Iron Deficiency Caused by Intestinal Iron Loss—Novel Candidate Genes for Severe Anemia

The adult human body contains about 4 g of iron. About 1–2 mg of iron is absorbed every day, and in healthy individuals, the same amount is excreted. We describe a patient who presents with severe iron deficiency anemia with hemoglobin levels below 6 g/dL and ferritin levels below 30 ng/mL. Although...

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Vydané v:Genes Ročník 12; číslo 12; s. 1869
Hlavní autori: Huettmann, Carolina, Stelljes, Matthias, Sivalingam, Sugirthan, Fobker, Manfred, Vrachimis, Alexis, Exler, Anne, Wenning, Christian, Wempe, Carola, Penke, Matthias, Buness, Andreas, Ludwig, Kerstin U., Muckenthaler, Martina U., Steinbicker, Andrea U.
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Abstract The adult human body contains about 4 g of iron. About 1–2 mg of iron is absorbed every day, and in healthy individuals, the same amount is excreted. We describe a patient who presents with severe iron deficiency anemia with hemoglobin levels below 6 g/dL and ferritin levels below 30 ng/mL. Although red blood cell concentrates and intravenous iron have been substituted every month for years, body iron stores remain depleted. Diagnostics have included several esophago-gastro-duodenoscopies, colonoscopies, MRI of the liver, repetitive bone marrow biopsies, psychological analysis, application of radioactive iron to determine intact erythropoiesis, and measurement of iron excretion in urine and feces. Typically, gastrointestinal bleeding is a major cause of iron loss. Surprisingly, intestinal iron excretion in stool in the patient was repetitively increased, without gastrointestinal bleeding. Furthermore, whole exome sequencing was performed in the patient and additional family members to identify potential causative genetic variants that may cause intestinal iron loss. Under different inheritance models, several rare mutations were identified, two of which (in CISD1 and KRI1) are likely to be functionally relevant. Intestinal iron loss in the current form has not yet been described and is, with high probability, the cause of the severe iron deficiency anemia in this patient.
AbstractList The adult human body contains about 4 g of iron. About 1–2 mg of iron is absorbed every day, and in healthy individuals, the same amount is excreted. We describe a patient who presents with severe iron deficiency anemia with hemoglobin levels below 6 g/dL and ferritin levels below 30 ng/mL. Although red blood cell concentrates and intravenous iron have been substituted every month for years, body iron stores remain depleted. Diagnostics have included several esophago-gastro-duodenoscopies, colonoscopies, MRI of the liver, repetitive bone marrow biopsies, psychological analysis, application of radioactive iron to determine intact erythropoiesis, and measurement of iron excretion in urine and feces. Typically, gastrointestinal bleeding is a major cause of iron loss. Surprisingly, intestinal iron excretion in stool in the patient was repetitively increased, without gastrointestinal bleeding. Furthermore, whole exome sequencing was performed in the patient and additional family members to identify potential causative genetic variants that may cause intestinal iron loss. Under different inheritance models, several rare mutations were identified, two of which (in CISD1 and KRI1) are likely to be functionally relevant. Intestinal iron loss in the current form has not yet been described and is, with high probability, the cause of the severe iron deficiency anemia in this patient.
The adult human body contains about 4 g of iron. About 1-2 mg of iron is absorbed every day, and in healthy individuals, the same amount is excreted. We describe a patient who presents with severe iron deficiency anemia with hemoglobin levels below 6 g/dL and ferritin levels below 30 ng/mL. Although red blood cell concentrates and intravenous iron have been substituted every month for years, body iron stores remain depleted. Diagnostics have included several esophago-gastro-duodenoscopies, colonoscopies, MRI of the liver, repetitive bone marrow biopsies, psychological analysis, application of radioactive iron to determine intact erythropoiesis, and measurement of iron excretion in urine and feces. Typically, gastrointestinal bleeding is a major cause of iron loss. Surprisingly, intestinal iron excretion in stool in the patient was repetitively increased, without gastrointestinal bleeding. Furthermore, whole exome sequencing was performed in the patient and additional family members to identify potential causative genetic variants that may cause intestinal iron loss. Under different inheritance models, several rare mutations were identified, two of which (in CISD1 and KRI1) are likely to be functionally relevant. Intestinal iron loss in the current form has not yet been described and is, with high probability, the cause of the severe iron deficiency anemia in this patient.The adult human body contains about 4 g of iron. About 1-2 mg of iron is absorbed every day, and in healthy individuals, the same amount is excreted. We describe a patient who presents with severe iron deficiency anemia with hemoglobin levels below 6 g/dL and ferritin levels below 30 ng/mL. Although red blood cell concentrates and intravenous iron have been substituted every month for years, body iron stores remain depleted. Diagnostics have included several esophago-gastro-duodenoscopies, colonoscopies, MRI of the liver, repetitive bone marrow biopsies, psychological analysis, application of radioactive iron to determine intact erythropoiesis, and measurement of iron excretion in urine and feces. Typically, gastrointestinal bleeding is a major cause of iron loss. Surprisingly, intestinal iron excretion in stool in the patient was repetitively increased, without gastrointestinal bleeding. Furthermore, whole exome sequencing was performed in the patient and additional family members to identify potential causative genetic variants that may cause intestinal iron loss. Under different inheritance models, several rare mutations were identified, two of which (in CISD1 and KRI1) are likely to be functionally relevant. Intestinal iron loss in the current form has not yet been described and is, with high probability, the cause of the severe iron deficiency anemia in this patient.
