Management Of Iron Deficiency Anemia Research Articles

The prevalence and clinical characteristics of restless legs syndrome in patients with iron deficiency anemia in Korea.

While the prevalence and clinical characteristics of restless legs syndrome (RLS) are known to vary according to ethnicity, a detailed evaluation of this condition among patients with iron deficiency anemia (IDA) has not yet been reported in an Asian population. We investigated the prevalence and clinical characteristics of RLS in patients with IDA in Korea compared with age- and sex-matched patients diagnosed with idiopathic RLS. This prospective single-center study was performed at a regional university hospital. Consecutive patients with IDA were enrolled over a 4-year period. Clinical interviews and laboratory tests were conducted at the first visit. RLS diagnosis was confirmed through face-to-face interviews. We randomly selected patients with idiopathic RLS without comorbid medical disorders from our sleep center dataset as control patients. The clinical characteristics of both groups were compared. We enrolled 124 patients with IDA. Fifty (40.3%) patients were diagnosed with RLS, with 82% exhibiting severe to very severe symptoms. Patients with IDA and RLS were older and reported more sleep deterioration than patients with IDA without RLS. Patients with IDA and RLS also had a more depressed mood and higher periodic limb movement index scores than patients with idiopathic RLS. The prevalence of RLS among patients with IDA in Korea was high, with the majority having severe to very severe symptoms. Patients with IDA and RLS had poorer sleep quality and more emotional problems than patients with IDA without RLS. Therefore, patients with IDA should be screened for RLS to prevent adverse effects on the quality of sleep and life.

Management of iron deficiency anemia in hemodialysis patients based on mean corpuscular volume

BackgroundTo manage the anemic status in hemodialysis (HD) patients, a well-balanced combination therapy based on the use of erythropoiesis-stimulating agents (ESAs) and iron supplementation is essential. Serum ferritin level and transferrin saturation rate (TSAT) are the current standard tests for screening iron deficiency status. However, these are not included in frequently checked regular blood measurements in many HD centers. Other parameters that could predict a hemoglobin (Hb) increase response from iron supplementation have yet to be established. To determine a frequently checked and regularly measured biomarker for predicting iron deficiency status, this study investigated the value of mean corpuscular volume (MCV) as a clinical parameter for HD patients receiving intravenous iron supplementation (Fe-IV) therapy.Methods and resultsOne hundred thirty four HD patients, 88 non-HD patients with anemia, and 50 HD patients on Fe-IV therapy from the Nozatomon clinic were assessed. Comparison of MCV values of anemic HD patients and anemic non-chronic kidney disease (CKD) patients showed that anemic HD patients had significantly higher MCV values (93.9 ± 7.3 fL) compared with anemic non-CKD patients (82.8 ± 8.8fL). Fifty HD patients, who received Fe-IV therapy at ten consecutive HD sessions (inclusion criteria: Hb ≤ 12.0 g/dL, TSAT < 20%, and serum ferritin < 100 ng/mL) showed a rapid increase during the Fe-IV period in MCV, Hb, and TSAT levels. After the completion of the Fe-IV therapy, MCV persisted at the increased levels, whereas Hb levels further increased and peaked at 1 month with a gradual decline after, largely influenced by ESA dosage reductions. The 50 patients were divided into three groups according to the MCV levels obtained immediately prior to the Fe-IV therapy (MCV ≤ 85 fL, 85 fL < MCV ≤ 90 fL, MCV > 90 fL), and Hb changes at 50 days after the initiation of the Fe-IV therapy were compared. All the patients in the MCV ≤ 85 fL group and most of the patients in the 85 fL < MCV ≤ 90 fL group showed linear and consistent Hb increase during the 50-day period. In marked contrast, patients in the MCV > 90 fL group showed dispersed trends in their Hb increase. The present study also revealed that successful ESA dosage reduction could be achieved after the Fe-IV therapy in both the MCV ≤ 85 fL and 85 fL < MCV ≤ 90 fL groups.ConclusionsThe present study underscored the value of MCV in perceiving iron deficiency status as well as predicting iron-based therapeutic response in HD patients.

