Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-08T20:24:25.215Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of iron supplementation on mild to moderate anaemia in pulmonary tuberculosis

Published online by Cambridge University Press:  09 March 2007

Uma Devi ,
C. Mohan Rao ,
Vinod K. Srivastava ,
Pramod K. Rath  and
Bhabani S. Das
Uma Devi
Affiliation:
Departments of Chest and Tubercular Diseases, Pathology, and Biochemistry, Ispat General Hospital, Rourkela - 769 005, Orissa, India
C. Mohan Rao
Affiliation:
Departments of Chest and Tubercular Diseases, Pathology, and Biochemistry, Ispat General Hospital, Rourkela - 769 005, Orissa, India
Vinod K. Srivastava
Affiliation:
Departments of Chest and Tubercular Diseases, Pathology, and Biochemistry, Ispat General Hospital, Rourkela - 769 005, Orissa, India
Pramod K. Rath
Affiliation:
Departments of Chest and Tubercular Diseases, Pathology, and Biochemistry, Ispat General Hospital, Rourkela - 769 005, Orissa, India
Bhabani S. Das*
Affiliation:
Departments of Chest and Tubercular Diseases, Pathology, and Biochemistry, Ispat General Hospital, Rourkela - 769 005, Orissa, India
*
*Corresponding author:Dr B. S. Das, fax +91 661 2642703/ +91 661 2510085, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Anaemia is a common complication of pulmonary tuberculosis. The precise mechanism of anaemia in pulmonary tuberculosis is not clearly known, but anaemia of inflammation as well as of Fe deficiency has been implicated. Both are common in developing countries. It is extremely difficult to distinguish anaemia of Fe deficiency from anaemia of inflammation with the haematological indices used routinely. Therefore, Fe preparations are usually prescribed for all anaemic patients irrespective of the aetiology. This approach has been questioned. The present study aimed to assess the effect of Fe supplementation on anaemic patients with pulmonary tuberculosis. Adult male patients 15–60 years of age with pulmonary tuberculosis and a blood haemoglobin concentration 80–110 g/l were included in the study; healthy adult males matched for age and socio-economic status were taken as controls. Blood haemoglobin concentration, total erythrocyte count (TEC), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin and serum Fe, total Fe-binding capacity and ferritin were estimated before treatment and 1, 2 and 6 months after treatment. The patients were divided randomly into three groups and during the initial 2 months of treatment were provided with one of three supplementary regimens consisting of placebo, Fe alone or Fe with other haematinics. Significant improvements in haematological indices and Fe status were noticed in all three groups. Blood haemoglobin concentration, MCV and PCV were significantly higher at 1 month in both Fe-supplemented groups than the placebo group. This difference, however, disappeared at 2 and 6 months with similar values in all three groups. The increase of other haematological indices was similar in all groups. Serum Fe and Fe saturation of transferrin were significantly higher in both Fe-supplemented groups than the placebo group up to 2 months; this effect, however, disappeared at 6 months. There was a consistent increase in TEC and decrease in ferritin values up to 6 months in all groups. Radiological and clinical improvement was similar in all three groups. These observations suggest that Fe supplementation in mild to moderate anaemia associated with pulmonary tuberculosis accelerated the normal resumption of haematopoiesis in the initial phases by increasing Fe saturation of transferrin. However, consistent improvement of haematological status was dependent only on the improvement of the disease process.

