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Banker TR, Gillam MH, O’Loughlin P, Rankin W, Ryan R, Caruso C, Roughead EE. To test or to not test: A retrospective cross-sectional study on potentially inappropriate use of pathology testing in South Australian hospitals. Am J Clin Pathol 2024; 161:342-348. [PMID: 37975596 PMCID: PMC10988106 DOI: 10.1093/ajcp/aqad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES To measure rates of potentially inappropriate pathology testing in the hospital setting. METHODS Retrospective cross-sectional study in hospital setting from July 2021 to December 2021. We examined 3 potentially inappropriate uses: overordering, selection errors, and unnecessary repeat testing. Overordering included vitamin D and lipids (rarely required in acute hospital care). Selection error was the ratio of iron studies to standalone ferritin requests. Unnecessary repeats included any repeat vitamin D, lipids, iron, or ferritin in an episode of care or C-reactive protein (CRP) repeated within 3 days and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 7 days and repeated previously abnormal CRP and NT-proBNP tests. Costs of inappropriate tests were estimated using the Australian Medicare Benefits Schedules. RESULTS Among 55,904 test requests, 15% (n = 8120) were potentially inappropriate. Vitamin D was frequently ordered (n = 4498), as were lipids (n = 2872). Ratio of iron studies to standalone ferritin was 36. Of 19,233 repeat CRPs, 36% (n = 6947) were within 3 days and 62% (n = 179) of repeat NT-proBNPs were within 7 days of the first test. For initially abnormal tests, 89% of CRPs and 97% of NT-proBNPs remained abnormal. Inappropriate test costs accounted for 12% to 30% of costs. CONCLUSIONS Frequent potential inappropriate use and selection of pathology tests was observed in South Australian hospitals.
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Affiliation(s)
- Twisha R Banker
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Marianne H Gillam
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Peter O’Loughlin
- SA Pathology, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Wayne Rankin
- SA Pathology, Adelaide, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | | | - Connie Caruso
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia
- Centre for Change and Complexity in Learning (C3L), University of South Australia, Adelaide, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
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Muñoz MPS, Ramirez ZPB, Rodriguez ELM, Blandón JDR, Aguiñaga SA, Orozco CAO, Yáñez ARE. Transferrin Saturation, Serum Ferritin, and C-Reactive Protein vs. Serum Ferritin for an optimal Iron Deficiency Diagnosis in Candidates for Bariatric Surgery. Obes Surg 2024; 34:1174-1184. [PMID: 38367125 DOI: 10.1007/s11695-024-07081-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID. MATERIALS AND METHODS We present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30 ng/mL) and method 2 divided into 2A (FER < 30 ng/mL), 2B (FER 30-100 ng/mL + CRP ≥ 5 mg/L), 2C (FER 100-300 ng/mL + CRP ≥ 5 mg/L + TS < 20%), and 2D (TS < 20%). RESULTS The prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%. CONCLUSION The inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity.
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Affiliation(s)
- M Patricia Sánchez Muñoz
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - Zuleyma P Bello Ramirez
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico.
| | - Eduardo L Martínez Rodriguez
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - José D Reyes Blandón
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - Soledad Aldana Aguiñaga
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - César A Ortiz Orozco
- General Surgery Department, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - Allison R Esparza Yáñez
- University Center for Biological and Agricultural Sciences, University of Guadalajara, Ramón Padilla Sanchez 2100, The Needles, C.P: 44600, Zapopan, Jalisco, Mexico
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Goel D, Avinash PR, Shangari S, Srivastav M, Pundeer A. Chronic nonspecific multiple-sites pain [CNMSP] of unknown etiology: Biopsychosocial method of evaluation for the primary care level. J Family Med Prim Care 2024; 13:1393-1400. [PMID: 38827703 PMCID: PMC11141980 DOI: 10.4103/jfmpc.jfmpc_722_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 06/04/2024] Open
Abstract
Background Understanding and dealing with chronic nonspecific pain (CNP) is the important entity at primary care hospital. Chronic nonspecific multiple-site pain [CNMSP] of unknown etiology creates diagnostic and therapeutic challenges for primary care physicians due to lack of guidance regarding evaluation and treatment. Aims and Objectives To classify and formulate the evaluation, treatment strategies, and prediction of prognosis of patients with CNMSP of unknown etiology. Methods Patients present with CNMSP of more than 3-month duration without any obvious medical cause. The biopsychosocial [BPS] model with 3P model was applied to see the biological, psychological, and social factors behind persistence. Finally, patients were classified into four groups for evaluation response to treatment and relapse rates in 12-month follow-up. Results Of the total 243 patients of CNMSP, 243 [96.3%] were females. Sixty [24.7%] patients had short duration, and 183 [75.3%] had long duration. Headache was in 115 [47%], low back pain ± leg pain in 96 [39.4%], cervical pain ± shoulder/arm pain in 83 [34.1%], and diffuse body pain in 50 [20.5%] in various combinations. A total of 155 [63.8%] patients had high somatization-sensitization index (SSI), and 144 [59.3%] had low ferritin level. Group 1 [high SSI and low ferritin] had 37.9% of patients, group 2 [high SSI and normal ferritin] had 25.9% of patients, group 3 [low to medium SSI with low ferritin] had 21.4% of patients, and group 4 [low to medium SSI with normal ferritin] had 14.8% of patients. Response to pain symptoms was better in group 1, and relapse rate was higher in group 2. Conclusion CNMSP of unknown etiology itself is a heterogeneous entity, and assessment based on the BPS model can be very useful to understand the treatment plan and outcome of these patients.
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Affiliation(s)
- Deepak Goel
- Department of Neurology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Priya R. Avinash
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Sushant Shangari
- Department of Neurology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Malini Srivastav
- Department of Clinical Psychology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Ashwani Pundeer
- Department of Clinical Psychology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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Du Pont-Thibodeau G, Li SYH, Ducharme-Crevier L, Jutras C, Pantopoulos K, Farrell C, Roumeliotis N, Harrington K, Thibault C, Roy N, Shah A, Lacroix J, Stanworth SJ. Iron Deficiency in Anemic Children Surviving Critical Illness: Post Hoc Analysis of a Single-Center Prospective Cohort in Canada, 2019-2022. Pediatr Crit Care Med 2024; 25:344-353. [PMID: 38358779 DOI: 10.1097/pcc.0000000000003442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Many children leave the PICU with anemia. The mechanisms of post-PICU anemia are poorly investigated, and treatment of anemia, other than blood, is rarely started during PICU. We aimed to characterize the contributions of iron depletion (ID) and/or inflammation in the development of post-PICU anemia and to explore the utility of hepcidin (a novel iron marker) at detecting ID during inflammation. DESIGN Post hoc analysis of a single-center prospective study (November 2019 to September 2022). SETTING PICU, quaternary center, Canada. PATIENTS Children admitted to PICU with greater than or equal to 48 hours of invasive or greater than or equal to 96 hours of noninvasive ventilation. We excluded patients with preexisting conditions causing anemia or those admitted after cardiac surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Hematological and iron profiles were performed at PICU discharge on 56 participants of which 37 (37/56) were diagnosed with anemia. Thirty-three children (33/56; 59%) were younger than 2 years. Median Pediatric Logistic Organ Dysfunction score was 11 (interquartile range, 6-16). Twenty-four of the 37 anemic patients had repeat bloodwork 2 months post-PICU. Of those, four (4/24; 16%) remained anemic. Hematologic profiles were categorized as: anemia of inflammation (AI), iron deficiency anemia (IDA), IDA with inflammation, and ID (low iron stores without anemia). Seven (7/47; 15%) had AI at discharge, and one had persistent AI post-PICU. Three patients (3/47; 6%) had IDA at discharge; of which one was lost to follow-up and the other two were no longer anemic but had ID post-PICU. Eleven additional patients developed ID post-PICU. In the exploratory analysis, we identified a diagnostic cutoff value for ID during inflammation from the receiver operating characteristic curve for hepcidin of 31.9 pg/mL. This cutoff would increase the detection of ID at discharge from 6% to 34%. CONCLUSIONS The burden of ID in children post-PICU is high and better management strategies are required. Hepcidin may increase the diagnostic yield of ID in patients with inflammation.
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Affiliation(s)
| | - Shu Yin Han Li
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | | | - Camille Jutras
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Kostas Pantopoulos
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Catherine Farrell
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Nadia Roumeliotis
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Karen Harrington
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Céline Thibault
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Noémi Roy
- Department of Hematology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Akshay Shah
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Jacques Lacroix
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Simon J Stanworth
- Department of Hematology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Walsh NM, Flynn A, Walton J, Kehoe L. Optimal growth and development: are teenagers getting enough micronutrients from their diet? Proc Nutr Soc 2024:1-9. [PMID: 38433580 DOI: 10.1017/s002966512400017x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
The teenage years represent a crucial period of physical and cognitive growth and development with sufficient micronutrient intakes necessary to meet high nutritional requirements. This review examines current micronutrient intakes in teenagers in the Western world in the context of public health implications including the prevalence of inadequate intakes and risk of excessive intakes. Intakes of vitamins A, D, E and C, folate, calcium, iron, magnesium, zinc and potassium in teenagers are low when compared to generally accepted recommendations, while there is little risk of excessive micronutrient intakes based on current dietary patterns. Therefore, strategies should focus on increasing micronutrient intakes in order to decrease the risk of negative impacts resulting from these low intakes. These strategies should be mindful of guidance towards an environmentally sustainable diet whilst ensuring that nutrient intakes in teenagers are not further negatively impacted. In order to identify, implement and monitor the effectiveness of such strategies, intakes of micronutrients should be continually monitored in nationally representative samples of the population for all age groups including this vulnerable cohort of teenagers.
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Affiliation(s)
- Niamh M Walsh
- School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
- Department of Biological Sciences, Munster Technological University, Cork, Republic of Ireland
| | - Albert Flynn
- School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
| | - Janette Walton
- Department of Biological Sciences, Munster Technological University, Cork, Republic of Ireland
| | - Laura Kehoe
- School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
- Department of Biological Sciences, Munster Technological University, Cork, Republic of Ireland
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Tang GH, Sholzberg M. Iron deficiency anemia among women: An issue of health equity. Blood Rev 2024; 64:101159. [PMID: 38042684 DOI: 10.1016/j.blre.2023.101159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
Iron deficiency is the most common and widespread nutritional deficiency in the world. For women, the risk of iron deficiency and iron deficiency anemia increases due to iron demands during pregnancy and regular iron losses due to menstruation during reproductive years. These interrelated conditions are of public health concern as they are highly prevalent, and the negative consequences such as chronic fatigue, cognitive impairment and poor quality of life are broad and multifaceted. People of low socioeconomic status are at higher risk of iron deficiency due to low intake of expensive iron-rich foods, and decreased access to healthcare. In this review, we applied a health equity lens to describe the current state of care for women with iron deficiency with or without anemia. We have highlighted several structural challenges that span from the laboratory diagnosis, inconsistent screening guidelines, and stigma associated with heavy menstrual bleeding, to treatment barriers.
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Affiliation(s)
- Grace H Tang
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Department of Medicine, and Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada.
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Telli H, Özdemir Ç. Is nociplastic pain, a new pain category, associated with biochemical, hematological, and inflammatory parameters? Curr Med Res Opin 2024; 40:469-481. [PMID: 38204412 DOI: 10.1080/03007995.2024.2304106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The aim of the study was to evaluate the relationship between biochemical, hematological, and inflammatory parameters and pain in patients with nociplastic pain. METHODS In this cross-sectional study, a total of 8632 patients, aged between 20 and 65, were evaluated according to the nociplastic pain diagnosis criteria determined by IASP. Excluding individuals who did not meet the criteria for nociplastic pain, the study included a total of 660 participants. The biochemical, hematological, and inflammatory parameters of all individuals were examined. The pain levels of the patients were assessed using the Visual Analogue Scale (VAS). The patients were categorized based on nociplastic pain types and pain regions for evaluation. RESULTS In this study, the female gender was more prevalent both in all nociplastic pain categories and in all pain region groups (p < 0.05). In the nociplastic pain categories, it was observed that vitamin D levels were lower in patients with chronic widespread pain, while ferritin and C-reactive protein levels were higher in patients with chronic primary musculoskeletal pain. Among patients with chronic widespread pain with low hemoglobin and/or ferritin levels, the Visual Analog Scale activity score was higher. For patients with chronic widespread pain and low vitamin D levels and/or high erythrocyte sedimentation rate levels, the Visual Analog Scale rest score was higher. In patients with fibromyalgia and high parathyroid hormone levels, the Visual Analog Scale activity score was higher. For patients with fibromyalgia and high Neutrophil/Lymphocyte ratio levels, the Visual Analog Scale rest score was higher. In patients with chronic primary musculoskeletal pain and high erythrocyte sedimentation rate and/or C-reactive protein levels, the Visual Analog Scale activity score was higher. While vitamin B12 levels were found to be lower in patients with widespread pain, no significant relationship was identified between electrolytes, other blood count results, and nociplastic pain. CONCLUSION In our study, it was observed that levels of vitamin D in individuals with nociplastic pain were low, while erythrocyte sedimentation rate, C-reactive protein, and Neutrophil/Lymphocyte ratio were high, and hemoglobin and ferritin levels were elevated. Furthermore, these findings were found to be associated with both the presence of pain and the severity of pain assessed using the visual analog scale.
