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Habibi A, Pirenne F. Les anémies aiguës et la stratégie transfusionnelle chez les drépanocytaires adultes. Rev Med Interne 2023; 44:4S12-4S17. [PMID: 38049241 DOI: 10.1016/s0248-8663(23)01304-8] [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] [Indexed: 12/06/2023]
Abstract
Worsening of anemia is very common in sickle cell disease. It is important to investigate specific complications related to sickle cell disease but also other causes of anemia in general. Transfusions or exchange transfusions are major therapeutic options and are frequently used for acute complications of sickle cell disease but also for primary and secondary prevention of some of the chronic complications. The transfusion strategy has been modified since the awareness of post-transfusion hemolysis by taking into account the transfusion risk score. A strong collaboration between the patient's expert center, the Blood center and the patient's hospitalization unit is required to make decisions. © 2023 Société nationale française de médecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- A Habibi
- Centre de référence des syndromes drépanocytaires majeurs, unité des maladies génétiques du globule rouge, CHU Henri-Mondor, AP-HP, Créteil, France; INSERM-U955, institut Mondor, université Paris-Est Créteil, team 2 Transfusion et maladies du globule rouge, laboratoire d´excellence GR-Ex, Créteil, France.
| | - F Pirenne
- INSERM-U955, institut Mondor, université Paris-Est Créteil, team 2 Transfusion et maladies du globule rouge, laboratoire d´excellence GR-Ex, Créteil, France; Établissement français du sang Île-de-France, Paris, France
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2
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Ghaznavi C, Ameen S, Srinivas M, Duncavage E, Saini S. Severe thrombocytopenia in the setting of anaemia: The role of iron-deficiency revisited. J Paediatr Child Health 2023; 59:191-193. [PMID: 36269613 DOI: 10.1111/jpc.16256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/26/2022] [Accepted: 10/08/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Cyrus Ghaznavi
- Medical Education Program, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Sabat Ameen
- Department of Pediatrics, St. Louis Children's Hospital/Washington University School of Medicine, St. Louis, Missouri, United States
| | - Meghana Srinivas
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, St. Louis Children's Hospital/Washington University School of Medicine, St. Louis, Missouri, United States
| | - Eric Duncavage
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Surbhi Saini
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, St. Louis Children's Hospital/Washington University School of Medicine, St. Louis, Missouri, United States
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3
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Liao R, Zhou X, Ma D, Tang J, Zhong H. Iron Deficiency is Associated With Platelet Count Elevation in Patients With Dialysis-dependent Chronic Kidney Disease. J Ren Nutr 2022; 32:587-594. [PMID: 35339349 DOI: 10.1053/j.jrn.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/18/2021] [Accepted: 09/05/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Iron deficiency is common in patients with end-stage renal disease (ESRD). Platelet count changes may reflect iron status, but the relationship between platelet count and iron indices is unclear in patients with ESRD. METHODS We conducted a retrospective study in 1,167 patients with ESRD from 2012 to 2017 in West China Hospital. Baseline data were used to analyze the relationship between the platelet count and iron indices. Patients were followed up for 3 years. RESULTS Patients with iron deficiency (both absolute and functional) had a higher platelet count than those without iron deficiency (174 ± 61 × 109/L vs. 153 ± 58 × 109/L, P < .001). Receiver operating characteristic analysis showed a weak predictive power of platelet count on absolute iron deficiency (area under curve 0.620; cutoff value > 137 × 109/L, sensitivity 76%, specificity 43%) and functional iron deficiency (area under curve 0.540; cutoff value > 124 × 109/L, sensitivity 77%, specificity 32%). Platelet count was negatively correlated with ferritin (Spearman's rho [ρ] -0.1547, P < .001), transferrin saturation (ρ = -0.1895, P < .001), and serum iron (ρ = -0.1466, P < .001). The abovementioned correlations remained significant in multivariate regression (β -0.7285, 95% confidence interval [CI] -1.0757 to -0.3814; β -.00347, 95% CI -0.0520 to -0.0174; β -0.0097, 95% CI -0.0159 to -0.0035, respectively). In unadjusted and adjusted Cox regression models, neither baseline platelet count nor relative thrombocytosis was associated with 3-year mortality. CONCLUSION There was a weak but significant platelet count elevation in patients with ESRD and with iron deficiency. KEY WORDS end-stage renal disease; iron deficiency; iron supplement; mortality; platelet count.
