Moderate Iron Deficiency Research Articles (Page 1)

Single-dose intravenous iron vs oral iron for treatment of maternal iron deficiency anemia: a randomized clinical trial.

BackgroundAnemia among women of reproductive age has remained highly prevalent globally. Intravenous (IV) iron is well tolerated and proven effective for treating postpartum iron deficiency anemia in high-income countries, but evidence from LMICs, where oral iron is standard treatment, is limited. The PRIORITY trial will test the effectiveness of IV iron compared to oral iron for postpartum women with moderate anemia in eight LMIC sites. An implementation research (IR) study will be conducted alongside the PRIORITY trial in India and Pakistan to gather information on the intervention characteristics and the implementation process, and to assess feasibility, acceptability, fidelity, and cost of implementation for providing IV iron to postpartum women with moderate iron deficiency anemia.MethodsThe PRIORITY IR study will use a mixed methods convergent parallel design guided by two frameworks: the Consolidated Framework for Implementation Research and Proctor’s implementation outcomes. The IR study will be conducted in the Belagavi, India and Karachi, Pakistan PRIORITY trial sites. Participants will include postpartum women in the IV iron intervention arm of the trial, family members, health workers administering IV iron, hospital administrators, postpartum women who refuse to be part of the trial (Pakistan only), and postpartum women in the oral iron arm of the trial (India only). Data collection methods will include surveys, in-depth interviews, a supervision checklist, and a cost assessment. Survey and supervision checklist data will be analyzed descriptively. Interview data will be analyzed using a directed content analysis approach.DiscussionThe PRIORITY IR study will contribute important information about implementation processes and strategies and feasibility, acceptability, fidelity, and costs for postpartum IV iron implementation. Results of the study can provide guidance for implementing effective anemia treatment in LMIC contexts with a high anemia burden.RegistrationNCT05590260 (21/10/2022),CTRI/2022/10/046632 (19/10/2022),CTRI/2023/05/053302 (31/05/2023).

Background: Iron-deficiency anemia during pregnancy remains a global health concern with serious maternal and fetal implications. While oral iron salts are the standard treatment, they are often poorly tolerated, leading to reduced compliance. Iron polymaltose complex (IPC) offers a potentially better-tolerated alternative, though comparative data on efficacy and safety in pregnancy are limited. Objective: To compare the efficacy and side effect profiles of oral iron salts and iron polymaltose complex in the treatment of pregnancy-related anemia. Methods: This randomized controlled trial was conducted over eight months at two tertiary care hospitals in Lahore, Pakistan. A total of 200 pregnant women diagnosed with moderate iron-deficiency anemia were randomly assigned to receive either ferrous sulfate (200 mg daily) or iron polymaltose complex (100 mg daily) for 12 weeks. Hemoglobin and serum ferritin levels were measured at baseline, 6 weeks, and 12 weeks. Gastrointestinal side effects and medication adherence were also recorded. Data were analyzed using SPSS v26, with t-tests and chi-square tests applied as appropriate. Results: Both groups showed significant increases in hemoglobin and serum ferritin over 12 weeks, with no statistically significant differences between them (p > 0.05). However, gastrointestinal side effects, particularly constipation and nausea, were more frequent in the iron salts group. Adherence was notably higher in the IPC group, with 79% completing over 90% of prescribed doses compared to 68% in the iron salts group. Conclusion: Iron polymaltose complex is as effective as iron salts in correcting pregnancy-related anemia but offers superior tolerability and adherence. It presents a viable alternative for women who experience side effects from traditional iron therapy.

