ANKMJ
Ankyra Medical Journal

Ankyra Medical Journal (AnkMJ), formerly known as the Journal of Translational and Practical Medicine, regularly publishes international quality issues in the field of Medicine in the light of current information.

eISSN: 3023-655X
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Evaluation of iron deficiency anemia during acute infection in children
Abstract
Aims: The purpose of this study was to assess changes in infection and iron parameters during infection and at least 4-6 weeks after recovery in children diagnosed with infections, to investigate the impact of infection on iron metabolism and to determine the prevalence of iron deficiency anemia (IDA).
Methods: In this study, 151 patients who presented with fever, were diagnosed with an infection as the source of the fever, had no prior anemia investigations or antianemic treatment, and had no history of recurrent infections or chronic diseases, between September 2005 and October 2005 were included. In addition to specific tests focused on the site of infection, complete blood count, serum iron, serum total iron-binding capacity (TIBC), ferritin, C-reactive protein (CRP), transferrin saturation, and peripheral smear levels were measured at the time of admission and 4-6 weeks after follow-up.
Results: The mean age of the patients was 4.5 ± 3.2 years, and 57.6% (n = 87) of them were male. During the infection, 12% of the cases (n = 18) showed iron deficiency, and 53% (n = 80) were diagnosed with IDA. After infection, iron deficiency was identified in 5% of the cases (n = 7), while IDA was present in 37.1% of the cases (n = 50). A significant decrease in both iron deficiency (12% vs. 5%, p = 0.001) and IDA (53.0% vs. 37.1%, p = 0.001) ratios was observed after the infection. The group with IDA showed a larger decrease in leukocyte and CRP levels compared to the group without IDA, alongside a more marked increase in TIBC levels.
Conclusion: The reduction in iron deficiency and IDA rates following infection suggests that infection may lead to substantial changes in iron metabolism. Monitoring iron parameters during the infection phase in pediatric patients may play a crucial role in distinguishing anemia of inflammation from IDA.

Keywords : Anemia, ferritin, infection, iron deficiency anemia, total iron-binding capacity

