Iron Supplementation Research Articles

Enteromorpha prolifera polysaccharide-Fe (III) complex promotes intestinal development as a new iron supplement.

Iron is a crucial micronutrient, and its deficiency can have detrimental effects on the health of infants. Dietary polysaccharide-iron (III) complexes (PICs) are promising for addressing iron deficiency due to their minimal adverse reactions and high iron absorption rate. This study aimed to investigate the effects of dietary Enteromorpha prolifera polysaccharide-Fe (III) complex (EP-Fe) on newborns, using 3-day weaned piglets as the iron-deficiency model. Results showed that EP-Fe improved iron levels and promoted intestinal development in piglets. Transcriptome sequencing revealed that EP-Fe increased the survival of intestinal epithelial cells under hypoxia by upregulating the expression of genes that promote the development of the vascular system. Additionally, EP-Fe enhanced the mucosal barrier functions by inhibiting myosin light chain kinase (MLCK)/phosphorylated myosin light chain (p-MLC) signaling pathway to increase the expression of intestinal tight junction proteins. Furthermore, the 16S rRNA gene sequencing of gut microbiota showed that EP-Fe promoted the enrichment of Bacteroides_fragilis and other gut microbes that can metabolize carbohydrates. In conclusion, EP-Fe is an effective iron supplement for newborns, and it can be developed as a comprehensive nutritional supplement.

Demographic and Clinical Characteristics of Patients with Primary Hypothyroidism and Adequacy of Levothyroxine Replacement Therapy in Them: A Nationwide Study in Bangladesh

ABSTRACT Background: Despite the huge burden of primary hypothyroidism in Bangladesh, no nationwide study has been conducted describing the demographic and clinical characteristics of these patients; data on the adequacy of levothyroxine (L-T4) replacement are also lacking. This study aimed to fill the knowledge gap. Materials and Methods: This cross-sectional study was conducted among patients with primary hypothyroidism attending the endocrinology outpatient clinics of several hospitals throughout Bangladesh from July 2023 to December 2023. Adults with primary hypothyroidism who had been on L-T4 replacement for at least 1 year were included. Data on their demographic and disease-related characteristics were collected. Serum thyroid-stimulating hormone (TSH) was measured; TSH 0.4–4.0 μIU/mL was considered the therapeutic target for nonmalignant thyroid cases. Results: Two thousand six hundred and forty-one patients (median age 37 years, 86.4% female, and median disease duration 5 years) were included. Hashimoto’s thyroiditis was the most common (40.9%) cause of hypothyroidism; 1.9% had differentiated thyroid cancer (DTC), and the etiology was not established in many (40.2%). Only 26.8% of patients had high adherence to L-T4. Among the non-DTC cases (n = 2590), over half (53.9%) had TSH within the target range, whether the disease was uncontrolled in the remaining 46.1% (TSH was below the target range in 5.6% and above the target range in 40.5%). Among the DTC cases (n = 51), only a few (9.8%) had a TSH within the target range; TSH was below and above the range in 2% and 88.2% of these patients, respectively. In the nonmalignant hypothyroid cases, vegetarian diet, smokeless tobacco use, disease duration >5 years, iron or calcium supplements consumption within 4 h of L-T4 intake, and low or medium adherence to L-T4 were associated with uncontrolled hypothyroidism. Conclusion: For nearly half of Bangladeshi patients with primary hypothyroidism, L-T4 replacement is not optimal. Physicians should address the barriers to reaching the therapeutic goal for these patients.

Epidemiology of Anaemia in Children under Five in Uganda: Current Trends, Challenges, and Strategic Approaches

