Iron deficiency in pernicious anaemia: a neglected diagnosis

In 114 patients (52 males and 62 females) with long-standing pernicious anaemia, hypoferritinaemia was found in 27 (23.7%) and hypochromic microcytic anaemia in 19 (16.6%). Our findings indicate that iron deficiency is a common yet neglected complication of long-standing pernicious anaemia and warrants greater diagnostic and therapeutic attention.     

Management of anemia in a general city hospital: value of chart review in establishing deficiencies in care

A retrospective review was done of the charts of 50 persons admitted to hospital for investigation of primary anemia. The duration of hospital stay was considered excessive for 80% of the patients and investigation was considered excessive for 34%. Nevertheless, underdiagnosis or misdiagnosis by the time of discharge was evident in 48% and was the result of inadequate investigation or faulty analysis of the results or both. Even when the type of anemia was established, investigations to determine the cause of specific deficiencies were frequently inadequate. Understandably treatment was inadequate for undiagnosed or misdiagnosed conditions but it was also inadequate for many correctly diagnosed conditions. Parenteral administration of iron was prescribed more often than oral administration, and 30% of patients with iron deficiency anemia failed to receive iron by either route. Most patients with vitamin B12 deficiency anemia received treatment late. Blood transfusion was given to 40% of patients but could be justified in only 16%.     

Recognizing and investigating iron-deficiency anemia in hospitalized elderly people.

OBJECTIVE: To determine whether anemia is documented and appropriately investigated for iron deficiency in hospitalized elderly people. DESIGN: Retrospective chart review. SETTING: Medical clinical teaching unit (CTU) in secondary care hospital in Hamilton, Ont. PARTICIPANTS: Consecutive patients 65 years of age or older admitted between April 1992 and March 1993. OUTCOME MEASURES: Proportion of anemic patients for whom documentation was adequate (included in problem list in patient chart) and for whom adequate investigations were performed (measurement of serum ferritin level in anemic patients in whom iron deficiency was suspected, bone-marrow aspiration for those with intermediate probability of iron deficiency after determination of serum ferritin level, and endoscopy of upper or lower gastrointestinal tract, or both, in patients with iron deficiency). RESULTS: Of 183 eligible patients admitted to the CTU 66 (36%) had anemia, in 47 cases (71%) the anemia was documented by house staff or attending physicians. Of the 66 anemic patients 49 had a non-macrocytic anemia of unknown cause: 26 had their serum ferritin level measured, 5 underwent bone-marrow aspiration, and 21 were referred for gastrointestinal endoscopy. Six of eight patients with probable iron deficiency (i.e., a serum ferritin level that was diagnostic [less than 18 micrograms/L] or suggestive [18 to 45 micrograms/L]) underwent endoscopy, two were found to have cancer of the stomach or cecum. Only 26 of the 49 patients had adequate investigation. CONCLUSIONS: Anemia is common among elderly patients in hospital. However, iron deficiency is underrecognized and underinvestigated.     

血清铁蛋白检测在贫血性疾病中的临床价值

目的探讨血清铁蛋白（Serum ferritin,SF）在贫血性疾病诊断及预后中的临床价值。方法采用放免法测定121例贫血患者SF的表达水平,其中缺铁性贫血20例,良性贫血性疾病30例,恶性贫血性疾病51例,恶性贫血性疾病缓解者20例,正常对照组20例。结果SF水平对照组为（183.7±39.7）μg/L,缺铁性贫血为（14.2±6.9）μg/L; 良性贫血性疾病为（195.3±66.7）μg/L,恶性贫血性疾病为（764.9±437.0）μg/L,两者相比差异有统计学意义; 经治疗后完全缓解的20例恶性贫血性疾病者SF为（270.6±128.1）μg/L,与正常对照组比较有统计学意义; SF小于800μg/L恶性贫血性疾病常规治疗缓解率为83.9%,大于800μg/L恶性贫血性疾病常规治疗缓解率为21.6%,差异有统计学意义。结论SF不仅可作为贫血性疾病的诊断及鉴别诊断指标,其浓度的检测亦有助于判断疗效和指导治疗。     

