Diagnostic utility of low hemoglobin density to detect iron deficiency in patients with inflammatory bowel disease

Farrag, Karima; Ademaj, Krenare; Leventi, E; Aksan, A; Stein, Jürgen M.

doi:10.20524/aog.2021.0622

Cited by 3 publications

(3 citation statements)

References 40 publications

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“…Thus, both infliximab and adalimumab act directly against TNF-α to suppress inflammatory process and are reported to improve iron metabolism through modulation of a cytokine network involving hepcidin and IL-6 [18]. Of interest, MCHC, a possible marker for iron availability during erythropoiesis, [ 29 , 30 ] is elevated by BP, but not by L/G-CAP (Fig. 4 B).…”

Section: Discussionmentioning

confidence: 99%

Sustained effect of leukocytapheresis/granulocytapheresis versus anti-human TNF-α monoclonal antibody on ulcerative colitis: A 2-year retrospective study

Sakai¹,

Hayashi

Ito³

et al. 2023

Medicine

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Although anti-tumor necrosis factor-α monoclonal antibody biological preparations (BP) agents are widely used as an established treatment tool for refractory ulcerative colitis (UC), whether leukocytapheresis/granulocytapheresis (L/G-CAP) has similar beneficial impact on the disease activity remains undetermined. Furthermore, the costs defrayed for the treatment with these 2 modalities have not been compared. We retrospectively evaluated whether L/G-CAP offered sustained beneficial effects over 2-year period. The patients who had moderately to severely active UC (Rachmilewitz clinical activity index (CAI) ≧ 5) and were treated with a series (10 sessions) of L/G-CAP (n = 19) or BP (n = 7) as an add-on therapy to conventional medications were followed. Furthermore, the cost-effectiveness pertaining to the treatment with L/G-CAP and BP was assessed over 12 months. At baseline, L/G-CAP and BP groups manifested similar disease activity (CAI, L/G-CAP; 7.0 [6.0–10.0], BP; 10.0 [6.0–10.0], P = .207). The L/G-CAP and BP treatment suppressed the activity, with CAI 1 or less attained on day 180. When the L/G-CAP group was dichotomized into L/G-CAP-high and L/G-CAP-low group based on CAI values (≥3 or < 3) on day 365, CAI was gradually elevated in L/G-CAP-high group but remained suppressed in L/G-CAP-low group without additional apheresis for 2 years. Anemia was corrected more rapidly and hemoglobin levels were higher in BP group. The cost of the treatment with L/G-CAP over 12 months was curtailed to 76% of that with BP (1.79 [1.73–1.92] vs 2.35 [2.29–3.19] million yen, P = .028). L/G-CAP is as effective as BP in a substantial number of patients over 2 years. The cost for the treatment of UC favors L/G-CAP although the correction of anemia may prefer BP. Thus, L/G-CAP can effectively manage the disease activity with no additional implementation for 2 years although further therapeutic modalities might be required in a certain population with high CAI observed on day 365.

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Section: Discussionmentioning

confidence: 99%

Sustained effect of leukocytapheresis/granulocytapheresis versus anti-human TNF-α monoclonal antibody on ulcerative colitis: A 2-year retrospective study

Sakai¹,

Hayashi

Ito³

et al. 2023

Medicine

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“…In a study of a paediatric population, Osta et al 16 have reported the optimal cut‐off point of 6% for LHD with the same sensitivity of 80% and better specificity of 88%. Farrag et al 33 have demonstrated that LHD is reliable biomarker of ID in patients with inflammatory bowel disease and anaemia, regardless of whether inflammation is present, proposing cut‐off of 3.8 with sensitivity of 82% and specificity of 85%.…”

Section: Discussionmentioning

confidence: 99%

Iron deficiency in nonanaemic COPD patients—Could Low haemoglobin density and Microcytic anaemia factor be usefull?

Trtica

Milenković

Janković

et al. 2023

Int J Lab Hematology

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Introduction: Erythrocyte indices LHD and Maf are complementary parameters to complete blood count and have been shown as reliable iron deficiency markers in different clinical settings. The aim of the study was to assess diagnostic performances of LHD and Maf in detecting iron deficiency in nonanaemic stable COPD patients.Methods: A total of 93 nonanaemic stable COPD patients were classified as either iron deficient (ID, N = 15) or non-iron deficient (non-ID, N = 78). Iron deficiency was defined as a ferritin level < 100 μg/L with a transferrin saturation (TSAT) <20%.A complete blood count, including LHD and Maf as well as other relevant inflammation and iron status parameters were obtained for all participants.Results: Both LHD and Maf have shown significant differences between the ID and non-ID group with p = .003 and p = .007 respectively. The AUC for LHD was .744 (95% CI: .626-.863, p = .003) with the best cut-off of 5.85 and sensitivity of 80% (95% CI: 76.0-84.0) and specificity of 61.5% (95% CI: 58.4-64.6). The AUC for Maf was .707 with optimal cut-off value 12.65 and sensitivity of 83.3% (95% CI: 79.1-87.5) and specificity of 60.0% (95% CI: 57.0-63.0). Furthermore, LHD performance was not affected by vitamin B12 status.Conclusion: LHD and Maf are useful for iron deficiency diagnosis in stable COPD patients. LHD was shown to be resistant to vitamin B12 deficiency, which is of substantial importance in specific patient subpopulations. Both parameters are not technology-dependant and do not require additional sample and/or reagent volume, which makes them cost-effective and convenient for everyday use.

