Screening For Iron Deficiency Research Articles

Position paper on management of iron deficiency in adult cancer patients

ABSTRACTIntroduction: Disorders of iron metabolism are commonly seen in onco-hematological clinical practice. Iron-deficiency anemia and cancer-associated anemia are usually treated with supportive therapies. Optimal management of these conditions are discussed in this perspective paper.Areas covered: A position paper discussing a number of hot topics on anemia in cancer patients is presented. The main areas covered by experts in the field are: definitions, prevalence and consequences of anemia and iron deficiency, incidence of anemia resulting from targeted therapies, importance of anemia diagnosis and monitoring, evaluation of iron status before and during treatment, role of transfusions and erythropoiesis-stimulating agents, management of iron deficiency with or without anemia, parenteral iron supplementation, role of new oral iron formulations, safety and cost issues regarding different iron compounds and administration routes.Expert commentary: Despite the availability of newer therapeutic options for its management, anemia still represents a major complication of treatment in cancer patients (surgery, chemotherapy, radiotherapy, targeted therapies), aggravating physical impairment, and negatively affecting general outcome. The view expressed by the panelists, attendees of the 4th Mediterranean Course on Iron Anemia, summarizes what they consider optimal clinical practice for screening, diagnosis, treatment and monitoring of iron deficiency and anemia in cancer patients.

Iron substitution in the treatment of chronic heart failure.

Iron deficiency is a prevalent and clinically relevant comorbidity in up to 50% of patients with chronic heart failure (CHF). Iron deficiency in CHF patients is associated with impaired quality of life, reduced exercise capacity and increased mortality, irrespective of the presence of anaemia. It is diagnosed by determining circulating ferritin levels and transferrin saturation. Three randomised trials (CONFIRM-HF, FAIR-HF, and EFFECT-HF) of intravenous ferric carboxymaltose in the treatment of iron deficiency in CHF patients with reduced left ventricular ejection fraction demonstrated improvement of symptoms, functional capacity and quality of life. These beneficial effects were independent of the presence of anaemia. In addition, CONFIRM-HF and subsequent meta-analyses indicated that treatment of iron deficiency may reduce the rate of hospitalisations for worsening CHF. Oral iron is available at lower cost than intravenous iron, but its use did not translate into beneficial effects in CHF patients with iron deficiency. Large randomised trials designed to assess long-term clinical outcomes of iron treatment in CHF patients are pending. Current guidelines advise establishing evidence-based pharmacological and device therapy to improve symptoms and prognosis in patients with CHF. In addition, screening for iron deficiency is recommended. Intravenous ferric carboxymaltose should be considered for treating iron deficiency in ambulatory symptomatic patients with reduced left ventricular ejection fraction in order to alleviate heart failure symptoms, and to improve exercise capacity and quality of life.

Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women?

Hemoglobin (Hb), mean cell volume (MCV), and erythrocyte protoporphyrin (EP) are commonly used to screen for iron deficiency (ID), but systematic evaluation of the sensitivity and specificity of these tests is limited. The objective of this study is to determine the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID in preschool children, non-pregnant women 15–49 years of age, and pregnant women. Data from the National Health and Nutrition Examination Surveys (NHANES) (NHANES 2003–2006: n = 861, children three to five years of age; n = 3112, non-pregnant women 15 to 49 years of age. NHANES 1999–2006: n = 1150, pregnant women) were examined for this purpose. Children or women with blood lead ≥10 µg/dL or C-reactive protein (CRP) >5.0 mg/L were excluded. ID was defined as total body iron stores <0 mg/kg body weight, calculated from the ratio of soluble transferrin receptor (sTfR) to serum ferritin (SF). The receiver operating characteristic (ROC) curve was used to characterize the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID. In detecting ID in children three to five years of age, EP (Area under the Curve (AUC) 0.80) was superior to Hb (AUC 0.62) (p < 0.01) but not statistically different from MCV (AUC 0.73). In women, EP and Hb were comparable (non-pregnant AUC 0.86 and 0.84, respectively; pregnant 0.77 and 0.74, respectively), and both were better than MCV (non-pregnant AUC 0.80; pregnant 0.70) (p < 0.01). We concluded that the sensitivity and specificity of EP in screening for ID were consistently superior to or at least as effective as those of Hb and MCV in each population examined. For children three to five years of age, EP screening for ID was significantly better than Hb and similar to MCV. For both non-pregnant and pregnant women, the performance of EP and Hb were comparable; both were significantly superior to MCV.

