Iron Deficit Research Articles

Skeletal Muscle Abnormalities and Iron Deficiency in Chronic Heart FailureAn Exercise 31P Magnetic Resonance Spectroscopy Study of Calf Muscle.

Heart failure (HF) is often associated with iron deficiency (ID). Skeletal muscle abnormalities are common in HF, but the potential role of ID in this phenomenon is unclear. In addition to hemopoiesis, iron is essential for muscle bioenergetics. We examined whether energetic abnormalities in skeletal muscle in HF are affected by ID and if they are responsive to intravenous iron. Forty-four chronic HF subjects and 25 similar healthy volunteers underwent 31P magnetic resonance spectroscopy of calf muscle at rest and during exercise (plantar flexions). Results were compared between HF subjects with or without ID. In 13 ID-HF subjects, examinations were repeated 1 month after intravenous ferric carboxymaltose administration (1000 mg). As compared with controls, HF subjects displayed lower resting high-energy phosphate content, lower exercise pH, and slower postexercise PCr recovery. Compared with non-ID HF, ID-HF subjects had lower muscle strength, larger PCr depletion, and more profound intracellular acidosis with exercise, consistent with an earlier metabolic shift to anaerobic glycolysis. The exercise-induced PCr drop strongly correlated with pH change in HF group ( r=-0.71, P<0.001) but not in controls ( r=0.13, P=0.61, interaction: P<0.0001). Short-term iron administration corrected the iron deficit but had no effect on muscle bioenergetics assessed 1 month later. HF patients display skeletal muscle myopathy that is more severe in those with iron deficiency. The presence of ID is associated with greater acidosis with exercise, which may explain early muscle fatigue. Further study is warranted to identify the strategy to restore iron content in skeletal muscle.

Joint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong.

The demand for blood products continues to grow in an unsustainable manner in Hong Kong. While anaemia associated with gastrointestinal bleeding (GIB) is the leading indication for transfusion, there is no local recommendation regarding best practices for transfusion. We aimed to provide evidence-based recommendations regarding management of anaemia in patients with acute and chronic GIB. We reviewed all original papers, meta-analyses, systematic reviews, or guidelines that were available in PubMed. For acute GIB, a restrictive transfusion strategy, targeting a haemoglobin threshold of 7 to 8 g/dL, should be adopted because overtransfusion is associated with significantly higher all-cause mortality and re-bleeding. A liberal transfusion strategy should only be considered in patients with co-existing symptomatic coronary artery disease, targeting a haemoglobin threshold of 9 to 10 g/dL. When acute GIB settles, patients should be prescribed iron supplements if iron deficiency is present. For chronic GIB, iron stores should be replenished aggressively via iron supplementation before consideration of blood transfusion, except in patients with symptoms of severe anaemia. Oral iron replacement is the preferred first-line therapy, while intravenous iron is indicated for patients with inflammatory bowel disease, poor response or poor tolerability to oral iron, and in whom a rapid correction of iron deficit is preferred. Intravenous iron is underutilised and the risk of anaphylactic reaction to current preparations is extremely low. These recommendations are provided to local clinicians to facilitate judicious and appropriate use of red cell products and iron replacement therapy in patients with GIB.

Infant anemia is associated with reduced TLR-stimulated cytokine responses and increased nasopharyngeal colonization with Moxarella catarrhalis

Anemia is a major public health problem in young children. Reports on the role of anemia on infectious diseases remained controversial. We aim to investigate the effect of anemia on innate immunity, nasopharyngeal bacterial colonization, and subsequent infectious outcome. Blood tests were examined at the age of 12 months. TLR-induced cytokine production was assessed by ELISA. Bacteria from nasopharyngeal specimens were identified with traditional culture. Clinical infectious diseases were followed yearly until 3 years of age. Result showed that of the 423 infants, 72 had hemoglobin level ≤ 11 g/dL, among which 55% had normal iron level. There was significant association between hemoglobin level and TLR1–2, and 4 induced IL-6 (p = 0.04, 0.02) and that of TLR4 stimulated TNF-α response (p = 0.04). Children with anemia had higher nasopharyngeal colonization with Moxarella catarrhalis. Clinical analysis did not show anemia to be associated with infectious morbidity. However, children who developed LRTIs had mean lower ferritin levels. We speculated that iron might be the key factor related to infectious morbidity. Thus, to investigate the role of anemia in infectious diseases, it is important to first consider the prevalence of iron deficit, since the incidence of iron deficiency-induced anemia may vary among different regions.

