Железодефицитные новости
 

Уважаемые коллеги,

Этим сообщением открываю новую тему, где буду размещать тезисы недавних публикаций по железодефициту или ЖД анемии, имеющие определенный клинический интерес. Начну с работы из Швейцарии от известного специалиста, работы которого посвящены изучению связи железодефицита и нарушению функции щитовидной железы:

J Clin Endocrinol Metab. 2007 Jun 12;
Iron deficiency predicts poor maternal thyroid status during pregnancy.
Zimmermann MB, Burgi H, Hurrell RF.
Laboratory for Human Nutrition, Swiss Federal Institute of Technology (ETH) Zürich; Committee for Fluoride-Iodine Fortification of Salt, Swiss Academy of Medical Science, Bern, Switzerland.

Context: Pregnant women are often iron deficient, and iron deficiency has adverse effects on thyroid metabolism. Impaired maternal thyroid function during pregnancy may cause neurodevelopmental delays in the offspring. Objective: To investigate if maternal iron status is a determinant of TSH and/or TT4 concentrations during pregnancy Design and Outcome Measures: In a representative national sample of Swiss pregnant women (n=365) in the 2(nd) and 3(rd) trimester, samples of urine and blood were collected, and data on maternal characteristics and supplement use was recorded. Concentrations of TSH, TT4, hemoglobin, mean corpuscular volume, serum ferritin (SF), transferrin receptor (TfR) and urinary iodine (UI) were measured. Body iron stores were calculated and stepwise regressions done to look for associations. Results: The median UI (range) was 139 (30-433) microg/L. In the 3(rd) trimester, nearly 40% of women had negative body iron stores, 16% of woman had a TT4 <100 nmol/L and 6% had a TSH >4.0 mU/L. Compared to the women with positive body iron stores, the relative risk of a TT4 <100 nmol/L in the group with negative body iron stores was 7.8 (95% CI: 4.1; 14.9). Of the 12 women with TSH >4.0 mU/L, 10 of them had negative body iron stores. SF, TfR and body iron stores were highly significant predictors of TSH (standardized beta: -0.506, 0.602, and -0.589, respectively, all p<0.0001) and TT4 (standardized beta: 0.679, -0.589, and 0.659, respectively, all p<0.0001). Conclusions: Poor maternal iron status predicts both higher TSH and lower TT4 concentrations during pregnancy in an area of borderline iodine deficiency.

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Эта работа еще раз показывает, что Мальтофер (трехвалентное железо) не всегда оптимальное лекарство для лечения ЖДА и достаточно порой просто сменить препарат на старый добрый сульфат или фумарат железа (II):

Hematology. 2007 Jun;12(3):255-6.
Ineffectiveness of oral iron hydroxide polymaltose in iron-deficiency anemia.
Ruiz-Argüelles GJ, Díaz-Hernández A, Manzano C, Ruiz-Delgado GJ.
Centro de Hematología y Medicina Interna de Puebla, Puebla, PUE, Mexico.

Two hundred and forty one patients with iron deficiency anemia (IDA) were identified in a single institution over a 24-year period; of these, 75 individuals were studied as the result of persistent IDA despite the administration of oral iron hydroxide polymatose (IP). The levels of hemoglobin when the patients were referred for study after being given oral IP had a median of 10.3 g/dl; after administration of oral iron fumarate during periods ranging from 1 to 14 months, the levels of hemoglobin rose to a median of 12.5 g/dl (p>0.01). Our data support previous observations made in other countries about the ineffectiveness of oral IP in the treatment of individuals with IDA and should alert the clinician to avoid unnecessary consultations and misdiagnosis.

Эту статью к новинкам отнести сложно, но в виду того, что только недавно удалось раскопать ее полный текст, приведу ее фрагменты: у студентов 16-19 лет (преимущественно девушек) на фоне коррекции железодефицита снизились головокружения, раздражимость, слабость/недомогание, депрессивные симптомы, чувствительность к холоду:

"There was a significant reduction after iron treatment in students with one abnormal laboratory test result, concerning the symptoms vertigo/dizziness, fatigue, irritability, over-exertion, depressive symptoms, indisposition, and sensitiveness to cold."

Symptom panorama in upper secondary school students and symptoms related to iron deficiency

Screening with laboratory tests, questionnaire and interventional treatment with iron

Scandinavian Journal of Primary Health Care, 2005; 23: 28-33

Еще одна работа от французов, известных своими изысканиями в области синдрома attention-deficit/hyperactivity и железодефицита: похоже, что у детей с наиболее выраженным этим расстройством часто присутствует и синдром беспокойных ног, а также наибольший железодефицит, оцениваемый по низкому уровню ферритина:

Sleep Med. 2007 Jul 17;
Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children.
Konofal E, Cortese S, Marchand M, Mouren MC, Arnulf I, Lecendreux M.

OBJECTIVE: Increasing evidence suggests a significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and restless legs syndrome (RLS). Iron deficiency may underlie common pathophysiological mechanisms in subjects with ADHD plus RLS (ADHD+RLS). To date, the impact of iron deficiency, RLS and familial history of RLS on ADHD severity has been scarcely examined in children. These issues are addressed in the present study. METHODS: Serum ferritin levels, familial history of RLS (diagnosed using National Institutes of Health (NIH) criteria) and previous iron supplementation in infancy were assessed in 12 ADHD+RLS children, 10 ADHD children and 10 controls. RLS was diagnosed using NIH-specific pediatric criteria, and ADHD severity was assessed using the Conners' Parent Rating scale. RESULTS: ADHD symptom severity was higher, although not significantly, in children with ADHD+RLS compared to ADHD. The mean serum ferritin levels were significantly lower in children with ADHD than in the control group (p<0.0005). There was a trend for lower ferritin levels in ADHD+RLS subjects versus ADHD. Both a positive family history of RLS and previous iron supplementation in infancy were associated with more severe ADHD scores. CONCLUSIONS: Children with ADHD and a positive family history of RLS appear to represent a subgroup particularly at risk for severe ADHD symptoms. Iron deficiency may contribute to the severity of symptoms. We suggest that clinicians consider assessing children with ADHD for RLS, a family history of RLS, and iron deficiency.

Одна из предыдущих публикаций от этих авторов в полном доступе:

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Еще одна публикация отражающая взаимосвязь ЖДА и повышенного гликогемоглобина: примечательна тем, что показывает на повышенные уровни малондиальдегида и фруктозамина у пациентов с ЖДА, корректирующиеся после терапии железом. Это может указывать на повышенный процесс гликирования гемоглобина при ЖДА, а не просто удельное повышение % гликогемоглобина вследствие уменьшения его негликированной фракции при анемии. (Если так, то выявление и коррекция латентного железодефицита у больных с СД теоретически может способствовать улучшению гликемического контроля по уровню HbA1c)

Biomed Pharmacother. 2007 Jul 23;
Increased plasma malondialdehyde and fructosamine in iron deficiency anemia: Effect of treatment.
Sundaram RC, Selvaraj N, Vijayan G, Bobby Z, Hamide A, Rattina Dasse N.
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Pondicherry 605 006, India.

Glycation and lipid peroxidation are spontaneous reactions that are believed to play a key role in the pathogenesis of many clinical disorders. Glycation of proteins is enhanced by elevated glucose concentrations. However, increased glycated hemoglobin levels have been documented in iron deficiency anemic patients without any history of diabetes. Collective evidences reveal that lipid peroxidation can modulate protein glycation. This study was undertaken to unravel the possible association of malondialdehyde and fructosamine in iron deficient anemic patients and to observe the possible alteration in malondialdehyde and fructosamine levels in these patients after one month supplementation with iron. Twenty non-diabetic anemic patients and 16 age-matched healthy subjects were enrolled for this study. Plasma lipid peroxides, fasting glucose, fructosamine, iron, ferritin and hemoglobin were analyzed in both the groups. Partial correlation analysis was performed to predict the independent association of malondialdehyde and fasting glucose on fructosamine. In anemic patients, while fructosamine and malondialdehyde levels were found to be significantly increased, hemoglobin, iron and ferritin levels decreased significantly when compared to before treatment. Fructosamine was found to have a significant positive correlation with malondialdehyde even after nullifying the effect of glucose. After one month supplementation with iron, both fructosamine and malondialdehyde levels decreased significantly when compared to before treatment. There was a significant increase in iron, ferritin and hemoglobin levels in anemic patients after one month of treatment. In conclusion, an increased level of fructosamine and malondialdehyde was found in anemic patients. These data suggest that fructosamine levels are closely associated with malondialdehyde concentrations in iron deficient anemic patients.

Pediatrics. 2007 Sep;120(3):568-575.
Iron Deficiency in Early Childhood in the United States: Risk Factors and Racial/Ethnic Disparities.
Brotanek JM, Gosz J, Weitzman M, Flores G.
Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063.

BACKGROUND. Iron deficiency affects 2.4 million US children, and childhood iron-deficiency anemia is associated with behavioral and cognitive delays. Given the detrimental long-term effects and high prevalence of iron deficiency, its prevention in early childhood is an important public health issue. OBJECTIVES. The study objectives were to (1) identify risk factors for iron deficiency in US children 1 to 3 years old, using data from the most recent waves of the National Health and Nutrition Examination Survey IV (1999-2002) and (2) examine risk factors for iron deficiency among Hispanic toddlers, the largest minority group of US children. PATIENTS AND METHODS. Analyses of the National Health and Nutrition Examination Survey IV were performed for a nationally representative sample of US children 1 to 3 years old. Iron-status measures were transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. Bivariate and multivariable analyses were performed to identify factors associated with iron deficiency. RESULTS. Among 1641 toddlers, 42% were Hispanic, 28% were white, and 25% were black. The iron deficiency prevalence was 12% among Hispanics versus 6% in whites and 6% in blacks. Iron deficiency prevalence was 20% among those with overweight, 8% for those at risk for overweight, and 7% for normal-weight toddlers. Fourteen percent of toddlers with parents interviewed in a non-English language had iron deficiency versus 7% of toddlers with parents interviewed in English. Five percent of toddlers in day care and 10% of the toddlers not in day care had iron deficiency. Hispanic toddlers were significantly more likely than white and black toddlers to be overweight (16% vs 5% vs 4%) and not in day care (70% vs 50% vs 43%). In multivariable analyses, overweight toddlers and those not in day care had higher odds of iron deficiency. CONCLUSIONS. Toddlers who are overweight and not in day care are at high risk for iron deficiency. Hispanic toddlers are more likely than white and black toddlers to be overweight and not in day care. The higher prevalence of these risk factors among Hispanic toddlers may account for their increased prevalence of iron deficiency.

