title: Genetic hemoglobin disorders rather than iron deficiency are a major predictor of hemoglobin concentration in women of reproductive age in rural prey Veng, Cambodia.
abstract: BACKGROUND
  Anemia is common in Cambodian women. Potential causes include micronutrient deficiencies, genetic hemoglobin disorders, inflammation, and disease.
  
  
  OBJECTIVE
  We aimed to investigate factors associated with anemia (low hemoglobin concentration) in rural Cambodian women (18-45 y) and to investigate the relations between hemoglobin disorders and other iron biomarkers.
  
  
  METHODS
  Blood samples were obtained from 450 women. A complete blood count was conducted, and serum and plasma were analyzed for ferritin, soluble transferrin receptor (sTfR), folate, vitamin B-12, retinol binding protein (RBP), C-reactive protein (CRP), and α1 acid glycoprotein (AGP). Hemoglobin electrophoresis and multiplex polymerase chain reaction were used to determine the prevalence and type of genetic hemoglobin disorders.
  
  
  RESULTS
  Overall, 54% of women had a genetic hemoglobin disorder, which included 25 different genotypes (most commonly, hemoglobin E variants and α(3.7)-thalassemia). Of the 420 nonpregnant women, 29.5% had anemia (hemoglobin <120 g/L), 2% had depleted iron stores (ferritin <15 μg/L), 19% had tissue iron deficiency (sTfR >8.3 mg/L), <3% had folate deficiency (<3 μg/L), and 1% had vitamin B-12 deficiency (<150 pmol/L). Prevalences of iron deficiency anemia (IDA) were 14.2% and 1.5% in those with and without hemoglobin disorders, respectively. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 μmol/L). Acute and chronic inflammation were prevalent among 8% (CRP >5 mg/L) and 26% (AGP >1 g/L) of nonpregnant women, respectively. By using an adjusted linear regression model, the strongest predictors of hemoglobin concentration were hemoglobin E homozygous disorder and pregnancy status. Other predictors were 2 other heterozygous traits (hemoglobin E and Constant Spring), parity, RBP, log ferritin, and vitamin B-12.
  
  
  CONCLUSIONS
  Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.
authors.affiliation: Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada;
authors.forename: Crystal D
authors.initials: CD
authors.lastname: Karakochuk
authors.affiliation: Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada;
authors.forename: Kyly C
authors.initials: KC
authors.lastname: Whitfield
authors.affiliation: Food, Nutrition, and Health, Departments of.
authors.forename: Susan I
authors.initials: SI
authors.lastname: Barr
authors.affiliation: Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada;
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lamers
authors.affiliation: Pathology and Laboratory Medicine, and Pediatrics, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, Vancouver, Canada;
authors.forename: Angela M
authors.initials: AM
authors.lastname: Devlin
authors.affiliation: Pathology and Laboratory Medicine, and The Child and Family Research Institute, Vancouver, Canada; Division of Hematopathology, Children and Women's Health Centre of British Columbia, Vancouver, Canada; and.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Vercauteren
authors.affiliation: Helen Keller International, Cambodia Country Office, Phnom Penh, Cambodia.
authors.forename: Hou
authors.initials: H
authors.lastname: Kroeun
authors.affiliation: Helen Keller International, Cambodia Country Office, Phnom Penh, Cambodia.
authors.forename: Aminuzzaman
authors.initials: A
authors.lastname: Talukder
authors.affiliation: Food, Nutrition, and Health, Departments of.
authors.forename: Judy
authors.initials: J
authors.lastname: McLean
authors.affiliation: Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada; tigreen@mail.ubc.ca.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000209:etiology* / Q000235:genetics*; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002160:Cambodia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D005838:Genotype; D006446:Hemoglobin E / Q000235:genetics; D006454:Hemoglobins / Q000032:analysis* / Q000235:genetics; D006455:Hemoglobins, Abnormal / Q000235:genetics*; D006801:Humans; D007249:Inflammation; D000090463:Iron Deficiencies; D016014:Linear Models; D018977:Micronutrients / Q000172:deficiency; D008875:Middle Aged; D011247:Pregnancy; D011990:Receptors, Transferrin / Q000097:blood; D012424:Rural Population
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D006455:Hemoglobins, Abnormal; D018977:Micronutrients; D011990:Receptors, Transferrin; D005293:Ferritins; D006446:Hemoglobin E
keywords: Cambodia; anemia; ferritin; hemoglobin; iron deficiency; micronutrient; serum transferrin receptor; thalassemia; women