Cause Of Iron Deficiency Research Articles

Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology.

Iron is an essential micronutrient for a myriad of physiological processes in the body beyond erythropoiesis. Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF), with a prevalence reaching up to 59% even in non-anaemic patients. ID impairs exercise capacity, reduces the quality of life, increases hospitalisation rate and mortality risk regardless of anaemia. Intravenously correcting ID has emerged as a promising treatment in HF as it has been shown to alleviate symptoms, improve quality of life and exercise capacity and reduce hospitalisations. However, the pathophysiology of ID in HF remains poorly characterised. Recognition of ID in HF triggered more research with the aim to explain how correcting ID improves HF status as well as the underlying causes of ID in the first place. In the past few years, significant progress has been made in understanding iron homeostasis by characterising the role of the iron-regulating hormone hepcidin, the effects of ID on skeletal and cardiac myocytes, kidneys and the immune system. In this review, we summarise the current knowledge and recent advances in the pathophysiology of ID in heart failure, the deleterious systemic and cellular consequences of ID.

The Evaluation of Iron Deficiency and Iron Overload

In the western world, 10-15% of women of child-bearing age suffer from iron-deficiency anemia. Iron overload due to chronic treatment with blood transfusions or hereditary hemochromatosis is much rarer. This review is based on pertinent publications retrieved by a selective search on the pathophysiology, clinical features, and diagnostic evaluation of iron deficiency and iron overload. The main causes of iron deficiency are malnutrition and blood loss. Its differential diagnosis includes iron-refractory iron deficiency anemia (IRIDA), a rare congenital disease in which the hepcidin level is pathologically elevated, as well as the more common anemia of chronic disease (anemia of chronic inflammation), in which increased amounts of hepcidin are formed under the influence of interleukin-6 and enteric iron uptake is blocked as a result. Iron overload comes about through long-term transfusion treatment or a congenital disturbance of iron metabolism (hemochromatosis). Its diagnostic evaluation is based on clinical and laboratory findings, imaging studies, and specific mutation analyses. Our improving understanding of the molecular pathophysiology of iron metabolism aids in the evaluation of iron deficiency and iron overload and may in future enable treatment not just with iron supplementation or iron chelation, but also with targeted pharmacological modulation of the hepcidin regulatory system.

An evaluation of gastrointestinal endoscopic examination outcomes in patients with iron deficiency through guidelines

Introduction:Chronic blood loss and intestinal malabsorption of iron are two important causes of iron deficiency in adult patients.We evaluated the demographic data and endoscopy findings of patients who underwent endoscopic examination due to iron deficiency. Materials and Method:The study was designed retrospectively.The database of patients who underwent endoscopic examination due to ID and/or IDA in the endoscopy unit of our hospital between June 2017-April 2020 were found through the database scan. After exclusion of patients with active bleeding finding, remaining 326 patients were evaluated. Findings:Median age of the patients was 58 years. The participants included 182 males and 144 females. Ninety three patients were below 50 years of age whereas 133 patients were above 50 years of age. Endoscopy was performed in 13.2% of the patients; colonoscopy was performed in 2.5% of the patients; and endoscopy + colonoscopy (dual procedure) was performed in 84.4% of the patients. Endoscopic examinations revealed pathological findings that may cause ID/IDA in 69.3% of the patients; however, no gastrointestinal pathology that may cause ID/IDA was detected in 30.7% of the patients.Twelve patients were diagnosed with malign diseases. Detection of any pathology that may cause ID/IDA during endoscopic examinations was significantly more in the dual examination group when compared to patients who had EGD or colonoscopy (p<0.001). Furthermore, concomitant pathologies that may cause ID/IDA in both lower and upper GIS were detected in 17.5% of the patients in the dual examination group. Conclusion:Dual endoscopic examinations according to guideline recommendations increase diagnostic efficiency compared to one-sided examinations.

Iron Repletion Increases Platelet Aggregation and Reduces Platelet Count in Iron Deficient Premenopausal Women

