Etiology Of Iron Deficiency Anemia Research Articles

Intravenous iron infusions in pediatric patients: A retrospective review of efficacy and safety.

Pediatric iron deficiency anemia (IDA) is often treated with oral iron supplementation as the first-line therapy despite poor adherence. This single-institution retrospective chart review of pediatric patients was conducted to assess the safety, efficacy, and adherence of intravenous (IV) iron infusions compared to oral iron therapy in patients who had failed a trial of oral iron supplementation. We reviewed medical records of patients aged 1-21 with IDA who received at least one IV iron infusion at Cooper University Hospital between 2016 and 2021. Paired t-tests compared pre-infusion and post-infusion hematologic indices of hemoglobin (Hgb), mean corpuscular volume, red blood cell count, red cell distribution width, ferritin, total iron binding capacity, iron stores, and iron saturation. We compared adherence and adverse reactions to both oral iron supplementation and IV iron infusions using McNemar's test. A total of 107 subjects were included (mean age of 12.7 years). Hgb, ferritin, iron, and iron saturation between pre-infusion and post-final infusion significantly improved (p < 0.001). Hgb, ferritin, and iron improved when subcategorizing by race and etiology of IDA. Adherence to IV iron infusions (70.1%) was significantly greater than adherence to oral iron therapy (43.0%). There were also significantly fewer adverse effects with IV iron infusions (3.7%) compared to oral iron (77.9%). We demonstrated the safety, efficacy, and improved adherence of IV iron infusions compared to oral iron supplementation for treatment of pediatric IDA in patients who were unable to tolerate oral iron supplementation. Future studies could compare adherence to multiple doses of IV iron infusions in contrast with other single-dosing IV iron formulations.

Navigating Diagnostic Challenges: Chronic Anemia Leading to the Diagnosis of Gastric Antral Vascular Ectasia (GAVE) in the Absence of Typical Symptoms

Gastric antral vascular ectasia (GAVE) is a rare acquired vascular dysplasia usually associated with portal hypertension or CREST syndrome. Here we present a case of a 62-year-old female with no significant related comorbidities who presented to our clinic due to severe acute on chronic anemia. On initial review of systems, the only complaint the patient had was fatigue, shortness of breath and being lightheaded. Patient denied hematochezia or melena, no hematemesis or other gastrointestinal complaints, no history of NSAIDs or aspirin use. Initial labs were significant for iron-deficiency anemia with hemoglobin of 8.5 g/ dL. Recent colonoscopy was non diagnostic for the cause of anemia as well. Due to unrevealing previous workup patient was referred to gastroenterologist and undergone esophagogastroduodenoscopy (EGD) with findings of ecstatic vessels in stomach antrum suggestive of GAVE, successfully treated with argon plasma coagulation. Total in a span of 4 years due to recurrence of anemia patient required 3 EGDs, while GAVE was successfully treated each time with argon plasma coagulation. Due to absence of gastrointestinal (GI) complaints patient was recommended to have regular laboratory workup to monitor for silent blood loss. This atypical presentation of upper GI bleeding warrants physicians to refer patients to gastroenterologists to perform EGD for further evaluation and treatment in cases of unknown etiology of iron deficiency anemia even in the absence of gastrointestinal (GI) complaints and non-revealing previous GI workup with colonoscopy

Causes of Iron Deficiency Anemia in Children Less Than 12 Years Old at Cooper University Hospital and Their Response to Intravenous Iron Replacement

