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Cohen CT, Powers JM. Intravenous iron therapy in pediatrics: who should get it and when is the right time? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:630-635. [PMID: 38066925 PMCID: PMC10727076 DOI: 10.1182/hematology.2023000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Iron-deficiency anemia occurs most commonly in young children due to a low-iron diet and adolescent girls due to menstrual blood loss. However, children with gastrointestinal conditions such as intestinal failure, inflammatory bowel disease, celiac disease, and/or other chronic conditions, including chronic kidney disease and heart failure, also commonly have iron deficiency. Many patients with classic iron-deficiency anemia will improve with oral iron therapy. However, in children who have an incomplete response to oral iron, intravenous iron therapy is increasingly being used. Benefits of intravenous iron therapy include a rapid repletion of iron stores in addition to resolution of anemia, less gastrointestinal side effects, and relief for patients and families struggling with long-term iron supplementation. Indications for first-line therapy with intravenous iron in children with chronic conditions have also increased. Four intravenous iron formulations have approved indications in pediatrics, and many are increasingly used off-label in children as well. Here we discuss the indications and appropriate timing of intravenous iron therapy in children with a wide range of underlying etiologies.
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Affiliation(s)
- Clay T Cohen
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Cancer and Hematology Center, Houston, TX
| | - Jacquelyn M Powers
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Cancer and Hematology Center, Houston, TX
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Esen Ağar B, Akarsu S, Aydin S. The Effect of Iron Deficiency Anemia and Different Treatment Methods on DNA Damage: 8-hydroxy-2-deoxyguanosine Level. Glob Pediatr Health 2021; 8:2333794X211041337. [PMID: 34458503 PMCID: PMC8392811 DOI: 10.1177/2333794x211041337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Ionic iron causes damages at the cellular level by forming free radicals. Reactive oxygen species lead to the formation of oxidative base damages in DNA. Among these forms the most common one and the one which has the best known mutagenity is 8-hydroxy-2′-deoxyguanosine (8-OHdG). We aimed to determine iron deficiency anemia (IDA) and its different forms of treatments; probable oxidative damage on DNA by looking at the level of 8-OHdG. The patients were divided into 4 subgroups: Oral treatment (p.o.) group; Intramuscular treatment (i.m.) group; Intravenous treatment (i.v.) group; Healthy control group. Blood and urine samples were taken from all patients totally 4 times. 8-OHdG levels detected in blood and urine samples were compared with the control group. IDA and the treatment of it affect the level of 8-OHdG. p.o. therapy should be the top priority on children.
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Affiliation(s)
- Buket Esen Ağar
- Doctor, Firat University Faculty of Medicine, Department of Pediatrics, Elazig, Turkey
| | - Saadet Akarsu
- Professor, Firat University Faculty of Medicine, Division of Pediatric Hematology, Elazig, Turkey
| | - Süleyman Aydin
- Professor, Firat University Faculty of Medicine, Department of Biochemistry, Elazig, Turkey
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Macdougall IC, Comin-Colet J, Breymann C, Spahn DR, Koutroubakis IE. Iron Sucrose: A Wealth of Experience in Treating Iron Deficiency. Adv Ther 2020; 37:1960-2002. [PMID: 32297281 PMCID: PMC7467495 DOI: 10.1007/s12325-020-01323-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 12/19/2022]
Abstract
Iron deficiency and iron-deficiency anemia are associated with increased morbidity and mortality in a wide range of conditions. In many patient populations, this can be treated effectively with oral iron supplementation; but in patients who are unable to take or who do not respond to oral iron therapy, intravenous iron administration is recommended. Furthermore, in certain conditions, such as end-stage kidney disease, chronic heart failure, and inflammatory bowel disease, intravenous iron administration has become first-line treatment. One of the first available intravenous iron preparations is iron sucrose (Venofer®), a nanomedicine that has been used clinically since 1949. Treatment with iron sucrose is particularly beneficial owing to its ability to rapidly increase hemoglobin, ferritin, and transferrin saturation levels, with an acceptable safety profile. Recently, important new data relating to the use of iron sucrose, including the findings from the landmark PIVOTAL trial in patients with end-stage kidney disease, have been reported. Several years ago, a number of iron sucrose similars became available, although there have been concerns about the clinical appropriateness of substituting the original iron sucrose with an iron sucrose similar because of differences in efficacy and safety. This is a result of the complex and unique physicochemical properties of nanomedicines such as iron sucrose, which make copying the molecule difficult and problematic. In this review, we summarize the evidence accumulated during 70 years of clinical experience with iron sucrose in terms of efficacy, safety, and cost-effectiveness.
