Management Of Iron Deficiency Anemia Research Articles

A Protocol for Systematic Review of Ayurvedic Interventions in Iron-deficiency Anemia

Background: In India, Iron-deficiency anemia (IDA) among women Is a problem of major health significance. This study reviews the clinical trials on Ayurvedic management of IDA to generate evidence on their safety and efficacy. Objectives: The primary objective of the present study is systematic review of selected studies and published clinical data in view of safety and efficacy of Ayurvedic interventions in the management of IDA. Materials and methods: Randomized controlled trials (RCTs), quasi-RCTs (QRCT), controlled clinical trials (CCTs), and multiple-arm clinical trials that are of at least 3 weeks' duration will be included. Studies having patients fulfilling the diagnostic criteria based on the symptomatology of Pandu and IDA will be selected. Search strategy (for electronic search) Ayurveda OR Ayurvedic OR Ayurvedic treatment OR Pandu OR iron- deficiency anemia AND Mrit bhakshanajanya pandu as titles, abstracts, or keywords from online databases will be searched. Three investigators shall independently screen all citations and abstracts identified by a primary comprehensive search to sort out potentially eligible trials. Full articles of potentially eligible trials shall be obtained and independently evaluated for inclusion in the review based on the participants (inclusion criteria). Data extraction forms for individual study shall be prepared. Dissemination: The results of systematic review will be disseminated manually and electronically in peer-reviewed journals. The present systematic review may help the health authorities in framing health policies more effectively. Trial registration number: PROSPERO 2019 CDR42019131191 Dated 29/07/2019.

An update on the evaluation and management of iron deficiency anemia in inflammatory bowel disease

Iron deficiency anemia (IDA) is widely accepted to be the most frequent systemic complication and extra-intestinal manifestation of inflammatory bowel disease (IBD), with a prevalence of up to 74% ...

Improvement of iron-deficiency anemia resulting from gastric antral vascular ectasia in patients with systemic sclerosis: cyclophosphamide versus argon plasma coagulation

BackgroundSystemic sclerosis is an autoimmune disease characterized by multisystem affection that could involve the gastrointestinal tract in the form of gastric antral vascular ectasia (GAVE) that might cause iron-deficiency anemia.ObjectiveEvaluation of the outcome and the experience of management of iron deficiency anemia resulting from GAVE in patients with scleroderma using cyclophosphamide therapy compared with argon plasma coagulation (APC).Patients and methodsThis study was conducted over a 2-year period from February 2015 to February 2017. Scleroderma patients with GAVE and iron deficiency anemia were treated with cyclophosphamide (group I) others with APC application to areas with mucosal vascular lesions (group II).ResultsIn total, 14 scleroderma patients with iron deficiency anemia resulting from associated GAVE were enrolled into two groups: group I included seven patients who were treated with cyclophosphamide infusion and group II were exposed to APC in sessions. Patients were followed up at 3 and 6 months; the endpoint was a complete response with improved anemia [hemoglobin (HB) and blood indices], and it was achieved in both groups as we found in group I patients there was a highly significant improvement (P<0.001) in HB, 3 and 6 months after therapy and in group II patients there was a highly significant improvement (P<0.001) in iron level 3 and 6 months, HB 6 months after. On comparing both groups it was clear that there was a significant improvement in group I as regards HB and ferritin levels 3 and 6 months after treatment when compared with group II, and highly significant increase in serum iron level 6 months after treatment in group I when compared with group II.ConclusionWe found that cyclophosphamide and APC are highly efficacious and safe in controlling anemia resulting from scleroderma-associated GAVE. Also, cyclophosphamide is more efficient than APC in improving in those patients.

An algorithm for the diagnosis and management of iron deficiency anaemia in chronic kidney disease

The guidance on the management of iron deficiency anaemia in patients with chronic kidney disease has been described by some clinicians as cumbersome and confusing. This has led to the development ...

Impact of Inflammation on Ferritin, Hepcidin and the Management of Iron Deficiency Anemia in Chronic Kidney Disease.

