Functional iron deficiency in patients on hemodialysis: prevalence, nutritional assessment, and biomarkers of oxidative stress and inflammation / Deficiência funcional de ferro em pacientes em hemodiálise: prevalência, avaliação nutricional e de biomarcadores de estresse oxidativo e de inflamação

Abstract Introduction: Anemic patients with chronic kidney disease (CKD) can be divided into anemic patients without or with functional iron deficiency (FID). The increase in the number of cases of hemosiderosis in patients on hemodialysis (HD) attributed to excessive intravenous iron replacement has called for the investigation of the factors involved in the genesis of FID. Objectives: This study aimed to describe the prevalence of FID in patients with CKD on HD, characterize the included individuals in terms of clinical and workup parameters, and assess their nutritional, oxidative stress, and inflammation statuses. This cross-sectional study assembled a convenience sample of 183 patients with CKD on HD treated in Southern Brazil. Patients meeting the inclusion and exclusion criteria were divided into two groups, one with anemic subjects with FID and one with anemic patients without FID. Participants answered a questionnaire probing into socio-epidemiological factors, underwent anthropometric measurements, and were tested for markers of anemia, oxidative stress, inflammation, and nutrition. Statistical analysis: The date sets were treated on software package GraphPad InStat version 3.1. Variables were tested with the Kolmogorov-Smirnov, chi-square, Student's t, and Mann-Whitney tests. Statistical significance was attributed to differences with a p < 0.05. Results: Markers of inflammation were not statistically different between the two groups. Markers of anemia and nutrition were significantly lower in patients with FID. Patients with FID were prescribed higher doses of parenteral iron (p < 0,05). Discussion: FID was associated with lower nutritional marker levels, but not to increased levels of markers of inflammation or oxidative stress, as reported in the literature. Additional studies on the subject are needed.

Resumo Introdução: A anemia na DRC pode ser dividida em anemia sem deficiência funcional de ferro e com deficiência funcional de ferro (ADFF). Diante do aumento dos casos de hemossiderose em pacientes em hemodiálise, atribuídos à reposição excessiva de ferro endovenoso, maiores conhecimentos sobre os fatores envolvidos na gênese da ADFF são importantes. Objetivos: documentar a prevalência de ADFF em renais crônicos em hemodiálise. Caracterizar clínica e laboratorialmente os portadores de ADFF em HD e avaliar o estado nutricional, estresse oxidativo e inflamatório. Estudo transversal, amostra de conveniência, envolvendo 183 renais crônicos em hemodiálise no sul do Brasil. Após aplicação dos critérios de exclusão, os pacientes foram separados em dois grupos: portadores de anemia com e sem deficiência funcional de ferro. Foram submetidos a questionário socioepidemiológico, à análise antropométrica e análise laboratorial dos marcadores de anemia, estresse oxidativo, inflamatórios e nutricionais. Análise estatística: programa GraphPad InStat versão 3.1. Foram aplicados os testes: Kolmogorov-Smirnov, qui-quadrado, t de Student e Mann-Whitney. Nível de significância adotado de 5%. Resultados: não houve diferença significativa nos marcadores inflamatórios entre os dois grupos. Houve diferença significativa nos marcadores de anemia e nutrição, significativamente menores nos pacientes com ADFF. Pacientes com ADFF receberam doses mais elevadas de ferro parenteral (p < 0,05). Discussão: ADFF esteve associada a menores valores de marcadores nutricionais, mas não esteve associada a marcadores inflamatórios ou de estresse oxidativo aumentados, como relatado na literatura. Estudos adicionais sobre o tema são necessários.

Guía de práctica clínica para el diagnóstico y manejo de la anemia en pacientes con enfermedad renal crónica / Clinical practice guideline for the diagnosis and management of anemia in patients with chronic kidney disease

La Guía de Práctica Clínica (GPC) tratará sobre la el diagnóstico y manejo de la anemia asociada a ERC en el paciente adulto, en el ámbito de todos los niveles de atención, servicios o unidades que presten servicios de a pacientes con Enfermedad Renal Crónica, en lo que corresponda a cada nivel.