Investigation and management of iron deficiency anaemia in a specialist palliative care setting and the role of intravenous iron: a descriptive analysis of hospice data

Background: Anaemia is common in hospice populations and associated with significant symptom burden. Guidelines recommend investigating for and treating iron deficiency (ID), but there is little evidence of this practice in palliative care populations. This report describes the results of investigations for and subsequent management of ID in a UK hospice. Methods: This is a descriptive study of routine clinical data. Laboratory and clinical records were reviewed retrospectively for 12 months following the implementation, in August 2018, of routine investigation for ID amongst patients with clinically relevant anaemia in whom treatment would be considered. Absolute (AID) and functional iron deficiency (FID) were diagnosed using established definitions and treatments recorded. Results: Iron status was evaluated in 112 cases, representing 25/110 (22.7%) of those with mild, 26/76 (60.5%) moderate and 41/54 (75.9%) severe anaemia. Twenty-eight (25%) were defined as having AID, 48 (42.8%) FID and 36 (32%) no ID. There was a significant difference between groups in symptoms triggering haemoglobin check and diagnosis, with a higher proportion of patients with classic symptoms of anaemia and gastrointestinal malignancy in those with AID. Intravenous iron was given on 12 occasions in the hospice with no major adverse events. Subjective symptom benefit in 7 cases and a significant increase in overall mean haemoglobin were observed. Conclusions: This report describes the outcome of investigations for iron deficiency in patients with clinically significant anaemia in a UK hospice. Results indicate iron deficiency is common and can be safely treated with intravenous iron replacement, within current guidelines, in a hospice setting. Further research should define the optimum use of this approach in palliative care patients.

Traitement par fer oral de l’anémie ferriprive lors de la grossesse : état des pratiques chez les sages-femmes

Iron deficiency anemia represents a public health issue which is usually managed by midwives. Because it is associated with maternal and fetal risks, a treatment is warranted. Oral iron represents the main option for treating this condition. Despite the existence of national and international guidelines no consensus about its modality of use has emerged so far. The primary objective of this study was to analyze midwives'practice with regards to iron deficiency anemia treatment using oral iron formulations. We conducted an observational and descriptive cross-sectional in a sample of midwives from the Gironde administrative region using a questionnaire. We obtained 85questionnaires from midwives working in private or public health facilities. Doses of iron and duration of treatment seem insufficient for a majority of responders. Folic acid and vitamin C are often associated with oral iron. Most midwives assess the efficacy of oral iron at one month with hemoglobin and ferritin levels. A significant fraction of these midwives shares similar practices which are in good accordance with the literature such as patient counselling with regards to drug intake, management of gastrointestinal side effects and inefficacity of oral iron. Noticeably, some of these midwives don't follow any guidelines. The majority of participants demonstrated practices in accordance with various national guidelines although no precise therapeutic algorithm is available as reference. Larger studies on the management of iron deficiency anemia in pregnancy by health professionals and harmonization of practices are necessary.

Review on Management of iron deficiency Anaemia with Ayurveda

Review on Management of iron deficiency Anaemia with Ayurveda

Revisiting Iron Metabolism, Iron Homeostasis and Iron Deficiency Anemia.

Iron deficiency anemia (IDA) is one of the commonest clinical scenarios especially in children, women of childbearing age, and elders. The crux of this review was revisiting iron homeostasis, mechanism of iron absorption, causes, laboratory diagnosis, and management of IDA. This narrative review is compiled after a relevant literature search from electronic databases including, but not limited to, Google, Google Scholar, PMC, PubMed, Science Direct, and Scopus. The key words used for searching relevant literature include iron, iron deficiency, iron deficiency anemia, iron metabolism, hepcidin, transferrin, causes of iron deficiency anemia, and laboratory diagnosis of iron deficiency anemia. Reference hema-tology books were also consulted. According to the published literature, about one mg of iron is required daily which equals its loss, although the iron requirement increases in pregnancy and lactating mothers. Dietary non heme iron (oxidized Fe3+) is reduced to the ferrous (Fe2+) form by ferrireductase present in the brush border of duodenal enterocytes. Ferrous iron is absorbed in the brush border of duodenal enterocytes through a carrier protein, divalent metal transporter 1 (DMT1). Heme iron is absorbed by the duodenal enterocytes through a mechanism that is not well understood or a receptor yet to be discovered. Transferrin receptor helps in the internalization of iron in the cells. Hepcidin acts as a gatekeeper and controls iron absorption by enterocytes and macrophages. IDA may be caused by decreased intake of iron, increased iron requirements or loss of iron from the body. Iron deficiency anemia is the most common nutritional anemia that affects large numbers of people in developed as well as in developing countries. It is estimated that approximately 2 billion people around the world have IDA. Microcytosis with marked reduction in serum iron, decreased % saturation of transferrin, low ferritin, and reduced or even undetectable hepcidin are the laboratory features of IDA. In addition, total iron binding capacity and soluble transferrin receptors increase significantly in IDA. Management of IDA is incomplete if the underlying cause is not ruled out and left untreated.

