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Query: UMLS:C0240066 (iron deficiency)
 7,156 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

When erythropoietin (epoetins or darbepoetin) is used to treat the anemias of chronic renal failure, cancer chemotherapy, inflammatory bowel diseases, HIV infection and rheumatoid arthritis, functional iron deficiency rapidly ensues unless individuals are iron-overloaded from prior transfusions. Therefore, iron therapy is essential when using erythropoietin to maximize erythropoiesis by avoiding absolute and functional iron deficiency. Body iron stores (800-1200 mg) are best maintained by providing this much iron intravenously in a year, or more if blood loss is significant (in hemodialysis patients this can be 1-3 g). There is no ideal method for monitoring iron therapy, but serum ferritin and transferrin iron saturation are the most common tests. Iron deficiency is also detected by measuring the percentage of hypochromic red blood cells, content of hemoglobin in reticulocytes, soluble transferrin receptor levels, and free erythrocyte protoporphyrin values, but iron overload is not monitored by these tests. Iron gluconate and iron sucrose are the safest intravenous medications.
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PMID:Iron requirements in erythropoietin therapy. 1573 95

Severe anaemia is a common presentation in non-pregnant adults admitted to hospital in southern Africa. Standard syndromic treatment based on data from the pre-HIV era is for iron deficiency, worms and malaria. We prospectively investigated 105 adults admitted consecutively to medical wards with haemoglobin < 7 g/dl. Those with acute blood loss were excluded. Patients were investigated for possible parasitic, bacterial, mycobacterial and nutritional causes of anaemia, including bone marrow aspiration, to identify potentially treatable causes. Seventy-nine per cent of patients were HIV-positive. One-third of patients had tuberculosis, which was diagnosed only by bone marrow culture in 8% of HIV-positive patients. In 21% of individuals bacteria were cultured, with non-typhi salmonella predominating and Streptococcus pneumoniae rare. Iron deficiency, hookworm infection and malaria were not common in HIV-positive anaemic adults, although heavy hookworm infections were found in 6 (27%) of the 22 HIV-negative anaemic adults. In conclusion, conventional treatment for severe anaemia in adults is not appropriate in an area of high HIV prevalence. Occult mycobacterial disease and bacteraemia are common, but iron deficiency is not common in HIV-positive patients. In addition to iron supplements, management of severe anaemia should include investigation for tuberculosis, and consideration of antibiotics active against enterobacteria.
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PMID:Treatable factors associated with severe anaemia in adults admitted to medical wards in Blantyre, Malawi, an area of high HIV seroprevalence. 1589 81

The risk factors for iron deficiency and iron deficiency anemia among female injection drug users are not well characterized. We measured hemoglobin and plasma ferritin and obtained demographic information and injection drug use history in the last 6 months in a cross-sectional study of 200 female injection drug users (134 HIV-positive and 66 HIV-negative). The women were participants in a natural history study, the AIDS Linked to Intravenous Experiences study in Baltimore, Maryland. In multivariate analyses adjusting for age, hepatitis C virus status, and HIV status, injection drug use within the last 6 months was associated with iron deficiency (odds ratio [OR] = 2.61, 95% confidence interval [CI]: 1.33 to 5.09) and iron deficiency anemia (OR = 6.65, 95% CI: 2.33 to 18.9). Among 134 HIV-positive women, injection drug use in the last 6 months was associated with iron deficiency (OR = 2.43, 95% CI: 1.08 to 5.48) and iron deficiency anemia (OR = 6.05, 95% CI: 1.82 to 20.1) in multivariate analyses adjusting for hepatitis C virus status and CD4 lymphocyte count. Injection drug use seems to be associated with iron deficiency and iron deficiency anemia. Further longitudinal studies are needed to gain insight into the nature of this association.
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PMID:Injection drug use is an independent risk factor for iron deficiency and iron deficiency anemia among HIV-seropositive and HIV-seronegative women. 1618 38

The prevalence of iron deficiency among infants and young children living in developing countries is high. Because of its chemical properties--namely, its oxidative potential--iron functions in several biological systems that are crucial to human health. Iron, which is not easily eliminated from the body, can also cause harm through oxidative stress, interference with the absorption or metabolism of other nutrients, and suppression of critical enzymatic activities. We reviewed 26 randomized controlled trials of preventive, oral iron supplementation in young children (aged 0-59 mo) living in developing countries to ascertain the associated health benefits and risks. The outcomes investigated were anemia, development, growth, morbidity, and mortality. Initial hemoglobin concentrations and iron status were considered as effect modifiers, although few studies included such subgroup analyses. Among iron-deficient or anemic children, hemoglobin concentrations were improved with iron supplementation. Reductions in cognitive and motor development deficits were observed in iron-deficient or anemic children, particularly with longer-duration, lower-dose regimens. With iron supplementation, weight gains were adversely affected in iron-replete children; the effects on height were inconclusive. Most studies found no effect on morbidity, although few had sample sizes or study designs that were adequate for drawing conclusions. In a malaria-endemic population of Zanzibar, significant increases in serious adverse events were associated with iron supplementation, whereas, in Nepal, no effects on mortality in young children were found. More research is needed in populations affected by HIV and tuberculosis. Iron supplementation in preventive programs may need to be targeted through identification of iron-deficient children.
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PMID:Iron supplementation in early childhood: health benefits and risks. 1715 6

