Iron Supplementation Research Articles

Ferric carboxymaltose: a potential game changer

Ferric carboxymaltose: a potential game changer

Diammonium glycyrrhizinate alleviates iron overload-induced liver injury in mice via regulating the gut-liver axis

BackgroundEvidence indicates a close association between iron overload (IO) and the pathogenesis of chronic liver diseases, highlighting the potential for interventions targeted at IO to impede or decelerate the progression of chronic liver diseases. Diammonium glycyrrhizinate (DG), the medicinal form of glycyrrhizic acid, a principal constituent of licorice, has been clinically employed as a hepatoprotective agent; however, its protective effect against IO-induced liver injury and underlying molecular mechanisms remain elusive. PurposeThe aim of the present study is to investigate the hepatoprotective effect of DG against IO-induced liver injury with a focus on the gut-liver axis. Study design and methodsAnimal models of IO-induced liver injury and DG treatment have been established in vivo. Iron deposition, liver injury, intestinal barrier damage, and liver inflammation were assessed in mice treated with iron dextran or DG. The microbiome composition in feces was analyzed using 16S rRNA full-length sequencing. Bile acids (BAs) profiles in feces were detected by UPLC-Q-TOF-MS technique, and the expression levels of receptors, enzymes or transporters involved in BAs metabolism were also determined. ResultsDG partially reduced the iron deposition and the levels of ferrous ion in the livers of mice with IO, thereby mitigating oxidative damage. DG also improved gut microbiota dysbiosis, repaired intestinal barrier damage, inhibited endotoxin translocation to the liver, and subsequently suppressed TLR4/NF-κB/NLRP3 pathway-mediated liver inflammation caused by IO. Moreover, DG modulated BAs metabolism disorder in IO mice, reducing the accumulation of BAs in the liver. ConclusionDG alleviates IO-induced liver injury in mice by regulating the gut-liver axis. This study provides novel insights into the underlying mechanisms through which DG ameliorates liver injury caused by IO.

Rhodotorulic Acid and its Derivatives: Synthesis, Properties, and Applications.

Siderophores are low molecular weight compounds produced by microorganisms to scavenge iron in iron-deficient environments. Rhodotorulic acid, a natural hydroxamate siderophore, plays a vital role in iron acquisition for fungi and bacteria. As the simplest natural hydroxamate siderophore, it exhibits a high affinity for ferric ions, enabling it to form stable complexes that facilitate iron uptake and transport within microorganisms. This article provides a comprehensive analysis of this hydroxamate siderophore, rhodotorulic acid, its synthesis, physicochemical properties, and biological significance. It also explores its applications in antifungal and plant protection strategies. Insights into RA derivatives reveal distinct biological effects and applications with potential in various fields, from antioxidants to antifungals. Rhodotorulic acid and its derivatives show promise for novel therapies, plant protection strategies, and iron supplementation in agriculture. Understanding their properties could advance science and medicine with sustainable practices.

Postpartum maternal and infant haematological effects of second-trimester ferric carboxymaltose versus standard-of-care oral iron in Malawi: longitudinal follow-up of a randomised controlled trial

Postpartum maternal and infant haematological effects of second-trimester ferric carboxymaltose versus standard-of-care oral iron in Malawi: longitudinal follow-up of a randomised controlled trial

Enhancing diagnostic accuracy for iron deficiency in pregnant women through mean reticulocyte volume.

Women are more prone to iron deficiency (ID) anemia when pregnant. The diagnostic use of mean reticulocyte volume (MRV) in identifying ID anemia during pregnancy has not been thoroughly investigated. The objective of this study is to evaluate the effectiveness of MRV in diagnosing ID in pregnant women. Firstly, MRV of 20 healthy female volunteers (healthy group) was measured on specific days for one month. Subsequently, clinical data from 724 pregnant women were thoroughly examined. These women were divided into two groups: 282 with ID (research group) and 442 without ID (control group). Parameters such as MRV, reticulocyte hemoglobin equivalent (RHE), red blood cell volume distribution width-standard deviation (RDW-SD), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), hematocrit (HCT), reticulocyte count (RET), MRV/MCV ratio, and serum ferritin (SF) were analyzed and compared. MRV remained consistent over a period of one month for 20 healthy individuals. In addition, there were significant differences in MRV, RHE, RDW-SD, MCV, MCH, MCHC, HCT, RET, and MRV/MCV between the research group and control group. The receiver operating characteristic (ROC) analysis showed that the areas under the curve (AUCs) for these measures were as follow: 0.840, 0.837, 0.676, 0.654, 0.639, 0.602, 0.571, 0.550, and 0.816, respectively. Ultimately, there was a substantial disparity in MRV prior to and following therapy with oral iron treatments. In healthy women, MRV remains stable and is a reliable ID marker, which can be used to assess oral iron treatment effectiveness during pregnancy.