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Affiliation(s)
- Hilal Telli
- Evliya Çelebi Training and Research Hospital, Physical Therapy and Rehabilitation Clinic, Kütahya Health Sciences University, Kütahya, Turkey
| | - Çağla Özdemir
- Evliya Çelebi Training and Research Hospital, Family Medicine Clinic, Kütahya Health Sciences University, Kütahya, Turkey
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Ding N, Ma YH, Guo P, Wang TK, Liu L, Wang JB, Jin PP. Reticulocyte hemoglobin content associated with the risk of iron deficiency anemia. Heliyon 2024; 10:e25409. [PMID: 38327465 PMCID: PMC10847927 DOI: 10.1016/j.heliyon.2024.e25409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Background/Objective Reticulocyte hemoglobin content (MCHr) was recognized as a rapid and reliable marker for investigating iron deficiency (ID). We hypothesized that MCHr was associated with the risk of iron deficiency anemia in adults. Methods This is a dual-center case-control study. A total of 806 patients and healthy individuals were recruited from Ruijin Hospital and Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2021 and December 2021. The participants were categorized into iron deficiency anemia (IDA) group (n = 302), non-IDA group (n = 366), and healthy control group (n = 138). According to the MCHr level, the participants were divided into two groups, i.e. normal MCHr (≥25 pg) and decreased MCHr (<25 pg) group. Multivariate logistic regression analysis and adjusted subgroup analysis were conducted to estimate the relative risk between MCHr and IDA, with confounding factors including age, sex, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), Hematocrit (HCT), serum iron (Fe), ferritin (Ferrit), and total iron binding capacity (TIBC). Results Compared with the non-IDA, the MCHr level with IDA decreased significantly. ROC curve analysis showed that MCHr had the largest area under the AUC curve. After comprehensive adjustment for confounding factors, individuals with normal level of MCHr exhibited a decreased risk of IDA (OR = 0.68 [0.60, 0.77], P < 0.01), while the risk of IDA was up to 5 times higher for those with decreased MCHr. Conclusion Our findings supported the hypothesis that MCHr was associated with the risk of IDA in adults and could serve as an indicator of IDA severity. MCHr holds clinical value as an auxiliary diagnostic indicator, providing valuable insights into whether invasive examinations are warranted in the assessment of IDA.
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Affiliation(s)
- Ning Ding
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
| | - Yan-Hui Ma
- Department of Laboratory Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Ping Guo
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tian-Kai Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
| | - Lin Liu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
| | - Jian-Biao Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Pei-Pei Jin
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
- Department of Laboratory Medicine, Ruijin-Hainan Hospital, Shanghai Jiao Tong University School of Medicine (Hainan Boao Research Hospital), Hainan, 571473, China
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Anthony P, Wu M, Shanmugalingam A, Ng CH, Wright D. Preoperative iron infusion does not reduce the requirement for blood transfusion in colorectal cancer surgery. Minerva Surg 2024; 79:28-32. [PMID: 37705393 DOI: 10.23736/s2724-5691.23.09975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Allogeneic blood transfusions (BT) for patients undergoing colorectal cancer surgery have demonstrated to increase postoperative morbidity and mortality. It has been suggested that the utilization of preoperative iron infusions may reduce the requirement for allogeneic BT in these patients. The aim of this project is to ascertain whether the preoperative use of intravenous iron is significantly associated with a reduction in perioperative blood transfusion requirement. METHODS A retrospective study of 130 patients was conducted in Blacktown Hospital, Australia. Data pertaining to patient demographics, as well as quantity of preoperative iron infusion and perioperative blood transfusion was collected. RESULTS Twenty-six (20%) patients required perioperative BT. Twenty-seven underwent preoperative iron infusion, with 20 of them not requiring BT and seven requiring BT. There was no evidence to suggest preoperative iron infusion reduces blood transfusion requirement (RR 1.55, 95% CI 0.57-4.18, P=0.39). For elective procedures, no significance was also demonstrated (RR 1.20, 95% CI 0.29-4.92, P=0.80). CONCLUSIONS There is no evidence suggesting that preoperative iron infusion reduces the requirement for perioperative blood transfusion in colorectal cancer surgery.
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Affiliation(s)
| | - Mike Wu
- Blacktown Hospital, Department of Surgery, Blacktown, Australia
| | | | - Cheuk H Ng
- Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Danette Wright
- Blacktown Hospital, Department of Surgery, Blacktown, Australia
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10
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Karregat JHM, Blokhuis D, Quee FA, van den Hurk K. Iron supplementation: A qualitative study on the perception of blood donors, blood collection staff and donor physicians. Vox Sang 2024; 119:16-26. [PMID: 37861453 DOI: 10.1111/vox.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Iron supplementation is an effective strategy to mitigate donation-induced iron deficiency in blood donors. However, evidence on the perception of individuals involved in blood donation on iron supplementation as a blood service policy is lacking. This study aimed to evaluate the knowledge and perception of whole blood donors (donors), blood collection staff (collection staff) and donor physicians (physicians) regarding donation-induced iron loss and iron supplementation. MATERIALS AND METHODS Online focus group discussions had four to six participants and followed a structured questioning approach. All participants had to be fluent in Dutch to participate, and donors had donated at least five times. Sixteen donors, eight collection staff members and four physicians participated in this study. Recordings were transcribed, coded and analysed using a grounded theory approach. RESULTS Awareness of donation-induced iron loss was limited in donors. Donors and physicians were predominantly positive towards iron supplementation; the primary motivator for donors was to prevent deferral and reduce iron-deficiency-related symptoms. Improving donor health was the main argument for physicians to advocate iron supplementation. Staff had a critical view on iron supplementation as a policy, as they perceived it as unethical and possibly ineffective. A knowledge gap might underlie their concerns. CONCLUSION Most individuals involved in blood donation are positive towards iron supplementation as a blood service policy. If implemented, guidance and monitoring is desired and adequate education of all stakeholders is required.
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Affiliation(s)
- Jan H M Karregat
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dayna Blokhuis
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Franke A Quee
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
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Pham J, Laven-Law G, Winter JM, Wassie MM, Cock C, Symonds EL. The Diagnostic Accuracy of a Fecal Immunochemical Test in Detecting Colorectal Cancer and Advanced Precancerous Colorectal Neoplasia in Patients with Iron Deficiency: A Protocol for Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2023; 2023:5982580. [PMID: 38107205 PMCID: PMC10723928 DOI: 10.1155/2023/5982580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023] Open
Abstract
Background. Iron deficiency (ID) is a common micronutrient deficiency and the leading cause of anemia worldwide. ID can be caused by chronic occult blood loss from colorectal neoplasia including colorectal cancer (CRC) and advanced precancerous colorectal lesions. Current guidelines recommend colonoscopy in both men and postmenopausal women presenting with ID anemia (IDA). However, there is controversy on the investigation of patients presenting with a lower risk of CRC including younger women with ID and those with nonanemic ID (NAID). There is a need for a triaging tool to identify which ID patients may benefit from colonoscopy. The fecal immunochemical test (FIT) is sensitive for CRC screening in an asymptomatic population, but its role in ID patients is unclear. The aim of this study is to conduct a systematic review to determine the diagnostic accuracy of FIT for detecting CRC and advanced precancerous neoplasia in individuals presenting with ID with or without anemia. Methods and Analysis. This protocol conforms with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A comprehensive search of the MEDLINE, Embase, and Web of Science databases will be undertaken for studies published after 2010 which involve patients with ID, who completed a FIT in the 6 months prior to colonoscopy, with FIT sensitivity and specificity calculated against the reference standard colonoscopy. The search will be limited to studies conducted after 2010 to reduce variability in colonoscopy quality. Risk of bias assessment will be conducted using the Quality Assessment of Diagnostic Accuracy Studies version 2. FIT sensitivity and specificity will be the primary measure of diagnostic accuracy, and data will be analysed using a random effects meta-analysis. Discussion. This review and meta-analysis will be the first to systematically explore the value of the FIT as a triaging tool for patients with ID. This trial is registered with CRD42022367162.
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Affiliation(s)
- Jennifer Pham
- Department of Medicine, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Geraldine Laven-Law
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Jean M. Winter
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Molla M. Wassie
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Charles Cock
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
- Department of Gastroenterology, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Erin L. Symonds
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
- Department of Gastroenterology, Flinders Medical Centre, Bedford Park, SA 5042, Australia
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12
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Kardasis W, Naquin ER, Garg R, Arun T, Gopianand JS, Karmakar E, Gnana-Prakasam JP. The IRONy in Athletic Performance. Nutrients 2023; 15:4945. [PMID: 38068803 PMCID: PMC10708480 DOI: 10.3390/nu15234945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
Iron is an essential micronutrient for athletes, intricately linked to their performance, by regulating cellular respiration and metabolism. Impaired iron levels in the body can significantly hinder athletic performance. The increased demand for iron due to exercise, coupled with potential dietary iron insufficiencies, particularly among endurance athletes, amplifies the risk of iron deficiency. Moreover, prolonged exercise can impact iron absorption, utilization, storage, and overall iron concentrations in an athlete. On the contrary, iron overload may initially lead to enhanced performance; however, chronic excess iron intake or underlying genetic conditions can lead to detrimental health consequences and may negatively impact athletic performance. Excess iron induces oxidative damage, not only compromising muscle function and recovery, but also affecting various tissues and organs in the body. This narrative review delineates the complex relationship between exercise and iron metabolism, and its profound effects on athletic performance. The article also provides guidance on managing iron intake through dietary adjustments, oral iron supplementation for performance enhancement in cases of deficiency, and strategies for addressing iron overload in athletes. Current research is focused on augmenting iron absorption by standardizing the route of administration while minimizing side effects. Additionally, there is ongoing work to identify inhibitors and activators that affect iron absorption, aiming to optimize the body's iron levels from dietary sources, supplements, and chelators. In summary, by refining the athletic diet, considering the timing and dosage of iron supplements for deficiency, and implementing chelation therapies for iron overload, we can effectively enhance athletic performance and overall well-being.
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Affiliation(s)
| | | | | | | | | | - Eshani Karmakar
- School of Medicine, Saint Louis University, St. Louis, MO 63104, USA; (W.K.); (E.R.N.); (R.G.); (T.A.); (J.S.G.)
| | - Jaya P. Gnana-Prakasam
- School of Medicine, Saint Louis University, St. Louis, MO 63104, USA; (W.K.); (E.R.N.); (R.G.); (T.A.); (J.S.G.)
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13
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Leung TW, Damodaran P, Torres R, Chuncharunee S, Chu MY, Gamilla Z, Lim NR, Luna J, Huang JP, Li WH, Tran TN, Sathar J, Jaisamrarn U. Expert consensus on improving iron deficiency anemia management in obstetrics and gynecology in Asia. Int J Gynaecol Obstet 2023; 163:495-509. [PMID: 37096333 DOI: 10.1002/ijgo.14804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023]
Abstract
Iron deficiency anemia (IDA) is a major health burden among women in Asia. Key issues in IDA management in Asia are under-diagnosis and under-treatment. The lack of Asia-specific guidelines, and suboptimal utilization of treatment compounds the management of IDA. To address these gaps, a panel of 12 experts in obstetrics, gynecology, and hematology from six regions in Asia convened to review current practices and clinical evidence and provide practical guidance on IDA diagnosis and management in Asian women. The Delphi approach was used to obtain objective opinions and attain consensus on statements pertaining to awareness, diagnosis, and management of IDA. In total, 79 statements attained consensus and are summarized to provide guidance on raising awareness of IDA and approaches for improved diagnosis and treatment of IDA among women in various settings: pregnancy, postpartum, heavy menstrual bleeding, gynecologic cancers, and perioperative care. This clinician-led consensus integrates appropriate recommendations based on clinical evidence and best practices and is intended to guide decision making in the management of iron deficiency/IDA in women. The expert panel raises a call for timely diagnosis and utilization of appropriate treatment, including use of high-dose intravenous iron, stringent blood management, and interdisciplinary collaboration, for optimization of IDA management among women in Asia.