Keywords

AnaemiaIronPulmonary tuberculosis
Type
Research Article
Information
British Journal of Nutrition , Volume 90 , Issue 3 , September 2003 , pp. 541 - 550
Copyright
Copyright © The Nutrition Society 2003

References

Abshire, TC (1996) The anaemia of inflammation: a common cause of childhood anaemia. Pediatr Clinics North America 43, 623–638.CrossRefGoogle Scholar
Andrews, NC (1999) Disorders of iron metabolism. New Eng J Med 341, 1986–1995.CrossRefGoogle ScholarPubMed
Baynes, RD, Flax, H, Bothwell, TH, et al. (1986 a) Haematological and iron related measurements in active pulmonary tuberculosis. Scand J Haematol 36, 280–287.CrossRefGoogle ScholarPubMed
Baynes, RD, Flax, H, Bothwell, TH, Bezwoda, WR, Atkinson, P & Mendelow, B (1986 b) Red blood cell distribution width in the anaemia secondary to tuberculosis. Am J Clin Pathol 85, 226–229.CrossRefGoogle ScholarPubMed
Baer, AN, Dessypris, EN & Krantz, SB (1990) The pathogenesis of anaemia in rheumatoid arthritis, a clinical and laboratory analysis. Semin Arthritis Rheum 14, 209–223.CrossRefGoogle Scholar
Bentley, DP & Williams, P (1982) Parenteral iron therapy in the anaemia of rheumatoid arthritis. Rheumatol Rehabil 21, 88–92.CrossRefGoogle ScholarPubMed
Bullen, JJ, Rogers, HJ & Griffiths, E (1978) Role of iron in bacterial infection. Curr Top Microbiol Immunol 80, 1–35.Google ScholarPubMed
Cavill, I & Bentley, DP (1982) Erythropoiesis in the anaemia of rheumatoid arthritis. Br J Haematol 50, 583–590.CrossRefGoogle ScholarPubMed
Dallman, PR, Reeves, JD, Driggers, DA & Lo, EYT (1981) Diagnosis of iron deficiency: the limitations of laboratory tests in predicting response to iron treatment in 1-year-old infants. J Pediatr 98, 376–381.CrossRefGoogle Scholar
Das, BS, Nanda, NK, Rath, PK, Satapathy, RN & Das, DB (1999) Anaemia in acute, Plasmodium falciparum malaria in children from Orissa state, India. Ann Trop Med Parasitol 93, 109–118.CrossRefGoogle ScholarPubMed
Das, BS, Thurnham, DI & Das, DB (1997) Influence of malaria on markers of iron status in children: implications for interpreting iron status in malaria-endemic communities. Br J Nutr 78, 751–760.CrossRefGoogle ScholarPubMed
DeMaeyer, EM (1989) Preventing and Controlling Iron Deficiency Anaemia through Primary Health Care: A Guide for Health Administrators and Programme Managers. Geneva: WHO.Google Scholar
Dhople, AM, Ibanez, MA & Poirier, TC (1996) Role of iron in the pathogenesis of Mycobacterium avium infection in mice. Microbiology 87, 77–87.Google ScholarPubMed
Douglas, SW & Adamson, JW (1975) The anaemia of chronic disorders: Studies of marrow regulation and iron metabolism. Blood 45, 55–65.CrossRefGoogle ScholarPubMed
Dussurget, O, Rodriguez, GM & Smith, I (1996) An ideR mutant of Mycobacterium smegmatis has a depressed siderophore production and an altered oxidative stress response. Mol Microbiol 22, 535–544.CrossRefGoogle Scholar
Ebrahim, O, Folb, PI, Robson, SC & Jacobs, P (1995) Blunted erythropoietin response to anaemia in tuberculosis. Eur J Haematol 55, 251–254.CrossRefGoogle ScholarPubMed
Fitzsimons, E & Govostis, M (1986) Changes in serum iron and ferritin concentrations associated with surgery. Clin Chem 32, 201.CrossRefGoogle ScholarPubMed
Fleck, A & Myers, MA (1985) Diagnostic and prognostic significance of acute phase proteins. In The Acute Phase Response to Injury and Infection, pp. 249–271 [Gordon, AH and Koj, A, editors]. Amsterdam: Elsevier Science Publishers.Google Scholar
