Iron Deficiency Anemia In Patients Research Articles

A study of effect of iron deficiency anemia on glycosylated hemoglobin in non-diabetic patients

Background: Diabetes mellitus is a rapidly increasing global health concern, having a substantial impact on morbidity and mortality. Glycated hemoglobin (HbA1c) is the primary measure of diabetes control, reflecting glycemic levels over the past 3 months. However, hemoglobin (Hb) abnormalities, such as those seen in iron deficiency anemia (IDA), can theoretically affect HbA1c levels. IDA, affecting over 30% of the global population, results from inadequate iron intake, hemorrhage, or poor iron absorption, leading to reduced Hb production. This study aims to evaluate the impact of IDA on HbA1c levels in non-diabetic patients, providing insights into accurate HbA1c interpretation in anemic patients. Aims and Objectives: The study aimed to determine the impact of IDA on HbA1c levels in non-diabetic individuals. Materials and Methods: This cross-sectional study was conducted over 6 months at Trichy SRM Medical College Hospital and Research Center. There were a total of 100 IDA patients and 100 age- and sex-matched healthy controls. Hb levels below 10 g/dL with a microcytic image suggestive of iron deficiency, postprandial blood sugar (PPBS) levels below 140 mg/dL following an oral glucose tolerance test (OGTT), and fasting blood sugar (FBS) levels below 100 mg/dL were the inclusion criteria. Exclusion criteria included Hb levels above 10 g/dL, altered FBS or PPBS values post-OGTT, diagnosed Type 2 diabetes mellitus, individuals younger than 18 years, and those with conditions such as hemoglobinopathies, hemolytic anemia, hypothyroidism, pregnancy, or abnormal renal function tests. Ethical approval and informed consent were obtained. Data collection included demographics, medical history, and laboratory investigations. Statistical analysis was performed using SPSS version 26, with t-tests, mean, and standard deviation (SD) for association analysis, and Chi-square tests for sex comparisons. Correlations were assessed through t-test. The significance level was kept at 0.05. Results: The study confirmed that both groups met the inclusion criteria for non-diabetic status. The control group exhibited normal Hb levels, whereas the study group had Hb levels indicative of IDA. General and systemic examination findings were normal in both groups. Significant differences were observed across all measured parameters, with Hb levels, serum ferritin, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, and red cell distribution width significantly lower in the study group. HbA1c levels were significantly elevated in the study group compared to the control group (5.87 ± 1.25 vs. 4.97 ± 1.59, P < 0.001), supporting the hypothesis that IDA is associated with elevated HbA1c levels in non-diabetic patients. Conclusion: The study’s findings align with previous research indicating that IDA leads to elevated HbA1c levels. The prolonged erythrocyte survival and altered Hb glycation processes in IDA are likely contributors to this elevation. These results emphasize the need to consider anemia status when interpreting HbA1c values to avoid misdiagnosis and inappropriate management of diabetes. Clinicians should ensure comprehensive evaluations, including iron status assessments when encountering unexpectedly high HbA1c levels in non-diabetic individuals.

Distinguishing Iron Deficiency Anemia from Anemia of Chronic Disease Using Hematological Measures

Anemia is a serious public health concern in today’s world which is particularly affecting young children, pregnant women, menstruating adolescent girls and women. The two most common causes of anemia are iron deficiency anemia (IDA) and anemia of chronic disease (ACD), often known as anemia of inflammation. This study aim was to assess the levels of certain hematological parameters, including Hemoglobin Estimation, Mean Corpuscular Volume (MCV), Serum Ferritin, Serum TIBC, Erythrocyte Sedimentation Rate and C - reactive protein to clearly differentiate between iron deficiency anemia and anemia of chronic disease. The study was conducted in Department of Medical Lab Technology, Riphah International University, Islamabad from September 01, 2023 to January 01, 2024. A total of 109 samples with 59 of iron deficiency anemia patients and 50 patients of Anemia of chronic disease were assessed for differentiation be these two diseases. The significant level was selected with p-value less than 0.05. Hemoglobin estimation, TIBC, and ESR were significant in our investigation as their p-values were less than 0.05. Hence, it concluded that Hemoglobin estimation, total Iron Binding Capacity and Erythrocyte Sedimentation Rate were Hematological parameters that distinguished between Iron Deficiency Anemia and Anemia of Chronic Disease.

Клинический случай железодефицитной анемии у пациента пожилого возраста с отягощенным сердечно-сосудистым анамнезом

A clinical case of iron deficiency anemia in a patient with chronic heart failure, coronary artery disease after myocardial infarction and coronary artery stenting, which aggravated the course of the underlying disease and worsened the quality of life, is presented. The important role of correction of iron deficiency anemia in patients with pathologies of the cardiovascular system is shown.

Ratio of hemoglobin to mean corpuscular volume: A new index for discriminating between iron deficiency anemia and thalassemia trait.