High prevalence of undiagnosed iron deficiency in endometriosis patients: A cross-sectional study.

The primary objective was to evaluate the prevalence of undiagnosed iron deficiency in patients with endometriosis. We performed a multi-center, cross-sectional study at two tertiary care hospitals. We included 251 non-pregnant women (18-50 years old) presenting with a clinical or surgical diagnosis of symptomatic endometriosis. Patients who consented to the study underwent screening bloodwork (including complete blood count, ferritin, and transferrin saturation) and completed the study survey assessing demographics, medical and surgical history, and validated questionnaires to assess iron deficiency and endometriosis symptoms. The prevalence of iron deficiency in our endometriosis cohort was 53.4% (134/251), and the prevalence of iron deficiency anemia was 13.5% (34/251). Patients with iron deficiency were more likely to have heavy menstrual bleeding (HMB) compared with patients without iron deficiency (66/133, 49.6% vs. 40/115, 34.8%, p = 0.022). Nonetheless, 58% (142/251) of our study population did not endorse HMB. Despite absence of HMB, 47% (67/142) of these patients were iron-deficient. Transferrin saturation was diagnostic for iron deficiency in 63 of 176 patients (35.7%) who had a normal ferritin (≥30 ng/mL). Patients with iron deficiency had a significantly lower adjusted median Functional Assessment of Chronic Illness Therapy Fatigue Subscale score compared with those without iron deficiency (26.3. vs. 29.8, p = 0.025). This study highlights the high prevalence of iron deficiency, which remains undiagnosed in over half of patients with endometriosis presenting to a gynecologist. Future research should focus on assessing the effectiveness of iron therapy in improving symptoms and overall well-being in this population.

Prevalence and management of anemia and impact of treatment burden on health-related quality of life in chronic kidney disease and dialysis patients.

Anemia management in chronic kidney disease (CKD) is a significant challenge for healthcare professionals worldwide. The extensive management of CKD and its complications is directly linked with a substantial treatment burden, which impacts quality of life (QoL). This study aimed to assess the prevalence and management of anemia and to evaluate the treatment burden and its impact on the QoL of CKD and dialysis patients in Pakistan. A multicenter prospective observational study was conducted in three hospitals. A total of 170 patients were enrolled, with 156 available for follow-up after six months. Their prior consent was obtained. Each participant was interviewed in person and received a data collection form. At baseline, the prevalence of anemia among CKD (stage 3-5) and dialysis patients was 78.7% and 94.7%, respectively. Patients on dialysis used more erythropoietin stimulating agents (ESAs), with 38.6% at baseline and 40.8% by month six, compared to non-dialysis CKD patients. Oral iron was used by 6.2% of stage 3, 25% of stage 4, 20% of stage 5 patients, and 6.6% of dialysis patients at baseline. At the six-month follow-up, 42.8% of CKD and 33.8% of dialysis patients achieved the target hemoglobin level. Dialysis patients had a higher treatment burden compared to CKD at baseline (77.4±10.6 vs 59.3±13.3) and at six-month visit (79.3±11.1 vs 59.1±14.5). The multiple regression analysis showed that treatment burden had a significant association with age, disease duration, and comorbidity at baseline. There was a significant negative correlation between overall treatment burden and QoL, indicating that QoL decreases as treatment burden increases. Anemia was prevalent, and its management was suboptimal in this study. The overall treatment burden score was high in dialysis patients, negatively affecting the QoL.

