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Fukumoto S, Murata T, Osuga Y, Pollock RF. Incidence of Hypophosphatemia After Intravenous Administration of Iron: A Matching-Adjusted Indirect Comparison of Data from Japanese Randomized Controlled Trials. Adv Ther 2023; 40:4877-4888. [PMID: 37702931 PMCID: PMC10567814 DOI: 10.1007/s12325-023-02591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 06/21/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Intravenous (IV) administration of iron is considered a safe and efficacious treatment for iron deficiency anemia (IDA), recommended in patients requiring rapid replenishment of iron, or intolerant or unresponsive to oral administration of iron. Recent randomized controlled trials (RCTs) have shown high incidence of hypophosphatemia after administration of two IV iron preparations: saccharated ferric oxide (SFO) and ferric carboxymaltose (FCM). The present study aimed to conduct matching-adjusted indirect comparison (MAIC) of hypophosphatemia incidence with these iron formulations and ferric derisomaltose (FDI) based on data from head-to-head RCTs conducted in Japan. METHODS A MAIC of hypophosphatemia incidence was conducted on the basis of data from two head-to-head RCTs. The relative odds of hypophosphatemia with FDI versus SFO were obtained from patient-level data from a recent RCT and adjusted for cumulative iron dose, while parametric models of serum phosphate levels from a separate RCT were used to estimate the relative odds of hypophosphatemia with FCM with SFO. An anchored MAIC was then conducted comparing FDI with FCM. RESULTS The adjusted odds of experiencing hypophosphatemia were significantly lower with FDI than SFO [odds ratio (OR) of 0.02; 95% confidence interval (CI) 0.01-0.05]. The parametric models of serum phosphate from the RCT comparing FCM with SFO provided an estimated OR of 1.17 for the incidence of hypophosphatemia with FCM versus SFO. Combining the two estimates in the MAIC showed that the odds of experiencing hypophosphatemia would be 52.5 (95% CI 27.7-99.4) times higher with FCM than FDI in patients with IDA associated with heavy menstrual bleeding in Japan. CONCLUSIONS Direct comparison of patient-level data and a MAIC from two RCTs in Japanese patients with heavy menstrual bleeding indicated that hypophosphatemia is less frequent in patients treated with FDI than those with FCM or SFO. Results are in agreement with RCTs comparing FDI and FCM in patients with various etiologies conducted in the USA and Europe.
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Affiliation(s)
- Seiji Fukumoto
- Fujii Memorial Institute of Medical Sciences, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | | | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Richard F Pollock
- Covalence Research Ltd, Rivers Lodge, West Common, Harpenden, AL5 2JD, UK.
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Lee JY, Kim SE, Park SJ, Park MI, Moon W, Kim JH, Jung K. Helicobacter pylori infection and iron deficiency in non-elderly adults participating in a health check-up program. Korean J Intern Med 2022; 37:304-312. [PMID: 34905815 PMCID: PMC8925964 DOI: 10.3904/kjim.2020.433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS Helicobacter pylori infection is presumably associated with iron deficiency and iron deficiency anemia (IDA). This study aimed to evaluate the relationship between H. pylori infection and the decline in iron stores in non-elderly adults during their health check-ups. METHODS We identified a total of 1,069 subjects who were tested for iron, ferritin, and total iron-binding capacity during their health check-ups, from January 2016 to May 2017. Of these, subjects who underwent endoscopy via rapid urease test and those aged 65 years or below were finally enrolled. RESULTS Overall, 281 subjects were enrolled, and 187 patients (66.5%) tested positive for H. pylori. The mean age was 36.1 years (range, 22 to 65), and 176 subjects (62.6%) were male. The mean levels of hemoglobin (14.1 ± 1.7 g/dL vs. 14.6 ± 1.4 g/dL, p = 0.019) and ferritin (121.7 ± 106.9 ng/mL vs. 151.8 ± 107.8 ng/mL, p = 0.027) in the H. pylori-positive group were significantly lower than those in the H. pylori-negative group. Iron deficiency (ferritin < 30 ng/mL) was more common in patients with H. pylori infection (p = 0.002). There was no significant difference in anemia (hemoglobin < 13 g/dL in men, < 12 g/dL in women) or IDA (anemia, ferritin < 10 ng/mL, and transferrin saturation < 16%) with H. pylori. Logistic regression analysis demonstrated that female sex (odds ratio, 197.559; 95% confidence interval, 26.461 to 1,475.015) and H. pylori infection (odds ratio, 3.033; 95% confidence interval, 1.216 to 7.567) were factors associated with iron deficiency. CONCLUSION H. pylori infection is associated with iron deficiency, suggesting a decline in iron stores among infected non-elderly adults.
