Iron Deficiency Anemia In Adults Research Articles

Reticulocyte hemoglobin content associated with the risk of iron deficiency anemia

Background/ObjectiveReticulocyte hemoglobin content (MCHr) was recognized as a rapid and reliable marker for investigating iron deficiency (ID). We hypothesized that MCHr was associated with the risk of iron deficiency anemia in adults. MethodsThis is a dual-center case-control study. A total of 806 patients and healthy individuals were recruited from Ruijin Hospital and Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2021 and December 2021. The participants were categorized into iron deficiency anemia (IDA) group (n = 302), non-IDA group (n = 366), and healthy control group (n = 138). According to the MCHr level, the participants were divided into two groups, i.e. normal MCHr (≥25 pg) and decreased MCHr (<25 pg) group. Multivariate logistic regression analysis and adjusted subgroup analysis were conducted to estimate the relative risk between MCHr and IDA, with confounding factors including age, sex, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), Hematocrit (HCT), serum iron (Fe), ferritin (Ferrit), and total iron binding capacity (TIBC). ResultsCompared with the non-IDA, the MCHr level with IDA decreased significantly. ROC curve analysis showed that MCHr had the largest area under the AUC curve. After comprehensive adjustment for confounding factors, individuals with normal level of MCHr exhibited a decreased risk of IDA (OR = 0.68 [0.60, 0.77], P < 0.01), while the risk of IDA was up to 5 times higher for those with decreased MCHr. ConclusionOur findings supported the hypothesis that MCHr was associated with the risk of IDA in adults and could serve as an indicator of IDA severity. MCHr holds clinical value as an auxiliary diagnostic indicator, providing valuable insights into whether invasive examinations are warranted in the assessment of IDA.

Pharmacotherapeutics for iron deficiency anemia in adults

Background: Iron deficiency anemia (IDA) is among the five greatest causes of disability globally. It can have various causes and may develop concurrently with other health issues. Recently, there have been advances in the treatment of IDA associated with various comorbidities.Current Concepts: The causes of IDA include chronic blood loss, inadequate iron absorption, and increased iron demand. Oral iron supplements are primarily recommended for the treatment of IDA. In cases where oral supplements are ineffective or cannot be used, parenteral iron supplements are administered.Discussion and Conclusion: Identifying the underlying reason for IDA is essential for determining the appropriate and effective treatment plan. In adults, it is important to be aware that gastrointestinal malignancies can be detected as a cause of IDA. Ferrous sulfate tablets are primarily recommended as oral supplements for treating IDA. Among the parenteral iron supplements available in South Korea, both iron sucrose and ferric carboxymaltose can be used relatively safely without significant side effects. Recently, ferric carboxymaltose was reported as being effective for treating iron deficiency associated with heart failure, chronic kidney disease, inflammatory bowel disease, and preoperative IDA.

Safety and Efficacy of Intravenous Ferric Derisomaltose Compared to Iron Sucrose for Iron Deficiency Anemia in Patients with Chronic Kidney Disease With and Without Heart Failure

Ferric derisomaltose (FDI) is an intravenous (IV) high-dose iron formulation approved in the US for the treatment of iron deficiency anemia in adults who are intolerant of/have had an unsatisfactory response to oral iron, or who have non-dialysis-dependent chronic kidney disease (NDD-CKD). FERWON-NEPHRO was a randomized, open-label, multicenter clinical trial evaluating the safety and efficacy of a single infusion of FDI 1,000 mg versus up to 5 doses of iron sucrose (IS) 200 mg (recommended cumulative dose, 1,000 mg) over 8 weeks in patients with NDD-CKD and iron deficiency anemia. Of 1,525 patients included in the safety analysis, 244 (16%) had a history of heart failure (HF). Overall, the rate of serious or severe hypersensitivity reactions was low and did not differ between treatment groups. Cardiovascular adverse events (AEs) were reported for 9.4% of patients who had HF and 4.2% who did not. Time to first cardiovascular AE was longer following administration of FDI compared with IS (hazard ratio: 0.59 [95% CI: 0.37, 0.92]; p=0.0185), a difference that was similar in patients with or without HF (p=0.908 for interaction). Patients achieved a faster hematological response (assessed by changes in hemoglobin and ferritin concentrations, and increase in transferrin saturation) with FDI versus IS. In conclusion, in patients with NDD-CKD, a single infusion of FDI was safe, well tolerated, and was associated with fewer cardiovascular AEs and a faster hematological response, compared to multiple doses of IS. These effects were similar for patients with and without HF.

