Железодефицитные новости

[Dr.Vad]

Железа сульфат в невысокой дозе (1-3 мг/кг) удваивает ферритин (с 24 до 45) за 6-8 недель приема, добавление пробиотиков не влияет на его усвоение:

This randomized, double-blinded, controlled trial of the treatment of iron deficiency in children compared the use of low-dose ferrous sulfate (1-3 mg/kg/day), with or without probiotic (LP299v).
Serum ferritin level increased in all children from a baseline of 23.7 ng/mL to 45.4 ng/mL after 6-8 weeks of treatment. There was no significant difference in the increase in serum ferritin in children taking the probiotic LP299v compared with controls (23.2 vs 20.0 ng/mL, respectively). Additionally, an increase in ferritin level was not significantly associated with probiotic use when controlling for other factors, including child weight and dosing. Overall, the treatments were well-tolerated, with mild side effects...
---
J Pediatr. 2019 Feb 4. pii: S0022-3476(18)31743-8.
Use of a Probiotic to Enhance Iron Absorption in a Randomized Trial of Pediatric Patients Presenting with Iron Deficiency.
Rosen GM и соавт.

[Dr.Vad]

еще одна публикация теперь из Турции, что у детей с аффективно-респираторными приступами лечение пр-том железа помогает вне зависимости от наличия анемизации:
Cyanotic breath-holding spells were diagnosed in 85.3% (n = 266) of patients, pallid spells in 5.1% (n = 16), and mixed-type spells in 9.6% (n = 30). Sleep electroencephalograms were applied for all patients, 98.2% (n = 306) of which were normal, while slow background rhythm was determined in 1.2% (n = 4). Epileptic activity was observed in only 2 patients (0.6%). The mean hemoglobin (Hb) value in the breath-holding spell group was 101 g/L. Patients’ mean corpuscular volume (MCV) was 73 fL. Patients’ Hb and MCV values were statistically significantly lower than those of the control group (P < 0.001). The difference between spell burden was not statistically significant (P = 0.691). Spell burden decreased equally in both groups.
---
Turk J Med Sci. 2019 Feb 11;49(1):230-237. doi: 10.3906/sag-1805-92.
Iron supplementation should be given in breath-holding spells regardless of anemia
Gürbüz G, и соавт.

[Dr.Vad]

De Novo Anemia and Relationship with Vitamin C Deficiency and Zinc Deficiency in a Southern Delaware Population, a Retrospective Analysis
Aasim S. Sehbai and Nouman Asif
Blood 2015 126:4547.

Background:
Vitamin C is an essential dietary nutrient. It is a water soluble vitamin that exists in the body primarily in the reduced form Ascorbic acid. It's deficiency leads to a disease called Scurvy which is rare in developed countries. The relationship between anemia, Iron deficiency and Vitamin C deficiency is not clear and not evidence-based although many hematologists recommend Vitamin C intake to help Iron absorption.

Method:
We reviewed the data from a single institution where cases of de novo anemia underwent diagnostic workup. The study was approved by the hospital IRB and it was a retrospective analysis of data from October 2007 through July 2014. In addition to checking patient's CBC, iron studies, ferritin, b12, folic acid all patients (pts) went through testing for Vitamin C, Copper and Zinc. All reference labs were send to Mayo medical laboratories for consistency and standardization. Vitamin C level was determined by a High-Performance Liquid Chromatography (HLPC) and samples were collected after a 12-14 hour fasting-overnight. The normal range for Vitamin C is 0.6-2.0 mg/dL. We divided patients into 5 categories Severe deficiency (<0.1 mg/dL), Moderate deficiency (0.1-0.3 mg/dL), Mild deficiency (0.4-0.6 mg/dL), Low normal or Borderline values (0.7-0.8 mg/dL) and Normal results (0.9-2.0 mg/dL).

Results:
Of the 482 pts with de novo anemia tested, 273 subjects were found to have a Vitamin C deficiency (56.6% of population). Of those 30 pts (10.9%) had severe Vit C deficiency, 96 (35.1%) had moderate deficiency, 84 (30.7%) mild deficiency and 63 (23%) had low normal or borderline values and 209 (43.3%) had normal results. In pts with Vitamin C deficiency, iron studies indicated a serum iron saturation below 20% (range 20-50%) in 115 out of 212 subjects tested giving an incidence of 54.2%. Pts who had Vitamin C deficiency about 212 of those pts were tested for zinc levels and 103 pts (48.5%) were found to have Zinc deficiency that's value below 0.66 mcg/ml (Normal range being 0.66-1.1 mcg/ml). Of the group with severe Vitamin C deficiency or undetectable levels (30 pts), average hemoglobin for that group was 8.8 gm/dl range being 11.3-15.5 (CI 5.5-14.9), average iron saturation was 31% range (20-50%)(CI 3-92%), average Zinc levels were 0.49 mcg/ml range 0.66-1.1 (CI 0.19-0.79) average copper value 1.26 mcg/ml range 0.75-1.45 mcg/ml (CI 0.77-1.74), average Ferritin value 104.8 ng/ml, range 22-322 ng/ml (CI 13.8-5621). This means that in pts with severe anemia and severe vitamin C deficiency we see a profile where 77% pts also present with Zinc deficiency, their copper values are normal, iron saturation is normal but Ferritin which is a marker of inflammation is elevated (66.6%). Taking all of Vitamin C deficiency cases in our study the average age of females was 57.4 years (CI 15-97) 67.3% of study group & average age for males was 59.6 years (CI 25-90) which is 32.7%

