Recurrent Iron Deficiency Anemia Research Articles

A Pediatric Case of Bannayan–Riley–Ruvalcaba Syndrome with Recurrent Iron Deficiency Anemia

A Pediatric Case of Bannayan–Riley–Ruvalcaba Syndrome with Recurrent Iron Deficiency Anemia

Hereditary hemorrhagic telangiectasia with splenic abscess: a case report

Hereditary hemorrhagic telangiectasia (HHT) is a rare disorder. Although it commonly causes recurrent bleeding manifestations and severe iron deficiency anaemia, they may be overlooked. Splenic abscess is rarely seen in clinical practice in patients with HHT. This case report describes a patient who presented with epistaxis and severe anaemic symptoms and found to have a splenic abscess with underlying HHT.

Three Case Reports of Pediatric Collagenous Gastritis with Recurrent Iron Deficiency Anemia

Three Case Reports of Pediatric Collagenous Gastritis with Recurrent Iron Deficiency Anemia

The efficacy and safety of intravenous sucrose iron therapy for recurrent iron deficiency anemia

Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) μg/L, and 54% (14/26) of these patients had SF levels of ≥100 μg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) μg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 μg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.

GAVE-синдром как редкая причина трансфузионно-резистентной железодефицитной анемии у женщины пожилого возраста

Antrum vein ectasia or GAVE syndrome, although rare, can lead to bleeding from the upper gastrointestinal tract in 4% of elderly patients. Its main manifestation includes refractory anemia, requiring regular blood transfusions and constant intake of iron supplements. It is diagnosed by presence of longitudinally located ectatic veins of the antrum of the stomach and histological examination data. Standard treatment includes endoscopic argon plasma coagulation. We present a clinical case report of an elderly woman with GAVE syndrome, severe recurrent iron deficiency anemia, and implanted permanent pacemaker. The treatment complexity in this case was presented by underestimating the endoscopic findings in the gastric mucosa at the onset of the disease, which made it difficult to find the source of bleeding, and the presence of a permanent pacemaker in the patient required correction of its work before the argon plasma coagulation procedure.

Helicobacter pylori-Associated Iron Deficiency Anemia in Childhood and Adolescence-Pathogenesis and Clinical Management Strategy.

Many epidemiological studies and meta-analyses show that persistent Helicobacter pylori infection in the gastric mucosa can lead to iron deficiency or iron deficiency anemia (IDA), particularly in certain populations of children and adolescents. Moreover, it has been demonstrated that H. pylori infection can lead to and be closely associated with recurrent and/or refractory iron deficiency and IDA. However, the pathogenesis and specific risk factors leading to this clinical outcome in H. pylori-infected children remain poorly understood. In general, most of pediatric patients with H. pylori-associated IDA do not show evidence of overt blood loss due to gastrointestinal hemorrhagic lesions. In adult populations, H. pylori atrophic gastritis is reported to cause impaired iron absorption due to impaired gastric acid secretion, which, subsequently, results in IDA. However, significant gastric atrophy, and the resultant substantial reduction in gastric acid secretion, has not been shown in H. pylori-infected children. Recently, it has been hypothesized that competition between H. pylori and humans for iron availability in the upper gastrointestinal tract could lead to IDA. Many genes, including those encoding major outer membrane proteins (OMPs), are known to be involved in iron-uptake mechanisms in H. pylori. Recent studies have been published that describe H. pylori virulence factors, including specific OMP genes that may be associated with the pathogenesis of IDA. Daily iron demand substantively increases in children as they begin pubertal development starting with the associated growth spurt, and this important physiological mechanism may play a synergistic role for the microorganisms as a host pathogenetic factor of IDA. Like in the most recent pediatric guidelines, a test-and-treat strategy in H. pylori infection should be considered, especially for children and adolescents in whom IDA is recurrent or refractory to iron supplementation and other definitive causes have not been identified. This review will focus on providing the evidence that supports a clear biological plausibility for H. pylori infection and iron deficiency, as well as IDA.

The Resolution of Severe Iron-Deficiency Anemia After Successful Eradication of Helicobacter pylori in Teenagers.

