RU2115118C1 - Method of assay of iron prelatent deficiency in children - Google Patents

Abstract

FIELD: pediatry. SUBSTANCE: method involves determination of ferritin content in children serum blood and at its value below 20 ng/ml prophylaxis treatment is prescribed. Method ensures to prevent anemia development and decrease morbidity. EFFECT: simplified method, retained high precision of diagnosis. 1 tbl

Description

 The invention relates to medicine, mainly to pediatrics, and finds use for the prevention of iron deficiency anemia in children from families of participants in the aftermath of the Chernobyl accident and in children living in areas contaminated with radionuclides.

 In modern conditions, the problem of childhood anemia is becoming especially urgent: according to international hematological congresses in many countries, about half of children suffer from anemia (Mosyagina NN Children's anemia. - M .: Medicine, 1969). In addition, according to various authors, from 15 to 35% of children suffer from latent iron deficiency and are threatened by the development of iron deficiency anemia (Anemia in children. Ed. By Prof. N. Kalinicheva - L.: Medicine, 1983). Many anemia in children is not well recognized. Some forms of anemia pose an immediate threat to life or are inevitably associated with the lag of children in physical and sometimes mental development. Even mild types of anemia often leave a deep mark in the child’s life, delay its development, and aggravate other diseases.

As you know, the development of iron deficiency goes through 3 stages:
1. Prolate iron deficiency.

 2. Latent or latent iron deficiency.

 3. Iron deficiency anemia.

 Identification of children who need to prevent anemia at the preferential stage of iron deficiency development allows prescribing corrective treatment at the early stages of the disease development, which makes it possible to prevent profound changes in bone marrow erythropoietic activity and to limit the drug load on the child's body.

 The method of recognition of the preferential deficit of tissue reserves of iron (Finch C. Iron nutrition. Ann. NY Acad. Sci., 1977, v. 300, p. 221 - 227; Anemia in children. Ed. By Prof. Kalinicheva N.I. . - L.: Medicine, 1983, p. 74; Diseases of the blood system. Fanstein F.E., Kozinets G.I., Bahramov S.M., Khokhlova M.P. Tashkent, Medicine, 1987, p. 402) . The essence of the method chosen as a prototype is that in the macrophages of the bone marrow a hemosiderin content is tested, in addition, an assessment is made of the level of absorption of radioactive iron from the gastrointestinal tract and with a decrease or absence of hemosiderin in bone marrow macrophages and an increase in intestinal resorption iron determine the preferential deficit of tissue stores of iron in the body.

This method has several disadvantages:
1. The complexity of the method.

 2. The method is traumatic, because involves taking bone marrow.

 3. The method has limited use due to the fact that the use of radioactive iron for diagnostic purposes in children has a number of contraindications, in particular it is not recommended to administer radioactive drugs to children living in areas contaminated with radionuclides.

 These shortcomings can be eliminated in the proposed technical solution.

 Object of the invention: the development of a simple, accurate method for diagnosing an early stage of development of iron deficiency in children for timely and pathogenetically substantiated therapy for the prevention of anemia.

 For this, the serum content of the child is determined in the blood serum of the child and, with a value below 20 ng / ml, prophylactic treatment of iron deficiency anemia is prescribed.

 Iron metabolism in the body is closely related to bone marrow functioning. The bulk of the serum iron (70 - 94%) enters the bone marrow, where the erythron is used to synthesize hemoglobin, the rest is exchanged with other tissues. Part of the bone marrow iron does not immediately go into normoblasts, but is stored in it in the form of ferritin, making up erythropoietic reserves. In this regard, two pools of reserve iron are distinguished: the brain, or labile pool, from which iron easily passes into normoblasts and with which serum iron is mainly exchanged, and the second pool, a depot represented by ferritin and hemosiderin, from which the metal is more difficult to pass into serum . The exchange between these two pools is ongoing (Bisyarina V.P., Kazakova L.M. Iron deficiency anemia in young children. - M .: Medicine, 1979, p. 42).

 Ferritin is a combination of apoferritin protein with a hydrated iron phosphate complex. Serum ferritin levels may reflect iron deficiency in tissues or the degree of degradation of rapidly growing cells. The decrease in the concentration of ferritin in the blood serum is in close correlation with the depletion of iron in the body, determined by stained bone marrow smears or quantitative phlebotmia.

 All of the above was the basis for using the level of ferritin as a diagnostic criterion for the initial stage of iron depletion in the child's body to prescribe preventive measures aimed at preventing the development of iron deficiency anemia in this contingent of children.

 The method is as follows. When examining a child, they take 0.1 ml of blood from a finger into a heparinized capillary. After centrifugation, the ferritin content is determined by any known method. We used Amerlight Ferritin reagent kits from Amersham (England).

To carry out the study, 25 μl of blood serum is added to wells coated with monoclonal antibodies to ferritin, 200 μl of buffered conjugate of horseradish peroxidase labeled mouse monoclonal antibodies to ferritin are added. After 60 minutes of incubation at 37 ^° C., unbound material is removed by suction and washing. The peroxidase activity of the conjugate is measured by enhanced luminescence reaction, for which 250 μl of a signal reagent containing a luminogenic substrate (luminol) and an amplifier is added to the wells. Light signals are read by the Amerlight analyzer.

 With a serum ferritin value below 20 ng / ml, prophylactic treatment of iron deficiency anemia is prescribed.

 We give specific examples illustrating the importance of determining the serum ferritin content in children from families of participants in the aftermath of the Chernobyl accident and in children living in areas contaminated with radionuclides.