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Affiliation(s)
- Jun Yeop Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Abstract
Ponikowski P, Kirwan BA, Anker SD, et al. Lancet. 2020;396:1895-904. 33197395.
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O'Morain NR, O'Donovan H, Conlon C, Shannon E, Manning D, Slattery E. Is Endoscopic Band Ligation a Superior Treatment Modality for Gastric Antral Vascular Ectasia Compared to Argon Plasma Coagulation? Clin Endosc 2021; 54:548-554. [PMID: 33435659 PMCID: PMC8357586 DOI: 10.5946/ce.2020.236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Gastric antral vascular ectasia (GAVE) is a rare acquired vascular lesion of the gastric antrum. The most frequent presentation of GAVE is iron deficiency anemia. Endoscopic therapy is the mainstay of treatment. However, there is no consensus regarding the optimal treatment modality. METHODS A retrospective cohort study was performed on patients with GAVE, including patients receiving endoscopic therapy. Treatment was with either argon plasma coagulation (APC) or endoscopic band ligation (EBL). Basic demographic data, indication for index procedure, number of sessions, and pre- and post-hemoglobin levels were collected. The aim of the study was to compare outcomes across the two treatment modalities. RESULTS One hundred and seventeen diagnoses of GAVE were made. Sixty-two patients (53%) required endoscopic treatment for symptomatic GAVE (female, n=38, 61%; mean age of 74.4 years). Two hundred and eighteen procedures were performed during the study period. APC was performed (n=161, 74%) more frequently than EBL (n=57, 26%). Patients treated with APC at index required a median 5 subsequent therapeutic interventions (APC or EBL), while those treated with EBL at index required a further 2.9 treatments (EBL only) (p<0.05). CONCLUSION APC was the most common treatment modality employed. We demonstrate an increasing incidence of EBL. Patients treated with EBL at index treatment required fewer subsequent treatment sessions and had a greater mean rise in hemoglobin. This suggests a more effective endoscopic response with EBL.
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Affiliation(s)
| | - Helen O'Donovan
- Department of Gastroenterology, University Hospital Galway, Galway, Ireland
| | - Caroline Conlon
- Department of Gastroenterology, University Hospital Galway, Galway, Ireland
| | - Eileen Shannon
- Department of Gastroenterology, University Hospital Galway, Galway, Ireland
| | - Diarmuid Manning
- Department of Gastroenterology, University Hospital Galway, Galway, Ireland
| | - Eoin Slattery
- Department of Gastroenterology, University Hospital Galway, Galway, Ireland
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[Multidisciplinary expert's consensus on the management of perioperative iron deficiency anemia in patients accepting general surgery]. Zhonghua Wai Ke Za Zhi 2020; 58:252-256. [PMID: 32241053 DOI: 10.3760/cma.j.cn112139-20200210-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Iron deficiency anemia is common in general surgery patients during the perioperative period, which will increase the morbidity and mortality. Timely diagnosis and treatment of iron deficiency anemia in the perioperative period will improve the clinical outcome of patients and reduce the medical burden.Management of perioperative iron deficiency anemia includes familiar with the diagnosis and grading of anemia, monitoring patient's hemoglobin, treatment of anemic etiology, nutritional support, iron supplementation, implementation of restrictive transfusion strategy, application of erythropoietin, autotransfusion, etc.Multidisciplinary management of iron deficiency anemia is encouraged.
