Iron Deficit Research Articles

A síndrome das pernas inquietas

Restless legs syndrome is a disorder of unknown cause that causes an irresistible urge to move the lower limbs, worsening at night, greatly disturbing sleep, with a consequent poor quality of life. It may begin in childhood, but diagnosis is usually late. It is also known as Willis-Ekbom Disease. It affects between 10% and 15% of the population. Iron deficiency is a frequently mentioned cause, which is why the study of iron metabolism is recommended. Clinical evaluation is normal, and it helps to identify possible secondary causes. The criteria for diagnosis were developed by the International Restless Legs Syndrome Study Group (IRLSG). In treatment, it is necessary to correct iron deficits and prescribe dopamine agonists. Many patients experience worsening of symptoms as they age.

UAS‐based multispectral imaging for detecting iron chlorosis in grain sorghum

AbstractThis study uses a small unmanned aircraft system equipped with a multispectral sensor to assess various vegetation indices (VIs) for their potential to monitor iron deficiency chlorosis (IDC) in a grain sorghum (Sorghum bicolor L.) crop. IDC is a nutritional disorder that stunts a plants’ growth and causes its leaves to yellow due to an iron deficit. The objective of this project is to find the best VI to detect and monitor IDC. A series of flights were completed over the course of the growing season and processed using Structure‐from‐Motion photogrammetry to create orthorectified, multispectral reflectance maps in the red, green, red‐edge, and near‐infrared wavelengths. Ground data collection methods were used to analyze stress, chlorophyll levels, and grain yield, correlating them to the multispectral imagery for ground control and precise crop examination. The reflectance maps and soil‐removed reflectance maps were used to calculate 25 VIs whose separability was then calculated using a two‐class distance measure, determining which contained the largest separation between the pixels representing IDC and healthy vegetation. The field‐acquired data were used to conclude which VIs achieved the best results for the dataset as a whole and at each level of IDC (low, moderate, and severe). It was concluded that the MERIS terrestrial chlorophyll index, normalized difference red‐edge, and normalized green (NG) indices achieved the highest amount of separation between plants with IDC and healthy vegetation, with the NG reaching the highest levels of separability for both soil‐included and soil‐removed VIs.

Impact of iron deficit in exercise capacity in heart failure patients: the role of VE/VCO2 slope and VO2peak

Impact of iron deficit in exercise capacity in heart failure patients: the role of VE/VCO2 slope and VO2peak

Parenteral Iron Therapy for Pediatric Patients

Iron deficiency (ID) is by far the most common nutritional disorder in developing and developed countries. When left untreated, ID leads to anemia. Although the usually recommended treatment for iron deficiency anemia (IDA) is oral iron therapy with countless products, such therapy necessitates administration for >3–6 months with questionable patient compliance since most oral iron products have an unpleasant metallic aftertaste and cause intestinal side effects. In addition, in certain gastrointestinal conditions, such as inflammatory bowel diseases or untreated gluten-sensitive enteropathy, oral iron therapy is contraindicated or unsuccessful. Intravenous iron is considered safe in adults, where adverse events are mild and easily managed. The experience with parenteral iron in children is much more limited, and many pediatricians appear reluctant to use it because of uncorroborated fears of serious anaphylactic reactions. In the current article, we thoroughly review the available pediatric literature on the use of all commercially available parenteral iron products except ferumoxytol, which was recently removed from the market. We conclude that parenteral iron appears to be safe in children; it works faster than oral iron, and the newer third-generation products allow replacement of the total iron deficit in a single sitting.

