Assessment of Iron Status by Erythrocyte Ferritin in Uremic Patients With or Without Recombinant Human Erythropoietin Therapy

Caravaca, Francisco; Vagace, José Manuel; Aparicio, A. García; Groiss, Jorge; Pizarro, José L.; Alonso, Nieves; García, María C.; Arrobas, M; Cubero, Juan José; Esparrago, J.F.; Sánchez-Casado, E.

doi:10.1016/s0272-6386(12)80697-4

Cited by 21 publications

(6 citation statements)

References 24 publications

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“…Functional iron deficiency could be more directly de tected by determining the percentage of hypochromic red cells [29], erythrocyte ferritin [30], erythrocyte zinc proto porphyrin [31] and serum transferrin receptor [6]. Iron deficiency erythropoiesis is accompanied by an increment of percentage or concentration of these markers.…”

Section: Discussionmentioning

confidence: 99%

Iron Metabolism Indices for Early Prediction of the Response and Resistance to Erythropoietin Therapy in Maintenance Hemodialysis Patients

Tarng

Chen

Huang³

1995

Am J Nephrol

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A prospective study with 65 maintenance hemodialysis (MHD) patients on recombinant human erythropoietin (rHuEPO) therapy was conducted to assess the effect of iron balance on responsiveness. An attempt to define the predictors of erythropoietin (EPO) response and identify the specific causes of EPO resistance was undertaken in the present study. The treatment protocol consisted of two stages, the first was rHuEPO therapy for 6 months and the second was iron supplementation plus rHuEPO therapy in patients without response to EPO for the next 6 months. According to the hemoglobin (Hb) changes (increment exceeded 30% of baseline or did not exceed 15% of baseline for 3 consecutive months) and whether or not there was an achievement of target Hb level ( > 10.5 g/dl), all patients (n = 65) were divided into EPO-responsive (n = 20) and EPO-resistant (n = 45) groups. The EPO-resistant patients were then further stratified into iron-responsive (n = 29) and iron-irresponsive (n = 16) groups. Iron metabolism and red cell indices were analyzed prior to and following rHuEPO therapy and iron supplementation. We found the following: (1) only serum ferritin (SF) was a reliable discriminator between the EPO-responsive (SF > 300 µg/l) and EPO-resistant (SF < 300µg/l) groups; (2) similarly, transferrin saturation (TFS) 25% was quoted as the best cut-off value between the iron-responsive (TFS < 25%) and iron-irresponsive (TFS > 25%) groups; (3) EPO-resistant patients with TFS < 2 5 % regained proper EPO response (Hb before and 6 months after therapy: 7.8 ± 0.9 vs. 10.6 ± 0.8 g/dl, p < 0.01) and the mean TFS increased significantly (initial TFS and peak level after therapy: 18.9 ± 4.7 vs. 34.5 ± 10.8%, p < 0.01) following iron therapy; (4) the cumulative incidence of TFS < 25% elevated to 44.5% 6 months following initial rHuEPO therapy, and (5) there was a strong inverse relationship between initial TFS and the changes of Hb following iron therapy in EPO-resistant patients (r = -0.75, p < 0.0001). By means of early detection and correction of functional iron deficiency, the goal of increment of therapeutic efficacy and prevention from unnecessarily high doses of rHuEPO can be achieved. In summary, SF > 300 µg/l equates adequate or increased body iron stores and seems to exclude iron deficiency in MHD patients. On the contrary, SF < 300 µg/l appears to be an insufficient diagnostic threshold for iron deficiency. Once resistance occurs during the rHuEPO therapy, in our opinion only patients with TFS < 25% need iron supplementation. However, in patients with TFS > 25% and resistance to EPO, further investigations are necessary before increasing the dose of rHuEPO to explore other possible conditions, such as aluminum overload, severe hyperparathyroidism, occult blood loss or hemolysis, and episodes of infection or inflammatory processes.

