الفهرس 
Normal Iron MetabolismOnly 14 pages are availabe for public view
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Abstract
Iron deficiency anemia is one of the most common disorders worldwide. In pregnant women it is mainly due to increased iron requirements. Several biomarkers are used to evaluate the iron status. Some are viewed as pseudomarkers e.g. Hb while others like ferritin are still seen as good. The impact of iron insufficiency is not limited to developing anemia but also affects the immune system. Iron is incorporated in some enzymes e.g. cytochrome oxidase and is necessary for the activity of myeloperoxidase enzyme, the latter is responsible for bactericidal functions of neutrophils. Iron deficiency during pregnancy has its effects on both mother and fetus. Changes in the immune response during normal pregnancy are still poorly understood and there seems to be an increased susceptibility to infection. This study aimed to evaluate the iron status among Egyptian pregnant women and the effect of iron deiciency on their neutrophil count and functions including its phagocytic activity. This study was carried out on 90 pregnant females (54 as cases with iron deficiency & 36 as normal controls) during their antenatal care. All subjects underwent full history taking, thorough clinical examination and laboratory investigations including complete blood count (CBC), erythrocyte sedimentation rate (ESR), albumin, iron profile [iron, ferritin, total iron binding capacity (TIBC) and % saturation]. In addition flowcytometric studies for neutrophil myeloperoxidase & oxidative burst as well as functional microphage assay (phagocytic and lytic index) were performed. The results of the present study showed that cases of iron deficiency comprised a significantly higher proportion of females in their 3rd trimester compared to controls (p = 0.051). Our study revealed cases to have a significantly higher absolute lymphocyte count compared to controls (p = 0.047). A higher platelets count was also found among cases but the difference was of borderline significance. Interestingly cases did not have significantly lower Hb level compared to controls (p=0.100). However a significant positive correlation was found between hemoglobin (Hb) & % saturation (p=0.023). Our study revealed cases to have a significantly lower phagocytic & lytic indices compared to controls (p = 0.014, 0.002 respectively). Also a significant negative correlation was established between serum TIBC level & phagocytic index (p=0.019). However there is no significant difference between cases and controls as regards previous infections and obstetric complications. Our work revealed significant negative correlations between serum TIBC level & each of % of MPO positive resting cells (p=0.000), % of MPO positive cells at 10 min. post stimulation (p=0.003) and % of MPO positive cells at 40 min. post stimulation (p=0.010). Also there was a significant positive correlation between serum ferritin level & absolute count of MPO positive resting cells (p=0.006). However there is no significant correlation between any of the iron profile parameters and DHR. The median intensity of MPO (Mdx) expression & the lytic index were the most sensitive parameters (94.4% & 98.1% respectively) while DHR & phagocytic index (77.4% & 72.7% respectively) were the more specific parameters on performing the receiver operating characteristic (ROC) curve in relation to iron status as represented by % saturation. Also absolute count of MPO positive resting cells & DHR were the most specific parameters (95.7% & 95.6% respectively) on performing the receiver operating characteristic (ROC) curve in relation to cellular immune response as represented by phagocytic functions. Due to differences in MPO trafficking between pregnancy and non-pregnancy neutrophils, flowcytometric studies for MPO and oxidative burst did not reflect iron status or cellular immune response. On the other hand functional assays appeared to be more effective tools in pregnant women.