Prevalence Of Iron Deficiency Anemia Research Articles

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Background: The prevalence of iron deficiency anemia is still high, especially in children under five. One effort to prevent iron deficiency anemia is exclusive breastfeeding for newborns. This study aims to analyze exclusive breastfeeding on the incidence of anemia in children under five. Subjects and Method: This study is a systematic review and meta-analysis, with PICO as follows: Population= toddlers aged <5 years; Intervention= exclusive breastfeeding; Comparison= nonexclusive breastfeeding; Outcome= iron deficiency anemia. The articles used in this study were obtained from several databases including PubMed, Springer Link, Science Direct, and Google Scholar, which were published from 2012 to 2022. The keywords to search for articles are as follows: "Children" AND ("exclusive Breastfeeding" OR "formula" OR "mixed feeding") AND (anemia OR "Iron deficiency"). The articles included in this study were full-text articles with a cross-sectional study design. Articles are collected using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.3 application. Results: A meta-analysis of 9 cross-sectional studies from Ethiopia, Taiwan, Bangladesh and China concluded that exclusive breastfeeding is effective in reducing the risk of anemia in children under five. Toddlers who are exclusively breastfed have a risk of developing anemia 0.55 times compared to those who are not exclusively breastfed, and the reduced risk is statistically significant (aOR= 0.55; 95% CI= 0.32 to 0.92; p= 0.020). Conclusion: Exclusive breastfeeding is effective in reducing the risk of anemia in children under five. Keywords: exclusive breastfeeding, anemia, toddlers. Correspondence: Fikri Dian Dinu Azizah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A Surakarta 57126, Central Java, Indonesia. Email: fikridianda@gmail.com. Mobile: 08122- 5002311.

Influence of exopolysaccharide EPSKar1-iron complexation on iron bioavailability and alleviating iron deficiency anaemia in Wistar rats.

The prevalence of iron deficiency anaemia is a significant issue worldwide, affecting individuals of all ages and often associated with inadequate iron bioavailability. Despite the use of ferrous salt supplements to address anaemia, their limited bioaccessibility and bioavailability in human GIT and adverse impact on food properties remain significant challenges. Hence, this study aims to explore the iron chelation mechanism of an exopolysaccharide EPSKar1 to enhance iron bioaccessibility, bioavailability, and anti-anaemic effects using cell culture and an anaemic rat model. EPSKar1 was extracted from Lacticaseibacillus rhamnosus Kar1 and complexed with FeSO4 to form "EPSKar1-iron". This novel complex, besides being bio-accessible after in vitro gastric digestion, demonstrated 61.27 ± 1.96% iron bioavailability to the Caco-2 cells. In line with these in vitro findings, intragastric administration of the EPSKar1-iron complex to anaemic Wistar rats at 25 and 50 mg per kg body weight significantly restored blood haemoglobin levels and re-established the morphological features of red blood cells. Furthermore, the apparent digestibility co-efficient and iron uptake improved significantly without adversely affecting the serum biochemical parameters in these anaemic rats. The levels of iron-transport proteins including serum transferrin and ferritin in tissue and plasma have increased remarkably upon oral administration of EPSKar1-iron at a higher dose of 50 mg per kg body weight. Oral supplementation of EPSKar1-iron did not foster adverse histological changes in the liver, kidneys, and spleen. In fact, the treatment with the EPSKar1-iron complex had a restitution effect on the tissue architecture, thereby ameliorating the tissue lesions. These findings collectively indicate that the EPSKar1-iron complex shows nutraceutical potential in enhancing the bioavailability of iron and could be a promising approach to tackle iron deficiency anaemia.

Avaliação de programas para aplicação de ferro dextrano na prevenção da anemia ferropriva de leitões

ABSTRACT To evaluate the effect of different iron dextran application programs on the performance, fecal score, and skin color of suckling piglets, as well as sow performance, 288 piglets from 24 sows were allocated to four treatments in six replications with 12 piglets per experimental unit, in a block design. The treatments were as follows: T200_000, T200_100, T200_200, and T100_100, whose respective values (in mg) corresponded to the applications of the first dose of iron dextran on the second day of life and of the second dose on the 10th day. Piglets on T200_000 and T200_200 showed the highest feed intake. In the period from 10 to 22 days, piglets receiving T100_100 exhibited the highest fecal score. On the 10th day of age, the lowest lightness (L*) value on the ear was obtained with T200_100, and the highest with T100_100. Treatments T200_000, T200_100, and T200_200 generated the highest red color (a*) intensity on the ear, whereas T100_100 provided the lowest hue and parameter b* values on the leg and snout. On the 22nd day of age, the highest b* and hue values of the ear and snout were found in the group fed T100_100. In conclusion, all evaluated programs were efficient in preventing iron deficiency anemia in newborn piglets. To reduce expenses, we recommend administering a single dose of 200 mg of iron dextran to piglets on the second day of life.