Association between menarche and iron deficiency in non-anemic young women.

BackgroundThe prevalence of iron deficiency (ID) among non-pregnant, reproductive-age US women significantly exceeds rates among males. In clinical practice ID screening relies on hemoglobin, a late-stage indicator of ID. As a single, low-cost laboratory test to diagnose ID before anemia develops is lacking, the study objective was to improve ID screening by identifying risk factors among non-anemic, iron-deficient reproductive age women.MethodsCross-sectional data were from the National Health and Nutrition Examination Survey (NHANES) 2003–2010. Hemoglobin identified non-anemic women. ID was defined using the body iron formula, requiring ferritin and transferrin receptor values. Logistic regression assessed the association of sociodemographic, behavioral, and reproductive risk factors in an anemia-based conceptual framework with non-anemic reproductive age women (12–49 years) with ID, as well as subsets of younger (12–21 years) and older (22–49 years) women, recognizing that risks may differ by age.ResultsAmong 6216 women, 494 had ID (prevalence was 8.0%, 95% CI 7.3%, 8.6%). Among non-anemic younger women, 250 (8.7%, 95% CI 7.7%, 9.8%) had ID, compared to 244 (7.3%, 95% CI 6.4%, 8.2%) older women. Among younger women, menstruation for over 3 years was the only variable significantly associated with non-anemic ID (risk ratio 3.18, 95% CI 2.03, 4.96). No other significant risk factors were identified.ConclusionMenstrual years was the only risk factor significantly associated with ID among non-anemic younger women. The negative results suggest ID risk factors among non-anemic women may need to be considered separately from those associated with ID anemia.

Clinical and biochemical profile of iron deficiency state in preanemic under 5 children in a tertiary care hospital

Background: Anemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. The aim was to identify iron deficiency state early before developing anemia and to analyze the clinical finding with iron deficiency state. Methods: Cross sectional study was done at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India. 100 children between 6 month to 5 years of age with normal haemoglobin were studied for iron deficiency state. After taking informed consent a detailed history and clinical examination was taken. In those children with normal Hb, investigations like serum ferritin, serum iron and transferrin saturation were done to diagnose the iron deficiency state.Results: Out of 100 children in the study, mean hemoglobin was 11.8 gm/dl, the mean serum ferritin level was 59.1ng/ml and transferrin saturation was 18.77%. The overall prevalence of iron deficiency in this study based on low serum ferritin was 16% and low transferrin saturation was 51%. 7 children has low DQ out of which 3 were ADHD, 2 had hyperactivity and 2 with learning problem. Among them one child has low ferritin and 5 had low transferrin saturation.Conclusions: Iron deficiency is an important public health problem. The findings in this study are consistent compared to other studies. Therefore, prompt screening for iron deficiency, even in non-anemic under five children in developing countries should be encouraged. If evaluation of iron status is done only by Hb early signs of iron depletion can go undetected. By monitoring the status of storage iron(ferritin), we can detect iron deficiency state earlier and initiate appropriate treatment to prevent IDA.

Iron deficiency anemia in gastric cancer: A single site retrospective cohort study.

