Hookworm anemia in the adult population of Jagapati village, Bali, Indonesia.

A cross sectional study was conducted in Jagapati Village, Bali to assess some characteristics of hookworm anemia among the adult population. Hookworm anemia was defined as an iron deficiency anemia in heavily infected individuals (EPG > 2,000). WHO criteria for anemia and criteria of Hercberg for iron deficiency were used. In this study, 15 cases of hookworm anemia were found among 454 total samples (3.3%), or among 123 cases of iron deficiency anemia (12.2%). The age varied between 16-69 years with male to female ratio of 1:2.8. Twelve cases were found with symptoms and signs of anemia, 1 case with full blown hookworm anemia, and 2 cases were asymptomatic. The hemoglobin level was found to be 4.5-12.9 g/dl, with 12 cases (80.0%) being classified as mild anemia, 2 cases (13.3%) as moderate anemia, and 1 case as severe anemia. The mean serum iron level was 39.6 mg/dl, mean transferrin saturation was 11.1%, and mean serum ferritin level was 9.6 ng/dl. Hypoalbuminemia was found in 9 cases (60.0%), eosinophilia in 8 cases (53.3%), and low serum folic acid level in 5 cases (38.5%). High total serum IgE level was found in all but one case, with mean total serum IgE level of 3,739 U/ml. The intensity of hookworm infection was moderate in 11 cases (73.3%) and severe in 4 cases (26.7%). It could be concluded that hookworm anemia was characterized by iron deficiency anemia with eosinophilia, high serum total IgE level, hypoalbuminemia and moderate to severe hookworm infection.