Железодефицитные новости

[Dr.Vad]

У пациента-донора тромбоцитов из-за частых процедур (24-26 в год) развился железодефицит, который спровоцировал антероградную амнезию и умеренную депресию по шкале Бека: коррекция железодефицита и снижение интенсивности тромбопцитофереза до 12-13 в год привела к восстановлению памяти и снижению депрессии:

Transfus Med. 2008 Oct;18(5):312-4.
Impairment of short-term memory associated with low iron stores in a volunteer multidose plateletpheresis donor.
Page EA, Harrison JF, Jaldow EJ, Kopelman M.
National Blood Service, Tooting, London, UK.

A platelet donor may lose 80-100 mL of blood both in the harness and by blood sampling at each donation, the equivalent of four to five whole blood donations per annum for a donor attending at 2-weekly intervals. A 54-year-old male multidose platelet donor had donated platelets at regular 2-weekly intervals for 6 years. He developed an impairment of anterograde memory (new learning). A self-rating scale revealed a moderate degree of depression [Beck Depression Inventory (BDI) score 22]. Memory testing (Doors and People Memory Battery) showed low scores, particularly for verbal recall and verbal recognition memory. He was found to have a normal haemoglobin of 157 g/L with normal red blood cell indices, but a low serum ferritin (15 ng/mL) and a low serum iron (8.1 mmol/L). Following iron therapy and a return of his iron stores to normal levels, there was an improved BDI score of 13 (minimal level of depression) and a marked improvement in memory test scores. This has been maintained even though he has resumed platelet donation but at reduced intervals.

[Dr.Vad]

Недавний кокрэйновский обзор на основании имеющегося эвиденса показывает, что назначение препарата железа высокоэффективно для коррекции аффективно-респираторных приступов у детей:

MAIN RESULTS: Two trials (87 children) fulfilled the inclusion criteria. In these trials, iron supplementation significantly reduced the frequency of breath-holding attacks in children (OR 76.48; 95% CI 15.65 to 373.72; P < 0.00001). A meta-analysis that solely examined iron supplementation causing complete resolution of breath-holding attacks maintained this significance (OR 53.43; 95% CI 6.57 to 434.57; P = 0.0002). AUTHORS' CONCLUSIONS: Iron supplementation (at 5 mg/kg/day of elemental iron for 16 weeks) appears to be useful in reducing the frequency and severity of breath-holding attacks. Supplementation is of particular benefit in children with iron deficiency anaemia, responses correlating with the improvements in haemoglobin values. Iron may still be of assistance in children who are not anaemic or who have low, normal haemoglobin levels.
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Cochrane Database Syst Rev. 2010 May 12;5:CD008132.
Iron supplementation for breath-holding attacks in children.

[Dr.Vad]

Коррекция железодефицита у пациентов с врожденным цианотическим пороком сердца и высоким гемоглобином улучшает выносливость к выполнению физнагрузки и повышает качество жизни, а также ведет к увеличению гемоглобина на 15 г/л, что может рассматриваться как вариант ис ходного наличия легкой анемизации организма, нежели только латентного железодефицита:

Int J Cardiol. 2010 Jun 24.

Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome.

Tay EL, Peset A, Papaphylactou M, Inuzuka R, Alonso-Gonzalez R, Giannakoulas G, Tzifa A, Goletto S, Broberg C, Dimopoulos K, Gatzoulis MA.

Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.

Abstract
INTRODUCTION: Iron deficiency is common in cyanotic congenital heart disease (CHD) and results in reduced exercise tolerance. Currently, iron replacement is advocated with limited evidence in cyanotic CHD. We investigated the safety and efficacy of iron replacement therapy in this population. METHODS: Twenty-five iron-deficient cyanotic CHD patients were prospectively studied between August 2008 and January 2009. Oral ferrous fumarate was titrated to a maximum dose of 200mg thrice-daily. The CAMPHOR QoL questionnaire, 6minute walk test (6MWT) and cardiopulmonary exercise testing were conducted at baseline and after 3months of treatment. RESULTS: Mean age was 39.9+/-10.9years, 80% females. Fourteen had Eisenmenger syndrome, 6 complex cyanotic disease and 5 Fontan circulation. There were no adverse effects necessitating termination of treatment. After 3months of treatment, hemoglobin (19.0+/-2.9g/dL to 20.4+/-2.7g/dL, p<0.001), ferritin (13.3+/-4.7mug/L to 54.1+/-24.2mug/L, p<0.001) and transferrin saturation (17.8+/-9.6% to 34.8+/-23.4%, p<0.001) significantly increased. Significant improvements were also detected in the total CAMPHOR score (20.7+/-10.9 to 16.2+/-10.4, p=0.001) and 6MWT distance (371.7+/-84.7m to 402.8.0+/-74.9m, p=0.001). Peak VO(2) remained unchanged (40.7+/-9.2% to 43.8+/-12.4% of predicted, p=0.15). CONCLUSION: Three months of iron replacement therapy in iron-deficient cyanotic CHD patients was safe and resulted in significant improvement in exercise tolerance and quality of life. Identification of iron deficiency and appropriate replacement should be advocated in these patients.

