Presence Of Iron Deficiency Research Articles

Association of iron deficiency anemia with the development of paroxysms of atrial fibrillation within a year after pharmacological cardioversion with amiodarone

BACKGROUND: Anemia is a common problem with atrial fibrillation. There is a limited number of studies examining the role of iron deficiency anemia in the course of atrial fibrillation. AIM: To evaluate the association of iron deficiency anemia with the development of recurrent atrial fibrillation within 12 months in patients after pharmacological cardioversion with amiodarone. MATERIAL AND METHODS: The study included 198 patients over 18 years of age [120 (60.6%) men and 78 (39.4%) women, median age 71 (63.2; 77) years] with paroxysmal non-valvular atrial fibrillation and duration of paroxysm 48 h, after successful pharmacological cardioversion with amiodarone. The group with anemia included 99 patients (all had iron deficiency anemia), the group without anemia included 99 people. Patients with anemia were older; the groups were comparable in other main indicators. The development of recurrent atrial fibrillation over 1 year of follow-up was assessed by the Kaplan–Meier method and the Cox proportional hazards model. Differences were considered statistically significant at a p value 0.05. RESULTS: In the iron deficiency anemia group, symptomatic relapses of atrial fibrillation developed in 40.4% of patients during 1 year of observation; in the group without anemia — in 25.3% of patients (p=0.003). Kaplan–Meier analysis showed that iron deficiency anemia is associated with an increased risk of developing recurrent atrial fibrillation within 1 year after pharmacological cardioversion with amiodarone, relative risk 1.87 (p=0.014). Comparison of the risks associated with iron deficiency anemia and iron deficiency (regardless of the presence of anemia) showed a greater risk of recurrent atrial fibrillation associated with iron deficiency than with anemia (for interaction p=0.014). CONCLUSION: A comparison of the risks of developing recurrent atrial fibrillation in patients with iron deficiency itself and in patients with iron deficiency anemia showed a greater influence on the prognosis of recurrent atrial fibrillation by the presence of iron deficiency.

Effect of anaemia and iron deficiency in heart failure with mildly reduced ejection fraction.

The present study aims to clarify the prevalence and prognostic impact of anaemia and iron deficiency in patients with heart failure with mildly reduced ejection fraction (HFmrEF). The prognostic impact of anaemia and iron deficiency in HFmrEF has not yet been clarified. Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. Patients with anaemia (i.e. haemoglobin <13 g/dL in males and < 12 g/dL in females) were compared to patients without, respectively patients with or without iron deficiency. The primary endpoint was all-cause mortality at 30 months (median follow-up), secondary endpoints comprised HF-related rehospitalisation. Two thousand one hundred and fifty four patients with HFmrEF with a median haemoglobin level of 12.2 g/dL were included. Anaemia was present in 52% of patients with HFmrEF and associated with a higher risk of all-cause mortality (44% vs. 18%; HR = 3.021; 95% CI 2.552-3.576; p =.001) and HF-related rehospitalisation (18% vs. 8%; HR = 2.351; 95% CI 1.819-3.040; p =.001) at 30 months, which was confirmed after multivariable adjustment. Although iron status was infrequently assessed in anaemics with HFmrEF (27%), the presence of iron deficiency was associated with higher risk of rehospitalisation for worsening HF (25% vs. 15%; HR = 1.746; 95% CI 1.024-2.976; p =.038), but not all-cause mortality (p =.279) at 30 months. Anaemia and iron deficiency are very common in atleast half of patients with HFmrEF and independently associated with adverse long-term prognosis.

Impact of anaemia and iron deficiency on outcomes in cardiogenic shock complicating acute myocardial infarction.

Anaemia and iron deficiency (ID) are common comorbidities in cardiovascular patients and are associated with a poor clinical status, as well as a worse outcome in patients with heart failure and acute myocardial infarction (AMI). Nevertheless, data concerning the impact of anaemia and ID on clinical outcomes in patients with cardiogenic shock (CS) are scarce. This study aimed to assess the impact of anaemia and ID on clinical outcomes in patients with CS complicating AMI. The presence of anaemia (haemoglobin <13 g/dl in men and <12 g/dl in women) or ID (ferritin <100 ng/ml or transferrin saturation <20%) was determined in patients with CS due to AMI from the CULPRIT-SHOCK trial. Blood samples were collected in the catheterization laboratory during initial percutaneous coronary intervention. Clinical outcomes were compared in four groups of patients having neither anaemia nor ID, against patients with anaemia with or without ID and patients with ID only. A total of 427 CS patients were included in this analysis. Anaemia without ID was diagnosed in 93 (21.7%), anaemia with ID in 54 study participants (12.6%), ID without anaemia in 72 patients (16.8%), whereas in 208 patients neither anaemia nor ID was present (48.9%). CS patients with anaemia without ID were older (73 ± 10 years, p = 0.001), had more frequently a history of arterial hypertension (72.8%, p = 0.01), diabetes mellitus (47.8%, p = 0.001), as well as chronic kidney disease (14.1%, p = 0.004) compared to CS patients in other groups. Anaemic CS patients without ID presence were at higher risk to develop a composite from all-cause death or renal replacement therapy at 30-day follow-up (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.23-6.62, p < 0.001) than CS patients without anaemia/ID. The presence of ID in CS patients, with and without concomitant anaemia, did not increase the risk for the primary outcome (OR 1.17, 95% CI 0.64-2.13, p = 0.64; and OR 1.01, 95% CI 0.59-1.73, p = 0.54; respectively) within 30 days of follow-up. In time-to-event Kaplan-Meier analysis, anaemic CS patients without ID had a significantly higher hazard ratio (HR) for the primary outcome (HR 2.11, 95% CI 1.52-2.89, p < 0.001), as well as for death from any cause (HR 1.90, 95% CI 1.36-2.65, p < 0.001) and renal replacement therapy during 30-day follow-up (HR 2.99, 95% CI 1.69-5.31, p < 0.001). Concomitant anaemia without ID presence in patients with CS at hospital presentation is associated with higher risk for death from any cause or renal replacement therapy and the individual components of this composite endpoint within 30 days after hospitalization. ID has no relevant impact on clinical outcomes in patients with CS.