Treatment of anemia in patients with solid tumors receiving chemotherapy in palliative setting: usual practice versus guidelines

ABSTRACTBackground Anemia is frequent in patients with cancer and is often multifactorial. Treatment depends on etiology and can consist of transfusions, intravenous iron (IV Fe), and/or erythropoiesis-stimulating agents (ESA). Several studies have shown that cancer-related anemia is undertreated. The aim of this study is to compare usual practice in a university hospital with the international guidelines.Methods Using the hospital and pharmacy informatics all adults (≥18 years), who received a treatment for anemia (transfusion, IV Fe, ESA) from February to August 2016 during palliative chemotherapy, were identified. Episodes of care were defined as the start of palliative chemotherapy up until 4 weeks after end of chemotherapy. After informed consent, relevant data in the episode of care were collected. Usual practice was compared to international guidelines adapted to Belgium reimbursement criteria.Results A total of 72 episodes of care were included. At initiation of chemotherapy, anemia was present in 59.7% of cases. Iron status was measured in 54.2% of all cases. Iron deficiency was found in 34.7% of patients. Only 52% of the iron deficient patents received IV Fe. Fifteen cases were considered eligible for ESA, six (40%) of these patients received an ESA. The most frequent treatments for anemia were transfusions (91.7%), followed by IV Fe (18.1%). Only 8.3% received an ESA.Conclusion Assessment for iron, Vitamin B12, and FA deficits are underused. We detected a high rate of transfusions. In contrast there is still a low use of IV Fe and ESA’s. There has been no major improvement in the implementation of the international guidelines in the last decade. We estimate that in at least 16.7–26.4% of our patients less to no transfusions would have been required, if guidelines were strictly followed.

GLOBALIZATION AS A CHALLENGE TO UKRAINIAN EXPORTERS OF IRON ORE RAW MATERIAL

The purpose of the article – to identify the main characteristics of iron ore mining and beneficiation enterprises that allow carrying out income-generating export activity in terms of increasing the level of globalization of the country. Methodology. Information background of the research consists of publications of KOF rating of the level of globalization of countries of the world (1991–2016), annual reports of the United States Geological Survey (1995–2016), statistical data of the State Statistics Service of Ukraine (2012–2016), scientific publications and findings of experts of the national and world markets for iron ore. Achieving the purpose of this article provides for the following stages and methods of scientific research: time series analysis – for evaluating dynamics of globalization index for Ukraine, dynamics of global iron ore production and export of iron ore raw material by Ukrainian producers; vertical analysis – for determining the structure of global iron ore production; methods of qualitative analysis (expert estimation) – for defining characteristics of mining and beneficiation enterprises that allow ensuring competitiveness in the global market; generalization – for determining options of sales of Ukrainian iron ore production in international markets in terms of globalization. Results. High-level globalization of Ukraine makes it significantly dependent on the condition of global markets of key export branches of the national economy. Ukraine belongs to the top ten countries with the largest reserves of iron ore and its production in the world; however, an insignificant part of the market doesn’t allow influencing its condition. The surplus of iron ore and deficit of iron-ore pellets in the global market stimulate the interest of Ukrainian mining and beneficiation enterprises in projects on improving their existing production facilities. The volatility of the global market for iron ore raw material increases the level of financial and investment risks. Practical significance. The established trends in globalization of Ukraine and the status of Ukrainian producers of iron ore raw material in the global market allow us more thoroughly analyse their competitive advantages in the long view and develop risk reduction programs. Alternatives to sales of Ukrainian iron ore production of vertically-integrated holding under globalization are made. Value/originality. Determined advantages of Ukrainian exporters of iron ore raw material in the global market that, in terms of high-level globalization of the country, are provided by the corporate synergy of the transnational vertically-integrated exporting company.

