A study on the boundary value of hemoglobin concentration for screening iron deficiency anemia in pregnant women

To evaluate whether a pregnant woman is in anemia or there exist the needs to replenish iron is usually based on the measurement of hemoglobin (HB) concentration, because the evaluation of iron nutritional status has not yet been used widely in our country. Blood specimens were collected from 258 pregnant women, and concentrations of Hb, serum ferritin (SF) and free erythrocyte protoporphyrin (FEP) were determined to find out a reasonably boundary value of Hb concentration from the two different ones set by our country and WHO, respectively, and the one averaged the former two, i.e, 100g/L, 110g/L and 105g/L. False positivity and false negativity in diagnosis of iron deficiency anemia (IDA) for pregnant women were evaluated based on the measurement of SF and FEP concentrations as gold standards. Results showed that the optimal Hb concentration for preliminary diagnosis of IDA was 105g/L with maximizing Yorden index.     

The frequency and development of tissue iron deficiency in 6 iron deficiency anemia patients with plummer-vinson syndrome

The physical signs of tissue iron deficiency include smooth and red tongue, angular stomatitis, koilonychia, and pica. The incidence of these conditions is unknown in Japan. We evaluated the frequency and development of tissue iron deficiency in 353 patients with iron deficiency anemia. The frequency of tissue iron deficiency was 6.8%; papillary atrophy of the tongue, 5.4%; abnormal nails, 5.4%; angular stomatitis, 1.1%; Plummer-Vinson syndrome, 1.7%; and pica, 0.06%. These findings were compared with the date collected by Wintrobe and Beveridge. The development and incidence of tissue iron deficiency correlated significantly with the severity of iron deficiency anemia.     

Occult celiac sprue masquerading as severe iron deficiency anemia

Severe iron deficiency was the presenting manifestation in a patient with occult celiac sprue that went unrecognized for a prolonged time. Endoscopic abnormalities and the absence of typical symptoms may contribute to a delay in diagnosis unless a high index of suspicion is maintained.     

Iron requirements and iron balance during pregnancy. Is iron supplementation needed for pregnant women?

Among fertile, nonpregnant, Danish women, 33% have absent or reduced iron stores; 22% have serum ferritin values above 70 micrograms/l, i.e., iron reserves of more than 530 mg, corresponding to the net iron losses during a normal pregnancy. During pregnancy, the demands for absorbed iron increase from 0.8 to 7.5 mg/day. Controlled studies show that iron-treated pregnant women have higher serum ferritin levels, i.e., larger iron stores, and higher haemoglobin levels than placebo-treated women. A supplement of 66 mg ferrous iron daily from the beginning of the 2nd trimester prevents iron deficiency anaemia. In Denmark, general iron prophylaxis with 60-70 mg ferrous iron daily from 20 weeks of gestation is recommended by the health authorities.     

Influence of nutritional iron deficiency development on some aspects of iron, copper and zinc metabolism

The permanent fibrocyte-like fish cell line RTG-2 from rainbow trout (Oncorhynchus mykiss) gonads was investigated by means of light and scanning electron microscopy with respect to alterations as a consequence of sublethal exposure to 0, 1, 10, 16, 25, and 50 mg/liter 3,5-dichlorophenol (3,5-DCP) for 24 h. Control RTG-2 cells were spindle-like in shape and almost three times longer than wide. In subconfluent cultures, they displayed widely spread, flat leading lamellae and formed small groups. Along the edges of the cell protrusions, numerous retraction fibrils could be identified. Except for shallow ridges and small folds, the surface of untreated cells was completely smooth. Following exposure to 3,5-DCP, distinct dose-dependent alterations in cell shape, the appearance of surface blebs and invaginations, as well as progressive retraction of cell extensions could be observed from the lowest test concentration. Morphological changes could be correlated to suppression of lactate dehydrogenase and reduced neutral red retention capacity.     