[Dr.Vad]

У пациентов на омепразоле или др. празолах хуже корректируется ЖД анемия или железодефицит: нужно или увеличивать дозу, или повышать длительность лечения, или в/в введение железа:

Am J Ther. 2010 Dec 3.
Suboptimal Response to Ferrous Sulfate in Iron-Deficient Patients Taking Omeprazole.

Ajmera AV, Shastri GS, Gajera MJ, Judge TA.

Iron deficiency anemia is commonly encountered in outpatient practice. Gastric acid is one of the important factors for optimum absorption of iron. Proton pump inhibitors are very commonly prescribed medications. One of the debated effects of proton pump inhibitors is on oral iron absorption. Their effect on absorption of oral iron supplementation in iron-deficient patients has not been studied. At the Cooper Hematology Outpatient office, we reviewed charts of iron-deficient anemic patients who were on omeprazole for the last 4 years. Fifty patients having no apparent ongoing blood loss, having other causes of anemia especially that of chronic diseases ruled out, and on omeprazole while starting ferrous sulfate therapy for iron deficiency were selected for chart review. The iron-study results at the start of oral ferrous sulfate therapy and at 3 months follow-up were compared to evaluate the response of ferrous sulfate. The mean hemoglobin change was 0.8 ± 1.2 g/L. The mean change in ferrtin values was 10.2 ± 7.8 μg/L. Only 16% of the patients had a normal response to hemoglobin levels (rise of >2 g/dL), and only 40% had a normal response to ferritin levels (rise of >20 μg/dL). The average age of patients having a suboptimal response to both hemoglobin and ferritin was significantly higher compared with that of the patients with an optimal response. Omeprazole and possibly all proton pump inhibitors decrease the absorption of oral iron supplementation. Iron-deficient patients taking proton pump inhibitors may have to be treated with high dose iron therapy for a longer duration or with intravenous iron therapy.

[Dr.Vad]

Низкий ферритин после родов может предсказывать повышенный риск развития послеродовой депрессии: этот риск в 3.7 выше, если ферритин менее 7.3:

J Affect Disord. 2010 Dec 2.

An association between plasma ferritin concentrations measured 48h after delivery and postpartum depression.

Albacar G, Sans T, Martín-Santos R, García-Esteve L, Guillamat R, Sanjuan J, Cañellas F, Gratacòs M, Cavalle P, Arija V, Gaviria A, Gutiérrez-Zotes A, Vilella E.

Hospital Psiquiàtric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain.

CONTEXT: Iron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear.

OBJECTIVE: To evaluate whether iron status 48h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD.

DESIGN: This was a prospective cohort study of depression-free women studied in the postpartum period.

SETTING: Women who give birth at obstetric units in several general hospitals in Spain.

PARTICIPANTS: A subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism.

MAIN OUTCOME MEASURES: We evaluated depressive symptoms at 48h, 8weeks and 32weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CRP.

RESULTS: Overall, the women in the study had low iron concentrations (8.8±6.9μmol/L) and low TfS (12.6±9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32week postpartum period; these women also had a lower ferritin concentration (15.4±12.7μg/L vs. 21.6±13.5μg/L, P=0.002). A strong association between ferritin and PPD was observed (odds ratio=3.73, 95% CI: 1.84-7.56; P=0.0001 for ferritin cutoff value of 7.26μg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD.

CONCLUSIONS: These findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation.

