This study was carried out on serum ferritin, acute phase reactants (APR), iron (Fe) and total iron binding capacity (TIBC) in healthy women in Ado Ekiti, Nigeria and in female patients undergoing suture (minor operation) and ceaserean operations at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between February and March, 2009. The results revealed post-operative serum ferritin and APR concentrations to be significantly higher (p> 0.01) while iron and TIBC were significantly lower in patients undergoing caesarean operation compared to both patients with minor operation and healthy women. The pre-operative results of serum ferritin were however significantly lower in patient undergoing major operation than in patients with minor operation. The present study was carried out to examine the changes in serum ferritin and other acute phase reactants in response to the magnitude of tissue damage. It can be concluded that the concentrations of serum ferritin and acute phase reactant increases as the magnitude of tissue damages increases. There is an acute phase response of serum ferritin levels following major surgery

Asaolu, M. F.

Fakunle, Julius B.

Oyeyemi, A. O.

African Journal of Microbiology Research

English

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African Journal of Microbiology ResearchVol. 3(12) pp. 887-890, September, 2009 Available online http://www.academicjournals.org/ajmr ISSN 1996-0808 ©2009 Academic Journals      Full Length Research Paper  A comparative study of serum ferritin and other "acute phase reactants" (APR) in minor and major surgery  M. F. Asaolu1*, A. O. Oyeyemi1 and J. B. Fakunle2  1Department of Biochemistry, University of Ado-Ekiti, Nigeria. 2Department of Chemical Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria.  Accepted 21 August, 2009  This study was carried out on serum ferritin, acute phase reactants (APR), iron (Fe) and total iron binding capacity (TIBC) in healthy women in Ado Ekiti, Nigeria and in female patients undergoing suture (minor operation) and ceaserean operations at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between February and March, 2009. The results revealed post-operative serum ferritin and APR concentrations to be significantly higher (p > 0.01) while iron and TIBC were significantly lower in patients undergoing caesarean operation compared to both patients with minor operation and healthy women. The pre-operative results of serum ferritin were however significantly lower in patient undergoing major operation than in patients with minor operation. The present study was carried out to examine the changes in serum ferritin and other acute phase reactants in response to the magnitude of tissue damage. It can be concluded that the concentrations of serum ferritin and acute phase reactant increases as the magnitude of tissue damages increases. There is an acute phase response of serum ferritin levels following major surgery.   Key words: Suture, surgery, ceaserean, acute phase reactants    INTRODUCTION  Ferritin is the soluble form in which iron is stored within cells. Ferritin is found in all tissues and in high concen-tration in liver, spleen and bone marrow. It is accepted that plasma ferritin is normally derived from cells of the reticulo endothelia system (RES) and any movement of iron from red cells to the storage compartment is reflected by a corresponding change in plasma ferritin concentration (Wormwood, 2001). Serum ferritins have been found to be significantly correlated with body iron stores in normal subjects and patients with iron deficiency or overload (Jacobs et al., 2002). The level of serum ferritin can be raised in acute and chronic inflammatory disorders, which may be due to inflammatory bowel disease (Bartels et al., 1998), viral or bacterial infection (Birgegard et al., 2008) and endotoxic without iron overload and this hyperferritinaemia may reflect the severity of  hepatocellular  damage  and  rheu-    *Corresponding author. E-Mail: mfasaolu@yahoo.com. Tel.:  +2348039246483. matic fever (Bentley and Williams, 2002). Elevated serum ferritins have been linked with malignancy (Jacobs et al., 2002). Acute phase reactants play a part in the very complex defensive process of inflammation. Their concentrations rise significantly during acute inflammation due to causes such as surgery, myocardial infarction, infections and tumors. This rise, caused by increased synthesis in the liver, do not aid in the diagnosis of the cause of inflam-mation, but measurement of those proteins with the largest and earliest rises can be useful in monitoring the progress of the inflammation or its response to treatment (Pepys, 2007). The limited information available makes serum ferritin, as an index of iron stores unreliable when there is tissue damage. Therefore, the magnitude of the changes in serum ferritin, iron concentration and total iron binding capacity (TIBC) in pregnant women undergoing suture and caesarean surgery was studied. These were choo-sing as examples of minor and major surgery respec-tively. For comparison, the plasma levels of C reactive protein  (CRP)  which  is  an  established   ' acute   phase  888                 Afr.   