Effectiveness of a Planned Teaching Programme to Educate Adolescent Girls in the Avoidance and Dealing with Iron Deficiency Anaemia in a Selected School of Bilaspur District

Background: Nowadays young adolescents face many problems because of their lifestyle modifications such as eating junk foods, fast foods, snacking, and skipping meals. Some adolescents are undernourished due to a lack of awareness regarding dietary iron and poor socioeconomic status. These are quite common among urban adolescent girls. Iron deficiency anaemia is the most prevalent nutritional disorder in the world today. Iron is a necessary mineral for body function and good health. A lack of iron in the blood can lead to iron deficiency anaemia, which is a very common nutritional deficiency among children and adolescents. Objective: This study is aimed to analyse the effectiveness of a planned teaching programme to educate adolescent girls in the prevention and management of iron deficiency anaemia in a selected school of Bilaspur district. Method: Convenient sampling technique and structured questionnaire were used in the study. Result and Conclusion: The findings revealed that about 38% of the adolescent girls belonged to the age group of 14.1-15 years, 85% belonged to the Hindu religion, 48% had family income &gt; 30,000 INR, 63% belonged to nuclear families, fathers of 60% of the adolescent girls were government employees, mothers of 48% of the adolescent girls were housewives, 78% of the adolescent girls belonged to urban areas, and 48% of the adolescent girls had got the information through mass media. The distribution of the adolescent girls among the 9th, 10th, 11th, and 12th standards was found to be equal (25% each). The assessment of the overall pre-test knowledge level of adolescent girls shows that 3% had good knowledge, 86% had average knowledge, and 11% had below-average knowledge.

A COMPARATIVE RANDOMIZED CLINICAL TRIAL OF NAVAYAS LOUHA SYRUP AND NISHA LOUHA SYRUP IN THE MANAGEMENT OF IRON DEFICIENCY ANEMIA IN INDIAN CHILDREN WITH SPECIAL REFERENCE TO PANDU ROGA

Iron deficiency is the most usual dietary deficiency worldwide, approximately 25% of the world’s population suffering from iron deficiency anemia according to the World Health Organization. A Neonate has total body iron of 250 mg (80 mg/kg), obtained from maternal sources. In the first 6 months of life, during the period when the infant gets an iron-deficient milk diet, this amount decreases to 60 mg/kg. Infants fed with cow’s milk are at greater risk to develop iron deficiency anemia because calcium from cow’s milk is competing with iron for absorption. There are a large number of formulations (like Navayas Louha Syrup, Nisha Louha Syrup etc.) that are mentioned to prevent iron deficiency anemia in Indian children. Despite lack of scientific data regarding the clinical efficacy of Navayas Louha Syrup and Nisha Louha Syrup, an effort has been done to present the current scenario. 60 anemic patients of either sex age between 1-15 years were randomly selected from Kaumarabhritya O.P.D. and I.P.D. of Rani Dullaiya Post Graduate Ayurvedic College and Hospital, Bhopal (M.P), India. Overall, in the study Navayas Louha is 74.53% and Nisha Louha is 69.34% having clinical efficacy. The study was showed in clinical trial efficacy of Navayas Louha syrup is better than Nisha Louha syrup in the management of iron deficiency anemia in Indian children.