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Affiliation(s)
- Tsin Wah Leung
- Department of Obstetrics & Gynecology, Kwong Wah Hospital, Hong Kong, China
| | - Premitha Damodaran
- Department of Obstetrics & Gynecology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Rosalio Torres
- Section of Hematology, Makati Medical Center & Cardinal Santos Medical Center, San Juan, The Philippines
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Man Yee Chu
- Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong, China
| | - Zaida Gamilla
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, The Philippines
| | | | - Jericho Luna
- Division of Gynecologic Oncology, Philippine General Hospital, Manila, The Philippines
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wai Hou Li
- Division of Obstetrics and Gynecology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Thang Nhat Tran
- Department of Obstetrics and Gynecology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - Jameela Sathar
- Department of Hematology, Ampang Hospital, Selangor, Malaysia
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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14
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Solberg A, Reikvam H. Iron Status and Physical Performance in Athletes. Life (Basel) 2023; 13:2007. [PMID: 37895389 PMCID: PMC10608302 DOI: 10.3390/life13102007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
Iron is an important mineral in the body, essential for muscle function and oxygen transport. Adequate levels of iron in the blood are necessary for athletes, as iron-deficiency anemia can reduce physical performance. Several studies have investigated iron status and supplementation in iron-deficient athletes, and determined how physical strain can change iron balance and markers related to iron status. The question of how to influence and optimize iron status, as well as other markers that can affect iron metabolism, has been less thoroughly investigated. Therefore, the aim of this review is to take a closer look at the importance of iron values, iron markers, and factors that can change iron metabolism for physical performance and the extent to which physical performance can be influenced in a positive or negative way. A systematic search of the PubMed database was performed, with the use of « iron» or «iron deficiency» or «hemoglobin» AND «athletes» AND «athletic performance» as a strategy of the search. After the search, 11 articles were included in the review after the application of inclusion and exclusion criteria. Major findings include that iron supplementation had the best effect in athletes with the lowest iron status, and effects on physical performance were mostly achieved in those who were originally in a deficit. Iron supplementation could be beneficial for optimal erythropoietic response during altitude training, even in athletes with normal iron stores at baseline, but should be performed with caution. Alteration of the hepcidin response can affect the use of existing iron stores for erythropoiesis. Energy intake, and the amount of carbohydrates available, may have an impact on the post-exercise hepcidin response. Optimal vitamin D and B12 levels can possibly contribute to improved iron status and, hence, the avoidance of anemia.
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Affiliation(s)
- Andrea Solberg
- Faculty of Medicine, University of Bergen, 5007 Bergen, Norway;
| | - Håkon Reikvam
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, 5007 Bergen, Norway
- Clinic for Medicine, Haukeland University Hospital, 5009 Bergen, Norway
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15
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Van ‘t Klooster SJ, de Vaan A, van Leeuwen J, Pekel L, van Rijn-van Kortenhof NM, Engelen ET, van Greevenbroek W, Huisman A, Fischer K, Schutgens RE, van Galen KP. Heavy menstrual bleeding in adolescents: incidence, diagnostics, and management practices in primary care. Res Pract Thromb Haemost 2023; 7:102229. [PMID: 38077824 PMCID: PMC10704495 DOI: 10.1016/j.rpth.2023.102229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Heavy menstrual bleeding (HMB), self-reported by 37% of adolescents, can be the first sign of a bleeding disorder (BD) during adolescence. The Dutch general practitioner (GP) guideline demands laboratory diagnostics and referral for patients at risk for a BD. How often adolescents consult the GP for HMB and which diagnostic and management strategies are used are unknown. OBJECTIVES This study aims to estimate the incidence of HMB in adolescents in primary care and to identify diagnostic and management practices for HMB, considering the HMB GP guideline. METHODS Retrospective analyses of a GP network database containing over 200 Dutch GPs were performed. Adolescents aged 10 to 21 years, with a new diagnosis of HMB between 2010 and 2020, and a 6-month follow-up were eligible. The incidence rate and diagnostic and therapeutic strategy data were extracted. RESULTS We identified 1879 new diagnoses of HMB in adolescents. The average incidence rate was 7.91 per 1000 person-years. No diagnostic studies were performed in 67%. Laboratory studies were mainly restricted to hemoglobin levels (31%). Full coagulation screening occurred in 1.3%, and ferritin levels in 10%. Medication was prescribed in 65%; mostly hormonal treatment (56%) and/or nonsteroidal antiinflammatory drugs (NSAIDs) (18%). The referral rate was higher after >2 follow-up visits (6.7%) vs after 1 GP visit for HMB (1.6%; Odds ratio: 8.8; 95% CI: 5.1-15), mostly to gynecologists (>85%). CONCLUSION According to this GP database study, few adolescents visit their GP with HMB despite its high self-reported incidence. Most adolescents were prescribed hormonal contraception without further diagnostics. Referral was rare and mostly occurred after multiple follow-up visits.
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Affiliation(s)
- Stella J. Van ‘t Klooster
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne de Vaan
- Center for Benign Hematology, Thrombosis and Hemostasis, van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Jeanette van Leeuwen
- Department of Reproductive Medicine & Gynaecology, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Lynnda Pekel
- Netherlands Hemophilia Patients Society, Nijkerk, Gelderland, The Netherlands
| | | | - Eveline T. Engelen
- Dutch Healthcare Network for Women With Bleeding Disorders, UMC Utrecht, Utrecht, the Netherlands
| | - Willie van Greevenbroek
- Center for Benign Hematology, Thrombosis and Hemostasis, van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Albert Huisman
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Center for Benign Hematology, Thrombosis and Hemostasis, van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Roger E.G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Karin P.M. van Galen
- Center for Benign Hematology, Thrombosis and Hemostasis, van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands
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16
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Al Mutawa OA, Izhari MA, Alharbi RA, Sindi AAA, Alqarni AM, Alotaibi FE, Gosady ARA, Dardari DMM, Almutairi AM, Alshehri M, Athathi AIE. Helicobacter pylori ( H. pylori) Infection-Associated Anemia in the Asir Region, Saudi Arabia. Diagnostics (Basel) 2023; 13:2404. [PMID: 37510148 PMCID: PMC10378611 DOI: 10.3390/diagnostics13142404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
H. pylori (ubiquitous) and anemia together represent one of the growing health concerns globally. Gastroduodenal sequelae of H. pylori infection are distinguished; however, for the H. pylori infection and its implication in the development of anemia, iron has a significant health impact. We aimed to evaluate H. pylori infection-associated anemia by employing a logistic regression analysis model. A retrospective (case-control) study design-based assessment of the H. pylori associated-anemia. The study area was geo-referenced by QGIS/QuickMapServies. Descriptive and inferential statistical analyses were accomplished using the R-base-R-studio (v-4.0.2)-tidyverse. A p-value < 0.05 was the statistical significance cut-off value. A ggplot2 package was used for data representation and visualization. Mean ± SD age, Hb, MCV, ferritin, and RBC for overall study participants were measured to be 44.0 ± 13.58, 13.84 ± 2.49, 83.02 ± 8.31, 59.42 ± 68.37, and 5.14 ± 0.75, respectively. Decreased levels of Hb (infected vs. uninfected: 13.26 ± 2.92 vs. 14.42 ± 1.75, p < 0.001) ferritin (infected vs. uninfected: 48.11 ± 63.75 vs. 71.17 ± 71.14, p < 0.001), and MCV (infected vs. uninfected: 81.29 ± 9.13 vs. and 84.82 ± 6.93, p < 0.05) were measured to be associated with H. pylori infection when compared with H. pylori uninfected control group. Moreover, the magnitude (prevalence) of anemia (infected vs. uninfected: 78% vs. 21%, p < 0.001), iron deficiency anemia (IDA) (infected vs. uninfected: 63.3% vs. 36.6%, p < 0.001), and microcytic anemia (infected vs. uninfected: 71.6% vs. 46.1%, p < 0.001) were significantly different among the H. pylori-infected participants. The higher likelihood of developing anemia (AOR; 4.98, 95% CI; 3.089-8.308, p < 0.001), IDA (AOR; 3.061, 95% CI; 2.135-4.416, p < 0.001), and microcytic anemia (AOR; 3.289, 95% CI; 2.213-4.949, p < 0.001) by 398%, 206.1%, and 229%, respectively, was associated with H. pylori-infected. We recommend the regular monitoring of hematological parameters and eradication of H. pylori infection to minimize the extra-gastric health consequences of H. pylori infection.
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Affiliation(s)
- Omar A Al Mutawa
- Medical Laboratory Department Southern Region Armed Forces Hospital, Khamis Mushait 62413, Saudi Arabia
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Mohammad Asrar Izhari
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Raed A Alharbi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Abdulmajeed Abdulghani A Sindi
- Department of Basic Medical Sciences, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Abdullah M Alqarni
- Medical Laboratory Department Southern Region Armed Forces Hospital, Khamis Mushait 62413, Saudi Arabia
| | - Foton E Alotaibi
- Department of Genetic Counseling, Al-Faisal University, Riyadh 11533, Saudi Arabia
| | - Ahmed R A Gosady
- Laboratory Department, Baish Primary Healthcare, Jazan 87386, Saudi Arabia
| | | | - Abdulrahman M Almutairi
- Health Facilities Infection Control Department, General Directorate of Health Al-Baha, Al-Baha 65522, Saudi Arabia
| | - Mohammed Alshehri
- Department of Community Health Sciences (Public Health), Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65528, Saudi Arabia
| | - Ahmed I E Athathi
- Laboratory Department, King Fahad Central Hospital, Jazan 85534, Saudi Arabia
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17
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Pai RD, Chong YS, Clemente-Chua LR, Irwinda R, Huynh TNK, Wibowo N, Gamilla MCZ, Mahdy ZA. Prevention and Management of Iron Deficiency/Iron-Deficiency Anemia in Women: An Asian Expert Consensus. Nutrients 2023; 15:3125. [PMID: 37513543 PMCID: PMC10383547 DOI: 10.3390/nu15143125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The lack of standardized clinical practice impeding the optimal management of iron deficiency (ID) and iron deficiency anemia (IDA) in women is a global concern, particularly in the Asia-Pacific region. The aim of this study was to determine best practices through a Delphi consensus process. In Round 1, panelists were asked to rate their level of agreement with 99 statements across four domains: identification, diagnosis and assessment, prevention, and treatment of ID/IDA in women. In Round 2, panelists reappraised their ratings in view of the collective feedback and responses to Round 1. After two rounds, consensus (≥85% agreement) was reached for 84% of the Delphi statements. Experts agreed on the role of presenting symptoms and risk factors in prompting assessments of anemia and iron status in women. Experts repeatedly called for prevention, recommending preventive iron supplementation for pregnant women irrespective of anemia prevalence levels, and for non-pregnant adult women, adolescent girls, and perimenopausal women living in areas with a high prevalence of anemia. Experts unanimously agreed to prescribing oral ferrous iron as first-line therapy for uncomplicated ID/IDA. The recommendations and clinical pathway algorithms generated should be used to inform clinical practice and standardize the care of women at risk or presenting with ID/IDA in the Asia-Pacific region.