Comparison of the effects of deferasirox film-coated tablets (Jadenu®) and deferasirox dispersible tablets (Exjade®) in patients with beta thalassemia major: a preliminary report of the effects on the satisfaction, convenience, cardiac/liver MRI T2*, serum ferritin level, and biochemical profiles

BackgroundDeferasirox (DFX) is a once-daily oral iron chelator with proven dose-dependent efficacy in patients with thalassemia major (TM). The reason for switching from DFX dispersible tablets (Exjade®) to DFX film-coated tablets (Jadenu®) was intolerance. Many patients also reported that deferasirox® did not taste good. In this study, we compared the effect of Jadenu® and Exjade® on satisfaction, convenience, cardiac/liver MRI T2*, serum ferritin levels, and biochemical profiles in patients with thalassemia major.MethodSixty-two patients with thalassemia over 2 years of age, who had iron overload indicated by chelation therapy, were randomly divided into two groups. The first group (n = 32) is treated with Exjade®, and the second group (n = 30) is treated with Jadenu®. Laboratory investigations included alkaline phosphatase (ALK), alanine transferase (ALT), aspartate transferase (AST), and serum ferritin levels. Cardiac/liver MRI T2* levels and patient satisfaction and convenience, were assessed before and 1 year after starting therapy.ResultsThe study found that 53.3% of Jadenu® patients were satisfied with the taste of the medication compared to only 12.5% of Exjade® patients, which was statistically significant (p = 0.001). Additionally, 40% of Jadenu® patients were satisfied with the ease of taking the medication compared to 28.1% of Exjade® patients, and again, the difference was statistically significant (p = 0.047). A comparison of the cardiac MRI T2* levels between the two studied groups showed no significant difference (p = 0.851).ConclusionJadenu® offers patients an improved formulation that can be taken on an empty stomach, has a better taste, and presents fewer gastrointestinal tolerability concerns. Overall, patient satisfaction is higher with Jadenu®, which may improve adherence and reduce the frequency and severity of complications associated with iron overload. This, in turn, may help mitigate cardiovascular and hepatic complications from iron overload in the long term.Clinical Trial Registrationhttps://irct.behdasht.gov.ir/search/result?query=IRCT20210830052346N1

Prevalence and influencing factors with knowledge, attitude, and practice toward anemia among school-going adolescent girls in rural Bangladesh

Background Anemia is a major public health concern; however, research on anemia and its contributing variables is scarce. To address the gap, we investigated the prevalence and associated factors of anemia in school-aged adolescent girls in rural Bangladesh. Methods We conducted a cross-sectional study in two secondary schools at Chandpur, Bangladesh, from January to April 2022. We randomly selected 422 adolescent girls based on prevalence rates from existing research to ensure reliable estimates and a robust study representation. We performed interviews with a semi-structured questionnaire after receiving ethical permission and written informed consent. In addition, physical examination and anthropometric measurements were done, followed by blood testing to identify anemia. Blood hemoglobin was measured using a spectrophotometric method, and quality control was ensured by validated results with control samples. Univariate with multiple logistic regression was employed for analysis to find the association between anemia and all other variables that were adjusted to control the potential effect of confounding variables. Results The overall prevalence of anemia was 37.7% (mild- 33.8% and moderate- 3.9%). In the univariate analysis having a working mother (OR 3.84; 95% CI 1.31–11.26), undernutrition (OR 2.40; 95% CI 1.27–4.52), and irregular lunch consumption (OR 2.15; 95% CI 1.00–4.60) were associated with anemia. Conversely, being a user of a slab latrine (OR 0.61; 95% CI 0.40–0.93) and not weekly consumption of pure milk (OR 0.62; 95% CI 0.41–0.92) were negatively associated with anemia. In multivariate logistic regression analysis, associated factors for prevalent anemia were working mother [adjusted odds ratio (aOR) 7.65; 95% CI 1.97–29.50], slab latrine user (aOR 0.46; 95% CI 0.26–0.79), and irregular lunch consumption (aOR 2.92; 95% CI 1.21–7.03). Conclusion The prevalence of anemia among adolescent girls in rural Bangladesh remains high with undernutrition. Anemia is associated with working mothers, slab latrine users, and irregular lunch consumers within the studied population.’ Thus, policymakers may promote school-based nutritional education and lunch programs with iron supplementation and improve sanitary facilities.

