Therapy Of Iron Deficiency Anemia Research Articles

Cancer therapy with iron oxide nanoparticles: Agents of thermal and immune therapies.

Significant research and preclinical investment in cancer nanomedicine has produced several products, which have improved cancer care. Nevertheless, there exists a perception that cancer nanomedicine 'has not lived up to its promise' because the number of approved products and their clinical performance are modest. Many of these analyses do not consider the long clinical history and many clinical products developed from iron oxide nanoparticles. Iron oxide nanoparticles have enjoyed clinical use for about nine decades demonstrating safety, and considerable clinical utility and versatility. FDA-approved applications of iron oxide nanoparticles include cancer diagnosis, cancer hyperthermia therapy, and iron deficiency anemia. For cancer nanomedicine, this wealth of clinical experience is invaluable to provide key lessons and highlight pitfalls in the pursuit of nanotechnology-based cancer therapeutics. We review the clinical experience with systemic liposomal drug delivery and parenteral therapy of iron deficiency anemia (IDA) with iron oxide nanoparticles. We note that the clinical success of injectable iron exploits the inherent interaction between nanoparticles and the (innate) immune system, which designers of liposomal drug delivery seek to avoid. Magnetic fluid hyperthermia, a cancer therapy that harnesses magnetic hysteresis heating is approved for treating humans only with iron oxide nanoparticles. Despite its successful demonstration to enhance overall survival in clinical trials, this nanotechnology-based thermal medicine struggles to establish a clinical presence. We review the physical and biological attributes of this approach, and suggest reasons for barriers to its acceptance. Finally, despite the extensive clinical experience with iron oxide nanoparticles new and exciting research points to surprising immune-modulating potential. Recent data demonstrate the interactions between immune cells and iron oxide nanoparticles can induce anti-tumor immune responses. These present new and exciting opportunities to explore additional applications with this venerable technology. Clinical applications of iron oxide nanoparticles present poignant case studies of the opportunities, complexities, and challenges in cancer nanomedicine. They also illustrate the need for revised paradigms and multidisciplinary approaches to develop and translate nanomedicines into clinical cancer care.

P003 Safety Profiles of Different Intravenous Iron Preparations for Therapy of Iron Deficiency Anemia: Preliminary Results From the IBD Subgroup Analysis

BACKGROUND: Iron deficiency anemia (IDA) is an integral part of many disorders and a negative prognostic factor. Although intravenous (IV) iron is increasingly used to treat IDA, some concerns persist regarding its safety. Furthermore, different IV iron compounds on the market have differing safety characteristics. In this ongoing study, we compare the safety of IV iron products to establish whether IV iron carries an increased risk compared to oral iron, and to determine which, if any, has a superior safety profile. Here, we report preliminary results from the inflammatory bowel disease subgroup analysis. METHODS: A literature search of PUBMED, SCOPUS, WoS and Cochrane Library was performed up to 07/2019. Primary outcome measure was pooled total of drug-related adverse events (AEs) and serious adverse events (SAEs) in proportion to the safety population. Secondary outcome measure was identification of the most common AEs. Bayesian NMA was performed to compare AE rates of each iron therapy relative to all comparators. Deviance information criterion (DIC) statistics were used to compare fixed effect and random effect models. RESULTS: 8086 distinct publications were found. Of 171 relevant full-text articles on IBD, 5 randomized controlled trials (RCTs) (n = 1143) were eligible, on which Bayesian NMA was performed using a fixed effects model. Low statistical heterogeneity was determined among the studies (I2 = 9%). No statistically significant difference was found between different IV iron products (ferric carboxymaltose, FCM; IS, iron sucrose; IIM, iron isomaltoside) or oral iron. Compared to oral iron; OR = 0.69, 95% CrI [0.29;1.7] for FCM, OR = 0.52, 95% CrI [0.22;1.2] for IS, OR = 1.5, 95% CrI [0.80;3.1] for IIM. Compared to FCM; OR = 0.74, 95% CrI [0.45;1.2] for IS, OR = 2.2,95% CrI [0.74;6.7] for IIM. Compared to IS; OR = 0.1.3, 95% CrI [0.82;2.2] for IS, OR = 3.0, 95% CrI [1.0;9.1] for IIM. Compared to IIM; OR = 0.45, 95% CrI [0.15;1.3] for FCM, OR = 0.33, 95% CrI [0.11;1.0] for IS. The most common AEs were: headache (1.8%) and transient hyperferritinemia (1.8%) for FCM; headache (1.5%), hyperferritinemia and rigors (both 1.2%) for IS; flushing (2.7%), hypersensitivity and hepatic enzyme increase (both 1.8%) for IIM; diarrhea (8.0%) and abdominal pain (7.7%) for oral iron. Hypophosphatemia, a much-debated complication of IV iron treatment, was reported in only one RCT of FCM, in this case transient and clinically asymptomatic. Six SAEs were recorded; 1/381 for FCM, 1/223 for IIM and 5/238 for oral iron (included in the calculation of total AE rate for the main analysis). No eligible RCTs were found for ferumoxytol or iron dextran. CONCLUSION(S): None of the IV iron products were found to be associated with an increased risk of adverse or serious adverse events compared to oral iron, and all showed similarly low rates of adverse events. However, the safety profiles of different IV iron preparations were found to differ: Whereas headaches were more common in patients receiving FCM or IS, IIM was more frequently associated with hypersensitivity reactions or raised levels of hepatic enzymes. On this evidence, therefore, while FCM, IS and IIM are all safe, they have differing safety characteristics which should be borne in mind when choosing suitable therapy options.