Iron deficiency anemia (IDA) and thalassemia trait (TT) are the most common microcytic and hypochromic anemias. Differentiation between mild TT and early IDA is still a clinical challenge. To develop and validate a new index for discriminating between IDA and TT. Blood count data from 126 patients, consisting of 43 TT patients and 83 IDA patients, was retrospectively analyzed to develop a new index formula. This formula was further validated in another 61 patients, consisting of 48 TT patients and 13 IDA patients. The new index is the ratio of hemoglobin to mean corpuscular volume. Its sensitivity, specificity, accuracy, Youden's Index, area under the receiver operating characteristic curve, and Kappa coefficient in discriminating between IDA and TT were 93.5%, 78.4%, 83.3%, 0.72, 0.97, and 0.65, respectively. This new index has good diagnostic performance in discriminating between mild TT and early IDA. It requires only two results of complete blood count, which can be a very desirable feature in under-resourced scenarios.

Optimizing Preoperative Iron Deficiency Anemia in Patients Undergoing Cardiac Surgery

Background: Preoperative anemia is common in patients undergoing cardiac surgery, with iron deficiency being the most common cause of anemia in these patients. Patients who are anemic in the preoperative setting have worse perioperative outcomes than patients with normal hemoglobin levels including higher rates of red cell transfusions, acute kidney injury, increased length of stay, and increased mortality. At the University of Virginia (UVA) Medical Center, there was no institutional process in place to identify and treat iron deficiency anemia in patients planned to undergo cardiac surgery. Objective: The UVA Perioperative Blood Management Committee is a newly-formed multidisciplinary group consisting of members from the departments of Hematology, Anesthesiology, Thoracic and Cardiovascular Surgery, Perfusion, and Blood Bank who work together to improve perioperative patient outcomes and blood product utilization. We set out to implement a testing algorithm with the purpose of improving the proportion of anemic patients undergoing cardiac surgery who have iron studies performed in the outpatient setting, thereby improving the percentage of patients receiving intravenous (IV) iron preoperatively. Methods: We adapted two published perioperative treatment algorithms (Lin, Hematology Am Soc Hematol Educ Program 2019; Munting and Klein, Anaesthesia 2019) which recommend iron therapy in patients with hemoglobin < 13 g/dL, ferritin < 100 µg/L, and/or transferrin saturation < 20% for our cardiac surgery preoperative clinic. In November 2022, we implemented a reflex test within Epic electronic medical record that automatically sent ferritin, iron, and transferrin for patients with hemoglobin < 13 g/dL to evaluate for iron deficiency. Patients meeting parameters for iron deficiency (ferritin < 30 ng/mL and/or transferrin saturation < 20%) were then scheduled for iron infusions. We compared the percentage of patients undergoing testing for iron deficiency, as well as the percentage of anemic patients receiving iron infusion preoperatively, to those from a six month period prior to our start date. Results: Between May 31, 2022 and October 31, 2022, 19% of cardiac surgery patients at UVA with hemoglobin values < 13 g/dL had iron studies drawn in the three months prior to surgery. After implementing outpatient reflex iron testing, that number increased to 42% between November 2022 and May 2023 (p < 0.001). In the six months prior to implementation, four iron deficient cardiac surgery patients received preoperative IV iron an average of one day prior to surgery. Between November 1, 2022 and May 29, 2023, fifteen patients received IV iron an average of 5.7 days prior to surgery. The patients who received IV iron had lower rates of blood transfusions than anemic patients who did not receive IV iron (53% vs. 65%) and fewer units of blood transfused per patient who received blood (3.1 vs. 5.7). Conclusions: Results from the first seven months of this project suggest that using a standardized testing methodology in the outpatient setting can increase the uptake of iron testing and thereby treatment of iron deficiency anemia in the preoperative setting. Patients who received IV iron had lower rates of blood transfusions and received fewer units of blood on average than anemic patients who did not receive IV iron. We next plan to implement an iron testing strategy in cardiac surgery inpatients to further improve rates of iron testing and iron infusions in this population. We have created an IRB-approved database to study more patient-centered outcomes such as acute kidney injury, stroke, length of stay, readmissions, and mortality to determine if we can detect a measurable impact from IV iron administration in our patient population.

Transferrin and Erythropoietin Increased Levels Correlate with Thrombosis at High Altitude