Оценка эффективности и комплаентности применения Вожея® у женщин на этапе прегравидарной подготовки и в ранние сроки беременности

Aim: to assess the clinical efficacy, safety and tolerability of Vojea® in the prevention of iron-deficiency anemia and folic acid deficiency in women during the preconception (pregravid) period and early stages of pregnancy, as well as to evaluate patient compliance with this product. Patients and Methods: this prospective multi-center observational study was performed in 2022 in four medical centers and women's health clinics of Ekaterinburg. The study included 87 women with latent iron deficiency (mean ferritin level below 15 ng/ml). The first group consisted of 37 women during the pregravid preparation period, and the second group consisted of 50 pregnant patients with up to 12 weeks of pregnancy. Patients received the Vojea® once daily for three months. Clinical and laboratory efficacy (the absence of objective anemia signs and the changes in hemoglobin level, folate and ferritin blood tests over time), as well as tolerability (the rate of adverse events, tolerability of the taken product evaluated using the visual analog scale) was assessed at days 30, 60 and 90 after the beginning of treatment. Results: beginning from the first month of treatment with the studied complex, some positive changes in clinical symptoms and laboratory findings were reported in both groups. By the third month of therapy, the increment of hemoglobin level in the pregravid preparation group was 17 (13.9%) units, the level of ferritin increased by 6.3 times (clinically significant after two months of the product intake), and the level of blood serum folates increased by 4.6 times. In group 2, the increment of hemoglobin level, as pregnancy was progressing, in three months of the product intake reached 19 units (17%), the level of ferritin increased by 5.9 times (clinically significant after two months of treatment), and the level of blood serum folates increased by 3.9 times. In group 1, adverse events were reported only in 2/37 (5.4%) patients who had dark stool color on the 2nd month of follow-up. In group 2, such adverse events as nausea were reported in 3/50 (6%) patients during the 1st month of product intake. All patients informed that the product was well tolerated which ensured high patient compliance. Conclusion: maintaining iron and folic acid homeostasis by oral intake of the Vojea® complex during three months in the preconception period and early stages of pregnancy is a feasible option based on its high efficacy and good tolerability with the minimal risk of side effects, encouraging high patient compliance. KEYWORDS: ferric pyrophosphate, folic acid, pregravid preparation, pregnancy, active metabolite of folic acid, methyltetrahydrofolate, glucosamine salt, Quatrefolic, micronized microencapsulated ferric iron, Vojea, compliance. FOR CITATION: Kononova I.N., Kareva E.N., Stebenyaeva E.V. et al. Assessment of the efficacy and compliance with Vojea® in women during the pregravid preparation and the early stages of pregnancy. Russian Journal of Woman and Child Health. 2023;6(2):95–104 (in Russ.). DOI: 10.32364/2618-8430-2023-6-2-95-104.

A prescription pattern of iron preparations among pregnant women with iron deficiency anemia attending antenatal clinic in a tertiary care hospital in Telangana, India

Background: Understanding and documenting the burden of Iron deficiency anemia (IDA) in pregnancy serves as feedback to realign the ongoing efforts in tackling it. Aim and Objectives: This study was conducted with the Objectives: (1) To estimate the prevalence of IDA in pregnancy (2) To determine the factors affecting the choice and the route of administration and (3) To compare the tolerability, efficacy, and adherence of oral and parenteral iron preparations. Material and Methods: A prospective observational study was conducted in an antenatal clinic at Mediciti Institute of Medical Sciences from April 1st, 2018 to March 31st, 2019 after obtaining Institutional Ethics Committee approval. Results: IDA was more in multigravida (66.17%). Majority of the participants were anaemic during their 2nd trimester (54.14%). By the time of delivery, 6 (33.33%), 34 (47.22%), and 20 (46.51%) participants enrolled in their first, second, and third trimesters, respectively, showed improved Hemoglobin (Hb) levels. Ferrous Sulphate (90.4%) and Iron Sucrose (98.53%) were the most prescribed oral and parenteral iron preparations, respectively. Among the participants on oral iron therapy, 30.65% had high adherence with Morisky’s Medication Adherence Scale and about 20.16% of participants had 100% adherence by pill count. Conclusion: Parenteral iron infusions, though brought about a significant rise in the mean Hb levels of the participants in a shorter time span than oral iron therapy, could not correct their anemic status by the time of their delivery. Almost half of the participants delivered in anemic status. Both the treatment modalities were well tolerated and the majority had good adherence.

Prevalence of Iron Deficiency Anaemia (IDA) among Pregnant Women Attending a Tertiary Health Care Facility in North-eastern Nigeria

Background: Iron Deficiency Anaemia (IDA) is the most frequent nutritional deficiency in the world and it is most prevalent in African countries including Nigeria. In pregnant women, IDA is associated with high morbidity and mortality. Aim: This study was to determine the prevalence and some associated risk factors for IDA in the third trimester. Materials and methods: This was a cross-sectional descriptive study involving 88 women in the third trimester of pregnancy attending Antenatal Clinic (ANC) of Federal Medical Centre in Nguru, Yobe State, North-East, Nigeria. Complete Blood Count (CBC) and serum ferritin were analysed and relation of serum ferritin with some variables were determined. Results: The mean age, parity, last child birth, haematocrit and ferritin of the study participants were 26.72±6.12years, 3.58±3.43, 1.89`±1.85 years, 32.51±7.41% and 68.87±151.88ng/ml respectively. Overall prevalence of anaemia was 22/88(25%) with the prevalence of iron deficiency (ID) being 53/88(60.2%); 10/88(11.4%) had IDA while ID without anaemia was present in 43/88(48.9%). There were no statistically significant correlations between maternal ferritin levels and age, surprisingly to note that ferritin levels were not significantly associated with parity, LCB and GA. Conclusion: We concluded that there was a high burden of third trimester ID among the study population. Maternal age and other assessed risk factors do not have any relationships with third trimester ferritin levels.