Background: Iron deficiency, heavy menstrual bleeding, and anemia are interrelated conditions with high prevalence in women's health. Together, they impact an estimated 310 million premenopausal women worldwide. Iron deficiency has been associated with development of anemia as well as thrombocytosis. However, the effects of iron deficiency on platelet function remain unknown.Objective: We set out to investigate the impact of IV iron repletion on platelet function, platelet count, and other blood cell indices in iron deficient premenopausal women.Methods: We conducted a prospective single-center study of iron deficient premenopausal women who underwent iron repletion with a single dose of 1000 mg of low molecular weight iron. Pre-infusion and post-infusion blood samples were obtained for laboratory analysis. Standard of care monitoring of iron indices and complete blood counts were also included in the analysis. Pre-infusion rates of anemia and thrombocytosis were calculated using minimum hemoglobin and peak platelet count in the 6 months preceding iron infusion. Platelet function was quantified by Fluorescence-Activated Cell Sorting (FACS) quantification of platelet activation marker antibodies for GPIIb/IIIa (PAC1) and P-selectin (CD62P) after exposure to multiple platelet agonists. Platelet aggregation was assessed by flow of anticoagulated whole blood at a shear rate of 300 s -1 for 5 minutes through chambers coated with type I collagen, imaged with differential interference contrast optics, and quantitatively represented through computation of percent total surface coverage. Pre-infusion and post-infusion cell indices and aggregation data were compared by paired samples t-test. All statistical analyses were performed in GraphPad Prism (Version 8.0.0).Results: Thirteen patients were included in the analysis. Heavy menstrual bleeding was the suspected cause of iron deficiency in 83% of patients. Thrombocytosis was present in 15% of patients at pre-infusion and no patients at post-infusion. Average ferritin was 14 µg/L at pre-infusion and 126 µg/L at post-infusion. The peak platelet count within 6 months pre-infusion was 309 K/mm 3 (±89) vs. 274 (±64) K/mm 3 at post-infusion (p<0.05). The average change to 6-month pre-infusion peak and post-infusion platelet count was -35.2 K/mm 3 (95%CI: -66.2, -5.23). The mean 6-month minimum hemoglobin was 11.9 (±1.9) g/dL vs. 13.3 (±1.1) g/dL at post-infusion (p<0.005). Acquisition of FACS platelet reactivity data are ongoing, with preliminary results for the first 7 consecutively enrolled study patients displayed in Figure 1. Platelet aggregation measured at pre-infusion showed 14% surface coverage, with a significant increase to 29% at post-infusion (p < 0.05). None of the 13 women experienced a thrombotic event during the study period.Conclusion: Correction of iron deficiency results in decreased platelet count and improves platelet aggregation over collagen. Iron repletion may also improve platelet reactivity in response to physiologic agonists. These findings may suggest that iron deficiency impairs hemostasis and that correction of low iron may be even more critical for women with heavy menstrual bleeding. [Display omitted] DisclosuresShatzel: Aronora Inc,: Consultancy.

The Use of Iron-Enriched Yeast for the Production of Flatbread.

The most common cause of iron deficiency is an improperly balanced diet, in which the body’s need for iron cannot be met by absorption of this element from food. Targeted iron supplementation and food fortification may be the main treatments for iron deficiency in the population. However, many iron-rich supplements and foods have low bioavailability of this element. In our study, we used yeast enriched with iron ions to produce flatbread. The yeast cells accumulated iron ions from the medium supplemented with Fe(NO3)3·9H2O, additionally one of the cultures was treated with pulsed electric field in order to increase the accumulation. The potential bioavailability of iron from flatbread containing 385.8 ± 4.12 mg of iron in 100 g dry mass was 10.83 ± 0.94%. All the flatbreads had a moderate glycemic index. There were no significant differences in antioxidant activity against DPPH• between flatbread with iron-enriched and non-iron-enriched yeast. Sensory evaluation showed that this product is acceptable to consumers since no metallic aftertaste was detected. Iron enriched flatbread can potentially be an alternative to dietary supplements in iron deficiency states.

Effect of Pica on Some Hematological Parameters in Thi-Qar Province

Pica items are deferent, and vary according to culture, race/ethnicity and geographic location. It is the eatingof a non-nutritional substance as defined by the American psychiatric association and the most widespreadof which is eating soil. A total of 163 iron deficient anemic patients included in this cross sectional study,where 18 substances nominated as causes of IDA were collected from …….. . Information was collectedfrom the patient involving gender, age, type of substance, and the causes of iron deficiency were sought toidentify clinical and laboratory correlates of pica in 163 .The result show where most targeted materialsas pica was Bitter gum 81 (22.8%) while the lowest were the Sesame =1, Nail=2, Soap=1 cases. whilesignificant statistical difference between the gender distribution and hemoglobin levels, WBC of picapatient, while age and platelets don’t showing this differences. only age of (35-40) years showing significantstatistical association of both Hb and WBC counts. The result show many comorbid condition in additionto anemia had been discovered, where most of these condition where linked to Khawa clay consumptions.Independent variables seems to be correlated really through the effect of the granulocytes and platelets withHb. This study is very important as a future study because it reveals many patterns of deficiency of someblood parameters with pica, as well as most people who suffer from Pica have iron deficiency, as this studyprovided a great incentive to know the ages and genders of the most vulnerable group of pica disorder.