Abordaje multidimensional de la anemia por deficiencia de hierro en niños menores de dos años de edad del Noreste Argentino: Años 2004-2005 / Multidimensional approach to iron deficiency anemia in infants younger than two years old in Northeast Argentina: 2004-2005

Introducción. La prevalencia de anemia por déficit de hierro (ADH) es alta en niños menores de dos años, especialmente en poblaciones carenciadas. Objetivo. Estudiar algunos determinantes sociales y biológicos que se asocian con la ADH en niños de 12 a 23,9 meses de edad de la región del Noreste Argentino durante los años 2004-2005. Metodología. Diseño transversal. Las variables explicativas fueron organizadas en tres niveles: distal (asistencia alimentaria, necesidades básicas insatisfechas, cobertura médica del j efe de hogar), intermedio (lactancia materna, suplementación con hierro y consumo de hierro) y proximal (estado nutricional, edad gestacional, peso al nacer, edad y sexo). La asociación entre las variables seleccionadas y ADH (Hb < 11 g/dl, ferritina < 12 ng/dl, glóbulos blancos < 15 000 ml) fue examinada con modelos de regresión logística con selecciónjerárquica de las variables. Resultados. La falta de asistencia alimentaria -#91;OR 1,85 (1,14; 3,02)-#93; y el consumo inadecuado de hierro -#91;OR 2,60 (1,18; 5,71)-#93; fueron asociados a ADH. Cuanto menor la edad gestacional -#91;OR 0,89 (0,81; 0,97)-#93; y menor la edad en meses -#91;OR 0,90 (0,84; 0,96)-#93;, mayor la prevalencia de anemia. Conclusiones. Este estudio pone en evidencia la estrecha y compleja relación entre los determinantes sociales y una enfermedad altamente prevalente en niños pequenos, como la anemia. Los programas de asistencia alimentaria tendrían un efecto protector sobre la ADH; el consumo de alimentos fortificados mejoraría la ingesta de hierro en los niños menores de dos años de edad. Se resalta, además, la necesidad de realizar evaluaciones del impacto de las políticas sobre la salud de la población.

Introduction. The prevalence of iron deficiency anemia (IDA) is high among infants younger than two years old, especially in disadvantaged populations. Objective. To study certain social and biological determinants associated with IDA in children aged 12 to 23.9 months old in Northeast Argentina in the 2004-2005 period. Methodology. Cross-sectional design. Explanatory outcome measures were organized in three levels: distal (food assistance, unmet basic needs, and head of household with medical coverage), intermediate (breastfeeding, iron supplementation, and iron intake), and proximal (nutritional status, gestational age, birth weight, age, and sex). The association between selected outcome measures and IDA (Hb< 11 g/dL, ferritin < 12 ng/dL, WBCs < 15 000/mL) was assessed using logistic regression models withhierarchical selection of outcome measures. Results. Lack of food assistance (OR: 1.85 -#91;1.14, 3.02-#93;) and inadequate iron intake (OR: 2.60 -#91;1.18, 5.71-#93;) were associated with IDA. The prevalence of anemia was higher with a younger gestational age (OR: 0.89 -#91;0.81, 0.97-#93;) and a younger age in months old (OR: 0.90 -#91;0.84, 0.96-#93;). Conclusions. This study evidences the strong and complex relationship between social determinants and anemia, a disease that is highly prevalent among young children. Food assistance programs may have a protective effect against IDA; consumption of fortified foods may improve iron intake in infants younger than two years old. In addition, emphasis is placed on the need to assess the impact of policies on population health.

Guía de práctica clínica para el diagnóstico y tratamiento de la anemia por deficiencia de hierro en niñas, niños y adolescentes en establecimientos de salud del primer nivel de atención / Clinical practice guideline for the diagnosis and treatment of iron deficiency anemia in children and adolescents in primary care health facilities

Contribuir en la mejora del estado de salud de las niñas, niños y adolescentes en el marco de la atención integral de salud. Estandarizar los criterios técnicos para el diagnóstico y tratamiento de la anemia por deficiencia de hierro en las niñas, niños y adolescentes em establecimientos de salud del primer nivel de atención.