J.    Microbiol.   Res    Table 1. Pre and post-operative ferritin, acute phase reactant, iron and total iron binding capacity in pregnant women with minor surgery.  Parameter Pre-operative Day 1-2 Day 3-4 Day 5-6 Day 7-8 Day 9-10 Day 11-13 Day 14-17 Day 18-20 Day 21+ 5 weeks Ferritin (µg/ml) Mean + SD  n = 30 Range 13 ±1.14 14 – 119 50* ± 3.50 45 – 700 78* ± 5.20 70 – 800 60 ± 3.45 59 – 6.94 52 ± 3.50 48 – 400 - - - - - - - - - - 17 ± 0.92 19 – 200 APR (mg/l) Mean + SD  n = 30 Range 72 ±3.40 68 – 100 100* ±10.11 35 – 340 73* ±5.12 22 – 260 26* ± 4.80 30 – 190 20±5.33 20 – 150 - - - - - - - - - - 75 ±4.45 70 – 95 Iron (µmol/l) Mean + SD  n = 30 Range 8.95±1.80 2.25 – 40.5 4.00* ± 0.11 1.01– 13.00 5.40* ± 0.30 1.80 – 16.00 6.30*±1.80 2.70 – 12.50 7.32 ± 1.91 2.90 – 1.40 - - - - - - - - - - 12.30 ±2.33 3.50 – 35.50 TIBC (µmol/l) Mean + SD  n = 30 Range 60 ± 5.00 41 – 80 53* ±3.60 38 - 67 43*±3.11 36 – 62 47* ±4.18 27 – 59 45 ±1.22 25 - 58 - - - - - - - - - - 61±5.23 43 - 79  SD = Standard Deviation * p < 0.01    reactant’ was also measured for comparison.    MATERIALS AND METHODS   Subjects   All the subjects used for the present study were admitted to the Obafemi Awolowo University Teaching Hospital, lIe-Ife, Nigeria except the normal women. The subjects were divided into three groups with thirty (30) patients in each group. Group 1 was made up of thirty (30) normal women with aged range of 30 - 65 years. These women were not suffering from any dis-ease or taking any medication. Group 2 were thirty (30) women involved in motor accidents who were admitted to the Obafemi Awolowo University Teaching Hospital Complex, lIe-Ife, Nigeria for various suture ope-rations and they represent groups with minor surgery. Their age ranged from 30 - 65 years with the mean age of 45.5 years. The average blood loss was estimated as 200 ml, there was no post-operative transfusion and no patient had any post-operative complications. Group 3  comprises  of  thirty  (30) patients all pregnant women  in  their third trimesters that were also admitted to the Obafemi Awolowo University Teaching Hospital Complex, lIe-Ife, Nigeria for ceaserean operation. The mean age of the group was 40.8 years with the range of 20 - 45 years. Blood samples were obtained pre-operatively, on the first post-operative day and thereafter at two-day intervals for twenty one (21) days and at fifth week.    Methods  Serum ferritin was measured by an ELISA method (Anderson and Kelly, 1981). Iron and TIBC were deter-mined by the method approved by theInternationa0l Committee on Standardization in Haematology (ICSH as described by (Tietz, 1986) while APR was estimated using radioimmuno assay (Claus et al., 1996).    Statistical analysis   All experiments were carried out in triplicate. Results were expressed  as  mean  ±  standard  deviation  and  the  data  were analysed by Students' t-test to verify  the  statistical significance at p < 0.01.    RESULTS  There were increases in the serum ferritin and CRP with sharp increase in days 3 - 4 (average-ly I0-fold increase) and days 1 - 2 (averagely 18 fold increases) respectively in group 1 patients (Table 1). There after concentration of both ferritin and CRP decreased and returned to pre-operative levels at 5 weeks follow-up. So also, iron and TIBC levels were found to be lowest on days 1 - and days 3 - 4 respectively. Group 2 patients showed peaks of serum ferritin and CRP concentrations at 3 - 4 days post operative (average 8 fold increase and average twenty fold increase) respectively. Thereafter, levels of serum ferritin and CRP remained elevated.  Serum ferritin  concentrations Asaolu et al.                           889   Table 2. Pre and post-operative ferritin, acute phase reactant, iron and total iron binding capacity in pregnant women with major surgery.  