Nearly Half of Extreme Preterm Infants Are Iron Deficient at 4-6 Months of Corrected Age Despite Prophylactic Iron Supplementation

Background: Iron deficiency (ID) is the most prevalent micronutrient deficiency globally and has been associated with negative neurodevelopmental and behavioral outcomes in infants and young children. Susceptibility to ID is heightened in preterm infants due to lower iron reserves at birth, rapid growth during the initial weeks of life, immature erythropoiesis, and frequent blood samplings during hospitalization. To mitigate this problem, international bodies recommend prophylactic iron therapy from 2-6 weeks of age until at least 6-12 months in preterm infants. Currently, the literature regarding iron status in extremely preterm infants (EPI, infants born less than 28 weeks gestational age) who receive prophylactic iron supplementation after birth is limited. Considering the potential long-term detrimental effects of ID on the developing brain of these high-risk preterm infants, examining the prevalence and risk factors for ID are crucial to implement prevention strategies. Objective: To investigate the prevalence and risk factors associated with ID in EPI Methods: A retrospective cohort study was conducted using a population-based Provincial Perinatal Follow-Up database on all live EPIs born in Nova Scotia between 2005 and 2018. Infants with congenital malformations, chromosomal anomalies, blood disorders or those who died before outcome assessment were excluded. Prophylactic iron supplementation (2-3 mg/kg/day) starting at 2-4 weeks of chronological age was a standard of care for all included infants. Further, the dosage of iron was adjusted regularly during the hospital stay based on serum ferritin (SF) levels. Discharge instructions recommended continuing iron prophylaxis until 9-12 months corrected age (CA). At 4-6 months CA, all infants underwent blood tests to evaluate hemoglobin, and SF levels. ID was defined as SF levels below 20g/L or 12g/L at 4 and 6 months CA, respectively. A univariate analysis was performed by using a series of single-variable logistic regression models to identify the factors associated with presence of ID. Factors with a p-value &amp;lt; 0.20 in the univariate analysis were entered into a multivariable risk model using a backward selection procedure. Variables with a p-value &amp;lt; 0.05 were retained. Results: Among 146 infants, 67 (45.9%) had ID. Ferritin (16.4 µg/L vs 50.0 µg/L, p &amp;lt; .001) and reticulocyte hemoglobin equivalent (28.4pg vs 31.6pg, p &amp;lt; .001) were significantly lower in the ID group than non-ID group. The prevalence of ID decreased over time, from 59.7% in 2005-2011 to 40.3% in 2012-2018 (p = 0.52). Table 1 compares the antenatal and neonatal characteristics of the ID and non-ID groups. Table 2 compares sociodemographic variables and clinical variables at 4-6 months CA between two groups. Breastfeeding (exclusive or partial) versus formula alone at a 4-6 months CA was identified as an independent factor protective for ID (Odds: 0.2 (0.1 - 0.6), p = 0.003). Iron therapy at follow-up was also protective for ID but did not remain significant in the final model. Of note, iron therapy was stopped in 40 (27.4%) EPI before 4-6 months CA. Supplemental iron intake at 4-6 months CA was significantly lower in the infants receiving exclusive formula feeding (66.1%) compared with those breastfed (99.1%, p = 0.006). Conclusion(s): Despite prophylactic iron supplementation, nearly half of the EPI had ID at 4-6 months CA, and iron therapy was discontinued in roughly a quarter of all EPI before 4-6 months CA. Breastfeeding at 4-6 months follow-up was found to be protective for ID. High prevalence of ID in EPI highlights the need for further research in this area to avert the negative neurodevelopmental consequences of ID on the developing brain of these high-risk infants. Closer monitoring of iron status and early identification of children at high risk for ID is imperative to maximize the benefits of prophylactic iron supplementation in EPI. Further, there is lack of sufficient data for iron requirements in EPI leading to a variability in iron therapy recommendations by different professional organizations. Future prospective studies to investigate specific iron requirements of EPI as well as risk factors for ID in this high-risk vulnerable population are essential to optimize their neurodevelopmental outcomes.

