J C Hull1,2, E M Bloch3, C Ingram4, R Crookes5, J Vaughan6,7, L Courtney8, A Jauregui9, J F Hilton10, E L Murphy10,11. 1. Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. 2. University of the Witwatersrand, Johannesburg, South Africa. 3. Johns Hopkins University School of Medicine, Baltimore, MA, USA. 4. National Bone Marrow Registry, Cape Town, South Africa. 5. Cryo-Save Inc., Johannesburg, South Africa. 6. National Health Laboratory Services, CH Baragwanath Hospital, Soweto, South Africa. 7. Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa. 8. RTI International, Rockville, MA, USA. 9. Stanford University School of Medicine, Stanford, CA, USA. 10. University of California San Francisco (UCSF), San Francisco, CA, USA. 11. Vitalant Research Institute (VRI), San Francisco, CA, USA.
Abstract
OBJECTIVE: Antenatal anaemia is associated with increased peripartum transfusion requirement in South Africa. We studied whether HIV was associated with the response to treatment of iron-deficiency anaemia. DESIGN: Prospective cohort study. SETTING: Hospital-based antenatal anaemia clinic in South Africa. SAMPLE: Equal-sized cohorts of pregnant women testing positive for HIV (HIV+) and testing negative for HIV (HIV-) with iron-deficiency anaemia. METHODS: Haemoglobin trajectories of women with confirmed iron-deficiency anaemia (ferritin < 50 ng/ml) were estimated from the initiation of iron supplementation using mixed-effects modelling, adjusted for baseline HIV status, ferritin level, maternal and gestational ages and time-varying iron supplementation. MAIN OUTCOME MEASURES: Haemoglobin trajectories. RESULTS: Of 469 women enrolled, 51% were HIV+, 90% of whom were on antiretroviral therapy (with a mean CD4+ lymphocyte count of 403 cells/mm3 ). Anaemia diagnoses did not differ by HIV status. A total of 400 women with iron-deficiency anaemia were followed during treatment with oral or intravenous (6%) iron therapy. In multivariable analysis, haemoglobin recovery was 0.10 g/dl per week slower on average in women who were HIV+ versus women who were HIV- (P = 0.001), 0.01 g/dl per week slower in women with higher baseline ferritin (P < 0.001) and 0.06 g/dl per week faster in women who were compliant with oral iron therapy (P = 0.002). CONCLUSIONS: Compared with women who were HIV-, women who were HIV+ with iron-deficiency anaemia had slower but successful haemoglobin recovery with iron therapy. Earlier effective management of iron deficiency could reduce the incidence of peripartum blood transfusion. TWEETABLE ABSTRACT: Among pregnant women with iron-deficiency anaemia in South Africa, HIV slows haemoglobin recovery in response to oral iron therapy.
OBJECTIVE: Antenatal anaemia is associated with increased peripartum transfusion requirement in South Africa. We studied whether HIV was associated with the response to treatment of iron-deficiency anaemia. DESIGN: Prospective cohort study. SETTING: Hospital-based antenatal anaemia clinic in South Africa. SAMPLE: Equal-sized cohorts of pregnant women testing positive for HIV (HIV+) and testing negative for HIV (HIV-) with iron-deficiency anaemia. METHODS: Haemoglobin trajectories of women with confirmed iron-deficiency anaemia (ferritin < 50 ng/ml) were estimated from the initiation of iron supplementation using mixed-effects modelling, adjusted for baseline HIV status, ferritin level, maternal and gestational ages and time-varying iron supplementation. MAIN OUTCOME MEASURES: Haemoglobin trajectories. RESULTS: Of 469 women enrolled, 51% were HIV+, 90% of whom were on antiretroviral therapy (with a mean CD4+ lymphocyte count of 403 cells/mm3 ). Anaemia diagnoses did not differ by HIV status. A total of 400 women with iron-deficiency anaemia were followed during treatment with oral or intravenous (6%) iron therapy. In multivariable analysis, haemoglobin recovery was 0.10 g/dl per week slower on average in women who were HIV+ versus women who were HIV- (P = 0.001), 0.01 g/dl per week slower in women with higher baseline ferritin (P < 0.001) and 0.06 g/dl per week faster in women who were compliant with oral iron therapy (P = 0.002). CONCLUSIONS: Compared with women who were HIV-, women who were HIV+ with iron-deficiency anaemia had slower but successful haemoglobin recovery with iron therapy. Earlier effective management of iron deficiency could reduce the incidence of peripartum blood transfusion. TWEETABLE ABSTRACT: Among pregnant women with iron-deficiency anaemia in South Africa, HIV slows haemoglobin recovery in response to oral iron therapy.
Authors: Galila M Mokhtar; Wafaa E Ibrahim; Nevine A Kassim; Iman A Ragab; Abeer A Saad; Heba G Abdel Raheem Journal: Platelets Date: 2014-07-15 Impact factor: 3.862
Authors: Evan M Bloch; Charlotte Ingram; Jennifer Hull; Susan Fawcus; John Anthony; Randolph Green-Thompson; Robert L Crookes; Solomuzi Ngcobo; Darryl V Creel; Lauren Courtney; Greg R M Bellairs; Edward L Murphy Journal: Transfusion Date: 2018-07-10 Impact factor: 3.157
Authors: Evan M Bloch; Robert L Crookes; Jennifer Hull; Sue Fawcus; Rajesh Gangaram; John Anthony; Charlotte Ingram; Solomuzi Ngcobo; Julie Croxford; Darryl V Creel; Edward L Murphy Journal: Transfusion Date: 2015-03-16 Impact factor: 3.157
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Authors: Amara E Ezeamama; Alla Sikorskii; Ramanpreet K Bajwa; Robert Tuke; Rachel B Kyeyune; Jenifer I Fenton; David Guwatudde; Wafaie W Fawzi Journal: Nutrients Date: 2019-03-31 Impact factor: 5.717