In this case series, 7 H. pylori-infected patients with recurrent and/or refractory IDA (12-16 y old) received successful eradication therapy and were then followed for a median of 20 months (range, 9-76 mo) after oral iron supplementation therapy (1-4 mo) was discontinued. Five patients of our study cohort participated in rigorous sports activities. No visual appearance of ulcerations or erosions was found by esophagogastroduodenoscopy. In all patients studied, the gastric biopsies showed histological evidence of chronic gastritis without significant atrophy and intestinal metaplasia. Compared with the baseline (median values: hemoglobin, 6.3 g/dL; serum iron, 9 μg/dL; serum ferritin, 1.5 ng/mL), values of hemoglobin (P < 0.001), serum iron (P < 0.005), and ferritin (P < 0.001) significantly increased, on average, 2-3 months after eradication therapy and these iron indices were maintained at the same or higher levels at the endpoint of follow-up (median values: 14.2 g/dL, 102 μg/dL, and 29.3 ng/mL, respectively). No patient had recurrence of IDA at the time of final follow-up. H. pylori infection can be closely associated with recurrent or refractory IDA in teenage children. It is speculated that increased iron demands as a result of growth spurt in adolescents may play a synergistic role in combination with H. pylori in the pathogenesis of IDA.

A31 OUTCOMES OF PATIENTS UNDERGOING REPEAT VIDEOCAPSULE ENDOSCOPY (VCE) PRESENTING WITH OBSCURE GASTROINTESTINAL BLEEDING (OGIB)

BackgroundVideocapsule Endoscopy (VCE) as well as balloon-assisted enteroscopy (BAE) are useful tools in the diagnosis and management of obscure gastrointestinal bleeding (OGIB). There is limited data assessing the diagnostic yield of VCE in subjects with OGIB according to different subtypes: 1) obscure overt 2) inactive overt and 3) active overt.AimsWe evaluated the diagnostic yield and outcomes of patients undergoing a second VCE in OGIB.MethodsThis is a retrospective analysis of all patients who underwent more than one VCE completed at the University of Alberta from January 1, 2015 to August 31, 2021. Demographic and background information was collected including previous endoscopy results, cross-sectional imaging, and subsequent interventions. Patient data was analyzed according to subtype of OGIB at presentation.ResultsDuring the study period, there were 59 subjects who met inclusion criteria. The indication for VCE was recurrent iron deficiency anemia (IDA), active OGIB, and/or inactive OGIB in 38 subjects. The median time to VCE after initial endoscopic evaluation was 61 days. Median age of cases was 61.5 years and 49% were female.Initial VCE had clinically significant positive findings in 68% of cases (Table 1). The diagnostic yield was 75%, 56% and 74% in active OGIB, inactive OGIB, and IDA, respectively. Active bleeding or fresh blood was present in 33% of VCEs for active OGIB compared to 11% of inactive OGIB and 13% of subjects with IDA.At second VCE investigation, there were positive findings in 42% of cases. Findings on second VCE differed from initial VCE in 17 of 38 cases. Findings that changed clinical management were found in 76% of patients after first and second VCE.BAEs were performed in 20 subjects after VCE, with therapeutics applied in 75%. The most common findings were arteriovenous malformations (AVMs) (65%) and erosions/ulcers (15%).ConclusionsThe diagnostic yield of VCE is high in appropriately selected patients and did not significantly differ in patients with IDA, active, and inactive OGIB. Serial VCE is appropriate for the investigation of suspected recurrent small bowel bleeding when initial workup is nondiagnostic.Table 1: Comparison of findings after 1st and 2nd VCEActive OGIB (n=12)Inactive OGIB (n=9)IDA (n=23)1st VCEComplete100%78%91%Source identified755674AVM253348Erosions/ulcers421117Mass114Fresh blood331113BAE505648BAE with treatment2533262nd VCEComplete8389100Negative findings427843AVM252243Erosions/ulcers89BAE83335BAE with treatment229Funding AgenciesNone

Small Bowel Malignancies in Patients Undergoing Capsule Endoscopy for Iron Deficiency Anemia.

Small bowel malignancies are rare and usually asymptomatic or symptoms are nonspecific. Therefore, small bowel tumors are difficult to diagnose. In patients with iron deficiency anemia (IDA) who have negative bidirectional endoscopy results, the small bowel may be considered the source of bleeding. However, in asymptomatic IDA patients with negative bidirectional endoscopy results, evidence supporting the routine use of capsule endoscopy (CE) is insufficient. CE can be considered in selected patients with recurrent or persistent IDA. The frequency of small bowel malignancies is low in patients undergoing CE for IDA, but the usefulness of CE for the diagnosis of small bowel malignancies in younger age groups with IDA has been reported. For patients with risk factors for small bowel malignancy, investigation of the small bowel should be considered. Efforts should be made to prevent adverse events, such as capsule retention or capsule aspiration, through meticulous history taking and endoscopic capsule delivery as necessary.

