Iron Deficiency In Patients Research Articles

Prevalence and determinant of iron deficiency in the three main types of cardiac amyloidosis

Cardiac amyloidosis (CA), mainly comprised of light chain (AL), hereditary transthyretin (ATTRv) and wild-type transthyretin (ATTRwt) amyloidosis, is a severe and fatal systemic disease, characterized by accumulation of amyloid fibrils in various tissues/organs, including nerves, kidneys, gastrointestinal tract, and heart. Amyloid deposits in the heart eventually lead to heart failure (HF). Iron deficiency (ID) is common in patient with chronic HF and has been investigated. In contrast, data concerning ID in patients with CA is limited. We performed this study to determine the prevalence and determinants of ID among the three main subtypes of CA. ID status was analysed in 816 CA patients enrolled at the French Referral Center for Cardiac Amyloidosis: 271 (33%) had AL, 164 (20%) ATTRv and 381 (47%) ATTRwt. ID affected 49% of CA patients. We identified ATTR status, diabetes, aspirin treatment, haemoglobin levels, and altered global longitudinal strain as independent ID determinants. ID is quite common in patients with CA whatever the subtype. Patients seem more likely to have ID if diagnosed with ATTR, diabetic, and/or treated with aspirin. Further studies are needed to assess the benefit of ID treatment by intravenous iron therapy in CA.

Clinico-aetiological Analysis of Anaemia along with Haematological Parameters in Children and Adolescents: A Retrospective Study from a Tertiary Care Hospital, Chhattisgarh, India

Introduction: Anaemia is defined as a decreased concentration of blood haemoglobin. World Health Organization (WHO) estimates that 42% of children less than 5 years of age worldwide are anaemic and prevalence of anaemia in India in children 6-59 months for year 2019 was 53.4%. Childhood anaemia not only affects physical health but cognitive and social development as well. Aim: To determine various causes of anaemia in children in age groups 1-5 years, 6-12 years and 13 to 18 years and to determine clinical features and haematological investigations in moderate to severe anaemia. Materials and Methods: This retrospective, observational study was conducted in Department of Paediatrics, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Charttisgarh, India, from September 2021 to December 2021. The data collection was done retrospectively over a period of 2 years, from September 2019 to September 2021 from patients case records which were available from Medical Record Department. A total of 300 patients from age 1 year to 18 years who were admitted in the paediatric ward with anaemia were included for study. Anaemia was defined and severity categorised based on WHO definition. The aetiology of anaemia was analysed based on Complete Blood Count (CBC) and investigations including serum ferritin, vitamin B12 level, bone marrow examination, High Performance Liquid Chromatography (HPLC) and other relevant investigations. Data was entered in a excel sheet and analysed using software Statistical Package for the Social Sciences (SPSS) version 21.0. Statistical test used was student’s t-test for paired and unpaired data for continuous variables. The p-value <0.05 was considered significant. Results: Out of total 300 patients, 148 (49.3%) were males and 152 (50.7%) were females. Most of the patients were in 1-5 years of age (45.6%), followed by 13-18 years age (29.4%) and 6-12 years (25%). Total 95 (31.6%) patients had mild, 112 (37.3%) had moderate and 93 (31%) had severe anaemia. The three most common causes of anaemia were iron deficiency in 77 patients (37.5%), haemolytic anaemia in 54 patients (26.3%) and vitamin B12 deficiency in 34 patients (16.5%). Mean Red Cell Distribution Width (RDW )(31.1±10.1%) values and mean of Mean Corpuscular Volume (MCV) (98.2±15.2 fL) were higher in vitamin B12 deficiency patients as compared to iron deficiency patients mean RDW (17.2±3.5%) and mean of MCV (58.14±7.3 fL), this difference was found to be significant with p-value <0.001. Conclusion: Most of the patients had moderate anaemia. Iron deficiency was most common cause of anaemia overall in children and especially below 13 years followed by haemolytic anaemia mainly sickle cell anaemia and Vitamin B12 deficiency anaemia. The MCV and RDW values from CBC can be used to identify two most common causes of nutritional anaemia.