'Исследование американских ученых впервые выявило связь между патологическим ожирением и недостатком железа в организме. По результатам анализов, 20% тучных детей страдают от низкого содержания железа в организме, в то время как только 7% детей с нормальным весом больны железодефицитной анемией...'

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Индукция железодефицита путем эксфузий крови в 2 раза сокращает развитие печеночно-клеточного рака у больных с хр. гепатитом С:

J Gastroenterol. 2007 Oct;42(10):830-6.
Long-term phlebotomy with low-iron diet therapy lowers risk of development of hepatocellular carcinoma from chronic hepatitis C.
Kato J, Miyanishi K, Kobune M, Nakamura T, Takada K, Takimoto R, Kawano Y, Takahashi S, Takahashi M, Sato Y, Takayama T, Niitsu Y.
Fourth Department of Internal Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.

BACKGROUND: We have previously demonstrated that in patients with chronic hepatitis C (CHC), iron depletion improves serum alanine aminotransferase (ALT) levels as well as hepatic oxidative DNA damage. However, it has not been determined whether continuation of iron depletion therapy for CHC favorably influences its progression to hepatocellular carcinoma (HCC). METHODS: We conducted a cohort study on biopsy-proven CHC patients with moderate or severe liver fibrosis who failed to respond to previous interferon (IFN) therapy or had conditions for which IFN is contradicted. Patients were divided into two groups: subjects in group A (n = 35) underwent weekly phlebotomy (200 g) until they reached a state of mild iron deficiency, followed by monthly maintenance phlebotomy for 44-144 months (median, 107 months), and they were advised to consume a low-iron diet (5-7 mg iron/day); group B (n = 40) comprised CHC patients who declined to receive iron depletion therapy. RESULTS: In group A, during the maintenance phase, serum ALT levels decreased to less than 60 IU/l in all patients and normalized (<40 IU/l) in 24 patients (69%), whereas in group B no spontaneous decrease in serum ALT occurred. Hepatocarcinogenesis rates in groups A and B were 5.7% and 17.5% at the end of the fifth year, and 8.6% and 39% in the tenth year, respectively. Multivariate analysis revealed that iron depletion therapy significantly lowered the risk of HCC (odds ratio, 0.57) compared with that of untreated patients (P = 0.0337). CONCLUSIONS: Long-term iron depletion for CHC patients is a promising modality for lowering the risk of progression to HCC.

Публикация будушего года от французских коллег - прием железа снижает остроту синдрома гиперактивности/нарушения внимания у детей с латентным железодефицитом:

Pediatr Neurol. 2008 Jan;38(1):20-26.
Effects of Iron Supplementation on Attention Deficit Hyperactivity Disorder in Children.Konofal E, Lecendreux M, Deron J, Marchand M, Cortese S, Zaïm M, Mouren MC, Arnulf I.
Hôpital Robert Debré, Service de Psychopathologie de l’Enfant et de l’Adolescent, Paris, France; Hôpital Pitié Salpetrière, Fédération des Pathologies du Sommeil, APHP, Paris, France.

Iron deficiency has been suggested as a possible contributing cause of attention deficit hyperactivity disorder (ADHD) in children. This present study examined the effects of iron supplementation on ADHD in children. Twenty-three nonanemic children (aged 5-8 years) with serum ferritin levels <30 ng/mL who met DSM-IV criteria for ADHD were randomized (3:1 ratio) to either oral iron (ferrous sulfate, 80 mg/day, n = 18) or placebo (n = 5) for 12 weeks. There was a progressive significant decrease in the ADHD Rating Scale after 12 weeks on iron (-11.0 +/- 13.9; P < 0.008), but not on placebo (3.0 +/- 5.7; P = 0.308). Improvement on Conners' Parent Rating Scale (P = 0.055) and Conners' Teacher Rating Scale (P = 0.076) with iron supplementation therapy failed to reach significance. The mean Clinical Global Impression-Severity significantly decreased at 12 weeks (P < 0.01) with iron, without change in the placebo group. Iron supplementation (80 mg/day) appeared to improve ADHD symptoms in children with low serum ferritin levels suggesting a need for future investigations with larger controlled trials. Iron therapy was well tolerated and effectiveness is comparable to stimulants.

Железодефицит или ЖД анемия может быть наиболее частой причиной генерализованного зуда:

Am J Clin Dermatol. 2008;9(1):39-44
Generalized pruritus: a prospective study concerning etiology.
Polat M, Oztas P, Ilhan MN, Yalçin B, Alli N.
1st Dermatology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.

BACKGROUND: Generalized pruritus can often be the primary manifestation of systemic disease. OBJECTIVE: To determine how frequently generalized pruritus had a systemic etiology in an outpatient population seen in a dermatology department and whether any identifiable patient characteristics meant a systemic explanation of generalized pruritus was more likely. METHODS: A prospective controlled study of 55 patients with generalized pruritus and 41 healthy age- and sex-matched control subjects. Clinical data were collected from patients and laboratory parameters investigated in both patients and healthy control subjects to determine the frequency of systemic disease in each group. RESULTS: Of 55 patients, 12 had a systemic cause of pruritus. Pruritus was the initial symptom of systemic disease in eight of these patients. The underlying diseases included hypothyroidism, chronic lymphocytic leukemia, hepatitis C, hepatitis B, diabetes mellitus, lung cancer, uremia, and iron deficiency anemia. Of these, iron deficiency anemia was the most common cause. Compared with the control group, mean serum hemoglobin, iron, and cyanocobalamin (vitamin B(12)) levels in patients with generalized pruritus were lower. No other patient characteristics were statistically associated with systemic causes of pruritus. CONCLUSION: Generalized pruritus was the initial symptom of a systemic disease in 8 of 55 patients presenting to a dermatology outpatient clinic with this complaint. A number of underlying diseases were identified, of which the most common was iron deficiency anemia.

Железодефицитная анемия может быть причиной повышенного риска желчнокаменной болезни:

Ann Hematol. 2009 Jan;88(1):17-20.
Patients with iron deficiency anemia have an increased prevalence of gallstones.
Pamuk GE, Umit H, Harmandar F, Yeşil N.
Division of Hematology, Trakya University Medical Faculty, Edirne, Turkey.

We determined the frequency of gallstones (GS) in iron deficiency anemia (IDA) patients and evaluated factors that could affect GS formation-like lipid levels and gallbladder (GB) motilities of the patients. One hundred and eleven IDA patients (88 females, 23 males; median age, 42) and 81 healthy controls (68 females, 13 males; median age, 42) were included into our study. The clinical findings of all IDA patients were recorded down; biochemical values and body mass index (BMI) were determined; and abdominal ultrasonography was performed. In addition, GB emptying was monitored by ultrasound at 30-min intervals for 2 h after a mixed meal in randomly chosen, age-matched 25 IDA patients and 26 controls. Fasting volume (FV), residual volume (RV), and ejection fraction (EF) for all GBs were determined. The frequency of GS plus cholecystectomy was significantly higher in IDA patients (15 cases, 13.5%) than in the control group (five cases, 6.2%, p = 0.048). IDA patients with GS plus cholecystectomy were older than those without GS plus cholecystectomy (p < 0.001). FV and EF did not differ between IDA and control groups (p > 0.05). On the other hand, RV was significantly higher in IDA group than in controls (p = 0.035). The frequency of GS in IDA patients was significantly higher than in controls. The increased prevalence of GS in IDA might be explained with impaired GB motility.

Железодефицитная анемия может быть причиной рецидивирующего среднего отита у детей 0,5-4 года: чем ниже уровень гемоглобина, тем больше число рецидивов в год, коррекция анемии приводила к снижению частоты рецидивов у большинства детей:

The association between iron-deficiency anemia and recurrent acute otitis media.
Golz A, Netzer A, Goldenberg D, Westerman ST, Westerman LM, Joachims HZ.
Am J Otolaryngol. 2001 Nov-Dec;22(6):391-4.

Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center and the Faculty of Medicine, Haifa, Israel.

PURPOSE: This study was designed to examine the association between iron-deficiency anemia and the frequency of recurrent acute otitis media in children, and to evaluate the effect of restoring normal hemoglobin levels on the frequency of acute otitis media attacks.
MATERIALS AND METHODS: A total of 680 children with frequent episodes of acute otitis media were enrolled in the study. The levels of the hemoglobin were measured in both these children and in 200 healthy children with no history of infections. All children with hemoglobin levels lower than 9.5 g/dL received iron supplementation until they reached a level of at least 11 g/dL, and the subsequent frequency of middle ear infections was recorded.
RESULTS: The 680 children had an average of 8.3 +/- 2.7 episodes of acute otitis media per year per child, and an average hemoglobin level of 11.4 +/- 2.7 g/dL, whereas the controls had an average hemoglobin level of 13.1 +/- 2.5 g/dL. Twenty percent had hemoglobin levels below 9.5 g/dL. These children had more episodes of acute otitis media when compared with children with average levels. By increasing the hemoglobin level in these children, the frequency of the episodes of acute otitis media decreased significantly.