Spotlight on… heavy menstrual bleeding and uterine fibroids

Heavy menstrual bleeding (HMB) is a common condition affecting 20–30% of women of reproductive age.1 In England and Wales, nearly 80 000 women a year are referred to secondary care, with one-third of those subsequently undergoing surgical interventions.1 It is not uncommon for HMB to be associated with fibroid uterus, endometriosis and adenomyosis, and in a minority of cases, it may be an early sign of endometrial hyperplasia or cancer. The national HMB audit also highlighted that almost one-third of women affected by HMB had not received treatment in primary care before referral to secondary care.1 This figure could be quite different during the current COVID-19 pandemic. The audit also pointed out that women from ethnic minority groups and those from more socio-economically deprived areas made more visits to their GP regarding their HMB and saw less improvement in their condition.1 Women from more deprived areas also reported more severe HMB symptoms and poorer quality of life.2 It is therefore important to recognise any intervention should aim to improve quality of life rather than focusing on blood loss.3 Heavy menstrual bleeding is also the most common cause of iron deficiency and iron-deficiency anaemia in premenopausal women, which is frequently overlooked in routine practice (TOG 2017;19:155–61). In the last 10 years, The Obstetrician & Gynaecologist (TOG) has featured a number of articles covering HMB-related topics. A well-established National Institute for Health and Care Excellence (NICE) guideline on assessment and management of HMB was updated in 2018 and 2020.3 Since the first edition published in 2007, there have been very few changes in the medical management of HMB. Carey and Allen (TOG 2012;14:223–8) described the noncontraceptive uses and benefits of combined oral contraception, while Murdoch and Roberts (TOG 2014;16:46–50) explored the mode of action and the potential use of selective progesterone receptor modulators in treating fibroid uterus, although its use on uterine fibroids has been largely halted in the last couple years due to serious health complications.3 Nearly one-third of women with HMB referred to secondary care will subsequently require surgical interventions.1 Saraswat and Cooper conducted an in-depth review of endometrial ablation (TOG 2017;19:37–45), which covers its development, patient satisfaction rates, safety, the long-term sequelae and the cost-effectiveness of first- and second-generation techniques of endometrial ablation. Overall patient satisfaction rates and amenorrhoea rates were up to 80% and 50%, respectively. Nevertheless, around one in six women would still require further surgical intervention within 5 years. Ultimately, only hysterectomy can ensure long term amenorrhoea. The same authors (TOG 2017;19:101–8) also examined different surgical approaches to hysterectomy (laparoscopic, abdominal and vaginal) as well as myomectomy. A recently published multi-centre randomised controlled trial (the HEALTH study)4 concluded that laparoscopic supracervical hysterectomy is superior to second generation endometrial ablation in terms of clinical effectiveness, although the differences were relatively moderate. A laparoscopic approach may and should become the standard approach in performing hysterectomy. Elnasharty and Moustafa provide useful tips and techniques on dealing with the challenges in laparoscopic hysterectomy (TOG 2020; 22:313–7). HMB is often found to be associated with fibroid uterus, although not all women with fibroid uterus complain of HMB. This poses a significant management dilemma, especially among women with a history of subfertility. Younas et al. summarised the recent evidence on managing uterine fibroids including uterine artery embolisation, magnetic resonance imaging-guided focused ultrasonography as well as a different surgical approach on myomectomy (TOG 2016;18:33–42). A similar review was also published in 2018, when Bryant-Smith and Holland predominately explored the techniques and controversies in laparoscopic myomectomy, although they also examined the potential risk of unintentional dissemination of malignant cells during intracorporeal morcellation of undiagnosed leiomyosarcoma (TOG 2018;20:261–8). In the same issue of TOG, Sampat and Alleemudder reviewed the management and outcomes of fibroids in pregnancy (TOG 2018;20:187–95). As mentioned earlier, HMB can be a sign of endometrial hyperplasia or cancer, particularly in women with history of polycystic ovary syndrome and/or being overweight. Jones et al. discussed the diagnostic tools for detecting endometrial cancer (TOG 2021;23:103–12). All of the above contributing authors emphasised the importance of involving patients in the decision-making process, however, Jeffery, Kayani and Garden reminded us of the difficulties in managing menstrual problems in adolescents with learning disabilities (TOG 2013;15:106–12). This article also evaluated the need for different management options. An online collection of TOG articles on heavy menstrual bleeding and uterine fibroids is available at http://onlinetog.org.

