Железодефицитные новости

[Dr.Vad]

еще из прежних публикаций, которые стали доступны в свободной версии недавно:

IRON: HOW TO MANAGE WHEN THERE IS TOO MUCH OR TOO LITTLE OF IT
DECEMBER 6, 2019
Management of iron deficiency
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

В подтверждение предыдущей статьи где ЖДА ассоциировалась с повышением риска деменции, эта публикация показывает, что и дефицит железа по низкому ферритину снижает когнитивные способности людей средних лет и пожилых:

SF is significantly and positively associated with cognition. In older people with low SF levels, iron supplementation may be a promising therapy to improve cognition.
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J Nutr Health Aging. 2024 Feb 17;28(4):100190.
Lower serum ferritin levels are associated with worse cognitive performance in aging

[Dr.Vad]

оценка железа бисглицината 25 мг (аля-Солгар) каждый день или через день у спортсменок с жд по ферритину менее 35 (около 20 в среднем), ежедневный прием чуть лучше повышал ферритин за 8 недель (2 мес. лечения), и становился более 35 у 60%, но он чаще сопровождался тошнотой и запорами; прием через день переносился легче, но ферритин более 35 повысился у 17% (у каждой шестой), при ферритине менее 15 ни у кого не было достигнуто повышение более 35 вне зависимости от режима; возраст 18-22 года, ИМТ 22-23, все подробности по ссылке на оригинал:

Daily versus three times weekly dosing for treatment of iron deficiency nonanemia in NCAA Division 1 female athletes

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Oral iron supplementation: new formulations, old questions. 2024

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

некоторые моменты про усвоение железа у человека:

Iron Absorption: Molecular and Pathophysiological Aspects

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

сравнение пациентов с В12 дефицитной анемией и комбинированной в12-железодефицитной - пациенты с комби-анемией были моложе (42-66 лет), преимущественно женщины, Витамин В12 был 200-308 или низконормальный, гемоглобин 121-131 или тоже низконормальный, гомоцистеин 11-18 или пограничный; жд как ферритин менее 30 или менее 100 и Ж/ОЖСС менее 0.2, ответ на лечение жд препаратами внутрь у трети пациентов и у 7/8 после в/в введения железа:

Iron deficiency in pernicious anemia: Specific features of iron deficient patients and preliminary data on response to iron supplementation.
Rogez J, Urbanski G, Vinatier E, Lavigne C, Emmanuel L, Dupin I, Ravaiau C, Lacombe V.
Clin Nutr. 2024 Apr;43(4):1025-1032.

[Dr.Vad]

боли роста в общей практике педиатра: были диагностированы у 333 детей в возрасте 7-8 лет что составило 73% от всех детей с хроническими болями в ногах, длились около 11 мес до диагностики; 267 детей выполнили назначенное лечение в течение 3 мес. и вернулись на повторный прием; тем, у кого была анемия (гемоглобин менее 110 г/л) был назначен препарат железа-2 к витамину д и препарату кальция, симптомы прошли у 67% детей после курса железа и у 29% без железа

72 out of 107 (67%) children, who received iron became symptom-free.
Only 43 out of 160 (29%) patients became symptom-free, who received only calcium and vitamin D3 and did not receive iron.

Prevalence of growing pains in a general paediatric OPD: A descriptive, observational and cross-sectional study
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

как достаток железа в организме по гемоглобину и ферритину положительно влияет на структуру кости голени и маркеры обмена костной ткани:

Higher ferritin was associated with higher total, trabecular, and cortical volumetric bone mineral density, trabecular volume, cortical area and thickness, stiffness, and failure load (all p ≤ 0.037).

Higher soluble transferrin receptor (sTfR) was associated with lower trabecular number, and higher trabecular thickness and separation, cortical thickness, and cortical pore diameter (all p ≤ 0.033).

Higher haemoglobin was associated with higher cortical thickness (p = 0.043).

Higher ferritin was associated with lower βCTX, PINP, total 25(OH)D, and total 24,25(OH)2D, and higher 1,25(OH)2D:24,25(OH)2D ratio (all p ≤ 0.029).

Higher sTfR was associated with higher PINP, total 25(OH)D, and total 24,25(OH)2D (all p ≤ 0.025).