188 Background: Gastric cancer is highly prevalent amongst men and women. While many studies have identified the prevalence and association of iron deficiency anemia (IDA) in all cancer patients, few have focused on the gastric cancer population. The primary objective of this study was to determine the proportion of patients with gastric cancer who developed IDA, and chemotherapy induced anemia (CIA) at our institution. Secondary objectives were to identify types and frequencies of IDA therapies used. Methods: A retrospective study was carried out in 110 consecutive gastric cancer patients from 2006 to 2014 at St. Michael’s Hospital, Toronto, Canada. Patient demographics, previous history of IDA, and IDA based therapies were reviewed. IDA was defined as hemoglobin (Hb) &lt; 130 g/L in men and &lt; 120g/L in women and iron deficiency (ID) was defined as a ferritin &lt; 15m/L. SAS 9.3 was used to calculate frequencies and proportions. Results: Of the 110 patients (median age 68.5 [interquartile range (IQR): 58-76]), 72 (65%) were male. Most patients were diagnosed at stage IV (35%) with a mean Hb of 118 g/L (standard deviation (SD): 19.7 g/L). Only 18 (16%) patients had a history of IDA prior to cancer diagnosis, and 63 (57%) had IDA at time of gastric cancer diagnosis. Only 29 patients (45%) had ferritin levels tested at first oncology visit. Of the 110 patients, 71 patients had an open (32%) or laparoscopic (68%) surgery. A total of 66 patients received chemotherapy, and 50 (76%) developed CIA. In this sample, 9 (14%) experienced a chemotherapy dose delay and 20 (30%) had a dose reduction. At last follow up, 87 (79%) of patients were diagnosed with IDA. Red blood cell (RBC) transfusions were most frequently prescribed (95%), compared to oral (29%) or intravenous iron (12%). Conclusions: A total of 87 (79%) gastric cancer patients were diagnosed with IDA and nearly all patients received a RBC transfusion. We found that the diagnosis of IDA increased by 22% from the time of gastric cancer diagnosis to last follow up. There was a high proportion of IDA in our gastric cancer population despite inconsistent screening for ID. This highlights the need for consistent screening and targeted therapy for ID to reduce transfusions and improve quality of life in this patient population.

Nutritional status among primary school children in rural Sri Lanka; a public health challenge for a country with high child health standards

BackgroundNutritional status of pre adolescent children is not widely studied in Sri Lanka. The purpose of this study was to determine the nutritional status among pre-adolescent school children in a rural province of Sri Lanka.MethodsA school based cross sectional study was carried out in North Central Province in 100 rural schools, selected using multi stage cluster sampling with probability proportionate to size. Children in grade one to five were enrolled with a maximum cluster size of fifty. Anthropometric measurements were done by trained data collectors and venesection was done at site by trained nurses. WHO AnthoPlus was used to calculate the BMI, height for age and weight for age Z scores. Survey design adjusted prevalence estimates with linearized standard errors were generated using svy function of STATA. Mean haemoglobin concentration (Hb) was calculated using methaeamoglobin method. Screening for iron deficiency and thalassemia trait was done using peripheral blood films.ResultsHeight and weight measurements were done for 4469 of children and the Hb data was available for 4398 children. Based on the survey design adjusted estimates, prevalence of severe thinness, thinness, overweight and obesity in this population was 8.60% (SE 0.94), 2.91%(SE 0.74), 2.95%(0.26) and 2.43%(SE 0.92) respectively. Similarly, survey design adjusted prevalence of underweight and stunting were, 25.93% (95% CI 24.07–27.89%) and 43.92%(95% CI 40.55–47.56%). Adjusted mean estimates for hemoglobin was 12.20 (95% CI 12.16–12.24) g/dL. Prevalence of anemia was 17.3% (n = 749). Prevalence of mild and moderate anemia was 9.4 and 7.6% respectively.ConclusionThis study confirms that malnutrition is still a major problem in North Central Province, Sri Lanka.

Endoscopic resolution and recurrence of gastric antral vascular ectasia after serial treatment with argon plasma coagulation.

