Effect of iron deficiency anemia and its treatment on cell mediated immunity

  • Mohamed Attia Attia
  • Salwa A. Essa
  • Nahla A. Nosair
  • Ahmed M. Amin
  • Osama A. El-Agamy
Original Article


Iron deficiency anemia (IDA) is one of the most prevalent micronutrient deficiencies particularly in the developing countries. While there is evidence of an altered immune profile in iron deficiency, the exact immunoregulatory role of iron is not known. Knowledge particularly in children, who are vulnerable to iron deficiency and infection, is lacking. We aimed to study the effects of IDA and its treatment with oral iron supplementation on cell-mediated immunity. The levels of T-lymphocytes, their CD4+, CD8+ and CD1a+ subsets, transferrin receptor (CD71) and serum ferritin were evaluated in 40 iron-deficient and 40 healthy children. The impact of oral iron supplementation for three months on the same parameters was also noted in children with IDA. The level of mature T-lymphocytes (CD4+ and CD8+) was significantly lower (P<0.001) while that of the immature T-cells (CD1a+) was significantly higher (p<0.001) in IDA children compared to the control. The mature T-cell count was significantly improved after iron therapy. In spite of significant reduction in the immature T-cells (CD1a+) level after iron supplementation, it was significantly higher than the control. The present study demonstrated that T-lymphocytes maturation was defective in IDA and improved partially after 3 months of iron supplementation. Therefore, longer time of iron therapy may be required to induce complete maturation of T-lymphocytes.


Iron deficiency anemia (IDA) Immunity Micronutrient deficiency T-lymphocytes 


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  1. 1.
    Sejas E, Kolsteren PK, Hoeree T and Roberfroid N (2008) Iron supplementation in previously anemic Bolvian children. J Trop Pediatr 54(3):164–168PubMedCrossRefGoogle Scholar
  2. 2.
    Johnson SR, Winkleby MA, Boyee T, McLaughlin R, Broadwin R and Goldman L (1992) The association between hemoglobin and behaviour problems in a sample of low income Hispanic preschool children. Dev Behav Pediatr 3:209–214Google Scholar
  3. 3.
    Lozoff B, Jimenez E and Xolf AW (1991) Long term developmental outcome of infants with iron deficiency. New Engl J Med 325:687–694PubMedCrossRefGoogle Scholar
  4. 4.
    Beard JL (2001) Iron biology in immune functions, muscle metabolism and neuronal functioning. J Nutr 131:568S–580SPubMedGoogle Scholar
  5. 5.
    Ekiz C, Agaoglu L, Karakas Z, Gurel N and Yalein I (2005) The effect of iron deficiency anemia on the function of the immune system. Hrmatol J 5:579–583CrossRefGoogle Scholar
  6. 6.
    Spear AT and Sherman AR (1992) Iron deficiency alters DMBA-induced tumor burden and natural killer cell cytotoxicityrats. J Nutr 122:46–55PubMedGoogle Scholar
  7. 7.
    Jason J, Archibald LK, Nwanyanwu OC, Bell M, Jensen RJ and Gunter E (2001) The effects of iron deficiency on lymphocyte cytokine production and activation: preservation of hepatic iron but not at all cost. Clin Exp Immunol 126:466–473PubMedCrossRefGoogle Scholar
  8. 8.
    Ferguson BJ, Skikne BS and Simpson KM (1992) Serum transferrin receptor distinguishes anemia of chronic disease from iron deficiency anemia. J Lab Clin Med 19:385–390Google Scholar
  9. 9.
    Chevalier P, Sevilla R and Zalles L (1998) Immune recovery of malnourished children takes longer than nutritional recovery: implications for treatment and discharge. J Trop Pediatr 44: 304–307PubMedCrossRefGoogle Scholar
  10. 10.
    Omara FO and Blakley BR (1994) The effects of iron deficiency and iron overload on cell mediated immunity in the mouse. Br J Nutr 72:899–909PubMedCrossRefGoogle Scholar
  11. 11.
    Santos PC and Falcao RP (1990) Decreased lymphocyte subsets and K-cell activity in iron deficiency anemia. Acta Haematol 84:118–121PubMedCrossRefGoogle Scholar
  12. 12.
    Luraschi A, Borgotti P, Gioria A and Fedeli P (1991) Determination of lymphocyte subpopulations, defined with monoclonal antibodies, in patients with iron deficiency anemia. Minerva Med 82:557–563PubMedGoogle Scholar
  13. 13.
    Kuvibidila SR, Kitchens D and Baliga BS (1999) In vivo and in vitro iron deficiency reduces protein kinase C activity and translocation in murine splenic and purified T cells. J cell Biochem 74:468–478PubMedCrossRefGoogle Scholar
  14. 14.
    Berger J, Schneider D, Dyck JL, Joseph A, Aplogan A, Galan P and Hercberg S (1992) Iron deficiency anemia, cell-mediated immunityand infection among 6–36 month old children living in rural Togo. Nutr Res 12:39–49CrossRefGoogle Scholar
  15. 15.
    Mullick S, Rusia U, Sikka M and Faridi MA (2006) Impact of iron deficiency anemia on T-lymphocytes and their subsets in children. Indian J Med Res 124:647–654PubMedGoogle Scholar
  16. 16.
    Feng Xue-bin, Yang Xi-qiang and Shen Jin (1994) Influence of iron deficiency on serum IgG subclass and pneumococcal polysaccharides specific IgG subclass antibodies. Chin Med J 107:813–816PubMedGoogle Scholar
  17. 17.
    Thibault H, Galan P, Selz F, Preziosi P, Olivier C, Badoual J and Hercberg S (1993) The immune response in iron deficiency young children: effect of iron supplementation on cell mediated immunity. Eur J Pediatr152:120–124PubMedCrossRefGoogle Scholar
  18. 18.
    Skikne BS, Flowes CH and Cook JD (1990) Serum transferrin receptor: A quantitative measure of tissue iron deficiency. Blood 75:1870–1876PubMedGoogle Scholar

Copyright information

© Indian Society of Haematology & Transfusion Medicine 2009

Authors and Affiliations

  • Mohamed Attia Attia
    • 1
  • Salwa A. Essa
    • 1
  • Nahla A. Nosair
    • 1
  • Ahmed M. Amin
    • 1
  • Osama A. El-Agamy
    • 1
  1. 1.Faculty of MedicineTanta UniversityTantaIndia

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