Micronutrient intakes in a young antenatal population—10‐year Retrospective survey at a Sydney hospital clinic

AbstractAimNutritional requirements are increased in young people to support growth, and this is particularly critical when pregnancy occurs within young age groups. The aim was to describe nutritional intakes (with particular emphasis on iron and calcium) and selected pregnancy outcomes, in a young antenatal population aged 14–24 years.MethodA retrospective audit was conducted using 404 records from a young parents' antenatal clinic which included prepregnancy body mass index (BMI), pregnancy weight gain, baby birth weight, nutritional biochemistry, and dietitian assessment of iron and calcium intakes and supplement use. Age groups were compared (adolescents aged 14–18 years versus older 19–24 years clients), and regression analysis was used to explore potential predictors of birth outcomes.ResultsThere was no difference in prepregnancy body mass index for age, pregnancy weight gain, baby birth weight or outcomes, between the age groups. Based on food group serves, intakes were inadequate for iron in 82% of clients and for calcium in 72%. Iron status declined in both groups during the pregnancy, while adolescents had less adequate calcium intake (p = 0.0001). Supplement use was more common in clients with poor iron (p = 0.015) or vitamin D status (p < 0.0001).ConclusionIron and calcium intakes were inadequate in this nutritionally vulnerable population. Further research would be beneficial to identify effective interventions to improve nutrition in this cohort.

Therapeutic intervention with intravenous ferric carboxy-maltose: addressing iron deficiency among heart failure patients

Therapeutic intervention with intravenous ferric carboxy-maltose: addressing iron deficiency among heart failure patients

Gut Dysbiosis and Its Role in the Anemia of Chronic Kidney Disease

The gut dysbiosis present in chronic kidney disease (CKD) has been associated with anemia. Factors such as the accumulation of gut-derived uremic toxins, increased gut barrier permeability-induced inflammation, and a reduced intestinal production of short-chain fatty acids (SCFAs), all associated with changes in the intestinal microbiota composition in CKD, may lead to the development or worsening of anemia in renal patients. Understanding and addressing these mechanisms related to gut dysbiosis in CKD patients can help to delay the development of anemia and improve its control in this population. One approach is to avoid or reduce the use of drugs linked to gut dysbiosis in CKD, such as phosphate binders, oral iron supplementation, antibiotics, and others, unless they are indispensable. Another approach involves introducing dietary changes that promote a healthier microbiota and/or using prebiotics, probiotics, or symbiotics to improve gut dysbiosis in this setting. These measures can increase the presence of SCFA-producing saccharolytic bacteria and reduce proteolytic bacteria, thereby lowering the production of gut-derived uremic toxins and inflammation. By ameliorating CKD-related gut dysbiosis, these strategies can also improve the control of renal anemia and enhance the responsiveness to erythropoiesis-stimulating agents (ESAs) in ESA-resistant patients. In this review, we have explored the relationship between gut dysbiosis in CKD and renal anemia and propose feasible solutions, both those already known and potential future treatments.

Abstract A015: Aging limits stemness and tumor development in the lung by reprogramming iron homeostasis

Abstract Aging is the most important and well-recognized risk factor for cancer. Aging leads to systemic decline of physical fitness, significantly changing the macroenvironment from the early tumor initiation to the terminal stage of metastasis. However, the underlying mechanisms only start to emerge. Here, using physiologically aged autochthonous genetically engineered mouse models (GEMMs) and primary cells, we demonstrate that aging suppresses lung cancer initiation and progression by degrading stemness of the alveolar cell of origin. Using single-cell transcriptomics, we uncover a distinct compositional landscape of cancer cell subsets in aged lung tumors, revealing a delay in the molecular progression of the lung lesions and an age-specific gene expression signature. Interestingly, key components of this gene signature were traced back to the aged cell of origin. Furthermore, the age-specific signature derived from GEMMs was predictive of patient age in human lung cancer, indicating conservation of the age-associated changes across species. Interestingly, our preliminary data suggested that tumor cells derived from aged tumor-bearing mice displayed higher metastatic potential, indicating that different mechanisms may govern tumor initiation and metastasis. Functional interrogation of the age-specific gene signature revealed that the loss of stemness and tumorigenic capacity is underpinned by aging-associated induction of the transcription factor NUPR1. We find that NUPR1 is induced in the cell of origin in aged mice and humans, which leads to a functional iron insufficiency in the aged cells. Genetic inactivation of the NUPR1 or iron supplementation restores stemness and promotes tumorigenic potential of aged alveolar cells. Conversely, targeting NUPR1 is detrimental to young alveolar cells by promoting ferroptosis. We find that aging-associated DNA hypomethylation at specific enhancer sites results in elevated NUPR1 expression, which is recapitulated in young cells by inhibition of DNA methylation. We uncover that, unlike the young, aged alveolar cells are functionally iron insufficient, which leads to loss of stemness and resistance to ferroptosis. Our results indicate that aging-associated reprogramming of the cell of origin determines tumor initiation potential, alters trajectory of tumor evolution and produces age-dependent vulnerabilities. These findings demonstrate that aging fundamentally changes the biology of lung cancer, shedding light on novel therapeutic modulation of cellular iron homeostasis or ferroptosis in regenerative medicine and in cancer prevention for the elderly population. Citation Format: Xueqian Zhuang, Qing Wang, Simon Joost, Alexander Ferrena, Melissa Blum, Klavdija Krause, Zhuxuan Li, Deyou Zheng, Emily S Wong, Tuomas Tammela. Aging limits stemness and tumor development in the lung by reprogramming iron homeostasis [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A015.