An assessment of the adequacy of iron deficiency anaemia management in the Namibian private healthcare system.

Anaemia, a condition characterized by reduced oxygen-carrying capacity, is a widespread public health problem with major consequences for human health as well as social and economic development. Prompt and accurate diagnosis as well as effective management of iron deficiency anaemia (IDA) is important to prevent the undesired adverse clinical outcomes. The purpose of the study was to assess the adequacy of IDA diagnosis and management within the Namibian private healthcare system. In this study, we used a quantitative, descriptive research design and data collection methods. The design was also nonexperimental in nature, employing a survey instrument to collect data. In total, 51 questionnaires were administered to private medical practitioners. The surveyed medical practitioners used different Standard Treatment Guidelines (STGs) in managing IDA cases, with the majority (76.5%) using the Namibia STGs. The other guidelines and their usage rates were as follows: World Health Organization guidelines (39.2%), Standard Treatment Guidelines and Essential Medicine List for South Africa (19.6%) and Essential Medicine List and Standard Treatment Guidelines for Zimbabwe (19.6%). Most of the medical practitioners used Namibian STGs although others used other treatment guidelines at their discretion. The study concluded that medical practitioners follow different guidelines and reference documents when dealing with patients with suspected IDA. Adherence to a single reference document would enable standardization of clinical practice. Management of IDA in the Namibian private healthcare system could be improved. To ensure adequate IDA management and prompt resolution of iron deficiency anaemia, we recommended the need to review the Namibia Standard Treatment guidelines and to ensure that training on the guidelines is offered.

Effect of oral iron and intravenous iron sucrose on pregnancy related outcome among pregnant females with iron deficiency anemia

Introduction: Intravenous iron sucrose and oral iron therapy are the primary therapeutic modalities for management of iron deficiency anaemia during pregnancy, but its efficacy during pregnancy is still a matter of argument among healthcare personnel. Therefore the objective of this study is to compare the effect of oral iron and intravenous iron sucrose on pregnancy related outcome among pregnant females with iron deficiency anemia. Materials and Methods: Randomized clinical trial was conducted among females between 14 to 36 weeks gestation with iron deficiency anemia who were managed either with oral ferrous sulphate or intravenous iron sucrose therapy. Chi-square test was used for statistical analysis with p Results: About 11.25% of the study subjects had the complication of abruption/ Post-Partum hemorrhage or had the need of blood transfusion in oral group. No significant difference in respect to maternal complications as well as mode of delivery was observed in between the two groups. In intravenous group proportion of appropriate for gestational age newborns (AGA) were significantly higher than the oral group (p Conclusions: Intravenous iron sucrose use for treatment of iron deficiency anaemia could reduce morbidities from iron deficiency and have better foetal outcome in terms of appropriate for gestational age in newborns. Keywords: Anaemia, Haemoglobin, Iron sucrose.

Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding: A systematic review.

BACKGROUNDAnemia is considered a public health issue and is often caused by iron deficiency. Iron-deficiency anemia (IDA) often originates from blood loss from lesions in the gastrointestinal tract in men and postmenopausal women, and its prevalence among patients with gastrointestinal bleeding has been estimated to be 61%. However, few guidelines regarding the appropriate investigation of patients with IDA due to gastrointestinal bleeding have been published.AIMTo review current evidence and guidelines concerning IDA management in gastrointestinal bleeding patients to develop recommendations for its diagnosis and therapy.METHODSFive gastroenterology experts formed the Digestive Bleeding and Anemia Workgroup and conducted a systematic literature search in PubMed and professional association websites. MEDLINE (via PubMed) searches combined medical subject headings (MeSH) terms and the keywords “gastrointestinal bleeding” with “iron-deficiency anemia” and “diagnosis” or “treatment” or “management” or “prognosis” or “prevalence” or “safety” or “iron” or “transfusion” or “quality of life”, or other terms to identify relevant articles reporting the management of IDA in patients over the age of 18 years with gastrointestinal bleeding; retrieved studies were published in English between January 2003 and April 2019. Worldwide professional association websites were searched for clinical practice guidelines. Reference lists from guidelines were reviewed to identify additional relevant articles. The recommendations were developed by consensus during two meetings and were supported by the published literature identified during the systematic search.RESULTSFrom 494 Literature citations found during the initial literature search, 17 original articles, one meta-analysis, and 13 clinical practice guidelines were analyzed. Based on the published evidence and clinical experience, the workgroup developed the following ten recommendations for the management of IDA in patients with gastrointestinal bleeding: (1) Evaluation of hemoglobin and iron status; (2) Laboratory testing; (3) Target treatment population identification; (4) Indications for erythrocyte transfusion; (5) Treatment targets for erythrocyte transfusion; (6) Indications for intravenous iron; (7) Dosages; (8) Monitoring; (9) Indications for intravenous ferric carboxymaltose treatment; and (10) Treatment targets and monitoring of patients. The workgroup also proposed a summary algorithm for the diagnosis and treatment of IDA in patients with acute or chronic gastrointestinal bleeding, which should be implemented during the hospital stay and follow-up visits after patient discharge.CONCLUSIONThese recommendations may serve as a starting point for clinicians to better diagnose and treat IDA in patients with gastrointestinal bleeding, which ultimately may improve health outcomes in these patients.