English

Diet based on whole cereal flours is associated with a high prevalence of iron deficiency anemia and zinc deficiency in low/middle-income countries. Such flours contain high content of phytate that chelates minerals such as iron and zinc, making them unavailable for absorption by humans. To improve the mineral absorption, a phytate:iron molar ratio <1 and a phytate:zinc molar ratio <5 is needed to be achieved. This study aimed to improve the phytate degradation in composite wheat-cassava-whole sorghum flour bread by adding a phytase releasing yeast Pichia kudriavzevii TY13 in baking, preincubated or not, with addition of yeast extract. The phytate and mineral contents were measured by high-performance ion chromatography. Addition of P. kudriavzevii TY13 to the composite flour dough and fermentation for 2 h at room temperature resulted in a 98% phytate degradation. However, the same phytate reduction in the composite bread was achieved after 1 h fermentation at room temperature with addition of preincubated P. kudriavzevii TY13 plus yeast extract. Increasing the fermentation temperature to 30°C, the phytate content was equally low after fermentation for 1 h with P. kudriavzevii TY13 (preincubated or not) plus yeast extract. In conclusion, a faster reduction of phytate in composite bread was obtained by increasing the fermentation temperature, and addition of P. kudriavzevii TY13 (preincubated or not) with added yeast extract. The phytate to iron molar ratio was then 0.2 and the phytate to zinc molar ratio 0.6, which strongly indicates an improved bioavailability of both minerals from such a bread.   Key words: Phytate, phytase, Pichia kudriavzevii TY13, yeast extract, wheat flour, cassava flour, sorghum flour, bread making.

A clinical study to evaluate the efficacy of Amalaki Churna in Pandu Vyadhi with special reference to Iron Deficiency Anaemia

Iron Deficiency Anaemia (IDA) is the most common type of Anaemia overall, and is caused when the dietary intake or absorption of Iron is insufficient. According to National family health survey, India report Anaemia affects an estimated 50% of the Indian population.[1] Rasayana Chikitsa is very beneficial to the patient of Pandu (IDA). In these diseases, the Saarta(essence) of all dhatus is lost hence the dhatus becomes Nissari.e., loss of qualitative physiological excellence, which ultimately results in Oja-Kshaya.[2] Here 30 patients were selected randomly in the study and given Amalaki Churna in 3 gms/day. At the end of 30 days symptomatic improvement and increase in Hb% in Group were noticed. No significant therapy is there for chronic Anaemias in Modern science, which are often due to metabolic defect, so an attempt has been made to evaluate the efficacy of Amalaki Churna on Iron Deficiency Anaemia. It is reported that this drug has useful role in preventing Iron deficiency Anaemia due to metabolic defect.

Iron deficiency, anemia and association with refugee camp exposure among recently resettled refugees: A Canadian retrospective cohort study.

Malnutrition and poor health are common among recently resettled refugees and may be differentially associated with pre-migration exposure to refugee camp versus non-camp dwelling. We aimed to investigate the associations of iron deficiency (ID), anemia, and ID anemia (IDA) with pre-migration refugee camp exposure among recently arrived refugees to Canada. To this end, we conducted a retrospective cohort study of 1032 adult refugees who received care between January 1, 2011, and December 31, 2015, within a specialized refugee health clinic in Calgary, Canada. We evaluated the prevalence, severity, and predictors of ID, anemia, and IDA, stratified by sex. Using multivariable logistic regression, we estimated the association of refugee camp exposure with these outcomes, adjusting for age, months in Canada prior to investigations, global region of origin, and parity. Among female refugees, the prevalence of ID, anemia, and IDA was 25% (134/534), 21% (110/534), and 14% (76/534), respectively; among males, 0.8% (4/494), 1.8% (9/494), and 0% (0/494), respectively. Anemia was mild, moderate, and severe in 55% (60/110), 44% (48/110) and 1.8% (2/110) of anemic females. Refugee camp exposure was not associated with ID, anemia, or IDA while age by year (ID OR = 0.96, 95% CI 0.93-0.98; anemia OR = 0.98, 95% CI 0.96-1.00; IDA OR = 0.96, 95% CI 0.94-0.99) and months in Canada prior to investigations (ID OR = 0.85, 95% CI 0.72-1.01; anemia OR = 0.81, 95% CI 0.67-0.97; IDA OR = 0.80, 95% CI 0.64-1.00) were inversely correlated with these outcomes. ID, anemia, and IDA are common among recently arrived refugee women irrespective of refugee camp exposure. Our findings suggest these outcomes likely improve after resettlement; however, given proportionally few refugees are resettled globally, likely millions of refugee women and girls are affected.

Factors Influencing Adherence to Iron and Folic Acid Supplementation among Pregnant Women attending Antenatal Care in Rubanda District, South Western-Uganda