Anemia in children with and without Helicobacter pylori infection

BACKGROUND: Iron deficiency is the most common cause of anemia in children. Recently there has been evidence to suggest a relationship between Helicobacter pylori gastritis and iron deficiency anemia. Because both H. pylori infection and iron-deficiency anemia are common in children, we studied any correlation between H. pylori infection and iron-deficiency anemia in children. METHOD: In a case-control study at the Children's Medical Center Hospital, 100 children with H. pylori infection and 109 children without infection according to histology were evaluated. Iron-deficiency anemia was diagnosed when serum ferritin and hemoglobin levels were less than adjusted values for age and sex. RESULTS: There were 111 boys and 98 girls with a median age of 7.1 years. The main symptom was abdominal pain in H. pylori-infected and non-infected patients. Frequency of H. pylori infection in anemic and non-anemic patients was nearly similar (43.9 and 50.4%, respectively). Among patients with H. pylori, 36% had anemia and in patient without H. pylori infection, its frequency was 42.2% (p = 0.59). Among patients with H. pylori, 19% had iron-deficiency anemia and in patients without H. pylori infection, its frequency was 21.1% (p = 0.7). Among patients with H. pylori, the difference between the severity of gastritis in those with anemia and those without anemia was not statistically significant (p = 0.382) and no correlation was found between degree of H. pylori colonization and anemia. CONCLUSIONS: Our results do not support the proposal that H. pylori infection is associated with iron-deficiency anemia in children. Further studies emphasizing the socioeconomic status of children, evaluation of strains of H. pylori, and posttreatment measurement of serum iron and serum ferritin are necessary to show the possible association.     

珠蛋白生成障碍性贫血患者红细胞游离原卟啉水平的研究

测定116例珠蛋白生成障碍性贫血、37例缺铁性贫血患者及45例正常人的FEP水平。结果:6例(9.2％)杂合子β珠蛋白生成障碍性贫血病人的FEP增高,其中4例合并缺铁;14例(27.5％)纯合子β珠蛋白生成障碍性贫血、HbH病及β珠蛋白生成障碍性贫血复合HbE病患者的FEP增高,与缺铁无关。缺铁性贫血病人的FEP水平显著高于杂合子β珠蛋白生成障碍性贫血病人。37例缺铁性贫血病人中,34例(91.9％)FEP增高;而37例非缺铁的杂合子β珠蛋白生成障碍性贫血患者中,36例(97.3％)FEP在正常范围,FEP测定对两者的鉴别诊断有一定的临床价值。     

136例缺铁性贫血病因分析

目的 分析总结缺铁性贫血的主要病因.方法 回顾分析台山市第二人民医院2003年1月至2008年12月门诊及住院的136例缺铁性贫血患者的临床资料.结果 男性病例中,胃肠道疾病是引起缺铁性贫血的主要病因,其中最为常见的是消化性溃疡、慢性胃炎,占46%,痔疮占10%;其次是钩虫病,占10%.女性病例中,月经过多是最主要的病因,占39%;其次是消化性溃疡、慢性胃炎,占21%;再次是妊娠、哺乳,占8%.结论 除月经过多、妊娠、哺乳等女性特殊生理时期外,从总体上看,消化性溃疡、慢性胃炎等胃肠道疾病是引起15岁以上人群缺铁性贫血的主要原因占31%应引起重视.     