Gobin, J, Moore, CH, Reeve, JR, Wong, DK, Gibson, BW & Horwitz, MA (1995) Iron acquisition by Mycobacterium tuberculosis: Isolation and characterization of a family of iron-binding exochelins. Proc Natl Acad Sci USA 92, 5189–5193.CrossRefGoogle ScholarPubMed
Goldenberg, AS (1996) Haematological abnormalities and mycobacterial infections. In Tuberculosis, pp. 645–652 [Rome, WN and Garay, S, editors]. Boston, MA: Little Brown and Company.Google Scholar
Gomes, MS, Dom, G, Pedrosa, J, Boelaert, JR & Appelberg, R (1999) Effect of iron deprivation on Mycobacterium avium growth. Tuber Lung Dis 79, 321–328.CrossRefGoogle ScholarPubMed
Harju, E, Pakarinen, A & Larmi, T (1984) A comparison between serum ferritin concentration and the amount of bone marrow stainable iron. Scand J Clin Lab Invest 44, 555–556.CrossRefGoogle ScholarPubMed
Henderson, A (1984) Ferritin levels in patients with microcytic anaemia complicating pulmonary tuberculosis. Tubercle 65, 185–189.CrossRefGoogle ScholarPubMed
Hercberg, S, Galan, P & Dupin, H (1987) Iron deficiency in Africa. World Review Nut Diet 54, 201–236.CrossRefGoogle ScholarPubMed
Jurado, RI (1997) Iron, infection, and anaemia of inflammation. Clin Infect Dis 25, 888–895.CrossRefGoogle Scholar
Lipschitz, DA, Cook, JD & Finch, CA (1974) A clinical evaluation of serum ferritin as an index of iron status. New Eng J Med 290, 1213–1216.CrossRefGoogle Scholar
Lombard, EH & Mansvelt, EP (1993) Haematological changes associated with milliary tuberculosis of bone marrow. Tuber Lung Dis 74, 131–135.CrossRefGoogle Scholar
Lounis, N, Truffot-Pernot, C, Grosset, J, Gordeuk, VR & Boelaert, JR (2001) Iron and mycobacterium tuberculosis infection. J Clin Virol 20, 123–126.CrossRefGoogle ScholarPubMed
National Tuberculosis, Association of USA (1961) Diagnostic Standards and Classification of Tuberculosis. New York: National Tuberculosis Association.Google Scholar
Punnonen, K, Irjala, K & Rajamaki, A (1994) Iron deficiency anaemia is associated with high concentrations of transferrin receptor in serum. Clin Chem 40, 774–776.CrossRefGoogle ScholarPubMed
Rafael, LJ (1997) Iron, infection and anaemia of inflammation. Clin Infect Dis 25, 888–895.Google Scholar
Robert, T & Means, JR (1999) The Anaemia of Chronic Disorders. In Wintrobe's Clinical Haematology, pp. 979–1010 [Lee, R and Foerster, J, editors]. Baltimore, OH: Willams and Wilkins.Google Scholar
Rodriguez, GM, Gold, B, Gomez, M, Dussurget, O & Smith, I (1999) Identification and characterization of two divergently transcribed iron regulated genes. Tuber Lung Dis 79, 287–298.CrossRefGoogle ScholarPubMed
Taylor, PG, Martinez-Torres, C & Mendez-Castellano, H, et al. (1993) The relationship between iron deficiency and anaemia in Venezuelan children. Am J Clin Nutr 58, 215–218.CrossRefGoogle ScholarPubMed
van den Broek, NR & Letsky, EA (2000) Etiology of anaemia in pregnancy in south Malawi. Am J Clin Nutr 72, Suppl., 47s–56s.CrossRefGoogle ScholarPubMed
Weinberg, E (1978) Iron and infection. Microbiol Rev 42, 45–66.CrossRefGoogle ScholarPubMed
Wessels, G, Schaaf, HS, Beyers, N, Gie, RP, Nel, E & Donald, PR (1999) Haematological abnormalities in children with tuberculosis. J Trop Pediatr 45, 307–310.CrossRefGoogle ScholarPubMed