Anaemia in children under five years old is a significant public health issue in Uganda, affecting over half of the vulnerable population and posing challenges to their health and development. The issue is influenced by nutritional deficiencies, infectious diseases, socioeconomic factors, and limited healthcare access. Clinical manifestations include pallor, fatigue, and developmental delays, and early detection is difficult due to non-specific symptoms, resource constraints, and cultural practices. The impact of anaemia on child health and development is profound, affecting physical growth, cognitive and motor skills, and overall well-being. Nutritional interventions, such as iron supplementation, fortified foods, and dietary education, are crucial for managing anaemia. Effective healthcare responses and policies, including routine screenings, treatment programs, and community outreach, are also necessary. Preventive measures and treatment programs are crucial for combating malaria and other infectious diseases. Community-based approaches, including training health workers and implementing grassroots education programs, are essential for improving anaemia management. Addressing gender dynamics and socioeconomic determinants is vital for reducing anaemia rates. Monitoring and evaluation frameworks are essential for assessing the effectiveness of anaemia control programs and guiding future efforts. In conclusion, a coordinated approach integrating nutritional, healthcare, environmental, and socioeconomic strategies is necessary to combat anaemia in Uganda. Through continued efforts and collaboration, the burden of anaemia can be mitigated, leading to improved health outcomes for children under five. Keywords: Anaemia, Children, Uganda, Current Trends, Challenges, Strategic Approaches

Gambaran Kepatuhan Ibu Hamil dalam Mengonsumsi Tablet Fe Terhadap Kejadian Anemia di Wilayah Kerja Puskesmas Sadananya

Anemia is a concerning condition for pregnant women. The World Health Organization (WHO) reports that the prevalence of anemia among pregnant women is around 35-37%, and this increases with the progression of pregnancy. Nutritional iron deficiency anemia tends to be more prevalent in developing countries than in developed ones. The incidence rate of anemia in Ciamis Regency, based on the health profile of the regency, is 20.05%. This study aims to depict the compliance of pregnant mothers in consuming iron (Fe) tablets concerning the occurrence of anemia in the working area of Sadananya Community Health Center in 2020. The research design employed in this study is descriptive research. The population consists of all pregnant mothers with anemia during pregnancy in the working area of Sadananya Community Health Center, Ciamis Regency, amounting to 723 individuals in the year 2020. Cluster Sampling technique was used for sample selection. The analysis conducted in this study is univariate. The research results revealed that almost all respondents, totaling 67 individuals (84.4%), were non-compliant in consuming Fe tablets, whereas a small portion of respondents, totaling 12 individuals (15.2%), exhibited compliance in consuming Fe tablets. In conclusion, the majority of respondents, 67 individuals (84.8%), were non-compliant in consuming Fe tablets. It is recommended that relevant institutions, particularly Sadananya Community Health Center, become more proactive in providing education to pregnant women about pregnancy-related anemia and the importance of consuming Fe tablets.

Effects of prenatal yoga exercise on hepcidin and ferritin levels in pregnant women

Prenatal yoga is a modification of hatha yoga tailored for pregnant women. This exercise is recommended throughout pregnancy. This study aimed to determine the effect of prenatal yoga exercise on the serum levels of hepcidin and ferritin in pregnant women. The study employed a quasi-experimental design with a pre- and post-test. A total of 134 second-trimester pregnant women participated and were divided into two groups (intervention group = 62, control group = 72). The intervention group received prenatal yoga exercises for 8 weeks (twice a week), while the control group attended only the standard pregnancy class. Each group was further divided into subgroups: anemic pregnant women, normal pregnant women, and overweight pregnant women. Demographic data were obtained through a basic questionnaire, while pre-pregnancy BMI data, obstetric history, and pregnancy examinations were sourced from the KIA book. Serum hepcidin levels significantly decreased in pregnant women who participated in prenatal yoga exercises (p=0.002), with the highest significance observed in overweight pregnant women (p=0.001). The average serum ferritin levels increased in all groups but were not statistically significant (p=0.759). Regular prenatal yoga exercises can reduce serum hepcidin levels in pregnant women, with a significant reduction noted in overweight pregnant women. Ferritin levels might be influenced by iron supplementation.