The greater density, size, and strength of the tibia, and lower circulating concentrations of markers of bone resorption and formation with better iron stores (higher ferritin) are likely as a result of the direct role of iron in collagen synthesis.
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Bone. 2024 Jun 3:186:117145.
Iron status is associated with tibial structure and vitamin D metabolites in healthy young men

[Dr.Vad]

ВEST PRACTICE ADVICE 1: No single formulation of oral iron has any advantages over any other. Ferrous sulfate is preferred as the least expensive iron formulation.
BEST PRACTICE ADVICE 2: Give oral iron once a day at most. Every-other-day iron dosing may be better tolerated for some patients with similar or equal rates of iron absorption as daily dosing.
BEST PRACTICE ADVICE 3: Add vitamin C to oral iron supplementation to improve absorption.
BEST PRACTICE ADVICE 4: Intravenous iron should be used if the patient does not tolerate oral iron, ferritin levels do not improve with a trial of oral iron, or the patient has a condition in which oral iron is not likely to be absorbed.
BEST PRACTICE ADVICE 5: Intravenous iron formulations that can replace iron deficits with 1 or 2 infusions are preferred over those that require more than 2 infusions.
BEST PRACTICE ADVICE 6: All intravenous iron formulations have similar risks; true anaphylaxis is very rare. The vast majority of reactions to intravenous iron are complement activation-related pseudo-allergy (infusion reactions) and should be treated as such.
BEST PRACTICE ADVICE 7: Intravenous iron therapy should be used in individuals who have undergone bariatric procedures, particularly those that are likely to disrupt normal duodenal iron absorption, and have iron-deficiency anemia with no identifiable source of chronic gastrointestinal blood loss.
BEST PRACTICE ADVICE 8: In individuals with inflammatory bowel disease and iron-deficiency anemia, clinicians first should determine whether iron-deficiency anemia is owing to inadequate intake or absorption, or loss of iron, typically from gastrointestinal bleeding. Active inflammation should be treated effectively to enhance iron absorption or reduce iron depletion.
BEST PRACTICE ADVICE 9: Intravenous iron therapy should be given in individuals with inflammatory bowel disease, iron-deficiency anemia, and active inflammation with compromised absorption.
BEST PRACTICE ADVICE 10: In individuals with portal hypertensive gastropathy and iron-deficiency anemia, oral iron supplements initially should be used to replenish iron stores. Intravenous iron therapy should be used in patients with ongoing bleeding who do not respond to oral iron therapy.
BEST PRACTICE ADVICE 11: In individuals with portal hypertensive gastropathy and iron-deficiency anemia without another identified source of chronic blood loss, treatment of portal hypertension with nonselective β-blockers can be considered.
BEST PRACTICE ADVICE 12: In individuals with iron-deficiency anemia secondary to gastric antral vascular ectasia who have an inadequate response to iron replacement, consider endoscopic therapy with endoscopic band ligation or thermal methods such as argon plasma coagulation.
BEST PRACTICE ADVICE 13: In patients with iron-deficiency anemia and celiac disease, ensure adherence to a gluten-free diet to improve iron absorption. Consider oral iron supplementation based on the severity of iron deficiency and patient tolerance, followed by intravenous iron therapy if iron stores do not improve.
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Clin Gastroenterol Hepatol. 2024 Jun 11:S1542-3565(24)00410-5.
AGA Clinical Practice Update on Management of Iron Deficiency Anemia: Expert Review

[Dr.Vad]

ввведение 500 или 1000 мг феринджекта при ЖДА, изменение лабораторных показателей до и через 2 недели после введения (повторное введение 500 мг феринджекта через 1 неделю после первого), 152 пациента, 80% женщин, средний возраст 39 лет

Hb level 81 (19.2) 105 (15.6)
HCT 27.3 (7.9) 32.4 (10.3)
Platelets 333 (128) 259 (189)
Ferritin 13.9 (26.4) 303 (650)
Reticulocyte 1.4 (1.2) 3.6 (17.3)
Ret-He 19.6 (5.7) 30.0 (25.5)

побочные действия свыше 10%

Pyrexia 39 (26%)
Dyspepsia 24 (16%)
Headache 27 (18%)
Constipation 8 + Diarrhea 4 + Vomiting 8 (13%)

Euroasian J Hepatogastroenterol. 2024 Jan-Jun;14(1):12-15.
Iron-deficiency Anemia Treatment with Ferric Carboxymaltose: A Real-world Quasi-experimental Study from Bangladesh

[Dr.Vad]

Детям с синдромом гиперактивности назначение железа на 6 недель даже с нормальным (более 30) ферритином улучшало течение болезни

significant change in median scores of inattention and hyperactivity sub-scale on Conner's Rating Scale (P = 0.036) as well as significant improvement on tests of attention; Children's Color Trails Test (CCTT) (P = 0.006) was observed after 6 weeks of iron therapy in all children.
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Indian Pediatr. 2024 Jul 12.
Iron Supplementation in Children with Attention Deficit Hyperactivity Disorder: A Single Centre Study

[Dr.Vad]

ошибки при ведении пациентов с жда - обзор:

Article highlights
Iron deficiency anaemia (IDA) is a significant cause of morbidity worldwide.