Iron deficiency chlorosis severely limits the productivity of ‘Yali’ pears in alkaline soils. This study systematically investigated the physiological and molecular responses of ‘Yali’ pears to varying degrees of iron deficiency, focusing on the roles of PbFRO2 (Pyrus bretschneideri Ferric Reductase Oxidase 2), PbIRT1 (Pyrus bretschneideri Iron-Regulated Transporter 1), and PbCS2 (Pyrus bretschneideri Citrate Synthase 2) in iron uptake and homeostasis. Based on field observations, pear trees were categorized into normal, moderately chlorotic, and severely chlorotic groups. Results demonstrated that moderate iron deficiency upregulated PbFRO2 (2.86–7.09-fold), enhanced root ferric reductase (FCR) activity, and promoted Fe3+ reduction and Fe2+ transport. In contrast, severe deficiency suppressed the expression of these genes and reduced photosynthetic efficiency. Leaf citrate content significantly increased with chlorosis severity, while root citrate content exhibited seasonal fluctuations, peaking in July. Multivariate analyses (PCA and PLS-DA) revealed distinct physiological clustering: normal and moderately chlorotic groups overlapped, whereas the severely chlorotic group formed a separate cluster, reflecting a transition from compensatory activation to metabolic collapse. PbFRO2 emerged as a central regulator, driving root iron storage in spring and redistribution in summer. These findings elucidate a biphasic adaptation strategy, where moderate deficiency triggers gene-mediated iron mobilization, whereas severe stress disrupts homeostasis. This study provides critical insights into iron metabolism dynamics and proposes PbFRO2 as a molecular target for breeding iron-efficient pear cultivars.

Iron is essential for bacterial growth, and Pseudomonas aeruginosa synthesizes the siderophores pyochelin (PCH) and pyoverdine to acquire it. PCH contains a thiazolidine ring that aids in iron chelation but is prone to hydrolysis, leading to the formation of 2-(2-hydroxylphenyl)-thiazole-4-carbaldehyde (IQS). Using mass spectrometry, we demonstrated that PCH undergoes hydrolysis and oxidation in solution, resulting in the formation of aeruginoic acid (AA). This study used proteomic analyses and fluorescent reporters to show that AA, dihydroaeruginoic acid (DHA), and PCH induce the expression of femA, a gene encoding the ferri-mycobactin outer membrane transporter in P. aeruginosa. Notably, the induction by AA and DHA was observed only in strains unable to produce pyoverdine, suggesting their weaker iron-chelating ability compared to that of pyoverdine. 55Fe uptake assays demonstrated that both AA-Fe and DHA-Fe complexes are transported via FemA; however, no uptake was observed for PCH-Fe through this transporter. Structural studies revealed that FemA is able to bind AA2-Fe or DHA2-Fe complexes. Key interactions are conserved between FemA and these two complexes, with specificity primarily driven by one of the two siderophore molecules. Interestingly, although no iron uptake was noted for PCH through FemA, the transporter also binds PCH-Fe in a similar manner. These findings show that under moderate iron deficiency, when only PCH is produced by P. aeruginosa, degradation products AA and DHA enhance iron uptake by inducing femA expression and facilitating iron transport through FemA. This provides new insights into the pathogen's strategies for iron homeostasis.

Abstract Background Iron deficiency anaemia (IDA) is the most common type of anaemia in patients with Crohn’s disease (CD). Due to the generally low absorption of oral iron, parenteral iron therapy is often the preferred treatment in these patients. However, in resource-limited countries like India, not all patients can afford the high costs and hospitalisations associated with parenteral therapy. This study aims to evaluate the effectiveness of oral iron therapy in CD patients. Methods Adult patients with CD presenting to our centre’s Inflammatory Bowel Disease clinic from July 2021 were screened for anaemia. Patients with IDA, defined as haemoglobin (Hb) <13 g/dL in males and <12 g/dL in non-pregnant females along with Transferrin saturation <20% and Serum Ferritin <30 µg/L or 30-100 µg/L (in the presence of elevated inflammatory markers)1, were prospectively included in this study after obtaining informed consent and Institutional review board approval (IRB no.14235). Patient demographics, disease characteristics and treatment details were noted. Anaemia was classified as mild (Hb: 10-11.9 g/dL in females and 10-12.9 g/dL in males), moderate (Hb: 7 - 9.9 g/dL) and severe (Hb: <7 g/dL). Response assessment was done by measuring Hb in patients who completed oral iron therapy for a period of 8 to 12 weeks. A response was defined as an increase in follow-up Hb by ≥2 g/dL from baseline or normalisation of Hb. Chi-square test was used to assess the difference between responders and non-responders among mild versus moderate and severe anaemia. Results Fifty three CD patients with IDA were included. Four patients switched to parenteral iron and 4 were noncompliant to oral iron. We analysed 45 patients who completed 8 to 12 weeks of oral iron therapy. Their details are in Table 1. Of these, 35 (77.8%) patients had exclusive IDA, while 10 (22.2%) patients had IDA alongside anaemia of chronic disease. Most common symptom was weight loss, seen in 23 (51.1%) patients. Mild anaemia was seen in 18 (40%) and moderate or severe anaemia was noted in 27 (60%) patients. Most patients received oral elemental iron dosage of 50mg per day, while only 2 patients received a dosage of 100mg. Response to oral iron was seen in 25 (55.6%) patients. Patients with moderate and severe anaemia showed a more pronounced response to oral iron therapy (n=19; 70.3%) compared to those with mild anaemia (n=6; 33.3%), which was statistically significant with a p-value of 0.014. A longer follow-up and a larger number of patients will be recruited to enhance these findings in the future. Conclusion Our study concludes that oral iron therapy is a decent option in CD patients to improve Hb levels, predominantly in patients with moderate and severe IDA, contrary to the traditional belief.