Title of project: Causes of iron deficiency anemia in children less than 12 years old at Cooper University Hospital and their response to intravenous iron Background: Iron deficiency anemia (IDA) is the most common type of anemia in children. Even among industrialized countries like the US, IDA affects many children. Serious adverse outcomes can occur in children with IDA including, cognitive and motor neurodevelopmental delays which may be irreversible. While poor oral intake tends to be the focus of screening and preventative measures, additional causes of IDA include malabsorption from gastrointestinal abnormalities, medications that decrease iron absorption, parasitosis, genitourinary loss, and blood loss. Menorrhagia is a common cause of IDA among adolescents. The average age of menarche for adolescent girls is 12.43 years. Therefore, on data evaluation for the cause of IDA among patients aged 1-21, menstrual bleeding was overrepresented. Objective: This sub-analysis of a single center retrospective chart review analyzed the causes of IDA among children less than 12 years of age at Cooper University Hospital and their response to intravenous iron treatment. Methods: Data on all patients 1-12 years old who received intravenous iron infusions at Cooper University Hospital for IDA between 2016 and 2021 was analyzed. Descriptive statistics on the etiology of IDA and paired t-tests comparing pre-infusion hematologic parameters (hemoglobin, RDW, RBC, MCV, iron, ferritin, TIBC, percent saturation) to post-infusion values were conducted. Results: From the 150 patients included in the original study, 26 patients were 12 years of age or younger. The causes of IDA among these patients included inadequate dietary intake (65.4%), inflammatory bowel disease (15.4%), menorrhagia (15.4%) and one patient with factor II deficiency (3.8%). These patients required between one to eleven infusions to return to normal lab values. When comparing pre-infusion to post-final infusion lab values, there was significant improvement in all values (ferritin, iron, hemoglobin, MCV and RBCs) except total iron binding capacity, RDW and percent saturation. Discussion: Inadequate dietary intake was the most common cause of IDA in children less that 12 years old treated at Cooper University Hospital. Other causes included inflammatory bowel disease, menorrhagia and factor II deficiency. In contrast, the most common cause of IDA in children 12 and older was menorrhagia. Childhood food insecurity has been linked to IDA among low-income patients in the United States. Despite food assistance programs and adequate dietary education, patients continue to remain iron deficient. The current first-line therapy at Cooper University Hospital is oral iron supplementation. However, many patients fail the oral iron trial due to non-adherence, children spitting up or refusing to take the medication, and gastrointestinal side effects. Many pediatric patients in our clinic population are on NJ state insurance which requires a failed oral iron therapy trial prior to qualifying for coverage of intravenous iron. Yet, in a previous retrospective study completed in our clinic, intravenous iron has proven to be effective and safe, with fewer side effects and better adherence. For many patients, especially infants and toddlers, intravenous iron may provide a quicker cure for IDA, preventing irreversible neurodevelopmental delays. We propose that treatment with oral iron and intravenous iron should both be considered for first-line therapies and should be a shared decision between parents and providers.

Fluxograma para diagnóstico precoce, tratamento e monitorização da deficiência de ferro na criança

Iron deficiency anemia is defined as a hemoglobin concentration less than a second standard deviation from the distribution mean for a population of the same sex and age. It is the last event in a progression of negative iron balance, with the stages: negative balance, iron deficiency, and iron deficiency anemia. It is the most common hematologic alteration in the world, especially in developing countries. The main source of iron in the body comes from the red blood cell recycling system, while a smaller portion comes from the diet. Despite this, nutritional deficiency is the main etiology of iron deficiency anemia and iron deficiency in childhood. Iron is essential for several physiological functions and its deficiency, especially in childhood, can compromise mental and physical development. Clinical manifestations usually become detectable in severe deficiency. For this reason, the early diagnosis of iron deficiency is through laboratory tests. It should be performed through screening at 12 months of life. Treatment should be started promptly after diagnosis. Diet is of little value in correcting iron owing to the low bioavailability of iron in most foods. However, preparations containing iron are easily absorbed by the body. Given the severity of this condition, treatment should be monitored using laboratory parameters. This study aims to develop a protocol for screening and monitoring the treatment of iron deficiency anemia to systematize and organize care, bringing better results for the childs development.

