Hemoglobin Iron Research Articles

Hubungan Lama Menstruasi dan Konsumsi Zat Besi dengan Kadar Hemoglobin pada Remaja Putri

Iron nutrient anemia in adolescents can harm health. The purpose of this study was to determine the relationship between menstrual periods and iron consumption with hemoglobin levels in young women at SMP Negeri 19 Kota Bengkulu. This study uses a cross-sectional design. The sampling technique was a purposive sampling of 44 young women. Primary data collection is obtained by measuring the hemoglobin values taken using the Easy Touch GCHb tool, menstrual time taken by questionnaire, and knowing daily iron consumption by direct interview using the Semi-FFQ form, while secondary data is obtained by name, class, age, and the total number of young women in SMP Negeri 19 Kota Bengkulu. The test used in this study is the Pearson correlation test. The results showed that the average menstrual period was 7.7 days, the average yield of iron consumption was 8.14mg/day, and the average yield on hemoglobin levels was 11.70g/dl. The test results of the relationship between menstrual periods and hemoglobin levels obtained p value=0.005 with r=-0.417 shows that the strength of a moderate and negative pattern of relationship means that the greater the duration of menstruation, the smaller the hemoglobin level, and there is a relationship between iron consumption and hemoglobin levels obtained p-value=0,000 with r=0.665 shows that the strength of a strong relationship and positive pattern means that the greater the consumption of iron, the greater the hemoglobin level. There is a relationship between the duration of menstruation and hemoglobin levels, iron consumption, and hemoglobin levels.

EVALUATION OF CLINICAL FEATURES AND RISK FACTORS AFFECTING BLEEDING IN PATIENTS WITH GASTROINTESTINAL ANGIODYSPLASIA

AIM: The aim of the study was to evaluate the clinical features and risk factors affecting bleeding in patients with angiodysplasia.
 MATERIA L AND METHOD: This retrospective study was conducted between January 2016 and December 2019, and included patients who underwent endoscopy/colonoscopy examination for any reason at two institutions (n=2177). Patients with angiodysplasia were divided into two groups according to their bleeding status, and their clinical features and risk factors affecting bleeding were analyzed.
 RESULTS: Angiodysplasia was detected in 44 (2.02%) patients who underwent endoscopy and colonoscopy. Bleeding was detected in 25% (n=11) of patients with angiodysplasia. Warfarin use frequency (p=0.016) and heart disease frequency (p=0.008) were higher in patients with angiodysplasia with bleeding. Hemoglobin (p=0.001), hematocrit (p < 0.001), platelet levels (p=0.009) and total iron binding capacity (p=0.036) were found to be significantly lower in patients with bleeding angiodysplasia. It was found that patients using warfarin had a 12.917-fold higher risk of bleeding than nonusers (OR:12.917, 95%CI: 2.014-82.830, p=0.007). Bleeding was not associated with age (p=0.196), gender (p=0.326), number of lesions (p=0.063), gastric lesion (p=0.880), duodenal lesion (p=0.472), colonic lesion (p=0.947), size of lesion (p=0.789), nonsteroidal anti-inflammatory drugs use (p=0.631), hypertension (p=0.163), cirrhosis (p=0.179), coronary artery disease (p=0.448) and heart diseases (p=0.207).
 CONCLUSION: The use of warfarin increases the risk of bleeding in patients with gastrointestinal angiodysplasia. Risk factors affecting bleeding in patients with gastrointestinal angiodysplasia need to be evaluated in comprehensive prospective studies.

