Железодефицитные новости

[Dr.Vad]

еще одна публикация теперь из Турции, что у детей с аффективно-респираторными приступами лечение пр-том железа помогает вне зависимости от наличия анемизации:
Cyanotic breath-holding spells were diagnosed in 85.3% (n = 266) of patients, pallid spells in 5.1% (n = 16), and mixed-type spells in 9.6% (n = 30). Sleep electroencephalograms were applied for all patients, 98.2% (n = 306) of which were normal, while slow background rhythm was determined in 1.2% (n = 4). Epileptic activity was observed in only 2 patients (0.6%). The mean hemoglobin (Hb) value in the breath-holding spell group was 101 g/L. Patients’ mean corpuscular volume (MCV) was 73 fL. Patients’ Hb and MCV values were statistically significantly lower than those of the control group (P < 0.001). The difference between spell burden was not statistically significant (P = 0.691). Spell burden decreased equally in both groups.
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Turk J Med Sci. 2019 Feb 11;49(1):230-237. doi: 10.3906/sag-1805-92.
Iron supplementation should be given in breath-holding spells regardless of anemia
Gürbüz G, и соавт.

[Dr.Vad]

De Novo Anemia and Relationship with Vitamin C Deficiency and Zinc Deficiency in a Southern Delaware Population, a Retrospective Analysis
Aasim S. Sehbai and Nouman Asif
Blood 2015 126:4547.

Background:
Vitamin C is an essential dietary nutrient. It is a water soluble vitamin that exists in the body primarily in the reduced form Ascorbic acid. It's deficiency leads to a disease called Scurvy which is rare in developed countries. The relationship between anemia, Iron deficiency and Vitamin C deficiency is not clear and not evidence-based although many hematologists recommend Vitamin C intake to help Iron absorption.

Method:
We reviewed the data from a single institution where cases of de novo anemia underwent diagnostic workup. The study was approved by the hospital IRB and it was a retrospective analysis of data from October 2007 through July 2014. In addition to checking patient's CBC, iron studies, ferritin, b12, folic acid all patients (pts) went through testing for Vitamin C, Copper and Zinc. All reference labs were send to Mayo medical laboratories for consistency and standardization. Vitamin C level was determined by a High-Performance Liquid Chromatography (HLPC) and samples were collected after a 12-14 hour fasting-overnight. The normal range for Vitamin C is 0.6-2.0 mg/dL. We divided patients into 5 categories Severe deficiency (<0.1 mg/dL), Moderate deficiency (0.1-0.3 mg/dL), Mild deficiency (0.4-0.6 mg/dL), Low normal or Borderline values (0.7-0.8 mg/dL) and Normal results (0.9-2.0 mg/dL).

Results:
Of the 482 pts with de novo anemia tested, 273 subjects were found to have a Vitamin C deficiency (56.6% of population). Of those 30 pts (10.9%) had severe Vit C deficiency, 96 (35.1%) had moderate deficiency, 84 (30.7%) mild deficiency and 63 (23%) had low normal or borderline values and 209 (43.3%) had normal results. In pts with Vitamin C deficiency, iron studies indicated a serum iron saturation below 20% (range 20-50%) in 115 out of 212 subjects tested giving an incidence of 54.2%. Pts who had Vitamin C deficiency about 212 of those pts were tested for zinc levels and 103 pts (48.5%) were found to have Zinc deficiency that's value below 0.66 mcg/ml (Normal range being 0.66-1.1 mcg/ml). Of the group with severe Vitamin C deficiency or undetectable levels (30 pts), average hemoglobin for that group was 8.8 gm/dl range being 11.3-15.5 (CI 5.5-14.9), average iron saturation was 31% range (20-50%)(CI 3-92%), average Zinc levels were 0.49 mcg/ml range 0.66-1.1 (CI 0.19-0.79) average copper value 1.26 mcg/ml range 0.75-1.45 mcg/ml (CI 0.77-1.74), average Ferritin value 104.8 ng/ml, range 22-322 ng/ml (CI 13.8-5621). This means that in pts with severe anemia and severe vitamin C deficiency we see a profile where 77% pts also present with Zinc deficiency, their copper values are normal, iron saturation is normal but Ferritin which is a marker of inflammation is elevated (66.6%). Taking all of Vitamin C deficiency cases in our study the average age of females was 57.4 years (CI 15-97) 67.3% of study group & average age for males was 59.6 years (CI 25-90) which is 32.7%

Pts who were found to have Vitamin C deficiency were given Vitamin C tablet 500 mg orally daily and if they have Zinc deficiency also supplemented with Zinc 50 mg orally daily. We have data on 67 of those 212 pts who had significant C deficiency (severe, moderate or mild). The average improvement in Vitamin C level for the group was 0.43 mg with average hemoglobin improvement of 0.96 gm.

Conclusion:
Vitamin C deficiency appears to play an important role in pathogenesis of nutritional anemia and it's incidence was more common than any other identifiable cause in our group. It can present as anemia regardless of the iron status and there appears to be a very strong correlation between Vit C deficiency and Zinc deficiency in patients with anemia. It also causes an Inflammatory response with elevation of Ferritin. Diet appears to play a major role in this type of anemia regardless of the body habitus. Malabsorption of Vitamin C and Zinc can be a reason as well. It is more common in females. Patients may or may not have other signs and symptoms of scurvy but in our population gum disease, bone pain, impaired wound healing and some degree of psychosis and mood disorder (scorbutic psychosis) was common. We believe that Vitamin C Deficiency is very common and under recognized cause of anemia. The exact pathophysiology needs to be established. Further studies need to be done to validate this important clinical finding but we recommend adding a fasting Vitamin C level and Zinc level as part of de novo anemia workup.