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Section: Discussionmentioning

confidence: 99%

Iron Metabolism Indices for Early Prediction of the Response and Resistance to Erythropoietin Therapy in Maintenance Hemodialysis Patients

Tarng

Chen

Huang³

1995

Am J Nephrol

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“…Increased erythrocyte ferritin concentrations both in CAPD and HD groups may be explained by the type of patients included in the study. For these patients, haemoglobin synthesis is not stimulated by r‐HuEPO therapy and, in consequence, a decrease in erythrocyte ferritin does not occur, as described by Caravaca et al 26 …”

Section: Discussionmentioning

confidence: 67%

“…It has been extensively documented that aluminium intoxication may cause hypochromic and microcytic anaemia as a pathogenetic factor added to chronic renal insufficiency. 26,27 Patients included in the current study showed no signs of aluminium intoxication and serum levels of this compound were relatively low. So, the effect of this factor on the differences observed between CAPD and HD patients seems unlikely.…”

Section: Discussionmentioning

confidence: 85%

Anaemia of renal failure: Differences between continuous ambulatory peritoneal dialysis and haemodialysis

Fernandez¹,

Guindeo²,

Molero

et al. 2000

Nephrology

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SUMMARY: A cross‐sectional study was performed to assess a series of parameters, especially those related to iron status, that may account for differences in the anaemia of patients treated with continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis (HD). Patients on CAPD (n = 37) and on haemodialysis (n = 27) were selected on the basis of clinical stability and absence of factors that may interfere with iron metabolism. Parameters measured included routine haematological and biochemical profile; serum iron metabolism (serum iron, transferrin saturation capacity, transferrin saturation index, serum ferritin); erythrocyte ferritin; bone marrow erythroid components and semiqualitative analysis of iron deposits in the bone marrow. The CAPD patients showed higher levels of haemoglobin and transferrin saturation capacity as well as lower serum ferritin than patients on haemodialysis. In the bone marrow, CAPD patients had a higher percentage of red blood cells and in those with low iron‐containing macrophages a higher percentage of sideroblasts than the haemodialysis group. Erythrocyte ferritin levels were similar in both groups. These data suggest more efficient iron metabolism in CAPD patients than in patients on haemodialysis.

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“…The iron deficiency threshold was set at 7 ag/cell based on data from previous study by our group [13]. EF mean concentrations in the iron deficiency group were significantly lower than those measured in control subjects (5.76 ± 4.29 vs. 9.92 ± 5.37 ag/cell, p < 0.0001).…”

Section: Erythrocyte Ferritin In Iron Deficiencymentioning

confidence: 99%

Clinical relevance of erythrocyte ferritin in microcytic anemias

Vagace

Peças

Groiss

et al. 2015

Clinica Chimica Acta

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Background: Erythrocyte ferritin (EF) reflects the balance between iron supply and its utilization for hemoglobin synthesis. This balance is altered in microcytosis. We aimed to evaluate the diagnostic value of both EF and the ratio (FRR) plasma ferritin (PF)/EF in these disorders.Methods: A total of 231 subjects participated in the study. Samples from 93 adult patients with different causes of microcytosis, 57 healthy subjects and 81 full term newborns were analyzed to determine EF and PF concentrations and other hematological parameters. Results:In patients with iron deficiency, and in contrast to PF, EF decreased only in the presence of anemia and in direct correlation with the degree of microcytosis (Pearson´s p<0.001). EF values for thalassemia patients were higher than those observed in controls (p < 10e-5), whilst PF concentrations were similar between these groups .This EF increase was more marked in the delta-beta thalassemia group (p<0.05). Finally, FRR was much higher in patients with anemia of inflammation than in those with thalassemia (p<10e-5), thus helping to discriminate between these disorders.Conclusions: EF and FRR are tools that may be useful in the diagnosis of the main causes of microcytosis.

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Assessment of Iron Status by Erythrocyte Ferritin in Uremic Patients With or Without Recombinant Human Erythropoietin Therapy

Cited by 21 publications

References 24 publications

Iron Metabolism Indices for Early Prediction of the Response and Resistance to Erythropoietin Therapy in Maintenance Hemodialysis Patients

Iron Metabolism Indices for Early Prediction of the Response and Resistance to Erythropoietin Therapy in Maintenance Hemodialysis Patients

Anaemia of renal failure: Differences between continuous ambulatory peritoneal dialysis and haemodialysis

Clinical relevance of erythrocyte ferritin in microcytic anemias

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