献血者铁缺乏研究进展

献血者及其捐献的各种血液成分,是保障医疗服务的关键。每次献血（尤其是捐献全血）均会丢失部分铁储备,两次献血之间,若铁摄入不足或是献血间隔时间不够,因重复献血导致的铁丢失会逐渐累积,进而出现铁缺乏,甚至贫血。此外,铁缺乏还可能影响献血者的健康,产生诸如疲劳、认知能力改变等症状,阻碍献血者坚持长期献血。为及时发现并预防献血者的铁缺乏,采供血机构可采取多种应对措施,包括及时调整献血者的献血间隔和频率,检测铁营养状况和补铁疗法等。本文将对献血者铁缺乏研究进展做一综述。     

深圳市固定献血者铁营养状况的调查

深圳市每年约有5万人次参加无偿献血,其中约60%的人为多次献血者,年献血频率为2次的约有3000人,400ml全血采集率连续3年保持在65%以上.     

江苏地区女性全血献血者铁营养状况调查

目的调查女性全血献血者铁营养状况,评估铁缺乏情况。方法 2017年5月和2018年2月,随机采集220例女性献血者血样,采用全自动生化仪检测女性献血者血清铁4项。结果多次献血的女性献血者的血清铁蛋白水平低于初次献血者。除了血清铁蛋白水平在初次献血者和多次献血者之间有统计学差异外,其他3项血清铁指标在2者之间无统计学差异。初次献血者的铁缺乏率为11.9%,多次献血者铁缺乏率为22.4%,且2者比较具有统计学差异。育龄女性(30—45)岁献血者的铁缺乏率最高为16.7%,但与其他年龄组铁缺乏率比较,差异无统计学意义。结论铁缺乏情况在多次献血的女性全血献血者,尤其育龄女性中更普遍,建议在可能的情况下对多次献血的女性献血者检测血清铁蛋白浓度并进行铁的相关知识教育和辅以铁剂补充。     

单采血小板献血者铁缺乏的影响因素分析

目的探讨单采血小板献血者铁缺乏的相关影响因素,为血站工作人员预测缺铁高危人群提供理论依据。方法选取2018年10月-2018年12月在福建省血液中心进行单采血小板捐献的618名献血者,采用多元线性回归分析评估血清铁蛋白的影响因素,采用二元Logistic回归分析评估铁缺乏的影响因素。结果多元线性回归分析显示:男性血清铁蛋白与年度单采次数、身高负相关(P0.05),与体重、血红蛋白水平正相关(P0.05);女性血清铁蛋白与年度单采次数负相关(P0.05),与血红蛋白水平、体重、年龄正相关(P0.05)。二元Logistic回归分析显示:铁缺乏的最重要影响因素是年度单采次数(OR=9.719,P0.05);其次分别是BMI(OR=0.362,P0.05)、性别(OR=0.124,P0.05)和血红蛋白(OR=0.055,P0.05)。结论年度单采次数越多、BMI越低、女性、低血红蛋白,可能预测缺铁的高风险。     

百次以上男性机采献血者铁营养状况研究

目的调查百次以上男性机采献血者的血清铁蛋白(SF)、血红蛋白(Hb)水平情况。方法随机抽取本站百次以上男性机采献血者91例和初次男性献血者40例,检测其SF和Hb水平并统计分析。结果首次献血者与百次以上男性机采献血者Hb均值分别为143.9g/L和141.8g/L,中位数为143.5g/L和139.0g/L;差异有统计学意义(P0.05)。首次献血者与百次以上男性机采献血者SF均值分别为66.6ng/mL和29.5ng/mL,中位数为65.5ng/mL和19.9ng/mL;差异有统计学意义(P0.05)。百次以上男性机采献血者SF和Hb水平会随着总献血次数的增加而下降(SF与献血次数的Spearman相关系数-0.208,P=0.048,Hb与献血次数的Spearman相关系数-0.054,P=0.611)。结论百次以上男性机采献血者SF和Hb水平会随着献血总次数和频率的增加而逐渐减少,采血机构应该更加重视对高频多次机采献血者SF的检测和加强铁营养的宣传和指导。     

固定无偿献血者血清铁和血清铁蛋白的变化研究

目的 了解固定献血者定期献血对其体内血清铁、血清铁蛋白等水平影响.方法 从2019年1月～2019年6月在本中心参加献血的固定献血者当中随机抽取240人(份)的血样[(4～5 mL/人(份),EDTA-2K抗凝管]作为研究组,同时随机抽取200名正常值范围内的体检人员作为对照组;分别采用Ferene法测定2组受检者的血...     

