title: Investigation of a Possible Association Between Refractory Iron Deficiency Anaemia to an Underlying Remote Helicobacter pylori Infection.
abstract: Helicobacter pylori is a bacterial infection accounts as the prevalent gastric pathogen. Helicobacter has been associated with many extradigestive disorders, as refractory iron deficiency anaemia (Sideropenic). The aim of this case control study was to investigate the role of remote Helicobacter pylori infection in refractory iron deficiency anaemia (RIDA); together with comparing two different methods for diagnosis of Helicobacter pylori infection. The study was conducted on thirty patients proved refractory IDA by therapeutic trial. Thirty normal non anaemic subjects were included as controls. Helicobacter pylori testing included stool antigen and Helicobacter pylori PCR. The Helicobacter pylori stool antigen test revealed 12 positive cases out of 30 IDA cases. Five of them were stool PCR cagA positive and four were stool PCR ureC positive. There was 100% agreement between PCR cagA and the stool antigen test in the detection of Helicobacter pylori infection (p= 0.003). Stool PCR cagA had a diagnostic accuracy of 76.67 and likelihood ratio of 3.57. There was 100% agreement between PCR ureC and the stool antigen test in the detection of Helicobacter pylori infection (p= 0.009). Stool PCR ureC had a diagnostic accuracy of 73.33 and likelihood ratio of 3.25. There was a very highly significant difference between the means of serum ferritin, serum iron, TIBC and transferrin saturation of Helicobacter pylori stool antigen positive and negative subjects (p<0.001).
  
  
  CONCLUSIONS
  There was a very highly significant association between Helicobacter pylori infection and refractory iron deficiency anaemia. Serum ferritin levels were significantly lower in Helicobacter pylori stool antigen positive cases than in negative cases (p< 0.001). Helicobacter pylori positive cases were 2.7 times more likely to develop anaemia than negative cases. The Helicobacter pylori stool antigen testing by ELISA proved to be more reliable compared to the stool PCR which is tedious and time consuming.
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Alexandria University, Egypt. nermohz@hotmail.com.
authors.forename: Nermine H
authors.initials: NH
authors.lastname: Zakaria
authors.forename: Ezzat A
authors.initials: EA
authors.lastname: Ahmed