Rise In Ferritin Levels Research Articles

Reduced HDL-cholesterol in long COVID-19: A key metabolic risk factor tied to disease severity

This controlled study investigated metabolic changes in non-vaccinated individuals with Long-COVID-19, along with their connection to the severity of the disease. The study involved 88 patients who experienced varying levels of initial disease severity (mild, moderate, and severe), and a control group of 29 healthy individuals. Metabolic risk markers from fasting blood samples were analyzed, and data regarding disease severity indicators were collected. Findings indicated significant metabolic shifts in severe Long-COVID-19 cases, mainly a marked drop in HDL-C levels and a doubled increase in ferritin levels and insulin resistance compared to the mild cases and controls. HDL-C and ferritin were identified as the leading factors predicted by disease severity. In conclusion, the decline in HDL-C levels and rise in ferritin levels seen in Long-COVID-19 individuals, largely influenced by the severity of the initial infection, could potentially play a role in the persistence and progression of Long-COVID-19. Hence, these markers could be considered as possible therapeutic targets, and help shape preventive strategies to reduce the long-term impacts of the disease.

EFFECTIVENESS OF IRON SUCROSE AND FERRIC CARBOXYMALTOSE IN THE MANAGEMENT OF POSTPARTUM IRON DEFICIENCY ANEMIA: A SOUTH INDIAN PERSPECTIVE

BACKGROUND: Postpartum iron deciency anemia is considered as one of major public health problem with a high prevalence in developing country like India .It is associated with signicant morbidity. AIM AND METHOD: This perspective observational study was carried out to estimate the safety and effectiveness of iron sucrose and ferric carboxymaltose in treatment of postpartum iron deciency anemia. Total 100 participants diagnosed with postpartum anemia were allotted to receive either iron sucrose complex (n=50) or ferric carboxymaltose (n=50). RESULTS: Hemoglobin improvement was signicantly higher in ferric carboxymaltose than iron sucrose complex group (4.37 vs. 3.85 gm/dl, p<0.001), but rise in ferritin levels was comparable between the groups (116.59 vs. 110.48 ng/ml, p=0.330). Most of the patients tolerated the preparation well, minor side effects were observed in 12% and 48% of cases among iron sucrose and ferric carboxymaltose group respectively CONCLUSION: Even though oral iron is considered as a rst line therapy, it requires a prolonged administration and is associated with suboptimal response due to gastric intolerance and poor compliance. Intravenous iron preparations are safer, more convenient and effective alternative for treatment of postpartum iron deciency anemia.

Automated exchange compared to manual and simple blood transfusion attenuates rise in ferritin level after 1 year of regular blood transfusion therapy in chronically transfused children with sickle cell disease

Optimal strategies for regular blood transfusion therapy are not well defined in sickle cell disease (SCD). This analysis tested the hypothesis that in the first of year of regular transfusions, when chelation therapy use is minimal, automated exchange transfusion would be the superior method for attenuating the rise in ferritin levels compared to simple and manual exchange transfusions. The Silent Cerebral Infarct Multi-Center Clinical Trial randomly allocated children with SCD and silent cerebral infarcts to receive standard care or regular transfusions with a target pre-transfusion HbS concentration ≤ 30% and minimum hemoglobin level > 9.0 g/dL. Participants with at least nine transfusions and sufficient ferritin testing in the first year of the trial were included in a planned secondary analysis. Ferritin levels by the end of the first study year were compared between participants receiving automatic exchange transfusion, manual exchange transfusion, and simple transfusion. A total of 83 participants were analyzed. During the first year of the study, 75.9% of the participants had >80% of transfusions via one transfusion method. At baseline no significant differences in ferritin levels were observed in the three transfusion groups (p = 0.1). After 1 year of transfusions the median (interquartile range) ferritin levels in the simple transfusion (n = 40), manual exchange transfusion (n = 34) and automatic exchange transfusion (n = 9) groups were 1800 ng/mL (1426-2204 ng/mL), 1530 ng/mL (1205-1805 ng/mL), and 355 ng/mL (179-579 ng/mL), respectively (p < 0.001). Automated exchange transfusion, when compared to other transfusion methods, is the optimal transfusion strategy for attenuating increase in ferritin levels in children with SCD.

Understanding the Recent Increase in Ferritin Levels in United States Dialysis Patients: Potential Impact of Changes in Intravenous Iron and Erythropoiesis-Stimulating Agent Dosing.

