Latent iron deficiency

Latent Iron Deficiency
Classification and external resources
Specialty endocrinology
ICD-10 E61.1

Latent iron deficiency (LID), also called iron-deficient erythropoiesis,[1] is a medical condition in that there is evidence of iron deficiency without anemia (normal hemoglobin[2]). It is important to assess this condition because it is accepted that individuals with latent iron deficiency will develop iron-deficiency anemia in the weeks or months following diagnoses of LID if they are not treated with iron supplementation. In addition, there is some evidence of a decrease in vitality and an increase in fatigue among individuals that have Latent Iron Deficiency.[3] Another clinical study has shown an increase of ferritin levels in those taking iron compared with others receiving a placebo from persons with LID.[4]

Clinical features

The clinical features of Latent Iron Deficiency are in discussion, some studies have not shown a clear difference between individuals with LID and control a group of the same age, gender and origin without LID. But may be it is not wrong to say that the persons with LID have a mild decrease in vitality and increase of fatigue. What seems important for preventive healthcare is to detect this medical condition, because it will avoid the patient probably developing an Iron-Deficiency Anemia.

Analytical features

Hematology
Hemoglobin (Hgb) and mean corpuscular volume (MCV), being normal, are lower and RDW higher in individuals with LID compared with non-deficient individuals. This is the reason why some new parameters/functions combining the previoustly mentioned (Hgb,MCV, RDW), have been developed, as MAf (Hgb x MCV ÷ 100) and MAf-RDW (Hgb x MCV ÷ RDW ÷ 10) (Beckman Coulter.[5][6] It has been published that the percentage of hypochromic (< 28 g.dl-1) red blood cells measured with hematology automated analysers, as the Technicon H1(tm),[7] the Reticulocyte Hb content (CHr) (ADVIA(tm) Siemens),[8] Reticulocyte Hemoglobin equivalent (Ret-He)(Sysmex XE-2100)[9] can also detect LID.
Immunochemistry
Serum soluble transferrin receptor (sTfR) in combination with Serum Ferritin, in the parameter called TfR-F Index = sTfR ÷ Logarithm (Ferritin) has shown high performance in detecting Latent Iron Deficiency.[10]

Treatment

There is no consensus on how to treat Latent Iron Deficiency but one of the options is to treat it as an iron-deficiency anemia with ferrous sulfate (Iron(II) sulfate) at a dose of 100 mg x day in two doses (one at breakfast and the other at dinner)[11] or 3 mg x Kg x Day in children (also in two doses)[12] during two or three months. The ideal would be to increase the deposits of Body Iron, measured as levels of Ferritin in serum, trying to achieve a Ferritin value between 30 and 100 ng/mL. With Ferritin levels higher than 100 ng/mL an increase in Infections, etc. has been reported.[13] Another way to treat LID is with an iron rich diet and in addition Ascorbic acid or Vitamin C, contained in many types of fruits as oranges, kiwifruits, etc. that will increase 2 to 5-fold iron absorption.[14][15]

Epidemiology

There are many studies about LID and the frequency varies according to country of origin, diet, pregnancy status age, gender, etc. Depending on these previous conditions, the frequency can change from 11% in male athletes (Poland) to 44.7% in children less than 1 year old (China):

Frequency of LID in different countries and populations:

References

  1. Suominen, P; Punnonen, K; Rajamäki, A; Irjala, K (October 1998). "Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits". Blood 92 (8): 2934–9. PMID 9763580.
  2. Beutler, E; Waalen, J (March 2006). "The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration?". Blood 107 (5): 1747–50. doi:10.1182/blood-2005-07-3046. PMC 1895695. PMID 16189263.
  3. Patterson, A. J.; Brown, W. J.; Roberts, D. C. (August 2001). "Dietary and supplement treatment of iron deficiency results in improvements in general health and fatigue in Australian women of childbearing age". Journal of the American College of Nutrition 20 (4): 337–42. doi:10.1080/07315724.2001.10719054. PMID 11506061.
  4. Leonard, A. J.; Chalmers, K. A.; Collins, C. E.; Patterson, A. J. (April 2014). "Comparison of two doses of elemental iron in the treatment of latent iron deficiency: efficacy, side effects and blinding capabilities". Nutrients 6 (4): 1394–405. doi:10.3390/nu6041394. PMC 4011041. PMID 24714351.
  5. Methods of determination of iron deficiency and hemochromatosis. Ramon Simon-Lopez. US Patent US 8154713 B2. https://docs.google.com/viewer?url=patentimages.storage.googleapis.com/pdfs/US8154713.pdf
  6. Dopsaj, V; Martinovic, J; Dopsaj, M (June 2013). "Early detection of iron deficiency in elite athletes: could microcytic anemia factor (Maf) be useful?". International Journal of Laboratory Hematology 36: 37. doi:10.1111/ijlh.12115. PMID 23731862.
  7. McKay, P. J.; Stott, D. J.; Holyoake, T; Hendry, A; MacDonald, J. B.; Lucie, N. P. (1993). "Use of the erythrogram in the diagnosis of iron deficiency in elderly patients". Acta Haematologica 89 (4): 169–73. doi:10.1159/000204517. PMID 8212996.
  8. Brugnara, C; Zurakowski, D; Dicanzio, J; Boyd, T; Platt, O (June 1999). "Reticulocyte hemoglobin content to diagnose iron deficiency in children". JAMA 281 (23): 2225–30. doi:10.1001/jama.281.23.2225. PMID 10376576.
  9. Canals, C; Remacha, A. F.; Sardá, M. P.; Piazuelo, J. M.; Royo, M. T.; Romero, M. A. (August 2005). "Clinical utility of the new Sysmex XE 2100 parameter - reticulocyte hemoglobin equivalent - in the diagnosis of anemia". Haematologica 90 (8): 1133–4. PMID 16079114.
  10. Punnonen, K; Irjala, K; Rajamäki, A (February 1998). "Serum transferrin receptor, ferritin and TfR-F index in identification of latent iron deficiency". European Journal of Haematology 60 (2): 135–7. doi:10.1111/j.1600-0609.1998.tb01011.x. PMID 9508356.
  11. Norrby, A (1974). "Iron absorption studies in iron deficiency". Scandinavian Journal of Haematology. Supplementum 20: 1–125. PMID 4526330.
  12. Dallman, P. R.; Siimes, M. A.; Stekel, A (January 1980). "Iron deficiency in infancy and childhood". The American Journal of Clinical Nutrition 33 (1): 86–118. PMID 6986756.
  13. Weiss, G; Goodnough, L. T. (March 2005). "Anemia of chronic disease". The New England Journal of Medicine 352 (10): 1011–23. doi:10.1056/NEJMra041809. PMID 15758012.
  14. Sayers, M. H.; Lynch, S. R.; Charlton, R. W.; Bothwell, T. H.; Walker, R. B.; Mayet, F (May 1974). "Iron absorption from rice meals cooked with fortified salt containing ferrous sulphate and ascorbic acid". The British Journal of Nutrition 31 (3): 367–75. doi:10.1079/BJN19740045. PMID 4835790.
  15. Sayers, M. H.; Lynch, S. R.; Charlton, R. W.; Bothwell, T. H.; Walker, R. B.; Mayet, P (December 1974). "The fortification of common salt with ascorbic acid and iron". British Journal of Haematology 28 (4): 483–95. doi:10.1111/j.1365-2141.1974.tb06667.x. PMID 4455301.
  16. Malczewska, J; Szczepańska, B; Stupnicki, R; Sendecki, W (March 2001). "The assessment of frequency of iron deficiency in athletes from the transferrin receptor-ferritin index". International Journal of Sport Nutrition and Exercise Metabolism 11 (1): 42–52. PMID 11255135.
  17. Mehta, B. C. (September 2004). "Iron deficiency amongst nursing students". Indian Journal of Medical Sciences 58 (9): 389–93. PMID 15470280.
  18. Capel-Casbas, Maria J.; Duran, Jose J.; Diaz, Jorge; Ruiz, Gerardo; Simon, Ramon; Rodriguez, Francisco; Piqueras, Josep; Pelegri, Dolors; Pujol-Moix, Nuria (2005). "Latent Iron Metabolism Disturbances in Fertile Women and Its Detection with the Automated Hematology Instrument LH750®". Blood 106 (11): 3707.
  19. Liao, Q. K.; Chinese Children, Pregnant Women & Premenopausal Women Iron Deficiency Epidemiological Survey Group (November 2004). "[Prevalence of iron deficiency in pregnant and premenopausal women in China: a nationwide epidemiological survey]". Zhonghua Xue Ye Xue Za Zhi (in Chinese) 25 (11): 653–7. PMID 15634568.
  20. Zhu, Y. P.; Liao, Q. K.; Collaborative Study Group for "The Epidemiological Survey of Iron Deficiency in Children in China" (December 2004). "[Prevalence of iron deficiency in children aged 7 months to 7 years in China]". Zhonghua Er Ke Za Zhi (in Chinese) 42 (12): 886–91. PMID 15733354.
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