The association between iron deficiency anemia and obesity in children

Objectives: To examine the association between obesity and iron status and the presence of iron deficiency anemia in children. Methods: This case-control study included 100 children between 2-14 years of age who were divided into two age- and sex- matched equal groups of 50 children each. Children with a body mass index (BMI) greater than or equal to 95th centile were categorized as obese while the other 50 children with a BMI greater than or equal to 5th centile but less than 95th centile were considered the normal weight group. Children with cardiac disease, liver disease, chronic gastrointestinal disease and chronic hematologic disorders except iron deficiency (with or without anemia) and those taking Vitamin or mineral supplements regularly during the previous year were excluded. Each participant was sent for serum iron, ferritin, total iron binding capacity (TIBC), transferrin saturation TS and complete blood count. Iron deficiency is defined as Transferrin Saturation (TS) lower than 16% and IDA is defined as TS lower than 16% and hemoglobin (Hb) concentration lower than 120 g/l or 12 mg/dl for children. The data were analyzed using SPSS-23 software and for all data normal distribution was tested so that P-value<0.05 is the level of threshold for statistical significance. Results: The gender distribution between the both group is reversed with male being more common in obese group but no statistical difference. The age distribution shows dominance of the age group 5-10 years in the both group with some differences which are of no statistical significance (P=0.294). The values of Hemoglobin, serum iron, serum ferritin, total iron binding capacity and transferrin saturation are obviously similar between the both genders of the whole study population with no statistically significant differences (P=0.084, 0.469, 0.48,0.4, 0.571 respectively). Obese children have higher level of Hemoglobin(P=0.069), Ferritin(P=0.5) and total iron binding capacity(P=0.449) but lower levels of serum iron (P =0.234) and transferrin saturation(P=0.45) but with no statistical significance. Conclusion: There is no significant association between obesity and iron status and the presence of iron deficiency anemia despite a lower level of serum iron and lower transferrin saturation in obese than normal weight children.

The Associations of Iron Related Biomarkers with Risk, Clinical Severity and Mortality in SARS-CoV-2 Patients: A Meta-Analysis.

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly around the world and has led to millions of infections and deaths. Growing evidence indicates that iron metabolism is associated with COVID-19 progression, and iron-related biomarkers have great potential for detecting these diseases. However, the results of previous studies are conflicting, and there is not consistent numerical magnitude relationship between those biomarkers and COVID-19. Thereby, we aimed to integrate the results of current studies and to further explore their relationships through a meta-analysis. We searched peer-reviewed literature in PubMed, Scopus and Web of Science up to 31 May 2022. A random effects model was used for pooling standard mean difference (SMD) and the calculation of the corresponding 95% confidence interval (CI). I2 was used to evaluate heterogeneity among studies. A total of 72 eligible articles were included in the meta-analysis. It was found that the ferritin levels of patients increased with the severity of the disease, whereas their serum iron levels and hemoglobin levels showed opposite trends. In addition, non-survivors had higher ferritin levels (SMD (95%CI): 1.121 (0.854, 1.388); Z = 8.22 p for Z < 0.001; I2 = 95.7%, p for I2 < 0.001), lower serum iron levels (SMD (95%CI): −0.483 (−0.597, −0.368), Z = 8.27, p for Z < 0.001; I2 = 0.9%, p for I2 =0.423) and significantly lower TIBC levels (SMD (95%CI): −0.612 (−0.900, −0.324), Z = 4.16, p for Z < 0.001; I2 = 71%, p for I2 = 0.016) than survivors. This meta-analysis demonstrates that ferritin, serum iron, hemoglobin and total iron banding capacity (TIBC) levels are strongly associated with the risk, severity and mortality of COVID-19, providing strong evidence for their potential in predicting disease occurrence and progression.

Glycochenodeoxycholate Affects Iron Homeostasis via Up-Regulating Hepcidin Expression.