Anemia remains a common comorbidity complicating over 28% of pregnancy in Indonesia by 2023, Iron deficiency anemia is the most common, and to date, ferritin serum has been used as a diagnostic marker, but has not been routinely examined in pregnant women, thus hindering the accurate diagnosis of iron deficiency anemia in pregnant women. Our study aimed to examine ferritin serum among pregnant women, as well as, to investigate the prevalence of iron deficiency anemia in the Dalu Sepuluh Health Center of Deli Serdang Regency. A total of 60 pregnant women were randomly selected to participate in this cross-sectional study. We found that iron deficiency anemia was most common in pregnant women aged 20 – 35 years old (75%), with second-trimester pregnancy (36.7%), multigravida, and multiparity. Interestingly, 57% of pregnant women were considered malnourished (upper arm circumference of < 23.5 cm) which was found in 36.7% of primigravida and is associated with moderate iron deficiency anemia (71.4%), marked with < 30µg/L ferritin serum (p < 0.05). Cut-off point of serum ferritin was 28.98 ng/dL with a sensitivity of 92% and a specificity of 91.4%, indicating that the body's iron levels are in low condition. This study indicated that lower levels of ferritin serum are associated with anemia in pregnant women. We suggested that ferritin serum be put as a mandatory routine examination in pregnancy.

Ferric carboxymaltose in treating moderate iron deficiency anaemia in pregnancy

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

The prevalence of iron deficient anemia in Indian children has continued to be high for decades, despite drastic measures. Natural food dietary diversification with foodstuffs prepared at home using locally available ingredients could be helpful to counter childhood anemia. In this open-labelled randomized controlled trial, 82 consecutive children aged 6-11 years diagnosed with moderate iron deficiency anemia were randomized into two groups. Children in the control group received 3mg/kg/day of elemental iron orally in a syrup form, for eight weeks. In addition to the oral iron syrup in the same dose, the intervention group received one sesame jaggery ball (containing 60g of sesame seeds and jaggery each) for eight weeks. The increases in hemoglobin (Hb) at 4 and 8 weeks were estimated as the primary outcomes. The increases in serum ferritin and body weight at eight weeks were measured as the secondary outcomes. The increase in the median Hb levels of the intervention group at four weeks [0.9 (0.6, 1.5) Vs 0.8 (0.4, 1.2), p-0.045] and eight weeks [1.7 (1.0, 2.4) Vs 1.3 (0.6, 2.0), p-0.013] were statistically more significant than the control group. Likewise, the increase in the serum ferritin levels [10.7 (6.4, 16.7) Vs 6.2 (4.6, 13.3), p-0.015] and body weight [0.8 (0.3, 1.4) Vs 0.1 (-0.4, 0.6)] in the intervention group were significantly more than in the control group. Besides routine oral iron syrup, daily supplementation of sesame jaggery balls in moderate iron-deficient anemic children improves their iron status.