Living at high altitude involves great interest because of the challenging multiple adaptive responses to a hypoxic environment. Native Bolivian Andeans have lived at an altitude of 4000 m in The Andes mountains for about 14,000 years exposed to a low atmospheric pressure (453 mmHg) and low oxygen concentration (12,7%). It was described Andeans adaptation to high altitude is mainly related to cardiovascular issues (PMID: 29100088), with a low significantly genetic selection in HIF pathway components responsible of erythropoiesis regulation (PMID: 36980912), so that they have adapted to exist with increased hemoglobin concentrations. Thus, Andeans can be prevalent to undergone hematological and thromboembolic disorders. Thrombotic events have been reported to be increased at high altitude, and this recently associated to increased transferrin (Tf) (PMID: 36040436), likewise to increased erythropoietin (Epo) (Amaru, RevMed 2022). Increased Tf were described to be induced by both iron deficiency and hypoxia via HIF (PMID: 9242677). In addition, iron deficiency was postulated to inhibit the function of prolyl hydroxylase 2 (PHD2) in the hydroxylation of HIF-2, necessary for recognition and degradation by VHL (PMID:22304911). Under normal conditions, Tf is bound to fibrinogen at a molar ratio of 4:1, leading to plasma Tf sequestration by fibrinogen and leaving little Tf free in the circulation. While at hypoxia conditions, abnormally upregulated Tf potentiates thrombin, factor XIIa and inhibits antithrombin, inducing hypercoagulability (PMID:36040436). Similarly, increased HIF1a at high altitude increases Tf promoting the transferrin gene expression, which contains HIF-1α binding sites in its enhancer region (PMID:36844187). HIF is a DNA-binding transcription factor for activating expression of Epo gene (PMID:32561149). Epo, in turn, is increased due to the hyperegulation of HIF as expected at low atmospheric pressure environments. Epo activates the hypoxia-inducible factor that leads to Epo synthesis to stimulate red blood cell production, which also increases the demand for iron to synthesize hemoglobin (PMID:21078592). This, added to a decreased iron and increased HIF 1a, gives rise to a hyperregulation of Tf. Epo has been described to have prothrombotic properties and be related to thrombotic events (PMID:10779449; Amaru, RevMed 2022). In this sense, to further observe a correlation of transferrin and erythropoietin increased levels with the risk of thrombotic events at high altitude, we studied patients with erythrocytosis, anemia and polycythemia vera. We analyzed clinical, lab tests and epidemiological data of 920 patients with Chronic Mountain Sickness erythrocytosis (CMS-e) (n=560), anemia (n=372), and Polycythemia Vera (PV) (n=20), all Bolivian Andeans born and residing at 4000 m. Considering at this altitude normal hemoglobin concentrations vary from 14-17 g/dl in women and 15-18 g/dl in men, erythrocytosis condition comprises Hb levels >18 g/dl in women and >19 g/dl in men (Amaru et al, Rev Hematol Mex, 2016); similarly, it embraces Hb <12 g/dl for women and <13 g/dl for men in anemias (PMID: 23317073). Positive JAK F617V tests were corroborated in PV patients. Iron deficiency correlation considered serum ferritin <30 ug/L and MCV <80 fL (Clark et al, Nutrition, 2008). Eco-doppler study records confirmed the occurrence of thrombotic events. Data analysis was performed through Excel 16.29.1 and SPSS program, Chi-squared, Fishers and Pearson tests were done. We observed significative increased Tf levels in erythrocytosis, anemia, and PV patients mainly on those presenting iron levels deficiency. Epo was highly increased in erythrocytosis patients with iron deficiency. These results correlated with the incidence of thrombotic events in erythrocytosis (CMS-e) and anemia patients with iron deficiency. Age was also relevant in both groups. (Table 1). The increase of Epo levels correlated with thrombosis in erythrocytosis and PV patients with iron deficiency (Table 1). Transferrin and Erythropoietin increased levels at high altitude correlated with thrombosis in Chronic Mountain Sickness erythrocytosis and iron deficiency anemia patients. However, Increased Tf did not correlate with thrombosis in PV patients at high altitude. Our data confirm that increased Tf and Epo have prothrombogenic properties in CMS-e, iron deficiency anemia patients at high altitude.

Efficacy, Safety, and Tolerability of Iron Infusions in Pregnant Women: A Retrospective Chart Review