Pts who were found to have Vitamin C deficiency were given Vitamin C tablet 500 mg orally daily and if they have Zinc deficiency also supplemented with Zinc 50 mg orally daily. We have data on 67 of those 212 pts who had significant C deficiency (severe, moderate or mild). The average improvement in Vitamin C level for the group was 0.43 mg with average hemoglobin improvement of 0.96 gm.

Conclusion:
Vitamin C deficiency appears to play an important role in pathogenesis of nutritional anemia and it's incidence was more common than any other identifiable cause in our group. It can present as anemia regardless of the iron status and there appears to be a very strong correlation between Vit C deficiency and Zinc deficiency in patients with anemia. It also causes an Inflammatory response with elevation of Ferritin. Diet appears to play a major role in this type of anemia regardless of the body habitus. Malabsorption of Vitamin C and Zinc can be a reason as well. It is more common in females. Patients may or may not have other signs and symptoms of scurvy but in our population gum disease, bone pain, impaired wound healing and some degree of psychosis and mood disorder (scorbutic psychosis) was common. We believe that Vitamin C Deficiency is very common and under recognized cause of anemia. The exact pathophysiology needs to be established. Further studies need to be done to validate this important clinical finding but we recommend adding a fasting Vitamin C level and Zinc level as part of de novo anemia workup.

[Dr.Vad]

Впервые турецкие специалисты показали, что коррекция ЖДА сопровождается улучшением аппетита у детей и повышением количества съедаемых калорий за счет белка и углеводов, что положительно сказывается на наборе веса ребенка:

Iron deficiency anemia was diagnosed by clinic and laboratory findings. All 19 cases were given 5 mg/kg/day iron therapy for 3 months. Results The mean plasma ghrelin level was 936.7±428.8 pg/mL before therapy and it increased to 1284.7±533.3 pg/mL (p<0.001) while the mean plasma leptin level decreased from 3.4±1.6 ng/mL to 1.9±1.0 ng/mL (p<0.01) after therapy. The amount of daily caloric intake, carbohydrate and protein intake were significantly increased after therapy (p<0.001). Δ body weight was correlated with plasma ghrelin levels before and after therapy significantly. In conclusion, the findings of this study indicate that plasma ghrelin level increases and leptin level decreases and growth accelerates because of an increase in appetite and daily calories, carbohydrate and protein amount in children with nutritional iron deficiency anemia after iron therapy.
---
J Pediatr Endocrinol Metab. 2019 Feb 23.
The effect of therapy on plasma ghrelin and leptin levels, and appetite in children with iron deficiency anemia.
Kucuk N и соавт.

[Dr.Vad]

Дефицит железа у пациентов с СД1 обнаруживается у каждого четвертого и ассоциируется с повышенным риском депрессии и сниженным качеством жизни:

Decreased serum iron (< 60µg/dl) and ferritin levels (< 50pg/nl) were observed in 18 (16.8%) and 28 (26.7%) patients, respectively. Anemia was present in 20 patients (18.34%). A high rate of depression was observed: 42.2% (WHO-5) and 40.7% (CES-D). The personal goals and current diabetes therapy satisfaction score (PWTSS) was significantly better in patients with sufficient iron status (ferritin level > 50pg/ml, p=0.018). Multiple regression analysis revealed iron status (p=0.03) to be an independent predictor for better PWTSS. Insufficient iron status correlated significantly with depression as measured by WHO-5 (p=0.044) and CES-D (p=0.029).

Type 1 diabetes patients in the current study were frequently depressive and reported an impaired QoL that associated with iron insufficiency. If confirmed a better awareness is needed for depression and ID in long standing disease.
---
Diabetes Res Clin Pract. 2019 Mar 29.
Iron deficiency in long standing type 1 diabetes mellitus and its association with depression and impaired quality of life.
Bergis D и соавт.