Increasing hepcidin expression is a vital factor in iron homeostasis imbalance among patients with chronic kidney disease (CKD). Recent studies have elucidated that abnormal serum steroid levels might cause the elevation of hepcidin. Glycochenodeoxycholate (GCDCA), a steroid, is significantly elevated in patients with CKD. However, the correlation between GCDCA and hepcidin has not been elucidated. Decreased serum iron levels and increased hepcidin levels were both detected in patients with CKD in this study. Additionally, the concentrations of GCDCA in nephropathy patients were found to be higher than those in healthy subjects. HepG2 cells were used to investigate the effect of GCDCA on hepcidin in vitro. The results showed that hepcidin expression increased by nearly two-fold against control under 200 μM GCDCA treatment. The phosphorylation of SMAD1/5/8 increased remarkably, while STAT3 and CREBH remained unchanged. GCDCA triggered the expression of farnesoid X receptor (FXR), followed with the transcription and expression of both BMP6 and ALK3 (upward regulators of SMAD1/5/8). Thus, GCDCA is a potential regulator for hepcidin, which possibly acts by triggering FXR and the BMP6/ALK3-SMAD signaling pathway. Furthermore, 40 C57/BL6 mice were treated with 100 mg/kg/d, 200 mg/kg/d, and 300 mg/kg/d GCDCA to investigate its effect on hepcidin in vivo. The serum level of hepcidin increased in mice treated with 200 mg/kg/d and 300 mg/kg/d GCDCA, while hemoglobin and serum iron levels decreased. Similarly, the FXR-mediated SMAD signaling pathway was also responsible for activating hepcidin in liver. Overall, it was concluded that GCDCA could induce the expression of hepcidin and reduce serum iron level, in which FXR activation-related SMAD signaling was the main target for GCDCA. Thus, abnormal GCDCA level indicates a potential risk of iron homeostasis imbalance.

Iron Supplementation in Anemic Pregnant Women: A Comparison of Different Prescription Options in Pakistan

Background &amp; objectives: Many pregnant women in Pakistan have iron deficiency anemia (IDA), a dietary deficit. It affects both the mother's and the foetal' health. Oral iron supplementation usually relieves IDA symptoms. Oral iron supplements are hazardous to the GI mucosa, and sensitivity is common. Poor therapeutic compliance leads to treatment failure. Ferrous ascorbate (FeA) and iron hydroxide polymaltose complex (IPC) reportedly improve gastrointestinal discomfort and increase patient compliance compared to ferrous sulphate (FS). These preparations reportedly improve hemoglobin levels and iron stores more quickly than FS. This analysis compared FS's efficacy and safety to IPC and FeA. Place of Study: Rashid Latif Medical College Lahore Duration of Study: February 2019 and October 2021 Methods: It was a randomized, parallel, open label, investigation among pregnant women of gestational age from 10 to 28 weeks with moderate anemia. Patients were randomly selected to receive either FS, IPC or FeA. They were then followed up for 3 months to look for improvement in the hemoglobin levels and other hematological indicators or any adverse drug response. Results: With the exception of 3 months, when the FeA group had a significantly higher hemoglobin level in comparison to the FS group (P &lt;0.05), the hemoglobin levels were comparable across the three groups. The overall risk profiles for side effects were likewise equal across the research groups, with the exception of epigastric discomfort, which was more frequently reported in the FS group. Conclusions: The findings of the study indicated that FS, IPC, and FeA all have an efficacy and safety profile in the treatment of IDA associated with pregnancy that is comparable to one another. Keywords Anemia, ferrous ascorbate , ferrous sulphate ,iron hydroxide polymaltose ,pregnancy

A model to visualize the fate of iron after intracranial hemorrhage using isotopic tracers and elemental bioimaging.

Hemoglobin-iron is a red blood cell toxin contributing to secondary brain injury after intracranial bleeding. We present a model to visualize an intracerebral hematoma and secondary hemoglobin-iron distribution by detecting 58Fe-labeled hemoglobin (Hb) with laser ablation-inductively coupled plasma-mass spectrometry on mouse brain cryosections after stereotactic whole blood injection for different time periods. The generation of 58Fe-enriched blood and decisive steps in the acute hemorrhage formation and evolution were evaluated. The model allows visualization and quantification of 58Fe with high spatial resolution and striking signal-to-noise ratio. Script-based evaluation of the delocalization depth revealed ongoing 58Fe delocalization in the brain even 6 days after hematoma induction. Collectively, the model can quantify the distribution of Hb-derived iron post-bleeding, providing a methodological framework to study the pathophysiological basis of cell-free Hb toxicity in hemorrhagic stroke.

The TAM receptor tyrosine kinases Axl and Mer drive the maintenance of highly phagocytic macrophages.

