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Feng Y, Wassie T, Wu Y, Wu X. Advances on novel iron saccharide-iron (III) complexes as nutritional supplements. Crit Rev Food Sci Nutr 2023:1-17. [PMID: 37366165 DOI: 10.1080/10408398.2023.2222175] [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: 06/28/2023]
Abstract
Iron deficiency is prevalent worldwide, and iron supplementation is a promising strategy to address iron needs of the body. However, traditional oral supplements such as ferrous sulfate, ferrous succinate, and ferrous gluconate are absorbed in the form of ferrous ions, leading to lipid peroxidation and side effects due to other reasons. In recent years, saccharide-iron (III) complexes (SICs) as novel iron supplements have aroused attention for the high iron absorption rate and no gastrointestinal irritation at oral doses. In addition, research on the biological activities of SICs revealed that they also exhibited good abilities in treating anemia, eliminating free radicals, and regulating the immune response. This review focused on the preparation, structural characterization, and bioactivities of these new iron supplements, as promising candidates for the prevention and treatment of iron deficiency.
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Affiliation(s)
- Yingying Feng
- Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, China
| | - Teketay Wassie
- Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences; National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Hunan Provincial Engineering Research Center for Healthy Livestock and Poultry Production, Changsha, China
| | - Yuying Wu
- Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, China
| | - Xin Wu
- Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, China
- Key Laboratory of Agro-ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences; National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Hunan Provincial Engineering Research Center for Healthy Livestock and Poultry Production, Changsha, China
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2
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Kupffer Cells and Blood Monocytes Orchestrate the Clearance of Iron-Carbohydrate Nanoparticles from Serum. Int J Mol Sci 2022; 23:ijms23052666. [PMID: 35269805 PMCID: PMC8910242 DOI: 10.3390/ijms23052666] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/05/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Intravenous (IV) iron nanoparticle preparations are widely used to treat iron deficiency. The mechanism of mononuclear phagocyte system-mediated clearance of IV iron nanoparticles is unknown. The early uptake and homeostasis of iron after injection of ferric carboxymaltose (FCM) in mice was studied. An increase in serum iron was observed at 2.5 h followed by a return to baseline by 24 h. An increase in circulating monocytes was observed, particularly Ly6Chi and Ly6Clow. FCM was also associated with a time-dependent decrease in liver Kupffer cells (KCs) and increase in liver monocytes. The increase in liver monocytes suggests an influx of iron-rich blood monocytes, while some KCs underwent apoptosis. Adoptive transfer experiments demonstrated that following liver infiltration, blood monocytes differentiated to KCs. KCs were also critical for IV iron uptake and biodegradation. Indeed, anti-Colony Stimulating Factor 1 Receptor (CSF1R)-mediated depletion of KCs resulted in elevated serum iron levels and impaired iron uptake by the liver. Gene expression profiling indicated that C-C chemokine receptor type 5 (CCR5) might be involved in monocyte recruitment to the liver, confirmed by pharmaceutical inhibition of CCR5. Liver KCs play a pivotal role in the clearance and storage of IV iron and KCs appear to be supported by the expanded blood monocyte population.
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Abdelaziz TA, Almalky M, Hanna D, Baz EG. Prevalence of Helicobacter pylori Infection among Anemic School-Age Children in Egypt: A Cross-Sectional Population-Based Study. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1740465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractAnemia and Helicobacter pylori infection in school-age children are important public health problems. The association between H. pylori infection and the development of anemia, especially iron deficiency anemia, has been previously studied and until now it is still a matter of argument. This study aimed to determine the prevalence of anemia and H. pylori infection among school-age children and to find the association between H. pylori infection and anemia in school-age children. We conducted this population-based cross-sectional study in six Egyptian primary schools over a 12-month-period, including 1,200 students from all grades who fulfilled the inclusion criteria. The study participants were subjected to the following: medical history, clinical examination, and laboratory investigations included complete blood count and H. pylori antigen in stool, and according to the level of hemoglobin (Hb), we divided the students into two groups; the anemic group with Hb level <11.5 g/dL and nonanemic group with Hb level ≥11.5 g/dL, and the serum ferritin levels were measured only for the anemic group as the best indicator for iron status. The overall prevalence of H. pylori infection was 25%. The overall prevalence of anemia was 13.25%, of which hypochromic microcytic anemia represented 87.4% of the anemic group, and the mean ferritin level in the anemic group was 18.56 ± 9.96 ng/mL. The prevalence of anemia among H. pylori-infected patients (62.3%) was significantly (p < 0.001) higher than in noninfected children (37.7%). In the anemic group, the mean ferritin level in H. pylori-infected children was significantly lower than the mean level in the noninfected children (p <0.001). Furthermore, the anemic group had a significantly higher incidence of H. pylori infection and a lower age (p <0.001) in comparison with the nonanemic group. The dominant type of anemia in H. pylori-infected children was the microcytic hypochromic anemia, with a significantly higher incidence in comparison to other types of anemia (p <0.001). The findings of this study demonstrate a significant association between H. pylori infection and anemia in school-aged children, especially iron deficiency anemia, as the incidence of H. pylori infection was greater in anemic children than in non-anemic children.
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Affiliation(s)
- Tarek A. Abdelaziz
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Mohamed Almalky
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Diana Hanna
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Eman Gamal Baz
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt
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Silva C, Martins J, Campos I, Arantes C, Braga CG, Salomé N, Gaspar A, Azevedo P, Álvares Pereira M, Marques J, Vieira C. Prognostic impact of iron deficiency in acute coronary syndromes. Rev Port Cardiol 2021; 40:525-536. [PMID: 34392892 DOI: 10.1016/j.repce.2020.09.005] [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] [Received: 04/28/2019] [Accepted: 09/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Iron deficiency (IDef) is a prevalent condition in patients with heart disease and in those with heart failure (HF). Evidence has shown that this deficit is associated with worse prognosis. Data in literature are scarce on the prognostic impact of IDef in acute coronary syndromes (ACS), which is the main objective of this study. METHODS Observational, retrospective study which included 817 patients admitted for ACS. Two groups were defined according to the presence (n=298) or absence of IDef (n=519) on admission. The clinical event under study was the occurrence of death or severe HF in the long term. Independent predictors of prognosis were determined with logistic regression analysis. RESULTS Thirty-six percent of patients had IDef. There was higher mortality (p=0.004), higher incidence of HF (p=0.011) during follow-up and a higher rate of hospital readmissions (p=0.048) in this group. IDef was an independent predictor of death or severe HF in follow-up, along with anemia, left ventricular dysfunction, renal dysfunction and the absence of revascularization. IDef also enabled us to further stratify the prognosis of patients without anemia based on the occurrence of death or severe HF and those with lower Killip classes (≤2) based on the occurrence of death. CONCLUSION IDef was an independent predictor of death or severe HF in patients admitted with ACS and enabled additional stratification for those without anemia on admission and in those with Killip classes ≤2.
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Affiliation(s)
- Carina Silva
- Serviço de Medicina Interna, Hospital Santa Maria Maior, Barcelos, Portugal
| | | | - Isabel Campos
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Carina Arantes
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Nuno Salomé
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - António Gaspar
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Pedro Azevedo
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Jorge Marques
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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Chang JE, Lee HM, Kim J, Rhew K. Prevalence of Anemia in Pediatric Patients According to Asthma Control: Propensity Score Analysis. J Asthma Allergy 2021; 14:743-751. [PMID: 34234469 PMCID: PMC8254559 DOI: 10.2147/jaa.s318641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate whether the degree of asthma control is associated with anemia in pediatric patients. Patients and Methods A cross-sectional study was performed using a dataset from the Health Insurance Reviews & Assessment Service (HIRA) of South Korea in 2016, which included children and adolescent patients diagnosed with asthma. Binary logistic regression was used to assess the association between asthma control and the prevalence of anemia. Results A total of 236,429 patients under 18 years old were included in the study, including 233,975 patients with controlled and 2454 with uncontrolled asthma. Binary logistic regression after adjustment for confounding factors showed that patients with uncontrolled asthma had a 2.64-fold higher prevalence of anemia than those with well-controlled asthma (OR = 2.64, 95% CI: 2.16-3.22). While there was no effect of gender on the results, there was a statistically significant association between the prevalence of anemia and asthma control in patients under 13 years old. Conclusion These findings suggest that the prevalence of anemia is inversely correlated with asthma control in pediatric patients. Further studies are necessary to obtain pathophysiological insight into the relationship between severe inflammatory diseases and anemia.
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Affiliation(s)
- Ji-Eun Chang
- College of Pharmacy, Dongduk Women's University, Seoul, Republic of Korea
| | - Hyang-Mi Lee
- College of Pharmacy, Dongduk Women's University, Seoul, Republic of Korea
| | - Jongyoon Kim
- College of Pharmacy, Dongduk Women's University, Seoul, Republic of Korea
| | - Kiyon Rhew
- College of Pharmacy, Dongduk Women's University, Seoul, Republic of Korea
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Ganie SA, Naik RA, Ali A, Mir TA, Mazumdar N. Preparation, characterization, release and antianemic studies of guar gum functionalized Iron complexes. Int J Biol Macromol 2021; 183:1495-1504. [PMID: 34029580 DOI: 10.1016/j.ijbiomac.2021.05.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
Guar gum is a neutral, non-ionic polysaccharide that has been extensively utilized in the food industry as a stabilizer, excipients, and emulsifier agent. An oxidized derivative of this edible guar gum was prepared and used as a complexing agent for iron to obtain a polysaccharide-bound iron (II) complex. The degree of oxidation varies between 30.12 and 60.63% with a corresponding aldehyde content (0.59-1.79 mmol/g) and carboxyl contents (0.49-1.62 mmol/g), which were determined by the titrimetry method. Sophisticated spectroscopic techniques characterized all the products. The natural polymer-based hydrophilic and hydrophobic formulations as coating were used for achieving the sustained or prolonged release from the complex tablets. Release studies of the tablets were carried out in different mediums of varying pH. The total iron available from the tablets was compared with that obtained from ferrous fumarate prepared under similar conditions, and the results were found to be comparable. Release results demonstrate the pH-sensitive behaviour of the guar gum-based delivery system towards the controlled release of iron. Antianemic effect of new functionalized guar gum iron complexes was investigated on male albino rats. The complexes may exhibit the potential to recover the hematological index of the albino rats with some positive effects on improving rat's growth with iron deficiency anaemia.
