were selected arbitrarily using the systematic simple random position. The current study enrolled 113 participants with a mean age of 33 years, including 94 (83.2%) females and 19 (16.8%) males. The concentration of iron absorption assessed among 62 individuals who participated in the group of occasional coffee drinkers was higher (54.9%) than the 51 individuals who participated in the group of regular coffee drinkers (45.1%). In daily coffee consumption, paired samples statistics in mean baseline WBC level (103/μl) was 6.396. On day 31 of June 2022, WBC level (103/μl) was 6.114. Paired samples statistics in mean baseline iron level was 44.29. On day 31 of June 2022, iron level was 72.15. The paired samples correlation in baseline and day 31 iron levels was 0.719, with a significant difference of 0.000. It is critical to acquire the most recent information and local statistics on the frequency of low serum iron levels in Saudi Arabia's diverse adult population. The adult population of Saudi Arabia correlates with coffee consumption and changes in serum ferritin or iron levels and WBC counts. Neither the WBC numbers nor the iron levels were significantly altered. Further research is needed to determine the potential mechanisms causing these relationships.

Micronutrient deficiencies according to sociodemographic factors and nutritional status among Panamanian children aged six to 59 months in 2019: a cross-sectional population-based study

Background

Micronutrient deficiencies have serious lifelong consequences. This study aimed to estimate the prevalence of anaemia, iron deficiency anaemia, iron deficiency, and vitamin A deficiency, according to sociodemographic factors and nutritional status among Panamanian children aged six to 59 months in 2019.

Methods

We used data from the National Health Survey of Panama (ENSPA), a population-based, cross-sectional study, with a nationally representative subsample to evaluate haemoglobin, C-reactive protein (CRP), ferritin, and retinol levels among children aged six to 59 months. The data are shown weighted.

Findings

A total of 625 children representing a population of 62,100 children (females 45.0%, 27,971/62,100; 95% CI: 37.3-53.1), aged six to 59 months were assessed. Nationally, the prevalence of anaemia was 15.5% (9604/62,100; 95% CI: 11.5-20.6), iron deficiency anaemia was 8.0% (4950/62,100; 95% CI: 5.1-12.2), iron deficiency was 26.2% (16,259/62,100; 95% CI: 20.7-32.5), and vitamin A deficiency was 3.4% (2087/62,100; 95% CI: 2.1-5.3). Children from indigenous areas exhibited a higher prevalence of all micronutrient deficiencies studied, and nationally 40.9% (2316/5656; 95% CI: 22.1-62.9) of the children with overweight/obesity exhibited at least one micronutrient deficiency.

Interpretation

Our results highlight important disparities in the prevalence of nutritional deficiencies among children in different living areas. Public health strategies should focus on these vulnerable populations, as the first years of life are crucial for adequate growth and development.

Funding

This work was supported by an institutional research grant via the Ministry of Economy and Finance of Panama (019910.002). The ENSPA study was funded by the Inter-American Development Bank.

Absolute and functional iron deficiency: Biomarkers, impact on immune system, and therapy

Iron is essential for numerous physiological processes and its deficiency often leads to anemia. Iron deficiency (ID) is a global problem, primarily affecting reproductive-age women and children, especially in developing countries. Diagnosis uses classical biomarkers like ferritin or transferrin saturation. Recent advancements include using soluble transferrin receptor (sTfR) or hepcidin for improved detection and classification of absolute and functional iron deficiencies, though mostly used in research. ID without anemia may present symptoms like asthenia and fatigue, even without relevant clinical consequences. ID impacts not only red-blood cells but also immune system cells, highlighting its importance in global health and immune-related comorbidities. Managing ID, requires addressing its cause and selecting appropriate iron supplementation. Various improved oral and intravenous products are available, but further research is needed to refine treatment strategies. This review updates on absolute and functional iron deficiencies, their relationships with the immune system and advancements in diagnosis and therapies.

A novel antioxidant iron-chelating peptide from yak skin: analysis of the chelating mechanism and digestion stability in vitro

BACKGROUND

The global prevalence of iron deficiency has posed significant public health risks. Animal-derived collagen peptides have been recognized for their potent metal ion-chelating capabilities, which can greatly enhance the bioavailability of iron. Yak skins, typically discarded during production and processing, serve as a valuable resource. Based on yak skin collagen peptide (YSP), we have developed a novel iron-chelating peptide: yak skin collagen iron-chelating peptide (YSP-Fe).

