Железодефицитные новости

[Dr.Vad]

Монофер для лечения ЖДА у больных Кроном и кязвенным колитом - улучшение гемоглобина ассоциировалось со снижением выраженности симптомов:

Hb increased from 107(±16) g/L at baseline to 131(±15) g/L at the final visit. In addition, serum iron, ferritin and transferrin saturation increased and soluble transferrin receptor decreased. Calprotectin decreased, as did IBD symptom scores, Harvey-Bradshaw Index (Crohn's disease) and partial Mayo score (Ulcerative colitis).
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Safety and efficacy of intravenous iron isomaltoside for correction of anaemia in patients with inflammatory bowel disease in everyday clinical practice.
Stein J, Walper A, Klemm W, Farrag K, Aksan A, Dignass A.
Scand J Gastroenterol. 2018 Sep 17:1-7.

[Dr.Vad]

Подробный обзор изменения качества жизни на фоне в/в введения железа, впервые анализируется интенсивность болевых ощущений (соматических болей) до и после введения железа и также на фоне введения плацебо (рисунок 4)

Health-related quality of life in patients with iron deficiency anemia: impact of treatment with intravenous iron
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

To compare the efficacy of oral supplementation with Iron bisglycinate chelate (FeBC) and polymaltose iron (FeP) in anemic children.

In this double-blind study, children aged 1 to 13 years who were diagnosed with IDA were randomly divided into two groups: i) FeBC, supplemented with iron bisglycinate chelate, and ii) FeP, supplemented with polymaltose iron (3.0 mg iron/kg body weight/day for 45 days for both groups).

Both treatments resulted in significant increases in hemoglobin levels, mean corpuscular volume (MCV) and cell distribution width (RDW) and in a reduction of transferrin levels, relative to initial values. However, only FeBC treatment significantly increased ferritin and mean corpuscular hemoglobin (MCH) levels. A significant negative correlation was observed between the increase in ferritin and initial hemoglobin levels in the FeBC group, indicating that the absorption of FeBC is regulated by the body iron demand.
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Curr Pediatr Rev. 2018 Oct 2.
Iron Bisglycinate Chelate and Polymaltose Iron for the Treatment of Iron Deficiency Anemia: a Pilot Randomized Trial.
Name JJ et al.

[Dr.Vad]

180 children (mean age: 1.8 ± 0.5 years) with cyanotic breath holding spells. They were divided into three groups: with iron deficiency, with iron deficiency anemia and without iron deficiency. Blood hemoglobin, ferritin and iron concentrations were measured at baseline and after 3 and 6 months of iron treatment.
The mean spell frequency was 24.6 ± 7.3/months, 83% had spells after the age of 1 year, 37% had daily spells, 16% had family history of spells, and 61% had iron deficiency/iron deficiency anemia (p = .001). No significant difference in the frequency of spells between children with iron deficiency and those with Iron deficiency anemia. Compared to patients without iron deficiency, there was significant reduction of spells frequency, increased hemoglobin, ferritin and iron levels after 3 and 6 months of iron therapy (p = .0001). Negative correlations were observed between spell frequency with hemoglobin (p = .001), ferritin (p = .0001) and iron (p = .001) levels.
Not only iron deficiency anemia but also iron deficiency alone without anemia is associated with a risk of high-frequency cyanotic breath holding spells.
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Pediatr Hematol Oncol. 2018 Oct 23:1-10.
Iron deficiency and cyanotic breath-holding spells: The effectiveness of iron therapy.
Hamed SA и соавт.

[Dr.Vad]

Случай раннего поседения волос у ребенка 11 лет на фоне ЖДА, которое ликвидировалось после успешного лечения железа сульфатом:

Ann Dermatol. 2016 Dec; 28(6): 775–776.
A Case of Premature Hair Graying Treated with Ferrous Sulfate
Joong-Woon Choi, и соавт.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

еще одна публикация, указывающая, что максимальные значения гемоглобина у детей 1-3 лет, когда их ферритин более 24:

SF value of 23.7 µg/L corresponding to the level at which Hb concentration was maximised...
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Re-Evaluation of Serum Ferritin Cut-Off Values for the Diagnosis of Iron Deficiency in Children Aged 12-36 Months.
J Pediatr. 2017 Sep;188:287-290.

[Dr.Vad]

У женщин с дефицитом веса при беременности или быстрорастущим плодом чаще развивается железодефицитная анемия:

Pregnant women who are underweight before pregnancy and who have faster gestational weight gain are more likely to develop IDA.
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Chin Med J (Engl). 2018 Nov 5;131(21):2566-2574.
Association between Maternal Weight Indicators and Iron Deficiency Anemia during Pregnancy: A Cohort Study.
Tan J и соавт.