AIMTo evaluate long-term endoscopic resolution and recurrence rate of gastric antral vascular ectasia (GAVE) after argon plasma coagulation (APC) treatment.METHODSThis was an IRB-approved retrospective single center study that included patients endoscopically treated for GAVE between 1/1/2008 to 12/31/2014. The primary and secondary end points of the study were rate of endoscopic resolution of GAVE after APC treatment and recurrence rate of GAVE after endoscopic resolution, respectively. Endoscopic resolution of GAVE was defined as no endoscopic evidence of GAVE after treatment with APC. Recurrence of GAVE was defined as endoscopic reappearance of GAVE after prior resolution.RESULTSTwenty patients met the study criteria. Median age (range) of the patients was 59.5 years (42-74 years). GAVE was associated with underlying cirrhosis in 16 (80%) patients. Indications for initial esophagogastroduodenoscopy (EGD) included hematemesis and/or melena (9/20, 45%), iron deficiency anemia (6/20, 30%), screening or surveillance of varices (4/20, 20%), and occult gastrointestinal bleeding (1/20, 5%). The patients were treated with a total of 55 APC sessions (range 1-7 sessions). Successful endoscopic resolution of GAVE was achieved in 8 out of 20 patients (40%). There was no correlation between number of treatment sessions and GAVE treatment success (P = NS). Recurrence of GAVE was noted on a subsequent EGD in 2 out of 8 patients (25%) with prior endoscopic resolution of GAVE. Median follow-up period for the study population was 627 d (range 63-1953 d).CONCLUSIONEndoscopic resolution rate of GAVE was low (40%) with a 25% recurrence rate after treatment with APC. These rates suggest that APC treatment of GAVE may not be optimal in many circumstances.

KESAHIHAN DIAGNOSTIK HEMOGLOBIN RETIKULOSIT UNTUK DETEKSI DEFISIENSI ZAT BESI DI KEHAMILAN

Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume and the development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stage parameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-He examination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those interm pregnancy without anemia. The research design was cross sectional. The subjects were women in term pregnancy, gathered from PKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from the cubital vein of the subjects. Two mL of the sample was tested for routine hematological examination using an EDTA tube, while the Ret-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serum of the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzer C501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two (2) groups based on the Hb levels, namely: anemia (Hb&lt;11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were alsoclassified into two (2) groups based on transferrin saturation values: iron deficient (Tsat &lt;9%) and normal (Tsat ≥9%). From 291 subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency in pregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for iron deficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87% respectively. The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.

Optimizing hemoglobin thresholds for detection of iron deficiency among reproductive-age women in the United States

Iron deficiency (ID) affects 9%-16% of US women with well-documented morbidity in academic performance, mood, and concentration. Current ID screening depends on the detection of low hemoglobin (ie, anemia, <12.0g/dL). However, anemia is a late-stage indicator of ID. The study hypothesis was that using higher hemoglobin thresholds would optimize ID screening. The objective was to assess the sensitivity and specificity of hemoglobin to detect ID among nonpregnant, reproductive-age women of 12-49years and to determine if psychometric characteristics varied by age and race. This cross-sectional study used National Health and Nutrition Examination Survey 2003-2010 data. ID was defined as body iron, calculated using ferritin and transferrin receptors. Logistic regression and receiver operating characteristic (ROC) curves were used to model the predictive probability of ID by hemoglobin values. ID prevalence by body iron was 11.5% (n=6602). Using <12.0g/dL, hemoglobin had a sensitivity of 42.9% (95% confidence interval [CI] = 39.4%, 46.4%) and specificity of 95.5% (95% CI = 95.0%, 96.0%) for ID. The ROC curve was optimized at the hemoglobin threshold of <12.8g/dL with the sensitivity and specificity of 71.3% (95% CI = 68.0%, 74.5%) and 79.3% (95% CI = 78.2%, 80.3%), respectively. The probability of ID at this threshold was 13.5% (95% CI = 11.3%, 15.9%). Hemoglobin better predicted ID among older (22-49years) vs younger (12-21years) women (c-index 0.87 vs 0.77, P<0.001). Among nonpregnant, reproductive-age women, current hemoglobin thresholds are insufficient to exclude ID. A threshold of <12.8g/dL improves the detection of ID.

