Железодефицитные новости

[Dr.Vad]

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

[Dr.Vad]

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.

[Dr.Vad]

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.

[Dr.Vad]

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.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

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.

[Dr.Vad]

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.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

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.

[Dr.Vad]

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.

[Dr.Vad]

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.

[Dr.Vad]

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.

[Dr.Vad]

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.

[Dr.Vad]

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.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

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

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

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.

[Dr.Vad]

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.