Many apoptotic thymocytes are generated during the course of T cell selection in the thymus, yet the machinery through which these dead cells are recognized and phagocytically cleared is incompletely understood. We found that the TAM receptor tyrosine kinases Axl and Mer, which are co-expressed by a specialized set of phagocytic thymic macrophages, are essential components of this machinery. Mutant mice lacking Axl and Mer exhibited a marked accumulation of apoptotic cells during the time that autoreactive and nonreactive thymocytes normally die. Unexpectedly, these double mutants also displayed a profound deficit in the total number of highly phagocytic macrophages in the thymus, and concomitantly exhibited diminished expression of TIM-4, CD163, and other non-TAM phagocytic engulfment systems in the macrophages that remained. Importantly, these previously unrecognized deficits were not confined to the thymus, as they were also evident in the spleen and bone marrow. They had pleiotropic consequences for the double mutants, also previously unrecognized, which included dysregulation of hemoglobin turnover and iron metabolism leading to anemia.

A New Potential Dietary Approach to Supply Micronutrients to Physically Active People through Consumption of Biofortified Vegetables.

Micronutrients are required in many reactions involved in physical activity and exercise. Most physically active people do not meet the body’s needs in terms of micronutrients through diet. The novelty of the present manuscript is the use of an innovative dietary approach to supply micronutrients to physically active people through biofortified food. Therefore, the key point of this study was to verify whether supplementation with biofortified vegetables—and specifically molybdenum (Mo)-enriched lettuce—in healthy volunteers affects essential regulators of body homeostasis and, specifically, hematological parameters, iron and lipid metabolism, and hepatic function. Twenty-four healthy volunteers were allocated in a double-blinded manner to either a control group that consumed lettuce, or the intervention group, which consumed Mo-enriched lettuce, for 12 days. Blood samples were collected at baseline (T0) and after 12 days (T1). We found that supplementation with Mo-enriched lettuce did not affect hematological parameters, liver function, or lipid metabolism, but significantly improved iron homeostasis by increasing non-binding hemoglobin iron by about 37% and transferrin saturation by about 42%, while proteins of iron metabolism (e.g., transferrin, ferritin, ceruloplasmin) were not affected. The serum molybdenum concentration increased by about 42%. In conclusion, this study shows that consumption of Mo-biofortified lettuce ameliorates iron homeostasis in healthy subjects, and suggests that it could be used as a new nutritional supplementation strategy to avoid iron deficiency in physically active people.

Significantly lower mean serum vitamin B12 and folic acid levels and a significantly higher frequency of serum iron deficiency in younger than in older atrophic glossitis patients

Background/purpose: Our previous study found that 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 atrophic glossitis (AG) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. This study mainly evaluated the anemia, hematinic deficiencies, and hyperhomocysteinemia in 224 younger (≤50 years old) and 840 older (>50 years old) AG patients. Materials and methodsThe blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, and homocysteine levels in 224 younger and 840 older AG patients were measured and compared with the corresponding levels in 112 younger (≤50 years old) and 420 older (>50 years old) healthy control subjects (HCSs), respectively. ResultsWe found that 224 younger AG patients had significantly lower mean blood Hb and serum iron levels than 112 younger HCSs. Moreover, 840 older AG patients had significantly lower mean blood Hb and serum iron levels and a significantly higher mean serum homocysteine level than 420 older HCSs. In addition, 224 younger AG patients had significantly lower mean serum vitamin B12 and folic acid levels, a lower mean serum homocysteine level (marginal significance, P = 0.056), a significantly higher frequency of serum iron deficiency, and a significantly lower frequency of hyperhomocysteinemia than 840 older AG patients. ConclusionThe younger AG patients do have significantly lower mean serum vitamin B12 and folic acid levels, a significantly higher frequency of serum iron deficiency, and a significantly lower frequency of hyperhomocysteinemia than the older AG patients.