Особенности выбора препарата для стартовой терапии железодефицитной анемии у детей

Особенности выбора препарата для стартовой терапии железодефицитной анемии у детей

Therapy of iron-deficiency anemia in gynecological patients

The article considers the indications for the use of iron carboxymaltosate, peculiarities of its structure, efficiency and safety of its use in various gynecological diseases, proved on the basis of meta-analysis of randomized clinical studies

Potensi Scopoletin sebagai Agonis Reseptor Transferin 2 untuk Pengembangan Terapi Anemia Defisiensi Besi

<p><strong>Introduction</strong>: Iron Deficiency Anemia (IDA) is caused by imbalance between iron intake and iron loss in blood circulation. Increased hepcidin level plays an important role in the etiology of IDA. Normally, expression of hepcidin protein is controlled by three different pathways, one of them is interaction between holo Transferin (Holo-Tf) and Transferrin Receptor 2 (TfR-2). Recently, Indonesian herbal plants have widely been used as herbal medicine but there is no active compound that can activate TfR-2 for IDA therapy. The aim of this study was to explore phytochemicals derived from Indonesian herbal plants to interact with TfR-2.</p><p><strong>Methods: </strong>The study was a bioinformatics study with a molecular docking method. The SWISS-MODEL software was used to make TfR-2 protein modeling because the molecular structure of TfR-2 remains unknown. Holo-Tf was used as a standard ligand and obtained from Protein Data Bank with PDB ID 1SUV. All Indonesian phytochemicals which (1) registered at HerbalDB (2) had a three-dimensional molecular structure at PubChem (3) met Lipinski’s Rule of Five criteria were used in this study. AutoDock Vina 1.1.2 was used to analyze the binding affinity which was in kcal/mol. Phytochemical-TfR-2 binding complexes were visualized by using Chimera 1.10rc and or Pymol 1.7.</p><p><strong>Result: </strong>The docking scores of holo-Tf modification with TfR-2 were -6,4±0,1 kcal/mol at Arg466 and -3,4±0,1 kcal/mol at Arg689 respectively. Interaction of modification holo-Tf and TfR-2 was observed not only at Arg466 and Arg689 but also with Asp642 and Ile682. Docking scores of scopoletin were -7,1±0,1 kcal/mol at Arg466 and -5,4±0,1 kcal/mol at Arg689. Scopoletin could interact with TfR-2 at Arg466, Arg689, and Leu630 residues.</p><p><strong>Conclusions: </strong>Computationally, scopoletin is a potential TfR-2 agonist. In future studies, in vitro assay will be used to evaluate the agonist effect of scopoletin in TfR-2.</p><p> </p>

High-Dosed Intravenous Iron Replacement Therapy for Iron Deficiency Anemia Does Not Hinder Drug-Induced Amelioration of Disease Activity in IBD Patients