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Affiliation(s)
- Rishma Dhillon Pai
- Department of Obstetrics and Gynaecology, Lilavati Hospital, Mumbai 400050, India;
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | | | - Rima Irwinda
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia—Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (R.I.); (N.W.)
| | - Trang Nguyen Khanh Huynh
- Department of Obstetrics and Gynecology, Pham Ngoc Thach University of Medicine, Ho Chi Minh 700000, Vietnam;
| | - Noroyono Wibowo
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia—Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (R.I.); (N.W.)
| | | | - Zaleha Abdullah Mahdy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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18
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Sulhariza HZ, Zalilah MS, Geeta A. Maternal hemoglobin change from early pregnancy to second trimester is associated with risk of gestational diabetes mellitus: a retrospective cohort study. Front Nutr 2023; 10:1197485. [PMID: 37396129 PMCID: PMC10308040 DOI: 10.3389/fnut.2023.1197485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The accrual of iron that is reflected in high maternal hemoglobin (Hb) status is increasingly recognized as a risk factor for gestational diabetes mellitus (GDM). Changes in maternal Hb level could also implicate glycemic status in pregnancy. This study aimed to determine the associations between maternal Hb levels and their changes with GDM. Methods In this retrospective cohort study, a total of 1,315 antenatal records of mothers with singleton pregnancies from eight health clinics of a district in the northern region of Peninsular Malaysia who delivered between 1st January 2016-31st December 2017 were analyzed. Data extracted from the records were socio-demographic, anthropometric, obstetrical, and clinical data. Hb levels were extracted at booking (<14 weeks) and second trimester (14-28 weeks). Change in Hb was determined by subtracting the Hb level in the second trimester from the booking Hb level and was categorized as decreased, unchanged, and increased Hb. The associations between maternal Hb levels and their changes with GDM risk were analyzed using multiple regression, adjusting for covariates in four different models. Model 1: maternal age and height. Model 2: covariates of Model 1 added with parity, history of GDM, and family history of diabetes. Model 3: covariates of Model 2 added with iron supplementation at booking. Model 4: covariates of Model 3 added with Hb level at booking. Results and Discussions Unchanged Hb level from booking to second trimester was significantly associated with GDM risk in Model 1 (AOR: 2.55; 95% CI: 1.20, 5.44; p < 0.05), Model 2 (AOR: 2.45, 95% CI: 1.13, 5.34; p < 0.05) Model 3 (AOR: 2.42; 95% CI: 1.11, 5.27; p < 0.05), and Model 4 (AOR: 2.51; 95% CI: 1.15, 5.49; p < 0.05). No significant associations were observed between maternal Hb levels and GDM in the study. Conclusion Unchanged Hb levels from the booking (<14 weeks of gestation) to the second trimester (14-28 weeks) increased GDM risk. Further investigation is warranted to evaluate the associations between changes in maternal Hb and GDM risk and to identify potential factors influencing this relationship.
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Affiliation(s)
- Husni Zain Sulhariza
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Institute of Public Health, National Institute of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Mohd Shariff Zalilah
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Appannah Geeta
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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19
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Stefan MW, Gundermann DM, Sharp MH, Jennings BA, Gheith RH, Lowery RP, LowDog T, Ghatak SB, Barbosa J, Wilson JM. Assessment of the Efficacy of a Low-Dose Iron Supplement in Restoring Iron Levels to Normal Range among Healthy Premenopausal Women with Iron Deficiency without Anemia. Nutrients 2023; 15:nu15112620. [PMID: 37299583 DOI: 10.3390/nu15112620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: Iron deficiency without anemia (IDWA) is a prevalent health concern in premenopausal women. Oral supplementation of iron may be a viable solution to improve blood-iron status in women; however, the effects of a high-dose iron-supplement regimen have been associated with gastrointestinal side effects. Therefore, the purpose of the present study was to evaluate the effectiveness of a low-dose liquid fermented iron-bisglycinate supplement (LIS) on improving blood-iron status in premenopausal women with IDWA without increasing constipation or gastrointestinal distress. (2) Methods: 85 premenopausal women with IDWA (ferritin < 70 ng/dL and hemoglobin > 11.0 g/dL) took a LIS (27 mg) or a placebo (PLA) for 8 weeks. Blood draws were taken at Wk0 and Wk8 of the study to measure serum-iron markers. In addition, surveys of gastrointestinal distress were administered at Wk0, Wk4, and Wk8 while the profile of mood states (POMS) was surveyed at Wk0 and Wk8. (3) Results: Compared to the placebo, the LIS was able to increase serum ferritin (p = 0.03), total serum iron (p = 0.03), and mean corpuscular volume (p = 0.02), while exhibiting no significant interaction in subjective gastrointestinal distress (p > 0.05). No significant effects were detected for POMS (p > 0.05). (4) Conclusions: Supplementing with LIS appears to improve blood-iron status without causing significant gastrointestinal distress in premenopausal women with IDWA.
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Affiliation(s)
- Matthew W Stefan
- The Applied Science and Performance Institute, Research Division, Tampa, FL 33607, USA
| | | | - Matthew H Sharp
- The Applied Science and Performance Institute, Research Division, Tampa, FL 33607, USA
| | - Brooke A Jennings
- The Applied Science and Performance Institute, Research Division, Tampa, FL 33607, USA
| | - Raad H Gheith
- The Applied Science and Performance Institute, Research Division, Tampa, FL 33607, USA
| | - Ryan P Lowery
- The Applied Science and Performance Institute, Research Division, Tampa, FL 33607, USA
| | | | | | | | - Jacob M Wilson
- The Applied Science and Performance Institute, Research Division, Tampa, FL 33607, USA
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20
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A New Artificial Intelligence Approach Using Extreme Learning Machine as the Potentially Effective Model to Predict and Analyze the Diagnosis of Anemia. Healthcare (Basel) 2023; 11:healthcare11050697. [PMID: 36900702 PMCID: PMC10000789 DOI: 10.3390/healthcare11050697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
The procedure to diagnose anemia is time-consuming and resource-intensive due to the existence of a multitude of symptoms that can be felt physically or seen visually. Anemia also has several forms, which can be distinguished based on several characteristics. It is possible to diagnose anemia through a quick, affordable, and easily accessible laboratory test known as the complete blood count (CBC), but the method cannot directly identify different kinds of anemia. Therefore, further tests are required to establish a gold standard for the type of anemia in a patient. These tests are uncommon in settings that offer healthcare on a smaller scale because they require expensive equipment. Moreover, it is also difficult to discern between beta thalassemia trait (BTT), iron deficiency anemia (IDA), hemoglobin E (HbE), and combination anemias despite the presence of multiple red blood cell (RBC) formulas and indices with differing optimal cutoff values. This is due to the existence of several varieties of anemia in individuals, making it difficult to distinguish between BTT, IDA, HbE, and combinations. Therefore, a more precise and automated prediction model is proposed to distinguish these four types to accelerate the identification process for doctors. Historical data were retrieved from the Laboratory of the Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia for this purpose. Furthermore, the model was developed using the algorithm for the extreme learning machine (ELM). This was followed by the measurement of the performance using the confusion matrix and 190 data representing the four classes, and the results showed 99.21% accuracy, 98.44% sensitivity, 99.30% precision, and an F1 score of 98.84%.
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Nicotra D, Arieli R, Redlich N, Navot-Mintzer D, Constantini NW. Iron Deficiency and Anemia in Male and Female Adolescent Athletes Who Engage in Ball Games. J Clin Med 2023; 12:jcm12030970. [PMID: 36769618 PMCID: PMC9918288 DOI: 10.3390/jcm12030970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to assess the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) among male adolescent athletes who participate in non-calorie-restricting sports, and to compare the results with female athletes of the same age and sports. Data of the hemoglobin concentration (Hb) and serum ferritin (sFer) levels of male (n = 350) and female (n = 126) basketball and football players, aged 11-18, from two sport medicine centers in Israel were gathered and analyzed. Mild ID was defined as sFer ≤ 30 µg/L, moderate as sFer ≤ 20 µg/L, and severe as sFer ≤ 10 µg/L. IDA was defined as sFer ≤ 20 µg/L and Hb < 13 g/dL for males and sFer ≤ 20 µg/L and Hb < 12 g/dL for females. The prevalence of mild ID was 41.1% and 53.2%, moderate was 17.4% and 27.8%, and severe was 2% and 4.8% in males and females, respectively. The prevalence of IDA was 2.6% in males and 4% in females. Mild and moderate ID was significantly higher among females. In conclusion, non-anemic ID, which is known to be common among female athletes, especially in sports requiring leanness, is also highly prevalent among adolescent males playing ball games. Therefore, screening for hemoglobin and sFer is recommended for young athletes of both genders and in all sports.
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Affiliation(s)
- Daniela Nicotra
- Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel
- Correspondence: ; Tel.: +972-504558208
| | - Rakefet Arieli
- Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel
| | - Noam Redlich
- Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel
| | - Dalya Navot-Mintzer
- The Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya 42902, Israel
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Reticulocyte Hemoglobin-Equivalent Potentially Detects, Diagnoses and Discriminates between Stages of Iron Deficiency with High Sensitivity and Specificity. J Clin Med 2022; 11:jcm11195675. [PMID: 36233545 PMCID: PMC9572493 DOI: 10.3390/jcm11195675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Iron deficiency anemia (IDA) is a global health problem affecting the quality of life of more than 2 billion individuals. The current practice guidelines diagnose and monitor IDA via conventional hematological and iron biomarkers, which take several months before they are corrected under an iron-treatment plan. Reticulocyte hemoglobin equivalent (Ret-He) is used as a marker in most new hematology analyzers to assess iron incorporation into erythrocyte hemoglobin directly. This study aims to examine the efficacy of Ret-He as a marker for iron deficiency (ID) and IDA and investigate whether Ret-He is sensitive to iron therapy. Methods: Two blood samples were drawn from 182 participants for CBC and iron profile measurements. Follow-up samples were drawn from participants with a confirmed diagnosis of ID and/or IDA. Results: Ret-He levels were lower in the ID and IDA groups compared to the control (p < 0.0001), and lower in the IDA group compared to the ID group (p < 0.0001). Ret-He was correlated with ferritin at ID level (<30.0 mg/mL; r = 0.39) and severe IDA (<13.0 ng/mL; p-value < 0.01, r = 0.57). Cut-off values of <28.25 pg for ID and <21.55 pg for IDA showed a higher specificity and sensitivity (ID; AUC: 0.99, sensitivity: 92.73%, specificity: 97.87%) and (IDA; AUC: 0.94, sensitivity: 90.63%, specificity: 92.31%). Finally, Ret-He successfully reflected the iron therapy (p < 0.001) when compared to hemoglobin (Hb) (p = 0.1). Conclusions: Ret-He is a potential marker for detecting and diagnosing different stages of ID with high validity and is very sensitive in reflecting the iron incorporation in a short time.
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Al-Azazi AA, Abdul-Ghani R, El-Sayad MH, Sadek NA, El-Taweel HA. Levels of Serum Ferritin and Hepcidin in Patients with Uncomplicated Falciparum Malaria in Hodeidah, Yemen: Considerations for Assessing Iron Status. Hemoglobin 2022; 46:100-105. [PMID: 35924733 DOI: 10.1080/03630269.2022.2083970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Understanding the key regulator of iron homeostasis is critical to the improvement of iron supplementation practices in malaria-endemic areas. This study aimed to determine iron indices and hepcidin (HEPC) level in patients infected with Plasmodium falciparum compared to apparently healthy, malaria-negative subjects in Hodeidah, Yemen. The study included 70 Plasmodium falciparum-infected and 20 malaria-negative adults. Blood films were examined for detection and estimation of parasitemia. Hemoglobin (Hb) level was measured using an automated hematology analyzer. Serum iron and total iron binding capacity (TIBC) were determined by spectrophotometric methods. Levels of serum ferritin (FER) and HEPC were measured by enzyme-linked immunosorbent assays. Data were stratified by sex and age. Comparable Hb levels were found in P. falciparum-infected patients and malaria-negative subjects in each sex and age group (p > 0.05). Compared to their malaria-negative counterparts, disturbed iron homeostasis in patients was evidenced by the significantly lower serum iron levels in females (p = 0.007) and those aged <25 years (p = 0.02) and the significantly higher TIBC in males (p = 0.008). Levels of serum FER and HEPC were significantly elevated in P. falciparum-infected patients compared to the corresponding malaria-negative participants (p < 0.001). Serum FER correlated positively with parasite density (p = 0.004). In conclusion, patients with uncomplicated P. falciparum in Hodeidah display elevated levels of serum HEPC and FER. Hemoglobin level may not reflect the disturbed iron homeostasis in these patients. The combined measurement of iron indices and HEPC provides comprehensive information on the iron status so that the right intervention can be chosen.
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Affiliation(s)
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Mona H El-Sayad
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Nadia A Sadek
- Department of Hematology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Hend A El-Taweel
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Influences of Vitamin D and Iron Status on Skeletal Muscle Health: A Narrative Review. Nutrients 2022; 14:nu14132717. [PMID: 35807896 PMCID: PMC9268405 DOI: 10.3390/nu14132717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
There is conflicting evidence of the roles vitamin D and iron have in isolation and combined in relation to muscle health. The purpose of this narrative review was to examine the current literature on the roles that vitamin D and iron have on skeletal muscle mass, strength, and function and how these nutrients are associated with skeletal muscle health in specific populations. Secondary purposes include exploring if low vitamin D and iron status are interrelated with skeletal muscle health and chronic inflammation and reviewing the influence of animal-source foods rich in these nutrients on health and performance. PubMed, Scopus, SPORT Discus, EMBAE, MEDLINE, and Google Scholar databases were searched to determine eligible studies. There was a positive effect of vitamin D on muscle mass, particularly in older adults. There was a positive effect of iron on aerobic and anaerobic performance. Studies reported mixed results for both vitamin D and iron on muscle strength and function. While vitamin D and iron deficiency commonly occur in combination, few studies examined effects on skeletal muscle health and inflammation. Isolated nutrients such as iron and vitamin D may have positive outcomes; however, nutrients within food sources may be most effective in improving skeletal muscle health.