Anemia management changed substantially among dialysis patients in the United States around the time of implementation of the new Centers for Medicare & Medicaid Services bundled payment system and erythropoiesis-stimulating agent (ESA) label change in 2011. Among these, average ferritin levels increased dramatically and have remained high since; this study sought to gain understanding of this sustained rise in ferritin levels. Trends in mean ferritin, hemoglobin, IV iron dose, and ESA dose from 2009 to 2013 were examined in 9735 patients from 91 United States Dialysis Outcomes and Practice Patterns Study facilities. Linear mixed models were used to assess the extent to which intravenous (IV) iron and ESA dose accounted for patients' changes in ferritin over time. Mean ESA dose and hemoglobin levels declined throughout the study. Mean IV iron dose increased from 210 mg/mo in 2009-2010 to a peak of 280 mg/mo in 2011, then declined back to 200 mg/mo and remained stable from 2012 to 2013. Mean ferritin increased from 601 ng/ml in the third quarter of 2009 to 887 ng/ml in the first quarter of 2012; models suggest that higher IV iron dosing was a primary determinant during 2011, but lower ESA doses contributed to the sustained high ferritin levels thereafter. In a subset of 17 facilities that decreased IV iron dose in 2011, mean ferritin rose by 120 ng/ml to 764 ng/ml, which appeared to be primarily due to ESA reduction. Together, changes in IV iron and ESA doses accounted for 46% of the increase in ferritin over the study period. In contrast to expectations, the rise in average IV iron dose did not persist beyond 2011. The sustained rise in ferritin levels in United States dialysis patients after policy changes in 2011, to average levels well in excess of 800 ng/ml, appeared to be partly due to reductions in ESA dosing and not solely IV iron dosing practices. The effect of these changes in ferritin on health outcomes requires further investigation.

The Use of Infliximab to Control Recurrent Cytokine Storms in EBV-Associated Angioimmunoblastic Lymphoma and Hemophagocytic Syndrome

Abstract 4887 Introduction:Chronic active Epstein-Barr virus infection (CAEBV) has been implicated in several diseases including hemophagocytic lymphohistiocytosis (EBV-HLH) and lymphomas including Angioimmunoblastic T cell lymphoma. The exact mechanism by which EBV infection causes these complications is currently not well understood. EBV-HLH is a syndrome in which T-cells, NK cells and macrophages are aberrantly activated. Cytokine storms play a major role in cellular damage and organ dysfunction. In the event that the body is unable to clear the EBV viremia, dysregulated T, NK cells and macrophages continue to release cytokines leading to the accumulation of lymphohistiocytic infiltrates into organs and organ damage. Cytokine storms can lead to death from multi-organ failure. During a cytokine storm, levels of several cytokines are elevated including TNF-a, IFN-g, sCD25, IL-12, IL-1, IL-10 and IL-18.1–3 Current lines of therapy of EBV-HLH include steroids, etoposide, cyclosporine, ATG and hematopoietic stem cell transplantation. We report successfully controlling frequent cytokine storms in a patient with EBV induced angioimmunoblastic lymphoma and HLH with weekly infliximab after failure to do so with chemotherapy (CHOP-E; cyclophosphamide, daunorubicin, vincristine, prednisone, etoposide), rituximab and bortezomib. Case:This is a 35 year old African American male with a long history of adenopathy who presented with autoimmune hemolytic anemia, autoimmune thrombocytopenia (ITP), neutropenia with fever and hypotension. Work up revealed persistent EBV viremia and the lymph node biopsy revealed Angioimmunoblastic T cell lymphoma. High dose dexamethasone and Intravenous immunoglobulins (IVIG) failed to control his hemolysis and ITP. Rituximab and bortezomib successfully controlled his autoimmune hemolysis and thrombocytopenia. However, cytokine storm episodes, characterized by high fevers, hypotension and respiratory distress, continued every 1–2 weeks requiring ICU admissions. Chemotherapy (CHOP-E), for his underlying lymphoma, followed by etoposide/steroids (HLH-94 protocol) were also ineffective at controlling his cytokine storms. Considering that he had high levels of TNF-a, infliximab was started in an attempt to control dysregulated macrophages and T-cells, and was able to successfully prevent the cytokine storms. High levels of IL-6, soluble IL-2 receptor and TNF-a were all detected during cytokine storm episodes. The patient is currently getting prepared for an allogeneic stem cell transplant. Discussion:We report successful control of EBV-HLH related cytokine storms, guided by TNF-a levels, with weekly infliximab (Fig 1). Hypercytokinemia is believed to result from dysregulated T cells, NK cells and macrophages as a result of failure to control the EBV viremia. In this case a TNF-a inhibitor (infliximab) was used to control dysregulated macrophages, T and NK cells and block further propagation of inflammatory cytokines. Initially infliximab was initiated on a once every 2 week schedule, however, this failed to prevent cytokine storms with high TNF-a levels. However, weekly dosing of infliximab successfully prevented cytokine storms and controlled his TNF-a levels (Fig 1). Moreover, an attempt to taper off the weekly infliximab and etoposide resulted in relapse of his symptoms and a sharp rise in ferritin levels, a marker for HLH activity (Fig 2). This suggests that infliximab might be an effective therapy in preventing cytokine storms related to EBV-HLH and further studies are warranted. [Display omitted] [Display omitted] Disclosures:Besa:Celgene: Research Funding.