Intravenous iron treatments for iron deficiency anemia in inflammatory bowel disease: a budget impact analysis of iron isomaltoside 1000 (Monofer) in the UK

ABSTRACTIntroduction: Iron deficiency is the leading cause of anemia in patients with inflammatory bowel disease (IBD). Intravenous iron is the first-line treatment for clinically active IBD or previous oral iron intolerance. The aim of the present study was to develop a comparative model of iron deficiency and delivery for iron isomaltoside (IIM), ferric carboxymaltose (FCM), low molecular weight iron dextran (LMWID), and iron sucrose (IS) in the treatment of iron deficiency anemia associated with IBD.Areas covered: A model was developed to evaluate iron delivery characteristics, resource use and costs associated with IIM, FCM, LMWID and IS. Iron deficiency was modeled using dosing tables and retreatments were modeled based on a pooled retrospective analysis. The analyses were conducted over 5 years in patients with IBD with mean bodyweight of 75.4 kg and hemoglobin levels of 10.77 g/dL based on observational data.Expert opinion: The modeling analysis showed that using IIM required 1.2 infusions (per treatment) to correct the mean iron deficit, compared with 1.6, 1.2, and 7.1 with FCM, LMWID and IS, respectively. Costs were estimated to be 2,518 pounds sterling (GBP) per patient with IIM or LMWID, relative to GBP 3,309 with FCM or GBP 14,382 with IS.

Intravenous Iron Treatments For Iron Deficiency Anemia In Inflammatory Bowel Disease: A Budget Impact Analysis Of Iron Isomaltoside 1000 In The UK

Iron deficiency (ID) is the leading cause of anemia in patients with inflammatory bowel disease (IBD). Intravenous iron should be considered the first-line iron-correction treatment in patients with clinically active IBD, hemoglobin <10g/dL, previous oral iron intolerance, or requiring erythropoiesis-stimulating agents. The study objective was to evaluate resource use and costs associated with using iron isomaltoside (Monofer; IIM) relative to other intravenous iron formulations in patients with iron deficiency anemia (IDA) associated with IBD. A budget impact model was developed to evaluate the cost of IIM relative to ferric carboxymaltose (Ferinject; FCM), low molecular weight iron dextran (Cosmofer; LMWID) and iron sucrose (Venofer; IS). Iron deficits were modeled using dosing tables and the need for retreatments was modeled using a pooled retrospective analysis of randomized trial data. The analysis was conducted over 5 years in patients with mean bodyweight of 75.4 kg (SD 17.4 kg) and hemoglobin levels of 10.8 g/dL (SD 1.4 g/dL) based on observational data from patients with IBD. Costs were modeled using healthcare resource groups. Using IIM required 1.29 infusions (per treatment) to correct the mean iron deficit, compared with 1.64, 1.29 and 7.14 with FCM, LMWID and IS, respectively. Patients using IIM required multiple infusions in 28.7% of cases, compared with, 64.3%, 28.7% and 100% with FCM, LMWID and IS, respectively. Total costs were estimated to be GBP 2,593 per patient with IIM or LMWID, relative to GBP 3,309 with FCM (savings of GBP 717 with IIM) or GBP 14,382 with IS (savings of GBP 11,789 with IIM). Using IIM in place of FCM or IS markedly reduced the number of infusions required to correct ID in patients with IBD and IDA. The reduction in infusions was accompanied by substantial reductions in cost relative to FCM and IS.

A budget impact analysis of parenteral iron treatments for iron deficiency anemia in the UK: reduced resource utilization with iron isomaltoside 1000.

Background and aimsThe reported prevalence of iron deficiency anemia (IDA) varies widely but estimates suggest that 3% of men and 8% of women have IDA in the UK. Parenteral iron is indicated for patients intolerant or unresponsive to oral iron or requiring rapid iron replenishment. This study evaluated differences in the cost of treating these patients with iron isomaltoside (Monofer®, IIM) relative to other intravenous iron formulations.MethodsA budget impact model was developed to evaluate the cost of using IIM relative to ferric carboxymaltose (Ferinject®, FCM), low molecular weight iron dextran (Cosmofer®, LMWID), and iron sucrose (Venofer®, IS) in patients with IDA. To establish iron need, iron deficits were modeled using a simplified dosing table. The base case analysis was conducted over 1 year in patients with IDA with mean bodyweight of 82.4 kg (SD 22.5 kg) and hemoglobin levels of 9.99 g/dL (SD 1.03 g/dL) based on an analysis of patient characteristics in IDA trials. Costs were modeled using UK health care resource groups.ResultsUsing IIM required 1.3 infusions to correct the mean iron deficit, compared with 1.3, 1.8, and 7.7 with LMWID, FCM, and IS, respectively. Patients using IIM required multiple infusions in 35% of cases, compared with 35%, 77%, and 100% of patients with LMWID, FCM, and IS, respectively. Total costs were estimated to be GBP 451 per patient with IIM or LMWID, relative to GBP 594 with FCM (a GBP 143 or 24% saving with IIM) or GBP 2,600 with IS (a GBP 2,149 or 83% saving with IIM).ConclusionUsing IIM or LMWID in place of FCM or IS resulted in a marked reduction in the number of infusions required to correct iron deficits in patients with IDA. The reduction in infusions was accompanied by substantial reductions in cost relative to FCM and IS over 1 year.