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Maniar AR, Mishra A, Sanghavi N, Maniar RN. Does Postoperative Intravenous Ferric Carboxymaltose Hasten the Recovery of Hemoglobin in Patients Post Total Knee Arthroplasty? J Arthroplasty 2022; 37:S155-S158. [PMID: 35202759 DOI: 10.1016/j.arth.2022.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/03/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Timely and effective iron supplementation may help reduce the incidence of postoperative anemia and its associated problems. In this study, we aim to assess the efficacy of intravenous ferric carboxy maltose (FCM) on improving hemoglobin(Hb) level posttotal knee arthroplasty (TKA). METHODS We retrospectively reviewed 263 patients who had undergone unilateral TKA with 157 patients in the study group (year 2019) and 106 in the control group (year 2016). Patients in the study group received FCM (500 mg IV) on postoperative day 1, whereas patients in the control group did not receive FCM or any other iron supplementation postoperatively. Hb levels were recorded preoperatively (Pr-Hb), postoperatively on day 3 (Day3-Hb) and postoperatively at 5(+1) weeks (Week5-Hb). Statistical analysis was performed using student's paired and unpaired t-tests. RESULTS Pr-Hb and Day3-Hb levels were comparable in the control and study group, while Week5-Hb levels were significantly higher (P < .001) in the study group. The drop in Hb at Day3 from preoperative values was comparable between the two groups (P = 1.0). The rise in Hb from Day3 to 5 weeks was significantly higher in the study group as compared to the control group (P < .001). The difference between Pr-Hb and Week5-Hb was significantly lower (P < .001) in the study group compared to the control group. However, Week5-Hb in both groups remained lower than Pr-Hb (P < .001) in all patients. CONCLUSION Intravenous FCM (500 mg) was found to be a safe method of iron supplementation to improve hemoglobin levels rapidly and consistently, post-TKA. We need to further study the additive effect of higher dose FCM (1000 mg) on hemoglobin recovery.
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Affiliation(s)
- Adit R Maniar
- Department of Orthopaedics, HBT Medical College and Dr. R N Cooper Municipal General Hospital, Juhu Mumbai, Maharashtra, India
| | - Abhinav Mishra
- Trauma and Joint Replacement Consultant, Department of Orthopaedics, Shriram Care Hospital and KIMS Superspeciality Hospital, Bilaspur, Chhattisgarh, India
| | | | - Rajesh N Maniar
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra (West), Mumbai, India; Consultant Orthopaedic Surgeon, Breach Candy Hospital Trust, Mumbai, India
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Stoffers VL, Weyand AC, Quint EH, Rosen MW. Assessment of Iron Status in Adolescents Presenting to the Emergency Department With Heavy Menstrual Bleeding. Pediatr Emerg Care 2022; 38:e1266-e1270. [PMID: 35482504 DOI: 10.1097/pec.0000000000002591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Iron deficiency is extremely common in adolescents with heavy menstrual bleeding (HMB) presenting to the emergency department; however, patients are rarely screened for this. The objective of this study was to evaluate screening for iron deficiency in adolescents presenting to the emergency department for HMB. METHODS This is a secondary analysis of a single-center, cross-sectional observational study using retrospective chart review. The study subjects are adolescents ages 11 to 19 years with International Classification of Diseases, Ninth Revision, Clinical Modification/International Classification of Diseases, Tenth Revision, Clinical Modification, codes for HMB who presented to the emergency department at a national tertiary care hospital from 2006 to 2018. Pregnant adolescents with HMB were excluded. Chart abstraction for demographic data, symptoms, laboratory tests, treatments, and outcomes was performed. The main outcome measure was the number of adolescents who had an iron evaluation in the emergency department and were discharged on oral iron. RESULTS Of the 258 nonpregnant adolescents who sought care for HMB in the emergency department, 225 (87.2%) were evaluated with serum hemoglobin testing. Ninety-four (41.7%) of those tested were anemic. Only 23 of the 258 patients (8.9%) had iron studies (serum ferritin) performed; 18 of 23 (78.3%) had iron deficiency and 21 of 23 (92.3%) were anemic. Subjects presenting with fatigue, headache, or palpitations were more likely to have iron studies performed than those without these symptoms (all P < 0.01). Thirty-two of the 258 subjects (12.4%) were discharged on oral iron therapy, which included only 15 of the 18 subjects (83.3%) with iron deficiency determined by ferritin testing. CONCLUSIONS Adolescents presenting to the emergency department with HMB are at significant risk of iron deficiency but are not being screened or treated, which may have significant consequences.
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Affiliation(s)
| | | | | | - Monica W Rosen
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Stahl-Gugger A, de Godoi Rezende Costa Molino C, Wieczorek M, Chocano-Bedoya PO, Abderhalden LA, Schaer DJ, Spahn DR, Orav EJ, Vellas B, da Silva JAP, Kressig RW, Egli A, Bischoff-Ferrari HA. Prevalence and incidence of iron deficiency in European community-dwelling older adults: an observational analysis of the DO-HEALTH trial. Aging Clin Exp Res 2022; 34:2205-2215. [PMID: 35304704 PMCID: PMC9464157 DOI: 10.1007/s40520-022-02093-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/03/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Iron deficiency is associated with increased morbidity and mortality in older adults. However, data on its prevalence and incidence among older adults is limited. The aim of this study was to investigate the prevalence and incidence of iron deficiency in European community-dwelling older adults aged ≥ 70 years. METHODS Secondary analysis of the DO-HEALTH trial, a 3-year clinical trial including 2157 community-dwelling adults aged ≥ 70 years from Austria, France, Germany, Portugal and Switzerland. Iron deficiency was defined as soluble transferrin receptor (sTfR) > 28.1 nmol/L. Prevalence and incidence rate (IR) of iron deficiency per 100 person-years were examined overall and stratified by sex, age group, and country. Sensitivity analysis for three commonly used definitions of iron deficiency (ferritin < 45 μg/L, ferritin < 30 μg/L, and sTfR-ferritin index > 1.5) were also performed. RESULTS Out of 2157 participants, 2141 had sTfR measured at baseline (mean age 74.9 years; 61.5% women). The prevalence of iron deficiency at baseline was 26.8%, and did not differ by sex, but by age (35.6% in age group ≥ 80, 29.3% in age group 75-79, 23.2% in age group 70-74); P < 0.0001) and country (P = 0.02), with the highest prevalence in Portugal (34.5%) and the lowest in France (24.4%). As for the other definitions of iron deficiency, the prevalence ranged from 4.2% for ferritin < 30 µg/L to 35.3% for sTfR-ferritin index > 1.5. Occurrences of iron deficiency were observed with IR per 100 person-years of 9.2 (95% CI 8.3-10.1) and did not significantly differ by sex or age group. The highest IR per 100 person-years was observed in Austria (20.8, 95% CI 16.1-26.9), the lowest in Germany (6.1, 95% CI 4.7-8.0). Regarding the other definitions of iron deficiency, the IR per 100 person-years was 4.5 (95% CI 4.0-4.9) for ferritin < 45 µg/L, 2.4 (95% CI 2.2-2.7) for ferritin < 30 µg/L, and 12.2 (95% CI 11.0-13.5) for sTfR-ferritin index > 1.5. CONCLUSIONS Iron deficiency is frequent among relatively healthy European older adults, with people aged ≥ 80 years and residence in Austria and Portugal associated with the highest risk.
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Affiliation(s)
- Alenka Stahl-Gugger
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - Caroline de Godoi Rezende Costa Molino
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - Maud Wieczorek
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - Patricia O Chocano-Bedoya
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Lab, University of Fribourg, Fribourg, Switzerland
| | - Lauren A Abderhalden
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - Dominik J Schaer
- Clinic for Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - E John Orav
- Department of Biostatistics, Harvard School of Public Health, Boston, USA
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Center Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - José A P da Silva
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, and University of Basel, Basel, Switzerland
| | - Andreas Egli
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University Hospital Zurich, Zurich City Hospital-Waid and University of Zurich, Zurich, Switzerland.
- Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland.
- University Clinic for Aging Medicine, Zurich City Hospital-Waid, Zurich, Switzerland.
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AlRajeh L, Zaher A, alghamdi A, Alsheikh R, AlSultan O. Effects of Iron Deficiency and Its Indicators on Lymphocyte Subsets: A Study at King Fahd Hospital of the University, Saudi Arabia. J Blood Med 2022; 13:61-67. [PMID: 35210893 PMCID: PMC8859536 DOI: 10.2147/jbm.s342321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Lolwa AlRajeh
- Department of Pathology, College of Medicine, Imam Abdulrahman University, Dammam, Saudi Arabia
- Correspondence: Lolwa AlRajeh, Email
| | - Amr Zaher
- Department of Pathology, College of Medicine, Imam Abdulrahman University, Dammam, Saudi Arabia
| | - Amal alghamdi
- Family and Community Medicine Department, College of Medicine, Imam Abdulrahman University, Dammam, Saudi Arabia
| | - Rasha Alsheikh
- Family and Community Medicine Department, College of Medicine, Imam Abdulrahman University, Dammam, Saudi Arabia
| | - Osama AlSultan
- Internal Medicine Department, King Fahd University Hospital, Al Khobar, Saudi Arabia
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Gupta A, Sachdev HS, Kapil U, Prakash S, Pandey RM, Sati HC, Sharma LK, Lal PR. Characterisation of anaemia amongst school going adolescent girls in rural Haryana, India. Public Health Nutr 2022; 25:1-10. [PMID: 35067260 PMCID: PMC9991616 DOI: 10.1017/s1368980022000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High burden of anaemia exists amongst rural adolescent girls in India. The objective of this study was to characterise anaemia in school going adolescent girls in rural Haryana, India. DESIGN Linear and multiple logistic regression analysis of data collected prior to an intervention trial was conducted. Participants were classified into anaemic (haemoglobin <12 g/dl) and non-anaemic group and were further classified into deficiencies of Fe, folate or vitamin B12, mixed, anaemia of other causes and inflammation. SETTING Three schools in Ballabgarh block of Faridabad District, Haryana, India. PARTICIPANTS One hundered and ninety-eight non-anaemic and 202 anaemic adolescent girls (12-19 years). RESULTS Anaemic girls had 29·6 % Fe deficiency, 28·1 % folate or vitamin B12 deficiency, 15·8 % mixed deficiency and 9·7 % acute inflammation. Anaemia of other causes was found in 16·8 % of the anaemic participants. Girls with Fe and isolated folate deficiency had 2·5 times and four times higher odds of developing anaemia, respectively, as compared with non-anaemic girls. Fe deficiency with no anaemia was found amongst 11 % non-anaemic girls. Non-anaemic girls had a high prevalence of combined deficiency of folate or vitamin B12 (29·5 %) and acute inflammation (14·4 %). CONCLUSIONS The current strategy of Fe and folic acid supplementation alone will not suffice for achieving the desired reduction in the prevalence of anaemia as unknown causes and anaemia of inflammation contribute to a substantial proportion of anaemia. Integrating other nutrition-specific components like improving water, sanitation and hygiene practices with the ongoing micronutrient supplementation program will comprehensively tackle anaemia. Unknown causes of anaemia warrant further research.
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Affiliation(s)
- Aakriti Gupta
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi110001, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Umesh Kapil
- Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Prakash
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Kumar Sharma
- Department of Biochemistry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Priti Rishi Lal
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi110001, India
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Suciadi LP, Henrina J, Putra ICS, Cahyadi I, Gunawan HFH. Chronic Heart Failure: Clinical Implications of Iron Homeostasis Disturbances Revisited. Cureus 2022; 14:e21224. [PMID: 35178308 PMCID: PMC8842304 DOI: 10.7759/cureus.21224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/05/2022] Open
Abstract
Iron deficiency is prevalent in chronic heart failure (CHF) patients. Nonetheless, the diagnosis is often overlooked and, often, the treatment is commenced just when overt anemia has ensued. Therefore, a better appreciation of this disease is needed, and all seasoned cardiologists should know how to approach CHF patients with iron deficiency correctly, as mandated by clinical practice guidelines. In this comprehensive review, we describe iron homeostasis, the pathophysiologic changes of iron homeostasis, and the clinical implications of iron deficiency on CHF patients. In addition, we delineate the evolution of clinical trials, ranging from the inception to the ongoing clinical trials of iron deficiency treatment in CHF patients. Iron deficiency contributes to the worse clinical outcome of the patients. Numerous studies have reported the clinical benefit of iron supplementation, particularly in intravenous preparation, in heart failure patients regarding symptoms, functional capacity, and quality of life (QoL) improvement. Therefore, the current guidelines recommend routine screening of iron status in all newly diagnosed heart failure patients. Eventually, intravenous iron replacement is recommended for symptomatic heart failure patients with iron deficiency, irrespective of anemia.
