Iron profile of pregnant sickle cell anemia patients in Odisha, India

ABSTRACT Introduction: During pregnancy, the iron requirement increases to meet the optimal growth of the fetus and prevent iron deficiency anemia-related complications in the mother. However, in sickle cell disease (SCD) primarily due to repeated blood transfusions and hemolysis-induced recycling of iron, its supplementation during pregnancy remains questionable and may be harmful. Methods: Twenty-five pregnant women with homozygous SCD and 25 pregnant women with normal hemoglobin variants were included as cases and control, respectively. Pregnancy and sickle cell anemia (SCA) were diagnosed using standard protocols. The serum iron, serum ferritin, total iron-binding capacity (TIBC), percentage transferrin saturation and C-reactive protein were estimated, as per the manufacturer's protocol. The complete blood count was performed. The unpaired 't-test' was performed using the SPSS v23.0 and the principal component analysis (PCA) was performed using the online software MetaboAnalyst for statistical analysis. Main Results: The studied cases had significantly lower mean hemoglobin and higher mean corpuscular volume (MCV), compared to controls. The mean serum-iron, serum-ferritin and percentage transferrin-saturation in the cases were significantly higher than that of the controls, while the TIBC was lower in the cases (p < 0.0001). The mean level of serum iron, ferritin, percentage transferrin saturation and TIBC were 309.44 ± 122.40mcg/dl, 860.36 ± 624.64ng/ml, 42.6 ± 17.30% and 241.32 ± 96.30 mcg/dl, respectively, in the cases and 95.36 ± 41.90mcg/dl, 122.28 ± 49.70ng/ml, 15.83 ± 3.10% and 492.6 ± 149.40mcg/dl in the controls, respectively. Higher MCV, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with lower hemoglobin (Hb) were noted in the cases. The PCA revealed that the cases were more heterogeneous in terms of the variability of the iron status and hematological indices than the controls. Conclusion: The current study shows iron sufficiency in most cases of pregnancy with SCA and suggests that evaluation of iron status must be made before initiating iron prophylaxis in pregnant women with SCA, especially in regions having a high prevalence of sickle cell hemoglobinopathy.

Prevalence and Risk Factors Associated with Bacterial Vaginosis and Candidiasis in Non-Pregnant Women of Western Odisha, India

The prevalence of Bacterial Vaginosis (BV) and candidiasis is high in Indian women in the reproductive age groups. Poor menstrual hygiene management (MHM) practices and low socio-demographic features are the major risk factors associated with BV and candidiasis. The aim of the study was to access the MHM practices in association with BV and Candida infection in the population of western Odisha.METHODSThis cross-sectional study was carried out in the outpatient department of O & G, VIMSAR, Burla, Odisha, from December 2016 to November 2018. Vaginal swabs were collected from the posterior vaginal fornix for analysis. BV was diagnosed by using Nugent’s laboratory diagnostic criteria and identification of Candida was done by Albi QuickTM rapid test. A pre-coded questionnaire was used to collect demographic, clinical, and behavioural (MHM practices) features from the study participants. All data were double-entered into Epi Info 7 software and analysed using Stata 11.0.RESULTSIn 352 women, the prevalence of BV and candidiasis was found in 38.92% (137/352) and 32.67% (115/352) of women respectively. Women were divided into three groups on the basis of age i.e. 18-25 years: 87 (24.72%); 26-35 years: 194 (55.11%); and 36-45 years: 71 (20.17%). Both BV and candidiasis were significantly high in women of 36-45 years age group compared to 18-25 years age group (p<0.05). Women of 36-45 years age group had more number of cases with low education (19.72%), housewife (67.61%), and living in rural villages (61.97%) compared to younger women (p<0.05). Regarding MHM practices, women in the higher age groups used more reusable cloths as absorbent materials (p<0.002), changed absorbent material less frequently (p=0.042) and changed their absorbents somewhere other than in a toilet facility (p<0.018) compared to younger women.CONCLUSIONSThe higher prevalence of BV and candidiasis in higher age groups of women may be due to the poor MHM practices, lack of higher education and other low socio-demographic conditions compared to younger age women. An increased awareness for MHM practices is important to combat the associated morbidities related to BV and candidiasis.