Vitamin B12 (cobalamin) deficiency in elderly patients

VITAMIN B₁₂ OR COBALAMIN DEFICIENCY occurs frequently (> 20%) among elderly people, but it is often unrecognized because the clinical manifestations are subtle; they are also potentially serious, particularly from a neuropsychiatric and hematological perspective. Causes of the deficiency include, most frequently, food-cobalamin malabsorption syndrome (> 60% of all cases), pernicious anemia (15%–20% of all cases), insufficent dietary intake and malabsorption. Food-cobalamin malabsorption, which has only recently been identified as a significant cause of cobalamin deficiency among elderly people, is characterized by the inability to release cobalamin from food or a deficiency of intestinal cobalamin transport proteins or both. We review the epidemiology and causes of cobalamin deficiency in elderly people, with an emphasis on food-cobalamin malabsorption syndrome. We also review diagnostic and management strategies for cobalamin deficiency.     

农村地区6个月~7岁儿童贫血及铁缺乏情况调查及干预

目的：了解合肥市农村地区6个月~7岁儿童的贫血及铁缺乏情况及干预效果。方法采取随机抽样的方法抽取2095名6个月~7岁儿童进行问卷调查并测定血红蛋白,对贫血和(或)铁缺乏的儿童进行干预。结果2095名研究对象中,正常儿童1764名,检出贫血患儿331例,检出率为15.80%。其中铁缺乏检出114人,检出率为5．44%,贫血患儿中铁缺乏检出率为34．44%。在接受干预的281名儿童中有218名血红蛋白恢复到正常水平,即干预后正常儿童为1982名,占96．92%;轻度、中度贫血检出率均明显下降。结论合肥市农村地区儿童贫血及铁缺乏干预效果显著。加强儿童贫血相关健康教育,科学合理的喂养方法及早期正确的喂养行为可以有效防治婴幼儿贫血及铁缺乏。     

The diagnostic yield of upper gastrointestinal endoscopy in the investigation of anaemia

Computer records of patients endoscoped over a 34-month period were studied to assess the diagnostic yield of gastrointestinal endoscopy in patients with anaemia. Patients with obvious gastrointestinal bleeding and known gastrointestinal pathology were excluded. On hundred and thirty-six patients were endoscoped for anaemia. Eighty-three of them (61%) had iron deficiency anaemia and 53 (39%) had other types of anaemia. The ages of the patients with iron deficiency anaemia (mean 56 years) were significantly lower than those of other anaemias (means 65 years), (p less than 0.003). Patient characteristics were otherwise comparable. There were significant endoscopic findings (ulcers, carcinoma and haemorrhagic or erosive gastritis) in 26 of 83 patients (31%) with iron deficiency anaemia, in 11 of 53 patients with other anaemias (21%) and 37 of 136 patients (27%) combined. Significant endoscopic findings were found in 506 of 2224 patients (23%) endoscoped during this period who were not anaemic, did not have obvious gastrointestinal haemorrhage and were not known to have gastrointestinal diseases. The diagnostic yield for iron deficiency anaemia was significantly higher than for the non anaemic group (p less than 0.05). There was no difference between the diagnostic yields of iron deficiency and other anaemias, other anaemias and the non anaemic group, or total anaemias and the non anaemic group. Gastrointestinal symptoms and history of analgesic or steroid usage did not appear to increase the incidence of gastrointestinal lesions in either iron deficiency anaemia or other anaemias. Twenty-three of 41 patients (56%) who had no cause for anaemia found at the end of all investigations were colonscoped.(ABSTRACT TRUNCATED AT 250 WORDS)     

江苏省徐州地区4300人贫血原因的调查分析

对徐州地区4300人进行了贫血调查,贫血的总患病率14.93％,其中轻度贫血占86.76％。缺铁性贫血最常见,占本组贫血的55.30％;叶酸或维生素B_(12)缺乏所致的贫血占11.84％;铁、叶酸和维生素B_(12)缺乏所致的贫血占2.80％,其它原因的贫血占30.06％。对造成贫血的原因进行了分析。     

