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Jia S, Wang Y, Ross MH, Zuckerman JB, Murray S, Han MK, Cahalan SE, Lenhan BE, Best RN, Taylor-Cousar JL, Simon RH, Fitzgerald LJ, Troost JP, Sood SL, Gifford AH. Association between CFTR modulators and changes in iron deficiency markers in cystic fibrosis. J Cyst Fibros 2024; 23:878-884. [PMID: 38490920 PMCID: PMC11399321 DOI: 10.1016/j.jcf.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/22/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Iron deficiency (ID) is a common extrapulmonary manifestation in cystic fibrosis (CF). CF transmembrane conductance regulator (CFTR) modulator therapies, particularly highly-effective modulator therapy (HEMT), have drastically improved health status in a majority of people with CF. We hypothesize that CFTR modulator use is associated with improved markers of ID. METHODS In a multicenter retrospective cohort study across 4 United States CF centers 2012-2022, the association between modulator therapies and ID laboratory outcomes was estimated using multivariable linear mixed effects models overall and by key subgroups. Summary statistics describe the prevalence and trends of ID, defined a priori as transferrin saturation (TSAT) <20 % or serum iron <60 μg/dL (<10.7 μmol/L). RESULTS A total of 568 patients with 2571 person-years of follow-up were included in analyses. Compared to off modulator therapy, HEMT was associated with +8.4 % TSAT (95 % confidence interval [CI], +6.3-10.6 %; p < 0.0001) and +34.4 μg/dL serum iron (95 % CI, +26.7-42.1 μg/dL; p < 0.0001) overall; +5.4 % TSAT (95 % CI, +2.8-8.0 %; p = 0.0001) and +22.1 μg/dL serum iron (95 % CI, +13.5-30.8 μg/dL; p < 0.0001) in females; and +11.4 % TSAT (95 % CI, +7.9-14.8 %; p < 0.0001) and +46.0 μg/dL serum iron (95 % CI, +33.3-58.8 μg/dL; p < 0.0001) in males. Ferritin was not different in those taking modulator therapy relative to off modulator therapy. Hemoglobin was overall higher with use of modulator therapy. The prevalence of ID was high throughout the study period (32.8 % in those treated with HEMT). CONCLUSIONS ID remains a prevalent comorbidity in CF, despite availability of HEMT. Modulator use, particularly of HEMT, is associated with improved markers for ID (TSAT, serum iron) and anemia (hemoglobin).
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Affiliation(s)
- Shijing Jia
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Yizhuo Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Melissa H Ross
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan B Zuckerman
- Department of Internal Medicine, Maine Medical Center, Tufts University, Portland, ME, USA
| | - Susan Murray
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - MeiLan K Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shannon E Cahalan
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Blair E Lenhan
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ryan N Best
- Department of Internal Medicine, Maine Medical Center, Tufts University, Portland, ME, USA
| | - Jennifer L Taylor-Cousar
- Departments of Internal Medicine and Pediatrics, National Jewish Health, Denver, CO, USA; Departments of Internal Medicine and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard H Simon
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Linda J Fitzgerald
- Department of Pharmacy Services, University of Michigan, Ann Arbor, MI, USA; Sanofi Medical Affairs, Bridgewater, NJ, USA
| | - Jonathan P Troost
- Michigan Institute for Clinical Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Suman L Sood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alex H Gifford
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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2
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Benotti PN, Kaberi-Otarod J, Wood GC, Gerhard GS, Still CD, Bistrian BR. Iron homeostasis in obesity and metabolic and bariatric surgery: a narrative review. Surg Obes Relat Dis 2024:S1550-7289(24)00737-8. [PMID: 39277530 DOI: 10.1016/j.soard.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/08/2024] [Accepted: 08/08/2024] [Indexed: 09/17/2024]
Abstract
Iron deficiency has been recognized as a potentially modifiable nutritional complication of metabolic and bariatric surgery (MBS) since prior to the turn of the century. Despite this, it remains the most common and clinically significant nutritional complication of this surgery with the potential to negate quality of life and the health benefits of surgical weight loss. This narrative review summarizes the current literature regarding iron deficiency as it relates to patients with severe obesity and those who undergo MBS. Advances in the clinical knowledge of iron homeostasis in severe obesity as a chronic disease, current diagnostic criteria for the diagnosis of iron deficiency in this patient population, the significance of preoperative iron deficiency, postoperative iron deficiency, and the status of supplementation and treatment will be reviewed with emphasis on gaps in knowledge and needed areas of further study.
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Affiliation(s)
- Peter N Benotti
- Center for Obesity and Metabolic Research, Geisinger Medical Center, Danville, PA.
| | | | - G Craig Wood
- Center for Obesity and Metabolic Research, Geisinger Medical Center, Danville, PA
| | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biology Temple University, School of Medicine, Philadelphia, PA
| | - Christopher D Still
- Center for Obesity and Metabolic Research, Geisinger Medical Center, Danville, PA
| | - Bruce R Bistrian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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3
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Iriarte-Gahete M, Tarancon-Diez L, Garrido-Rodríguez V, Leal M, Pacheco YM. Absolute and functional iron deficiency: Biomarkers, impact on immune system, and therapy. Blood Rev 2024:101227. [PMID: 39142965 DOI: 10.1016/j.blre.2024.101227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
Iron is essential for numerous physiological processes and its deficiency often leads to anemia. Iron deficiency (ID) is a global problem, primarily affecting reproductive-age women and children, especially in developing countries. Diagnosis uses classical biomarkers like ferritin or transferrin saturation. Recent advancements include using soluble transferrin receptor (sTfR) or hepcidin for improved detection and classification of absolute and functional iron deficiencies, though mostly used in research. ID without anemia may present symptoms like asthenia and fatigue, even without relevant clinical consequences. ID impacts not only red-blood cells but also immune system cells, highlighting its importance in global health and immune-related comorbidities. Managing ID, requires addressing its cause and selecting appropriate iron supplementation. Various improved oral and intravenous products are available, but further research is needed to refine treatment strategies. This review updates on absolute and functional iron deficiencies, their relationships with the immune system and advancements in diagnosis and therapies.
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Affiliation(s)
- Marianela Iriarte-Gahete
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Laura Tarancon-Diez
- Group of Infections in the Pediatric Population, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Vanesa Garrido-Rodríguez
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Manuel Leal
- Internal Medicine Service, Viamed Santa Ángela de la Cruz Hospital, Seville, Spain
| | - Yolanda María Pacheco
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain; Universidad Loyola Andalucía, Facultad de Ciencias de la Salud, Campus Sevilla, 41704, Dos Hermanas, Sevilla, Spain.
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4
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Jäger L, Rachamin Y, Senn O, Burgstaller JM, Rosemann T, Markun S. Ferritin Cutoffs and Diagnosis of Iron Deficiency in Primary Care. JAMA Netw Open 2024; 7:e2425692. [PMID: 39102268 DOI: 10.1001/jamanetworkopen.2024.25692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
Importance Ferritin is often measured by general practitioners, but the association of different cutoffs with the rates of iron deficiency diagnoses, particularly nonanemic iron deficiency, is unknown. Objective To investigate the association of the ferritin cutoff choice with the incidence of nonanemic and anemic iron deficiency diagnoses in primary care. Design, Setting, and Participants In this retrospective cohort study, patients 18 years or older with at least 1 consultation with a general practitioner participating in the Family Medicine Research Using Electronic Medical Records (FIRE) project, an electronic medical records database of Swiss primary care, from January 1, 2021, to November 30, 2023, were evaluated. Exposures Sex, age, clinical patient characteristics, and professional general practitioner characteristics. Main Outcomes and Measures Incidence of iron deficiency diagnoses (nonanemic and anemic) at ferritin cutoffs of 15, 30, and 45 ng/mL and ferritin testing itself. Time-dependent Cox proportional hazards regression was used to examine associations of patient and general practitioner characteristics with ferritin testing as adjusted hazard ratios (AHRs). Results The study included 255 351 patients (median [IQR] age, 52 [36-66] years; 52.1% female). Per 1000 patient-years and at ferritin cutoffs of 15, 30, and 45 ng/mL, iron deficiency diagnoses had incidences of 10.9 (95% CI, 10.6-11.2), 29.9 (95% CI, 29.4-30.4), and 48.3 (95% CI, 47.7-48.9) cases, respectively; nonanemic iron deficiency diagnoses had incidences of 4.1 (95% CI, 3.9-4.2), 14.6 (95% CI, 14.3-15.0), and 25.8 (95% CI, 25.3-26.2) cases, respectively; and anemic iron deficiency diagnoses had incidences of 3.5 (95% CI, 3.3-3.7), 6.0 (95% CI, 5.8-6.2), and 7.5 (95% CI, 7.3-7.7) cases, respectively. Ferritin testing showed notable associations with fatigue (AHR, 2.03; 95% CI, 1.95-2.12), anemia (AHR, 1.75; 95% CI, 1.70-1.79), and iron therapy (AHR, 1.50; 95% CI, 1.46-1.54). Ferritin testing was associated with female sex in all age groups, including postmenopausal. Of the patients who received ferritin testing, 72.1% received concomitant hemoglobin testing, and 49.6% received concomitant C-reactive protein testing. Conclusions and Relevance In this retrospective cohort study of primary care patients, ferritin cutoffs of 30 and 45 ng/mL were associated with a substantially higher incidence of iron deficiency compared with 15 ng/mL. These results provide a basis for health system-level evaluation and benchmarking of ferritin testing in high-resource settings and call for a harmonization of diagnostic criteria for iron deficiency in primary care.
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Affiliation(s)
- Levy Jäger
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yael Rachamin
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Campus Stiftung Lindenhof Bern (SLB), Bern, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jakob M Burgstaller
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Markun
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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5
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Kosugi M, Takezawa R, Shiota S, Tsuchikawa M, Ikuta K. Clinical management of iron deficiency anemia in Japan: iron prescription patterns, treatment effectiveness, and assessments. Int J Hematol 2024; 120:167-178. [PMID: 38806795 DOI: 10.1007/s12185-024-03801-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
Iron deficiency anemia is one of the most common types of anemia, but real-world clinical management practices in Japan are unclear. This study retrospectively explored iron prescription patterns, treatment effectiveness, and assessments. Patients with at least one treatment period between September 2020 and September 2022 were included and classified into three groups (ferric carboxymaltose [FCM]: 7437 patients, saccharated ferric oxide [SFO]: 98,648 patients, and oral iron: 359,547 patients). Iron-related laboratory values over time and testing proportions were evaluated. Median baseline hemoglobin levels were lowest with FCM (FCM: 8.10 g/dL, SFO: 8.70 g/dL, oral iron: 9.70 g/dL), but changes in hemoglobin levels by 12 weeks were greatest with FCM (FCM: 3.20 g/dL, SFO: 2.60 g/dL, oral iron: 1.70 g/dL). The median serum ferritin level at 8 weeks after FCM treatment was 43.70 ng/mL for ≤500 mg, versus 123.30 ng/mL for >500 to ≤1500 mg. All groups had a low proportion of serum ferritin and transferrin saturation (TSAT) testing at diagnosis (<38%), which decreased further for post-treatment assessment (<24%). This study suggests the importance of prescribing an appropriate total iron cumulative dose per the package insert, along with diagnosis and assessments based on serum ferritin/TSAT.
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Affiliation(s)
- Miyako Kosugi
- Data Science Department, Zeria Pharmaceutical Co., Ltd, 10-11 Nihonbashi Kobuna-Cho, Chuo-Ku, Tokyo, 103-8351, Japan
| | - Ryo Takezawa
- Data Science Department, Zeria Pharmaceutical Co., Ltd, 10-11 Nihonbashi Kobuna-Cho, Chuo-Ku, Tokyo, 103-8351, Japan
| | - Shun Shiota
- Data Science Department, Zeria Pharmaceutical Co., Ltd, 10-11 Nihonbashi Kobuna-Cho, Chuo-Ku, Tokyo, 103-8351, Japan
| | - Masaru Tsuchikawa
- Data Science Department, Zeria Pharmaceutical Co., Ltd, 10-11 Nihonbashi Kobuna-Cho, Chuo-Ku, Tokyo, 103-8351, Japan.
| | - Katsuya Ikuta
- Program Promotion Department, Hokkaido Blood Center, Sapporo, Japan
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6
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Urback AL, Martens K, McMurry HS, Sharma A, Citti C, DeLoughery TG, Shatzel JJ. Serum ferritin and risk of colonic neoplasia: Implications for the workup and treatment of iron deficiency. Eur J Haematol 2024; 113:138-145. [PMID: 38757452 PMCID: PMC11222030 DOI: 10.1111/ejh.14229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024]
Abstract
Iron deficiency is the most common extraintestinal sign of colonic neoplasia, including colorectal cancer (CRC) and other lower gastrointestinal pathology. Both upper endoscopy and colonoscopy is usually recommended in the work-up of patients with unexplained iron deficiency, particularly in men and postmenopausal women. As the incidence of early-onset CRC (age <50 years) rises in the United States, there is an increasing need to identify risk predictors to aid in the early detection of CRC. It remains unknown if serum ferritin (SF), and what specific threshold, can be used as a marker to stratify those at risk for CRC and other lower gastrointestinal pathology. In this current review of the literature, we aimed to review guidelines for diagnostic workup of colonic neoplasia in the setting of iron deficiency and examine the association and specific thresholds of SF and risk of CRC by age. Some of the published findings are conflicting, and conclusions specific to younger patients are limited. Though further investigation is warranted, the cumulative findings suggest that SF, in addition to considering the clinical context and screening guidelines, may have potential utility in the assessment of colonic neoplasia.