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Bani-Ahmad MA, Obeidat MM, Ahmad MH, Barqawi M. The modulation of Plasma Levels of Dopamine, Serotonin, and Brain-derived neurotrophic factor in response to variation in iron availability. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022293. [PMID: 36533769 PMCID: PMC9828900 DOI: 10.23750/abm.v93i6.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/31/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIM In the context of iron deficiency anemia, central dopamine, serotonin, and brain-derived neurotrophic factor (BDNF) are intensively investigated. However, peripheral isoforms are poorly investigated. This study aimed to investigate the modulation of plasma levels of dopamine, serotonin, and BDNF among children with iron deficiency anemia. METHODS A total of seventy-three iron-deficient (n=38) and iron-sufficient (n=35) children were included in the study. Twenty-nine subjects were showing clinical presentations and were diagnosed with iron deficiency anemia and forty-four were asymptomatic normal children. Plasma levels of dopamine, serotonin, and brain-derived neurotrophic factor were determined by enzyme-linked immunosorbent assay. RESULTS As compared to corresponding levels among control subjects, Anemic subjects were having significantly higher plasma dopamine and lower plasma brain-derived neurotrophic factor levels. A significant linear and monotonic association of plasma dopamine and brain-derived neurotrophic factor with hemoglobin concentration (r=-0.520, P < 0.001 and ρ = 0.411, P = 0.001), respectively. Furthermore, there were significantly higher plasma serotonin levels among iron-deficient subjects with a significant inverse linear association with serum ferritin levels (r = -0.337, P = 0.005). CONCLUSIONS Iron deficiency anemia is associated with the modulation of peripheral dopamine, serotonin, and brain-derived neurotrophic factor. Upregulation of dopamine and downregulation of brain-derived neurotrophic factor are correlated to the anemic status. The upregulation of plasma serotonin levels is iron-dependent and, probably, is attributed to the impairment of its metabolic fate. Further investigation is required to explore the pathophysiological and clinical association of these peripheral biomolecules in the context of iron deficiency anemia. (www.actabiomedica.it).
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Affiliation(s)
- Mohammad A. Bani-Ahmad
- Department of Medical Laboratory Science, Faculty of Applied Medical Science, Jordan University of Science and Technology, Irbid 22110. Jordan
| | - Marya M. Obeidat
- Department of Medical Laboratory Science, Faculty of Applied Medical Science, Jordan University of Science and Technology, Irbid 22110. Jordan
| | - Marah H. Ahmad
- Department of Medical Laboratory Science, Faculty of Applied Medical Science, Jordan University of Science and Technology, Irbid 22110. Jordan
| | - Mousa Barqawi
- Department of Pediatrics, Rahma Children’s Hospital, Ministry of Health, Irbid, Jordan
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Abstract
Iron deficiency without anaemia is common. Patients may present with unexplained, non-specific symptoms. Iron studies will usually show a low ferritin and low transferrin saturation with a normal haemoglobin concentration. The cause of the iron deficiency should be identified and managed. There is limited evidence about the benefits of giving iron to people who do not have anaemia. If there is iron deficiency, most people can be given oral iron supplements. Iron studies are repeated after 60-90 days of oral iron supplements. Further investigations are needed if the iron deficiency has not been corrected. Some patients, including those who have not responsed to oral supplements may benefit from intravenous iron. There is no role for intramuscular injections of iron.
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Affiliation(s)
- Shalini Balendran
- Westmead Hospital, Sydney
- Central Coast Haematology, Gosford, New South Wales
| | - Cecily Forsyth
- Westmead Hospital, Sydney
- Central Coast Haematology, Gosford, New South Wales
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Pramod S, Goldfarb DS. Challenging patient phenotypes in the management of anaemia of chronic kidney disease. Int J Clin Pract 2021; 75:e14681. [PMID: 34331826 PMCID: PMC9285529 DOI: 10.1111/ijcp.14681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/12/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is often complicated by anaemia, which is associated with disease progression and increased hospital visits, decreased quality of life, and increased mortality. METHODS A comprehensive literature search of English language peer-reviewed articles in PubMed/MedLine published between 1998 and 2020 related to the treatment of anaemia of CKD was conducted. The United States Renal Database System and Dialysis Outcomes and Practice Patterns Study (DOPPS) data reports, the Centers for Disease Control and Prevention and the US Food and Drug Administration websites, and published congress abstracts in 2020 were surveyed for relevant information. RESULTS Subgroups of patients with anaemia of CKD present a clinical challenge throughout the disease spectrum, including those with end-stage kidney disease, advanced age or resistance to or ineligibility for current standards of care (ie, oral or intravenous iron supplementation, erythropoietin-stimulating agents and red blood cell transfusions). In addition, those with an increased risk of adverse events because of comorbid conditions, such as cardiovascular diseases or diabetes, comprise special populations of patients with an unmet need for interventions to improve clinical outcomes. These comorbidities must be managed in parallel and may have a synergistic effect on overall disease severity. CONCLUSIONS Several therapies provide promising opportunities to address gaps with a standard of care, including hypoxia-inducible factor prolyl hydroxylase inhibitors, which stimulate haematopoiesis through promoting modest increases in serum erythropoietin and improved iron homeostasis. The critical issues in the management of anaemia of CKD in these challenging phenotypes and the clinical utility of new therapeutic agents in development for the treatment of anaemia of CKD should be assessed and the information should be made available to healthcare providers.
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Affiliation(s)
- Sheena Pramod
- Department of Internal MedicineDivision of NephrologyMarshall University School of MedicineHuntingtonWest VirginiaUSA
| | - David S. Goldfarb
- Department of MedicineDivision of NephrologyNYU School of MedicineNew YorkNew YorkUSA
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Reticulocyte and Erythrocyte Hemoglobin Parameters for Iron Deficiency and Anemia Diagnostics in Patient Blood Management. A Narrative Review. J Clin Med 2021; 10:jcm10184250. [PMID: 34575361 PMCID: PMC8470754 DOI: 10.3390/jcm10184250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 01/01/2023] Open
Abstract
Anemia, iron deficiency and other hematinic deficiencies are a major cause of perioperative transfusion needs and are associated with increased morbidity and mortality. Anemia can be caused either by decreased production of hemoglobin or red blood cells or by increased consumption and blood loss. Decreased production can involve anything from erythropoietin or vitamin B12 insufficiency to absolute or functional lack of iron. Thus, to achieve the goal of patient blood management, anemia must be addressed by addressing its causes. The traditional parameters to diagnose anemia, despite offering elaborate options, are not ideally suited to giving a simple overview of the causes of anemia, e.g., iron status for erythropoiesis, especially during the acute phase of inflammation, acute blood loss or iron deficiency. Reticulocyte hemoglobin can thus help to uncover the cause of the anemia and to identify the main factors inhibiting erythropoiesis. Regardless of the cause of anemia, reticulocyte hemoglobin can also quickly track the success of therapy and, together with the regular full blood count it is measured alongside, help in clearing the patient for surgery.
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Imai K. Parity-based assessment of anemia and iron deficiency in pregnant women. Taiwan J Obstet Gynecol 2021; 59:838-841. [PMID: 33218398 DOI: 10.1016/j.tjog.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study aimed to separately evaluate the prevalence of anemia and iron deficiency in nulliparous and multiparous women. MATERIALS AND METHODS We retrospectively examined data of women who delivered in our clinic from January 2016 to December 2018. Inclusion criteria were delivery occurring at ≥36 weeks and singleton pregnancy. Pregnant women with severe medical disorders were excluded. We estimated complete blood count (CBC) and serum ferritin (SF) in the first trimester and only CBC in the late second trimester. Data of nulliparas and multiparas were analyzed separately. Statistically significance was set at p < 0.05. RESULTS Totally, 481 nulliparas and 603 and multiparas were enrolled. Mean hemoglobin values in the first trimester were 12.6 ± 1.0 and 12.4 ± 1.0 g/dl (p < 0.001), while median SF values were 42.7 (12.2, 108.2) and 27.7 (8.0, 72.6) ng/ml (p < 0.001) in nulliparas and multiparas, respectively. Hemoglobin in the late second trimester was 11.2 ± 0.9 and 10.7 ± 1.0 g/dl (p < 0.001) in nulliparas and multiparas, respectively. Low ferritin levels (SF < 12 ng/ml) were more frequently found in multiparas than in nulliparas (111/603 vs. 46/481, p < 0.001, Odds ratio [OR] = 2.13). Anemia in the first trimester (hemoglobin<11.0 g/dl) was found in 3.5% (17/481) and 8.8% (53/603) (p < 0.001; OR, 2.63), while that in late second trimester (hemoglobin<10.5) was observed in 21.0% (101/481) and 36.3% (219/603) (p < 0.001, OR = 2.15) nulliparas and multiparas, respectively. Non-anemic women (hemoglobin level ≥11.0) with low ferritin levels (SF < 12 ng/ml) in the first trimester showed higher rate of anemia development in the second trimester than those with both normal hemoglobin and ferritin levels, irrespective of parity (51.3% [19/37] vs. 16.2% [69/427], p < 0.001 in nulliparas and 76.9% [60/78] vs. 26.5% [125/472], p < 0.001 in multiparas]. CONCLUSION Anemia and low SF levels occurred more commonly in multiparous than in nulliparas. Further, low SF was a risk factor for anemia development in later pregnancy.
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Affiliation(s)
- Kimitoshi Imai
- Imai OB/GYN Clinic, Suehiro-cho 117-1, Aoi-ku, Shizuoka, 420-004, Japan.
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36
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Sezgin G, Li L, Westbrook J, Wearne E, Azar D, McLeod A, Pearce C, Ignjatovic V, Monagle P, Georgiou A. Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study. BMJ Open 2021; 11:e046865. [PMID: 34226221 PMCID: PMC8258555 DOI: 10.1136/bmjopen-2020-046865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Serum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners. DESIGN, SETTING, PATIENTS AND MAIN OUTCOME MEASURES A retrospective observational study of 14 187 children aged 1-18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L. RESULTS 3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia. CONCLUSION Serum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.
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Affiliation(s)
- Gorkem Sezgin
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ling Li
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Elisabeth Wearne
- Gippsland Primary Health Network, Traralgon, Victoria, Australia
| | - Denise Azar
- Gippsland Primary Health Network, Traralgon, Victoria, Australia
| | - Adam McLeod
- Outcome Health, Burwood, Victoria, Australia
| | | | - Vera Ignjatovic
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Paul Monagle
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - A Georgiou
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Boonkaew S, Teengam P, Jampasa S, Rengpipat S, Siangproh W, Chailapakul O. Cost-effective paper-based electrochemical immunosensor using a label-free assay for sensitive detection of ferritin. Analyst 2021; 145:5019-5026. [PMID: 32520014 DOI: 10.1039/d0an00564a] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ferritin, a blood cell protein containing iron, is a crucial biomarker that is used to estimate the risk assessment of iron deficiency anemia. For point-of-care analysis, a reliable, cost-effective, selective, sensitive, and portable tool is extremely necessary. In this study, a label-free electrochemical immunosensor for detecting ferritin using a paper-based analytical device (ePAD) was created. The device pattern was custom designed onto filter paper to successfully fabricate a deliverable immunosensor. Graphene oxide was first modified onto the working electrode using an inkjet printing technique. An activation step of the electrode surface was then performed using standard 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC)/N-hydroxysulfosuccinimide (sulfo-NHS) chemistry. Anti-ferritin antibodies were covalently immobilized onto the amine-reactive ester surface. The amount of ferritin was monitored by observing the electrochemical signal of the selected redox couple by differential pulse voltammetry (DPV). In the presence of ferritin, the sensor showed a considerable decrease in electrochemical response in a concentration-dependent manner. In contrast, there was no observable change in current response detected in the absence of ferritin. The current response provided a good correlation with ferritin concentrations in the range of 1 to 1000 ng mL-1, and the limit of detection (3SD/slope) was found to be 0.19 ng mL-1. This fabricated immunosensor offered good selectivity, reproducibility, and long-term storage stability. In addition, this proposed immunosensor was successfully applied to detect ferritin in human serum with satisfactory results. The promising results suggested that this handmade paper-based immunosensor may be an alternative device for the diagnosis of iron deficiency anemia.
