Natural history of recessive inheritance of DMT1 mutations.

DMT1 deficiency causes microcytic hypochromic anemia due to decreased erythroid iron utilization. Anemia is present from birth. Transferrin saturation is high and serum ferritin is mildly elevated, despite liver iron overload. DMT1 deficiency must be considered in the differential diagnosis of microcytic hypochromic anemia observed in the newborn period.

Behavioral and developmental effects of preventing iron-deficiency anemia in healthy full-term infants.

OBJECTIVE: To determine the behavioral and developmental effects of preventing iron-deficiency anemia in infancy. METHODS: Healthy full-term Chilean infants who were free of iron-deficiency anemia at 6 months were assigned to high- or low-iron groups or to high- or no-added-iron groups. Behavioral/developmental outcomes at 12 months of age included overall mental and motor test scores and specific measures of motor functioning, cognitive processing, and behavior. There were no differences between high- and low-iron groups in the prevalence of iron-deficiency anemia or behavioral/developmental outcome, and they were combined to form an iron-supplemented group (n = 1123) for comparison with the no-added-iron group (n = 534). RESULTS: At 12 months, iron-deficiency anemia was present in 3.1% and 22.6% of the supplemented and unsupplemented groups, respectively. The groups differed in specific behavioral/developmental outcomes but not on global test scores. Infants who did not receive supplemental iron processed information slower. They were less likely to show positive affect, interact socially, or check their caregivers' reactions. A smaller proportion of them resisted giving up toys and test materials, and more could not be soothed by words or objects when upset. They crawled somewhat later and were more likely to be tremulous. CONCLUSIONS: The results suggest that unsupplemented infants responded less positively to the physical and social environment. The observed differences seem to be congruent with current understanding of the effects of iron deficiency on the developing brain. The study shows that healthy full-term infants may receive developmental and behavioral benefits from iron supplementation in the first year of life.

The quantitative assessment of body iron.

Current initiatives to reduce the high prevalence of nutritional iron deficiency have highlighted the need for reliable epidemiologic methods to assess iron status. The present report describes a method for estimating body iron based on the ratio of the serum transferrin receptor to serum ferritin. Analysis showed a single normal distribution of body iron stores in US men aged 20 to 65 years (mean +/- 1 SD, 9.82 +/- 2.82 mg/kg). A single normal distribution was also observed in pregnant Jamaican women (mean +/- 1 SD, 0.09 +/- 4.48 mg/kg). Distribution analysis in US women aged 20 to 45 years indicated 2 populations; 93% of women had body iron stores averaging 5.5 +/- 3.35 mg/kg (mean +/- 1 SD), whereas the remaining 7% of women had a mean tissue iron deficit of 3.87 +/- 3.23 mg/kg. Calculations of body iron in trials of iron supplementation in Jamaica and iron fortification in Vietnam demonstrated that the method can be used to calculate absorption of the added iron. Quantitative estimates of body iron greatly enhance the evaluation of iron status and the sensitivity of iron intervention trials in populations in which inflammation is uncommon or has been excluded by laboratory screening. The method is useful clinically for monitoring iron status in those who are highly susceptible to iron deficiency.

Copper deficiency in Creole goat kids.

Serum copper determination is important to confirm hypocupremia. Twenty healthy kids constituted the Control Group, and sixteen kids with symptoms of copper deficiency, the Problem Group. Animals from the Problem Group showed a low number of red blood cells (RBC) and variations in RBC size and shape. The values found for hemoglobin and mean corpuscular hemoglobin (MCH) in the Control Group were 10.42 +/- 1.34 g.dL(-1) and 33.07 +/- 1.11 g.dL(-1) respectively, while the levels of the Problem Group were 7.95 +/- 1.21 g.dL(-1) and 29.45 +/- 0.78 g.dL(-1), respectively. The kids from the Problem Group presented an important increase in monocytes, neutrophiles and leukocytes; precursor cells of the neutrophile were also observed. The anemia of these animals was hypochromic and macrocytic. Our results indicate that Creole kids with serum copper levels > 450 microg.L(-1) improved after treatment with copper glycinate. The six goats with cupremia < 450 microg.mL(-1) were unable to improve their deficiency and died.

Nutrition of Honduran mothers/caretakers.