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Affiliation(s)
- Adam L Urback
- Division of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Hannah Stowe McMurry
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Anil Sharma
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon, USA
| | - Caitlin Citti
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas G DeLoughery
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
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7
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Farrag K, Aksan A, Ademaj-Kospiri V, Leventi E, Stein J. Use of Biomarkers of Inflammation in the Differentiation of Iron Deficiency and Anaemia-Lessons from Inflammatory Bowel Disease. Diagnostics (Basel) 2024; 14:1515. [PMID: 39061651 PMCID: PMC11275494 DOI: 10.3390/diagnostics14141515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Iron deficiency and iron deficiency anaemia are common in inflammatory bowel disease (IBD), to the detriment of the patients' quality of life. Since ferritin, as an acute-phase protein (APP), has limited diagnostic value in IBD, concurrent assessment of C-reactive protein (CRP) is recommended. The World Health Organization suggests using α1-acid glycoprotein (AGP) as an additional biomarker due to its differing half-life. This study aimed to evaluate ferritin levels in patients with IBD using CRP and AGP, individually and in combination. A total of 118 patients with IBD (mean age: 45.48 ± 15.25 years, 47.46% female) were recruited, including 38 with Crohn's disease, 47 with ulcerative colitis, and 33 controls. The results showed that while CRP alone detected an inflammatory increase in ferritin of 29.76%, this increased to 82.14% when AGP or both AGP and CRP were considered (p < 0.05). Elevated AGP levels were more prevalent in patients with ulcerative colitis. However, concordance between high CRP and AGP levels was confirmed in only 55% of cases. Correcting for inflammation using CRP and/or AGP significantly improved the diagnostic accuracy of ferritin levels in patients with IBD, highlighting the challenge posed by inflammation when assessing iron deficiency.
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Affiliation(s)
- Karima Farrag
- Innere Medizin, DGD Kliniken Sachsenhausen, Schulstrasse 31, 60594 Frankfurt am Main, Germany;
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Schifferstr. 59, 60594 Frankfurt am Main, Germany; (A.A.); (V.A.-K.); (E.L.)
| | - Aysegül Aksan
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Schifferstr. 59, 60594 Frankfurt am Main, Germany; (A.A.); (V.A.-K.); (E.L.)
- Institute of Nutritional Science, Justus Liebig University, 35392 Giessen, Germany
| | - Valëza Ademaj-Kospiri
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Schifferstr. 59, 60594 Frankfurt am Main, Germany; (A.A.); (V.A.-K.); (E.L.)
- Radiologie, Klinikum Aschaffenburg-Alzenau, Am Hasenkopf 1, 63739 Aschaffenburg, Germany
| | - Eleni Leventi
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Schifferstr. 59, 60594 Frankfurt am Main, Germany; (A.A.); (V.A.-K.); (E.L.)
| | - Jürgen Stein
- Innere Medizin, DGD Kliniken Sachsenhausen, Schulstrasse 31, 60594 Frankfurt am Main, Germany;
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Schifferstr. 59, 60594 Frankfurt am Main, Germany; (A.A.); (V.A.-K.); (E.L.)
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8
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Truong J, Naveed K, Beriault D, Lightfoot D, Fralick M, Sholzberg M. The origin of ferritin reference intervals: a systematic review. Lancet Haematol 2024; 11:e530-e539. [PMID: 38937026 DOI: 10.1016/s2352-3026(24)00103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 06/29/2024]
Abstract
Iron deficiency is a highly prevalent condition, which contributes to unnecessary morbidity, mortality, and health inequity. A serum ferritin concentration of less than 30 μg/L has a high specificity and sensitivity for diagnosing iron deficiency in adults, but the laboratory reported lower limit of normal (LLN) is typically lower. These LLNs might not be rooted in rigorous scientific evidence and might be contributing to structural underdiagnosis of iron deficiency. A systematic review was done per systematic reviews and meta-analysis guidelines with the use of medical literature databases from inception of each database to Nov 30, 2021, to identify studies that determined ferritin reference intervals in healthy adults and grey literature search for the five most common ferritin assays (registration number CRD42022268844). The objectives were to systematically summarise the ferritin reference intervals and to do a methodological quality assessment of the included studies. 2306 studies were screened and 61 full texts were included. 37 studies were eligible for analysis of the ferritin LLN in the general population. The population the sample was comprised of was a total of 21 882 females and 23 650 males participants. The ferritin LLN was a median of 8 μg/L (IQR 5-15) and mean of 9 μg/L (SD 11) in females and a median of 25 μg/L (IQR 16-44) and mean of 25 μg/L (SD 29) in males. 30 (49%) of 61 studies did not explicitly screen for patients at risk of iron deficiency, and 32 (52%) did not refer to a reference interval establishment guideline (eg, guideline recommended by Clinical and Laboratory Standards Institute). The five most used commercial ferritin laboratory assays reported reference intervals with a median LLN of 11 (IQR 9-12) and mean of 9 μg/L (SD 4) for females and median of 22 (IQR 22-24) and mean of 23 μg/L (SD 4) for males. In the literature, serum ferritin reference intervals in healthy adults consistently report a LLN of less than 30 μg/L. Data driving these ferritin reference intervals are at high risk of bias, given no exclusion of individuals at risk for iron deficiency in the presumed normal population sample and no adherence to reference interval establishment standards. We suggest the use of evidence-based laboratory clinical decision limits to diagnose iron deficiency.
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Affiliation(s)
- Judy Truong
- Department of Medicine Canada, University of Toronto, Ontario, Canada.
| | - Kanza Naveed
- Department of Medicine Canada, University of Toronto, Ontario, Canada
| | - Daniel Beriault
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada; St Michael's Hospital, Toronto, ON, Canada
| | | | - Michael Fralick
- Sinai Health System, Division of General Internal Medicine, Toronto, ON, Canada
| | - Michelle Sholzberg
- Department of Medicine Canada, University of Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada; St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, ON, Canada
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9
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Iolascon A, Andolfo I, Russo R, Sanchez M, Busti F, Swinkels D, Aguilar Martinez P, Bou-Fakhredin R, Muckenthaler MU, Unal S, Porto G, Ganz T, Kattamis A, De Franceschi L, Cappellini MD, Munro MG, Taher A. Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia. Hemasphere 2024; 8:e108. [PMID: 39011129 PMCID: PMC11247274 DOI: 10.1002/hem3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/17/2024] Open
Abstract
Iron is an essential nutrient and a constituent of ferroproteins and enzymes crucial for human life. Generally, nonmenstruating individuals preserve iron very efficiently, losing less than 0.1% of their body iron content each day, an amount that is replaced through dietary iron absorption. Most of the iron is in the hemoglobin (Hb) of red blood cells (RBCs); thus, blood loss is the most common cause of acute iron depletion and anemia worldwide, and reduced hemoglobin synthesis and anemia are the most common consequences of low plasma iron concentrations. The term iron deficiency (ID) refers to the reduction of total body iron stores due to impaired nutrition, reduced absorption secondary to gastrointestinal conditions, increased blood loss, and increased needs as in pregnancy. Iron deficiency anemia (IDA) is defined as low Hb or hematocrit associated with microcytic and hypochromic erythrocytes and low RBC count due to iron deficiency. IDA most commonly affects women of reproductive age, the developing fetus, children, patients with chronic and inflammatory diseases, and the elderly. IDA is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39% and 48.1% in developing countries). The diagnosis, management, and treatment of patients with ID and IDA change depending on age and gender and during pregnancy. We herein summarize what is known about the diagnosis, treatment, and prevention of ID and IDA and formulate a specific set of recommendations on this topic.
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Affiliation(s)
- Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Mayka Sanchez
- Department of Basic Sciences, Iron metabolism: Regulation and Diseases Universitat Internacional de Catalunya (UIC) Barcelona Spain
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine and Azienda Ospedaliera Universitaria Integrata of Verona, EuroBloodNEt Referral Center for Iron Disorders, Policlinico G.B. Rossi University of Verona Verona Italy
| | - Dorine Swinkels
- Department of Laboratory Medicine, Translational Metabolic Laboratory (TML 830) Radboud University Medical Center Nijmegen The Netherlands
| | - Patricia Aguilar Martinez
- Department of Hematological Biology, Reference Center on Rare Red Cell Disorders Montpellier University Hospital Montpellier France
| | - Rayan Bou-Fakhredin
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Martina U Muckenthaler
- Molecular Medicine Partnership Unit European Molecular Biology Laboratory Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg Heidelberg Germany
- German Centre for Cardiovascular Research, Partner Site Heidelberg Germany
| | - Sule Unal
- Department of Pediatric Hematology Hacettepe University Ankara Turkey
| | - Graça Porto
- HematologyServiço de Imuno-hemoterapia, CHUdSA-Centro Hospitalar Universitário de Santo António Porto Portugal
| | - Tomas Ganz
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National & Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Lucia De Franceschi
- Department of Medicine University of Verona & AOUI Verona, Policlinico GB Rossi Verona Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community University of Milan, Cà Granda Foundation IRCCS Maggiore Policlinico Hospital Milan Italy
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology David Geffen School of Medicine Los Angeles California USA
| | - Ali Taher
- Division of Hematology-Oncology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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10
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H S S, Kumar M, Choudhary T, Katewa V, Sharma P. Prevalence of Iron Deficiency Anemia and Iron Deficiency Without Anemia Among Moderate and Severely Acute Malnourished Children. Cureus 2024; 16:e65633. [PMID: 39205775 PMCID: PMC11357731 DOI: 10.7759/cureus.65633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Iron deficiency remains one of the globally recognized leading causes of morbidity and mortality in children, among developing countries like India as compared to the Western world. OBJECTIVE To estimate the prevalence of iron deficiency anemia (IDA) and iron deficiency without anemia (IDWA) among malnourished children. METHODS This cross-sectional study was conducted in the Department Of Pediatrics, Tertiary Care Hospital, Western Rajasthan. Demographic data and serum samples were collected and analyzed. Hematological and biochemical values were determined for 300 children aged 6 months to 59 months. RESULTS A total of 93.9% of severe acute malnutrition (SAM) children and 83.24% of moderate acute malnutrition (MAM) children had anemia as per WHO definition, with moderate anemia (47.66%) being the predominant type of anemia. About 64% of children showed iron deficiency with a prevalence of IDA and IDWA being 94.27% and 5.72%, respectively. The mean values of serum ferritin, serum iron, serum total iron binding capacity (TIBC), and transferrin saturation in children with IDWA were 8.34±2.85, 17.43±7.57, 454.09±40.76, and 4.09±1.44, respectively. CONCLUSION The proportion of anemic children in both SAM and MAM groups was very high. Our study shows that more than 60% of the MAM and SAM children were iron deficient. We recommend future measures for the prevention and control of anemia, including increased coverage of nutritional supplementation, fortification programs, and supplement iron in this sub-group (IDWA) to take care of their symptoms due to iron deficiency even before the development of overt IDA.
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Affiliation(s)
- Suhas H S
- Pediatrics, Dr. S. N. Medical College, Jodhpur, IND
| | - Manoj Kumar
- Pediatrics, Dr. S. N. Medical College, Jodhpur, IND
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11
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Barton JC, Wiener HW, Barton JC, Acton RT. Prevalence of Iron Deficiency Using 3 Definitions Among Women in the US and Canada. JAMA Netw Open 2024; 7:e2413967. [PMID: 38848068 PMCID: PMC11161847 DOI: 10.1001/jamanetworkopen.2024.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/26/2024] [Indexed: 06/10/2024] Open
Abstract
Importance The prevalence of iron deficiency varies widely according to how it is defined. Objective To compare the prevalence of iron deficiency among women using 3 different definitions. Design, Setting, and Participants The cross-sectional Hemochromatosis and Iron Overload Screening Study (HEIRS; 2000-2006) evaluated the prevalence, determinants, and outcomes of hemochromatosis and other iron-related disorders. Multiethnic, primary care-based screening (2001-2003) was performed at 5 field centers (4 in the US and 1 in Canada). Volunteer women aged 25 years and older were recruited at primary care venues associated with the field centers. Data were analyzed from June to December 2023. Main Outcomes and Measures Measures included transferrin saturation, serum ferritin level, and self-reported age, pregnancy, and race and ethnicity. Three iron deficiency definitions were studied: (1) combined transferrin saturation less than 10% and serum ferritin less than 15 ng/mL (HEIRS), (2) serum ferritin less than 15 ng/mL (World Health Organization [WHO]), and (3) serum ferritin less than 25 ng/mL (a threshold for iron-deficient erythropoiesis [IDE]). Results Among 62 685 women (mean [SD] age, 49.58 [14.27] years), 1957 women (3.12%) had iron deficiency according to the HEIRS definition, 4659 women (7.43%) had iron deficiency according to the WHO definition, and 9611 women (15.33%) had iron deficiency according to the IDE definition. Among 40 381 women aged 25 to 54 years, 1801 women (4.46%) had iron deficiency according to HEIRS, 4267 women (10.57%) had iron deficiency according to WHO, and 8573 women (21.23%) had iron deficiency according to IDE. Prevalence rates of iron deficiency among 2039 women aged 25 to 44 years who reported pregnancy were 5.44% (111 women) according to HEIRS, 18.05% (368 women) according to WHO, and 36.10% (736 women) according to IDE. Iron deficiency prevalence by the 3 respective definitions increased significantly in each racial and ethnic group and was significantly higher among Black and Hispanic participants than Asian and White participants. The relative iron deficiency prevalence among the 62 685 women increased 2.4-fold (95% CI, 2.3-2.5; P < .001) using the WHO definition and increased 4.9-fold (95% CI, 4.7-5.2; P < .001) using the IDE definition. Conclusions and Relevance Three definitions of iron deficiency were associated with significantly different prevalence of iron deficiency in women, regardless of self-reported age, pregnancy, or race and ethnicity. Using higher serum ferritin thresholds to define iron deficiency could lead to diagnosis and treatment of more women with iron deficiency and greater reduction of related morbidity.