The value of erythropoietin in the pathogenesis of anemia of chronic diseases in the rheumatic patients

The features of erythropoietin secretion in patients with a rheumatic pathology and anemia of the chronic diseases in comparison with patients having iron deficiency anemia, as well as the relationship between erythropoietin, hepcidin, proinflammatory, and antiinflammatory cytokines, have been investigated. 126 patients suffering from the rheumatic pathology were examined, including 34 men aged 3655 years and 92 women aged 3860 years. At the same time, 104 (82.5%) patients suffered from anemia, 22 (17.5%) patients did not have it. Patients suffering from anemia, depending on the leading pathogenetic factor, were divided into three groups such as: the 1st group patients suffering from anemia of chronic diseases; 2nd grouppatients suffering from a combination of anemia of chronic diseases and iron deficiency anemia; 3rd grouppatients suffering from iron deficiency anemia. In patients suffering from anemia of chronic diseases, the maximum concentration of interleukin-6, hepcidin, and the minimum concentration of erythropoietin were detected in comparison with the patients suffering from iron deficiency anemia and patients suffering from anemia of chronic diseases, and iron deficiency anemia (p 0.05). The maximum concentration of the erythropoietin has been established in patients suffering from iron deficiency anemia. About the concentrations of interleukin-10 and interleukin-1, tumor necrosis factor-, interferon-, no differences were found in the study groups. A direct correlation was found between the erythropoietin and erythrocytes (r = 0.57), hemoglobin (r = 0.41), hepcidin (r = 0.65). There was a strong negative correlation between the erythropoietin and interleukin-6 (r = 0.75), and a weak relationship with interferon gamma, tumor necrosis factor alpha, interleukin-10, and interleukin-1 (r 0.3). Thus, for patients with a rheumatic profile, a specific molecular profile should be identified, leading to the development of anemia of the chronic diseases, which consists in increased concentrations of hepcidin and interleukin-6 in combination with the insufficient secretion of erythropoietin. The found changes fit into the structure of the previously proposed working version of the classification of anemia of chronic diseases (with a predominant iron deficiency, with disturbances in the regulatory mechanisms of the erythropoiesis, with an insufficient production of erythropoietin). Isolation of the leading factor in the development of anemia of chronic diseases in the future will allow for a more optimal approach to its correction, including with the targeted therapy drugs.

Acute heart failure and iron deficiency: a prospective, multicentre, observational study.

AimsThe prevalence and the natural course of iron deficiency (ID) in acute heart failure (AHF) are still unclear. We investigated the prevalence of ID in unselected patients admitted with AHF on admission, at discharge and up to 3 months thereafter.Methods and resultsIn this prospective, multicentre, observational study, 742 patients admitted with AHF were enrolled. The main study outcome was the percentage of patients with ID (ferritin <100 μg/L = absolute ID or ferritin 100–299 μg/L and transferrin saturation <20% = functional ID) at admission (T0), after clinical stabilization prior to discharge (T1), and 10 ± 6 weeks after discharge (T2). At T0, ID was present in 71.8% of the patients (44.1% absolute and 27.7% functional ID). At T1 and T2, ID was present in 56.4% (32.4% absolute and 24% functional ID) and 50.3% (36.8% absolute and 13.5% functional ID), respectively. Absolute ID persisted from T0 to T2 in 66% of the patients, while functional ID resolved in 56% of the patients. Ferritin (median [interquartile range] 124 μg/L [56–247] to 150 μg/L [73–277]), transferrin saturation (15% [10–20] to 18% [12–27]), and iron levels (9 μmol/L [6–13] to 11 μmol/L [8–16]) increased significantly (all P < 0.001) from T0 to T1. Transferrin saturation (to 21% [15–29]) and iron levels (to 13 μmol/L [9–17]) also increased significantly (both P < 0.01) from T1 to T2 without iron supplementation.ConclusionsIron deficiency is highly prevalent in patients with AHF, but resolves during treatment in some patients, even without iron supplementation. Absolute ID is more likely to persist over time, whereas functional ID often resolves during treatment of AHF, representing probably a reduced iron availability rather than a true deficiency.

The Impact of Intravenous Iron on Renal Injury and Function Markers in Patients With Chronic Kidney Disease and Iron Deficiency Without Anemia

The Impact of Intravenous Iron on Renal Injury and Function Markers in Patients With Chronic Kidney Disease and Iron Deficiency Without Anemia

Abstract 11864: Ironing Out the Details: Increasing the Screening of Iron Deficiency in Heart Failure Patients and the Promotion of Intravenous Iron Replacement