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Affiliation(s)
- Showkat Ali Ganie
- Department of Chemistry, Jamia Millia Islamia, New Delhi 110025, India.
| | - Rayees Ahmad Naik
- Department of Zoology, Dr. Harisingh Gour, Vishwavidyalaya Sagar (M.P.) 470003, India
| | - Akbar Ali
- Department of Chemistry, Jamia Millia Islamia, New Delhi 110025, India
| | - Tariq Ahmad Mir
- Department of Chemistry, Jamia Millia Islamia, New Delhi 110025, India
| | - Nasreen Mazumdar
- Department of Chemistry, Jamia Millia Islamia, New Delhi 110025, India
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7
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Silva C, Martins J, Campos I, Arantes C, Braga CG, Salomé N, Gaspar A, Azevedo P, Álvares Pereira M, Marques J, Vieira C. Prognostic impact of iron deficiency in acute coronary syndromes. Rev Port Cardiol 2021. [PMID: 34006413 DOI: 10.1016/j.repc.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Iron deficiency (IDef) is a prevalent condition in patients with heart disease and in those with heart failure (HF). Evidence has shown that this deficit is associated with a worse prognosis. There is only a small amount of data in the literature regarding the prognostic impact of IDef in acute coronary syndromes (ACS), which is the main objective of this study. METHODS Observational, retrospective study which included 817 patients admitted for ACS. Two groups were defined according to the presence (n = 298) or absence of IDeF (n = 519) on admission. The clinical event under study was the occurrence of death or severe HF in long term. Independent predictors of prognosis were determined with logistic regression analysis. RESULTS 36% of patients had IDef. These patients had a higher mortality rate (p = 0.004), higher incidence of HF (p = 0.011) during follow-up and a higher rate of hospital readmissions (p = 0.048). IDef was an independent predictor of death or severe HF in follow-up, along with anemia, left ventricular dysfunction, renal dysfunction and the absence of revascularization. Besides, IDef also enabled us to further stratify the prognosis of patients without anemia based on the occurrence of death or severe HF and those with lower Killip classes (≤2) based on the occurrence of death. CONCLUSION IDef was an independent predictor of death or severe HF in patients admitted with ACS and enabled additional stratification for those without anemia on admission and in those with Killip classes ≤2.
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Affiliation(s)
- Carina Silva
- Serviço de Medicina Interna, Hospital Santa Maria Maior, Barcelos, Portugal
| | | | - Isabel Campos
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Carina Arantes
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Nuno Salomé
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - António Gaspar
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Pedro Azevedo
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Jorge Marques
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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Ha EK, Kim JH, Lee E, Sung M, Jee HM, Baek HS, Shin YH, Lee NH, Han MY. Abnormal iron status is independently associated with reduced oscillometric lung function in schoolchildren. CLINICAL RESPIRATORY JOURNAL 2021; 15:870-877. [PMID: 33848060 DOI: 10.1111/crj.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Associations between anemia and allergic diseases have been reported, but the relationship of iron deficiency with airway dysfunction in children remains unclear. We aimed to investigate the relationship between abnormal iron parameters and lung function in schoolchildren. METHODS Four hundred and forty-five children (10-12 years-old) from 11 elementary schools in were enrolled. The relationships of different iron parameters (hemoglobin, serum iron, transferrin saturation, and serum ferritin) with lung function evaluated by impulse oscillometry (airways resistance at 5 Hz [Rrs5], 10 Hz [Rrs10], and the difference of Rrs5 and Rrs20 Hz [Rrs5-20]), and with exhaled nitric oxide (FeNO) were evaluated after adjustment for confounders including height, sex, and body mass index z-score, and for additional covariates that could affect airway function. RESULTS Total airway dysfunction represented by Rrs5 was reduced in participants with low serum iron level (aβ: -0.13, 95% CI: -0.23 to -0.03, p = 0.040) after adjustment for key confounders, but did not correlate with other iron profiles. Reduced oscillometric lung function recorded as Rrs5-20 was related with low serum iron and high serum ferritin, but the results were inconsistent after multiple comparisons. Associations were not observed with serum hemoglobin. CONCLUSIONS Decreased serum iron level was related with airway dysfunction represented as oscillomteric Rrs5. Our results suggest a relationship of reduced lung function with abnormal iron status in children.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Ju Hee Kim
- Department of Pediatrics, Hallym University Kandong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soon Chun Hyang University Gumi Hospital, Soon Chun Hyang University College of Medicine, Gumi, Republic of Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hey Sung Baek
- Department of Pediatrics, Hallym University Kandong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Na Hee Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Abstract
Background: Aortic valve sclerosis (AVSc) is defined as the thickening and calcification
of aortic valve cusps, in the absence of obstruction of ventricular outflow.
AVSc is linked with a clear imbalance in some trace elements. Aims: The objective of this study was to investigate the relationship between AVSc
and serum levels of iron (Fe), zinc (Zn), selenium (Se), and copper (Cu).
Additionally, this research aimed to explore the clinical significance of
human serum zinc, selenium, copper, and iron concentrations as a potential
new biomarker for AVSc patients and to clarify the pathophysiological role
in individuals at risk of developing AVSc. Patients and methods: The study included 40 subjects with AVSc (25% male and 75% female) who were
compared with a healthy control group with the same gender ratio. AVSc was
based on comprehensive echocardiographic assessments. Blood samples were
taken and Zn and Cu concentrations were determined through the use of atomic
absorption spectroscopy. Se was measured using an inductively coupled plasma
mass spectrometry device and Fe was measured using a Beckman Coulter
instrument. Results: There was a significant difference in the prevalence of diabetes, blood
pressure levels, and body mass index between the patients and the healthy
subjects (p < 0.05). The differences between the serum
Fe, Se, and Cu levels of the AVSc patients and the healthy subjects
(p > 0.05) were recorded. The serum Zn of AVSc
patients when compared was significantly lower compared with that of the
control group (p < 0.01). Conclusion: Patients with AVSc had an imbalance in some of the trace elements in their
blood. The patient group’s valves had higher serum Cu levels and lower serum
Se, Zn, and Fe concentrations compared with the healthy group’s valves. In
the valve patients as compared, AVSc had a high prevalence of obesity,
hypertension, and diabetes.
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Affiliation(s)
- Hataw Al-Taesh
- Department of Biochemistry Science and Technology, Institute of Natural and Applied Sciences, Faculty of Arts and Science, Gaziantep University, Gaziantep, Turkey
| | - Abuzer Çelekli
- Department of Biology, Faculty of Arts and Science, Gaziantep University, Gaziantep, Turkey
| | - Murat Sucu
- Department of Cardiology, Gaziantep University, Gaziantep, 27310, Turkey
| | - Seyithan Taysi
- Department of Medical Biochemistry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Paternostro R, Kapzan L, Mandorfer M, Schwarzer R, Benedikt S, Viveiros A, Bauer D, Ferlitsch M, Zoller H, Trauner M, Ferlitsch A. Anemia and iron deficiency in compensated and decompensated cirrhosis: Prevalence and impact on clinical outcomes. J Gastroenterol Hepatol 2020; 35:1619-1627. [PMID: 31972057 DOI: 10.1111/jgh.14988] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 12/19/2019] [Accepted: 01/22/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Iron deficiency anemia (IDA)is the leading cause of anemia worldwide. Data on prevalence and clinical impact of anemia in cirrhosis are scarce. Aim was to report on the following:(i) prevalence of anemia and IDA in cirrhosis and (ii) its possible impact on clinical outcomes. METHODS Consecutive cirrhotic patients from a prospective registry study were included. Anemia was defined as hemoglobin concentration ≤ 12 g/dL. IDA was defined as Hb ≤ 12 g/dL + transferrin-saturation < 20%. Follow up for hepatic decompensation and mortality started with study inclusion and terminated in December 2017. A retrospective validation cohort of 1244 patients was used to validate our findings. RESULTS Two hundred forty-two patients with compensated (n = 53 [21.9%]) and decompensated (n = 189 [78.1%]) cirrhosis were included. Anemia was present in 128 patients (52.9%); of those, 63 (49.2%) had IDA. Prevalence of anemia increased with Child-Pugh Score (CPS; A: 26.5%, B: 59.2%, C: 69%; P < 0.001) and with decompensated cirrhosis(62.4% vs 18.8%, P < 0.001). Within anemic patients, a higher proportion of patients in CPS A/B vs C (73% vs 35%; P = 0.025) and in compensated cirrhosis (80% vs 46.6%; P = 0.043) were found with IDA. Model for End-Stage Liver Disease (MELD) scores were significantly lower in patients with IDA (14.4 vs 17.9 non-ID-anemia; P = 0.005). Similar results were found in the validation cohort: median MELD (16[8-28]non-IDA vs 12 [7-23] IDA; P < 0.001) and within anemic patients IDA was more common in patients with MELD <15 (58%) versus >15 (24%, P < 0.001). Anemia was associated with a significant risk for hepatic decompensation and/or mortality both in the validation (aSHR: 1.65, P = 0.008) and in the derivation cohort (aSHR: 2.11, P < 0.001) and an independent risk factor for hepatic decompensation and/or mortality in compensated patients (aHR: 4.91, P = 0.004). CONCLUSION Anemia is highly prevalent in cirrhosis. In compensated cirrhosis, CPS A/B, and low MELD, IDA seems to be the most likely reason for anemia. Furthermore, anemia is associated with a significant risk for hepatic decompensation or mortality during long-term follow up.