RESULTS

The maximum level of iron chelation of YSP-Fe achieved was 42.72 ± 0.65 mg g-1. Structural analysis indicated that YSP-Fe was primarily formed from amino, carboxyl and carbonyl groups combined with ferrous ions. Through examination of the amino acid composition, molecular docking and peptide sequence identification, it was determined that Gly, Asp and Arg played crucial roles in the chelation of ferrous ions by YSP. Furthermore, YSP-Fe was more stable in simulated gastrointestinal digestion compared to FeSO4.

CONCLUSION

YSP-Fe demonstrated dual benefits of iron supplementation and antioxidant effects. These significant findings provide a foundation for the development of novel iron supplements and the effective utilization of yak skin as a valuable resource. © 2024 Society of Chemical Industry.

The Case for the Role of Primary Care in Patient Blood Management

Patient blood management (PBM) is a patient-centered evidence-based strategy designed to preserve a patient's own blood and improve health outcomes. The effectiveness of PBM programs is now well-established globally within tertiary and secondary sectors, with demonstrable outcome benefits and cost savings. However, the role of primary care and the general practitioner in PBM is poorly understood. Yet the essential attributes of primary care, including access, continuity, coordination, and comprehensiveness, align well with PBM principles, enabling general practitioners to provide personalized holistic management of anemia for the community. The skill set of general practitioners in integrating and continuing care through the transition period after hospitalization is especially important. General practitioners are well-suited to the roles of health promotion and prevention, and have the potential to deliver substantial population health benefits. Given the public health imperative of this condition, it is vital that policy-makers appropriately support the role of general practitioners with financing, education, and resources for PBM in primary care.

Treatment of Iron-Induced Cutaneous Hyperpigmentation With Energy-Based Devices

OBJECTIVES

Iatrogenic cutaneous siderosis is a well-recognized dermatologic complication after parenteral iron infusion. The condition manifests as discrete, hyperpigmented patches near the site of injection. Most cases do not resolve spontaneously, leading to significant aesthetic and psychological distress to patients. A recent case of iatrogenic cutaneous siderosis at our institution prompted a systematic review of the efficacy of energy-based devices previously reported in the treatment of this condition.

METHODS

PubMed and Cochrane databases were searched for all peer-reviewed articles published using the following search terms: "iron OR heme OR hemosiderosis OR siderosis" and "hyperpigmentation OR staining OR tattoo." Articles reporting on energy-based devices in the treatment of iron-induced hyperpigmentation were included.

RESULTS

A total of seven articles and 54 total patients were included in this review. All patients, including the patient treated at our institution, were female, with an average age of 44 years. Hyperpigmentation was most commonly associated with intravenous iron infusion (48/54, 89%), on the arm or forearm (44/54, 81%), and used for the treatment of underlying iron deficiency anemia (54/54, 100%). The application of six different nanosecond or picosecond quality-switched laser systems was reported in the treatment of cutaneous siderosis, with wavelengths ranging from 532 to 1064 nm. Spot sizes varied between 2 and 7 mm, with energy fluences spanning 0.5-40 J/cm2 depending on both the device and spot size. Outcomes were measured after an average of 5.4 laser treatments and 10.4 months, with over half of all reported patients experiencing complete clearance (27/50, 54%). Our patient received treatment in three test areas with picosecond alexandrite 785 nm, nanosecond Nd:YAG 532 nm, and picosecond Nd:YAG 532 nm devices. The nanosecond Nd:YAG 532 nm treated area demonstrated the greatest improvement, and the entire arm was subsequently treated with this device.

CONCLUSIONS

Despite the often intractable nature of iatrogenic cutaneous siderosis, laser surgery is a reasonable and safe treatment modality for patients seeking cosmetic improvement of this dyschromia. Dermatologists should be aware of this entity and the efficacy of the energy-based devices currently in our armamentarium. A combination approach may need to be utilized with different wavelengths and pulsed widths to target iron pigment in both dermal and subcutaneous layers.

Functional iron deficiency anemia in patients with cancer

Anemia is frequently observed in patients with cancer owing to anticancer chemotherapy, radiation therapy, and inflammatory responses. This often leads to functional iron deficiency, characterized by adequate iron stores but impaired use of iron for red blood cell production. This condition, termed functional iron deficiency anemia (IDA), is identified by a ferritin level of 30-500 µg/dL and a transferrin saturation < 50%. Functional iron deficiency often develops with the prolonged use of erythropoiesis-stimulating agents, leading to a diminished response to anemia treatment. Although oral iron supplementation is common, intravenous iron is more effective and recommended in such cases. Recent studies have shown that ferric carboxymaltose (FCM) is effective in treating functional IDA in patients with cancer. However, because of its potential to induce asymptomatic severe phosphate deficiency, it is important to closely monitor phosphate levels in patients receiving FCM.