P-17 Hypophosphatemia related to intravenous iron therapy: A case report

Abstract Introduction Intravenous iron supplementation is a good alternative to oral iron replacement in iron deficiency anaemia. Intravenous iron formulations such as ferric carboxymaltose allow administration of high doses of elemental iron and enable correction of total iron deficit in one or two infusions. An important complication of ferric carboxymaltose is hypophosphatemia caused by increased secretion of the phosphaturic hormone, fibroblast growth factor 23 (FGF23). In this case, we aimed to present our patient with this rare side effect of intravenous iron replacement. Clinical Case A 40-year-old female patient who has no chronic systemic disease was admitted to our endocrinology service for fatigue and weakness. In the patient's history, it was learned that she had been treated with 2500 mg intravenous iron replacement (ferric carboxymaltose) for iron deficiency anaemia in the last month. In the laboratory tests; serum phosphorus 1.05 mg/dl (normal 2.5-4.5 mg/dl), corrected calcium 8.45 mg/dl (normal 8.4-10.2 mg/dl), 25-OH vitamin D 31.4 µg/L (normal >30 µg/L), parathormone 83.2 pg/ml (normal 15-65 ng/ml), alkaline phosphatase 63 U/L (normal 35-105 U/L). Fractional excretion of phosphate (FePO4) confirmed renal phosphate wasting (FePO4: 28.6%; normal <5%). Urinary protein and glucose were negative. FGF23 measured 71 pg/ml (normal <59 pg/mL). Intravenous iron-induced hypophosphataemia was suspected. After initiation of oral phosphate and 1,25-dihydroxyvitamin D3 supplementation, serum phosphate rose to reference range (Figure 1). The patient was taken to outpatient follow-up. Conclusion Physicians should be aware of hypophosphatemia as a common complication of intravenous iron therapy and monitor serum phosphate concentrations in patients receiving repeated doses.Figure 1.Patient phosphorus data during follow-up

Expedition 5300: limits of human adaptations in the highest city in the world.

Exposure to chronic hypobaric hypoxia imposes a significant physiological burden to more than 80 million humans living above 2500m throughout the world. Among them, 50000 live in the world's highest city, La Rinconada, located at 5000-5300m in southern Peru. Expedition 5300 is the first scientific and medical programme led in La Rinconada to investigate the physiological adaptations and altitude-related health issues in this unique population. Dwellers from La Rinconada have very high haemoglobin concentration (20.3±2.4g/dL; n=57) and those with chronic mountain sickness (CMS) exhibit even higher concentrations (23.1±1.7g/dL; n=150). These values are associated with large total haemoglobin mass and blood volume, without an associated iron deficit. These changes in intravascular volumes lead to a substantial increase in blood viscosity, which is even larger in CMS patients. Despite these large haematological changes, 24h blood pressure monitoring is essentially normal in La Rinconada, but some results suggest impaired vascular reactivity. Echocardiography revealed large right heart dilatation and high pulmonary arterial pressure as well as left ventricle concentric remodelling and grade I diastolic dysfunction. These changes in heart dimension and function tend to be more severe in highlanders with CMS. Polygraphy evaluations revealed a large reduction in nocturnal pulse oxygen saturation (median SpO2 =79%), which is even more severe in CMS patients who also tended to show a higher oxygen desaturation index. The population of La Rinconada offers a unique opportunity to investigate the human responses to chronic severe hypoxia, at an altitude that is probably close to the maximum altitude human beings can permanently tolerate without presenting major health issues.

Rker-216 Reversed Microcytic Anemia in a Mouse Model of Iron Refractory Iron Deficiency Anemia

