Journal reading

Oleh :
Karunia Dias Bhaskoro
 BACKGROUND

• Inflammatory bowel disease (IBD) describes a set of chronic gastrointestinal

illnesses of multifactorial etiology, including Crohn’s disease (CD) and
ulcerative colitis (UC), characterized by periods of remission and relapse.
• Anemia is a common complication of IBD and key contributing factors are
iron deficiency, related to blood loss and iron malabsorption, and
inflammation, as in anemia of chronic disease (ACD).
• Anemia manifests in approximately one-third of IBD patients and iron
deficiency is the main cause of anemia, occurring in about 60–80% of
anemic patients.
• A common problem for clinicians taking care of IBD patients is to diagnose
the type of anemia and to determine the degree of iron deficiency and
inflammation in each patient, in order to decide on the best management of
the condition in view of each individual’s real iron requirements.
 BACKGROUND

• In conditions associated with inflammation, biochemical parameters alone

could be inadequate for assessing iron status.
• Functional iron deficiency (FID) is a state in which, despite apparently
adequate body stores, the availability of iron for erythroid precursors in the
bone marrow is insufficient to meet the requirements of erythropoiesis: this is
the major feature of ACD.
• MCHr is recognized as a reliable marker of FID and current iron supply for
erythropoiesis.
• A MCHr value of 29 pg is recommended (evidence level B) as indicative of the
adequacy of iron incorporation into developing red cells, while MCHr <29 pg
predicts
FID in patients receiving ESA therapy and predicts iron-restricted
erythropoiesis in patients with iron deficiency anemia.
Aim

• Investigating the diagnostic performance of MCHr measured with a

CELL-DYN Sapphire analyzer in the assessment of erythropoiesis in
IBD
 Method : Patients

• In a 4-months period initially recruited all patients with IBD and anemia
followed up at the Gastroenterology Department at Galdakao-Usansolo
Hospital, and then applied the following exclusion criteria
• The usual laboratory tests were requested as part of the routine check-up of
outpatients; no changes were made to drug doses, tests requested or visits to
clinicians.
• Blood samples were collected in K2 EDTA anticoagulant tubes, and were run in
the CELL-DYN analyzer within 6 h of collection. Serum iron, transferrin,
transferrin saturation (TSAT) and ferritin and were measured in a Cobas c702
clinical chemistry analyzer with Tina-quant reagents.
Method Subject : Patient at the
Gastroenterology
Department at
Galdakao-Usansolo
Hospital

Inclusion Exclusion

pregnancy, thalassemia carrier,

all patients with IBD kidney disease, and
and anemia hospital admission in the
previous 3 months
 Method : Statistical analysis
• A descriptive analysis was initially performed: median and interquartilic range
for continuous variables and frequencies and percentages for categorical data.
The normality of the distribution of the data under study was investigated
with the
Kolmogorov–Smirnoff test.
• Differences among groups were assessed using analysis of variance (ANOVA)
and Mann–Whitney U test. Additionally, the Scheffé post-hoc test was
performed to assess pairwise diagnostic group comparisons, considering P <
0.05 to be significant.
• the receiver operating characteristic (ROC) curve analysis was used to assess
the diagnostic performance of MCHr for detecting iron-deficient
erythropoiesis. The reference measurement used as an indicator of
insufficient iron availability was TSAT <20%, the parameter traditionally used
to assess iron availability
Results
Results
Results
• Using MCHr <30.3 pg as a criterion, we were able to diagnose 70.6%
of the patients as having iron-restricted erythropoiesis; in contrast,
when ferritin <30 pg/L was the criterion, we were only able to
establish iron-restricted erythropoiesis in 47.8% of the patients.
 Discussion
• Anemia is the most prevalent extra-intestinal complication of IBD and
can substantially affect the quality of life of patients with this disease.
• In a population with a predisposition to anemia, like IBD patients, early
diagnosis and management of iron deficiency can, improve quality of life,
reduce losses in productivity, and ultimately result in lower health care costs
• Common and complicated problems that clinicians face when taking care of
IBD patients are to diagnose the type of anemia present in a given individual
and to determine the degrees of iron deficiency and of inflammation in order
to make a decision on how best to manage the anemia
• New indices of iron metabolism that may help to improve the
assessment of iron status in patients with IBD include: hepcidin,
soluble transferrin receptor, Zn-protoporphyrin, hypochromic red
cells and reticulocyte indices
• A negative balance between iron requirements and iron supply
decreases the availability of iron for hemoglobinization and results in
a reduction in MCHr and in an increase in the number of
hypochromic reticulocytes, which later mature into hypochromic
erythrocytes.
Conclusion

• Our conclusion is that MCHr as reported by the CELL-DYN Sapphire

analyzer could be useful for assessing FID In conjunction with
standard parameters, and thereby aid the management of anemia in
IBD patients, enabling the rapid and accurate identification of
patients who are likely to benefit from iron therapy.
• Assessing iron deficiency including MCHr is simple, inexpensive, rapid
and practical, it being measured as a by-product of routinecomplete
blood count at little incremental cost in the same blood sample.