The Effect of Iron Deficiency on Immune Parameters, Including Memory B Cells and Infection Presentations: A Cohort Study in Premenopausal Women
Abstract
Background: Iron deficiency anemia (IDA) is a condition associated with increased susceptibility to infections in the general population and more common in premenopausal women (PW). Clinical research focussing on humoral immunity and immune memory is limited in contrast to laboratory research.
Objective: This study aims to explore the effects of iron deficiency (ID) and IDA on immune function in PW by assessing immunoglobulins, lymphocyte subsets, memory B cell (MBC) quantities, and infection presentations.
Methods: A total of 180 PW who presented to the immunology outpatient clinic of a tertiary referral center between 2017 and 2024 were included. Infection history data were collected during routine clinical interviews using a six-question screening form designed to identify frequent or severe infections. Patient responses were verified through prescriptions, radiological reports, or physician documentation retrieved from the national health database. Measured parameters included haemoglobin, ferritin, immunoglobulins (IgG, A, M) and IgG subclasses, lymphocyte subsets (CD3+, CD4+, CD8+, CD19+, CD16+56+), and MBCs (CD19+CD27+IgM−IgD−). Subjects were categorized into three groups: IDA, ID, and a control group with normal haemoglobin and ferritin levels.
Results: Total lymphocyte and Natural Killer (NK) cell counts, percentage of MBCs in B lymphocytes and IgG levels were significantly lower in the IDA compared to control group. For MBC and IgG1, IDA had lower levels than both groups. Recurrent pneumonia was a more frequent infection presentation in the IDA compared to control group.
Conclusions: In PW with IDA, reductions in lymphocytes, NKs, IgG, IgG1, and MBCs, along with the higher frequency of recurrent pneumonia, may indicate a reduced capacity of immune responses against pathogens. Given the role of MBCs in maintaining long-term, even lifelong immune responses to infections or vaccinations, the potential relationship between IDA and MBC levels may represent an important and open area for further investigation regarding the sustainability of long-term immunity.
Keywords
Iron deficiency anemia, premenopause, humoral immunity, memory B cells, lymphocyte subsets, immunoglobulins
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