Железодефицитные новости

[Dr.Vad]

Суммируя имеющийся эвиденс о влиянии железа на когнитивную функцию человека:

Neuropsychiatr Dis Treat. 2014; 10: 2087–2095.
Iron deficiency and cognitive functions.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

У чилийских детей с железодефицитом во младенчестве в детстве был риск повышенного нарушения эмоциональной сферы, что в подростковом периоде ассоциировалось со злоупотреблением алкоголем и беспорядочным сексом:

IDA in infancy was related to excessive alcohol use and risky sexual behavior in adolescence through its effect on poor emotion regulation in childhood. Attentional control deficits at age 10 were also related to both infant IDA and heightened risk taking in adolescence. [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Наконец-то в мед. литературе зафиксировали не только тягу к поеданию на фоне ЖДА (пика), но и тягу к определенным запахам на фоне ЖДА и назвали "Desiderosmia":

Desiderosmia (olfactory craving): A novel symptom associated with iron deficiency anemia.
Hansen BR, Bottner WA, Ravindran A, DeJesus R, Go RS.
Am J Hematol. 2017 Feb 27.

Впервые эта инфа была изложена в конце 2016 в Бладе: [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

A Rare Case of Stroke Secondary to Iron Deficiency Anemia in a Young Female Patient
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Среди пациентов старше 55 лет и с жалобами на забывчивость более часто встречались женшины с депрессией и более низкими цифрами гемоглобина, ферритина и своб. уровня Т4:

We recruited 405 patients over 55 years of age who were referred to Neurology, Cardiology, or Physical Therapy and Rehabilitation outpatient clinics. All subjects were questioned regarding forgetfulness and then were administered the Subjective Memory Complaint (SMC) Scale, Mini Mental Test (MMT), Verbal Fluency Test (VFT), Clock Drawing Test (CDT) and the Geriatric Depression Scale (GDS). Subjects with SMC were compared with those without SMC in terms of cognition, depression and some laboratory parameters.
Of the patients, 42.5% complained of forgetfulness...Women and patients with low education had more forgetfulness as well as poorer results on the SMC Scale, MMT, VFT, and GDS. Patients with SMC had lower hemoglobin, ferritin and free T4 levels. Female gender and depression was found to be a risk factor for SMCs.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

35 мг железа в день настолько же эффективно, как и 70 мг железа в день (в виде железа сульфата) у беременных во втором триместре с легкой ЖДА (гемоглобин 101 г/л, ферритин менее 10), если принимать лечение до конца беременности - в 35 недель гемоглобин в среднем 108 г/л:

J Perinatol. 2017 Apr 6. doi: 10.1038/jp.2017.43.
Iron supplementation in singleton pregnancy: Is there a benefit to doubling the dose of elemental iron in iron-deficient pregnant women? a randomized controlled trial.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Выраженная симптоматическая гипофосфатемия после в/в введения железа (Феринджект) на фоне дефицита витамина Д - его коррекция привела к ликвидации симптомов (слабость, боли в мышцах):

BMJ Case Rep. 2017 Mar 13;2017.
Severe hypophosphataemia after intravenous iron administration.
[Ссылки доступны только зарегистрированным пользователям ]

Скрининг на дефицит витамина Д и его коррекция может быть опцией для профилактики или коррекции данного осложнения:

Curr Opin Nephrol Hypertens. 2017 Apr 8.
Iron-induced hypophosphatemia: an emerging complication.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Повышение гемоглобина на менее 10 г/л через 2 недели лечения ЖДА пероральными препаратами железа может быть хорошим индикатором плохого ответа на лечение и последуюшим назначением таким пациентам в/в введения железа - доля таких пациентов в среднем 27% :

Pooled data from 5 randomized trials were analyzed to compare oral and IV iron-replacement therapy for iron-deficiency anemia. Treatment criteria and assignment to oral versus IV iron were defined per protocol; this analysis included only subjects receiving oral iron. Responders were subjects with ≥1.0 g/dL increases in hemoglobin at day 14, and nonresponders were those with smaller increases. Demographic and clinical characteristics were evaluated for association with hemoglobin response at multiple timepoints.

Most subjects (72.8%) were classified as responders. The proportion of subjects with hemoglobin increases ≥1.0, ≥2.0, and ≥3.0 g/dL was greatest among those with postpartum anemia, intermediate among those with heavy uterine bleeding or gastrointestinal-related causes of anemia, and lowest among those with other causes; this proportion was also significantly greater among responders than nonresponders. A ≥1.0 g/dL increase in hemoglobin on day 14 most accurately predicted satisfactory overall hemoglobin response to oral iron on day 42/56 (sensitivity: 90.1%; specificity: 79.3%; positive and negative predictive values: 92.9% and 72.7%, respectively). Iron-replacement therapy improved quality of life and reduced fatigue.
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Am J Med. 2017 Apr 25. pii: S0002-9343(17)30389-3.
Iron supplementation, response in iron-deficiency anemia: analysis of five trials.
Okam MM, Koch TA, Tran MH.