Advancing OB/GYN Knowledge, Competence, and Performance Related to Abnormal Uterine Bleeding and Intravenous Iron Supplementation for Effective Management of Iron Deficiency Anemia: Outcomes Analysis from a 2019 Educational Initiative

Background: Iron deficiency anemia (IDA) is a multifaceted condition associated with immense obstetrical morbidity and mortality, and is especially prevalent in female patients of reproductive age.Abnormal uterine bleeding (AUB), which often manifests clinically as heavy menstrual bleeding (HMB), is the leading cause of IDA among reproductive age women in the United States, with a prevalence ranging from ~30-50% in this patient population; further, HMB is estimated to account for nearly one-third of all IDA causes worldwide. For these reasons, AUB/HMB is generally accepted as the primary causal source of IDA in daily clinical practice.As frontline clinicians who routinely manage HMB, OB/GYNs are optimally positioned to subsequently recognize, diagnose, and treat the IDA precipitated by HMB. However, to ensure the provision of safe and effective care, adaptive educational initiatives with an emphasis on evolving iron supplementation strategies are needed. Methods: Creative Educational Concepts (CEC) conducted a literature review, needs assessment, and detailed gap analysis to identify prominent clinical and educational gaps that exist among OB/GYNs with regard to IDA sign and symptom recognition, epidemiology, clinical gravity and risk factors, formal diagnosis, and appropriate treatment.Consequently, our team at CEC composed a responsive, multi-pronged educational design targeted to obstetricians, gynecologists, and women's health professionals, in a tailored effort to bridge the aforementioned gaps in current practice and improve outcomes for patients.CEC consulted with top experts in obstetrics and gynecology, maternal fetal medicine, pelvic surgery, and hematology at every stage of the educational design and delivery continuum, from proposal ideation to content development to live, on-site presentation.To dynamically engage the target audience, especially at the community, grassroots level, this educational initiative was delivered at a series of five American College of Obstetricians and Gynecologists (ACOG) District Meetings across the United States; live meetings were held in Lake Geneva, WI; San Diego, CA; Kapalua, HI; Rockport, ME; and Manhattan, NY. Results: 203 total clinicians were educated across the initiative Profession MD/DO - 93%APRN/CNM - 3%RN - 2%Other - 2%Specialty General OB/GYN - 81%Maternal/fetal Medicine - 11%Reproductive endocrinology - 4%Pelvic medicine/surgery - 2%Other - 2%&amp;gt;5,000 IDA patients potentially impacted per month as a result of the initiativeStatistically significant advances in learning and knowledge were achieved from pre- to post-activity for all tested educational gaps: Identification of IDA risk factors (85% post vs. 46% pre; P&amp;lt;0.001)Clinical implications of AUB (95% post vs. 74% pre; P&amp;lt;0.001)Appropriate clinical utility of IV iron (93% post vs. 63% pre; P&amp;lt;0.001)Top intended practice changes: Consider IV iron supplementation in my patients with IDA for whom oral iron supplementation is ineffective or intolerableConsider IV iron supplementation as first-line treatment for my patients with severe IDA, ongoing bleeding, and/or absorption deficienciesShare information learned with colleagues and other members of my healthcare teamTop anticipated barriers to change: Limited experience with parenteral iron supplementation therapiesPatient non-adherenceInadequate care coordination between OB/GYNs and primary care physiciansGiven an HMB-associated IDA patient case, activity attendees demonstrated a significant retention of knowledge and clinical performance improvement from pre-test to 4-week follow-up related to appropriate initiation of IV iron 90% at 4-wk follow-up vs. 63% at pre-test (P=0.018) Conclusions: Our 2019 ACOG District Meeting educational initiative precipitated substantive practice advances in knowledge, competence, and performance among OB/GYNs and women's health professionals related to IDA management.Statistically significant performance improvements in appropriate initiation of IV iron for treatment of HMB-associated IDA were achieved at follow-up assessment.Learning and knowledge endpoints for IDA risk factor recognition and AUB clinical implications were not retained with statistical significance at follow-up assessment, thereby evidencing residual educational gaps and a need for ongoing education in this space. Disclosures Shulman: Bayer: Consultancy; AMAG: Speakers Bureau; Lupin: Speakers Bureau; Vermillion: Speakers Bureau. Munro:Vifor: Consultancy; Abbvie: Consultancy, Research Funding; American Regent: Consultancy; Boston Scientific: Consultancy; Daiichi Sankyo: Consultancy. Martin:Daiichi Sankyo: Consultancy. Nelson:Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Bayer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AMAG: Consultancy; Agile Pharmaceutical: Consultancy, Research Funding; EvoFem: Research Funding; Sebela Pharmaceutica: Consultancy, Research Funding; TherapeuticsMD: Membership on an entity's Board of Directors or advisory committees; American Regent: Consultancy, Membership on an entity's Board of Directors or advisory committees.