Folate, vitamin D, and iron intakes are low among pregnant Finnish women

OBJECTIVE: To evaluate dietary habits and nutrient intake of Finnish pregnant women, to relate these to the use of dietary supplements, and to explore possible dietary variations according to age and education. DESIGN: A random dietary survey using two five day estimated food records. SETTING: Pregnant women from 13 maternity clinics in the city of Oulu, Finland. SUBJECTS: One hundred and eighteen pregnant women in their third trimester. MAIN RESULTS: The main sources of energy were cereal products and milk products. The consumption of fish and poultry was low. Women with a higher educational level consumed more vegetables, fruit, fruit juices, and tea and less sausages, inner organs and coffee than women with a lower educational level. Younger women (< 25 y) consumed more sugar and pork and less berries, butter and inner organs than older women. On average 15% of the total energy was supplied by protein, 33% by fats, 52% by carbohydrates, and 12% by sucrose. Compared to the Nordic nutrition recommendations, the proportion of polyunsaturated fatty acids and the intake of dietary fibre were low and the intake of sugar high. The intakes of vitamins and minerals met or exceeded the recommended allowances, except for vitamin D, folate, and iron. Of the subjects 70% used dietary supplements. With the exception of vitamin D, folate, and iron, both the supplement users and non-users had an adequate nutrient intake from their diet. CONCLUSIONS: A balanced diet covers the increased nutrient requirements during pregnancy, with the exception for vitamin D, folate, and iron. The use of dietary supplements during pregnancy is excessive and partly focused on the wrong nutrients. Young and less educated, and smoking pregnant women need more nutritional guidance.     

Prevalence of monosymptomatic celiac disease in patients with iron deficiency anemia

A prospective study of the prevalence of monosymptomatic celiac disease presented as ferropenic anemia in patients admitted for study such complication of was carried out. All the patients were evaluated by gastroscopy and biopsy of the distal duodenal segment, regardless of endoscopic appearance. Patients presenting an endoscopic lesion clearly suggestive as the origin of the chronic bleeding were excluded from the study. The prevalence of celiac disease, the only manifestation of which was ferropenic anemia, was 3.3% in this series. What is important to note in this study is the importance of duodenal biopsy in the study of ferropenic anemia, with the aim of avoiding diagnostic delay of a possible monosymptomatic celiac disease as the cause of the anemia.     

Estimation of iron reserves in the body of pregnant women

The iron reserves were assessed using Cook's formulas in 86 women in following trimesters of pregnancy and in the course of labour. The range of obtained iron reserves' levels was wide and amounted from -570 mg to 874 mg. The iron reserves' levels differed statistically in the groups of women with normal iron amount, with hypoferraemia and with sideropenic anaemia diagnosed on the basis of haematologic and iron indexes. Iron reserves insufficient for the maintenance of iron positive balance in organism were found in about 30% of examined gravidae.     

Is general screening for anemia and iron deficiency justified in nursing infants?

OBJECTIVE: To establish the necessity of anemia and iron deficiency screening in breast-feeders in our environment. DESIGN: A crossover study, after data collection from case records. SETTING AND PATIENTS: 93 children of 18 and 24 months living in a urban area. All of them are included in the Healthy Breast-feeder Programme of the Health Center of Teruel city. INTERVENTIONS: Detection in venous blood of hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, transferrin saturation and ferritin in serum. MEASUREMENTS AND MAIN RESULTS: We founded a 1.1% of anemia with iron deficiency and a 3.4% of latent iron deficiency. We detected a total of 5.4% cases of iron deficiency. We didn't find any statistical significance when comparing the haematic values among children who had received different kinds of milk nor in relation with the time in which they got it. We didn't find either any differences when comparing such values among those who had received iron prophylaxis and those in which this treatment was not considered necessary. CONCLUSIONS: Therefore we suggest selective iron prophylaxis for risk groups and laboratory studies only in those with evident signs of anemia or iron deficiency.     