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Affiliation(s)
| | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain
| | | | - Donat R Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital Zürich, Zurich, Switzerland
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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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Monitoring oral iron therapy in children with iron deficiency anemia: an observational, prospective, multicenter study of AIEOP patients (Associazione Italiana Emato-Oncologia Pediatrica). Ann Hematol 2020; 99:413-420. [PMID: 31965272 DOI: 10.1007/s00277-020-03906-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Oral ferrous salts are standard treatment for children with iron deficiency anemia (IDA). The objective of our study was to monitor oral iron therapy in children, aged 3 months-12 years, with IDA. We prospectively collected clinical and hematological data of children with IDA, from 15 AIEOP (Associazione Italiana di Ematologia ed. Oncologia Pediatrica) centers. Response was measured by the increase of Hb from baseline. Of the 107 analyzed patients, 18 received ferrous gluconate/sulfate 2 mg/kg (ferrous 2), 7 ferrous gluconate/sulfate 4 mg/kg (ferrous 4), 7 ferric iron salts 2 mg/kg (ferric), 62 bis-glycinate iron 0.45 mg/kg (glycinate), and 13 liposomal iron 0.7-1.4 mg/kg (liposomal). Increase in reticulocytes was evident at 3 days, while Hb increase appeared at 2 weeks. Gain of Hb at 2 and 8 weeks revealed a higher median increase in both ferrous 2 and ferrous 4 groups. Gastro-intestinal side effects were reported in 16% (ferrous 2), 14% (ferrous 4), 6% (glycinate), and 0 (ferric and liposomal) patients. The reticulocyte counts significantly increased after 3 days from the start of oral iron supplementation. Bis-glycinate iron formulation had a good efficacy/safety profile and offers an acceptable alternative to ferrous iron preparations.
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Nadar SK, Shaikh MM. Red Cell Distribution Width as a Biomarker for Heart Failure: Still Not Ready for Prime-Time. Card Fail Rev 2019; 5:180-181. [PMID: 31782414 PMCID: PMC6848941 DOI: 10.15420/cfr.2019.16.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital Oman
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Senthong V, Hudec T, Neale S, Wu Y, Hazen SL, Tang WHW. Relation of Red Cell Distribution Width to Left Ventricular End-Diastolic Pressure and Mortality in Patients With and Without Heart Failure. Am J Cardiol 2017; 119:1421-1427. [PMID: 28285713 DOI: 10.1016/j.amjcard.2017.01.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 01/06/2023]
Abstract
Higher red cell distribution width (RDW) has been associated with poor prognosis in patients with heart failure (HF). RDW is also closely associated with iron deficiency. However, the mechanism underlying this association is unclear. The relation between left ventricular end-diastolic pressure (LVEDP) and RDW has not been studied, especially in those without HF. We examined the relation between LVEDP and RDW in 1,084 consecutive stable patients who underwent elective coronary angiography. We observed that 38% had high LVEDP (>16 mm Hg) and 29% had history of HF. The median RDW was 13.4%, which was higher with increasing LVEDP (p <0.0001) and significantly higher in patients with HF (p <0.0001). Baseline RDW were independently associated with high LVEDP even after multivariable logistic regression analysis (adjusted odds ratio [OR] per unit change 1.14, 95% confidence interval [CI] 1.0 to 1.29, p = 0.044). Interestingly, result were stronger in non-HF cohort (adjusted OR per unit change 1.37, 95% CI 1.13 to 1.67, p = 0.001). In addition, elevated (third vs first tertiles) RDW levels were independently a predictor of high LVEDP and were associated with a 4.8-fold increased 5-year mortality risk (adjusted hazard ratio 4.11, 95% CI 2.12 to 7.96, p <0.0001), even with the addition of B-type natriuretic peptide to the model (adjusted OR for LVEDP 2.25, 95% CI 1.0 to 5.05, p = 0.05; adjusted hazard ratio for mortality 3.79, 95% CI 1.033 to 13.89, p = 0.044, respectively). In conclusion, high RDW levels were observed in patients with or without HF and independently associated with high LVEDP and with mortality.