Background: Iron deficiency (ID) is the most common nutritional deficiency in pregnancy. Iron deficiency anemia (IDA) is also known to be a common problem among pregnant women, and it has been associated with maternal morbidity, peripartum complications, and impaired infant development. Pregnant women who have ID or IDA may benefit from iron infusions to optimize their iron stores more rapidly prior to delivery, however per the American College of Obstetricians and Gynecologists, oral iron is recommended first-line agent for IDA in pregnancy and treating ID without anemia (IDWA) in pregnancy is not currently recommended. IV iron for IDA is considered a second-line agent in pregnancy for many reasons: lack of data on the experience of iron infusions in U.S. pregnant women, lack of randomized trials in pregnant women, and FDA prescribing information labels for all iron formulations containing warnings about possible adverse effects. Also, there has been reluctance to prescribe newer iron formulations including Ferric Carboxymaltose (FCM), Ferumoxytol (FM), and Ferric Derisomaltose (FDI). Methods: In this single center case series, pregnant women in their 2nd or 3rd trimesters who had IDWA or IDA received iron infusions in an outpatient infusion center with nurses trained to monitor pregnant patients carefully for infusion reactions. Before the infusions, the women were assessed in a hematology consult for symptoms of ID, including shortness of breath, fatigue, and ice craving/ice chewing, as well as lab testing consistent with ID (ferritin<30 or iron saturation <16%) and anemia (hemoglobin<12). The iron formulation each woman received was determined by her health plan coverage and, in some cases, by her experience with prior iron infusions. Most women with IDWA were prescribed 400-500mg iron and most women with IDA were prescribed 1000mg iron. Two weeks after the final infusion, follow-up iron and blood counts were measured, and symptoms were re-assessed in a follow-up visit. Safety of iron infusions was determined by reviewing frequency of reactions that occurred during infusions (observed) including complement activation-related pseudoallergy (CARPA) and immune-mediated hypersensitivity reactions, as well as transient discomfort within the first few days after iron infusions (assessed by self-reports or reported during follow-up visits), as well as frequency of discontinuing the infusions. Results: 1,383 pregnant women with IDWA (n=69) or IDA (n=1,314) received a total of 2,971 iron infusions between June 2021 and June 2023, including Ferric Derisomaltose (FDI) 1000 mg single dose (n=417), two Ferumoxytol (FM) 510 mg doses (n=510), four Iron Sucrose (IS) 200 mg doses (n=1,661) or two IS 400 mg doses (n=383). No routine pre-medications were used. Among these pregnant women who received iron infusions, 94% reported improvement of one or more symptoms (shortness of breath, fatigue, or ice craving/ice chewing). Two weeks after the final infusion, 87% were found to have iron saturation greater than 15%, 83% were found to have ferritin above 30, and 88% were found to have increased hemoglobin compared to their pre-infusion hemoglobin. The average hemoglobin increase was 1.2 g/dL. IDA patients had higher hemoglobin increases than IDWA patients but similar increases in iron saturation and ferritin, regardless of iron formulation received. Iron infusions were usually well tolerated. The overall incidence of infusion reactions occurring during infusions, including CARPA reactions, was 4.5% (9.8% for FDI, 4.9% for FM, 1.4% for IS 200 mg doses, and 0.5% for IS 400mg doses). Five pregnant women (0.17%) discontinued iron treatments because of infusion reactions. The overall incidence of post-infusion discomfort symptoms was 22.5% (9.5% for FDI, 18.8% for FM, 31.3% for IS 200 mg doses, and 26.7% for IS 400 mg doses), including tiredness, headache, low back pain, leg swelling, or shortness of breath. Two women were evaluated in hospital ER's, one for hypotension during an iron infusion and one for hives after an iron infusion. There were no adverse events that impacted a woman's pregnancy. Conclusions: Iron infusions in pregnant women are effective, safe, and well-tolerated when administered in an outpatient infusion center that has nurses trained to monitor pregnant patients carefully for infusion reactions. For pregnant women who have IDWA or IDA, the benefits of iron infusions likely outweigh the risks.

Efficacy of Vitamin C with Iron Supplementation in Iron Deficiency Anemia Patients: A Systematic Review and Meta-Analysis

Background Oral iron supplementation is one of the mainstays of treatment for iron deficiency anemia (IDA) but can be complicated by poor absorption. Vitamin C is hypothesized to increase the acidity of the GI tract and enhance the conversion of non-absorbable ferric iron (Fe 3+) to its absorbable ferrous (Fe 2+) state for improved absorption and is often prescribed with iron. However, whether vitamin C supplementation translates to clinically relevant differences, such as sufficient improvements in hemoglobin, remains unclear and a synthesis of available evidence is lacking. Therefore, the present systematic review and meta-analysis aims to compare oral iron with or without vitamin C supplementation in patients with IDA. Methods MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials were searched from database inception to July 2023 for randomized controlled trials (RCTs) and non-randomized studies (NRSs) that investigated the use of oral iron supplements with vitamin C compared to oral iron supplements only in patients with IDA. Title & abstract, full text review and data extraction were conducted independently and in duplicate. The primary outcome was the change in serum hemoglobin levels in g/dL. Secondary outcomes include change in serum ferritin, change in transferrin saturation, change in reticulocyte percentage, and incidence of adverse events including constipation, nausea/vomiting, GI upset and poor taste. The Mantel-Haenszel fixed effects model was utilized for the meta-analysis. The calculated effect sizes were represented by odds ratios (OR) and mean differences (MD) for binary endpoints and continuous endpoints, respectively, with 95% confidence intervals (CI). Results 2231 studies were retrieved from electronic databases. 12 RCTs and one prospective cohort study comprising 2240 patients were included. There was a small but statistically significant increase in serum hemoglobin level (MD 0.14 g/dL [95%CI 0.08, 0.20]) and serum ferritin levels (MD 3.23 µg/L [95%CI 1.63, 4.84]) in the iron + vitamin C group compared to the iron only group. There was a greater reduction in serum transferrin saturation associated with vitamin C supplementation (MD -2.01% [95%CI -3.31, -0.71%]) but the pool of evidence consists of only two studies. Reticulocyte percentage (MD 0.22% [95%CI 0.08, 0.36]) was higher in the iron + vitamin C group than in the iron only group. There were no significant differences between the iron + vitamin C group and the iron only group in overall incidence of adverse effects (OR 0.71 [95%CI 0.50, 1.00]), constipation (odds ratio (OR) 0.83 [95%CI 0.35, 1.96]), or nausea/vomiting (OR 0.80 [95%CI 0.52, 1.24]). The risk of GI upset is lower in the iron + vitamin C group (OR 0.40 [95%CI 0.18, 0.92]). Nevertheless, only three primary studies reported on incidence of adverse events. Conclusion The addition of vitamin C to iron supplementation in the management of IDA was associated with a statistically significant, but likely clinically unimportant, increase in serum hemoglobin of 0.14 g/dL. Similarly, a statistically significant increase in serum ferritin levels by 3.23 µg/L was observed, but its clinical relevance remains uncertain. A strength of the present analysis is the number of RCTs included; however, its conclusions are limited by the heterogeneity of interventions (e.g. different formulations/dosage) across studies. Our results do not provide strong evidence for adding vitamin C to iron supplementation.

