The effect of chelating agents on iron mobilization in Chang cell cultures.
The investigation of chelating agents with potential therapeutic value in patients with transfusional iron overload has been facilitated by the use of Chang cell cultures. These cells have been incubated with [59Fe]transferrin for 22 hr, following which most of the intracellular radioiron is found in the cytosol, distributed between a ferritin and a nonferritin form. Iron release from the cells depends on transferrin saturation in the medium, but when transferrin is 100% saturated, which normally does not allow iron release, desferrioxamine, 2,3-dihydroxybenzoic acid, rhodotorulic acid, cholythydroxamic acid, and tropolone all promote the mobilization of ferritin iron and its release from cells. They are effective to an approximately equal degree. The incubation of [59Fe]transferrin with tropolone in vitro at a molar ratio of 1:500 results in the transfer of most of the labeled iron to the chelator, reflecting the exceptionally high binding constant of this compound. How far these phenomena relate to therapeutic potentially remains to be seen. (+info)
Evidence for and consequences of chronic heme deficiency in Belgrade rat reticulocytes.
The Belgrade rat has a microcytic, hypochromic anemia inherited as an autosomal recessive trait (gene symbol b). Transferrin-dependent iron uptake is defective because of a mutation in Nramp2 (now DMT1, also called DCT1), the protein responsible for endosomal iron efflux. Hence, Belgrade reticulocytes are iron deficient. We show that a chromatographic method is able to measure the amount of 'free' heme in reticulocytes. Most of the 'free' heme is the result of biosynthesis. Succinylacetone, an inhibitor of heme synthesis, decreases the level of 'free' heme and cycloheximide, an inhibitor of globin synthesis, increases the 'free' heme level. In a pulse-chase experiment with 59Fe-transferrin, the 'free' heme pool behaves as an intermediate, with a half-life of just over 2 h. Belgrade reticulocytes contain about 40% as much 'free' heme as do heterozygous or homozygous reticulocytes. This deficiency of 'free' heme slows initiation of translation in Belgrade reticulocytes by increasing the level of an inhibitor of initiation. Thus the Belgrade rat makes a whole animal model available with chronic heme deficiency. (+info)
Hypochromic red cells and reticulocyte haemglobin content as markers of iron-deficient erythropoiesis in patients undergoing chronic haemodialysis.
BACKGROUND: In patients on chronic haemodialysis, because of a non-specific increase in serum ferritin, iron deficiency may be overlooked leading to failure of erythropoietin treatment. A reticulocyte haemglobin content < 26 pg and a percentage of hypochromic red cells > 2.5 have been proposed as markers of iron-deficient erythropoiesis in such subjects, but it is unclear which parameter is superior. METHODS: We measured haematocrit, reticulocyte haemglobin content, ferritin and the percentage of hypochromic red cells over 10-150 days in 36 chronic haemodialysis patients in a university hospital. Transferrin saturation was also measured in a subset of 25 patients; iron deficiency was defined as a transferrin saturation < 15%. RESULTS: The diagnostic sensitivity and specificity of a reticulocyte haemoglobin content < 26 pg in detecting iron deficiency were 100% and 73% respectively, compared with 91% and 54% for a percentage of hypochromic red cells > 2.5. Paradoxical reticulocyte haemglobin concentrations occurred on follow-up in five patients receiving 4000 U erythropoietin per haemodialysis (HD). In three patients, reticulocyte haemglobin content exceeded 26 pg despite a persistent lack of iron. In a fourth, iron gluconate (62.5 mg i.v./HD) increased transferrin saturation to 27% and reduced the percentage of hypochromic red cells from 12 to 4, while reticulocyte haemglobin remained > 30 pg. In the final patient, iron gluconate increased transferrin saturation from 8 to 30% and reduced the percentage of hypochromic red cells from 40 to below 5, but reticulocyte haemglobin content remained < or = 26 pg throughout. CONCLUSIONS: The reticulocyte haemglobin content is superior to the percentage of hypochromic red cells in detecting iron deficiency in haemodialysis patients. (+info)
The contribution of alpha+-thalassaemia to anaemia in a Nigerian population exposed to intense malaria transmission.