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Affiliation(s)
- Rafael Paternostro
- Vienna Hepatic Hemodynamic Lab, Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lea Kapzan
- Vienna Hepatic Hemodynamic Lab, Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Remy Schwarzer
- Vienna Hepatic Hemodynamic Lab, Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Schaefer Benedikt
- Division for Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - André Viveiros
- Division for Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - David Bauer
- Vienna Hepatic Hemodynamic Lab, Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Monika Ferlitsch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Heinz Zoller
- Division for Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Trauner
- Vienna Hepatic Hemodynamic Lab, Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Arnulf Ferlitsch
- Vienna Hepatic Hemodynamic Lab, Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, KH Barmherzige Brüder Vienna, Vienna, Austria
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Mattiello V, Schmugge M, Hengartner H, von der Weid N, Renella R. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr 2020; 179:527-545. [PMID: 32020331 DOI: 10.1007/s00431-020-03597-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.What is Known:• Iron deficiency (ID) is one of the most common challenges faced by pediatricians.• Significant progress in the diagnosis and therapy of ID has been made over the last decade.What is New:• Our expert panel provides ID management recommendations based on the best available evidence.• They include strategies for ID diagnosis and therapy, both oral and intravenous.
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Affiliation(s)
- Veneranda Mattiello
- Department "Woman-Mother-Child and Adolescent", Pediatric Hematology-Oncology Unit, Division of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Markus Schmugge
- Division of Pediatric Hematology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Heinz Hengartner
- Pediatric Hematology-Oncology Unit, Children's Hospital of Sankt Gallen, Sankt Gallen, Switzerland
| | - Nicolas von der Weid
- Pediatric Hematology-Oncology Department, University Children's Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Renella
- Department "Woman-Mother-Child", Pediatric Hematology-Oncology Unit, Division of Pediatrics, Lausanne University Hospital and University of Lausanne, Vaudois, BH11, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Atopic Disease and Anemia in Korean Patients: Cross-Sectional Study with Propensity Score Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061978. [PMID: 32197291 PMCID: PMC7142528 DOI: 10.3390/ijerph17061978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 02/07/2023]
Abstract
Atopic disease is associated with chronic inflammation, and anemia has been reported in patients with inflammatory disorders such as rheumatoid arthritis, chronic obstructive pulmonary disease, and irritable bowel disease. The objective of this study was to determine whether atopic disease is associated with an increased risk of anemia. A cross-sectional study with propensity score weighting was conducted using a health insurance review agency claims dataset comprised of randomized patients who used the Korean national health system at least once in 2016. The association between atopic disease (asthma, atopic dermatitis, allergic rhinitis) and anemia (iron deficiency anemia (IDA) and/or anemia of inflammation (AI)) was examined. A total of 1,468,033 patients were included in this study. The IDA/AI prevalence was 3.1% (45,681 patients). After propensity score weighting, there were 46,958 and 45,681 patients in the non-anemic and anemic groups, respectively. The prevalence of IDA/AI in patients with atopic dermatitis, allergic rhinitis, or asthma had an odds ratio (OR) of 1.40 (95% confidence interval (CI), 1.33–1.48; p < 0.001), 1.17 (95% CI, 1.14–1.21; p < 0.001), and 1.32 (95% CI, 1.28–1.36; p < 0.001), respectively. In addition, the prevalence of IDA increased with higher numbers of atopic diseases. In conclusion, the prevalence of IDA/AI was higher in patients with atopic disease, even after adjusting for demographic characteristics and other risk factors. Further study is needed to distinguish between IDA and AI and to enhance understanding of the etiology of anemia in patients with inflammatory conditions.
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13
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Rhew K, Oh JM. Association between atopic disease and anemia in pediatrics: a cross-sectional study. BMC Pediatr 2019; 19:455. [PMID: 31760939 PMCID: PMC6876088 DOI: 10.1186/s12887-019-1836-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Atopic diseases, such as atopic dermatitis, allergic rhinitis, and asthma, are inflammatory diseases common in pediatric patients. This study investigated whether these inflammatory atopic diseases were associated with anemia in pediatrics. METHODS A cross-sectional study was conducted using a pediatric dataset from the Health Insurance Review and Assessment Service (HIRA) of South Korea in 2016. Multivariable logistic regression, adjusting for demographic covariates was used for analyse the association between atopic disease and iron deficiency anemia (IDA). RESULTS A total of 846,718 pediatric patients were included in the study. Of these, 19,594 (2.31%) had a diagnosis of IDA. The logistic regression analyses including covariates revealed there were association between atopic disease and IDA. The adjusted OR (aOR) of IDA was 1.42 (95% CI, 1.37-1.47) for atopic dermatitis, 1.25 (95% CI, 1.21-1.29) for allergic rhinitis, and 1.71 (95% CI, 1.65-1.76) for asthma. IDA was more prevalent in patients with multiple comorbid atopic diseases, with aOR of 1.30 (95% CI, 1.25-1.35), 1.81 (95% CI, 1.73-1.89), and 2.58 (95% CI, 2.43-2.73) for 1, 2, or 3 atopic diagnoses. There was no evidence of multicollinearity among covariates. CONCLUSIONS Our findings suggest that atopic disease was associated with IDA. Further study is needed to clarify the distinction between IDA and/or AI to better understand the cause of anemia in patients with inflammatory diseases.
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Affiliation(s)
- Kiyon Rhew
- College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.,College of Pharmacy, Dongduk Women's University, 60 Hwarang-ro 13-gil, Seongbuk-gu, Seoul, 02748, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea. .,Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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14
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Nersesjan V, Zervides KA, Sørensen AL, Kjaer L, Skov V, Hasselbalch HC. The red blood cell count and the erythrocyte sedimentation rate in the diagnosis of polycythaemia vera. Eur J Haematol 2019; 104:46-54. [PMID: 31584701 DOI: 10.1111/ejh.13334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Iron deficiency in polycythaemia vera (PV) may impact the validity of the haematocrit (HCT), since HCT is red blood cell count (RBC) × mean corpuscular volume (MCV). OBJECTIVES To investigate (a) the effect of microcytosis on HCT, (b) the erythrocyte sedimentation rate (ESR) as a possible additional diagnostic marker for PV. MATERIAL AND METHODS This study included 182 subjects: 39 with PV, 27 with essential thrombocythemia (ET) and 116 suspected of myeloproliferative neoplasm (MPN) with a secondary cause for either thrombocytosis or erythrocytosis. RESULTS Patients with PV had significantly lower ratio of MCV and serum ferritin compared to MPN suspects. A good correlation of RBC versus HCT was found for PV and MPN subjects when individuals with microcytosis were excluded (R2 = .87 in PV and R2 = .82 in MPN suspects). We found a specificity of 98% and a sensitivity of 37% for ESR <2 mm in the diagnosis of PV. CONCLUSION The RBC may more precisely reflect the total red cell mass and accordingly the hypercoagulable state of the PV patient, which is integrated in the ESR. A combination of RBC and ESR is proposed as a novel tool to substitute the Hb concentration and the HCT in the diagnosis of PV.
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Affiliation(s)
- Vardan Nersesjan
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristoffer A Zervides
- Department of Clinical Sciences, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders L Sørensen
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark.,Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lasse Kjaer
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Vibe Skov
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Hans C Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
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15
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Rostoker G, Vaziri ND. Risk of iron overload with chronic indiscriminate use of intravenous iron products in ESRD and IBD populations. Heliyon 2019; 5:e02045. [PMID: 31338466 PMCID: PMC6627982 DOI: 10.1016/j.heliyon.2019.e02045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 03/14/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023] Open
Abstract
The routine use of recombinant erythropoiesis-stimulating agents (ESA) over the past three decades has enabled the partial correction of anaemia in most patients with end-stage renal disease (ESRD). Since ESA use frequently leads to iron deficiency, almost all ESA-treated haemodialysis patients worldwide receive intravenous iron (IV) to ensure sufficient available iron during ESA therapy. Patients with inflammatory bowel disease (IBD) are also often treated with IV iron preparations, as anaemia is common in IBD. Over the past few years, liver magnetic resonance imaging (MRI) has become the gold standard method for non-invasive diagnosis and follow-up of iron overload diseases. Studies using MRI to quantify liver iron concentration in ESRD have shown a link between high infused iron dose and risk of haemosiderosis in dialysis patients. In September 2017, the Pharmacovigilance Committee (PRAC) of the European Medicines Agency (EMA) considered convergent publications over the last few years on iatrogenic haemosiderosis in dialysis patients and requested that companies holding marketing authorization for iron products should investigate the risk of iron overload, particularly in patients with end-stage renal disease on dialysis and, by analogy, patients with IBD. We present a narrative review of data supporting the views and decision of the EMA, and then give our expert opinion on this controversial field of anaemia therapeutics.
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Affiliation(s)
- Guy Rostoker
- Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Ramsay-Générale de Santé, Quincy-sous-Sénart, France
| | - Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California, Irvine, USA
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16
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Čížková J, Erbanová M, Sochor J, Jindrová A, Strnadová K, Horák V. Relationship between haematological profile and progression or spontaneous regression of melanoma in the Melanoma-bearing Libechov Minipigs. Vet J 2019; 249:1-9. [PMID: 31239158 DOI: 10.1016/j.tvjl.2019.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 12/22/2022]
Abstract
Haematological parameters, plasma iron concentration, and bodyweight were monitored in Melanoma-bearing Libechov Minipigs (MeLiM) from 5 to 18 weeks old. Animals with melanoma progression (P group) and spontaneous regression (SR group) were compared. The P group showed the lowest median values of red blood cell counts (RBC), haematocrit (HCT), haemoglobin concentration (HGB), and bodyweight, whereas the control white (tumour-free) pigs (C group) revealed the highest mean values of these parameters. The mean values of pigs with SR fell between the P and C groups. In addition, a stable concentration of plasma iron was found in the C group, while iron deficiency that increases with age was observed in the MeLiM groups. These results indicate that MeLiM are affected by cancer-related microcytic hypochromic anaemia. The lowest values of HGB, RBC, and HCT, together with the highest number of platelets (PLT) in the P group correspond to melanoma progression. Higher values of these parameters and lower PLT in the MeLiM pigs with SR reflected health improvement due to the destruction of melanoma cells during spontaneous regression. Monitoring of these haematological parameters can help distinguish MeLiM piglets with progression and spontaneous regression of melanoma in the early stages of postnatal development. The findings of this study correspond to findings in human patients in which cancer-related anaemia, thrombocytosis, and iron deficiency are often diagnosed.