Study of Association of Sensory Neural Hearing Loss with Iron Deficiency Anaemia.

The online version contains supplementary material available at 10.1007/s12070-021-02619-4.

Efficacy and Tolerability of Oral Iron Protein Succinylate in the Treatment of Iron Deficiency Anemia in Adults with Diverse Pathologies

An increasing number of prevalent conditions in the adult population associated with absolute or/and functional iron deficiencies (ID) may predispose to iron deficiency anemia (IDA). Oral iron formulations, especially ferrous salts, are generally regarded as the first line therapies for adult-onset ID and IDA according to several current guidelines. However, they have been frequently associated with gastrointestinal side effects, and with a subsequent high treatment discontinuation. Iron protein succinylate (IPS) is an iron complex containing 5% of ferric iron engulfed in a succinylated casein shell that precipitates in acid pH and becomes soluble at neutral to alkaline pH, gradually releasing iron into the intestinal lumen, and, hence, overcoming the gastric and intestinal problems of the ferrous compounds, as well as improving intestinal iron absorption. Besides, IPS has shown to prevent the up regulation of the expression of hepcidin or to induce its expression at a smaller extent when compared with ferrous sulphate (FS). This narrative review addresses the efficacy and safety profiles of IPS for the treatment of ID and IDA in adult patients with a wide range of clinical conditions, such as preoperative and postoperative ID, elderly ID, Chronic Kidney Disease (CKD), Hypothyroidism, regular blood donors, and ID developed in young athletes. In conclusion, IPS compares favorably in efficacy and safety with other currently available oral iron preparations, showing a fast and steady improvement in hematologic parameters (that reflect a better iron absorption), and a lower incidence of adverse events.

Efficacy and Tolerability of Oral Iron Protein Succinylate in the Treatment of Iron Deficiency Anemia in Adults with Gastrointestinal Diseases

Iron deficiency anemia (IDA) is commonly associated with several pathological gastrointestinal (GI) conditions in adults, being induced through different mechanisms, such as chronic bleeding, chronic inflammation, malabsorption, autoimmune re-actions, or, quite frequently, as a combination of different mechanisms. All patients must be treated with iron supplementation with the aim of restoring normal hemoglobin levels and iron status. Oral iron compounds are the first line treatment options for ID clinical conditions, according to International Guidelines, as they have proven to be efficacious, safe, and relatively inexpensive. However, ferric salts are scarcely absorbed, and ferrous compounds present a poor GI tolerability. Iron-protein succinylate (IPS), an iron complex that keeps ferric iron bonded to the protein content of a succinylated casein shell at acid pH values, has been shown to release gradually iron into the intestinal lumen, protecting the gastrointestinal mucosa from eventual damage, an ensuring an optimal intestinal iron absorption. This review focuses on IPS in the treatment of IDA associated to a variety of GI medical conditions in adults. Results from diverse studies including IDA due to acute and chronic GI conditions, as well as IDA associated to gastric surgery, confirm a consistent improvement in hematologic parameters and clinical symptoms, and an optimal tolerability profile.

Revising Ferritin Lower Limits: It's Time to Raise the Bar on Iron Deficiency.