Abstract 18608: Using Electronic Medical Record Based Tools to Assess the Prevalence of Iron Deficiency, Iron Deficiency Anemia, and Treatment With IV Iron Among Patients With Decompensated Heart Failure

Introduction: Iron deficiency (ID) and iron deficiency anemia (IDA) are common among patients with heart failure (HF). They are associated with increased hospitalizations and all-cause mortality. Intravenous (IV) iron repletion has been associated with significant improvement in these outcomes, but is underutilized during HF admissions. Electronic medical record (EMR) based tools to increase recognition of ID and IDA in patients with HF and promote treatment with IV iron have not been described. We developed an EMR based tool to identify patients admitted with HF with ID and IDA who were candidates for IV iron repletion in an urban academic medical center. Hypothesis: ID and IDA are underdiagnosed and undertreated among patients admitted for HF. EMR based tools can be used to systematically identify patients with ID, IDA, and increase appropriate use of IV iron in patients with HF. Methods: Retrospective analysis of patients admitted with HF between March and May 2023. The EMR based tool defined HF by encounter diagnosis and use of IV diuretics, anemia by hgb of < 13 g/dl (male) and < 12 g/dl (female), ID by ferritin < 100 ng/ml or ferritin < 300 ng/ml and iron saturation < 20%, IDA by presence of ID and anemia, and if the patient received IV iron. Presence of HF, anemia, ID, IDA, and use of IV iron were confirmed by manual chart review. Results: The EMR based tool identified 116 patients admitted with a diagnosis of HF who received IV diuretics. In total, 103 (89.6%) had clinically decompensated HF by chart review. Three patients were excluded due to leaving AMA or on hospice. The average patient age was 63.8 years, 49 (50%) were male, and 50 (50%) were female, and 72 (73%) were African American (AA). In this sample, 81 (82%) had anemia, of which 47 (58%) had both ferritin and iron saturation levels collected during the admission. A total of 15 (19%) had no record for ferritin, iron saturation, or both. By including labs from prior admissions, a total of 64 (65%) of the 99 patients had ID while 57 (58%) had IDA. In total, 22 received IV iron (34% of patients with ID, 39% of patients with IDA). Conclusions: An EMR based tool can be used to identify patients with HF, ID, IDA, and the use of IV iron. ID and IDA are prevalent among patients with HF but remain underdiagnosed and undertreated.

Ferric derisomaltose and Outcomes in the Recovery of Gynecologic oncology: ERAS (Enhanced Recovery After Surgery) (FORGE) – a protocol for a pilot randomised double-blinded parallel-group placebo-controlled study of the feasibility and efficacy of intravenous ferric derisomaltose to correct preoperative iron-deficiency anaemia in patients undergoing gynaecological oncology surgery

IntroductionIron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment...

Efficacy and Safety of Intravenous Ferric Carboxymaltose Treatment of Iron Deficiency Anaemia in Patients with Corpus Atrophic Gastritis: A Retrospective Study.

Corpus Atrophic Gastritis (CAG) is characterised by iron malabsorption leading to iron deficiency anaemia (IDA), which rarely responds to oral therapy. Ferric carboxymaltose (FCM), shown to be a safe and effective intravenous iron therapy in other diseases, has not been investigated yet in CAG. Thus, we aimed to assess the safety and efficacy of FCM in CAG-related IDA. A retrospective study on 91 patients identified CAG as the only cause of IDA treated with FCM. Twenty-three were excluded for incomplete follow-up. Sixty-eight were evaluated for safety and efficacy, while three were evaluated for safety only due to infusion interruption for side effects. Haemoglobin and iron storage were evaluated pre-infusion (T0), at 4 weeks (T4) and 12 weeks (T12) after infusion. An eventual IDA relapse was analysed. Two cases reported mild side effects. Haemoglobin significantly increased at T4, and T12, reaching +3.1 g/dL. Ferritin increased at T4, decreasing at T12, while transferrin saturation increased progressively until reaching a plateau. IDA relapsed in 55.4% of patients at a mean of 24.6 months. The only factor associated with relapse was female gender [OR (95% CI): 6.6 (1.5-28.6)]. FCM proved to be safe and effective in treating CAG-related IDA, ensuring quick and long-lasting recovery.