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Affiliation(s)
- Ruoxi Liao
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xueli Zhou
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Dengyan Ma
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing Tang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hui Zhong
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Liu ZJ, Deschmann E, Ramsey HE, Feldman HA, Psaila B, Cooper N, Vlachodimitropoulou E, Porter J, Bussel J, Georgieff M, Sola-Visner M. Iron status influences the response of cord blood megakaryocyte progenitors to eltrombopag in vitro. Blood Adv 2022; 6:13-27. [PMID: 34654056 PMCID: PMC8753208 DOI: 10.1182/bloodadvances.2021004207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/17/2021] [Indexed: 11/20/2022] Open
Abstract
Eltrombopag (ELT) is a thrombopoietic agent approved for immune thrombocytopenia and also a potent iron chelator. Here we found that ELT exhibited dose-dependent opposing effects on in vitro megakaryopoiesis: low concentrations (≤6 µM, ELT6) stimulated megakaryopoiesis, but high concentrations (30 µM, ELT30) suppressed megakaryocyte (MK) differentiation and proliferation. The suppressive effects of ELT30 were reproduced by other iron chelators, supporting iron chelation as a likely mechanism. During MK differentiation, committed MK progenitors (CD34+/CD41+ and CD34-/CD41+ cells) were significantly more sensitive than undifferentiated progenitors (CD34+/CD41- cells) to the suppressive effects of ELT30, which resulted from both decreased proliferation and increased apoptosis. The antiproliferative effects of ELT30 were reversed by increased iron in the culture, as were the proapoptotic effects when exposure to ELT30 was short. Because committed MK progenitors exhibited the highest proliferative rate and the highest sensitivity to iron chelation, we tested whether their iron status influenced their response to ELT during rapid cell expansion. In these studies, iron deficiency reduced the proliferation of CD41+ cells in response to all ELT concentrations. Severe iron deficiency also reduced the number of MKs generated in response to high thrombopoietin concentrations by ∼50%, compared with iron-replete cultures. Our findings support the hypothesis that although iron deficiency can stimulate certain cells and steps in megakaryopoiesis, it can also limit the proliferation of committed MK progenitors, with severity of iron deficiency and degree of thrombopoietic stimulation influencing the ultimate output. Further studies are needed to clarify how megakaryopoiesis, iron deficiency, and ELT stimulation are clinically interrelated.