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Affiliation(s)
- Suchanat Boonkaew
- Electrochemistry and Optical Spectroscopy Center of Excellence (EOSCE), Department of Chemistry, Chulalongkorn University, Bangkok, Pathumwan 10330, Thailand
| | - Prinjaporn Teengam
- Electrochemistry and Optical Spectroscopy Center of Excellence (EOSCE), Department of Chemistry, Chulalongkorn University, Bangkok, Pathumwan 10330, Thailand
| | - Sakda Jampasa
- Institute of Biotechnology and Genetic Engineering, Chulalongkorn University, Bangkok 10330, Pathumwan, Thailand
| | - Sirirat Rengpipat
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Pathumwan 10330, Thailand
| | - Weena Siangproh
- Department of Chemistry, Faculty of Science, Srinakharinwirot University, Bangkok, Wattana 10110, Thailand
| | - Orawon Chailapakul
- Electrochemistry and Optical Spectroscopy Center of Excellence (EOSCE), Department of Chemistry, Chulalongkorn University, Bangkok, Pathumwan 10330, Thailand and Center of Excellence on Petrochemical and Materials Technology, Chulalongkorn University, Bangkok, Pathumwan 10330, Thailand.
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38
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Antimicrobial and Wound Healing Properties of FeO Fabricated Chitosan/PVA Nanocomposite Sponge. Antibiotics (Basel) 2021; 10:antibiotics10050524. [PMID: 34063621 PMCID: PMC8147619 DOI: 10.3390/antibiotics10050524] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetic and anemia-associated diabetic wounds increase the considerable morbidity and mortality in people, as reported by clinical studies. However, no anemia-associated diabetic wound dressing materials have been developed until now. Hence, this study aimed to develop a nanocomposite scaffold composed of chitosan (CS), poly (vinyl alcohol) (PVA), and phytogenic iron oxide nanoparticles (FeO NPs), for accelerated anemia-associated diabetic wound healing. The aqueous leaves extract of Pinus densiflora (PD) was utilized for the synthesis of iron oxide nanoparticles (FeO NPs). TEM and elemental analysis confirmed smaller size PD-FeO NPs (<50 nm) synthesis with the combination of iron and oxide. In addition, in vitro biological studies displayed the moderate antioxidant, antidiabetic activities, and considerable antibacterial activity of PD-FeO NPs. Further, the different concentrations of PD-FeO NPs (0.01, 0.03, and 0.05%) incorporated CS/PVA nanocomposites sponges were developed by the freeze-drying method. The porous structured morphology and the presence of PD-FeO NPs were observed under FE-SEM. Among nanocomposite sponges, PD-FeO NPs (0.01%) incorporated CS/PVA sponges were further chosen for the in vitro wound-healing assay, based on the porous and water sorption nature. Furthermore, the in vitro wound-healing assay revealed that PD-FeO NPs (0.01%) incorporated CS/PVA has significantly increased the cell proliferation in HEK293 cells. In conclusion, the CS/PVA-PD-FeO NPs (0.01%) sponge would be recommended for diabetic wound dressing after a detailed in vivo evaluation.
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39
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Sezgin G, Loh TP, Markus C. Functional reference limits: a case study of serum ferritin. J LAB MED 2021. [DOI: 10.1515/labmed-2020-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Reference intervals depend on the distribution of results within a reference population and can be influenced by subclinical disease. Functional reference limits present an opportunity to derive clinically relevant reference limits from routinely collected data sources, which consist of mixed populations of unhealthy and healthy groups. Serum ferritin is a good example of the utility of functional reference limits. Several studies have identified clinically relevant reference limits through examining the relationship between serum ferritin and erythrocyte parameters. These ferritin functional limits often represent the inflection point at which erythrocyte parameters change significantly. Comparison of ferritin functional reference limits with those based on population distributional reference limits reveals that the lower reference limit may fall below the point at which patients become clinically unwell. Functional reference limits may be considered for any biomarker that exhibits a correlated relationship with other biomarkers.
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Affiliation(s)
- Gorkem Sezgin
- Faculty of Medicine, Health, and Human Sciences , Macquarie University , Sydney , Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine , National University Hospital , Buona Vista , Singapore
| | - Corey Markus
- International Centre for Point-of-Care Testing , Flinders University , Adelaide , Australia
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40
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Al-Naseem A, Sallam A, Choudhury S, Thachil J. Iron deficiency without anaemia: a diagnosis that matters. Clin Med (Lond) 2021; 21:107-113. [PMID: 33762368 PMCID: PMC8002799 DOI: 10.7861/clinmed.2020-0582] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Iron deficiency anaemia (IDA) currently affects 1.2 billion people and iron deficiency without anaemia (IDWA) is at least twice as common. IDWA is poorly recognised by clinicians despite its high prevalence, probably because of suboptimal screening recommendations. Diagnosing IDWA relies on a combination of tests, including haemoglobin and ferritin levels, as well as transferrin saturation. Although the causes of iron deficiency may sometimes be obvious, many tend to be overlooked. Iron sufficiency throughout pregnancy is necessary for maternal and foetal health. Preoperative IDWA must be corrected to reduce the risk of transfusion and postoperative anaemia. Oral iron is the first-line treatment for managing IDWA; however, intravenous supplementation should be used in chronic inflammatory conditions and when oral therapy is poorly tolerated or ineffective. This review considers the causes and clinical features of IDWA, calls for greater awareness of the condition, and proposes diagnostic and management algorithms.
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41
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Sandvik J, Bjerkan KK, Græslie H, Hoff DAL, Johnsen G, Klöckner C, Mårvik R, Nymo S, Hyldmo ÅA, Kulseng BE. Iron Deficiency and Anemia 10 Years After Roux-en-Y Gastric Bypass for Severe Obesity. Front Endocrinol (Lausanne) 2021; 12:679066. [PMID: 34630319 PMCID: PMC8493084 DOI: 10.3389/fendo.2021.679066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Iron deficiency with or without anemia is a well-known long-term complication after Roux-en-Y, gastric bypass (RYGB) as the procedure alters the gastrointestinal absorption of iron. Iron is essential for hemoglobin synthesis and a number of cellular processes in muscles, neurons, and other organs. Ferritin is the best marker of iron status, and in a patient without inflammation, iron deficiency occurs when ferritin levels are below 15 µg/L, while iron insufficiency occurs when ferritin levels are below 50 µg/L. Lifelong regular blood tests are recommended after RYGB, but the clinical relevance of iron deficiency and iron insufficiency might be misjudged as long as the hemoglobin levels are normal. The aim of this study was to explore the frequency of iron deficiency and iron deficiency anemia one decade or more after RYGB, the use of per oral iron supplements, and the frequency of intravenous iron treatment. Nine hundred and thirty patients who underwent RYGB for severe obesity at three public hospitals in Norway in the period 2003-2009 were invited to a follow-up visit 10-15 years later. Results from blood tests and survey data on the use of oral iron supplements and intravenous iron treatment were analyzed. Ferritin and hemoglobin levels more than 10 years after RYGB were available on 530 patients [423 (79.8%) women]. Median (IQR) ferritin was 33 (16-63) µg/L, and mean (SD) hemoglobin was 13.4 (1.3) g/dl. Iron deficiency (ferritin ≤ 15 µg/L) was seen in 125 (23.6%) patients; in addition, iron insufficiency (ferritin 16-50 µg/L) occurred in 233 (44%) patients. Mean (SD) hemoglobin levels were 12.5 (1.4) g/dl in patients with iron deficiency, 13.5 (1.2) g/dl in patients with iron insufficiency, 13.8 (1.3) g/dl in the 111 (21%) patients with ferritin 51-100 µg/L, and 13.8 (1.2) g/dl in the 55 (10%) patients with ferritin >100 µg/L. Two hundred and seventy-five (56%) patients reported taking oral iron supplements, and 138 (27.5%) had received intravenous iron treatment after the RYGB procedure. Iron deficiency or iron insufficiency occurred in two-thirds of the patients 10 years after RYGB, although more than half of them reported taking oral iron supplements.
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Affiliation(s)
- Jorunn Sandvik
- Department of Surgery, Møre and Romsdal Hospital trust, Ålesund, Norway
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- *Correspondence: Jorunn Sandvik,
| | - Kirsti Kverndokk Bjerkan
- Department of Surgery, Møre and Romsdal Hospital trust, Ålesund, Norway
- Faculty of Social Science and History, Volda University College, Volda, Norway
| | - Hallvard Græslie
- Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Dag Arne Lihaug Hoff
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Gjermund Johnsen
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
| | - Christian Klöckner
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ronald Mårvik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
| | - Siren Nymo
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Åsne Ask Hyldmo
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
| | - Bård Eirik Kulseng
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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42
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Sezgin G, Monagle P, Loh TP, Ignjatovic V, Hoq M, Pearce C, McLeod A, Westbrook J, Li L, Georgiou A. Clinical thresholds for diagnosing iron deficiency: comparison of functional assessment of serum ferritin to population based centiles. Sci Rep 2020; 10:18233. [PMID: 33106588 PMCID: PMC7589482 DOI: 10.1038/s41598-020-75435-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022] Open
Abstract
Low serum ferritin is diagnostic of iron deficiency, yet its published lower cut-off values are highly variable, particularly for pediatric populations. Lower cut-off values are commonly reported as 2.5th percentiles, and is based on the variation of ferritin values in the population. Our objective was to determine whether a functional approach based on iron deficient erythropoiesis could provide a better alternative. Utilizing 64,443 ferritin test results from pediatric electronic health records, we conducted various statistical techniques to derive 2.5th percentiles, and also derived functional reference limits through the association between ferritin and erythrocyte parameters: hemoglobin, mean corpuscular volume, mean cell hemoglobin concentration, and red cell distribution width. We find that lower limits of reference intervals derived as centiles are too low for clinical interpretation. Functional limits indicate iron deficiency anemia starts to occur when ferritin levels reach 10 µg/L, and are largely similar between genders and age groups. In comparison, centiles (2.5%) presented with lower limits overall, with varying levels depending on age and gender. Functionally-derived limits better reflects the underlying physiology of a patient, and may provide a basis for deriving a threshold related to treatment of iron deficiency and any other biomarker with functional outcomes.
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Affiliation(s)
- Gorkem Sezgin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Ryde, NSW, 2109, Australia.
| | - Paul Monagle
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Hematology Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Hematology, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Kent Ridge, Singapore
| | - Vera Ignjatovic
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Hematology Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Monsurul Hoq
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | | | - Adam McLeod
- Outcome Health, East Burwood, VIC, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Ryde, NSW, 2109, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Ryde, NSW, 2109, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Ryde, NSW, 2109, Australia
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Alkhaldy HY, Hadi RA, Alghamdi KA, Alqahtani SM, Al Jabbar ISH, Al Ghamdi IS, Bakheet OSE, Saleh RAM, Shehata SF, Aziz S. The pattern of iron deficiency with and without anemia among medical college girl students in high altitude southern Saudi Arabia. J Family Med Prim Care 2020; 9:5018-5025. [PMID: 33209838 PMCID: PMC7652112 DOI: 10.4103/jfmpc.jfmpc_730_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: The prevalence of iron deficiency, latent and symptomatic, is heterogeneous worldwide. In this study, we aim to explore the prevalence of iron deficiency, with and without anemia, among medical college females at the high Altitude Aseer region of Southwestern Saudi Arabia. Methodology: 200 female medical students were randomly sampled, between the ages of 19 and 27 years. Blood samples were collected for complete blood count (CBC) values and serum ferritin determination. Questionnaires were completed in order to collect demographics, medical history, and socioeconomic information of the participants. Results: Prevalence of overall iron deficiency was high (63%, serum ferritin <20 μg/L, 52.5%, ferritin <15 μg/L). Anemia, adjusted for high altitude (defined as less than 13 g/dL was present in 41 participants (20.5%) and 12 (6.5%) have Hb <12 g/dL. Iron-deficiency anemia (Hb <13 g/dL and serum ferritin <15 μg/L) was present in 35 (17.5%). Personal and family history of anemia and poor animal product containing meals were positively correlated with the presence of iron deficiency state. Neither symptoms of anemia, nor the presence of menorrhagia correlate with the presence of iron deficiency anemia. Conclusion: Iron deficiency with and without anemia is a very common and condition in young females’ population at high altitude. Implementing a lab method to screen for anemia on vulnerable populations is needed. Frequently asymptomatic, the primary care providers should maintain a high degree of suspicion in order to initiate screening for iron status.
