Severe Anemia in Malawian Children

Calis, Job C. J.; Phiri, Kamija S.; Faragher, E. B.; Brabin, Bernard; Bates, Imelda; Cuevas, Luís E.; Haan, Rob J. de; Phiri, Ajib; Malange, Pelani; Khoka, Mirriam; Hulshof, P.J.M.; Lieshout, Lisette van; Beld, Marcel; Teo, Yik Ying; Rockett, Kirk A.; Richardson, Anna; Kwiatkowski, Dominic P.; Molyneux, Malcolm E.; Hensbroek, Michaël Boele van

doi:10.1056/nejmoa072727

Cited by 389 publications

(435 citation statements)

References 79 publications

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“…Even in children with severe anaemia (haemoglobin concentration <50 g/l), there is no evidence of folate deficiency, and severe anaemia is not associated with plasma folate concentrations (Calis et al , 2008). …”

Section: Evidence Of Folate Deficiencymentioning

confidence: 99%

Safety and benefits of interventions to increase folate status in malaria‐endemic areas

et al. 2017

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SummaryFor decades, folic acid has routinely been given to prevent or treat anaemia in children, pregnant women and people with sickle cell disease. However, there is no conclusive evidence that folate deficiency anaemia constitutes a public health problem in any of these groups. Industrial flour fortification is recommended and implemented in many countries to combat neural tube defects. Dietary folates or folic acid can antagonise the action of antifolate drugs that play a critical role in the prevention and treatment of malaria. Randomised trials have shown that folic acid supplementation increases the rate of treatment failures with sulfadoxine‐pyrimethamine. The efficacy of antifolate drugs against Plasmodium is maximized in the absence of exogenous folic acid, suggesting that there is no safe minimum dose of ingested folic acid. We here review the safety and benefits of interventions to increase folate status in malaria‐endemic countries. We conclude that formal cost‐benefit analyses are required.

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Section: Evidence Of Folate Deficiencymentioning

confidence: 99%

Safety and benefits of interventions to increase folate status in malaria‐endemic areas

et al. 2017

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“…4 This raises the possibility of development of a POC device for non-invasive diagnosis of iron deficiency, which could be very useful in the blood donation setting. A POC test could also be of value in developing countries where high burdens of anemia are attributable to iron deficiency and infectious diseases such as malaria, 37 and where targeted therapy (iron supplementation or antimicrobials) for the anemia is advisable. 38 A potential limitation of this approach is the higher pre-analytical variability associated with urine (as compared with serum) hepcidin measurements.…”

Section: S-r Pasricha Et Almentioning

confidence: 99%

Serum hepcidin as a diagnostic test of iron deficiency in premenopausal female blood donors

Pasricha¹,

McQuilten²,

Westerman³

et al. 2011

Haematologica

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BackgroundCurrently used indicators of iron status have limitations. Hepcidin, a key regulator of iron metabolism, is reduced in iron deficiency. We sought to determine the properties of hepcidin as a diagnostic test of iron deficiency. Design and MethodsSera from female, non-anemic, whole blood donors were analyzed for hepcidin (enzymelinked immunosorbent assay), ferritin, soluble transferrin receptor and C-reactive protein. Iron deficiency was defined as (i) serum ferritin less than 15 ng/mL or (ii) soluble transferrin receptor /log(ferritin) index greater than 3.2 if the C-reactive protein concentration was less than 10 mg/L, or greater than 2.2 if the C-reactive protein concentration was greater than 10 mg/L). Receiver operating characteristic curves were plotted to determine the overall utility and identify optimal cut-points of hepcidin as a test of iron deficiency. ResultsIn 261 blood donors the prevalence of iron deficiency defined by ferritin concentration was 59/261 [22.6% (17.5, 27.7)], whereas defined by soluble transferrin receptor/log(ferritin) index it was 53/261 [20. 4% (15.4, 25.2)]. The 95% reference range of hepcidin concentration in the iron-replete population was 8.2-199.7 ng/mL. The area under the receiver operating characteristic curve for hepcidin compared with ferritin concentration less than 15 ng/mL was 0.87 (0.82, 0.92), while that compared with the soluble transferrin receptor /log(ferritin) index was 0.89 (95% CI 0.84, 0.93). For a diagnosis of iron deficiency defined by the soluble transferrin receptor/log(ferritin) index, hepcidin less than 8 ng/mL had a sensitivity of 41.5% and a specificity of 97.6%, while hepcidin less than 18 ng/mL had a sensitivity of 79.2% and a specificity of 85.6%. ConclusionsSerum hepcidin concentration may be a useful indicator of deficient iron stores. Further studies are required to evaluate the role of hepcidin in the diagnosis of iron deficiency in other groups of patients.

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“…Epidemiological studies (Calis et al, 2008;George et al, 2012), and early nutrition-based animal models (Hodges et al, 1978) found a strong association of vitamin A deficiency with anaemia in humans. Indeed, anaemia associated with nutritional deficiencies including vitamin A deficiency is a serious health problem, especially in developing countries.…”

mentioning

confidence: 99%

Erythroid‐extrinsic regulation of normal erythropoiesis by retinoic acid receptors

et al. 2013

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Vitamin A and its derivatives (retinoids) are important regulators of haematopoiesis, acting via retinoic acid receptors (RARs). Epidemiological studies indicated an association of vitamin A deficiency with anaemia in humans. To define the requirements of RARs in erythropoiesis, we evaluated erythroid parameters in RAR germline deficient and conditional knock out mice with erythroid specific deletion of RARs. Adult RARc À/À mice were anaemic, however, Epor-Cre Rara fl/fl , Epor-Cre Rarg fl/fl and Epor-Cre Rara fl/fl g fl/fl mice were normal, indicating a lack of an erythroid intrinsic RAR function. Therefore, erythroid-specific RAR function is dispensable for erythropoiesis and RARc plays an erythroid extrinsic role in erythropoiesis.

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Severe Anemia in Malawian Children

Abstract: There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered.

Cited by 389 publications

References 79 publications

Safety and benefits of interventions to increase folate status in malaria‐endemic areas

Safety and benefits of interventions to increase folate status in malaria‐endemic areas

Serum hepcidin as a diagnostic test of iron deficiency in premenopausal female blood donors

Erythroid‐extrinsic regulation of normal erythropoiesis by retinoic acid receptors

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