Anemia of chronic diseases

Scientific Reports, 2022

Inflammatory states are associated with anemia of chronic disease and acute infection. Hepcidin, a regulator of iron metabolism, is involved in iron pathophysiology during inflammation. We investigated biochemical characteristics in children with anemia from different causes. Four patient groups (n = 38; mean age: 12.44 ± 4.35 years) were studied: (1) inflammatory bowel disease (IBD, 10 patients); (2) iron deficiency anemia (IDA, 12); (3) celiac disease (CD, 8); (4) acute infection (AI, 8). Laboratory measurements were evaluated at diagnosis: blood count, serum iron, transferrin, ferritin, vitamin B 12 , folic acid, CRP, erythropoietin, hepcidin and soluble transferrin receptor (sTfR). IDA patients had the lowest Hgb (6.9 ± 1.7 g/dL), MCV (63.2 ± 7.2 fL), iron (16.8 ± 13.5 µg/dL), ferritin (4.5 ± 4.5 ng/mL) and hepcidin (3.1 ± 0.8 ng/mL) values, and the highest transferrin and sTfR values. AI patients had the highest ferritin (156.2 ± 124.5 ng/mL), CRP (144.6 ± 94 mg/L) and hepcidin (74.67 ± 12.3 ng/ml) values. Overall, hepcidin levels correlated with CRP and with ferritin (r = 0.83 and 0.85, respectively). Elucidating specific etiology-related biochemical profiles in pediatric patients with anemia from different causes using a combination of laboratory biomarkers, including hepcidin, can help physicians treat the anemia. Abbreviations IBD Inflammatory bowel disease IDA Iron deficiency anemia CD Celiac disease AI Acute infection Hgb Hemoglobin MCV Mean corpuscular volume MCH Mean corpuscular hemoglobin MCHC Mean corpuscular hemoglobin concentration RDW Red blood cell distribution width CHr Content of Hgb in reticulocytes WBC White blood cells ANC Absolute neutrophil count EPO Erythropoietin CRP C reactive protein sTfR Serum transferrin receptor NS Not significant Anemia is frequently encountered in the pediatric population; the most common etiology is iron deficiency (ID). However, other conditions, such as anemia of chronic disease (ACD) and acute infection (AI), often coexist with ID and affect iron status as well, although not necessarily via iron deficiency 1,2. There are several commonly used biomarkers for evaluation of iron status. According to the 2020 WHO guidelines, measurement of serum ferritin assesses storage iron, while measurements of serum iron and the percentage of transferrin saturation reflect the iron supply to tissues. Serum transferrin receptor (sTfR), erythrocyte ferritin and red cell zinc protoporphyrin are indicators of the iron supply to bone marrow. The use of iron by the bone marrow can be assessed by the percentage of hypochromic red blood cells, mean corpuscular volume and

Objective: Hepcidin is a key regulator of iron homeostasis. Increased hepcidin concentrations cause iron sequestration in enterocytes and macrophages. The role of hepcidin in children with iron-deficiency anemia and anemia of inflammation is unclear. In this study, we aimed to evaluate the use of serum hepcidin level as an index for iron deficiency and inflammation anemia in pediatric population. Furthermore, hepcidin is also known to be an acute-phase reactant induced by interleukin-6 (IL-6) during infection. Therefore, we investigated the relationships between hepcidin and inflammatory markers. Methods: This study included 50 children with anemia (13 with iron deficiency and 37 with inflammation) and 17 age-and gender-matched healthy children (control group). Parameters related to iron metabolism (ferritin, serum iron and total iron binding capacity), infection (Creactive protein, white blood cell count and neutrophil percentage) and hepcidin levels were measured. Results: Serum hepcidin levels in patients with anemia of inflammation (362.63±132.27 ng/ mL) were significantly higher than in patients with iron-deficiency anemia (234.10±93.59 ng/ mL) and healthy controls (220.44±49.52 ng/mL) (p=0.002, p<0.001, respectively). Serum hepcidin levels were positively correlated with ferritin (r=0.246, p=0.045), leucocytes (r=0.259, p=0.034) and CRP (r=0.426, p<0.001) levels in all children.

Asian Journal of Clinical Pediatrics and Neonatology, 2018

Background: Public health significance of anemia in children was classified as severe in India. Severe anemia (Hb < 7g/dL) significantly increases the risk of death. Critical diagnostic evaluation and a thorough work-up make the accurate diagnosis of intrinsic red cell abnormalities feasible. Review of etiology helps to formulate strategies to prevent them, and to know the degree of achievement of the targets. Objectives: The aim of the present study was to identify the etiology of severe anemia. Subjects and Methods: It is a retrospective record based study done at a tertiary care center. All new severe anemia cases aged 1 month to 18 yrs, which were admitted on Monday from Jan 2017 to Dec 2017 were included. Previously worked up cases coming for transfusions and anemia due to bleeding were excluded. Details of history, physical examination and work-up were obtained for justification of diagnosis based on existing evidence. Results: 112 children were included. Mean age was 3.94 yrs (+/_3.52) (Range: 1 month-13 years), median and mode were 3 years. Male to female ratio was 1.95:1. 51% of severe anemia cases were due to iron deficiency. 11.6% had confirmed β-Thalassemia Trait (BTT) and 18.75% had suspected Thalassemia Trait (TT). Other causes of severe anemia were: folate deficiency (13.4%), B12 deficiency (1.8%), hereditary spherocytosis (HS) (7.1%), marrow replacement by acute leukemia (6.25%), aplastic anemia (2.7%), malaria (2.7%), and antiretroviral therapy induced anemia (0.9%). HS was the second most common cause of hemolytic anemia after thalassemias. Conclusion: Though a number of nutrition based initiatives have been initiated in the country, the burden of preventable iron deficiency, contributing to severe anemia cases is enormous, signifying the need for more effective programs to be implemented in India. Folate should be supplemented to all children with anemia irrespective of the cause. Essential workup with proper interpretation of investigations for arriving at diagnosis prior to transfusing the child is obligatory.

