Железодефицитные новости

[Dr.Vad]

ЖДА как фактор риска ишемического инсульта у детей: ЖДА (особенно с тромбоцитозом) повышает риск инсульта в 4 (10 раз):

This was a case-control study that included 21 stroke cases with patients who had previously been generally healthy, and matched with age and gender of 100 healthy control subjects. Patients were included if a diagnosis of definite stroke had been made and other known etiologies of childhood onset stroke were excluded. For all subjects, iron parameters including serum iron, ferritin, transferrin, total iron binding capacity, and transferrin saturation were assessed.... Our results showed that IDA was disclosed in 57.1 % of stroke cases with no identified cause, as compared to 26 % of controls. Our study suggest that previously healthy children who developed stroke are 3.8 times more likely to have IDA than healthy children, who do not develop stroke (OR, 3.8; 95 % CI:1.3-11.2 P = 0.005). In addition, there was significant interaction between IDA and thrombocytosis among studied cases (OR, 10.5; 95 % CI, 1.0-152 P = 0.02).

Ann Hematol. 2013 Oct 19. Iron deficiency anemia as a risk factor for cerebrovascular events in early childhood: a case-control study

[Dr.Vad]

Новый внутривенный препарат железа монофер так и не смог показать себя столь же эффективным как и старый добрый сульфат железа при лечении ЖДА у пациентов с воспалительными болезнями кишечника (болезнь Крона и язвенный колит):

Am J Gastroenterol. 2013 Oct 22.
A Randomized, Open-Label, Non-Inferiority Study of Intravenous Iron Isomaltoside 1,000 (Monofer) Compared With Oral Iron for Treatment of Anemia in IBD (PROCEED).
Reinisch W, Staun M, Tandon RK, Altorjay I, Thillainayagam AV, Gratzer C, Nijhawan S, Thomsen LL.
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital, Vienna, Austria.

OBJECTIVES: In the largest head-to-head comparison between an oral and an intravenous (IV) iron compound in patients with inflammatory bowel disease (IBD) so far, we strived to determine whether IV iron isomaltoside 1,000 is non-inferior to oral iron sulfate in the treatment of iron deficiency anemia (IDA).

METHODS: This prospective, randomized, comparative, open-label, non-inferiority study was conducted at 36 sites in Europe and India. Patients with known intolerance to oral iron were excluded. A total of 338 IBD patients in clinical remission or with mild disease, a hemoglobin (Hb) <12 g/dl, and a transferrin saturation (TSAT) <20% were randomized 2:1 to receive either IV iron isomaltoside 1,000 according to the Ganzoni formula (225 patients) or oral iron sulfate 200 mg daily (equivalent to 200 mg elemental iron; 113 patients). An interactive web response system method was used to randomize the eligible patient to the treatment groups. The primary end point was change in Hb from baseline to week 8. Iron isomaltoside 1,000 and iron sulfate was compared by a non-inferiority assessment with a margin of -0.5 g/dl. The secondary end points, which tested for superiority, included change in Hb from baseline to weeks 2 and 4, change in s-ferritin, and TSAT to week 8, number of patients who discontinued study because of lack of response or intolerance of investigational drugs, change in total quality of life (QoL) score to weeks 4 and 8, and safety. Exploratory analyses included a responder analysis (proportion of patients with an increase in Hb ≥2 g/dl after 8 weeks), the effect of regional differences and total iron dose level, and other potential predictors of the treatment response.

RESULTS: Non-inferiority in change of Hb to week 8 could not be demonstrated. There was a trend for oral iron sulfate being more effective in increasing Hb than iron isomaltoside 1,000. The estimated treatment effect was -0.37 (95% confidence interval (CI): -0.80, 0.06) with P=0.09 in the full analysis set (N=327) and -0.45 (95% CI: -0.88, -0.03) with P=0.04 in the per protocol analysis set (N=299). In patients treated with IV iron isomaltoside 1,000, the mean change in s-ferritin concentration was higher with an estimated treatment effect of 48.7 (95% CI: 18.6, 78.8) with P=0.002, whereas the mean change in TSAT was lower with an estimated treatment effect of -4.4 (95% CI: -7.4, -1.4) with P=0.005, compared with patients treated with oral iron. No differences in changes of QoL were observed. The safety profile was similar between the groups. The proportion of responders with Hb ≥2 g/dl (IV group: 67%; oral group: 61%) were comparable between the groups (P=0.32). Iron isomaltoside 1,000 was more efficacious with higher cumulative doses of >1,000 mg IV. Significant predictors of Hb response to IV iron treatment were baseline Hb and C-reactive protein (CRP).