Adequação de micronutrientes da dieta de pacientessubmetidos à cirurgia bariátrica / Micronutrient adequacy of the diet of patients undergoing bariatricsurgery

Introdução: a obesidade é uma doença crônica caracterizada peloexcesso de tecido adiposo. O tratamento considerado mais eficientepara o grau severo desta patologia é a cirurgia bariátrica. Apesar dosevidentes benefícios da cirurgia, há riscos inerentes a esse tipo detratamento, incluindo a deficiência de nutrientes.Objetivo: realizar uma revisão bibliográfica da literatura científicasobre a adequação na ingestão de cálcio, ferro, vitamina B12 evitamina D na dieta de pacientes submetidos à cirurgia bariátrica.Métodos: foi realizada pesquisa nas bases de dados PubMed, Medline,Lilacs e Scielo utilizando as palavras-chave Cirurgia Bariátrica,Dieta e Micronutrientes. Os critérios de inclusão adotados foram:artigos que abordavam o consumo de ferro, cálcio, vitamina D e/ouvitamina B12 após realização de cirurgia bariátrica, independente datécnica cirúrgica; trabalhos que avaliaram a dieta no pós-operatório;pesquisas que utilizaram apenas adultos na amostra do estudo.Foram excluídos artigos que consideraram o uso de suplementosnutricionais.Resultados e discussão: foram utilizados 11 trabalhos publicadosentre 1991 e 2013. Grande parte dos estudos encontrados apontapara uma inadequação importante da ingestão exclusivamente alimentarde ferro, cálcio e vitamina D. Apenas a vitamina B12 comportou-se de maneira diferenciada, estando adequada na alimentaçãoda amostra na maioria das pesquisas.Conclusão: Apesar da escassez de estudos, diferenças metodológicase difícil comparação entre os estudos analisados, observou-se,em diferentes técnicas cirúrgicas e em períodos pós-operatóriosdistintos, uma inadequação na ingestão de micronutrientes da dieta,especialmente de cálcio, ferro e vitamina D, em pacientes submetidosà cirurgia bariátrica.

Introduction: Obesity is a chronic disease in which occurs the excessof adipose tissue. The method that has been shown to be moreeffective in treating this disease is bariatric surgery. Despite the apparentbenefits of surgery, there are risks inherent to this type oftreatment, including nutrient deficiency.Objective: to review the scientific literature on the adequate intakeof calcium, iron, vitamin B12 and vitamin D of patients undergoingbariatric surgery.Methods: The research was conducted through the databasesPubMed, Medline, Lilacs and SciELO using the keywords BariatricSurgery, Diet and Micronutrients. Inclusion criteria adopted were:articles that addressed the use of iron, calcium, vitamin D and / orvitamin B12 after bariatric surgery, regardless of the surgical technique;studies that assessed the diet postoperatively; studies withadults.Results and discussion: The review found 11 articles publishedfrom 1991 to 2013. Most studies suggest significant inadequacy iniron, calcium and vitamin D intake exclusively through diet. Onlyvitamin B12 had a different result, with adequate intake being foundin the majority of the studies.Conclusion: Despite the lack of studies, the methodological differencesand the difficulty to compare the studies, it was verifiedthat the inadequate intake of micronutrients, especially iron, calciumand vitamin D, is found in distinct surgical and postoperativeperiods of patients undergoing bariatric surgery.