[Dr.Vad]

Еще одна статья, показывающая, что именно двухвалентное (а не трехвалентное) железо лучше всасывается у людей с железодефицитом и именно двухвалентное железо обладает б0льшей эффективностью при лечении железодефицита:

Br J Nutr. 2011 Apr;105(8):1245-50.
Iron deficiency up-regulates iron absorption from ferrous sulphate but not ferric pyrophosphate and consequently food fortification with ferrous sulphate has relatively greater efficacy in iron-deficient individuals.
Zimmermann MB, Biebinger R, Egli I, Zeder C, Hurrell RF.
SourceLaboratory for Human Nutrition, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH) Zurich, Schmelzbergstrasse 7, LFV E19, CH-8092 Zurich, Switzerland.
AbstractFe absorption from water-soluble forms of Fe is inversely proportional to Fe status in humans. Whether this is true for poorly soluble Fe compounds is uncertain. Our objectives were therefore (1) to compare the up-regulation of Fe absorption at low Fe status from ferrous sulphate (FS) and ferric pyrophosphate (FPP) and (2) to compare the efficacy of FS with FPP in a fortification trial to increase body Fe stores in Fe-deficient children v. Fe-sufficient children. Using stable isotopes in test meals in young women (n 49) selected for low and high Fe status, we compared the absorption of FPP with FS. We analysed data from previous efficacy trials in children (n 258) to determine whether Fe status at baseline predicted response to FS v. FPP as salt fortificants. Plasma ferritin was a strong negative predictor of Fe bioavailability from FS (P < 0·0001) but not from FPP. In the efficacy trials, body Fe at baseline was a negative predictor of the change in body Fe for both FPP and FS, but the effect was significantly greater with FS (P < 0·01). Because Fe deficiency up-regulates Fe absorption from FS but not from FPP, food fortification with FS may have relatively greater impact in Fe-deficient children. Thus, more soluble Fe compounds not only demonstrate better overall absorption and can be used at lower fortification levels, but they also have the added advantage that, because their absorption is up-regulated in Fe deficiency, they innately 'target' Fe-deficient individuals in a population.

[Dr.Vad]

Еще одно исследование из Израиля подтверждает б0льшую эффективность, но худшую переносимость двухвалентного железа у детей первого года жизни (на фоне приема 3-валентного железа анемия может сохраняться у 20% (!) детей):


J Pediatr Hematol Oncol. 2010 Nov;32(8):585-8.
Iron polymaltose versus ferrous gluconate in the prevention of iron deficiency anemia of infancy.
Jaber L, Rigler S, Taya A, Tebi F, Baloum M, Yaniv I, Haj Yehia M, Tamary H.
SourceNeurology Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
AbstractWe prospectively compared the efficacy and safety of iron deficiency anemia prophylaxis with iron gluconate (IG) or iron polymaltose complex (IPC) in healthy infants attending a community pediatric center. Participants were randomly assigned to receive one of the test drugs from age 4 to 6 months to age 12 months. Parents/guardians were given extensive information on iron-rich diets and anemia prevention. Main outcome measures were blood levels of hemoglobin, hematocrit, mean corpuscular volume, red blood cell distribution width, and serum iron, ferritin, and transferrin, in addition to adverse effects. One hundred five children completed the study: 53 in the IG group and 52 in the IPC group Mean hemoglobin levels at study end were significantly higher in the IG group (12.04±0.09 g/dL vs. 11.68±0.11, P<0.014). A hemoglobin level <11 g/dL was detected in 3 infants of the IG group, and in 10 infants of the IPC group (P<0.04). Adverse effects (spitting, vomiting, diarrhea, constipation, discolored teeth) were significantly more common in the IG group (47% vs. 25%, P>0.025). In conclusion, both oral IG and IPC prevent iron deficiency anemia in infants. Iron gluconate seems to be more effective but less tolerable.

[Dr.Vad]

Детальный обзор преимуществ и недостатков назначения дивалентных и тривалентных препаратов железа в полной версии:

Ferrous versus Ferric Oral Iron Formulations for the Treatment of Iron Deficiency: A Clinical Overview.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

В то время, как железодефицит может быть причиной кашля при лечении ИАПФ и его коррекция может сничить частоту данного симптома (Iron supplementation inhibits cough associated with ACE inhibitors./ Hypertension. 2001 Aug;38(2):166-70.///// Attenuation of angiotensin converting enzyme inhibitor induced cough by iron supplementation: role of nitric oxide./ J Renin Angiotensin Aldosterone Syst. 2011 Dec;12(4):491-7.) недавняя публикация показывает, что железодефицит может быть причиной хронического кашля и его коррекция снижает интенсивность кашля:

Int J Clin Pract. 2012 Nov;66(11):1095-1100.
Effect of iron supplementation in women with chronic cough and iron deficiency.
Bucca C, Culla B, Brussino L, Ricciardolo FL, Cicolin A, Heffler E, Bugiani M, Rolla G.

