RESUMO
Resumen Justificación y objetivo: gran parte de los casos descritos de anemias microcíticas-hipocrómicas corresponden a anemias ferropénicas y síndromes talasémicos. El diagnóstico diferencial se complementa con pruebas de laboratorio como el hierro sérico, ferritina, entre otras; sin embargo, estas son de baja disponibilidad en países en vías de desarrollo. En Nicaragua, el diagnóstico de estas patologías se basa en el historial clínico y análisis hematológicos de rutina. El objetivo de este trabajo fue la implementación de la técnica de cuantificación de hemoglobina A2 en el diagnóstico clínico de β-talasemia. Métodos: se realizó un estudio transversal con 30 pacientes que mostraban microcitosis e hipocromía después de 3 meses de tratamiento con sales de hierro. Se realizó electroforesis de hemoglobina y se utilizó el kit de la casa comercial Beta-Thal HbA2 Quik Column para cuantificar la hemoglobina A2 en cada paciente. El análisis estadístico utilizado fue la prueba de t de student. Se consideraron significativas las diferencias a p<0,05. Esta investigación respetó los principios éticos que conciernen. Se contó con la aprobación del Comité de Ética Institucional, UNAN-Managua. Los participantes dieron su consentimiento informado. Resultados: al aplicar el método para cuantificación de hemoglobina A2, se obtuvo que el 67 % de las muestras presentaron una concentración de hemoglobina A2 mayor al valor de referencia establecido (3,3 %), siendo pacientes diagnosticados para β-talasemia menor. El 33 % restante presentó valores normales de hemoglobina A2 con microcitosis e hipocromía. Se encontraron diferencias estadísticamente significativas entre las medias de glóbulos rojos, volumen corpuscular medio, hemoglobina corpuscular media y hemoglobina A2, entre ambos grupos. Conclusión: el diagnóstico diferencial de anemias microcíticas hipocrómicas refractarias al tratamiento con hierro, se realiza inicialmente por el historial clínico del paciente, pero es necesario contar con pruebas diagnósticas como la cuantificación de hemoglobina A2 que permitan identificar las diversas patologías que cursan con microcitosis e hipocromía.
Abstract Justification and objective: much of the described cases of microcytic-hypochromic anemias are ferropenic anemias and Thalassemia syndromes. The differential diagnosis is complemented by laboratory tests as serum iron, ferritin, among others; However, these are of low availability in developing countries. In Nicaragua, the diagnosis of these diseases is based on clinical history and routine blood analysis. The objective of this work was to implement a technique for quantification of hemoglobin A2 in the clinical diagnosis of β-Thalassemia. Methods: We conducted a cross-sectional study with 30 patients showing hypochromia and microcytosis after 3 months of treatment with iron salts. Hemoglobin electrophoresis was performed, a kit from Beta-Thal HbA2 Quik Column was used to quantify the hemoglobin A2 in each patient. The statistical analysis used was the student's t test. The differences were considered significant at p < 0.05. This research respected ethical principles that concern. It had the approval of the committee of ethics institutional, UNAN-Managua and the participants gave their informed consent. Results: when applying the method for quantification of hemoglobin A2, 67% of samples presented a concentration of hemoglobin A2 greater than the reference value set at 3.3%, these patients were diagnosed with β-Thalassemia minor. The remaining 33% presented normal values of hemoglobin A2 with hypochromia and microcytosis. Statistically significant differences between the averages of red blood cells, mean corpuscular volume, mean corpuscular hemoglobin and hemoglobin A2 between the two groups was observed. Conclusion: The differential diagnosis of microcytic hypochromic anemias refractory to treatment with iron, is initially performed by the clinical history of the patient, but it is necessary to have diagnostic tests such as the quantification of hemoglobin A2, which allow the identification of patients with β-Thalassemia minor within this group. In our study 67% of the studied samples were identified as β-Thalassemia minor.