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Affiliation(s)
- Vichai Senthong
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio; Queen Sirikit Heart Center of the Northeast, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Timothy Hudec
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio
| | - Sarah Neale
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, Ohio
| | - Stanley L Hazen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio; Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio; Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
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Mantadakis E, Tsouvala E, Xanthopoulou V, Chatzimichael A. Intravenous iron sucrose for children with iron deficiency anemia: a single institution study. World J Pediatr 2016; 12:109-13. [PMID: 25754747 DOI: 10.1007/s12519-015-0010-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/18/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intravenous iron sucrose is not recommended by its manufacturers for use in children despite extensive safety and efficacy data in adults. METHODS We reviewed the experience of our department between January, 2011 and February, 2014 with the use of intravenous iron sucrose in children ≤14 years of age who failed in oral iron therapy for iron deficiency anemia (IDA). RESULTS Twelve children (6 females) aged 1.2-14 years (median age 8.9 years) received at least one dose of intravenous iron sucrose. Ten patients had IDA inadequately treated or non-responsive to oral iron therapy. One patient received therapy for blood transfusion avoidance and one for presumed iron refractory iron deficiency anemia (IRIDA). Iron sucrose infusions were given on alternate days up to three times per week. The number of infusions per patient ranged from 2 to 6 (median, 3), the individual doses from 100 mg to 200 mg (median, 200 mg), and the total doses from 200 mg to 1200 mg (median, 400 mg). Iron sucrose was effective in raising the hemoglobin concentration to normal in all patients with IDA, i.e., from 7.6±2.38 g/dL to 12.4±0.64 g/dL, within 31-42 days after the first infusion. The single patient with IRIDA demonstrated a 1.8 g/dL rise. Injection site disorders in three cases and transient taste perversion in one case were the only side effects. CONCLUSION Intravenous iron sucrose appears to be safe and very effective in children with IDA who do not respond or cannot tolerate oral iron therapy.
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Affiliation(s)
- Elpis Mantadakis
- Department of Pediatrics, Democritus University of Thrace Faculty of Medicine, University General Hospital of Evros, Alexandroupolis, Thrace, Greece.
| | - Emmanouela Tsouvala
- Department of Pediatrics, Democritus University of Thrace Faculty of Medicine, University General Hospital of Evros, Alexandroupolis, Thrace, Greece
| | - Varvara Xanthopoulou
- Department of Pediatrics, Democritus University of Thrace Faculty of Medicine, University General Hospital of Evros, Alexandroupolis, Thrace, Greece
| | - Athanassios Chatzimichael
- Department of Pediatrics, Democritus University of Thrace Faculty of Medicine, University General Hospital of Evros, Alexandroupolis, Thrace, Greece
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9
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Akin M, Sarbay H, Guler S, Balci YI, Polat A. Response to parenteral iron therapy distinguish unexplained refractory iron deficiency anemia from iron-refractory iron deficiency anemia. Int J Lab Hematol 2016; 38:167-71. [PMID: 26818204 DOI: 10.1111/ijlh.12462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/04/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We evaluated that response to parenteral iron therapy could be helpful in distinguishing the types of iron deficiency anemia. PATIENTS AND METHODS This study analyzed responses to IV iron sucrose therapy of 15 children with unexplained refractory iron deficiency anemia (URIDA). We compared the results at diagnosis, 6 weeks and 6 months after the therapy. Results were compared with responses of 11 patients' results with iron-refractory iron deficiency anemia (IRIDA) from our previous study. RESULT Six weeks after the start of treatment, ferritin, MCV, MCH and Hb values were in normal range in 10 patients. The increase in Hb, MCH, MCV, and ferritin values ranged 2.6-3.5 g/dL, 1.7-4.2 pg, 2-9 fL, and 13-25 ng/mL, respectively. In five patients, Hb, MCH, and MCV mean (range) values [11.2 g/dL (11-12.2), 24.5 pg (24-25.6), and 67 fL (65-70)] were nearly normal but ferritin mean (range) values [9.8 ng/mL (8-11)] were below normal. Six weeks after the start of treatment, Hb, MCH, MCV and ferritin values of patients with IRIDA were increased. The increase in Hb, MCH, MCV, and ferritin values ranged 0.8-2.7 g/dL, 1.7-4.2 pg, 2-9 fL, and 13-25 ng/mL, respectively. IRIDA is only partially responsive to parenteral iron supplementation. In conclusion, this study demonstrated that the response to intravenous iron therapy for the URIDA cases improved blood parameters more effectively than hereditary IRIDA. Response to parenteral iron therapy would be helpful to distinguish unexplained refractory IDA from hereditary IRIDA for clinicians who do not have access to hepcidin or TMPRS6 mutation analysis.
