Soo Hwan Pai

Randomized Placebo‐Controlled Trial of Helicobacter pylori Eradication for Iron‐Deficiency Anemia in Preadolescent Children and Adolescents

Background. A few cases relating H. pylori infection to iron‐deficiency anemia have been described recently. We investigated the role of H. pylori infection in iron‐deficiency anemia in preadolescent children and adolescents.

Erythropoietic activity and soluble transferrin receptor level in neonates and maternal blood

Serum transferrin receptor (sTfR) concentration reflects functional iron status and erythropoietic activity. The aims of this study were to examine gender differences of erythropoiesis in newborns and to evaluate the influences of maternal anaemia or iron deficiency on foetal cord blood parameters for iron status and sTfR. In total, 527 newborns and their mothers were examined. Reticulocytes were analysed by flow cytometry and sTfR was measured by an immunoenzymo‐metric method. There were no sex differences in haematological or iron parameters. However, the reticulocyte maturity index (RMI) of male neonates was 37.45%, significantly higher than the 26.81% in female neonates (p < 0.01). The high fluorescence reticulocytes (HFR) and middle fluorescence reticulocytes (MFR) of male neonates were 4.91% and 22.36%, respectively, while those of female neonates were 3.31% and 17.83%, respectively (p < 0.01 for each gender). The sTfR concentrations of male and female neonates were 6.27 mg/l and 5.09 mg/l, respectively (p < 0.01). Values for serum iron, ferritin and reticulocyte subpopulations were significantly lower in the newborns of anaemic mothers. However, newborns of iron‐deficient mothers showed no differences in iron parameters from those of non‐iron‐deficient mothers.

Change in erythropoiesis with gestational age during pregnancy.

Abstract To investigate the changes in erythropoiesis during pregnancy, 342 pregnant and postpartum women were examined for reticulocyte subpopulations, reticulocyte maturity index (RMI), and serum transferrin receptor (sTfR) levels. The reticulocyte subpopulations were analyzed by flow cytometry, and the sTfR concentration was measured by an immunoenzymometric method. There were no significant differences in the values of reticulocyte subpopulations, RMI, and sTfR between first trimester and non-pregnant women. However, the RMI and sTfR concentration increased gradually from the second trimester of pregnancy, during which time values were twofold higher than those in the first trimester, and peaked in the third trimester. Then the RMI and sTfR values decreased abruptly 1–4 weeks postpartum and finally dropped to the levels of non-pregnant women 5 weeks after delivery. The maternal sTfR concentration correlated significantly with the corrected reticulocyte count (r=0.52, P<0.01), RMI (r=0.67, P<0.01), and high fluorescence reticulocytes (HFR) (r=0.62, P<0.01); however, the serum ferritin level correlated poorly with the reticulocyte subpopulations during pregnancy. In conclusion, erythropoiesis increases with gestational age during pregnancy and returns to normal 5 weeks after delivery. Measurement of sTfR in combination with RMI may improve the assessment of erythropoietic activity during pregnancy.

Serum lipid concentrations correlate more strongly with total body fat than with body mass index in obese humans.

BACKGROUND To investigate the associations of body mass index (BMI) and total body fat (TBF) vs. blood lipid concentrations, we measured six anthropometric parameters, body fat mass, and serum lipid profiles in 1529 apparently healthy adults. METHODS TBF was assessed using a body fat analyzer. Serum concentrations of triglyceride, total cholesterol, and low- or high-density lipoprotein cholesterol (LDL-C or HDL-C) were determined by standard enzymatic procedures. RESULTS Serum lipid concentrations were more strongly correlated with TBF than with BMI or waist circumference in both men and women. The mean concentrations of total cholesterol in the subjects with high fatness (TBF>95th percentile) were significantly higher than those for the subjects with low fatness (TBF<5th percentile; p<0.01), but no significant differences were observed in serum lipid levels between overweights (BMI>95th percentile) and underweights (BMI<5th percentile). The incidence of hypercholesterolemia was significantly higher in the subjects with high fatness (TBF>95th percentile) than the corresponding overweight subjects (BMI>95th percentile; p<0.01). CONCLUSION TBF is more strongly associated with serum lipid concentrations in adults, at least as compared to BMI.

Bone mineral density correlates strongly with basal metabolic rate in postmenopausal women.