The impact of short daily hemodialysis on anemia and the quality of life in Chinese patients

Anemia is a frequent complication in hemodialysis patients. Compared to conventional hemodialysis (CHD), short daily hemodialysis (sDHD) has been reported to be effective in many countries except China. The aim of the present study was to determine whether sDHD could improve anemia and quality of life (QOL) for Chinese outpatients with end-stage renal disease. Twenty-seven patients (16 males/11 females) were converted from CHD to sDHD. All laboratory values were measured before conversion (baseline), at 3 months after conversion (sDHD1), and at 6 months after conversion (sDHD2). The patient's QOL was evaluated at baseline and 6 months after conversion using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Hemoglobin concentration increased significantly from 107.4±7.9 g/L at baseline to 114.4±6.8 g/L (P<0.05) at sDHD1, and 118.3±8.4 g/L (P<0.001) at sDHD2 (Student paired t-test). However, the dose requirement for erythropoietin decreased from 6847.8±1057.3 U/week at baseline to 5869.6±1094.6 U/week (P<0.05) at sDHD2. Weekly stdKt/V increased significantly from 2.05±0.13 at baseline to 2.73±0.20 (P<0.001) at sDHD1, and 2.84±0.26 (P<0.001) at sDHD2. C-reactive protein decreased from baseline to sDHD1 and sDHD2, but without statistically significant differences. Physical and mental health survey scores increased in the 6 months following conversion to sDHD. sDHD may increase hemoglobin levels, decrease exogenous erythropoietin dose requirements, and improve QOL in Chinese hemodialysis patients compared to CHD. A possible mechanism for improvement of clinical outcomes may be optimized management of uremia associated with the higher efficiency of sDHD.

El tratamiento del plan AUGE (GES) de la anemia en diálisis crónica no ha sido eficaz y, probablemente, no se han aprovechado los recursos económicos destinados para ello / Results of the explicit health guaranties program to correct anemia of end stage renal disease patients in dialysis

Background: In July 2010 end stage renal disease anemia correction was incorporated to the program of explicit health guaranties of the Ministry of Health. The treatment plan included intravenous iron and erythropoietin. The prescription of these medications carne from the deriving health organizations. Aim: To describe the results of that program in 11 dialysis facilities belonging to Fresenius Medical Care (a private organization) distributed in the six Metropolitan Health Services (MHS) in Santiago, Chile. Material and Methods: We selected 328 patients who remained in dialysis treatment at least between June 2010 and March 2011 and had a packed red cell volume lower than 30%, representing the target of the Plan. The evolution of packed red cell volume and the proportion of anemic patients in the facilities from each MHS were evaluated. Results: The two above mentioned variables began to improve only in December 2010. In no MHS, with the exception of the Eastern MHS, the mean hematocrit improved to higher than 30%, nor was the proportion of anemic patients reduced to lower than 50%o. Conclusions: Treatment of anemia of end stage renal disease in dialysis, implemented by the explicit health guaranties program of the Ministry of Health, was ineffective in almost all MHS in Santiago.

Compliance to micronutrient supplementation in children 3 to 24 months of age from a semi-rural community in Mexico

OBJECTIVE: To identify associated factors to compliance for multiple micronutrient (MM) or iron and vitamin A (IVITA) supplementation, in children (3 to 24 months old). MATERIALS AND METHODS: A database (n=465 children) from a randomized, controlled, clinical trial, carried out in a semi-rural setting in Mexico, was analyzed. The compliance rate of MM and IVITA supplements was calculated. Adequate compliance rate (AC>80%), and its association with children and households characteristics, was determined. RESULTS: The compliance mean was high (MM:78.2%, IVITA:80.1%; p<0.05). The odds of AC were 59% greater in the children of IVITA than with MM group, although the estimate was only marginally significant (p=0.052). Maternal education (p<0.001), child birth weight (p=0.003), and children with cough (p<0.001) or fever (p=0.024) were significantly associated with AC and significantly marginal was maternal indigenous (p=0.071). CONCLUSION: The high AC was consistent with others efficacy studies. More research is needed to document physiological, cultural, social and operative factors affecting compliance with supplementation.