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Affiliation(s)
- James C. Barton
- Department of Medicine, The University of Alabama at Birmingham, Birmingham
- Southern Iron Disorders Center, Birmingham, Alabama
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham
| | | | - Ronald T. Acton
- Southern Iron Disorders Center, Birmingham, Alabama
- Department of Microbiology, The University of Alabama at Birmingham, Birmingham
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12
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Lee NH. Iron deficiency in children with a focus on inflammatory conditions. Clin Exp Pediatr 2024; 67:283-293. [PMID: 38772411 DOI: 10.3345/cep.2023.00521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 05/23/2024] Open
Abstract
Iron deficiency (ID) tends to be overlooked compared with anemia. However, its prevalence is estimated to be twice as high as that of ID anemia, and ID without anemia can be accompanied by clinical and functional impairments. The symptoms of ID are nonspecific, such as fatigue and lethargy, but can lead to neurodevelopmental disorders in children, restless legs syndrome, and recurrent infections due to immune system dysregulation. In particular, the risk of ID is high in the context of chronic inflammatory diseases (CIDs) due to the reaction of various cytokines and the resulting increase in hepcidin levels; ID further exacerbates these diseases and increases mortality. Therefore, the diagnosis of ID should not be overlooked through ID screening especially in high-risk groups. Ferritin and transferrin saturation levels are the primary laboratory parameters used to diagnose ID. However, as ferritin levels respond to inflammation, the diagnostic criteria differ among guidelines. Therefore, new tools and criteria for accurately diagnosing ID should be developed. Treatment can be initiated only with an accurate diagnosis. Oral iron is typically the first-line treatment for ID; however, the efficacy and safety of intravenous iron have recently been recognized. Symptoms improve quickly after treatment, and the prognosis of accompanying diseases can also be improved. This review highlights the need to improve global awareness of ID diagnosis and treatment, even in the absence of anemia, to improve the quality of life of affected children, especially those with CIDs.
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Affiliation(s)
- Na Hee Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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13
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Mustafa A. Serum Iron and Ferritin Levels in Beta Thalassemia Carriers in Duhok Governorate, Iraq. Cureus 2024; 16:e61748. [PMID: 38975448 PMCID: PMC11226240 DOI: 10.7759/cureus.61748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Background Thalassemia and iron deficiency anemia (IDA) account for most cases of microcytic hypochromic anemia. It is a common misconception that iron deficiency does not occur in thalassemia. However, studies have found that iron deficiency can coexist in carriers of beta thalassemia. Objective The aim of this study was to determine the prevalence of iron deficiency and iron overload in carriers of beta thalassemia in Duhok, Iraq. Patients and methods This prospective cross-sectional study included 250 patients with beta thalassemia carriers attending Kurdistan Private Hospital Laboratory Department from July 2021 to June 2023. Patients with microcytic hypochromic blood picture were tested for HbA2 levels, and those with a level >3.7% were included in the study and were tested for serum iron and serum ferritin levels. Results The age range was 15-80 years, with a mean of 25 years, and the male-to-female ratio was 1.5:1. The prevalence of iron deficiency in beta thalassemia carriers was 16% (N = 40). The prevalence of iron overload was 8.4% (N = 21). There was a significant statistical difference among those with iron deficiency, normal iron status, and iron overload in terms of hemoglobin level (P=0.001), RBC count (P=0.012), HbA2 (P=0.015), and serum ferritin (P < 0.0001). Conclusion Iron deficiency is more prevalent in beta thalassemia carriers than iron overload, necessitating proper assessment of iron status in patients with beta thalassemia carriers. Those with abnormal iron status need effective treatment to optimize the overall outcomes in patients with beta thalassemia carriers.
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Affiliation(s)
- Aveen Mustafa
- College of Medicine, University of Duhok, Duhok, IRQ
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14
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Packer M, Anker SD, Butler J, Cleland JGF, Kalra PR, Mentz RJ, Ponikowski P, Talha KM. Critical re-evaluation of the identification of iron deficiency states and effective iron repletion strategies in patients with chronic heart failure. Eur J Heart Fail 2024; 26:1298-1312. [PMID: 38727791 DOI: 10.1002/ejhf.3237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/17/2024] [Accepted: 03/30/2024] [Indexed: 06/28/2024] Open
Abstract
According to current guidelines, iron deficiency is defined by a serum ferritin level <100 ng/ml or a transferrin saturation (TSAT) <20% if the serum ferritin level is 100-299 μg/L. These criteria were developed to encourage the use of intravenous iron as an adjunct to erythropoiesis-stimulating agents in the treatment of renal anaemia. However, in patients with heart failure, these criteria are not supported by any pathophysiological or clinical evidence that they identify an absolute or functional iron deficiency state. A low baseline TSAT-but not serum ferritin level-appears to be a reliable indicator of the effect of intravenous iron to reduce major heart failure events. In randomized controlled trials, intravenous iron decreased the risk of cardiovascular death or total heart failure hospitalization in patients with a TSAT <20% (risk ratio 0.67 [0.49-0.92]) but not in patients with a TSAT ≥20% (risk ratio 0.99 [0.74-1.30]), with the magnitude of the risk reduction being proportional to the severity of hypoferraemia. Patients who were enrolled in clinical trials solely because they had a serum ferritin level <100 μg/L showed no significant benefit on heart failure outcomes, and it is noteworthy that serum ferritin levels of 20-300 μg/L lie entirely within the range of normal values for healthy adults. Current guidelines reflect the eligibility criteria of clinical trials, which inadvertently adopted unvalidated criteria to define iron deficiency. Reliance on these guidelines would lead to the treatment of many patients who are not iron deficient (serum ferritin level <100 μg/L but normal TSAT) and ignores the possibility of iron deficiency in patients with a low TSAT but with serum ferritin level of >300 μg/L. Importantly, analyses of benefit based on trial eligibility-driven guidelines substantially underestimate the magnitude of heart-failure-event risk reduction with intravenous iron in patients who are truly iron deficient. Based on all available data, we recommend a new mechanism-based and trial-tested approach that reflects the totality of evidence more faithfully than the historical process adopted by clinical investigators and by the guidelines. Until additional evidence is forthcoming, an iron deficiency state in patients with heart failure should be defined by a TSAT <20% (as long as the serum ferritin level is <400 μg/L), and furthermore, the use of a serum ferritin level <100 μg/L alone as a diagnostic criterion should be discarded.
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Affiliation(s)
- Milton Packer
- Baylor University Medical Center, Dallas, TX, USA
- Imperial College, London, UK
| | - Stefan D Anker
- Department of Cardiology of German Heart Center Charité, Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research, Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Javed Butler
- Baylor Scott and White Research Institute, Baylor University Medical Center, Dallas, TX, USA
- University of Mississippi Medical Center, Jackson, MS, USA
| | - John G F Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
- Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, and Duke Clinical Research Institute, Durham, NC, USA
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
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15
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Luporsi E, Turpin A, Massard V, Morin S, Chauffert B, Carnot A, Cacoub P. Iron deficiency in patients with cancer: a prospective cross-sectional study. BMJ Support Palliat Care 2024; 14:215-221. [PMID: 34330792 DOI: 10.1136/bmjspcare-2021-002913] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite the deleterious consequences of iron deficiency (ID) in patients with cancer, underdiagnosis is frequent. The CARENFER study aimed to assess the prevalence of ID using both serum ferritin concentration and transferrin coefficient saturation (iron-saturation of transferrin, TSAT) index, as well as ID anaemia in patients with cancer. METHODS This prospective cross-sectional study was conducted in 15 oncology units in France in 2019. All patients present in the medical unit during the 2-week study period, regardless of the type of tumour (solid or haematological) and treatment, were eligible. Serum ferritin concentration, TSAT index and haemoglobin level were determined. ID and ID-associated anaemia were defined according to European Society of Medical Oncology 2018 Guidelines: ID was defined either as ferritin <100 µg/L (absolute ID) or as ferritin ≥100 µg/L and TSAT <20% (functional ID). RESULTS A total of 1221 patients with different types of solid malignant tumours were analysed: median age 64 years; 89.4% under treatment for their cancer, mainly by chemotherapy (75.4%). Overall, ID was found in 57.9% (55.1-60.6) of patients. Among them, functional ID accounted for 64% of cases. ID anaemia was reported in 21.8% (19.6-24.2) of all patients with cancer. ID was highly prevalent in untreated (75/130, 57.4%) and non-anaemic (419/775, 54.1%) patients. CONCLUSION This study highlights the high prevalence of ID in patients with cancer, whether or not associated with anaemia or treatment. These results emphasise the need to a better detection and management of ID in cancer, thereby optimising overall patient care. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03924271.
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Affiliation(s)
| | - Anthony Turpin
- Medical Oncology Department, CHU Lille, Lille, France
- UMR9020 - UMR-S 1277 Canther, University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Vincent Massard
- Oncology Unit, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France
| | - Sophie Morin
- Oncology Unit, Institut Bergonié, Bordeaux, France
| | | | - Aurélien Carnot
- Medical Oncology Department, Oscar Lambret Cancer Centre, Lille, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Hopital Universitaire AP HP Pitie Salpetriere, Paris, France
- UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), Sorbonne Université, Paris, France
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16
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Kang Y, Zhou M, Jin Q, Geng YL, Wang Y, Lv J. The efficacy and safety of molidustat for anemia in dialysis-dependent and non-dialysis-dependent chronic kidney disease patients: A systematic review and meta-analysis. Heliyon 2024; 10:e30621. [PMID: 38765138 PMCID: PMC11101811 DOI: 10.1016/j.heliyon.2024.e30621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/21/2024] Open
Abstract
Objective Molidustat is a novel agent investigated for the treatment of anemia in both dialysisdependent (DD) and non-dialysis-dependent (NDD) patients. Its efficacy and safety are still unclear. Methods We searched five databases to identify randomized controlled trials comparing molidustat to erythropoiesis-stimulating agents (ESAs) or placebo in patients with anemia. Results Six studies containing 2025 eligible participants were identified. For NDD patients, the change in Hb levels from baseline (ΔHb) was significantly higher for molidustat than for placebo [mean difference (MD) = 1.47 (95 % CI: 1.18 to 1.75), P < 0.00001] and ΔHb was also significantly higher for molidustat than for ESAs [MD = 0.25 (95 % CI 0.09 to 0.40), P = 0.002]. For NDD patients, Δhepcidin was significantly lower for molidustat than for placebo [MD = -20.66 (95 % CI: -31.67 to -9.66), P = 0.0002] and Δhepcidin was also significantly lower for molidustat than for ESAs [MD = -24.51 (95 % CI: -29.12 to -19.90), P < 0.00001]. For NDD patients, Δiron was significantly lower for molidustat than for ESAs [MD = -11.85 (95 % CI: -15.52 to -8.18), P < 0.00001], and ΔTSAT was also significantly lower for molidustat than for ESAs [MD = -5.29 (95 % CI: -6.81 to -3.78), P < 0.00001]. For NDD patients, Δferritin was significantly lower for molidustat than for placebo [MD = -90.01 (95 % CI: -134.77 to -45.25), P < 0.00001]. However, for DD-CKD patients, molidustat showed an effect similar to that of ESAs on increasing the Hb level [MD = -0.18 (95 % CI: -0.47 to 0.11), P = 0.23], Δiron level [MD = 3.78 (95 % CI: -7.21 to 14.76), P = 0.5], Δferritin level [MD = 25.03 (95 % CI: -34.69 to 84.75), P = 0.41], and Δhepcidin level [MD = 1.20 (95 % CI: -4.36 to 6.76), P = 0.67]. For DD-CKD patients, compared with the placebo or ESA group, molidustat showed a significantly higher level on ΔTSAT[MD = 3.88 (95 % CI: 2.10 to 5.65), P < 0.0001] and a slightly increased level on ΔTIBC level [MD = 1.08 (95 % CI: -0.07 to 2.23), P = 0.07]. There was no significant difference in the incidence of severe adverse events (SAEs), death, and cardio-related adverse events between molidustat and the ESAs groups. Conclusions Moricizine can effectively improves Hb levels in NDD patients and corrects anemia in DD patients without increasing adverse event incidence.