Ferritin is a key diagnostic marker of iron deficiency (ID), but the interpretative guidance provided to physicians varies significantly. Clear discrepancies exist between clinical guidelines that recommend evidence-based ferritin cutoffs and clinical laboratories that report highly variable ferritin reference intervals (RIs) derived from apparently healthy populations. In this study, clinical laboratories across North America were surveyed to assess the RIs provided with ferritin results. Although clinical guidelines often recommend ferritin cutoffs of 15 or 30 µg/L to identify uncomplicated ID, the survey showed that 18 of 23 responding laboratories reported female RI lower limits well below 15 µg/L. To understand the clinical impact, we analyzed 52027 unique patient ferritin values over a 5-year period (2013-2017) from a tertiary care hospital. In this population, the 90th percentile ferritin cutoff to identify ID anemia in adults was 24 µg/L in female patients and 25 µg/L in male patients. Distribution of ferritin results in female patients showed that menopausal status had a significant effect on median values, which increased 2- to 3-fold in the postmenopausal state. Furthermore, sorting the data for female patients by physician specialty showed the highest prevalence of low ferritin values in patients seen in obstetrics and gynecology. This study highlights the discrepancy between clinical guidelines and clinical laboratory practice for ferritin reporting and indicates that ferritin RIs, particularly for female patients, are set to an inappropriately low threshold in most clinical laboratories in North America; this level provides good specificity but poor sensitivity when screening for ID.

Metal Contaminants Leached by the Lucky Iron Fish When Boiled in Deionized Distilled Water

Abstract Objectives The Lucky Iron Fish® (LIF) is a reusable fish-shaped iron ingot that was developed to address iron deficiency and iron deficiency anemia in adults and young children under 5 years. The primary objective of this study was to determine the amount of iron and metals leached from the LIF. Methods LIF produced in Cambodia, Canada, and India were obtained from the LIF company for analysis. Ingots were used for the first time in this study. All equipment was cleaned prior to use. LIF were boiled in deionized distilled water with lemon juice for 10 and 60 minutes. Water samples were sent to a commercial laboratory for analysis. Results When boiled for 10 minutes, the Cambodia, Canada, and India LIF leached concentrations of iron greater than 68,600 ug/L. Quantities of heavy metals leached varied depending on where the ingot was manufactured. When boiled for 10 minutes, arsenic concentrations ranged from 2.5 ug/L to 4.7 ug/L in an India and Cambodia LIF. Chromium ranged from 4–80 ug/L in an India and Cambodia LIF, respectively. Similarly, lead leached ranged from 0.3 ug/L in a Cambodia LIF to 6.3 ug/L in an India LIF. Conclusions Despite high quantities of iron leached in water, it is unclear whether the quantity of absorbable iron leached from the LIF is enough to make a difference on iron stores of a young child. As research on the efficacy of the LIF has not been studied in this population. In addition, the potential harms of ingesting these heavy metals must be further investigated. Funding Sources None.

The role of iron repletion in adult iron deficiency anemia and other diseases.

Iron deficiency anemia (IDA) is the most prevalent and treatable form of anemia worldwide. The clinical management of patients with IDA requires a comprehensive understanding of the many etiologies that can lead to iron deficiency including pregnancy, blood loss, renal disease, heavy menstrual bleeding, inflammatory bowel disease, bariatric surgery, or extremely rare genetic disorders. The treatment landscape for many causes of IDA is currently shifting toward more abundant use of intravenous (IV) iron due to its effectiveness and improved formulations that decrease the likelihood of adverse effects. IV iron has found applications beyond treatment of IDA, and there is accruing data about its efficacy in patients with heart failure, restless leg syndrome, fatigue, and prevention of acute mountain sickness. This review provides a framework to diagnose, manage, and treat patients presenting with IDA and discusses other conditions that benefit from iron supplementation.

Iron deficiency anaemia in adults: what to look for and what to ask

Iron deficiency anaemia in adults: what to look for and what to ask

Association of Zinc Deficiency with Iron Deficiency Anemia and its Symptoms: Results from a Case-control Study.