Purpose: Globally, about 40% of pregnant women have anemia. Pregnant women are at high risk of iron and folic acid deficiency anemia due to increased nutrient requirement during pregnancy. Iron/folic acid supplementation with optimal adherence is the main cost-effective strategy for prevention of iron deficiency anemia in pregnant women. However, there remains poor adherence to iron and folic acid supplementation in pregnancy in many countries especially low-income countries. The aim of this study was to evaluate the level of adherence and the factors influencing adherence to iron and folic acid supplementation among pregnant women attending antenatal care in Rubanda District, south Western-Uganda.
 Methodology: A multi-Health facility based observational and descriptive cross-sectional study was done. One hundred seventy two (172) pregnant mothers attending antenatal clinic in six selected health facilities in Rubanda District were enrolled in this study from December 2021 to March 2022. The interviewer administered questionnaire was used to study the participant characteristics and logistic regression was used to identify the factors influencing adherence to iron and folic acid supplements.
 Findings: Majority of women were aged between 20-29 years (57.56%), married (94.77%) and unemployed (80.23%). More than half of the respondents (62.21%, 95% CI 54.89%-69.53%) had taken at least 80% of the prescribed iron and folic acid tablets. This reflected good adherence level. Factors independently influencing adherence included maternal age below 20 years (aOR 3.83, 95% CI 1.12-13.08, p-value 0.032), age between 20-29 years (aOR=4.86, 95%CI: 2.03-11.63, p value <0.001), adherence partner (aOR=2.82, 95%CI: 1.34-5.91, pvalue <0.001) and being counselled on importance of iron and folic acid tablets (aOR=4.42, 95%CI: 2.08-9.42, p-value <0.001).
 Recommendations: Intensive counselling during antenatal care about the importance of iron and folic acid supplements should be done on a daily basis with particular attention to women aged 30 years and above.

Iron Deficiency Anaemia and Anaemia of Inflammation in Enteropathies Caused by Commonest Small Intestine Disorders: Current Evidence

Abstract It is no mystery that iron deficiency is the most common anaemia and multiple studies have shown that anaemia is a main factor for decreased quality of life. The focus of our article is an up-to-date review of different enteropathies caused by specific disorders and the prevalence of iron deficiency anaemia (IDA), starting with the understanding of physiology of iron absorption and regulation in the intestine. The pathologies that we tried to cover were celiac disease, Crohn’s disease, nonsteroidal anti-inflammatory drugs (NSAID)-induced enteropathy and protein losing enteropathy. Unfortunately, not everything still understood and questions still remain. The main questions are associated with our understanding of iron regulation beyond the ferroportin-hepcidin axis and what mechanism is behind changes of epithelium in different conditions. Depending on the study and pathology of enteropathy, almost half of the studied patients had iron deficiency anaemia. However, in all enteropathies, IDA is more an additional finding or an additional symptom that needs further investigations. That is why many authors consider that IDA is caused by secondary mechanisms and not enteropathy per se and should be correlating with undernourishment, severe mucosal atrophy, malabsorption, and bleeding.

Prevalence of Iron Deficiency Anemia in School Going Children at District Bannu Khyber Pakhtunkhwa, Pakistan

Purpose: The purpose of the current research was to determine how common iron deficiency anaemia was among school-age children. Methodology: A total 200 blood sample in EDTA tube from school going children (6-12 year old) was collected at district Bannu KPK and then transported to Pathology Lab for Complete blood count using hematology analyzer and also transported for microscopy to evaluate the morphology of Red blood cells. Result: Total 200 blood samples were subject to Pathology Lab. Male was 110 (55%) and female were 90(45%). Total IDA positive cases were 120/200 (60%). IDA can be divided into three types of anemia due to Hemoglobin. The following types can occur First Mild Anemia: 10-10.9gm/dl (41.66%), second Moderate Anemia: 7-9.9gm/dl (37.5%), third extreme Anemia :< 7gm/dl (20.83%). Practical Implications: In district Bannu, a large number of children at school age had anemia despite the fact that its symptoms were challenging to identify and diagnose, but pale skin was the most prevalent sign of anemia. Conclusion: From this study we concluded that in district Bannu school going children have 60% anemia. The pale color of the children decreases physiological growth, and physical and mental activity. The female had 42.5% anemia as compare to male i.e. 17.5%. Between age of 10 and 12 the anemia cases was found. Keywords: IDA, MCV, MCH, MCHC, Serum ferritin prevalence, Bannu, Khyber Pakhtunkhwa. Keywords: anaemia, iron, children, Hemoglobin, human health

Prevalence of iron-deficiency anemia in pregnant women with various thalassemia genotypes: Thoughts on iron supplementation in pregnant women with thalassemia genes.

There are limited studies on iron-deficiency anemia (IDA) in carriers of various thalassemia genotypes. However, for pregnant women (PW) with high iron demand, ignoring the phenomenon of carrying the thalassemia genes combined with IDA may lead to adverse pregnancy outcomes. The hematological phenotype indexes of 15,051 PW who received a prenatal diagnosis of thalassemia in our hospital were analyzed, and the plasma ferritin (PF) of 714 anemic pregnant women (APW) was determined. The results showed that 87.43% of APW without thalassemia suffered from IDA. Among APW with various thalassemia genotypes, we found that 40.00∼77.78% of subjects with α-thalassemia silent genotypes [αCS (or QS)α/αα (40.00%), -α3.7(or 4.2)/αα (57.65%), and αWSα/αα (77.78%)] and 18.18∼84.21% of subjects with α-thalassemia minor genotypes [αCS (or QS)α/-α3.7(or 4.2) (18.18%), -α3.7(or 4.2)/-α3.7(or 4.2) (40.00%), αα/-SEA (44.55%), and αWSα/-α3.7(or 4.2) (84.21%)] developed IDA, while in subjects with α-thalassemia intermedia genotypes, only αWSα/-SEA was associated with IDA, with an incidence of 16.67%. However, the incidence of IDA in APW with common β-thalassemia minor genotypes (βCD17(A>T)/β, βCD41/42 (-TTCT)/β, βCD71/72(+A)/β, βIVS-II-654(C>T)/β, and β-28(A>G)/β) was less than 10.85%. In addition, the APW with β-thalassemia minor had a higher PF level than the APW without thalassemia. Our study is the first to reveal differences in the prevalence of IDA among PW with various thalassemia genotypes, indicating that the possibility of IDA should be fully considered when managing PW with α-thalassemia silent or minor genotypes in high-risk areas, and that iron supplementation should be monitored dynamically for PW with β-thalassemia minor genotypes.