Approaches for optimising intravenous iron dosing in pregnancy: a retrospective cohort study.

Intravenous iron is commonly utilised in pregnancy when treatment with oral is not tolerated or where rapid replenishment of iron stores is required. To examine the relationship between doses of intravenous iron administered during pregnancy according to different maternal bodyweight measures and subsequent treatment response. Retrospective cohort study of pregnant women with confirmed iron deficiency anaemia who received intravenous iron polymaltose at a tertiary teaching hospital in Australia from 1 January 2014 to 31 January 2016. Diagnosis of anaemia and/or iron deficiency, infusion dosage characteristics and haematological parameters were collected from paper-based case notes and electronic records. The dose of intravenous iron administered was examined relative to maternal total bodyweight (TBW), ideal bodyweight (IBW) (equation = 45.5 kg + 0.9 kg/cm for each cm over 152 cm) and adjusted bodyweight (equation = IBW + [0.4 × (TBW - IBW)]). A total of 122 pregnancies was identified where women had confirmed iron deficiency anaemia and received a single infusion of intravenous iron polymaltose. Dose-response relationships were evident between change in haemoglobin from treatment until delivery and intravenous iron dose according to adjusted bodyweight (adjusted beta coefficient 0.70 (95% CI 0.24-1.15)) and pre-pregnancy total bodyweight (adjusted beta coefficient 0.83 (95% CI 0.36-1.29)), but not ideal bodyweight (adjusted beta coefficient 0.37 (95% CI -0.04-0.78)). Calculating iron deficit using adjusted bodyweight most closely matched that based on a physiological estimate of iron deficit according to weight-based total blood volume. Optimal treatment outcomes in pregnant women requiring intravenous iron may be reached by dosing according to adjusted pre-pregnancy bodyweight rather than ideal bodyweight.

Correction of Platelet Activity in New-Born Calves with Iron Deficit as a Result of Ferroglukin, Polyson and Cresacin

Correction of Platelet Activity in New-Born Calves with Iron Deficit as a Result of Ferroglukin, Polyson and Cresacin

The challenge of achieving basal energy, iron and zinc provision for home consumption through family farming in the Andes: a comparison of coverage through contemporary production systems and selected agricultural interventions

Child undernutrition is persistently high in the central Andes of Peru, and numerous smallholder households fail to meet their basic needs of energy, iron and zinc. Food-based approaches assume household-level nutrition can be improved following agricultural interventions. This study assesses for the first time whether current Andean production systems provide sufficient energy, iron and zinc output to meet household-level requirements and explores the likely effect of commonly promoted food-based approaches. Across four communities, we determined the crop and livestock production output for each household (n = 165) during one growing season. The household-level nutritional demand or input was calculated as a function of household composition and daily requirements of energy, iron and zinc as established by FAO/WHO. We examined five scenarios, current practice or status quo and four food-based interventions: (1) increased potato yield, (2) introduced biofortified potatoes, (3) promotion of guinea pigs and (4) a mixed strategy combining all of the above. Under status quo, 86, 62 and 76 % of households obtained sufficient production output to meet energy, iron and zinc requirements, respectively. Considering the three parameters simultaneously, 59 % of households were able to meet their energy, iron and zinc requirements. The total crop production among households provided more than the necessary energy, iron and zinc output to meet the demand of all 165 households. Yet, significant differences between households account for individual deficits or surpluses in household-level output–input balances. Potato (Solanum spp.), barley (Hordeum vulgare) and faba (Vicia faba) production was particularly significant in determining the energy, iron and zinc output. Livestock did not make a substantial contribution. The main difference between households with negative versus positive coverage, in terms of household-level production output from agriculture meeting demand (=input), was available cropping area given household size. None of the explored food-based interventions closed the energy, iron and zinc deficit from production among households with negative coverage. The smallholder production systems analyzed are only partially capable of providing sufficient production output to cover household-level energy, iron and zinc demands. Of the four interventions examined, a mixed strategy holds most potential for reducing nutrition gaps. Particularly potato yield increases had a positive effect. The carrying capacity of high-altitude Andean farming systems is strained for households with limited land. Food-based approaches to nutrition under scenarios similar to those reported in this study are advised to balance agricultural interventions with options to enhance off-farm access to food.