Background: The American College of Cardiology (ACC) recommends intravenous iron replacement (IVIR) in patients with iron deficiency (ID) and heart failure with reduced ejection fraction (HFrEF). IVIR, in patients with HFrEF and ID, is associated with improvement in patient symptoms, functional capacity, 6-minute walk distance, and quality of life. Emerging data demonstrates IVIR can reduce hospital admissions for HFrEF. The purpose of this study is to enhance screening of ID in the HFrEF population and IVIR in the inpatient setting. Methods: This is a single-center, retrospective chart review using ICD 10 codes I50.2 and I50.42 to query the diagnosis of HFrEF in admissions from January 2018 to June 2020. Patients with recent major surgery within the last three months, use of erythropoietin stimulating agents, blood transfusions within a six-week time period, a history of cirrhosis, and/or a diagnosis of end stage renal disease receiving IVIR were excluded. ID in HFrEF is defined as ferritin &lt;100 micrograms/L or a ferritin of 100-299 micrograms/L with transferrin saturation of &lt;20%, per ACC guidelines. Further analysis was performed on 150 of 600 admissions pulled. Results: Of the 150 admissions analyzed, 108 of 150 were due to decompensated HFrEF and only 22 of the 150 had iron studies performed during admission. Approximately 15 of 22 patients with iron studies had a diagnosis of ID and only 1 of the 15 patients was initiated on IVIR. Additionally, 22 of the 150 total patients were on oral iron replacement and were not placed on IVIR. Discussion: Work-up of ID in patients with HFrEF is frequently omitted in the inpatient setting. In patients that have been diagnosed with ID, few receive appropriate treatment. There should be increased efforts to identify and administer IVIR to hospitalized patients with HFrEF and ID once their acute decompensation has been stabilized. This study aims to increase usage of HFrEF order sets on admissions by including iron studies within the workflow. The initiative includes administering first doses of IVIR in the hospital with subsequent transition to the outpatient setting, providing patient/provider education, and offering clinical decision support at time of ordering.

Abstract 9127: The Impact of Iron Deficiency on Long-Term Outcomes in Patients with Acute Decompensated Heart Failure

Introduction: Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF). However, the significance of ID as a prognostic factor has not been fully elucidated in patients with acute decompensated heart failure (ADHF). Hypothesis: ID is associated with a high cardiovascular event risk in ADHF. Methods: We retrospectively reviewed the ADHF patients who admitted to our hospital between December 2014 and March 2018. ID was defined as TSAT (transferrin saturation) &lt; 20% at discharge. Primary outcome measure was a composite of all-cause death and HF rehospitalization. Patients who died or underwent transfusion during index hospitalization were excluded from the analysis. Results: Among 256 patients who enrolled in the analysis, 119 patients (46.5%) had ID and 137 patients (53.5%) did not. Patients with ID had significantly lower hemoglobin levels (11.0 vs 12.1g/dl; p&lt;0.01) and estimated glomerular filtration rates (42.3 vs 48.1 ml/min/m2; p&lt;0.01) than non-ID patients. During the median follow-up period of 2.8 years, patients (30.1%) died and 96 patients (37.5%) re-hospitalized for HF. Although HF rehospitalization was numerically higher in ID patients than in non-ID patients (44.5% vs 31.4%, p = 0.03), Kaplan-Meier analysis showed comparable risks for all-cause death (log-rank p=0.67) and HF rehospitalization (log-rank p=0.90) between ID and non-ID patients. Conclusions: ID in patients with ADHF were common and associated with anemia and renal impairment. However, ID might not be a significant prognostic factor in ADHF patients.

Abstract 12675: Intravenous Iron Decreases Rehospitalizations but Doesn’t Change Mortality in Patients Admitted With Acute Heart Failure and Iron Deficiency: A Systematic Review and Meta-Analysis

