Shah Niharika, Pokharel Sairil, Mishra Deebya Raj, Adhikari Purbesh
Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
JNMA J Nepal Med Assoc. 2019 Sep-Oct;57(219):297-301. doi: 10.31729/jnma.4632.
Anemia due to iron deficiency and chronic diseases is common occurrence in developing country like Nepal, the latter seen in patients with various inflammatory, autoimmune, and malignant disorders . The Intensive method of marrow iron examination, which this study has employed, provides clinically useful iron status classification in cases of functional iron deficiency. The aim of the study is to find out the prevalence of iron deficiency anemia in biochemically defined moderate to severe anemic patients in tertiary care center.
A descriptive cross-sectional study was done in 43 patients who underwent bone marrow aspiration for evaluation of any cause and had moderate to severe anemia at the same time over a period of one year from Nov 2015 to 2016. Ethical clearance was obtained from Institutional Review Committee. The bone marrow iron stores were assessed by"intensive method" apart from the routinely used Gale's method. Data was collected and entry were done in Statistical Package for Social Sciences version 24. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
The intensive grading system demonstrated normal marrow iron store in 13 (30.2%), depleted iron stores in 3 (7%), functional iron deficiency in 14 (32.6%), and combined deficiency in 13 (30.2%) patients. Mean log ferritin concentration was lower in patients with depleted iron stores (2.2μg/l) than in those with normal (2.7μg/l), and functional iron deficiency (2.4μg/l). The mean log ferritin in combined deficiency was lower than the mean log ferritin concentration in iron store deficiency (1.9μg/l).
The prevalence of functional iron deficiency anemia was greatest when the intensive method for assessment of bone marrow iron was used, thus differentiating four different iron status categories, including functional iron deficiency, from actual iron store deficiency, avoiding unnecessary iron supplementation in the former group.
在尼泊尔这样的发展中国家，缺铁性贫血和慢性病性贫血很常见，后者见于患有各种炎症、自身免疫性和恶性疾病的患者。本研究采用的骨髓铁检查强化方法，可对功能性缺铁病例进行临床上有用的铁状态分类。本研究的目的是在三级医疗中心找出生化定义为中度至重度贫血患者中铁缺乏性贫血的患病率。
在2015年11月至2016年的一年时间里，对43例因任何原因接受骨髓穿刺评估且同时患有中度至重度贫血的患者进行了描述性横断面研究。获得了机构审查委员会的伦理批准。除了常规使用的盖尔方法外，还通过“强化方法”评估骨髓铁储备。收集数据并录入社会科学统计软件包第24版。计算95%置信区间的点估计值以及二元数据的频率和比例。
强化分级系统显示，13例（30.2%）患者骨髓铁储备正常，3例（7%）患者铁储备减少，14例（32.6%）患者功能性缺铁，13例（30.2%）患者合并缺乏。铁储备减少的患者平均对数铁蛋白浓度（2.2μg/l）低于铁储备正常（2.7μg/l）和功能性缺铁（2.4μg/l）的患者。合并缺乏患者的平均对数铁蛋白低于铁储备缺乏患者的平均对数铁蛋白浓度（1.9μg/l）。
使用骨髓铁评估强化方法时，功能性缺铁性贫血的患病率最高，从而区分了包括功能性缺铁在内的四种不同铁状态类别与实际铁储备缺乏，避免了在前一组中不必要的铁补充。