E-Iron: Rethinking the Way We Deliver Intravenous Iron. Report of a Pilot Telemedicine Initiative

Introduction Iron deficiency is common in the community, affecting upwards of a third of females in their childbearing years. The majority of patients with iron deficiency anemia (IDA) will be successfully managed with simple oral iron supplementation. However, a substantial proportion will only achieve normal hematocrits after protracted courses of treatment, often entailing significant GI toxicity. In recent years, with the availability of formulations that allow for total dose infusion, the role of intravenous iron (IVI) has become increasingly appreciated as a rapid, reliable, and safe strategy in addressing IDA. Historically, at our institution and at many others, the path to IVI treatment entails initial referral to hematology, a face-to-face evaluation at a hematology clinic, followed by scheduling for infusion on another visit. The median time from referral to infusion is approximately 35 days, with timing of infusions determined not by clinical considerations, but by chair availability and the whims of non-clinical personnel entrusted with the scheduling. Inappropriate delays are common, and of practical import when occurring, say, in pregnant women approaching their due dates, or patients scheduled for surgery. With the purpose of expediting the above process, capitalizing on a robust e-consult platform already operational at our institution, e-IRON was made available to referring providers as a function in the EPIC EMR, that facilitates an 'electronic' referral to hematology, for consideration for IVI. A template-based design ensures that all information required (indication, experience with oral iron, current lab-work, etc.) is included. Following the institutional protocol for e-consults, e-IRON referrals are 'chart-reviewed' by a specialist hematologist within 3 business days, and a determination regarding IVI is made. If deemed appropriate, the patient is scheduled for infusion within 10 business days. The specialist also specifies whether a face-to-face hematology appointment is required, and in cases where IVI is not deemed appropriate, will provide guidance as to alternate management. Results During the initial 75 day evaluation period 81 e-IRON referral were received. Indications are listed in table 1, and responses in table 2. The largest subgroup of referrals was from the prenatal clinics, likely as a result of a proactive protocol for management of IDA in pregnancy adopted by the department of obstetrics in conjunction with hematology. Of note, IVI was approved and scheduled for 60 of 81 (74%) patients, of which only 2 were required to be seen by hematology. Reasons for non-approval of IVI varied, but the most common reason cited was an inadequate trial of oral iron, in which case specific instructions were provided for oral iron supplementation. In one notable case, wherein a referred patient's anemia was felt to be discordant with his degree of iron deficiency, a more extensive workup was recommended resulting in a diagnosis of previously unsuspected myeloma. Recommendations were generated within 3 business days for 77 (95%) consults and in 1 day for 47 (58%). Recommended IVI regimens all entailed 1 or 2 infusion days, depending on the estimated iron deficit, and all first infusions were scheduled within 2 weeks of the request. Conclusion The e-IRON pilot project demonstrates the feasibility and efficacy of a telemedicine approach in triaging, and expediting the management of patients requiring IVI. Using a template-based e-consult platform, reviewing hematologists are in the vast majority of cases able to rapidly determine appropriate management, and facilitate IVI when appropriate. The platform ensures effective supervision by specialist hematologists, but dispenses with the laborious, costly, and time consuming traditional requirement of a face-to-face visit to the hematology clinic. The value of this paradigm shift in patient care is underscored by lessons learned during the ongoing COVID19 pandemic. Disclosures No relevant conflicts of interest to declare.

