Железодефицитные новости

[Dr.Vad]

еще один обзор о дефиците железа и у женщин - ЖД без анемии может быть принят за синдром хронической усталости, вызванный вирусными заболеваниями, или могут быть назначены антидепрессанты, если врач не проведет диагностику ЖД:

Many women may be investigated for viral causes of chronic fatigue syndrome or treated with antidepressants when the diagnosis of iron deficiency has not been made.
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The effect of iron deficiency and anaemia on women’s health
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Экспериментальная статья, показывающая, что низкое содержание железа в крови, вызванное вирусной инфекцией, может способствовать худшему иммунному ответу на вирус и утяжелению течения болезни - на примере КОВИД-19:

Hepcidin, Hypoferremia, and Viral Infections

Although inflammatory hypoferremia can be beneficial in the context of infections with single-cell organisms that must acquire iron from their host, evidence that low serum iron is protective in the context of viral infections is lacking. In fact, in our experiments with influenza virus, imposing hepcidin-induced hypoferremia resulted in an impaired adaptive immune response, viral persistence, and severe pulmonary disease, suggesting that low serum iron may sometimes be an unhelpful response to infection. Recent reports show that hypoferremia is present in coronavirus disease 2019 (COVID-19) patients on admission to the intensive care unit (ICU). Low serum iron correlated with lymphopenia, and extremely low serum iron (~3 μmol/L) identified COVID-19 patients with severe respiratory hypoxemia, likely secondary to pulmonary damage. This hypoferremia is more profound than in previously reported cohorts of non-COVID-19 ICU patients, including those with sepsis, indicating that extreme hypoferremia may be a particular feature of severe COVID-19 disease. IL-6 drives hepcidin expression, and an unbalanced inflammatory response of high IL-6 and relatively low type I and type III IFN associates with severe COVID-19 and poor outcomes. IL-6-driven and hepcidin-mediated hypoferremia could impair the antiviral adaptive immune response, contributing to the severity of infection.
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Hepcidin-Mediated Hypoferremia Disrupts Immune Responses to Vaccination and Infection
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

пилотник из Японии - коррекция как ЖДА, так и безанем. ЖД убирает головные боли у менстр. женщин:

14 iron deficiency patients presented at our outpatient department of general medicine were divided into the IDWA group (Hb12 ≥ g/dL, ferritin <12 ng/mL) or IDA group (Hb<12 g/dL, ferritin <12 ng/mL). Patients’ ages, physical signs, laboratory data, and symptoms were compared between the two groups.

Results: There were no statistical differences in age, vital signs, or serum ferritin levels between the groups. Headache and fatigue were found more commonly in IDWA patients. Their headaches closely resembled that of migraines or tension-type headaches. Although their symptoms were relieved completely following oral iron replacement, the diagnosis of IDWA could not be inferred from these clinical presentations.

Iron Deficiency Without Anemia As A Cause Of Treatable Headache: A Pilot Study
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

назначение пр-та железа 2 погранично-недоношенным детям (рожденным в 34-36 недель) с первого месяца и по 6 мес. возраст улучшали когнитивное и моторное развитие к 12 мес. возрасту:

66 healthy LPT infants born between 34 and 36.9 weeks of gestational age were enrolled in the study. One group received martial prophylaxis from the third week of life to 6 months of post-conceptional age (2 mg/kg/day of iron pidolate), the other received placebo. 52 of the enrolled infants were assessed using the GMDS at 12-month of post-conceptional age. Statistical analysis of the mean scores of the Griffiths subscales was performed. There was a difference in the mean developmental quotient (DQ) (p < 0.01) between the two groups: iron group mean DQ 121.45 ± 10.53 vs placebo group mean DQ 113.25 ± 9.70.

Conclusions: We recommend that all LPT neonates receive iron supplementation during the first 6 months of life in order to improve their 1-year neurodevelopmental quotient.
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Eur J Pediatr. 2021 Jul 21.
Neurological development and iron supplementation in healthy late-preterm neonates: a randomized double-blind controlled trial

[Dr.Vad]

добавление железа к methylphenidate 2 раза в день детям при гиперактивности и жд улучшает шкалу поведения по оценке родителей, но не учителей:

116 children who participated in this study, 44.8% (52/116) met the criteria for iron deficiency. Of the total 52 participants with iron deficiency, 26 were randomized to the ferrous group and 26 to the placebo group. Most participants in each group had been prescribed short-acting methylphenidate twice daily in the morning and at noon. After a 12-week study period, total parents' Vanderbilt ADHD symptom scores showed a significant improvement between the groups (mean decrement = -3.96 ± 6.79 vs 0 ± 6.54, p = 0.037). However, teachers' Vanderbilt ADHD symptom scores showed no difference between the groups.
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J Dev Behav Pediatr. 2021 Jul 26.
Effect of Iron Supplementation in Children with Attention-Deficit/Hyperactivity Disorder and Iron Deficiency: A Randomized Controlled Trial