Malaria is a cause of iron deficiency in African children.

Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n =7,453), but not among individuals living in malaria-free areas (n =3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.

Quando la carenza di ferro diventa rara…

Iron deficiency anemia is the most common nutritional disorder in the world, the most widespread form of anemia and the most frequent in children. In the presence of microcytic anemia, evidence of an iron deficiency (transferrin saturation index &lt;10% and ferritin &lt;12 mg/l) allows the diagnosis. An increase in requests and a reduced income are the most common causes in early childhood and adolescence. It is essential to ensure that the disorder is corrected at the end of therapy, in order to exclude rarer causes of iron deficiency. A correct diagnosisi and therapy are also essential to guarantee patients so to spare additional costs and stress for the whole family.

Upper and Lower Gastrointestinal Endoscopic Lesions in Patients with Unexplained Iron Deficiency Anaemia- A Cross-sectional Study

Introduction: Anaemia, due to iron deficiency, is very common in India. In many cases, the underlying cause of iron deficiency remains unknown even after detailed laboratory investigations. It is often due to malabsorption of iron from the gut and occult blood loss from the Gastrointestinal (GI) tract. Bidirectional GI endoscopy can help in finding these causes. Aim: To study the upper and lower GI endoscopic lesions in patients with unexplained Iron Deficiency Anaemia (IDA). Materials and Methods: This was a cross-sectional observational study, conducted on 75 patients with unexplained IDA in Dr. DY Patil Medical College and Hospital, Pune, Maharashtra, India, between June 2019 to June 2020. Patients above the age of 18 years and with Haemoglobin (Hb) of less than 13 g/dL (males) and less than 12 g/dL (females) underwent upper GI endoscopy and colonoscopy with biopsies, after ethics committee approval and informed consent. Complete haemogram with blood indices, iron studies and faecal Occult Blood Test (OBT) were conducted for all the patients. The patients were divided into Group A, those with upper/lower GI endoscopy lesions thought to be responsible for IDA and Group B, those without GI endoscopic lesions. Statistical analysis was performed using IBM, Statistical Package for the Social Sciences (SPSS), version 21.0 and statistical tests (Chi-square test, Student’s t-test and multivariate logistic regression analysis, with 95% Confidence Interval (CI) and p-value &lt;0.05 was taken as significant) were used when required. Results: There were 44 females and 31 males in the study, with the age range of 20-81 years. The mean age of patients in Group A (n=44) was 58.57±11.68 years and Group B (n=31) was 49.68±14.45 years. On multivariate analysis, advance age, history of weight loss and faecal occult blood were statistically significantly associated with the presence of GI endoscopic lesions responsible for IDA (p-value&lt;0.05). Maximum lesions responsible for IDA were found in stomach (48%), erosive and inflammatory lesions causing IDA were more common in upper GI tract. Peptic ulcers were found in 12% cases. The GI malignancies were found in 14.66% subjects. Colorectal cancers (8%) were more common than upper GI cancers (6.66%). Conclusion: In patients with IDA, erosive oesophagitis and haemorrhagic gastritis were commonly found followed by peptic ulcers and malignant GI lesions on bidirectional endoscopy. GI endoscopy is a very important tool to diagnose the cause of IDA. All patients with advanced age, history of weight loss and a positive faecal OBT should undergo bidirectional GI endoscopy routinely.

Частота и причины железодефицита у малочисленных народов Севера (ханты и манси), мигрировавших в город и ведущих традиционный образ жизни (стойбища, село), опыт применения препаратов железа

Objective. To study the health status of women from among the small-numbered indigenous peoples of the North (SIPN), including those leading a traditional way of life in camps and rural areas. Patients and methods. Using continuous sampling method, a prospective analysis of complaints, anamnestic, anthropometric, and laboratory data was carried out in female patients from among SIPN (Khanty and Mansi) living in rural areas and camps, as well as in the city of Khanty-Mansiysk. The comparison group consisted of women from the migrant population (Russians) living in the city of Khanty-Mansiysk. Results. The greatest number of health disorders was found among SIPN who migrated to the city in the first and second generations. Overweight was observed in 46.2% of women in this cohort, obesity was diagnosed in 19.2% of women. Heavy and prolonged menstrual bleeding was the main cause of iron deficiency (11.5%) and iron deficiency anemia (IDA) (30.8%) in the group of SIPN living in the city. IDA of mild severity occurred in 19.2% of patients, and of moderate severity – in 11.5%. Conclusion. Iron metabolism disorders were observed in 42.3% of women from among SIPN who migrated to the city. Iron(III)- hydroxide polymaltose complex (Ferrum Lek®), which is used in the complex therapy of gynecological diseases (menstrual disorders) and gastrointestinal diseases, has high efficiency, good tolerability and the least number of adverse effects. This makes it possible to recommend it for the treatment of IDA and for the replenishment of iron stores in women in both SIPN and newcomer populations. Key words: anemia, iron deficiency, female residents of the Khanty-Mansi Autonomous Area-Yugra, small-numbered indigenous peoples of the North (Khanty and Mansi), Ferrum Lek

