[Transferrin microheterogeneity in patients treated by maintenance haemodialysis]. / Mikroheterogennosc transferyny u chorych leczonych powtarzana hemodializa.

Transferrin (Tf) plays a crucial role in iron transport in the human body. In physiologically status Tf occurs in four variants. The concentration of Tf and its variants is changing in several conditions, especially during acute phase response, which may take place in end-stage renal disease (ESRD). The aim of this study was the assessment of the associations between changes of glycosylation of transferrin and selected blood cell count and iron metabolism parameters in ESRD patients treated by maintenance hemodialysis (mHD) with long lasting anaemia despite treatment by rHuEPO. Studies were carried out on a group of 55 ESRD patients treated by HD (ESRD group). The reference values were obtained from a group of 20 healthy volunteers (HV group). The Tf concentration was determined by the rocket immunoelectrophoresis according to Laurell. To estimate the microheterogenity of Tf the crossed affinoimmunoelectrophoresis according to Bog-Hansen was used. The concentration of selected hematological variables, and selected liver metabolism variables was assessed by routine laboratory tests, while the concentration of cytokines was measured by ELISA method, and selected acute phase proteins, i.e. C-reactive protein, by immunonephelometry method. Tf in studied sera was divided into four variants Tf1, Tf2, Tf3, Tf4. The percentage contents of variants in HV was Tf1=4%, Tf2=9%, Tf3=82%, Tf4=4%. In the sera of ESRD group the percentage contents of the Tf1, Tf2, Tf4 variants increased to 9%, 16%, 10% respectively, while the Tf3 variant decreased to 65%. Serum concentration of Tf was lower (1441 +/- 526 mg/L) in ESRD patients (p<0.0001) vs. 3539 +/- 955 mg/L in HV group. During this study we have revealed that the quantity and the quality of Tf is changing in ESRD patients. The observed correlations between concentration of Tf3 and selected hematological variables and also between Tf3 and rHuEPO, suggests that the decrease concentration of the Tf3 may lead to an impaired iron transport to the cells and may be one of the factors affecting anaemia in patients treated by HD and rHuEPO.

Hemolytic drugs aniline and dapsone induce iron release in erythrocytes and increase the free iron pool in spleen and liver.

Incubation of rat erythrocytes with the hydroxylated metabolites of aniline and dapsone (4-4'-diaminodiphenylsulfone), phenylhydroxylamine and dapsone hydroxylamine, respectively, induced marked release of iron and methemoglobin formation. On the contrary, no release of iron nor methemoglobin formation was seen when the erythrocytes were incubated with the parent compounds (aniline and dapsone). The acute intoxication of rats with aniline or dapsone induced a marked increase in the erythrocyte content of free iron and methemoglobin, indicating that the xenobiotics are effective only after biotransformation to toxic metabolites in vivo. Prolonged administration of aniline or dapsone to rats produced continuous release of iron from erythrocytes. Marked iron overload was seen in the spleen and in the liver Kupffer cells, as detected histochemically. The spleen weight in these subchronically treated animals was significantly increased. The free iron pool was markedly increased in the spleen and to a lower extent in the liver. The possible relationships between iron release in erythrocytes, oxidative damage seen in senescent cells, hemolysis, overwhelmed capacity of spleen and liver to keep iron in storage forms and subsequent increase in low molecular weight, catalitically active iron is discussed.

Anaemia, iron-related measurements and erythropoietin levels in untreated patients with active leprosy.

The mechanisms responsible for anaemia in leprosy were studied prior to the institution of therapy in 56 patients with active disease. Haematological indices, iron-related measurements, inflammatory markers and erythropoietin levels were assessed, with bone-marrow studies being performed on anaemic patients. Anaemia was more common in the patients with lepromatous leprosy (85.7%) than it was in the rest of the group (19%). The lepromatous group exhibited the disordered iron transport of the anaemia of chronic disorders in that they had a significantly lower mean serum iron level (P less than 0.05), and a mildly raised serum ferritin concentration. Anaemic lepromatous patients also showed a blunted erythropoietin response compared with controls with non-inflammatory anaemia. A subgroup of five anaemic subjects displayed apparently adequate transport of iron to the erythroid marrow (normal percentage transferrin saturations and appropriate sideroblast counts) and the blunted erythropoietin response appeared to be the dominant factor in the pathogenesis of their anaemia. Analysis of inflammatory markers revealed that while the erythrocyte sedimentation rate was very high in the lepromatous subjects, there was no concomitant rise in C-reactive protein concentration. This suggests the presence of a disordered cytokine-mediated acute phase response in the condition.

Serum iron and total iron binding capacity in leprosy patients.

