Железодефицитные новости

[Dr.Vad]

Интересная работа от датчан: они опять показали, что и ферритин и железо/ожсс (TS) ассоциируется с выживаемостью, причем как дефицит железа так и его избыток отрицательно влияют на продолж. жизни, оптимальные цифры мало зависят от Ц-реактивного белка:

The ferritin level associated with lowest mortality was 60 µg/L for females and 125 µg/L for males with CRP < 10 mg/L.
It was 52 µg/L for females and 118 µg/L for males with CRP ≥ 10 mg/L.

The TS level associated with lowest mortality was 33.9% for females and 32.3% for males with CRP < 10 mg/L.
It was 28.7% for females and 30.6% for males with CRP ≥ 10 mg/L.
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Scand J Clin Lab Invest. 2022 Oct 11;1-8.
Association of ferritin and transferrin saturation with all-cause mortality, and the effect of concurrent inflammation: a danish cohort study

[Dr.Vad]

еще одна публикация, показывающая, что ферритин менее 50 является ранним маркером дефицита железа, согласно изменениям в крови гепцидина и уровня рецепторов к трансферрину:

ferritin level < 50 ng/mL is the clinical threshold to redefine and consider ferropenia, in order to achieve an early diagnosis and initiate treatment for iron deficiency.
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Threshold Ferritin Concentrations Reflecting Early Iron Deficiency Based on Hepcidin and Soluble Transferrin Receptor Serum Levels in Patients with Absolute Iron Deficiency.
Nutrients. 2022 Nov 10;14(22):4739.

[Dr.Vad]

в/в феринджект детям до 18 лет, подробно обо всем в полном тексте

A retrospective cohort of 144 consecutive patients aged 18 months to<18 years with iron deficiency anemia (IDA) or iron deficiency (ID) without anemia was investigated. All patients had failed oral iron therapy.

100 of 117 (85 %) of patients with complete data achieved the target ferritin level≥30 µg/L after a single FCM dose.
Of 77 patients with IDA and complete data, 38 (49%) showed a complete hematological response within 6-12*weeks; a complete or partial response was achieved by 83%.
Clinical symptoms improved in 85% of all patients. In 92% of patients (n=133 /144), FCM infusion was uneventful.
During the 96-hour follow-up, 5 patients reported potentially related symptoms. No serious adverse events occurred.

Intravenous ferric carboxymaltose for iron deficiency anemia or iron deficiency without anemia after poor response to oral iron treatment: Benefits and risks in a cohort of 144 children and adolescents [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

феринджект у беременных с анемией - ответ по гемоглобину через 4 недели после введения:

тяжелая анемия Hb < 70 - повышение на 36 г/л
средней тяжести Hb 70 to 99 - повышение на 27.4 г/л
лёгкая анемия Hb 100-110 - повышение на 20 г/л

риск поб. действия 8.6%

Obstet Gynecol Int. 2022 Nov 28;2022:5759740.
Ferric Carboxymaltose in the Management of Iron Deficiency Anemia in Pregnancy:
A Subgroup Analysis of a Multicenter Real-World Study Involving 1191 Pregnant Women
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

изменения глико-гемоглобина при различных анемиях в сравнении с контролем у пациентов без диабета:

control group at 5.32% (95% CI = 5.22-5.41)
megaloblastic anemia were 5.38% (95% CI = 5.26-5.5)
beta thalassemia trait 5.45% (95% CI = 5.21-5.69)
iron deficiency anemia at 5.75% (95% CI = 5.68-5.82)
sickle cell anemia at 5.83% (95% CI = 5.39-6.28)

лечение железом снизило его цифры на 0.3%, но не до цифр контрольной группы

HbA1c significantly decreased from 5.75 to 5.44% after treatment in the iron-deficient group
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BMC Endocr Disord. 2023 Jan 28;23(1):24.
The effect of different types of anemia on HbA1c levels in non-diabetics

[Dr.Vad]

железа фумарат 3 раза в день или 3 раза в неделю для лечения ЖДА - оба подхода вылечивают анемию и корректируют ферритин к 12-ой неделе - один вариант просто быстрее ответ и выше частота поб. действия со стороны ЖКТ, подробнее:

A randomized controlled trial of thrice-weekly versus thrice-daily oral ferrous fumarate treatment in adult patients with iron-deficiency anemia
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

