{"title":"地中海贫血高发地区6-12个月婴儿普遍补铁的理由","authors":"Phakatip Sinlapamongkolkul, Pacharapan Surapolchai, Vip Viprakasit","doi":"10.4084/MJHID.2023.056","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Many clinicians hesitate to adopt a universal infant iron supplementation program due to the risk of increased iron absorption for those with thalassemia. We aimed to determine thalassemia prevalence in 6- to 12-month-old infants, along with the iron status of those with and without thalassemia.</p><p><strong>Methods: </strong>We performed a cross-sectional descriptive study of infants attending the Well Baby Clinic at Thammasat University Hospital for routine checkups. Complete blood count, hemoglobin electrophoresis, iron parameters, and molecular genetics for common α- and β-thalassemia were evaluated.</p><p><strong>Results: </strong>Overall, 97 of 206 (47%) participants had thalassemia minor, the majority having Hb E traits. None had thalassemia intermedia or major. Familial history of anemia or thalassemia presented an increased risk of detecting thalassemia minor in offspring (OR 5.18; 95% CI 2.60-10.33, <i>p</i>=0.001). There were no statistical differences in transferrin saturation, serum ferritin and hepcidin between iron-replete infants with thalassemia minor and those without. However, one-third of infants with thalassemia minor (31/97) also had iron deficiency anemia (IDA), with a similar risk of having iron deficiency to infants without thalassemia. There was no hepcidin suppression in our infants with thalassemia minor as compared to controls.</p><p><strong>Conclusions: </strong>Both thalassemia and IDA are endemic to Southeast Asia. Infants with thalassemia minor, particularly with Hb E and α-thalassemia traits, are at risk of IDA. Our short-term universal iron supplementation program for 6- to 12-month-old infants does not appear to increase the risk of those with thalassemia minor developing iron overload in the future.</p>","PeriodicalId":18498,"journal":{"name":"Mediterranean Journal of Hematology and Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/3f/mjhid-15-1-e2023056.PMC10497306.pdf","citationCount":"0","resultStr":"{\"title\":\"Justification of Universal Iron Supplementation for Infants 6-12 months in Regions with a High Prevalence of Thalassemia.\",\"authors\":\"Phakatip Sinlapamongkolkul, Pacharapan Surapolchai, Vip Viprakasit\",\"doi\":\"10.4084/MJHID.2023.056\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Many clinicians hesitate to adopt a universal infant iron supplementation program due to the risk of increased iron absorption for those with thalassemia. We aimed to determine thalassemia prevalence in 6- to 12-month-old infants, along with the iron status of those with and without thalassemia.</p><p><strong>Methods: </strong>We performed a cross-sectional descriptive study of infants attending the Well Baby Clinic at Thammasat University Hospital for routine checkups. Complete blood count, hemoglobin electrophoresis, iron parameters, and molecular genetics for common α- and β-thalassemia were evaluated.</p><p><strong>Results: </strong>Overall, 97 of 206 (47%) participants had thalassemia minor, the majority having Hb E traits. None had thalassemia intermedia or major. Familial history of anemia or thalassemia presented an increased risk of detecting thalassemia minor in offspring (OR 5.18; 95% CI 2.60-10.33, <i>p</i>=0.001). There were no statistical differences in transferrin saturation, serum ferritin and hepcidin between iron-replete infants with thalassemia minor and those without. However, one-third of infants with thalassemia minor (31/97) also had iron deficiency anemia (IDA), with a similar risk of having iron deficiency to infants without thalassemia. There was no hepcidin suppression in our infants with thalassemia minor as compared to controls.</p><p><strong>Conclusions: </strong>Both thalassemia and IDA are endemic to Southeast Asia. Infants with thalassemia minor, particularly with Hb E and α-thalassemia traits, are at risk of IDA. 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引用次数: 0
