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[Iron deficiency and Pseudomonas aeruginosa colonization in cystic fibrosis]
M de Montalembert1, J L Fauchère, R Bourdon
1Département de Pédiatrie, Hôpital des Enfants-Malades à Paris.
Insights
Iron deficiency is common in cystic fibrosis (CF) patients, but ferritin levels are unreliable indicators. Sputum iron concentration does not correlate with Pseudomonas aeruginosa (PA) colonization in CF.
Area of Science:
- Pediatric Pulmonology
- Nutritional Science
- Infectious Diseases
Background:
- Cystic Fibrosis (CF) is a genetic disorder affecting multiple organs, particularly the lungs.
- Iron deficiency is a recognized complication in chronic diseases, but its prevalence and impact in CF require further elucidation.
- Pseudomonas aeruginosa (PA) colonization is a major driver of morbidity and mortality in CF patients.
Purpose of the Study:
- To investigate the incidence of iron deficiency in pediatric cystic fibrosis patients.
- To examine the relationship between iron status, sputum iron concentration, and PA colonization.
- To evaluate the utility of ferritin as a marker for iron deficiency in CF.
Main Methods:
- Assessed iron status using serum iron and transferrin saturation in 53 CF patients (3 months-21 years).
- Measured ferritin levels in 50 patients to estimate iron stores.
- Analyzed sputum iron concentration and PA colony counts in 24 patients, compared to 8 controls.
Main Results:
- A strong correlation was observed between serum iron and transferrin saturation (r=0.952, p<0.001).
- Iron deficiency was present in 22.6-28.3% of CF patients; low ferritin (<12 ng/ml) was found in 28% but did not correlate with infection severity.
- Sputum iron levels showed no correlation with PA colony counts.
Conclusions:
- Iron deficiency is more prevalent in CF than previously recognized.
- Ferritin is an unreliable indicator of iron deficiency in CF patients.
- PA colonization is independent of bronchial secretion iron content in CF.
Abstract:
The incidence of iron deficiency and its relationship with the concentration or iron in sputum and the number of Pseudomonas aeruginosa (PA) colonies was studied in an unselected group of 53 cystic fibrosis (CF) patients with an age range of 3 months to 21 years. Parameters used to assess the iron status included serum iron, the % saturation of transferrin (n = 53). The number of subjects with depletion of iron stores was estimated by levels of ferritin (n = 50). The concentration of iron and of PA was measured in a subgroup (n = 24) and compared to a control group (n = 8) with pulmonary infections of varying etiology. A close correlation was found between serum iron and the % saturation of transferrin (r = 0.952; p less than 0.001). Between 22.6 to 28.3% of patients were found to be iron deficient. An abnormally low ferritin (less than 12 ng/ml) was noted in 28% of cases but no correlation could be established between changes of serum iron and ferritin levels as a function of the degree of infection and/or of inflammation. In 62% of cases (n = 15) the concentration of iron in sputum was found to be within the range of control values (12-27 mumols/l). In 38% of cases (n = 9), ferritin values were above 27 mumols/l. No correlation was found between the concentration of iron and the number of PA colonies in sputum. We can therefore conclude the following: 1) iron deficiency is more common in CF than previously reported; 2) ferritin levels constitute a poor index of iron deficiency; 3) colonisation with PA is not associated with iron content of bronchial secretions.