[Dr.Vad]

Ассоциация дефицита витамина Д у матери и ребенка с латентным дефицитом железа и ЖДА у детей первых 5 лет жизни:

There were 67 children with ID/IDA [Group 1, mean age (years):2.05±1.24 (0.5-5)] and 50 normal children [Group 2, mean age (years): 1.87±1.12 (0.58-5)]. There were more VitD deficient children and mothers in Group 1 than in Group 2 (respectively, children 49.3 % vs. 20 % p=0.002; mothers 94 % vs.64 %, p=<0.001). There was a positive correlation between hemoglobin levels of children and maternal/child 25-OHD. The independent risk factors for IDA in children were longer exclusively breastfeeding time (odds ratio [OR], 0.35; 95 % confidence interval [CI], 0.1550.789; p=0.011), shorter duration of regular iron supplementation during infancy and pregnancy (infancy: OR,1.69; 95 % CI 1.148-2.508; p=0.008. pregnancy: OR,1.39; 95 % 0,1.070-1.820; p=0.014) and lower maternal 25-OHD level (OR,1.16; 95 % 0,1.034-1.292; p=0.011).
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Arch Argent Pediatr. 2018 Dec 1;116(6):e736-e743.
Is there an association between vitamin D level and iron deficiency in children?

[Dr.Vad]

Опыт применения феринджекта у 863 беременных из Австралии для лечения ЖДА или ЖД (гемоглобин более 110, перед введением ферритин менее 15):

Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Еще одно исследование из Ирана, что наличие ЖДА негативно влияет на сексуальную функцию и сатисфакцию у женщин:
PLoS One. 2018 Dec 6;13(12):e0208485.
The relationship between iron deficiency anemia and sexual function and satisfaction among reproductive-aged Iranian women.
Nikzad Z и соавт.

[Dr.Vad]

Феринджект чаще вызывает гипофосфатемию, чем монофер, которая может длиться до 5 недель у каждого третьего-четвертого:

The incidence of hypophosphatemia was significantly higher in the ferric carboxymaltose versus the ferumoxytol group (<2.0 mg/dl [0.65 mM], 50.8% vs. 0.9%; <1.3 mg/dl [0.42 mM], 10.0% vs. 0.0%; P < 0.001), and hypophosphatemia persisted through the end of the 5-week study period in 29.1% of ferric carboxymaltose-treated patients versus none of the ferumoxytol-treated patients (P < 0.001).
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JCI Insight. 2018 Dec 6;3(23).
Randomized trial of intravenous iron-induced hypophosphatemia.
Wolf M. и соавт.

[Dr.Vad]

Ферритин 15 указывает на отсутствие железа в костном мозге, тогда как его цифра 70 мкг/л говорит о наличии железа для гемопоэза (1+ и более):

For iron deficiency, the mean ferritin concentration in healthy individuals was 15.1 μg/L (9 studies, 390 participants) when bone marrow iron content was 0, and 70.4 μg/L (3 studies, 151 participants) when bone marrow iron was 1+ or higher.
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Arch Med Res. 2018 Dec 17.
Are Current Serum and Plasma Ferritin Cut-offs for Iron Deficiency and Overload Accurate and Reflecting Iron Status? A Systematic Review.
Garcia-Casal MN. и соавт.

[Dr.Vad]

ЖД дефицит у детей с проблемами поведения и их частичная коррекция при ликвидации ЖД:

Iron Profile in Children with Behavioural Disorders: A Prospective Study in a Tertiary Care Hospital in North India
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Впервые медики из Израиля показали, как при в/в лечении ЖДА снижается эндогенный потенциал образования тромбина и снижение активности фактора 8, тем самым снижая риск тромбообразования:
48 participants received intravenous iron and were included in this study. After treatment with intravenous iron, endogenous thrombin potential and peak height decreased in IDA patients by a mean of 122 nmol/l/min (95% confidence interval [CI]: 18-227, P = 0·023) and 52 (95% CI: 27-77, P < 0·001) respectively. Time to peak (peak time) increased by a mean of 24 s (95% CI: 5-42, P = 0·012). FVIII activity was reduced by a mean of 9.6% (95% CI: 2.5-16.7, P = 0·009). In conclusion, treating IDA reduces the blood's coagulability, as evidenced by the change in thrombin generation and FVIII activity levels.
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Br J Haematol. 2019 Jan 25.
Intravenous iron treatment reduces coagulability in patients with iron deficiency anaemia: a longitudinal study.
Nashashibi J и соавт.

[Dr.Vad]

Цинга в современной практике: у большинства пациентов была ЖДА и проблемы с ЖКТ, принимали ИПП (празолы), наиболее частые проявления - кровотечения и синяки/кровоподтеки:

22 adults patient had a diagnosis of scurvy with a mean vitamin C level of 6 μmol/L. Iron deficiency anemia (54%) and gastrointestinal disorders (54%) were the most common comorbidities noted in our cohort. Proton-pump inhibitors use was noted in 54% of patients. Bleeding (45%) and bruising (45%) were the most commonly reported clinical features. Eleven patients received oral supplementation, five had intravenous (IV) vitamin C and six were not treated. Two patients required a transition from oral to IV supplementation. Vitamin C dosing ranged between 250 and 2000 mg and the frequency varied from daily for oral therapy to every few weeks or months for IV.
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Blood Cells Mol Dis. 2019 Jan 24.
Scurvy, an old story in a new time: The hematologist's experience.
Khalife R и соавт.