Treatment of anemia using parenteral iron supplements

Background. Anemia occurs in 30 % of women of childbearing age worldwide. The main causes of iron deficiency and iron deficiency anemia (IDA) are the decrease in iron intake from food (vegetarian diet, unbalanced diet, anorexia, eating disorders), impaired iron absorption (celiac disease, malabsorption, concomitant digestive diseases, drug use), blood losses (menstrual bleeding, childbirth, surgery, gastrointestinal bleeding, blood donation), and the increased need for iron (children and adolescents, pregnancy and lactation, endurance exercise). In the 3rd trimester of pregnancy, the need for iron is almost 10 times higher than in the 1st trimester (7.5 vs. 0.8 mg per day).&#x0D; Objective. To describe the treatment of anemia with parenteral iron supplements.&#x0D; Materials and methods. Analysis of literature sources on this topic.&#x0D; Results and discussion. Hemoglobin content &lt;90 g/l increases the risk of miscarriage, low birth weight and gestational age, premature birth, preeclampsia and eclampsia. Low hematocrit (&lt;29 %) is accompanied by an increase in the probability of growth retardation and fetal death. On the part of the pregnant woman, tolerance to physical activity worsens, the probability of heart failure increases (in severe anemia), the condition of the thyroid gland and wound healing deteriorates. Among children born to mothers with IDA, the probability of IDA is higher than among children born to mothers with normal hemoglobin levels (47.2 % vs. 6.5 %; Colomer I. et al., 1990). Childbirth deepens IDA due to blood loss. During vaginal childbirth or cesarean section 300-500 ml of blood is lost, in case of profuse bleeding – 500-1000 ml, and in case of profuse bleeding, uterus atony, and in case of the disseminated intravascular coagulation – 2-3 L or even more. Iron supplements are prescribed for the treatment of IDA. They can be divided into oral (iron salts, iron complexes, elemental iron) and parenteral. Pregnant women are recommended to take 60 mg of iron per day from the beginning of gestation (as early as possible) until the end of pregnancy, as well as during the first 3 months of lactation. Oral iron preparations have a number of side effects: constipation, diarrhea, heartburn, nausea, and epigastric pain. This causes unsatisfactory adherence: one in five women stops taking iron supplements. Polymaltose iron complex is tolerated slightly better than iron sulfate. In case of intolerance to oral drugs, intravenous iron may be prescribed. Its advantages include fast action and good efficiency. Drugs for intravenous administration are divided into iron preparations and iron complexes with carbohydrates (carboxymaltose, sucrose, dextran). The sucrose complex of iron allows to reach the maximum level of hemoglobin much faster than iron sulfate (6.6 against 9.4 weeks). According to German and French guidelines for the treatment of anemia in pregnant women, if the hemoglobin is reduced to &lt;90 g/l, IDA should be treated with intravenous iron. In the recommendations of the Asia-Pacific region, the threshold value is 100 g/l.&#x0D; Conclusions. 1. Insufficient iron levels before pregnancy and the increased need in iron during pregnancy justify the proactive assessment and correction of IDA in pregnant women. 2. In case of moderate anemia and early stages of pregnancy, normal iron levels can be restored before delivery with the help of oral medications. 3. Intravenous iron supplements normalize iron levels faster than oral ones.