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“…Thus, both in iximab and adalimumab act directly against TNF-α to suppress in ammatory process and are reported to improve iron metabolism through modulation of a cytokine network involving hepcidin and IL-6 [18]. Of interest, MCHC, a possible marker for iron availability during erythropoiesis [29,30], is elevated by BP, but not by L/G-CAP (Fig 4B). In contrast, L/G-CAP, which methodologically requires extracorporeal circulation, might more or less decreases blood hemoglobin levels [31,32] though it also acts to improve anemia through stabilization of the disease activity.…”

Section: Sustained E Cacy Of L/g-capmentioning

confidence: 99%

Sustained effect of leukocytapheresis/granulocytapheresis versus anti-human TNF-α monoclonal antibody on ulcerative colitis - a 2-year retrospective study -

Sakai¹,

Hayashi

Ito³

et al. 2022

Preprint

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Background: Although anti-TNF-α monoclonal antibody (BP) agents are widely used as an established treatment tool for refractory ulcerative colitis (UC), whether leukocytapheresis/granulocytapheresis (L/G-CAP) has similar beneficial impact on the disease activity remains undetermined. Furthermore, the costs defrayed for the treatment with these two modalities have not been compared. Methods: We retrospectively evaluated whether L/G-CAP offered sustained beneficial effects over 2-year period. The patients who had moderately to severely active UC (Rachmilewitz Clinical Activity Index (CAI)≧5) and were treated with a series (10 sessions) of L/G-CAP (n=19) or BP (n=7) as an add-on therapy to conventional medications were followed. Furthermore, the cost-effectiveness pertaining to the treatment with L/G-CAP and BP was assessed over 12 months. Results: At baseline, L/G-CAP and BP groups manifested similar disease activity (CAI, L/G-CAP; 7.0 [6.0-10.0], BP; 10.0 [6.0-10.0], p=0.207). The L/G-CAP and BP treatment suppressed the activity, with CAI 1 or less attained on day 180. When the L/G-CAP group was dichotomized into L/G-CAP-high and L/G-CAP-low group based on CAI values (≥3 or <3) on day 365, CAI was gradually elevated in L/G-CAP-high group but remained suppressed in L/G-CAP-low group without additional apheresis for two years. Anemia was corrected more rapidly and hemoglobin levels were higher in BP group. The cost of the treatment with L/G-CAP over 12 months was curtailed to 76% of that with BP (1.79 [1.73-1.92] vs. 2.35 [2.29-3.19] million yen, p=0.028). Conclusions: L/G-CAP is as effective as BP in a substantial number of patients over two years. The cost for the treatment of UC favors L/G-CAP although the correction of anemia may prefer BP. Thus, L/G-CAP can effectively manage the disease activity with no additional implementation for two years although further therapeutic modalities might be required in a certain population with high CAI observed on day 365. Trial registration: This study is a retrospective analysis evaluating the long-term efficacy of L/G-CAP and anti-TNF-α monoclonal antibody agents on the disease activity during a total of two years, and also assessing the costs of the treatment for UC over 12-month period (UMIN trial No. 000036954). The study was approved by the Ethics Committee of Tokyo Bay Urayasu Ichikawa Medical Center (Chiba, institutional approval No. 376) and Keiyu Hospital (Yokohama, Kanagawa, institutional approval No. R3-26) with waiver of the requirement for obtaining informed consent, and was conducted in accordance with the Declaration of Helsinki. Information from medical records was anonymized and de-identified prior to final analysis.

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Diagnostic utility of low hemoglobin density to detect iron deficiency in patients with inflammatory bowel disease

Cited by 3 publications

References 40 publications

Sustained effect of leukocytapheresis/granulocytapheresis versus anti-human TNF-α monoclonal antibody on ulcerative colitis: A 2-year retrospective study

Sustained effect of leukocytapheresis/granulocytapheresis versus anti-human TNF-α monoclonal antibody on ulcerative colitis: A 2-year retrospective study

Iron deficiency in nonanaemic COPD patients—Could Low haemoglobin density and Microcytic anaemia factor be usefull?

Sustained effect of leukocytapheresis/granulocytapheresis versus anti-human TNF-α monoclonal antibody on ulcerative colitis - a 2-year retrospective study -

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