Management of iron deficiency anaemia in secondary care across England between 2012 and 2018: a real-world analysis of Hospital Episode Statistics

ObjectiveIron deficiency anaemia (IDA) occurs in 2%–5% of men and postmenopausal women in the developed world and, if left untreated, can significantly impair quality of life or decompensate chronic illnesses....

The Impact of Lactoferrin Fortification on the Health Benefits and Sensory Properties of Yogurt

The aim of this work was to study the effect of milk supplementation with lactoferrin on the rheological and sensory properties of yogurt and to evaluate the efficiency of lactoferrin-fortified yogurt in the treatment of iron deficiency anemia (IDA), microcytic hypochromic anemia, in children. For this purpose, yogurt was manufactured from milk fortified with commercial lactoferrin and the yogurt sensory characteristics, pH and concentration of lactic acid of supplemented yogurts, were determined throughout the shelf-life period storage (7 days) at 4°C and compared with a control yogurt. Furthermore, the use of lactoferrin-fortified yogurt in treatment of IDA in comparison to commercial lactoferrin alone (lactoferrin dissolved in water) were assessed with 20 children (2–5 years old) suffering from IDA. Children were divided into two groups (A and B), 10 children each. Group A received lactoferrin-fortified yogurt while, group B received commercial lactoferrin dissolved in water. The blood cells indices, Hb, HCT, MCV, TLC, Platelets, Serum iron, Serum ferritin, TIBC and Transferrin were analyzed before and after treatment for each group. The results showed that manufactured fortified yogurt was firm, with acceptable sensory properties and the Hb and red blood cell indices significantly improved in patients received lactoferrin-fortified yogurt even than patients received lactoferrin only. This study concluded that lactoferrin addition had no significant effect on yogurt manufacture and the yogurt produced from milk fortified with lactoferrin had a vital supportive treatment for the management of IDA in children.

Effects of a multifaceted intervention to promote the use of intravenous iron sucrose complex instead of ferric carboxymaltose in patients admitted for more than 24 h

Although more practical for use, the impact of ferric carboxymaltose (FCM) on the hospital budget is considerable, and intravenous iron sucrose complex (ISC) represents a cost-saving alternative for the management of iron deficiency anemia in patients during hospitalization. The Drug Committee decided to reserve FCM for day hospitalizations and contraindications to ISC, especially allergy. ISC was available for prescription for all other situations. The impact of a multifaceted intervention promoting a switch from FCM to ISC was evaluated using an interrupted time series model with segmented regression analysis. The standardized rate of the dispensing of FCM, ISC, and oral iron by the hospital pharmacy, as well as the rate of the dispensing of packed red blood cells and the number of biological iron status measurements, was analyzed before and after the intervention. There was an immediate decrease in FCM consumption following the intervention, with a reduction of 88% (RR: 0.12 [CI95% 0.10 to 0.15]). Conversely, there was a large increase in ISC use (RR: 5.1 [CI95% 4.4 to 5.9]). We did not observe a prescription shift to packed red blood cells or oral iron after the intervention. The time series analysis showed the frequency of iron status testing to remain stable before and after. The direct savings for intravenous iron for 8 months were 187,417.54 €. Our intervention to lower the impact of intravenous iron therapy on the hospital budget was effective.