Clinical management of iron deficiency anemia in Japan: iron prescription patterns, treatment effectiveness, and assessments

Iron deficiency anemia is one of the most common types of anemia, but real-world clinical management practices in Japan are unclear. This study retrospectively explored iron prescription patterns, treatment effectiveness, and assessments. Patients with at least one treatment period between September 2020 and September 2022 were included and classified into three groups (ferric carboxymaltose [FCM]: 7437 patients, saccharated ferric oxide [SFO]: 98,648 patients, and oral iron: 359,547 patients). Iron-related laboratory values over time and testing proportions were evaluated. Median baseline hemoglobin levels were lowest with FCM (FCM: 8.10 g/dL, SFO: 8.70 g/dL, oral iron: 9.70 g/dL), but changes in hemoglobin levels by 12 weeks were greatest with FCM (FCM: 3.20 g/dL, SFO: 2.60 g/dL, oral iron: 1.70 g/dL). The median serum ferritin level at 8 weeks after FCM treatment was 43.70 ng/mL for ≤500 mg, versus 123.30 ng/mL for >500 to ≤1500 mg. All groups had a low proportion of serum ferritin and transferrin saturation (TSAT) testing at diagnosis (<38%), which decreased further for post-treatment assessment (<24%). This study suggests the importance of prescribing an appropriate total iron cumulative dose per the package insert, along with diagnosis and assessments based on serum ferritin/TSAT.

Alternative splicing generates a novel ferroportin isoform with a shorter C-terminal and an intact iron- and hepcidin-binding property

Ferroportin (FPN) is a transmembrane protein and is the only known iron exporter that helps in maintaining iron homeostasis in vertebrates. To maintain stable iron equilibrium in the body, ferroportin works in conjunction with a peptide called hepcidin. In this study, we have identified an alternatively spliced novel isoform of the human SLC40A1 gene, which encodes for the FPN protein and is found to be expressed in different tissues. The novel transcript has an alternate last exon and encodes 31-amino acid long peptide sequence that replaces 104 amino acids at C-terminal in the novel transcript. Molecular modelling and molecular dynamics (MD) simulation studies revealed key structural features of the novel isoform (FPN-N). FPN-N was predicted to have 12 transmembrane domains similar to the reported isoform (FPN), despite being much smaller in size. FPN-N was found to interact with hepcidin, a key regulator of ferroportin activity. Also, the iron-binding sites were retained in the novel isoform as revealed by the MD simulation of FPN-N in bilipid membrane. The novel isoform identified in this study may play important role in iron homeostasis. However, further studies are required to characterize the FPN-N isoform and decipher its role inside the cell.

Global prevalence of anemia among women of reproductive age, 2000-2019

A common disease with significant impacts on health and quality of life, anemia is particularly prevalent in women of reproductive age due to blood losses during menstruation and pregnancy. Data from the World Health Organization (WHO) was analyzed to compare trends in prevalence of anemia in women aged 15-49 among countries and over time with the goal of identifying regions both successful and in need of assistance in combatting anemia. Worldwide from 2000 to 2013 the prevalence of anemia among women aged 15-49 decreased, and then increased from 2013 to 2019; severe anemia decreased throughout the world from 2000 to 2019. Throughout all years, African countries had the highest prevalence of anemia and severe anemia while American and European countries had the lowest. With each decrease in human development index (HDI) category (very high to high, etc.) there was a significant increase in prevalence of total anemia (P < 0.001 for all). This data suggests that although the prevalence of anemia among reproductive age women has decreased over time there is still much work remaining, particularly in low HDI countries. More effort is needed in preventing, recognizing and treating anemia.