Individual and community level determinants of iron intake among children 6–59 months old in Ethiopia: multilevel logistic regression analysis

BackgroundIron deficiency is one of the most important factors of anemia which is caused by poor iron intake. In addition, children need more iron because of their rapid growth. On the other side, daily intake of iron is also recommended as a standard approach for the treatment and prevention of iron deficiency anemia. In Ethiopia, although more than half of children 6–59 months of age were affected by anemia, the magnitude and factors associated with iron intake among them are understudied. Therefore this study aimed to assess the magnitude and community and individual level determinants of iron intake among 6–59 months children in Ethiopia.MethodsDemographic and Health Survey datasets (EDHS) were used for this study. The data were weighted using sampling weight to get valid statistical estimates. The total weighted samples of 9,218 children aged 6–59 months were included. A multilevel binary logistic regression model was fitted to identify factors associated with iron intake among 6–59 months of children in Ethiopia. In the final model adjusted odds ratio with a 95% confidence interval and p-value < 0.05 was taken to declare statistical significance.ResultsThe magnitude of iron intake among children 6–59 months in Ethiopia was 9.24% (95% CI: 8.31%, 10.15%). Individual level variables such as having at least one antenatal care visit (ANC) [AOR = 1.27; 95%CI; 1.01, 1.61], having health institution delivery [AOR = 1.46; 95%CI;1.04, 2.04], age of children ≥ 24 months [AOR = 1.82; 95%CI; 1.29, 2.57], being female child [AOR = 0.81; 95%CI; 0.67, 0.99], being greater than three birth order [AOR = 0.73, 95%CI: 0.55, 0.98], whereas community level variables such as living in large central regions [AOR = 3.68; 95%CI; 1.47, 9.21], and living in community with high women education [AOR = 1.96; 95%CI; 1.28, 2.98] have an association with iron supplements among children 6–59 months years old in Ethiopia.Conclusion and recommendationsThe magnitude of iron intake among children 6–59 months old in Ethiopia is relatively low. Individual level factors such as; ANC visit, institution delivery, age of children, sex of the child, and birth order as well as; community level variables such as regions, and community women's education have a significant association with iron intake among children 6–59 months in Ethiopia. Prior attention should be given for under two years old children, children greater than three birth orders, and children living in small peripheral regions. Moreover, policymakers and other stakeholders had better plan and implement programs that empower women, enhance ANC visits, and health institution delivery to have a sustainable increment in iron intake for children in Ethiopia.

Prevalence of iron deficiency in simple febrile seizures in children at different age group in Maharashtra

Prevalence of iron deficiency anaemia and febrile convolutions was observed in children at different age groups. Hence haematological profile has to be correlated with simple seizures. 130 Iron deficiency children below 5 years were compared with same number of healthy children (controlled group). Blood examination included Hb% HCT, MCV, MCH, MCHS, RDW, PS. Serum Ferritin was ruled out and compared in both groups. The Haematological profile and serum Ferritin study was compared in both groups and p value was highly significant (p&amp;#60;0.00) in all parameters. The result suggests that, Iron deficiency is the main root cause for febrile seizures in children below 5 years of age. This pragmatic study will help paediatrician to treat such patients efficiently to avoid morbidity and mortality.

Characteristics and Bleeding Behavior of Females with Mild Hemophilia A: Longitudinal Study from Picnichealth Hemophilia A Database