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Affiliation(s)
- M Akin
- Department of Pediatric Hematology, Pamukkale University, Denizli, Turkey
| | - H Sarbay
- Department of Pediatric Hematology, Pamukkale University, Denizli, Turkey
| | - S Guler
- Department of Pediatric Hematology, Pamukkale University, Denizli, Turkey
| | - Y I Balci
- Department of Pediatric Hematology, Pamukkale University, Denizli, Turkey
| | - A Polat
- Department of Pediatric Hematology, Pamukkale University, Denizli, Turkey
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Mantadakis E. Advances in Pediatric Intravenous Iron Therapy. Pediatr Blood Cancer 2016; 63:11-6. [PMID: 26376214 DOI: 10.1002/pbc.25752] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/18/2015] [Indexed: 12/14/2022]
Abstract
Iron deficiency anemia (IDA) continues to be very common worldwide. Intravenous (IV) iron is an infrequently used therapeutic option in children with IDA despite numerous studies in adults and several small but notable pediatric studies showing efficacy and safety. Presently, the availability of newer IV iron products allows for replacement of the total iron deficit at a single setting. These products appear safer compared to the high molecular weight iron dextrans of the past. Herein, we review the medical literature and suggest that front line use of IV iron should be strongly considered in diseases associated with IDA in children.
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Affiliation(s)
- Elpis Mantadakis
- Department of Pediatrics, Pediatric Hematology/Oncology Unit, Democritus University of Thrace Faculty of Medicine and University General District Hospital of Evros, Alexandroupolis, Thrace, Greece
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Beguin Y, Jaspers A. Iron sucrose - characteristics, efficacy and regulatory aspects of an established treatment of iron deficiency and iron-deficiency anemia in a broad range of therapeutic areas. Expert Opin Pharmacother 2014; 15:2087-103. [PMID: 25186219 DOI: 10.1517/14656566.2014.953928] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Iron is a key element in the transport and utilization of oxygen and a variety of metabolic pathways. Iron deficiency is a major cause of anemia and can be associated with fatigue, impaired physical function and reduced quality of life. Administration of oral or intravenous (i.v.) iron is the recommended treatment for iron-deficiency anemia (IDA) in different therapeutic areas. AREAS COVERED This article provides an overview of studies that evaluated i.v. iron sucrose for anemia and iron status management, either alone or in combination with erythropoiesis-stimulating agents, across various diseases and conditions. EXPERT OPINION Iron sucrose is an established, effective and well-tolerated treatment of IDA in patients with acute or chronic conditions such as chronic kidney disease, inflammatory bowel disease, pregnancy (second and third trimester), postpartum period, heavy menstrual bleeding and cancer who need rapid iron supply and in whom oral iron preparations are ineffective or not tolerated. Available data on patient blood management warrant further studies on preoperative iron treatment. First experience with iron sucrose follow-on products raises questions about their therapeutic equivalence without comparative clinical data in newly diagnosed patients or patients on existing chronic treatment.
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Affiliation(s)
- Yves Beguin
- University Hospital of Liège , Avenue de l'Hopital1, B-4000 Liège , Belgium +32 43 66 72 01 ; +32 43 66 88 55 ;
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12
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Van Craenenbroeck EM, Conraads VM, Greenlaw N, Gaudesius G, Mori C, Ponikowski P, Anker SD. The effect of intravenous ferric carboxymaltose on red cell distribution width: a subanalysis of the FAIR-HF study. Eur J Heart Fail 2014; 15:756-62. [DOI: 10.1093/eurjhf/hft068] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emeline M. Van Craenenbroeck
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Viviane M. Conraads
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | | | | | - Piotr Ponikowski
- Department of Heart Diseases; Medical University Military Hospital; Wroclaw Poland
| | - Stefan D. Anker
- Applied Cachexia Research, Department of Cardiology; Charité, Campus Virchow-Klinikum; Berlin Germany
- Centre for Clinical and Basic Research; IRCCS San Raffaele; Rome Italy
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Plummer ES, Crary SE, McCavit TL, Buchanan GR. Intravenous low molecular weight iron dextran in children with iron deficiency anemia unresponsive to oral iron. Pediatr Blood Cancer 2013; 60:1747-52. [PMID: 23832487 DOI: 10.1002/pbc.24676] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/07/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Iron deficiency anemia (IDA) in children is usually treated with oral iron, yet many respond poorly. Intravenous low molecular weight iron dextran (LMWID) offers the opportunity of employing a single outpatient infusion to correct the anemia and reduce the overall burden of treatment, but its use in children has been limited due to concerns of serious adverse effects. In this study we report our initial experience using LMWID in children with iron deficiency in whom oral iron was ineffective. METHODS We performed a case series of LMWID treatment of children with IDA of diverse etiologies who were poorly responsive to oral iron therapy with the aim of measuring its efficacy and adverse effects. LMWID was administered as a total dose infusion over 60 minutes in the outpatient setting. RESULTS Thirty-one patients age 11 months to 18 years received intravenous LMWID, and 24 were evaluable for hematologic response. Median hemoglobin increments were respectively 3.5, 1.9, and 1.8 g/dl in patients with IDA due to poor nutrition (n = 11), chronic blood loss (n = 13), and miscellaneous causes (n = 7). Two thirds of evaluable patients had a complete hematologic response. Nine of the patients (29%) had mild non-specific adverse effects upon initiation of the LMWID infusion. CONCLUSIONS LMWID as a total dose infusion was well tolerated and effective in a heterogeneous group of children and adolescents with IDA who were refractory to oral iron therapy. Transient reactions were common but not serious.
