SERUM IRON STUDIES IN ANAEMIC HIV- INFECTED PERSONS SEEN AT THE LAGOS UNIVERSITY TEACHING HOSPITAL

Abstract

Introduction:
Iron is an indispensable mineral in humans which is essential for transporting oxygen to the
tissue via red cell. It is very important to know a patient’s iron status especially in chronic
infections like HIV which is a viral illness that causes Acquired Immunedeficiency Syndrome
(AIDS). AIDS is a retroviral disease characterized by profound immunosuppression and also
associated with anaemia, neutropenia and thrombocytopaenia. The aim of this study was to
determine the iron status of anaemic HIV- infected patients in Lagos University Teaching
Hospital, Idi-Araba.
Methodology:
In this study 100 HIV- infected subjects with Haemoglobin below 10g/dl and/or Packed Cell
Volume (PCV) below 30% were enrolled. Questionnaires were administered to obtain
demographic and clinical information. Blood was taken for full blood count, red cell indices,
blood film, reticulocyte count, CD4 cell count, serum iron, ferritin and transferrin estimations.
Forty nine subjects that gave their consent had bone marrow aspiration done for iron staining.
Results:
The mean PCV (22.52 ± 5.79%) for females (n = 54) was significantly lower than the mean
PCV (24.85 ± 4.76%) for males (n = 46), p = 0.03.
The mean serum iron (195.16 ± 144.62µg/dl) for the subjects (n = 100) was significantly
lower than that (280.26 ± 180.4µg/dl) for the control (n = 50), p = 0.002. The mean serum
transferrin (1.47 ± 0.46g/L) for the subjects was also significantly lower than for the controls
(2.31 ± 0.46g/L), p = 1.72×10−19, while the mean serum ferritin for the subjects (540.3 ±
299.12ng/ml) was significantly higher than for the controls (141 ± 214.2ng/ml), p = 3.08×10−14. Higher ferritin and lower transferrin concentrations were associated with lower
CD4 cell counts. The lower the CD4 cell count, the lower the transferrin though this did not
reach a significant level, p = 0.32. With ferritin, the lower the CD4 cell counts, the higher the
ferritin levels. This relationship was found to be significant, p = 0.01.
Two of the 49 subjects that had bone aspiration had absent iron store while the rest had trace,
normal to increased iron store. Increased serum ferritin levels and decreased levels of serum
transferrin corresponded significantly with increased bone marrow iron store, p = 0.001 and
0.03 respectively.
Conclusion:
The finding of only 2 out of 49 subjects that had bone marrow aspiration with absent iron
store shows that iron deficiency is very unlikely to be a cause of severe anaemia in HIV –
infected patients, but evidence points to anaemia of chronic disorder as shown by low MCV,
low MCH, in the presence of increased serum iron, increased serum ferritin, decreased serum
transferrin and increased bone marrow iron store in these subjects.