Iron deficiency among apparently healthy children aged 6 to 24 months in Ibadan, Nigeria

ABSTRACTIron deficiency remains a global public health challenge, with a higher burden in children in the tropics. When it occurs early in life, it may have long-term effects on neurodevelopment. The aims of this study were to assess the iron status of children aged 6–24 months, to determine the prevalence of iron deficiency and its associated factors in Ibadan, Nigeria. The authors conducted a cross-sectional study between March and June 2014. A total of 202 apparently healthy children aged between 6 and 24 months attending 2 major immunization clinics in Ibadan were included. A questionnaire was used to collect information on sociodemographic characteristics, pregnancy and birth history, and nutritional history. Physical examination was carried out on all the subjects, and serum ferritin level was determined using an enzyme-linked immunosorbent assay (ELISA) technique. Iron deficiency was defined using a cutoff value of <30 µg/L. Fifty-nine children (29.2%) had iron deficiency. No clinical features were found to be significantly associated with iron deficiency. Iron deficiency was associated with breastfeeding (P = .020) and younger age (P = .015) in the study population. One hundred and forty-three (70.8%) of the study participants had anemia, and 39 (19.3%) had iron deficiency anemia. The prevalence of iron deficiency among apparently healthy children aged 6–24 months in Ibadan, Nigeria, is high. There is the need for a national policy on routine screening for iron deficiency and iron supplementation for infants and young children as recommended by the World Health Organization.

Iron deficiency screening with content hemoglobin reticulocyte (chr) in children aged 6 months to 5 years

Anemia is a major health problem around the world and iron deficiency is the major cause. In children under 5 years old iron deficiency cause disruption in their growth and development. For that reasons iron deficiency in children should be detected as early as possible. The gold standard for the detection of iron deficiency is hemosiderin examination from bone marrow aspiration, but this examination is invasive and difficult to implement. Ferritin is often used to detect iron deficiency but it has various limitations. Reticulocyte hemoglobin content (CHr) was introduced as a new parameter for the identification of iron deficiency. This parameter measures the levels of hemoglobin in the reticulocyteswhich is newly released from bone marrow and expected to reflect the actualconditions in the bone marrow, therefore it can detect early iron deficiency. It is expected that CHr can identify iron deficiency with cheaper, easy, and applicative method. The aim of this study was to determine the diagnostic performance of CHr in screening of iron deficiency in children aged 6 months to 5 years old. The present study was a cross sectional study to determine the diagnostic performance of CHr and use ferritin as gold standard. The subjects of this study were healthy children aged 6 months-5 years old taken from Posyandu in Yogyakarta district and previously had obtained the consent of their parent/guardian. The CHr examination used a flowcytometry method by Advia120 Hematology Analyzer. The ferritin examination used an electrochemiluminescens method with Elecsys 1010. ROC curve analysis was performed using SPSS version 17. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and likelihood ratio were calculated using a 2x2 TABLE. Youden’s index was used to choose the proper cutoff level of CHr for diagnosing iron deficiency. The study was conducted on 104 subjects. Cutoff level of CHr was ≤27.65 pg and the sensitivity, specificity, diagnostic accuracy, positive, and negative predictive values were 91.7%,78.3%, 79.8%, 35.4%, 98.63% respectively. Positive and negative results of likelihood ratios were 4.21 and 0.1. CHr is expected to be used to screen iron deficiencyin children under 5 years old.