Iron deficiency anemia – new possibilities of iron supplementation in various clinical conditions

AbstractIron deficiency anemia (IDA) treatment is done to eliminate the causes of iron deficiency, iron supplementation, and rarely red blood cell transfusion. Divalent iron salts are the first line of oral treatment, but their use lead to frequent gastrointestinal adverse reactions. Iron is administered intravenously in the event of contraindications, intolerance, or inefficiency of oral therapy, but the parenteral route of drug delivery is not easily accepted by the patients. Intravenous preparations for single administration of a large dose of iron have a good therapy safety profile, but are more expensive than oral and are usually administered in a hospital setting. The availability of new iron compounds: sucrosomial iron, ferric citrate complexes, and ferric maltol widen the possibilities of IDA therapy and enable the better selection of iron preparations in various clinical situations. The innovative structure of sucrosomial iron leads to absorption in different ways (through endocytosis, the paracellular pathway, M cells of Peyer's patches), ensures high bioavailability, and good tolerance of therapy. Ferric citrate, in addition to iron supplementation, reduces phosphate levels, and is beneficial to chronic kidney disease. Ferric maltol is currently being studied for IDA treatment with various comorbidities. Some studies indicate that new iron formulas may be used where intravenous intake has been recommended so far. So, we can expect treatment with iron nanoparticles and drugs that affect the intestinal microflora in the future. The paper presents current knowledge about new iron preparations that are already available in everyday practice, but also those that are at various stages of pre-clinical and clinical studies.

Intravenous Iron Infusion Administration Schedule and Hematologic Response; A Single-Center Retrospective Cohort Study

Background: Clinical trials studying the efficacy of intravenous (IV) iron replacement have used a variety of dosing schedules, even for the same iron formulations and there isn't a clear standard for how IV iron replacement should be scheduled. Differences in iron absorption efficiency have been observed with different oral iron supplementation schedules but it is not known if the same is true for IV iron. The objective of this study was to evaluate the association between iron administration schedule and hemoglobin response in patients treated at a tertiary care center. Methods: Data was collected retrospectively using The Ottawa Hospital Data Warehouse (OHDW) capturing all iron infusions given at 3 local institutions between January 2007 and December 2018. Patients that received at least 2 intravenous iron infusions within 180 days of each other were included. A 'course' of iron replacement was defined as consecutive infusions with ≤180 days between doses. Patients transfused red blood cells within 90 days of the last iron infusion in each course were excluded. Patient age, sex, dose and formulation of administered, date of each iron infusion, and laboratory parameters from the period starting 3 months before the first infusion to 6 months after the last infusion were extracted for analysis. Patients were categorized into 4 groups based on the mean time between iron infusions in each course: 1-10 days, 11-20 days, 21-30 days, and &amp;gt;30 days. Achieving a maximum hemoglobin (Hb) 10 g/L or higher than the pre-infusion Hb was defined as a 'good' response. A logistic regression model was used to evaluate the association between interval between infusions and achieving a 'good' Hb response. The model was adjusted for sex, age, presence of chronic kidney disease (CKD), dose of iron per course, number of infusions per course, and number of courses. CKD was defined as having a serum creatinine &amp;gt;177 µmol/L. Iron sucrose, iron gluconate, and iron dextran were available for administration during the study period. Results: A total of 4350 patients were included in the analysis. These patients received a total of 6409 courses of iron replacement, with a median of 2 courses (interquartile range [IQR] 1-3) per patient, and 4 infusions (IQR 3-6) per replacement course. Infusions were given a median of 21.9 days (IQR 12-34) apart in each course, with a range of 1-179 days. Iron sucrose was given in most courses (81.6%), followed by iron gluconate (18.2%) and iron dextran (0.1%). Patient characteristics are summarized in Table 1 and laboratory values prior to the first infusion of each course are summarized in Table 2. The interval between iron infusions was associated with Hb response. Results of the logistic regression are summarized Table 3. Compared with patients receiving infusions every 10-20 days, patients receiving infusions more frequently or less frequently were less likely to achieve a good Hb response. Male sex was associated with increased odds of response, while increasing age, having CKD, and receiving more courses of iron were associated with decreased odds of response. Conclusions: In this single-center retrospective cohort analysis, an association between interval of iron infusions and hematologic response was observed. Patients given iron every 10-20 days more likely to achieve a good response compared with more, or less frequent dosing intervals. Strengths of this study include the large sample size, adjustment for sex, age, presence of CKD, and number of iron infusions and courses given. Transfused patients were excluded, so the hemoglobin response is attributable to iron replacement. The study has several important limitations. The clinical decision-making for the infusion schedule was not known and factors that went into this decision are a possible source of confounding (for example, ongoing bleeding). The suspected cause of iron deficiency was not known. Additionally, concomitant oral iron supplementation and iron infusions or transfusions occurring outside the study institution are unknowns and may influence to outcome. The hypothesis-generating findings suggest that the schedule of iron administration may play an important role in hematologic response to iron infusions. Disclosures No relevant conflicts of interest to declare.

Iron homeostasis disorder in piglet intestine.