ВПЛИВ ФЕРРОВЕТУ 7,5 % І ФЕРОСЕЛУ Т НА КОНЦЕНТРАЦІЮ МІНЕРАЛЬНИХ РЕЧОВИН В СИРОВАТЦІ КРОВІ ПОРОСЯТ, ХВОРИХ НА ФЕРУМДЕФІЦИТНУ АНЕМІЮ

In the article presents the results of experimental studies on the pharmacological action of iron dextran preparations – ferrovet–7.5%, which in 1 ml dextran containing 75 mg of ferric iron, and ferosel–T, 1 ml of which, in addition to 75 mg of ferric iron, additionally contains 0.3 mg selenium (in the form of sodium selenite) the concentration of minerals in the blood serum of pigs for latent iron deficit anemia.Established that at 21 days postnatal period, in the whey of blood of piglings for latent iron deficit anemia, a level of Calcium was on 11.8%, and to Phosphorus – on to 8.4% lower. Reserves of iron in the indicated period of depot were fully used for hematopoietic and receipt of its mother's milk insufficient for optimal erytrotsytopoez because the concentration of iron in the blood serum of pigs did not satisfy his need for hematopoiesis.In the case of iron dextran preparations for the treatment of iron deficiency anemia pigs found an increase in Calcium, Phosphorus, Selenium and Iron. So on 21 days after birth for piglings, which entered ferrovet 7.5%, in the whey of blood the concentration of Calcium was increased on 30.0% (r &lt; 0.01), to Phosphorus – on 15.6%, and which ferosel–T was entered accordingly increased on 33.4% (r &lt; 0.01) and 19.3%.The concentration of Selenium and Iron in the blood serum of piglets research groups, which used ferrovet 7.5% and ferosel–T is likely to have increased since 7 day experiment. Shown that iron deficit anemia of piglings efficiency of application of preparation of ferosel–T with a medical and prophylactic purpose is higher, than to preparation of ferrovet–7.5 %, that predefined by the combined action of Iron and Selenium.

IRON DEFICIENCY ANEMIA

Globally about two billion people suffer from anemia of various types amongstwhich Iron Deficiency Anemia (IDA) is the most prevalent type. According to National NutritionSurvey of Pakistan 2011 (NNS), 50.4 % of non-pregnant females suffer from IDA, despite thefact that a variety of low cost, indigenous food sources of iron are available, affordable andaccessible in Pakistan. IDA is a risk factor for complications of pregnancy and low birth weightbaby and is also an independent cause of morbidity and mortality in all ages. Therefore thisstudy was conducted to determine the dietary patterns of iron intake in females of reproductiveage group who had IDA without any other known cause. Study Design: A cross sectionalstudy. Setting: Three tertiary care centers of Ziauddin Hospital located at Clifton, Kemari andNorth Nazimabad. Methods: Reproductive age females suffering from IDA according to theirCBC profile within three months prior to the study were selected through purposive sampling.Females taking iron supplements or with any known cause of iron deficiency were excluded.Total of 141 eligible and consenting IDA patients filled a 7 Day dietary recall questionnaireto determine the iron intake of indigenously available iron rich foods and blood sample wascollected for hematological profiles and iron studies. Results: Mean iron intake was 6.41 ±4.39 mg/day. Median heme and non heme iron intake was 8.0 mg and 28.0 mg per week,respectively. 52.4% of our study population had moderate IDA, 38.2% had pica for one or moresubstance and almost all suffered from one or more symptoms of iron deficiency. Majority ofthe population was consuming non-heme sources of iron. Conclusion: The iron consumptionfrom indigenous dietary sources is very low and contributes significantly to development of IDA.Increasing awareness regarding signs and symptoms of IDA and common dietary sources ofiron will contribute to screening, early diagnosis and correction of the iron deficit thus promotinghealth and preventing complications.