OBJETIVO: Identificar factores asociados con el cumplimiento del consumo de suplementos con micronutrimentos múltiples (MM) o con hierro y vitamina A (FEVITA) en niños (<24 meses de edad). MATERIAL Y MÉTODOS: Información de un ensayo clínico aleatorizado, doble ciego en una localidad semirrural en México. Se calculó el porcentaje de cumplimiento (n=465 niños), cumplimiento adecuado (CA: >80%) y su asociación con varias características. RESULTADOS: El cumplimiento fue alto (MM: 78.2%, FEVITA: 80.1%; p<0.05). Los momios de CA fueron 59% mayores en niños del grupo FEVITA que en MM (p=0.052). Escolaridad materna (p<0.001), peso al nacer del niño (p=0.003), porcentaje de tiempo con tos (p<0.001) y con fiebre (p=0.024) y marginalmente, la condición indígena materna (p=0.071) se asociaron con el CA. CONCLUSIONES: La alta tasa de cumplimiento fue consistente con otros estudios. Es necesaria mayor investigación sobre factores fisiológicos, culturales, sociales y operativos relacionados con el cumplimiento del consumo de suplementos.

Impacto da inflamação na regulação do ferro e deficiência funcional de ferro: [revisão] / Importance of inflammation on iron homeostasis and functional iron deficiency: [review]

Deficiência funcional de ferro (Fe) pode ser definida como o desbalanço entre a quantidade necessária de Fe para a síntese de hemoglobina e o seu suprimento. Ela ocorre na ausência de estoque de Fe, característica da anemia ferropênica (AF), e na presença de bloqueio da homeostasia do Fe, como na anemia da inflamação (AI). Na AI, citocinas e células do sistema retículo-endotelial induzem alterações que interferem em diferentes vias da eritropoese levando à anemia. O bloqueio na mobilização do Fe de estoque pela hepcidina, embora não único, é o mecanismo etiológico mais evidente da AI. A hepcidina, regulador negativo da entrada de Fe no plasma, atua ligando-se à ferroportina, induzindo sua internalização e degradação. Embora a diferenciação entre AF e AI seja relativamente tranquila, pacientes com AI podem cursar com deficiência de Fe associada. O diagnóstico diferencial entre AI e AI com deficiência de Fe tem evidente importância clínica, e novas técnicas laboratoriais têm sido sugeridas para auxiliar neste diagnóstico.

Functional iron deficiency can be defined as an imbalance between the iron needs of the erythroid marrow and iron supply. Iron deficiency occurs in the absence of iron deposits, as in the case of iron deficiency anemia (IDA), or when there is an impaired iron mobilization, such as in anemia of inflammation (AI). Cytokines and cells of the reticuloendothelial system can induce changes in several pathways, interfering in erythropoiesis and causing anemia. The retention of iron within cells of the reticuloendothelial system is due to hepcidin. Although this is not the only mechanism evolved in AI, it is the most important. Hepcidin is a negative regulator of iron entry into the plasma. Hepcidin binds to ferroportin, inducing its internalization and degradation. Differentiation between IDA and AI is relatively easy, but patients with AI can have the association of true iron deficiency. The differential diagnosis of AI and AI with iron deficiency is clinically important and new laboratorial markers can be used to help this differentiation.

Metabolismo do ferro: uma revisão sobre os principais mecanismos envolvidos em sua homeostase: [revisão] / Iron metabolism: an overview on the main mechanisms involved in its homeostasis: [revision]

Um perfeito sincronismo entre absorção, utilização e estoque de ferro é essencial para a manutenção do equilíbrio desse metal no organismo. Alterações nesses processos podem levar tanto à deficiência como ao seu acúmulo de ferro, duas situações com repercussões clínicas e laboratoriais importantes para o paciente. Essa revisão aborda os diversos aspectos relacionados com a cinética do ferro, descrevendo as proteínas e mediadores nela envolvidos. Apresenta, ainda, como é feita a regulação intracelular e sistêmica do ferro que visa a manutenção de uma quantidade ótima de ferro para o metabolismo das células e, em especial, para uma perfeita hematopoiese.É discutido também o importante papel da hepcidina, como regulador da homeostase sistêmica. Será a apresenta da a relação entre a hepcidina e a resposta de fase aguda, e como as alterações na expressão da hepcidina podem contribuir com a fisiopatogênese da anemia de doença crônica.