Geophagy, iron status and anaemia among pregnant women on the coast of Kenya

OBJECTIVE: To report a case of methemoglobinemia in a patient receiving dapsone for prophylaxis of Pneumocystis carinii pneumonia (PCP). CASE SUMMARY: A 69-year-old white woman was hospitalized to rule out sepsis. Two years prior to this admission, the patient received an orthotopic liver transplant after which she required hemodialysis three times weekly. Because of intolerance to trimethoprim/ sulfamethoxazole and aerosolized pentamidine, she was prescribed dapsone therapy on hospital day 13, that was continued for 11 days. On hospital day 45 the patient received a cadaveric kidney transplant, and dialysis treatments were scheduled only as needed. One week after the transplant, dapsone therapy was resumed. Nine days into this course of dapsone, the patient developed dyspnea and oxygen desaturation of unknown etiology. The patient was evaluated for and diagnosed with methemoglobinemia. She received two doses of intravenous methylene blue and one dose of oral activated charcoal due to fluctuating methemoglobin concentrations. DISCUSSION: The elimination of dapsone is not completely understood. Several case reports of dapsone-induced methemoglobinemia are present in the literature. Most have occurred in patients who have accidentally or deliberately overdosed. Cases of methemoglobinemia in patients receiving therapeutic doses of dapsone are discussed. CONCLUSIONS: The growing numbers of immunosuppressed patients due to transplantation of HIV may result in increased dapsone use for the prevention of PCP. Clinicians should be aware of the adverse effects associated with dapsone therapy, and patients with dyspnea and hypoxemia of unclear etiology should be evaluated for methemoglobinemia.     

Increased erythron transferrin uptake associated with ineffective erythropoiesis in iron deficiency state--the common factors to iron deficiency anemia and portal hypertensions]

Physicians frequently order batteries of tests that are used to assess liver injury or function. These tests are frequently ordered to screen for disease. However, a lack of understanding of the nature of the assays and the laboratory assignment of normal versus abnormal often leads to unnecessary workup or missed disease. We attempt to describe the nature of the most commonly used laboratory tests for liver disease, including alanine and aspartate aminotransferases, alkaline phosphatase, bilirubin, and gamma glutamyl transpeptidase. In addition, the role of functional tests of the liver, including prothrombin time, and metabolite clearance tests, such as aminopyrine and monoethylglycinexylidine, are examined.     

Evaluation of hemoglobin and hematocrit in pregnant women receiving folate and iron supplements

BACKGROUND AND AIMS: From week 8 there is a reduction in hemoglobin and hematocrit (owing to the increased plasma volume which exceeds the increased erythrocytic content) that continues to fall steadily until week 16-22, flattening out at a level of 10-11 g/100 ml for hemoglobin and 32-34% for hematocrit. Bone marrow produces red blood cells and hemoglobin in proportion to the increase in plasma volume, provided that there is an adequate iron supply (higher in pregnancy compared to the usual dietary intake). For this reason, the authors examined the systematic supplementation of pregnant women with ferrous gluconate and folic acid, another important element for numerous metabolic reactions which is also lacking in pregnancy owing to increased requirements. METHODS: The study showed that pregnant patients receiving folic acid and iron supplements from week 5 to 40 presented hematocrit readings and hemoglobin levels from week 12 that were constantly higher compared to the population not receiving supplements, with statistically significant and highly significant differences respectively. The few collateral effects observed in a limited group of patients allow the authors to define the tolerability of the proposed treatment as "excellent". They emphasise, however, the importance of constant supplementation with folic acid and iron throughout pregnancy to avoid sideropenic anemia, with considerable benefits in terms of the physical conditions of the pregnant woman, the supply of O2 to the villi, fetal wellbeing and the need to resort to possible blood transfusions in the event of major blood losses at birth.     

The efficiency of goiter prevention due to iodine deficiency in pregnant women

The iodine is indispensable element for life that is also fundamental substract for thyroid hormone synthesis which make very important influence on protein's lipid's, carbohydrate's and highly caloric substances metabolism and are a requisite of proper man development. The pregnant women are one of population group which is the most sensitive on iodine's deficiency. The results of researches indicate on insufficient iodine intake in pregnant women diet, whose take food even according to diet's recommendation given by physician. The wide iodine's prophylaxis which was provided as yet is insufficient in case of pregnant and nursing women. It is confirmed the necessity of additional iodine supplementation. A set of control tests should be done in requires cases that inform physician about changes in function and size of thyroid gland and make possible the individualization of treatment. The supplementation doses of iodine about 150 micrograms are safe and there was not observed any side effects during their taking.