A Time Interval of More Than 18Months Between a Pregnancy and a Roux-en-Y Gastric Bypass Increases the Risk of Iron Deficiency and Anaemia in Pregnancy.

The aim of the study is to explore the impact of time between Roux-en-Y gastric bypass (RYGB) and pregnancy on obstetrical outcome and nutritional derangements. In a retrospective cross-sectional study of pregnant women admitted for antenatal care at two tertiary hospitals, we examined 153 women with RYGB and a singleton pregnancy of at least 24weeks. The women were stratified according to a pregnancy <18months (40 women) or ≥18months (113 women) after RYGB. Main outcome measures were nutritional parameters and glycated haemoglobin 1Ac (HbA1c) in second and third trimester of pregnancy, gestational hypertension, length of pregnancy, mode of delivery and foetal birth weight. The two groups were comparable regarding age, parity and prepregnancy body mass index. The frequency of iron deficiency anaemia (ferritin <12μg/L and haemoglobin <6.5mmol/L/10.5g/dL) was significantly higher in the late group, 29 vs. 8% in the early group, p = 0.010. No differences were found for vitamin B12, vitamin D and zinc. Median HbA1c was significantly higher in the late group than in the early group (33 vs. 31mmol/mol, p = 0.027). There were no significant differences in the risk of adverse pregnancy outcome or birth weight between the two groups. A long surgery-to-pregnancy time interval after a RYGB increases the risk of iron deficiency anaemia but not of other nutritional deficits. Time interval does not seem to have an adverse effect on the obstetrical outcome, including intrauterine growth restriction. Specific attention is needed on iron deficit with increasing surgery-to-pregnancy time interval.

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

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

CORRECTION OF IRON DEFICIENCY IN CKD V HD PATIENTS WITH ANEMIA

Hemodialysys results in loss of15-20 ml of blood or 5-7 mg of iron during each session or at least 1 g/ year. Additional iron may be lost through the gastrointestinal tract and during the menstruation in women. Excluding others possible reasons (genitourinary issues, laboratory investigations iron losses can amount minimum 1.7g per year). Dietary iron intake (0.5 – 1.0 g/year) only partially offsets iron deficit.&#x0D; According to KDOQI Anemia Guidelines (2006), “the average iv iron needed to maintain a stable serum ferritin (SF) level and in that way neutral iron balance, appears to be range 22-65 mg/week; this amount corresponds with SFl &gt; 200 mg/ at but the same time there is no sufficient evidence to recommend routine administration of iron if SF &gt; 500 mg/l.&#x0D; KDIGO Guidelines (2012) do not recommend routine use of iron supplementation in patients with transferrin saturation (TSAT) &gt; 30% and SF &gt; 500 mg/1.&#x0D; Thereby the target SF and TSAT levels in CKD VD patients remain controversial and in practice are determined by specific clinical tasks requiring resolution: to increase hemoglobin level without erythropoiesis stimulating agents (ESA) administration, or to decrease ESA dose in its turn depends on specific patient’s iron status (absolute or functional iron deficit) and treatment period, – predialysis or dialysis.

The Relation of Blood Iron Level with Frontal Function in Children with Attention-Deficit/Hyperactivity Disorder

ObjectivesZZAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder showing many neuropsychological deficits. Many environmental risk factors have been thought to increase the risk for the disorder. We examined blood iron levels in children with ADHD and a control group to find an association between iron deficit and diagnosis, neuropsychological characteristics and clinical features.

Восприимчивость организма к патогенам в зависимости от гомеостаза железа

We studied the effects of iron homeostasis on the mechanisms of innate immunity. Latent iron deficiency and iron deficiency anemia were accompanied by a decrease in the functional activity of cellular and humoral innate immunity that is expressed in the reduction of all parameters of phagocytosis, the activities of the complement system, and the bactericidal activity of serum. Immunosuppression depended on the degree of anemia. The experimental modeling of serum iron deficit and excess revealed that phagocytic activity did not apparently depend on the presence and concentrations of iron chelator, and bactericidal activity of serum decreased both in serum iron deficit and excess. The study shows the importance of maintaining a narrow range of iron concentrations within which the host interaction with pathogens occurs. The change in this optimal range for the host organism leads to the increased susceptibility to pathogens.