Недавняя работа от турецких коллег: одна из возможных причин повышенных кровопотерь во время месячных у женщин с ЖДА - снижение агрегации тромбоцитов на арахидоновую кислоту (аспириноподобное действие), которая возвращается к норме после лечения препаратами железа:

Pathophysiol Haemost Thromb. 2008;36(2):80-3.
Effect of Iron Therapy on Platelet Function among Iron-Deficient Women with Unexplained Menorrhagia.
Akay OM, Akin E, Mutlu FS, Gulbas Z.
Department of Hematology, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey.

This study was performed to evaluate the effect of iron therapy on platelet function among women with unexplained menorrhagia in order to better understand possible interactions between iron deficiency anemia and platelet behavior and menorrhagia. Platelet aggregation and adenosine triphosphate (ATP) release induced by 5.0 mM adenosine diphosphate (ADP), 0.5 mM arachidonic acid (AA), 1.0 mg/ml ristocetin and 2 microg/ml collagen were studied by whole-blood platelet lumi-aggregometer in 50 menorrhagic women before and after oral iron therapy and in 22 women of the control group. There was a significant increase in AA- induced platelet aggregation (p < 0.05) and a decrease in ristocetin-induced platelet aggregation (p < 0.01) after treatment. Pre- and posttreatment platelet aggregation responses to ADP and collagen were not significantly different (p > 0.05). Pre- and posttreatment platelet secretion responses to all agonists disclosed no significant difference (p > 0.05). There was no significant difference between the study group after treatment and the control group in respect to platelet aggregation and ATP secretion values induced by all agonists (p > 0.05). We conclude that iron deficiency anemia in women causes AA-induced platelet dysfunction, which may give rise to increased menstrual blood loss and can be reversed by iron repletion.

Еще один эвиденс, что в основе зуда неясной этиологии наиболее часто может быть латентный железодефицит:

J Eur Acad Dermatol Venereol. 2008 May;22(5):615-618
Positivity of iron studies in pruritus of unknown origin.
Bharati A, Yesudian PD.

We audited 21 patients with Pruritus of unknown origin (PUO), obtaining case-notes from 4 hospitals in Merseyside, United Kingdom. The investigations done in these patients included full blood count (FBC), erythrocyte sedimentation rate (ESR), urea and electrolytes (U & E), liver function tests (LFT), glucose, ferritin, iron studies, thyroid function tests (TFT), IgE, RAST, immunoglobulins and chest X-ray (CXR).

The age range was 27 to 89 years (mean, 66.7 years), with 15 female and 6 male patients. The average number of investigations done for each patient was 5.3 (range, 0–9). The mean number of investigations per patient varied from hospital to hospital (range, 2.5–6.8).

Ferritin, iron studies or both had been done in 17 patients and an abnormality found in 8 (47%). Ferritin was abnormal in 4 (44%) of 9 patients and iron studies in 4 (36%) of 11 patients. LFTs showed an abnormality in 20%, whereas the positivity rate was less for other investigations. CXR, immunoglobulins and RAST were normal in all patients.

The causes of PUO are wide-ranging and include chronic renal failure, cholestasis, iron deficiency and internal malignancy. The mechanism underlying the association between iron deficiency and PUO remains unclear. Restoring the serum ferritin to normal levels by iron supplementation therapy has been reported to result in the resolution of pruritus of iron deficiency.

In our audit, none of the investigations were found to be significantly useful except ferritin and iron studies. With the high positivity rate in our audit for iron studies and ferritin, we recommend that they should be done in all patients with PUO.

Идиопатическая интракраниальная гипертензия в 10% случаев может быть обусловлена железодефицитной анемией, коррекция анемии в большинстве случаев приводит к излечению:

Eur Neurol. 2009 Jun 12;62(2):105-108.
Idiopathic Intracranial Hypertension Associated with Iron Deficiency Anaemia: A Lesson for Management.
Mollan SP, Ball AK, Sinclair AJ, Madill SA, Clarke CE, Jacks AS, Burdon MA, Matthews TD.
The Birmingham Neuro-Ophthalmology Unit, Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK.

Aim: To document the causal association of iron deficiency anaemia (IDA) and intracranial hypertension (IH). Methods: A consecutive case note review of patients with a clinical diagnosis of idiopathic intracranial hypertension (IIH) and anaemia presenting to a tertiary referral unit over a 2.5-year period. Demographics, aetiology and clinical details were recorded and analysed. Results: Eight cases were identified from 77 new cases presenting with IIH. All 8 had documented microcytic anaemia with clinical evidence of raised intracranial pressure. There was no evidence of venous sinus thrombosis on MRI and MR venography in 7 subjects and on repeated CT venography in 1. On correction of anaemia alone, 7 cases resolved. One patient with severe progressive visual loss underwent ventriculoperitoneal shunt in addition to treatment of anaemia, with good outcome. The incidence of this association is 10.3%. Conclusion: These cases present an association between IDA and IH, in the absence of cerebral sinus thrombosis. As a clinically significant proportion of cases presenting with signs of IIH have IDA, we recommend all patients presenting with IIH have full blood counts and if they are found to be anaemic, they should be treated appropriately.
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Еще более ранний эвиденс по теме с обзором всех опубликованных случаев:

We found 30 well-documented cases with isolated anemia and papilledema in the English and French literature. Among those, 13 were excluded from our analyses (11 had confounding disorders and 2 had cerebral venous thrombosis). In the remaining 17 cases isolated raised ICP associated with anemia was the most likely diagnosis, although in none of these cases was cerebral venous thrombosis excluded. A lumbar puncture confirmed raised ICP in only 10 cases. The remaining 7 cases did not have a lumbar puncture, therefore raised ICP could not be confirmed; however, the clinical presentations were highly suggestive of raised ICP associated with anemia. There were 14 women and 3 men, with a mean age of 24 years, range 4 to 56; 6 were obese; all had bilateral papilledema, associated with cotton–wool spots (CWS) in 8, peripapillary hemorrhages in 9, and retinal or preretinal hemorrhages in 4; 11 had chronic headaches, 1 had tinnitus, 5 had VIth nerve palsies, and 4 complained of dizziness. The ICP was elevated in all 10 patients in whom a lumbar puncture was performed (mean opening pressure of 385 mm; range, 220–600). All 17 cases had severe anemia, with a mean hemoglobin of 5.4 g/dl, range, 17 to 25 secondary to iron deficiency in 11, B12 deficiency in 1, combined B12 and folate deficiencies in 1, aplastic anemia in 3, and transient erythroblastopenia in 1. Treatment included successful reversal of the anemia in all 17, and lumbar puncture in 10 patients. Visual prognosis was good in 15 patients and unknown in 2.

Anemia and papilledema.
Biousse V, Rucker JC, Vignal C, Crassard I, Katz BJ, Newman NJ.
Am J Ophthalmol. 2003 Apr;135(4):437-46.

Железодефицитная анемия может нарушать регенерацию энтероцитов тонкого кишечника и приводить виллозной (сосочковой) атрофии, тем самым вызывая мальабсорбцию и нарушение усвоения пероральных препаратов - в/в коррекция препаратом железа привела к ликвидации анемии и полной регенерации нормальной слизистой кишечника:

Nutr Hosp. 2009 Oct;24(5):618-621.

Atrophy of the intestinal villi in a post-gastrectomy patient with severe iron deficiency anemia.
Lizarraga A, Cuerda C, Junca E, Bretón I, Camblor M, Velasco C, García-Peris P.

Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, España.

Background & aims: Iron deficiency anemia is a common complication of gastric surgery that in certain patients can be refractory to treatment with oral iron and needs to be treated parenterally. Methods: A 48-year woman underwent gastric surgery for a gastric ulcer. She was referred to the nutrition unit for the study and treatment of a 3-year iron deficiency anemia refractory to oral iron supplementation. Blood tests, endoscopy and jejunal biopsy were made to study the case. Results: Intestinal villi atrophy in the absence of celiac disease was the result. She was treated with intravenous iron, resolving the villous atrophy and thus oral iron supplementation could be effective. Conclusion: This case illustrates that iron deficiency may cause villous atrophy. In this setting, parenteral iron administration is necessary to correct the haematological and non-hematological alterations associated with this deficiency.

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оттуда:

А lack of iron alters the efficiency of cell proliferation and regeneration.(10) After bone marrow germinal blood cells, enterocytes have the second highest proliferation rate. Iron deficiency can have non-hematological manifestations, some of which may affect the gastrointestinal tract. Structural and functional abnormalities of the intestine including villous atrophy,(4,5) reduced absorption of D-xylose,(4,5) decrease in intestinal disaccharidase,(6) and alteration in intestinal permeability(7,8) have been previously reported.

У пациента-донора тромбоцитов из-за частых процедур (24-26 в год) развился железодефицит, который спровоцировал антероградную амнезию и умеренную депресию по шкале Бека: коррекция железодефицита и снижение интенсивности тромбопцитофереза до 12-13 в год привела к восстановлению памяти и снижению депрессии:

Transfus Med. 2008 Oct;18(5):312-4.
Impairment of short-term memory associated with low iron stores in a volunteer multidose plateletpheresis donor.
Page EA, Harrison JF, Jaldow EJ, Kopelman M.
National Blood Service, Tooting, London, UK.

A platelet donor may lose 80-100 mL of blood both in the harness and by blood sampling at each donation, the equivalent of four to five whole blood donations per annum for a donor attending at 2-weekly intervals. A 54-year-old male multidose platelet donor had donated platelets at regular 2-weekly intervals for 6 years. He developed an impairment of anterograde memory (new learning). A self-rating scale revealed a moderate degree of depression [Beck Depression Inventory (BDI) score 22]. Memory testing (Doors and People Memory Battery) showed low scores, particularly for verbal recall and verbal recognition memory. He was found to have a normal haemoglobin of 157 g/L with normal red blood cell indices, but a low serum ferritin (15 ng/mL) and a low serum iron (8.1 mmol/L). Following iron therapy and a return of his iron stores to normal levels, there was an improved BDI score of 13 (minimal level of depression) and a marked improvement in memory test scores. This has been maintained even though he has resumed platelet donation but at reduced intervals.