Assuntos
Humanos , Talassemia beta , Anemia Ferropriva/sangue , Anemia Hipocrômica/sangue , Anemia Macrocítica/diagnóstico , Ferro/deficiência , NicaráguaRESUMO
El siguiente es un trabajo prospectivo realizado en el Servicio de Obstetricia del Hospital Central de San Cristóbal, durante el mes de abril del año 2005, en el cual se analizaron los valores hematológicos de 107 mujeres en diferentes trimestres de gestación, con el objetivo de determinar el valor promedio de hemoglobina (Hb) en nuestra población obstétrica, la incidencia de pacientes con anemia, el grado de anemia más frecuente y la (s) patología (s) más frecuente asociada (s) a la misma. Se revisó la hematología de ingreso de cada paciente para recoger los datos correspondientes a los valores hematológicos y se les aplicó una encuesta para obtener datos relevantes a este trabajo. Se encontró que: 1º El valor promedio de Hb fue de 10,67 gldL, 2º El 57 por ciento, es decir 61 pacientes presentaban algún grado de anemia, de las cuales la mayoría (29,9 por ciento) cursaban con anemia moderada, 3º la complicación más frecuente durante el embarazo de las pacientes con anemia fue amenaza de parto pretérmino (APP) en 17 pacientes (27,86 por ciento), seguido de eclampsia severa en 4 pacientes (6,56 por ciento). A pesar que el control pre natal incluye la indicación de hierro y ácido fólico, la población obstétrica estudiada tiene valores hematológicos por debajo de lo considerado normal por el Anemia Working Group Latin America (AWLA), lo que puede traer como consecuencia complicaciones perinatales.
Assuntos
Humanos , Feminino , Gravidez , Ácido Fólico/análise , Anemia Hipocrômica/diagnóstico , Anemia Hipocrômica/patologia , Anemia Hipocrômica/sangue , Ferro/análise , Valores de Referência , Anemia/complicações , Anemia/sangue , Cuidado Pré-Natal/estatística & dados numéricos , Idade Gestacional , Hematologia/métodos , Obstetrícia , Saúde PúblicaRESUMO
Serum copper determination is important to confirm hypocupremia. Twenty healthy kids constituted the Control Group, and sixteen kids with symptoms of copper deficiency, the Problem Group. Animals from the Problem Group showed a low number of red blood cells (RBC) and variations in RBC size and shape. The values found for hemoglobin and mean corpuscular hemoglobin (MCH) in the Control Group were 10.42 +/- 1.34 g.dL(-1) and 33.07 +/- 1.11 g.dL(-1) respectively, while the levels of the Problem Group were 7.95 +/- 1.21 g.dL(-1) and 29.45 +/- 0.78 g.dL(-1), respectively. The kids from the Problem Group presented an important increase in monocytes, neutrophiles and leukocytes; precursor cells of the neutrophile were also observed. The anemia of these animals was hypochromic and macrocytic. Our results indicate that Creole kids with serum copper levels > 450 microg.L(-1) improved after treatment with copper glycinate. The six goats with cupremia < 450 microg.mL(-1) were unable to improve their deficiency and died.
Assuntos
Anemia Hipocrômica/veterinária , Anemia Macrocítica/veterinária , Cobre/deficiência , Glicina/uso terapêutico , Doenças das Cabras/sangue , Compostos Organometálicos/uso terapêutico , Anemia Hipocrômica/sangue , Anemia Hipocrômica/tratamento farmacológico , Anemia Macrocítica/sangue , Anemia Macrocítica/tratamento farmacológico , Animais , Animais Recém-Nascidos , Cobre/sangue , Contagem de Eritrócitos/veterinária , Índices de Eritrócitos/veterinária , Feminino , Doenças das Cabras/tratamento farmacológico , Cabras , Hemoglobinas/análise , MasculinoRESUMO
With the widespread use of cell counters we have now acquired new red cell indices complementary of the old ones, like the HDW and RDW (Red Cell Distribution Width) which detect the heterogeneity of red cell size and anisocytosis in the blood smear. We studied 90 patients with the following results. 1) in the control group of healthy volunteers (n = 50) RDW results were (mean +/- ES) 13.90 +/- 0.10% and MCV (mean +/- ES) 90 +/- 5 fl; 2) the iron deficiency patients (IDA) (n = 20) gave a MCV of (mean +/- ES) 68.60 +/- 1.77 fl., and RDW (mean +/- ES) 20.20 +/- 1.21%; 3) the beta-thalassemic patients (n = 20) had an MCV of (mean +/- ES) 66.45 +/- 1.95 fl, and RDW (mean +/- ES) 17.08 +/- 0.40%. We compared the results of MCV between IDA and thalassemics and against the control group with the following results: control vs IDA and control vs thalassemic with significant differences with p < 0.01, and no significant difference when we compared IDA vs thalassemics. Then we compared the results of RDW between IDA and thalassemics and against the control group with the following results: control vs IDA and control vs thalassemic with significant differences with p < 0.001 and with significant differences when we compared IDA vs thalassemics p < 0.001. The statistical results were obtained with the one-way analysis of variance (ANOVA). The results show that RDW is a more sensitive indicator than MCV to establish the possible origin of microcytic hypochromic anemias and that both should be used together in early diagnosis.