Introduction: The role of intravenous (IV) iron in chronic heart failure has been well studied, however, its role in acute heart failure (AHF) is lesser well-known. Including the recent late breaking AFFIRM-HF trial, we performed a systematic review and meta-analysis to highlight the role of IV iron in AHF in iron deficiency. Hypothesis: We hypothesized that IV iron doesn’t change mortality or heart failure re-hospitalization rates in patients with AHF with iron deficiency. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies published from inception till May 8, 2021. We searched PubMed, MEDLINE, EMBASE (embase.com), and Cochrane database including only RCTs and Cohort studies. We included one prospective and one retrospective Cohort studies and two RCT in our meta-analysis. Eligible studies included adults with AHF, LVEF less than 40%-50%, and able to receive iv iron therapy. Outcomes included re-hospitalization rates and overall mortality from 30 days to 52 weeks post randomization (in one RCT). We used random-effects model calculating Risk Ratio (RR) with 95% confidence interval (95%CI) using Review Manger 5.4 software. I 2 statistics was used to assess heterogeneity. Results: There were total 1561 participants in both groups (iv iron and placebo/control) of four studies. The controls were comparable in both cohort studies and both the RCTs were well matched. Our results showed re-hospitalization in 278 of 833 (33.37%) patients in the IV iron/exposure group and 337 of 728 (0.46%) patients in the placebo/control group. The pooled result showed that the risk of rehospitalization was comparable across both groups (RR 0.85, 95%CI 0.62-1.17; I 2 =45%, P=0.14). However, subgroup analysis, including RCTs only showed that iv iron decreases re-hospitalization rate by 28% compared to placebo (RR 0.72, 95% CI: 0.64, 0.82, I 2 =0%, P&lt;0.00001) but didn’t improve mortality when compared to placebo (RR 0.97, 95% CI: 0.73, 1.30, I 2 =0%). Conclusions: IV iron showed significant improvement in re-hospitalization rate for AHF hospitalizations in iron deficient patients but didn’t improve overall mortality. We need larger RCTs to further validate its effect on mortality.

Pediatric Heart Failure: Cardiac Ejection Fraction with Cardiomyopathy Decreased to 21% in Iron Deficient from 37% in Iron Sufficient Children

▪Introduction: The overall aim of our study was to determine if iron deficiency has harmful effects on cardiac function in children with chronic heart failure. Heart failure in children is a complex, heterogeneous disorder leading to a final common pathway of cardiomyocyte dysfunction and attrition. Cellular, animal, and human studies have shown that iron deficiency causes cardiomyocyte dysfunction that can be reversed with iron treatment. Cellular studies of human iron-deficient cardiomyocytes have shown that supplemental iron restores impaired contractility and relaxation. Animal studies have found that cardiomyocyte-specific deletions or alterations of critical iron proteins (transferrin receptor 1, hepcidin, ferroportin) produce cardiomyocyte iron deficiency (without anemia) and result in ultimately fatal cardiac dysfunction that can be rescued with intravenous (IV) iron. Over half of adults with chronic heart failure are iron deficient. Meta-analysis of small randomized clinical trials has shown that IV iron significantly reduces recurrent hospitalization, cardiovascular mortality, and all-cause mortality in iron deficient adults with heart failure. European Society of Cardiology, American College of Cardiology and American Heart Association guidelines recommend consideration of IV iron therapy for adult iron-deficient patients with heart failure.The prevalence and consequences of iron deficiency in children with heart failure have not been established. Previously, two small retrospective studies of children with heart failure have reported that 56% to 96% were iron deficient, with increased morbidity and mortality. The goals of our study of children with heart failure were to determine (i) how often iron status is assessed, (ii) the prevalence of iron deficiency, and (iii) the effects of iron deficiency on cardiac function in patients with cardiomyopathy.Methods: We retrospectively reviewed electronic medical records to identify pediatric patients ages 1-21 years old seen at Columbia University Irving Medical Center Pediatric Heart Failure clinic with absolute iron deficiency during 2010-2020. Heart failure was defined as presence of symptoms or systolic dysfunction by echocardiography. Patients were excluded with a history of heart transplant, isolated diastolic failure, or renal failure requiring dialysis. In adults with heart failure, a transferrin saturation <20% has a sensitivity of 94% and a specificity of 84% in identifying absolute iron deficiency, as determined from a bone marrow aspirate, and iron stores were present in 100% of patients with a transferrin saturation ≥30% (Circ Heart Fail. 2018;11:e0045). In children with heart failure, we used these criteria to define absolute iron deficiency as a transferrin saturation <20% and iron sufficiency as a transferrin saturation ≥30%.Patients with an intermediate transferrin saturation are likely a mixture of absolute and functional iron deficiency, and of iron sufficiency and were excluded from our analysis of cardiomyopathy. Cardiac ejection fraction was evaluated by an echocardiogram performed within 3 months of measurement of transferrin saturation.Results: Of 579 patients with heart failure, only 159 (27%) had any type of laboratory iron studies. Of patients with iron studies, 81 (51%) were evaluated as outpatients; 49% as inpatients. The cause of heart failure was cardiomyopathy (52%), congenital heart disease (34%), acute myocarditis (6%), and other (8%).In the 82 patients with heart failure due to cardiomyopathy, 39 (48%) were iron deficient and 16 (20%) iron sufficient. In the iron deficient children with cardiomyopathy, the left ventricular ejection fraction was lower than in the iron sufficient patients (median 21% vs. 37%; p=0.03 (Mann-Whitney); Figure). The groups did not differ significantly with respect to hemoglobin (Figure), sex, age, or New York Heart Association class.Conclusion: We report a clinically important decrease in cardiac ejection fraction in children with heart failure due to cardiomyopathy who have absolute iron deficiency. Potentially, iron treatment could safely and effectively reverse the harmful effect of iron deficiency on heart function and prospective randomized trials of oral and intravenous iron therapy are urgently needed. Measurement of iron status should routinely be included in the evaluation of children with heart failure. [Display omitted] DisclosuresNeunert: Novartis: Research Funding.