CONCLUSIONS: We could not demonstrate non-inferiority of IV iron isomaltoside 1,000 compared with oral iron in this study. Based on the dose-response relationship observed with the IV iron compound, we suggest that the true iron demand of IV iron was underestimated by the Ganzoni formula in our study. Alternative calculations including Hb and CRP should be explored to gauge iron stores in patients with IBD.

[Dr.Vad]

Клиническое исследование из Дании показало, что хелат железа с аминокислотой в половинной дозе столь же эффективен, как и 50 мг железа сульфата для профилактики ЖДА во время беременности, но с более редкой частотой побочный явлений со стороны ЖКТ; связано ли это с тем, что хелатное железо лучше усваивается, чем сульфатное, или всего 25 мг железа достаточно для профилактики в данной ситуации - непонятно:

J Perinat Med. 2013 Oct 24:1-10.
Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial.
Milman N, Jønsson L, Dyre P, Pedersen PL, Larsen LG.
Objective: To compare the effects of oral ferrous bisglycinate 25 mg iron/day vs. ferrous sulfate 50 mg iron/day in the prevention of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women. Design: Randomized, double-blind, intention-to-treat study. Setting: Antenatal care clinic.
Sample: 80 healthy ethnic Danish pregnant women. Methods: Women were allocated to ferrous bisglycinate 25 mg elemental iron (Aminojern®) (n=40) or ferrous sulfate 50 mg elemental iron (n=40) from 15 to 19 weeks of gestation to delivery. Hematological status (hemoglobin, red blood cell indices) and iron status (plasma iron, plasma transferrin, plasma transferrin saturation, plasma ferritin) were measured at 15-19 weeks (baseline), 27-28 weeks and 36-37 weeks of gestation. Main outcome measures: Occurrence of ID (ferritin <15 μg/L) and IDA (ferritin <12 μg/L and hemoglobin <110 g/L).
Results: At inclusion, there were no significant differences between the bisglycinate and sulfate group concerning hematological status and iron status. The frequencies of ID and IDA were low and not significantly different in the two iron groups. The frequency of gastrointestinal complaints was lower in the bisglycinate than in the sulfate group (P=0.001). Newborns weight was slightly higher in the bisglycinate vs. the sulfate group (3601±517 g vs. 3395±426 g, P=0.09).
Conclusions: In the prevention of ID and IDA, ferrous bisglycinate was not inferior to ferrous sulfate. Ferrous bisglycinate in a low dose of 25 mg iron/day appears to be adequate to prevent IDA in more than 95% of Danish women during pregnancy and postpartum.

[Dr.Vad]

Редкое употребление красного мяса, но не птицы, ассоциируется с повышенным (4-х кратным) повышением риска развития анемии в детском возрасте:

J Pediatr Gastroenterol Nutr. 2013 Dec;57(6):722-7.
Anemia and iron deficiency in children: association with red meat and poultry consumption.
Moshe G, Amitai Y, Korchia G, Korchia L, Tenenbaum A, Rosenblum J, Schechter A.
Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan Meuhedet Health Services Hadassah University Mt Scopus, Jerusalem, Israel.

OBJECTIVE: The aim of this study was to study the relative contribution of dietary sources of iron in children with high prevalence of anemia and iron deficiency (ID).

METHODS: A cross-sectional study in 263 healthy, 1.5- to 6-year-old children in the Jewish sector of Jerusalem, Israel. Venous blood samples and a qualitative Food Frequency Questionnaire on iron-rich foods were obtained. Anemia was defined as hemoglobin <11 g/dL for children younger than 4 years and <11.5 g/dL for children older than 4 years; ID was defined as ferritin <12 μg/L.