Abstract 18608: Using Electronic Medical Record Based Tools to Assess the Prevalence of Iron Deficiency, Iron Deficiency Anemia, and Treatment With IV Iron Among Patients With Decompensated Heart Failure

Introduction: Iron deficiency (ID) and iron deficiency anemia (IDA) are common among patients with heart failure (HF). They are associated with increased hospitalizations and all-cause mortality. Intravenous (IV) iron repletion has been associated with significant improvement in these outcomes, but is underutilized during HF admissions. Electronic medical record (EMR) based tools to increase recognition of ID and IDA in patients with HF and promote treatment with IV iron have not been described. We developed an EMR based tool to identify patients admitted with HF with ID and IDA who were candidates for IV iron repletion in an urban academic medical center. Hypothesis: ID and IDA are underdiagnosed and undertreated among patients admitted for HF. EMR based tools can be used to systematically identify patients with ID, IDA, and increase appropriate use of IV iron in patients with HF. Methods: Retrospective analysis of patients admitted with HF between March and May 2023. The EMR based tool defined HF by encounter diagnosis and use of IV diuretics, anemia by hgb of &lt; 13 g/dl (male) and &lt; 12 g/dl (female), ID by ferritin &lt; 100 ng/ml or ferritin &lt; 300 ng/ml and iron saturation &lt; 20%, IDA by presence of ID and anemia, and if the patient received IV iron. Presence of HF, anemia, ID, IDA, and use of IV iron were confirmed by manual chart review. Results: The EMR based tool identified 116 patients admitted with a diagnosis of HF who received IV diuretics. In total, 103 (89.6%) had clinically decompensated HF by chart review. Three patients were excluded due to leaving AMA or on hospice. The average patient age was 63.8 years, 49 (50%) were male, and 50 (50%) were female, and 72 (73%) were African American (AA). In this sample, 81 (82%) had anemia, of which 47 (58%) had both ferritin and iron saturation levels collected during the admission. A total of 15 (19%) had no record for ferritin, iron saturation, or both. By including labs from prior admissions, a total of 64 (65%) of the 99 patients had ID while 57 (58%) had IDA. In total, 22 received IV iron (34% of patients with ID, 39% of patients with IDA). Conclusions: An EMR based tool can be used to identify patients with HF, ID, IDA, and the use of IV iron. ID and IDA are prevalent among patients with HF but remain underdiagnosed and undertreated.

Clinical and Echocardiographic Correlates of Iron Status in Chronic Heart Failure Patients: A Cross-Sectional Descriptive Study.

Chronic heart failure (HF) is one of the conditions commonly seen in the medical outpatient departments, and iron deficiency (ID) has been reported as the commonest nutritional deficiency in these patients. The presence of ID may interfere with the clinical parameters of chronic HF. The relationship between iron status and chronic HF needs more attention and should be given more consideration in the evaluation of patients with chronic HF. The aim of the study was to determine the relationship, if any, between iron status and clinical/echocardiographic variables in chronic HF. A cross-sectional descriptive study was carried out at the Lagos University Teaching Hospital (LUTH), Nigeria, where 88 patients with chronic HF were recruited to participate in this study. The participants underwent clinical and laboratory assessments. Iron status was assessed with full blood count parameters; serum ferritin and transferrin saturation (Tsat) and its relationship with clinical parameters among these participants were also studied. No correlations existed between the duration of chronic HF and iron status when compared using Tsat. However, a significant weak negative correlation was observed between the duration of HF and the serum ferritin levels. The clinical characteristics of the HF participants with and without ID were compared. There was no significant difference in the frequency of prior hospitalization in both groups. However, a higher proportion of participants with severe HF (New York Heart Association (NYHA) classes III/IV) (n = 14; 46.7%) were iron-deficient compared to those with moderate chronic HF (NYHA II) (n = 11; 36.7%). This relationship was statistically significant. Left ventricular ejection fraction (LVEF) was similar in the iron-deficient and iron-replete groups (using serum ferritin or Tsat) both when compared as means and when compared after categorizing LVEF as HF with preserved ejection fraction (HFpEF) vs HF with reduced ejection fraction (HFrEF). There was no statistically significant correlation between the severity of ID and LVEF. Conclusion: A spectrum of clinical changes occurs in patients with chronic HF. ID can make these changes more profound and the condition less amenable to standard HF treatments. These patients may therefore benefit from further evaluation for this nutritional deficiency. Laboratory measurements including Tsat and serum ferritin may help in further assessment of select patients with worse and/or non-responsiveclinical parameters.

The role of iron deficiency in heart failure.