Assuntos
Anemia Hipocrômica/sangue , Anemia Hipocrômica/diagnóstico , Índices de Eritrócitos , Volume de Eritrócitos , Análise de Variância , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Humanos , Sensibilidade e Especificidade , Talassemia beta/sangue , Talassemia beta/diagnósticoRESUMO
Con el advenimiento de los contadores hematológicos se introduce un nuevo parámetro complementario de los valores hematimétricos, el EDW (Red distribution width o indice de distribución de glóbulos rojos) que mide el grado de anisocitosis. Se estudiaron 90 pacientes con los siguientes resultados: 1) Para el grupo control constituido por voluntarios sanos (n = 50) los valores RDW fueron X+ES) 13.90 + 0.10 por ciento y VCM (X + ES) 90 + 5 fl.2) Los pacientes ferropénicos (n = 20) presentaban un VCM (X + ES) 68.60 + 1.77 fl., y RDW (X + ES) 20.20 + 1.21 por ciento.3) Los pacientes Beta-talasémicos (n = 20) VCM (X + ES) 66.45 + 1.95 fl y RDW (X + ES) 17.08 + 0.40 por ciento. Se compararon los valores obtenidos de VCM entre los pacientes ferropénicos y talasémicos entre sí y con respecto al control normal obteniéndose los siguientes resultados: control vs. ferropénico y control vs talasémicos se obtuvieron diferencias significativas con un p < 0.01. No obteniéndose diferencias significativas cuando se compararon ferropénicos vs talasémicos. Se compararon los valores obtenidos de RDW entre los pacientes ferropénicos y talasémicos entre sí y con respecto al control normal obteniéndose los siguientes resultados: control vs ferropénico y control vs talasémicos se obtuvieron diferencias significativas con un p < 0.001. También se obtuvieron diferencias significativas cuando se compararon ferropénicos vs talasémicos entre sí con un p < 0.001. Los datos estadísticos se obtuvieron aplicando el test estadístico de análisis de la varianza de una vía (ANOVA). Los resultados indican que el RDW es un indicador más sensible que el VCM en delinear el posible origen de las anemias microcíticas hipocrómicas y deberían utilizarse conjuntamente en el diagnóstico precoz de las mismas.
Assuntos
Humanos , Anemia Hipocrômica/sangue , Anemia Hipocrômica/diagnóstico , Índices de Eritrócitos , Volume de Eritrócitos , Análise de Variância , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Talassemia beta/sangue , Talassemia beta/diagnóstico , Eletroforese em Acetato de Celulose , Sensibilidade e EspecificidadeRESUMO
Con el advenimiento de los contadores hematológicos se introduce un nuevo parámetro complementario de los valores hematimétricos, el EDW (Red distribution width o indice de distribución de glóbulos rojos) que mide el grado de anisocitosis. Se estudiaron 90 pacientes con los siguientes resultados: 1) Para el grupo control constituido por voluntarios sanos (n = 50) los valores RDW fueron X+ES) 13.90 + 0.10 por ciento y VCM (X + ES) 90 + 5 fl.2) Los pacientes ferropénicos (n = 20) presentaban un VCM (X + ES) 68.60 + 1.77 fl., y RDW (X + ES) 20.20 + 1.21 por ciento.3) Los pacientes Beta-talasémicos (n = 20) VCM (X + ES) 66.45 + 1.95 fl y RDW (X + ES) 17.08 + 0.40 por ciento. Se compararon los valores obtenidos de VCM entre los pacientes ferropénicos y talasémicos entre sí y con respecto al control normal obteniéndose los siguientes resultados: control vs. ferropénico y control vs talasémicos se obtuvieron diferencias significativas con un p < 0.01. No obteniéndose diferencias significativas cuando se compararon ferropénicos vs talasémicos. Se compararon los valores obtenidos de RDW entre los pacientes ferropénicos y talasémicos entre sí y con respecto al control normal obteniéndose los siguientes resultados: control vs ferropénico y control vs talasémicos se obtuvieron diferencias significativas con un p < 0.001. También se obtuvieron diferencias significativas cuando se compararon ferropénicos vs talasémicos entre sí con un p < 0.001. Los datos estadísticos se obtuvieron aplicando el test estadístico de análisis de la varianza de una vía (ANOVA). Los resultados indican que el RDW es un indicador más sensible que el VCM en delinear el posible origen de las anemias microcíticas hipocrómicas y deberían utilizarse conjuntamente en el diagnóstico precoz de las mismas. (AU)
