Optimizing diagnostic biomarkers of iron deficiency anemia in community-dwelling Indian women and preschool children

Abstract

The detection of iron deficiency anemia is challenged by the paucity of diagnostic tests demonstrating high sensitivity and specificity. Using two biomarkers, zinc-protoporphyrin/heme and hepcidin, we established the diagnostic cut-off values for iron deficiency anemia in preschool children and women. We randomly selected non-anemic individuals (n=190; women=90, children=100) and individuals with iron deficiency anemia (n=200; women=100, children=100) from a preexisting cohort of healthy preschool children and their mothers. The diagnostic performance of these biomarkers was estimated by analyzing receiver operating characteristic curves. Diagnostic cut-offs with a high predictive value for iron deficiency anemia were selected. Median zinc-protoporphyrin/heme and hepcidin values in non-anemic children were 49 μmol/mol heme and 42 ng/mL, respectively, and in non-anemic women these values were 66 μmol/mol heme and 17.7ng/mL, respectively. Children and women with iron deficiency anemia had higher zinc-protoporphyrin/heme ratios (children=151 μmol/mol heme and women=155 μmol/mol heme) and lower hepcidin levels (children=1.2ng/mL and women=0.6ng/mL). A zinc-protoporphyrin/heme ratio cut-off >90 μmole/mole heme in children and >107 μmole/mole heme in women was associated with a high diagnostic likelihood for iron deficiency anemia (children, likelihood ratio=20.2: women, likelihood ratio=10.8). Hepcidin cut-off values of ≤6.8ng/mL in children and ≤4.5ng/mL in women were associated with a high diagnostic likelihood for iron deficiency anemia (children, likelihood ratio=14.3: women, likelihood ratio=16.2). The reference ranges and cut-off values identified in this study provide clinicians with guidance for applying these tests to detect iron deficiency anemia. Erythrocyte zinc-protoporphyrin/heme ratio is a valid point-of-care biomarker to diagnose iron deficiency anemia.

Impact of iron fortification on anaemia and iron deficiency among pre-school children living in Rural Ghana

“…However, no additional predictive benefit was found even when paired with levels of haemoglobin, but rather overestimated ID prevalence relative to standard cut-off points (> 52 μmol / mol haeme). These findings from our study is consistent with other MNP studies that used ZPP as additional iron indicator [31,47,48], but contrary to other MNP intervention findings [31,49]. This may be attributed to the differences in ZPP cut-offs used to define iron deficiency, which was lower in our study (> 52 μmol / mol of haeme) compared to a study in Zanzibar (> 80 μmol / mol of haeme) [31,49,50].…”

Assessment of iron deficiency

“…Hanoun et al showed that MLL-AF9induced AML cells disrupt bone marrow HSC niche function through alteration of the niche compartments and decrease of the expression of MSC-derived Cxcl12, Scf, Vcam1, and increased expression of Opn. 15 These phenotypes in the MLL-AF9-induced AML bone marrow niche mirrored those in the Twist1-deficient bone marrow niche observed by Liu et al 2 They also found that a Twist1-deficient niche promoted progression of MLL-AF9-induced AML. By using RNAsequencing, the authors found that Jagged-2 is significantly increased in the stromal cells from the Twist1-deficient bone marrow niche and that Notch receptors are upregulated on leukemia cells.…”

“…However, iron deficiency and other conditions associated with anemia, such as the anemia of chronic disease and hemoglobinopathies often coexist, requiring further refinement of diagnostic strategies. The study reported by Kanuri et al 2 in this issue represents an effort to opti-mize diagnostic biomarkers of iron deficiency anemia employing erythrocyte zinc-protoporphyrin/heme ratio (ZPP/H) and serum hepcidin measurements.…”

“…Only decades ago, the lifespan of a chronic phase CML patient was less than seven years while now these patients enjoy a survival roughly that of the normal population. 2,3 Chronic myeloid leukemia has also been the model of disease monitoring using specific molecular markers. In this case, the BCR-ABL chimeric RNA is used to assess disease burden, and the clinical significance of BCR-ABL levels are so compelling as to drive treatment milestones based on BCR-ABL levels that are codified in European and US CML guidelines.…”

Factors Affecting Ferritin Level in Children of 6 to 59 Months in the Eastern Region of Cameroon

“…As a matter of fact differentiating iron deficiency from normal iron status in inflammatory context is of great complexity association of other tests is currently examined and studied worldwide [25][26][27][28][29].…”