The role of iron supplementation in reducing all-cause mortality of heart failure patients with iron deficiency: a systematic review and meta-analysis

Abstract Background Many heart failure patients also suffer from anemia suggesting potential therapeutic targets. However, the role of iron supplementation in patients with heart failure with iron deficiency in reducing all-cause mortality remains unclear. Purpose We aim to compare the risk of all-cause mortality in iron deficient heart failure patients who were given iron therapy versus placebo. Methods We systematically searched for RCTs comparing Fe supplementation with placebo in heart failure patients with iron deficiency from PubMed, Scopus, Science Direct, and ProQuest up to March 2021. The inclusion criteria was Randomized Controlled Trial Study with outcome of all-cause mortality. The exclusion criteria were observational studies, animal studies, and studies without English language. Odds ratio (OR) was calculated with 95% confidence interval (CI), while heterogeneity was assessed using the I2 statistics. The primary outcome was all-cause mortality. Data from eligible studies were pooled for effect estimates. Statistical analysis was performed using Review Manager software. Results From literature search, 7 RCTs were obtained. The total patients used for pooled analysis were 1192 patients receiving iron therapy and 973 patients receiving placebo. Pooled analysis using a random-effect model showed that iron therapy use was not associated with better all-cause mortality in heart failure patients with iron deficiency (OR: 0.91; 95% CI: 0.68–1.23; p: 0.56; I2: 0%). The funnel plot was asymmetric, suggesting presence of publication bias. Conclusion No benefit of Fe supplementation in reducing all-cause mortality of heart failure patients with iron deficiency. Funding Acknowledgement Type of funding sources: None. Pooled analysis for all-cause mortality

Effect of Iron deficiency on health-related quality of life in chronic heart failure patients regardless of anaemia status

Abstract Background Chronic Heart Failure (CHF) patients have marked functional limitations causing a significant impact on Health Related Quality of Life (HRQoL) in these patients. Iron Defeciency is very common in Heart Failure patients &amp; it is suggested that it affects HRQoL in CHF patients regardless of the Anemia status . Objective To evaluate the impact of iron deficiency (ID) on health-related quality of life (HRQoL) in chronic heart failure (CHF) patients using Minnesota Living with Heart Failure questionnaire (MLHFQ) in patients with normal hemoglobin levels . Methods From October 2018 to August 2019 ,100 patients with CHF from out- patient clinics in ASU university hospitals were subjected to history taking , examination , Echocardiography , measurement of Iron status using serum ferritin, Assessment of Health Related Quality of Life (HRQoL) using Minnesota Living with Heart Failure Questionnaire (MLHFQ) . Patients then were divided into 2 equal groups depending on their serum ferritin level &amp; comparison of MLHFQ score between the 2 groups was done . Results The study population was divided into 2 groups: Iron Defecient (ID) (n = 50) &amp; non Iron Defecient (non ID) (n = 50) , 61 patients were males &amp; 39 were females. The MLHFQ scores were 66.9 ± 9.1 among ID patients vs 46.9 ± 7.3 in non ID patients (p value &amp;lt; 0.001) indicating worse HRQoL in ID group . The physical domain (p value &amp;lt; 0.001) was markedly affected than the emotional domain (p value 0.006) of the MLHFQ score . Conclusion In CHF patients , HRQoL was markedly affected among ID patients than non ID patients with physical factors more affected than the emotional factors .

In patients with acute HF and iron deficiency, IV ferric carboxymaltose improved quality of life at 4 to 24 wk.

Jankowska EA, Kirwan BA, Kosiborod M, et al. The effect of intravenous ferric carboxymaltose on health-related quality of life in iron-deficient patients with acute heart failure: the results of the AFFIRM-AHF study. Eur Heart J. 2021;42:3011-20. 34080008.