FLUXOGRAMA PARA DIAGNÓSTICO PRECOCE, TRATAMENTO E MONITORIZAÇÃO DA DEFICIÊNCIA DE FERRO NA CRIANÇA

Iron deficiency anemia is defined as a hemoglobin concentration less than a second standard deviation from the distribution mean for a population of the same sex and age. It is the last event in a progression of negative iron balance, with the stages: negative balance, iron deficiency, and iron deficiency anemia. It is the most common hematologic alteration in the world, especially in developing countries. The main source of iron in the body comes from the red blood cell recycling system, while a smaller portion comes from the diet. Despite this, nutritional deficiency is the main etiology of iron deficiency anemia and iron deficiency in childhood. Iron is essential for several physiological functions and its deficiency, especially in childhood, can compromise mental and physical development. Clinical manifestations usually become detectable in severe deficiency. For this reason, the early diagnosis of iron deficiency is through laboratory tests. It should be performed through screening at 12 months of life. Treatment should be started promptly after diagnosis. Diet is of little value in correcting iron owing to the low bioavailability of iron in most foods. However, preparations containing iron are easily absorbed by the body. Given the severity of this condition, treatment should be monitored using laboratory parameters. This study aims to develop a protocol for screening and monitoring the treatment of iron deficiency anemia to systematize and organize care, bringing better results for the childs development.

S2435 A Rare Case of Plummer-Vinson Syndrome Treated With Pneumatic Dilations and Iron Supplementation

Introduction: Plummer-Vinson Syndrome (PVS), also known as Paterson-Kelly syndrome, presents with a classic triad of dysphagia, iron-deficiency anemia and esophageal webs. Although this triad of disease is increasingly less prevalent, early detection and intervention are imperative to reduce mortality given increased risk of malignant transformation.1 Case Description/Methods: A 22-year-old female with a history of iron deficiency anemia presented to the emergency department with syncope in the setting of palpitations and dyspnea. The patient endorsed alarm symptoms including hematochezia over the past 6 weeks, 20-lb unintentional weight loss and dysphagia. Initial labs were remarkable for a hemoglobin of 11.1 g/dL, and microcytic indices, with an MCV of 72.4 fL. The patient underwent esophagogastroduodenoscopy (EGD) to investigate the etiology of iron deficiency anemia. EGD revealed a prominent esophageal web (Figure A) in the proximal esophagus with associated erythema and mucosal friability. Significant narrowing impeded safe passage of the endoscope and thus serial pneumatic dilations to 10 mm were performed. Following pneumatic dilation, the endoscope was successfully advanced beyond the web (Figure B) to the gastroesophageal junction. The patient tolerated the procedure well and had immediate resolution of dysphagia following EGD with pneumatic dilation. She was then continued on iron supplementation as previously prescribed at discharge. Discussion: Plummer-Vinson Syndrome comprises the pathological triad of dysphagia, esophageal web, and iron deficiency anemia. Other signs and symptoms can include glossitis, angular cheilitis, and koilonychia. The decreased incidence of this syndrome parallels the decreased prevalence of iron deficiency in the developed world. Iron deficiency induces an iron-dependent enzyme dysfunction which causes oxidative stress, mucosal DNA damage and ultimately potentiates the formation of esophageal webs. 2 Without intervention, patients with this syndrome may develop absolute dysphagia, aspiration pneumonia and other complications. Due to increased risk of malignancy, surveillance EGDs are necessary to screen for esophageal carcinoma in patients with PVS.Figure 1.: Esophageal Web pre dilation (a) and post dilation (b).

The Relevance of Helicobacter pylori Infection to Iron Deficiency Anemia in Duhok City

Background:Helicobacter pylori (H. pylori) infection had been criticized for many deleterious effects and had been amalgamated to iron deficiency by many authors, frequently based on correlative rather than direct relationship studies and often opposed by others. Objective: To evaluate the role of H. pylori infection in the etiology of iron deficiency anemia and to study the impact of the bacterial eradication on the response to iron therapy. Methods:The current study represents an interventional prospective study and involved 52 non-pregnant females with iron deficiency anemia. All patients were tested for the presence of active H. pylori infection by stool antigen test and they followed after one month of iron therapy. Patients with positive H. pylori infection followed for another month after eradication of H. pylori and iron therapy. Results: Fifteen patients (28.85%) were positive for H. pylori. Hematological and biochemical data were not different among both groups (H. pylori positive and negative) at presentation despite significant better response among H. pylori negative individuals. Continuation of iron therapy after eradication of H. pylori infection improve the response to therapy significantly. Conclusion: Eradication of H. pylori enhances the response to iron therapy significantly. Keywords: Iron deficiency anemia, H. pylori, iron therapy, eradication Citation: Eissa AA, Mirza SS. The relevance of Helicobacter pylori Infection to iron deficiency anemia in Duhok City. Iraqi JMS. 2021; 19(1): 33-38. doi: 10.22578/IJMS.19.1.5