Iron is an essential micronutrient for several physiological processes in the body beyond erythropoiesis. Iron deficiency (ID) is a common comorbidity observed in about 50% of patients with stable heart failure (HF) irrespective of the left ventricular function. The presence of ID is often as a multi-factorial condition, and it is associated with exercise intolerance, reduced quality of life, increased hospitalization rate, and mortality risk regardless of anaemia. The intravenous administration of iron to correct ID has emerged as a promising treatment in HF with reduced ejection fraction as it has been shown to alleviate symptoms, improve quality of life and exercise capacity, and reduce hospitalizations.

Iron Deficiency and Iron Deficiency Anemia Among Children 3 to 59 Months of Age in Kinondoni Municipal, Dar es Salaam: A Facility-Based Cross-Sectional Study

Background: Iron deficiency with subsequent iron deficiency anemia is the most common micronutrient disorder in children below 5 years of age worldwide. The developing countries bear more weight on the problem as the result of multifactorial factors including but not limited to recurrent infections such as malaria, helminths infestation, and inadequate food security. However, its magnitude in children living in Kinondoni Municipal in Dar es salaam is not well understood. Therefore, the aim of this study was to determine the prevalence of anemia and how it is contributed by the presence ofiron deficiency among children between 3-59months of age in the above-mentioned setting. Methods: A facility-based cross-section study was conducted among children 3-59months attending Reproductive and Child Health Services at Kairuki, Sinza Hospital, and Kambangwa dispensary. Children who met the criteria, their basic social demographic information, complete blood count and differentials as well as blood ferritin levels were collected to assess the level of anemia, erythrocytic indices, and iron deficiency. Data were analyzed using the Statistical Package of Social Sciences (SPSS version 22). The magnitude of anemia and iron deficiencies were presented in percentages, and the relationship between hemoglobin and blood ferritin was assessed using Spearman’s correlation test for two continuous variables. The p-value of less or equal to 0.05 was considered statistically significant. Results: A total of 350 children were recruited for the study, 255 Children (72.9%) were anemic. Children below 24 months of age were more anemic compared to the older age group (X2 = 50, p &lt;0.001). Furthermore, anemia was significantly associated with low ferritin levels (X2 = 65, p &lt;0.001). Iron deficiency was found in 156 (44.6%) participants while iron deficiency anemia (low MCV, low ferritin, and low hemoglobin) was found in 138 (39.4%) participants. However, among 255 participants with anemia, 147(65.3%) had iron deficiency. There was a significant positive correlation between hemoglobin and blood ferritin levels (Spearman’s correlation coefficient = 0.6; p&lt;0.01. Conclusion: Prevalence of anemia was high among children and was highly associated with younger age and iron deficiency. To overcome this problem, appropriate interventions such as massive promotion of breastfeeding, appropriate complementary feeding, and ensuring food security are warranted.

The effect of iron deficiency and goiter on the adaptation process of iatrogenic cerebral vasodilation and cardiac parameters

Aim: Adenosine is a pharmacological stress agent used in many nuclear medicine clinics. It causes different and widespread effects in different tissues. It causes widespread inhibition and cerebral vasodilation through A1 and A2a receptors in the central nervous system. We evaluated the duration of side effects in patients with iron deficiency and euthyroid goiter. Materials and Methods: Our study included 183 patients with atypical chest pain who underwent myocardial perfusion scintigraphy to investigate the presence of coronary artery disease. Adenosine infusion was administered intravenously at a rate of 140 µg/kg/min for 6 minutes. Complaints that occurred during intravenous administration of adenosine were questioned. The presence of at least three of the most common complaints of flushing, headache, nausea, and feeling of ill feeling was considered to have prominent complaints. If these complaints continued for at least 30 minutes, the presence of prolonged prominent complaints was accepted. Patients who developed prolonged complaints were categorized as group 1 and patients without prolonged complaints as group 2. Results: The number of patients diagnosed with euthyroid goiter was significantly higher in Group 1 (p&lt;0.005). Additionally, thyroid size was significantly larger in patients in Group 1 compared to those in Group 2, with respective medians (minimum-maximum) of 20 (11-18 ml) and 15 (11-28 ml) (p&lt;0.005). In group 1, 44 (86.3%) patients had iron deficiency, while in group 2 37 (28%) patients had iron deficiency (p&lt;0.005). The free variables determining the development of prolonged prominent complaints in patients who received adenosine infusion were found to be goiter size (Odds: 1.437, confidence interval: 1.264-1.633; p&lt;0.005) and presence of iron deficiency (Odds: 135.744, confidence interval: 27.055-681.074; p&lt;0.005). Conclusion: Iron deficiency and euthyroid goiter are common subclinical conditions in the Turkish population. In the presence of subclinical diseases followed without treatment, the duration of drug effects may be prolonged. Prospective and more comprehensive studies are needed on this subject.