Iron deficiency anemia (IDA) is a major problem in chronic kidney disease (CKD), causing increased mortality. Ferritin stores iron, representing iron status. Hepcidin binds to ferroportin, thereby inhibiting iron absorption/efflux. Inflammation in CKD increases ferritin and hepcidin independent of iron status, which reduce iron availability. While intravenous iron therapy (IIT) is superior to oral iron therapy (OIT) in CKD patients with inflammation, OIT is as effective as IIT in those without. Inflammation reduces predictive values of ferritin and hepcidin for iron status and responsiveness to iron therapy. Upper limit of ferritin to predict iron overload is higher in CKD patients with inflammation than in those without. However, magnetic resonance imaging studies show lower cutoff levels of serum ferritin to predict iron overload in dialysis patients with apparent inflammation than upper limit of ferritin proposed by international guidelines. Compared to CKD patients with inflammation, optimal ferritin levels for IDA are lower in those without, requiring reduced iron dose and leading to decreased mortality. The management of IDA should differ between CKD patients with and without inflammation and include minimization of inflammation. Further studies are needed to determine the impact of inflammation on ferritin, hepcidin and therapeutic strategy for IDA in CKD.

Iron Deficiency Anaemia in Pregnancy: Developed Versus Developing Countries

Anaemia is the most widespread of the haematological disorders, affecting about one-third of the global population. Despite decades of public health interventions, anaemia in pregnancy remains a major health problem worldwide, with an estimated 41.8% of pregnant women being diagnosed with anaemia at some point in their gestation. At least half of the cases of anaemia in pregnant women are assumed to be due to iron deficiency, with folate or vitamin B12 deficiency, chronic inflammatory disorders, parasitic infections like malaria, and certain inherited disorders accounting for the remaining cases. A considerable variation has been observed in the incidence and aetiology of iron deficiency anaemia among developed and developing nations, warranting differences in the screening protocols and management strategies used by clinicians in these countries. This article highlights the differences in the management of iron deficiency anaemia among low and high-income countries, with a detailed review of the policies followed in India.

IRON DEFICIENCY ANEMIA BY SERUM FERRITIN LEVELS AT A TERTIARY CARE HOSPITAL

Background : Iron deficiency anemia (IDA) during pregnancy is a common nutritional disorder with adverse effects for the baby, such as premature birth and low birth weight, and the mother, such as cardiovascular symptoms and reduced physical and mental strength. Objective; To determine the frequency of iron deficiency anemia by serum ferritin levels at a tertiary care hospital. Material and Methods; All the patients who meet inclusion criteria of this study were registered from Department of Gynecology and Obstetrics, Nishtar Hospital Multan. Proper permission was taken from Institutional Ethical Committee to conduct this study. Examination was done including general physical examination. Venous blood sample (3 ml) was taken and sent to the Pathology Laboratory of the Hospital for serum ferritin levels estimation to diagnose iron deficiency anemia. Data was entered and analyzed by SPSS version 20. Results; Our study comprised of a total of 382 patients meeting inclusion criteria of our study. Mean gestational age of our study cases was 29.21 ± 7.16 weeks and 198 (51.8 %) had gestational age up to 30 weeks. Mean age of our study cases was 26.77 ± 4.29 years (with minimum age of our study cases was 20 years while maximum age was 36 years). Our study results have indicated that majority of our study cases i.e. 298 (78.0 %) were aged up to 30 years. Of these 382 study cases, 156 (40.8 %) belonged to rural areas and 226 (59.2 %) belonged to urban areas. Monthly family income up to Rs. 25000 was noted in 213 (55.8%) while more than Rs. 25000 was noted in 169 (44.2%). Of these 382 study cases, 241 (63.1%) were illiterate and 141 (36.9%) were literate. Mean duration of marriage was 5.17 ± 2.41 years and 199 (52.1%) had duration of marriage more than 5 years. Mean body mass index of our study cases was 25.82 ± 2.44 kg/m 2 and obesity was present in 56 (14.7 %) of our study cases. Mean serum Ferritin level was 11.43 ± 3.98 mg/dl and iron deficiency anemia was noted in 213 (55.8%) of our study cases. Conclusion; Very high frequency of iron deficiency anemia was noted in our study among pregnant women. Iron Deficiency anemia was significantly associated with gestational age, age, residential status, low family income and duration of marriage. All the clinicians should screen these pregnant ladies for serum ferritin levels at the start of pregnancy and should counsel them for better awareness which will lead to proper management of iron deficiency anemia. Keywords; Iron Deficiency anemia, Pregnancy, Ferritin level. DOI : 10.7176/JMPB/52-10