Gastrointestinal Endoscopic Outcome in Late Adolescent Women With Iron-Deficiency Anemia in Basrah-Iraq: A Multicenter Study.

BackgroundIron deficiency anemia (IDA) in late adolescent women has multiple pathophysiologies. Silent blood loss, celiac disease (CD), malignancies, and other gastrointestinal (GI) lesions receive much attention during IDA management. There is no consensus about endoscopic screening. Our study evaluates factors affecting GI endoscopic diagnosis for the etiology of IDA in late adolescent women.Materials and MethodsWe conducted an observational, multicenter retrospective analysis of 192 adolescent women with IDA admitted for GI endoscopic diagnosis from 2006 to 2016. Baseline measurements included hemoglobin, serum ferritin, mean corpuscular volume, serum iron, total iron-binding capacity, and transferrin saturation. We collected demographic characteristics, duration of hospital stay, the degree of severity of anemia, and endoscopic findings.ResultsThe mean age was 19±1 years (range 17 to 21 years), with mildly to moderately severe IDA. Patients received esophagogastroduodenoscopy (EGD, n=178) or colonoscopy (n=14). The mean hospital stay was 2.0±1.0 days. We found negative endoscopies (n=74), CD (n=85), gastric ulcer (n=19), malignancy (n=2), inflammatory bowel disease (n=1), and other nonsignificant endoscopic findings (n=11). We found no correlation between the duration of the hospital stay with the severity of IDA, no significant association between GI symptoms of the patients with endoscopic findings, and a significant but weak association between GI symptoms and serum ferritin.ConclusionsIn late adolescent women with IDA who have significant GI endoscopic lesions, the GI symptoms are of limited value in guiding the endoscopic diagnostic approach for evaluation of IDA.

2985 Low Diagnostic Yield of Routine Duodenal Biopsies in Asymptomatic Patients With Iron Deficiency Anemia

INTRODUCTION: It is estimated that 1.6 billion people worldwide are anemic. Iron deficiency anemia (IDA) is the most common form of anemia worldwide. In adults without an obvious source of blood loss, the explanation for IDA is generally thought to be due to chronic gastrointestinal blood loss. Current guidelines recommend performing both upper and lower endoscopies for patients with iron deficiency anemia. Duodenal biopsies are routinely performed to evaluate for celiac sprue as the etiology of IDA. The primary aim of this study is to determine the diagnostic yield of routine duodenal biopsies performed for investigation of asymptomatic patients with iron deficiency anemia (without malabsorption symptoms). METHODS: A retrospective chart review was performed of patients undergoing esophagogastroduodenoscopy (EGD) with duodenal biopsy as work up of IDA. All duodenal biopsies were performed from January 2011 through April 2019 at an academic tertiary referral center. Inclusion criteria was ferritin ≤45 ng/mL within 1 year prior to EGD. If ferritin data was unavailable, physician records were reviewed for diagnosis of iron deficiency anemia in patients who had proven serum MCV &lt; 80 um3 within 1 year prior to EGD. Data was collected for asymptomatic patients, N = 250. Charts were reviewed and patients with malabsorption symptoms such as abdominal pain, weight loss, diarrhea, and bloating were excluded. In addition, patients with rectal bleeding, history of IBD, gastrointestinal cancer, lymphoma or abdominal surgery leading to malabsorption were also excluded. A diagnosis of celiac disease was defined as a Marsh type 2 or greater on tissue biopsy. RESULTS: The median age of patients was 60.6 ± 14.1 of whom 43% were female. A total of 59% of cases were Caucasian, 19% were Hispanic, 8% African American, 8% Asian and 9% other. The mean of Hgb was 9.2 ± 1.9 gm/dL, MCV, 76.4 ± 8.0% and ferritin, 21.7 ± 38.7 um3. Of the sample, 25% had DM2, 20% had CAD, 14% had CKD, 12% had atrial fibrillation and 6% had cirrhosis. The overall diagnostic yield of the duodenal biopsies was 0.4% in asymptomatic patients. CONCLUSION: These results suggest that performing routine duodenal biopsies for celiac disease in patients with IDA is low yield in asymptomatic patients. Further studies are needed to characterize which patients with IDA would benefit from a duodenal biopsy for diagnosis of celiac disease.