RESULTS: Anemia was found in 11.2%, ID in 22%, and iron-deficiency anemia in 3.7%. The prevalence of anemia was higher in toddlers ages 1.5 to 3 years compared with children ages 3 to 6 years (17.7% vs 7.3%, P = 0.01). Children with extremely low red meat consumption (seldom) had 4-fold higher rates of ID than those who consumed ≥2 times per week (odds ratio 3.98; 95% confidence interval 1.21-13.03; P = 0.023), whereas poultry consumption was not associated with ID. Soy consumption was inversely associated with ferritin (marginally significant, r = -0.134, P = 0.057).

CONCLUSIONS: The high prevalence of anemia and ID found in this study, mainly in children 1.5 to 3 years old, is related to low red meat consumption. The characteristically high poultry consumption in the Israeli population was not protective. The shift toward reduced red meat consumption and higher poultry consumption in developed countries may result in increasing the risk of ID.

[Dr.Vad]

Недавнее описание клинического случая длительной лейкопении (доброкачественной нейтропении) на фоне ЖДА, когда коррекция железодефицита привела к восстановлению нормального числа лейкоцитов/нейтрофилов:

Int J Clin Pharm. 2013 Dec 18.
Unexplained chronic leukopenia treated with oral iron supplements.
Abuirmeileh A, Bahnassi A, Abuirmeileh A.
Internal Medicine, Isawiya Medical Center, Amman, Jordan.

Case A 67-year-old woman known to have iron deficiency anemia and persistent unexplained chronic leukopenia was cared for by our medical center for about 16 years. During this period she was examined thoroughly and diagnosed to have chronic idiopathic neutropenia (also known as chronic benign neutropenia). Her iron deficiency was attributed to nutritional factors and she was non-compliant with her oral iron supplements. The patient fully received her iron supplement medication by nursing staff for two and a half months during an unexpected prolonged hospital stay after her suffering an acute ischemic cerebrovascular accident. An astonishing outcome was that in addition to having her iron deficiency anemia treated, her long-term unexplained neutropenia was also corrected. Conclusion Some patients diagnosed with chronic idiopathic neutropenia and clinically present as having unexplained chronic neutropenia might actually be suffering from a form of not yet described iron deficiency induced neutropenia.

[Dr.Vad]

Презентация клинического случая синдрома беспокойных ног у женжины с избыточным весом и нормальным ферритином: диагноз дефицита железа был заподозрен клинически и подтвержден с помощью низкой сатурации трансферрина железом (железо/ОЖСС менее 20%):

J Clin Sleep Med. 2013 May 15;9(5):511-3.
Normal ferritin in a patient with iron deficiency and RLS.
Mackie S, Winkelman JW.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Дефицит железа (насыщение трансферрина железом менее 24%) как и его избыток (насыщение трансферрина железом более 40%) ассоциируются с повышенной смертностью у людей в том числе и от сердечно-сосудистых заболеваний:

Both low and high TSAT ratios are significantly and independently associated with increased total and cardiovascular mortality. The optimal TSAT ratio associated with the greatest survival is between 24% and 40%.
--
Stack AG и соавт. Transferrin Saturation Ratio and Risk of Total and Cardiovascular Mortality in the General Population. QJM. 2014 Mar 5.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Experience with intravenous ferric carboxymaltose in patients with iron deficiency anemia
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Публикация из Турции показывает, что вслед за коррекцией ЖДА у женщин улучшились показатели по шкале тревожности Бека и индексу сексуальной оценки (Beck Anxiety Inventory, Female Sexual Function Index), в то время как качество жизни осталось прежним:

J Sex Med. 2014 Apr;11(4):1042-6.
Impact of iron supplementation on sexual dysfunction of women with iron deficiency anemia in short term: a preliminary study.
Gulmez H, Akin Y, Savas M, Gulum M, Ciftci H, Yalcinkaya S, Yeni E.
Author information Department of Family Medicine, Public Health Institution of Turkey, Konya, Turkey.