Background: Hemophilia A (HA) is an X-linked condition characterized by factor VIII (FVIII) levels below the normal range, leading to excessive bleeding. Disease severity can be categorized as mild (FVIII: >5-40%), moderate (FVIII: 1-5%) or severe (FVIII: <1%) (Blanchette et al. J Thromb Haemost 2014). Females represent a minority of patients with HA and their bleeding phenotypes are poorly characterized in scientific literature. In this retrospective cohort study, the real-world, patient-centric PicnicHealth database, which integrates clinical data with patient-reported outcomes, is used to examine the epidemiology and bleeding phenotype in females with mild HA (FwHA) compared with a cohort of males with mild HA (MwHA). Methods: FwHA and MwHA have been recruited since June 2020 in the United States. Severity of HA was based on physician-reported provider notes, or baseline FVIII levels if provider notes were inconclusive (for this analysis, mild HA was defined as FVIII >5-50%). Demographics, disease characteristics, and patient-reported outcomes were collected. Bleeding phenotype was assessed up to a year prior to enrollment and described according to bleed etiology (i.e., traumatic, spontaneous, procedure-related, unknown), bleed frequency, and bleed management (use of FVIII concentrates). A two-tailed test was used to analyze differences between the cohorts, with p<0.05 considered significant. Results: At data cut-off on May 31, 2022, 68 patients with mild HA had been recruited: 23 FwHA and 45 MwHA (Table 1A). There were no differences in racial demographics, with approximately 70% identifying as 'White' in both groups. The median FVIII level was significantly higher in the female cohort at 26% (Q1, Q3: 17, 36%), compared with the male cohort at 10% (Q1, Q3: 6, 13%; p=<0.001). Median (Q1, Q3) age at first diagnosis was also significantly higher in the female cohort, at 24.3 (8.71, 36.0) years, compared with the male cohort, at 10.5 (1.02, 21.4) years (p=0.048). However, after adjusting for median FVIII levels, the difference in age at first diagnosis was not statistically significant (p=0.56) between males and females. Median (Q1, Q3) follow-up periods available from medical records were similar for FwHA and MwHA (8.92 [5.60, 12.9] years and 9.22 [4.27, 12.4] years, respectively). FVIII inhibitors were not identified in any FwHA but were present in 13.3% of MwHA. The majority of patients’ records had no evidence of HIV, hepatitis B, or hepatitis C status; however, 5.9% of MwHA were reported to be positive for hepatitis B and C, compared with no FwHA. Prevalence of iron deficiency anemia was higher in FwHA compared with MwHA, at 27.7% vs. 6.7% (significance not assessed due to low numbers). Access to hemophilia treatment centers was numerically higher for FwHA compared with MwHA (82.6% vs. 73.3%), but this difference was not significant. Evaluation of bleeding phenotype in the female and male cohorts is described in Table 1B. The small number of recorded events does not allow for meaningful conclusions about the differences in bleeding phenotypes between females and males with mild disease. The proportion of FwHA treated with FVIII prophylaxis (30.4%) was numerically lower than the MwHA (40.0%), but not statistically significant (p=0.611). For patients on prophylaxis in the year before enrollment, the median (Q1, Q3) number of days on prophylaxis was 209 (149, 268) days for FwHA and 365 (168, 365) days for MwHA (significance not assessed due to low numbers). On-demand FVIII concentrate usage was similar in both groups with 47.8% of FwHA and 51.1% of MwHA receiving FVIII. Conclusions: This real-world cohort study observed differences in disease characteristics between FwHA and MwHA, but statistical analysis was limited by low participant numbers. FwHA had higher baseline FVIII levels compared with MwHA. On-demand use of FVIII concentrates was comparable between the cohorts. Recorded bleeding events were too low in number to draw conclusions regarding bleeding phenotype. As this database relies on patient participation, there was a potential selection bias towards those with more symptomatic disease, and some data were incomplete. Future studies will analyze ongoing prospective data, collect more granular data on bleeding phenotype, and conduct comparative analyses of cohorts stratified by baseline FVIII levels. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Randomised Controlled Trial of Intravenous Iron (ferric carboxymaltose) for Second Trimester Anaemia in Malawian Pregnant Women (REVAMP)

Introduction Anemia affects 46% of pregnancies in Africa. WHO estimates 50% of anaemia in pregnancy (44% in Africa) is responsive to iron; other causes of anaemia in Africa include infection (e.g. P. falciparum). Antenatal oral iron supplementation improves maternal anaemia and birthweight, but adherence may be suboptimal. Ferric carboxymaltose (FCM) is a modern intravenous iron formulation which enables provision of 1000mg (or 20mg/kg) in one 15 minute infusion. We reasoned FCM is an option to treat antenatal anaemia in low income primary-care settings, but the feasibility, efficacy and safety of this approach is unproven. Methods REVAMP was an open label, individually randomised controlled trial set in Malawi, sub-Saharan Africa, a low income setting where anaemia, malaria and other infections (including HIV) are common. Women were screened at antenatal clinics and were eligible if they met criteria including capillary haemoglobin (Hb) <10.0g/dL, negative Plasmodium rapid diagnostic test, and ultrasound-confirmed singleton pregnancy of 13 to 26 weeks gestation. HIV positivity was not an exclusion. Women were randomly assigned 1:1 to the intervention arm (FCM 20mg/kg, up to 1000mg, once at enrolment) or standard of care (SOC, 60mg elemental iron b.d for 90 days, in alignment with local practice). All women received IPTp with Suphadoxine-Pyrimethamine at enrolment and 28 days. The primary maternal outcome was anaemia at 36 weeks gestation. Secondary maternal outcomes included anaemia at other timepoints (28 days post infusion, during delivery and 28 days post-partum), and Hb, iron deficiency (ID) and iron deficiency anaemia (IDA) at each timepoint. The primary neonatal outcome was birthweight. Subgroup analyses (e.g. by baseline anaemia severity, ID, IDA, HIV status) were prespecified. Safety outcomes included incidence of adverse events (AEs) during infusion, and all AEs from randomisation to 4 weeks postpartum, including serious AEs (SAEs): unplanned hospitalisation or death including pregnancy loss and neonatal death. Results We screened 21258 women and randomised 862. Baseline characteristics, including anaemia severity and prevalence of iron deficiency, inflammation, and HIV were similar between arms. Compared with SOC, FCM reduced the prevalence of anaemia at 28 days post infusion (PR 0.91 95% CI 0.85 to 0.97, P=0.007) but did not statistically significantly decrease anaemia prevalence at the primary timepoint of 36 weeks gestation (52.5% vs 56.8%, prevalence ratio (PR) 0.92, 95% CI 0.81 to 1.06, P=0.27), or at delivery or 28 days postpartum (Table 1). Hb concentrations increased from baseline to 28 days post partum in both arms and were greater in women randomised to FCM 28 days post infusion (1.3 vs 1.1 g/dL, difference 0.19 [0.06-0.33]) and at 28 days postpartum (3.1 vs 2.9 g/dL, difference 0.25 [0.06-0.45]). IDA prevalence was reduced at each timepoint, including at 36 weeks gestation (PR 0.29 [0.20 to 0.43], P<0.001). ID prevalence was also reduced at all timepoints. Birthweight did not differ between FCM and SOC. Adverse reactions during FCM administration were reported by 26/430 (6.0%) women; there were no infusion-related SAEs. There was no clinically relevant difference in AEs by any systemic organ class, including infection (including malaria), and SAEs in women and neonates (Table 2). Hypophosphataemia (PO4<0.080mmol/L) at 28 days post infusion was seen in 22/403 (5.5%) women randomised to FCM compared to 8/382 (2.0%) with SOC. There was no difference in pregnancy loss or stillbirth between arms. Conclusions In this low-income, malaria endemic setting, treatment of anaemic pregnant women in the second trimester with FCM worked faster than SOC to resolve anaemia but benefit was not evident by 36 weeks. However FCM reduced ID and IDA at every timepoint. Administration of FCM was feasible and safe. Extended follow-up of mothers and babies is underway. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Iron Supplementation May Selectively Reprofile the Gut Microbiome in Iron-Deficient Bangladeshi Infants