An In Vitro Analysis and In Vivo Trial Demonstrating the Improved Iron Bioavailability of White Beans (Phaseolus vulgaris L.) After Processing Into Pasta

Abstract Objectives The cotyledon cell wall of the common bean can be a factor in Fe bioavailability. This study evaluated the iron bioavailability of two bean varieties (white or black) either boiled (intact cell walls) or extruded into pasta formulated from heat treated bean flour as the major ingredient (100% bean flour; broken cell walls). Methods In vitro Fe bioavailability was determined via the Caco-2 Cell Bioassay. In vivo Fe bioavailability was measured by the capacity of a bean-based or bean pasta-based diet to generate and maintain total body hemoglobin iron (Hb-Fe) during a 6 week poultry feeding trial. Results The iron and phytate concentrations of the bean-based and bean pasta-based diets consisting of tomato paste, carrot, cabbage, milk, potato and corn oil were not significantly different. The Caco-2 cell bioassay predicted that the white bean pasta diet would have the highest Fe bioavailability, closely followed by the white bean diet. The bioassay predicted the black bean diet and the black bean pasta diet would have significantly lower Fe bioavailability. For the in vivo studies, animals fed the white bean pasta diet (broken cell walls) had significantly (p ≤ 0.05) higher hemoglobin, Hb-Fe and hemoglobin maintenance efficiencies than animals fed a white bean, black bean or black bean pasta-based diet. Although cotyledon cells were broken, the iron bioavailability of the black bean pasta was not improved after processing into pasta. The low iron bioavailability of black beans was associated with their high concentrations of seed coat procyanidin, cinnamtannin and anthocyanidin compounds that have a negative impact on the absorption of iron. Conclusions This study shows that white colored dry bean possesses a combination of traits that result in improved iron bioavailability after processing into pasta. The enhanced Fe bioavailability from the white bean pasta is likely due to the breakage of the cotyledon cell wall during processing, thus allowing enhanced bioaccessibility of the intracellular Fe. In the black bean pasta diet, this enhancement was not observed due to the presence of the seed coat polyphenols which interacted with the released intracellular Fe and prevented Fe absorption. Funding Sources Funded by the United States Department of Agriculture, Agricultural Research Service.

Significantly higher frequencies of macrocytosis, anemia, serum vitamin B12 and folic acid deficiencies, and hyperhomocysteinemia in male than in female atrophic glossitis patients

Background/purposeOur previous study found that 19.0%, 16.9%, 5.3%, 2.3%, 11.9%, and 26.7% of 1064 atrophic glossitis (AG) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity, respectively. This study evaluated the anemia, hematinic deficiencies, and hyperhomocysteinemia in 150 male and 914 female AG patients. Materials and methodsThe blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, GPCA levels in 150 male and 914 female AG patients were measured and compared with the corresponding levels in 75 male and 457 female healthy control subjects (HCSs), respectively. ResultsWe found that 150 male AG patients had significantly lower mean blood Hb, serum iron, vitamin B12, and folic acid levels, and significantly higher mean serum homocysteine levels than 75 male HCSs. Moreover, 914 female AG patients had significantly lower mean blood Hb and serum iron levels and significantly higher mean serum homocysteine level than 457 female HCSs. In addition, 150 male AG patients had significantly higher mean blood Hb and serum homocysteine levels, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of Hb, vitamin B12, and folic acid deficiency and hyperhomocysteinemia than 914 female AG patients. ConclusionThe male AG patients do have significantly higher mean blood Hb and serum homocysteine levels, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of Hb, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia than the female AG patients.

Effect biological life factors on pregnant woman

Define anemia is the low concentration in the amount of hemoglobin according to age, sex and trimester pregnancy. The pregnant has three trimesters and has an exceptional hemoglobin range in every trimester. The pregnant has 124-135 g/dl in the 1st trimester, 110-117 g/dl in the 2nd trimester and 106-109 g/dl in the 3rd trimester. Many pregnant females had been found with anemia because of a low level of Iron. This leads to megaloblastic anemia because of iron deficiency anemia and B12 Vitamin, diet, gastrectomy, malabsorption, blood loss and physiological demand (pregnancy infancy and adolescence). The blood consists of Hemoglobin (Heam + globin) Heam and Iron protoporphyrin ring. Globin is the type of protein with a specific length of amino acid and a specific type of A, maybe 2 Alpha 2 Beta called A1 or 2 Alpha and 2 Bata called A2 or 2Alpha and Gamma called F Fetal. The production of hemoglobin depends on the previously mentioned factors. In this study, we focused on some factors associated with the amount of blood and how these factors affected anemia, which is the most important in Iron treatments, with considering other factors such as food, diversity, Economic situation, social status, number of the fetus, and number of pregnancies. Statistical analysis was used to detect the effect factors of anemia in pregnant. This study refers to 23.2% of anemia because of Iron deficiency during pregnancy. So, treatment of Iron deficiency reduces anemia during pregnancy time. Keywords. Anemia; Hemoglobin; Pregnant Woman