Assuntos
Humanos , Estudo Comparativo , Índices de Eritrócitos , Volume de Eritrócitos , Anemia Hipocrômica/diagnóstico , Anemia Hipocrômica/sangue , Eletroforese em Acetato de Celulose , Análise de Variância , Sensibilidade e Especificidade , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/sangue , Talassemia beta/diagnóstico , Talassemia beta/sangueRESUMO
Las constantes hematológicas determinadas por métodos manuales han sido por muchos años un buen índice para estimar la normalidad o patología de las células rojas sanguíneas y según sus valores se han clasificado morfológicamente las anemias. El uso de los autoanalizadores hematológicos ha permitido aumentar la precisión de los parámetros de un hemograma, sin embargo, de las tres constantes determinadas, sólo el volumen corpuscular medio (VCM) es medido directamente, en cambio la hemoglobina corpuscular media (HCM) y la concentración de hemoglobina corpuscular media (CHCM) son calculadas por el instrumento. Nuestro propósito fue evaluar la utilidad de las constantes hematológicas determinadas por un autoanalizador, asociándolas con las características morfológicas de los eritrocitos. Se analizaron 1000 hemogramas realizados en un autoanalizador Cell-Dyn 1400 (Abbott), de pacientes que acuden al consultorio Miraflores en un período de dos meses. En cada caso se observaron las características de los hematíes al frotis. El análisis estadístico se efectuó mediante pruebas t Student, análisis de varianza, comparaciones múltiples de Bonferroni, prueba de Chi2 y regresión logística como modelo predictivo para la determinación de sensibilidad, especificidad y valores predictivos. Los resultados mostraron que el 83 por ciento de los casos con VCM normal presentó normocitosis y el 17 por ciento microcitosis. De los casos con HCM normal, el 97,5 por ciento se asoció con normocromía y el 2,5 por ciento presentó hipocromía. Respecto a la CHCM normal, el 79 por ciento presentó normocromía y en el 21 por ciento se observó hipocromía. Al calcular la sensibilidad y especificidad de las constantes se obtuvo para el VCM: 86,8 por ciento y 87,8 por ciento, para la HCM: 97,5 por ciento y 74,7 por ciento, para la CHCM: 21,5 por ciento y 99 por ciento respectivamente. Se concluye que, de las constantes hematológicas evaluadas, la CHCM no se presenta como una medida válida, ya que en un alto porcentaje de los pacientes con hipocromía al frotis, el autoanalizador entregó un CHCM normal (78 por ciento de falsos negativos), por el contrario, la HCM presentó una alta sensibilidad y un buen rendimiento en la predicción de la hipocromía al frotis (2,5 por ciento de falsos negativos)
Assuntos
Humanos , Masculino , Feminino , Anemia Hipocrômica/sangue , Índices de Eritrócitos , Anemia Hipocrômica/diagnóstico , Autoanálise/métodos , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Objetivo: Estudar a prevalência de anemia ferropriva em crianças entre 12 a 18 meses nos ambulatórios do IPPMG e os marcadores de risco a ela associados, no intuito de avaliar e monitorizar o serviço. Métodos: Trata-se de um estudo descritivo de corte transversal. Foram incluídas 288 crianças atendidas no ambulatório do IPPMG, de janeiro a dezembro de 1993. A anemia foi diagnosticada através da dosagem de hemoglobina sérica. Os marcadores de risco estudados foram: realizaçäo de pré-natal, peso ao nascer, acompanhamento pediátrico, características sócio-econômicas, padräo de amamentaçäo, estado nutricional e prescriçäo de ferro. Os dados foram computados e analisados pelos programas EPI-INFO e EGRET...