[Dr.Vad]

Желание хрустеть льдом как железодефицитная пика у мужчин бывает у каждого третьего с ЖДА, которая в большинстве случаев из-за ЖК-кровотечений:

Iron-deficiency anemia was defined as transferrin saturation (TS) <15%, serum ferritin (SF) <30 μg/L, and hemoglobin (Hb) <13.0 g/dL....Median age of 41 men was 54 y (range 18-81). Fourteen men (34%) had pagophagia. Thirty-six men (88%) had gastrointestinal bleeding. Mean Hb was 94 ± 22 g/dL. Six men (15%) had thrombocytosis; two (5%) had thrombocytopenia.
---
Pagophagia in men with iron-deficiency anemia.
Barton JC, Barton JC, Bertoli LF.
Blood Cells Mol Dis. 2019 Apr 7;77:72-75.

[Dr.Vad]

аскорбат железа-2 быстрее ликвидирует ЖДА у детей по сравнению с Мальтофером:

To compare the therapeutic efficacy of Ferrous ascorbate (FA) and Iron polymaltose complex (IPC) in Iron deficiency anemia (IDA) in children.

A randomized controlled trial (RCT) was conducted at a tertiary care hospital with 125 (1-12 y) children having clinical symptoms and signs of IDA. Participants were randomized into FA group and IPC group. Both the groups received iron salts (FA or IPC) randomly in a dose of 6 mg/kg elemental iron for 3 mo and followed up on day 3, day 7, at the end of 1 mo and 3 mo for Hemoglobin (Hb), Mean corpuscular volume (MCV), Red cell distribution width (RDW) and reticulocyte count.

Both groups had an improvement in hematological parameters at 3 mo of intervention. The difference in the rise of Hb (g/L) at the end of 1 mo in FA group (31.3 ± 10.1) vs. IPC group (20 ± 8.5); p = 0.017 and at 3 mo in FA group (48.8 ± 12.8) vs. IPC group (33.3 ± 13.3); p = 0.001 was statistically significant.

The difference in the mean increase in MCV (fL) at day 7 in FA group (6.71 ± 8.32) vs. IPC group (2.91 ± 6.16); p = 0.011 and at 1 mo FA group (9.80 ± 8.56) vs. IPC group (5.35 ± 6.11); p = 0.004 was statistically significant.

The mean decrease in RDW (%) at 1 mo in FA group (4.23 ± 3.27) vs. IPC group (2.67 ± 1.95); p = 0.005 and at 3 mo in FA group (5.74 ± 3.63) vs. IPC group (4.04 ± 2.17); p = 0.006 was statistically significant. The difference in the rise in mean reticulocyte count at day 3 in FA group (0.88 ± 0.50) vs. IPC group (0.43 ± 1.20); p = 0.017 and at day 7 in FA group (4.00 ± 1.69) vs. IPC group (2.19 ± 1.24); p = 0.001 was statistically significant.

During the study period, the FA group had minor adverse reactions whereas the IPC group had none.
----
Indian J Pediatr. 2019 Sep 13.
Comparison of Therapeutic Efficacy of Ferrous Ascorbate and Iron Polymaltose Complex in Iron Deficiency Anemia in Children: A Randomized Controlled Trial.

[Dr.Vad]

IDA patients have a reduced appetite and paradoxically elevated ghrelin hormone activity compared to healthy controls. Treating IDA enhances appetite and lowers ghrelin levels.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

назначение железа сульфата через день 60 мг лучше переносилось и приводило к раннему повышению гемоглобина в ретикулоцитах и большему росту гемоглобина через 3 недели лечения (+15.8 г/л против +4.1 г/л) по сравнению с ежедневным приемом:
Group 1 received oral iron supplements on alternate day and Group 2 received iron supplements daily. Hemoglobin, reticulocyte hemoglobin equivalent (RET-He), Serum ferritin and Hepcidin level were assessed.
On day 2nd, the rise in Hepcidin was not significant from base line in alternate day therapy group but was significantly increased in daily therapy group. On day 3, the rise in hepcidin was significant from base line in both the groups but the mean change in hepcidin was more in daily therapy group. RET-He began increasing on day 2nd in both the groups. In alternate day therapy group, the rise in RET-He was significant from base line from the day 2nd onwards while the rise in RET-He in daily therapy group was not significant even on day 3. In alternate day iron therapy group, the mean increase in hemoglobin on day 21th (1.58 ±0.53 gm/dl) was significantly more than mean increase among daily therapy (0.41 ± 0.25 gm/dl, P <0.05).
---
J Assoc Physicians India. 2020 May;68(5):39-41.
A Prospective, Randomized, Interventional Study of Oral Iron Supplementation Comparing Daily Dose With Alternate Day Regimen Using Hepcidin as a Biomarker in Iron Deficiency Anemia