Mild to moderate thalassemia trait (TT) and iron deficiency anemia (IDA) are the most common conditions of microcytic hypochromic anemia (MHA) and they exhibit highly similar clinical and laboratory features. It is sometimes difficult to make a differential diagnosis between TT and IDA in clinical practice. Therefore, a simple, effective, and reliable index is needed to discriminate between TT and IDA. Data of 598 patients (320 for TT and 278 for IDA) were enrolled and randomly assigned to training set (278 of 598, 70%) and validation set (320 of 598, 30%). Stepwise discriminant analysis was used to define the best diagnostic formula for the discrimination between TT and IDA in training set. The accuracy and diagnostic performance of formula was tested and verified by receiver operating characteristic (ROC) analysis in validation set and its diagnostic performance was compared with other published indices. A novel formula, Thalassemia and IDA Discrimination Index (TIDI) = -13.932 + 0.434 × RBC + 0.033 × Hb + 0.025 ×MCHC + 53.593 × RET%, was developed to discriminate TT from IDA. TIDI showed a high discrimination performance in ROC analysis, with the Area Under the Curve (AUC) = 0.936, Youden' s index = 78.7%, sensitivity = 89.5%, specificity = 89.2%, respectively. Furthermore, the formula index also obtained a good classification performance in distinguishing 5 common genotypes of TT from IDA (AUC from 0.854-0.987). The new, simple algorithm can be used as an effective and robust tool for the differential diagnosis of mild to moderate TT and IDA in Guangxi region, China.

Iron deficiency has been found to affect hemoglobin A2 (HbA2) values in HPLC. This can be an issue for thalassemia screening laboratories where there is heavy reliance on increased Hb A2 levels for diagnosis of heterozygous thalassemia state. In resource constrained countries like India this could be real challenging where iron deficiency is widespread and facilities for molecular confirmation in borderline HbA2 values is generally unavailable. It was a prospective study done in a tertiary care center over 18 months. All consecutive patients (n = 164) presenting with microcytic hypochromic anemia on peripheral smear were included for further investigations out of which 92 were found to have pure iron deficiency (Hb < 12 Gm/dL with ferritin less than12 ng/ml) on iron parameters. These patients were divided into two groups, Group A with Hb < 9 g/dl and Group B with Hb > 9 g/dl. Common hematological parameters, iron indices and HbA2 levels were analysed in these two group of patients at baseline and after 3 months of documented oral iron therapy. Chi-square and Pearson tests were used for statistical analysis and a P- value of < 0.05 was considered statistically significant. As expected iron deficiency was found more prevalent in females (72%) than in males(28%). Mean pre -treatment and post - treatment hemoglobin of patients in group A was 8±0.5 gm/dl and 11.3±1.1gm/dl respectively and in group B was 10.2±0.6 g/dl and 11.5±1 g/dl showing positive correlation. Mean pre treatment and post treatment HbA2 levels of patients in group A were 1.8±0.5% and 2.4±0.5% respectively showing statistically significant change after iron therapy (P< 0.0001) but mean pre treatment and post treatment HbA2 levels of patients in group B were 2.1±0.4% and 2.2±0.5% respectively . this change post therapy was statistically insignificant(P=0.1517). The change in HbA2 levels was statistically insignificant for patients with mild / moderate iron deficiency anemia (Hb > 9 Gm/DL). Thus diagnosis of β thalassemia trait will not be difficult in patients with concomitant mild iron deficiency anemia but patients with severe iron deficiency anemia should first be treated with iron supplements for correct diagnosis of β Thalassemia trait especially patients with borderline Hb A2 levels.

