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Trace Mineral Deficiencies – Diagnosis and Treatment
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Kavitha Krishnan, Julianne Werner
The major iron-transport protein in the blood is transferrin. During iron deficiency the ratio between iron and transferrin decreases because there is less iron to transport. Transferrin saturation is calculated by the formula: (serum iron × 100)/ total iron binding capacity (TIBC). TIBC is a marker for circulating transferrin. Transferrin saturation less than 18% indicates iron deficiency with a normal range from 18% to 50%. Mean corpuscular volume (MCV) is a measure of the size and volume of red blood cells. A low MCV defined as 80 fL or less may indicate iron deficiency; however, other causative factors, such as blood loss, should be ruled out.16
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Published in Henry J. Woodford, Essential Geriatrics, 2022
Iron deficiency anaemia (IDA) constitutes around 17–20% of anaemia in community-dwelling people aged over 65.1 It may be due to inadequate dietary iron, malabsorption or blood loss. It is associated with red blood cell microcytosis (mean cell volume [MCV] < 80 fL), which may also be seen in anaemia of chronic disease, sideroblastic anaemia and haemoglobin disorders (e.g. thalassaemia). It may present with normocytosis when coupled with deficiency in folate or vitamin B12. In addition to microcytosis, a low ferritin, serum iron and transferrin saturation ratio and a raised total iron-binding capacity all suggest IDA. Of these additional tests, a serum ferritin level is most helpful. A ferritin concentration < 12 mcg/dL always indicates iron deficiency, but a level of 12–45 mcg/dL is also suggestive.8 Ferritin is an acute-phase reactant and may be in the normal range if an inflammatory process is also present (i.e. 45–100 mcg/dL).9 Transferrin and serum iron fall in inflammatory states and transferrin saturation is low in chronic disease.10 These tests may be more helpful when iron overload is suspected. Transferrin saturation < 20% can indicate iron deficiency, while transferrin saturation > 50% suggests iron overload. Bone marrow examination would reveal decreased bodily iron stores.
Iron Metabolism: Iron Transport and Cellular Uptake Mechanisms
Published in Bo Lönnerdal, Iron Metabolism in Infants, 2020
Iron supplied to transferrin in infancy and childhood has presented a problem of interpretation. Transferrin saturation is lower than in adulthood and often falls below the critical level of 16% established in the adult.257–259 Other indices of iron status, including red cell protoporphyrin and ferritin, also show values that would indicate iron deficiency in the adult. However, iron therapy does not necessarily improve the hemoglobin concentration as would be expected in an iron-deficient adult. It has, therefore, been suggested that these findings constitute a physiologic difference in the regulation of iron supply in childhood, one resembling to some degree the changes produced by inflammation (Table 2). Criteria for identification of iron deficiency at different ages employed in the NHANES II survey are summarized in the accompanying table (Table 2).
Iron deficiency in pulmonary arterial hypertension associated with congenital heart disease
Published in Scandinavian Cardiovascular Journal, 2018
Xue Yu, Yi Zhang, Qin Luo, Zhihong Liu, Zhihui Zhao, Qing Zhao, Liu Gao, Qi Jin, Lu Yan
Patients who were newly diagnosed with CHD-PAH between September 2015 and December 2017 were retrospectively enrolled. Clinical materials of all patients were collected and assessed. The diagnosis of “CHD-PAH” was established as follows [3]: 1) mean pulmonary arterial pressure (mPAP) ≥25 mm Hg with pulmonary capillary wedge pressure ≤15 mm Hg at rest measured by right heart catheterization; 2) cardiac defects or defect correction confirmed by echocardiography; 3) no other forms of pulmonary hypertension being present. Patients having one of the following conditions were excluded [10]: 1) age less than eighteen years old; 2) pathological conditions affecting iron status like massive hemoptysis and hypermenorrhea; 3) major surgery within a year; 4) hematological tumor; 5) recent iron supplementation therapy; 6) severe liver or kidney dysfunction. Transferrin saturation is a more favorable marker of iron status than serum iron and ferritin [11,12]. In this study ID was defined as transferrin saturation <20% in male and transferrin saturation <25% in female. Patients were divided into iron-deficient and iron-replete groups according to the above criteria.
Evaluation of hypercoagulability with rotational thromboelastometry in children with iron deficiency anemia
Published in Hematology, 2018
Zeynep Canan Özdemir, Yeter Düzenli Kar, Eren Gündüz, Ayşe Bozkurt Turhan, Özcan Bör
All blood samples were collected after eight hours of fasting and were studied immediately. Specimens for the ROTEM and coagulation tests were drawn into tubes containing a 3.2% buffered sodium citrate (0.129 mol/ L) as the anticoagulant (9:1). Complete blood counts were measured using a Beckman Coulter LH750 machine (Kraemer Blud. Brea, CA, US). Prothrombin time (PT, s), activated partial thromboplastin time (aPTT, s) and fibrinogen (mg/dL) tests were performed immediately on a Siemens BCS XP machine (Tem International, Marburg, Germany). Serum iron levels were measured using a photometric method (Hitachicobas c 502, Roche Diagnostics, Germany), while serum ferritin levels were determined through a chemiluminescent immunoassay method (Cobas E-602, Roche Diagnostics, Germany). Transferrin saturation was calculated as serum iron × 100/total iron-binding capacity.
Arthropathy in hereditary haemochromatosis segregates with elevated erythrocyte mean corpuscular volume
Published in Scandinavian Journal of Rheumatology, 2021
A Rehman, GJ Carroll, LW Powell, LE Ramm, GA Ramm, JK Olynyk
Transferrin saturation was similar in HH subjects with or without arthritis (Table 1). Serum ferritin levels, HIC, and iron removed were significantly higher in HH subjects with arthritis compared to those without (Table 1). Hepatic fibrosis was significantly greater in HH subjects with arthritis compared to those without (median Scheuer score 1 in those with arthritis vs 0 in those without fibrosis, p < 0.0001, Mann–Whitney test). Using linear regression analysis, no relationships were observed between MCV and serum ferritin, HIC, or iron removed. Multivariable logistic regression analysis confirmed that fibrosis severity [odds ratio (OR) 2.2, 95% confidence interval (CI) 1.1–4.7] and iron removal (OR 1.5, CI 1.3–2.3) exhibited ongoing associations with arthritis.