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Affiliation(s)
- Yi Kang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Mengqi Zhou
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing Puren Hospital, Beijing, China
| | - Qian Jin
- Beijing University of Chinese Medicine, Beijing, China
| | - Yun Ling Geng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Yaoxian Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jie Lv
- Department of Nephrology, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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17
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Zeidan RS, Martenson M, Tamargo JA, McLaren C, Ezzati A, Lin Y, Yang JJ, Yoon HS, McElroy T, Collins JF, Leeuwenburgh C, Mankowski RT, Anton S. Iron homeostasis in older adults: balancing nutritional requirements and health risks. J Nutr Health Aging 2024; 28:100212. [PMID: 38489995 DOI: 10.1016/j.jnha.2024.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Iron plays a crucial role in many physiological processes, including oxygen transport, bioenergetics, and immune function. Iron is assimilated from food and also recycled from senescent red blood cells. Iron exists in two dietary forms: heme (animal based) and non-heme (mostly plant based). The body uses iron for metabolic purposes, and stores the excess mainly in splenic and hepatic macrophages. Physiologically, iron excretion in humans is inefficient and not highly regulated, so regulation of intestinal absorption maintains iron homeostasis. Iron losses occur at a steady rate via turnover of the intestinal epithelium, blood loss, and exfoliation of dead skin cells, but overall iron homeostasis is tightly controlled at cellular and systemic levels. Aging can have a profound impact on iron homeostasis and induce a dyshomeostasis where iron deficiency or overload (sometimes both simultaneously) can occur, potentially leading to several disorders and pathologies. To maintain physiologically balanced iron levels, reduce risk of disease, and promote healthy aging, it is advisable for older adults to follow recommended daily intake guidelines and periodically assess iron levels. Clinicians can evaluate body iron status using different techniques but selecting an assessment method primarily depends on the condition being examined. This review provides a comprehensive overview of the forms, sources, and metabolism of dietary iron, associated disorders of iron dyshomeostasis, assessment of iron levels in older adults, and nutritional guidelines and strategies to maintain iron balance in older adults.
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Affiliation(s)
- Rola S Zeidan
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Matthew Martenson
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Javier A Tamargo
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian McLaren
- Department of Clinical and Health Psychology, College of Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Armin Ezzati
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| | - Yi Lin
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jae Jeong Yang
- UF Health Cancer Center, Gainesville, FL, USA; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Hyung-Suk Yoon
- UF Health Cancer Center, Gainesville, FL, USA; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Taylor McElroy
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - James F Collins
- Department of Food Science & Human Nutrition, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA
| | - Christiaan Leeuwenburgh
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert T Mankowski
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephen Anton
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Health and Health Professions, University of Florida, Gainesville, Florida, USA.
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18
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Dentand AL, Schubert MG, Krayenbuehl PA. Current iron therapy in the light of regulation, intestinal microbiome, and toxicity: are we prescribing too much iron? Crit Rev Clin Lab Sci 2024:1-13. [PMID: 38606523 DOI: 10.1080/10408363.2024.2331477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
Iron deficiency is a widespread global health concern with varying prevalence rates across different regions. In developing countries, scarcity of food and chronic infections contribute to iron deficiency, while in industrialized nations, reduced food intake and dietary preferences affect iron status. Other causes that can lead to iron deficiency are conditions and diseases that result in reduced intestinal iron absorption and blood loss. In addition, iron absorption and its bioavailability are influenced by the composition of the diet. Individuals with increased iron needs, including infants, adolescents, and athletes, are particularly vulnerable to deficiency. Severe iron deficiency can lead to anemia with performance intolerance or shortness of breath. In addition, even without anemia, iron deficiency leads to mental and physical fatigue, which points to the fundamental biological importance of iron, especially in mitochondrial function and the respiratory chain. Standard oral iron supplementation often results in gastrointestinal side effects and poor compliance. Low-dose iron therapy seems to be a valid and reasonable therapeutic option due to reduced hepatic hepcidin formation, facilitating efficient iron resorption, replenishment of iron storage, and causing significantly fewer side effects. Elevated iron levels influence gut microbiota composition, favoring pathogenic bacteria and potentially disrupting metabolic and immune functions. Protective bacteria, such as bifidobacteria and lactobacilli, are particularly susceptible to increased iron levels. Dysbiosis resulting from iron supplementation may contribute to gastrointestinal disorders, inflammatory bowel disease, and metabolic disturbances. Furthermore, gut microbiota alterations have been linked to mental health issues. Future iron therapy should consider low-dose supplementation to mitigate adverse effects and the impact on the gut microbiome. A comprehensive understanding of the interplay between iron intake, gut microbiota, and human health is crucial for optimizing therapeutic approaches and minimizing potential risks associated with iron supplementation.
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Affiliation(s)
- Anaëlle L Dentand
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | - Morton G Schubert
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | - Pierre-Alexandre Krayenbuehl
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
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19
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Sun Y, Peng W, Lin S, Cui J, Lu J. Iron Metabolic Biomarkers and the Mortality Risk in the General Population: A Nationwide Population-Based Cohort Study. J Endocr Soc 2024; 8:bvae063. [PMID: 38623382 PMCID: PMC11017327 DOI: 10.1210/jendso/bvae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Indexed: 04/17/2024] Open
Abstract
Context Iron is an essential element in the human body and plays a critical role in many physiological and cellular processes. However, the association between iron status and the risk of all-cause or cause-specific mortality has not been well-investigated. And it is unclear whether the association between iron metabolic biomarkers and the risk of mortality differs between people with and without diabetes mellitus (DM). Objective This work aimed to investigate associations between iron metabolic biomarkers and all-cause and cause-specific mortality risk in the general population, and heterogeneities in the associations among population with and without DM.. Methods A total of 29 166 adults from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999 to 2010 were included, with linkage to the National Death Index to December 31, 2019. Cox proportional-hazard models and Fine-Gray subdistribution hazard models were used to estimate associations between iron metabolic biomarkers and outcomes. Results During a median follow-up of 18.83 years, 9378 deaths were observed, including 3420 cardiovascular disease (CVD) deaths and 1969 cancer deaths. A significant linear association between serum ferritin (SF) and all-cause mortality was observed among the overall population and those without DM. J-shaped associations between transferrin saturation (TSAT) and all-cause and CVD mortality were observed among all populations. In the overall population, compared to the first quartile (Q1) group, the adjusted hazard ratio (HR) (95% CI) for all-cause mortality was 1.07 (1.00-1.15), 1.05 (0.98-1.12), 1.13 (1.05-1.21) in Q2, Q3, and Q4 groups for SF, while the HR was 0.94 (0.88-0.99), 0.92 (0.86-0.97), and 0.93 (0.88-0.99) for TSAT. In individuals without DM, the adjusted HR of the Q4 of SF were 1.19 (1.03-1.37) for CVD mortality and 1.25 (1.05-1.48) for cancer mortality. In individuals with DM, the adjusted HRs of the Q4 of TSAT were 0.76 (0.62-0.93) for CVD mortality and 1.47 (1.07-2.03) for cancer mortality. Conclusion Iron metabolism abnormalities increase mortality risk in the general population. The associations of iron status with mortality were significantly different between individuals with and without DM, which indicated tailored strategies for iron homeostasis are needed.
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Affiliation(s)
- Yuanyuan Sun
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, People's Republic of China
| | - Wenyao Peng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
| | - Siqi Lin
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
| | - Jingjing Cui
- Department of Geriatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, People's Republic of China
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
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20
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Payán-Pernía S, Pérez-Simón JA, García-Erce JA. Comment on: Intravenous iron for critically ill children. Comparison of three dose regimens. Pediatr Blood Cancer 2024; 71:e30857. [PMID: 38251819 DOI: 10.1002/pbc.30857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Salvador Payán-Pernía
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS)-CSIC, Universidad de Sevilla, Sevilla, Spain
| | - José Antonio Pérez-Simón
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS)-CSIC, Universidad de Sevilla, Sevilla, Spain
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21
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Tang GH, Sholzberg M. Iron deficiency anemia among women: An issue of health equity. Blood Rev 2024; 64:101159. [PMID: 38042684 DOI: 10.1016/j.blre.2023.101159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
Iron deficiency is the most common and widespread nutritional deficiency in the world. For women, the risk of iron deficiency and iron deficiency anemia increases due to iron demands during pregnancy and regular iron losses due to menstruation during reproductive years. These interrelated conditions are of public health concern as they are highly prevalent, and the negative consequences such as chronic fatigue, cognitive impairment and poor quality of life are broad and multifaceted. People of low socioeconomic status are at higher risk of iron deficiency due to low intake of expensive iron-rich foods, and decreased access to healthcare. In this review, we applied a health equity lens to describe the current state of care for women with iron deficiency with or without anemia. We have highlighted several structural challenges that span from the laboratory diagnosis, inconsistent screening guidelines, and stigma associated with heavy menstrual bleeding, to treatment barriers.
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Affiliation(s)
- Grace H Tang
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Department of Medicine, and Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada.
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22
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Lemaire B, Frias MA, Golaz O, Magnin JL, Viette V, Vuilleumier N, Waldvogel Abramowski S. Ferritin: A Biomarker Requiring Caution in Clinical Decision. Diagnostics (Basel) 2024; 14:386. [PMID: 38396425 PMCID: PMC10887646 DOI: 10.3390/diagnostics14040386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES To determine the ferritin inter-assay differences between three "Conformité Européenne" (CE) marked tests, the impact on reference intervals (RI), and the proportion of individuals with iron deficiency (ID), we used plasma and serum from healthy blood donors (HBD) recruited in three different Switzerland regions. DESIGN AND METHODS Heparinized plasma and serum from HBD were obtained from three different transfusion centers in Switzerland (Fribourg, Geneva, and Neuchatel). One hundred forty samples were recruited per center and per matrix, with a gender ratio of 50%, for a total of 420 HBD samples available per matrix. On both matrices, ferritin concentrations were quantified by three different laboratories using electrochemiluminescence (ECL), latex immunoturbidimetric assay (LIA), and luminescent oxygen channeling immunoassay (LOCI) assays, respectively. The degree of agreement between matrices and between the three sites/methods was assessed by Passing-Bablok and we evaluated the proportion of individuals deemed to have ID per method. RESULTS Overall, no difference between serum and heparinized plasma ferritin values was observed according to Passing-Bablok analyses (proportional bias range: 1.0-3.0%; maximum constant bias: 1.84 µg/L). Significant median ferritin differences (p < 0.001 according to Kruskal-Wallis test) were observed between the three methods (i.e., 83.6 µg/L, 103.5 µg/L, and 62.1 µg/L for ECL, LIA, and LOCI in heparinized plasma, respectively), with proportional bias varying significantly between ±16% and ±32% on serum and from ±14% to ±35% on plasma with no sign of gender-related differences. Affecting the lower end of RI, the proportion of ID per method substantially varied between 4.76% (20/420) for ECL, 2.86% (12/420) for LIA, and 9.05% (38/420) for LOCI. CONCLUSIONS Serum and heparinized plasma are exchangeable for ferritin assessment. However, the order of magnitude of ferritin differences across methods and HBD recruitment sites could lead to diagnostic errors if uniform RI were considered. Challenging the recently proposed use of uniform ferritin thresholds, our results highlight the importance of method- and region-specific RI for ferritin due to insufficient inter-assay harmonization. Failing to do so significantly impacts ID diagnosis.
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Affiliation(s)
- Baptiste Lemaire
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
- Medicine Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Miguel A. Frias
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Olivier Golaz
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Jean-Luc Magnin
- Central Laboratory, HFR-Fribourg, 1700 Fribourg, Switzerland
| | | | - Nicolas Vuilleumier
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Sophie Waldvogel Abramowski
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
- Medicine Department, Geneva University Hospitals, 1205 Geneva, Switzerland
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23
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Fougère B, Puisieux F, Chevalet P, Annweiler C, Michel E, Joly L, Blanc F, Azouzi AE, Desré-Follet V, Cacoub P. Prevalence of iron deficiency in patients admitted to a geriatric unit: a multicenter cross-sectional study. BMC Geriatr 2024; 24:112. [PMID: 38287253 PMCID: PMC10826072 DOI: 10.1186/s12877-024-04719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Iron deficiency (ID) is often associated with other comorbidities in older patients and is a factor of morbimortality. However, the prevalence of ID remains poorly documented in this population. METHODS The CARENFER PA study was a French multicenter cross-sectional study whose objective was to evaluate ID in patients (> 75 years) admitted to a geriatric unit. The primary endpoint was the ID prevalence defined as: serum ferritin < 100 µg/L and/or transferrin saturation coefficient (TSAT) < 20%. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death). RESULTS A total of 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were included from October 2022 to December 2022. The prevalence of ID was 57.6% (95% CI, 54.3-60.9) in the cohort of older patients (62.6% in anemic and 53.3% in non-anemic patients; p = 0.0062). ID prevalence increased significantly with the presence of more than three comorbidities (65.6% vs. 55.9%; p = 0.0274), CRP ≥ 12 mg/L (73.0% vs. 49.3%; p < 0.001) and treatment that may influence ID/anemia (60.5% vs. 49.6%; p = 0.0042). In multivariate analysis, only CRP ≥ 12 mg/L was an independent predictive factor of ID (odds ratio, 2.78; 95% CI, 1.92-4.08; p < 0.001). SPPB scores were low (0-6) in 60.5% of patients with ID versus 48.6% of patients without ID (p = 0.0076). CONCLUSION More than half of older patients had ID, including non-anemic patients. ID was associated with the presence of inflammation and a low SPPB score. TRIAL REGISTRATION NCT05514951.
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Affiliation(s)
- Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France.
