Using iron profiles to identify anemia of chronic disease in anemic children with tuberculosis
Background Anemia of chronic disease (ACD) is commonly found in patients with chronic inflammation or infection. By examining soluble transferrin receptor or bone marrow iron, ACD was found in 80% of anemic adult tuberculosis (TB) patients. Iron profile, another tool to differentiate ACD from iron deficiency anemia (IDA), is both less expensive and less invasive. Few studies have been reported on iron profiles of anemic children with TB in Indonesia.
Objective We aimed to use iron profiles to determine the proportion of ACD in anemic children with tuberculosis.
Methods A cross-sectional study on anemic children with TB who came to Cipto Mangunkusumo Hospital and Tebet Puskesmas (community health center) was performed in September-November 2010. Iron profiles included the measurements of serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TF), and serum ferritin (SF).
Results Our study comprised of 66 subjects, with a median age of 3.8 years (6 monthsâ€“18 years). Most subjects had normal SI (85%), normal TIBC (71%), low transferrin saturation (51%), and normal SF (71%). Only 10 children had iron homeostasis disorder and 6 of these were diagnosed as having ACD. Thus, iron profiles failed to prove that iron metabolism was disturbed. The profile of children with organ-specific TB was more consistent with ACD compared to the profile of childhood TB. [SI 29.1 (11-83) vs 44 (10-151) Î¼g/dL; TIBC 239.3 (100.80) vs 299.0 (58.51) Î¼g/dL; TF 18.3 (4-100) vs 15 (1-53) %; and SF 154 (34.9-655) vs 36.1 (2.5-213.4) Î¼g/L].
Conclusion The proportion of ACD (9%) diagnosed by using iron profiles was not as high as previously reported. Further research using newer techniques is needed to detect ACD in anemic children with TB. [
2. Ganz T. Molecular pathogenesis of anemia of chronic disease. Pediatr Blood Cancer. 2006;46:554-7.
3. Abramson SD, Abramson N. â€˜Commonâ€™ uncommon anemias. Am Fam Physic. 1999;59:851-8.
4. Provan D, Oâ€™Shaughnessy DF. Recent advances in haematology. BMJ. 1999;318:991-4.
5. Dahiya N. Diagnosis of anaemia: role of CBC and peripheral blood smear. Indian J Prac Doc. 2005;1:1-2.
6. Andrews NC. Anemia of inflammation: the cytokine-hepcidin link. J Clin Invest. 2004;113:1251-3.
7. Cavill I, Auerbach M, BailieGR, Lee PB, Beguin Y, Kaltwasser P, et al. Iron and the anaemia of chronic disease: a review and strategic recommendations. Curr Med Res Opin. 2006;22:731-7.
8. M Means RT, Krantz SB. Progress in understanding the pathogenesis of the anemia of chronic disease. Blood. 1992;80:1639-47.
9. Agarwal MB, Mishra DK, Chudgar U, Farah J. Iron deficiency: Advances in diagnosis and management. 2011 April [cited 2011 April 11]. Available from: http://www.apiindia.org/medicine_update_2005/chapter_162.pdf.
10. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in United States: evidence for a high rate of unexplained anemia. Blood. 2004;104:2263-8.
11. Rahajoe NN, Basir D, Makmuri MS, Kartasasmita CB, editors. Pedoman nasional tuberkulosis anak. 2nd ed. Jakarta: UKK Respirologi IDAI; 2007.p.3-6.
12. World Health Organization. 2009 update tuberculosis facts. 2010 Aug [cited 2011 Aug 10]. Available from: http://www.who.int/tb/publications/2009/tbfactsheet_2009update_one_page.pdf.
13. Lee SW, Kang YA, Yoon YS, Um SW, Lee SM, Yoo CG, et al. The prevalence and evolution of anemia associated with tuberculosis. J Korean Med Sci. 2006;21:1028-32.
14. Devi U, Rao CM, Srivastava VK, Rath PK, Das R, Das BS. Effect of iron supplementation on mild to moderate anaemia in pulmonary tuberculosis. Brit J Nutr. 2003;90:541-50.
15. R Ratnaningsih T. The role of red blood cell indices to identify iron deficiency in anemic pulmonary tuberculosis patient. Berkala ilmu kedokteran. 2008;40:11-9.
16. Kotru M, Rusia U, Sikka M, Chaturvedi S, Jain AK. Evaluation of serum ferritin in screening for iron deficiency in tuberculosis. Ann Hematol. 2004;83:95-100.
17. Pusponegoro HD. Anemia defisiensi besi dan gangguan perkembangan otak. Presented at symposium of Anemia in UNS. Solo: 2006.
18. Andrews NC. Disorders of iron metabolism. N Engl N Med 1999;341:1986-95.
19. Chan PC, Huang LM, Wu YC, Yang HL, Chang S, Lu CY, et al. Tuberculosis in children and adolescents, Taiwan, 1996-2003. Emerging Infect Dis. 2007;13:1361-3.
20. Anemia of chronic disease. 2007 Aug [cited 2007 March 31]. Available from: http://en.wikipedia.org/wiki/Anemia_of_chronic_disease.
21. Brugnara C. Iron deficiency and erythropoiesis: new diagnostic approaches. Clin Chem. 2003;49:1573-8.
22. Total iron-binding capacity. 2010 Dec [cited 2011 Dec 13]. Available from: http://www.en.wikipedia.org/wiki/Total_iron-binding_capacity.
23. Henderson A. Ferritin levels in patients with microcytic anemia complicating pulmonary tuberculosis. Tubercle. 1984;85:185-9.
24. Rodriguez GM. Control of iron metabolism in Mycobacterium tuberculosis. Trends in Microbiology. 2006;14:320-7.
25. Gangaidzo IT, Moyo VM, Mvundura E, Aggrey G, Murphree NL, Khumalo H, et al. Association of pulmonary tuberculosis with increased dietary iron. J Infect Dis. 2001;184:936-9.
26. Lounis N, Truffot-Pemot C, Grosset J, Boelaert JR. Iron and Mycobacterium tuberculosis infection. J Clin Virol. 2001;20:123-6.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.