Железодефицитные новости

[Dr.Vad]

Депрессия, фобии и ежедневная физическая и умственная работоспособность у женщин с обильными месячными: целый год после успешного лечения потребовался, чтобы улучшить как показатели крови (гемоглобин), так и психоэмоциональное состояние, коррекция ферритина заняла 5 лет:

Acta Obstet Gynecol Scand. 2014 Jun 9.
Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding.
Peuranpää P и соавт.

OBJECTIVE: To assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in women treated for heavy menstrual bleeding (HMB).

DESIGN: Secondary analysis of a randomized controlled trial.

SETTING: Five university hospitals in Finland.

SAMPLE: A total of 236 women referred for HMB.

METHODS: Women were randomized to treatment with hysterectomy or a levonorgestrel-releasing intrauterine system. We defined groups based on women's pretreatment hemoglobin [hemoglobin <120 g/L (anemic) vs. hemoglobin ≥120 g/L (nonanemic)] and serum ferritin (ferritin <15 μg/L vs. ≥15 μg/L) concentrations. HRQoL was compared between groups at baseline, 6 and 12 months after treatment. Hemoglobin and ferritin were followed for 5 years.

MAIN OUTCOME MEASURES: HRQoL was measured by the RAND 36-item health survey (RAND-36), 5-Dimensional EuroQol and two questionnaires of mental wellbeing.

RESULTS: At baseline, 63 women (27%) were anemic and 140 (60%) were severely iron deficient (ferritin <15 μg/L). Only 8% of the anemic women had taken iron supplementation. Twelve months after treatment hemoglobin had increased in both hemoglobin groups, but was still significantly lower (p < 0.001) in initially anemic women (128 g/L) compared with nonanemic women (136 g/L). Twelve months after treatment three domain scores of RAND-36 increased more (energy, p = 0.002; physical functioning, p = 0.04; social functioning, p = 0.05), and anxiety (p = 0.02) and depression scores (p = 0.002) decreased more in anemic compared with nonanemic women. Serum ferritin took 5 years to reach normal levels.

CONCLUSIONS: Improved HRQoL after treatment of HMB is associated with correction of anemia. Clinicians should actively screen for anemia in women with HMB and emphasize early iron substitution as an integral part of treatment.

[Dr.Vad]

Весьма неожиданные наблюдения от медиков из Катара: в/в назначение железа мужчинам с ЖДА (гемоглобин менее 100 г/л) улучшал их гормональный статус и показатели спермограммы:

Indian J Endocrinol Metab. 2014 May;18(3):310-6.
Intravenous iron replacement therapy in eugonadal males with iron-deficiency anemia: Effects on pituitary gonadal axis and sperm parameters; A pilot study.
Soliman A1, Yassin M2, De Sanctis V3.
1Department of Pediatric Endocrinology, Hamad Medical Center, Doha, Qatar.
2Department of Hematology, Hamad Medical Center, Doha, Qatar.
3Department of Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.

AIM OF THE STUDY: To evaluate semen parameters and to assess serum FSH, LH, Testosterone (T) concentrations before and 12 weeks after intravenous iron therapy (800-1200 mg elemental iron therapy - IVI) in adults with iron-deficiency anemia (IDA).

MATERIALS AND METHODS: We studied 11 eugonadal adults with IDA, aged 40 ± 5 years, due to defective intake of iron. Anemia was diagnosed when hemoglobin (Hb) was equal or below 10 g/dl. Serum iron, total iron-binding capacity (TIBC) and ferritin concentrations confirmed the diagnosis of IDA. Basal serum concentrations of FSH, LH, and T were measured. Semen parameters were evaluated before and 6-7 weeks after IVI therapy.

RESULTS: After IVI therapy and correction of anemia, a significant increase of Hb from 8.1 ± 1.17 g/dL to 13.1 ± 0.7 g/dL was observed and was associated with an increase of T (from 12.22 ± 1.4 nmol/L to 15.9 ± 0.96 nmol/L; P < 0.001), FSH (from 2.82 ± 0.87 to 3.82 ± 1.08 IU/L; P = 0.007), and LH (from 2.27 ± 0.9 to 3.82 ± 1.5 IU/L; P = 0.0002). Total sperm count (TSC) increased significantly from 72 ± 17.5 million/ml to 158 ± 49 million/mL (P < 0.001), rapid progressive sperm motility (RPM) increased from 22 ± 9.4 to 69 ± 30 million/ml (P < 0.001), and sperms with normal morphology (NM) increased from 33 ± 5 to 56 ± 7 million/ml (P < 0.001). Increment in Hb concentration was correlated significantly with LH, FSH, and T concentrations after IVI (r = 0.69 and r = 0.44, r = 0.75, respectively; P < 0.01). The increment in serum T was correlated significantly with increments in the TSC and total sperm motility and RPM (r = 0.66, 0.43, and 0.55, respectively; P < 0.001) but not with gonadotrophin levels.