Potensi Scopoletin sebagai Agonis Reseptor Transferin 2 untuk Pengembangan Terapi Anemia Defisiensi Besi

&lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: Iron Deficiency Anemia (IDA) is caused by imbalance between iron intake and iron loss in blood circulation. Increased hepcidin level plays an important role in the etiology of IDA. Normally, expression of hepcidin protein is controlled by three different pathways, one of them is interaction between holo Transferin (Holo-Tf) and Transferrin Receptor 2 (TfR-2). Recently, Indonesian herbal plants have widely been used as herbal medicine but there is no active compound that can activate TfR-2 for IDA therapy. The aim of this study was to explore phytochemicals derived from Indonesian herbal plants to interact with TfR-2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was a bioinformatics study with a molecular docking method. The SWISS-MODEL software was used to make TfR-2 protein modeling because the molecular structure of TfR-2 remains unknown. Holo-Tf was used as a standard ligand and obtained from Protein Data Bank with PDB ID 1SUV. All Indonesian phytochemicals which (1) registered at HerbalDB (2) had a three-dimensional molecular structure at PubChem (3) met Lipinski’s Rule of Five criteria were used in this study. AutoDock Vina 1.1.2 was used to analyze the binding affinity which was in kcal/mol. Phytochemical-TfR-2 binding complexes were visualized by using Chimera 1.10rc and or Pymol 1.7.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;The docking scores of holo-Tf modification with TfR-2 were -6,4±0,1 kcal/mol at Arg466 and -3,4±0,1 kcal/mol at Arg689 respectively. Interaction of modification holo-Tf and TfR-2 was observed not only at Arg466 and Arg689 but also with Asp642 and Ile682. Docking scores of scopoletin were -7,1±0,1 kcal/mol at Arg466 and -5,4±0,1 kcal/mol at Arg689. Scopoletin could interact with TfR-2 at Arg466, Arg689, and Leu630 residues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Computationally, scopoletin is a potential TfR-2 agonist. In future studies, in vitro assay will be used to evaluate the agonist effect of scopoletin in TfR-2.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Iron deficiency anemia referral to the hematologist. Real-world data from Mexico: the need for targeted teaching in primary care

ABSTRACT Objectives: To determine the referral patterns and etiology of iron deficiency anemia (IDA) at an academic hematology center in northeast Mexico. Methods: We included all consecutive outpatients older than 16 years, non-pregnant, with IDA diagnosed in the Hematology Service of the Dr. José E. González University Hospital between January 2012 and May 2017. Appropriate data were collected retrospectively from the electronic medical record. Data regarding first medical contact (primary care physician or hematologist) were compared. Results: One hundred fifty-three patients were included in this study. The median age was 43 years (interquartile range, 35–51) and 85.6% were female; 128 (83.7%) patients were seen by a primary care physician before our evaluation. Abnormal uterine bleeding (AUB) was the cause of IDA in 76 patients (49.6%), gastrointestinal bleeding (GIB) in 31 (20.2%), H. pylori infection in 12 (7.8%), urinary tract bleeding in three (1.9%) and malabsorption-syndrome in two (1.3%). The etiology remained unknown in 29 (18.9%). The p value was <0.05 between groups according to the first medical contact, including frequency of at least one sign or symptom of IDA, previous use of iron supplementation and blood transfusion, comorbidities, complete blood count at diagnosis, and resolution rates of anemia. Conclusion: The majority of our IDA patients were referred by another physician. Nearly half of the patients with IDA had AUB. IDA remains a diagnostic challenge for first contact physicians requiring a targeted educational intervention to improve IDA awareness and diagnostic skills.