85例类风湿关节炎患者合并贫血的类型及其相关因素分析

目的 探讨类风湿关节炎(rheumatoid arthritis,RA)患者合并贫血的类型及其相关因素。 方法 选取衢州市人民医院2012年1月—2014年12月3年间确诊的RA患者,在清晨空腹状态下,抽取静脉血送实验室进行相关指标检查。将得到的资料进行统计分析。 结果 合并慢性病性贫血(chronic disease anemia,ADC)27例,占总贫血的47.37%(27/57),缺铁性贫血(iron deficiency anemia,IDA)20例,占总贫血的35.09%(20/57),巨幼细胞性贫血(MA)10例,占总贫血的17.54%(10/57)。女性贫血发生率显著高于男性(P＜0.05)。ADC患者与无贫血患者比较,强的松的用量显著增加(P＜0.05),MA患者年龄显著高于无贫血患者(P＜0.05);ADC患者与无贫血患者比较,病情活动度、血沉、C反应蛋白均显著增高(P均＜0.05)。 结论 RA患者合并贫血的类型主要是慢性病性贫血和缺铁性贫血,与长期口服药物、病情活动度、血沉、C反应蛋白可能有关,RA患者并发贫血还需警惕和预防恶病质的出现,通过饮食增加营养摄入,补充蛋白质、维生素和矿物质,这对预防和避免贫血能起到重要作用。      

儿童铁营养状况调查

对118例1.5月～4岁健康小儿进行了铁缺乏症流行病学调查,结果表明铁缺乏总发病率为41.8%,缺铁性贫血32.2%,其中以6月～2岁发病率最高,病因与婴幼儿阶段生长发育快,铁需要量增加而辅食添加不及时,品种单调有关。本组比较母乳、工人、混合三种喂养方式的缺铁发病率,结果无显著差异。     

Cobalt Excretion Test for the Assessment of Body Iron Stores

Iron absorption is under delicate control and the level of absorption is adjusted to comply with the body's need for iron. To measure the intestinal setting for iron absorption, and thereby indirectly assess body iron requirements, cobaltous chloride labelled with ⁵⁷Co or ⁶⁰Co was given by mouth and the percentage of the test dose excreted in the urine in 24 hours was measured in a gamma counter. Seventeen control subjects with normal iron stores excreted 18% (9-23%) of the dose. Increased excretion, 31% (23-42%), was found in 10 patients with iron deficiency anemia and in 15 patients with depleted iron stores in the absence of anemia. In contrast, 12 patients with anemia due to causes other than iron deficiency excreted amounts of radiocobalt within the normal control range. In patients with iron deficiency, replenishment of iron stores by either oral or parenteral iron caused the previously high results to return to normal.

Excretion of the test dose was normal in portal cirrhosis with normal iron stores but it was markedly increased in patients with cirrhosis complicated by either iron deficiency or endogenous iron overload. It was also raised in primary hemochromatosis. Excretion of the dose was reduced in gluten-sensitive enteropathy. Gastrointestinal surgery and inflammatory disease of the lower small intestine had no effect on the results except that some patients with steatorrhea had diminished excretion.

The cobalt excretion test provides the clinician with a tool for the assessment of iron absorption, the detection of a reduction in body iron stores below the level that is normal for the subject in question, the differentiation of iron deficiency anemia from anemia due to other causes, and the investigation of patients with iron-loading disorders.

     

PEDIATRIC IRON NUTRITION AND LABORATORY'' DIAGNOSTIC CRITERIA OF IRON DEFICIENCY

Normal values of Hb, RBC count, serum ferri tin, free erythrocyte protoporphyrin (FEP) and FEP/Hb ratio and their diagnostic criteria in iron deficiency were obtained in 296 children aged 4.5 months t0 7 years who were supplied with adequate folic acid and iron. Evaluating the status of iron nutrition of 398 children aged l.5 months t0 7 years before iron supplement, with the criteria mentioned above, we. found 119 cases (29.9%) of total iron deficiency and only 28 ciency anemia (IDA). were mild cases. Iron cases (7.0%) of iron defi- Most of the IDA patients deficiency was rare under the age of 3 months. The morbidity rates of total iron deficiency and IDA were highest at 6 months and l year, respectively. The results suggest that much more attention should be paid to infants after 3 months of age, especially the 6-month t0 2-year age group to prevent and treat iron deficiency.     