Background Iron refractory iron deficiency anemia (IRIDA) is an inherited disease caused by TMPRSS6 mutations that increase serum hepcidin and result in microcytic anemia from iron malabsorption. As hepcidin promotes ferroportin (Fpn) degradation to limit iron absorption, its production in anemia should be decreased to make up body iron deficits. In contrast to typical iron deficiency anemia that can be improved by oral iron supplementation or intravenous (IV) iron infusion, IRIDA patients tend to have no response to iron supplements and only transiently respond to iron infusion, resulting in lifelong anemia. Hepcidin is mainly regulated by the bone morphogenetic protein (BMP) pathway, in which BMP ligands activate transcription factors SMAD1/5/9 by binding to the BMP receptors, including ALK2. We previously showed that RKER-216 (m216), a research ALK2 neutralizing antibody, improved iron availability in mice with anemia of inflammation resulting from high hepcidin. Here, we explored m216 pharmacology in an IRIDA mouse model. Aim To examine 1) mechanism of action (MOA), 2) efficacy of IV iron infusion and m216-mediated iron absorption, and 3) dose response of m216 in resolving microcytic anemia in Tmprss6 knockout (KO) mice. Methods TMPRSS6 KO mice at 8-11 weeks (wk) were subcutaneously dosed with isotype control or m216 at 1 or 3 mg/kg in all studies. Mice were given a single dose for 6, 24 or 96 h in MOA and twice weekly for 9 or 21 d for efficacy studies. For IV iron, KO mice were given a single dose of iron dextran at 100 mg/kg and evaluated on day 9. Results TMPRSS6 KO mice at 8 wk had high serum hepcidin, low transferrin saturation (TSAT), and microcytic anemia as indicated by low mean corpuscular volume (MCV) and hemoglobin (Hb), key features in IRIDA. Liver SMAD1/5/9 phosphorylation, hepcidin ( Hamp) mRNA, and serum hepcidin levels were decreased similarly in KO mice dosed with 1 or 3 mg/kg of m216 for 6 h, compared to isotype controls. KO mice given both dose levels for 24 h decreased serum hepcidin by 88% and increased TSAT by 4-fold, compared to isotype mice, but only mice receiving 3 mg/kg had sustained effects by 96 h. These data suggest that m216 inhibited SMAD signaling to lower serum hepcidin, allowing more iron absorption to increase TSAT. To explore the relevance of m216 to current therapy, we compared the result of IV iron or 1 mg/kg of m216 in KO mice for 9 d. Compared to controls, liver iron, serum hepcidin, and TSAT were increased in mice given IV iron whereas mice receiving m216 exhibited reduced hepcidin with increased duodenal Fpn and TSAT, confirming target engagement. Although TSAT was higher in mice dosed with m216 compared to IV iron, anemia improved similarly (1-2 g/dl in Hb; 2 fl in MCV) in these two groups. These data suggest that despite high hepcidin, IV iron improved anemia via increased TSAT; however, the relationship between TSAT and anemia recovery is not always linear. We next examined KO mice dosed with m216 at 1 or 3 mg/kg for 3 wk. Hb and MCV improved from 9.2 g/dl and 26.2 fl in isotype controls to 11.5 g/dl and 33.7 fl in 1 mg/kg-m216 mice and further improved to 14.1 g/dl and 39.8 fl in the 3 mg/kg-m216 cohort, respectively, showing a dose proportional mitigation in improving microcytic anemia compared to isotype controls. In fact, Hb and MCV of the 3 mg/kg-m216 cohort were restored to the levels of WT mice, indicating that microcytic anemia was fully resolved in this group. Conclusion These data suggest that m216 inhibited the BMP pathway to increase iron absorption via hepcidin suppression and was able to provide similar effects as iron infusion in reversing microcytic anemia in a mouse model of IRIDA.

Definition of malnutrition from routinely-collected data for orthopedic surgery research: the global leadership initiative on malnutrition (GLIM) tool and others.

The correct identification of malnourished patients in the context of hip, knee, or spine surgery research would enhance the quality of analytical studies investigating the prediction potential of preoperative nutritional disorders on postoperative recovery. However, accurate malnutrition screening and diagnostic assessment rely on parameters that were not routinely collected in routine practice until a few years ago. The authors of this article present substitute literature-based equations that can be built up using historical routinely collected data to classify patients that had been at risk of malnutrition or malnourished. For what concerns the risk screening, several methods are available to identify patients at risk of over- or undernutrition, encompassing the BWd (body weight difference from the ideal weight), GNRI (geriatric nutritional risk index), INA (instant nutritional assessment), LxA (combination of lymphocyte count and albumin), PMA (protein malnutrition with acute inflammation), PMAC (protein malnutrition with acute and chronic inflammation), IDM (iron deficit malnutrition), and VBD (vitamin B deficit malnutrition). Conversely, the GLIM (global leadership initiative on malnutrition) criteria can be used to assess malnutrition and diagnose subclasses of undernutrition. Rational use of these tools can facilitate the conduction of efficient prospective studies in the future, as well as bespoke retrospective cohort studies and database research.

Intravenous iron for critically ill children. Comparison of three dose regimens.