Assuntos
Humanos , Masculino , Feminino , Lactente , Anemia Hipocrômica/epidemiologia , Anemia Ferropriva/epidemiologia , Pacientes Ambulatoriais , Anemia Hipocrômica/sangue , Anemia Ferropriva/sangue , Estudos de Coortes , Estudos Transversais , Prevalência , Fatores de RiscoRESUMO
The hematological status of 406 Bari indians from two communities was studied. One hundred and seventy nine individuals were from Campo Rosario a village located in a low arid plain south to the Perijá mountain range and 287 were from Saimadoyi, a fertile valley in the heart of the mountain. Anemia was found in 54% and 31% of the people from Campo Rosario and Saimadoyi respectively. Low serum iron was present in 28% of the population in both communities while low serum ferritin levels were encountered in 20% of the population from Campo Rosario and 5% of the people from Saimadoyi. A high prevalence of serum folate and vitamin B12 deficiency (91% and 64% respectively) was found in Campo Rosario, in contrast only 5% of the population from Saimadoyi had low folate and none were vitamin B12 deficient. While there was a positive significant correlation between hemoglobin and serum iron concentrations (r = 0.517, p < 0.001), no significative correlation was found between the other parameters studied. The high prevalence of anemia and nutrient deficiency among the Bari indians, can be attributed to inadequate diets and the varied diseases encountered in the population.
Assuntos
Anemia/epidemiologia , Deficiência de Ácido Fólico/epidemiologia , Indígenas Sul-Americanos , Deficiências de Ferro , Distúrbios Nutricionais/epidemiologia , Deficiência de Vitamina B 12/epidemiologia , Adolescente , Adulto , Idoso , Anemia/sangue , Anemia Hipocrômica/sangue , Anemia Hipocrômica/epidemiologia , Anticorpos Antibacterianos/sangue , Criança , Pré-Escolar , Dieta , Etnicidade , Feminino , Ferritinas/sangue , Deficiência de Ácido Fólico/sangue , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/imunologia , Helicobacter pylori/imunologia , Humanos , Lactente , Ferro/sangue , Masculino , Pessoa de Meia-Idade , Distúrbios Nutricionais/sangue , Doenças Parasitárias/epidemiologia , Prevalência , Venezuela/epidemiologia , Deficiência de Vitamina B 12/sangueRESUMO
The efficacy of medical prophylaxis in the fight against iron deficiency anemia in 620 children aged from four to thirty-six months, attended in two health units of the municipality of S. Paulo, Brazil, was tested. First, the children's blood was tested for hemoglobin level and electrophoresis. Then they received daily doses of iron sulphate in the form of drops, corresponding to 12 mg/day of elementary iron, over a 30-day period. Afterwards, they were asked to return for re-evaluation. Twenty-five percent of children under 6 months presented hemoglobin levels under 11.0 g/dl. The highest occurrences of anemia were detected among children aged 9 to 11 months (49.5%) and in the age bracket between 12 and 23 months (50.4%). After the established period, only 37.4% of the children with anemia and 52.4% of children who did not present anaemia returned for further evaluation. Of the 299 evaluated, only 157 (52.5%) had taken the medication correctly. Frequency of hemoglobin inferior to 9.5 g/dl dropped from 17.1% at the beginning to 8.1% at the end of the intervention. On the other hand, the percentage of children with hemoglobin above 12.0 g/dl increased from 13.4% to 33.4%. Those children who took their iron supplements correctly registered a significantly higher drop in the number of cases of anemia than that observed in those who had not taken the supplement correctly. The great majority (80.3%) did not present any side effects of medication.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Anemia Hipocrômica/prevenção & controle , Serviços de Saúde Comunitária , Compostos Ferrosos/uso terapêutico , Anemia Hipocrômica/sangue , Anemia Hipocrômica/tratamento farmacológico , Anemia Hipocrômica/epidemiologia , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Pré-Escolar , Compostos Ferrosos/administração & dosagem , Hemoglobinas/análise , Humanos , Lactente , PrevalênciaRESUMO
A anemia tem sido descrita em atletas, mesmo entre membros de equipes olimpicas. Esta anemia pode ser dilucional, que seria uma adaptacao benefica ao treinamento, como pode ser uma verdadeira deficiencia de hemoglobina (Hb) por deficiencia de ferro e/ou hemolise que poderia interferir no desempenho psico-motor. Os 16 integrantes da selecao masculina de volei de 1994 foram comparados com 23 individuos do mesmo sexo atendidos no ambulatorio geral didatico do HCFMUSP, que nao apresentavam doenca clinica expressiva. Nenhum participante, atleta ou controle, apresentou Hb<13 g/dl (que e o criterio usado pela OMS para anemia)....