Aims:  Chronic cough is more frequent and severe in women than in men. Women often have decreased iron stores, because of menses and pregnancies. We investigated if iron deficiency has a role in chronic cough by increasing airway sensitivity to inhaled irritants.
Methods:  Twenty-two non-smoking women with chronic unexplained cough and iron deficiency (serum ferritin below 15 ng/ml) were examined in baseline, after 2 months empiric treatment with anti H1-histaminic drug and proton pump inhibitor, and after iron supplementation (330-660 mg iron sulphate tablets daily) for 2 months. Outcome measures were cough visual analogue scale (VAS), and histamine thresholds of the larynx (PC25MIF50, concentration causing 25% in MIF50), bronchi (PC20FEV1) and cough (PC5cough).
Results:  Mean serum ferritin was 9.3 ng/ml (95% CI 7.7-10.9), 13 patients had mild anaemia. All the patients had laryngeal and cough hyperresponsiveness,12 had also bronchial hyperresponsiveness. Empiric treatment produced no significant effect, whereas iron supplementation improved cough VAS from 4.03 (3.6-4.47) to 2.6 (1.9-3.27), p < 0.0001, PC20FEV1 from 10.04 mg/ml (5.37-18.77) to 22.2 (11.7-41.8), p < 0.001, PC25MIF50 from 3.09 mg/ml (1.9-4.9) to 11.9 (7.3-19.4), p < 0.001 and PC5cough from 2.1 mg/ml (1.2-3.6) to 8.8 (5.2-15.1), p < 0.001.
Conclusion:  In women with unexplained chronic cough unresponsive to targeted treatment, airway and cough hyperresponsiveness may be sustained by iron deficiency. Healthy women with chronic cough should be checked for iron deficiency as iron repletion may resolve such disturbing symptom.

[Dr.Vad]

Iron Deficiency: What Are the Future Trends in Diagnostics and Therapeutics?
Clin Chem. 2012 Nov 13.

[Dr.Vad]

недавняя публикация показывает, что раннее назначение железа детям с пограничным весом при рождении не влияет на их умственные способности к 3 годам, но снижает риск поведенческих отклонений:

Pediatrics. 2012 Dec 10.
Effects of Iron Supplementation of LBW Infants on Cognition and Behavior at 3 Years.
Berglund SK, Westrup B, Hägglöf B, Hernell O, Domellöf M.

OBJECTIVE:Low birth weight (LBW) infants are at increased risk of cognitive and behavioral problems and at risk for iron deficiency, which is associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants would improve cognitive scores and reduce behavioral problems.
METHODS:In a randomized controlled trial, 285 marginally LBW (2000-2500 g) infants received 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 3.5 years of age, these infants and 95 normal birth weight controls were assessed with a psychometric test (Wechsler Preschool and Primary Scale of Intelligence) and a questionnaire of behavioral problems (Child Behavior Checklist; CBCL).
RESULTS:There were no significant differences in IQ between the LBW groups or LBW infants versus controls. Mean (SD) full-scale IQ was 105.2 (14.5), 104.2 (14.7), and 104.5 (12.7) in the placebo, 1 mg, and 2 mg groups, respectively (P = .924). However, for behavioral problems, there was a significant effect of intervention. The prevalence of children with CBCL scores above the US subclinical cutoff was 12.7%, 2.9%, and 2.7% in the placebo, 1-mg, and 2-mg groups, respectively (P = .027), compared with 3.2% in controls. Relative risk (95% confidence interval) for CBCL score above cutoff in placebo-treated children versus supplemented was 4.5 (1.4-14.2). CONCLUSIONS:Early iron supplementation of marginally LBW infants does not affect cognitive functions at 3.5 years of age but significantly reduces the prevalence of behavioral problems. The study suggests a causal relation between infant iron deficiency and later behavioral problems.

[Dr.Vad]

Повышенный гепцидин может быть использован как индикатор плохого ответа на лечение ЖДА пероральными препаратами железа; в/в введение железа в такой ситуации помогает в 2/3 случаев, тогда как продолжение приема перорального железа только в 20% дает ответ на лечение:

Am J Hematol. 2012 Nov 17.
Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia.
Bregman DB, Morris D, Koch TA, He A, Goodnough LT.
SourceLuitpold Pharmaceuticals, Inc., Valley Forge, Pennsylvania; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York.