A case study of Human iron deficiency Anaemia in different age groups from Ujjain (M.P.) India

Iron deficiency Anaemia is the most common case of nutritional Anaemia worldwide and is a public health problem in developing countries; characterized by abnormal red cell count (MCV, MCHC). Iron deficiency Anaemia associated with fatigue, skin paleness, weakness etc. The aim of the study is to determine the risk factors for iron deficiency Anaemia among population of Ujjain district (M.P.). Both male and female iron deficient patients were studied from the SS hospital and CHL applo hospitals during Jan. 2012 to Dec. 2012. A group of 6828 patients were studied for iron deficiency Anaemia in different age groups. A total of 4549 female and 2279 males were studied. Information was collected about sex, socioeconomic level. It is inferred that the percentage of anaemia is more in women compared to men.

Effect of iron supplementation in patients with heart failure and iron deficiency: A systematic review and meta-analysis.

BackgroundThe effectiveness of oral and intravenous iron supplementation in reducing the risk of mortality and hospitalizations in HF patients with iron deficiency is not well-established.MethodsA thorough literature search was conducted across 2 electronic databases (Medline and Cochrane Central) from inception through March 2021. RCTs assessing the impact of iron supplementation on clinical outcomes in iron deficient HF patients were considered for inclusion. Primary end-points included all-cause mortality and HF hospitalization. Evaluations were reported as odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CI) and analysis was performed using a random effects model. I2 index was used to assess heterogeneity.ResultsFrom the 2599 articles retrieved from initial search, 10 potentially relevant studies (n = 2187 patients) were included in the final analysis. Both oral (OR: 0.93; 95% CI: 0.08–11.30; p = 0.951) and intravenous (OR: 0.97; 95% CI: 0.73–1.29; p = 0.840) iron supplementation did not significantly reduce all-cause mortality. However, intravenous iron supplementation significantly decreased the rates of overall (OR: 0.52; 95% CI: 0.33–0.81; p = 0.004) and HF (OR: 0.42; 95% CI: 0.22–0.80; p = 0.009) hospitalizations. In addition, intravenous ferric carboxymaltose therapy significantly reduced the time to first HF hospitalization or cardiovascular mortality (RR = 0.70; 95% CI = 0.50–1.00; p = 0.048), but had no effect on time to first cardiovascular death (RR: 0.94; 95% CI: 0.70–1.25; p = 0.655).ConclusionOral or intravenous iron supplementation did not reduce mortality in iron deficient HF patients. However, intravenous iron supplementation was associated with a significant decrease in overall and HF hospitalizations.

Prevalence of iron deficiency and red blood cell transfusions in surgical patients.

Background and ObjectivesWhile iron deficiency (ID) is the most common cause of anaemia, little is known about the prevalence and type of ID in preoperative surgical patients. The aims of the present study were to investigate the prevalence and types of ID in a large cohort of surgical patients, and how these are related to perioperative blood use after correction for confounders such as haemoglobin level.Materials and MethodsData were retrospectively extracted from electronic case records of all patients who underwent elective surgery between September 2016 and November 2017 (n = 2711). Iron parameters, haemoglobin and details of perioperative red cell transfusions were collected.ResultsOf 2711 patients, 618 (22.8%) were iron deficient (= transferrin saturation [TSAT] < 16%) preoperatively, 173 (6.4% of the cohort) had an absolute iron deficiency (AID; TSAT < 16% and ferritin < 30 μg/L) and 445 (16.4%) had functional/mixed ID (TSAT < 16% and ferritin ≥ 30 μg/L). Corrected for Hb level, iron‐deficient patients received significantly more red cell units than patients without ID (p = 0.026). AID was not associated with a significantly higher incidence of transfusions (7.5% of patients transfused; p = 0.12 after correction for Hb) than patients without ID, whereas patients with functional/mixed deficiency did receive significantly more transfusions (6.1%; p = 0.021) as compared to patients without ID (1.7%).ConclusionPreoperative ID, in particular the functional/mixed type, was associated with a higher risk of receiving perioperative red cell transfusions as compared to patients without ID. Adequately treating ID might, therefore, reduce the need for perioperative red cell transfusions.

Iron therapy in iron-deficiency patients with heart failure with preserved ejection fraction: A protocol for meta-analysis.