Assuntos
Humanos , Masculino , Feminino , Anemia Hipocrômica/sangue , Deficiências de Ferro/sangue , Exercício Físico , Anemia Hipocrômica/diagnóstico , Técnicas de Laboratório Clínico , Esportes/classificaçãoRESUMO
Se estudió la eficacia y el efecto del sulfato ferroso en el tratamiento de la deficiencia de hierro. Con este propósito se comparó el incremento en la concentración de hemoglobina en niños escolares después de administrar por 12 semanas esta sal, a razón de 5 mg de hierro elemental por kg/día. Los datos se analizaron de acuerdo a los cambios en la distribución acumulada de las frecuencias de concentración de hemoglobina, antes y después del tratamiento. Considerando el desplazamiento de las frecuencias acumuladas a nivel del 25 percentil, se calculó el efecto y eficacia del tratamiento en los niños deficientes, con y sin anemia; entre los primeros el efecto del sulfato de hierro fue de 1.38 g/dL y entre los segundos fue de 0.64 g/dL; la eficacia calculada, en el mismo orden, fue de 76.1 por ciento y 108.5 por ciento. Se comentan los hallazgos y se hace énfasis en que la respuesta al tratamiento depende de la concentración inicial de hemoglobina. En el presente estudio todos los niños anémicos tuvieron más de 10 g/dL de hemoglobina
Assuntos
Criança , Hemoglobinas/análise , Hemoglobinas/efeitos dos fármacos , Sulfato Ferroso , Saúde Ambiental , Anemia Hipocrômica/sangue , Anemia Hipocrômica/terapiaRESUMO
The present study sought to determine the prevalence of anemia in 2,992 children, aged between 6 and 23 months, who voluntarily attended 160 Basis Health Care Units, located in 63 cities of the 5 Regional Health Coordinating areas of the State of S. Paulo, Brazil. Blood samples were collected by venous puncture and hemoglobin was measured by the cianometahemoglobin method. The WHO criteria for the diagnosis of anemia (Hb < 11.0 g/dl) were used: 59.1% of the children were shown to be anemic, with prevalence varying from 47.8% to 68.7% in the 5 RHCs. RHC 1, which comprises the Greater S. Paulo Region, presented a prevalence of anemia significantly lower than the other 4 RHCs, which cover the rest of the State. Hemoglobin levels 9.5 g/dl were found in 25.1% of the children. Anemia was more frequent in male children in male children, in those born, with a weight of less than 3,000 gr, in those who were breastfed for less than 2 months and in those that who presented some degree of energy deficient proteic malnutrition, according to Gomez's criteria. This is the first of a series of 4 articles whose purpose is the determining the prevalence of anemia in the State of S. Paulo and of testing the intervention alternatives with a view to curtailing the incidence of this pathology which today is the most prevalent nutritional disturbance in the world.
Assuntos
Anemia Hipocrômica/epidemiologia , Serviços de Saúde Comunitária , Fatores Etários , Anemia Hipocrômica/sangue , Peso ao Nascer , Brasil/epidemiologia , Aleitamento Materno , Feminino , Hemoglobinas/análise , Humanos , Lactente , Recém-Nascido , Masculino , Estado Nutricional , Prevalência , Características de Residência , Fatores Sexuais , População UrbanaRESUMO
The effect of iron and folate supplementation on the hemoglobin response and iron status was studied in male and female equatorian medical students: 66 in Quito (2,800 m altitude) and 40 in Guayaquil (sea level). At the end of the supplementation, there was a nearly complete disappearance of biochemical evidence of iron deficiency in the two groups of students. In Quito, 30% of the men and 26% of the women increased their hemoglobin concentration by more than 1 g/dl after one month of supplementation and could be considered as true anemics, compared to 31% of the men and 29% of the women in Guayaquil. This study shows that at sea level, cut-off points defined by WHO for hemoglobin, taking as reference the impact of a supplementation trial, have a specificity of 100% but poor sensitivity (58%). For people living at high altitudes, cut-off limits adjusted for altitude seem unsuitable: the specificity is 98% but the sensitivity is 0%. Studies taking into account all the factors impacting on the hemoglobin level could be useful for defining cut-off points for high-altitude anemia better than those currently recommended.
