Treatment Of Iron Deficiency Anemia Research Articles

Recombinant erythropoietin for the treatment of iron deficiency anemia in pregnancy: A systematic review.

Treatment options for severe, refractory iron deficiency anemia are limited in pregnancy. To review the available literature on the use of recombinant erythropoietin in the treatment of iron deficiency anemia in pregnancy. An electronic search of seven databases from inception to March 2022 was performed using a combination of keywords. We included all randomized controlled or observational studies of pregnant patients with iron deficiency anemia who received recombinant erythropoietin or control. The primary outcome was a change in hematologic parameters (hemoglobin or hematocrit) after treatment. Studies were appraised using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Data were summarized using narrative synthesis and descriptive statistics as appropriate. This study was registered with PROSPERO, CRD42022313328. Of 234 studies screened, five studies met the inclusion criteria and had sufficient data for analysis (n = 103 recombinant erythropoietin and n = 104 controls). All patients in the intervention group received iron supplementation (intravenous or oral) in addition to recombinant erythropoietin. All patients in the control group received iron supplementation (intravenous or oral) alone. As the result of variance between studies in inclusion criteria, the timing of repeat blood draws, and data reporting, a meta-analysis could not be performed. Three studies found that serial recombinant erythropoietin combined with iron supplementation was more effective at raising hematologic laboratory parameters (hemoglobin or hematocrit) than iron alone. One study reported no difference in hemoglobin or hematocrit levels between groups at day 28. However, patients in this study only received one dose of recombinant erythropoietin, whereas those in the other studies received serial doses. Another study also found no difference in hemoglobin levels by day 28, but patients in the recombinant erythropoietin group had lower hemoglobin levels at baseline and a more rapid rise in hemoglobin than iron alone. This is demonstrated by a more significant rise in hemoglobin at day 11 in the recombinant erythropoietin group than in the control group. Serial recombinant erythropoietin administration and iron supplementation may be more effective at treating refractory iron deficiency anemia in pregnancy than iron supplementation alone.

The Effects of Prenatal Iron Supplementation on Offspring Neurodevelopment in Upper Middle- or High-Income Countries: A Systematic Review

Iron supplementation is commonly recommended for the prevention and treatment of maternal iron deficiency (ID) or iron deficiency anemia (IDA). However, the impacts of prophylactic of therapeutic prenatal iron supplementation on child neurodevelopment in upper middle-income (UMI) and high-income countries (HICs), where broad nutritional deficiencies are less common, are unclear. To investigate this, we conducted a systematic review, searching four databases (Medline, CINAHL, EMBASE, Cochrane Library) through 1 May 2023. Randomized controlled trials (RCTs) assessing oral or intravenous iron supplementation in pregnant women reporting on child neurodevelopment (primary outcome: age-standardized cognitive scores) were eligible. We included three RCTs (five publications) from two HICs (Spain and Australia) (N = 935 children; N = 1397 mothers). Due to clinical heterogeneity of the RCTs, meta-analyses were not appropriate; findings were narratively synthesized. In non-anemic pregnant women, prenatal iron for prevention of IDA resulted in little to no difference in cognition at 40 days post-partum (1 RCT, 503 infants; very low certainty evidence). Similarly, the effect on the intelligence quotient at four years was very uncertain (2 RCTs, 509 children, very low certainty evidence). No RCTs for treatment of ID assessed offspring cognition. The effects on secondary outcomes related to language and motor development, or other measures of cognitive function, were unclear, except for one prevention-focused RCT (302 children), which reported possible harm for children’s behavioral and emotional functioning at four years. There is no evidence from UMI countries and insufficient evidence from HICs to support or refute benefits or harms of prophylactic or therapeutic prenatal iron supplementation on child neurodevelopment.