A Study to Assess the Prevalance of Anemia and the Effectiveness of Weekly Iron and Folic Acid Supplementaton among the Adolescent Girls and Boys in the Schools in Bangalore

Anemia is defined as reduction in the volume of blood cells or in concentration of hemoglobin, below the lower limit of the normal range for the age and sex of the individual. Anemia in adolescents is very common now a days. Anemia is not a specific disease but a sign of an underlying diseases or disorders. To assess the prevalence of Anemia among adolescents. To evaluate the effectiveness of weekly Iron and Folic acid Supplementation among adolescent girls and boys in schools in Bangalore.To find out the significant association between the level of prevalence of Anemia and socio demographic variables. The research design for the study was quasi experimental design with pretest-posttest having non-equivalent control group. The study was conducted in Rajarajeshwari School in Bangalore. The subjects were selected by random number table. The data was collected through socio-demographic datasheet, clinical Proforma, checklist of anemia and intervention package. The data was analyzed through descriptive and inferential statistics. that there was a significant association between pre-test scores of experimental and control group with family monthly income and food habits whereas there was no significant association between pre-test scores of experimental and control group with mother’s education, fathers education, occupation of father and occupation of mother. Hence H3 was retained which stated that there is a significant association between the pre-test visual analogue score and the selected socio- demographic variables of both experimental and control group at p < 0.05. The study conducted that the anaemis among adolescents was high and prevention is needed before any complication developed.

Magnitude of anemia and associated factors among pregnant women attending antenatal care in governmental health facilities of Shashemene Town, Oromia region, Ethiopia.

Anemia during pregnancy is a common issue that significantly affects the health of both the mother and her child. Globally, anemia is a major public health concern, affecting both developing and developed countries, with approximately 1.3 billion people affected. Pregnant women are among the most vulnerable to anemia. To assess the magnitude and risk factors of anemia among pregnant women attending antenatal care in Shashemene Town, Oromia, Ethiopia. A facility-based cross-sectional study was conducted among 391 pregnant women in Shashemene Town in April 2022. Data were collected using interviewer-administered questionnaires, along with laboratory examinations of blood and stool samples. The data were entered into EpiData 3.1 and analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Bivariate logistic regression was performed, and variables with a p-value of <0.25 were included in the multivariate logistic regression analysis to identify factors associated with anemia. Adjusted odds ratio (AOR) with 95% CIs were calculated, and a p-value of < 0.05 was considered statistically significant. Finally, the results are presented using narration, descriptive statistics, such as tables, graphs, and charts. The prevalence of anemia was found to be 30.9% (95% CI: 26.4, 35.4%). Factors significantly associated with a reduced risk of anemia included high dietary diversity (AOR = 0.217, 95% CI: 0.105-0.451), no history of excessive menstrual bleeding (AOR = 0.162, 95% CI 0.076-0.345), age 25-34 years (AOR = 0.391, 95% CI 0.173-0.883), and age ≥ 35 years (AOR = 0.068, 95% CI 0.011-0.444). Conversely, a mild upper arm circumference (MUAC) of <23 cm (AOR = 4.939, 95% CI 2.330-10.469), no use of contraceptives (AOR = 4.935, 95% CI 2.207-11.032), and no iron supplementation use (AOR = 3.588, 95% CI 1.794-7.175) were significantly associated with an increased risk of anemia. According to the WHO classification, anemia in this study was found to be a moderate public health issue. High dietary diversity, no previous excessive menstrual bleeding, and age were significantly associated with a reduced risk of anemia, whereas a MUAC of <23 cm, no contraceptive use, and no iron supplementation were significantly associated with an increased risk of anemia. Therefore, promoting diverse diets among pregnant women, providing counseling on the benefits of family planning and iron-folic acid supplements, and improving women's education and empowerment are essential.

Comprehensive knowledge and supports from closest relatives are crucial to improve awareness and participation of Indonesian adolescent girls in anemia prevention program.

This qualitative study explored perceptions of anemia prevention among adolescent girls from low- to mid-socioeconomic backgrounds to identify educational needs for effective intervention. This qualitative study employed focus group discussions (FGDs) for data collection. Participants were recruited through purposive sampling based on specific criteria, with each FGD comprising 7-9 participants. A total of 3 FGDs were conducted, involving 23 high school female students. The discussions, guided by an interview guide, took place in classrooms at two different schools. Verbatim transcripts were created from the FGD recordings and analyzed using a thematic analysis approach. The study revealed several information gaps, including an incomplete understanding of anemia, prevention strategies, and its consequences. Comprehensive knowledge about the causes and effects of anemia, along with the importance of iron supplementation, was identified as essential educational needs for adolescent girls. Support from family members and teachers was deemed crucial during the implementation of anemia prevention strategies. The participants recognized anemia as a serious health issue and emphasized the importance of prevention. Key aspects of anemia prevention need to be integrated into nutrition education programs for adolescents. Addressing these information gaps can enhance the promotion of anemia prevention strategies and improve adherence among adolescents.