как показатель RET-He помогает в диагностике безанемического жд: если он менее 31, то и ферритин менее 15, сравнение 2 групп показывает, что у увсех пациентов хоть анемии и не было, но и гемоглобин и гематокрит статистически ниже в группе жд (ферритин менее 15)

Control group G1: normal ferritin (≥ 15 ng/mL)
LID group G2: low ferritin (< 15 ng/mL).
Results: We selected 108 participants (G1: 88 (81.5%), G2: 20 (18.5%)), mean age = 36 years, F:M = 9:1. We noted, in G2, significantly lower rates for hemoglobin Hb (p < 0.001), hematocrit (p < 0.001), mean corpuscular hemoglobin MCH (p = 0.026), reticulocyte count (p = 0.039) and RET-He (p < 0.001) and significantly higher rate for RDW/CV (p = 0.009). RET-He averages were 29.1 pg in G2 and 31.1pg in G1. In multivariate analysis, only RET-He showed a significant difference between the two groups. Area under the curve was 0.872, the cutoff = 30.9 (sensitivity 100%, specificity 61%, PPV 37%, NPV 100%).
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Ann Biol Clin (Paris). 2023 Jun 17;81(3).
Importance of the reticulocyte hemoglobin equivalent in the exclusion of latent iron deficiency

[Dr.Vad]

еще одна публикация о том, что у женщин с бесплодием чаще выявляется дефицит железа как по насыщению трансферрина менее 20%, так и по ферритину менее 30:

Women with unexplained infertility demonstrated a lower transferrin saturation (median 17.3%, IQR 12.7-25.2 versus 23.9%, IQR 15.4-31.6; p= 0.034) and a lower mean corpuscular hemoglobin concentration (median 33.6 g/dL, IQR 33.0-34.1 versus 34.1 g/dL, IQR 33.2-34.7; p= 0.012). Despite the fact that there was no statistically significant difference in median ferritin levels (p= 0.57), women with unexplained infertility had ferritin levels <30µg/L more often (33.3%) than controls (11.1%; p= 0.023). In a multivariate model, unexplained infertility and abnormal thyroid antibodies were associated with ferritin <30µg/L (OR 4.9, 95%CI: 1.2-20.4; p= 0.029 and OR 13.1; 2.4-72.0; p= 0.029, respectively).

Iron status in women with infertility and controls: a case-control study
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

коррекция жд улучшает многие параметры умственной способности у детей, включая внимание, память, но не улучшает успеваемость в школе

iron supplementation significantly improved
intelligence (standardized mean difference, 95% confidence interval) (SMD 0.46, 95%CI: 0.19, 0.73, P<0.001),
attention and concentration (SMD 0.44, 95%CI: 0.07, 0.81, P = 0.02) and
memory (SMD 0.44, 95%CI: 0.21, 0.67, P <0.001) of school-age children.
There was no significant effect of iron supplementation on school achievement of school-age children (SMD 0.06, 95%CI: -0.15, 0.26, P = 0.56). In a subgroup analysis, iron-supplemented children who were anemic at baseline had had better outcomes of intelligence (SMD 0.79, 95%CI: 0.41, 1.16, P = 0.001) and memory (SMD 0.47, 95%CI: 0.13, 0.81; P = 0.006).

Iron supplementation has a significant positive effect on the intelligence, attention and concentration, and the memory of school-age children but there was no evidence on the effect of iron supplementation on their school achievement.
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PLoS One. 2023 Jun 27;18(6):e0287703.
Effects of iron supplementation on cognitive development in school-age children: Systematic review and meta-analysis

[Dr.Vad]

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

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

[Dr.Vad]

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

Intravenous iron: an update 2023

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

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

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

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

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

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

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

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

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

[Dr.Vad]

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

CHRONIC IRON NEED

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

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

[Dr.Vad]

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

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

[Dr.Vad]

Железо в лечении психиатрических пациентов - полный текст в журнале "Современная психиатрия" - фрагменты оттуда:

Iron deficiency is common and can cause or contribute to psychiatric symptoms
and disorders. Consider screening patients for iron deficiency and treating it with
oral supplementation in individuals without any comorbidities...

Clinical Point
We suggest aiming for a serum ferritin level >100 ug/L and monitoring every 4 to 6 weeks

Iron deficiency in psychiatric patients
Current Psychiatry. 2023 March;22(3):25-29,34 | doi: 10.12788/cp.0337
[Ссылки доступны только зарегистрированным пользователям ]