[Dr.Vad]

Symptoms described by anemic and non-anemic patients with iron deficiency
Common:
Exceptional fatigue*
Reduced mental awareness*
Absent-mindedness and poor concentration*
Headache*
Hair loss*
Muscle and joint pain*
Edema*
Shortness of breath and dyspnea*
High resting heart rate and rapid acceleration
of heart rate during exertion; palpitations*
Weight gain*
Loss of initiative
Memory lapses
Difficulties finding words
Vertigo
Depression
Anxiety
Globus, pharyngeal irritation and phlegm,
dysphagia, cough#
Heartburn
Cold hands and feet
Diaphoresis or no sweating
Restless legs#
Reduce aerobic performance, myalgia
associated with even slight muscle strain
Sleeping disturbances
Abnormal menstruation
Mild pyrexia (<38 C)
Dry skin and pruritus
Easy bruising
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Iron Deficiency Without Anemia – Common, Important,
Neglected 2019 [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

частота побочного действия на в/в железо была выше у венофера и железа-декстрана, чем у феринжекта или монофера, переход на альтернативный препарат в таком случае предпочтительнее, чем введение прежнего под лек. прикрытием:

Rate of infusion events differed among iron formulations:
4.3% (n = 970; 95% CI, 4.1%-4.6%) iron sucrose,
3.8% (n = 345, 95% CI: 3.4%-4.2%) iron dextran (test and full doses or test dose alone),
1.8% (n = 57; 95% CI, 1.4%-2.3%) ferumoxytol, and
1.4% (n = 17, 95% CI, 0.8%-2.3%) ferric carboxymaltose (P < .001).
Severe adverse events were exceedingly rare with only 2 documented epinephrine administrations, both associated with iron dextran.
Incidence of adverse events among those who received premedication was 23-fold higher compared with those who did not (38.6% vs 1.7% P < .001).
Among 873 patients with history of infusion reaction who underwent readministration, the majority received the same formulation, which was associated with significantly higher reaction rate particularly if premedication was administered (68% [95% CI, 64%-72%] vs 32% [95% CI, 26%-41%], respectively), compared with those who received an alternate formulation (21% [95% CI, 11%-35%] vs 5% [95% CI, 2%-12%], respectively) (P < .001).
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JAMA Netw Open. 2022 Mar 1;5(3):e224488.
Analysis of Adverse Events and Intravenous Iron Infusion Formulations in Adults With and Without Prior Infusion Reactions

[Dr.Vad]

немного о дефиците железа и ЖДА через 2 недели после родов - ЖДА как гемоглобин менее 120 была у 25%, но ЖД как ферритин менее 15 - у 39%; в среднем гемоглобин был 128 г/л если ферритин был более 15, и 126 г/л - если менее 15: итог - у 2/5 после родов ферритин менее 15 и гемоглобин 126 г/л или выраженный ЖД, но и гемоглобин 128 г/л не исключает жд по ферритину менее 25, что предполагает послеродовый гемоглобин более 130 г/л может рассматриваться как нормальный и безжелезодефицитный:

...assess the prevalence of anaemia and iron deficiency (ID) by three iron indicators 14 weeks postpartum, their relations to haemoglobin (Hb)...
...cohort study of 573 women followed from early pregnancy...
The prevalence of postpartum anaemia (Hb <120 g/l) was 25 %. ID prevalence varied from 39 % by serum ferritin (SF <15 μg/l)...
The mean Hb concentration was 128 g/l in women with no ID, 126 g/l in those with ID by SF ...
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J Nutr Sci. 2022 Jun 13;11:e46.
Prevalence of postpartum anaemia and iron deficiency by serum ferritin, soluble transferrin receptor and total body iron, and associations with ethnicity and clinical factors: a Norwegian population-based cohort study

[Dr.Vad]

Первая публикация о том как лейкопения или нейтропения при ЖДА отвечает на лечение железом:

Out of 1,567 adult females with IDA, 80 patients had leukopenia (5.1%), 64 had neutropenia (4.0%), and 20 had lymphocytopenia (1.2%).

After iron therapy, their mean leukocytes, neutrophils, and lymphocytes increased significantly to 4.38 ± 1.82 ×10/3/L, 2.3 ±1.56 ×10/3/L and 1.76 ± 0.48 ×10/3/L, respectively. About 67% of women with IDA and neutropenia had increased ANC in response to iron therapy.

Neutropenia and/or lymphocytopenia may occur in patients with IDA and are reversible with iron therapy. Iron therapy led to the correction of anemia in 100% and increased ANC in 67%. Therefore, neutropenic women with IDA should be treated, initially only with iron, and observed for their Hb and ANC responses before starting any other treatment.
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Acta Biomed. 2022 Jul 1;93(3):e2022235.
Neutropenia and Lymphocytopenia Among Arab Females with Iron Deficiency Anemia (IDA) and their Response to Iron therapy.