In 1996, the Honduran Ministry of Health conducted a national micronutrient survey of children 12-71 months old, which also included an assessment of the nutrition status of their mothers/caretakers. The 1,126 mothers/caretakers who participated in the survey tended to be short and plump. About 15% of them were at obstetric risk by virtue of their short stature and/or low body weight. About 9% had chronic energy deficiency (CED), but 27% were at least 20% overweight. CED was associated with socioeconomic indicators of poverty. Risk factors for being at least 20% overweight included being over 30 years old, not breast-feeding, having attended no higher than grade 4, 5, or 6 of primary school, coming from a wealthier household, and living in San Pedro Sula or medium-sized cities. Among the women surveyed, 26% of nonpregnant and 32% of pregnant mothers/caretakers were anemic. The likely principal cause of anemia was the low intake of bioavailable iron from food and, in some cases, excessive iron loss associated with intestinal parasites, especially hookworm. Only 50% of the mothers/caretakers participating in this study had received iron during their last pregnancy, and just 13% had received postpartum vitamin A. The results highlight the need to develop and implement an effective program to control iron deficiency anemia in women of reproductive age, including by fortifying such widely consumed foods as processed wheat and maize flour and by routinely administering iron supplements to high-risk groups. Postpartum vitamin A supplementation should be encouraged to protect both the mother and newborn infant against vitamin A deficiency.

[Treatment with prophylactic doses of ferrous sulphate as an intervention measure in the campaign++ against iron deficiency in children cared for in basic health units]. / Terapêutica com doses profiláticas de sulfato ferroso como medida de intervenção no combate à carência de ferro em crianças atendidas em unidades básicas de saúde.

The efficacy of medical prophylaxis in the fight against iron deficiency anemia in 620 children aged from four to thirty-six months, attended in two health units of the municipality of S. Paulo, Brazil, was tested. First, the children's blood was tested for hemoglobin level and electrophoresis. Then they received daily doses of iron sulphate in the form of drops, corresponding to 12 mg/day of elementary iron, over a 30-day period. Afterwards, they were asked to return for re-evaluation. Twenty-five percent of children under 6 months presented hemoglobin levels under 11.0 g/dl. The highest occurrences of anemia were detected among children aged 9 to 11 months (49.5%) and in the age bracket between 12 and 23 months (50.4%). After the established period, only 37.4% of the children with anemia and 52.4% of children who did not present anaemia returned for further evaluation. Of the 299 evaluated, only 157 (52.5%) had taken the medication correctly. Frequency of hemoglobin inferior to 9.5 g/dl dropped from 17.1% at the beginning to 8.1% at the end of the intervention. On the other hand, the percentage of children with hemoglobin above 12.0 g/dl increased from 13.4% to 33.4%. Those children who took their iron supplements correctly registered a significantly higher drop in the number of cases of anemia than that observed in those who had not taken the supplement correctly. The great majority (80.3%) did not present any side effects of medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaemia, iron deficiency and malaria in a rural community in Brazilian Amazon.

OBJECTIVE: To assess the incidence of anaemia, iron deficiency and malaria in a malaria-endemic community. DESIGN: Three consecutive cross-sectional surveys (A, B and C) of the whole population made at 6-month intervals and malaria surveillance between the surveys. SETTING: Urupá, a rural community in Western Brazilian Amazon. SUBJECTS: 133 people of all age groups present in at least two cross-sectional surveys. INTERVENTIONS: Anaemic patients received ferrous sulphate during 3 months. Patients parasitized by intestinal nematodes were given mebendazole and parasitologically proven Plasmodium falciparum and P. vivax malaria attacks were treated with quinine or chloroquine plus primaquine. RESULTS: Anaemia (haemoglobin concentrations [Hb] below the cut-off values proposed by the World Health Organization) was diagnosed in respectively 10.0% (13 of 130) subjects in survey A, 9.2% (10 of 109) in B and 29.7% (27 of 91) in C. Depleted iron stores [serum ferritin (SF) < 12 micrograms/l] were detected in 10.0% subjects in survey A, 10.1% in B but in only 8.8% subjects in survey C. Concomitant anaemia and low SF was detected in 5.4% subjects in survey A, 3.7% in B and 6.6% in C. Mean Hb from anaemic patients diagnosed and treated during the study (n = 17) raised 1.2 g/dl after iron therapy and most of them (13 of 17, 76.5%) became non-anaemic. The highest malaria transmission was observed between surveys B and C. People who suffered at least one malaria attack during this period (27 of 63) were at a slightly greater risk of subsequent anaemia (odds ratio = 2.85, 95% confidence interval 0.81-10.28). CONCLUSIONS: Both malaria and iron deficiency could be considered as important causes of anaemia in this population. SPONSORSHIP: Supported by grants from the UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (no. 890245), the Ministére des Affaires Etrangeres, France, and from the Fundação de Amparo à Pesquisa do Estado de São Paulo (no. 92/1336-4). M.A.C. was supported by a doctoral fellowship from the Conselho Nacional de Desenvolvimento Científico e Tecnológico.