Absolute and Functional Iron Deficiency in the US, 2017-2020

The prevalence of absolute and functional iron deficiency among adults in the US is unknown. To estimate the prevalence of absolute and iron deficiency and iron supplement use in the US across age, sex, and comorbidity categories. This cross-sectional study analyzed data from the National Health and Nutritional Examination Survey (NHANES) 2017 to 2020 prepandemic cycle. Participants included noninstitutionalized, civilian women and men aged 18 years or older who had available serum ferritin, iron, and unsaturated iron binding capacity measurements. Data analysis was performed from March 21, 2023, to July 5, 2024. Absolute iron deficiency and functional iron deficiency. Absolute iron deficiency was defined as serum ferritin less than 30 ng/mL regardless of transferrin saturation. Functional iron deficiency was defined as serum ferritin greater than or equal to 30 ng/mL with transferrin saturation less than 20%. The prevalence of absolute and functional iron deficiency was estimated among all adults in the US and separately among women and men according to age category (>18 years to <50 years, 50-65 years, and ≥65 years) using recommended sample weights and sampling design factors to provide estimates representative of the national, noninstitutionalized civilian population. The 95% CIs were calculated using the Korn-Graubard method. A total of 8021 US adults (mean age, 48 years; 95% CI, 47-49 years; 52% [95% CI, 50%-53%] female) were included in this analysis. An estimated 14% (95% CI, 13%-15%) of adults in the US met the criteria for absolute iron deficiency, and an estimated 15% (95% CI, 14%-17%) met the criteria for functional iron deficiency. Among US adults without anemia, heart failure, chronic kidney disease, or current pregnancy, the estimated prevalence of absolute iron deficiency was 11% (95% CI, 10%-11%), and that of functional iron deficiency was 15% (95% CI, 14%-17%). The prevalence of functional iron deficiency exceeded that of absolute iron deficiency in all US adults except women younger than 50 years. Iron supplement use ranged from 22% (95% CI, 12%-37%) to 35% (95% CI, 29%-42%) of women with iron deficiency and 12% (95% CI, 5%-21%) to 18% (95% CI, 8%-32%) of men with iron deficiency depending on age. These findings suggest that absolute and functional iron deficiency affect a large proportion of American adults even in the absence of anemia, heart failure, or chronic kidney disease. Further research on the role of functional iron deficiency in adverse health outcomes and on iron deficiency screening strategies is needed.

Perinatal Outcomes Following Intravenous Iron for Treatment of Iron Deficiency With and Without Anemia.

To determine maternal and neonatal outcomes in individuals with iron deficiency receiving antepartum intravenous (IV) iron supplementation, stratified by the degree of anemia. Retrospective cohort study of iron-deficient pregnant patients who received at least one IV infusion of iron (iron sucrose, low molecular weight iron dextran [LMWID], or ferric carboxymaltose) during their pregnancy from January 1, 2011 through June 16, 2022. Our primary outcomes included both neonatal composite morbidity and maternal composite morbidity in the context of maternal anemia. Patients who received LMWID had fewer infusion visits, received higher total doses of iron and had a more substantial correction of hemoglobin compared to those who received iron sucrose (p < 0.01). Maternal anemia at the time of admission was not associated with neonatal composite morbidity. However, there was a significant association between anemia status and maternal composite outcome (p = 0.05). Anemia at time of delivery was associated with the likelihood of requiring a blood transfusion (p = 0.01). This study reinforces previous findings emphasizing the adverse effects of iron deficiency on maternal health and the role of IV iron in reducing these risks.