Anemia is extremely common among patients admitted to pediatric intensive care. Alternative treatments to transfusions such as intravenous iron must be considered. There are no published data for a prospective intravenous (IV) iron study focused in the critically ill children. The objective is to examine the safety and efficacy of intravenous iron sucrose infusion to manage anemia in pediatric critical care. A secondary objective is to examine the effect of different dose regimens of iron sucrose (3, 5, and 7mg/kg dose). Prospective investigation of intravenous iron sucrose utilization at a tertiary pediatric intensive care unit between October 2017 and November 2022. In all 115 patients received a total of 616 infusions of IV iron. Transferrin saturation index (TSI) was the most common altered iron deficiency biomarker (91.8%). After IV iron treatment, hemoglobin showed a significant increase within a 30-day follow-up (9.2 vs. 11.6g/dL, p<.001). There was also a significant improvement in TSI and serum iron (p<.001). Iron deficit replacement was higher in the 7mg/kg dose group (94%) compared to 85.9% in the 5mg/kg regimen and 77.5% in the lower dose group (p=.008), requiring less doses and a shorter time. Very few mild adverse reactions were reported (1.3% of infusions), with no differences between groups. The most frequent adverse effect was gastrointestinal in three cases. There were no anaphylaxis-like or other serious/life-threatening adverse effects. This is the first study to evaluate intravenous iron therapy in pediatric critical care, providing preliminary evidence of safety and efficacy of IV iron sucrose. The 7mg/kg dose regimen showed higher iron deficit replacement in a shorter time, which could be beneficial in critically ill children.

Bacillibactin siderophore induces iron mobilisation responses inside aerobic rice variety through YSL15 transporter

Iron uptake in Oryza sativa primarily occurs with the help of phytosiderophore i.e., deoxymugineic acid in aerobic condition. Internalisation of phytosiderophore-iron complex occurs through YSL15. However, aerobic rice at high pH faces iron deficit condition due to low secretion of plant siderophore and its early diminution. There might be a possibility that microbial siderophore of predominant rhizobacteria present in soil around rice may assist in iron uptake and transport through same transporter providing survival advantage to the plant. Present study aims to explore role of siderophore of Bacillus subtilis in improving root architecture and iron uptake in aerobic rice at high pH and explore possible transporters involved in transporting siderophore-Fe3+ complex inside rice root from rhizosphere. Identification by chrome azurol sulphonate assay and characterisation of purified extract from B. subtilis culture through LC-ESI MS confirmed presence of catecholate siderophore, Bacillibactin. Aerobic rice variety viz. Swarna Shreya grown with 5 ng/ml bacillibactin showed improved morphology and anatomy than untreated sample at alkaline pH 7.5. This is possibly due to enhanced intracellular iron content as observed in atomic absorption spectroscopy. Whole root proteomic analysis of rice root by using LC-ESI MS/MS revealed presence of YSL like transporter and siderophore import proteins in treated sample. RT-qPCR analysis showed enhanced expression of gene YSL15 in siderophore treated sample than control (pH 7.5). The present study possibly suggest role of foreign siderophore (xenosiderophore) in plant growth and development through iron uptake and transport inside rice.

Association between iron deficit repletion with ferric carboxymaltose relative to iron sucrose in children with inflammatory bowel disease: a retrospective cohort study.

Iron deficiency and iron deficiency anemia are common in pediatric inflammatory bowel disease and often require supplementation with iron. There is a paucity of literature regarding optimal iron formulation. The aim of this study is to compare outcomes in pediatric patients with inflammatory bowel disease receiving either iron sucrose or ferric carboxymaltose during inpatient hospitalizations. This was a single-center retrospective study of pediatric patients with inflammatory bowel disease admitted for newly diagnosed disease or flare who received either iron sucrose or ferric carboxymaltose. Linear regression was used to assess differences in iron repletion. Longitudinal linear mixed-effects models and generalized estimating equations compared hematologic and iron outcomes six months post iron repletion. Thirty patients received ferric carboxymaltose. Sixty-nine patients received iron sucrose. Baseline hemoglobin and iron deficits were similar in both groups. A larger percentage of iron deficit was repleted in the ferric carboxymaltose group (81.4%) compared to iron sucrose (25.9%) (p<0.001) with fewer infusions. Cumulative doses of ferric carboxymaltose administered (18.7 mg/kg) were higher than iron sucrose (6.1 mg/kg) (p<0.001). Hemoglobin increased more quickly with ferric carboxymaltose compared to iron sucrose (p=0.04 and p=0.02, respectively). Total iron binding capacity and red cell distribution width levels decreased more over time with ferric carboxymaltose versus iron sucrose (p<0.01 and p=0.01, respectively). No adverse effects were seen. Hematologic and iron parameters responded more quickly with fewer infusions in patients who received ferric carboxymaltose versus iron sucrose. Patients who received ferric carboxymaltose achieved a higher percentage of iron deficit repleted. This article is protected by copyright. All rights reserved.