CONCLUSION: Our study proved for the first time, to our knowledge, that correction of IDA with IVI is associated with significant enhancement of sperm parameters and increased concentrations of serum LH, FSH, and T. These effects on spermatogenesis are reached by an unknown mechanism and suggest a number of pathways that need further human and/or experimental studies.

[Dr.Vad]

Импульсивность и концентрация внимания изменялись у железодефицитных (ферритин менее 20) женщин на фоне приема железа в течение 4 мес. и сопутств. роста ферритина, согласно пилотному исследованию из Австралии:

Nutrients. 2014 Jun 23;6(6):2419-2435.
A Study of the Effects of Latent Iron Deficiency on Measures of Cognition: A Pilot Randomised Controlled Trial of Iron Supplementation in Young Women.

The aim was to determine the suitability of the IntegNeuro test battery for assessing cognitive function in iron-deficient and iron-sufficient young women. A pilot double-blinded, placebo-controlled intervention trial was conducted in iron-deficient (serum ferritin ≤ 20 μg/L and haemoglobin > 120 g/L) and iron-sufficient young women (18-35 years). Cognitive function and haematological markers of iron status were measured at baseline and follow-up. Iron-deficient participants (n = 24) were randomised to receive placebo, 60 mg or 80 mg elemental iron daily supplements for 16 weeks. A control group of iron-sufficient participants (n = 8) was allocated to placebo. Change scores for Impulsivity and Attention were significantly greater in plasma ferritin improvers than in non-improvers (p = 0.004, p = 0.026). IntegNeuro was easy to administer and acceptable to young women.

[Dr.Vad]

обзор по ЖД и его влиянию на самочувствие у женщин детородного возраста:
Journal of Nutritional Science / Volume 2 / 2013, e14 (14 pages)
Iron deficiency, cognition, mental health and fatigue in women of childbearing age: a systematic review
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

ЖДА у подростков - обзор литературы:

Nutr Hosp. 2014 Jun 1;29(n06):1240-1249.
IRON DEFICIENCY ANEMIA IN ADOLESCENTS: A LITERATURE REVIEW
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

глава "Iron therapy" из книги "ESH Handbook on Disorders of Iron Metabolism (2009)"

[Ссылки доступны только зарегистрированным пользователям ]

вся книга полностью здесь: [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Врачи из Тайваня обнаружили, что у пациентов с малой талассемией высокий риск обнаружения сопутств. железодефицита (у каждого третьего), и гемоглобин менее 115 г/л с 80% специфичностью и чувствительностью указывает на его наличие, подробнее:

Kaohsiung J Med Sci. 2014 Aug;30(8):409-14.
Underestimation of the coexistence of iron deficiencies and thalassemia minors: a single institution experience in Taiwan.
Lin CK и соавт.
Some physicians neglect the possible coexistence of an iron deficiency with a thalassemia minor and do not treat the iron deficiency accordingly. This motivated us to conduct this study. We retrospectively reviewed the records of 3892 patients who visited our clinics and had hemoglobin (Hb) electrophoreses performed in our hematologic laboratory from August 1, 2007 to December 31, 2012. The thalassemia minors were identified by characteristic complete blood count (CBC) parameters obtained from an autoanalyzer and Hb electrophoresis, and some cases were confirmed with molecular tests. Then, we checked iron studies [ferritin and/or serum iron with total iron-binding capacity (TIBC)] to determine the coexistence of an iron deficiency with a thalassemia minor and a response to iron, if such treatments were given. We found 792 cases with thalassemia minors, and excluded those without iron studies, with 661 cases as our sample. A total of 202/661 cases (31%) also had iron deficiencies. They had lower red blood cell (RBC) counts, Hb, and ferritin levels as compared to those thalassemia minor cases without coexistence of iron deficiencies. We concluded that the thalassemia minor patients did not have iron overload complications in our population. On the contrary, iron deficiencies commonly coexist in the clinical visits. We propose that if Hb < 11.5 g/dL in a case of thalassemia minor, one should screen for iron deficiency simultaneously. The sensitivity is 79.8% and the specificity is 82.6%. Therefore, physicians should be aware of this coexisting condition, and know how to recognize and treat it accordingly.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Диагностика и коррекция железодефицита при носительстве талассемии приводит к повышению гемоглобина, ферритина, железа в крови, снижению трансферрина, подробнее:

Coexisting iron deficiency anemia and Beta thalassemia trait: effect of iron therapy on red cell parameters and hemoglobin subtypes.
Verma S, Gupta R, Kudesia M, Mathur A, Krishan G, Singh S.
ISRN Hematol. 2014 Mar 12;2014:293216
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Коллеги из Турции в очередной раз подтвердили, что при назначении идентичного количества железа для лечения ЖДА, гемоглобин после 3 мес. лечения препаратом железа-2 поднялся на 22.5 г/л, тогда как на фоне приема железа-3 всего на 9.5 г/л при одинаковой переносимости:

Adv Hematol. 2014;2014:297057.
Evaluation of ferric and ferrous iron therapies in women with iron deficiency anaemia.
Berber I1, Diri H2, Erkurt MA1, Aydogdu I1, Kaya E1, Kuku I1.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Еще одно подтверждение, что у детей с ЖДА может быть нарушена/снижена функция тромбоцитов, и ликвидация ЖДА после приема препарата железа приводит к нормализации функции тромбоцитов:

Platelets. 2014 Jul 15:1-5.
Alterations of platelet functions in children and adolescents with iron-deficiency anemia and response to therapy.
Mokhtar GM, Ibrahim WE, Kassim NA, Ragab IA, Saad AA, Abdel Raheem HG.

Several changes in platelets have been reported in patients with iron-deficiency anemia (IDA), so a relationship between iron metabolism and thrombopoiesis should be considered. We aimed to study the alterations of platelet functions in patients with IDA by assessment of platelet aggregation with epinephrine, adenosine diphosphate (ADP) and ristocetin and by measuring platelet function analyzer-100 (PFA-100) closure time together with the effect of iron therapy on the same tests. A follow-up study was conducted in Ain Shams University Children's hospital in the period from June 2011 to June 2012 including 20 patients with confirmed IDA and 20 healthy age- and sex-matched control. Bleeding manifestations were reported. Laboratory analysis included complete blood count, assessment of iron status by measuring serum iron, TIBC and ferritin, assessment of platelet functions by PFA-100 closure time and platelet aggregation with collagen, ADP and ristocetin. Patients with IDA were treated by oral iron therapy 6 mg/kg/day of ferrous sulfate and post-therapeutic re-assessment was done. Mean age of IDA patients was 5.7 ± 4.2 years. Bleeding manifestations were more common in patients group. Mean PFA-100 closure times (with epinephrine) were significantly longer in patients (179.1 ± 86.4 seconds) compared to control group (115 ± 28.5 seconds) (p < 0.05). Platelet aggregation by ADP (38.1 ± 22.2%), epinephrine (19.7 ± 14.2%) and ristocetin (58.8 ± 21.4%) were significantly reduced in patients compared to control (62.7 ± 6.2, 63.3 ± 6.9, 73.8 ± 8.3, respectively; p < 0.001). After treatment platelet aggregation tests induced by ADP (64.78 ± 18.25%), and epinephrine (55.47 ± 24%) were significantly increased in patients with IDA compared to before treatment (39.44 ± 21.85%, 20.33 ± 14.58%; p < 0.001). PFA-100 closure time as well showed significant decreased after treatment (118.4 ± 27.242) compared to before treatment (186.2 ± 90.35; p < 0.05). A negative correlation between platelet aggregation induced by ADP and mean values of serum ferritin before treatment (r = 0.042, p < 0.05) was found. A mutual effect is considered between iron deficiency and platelet functions. Subtle bleeding manifestations can occur in patients with IDA with delay in platelet aggregation and prolongation in PFA-100 closure times which can be reversed by iron therapy.

