Iron deficiency (ID) and beta thalassemia trait (betaTT) are the most common causes of hypochromia and microcytosis. This study evaluates the reliability of some of the red blood cell (RBC) indices and the formulas used in the differentiation between betaTT and ID in a cohort of 458 children aged between 1.8 and 7.5 years (mean age 5.6+/-1.7 years) with mild hypochromic microcytic anemia. Within this group, 243 were confirmed with ID and 215 with betaTT. Red cell indices derived from automated red cell analyzers were used to evaluate the following discriminant indices and formulas: Mentzer Index (MI), Green and King Index (G&K), England and Fraser Index (E&F), RBC Distribution Width Index (RDWI), RBC distribution width (RDW) and RBC count. Sensitivity (SENS), specificity (SPEC), positive and negative prognostic value, efficiency (EFF) and Youden's Index (YI) were evaluated. For each index or formula Gauss curves were constructed. The highest SENS was obtained with RDWI (78.9%), while the highest SPEC and YI with E&F (99.1 and 64.2% respectively), the highest EFF (80.2%) with G&K. Gauss curves obtained from betaTT and ID children showed a different degree of overlap for each formula or index. In conclusion, none of RBC indices or formulas appears reliable to discriminate between betaTT and ID subjects.
In 35 patients of both sexes (18 boys and 17 girls), mean age 8.9 ± 4.5 years, affected by migraine both with (45.2%) and without an aura (54.9%) (P > 0.05) who had no alteration of brain computerized tomography and/or magnetic resonance imaging, we evaluated possible thrombotic events in the pathogenesis of the disease. In all cases and in 50 random healthy controls clotting tests (prothrombin time, activated partial thromboplastin time, protein C activity (PC), antithrombin III (ATIII), protein S (PS), antiphospholipid antibodies (aPL), and Lupus anticoagulant (LA) were normal. FVIII and FIX activities were increased in seven and five migraine sufferers, respectively. Genetic thrombophilic risk factors - factor V Leiden (FVL) and MTHFR677T - resulted in a significantly increased prevalence in migraine patients when compared with controls but without significant differences for the F2 polymorphism. The examined polymorphisms were associated with an increased risk of developing migraine (odds ratio (OR) > 1). These findings could confirm the key role of a reduced cerebral flow in the pathogenesis of migraine and possible risk of ischaemic stroke (IS) but we feel that these observations need to be confirmed in larger multi-centre studies.
In an observational cohort of 385 infants, we have investigated the relationship between hemoglobin (Hb) levels and iron stores and the type of milk feeding [breast milk (BM), formula milk (FM), cow's milk (CM), age and type of weaning, and socioeconomic status] at 8 and 12 months of age. Levels of Hb<11 g/dl and iron stores <15 ng/ml were significantly more frequent in BM and CM groups than in FM group (P<0·05). Significant differences of Hb mean were observed among the three groups, while ferritin mean were lower in BM and CM groups than in FM group (P<0·05). Socioeconomic factors also influenced Hb levels and iron stores through differences in diet. Deprived infants were 23·1% of cohort and many of them received BM (43·5% at 8 months versus 38·5% at 12 months) or CM (42·6% at 8 months versus 47% at 12 months), while >50% were weaned before 6th month of age. FM feeding and weaning <6 months of age are related with better Hb levels and iron stores. Analysis of the impact of weaning on Hb levels and iron stores showed that infants weaned <6 months of life had, regardless of milk feeding, higher Hb and ferritin levels than weaned >6 months.
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