Effect of dietary intervention treatment on children with iron deficiency anemia in China: a meta-analysis

BackgroundPrevious studies have shown beneficial effects of dietary approaches for iron deficiency anemia (IDA) control. This study was design to investigate the effect of dietary intervention treatment on children with iron deficiency anemia.MethodsWe performed a systematic review of published dietary interventions effect on IDA treatment through meta-analysis. CBM, CNKI, Wanfang database, EMBASE, VIP, PubMed and Web of science database were searched to identify studies published between January, 1980 and December, 2016. Statistical analysis was performed by Revmen5.2 software.ResultsInitially we retrieved for 373 studies, and then 6 studies with a total of 676 individuals were included in the analysis according to the inclusion and exclusion criteria for meta-analysis. The overall pooled estimate of odds ratio [(OR), 95% confidence intervals (95% CI)] in the dietary intervention on children with iron deficiency anemia was 6.54 (95% CI: 3.48-12.31, Z = 5.82, p<0.001) and funnel plot is symmetric.ConclusionsOur meta-analysis suggested that dietary interventions are effective in improving the iron deficiency in children with iron deficiency anemia (IDA) and should be considered in the overall strategy of IDA management.

Improving quality of care for patients with iron deficiency anemia presenting to the emergency department.

Patients presenting to the emergency department (ED) with iron deficiency anemia (IDA) are underrecognized, undertreated with iron, and overtransfused. A 3-month audit of red blood cell (RBC) transfusions at the Sunnybrook Health Sciences Centre ED in 2013 showed that only 53% of transfusions for IDA were appropriate. The aim of this quality improvement project was to increase the rate of appropriate transfusion to greater than 80%. Since November 2013, several quality improvement interventions have been implemented, including educational presentations, development of an algorithm on IDA management in the ED, and development of an ED IDA toolkit. The primary outcome was appropriateness of RBC transfusions per month. The process measure was monthly intravenous (IV) iron use in IDA patients managed exclusively by ED staff. Balancing measures included IV iron use according to the algorithm and undertransfusion. Over a 24-month period beginning January 2014, assessment of 193 units transfused in the ED showed an improvement of RBC appropriateness to 91% (range 50%-100%). IV iron use increased from one dose in the 3-month audit to an average of 2.6 and 4.7 per month in 2014 and 2015, respectively. IV iron use did not follow the algorithm in 19% (18 of 93) of cases: 12 were given to patients with less severe iron deficiency or bleeding. Improved RBC transfusion appropriateness for IDA in the ED can be achieved and maintained with the implementation of simple educational and practical interventions.

The Role of Reticulocyte Hemoglobin Content in the Management of Iron Deficiency Anemia in Patients on Hemodialysis

Background: The objectives of this study were to correlate reticulocyte Hemoglobin Content (CHr) with Hemoglobin (Hb), ferritin, and Transferrin Saturation (TSAT) in Patients on Hemodialysis (HD) and to determine the Hb response with intravenous iron supplementation in anemic HD patients with adequate ferritin and TSAT yet low CHr. Methods: This was a prospective, randomized controlled trial involving patients on HD. Patients with baseline results that fulfilled the randomization criteria (CHr 400 ng/mL and/or TSAT > 20%) were then randomized to group A and B. Group A patients received a total of 1 g of intravenous iron and group B served as the control. Results: One hundred and twenty - one patients were enrolled in this study. There was a significant correlation between CHr and TSAT, ferritin, and Hb. A total of 12 patients were randomized to group A and B. There was a significant increase in Hb level observed in group A with median change from baseline of 1g/dL (IQR: - 0.5 to 2.8) at the end of the trial compared to the control group. Conclusions: There was a significant correlation between CHr, Hb, ferritin, and TSAT. Intravenous iron supplement improved Hb level in patients on HD with adequate serum ferritin and/or TSAT levels yet low CHr.