Iron Deficiency Anemia in Pregnancy: Novel Approaches for an Old Problem.

Iron needs increase exponentially during pregnancy to meet the increased demands of the fetoplacental unit, to expand maternal erythrocyte mass, and to compensate for iron loss at delivery. In more than 80% of countries in the world, the prevalence of anemia in pregnancy is > 20% and could be considered a major public health problem. The global prevalence of anemia in pregnancy is estimated to be approximately 41.8%. Undiagnosed and untreated iron deficiency anemia (IDA) can have a great impact on maternal and fetal health. Indeed, chronic iron deficiency can affect the general wellbeing of the mother and leads to fatigue and reduced working capacity. Given the significant adverse impact on maternal-fetal outcomes, early recognition and treatment of this clinical condition is fundamental. Therefore, the laboratory assays are recommended from the first trimester to evaluate the iron status. Oral iron supplementation is the first line of treatment in cases of mild anemia. However, considering the numerous gastrointestinal side effects that often lead to poor compliance, other therapeutic strategies should be evaluated. This review aims to provide an overview of the current evidence about the management of IDA in pregnancy and available treatment options.

A Comparison of efficacy of I/V Iron V/S Oral Iron for management of iron deficiency anemia in pregnant women in a tertiary care center

A Comparison of efficacy of I/V Iron V/S Oral Iron for management of iron deficiency anemia in pregnant women in a tertiary care center

Gastroenterologist-Lead Management of Iron Deficiency Anemia in Inflammatory Bowel Disease Is Effective, Safe, and May Increase Quality of Life.

BackgroundThe effectiveness and safety of gastroenterologist (GI)-lead treatment of iron deficiency anemia (IDA) in inflammatory bowel disease (IBD) have not been well-studied.MethodsA retrospective chart review of patients with IBD, IDA, and evidence of treatment with iron at a tertiary IBD center was conducted.ResultsIn 351 patients, hemoglobin and quality of life scores increased significantly after treatment with iron. Twelve of 341 patients treated with intravenous iron had an adverse effect. Twenty-seven patients required a hematology referral.ConclusionGIs should consider treating patients with IBD and IDA with intravenous iron as it is safe and effective.

Trends in Anemia, Iron, Therapy, and Transfusion in Hospitalized Pediatric Patients with Inflammatory Bowel Disease

To evaluate trends in diagnosis and management of iron deficiency anemia using a large national children's hospital database in pediatric patients admitted with inflammatory bowel disease (IBD). In this retrospective multicenter cohort study, we used the Pediatric Health Information System de-identified administrative database. Patients age <21years with ≥2 admissions with International Classification of Disease, Ninth Revision and Tenth Revision codes for Crohn's disease or ulcerative colitis from 2012 to 2018 were included. We extracted data regarding diagnoses of anemia and/or iron deficiency, and receipt of oral iron, intravenous (IV) iron, and/or blood transfusion. Data were analyzed descriptively. We identified 8007 unique patients meeting study criteria for a total of 28 260 admissions. The median age at admission was 15.4years. A diagnosis of anemia was documented in 29.8% of admissions and iron studies were performed in 12.6%. IV iron was given in 6.3% of admissions and blood transfusions in 7.4%. The prevalence of the diagnosis of anemia among IBD admissions increased from 24.6% in 2012 to 32.4% in 2018 (P<.0001). There was a steady increase in the proportion of IBD admissions that used IV iron, from 3.5% in 2012 to 10.4% in 2018 (P<.0001), and the proportion of admissions with red cell transfusions decreased over time from 9.4% to 4.4% (P<.0001). Iron deficiency anemia is prevalent among pediatric patients with IBD admitted to US children's hospitals. From 2012 to 2018, there was an increase in the use of inpatient IV iron for the treatment of iron deficiency anemia and a decrease in transfusions.