ABSTRACT
A hematological finding in cobalamin and folic acid deficiency is increased neutrophil lobulation [hypersegmentation]. There are contradictory reports about correlation of neutrophil hypersegmentation [NH] to iron deficiency in recent studies. This study re-examines the relationship between both iron deficiency [ID] and iron deficiency anemia [IDA] to hypersegmentation. The effect of folate deficiency was also investigated. Due to the high prevalence of iron deficiency in young Iranian women, the study groups were selected among young women. 90 subjects, 30-16 years of age, admitted to the Clinical Laboratory of Imam Reza Hospital, Mashhad [29 subjects with ID, 30 with IDA and 31 controls] were studied. Ferritin, folate and cobalamin levels in serum were measured by RIA [Kavos-hyar reagent]. Iron and Total Iron Binding Capacity [TIBC] were measured using Colorimetric methods. CBC and RBC Indexes were measured by Sysmex k-21. To investigate each patient's peripheral blood hypersegmentation, 100 neutrophils were counted separately by two experts. Chi-square test revealed significant differences among NH and three groups of ID, IDA and control group [P=0.001]. NH showed significant relationships with decreased serum Ferritin and Iron [P=0.001]. Logistic regression analysis showed that the relationship between NH and ID / IDA is mostly due to the simultaneous presence of low normal levels of folate deficiency [P= 0.044]. This study showed a correlation between NH and iron pools and Low normal levels of Folate. Therefore, when observing NH in peripheral blood of patients, especially in women of childbearing ages, it should be suspicious of coexistence of iron and mild folate deficiency and that further investigation must be done. Because NH is a simple and low-cost testing, it could be a useful diagnostic test for screening of IDA/ID and folate deficiency especially for women of childbearing ages
ABSTRACT
The prevalence of cobalamin and folic acid is high in elderly. Ambiguous clinical findings, various laboratory methods and normal range and cost of laboratory tests have been resulted in complexity and delay of the deficiency diagnosis. The aim of this study is to evaluate the relation between hematologic parameters, especially neutrophil hypersegmentation and cobalamin and folic acid insufficiency as well as increased serum hemocystein. Three hundred subjects more than 65 years age from twelve regions of Mashhad were studied. This population was selected by the Provincial Health Center. 250 subjects were analyzed for serum cobalamin and folate by RIA method. 78 subjects, who had cobalamin 120-450 pg/ml and folate 1.5-17ng/ml without any confounders, were analyzed for homocystein [Hcy] by Elisa method. Hematological parameters were assayed by H1 system and blood smear by microscopic observation. Data were analyzed by SPSS 11.5 software. p<0.05 was considered statistically significant. Among 235 participants, 45.5% and 54.5% were positive and negative for neutrophil hypersegmentation [NH], respectively. Significant correlation was not found between NH and gender. In 216 subjects, 56.7% had red blood cell macrocytosis. There was a significant relation between severity of NH and macrocytosis [p=0.001]. Macrocytosis had significant correlation with folate deficiency [p=0.017]. NH showed a statistically significant relation with folate [p=0.036], however, no correlation with cobalamin<122 pg/ml and increased homocystein. Folate showed significant relation with increased homocystein [p= 0.001]. Specificity and sensitivity of NH for diagnosis of cobalamin and folate deficiency was low. With respect to the high incidence of folate deficiency in elderly, a simple and economic screening test such as NH and macrocytosis could be performed for evaluation of serum folate. Although the specificity and sensitivity of NH for diagnosis of folate deficiency is not high, it may be used as a screening test