We evaluated peripheral blood tests to diagnose iron deficiency on medical wards in Blantyre, Malawi, where infection and HIV are prevalent. We compared full blood count, ferritin and serum transferrin receptor (TfR) levels with an estimation of iron in bone marrow aspirates. Of consecutive adults admitted with severe anaemia (haemoglobin <7 g/dl), 81 had satisfactory bone marrow aspirates. The main outcome measures were the validity of each test (sensitivity, specificity, and positive and negative predictive values) and likelihood ratios (LR) for iron deficiency. Twenty patients (25%) were iron deficient and 64 (79%) were HIV-positive. Iron deficiency was more common in HIV-negative compared with HIV-positive patients (59% vs. 16%; P<0.001). In HIV-positive patients, the optimal ferritin cut-off was 150 microg/l (sensitivity 20%, specificity 93%, LR 2.7), but no test was accurate enough to be clinically useful. In HIV-negative patients, ferritin was the single most accurate test (cut-off <70 microg/l, 100% specificity, 90% sensitive, LR if positive infinity, LR if negative 10). TfR measurement did not improve the accuracy. Mean cell volume was not a good predictor of iron status except in HIV-negative patients (cut-off <85 fl, specificity 71%, sensitivity 90%). In populations with high levels of infection and HIV, an HIV test is necessary to interpret any tests of iron deficiency. In HIV-negative patients, ferritin is the best blood test for iron deficiency, using a higher cut-off than usual. For HIV-positive patients, it is difficult to diagnose iron deficiency without bone marrow aspirates.
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PMID:Interpreting tests for iron deficiency among adults in a high HIV prevalence African setting: routine tests may lead to misdiagnosis. 1727 Feb 26

Iron deficiency is widespread in sub-Saharan Africa, but its predictors are not fully understood. We conducted a cross-sectional study among adults around Lake Victoria to describe iron status and asses the role of dietary and infectious predictors. Linear regression analyses were used to assess the role of infections and intake of meat, fish, fruit/vegetables, alcoholic beverages, and soil on hemoglobin and serum ferritin, while controlling for elevated serum alpha(1)-antichymotrypsin (ACT). Among 1498 participants, the mean age was 33.3 (14-87) y with 53.9% females. More than one-half ate fish daily, 6% ate fruit/vegetables daily, and only 11% ate meat weekly. One-third consumed alcoholic beverages and one-fifth of females consumed soil. Hookworm (80.3%), Schistosoma mansoni (64.7%), and HIV (7.3%) infection were common. Anemia was found in 48.2% of females (<120 g/L hemoglobin) and 40.1% of males (<130 g/L hemoglobin), and 22.3% of females and 7.0% of males had depleted iron stores (serum ferritin <12 microg/L). In multivariate analyses, alcoholic beverage consumption and HIV were positive, whereas soil eating and hookworm infection were negative predictors of serum ferritin. Alcoholic beverage consumption was a positive predictor of hemoglobin, and soil eating, HIV, and hookworm infection were negative predictors. Intakes of meat, fish, and fruit or vegetables were not predictors. Elevated serum ACT was a predictor of both hemoglobin and serum ferritin. Anemia and depleted iron stores were common, whereas iron overload was rare. In conclusion, the associations between alcoholic beverage intake and hemoglobin and iron status suggest that alcoholic beverages may contain micronutrients essential to erythropoiesis. The role of alcoholic beverage intake and other determinants of hemoglobin and iron status in low-income populations needs to be better elucidated.
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PMID:Intake of alcoholic beverages is a predictor of iron status and hemoglobin in adult Tanzanians. 1770 55