Недавний кокрэйновский обзор на основании имеющегося эвиденса показывает, что назначение препарата железа высокоэффективно для коррекции аффективно-респираторных приступов у детей:

MAIN RESULTS: Two trials (87 children) fulfilled the inclusion criteria. In these trials, iron supplementation significantly reduced the frequency of breath-holding attacks in children (OR 76.48; 95% CI 15.65 to 373.72; P < 0.00001). A meta-analysis that solely examined iron supplementation causing complete resolution of breath-holding attacks maintained this significance (OR 53.43; 95% CI 6.57 to 434.57; P = 0.0002). AUTHORS' CONCLUSIONS: Iron supplementation (at 5 mg/kg/day of elemental iron for 16 weeks) appears to be useful in reducing the frequency and severity of breath-holding attacks. Supplementation is of particular benefit in children with iron deficiency anaemia, responses correlating with the improvements in haemoglobin values. Iron may still be of assistance in children who are not anaemic or who have low, normal haemoglobin levels.
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Cochrane Database Syst Rev. 2010 May 12;5:CD008132.
Iron supplementation for breath-holding attacks in children.

Коррекция железодефицита у пациентов с врожденным цианотическим пороком сердца и высоким гемоглобином улучшает выносливость к выполнению физнагрузки и повышает качество жизни, а также ведет к увеличению гемоглобина на 15 г/л, что может рассматриваться как вариант ис ходного наличия легкой анемизации организма, нежели только латентного железодефицита:

Int J Cardiol. 2010 Jun 24.

Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome.

Tay EL, Peset A, Papaphylactou M, Inuzuka R, Alonso-Gonzalez R, Giannakoulas G, Tzifa A, Goletto S, Broberg C, Dimopoulos K, Gatzoulis MA.

Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.

Abstract
INTRODUCTION: Iron deficiency is common in cyanotic congenital heart disease (CHD) and results in reduced exercise tolerance. Currently, iron replacement is advocated with limited evidence in cyanotic CHD. We investigated the safety and efficacy of iron replacement therapy in this population. METHODS: Twenty-five iron-deficient cyanotic CHD patients were prospectively studied between August 2008 and January 2009. Oral ferrous fumarate was titrated to a maximum dose of 200mg thrice-daily. The CAMPHOR QoL questionnaire, 6minute walk test (6MWT) and cardiopulmonary exercise testing were conducted at baseline and after 3months of treatment. RESULTS: Mean age was 39.9+/-10.9years, 80% females. Fourteen had Eisenmenger syndrome, 6 complex cyanotic disease and 5 Fontan circulation. There were no adverse effects necessitating termination of treatment. After 3months of treatment, hemoglobin (19.0+/-2.9g/dL to 20.4+/-2.7g/dL, p<0.001), ferritin (13.3+/-4.7mug/L to 54.1+/-24.2mug/L, p<0.001) and transferrin saturation (17.8+/-9.6% to 34.8+/-23.4%, p<0.001) significantly increased. Significant improvements were also detected in the total CAMPHOR score (20.7+/-10.9 to 16.2+/-10.4, p=0.001) and 6MWT distance (371.7+/-84.7m to 402.8.0+/-74.9m, p=0.001). Peak VO(2) remained unchanged (40.7+/-9.2% to 43.8+/-12.4% of predicted, p=0.15). CONCLUSION: Three months of iron replacement therapy in iron-deficient cyanotic CHD patients was safe and resulted in significant improvement in exercise tolerance and quality of life. Identification of iron deficiency and appropriate replacement should be advocated in these patients.

У пациентов на омепразоле или др. празолах хуже корректируется ЖД анемия или железодефицит: нужно или увеличивать дозу, или повышать длительность лечения, или в/в введение железа:

Am J Ther. 2010 Dec 3.
Suboptimal Response to Ferrous Sulfate in Iron-Deficient Patients Taking Omeprazole.

Ajmera AV, Shastri GS, Gajera MJ, Judge TA.

Iron deficiency anemia is commonly encountered in outpatient practice. Gastric acid is one of the important factors for optimum absorption of iron. Proton pump inhibitors are very commonly prescribed medications. One of the debated effects of proton pump inhibitors is on oral iron absorption. Their effect on absorption of oral iron supplementation in iron-deficient patients has not been studied. At the Cooper Hematology Outpatient office, we reviewed charts of iron-deficient anemic patients who were on omeprazole for the last 4 years. Fifty patients having no apparent ongoing blood loss, having other causes of anemia especially that of chronic diseases ruled out, and on omeprazole while starting ferrous sulfate therapy for iron deficiency were selected for chart review. The iron-study results at the start of oral ferrous sulfate therapy and at 3 months follow-up were compared to evaluate the response of ferrous sulfate. The mean hemoglobin change was 0.8 ± 1.2 g/L. The mean change in ferrtin values was 10.2 ± 7.8 μg/L. Only 16% of the patients had a normal response to hemoglobin levels (rise of >2 g/dL), and only 40% had a normal response to ferritin levels (rise of >20 μg/dL). The average age of patients having a suboptimal response to both hemoglobin and ferritin was significantly higher compared with that of the patients with an optimal response. Omeprazole and possibly all proton pump inhibitors decrease the absorption of oral iron supplementation. Iron-deficient patients taking proton pump inhibitors may have to be treated with high dose iron therapy for a longer duration or with intravenous iron therapy.

Низкий ферритин после родов может предсказывать повышенный риск развития послеродовой депрессии: этот риск в 3.7 выше, если ферритин менее 7.3:

J Affect Disord. 2010 Dec 2.

An association between plasma ferritin concentrations measured 48h after delivery and postpartum depression.

Albacar G, Sans T, Martín-Santos R, García-Esteve L, Guillamat R, Sanjuan J, Cañellas F, Gratacòs M, Cavalle P, Arija V, Gaviria A, Gutiérrez-Zotes A, Vilella E.

Hospital Psiquiàtric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain.

CONTEXT: Iron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear.

OBJECTIVE: To evaluate whether iron status 48h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD.

DESIGN: This was a prospective cohort study of depression-free women studied in the postpartum period.

SETTING: Women who give birth at obstetric units in several general hospitals in Spain.

PARTICIPANTS: A subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism.

MAIN OUTCOME MEASURES: We evaluated depressive symptoms at 48h, 8weeks and 32weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CRP.

RESULTS: Overall, the women in the study had low iron concentrations (8.8±6.9μmol/L) and low TfS (12.6±9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32week postpartum period; these women also had a lower ferritin concentration (15.4±12.7μg/L vs. 21.6±13.5μg/L, P=0.002). A strong association between ferritin and PPD was observed (odds ratio=3.73, 95% CI: 1.84-7.56; P=0.0001 for ferritin cutoff value of 7.26μg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD.

CONCLUSIONS: These findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation.

Еще одна статья, показывающая, что именно двухвалентное (а не трехвалентное) железо лучше всасывается у людей с железодефицитом и именно двухвалентное железо обладает б0льшей эффективностью при лечении железодефицита:

Br J Nutr. 2011 Apr;105(8):1245-50.
Iron deficiency up-regulates iron absorption from ferrous sulphate but not ferric pyrophosphate and consequently food fortification with ferrous sulphate has relatively greater efficacy in iron-deficient individuals.
Zimmermann MB, Biebinger R, Egli I, Zeder C, Hurrell RF.
SourceLaboratory for Human Nutrition, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH) Zurich, Schmelzbergstrasse 7, LFV E19, CH-8092 Zurich, Switzerland.
AbstractFe absorption from water-soluble forms of Fe is inversely proportional to Fe status in humans. Whether this is true for poorly soluble Fe compounds is uncertain. Our objectives were therefore (1) to compare the up-regulation of Fe absorption at low Fe status from ferrous sulphate (FS) and ferric pyrophosphate (FPP) and (2) to compare the efficacy of FS with FPP in a fortification trial to increase body Fe stores in Fe-deficient children v. Fe-sufficient children. Using stable isotopes in test meals in young women (n 49) selected for low and high Fe status, we compared the absorption of FPP with FS. We analysed data from previous efficacy trials in children (n 258) to determine whether Fe status at baseline predicted response to FS v. FPP as salt fortificants. Plasma ferritin was a strong negative predictor of Fe bioavailability from FS (P < 0·0001) but not from FPP. In the efficacy trials, body Fe at baseline was a negative predictor of the change in body Fe for both FPP and FS, but the effect was significantly greater with FS (P < 0·01). Because Fe deficiency up-regulates Fe absorption from FS but not from FPP, food fortification with FS may have relatively greater impact in Fe-deficient children. Thus, more soluble Fe compounds not only demonstrate better overall absorption and can be used at lower fortification levels, but they also have the added advantage that, because their absorption is up-regulated in Fe deficiency, they innately 'target' Fe-deficient individuals in a population.

