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0SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL SPECIAL ISSUE: ACTUAL PROBLEMS OF PHARMACOLOGY AND PEDIATRIC
IMMUNE RESPONSE FEATURES TO VIRAL INFECTION IN CHILDREN WITH IRON DEFICIENCY ANEMIA
Jiemuratova G.K., 2Matkarimova A.A., 3Urazova G.B.
1Nukus Branch of the Institute of Immunology and Human Genomics, Academy of Sciences of
the Republic of Uzbekistan 2Republican Children's Multidisciplinary Medical Center, Nukus
3Karakalpak Branch of the Republican Scientific Center for Emergency Medical Care https://doi.org/10.5281/zenodo.12504439
The emergence of the novel coronavirus infection, SARS-CoV-2, presents new challenges for specialists and remains a subject of intense scrutiny. Particularly relevant is the active research into the role of various biologically active substances in assessing the severity and likelihood of adverse outcomes of the disease. Anemia is detected in a quarter of the world's population, including children under 5 years of age and women, with iron deficiency anemia (IDA) being the most common, accounting for about 90% of all anemias.
The normal iron (Fe) content in the body is necessary for adequate phagocytosis, high natural killer cell activity, serum bactericidal capacity, and sufficient synthesis of properdin, complement, lysozyme, interferon, IgA, to confer resistance to adverse environmental conditions. Iron deficiency in children can lead to increased susceptibility to respiratory infections.
The literature continues to discuss the pathogenetic model of the systemic action of SARS-CoV-2, which is based on the hypothesis of the virus's hematotoxic effect, leading to erythrocyte hemolysis and the release of free iron into the bloodstream. One of the biomarkers attracting attention is ferritin, the concentration of which in the blood, especially in severe COVID-19 cases, significantly increases.
In clinical practice, serum ferritin (SF) levels have been used to assess Fe reserves in the body. It is well known that SF is an acute-phase protein in inflammation; its concentration increases in infectious and non-neoplastic processes, liver diseases, which limits its diagnostic value in detecting iron deficiency (ID) in these cases. A solution to this problem has been proposed - to determine the level of serum ferritin in conjunction with other acute-phase markers such as C-reactive protein, procalcitonin.
All the above allows us to consider the study of the features of COVID-19 progression and immune response in children with IDA as a relevant issue in Karakalpakstan, the resolution of which will help understand the pathogenesis of this condition and develop effective approaches to its diagnosis and treatment tailored to children's specificities.
Research objective. To study the features of COVID-19 progression and immune response in children with IDA.
Materials and methods. A retrospective analysis of all confirmed cases of COVID-19 in children with IDA from October 2020 to April 2021 in the Republic of Karakalpakstan was conducted. Clinical and laboratory examinations were performed for all children, and epidemiological history was clarified. The dynamics of erythrocyte count and hemoglobin level in the blood were monitored. All children had hemoglobin levels and erythrocyte counts below the norm. Additionally, markers such as ferritin level, along with other acute-phase markers such as C-reactive protein, fibrinogen, procalcitonin in the blood, were evaluated. Liver function was assessed by determining the levels of total, direct, and indirect bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST).
SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL SPECIAL ISSUE: ACTUAL PROBLEMS OF PHARMACOLOGY AND PEDIATRIC
Research results. The ferritin level significantly increased and exceeded the upper limit of the norm until the end of the diseases. While initially, the increase in ferritin level can be easily explained by the cytokine storm, which stimulates its production and entry into the bloodstream, clear differences in ferritin dynamics between individuals with favorable and unfavorable outcomes require explanation.
All patients initially exhibited signs of pronounced inflammation. Unlike CRP, fibrinogen, and procalcitonin levels, which gradually decreased in all patients, ferritin did not show a similar trend: its concentration fluctuated around the initial values throughout the observation period, remaining above the norm.
Conclusion. The pathophysiological basis for the development of hyperferritinemia in SARS-CoV-2 infection is not fully established. The dynamics of erythrocyte count, hemoglobin level, as well as normal levels of indirect bilirubin in patients with very high ferritin levels, even in the absence of data on the presence of free hemoglobin, still allows clarification of the virus's hematotoxic effect. Whether serum ferritin is released from damaged cells or actively secreted by cells remains a matter of discussion.