Oxygen-Driven Enhancement of the Electron Correlation in Hexagonal Iron at Earth's Inner Core Conditions.

Earth's inner core (IC) consists of mainly iron with some light elements. Understanding its structure and related physical properties has been elusive as a result of its required extremely high pressure and temperature conditions. The phase of iron, elastic anisotropy, and density-velocity deficit at the IC have long been questions of great interest. Here, we find that the electron correlation effect is enhanced by oxygen and modifies several important features, including the stability of iron oxides. Oxygen atoms energetically stabilize hexagonal-structured iron at IC conditions and induce elastic anisotropy. Electrical resistivity is much enhanced in comparison to pure hexagonal close-packed (hcp) iron as a result of the enhanced electron correlation effect, supporting the conventional thermal convection model. Moreover, our calculated seismic velocity shows a quantitative match with geologically observed preliminary reference Earth model (PREM) data. We suggest that oxygen is the essential light element to understand and model Earth's IC.

Magnetic resonance imaging of organ iron before and after correction of iron deficiency in patients with heart failure.

Intravenous iron therapy (IVIT) is known to improve functional status in chronic heart failure (CHF) patients. The exact mechanism is not completely understood. We correlated magnetic resonance imaging (MRI) patterns of T2* iron signal in various organs to systemic iron and exercise capacity (EC) in CHF before and after IVIT. We prospectively analysed 24 patients with systolic CHF for T2* MRI pattern of the left ventricle (LV), small and large intestines, spleen, liver, skeletal muscle, and brain for iron. In 12 patients with iron deficiency (ID), we restored iron deficit by IVIT using ferric carboxymaltose. The effects after 3months were analysed by spiroergometry and MRI. Patients with vs. without ID showed lower blood ferritin, haemoglobin (76±63 vs. 196±82μg/L and 12.3±1.1 vs. 14.2±1.1g/dL, all P<0.002), and in trend a lower transferrin saturation (TSAT) (19.1 [13.1; 28.2] vs. 25.1 [21.3; 29.1] %, P=0.05). Spleen and liver iron was lower as expressed by higher T2* value (71.8 [66.4; 93.1] vs. 36.9 [32.9; 51.7] ms, P<0.002 and 33.5±5.9 vs. 28.8±3.9ms, and P<0.03). There was a strong trend for a lower cardiac septal iron content in ID (40.6 [33.0; 57.3] vs. 33.7 [31.3; 40.2] ms, P=0.07). After IVIT, ferritin, TSAT, and haemoglobin increased (54 [30; 104] vs. 235 [185; 339] μg/L, 19.1 [13.1; 28.2] vs. 25.0 [21.0; 33.7] %, 12.3±1.1 vs. 13.3±1.3g/L, all P<0.04). Peak VO2 improved (18.2±4.2 vs. 20.9±3.8mL/min/kg-1 , P=0.05). Higher peak VO2 at anaerobic threshold was associated with higher blood ferritin, reflecting higher metabolic exercise capacity after therapy (r=0.9, P=0.0009). Increase in EC was associated with haemoglobin increase (r=0.7, P=0.034). LV iron increased by 25.4% (48.5 [36.2; 64.8] vs. 36.2 [32.9; 41.9] ms, P<0.04). Spleen and liver iron increased by 46.4 and 18.2%, respectively (71.8 [66.4; 93.1] vs. 38.5 [22.4; 76.9] ms, P<0.04 and 33.5±5.9 vs. 27.4±8.6ms, P<0.007). Iron in skeletal muscle, brain, intestine, and bone marrow remained unchanged (29.6 [28.6; 31.2] vs. 30.4 [29.7; 30.7] ms, P=0.7, 81.0±6.3 vs. 82.9±9.9ms, P=0.6, 34.3±21.4 vs. 25.3±14.1ms, P=0.2, 9.4 [7.5; 21.8] vs. 10.3 [6.7; 15.7] ms, P=0.5 and 9.8±1.5 vs. 13.7±8.9ms, P=0.1). CHF patients with ID showed lower spleen, liver, and in trend lower cardiac septal iron. After IVIT, iron signal of the left ventricle as well as spleen and liver increased. Improvement in EC was associated with increase in haemoglobin after IVIT. In ID, liver, spleen, and brain but not heart iron were associated with markers of systemic ID.