Safety and Efficacy Of Ferumoxytol For The Episodic Treatment Of Iron Deficiency Anemia In Patients With a History Of Unsatisfactory Oral Iron Therapy: Results Of a Phase III Open-Label, Six Month Extension Study

▪ BackgroundThe efficacy of intravenous iron replacement in treating iron deficiency anemia (IDA) has been studied in patients with various underlying conditions. In some conditions like abnormal uterine and gastrointestinal bleeding, there may be ongoing blood loss leading to a continuing need for treatment that may require episodic iron replacement. MethodsA 6 month Phase III, open-label extension study was designed to evaluate the safety and efficacy of ferumoxytol (FER) for the episodic treatment of IDA patients with a history of unsatisfactory oral iron therapy or in whom oral iron could not be used. The study enrolled patients from a double-blind, placebo (P)-controlled 5-week Phase III study, who had been randomized 3:1 to treatment with FER or P and completed that study. Enrolled patients were evaluated for IDA monthly throughout the 6-month Observation Period. Those with persistent or recurrent IDA (defined as Hgb <11.0 g/dL and TSAT <20%) at any evaluation visit, began a 5-week Treatment Period (TP), receiving a course of FER (2 x 510 mg) with response assessed at TP Week 5. ResultsThis extension study enrolled 78.5% of patients from the previous Phase III study (163/200 P, 471/608 FER), of whom 93% of the P- and 39% of the FER-treated patients met treatment criteria during the 6-month extension and received at least 1 course of FER. In the remaining (12 P, 285 FER) patients, mean monthly Hgb remained ≥12.1 g/dL without further treatment. Mean Hgb increased significantly (p<0.0001) from TP Baseline to TP Week 5 following Treatment Course 1 (2.6 g/dL; N=151) and repeat courses (Course 2: 1.5 g/dL, N=244 [38.5%]; Course 3: 1.1 g/dL, N=69 [10.9%]); mean Week 5 Hgb was comparable following Courses 1, 2 and 3. The few patients receiving Treatment Courses 4 (N=18) or 5 (N=4) limited further analyses. Overall, 61% of FER treated patients never required a 2nd course of treatment. Statistically significant (p<0.0001) increases in mean TSAT from TP Baseline to TP Week 5 followed Course 1 and subsequent courses.FER was also well-tolerated and no new safety signals were observed among patients who received repeat dosing. The incidence of treatment emergent adverse events (TEAEs) was 47.7%, 38.1% and 37.7% in patients who received Course 1, 2 and 3 of FER, respectively. The pattern of related TEAEs decreased in subsequent courses, and none were reported in patients who received more than 3 courses. The incidence of serious adverse events (SAEs) was comparable in patients who received Course 1, 2 and 3, and most were attributable to comorbidities and/or procedural complications; no related SAEs or deaths were reported. For all other TEAE categories, no clear pattern of incidence was observed between Treatment Courses. [Display omitted] ConclusionFER (2x 510 mg) delivered over multiple treatment courses was generally well tolerated in IDA patients with a history of unsatisfactory oral iron therapy or in whom oral iron could not be used with persistent or recurrent IDA; Week 5 post-treatment Hgb was comparable following Courses 1, 2 and 3. No trend of increasing incidence of TEAEs was identified with repeat dosing, and a consistent, positive and robust treatment effect was observed. Durability of the treatment effect following FER was demonstrated by the majority of patients not requiring further iron treatment following the initial course during this 6 month extension study. Disclosures:Vadhan-Raj:AMAG Pharmaceuticals, Inc: Research Funding. Off Label Use: Feraheme (ferumoxytol) injection. For treatment of iron deficiency anemia in non-CKD patients. Dahl:AMAG Pharmaceuticals, Inc: Employment. Lau:AMAG Pharmaceuticals, Inc: Employment. Bernard:AMAG Pharmaceuticals, Inc: Employment. Li:AMAG Pharmaceuticals, Inc: Employment. De:AMAG Pharmaceuticals, Inc: Employment. Allen:AMAG Pharmaceuticals, Inc: Consultancy. Strauss:AMAG Pharmaceuticals, Inc: Employment.FER Received in Extension Study (N=337) Treatment Course‡Course 1 (N=151)Course 2 (N=244)Course 3 (N=69)Efficacy Results (ITT Population)Mean Change in Hgbµ2.6 (1.6)*1.5 (1.3)*1.1 (1.3)*% Patients with Increase in Hgb ≥ 2.0 g/dL¥78.843.937.7Mean Change in TSAT (%)µ12.8 (10.2)*11.7 (12.5)*7.5 (9.1)*Safety Results (Safety Population)All AEs47.7%38.1%37.7%Related AEs12.6%5.3%2.9%SAEs4.6%4.9%4.3%Related SAEs000AEs of Special Interest- protocol-defined€00.4%0Cardiovascular AE Composite EndpointΩ1.3%0.8%1.4%AEs Resulting in Study Discontinuation2.6%04.3%Death000* p-value <0.0001 based on paired t-test‡ Course numbering based on treatment received in placebo-controlled studyµ from Baseline to Week 5¥ at any time from Baseline to Week 5€ includes protocol defined signs and symptoms of hypotension and hypersensitivityΩ includes myocardial infarction, heart failure, moderate to severe hypertension and hospitalization due to any cardiovascular cause