Single-center experience of four cases with iron-refractory iron deficiency anemia (IRIDA)

Background. Iron refractory iron deficiency anemia (IRIDA) is a rare autosomal recessive type of anemia characterized by unresponsiveness to oral iron therapy and partial response to parenteral iron therapy. In this article, we report the clinical presentation of four patients with IRIDA admitted to our clinic, including their laboratory values at admission and after oral and parenteral iron treatment, and the analysis of their mutation(s) in TMPRSS6 gene. Case. Four patients from different families, aged between 3 and 14 years, two girls and two boys, two of whom were from consanguineous marriages, who were diagnosed with iron deficiency anemia in primary health care institutions and referred to our clinic because of inadequate response to oral iron treatment were included. Patients were evaluated for the differential diagnosis of microcytic, hypochromic anemia and investigated for the etiology of IDA. Homozygous or compound heterozygous mutations causing defective matriptase-2 protein expression were detected in the TMPRSS6 gene; these mutations included four frameshift mutations-two of which were the same in two cases and causing premature terminal stop codons-and a nonsense mutation, all of which were previously demonstrated in the literature. The response to parental iron therapy ranged from complete non-response to mild to good response in hemoglobin levels, but none of the patients showed improvement in iron parameters. Conclusions. Increased awareness of IRIDA and keeping it in mind in the differential diagnosis in the presence of hypochromic microcytic anemia that does not respond to iron treatment will be crucial in improving the diagnosis and treatment of the disease and ultimately enhancing the quality of care for affected individuals.

Accuracy of Mentzer index for predicting iron deficiency anemia in adults

Background: It is of great clinical significance to differentiate between causes of microcytic, hypo chromatic anemias, iron deficiency anemia being one of them as it will improve with iron supplements. Complete blood picture is unable to differentiate. Iron studies and Hemoglobin electrophoresis are expensive tests. This necessitates the need of a cost-effective test and therefore we tried to determine the effectiveness of mentzer index in predicting iron deficiency anemia. Methods: It was an Observational, Cross-sectional study, conducted in Department of General Medicine, Federal government polyclinic hospital, Islamabad. Patients with microcytic hypochromic anemia, both from indoor and outdoor were included in study. Iron deficiency Anemia was diagnosed by iron studies (serum ferritin, Serum Iron, TIBC and transferrin saturation) and then mentzer index was calculated to check accuracy. Patient with normocytic or macrocytic anemia or other cell lines deficiency, patients with infectious diseases or inflammatory process were excluded from study. Results: A total of 155 patients were included in the study. Out of all the patients 145(93.5%) had mentzer index of > 13 while 10(6.5%) had mentzer index of <13. All of 150 patients (100%) had transferrin saturation lessthan 20 % indicating iron deficiency anemia against 93.5% picked up by Mentzer index. The receiver operator curves (ROC) showed that the MCV was the most important predictor of anemia while calculating mentzer index. The AUC value for MCV was 0.886(CI: 95%, 0.806-0.966, p value <0.000). MCV value between 52.6 to 63.5 fl predicted that the Mentzer index would be above 13, thus suggesting iron deficiency anemia with a sensitivity of more than 86%. Conclusion: Study findings support the use of Mentzer index, particularly MCV, as a valuable tool for predicting iron deficiency anemia.