Frequency of iron deficiency anemia among children with poor appetite complaint

Iron deficiency anemia (IDA) in children causes both mental and psychomotor impairment. This study was planned to investigate the frequency of iron deficiency anemia in children with poor appetite. Complete blood count and ferritin values of children admitted to the pediatric outpatient clinic due to poor appetite were analyzed retrospectively. Cases with a hemoglobin (Hgb) value below -2 SD and a ferritin level below 12 ng/ml according to the age group were considered as IDA. Four hundred and twenty-eight children aged between 6 months and 18 years were evaluated. 210 (49.06%) and 218 (50.94%) of children were male and female, respectively. Children were examined in four groups according to their age: 1) 6 months-2 years (n=193), 2) 3-6 years (n=142), 3) 7-11 years (n=67) and 4) 12-17 years (n=26). Children were divided into three groups according to their ferritin values: Group 1: ≥12 ng/ml (n=299), Group 2: between 6-12 ng/ml (n=95) and Group 3: ≤6 ng/ml (n=34). The rate of IDA was found to be 28.2% in children with a ferritin value of ≤12 ng/ml. The relationship between age and gender to the frequency of anemia was not statistically significant (p≥0.05). IDA is a common hematological disorder that can be seen at any age, especially in children aged 6-36 months. In children with poor appetite, the presence of iron deficiency should be investigated.

Formula Feeding Significantly Increases Risk of Iron Deficiency in Very Preterm Infants during the First 4-6 Months of Life

Introduction: Iron deficiency (ID) early in life is associated with adverse neurodevelopmental and behavioural outcomes later in life. Preterm infants are considered at increased risk of developing ID due to their relative lack of iron stores, accelerated growth during the first few weeks of life and multiple phlebotomies received while in hospital. Breast fed (BF) preterm infants are considered at particularly increased risk of ID due to the lower iron content of breast milk. Therefore, iron supplementation is routinely recommended for these infants. However, the supplemental iron requirements of formula fed (FF) preterm infants are generally deemed to be lower due to the presence of iron in formulas. The Canadian Pediatric Society recommends no additional iron supplementation for preterm infants with a birth weight <2kg if they are primarily FF with iron-rich formula. The American Academy of Pediatrics makes no general recommendation for iron supplementation in infants fed primarily with iron-rich formula. The primary objective of this study was to investigate how feeding type influences the iron status of very preterm infants at 4-6-months corrected age (CA). A secondary objective was to further explore the risk factors associated with ID in the FF group. Methods: A retrospective population-based cohort study was conducted at IWK Health using the Perinatal Follow-Up Program database, a provincial database containing relevant clinical information for all very preterm infants (<31 weeks gestational age) born in the province of Nova Scotia, Canada. All very preterm infants born in Nova Scotia from 2005-2018 were included. Infants with severe congenital malformations, chromosomal anomalies and/or hemolytic anemias were excluded. Information about presence of ID, feeding type, iron intake from formula, and supplemental iron therapy at 4-6-month follow-up was extracted, as were neonatal variables. ID was defined as serum ferritin <20 and <12 mcg/L at 4-and 6-months CA, respectively. Variables were compared between the FF and BF groups using chi square and unpaired t-tests. The FF group was further divided into ID and non-ID groups, which were compared using similar analysis techniques. Results: A total of 392 infants were studied (gestational age: 23-30 weeks; 55.75% male). Of these, 285 were exclusively FF with iron-rich formula and 107 were exclusively or partially BF. Mean birth weight, gestational age and neonatal variables were comparable between the two groups. Mean iron intake from formula in the FF group was 1.66 mg/kg/day. An elemental iron intake of ≥ 2mg/kg/day was obtained from formula alone in only 20.4% of FF infants. FF infants were also less likely to receive additional iron supplements (Table 1). However, mean total daily iron intake (from formula and supplements) was higher in the FF group. Despite this, 36.8% of infants in FF group developed ID versus 20.6% in BF group (p=0.002). Table 2 shows key characteristics of ID and non-ID FF infants. Mean gestational age and birth weight were both lower in the ID group. The ID group also had a higher percentage of infants born <1100g (p=0.01). More babies in the ID group received at least one blood transfusion (Odds:1.1-3.0). Other neonatal variables were comparable between the two groups. ID infants had a higher daily formula intake, daily iron intake from formula and total daily iron intake combined from formula and supplements. Conclusion: Most very preterm infants fail to receive elemental iron of 2mg/kg/day from formula alone. ID is significantly more prevalent in FF infants than BF infants despite higher iron intake overall. A possible explanation for this finding could be that the bioavailability of iron from formula is lower than from breast milk. Breast milk contains lactoferrin, which aids iron absorption. Thus, iron from breast milk may be better absorbed than iron from formula. Our observations suggest the need to revisit the international recommendations for iron supplementation in FF very preterm infants. Lower gestational age, lower birth weight and need for blood transfusions were associated with ID in FF infants. Plausibly, blood transfusions may lead clinicians to withhold necessary iron supplementation for fear of iron overload in these infants, leading to unintentional ID. We suggest that optimal iron supplementation in this population should be guided by a risk adapted strategy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Why Iron Deficiency in Acute Heart Failure Should Be Treated: A Real-World Clinical Practice Study.