Levels of hepcidin, a major regulator of iron homeostasis, may identify patients with iron deficiency anemia (IDA) who will not respond to oral iron therapy. In this study, IDA patients underwent a 14-day trial (run-in) course of ferrous sulfate therapy. Nonresponders (Hgb increase <1 g/dL with 67% compliance rate) were randomized to IV ferric carboxymaltose (FCM; two injections of 750 mg) or further oral iron for 14 days. Screening hepcidin levels were 38.4 versus 11.3 ng/mL, P = 0.0002 in nonresponders versus responders to a trial of oral iron. Hepcidin of > 20 ng/mL, showed sensitivity of 41.3%, specificity of 84.4%, and positive predictive value of 81.6% for predicting nonresponsiveness to oral iron. PPVs for ferritin> 30 ng/mL or transferrin saturation (TSAT)>15% were 59.2 and 55%, respectively. Negative predictive values for hepcidin, ferritin, and TSAT were 46.3, 22.7, and 19.7, respectively. FCM versus oral iron showed Hgb increases of ≥1 gm/dL in 65.3% versus 20.8% (P < 0.0001) and Hgb increases of 1.7 ± 1.3 versus 0.6 ± 0.9 g/dL (P = 0.0025), respectively. We conclude that hepcidin predicts nonresponsiveness to oral iron in patients with IDA and is superior to TSAT or ferritin for this purpose. Nonresponse to oral iron therapy does not rule out IDA, since two-thirds of patients subsequently responded to intravenous iron.

[Dr.Vad]

Еще одна статья о ЖДА как риске кариеса у детей

BMC Pediatr. 2013 Feb 7;13(1):22.
Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case--control study.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

У пациентов с отрицательными серологическими тестами на целиакию нередко выявляется умеренная энтеропатия, которая может быть из-за целиакии, хеликобактерной инфекции или причину установить не удается, если генетические тесты на целиакию отрицательны.

Dig Liver Dis. 2011 Jun;43(6):448-53.
Mild enteropathy as a cause of iron-deficiency anaemia of previously unknown origin.
Monzón H, Forné M, González C, Esteve M, Martí JM, Rosinach M, Mariné M, Loras C, Espinós JC, Salas A, Viver JM, Fernández-Bañares F.
Department of Gastroenterology, Hospital Universitari Mútua Terrassa and Research Foundation Mútua Terrassa, Barcelona, Spain.

BACKGROUND AND AIMS:
We assessed whether mild enteropathy with negative coeliac serology may be gluten-dependent, and a cause of iron-deficiency anaemia. In cases not responding to gluten-free diet, the role of Helicobacter pylori infection was evaluated.
METHODS:
55 consecutive unexplained iron-deficiency anaemia patients were included. In all of them we performed: HLA-DQ2/DQ8 coeliac genetic study, distal duodenum biopsies, and tests to assess H. pylori infection. A gluten-free diet or H. pylori eradication was used as indicated. Final diagnosis was established based on response to specific therapy after a 12-month follow-up period.
RESULTS:
Histological findings were: (1) group A (positive genetics): 21 Marsh I, 2 Marsh IIIA, 12 normal; (2) group B (negative genetics): 16 Marsh I, 4 normal. Final diagnosis of anaemia in patients with enteropathy were: group A, gluten-sensitive enteropathy, 45%; H. pylori infection, 20%; gluten-sensitive enteropathy plus H. pylori, 10%; other, 10%; unknown, 15%; group B, gluten-sensitive enteropathy, 10%; H. pylori infection, 0% (1 non-eradicated case, 10%); non-steroidal anti-inflammatory drug intake, 20%; other, 20%; unknown, 40% (p=0.033).
CONCLUSIONS:
Mild enteropathy is frequent in patients with unexplained iron-deficiency anaemia and negative coeliac serology. Most cases are secondary to either gluten-sensitive enteropathy or H. pylori infection, or both; however, there is also a substantial number of patients without a definitive diagnosis.

[Dr.Vad]

Британский гайд по принципам диагностики функционального (латентного) железодефицита:

Guideline for the laboratory diagnosis of functional iron deficiency.
Thomas DW, Hinchliffe RF, Briggs C, Macdougall IC, Littlewood T, Cavill I; British Committee for Standards in Haematology. Br J Haematol. 2013 Apr 10.

[Ссылки доступны только зарегистрированным пользователям ]