- CHRU Tours - Pôle Vieillissement, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044, Tours Cedex 9, France.
| | | | - Pascal Chevalet
- Nantes Université, CHU Nantes, Pôle de Gérontologie Clinique, Nantes, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center On Autonomy and Longevity, University Hospital & Laboratoire de Psychologie Des Pays de La Loire, LPPL EA 4638, SFR Confluences, University of Angers, Angers, France
| | - Emeline Michel
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
- Université Côte d'Azur, LAHMESS, Nice, France
| | - Laure Joly
- Geriatric Department, CHRU Nancy, Université de Lorraine, Nancy, France
- INSERM, DCAC, Université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Frédéric Blanc
- Team IMIS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg and CNRS, Strasbourg, France
- 3CM2R (Research and Resources Memory Centre), Geriatrics Department, Day Hospital and Cognitive-Behavioral Unit University Hospitals of Strasbourg, Strasbourg, France
| | | | | | - Patrice Cacoub
- UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, Paris, France
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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24
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Krieg S, Loosen S, Krieg A, Luedde T, Roderburg C, Kostev K. Association between iron deficiency anemia and subsequent stomach and colorectal cancer diagnosis in Germany. J Cancer Res Clin Oncol 2024; 150:53. [PMID: 38289465 PMCID: PMC10827837 DOI: 10.1007/s00432-023-05534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/26/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Iron deficiency anemia (IDA) is the most common form of anemia worldwide, resulting in a high burden of disease. Accumulating evidence suggests that IDA is associated with the development of gastrointestinal (GI) cancers. METHODS Data from the IDA database (IQVIA) of primary care practices in Germany of adult patients first diagnosed with IDA between January 2005 and December 2021 were retrospectively analyzed and compared with a 1:1 propensity score-adjusted cohort without IDA. Study outcomes were first stomach cancer or colorectal cancer (CRC) diagnosis up to 10 years after the index date as a function of IDA. RESULTS A total of 122,502 individuals with IDA and 122,502 individuals without IDA were included. The 10-year cumulative incidence of CRC was 1.4% in the IDA patients compared to 0.8% in the cohort without IDA (p < 0.001). Regression analysis revealed a significant association between IDA and subsequent CRC (HR 2.05; 95% CI 1.83-2.30). Stomach cancer was diagnosed in 0.3% of IDA patients compared to 0.2% in the non-IDA cohort during the 10-year follow-up period (p = 0.002). However, this was significant only in the age group > 80 years (HR 2.73; 95% CI 1.60-4.67) and in men (HR 1.90; 95% CI 1.38-2.61). CONCLUSION These findings add to the literature and suggest an association between IDA and GI cancers. The extent to which this association is due to GI bleeding or other pathophysiological processes that may be caused by IDA requires further investigation, particularly experimental studies.
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Affiliation(s)
- Sarah Krieg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Sven Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225, Duesseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Stangl S, Popp M, Reis S, Sitter M, Saal-Bauernschubert L, Schießer S, Kranke P, Choorapoikayil S, Weibel S, Meybohm P. Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes. Syst Rev 2024; 13:5. [PMID: 38167004 PMCID: PMC10759584 DOI: 10.1186/s13643-023-02431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Iron deficiency (ID) is the leading cause of anemia worldwide. The prevalence of preoperative ID ranges from 23 to 33%. Preoperative anemia is associated with worse outcomes, making it important to diagnose and treat ID before elective surgery. Several studies indicated the effectiveness of intravenous iron supplementation in iron deficiency with or without anemia (ID(A)). However, it remains challenging to establish reliable evidence due to heterogeneity in utilized study outcomes. The development of a core outcome set (COS) can help to reduce this heterogeneity by proposing a minimal set of meaningful and standardized outcomes. The aim of our systematic review was to identify and assess outcomes reported in randomized controlled trials (RCTs) and observational studies investigating iron supplementation in iron-deficient patients with or without anemia. METHODS We searched MEDLINE, CENTRAL, and ClinicalTrials.gov systematically from 2000 to April 1, 2022. RCTs and observational studies investigating iron supplementation in patients with a preoperative diagnosis of ID(A), were included. Study characteristics and reported outcomes were extracted. Outcomes were categorized according to an established outcome taxonomy. Quality of outcome reporting was assessed with a pre-specified tool. Reported clinically relevant differences for sample size calculation were extracted. RESULTS Out of 2898 records, 346 underwent full-text screening and 13 studies (five RCTs, eight observational studies) with sufficient diagnostic inclusion criteria for iron deficiency with or without anemia (ID(A)) were eligible. It is noteworthy to mention that 49 studies were excluded due to no confirmed diagnosis of ID(A). Overall, 111 outcomes were structured into five core areas including nine domains. Most studies (92%) reported outcomes within the 'blood and lymphatic system' domain, followed by "adverse event" (77%) and "need for further resources" (77%). All of the latter reported on the need for blood transfusion. Reported outcomes were heterogeneous in measures and timing. Merely, two (33%) of six prospective studies were registered prospectively of which one (17%) showed no signs of selective outcome reporting. CONCLUSION This systematic review comprehensively depicts the heterogeneity of reported outcomes in studies investigating iron supplementation in ID(A) patients regarding exact definitions and timing. Our analysis provides a systematic base for consenting to a minimal COS. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020214247.
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Affiliation(s)
- Stephanie Stangl
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Maria Popp
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Stefanie Reis
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Magdalena Sitter
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Lena Saal-Bauernschubert
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Selina Schießer
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Peter Kranke
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Suma Choorapoikayil
- Department for Anaesthesiology, Intensive Care and Pain Therapy, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephanie Weibel
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Patrick Meybohm
- Department for Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
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26
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Lucas S, Garg M. Intravenous iron: an update. Intern Med J 2024; 54:26-34. [PMID: 37490496 DOI: 10.1111/imj.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/29/2023] [Indexed: 07/27/2023]
Abstract
Iron deficiency is the most common nutritional deficiency worldwide, with significant adverse health consequences in the presence or absence of anaemia. Total dose intravenous iron replacement is recommended for replacement of iron in patients with severe iron deficiency, especially in the presence of anaemia, intolerance or inefficacy following oral iron, or states of inflammation where upregulation of hepcidin may impair gastrointestinal absorption of iron. Currently, available intravenous iron formulations have been demonstrated to have an excellent overall safety profile, but potential adverse effects, including skin staining, infusion-related reactions and hypophosphataemia, have been described. Knowledge of differences in administration and safety profiles of currently available iron formulations will allow appropriate prescription, counselling, as well as recognition and management of adverse events in patients requiring intravenous iron.
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Affiliation(s)
- Sarah Lucas
- Northern Health, Melbourne, Victoria, Australia
| | - Mayur Garg
- Northern Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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27
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Cao J, Yang Z, Liu W, Chen S, Qu G, Zhong C. Association of iron deficiency with chronic suppurative otitis media in adults. Acta Otolaryngol 2024; 144:19-22. [PMID: 38315117 DOI: 10.1080/00016489.2024.2310013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Chronic suppurative otitis media (CSOM) is a prevalent chronic inflammatory disease globally. Current research suggests a possible association between anaemia and the development of CSOM. OBJECTIVES The objective of this trial was to investigate the relationship between iron metabolism and chronic suppurative otitis media (CSOM) in adults aged 20-60 years. MATERIALS AND METHODS A consecutive sampling case-control study was used. The study participants were divided into a case group (42 children diagnosed with CSOM) and a control group (42 children with normal ears). Haemoglobin (Hb), Hematocrit (Hct), mean corpuscular volume of erythrocytes (MCV), serum iron level (SI), unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), transferrin (TF), ferritin (Fer) were tested in all the participants, and the results were compared with the normal ranges of the World Health Organization (WHO). The comparative analysis of cases and controls was performed using the Fisher extract test, independence t-test, or Mann-Whitney U test. p-value <.05 was considered statistically significant for correlation. RESULTS There were 61 patients with CSOM and 61 controls included in the study. In the case group, 16 out of 61 patients (26.2%) had low ferritin levels and in the control group, 1 out of 61 patients (1.6%) had low ferritin levels (p < .001). In the case group, 6 (9.8%) of 61 patients had IDA, and in the control group, there were no patients with IDA among 61 patients (p = .027). There were significant differences in SI, UIBC, and Fer parameters between the groups. CONCLUSIONS In adult patients, the incidence of iron deficiency was higher in CSOM patients than in controls. Iron deficiency may be considered a potential risk factor for chronic suppurative otitis media, and serum iron parameters should be evaluated in these CSOM patients and further studies should be conducted to better understand the potential link between iron deficiency and CSOM.
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Affiliation(s)
- Jingwen Cao
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
- Ningxia Medical University, Ningxia, China
| | - Zixuan Yang
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Wei Liu
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Sijing Chen
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Gaoya Qu
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Cuiping Zhong
- Otolaryngology-Head and Neck Surgery, The 940th Hospital Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China
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28
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Sergeant M, Do J, Hategan A. Sustainable practice: Sustainable prescribing of iron replacement therapy. BMJ 2023; 383:e075741. [PMID: 37931931 DOI: 10.1136/bmj-2023-075741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Myles Sergeant
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Do
- Medication Information, Quality, and Safety (MedIQS), Pharmacy Department, Sunnybrook HSC, Toronto, Ontario, Canada
| | - Ana Hategan
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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29
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Bantounou MA, Lamb A, Young D, Ramage IJ, Reynolds BC. Clinical Experience of a Long-acting Pegylated Erythropoietin-Stimulating Agent in Pediatric Chronic Kidney Disease. J Pediatr Pharmacol Ther 2023; 28:509-518. [PMID: 38130347 PMCID: PMC10731941 DOI: 10.5863/1551-6776-28.6.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Management of anemia of chronic kidney disease (CKD) often includes subcutaneous or intravenous administration of erythropoietin-stimulating agents (ESAs). Mircera, a pegylated continuous erythropoietin receptor agonist, has a longer duration of action and requires less frequent administration than other ESAs. Pediatric experience with Mircera is limited. We retrospectively reviewed our long-term experience of Mircera in a national pediatric nephrology center. METHODS Patients were identified via an electronic patient record database. Data collected included demographics (sex, age, etiology of CKD, CKD stage, dialysis modality), dosing information, and laboratory data-hemoglobin (Hb), parathormone (PTH), ferritin, hematinics prior to commencing Mircera and all subsequent values associated with dose adjustments. RESULTS Seventy-seven patients aged 2 to 18 years, with CKD stages 2 to 5T had received at least 1 dose of Mircera, with 75 patients having sufficient data and a total of 1473 doses. No patients discontinued Mircera owing to adverse effects. One patient experienced a potential severe adverse drug reaction. Mircera was effective in improving or maintaining Hb ≥10.0 g/dL in most (58/75, 77.3%) patients. The median dose to achieve Hb ≥10.0 g/dL was 2.1 µg/kg/4 wk. Most doses (1039, 71.5%) were administered 4-weekly. The doses (161, 11.1%) that were administered 6-weekly remained efficacious. Thirty-two patients started Mircera with Hb <10.0 g/dL; 26 (81%) achieved Hb ≥10.0 g/dL within a median time of 4 months. Mircera was less effective if given every 8 weeks, or in the presence of hyperparathyroidism or hyperferritinemia. CONCLUSION Mircera appears safe and effective in pediatric patients with CKD.
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Affiliation(s)
- Maria Anna Bantounou
- School of Medicine and Dentistry (MAB), University of Aberdeen, Aberdeen, United Kingdom
| | - Angela Lamb
- Department of Pediatric Nephrology (AL, IJR, BCR), Royal Hospital for Children, Glasgow, United Kingdom
| | - David Young
- Department of Mathematics and Statistics (DY), University of Strathclyde, Glasgow, United Kingdom
| | - Ian James Ramage
- Department of Pediatric Nephrology (AL, IJR, BCR), Royal Hospital for Children, Glasgow, United Kingdom
| | - Ben Christopher Reynolds
- Department of Pediatric Nephrology (AL, IJR, BCR), Royal Hospital for Children, Glasgow, United Kingdom
- University of Glasgow (BCR), Glasgow, United Kingdom
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Ruiz-Castellano M, Jericó C, García-Erce JA. [Intravenous iron administration in Home Hospitalization Units: Good practice recommendations]. Med Clin (Barc) 2023; 161:351-356. [PMID: 37537018 DOI: 10.1016/j.medcli.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023]
Affiliation(s)
- María Ruiz-Castellano
- Unidad de Hospitalización a Domicilio, Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, España.
| | - Carlos Jericó
- Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi - Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España; Grupo Español de Rehabilitación Multimodal (GERM), España; Grupo de Investigación de Gestión en el Paciente Sangrante, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Jose Antonio García-Erce
- Grupo Español de Rehabilitación Multimodal (GERM), España; Grupo de Investigación de Gestión en el Paciente Sangrante, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España
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Waworuntu W, Tanoerahardjo FS, Mallongi A, Ahmad A, Amin M, Djaharuddin I, Bukhari A, Tabri NA, Bahar B, Hidayah N, Halik H, Massi MN. Serum iron levels in tuberculosis patients and household contacts and its association with natural resistance-associated macrophage protein 1 polymorphism and expression. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:893-904. [PMID: 37607533 PMCID: PMC10500328 DOI: 10.1111/crj.13677] [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: 02/10/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Iron deficiency can impair immune function, increasing tuberculosis (TB) susceptibility and severity. The research aimed to investigate iron deficiency anemia in TB patients and household contacts and its association with natural resistance-associated macrophage protein 1 (NRAMP1) polymorphism and expression. METHODS The levels of iron, ferritin, and transferrin were measured in the serum by ELISA (Enzyme-Linked Immunosorbent Assay). NRAMP1 polymorphisms were determined by polymerase chain reaction (PCR) and sequencing. NRAMP1 gene expression was measured by real-time PCR. Interferon-gamma release assay (IGRA) checked on household contacts to screen household contacts with positive IGRA as the control. RESULTS This study involved 35 TB cases and 35 TB contacts. The results showed that the serum Fe levels were found to be lower in the TB case group (median 149.6 μmol/L) than in the positive IGRA household contacts group (median 628.53 μmol/L) with a p-value <0.001. Meanwhile, ferritin levels in TB cases tended to be higher, in contrast to transferrin, which was found to tend to be lower in TB cases than household contacts but did not show a significant difference. This study found no association between the polymorphism of exon 15 D543 and active TB. However, NRAMP1 gene expression was lower in TB cases than in positive IGRA household contacts (p = 0.011). Besides, there was a positive correlation between NRAMP1 gene expression and serum Fe levels (r = 0.367, p = 0.006). TB was associated with decreased NRAMP1 gene expression (OR 0.086 95% CI 0.02-0.366, p = 0.001). Besides, TB was associated with low Fe levels (OR 0.533 95% CI 0.453-0.629, p < 0.001). CONCLUSION Comparing the TB case to the household contacts group, decreased serum Fe levels were discovered in the TB case group. This study also shows a correlation of NRAMP1 gene expression to Fe levels in TB patients and household contacts and describes that TB may lead to decreased Fe levels by downregulating NRAMP1 expression.