Parameter Pre- operative Day 1-2 Day 3-4 Day 5-6 Day 7-8 Day 9-10 Day 11-13 Day 14-17 Day 18-20 Day 21+ 5 weeks Ferritin (µg/ml) Mean + SD  n = 30 Range 105±10.55 60 – 1890 408 ± 20.40 53 – 3552 430* ±35.11 56 – 3000 382* ± 20.48 59 – 2400 450* ± 30.12 120 – 1700 470 ± 20.22 140 – 1837 500 ±30.80 250 – 1162 520 ±38.00 234 – 1511 530 ±30.22 210 – 1110 460±20.48 190 – 850 - - APR (mg/l) Mean + SD  n = 30 Range 80 ± 10.33 2 – 170 165*±15.80 15 – 2197 155* ±20.22 35 – 700 120* ±11.00 8 –1934 100 ± 20.22 1 – 2300 59* ± 15.00 2 – 1450 49 ±10.28 1 –3227 630 ± 30.18 1 - 3660 20 ±1.23 1 – 2290 15 ± 0.99 2 – 1800 - - Iron (µmol/l) Mean + SD  n = 30 Range 8.90 ±2.44 4.00-25.00 5.01* ± 1.85 2.0012.50 5.00* ± 1.22 1.90 – 12.60 6.70* ± 2.55 2.50 – 14.20 7.00* ±0.80 1.90 – 20.00 6.80* ±2.11 3.80 – 9.80 7.80 ± 1.80 2.50 – 22.00 7.70 ± 1.99 2.40 – 19.00 6.80 ± 1.45 3.91 – 9.6 6.30 ±1.80 2.25 – 20.8 - - TIBC (µmol/l) Mean + SD  n = 30 Range  57±1.11 36 - 75 44* ± 2.11 30 - 55 43* ± 3.00 15 - 70 40* ±5.22 20 - 60 46* ± 6.11 25 - 70 42* ± 5.88 25 - 58 38* ± 4.57 25 - 56 45 ± 3.00 20 - 58 44±3.09 20 - 58 - - - -  SD = Standard Deviation * p<0.01    were significantly higher in 51 - 65year old group than in younger subjects. There were highly signi-ficant differences (p > 0.001) in the levels of all the parameters studied in pre and post operative states   DISCUSSION   The results obtained from this study have shown that patients undergoing minor surgery had a significant low level of pre-operative serum ferritin relative to their age matched healthy women. This implies that, there is depletion of body iron stores in these patients as majority of them had menor-rhagia. The serum CRP levels in patients under-going caesarean operation (Table 2) which is a major operation (group 2) were found to be significantly (p < 0.01) higher than what is obtained for patients with minor operation, although both showed a decrease level of iron and TIBC. There was a continued marked increase in serum ferritin and CRP in group 2 patients (Table 2). This might be a reflection of high incidence of post-operative complications that may occur in these patients. This observation was in agreement with the reports of Bartels et al., (1998) and Elin et al., (2007) that major surgical procedures and inflammatory diseases result in large increases in serum ferritin and CRP concentration. A two fold rise in serum ferritin levels which peaked on the third post- operative day and not significantly elevated by day 7 in minor surgical procedure of arthroscopy has been reported (Mohammed et al., 2005). Results obtained from the present study show much higher rises fol-lowing more extensive surgical procedures. This shows that the magnitude of the elevation in serum ferritin levels depends on the degree of associated stress. This  may  be  due to  length  of  post-operative stay, length of anesthesia and likelihood of complications. It can be concluded that there is an acute phase response of serum ferritin levels following major surgery.    REFERENCES  Anderson MG, Kelly AM (1981). Serum ferritin by a rapid and inexpensive ELISA method. Clin. Chim. Acta. 116: 405 - 408.  Bartels U, Peudeseu NS, Jarnum S (1998). Iron absorption and serum ferritin in chronic inflammatory bowel disease. Scand. J. Gastroenterol. 13: 649 - 656. Bentley DP, Williams P (2002). Serum ferritin concentration as an index of storage iron in rheumatoid arthritis, J. Clin. Pathol. 27: 786- 88. Birgegard G, Hallgreu R, Killandir A (2008). Serum ferritin during infection a longitudinal study. Scand. J. Haematol. 21: 333 - 340. Claus DR, Osmand AP, Gewurz H (1996). Radioimmunoassay of human C-reactive protein  and  levels  in  normal  sera.  J.  890                 Afr.   J.    Microbiol.   Res    Lab. Clin. Med. 87: 120 -123. Elin RJ, Wolf SM, Finch CA (2002). Effect of induced fever on serum iron and ferritin concentrations in man. Blood.  49: 147 - 53. Jacobs A, Miller F, Wormwood M (2002). Ferritin in the serum of normal subjects and patients with iron deficiency and iron overload. Br. Med.  J. 4: 206 - 210. Pepys MB (2007). C-reactive protein. Fifty years on. Lancet. 1: 653 – 657 Mohammed E, McColl KEL, Veitch D (2005). Changes in iron metabolism following surgery. Br. J. Surg. 70: 161 - 162.                                                                    Tietz NW (1986). Biochemical aspects ofhaemato1ogy: In: Textbook of     Clinical chemistry. 2nd ed. WB Saunders Company. pp. 1579 - 1582.  Wormwood M (2001). Serum ferritin. Crit. Rev. Clin. Lab. Sci. 10: 171 - 204.   

A comparative study of serum ferritin and other acute phase reactants (APR) in minor and major surgery

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A comparative study of serum ferritin and other acute phase reactants (APR) in minor and major surgery

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