Еще одно исследование из Израиля подтверждает б0льшую эффективность, но худшую переносимость двухвалентного железа у детей первого года жизни (на фоне приема 3-валентного железа анемия может сохраняться у 20% (!) детей):


J Pediatr Hematol Oncol. 2010 Nov;32(8):585-8.
Iron polymaltose versus ferrous gluconate in the prevention of iron deficiency anemia of infancy.
Jaber L, Rigler S, Taya A, Tebi F, Baloum M, Yaniv I, Haj Yehia M, Tamary H.
SourceNeurology Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
AbstractWe prospectively compared the efficacy and safety of iron deficiency anemia prophylaxis with iron gluconate (IG) or iron polymaltose complex (IPC) in healthy infants attending a community pediatric center. Participants were randomly assigned to receive one of the test drugs from age 4 to 6 months to age 12 months. Parents/guardians were given extensive information on iron-rich diets and anemia prevention. Main outcome measures were blood levels of hemoglobin, hematocrit, mean corpuscular volume, red blood cell distribution width, and serum iron, ferritin, and transferrin, in addition to adverse effects. One hundred five children completed the study: 53 in the IG group and 52 in the IPC group Mean hemoglobin levels at study end were significantly higher in the IG group (12.04±0.09 g/dL vs. 11.68±0.11, P<0.014). A hemoglobin level <11 g/dL was detected in 3 infants of the IG group, and in 10 infants of the IPC group (P<0.04). Adverse effects (spitting, vomiting, diarrhea, constipation, discolored teeth) were significantly more common in the IG group (47% vs. 25%, P>0.025). In conclusion, both oral IG and IPC prevent iron deficiency anemia in infants. Iron gluconate seems to be more effective but less tolerable.

У женщин с дефицитом железа (ферритин менее 20) до беременности назначение препарата железа во время беременности приводило к улучшению веса новорожденного:

Early Hum Dev. 2011 Jun 29.
Pre-pregnancy iron reserves, iron supplementation during pregnancy, and birth weight.
Aranda N, Ribot B, Garcia E, Viteri FE, Arija V.
SourceIISPV, Departament de Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili (URV), Spain.

BACKGROUND: Early iron supplementation in women with sufficient reserves could provoke iron excess resulting in haemoconcentration and low infant birth weight (IBW).

AIM: To clarify the influence of early iron supplementation on maternal iron status and the IBW, taking into account pre-pregnancy iron deposits.

STUDY DESIGN: Longitudinal, prospective study.

SUBJECTS: Healthy women volunteers (n=82) intending to become pregnant.

OUTCOME MEASURES: Women were grouped as a function of their pre-pregnancy (low or present) iron stores (serum ferritin (SF)<or≥20μg/L) and time of commencement of iron supplementation during pregnancy; "early" (<20weeks) or "late" (≥20weeks). Obstetric and clinical history, smoking habit, dietary intake and iron biochemical parameters were obtained at pre-pregnancy as well as at 1st, 2nd and 3rd trimesters. Haemoglobin, MCV, SF and transferrin saturation (TS) were measured.

RESULTS: Overall, 36% of the women had low iron stores at pre-pregnancy. The mean early supplementation with iron was 140.7mg/d and the mean of late supplementation was 99.01mg/d. Early supplementation improves the biochemical status of the mother and does not provoke a significant increase in haemoconcentration relative to late supplementation independently of the pre-pregnancy iron levels. Supplemental iron had a positive effect on birth weight among women with pre-pregnancy low iron stores (β=4.37; SE=1.8; p=0.038) and did not affect birth weight among women with present iron stores (β=-0.008; SE=3.03; p=0.998).

CONCLUSION: Early iron supplementation with doses ~100mg/d improves the biochemical status of the mother independently of her pre-pregnancy iron status. Supplementation with iron improves newborn birth weight in those women who start pregnancy with iron deficiency, and makes no significant difference to those women who are not iron deficient.

Впервые хорватские коллеги обнаружили ассоциативную связь между менструальной мигренью и железодефицитной анемией:

Acta Clin Croat. 2010 Dec;49(4):389-94.
Is iron deficiency anemia related to menstrual migraine? Post hoc analysis of an observational study evaluating clinical characteristics of patients with menstrual migraine.
Vuković-Cvetković V, Plavec D, Lovrencić-Huzjan A, Galinović I, Serić V, Demarin V.
University Department of Neurology, Sestre milosrdnice University Hospital, Zagreb, Croatia.

The aim of this study was to determine the relative prevalence and clinical characteristics of patients with pure menstrual migraine (PMM) and menstrually related migraine (MRM), and to compare them with the women free of it in an outpatient clinic-based population. Adult menstruating women with ICHD-2 migraine were included. Demographic data were obtained by verbal report. Study women were asked to keep a headache diary for 6 months, in which they recorded information on headache characteristics, medication use and presence of menses. Iron deficiency anemia was considered to be present if the patient had received therapy for iron deficiency anemia or laboratory tests indicated low iron and/or hemoglobin levels (within one year). A total of 289 women were included, 52 (18.0%) with PMM and 116 (40.1%) with MRM, whereas 121 (41.9%) women had not observed any relationship between migraine and their menstrual cycle (non-MM). Duration of migraine attacks was longer in PMM/MRM patients (P < 0.0001). No significant difference was observed according to other migraine-associated symptoms. Women with PMM/ MRM took significantly more tryptans (P < 0.0001) and iron deficiency anemia was significantly more common in women with PMM/MRM (P = 0.008). In conclusion, this study supported earlier findings that PMM/MRM has similar clinical characteristics as non-MM, except for longer duration. In addition, iron deficiency anemia is more common in women with PMM/MRM, which may be an underlying mechanism aggravating migraine attacks.

первая публикация из Израиля, показывающая, что у детей 3-7 лет с кариесом выше риск обнаружения и железодефицита (у 80% ферритин менее 24) и железодефицитной анемии (у 65% гемоглобин менее 120):

Acta Paediatr. 2011 Aug 24.
The association of childhood iron deficiency anemia and severe dental caries.
Shaoul R, Gaitini L, Kharouba J, Darawshi G, Maor I, Somri M.

Очень детальный обзор по всем аспектам обмена железа в организме, потребностям по возрастам, продуктам питания и многое другое
Iron, meat and health
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Individualized treatment for iron deficiency anemia in adults

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в/в железо однократно 500 мг может быть эффективным при лечении синдрома беспокойных ног у молодых пациентов с низким ферритином или функциональным дефицитом железа - эффект от лечения может наблюдаться уже через неделю:

Sleep Med. 2012 Apr 11.
Investigating the response to intravenous iron in restless legs syndrome: An observational study.
Hornyak M, Scholz H, Kiemen A, Kassubek J.
Interdisciplinary Pain Centre, University Medical Centre, Freiburg, Germany; Department of Neurology, University of Ulm, Ulm, Germany.

OBJECTIVE: To investigate the effect of intravenous (IV) iron (500mg ferric carboxymaltose [FCM] as a single dose) on restless legs syndrome (RLS) severity on a day-to-day basis.

METHODS: Twenty patients with RLS and absolute or functional iron deficiency or low normal serum ferritin (<45μg/l) were included. Change of RLS severity was evaluated using the International RLS severity scale (IRLS) and the RLS-severity diary (RLS-SD) which evaluates symptom severity over a 6-h period on an 11-point numerical Likert scale, four times a day.

RESULTS: Twelve patients reported that IV FCM improved RLS ("responders"). IRLS score decreased from 30.1 (±5.9) to 23.07 (±9.5) (p=0.001) in the whole group and from 28.3 (±6.1) to 18.3 (±8.0) (p=0.002) in the responder group three weeks after IV FCM treatment. A clinically relevant effect of IV iron on RLS severity could be seen as early as day eight. The responder group differed from the non-responder group in tendency by being younger (p=0.064), having a lower serum ferritin level at baseline (p=0.097), and presenting a lower number of comorbid conditions.

CONCLUSIONS: FCM led to a considerable improvement in RLS in the responder group within about one week. These findings are clinically relevant, especially for patients with severe RLS symptoms and iron deficiency, since a change or uptitration of RLS-specific medication can be avoided or postponed in these patients due to the rapid response to IV FCM treatment.

Детальный обзор преимуществ и недостатков назначения дивалентных и тривалентных препаратов железа в полной версии:

Ferrous versus Ferric Oral Iron Formulations for the Treatment of Iron Deficiency: A Clinical Overview.

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В то время, как железодефицит может быть причиной кашля при лечении ИАПФ и его коррекция может сничить частоту данного симптома (Iron supplementation inhibits cough associated with ACE inhibitors./ Hypertension. 2001 Aug;38(2):166-70.///// Attenuation of angiotensin converting enzyme inhibitor induced cough by iron supplementation: role of nitric oxide./ J Renin Angiotensin Aldosterone Syst. 2011 Dec;12(4):491-7.) недавняя публикация показывает, что железодефицит может быть причиной хронического кашля и его коррекция снижает интенсивность кашля:

Int J Clin Pract. 2012 Nov;66(11):1095-1100.
Effect of iron supplementation in women with chronic cough and iron deficiency.
Bucca C, Culla B, Brussino L, Ricciardolo FL, Cicolin A, Heffler E, Bugiani M, Rolla G.

Aims:  Chronic cough is more frequent and severe in women than in men. Women often have decreased iron stores, because of menses and pregnancies. We investigated if iron deficiency has a role in chronic cough by increasing airway sensitivity to inhaled irritants.
Methods:  Twenty-two non-smoking women with chronic unexplained cough and iron deficiency (serum ferritin below 15 ng/ml) were examined in baseline, after 2 months empiric treatment with anti H1-histaminic drug and proton pump inhibitor, and after iron supplementation (330-660 mg iron sulphate tablets daily) for 2 months. Outcome measures were cough visual analogue scale (VAS), and histamine thresholds of the larynx (PC25MIF50, concentration causing 25% in MIF50), bronchi (PC20FEV1) and cough (PC5cough).
Results:  Mean serum ferritin was 9.3 ng/ml (95% CI 7.7-10.9), 13 patients had mild anaemia. All the patients had laryngeal and cough hyperresponsiveness,12 had also bronchial hyperresponsiveness. Empiric treatment produced no significant effect, whereas iron supplementation improved cough VAS from 4.03 (3.6-4.47) to 2.6 (1.9-3.27), p < 0.0001, PC20FEV1 from 10.04 mg/ml (5.37-18.77) to 22.2 (11.7-41.8), p < 0.001, PC25MIF50 from 3.09 mg/ml (1.9-4.9) to 11.9 (7.3-19.4), p < 0.001 and PC5cough from 2.1 mg/ml (1.2-3.6) to 8.8 (5.2-15.1), p < 0.001.
Conclusion:  In women with unexplained chronic cough unresponsive to targeted treatment, airway and cough hyperresponsiveness may be sustained by iron deficiency. Healthy women with chronic cough should be checked for iron deficiency as iron repletion may resolve such disturbing symptom.