Nanoplatforms derived from iron dextran combined with ascorbic acid for enhanced photothermal-chemodynamic therapy of tumors

The current limitations of chemodynamic therapy (CDT) are mainly due to the lack of metal ions (Fe2+, Cu+, etc.), glutathione overexpression, and insufficient hydrogen peroxide level in the tumor microenvironment. Here, we constructed a safe and effective nanoplatform (abbreviate as MPCF, M: 4T1 cell membranes; P: polydopamine; C: calcium phosphate; F: iron dextran) for tumor CDT applications based on ascorbic acid and iron dextran, which is clinically used in the treatment of iron deficiency anemia. The MPCF was fabricated by encapsulating iron dextran nanoparticles within porous calcium phosphate nanoparticle carriers and surface modifying with polydopamine and 4T1 tumor cell membranes. The MPCF can efficiently accumulate at tumor sites and gradually degrade to release the encapsulated iron dextran nanoparticles in response to the acidic tumor microenvironment. Intraperitoneally injected ascorbic acid not only generated hydrogen peroxide at the tumor site, but also synergistically acted with endogenous glutathione to reduce trivalent iron ions in the iron dextran to divalent iron ions, leading to depletion of the excess glutathione at the tumor site and amplification of oxidative stress effects. In addition, polydopamine-mediated photothermal therapy (PTT) can further enhance the CDT effect. In vitro and in vivo experiments demonstrated that the combination therapy of CDT and PTT based on the MPCF exhibited effective tumor inhibition and good biosafety properties. Therefore, the nanoplatforms prepared with the clinical drug iron dextran provide a new idea for the design of nanoprobes of tumor therapy with clinical translational potential.

A Propensity-Matched Cohort Study of Intravenous Iron versus Red Cell Transfusions for Preoperative Iron-Deficiency Anemia.

While preoperative anemia is associated with adverse perioperative outcomes, the benefits of treatment with iron replacement versus red blood cell (RBC) transfusion remain uncertain. We used a national database to establish trends in preoperative iron-deficiency anemia (IDA) treatment and to test the hypothesis that treatment with preoperative iron may be superior to RBC transfusion. This study is a propensity-matched retrospective cohort analysis from 2003 to 2023 using TriNetX Research Network, which included surgical patients diagnosed with IDA within 3 months preoperatively. After matching for surgery type and comorbidities, we compared a cohort of patients with preoperative IDA who were treated with preoperative intravenous (IV) iron but not RBCs (n = 77,179), with a cohort receiving preoperative RBCs but not IV iron (n = 77,179). Propensity-score matching was performed for age, ethnicity, race, sex, overweight and obesity, type 2 diabetes, hyperlipidemia, essential hypertension, heart failure, chronic ischemic heart disease, neoplasms, hypothyroidism, chronic kidney disease, nicotine dependence, surgery type, and lab values from the day of surgery including ferritin, transferrin, and hemoglobin split into low (<7 g/dL), medium (7-<12 g/dL), and high (≥12 g/dL) to account for anemia severity. The primary outcome was 30-day postoperative mortality with the secondary outcomes being 30-day morbidity, postoperative hemoglobin level, and 30-day postoperative RBC transfusion. Compared with RBC transfusion, preoperative IV iron was associated with lower risk of postoperative mortality (n = 2550/77,179 [3.3%] vs n = 4042/77,179 [5.2%]; relative risk [RR], 0.63, 95% confidence interval [CI], 0.60-0.66), and a lower risk of postoperative composite morbidity (n = 14,174/77,179 [18.4%] vs n = 18,632/77,179 [24.1%]; RR, 0.76, 95% CI, 0.75-0.78) (both P = .001 after Bonferroni adjustment). Compared with RBC transfusion, IV iron was also associated with a higher hemoglobin in the 30-day postoperative period (10.1 ± 1.8 g/dL vs 9.4 ± 1.7 g/dL, P = .001 after Bonferroni adjustment) and a reduced incidence of postoperative RBC transfusion (n = 3773/77,179 [4.9%] vs n = 12,629/77,179 [16.4%]; RR, 0.30, 95% CI, 0.29-0.31). In a risk-adjusted analysis, preoperative IDA treatment with IV iron compared to RBC transfusion was associated with a reduction in 30-day postoperative mortality and morbidity, a higher 30-day postoperative hemoglobin level, and reduced postoperative RBC transfusion. This evidence represents a promising opportunity to improve patient outcomes and reduce blood transfusions and their associated risk and costs.

Preparation and Performance Evaluation of Polysaccharide-Iron Complex of Eucommia ulmoides.