Der Einfluss von eisenhaltigen Heil- und Mineralwässern auf die Eisenversorgung des menschlichen Organismus – eine kontrollierte Interventionsstudie

PURPOSE: The study should assess, whether intake of medicinal mineral water, rich in iron, has a positive effect on hematological parameters and the subjective well-being of members of the Sabbathrest-Advent-Church (a Protestant church) and patients of a medical practice. MATERIALS AND METHODS: In a baseline survey 58 church members and 10 patients filled a standardized questionnaire and were screened for blood-parameters associated with the iron metabolism. Participants were randomly assigned to an intervention and control group. Intervention: Drinking at least 750 ml of medicinal mineral water of high iron content each day for 6 weeks. Follow-up of both groups after 6 weeks. RESULTS: Changes in hematological parameters did not reach statistical significance in the intervention group. Concerning their well-being, participants in the invention group referred more frequently to positive effects during the intervention-period. 16 participants were excluded from randomization because of low ferritin levels (<12 ng/ml). Nevertheless this group took part in a treatment, which consisted solely in drinking medical mineral waters, rich in iron (without taking any other iron-supplements). As a result there was a significant rise in ferritin levels and a highly significant reduction of erythrocytes with low pigmentation. CONCLUSIONS: It is well known that mineral waters can improve the supply of minerals to the human body. Although we could not assess significant changes in blood parameters of healthy participants, our findings showed that regular drinking of medicinal mineral water of high iron content can improve hematological parameters in persons with existing iron deficiency.

Iron and erythropoietin measurement in autologous blood donors with anemia: implications for management

The importance of autologous blood donation for elective surgery is recognized, and the method is being used at many hospitals. Not all patients are able to deposit a sufficient amount of blood before surgery because they cannot recover rapidly enough from phlebotomy-induced anemia. The ability to donate sufficient blood for autologous use was studied in patients who are particularly susceptible to phlebotomy-induced anemia. Of 840 patients who donated blood for autologous use in elective surgery from November 1987 through May 1993, 20 with rheumatoid arthritis, 24 with iron deficiency anemia, and 37 aged 65 years and above with normocytic anemia were compared with 24 nonanemic elderly patients who donated a total of 1000 mL of blood for autologous use. Patients received iron sulfate orally and donated blood once a week until operation. The amount of blood collected before surgery per control patient was more than that in others. Consequently, there was a tendency to allogeneic blood transfusion in patients with rheumatoid arthritis or elderly patients. The ferritin levels in controls and in patients with iron deficiency anemia during the donation period were almost within the normal range in spite of iron supplementation, which implied a good utilization of iron sulfate for erythropoiesis. On the other hand, the rise in ferritin levels in the elderly and in patients with rheumatoid arthritis suggested inappropriate iron availability for erythropoiesis and resulted in an increase in iron storage. Since an adequate endogenous erythropoietin response to phlebotomy-induced anemia was not observed in these patients, impaired erythropoietin production was considered one of the reasons for anemia. Patients with iron deficiency anemia are able to continue donating blood for autologous use so long as they have sufficient iron supplementation. However, the elderly or those with rheumatoid arthritis occasionally fail to donate a sufficient volume of blood before surgery as a result of phlebotomy-induced anemia, which is caused in turn by impaired erythropoietin production.

The role of serum ferritin in the management of idiopathic haemochromatosis.

The value of the serum ferritin assay in the management of idiopathic haemochromatosis has been examined in groups of patients at diagnosis, during venesection therapy, and following completion of therapy. At diagnosis, serum ferritin levels were elevated in all 16 patients studied, including 10 with precirrhotic disease. Venesection resulted in a gradual fall in serum ferritin which commenced shortly after the start of treatment in 5/8 patients. In 3/8 the fall was preceded by a transient rise in ferritin levels. In three patients serum ferritin fell to normal before liver iron stores had been restored to normal. After therapy serum ferritin proved unreliable in detecting early re-accumulation of hepatic iron stores. Serum ferritin does provide valuable information in patients with idiopathic haemochromatosis, particularly at diagnosis and during therapy. A normal value does not exclude iron storage disease.