Prevalence of iron deficiency anaemia among microcytic anaemic premenopausal patients at tertiary care hospital, Karachi
Ghulam Abbas MemonTooba Jawed KhanShabnam AbbasGhulam Abbas ShaikhNusrat ShahHammad Afzal KayaniAtif Habib
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Abstract:
Background: Iron deficiency anaemia (IDA) is the prevalent form of anaemia which has become a major public health problem, globally. Women in the reproductive age group (15–49 years of age) are at increased risk, especially in the South Asian population. It is of paramount importance to identify these micronutrient deficiencies in this age group as it adversely affects the birth outcomes, but the mother and the child at risk of morbidity and mortality during pregnancy. Methods: A cross-sectional study was conducted at Civil Hospital, Karachi for 12 months i.e. October, 2018 to December, 2019. Data was prospectively collected from patients after obtaining written informed consent. 377 patients were included who met the diagnostic criteria. Descriptive statistics were used and qualitative data analysis; mean, standard deviation, frequency, and percentages were respectively calculated. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. For post-stratification, the chi-square test was applied with a p value of≤0.05.Results: A total of 377 patients with microcytic anaemia were enrolled from Civil Hospital, Karachi. Mean age, duration of anaemia, haemoglobin, height, weight and BMI in our study was 29.28±6.14 years, 1.41±0.26 months, 9.27±0.86 mg/dl, 26.72±1.56 kg/m2, 138±7.28 cm and 78.7±9.87 kg. Out of 377 patients with microcytic anaemia, 144 (38.2%) and 233 (61.8%) had and did not have iron deficiency anaemia. Conclusions: IDA is frequently found in microcytic anaemia patients. Thus, it is important to screen premenopausal in female patients for iron deficiency presenting with microcytic anaemia to prevent adverse outcomes.Keywords:
Cross-sectional study
Micronutrients perform a key role in almost all vital body functions like those related to vision, immunity, bone formation, brain function and many others that help in proper growth and maintaining good health. Deficiency of any one or more of the micronutrients can have a negative impact on the overall health. The causes of micronutrient deficiencies and their signs and symptoms are explained in this chapter in a precise manner. Plant and animal food sources with high micronutrient contents with ready-to-eat food supplements per serving size are illustrated for each micronutrient. These can serve as a guideline for preventive measures and diet therapy. Micronutrients are increasingly used as an adjunct therapy in managing various health problems. Effective therapeutic uses of vitamins and minerals are exemplified for a ready reference. Overdose of synthetic supplements of micronutrients and certain environmental conditions may result in toxic effects. To address this, the upper limit for micronutrient intakes and toxic effects of excess micronutrient intakes are also described. The relevance of the yogic concept of ‘sattvic’ diet in modern nutrition and the potential of yoga for micronutrient absorption is also highlighted. The approach of yoga towards healthy diet and the relation between diet and psychological health is explained based on experimental data. The importance of specific micronutrients in health at different stages of life, from pregnancy to old age, is elucidated and remedial measures are suggested. Lastly, evidence for micronutrient supplements as an adjunct therapy for COVID-19 is briefly described. <br>
Micronutrient deficiency
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Anaemia in pregnancy is a common and worldwide problem that deserves more attention. For many developing countries, prevalence rates of up to 75% are reported. Anaemia is frequently severe in these situations and can be expected to contribute significantly to maternal mortality and morbidity. After a discussion of definitions, screening for anaemia and prevalence, the relationship between anaemia and maternal mortality and morbidity will be reviewed. Micronutrient deficiency and especially iron deficiency is believed to be the main underlying cause for anaemia. More recently the role of vitamin A deficiency as a contributing factor to anaemia has also been examined. The difficulties of assessment of micronutrient sufficiency or deficiency in pregnancy are described, as is the interaction between infection and micronutrient deficiency states.
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Micronutrient deficiencies compromise the health and development of many school-age children worldwide. Previous research suggests that micronutrient interventions might benefit the health and development of school-age children and that multiple micronutrients might be more effective than single micronutrients. Fortification of food is a practical way to provide extra micronutrients to children. Earlier reviews of (multiple) micronutrient interventions in school-age children did not distinguish between supplementation or fortification studies. The present review includes studies that tested the impact of multiple micronutrients provided via fortification on the micronutrient status, growth, health, and cognitive development of schoolchildren. Twelve eligible studies were identified. Eleven of them tested the effects of multiple micronutrients provided via fortified food compared to unfortified food. One study compared fortification with multiple micronutrients to fortification with iodine alone. Multi-micronutrient food fortification consistently improved micronutrient status and reduced anemia prevalence. Some studies reported positive effects on morbidity, growth, and cognitive outcomes, but the overall effects on these outcomes were equivocal.