Evaluating the effect of grape syrup on iron deficiency anemia in women: A randomized clinical trial

Globally, iron deficiency reigns as the most prevalent nutritional disorder, with anemia disproportionately impacting women of childbearing age. Despite the effectiveness of existing treatments, like iron supplements, their side effects remain a concern. This study explores the potential of grape syrup (GS), a functional iron-rich food, to modulate markers of iron-deficient anemia in women. A randomized, double-blind study explored the impact of GS on iron deficiency anemia markers in 130 women. Participants were allocated to intervention or placebo groups. For 4 weeks, the intervention group received a daily 50 mg ferrous sulfate tablet alongside 10 cc of GS thrice daily. The placebo group received a 50 mg ferrous sulfate tablet with a 10 cc placebo syrup thrice daily. Before and after the intervention, key markers like red blood cell count (RBC), mean corpuscular volume (MCV), hemoglobin (Hb), hematocrit (Hct), ferritin, total iron binding capacity (TIBC), and serum iron were assessed. Notably, both Hb and Hct levels were significantly higher in the GS group (p < .05). Additionally, RBC and MCV values showed significant improvement compared to the placebo group (p < .05). However, no significant difference was observed for other iron deficiency markers like serum iron, ferritin, and TIBC (p > .05). This study's findings suggest that combining grape syrup with iron tablets might offer potential advantages over iron tablets alone in managing iron deficiency anemia.

Predicting Recurrent Deficiency and Suboptimal Monitoring of Thiamin Deficiency in Patients with Metabolic and Bariatric Surgery

INTRODUCTION

Vitamin B1 (thiamine) deficiency (TD) after metabolic and bariatric surgery (MBS) is often insidious and, if unrecognized, can lead to irreversible damage or death. As TD symptoms are vague and overlap with other disorders, we aim to identify predictors of recurrent TD and failure to collect B1 labs.

METHODS

We analyzed a large sample of data from patients with MBS (n = 878) to identify potential predictors of TD risk. We modeled recurrent TD and failure to collect B1 labs using classical statistical and machine learning (ML) techniques.

RESULTS

We identified clusters of labs associated with increased risk of recurrent TD: micronutrient deficiencies, abnormal blood indices, malnutrition, and fluctuating electrolyte levels (aIRR range: 1.62-4.68). Additionally, demographic variables associated with lower socioeconomic status were predictive of recurrent TD. ML models predicting characteristics associated with failure to collect B1 labs achieved 75-81% accuracy, indicating that clinicians may fail to match symptoms with the underlying condition.

CONCLUSIONS

Our analysis suggests that both clinical and social factors can increase the risk of life-threatening TD episodes in some MBS patients. Identifying these indicators can help with diagnosis and treatment.

Immunological Insights Into Nutritional Deficiency Disorders

Essential nutrients play a vital role in influencing immune cell development. This chapter explores the crucial relationship between nutrition and the immune system, delving into the profound impact of dietary choices on overall health. Research highlights the benefits of nutrient-rich foods in supporting optimal immune function, while deficiencies in key nutrients (vitamins A, D, zinc, and iron) compromise immune responses, increasing susceptibility to infections. The bidirectional nature of the relationship is emphasized, underscoring the critical role of a balanced diet in supporting immune cell development, activation, and function. Case studies illustrate immunological vulnerabilities linked to inadequate nutritional status, stressing the importance of maintaining optimal nutrient levels for a robust immune system. In summary, an individual's nutritional status significantly influences immune response effectiveness. Addressing deficiencies through supplementation, dietary interventions, and public health initiatives is crucial for improving immune function.

A clinical study evaluating low dose ferrous fumarate vs. standard iron supplements in iron-deficient non-anemic to mild anemic adults

Our study aims to validate safety and efficacy of Feroglobin capsule compared with different iron supplementations in adult subjects diagnosed with non-anemic to mild anemic iron deficiency and fatigue. Enrolled 302 participants diagnosed with non-anemic to mild anemic iron deficiency and fatigue. Group A (n = 147) received Feroglobin, Group B (n = 146) received standard of care [Haem Up Gems capsules (Ferrous fumarate) or Fericip tablets (Ferrous ascorbate)]. 293 subjects completed the study with follow-up visits on days 30, 60, and 90. Feroglobin treatment significantly increased hemoglobin levels from mean 12.43 g/dl to 13.24 g/dl in 90 days. Ferritin levels improved significantly by 442.87% compared to the standard care's 256.67%. Fatigue scale scores reduced by 47.51%, and all presenting health complaints resolved completely. Gastrointestinal symptoms observed were similar in both the groups. Both groups exhibited moderate treatment adherence. Quality of life improved in pain and general health domains, exhibiting a good tolerability. Adverse events were unrelated to the investigational products. Feroglobin serves as an efficacious therapeutic alternative for improving hemoglobin, ferritin, and reducing fatigue with low doses compared to standard of care. However, longer-term effects of low-dose require further investigations in different target groups.