Anemia ferropriva y respuesta inmune celular / Iron deficiency anemia and cellular inmune response

Existe información contradictoria en relación al efecto de la carencia de hierro sobre respuesta inmune. La interpretación de los datos inmunológicos obtenidos en pacientes con anemia ferropriva varía según edad, estado nutricional, presencia de infecciones y asociación con otras deficiencias nutricionales. Para definir el efecto que ejerce la anemia ferropriva sobre la respuesta inmunitaria celular se seleccionaron 15 lactantes con anemia ferropriva y 11 controles adecuadamente nutridos con hierro, entre 15 y 19 meses de edad, eutróficos, sin infecciones ni deficiencias nutricionales asociadas. Se determinó la capacidad de sensibilización a antígenos que evocan respuestas cutáneas de hipersensibilización retardada con 2-4 dinitroclorobenceno y PPD, como también la capacidad proliferativa de sus linfocitos al estímulo con fitohemaglutinina. No se observaron diferencias significativas en la respuesta inmune celular entre pacientes y controles antes y al cabo de tres meses de tratamiento con 5 mgù kgù día de hierro elemental en forma de sulfato ferroso. Se sugiere que la anemia ferropriva leve no alteraría la respuesta inmune celular

[High altitude anemia: validity of definition criteria]. / Anémie en altitude: validité du critère de définition.

The effect of iron and folate supplementation on the hemoglobin response and iron status was studied in male and female equatorian medical students: 66 in Quito (2,800 m altitude) and 40 in Guayaquil (sea level). At the end of the supplementation, there was a nearly complete disappearance of biochemical evidence of iron deficiency in the two groups of students. In Quito, 30% of the men and 26% of the women increased their hemoglobin concentration by more than 1 g/dl after one month of supplementation and could be considered as true anemics, compared to 31% of the men and 29% of the women in Guayaquil. This study shows that at sea level, cut-off points defined by WHO for hemoglobin, taking as reference the impact of a supplementation trial, have a specificity of 100% but poor sensitivity (58%). For people living at high altitudes, cut-off limits adjusted for altitude seem unsuitable: the specificity is 98% but the sensitivity is 0%. Studies taking into account all the factors impacting on the hemoglobin level could be useful for defining cut-off points for high-altitude anemia better than those currently recommended.

Prevalencia de anemia nutricional de mujeres en edad fertil de un área de salud / Nutritional anemia prevalence in reproductive age women of public health area

Se estudiaron 79 mujeres en edad fértil con el objeto de conocer la prevalencia de anemia nutricional. Las anémicas recibieron tratamiento de acuerdo con la carencia encontrada. La causa fundamental de la anemia fue la deficiencia de hierro. Se halló correlación significativa de la ferritina sérica y del índice de saturación, con las características demográfico-sociales; y de la hemoglobina y la protoporfirina eritrocitaria libre, con los días de duración de la menstruación. El promedio de estos últimos fue significativamente más alto en las mujeres anémicas. El grupo tratado incrementó significativamente las cifras de hemoglobina e índice de saturación y disminuyó la protoporfirina eritrocitaria libre (AU)

Tratamiento de la anemia posparto con hierro oral / Treatment of postpartum anemia with oral iron

Se estudió a 51 pacientes con anemia posparto, a quienes se les administró hierro por vía oral, a dosis de 2.5 mg/Kg/día y se obdervó qu el grupo de edad más frecuente fue el de los 17 a 21 años, y en multíparas. Hubo un aumento total de hemoglobina de 4.91 g/dL en 30 días de tratamiento, que fue significativo desde el punto de visita estadístico; igual resultado se obtuvo con las cifras de hematócrito y hierro sérico, que fueron marcadores útiles en el seguimiento de la paciente anémica. La cuenta de plaquetas y reticulocitos fue normal antes y después del tratamiento. No se observaron otras alteraciones que desviaran el curso normal del puerperio. La anemia bien tratada no es factor modifique la normalidad del puerperio. Se concluye que la administración oral de hierro es un método terapéutico que no causa daño y es eficaz en el tratamiento de la anemia posparto

Prevalencia de anemia nutricional de mujeres en edad fertil de un área de salud / Prevalence of the anemia nutritional of the women in age fertility in the health area

Se estudiaron 79 mujeres en edad fértil con el objeto de conocer la prevalencia de anemia nutricional. Las anémicas recibieron tratamiento de acuerdo con la carencia encontrada. La causa fundamental de la anemia fue la deficiencia de hierro. Se halló correlación significativa de la ferritina sérica y del índice de saturación, con las características demográfico-sociales; y de la hemoglobina y la protoporfirina eritrocitaria libre, con los días de duración de la menstruación. El promedio de estos últimos fue significativamente más alto en las mujeres anémicas. El grupo tratado incrementó significativamente las cifras de hemoglobina e índice de saturación y disminuyó la protoporfirina eritrocitaria libre

Esophageal motility impairment in Plummer-Vinson syndrome. Correction by iron treatment.