The perfect synchronism of intestinal absorption, use and storage of iron is critical for maintaining a balance in the organism. Disorders in these processes may lead either to iron deficiency or to iron overload, both of which have important clinical and laboratorial consequences for the patient. This review describes aspects related to iron metabolism and the participation of several proteins and mediators in these mechanisms. Moreover, intracellular and systemic regulation is responsible for providing the optimal iron concentration for cellular metabolism and, in particular, for adequate hematopoiesis. The relationship between hepcidin and acute phase response is presented and how changes in hepcidin expression may be related to the physiopathogenesis of anemia of chronic disease.

Impacto obtenido sobre la morbilidad infantil suplementando vitamina A, hierro y cinc a niños <5 años de edad residentes en una zona de alta pobreza: caso: Relleno Sanitario Sector Walter Marquez / The impact obtained about infantile morbidity supplement with vitamin A, iron and zinc to children <5 years old that live in poverty places

La ciencia y la tecnología nunca resolverán todos los problemas suscitados por la insuficiencia de alimentos y la falta de servicios de salud y saneamiento, propiciantes de la desnutrición infantil. Pero los éxitos de los adelantos científicos y los conocimientos obtenidos, han dado pie a nuevas esperanzas de lograr vidas más saludables y productivas, tanto para los niños como para los adultos. Parte de estos conocimientos, como el fortalecimiento del sistema de inmunidad gracias a los efectos de la vitamina A, están bien establecidos. Con el objetivo de demostrar que la suplementación de micro nutrientes a niños en situaciones de pobreza puede propiciar una reducción en la aparición de enfermedades infecciosas más frecuentes, se diseñó un estudio experimental de campo, descriptivo y longitudinal, sobre una población integrada por niños de educación inicial ubicados en el Barrio “Hugo Rafael Chávez” del Sector Walter Márquez de San Josecito, Municipio Torbes. Luego de visitas de inducción, capacitación y censo de morbilidad, se procedió a desparasitar con albendazol y a suministrar dosis pediátricas de vitamina A en capsulas blandas 3 días, sulfato de cinc en tabletas 15 días y sulfato ferroso en jarabe 3 meses, para cumplir un plan de seguimiento mensual durante tres meses. Se incorporan 25 niños y niñas, de los cuales el 50 por ciento de los menores de 2 años de edad tenían algún grado de desnutrición aguda. Mientras que el 36 por ciento de los mayores de dos años tenían desnutrición crónica. De las enfermedades conseguidas, las del aparato respiratorio fueron las más frecuentes, seguidas por las intestinales. Dentro de las respiratorias, las gripes, rinitis y catarro fueron el 81,3 por ciento. Las diarreas fueron el 57,8 por ciento de las digestivas. Las piodermitis fueron el 50 por ciento de las infecciones de piel. Finalmente, la caries dental como enfermedad infecciosa bucal, fue el 55,8 por ciento de otras enfermedades.

Uso de hierro intravenoso en pacientes renales crónicos con anemia. Mayores niveles de hemoglobina a más bajo costo / Use of intravenous iron in chronic renal patients with anemia. Higher levels of hemoglobin at a lower cost

It is presented the experience with 90 patients receiving Eritropoietin s.c. and oral iron who were in chronic haemodialysis. After basic laboratories, including iron kinetic, in all of them was stopped oral iron and started i.v. iron 60 mgs per week, but keeping the same eritropoietin doses. The results showed an increased haemoglobin level from 6.5 to 11 g/dl mean values and a decreased doses of eritropoietin between 25 to 50%. This represent an important elevation of haemoglobin levels at a significant low cost

Eritropoietina y transfusiones en la anemia del insuficiente renal crónico: visión actualizada / Erytropoietin and tranfusions in anemia of chronic renal failure: update view