Objective: We conducted this single-center, double-blinded, randomized and placebo-controlled study to explore the efficacy of an iron-fortified gummy on relieving iron-deficiency anemia in young Chinese women. Participants’ blood hemoglobin level was set as the primary outcome. The secondary objectives were to assess the effects of the iron-fortified gummy on participants’ blood iron levels, skin barrier functions, skin temperature regulating ability, menstruation and leucorrhea status, sleep quality, and overall quality of life.Methods: Seventy female participants aged 18-35 years with moderate iron-deficiency anemia (blood hemoglobin 90-120 g/L) were recruited and randomly assigned to an intervention group or a placebo group. We supplemented the diets of the participants with an iron-fortified gummy or a placebo for eight weeks. Their blood hemoglobin level, iron biomarkers, skin biophysical characteristics, hand temperature, self-reported menstruation and leucorrhea status, life quality and sleep quality were recorded at baseline, mid-way through the study and the end of the study. We compared the differences of the above outcomes between the intervention group and the control group. Results: After eight weeks of daily iron-fortified gummy intake, 80% of the participants showed improvement in blood hemoglobin concentration, with a mean increase of 14.5 g/L (95% confidence interval: 9.4, 19.5 g/L) compared to the control. Their serum iron and ferritin levels had significantly increased. They also had improved facial skin hydration and complexions, reduced transepidermal water loss, and accelerated temperature recovery in their hands. Intake of the iron-fortified gummy effectively reduced the incidence of menstrual headaches and insomnia. Participants reported prolonged sleep time, improved energy level, mobility, mental concentration, ability to engage in daily activities and work, as well as better perception of quality of life and health satisfaction.Conclusion:Daily consumption of the iron-fortified gummy over eight weeks could help build up blood iron levels to generate hemoglobin, relieve iron-deficiency anemia and related symptoms in young Chinese women. Intake of iron through gummy on a daily basis is an effective method to gradually increase the participants’ iron levels, leading to sustainable long-term benefits.Study registration: Chinese Clinical Trial Registry (ChiCTR2200061345).

Background: The Phase IV, open-label, single arm, prospective, non-interventional SANOIN study demonstrated that an oral fixed dose combination of ferrous gluconate, multivitamins and minerals (Sangobion® IRON+) was effective and well-tolerated in treating mild to moderate Iron Deficiency Anemia (IDA) in women aged 15-55 years. Methods: We present a subgroup analysis of the SANOIN Hemoglobin (Hb) and serum ferritin data over the 90-day treatment period based on menstrual flow (normal vs. heavy vs. very heavy) and pregnancy status (pregnant vs. non- pregnant). The frequency and severity of IDA symptoms at baseline and improvement at Days 30, 60 and 90 were assessed in these subgroups, and by IDA status (mild vs. moderate). Results: Within the intent-to-treat population (n=87), 78 subjects were evaluated according to menstrual flow (normal, 44.9%; heavy, 47.4%; very heavy, 7.7%). Eight out of 87 subjects were pregnant. All subgroups demonstrated similar Hb normalization and increase in ferritin levels after 90 days. Overall, 72.4% of the subjects were anemia-free by Day 90. The most frequently occurring IDA symptoms at baseline were headache, dizziness and fatigue in most subgroups, while tachycardia and shortness of breath were frequent in the small pregnant subgroup. IDA symptoms significantly improved by Day 90 across all subgroups. Conclusion: This subgroup analysis demonstrated the broad efficacy of an oral fixed dose combination of ferrous gluconate, multivitamins and minerals in providing rapid and sustainable improvement in IDA symptoms, Hb and ferritin levels in the diverse range of baseline IDA status, menstrual flow, and pregnancy status. Keywords Iron+multivitamin and mineral; Sangobion; Iron deficiency anemia; Ferrous gluconate; Menstruation; Pregnancy

Background: The Phase IV, open-label, single arm, prospective, non-interventional SANOIN study demonstrated that an oral fixed dose combination of ferrous gluconate, multivitamins and minerals (Sangobion® IRON+) was effective and well-tolerated in treating mild to moderate Iron Deficiency Anemia (IDA) in women aged 15-55 years. Methods: We present a subgroup analysis of the SANOIN Hemoglobin (Hb) and serum ferritin data over the 90-day treatment period based on menstrual flow (normal vs. heavy vs. very heavy) and pregnancy status (pregnant vs. non- pregnant). The frequency and severity of IDA symptoms at baseline and improvement at Days 30, 60 and 90 were assessed in these subgroups, and by IDA status (mild vs. moderate). Results: Within the intent-to-treat population (n=87), 78 subjects were evaluated according to menstrual flow (normal, 44.9%; heavy, 47.4%; very heavy, 7.7%). Eight out of 87 subjects were pregnant. All subgroups demonstrated similar Hb normalization and increase in ferritin levels after 90 days. Overall, 72.4% of the subjects were anemia-free by Day 90. The most frequently occurring IDA symptoms at baseline were headache, dizziness and fatigue in most subgroups, while tachycardia and shortness of breath were frequent in the small pregnant subgroup. IDA symptoms significantly improved by Day 90 across all subgroups. Conclusion: This subgroup analysis demonstrated the broad efficacy of an oral fixed dose combination of ferrous gluconate, multivitamins and minerals in providing rapid and sustainable improvement in IDA symptoms, Hb and ferritin levels in the diverse range of baseline IDA status, menstrual flow, and pregnancy status. Keywords Iron+multivitamin and mineral; Sangobion; Iron deficiency anemia; Ferrous gluconate; Menstruation; Pregnancy