A199 SEVERE COLITIS FOLLOWING PELVIC RADIOTHERAPY: CASE REPORT AND REVIEW OF THE LITERATURE

Abstract Background Mild-to-moderate proctocolitis is a well-known complication of pelvic radiation therapy, occurring in 43% and 6% of patients following external beam radiotherapy (EBRT) and brachytherapy (BT), respectively. This typically presents as recurrent painless rectal bleeding, diarrhea, urgency, and/or iron-deficiency anemia. Severe ulcerating proctocolitis is a less common complication of pelvic radiotherapy and is rare following BT. We report two cases of severe ulcerating proctocolitis mimicking inflammatory bowel disease (IBD) following pelvic radiotherapy in patients without known IBD, including an elderly male undergoing EBRT, and an elderly female undergoing vaginal vault BT. Aims To describe two cases of severe ulcerating proctocolitis, mimicking IBD, following pelvic radiotherapy. Methods Case descriptions and literature review. Results A 71-year-old male without antecedent gastrointestinal disease developed bloody diarrhea 3 months following EBRT for treatment of prostate cancer. Infectious work-up was negative. Blood work showed anemia and an elevated CRP. CT scan showed distal large bowel inflammation concerning for proctocolitis. Flexible sigmoidoscopy revealed severe proctosigmoiditis with circumferential thickening and nodularity of the mucosa and multiple ulcers. Biopsies showed ulcer tissue with fibrinopurulent exudate. He was treated with systemic corticosteroids and symptoms gradually resolved. Repeat colonoscopy 8 months later showed healed inflammation with scarring and residual radiation proctosigmoiditis. A 74-year-old female without antecedent gastrointestinal disease developed watery diarrhea 2 weeks after initiating low dose vaginal vault BT for treatment of endometrial cancer. Infectious work-up was negative. Blood work showed an elevated CRP and CT scan revealed proctocolitis extending to the descending colon. Flexible sigmoidoscopy revealed severe ulcerating proctosigmoiditis with tram tracks of denuded mucosa. Biopsies showed moderate diffuse chronic active colitis with crypt abscesses and apoptotic bodies. She was treated with systemic corticosteroids followed by infliximab and methotrexate, with mild symptomatic improvement. However, repeat endoscopy revealed persistent severe ulceration. Unfortunately, she developed a sigmoid perforation with pelvic abscess, leading to bacteremia and fungemia, and subsequently passed. Conclusions While rare, severe ulcerating proctocolitis mimicking IBD can occur following pelvic radiotherapy, including BT. The decision to manage these patients as IBD using immunosuppressive therapy should be weighed against the risks of these therapies, considering a patient’s age and underlying health, and in collaboration with a patient’s health care team. Careful assessment for risk factors and pathological findings from biopsy specimens may help in predicting the likelihood of IBD in such patients. Funding Agencies None