Preoperative intravenous iron treatment – a cohort study on colorectal cancer recurrence

BackgroundIntravenous (i.v.) iron treatment has been speculated to increase the malignant potential of colorectal malignancies but also to enhance the immune systems potential to fight the invasive tumor. Clinical data however is very limited. We investigate if preoperative i.v. iron treatment is associated with colorectal cancer (CRC) recurrence. MethodsRetrospective cohort study on surgical CRC patients with iron deficiency anemia (1st March 2013 - 31st December 2019). Patients were grouped based on whether they had received preoperative treatment with i.v. iron. Local data was combined with data from the National Danish Health registries to identify recurrences, death, and emigration. Survival analysis, including Kaplan-Meyer curves and multivariate competing risk analysis adjusting for sex, age, ASA-group, tumor stage, surgical radicality, and miss match repair status was performed. ResultsOf 1228 patients, 125 were available for analysis. 89 patients had received preoperative i.v. iron and 36 had not. The two groups were comparable on baseline and surgical characteristics. Median follow-up times were 4.74 in iron treated patients and 5 years in patients not receiving iron treatment. Five-year rate of non-recurrence was 85 % (0.74–0.91) in the i.v. iron treated group vs. 82 % (0.64–0.91) in the control group, non-significant difference. Multivariate survival analysis did not find iron treatment to be associated with recurrence rates (Hazard Ratio 0.88 (95 % ci; 0.31–2.51). ConclusionNo association between preoperative i.v. iron treatment and the five-year cancer recurrence rate in iron deficient anemic CRC patients was found.

Effect of treatment of Helicobacter pylori with combination antibiotic therapy on iron deficiency anemia in patient with H. pylori-associated gastritis

Background: The failure to identify a cause of iron deficiency in a substantial subset of patients with low iron stores raises the question of whether there are additional as of yet unexplained causes of iron depletion. Recently, there has been a growing body of evidence to suggest a relationship between Helicobacter pylori gastritis and iron deficiency anemia (IDA) in the absence of peptic ulcer disease. Aims and Objectives: Therefore, the present study was undertaken to investigate the effect of treatment of H. pylori with combination antibiotic therapy on IDA in patient with H. pylori-associated gastritis. Materials and Methods: The present study was carried out at a tertiary care hospital catering to a large population in south Solapur and nearby areas. The study was conducted for 2 years. All patients with IDA attending outpatient department and admitted to the hospital for 2 years, were included in the present study. All patients who have IDA according to the World Health Organization criteria, as a hemoglobin concentration <13 g/dL for men and <12 g/dL for women, a mean corpuscular volume (MCV) <75 fL and a serum ferritin level < 30 ng/mL, both in-patient and outpatient setting were evaluated with detail history, clinical examination, and investigation. Results: Baseline hemoglobin (Hb) in group I is 8.99±1.23, while in group II 7.55±2.08.All the parameters are comparable in groups I and II except baseline Hb%. There is a significant increase in Hb, packed cell volume (PCV), MCV, mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC) after 2 months of treatment with oral iron therapy. There is a significant increase in Hb, PCV, MCV, MCH, and MCHC after 2 months of treatment with oral iron and triple therapy for H. pylori. Conclusion: Treatment of H. pylori infection was associated with more rapid and significant response to oral iron therapy in IDA as compared with the use of iron therapy alone.

Outcome of Iron Deficiency Anemia in patients presenting with Breath Holding Spellsat Lady Reading Hospital Peshawar

Aim: To ascertain the course of iron deficiency anemia in patients who presented to OPD and wards with breath-holding episodes. Methodology: From June 19 through December 18, 2019, the pediatrics department of Lady Reading Hospital in Peshawar conducted this study with ethical committee approval. The study included all kids aged 1 to 5 years, both genders, and those who had Cyanotic Breath spell lasting two or more episodes. Children with Cyanotic congenital heart disease, a history of febrile convulsions or epilepsy, anticonvulsive therapy currently being used, delayed children, and malnutrition in the past were not included in the study. Results: In our 161 patients, the average age was 2.671.811, the average weight was 12.913.33kg, and the average length of illness was 6.834.24 months. Males made up 94(58.4%) and females 67 (41.6%) of the patient population, while PICA children made up 72(44.7%). Iron deficiency anemia was present in 87(54%) of the patient population, but not in 74(46%), who had it. PICA children and children who were breastfed exclusively had a significantly higher correlation with iron deficient anemia. Conclusion: It is highly typical for patients who experience breath holding spells to have iron deficient anemia. These patients should receive an accurate diagnosis of iron deficiency anemia and treatment to soothe the parents' concerns and limit the frequency of unneeded hospital visits. Key words: iron deficiency anemia, breath holding spells, PICA child

ThTP7.5 An Assessment of Outcome in Patients with Anaemia (Iron Deficient and Non-Iron Deficient) Who Have Colon Cancer - Effect of treatment with Oral / IV Iron