Red cell distribution width as a predictor of impaired exercise capacity in patients with heart failure

Aim To test a hypothesis that increased values of red cell distribution width (RDW) in patients with chronic heart failure (CHF) can be related with low exercise tolerance.Material and methods 102 patients were evaluated who had CHF with mid-range and reduced left ventricular ejection fraction (LV EF) without anemia (72% men, mean age 66±10.2 years). Cardiopulmonary stress test (CPST), echocardiography, 6‑min walk test (6MWT), blood count, and measurements of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and serum iron were performed.Results The average LV EF was 39±8.7 %; the peak oxygen consumption (VO2peak) was 13.7±4.8 ml /kg /min; and the median NT-pro-BNP was 595.3 pg /ml (Q1-3 1443-2401). RDW variables, including the RDW coefficient of variation (RDW-CV) and RDW standard deviation (RDW-SD), were not significantly related with serum iron or hemoglobin concentrations. A one-factor linear regression analysis showed a significant correlation of VO2peak with RDW-SD (р=0.039). A multivariate linear regression analysis with adjustments for LV EF, hemoglobin concentration, and age did not reveal any significant correlation of VO2peak with RDW variables. The distance covered in the 6MWT was significantly associated with RDW-CV both in the one-factor analysis and with adjustments for LV EF, hemoglobin and serum iron concentrations, and age.Conclusion This study showed that high RDW values in CHF patients without anemia predicted low exercise tolerance regardless of the age, LV systolic function, and hemoglobin and serum iron concentrations. A 16% increase in RDW-CV significantly decreased the likelihood of covering a distance longer than 360 m during 6 min.

Corrigendum

Transfusion MedicineEarly View CORRIGENDUMFree Access Corrigendum This article corrects the following: Poster session Volume 31Issue S1Transfusion Medicine pages: 9-45 First Published online: September 14, 2021 First published: 28 April 2022 https://doi.org/10.1111/tme.12861AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat The surname of the last two authors were misspelled and the affiliation linked to the last author was incorrect in the poster abstract entitled ‘PO5 | Do deferred blood donors with low haemoglobin or low iron stores seek medical care?’ by James et al.1 The correct surnames and affiliation link are presented below. Sian Elizabeth James1, Nigel Kirby2, Nicholas O'Sullivan1,3, Victoria Sachser1, Ali Shokoohi1,4 1Welsh Blood Service, Pontyclun, UK 2Cardiff University, Cardiff, UK 3Cardiff and Vale University Health Board, Cardiff, UK 4The Princess Alexandra Hospital NHS Trust, Harlow, UK REFERENCE 1XXXVIII annual scientific meeting of the British Blood Transfusion Society 13–15 September 2021 virtual event. Transfus Med. 2021; 31(S1): 9- 45. https://doi.org/10.1111/tme.12816Wiley Online LibraryGoogle Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Intravenous Ferric Carboxymaltose Improves Response to Postoperative Anemia Following Total Knee Arthroplasty: A Prospective Randomized Controlled Trial in Asian Cohort.

Background: Ferric carboxymaltose (FCM) is an intravenous (IV) high-dose iron that is effective in the treatment of iron deficiency anemia. This study was performed to determine whether postoperative FCM infusion is effective at improving hemoglobin (Hb) responders, Hb and iron profiles, and the patient’s quality of life (QOL). Methods: A total of 110 patients with postoperative anemia, defined by a Hb < 10 g/dL within 3 days of unilateral primary TKA, between June 2018 and February 2020 were randomized into either the FCM or Control group. On postoperative day 3, the FCM group (55 patients) received IV FCM while the Control group (55 patients) did not. The Hb responders (Hb increase ≥ 2 g/dL compared to baseline), Hb level, iron profiles (ferritin, total iron-binding capacity (TIBC), transferrin saturation (TSAT)), and EQ-5D scores were compared at weeks 2, 4, and 8. Results: The FCM group demonstrated a significantly greater number of Hb responders (p < 0.001) and a higher Hb level (p = 0.008) at 2 weeks postoperative than did the Control group. The FCM group recovered its preoperative Hb level between 4 and 8 weeks. In contrast, the Control group did not recover its preoperative level until 8 weeks. The FCM infusion group also had higher serum ferritin, iron and TSAT, and lower TIBC levels than those of the Control group between 2 and 8 weeks (all p < 0.001). However, there was no significant difference in the postoperative transfusion rate (p = 0.741) or EQ-5D score between the two groups (all p > 0.05). Discussion: In postoperative anemia following TKA, IV FCM increases the Hb response and improves Hb and iron metabolism variables, however, it does not affect the transfusion rate or QOL.