We report the case of a 41-year-old woman with Plummer-Vinson syndrome and an esophageal motility disorder. She complained of dysphagia and odynophagia and had cheilitis, glossitis, and hypochromic anemia. An esophageal motility study showed low amplitude of contraction and high intrabolus pressure in the esophageal body. After iron replacement, the patient was free from symptoms, and a new motility study showed increased amplitude of contraction and decreased intrabolus pressure.

Iron status in low-birth-weight infants, small and appropriate for gestational age. A follow-up study.

Iron nutrition was measured in 84 low-birth-weight infants. At birth, they were assigned to three groups: preterm infants appropriate for gestational age (n = 29); preterm infants small for gestational age (n = 17); and full-term infants small for gestational age (n = 38). A sub-sample of infants was supplemented with iron 3 mg/kg from two to four months of age. At birth, preterm appropriate-for-gestational-age infants had a lower hemoglobin concentration than full-term small-for-gestational-age infants (p < 0.01) and a higher serum ferritin than preterm small-for-gestational-age infants (p < 0.05). In the non-supplemented group, full-term small-for-gestational-age infants had significantly higher hemoglobin concentrations at four months of age. At this age, iron-supplemented preterm infants appropriate or small for gestational age had significantly higher hemoglobin levels than non-supplemented subjects, while iron supplementation did not have an effect on final hemoglobin concentration in full-term small-for-gestational-age infants. We conclude that preterm infants, irrespective of their adequacy for gestational age, show evidence of iron deficiency before four months of age. Full-term infants do not develop iron deficiency up to this age.

[Anemias in preschool children: diagnosis, treatment and evaluation, Recife-PE, Brazil]. / Anemias em pre-escolares: diagnostico, tratamento e avaliação Recife-PE, Brasil.

The diagnosis and the effects of treatment of anemia were assessed in children aged 6-71 months. A total of 1,161 preschool children from a health center of INAMPS (Instituto Nacional de Assistência Médica e Previdência Social) in Recife, Pernambuco, was studied. Hemoglobin was determined by the method described by Hainline. WHO criteria were used to identify anemia. According to their age, nutritional status and family income, the children were divided into groups, and those with anemia were treated with ferrous sulphate and an anti-helminthic (mebendazole). Anemia prevalence was substantially higher in children aged 2 years, and a statistically significant association (0.01 level) was found between anemia and nutritional status and family income. After treatment, hemoglobin values were normal in 40% of the anemic children; simultaneously, mean hemoglobin values increased from 9.11 to 10.3 g/dl which was statistically significant (p less than 0.001). This investigation is part of a collaborative study performed in four Brazilian states to offer "know-how" to a national program for combating iron deficiency anemia.

Anemias em pré-escolares: diagnóstico, tratamento e avaliaçäo; Recife, PE, Brasil / Anemias in preschool children: diagnosis, treatment and evaluation; Recife, PE, Brazil

Proposto para diagnosticar, tratar e avaliar os resultados do tratamento de anemias em pré-escolares de 06 a 71 meses, o estudo envolveu uma amostra de 1,161 crianças de uma Unidade de Saúde de INAMPS (Instituto Nacional de Assistência Médica e Previdencia Social), em Recife, Pernambuco. A dosagem de hemoglobina foi determinada pelo método descrito por Haitiline, utilizando-se o critério da OMS para discriminar os casos de anemia. As crianças foram agrupadas segundo sua idade, estado nutricional e renda familiar, tratando-se os casos de anemia com uma prescriçäo padräo de sulfato ferroso e mebendazol. A prevalência de anemia foi substancialmente mais elevada em menores de 2 anos, havendo associaçäo estatística (nível de 0.01) com o estado nutricional e renda familiar dos examinados. 40% das crianças anemicas atingiram valores normais de hemoglobina ao fim do tratamento padräo, ocorrendo, simultaneamente, um aumento de 9.11 para 10.39 g/dl nas médias de hemoglobina, estatisticamente significativo (P , 0.001). O trabalho faz parte de um estudo colaborativo desenvolvido em quatro estados do Brasil, com o propósito de oferecer "know how" paraum programa nacional de combate à anemia ferropriva