Hematology of malnutrition, part one

Undernutrition in Santal children: a biochemical and hematological study

The nutritional status of the children can be measured by biochemical and hematological parameters and dietary assessment. The objectives of the present study were to evaluate the causes of the undernutrition in the surveyed Santal children, where high degree of undernutrition exists, by measuring selected hematological and biochemical parameters and dietary intake. Nutritional status was assessed by height-for-age Z-score. Total count of red blood cells (RBC count), packed cell volume (PCV), hemoglobin concentration (Hb%), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) were measured. Biochemical parameters such as serum iron, total iron binding capacity (TIBC), serum ferritin, serum transferrin, transferrin saturation (TS) and serum albumin were also measured. Serum iron, serum ferritin, transferrin saturation, hemoglobin level and serum albumin of stunted children were significantly lower (p<0.05) than those in children of normal stature. Total iron binding capacity and serum transferrin of stunted children were significantly higher (p<0.05) than the values in children of normal stature. More than 29% of surveyed children were suffering from iron deficiency. Hemoglobin concentration was found to be strongly associated (p<0.001) with the nutritional status. Dietary intake of almost all nutrients in all age groups was found to be lower than the recommended dietary allowances (RDA) in both sexes. A mild iron deficiency was found in stunted Santal children. The stunting may be associated with the deficiency of specific nutrients such as iron and protein in surveyed Santal children.

Undernutrition in Nepalese children: a biochemical and haematological study

AIM

This study was undertaken to assess the nutritional status of 6-10 years old Nepalese children by measuring some haematological and biochemical parameters.

METHODS

Nutritional status was assessed by height-for-age z-score. Total count of red blood corpuscles (TC of RBC), packed cell volume, haemoglobin concentration, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration were measured. Biochemical parameters such as serum iron, total iron-binding capacity (TIBC), serum ferritin, serum transferrin, transferrin saturation (TS) and serum albumin were also measured. Serum folate and vitamin B(12) were measured in well-nourished and undernourished children.

RESULTS

TC of RBC, serum iron, serum ferritin, TS and serum albumin of stunted children were significantly lower (p < 0.05) than that of well-nourished children. MCV, MCH, TIBC and serum transferrin of stunted children were significantly higher (p < 0.05) than that of well-nourished children. Serum folate and vitamin B(12) values of stunted children were significantly lower (p < 0.001) than that of well-nourished children.

CONCLUSION

A mild iron deficiency was found in stunted Nepalese children. The serum ferritin has been identified as a sensitive marker for measurement of iron status in surveyed children. A deficiency of serum protein, serum folate and vitamin B(12) was also found in the undernourished Nepalese children.

Hematological manifestations of copper deficiency: a retrospective review

Copper deficiency is an established cause of hematological abnormalities but is frequently misdiagnosed. Copper deficiency can present as a combination of hematological and neurological abnormalities and it may masquerade as a myelodysplastic syndrome. We reviewed the records of patients with hypocupremia and hematologic abnormalities identified between 1970 and 2005. Patients with hypocupremia unrelated to copper deficiency (e.g. Wilson's disease) were excluded. Forty patients with copper deficiency and hematological abnormalities were identified. Ten patients (25%) had undergone bariatric (weight reduction) surgery and an additional 14 patients (35%) had undergone surgery on the gastrointestinal tract, most commonly gastric resection. In 12 cases, no cause for copper deficiency was identified. Anemia and neutropenia were the most common hematologic abnormalities identified and the majority of the patients also had neurologic findings, most commonly due to myeloneuropathy. Abnormalities observed on bone marrow examination including vacuoles in myeloid precursors, iron-containing plasma cells, a decrease in granulocyte precursors and ring sideroblasts may be valuable clues to the diagnosis. Copper deficiency is an uncommon but very treatable cause of hematologic abnormalities.