An innovative iron supplement crucial for treating iron-deficiency anemia was developed in this study. Polysaccharide was extracted from Eucommia ulmoides leaves using a microwave-assisted hot water method, and subsequently, the polysaccharide-iron complex was synthesized through co-thermal synthesis with FeCl3. The physicochemical properties, structure, and thermal stability of the complex were analyzed using FE-SEM, SEC-MALLS, FT-IR, XRD, and DSC techniques. Furthermore, the antioxidant activity of the polysaccharide-iron complex was evaluated through an experiment in vitro. The results revealed that the polysaccharide-iron complex had an iron content of 6.1% and an average particle size of 860.4 nm. The microstructure analysis indicated that the polysaccharide-iron complex possessed a flaky morphology with smooth and compact surfaces. Moreover, the formation of the Fe3+ complex did not alter the structural framework of the polysaccharide; instead, it enhanced the polysaccharide's thermal stability. Compared to traditional iron supplements, the E. ulmoides-derived polysaccharide-iron complex demonstrated significant antioxidant activity. Therefore, this novel compound exhibits significant potential as a viable iron supplement.

A Comparative Study between Efficacy of Ferric Carboxymaltose and Iron Sucrose Complex for Treatment of Iron Deficiency Anemia in Pregnancy

A Comparative Study between Efficacy of Ferric Carboxymaltose and Iron Sucrose Complex for Treatment of Iron Deficiency Anemia in Pregnancy

Preparation of Rehmanniae Radix Praeparata Polysaccharide Iron(III) Complex and Evaluation of Its Biological Activity.

This study extracted and purified a polysaccharide from Rehmanniae radix praeparata (RGP) with an average molecular weight. The structural characteristics of RGP and its iron (III) complex, RGP-Fe(III), were examined for their antioxidant properties and potential in treating iron deficiency anemia (IDA). Analysis revealed that RGP comprised Man, Rha, Gal, and Xyl, with a sugar residue skeleton featuring 1→3; 1→2, 3; and 1→2, 3, 4 linkages, among others. RGP-Fe(III) had a molecular weight of 4.39×104 Da. Notably, RGP-Fe(III) exhibited superior antioxidant activity compared to RGP alone. In IDA rat models, treatment with RGP-Fe(III) led to increased weight gain, restoration of key blood parameters including hemoglobin, red blood cells, and mean hemoglobin content, elevated serum iron levels, and decreased total iron-binding capacity. Histological examination revealed no observable toxic effects of RGP-Fe(III) on the liver and spleen. These findings suggest the potential of RGP-Fe(III) as a therapeutic agent for managing IDA and highlight its promising antioxidant properties.

Study the Effect and Safety of Oral Lactoferrin Therapy for Functional Iron Deficiency Anemia in Prevalent Hemodialysis Patients

Abstract Background Anemia is one of the main problems in hemodialysis patients, which is caused by inadequate production of erythropoietin. Functional iron deficiency (FID) anemia is a kind of anemia, which lack of functional iron therein leads to resistance and inappropriate response to erythropoietin in hemodialysis patients. Aim of the Work The aim of the present study was to study the effect and safety of oral lactoferrin therapy for functional iron deficiency anemia in prevalent hemodialysis patients. Patients and Methods This was Randomized clinical trial, was conducted at El Demerdash hemodialysis unit on 70 prevalent hemodialysis patients divided into 2 groups: (Group A): included 35 patients with functional iron deficiency anemia, received lactoferrin together with the recommended dose of ESA therapy for 3 months, (Group B): included 35 patients with functional iron deficiency anemia, received no lactoferrin apart from the recommended dose of ESA therapy for 3 months. Results There was no statistically significant difference between the two studied groups (group A and group B) as regard sex, occupation, residence and age. There was no statistically significant difference between the two studied groups (group A and group B) as regard height, weight and BMI. There was no statistically significant difference between the two studied groups (group A and group B) as regard history. There was no statistically significant difference between the two studied groups (group A and group B) as regard hemoglobin and WBCs. There was no statistically significant difference between the two studied groups (group A and group B) as regard PLT and Reticulocyte %. There was no statistically significant difference between the two studied groups (group A and group B) as regard ferritin, serum iron and TSAT. There was highly statistically significant difference between the two studied groups (group A and group B) as regard KT/V and URR at 3 months. There was nostatistically significant difference between the two studied groups (group A and group B) as regard KT/V and URR at baseline. Conclusion Oral lactoferrin could not be used as a substitute to totally replace IV ferrous sulphate in treating iron deficiency anemia in end stage renal disease (ESRD) on dialysis. Oral lactoferrin could not even control Hb level constant without dropping in patients with end stage renal disease (ESRD). Oral lactoferrin had some gastrointestinal effects on some patients which did not allow compliance on the medication.