[Dr.Vad]

еще одно наблюдение, что ферритин более 17 ассоциируется с наилучшими когнитивными способностями у детей 1-3 лет жизни:

In infants 1-3 years of age, we found higher serum ferritin values associated with higher cognitive function, as measured by the Mullen Scales of Early Learning (P = .02 for the nonlinear relationship). A serum ferritin of 17 μg/L corresponded to the maximum level of cognition, beyond which there was no meaningful improvement.
---
J Pediatr. 2020 Feb;217:189-191.e2.
Association between Serum Ferritin and Cognitive Function in Early Childhood

[Dr.Vad]

наблюдение за тысячей женщин детородного возраста из Швейцарии, у которых оcнoвными симптомами были усталость и снижение работоспособности, диагноз иной чем ЖД был изначально поставлен у каждой третьей и половина из них получали психотерапию или иное фарм. лечение в течение полугода-года, прежде, чем был подтвержден ЖД:

Blank, P.R., Tomonaga, Y., Szucs, T.D. et al. Economic burden of symptomatic iron deficiency – a survey among Swiss women. BMC Women's Health 19, 39 (2019)
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

добавление витамина С к железа сульфату незначительно повышает прирост гемоглобина во время лечения (на 1.5-2 г/л) и не снижает частоту побочных действий:

Among the 440 randomized patients (220 each in the oral iron supplements plus vitamin C group and iron-only group; 426 women [96.8%]; mean [SD] age, 38.3 [11.7] years), all were assessed for the primary outcome, and 432 (98.2%) completed the trial. From baseline to the 2-week follow-up, the mean (SD) change in hemoglobin level was 2.00 (1.08) g/dL in the oral iron supplements plus vitamin C group and 1.84 (0.97) g/dL in the oral iron supplements-only group (between-group difference, 0.16 g/dL; 95% CI, -0.03 to 0.35 g/dL), thus meeting the criteria for equivalence. The mean (SD) change in serum ferritin level from baseline to 8-week follow-up was 35.75 (11.52) ng/mL in the vitamin C plus iron group and 34.48 (9.50) ng/mL in the iron-only group (between-group difference, 1.27 ng/mL; 95% CI, -0.70 to 3.24 ng/mL; P = .21). There were no significant differences between the 2 groups regarding the rates of adverse events (46 [20.9%] vs 45 [20.5%]; difference, 0.4%; 95% CI, -6.7% to 8.5%; P = .82). No patient withdrew because of adverse events.
---
JAMA Netw Open. 2020 Nov 2;3(11):e2023644.
The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia: A Randomized Clinical Trial

[Dr.Vad]

Studies have shown that the problem ceases when PPI therapy is discontinued or replaced by the use of an H2‐receptor antagonist 4, 11, but treatment of ID in situations in which continued PPI therapy is required has been poorly studied. Intravenous iron therapy should be avoided. Over a decade, we have found (unpublished observations) that, in most cases, daily administration of low oral doses of iron, at a meal preceded by 250–500 mg vitamin C and not following ingestion of a PPI, is usually effective.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Мальтофер хуже чем актиферрин у детей для коррекции ЖДА, но и не переносится лучше со статистической точки зрения:

8 trials comprising 493 randomized patients were included and analyzed using three comparison groups. The comparison group of which was used to evaluate IPC and ferrous sulphate (FS) for treatment of IDA showed that IPC is less effective in increasing Hb (MD -0.81, 95% CI -1.08 to -0.53; I2 = 48%, P < 0.001; six studies, 368 participants; high certainty of evidence), ferritin (MD -21.24, 95% CI -39.26 to -3.23, random-effects; I2 = 65%, P = 0.020; 3 studies, 183 participants; moderate certainty of evidence) and MCV levels (MD -3.20, 95% CI -5.35 to -1.05; P = 0.003; one study, 103 participants; low certainty of evidence). There was no difference in the occurrence of side effects between IPC and FS group (MD 0.78, 95% CI 0.47 to 1.31; I2 = 4%, P = 0.35; three studies, 274 participants; high certainty of evidence).

There was moderate to high certainty evidence that FS is superior to IPC with a clinically meaningful difference in improving the Hb and ferritin levels in the treatment of IDA in children. There was no difference in the occurrence of gastrointestinal side effects with high certainty evidence between the IPC and FS groups.
---
PeerJ. 2021 Jan 13;9:e10527.
Effectiveness of iron polymaltose complex in treatment and prevention of iron deficiency anemia in children: a systematic review and meta-analysis

[Dr.Vad]

Обзор по ЖД от австралийцев и британцев, включая частоту симптомов ЖД у 450 женщин:
The misogyny of iron deficiency
[Ссылки доступны только зарегистрированным пользователям ]