Anaemia is a major public health problem in India as it is estimated that most of the non-pregnant women of reproductive age group are anaemic. It occurs when there is decreased level of haemoglobin in red blood cells. The primary cause of anaemia is iron deficiency. Iron deficiency anaemia (IDA) may be present with other systemic diseases. People with mild and moderate iron deficiency anaemia may not have any sign and symptom. But more severe iron deficiency anaemia may cause fatigue, tiredness, shortness of breath or chest pain. Although Homoeopathy gives importance to the individualisation of the patients, for remedy selection, still then, some medicines are prescribed based on disease diagnostic features. Such medicines are not well proved, so they are known as rare/lesser-known medicines. Of course, their role in the management of certain diseases cannot be ignored. This article aims at showing the effectiveness of some lesser-known medicines in the treatment of iron deficiency anaemia.

Moderate Iron Deficiency Does Not Potentiate Renal or Cardiac Calcification and Subsequent Tissue Injury in Mouse Models of CKD

The Impact of Iron Deficiency Anemia on Cerebrovascular Physiology, Brain Structure, and Cognitive Function in Otherwise Healthy Women

Oral iron versus intravenous iron therapy in moderate iron deficiency anemia in pregnancy

BackgroundPostpartum iron deficiency anemia (PPIDA) is highly prevalent in developing countries where it constitutes an important cause of maternal morbidity and mortality. Potential determinants of PPIDA are prepartum iron deficiency or iron deficiency anemia in association with severe blood loss during delivery. We investigated the efficacy of oral Sucrosomial® iron for recover from mild-to-moderate PPIDA.MethodsThis pilot study was conducted in three medical centers in Romania.Adult women (≥ 18y) with mild (hemoglobin [Hb] 9–11 g/dL) or moderate (Hb 7–9 g/dL) PPIDA diagnosed at screening (2–24 h after delivery) were eligible.Women with mild PPIDA received oral Sucrosomial® iron (Pharmanutra, S.p.A, Italy) once daily (30 mg elemental iron per capsule) for 60 days. Those with moderate PPIDA received oral Sucrosomial® iron twice daily (60 mg elemental iron) for 10 days, followed by a 50-day course of oral Sucrosomial® iron once daily (30 mg elemental iron). Laboratory parameters, as well as subjective clinical symptoms using a 3-point Likert Scale, were assessed at baseline and on study days 10, 30 and 60.ResultsSixty anemic women entered the study, but three were missed during follow-up. At day 60, a Hb rise was observed in both groups (+ 3.6 ± 1.5 g/dL; p < 0.01), 81% experienced correction of anemia (Hb ≥ 12 g/dL), 36% achieved a ferritin concentration ≥ 30 ng/mL (p < 0.05), and 54% a transferrin saturation (TSAT) ≥ 20% (p < 0.01). For women still anemic at day 60, mean Hb was close to normality (11.3 ± 0.8 g/dL). Resolution of IDA-associated clinical symptoms was already observed just 10 days after treatment initiation. No patient discontinued treatment due to gastrointestinal adverse events.ConclusionsSucrosomial® iron was shown to be potentially effective and well tolerated at treating mild and moderate PPIDA. These results encourage the use of oral Sucrosomial® iron as a treatment option for PPIDA, but larger studies with longer follow-up are warrant.