Iron Deficiency Anemia: A profile of a tertiary care hospital

Background and aim: Iron deficiency refers to the reduction of iron stores that precedes overt iron deficiency anemia. Iron deficiency anemia (IDA) is the commonest nutritional deficiency around the globe. Though etiology of IDA is multifaceted, and results from the iron demands which is not met by iron absorption in the body, regardless of the reason. This study was aimed to observe the several hematologic parameters among IDA cases presented to a tertiary level referral hospital of Nepal army.Methods: This prospective hospital based study was conducted among cases of iron deficiency anemia presented to a hematology clinic for six-month duration. With the help of semi-structured questionnaire demographic variables, presenting complaints, baseline laboratory parameters, iron profile and etiology of iron deficiency anemia were recorded. The collected data were entered in SPSS version 22 and analyzed.Results: In the six-month study period, there were 175 IDA cases who presented to hematology clinic. IDA was more common in females accounting 78% of 175 cases while rest were male. Mean value of parameters of iron profile were all significantly lower than normal range except TIBC which was significantly raised clinching the diagnosis of IDA. Weakness was the commonest mode of presentation (83, 47.4%). Poor intake was the main culprit of IDA (88, 50.3%). Most of the cases (82, 46.9%) belonged to moderate anemia group. Severity of anemia was associated with platelet count and total leucocyte count (p&lt;0.05) while it was not associated with iron profile values (p&gt;0.05).Conclusion: In adult group, IDA is more common in women and non-specific symptoms like weakness is the commonest mode of presentation. Poor dietary intake is the main cause of IDA in our context. Among IDA cases, most of them belonged to moderate anemia.

Inverted Meckel's Diverticulum in Adult Presented with Iron Deficiency Anemia and Caused Intussusception But Not Obstruction: Case Report

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract that seen in the 1-2% of the population. However it is often asymptomatic it may present with hemorrhage, intestinal obstruction, intussusceptions or inflammation. Inverted MD, where MD literally inverts on itself, is an uncommon condition underlying pathophysiology has not been explained fully. It may cause obstruction or occult bleeding due to the intussusception. We presented a case of 52-year-old male which inverted MD causing ileoileal intussusception without any symptoms of obstruction or abdominal pain detected while investigating the etiology of iron deficiency anemia. Inverted Meckel's diverticulum should be suspected in adult patients with iron deficiency anemia even if abdominal symptoms does not accompany.

Iron Deficiency Anemia in Infants and Young Children

The etiology of iron deficiency anemia (IDA) in infancy (9-24 months) are diet, parasite, blood loss and Helicobacter pylori. Diet is the most common etiology of IDA in infancy. If infant with breastfeeding beyond 6 months of life is premature, low birth weight and twin, the risk of IDA will increase. Hookworm infestation could be an etiology in some underdeveloped countries. Blood loss could be caused by hospitalization (blood sampling especially in premature newborn), diet-related (exposure to a heat-labile protein in whole cow’s milk), and lesion of gastrointestinal tract. The diagnosis of IDA is simple (a hemoglobin level <11 g/dL and serum ferritin <12 g/L). But most of the patients we encounter have acute infections (respiratory infections, urinary tract infection and acute otitis media etc) at sampling time. Because ferritin is an acute phase reactant, the level of ferritin cannot stand true iron status in an acutely infected infant. We recommend two methods to help differentiate pure IDA and anemia of inflammation. One is to check ratio of transferrin receptor and ferritin. The other is to check ferritin after CRP is normalized. Because the international marriage increases, thalassemia is also included in differential diagnosis of microcytic anemia of infant. pISSN 2233-5250 / eISSN 2233-4580 http://dx.doi.org/10.15264/cpho.2014.21.2.47 Clin Pediatr Hematol Oncol 2014;21:47∼51