Background. This study aims to determine whether the administration of ferric carboxymaltose (FCM) in patients with acute heart failure (AHF) and iron deficiency (ID) improves morbidity and mortality. Methods. We studied 890 consecutive patients admitted for AHF. Patients were divided into six groups according to reduced left ventricular ejection fraction (HFrEF) or preserved (HFpEF), presence of ID, and administration of FCM. Emergency visits, re-admissions, and all-cause mortality were assessed at 6 months. Results. The overall prevalence of ID was 91.2%. In the HFrEF group, no differences were found in isolated events when patients with untreated vs. treated ID were compared, while differences were found in the combined event rate (p = 0.049). The risk calculation showed an absolute risk reduction (ARR) of 10% and relative risk reduction (RRR) of 18%. In HFpEF there was a positive trend with regard to the combined event (p = 0.107), with an ARR of 9% and an RRR of 15%. The number of patients we needed to treat to prevent a combined event was 10.5 in HFrEF and 10.8 in HFpEF. Conclusions. FCM in AHF reduced the combined event rate of emergency visits, re-admission, and all-cause death at 6 months in HF with left ventricular ejection fraction <50%, and showed a positive trend in HFpEF.

Iron Deficiency in Heart Failure and Pulmonary Hypertension.

To describe the role of iron deficiency in both heart failure and pulmonary hypertension. To role of iron deficiency in heart failure is well established and pathophysiologic overlap with pulmonary hypertension exists. Iron deficiency is common co-morbidity in heart failure and pulmonary hypertension. The high prevalence is intertwined into the pathophysiology of these conditions (e.g., neurohormonal activation, inflammation). The presence of iron deficiency has a negative impact on cardiomyocytes and cardiac function, skeletal muscle function, and pulmonary vascular function. In heart failure data from over 2000 randomized patients with iron deficiency using a uniform diagnosis, have illustrated beneficial effects on functional status, quality of life, reverse cardiac remodeling, and heart failure admissions. While iron deficiency is recognized to be prevalent in pulmonary hypertension and associated with worse functional status, the absence of a uniform definition and the absence of large prospective randomized controlled trials with iron therapies limits the conclusions on the causal role of iron deficiency such as observed in heart failure.

Importance Of Iron Deficiency in Patients with Recurrent Aphthous Stomatitis

Aphtha is a Greek word for ulceration which is a common problem in dentistry for diagnosis and treatment. Objective: To assess serum levels of iron among patients with RAS and its comparison with the control group. Methods: The analysis involved 150 subjects alienated into 2 groups as a group with recurrence of aphthous ulcer and a control group. The 75 patients were encompassed in the control group and 70 in the aphthous ulcer matched for age and sex. Based on the history and clinical examination, the diagnosis of RAS was made. By ELISA test and ELX 800 Absorbance Microplate Reader tool, Serum ferritin was measured, while micro-lab 300 was used to evaluate serum hemoglobin and iron levels. Results: Grounded on standard values of laboratory investigations, serum levels of iron were suggestively lower in patients of RAS in comparison to the control group. Minor RAS type was observed in 71 patients (94.7%), while major RAS was reported in 4 patients (5.3%). Out of 75, 20% had multiple ulcers and 80% had a single ulcer. While RAS was localized in non-keratinized mucous membrane in 64 patients (85.3%), in 6 patients (8%); RAS was located in keratinized mucous membrane and both non-keratinized and keratinized mucosa were seen in 5 subjects (6. 7%). Conclusion: The presence of iron deficiency has been linked to recurrent aphthous stomatitis

Depression, anxiety and asthenia in patients with comorbidity of chronic heart failure and iron deficiency

BACKGROUND: A common comorbid pathology in patients with chronic heart failure is iron deficiency, as well as depressive and anxiety disorders.&#x0D; AIM: To study the frequency and severity of depression, anxiety and asthenia in patients with heart failure and iron deficiency.&#x0D; MATERIALS AND METHODS: 290 patients, 78 men and 212 women (mean age 71.29 8.11 years) with chronic heart failure, functional class IIIV, have been examined. All the patients underwent clinical examination, a 6-minute walk test; a general blood test, the level of NT-proBNP, iron, transferrin, and ferritin in blood serum have been studied; the percentage of transferrin saturation with iron has been calculated. The presence of iron deficiency has been diagnosed on the basis of the following criteria: a decrease in the level of serum ferritin (less than 100 g/L) or ferritin in the range from 100 to 299 g/L and saturation of transferrin with iron less than 20 %. Hospital anxiety and depression scale (HADS) has been used to determine the presence and severity of depression and anxiety in points; the presence and severity of asthenia have been evaluated according to MFI-20 asthenia scale.&#x0D; RESULTS: It has been found that in patients with chronic heart failure and iron deficiency, depression and anxiety are diagnosed significantly more often than in patients without iron deficiency. In addition, in patients with iron deficiency, the severity of depression, anxiety and various manifestations of asthenia are significantly greater.&#x0D; CONCLUSIONS: In chronic heart failure, iron deficiency predisposes patients to the development of depression and anxiety and an increase in various manifestations of asthenia.

