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Using iron profile to identifyUsing iron profile to identifyanemia of chronic disease inanemia of chronic disease inanemic children withanemic children withtuberculosistuberculosis

dr. RANTI ADRIANI

JOURNAL READING



INTROD UC TION

y Anemia of chronic disease ( ACD) iscommonly found in patients with chronicinfection.

y ACD pathogenesis commonly referred

to as anemia of inflamationy Differentiate ACD from iron deficiencyanemia ( IDA) important, cause theyhave different in treatments.

backg round



y Few studies have been reportedy Profile iron less expensive, less invasivey B

one marrow iron gold standar, butinvasive and impracticaly O ther test (s TR) : expensive,not yet

applicable



y TB is a chronic infection disease indeveloped in developing countries.

y almost 80% childreny Indonesia third highesty Anemia in TB IDA, as malnutrition

commonly occury Recent research : ACD is more common

in TB patientsy Research on ACD in TB cases has not

been widely reported and is generallyperfomed on adult TB patients ratherthan children.



ME THODSME THODS

y To use iron profiles of children with TB inorder to determine the etiology of anemia and the prevalence of ACD

y Cross sectional study was done in CiptoM angunkusumo Hospital and Tebet HC

y September ² November 2010y Children with TB based on Paediatric TB

scoring system

O bjective



y

Anemia children having a hemoglobinvalue in the less than normal rangey Excluded criteria :

Treated with anti TB drugs for more 2months

Had received anti inflammatory drugs oriron supplementation

With other condition causing anemia With other chronic disease

M eth ods.. c on tinu e



y

Iron profile were measured at the ClinicalPathology Laboratory C M Hy Parameter tested :

SI,TIBC, transferin saturation, SF

C reaktif protein inflamation marker diagnosis childhood TB scoring system organ specific TB specialist consultant Type of anemia : Table 1

Statical analysis: SPSS 17,0Normally distrubuted data : M ean ( SD)Non Normally distrubuted data : median

(range )

M eth ods.. c on tinu e



RESULTRESULTy 81 children as sample of study, anemia

was found in 66 children.



M edian serumM edian serum ferritinferritin levels andlevels andmedian C RP wasmedian C RP was hingerhinger in thein the

organorgan spesificspesific TBTB



y O nly 10 children with below normalserum iron levels

y O nly 1 child was diagnosed with pureACD, while 5 children combinationanemia ( ACD and IDA)

y 9 % subject with ACD

R e sul t .. c on tinu enu e



DISCU SSIONDISCU SSIONy Profile of iron reserve obtained from

subject were not compared with actuallevel of iron the body shoud used thelatest technic

y Serum iron level in this study cannot helpdistinguish between ACD and IDA

y Normal TIB C levels may be due to fewsubject having ACD or combinationanemia



y Diagnosis of IDA should be considered in

subject group with lower serum ferritinlevely O rgan spesific TB patients had lower

serum iron levels, lower TIB C, similartransferin saturation, higher serum ferritinlevels and higher C RP levels thanchildhood TB patients

y O nly 9 % of subject with ACD smallerthan the result was reported in adult TB patients



y Patients taking more than 2 months

of anti TB drugs exlusion criteria of patients. This is caused have affectedthe result of the study possibility

that inflamation has subsided couldnot be ruled out

y This is the first study in Indonesia oniron profiles in anemic children withchronic infection disease.



y Result of this research should befollowed up correct diagnosis isimportantpatient management

y Iron deficiency in anemic child withTB should be proven before ironsuplementation is given, although theincidence of IDA is high in Indonesia



CON CLUSIONCON CLUSIONy M ost subjects had normal serum iron

levels, normal TIB C, low transferrinsaturation, normal serum ferritin levels.

y The proportion of ACD diagnosed byusing iron profile was not as high asprevious finding in adult TB patients

y Further research using newer technic isneeded to detect ACD in anemic childrenwith TB



THANK YOUTHANK YOU