SERUM TRANSFERRIN RECEPTOR LEVELS AND OTHER CORRELATES OF IRON DEFICIENCY ANAEMIA IN MULTIGRAVIDAE PATIENTS ATTENDING UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

Abstract

Iron deficiency is known to be a common cause of anaemia in pregnancy; this is largely
due to the increased demand for iron by the developing feotus. The extent of physiological stress
on iron reserve of a gravid woman is dependent on a number of factors that have not been clearly
defined. This study was carried out with a view of determining the prevalence of iron deficiency
anaemia (IDA) and other correlates of iron deficiency among multi-gravidae.
This is a case control study involving 384 consecutive multi-gravidae attending Antenatal
Clinic at the University of Ilorin Teaching Hospital and 384 age-matched multi-para controls
whose last confinements were greater than 24 months. Informed consent and relevant
information such as, bio-data, parity, gravidity gestational age, child spacing interval, type of
contraceptive and the use of haematinics were obtained using a study proforma. Blood samples
(8 mls of venous blood) were collected to determine the haematological profile and serum
transferrin receptor (sTfR) levels of both subjects and controls. Data was analysed using
descriptive and inferential statistics on an SPSS software version 20.0. The level of statistical
significance was set at p-value ≤ 0.05
The mean ages of subjects and controls were 31 ± 4.6 years and 33 ± 4.7 years
respectively (p > 0.05). Majority of the subjects were in second trimester (44%), child spacing
interval of 12-23 months was most common among subjects (33.6%), while most of the controls
had child spacing intervals of greater than 48 months (36.2%; p < 0.001). The mean value of Hb
in the subjects (10.9 ± 1.1 g/dl) was significantly lower than the controls (11.7 ± 0.74 g/dl), while
sTfR levels were higher among subjects (30.3 ± 10.9 mmol/l) than controls (22.1 ± 5.2 mmol/l).
Likewise the mean value of MCV for subjects (84.9 ± 7.8 fl) was higher than the controls (81.2 ±
7.3fl; p < 0.001), MCH mean value for subjects (26.1 ± 2.5 pg) was also significantly higher than
the controls (24.9 ± 2.7 pg ; p < 0.001) and for MCHC, the mean value for subjects (30.7 ± 1.4
g/dl) was significantly higher than that of controls (30.3 ± 1.1 g/dl ; p < 0.001). Red cell
distribution width was significantly higher among the subjects (14.5 ± 1.6 %) than controls (14.2
± 1.2 %; p < 0.001). Majority of subjects 253 (65.9%) had normal peripheral blood film (PBF)
appearance, while hypochromia, macrocytosis and mixed deficiencies were seen in 3.9%, 18.8%
and 11.4% respectively. Among the controls, 95% had normal PBF appearance, while
hypochromia, and macrocytosis were seen in 3.2 and 1.6% respectively. Anaemia was seen in
48% of subjects and 23% of controls. Nine percent of these subjects had demonstrable iron
deficiency anaemia (IDA) using sTfR level. Variable PBF appearances were seen in non
aenemic subjects with iron deficiency (12%), while none of the controls had iron deficiency and
PBF were less variable whether anaemia was present or not. The relationship between child
spacing interval and all haematological parameters was weak. Serum transferrin receptor (sTfR)
had a weakly positive correlation with gestational age of subjects (r = 0.121; p =0.018), and
inversely with parity of the controls. (r = -0.132; p = 0.010). Also a weak positive correlation
exists between sTfR and PCV(r = 0.165; p = 0.001), RDW (r 0.160; p = 0.002) and platelet
counts (r = 0.111; p = 0.030) of subjects, while there was no significant relationship among
controls. Sixty five percent of subjects and 72.6% of controls used contraceptives (p = 0.03),
while haematinics were used by 68% of subjects and none of the controls (p < 0.001).
In conclusion this study has shown that IDA is not the predominating type of anaemia in
pregnant women in this environment, however sTfR concentration is a useful parameter for
diagnosing iron deficiency in anaemic and non- anaemic subjects especially when the PBF and
red cell indices are inconclusive.

SERUM TRANSFERRIN RECEPTOR LEVELS AND OTHER CORRELATES OF IRON DEFICIENCY ANAEMIA IN MULTIGRAVIDAE PATIENTS ATTENDING UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN