Prevalence and spectrum of iron deficiency anaemia in heart failure patients

Background: To study the prevalence and pattern of iron de?ciency (ID)in heart failure (HF) patients with or without anaemia.Methods: This is a single-centre observational study, conducted at a tertiary care hospital of Punjab. Patients were selected based on validated clinical criteria-Framingham criteria. The iron parameters were done during the study including serum iron, serum ferritin, total iron binding capacity, and transferrin saturation (TSAT), to diagnose iron deficiency anaemia. Anaemia was defined as haemoglobin (Hb) < 13g/dl in males and <12 g/dL in females, based on WHO definition. Absolute iron deficiency is defined as serum ferritin < 100 mg/L and functional ID was defined as normal serum ferritin (100�0 mg/L) with low TSAT (<20%).Results: A total of 120 patients of Heart Failure (54% males and 46% females) were studied. Most of the patients were of high-functional NYHA class (Class IV NYHA n=45). Iron Deficiency was present in 60% patients with 31.66% patients having absolute and 28.33% patients having functional ID. Nearly one-fifth of the patients were having ID but without anemia, signifying importance of workup of Iron deficiency other than haemoglobin levels.Conclusions: Study highlights the neglected burden of ID in HF patients in India. This study suggests further large-scale studies to better characterize this easily treatable condition and considering routine testing in future Indian guidelines.

Hemoglobina reticulocitaria: un nuevo parámetro del hemograma de gran valor en el diagnóstico y manejo de la eritropoyesis deficiente en hierro / Reticulocyte hemoglobin: a new complete blood count (CBC) parameter valuable in the diagnosis and management of iron-deficient erythropoiesis

Resumen: la incorporación de los autoanalizador de hematología al laboratorio clínico no solo mejoró la calidad de los resultados de los parámetros convencionales del hemograma sino que ha permitido,especialmente con aquellos de última generación, introducir nuevos parámetros de gran utilidad clínica. Uno de los nuevos parámetros es la hemoglobina reticulocitaria, la cual se vislumbra como una potente herramienta en el diagnóstico y el manejo de la eritropoyesis deficiente en hierro en sus diferentes manifestaciones, en particular la deficiencia absoluta de hierro, la deficiencia funcional de hierro y el secuestro del hierro. La hemoglobina reticulocitaria en todos los casos en donde hay eritropoyesis deficiente en hierro es el primer parámetro detectable en el hemograma y, a su vez, es el primero que se normaliza cuando la terapia administrada ha sido la adecuada; además, ha demostradoser costo eficiente, sobre todo por ser un parámetro del hemograma más que una prueba adicional. El único problema, hasta el momento, es que solo está disponible en algunos autoanalizadoresde hematología como los de las compañías Siemens y Sysmex, en sus modelos de cuarta generación, también conocidos como hemograma tipo VI o hemograma ampliado o extendido. Con el presente módulo se pretende presentar este nuevo parámetro que la comunidad médica debe incorporar como propio y los laboratorios clínicos deberían estar preparados para incorporarlo a sus portafolios de servicios, como una nueva herramienta complementaria en la prevención, la detección y el manejo de la eritropoyesis deficiente en hierro en sus diversas manifestaciones.

Abstract: the incorporation of hematology autoanalyzers in the clinical laboratory improved the quality of the results of conventional blood count (CBC) parameters. In addition, these machines, especially those of last generation, have allowed introducing new parameters of great clinical utility. One of these new parameters is the reticulocyte hemoglobin that is emerging as a powerful tool in the diagnosis and management of iron-deficient erythropoiesis. Also is useful in several of its forms, particularly in absolute iron deficiency, functional iron deficiency, and iron sequestration. The reticulocyte hemoglobin in all cases where there is iron-deficient erythropoiesis is the first parameter detectable in the CBC, in turn; it is the first that is normalized when the administered therapy has been adequate. It has also proven to be cost effective, especially for being a CBC parameter more than an additional test. The only problem so far is that it is only available in some hematology autoanalyzers as those of Siemens and Sysmex companies, in its fourth generation models, also known as type-VI CBC or expanded or extended CBC. With this module pretends to present a new parameter that the medical community should incorporate as own and the clinical laboratories should be prepared to include it into their service portfolios as a new complementary tool in the prevention, detection, and management of iron-deficient erythropoiesis in its various manifestations.

Impacto da inflamação na regulação do ferro e deficiência funcional de ferro: [revisão] / Importance of inflammation on iron homeostasis and functional iron deficiency: [review]

Deficiência funcional de ferro (Fe) pode ser definida como o desbalanço entre a quantidade necessária de Fe para a síntese de hemoglobina e o seu suprimento. Ela ocorre na ausência de estoque de Fe, característica da anemia ferropênica (AF), e na presença de bloqueio da homeostasia do Fe, como na anemia da inflamação (AI). Na AI, citocinas e células do sistema retículo-endotelial induzem alterações que interferem em diferentes vias da eritropoese levando à anemia. O bloqueio na mobilização do Fe de estoque pela hepcidina, embora não único, é o mecanismo etiológico mais evidente da AI. A hepcidina, regulador negativo da entrada de Fe no plasma, atua ligando-se à ferroportina, induzindo sua internalização e degradação. Embora a diferenciação entre AF e AI seja relativamente tranquila, pacientes com AI podem cursar com deficiência de Fe associada. O diagnóstico diferencial entre AI e AI com deficiência de Fe tem evidente importância clínica, e novas técnicas laboratoriais têm sido sugeridas para auxiliar neste diagnóstico.

Functional iron deficiency can be defined as an imbalance between the iron needs of the erythroid marrow and iron supply. Iron deficiency occurs in the absence of iron deposits, as in the case of iron deficiency anemia (IDA), or when there is an impaired iron mobilization, such as in anemia of inflammation (AI). Cytokines and cells of the reticuloendothelial system can induce changes in several pathways, interfering in erythropoiesis and causing anemia. The retention of iron within cells of the reticuloendothelial system is due to hepcidin. Although this is not the only mechanism evolved in AI, it is the most important. Hepcidin is a negative regulator of iron entry into the plasma. Hepcidin binds to ferroportin, inducing its internalization and degradation. Differentiation between IDA and AI is relatively easy, but patients with AI can have the association of true iron deficiency. The differential diagnosis of AI and AI with iron deficiency is clinically important and new laboratorial markers can be used to help this differentiation.