Iron Deficiency: What Are the Future Trends in Diagnostics and Therapeutics?
Clin Chem. 2012 Nov 13.

недавняя публикация показывает, что раннее назначение железа детям с пограничным весом при рождении не влияет на их умственные способности к 3 годам, но снижает риск поведенческих отклонений:

Pediatrics. 2012 Dec 10.
Effects of Iron Supplementation of LBW Infants on Cognition and Behavior at 3 Years.
Berglund SK, Westrup B, Hägglöf B, Hernell O, Domellöf M.

OBJECTIVE:Low birth weight (LBW) infants are at increased risk of cognitive and behavioral problems and at risk for iron deficiency, which is associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants would improve cognitive scores and reduce behavioral problems.
METHODS:In a randomized controlled trial, 285 marginally LBW (2000-2500 g) infants received 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 3.5 years of age, these infants and 95 normal birth weight controls were assessed with a psychometric test (Wechsler Preschool and Primary Scale of Intelligence) and a questionnaire of behavioral problems (Child Behavior Checklist; CBCL).
RESULTS:There were no significant differences in IQ between the LBW groups or LBW infants versus controls. Mean (SD) full-scale IQ was 105.2 (14.5), 104.2 (14.7), and 104.5 (12.7) in the placebo, 1 mg, and 2 mg groups, respectively (P = .924). However, for behavioral problems, there was a significant effect of intervention. The prevalence of children with CBCL scores above the US subclinical cutoff was 12.7%, 2.9%, and 2.7% in the placebo, 1-mg, and 2-mg groups, respectively (P = .027), compared with 3.2% in controls. Relative risk (95% confidence interval) for CBCL score above cutoff in placebo-treated children versus supplemented was 4.5 (1.4-14.2). CONCLUSIONS:Early iron supplementation of marginally LBW infants does not affect cognitive functions at 3.5 years of age but significantly reduces the prevalence of behavioral problems. The study suggests a causal relation between infant iron deficiency and later behavioral problems.

Повышенный гепцидин может быть использован как индикатор плохого ответа на лечение ЖДА пероральными препаратами железа; в/в введение железа в такой ситуации помогает в 2/3 случаев, тогда как продолжение приема перорального железа только в 20% дает ответ на лечение:

Am J Hematol. 2012 Nov 17.
Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia.
Bregman DB, Morris D, Koch TA, He A, Goodnough LT.
SourceLuitpold Pharmaceuticals, Inc., Valley Forge, Pennsylvania; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York.

Levels of hepcidin, a major regulator of iron homeostasis, may identify patients with iron deficiency anemia (IDA) who will not respond to oral iron therapy. In this study, IDA patients underwent a 14-day trial (run-in) course of ferrous sulfate therapy. Nonresponders (Hgb increase <1 g/dL with 67% compliance rate) were randomized to IV ferric carboxymaltose (FCM; two injections of 750 mg) or further oral iron for 14 days. Screening hepcidin levels were 38.4 versus 11.3 ng/mL, P = 0.0002 in nonresponders versus responders to a trial of oral iron. Hepcidin of > 20 ng/mL, showed sensitivity of 41.3%, specificity of 84.4%, and positive predictive value of 81.6% for predicting nonresponsiveness to oral iron. PPVs for ferritin> 30 ng/mL or transferrin saturation (TSAT)>15% were 59.2 and 55%, respectively. Negative predictive values for hepcidin, ferritin, and TSAT were 46.3, 22.7, and 19.7, respectively. FCM versus oral iron showed Hgb increases of ≥1 gm/dL in 65.3% versus 20.8% (P < 0.0001) and Hgb increases of 1.7 ± 1.3 versus 0.6 ± 0.9 g/dL (P = 0.0025), respectively. We conclude that hepcidin predicts nonresponsiveness to oral iron in patients with IDA and is superior to TSAT or ferritin for this purpose. Nonresponse to oral iron therapy does not rule out IDA, since two-thirds of patients subsequently responded to intravenous iron.

Еще одна статья о ЖДА как риске кариеса у детей

BMC Pediatr. 2013 Feb 7;13(1):22.
Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case--control study.

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У пациентов с отрицательными серологическими тестами на целиакию нередко выявляется умеренная энтеропатия, которая может быть из-за целиакии, хеликобактерной инфекции или причину установить не удается, если генетические тесты на целиакию отрицательны.

Dig Liver Dis. 2011 Jun;43(6):448-53.
Mild enteropathy as a cause of iron-deficiency anaemia of previously unknown origin.
Monzón H, Forné M, González C, Esteve M, Martí JM, Rosinach M, Mariné M, Loras C, Espinós JC, Salas A, Viver JM, Fernández-Bañares F.
Department of Gastroenterology, Hospital Universitari Mútua Terrassa and Research Foundation Mútua Terrassa, Barcelona, Spain.

BACKGROUND AND AIMS:
We assessed whether mild enteropathy with negative coeliac serology may be gluten-dependent, and a cause of iron-deficiency anaemia. In cases not responding to gluten-free diet, the role of Helicobacter pylori infection was evaluated.
METHODS:
55 consecutive unexplained iron-deficiency anaemia patients were included. In all of them we performed: HLA-DQ2/DQ8 coeliac genetic study, distal duodenum biopsies, and tests to assess H. pylori infection. A gluten-free diet or H. pylori eradication was used as indicated. Final diagnosis was established based on response to specific therapy after a 12-month follow-up period.
RESULTS:
Histological findings were: (1) group A (positive genetics): 21 Marsh I, 2 Marsh IIIA, 12 normal; (2) group B (negative genetics): 16 Marsh I, 4 normal. Final diagnosis of anaemia in patients with enteropathy were: group A, gluten-sensitive enteropathy, 45%; H. pylori infection, 20%; gluten-sensitive enteropathy plus H. pylori, 10%; other, 10%; unknown, 15%; group B, gluten-sensitive enteropathy, 10%; H. pylori infection, 0% (1 non-eradicated case, 10%); non-steroidal anti-inflammatory drug intake, 20%; other, 20%; unknown, 40% (p=0.033).
CONCLUSIONS:
Mild enteropathy is frequent in patients with unexplained iron-deficiency anaemia and negative coeliac serology. Most cases are secondary to either gluten-sensitive enteropathy or H. pylori infection, or both; however, there is also a substantial number of patients without a definitive diagnosis.

Британский гайд по принципам диагностики функционального (латентного) железодефицита:

Guideline for the laboratory diagnosis of functional iron deficiency.
Thomas DW, Hinchliffe RF, Briggs C, Macdougall IC, Littlewood T, Cavill I; British Committee for Standards in Haematology. Br J Haematol. 2013 Apr 10.

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Риск латентного железодефицита, но не ЖД анемии, у детей возрастает при более длительном грудном вскармливании: железодефицит был в 1.7 раз чаще у детей, у которых грудное вскармливание было более 12 месяцев, по сравнению с теми, у кого грудное вскармливание было менее года, подробнее:

Included were 1647 healthy children (median age 36 months) with survey, anthropometric, and laboratory data. An association was found between increasing duration of breastfeeding and lower serum ferritin (P = .0015). Adjusted logistic regression analysis revealed the odds of iron deficiency increased by 4.8% (95% confidence interval: 2%-8%) for each additional month of breastfeeding. Exploratory analysis suggested an increasing cumulative probability of iron deficiency with longer total breastfeeding duration with an adjusted odds ratio of 1.71 (95% confidence interval: 1.05-2.79) for iron deficiency in children breastfed over versus under 12 months of age. The relationship between total breastfeeding duration and iron deficiency anemia did not meet statistical significance.
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Association Between Total Duration of Breastfeeding and Iron Deficiency. Pediatrics. 2013 Apr 15.

Eur J Clin Microbiol Infect Dis. 2013 Apr 18.
Iron deficiency and susceptibility to infections: evaluation of the clinical evidence.
Tansarli GS, Karageorgopoulos DE, Kapaskelis A, Gkegkes I, Falagas ME.
Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23, Marousi, Athens, Greece.

Iron is a fundamental nutrient for human and microbial life. We sought to examine the association of iron deficiency versus normal iron status with the susceptibility to infections. A systematic search in the PubMed and Scopus databases was performed to identify relevant clinical studies. Six studies (including a total of 1,422 participants) met the inclusion criteria: four prospective cohort (859 participants), one retrospective case-control (115 participants), and one retrospective cohort study (448 participants). Intensive care unit (ICU)-acquired and postoperative infections were more common in patients with iron deficiency than among those with normal iron status in two studies, while no difference was reported in another study. In one study examining pregnant women with normal mean iron values, higher soluble transferrin receptor values independently predicted vaginosis-like microflora. Iron deficiency anemia was an independent predictor of respiratory tract infections in one study, and postoperative urinary tract infections were more common in patients with iron deficiency anemia in another. The limited available evidence suggests that individuals with iron deficiency and those with iron deficiency anemia may be more susceptible to infections than patients with normal iron status. Future studies should elucidate further these findings.

Внутривенное введение железа пациентам с воспалительными заболеваниями кишечника и тромбоцитозом ассоциируется с повышением гемоглобина, снижением числа тромбоцитов, но не влияет на течение основного заболевания:

Inflamm Bowel Dis. 2013 May 2.
Iron Deficiency Generates Secondary Thrombocytosis and Platelet Activation in IBD: the Randomized, Controlled ThromboVIT Trial.
Kulnigg-Dabsch S, Schmid W, Howaldt S, Stein J, Mickisch O, Waldhör T, Evstatiev R, Kamali H, Volf I, Gasche C.