Recurrence of Hepatocellular Carcinoma after Living Donor Liver Transplantation Prevalence, Patterns, Perioperative Factors and Outcome

Abstract Background Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third cause of cancer-related mortality world- wide. The incidence of HCC is on the increase, and it is a major threat to our modern life. Epidemiological studies have indicated that HCC are related to chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infection. Aim of the Work To detect prevalence, patterns, perioperative factors and outcome of recurrence of HCC after living donor liver transplantation. Patients and Methods This was a cross sectional study based on the review of medical records of all patients undergoing LT at Ain Shams Centre of Transplantation, between January 1, 2010, and December 31, 2018. Results we detected prevalence, patterns, perioperative factors and outcome of recurrence of HCC after living donor liver transplantation. Conclusion Oral lactoferrin could not be used as a substitute to totally replace IV ferrous sulphate in treating iron deficiency anemia in end stage renal disease (ESRD) on dialysis. Oral lactoferrin could not even control Hb level constant without dropping in patients with end stage renal disease (ESRD). Oral lactoferrin had some gastrointestinal effects on some patients which did not allow compliance on the medication.

Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia.

Iron is an essential nutrient and a constituent of ferroproteins and enzymes crucial for human life. Generally, nonmenstruating individuals preserve iron very efficiently, losing less than 0.1% of their body iron content each day, an amount that is replaced through dietary iron absorption. Most of the iron is in the hemoglobin (Hb) of red blood cells (RBCs); thus, blood loss is the most common cause of acute iron depletion and anemia worldwide, and reduced hemoglobin synthesis and anemia are the most common consequences of low plasma iron concentrations. The term iron deficiency (ID) refers to the reduction of total body iron stores due to impaired nutrition, reduced absorption secondary to gastrointestinal conditions, increased blood loss, and increased needs as in pregnancy. Iron deficiency anemia (IDA) is defined as low Hb or hematocrit associated with microcytic and hypochromic erythrocytes and low RBC count due to iron deficiency. IDA most commonly affects women of reproductive age, the developing fetus, children, patients with chronic and inflammatory diseases, and the elderly. IDA is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39% and 48.1% in developing countries). The diagnosis, management, and treatment of patients with ID and IDA change depending on age and gender and during pregnancy. We herein summarize what is known about the diagnosis, treatment, and prevention of ID and IDA and formulate a specific set of recommendations on this topic.

Comparative efficacy and safety of Chinese patent medicines of iron deficiency anemia during pregnancy: A network meta-analysis.

Iron deficiency anemia (IDA) is a prevalent nutritional disorder during pregnancy. Clinical studies indicate that incorporating Chinese patent medicines (CPMs) with oral iron (OI) in treating IDA in pregnancy can reduce adverse effects and improve clinical outcomes. Nonetheless, the comparative efficacy of different CPMs remains unclear. To assess the safety and effectiveness of different CPMs for treating IDA during pregnancy using network meta-analysis. We conducted a search for randomized controlled trials (RCTs) that combined CPM and OI for IDA treatment in pregnancy, spanning from 2013 to the present. Data analysis was performed using Rev Man 5.3 and Stata 14.0 on literature that satisfied the quality criteria. The analysis included 45 RCTs, encompassing 4422 pregnant patients with IDA. Six CPMs were examined, including Shengxuebao Mixture, Shengxuening Tablets (SXN), Yiqi Weixue CPMs (YQWX), Jianpi Shengxue CPMs (JPSX), Yiqi Buxue Tablets, and Compound Hongyi Buxue Oral Liquid (FFHY). Findings indicated that FFHY + OI significantly improved the clinical effective rate. SXN + OI was most effective in boosting red blood cells counts and hemoglobin levels. YQWX + OI showed superior results in improving serum ferritin, and SXN + OI was most effective in increasing serum iron levels. JPSX + OI was optimal in reducing adverse pregnancy outcomes, while YQBX + OI effectively minimized adverse events. A cluster analysis suggested that SXN + OI could be the potentially optimal therapeutic regimen for IDA in pregnancy. This study demonstrates that the combination of OI with CPMs offers better outcomes than OI alone. Based on clinical efficacy and other measured outcomes, SXN + OI emerges as the most effective treatment modality for improving the health of pregnant patients with IDA.