Low mean cell hemoglobin is a reliable marker for iron deficiency screening

Screening for iron deficiency, which affects a significant proportion of the population, is a burning issue in the health care system. The aim of the authors was to examine whether low mean cell hemoglobin concentration measured by automated hematology analyzers is a suitable screening parameter for iron deficiency. The data for this study included a total of 247,705 complete blood counts and 10,840 tests with different parameters of iron metabolism. Patients were evaluated at Somogy County Kaposi Mór Teaching Hospital during a period of 30 months between January 1, 2013 and June 30, 2015. Low cell hemoglobin values were analyzed with iron metabolism parameters measured simultaneously. A total of 830 patients whose iron metabolism parameters were measured simultaneously had low mean cell hemoglobin (<28pg). Of the 830 patients, 679 (82%) had both low mean cell hemoglobin and iron deficiency, while in 126 hemodialysed patients (15%), 8 patients with myelofibrosis, and 5 patients with rheumatic arthritis had low mean cell hemoglobin without iron deficiency. In the remaining 6 patients the cause of low mean cell hemoglobin or iron deficiency was not identified. Based on these findings the authors conclude that mean cell hemoglobin may be a reliable screening marker for iron deficiency.

Iron Deficiency Is Common During Remission in Children With Inflammatory Bowel Disease.

The aim was to study prevalence of iron deficiency in children with inflammatory bowel disease (IBD) during remission. In addition, there was an observational evaluation of hematological response to oral iron. A population-based retrospective study including 90 Swedish children (median 13 years) with IBD was performed. Patient records covered in median 25 months. Iron deficiency was present in 70/77 children (91%) in which iron status could be assessed. In clinical and biochemical remission, iron deficiency was found in 57/67 (85%) of children, and 23 (34%) of them had iron deficiency anemia. Thirty-six iron-deficient children were prescribed oral iron supplementation and 32 (89%) improved hemoglobin levels over 6 months. In conclusion, iron deficiency is common during clinical remission in children with IBD, even in cohorts with low prevalence of anemia. Therefore, regular biochemical screening for iron deficiency is warranted during all stages of disease, irrespective of symptoms and inflammatory blood markers.

Screening for iron deficiency and iron deficiency anaemia in pregnancy: a structured review and gap analysis against UK national screening criteria.

BackgroundIron deficiency anaemia is a common problem in pregnancy despite national recommendations and guidelines for treatment. The aim of this study was to appraise the evidence against the UK National Screening Committee (UKNSC) criteria as to whether a national screening programme could reduce the prevalence of iron deficiency anaemia and/or iron deficiency in pregnancy and improve maternal and fetal outcomes.MethodsSearch strategies were developed for the Cochrane library, Medline and Embase to identify evidence relevant to UK National Screening Committee (UKNSC) appraisal criteria which cover the natural history of iron deficiency and iron deficiency anaemia, the tests for screening, clinical management and evidence of cost effectiveness.ResultsMany studies evaluated haematological outcomes of anaemia, but few analysed clinical consequences. Haemoglobin and ferritin appeared the most suitable screening tests, although future options may follow recent advances in understanding iron homeostasis. The clinical consequences of iron deficiency without anaemia are unknown. Oral and intravenous iron are effective in improving haemoglobin and iron parameters. There have been no trials or economic evaluations of a national screening programme for iron deficiency anaemia in pregnancy.ConclusionsIron deficiency in pregnancy remains an important problem although effective tests and treatment exist. A national screening programme could be of value for early detection and intervention. However, high quality studies are required to confirm whether this would reduce maternal and infant morbidity and be cost effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0679-9) contains supplementary material, which is available to authorized users.

Screening for Iron Deficiency Anemia and Iron Supplementation in Pregnant Women to Improve Maternal Health and Birth Outcomes: U.S. Preventive Services Task Force Recommendation Statement.

