Iron loading anaemias.

Iron loading anaemias are characterized by anaemia, high serum iron, transferrin saturation and ferritin values, and haemosiderin deposits in parenchymal cells and reticuloendothelial tissue with or without organ dysfunction. Sideroblastic anaemias and congenital dyserythropoietic anaemias (CDA) are important types of iron loading anaemias. Two cases of sideroblastic anaemia and five cases of CDA type I are presented as prototypes of iron loading anaemias. Increased gastrointestinal absorption of iron remains the main mechanism of iron loading in these anaemias. Phlebotomy can be used to reduce the iron load in those with mild or moderate anaemia, whereas desferrioxamine can be used to chelate excessive iron in all cases irrespective of severity of anaemia.

Bone marrow iron in nutritional anaemias.

Bone marrow smears of 168 patients with nutritional anaemias attending the Dr. J.C. Patel, Department of Hematology, K.E.M. Hospital were stained by Prussian blue method for iron (haemosiderin). Iron in the bone marrow was classified as absent, decreased, normal or increased. Amongst 93 cases with transferrin saturation (TS) of less than 16% and normoblastic erythropoiesis, bone marrow iron was absent in 48 (51.6%) and decreased in 45 (48.4%). In 50 cases with TS of less than 16% and marrow showing megaloblasts and/or giant myelocytes and metamyelocytes, bone marrow iron was absent in 15 (30%), decreased in 22 (44%), normal in 7 (14%) and increased in 6 (12%). In 25 cases with TS over 16% and megaloblastic erythropoiesis, bone marrow iron was absent in 4 (16%), decreased in 1 (4%), normal in 7 (28%) and increased in 13 (52%). In 150 (89.3%) patients out of 168, bone marrow iron and TS gave concordant results whereas in 18 (10.7%), the results were discordant; former was encountered in cases of uncomplicated iron deficiency while latter was found with megaloblastic morphology of the marrow. It is concluded that there is a good correlation between TS and bone marrow iron and hence, either of the criteria can be used for the diagnosis of iron deficiency especially when it is not complicated by megaloblastosis.

Iron status of beta thalassemia carriers.

One hundred twenty-four relatives (aged 17-52 years) of 35 children with severe transfusion-dependent beta thalassemia major were investigated for their beta thalassemia carrier status (determined by Hb-A2 level) and iron status (determined by serum ferritin level). Forty-eight males had beta thalassemia trait (BTT) and 18 males did not have BTT (control); 41 females had BTT and 17 females did not have BTT (control). Serum ferritin levels (mean +/- SEM) of male BTT, male control, female BTT, and female control groups were 151.0 +/- 27.4, 59.6 +/- 16.3, 120.6 +/- 36.6, and 17.2 +/- 6.1 mcg/liter respectively; the differences between the two male and the two female groups were statistically significant (p = .05 and p less than .001). Iron deficiency (serum ferritin below 10.0 mcg/liter) was present in 6.3%, 38.9%, 24.4%, and 58.8% of male BTT, male control Female BTT, and female control groups, respectively; the differences between the two male and two female groups were statistically significant (p less than .01 and p less than .01). Serum ferritin was over 1,000 mcg/liter in four individuals with BTT (2 male and 2 female). Thus, the BTT group had better iron nutrition. This may suggest that the BTT group has an advantage in maintaining iron balance.