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Affiliation(s)
- J Čížková
- Czech Academy of Sciences, Institute of Animal Physiology and Genetics,v.v.i., Laboratory of Applied Proteome Analyses, and Laboratory of Tumour Biology, Rumburska 89, CZ-277 21 Libechov, Czech Republic; Czech University of Life Sciences Prague, Faculty of Agrobiology, Food and Natural Resources, Department of Veterinary Sciences, Kamycka 129, CZ-165 00 Prague, Czech Republic
| | - M Erbanová
- Czech Academy of Sciences, Institute of Animal Physiology and Genetics,v.v.i., Laboratory of Applied Proteome Analyses, and Laboratory of Tumour Biology, Rumburska 89, CZ-277 21 Libechov, Czech Republic
| | - J Sochor
- Mendel University in Brno, Department of Viticulture and Enology, Valticka 337, CZ-691 44 Lednice, Czech Republic; Department of Chemistry and Biochemistry, Zemedelska 1, CZ-613 00 Brno, Czech Republic
| | - A Jindrová
- Czech University of Life Sciences Prague, Faculty of Economics and Management, Department of Statistics, Prague, Czech Republic
| | - K Strnadová
- Czech Academy of Sciences, Institute of Animal Physiology and Genetics,v.v.i., Laboratory of Applied Proteome Analyses, and Laboratory of Tumour Biology, Rumburska 89, CZ-277 21 Libechov, Czech Republic; Czech University of Life Sciences Prague, Faculty of Agrobiology, Food and Natural Resources, Department of Veterinary Sciences, Kamycka 129, CZ-165 00 Prague, Czech Republic
| | - V Horák
- Czech Academy of Sciences, Institute of Animal Physiology and Genetics,v.v.i., Laboratory of Applied Proteome Analyses, and Laboratory of Tumour Biology, Rumburska 89, CZ-277 21 Libechov, Czech Republic.
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17
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Blank PR, Tomonaga Y, Szucs TD, Schwenkglenks M. Economic burden of symptomatic iron deficiency - a survey among Swiss women. BMC Womens Health 2019; 19:39. [PMID: 30808368 PMCID: PMC6390630 DOI: 10.1186/s12905-019-0733-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/15/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Symptomatic iron deficiency (ID) is a disorder affecting 10-20% of menstruating women. ID is diagnosed by measuring serum ferritin, a protein helping to store iron in the body. A deeper understanding of the association between ID and its societal and economic burden is relevant for patients, physicians, health care decision makers. METHODS An online household survey was carried out among Swiss women aged 18-50 years suffering from debilitating symptoms due to ID. The data was population-weighted for age and region. The costs of misdiagnosis and the ID-related economic burden (i.e. days of sick leave) from productivity losses on the labor market were determined and extrapolated to the Swiss population. Furthermore, the patient burden was assessed based on quality of life daily measurements. RESULTS The total sample included 1010 women who received an ID diagnosis with a blood test in the last 2 years (mean age: 33.5 years). Most named symptoms were "being tired or exhausted" (96.4%) and reduced physical energy level (41.0%). In total, 354 (35.0% of the total sample) patients received an initial diagnosis other than ID. Of those, 46.8% were treated prior to the ID diagnosis with a pharmacological medical therapy or psychotherapy. Extrapolating these numbers to the Swiss female population aged 18-50 years, the direct medical costs would be CHF 78 million (assuming an annual ID incidence of ID diagnosis of 9.5%). On average, 28.5% of participants in the work-force had to take sick leave due to ID symptoms within a period of 2 years (mean: 5.2 days, i.e. 2.6 days/year). The estimated annual indirect costs in Switzerland would be CHF 33 million (human capital approach) or CHF 26 million (friction cost method), respectively. Being exhausted and impaired concentration appear to be the most important factors negatively impacting daily living and hence quality of life. CONCLUSION The societal and economic burden among women due to debilitating symptoms of ID in Switzerland is substantial. Timely, correct diagnosis and treatment of ID may contribute to reducing this burden. Further studies are needed in this area to validate our results.
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Affiliation(s)
- Patricia R. Blank
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Yuki Tomonaga
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Thomas D. Szucs
- University of Basel, Institute of Pharmaceutical Medicine, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Matthias Schwenkglenks
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001 Zurich, Switzerland
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18
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Cinnella G, Pavesi M, De Gasperi A, Ranucci M, Mirabella L. Clinical standards for patient blood management and perioperative hemostasis and coagulation management. Position Paper of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Minerva Anestesiol 2019; 85:635-664. [PMID: 30762323 DOI: 10.23736/s0375-9393.19.12151-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patient blood management is currently defined as the application of evidence based medical and surgical concepts designed to maintain hemoglobin (Hb), optimize hemostasis and minimize blood loss to improve patient outcome. Blood management focus on the perioperative management of patients undergoing surgery or other invasive procedures in which significant blood loss occurs or is expected. Preventive strategies are emphasized to identify and manage anemia, reduce iatrogenic blood losses, optimize hemostasis (e.g. pharmacologic therapy, and point of care testing); establish decision thresholds for the appropriate administration of blood therapy. This goal was motivated historically by known blood risks including transmissible infectious disease, transfusion reactions, and potential effects of immunomodulation. Patient blood management has been recognized by the World Health Organization (WHO) as the new standard of care and has urged all 193-member countries of WHO to implement this concept. There is a pressing need for this new "standard of care" so as to reduce blood transfusion and promote the availability of transfusion alternatives. Patient blood management therefore encompasses an evidence-based medical and surgical approach that is multidisciplinary (transfusion medicine specialists, surgeons, anesthesiologists, and critical care specialists) and multiprofessional (physicians, nurses, pump technologists and pharmacists). The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving a Task Force of expert anesthesiologists that reviewing literature provide appropriate levels of care and good clinical practices. Hence, this article focuses on achieving goals of PBM in the perioperative period.
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Affiliation(s)
- Gilda Cinnella
- Unit of Anesthesia and Resuscitation, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Marco Pavesi
- Division of Multispecialty Anesthesia Service of Polispecialistic Anesthesia, San Donato IRCCS Polyclinic, San Donato Milanese, Milan, Italy
| | - Andrea De Gasperi
- Division of Anesthesia and Resuscitation, Niguarda Hospital, Milan, Italy
| | - Marco Ranucci
- Division of Anesthesia and Cardio-Thoraco-Vascular Therapy, San Donato IRCCS Polyclinic, San Donato Milanese, Milan, Italy
| | - Lucia Mirabella
- Unit of Anesthesia and Resuscitation, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy -
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19
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Serum Concentration of Hepcidin as an Indicator of Iron Reserves in Children. J Med Biochem 2018; 37:456-464. [PMID: 30584405 PMCID: PMC6298481 DOI: 10.2478/jomb-2018-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/06/2018] [Indexed: 12/27/2022] Open
Abstract
Background Anemia represents a significant cause of maternal and perinatal mortality, as well as child mortality. The aim of the research was to determine the serum concentration of hepcidin in children aged 6 months to 2 years and adolescents aged 11 to 19 years which suffer from iron deficiency anemia and compare it with the serum concentration of hepcidin in the control groups, as well as to determine its connection with the parameters of the iron metabolism. Methods The research included 173 examinees, 89 of them suffered from iron deficiency anemia and 84 did not suffer from iron deficiency anemia (the latter represented the control group). Blood samples were collected from all study participants. The samples were analyzed for complete blood count and parameters of iron metabolism. ELISA method was used for establishing serum hepcidin levels. Results The research showed that the concentration of hepcidin is statistically lower in children (4.4 ng/mL) and adolescents (4.1 ng/mL) who suffer from iron deficiency anemia in comparison with the control group (14 ng/mL, 10 ng/mL, respectively). The positive correlation between serum hepcidin level and iron in the serum, ferritin, the mean corpuscular volume and transferrin saturation was confirmed, but the negative one occurred in serum hepcidin level, transferrin and reticulocytes. Conclusions The age of the examinees does not influence the level of serum hepcidin which makes it a more sensitive indicator of the level of iron in the body. Besides this, serum hepcidin is a reliable biological marker for the assessment of iron deficiency anemia.
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20
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Lam CSP, Doehner W, Comin-Colet J. Iron deficiency in chronic heart failure: case-based practical guidance. ESC Heart Fail 2018; 5:764-771. [PMID: 30073785 PMCID: PMC6165963 DOI: 10.1002/ehf2.12333] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/18/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022] Open
Abstract
In patients with chronic heart failure, iron deficiency, even in the absence of anaemia, can aggravate the underlying disease and have a negative impact on clinical outcomes and quality of life. The 2016 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure recognize iron deficiency as a co‐morbidity in chronic heart failure and recommend iron status screening in all newly diagnosed patients with chronic heart failure. Furthermore, the guidelines specifically recommend considerations of intravenous iron therapy, ferric carboxymaltose, for the treatment of iron deficiency. However, in spite of these recommendations, iron deficiency remains often overlooked and undertreated. This may be due, in part, to the lack of clinical context and practical guidance accompanying the guidelines for the treating physician. Here, we provide practical guidance complemented by a case study to assist and improve the timely diagnosis, treatment, and routine management of iron deficiency in patients with chronic heart failure.