Dramatic and prompt efficacy of Helicobacter pylori eradication in the treatment of severe refractory iron deficiency anemia in adults

Dear Editor, Iron deficiency anemia (IDA) is one of the most common nutritional diseases worldwide. The basic treatment for IDA is oral iron medication; however, some patients with IDA are occasionally refractory to this type of therapy [1]. Recently, the role of Helicobacter pylori in the etiology of IDA has become a focus of considerable interest [2, 3]. Although the association of H. pylori with IDA has been examined extensively, most studies have focused on mild IDA in school-aged children and young people [4–6]. Here, we report two adult cases of severe IDA refractory to oral iron therapy in which the anemia was dramatically and promptly improved by H. pylori eradication (Fig. 1).

Anemia ferropénica en el deporte e intervenciones dietético-nutricionales preventivas

La anemia ferropénica en los deportistas es una afección muy frecuente que conduce a un menor rendimiento físico. Los deportistas son susceptibles al descenso de los depósitos de hierro, fundamentalmente por un incremento en su utilización, por su pérdida, o por una ingesta insuficiente. El presente artículo pretende revisar la literatura científica respecto a: qué deportes-deportistas tienen mayor riesgo de padecer anemia, la etiología de la anemia ferropénica en el colectivo deportivo, además de sugerir pautas dietético-nutricionales para su prevención. Las bases de datos consultadas fueron: Pubmed, Scirus y Scielo, así como las páginas oficiales de organizaciones de reconocido prestigio; recuperando artículos mediante las palabras clave: “iron-deficiency anaemia”, “sports”, “athletic performance”, “iron intake” o sus homólogos españoles. La anemia ferropénica afecta principalmente a deportistas de resistencia (especialmente mujeres y maratonianos), así como a los integrantes de deportes de equipo con alto impacto (voleibol y balonmano). Las anemias suelen ser secundarias a hemólisis y estrés oxidativo derivados de la práctica del deporte, pero también se han documentado casos por aumento de las pérdidas de hierro asociadas a la práctica de ejercicio. Las pautas dietético-nutricionales para prevenir la anemia ferropénica en el deportista deberían ir encaminadas a asegurar: una ingesta de hidratos de carbono entre el 60-65% de la energía total diaria, una ingesta mínima de 1,4 g de proteína al día y un consumo de 20-40 mg de hierro por día y separando su ingesta de los principales inhibidores de su absorción (fitatos, tanatos y calcio). Es necesario valorar mediante analíticas el estado de hierro del deportista cada 2-3 meses.

A Case of Acute Phosphate Nephropathy after Colonoscopy

Acute phosphate nephropathy is a form of acute kidney injury (AKI) due to oral sodium phosphate (ONaP) purgatives used for bowel cleansing before colonoscopy. Usually, 45 ml ONaP is given two times daily 12-24 hours prior to colonoscopy. Intestinal absorption is followed by transient hypocalcemia and hyperphosphatemia in almost all patients. In addition, severe hyperphosphatemia, symptomatic hypocalcemia, hypernatremia, hypocalcemia, hyponatremia, hypokalemia, high anion gap metabolic acidosis and AKI can be seen. The patient presented in this paper is a 65-year-old female. She was diagnosed with type 2 diabetes mellitus and hypertension. Colonoscopy was performed in order to investigate the etiology of iron deficiency anemia. ONaP was administered for preparation of colonoscopy and AKI which was clinically compatible with APN developed after the procedure. KEY wORdS: Acute phosphate nephropathy, Colonoscopy, Oral sodium phosphate doi: 10.5262/tndt.2013.1001.19 Yazisma Adresi: omer Celal ElCIOglu Saglik Bakanligi Istanbul Medeniyet Universitesi, Goztepe Egitim ve Arastirma Hastanesi, Nefroloji, Bilim Dali, Istanbul, Turkiye Tel : 0 212 570 92 87 E-posta : o.c.elcioglu@gmail.com Gelis Tarihi : 09.07.2012 Kabul Tarihi : 05.08.2012 dir. Ayrica ciddi hiperfosfatemi, semptomatik hipokalsemi, hipernatremi, semptomatik hiponatremi; hipokalemi, yuksek anyon acikli metabolik asidoz ve ABH gorulebilmektedir. Bu yazida ONaP ile kolonoskopi hazirligi yapildiktan sonra ABH gelismis bir