Assessing the costs and benefits of perioperative iron deficiency anemia management with ferric carboxymaltose in Germany

BackgroundPerioperative administration of ferric carboxymaltose (FCM) was previously shown to reduce both the need for transfusions and the hospital length of stay in patients with preoperative iron deficiency anemia (IDA). In this study, we estimated the economic consequences of perioperative administration using FCM vs usual care in patients with IDA from the perspective of a German hospital using decision-analytic modeling.Materials and methodsThe model was populated with clinical inputs (transfusion rates, blood units transfused, hospital length of stay) from a previously reported randomized trial comparing FCM vs usual care for managing IDA patients undergoing elective abdominal surgery. We applied a hospital perspective to all costs, excluding surgery-related costs in both treatment arms. One-way sensitivity analyses were undertaken to evaluate key drivers of cost analysis.ResultsThe average costs per case treated using FCM compared to usual care were €2,461 and €3,246, respectively, for resource expenses paid by hospital per case. This would suggest potential savings achieved with preoperative intravenous iron treatment per patient of €786 per case. A sensitivity analysis varying the key input parameters indicated the cost analysis is most sensitive to changes in the length of stay and the cost of hospitalization per day.ConclusionPerioperative administration of FCM results in cost savings to hospitals based on reduced blood transfusions and length of stay following elective abdominal surgery.

Study to Evaluate Efficacy of Vajravatakmaņdura in Iron Deficiency Anemia in Adolescent Girls: A Randomized Controlled Trial

Background: Anemia in adolescent girls possess greatest burden on their health as it leads to poor cognitive development, poor reproductive health and if not treated may lead to intrauterine growth retardation in their developing fetus. The prevalence of anemia among adolescent is 27% in developing country and 6% in developed country. The Government of India has launched National Anemia Control Programme, to prevent and control anaemia in children and adolescents. But the problem is still persisting because of many issues like - poor palatability, intolerance to the drug used, poor absorption of the drugs used, constipation, discoloration of stool, unpleasant odor and taste etc. result in poor compliance and therefore non adherence to the therapy which finally results in poor improvement. By looking at the magnitude of the problem, an Ayurveda drug Vajravatakmandura has been selected for the study and the present study was undertaken to evaluate the efficacy of the trial drug in iron deficiency anemia in adolescent girls. Material and methods: 100 subjects satisfying inclusion and exclusion criteria were selected and were randomly divided in two groups. In group A, the trial drug Vajravatakmaņdura was administered and in group B, IFA tablets were given for two month of duration with follow up at every fortnight. Result: Both the trial and control groups showed extremely significant result over subjective parameters. Trial drug Vajravatakmaņdura in group A was found more effective over the subjective parameters - weakness, palpitation, pallor and loss of appetite with % gain of 39.77%, 39.39%, 39.17%, 38.09% respectively. Statistical analysis between before and after treatment findings of objective parameters, extremely significant (P less than 0.0001) improvement was found in both groups in all parameters, except for RBC count in group A, which was significant. No adverse effects were reported during entire period of study by any of the patients in trial group treated with trial drug. Conclusion: The trial drug “Vajravatakmandura” is effective, safe and palatable for the management of iron deficiency anemia in adolescent girls.

Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three-year results of a prospective observational study.

Anemia is the main indication for red blood cell (RBC) transfusion and iron deficiency is the most prevalent, preventable, and treatable cause of anemia worldwide. We aimed to assess the impact of iron deficiency anemia (IDA) on RBC transfusion by means of a program for prevention, early detection, and treatment. A prospective observational study was conducted starting in 2014 after an intervention in clinical practice in Melilla, a peripheral city isolated by 207 km sea distance to nearest continental Spain. Recommendations were proposed for first-step diagnosis of iron deficiency in the laboratory, oral iron prevention and treatment in primary care, and intravenous iron complexes and RBC transfusion for hospital management. Reduction in RBC use for years 2014 to 2016 was the primary outcome, with the period 2010 to 2013 considered as baseline performance for statistical analysis. Compared to baseline, there was a significant (p < 0.05) increase in mean (±SD) yearly reference population (79,748 ± 3265 vs. 85,376 ± 781), ferritin assays (6980 ± 997 vs. 11,794 ± 1567), admissions (6768 ± 239 vs. 7629 ± 191), and subjects exposed to iron therapy (3975 ± 0.0 vs. 4667 ± 21 for oral, 54 ± 7 vs. 257 ± 109 for sucrose, and 128 ± 9 vs.176 ± 15 for carboxymaltose iron). Mean yearly number of RBC units transfused decreased (1622 ± 112 vs. 1434 ± 44; p = 0.043), with a mean reduction of 11.6% from baseline, or 21.4% when estimated by units transfused per 1000 admissions. Management of IDA is a target to avoid RBC transfusion, and awareness of this health problem should be among the first pillars for any patient blood management program.