INTRODUCTION: Iron deficiency anemia (IDA) is a common micronutrient deficiency worldwide. It is an important health problem especially in women of reproductive age. IDA may cause anxiety, which is the major factor for female sexual dysfunction (FSD).

AIM: The aim of the present study was to determine the impact of IDA on FSD in women of reproductive age.

METHODS: In total, 207 women were enrolled. Women with IDA who were admitted in an outpatient clinic of family medicine were asked to complete Beck Anxiety Inventory (BAI), Female Sexual Function Index (FSFI), and Quality of Life (QoL) questionnaires. Questionnaires were completed before and after IDA treatments. Blood samples were obtained for measurements of hemoglobin, hematocrit, levels of serum iron, and iron-binding capacity.

MAIN OUTCOME MEASURES: Outcomes of blood samples were used for diagnosing of IDA. BAI, FSFI, and QoL scores were evaluated. Paired samples t-tests and Pearson correlation analyses were used to assess relationship between findings of IDA treatments and other parameters.

RESULTS: The mean age was 33.6 ± 8.4 years. There were statistical significant differences between pre- and posttreatment in terms of hemoglobin, hematocrit, serum iron, and serum iron-binding capacity. BAI scores were decreased and FSFI scores, which were statistically significant, increased after IDA treatments (P < 0.001). However, QoL scores were developed without statistical significance.

CONCLUSION: There is a risk for anxiety as well as FSD in IDA women of reproductive age. Treatment of IDA can significantly improve sexual functions and QoL in these women population in short term.

[Dr.Vad]

Железодефицит у молодых японок ассоциируется с более высокими индексами утомляемости, напряжения и гнева, похоже, что более высокое потребление зеленого чая с витамином С препятствует развитию анемизации (снижению гемоглобина менее 120 г/л) у них:

Biol Trace Elem Res. 2014 Apr 23.
Iron Deficiency Without Anemia Is Associated with Anger and Fatigue in Young Japanese Women.
Sawada T, Konomi A, Yokoi K.
Faculty of Food and Nutritional Sciences, Toyo University, Gunma, Japan.

Iron deficiency without anemia (IDNA), the most prevalent nutritional deficiency worldwide, affects young women of reproductive age. This study aimed to elucidate the relationship between IDNA and mental and somatic symptoms including anger and fatigue using the Japanese version of the Cornell Medical Index Health Questionnaire (CMI-J). Data regarding demographic characteristics, anthropometry, hematological, and biochemical indices of the iron status, frequencies of selected food intakes assessed by self-administered food frequency questionnaires (FFQs), frequencies of nonspecific symptoms, and grades of neurotic tendencies assessed by CMI-J were collected from 76 young women aged 18-22 years living in the metropolitan area of Tokyo, Japan. The subjects were classified as having IDNA (hemoglobin (Hb) ≥ 12 g/dL and serum ferritin < 20 ng/mL; n = 29), having iron deficiency anemia (IDA) (Hb < 12 g/dL and serum ferritin < 20 ng/mL; n = 10), or having a normal iron status (Hb ≥ 12 g/dL and serum ferritin ≥ 20 ng/mL; n = 36). One subject was excluded from the analyses because of Hb < 12 g/dL and serum ferritin ≥ 20 ng/mL. Fisher's protected least significant difference and the Dwass-Steel-Chritchlow-Fligner multiple comparison tests were used to compare the data of the three groups. P values <0.05 were considered significant. Sections M-R (mental complaints) were significantly higher in the IDNA subjects than in the normal subjects. No significant difference in CMI scores was found between the normal and IDA subjects. Sections I (fatigability), Q (anger), and R (tension) were significantly higher in the IDNA subjects than in the normal subjects, regardless of no significant differences between the normal and IDA subjects in those sections. Young women with IDNA demonstrated a significantly higher proportion of neurotic tendencies (grades II-IV). The intake frequency score of canned or bottled green tea fortified with vitamin C was significantly higher in the IDNA subjects than the IDA subjects. The findings suggest that IDNA may be a risk factor for anger, fatigue, and tension in women of childbearing age.