Iron plays an essential role in preventing iron deficiency anemia and ensuring the healthy growth of animals. The special physiological condition of piglets is the main cause of iron deficiency. Iron metabolism in the intestine is the basis for understanding the effects of iron on the health of piglets. In order to scientifically evaluate dietary iron supplementation doses, it is necessary to recognize the effects of iron deficiency and iron overload on piglet intestinal health. Besides, iron as a cofactor is essential for the growth of microorganisms, and microorganisms compete with the host to absorb iron. Under the stress of iron deficiency and iron overload, various control schemes (such as precise nutrition, element balance, elimination of oxidation, etc.) are effective measures to eliminate adverse effects. In this review, we comprehensively review recent findings on the effects of iron deficiency and iron overload on intestinal health. This review will provide a rational design strategy to achieve a reasonable iron supplement, which will guide the use of iron in animal husbandry.

New Possibilities of Correction of Iron Deficiency Conditions in the Practice of a Family Doctor

The article considers the main causes of iron deficiency and iron deficiency anemia (IDA) in the practice of a family doctor, in particular – conditions accompanied by a significant increase in the physiological need for iron. Special attention is paid to the clinical aspects of iron deficiency and IDA in women of reproductive age. Differences in the absorption of heme and non-heme iron are described. The advantages of prevention and dietary correction of iron deficiency conditions using a combination of heme iron and ferrous sulfate (Richter FerroBio) are revealed, taking into account the importance of tolerability and safety issues for patients.

A91 SARCOMATOID CARCINOMA OF THE COLON PRESENTING AS IRON DEFICIENCY ANEMIA

Abstract Background Gastrointestinal malignancy is a common cause of iron deficiency and occult gastrointestinal bleeding among adults in developed countries. Given the high prevalence of colorectal cancer and adenomatous polyps in our population, it is imperative that these patients undergo early colonoscopy. Sarcomatoid carcinoma (SCA) of the colon is a very rare condition, with less than 30 cases reported in the literature. Given the highly aggressive nature of this neoplasm, it is important to familiarize oneself with its presentation, histopathology and treatment options. Aims Describe a case of SCA of the colon in a cirrhotic patient, presenting initially as iron deficiency anemia of unknown etiology. Methods Case report and literature review. Results A 69-year-old female presented to the emergency department with complaints of progressive weakness and failure to thrive. Past medical history was significant for chronic kidney disease, NASH cirrhosis Child-Pugh C and recurrent hepatocellular carcinoma despite previous radiofrequency ablation. Investigations demonstrated de novo iron deficiency anemia with the following blood results: hemoglobin of 96, iron of 8.6, iron saturation of 20% and ferritin of 56. Subsequently, gastroenterology was consulted in order to assess for an occult source of bleeding. A gastroscopy was first performed in which no abnormalities were found. She then underwent a colonoscopy, which demonstrated a very large indurated nodular ulcer in the ascending colon, suggestive of invasive neoplasm (Figure A). Indeed, the biopsies demonstrated a malignant spindle cell neoplasm consistent with SCA. On immunohistochemistry, the tumor cells stained positive for keratin AE1/AE3, weakly positive for SMA and S-100, but negative for SMM, HMB45, DOG1, C-KIT and CD31. Given her severe comorbidities, no therapeutic options were available for this patient, thus further staging investigations were not pursued. Unfortunately, the patient rapidly deteriorated and died less than 8 weeks following her diagnosis. Conclusions Sarcomatoid carcinoma of the colon is an extremely rare neoplasm with very poor prognosis. Histologically, this tumor is characterized by a typical biphasic pattern, composed of both mesenchymal and epithelial cells. However, as demonstrated in this case, some SCA display a rather predominantly mesenchymal pattern, rendering the diagnosis difficult using morphology only. Immunostaining is therefore used to identify carcinoma features and to rule out similar tumors such as sarcoma, GIST, mesothelioma and melanoma. SCA of the colon is exceedingly aggressive, with remarkably rapid tumor growth and early distant metastasis. Indeed, median survival is reported to be less than 6 months. Given its rarity, no well-defined treatment guidelines exist, however most patients are managed with early radical surgery, adjuvant chemotherapy and close follow-up. Funding Agencies None

Iron deficiency in heart failure: beyond the anemia.