Role of vitamin A supplementation in management of iron deficiency anemia in children

Background: The objective of the study were to study the effect of the supplementation of vitamin A along with standard dose of iron on hematopoiesis in children with documented iron deficiency anemia, a hospital based prospective study is carried out for 6 months on children with documented iron deficiency anemia in OPD and indoor patients of the department of paediatric medicine, Medical College Kolkata..Methods: Thirty children (1-12 years age) presenting with iron deficiency anemia (hemoglobin less than 10 g/dl, mean corpuscular volume (MCV) &lt;75 fl, and serum iron &lt;55 mcg/dl) were studied in two groups of 15 each. Group I was supplemented with iron (ferrous sulphate 3 mg/kg/d) while group II in addition to iron was also supplemented with vitamin A (5000 IU/d).Collected data were expressed as mean±SE. Comparison of variables was done by using student t test or chi square test as applicable. P&lt;0.0001 was taken as statistically significant.Results: Hemoglobin concentration was found to be significantly increased after 4 weeks of iron supplementation. Rise in hemoglobin was comparatively more in group II, as compared to group I, after 4 and 8 weeks.Conclusions: The result of this study suggests that supplementation of vitamin A improves hematopoiesis.

Management of Iron Deficiency Anemia in Pregnancy in India.

Iron deficiency anemia (IDA) continues to be the commonest etiology of anemia in pregnancy. The prevalence of iron deficiency (ID) in pregnant Indian women is amongst the highest in the world. Untreated iron deficiency (ID) has significant adverse feto-maternal consequences. Plethora of investigations are available for diagnosis of IDA, each having specific advantages and disadvantages when used in the pregnancy setting. Therapy for ID includes dietary modification, oral iron supplementation, intravenous iron and blood transfusion. Newer parenteral iron preparations are safe and there is mounting evidence to suggest their use in frontline settings for pregnancy associated IDA in the second and third trimester. Through this review, we suggest an algorithm for diagnosis and treatment of IDA in pregnancy depending on the severity of anemia and period of gestation suited for widespread use in resource limited settings. Also, we recommend ways for increasing public awareness and tackling this health issue including the observance of "National Anemia Awareness and Treatment Day."

Rapidly Dissolving Microneedle Patches for Transdermal Iron Replenishment Therapy

The prevalence of iron deficiency anemia (IDA) is predominant in women and children especially in developing countries. The disorder affects cognitive functions and physical activity. Although oral iron supplementation and parenteral therapy remains the preferred choice of treatment, gastric side effects and risk of iron overload decreases adherence to therapy. Transdermal route is an established approach, which circumvents the side effects associated with conventional therapy. In this project, an attempt was made to investigate the use of rapidly dissolving microneedles loaded with ferric pyrophosphate (FPP) as a potential therapeutic approach for management of IDA. Microneedle array patches were made using the micromolding technique and tested in vitro using rat skin to check the duration required for dissolution/disappearance of needles. The ability of FPP-loaded microneedles to replenish iron was investigated in anemic rats. Rats were fed iron-deficient diet for 5 weeks to induce IDA following which microneedle treatment was initiated. Recovery of rats from anemic state was monitored by measuring hematological and biochemical parameters. Results from in vivo study displayed significant improvements in hemoglobin and serum iron levels after 2-week treatment with FPP-loaded microneedles. The study effectively demonstrated the potential of microneedle-mediated iron replenishment for treatment of IDA.

The perspective of primary health care pediatricians regarding childhood anemia and iron supplementation.