Human-Centered Design of a Clinical Decision Support for Anemia Screening in Children with Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) commonly leads to iron deficiency anemia (IDA). Rates of screening and treatment of IDA are often low. A clinical decision support system (CDSS) embedded in an electronic health record could improve adherence to evidence-based care. Rates of CDSS adoption are often low due to poor usability and fit with work processes. One solution is to use human-centered design (HCD), which designs CDSS based on identified user needs and context of use and evaluates prototypes for usefulness and usability. this study aimed to use HCD to design a CDSS tool called the IBD Anemia Diagnosis Tool, IADx. Interviews with IBD practitioners informed creation of a process map of anemia care that was used by an interdisciplinary team that used HCD principles to create a prototype CDSS. The prototype was iteratively tested with "Think Aloud" usability evaluation with clinicians as well as semi-structured interviews, a survey, and observations. Feedback was coded and informed redesign. Process mapping showed that IADx should function at in-person encounters and asynchronous laboratory review. Clinicians desired full automation of clinical information acquisition such as laboratory trends and analysis such as calculation of iron deficit, less automation of clinical decision selection such as laboratory ordering, and no automation of action implementation such as signing medication orders. Providers preferred an interruptive alert over a noninterruptive reminder. Providers preferred an interruptive alert, perhaps due to the low likelihood of noticing a noninterruptive advisory. High levels of desire for automation of information acquisition and analysis with less automation of decision selection and action may be generalizable to other CDSSs designed for chronic disease management. This underlines the ways in which CDSSs have the potential to augment rather than replace provider cognitive work.

Parental Iron Therapy to Treat Iron Deficiency Anemia in Malnourished Children

Objective: To evaluate the safety and efficacy of parental iron therapy to treat iron deficiency anemia in malnourished children. Study Design: Quasi experimental design. Place and Duration of Study: Stabilization Centre, Children Hospital and the Institute of Child Health, Multan from 1 December 2014 to 31 December 2020. Materials and Methods: A total of 250 malnourished children with iron deficiency were included in the study. The laboratory parameters i.e., Hemoglobin, Hematocrit, Red Blood Cells Count, mean corpuscular hemoglobin, mean corpuscular volume, and Serum ferritin of all patients were done. Using the iron deficit formula, all participants were given the measured iron sucrose complex. The iron sucrose complex was diluted with 0.9% normal saline and administered steadily for 3-4 hours. After 6 weeks of therapy, hemoglobin, RBC count , ferritin was measured. Comparison of mean ±SD of baseline laboratory parameters and after 6 weeks of iron supplementation was analyzed by using t-test. Results: A total of 250 participants were registered, male patients (57.2%) were more than female patients (42.8 %). Most of the 92(36.8%) participants were 12-24 months old. The key cause of anemia among 102(40.8%) admitted patients was inadequate diet or excessive milk consumption. The mean ±SD value of the Hb level at admission was 7.5±1.9 and it increased to 11±1.15g/dL after 6 weeks of active supplementation which is statistically significant (P-value &lt; 0.05). Six weeks after giving intravenous iron therapy mean serum Ferritin increased from 11.5ml to 21.61 ng/ml. Conclusion: Current study concluded that controlled administration of IV iron sucrose for treatment of iron deficiency anemia among inpatients is efficacious and safe. IV iron sucrose should be considered for patient with severe IDA, those who are not compliant with oral formulations, and patients with malabsorption.

Iron Deficiency and Blood Donation: Links, Risks and Management.