Iron deficiency is an independent risk factor of increased myocardial energy expenditure in chronic heart failure patients

Chronic heart failure (CHF) is a major public health burden and is associated with high morbidity, mortality, and cost. Recent studies demonstrated iron metabolism and myocardial energy metabolism were altered in CHF patients. In this study, we aimed to analyze the effects and correlations of iron metabolism on myocardial energy metabolism in CHF. One hundred and thirty patients with CHF [age: 66.2±11.5 years, males: 58.5% and New York Heart Association (NYHA) class (II/III/IV): 67/43/20] were included. Serum concentrations of ferritin, transferrin saturation (Tsat), and soluble transferrin receptor (sTfR) were quantified as the indexes of iron metabolism, and echocardiography was used to assess myocardial energy expenditure (MEE) levels. Iron deficiency (ID) was defined as ferritin <100 or 100-300 µg/L with Tsat <20%. Patients with CHF were divided into two groups based on iron status. The prevalence of ID in CHF was 36.9%, and increased with the severity of CHF, reaching 80.0% in those with NYHA class IV (NYHA class II/III/IV: 17.9% vs. 46.5% vs. 80.0%, P=0.000). The demographic characteristics [age, sex, body mass index (BMI), blood pressure, and heart rate] and hemoglobin (HGB) concentrations in two groups were similar (all P>0.05). MEE was significantly higher in the ID group (92.7±23.0 vs. 65.6±20.8 cal/min, P=0.000), while NYHA classes II and III was significantly higher in the ID group (71.6±16.4 vs. 60.3±14.8 cal/min, P=0.022; 88.9±10.4 vs. 69.1±20.1 cal/min, P=0.000). In univariable linear regression models, the presence of ID, higher NYHA class, increased N-terminal pro-B-type natriuretic peptide (NT-proBNP), sTfR, left ventricular internal diastolic diameter (LVIDd), as well as reduced ferritin, Tsat levels, and lower left ventricular ejection fraction (LVEF) were associated with elevated MEE levels (all P<0.05). In multivariable regression models, the presence of ID, reduced Tsat. and increased sTfR remained independent predictors of elevated MEE levels after adjustment for all variables that showed a significant association with MEE (all P<0.05). The prevalence of ID is high in CHF and is associated with the severity of cardiac dysfunction. The presence of ID as well as reduced Tsat and increased sTfR concentrations are associated with elevated MEE levels in CHF.

Iron deficiency – a factor in left ventricular ejection fraction depression post-myocardial infarction

Abstract Introduction Iron deficiency was shown to affect functional capacity and ejection fraction in patients with heart failure and reduced ejection fraction. Myocardial infarction is an important cause of reduced left ventricular ejection fraction (LVEF). Moreover, there is some evidence of the iron deficiency as a factor to predict cardiovascular and non-cardiovascular mortality. Purpose Evaluate the presence of iron deficiency in patients with acute coronary syndromes (ACS) admitted to the intensive cardiac care unit and its eventual association with LVEF and mortality. Population and methods We performed a prospective study in which ACS patients were divided into groups according to the presence or absence of iron deficiency. We collected demographic data, comorbidities, as well as determination of troponin I, haemoglobin and criteria for absolute and functional iron deficiency (ID) and other data related to the use of mechanical ventilation, need for aminergic support, LVEF and death. Results From 148 patients we included 78 patients who met the criteria for being analysed. 49 patients had iron deficiency (51% had absolute iron deficiency and 49% had relative iron deficiency). There were no differences between groups in terms of myocardial infarction with or without ST segment elevation (p=0.609 and p=0.329, respectively), hypertension (p=0.926), diabetes (p=0.882), obesity (p=0.343), dyslipidaemia (p=0.482), smoking (p=0.876), valvular heart disease (p=0.888), acute and chronic renal failure (p=0.800 and p=0.888, respectively) and LVEF (p=0.886). There were no differences in need for aminergic support (p=0.984), ventilation (p=0.315) and death (p=0.704). We found that in the sub-population of patients without anaemia (Hb&amp;gt;12g/dL), the proportion of patients with depressed LVEF (inferior to 50%) and relative iron deficiency was significantly higher than those with preserved LVEF (48.1 vs 13.8%, p=0.005). Furthermore, we also found that in this sub-population, patients with myocardial infarction without ST segment elevation had higher proportion of absolute iron deficiency (45.0 vs 19.4%, p=0.043). Conclusion Our study showed that the prevalence of iron deficiency in ACS patients is 62.9% (n=49). Moreover, in patients without anaemia, this results seems to point out that the presence of iron deficiency may be related with LVEF, at least during the acute event. Further studies with a higher sample size are warranted to either establish or discard this association. Furthermore, a follow-up of this patients can further enlighten us as to the role of iron deficiency in long term LVEF and mortality. Funding Acknowledgement Type of funding sources: None.