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No evidence based recommendations for micronutrient requirements during paediatric critical illness are available, other than those arising from recommended nutrient intakes (RNI) for healthy children and expert opinion.The objective of this review is to examine the available evidence from micronutrient status in critically ill children considering studies which describe 1) micronutrient levels, 2) associations between micronutrient levels and clinical outcome, and 3) impact on clinical outcome with micronutrient supplementation during PICU admission.Scoping review.Any study which used a qualitative and quantitative design considering causes and consequences of micronutrient levels or micronutrient supplementation during paediatric critical illness.NICE Healthcare Databases Advanced Search website (https://hdas.nice.org.uk/) was used as a tool for multiple searches, with a content analysis and charting of data extracted.711 records were identified, 35 were included in the review. Studies evaluated serum micronutrient status was determined on admission day in majority of patients. A content analysis identified (n = 49) initial codes, (n = 14) sub-categories and (n = 5) overarching themes during critical illness, which were identified as: i) low levels of micronutrients, ii) causes of aberrant micronutrient levels, iii) associations between micronutrients levels and outcome, iv) supplementation of micronutrients.During critical illness, micronutrients should be provided in sufficient amounts to meet reference nutrient intakes for age. Although, there is insufficient data to recommend routine supplementations of micronutrients at higher doses during critical illness, the 'absence of evidence should not imply evidence of absence', and well designed prospective studies are urgently needed to elucidate paediatric micronutrient requirements during critical illness. The absence of reliable biomarkers make it challenging to determine whether low serum levels are reflective of a true deficiency or as a result redistribution, particularly during the acute phase of critical illness. As more children continue to survive a PICU admission, particularly those with complex diseases micronutrient supplementation research should also be inclusive of the recovery phase following critical illness.
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Micronutrient deficiency
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Micronutrients play a crucial role in maintaining good health as they are required for various processes within the body. Every individual has different micronutrient needs depending on their metabolic condition. To achieve optimal health, these needs must be met adequately.
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Objective: In order to investigate the effect of zinc and/or micronutrients compound intervention on the physicaldevelopment in pre-school children. Methods: 480 children were divided into 3 groups: zinc group, micronutrients group, zincplus micronutrients group. During the experiment of 10 weeks, the children were supplied with zinc, micronutrients or zinc plusmicronutrients respectively. Results: The data showed that the increases of children's height and weight were significantly higherin micronutrients and zinc plus micronutrients groups than those in zinc group. Conclusion: it suggests that the supplementationof mieronutrients compound should promote children's growth and development, and that attention should be paid to the supplementation of other nutrients while zinc be supplied for children.
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Vitamins, zinc and selenium are important micronutrients that play crucial functions at the cellular and molecular level. Immune response of several different cell types can be modulated by these micronutrients. Deficiency in micronutrients has been extensively reported in HIV-1-infected individuals and further correlated with CD4+ T-cell count, HIV-1 plasma viral load, disease progression and mortality. Supplementation by micronutrients has had controversial effects. Thorough future investigations and trials are certainly needed to strategically plan evidence-based interventions. Here, we review the available data on use of micronutrients during the course of HIV-1 infection.
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In metabolism and tissue performance, micronutrients play a key role. Sufficient amount of intake is required to maintain tissue function and metabolic processes. In those people who are extremely depleted and the possibility for complications, the clinical benefits of micronutrient supplements are more advantageous in health improvement. Zinc and vitamin A supplements have contributed to lowered diarrhoea and pneumonia in children in developing countries. In slightly malnourished children, there are some indications that micronutrient supplements have cognitive influence. In several diseases, there is strong proof of the benefit of micronutrient supplements. A well-balanced diet tends to support most of the micronutrients.
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Objective
To find out the validity of assumption that anemia is used as an indicator of iron deficiency and children found to be anemic are put on supplemental iron.
Method
In this cross sectional study, children between 5-12 years of were tested for anemia and iron deficiency. Hemoglobin (Hb) of less than 11.5 gm/dl was defined as anemia. Serum iron 360 mcg/dl were used as an indicator of iron deficiency.
Results
Out of 319 school children, 87 (27%) were found to be anemic. Out of these, almost half (43 children) had no associated iron deficiency. Also, 130/319 (40.7%) children had depletion of iron stores, and out of these only 44 had anemia and 86 had iron deficiency without anemia. This makes both specificity and sensitivity of anemia low for iron deficiency. Positive predictive value of anemia for depleted iron stores was 50.6%. Sensitivity of anemia for depleted iron stores was 33.8%.
Conclusions
Since low hemoglobin is not a sensitive indicator of iron deficiency, and since iron deficiency is wide spread and causes multiple problems in children, we suggest that hemoglobin level should not be taken as the only indicator of iron status in children. (Rawal Med J 2009; 34: 61-64).
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