摘要
导言:由于地中海贫血患者铁吸收增加的风险,许多临床医生对采用普遍的婴儿补铁方案犹豫不决。我们的目的是确定6至12个月大婴儿的地中海贫血患病率,以及患有和不患有地中海贫血的婴儿的铁状态。方法:我们对在法政大学医院Well婴儿诊所进行常规检查的婴儿进行了横断面描述性研究。对常见α-和β-地中海贫血的全血细胞计数、血红蛋白电泳、铁参数和分子遗传学进行了评估。结果:总体而言,206名参与者中有97名(47%)患有轻度地中海贫血,其中大多数具有Hb E特征。没有人患有中度或重度地中海贫血。有贫血或地中海贫血家族史的人在后代中发现轻度地中海贫血的风险增加(or 5.18;95% CI 2.60-10.33, p=0.001)。低铁血症患儿与低铁血症患儿在转铁蛋白饱和度、血清铁蛋白和肝磷脂水平上无统计学差异。然而,三分之一的轻度地中海贫血婴儿(31/97)也患有缺铁性贫血(IDA),其缺铁风险与非地中海贫血婴儿相似。与对照组相比,我们研究的轻度地中海贫血婴儿中没有肝磷脂抑制。结论:地中海贫血和IDA都是东南亚地区的地方性疾病。患有轻度地中海贫血的婴儿,特别是具有Hb E和α-地中海贫血特征的婴儿,有IDA的风险。我们针对6- 12个月婴儿的短期普遍补铁计划似乎不会增加未来轻度地中海贫血患者发生铁超载的风险。
Justification of Universal Iron Supplementation for Infants 6-12 months in Regions with a High Prevalence of Thalassemia.
Introduction: Many clinicians hesitate to adopt a universal infant iron supplementation program due to the risk of increased iron absorption for those with thalassemia. We aimed to determine thalassemia prevalence in 6- to 12-month-old infants, along with the iron status of those with and without thalassemia.
Methods: We performed a cross-sectional descriptive study of infants attending the Well Baby Clinic at Thammasat University Hospital for routine checkups. Complete blood count, hemoglobin electrophoresis, iron parameters, and molecular genetics for common α- and β-thalassemia were evaluated.
Results: Overall, 97 of 206 (47%) participants had thalassemia minor, the majority having Hb E traits. None had thalassemia intermedia or major. Familial history of anemia or thalassemia presented an increased risk of detecting thalassemia minor in offspring (OR 5.18; 95% CI 2.60-10.33, p=0.001). There were no statistical differences in transferrin saturation, serum ferritin and hepcidin between iron-replete infants with thalassemia minor and those without. However, one-third of infants with thalassemia minor (31/97) also had iron deficiency anemia (IDA), with a similar risk of having iron deficiency to infants without thalassemia. There was no hepcidin suppression in our infants with thalassemia minor as compared to controls.
Conclusions: Both thalassemia and IDA are endemic to Southeast Asia. Infants with thalassemia minor, particularly with Hb E and α-thalassemia traits, are at risk of IDA. Our short-term universal iron supplementation program for 6- to 12-month-old infants does not appear to increase the risk of those with thalassemia minor developing iron overload in the future.
期刊介绍:
Reciprocal interdependence between infectious and hematologic diseases (malignant and non-malignant) is well known. This relationship is particularly evident in Mediterranean countries. Parasitosis as Malaria, Leishmaniosis, B Hookworms, Teniasis, very common in the southeast Mediterranean area, infect about a billion people and manifest prevalently with anemia so that they are usually diagnosed mostly by experienced hematologist on blood or bone marrow smear. On the other hand, infections are also a significant problem in patients affected by hematological malignancies. The blood is the primary vector of HIV infection, which otherwise manifest with symptoms related to a reduction in T lymphocytes. In turn, infections can favor the insurgency of hematological malignancies. The causative relationship between Epstein-Barr virus infection, Helicobacter pylori, hepatitis C virus, HIV and lymphoproliferative diseases is well known.