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Trace Mineral Deficiencies – Diagnosis and Treatment
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Kavitha Krishnan, Julianne Werner
A bone marrow biopsy is considered the gold standard to diagnose iron deficiency but is not used due to cost and patient discomfort. Serum ferritin is the preferred biochemical marker of iron stores. Iron deficiency occurs when iron stores are depleted, indicated by a serum ferritin level of 20 µg/L or less.16 However, serum ferritin is a positive acute-phase protein, and as such during inflammation it may be elevated and not accurately depict deficiency states.15 The average ferritin values for adult men and women are 100 µg/L and 30 µg/L, respectively.17
Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Ferritin: A high serum ferritin may indicate iron overload or hepatocellular disease. Ferritin is an acute phase protein and is elevated in conditions such as rheumatoid arthritis, some cancers such as Hodgkins lymphoma, hyperthyroidism as well as alcohol and non-alcohl related liver disease.
Oral
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
SMALL PRINT: Swab, autoantibody screen, syphilis and HIV serology, biopsy. FBC: Essential basic investigation for anaemia and rarer blood dyscrasias. Ferritin for iron deficiency.Urinalysis: Check for glycosuria. Underlying diabetes may predispose to infective causes (especially Candida).Vitamin B12 and folate: To establish underlying vitamin deficiency (especially if MCV raised).Coeliac screen: Anti-endomysial and anti-gliadin antibodies suggest coeliac disease if positive.Swab: May help confirm doubtful diagnosis of ANUG – confirms presence of Vincent's organisms.Autoantibody screens and HLA tests may be useful if autoimmune causes are suspected.Syphilis or HIV serology: If syphilis or HIV are suspected.Biopsy: Required in persistent ulcer of uncertain aetiology (secondary care investigation).
Prevalence and severity of thrombocytopenia in patients with hyperferritinemia
Published in Hematology, 2023
Shifang Yu, Qiang Li, Kaihua Xiang, Yanjie Hua, Xiaoying Zhao
Ferritin, a molecule that binds to iron, is critical in the storage and release of iron in the body. Severe hyperferritinemia indicates an overload of iron and reflects the severity and poor prognosis of various diseases, including tumors, inflammation, and blood disorders [1–3], which are often accompanied by low platelet counts. Lodha et al. [4] conducted a study on 200 dengue patients, measuring serum ferritin levels at initial presentation and monitoring platelet counts serially. The results showed that a high serum ferritin level upon initial contact could indicate potentially severe disease, with levels ≥593 ng/mL helping to identify patients at risk for developing severe thrombocytopenia and aiding doctors in prognosis. Thrombocytopenia and elevated ferritin levels have also been observed in critically ill COVID-19 patients, indicating poor prognosis [5,6]. Cheong et al. [7] conducted a study of 96 patients with myelodysplastic syndromes (MDS) or aplastic anemia (AA) and reported that elevated platelet counts were associated with a significant decrease in serum ferritin and liver iron concentrations. Thrombocytopenia has also been observed in patients receiving gastrointestinal iron supplementation [8,9]. In patients with acquired iron overload, such as those who receive blood transfusions and/or have abnormal erythropoiesis, oral iron chelators can increase platelet counts [10]. To sum up, iron reserves may be related to platelet counts in certain patients.
Serum ferritin is a good indicator for predicting the efficacy of adult HLH induction therapy
Published in Annals of Medicine, 2022
Zhengjie Hua, Lingbo He, Ruoxi Zhang, Menghan Liu, Zhao Wang, Yini Wang
HLH is a high-inflammatory factor storm syndrome characterized by an extreme increase in pro-inflammatory cytokines. The early symptoms are atypical, and the diagnosis is difficult. However, the disease progresses rapidly, and many patients die rapidly due to seeking medical treatment too late or unclear diagnosis. Thus, early diagnosis and treatment of HLH are very important. The reactants in the acute phase of HLH are often elevated, and the most relevant one is serum ferritin [8]. Ferritin is an acute-phase reactive protein that regulates the homeostasis and storage of iron. It mainly exists in reticuloendothelial cells. The content in macrophages is the highest [4]. And the extensive activation of macrophages may be responsible for the significant increase of ferritin in HLH [9]. Studies have found that increased serum ferritin is a clinical parameter of iron overload, inflammation, tumour burden and liver disease [10]. In adults, the most common condition associated with elevated ferritin is haematological malignancies, followed by liver failure, HLH and other common causes including infection, kidney failure, chronic blood transfusion and haemoglobinopathy. Studies have shown that increased ferritin has no significant specificity for the diagnosis of HLH in adults [11], and not all hyperferritinemia patients have HLH. Therefore, clinical manifestations and other laboratory indicators should be combined to identify the disease in diagnosis.
Addition of glomerular lesion severity improves the value of anemia status for the prediction of renal outcomes in Chinese patients with type 2 diabetes
Published in Renal Failure, 2022
Lijun Zhao, Qianqian Han, Li Zhou, Lin Bai, Yiting Wang, Yucheng Wu, Honghong Ren, Yutong Zou, Shuangqing Li, Qiaoli Su, Huan Xu, Lin Li, Zhonglin Chai, Mark E. Cooper, Nanwei Tong, Jie Zhang, Fang Liu
Baseline demographic and clinical data, including age, sex, body mass index (BMI), smoking status, hemoglobin A1c (HbA1c), presence of diabetic retinopathy, 24-h proteinuria, and use of renin-angiotensin-aldosterone system blockade were collected from the electronic medical records at the time of renal biopsy. The estimated glomerular filtration rate (eGFR) was evaluated using the Chronic Kidney Disease Epidemiology Collaboration formula [15,16]. The Hb concentration was measured by the resistance method using System XE-2100. Serum ferritin was measured with an immunoradiometric assay. Serum iron and total iron-binding capacity (TIBC) were measured with a modified automated AAII-25 colorimetric method. Transferrin saturation (TSAT) was calculated as (iron/TIBC) × 100% [16]. During the follow-up period, patients attended follow-up appointments 2–4 times annually, depending on their clinical condition.