Journal of medical science and clinical research, 2018

Anaemia in children is a major public health problem throughout the world. It is estimated that at least onethird of the population has been at one-time anemic. It is often multifactorial, iron deficiency being the most frequent etiology and reasons like malaria endemicity, poor nutrition including micronutrient deficiency, haemoglobinopathies, frequent bacterial infections and high parasitic infestations have been given for these high prevalence rates. The ranges for Hb were first derived from 554 subjects in whom laboratory values for serum iron/iron-binding capacity, mean corpuscular volume, and erythrocyte protoporphyrin were all normal (≥16%, ≥80 fl, and ≤75 µg/dl red blood cells, respectively). Using these reference standards, the prevalence of Anaemia (Hb values below the 95% reference range for age and sex) among the 354 subjects with complete laboratory results was highest in infants (5.8%), teenage girls (5.10%), young women (5.9%), and elderly men (4.5%). Chronic Anaemia may impair growth, cardiac function and cognitive development in infants but other consequences are rather poorly explored more thoroughly. Chronic disorders and iron deficiency were the most common causes of Anaemia. Anaemia was frequently diagnosed in this series of elderly patients. Partly treatable nutritional deficiencies, such as iron or folate deficiency, were identified as possible causes. A complex and heterogeneous interplay of chronic inflammation, functional iron deficiency, and renal impairment was identified in a large proportion of patients. Measures directed at prevention and control of anemia, include increased coverage of supplementation and fortification programs are strongly recommended.

2016

Anemia is a very serious health problem in India and most common nutritional problems in many parts of the world. We estimated the different types of prevalence of anemia in children, an observational study. We collected data from 140 pediatric patients. The study had been conducted for six months and the required data was collected. We included 140 pediatric patients who are anemic irrespective of their gender and age. We documented the prevalence of different types of anemia, in which the iron deficiency is highly prevalent i.e., 37.85%.Our data shows that the mean age of the patients was 6.6±4.1 years (range 1-15 years). It was found that 53 (37.8%) patients have iron deficiency anemia which is highly prevalent, 15 (10.7%) patients have sickle cell anemia, 26 (18.5%) patients have severe anemia and hemolytic anemia, 18 (12.8%) patients have ßThalassemia minor and ß-Thalassemia major, 10 (7.14%) patients have sickle cell thalassemia, 8 (5.7%) patients have thrombocytopenia, 6 (4.2...

HEALTH SCIENCES AND DISEASES, 2017

Introduction. Although malaria is the most common cause of anemia in children in our context, it is still common practice for health practitioners to prescribe iron to patients with anemia based only on red blood cell indices. The assessment of iron stores is not common practice. Objective. To report the prevalence of iron deficiency in acute anemia among children received at the Yaounde Gyneco-Obstetric and Pediatric Hospital in an infectious context. Methodology. This was a cross-sectional study over a period of 6 months, including 1451 Children with infection; aged 6 months to 15 years. Laboratory tests included, full blood count, septic screen depending on the clinical presentation, malaria test, direct stool examination, measurement of iron and ferritin levels in those presenting with biological anemia. The Chi² test was used for comparison and the association between qualitative variables; the threshold of significance was 0.05. Results. The sex ratio was 1.27. Children aged 6...

Medical Science and Discovery

Objective: Anemia, which is a public health problem on a global scale, continues to maintain its importance in pediatric patients. There are few studies on the prevalence of anemia in hospitalized children. This study was conducted to evaluate the prevalence and etiologies of anemia in hospitalized pediatric patients. Material and Method: This is a cross-sectional epidemiological study. The study group consists of 1000 patients between the ages of 6 months and 18 years who were hospitalized in the Department of Pediatrics of Prof. Dr. Cemil Tascioglu City Hospital. The data of the patients were reviewed retrospectively. The SPSS 22.0 program was used for statistical analyzes and calculations and p&lt; 0.05 was accepted for significance. Results: Of the patients included in the study, 569 (56.9%) were male, and 431 (43.1%) were female. In the study, the number of patients with anemia was 276 (27.6%), and among those 151 (26.5%) were male and 125 (29.0%) were female. The highest rate ...

Aim: Anemia is an important public health problem that concerns human and community health. In this study, we aimed to determine the etiology of anemia in different age groups and create social awareness. Methods: The study (retrospective cohort study) included anemia patients between 6 months and 18 years old who applied to the Pediatric Hematology and Oncology Outpatient Clinic of KSU Medical Faculty between January 2015 and January 2018. Results: 1120 patients were included in the study. There were 873 with iron deficiency anemia, 184 with thalassemia minor, 25 with vitamin B12 deficiency anemia, 13 with autoimmune hemolytic anemia, 10 with hereditary spherocytosis and the other etiology of anemia. While 16.4% of all patients and 33.8% of patients aged 6-12 years had thalassemia minor. On the other side, 81.3% of patients aged 6 months-2 years, 74.3% of patients aged 2-6 years, 60.4% of patients aged 6-12 years and 85.0% of patients aged 12-18 years had iron-deficiency anemia. Iron deficiency anemia was common in males (60.2%) in the 2-6 years age group (P=0.002), but it was common in females (80.6%) in the 12-18 years age group (P<0.001). Conclusion: As a result of this study, it has been concluded that screening and iron supplementation should be done in societies at risk.

Journal of Clinical Biochemistry and Nutrition, 1987