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Affiliation(s)
- Husain Y Alkhaldy
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Rawan A Hadi
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Khalid A Alghamdi
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Saleh M Alqahtani
- Department of Laboratory Medicine and Blood Bank, Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | | | - Ibrahim S Al Ghamdi
- Department of Laboratory Medicine and Blood Bank, Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Omayma Saad E Bakheet
- Department of Laboratory Medicine and Blood Bank, Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Rayyh A M Saleh
- Department of Laboratory Medicine and Blood Bank, Aseer Central Hospital, Abha, Kingdom of Saudi Arabia.,Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Shehata F Shehata
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia.,High Institute of Public Health, Alexandria University, Egypt
| | - Shahid Aziz
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Majeed T, Solomon J, Ali RS, Chitsabesan P. Non-anaemic iron deficiency should be investigated with the same priority as iron deficiency anaemia in fast track colorectal clinics-retrospective cohort study. J Gastrointest Oncol 2020; 11:609-615. [PMID: 32953144 DOI: 10.21037/jgo-19-451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Since year 2000 the diagnostic criterion for fast track (FT) referrals for patients with suspected colorectal cancer (CRC) is used in the UK. Iron deficiency anaemia (IDA) is one of the diagnostic criteria. There is a strong evidence in the literature which suggests that Iron deficiency (ID) alone has a strong relationship with CRC. Non-anaemic Iron deficiency (NAID) and all other types of anaemia are investigated outside the scope of FT clinics. We postulated that patients with ID regardless of degree of anaemia have an increased risk of CRC. By confirming this hypothesis, we can broaden the scope of the diagnostic criterion for referral that can help to increase diagnostic yield of FT CRC services. Methods A retrospective observational cohort study was conducted from a dedicated data for FT clinics from 2016-2018. Association between CRC and different forms of anaemia, Iron deficiency alone and bowel symptoms was determined. Results Patients with iron deficiency (low MCV, MCH and ferritin) regardless of degree of anaemia were found more likely to have CRC. Factors like age, gender, family history and bowel symptoms (except abdominal mass) showed a very weak association with CRC in patients with ID. Conclusions ID without anaemia has a strong relationship with CRC and should be investigated with the same priority as IDA is investigated.
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Affiliation(s)
- Talal Majeed
- Department of Colorectal Surgery, Wirral University Teaching Hospital, Wirral, UK
| | - Joshua Solomon
- Department of Upper GI Surgery, Wirral University Teaching Hospital, Wirral, UK
| | - Romassa Siddiq Ali
- Department of Emergency Medicine, Wirral University Teaching Hospital, Wirral, UK
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Grzeszczak K, Kwiatkowski S, Kosik-Bogacka D. The Role of Fe, Zn, and Cu in Pregnancy. Biomolecules 2020; 10:E1176. [PMID: 32806787 PMCID: PMC7463674 DOI: 10.3390/biom10081176] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Iron (Fe), copper (Cu), and zinc (Zn) are microelements essential for the proper functioning of living organisms. These elements participatein many processes, including cellular metabolism and antioxidant and anti-inflammatory defenses, and also influence enzyme activity, regulate gene expression, and take part in protein synthesis. Fe, Cu, and Zn have a significant impact on the health of pregnant women and in the development of the fetus, as well as on the health of the newborn. A proper concentration of these elements in the body of women during pregnancy reduces the risk of complications such as anemia, induced hypertension, low birth weight, preeclampsia, and postnatal complications. The interactions between Fe, Cu, and Zn influence their availability due to their similar physicochemical properties. This most often occurs during intestinal absorption, where metal ions compete for binding sites with transport compounds. Additionally, the relationships between these ions have a great influence on the course of reactions in the tissues, as well as on their excretion, which can be stimulated or delayed. This review aims to summarize reports on the influence of Fe, Cu, and Zn on the course of single and multiple pregnancies, and to discuss the interdependencies and mechanisms occurring between Fe, Cu, and Zn.
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Affiliation(s)
- Konrad Grzeszczak
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Danuta Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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46
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Factors Affecting Vision and Visio-Spatial Intelligence (VSI) in Sport: A Review of the Literature. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.101670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
: Sport has become increasingly competitive, prompting the need to determine, as far as possible, any likely performance advantage. While the focus of athletic research, testing, and training is on the physiological and physical characteristics of the sport, visual abilities not only affect sport performance directly, but also affect the acquisition of motor skills. Vision, and visual-spatial intelligence (VSI), are a relatively new and underexplored area of athletic performance. As with physiological and physical parameters, a range of factors affect vision and VSI in sporting activities. This review of the literature is a first attempt to summarize and compile an overview of the factors affecting vision and VSI in athletes, covering those previously connected with sport, as well as those hitherto not associated with athletic activities, but that could also play a part in sports performance. The evidence from this review suggests that while current research still tends to focus on single factors affecting vision and VSI, a large number of such factors have been identified that could affect vision and VSI. This offers new opportunities for researchers to investigate the effects of a combination of factors, and for conditioning and/or sports vision specialists to explore further possibilities for competitive advantage.
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Vinkenoog M, van den Hurk K, van Kraaij M, van Leeuwen M, Janssen MP. First results of a ferritin-based blood donor deferral policy in the Netherlands. Transfusion 2020; 60:1785-1792. [PMID: 32533600 PMCID: PMC7496980 DOI: 10.1111/trf.15906] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whole blood donors are at risk of becoming iron deficient. To monitor iron stores, Sanquin implemented a new deferral policy based on ferritin levels, in addition to the traditional hemoglobin measurements. METHODS Ferritin levels are determined in every fifth donation, as well as in all first-time donors. Donors with ferritin levels <15 ng/mL (WHO threshold) are deferred for 12 months; those ≥15 and ≤30 ng/mL for 6 months. The first results were analyzed and are presented here. RESULTS The results show that 25% of women (N = 20151, 95% CI 24%-25%) and 1.6% of men (N = 10391, 95% CI 1.4%-1.8%) have ferritin levels ≤30 ng/mL at their first blood center visit. For repeat (non-first-time) donors, these proportions are higher: 53% of women (N = 28329, 95% CI 52%-54%) and 42% of men (N = 31089, 95% CI 41%-43%). After a 6-month deferral, in 88% of returning women (N = 3059, 95% CI 87%-89%) and 99% of returning men (N = 3736, 95% CI 98%-99%) ferritin levels were ≥15 ng/mL. After a 12-month deferral, in 74% of returning women (N = 486, 95% CI 70%-78%) and 95% of returning men (N = 479, 95% CI 94%-97%) ferritin levels increased to ≥15 ng/mL. CONCLUSION Deferral of donors whose pre-donation ferritin levels were ≤30 ng/mL might prevent donors from returning with ferritin levels <15 ng/mL. This policy is promising to mitigate effects of repeated donations on iron stores.
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Affiliation(s)
- Marieke Vinkenoog
- Donor Medicine Research, Sanquin ResearchAmsterdamThe Netherlands
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenThe Netherlands
| | | | | | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenThe Netherlands
| | - Mart P. Janssen
- Donor Medicine Research, Sanquin ResearchAmsterdamThe Netherlands
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Drabinski T, Zacharowski K, Meybohm P, Rüger AM, Ramirez de Arellano A. Estimating the Epidemiological and Economic Impact of Implementing Preoperative Anaemia Measures in the German Healthcare System: The Health Economic Footprint of Patient Blood Management. Adv Ther 2020; 37:3515-3536. [PMID: 32562124 PMCID: PMC7370967 DOI: 10.1007/s12325-020-01372-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study aimed to quantify the potential epidemiological and health economic benefits of implementing preoperative anaemia measures (PAMs) in clinical practice in the German healthcare system. METHODS An evidence-based health economic model was developed to assess the possible impact of implementing PAMs, the first pillar of patient blood management (PBM), in a German population. The analysis of two risk factors-iron-deficiency anaemia (IDA) and receipt of a red blood cell concentrate (RBC) transfusion during elective surgery-allowed the estimation of relative risks (RRs), average cost per patient, average length of hospital stay, and avoided hospital deaths after the implementation of PAMs. RESULTS A total of 4,591,060 patients who had undergone elective surgery during 2015 were identified, of which 29,170 (0.64%) were diagnosed with preoperative IDA. These patients had an increased RR of receiving a RBC transfusion during surgery (RR 5.031; 95% confidence interval [CI] 4.928, 5.136) and increased mortality risk (RR 3.630; 95% CI 3.401, 3.874) versus patients without IDA. Patients who received a RBC transfusion during surgery had a 24.6-times higher risk of death than those who did not (RR 24.593; 95% CI 24.121, 25.075). Average cost of treatment was €7883 in patients with IDA, €21,744 in patients with IDA and RBC transfusion, and €4560 in patients without risk factors. The model identified 29,714 patients (0.65%) who had received a RBC transfusion and who potentially had IDA but remained undiagnosed before surgery. Hypothetical implementation of PAMs would have resulted in an estimated annual net hospital direct cost saving of €1029 million (1.58%) of total hospital direct costs of the German healthcare system and 3036 hospital deaths (0.07%) avoided. CONCLUSIONS This model estimated the impact of implementing PAMs for patients with IDA undergoing elective surgery. A significant number of deaths, costly treatments, and hospital days could have been avoided by the introduction of PAMs in routine clinical practice in Germany.
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Affiliation(s)
- Thomas Drabinski
- Institut für Mikrodaten-Analyse (IfMDA), Harmsstr. 13, 24114, Kiel, Germany.
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Patrick Meybohm
- Clinic and Polyclinic for Anaesthesiology, Intensive Medicine and Pain Therapy, University Hospital Würzburg, Würzburg, Germany
| | - Alexandra M Rüger
- Vifor Pharma, Baierbrunner Str. 29 (Eingang Baierbrunner Str. 27), 81379, Munich, Germany
- Charité Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie Campus Virchow-Klinikum, Berlin, Germany
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Zhu XY, Wu TT, Wang HM, Li X, Ni LY, Chen TJ, Qiu MY, Shen J, Liu T, Ondo WG, Wu YC. Correlates of Nonanemic Iron Deficiency in Restless Legs Syndrome. Front Neurol 2020; 11:298. [PMID: 32425874 PMCID: PMC7205016 DOI: 10.3389/fneur.2020.00298] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/30/2020] [Indexed: 01/23/2023] Open
Abstract
Objective: Iron deficiency anemia (IDA) is a well-known cause of secondary restless legs syndrome (RLS). Iron deficiency without anemia (IDNA) is insidious, and its association with RLS is less evaluated. We investigate prevalence and features of IDNA in a consecutive cohort of patients with RLS. Methods: We included sequential primary RLS patients and RLS patients with IDA. We also recruited age- and gender-matched healthy controls. RLS mimics and other comorbidities were carefully excluded. Results: One-hundred and ninety-six RLS patients without anemia, 26 RLS patients with IDA, and 63 controls were included. 42.3% of RLS patients without anemia had iron deficiency. Women were much more susceptible for IDNA with a relative risk of 5.51 (p < 0.0001). Women with IDNA and RLS had younger age both at interview and at RLS onset compared to women with RLS without iron deficiency (NID) (P < 0.01). IDNA RLS patients showed a tendency to higher risk of severe/very severe tiredness or sleepiness during the day as compared to NID RLS patients. Furthermore, IDNA RLS patients had longer duration of RLS (P < 0.01 in men, P < 0.05 in women) and younger age at onset (only in men, P < 0.05) compared to IDA RLS patients. Conclusion: IDNA is frequent in RLS and iron deficiency may be severe despite a normal hemoglobin level. Women are at much higher risk for IDNA, and IDNA in women presents some specific clinical features. Features of IDNA RLS are different from IDA RLS. Regular screening of peripheral iron parameters even in patients with normal blood counts is recommended for timely optimal management.
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Affiliation(s)
- Xiao-Ying Zhu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting-Ting Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-Ming Wang
- Department of Clinical Laboratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Li
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling-Yan Ni
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian-Jiao Chen
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng-Yao Qiu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Shen
- Department of Clinical Laboratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Te Liu
- Geriatric Laboratory, Shanghai Geriatric Institute of Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - William G Ondo
- Department of Neurology, Methodist Neurological Institute, Weill Cornell Medical School, Houston, TX, United States
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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He H, An F, Huang Q, Kong Y, He D, Chen L, Song H. Metabolic effect of AOS-iron in rats with iron deficiency anemia using LC-MS/MS based metabolomics. Food Res Int 2020; 130:108913. [DOI: 10.1016/j.foodres.2019.108913] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/02/2019] [Accepted: 12/15/2019] [Indexed: 12/17/2022]
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