BACKGROUND: Secondary thrombocytosis is a common clinical feature. In patients with cancer, it is a risk factor for venous thromboembolic events. In inflammatory bowel disease (IBD), thrombocytosis is so far considered a marker of active disease and may contribute to the increased thromboembolic risk in this population. Observed effects of iron therapy on normalization of platelet counts led us to hypothesize that iron itself may regulate megakaryopoiesis. Here, we want to test the effect of iron replacement on platelet count and activity in IBD-associated thrombocytosis.
METHODS: We performed a randomized, single-blinded placebo-controlled trial testing the effect of ferric carboxymaltose (FCM) in patients with IBD with secondary thrombocytosis (platelets > 450 G/L). Changes in platelet counts, hemoglobin, iron parameters, disease activity, megakaryopoietic growth factors, erythropoietin, and platelet activity were assessed. Patients received placebo or up to 1500 mg iron as FCM. Endpoints were evaluated at week 6. RESULTS: A total of 26 patients were included in the study, 15 patients were available for the per protocol analysis. A drop in platelets >25% (primary endpoint) was observed in 4 of 8 (50%, iron group) and 1 of 7 patients (14%, placebo group, P = 0.143). Mean platelet counts dropped on FCM but not on placebo (536 G/L to 411 G/L versus 580 G/L to 559 G/L; P = 0.002). Disease activity and megakaryopoietic growth factors remained unchanged and hemoglobin and iron parameters increased on FCM. The normalization of platelet counts was associated with a decrease in platelet aggregation and P-selectin expression. CONCLUSION: FCM lowers platelet counts and platelet activation in patients with IBD-associated secondary thrombocytosis.

Уровень ферритина для исключения железодефицита: 25-30 (или менее 40) мкг/л согласно двум недавним публикациям:

A total of 14 studies were included and were divided into three groups. After the pooled efficacy analysis, we found that the 12 - 20 microg/L group showed the lowest pooled sensitivity (0.767, 95 CI 0.705 -0.821) but highest specificity (0.959, 95 CI 0.934 -0.976). Compared with the other two groups, the pooled sensitivity of 25 - 30 microg/L group (0.877, 95 CI 0.799 - 0.933) was highest, its pooled specificity was (0.944, 95 CI 0.888 - 0.977), the pooled sensitivity and pooled specificity of 36 - 60 microg/L group (0.836, 95 CI 0.797 - 0.870), (0.876, 95 CI 0.846 - 0.901)] were both relatively low. In terms of the integrated diagnostic capabilities, the 25 - 30 microg/L group showed the highest diagnostic odds ratio (101.42, 95 CI 36.137 - 284.64), the largest AUC (0.9497 +/- 0.039) and the Q * index nearest 1 (0.8901 +/- 0.052) among the three groups. After we removed the studies with samples less than 50 and the studies from Chinese authors, the 25 - 30 microg/L group still showed the best diagnostic efficiency.
25 - 30 microg/L of SF as the cut-off value of identifying iron deficiency shows high accuracy and good integrated diagnostic capability.
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Wei Sheng Yan Jiu. 2013 Mar;42(2):228-35.
[Meta-analysis of studies on cut-off value of serum ferritin for identifying iron deficiency].

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Results showed that ferritin can effectively rule out ID anemia in patients with or without inflammatory disease at cut-offs of 70 and 40 μg/L, respectively.
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Clin Chem Lab Med. 2012 Nov;50(11):1911-6.
Revaluating serum ferritin as a marker of body iron stores in the traceability era.

Высокая частота железодефицита (и ЖДА) у подростков с ортостатической тахикардией и синкопальными нарушениями:

Clin Auton Res. 2013 May 30.
Low iron storage and mild anemia in postural tachycardia syndrome in adolescents.
Jarjour IT, Jarjour LK.
Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, CC 1250, Houston, TX, 77030, USA.

OBJECTIVE: We reported low iron storage in neurally mediated syncope (NMS). While reduced red cell mass indicative of anemia has been reported in POTS, iron indices and hemoglobin (Hb) data were not reported. We investigated whether POTS, like NMS, is associated with low iron storage and anemia.

METHODS: Thirty two children evaluated in 2007 and 2008 for probable POTS by a standing or tilt test or both at Texas Children's Hospital were included in a retrospective study. We measured serum ferritin (SF) and Hb values. We defined iron deficiency as SF < 12 μg/L, low iron storage as SF ≤ 25 μg/L, anemia as low Hb values for age and sex, and POTS as ≥2 symptoms of orthostatic intolerance >3 months and increased HR of >30 BPM or HR of >120 BPM within 10 min of standing or 70° tilt.

RESULTS: Twenty four children had POTS, ages 12-18 years, 17 (71 %) were females. Value range (median) of SF 2-289 μg/L (25), Hb 11.5-14.6 (12.5) in females and 12-15.9 g/L (13.6) in males. Patients with POTS, when compared with normal US pediatric population had higher prevalence of low iron storage (50 vs. 14 %), iron deficiency (25 % of teenage girls vs. 9 %, and 16 % of teenage boys vs. 1 %), and anemia (18 % of teenage girls vs. 1.5 %, and 43 % of teenage boys vs. 0.1 %).

INTERPRETATION: Low iron storage and mild anemia are associated with POTS suggesting that low iron storage is a potentially pathophysiologic factor in both POTS and NMS.

Железодефицитная анемия у детей/подростков ассоциируется с повышенным риском психических отклонений:

Utilizing the National Health Insurance Database from 1996 to 2008, children and adolescents with a diagnosis of IDA were identified and compared with age and gender-matched controls (1:4) in an investigation of the increased risk of psychiatric disorders.

A total of 2957 patients with IDA, with an increased risk of
unipolar depressive disorder (OR = 2.34, 95% CI = 1.58 ~ 3.46),
bipolar disorder (OR = 5.78, 95% CI = 2.23 ~ 15.05),
anxiety disorder (OR = 2.17, 95% CI = 1.49 ~ 3.16),
autism spectrum disorder (OR = 3.08, 95% CI = 1.79 ~ 5.28),
attention deficit hyperactivity disorder (OR = 1.67, 95% CI = 1.29 ~ 2.17), tic disorder (OR = 1.70, 95% CI = 1.03 ~ 2.78),
developmental delay (OR = 2.45, 95% CI = 2.00 ~ 3.00), and
mental retardation (OR = 2.70, 95% CI = 2.00 ~ 3.65), were identified.
A gender effect was noted, in that only female patients with IDA had an increased OR of bipolar disorder (OR = 5.56, 95% CI = 1.98 ~ 15.70) and tic disorder (OR = 2.95, 95%CI = 1.27 ~ 6.86).

Iron deficiency increased the risk of psychiatric disorders, including mood disorders, autism spectrum disorder, attention deficit hyperactivity disorder, and developmental disorders.

BMC Psychiatry. 2013 Jun 4;13(1):161.
Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study.

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Когда клинически необходимо введение железа в/в плюс обзор/сравнение имеющихся в/в препаратов железа:

Drug Des Devel Ther. 2011 Jan 20;5:51-60.
When is high-dose intravenous iron repletion needed? Assessing new treatment options.
Gozzard D.
Betsi Cadwaladr University Health Board, Llandudno, Wales, UK

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25-летнее наблюдение за индивидами, которые были железодефицитны на первом году жизни - они чаще не заканчивают среднюю школу, не продолжают дальнейшее обучение, не обзаводятся семьей:

Adjusting for sex and socioeconomic status, a higher proportion of the group with chronic iron deficiency did not complete secondary school (58.1% vs 19.8% in iron-sufficient group; Wald value = 8.74; P = .003), were not pursuing further education/training (76.1% vs 31.5%; Wald value = 3.01; P = .08; suggestive trend), and were single (83.9% vs 23.7%, Wald value = 4.49; P = .03). They reported poorer emotional health and more negative emotions and feelings of dissociation/detachment.

J Pediatr. 2013 Jul 1.
Functional Significance of Early-Life Iron Deficiency: Outcomes at 25 Years.
Lozoff B, Smith JB, Kaciroti N, Clark KM, Guevara S, Jimenez E.
Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.

Готовка обогащенной железом еды в железных кастрюлях еще больше повышает содержание железа в пище, нежели в тефлоновой посуде, и на 8% повышает гемоглобин у дошкольников:

Indian J Pediatr. 2013 Jul 19.
Beneficial Effect of Iron Pot Cooking on Iron Status.
Kulkarni SA, Ekbote VH, Sonawane A, Jeyakumar A, Chiplonkar SA, Khadilkar AV.
Department of Dietetics, School of Health Sciences, University of Pune, Pune, India.

OBJECTIVES: To develop iron rich snacks using locally available iron rich foods and analyze their iron content when cooked in iron pots. Further, the efficacy of the developed snacks, cooked in iron pots was examined on the hemoglobin status of pre-school children through a three month randomized trial.

METHODS: Four iron rich snacks (mean iron content 2.1mg/serving) were cooked in iron pots and 27 preschool children (mean age 2.9 ± 0.9 y, 12 boys) were supplemented with the snacks for 4 mo. Anthropometry and dietary intake data were collected. Hemoglobin, serum iron and transferrin saturation were assessed.

RESULTS: An increase of 16.2 % in the iron content was found in the snacks cooked in iron pots than cooked in Teflon coated non-stick pots. After 4 mo of supplementation, a significant increase of 7.9 % was seen in the hemoglobin of the children.

CONCLUSION: This pilot study demonstrated that iron rich recipes cooked in iron pot have a beneficial effect on iron status of children.