Rhabdomyolysis after Intravenous Ferric Gluconate: A Case Report.

Patients with severe iron deficiency, malabsorption or intolerance to oral iron are frequently treated with intravenous iron replacement. We report the case of a 42-year-old woman with non-erosive oligoarticular arthritis with antiparietal cell antibodies and iron deficiency anemia secondary to menorrhagia and unresponsive to oral iron preparations. She was treated with an intravenous infusion of ferric gluconate. After the first infusion of 125 mg (in 250 mL saline), she developed transient pain in her knee and wrist joints. When the dose was subsequently halved, the patient showed no adverse symptoms in the next four infusions and had normalized hemoglobin levels and iron indices. However, after a subsequent 125 mg ferric gluconate infusion she developed severe leg pain, muscular and joint stiffness, and functional impairment of her hands, right foot, and ankle. Laboratory tests showed a progressive increase in creatine kinase, transaminase, and C-reactive protein that normalized several days after the infusion. Although rhabdomyolysis is not reported among endovenous iron-induced adverse events, our findings suggest that intravenous iron infusions might have increased free iron generation promoting oxidative joint and muscular injury, which would explain the joint pain and stiffness, and rhabdomyolysis. Greater attention should be paid to the more frequent cases of myalgia occurring after iron infusion, which may underlie a rhabdomyolytic event requiring clinical observation.LEARNING POINTSRhabdomyolysis can occur not only after intramuscular injection of iron dextran but also after infusion of ferric gluconate.The generation of increased free iron following iron administration can promote oxidative joint and muscular injury.Leg cramps and myalgia, which are relatively common adverse events after iron infusions, might represent undiagnosed events of mild to moderate rhabdomyolysis requiring further investigation.

The efficacy and safety of roxadustat for the treatment of anemia in non-dialysis dependent chronic kidney disease patients: An updated systematic review and meta-analysis of randomized clinical trials.

Roxadustat (ROX) is a new medication for anemia as a complication of chronic kidney disease (CKD). Our meta-analysis aims to evaluate the efficacy and safety of ROX, especially on the cardiovascular risks, for anemia in NDD-CKD patients. Electronic databases were searched systematically from inception to July 2021 to look for randomized control trials (RCTs) that evaluated ROX NDD-CKD patients. Hemoglobin level and iron utilization parameters, including ferritin, serum iron, transferrin saturation (TSAT), total iron-binding capacity (TIBC), transferrin, and hepcidin were analyzed for efficacy. Pooled risk ratios (RRs) and standardized mean differences (SMDs) were calculated and presented with their 95% confidential intervals (CIs). Nine RCTs included a total of 3,175 patients in the ROX group and 2,446 patients in the control group. When compared the control group, ROX increased Hb level significantly (SMD: 1.65; 95% CI: 1.08, 2.22; P< 0.00001) and improved iron utilization parameters by decreasing ferritin (SMD: -0.32; 95% CI: -0.51, -0.14; P = 0.0006), TSAT (SMD: -0.19; 95% CI: -0.32, -0.07; P = 0.003), and hepcidin (SMD: -0.74; 95% CI: -1.09, -0.39; P< 0.0001) and increasing TIBC (SMD: 0.99; 95% CI: 0.76, 1.22; P< 0.00001) and transferrin (SMD: 1.20; 95% CI: 0.70, 1.71; P< 0.00001). As for safety, ROX was associated with higher serious adverse effects (RR: 1.07; 95% CI: 1.01, 1.13; P = 0.01), deep venous thrombosis (DVT) (RR: 3.80; 95% CI: 1.5, 9.64; P = 0.08), and hypertension (HTN) (RR: 1.37; 95% CI: 1.13, 1.65; P = 0.001). We concluded that ROX increased Hb level and improved iron utilization parameters in NDD-CKD patients, but ROX was associated with higher serious adverse effects, especially DVT and HTN. Our results support the use of ROX for NDD-CKD patients with anemia. However, higher-quality RCTs are still needed to ensure its safety and risk of thrombosis.