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Affiliation(s)
- Ellen S Plummer
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Children's Medical Center, Dallas, Texas
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Aung N, Dworakowski R, Byrne J, Alcock E, Deshpande R, Rajagopal K, Brickham B, Monaghan MJ, Okonko DO, Wendler O, Maccarthy PA. Progressive rise in red cell distribution width is associated with poor outcome after transcatheter aortic valve implantation. Heart 2013; 99:1261-6. [PMID: 23735935 DOI: 10.1136/heartjnl-2013-303910] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the prognostic value of baseline and temporal changes in red cell distribution width (RDW) in patients undergoing transcatheter aortic valve implantation (TAVI). DESIGN Single-centre retrospective observational study. SETTING Tertiary cardiac centre. PATIENTS 175 patients undergoing TAVI were included in this study. MAIN OUTCOME MEASURE Survival. RESULTS We analysed data from 175 TAVI patients (mean (± SD) age 83 ± 7 years, 49% men, mean Logistic EuroSCORE 23 ± 1, 66% preserved left ventricular ejection fraction (LVEF)). Immediately pre-TAVI, mean RDW was 14.6 ± 1.6% with an RDW>15% in 29% of patients. Over median follow-up of 12 months, the median rate of change in RDW was 0.2% per month, and 51 (29%) patients died. On multivariate survival analyses, baseline RDW ≥ 15.5% predicted death (adjusted HR 2.70, 95% CI 1.40 to 5.22, p=0.003) independently of LVEF, transfemoral approach, baseline pulmonary artery systolic pressure, moderate/severe mitral regurgitation and body mass index. A greater rate of increase in RDW over time was associated with increased mortality (adjusted HR 1.11, 95% CI 1.04 to 1.18, p=0.001) independently of baseline RDW and other significant temporal variables including a change in creatinine, bilirubin, mean cell haemoglobin concentration or urea. An increase in RDW>0.1%/month was associated with a twofold increased risk of mortality. CONCLUSIONS Baseline RDW ≥ 15.5% and a rising RDW over time strongly correlate to an increased risk of death post-TAVI, and could be used to refine risk stratification. Investigating and ameliorating the causes of RDW expansion may improve survival.
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Affiliation(s)
- Nay Aung
- Cardiovascular Division, King's College Hospital and King's Health Partners, London, UK
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15
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Akarsu S, Demir H, Selek S, Oguzoncul F. Iron deficiency anemia and levels of oxidative stress induced by treatment modality. Pediatr Int 2013; 55:289-95. [PMID: 23316876 DOI: 10.1111/ped.12054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 07/22/2012] [Accepted: 10/09/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND The effects of iron deficiency anemia (IDA) and its treatment on plasma total antioxidant capacity (TAOC) were investigated. METHODS Sixty patients with IDA and 20 healthy controls were divided into four subgroups: an oral (per os: PO) group (n = 20); an intramuscular (IM) group (n = 20); an intravenous (IV) group (n = 20); and the control group (n = 20). Blood samples were obtained from all patients before treatment, and at 24 h, 7 days, 6 and 13 weeks after initiation of IDA therapy. RESULTS TAOC in the IDA group was low when compared with the control group (P < 0.001). Although TAOC at 24 h in the PO group was not different from the control group, the TAOC in the IM and IV groups was relatively lower (P < 0.001). The TAOC in the PO group at 7 days, and at 6 and 13 weeks was closest to the control group level. The mean TAOC in the IV group at 13 weeks was clearly lower relative to the PO and IM groups. CONCLUSIONS Oxidative stress was minimally induced with oral therapy, while IM and IV therapies induced higher levels of oxidative stress, in increasing order of intensity.
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Affiliation(s)
- Saadet Akarsu
- Division of Hematology, Firat University Faculty of Medicine, Elazig, Turkey.