ЖДА как фактор риска ишемического инсульта у детей: ЖДА (особенно с тромбоцитозом) повышает риск инсульта в 4 (10 раз):

This was a case-control study that included 21 stroke cases with patients who had previously been generally healthy, and matched with age and gender of 100 healthy control subjects. Patients were included if a diagnosis of definite stroke had been made and other known etiologies of childhood onset stroke were excluded. For all subjects, iron parameters including serum iron, ferritin, transferrin, total iron binding capacity, and transferrin saturation were assessed.... Our results showed that IDA was disclosed in 57.1 % of stroke cases with no identified cause, as compared to 26 % of controls. Our study suggest that previously healthy children who developed stroke are 3.8 times more likely to have IDA than healthy children, who do not develop stroke (OR, 3.8; 95 % CI:1.3-11.2 P = 0.005). In addition, there was significant interaction between IDA and thrombocytosis among studied cases (OR, 10.5; 95 % CI, 1.0-152 P = 0.02).

Ann Hematol. 2013 Oct 19. Iron deficiency anemia as a risk factor for cerebrovascular events in early childhood: a case-control study

Новый внутривенный препарат железа монофер так и не смог показать себя столь же эффективным как и старый добрый сульфат железа при лечении ЖДА у пациентов с воспалительными болезнями кишечника (болезнь Крона и язвенный колит):

Am J Gastroenterol. 2013 Oct 22.
A Randomized, Open-Label, Non-Inferiority Study of Intravenous Iron Isomaltoside 1,000 (Monofer) Compared With Oral Iron for Treatment of Anemia in IBD (PROCEED).
Reinisch W, Staun M, Tandon RK, Altorjay I, Thillainayagam AV, Gratzer C, Nijhawan S, Thomsen LL.
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital, Vienna, Austria.

OBJECTIVES: In the largest head-to-head comparison between an oral and an intravenous (IV) iron compound in patients with inflammatory bowel disease (IBD) so far, we strived to determine whether IV iron isomaltoside 1,000 is non-inferior to oral iron sulfate in the treatment of iron deficiency anemia (IDA).

METHODS: This prospective, randomized, comparative, open-label, non-inferiority study was conducted at 36 sites in Europe and India. Patients with known intolerance to oral iron were excluded. A total of 338 IBD patients in clinical remission or with mild disease, a hemoglobin (Hb) <12 g/dl, and a transferrin saturation (TSAT) <20% were randomized 2:1 to receive either IV iron isomaltoside 1,000 according to the Ganzoni formula (225 patients) or oral iron sulfate 200 mg daily (equivalent to 200 mg elemental iron; 113 patients). An interactive web response system method was used to randomize the eligible patient to the treatment groups. The primary end point was change in Hb from baseline to week 8. Iron isomaltoside 1,000 and iron sulfate was compared by a non-inferiority assessment with a margin of -0.5 g/dl. The secondary end points, which tested for superiority, included change in Hb from baseline to weeks 2 and 4, change in s-ferritin, and TSAT to week 8, number of patients who discontinued study because of lack of response or intolerance of investigational drugs, change in total quality of life (QoL) score to weeks 4 and 8, and safety. Exploratory analyses included a responder analysis (proportion of patients with an increase in Hb ≥2 g/dl after 8 weeks), the effect of regional differences and total iron dose level, and other potential predictors of the treatment response.

RESULTS: Non-inferiority in change of Hb to week 8 could not be demonstrated. There was a trend for oral iron sulfate being more effective in increasing Hb than iron isomaltoside 1,000. The estimated treatment effect was -0.37 (95% confidence interval (CI): -0.80, 0.06) with P=0.09 in the full analysis set (N=327) and -0.45 (95% CI: -0.88, -0.03) with P=0.04 in the per protocol analysis set (N=299). In patients treated with IV iron isomaltoside 1,000, the mean change in s-ferritin concentration was higher with an estimated treatment effect of 48.7 (95% CI: 18.6, 78.8) with P=0.002, whereas the mean change in TSAT was lower with an estimated treatment effect of -4.4 (95% CI: -7.4, -1.4) with P=0.005, compared with patients treated with oral iron. No differences in changes of QoL were observed. The safety profile was similar between the groups. The proportion of responders with Hb ≥2 g/dl (IV group: 67%; oral group: 61%) were comparable between the groups (P=0.32). Iron isomaltoside 1,000 was more efficacious with higher cumulative doses of >1,000 mg IV. Significant predictors of Hb response to IV iron treatment were baseline Hb and C-reactive protein (CRP).

CONCLUSIONS: We could not demonstrate non-inferiority of IV iron isomaltoside 1,000 compared with oral iron in this study. Based on the dose-response relationship observed with the IV iron compound, we suggest that the true iron demand of IV iron was underestimated by the Ganzoni formula in our study. Alternative calculations including Hb and CRP should be explored to gauge iron stores in patients with IBD.

Клиническое исследование из Дании показало, что хелат железа с аминокислотой в половинной дозе столь же эффективен, как и 50 мг железа сульфата для профилактики ЖДА во время беременности, но с более редкой частотой побочный явлений со стороны ЖКТ; связано ли это с тем, что хелатное железо лучше усваивается, чем сульфатное, или всего 25 мг железа достаточно для профилактики в данной ситуации - непонятно:

J Perinat Med. 2013 Oct 24:1-10.
Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial.
Milman N, Jønsson L, Dyre P, Pedersen PL, Larsen LG.
Objective: To compare the effects of oral ferrous bisglycinate 25 mg iron/day vs. ferrous sulfate 50 mg iron/day in the prevention of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women. Design: Randomized, double-blind, intention-to-treat study. Setting: Antenatal care clinic.
Sample: 80 healthy ethnic Danish pregnant women. Methods: Women were allocated to ferrous bisglycinate 25 mg elemental iron (Aminojern®) (n=40) or ferrous sulfate 50 mg elemental iron (n=40) from 15 to 19 weeks of gestation to delivery. Hematological status (hemoglobin, red blood cell indices) and iron status (plasma iron, plasma transferrin, plasma transferrin saturation, plasma ferritin) were measured at 15-19 weeks (baseline), 27-28 weeks and 36-37 weeks of gestation. Main outcome measures: Occurrence of ID (ferritin <15 μg/L) and IDA (ferritin <12 μg/L and hemoglobin <110 g/L).
Results: At inclusion, there were no significant differences between the bisglycinate and sulfate group concerning hematological status and iron status. The frequencies of ID and IDA were low and not significantly different in the two iron groups. The frequency of gastrointestinal complaints was lower in the bisglycinate than in the sulfate group (P=0.001). Newborns weight was slightly higher in the bisglycinate vs. the sulfate group (3601±517 g vs. 3395±426 g, P=0.09).
Conclusions: In the prevention of ID and IDA, ferrous bisglycinate was not inferior to ferrous sulfate. Ferrous bisglycinate in a low dose of 25 mg iron/day appears to be adequate to prevent IDA in more than 95% of Danish women during pregnancy and postpartum.

Редкое употребление красного мяса, но не птицы, ассоциируется с повышенным (4-х кратным) повышением риска развития анемии в детском возрасте:

J Pediatr Gastroenterol Nutr. 2013 Dec;57(6):722-7.
Anemia and iron deficiency in children: association with red meat and poultry consumption.
Moshe G, Amitai Y, Korchia G, Korchia L, Tenenbaum A, Rosenblum J, Schechter A.
Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan Meuhedet Health Services Hadassah University Mt Scopus, Jerusalem, Israel.

OBJECTIVE: The aim of this study was to study the relative contribution of dietary sources of iron in children with high prevalence of anemia and iron deficiency (ID).

METHODS: A cross-sectional study in 263 healthy, 1.5- to 6-year-old children in the Jewish sector of Jerusalem, Israel. Venous blood samples and a qualitative Food Frequency Questionnaire on iron-rich foods were obtained. Anemia was defined as hemoglobin <11 g/dL for children younger than 4 years and <11.5 g/dL for children older than 4 years; ID was defined as ferritin <12 μg/L.

RESULTS: Anemia was found in 11.2%, ID in 22%, and iron-deficiency anemia in 3.7%. The prevalence of anemia was higher in toddlers ages 1.5 to 3 years compared with children ages 3 to 6 years (17.7% vs 7.3%, P = 0.01). Children with extremely low red meat consumption (seldom) had 4-fold higher rates of ID than those who consumed ≥2 times per week (odds ratio 3.98; 95% confidence interval 1.21-13.03; P = 0.023), whereas poultry consumption was not associated with ID. Soy consumption was inversely associated with ferritin (marginally significant, r = -0.134, P = 0.057).

CONCLUSIONS: The high prevalence of anemia and ID found in this study, mainly in children 1.5 to 3 years old, is related to low red meat consumption. The characteristically high poultry consumption in the Israeli population was not protective. The shift toward reduced red meat consumption and higher poultry consumption in developed countries may result in increasing the risk of ID.

Недавнее описание клинического случая длительной лейкопении (доброкачественной нейтропении) на фоне ЖДА, когда коррекция железодефицита привела к восстановлению нормального числа лейкоцитов/нейтрофилов:

Int J Clin Pharm. 2013 Dec 18.
Unexplained chronic leukopenia treated with oral iron supplements.
Abuirmeileh A, Bahnassi A, Abuirmeileh A.
Internal Medicine, Isawiya Medical Center, Amman, Jordan.

Case A 67-year-old woman known to have iron deficiency anemia and persistent unexplained chronic leukopenia was cared for by our medical center for about 16 years. During this period she was examined thoroughly and diagnosed to have chronic idiopathic neutropenia (also known as chronic benign neutropenia). Her iron deficiency was attributed to nutritional factors and she was non-compliant with her oral iron supplements. The patient fully received her iron supplement medication by nursing staff for two and a half months during an unexpected prolonged hospital stay after her suffering an acute ischemic cerebrovascular accident. An astonishing outcome was that in addition to having her iron deficiency anemia treated, her long-term unexplained neutropenia was also corrected. Conclusion Some patients diagnosed with chronic idiopathic neutropenia and clinically present as having unexplained chronic neutropenia might actually be suffering from a form of not yet described iron deficiency induced neutropenia.