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Affiliation(s)
- Zhi-Jian Liu
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA
| | - Emoke Deschmann
- Division of Neonatology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Haley E. Ramsey
- Department of Medicine, Vanderbilt University, Nashville, TN
| | - Henry A. Feldman
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA
| | - Bethan Psaila
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nichola Cooper
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | | | - John Porter
- Department of Hematology, University College London, London, United Kingdom
| | - James Bussel
- Division of Hematology, Department of Pediatrics, Weill Cornell Medicine, New York, NY; and
| | - Michael Georgieff
- Department of Pediatrics, Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN
| | - Martha Sola-Visner
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA
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Park MY, Le Henaff C, Sitara D. Administration of α-Klotho Does Not Rescue Renal Anemia in Mice. Front Pediatr 2022; 10:924915. [PMID: 35813388 PMCID: PMC9259788 DOI: 10.3389/fped.2022.924915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/27/2022] [Indexed: 12/05/2022] Open
Abstract
Renal anemia is a common complication in chronic kidney disease (CKD), associated with decreased production of erythropoietin (EPO) due to loss of kidney function, and subsequent decreased red blood cell (RBC) production. However, many other factors play a critical role in the development of renal anemia, such as iron deficiency, inflammation, and elevated fibroblast growth factor 23 (FGF23) levels. We previously reported that inhibition of FGF23 signaling rescues anemia in mice with CKD. In the present study we sought to investigate whether α-Klotho deficiency present in CKD also contributes to the development of renal anemia. To address this, we administered α-Klotho to mice with CKD induced by an adenine-rich diet. Mice were sacrificed 24 h after α-Klotho injection, and blood and organs were collected immediately post-mortem. Our data show that α-Klotho administration had no beneficial effect in mice with CKD-associated anemia as it did not increase RBC numbers and hemoglobin levels, and it did not stimulate EPO secretion. Moreover, α-Klotho did not improve iron deficiency and inflammation in CKD as it had no effect on iron levels or inflammatory markers. Interestingly, Klotho supplementation significantly reduced the number of erythroid progenitors in the bone marrow and downregulated renal Epo and Hif2α mRNA in mice fed control diet resulting in reduced circulating EPO levels in these mice. In addition, Klotho significantly decreased intestinal absorption of iron in control mice leading to reduced serum iron and transferrin saturation levels. Our findings demonstrate that α-Klotho does not have a direct role in renal anemia and that FGF23 suppresses erythropoiesis in CKD via a Klotho-independent mechanism. However, in physiological conditions α-Klotho appears to have an inhibitory effect on erythropoiesis and iron regulation.
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Affiliation(s)
- Min Young Park
- Department of Molecular Pathobiology, NYU College of Dentistry, New York, NY, United States
| | - Carole Le Henaff
- Department of Molecular Pathobiology, NYU College of Dentistry, New York, NY, United States
| | - Despina Sitara
- Department of Molecular Pathobiology, NYU College of Dentistry, New York, NY, United States.,Medicine, NYU School of Medicine, New York, NY, United States
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van den Akker M, Chielens L, Lopes L, van Heerden J, Zaqout M, van der Werf Ten Bosch J. Thrombocytopenia in severe iron deficiency anemia in children. Health Sci Rep 2021; 4:e351. [PMID: 34557594 PMCID: PMC8448394 DOI: 10.1002/hsr2.351] [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: 01/30/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 11/05/2022] Open
Abstract
AIM Iron deficiency anemia (IDA) is common in the pediatric population and often accompanied by mild thrombocytosis, but rarely profound thrombocytopenia is seen. We describe the data of children with IDA and thrombocytopenia in two centers and discuss the published data in the literature. METHODS In this retrospective case series, the medical records of patients under the age of 19 years old diagnosed with IDA in two tertiary medical centers over the last 10 years, were reviewed. The data were collected and compared to the data published in the medical literature. RESULTS All the patients presented with severe IDA and thrombocytopenia improved with iron treatment. Although none of the patients had signs of major bleeding, the thrombocytopenia could mostly be classified as severe (platelet count <50×10E9/L). Due to the severity of the anemia, in about half of the cases, a red blood cell transfusion was given. The peak of the platelet count was seen in the first month after the start of iron treatment. In eight cases of children with IDA, the thrombocytopenia appeared after the supplementation of iron was started. CONCLUSION Clinically stable children with severe IDA and thrombocytopenia, where other causes are very unlikely, warrant an empiric monotherapy with iron to prevent unnecessary investigations and treatments.