[Dr.Vad]

Дополнительные преимущества влияния витамина С на метаболизм железа в организме, кроме улучшения всасывания, подробно рассматривается в недавнем обзоре:

Free Radic Biol Med. 2014 Jul 15. pii: S0891-5849(14)00322-0.
The Active Role of Vitamin C in Mammalian Iron Metabolism: Much More Than Just Enhanced Iron Absorption!
Lane DJ и соавт.

Ascorbate is a co-factor in numerous metabolic reactions. Humans cannot synthesize ascorbate due to inactivation of the gene encoding the enzyme, l-gulono-γ-lactone oxidase, which is essential for ascorbate synthesis. Accumulating evidence strongly suggests that in addition to the known ability of dietary ascorbate to enhance non-heme iron absorption in the gut, ascorbate within mammalian systems can regulate cellular iron uptake and metabolism. Ascorbate modulates iron metabolism by stimulating ferritin synthesis, inhibiting lysosomal ferritin degradation and decreasing cellular iron efflux. Furthermore, ascorbate cycling across the plasma membrane is responsible for ascorbate-stimulated iron uptake from low molecular-weight iron-citrate complexes, which are prominent in the plasma of individuals with iron-overload disorders. Importantly, this iron-uptake pathway is of particular relevance to astrocyte brain iron metabolism and tissue iron-loading in disorders such as hereditary hemochromatosis and β-thalassemia. Recent evidence also indicates that ascorbate is a novel modulator of the classical transferrin-iron uptake pathway, which provides almost all iron for cellular demands and erythropoiesis under physiological conditions. Ascorbate acts to stimulate transferrin-dependent iron uptake by an intracellular reductive mechanism, strongly suggesting that it may act to stimulate iron mobilization from the endosome. The ability of ascorbate to regulate transferrin iron uptake could help explain the metabolic defect that contributes to ascorbate-deficiency-induced anemia.

[Dr.Vad]

Тяга к поеданию несьедобных веществ во время беременности у подростков ассоциируется с более низким содержанием железа в организме и ферритином менее 17-18, своевременная профилактика/коррекция ЖД может обезопасить беременных от поедания потенциально опасных веществ:

J Nutr. 2014 Aug 13.
Gestational Iron Deficiency Is Associated with Pica Behaviors in Adolescents.
Lumish RA и соавт.
A relation between pica (the craving and purposive consumption of nonfood items) during pregnancy and anemia is observed frequently. However, few studies related pica behaviors to biomarkers of iron status, and little is known about pica prevalence in U.S. pregnant adolescents. To address this, we undertook a longitudinal study examining iron status and pica behaviors among a group of 158 pregnant adolescents (aged ≤18 y). Approximately two-thirds of the participants were African American and 25% were Hispanic. Maternal iron status indicators [hemoglobin, soluble transferrin receptor, serum ferritin (SF), total body iron (TBI), and serum hepcidin] were assessed during pregnancy (18.5-37.3 wk) and at delivery. Pica behavior was assessed up to 3 times across gestation. Among the 158 adolescents, 46% reported engaging in pica behavior. Substances ingested included ice (37%), starches (8%), powders (4%), and soap (3%). During pregnancy, mean SF [geometric mean: 13.6 μg/L (95% CI: 11.0, 17.0 μg/L)], TBI (mean ± SD: 2.5 ± 4.2 mg/kg), and hepcidin [geometric mean: 19.1 μg/L (95% CI: 16.3, 22.2 μg/L)] concentrations were significantly lower (P < 0.05) in the pica group (n = 72) than values observed among the non-pica group [SF, geometric mean: 21.1 μg/L (95% CI: 18.0, 25.0 μg/L); TBI, mean ± SD: 4.3 ± 3.5 mg/kg; hepcidin, geometric mean: 27.1 μg/L (95%: 23.1, 32.1 μg/L); n = 86]. Although additional studies must address the etiology of these relations, this practice should be screened for, given its association with low iron status and because many of the substances ingested may be harmful.