The purpose of this review is to raise awareness about the frequently underappreciated association of blood donation with iron deficiency, and to describe methods for its prevention and management. Blood donors cannot expect any health benefits from the donation but have justified expectations of no harm. Iron deficiency without anemia (IDWA) and iron deficiency anemia (IDA) are common consequences of regular blood donation, and this activity is the most important factor affecting iron status in regular blood donors. Awareness of blood donation as a primary cause of sideropenia is surprisingly low among physicians. Blood donation screening identifies potential donors with IDA but is frequently inadequate to detect IDWA. For the assessment of body iron stores, plasma or serum ferritin, transferrin saturation (TSAT) and soluble transferrin receptors (sTfR) concentrations are the most widely used biochemical markers, although the percentage of hypochromic mature erythrocytes and the hemoglobin content of reticulocytes are also useful. IDWA can be prevented by limiting the total volume of blood collected, by iron deficiency screening and deferral of sideropenic donors, by prolonging the interdonation intervals, and by iron supplementation between donations. IDWA tends to be more prevalent in younger people, females, and high-intensity donors. A potentially effective strategy to address sideropenia in blood donors is serum ferritin testing, but this may lead to a higher rate of deferral. Most regular blood donors cannot replenish their iron deficit by an iron-rich diet alone and will benefit from low-dose oral iron administration with various commercially available products post-donation, a well-tolerated strategy. However, valid concerns exist regarding the possibility of worsening the iron overload in donors with undiagnosed hemochromatosis or masking the symptoms of a clinically important gastrointestinal hemorrhage or other underlying medical condition. Finally, educational efforts should be intensified to improve the awareness of blood donation as a primary cause of iron deficiency among physicians of all specialties.

Iron Deficiency Anemia in Pregnancy.

Through its functions in oxygen delivery, electron transport, and enzymatic activity, iron is crucial for the operation of all cells. High metabolic rate cells need more iron and are more likely to malfunction when there is an iron deficit. Since the mother's blood volume expands during pregnancy, and the fetus grows and develops, there is a sharp increase in the need for iron. Negative pregnancy outcomes, such as increased maternal sickness, low birthweight, preterm, and intrauterine growth restriction, are linked to iron deficiency. IDA, or nutritional iron deficiency anemia, affects more than two billion people worldwide and is the most prevalent disease. Based on the regression-based analysis, the prevalence of anemia in the World Health Organization's global database was calculated to be 14%. According to recent data, there are 17.4% more IDA cases among pregnant women in industrialized countries than in poor ones (up to 56% more cases). Despite the fact that oral iron supplementation is frequently used to treat IDA, not all patients benefit from oral iron therapy. This is caused by a number of things, which include the adverse effects of oral iron, resulting in low compliance and ineffectiveness. In a sizable group of patients taking oral iron preparations, the adverse effects primarily include GI symptoms. Intravenous iron was previously underutilized since it was linked to unfavorable and occasionally dangerous side effects. New type II and III iron complexes have been created recently, though, and they offer superior compliance and toleration in addition to strong efficacy and a good safety profile.

Decreased basal ganglia and thalamic iron in early psychotic spectrum disorders are associated with increased psychotic and schizotypal symptoms.

Iron deficits have been reported as a risk factor for psychotic spectrum disorders (PSD). However, examinations of brain iron in PSD remain limited. The current study employed quantitative MRI to examine iron content in several iron-rich subcortical structures in 49 young adult individuals with PSD (15 schizophrenia, 17 schizoaffective disorder, and 17 bipolar disorder with psychotic features) compared with 35 age-matched healthy controls (HC). A parametric approach based on a two-pool magnetization transfer model was applied to estimate longitudinal relaxation rate (R1), which reflects both iron and myelin, and macromolecular proton fraction (MPF), which is specific to myelin. To describe iron content, a synthetic effective transverse relaxation rate(R2*) was modeled using a linear fitting of R1 and MPF. PSD patients compared to HC showed significantly reduced R1 and synthetic R2*across examined regions including the pallidum, ventral diencephalon, thalamus, and putamen areas. This finding was primarily driven by decreases in the subgroup with schizophrenia, followed by schizoaffective disorder. No significant group differences were noted for MPF between PSD and HC while for regional volume, significant reductions in patients were only observed in bilateral caudate, suggesting that R1 and synthetic R2*reductions in schizophrenia and schizoaffective patients likely reflect iron deficits that either occur independently or precede structural and myelin changes. Subcortical R1 and synthetic R2*were also found to be inversely related to positive symptoms within the PSD group and to schizotypal traits across the whole sample. These findings that decreased iron in subcortical regions are associated with PSD risk and symptomatology suggest that brain iron deficiencies may play a role in PSD pathology and warrant further study.