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16
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Barot BS, Parejiya PB, Mehta DM, Shelat PK, Shah GB. Physicochemical and structural characterization of iron–sucrose formulations: a comparative study. Pharm Dev Technol 2013; 19:513-20. [DOI: 10.3109/10837450.2013.795171] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Aung N, Ling HZ, Cheng AS, Aggarwal S, Flint J, Mendonca M, Rashid M, Kang S, Weissert S, Coats CJ, Richards T, Thomas M, Woldman S, Okonko DO. Expansion of the red cell distribution width and evolving iron deficiency as predictors of poor outcome in chronic heart failure. Int J Cardiol 2013; 168:1997-2002. [PMID: 23351789 DOI: 10.1016/j.ijcard.2012.12.091] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/26/2012] [Accepted: 12/28/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND An elevated red cell distribution width (RDW) and iron deficiency (ID) at baseline predict enhanced mortality in chronic heart failure (CHF), but little is known about the prognostic implications of their temporal trends. We sought to determine the survival implications of temporal changes in RDW and evolving ID in patients with CHF. METHODS The relation between red cell indices on first consultation and over time with mortality in 274 stable patients with systolic CHF was analysed. The combination of a rising RDW with a falling mean cell volume (MCV) over time defined evolving ID. RESULTS Over a median 12 month period, 51% and 23% of patients had a rise in RDW and evolving ID, respectively. After a median follow-up of 27 months, 60 (22%) patients died. A rising RDW predicted enhanced all-cause mortality (unadjusted HR for 1% per week rise 9.27, 95% CI 3.58 to 24.00, P<0.0001) independently and incrementally to baseline RDW, with an absolute increase >0.02% per week optimally predictive. Evolving ID also related to higher rates of mortality (HR 2.78, 95% CI 1.64 to 4.73, P<0.001) and was prognostically worse than a rising RDW alone (P<0.005). Patients with evolving ID who maintained their Hb levels over time had a 2-fold greater risk of death than those whose Hb levels declined without evolving ID. CONCLUSIONS An expanding RDW and evolving iron deficiency over time predict an amplified risk of death in CHF and should be utilised for risk stratification and/or therapeutically targeted to potentially improve outcomes.
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Affiliation(s)
- Nay Aung
- University College London Hospital, London, UK
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18
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Abstract
Iron deficiency anemia (IDA) continues to be overwhelmingly the leading cause of anemia in early childhood and a global public health challenge. Although there has been a significant decrease in the frequency of IDA and iron deficiency (ID) in infants and toddlers in recent years in the United States, ID and IDA persist and the adverse effects of ID are long-lasting if not permanent. Moreover, ID can result in lead toxicity, and this toxic exposure, even with low levels, can impair neurocognitive function as well. This review describes the major steps that have taken place to decrease the frequency of ID and IDA.
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19
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Reticulocyte parameters: markers of early response to oral treatment in children with severe iron-deficiency anemia. J Pediatr Hematol Oncol 2012; 34:e249-52. [PMID: 22810756 DOI: 10.1097/mph.0b013e3182588996] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to determine the effects of exclusive oral iron supplementation (iron sulphate 2 mg/kg/die) in asymptomatic children with severe iron-deficiency anemia [median hemoglobin (Hb) level before treatment 6.3 g/dL; range 4.5 to 7 g/dL] and to investigate the accuracy of Hb, reticulocyte hemoglobin content (CHr), and absolute reticulocyte count (ARC) as markers for monitoring early response to treatment. The increase in ARC and CHr was statistically significant at day +3. There was a significant association between suitable logarithmic functions of the percentage increase in CHr and ARC at day +3 and the fraction of required Hb increase compared with baseline to reach the mean reference value for age and sex at day +14. If these results are confirmed in a larger population, ARC and CHr could be considered affordable and widely available markers to detect early responders to oral iron therapy, and to switch unresponsive children to parenteral iron supplementation or transfusion.
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Vu'o'ng Lê B, Khorsi-Cauet H, Villegier AS, Bach V, Gay-Quéheillard J. New rat models of iron sucrose-induced iron overload. Exp Biol Med (Maywood) 2011; 236:790-9. [DOI: 10.1258/ebm.2011.010298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The majority of murine models of iron sucrose-induced iron overload were carried out in adult subjects. This cannot reflect the high risk of iron overload in children who have an increased need for iron. In this study, we developed four experimental iron overload models in young rats using iron sucrose and evaluated different markers of iron overload, tissue oxidative stress and inflammation as its consequences. Iron overload was observed in all iron-treated rats, as evidenced by significant increases in serum iron indices, expression of liver hepcidin gene and total tissue iron content compared with control rats. We also showed that total tissue iron content was mainly associated with the dose of iron whereas serum iron indices depended essentially on the duration of iron administration. However, no differences in tissue inflammatory and antioxidant parameters from controls were observed. Furthermore, only rats exposed to daily iron injection at a dose of 75 mg/kg body weight for one week revealed a significant increase in lipid peroxidation in iron-treated rats compared with their controls. The present results suggest a correlation between iron overload levels and the dose of iron, as well as the duration and frequency of iron injection and confirm that iron sucrose may not play a crucial role in inflammation and oxidative stress. This study provides important information about iron sucrose-induced iron overload in rats and may be useful for iron sucrose therapy for iron deficiency anemia as well as for the prevention and diagnosis of iron sucrose-induced iron overload in pediatric patients.