Aiming to know the factors that influenced the use of erythropoietin (EPO) in chronic hemodialysis patients, we retrospectively studied 82 patients (41 male), of whom 15 received EPO. No differences, between patients receiving or not receiving EPO, were found in age (46.9ñ25 and 57ñ13 years respectively), male/female ratio (9/6 and 32/35 respectively), time on dialysis (36.4ñ25.6 and 36.8ñ31.8 months respectively), dialysis hours (3.19ñ0.6 and 3.33ñ0.39 h respectively) and proportion of diabetics (6.6 and 20.8 percent respectively). Prior to EPO use and compared to untreated patients, treated patients were transfused with a higher frequency (60 vs 22 percent) and with more units/patients/years (0.12 vs 0.08). Hemoglobin levels at the start of the treatment was similar in treated and untreated patients (8.4ñ1.46 vs 8.78ñ1.97 g/dl). Epo was indicated in 11 patients due to general symptomatology associated to anemia and in 4 due to cardiac failure or angina. We conclude that EPO treatment is indicated in approximately 18 percent of patients in dialysis. An adequate dialytic treatment may achieve optimal hemoglobin levels with minimal transfusion requirements and without need of EPO, thus reducing costs

Lactoferrin levels and unsaturated iron-binding capacity in colostrum of Brazilian women of two socioecomic levels

The objetive of this study was to compare lactoferrin (LF) levels and unsaturated iron-binding capacity (UIBC) of colostrum from Brazilian women aged 20-38 years of low (N = 28) and high (N = 15) socioeconomic level. Both groups received a similar amount of supplental iron (25-65 mg/day) during pregnancy. We also determined the relationship between LF levels and UIBC, and between these components and maternal iron status. Both groups (low and high socieconomic level) showed adequate and similar mean hematocrit (35.0 ñ 13% and 35.9 ñ 1.3%, respectively) and serum ferritin (64 ñ 12 µg/1 and 57 ñ 12 µg/1, respectively) levels. Furthermore, LF levels (5.7 ñ 0.9 mg/ml and 5.5 ñ 0.6 mg/ml) and UIBC (3.8 ñ 0.3 µg/ml and 3/1 ñ 0.3 µg/ml) were not significantly different in the two groups of women, nor were they related to maternal hematocrit or serum ferritin. UIBC was significantly (P = 0.009), although weakly positively correlated (r= 0.45) with LF levels, suggesting that other colostrum ligands may contribute substantially to the capacity of colostrum to bind exogenous iron

Valores normales de hemoglobina y hematócrito en niñas sanos de 9 a 12 años de edad de la ciudad de Hermosillo, Sonora, México / Normal values of hemoglobin and hematocrit in healthy children 9 to 12 years old in Hermosillo, Sonora, Mexico

Se determinaron los valores de hemoglobina (Hb) y hematócrito (Hto) en niños sanos escolares (9 a 12 años) de la ciudad de Hermosillo, Sonora, a partir de un total de 797 niños (5 a 15 años) como muestra inicial. Se seleccionaron los que cumplían los siguientes requisitos: residencia de seis meses, porciento peso para la talla entre 90-110% de la media de Ramos-Galván, ausencia de antecedentes infecciosos y de sangrado en los dos meses previos, no antecedentes de recibir medicamentos 15 días antes, niveles de proteína sérica superior a 5.0 g/dl (50 g/l), hierro sérico superior a 50.0 microng/dl (8.955 micronmol/l), examen de orina normal, estudios de materia fecal para sangre oculta negativos y ausencia de parásitos. Quedaron 180 sujetos entre 9 y 12 años y se eliminaron 50 por no cumplir con alguna de las restricciones del protocolo; por lo tanto, se estudiaron 130, 64 del sexo masculino y 66 del femenino, quedando la muestra por arriba del 99% de confiabilidad y un error máximo del 1%. Después de la primera determinación de Hb y Hto, se suplementó con hierro, ácido fólico y vitamina B12 durante 4 semanas; posteriormente, se determinó Hb y Hb nuevamente. No se encontró diferencia significativa (p <0.01) con respecto a los iniciales. El valor medio de Hb y Hto fue de 13.4 g/dl (8.316 mmol/l) y 41% respectivamente