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

Abstract

Lolwa AlRajeh,1 Amr Zaher,1 Amal alghamdi,2 Rasha Alsheikh,2 Osama AlSultan3 1Department of Pathology, College of Medicine, Imam Abdulrahman University, Dammam, Saudi Arabia; 2Family and Community Medicine Department, College of Medicine, Imam Abdulrahman University, Dammam, Saudi Arabia; 3Internal Medicine Department, King Fahd University Hospital, Al Khobar, Saudi ArabiaCorrespondence: Lolwa AlRajeh, Email lrajeh@iau.edu.saBackground: 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