Assuntos
Altitude , Anemia Hipocrômica/sangue , Anemia Hipocrômica/tratamento farmacológico , Anemia/sangue , Anemia/etiologia , Compostos Ferrosos/uso terapêutico , Ácido Fólico/uso terapêutico , Adulto , Anemia/epidemiologia , Anemia Hipocrômica/epidemiologia , Diagnóstico Diferencial , Equador/epidemiologia , Estudos de Avaliação como Assunto , Feminino , Ferritinas/sangue , Hematócrito , Hemoglobinas/análise , Humanos , Masculino , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Organização Mundial da SaúdeRESUMO
Several laboratory tests have been proposed for the differentiation of beta thalassemia from iron deficiency, including decision functions based on red blood cells indices generated by electronic cell counters. The accuracy of these screening methods was assessed in 192 patients with microcytosis known to be secondary to beta thalassemia minor and 72 patients with iron deficiency. The functions evaluated were: 1) discriminant function of England an Fraser: MCV--(5xHb)--RBC--8.4; 2) ratio of MCH/RBC; 3) ratio of MCV/RBC; 4) ratio of (MCV)2 x MCH and 5) the erythrocyte count. The discriminant function of England and Fraser showed the highs, percentage of correct distinction between iron deficiency and beta thalassemia minor, although diagnosis errors occurred in 10%. Mentzer ratio MCV/RBC detected all cases of beta thalassemia but was a poor index for iron deficiency detection. The tested discriminant function, with exception of the Mentzer ratio, although not sufficiently accurate for definitive diagnosis, appears to be a useful technique in the initial screening of patients with microcytosis.
Assuntos
Anemia Hipocrômica/diagnóstico , Talassemia beta/diagnóstico , Adulto , Anemia Hipocrômica/sangue , Diagnóstico Diferencial , Hemoglobina A2/análise , Heterozigoto , Humanos , Transferrina/análise , Talassemia beta/genética , Talassemia beta/metabolismoRESUMO
Se evaluó la eficiencia diagnóstica de la amplitud de la distribución del volumen de los eritrocitos (ADE > 14.2 por ciento) y el volumen corpuscular medio (VGM < 83.5 fL) en la detección de deficiencia de hierro en mujeres candidatas a donar sangre. Empleando la saturación de la transferrina < 17 por ciento, la prevalencia de deficiencia de hierro en 296 mujeres fue de 23 por ciento, y en 635 varones donadores de 1.1 por ciento. En el grupo total de mujeres la sensibilidad y especificidad de los índices fueron de 78 por ciento y 92 por ciento respectivamente. cuando estos parámetros diagnósticos se calcularon separando las mujeres anémicas de aguéllas no anémicas, en las primera se obtuvieron valores más altos (sensibilidad 90 por ciento y valor predictivo positivo 92 por ciento) que en las no anémicas (sensibilidad 58 por ciento y valor predictivo positivo 50 por ciento). Estos resultados confirman que hay un traslape en los valores de ADE y de VGM entre los sujetos con y sin deficiencia de hierro, y que esta sobreposición parece ser mayor entre los individuos no anémicos pero con eritropoyesis deficiente en hierro. Concluimos que los índices eritrocíticos parecerían ser pruebas útiles para identificar deficiencia de hierro en las donadoras de sangre anémicas mas no en aguéllas no anémicas
Assuntos
Humanos , Masculino , Feminino , Adulto , Anemia Hipocrômica/diagnóstico , Anemia Hipocrômica/sangue , Doadores de Sangue , Volume de Eritrócitos/fisiologia , /sangue , /diagnósticoRESUMO
The clinical efficacy of the red cell distribution width (RDW > 14.2%) and the mean corpuscular volume (MCV < 83.5 fL) in detecting iron deficiency was evaluated in female blood donors. Employing transferrin saturation < 17%, the prevalence of iron deficiency in 296 female donors was 23%, and in 635 male donors 1.1%. In the total female population, the sensitivity and specificity of the indices were 78% and 92%, respectively, but they were higher in anemic females (sensitivity 90% and positive predictive value 92%) than in non anemic females (sensitivity 58% and positive predictive value 50%). Our results confirm that there is an overlap in the levels of RDW and MCV between the iron and non iron deficient subjects, and these overlap seems to be more remarkable in the non anemic individuals. We conclude that these erythrocyte indices could be useful to identify iron deficiency in anemic female blood donors, but not in non anemic ones.