[Dr.Vad]

врачи из Турции подметили, что лечение ЖДА у женщин ассоциируется со снижением окружности талии, веса и ИМТ, также было замечено повышение холестерина высокой плотности и снижение уровня триглицеридов:

Clin Ter. 2014 Mar-Apr;165(2):e87-9.
Treatment of iron deficiency anemia induces weight loss and improves metabolic parameters.
Aktas G, Alcelik A, Yalcin A, Karacay S, Kurt S, Akduman M, Savli H.
Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey.

BACKGROUND: The treatment of iron deficiency anemia is oral iron replacement which has side effects mostly related with gastrointestinal system. A significant rate of the patients that discontinuing the treatment complained of weight gain during treatment in our clinical practise, despite, oral iron preparations are not known to have such a side effect in adults. Therefore, we planned to investigate this myth whether iron preparations cause an increase in weight, waist circumference, body mass index and laboratory metabolic parameters that may accompany to weight gain.

MATERIALS AND METHODS: Twenty-one women admitted to our out-patient clinics with iron deficiency anemia were enrolled to the study. Waist circumference, body weight, body mass index, systolic and diastolic blood pressures, hemogram and other laboratory parameters assessed and recorded at the first visit and repeated 4 to 6 moths after initiation of treatment.

RESULTS: Waist circumference, body weight and BMI significantly reduced in patients after treatment compared to pre-treatment period. Moreover, HDL was increased and triglyceride was decreased significantly in after treatment compared to pre-treatment period.

CONCLUSIONS: We suggest that treatment of iron deficiency may improve not only haematological but also metabolic and anthropometric parameters. Due to the small study population of our cohort, larger prospective studies are needed to confirm our results.

[Dr.Vad]

Подробный обзор по теме как диагностировать/лечить непонятную ЖДА, резистентную к лечению пероральными препаратами железа, от гуру Хайма Хершко:

How I treat unexplained refractory iron deficiency anemia.
Blood. 2014 Jan 16;123(3):326-33.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Интересное наблюдение от чилийских врачей: в то время как у женщин с нормальным весом усвоение железа было примерно одинаковым, если оно давалось с витамином С или без, у женщин с избыточным весом назначение железа с витамином С ( в соотн. 1:2) увеличивало усвоение железа в полтора раза:

A cross sectional sample of 318 Chilean childbearing age women was studied. The women received either a single dose of 0.5mg of Fe (n=137, group 1) or 3mg of Fe plus ascorbic acid (1:2 molar ratio) (n=181, group 2), both as FeSO4 with labeled radioisotopes. Fe absorption was assessed through radio Fe erythrocyte incorporation. Fe status was determined by hemoglobin (Hb), mean corpuscular volume, serum Fe, total iron binding capacity, transferrin saturation, erythrocyte Zn protoporphyrin and serum ferritin (SF).

RESULTS: 29%, 47% and 24% of the women were classified as normal, overweight or obese, respectively. Fe absorption was significantly lower in obese women (p<0.05). In group 1, the geometric mean and range ±1 SD of the percentage of Fe absorption for normal-weight women was 32.9% vs. 19.7% in obese. For group 2, this percentage was 36% vs. 30%, respectively (2-way ANOVA: BMI classification and Fe dose p<0.05; interaction p=0.34). Although Fe absorption was lower in obese women, they had higher SF (p<0.01) and Hb (p<0.05) concentrations.
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J Trace Elem Med Biol. 2014 Apr 5.
Body mass index, iron absorption and iron status in childbearing age women.

[Dr.Vad]

...inflammation increased ferritin by ap 30% and was associated with a 14% (CI: 7%, 21%) underestimation of ID. Measures of both APP and CRP are needed to estimate the full effect of inflammation and can be used to correct ferritin concentrations.
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Am J Clin Nutr. 2010 Sep;92(3):546-55.
Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Статья из Германии, показывающая как улучшились симптомы связанные со слабостью, депрессивным настроением, головная боль, выпадение волос и др. у женщин с гинекологическими проблемами (плюс ЖДА или латентный ЖД) после введения феринжекта:

Treatment of Iron Deficiency with or without Anaemia with Intravenous Ferric Carboxymaltose in Gynaecological Practices – A Non-Interventional Study

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