生血宁对缺铁性与失血性贫血造血功能的影响

目的观察生血宁对缺铁性与失血性贫血造血功能的影响。方法缺铁性贫血患者随机双盲分为生血宁治疗组和葡萄糖酸亚铁对照组各50例,剂量0.1 tid,连续服用30天。治疗前后各测一次血清铁(Fe)、总铁结合力(TIBC)、转铁蛋白饱和度(TS)、铁蛋白(SF)、转铁蛋白(Tf)、血清可溶性转铁蛋白受体(sTfR)、血常规等。将大鼠随机分成正常对照组、失血模型对照组、琥珀酸亚铁对照组(100mg/kg/d)、生血宁治疗组(100mg/kg/d),每组10只。除正常对照组外。其他三组每天尾端放血2ml,连续6天,使造成失血性贫血模型。第6天开始灌药或水。第24天取血测血常规。结果生血宁能促进红细胞、白细胞及血小板生成;能改善铁代谢,提高Fe、TS、SF,降低TIBC、Tf、sTfR;治缺铁性贫血总有效率为92％、显效率为82％、痊愈率62％。失血性贫血大鼠的血常规变化与临床研究相似。结论生血宁治疗缺铁性与失血性贫血效果明显,促进红细胞、白细胞及血小板生成。在分子水平能改善铁代谢,提高Fe、TS、SF,降低TIBC、Tf、sTfR。     

似然比和受试者工作特征曲线在评价铁参数对铁缺乏症诊断中的应用

目的评价几种铁参数在铁缺乏症诊断中的价值。方法连续性收集９０例贫血病人（缺铁性贫血３６例,慢性病贫血２３例,慢性病伴缺铁性贫血３１例）,做骨髓铁染色、血清转铁蛋白受体（ｓＴｆＲ）、血清铁蛋白（Ｓｅｒｕｍｆｅｒｉｔｉｎ,ＳＦ）、血清铁（Ｓｅｒｕｍｉｒｏｎ,ＳＩ）、总铁结合力（Ｔｏｔａｌｉｒｏｎｂｉｎｄｉｎｇｃａｐａｃｉｔｙ,ＴＩＢＣ）、转铁蛋白饱和度（Ｔｒａｎｓｆｅｒｉｎｓａｔｕｒａｔｉｏｎ,ＴＳ）等检查,应用似然比（ＬＲ）和受试者工作特征（ＲＯＣ）曲线分析方法,以骨髓铁染色作为金标准对以上的铁参数诊断慢性病合并缺铁性贫血的价值进行分析。结果在判断慢性病是否合并缺铁性贫血时ＳＦ在２５～４４μｇ／Ｌ时的ＬＲ最大（５８）,ｓＴｆＲ＞５０ｎｍｏｌ／Ｌ时的ＬＲ最大（６０）;ＲＯＣ曲线下面积以ｓＴｆＲ最大（０８４）,其他依次是ｓＴｆＲ／ｌｏｇＳＦ（０．８３）、ＳＦ（０７７）、ｓＴｆＲ／ＳＦ（０．７４）、ＳＩ（０７２）、ＴＩＢＣ（０６８）。结论认为ＲＯＣ曲线与ＬＲ对科学评价铁参数诊断价值有重要的意义,研究结果对于临床诊断具有重要的参考价值     