Assuntos
Anemia Hipocrômica/sangue , Doadores de Sangue , Índices de Eritrócitos , Adolescente , Adulto , Idoso , Anemia Hipocrômica/diagnóstico , Anemia Hipocrômica/epidemiologia , Feminino , Citometria de Fluxo , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Sensibilidade e Especificidade , Fatores Sexuais , Transferrina/análiseRESUMO
The iron status of 3228 subjects from the nutrition survey Proyecto Venezuela was studied. The sample included children from 1 to 16 y of age grouped by age and sex. Values for three indicators of iron status were compared: hemoglobin concentration, serum ferritin concentration, and percentage saturation of serum transferrin. In all groups there was a strong overlap in the hemoglobin concentration distribution curves for non-iron-deficient and iron-deficient subjects classified as such according to the other two indexes. The prevalence of iron deficiency ranged from 35% in 1-3 y olds to 10% in adolescent males, the values being almost identical in the nonanemic group compared with the total population. In the different groups, 80-97% of the subjects with abnormal values of at least one of these two indexes were not anemic. The difficulties involved in establishing a state of iron deficiency according to these indexes are discussed.
Assuntos
Anemia Hipocrômica/sangue , Deficiências de Ferro , Adolescente , Fatores Etários , Anemia Hipocrômica/epidemiologia , Criança , Pré-Escolar , Feminino , Ferritinas/sangue , Hemoglobinas/análise , Humanos , Lactente , Masculino , Prevalência , Fatores Sexuais , Transferrina/análise , Venezuela/epidemiologiaRESUMO
Using an in vitro technique the ability of the Fe/Transferrin complex in the serum of calories and proteins in chronically deprived adult males was investigated. The study included the behavior of the same function in the sera of other types of anemias. A significant reduction of the Fe donating capacity was found in the sera of patients suffering from nutritional anemia (NA), whereas this change was absent in the sera of other type of anemias. A deterioration of the iron donating function of the Fe/Transferrin complex caused by malnutrition, is postulated. The participation of this alteration in the production of NA is considered.
Assuntos
Anemia Hipocrômica/sangue , Ferro/sangue , Distúrbios Nutricionais/complicações , Reticulócitos/metabolismo , Transferrina/metabolismo , Adulto , Anemia Hemolítica/sangue , Anemia Hipocrômica/etiologia , Animais , Doença Crônica , Eritropoese , Hemorragia/sangue , Humanos , Masculino , Camundongos , Distúrbios Nutricionais/sangueRESUMO
For a prospective study of lead exposure, iron status, and infant development, we recruited infants living in a smelter town and a non-lead-exposed town in Kosovo, Yugoslavia. Among 392 infants assessed at age 2 years, the mean Mental Development Index (MDI), Bayley Scales of Infant Development, was 105.2. At age 2 years, geometric mean blood lead concentrations were 35.5 and 8.4 micrograms/dl, respectively, among infants from the exposed and nonexposed towns. After controlling for variables associated with MDI, we found significant independent associations for both blood lead and hemoglobin concentrations. For example, a rise in blood lead concentration at age 2 years from 10 to 30 micrograms/dl was associated with an estimated 2.5 point decrement in MDI (p = 0.03); statistically nonsignificant decrements were associated with blood lead levels measured at birth and at 6, 12, and 18 months of age. A decrease in hemoglobin concentration at 18 months of age from 12 to 10 gm/dl was associated with an estimated 3.4 point decrement in MDI (p = 0.02); the latter association was present in both towns, suggesting that it was due to iron deficiency anemia independent of lead exposure. The findings suggest that the brain is vulnerable to the effects of both lead exposure and anemia before 2 years of age. On a global basis, the developmental consequences of anemia may exceed those of lead exposure.