Components of Iron Deficiency Anemia: Understanding Pathophysiology, Diagnosis, and Management

Iron deficiency anemia (IDA) is a prevalent global health concern, marked by a significant reduction in iron levels, leading to diminished hemoglobin production and compromised oxygen transport. This condition disproportionately affects vulnerable populations, including women of reproductive age, infants, and individuals in low-resource settings, resulting in a multitude of health complications. The pathophysiology of IDA involves complex interactions between dietary iron intake, increased physiological demands, chronic blood loss, and malabsorption syndromes. Clinically, IDA manifests through symptoms such as fatigue, pallor, and cognitive impairments, necessitating a thorough diagnostic approach that includes complete blood counts, iron studies, and reticulocyte counts. Effective management strategies encompass dietary modifications, iron supplementation, and treatment of underlying causes. Furthermore, preventive measures—such as public health initiatives and food fortification—are crucial in addressing the root causes of IDA. Emerging research suggests innovative approaches, including bioavailable iron sources and genetic studies, to enhance prevention and treatment efforts. This review comprehensively examines the components of IDA, providing insights into its pathophysiology, diagnosis, management, and future directions for research and intervention. Keywords Iron deficiency anemia (IDA), Pathophysiology, Diagnosis, Management, Dietary iron.

The impact of different doses of oral iron supplementation during pregnancy: a pilot randomized trial

AbstractOral iron is first-line medication for iron deficiency anemia in pregnancy. We conducted a pilot randomized trial to investigate the impact of different doses of oral iron supplementation started early in pregnancy on women without anemia for 4 main outcomes: recruitment and protocol compliance, adherence, maintenance of maternal hemoglobin, and side effects. At antenatal clinic visits, participants were allocated to 1 of 3 trial arms in a 1:1:1 ratio: 200 mg ferrous sulfate daily, alternate days, or 3 times per week. The participants were followed to delivery. Baseline characteristics of 300 recruited participants were well matched between trial arms. The mean proportion of tablets taken as expected per participant was 82.5% overall (72.3%, 89.6%, and 84.5% for the daily, alternate days, and 3 times a week arm, respectively). There was a lower overall adherence rate in the daily arm (47%) than in the alternate days (62%) and the 3 times per week (61%) arms. A reduction in hemoglobin between randomization and 28 weeks’ gestation seemed smaller for the daily arm. A range of side effects were commonly reported at baseline before starting interventions and at later antenatal visits. Many side effects of iron overlapped with normal pregnancy symptoms. A daily iron dosing schedule might give the best opportunity for delivering an adequate iron load during pregnancy in women without anemia. Further randomized trials powered on clinical outcomes are needed to establish the clinical effectiveness of oral iron supplementation to prevent iron deficiency anemia. This study was registered (#ISRCTN12911644).

Insufficient Awareness Regarding Anemia Prevention during Pregnancy among Expectant Women in Uganda

Anemia during pregnancy is a significant public health issue in Uganda, affecting 30-50% of expectant mothers, with detrimental consequences for both maternal and fetal health. This condition, characterized by low hemoglobin levels, increases the risks of preterm birth, low birth weight, and maternal mortality. Despite its prevalence, there is insufficient awareness regarding anemia prevention among pregnant women in Uganda. Contributing factors include poor nutrition, chronic infections, lack of access to healthcare, and cultural beliefs that hinder dietary practices. This review explores the types, causes, and consequences of anemia during pregnancy, as well as existing prevention strategies, such as iron and folic acid supplementation, malaria prevention, and community health initiatives. It also highlights the barriers to awareness, including educational, socioeconomic, and healthcare access challenges, and offers recommendations for improving awareness, prevention, and healthcare access. Strengthening education campaigns, leveraging community health workers, and enhancing healthcare infrastructure are vital for reducing the burden of anemia in pregnancy and improving maternal and child health outcomes. Keywords: Anemia, pregnancy, Uganda, iron deficiency, maternal health, prevention strategies, public health.

Comparison of the efficacy and adverse effects of oral ferrous succinate tablets and intravenous iron sucrose: a retrospective study