Update of the 2006 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for iron deficiency anemia. The USPSTF reviewed the evidence on the association between change in iron status as a result of intervention (oral supplementation or treatment) in pregnant women and adolescents and improvement in maternal and infant health outcomes. This recommendation applies to pregnant women and adolescents living in the United States who do not have symptoms of iron deficiency anemia. It does not address pregnant women who are malnourished, have symptoms of iron deficiency anemia, or have special hematologic conditions or nutritional needs that may increase their need for iron. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in pregnant women to prevent adverse maternal health and birth outcomes. (I statement). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine iron supplementation for pregnant women to prevent adverse maternal health and birth outcomes. (I statement).

Screening for Iron Deficiency Anemia in Young Children: USPSTF Recommendation Statement.

Update of the US Preventive Services Task Force (USPSTF) 2006 recommendation on screening for iron deficiency anemia. The USPSTF reviewed the evidence on the association between change in iron status as a result of intervention and improvement in child health outcomes, as well as screening for and treatment of iron deficiency anemia with oral iron formulations, in children ages 6 to 24 months. This recommendation applies to children ages 6 to 24 months living in the United States who are asymptomatic for iron deficiency anemia. It does not apply to children younger than age 6 months or older than 24 months, children who are severely malnourished, children who were born prematurely or with low birth weight, or children who have symptoms of iron deficiency anemia. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in children ages 6 to 24 months. (I statement).

24 Anaemia in heart failure unit St. Michaels hospital dun laoghaire

Background Iron deficiency anaemia is a frequent finding in adults with heart failure (HF). The prevalence varying depending upon the population studied. 1,2 The recent FAIR-HF trial, demonstrates the importance of iron metabolism in patients with HF. 3 Moreover, that a work-up evaluation for absolute or functional iron deficiency should be considered, and implementation of IV iron replacement for symptomatic improvement. In this audit we wish to evaluate the prevalence of anaemia and iron deficiency in our unit Method This was a prospective single centre audit between 21 October and 18 November 2014. The cycle was repeated between 26 March and 26 April 2015. The audit standard was the WHO definition of anaemia. Results Part 1: Demographics During cycle 1 Population: 86 patients were worked up for anaemia and iron deficiency. The average follow up time in Heart Failure Unit was 19.6 months There were more males than females in our population. Only one female patient is still menstruating. 74% of our population are HfREF (n = 64) versus 26% HfPEF (n = 22). During cycle 2 Population: 56 patients were worked up for anaemia and iron deficiency. The average follow up time in Heart Failure Unit was 20.4 months. There were more males than females in our population. 57% of our population are HfREF (n = 31) versus 43% HfPEF (n = 23). Part 2: Prevalence and incidence The prevalence of anaemia in our cohort was 48% during cycle 1 and 64.8% during cycle 2. Previous studies have found that the incidence of anaemia appears to increase with worsening functional class (from 9% for NYHA class I to 79% for class IV in one report). 4,5 We found no association between the incidence of anaemia for NYHA, BNP or EF in our cohort. Part 3: Haematinic Screen Haematinic screens were not routinely ordered on all anaemic patients during cycle 1. No haematinic screen was found for 15 anaemic patients, an incomplete screen was carried out on 9 anaemic patients and a complete anaemic screen on 17 patient. A complete haematinic screen was carried out on 8 patients with normal Hb levels. Iron deficency was detected in 17 patients. Five patient with iron deficency were noted to have a normal Hb level. During cycle 2 and implementation of a routine strategy of a haematinic screening at initial programme visit or at annual review, if no such screen were on record, all patients had a haematinic screen. Summary Iron deficiency management is not incorporated in the current ESC HF guidelines. 6 However, recent studies have raised interest in the importance in symptomatic and QUAL in of HfREF patients, and experts anticipate it’s inclusion in future guidelines. Further given that there are few treatment strategies for HfPEF patients, management of iron deficiency in this cohort would be an area of interest to access any symptomatic and other clinical benefit. In this audit we successfully implemented a strategy of routine screening for iron deficiency, to capture all patients in both HfREF and HfPEF patients. Importantly, at present our cohort our stable from a heart failure perspective. In future direction and management of these patients we aim to implement a strategy of IV iron replacement based on recent FAIR-HF and CONFIRM-HF studies. 3,7 References De Silva R, Rigby AS, Witte KK, et al . Anemia, renal dysfunction, and their interaction in patients with chronic heart failure. Am J Cardiol. 2006; 98 :391–398 Westenbrink BD, Visser FW, Voors AA, et al . Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well. Eur Heart J. 2007; 28 :166–171 Anker SD, Comin Colet J, Filippatos G, et al . Rationale and design of Ferinject assessment in patients with iron deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia. Eur J Heart Fail . 2009; 11 :1084–1091 Silverberg DS, Wexler D, Sheps D, et al . The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study. J Am Coll Cardiol . 2001; 37 :1775–1780 Van der Meer P, Groenveld HF, Januzzi JL Jr, et al . Erythropoietin treatment in patients with chronic heart failure: a meta-analysis. Heart 2009; 95 :1309–1314 McMurray J, Adamopoulos S, Anker S, et al . ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J . 2012; 33 :1787–1847 Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al . Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J . 2015; 36 (11):657–68