Tekrarlayan Akciğer Enfeksiyonu ve Dirençli Demir Eksikliği Anemisi Ayırıcı Tanısında Nadir Bir Antite: İdiyopatik Pulmoner Hemosiderozis

İdiyopatik pulmoner hemosiderozis (İPH), demir eksikliği anemisi (DEA), tekrarlayan alveoler hemoraji atakları ve hemoptizi ile seyreden ve etyolojisi tam bilinmeyen nadir bir hastalıktır. Olguların büyük çoğunluğu çocukluk döneminde görülür. Klinik olarak hemoptizi, alveoler hemoraji atakları sırasında gelişen solunum sıkıntısı, akciğer grafisinde parankimal infiltratlar ve sekonder demir eksikliği anemisi gibi bulgularla prezente olur. Bu nedenle de tekrarlayan solunum sıkıntısı ve demir eksikliği anemisine neden olan diğer hastalıklarla ayırıcı tanısı yapılmalıdır. Biz burada tekrarlayan alt solunum yolu infeksiyonu ve kistik fibrozis ön tanısıyla izlenen ve İPH tanısı alan iki yaşındaki bir olguyu sunuyoruz. Olgunun tanısı bronkoalveoler lavaj sıvısında hemosiderin yüklü makrofajlar görülerek doğrulanmış ve steroid tedavisi ile remisyon sağlanmıştır.

The dedicated iron deficiency anaemia clinic: a 15-year experience

ObjectiveTo report our cumulative experience from a dedicated iron deficiency anaemia (IDA) clinic over the last 15 years—with particular emphasis on referral rate, uptake of investigation, impact on endoscopy services,...

2535 Localized AL-Type Intestinal Amyloidosis Presenting as Refractory Iron Deficiency Anemia and Right Lower Quadrant Abdominal Pain

INTRODUCTION: Amyloidosis is characterized by extracellular deposition of abnormally folded proteins creating insoluble fibrils, which disrupt tissue structure and function. Amyloidosis can be either systemic or localized. Localized amyloidosis is defined by the production of precursor proteins in the same location as amyloid deposition. We present a case of biopsy-proven localized AL intestinal amyloidosis. CASE DESCRIPTION/METHODS: A 91-year-old female with a past medical history significant for hypertension and iron deficiency anemia not improving with oral iron presented with progressively worsening dyspnea on minimal exertion, with diffuse weakness and fatigue. She denied any NSAID use. Hemoglobin on admission was 3.8 g/dL, improving to 6.4 g/dL after transfusion of 3 units of packed red blood cells. Upper endoscopy showed very friable mucosa with contact bleeding in the duodenum, along with patchy areas of abnormal mucosa in the 2nd portion (Figure 1). Duodenal biopsies were consistent with amyloidosis based on Congo red and crystal violet stains. Liquid chromatography tandem mass spectrometry was performed on peptides extracted from the specimen and indicated AL (lambda)-type amyloid deposition. Cardiac MRI showed no evidence of infiltrative heart disease or amyloid deposition. Bone survey showed no lytic lesion, and a marrow biopsy showed no morphologic evidence of plasma cell neoplasm with normal karyotype. Urine immunofixation electrophoresis showed no abnormalities. Urine and serum protein electrophoresis showed no monoclonal protein. With no evidence of systemic amyloidosis, diagnosis of localized intestinal amyloidosis was made. No systemic therapy was indicated. Patient was treated with IV iron transfusions. At a subsequent admission, she presented with subacute right lower quadrant pain. CT abdomen/pelvis with oral and intravenous contrast showed thickening of the distal small bowel with shouldering (Figure 2). Lesion was presumed to be secondary to intestinal amyloidosis. Patient refused further invasive interventions. DISCUSSION: Localized AL-type intestinal amyloidosis is rarely diagnosed. Common symptoms are non-specific and can include erosion, ulceration, bleeding, malabsorption, intractable diarrhea, obstruction or ischemia. This patient presented with recurrent symptomatic iron deficiency anemia refractory to oral iron repletion. Intestinal amyloidosis should be considered in similar presentations.