Background:Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality and morbidity of patients with HF with preserved EF (HFpEF) are high. However, there is no established therapy to improve survival in these patients. HFpEF patients are often elderly and their primary chronic symptom is severe exercise intolerance. Thus, improvement of exercise capacity presents another important clinical outcome in HFpEF patients. Iron deficiency is common in HF patients, and the presence of iron deficiency, regardless of concomitant anemia, is associated with worse symptoms, impaired exercise capacity, and higher mortality and hospitalization in these patients. Several meta-analyses of randomized controlled trials reported that iron administration improved HF symptoms, exercise capacity, and clinical outcomes in iron-deficiency patients with HF with reduced EF. However, there is insufficient evidence as to the effect of iron administration in iron-deficiency HFpEF patients.Methods and Results:This meta-analysis will include randomized controlled trials on the effects of iron administration on HF symptoms, exercise capacity, and health-related quality of life in iron-deficiency HFpEF patients. Information of studies will be collected from PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov. The primary outcome will be exercise capacity (6-minute walking distance). The secondary outcomes will be HF symptoms, health-related quality of life, and mortality and hospitalization rates.Conclusion:This meta-analysis will evaluate the effect of iron therapy in iron-deficiency HFpEF patients, providing evidence as to the iron administration in these patients.Systematic review registration:PROSPERO CRD42020205297.

Anemia in Cardiovascular Disease: Marker of Disease Severity or Disease-modifying Therapeutic Target?

In this review paper, we examine the latest evidence regarding the use of iron supplementation, erythropoiesis-stimulating agents (ESAs), and blood transfusions as therapeutic targets for anemia to mitigate morbidity and mortality in patients with cardiovascular disease. Intravenous ferric carboxymaltose (FC) injections in heart failure (HF) have resulted in improved self-reported patient symptoms; higher exercise capacity, as measured by 6-min walk test distance in anemic patients; and lower re-hospitalization rates in iron deficient patients. Darbepoetin alfa has shown evidence of improved Kansas City Cardiomyopathy Questionnaire scores. No mortality benefits have been noted thus far with FC injections or darbepoetin in HF, with an increase in adverse events with darbepoetin. Aggressive transfusions (Hg < 10g/dL) are not associated with improved outcomes in cardiovascular disease. Quality of life metrics, rather than mortality, appear to improve with IV FC and ESA use in HF. More studies are required to see if these treatments have a role in coronary artery disease. Current evidence suggests that anemia is a marker of underlying disease severity, with a limited role in disease modification. Further studies are required to solidify our understanding of this topic.

The effect of intravenous ferric carboxymaltose on health-related quality of life in iron-deficient patients with acute heart failure: the results of the AFFIRM-AHF study.

AimsPatients with heart failure (HF) and iron deficiency experience poor health-related quality of life (HRQoL). We evaluated the impact of intravenous (IV) ferric carboxymaltose (FCM) vs. placebo on HRQoL for the AFFIRM-AHF population.Methods and resultsThe baseline 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12), which was completed for 1058 (535 and 523) patients in the FCM and placebo groups, respectively, was administered prior to randomization and at Weeks 2, 4, 6, 12, 24, 36, and 52. The baseline KCCQ-12 overall summary score (OSS) mean ± standard error was 38.7 ± 0.9 (FCM group) and 37.1 ± 0.8 (placebo group); corresponding values for the clinical summary score (CSS) were 40.9 ± 0.9 and 40.1 ± 0.9. At Week 2, changes in OSS and CSS were similar for FCM and placebo. From Week 4 to Week 24, patients assigned to FCM had significantly greater improvements in OSS and CSS scores vs. placebo [adjusted mean difference (95% confidence interval, CI) at Week 4: 2.9 (0.5–5.3, P = 0.018) for OSS and 2.8 (0.3–5.3, P = 0.029) for CSS; adjusted mean difference (95% CI) at Week 24: 3.0 (0.3–5.6, P = 0.028) for OSS and 2.9 (0.2–5.6, P = 0.035) for CSS]. At Week 52, the treatment effect had attenuated but remained in favour of FCM.ConclusionIn iron-deficient patients with HF and left ventricular ejection fraction <50% who had stabilized after an episode of acute HF, treatment with IV FCM, compared with placebo, results in clinically meaningful beneficial effects on HRQoL as early as 4 weeks after treatment initiation, lasting up to Week 24.