Quantifying the burden of lipid anomalies among adolescents in India

BackgroundThe present study’s aim is to quantify the burden of lipid abnormalities (excessive non-high-density lipoprotein (non-HDL) cholesterol and low-density lipoprotein (LDL) cholesterol) among Indian adolescents. Which has emerged as a significant covariate of coronary heart disease (CHD).MethodsThe present study aims to unearth the prevalence of any lipid anomalies, their level, and types of lipid profiles among adolescents in India using the Comprehensive National Nutrition Survey 2016–18 i.e., cross-sectional data. Descriptive and bivariate statistical analyses have been used to check the associations and significant differences between groups of individuals suffering from any type of lipid abnormalities.ResultsA total of 35,830 adolescents aged between 10 and 19 years (mean age:14.36 yrs.; SD = 2.81 for males and 14.39 yrs.; SD = 2.78 for females) were included. Roughly 77 percent of the adolescents are suffering from any lipid anomalies. Their mean lipid levels are 140.6 (SD = 32.9), 84.1 (SD = 24.8), 47.3 (SD = 10.7), and 95.3 (SD = 50.0) for total cholesterol, LDL, HDL, and triglycerides, respectively. A higher proportion of adolescents suffered from lipid anomalies among those who were overweight or obese (89%, 95% CI 85, 92) and pre-diabetics (81%, 95% CI 78, 83) compared to each of their counterparts. Furthermore, a considerable proportion of samples with vitamin A (70%, 95% CI 68, 73), D (81%, 95% CI 79, 82), and B12 deficits (73%,95% CI 72, 75), as well as zinc (77%, 95% CI 76, 77), folate (76%, 95% CI 74, 77), and iron deficits (75%,95% CI 73, 77), were suffering from any lipid anomalies. Of individuals who consume an unhealthy diet, 77% (95% CI 76, 78) of them were suffering from any lipid anomalies than others.ConclusionsThe study contends that preventing the increasing burden of lipid abnormalities among Indian adolescents is essential. Vitamin and mineral deficiencies and unhealthy dietary habits are significantly associated with high LDL and non-HDL levels. In the longer run, this might cause the early onset of hypertension, diabetes, and CHDs. Hence, appropriate interventions are needed to curtail these early onsets by primarily focusing on adolescents.

Single-dose intravenous ferric carboxymaltose infusion versus multiple fractionated doses of intravenous iron sucrose in the treatment of post-operative anaemia in colorectal cancer patients: a randomised controlled trial.

Recent clinical guidelines suggest that treatment of postoperative anaemia in colorectal cancer surgery with intravenous iron reduces transfusion requirements and improves outcomes. The study aimed at comparing two intravenous iron regimens in anaemic patients after colorectal cancer surgery. This was a single-centre, open-label, randomised, controlled trial in patients undergoing elective colorectal cancer surgery. Patients with moderate to severe anaemia (haemoglobin [Hb] <11 g/dL) after surgery were randomly assigned 1:1 to receive ferric carboxymaltose (FC; 1,000 mg, single dose) or iron sucrose (IS; 200 mg every 48 hours until covering the total iron deficit or discharge). Randomisation was stratified by Hb level: <10 g/dL (Group A) or ≥10-10.9 (Group B). The primary endpoint was the change in Hb concentration at postoperative day 30. Secondary endpoints included iron status parameters, transfusion requirements, complications, and length of hospital stay. From September 2015 to May 2018, 104 patients were randomised (FC 50, IS 54). The median intravenous iron dose was 1,000 mg and 600 mg in the FC and IS groups, respectively. There were no between-group differences in mean change in Hb from postoperative day 1 to postoperative day 30 (FC: 2.5 g/dL, 95% CI: 2.1-2.9; IS: 2.4 g/dL, 95% CI: 2.0-2.8; p=0.52), in transfusion requirements or length of stay. The infection rate was lower in the FC group compared with the IS group (9.8% vs 37.2%, respectively). The administration of approximately 500 mg of IS resulted in an increase in Hb at postoperative day 30 similar to that of 1,000 mg of FC, but it was associated with a higher infection rate. Future research will be needed to confirm the results, and to choose the best regime in terms of effectiveness and side effects to treat postoperative anaemia in colorectal cancer patients.