[Dr.Vad]

Возможное обьяснение, почему при ЖДА возникает чрезмерная тяга кушать лёд или пить напитки со льдом - улучшает работу головного мозга:

Med Hypotheses. 2014 Aug 5. pii: S0306-9877(14)00271-0.
Pagophagia improves neuropsychological processing speed in iron-deficiency anemia.
Hunt MG, Belfer S, Atuahene B.
University of Pennsylvania, United States.
Pagophagia (compulsive ice chewing) has long been associated with iron deficiency anemia, but prior attempts to account for this craving have been unsatisfactory. We hypothesize that chewing ice triggers vascular changes that lead to preferential or increased perfusion of the brain. This would result in increased alertness and processing speed in anemic patients, but not in healthy controls who are already at ceiling, and would explain why anemic individuals crave ice. Preliminary support for this hypothesis was found in two studies. In Study 1, non-anemic subjects reported very low rates of pagophagia (only 4%) while anemic subjects reported significantly higher rates (56%). In Study 2, chewing ice dramatically improved response time on a neuropsychological test, but only for anemic individuals. In a small randomized controlled trial, iron deficient anemic subjects and healthy controls were assigned to chew ice or drink tepid water and then took a continuous performance test that measures response time, response time variability, errors of impulsivity and errors of inattention. In the water condition, anemic subjects performed significantly worse than healthy controls. Chewing ice had no effect on the performance of healthy controls, but significantly improved the performance of anemic patients. Potential explanations include activation of the dive reflex, which would lead to peripheral vasoconstriction and preferential perfusion of the brain or, alternatively, sympathetic nervous system activation, which would also increase blood-flow to the brain.

[Dr.Vad]

Снижение потребления железа матерью особенно во время кормления грудью, ассоциируется с повыш. риском развития аутизма и релевантных заболеваний (autism spectrum disorder) у их детей:

Am J Epidemiol. 2014 Sep 22.
Maternal Intake of Supplemental Iron and Risk of Autism Spectrum Disorder.
Schmidt RJ, Tancredi DJ, Krakowiak P, Hansen RL, Ozonoff S.
Iron deficiency affects 40%-50% of pregnancies. Iron is critical for early neurodevelopmental processes that are dysregulated in autism spectrum disorder (ASD). We examined maternal iron intake in relation to ASD risk in California-born children enrolled in a population-based case-control study (the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study) from 2003 to 2009 with a diagnosis of ASD (n = 520) or typical development (n = 346) that was clinically confirmed using standardized assessments. Mean maternal daily iron intake was quantified on the basis of frequency, dose, and brands of supplements and cereals consumed each month from 3 months before pregnancy through the end of pregnancy and during breastfeeding (the index period), as reported in parental interviews. Mothers of cases were less likely to report taking iron-specific supplements during the index period (adjusted odds ratio = 0.63, 95% confidence interval: 0.44, 0.91), and they had a lower mean daily iron intake (51.7 (standard deviation, 34.0) mg/day) than mothers of controls (57.1 (standard deviation, 36.6) mg/day; P = 0.03). The highest quintile of iron intake during the index period was associated with reduced ASD risk compared with the lowest (adjusted odds ratio = 0.49, 95% confidence interval: 0.29, 0.82), especially during breastfeeding. Low iron intake significantly interacted with advanced maternal age and metabolic conditions; combined exposures were associated with a 5-fold increased ASD risk.

[Dr.Vad]

Публикация о 3 педиатрических пациентах с когнитивными нарушениями, у которых не было обнаружено никаких отклонений, кроме дефицита железа (у двоих - из-за избытка коровьего молока в рационе). Коррекция ЖД/рациона привела к драматическому улучшению их состояния:

Pediatr Neurol. 2014 Sep 6.
Cognitive Impairment Associated With Low Ferritin Responsive to Iron Supplementation.
Qubty W, Renaud DL.

BACKGROUND: Iron deficiency is the most common nutritional deficiency in children. It affects 9% of children ages 1-3 years. Iron is essential for effective mitochondrial electron transport and neurotransmitter synthesis. Iron deficiency has been correlated with impaired psychomotor development, pica, attention deficit disorder, periodic limb movements of sleep, and breath-holding spells. Ferritin is the storage form of iron.

PATIENT SERIES: We assessed three children referred for developmental concerns. Extensive testing and neuroimaging were all unremarkable except for low iron stores. Dietary histories revealed excessive milk consumption in two of the children. After dietary adjustments and iron supplementation, iron stores normalized.

CONCLUSIONS: This cohort demonstrated a dramatic improvement in cognition once iron stores were repleted, suggesting iron studies should be considered as part of initial investigations of patients with cognitive concerns.