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Intra J, Limonta G, Cappellini F, Bertona M, Brambilla P. Glycosylated Hemoglobin in Subjects Affected by Iron-Deficiency Anemia. Diabetes Metab J 2019; 43:539-544. [PMID: 30604593 PMCID: PMC6712229 DOI: 10.4093/dmj.2018.0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022] Open
Abstract
Previous studies have suggested that iron-deficiency anemia affects glycosylated hemoglobin (HbA1c) measurements, but the results were contradictory. We conducted a retrospective case-control study to determine the effects of iron deficiency on HbA1c levels. Starting with the large computerized database of the Italian Hospital of Desio, including data from 2000 to 2016, all non-pregnant individuals older than 12 years of age with at least one measurement of HbA1c, cell blood count, ferritin, and fasting blood glucose on the same date of blood collection were enrolled. A total of 2,831 patients met the study criteria. Eighty-six individuals were diagnosed with iron-deficiency anemia, while 2,745 had a normal iron state. The adjusted means of HbA1c were significantly higher in anemic subjects (5.59% [37.37 mmol/mol]), than those measured in individuals without anemia (5.34% [34.81 mmol/mol]) (P<0.0001). These results suggest that clinicians should be cautious about diagnosing prediabetes and diabetes in individuals with anemia.
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Affiliation(s)
- Jari Intra
- Department of Laboratory Medicine, Desio Hospital, University of Milano-Bicocca, Desio, Italy.
| | - Giuseppe Limonta
- Department of Laboratory Medicine, Desio Hospital, University of Milano-Bicocca, Desio, Italy
| | - Fabrizio Cappellini
- Department of Laboratory Medicine, Desio Hospital, University of Milano-Bicocca, Desio, Italy
| | - Maria Bertona
- Department of Laboratory Medicine, Desio Hospital, University of Milano-Bicocca, Desio, Italy
| | - Paolo Brambilla
- Department of Laboratory Medicine, Desio Hospital, University of Milano-Bicocca, Desio, Italy
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He GL, Sun X, Tan J, He J, Chen X, Liu CX, Fan L, Zou L, Cao YL, Xiao M, Zhang XQ, Zhang GH, Zhou W, Cai Y, Zhao XL, Gao Y, Li HM, Liu XL, Zhang HP, Wang Y, Tang H, Yuan NX, Ding GF, Zhan F, Yin CX, Zhang JW, Yang HM, Qi YN, Liu XX. [Survey of prevalence of iron deficiency and iron deficiency anemia in pregnant women in urban areas of China]. Zhonghua Fu Chan Ke Za Zhi 2018; 53:761-767. [PMID: 30453423 DOI: 10.3760/cma.j.issn.0529-567x.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods: The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country.Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results: The median serum ferritin level during pregnancy was 20.60 μg/L (11.78-36.98 μg/L) , the hemoglobin level was (118±12) g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L (34.48-94.01 μg/L) , 28.60 μg/L (16.40-50.52 μg/L) , and 16.70 μg/L (10.20-27.00 μg/L) respectively (P<0.01) . The mean hemoglobin levels were (127±10) g/L, (119±11) g/L and (117±11) g/L respectively (P<0.01) . The prevalence of ID in urban pregnant women was 48.16% (5 973/12 403) , and IDA prevalence was 13.87% (1 720/12 403) . The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019) , 8.40% (293/3 487) and 17.82% (1 407/7 897) ,respectively (P<0.01) . The prevalence of standardized ID and IDA were significantly different in various regions of China (P<0.01) . The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%, the differents in various regions were significant (all P<0.01) . Conclusion: The current phenomenon of ID and IDA in pregnant women is still very common, and nutrition and health care during pregnancy should be strengthened.
