Effect of iron supplementation on mild to moderate anaemia in pulmonary tuberculosis

Abstract

Anaemia is a common complication of pulmonary tuberculosis. The precise mechanism of anaemia in pulmonary tuberculosis is not clearly known, but anaemia of inflammation as well as of Fe deficiency has been implicated. Both are common in developing countries. It is extremely difficult to distinguish anaemia of Fe deficiency from anaemia of inflammation with the haematological indices used routinely. Therefore, Fe preparations are usually prescribed for all anaemic patients irrespective of the aetiology. This approach has been questioned. The present study aimed to assess the effect of Fe supplementation on anaemic patients with pulmonary tuberculosis. Adult male patients 15–60 years of age with pulmonary tuberculosis and a blood haemoglobin concentration 80–110 g/l were included in the study; healthy adult males matched for age and socio-economic status were taken as controls. Blood haemoglobin concentration, total erythrocyte count (TEC), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin and serum Fe, total Fe-binding capacity and ferritin were estimated before treatment and 1, 2 and 6 months after treatment. The patients were divided randomly into three groups and during the initial 2 months of treatment were provided with one of three supplementary regimens consisting of placebo, Fe alone or Fe with other haematinics. Significant improvements in haematological indices and Fe status were noticed in all three groups. Blood haemoglobin concentration, MCV and PCV were significantly higher at 1 month in both Fe-supplemented groups than the placebo group. This difference, however, disappeared at 2 and 6 months with similar values in all three groups. The increase of other haematological indices was similar in all groups. Serum Fe and Fe saturation of transferrin were significantly higher in both Fe-supplemented groups than the placebo group up to 2 months; this effect, however, disappeared at 6 months. There was a consistent increase in TEC and decrease in ferritin values up to 6 months in all groups. Radiological and clinical improvement was similar in all three groups. These observations suggest that Fe supplementation in mild to moderate anaemia associated with pulmonary tuberculosis accelerated the normal resumption of haematopoiesis in the initial phases by increasing Fe saturation of transferrin. However, consistent improvement of haematological status was dependent only on the improvement of the disease process.

Iron Status Predicts Treatment Failure and Mortality in Tuberculosis Patients: A Prospective Cohort Study from Dar es Salaam, Tanzania

“…Concerns have been raised about the safety of iron supplementation and iron overload in the context of infectious diseases, but the available evidence is conflicting [10], [36], [37], [38]. While our results are not conclusive, they are in agreement with the hypotheses that iron imbalance at both ends of the continuum exist in TB patients and may contribute to disease progression and poor clinical outcomes.…”

Transcriptional Profiling of Mycobacterium tuberculosis Replicating Ex vivo in Blood from HIV- and HIV+ Subjects

“…While iron deficiency, anemia of inflammation, and hemoptysis are all contributors to TB-associated anemia [102], hemolysis due to the activity of ESAT-6 (and possibly other ESAT-6-like proteins), could potentially also contribute to driving anemia in HIV+ TB patients with bacteremia. Interestingly, TB-associated hemolytic anemia is resolved by successful treatment with ATT in the absence of transfusions, corticosteroids, or iron supplementation indicating that TB alone was the cause of anemia [103].…”

Anemia and Hematologic Characteristics in Newly Diagnosed Pulmonary Tuberculosis Patients at Diagnosis in Kinshasa

“…It can be speculated, based on the low BMI and hypoalbuminemia, that unbalanced or insufficient nutrition partly explains the iron deficiency identified in the current study. Considering that iron supplementation in mild to moderate PTB-associated anemia previously showed increased Fe saturation of transferrin [11], we recommend systematic assessment, wherever it is possible, of iron profile, and subsequent iron supplementation at early stage of TB treatment in PTB patients with iron-responsive anemia in Kinshasa. The multifactorial nature of Journal of Tuberculosis Research anemia is not easy to establish in Congolese setting and was not assessed here.…”

“…Of interest, patients with iron-responsive anemia (iron deficiency anemia (IDA), and multifactorial anemia (IDA + AI)) [4] [9] do not show spontaneous resolution of anemia with TB treatment. Rather, iron-responsive anemia in TB tends to recover quickly after 2 or 3 months of iron supplement in addition to TB treatment [4] [11]. Based on the observation that anemia is generally multifactorial in Sub-Saharan Africa (SSA) [8], it can be speculated that majority of TB-patients would need iron supplement.…”