1544 Klippel-Trenaunay-Weber: Rare Congenital Syndrome Causing Persistent Rectal Bleeding

INTRODUCTION: Klippel-Trenaunay Weber syndrome (KTS) is a rare congenital disorder characterized by a triad of cutaneous capillary malformation (port-wine stain), venous malformations and limb hypertrophy. Diffuse vascular malformations of the gut in KTS can lead to gastrointestinal (GI) bleeding ranging from minor to life threatening hemorrhage necessitating surgical intervention. We describe a case of persistent rectal bleeding and iron dependent anemia in a patient with KTS. CASE DESCRIPTION/METHODS: A 32-year-old female with previous diagnosis of KTS was seen for recurrent hematochezia and iron deficiency anemia. A recent colonoscopy demonstrated non-bleeding arteriovenous malformations (Figure 1), presumed to be the source for the recurrent rectal bleeding episodes. On exam, she appeared pale, had a right hip deep purple telangiectasia, right posterior thigh palpable mass without visible varicosities and no limb hypertrophy. Her laboratory tests revealed: Hb: 9 g/dl, mean corpuscular volume: 75.0 fl, ferritin: 3 ng/ml and serum iron: 22 mcg/dl. CT abdomen/pelvis showed diffuse thickening of the rectum and sigmoid colon with scattered mural calcifications. A repeat colonoscopy demonstrated non-bleeding large circumferential vascular malformation extending from the dentate line to about 20 cm in the rectum (Figure 2) and multiple soft, pale lymphatic blebs in the colon and rectum (Figure 3). Her iron deficiency anemia from chronic blood loss was treated with oral and IV iron therapy. Despite conservative therapy, patient continues to bleed intermittently but has decided against surgical intervention at this time. DISCUSSION: GI hemorrhage occurring in association with KTS is an uncommon cause of rectal bleeding but is the most common symptom and potentially life-threatening emergency of KTS involving the gut. Investigation should begin with visualization of the entire GI tract for localization and extension of the disease. Angiography remains the gold standard and carries the advantage of allowing therapeutic interventions to control bleeding. The management of GI vascular malformations in KTS depends on the frequency and severity of blood loss requiring transfusions. Conservative management and iron supplements may be sufficient in the patient who presents with occasional non-debilitating bleeding. Transfusion dependency and life-threatening bleeding episodes necessitate definitive surgical therapy which involves resection of the diseased bowel.

Video Comment on Hey-Long Ching et al.

Hey-Long Ching et al. Diagnostic yield of magnetically assisted capsule endoscopy versus gastroscopy in recurrent and refractory iron deficiency anemia

P074 SUSTAINED IMPROVEMENTS IN FATIGUE AND QUALITY OF LIFE IN PATIENTS WITH IBD AND IRON DEFICIENCY ANEMIA FOLLOWING A SINGLE COURSE OF FERUMOXYTOL: RESULTS OF A 6-MONTH EXTENSION STUDY