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Affiliation(s)
- Wiendra Waworuntu
- Pusat Kebijakan Sumber Daya dan Sistem Ketahanan Kesehatan, Badan Kebijakan Pembangunan KesehatanMinistry of Health Republic IndonesiaJakartaIndonesia
- Postgraduate Program, Faculty of Medicine, Universitas HasanuddinMakassarSouth SulawesiIndonesia
| | | | - Anwar Mallongi
- Department of Environmental Health, Faculty of Public HealthUniversitas HasanuddinMakassarSouth SulawesiIndonesia
| | - Ahyar Ahmad
- Department of Chemistry, Faculty of Mathematics and Natural SciencesUniversitas HasanuddinMakassarSouth SulawesiIndonesia
| | - Muhammad Amin
- Department of Pulmonology and Respiratory Diseases, Faculty of MedicineUniversitas AirlanggaSurabayaWest JavaIndonesia
| | - Irawaty Djaharuddin
- Department of Pulmonology and Respiratory Diseases, Faculty of MedicineUniversitas HasanuddinMakassarSouth SulawesiIndonesia
- Dr. Wahidin Sudirohusodo HospitalMakassarSouth SulawesiIndonesia
| | - Agussalim Bukhari
- Department of Clinical Nutrition, Faculty of MedicineUniversitas HasanuddinMakassarSouth SulawesiIndonesia
| | - Nur Ahmad Tabri
- Department of Pulmonology and Respiratory Diseases, Faculty of MedicineUniversitas HasanuddinMakassarSouth SulawesiIndonesia
- Dr. Wahidin Sudirohusodo HospitalMakassarSouth SulawesiIndonesia
| | - Burhanuddin Bahar
- Department of Nutrition Sciences, Faculty of Public HealthHasanuddin UniversityMakassarIndonesia
| | - Najdah Hidayah
- Research Center for Vaccine and DrugsNational Research and Innovation Agency (BRIN)Tangerang SelatanBantenIndonesia
| | - Handayani Halik
- Postgraduate Program, Faculty of Medicine, Universitas HasanuddinMakassarSouth SulawesiIndonesia
- Hasanuddin University Medical Research Center Laboratory, Faculty of MedicineUniversitas HasanuddinMakassarSouth SulawesiIndonesia
| | - Muhammad Nasrum Massi
- Hasanuddin University Medical Research Center Laboratory, Faculty of MedicineUniversitas HasanuddinMakassarSouth SulawesiIndonesia
- Department of Clinical Microbiology, Faculty of MedicineUniversitas HasanuddinMakassarSouth SulawesiIndonesia
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Awomolo AM, McWhirter A, Sadler LC, Coppola LM, Hill MG. Intravenous infusions of ferumoxytol compared to oral ferrous sulfate for the treatment of anemia in pregnancy: a randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:101064. [PMID: 37348816 DOI: 10.1016/j.ajogmf.2023.101064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Iron-deficiency anemia in pregnancy is highly prevalent and presents significant risk to patients. Initial treatment is often with oral medication. We hypothesized that intravenous ferumoxytol would result in superior treatment of anemia as compared to oral ferrous sulfate. OBJECTIVE This study aimed to investigate whether 2 infusions of intravenous ferumoxytol are superior to the use of twice-daily oral ferrous sulfate for the treatment of iron-deficiency anemia in pregnancy. STUDY DESIGN A randomized controlled trial was performed in which participants with anemic (hemoglobin <11 g/dL and hematocrit <33%) were allocated to receive either 2 infusions of 510 mg of intravenous ferumoxytol approximately 7 days apart, or 325 mg oral ferrous sulfate twice daily from enrollment to the end of their pregnancy. Participants were randomized in a 1:1 ratio to each treatment. Our primary outcome was the change in maternal hemoglobin. Secondary outcomes included maternal iron indices, maternal safety, and maternal tolerability. RESULTS There were 124 participants (N=62 per group). In the intravenous iron group, the mean change in hemoglobin was 1.86 g/dL (95% confidence interval, 1.57 g/dL-2.14 g/dL) and in the oral group was 0.79 g/dL (95% confidence interval, 0.42 g/dL-1.17 g/dL) (P<.0001). The median change in ferritin between groups was 64.5 (range, 31-364) vs 8 (range, -436 to +167) (P=.0001). The median change in iron between groups was also statistically significant with 47.5 ug/dL (range, -133 ug/dL to +664 ug/dL) in the intravenous group vs 8.5 ug/dL (range, -313 ug/dL to +437 ug/dL) in the oral iron group (P=.001). CONCLUSION Intravenous ferumoxytol was well tolerated, and it was associated with statistically significant increases in maternal hemoglobin, hematocrit, iron, and ferritin compared to oral ferrous sulfate.
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Affiliation(s)
- Adeola M Awomolo
- College of Medicine, University of Arizona, Tucson, AZ (Drs Awomolo, McWhirter, and Coppola)
| | - Amanda McWhirter
- College of Medicine, University of Arizona, Tucson, AZ (Drs Awomolo, McWhirter, and Coppola)
| | - Lynn C Sadler
- Te Whatu Ora - Health New Zealand, New Zealand (Dr Sadler)
| | - Lynn M Coppola
- College of Medicine, University of Arizona, Tucson, AZ (Drs Awomolo, McWhirter, and Coppola)
| | - Meghan G Hill
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Dr Hill).
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Pai RD, Chong YS, Clemente-Chua LR, Irwinda R, Huynh TNK, Wibowo N, Gamilla MCZ, Mahdy ZA. Prevention and Management of Iron Deficiency/Iron-Deficiency Anemia in Women: An Asian Expert Consensus. Nutrients 2023; 15:3125. [PMID: 37513543 PMCID: PMC10383547 DOI: 10.3390/nu15143125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The lack of standardized clinical practice impeding the optimal management of iron deficiency (ID) and iron deficiency anemia (IDA) in women is a global concern, particularly in the Asia-Pacific region. The aim of this study was to determine best practices through a Delphi consensus process. In Round 1, panelists were asked to rate their level of agreement with 99 statements across four domains: identification, diagnosis and assessment, prevention, and treatment of ID/IDA in women. In Round 2, panelists reappraised their ratings in view of the collective feedback and responses to Round 1. After two rounds, consensus (≥85% agreement) was reached for 84% of the Delphi statements. Experts agreed on the role of presenting symptoms and risk factors in prompting assessments of anemia and iron status in women. Experts repeatedly called for prevention, recommending preventive iron supplementation for pregnant women irrespective of anemia prevalence levels, and for non-pregnant adult women, adolescent girls, and perimenopausal women living in areas with a high prevalence of anemia. Experts unanimously agreed to prescribing oral ferrous iron as first-line therapy for uncomplicated ID/IDA. The recommendations and clinical pathway algorithms generated should be used to inform clinical practice and standardize the care of women at risk or presenting with ID/IDA in the Asia-Pacific region.
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Affiliation(s)
- Rishma Dhillon Pai
- Department of Obstetrics and Gynaecology, Lilavati Hospital, Mumbai 400050, India;
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | | | - Rima Irwinda
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia—Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (R.I.); (N.W.)
| | - Trang Nguyen Khanh Huynh
- Department of Obstetrics and Gynecology, Pham Ngoc Thach University of Medicine, Ho Chi Minh 700000, Vietnam;
| | - Noroyono Wibowo
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia—Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (R.I.); (N.W.)
| | | | - Zaleha Abdullah Mahdy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Munro MG, Mast AE, Powers JM, Kouides PA, O'Brien SH, Richards T, Lavin M, Levy BS. The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. Am J Obstet Gynecol 2023; 229:1-9. [PMID: 36706856 DOI: 10.1016/j.ajog.2023.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Abstract
For reproductive-aged women, the symptom of heavy menstrual bleeding is highly prevalent and a major contributor to iron deficiency and its most severe manifestation, iron deficiency anemia. It is recognized that these 2 clinical entities are not only highly prevalent, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both heavy menstrual bleeding and iron deficiency, with or without anemia, adversely impact quality of life-heavy menstrual bleeding during the episodes of bleeding and iron deficiency on a daily basis. These combined issues adversely affect the lives of reproductive-aged girls and women of all ages, from menarche to menopause, and their often-insidious nature frequently leads to normalization. The effects on cognitive function and the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence that suggests that iron deficiency, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders, critically important evidence that begs the normalization of iron stores in reproductive-aged women. The authors seek to raise individual, societal, and professional awareness of this underappreciated situation in a fashion that leads to meaningful and evidence-based changes in clinical guidance and healthcare policy directed at preventing, screening, diagnosing, and appropriately managing both disorders. This manuscript provides evidence supporting the need for action and describes the elements necessary to address this pervasive set of conditions that not only affect reproductive-aged girls and women but also the lives of children everywhere.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Alan E Mast
- Versiti Blood Research Institute, Milwaukee, WI
| | - Jacquelyn M Powers
- Department of Pediatrics, Baylor College of Medicine, Houston TX; Cancer and Hematology Center, Texas Children's Hospital, Houston, TX
| | - Peter A Kouides
- Mary M. Gooley Hemophilia Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sarah H O'Brien
- Center for Health Equity and Outcomes Research and the Hemostasis and Thrombosis Center, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Division of Pediatric Hematology, Oncology & Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH
| | - Toby Richards
- Division of Surgery, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Michelle Lavin
- National Coagulation Centre, St James' Hospital, Dublin, Ireland; Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Barbara S Levy
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, CA; Department of Obstetrics and Gynecology, The George Washington University, Washington, DC
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Durand A, Routier B, Druesne L, Dubois-Laurent M, Roca F, Chenailler C. [The proper use of carboxymaltose iron and its economic impact in the geriatric wards of a French university hospital]. SOINS. GERONTOLOGIE 2023; 28:42-46. [PMID: 37481291 DOI: 10.1016/j.sger.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
The proper use and economic impact of carboxymaltose iron were evaluated for patients hospitalized in the geriatric wards of a French university hospital from November 2019 to April 2020. Martial supplementation was recommended for 75.7% of the 173 patients who received carboxymaltose iron: 43.4% had a real indication for carboxymaltose iron, while 14.4% could have received sucrose iron and 17.9% could have received per os iron. Compliance with the recommendations would have generated savings of 10,345.80 euros (32.1%).
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Affiliation(s)
- Amaury Durand
- Pharmacie à usage interne, CHU Rouen, 37 boulevard Gambetta, 76000 Rouen, France; Médecine interne gériatrique, CHU Rouen, 37 boulevard Gambetta, 76000 Rouen, France; Soins de Suite et de Réadaptation, CHU Rouen, 37 boulevard Gambetta, 76000 Rouen, France.
| | - Baptiste Routier
- Pharmacie à usage interne, CHU Rouen, 37 boulevard Gambetta, 76000 Rouen, France; Médecine interne gériatrique, CHU Rouen, 37 boulevard Gambetta, 76000 Rouen, France
| | - Laurent Druesne
- Médecine interne gériatrique, CHU Rouen, 37 boulevard Gambetta, 76000 Rouen, France
| | | | - Frédéric Roca
- Médecine interne gériatrique, CHU Rouen, 37 boulevard Gambetta, 76000 Rouen, France
| | - Catherine Chenailler
- Pharmacie à usage interne, CHU Rouen, 37 boulevard Gambetta, 76000 Rouen, France
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Liu JQ, Yang XW, Liu X, Hu J, Hu XR, Li XX, Zhao YF, Shi YM, Zhang BH, Yang WR, Peng GX, Zhao X, Zhang FK. [The efficacy and safety of intravenous sucrose iron therapy for recurrent iron deficiency anemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:408-412. [PMID: 37550191 PMCID: PMC10440614 DOI: 10.3760/cma.j.issn.0253-2727.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 08/09/2023]
Abstract
Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) μg/L, and 54% (14/26) of these patients had SF levels of ≥100 μg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) μg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 μg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.