Serum Iron and total Iron binding capacity was estimated by Ramsay's Method in 40 leprosy patients having different types of leprosy and 20 normal subjects serving as controls. Significantly low serum Iron and total Iron binding capacity were observed in lepromatous leprosy patients.

Avaliaçäo da taxa de hemoglobina e ferro sérico em hansenianos virchovianos portadores de parasitas intestinais / Evaluation of hemoglobin rate and iron in lepromatous leprosy patients who are bearers of intestine parasites

Os autores estudaram dois grupos de pacientes com hanseníase virchoviana do Instituto Lauro de Souza Lima que tomavam diamino difenil sulfona (DDS) por mais de um ano. Um grupo além de portador de hanseníase era portador também de parasitas intestinais (Ancylostoma duodenalis s Etrongyloides stercoralis). A taxa de hemoglobina, o valor globular e a taxa de ferro sérico, nos dois grupos, foram inferiores às observadas em indivíduos sadios. No grupo de indivíduos portadores de parasitas intestinais, as taxas foram inferiores às observadas naqueles portadores somente de hanseníase

Undernutrition and lepromatous leprosy. III. Micronutrients and their transport proteins.

The present report is a continuation of our earlier studies on the complex interaction between undernutrition and leprosy. Serum levels of vitamins A and E, zinc and iron were determined in healthy control subjects and lepromatous leprosy patients belonging to an eastern state of India. Results indicated a significant lowering in the two above-mentioned fat-soluble vitamins and also a remarkable hypozincaemia in the patient group. However, serum iron levels were found to be comparable in both the groups. Also concentrations of vitamin A transport proteins such as retinol binding protein and prealbumin in sera of the lepromatous patients were significantly decreased in comparison with the control subjects. Of the two zinc-binding proteins, ie, serum albumin and alpha-2 macroglobulin, only the former was significantly reduced in the patient group. Surprisingly, though serum iron, transferrin and ferritin levels were similar in both the patient and control groups, the haemoglobin levels were significantly reduced in the lepromatous patients. The implications of these findings have been discussed. This is the first report describing the serum ferritin levels in lepromatous patients.

Serum trace elements and vitamin A in leprosy subtypes.

Serum zinc, copper, iron, and vitamin A levels were determined in patients with leprosy and healthy controls. Leprosy patients were classified according to the Ridley and Jopling classification and divided into two main groups as follows: tuberculoid, which consisted mainly of borderline tuberculoid patients and lepromatous, which consisted of borderline lepromatous and true lepromatous patients. The lepromatous group was found to have significantly lower serum levels of zinc and iron and elevated levels of copper. Vitamin A levels were also significantly lower in the lepromatous groups than in the tuberculoid group. Furthermore, the true lepromatous vitamin A determinations were significantly lower than those of the borderline lepromatous patients. The mechanism of these alterations in trace elements is probably due to a redistribution of these metals from the blood to various tissues; brought about by the release of leucocyte endogenous mediators by continuing phagocytosis of tissue macrophages in the lepromatous group of patients.

Serum iron and total iron binding capacity in leprosy patients.

Serum Iron and Total Iron Binding capacity were estimated on the sera collected from 45 leprosy patients attending the out-patient department of the Central JALMA Institute for Leprosy, Agra. The Sera from 15 healthy subjects were included in the study as controls. Hypoferraemia was observed in lepromatous leprosy and was particularly marked during the reactive phase. Further investigations to elucidate the pathogenesis of anaemia in leprosy are being planned.

Haematological profile in leprosy. Part II--Relationship to severity of disease and treament status.

321 adult male lepromatous leprosy patients were studied for relationship between haematological findings, severity of disease and duration of treatment. Significant changes were noticed in relation in haemoglobin concentration, serum vitamin B12 and serum folate levels, serum albumin and globulin. No significant changes were observed in serum iron levels in relation to disease and treatment status. With rising bacterial load, there was a trend towards lower haemoglobin concentration, higher vitamin B12 level and lowered serum folate levels. Serum albumin showed a significant decline, while serum globulin showed a significant rise. The findings are discussed in relation to replacement of bone marrow by lepromatous tissue as well as possible interference in the metabolism of haematinics by M. leprae. The exact mechanism of neurlogical deficit in leprosy in relation to deficiency of vitamin B12 and folic acid need to be further elucidated.

Haematological profile in leprosy. Part I--general findings.

Haematological studies in 904 adult leprosy patients with different types of leprosy, in various stages of the disease and treatment are described. Haemoglobin, packed cell volume, serum albumin and serum iron are significantly lower among lepromatous leprosy patients as compared with non-lepromatous patients. The serum B12 levels were significantly higher among the lepromatous group. Acid fast bacilli have been demonstrated in skin smear negative leprosy patients with indeterminate and tuberculoid leprosy, suggesting occurrence of bacillaemia in these groups of patients.