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Affiliation(s)
- G L He
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
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Bae SJ, Hwang G, Kang HS, Song HJ, Chang WY, Maeng YH, Kang KS. Single Cavernous Hemangioma of the Small Bowel Diagnosed by Using Capsule Endoscopy in a Child with Chronic Iron-Deficiency Anemia. Clin Endosc 2015; 48:340-4. [PMID: 26240811 PMCID: PMC4522429 DOI: 10.5946/ce.2015.48.4.340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/12/2014] [Accepted: 12/08/2014] [Indexed: 12/25/2022] Open
Abstract
Cavernous hemangiomas of the gastrointestinal tract are extremely rare. In particular, the diagnosis of small bowel hemangiomas is very difficult in children. A 13-year-old boy presented at the outpatient clinic with dizziness and fatigue. The patient was previously diagnosed with iron-deficiency anemia at 3 years of age and had been treated with iron supplements continuously and pure red cell transfusion intermittently. Laboratory tests indicated that the patient currently had iron-deficiency anemia. There was no evidence of gross bleeding, such as hematemesis or bloody stool. Laboratory findings indicated no bleeding tendency. Gastroduodenoscopy and colonoscopy results were negative. To obtain a definitive diagnosis, the patient underwent capsule endoscopy. A purplish stalked mass was found in the jejunum, and the mass was excised successfully. We report of a 13-year-old boy who presented with severe and recurrent iron-deficiency anemia caused by a cavernous hemangioma in the small bowel without symptoms of gastrointestinal bleeding.
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Affiliation(s)
- Soo Jin Bae
- Department of Pediatrics, Jeju National University College of Medicine, Jeju, Korea
| | - Geol Hwang
- Department of Pediatrics, Jeju National University College of Medicine, Jeju, Korea
| | - Hyun Sik Kang
- Department of Pediatrics, Jeju National University College of Medicine, Jeju, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Weon Young Chang
- Department of Surgery, Jeju National University College of Medicine, Jeju, Korea
| | - Young Hee Maeng
- Department of Pathology, Jeju National University College of Medicine, Jeju, Korea
| | - Ki-Soo Kang
- Department of Pediatrics, Jeju National University College of Medicine, Jeju, Korea
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Torino ABB, Gilberti MDFP, da Costa E, de Lima GAF, Grotto HZW. Evaluation of erythrocyte and reticulocyte parameters as indicative of iron deficiency in patients with anemia of chronic disease. Rev Bras Hematol Hemoter 2015; 37:77-81. [PMID: 25818816 PMCID: PMC4382577 DOI: 10.1016/j.bjhh.2015.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/24/2014] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to evaluate the effectiveness of mature red cell and reticulocyte parameters to identify three conditions: iron deficiency anemia, anemia of chronic disease, and anemia of chronic disease associated with absolute iron deficiency. Methods Peripheral blood cells from 117 adult patients with anemia were classified according to iron status, inflammation, and hemoglobinopathies as: iron deficiency anemia (n = 42), anemia of chronic disease (n = 28), anemia of chronic disease associated with iron deficiency anemia (n = 22), and heterozygous β-thalassemia (n = 25). The percentage of microcytic erythrocytes, hypochromic erythrocytes, and the levels of hemoglobin in both reticulocytes and mature red cells were determined. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating anemia. Results There was no difference between the groups of iron deficiency and anemia of chronic disease associated with absolute iron deficiency for any of the parameters. The percentage of hypochromic erythrocytes was the best parameter to identify absolute iron deficiency in patients with anemia of chronic disease (area under curve = 0.785; 95% confidence interval: 0.661–0.909 with sensitivity of 72.7%, and specificity of 70.4%; cut-off value 1.8%). The formula microcytic erythrocyte count minus hypochromic erythrocyte count was very accurate to differentiate iron deficiency anemia from heterozygous β-thalassemia (area under curve = 0.977; 95% confidence interval: 0.950–1.005 with a sensitivity of 96.2%, and specificity of 92.7%; cut-off value 13.8). Conclusion The erythrocyte and reticulocyte indices are moderately good to identify absolute iron deficiency in patients with anemia of chronic disease.