[Dr.Vad]

еще одна публикация и краткий обзор опубликованного о децизионных уровнях показателя reticulocyte hemoglobin в диагностике жд или жда:

CHr cutoff value of 30.15 pg can identify IDA with a 87.8% sensitivity and 77.7% specificity. The aforesaid cut-off value is similar to the 30.7 pg cut-off value reported by Auerbach et al. (2021) in a cohort of 556 patients [13]. Additionally, a number of recent studies reported similar cut-off values ranging from 30 pg to 30.9 pg [19, 20].
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Defining an optimal cut-off point for reticulocyte hemoglobin as a marker for iron deficiency anemia/PLOS 2023

[Dr.Vad]

апдейт по в/в препаратам железа из Австралии - открытый доступ к полному тексту обзора:

Intravenous iron: an update 2023

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

обзор вышел 3 года назад, но на глаза попалась только сейчас - полная версия по ссылке:

Conclusions
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The bioavailability and side effect profile of ferrous iron salts are similar, but their elemental iron content and cost varies; thus, choice should generally be based on the amount of iron and cost.

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Compared to ferric Fe3+ salts, ferrous Fe2+ salts are generally better absorbed.

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Absorption of oral iron, particularly when taken with meals, will be higher if given with ascorbic acid at a molar ratio of ≥2:1 to iron; that is, about 6 mg of ascorbic acid for each 1 mg of iron.

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Although WHO has recommended intermittent iron supplementation (WHO, 2011), proposing as the rationale a mucosal block in enterocytes lasting for 5–6 days, our data clearly indicate that 48 h, not 5 or 6 days, is sufficient time for iron absorption to return to baseline.

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Given as ferrous sulfate, oral iron doses ≥60 mg in non-anemic women with iron deficiency and ≥100 mg in women with IDA trigger an increase in circulating hepcidin that persists 24 h after the dose, but subsides by 48 h. It appears oral iron doses ≤40 mg do not trigger an acute increase in circulating hepcidin in iron-deficient subjects. This suggests the optimal dosing schedule to maximize fractional iron absorption in women with iron deficiency and mild IDA is to give oral doses ≤40 mg daily and give doses ≥60 mg on alternate days.

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There is a circadian increase in circulating hepcidin over the day and this is augmented by a morning iron dose; therefore, iron doses should not be given in the afternoon or evening after a morning dose.

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If rate of Hb response is important, twice the target daily iron dose can be given on alternate days. However, because fractional iron absorption decreases sharply with increasing iron doses, and unabsorbed luminal iron likely has adverse effects on the gut, lower doses may be better tolerated and improve compliance.
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Oral iron supplementation in iron-deficient women: How much and how often?
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Длительная терапия железом у пациентов с риском редидива ЖД из-за мальабсорбции или потерь - варианты лечения/мониторинг анализами крови и др.

CHRONIC IRON NEED

There are many populations who will require ongoing iron supplementation beyond initial iron repletion as a maintenance iron therapy. Such populations include those with inflammatory bowel disease and malabsorption (e.g., bariatric surgery) or ongoing GI blood loss (e.g., abnormal uterine bleeding refractory to or awaiting gynecologic intervention).

Current guidelines recommend routinely rechecking complete blood count, reticulocytes, reticulated-Hb content, and iron parameters 3–6 months after initial iron repletion to determine whether ongoing iron supplementation is required and to establish the optimal route, dose, and frequency. For some patients (e.g., women with HBM), asymptomatic outpatients with mild ID/IDA in whom there is no inflammation and in whom oral iron is well tolerated, we are successful in maintaining normal iron stores and Hb levels using once-per-day or every-other-day oral iron. In other patients, a regimen of once per month, once every 3 months, or once every 6 months IV of iron is required, with the goal of maintaining normal iron status (ferritin >30 mg/L; TSAT >20%)
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из Iron deficiency anemia in women: pathophysiological, diagnosis, and practical management.
Cançado RD.
Rev Assoc Med Bras (1992). 2023 Aug 4;69(suppl 1):e2023S112.

[Dr.Vad]

Американский опыт лечения ЖДА в/в феринджектом - оценка некоторых показателей шкал здоровья до и спустя 3 мес. лечения (гемоглобин повысился с 102 до 128 г/л)

total of 152 patients were enrolled.
Mean age was 47.4 ± 16.0 years and 82.2% were female.
All patients were treated with at least one FCM dose at baseline, with 77.6% receiving a two-dose treatment course.
A minimum 5-point improvement, pre-defined as clinically meaningful, was seen in the
FACIT-Fatigue for 73%,
PROMIS Global Physical Health = 53%,
Global Mental Health = 42%,
PROMIS Physical Function scores = 40% of patients at 3 months...
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Int J Gen Med.. 2023 Aug 2;16:3291-3300.
Patient-Reported Outcomes After Ferric Carboxymaltose Treatment for Iron Deficiency Anemia: A Prospective Observational Study