Effect of Pica on Some Hematological Parameters in Thi-Qar Province

Pica items are deferent, and vary according to culture, race/ethnicity and geographic location. It is the eatingof a non-nutritional substance as defined by the American psychiatric association and the most widespreadof which is eating soil. A total of 163 iron deficient anemic patients included in this cross sectional study,where 18 substances nominated as causes of IDA were collected from …….. . Information was collectedfrom the patient involving gender, age, type of substance, and the causes of iron deficiency were sought toidentify clinical and laboratory correlates of pica in 163 .The result show where most targeted materialsas pica was Bitter gum 81 (22.8%) while the lowest were the Sesame =1, Nail=2, Soap=1 cases. whilesignificant statistical difference between the gender distribution and hemoglobin levels, WBC of picapatient, while age and platelets don’t showing this differences. only age of (35-40) years showing significantstatistical association of both Hb and WBC counts. The result show many comorbid condition in additionto anemia had been discovered, where most of these condition where linked to Khawa clay consumptions.Independent variables seems to be correlated really through the effect of the granulocytes and platelets withHb. This study is very important as a future study because it reveals many patterns of deficiency of someblood parameters with pica, as well as most people who suffer from Pica have iron deficiency, as this studyprovided a great incentive to know the ages and genders of the most vulnerable group of pica disorder.

MO547ASSOCIATION BETWEEN SERUM INDICES OF IRON METABOLISM AND CARDIOVASCULAR MORBIDITY IN PATIENTS WITH PREDIALYSIS CHRONIC KIDNEY DISEASE

Abstract Background and Aims Patients with predialysis chronic kidney disease (CKD) have a greater risk of developing cardiovascular disease (CVD) events than the general population. Anaemia is the most frequent comorbidity in pre-dialysis CKD patients and is associated with an increase in CVD events. Iron deficiency is the most frequent cause of erythropoiesis-stimulating agents (ESAs) resistant anaemia in CKD patients and is modifiable by therapeutic intervention. However, the optimal ranges of iron markers are uncertain in predialysis CKD patients. Therefore, we aimed to investigate the association between serum indices of iron metabolism and the incidence of CVD events in patients with predialysis CKD using the CKD-Japan Cohort (CKD-JAC) data. Method We prospectively followed 1550 CKD patients aged 20-75 years with an estimated glomerular filtration rate (eGFR) &amp;lt;60 mL/min/1.73 m2 for a mean of 4.21 years. We set serum transferrin saturation (TSAT) and ferritin levels as the main exposures to be tested. Our main outcome measures were any of the CVD events including fatal or non-fatal myocardial infarction, congestive heart failure (CHF), angina pectoris, arrhythmia, aorta dissection, cerebrovascular disorder, and peripheral artery diseases identified at each facility and adjudicated by the independent cardiac function evaluation committee. Multivariable Cox proportional hazards regression models were employed to examine the association between serum TSAT or ferritin levels with time to events. Death was considered as a competing risk with the Fine and Gray model. All models were stratified by facilities and adjusted for potential confounders as follows: age, sex, systolic blood pressure, diabetes mellitus, history of CHF, haemoglobin, serum calcium, serum phosphorus, intact parathyroid hormone, eGFR, proteinuria, ESAs, iron supplementation, renin-angiotensin system inhibitors, and beta-blockers. We also applied the multivariable fractional polynomial interaction (MFPI) approach to investigate whether TSAT levels are the effect modifier of the association between iron supplementation and the outcomes. Results In the overall cohort, 208 (13.4 %) patients developed CVD events (including 97 CHF) during the follow-up period (26.6 events/1000 person-year). The incidence rate of CVD events was the highest in the TSAT &amp;lt; 20% category (33.0 events/1000 person-year). Compared to patients in the TSAT &amp;gt; 40% category, those in the TSAT &amp;lt; 20% category demonstrated an increased risk of CVD events (adjusted hazard ratio (AHR): 1.86, 95% confidence interval (CI): 1.06-3.26) and CHF events (AHR: 2.82, 95% CI: 1.15-6.89), respectively. Meanwhile, there was no association between serum ferritin levels and the risk of developing CVD or CHF events. MFPI analyses showed a reduced risk of CVD in patients receiving iron supplementation only in patients with TSAT &amp;lt;20% (P for interaction=0.02). Conclusion Maintaining TSAT &amp;gt;20% could be effective to reduce the risk of developing CVD events (especially CHF) in patients with predialysis CKD. Our analyses also suggest that iron-deficient patients with predialysis CKD may benefit from iron supplementation for reduced risk of CVD events.