Prescription rate of erythropoietin-stimulating agents is low for patients with renal impairment under non-nephrology care in a tertiary-level academic medical center in Japan.

Erythropoiesis-stimulating agents (ESAs) and iron supplements may be prescribed appropriately under nephrology care. However, there are few reports detailing the differences in prescription rates of these therapies among clinical departments. A total of 39,585 patients with renal impairment were enrolled from a database of 914,280 patients. Patients were selected based on an estimated glomerular filtration rate (eGFR) less than 60ml/min/1.73m2. There were eight clinical departments from internal medicine, including nephrology. We defined a hemoglobin level less than 11.0g/dL as anemia and set 20% of transferrin saturation and 100ng/mL of serum ferritin as cutoff points. We compared the prescription rates of ESAs and iron supplementation based on the hemoglobin level and iron status among the patients seen across the eight clinical departments. The lower the eGFR, the more the number of patients seen under nephrology care. The rates of patients with no prescription were 52.3, 39.9, 45.9, and 54.3% among those with hemoglobin levels of < 8, 8 ≤ < 9, 9 ≤ < 10, and 10 ≤ < 11g/dL, respectively. Of the patients with less than 11.0g/dL of hemoglobin, 77.3% were prescribed ESAs under nephrology care. Meanwhile, only 18.5 and 8.2% of patients were prescribed ESAs in clinical departments of internal medicine, other than nephrology, and non-internal medicine care, respectively. Treatment for anemia has not been sufficiently performed in patients with renal impairment under non-nephrology care in a real-world clinical setting.

A Novel Ferritin-Core Analog Is a Safe and Effective Alternative to Oral Ferrous Iron for Treating Iron Deficiency during Pregnancy in Mice

BackgroundMany women enter pregnancy with iron stores that are insufficient to maintain maternal iron balance and support fetal development and consequently, often require iron supplements. However, the side effects associated with many currently available iron supplements can limit compliance. ObjectiveThis study aimed to test the safety and efficacy of a novel nanoparticulate iron supplement, a dietary ferritin analog termed iron hydroxide adipate tartrate (IHAT), in pregnant mice. MethodsFemale C57BL/6 mice were maintained on either an iron-deficient or a control diet for 2 wk prior to timed mating to develop iron-deficient or iron-sufficient pregnancy models, respectively. Mice from each model were then gavaged daily with 10 mg iron/kg body weight as either IHAT or ferrous sulfate, or with water only, beginning on embryonic day (E) 4.5. Mice were killed on E18.5 and maternal iron and hematological parameters were measured. The expression of genes encoding iron transporters and oxidative stress markers in the duodenum and placenta were determined, along with hepatic expression of the gene encoding the iron regulatory hormone hepcidin and fetal iron. ResultsOral IHAT and ferrous sulfate were equally effective at increasing maternal hemoglobin (20.2% and 16.9%, respectively) and hepatic iron (30.2% and 29.3%, respectively), as well as total fetal iron (99.7% and 83.8%, respectively), in iron-deficient pregnant mice compared with those gavaged with water only, with no change in oxidative stress markers seen with either treatment. However, there was a significant increase in the placental expression of the oxidative stress marker heme oxygenase 1 in iron-replete pregnant mice treated with ferrous sulfate when compared with iron-replete pregnant mice gavaged with IHAT (96.9%, P<0.05). ConclusionsIHAT has proved a safe and effective alternative to oral ferrous sulfate in mice, and it has potential for treating iron deficiency in human pregnancy.