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Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore, Duke-NUS Medical School, Singapore.,University Medical Centre Groningen, Groningen, The Netherlands
| | - Wolfram Doehner
- Centre for Stroke Research CSB, Department of Cardiology, Virchow Campus, Berlin Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Josep Comin-Colet
- Community Heart Failure Programme, Department of Cardiology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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21
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Nguyen PVQ, Latour J. Ferric Gluconate Complex in Elderly Hospital Inpatients without Terminal Kidney Failure. Can J Hosp Pharm 2018; 71:173-179. [PMID: 29955190 PMCID: PMC6019086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Anemia is a common health issue for elderly patients. For patients with iron deficiency who cannot tolerate iron supplementation by the oral route, the parenteral route may be used. Options for parenteral iron supplementation include ferric gluconate complex (FGC). OBJECTIVES To evaluate the safety of FGC in elderly patients without terminal kidney failure and to assess its efficacy in treating iron-deficiency anemia. METHODS An observational chart review was conducted at a tertiary care university health centre. Patients included in the study were 65 years of age or older, had received at least 1 dose of FGC between January 1, 2014, and December 31, 2015, and had a hemoglobin count of less than 130 g/L (men) or less than 120 g/L (women) at baseline. For each patient, the observation period began when the first dose of FGC was administered and ended 60 days after the last dose. The main safety outcome (occurrence of any adverse reaction) was evaluated for every patient, with the efficacy analysis being limited to patients with a diagnosis of iron-deficiency anemia. RESULTS A total of 144 patients were included in the study, of whom 76 had iron-deficiency anemia. No serious, life-threatening adverse reactions were reported. The most commonly reported adverse reactions were nausea and vomiting. The mean increase in hemoglobin count was 13.5 g/L, a statistically significant change from baseline. CONCLUSIONS These results show that FGC is safe for use in elderly patients, with very few mild adverse reactions. Use of FGC led to increased hemoglobin count within 60 days. Of the 3 options for parenteral iron supplementation available in Canada, iron sucrose has not been studied in elderly patients, and iron dextran has a higher incidence of anaphylaxis, whereas FGC appears to be a safe alternative for patients with intolerance to oral iron.
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Affiliation(s)
- Patrick Viet-Quoc Nguyen
- , MSc, is a Pharmacist with the Centre hospitalier de l'Université de Montréal (CHUM) and the CHUM Research Center, Montréal, Quebec
| | - Judith Latour
- , MD, is a Geriatrician with the Centre hospitalier de l'Université de Montréal, Montréal, Quebec
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22
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Patel D, Trivedi C, Khan N. Management of Anemia in Patients with Inflammatory Bowel Disease (IBD). ACTA ACUST UNITED AC 2018; 16:112-128. [PMID: 29404920 DOI: 10.1007/s11938-018-0174-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Anemia is the most common complication as well as an extra intestinal manifestation of inflammatory bowel disease (IBD). It is associated with a significant impact on patient's quality of life (QoL); as well it represents a common cause of frequent hospitalization, delay of hospital inpatient discharge and overall increased healthcare burden. In spite of all these, anemia is still often underdiagnosed and undertreated. Our aim in this review is to provide a pathway for physicians to help them achieve early diagnosis as well as timely and appropriate treatment of anemia which in turn would hopefully reduce the prevalence and subsequent complications of this condition among IBD patients. RECENT FINDINGS The etiology of anemia among IBD patients is most commonly due to iron deficiency anemia (IDA) followed by anemia of chronic disease. Despite this, more than a third of anemic ulcerative colitis (UC) patients are not tested for IDA and among those tested and diagnosed with IDA, a quarter are not treated with iron replacement therapy. A new algorithm has been validated to predict who will develop moderate to severe anemia at the time of UC diagnosis. While oral iron is effective for the treatment of mild iron deficiency-related anemia, the absorption of iron is influenced by chronic inflammatory states as a consequence of the presence of elevated levels of hepcidin. Also, it is important to recognize that ferritin is elevated in chronic inflammatory states and among patients with active IBD, ferritin levels less than 100 are considered to be diagnostic of iron deficiency. Newer formulations of intra-venous (IV) iron have a good safety profile and can be used for replenishment of iron stores and prevention of iron deficiency in the future. Routine screening for anemia is important among patients with IBD. The cornerstone for the accurate management of anemia in IBD patients lies in accurately diagnosing the type of anemia. All IBD patients with IDA should be considered appropriate for therapy with iron supplementation whereas IV administration of iron is recommended in patients with clinically active IBD, or for patients who are previously intolerant to oral iron, with hemoglobin levels below 10 g/dL, and in patients who need erythropoiesis-stimulating agents (ESAs). As the recurrence of anemia is common after resolution, the monitoring for recurrent anemia is equally important during the course of therapy.
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Affiliation(s)
- Dhruvan Patel
- Section of Gastroenterology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Chinmay Trivedi
- Section of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Nabeel Khan
- Section of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Section of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- , 3900 Woodland Avenue, Philadelphia, PA, 19104, USA.
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23
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Cui J, Li Y, Yu P, Zhan Q, Wang J, Chi Y, Wang P. A novel low molecular weight Enteromorpha polysaccharide-iron (III) complex and its effect on rats with iron deficiency anemia (IDA). Int J Biol Macromol 2017; 108:412-418. [PMID: 29223752 DOI: 10.1016/j.ijbiomac.2017.12.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/26/2017] [Accepted: 12/05/2017] [Indexed: 11/25/2022]
Abstract
Iron deficiency anemia (IDA) is a common nutritional disease that affects normal erythropoiesis. Traditional iron supplements usually cause gastrointestinal irritation. In this study, a novel low-molecular-weight polysaccharide from Enteromorpha prolifera (LPE) was prepared by oxidation degradation, and LPE-iron (III) complex was synthesized and characterized. The molecular weight of LPE-iron (III) complex was 21.25kDa, and iron content was 25%. The therapeutic effects of LPE-iron (III) complex on IDA were investigated in rats. The hematological indices and organ coefficients of the rats were analyzed. Results showed a dose-dependent relationship, and a prior intragastric administration of LPE-iron (III) complex (2mg Fe/kg body weight) exhibited considerable effect when compared with the positive control. Therefore, LPE-iron (III) complex could be exploited as a new iron fortifier.
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Affiliation(s)
- Jiefen Cui
- College of Food Science and Engineering, Ocean University of China, Qingdao 266003, PR China
| | - Yinping Li
- College of Food Science and Engineering, Ocean University of China, Qingdao 266003, PR China
| | - Peng Yu
- College of Food Science and Engineering, Ocean University of China, Qingdao 266003, PR China
| | - Qiping Zhan
- College of Food Science and Engineering, Ocean University of China, Qingdao 266003, PR China
| | - Jingfeng Wang
- College of Food Science and Engineering, Ocean University of China, Qingdao 266003, PR China
| | - Yongzhou Chi
- College of Food Science and Engineering, Ocean University of China, Qingdao 266003, PR China
| | - Peng Wang
- College of Food Science and Engineering, Ocean University of China, Qingdao 266003, PR China; State Key Laboratory of Bioactive Seaweed Substances, Qingdao 266400, PR China.
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Iatrogenic iron overload and its potential consequences in patients on hemodialysis. Presse Med 2017; 46:e312-e328. [PMID: 29153377 DOI: 10.1016/j.lpm.2017.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 12/13/2022] Open
Abstract
Iron overload was considered rare in hemodialysis patients until recently, but its clinical frequency is now increasingly recognized. The liver is the main site of iron storage and the liver iron concentration (LIC) is closely correlated with total iron stores in patients with secondary hemosiderosis and genetic hemochromatosis. Magnetic resonance imaging (MRI) is now the gold standard method for estimating and monitoring LIC. Studies of LIC in hemodialysis patients by magnetic susceptometry thirteen years ago and recently by quantitative MRI have demonstrated a relation between the risk of iron overload and the use of intravenous (IV) iron products prescribed at doses determined by the iron biomarker cutoffs contained in current anemia management guidelines. These findings have challenged the validity of both iron biomarker cutoffs and current clinical guidelines, especially with respect to recommended IV iron doses. Moreover, three recent long-term observational studies suggested that excessive IV iron doses might be associated with an increased risk of cardiovascular events and death in hemodialysis patients. It has been hypothesized that iatrogenic iron overload in the era of erythropoiesis-stimulating agents might silently increase complications in dialysis patients without creating obvious, clinical signs and symptoms. High hepcidin-25 levels were recently linked to fatal and nonfatal cardiovascular events in dialysis patients. It has been postulated that the main pathophysiological pathway leading to these events might involve the pleiotropic master hormone hepcidin, which regulates iron metabolism, leading to activation of macrophages in atherosclerotic plaques and then to clinical cardiovascular events. Thus, the potential iron overload toxicity linked to chronic administration of IV iron therapy is now becoming one of the most controversial topics in the management of anemia in hemodialysis patients.
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Azzouz A, Hanini A, Bouslama Z, Saili L, Benaceur S, Sakly M, Tliba S, Abdelmelek H. Iron prevents demyelination of frog sciatic nerves. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2017; 55:51-54. [PMID: 28823653 DOI: 10.1016/j.etap.2017.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 06/07/2023]
Abstract
Metal ions are of particular importance in nervous system function, notably iron. However, very little has been done to investigate its physiological role in frog peripheral nervous system. The present research aim to evaluate i) the time-effect of sciatic nerve ligation and/or ii) iron sulphate (1.50mg/kg, in lymphatic sac) on frog myelin sheaths. Histological sections following ligation shows degeneration of some fibres with axonal and myelin breakdown associated to a decrease of Schwann cells number following 2h (45.00±0.30, p<0.0001), 24h (28.00±0.020, p<0.0001). Interestingly, iron administration reduces the degeneration of myelin sheaths classically observed in frog ligated sciatic nerve associated with an increase of Schwann cells number (139.00±0.50, p<0.0001). Thus, iron could prevent degeneration or promote regeneration induced by ligation in frog sciatic nerve.
