Effects of Iron Deficiency and Its Indicators on Lymphocyte Subsets: A Study at King Fahd Hospital of the University, Saudi Arabia

Abstract

Background

Iron deficiency plays an important role in our body’s immunity. Several studies have shown that it is frequently associated with infections.

Objective

This study aimed to discover the effect of iron deficiency on immunity by demonstrating changes occurring in lymphocyte subsets among patients with an established diagnosis of iron deficiency.

Methods

A total of 64 iron-deficient patients and 19 healthy controls were included. Complete blood counts, serum iron, ferritin, and total iron-binding capacity were assessed. Lymphocyte subsets were evaluated by flow cytometry.

Results

Among iron-deficient patients, the anemic ones (Hb ≤11 g/dL) showed significantly lower absolute lymphocyte counts (p=0.013), lower relative and absolute NK-cell counts (p=0.025 and p=0.003, respectively), higher relative T-cell and CD4⁺-cell counts (p=0.026 and p=0.002, respectively). B cells and CD8⁺ T cells were not affected by any iron-deficiency indicators. Iron-deficient anemia patients showed a three- to fourfold increase in risk of having recurrent infections.

Conclusion

Iron deficiency has an obvious effect on lymphocyte subsets. Changes in lymphocyte subsets started mainly in response to decreased hemoglobin, rather than decreased ferritin and/or iron. Synchronously decreased hemoglobin and increased total iron-binding capacity led to absolute decreases in total lymphocytes, mainly NK cells, and relative increases in T cells, mainly the helper ones. Monitoring changes in lymphocyte subsets may be helpful in identifying patients at risk of recurrent infections.

Keywords:

• iron deficiency
• lymphocyte subsets
• immunity
• flow cytometry

Acknowledgment

The Authors appreciate all efforts made by everyone who contributed to this study; Dr. Hanan AlDuailej, Sawsan AlMatroud, Rana AlYousef, short stay ward (1C) staff, and Hematology Laboratory staff.

Disclosure

The authors report no conflicts of interest in this work.