Harnessing the Power of a Novel Triple Chelate Complex in Fermented Probiotic Dairy Products: A Promising Solution for Combating Iron Deficiency Anemia

This study discovered and examined novel triple chelate complexes involving iron, ascorbic acid, and essential amino acids (AsA-Fe-AmA triple chelate complexes) for the first time. The mechanism of complex formation was studied using FTIR spectroscopy and quantum chemical modeling. The produced complexes were shown to be suitable for fortifying food items with a pH of 3-7 that have not been exposed to heat treatment at temperatures over 75 °C for more than 15 min. Thus, it can be said that the concentration for milk fortification should be 0.005 mol/L or less. In vivo experiments in rats models revealed that the synthesized complexes increased serum iron levels after a single application to reference values within 24 h of oral administration. The iron level increased by 14.0 mmol/L at 2 mL dose of the complex. This fact makes it possible to consider the use of developed complexes and developed fermented dairy products for the prevention of iron deficiency and iron deficiency anemia. Research on the effect of discovered compounds on the physicochemical and organoleptic qualities of milk was conducted. Furthermore, iron ascorbate threoninate, iron ascorbate methioninate, iron ascorbate lysinate, and iron ascorbate tryptophanate all had a beneficial effect on Lacticaseibacillus rhamnosus at concentrations as low as 0.0005 mol/L, which is significant for milk fermentation. A study of fermented milk products revealed that the most effective AsA-Fe-AmA triple chelate complex is iron ascorbate lysinate, which might be further investigated as a viable molecule for dietary fortification in iron deficiency anemia. It was found that fortified fermented milk products had a titratable acidity of 67 ± 1°T, pH of 4.38 ± 0.05, and a viscosity of 2018 ± 142 Pa·s.

Intravenous Iron Versus Oral Iron Administration for the Treatment of Iron Deficiency Anemia: A Patient-Preference Study

BACKGROUND

Intravenous iron supplementation has been reported to provide a superior safety profile and effectiveness in the treatment of iron deficiency anemia (IDA) compared to traditional oral iron supplements.

AIM

To assess preference for intravenous iron versus oral iron among patients with IDA at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

METHODS

This observational cross-sectional study included 267 adults diagnosed with IDA or on treatment for IDA at King Abdulaziz University Hospital between February 2023 and March 2024. A specially modified questionnaire was used for the collection of data, which included demographic and treatment-related data. The values of the variables are presented as mean and standard deviation or median and interquartile range. Differences with an asymptotic two-tailed P-value of less than 0.05 were considered to be statistically significant.

RESULTS

The majority of the included patients were women (95.5%), Saudi nationals (90.6%), and from the Western region (98.1%). About half of the included patients were receiving intravenous iron supplementation (51.7%), and the other half were receiving oral iron supplements (48.3%). However, the majority of the patients (74.9%) reported that they preferred intravenous iron treatment. With regard to factors that affected their preference, education level (P = 0.044), employment status (P = 0.009), and income level (P = 0.007) were identified as significant predictors. Among the patients who preferred oral iron therapy, the reason cited by the majority, that is, 79.1%, was that tablets were easier to adhere to than needles, while 50.7% stated that tablets had fewer side effects than needles and 64.2% reported a fear of needles. Among the patients who preferred intravenous iron therapy, the majority, that is, 82.4%, stated that intravenous administration was easier for them. Further, 73.5% were of the opinion that intravenous iron therapy had fewer side effects (73.5%), 27.7% reported that they were unable to swallow iron tablets, and 52.5% reported that they had difficulty remembering to take iron tablets. About a third of patients discontinued oral iron therapy due to changes in bowel habits (35%). Although 18.7% of the patients reported feeling pain with intravenous iron therapy, the majority were satisfied (79.4%) and recommended intravenous iron treatment for anemia to friends and family members (84.6%). In contrast, more than half of the patients on oral therapy were uncomfortable (56.2%) with the treatment. Further, 37.1% were not satisfied with their iron tablets, and 25.1% of patients stated that they would not recommend iron tablets for anemia treatment to their friends or family members.

CONCLUSION

The majority of the patients preferred intravenous iron therapy to correct IDA because oral therapy was associated with difficulties related to swallowing iron tablets and remembering to take the tablets. Although the results indicate that both therapies have similar effectiveness, patients receiving intravenous treatment appeared to be more satisfied with the treatment and recommended it to friends and family.