ObjectiveTo analyse the clinical efficacy and adverse drug reactions (ADRs) of iron preparations.MethodsA total of 374 patients with iron deficiency anaemia admitted to our hospital between 1 January and 31 December 2020 were included in this study. They were divided into 2 groups based on their medication regimens: Group A (n = 187) took oral ferrous succinate tablets, and Group B (n = 187) received intravenous iron sucrose. The remission of major symptoms, laboratory test results, ADRs and other related data were collected after 4 weeks of treatment.ResultsCompared with the pre-treatment baseline, haemoglobin (Hb), serum iron (SI), serum ferritin (SF) and the mean corpuscular volume (MCV) increased in both groups at 4 weeks of treatment (P < 0.05). After treatment, Group A had lower levels of Hb (108.41 ± 8.39 vs. 122.31 ± 6.04 g/L, t = 6.293, P < 0.001), SI (9.72 ± 4.24 vs. 15.62 ± 5.41 µmol/L, t = 5.482, P < 0.001) and SF (27.1 ± 10.82 vs. 39.82 ± 10.44 ug/L, t = 6.793, P < 0.001) compared with Group B. In contrast, there was no significant difference in the post‐treatment level of MCV (P > 0.05). The overall response rate significantly differed between the 2 groups (78.61% vs. 90.91%, χ2 = 10.949, P < 0.001). The incidence of ADRs of both groups were similar, and the difference was not statistically significant (χ2 = 0.035, P = 0.851).ConclusionIron sucrose demonstrates favourable efficacy and safety in treating iron deficiency anaemia.

How Reproducible Is Feraheme® (Ferumoxytol Injection)? Comparison of Size, Zeta Potential, and Complement Activation of Different Batches over 15 Years

Ferumoxytol injection, also known as Feraheme®, is an approved IV injectable iron supplement and an experimental MRI contrast agent. Initially, it was approved as an IV bolus agent, but its use was later limited to a slow infusion drip due to high levels of infusion reactions. We collected various batches of ferumoxytol with expiration dates ranging from 2010 to 2025 and compared their size and zeta potential. Since nanoparticle surface properties can affect infusion reactions, we conducted a dot blot immunoassay to measure complement C3 opsonization with ferumoxytol preparations. We observed differences in nanoparticle size and zeta potential between batches and a 2.5-fold variation in complement activation. Interestingly, older batches from 2010 showed more uniform size distribution and lower complement activation than some of the newer batches. This finding may be valuable to the nanomedicine community and regulatory authorities.

Penggunaan Bambu Sebagai Struktur Rumah Tinggal Modern Ramah Gempa

Bamboo material can be applied to structural and decorative elements of modern and minimalist architecture. Use bamboo as structural element, among: 1) as reinforcement structural column, bamboo diameter of 12 cm inserted into the structural column inside iron reinforcement, then cast with concrete. This technique can reduce concrete volume up to 50% than conventional concrete columns, 2) as wall reinforcement, bamboo inserted between the iron reinforcement of the supporting wall, then cast with concrete mortar. This system in addition strengthening walls against the moment forces pressure, can also reduce the volume of concrete. This system can produce walls with a thickness of only 8 cm, much thinner when compared to conventional brick walls 15 cm thick, 3) as reinforcement of concrete slabs, woven bamboo is laid horizontally as a partial replacement for concrete reinforcement iron. This system aims to significantly reduce the amount of iron on the slab, which will reduce construction costs. Science and technology application activities for lecturers of the Department of Civil Engineering, Politeknik Negeri Padag regarding the use of bamboo as earthquake strength for modern residential structure have been carried out at Panti Asuhan Khusus Anak Mentawai, Jl.Purus 4 Padang, on Sunday, August 20, 2023. This activity provides knowledge and adds insight for orphanage children, will finish their education in high school, about alternative materials to replace wood and concrete that are cheaper. So later it is hoped that if they are entrepreneurial or involved in the construction world use of bamboo.

Impact of anaemia in pregnancy on maternal and fetal wellbeing in Oman: a retrospective study

Background/Aims Anaemia is associated with negative outcomes for both mothers and infants. Better understanding of its consequences could lead to improved guidelines for screening and treatment. The aim of this study was to investigate anaemia in pregnancy and adverse maternal and fetal outcomes among pregnant women in Oman. Methods This retrospective study examined the medical records of women who gave birth at a university hospital in Oman over a 3-year period. Chi-squared tests were used for data analysis. Results A total of 723 pregnant women were included, with 62.8% diagnosed with anaemia. Anaemia was significantly associated with preterm birth (P=0.037), low birth weight (P=0.009), intrauterine growth restriction (P=0.002) and postpartum heamorrhage (P=0.019). Conclusions Anaemia is a significant health concern for pregnant women in Oman. Further research will provide more data on its effects, informing targeted interventions and policy enhancements. Implications for practice Early antenatal screening, targeted iron supplementation, nutritional education, appropriate treatment and active management during birth would help address this issue.