Iron deficiency anemia (IDA), common in patients with inflammatory bowel disease (IBD) due to blood loss, inflammation and malabsorption, negatively impacts patients’ health-related quality of life (HRQOL). Oral iron is often first-line treatment, but many patients do not tolerate it, or do not adequately respond; many live with chronic anemia and its related negative effects. A Phase 3 double-blind, placebo-controlled trial (NCT01114139) previously found that patients unsuccessfully treated with oral iron, including those with IBD, had very poor baseline HRQOL scores associated with fatigue, and that IV iron treatment resulted in significant, clinically meaningful improvement. To explore the durability of this treatment effect, this subgroup analysis reports on the impact on patient-reported outcomes (PRO) of a single course of IV ferumoxytol, received during the double-blind trial, over the subsequent 6-month extension study (NCT01114217) in patients with IBD. Patients with persistent or recurrent IDA (Hgb <11.0 g/dL and TSAT <20%) at any time during the extension study received ferumoxytol (1 course = 2x510 mg IV, 3 to 8 days apart). The same validated PRO instruments were administered as in the preceding double-blind trial: Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-Fatigue), and Linear Analogue Scale Assessment (LASA) -Energy, -Activities of Daily Living (ADL) and -HRQOL. This analysis reports on the subgroup of patients who did not receive any additional ferumoxytol during the entire 6-month extension study. Most patients who had received a dose of ferumoxytol in the double-blind trial did not require any further doses during the extension study (285/471; 61% Overall) including 61% (23/30) of those with IBD. Among this cohort, the IBD patients’ mean Hgb had increased from 8.9 ± 0.7 g/dL at Baseline to 12.0 ± 0.8 at Week 5 of the double-blind trial and remained above 12.0 throughout the 6-month extension study visits (Month 7 Hgb 12.1 ± 1.0) despite receiving no further ferumoxytol. At Baseline of the double-blind trial, their FACIT-Fatigue scores were lower (Overall 24.3 ± 12.3; IBD 18.7 ± 12.6) than general (non-anemic) US population norms (40.1-43.6), and comparable to the scores of anemic cancer patients receiving chemotherapy (23.9, Cella 2002). By Week 5, FACIT-Fatigue scores increased significantly (Overall 36.1 ± 11.2; IBD 31.9 ± 13.4), and the improvement was sustained over 6 months (Month 7 score Overall 38.8 ± 11.5; IBD 37.0 ± 13.7). Significant improvements in the LASA domains that were observed in the double-blind study were also maintained. This study found that for the majority of patients, significant improvements in fatigue and quality of life domains, greater than the previously reported Minimal Clinically Important Differences (MID), were achieved and sustained for 6 months following a single treatment of ferumoxytol. Tabled 1Change from Baseline PRO Measures in IBD PatientsPRO InstrumentPretreatment BaselineMean (SD)Month 4 Change Mean (95% CI)Month 7 Change Mean (95% CI)MIDLASA-Energy36.2 (24.15)24.6 (12.8, 36.3)14.7 (4.5, 24.9)9.61LASA-Activity44.4 (23.7)15.9 (5.4, 26.3)13.3 (2.9, 23.8)8.74LASA-QOL46.9 (25.3)18.6 (8.2, 29.1)13.6 (4.5, 22.6)9.81FACIT-Fatigue18.7 (12.6)15.9 (9.3, 22.5)14.2 (8.1, 20.3)3.0PRO = Patient-reported outcomes; CI = confidence interval; MID = Minimum Important Difference (Patrick et al, Euro J Cancer 2003; Norman et al, Med Care 2003; Cella et al, J Pain Symptom Management 2002). Open table in a new tab PRO = Patient-reported outcomes; CI = confidence interval; MID = Minimum Important Difference (Patrick et al, Euro J Cancer 2003; Norman et al, Med Care 2003; Cella et al, J Pain Symptom Management 2002).

Rare cause of recurrent iron deficiency anemia

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder, characterized by multifocal venous malformations predominantly affecting skin, soft tissues, and gastrointestinal (GI) tract. Its presentation is usually sporadic although cases of autosomal dominant inheritance have been reported. Usually seen in children, BRBNS presentation in adults is rare. Most common symptoms of GI tract involvement are iron deficiency anemia and bleeding. We present a case of 16-year-old boy, who presented with recurrent anemia requiring multiple blood transfusions.

RELATIONSHIP BETWEEN RECURRENT APHTHOUS STOMATITIS WITH IRON DEFICIENCY ANEMIA

Recurrent aphtous stomatitisis a recurrent oral ulcer. Clinically recurrent aphtous stomatitis is easy to diagnose, but its etiology and pathogenesis remain unclear because it has no single or specific cause. The main predisposing factors associated with recurrent aphtous stomatitis are genetic factors, hematological and immunologic abnormalities, local factors such as trauma, and smoking cessation. Several studies have shown that hematological abnormalities can affect the oral mucosa and cause recurrent aphtous stomatitis. The purpose of this study was to examine the relationship between recurrent aphthous stomatitis and iron deficiency anemia, as well as the relationship between recurrent aphthous stomatitis and hematological status. The subjects consist of 59 recurrent aphtous stomatitis patients and 60 control patients. A full blood examination was carried out for all subjects. Hemoglobin level, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and serum iron level are determined for each subject.The result of this study showed that there is no significant difference in hemoglobin level, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and serum iron level with p-value of 0.714, 0.395, 0.809, 0.497, and 0.368, respectively. The result also showed that there is no significant difference in iron deficiency anemia status between the recurrent aphtous stomatitis and control group (p = 0,7). Therefore, it can be concluded that there is no relationship between iron deficiency anemia and recurrent aphtous stomatitis incidence.