Abstract Aim Treatment of iron deficiency anaemia in patients undergoing colon cancer resection improves outcome defined by length of stay (LOS), recurrence and requirements for blood transfusions. Method Retrospective analysis of patients with anaemia and colonic cancer between January 2018 - August 2019. Anaemia categorised as – Iron Deficiency Anaemia (IDA) and Non - Iron Deficiency Anaemia(non-IDA). IDA was defined as hypochromic microcytic anaemia. Patient demographics, tumour location, pre- and post-operative haemoglobin, LOS, recurrence, requirement for blood transfusions and treatment for anaemia were collected. Comparisons made between IDA and non-IDA groups in relation to treatment for anaemia with iron (oral/IV). Non-parametric statistical tests used (median, 2-way ANOVA, Kruskal-Wallis) with significance at P <0.05. Results 150 patients with colonic cancer identified: 77 in IDA group, 46 treated (42 oral, 4 iv iron). 11 in non- IDA group, 8 treated (oral iron). IDA oral and IV treatment versus non-IDA: Median age 74, 80 and 78 years (P = 0.814), Pre- and post op Hb IDA vs non-IDA: 107, 97; 109, 101 (P 0.007 significant), Requirement for blood transfusion (units) 0.77, 0.50;0.90 (P 0.596) Length of Stay (days) 6, 5; 7 (P 0.113), Tumour location: mean of right colon and transverse colon 24.33, 3.667 (P >0.1), and Recurrence P >0.1. Conclusion In our series, iron treatment does not influence recurrence, LOS, blood transfusion requirements. Tumour location is not significantly different between IDA and non-IDA groups. Patients treated with oral iron are seen to have a larger drop in haemoglobin post operatively than the other groups.

Adherence to ECCO Guidelines for Management of Iron Deficiency and Anemia in Inflammatory Bowel Diseases Among Israeli Adult and Pediatric Gastroenterologists.

The consensus guidelines of the European Crohn's and Colitis Organization (ECCO) for the diagnosis and treatment of iron deficiency anemia (IDA) were published in 2015. We examined the management practices of both adult gastroenterologists (AGs) and pediatric gastroenterologists (PGs) in Israel in treating ID among patients with inflammatory bowel disease (IBD). An 18-question multiple-choice anonymous questionnaire was electronically delivered to AGs and PGs. Questions explored 3 areas of interest: physician demographics, adherence to ECCO guidelines, and management practices of IDA in patients with IBD. Completed questionnaires were returned by 72 AGs and 89 PGs. Practice setting and years of practice were similar. A large majority of AGs and PGs (89% and 92%, respectively) measure complete blood count (CBC) and serum ferritin (S-Fr) at least every 3 months in outpatients with active IBD, as recommended by the ECCO guidelines. In contrast, in IBD patients in remission, only 53% and 26% of AGs and PGs, respectively ( P < 0.001), reported adherence to ECCO guidelines, measuring CBC and S-Fr every 6 months. The ECCO treatment guidelines recommend that intravenous (IV) iron should be considered the first-line treatment in patients with clinically active IBD, with previous oral iron intolerance and those with a hemoglobin level <10 g/dL. Study results indicate that only 43% of AGs recommend IV iron for these indications, compared to 54% of PGs ( P > 0.1). In this study we have demonstrated a relatively low level of adherence to ECCO guideline recommendations among both AGs and PGs, regarding the management of IDA in patients with IBD.

Patient-Reported Outcomes After Ferric Carboxymaltose Treatment for Iron Deficiency Anemia: A Prospective Observational Study.

Iron deficiency anemia (IDA) is a common cause of fatigue and impaired quality of life. The present study aimed to evaluate the impact of intravenous iron supplementation with ferric carboxymaltose (FCM) on fatigue, physical function, and general health among patients with IDA attending routine clinical care. This was a prospective, single arm, observational study of adult patients prescribed with intravenous FCM for the treatment of IDA during routine clinical care. We used Patient-Reported Outcomes Measurement Information System (PROMIS) instruments to evaluate fatigue (PROMIS Short Form v1.0 13a [FACIT-Fatigue]), general health status (PROMIS Scale v1.2), and physical function (PROMIS Short Form v2.0 4a) before and at 3 and 6 months after FCM treatment. A total of 152 patients were enrolled. Mean age was 47.4 ± 16.0 years and 82.2% were female. Mean serum hemoglobin was 10.2 ± 1.4 g/dL at baseline. All patients were treated with at least one FCM dose at baseline, with 77.6% receiving a two-dose treatment course. The mean baseline FACIT-Fatigue score was 61.0 ± 9.0, improving significantly to 50.2 ± 9.5 at 3 months after FCM treatment. A minimum 5-point improvement, pre-defined as clinically meaningful, was seen in the FACIT-Fatigue, PROMIS Global Physical Health, Global Mental Health and PROMIS Physical Function scores for 72.7%, 52.8%, 41.7% and 39.8% of patients at 3 months (p < 0.0001 for each change from baseline), with statistically significant improvement continuing at 6 months. Mean serum hemoglobin was significantly increased at both 3 and 6 months (12.8 g/dL [N = 44] and 12.4 g/dL [N = 54], respectively). IDA patients attending routine clinical practice reported substantial levels of fatigue and impairments in physical function and global health prior to intravenous iron treatment. Patients experienced significant improvements in fatigue symptoms, physical function, and global health at 3 months after treatment with FCM, which were sustained at 6 months.