Iron deficiency in heart failure is a frequent condition and may be a prerequisite for the development of anemia but not necessarily the two conditions coexist. Iron deficiency in itself independently of the presence of anemia, determines a series of alterations of the cellular processes of our body related to the production of energy in the form of ATP, cell proliferation and DNA synthesis. The causes of iron deficiency are several and among the various, the inflammatory state present in chronic heart failure, combined with the absorption deficit seems to play a predominant role. This review aims to cover all the main aspects related to iron deficiency in patients with heart failure starting from aetiology up to the therapeutic implications. In particular, the different causes and the pathophysiological mechanisms that underlie the iron deficiency will be examined, describing what are the consequences on the alterations on the biochemical processes in terms of absorption, transport and use of iron by target cells with particular regard to muscle cells and Erythropoietic line. The meaning, the role and the importance in clinical practice of the different laboratory tests that dose the iron (Ferritin, Serum Iron, Transferrin and Transferrin saturation or TSAT) that allow to identify the presence of absolute or relative iron deficiency will also be underlined. Literature data related to the consequences of iron deficiency and to the alterations concerning its transport on the symptoms and functional capacity of patients with heart failure will be reported as well as their impact on prognosis. A second part of the paper will address the main aspects related to iron therapy. We will discuss the administration of iron per os with regard to the different drugs, to the processes of absorption and to the use of different pharmaceutical formulations with their associated side effects. The scientific evidences on parenteral formulations and in particular on the use of Fe-carboxymaltose will be reported. Finally, we will discuss the role of erythropoietin in the context of heart failure.

Study to evaluate the etiology of iron deficiency anemia at a teaching hospital in northeastern part of India.

Introduction:The causes of iron deficiency may be either due to excessive loss or, less frequently, decrease absorption. Data related to etiology are not available from this part of the country.Objective:A study to evaluate the etiology of iron-deficiency anemia at a teaching hospital in the northeastern part of India.Materials and Methods:In this cross-sectional study, cases of iron-deficiency anemia were selected from the OPD and indoor, after taking proper written consent. Iron-deficiency anemia was diagnosed by sending the complete hematological investigations. Other specific investigations including imaging were done in selected patients as per indications.Results:A total of 102 patients of iron-deficiency anemia were included in the study. The age of the selected population was between 18 and 80 years. 37.3% were male and 62.7% were female patients. Upper gastrointestinal endoscopy was done in 56, out of these, 9.7% had antral gastritis and 2.9% had a duodenal ulcer. Lower gastrointestinal endoscopy was done in 30 patients and out of these seven patients had hemorrhoids, one patient had multiple ulcers in the colon, one had ulcers in the sigmoid colon, and one had ulceroproliferative mass in the transverse colon. Biopsy through the upper gastrointestinal endoscopy showed chronic duodenitis in three patients (2.9%), carcinoma stomach in one (0.98%), and periampullary carcinoma in one (0.98%). Biopsy after lower gastrointestinal endoscopy showed one case each of carcinoma colon, ulcerative colitis, nonspecific colitis, and nonspecific enteritis.Conclusion:Diagnosis of iron-deficiency anemia is not sufficient without the diagnosis of underlying etiology. Special concern will be taken to gastrointestinal malignancies like colorectal cancers in which iron-deficiency anemia may be the only manifestation and diagnosis that can be missed if we do not investigate properly.

Анемизирующий синдром у современных женщин — нерешенная мировая проблема. Врачебная тактика

Objective of the Review: To set forth the frequency and prevalence of the anemia syndrome in non-pregnant and pregnant women and approaches to treating this disorder. Key Points: Anemia syndrome is the most common health problem in contemporary women. The leading cause of iron deficiency in women of reproductive age is abnormal uterine bleeding (AUB). Anemia in women significantly reduces their ability to work and quality of life, and increases the rates and severity of complications in pregnant women and parturients. It is also a significant contributor to maternal mortality and fetal and neonatal morbidity. Treating anemia in pregnant women presents certain challenges. In the period between the first trimester and delivery, there is an 8-fold increase in the requirement for iron; therefore, hemoglobin levels return to normal slowly. The active ingredient of Ferrum Lek is a ferric hydroxide polymaltose complex, which is as effective as medications containing ferrous sulfate, but is significantly better tolerated by patients and easier to use. The active transport of iron allows its controlled absorption from the polymaltose complex, minimizing the risk of an increase in serum levels of iron not bound to transferrin. This ensures that this medication is very safe and eliminates the risk of overdose or poisoning. Conclusion: Anemia syndrome is the most common type of homeostatic imbalance in women of reproductive age. It most often results from frequent and abundant uterine bleeding (AUB). Therefore, an obstetrician-gynecologist plays the leading role in identifying menstrual disorders and choosing therapies to reduce blood loss. A gynecologist will also work with an internist (hematologist) in treating iron deficiency anemia. Keywords: anemia syndrome, iron deficiency anemia, abnormal uterine bleeding, ferric hydroxide polymaltose complex.