İbrahim ŞİLFELER, DİLEK BENK ŞİLFELER, BURCU ARTUNÇ ÜLKÜMEN, Fügen PEKÜN

Anne ve kordon kan ferritin düzeyleri ile anemi gelişimi arasındaki ilişki

Bu çalışmada sütçocukluğu fizyolojik anemi gelişme yaşı ile kordon kanındaki ferritin düzeyi arasında anlamlı bir ilişki saptamayı amaçladık. 15/11/2008 - 31/12/2008 tarihleri arasında hastanemize başvuran travaydaki 37-42 gestasyon haftaları arasındaki gebelerden rastgele yöntemle 86 olgu çalışmaya alındı. Çalışmamıza aldığımız olgular 4. ay hemogram sonuçlarında hemoglobin değeri llgr/dl 'nin altında olan bebekler Grup 1, hemoglobin değeri llgr/dl veya daha yüksek olarak bulunan bebekler ise Grup 2 olarak sınıflandırıldı. Tüm olgular içinde 4. ay bebek kanı ortalama hemoglobin değeri 10,88 ± 0,850 idi. Grup 1 'de 4.ay bebek kanı ortalama hemoglobin değeri 10,32 ± 0,549 iken Grup 2'de 11,60 ± 0,563 olarak bulundu. Tüm olgular içinde 4.ay bebek kanı ortalama hemotökrit değeri 32,85 ± 3,211 idi. Grup 1 'de 4. ay bebek kanı ortalama hemoglobin 30,99 ± 2,476 iken Grup 2'de 35,29 ± 2,371 olarak bulundu. Bu iki parametreler arasında istatistiksel olarak anlamlı bir fark yoktur (p>0,05). Grup 1 ile Grup 2 kordon kanı ferritin değerleri arasında anlamlı bir fark olup olmadığı araştırılmış ve p değeri 0,05). 4. ayda anemi gelişen bebeklerin kordon kanlarındaki ferritin değerleri, anemi gelişmemiş olan bebeklerin ferritin düzeylerine göre istatistiksel olarak anlamlı bir farkla düşük saptanmıştır. Her ne kadar çalışmamızda annenin demir depoları ile kordon kanı ferritin değerleri ve 4. ay anemi gelişimi arasında ilişki tespit edilemese de, annenin demir deposu emzirme döneminde anne sütündeki demir düzeyini etkilemektedir. Bu da annenin demir kullanımının önemini bir kez daha ortaya koymaktadır.

Anahtar Kelimeler:

Süt çocuğu, Anemi, Ferritin, Gebelik

The relation between maternal and umbilical cord ferritin levels and developing anemia

In this study, we aimed to establish a significant correlation between umbilical cord ferritin levels and the age when physiologic anemia develops in a nursing child. Randomly selected 86 cases underwent vaginal labor or cesarean section between 37-42 gestational weeks admitted to Okmeydanı Training andResearh Hospital between 15.11.2008-31.12.2008 were included in the study. In our study, we have classified cases according to the Hemoglobin levels of fourth month CBC as group 1 which Hb levels are '3f 11gr/dl. Regarding all cases, the mean hemoglobin level of babies at 4th months was 10,88 ± 0,850. Regarding Group I, the mean hemoglobin level of babies at 4th months was 10,32 ± 0,549 and regarding Group II, the mean hemoglobin level of babies at 4th months was 11,60 ± 0,563. The mean hematocrit level of all cases was in average 32,85 ± 3,211. The mean hematocrit level of babies at 4th months was 30,99 ± 2,476 in group I and 35,79 ± 2,371 in group II respectively. There was no significant difference between the groups (p>0,05). We have searched if the difference between these groups cord cord blood Hb values are remarkable or not and p values was found 0.05).The umbilical cord ferritin levels of the babies who developed anemia at 4th months were significantly lower than the umbilical cordferritin levels of the babies with no anemia. There was no significant correlation between maternal iron stores, umbilical cord ferritin levels and anemia at 4th months; neverthless, maternal iron stores affect the iron level in the maternal milk during lactation period. This shows the importance of the maternal iron supplementation during pregnancy.

Keywords:

Infant, Anemia, Ferritins, Pregnancy,

PDF

___

1. Dallman PR, Yıp R, Oski A. Iron deficiency and related nutritional anemias. In: Nathan DG. Oski FA(eds). Hematology of Infancy and Childhood. (5 th ed).Philadelphia: WB Saunders. 1998; 430-76
2. Tunalı A. Kan Hastalıkları. İç Hastalıkları Kitabı. Bursal990; 7:699-716 3. Foirbanks VF, Beutler E. Iron Defiency. Williams Hematology 5th edition USA Mc Grow-Hill. 1995;46:490-506 4. Tamura T, Goldenberg R L, Hou j, jonston K E, Cliver S P, Ramey S L and Nelson K G, Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. The Journal of pediatrics 2002; feb: 165-170 5. Gambling L and McArdle H J. Iron, copper and fetal development. Proceeding of the Nutrition Society 2004;63:553-62 6. Tamura T, Goldenberg RL. Cord serum ferritin concentrations and mental and pschomotor development of children at five years of age. J Pediatr 2001; 140: 165-170 7. Toppare FM. Genel Obstetrik-Fetal fizyoloji, erken neonatal fizyoloji. Temel Kadın Hastalıkları ve Doğum Bilgisi. 1996; 2: s: 233-237 8. Choi WJ, Pai SH, Im MW, Kim SK. Change in transferin receptor concentrations with age. Clinical Chemistry 1999; 45(9): 1562-1563 9. Milman N, Agger A O and Nielsen O.J. Iron status markers and serum erytropoietin in 120 mothers and newborn infants. Acta Obstet Gynecol Scand 1994;73:200-204 10. Van Dijk JP. Regulatory aspects of placental iron transfer-a comparative study. Placenta 1988, 9:215-226 11. Cunnigham FG, Gant NF, Leveno KS, Gilstrop LC, Hauth JC, Wenstrom KD. Hemotological Disardes-Anemies. Williams Obstetries Hot Edition. USA. The Mc Grow-Hill Gmponies. 2001; 47: 1308-1310 12. O'Brien K.O, Zavaleta N, Abrams S.A and Caul field L.E. Maternal iron status influences iron transfer to the fetus during the third trimester of pregnancy. Am J Clin Nutr 2003;77:924-30 13. Fleming RE. Cord serum ferritin levels, fetal iron status, and neurodevelopmental outcomes: Correlations and confounding variables. J Pediatr 2002 Feb;140(2):145-8
14. Meyerovitch J, Sherf M, Antebi F, Barhoum- Noufı M, Horev Z, Jaber L, Weiss D, Koren A. The incidence of anemia in an Israeli population: a population analysis for anemia in 34.512 Israeli infants aged 9 to 18 monthsh Pediatrics. 2006 Oct; 118(4): 1055-60
15. World Health Organization, UNICEF. Global Strategy for Infant and Young Child Feeding, Geneva: WHO, 2003:1-4, 7-9.
16. Lawrens RA, Lawrence RM. Host-resistance factors and immunologic significance of human milk. In: Lawrens RA, Lawrence RM (eds). Breastfeeding. St. Louis: Mosby, 1994: 159-95
17. T.C. Sağlık Bakanlığı, Hacettepe Üniversitesi Nüfus Etüdleri Enstitüsü. Türkiye Nüfus ve Sağlık Araştırması 2003. Ankara: Macro International Inc, 2003
18. International Nutritional Anemia Consultative Group (INACG) World Health Organization (WHO) United Nations Children's Fund (UNICEF). Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. Washington DC: International Life Sciences Institute, 1998
19. Tekinalp G, Oran O, Gür akan B, Saraçel M. Relationship between maternal and neonatal iron stores. The Turkish Journal of pediatrics 1996; 38: 439-445 20. Milman N, İbsen KK, Christensen JM. Serum ferrritin and iron status mothers and newborn infant. Acta Obstet. Gynecol Scand 1987; 66 (3): 205-11 21. Thararaj VK, Sos try G, Reddy V. Relation between maternal and cord serum ferrritin. Indian Pediatrics 1986; 23: 29-32 22. Choi JW, Im MW, Pai SH. Serum transferin Receptor Concentrations during normal pregnancy. Clinical Chemistry 2000; 46: 725-727 23. Agrawal RMD, Tripathi AM and agrawal KN. Cord blood haemoglobin, iron and ferritin ststus in maternal anaemia. Acta Paediatr Scand 1983;72:545-548
24. Telâtar B, Ezengin B, Vitrine! A, Erginöz E, AyazZ. Anne sütü alan bebeklerde 4. Demir durumu. Türk Aile Hekimliği Derg. 2005;9(4):163-166 25. Hussian MAM, Gaafar TH, Laulicht M and Hoffbrand AV. Relation of maternal and cord blood serum ferritin. Archives od disease in childhood 1977;52:782-784 26. Choi JW, Kim CS, Pai SH. Erythropoietic activity and soluble transferin receptor level in neonates and maternal blod. Acta Paediatr2000;89:675-9 27. Harthoorn-Loothuizen EJ. Lindemono J, Longenhuijsen M.AC Does iron-deficient rythnopoiesis in prepnancy influence fetal iron supply 28. Singla PN, Tyapi M, Kunar A, Dash D, Shonkar R. Fetalprowth in maternal anemia. J Trop Pdiatr. 1997;43(2):89-92 29. Siimes AS, Siimes MA. Changes in the concentration offerritin in the serum during fetal life in singletons and twins. Early Hum Dev 1986; 13: 47-52 30. Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency. N Engl J Med 1991; 325: 687-94 31. Calvo EB, Galindo AC, Aspres NB. Iron status exclusively breast-fed infants. Pediatrics 1992: 90: 375-9 32. FrielJK, Aziz K, Andrews WL, Harding CV, Courage ML. A double- masked, randomized control trial of iron supplementation in early infancy in healthy term breast-fed infants. JPediatr 2003; 143: 582-6 33. Dallman PR. Progress in the prevention of iron deficiency in infants. Acta Paediatr Scand 1990; 365:28-37 34. McMillan J A, Landaw SA, Oski FA. Iron sufficiency in breast-fed infants and availability of iron from human milk. Pediatrics 1976; 58: 686- 91