Thyroid Function Status in Patient with Iron Deficiency Anaemia in A Tertiary Care Hospital of Lalitpur, Nepal

Introduction: Studies have found that iron deficiency anaemia (IDA) impairs thyroid hormone metabolism. The prevalence of thyroid dysfunction in adults in the general population ranges from 1 to 10 percent, and is even higher in selected groups. Thus, in this study we would like to see thyroid function status in people with IDA. Materials and Methods: It was Laboratory based cross sectional study conducted in the Department of Biochemistry of a tertiary care hospital of KIST Medical College and Teaching Hospital, Lalitpur, Nepal. Secondary data of 162 patients available in laboratory database of 3 years’ duration from August 2018 to August 2021 were taken. All Patients diagnosed with IDA whose thyroid profile was also done were included in the study. Data were entered in Microsoft Excel. Statistical analysis was performed using version 29 of the Statistical Package for Social Sciences (SPSS Inc, Chicago IL, USA). Results: Among 162 IDA patients, 86.4% (n=140) were females and 13.62% (n=22) were males. Age ranged widely from 19 to 88 years and median age was 38 years. Out of 162 patients most of the patients 68.5% were euthyroid, 8.7% had euthyroid hypothyroxinemia, 7.4% had primary hypothyroidism,3.7% had subclinical hypothyroidism, 3.1% had secondary hypothyroidism, 1.2% had primary hyperthyroidism, 1.2% had T3 toxicosis, 0.6% had euthyroid hyperthyroxinemia. Based on multiple independent KW test, relationship between category of thyroid disorders and iron profile as well as thyroid disorder and Hb level were found not to be statistically significant. No category of thyroid dysfunction was associated with value of haemoglobin level or severity of anaemia. Irrespective of category of thyroid profile including euthyroid, hypothyroid and hyperthyroid, no category is particularly associated with IDA. Conclusion: In patients with IDA, there is no significant association between Hb level or severity of iron deficiency irrespective of patient being euthyroid, hypothyroid or hyperthyroid.

Low Serum Hepcidin Levels in Patients with Ulcerative Colitis - Implications for Treatment of Co-existent Iron-Deficiency Anemia.

Ulcerative colitis (UC) is often associated with anemia. Hepcidin, the central regulator of iron homeostasis, is known to be induced by inflammation and suppressed by anemia. It is not clear how hepcidin is affected in those with UC, when both inflammation and anemia may co-exist.Such knowledge may hold implications for treatment. Hematological and iron-related parameters, C-reactive protein (CRP), growth differentiation factor 15 (GDF-15) and erythroferrone (ERFE) (erythroid regulators of hepcidin) levels were estimated in blood from those with UC and in control subjects. Values for hematological and iron-related parameters showed evidence of iron-deficiency and resultant anemia, in patients with UC. The presence of UC was significantly associated with inflammation. Serum levels of ERFE, but not of GDF-15, were significantly higher in patients with UC than in control patients, while hepcidin levels were significantly lower. Serum hepcidin concentrations in patients with UC correlated positively with serum iron, ferritin and GDF-15, and negatively with serum ERFE. The iron status and serum hepcidin levels in UC patients with co-existent anemia were significantly lower and serum ERFE values significantly higher than in those with UC without anemia. The effect of anemia on hepcidin predominated over that of inflammation in patients with UC, resulting in suppressed hepcidin levels. This effect is possibly mediated through erythroferrone. We suggest that a serum hepcidin-guided approach may be useful to guide use of oral iron supplements to treat co-existent iron-deficiency anemia in patients with UC and other chronic inflammatory diseases.

Evaluation and Comparison of the Effects of Low and High Doses of Herbal Medicinal Plant Emblic Myrobalan (AMLA) on Red Cell Parameters of Normal Healthy Rabbits

Objective: To study and compare the effects of low and high doses of Emblic myrobalan (Amla) on the red blood cells hemoglobin (Hb), packed cell volume (PCV) red cell count (RCC), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin Concentration (MCHC) of rabbits. Study Design: Laboratory based experimental study. Place and Duration of Study: Department of Pharmacology, and Animal House of Baqai Medical University Karachi Pakistan, from Jul to Aug 2016. Methodology: Twenty-seven male rabbits of 1-2kg body weight were taken and equally divided into 3 groups (group A, B and C). Group A served as control group; group B (Low dose group) was administered Amla at 2g/kg body weight while group C (High dose group) was administered Amla at 4g/kg body weight. Amla was mixed with water and administered orally with syringe for 60 days. Blood samples were drawn via cardiac puncture on day 61 for red cell parameters and reports were analyzed using Statistically Package for Social Sciences (SPSS) version 21. Results: Administration of low dose Amla resulted in significant increase in Hb (0.001) and PCV (0.001) compared to normal while high dose Amla produced significant increase in Hb (0.001), PCV (0.001), MCV (0.043), MCH (0.027) and RCC (0.001). Administration of high dose Amla showed significant improvement in red cell parameters compared to low dose Amla. Conclusions: Amla may be used to improve the red cell hemoglobin in patients of iron deficiency anemia