Iron-deficiency Anemia Treatment with Ferric Carboxymaltose: A Real-world Quasi-experimental Study from Bangladesh.

Miah MMZ, Pramanik MEA, Rafi A, et al. Iron-deficiency Anemia Treatment with Ferric Carboxymaltose: A Real-world Quasi-experimental Study from Bangladesh. Euroasian J Hepato-Gastroenterol 2024;14(1):12-15.

A retrospective audit to identify the cost & service implications of switching from Ferinject® to CosmoFer® for the treatment of iron deficiency anaemia

A retrospective audit to identify the cost & service implications of switching from Ferinject® to CosmoFer® for the treatment of iron deficiency anaemia

Ferric carboxymaltose: A game changer in the management of iron deficiency anaemia in pregnancy.

A single-arm prospective cohort (before-after) study among 60 antenatal women with moderate to severe anaemia in the second and third trimesters was conducted from December 2020 to December 2022, and the eligible women were given 1000 mg of intravenous FCM injection. Efficacy was assessed by rate of improvement in haemoglobin and ferritin at 2 weeks post infusion. Safety analysis was done by assessing adverse drug reactions and foetal heart monitoring during the infusion. A total 60 antenatal women with a median gestational age of 32.5 weeks at presentation received 1000 mg of intravenous FCM. There was a rise in mean haemoglobin from 8.05 gm% pre-infusion to 10.93 gm% 2 weeks post infusion, showing a mean rise of 2.88 gm%. Similar improvement was noted in mean serum ferritin levels from 25.92 pre-infusion to 253.96 post FCM infusion. There were no reports of drug-related major adverse effects in the mother or the foetus. FCM is found to be safe and effective treatment with rapid replenishment of haemoglobin and ferritin levels in a single dose, which makes it suitable and compels consideration as the first choice for treatment of iron-deficiency anaemia.

Efficacy of ferric carboxymaltose therapy in celiac patients

Aims: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA can be caused by reduced iron intake, impaired iron absorption or losses. Celiac disease can cause iron malabsorption by decreasing the surface absorption area in the duodenum and consequently can cause IDA. Oral or intravenous iron preparations are used in the treatment of IDA. In this study, we wanted to investigate the efficacy of ferric carboxymaltose (FCM) in celiac patients with RIA. Methods: Twenty-three patients who were followed up in the gastroenterology outpatient clinic of İnönü University Medical Faculty Hospital Turgut Özal Medical Center with the diagnosis of CD and who received FCM were included in the study. The hemogram, ferritin, iron and iron binding levels of the patients were retrospectively screened through the hospital medical record system. Results: Of the 23 patients included in the study, 3 (13.05%) were male and 20 (86.95%) were female. Hemoglobin concentration, iron and iron binding capacity before and after treatment showed a significant increase in all parameters after treatment. Ferritin value increased, although not significantly. Conclusion: In our study, we found that FCM is an effective and safe treatment modality in the treatment of IDA in celiac patients.