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Affiliation(s)
- Machiel van den Akker
- Department of PediatricsZNA Queen Paola Children's HospitalAntwerpBelgium
- Pediatric Hematology/Oncology Unit, Queen Mathilde Mother and Child CenterAntwerp University HospitalEdegemBelgium
- Department of Pediatric Hematology OncologyUZ BrusselJetteBelgium
| | - Laura Chielens
- Faculty of Medicine and Health SciencesUniversity of BrusselsJetteBelgium
| | - Lisa Lopes
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
| | - Jaques van Heerden
- Pediatric Hematology/Oncology Unit, Queen Mathilde Mother and Child CenterAntwerp University HospitalEdegemBelgium
| | - Mahmoud Zaqout
- Department of PediatricsZNA Queen Paola Children's HospitalAntwerpBelgium
- Pediatric Cardiology Unit, Queen Mathilde Mother and Child CenterAntwerp University HospitalEdegemBelgium
| | - Jutte van der Werf Ten Bosch
- Department of PediatricsZNA Queen Paola Children's HospitalAntwerpBelgium
- Department of Pediatric Hematology OncologyUZ BrusselJetteBelgium
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Brissot E, Troadec M, Loréal O, Brissot P. Iron and platelets: A subtle, under-recognized relationship. Am J Hematol 2021; 96:1008-1016. [PMID: 33844865 DOI: 10.1002/ajh.26189] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022]
Abstract
The role of iron in the formation and functioning of erythrocytes, and to a lesser degree of white blood cells, is well established, but the relationship between iron and platelets is less documented. Physiologically, iron plays an important role in hematopoiesis, including thrombopoiesis; iron levels direct, together with genetic factors, the lineage commitment of megakaryocytic/erythroid progenitors toward either megakaryocyte or erythroid progenitors. Megakaryocytic iron contributes to cellular machinery, especially energy production in platelet mitochondria. Thrombocytosis, possibly favoring vascular thrombosis, is a classical feature observed with abnormally low total body iron stores (mainly due to blood losses or decreased duodenal iron intake), but thrombocytopenia can also occur in severe iron deficiency anemia. Iron sequestration, as seen in inflammatory conditions, can be associated with early thrombocytopenia due to platelet consumption and followed by reactive replenishment of the platelet pool with possibility of thrombocytosis. Iron overload of genetic origin (hemochromatosis), despite expected mitochondrial damage related to ferroptosis, has not been reported to cause thrombocytopenia (except in case of high degree of hepatic fibrosis), and iron-related alteration of platelet function is still a matter of debate. In acquired iron overload (of transfusional and/or dyserythropoiesis origin), quantitative or qualitative platelet changes are difficult to attribute to iron alone due to the interference of the underlying hematological conditions; likewise, hematological improvement, including increased blood platelet counts, observed under iron oral chelation is likely to reflect mechanisms other than the sole beneficial impact of iron depletion.
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Affiliation(s)
- Eolia Brissot
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine APHP Paris France
- Sorbonne Universités, UPMC Univ. Paris 06, Centre de recherche Saint‐Antoine, UMR‐S938 Paris France
| | - Marie‐Bérengère Troadec
- Univ Brest, Inserm, EFS, UMR 1078, GGB Brest France
- Service de génétique, laboratoire de génétique chromosomique CHRU Brest Brest France
| | - Olivier Loréal
- Inserm, University of Rennes1, UMR 1241, Inrae, NuMeCan Institute Rennes France
| | - Pierre Brissot
- Inserm, University of Rennes1, UMR 1241, Inrae, NuMeCan Institute Rennes France
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Mohammad F, Sridhar M, Samprathi M, Vemgal P. Thrombocytopenia in severe iron deficiency anaemia: A report of two cases. Trop Doct 2021; 51:448-450. [PMID: 33427090 DOI: 10.1177/0049475520983658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iron deficiency, the commonest cause of anaemia in children, is a global public health problem. Worldwide, almost 50% of children <5 years of age are anaemic. Platelet count in iron deficiency anaemia is mostly normal or high; thrombocytopenia is rare. We describe two children with iron deficiency anaemia and severe thrombocytopenia who recovered with iron supplementation alone.
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Affiliation(s)
- Faisal Mohammad
- Fellow, Pediatric Intensive Care Unit, Rainbow Children's Hospital, Bangalore, India
| | - M Sridhar
- Consultant Pediatric Intensivist, Rainbow Children's Hospital, Bangalore, India
| | | | - Prakash Vemgal
- Director, Department of Pediatrics, Rainbow Children's Hospital, Bangalore, India
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