 Example 1. Child P-born in 1987, was admitted to the hospital 11/18/91. The father of the child was for 1 month. (May 1986) on the deactivation of the reactor at the Chernobyl nuclear power plant.

 The examination was diagnosed with hypertension syndrome in the stage of subcompensation.

 The treatment for the underlying disease.

 Laboratory examination. Complete blood count: Hb - 139 g / l, Er - 4.2 • 10 / l, col. p. - 0.9. Serum ferritin - 16 ng / ml.

 The conclusion is made about the preferential deficiency of iron.

 The child was discharged in satisfactory condition.

 For the clinic, recommendations are given for further treatment of the child, attention is drawn to the need for the prevention of anemia.

 Data from the child’s development history: after discharge from the hospital, the child was under the supervision of a local pediatrician; preventive treatment of anemia was not carried out.

 08/27/92 made a general blood test: Hb - 100 g / l, Er. - 3.4 • 10 / l.

 The child is referred for inpatient treatment at RNIIAP.

 09/13/92 consulted again in the clinic RNIIAP.

 Laboratory examination. Complete blood count: Hb - 96 g / l, Er. - 3.2 • 10 / l. Serum ferritin - 4.2 ng / ml.

 Diagnosed with anemia. The child is hospitalized, treatment is prescribed.

 Thus, in a child only 9 months after detecting a low concentration of ferritin in the blood serum, the local pediatrician revealed anemia, moreover, it was detected at a stage requiring a large amount of therapeutic measures.

 Example 2. The child I-o born in 1984 lived in the Gomel region until July 1990, was admitted to the hospital for examination on 5.06.91.

 Diagnosed with chronic cholecystitis.

 Laboratory examination. General blood test: Hb - 136 g / l, Er. - 3.95 • 10 / l, col. p. - 1.0. Serum ferritin - 20 ng / ml.

 The department treated for the underlying disease. The child was discharged in satisfactory condition.

 12/18/91 consulted again in the clinic RNIIAP.

 Laboratory examination. Complete blood count: Hb - 126 g / l, Er. - 4.2 • 10 / l. Serum ferritin - 23 ng / ml.

 On June 9, 1992, he was again consulted at the polyclinic RNIIAP.

 Laboratory examination. General blood test: Hb - 134 g / l, Er. - 4.0 • 10 / l. Serum ferritin - 22 ng / ml.

 Thus, observation of the child during the year showed that, with ferritin levels of 20 ng / ml and above, the development of anemia does not occur.

 Example 3. A child born in 1977 lived in the city of Pripyat until 1.05.86. The child was admitted to the hospital for a routine examination on 04.17.91.

 The examination was diagnosed with cerebrosthenic syndrome with cerebrospinal fluid disorders.

 The department was treated for the underlying disease.

 Laboratory examination. General blood test: Hb - 142 g / l, Er. - 4.3 • 10 / l, col. p. - 0.9. Serum ferritin - 19 ng / ml.

 September 4, 91 was consulted repeatedly at the polyclinic RNIIAP.

 Laboratory examination. Complete blood count: Hb - 112 g / l, Er. - 3.6 • 10 / l, col. p. - 0.8. Serum ferritin - 10.2 ng / ml.

 It is concluded that the child develops iron deficiency anemia. Recommendations are given for the district pediatrician for further treatment of the child, attention is drawn to the need for iron deficiency therapy.

 Data from the history of the child’s development: 09/29/91 a general blood test was done: Hb - 98 g / l, Er. - 3,5 • 10 / l, col. p. - 0.8.

 Diagnosed with anemia. Prescribed treatment.

 Thus, a few months after the detection of the ferritin value of 19 ng / ml in the child, the initial stage of the development of anemia was noted.

 From the above examples it follows that preferential iron deficiency, which subsequently leads to the development of anemia, was detected in children whose serum ferritin content was below 20 ng / ml. Therefore, if during the examination of children a low concentration of ferritin in the blood serum (19 ng / ml and below) was found, then these children need to be prescribed preventive treatment in order to prevent the development of iron deficiency anemia.

 The inventive method, studies were conducted in 108 children aged 1 to 5 years old, born in the families of participants in the liquidation of the Chernobyl accident, and children living in areas contaminated with radionuclides, in which the number of red blood cells and hemoglobin was normal at the time of the examination.

 Of these, 65 children had serum ferritin levels of 20 ng / ml or higher (group 1). The content of red blood cells and hemoglobin in the blood of these children during the year of observation was normal.

 In 43 children, the serum ferritin level was below 20 ng / ml (group 2). All children in this group subsequently noted a decrease in the number of red blood cells and hemoglobin in the blood and iron deficiency anemia was diagnosed.

 The results of the study are shown in the table.

 From the table it follows that there is a statistically significant difference between serum ferritin in groups 1 and 2. Moreover, the content of ferritin in the blood serum in the compared groups is in non-overlapping diagnostic intervals. The accuracy of the method is 100%.

 The proposed method allows to detect preferential iron deficiency in the child's body and to prevent iron deficiency anemia.

The proposed method has several advantages over the prototype method:
1. The method is not traumatic.

 2. The method can find wide application, because has no contraindications.

 3. The method has sufficient simplicity.

 The method was tested on a significant volume of clinical material.

Claims (1)

 A method for determining preferential iron deficiency in children, including a general clinical examination, characterized in that the content of ferritin is determined in the blood serum and, with its value of 19 ng / ml and lower, preferential iron deficiency is determined.

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