Utility of new red cell parameters for distinguishing functional iron deficiency from absolute iron deficiency in children with familial Mediterranean fever

Abstract

Introduction Few data are available on the clinical utility of new red cell parameters for detecting anemia in children with inflammatory diseases. The aim was to investigate the utility of three new red cell parameters for distinguishing functional iron deficiency (FID) from absolute iron deficiency (AID) in children with familial Mediterranean fever (FMF). Methods The study involved 198 children with genetically confirmed FMF and 18 healthy‐age and sex‐matched controls. Complete blood counts with the new red cell parameters of low hemoglobin (Hb) density (LHD), microcytic anemia factor (MAF), and red blood cell size factor (RSF) were measured in a Unicel® DxH800, along with conventional iron parameters. The FMF patients’ medical records were retrospectively reviewed to assess inflammation status and genetic results. Results The frequencies of FID and AID among the 198 FMF patients were 35% and 65%, respectively. Among patients with homozygous MEFV mutation, FID was more common than AID (P < 0.05). Mean LHD was significantly higher and mean Hb, MCV, MAF, and RSF were significantly lower among the FMF patients with FID compared to those with AID and controls (P < 0.05). Specificity for distinguishing FID from AID in children with FMF was greatest for MAF (92%; 95% confidence interval [CI] 85%‐96%), followed by LHD (85%; 95% CI 76%‐91%) and RSF (81%; 95% CI 72%‐88%). Conclusion The new red cell parameters measured by the Unicel® DxH800 may be useful for guiding physicians in distinguishing FID from AID in children with FMF.

Genotype Mutations in Palestinian Children with Familial Mediterranean Fever: Clinical Profile, and Response to Colchicine Treatment: A Retrospective Cohort Study

“…About 26.9% of our patients had microcytic anaemia, while anaemia in FMF patients can be functional, due to chronic inflammation, absolute iron deficiency (AID), or a combination of both, differentiating between them is essential, as iron therapy alone is adequate to improve anaemia in FMF patients with AID, but not in the other types. 47 Further, Celkan et al28 mentioned that Colchicine therapy has a role in the treatment of anaemia via suppression of the active inflammatory process.…”

Identification of subclinical iron deficiency using new erythrocytes, leukocytes, and reticulocytes parameters during nonsevere acute infection in pediatric outpatients

“…In this study, we found the subclinical ID or FID frequency of (24%) and the AID frequency of (76%) among 102 children less than 6 years old with nonsevere acute infection in POSs. Similarly, the literature indicates a wide range of FID incidence, from 13% to 90%, in children with the inflammatory phase of chronic conditions [ 14 – 16 ]. During the acute infection or the inflammatory phase of chronic disease, serum iron and ferritin are increased, whereas transferrin is decreased.…”

“…Serum transferrin receptor level and hepcidin may be useful for distinguishing anemia of inflammation from iron deficiency anemia (IDA), but these tests are not widely available [ 17 ]. Previous authors have documented the use of new red cell parameters in hematology analyzers for discriminating between FID and AID in the inflammatory phase of chronic disease [ 14 – 16 ]. Absolute and true ID have been well described in children less than 6 years old according to the World Health Organization guideline, but recognizing FID during acute infection can be challenging [ 1 ].…”

“…Functional iron deficiency is a major component of anemia of chronic disease [ 14 – 16 ]. It is most commonly identified as normocytic or normochromic anemia, but can become microcytic and hypochromic as the disease progresses.…”

Microalgal nanosized polyphosphate bodies as novel iron supplements for iron-deficiency anemia treatment in rats

“…The absolute reticulocyte content is another important predictor of iron-deficiency anemia (Gezgin Yıldırım et al, 2019;Parodi et al, 2016). The absolute reticulocyte content in Con group was significantly higher than that in Fe-deficiency group (Fig.…”