Iron deficiency anemia is common in low- and middle-income countries. According to the evidence, the impact of ferrous sulfate supplementation in the pediatric population is low. Our objective was to analyze the perspective of pediatricians regarding anemia and iron supplementation. Qualitative, exploratory study. Semi-structured interviews were conducted with primary health care pediatricians from Rosario. Three core inquiry concepts were included: importance of this problem, clinical practice, and representations about iron supplementation. The analysis consisted in the systematization of the information collected by transcribing the recorded interviews and notes. A total of 32 interviews were conducted. All interviewees considered anemia was a relevant problem. At present, anemia is associated with a poor-quality diet. Based on the findings, pediatric practice follows national standards. There is consensus that low adherence is a barrier for the clinical management of iron deficiency anemia. Pediatricians described concepts that are potentially beneficial for the local setting, including workshops on anemia and free provision of more flavorful iron supplements. Iron deficiency anemia was considered a severe problem. In the primary health care setting, outstanding interventions included workshops and access to more flavorful iron supplements.

Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease.

Anaemia is the most frequent, though often neglected, comorbidity of inflammatory bowel disease (IBD). Here we want to briefly present (1) the burden of anaemia in IBD, (2) its pathophysiology, which mostly arises from bleeding-associated iron deficiency, followed by (3) diagnostic evaluation of anaemia, (4) a balanced overview of the different modes of iron replacement therapy, (5) evidence for their therapeutic efficacy and subsequently, (6) an updated recommendation for the practical management of anaemia in IBD. Following the introduction of various intravenous iron preparations over the last decade, questions persist about when to use these preparations as opposed to traditional and other novel oral iron therapeutic agents. At present, oral iron therapy is generally preferred for patients with quiescent IBD and mild iron-deficiency anaemia. However, in patients with flaring IBD that hampers intestinal iron absorption and in those with inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice, although information on the efficacy of intravenous iron in patients with active IBD and anaemia is scare. Importantly, anaemia in IBD is often multifactorial and a careful diagnostic workup is mandatory for optimized treatment. Nevertheless, limited information is available on optimal therapeutic start and end points for treatment of anaemia. Of note, neither oral nor intravenous therapies seem to exacerbate the clinical course of IBD. However, additional prospective studies are still warranted to determine the optimal therapy in complex conditions such as IBD.

Structural and functional characterization of legume seed ferritin concentrates

The aim of this work was to produce legume seed ferritin concentrates, which were then evaluated for structural properties and susceptibility to gastrointestinal proteases. Five legume seeds, namely red lentil (RL), chickpea (CP), green lentil whole (GLW), moon dal washed (MDW), and yellow split peas (YSP) were subjected to aqueous extraction followed by MgCl2 + sodium citrate-induced precipitation of iron-binding proteins. Ferritin concentrate gross yield was highest for CP (19.1 ± 2.6%) followed by RL (17.6 ± 1.4%), YSP (14.8 ± 1.4%), and GLW (12.9 ± 4.3%), while MDW (9.7 ± 3.3%) was lowest. Iron content of the ferritins ranged from 30–45 mg/100 g in comparison to 5–17 mg/100 g in the seed flour. During simulated gastrointestinal digestion, most of the iron was released by pepsin digestion. We conclude that these iron-enriched protein concentrates are potential ingredients to formulate functional foods and nutraceuticals against iron deficiency anemia. Practical applications Iron deficiency anemia (IDA) continues to be a global problem that can inflict severe damages to human health. The current and most common therapeutic approach to IDA treatment involves the use of inorganic iron supplements. However, the low level of inorganic iron absorption creates serious side-effects such as constipation and high oxidative stress that could lead to degenerative diseases. Organic iron in the form of plant ferritins provides a more absorbable alternative to inorganic iron. However, phytoferritins are present in very small quantities, which make the use of pure forms mostly impracticable. In this work, the preparation of crude phytoferritin concentrates was achieved in addition to their structural and functional characterization that demonstrates potential utility in IDA treatment. The crude ferritin concentrates can be used to formulate functional foods and nutraceuticals as therapies for IDA management.

To Study the Efficacy of Lecithin in Management of Iron Deficiency Anaemia in Adolescent Girls

To Study the Efficacy of Lecithin in Management of Iron Deficiency Anaemia in Adolescent Girls