Incidence of Small Intestinal Lesions in Patients with Iron Deficiency Anemia

A major etiology of iron deficiency anemia (IDA) is chronic blood loss from the gastrointestinal tract or gynecological organs. The impact of small intestinal lesions on IDA is as yet unclear. The aim of the present study was to estimate the incidence of small intestinal lesions in patients with IDA and elucidate the pathogenic nature of small intestinal mucosal abnormalities for IDA. Between January 2007 and October 2008, a total of 30 IDA patients (hemoglobin (Hb) <13.5g/dL for all men and post-menopausal women, Hb <11.0g/dL for pre-menopausal women) without any bleeding sources detected by upper and lower endoscopy were enrolled. All patients underwent CE. The Given Imaging Ltd. database containing 61 healthy volunteers was used as a control. The prevalence of small intestinal lesions was compared. The prevalence of significant lesions including angioectasias, tumors and erosions was higher in patients with IDA than controls (46% vs. 15%, p<0.01). Multivariate analysis showed that IDA was related to significant lesions in the small intestine (OR: 4.7, 95%CI: 1.1-21.3, p=0.04). Subjects with iron deficiency anemia after negative work-up on the bleeding source by conventional upper and lower endoscopies should undergo capsule endoscopy.

Efeito da duração da amamentação exclusiva e mista sobre os níveis de hemoglobina nos primeiros seis meses de vida: um estudo de seguimento

This six-month follow-up study aimed to assessing the effect of length of both exclusive breastfeeding and mixed feeding on hemoglobin levels in 150 infants born at the Mutuípe maternity facility in Bahia State, Brazil. Blood tests were performed monthly to assess the hemoglobin levels, at which time data were gathered on food intake. Obstetric and socioeconomic data were also collected. The linear mixed effects model was used to investigate the target associations. Loss to follow-up was 15.3%, and anemia prevalence was 71.7%. An increase of 0.091 g/dL (p = 0.031) in hemoglobin levels was found for each month of exclusive breastfeeding, while a decrease of 0.097 g/dL (p = 0.017) was shown for each month of mixed feeding. In conclusion, inadequate food practices appear to be directly involved in the etiology of iron deficiency anemia during infancy.

Hookworm control as a strategy to prevent iron deficiency.

The hookworms Necator americanus and Ancylostoma duodenale infect approximately 1 billion people worldwide. The prevalence of hookworm infection increases with age in children, typically reaching a plateau in late adolescence, whereas the intensity of infection may continue to increase throughout adulthood. Hookworms cause intestinal blood loss in amounts proportional to the number of adult worms in the gut. The relationship between hookworm infection intensity and hemoglobin concentration is evident in epidemiologic studies, but may be apparent only above a threshold worm burden that is related to the iron stores of the population. Current hookworm control efforts are focused on reducing infection load and transmission potential through periodic anthelminthic chemotherapy. Several controlled trials have demonstrated a positive impact of anthelminthic treatment on hemoglobin levels, with best results obtained in settings where iron intakes were also increased. Evidence suggests that anthelminthic programs will have modest impacts on iron deficiency anemia in the short term, with greater impacts on more severe anemia. Hookworms are an important cause of anemia in women, who are often overlooked by current helminth control programs. Current WHO recommendations for use of anthelminthics in schoolchildren and women are reviewed. There is a need to clarify whether hookworms are an important etiology of iron deficiency anemia in preschool children.