Children in low- and middle-income countries (LMICs) have a high burden of anemia, much of which is attributable to iron deficiency. The World Health Organization (WHO) recommends universal iron interventions in preschool-aged children in countries where there is a high anemia prevalence. However, oral iron supplementation is associated with increased risks of infection, including diarrhea. In small studies in Africa, iron has been shown to reprofile the intestinal microbiota leading to a reduction in commensal bacteria and an increase in pathogenic taxa. Gut dysbiosis has been implicated in the pathogenesis of gastrointestinal, autoimmune and inflammatory disease. The BRISC (Benefits and Risks of Iron Interventions in Children) trial was a double-blind, placebo-controlled randomized controlled trial of oral iron supplementation in 3,300 infants in Bangladesh. Children were randomized to receive one of iron syrup, iron-containing multiple micronutrient powder (MNP) or placebo daily for three months. The primary outcome of the trial was child cognitive development. Key findings from the trial were an improvement in hematological indices with iron but no effect on the functional outcomes assessed (Pasricha et al New Engl J Med 2021). We aimed to study the effect of iron on microbiome composition, diversity and function in the BRISC participants. To achieve this aim we undertook a substudy in which we collected stool samples from 925 children at the three time points of the main BRISC trial: at recruitment, end of intervention and at nine-month follow up. DNA was extracted and analyzed by 16S ribosomal RNA gene (rRNA) amplicon sequencing (2,339 samples across three timepoints) and shotgun metagenomics (965 samples across three timepoints). Episodes of infection were documented as per the main BRISC trial and included diarrhea, respiratory symptoms, antibiotic use, and clinic/hospital visits. The V4 hypervariable region of the 16S rRNA gene was amplified and sequenced on the Illumina MiSeq instrument together with negative and positive controls. Demultiplexed forward and reverse FASTQ files for each sample were trimmed and processed using the DADA2 package in RStudio, and taxonomy was assigned using the SILVA 138 SSU Ref NR 99 reference database. Control samples and samples with fewer than 500 reads were removed (2,284 samples met this minimum read threshold). Taxonomic, alpha diversity and beta diversity measures were conducted using phyloseq and microbiomeSeq packages in RStudio. Differential abundance was calculated by two separate methods: i. limma voom (using trimmed mean of M values [TMM] normalization and log transformation) and ii. ANCOM-BC (using additive log-ratio transformation). Prior to implementing differential abundance methods a filter was applied such that operational taxonomic units (OTUs) found in under 10% of samples were pruned from the samples. As previously reported, there was no overall significant increase in diarrhea incidence among participants receiving iron compared to those given placebo among BRISC trial participants. Baseline iron deficiency, anemia and iron deficiency anemia prevalence among substudy participants was 33%, 42% and 26% respectively. 16S rRNA analysis demonstrated that recent antibiotic (12% of children at end of intervention) was associated with a significant reduction in alpha diversity. Accordingly, analysis was conducted to exclude recent antibiotic use from analysis by intervention arm. Using this analysis, there were no significant differences in alpha or beta diversity between trial intervention groups at the end of intervention (alpha diversity by Shannon index shown in Figure 1). Members of Ruminococcus torques group (limma voom and ANCOM-BC) and Leuconostoc (limma voom only) were more abundant in the intestinal microbiota of children randomized to iron, but no genus was found to be differentially abundant when controlling for multiple comparisons. However, several bacterial genera were differentially abundant in children who were iron deficient at baseline who received iron. Two forms of analyses (Limma voom and ANCOM-BC) showed agreement in finding a reduction in Sutterella and Lactococcus species in iron deficient children receiving iron. These results are shown in Table 1. These data indicate that reprofiling of the intestinal microbiota in response to iron supplementation is dependent on baseline host iron status. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

High Prevalence of Iron Deficiency and Socioeconomic Disparities in Laboratory Screening of Non-Pregnant Females of Reproductive Age