Iron deficiency anemia (IDA) is the most common type of anemia. Impaired iron absorption can be caused by a decrease in trace elements as zinc, which is found in the structure of enzymes that coordinate or catalyst iron metabolism. The aim of this study is to detect if zinc deficiency is associated with IDA and to determine the effect of associated zinc deficiency on symptoms of IDA in adult IDA patients. This case-control study included 30 IDA patients with matched healthy control group (n = 30) for age and sex. For each subject, the parameters were evaluated: hemoglobin (Hb); mean corpuscular volume (MCV), total iron binding capacity (TIBC), serum iron, serum ferritin (SF). Serum zinc levels were measured by atomic absorption method with the PerkinElmer Analyst. Symptoms attributed to iron deficiency or depletion, defined as fatigue, cardiopulmonary symptoms, mental manifestations, epithelial manifestations, and neuromuscular symptoms were recorded. Serum zinc levels were lower in IDA patients (43.4 ± 7.9 mg/dL) than in the control subjects (94.7 ± 16.75 mg/dL; p < 0.0001). Zinc deficiency was associated with worse cardiovascular symptoms (p = 0.04), epithelial symptoms (p = 0.027), and restless leg syndrome (p < 0.001) in patients with IDA. Measurement of zinc levels should be considered for IDA patients. With the help of our study, iron and zinc supplementation instead of only iron replacement may be considered in cases of iron deficiency particularly, in patients with severe epithelial dysfunctions. Further studies are still needed to evaluate the benefit of zinc and iron supplementation in IDA patients.

Small Bowel Anastomotic Ulcers: A Source of Iron Deficiency Anemia in Adults Detected by Capsule Endoscopy

Small Bowel Anastomotic Ulcers: A Source of Iron Deficiency Anemia in Adults Detected by Capsule Endoscopy

Intravenous Iron Sucrose for Treatment of Iron Deficiency Anemia in Pediatric Inflammatory Bowel Disease.

Iron deficiency anemia (IDA) is a common complication of pediatric inflammatory bowel disease (IBD), yet the effectiveness of oral iron supplementation is limited. Intravenous iron sucrose is an effective and safe alternative treatment for IDA in adults with IBD, but its role in the treatment of IDA in pediatric IBD is unclear. The primary aim of this study was to evaluate the use of iron sucrose in pediatric IBD subjects with IDA and determine the clinical response as measured by improvement in hemoglobin concentration. The secondary aim was to describe adverse events associated with iron sucrose use in this cohort. A retrospective chart review was performed of all pediatric patients with IBD receiving iron sucrose infusions for IDA at a single tertiary care center between 2011 and 2015. Seventy-two subjects (53 with Crohn disease, 11 with ulcerative colitis, and 8 with IBD-unclassified) received a total of 273 iron sucrose infusions. Forty-three subjects qualified for the efficacy analysis. There was a significant increase in hemoglobin over the treatment course, with mean (±SD) hemoglobin increasing from 9.6 ± 1.2 g/dL at baseline to 12.1 ± 1.3 g/dL after iron sucrose treatment (P < 0.001). Eighteen adverse events were reported in 13 subjects (18.1% of subjects and 6.6% of infusions). No anaphylaxis reactions occurred and none of the adverse events were, however, life-threatening or required hospitalization. Intravenous iron sucrose is a safe and potentially efficacious treatment choice for IDA in pediatric IBD.

Iron deficiency and iron deficiency anemia in the adult omani population

Context: The prevalence of iron deficiency anemia (IDA) in adults from the Sultanate of Oman is unknown. Aims: The aim of this study was to assess the prevalence of IDA and latent iron deficiency (ID) in students admitted to a university hospital. Settings and Design: This is a prospective, cross-sectional cohort study. Subjects and Methods: In asymptomatic university students, blood samples were obtained for blood counts and iron status after obtaining consent. Students who were found to have IDA or ID were given oral iron therapy for a minimum of 3 months to study the response to treatment. Statistical Analysis Used: Student's t-test (continuous variables) and Chi-square test (categorical variable) were used for statistical analysis. Results: The mean age + standard deviation was 21 + 1.3 years with a range from 17 to 29 years in 350 students, with 274 students being females (78.8%). Using the World Health Organization criteria, 91 (26%), 133 (38%), and 126 (36%) students, respectively, were classified as IDA, ID, and normal. HPLC showed that 28 students had sickle cell trait (HbS: 26%–35%), and one each had sickle cell disease (HbS 92%), Hb C trait (31%), Hb D trait (30%), Hb E trait (19%), and delta gene variant (HbA2 – 1.6%). Among the students who received treatment (52 IDA and 20 ID), Hb, mean corpuscular volume, mean corpuscular hemoglobin, and serum ferritin showed statistically significant improvement after oral iron therapy (P Conclusions: The prevalence of IDA was 26% and that of ID was 38%, with a preponderance of females.