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Affiliation(s)
- Amina Azzouz
- Laboratoire d'Ecologie des Systèmes Terrestres et Aquatiques, Faculté des Sciences, Université Badji Mokhtar, BP 12, 23000 Sidi Amar, Annaba, Algeria.
| | - Amel Hanini
- Laboratoire de Physiologie Intégrée, Faculté des Sciences, Université de Carthage, Jarzouna, Bizerte 7021, Tunisia
| | - Zihad Bouslama
- Laboratoire d'Ecologie des Systèmes Terrestres et Aquatiques, Faculté des Sciences, Université Badji Mokhtar, BP 12, 23000 Sidi Amar, Annaba, Algeria
| | - Linda Saili
- Laboratoire d'Ecologie des Systèmes Terrestres et Aquatiques, Faculté des Sciences, Université Badji Mokhtar, BP 12, 23000 Sidi Amar, Annaba, Algeria
| | - Sihem Benaceur
- Laboratoire de Physiologie Intégrée, Faculté des Sciences, Université de Carthage, Jarzouna, Bizerte 7021, Tunisia
| | - Mohsen Sakly
- Laboratoire de Physiologie Intégrée, Faculté des Sciences, Université de Carthage, Jarzouna, Bizerte 7021, Tunisia
| | - Souhil Tliba
- Laboratoire de Génie Biologique des Cancers, Faculté de Médecine, Université Abderrahmane Mira, Aboudaou, Bejaia 06000, Algeria
| | - Hafedh Abdelmelek
- Laboratoire de Physiologie Intégrée, Faculté des Sciences, Université de Carthage, Jarzouna, Bizerte 7021, Tunisia
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Cappellini MD, Comin-Colet J, de Francisco A, Dignass A, Doehner W, Lam CS, Macdougall IC, Rogler G, Camaschella C, Kadir R, Kassebaum NJ, Spahn DR, Taher AT, Musallam KM. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J Hematol 2017; 92:1068-1078. [PMID: 28612425 PMCID: PMC5599965 DOI: 10.1002/ajh.24820] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 12/11/2022]
Abstract
Iron deficiency, even in the absence of anemia, can be debilitating, and exacerbate any underlying chronic disease, leading to increased morbidity and mortality. Iron deficiency is frequently concomitant with chronic inflammatory disease; however, iron deficiency treatment is often overlooked, partially due to the heterogeneity among clinical practice guidelines. In the absence of consistent guidance across chronic heart failure, chronic kidney disease and inflammatory bowel disease, we provide practical recommendations for iron deficiency to treating physicians: definition, diagnosis, and disease‐specific diagnostic algorithms. These recommendations should facilitate appropriate diagnosis and treatment of iron deficiency to improve quality of life and clinical outcomes.
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Affiliation(s)
- Maria Domenica Cappellini
- Rare Diseases Centre; Department of Medicine and Medical Specialties, Fondazione IRCCS Ca'Granda-Ospedale Maggiore Policlinico; Milan Italy
- Department of Clinical Sciences and Community Health; Università degli Studi di Milano; Milan Italy
| | - Josep Comin-Colet
- Community Heart Failure Program; Department of Cardiology, Bellvitge University Hospital, University of Barcelona and Biomedical Research Institut (IDIBELL), Hospitalet de Liobregat; Barcelona Spain
| | - Angel de Francisco
- Department of Nephrology; Valdecilla Universitario Hospital, University of Cantabria; Santander Spain
| | - Axel Dignass
- Department of Medicine I; Agaplesion Markus Hospital; Frankfurt Germany
| | - Wolfram Doehner
- Center for Stroke Research CSB and Department of Cardiology; Virchow Campus, Charité Universitätsmedizin Berlin; Berlin Germany
| | - Carolyn S. Lam
- Department of Cardiology; National Heart Centre Singapore and Duke-NUS Medical School; Singapore
| | - Iain C. Macdougall
- Department of Renal Medicine; King's College Hospital; London United Kingdom
| | - Gerhard Rogler
- Division of Gastroenterology and Hepatology; University of Zurich; Zurich Switzerland
| | - Clara Camaschella
- Division of Genetics and Cell Biology; San Raffaele Scientific Institute and Vita-Salute University; Milan Italy
| | - Rezan Kadir
- Department of Obstetrics & Gynaecology; Royal Free Foundation Hospital and University College Hospital; London United Kingdom
| | - Nicholas J. Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington; Seattle Washington, DC
- Department of Anesthesiology and Pain Medicine; Seattle Children's Hospital, University of Washington; Seattle Washington, DC
| | - Donat R. Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich; Zurich Switzerland
| | - Ali T. Taher
- Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
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Bou-Fakhredin R, Halawi R, Roumi J, Taher A. Insights into the diagnosis and management of iron deficiency in inflammatory bowel disease. Expert Rev Hematol 2017; 10:801-808. [PMID: 28701106 DOI: 10.1080/17474086.2017.1355233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Iron deficiency is a frequent comorbidity of chronic diseases such as inflammatory bowel disease that can severely impact the health and quality of life of affected individuals. It can exist as a silent condition and manifest in non-specific symptoms even in the absence of anemia. Even though iron deficiency anemia is the most common complication and extra-intestinal manifestation of inflammatory bowel disease, the majority of inflammatory bowel disease patients who are diagnosed with iron deficiency anemia are not treated. Areas covered: In this review, we discuss iron deficiency and iron deficiency anemia in patients with inflammatory bowel disease, and review diagnostic and therapeutic options. Expert commentary: We invite international gastroenterological societies and associations to refine the practice guidelines and include iron deficiency as a potential morbidity associated with IBD in analogy to arthritis, uveitis or any other extra intestinal manifestations. There should a more unanimous agreement among different societies on the specific diagnostic cutoff values for C-reactive protein levels, serum ferritin, and transferrin saturation in order to differentiate iron deficiency anemia from anemia of chronic disease.
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Affiliation(s)
- Rayan Bou-Fakhredin
- a Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Racha Halawi
- b Division of General Medicine and Geriatrics , Emory University School of Medicine , Atlanta , GA , USA
| | - Joseph Roumi
- a Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Ali Taher
- a Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
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Haider LM, Schwingshackl L, Hoffmann G, Ekmekcioglu C. The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis. Crit Rev Food Sci Nutr 2017; 58:1359-1374. [PMID: 27880062 DOI: 10.1080/10408398.2016.1259210] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vegetarian diets exclude meat, seafood, and products containing these foods. Although the vegetarian lifestyle could lead to a better health status in adults, it may also bear risks for certain nutritional deficiencies. Cross-sectional studies and narrative reviews have shown that the iron status of vegetarians is compromised by the absence of highly bioavailable haem-iron in meatless diets and the inhibiting effect of certain components present in plant foods on non-haem iron bioavailability. METHODS The databases Pubmed, Scopus, Embase, and Cochrane CentralRegister of Controlled Trials were searched for studies comparing serum ferritin, as the major laboratory parameter for iron status of adult vegetarians with non-vegetarian control groups. A qualitative review was conducted as well as an inverse-variance random-effects meta-analysis to pool available data. In addition the effect of vegetarian diets according to gender was investigated with a subgroup analysis. The results were validated using a sensitivity analysis. RESULTS A total of 27 cross-sectional studies and three interventional studies were selected for the systematic review. The meta-analysis which combined data of 24 cross-sectional studies showed that adult vegetarians have significantly lower serum ferritin levels than their non-vegetarian controls (-29.71 µg/L, 95% CI [-39.69, -19.73], p < 0.01). Inclusion of semi-vegetarian diets did not change the results considerably (-23.27 µg/L, 95% CI [-29.77, -16.76], p < 0.01). The effects were more pronounced in men (-61.88 µg/L, 95% CI [-85.59, -38.17], p < 0.01) than in both premenopausal women (-17.70 μg/L, 95% CI [-29.80, -5.60], p < 0.01) and all women (-13.50 μg/L, 95% CI [-22.96, -4.04], p < 0.01), respectively. CONCLUSIONS In conclusion our results showed that vegetarians are more likely to have lower iron stores compared with non-vegetarians. However, since high iron stores are also a risk factor for certain non-communicable diseases, such as type 2 diabetes, it is recommended that not only vegetarians but also non-vegetarians should regularly control their iron status and improve their diet regarding the content and bioavailability of iron by consuming more plants and less meat.
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Affiliation(s)
- Lisa M Haider
- a Department of Environmental Health , Center for Public Health, Medical University of Vienna , Vienna , Austria
| | - Lukas Schwingshackl
- b Department of Epidemiology , German Institute of Human Nutrition , Nuthetal , Germany
| | - Georg Hoffmann
- c Department of Nutritional Sciences , University of Vienna , Vienna , Austria
| | - Cem Ekmekcioglu
- a Department of Environmental Health , Center for Public Health, Medical University of Vienna , Vienna , Austria
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Rostoker G, Vaziri ND. Impact of iatrogenic iron overload on the course of hepatitis C in the dialysis population: A plea for caution. Hemodial Int 2017; 21 Suppl 1:S68-S77. [PMID: 28332306 DOI: 10.1111/hdi.12557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
About 2.5% of the world population, corresponding to about 177 million individuals, are infected by hepatitis C virus (HCV), a small, single-stranded RNA virus. The prevalence of HCV infection among dialysis patients in Japan, Europe, and North America during the 2012 to 2015 period was found to be 8.7% in the DOPPS study. Nosocomial HCV spread in hemodialysis facilities still occurs. Increased hepatic tissue iron has been shown to play a deleterious role in the course of hepatitis C, favor development of fibrosis and cirrhosis and possibly increase the risk of liver cancer in the general population. Regular loss of blood in the hemodialysis circuit, in routine blood sampling for laboratory tests (for uremia monitoring), and in gut due to uremic enteropathy, invariably results in iron deficiency for which patients are commonly treated with intravenous (IV) iron preparations. Data on the effects of IV iron in hemodialysis patients with hepatitis C are limited (2 studies) and strongly suggest that parenteral iron may contribute to hepatocellular injury. Iatrogenic iron overload is extremely prevalent among hemodialysis population worldwide. Iron overload and toxicity has emerged as one of the most controversial topic in the management of anemia in dialysis patients. Given the known impact of iron in promoting growth and virulence of HCV and the associated liver disease, it is necessary to use iron therapy cautiously and closely monitor plasma markers of iron metabolism and liver iron stores non-invasively by means of MRI to avoid iron overload in this vulnerable population.