The adult human body contains about 4 g of iron. About 1-2 mg of iron is absorbed every day, and in healthy individuals, the same amount is excreted. We describe a patient who presents with severe iron deficiency anemia with hemoglobin levels below 6 g/dL and ferritin levels below 30 ng/mL. Although red blood cell concentrates and intravenous iron have been substituted every month for years, body iron stores remain depleted. Diagnostics have included several esophago-gastro-duodenoscopies, colonoscopies, MRI of the liver, repetitive bone marrow biopsies, psychological analysis, application of radioactive iron to determine intact erythropoiesis, and measurement of iron excretion in urine and feces. Typically, gastrointestinal bleeding is a major cause of iron loss. Surprisingly, intestinal iron excretion in stool in the patient was repetitively increased, without gastrointestinal bleeding. Furthermore, whole exome sequencing was performed in the patient and additional family members to identify potential causative genetic variants that may cause intestinal iron loss. Under different inheritance models, several rare mutations were identified, two of which (in and ) are likely to be functionally relevant. Intestinal iron loss in the current form has not yet been described and is, with high probability, the cause of the severe iron deficiency anemia in this patient.
Author Wempe, Carola
Muckenthaler, Martina U.
Buness, Andreas
Sivalingam, Sugirthan
Penke, Matthias
Ludwig, Kerstin U.
Huettmann, Carolina
Steinbicker, Andrea U.
Wenning, Christian
Exler, Anne
Vrachimis, Alexis
Stelljes, Matthias
Fobker, Manfred
AuthorAffiliation 12 Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, 60590 Frankfurt am Main, Germany
4 Institute for Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
2 Medical Clinic D: Hematology, Haemostaseology, Oncology and Pneumology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; Matthias.Stelljes@ukmuenster.de
1 Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; carolina.huettmann@uni-muenster.de (C.H.); carola.wempe@ukmuenster.de (C.W.)
3 Core Unit Bioinformatics Data Analysis, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; s.sivalingam@uni-bonn.de (S.S.); buness@uni-bonn.de (A.B.)
7 Department of Nuclear Medicine, University Hospital Muenster, University of Muenster, 48149 Muenster, German
AuthorAffiliation_xml – name: 9 Institute of Human Genetics, University Hospital Bonn, Medical Faculty University of Bonn, 53113 Bonn, Germany; kerstin.ludwig@uni-bonn.de
– name: 3 Core Unit Bioinformatics Data Analysis, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; s.sivalingam@uni-bonn.de (S.S.); buness@uni-bonn.de (A.B.)
– name: 8 Oncological Clinic, St. Franziskus Hospital, Franziskusstraße 6, 49393 Oldenburg, Germany; p.onkolohne@gmail.com
– name: 5 Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
– name: 4 Institute for Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
– name: 1 Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; carolina.huettmann@uni-muenster.de (C.H.); carola.wempe@ukmuenster.de (C.W.)
– name: 2 Medical Clinic D: Hematology, Haemostaseology, Oncology and Pneumology, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; Matthias.Stelljes@ukmuenster.de
– name: 11 Molecular Medicine Partnership Unit (MMPU), 69117 Heidelberg, Germany
– name: 7 Department of Nuclear Medicine, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; Alexis.Vrachimis@goc.com.cy (A.V.); anne.exler@ukmuenster.de (A.E.); christian.wenning@hospital-lingen.de (C.W.)
– name: 6 Center for Laboratory Medicine, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany; Manfred.Fobker@ukmuenster.de
– name: 10 Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, 69117 Heidelberg, Germany; Martina.Muckenthaler@med.uni-heidelberg.de
– name: 12 Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, 60590 Frankfurt am Main, Germany
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CitedBy_id crossref_primary_10_1038_s41420_024_02022_2
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crossref_primary_10_1080_10408398_2022_2074961
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Issue 12
Keywords genetically caused iron imbalance
iron
erythropoiesis
intestinal iron loss
red cells
Language English
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Former affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, 48149 Muenster, Germany.
Current affiliation: German Oncology Center, 4108 Limassol, Cyprus.
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Snippet The adult human body contains about 4 g of iron. About 1–2 mg of iron is absorbed every day, and in healthy individuals, the same amount is excreted. We...
The adult human body contains about 4 g of iron. About 1-2 mg of iron is absorbed every day, and in healthy individuals, the same amount is excreted. We...
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StartPage 1869
SubjectTerms Aged
Aged, 80 and over
Anemia
Anemia, Iron-Deficiency - blood
Anemia, Iron-Deficiency - etiology
Anemia, Iron-Deficiency - genetics
Biopsy
Bleeding
Blood
Bone marrow
Chronic illnesses
Cytokines
diagnostic techniques
Erythrocytes
Erythropoiesis
Erythropoiesis - genetics
Excretion
Families & family life
Feces
Female
Ferritin
Gastrointestinal Tract - metabolism
Genetic diversity
Genetic Variation - genetics
Graphite
Hemoglobin
Hemorrhage - complications
Hemorrhage - genetics
Heredity
Humans
Intestine
intestines
Intravenous administration
intravenous injection
Iron
Iron - blood
Iron - metabolism
Iron - urine
Iron Deficiencies - etiology
Iron Deficiencies - genetics
Iron deficiency
iron deficiency anemia
liver
Magnetic resonance imaging
Male
Middle Aged
Mutation
Mutation - genetics
Nutrient deficiency
Patients
Plasma
probability
urine
Title Iron Deficiency Caused by Intestinal Iron Loss—Novel Candidate Genes for Severe Anemia
URI https://www.ncbi.nlm.nih.gov/pubmed/34946818
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https://pubmed.ncbi.nlm.nih.gov/PMC8700796
Volume 12
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