Risk factors, practice variation and hematological outcomes of children identified with non-anemic iron deficiency following screening in primary care setting.

To determine the prevalence, risk factors, physician practice patterns and longitudinal hematological outcome of children following screening for non-anemic iron deficiency (NAID). The present analysis was a longitudinal cohort study invovling healthy children one to five years of age. Descriptive statistics were used to describe the prevalence, risk factors, practice patterns and hematological outcome of children identified with NAID. The association between NAID and potential risk factors were examined using multivariate logistic regression analysis. Of 2276 children undergoing screening, 155 had NAID, corresponding to a prevalence of 7% (95% CI 5.95% to 8.05%). Risk factors significantly associated with NAID included: younger age (OR 1.08 [95% CI 1.06 to 1.11]), higher body mass index z-score (OR 1.22 [95% CI 1.01 to 1.48]), longer duration of breastfeeding (OR 1.05 [95% CI 1.01 to 1.08]) and increased volume of cow's milk intake (OR 1.13 [95% CI 1.01 to 1.26]). An assessment of practice patterns revealed that for 37% of children, an intervention for NAID was documented; and for 8.4% a physician-ordered follow-up laboratory test was completed to re-evaluate iron status. A total of 58 (37%) children underwent a follow-up laboratory test, of whom 38 (65.5%) had resolution of NAID, 15 (25.9%) had persistence of NAID and two (3.4%) had progression of NAID to anemia. NAID is common in early childhood and is associated with modifiable risk factors. Substantial practice variation exists in the management of NAID. Further research is necessary to understand the benefits of screening for NAID and evidence-informed practice guidelines may reduce practice variation in the management of NAID in early childhood.

Anaemia and iron deficiency in systolic heart failure

Heart failure is associated with symptoms of fatigue, poor quality of life and reduced exercise tolerance. One of the contributing factors to these symptoms is iron deficiency, which is present in up to one-third of patients with heart failure. The cause is complex and multifactorial, and is perceived as the initial step in developing anaemia. Randomised controlled trials have demonstrated the benefit of intravenous iron supplementation in reducing symptoms and improving exercise tolerance and quality of life, in addition to improving serum parameters and reducing inflammatory markers. Adverse effects reported in trials include pain at the injection site and injection site discolouration. No serious adverse effects were reported. There are generally no acceptable recommendations for clinical practice but intravenous iron supplementation is advocated in European and international guidelines for patients with heart failure. Routine screening for iron deficiency in this patient population is advocated, with the aim of treating any identified deficiency in a prompt manner in order to maintain functional capacity and quality of life.