Neutropenia and Lymphocytopenia Among Arab Females with Iron Deficiency Anemia (IDA) and their Response to Iron therapy
IDA and cytopenia
Keywords:
Iron Deficiency Anemia (IDA), leukopenia, neutropenia, lymphocytopenia, iron metabolism, iron treatmentAbstract
. Introduction: The link between iron deficiency anemia (IDA) and neutropenia/ lymphocytopenia is not well established in the literature. This study aims at assessing the prevalence and clinical characteristics of neutropenia and lymphocytopenia in IDA patients considering the impact of iron replacement on the total and differential WBCs’ count.
Subjects and Methods: The records of all female patients with IDA who attended our hematology clinic (Jan 2018 to Jan 2020) were retrospectively reviewed. Patients with systemic or chronic diseases were excluded. Age, BMI, CBC, and iron parameters were collected before and after IV iron therapy. Results: Out of 1,567 adult females with IDA, 80 patients had leukopenia (5.1%), 64 had neutropenia (4.0%), and 20 had lymphocytopenia (1.2%). After iron therapy, their mean leukocytes, neutrophils, and lymphocytes increased significantly to 4.38 ± 1.82 ×103/L, 2.3 ±1.56 ×109/L and 1.76 ± 0.48 ×103/L, respectively. About 67% of women with IDA and neutropenia had increased ANC in response to iron therapy. However, no significant correlation was found between leukocytes, ANC, or lymphocytes with TIBC or serum iron concentration.
Conclusions: Neutropenia and/or lymphocytopenia may occur in patients with IDA and are reversible with iron therapy. Iron therapy led to the correction of anemia in 100% and increased ANC in 67%. Therefore, neutropenic women with IDA should be treated, initially only with iron, and observed for their Hb and ANC responses before starting any other treatment.
References
Muckenthaler MU, Rivella S, Hentze MW, Galy B. A red carpet for iron metabolism. Cell. 2017;168:344-61.
Shvartsman M, Bilican S, Lancrin C. Iron deficiency disrupts embryonic haematopoiesis but not the endothelial to haematopoietic transition. Sci Rep. 2019;9:1-12.
Wang S, He X, Wu Q, Jiang L, Chen L, Yu Y, et al. Transferrin receptor 1-mediated iron uptake plays an essential role in hematopoiesis. Haematologica. 2020;105:2071-82.
CDC. Iron deficiency--United States, 1999-2000. MMWR Morbidity and mortality weekly report. 2002;51(40):897.
UNICEF. WHO. Iron Deficiency Anemia Assessment, Prevention, and Control: A Guide for Programme Managers. 2001.
Fraser IS, Langham S, Uhl-Hochgraeber K. Health-related quality of life and economic burden of abnormal uterine bleeding. Exp Rev Obstetr Gynecol. 2009;4:179-89.
Organization WH. Iron deficiency anemia. assessment, prevention, and control. A guide for programme managers. 2001:47-62.
Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107:1747-50.
Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23:95-104.
Mast AE, Blinder MA, Gronowski AM, Chumley C, Scott MG. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem. 1998;44:45-51.
Wish JB. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol. 2006;1(Supplement 1):S4-S8.
Goddard AF, James MW, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60:1309-16.
Galloway MJ, Smellie WSA. Investigating iron status in microcytic anaemia. BMJ. 2006;333:791-3.
Basha A, Ibrahim MI, Hamad A, Chandra P, Omar NE, Abdullah MA, et al. Efficacy and cost effectiveness of intravenous ferric carboxymaltose versus iron sucrose in adult patients with iron deficiency anaemia. PloS one. 2021;16(8):e0255104.
Abdelmahmuod EA, Yassin MA. Iron Deficiency Anemia-Induced Lymphocytopenia in a Young Female. Case Rep Oncol. 2020;13:793-7.
Abdelmahmuod E, Yassin MA, Ahmed M. Iron Deficiency Anemia-Induced Neutropenia in Adult Female. Cureus. 2020;12(6) ):e8899.
Özdemir N, Celkan T, Kebudi R, Bor M, Yildiz I. Cytopenia associated with iron deficiency anemia and iron therapy: A report of two cases. Turk J Haematol. 2011;28:243-4.
Abuirmeileh A, Bahnassi A, Abuirmeileh A. Unexplained chronic leukopenia treated with oral iron supplements. Int J Clin Pharm. 2014;36:264-7.