PREVALENCE AND MANAGEMENT OF IRON DEFICIENCY ANEMIA IN CHILDREN: A SYSTEMATIC REVIEW

Background: Even in affluent nations, IDA is still a significant public health issue, particularly for young children and women who are ready to have children. Aims: This systematic review is to review the treatment and prevalence of iron deficiency anemia in children. Methods: This study demonstrated compliance with all requirements by means of a comparison with the standards established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. Thus, the specialists were able to guarantee that the research was as current as feasible. Publications released between 2014 and 2024 were considered for this search strategy. This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub. It was determined that reviews, previously published works, and partially completed works would not be included. Result: In the PubMed database, the results of our search brought up 353 articles, whereas the results of our search on SCIENCE DIRECT brought up 8.865 articles, our search on SAGEPUB brought up 3.269 articles. The results of the search conducted for the last year of 2014 yielded a total 184 articles for PubMed, 4.071 articles for SCIENCE DIRECT and 1.144 articles for SAGEPUB. In the end, we compiled a total of 5 papers, 3 of which came from PubMed, 1 of which came from SCIENCE DIRECT and 1 of which came from SAGEPUB. We included five research that met the criteria. Conclusion: In summary, with its haematological repercussions of anemia, IDA is a prevalent and significant children health concern. To assess the effects of IDA on immunity and neurocognition, additional research is necessary. The key to successfully treating children with IDA is early identification and diagnosis of the condition together with competent interpretation of laboratory tests.

Randomized Controlled Trial of Intravenous Ferric Carboxymaltose vs Oral Iron to Treat Iron Deficiency Anemia After Variceal Bleed in Patients With Cirrhosis.

Limited evidence exists on the optimal strategy to correct iron deficiency anemia after variceal bleeding (VB) in cirrhosis. This trial compared the efficacy and safety of intravenous ferric carboxymaltose (IV-FCM) with those of oral iron therapy in this cohort. In this open-label, single-center, randomized controlled trial, eligible patients with hemoglobin <10 g/dL and iron deficiency (ferritin <100 ng/mL) after VB received either IV-FCM (1,500-2,000 mg) divided into 2 doses (n = 48) or oral carbonyl iron (100 mg elemental iron/day) (n = 44) for 3 months. The primary outcome was change in hemoglobin at 3 months. Secondary outcomes included improvement in anemia (last hemoglobin >12 g/dL), normalization of iron stores (ferritin >100 ng/mL), liver-related adverse events, adverse drug reactions, and changes in quality of life (CLDQOL questionnaire). Baseline characteristics, including median Child-Turcotte-Pugh score 7 (interquartile range [IQR] 6-9), Model for End-Stage Liver Disease score 12 (IQR 10-17), blood hemoglobin (8.25 ± 1.06 g/dL), and ferritin (30.00 ng/mL [15.00-66.50]), were comparable in both arms. The median increase in hemoglobin at 3 months in the IV and oral arms was 3.65 g/dL (IQR 2.55-5.25) and 1.10 g/dL (IQR 0.05-2.90 g/dL) ( P < 0.001), respectively. Iron stores normalized in 84.6% and 21% of the IV and oral arms, respectively ( P < 0.001). Anemia improved in 50% and 21.9% in the IV and oral arms, respectively ( P < 0.009). Patients in the IV arm showed a significant improvement in all domains of CLDQOL. Liver-related adverse events were comparable in both arms. Transient mild/moderate hypophosphatemia developed in 43% of patients receiving IV-FCM. Intravenous iron replacement is efficacious and safe to treat iron deficiency anemia after VB in patients with cirrhosis.

Selection of parenteral iron supplement for iron deficiency anemia: A review

The article reviews medicinal products for the treatment of iron deficiency conditions and iron deficiency anemia, the prevalence of which is about 30% among the world population. Iron deficiency is a significant cause of anemia, which can lead to hospitalization and even death. In case of intolerance or ineffectiveness of oral formulations of iron supplements, if it is necessary to replenish the iron level quickly, trivalent iron formulations for intravenous administration are used. These supplements are iron complexes with an iron hydroxide core surrounded by a carbohydrate shell. Iron formulations for intravenous administration can be divided into drugs of the "old" and "new" generation. One of the most studied and popular representatives of the "new" generation is iron carboxymaltose (ICM). The results of clinical studies showed that ICM better and faster increases hemoglobin concentration and replenishes iron stores in patients compared to the "old" generation formulations and also has a more favorable safety profile. Large doses of ICM can be administered in a short time, saving resources and increasing patient satisfaction. The injection of large doses of iron with a small number of infusions in the case of ICM is more economically beneficial for all departments of medical institutions, as it significantly reduces the total cost of medical care. Intravenous iron plays an essential role in the perioperative treatment of iron deficiency anemia, especially in elective surgery. Currently, there is a reliable evidence base confirming the efficacy and safety of intravenous iron formulations in chronic kidney disease, inflammatory bowel disease, heart failure, gynecological and obstetric diseases, and cancer.