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Affiliation(s)
- J Q Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - X W Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - X Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - J Hu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - X R Hu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - X X Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Y F Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - Y M Shi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - B H Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - W R Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - G X Peng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - X Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
| | - F K Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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Rosano GMC, Kalantar‐Zadeh K, Jankowska EA. Hypophosphataemia risk associated with ferric carboxymaltose in heart failure: A pooled analysis of clinical trials. ESC Heart Fail 2023; 10:1294-1304. [PMID: 36722321 PMCID: PMC10053364 DOI: 10.1002/ehf2.14286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
AIMS Iron deficiency is a common finding among patients with heart failure (HF) and is associated with adverse outcomes, including decreased quality of life, increased risk of hospitalization, and decreased survival. Intravenous ferric carboxymaltose (FCM) has been shown to improve outcomes among patients with HF and concomitant iron deficiency, but FCM is associated with an increased risk of hypophosphataemia. We aimed to better characterize this risk among HF populations. METHODS AND RESULTS This pooled analysis examined data from 41 studies of adults with iron deficiency across disease states and therapeutic areas. Among the 7931 patients treated with FCM available for analysis, 14% made up the HF subgroup. Additional subgroups included women's health (36%), non-dialysis-dependent chronic kidney disease (NDD-CKD; 27%), haemodialysis-dependent chronic kidney disease (HD-CKD; 1%), gastrointestinal (10%), neurology (3%), and other (10%). The incidence of post-baseline moderate or severe hypophosphataemia (i.e. serum phosphate [PO4 3- ] level <2.0 mg/dL) varied across the therapeutic areas, with the lowest incidences observed in the HD-CKD (0%), HF (8.1%), and NDD-CKD (12.8%) subgroups. The prevalence of moderate or severe hypophosphataemia among the women's health, other, gastrointestinal, and neurology subgroups was 30.1%, 40.6%, 51.0%, and 55.6%, respectively. In the HF subgroup, one patient (<0.1%) had a serum PO4 3- of <1.0 mg/dL recorded, compared with 4.8% and 4.0% of the subjects in the neurology and gastrointestinal groups, respectively. With the exception of the HD-CKD subgroup, mean serum PO4 3- levels decreased through weeks 2 to 4, and then returned toward baseline and plateaued by week 8. The strongest predictor of hypophosphataemia was preserved kidney function (estimated glomerular filtration rate: >60 mL/min/1.73 m2 vs. <30 mL/min/1.73 m2 ; odds ratio: 12.2). Among patients in the HF subgroup, the incidence of treatment-emergent adverse events potentially related to hypophosphataemia (e.g. cardiac failure, ventricular tachyarrhythmias, fatigue, muscle weakness, bone pain, neurological symptoms, and muscle pain) was lower among FCM-treated patients than among those receiving placebo, and lower among patients with a post-baseline PO4 3- <2 mg/dL vs. those not meeting such criteria. CONCLUSIONS The risk of laboratory-assessed hypophosphataemia in HF patients treated with FCM was lower than that seen in patients in other therapeutic areas treated with FCM, and clinical events associated with hypophosphataemia are uncommon with FCM therapy in this population. Appropriate monitoring, particularly soon after administration in the unlikely event of repeated dosing in HF patients, will allow for further refinement of management strategies. [Correction added on 24 February 2023, after first online publication: In the preceding sentence, "…administration, will allow…" has been corrected to "…administration in the unlikely event of repeated dosing in HF patients, will allow…" in this version.].
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Affiliation(s)
| | - Kamyar Kalantar‐Zadeh
- Division of Nephrology and Hypertension and Kidney TransplantationUniversity of CaliforniaIrvineCaliforniaUSA
| | - Ewa A. Jankowska
- Institute of Heart DiseasesWrocław Medical UniversityWrocławPoland
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Czempik PF, Wiórek A. Iron deficiency in sepsis patients managed with divided doses of iron dextran: a prospective cohort study. Sci Rep 2023; 13:5264. [PMID: 37002279 PMCID: PMC10066317 DOI: 10.1038/s41598-023-32002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Iron deficiency (ID) impairs hemoglobin (Hb) synthesis and immune function, both crucial for sepsis patients. We assessed the impact of iron dextran on reticulocyte (Ret) Hb equivalent (Ret-He) and Ret subpopulations in iron-deficient sepsis patients. In this prospective clinical study we enrolled patients with sepsis or septic shock with procalcitonin concentration > 0.5 ng/mL, diagnosed with ID based on Ret-He. Study subjects received divided doses of iron dextran until normalization of Ret-He. The study population included 35 subjects. The median Ret-He increase after 2 doses of iron dextran was 3.0 (IQR 1.9-6.1) pg (p < 0.01) with median time to normalization 4 (IQR 3-5) days. Although no change in Ret percentage [Me 1.5 (IQR 1.1-2.1) vs. Me 1.4 (IQR 1.1-2.4) %, p = 0.39] and number [Me 0.05 (IQR 0.04-0.07) vs. Me 0.05 (IQR 0.03-0.06) 106/µL, p = 0.88] was noted, Ret subpopulations changed significantly (p for all < 0.01). Divided doses of iron dextran relatively quickly normalize Ret-He in iron-deficient sepsis patients. Changes in Ret subpopulations suggest increased erythropoietic activity. Further research is needed to explore the role of intravenous iron in this clinical setting.
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Affiliation(s)
- Piotr F Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752, Katowice, Poland.
- Transfusion Committee, University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland.
| | - Agnieszka Wiórek
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752, Katowice, Poland
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Plotnikoff GA, Dobberstein L, Raatz S. Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions. Nutrients 2023; 15:1387. [PMID: 36986117 PMCID: PMC10056340 DOI: 10.3390/nu15061387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.
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Affiliation(s)
| | | | - Susan Raatz
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
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40
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Fiddler JL, McBurney MI, Haas JD. Using Capillary Whole Blood to Quantitatively Measure Ferritin: A Validation Trial of a Point-of-Care System. Nutrients 2023; 15:nu15061305. [PMID: 36986035 PMCID: PMC10052100 DOI: 10.3390/nu15061305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Iron deficiency is a public health problem with devastating health, developmental and behavioral effects which often exacerbated due to affordability and access to screening and diagnosis. Using IronScan™ a portable, point-of-care diagnostic system capable of quantitatively measuring ferritin in blood, we validated IronScan™ ferritin measurements using whole blood and serum with a lab-based, regulator-approved analytical device for measuring ferritin in venous serum. Capillary (finger stick) and venous whole blood samples were obtained from 44 male and female volunteers. Venous serum (vSer) ferritin concentrations were measured on Immulite 2000 Xpi (gold standard). Capillary whole blood (cWB), venous whole blood (vWB), and vSer ferritin levels were measured by IronScan™. cWB ferritin concentrations from IronScan™ were significantly correlated (R2 = 0.86) with vSer measured with the FDA-approved Immulite system. The results from the multiple regression analysis indicate that 10% of the variability was due to the method of blood collection (venous vs. capillary) and 6% was due to the form of blood analysis (whole blood vs. serum). The sensitivity of diagnosing iron deficiency using the WHO cutoff of <30 ng/mL is 90%, with a specificity of 96%. In conclusion, IronScan™ is a rapid viable option for measuring ferritin as a point-of-care system.
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Affiliation(s)
- Joanna L. Fiddler
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC 29634, USA
- Correspondence: ; Tel.: +1-864-656-3397
| | - Michael I. McBurney
- Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
- Friedman School of Nutrition Policy and Science, Tufts University, Boston, MA 02111, USA
| | - Jere D. Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
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41
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Rohr M, Brandenburg V, Brunner-La Rocca HP. How to diagnose iron deficiency in chronic disease: A review of current methods and potential marker for the outcome. Eur J Med Res 2023; 28:15. [PMID: 36617559 PMCID: PMC9827648 DOI: 10.1186/s40001-022-00922-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/30/2022] [Indexed: 01/10/2023] Open
Abstract
Iron deficiency (ID) is the most common nutritional disorder worldwide. It is often observed in patients with chronic diseases, such as heart failure (HF), chronic kidney disease (CKD), inflammatory bowel disease (IBD) and cancer. ID is associated with poor clinical outcome, including poor performance, reduced quality of life, as well as increased hospitalization and mortality. The aim of this review is to provide an overview about the role of ID in chronic diseases (HF, CKD, IBD, cancer) regarding their current definitions and clinical relevance; diagnostic accuracy of iron parameters in chronic inflammatory conditions and its potential as prognostic markers. Due to different definitions and guideline recommendations of ID, various laboratory parameters for ID diagnostic exist and there is no general consensus about the definition of ID and its treatment. Still, a general trend can be observed across all investigated indications of this review (HF, CKD, IBD, cancer) that serum ferritin and transferrin saturation (TSAT) are the two parameters mentioned most often and emphasized in all guidelines to define ID and guide treatment. The most commonly used threshold values for the diagnosis of ID are TSAT of < 20% and serum ferritin of < 100-300 µg/L. Noteworthy, both TSAT and particularly ferritin are frequently applied, but both may vary due to inflammatory conditions. Studies showed that TSAT is less affected by inflammatory processes and may therefore be more accurate and reliable than serum ferritin, particularly in conditions with elevated inflammatory state. A low iron status and particularly a low TSAT value was associated with a poor outcome in all investigated indications, with the strongest evidence in HF patients. Routine surveillance of iron status in these groups of patients with chronic conditions is advisable to detect ID early. Depending on the inflammatory state, TSAT < 20% may be the more accurate diagnostic marker of ID than ferritin. Moreover, TSAT may also be the more reliable estimate for the prognosis, particularly in HF.
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Affiliation(s)
- Martina Rohr
- grid.476593.a0000 0004 0422 3420Vifor Pharma Deutschland GmbH, Baierbrunner Straße 29, 81379 Munich, Germany
| | - Vincent Brandenburg
- Dept of Cardiology and Nephrology, Rhein-Maas Klinikum Würselen, Mauerfeldchen 25, 52146 Würselen, Germany
| | - Hans-Peter Brunner-La Rocca
- grid.5012.60000 0001 0481 6099Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Cardiology, MUMC+, Maastricht University Medical Centre, P. Debyelaan 25, Main Building, 3rd Floor, room 3.B2.022, 6229 HX Maastricht, The Netherlands ,PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Naveed K, Goldberg N, Shore E, Dhoot A, Gabrielson D, Goodarzi Z, Lin Y, Pai M, Pardy NA, Robinson S, Andreou R, Sood M, Price V, Storm S, Verduyn A, Parker ML, Fralick M, Beriault D, Sholzberg M. Defining ferritin clinical decision limits to improve diagnosis and treatment of iron deficiency: A modified Delphi study. Int J Lab Hematol 2023; 45:377-386. [PMID: 36602151 DOI: 10.1111/ijlh.14016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Iron deficiency is highly prevalent worldwide and is an issue of health inequity. Despite its high prevalence, uncertainty on the clinical applicability and evidence-base of iron-related lab test cut-offs remains. In particular, current ferritin decision limits for the diagnosis of iron deficiency may not be clinically appropriate nor scientifically grounded. METHODS A modified Delphi study was conducted with various clinical experts who manage iron deficiency across Canada. Statements about ferritin decision limits were generated by a steering committee, then distributed to the expert panel to vote on agreement with the aim of achieving consensus and acquiring feedback on the presented statements. Consensus was reached after two rounds, which was defined as 70% of experts rating their agreement for a statement as 5 or higher on a Likert scale from 1 to 7. RESULTS Twenty-six clinical experts across 10 different specialties took part in the study. Consensus was achieved on 28 ferritin decision limit statements in various populations (including patients with multiple comorbid conditions, pediatric patients, and pregnant patients). For example, there was consensus that a ferritin <30 μg/L rules in iron deficiency in all adult patients (age ≥ 18 years) and warrants iron replacement therapy. CONCLUSION Consensus statements generated through this study corresponded with current evidence-based literature and guidelines. These statements provide clarity to facilitate clinical decisions around the appropriate detection and management of iron deficiency.
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Affiliation(s)
- Kanza Naveed
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicola Goldberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Eliane Shore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arti Dhoot
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Denise Gabrielson
- Division of Hematology/Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Zahra Goodarzi
- Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Menaka Pai
- Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Natasha A Pardy
- Department of Hematology, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Sue Robinson
- Division of Hematology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Roseann Andreou
- Division of Hematology/Oncology, Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | - Manish Sood
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sherri Storm
- Academic Family Health Team & Women's and Children's Health Program, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Verduyn
- Department of Rehabilitative Care, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle L Parker
- DynaLIFE Medical Labs and Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Fralick
- Department of Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel Beriault
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
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43
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Husmann FMD, Zimmermann MB, Herter-Aeberli I. The Effect of Prebiotics on Human Iron Absorption: A Review. Adv Nutr 2022; 13:2296-2304. [PMID: 35816457 PMCID: PMC9776726 DOI: 10.1093/advances/nmac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/22/2022] [Accepted: 07/06/2022] [Indexed: 01/29/2023] Open
Abstract
Iron deficiency remains the most common nutritional deficiency. Oral iron supplementation is the recommended first-line treatment and used as a preventive measure as well. Enhancers of iron absorption are highly sought after to improve supplementation outcomes. Evidence from animal and human studies exists that prebiotics can enhance iron absorption. The purpose of this present narrative review of the literature is to summarize the existing evidence on the effects of prebiotics on human iron absorption. Relevant articles were identified from PUBMED, Scopus, and Web of Science from inception to November 2021. Only human trials investigating the effect of prebiotics on iron absorption were included. Eleven articles were identified and included for review. There are promising findings supporting an enhancing effect of certain prebiotics, but inconsistencies between the studies and results exist. The most convincing evidence exists for the prebiotics galacto-oligosaccharides and fructo-oligosaccharides combined with the commonly used iron compound ferrous fumarate, from studies in adult women with low iron stores and in anemic infants. Many factors seem to play a role in the enhancing effect of prebiotics on iron absorption such as type of prebiotic, dose, acute (single-dose) or chronic (long-term) prebiotic consumption, iron compound, iron status, inflammatory status, and age of the population studied. More research investigating the optimal combination of prebiotic, iron compound, and dose as well as the effect of long-term application on iron status outcomes is needed.