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Affiliation(s)
- Bá Vu'o'ng Lê
- Peritox Laboratory (Périnatalité et Risques Toxiques) EA4285-UMI01, Faculty of Medicine, Picardy Jules Verne University, 3 rue des Louvels, 80036 Amiens
| | - Hafida Khorsi-Cauet
- Peritox Laboratory (Périnatalité et Risques Toxiques) EA4285-UMI01, Faculty of Medicine, Picardy Jules Verne University, 3 rue des Louvels, 80036 Amiens
| | - Anne-Sophie Villegier
- Peritox Laboratory (Périnatalité et Risques Toxiques) EA4285-UMI01, Faculty of Medicine, Picardy Jules Verne University, 3 rue des Louvels, 80036 Amiens
- Experimental Toxicology Unit, Direction of Chronic Risks, National Institute for the Industrial Environment and Risks (INERIS), Parc technologique ALATA, BP.2 60550 Verneuil-en-Halatte, France
| | - Véronique Bach
- Peritox Laboratory (Périnatalité et Risques Toxiques) EA4285-UMI01, Faculty of Medicine, Picardy Jules Verne University, 3 rue des Louvels, 80036 Amiens
| | - Jérôme Gay-Quéheillard
- Peritox Laboratory (Périnatalité et Risques Toxiques) EA4285-UMI01, Faculty of Medicine, Picardy Jules Verne University, 3 rue des Louvels, 80036 Amiens
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21
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Crary SE, Hall K, Buchanan GR. Intravenous iron sucrose for children with iron deficiency failing to respond to oral iron therapy. Pediatr Blood Cancer 2011; 56:615-9. [PMID: 21298748 PMCID: PMC3079959 DOI: 10.1002/pbc.22930] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 11/03/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND For decades, parenteral iron has been used in patients with iron deficiency unresponsive to oral iron therapy and in hemodialysis-dependent patients receiving erythropoietin. Newer intravenous (IV) iron formulations such as iron sucrose have replaced high-molecular weight iron (HMW) dextran in dialysis patients; however, the use of parenteral iron in children without renal disease has not been well defined. PROCEDURE Pharmacy records were reviewed on children (≤ 18 years of age) who received IV iron sucrose at Children's Medical Center Dallas between January 1, 2004 and June 30, 2009. Patients who received iron sucrose for chronic renal disease were excluded from analysis. RESULTS Thirty-eight children received iron sucrose for non-renal indications, 13 with iron deficiency refractory to oral iron therapy, 13 with iron malabsorption or dependence on parenteral nutrition, 7 for chronic gastrointestinal blood loss, and 5 for miscellaneous indications. Among these 38 children, who received a total of 510 doses of IV iron sucrose, there were only six adverse reactions. Patients in all categories had a good response to the iron sucrose, with a median hemoglobin rise of 1.9-3.1 g/dl depending on the indication. CONCLUSIONS Parenteral iron is a safe and effective means to treat iron deficiency in children who cannot receive or do not respond to oral iron due to intolerance, poor adherence, or iron malabsorption.
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Affiliation(s)
- Shelley E. Crary
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX,Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX
| | - Katherine Hall
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX,Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX
| | - George R. Buchanan
- Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX,Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX
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22
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Zhu A, Kaneshiro M, Kaunitz JD. Evaluation and treatment of iron deficiency anemia: a gastroenterological perspective. Dig Dis Sci 2010; 55:548-59. [PMID: 20108038 PMCID: PMC2822907 DOI: 10.1007/s10620-009-1108-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 12/15/2009] [Indexed: 12/13/2022]
Abstract
A substantial volume of the consultations requested of gastroenterologists are directed towards the evaluation of anemia. Since iron deficiency anemia often arises from bleeding gastrointestinal lesions, many of which are malignant, establishment of a firm diagnosis usually obligates an endoscopic evaluation. Although the laboratory tests used to make the diagnosis have not changed in many decades, their interpretation has, and this is possibly due to the availability of extensive testing in key populations. We provide data supporting the use of the serum ferritin as the sole useful measure of iron stores, setting the lower limit at 100 microg/l for some populations in order to increase the sensitivity of the test. Trends of the commonly obtained red cell indices, mean corpuscular volume, and the red cell distribution width can provide valuable diagnostic information. Once the diagnosis is established, upper and lower gastrointestinal endoscopy is usually indicated. Nevertheless, in many cases a gastrointestinal source is not found after routine evaluation. Additional studies, including repeat upper and lower endoscopy and often investigation of the small intestine may thus be required. Although oral iron is inexpensive and usually effective, there are many gastrointestinal conditions that warrant treatment of iron deficiency with intravenous iron.