Association of Iron Deficiency Anemia With Hearing Loss in US Adults

Hearing loss in the US adult population is linked to hospitalization, poorer self-reported health, hypertension, diabetes, and tobacco use. Because iron deficiency anemia (IDA) is a common and easily correctable condition, further understanding of the association between IDA and all types of hearing loss in a population of US adults may help to open new possibilities for early identification and appropriate treatment. To evaluate the association between sensorineural hearing loss (SNHL) and conductive hearing loss and IDA in adults aged 21 to 90 years in the United States. The prevalence of IDA and hearing loss (International Classification of Diseases, Ninth Revision codes 389.1 [SNHL], 389.0 [conductive hearing loss], and 389 [combined hearing loss]) was identified in this retrospective cohort study at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Iron deficiency anemia was determined by low hemoglobin and ferritin levels for age and sex in 305 339 adults aged 21 to 90 years. Associations between hearing loss and IDA were evaluated using χ2 testing, and logistic regression was used to model the risk of hearing loss among those with IDA. The study was conducted from January 1, 2011, to October 1, 2015. Hearing loss. Of 305 339 patients in the study population, 132 551 were men (43.4%); mean (SD) age was 50.1 (18.5) years. There was a 1.6% (n = 4807) prevalence of combined hearing loss and 0.7% (n = 2274) prevalence of IDA. Both SNHL (present in 26 of 2274 individuals [1.1%] with IDA; P = .005) and combined hearing loss (present in 77 [3.4%]; P < .001) were significantly associated with IDA. Logistic regression analysis confirmed increased odds of SNHL (adjusted odds ratio [OR], 1.82; 95% CI, 1.18-2.66) and combined hearing loss (adjusted OR, 2.41; 95% CI, 1.90-3.01) among adults with IDA, after adjusting for sex. Iron deficiency anemia was associated with SNHL and combined hearing loss in a population of adult patients. Further research is needed to better understand the potential links between IDA and hearing loss and whether screening and treatment of IDA in adults could have clinical implications in patients with hearing loss.

AMD-like retinopathy associated with intravenous iron

Iron accumulation in the retina is associated with the development of age-related macular degeneration (AMD). IV iron is a common method to treat iron deficiency anemia in adults, and its retinal manifestations have not hitherto been identified. To assess whether IV iron formulations can be retina-toxic, we generated a mouse model for iron-induced retinal damage. Male C57BL/6J mice were randomized into groups receiving IV iron-sucrose (+Fe) or 30% sucrose (−Fe). Iron levels in neurosensory retina (NSR), retinal pigment epithelium (RPE), and choroid were assessed using immunofluorescence, quantitative PCR, and the Perls' iron stain. Iron levels were most increased in the RPE and choroid while levels in the NSR did not differ significantly in +Fe mice compared to controls. Eyes from +Fe mice shared histological features with AMD, including Bruch's membrane (BrM) thickening with complement C3 deposition, as well as RPE hypertrophy and vacuolization. This focal degeneration correlated with areas of high choroidal iron levels. Ultrastructural analysis provided further detail of the RPE/photoreceptor outer segment vacuolization and Bruch's membrane thickening. Findings were correlated with a clinical case of a 43-year-old patient who developed numerous retinal drusen, the hallmark of AMD, within 11 months of IV iron therapy. Our results suggest that IV iron therapy may have the potential to induce or exacerbate a form of retinal degeneration. This retinal degeneration shares features with AMD, indicating the need for further study of AMD risk in patients receiving IV iron treatment.

Contrast-enhanced magnetic resonance venography in pediatric patients with chronic kidney disease: initial experience with ferumoxytol.

Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) particle that is FDA-approved for parenteral treatment of iron deficiency anemia in adults with chronic kidney disease. Because of the association between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with severe chronic kidney disease, we sought to evaluate the diagnostic role of ferumoxytol-enhanced MR venography in children with chronic kidney disease. Twenty children underwent 22 high-resolution ferumoxytol-enhanced MR venography examinations at 3.0T. High-resolution 3-D contrast-enhanced imaging was performed at a minimum of 3 time points following injection of ferumoxytol at a total dose of 4mg/kg. Two blinded pediatric radiologists independently scored six named veins on ferumoxytol-enhanced MR venography examinations according to a three-point subjective score, where a score ≥2 was considered diagnostic. Additionally, all relevant venous structures in the included field of view were analyzed for occlusive or non-occlusive thrombosis, compression and presence of collaterals. All patients underwent ferumoxytol-enhanced MR venography successfully and without adverse event. The overall scores of the reviewing radiologists for all venous structures were 2.7-2.9. In all cases, the reviewers were confident basing their diagnoses on the ferumoxytol-enhanced MR venography findings. In 12 of 22 examinations, findings on follow-up imaging or invasive procedures were available to correlate with the findings on ferumoxytol-enhanced MR venography. There was complete concordance between the findings from follow-up imaging and invasive procedures with findings from ferumoxytol-enhanced MR venography. Ferumoxytol holds promise as a powerful alternative to gadolinium-based contrast agents for reliable, high-resolution MR venography in children with chronic kidney disease.

Serum zinc levels in patients with iron deficiency anemia and its association with symptoms of iron deficiency anemia.

Iron deficiency anemia (IDA) is a major public health problem especially in underdeveloped and developing countries. Zinc is the co-factor of several enzymes and plays a role in iron metabolism, so zinc deficiency is associated with IDA. In this study, it was aimed to investigate the relationship of symptoms of IDA and zinc deficiency in adult IDA patients. The study included 43 IDA patients and 43 healthy control subjects. All patients were asked to provide a detailed history and were subjected to a physical examination. The hematological parameters evaluated included hemoglobin (Hb); hematocrit (Ht); red blood cell (erythrocyte) count (RBC); and red cell indices mean corpuscular volume (MCV), mean corpuscular hemoglobin (МСН), mean corpuscular hemoglobin concentration (МСНС), and red cell distribution width (RDW). Anemia was defined according to the criteria defined by the World Health Organization (WHO). Serum zinc levels were measured in the flame unit of atomic absorption spectrophotometer. Symptoms attributed to iron deficiency or depletion, defined as fatigue, cardiopulmonary symptoms, mental manifestations, epithelial manifestations, and neuromuscular symptoms, were also recorded and categorized. Serum zinc levels were lower in anemic patients (103.51 ± 34.64 μ/dL) than in the control subjects (256.92 ± 88.54 μ/dL; <0.001). Patients with zinc level <99 μ/dL had significantly more frequent mental manifestations (p < 0.001), cardiopulmonary symptoms (p = 0.004), restless leg syndrome (p = 0.016), and epithelial manifestations (p < 0.001) than patients with zinc level > 100 μ/dL. When the serum zinc level was compared with pica, no statistically significant correlation was found (p = 0.742). Zinc is a trace element that functions in several processes in the body, and zinc deficiency aggravates IDA symptoms. Measurement of zinc levels and supplementation if necessary should be considered for IDA patients.

O-022 Intravenous Iron Sucrose for Treatment of Iron Deficiency Anemia in Pediatric Inflammatory Bowel Disease