In HIV-infected populations from developing countries, it is unclear what proportion of anemia is attributable to iron deficiency (ID) and whether high body iron stores worsen HIV disease progression. We therefore evaluated these research questions in 584 HIV-infected Tanzanian women. Hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (sTfR), and C-reactive protein (CRP) concentrations were evaluated between 13 and 43 wk after women gave birth. ID was defined as SF or sTfR outside normal ranges, and ID anemia (IDA) as ID plus low Hb. In multivariate Cox regression models, the association between SF and HIV disease progression was assessed. Participants received iron + folate supplements during pregnancy. Hb (r = -0.159; P = 0.0001), SF (r = 0.355; P < 0.0001), and sTfR/log SF index (r = -0.119; P = 0.004) were related to CRP, whereas sTfR (r = 0.029; P = 0.48) was not. Prevalence estimates were 39.7% for ID and 23.6% for IDA. ID was associated with 48.9% of anemia cases. Categories of SF were not significantly associated with HIV-related mortality or progression to stage 4. Nevertheless, SF > 150.0 microg/L was related to a nonsignificantly elevated risk of progression to stage 4 (rate ratio = 1.78; 95% CI = 0.68-4.64; P = 0.24) compared with SF < 12.0 microg/L. In HIV-infected, parous women from sub-Saharan Africa, ID is of moderately high prevalence and is an important underlying cause of anemia. High storage iron does not appear to be related to HIV disease progression in this population, but more research on the role of iron during HIV disease is needed.
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PMID:Iron status is an important cause of anemia in HIV-infected Tanzanian women but is not related to accelerated HIV disease progression. 1788 17

Several observations have been made suggesting that excess iron is harmful to patients with HIV/AIDS disease. Bone marrow macrophage iron stores of 30 anaemic HIV infected patients (median age 32.7 years) and 20 anaemic AIDS-associated Kaposi's sarcoma patients (median age 37 years) were studied at the haematology department of the University of Maiduguri Teaching Hospital. Macrophage iron stores were assessed as either normal, decreased or increased by using grades ranging from 0 to 6. Marrow iron stores was increased in 16 (80%) of the patients with Kaposi's sarcoma and normal in 4 (20%) patients. Three of the 4 patients with normal iron stores were females of reproductive age. Regression analysis of iron status and opportunistic infection showed a positive correlation (p-value=0.001). Of the 30 patients with HIV infection, 22 (73.3%) had normal iron stores and 8 (26.7%) had decreased iron stores. All the 8 (26.7%) patients with no stainable iron in the marrow were females of reproductive age group. Iron deficiency anaemia can complicate anaemia of HIV infected patients. In view of the documented risk associated with iron supplementation in anaemic patients with HIV/AIDS disease, little caution should be exercise as regards the use of haematinics and/or blood tonics in anaemic HIV-infected or AIDS-associated Kaposi's sarcoma patients. The fact that noninvasive evaluation for iron deficiency is compromised in many individuals due to the presence of chronic inflammatory process and/or malignancy, bone marrow evaluation for iron stores still remains an important tool often underutilized by many clinicians attending to patients living with HIV/AIDS.
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PMID:Bone marrow macrophage iron stores in patients with HIV infection and AIDS-associated Kaposi's sarcoma. 1920 74

We conducted a study to determine the role of iron, folate and vitamin B12 in HIV-infected patients with anaemia attending a tertiary-care hospital in southern Brazil. Low serum folate levels were found in 14 (41%) HIV-infected patients; parameters of iron deficiency such as low transferring saturation index and ferritin in 10 (30%); and combined folate and iron deficiency in five (14%). Vitamin B12 deficiency was found in only two (6%) patients who presented with mean corpuscular volumes within the normal range. Our study has shown that folate and iron deficiency were frequently detected in HIV-infected patients at our institution, and should be considered in the differential diagnosis of anaemia in all HIV-infected patients independent of their HIV stage of progression.
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PMID:Iron, folate and vitamin B12 parameters in HIV-1 infected patients with anaemia in southern Brazil. 1929 88

The fungal pathogen Candida glabrata has risen from an innocuous commensal to a major human pathogen that causes life-threatening infections with an associated mortality rate of up to 50%. The dramatic rise in the number of immunocompromised individuals from HIV infection, tuberculosis, and as a result of immunosuppressive regimens in cancer treatment and transplant interventions have created a new and hitherto unchartered niche for the proliferation of C. glabrata. Iron acquisition is a known microbial virulence determinant and human diseases of iron overload have been found to correlate with increased bacterial burden. Given that more than 2 billion people worldwide suffer from iron deficiency and that iron overload is one of the most common single-gene inherited diseases, it is important to understand whether host iron status may influence C. glabrata infectious disease progression. Here we identify Sit1 as the sole siderophore-iron transporter in C. glabrata and demonstrate that siderophore-mediated iron acquisition is critical for enhancing C. glabrata survival to the microbicidal activities of macrophages. Within the Sit1 transporter, we identify a conserved extracellular SIderophore Transporter Domain (SITD) that is critical for siderophore-mediated ability of C. glabrata to resist macrophage killing. Using macrophage models of human iron overload disease, we demonstrate that C. glabrata senses altered iron levels within the phagosomal compartment. Moreover, Sit1 functions as a determinant for C. glabrata to survive macrophage killing in a manner that is dependent on macrophage iron status. These studies suggest that host iron status is a modifier of infectious disease that modulates the dependence on distinct mechanisms of microbial Fe acquisition.
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PMID:Host iron withholding demands siderophore utilization for Candida glabrata to survive macrophage killing. 2144 36


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