Jose A, Bodade A, Madkaikar M R
Department of Pediatric Immunology and Leukocyte Biology, ICMR-National Institute of Immunohaematology, Parel, Mumbai, Maharashtra, India.
Scientist E, ICMR-CRMCH, Chandrapur and ICMR-Headquarters, Delhi, India.
J Postgrad Med. 2025 Jan 1;71(1):33-40. doi: 10.4103/jpgm.jpgm_590_24. Epub 2025 Mar 6.
Sickle cell disease (SCD) is prevalent in Sub-Saharan Africa, the Middle East, and parts of India, where it is often complicated by iron deficiency anemia (IDA). Untreated IDA exacerbates SCD symptoms, reducing quality of life (QOL) and increasing morbidity and mortality. Diagnosis typically depends on ferritin levels, which can be unreliable due to inflammation associated with SCD's altered red cell morphology and chronic hemolysis. This systematic review and meta-analysis explores the interplay between IDA and SCD, focusing on diagnostic criteria for effective management. We conducted a thorough search of PubMed and EMBASE, leading to the selection of 14 studies following PRISMA guidelines. The review protocol was registered in PROSPERO (CRD42023462914). Data extraction, quality assessments, and heterogeneity checks were rigorously performed. Out of 3188 articles, 14 studies met the inclusion criteria, covering 763 SCD cases with 118 instances of IDA. The meta-analysis found an IDA prevalence of 6% (95% CI: 1%-20%) among SCD patients, with high heterogeneity (I 2 = 88.8%). Sensitivity analysis adjusted for publication bias indicated an 8% prevalence (95% CI: 4%-19%) with reduced heterogeneity (I 2 = 19.5%). Subgroup analysis revealed a lower prevalence of IDA in pregnant women (0.01%; 95% CI: 0.00%-0.92%) compared to non-pregnant individuals (7%; 95% CI: 2%-22%). The study highlights significant regional variability in IDA prevalence among SCD patients, emphasizing the importance of early diagnosis and targeted management to improve patient outcomes and QOL.
镰状细胞病（SCD）在撒哈拉以南非洲、中东和印度部分地区普遍存在，在这些地区，它常并发缺铁性贫血（IDA）。未经治疗的IDA会加重SCD症状，降低生活质量（QOL），并增加发病率和死亡率。诊断通常取决于铁蛋白水平，但由于与SCD改变的红细胞形态和慢性溶血相关的炎症，铁蛋白水平可能不可靠。本系统评价和荟萃分析探讨了IDA与SCD之间的相互作用，重点关注有效管理的诊断标准。我们对PubMed和EMBASE进行了全面检索，按照PRISMA指南筛选出14项研究。该评价方案已在PROSPERO（CRD42023462914）注册。严格进行了数据提取、质量评估和异质性检查。在3188篇文章中，14项研究符合纳入标准，涵盖763例SCD病例，其中118例为IDA。荟萃分析发现，SCD患者中IDA患病率为6%（95%CI：1%-20%），异质性较高（I² = 88.8%）。针对发表偏倚进行调整的敏感性分析表明，患病率为8%（95%CI：4%-19%），异质性降低（I² = 19.5%）。亚组分析显示，与非孕妇（7%；95%CI：2%-22%）相比，孕妇中IDA患病率较低（0.01%；95%CI：0.00%-0.92%）。该研究强调了SCD患者中IDA患病率存在显著的区域差异，强调了早期诊断和针对性管理对改善患者预后和生活质量的重要性。