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Affiliation(s)
- Guy Rostoker
- Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Ramsay-Générale de Santé, Quincy sous Sénart, France
| | - Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California, Irvine, California, USA
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30
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Rostoker G, Vaziri ND, Fishbane S. Iatrogenic Iron Overload in Dialysis Patients at the Beginning of the 21st Century. Drugs 2017; 76:741-57. [PMID: 27091216 PMCID: PMC4848337 DOI: 10.1007/s40265-016-0569-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Iron overload used to be considered rare in hemodialysis patients but its clinical frequency is now increasingly realized. The liver is the main site of iron storage and the liver iron concentration (LIC) is closely correlated with total iron stores in patients with secondary hemosideroses and genetic hemochromatosis. Magnetic resonance imaging is now the gold standard method for LIC estimation and monitoring in non-renal patients. Studies of LIC in hemodialysis patients by quantitative magnetic resonance imaging and magnetic susceptometry have demonstrated a strong relation between the risk of iron overload and the use of intravenous (IV) iron products prescribed at doses determined by the iron biomarker cutoffs contained in current anemia management guidelines. These findings have challenged the validity of both iron biomarker cutoffs and current clinical guidelines, especially with respect to recommended IV iron doses. Three long-term observational studies have recently suggested that excessive IV iron doses may be associated with an increased risk of cardiovascular events and death in hemodialysis patients. We postulate that iatrogenic iron overload in the era of erythropoiesis-stimulating agents may silently increase complications in dialysis patients without creating frank clinical signs and symptoms. High hepcidin-25 levels were recently linked to fatal and nonfatal cardiovascular events in dialysis patients. It is therefore tempting to postulate that the main pathophysiological pathway leading to these events may involve the pleiotropic master hormone hepcidin (synergized by fibroblast growth factor 23), which regulates iron metabolism. Oxidative stress as a result of IV iron infusions and iron overload, by releasing labile non-transferrin-bound iron, might represent a ‘second hit’ on the vascular bed. Finally, iron deposition in the myocardium of patients with severe iron overload might also play a role in the pathogenesis of sudden death in some patients.
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Affiliation(s)
- Guy Rostoker
- Division of Nephrology and Dialysis, Hôpital Privé Claude Galien, Ramsay-Générale de Santé, Quincy sous Sénart, France. .,Service de Néphrologie et de Dialyse, HP Claude Galien, 20 route de Boussy, Quincy sous Sénart, 91480, France.
| | - Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California, Irvine, CA, USA
| | - Steven Fishbane
- Division of Nephrology, Hofstra North-Shore-LIJ School of Medicine, Great Neck, New York, NY, USA
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Evaluation of iron deficiency anaemia for gastrointestinal causes in patients without GI symptoms in high prevalent GI malignancy zones. Arab J Gastroenterol 2016; 17:67-72. [PMID: 27426957 DOI: 10.1016/j.ajg.2016.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 01/26/2016] [Accepted: 05/27/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND STUDY AIMS Gastric cancer is highly prevalent in Kashmir, as are lower gastrointestinal (LGI) malignancies. Colonic cancer, gastric cancer, and coeliac disease are the most important gastrointestinal (GI) causes of iron deficiency anaemia (IDA) worldwide. Approximately 9% of patients with IDA present with a suspicious lesion in the GI tract upon examination. However, the absence of GI symptoms and a possible lesion accounting for blood loss in IDA have not been studied in this zone with a high prevalence of GI malignancy. We aimed to examine IDA patients without GI symptoms to determine the most plausible cause of their blood loss. PATIENTS AND METHODS A total of 100 patients with IDA and 250 control subjects without IDA and referred for gastrointestinal endoscopy were enrolled in a cross-sectional, comparative study. Patients presenting with a significant lesion proportionate to their anaemia in the upper GI tract were not examined further, if no further strong indications were present. RESULTS Twenty-nine patients (29%) were found to have malignancy: 13 with gastric cancer and 16 with colonic malignancies. Other apparent causes of GI blood loss included peptic ulcer disease in 10 (10%) patients, haemorrhoids in 22 (25%), polyps in eight (three in the upper GI tract and five in the LGI tract), gastric erosions in eight (8%), and angiodysplasia, diverticulitis, and trichuriasis in two (2%) each. CONCLUSION In light of the high incidence of GI malignancies in this patient group, a low threshold for GI screening as well as mass screening for IDA is needed.
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Abstract
Hypochromic-microcytic anemias are characterized by a hemoglobin deficiency of the erythrocytes. The main reason for the insufficient hemoglobin synthesis is, with exception of thalassemia and a few other rare conditions, primarily a disorder of iron metabolism. Differential diagnostic considerations are focused on iron deficiency anemia, with approximately 80% the most common form of anemia worldwide. Iron deficiency anemia shows a particularly high prevalence in developing countries, but is also in industrialized Western countries the most common cause of anemia. Infants, toddlers, premenopausal or pregnant women, and elderly people are at particularly high risk of iron deficiency anemia. The most important differential diagnosis for iron deficiency anemia is the anemia of chronic disorders (ACD). This anemia is caused by a disturbance of iron utilization (functional iron deficiency), in which iron absorption and iron release, as a nonspecific defense mechanism, is blocked to restrict iron availability for the inflammatory process but also withhold iron from the erythropoiesis. ACD is not rare, but plays a significant role in hospitalized patients and in the elderly. The differentiation between ACD and iron deficiency anemia is highly important from a clinical point of view, due to different types of further management. The cause for iron deficiency should be clarified in each case, whereas the etiology for ACD is often obvious. The standard treatment of iron deficiency anemia is oral iron supplementation. Intravenous iron application is reserved for problem patients. The best treatment for ACD is the elimination of the underlying chronic disorder. In case of persistent ACD, red blood cell transfusions, erythropoietin, and intravenous iron are used therapeutically.
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Affiliation(s)
- G Metzgeroth
- III. Medizinische Klinik, Hämatologie und Internistische Onkologie, Universitätsmedizin Mannheim, Medizinische Fakultät Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland,
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Matsumoto N, Ikeda H, Shigefuku R, Hattori N, Watanabe T, Matsunaga K, Hiraishi T, Tamura T, Noguchi Y, Fukuda Y, Ishii T, Okuse C, Sato A, Suzuki M, Itoh F. Hemoglobin Decrease with Iron Deficiency Induced by Daclatasvir plus Asunaprevir Combination Therapy for Chronic Hepatitis C Virus Genotype 1b. PLoS One 2016; 11:e0151238. [PMID: 26990758 PMCID: PMC4798293 DOI: 10.1371/journal.pone.0151238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/25/2016] [Indexed: 01/02/2023] Open
Abstract
Background Decreased hemoglobin (Hb) level has been supposed to be a relatively rare side effect of a combination therapy against hepatitis C virus that consists of the NS5A inhibitor daclatasvir (DCV) and the NS3/4A protease inhibitor asunaprevir (ASV). Methods The study was conducted in 75 patients with genotype 1b chronic hepatitis C virus infection who had started combination therapy with DCV and ASV at St. Marianna University School of Medicine Hospital between September 2014 and December 2014. Results Among the patients examined, decreased Hb level by ≥1.5 g/dL from the values at treatment initiation was observed in 11 individuals. This was accompanied by decreased mean corpuscular volume, and iron and ferritin levels. Conclusions These findings suggest that the mechanism of the phenomenon is caused by iron deficiency. The underlying mechanism and clinical impacts will need to be further examined.
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Affiliation(s)
- Nobuyuki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
- * E-mail:
| | - Hiroki Ikeda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Ryuta Shigefuku
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Nobuhiro Hattori
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Tsunamasa Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Kotaro Matsunaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Tetsuya Hiraishi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Tomohiro Tamura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Yohei Noguchi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Yasunobu Fukuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Toshiya Ishii
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Chiaki Okuse
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Akira Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Michihiro Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
| | - Fumio Itoh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216–8511, Japan
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Abstract
Disturbances of iron metabolism are a frequent challenge in outpatient and inpatient care. Although several established biomarkers are commonly used by clinicians for differential diagnosis, the discrimination between latent or classic iron deficiency, anaemia of chronic disease or a combination of functional iron deficiency (iron-restricted erythropoiesis) with anaemia of chronic disease in patients affected by inflammatory disease can be demanding. Soluble transferrin receptor (sTfR) is a cleaved monomer of transferrin receptor 1 and correlates positively with tissue iron deficiency as well as with stimulated erythropoiesis. The ratio between sTfR and ferritin in combination with reticulocyte haemoglobin content further helps to identify different states of iron deficiency. In this review, we will focus on biological aspects of iron metabolism and sTfR, established clinical applications and limitations of sTfR and derived indices, and prospects of future research and applications.