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Affiliation(s)
- Amy Zhu
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA USA ,Cedars-Sinai—VA Residency Program, Los Angeles, CA USA
| | - Marc Kaneshiro
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA USA ,Cedars-Sinai—VA Residency Program, Los Angeles, CA USA
| | - Jonathan D. Kaunitz
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA USA ,Department of Medicine, School of Medicine, University of California Los Angeles, Los Angeles, CA USA ,Brentwood Biomedical Research Institute, Los Angeles, CA 90073 USA ,West Los Angeles VA Medical Center, Bldg. 114, Suite 217, 11301 Wilshire Blvd., Los Angeles, CA 90073 USA
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23
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Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 2009; 158:659-66. [PMID: 19781428 DOI: 10.1016/j.ahj.2009.07.024] [Citation(s) in RCA: 440] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 07/10/2009] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The goal of this study was to independently validate the recent observations on the predictive role of red cell distribution width (RDW) for outcomes in chronic heart failure and to provide epidemiologic data on the biological correlates of RDW in heart failure (HF). Understanding the mechanism underlying this observation is unclear, largely hampered by the lack of epidemiologic studies demonstrating factors that are associated with anisocytosis in cardiovascular diseases. METHODS One hundred ninety-five patients (145 men, 50 women) with systolic HF were enrolled and followed up for a median of 14.5 months. Primary end points were all-cause mortality and hospital readmission due to worsening HF symptoms. A total of 19 clinical chemistry, hematology, and biochemical variables were considered for analysis together with clinical parameters in Cox proportional hazards and multiple regression models. RESULTS Red cell distribution width was found to be an N-terminal pro-brain natriuretic peptide independent predictor of all-cause mortality (adjusted HR 1.61 per 1 SD increase) in our study. Multiple correlations between biomarkers of ineffective erythropoiesis (serum iron, ferritin, and soluble transferrin receptor levels), inflammation and acute-phase reaction (interleukin-6, soluble tumor necrosis factor (TNF) receptor I and soluble TNF receptor II, C-reactive protein, and prealbumin concentrations), undernutrition (total cholesterol and albumin levels), and renal function were observed. In the multiple regression model, the strongest relationship for RDW was obtained with soluble transferrin receptor, soluble TNF receptor I, soluble TNF receptor II, and total cholesterol. CONCLUSIONS Here we validate the strong, independent prediction of morbidity and mortality in HF by RDW. The described correlations between RDW and inflammation, ineffective erythropoiesis, undernutrition, and impaired renal function may facilitate the understanding why this marker is associated with adverse outcomes in HF.
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Synthesis, chemical and biological studies on new Fe3+-glycosilated β-diketo complexes for the treatment of iron deficiency. Eur J Med Chem 2008; 43:2549-56. [DOI: 10.1016/j.ejmech.2008.02.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 02/25/2008] [Accepted: 02/29/2008] [Indexed: 12/13/2022]
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Tao J, Liu YQ, Li Y, Peng JL, Li L, Liu J, Shen X, Shen GX, Tu YT. Hypoxia: dual effect on the expression of transferrin receptor in human melanoma A375 cell line. Exp Dermatol 2008; 16:899-904. [PMID: 17927572 DOI: 10.1111/j.1600-0625.2007.00601.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Over-expression of transferrin receptor (TfR) is a common feature of human malignancies. Therapeutic strategies designed to interfere with tumor iron metabolism have targeted TfR. In previous studies, our laboratory successfully constructed the human-mouse chimeric antibody against TfR and it displayed a tumor-specificity distribution, and has a strong anti-tumor effect. We also found that there were still some limitations to anti-tumor effect in vivo. Oxygen and iron have a very tight relationship, and hypoxia is considered a fundamentally important characteristic of the tumor microenvironment. To exploit the target molecule TfR more rationally and effectively, we were prompted to explore TfR expression under hypoxia. OBJECTIVE To examine the expressing alteration of TfR of human melanoma A375 cell line under hypoxia at various time points (0, 12, 24, 36, 48 and 60 h). DESIGN The expressing alteration of TfR of A375 cell line under hypoxia at various time points (0, 12, 24, 36, 48 and 60 h) was assayed by flow cytometry, real-time RT-PCR and Western blot. RESULTS Hypoxia has dual effect on the expression of TfR in human melanoma A375 cell line. CONCLUSIONS These findings may have important implications for more rational, individualized gene-based therapy using TfR as target receptor in melanoma.
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Affiliation(s)
- Juan Tao
- Department of Dermatology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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