[Dr.Vad]

Чем дольше у младенцев исключительное/преимущественное грудное вскармливание во втором полугодии от рождения и тем меньше в рационе красного мяса, тем выше риск обнаружения ЖДА:

Among 619 infants, ID and IDA were present in 174 infants (28.1%) and 87 infants (14.0%), respectively. The 288 infants with exclusively/mostly breastfeeding until late infancy (BFL) were most likely to exhibit ID (53.1%) and IDA (28.1%). The risk of ID was independently associated with BFL (adjusted odds ratio [aOR], 47.5; 95% confidence interval [CI], 18.3-122.9), male sex (aOR, 1.9; 95% CI, 1.2-2.9), fold weight gain (aOR, 2.6; 95% CI, 1.5-4.6), and perceived inadequacy of red meat intake (aOR, 1.7; 95% CI, 1.0-2.7). In addition to the risk factors for ID, Cesarean section delivery (aOR, 1.9; 95% CI, 1.1-3.2) and low parental CF-related knowledge (aOR, 2.8; 95% CI, 1.5-5.2) were risk factors for IDA. In conclusion, prolonged breastfeeding and perceived inadequacy of red meat intake may be among the important feeding-related risk factors of ID and IDA.

J Korean Med Sci. 2017 Jun;32(6):974-984.
Breastfeeding and Red Meat Intake Are Associated with Iron Status in Healthy Korean Weaning-age Infants.

[Dr.Vad]

Пика (ледяные страсти) после бариатрической операции у женщин ассоциируется с нескомпенсированным железодефицитом (ферритин 5 (2-27) нг/мл) и корректируется в/в введением железа:

Pica was identified in 16/959 (1.7%) patients who underwent RYGB during the study period. The most common presenting sign was pagophagia. All patients with pica were female and had multiple risk factors for iron deficiency with 13/16 being premenopausal and 7/16 non-compliant with oral iron supplementation. Pica symptoms presented at a mean of 3.9 ± 1.9 years after RYGB. Iron deficiency was identified in all 16 patients, with a median ferritin level of 5.0 ng/mL (range 2-27). All 16 patients received intravenous iron and pica symptoms resolved.
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World J Surg. 2017 May 5.
A Different Kind of Craving: Incidence and Treatment of Pica After Laparoscopic Roux-en-Y Gastric Bypass.

[Dr.Vad]

дефицит железа и тики у детей с синдромом Туретта - похоже, что коррекция ЖД может снизить их интенсивность:

In 57 patients, M:F = 2:1, serum ferritin was 48.0 ± 33.28 ng/mL, tic severity score 2.3 ± 0.80, impact on life score 2.2 ± 0.93, and composite score 4.57 ± 1.6. Serum ferritin was not influenced by comorbid obsessive compulsive disorder (OCD), attention deficit hyperactive disorder (ADHD), or anxiety (P > 0.16); 38% with low serum ferritin (≤50 ng/mL) (n = 37) had severe tics (>5 composite score), compared with 25% in normal ferritin group (n = 20). Over 6-12 months, tic severity score improved in both iron treated groups, deficient (2.70 to 1.90) and sufficient (2.40 to 1.95), whereas tics worsened or remained the same when not treated with iron.
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Childs Nerv Syst. 2017 May 3.
Relationship of serum ferritin level and tic severity in children with Tourette syndrome.
Ghosh D, Burkman E.

[Dr.Vad]

Наводящие вопросы не всегда могут предсказать ЖД и ЖДА у подростков:

J Pediatr. 2017 May 9.
Risk-Based Questionnaires Fail to Detect Adolescent Iron Deficiency and Anemia.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Вот такое научное наблюдение, почему хелат железа с глицином быть может имеет преимущества перед неорганическими соединениями железа при ликвидации ЖДА:

Haematologica. 2017 May 11.
Extracellular glycine is necessary for optimal hemoglobinization of erythroid cells.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

мигренозные боли, рецидив. боли в животе, спине и синдром беспокойных ног у детей ассоциируются с наличием дефицита железа:

Iron deficiency remained significantly associated with migraine (OR 2.38), persistent pain (OR 3.70) and restless legs syndrome (OR 5.10).
the common pain conditions, persistent pain, restless legs syndrome, iron deficiency, anxiety and depression, are likely to involve common etiological mechanisms
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Clin J Pain. 2017 Mar 7.
Common Pediatric Pain Disorders and their Clinical Associations.

[Dr.Vad]

Интересный опыт лечения аффективно-респираторных приступов препаратами железа из Индии: лечение помогало многим даже у тех, кого не было дефицита железа по ферритину:

Study population comprised of patients aged 6-36 months, attending a paediatric outpatient department with recurrent episodes (more than three in last 4 weeks) of breath holding spells. Children with loss of consciousness or convulsive movements associated with breath holding spells were considered as severe. After baseline investigations, all enrolled patients were given elemental iron at the dose of 3 mg/kg/day as a single daily dose. Four weekly follow-ups were done until 3 months after initiation of the intervention. At 12 weeks, investigations were repeated and outcome assessed for remission or decrease in severity of breath holding episodes.

A total of 100 children with breath holding spells received iron supplementation. Almost 73% of children showed complete response, with another 23% showing greater than 50% reduction in frequency. Frequency of spells at diagnosis and intolerance to oral iron were significantly associated with poor response to iron supplementation. Other factors such as age at onset, age at presentation, severity of spells, anaemia and serum iron parameters had no significant association with the response. Of the 27 children without iron deficiency (serum ferritin ≥ 30 µg/L), 77.7% responded completely to iron supplementation, similar to the iron-deficient group.
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J Paediatr Child Health. 2017 Jun 1.
Effect of iron supplementation in children with breath holding spells.