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Affiliation(s)
- Kristian Harms
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany.
| | - Thorsten Kaiser
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
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Mao K, Liu L, Mo T, Pan H, Liu H. Preparation, Characterization, and Antioxidant Activity of an Isomaltooligosaccharide–Iron Complex (IIC). J Carbohydr Chem 2015. [DOI: 10.1080/07328303.2015.1085551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Greminger AR, Mayer-Pröschel M. Identifying the threshold of iron deficiency in the central nervous system of the rat by the auditory brainstem response. ASN Neuro 2015; 7:7/1/1759091415569911. [PMID: 25732706 PMCID: PMC4366421 DOI: 10.1177/1759091415569911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The deleterious effects of anemia on auditory nerve (AN) development have been well investigated; however, we have previously reported that significant functional consequences in the auditory brainstem response (ABR) can also occur as a consequence of marginal iron deficiency (ID). As the ABR has widespread clinical use, we evaluated the ability of this electrophysiological method to characterize the threshold of tissue ID in rats by examining the relationship between markers of tissue ID and severity of ABR latency defects. To generate various levels of ID, female Long-Evans rats were exposed to diets containing sufficient, borderline, or deficient iron (Fe) concentrations throughout gestation and offspring lifetime. We measured hematological indices of whole body iron stores in dams and offspring to assess the degree of ID. Progression of AN ID in the offspring was measured as ferritin protein levels at different times during postnatal development to complement ABR functional measurements. The severity of ABR deficits correlated with the level of Fe restriction in each diet. The sufficient Fe diet did not induce AN ID and consequently did not show an impaired ABR latency response. The borderline Fe diet, which depleted AN Fe stores but did not cause systemic anemia resulted in significantly increased ABR latency isolated to Peak I.The low Fe diet, which induced anemia and growth retardation, significantly increased ABR latencies of Peaks I to IV. Our findings indicate that changes in the ABR could be related to various degrees of ID experienced throughout development.
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Affiliation(s)
- Allison R. Greminger
- Department of Environmental Medicine, University of Rochester, Rochester, NY, USA
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37
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The iron-regulatory hormone hepcidin: A possible therapeutic target? Pharmacol Ther 2015; 146:35-52. [DOI: 10.1016/j.pharmthera.2014.09.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 01/19/2023]
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Ma J, Wen X, Mo F, Wang X, Shen Z, Li M. Effects of different doses and duration of iron supplementation on curing iron deficiency anemia: an experimental study. Biol Trace Elem Res 2014; 162:242-51. [PMID: 25216792 DOI: 10.1007/s12011-014-0115-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/25/2014] [Indexed: 01/01/2023]
Abstract
Many controversies persist with respect to the dosage and therapeutic duration concerning iron deficiency anemia (IDA) treatment. To identify the most suitable cure, this study evaluated the effect of iron supplementation with different doses and for different time periods in rats with iron deficiency anemia. The rats were randomly divided into five groups [normal control (NC), low- iron diet control (LC), normal doses of iron group (NI), middle dose of iron group (MI), and high dose of iron group (HI)]. Each group was subdivided into two subgroups (2 and 4 weeks). The rats were maintained on low-iron diets and treated with oral iron dextran at different dosages. Finally, we investigated red blood cell parameters, iron absorption and metabolism, oxidative stress, and the antioxidant capacity. Our study indicated that through the administration of normal dose iron by gavage to IDA rats, the levels of the red blood cell parameters can be restored in only 2 weeks. In the HI group, iron absorption and transferrin receptor expressions were markedly reduced after 2 weeks. However, the iron content, ferritin and hepcidin expressions were notably increased, and the changes were more apparent after 4 weeks. With increasing doses of iron supplementation and durations of treatment, the liver malondialdehyde (MDA) content in the LC, MI, and HI groups was markedly increased, whereas the superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were obviously reduced. This study demonstrated that the dose of iron treatment for IDA should be controlled in a safe range, and a reasonable duration is also critical for IDA therapeutics.
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Affiliation(s)
- Juan Ma
- Department of Ship Hygiene, Second Military Medical University, NO.800 Xiangyin Road, Yangpu District, Shanghai, 200433, China
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Evaluation of ferric and ferrous iron therapies in women with iron deficiency anaemia. Adv Hematol 2014; 2014:297057. [PMID: 25006339 PMCID: PMC4071784 DOI: 10.1155/2014/297057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/04/2014] [Accepted: 05/22/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction. Different ferric and ferrous iron preparations can be used as oral iron supplements. Our aim was to compare the effects of oral ferric and ferrous iron therapies in women with iron deficiency anaemia. Methods. The present study included 104 women diagnosed with iron deficiency anaemia after evaluation. In the evaluations performed to detect the aetiology underlying the iron deficiency anaemia, it was found and treated. After the detection of the iron deficiency anaemia aetiology and treatment of the underlying aetiology, the ferric group consisted of 30 patients treated with oral ferric protein succinylate tablets (2 × 40 mg elemental iron/day), and the second group consisted of 34 patients treated with oral ferrous glycine sulphate tablets (2 × 40 mg elemental iron/day) for three months. In all patients, the following laboratory evaluations were performed before beginning treatment and after treatment. Results. The mean haemoglobin and haematocrit increases were 0.95 g/dL and 2.62% in the ferric group, while they were 2.25 g/dL and 5.91% in the ferrous group, respectively. A significant difference was found between the groups regarding the increase in haemoglobin and haematocrit values (P < 0.05). Conclusion. Data are submitted on the good tolerability, higher efficacy, and lower cost of the ferrous preparation used in our study.
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Goldsmith JR, Sartor B. The role of diet on intestinal microbiota metabolism: downstream impacts on host immune function and health, and therapeutic implications. J Gastroenterol 2014; 49:785-98. [PMID: 24652102 PMCID: PMC4035358 DOI: 10.1007/s00535-014-0953-z] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 03/10/2014] [Indexed: 02/07/2023]
Abstract
Dietary impacts on health may be one of the oldest concepts in medicine; however, only in recent years have technical advances in mass spectroscopy, gnotobiology, and bacterial sequencing enabled our understanding of human physiology to progress to the point where we can begin to understand how individual dietary components can affect specific illnesses. This review explores the current understanding of the complex interplay between dietary factors and the host microbiome, concentrating on the downstream implications on host immune function and the pathogenesis of disease. We discuss the influence of the gut microbiome on body habitus and explore the primary and secondary effects of diet on enteric microbial community structure. We address the impact of consumption of non-digestible polysaccharides (prebiotics and fiber), choline, carnitine, iron, and fats on host health as mediated by the enteric microbiome. Disease processes emphasized include non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, IBD, and cardiovascular disease/atherosclerosis. The concepts presented in this review have important clinical implications, although more work needs to be done to develop fully and validate potential therapeutic approaches. Specific dietary interventions offer exciting potential for nontoxic, physiologic ways to alter enteric microbial structure and metabolism to benefit the natural history of many intestinal and systemic disorders.
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Affiliation(s)
| | - Balfour Sartor
- Departments of Medicine, Microbiology and Immunology University of North Carolina at Chapel Hill
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CASTRO RGD, MARTINS-JÚNIOR JA, LIMA LM. RISCO DE ANEMIA FERROPRIVA EM CRIANÇAS COM BAIXOS NÍVEIS DE FERRITINA. ACTA ACUST UNITED AC 2013. [DOI: 10.14450/2318-9312.v25.e3.a2013.pp138-142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Em crianças pré-escolares a anemia ferropriva pode comprometer a capacidade de aprendizagem, além de produzir efeitos comportamentais como a falta de atenção, fadiga e cansaço que podem levar ao baixo rendimento escolar. O objetivo deste estudo foi verificar o número de crianças de 02 a 06 anos que realizaram as dosagens de ferritina, ferro sérico e hemograma, com suspeita de anemia ferropriva, num laboratório clínico, no primeiro semestre de 2011, buscando avaliar os resultados dos referidos exames e estabelecer a prevalência de anemia ferropriva nos indivíduos estudados. Foi conduzido um estudo observacional descritivo do tipo transversal. Através do software SADIG-BI, utilizado para gerenciamento de dados, foram selecionadas 363 crianças de 02 a 06 anos que realizaram os exames ferritina, ferro sérico e hemograma no período de 01/01/2011 a 31/07/2011. As crianças do sexo masculino apresentaram níveis plasmáticos de ferritina significativamente mais baixos quando comparadas com as crianças do sexo feminino (p<0,05). Com relação aos parâmetros ferro sérico e hemoglobina, não foram observadas diferenças significativas entre os participantes dos dois sexos. Das 363 crianças estudadas, 9 (2,5%) apresentavam anemia ferropriva (Hb ≤11,0 g/dL e Ferritina ≤12 ng/mL). Foi observada uma baixa prevalência de anemia ferropriva nas crianças estudadas. O achado mais importante deste estudo foi o risco quase cinco vezes maior do desenvolvimento de anemia ferropriva em crianças que apresentaram níveis plasmáticos de ferritina menores ou iguais a 12 ng/mL, sugerindo que este valor pode ser considerado o melhor ponto de corte para a população estudada.
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Out of balance--systemic iron homeostasis in iron-related disorders. Nutrients 2013; 5:3034-61. [PMID: 23917168 PMCID: PMC3775241 DOI: 10.3390/nu5083034] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/16/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
Iron is an essential element in our daily diet. Most iron is required for the de novo synthesis of red blood cells, where it plays a critical role in oxygen binding to hemoglobin. Thus, iron deficiency causes anemia, a major public health burden worldwide. On the other extreme, iron accumulation in critical organs such as liver, heart, and pancreas causes organ dysfunction due to the generation of oxidative stress. Therefore, systemic iron levels must be tightly balanced. Here we focus on the regulatory role of the hepcidin/ferroportin circuitry as the major regulator of systemic iron homeostasis. We discuss how regulatory cues (e.g., iron, inflammation, or hypoxia) affect the hepcidin response and how impairment of the hepcidin/ferroportin regulatory system causes disorders of iron metabolism.
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