Interaction of Iron Deficiency Anemia and Hemoglobinopathies Among College Students and Pregnant Women: A Multi Center Evaluation in India

Abstract

Although iron deficiency anemia is very common in India, systematic large studies on the prevalence and hematological consequences of iron deficiency among carriers of β-thalassemia (β-thal) and other hemoglobinopathies are lacking. A multi center project was undertaken to screen college/university students and pregnant women for iron deficiency anemia and various hemoglobinopathies. Fifty-six thousand, seven hundred and seventy-two subjects from six states, Maharashtra, Gujarat, Karnataka, West Bengal, Assam and Punjab, were studied. Iron deficiency anemia was evaluated by measuring zinc protoporphyrin (ZPP) and hemoglobin (Hb) levels, while β-thal and other hemoglobinopathies were detected by measuring the red cell indices and by Hb analysis using high performance liquid chromatography (HPLC). College boys (2.2%), college girls (14.3%) and antenatal women (27.0%) without any hemoglobinopathies had iron deficiency anemia. Among the β-thal carriers, the prevalence of iron deficiency anemia was 17.3% in college boys, 38.1% in college girls and 55.9% in pregnant women, while in the Hb E [β26(B8)Glu→Lys; HBB: c.79G>A] carriers, it was 7.3% in college boys, 25.4% in college girls and 78.0% in antenatal women. In individuals with Hb E disease, the prevalence of iron deficiency anemia varied from 31.2-77.3% in the three groups. A significant reduction in Hb levels was seen when iron deficiency anemia was associated with hemoglobinopathies. However, the Hb A2 levels in β-thal carriers were not greatly reduced in the presence of iron deficiency anemia.

HbA2: biology, clinical relevance and a possible target for ameliorating sickle cell disease

“…It is now clear that increased HbA 2 need not be an ‘invariable’ accompaniment of β‐thalassaemia trait. Thalassaemia trait patients who are iron deficient have slightly reduced but still elevated HbA 2 , although it remains possible that severe iron deficiency can at times reduce HbA 2 levels in β‐thalassaemia into a non‐diagnostic range (Verhovsek et al , ; Mohanty et al , ). Sometimes in β‐thalassaemia trait the HbA 2 is borderline or normal.…”

Iron status in chronic kidney disease patients

“…13 Anaemia is common in North-Eastern region of India. 14,15 The present study was done to evaluate the iron status in the CKD patients as iron deficiency is common in this region and this kind of study has not been done previously in this part of India.…”

Challenges in prenatal diagnosis of beta thalassaemia: couples with normal HbA2 in one partner

“…However several studies have shown that the HbA 2 levels in β-thalassaemia heterozygotes are not reduced so significantly to lead to a misdiagnosis of carriers of β-thalassaemia. 20,21 A β-thalassaemia mutation could not be identified in nine of the individuals with borderline/normal HbA 2 level; however five of them showed the presence of alpha gene triplication. Co-inheritance of a β-thalassaemia gene and α gene triplication can lead to a thalassaemia intermedia phenotype with a variable clinical presentation.…”

“…Associated iron deficiency anaemia can also lower HbA 2 levels, and iron deficiency is rampant in India. However several studies have shown that the HbA 2 levels in β ‐thalassaemia heterozygotes are not reduced so significantly to lead to a misdiagnosis of carriers of β ‐thalassaemia …”