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Affiliation(s)
- Frederike M D Husmann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and
Health, ETH Zurich, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and
Health, ETH Zurich, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Human Nutrition, Institute of Food, Nutrition and
Health, ETH Zurich, Zurich, Switzerland
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de Araújo LKAR, Faria JCP, Sarni ROS. Iron deficiency anemia in infants in Sousa (PB), Brazil: an association with nutritional status. Rev Assoc Med Bras (1992) 2022; 68:1698-1704. [PMID: 36477102 PMCID: PMC9779981 DOI: 10.1590/1806-9282.20220761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe the prevalence of anemia and iron deficiency anemia (IDA) in infants and verify the association of iron deficiency with nutritional status. METHODS This cross-sectional and observational study included 104 infants aged between 7 and 9 months, assisted from August to September 2021 by the Family Health Strategy program in Sousa municipality (Paraíba, Brazil). Clinical and anthropometric data were collected, and a 24-h food recall questionnaire was applied using the DietPro software (version 5.0) in order to verify food consumption and assess iron intake. Variables associated with iron deficiency (p<0.05) were analyzed using multiple logistic regression. RESULTS Anemia and IDA were observed in 40.4% and 19.2% of infants, respectively. Only one infant was taking prophylactic supplementation (ferrous sulfate). Infants with IDA presented reduced hemoglobin (p<0.001) and ferritin (p<0.001) and increased Z-scores of body mass index-for-age (Z-BMI) (p=0.027), weight-for-height (p=0.007), and weight-for-age (p=0.032). All Z-scores were inversely correlated with ferritin (Z-BMI [rho: -0.37; p<0.001], weight-for-height [rho: -0.37; p<0.001], and weight-for-age [rho: -0.29; p=0.002]). Ferritin was also directly correlated with daily iron intake (rho: 0.22; p=0.018). Finally, multiple logistic regression showed a significant and direct association of iron deficiency with weight-for-height Z-score (odds ratio: 2.86; 95% confidence interval: 1.38-5.64; p=0.004). CONCLUSION About 60% of infants presented anemia or IDA. Iron deficiency was associated with the weight-for-height Z-score, showing the vulnerability of infants during the introduction of complementary feeding.
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Affiliation(s)
| | - João Carlos Pina Faria
- Centro Universitário Faculdade de Medicina do ABC, Departamento de Pediatria – Santo André (SP), Brasil.,Universidade Nove de Julho, Departamento de Pediatria – São Paulo (SP), Brasil.,Corresponding author:
| | - Roseli Oselka Saccardo Sarni
- Centro Universitário Faculdade de Medicina do ABC, Departamento de Pediatria – Santo André (SP), Brasil.,Universidade Federal de São Paulo, Departamento de Pediatria – São Paulo (SP), Brasil
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Repo M, Kurppa K, Huhtala H, Luostarinen L, Kaukinen K, Kivelä L. Significance of low ferritin without anaemia in screen-detected, adult coeliac disease patients. J Intern Med 2022; 292:904-914. [PMID: 35925673 PMCID: PMC9805163 DOI: 10.1111/joim.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Low ferritin without anaemia has been linked to adverse health effects. OBJECTIVES To investigate the prevalence and clinical significance of low ferritin in screen-detected coeliac disease. METHODS Seventy-six screen-detected coeliac disease patients were enrolled in the prospective collection of comprehensive clinical, laboratory and histological data at diagnosis and after 1-2 years on a gluten-free diet (GFD). All variables were compared between patients with different ferritin levels. RESULTS At coeliac disease diagnosis, six patients had anaemia. Of the 70 nonanaemic patients, ferritin levels were <15 μg/L in 21%, 15-29 μg/L in 19%, 30-99 μg/L in 36% and ≥100 μg/L in 24%. Those with lower ferritin were more often females, had lower body mass index, haemoglobin and villous height-crypt depth ratio and also had higher intra-epithelial lymphocyte CD3+ levels in duodenal biopsies. The groups did not differ in neurological or gastrointestinal symptoms, health-related quality of life, bone mineral density, liver values, vitamin, albumin or coeliac autoantibody levels or the prevalence of comorbidities. Median ferritin levels increased from 41.5 μg/L to 86.0 μg/L on GFD (p < 0.001). Ferritin remained <30 μg/L in 21% of patients but was not associated with dietary compliance, nor was any correlation between changes in ferritin and quality of life, gastrointestinal symptoms, autoantibody levels or degree of histological damage detected. CONCLUSION Decreased ferritin is a frequent finding in screen-detected coeliac disease and may not be fully restored on a GFD. However, low ferritin levels are not associated with more severe symptoms or poorer quality of life.
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Affiliation(s)
- Marleena Repo
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Pediatrics, Central Finland Central Hospital, Jyväskylä, Finland
| | - Kalle Kurppa
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,The University Consortium of Seinäjoki and Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Liisa Luostarinen
- Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Laura Kivelä
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Li K, Hou L, Tan Y, Huang Y, Shi J, Han J, Yan J, Guan Y. Iron metabolism patterns in non-anemic patients with myasthenia gravis: A cross-sectional and follow-up study. Front Neurol 2022; 13:1060204. [PMID: 36504650 PMCID: PMC9729274 DOI: 10.3389/fneur.2022.1060204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Iron metabolism in myasthenia gravis (MG) and factors associated with it are explored by few published studies. Therefore, this study aimed to compare iron metabolism patterns between patients with MG and healthy individuals as well as between the same group of patients before and after immunotherapy, and to identify predictors of iron metabolism disorders in MG. Materials and methods For this study, 105 patients and healthy individuals were included at baseline, after which paired parametric and non-parametric tests were adopted to compare their iron metabolism patterns, and multivariate binary logistic regression was used to identify predictors of iron metabolism disorders. Patients with MG were then followed up for 12 ± 3 months to explore alterations in their iron metabolism patterns after starting immunotherapy with the help of paired tests. Results Non-anemic immunotherapy-naive patients with MG had significantly lower serum iron (SI) and transferrin saturation (TS) levels than healthy individuals. Premenopausal female was significantly associated with SI < 65 μg/dL and iron deficiency in these patients. However, iron metabolism parameters did not significantly alter after around 12 months of immunotherapy in patients with MG. Conclusion Iron inadequacy was present in patients with MG, particularly premenopausal female patients, and it would hardly improve after immunotherapy. Given the significant role of iron in human body, it should be given more attention in patients with MG.
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Affiliation(s)
- Ke Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li'an Hou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Tan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangyu Huang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiayu Shi
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhua Han
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwen Yan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Yuzhou Guan
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Tarancon-Diez L, Genebat M, Roman-Enry M, Vázquez-Alejo E, Espinar-Buitrago MDLS, Leal M, Muñoz-Fernandez MÁ. Threshold Ferritin Concentrations Reflecting Early Iron Deficiency Based on Hepcidin and Soluble Transferrin Receptor Serum Levels in Patients with Absolute Iron Deficiency. Nutrients 2022; 14:nu14224739. [PMID: 36432426 PMCID: PMC9692751 DOI: 10.3390/nu14224739] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
(1) Background: The serum ferritin cut-off to define absolute iron deficiency is not well-established. The aim of the present study was to determine a clinically relevant ferritin threshold by using early serum biomarkers of iron deficiency such as hepcidin and the soluble transferrin receptor; (2) Methods: Two hundred and twenty-eight asymptomatic subjects attending a hospital as outpatients between 1st April 2020 and 27th February 2022 were selected. Iron metabolism parameters as part of the blood analysis were requested by their doctor and included in the study. Then, they were classified into groups according to their ferritin levels and iron-related biomarkers in serum were determined, quantified, and compared between ferritin score groups and anemic subjects. (3) Results: Serum ferritin levels below 50 ng/mL establish the point from which the serum biomarker, the soluble transferrin receptor to hepcidin ratio (sTfR/Hep ratio), begins to correlate significantly with ferritin levels. (4) Conclusion: Ferritin levels ≤ 50 ng/mL are indicative of early iron deficiency; hence, this should be considered as a clinically relevant cut-off for iron deficiency.
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Affiliation(s)
- Laura Tarancon-Diez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Miguel Genebat
- Internal Medicine Department, Hospital Fátima, 41012 Sevilla, Spain
| | | | - Elena Vázquez-Alejo
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Maria de la Sierra Espinar-Buitrago
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Manuel Leal
- Internal Medicine Department, Hospital Viamed Santa Ángela de la Cruz, 41014 Sevilla, Spain
- Correspondence: (M.L.); (M.Á.M.-F.)
| | - Mª Ángeles Muñoz-Fernandez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
- Correspondence: (M.L.); (M.Á.M.-F.)
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Ferritin and its association with anaemia in a healthy adult population in Kenya. PLoS One 2022; 17:e0275098. [PMID: 36240192 PMCID: PMC9565368 DOI: 10.1371/journal.pone.0275098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Iron deficiency is the commonest cause of anaemia worldwide. Serum ferritin is the most sensitive non-invasive indicator of iron stores but its utility is compromised in inflammatory states as it is an acute phase reactant. This study sought to estimate the burden of iron deficiency in a healthy adult population residing in Kenya and to determine the association between various ferritin cut-offs and anaemia in a population known to have chronic low-grade inflammation. METHODS Healthy adults aged 18-65 years were recruited from urban towns in 4 counties in Kenya at average altitudes of 1683-2099m above sea level as part of a global study conducted by the International Federation of Clinical Chemistry (IFCC) to determine reference intervals (RIs) for common laboratory tests. We analyzed complete blood count (CBC), C-reactive protein, iron, transferrin, transferrin saturation and ferritin data. RESULTS We obtained data from 528 participants. There were 254 (48.1%) males and 274 females (51.9%). Based on a ferritin cut-off of 15 μg/L and Hb cut-offs of 14.5 g/dL and 12 g/dL, the prevalence of iron deficiency anaemia was 0.8% and 7.3% in males and females respectively. The odds of having anaemia was highest if one had a ferritin value less than 15 μg/L with a sensitivity of 28.6% and specificity of 98.4% in males, and sensitivity of 83.3% and specificity of 78.0% in females. CONCLUSION Only the ferritin cut-off of 15 ug/L had an association with anaemia where it can be used for ruling out iron deficiency as the cause. Sex specific ferritin cut-offs for diagnosing iron deficiency in adults in sub-Saharan Africa need to be derived by comparing ferritin levels to stainable iron in bone marrow aspirates and trephines in order to ensure that we are using appropriate clinical decision limits.
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Tolerability of Oral Supplementation with Microencapsulated Ferric Saccharate Compared to Ferrous Sulphate in Healthy Premenopausal Woman: A Crossover, Randomized, Double-Blind Clinical Trial. Int J Mol Sci 2022; 23:ijms232012282. [PMID: 36293136 PMCID: PMC9603338 DOI: 10.3390/ijms232012282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
A single-center, crossover, randomized, double-blind, and controlled clinical study was conducted to assess the tolerability profile, especially with regard to gastrointestinal complaints, of oral supplementation with AB-Fortis®, a microencapsulated ferric saccharate (MFS), as compared with conventional ferrous sulphate (FS) in healthy premenopausal women. A dose of 60 mg/day of elemental iron was used. The test products were administered for 14 consecutive days with a washout period of two menstrual episodes and a minimum of one month between the two intervention periods. The subjects completed simple-to-answer questionnaires daily for 14 days during both the intervention and the washout periods, capturing the symptoms associated with oral iron supplementation and overall health aspects. Following product consumption, the incidences of symptoms, numbers of complaints/symptoms, overall intensity, and total days with symptoms were found to be significantly higher for FS consumption as compared to MFS. The better tolerability profile of MFS over FS was further substantiated when both products were compared to a real-life setting (i.e., the washout period). Overall, the administration of both study products was safe with no serious or significant adverse events reported. In summary, the current study shows the better tolerability of the MFS preparation when compared to that of the FS, presenting MFS as a well-tolerated and safe option for improving iron nutrition.
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Jefferds MED, Mei Z, Addo Y, Hamner HC, Perrine CG, Flores-Ayala R, Pfeiffer CM, Sharma AJ. Iron Deficiency in the United States: Limitations in Guidelines, Data, and Monitoring of Disparities. Am J Public Health 2022; 112:S826-S835. [PMID: 36288529 PMCID: PMC9612197 DOI: 10.2105/ajph.2022.306998] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/04/2022]
Abstract
Iron deficiency and the more severe sequela, iron deficiency anemia, are public health problems associated with morbidity and mortality, particularly among pregnant women and younger children. The 1998 Centers for Disease Control and Prevention recommendations for prevention and control of iron deficiency in the United States is old and does not reflect recent evidence but is a foundational reference for many federal, clinical, and program guidelines. Surveillance data for iron deficiency are sparse at all levels, with critical gaps for pregnant women and younger children. Anemia, iron deficiency, and iron deficiency anemia are often conflated but should not be. Clinical guidelines for anemia, iron deficiency, and iron deficiency anemia give inconsistent recommendations, causing nonsystematic assessment of iron deficiency. Screening for iron deficiency typically relies on identifying anemia, despite anemia's low sensitivity for iron deficiency. In the National Health and Nutrition Examination Survey, more than 70% of iron deficiency is missed among pregnant women and children by relying on hemoglobin for iron deficiency screening. To improve assessment and diagnosis and strengthen surveillance, better and more complete data and updated foundational guidance on iron deficiency and anemia are needed that consider new evidence for measuring and interpreting laboratory results. (Am J Public Health. 2022;112(S8):S826-S835. https://doi.org/10.2105/AJPH.2022.306998).
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Affiliation(s)
- Maria Elena D Jefferds
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Zuguo Mei
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Yaw Addo
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Heather C Hamner
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Cria G Perrine
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Rafael Flores-Ayala
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Christine M Pfeiffer
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Andrea J Sharma
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
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