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Cançado RD, de Figueiredo PON, Olivato MCA, Chiattone CS. Efficacy and safety of intravenous iron sucrose in treating adults with iron deficiency anemia. Rev Bras Hematol Hemoter 2013; 33:439-43. [PMID: 23049360 PMCID: PMC3459362 DOI: 10.5581/1516-8484.20110119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 10/24/2011] [Indexed: 01/06/2023] Open
Abstract
Background Iron deficiency is the most common disorder in the world, affecting approximately 25% of the world`s population and the most common cause of anemia. Objective To evaluate the efficacy and safety of intravenous iron sucrose (IS) in the treatment of adults with iron deficiency anemia Methods Eighty-six adult patients with iron deficiency anemia, who had intolerance or showed no effect with oral iron therapy, received a weekly dose of 200 mg of intravenous iron sucrose until the hemoglobin level was corrected or until receiving the total dose of intravenous iron calculated for each patient Results The mean hemoglobin and serum ferritin levels were 8.54 g/dL and 7.63 ng/mL (pre-treatment) and 12.1 g/dL and 99.0 ng/mL (post-treatment) (p-value < 0.0001), respectively. The average increases in hemoglobin levels were 3.29 g/dL for women and 4.58 g/dL for men; 94% of male and 84% of female patients responded (hemoglobin increased by at least 2 g/dL) to intravenous iron therapy. Correction of anemia was obtained in 47 of 69 (68.1%) female patients and in 12 of 17 male (70.6%) patients. A total of 515 intravenous infusions of iron sucrose were administered and iron sucrose was generally well tolerated with no moderate or serious adverse drug reactions recorded by the investigators. Conclusions Our data confirm that the use of intravenous iron sucrose is a safe and effective option in the treatment of adult patients with iron deficiency anemia who lack satisfactory response to oral iron therapy. Intravenous iron sucrose is well tolerated and with a clinically manageable safety profile when using appropriate dosing and monitoring. The availability of intravenous iron sucrose would potentially improve compliance and thereby reduce morbidities from iron deficiency.
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Affiliation(s)
- Rodolfo Delfini Cançado
- Hematology-Oncology Department, Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, São Paulo, SP, Brazil
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Abstract
Oral iron supplementation is usually the first choice for the treatment of iron deficiency anemia (IDA) because of its effectiveness and low cost. But unfortunately in many iron deficient conditions, oral iron is a less than the ideal treatment mainly because of adverse events related to the gastrointestinal tract as well as the long course required to treat anemia and replenish body iron stores. The first iron product for intravenous use was high-molecular-weight iron dextran. However, dextran-containing intravenous iron preparations are associated with an elevated risk of anaphylactic reactions, which made physicians reluctant to prescribe intravenous iron in the treatment of iron deficiency anemia for many years. In 1999 and 2001, two new intravenous iron preparations (ferric gluconate and iron sucrose) were introduced into the market as safer alternatives to iron dextran. Over the last five years, three new intravenous iron dextran-free preparations have been developed and have better safety profiles than the more traditional intravenous compounds, as none require test doses and all these products are promising in respect to a more rapid replacement of body iron stores (15-60 minutes/infusion) as they can be given at higher doses (from 500 mg to more than 1000 mg/infusion). The purpose of this review is to discuss some pertinent issues in relation to the history, pharmacology, administration, efficacy, safety profile and toxicity of intravenous iron for the treatment of iron deficiency anemia.