Randomized comparative study between ferric carboxymaltose and iron sucrose for correction of anemia in antenatal women

Anemia during pregnancy is a significant global health concern. This study aims to evaluate the efficacy and safety of Ferric Carboxymaltose (FCM) compared to Iron Sucrose (ISC) in treating mild to moderate iron deficiency anemia (IDA) in pregnant women. A randomized prospective control study was conducted with antenatal women suffering from mild to moderate anemia at Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital from December 2018 to November 2019. Participants were randomly assigned to either Group A (FCM) or Group B (ISC). A total of 128 women were randomized, with 64 in each group. The mean increase in hemoglobin was significantly higher in the FCM group (1.34 g/dl) compared to the ISC group (0.98 g/dl) (p < 0.001). FCM required fewer administrations, improving patient compliance. Both treatments were well-tolerated, with minor local reactions observed. FCM offers a more effective, convenient, and well-tolerated treatment option for IDA in pregnancy compared to ISC.

Using an experience-based co-design approach to develop strategies for implementing an intravenous iron intervention to treat moderate and severe anemia in pregnancy in Malawi.

In low- and middle-income countries, women experiencing anemia during pregnancy are recommended to take 30mg to 60mg of oral iron daily throughout pregnancy. However, oral iron tablets are often poorly tolerated and slow in correcting anemia, resulting in low adherence, prolonged anemia, and increased risk of adverse maternal and fetal outcomes. An alternative to oral iron is intravenous (IV) iron, commonly used in high-income countries to restore the body's iron stores rapidly. A randomized controlled trial was conducted to investigate the effectiveness and safety of IV iron compared to standard-of-care oral iron supplementation for pregnant women with moderate and severe anemia in the third trimester in Malawi (REVAMP-TT). Using an experience-based co-design approach, our study aimed to identify barriers and facilitators to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi, and develop mitigating strategies for the successful implementation of REVAMP-TT. The co-design process involved two phases: i) We conducted an information-gathering exercise to identify barriers and facilitators to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi. We interviewed key informants (n = 53) including the policymakers, government partners, healthcare managers, and healthcare providers. We also gathered previous research findings from a formative qualitative study on the perceptions and experiences of IV iron treatment for pregnant women experiencing anemia in Malawi (n = 29). ii) We conducted two co-design workshops with end-users (n = 20) and healthcare providers (n = 20) to confirm and identify the key barriers and facilitators and developed mitigating strategies to inform the successful implementation of the REVAMP-TT trial. We mapped the emerging barriers to the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0) and matched the mitigating strategies to the corresponding Expert Recommendations for Implementing Change (ERIC) compilation. The following were identified as key barriers to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi: the cost of IV iron, the lack of available resources and knowledge, local attitudes including myths and misconceptions about IV iron and keeping pregnancy a secret, local conditions, the lack of political will and buy-in from high-level leaders, the lack of capability of healthcare providers to deliver IV iron, and the lack of male involvement to support pregnant women's access to antenatal care. The proposed strategies to mitigate the barriers for the successful implementation of the REVAMP TT trial included providing financial strategy, developing stakeholder relationships, training and educating stakeholders, supporting clinicians, and engaging end-users. The use of the experience-based co-design approach in our study provided a valuable method to expose the potential barriers and facilitators to IV iron use and develop mitigating strategies to successfully implement the REVAMP-TT trial. Engaging both the key informants and end users promoted ownership and consensus among stakeholders and ensured a collaborative environment for sharing deeply rooted real-world experiences and insights. Not only do these findings address the needs of this study, but they also, lay a groundwork for the possible integration of IV iron into routine care in Malawi and provide knowledge for policymakers to make informed decisions on the management of anemia in the primary healthcare systems of Malawi.

Iron Deficiency Anemia: Etiology, Pathophysiology, Diagnosis, and Treatment Approaches

Iron deficiency anemia (IDA) is a common health problem that affects about 1.24 billion people around the world, mostly children and women of childbearing age. IDA happens when the body doesn't get enough iron, loses too much iron, or can't absorb it properly. This makes erythropoiesis, cellular metabolism, and immune function worse. The World Health Organization says that 40% of women who are pregnant and 32.5% of women who are not pregnant have anemia. People with IDA often feel tired, weak, pale, and have trouble thinking clearly. Lab tests, such as hemoglobin, blood ferritin, and transferrin saturation, are used to make the diagnosis. You can treat the condition in two ways: by taking iron supplements by mouth, such as ferrous sulfate, ferrous gluconate, and ferrous fumarate; or, for serious cases, by giving iron through an IV. Strategies for prevention depend on increasing the amount of iron you get from food, making it more bioavailable, and keeping infections under control. Food addition and fortification programs have been shown to help lower the number of people with IDA. However, problems still exist, especially in areas with poor economies. Recent advance in acknowledging how iron is used and controlled has implications for creating targeted therapeutic approaches. A key regulator of iron balance, hepcidin, is a key player in the pathophysiology of IDA. This review shows how complicated IDA is and how important it is to have treatment plans that consider underlying causes, dietary factors, and socioeconomic factors. Keywords: Iron Deficiency Anemia (IDA), Erythropoiesis, Hemoglobin, Nutritional Deficiencies, Neurological Disorders, Iron Supplements.