血清可溶性转铁蛋白受体在恶性肿瘤贫血伴缺铁诊断中的意义

目的：测定恶性肿瘤贫血,缺铁性贫血STfR值,为恶性肿血复合缺铁提供诊断依据。方法：对于32例恶性肿瘤贫血经骨髓可染铁检测分复合缺铁组,非复合缺铁组同时和20例缺铁性贫血组作SI,TIBC,SF,骨髓可染铁及STfR测定,并将结果进行比较,结果：32例恶性肿瘤贫血中显示22例骨髓可染铁缺乏,占68．8％,SI,TIBC,SF在恶性肿瘤贫血复合缺铁和非复合缺铁两组比差异无统计学意义（P＞0．05）,与IDA组比差异有显著性（P＜0．01）,STfR值在恶性肿瘤贫血复合缺铁组和IDA组明显增高,两组比差异无意义（P＞0．05）,恶性肿瘤贫血非复合缺铁组STfR值无增高,和恶性肿瘤贫血复合缺铁组和IDA组比差异有显著性＊P＜0．01）,结论：恶性肿瘤贫血中有较多存在复合缺铁状况,常规进行S,TIBC,SF检测难以准确评估恶性肿瘤贫血贮铁状况,骨髓可染铁检测为创伤性检查,增加病人痛苦,而STfR测定在贮存铁缺乏时明显增高,可作为临床评估贮存铁状况的实验室 依据。     

Iron deficiency anemia in 1-year-old children of disadvantaged families in Montreal.

OBJECTIVES: To determine the prevalence of iron deficiency anemia among 1-year-old infants of disadvantaged families in Montreal as well as certain predictors of this condition. DESIGN: Cohort study. SETTING: Five poorest health districts in Montreal. PARTICIPANTS: Infants 10 to 14 months of age were identified from registration lists of births from May 1988 to August 1989. Those whose mother had less than 11 years of schooling and a family income below the government-defined low-income cutoff point were eligible. INTERVENTION: During a home visit capillary blood samples were obtained from the child, and the mother answered a questionnaire about infant-feeding practices. Infants with a serum ferritin level of 10 micrograms/L or less and either a hemoglobin level of 115 g/L or less or a mean corpuscular volume of 72 fL or less were considered as having iron deficiency anemia. RESULTS: Of the 299 mothers who were eligible and could be located 220 (74%) agreed to participate; 218 blood samples were available. Iron deficiency anemia was found in 25% of the infants (95% confidence interval [CI] 19% to 31%). The mean hemoglobin level was 115 (standard deviation 11) g/L. The serum ferritin level, assessed routinely in the last 62 infants, was 10 micrograms/L or less in 37% of the infants. The factors that were found to be predictors of iron deficiency anemia included the use of whole cow's milk before 6 months of age (odds ratio [OR] 3.56 [95% CI 1.07 to 11.26]) and the use of iron-fortified infant cereal for less than 6 months (OR 3.15 [95% CI 1.25 to 7.96]). A low birth weight and the use of iron-fortified formula for less than 6 months were associated with iron deficiency anemia. CONCLUSIONS: Despite a decrease in the prevalence of iron deficiency anemia among children of disadvantaged families in the United States socioeconomically disadvantaged infants in Montreal are at risk. Preventive measures must be taken to ensure adequate iron status in the first year of life.     

Development of rheumatoid arthritis in a patient with pernicious anemia: case report

Very few cases of rheumatoid arthritis combined with pernicious anemia have been reported in the world literature and none in the Chinese literature. A 62-year-old female initially presented with anemia. Pernicious anemia was diagnosed by characteristic blood and bone marrow morphology. Laboratory data showed a deficiency of vitamin B12 and positive anti-gastric parietal cell antibodies. Her anemia improved after vitamin B12 therapy. Painful swelling of multiple joints developed 6 years later. The clinical presentation supported a diagnosis of rheumatoid arthritis. We report herein a rare case of rheumatoid arthritis and pernicious anemia in the same ethnic Chinese patient. We also review the literature and discuss a possible association between a non-organ-specific autoimmune disease, rheumatoid arthritis, and an organ-specific autoimmune disease, pernicious anemia.