Perioperative anemia

Over 10 million operations are performed each year in Russia. A successful surgical treatment demands assessment and mitigation of perioperative risks, one of which is anemia. Patients with low hemoglobin are at greater risk of developing complications and adverse outcomes. These patients more often stay longer at hospitals, have more in-hospital events and readmissions.Perioperative anemia may be present before surgery, low hemoglobin levels can result from surgery, and can persist after hospital discharge. Preoperative anemia is associated with inferior surgical outcomes and is also an independent risk factor for perioperative complications (acute kidney injury, infectious, thromboembolic, cardiovascular events) and death. Postoperative anemia impairs recovery and increases the risk of reoperations and readmissions.Absolute and functional iron deficiency is the most common cause of anemia in the perioperative period. The prescription of iron supplements is indicated in the presence of iron deficiency. If the operation is scheduled to be performed in 6 weeks and longer, the prescription of oral iron forms is recommended. If less than 6 weeks remain before surgery, parenteral iron therapy is prescribed. If hemoglobin levels increase insignificantly during such therapy, high-dose iron supplements are indicated. When it comes to emergency surgery and the anemia is not severe, it is recommended to intravenously administer high-dose iron supplements immediately before surgery. In case of severe anemia, blood transfusion is indicated. According to the patient’s blood management concept, blood transfusion should be minimized, including due to the use of high-dose iron supplements, one of which is ferric carboxymaltose.The choice of treatment for anemia in the postoperative period depends on its severity, the patient’s comorbidities, the type of surgery and the presence of surgical events. In most cases, early intravenous iron therapy is recommended, giving priority to single administration of high-dose iron supplements. Blood transfusion is indicated to patients who have severe anemia, are actively bleeding, and to patients with a severe anemia after the bleeding has been stopped. Iron therapy continues at the outpatient stage of treatment for a long time until the hemoglobin and ferritin levels are normalized, reflecting the replenishment of iron stores in the depot organs.

Iron therapy in iron-deficiency patients with heart failure with preserved ejection fraction: A protocol for meta-analysis.

Background:Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality and morbidity of patients with HF with preserved EF (HFpEF) are high. However, there is no established therapy to improve survival in these patients. HFpEF patients are often elderly and their primary chronic symptom is severe exercise intolerance. Thus, improvement of exercise capacity presents another important clinical outcome in HFpEF patients. Iron deficiency is common in HF patients, and the presence of iron deficiency, regardless of concomitant anemia, is associated with worse symptoms, impaired exercise capacity, and higher mortality and hospitalization in these patients. Several meta-analyses of randomized controlled trials reported that iron administration improved HF symptoms, exercise capacity, and clinical outcomes in iron-deficiency patients with HF with reduced EF. However, there is insufficient evidence as to the effect of iron administration in iron-deficiency HFpEF patients.Methods and Results:This meta-analysis will include randomized controlled trials on the effects of iron administration on HF symptoms, exercise capacity, and health-related quality of life in iron-deficiency HFpEF patients. Information of studies will be collected from PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov. The primary outcome will be exercise capacity (6-minute walking distance). The secondary outcomes will be HF symptoms, health-related quality of life, and mortality and hospitalization rates.Conclusion:This meta-analysis will evaluate the effect of iron therapy in iron-deficiency HFpEF patients, providing evidence as to the iron administration in these patients.Systematic review registration:PROSPERO CRD42020205297.

Behavior of Iron and Ferritin After Bariatric Surgery in Patients With and Without Hepatic Steatosis.

Iron deficiency and hepatic steatosis are common in bariatric surgery patients. Steatosis can falsely elevate ferritin values even in presence of iron deficiency. This study aims to assess the influence of hepatic steatosis on iron deficiency and replacement therapy after bariatric surgery. Seventy-nine individuals undergoing gastric bypass have been studied at 4 time points (preoperative and 1, 3, and 6months after surgery). Weight, body mass index (BMI), iron, ferritin, vitamin B12, folate, hemoglobin, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and use of iron replacement were recorded. Forty-two individuals (53%) had moderate/severe steatosis assessed by ultrasound. No differences were seen in iron profile and replacement therapy features compared to individuals with no/mild steatosis both in the preoperative and postoperative periods. Mixed model analysis showed ferritin levels to be higher in the moderate/severe steatosis group than in no/mild steatosis at the 6th month (139 ± 131 vs. 60.9 ± 49.8, p < 0.05). Values in both groups were lower than baseline, with p < 0.0001. The same was observed with serum iron (92.1 ± 39.6 moderate/severe steatosis vs. 68.6 ± 33.4 no/mild steatosis, p < 0.001; p from baseline < 0.01 for both). GGT was higher in moderate/severe steatosis in the 3rd month (38.8 ± 40.5 vs. 28.8 ± 20.8, p < 0.05; p from baseline < 0.0001 for both). Ferritin levels were consistently higher in individuals with steatosis in the follow-up of bariatric surgery, but no apparent implication on the diagnosis of iron deficiency and in the prescription of replacement therapy was demonstrated at 6months of follow-up. Longer studies are probably necessary to investigate this matter.