Sustained Improvements in Fatigue and Quality of Life in Iron Deficiency Anemia Patients Following a Single Course of Ferumoxytol: Results of a 6-Month Extension Study

Introduction: Iron is essential for the function of many key proteins including hemoglobin (Hgb) and myoglobin (involved in oxygen transport/exchange), cytochromes (involved in energy generation), various enzymes (involved in cell proliferation and neurotransmission), and immune function. Iron deficiency can, therefore, negatively impact patients' health-related quality of life (HRQOL) and requires treatment to replete iron stores. Although oral iron is a common initial treatment, some patients do not tolerate it or fail to adequately respond, and many of these patients live with chronic anemia and the related negative effects on their HRQOL. A Phase 3 double-blind, placebo-controlled trial (NCT01114139) had previously found that patients with iron deficiency anemia (IDA), unsuccessfully treated with oral iron, had very poor baseline HRQOL scores associated with fatigue, and that IV iron treatment with ferumoxytol resulted in clinically meaningful improvements, significantly greater than placebo, over the 5-week study period. To explore the durability of this treatment effect, this analysis reports on the impact on patient-reported outcomes (PRO) of a single course of ferumoxytol therapy over the course of the subsequent 6-month extension study.Methods: A 6-month Phase 3, open-label extension study (NCT01114217) was conducted in patients who had completed the double-blind, placebo-controlled Phase 3 trial. Enrolled patients were evaluated for IDA monthly throughout the study period. Those with persistent or recurrent IDA (Hgb <11.0 g/dL and TSAT <20%) at any evaluation visit, received a course of ferumoxytol (2 x 510 mg, 3-8 days apart). The same validated PRO instruments were administered in this extension study as in the preceding double-blind trial: Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-Fatigue), Short Form Health Survey (SF-36), and Linear Analogue Scale Assessment (LASA) of Energy, Activities of Daily Living (ADL) and HRQOL. This analysis reports results for the subgroup of patients who did not receive any additional doses of ferumoxytol during the entire 6-month period of the extension study.Results: The majority of patients enrolled in the extension study who had received ferumoxytol in the previous Phase 3 trial (285/471; 61%) did not meet the above-noted re-treatment criteria during the 6-month extension, and did not receive any further doses of ferumoxytol. Reflecting the overall enrollment in the extension study, these patients were predominantly female (90.0%) and white (63.5%), with mean age of 43.6±13.3 years (range 19-88). The most common primary underlying conditions were abnormal uterine bleeding (41.8%), GI disorder (33.0%), and cancer (10%). Their mean Hgb had increased from 9.0±0.8 g/dL at Baseline to 12.1±1.1 at Week 5 of the double-blind trial and remained above 12.0 throughout the 6-month extension study visits (Month 7 Hgb 12.1±1.2) despite receiving no further ferumoxytol.At Baseline of the double-blind trial, their FACIT-Fatigue scores were lower (24.3±12.3) than general (non-anemic) US population norms (40.1-43.6), and comparable to anemic cancer patients receiving chemotherapy (23.9, Cella 2002). By Week 5 following ferumoxytol treatment, their FACIT-Fatigue scores had increased significantly (36.1±11.2), approaching general population norms. This improvement was sustained over the following 6 months (Month 7 score 38.8±11.5).Their SF-36 Vitality scores increased from 37.6 ±11.8 at Baseline of the double-blind trial to 47.7±12.0 at Week 5, approaching the general US population norm (50.0, McHorney 1993) and continued to increase slightly over the next 6 months (Month 4, 50.0±12.0; Month 7, 50.9±11.5). Similarly, the significant improvements in LASA Energy, ADL and HRQOL scores that were observed in the double-blind study were also maintained over the next 6 months.Conclusions:These data suggest that ferumoxytol may provide important clinical benefits to IDA patients with a history of unsatisfactory oral iron therapy; these benefits include reductions in fatigue, increased energy, vitality, and ability to perform ADL and improved HRQOL. This is important especially in light of the poor baseline energy and HRQOL scores of patients who cannot take oral iron. This study found that for the majority of patients, these improvements were sustained for at least 6 months after a single course of therapy. [Display omitted] DisclosuresVadhan-Raj:AMAG Pharmaceuticals, Inc: Other: received funding from Amag to support clinical trial. Dahl:AMAG Pharmaceuticals, Inc: Employment, Equity Ownership. Jiang:AMAG Pharmaceuticals, Inc: Employment, Equity Ownership. Strauss:AMAG Pharmaceuticals, Inc: Employment, Equity Ownership.