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Affiliation(s)
- Rodolfo Delfini Cançado
- Hematology-Oncology Department, Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, São Paulo, SP, Brazil
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Abstract
With the objective of reducing the high incidence of iron deficiency anemia, the
Brazilian National Health Surveillance Agency (ANVISA) adopted Resolution 344 in
December 2002, which made the addition of iron and folic acid to all industrialized
wheat and maize flours in Brazil compulsory. After a series of doubts about this
universal measure of food fortification, a review of case reports on long-term
medicinal iron intake published in the medical literature was undertaken to
investigate the clinical behavior of this hematological conduct. Long-term medicinal
iron ingestion is an extremely rare and serious situation. The data suggest that
there are cases of hemochromatosis in women whose illnesses were accelerated with
this therapy. It is very difficult to determine the amount of iron ingested by
Brazilian citizens in the current system of fortification, but there is evidence that
there has been an appreciable increase. Although iron fortification of food has been
recognized by some authors as a good strategy to combat iron deficiency, some nation
shave abandoned this measure. The patient with hemochromatosis is the most affected
by compulsory iron fortification and as this disease is now considered a public
health problem, we believe that Resolution 344 of ANVISA should be reviewed in order
to find a solution beneficial to all segments of the Brazilian population; one should
not try to correct one condition (iron deficiency) by exacerbating another
(acceleration of iron overload cases).
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Abstract
Government health authorities approved, in December 2002, the ANVISA (National Sanitary Vigilance Agency) resolution number 344, making the addition of iron and folic acid to all wheat and maize flours industrialized in Brazil obligatory. After a brief review of iron deficiency, iron overload and folic acid deficiency several questions and remarks need to be made about this universal food fortification program. Iron salts and folic acid are drugs widely used in medicine and they may present undesirable side effects. There are potential risks with offering iron to the normal population for a long period of time and to patients with iron overload. Other important remarks are: there is no medical follow up of this treatment in the Brazilian population; patients can decide the quantity of foods (and of these nutrients) that they want to ingest; fortified foods may correct iron deficiency anemia but not necessarily the causes, which include gastrointestinal neoplasms; and folic acid in the diet may interfere with several treatment protocols that use folic acid antagonists, such as methotrexate. Finally, with the exception of some social programs, the costs of treatment using fortified foods are passed on to the population. Considering that Brazil has 330,000 active medical doctors it is suggested that our Health Ministry should invite them to take care of these important medical conditions.
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Lee SY, Song EY, Yun YM, Yoon SY, Cho YH, Kim SY, Lee MH. Serum prohepcidin levels in Helicobacter pylori infected patients with iron deficiency anemia. Korean J Intern Med 2010; 25:195-200. [PMID: 20526394 PMCID: PMC2880694 DOI: 10.3904/kjim.2010.25.2.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 02/12/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS Helicobacter pylori (H. pylori) infection appears to subvert the human iron regulatory mechanism and thus upregulates hepcidin, resulting in unexplained iron-deficiency anemia (IDA). We evaluated serum prohepcidin levels before and after eradication of H. pylori in IDA patients to assess whether it plays a role in IDA related to H. pylori infection. METHODS Subjects diagnosed with unexplained IDA underwent upper gastrointestinal endoscopy and colonoscopy to confirm H. pylori infection and to exclude gastrointestinal bleeding. Blood was sampled before treatment to eradicate H. pylori and again 1 month later. Serum prohepcidin levels were measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS Serum prohepcidin levels decreased significantly after oral iron replacement combined with H. pylori eradication (p = 0.011). The reduction ratio of serum prohepcidin levels after the treatment did not differ among the combined oral iron replacement and H. pylori eradication groups, the H. pylori eradication only group, and the iron replacement only group (p = 0.894). CONCLUSIONS Serum prohepcidin levels decrease after both H. pylori eradication and oral iron administration, with improvement in IDA. Serum concentration of prohepcidin is related to the anemia status, rather than to the current status of H. pylori infection, in IDA patients.
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Affiliation(s)
- Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeo Min Yun
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - So Young Yoon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yo Han Cho
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sung-Yong Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mark Hong Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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