The Importance and Essentiality of Natural and Synthetic Chelators in Medicine: Increased Prospects for the Effective Treatment of Iron Overload and Iron Deficiency.

The supply and control of iron is essential for all cells and vital for many physiological processes. All functions and activities of iron are expressed in conjunction with iron-binding molecules. For example, natural chelators such as transferrin and chelator-iron complexes such as haem play major roles in iron metabolism and human physiology. Similarly, the mainstay treatments of the most common diseases of iron metabolism, namely iron deficiency anaemia and iron overload, involve many iron-chelator complexes and the iron-chelating drugs deferiprone (L1), deferoxamine (DF) and deferasirox. Endogenous chelators such as citric acid and glutathione and exogenous chelators such as ascorbic acid also play important roles in iron metabolism and iron homeostasis. Recent advances in the treatment of iron deficiency anaemia with effective iron complexes such as the ferric iron tri-maltol complex (feraccru or accrufer) and the effective treatment of transfusional iron overload using L1 and L1/DF combinations have decreased associated mortality and morbidity and also improved the quality of life of millions of patients. Many other chelating drugs such as ciclopirox, dexrazoxane and EDTA are used daily by millions of patients in other diseases. Similarly, many other drugs or their metabolites with iron-chelation capacity such as hydroxyurea, tetracyclines, anthracyclines and aspirin, as well as dietary molecules such as gallic acid, caffeic acid, quercetin, ellagic acid, maltol and many other phytochelators, are known to interact with iron and affect iron metabolism and related diseases. Different interactions are also observed in the presence of essential, xenobiotic, diagnostic and theranostic metal ions competing with iron. Clinical trials using L1 in Parkinson's, Alzheimer's and other neurodegenerative diseases, as well as HIV and other infections, cancer, diabetic nephropathy and anaemia of inflammation, highlight the importance of chelation therapy in many other clinical conditions. The proposed use of iron chelators for modulating ferroptosis signifies a new era in the design of new therapeutic chelation strategies in many other diseases. The introduction of artificial intelligence guidance for optimal chelation therapeutic outcomes in personalised medicine is expected to increase further the impact of chelation in medicine, as well as the survival and quality of life of millions of patients with iron metabolic disorders and also other diseases.

Amino Acid Chelated Iron Versus Ferric Ammonium Citrate on Iron Status in Egyptian Children with Iron Deficiency Anemia: A Randomized Controlled Study

AbstractFew studies have compared the relative effectiveness of different iron compounds on iron status in school-age children with iron deficiency anemia. The objective of this study was to compare the effect of iron amino acid chelated (AACI) preparation versus ferric ammonium citrate (FAC) in treatment of iron deficiency anemia. Patients and methods: A randomized, clinical study was conducted on one hundred and sixty children aged 5–13 years old proved to have iron deficiency according to guide lines of WHO, 2001. All included children were subjected to the following laboratory investigations: CBC, reticulocytic count, CRP, serum iron, total iron binding capacity (TIBC), serum ferritin (SF), and serum hepcidin. Patients were assigned to two treatment regimens on randomized base 1:1 either to supplement with (AACI) or (FAC) once daily at bedtime. The subjects were followed up for eight weeks. Results: At the end of the study, group 1 who received AACI had increase in: Hb from 9.9 ± 1.1to 11.5 ± 0.3 gm/l(p = 0.01), MCV(fl) from 63.57.7 ± to 69 ± 6.3 (p = 0.05), serum iron from 49.5 ± 5.8 to 87 ± 12.7ug/dl(p = 0.001), serum ferritin from26.2 ± 10.5to 116.4 ± 19.7ng/ml(p = 0.001) while in group 2 who received FAC, there was increase in: HB from10.1 ± 1.7 to 11.2 ± 0.8, (p = 0.1), MCV from 64.5 ± 8.02 to 73.2 ± 8.9 (p = 0.01), serum iron from 48.2 ± 3.5to74 .3 ± 15 ug/dl (p = 0.01) and serum ferritin from 28.1 ± 9.3 to 84.3 ± 15.2 ng/ml (p = 0.006). Conclusion: Our study showed much improvement in iron status indices in AACI preparation with no significant statistically difference between it and FAC.