BACKGROUND This study investigated the relationships of bone mineral density (BMD) with body composition, basal metabolic rate (BMR), and fat distribution. METHODS We measured body mass index (BMI), anthropometrics, and BMD in 345 postmenopausal women and 224 elderly men. Total body fat (TBF), fat distribution, and BMR were assessed using a body composition analyzer. Lumbar spine and proximal femur BMDs were measured with dual-energy X-ray absorptiometry. RESULTS Lumbar spine BMD was more strongly correlated with BMR (r=0.51, p<0.01) than with lean body mass (r=0.39, p<0.01) and waist hip ratio (r=-0.28, p<0.01) in postmenopausal women. The mean values of BMR in osteoporotic women were significantly lower than those for non-osteoporotic women (p<0.01). The prevalences of osteoporosis at the sites of lumbar spine and proximal femur were 32.1% and 23.3% in the women with BMR<1230 kcal, which were significantly higher than those of osteoporosis (5.4% and 7.7%) at the corresponding sites in the women with BMR> or =1230 kcal (p<0.01). In elderly men, the incidence of osteoporosis at the proximal femur was 29.5% in the subjects with BMR<1390 kcal, significantly higher than that (2.2%) in the subjects with BMR> or =1390 kcal (p<0.01). CONCLUSION BMR is more closely associated with bone density in elderly persons, at least as compared to TBF, BMI, or lean body mass.

Significance of the ratio of reticulocyte subpopulations in bone marrow and peripheral blood from patients with myelodysplastic syndromes

Flow cytometric analysis enables evaluating maturation of reticulocytes by quantitating the fraction of reticulocytes within low-, middle-, and high-fluorescence intensity regions (LFR, MFR, and HFR, respectively) [1]. The immature reticulocyte fraction (IRF), the sum of MFR and HFR, which corresponds to young reticulocytes released prematurely, is a useful parameter to evaluate the erythropoietic activity in anemia. The reticulocyte maturity index (RMI) is calculated from the proportion of reticulocyte subpopulations and can be used as the earliest and most sensitive predictor of erythropoiesis [2]. The premature destruction of erythroid precursors in the medullary cavity is termed ineffective erythropoiesis and occurs normally in less than 10% of the developing cells [3]. However, loss of much larger numbers of cells is seen in myelodysplastic syndromes (MDS), megaloblastic anemia, hemoglobinopathies, and several rare congenital anemias such as congenital dyserythropoietic anemias. MDS are bone marrow stem cell disorders characterized by ineffective hematopoiesis leading to blood cytopenias despite the presence of a cellular marrow and a propensity towards leukemic transformation [4]. There have been few studies, which have closely examined the production of reticulocytes in the bone marrow from patients with MDS and the significance of the ratio of reticulocyte subpopulations. Hence, in this study we assessed the immature reticulocytes and RMI using flow cytometry in both bone marrow and peripheral blood from MDS patients and compared the values to those of non-MDS patients as well as healthy controls. The number of mature reticulocytes and immature reticulocyte subpopulations were measured with flow cytometry in bone marrow and venous blood samples from 72 MDS patients and 65 controls (70 males, 67 females, age range: 51–76 years). The MDS patients included 31 with refractory anemia (RA), 12 RA with ringed sideroblasts, and 29 RA with excess of blasts. We studied 34 ageand gender-matched nonanemic individuals as controls, who had no hematologic disorders. As additional controls, we also assessed the reticulocytes in the bone marrow from non-MDS patients (n=31) with anemia but with no evidence of ineffective erythropoiesis such as carcinoma (n=12) and lymphoma (n=19) not involving the bone marrow. Because reticulocyte production is affected by the degree of anemia, we compared MDS patients not only to the healthy controls but also to non-MDS patients who showed similar hemoglobin levels to MDS patients. Bone marrow and peripheral blood specimens were obtained at initial presentation from patients, and none of the patients had received any specific therapy prior to the study. Complete blood cell count was determined using an electronic counter (SE 9000, Sysmex, Kobe, Japan). Reticulocytes and their subpopulations were automatically analyzed by flow cytometry (R-3000, Sysmex, Kobe, Japan). The corrected reticulocyte count was calculated, based on a normal hematocrit of 45%, using the following formula: corrected reticulocyte (%) = (subject’s hematocrit/45) reticulocyte count (%). RMI was calculated using the equation: RMI = (MFR + HFR) 100/LFR and expressed as the percentage [5]. We compared the values of reticulocytes, corrected reticulocytes, IRF, and RMI of bone marrow (BM) to those of peripheral blood (PB). The Mann-Whitney U test was used to compare differences of mean values. P<0.01 was considered statistically significant (Table 1). There were no significant differences in the mean values of total reticulocytes between MDS patients and control group, nor between MDS patients and non-MDS patients in bone marrow. However, immature reticulocyte subpopulations in bone marrow from patients with MDS J. W. Choi ()) · S. H. Pai Department of Laboratory Medicine, College of Medicine, Inha University, 400-711 Inchon, South Korea e-mail: jwchoi@inha.ac.kr Tel.: +82-32-8902503 Fax: +82-32-8902529