依据红细胞指数快速确定献血者的铁缺乏[英]／Radtke H…／／Transfusion

背景新一代的自动血液分析仪可以快速测定不同的红细胞指数．包括低血红蛋白成熟红细胞(HYPOm)的百分率和网织红细胞(CHr)中的血红蛋白(Hb)含量。这些指标能否作为检测供血者铁缺乏的指标，尚未得到确认。设计和方法在测量血清铁蛋白、可溶性转铁蛋白受体和血红蛋白的基础上，评估总共1142名未经挑选献血者的体内铁状态，并与自动血液分析仪(Advia 120，Bayer HeahhCare)所提供的红细胞指数(包括HYPOm、CHr)进行比较。     

育龄女性固定献血者铁缺乏与补铁方案的研究

铁缺乏症是常见的营养缺乏症，它包括相互关联的3个阶段，即体内储存铁耗尽（iron deleption，ID），继之红细胞内铁缺乏（iron deficient erythropoiesis，IDE）和最终缺铁性贫血（iron deficient anemia，IDA）。育龄妇女因月经、妊娠损失血液，若加之饮食含铁量不充足，则易成为铁缺乏症的高危人群。为了满足日益增长的临床用血需要，国内采供血机构一直致力于固定献血者的招募，     

血清铁蛋白与妊娠期铁缺乏、缺铁性贫血的相关性研究

目的 检测妊娠期血清铁蛋白水平的变化,探讨血清铁蛋白与妊娠期铁缺乏(iron deficiency,ID)、妊娠期缺铁性贫血(iron deficiency anemia,IDA)的相关性。方法 选择2016—2018年在南京市溧水区人民医院建卡生产的单胎孕妇142例为研究对象,分为ID组(n=46),IDA组(n=50)和正常组(n=46)。分别检测血常规和血清铁蛋白,用受试者工作特征曲线(ROC)和曲线下面积(AUC)分析血清铁蛋白对妊娠期铁缺乏、缺铁性贫血的预测价值,并对比分析各组不同时期检验指标的差异。结果 IDA组与正常组和ID组RBC、Hb、MCV、MCH、MCHC、SF水平比较,差异有统计学意义(P<0.05)。ROC曲线分析血清铁蛋白对妊娠期缺铁性贫血的诊断效率,AUC为0.93(95%CI=0.87～0.99)。血清铁蛋白水平分布正常组明显高于ID组和IDA组,血清铁蛋白为16 ng/mL时,敏感性为95%,特异性为86%。结论 妊娠各期监测血清SF对妊娠期铁缺乏、缺铁性贫血发生具有较好的预测价值。     

Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review

The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre‐defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL^?1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.     

乙型肝炎后肝硬化并发缺铁性贫血患者的血液检验结果分析

目的对乙型肝炎后肝硬化并发缺铁性贫血(IDA)患者的血液进行检测分析。方法选取2013年12月至2015年5月在该院进行治疗的100例乙型肝炎后肝硬化并发IDA和乙型肝炎后肝硬化并发非缺铁性贫血(NIDA)患者,根据是否并发IDA分为观察组(50例)和对照组(50例),对两组患者进行肝功能、血常规、肝硬化患者止凝血试验和血小板参数测定,并比较分析。结果观察组在治疗后清蛋白、胆红素、胆汁酸、碱性磷酸酶水平与对照组相比,差异无统计学意义(P0.05);观察组的丙氨酸氨基转移酶(ALT)、γ-谷氨酰基转移酶(GGT)明显高于对照组,且差异具有统计学意义(P0.05)。观察组患者的血红蛋白、血清铁蛋白(SF)、红细胞平均体积(MCV)、红细胞平均血红蛋白量(MCH)均低于对照组,叶酸(FA)水平高于对照组,差异均具有统计学意义(P0.05);红细胞计数(RBC)与对照组相比,差异无统计学意义(P0.05)。观察组凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)均高于对照组,差异具有统计学意义(P0.05);纤维蛋白原(FIB)、血小板数(PLT)均明显降低,差异具有统计学意义(P0.05)。两组患者血小板分布宽度(PDW)水平差异无统计学意义(P0.05)。结论对乙型肝炎后肝硬化并发IDA的患者进行血液检测,对评估肝脏的损坏程度及疾病的诊断具有重大意义,值得在今后的临床中应用。     

Low ferritin levels indicate the need for iron supplementation: strategy to minimize iron-depletion in regular blood donors

Iron deficiency is a common problem in regular blood donors which can be prevented by timely iron supplementation. Consequently, these donors should be supplied with oral iron in good time. We evaluated the need to use ferritin rather than or in addition to haemoglobin to screen iron deficiency in blood donors. To this end, serum ferritin was measured routinely every 10th donation in 632 long-term and 171 first-time donors. Furthermore, donors with ferritin < 15 microg L-1 were supplemented with iron. The supplementation efficiency was assessed by follow-up haemoglobin levels over the course of five donations in blood donors with high donation frequency. Our results showed that ferritin decreases after 10 donations and with the increase of donation frequency. In 26% of regular donors, ferritin levels were < 15 microg L-1 and 12% of them were anaemic due to low haemoglobin. After iron supplementation, haemoglobin was raised rapidly in donors with initially low haemoglobin, and thus donor deferment was never indicated. In conclusion, regular ferritin measurement is a useful indicator for iron depletion in blood donors. Our data suggested the usefulness of ferritin screening in first-time donors and regular donors with low haemoglobin levels within the normal range.     

红细胞参数及铁代谢指标在鉴别缺铁性贫血与慢性病贫血中的临床意义

目的探讨缺铁性贫血（IDA）和慢性病贫血（ACD）的实验室鉴别诊断,提高诊断水平。方法测定以上两种贫血患者标本的红细胞参数：平均血红蛋白含量（Hb）、平均红细胞体积（MCV）、平均血红蛋白含量（MCH）、平均红细胞血红蛋白浓度（MCHC）、铁代谢指标铁蛋白（SF）、转铁蛋白（TRF）,并对结果进行统计学分析。结果 IDA组与ACD组比较,IDA组Hb、MCV、MCH、MCHC、SF均明显降低,但TRF增高,差异具有统计学意义（P〈0.05）。结论红细胞参数及铁代谢指标结合检测可以作为IDA与ACD的鉴别诊断简便有价值的指标。     

Using iron deficiency tests for colorectal cancer screening: a feasibility study in one UK general practice

Iron deficiency is common at presentation in colorectal cancer. Testing for it may complement other screening tests such as faecal occult blood testing and sigmoidoscopy. We therefore examined the feasibility of offering iron deficiency testing to patients in a primary care setting in the UK, offering testing to all 1240 patients aged 55-74 years in one general practice in South Wales, UK. Patients with abnormal results were assessed and offered further investigations. Five hundred and fifty-one people (44.4%) attended for iron deficiency blood tests, of whom 26 patients (4.7%) were iron deficient and offered endoscopic assessment. This identified two cases of benign neoplasia amenable to treatment and no cases of cancer. Iron deficiency testing in a screening context appeared feasible although uptake may be low.     

Microcytosis,iron deficiency and thalassaemia in a multi‐ethnic community: a pilot study

The high prevalence of microcytosis (defined here as mean cell haemoglobin<27?pg) with no other abnormality is a principal cause of confusion in screening for haemoglobin disorders. Here we report the results of a small pilot study aiming to resolve this confusion by routinely proceeding to plasma ferritin and HPLC assay, using the original sequestrene blood sample, when microcytosis is detected. Participants comprised a random sample of 1,302 people referred for a full blood count by their General Practitioner (GP) to the laboratory of a North London district general hospital serving a multi‐ethnic inner‐city population. Ethnicity was established by questionnaire. In North Europeans, microcytosis was present in 3?% of males (half were iron‐deficient) and 11?% of females (most were iron‐deficient). Among ethnic minorities, microcytosis was present in 35?% of males (one tenth were iron‐deficient), and 45?% of females (less than half were iron‐deficient): an exclusion diagnosis of “probable alpha thalassaemia” could be made in the remainder. We conclude that when microcytosis is present, routine further analysis of the original sequestrene sample by plasma ferritin assay and haemoglobinopathy screening could lead to a more efficient and cost‐effective laboratory service for primary care and maternity services.     

A comparison between concentrations of free erythrocyte protoporphyrin and serum ferritin during development of iron deficiency by phlebotomy in polycythaemia vera patients

Therapeutic venesection for polycythaemia vera (PV) produces iron deficiency. If iron supplementation is avoided, the frequency of venesections can be kept lower than if iron is given. This is the standard treatment for PV in our department, and this model for iron deficiency was used to compare serum ferritin, free erythrocyte protoporphyrin (FEP), serum iron and transferrin as indicators of iron deficiency. Eleven patients with PV were studied on a total of 90 occasions. Five patients were followed from normal iron status to iron deficiency, the other six were iron deficient at the start of the study. Serum ferritin and FEP became abnormal approximately simultaneously during the development of iron deficiency, serum ferritin in all patients, FEP in 8 out of 11 patients. There was a correlation between the two in all specimens (r=0.75, p<0.001), but serum ferritin showed fewer false negative results. Serum transferrin alone was elevated only in 25% of the patients, and serum iron, although mostly subnormal, was rather inconsistent. It is concluded that serum ferritin and FEP can both be used to diagnose iron deficiency during venesection treatment of PV, whereas serum iron and transferrin are of little value.;