Effects of Different Doses of Oral Iron on Hepcidin and Treatment Response in Iron Deficiency Anemia

Effects of Different Doses of Oral Iron on Hepcidin and Treatment Response in Iron Deficiency Anemia

Ferric carboxymaltose in reducing blood transfusions and infections after cardiac surgery

ObjectiveIron supplementation may reduce postoperative anemia, blood transfusions, and infections in patients undergoing surgery. We sought to assess efficacy and safety of prophylactic intravenous iron supplementation in patients without anemia undergoing cardiac surgery. MethodsIn this investigator-initiated industry-sponsored single-center randomized double-blind parallel group trial, we enrolled patients undergoing coronary bypass, aortic or mitral valve or ascending aortic surgery who fulfilled prespecified iron blood test safety criteria. Patients were randomized to receive either a single intravenous 1000 mg dose of ferric carboxymaltose (FCM) or placebo (saline only). Independent unblinded study nurse administered the infusion with masked lines and cannula 2 to 21 days before surgery. Primary efficacy end point was a composite of in-hospital blood transfusions >2 U and nosocomial infection. The trial was registered in Eudract (2017-004901-41). ResultsAltogether 171 patients were screened and 78 randomly assigned to FCM (n = 39) or placebo (n = 39). Trial was prematurely discontinued for futility with regard to reaching the primary end point by the recommendation of the independent data monitoring committee. The primary end point occurred in 3 (7.7%) versus 3 (7.7%) (P = 1.00) of patients assigned to FCM and placebo, respectively, with no difference in blood transfusions >2 U. Fewer hospital readmissions by 3 months follow-up (1 [2.6%] vs 8 [20.5%]; P = .028) were noted in FCM group in a post hoc analysis. Ferritin levels were higher in the FCM group at 3 months indicating more preserved iron stores. ConclusionsProphylactic treatment with FCM was safe but did not reduce the need for blood transfusions or postoperative infections at index hospitalization in patients without anemia undergoing cardiac surgery.

Sacubitril/valsartan reduces incident anaemia and iron therapy utilization in heart failure: The PARAGON-HF trial.

Renin-angiotensin system inhibitors (RASi) have been shown to lower haemoglobin levels, potentially related to reductions in erythropoietin levels and haematopoiesis. We examined whether sacubitril/valsartan might attenuate this effect of RASi alone on incident anaemia in patients with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). PARAGON-HF was a global, multicentre randomized clinical trial of sacubitril/valsartan versus the RASi valsartan in patients with HF and left ventricular ejection fraction ≥45%. We evaluated haemoglobin trajectory and risks of incident anaemia and new iron therapy initiation during follow-up. Among 4795 participants, 1111 (23.2%) had anaemia at randomization and 5.6% were treated with iron at baseline. Over a median follow-up of 2.9 years, patients with anaemia were at significantly higher risk for total HF hospitalizations and cardiovascular death, compared with those without anaemia (21.6 vs. 11.5 per 100 patient-years; adjusted rate ratio 1.31; 95% confidence interval [CI] 1.12-1.54; p = 0.001). Sacubitril/valsartan slightly slowed the decline in haemoglobin levels by 0.1 g/dl (95% CI 0.0-0.2 g/dl; p = 0.005). Participants treated with sacubitril/valsartan were at significantly lower risk of developing anaemia (30.3% vs. 37.6%; hazard ratio [HR] 0.76; 95% CI 0.68-0.85; p < 0.001) and starting iron therapy (8.1% vs. 10.0%; HR 0.81; 95% CI 0.67-0.97; p = 0.026). Treatment effects of sacubitril/valsartan versus valsartan on total HF hospitalizations and cardiovascular death were consistent among patients across the haemoglobin spectrum (pinteraction = 0.60). Among patients with HFmrEF/HFpEF, treatment with sacubitril/valsartan resulted in modestly smaller declines in haemoglobin, lower rates of incident anaemia, and fewer new initiations of iron therapy compared with RASi. ClinicalTrials.gov ID NCT01920711.