Iron Sucrose versus Ferric Carboxymaltose: Effectiveness in Treatment of Postpartum Anaemia following Caesarian Section

Background: Postpartum anemia is a leading cause of maternal mortality and morbidity throughout the world, particularly in developing countries.The most common causes of postpartum anemia are antepartum iron deficiency anemia and blood loss during childbirth. Treatment of anemia with ferric carboxymaltose during labor can considerably reduce maternal and newborn morbidity. The aim of the study is to compare the effectiveness of iron sucrose and ferric carboxymaltose in the treatment of postpartum anaemia following caesarian section. Materials and methods: A comparative cross-sectional study was carried out among the 234 outdoor patients of the Department of Obstetrics and Gynecology at Sheikh Hasina Medical College Hospital, Tangail during the period from July 2017 to June 2020. Results: The pre-transfusion mean of hemoglobin level was 8.9±0.5 gm/dl and the post-transfusion mean of hemoglobin level was 10.4±0.4 gm/dl in group A. The pre-transfusion mean of hemoglobin level was 8.7±0.7 gm/dl and the post-transfusion mean of hemoglobin level was 11.0±0.4 gm/dl in group B. The mean of increased hemoglobin level was 1.5±0.4 gm/dl and 2.3±0.5 gm/dl respectively in both groups. The pre-transfusion mean of ferritin level was 46.3±16.1 ng/mL and the post-transfusion mean of ferritin level was 171.5±25.8 ng/mLin group A. The pre-transfusion level was 46.5±16.2 ng/mL and the post-transfusion mean ferritin level was ±24.9 ng/mLin group B. The mean of increased ferritin level was 125.2±22.2 ng/mL and 149.0± 20.5 ng/mL respectively in both groups. These differences were statistically significant within the study groups (p<0.05). Conclusions: The study revealed that serum ferritin levels increased significantly in the FCC group than ISC group. Ferric carboxymaltose are more effective and safe for the treatment of iron deficiency anemia in postpartum patients. IAHS Medical Journal Vol 7(1), June 2024; 8-12

Knowledge, Attitudes, Eating Practices, and Iron (Fe) Consumption among Adolescent Girls (Aged 10-18 Years) in Central Java, Indonesia

Background The Iron (Fe) supplementation program was initiated in 2016 by the Indonesian government. The program included administering iron tablets once a week to female students in schools, although it was not effectively implemented. Objective This study aimed to examine knowledge, attitudes, and eating practices as well as iron intake among adolescent girls (Aged 10-18 Years) in Central Java, Indonesia. Methods and Materials A cross-sectional study was conducted with 484 respondents. The data obtained were analyzed using univariate as the descriptive method, bivariate with Chi-square, and multivariate through logistic regression. Results This study found that knowledge and positive attitudes toward iron tablet consumption were prevalent among respondents, but actual adherence was low, with only 14.7% adhering to the recommended intake. Although adolescent girls showed better eating practices, adherence to consumption did not differ significantly across age groups. A healthy lifestyle significantly improved iron tablet consumption (OR = 14.684) and eating practices (OR = 30.298). The source of information played a crucial role, with health providers being more effective in promoting behaviors (OR = 2.615 for iron tablet consumption and OR = 1.713 for healthy eating practices) compared to non-health attendants (OR = 0.332 for poor eating practices). These results suggested that targeted interventions focusing on lifestyle and information sources could enhance health behaviors in this population. Conclusion A significant influence of knowledge related to anemia, the benefits of iron tablets, healthy eating patterns, and sources of information was observed on the adherence to iron tablet consumption. However, this study recommended that to improve adolescent adherence to iron tablet consumption and eating practices, comprehensive knowledge related to anemia should be provided through various sources, particularly from health professionals.