[Dr.Vad]

жд и аллергия: Consequently, iron deficiency has a pronounced impact on immune cells, favoring Th2-cell survival, immunoglobulin class switching and primes mast cells for degranulation. Iron deficiency during pregnancy increases the risk of atopic diseases in children, while both children and adults with allergy are more likely to have anemia. In contrast, an improved iron status seems to protect against allergy development...

подробнее в публикации:

Front Allergy. 2022 May 10;3:859922.
Iron-Deficiency in Atopic Diseases: Innate Immune Priming by Allergens and Siderophores

[Dr.Vad]

назначение препарата железа через день в идентичной дозе 100 мг железа у беременных с ЖДА привело к чуть лучшему ответу на лечение по приросту гемоглобина и снижению частоты поб. действия в 2.7 раза:

there were 111 women in the daily group and 106 women in the other day group...

ferritin levels increased 4.9 ± 4.2 ng/mL in the daily intake group and 3.9 ± 2.9 ng/mL in every other day group (p = .215).

The Hb increased 14 ± 7 g/L in the daily intake group and 16 ± 6 g/L in the other day group (p = .021).

The rate of gastrointestinal side effect was lower in every other day group (41.4% vs 15.1%, p = .0057).

J Matern Fetal Neonatal Med. 2022 Mar;35(5):832-836.
Is every other day iron supplementation effective for the treatment of the iron deficiency anemia in pregnancy?

[Dr.Vad]

железо-дефицит и депрессия - механизмы и возможные варианты лечения:

Iron, neuro-bioavailability and depression

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

обзор про жд у новорожденных в полной версии - замечательная фраза о "пользе" проверки гемоглобина

Iron Deficiency in Newborn Infants

Newborn (Clarksville). 2022 Jan-Mar;1(1):97-103.

As a screening method to detect neonatal/infant iron deficiency,
measuring the hematocrit or blood hemoglobin level will not do.
Why? Because, by the time iron deficiency has caused neonatal
anemia, iron-deficient neurodevelopmental damage has probably
already occurred. Thus, screening for iron deficiency by looking for
anemia is like closing the barn door after the horse already escaped.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Интересная статья опубликована из Японии - есть ли разница в симптомах или исходах после лечения, будь у женщины железодефицит без анемии или ЖДА - разницы не было, подробное описание симптомов и их частоты - например боли в мышцах/суставах были у каждой третьей, лихорадка (субфебрилитет?) около 20%, отёки у 10% и тп. ответ на лечение тоже был одинаков - снижение симптоматики у 60%, другие детали - по ссылке

The Clinical and Biological Manifestations in Women with Iron Deficiency Without Anemia Compared to Iron Deficiency Anemia in a General Internal Medicine Setting:
A Retrospective Cohort Study

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Тромбоцитоз как более 450 был у 8% женщин с ЖДА и ассоциировался с более тяжелой анемизацией и ЖД, коррекция ЖДА привела к нормализации числа тромбоцитов через 2 недели у половины из них и у всех в течение 6 недель лечения:

The mean ± standard deviation (SD) platelet counts of the 440 patients with IDA was 310± 99 × 109/L. With baseline platelet counts>450 × 109 /L as the cutoff for thrombocytosis, patients were divided into 2 groups: 36 (8.1%) in the IDA with thrombocytosis group (mean ± SD platelet count, 522 ± 74 × 109/L) and the remaining 404 in the IDA without thrombocytosis group (mean ± SD platelet count, 291 ± 76 × 109/L). Differences were found in baseline characteristics including white blood cell (WBC) count, hemoglobin (Hb) level, mean corpuscular volume (MCV), transferrin saturation (TSAT), serum iron (SI) level, and total iron-binding capacity (TIBC) between the two groups (P < .05).

From baseline to 8 weeks of continuous iron supplementation treatment, the mean platelet counts in both groups were decreased at 2-week treatment intervals. And in the IDA with thrombocytosis group, half of the patients resolved thrombocytosis after 2 weeks of iron supplementation, and the counts of all patients with thrombocytosis decreased below 450 × 109 /L within 6 weeks.

In conclusion, the rate of reactive thrombocytosis in patients with IDA was 8.1%. IDA patients with thrombocytosis showed more severe anemia, lower ferritin, and more advanced iron deficiency than those without thrombocytosis. Platelet counts of half of the patients with thrombocytosis reduced below cut off of 450 × 109/L for thrombocytosis after 2 weeks of treatment, and all patients resolved thrombocytosis after 6 weeks.
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Platelets. 2022 Sep 1;1-6.
Effect of iron supplementation on platelet count in adult patients with iron deficiency anemia.