Iron deficiency anemia (IDA) is a common complication of pediatric inflammatory bowel disease (IBD). The effectiveness of oral iron supplementation in the treatment of IDA is limited by its slow onset of action, daily dosing, gastrointestinal side effects, and potential for exacerbation of intestinal inflammation. Intravenous iron sucrose (IS) is an effective and safe alternative treatment for IDA in adults with IBD, but its role in the treatment of IDA in pediatric IBD is unclear. The primary aim of this study was to evaluate the use of IS in pediatric IBD patients with IDA and determine the clinical response measured by improvement in hemoglobin. Secondary aim was to describe adverse events associated with IS use in this population. A retrospective chart review of all pediatric IBD patients receiving IS infusions for IDA at The Children's Hospital of Philadelphia between January 2011 and August 2015 was performed. The diagnosis of IDA was based on low hemoglobin for age and sex, although serum concentrations of iron, ferritin, mean corpuscular volume, total iron-binding capacity, and red blood cell distribution width were also referenced to confirm the diagnosis. Patients who had a transfusion of blood products within 2 months of an IS infusion or who had no follow-up laboratory evaluation within 2 months of the last IS infusion were excluded from the efficacy analysis. Adverse events were reported descriptively. Repeated measures ANOVA was used to evaluate paired continuous variables with post-hoc testing performed using Tukey's test. Seventy-five patients (57 with Crohn disease, 10 with ulcerative colitis, and 8 with indeterminate colitis) received a total of 280 IS infusions with 4 patients receiving multiple treatment courses. Patients were administered 200 mg per dose, 2 mg/kg per dose, or dosing calculated based on total iron deficit. The mean treatment course (±SD) was 3.5 ± 1.6 doses. Fifty-two patients qualified for analysis. The mean age (±SD) was 14.6 ± 3.1 years. There was a statistically significant increase in hemoglobin over the treatment course, with mean hemoglobin increasing from 9.6 ± 1.2 g/dL at baseline to 12.0 ± 1.3 g/dL after IS treatment (P < 0.0001). Post-hoc analysis revealed that change in hemoglobin was greatest after 4 infusions with subsequent dosing having no increased benefit. There were no statistically significant differences in change in hemoglobin between the 3 different IS doses. Twenty-two adverse events were reported in 15 patients (7.9% of the total number of infusions), including blood pressure (8/22) and pulse fluctuations (6/22), pain at IV site (6/22), chills (1/22), and IV infiltration (1/22). No anaphylaxis reactions occurred. The patient with IV infiltration required IS infusion discontinuation. Otherwise, none of the adverse events resulted in IS discontinuation and none were life-threatening, required treatment, or hospitalization. This is one of the first reported studies on IS therapy in a cohort of children with IBD and suggests that IS is a safe and potentially efficacious treatment for IDA in pediatric IBD.

Ferumoxytol as an off-label contrast agent in body 3T MR angiography: a pilot study in children.

Ferumoxytol is an ultrasmall superparamagnetic iron oxide (USPIO) nanoparticle agent used to treat iron deficiency anemia in adults with chronic kidney disease. We aim to determine the feasibility of using ferumoxytol for clinical pediatric cardiac and vascular imaging. We retrospectively identified 23 consecutive children who underwent MRI with ferumoxytol (11 males; mean age: 7.4years, range: 3days-18years), yielding 12 abdominal MR angiography and 15 cardiac MRI studies. Medical records were reviewed for the clinical indication, ferumoxytol dose, injection rate, sedation and any complication. A two-reader consensus scored the images on a five-point scale for overall image quality and delineation of various anatomical structures. Signal-to-background ratios for abdominal aorta and inferior vena cava for abdominal cases and blood pool-myocardium contrast ratios for cardiac cases were calculated. The confidence intervals for obtaining a score of three or above for each image parameter were calculated by using adjusted Wald method. For abdominal MR angiography, average scores for overall image quality, as well as delineation of the hepatic artery, superior mesenteric artery, renal artery and veins were 4.5, 4.3, 4.3, 3.7 and 4.7, respectively. For cardiac exams, the average scores for overall image quality, systemic arteries, pulmonary arteries, pulmonary veins, valves and ventricles were 4.4, 4.6, 4.1, 4.8, 4.1 and 4.7, respectively. For all parameters, the lower bound for the proportion of cases to have a score of 3 or above was 65%. Signal-to-background ratios for aorta and abdominal veins averaged 86 +/- 74 and 86 +/- 77 for full-dose images, and 23 and 18 for half-dose images, respectively. Mean blood pool to myocardium contrast ratio was 3:3. Ferumoxytol can provide excellent image quality for pediatric body MR angiography/MR venography at a dose of 1.5 or 3mg Fe/kg. Further investigation should be directed toward understanding the lowest dose that can be administered.