Abdel-Razeq H, Radwi G, Khalil M, Bajouda A, Macalintal M. Parental Ferric Hydroxide Saccharate Therapy for Iron Deficiency Anemia: Safety and Efficacy. Am Soc Hematol. 2004;104: 3681.
Al-Dabbagh B, Shawqi S, Yasin J, Al Essa A, Nagelkerke N, Denic S. Half of the Emirati population has abnormal red cell parameters: challenges for standards and screening guidelines. Hemoglobin. 2014;38:56-9.
Alquaiz A-JM, Khoja TA, Alsharif A, Kazi A, Mohamed AG, Al Mane H, et al. Prevalence and correlates of anaemia in adolescents in Riyadh city, Kingdom of Saudi Arabia. Public Health Nutr. 2015;18:3192-200.
AlQuaiz AM, Gad Mohamed A, Khoja TA, AlSharif A, Shaikh SA, Al Mane H, et al. Prevalence of anemia and associated factors in child bearing age women in Riyadh, Saudi Arabia. Journal of nutrition and metabolism. 2013;2013.
Al-Sayes F, Gari M, Qusti S, Bagatian N, Abuzenadah A. Prevalence of iron deficiency and iron deficiency anemia among females at university stage. J Med Lab Diagn. 2011;2:5-11.
Denic S, Showqi S, Klein C, Takala M, Nagelkerke N, Agarwal MM. Prevalence, phenotype and inheritance of benign neutropenia in Arabs. BMC Blood Disord. 2009;9:3.
Weingarten MA, Pottick-Schwartz E, Brauner A. The epidemiology of benign leukopenia in Yemenite Jews. Isr J Med S. 1993;29:297-9.
Shoenfeld Y, Alkan ML, Asaly A, Carmeli Y, Katz M. Benign familial leukopenia and neutropenia in different ethnic groups. Eur J Haematol. 1988;41:273-7.
Jumean HG, Sudah FI. Chronic benign idiopathic neutropenia in Jordanians. Acta Haematologica. 1983;69:59-60.
Kaaba SA, Al Fadhli S, Burhamah M, Al Jafar H, Khamis A. Lymphocyte subsets in healthy adult Kuwaiti Arabs with relative benign ethnic neutropenia. Immunol Lett. 2004;91:49-53.
Lima CS, Paula EV, Takahashi T, Saad ST, Lorand-Metze I, Costa FF. Causes of incidental neutropenia in adulthood. Ann Hematol. 2006;85:705-9.
Jhamb R, Kumar A. Iron deficiency anemia presenting as pancytopenia in an adolescent girl. Int J Adolesc Med Health. 2011;23:73-4.
Kloub MN, Yassin MA. Oral Iron Therapy-Induced Neutropenia in Patient with Iron Deficiency Anemia. Case Rep Oncol. 2020;13:721-4.
Nairz M, Weiss G. Infections associated with iron administration. Met Ions Life Sci. 2019 Jan 14;19:/books.
Yadav D, Chandra J. Iron deficiency: beyond anemia.Indian J Pediatr. 2011;78:65-72.
Beard JL. Iron biology in immune function, muscle metabolism and neuronal functioning. J Nutr. 2001;131:568S-80S.
Ross AC. Impact of chronic and acute inflammation on extra-and intracellular iron homeostasis. Am J Clin Nutr. 2017;106 (Suppl.6):1581S-7S.
Chandra R. Reduced bactericidal capacity of polymorphs in iron deficiency. Arch Dis Child. 1973;48:864-6.
Jonker FA, van Hensbroek MB. Anaemia, iron deficiency and susceptibility to infections. J Infect. 2014;69:S23-S7.
Jonker FA, Te Poel E, Bates I, Boele van Hensbroek M. Anaemia, iron deficiency and susceptibility to infection in children in sub‐Saharan Africa, guideline dilemmas. Br J Haematol. 2017;177:878-83.
Chwang LC, Soemantri A, Pollitt E. Iron supplementation and physical growth of rural Indonesian children. Am J Clin Nutr. 1988;47:496-501.
Idjradinata P, Watkins WE, Pollitt E. Adverse effect of iron supplementation on weight gain of iron-replete young children. Lancet. 1994;343:1252-4.
Murray MJ, Murray AB, Murray MB, Murray C. The adverse effect of iron repletion on the course of certain infections. Br Med J. 1978;2:1113-5.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Mohamed Yassin, Hussam Almasri, Mustafa Al-Tikrity , Abdulqadir Nashwan, Ashraf Soliman
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.