Download Article


1. Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harb Perspect Med. 2013;3(7):a011866. doi:10.1101/cshperspect.a011866
2. Yang J, Li Q, Feng Y, Zeng Y. Iron Deficiency and iron deficiency anemia: potential risk factors in bone loss. Int J Mol Sci. 2023;24(8):6891. doi:10. 3390/ijms24086891
3. Aksu T, Unal S. Iron deficiency anemia in infancy, childhood, and adolescence. Turk Arch Pediatr. 2023;58(4):358-362. doi:10.5152/TurkArchPediatr.2023.23049
4. Jonker FA, Boele van Hensbroek M. Anaemia, iron deficiency and susceptibility to infections. J Infect. 2014;69(Suppl 1):S23-27. doi:10.1016/j.jinf.2014.08.007
5. Wessling-Resnick M. Iron homeostasis and the inflammatory response. Annu Rev Nutr. 2010;30:105-22. doi:10.1146/annurev.nutr.012809.104804
6. Osterholm EA, Georgieff MK. Chronic inflammation and iron metabolism. J Pediatr. 2015;166(6):1351-1357 e1. doi:10.1016/j.jpeds.2015.01.017
7. Nemeth E, Ganz T. Anemia of inflammation. Hematol Oncol Clin North Am. 2014;28(4):671-681. vi. doi:10.1016/j.hoc.2014.04.005
8. Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019; 133(1):40-50. doi:10.1182/blood-2018-06-856500
9. Rusch JA, van der Westhuizen DJ, Gill RS, Louw VJ. Diagnosing iron deficiency: controversies and novel metrics. Best Practice Res Clin Anaesthesiol. 2023;37(4):451-467. doi:10.1016/j.bpa.2023.11.001
10. Dignass A, Farrag K, Stein J. Limitations of serum ferritin in diagnosing iron deficiency in inflammatory conditions. Int J Chronic Dis. 2018;2018: 9394060. doi:10.1155/2018/9394060
11. Gattermann N, Muckenthaler MU, Kulozik AE, Metzgeroth G, Hastka J. The evaluation of iron deficiency and iron overload. Dtsch Arztebl Int. 2021;118(49):847-856. doi:10.3238/arztebl.m2021.0290
12. Abuga KM, Nairz M, MacLennan CA, Atkinson SH. Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections. Wellcome Open Res. 2023;8:48. doi:10.12688/wellcomeopenres.18829.1
13. Viana MB. Anemia and infection: a complex relationship. Rev Bras Hematol Hemoter. 2011;33(2):90-92. doi:10.5581/1516-8484.20110024
14. Baker RD, Greer FR, Committee on Nutrition American Academy of P. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126(5):1040-1050. doi:10.1542/peds.2010-2576
15. De Benoist B, Cogswell M, Egli I, McLean E. Worldwide prevalence of anaemia 1993-2005; WHO Global Database of anaemia. Available from: https://www.who.int/publications/i/item/9789241596657. Access date: 01. 05.2024. 2008;
16. Jia H, Song N, Ma Y, et al. Salmonella facilitates iron acquisition through umpylation of ferric uptake regulator. mBio. 2022;13(3):e0020722. doi:10. 1128/mbio.00207-22
17. Caza M, Kronstad JW. Shared and distinct mechanisms of iron acquisition by bacterial and fungal pathogens of humans. Front Cell Infect Microbiol. 2013;3:80. doi:10.3389/fcimb.2013.00080
18. Hoffmann A, Valente de Souza L, Weiss G. Iron deficiency and anemia associated with infectious and inflammatory diseases. In: Karakochuk CD, Zimmermann MB, Moretti D, Kraemer K, eds. Nutritional Anemia Nutrition and Health. Springer, Cham; 2022:223-234.
19. Langer AL, Ginzburg YZ. Role of hepcidin-ferroportin axis in the pathophysiology, diagnosis, and treatment of anemia of chronic inflammation. Hemodial Int. 2017;21 (Suppl 1):S37-S46. doi:10.1111/hdi. 12543
20. Wang CY, Babitt JL. Hepcidin regulation in the anemia of inflammation. Curr Opin Hematol. 2016;23(3):189-197. doi:10.1097/MOH.0000000000000236
21. Nairz M, Theurl I, Wolf D, Weiss G. Iron deficiency or anemia of inflammation? : Differential diagnosis and mechanisms of anemia of inflammation. Wien Med Wochenschr. 2016;166(13-14):411-423. doi:10. 1007/s10354-016-0505-7
22. Behairy OG, Mohammad OI, Elshaer OS. Iron-deficiency anemia as a risk factor for acute lower respiratory tract infections in children younger than 5 years. Egyptian J Bronchol. 2018;12:352-357. doi:10.4103/ejb.ejb_67_17
23. Kossiva L, Soldatou A, Gourgiotis DI, Stamati L, Tsentidis C. Serum hepcidin: indication of its role as an “acute phase” marker in febrile children. Ital J Pediatr. 2013;39:25. doi:10.1186/1824-7288-39-25
24. Spottiswoode N, Armitage AE, Williams AR, et al. Role of activins in hepcidin regulation during malaria. Infect Immun. Dec 2017;85(12):e00191-17. doi:10.1128/IAI.00191-17
25. Basseri RJ, Nemeth E, Vassilaki ME, et al. Hepcidin is a key mediator of anemia of inflammation in Crohn’s disease. J Crohns Colitis. 2013;7(8):e286-91. doi:10.1016/j.crohns.2012.10.013
26. Pfeiffer CM, Looker AC. Laboratory methodologies for indicators of iron status: strengths, limitations, and analytical challenges. Am J Clin Nutr. 2017;106(Suppl 6):1606S-1614S. doi:10.3945/ajcn.117.155887
27. Suchdev PS, Williams AM, Mei Z, et al. Assessment of iron status in settings of inflammation: challenges and potential approaches. Am J Clin Nutr. 2017;106(Suppl 6):1626S-1633S. doi:10.3945/ajcn.117.155937
28. Ni S, Yuan Y, Kuang Y, Li X. Iron metabolism and immune regulation. Front Immunol. 2022;13:816282. doi:10.3389/fimmu.2022.816282
29. Dunnill C, Patton T, Brennan J, et al. Reactive oxygen species (ROS) and wound healing: the functional role of ROS and emerging ROS-modulating technologies for augmentation of the healing process. Int Wound J. 2017; 14(1):89-96. doi:10.1111/iwj.12557
30. Galaris D, Barbouti A, Pantopoulos K. Iron homeostasis and oxidative stress: an intimate relationship. Biochim Biophys Acta Mol Cell Res. 2019; 1866(12):118535. doi:10.1016/j.bbamcr.2019.118535
31. Cronin SJF, Woolf CJ, Weiss G, Penninger JM. The role of iron regulation in immunometabolism and immune-related disease. Front Mol Biosci. 2019; 6:116. doi:10.3389/fmolb.2019.00116
32. Suega K, Widiana GR. Predicting hepcidin level using inflammation markers and iron indicators in patients with anemia of chronic disease. Hematol Transfus Cell Ther. 2019;41(4):342-348. doi:10.1016/j.htct.2019.03.011
33. D’Angelo G. Role of hepcidin in the pathophysiology and diagnosis of anemia. Blood Res. 2013;48(1):10-15. doi:10.5045/br.2013.48.1.10
Article available in :
Volume 3, Issue 6, 2024
Page : 126-129
https://doi.org/10.51271/ANKMJ-0029
Article Information
Received : 19 Eyl 2024
Accepted : 24 Eki 2024
Published : 13 Kas 2024
Corresponding Author :

Yunus Nas: Department of Child Health and Diseases, Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, İstanbul, Turkiye

[email protected]
Citation : Nas Y, Bozaykut A. Evaluation of iron deficiency anemia during acute infection in children. Ank Med J. 2024;3(6):126-129.

Read: 4438
Download : 4578
Cited: 0
_Footer