Malnutrition in Very Old Hospitalized Patients: A New Etiologic Factor of Anemia?

Anemia and malnutrition are highly prevalent, frequently concomitant and associated with negative outcomes and mortality in the elderly. To evaluate the association between these two entities, and test the hypothesis that protein-energy deficit could be etiology of anemia. Prospective case-control study. Geriatric and Rehabilitation Hospital, Geneva University Hospitals, Switzerland. 392 patients (mean age 84.8 years old, 68.6% female). Hematological (hemoglobin (Hb)), chemical (iron work up, cyanocobalamin, folates, renal function, C-Reactive Protein (CRP)) and nutrition (albumin, prealbumin) parameters, and mini nutritional assessment short form (MNA-SF). The prevalence of anemia (defined as Hb<120 g/l) was 39.3%. Anemic patients were more frequently malnourished or at risk of malnutrition according to the MNA-SF (p=0.047), with lower serum albumin (p <0.001) and prealbumin (p <0.001) levels. Thirty-eight percent of these patients had multiple causes and 14.3% had no cause found for anemia. Among the latter 90.9% of patients with unexplained anemia had albumin levels lower than 35g/l. After exclusion of iron,vitamin B12 and folic acid deficits, anemic patients had lower albumin (p<0.001) and prealbumin (p 0.007) levels. Albumin level explained 84.5% of the variance in anemia. In multivariate analysis albumin levels remain associated with Hb only in anemic patients, explaining 6.4% of Hb variance (adj R2) and 14.7% (adj R2) after excluding inflammatory parameters (CRP>10). Albumin levels are strongly associated with anemia in the elderly. Screening for undernutrition should be included in anemia assessment in those patients. Further prospective studies are warranted in order to explore the effect of protein and energy supplementation on hemoglobin level.

Possible mechanism of iron deficit development in Mimulus guttatus plants exposed to joint action of nickel and zinc salts

Possible reasons for development of iron deficiency were investigated in the plants of Mimulus guttatus Fischer ex DC exposed to separate or joint action of NiSO4 (20 and 80 μM) and ZnSO4 (50, 100, and 200 μM). Six-week-old plants were grown during the next 28 days under controlled-climate conditions in water culture on a modified Rorison’s medium supplemented with or without NiSO4 and/or ZnSO4. It was found that the plants of M. guttatus are very tolerant to joint action of nickel and zinc sulfates. We revealed an antagonism between Ni2+ and Zn2+ in the course of uptake by the roots: Zn2+ impeded Ni2+ uptake by the roots even if concentration of Zn2+ in the medium was 1.6 times lower than the concentration of Ni2+, whereas Ni2+ inhibited uptake of Zn2+ by the roots if concentration of Ni2+ in the medium was 1.6 times higher than the level of Zn2+. The nickel did not affect zinc translocation to the aboveground organs, whereas zinc boosted translocation of nickel from the roots to the leaves. We showed a strong reverse correlation between the content of iron and total content of zinc and nickel in the leaves and a reverse correlation between translocation of iron and nickel. Assay of iron and determination of Fe(III)-chelate reductase activity in the roots showed that development of iron deficit in plants exposed to NiSO4 and ZnSO4 was not associated with inhibition by Ni2+ and Zn2+ of Fe2+ uptake by the roots. It was found that the plants responded to exposure to 50–200 μM ZnSO4 with a manifold rise in the content of free nicotianamine (NA) in the root system, whereas when culture medium was supplemented with 20 or 80 μM NiSO4 in addition to ZnSO4, the level of free NA in the roots became at least three times lower relative to the content of free NA in the roots exposed to ZnSO4 alone. Finally, we revealed a direct correlation between the content of free NA and accumulation of nickel in plant leaves. The data suggest that development of iron deficit in the plants of M. guttatus exposed to joint influence of nickel and zinc sulfates depends on the competition between Ni2+ and Fe2+/Fe3+ for a chelating agent (probably, NA).