Diagnostic Implication of Iron Deficiency in the management of Toxicity Associated with Chronic Diseases

Objective: The current investigation focuses on the differentiation between true iron deficiency anemia (IDA), anemia of chronic diseases (ACD) and coexistence iron deficiency anemia in patients with chronic inflammatory disorders (ACD/IDA), in order to avoid toxicity and complications resulting from serious effects of therapeutic iron supplementation to patients with anemia of chronic diseases (ACD). Therefore, the accurate iron therapy could be given safely to those patients. To achieve these goals, 64 anemic patients (males and females), in addition to 10 healthy normal subjects were chosen. Individual parameters in blood serum related to iron and inflammation besides, bone marrow examination for the presence of stainable iron were estimated. Patients and Methods: The anemic patients were classified into three groups according to the presence or absence of stainable iron in bone marrow, also according to clinical data. ITrue iron deficiency anemia (IDA) Group: patients had no stainable iron in the bone marrow. I-Anemia of chronic disease (ACD) Group: patients had stainable iron in bone marrow with chronic disorders. III-COMBI (ACD/ IDA) group: patients had no stainable iron in bone marrow together with an infectious diseases, chronic inflammatory diseases or nonhematological malignancy, in addition to patients who had a C-reactive protein (CPR) above 20mg/l. Samples and analysis: 1-Bone marrow aspiration: was collected from the sternum bone or iliac crest by using bone marrow aspiration needle under local anesthesia, and many thin smears from bone marrow were done immediately. 2-Blood analysis: included; complete blood count with the assessment of RBCs indices. 3-Serum iron profile: included; serum iron concentration, total iron binding capacity (TIBC) (an indirect measurement of transferrin concentration) and serum ferritin level. 4-Estimation of Creactive protein (CRP) and erythrocyte sedimentation rate (ESR) as indicators for the presence of inflammation.5Determination of serum transferrin receptors level (sTfR) 6-Measurement of serum hepcidin hormone concentration. Results: Regard to, sex and age distributions: there were insignificant differences between the studied groups. Hemoglobin concentrations: showed significant decrease between three patient groups (IDA, ACD and ACD/ IDA) with normal group. MCH & MCV values: indicated significant decrease between IDA, ACD/ IDA groups with normal groups, but there was insignificant difference between ACD group with normal group. Regard to RBCs count, there was significant decrease between the three patient groups (IDA, ACD and ACD/ IDA) with normal group. Considering the reticulocytes count, there was significant increase between the three patient groups (IDA, ACD and ACD/ IDA) with normal group. Regard to serum iron concentrations, there were significant decrease between the three patient groups with normal group. Regard to TIBC values, There were significant increase differences between IDA, ACD/IDA groups with normal group, but there were significant decrease between ACD group and normal group, whereas there was significant increase between IDA with ACD/IDA groups. Regard to ferritin levels, showed significant decrease between IDA group with normal group and significant increase between ACD and ACD/IDA groups with normal group. Considering CRP levels, there were insignificant differences between IDA group with normal group, but there were significant increase between ACD and ACD/IDA groups with normal group. Considering serum transferrin receptors level, there were significant increase between IDA and ACD/IDA groups with normal group, but insignificant differences between ACD group with normal group and between IDA with ACD/IDA. As regards hepcidin level, there was significant decrease between IDA group with normal group, but significant increase differences between ACD and ACD/IDA groups with normal groups. Also, there was significant increase between ACD group with ACD/IDA group. In conclusion: the present data suggested that the sTfR could be used as a credible differentiating marker in the diagnosis of true iron deficiency anemia accompanied by chronic disorders (ACD/IDA). As well as, serum hepcidin might be worthy diagnostic gadget to recognize between ACD and ACD/IDA to appraise the ability to respond to oral iron therapy and stimulating the development of new diagnostic and therapeutic methods for these disorders. Therefore, the proper iron supplementation could be given safely, to avoid toxicity resulting from the growth-promoting effect of iron on microorganisms, as well as the negative effect of iron on innate immune functions. [Nabeeh Helal Al-Fadaly, Abd El-Hamid Mohamed Elwy, Nabila Ibrahim EL-Desoki and Eman Rashed Mossaed. Diagnostic Implication of Iron Deficiency in the management of Toxicity Associated with Chronic Diseases. J Am Sci 2017;13(4):51-59]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience. org. 6. doi:10.7537/marsjas130417.06. Journal of American Science 2017;13(4) http://www.jofamericanscience. org 52