The proportion to which alpha-thalassaemia contributes to anaemia in Africa is not well recognized. In an area of intense malaria transmission in South-West Nigeria, haematological parameters of alpha-thalassaemia were examined in 494 children and 119 adults. The -alpha3.7 type of alpha+-thalassaemia was observed at a gene frequency of 0.27. Nine and 36.5% of individuals were homozygous and heterozygous, respectively. P.falciparum-infection was present in 78% of children and in 39% of adults. The alpha-globin genotypes did not correlate with the prevalence of P. falciparum-infection. alpha+-thalassaemic individuals had significantly lower mean values of haemoglobin, mean corpuscular volume, and mean corpuscular haemoglobin than non-thalassaemic subjects. Anaemia was seen in 54. 7% of children with a normal alpha-globin genotype, in 69.9% of heterozygous (odds ratio: 1.99, 95% confidence interval: 1.32-3.00, P = 0.001), and in 88.4% of homozygous alpha+-thalassaemic children (odds ratio: 7.72, 95% confidence interval: 2.85-20.90, P = 0.0001). The findings show that alpha+-thalassaemia contributes essentially to mild anaemia, microcytosis, and hypochromia in Nigeria. (+info)
Fe(III)-EDTA complex as iron fortification. Further studies.
The data presented confirm the advantages of Fe(III)-EDTA as a salt for iron fortification. This iron compound exchanges completely with intrinsic wheat iron in the lumen of the gut. The iron absorption data from this salt tested with six different food vehicles compared with the absorption of ferrous sulfate administered with the same vehicles indicate that while the mean absorption from ferrous sulfate varies from 2 to 30% according to the food vehicle mixed with the salt, the absorption from Fe(III)-EDTA remains practically the same. Apparently, the iron absorption from Fe(III)-EDTA complex is slightly or not affected by the presence of vegetable foods or milk. All these data suggest that only a small amount of iron from this salt, about 10 mg/day, would be necessary to prevent iron deficiency anemia even in those populations relying for their subsistence on vegetable food only. (+info)
Isoimmune haemolysis in pathogenesis of anaemia after cardiac surgery.
A patient who had received multiple transfusions developed antiglobulin-positive haemolytic anaemia due to a delayed haemolytic transfusion reaction. Many cases of haemolytic anaemia after cardiac surgery could be explained on this basis. (+info)
Cardiorespiratory, hematological and physical performance responses of anemic subjects to iron treatment.
Twenty-nine adult iron-deficient anemis subjects (13 men and 16 women) with hemoglobin levels of 4.0 to 12.0 g/100 ml blood were divided into either an iron treatment or placebo group. Hematological, cardiorespiratory and performance data were collected before, during, and after treatment and compared with data from a control group of subjects (4 men and 6 women) from the same socioeconomic population. Hemoglobin levels for the iron treatment group improved from 7.7 to 12.4 g for the women and from 7.1 to 14.0 g for the men. Values for the control group were 13.9 g and 14.3 g for the women and men, respectively. The placebo group showed virtually no change over the 80-day period (8.1-8.4 g for women and 7.7-7.4 g for men). Peak exercise heart rates (5 min, 40-cm step test) were significantly reduced after treatment from 155 to 113 for the iron treatment men and 152 to 123 for the women compared with the placebo group which showed no changes. Values for the control group were 119 and 142 for the men and women, respectively. In response to the exercise test, no difference in oxygen consumption was found between the iron treatment and placebo group although 15% more O2 was delivered per pulse in the iron treatment group. Blood lactates were significantly highein the placebo than iron treatment group both at rest, 1.18 versus 0.64 mmole/liter, and 1 min after exercise, 5.30 versus 2.68 mmoles/liter. No changes in handgrip or shoulder adductor strength were observed following treatment. These results clearly support the concept that performance requiring high oxygen delivery is significantly affected by hemoglobin levels. (+info)
Anemia in the elderly.
Anemia should not be accepted as an inevitable consequence of aging. A cause is found in approximately 80 percent of elderly patients. The most common causes of anemia in the elderly are chronic disease and iron deficiency. Vitamin B12 deficiency, folate deficiency, gastrointestinal bleeding and myelodysplastic syndrome are among other causes of anemia in the elderly. Serum ferritin is the most useful test to differentiate iron deficiency anemia from anemia of chronic disease. Not all cases of vitamin B12 deficiency can be identified by low serum levels. The serum methylmalonic acid level may be useful for diagnosis of vitamin B12 deficiency. Vitamin B12 deficiency is effectively treated with oral vitamin B12 supplementation. Folate deficiency is treated with 1 mg of folic acid daily. (+info)