BACKGROUND Iron deficiency anemia (IDA) is one of the most prevalent medical conditions in the world. Iron deficiency (ID) and IDA are common among females of reproductive age, with health consequences both during and outside of pregnancy. However, screening for ID and IDA is variable, and often screening is performed with a complete blood count (CBC) alone, which is neither sensitive nor specific for IDA, in contrast to ferritin. OBJECTIVES The primary objective was to determine the prevalence of screening for ID and IDA over a 3-year period in non-pregnant females of reproductive age who had tests performed at outpatient laboratories in Ontario, Canada. Secondary objectives were to determine the prevalence and severity of ID and IDA, and to identify demographic and provider characteristics that influence the likelihood of screening. METHODS This was a retrospective cohort study of non-pregnant females ages 15-54 in Ontario, Canada. Laboratory data was provided by Dynacare, the second-largest laboratory company in the province, performing around 30% of annual non-hospital outpatient laboratory testing. Tests between January 2017 and December 2019 were retrieved. Tests ordered by providers other than physicians, midwives, or nurse practitioners were excluded. As this was a study of non-pregnant patients, records from patients who had a beta-hCG test of 5 IU or greater, explicitly defined antenatal laboratory testing, or who fulfilled criteria of a previously published laboratory definition of pregnancy were excluded. ID was defined as ferritin < 30 µg/L and severe ID ferritin < 15 µg/L. Anemia was defined as hemoglobin < 120 g/L, and IDA defined as a ferritin < 30 µg/L and hemoglobin < 120 g/L measured within 90 days of each other. Annual household income was estimated using the patient's postal code and Statistics Canada census data. Research ethics board approval was obtained. Dynacare was not involved in study design or analysis. RESULTS 6,652,487 records were retrieved from the Dynacare database. 4,623,284 records representing 784,132 non-pregnant females were eligible for inclusion (Figure 1). Of this cohort, 644,066 patients (82.1%) had a ferritin checked at least once during the study period, with a mean ferritin of 60.7 µg/L (SD 86.9 µg/L). 245,953 (38.3%) were iron deficient with a < 30 µg/L at least once, with 14.4% of patients having severe ID with ferritin < 15 µg/L. Family physicians or general practitioners ordered most ferritin tests (74.1%). 709,434 patients (90.5%) had a CBC checked at least once, with a mean hemoglobin of 130.1 g/L (SD 12.9 g/L). Of those who had a CBC checked, 134,265 (19%) had anemia (hemoglobin < 120 g/L) at least once. 633,396 patients (80.8%) were screened for and 82,655 (13.1%) had IDA. The proportion of ferritin testing increased with increasing anemia severity (Table 1), ranging from 40.2% of patients with normal hemoglobin levels having a ferritin test, to 66.4% of patients with hemoglobin < 70 g/L having a ferritin checked. Median annual household income was CAD$89,387.80 (IQR 69178.8, 107037.5) at the first service date. Compared to patients in the lowest household income quintile (Q1, <CAD$60,000 per year), the odds of ever having a normal hemoglobin generally increased with increasing income quintiles, with odds ratio (OR) 1.08 (95% CI 1.05-1.11), 1.07 (95% CI 1.04-1.10), 1.36 (95% CI 1.30-1.43), and 1.47 (95% CI 1.25-1.72) for Q2-5 respectively. Compared to patients in Q1, the odds of having a ferritin checked was also greater with higher income quintiles with OR for Q2-5 1.20 (95% CI 1.18-1.23), 1.56 (95% CI 1.53-1.60), 1.67 (95% CI 1.61-1.73), and 1.21 (95% CI 1.09-1.34) respectively (Figure 2). CONCLUSION: This was a large study of non-pregnant females of reproductive age in Ontario, Canada, a high-income province within a publicly funded health services system. Our cohort had a high median household income ($89,387.80, compared to a province-wide median of $65,285 in 2016). A large proportion of patients were screened for ID - yet even in this relatively privileged population, ID affected nearly 40% and IDA 13% of those screened. Screening for ID was more likely with increasing anemia severity. Despite low household income being associated with the greatest odds of anemia, low income was associated with lower odds of having a ferritin check. These findings highlight socioeconomic disparities in screening and inequitable diagnosis of ID and IDA in this population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Iron deficiency anaemia: prevalence and associated factors among residents of northern Asir Region, Saudi Arabia

Iron deficiency anaemia is known to be one of the most common disorders that are associated with malnutrition. This study was conducted to form an understanding of the prevalence of Iron deficiency Anaemia (IDA) and evaluate its risk factors among the residents of the northern Asir Region, Saudi Arabia. Understanding the prevalence of IDA in different populations is important not only for therapeutic purposes but also for preventing the development of IDA in a given community. Moreover, this study was conducted to raise awareness about the significance of following iron-rich diet among high-risk groups such as women and children. This study collected data from 683 anaemic patients who are enrolled at the haematology unit in the Department of Internal Medicine at King Abdullah Hospital, Bisha Saudi Arabia. 398 participants who have IDA were included in this study where the collected data from the subjects included Age, gender, education, marital status, nationality, consanguinity, dietary habits and the clinical presentation of the participants. Our findings have shown that the prevalence of IDA among the participants is 58.27% where children under the age of 10 and females are the most affected individuals. Adults over 40, unmarried, and non-Saudis represented the second most affected portion of the subjects. IDA was prevalent among participants who shared the same ancestors and individuals with limited education. Moreover, participants did not consume sufficient iron and iron enhancing food or supplements. Inadequate iron intake is a major risk factor for anaemia. Low red fish and meat consumption contributed to the increase in ID. Findings highlight the need to raise awareness about the importance of a balanced diet and regular consumption of iron-containing food.