The initial evaluation should contain a thorough history (including dietary habits, medication use, and menstrual cycles), identification of any concurrent disorders, and clinical examination.

To confirm IDA and rule out other potential causes, a relevant standardised laboratory workup such as iron studies, red cell indices, and haemoglobin electrophoresis (if relevant) should be performed.

An excellent response (Hb rise ≥10 g/L within a 2-week timeframe) to iron replacement therapy (IRT) in anaemic patients is highly suggestive of absolute iron deficiency, even if the results of iron studies are equivocal.

In cases of inexplicable IDA or IDA from high-prevalence areas, active screening for Helicobacter pylori (using non-invasive testing methods) and treatment initiation should be implemented.

As blood loss from the gastrointestinal tract is the commonest cause of IDA in adult men and post-menopausal females, bidirectional endoscopy must be conducted.

In pre-menopausal women with IDA, guidance about investigations varies.

In cases of persistent or recurrent IDA despite adequate IRT and negative bidirectional endoscopy, further evaluation of the small bowel (by capsule endoscopy, enteroscopy or CT/MR enterography) may be warranted.

Patient factors and the urgency of iron repletion must be considered when determining the appropriateness of the type of IRT.

IRT to replenish iron stores and improve haemoglobin levels can be done with iron therapy (oral/intravenous) or blood transfusions (reserved for severe, symptomatic patients).

Following the correction of anaemia, a clinical review according to standardised follow-up protocol focusing on symptom management, treatment compliance, and the presence of adverse events should be conducted.
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Mistakes in the management of iron deficiency anaemia: a narrative review
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Compared with the control condition — overnight fasting followed by a morning iron dose taken with water three hours before coffee or breakfast
—
a morning dose taken with either 80 mg or 500 mg of ascorbic acid significantly improved iron absorption by about 30%.

The higher dose did not yield significantly higher absorption.

All other strategies reduced iron absorption:
afternoon dosing by 37%;
coadministration with coffee in the morning by 54%;
administration in the morning with coffee, 90 mg of ascorbic acid, and food by 66%.

Compared to consuming a 100 mg iron dose in the morning with coffee or breakfast, consuming it with orange juice alone results in a ~ 4-fold increase in iron absorption, and provides ~20 more mg of absorbed iron per dose.

Effect of dietary factors and time of day on iron absorption from oral iron supplements in iron deficient women
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

A total of 71 677 veterans with IDA (63 202 male [88.2%] and 8475 female [11.8%]; mean [SD] age, 68.5 [13.1] years), including 47 201 with NKF and 24 476 with CKD, were identifed. In patients with NKF in the daily group, hemoglobin increased from baseline (estimated per-30-day difference [SE], 0.27 [0.00] g/dL; P < .001).

Patients were classified into 3 groups based on their oral iron dosing schedule: daily (once a day), multiple doses per day (MDD; ≥2 times per day), or alternate-day dose (ADD).

In comparison with the daily group, hemoglobin increased more in the MDD group (estimated per-30-day difference [SE], 0.08 [0.03] g/dL; P < .001), but no difference was noted in the ADD group (estimated per-30-day difference [SE], −0.01 [0.01] g/dL; P = .38).

Among patients with NKF, the adjusted mean increase in hemoglobin was
1.03 g/dL (95% CI, 1.01-1.06 g/dL) for those in the daily group,
1.38 g/dL (95% CI, 1.36-1.40 g/dL) for those in the MDD group, and
0.93 g/dL (95% CI, 0.84-1.02 g/dL) for those in the ADD group at 90 days.

Among patients with CKD, the adjusted mean increase in hemoglobin was
0.71 g/dL (95% CI, 0.68-0.73 g/dL) for those in the daily group,
0.99 g/dL (95% CI, 0.97-1.01 g/dL) for those in the MDD group, and
0.62 g/dL (95% CI, 0.52-0.73 g/dL) for those in the ADD group at 90 days.

Optimal Oral Iron Therapy for Iron Deficiency Anemia Among US Veterans
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

еще одна публикация о том, что разные методики определения ферритина могут давать разные цифры: набор от рош показывает на 60% выше цифры, чем бекман

equivalent ferritin measures determined by
Beckman, Roche were:
50 mcg/dL, 83 mcg/dL;
75 mcg/dL, 121 mcg/dL;
100 mcg/dL, 158 mcg/dL; and
300 mcg/dL, 457 mcg/dL.

J Clin Sleep Med. 2024 Aug 22.
Serum ferritin measurements differ according to assay used: implications for iron therapy in restless legs syndrome