BACKGROUND: Iron deficiency and iron deficiency anemia (IDA) are common complications in IBD patients, and can seriously affect quality of life, hospitalization rates, and time lost from work. In IBD patients, anemia is caused by chronic blood loss and/or impaired iron intake and absorption. International guidelines recommend intravenous iron supplementation in IBD patients with moderate-severe anemia or intolerance to oral iron. While oral supplements are convenient and relatively inexpensive, they fail to compensate continuous iron loss due to inadequate intestinal absorption in the presence of inflammation. Oral iron intake is associated with gastrointestinal side-effects including abdominal pain and nausea. Moreover, mounting evidence from animal and human studies shows that non-absorbed iron enhances mucosal inflammation. Intravenous iron has been demonstrated to be safe, effective and well tolerated in correction of IDA and maintenance of iron stores in patients with IBD. Intravenous ferric carboxymaltose (FCM; Ferinject® 50mg ferric iron(III)/mL suspension) can be administered in single 15-minute infusions of up to 1,000mg per week. Here, we assess the effect of high-dosed intravenous FCM on inflammatory activity in IBD patients. METHODS: A prospective non-interventional post-marketing study was performed in 101 centers in Germany to assess efficacy, tolerability, and convenience of Ferinject® in clinical practice. Alongside primary outcomes including response rates and adverse events, changes in clinical disease indices (CDAI/CAI), changes in CRP values, and self-reported disease-related symptoms (fatigue, concentration lack, headache, paleness of mucous membranes, hair loss, (exertional) dyspnoea, sleeping disorders, restless legs syndrome) rated on a severity scale of 1 to 4, were analyzed. Patients were additionally analyzed in subgroups according to baseline CRP levels (<5mg/L, >5mg/L, 5-10mg/L, >10mg/L). RESULTS: Intravenous FCM was administered to 224 subjects (127 CD; 97 UC). Mean total iron dose over ca. 12 weeks was 1,139mg (range: 100mg-4,800mg). 76.7% of doses were between 500mg and 2,000mg. Concomitant drugs included aminosalicylates (89 patients/46.1%), corticosteroids (84/43.5%), immunosuppressants (36/18.7%), biologics (36/19%), antibiotics (8/4.1%) and antidiarrheics (11/5.7%). Although patients (n=97) with elevated CD or UC activity indices (CDAI ≥150; CAI ≥5) presented with lower mean Hb values at baseline compared to those with normal activity indices, mean Hb levels at end of study (EOS) were similar. Subjects with higher activity indices presented with higher mean CRP values at baseline (6.1mg/L) compared to those with normal activity indices (3.6mg/L). CRP levels decreased significantly during the observation period, falling from 6.4mg/L to 3.5mg/L in mean (median 1.9 -1.0mg/L), indicating a general reduction in inflammatory activity, which was independent of baseline Hb levels. Change in CRP levels was statistically significant in subgroups of patients with high disease activity, CD and UC patients treated with a total dose of 500-1000mg iron, and patients who completed therapy. Amelioration of inflammatory activity as indicated by lower CRP levels was confirmed by reduced mean clinical disease activity indices (CDAI/CAI). Patients in both CRP subgroups showed increases in Hb, s-ferritin and TSAT, but reduced CRP levels and fewer symptoms. CONCLUSION(S): High-dosed FCM therapy does not appear to inhibit drug-induced amelioration of inflammatory activity in patients with IBD.

Efficacy and Compliance of Oral Iron Poly-Maltose Complex versus Oral Ferrous Sulfate in the Treatment of Iron Deficiency Anemia in Pregnant Women

Objective: To compare the efficacy and compliance of the conventional therapy of iron deficiency anemia (ferrous sulfate) with the new forms of therapy chewable iron tablets: (iron polymaltose complex) in the treatment of iron deficiency anemia in pregnant women. Methods: This Randomized Control Trial study included 290 pregnant women with iron deficiency anemia, and they were randomly allocated to a control group who received ferrous sulfate capsules for two months and study group who received iron polymaltose complex chewable tablets for two months. Complete Blood Picture (hemoglobin level and hematocrit level) and Serum ferritin level were done after four and eight weeks to determine the efficacy. In addition, any complains or side effects had been reported to assess the tolerability of the drugs. Two-factor repeated-measures analysis of variance (ANOVA) was used to compare the change in hemoglobin and serum ferritin levels in both groups. Results: There was no statistical significant difference between the two research groups as regards baseline hemoglobin, and at week 4 from onset of treatment (p values = 0.990, 0.112, consecutively). However, there was statistical significant difference on week 8 of continuous drug intake in both groups in which the iron poly maltose complex research group had significantly higher hemoglobin levels (p value = 0.006). Conclusion: The results of the study showed oral iron polymaltose complex increases Hemoglobin and serum ferritin levels more than oral ferrous sulfate and produces less adverse effects than ferrous sulfate.

Niedokrwistość z niedoboru żelaza – diagnostyka i leczenie

Anemia affects approximately one third of human population. The major cause is iron deficiency. Spectrum of iron deficiency symptoms covers broad range of complaints from fatigue, cold intolerance, pallor to pagophagia and beeturia. In case of iron deficiency a priority should be given to the identification of the underlying cause. Blood loss from the gastrointestinal tract or due to menorrhagia is the most common cause in resource-rich countries. Iron studies are required to confirm the diagnosis of iron deficiency. Oral iron remains the first line therapy. Intravenous administration is suggested in case of intolerable side effects or ineffectiveness of oral therapy. Currently available intravenous iron formulations are characterized by acceptable safety profile. The review presents recent data regarding diagnosis and therapy of iron deficiency anemia.

Parenteral Iron Sucrose Therapy for Moderate and Severe Iron-Deficiency Anemia in Pregnancy

Objective: Parenteral iron therapy for iron deficiency anemia is gaining popularity due to its fast and impressing action. However, effectiveness and safety of iron sucrose in pregnant patient population is less clear. In this study, we aimed to review our intravenous iron sucrose use in pregnant patients.Study Design: The medical records of all anemic pregnant patients hospitalized for parenteral iron sucrose therapy were reviewed retrospectively.Results: The results of 117 pregnant women were available. Thirty-one (26.5%) and 86 (73.5%) of the patients were in the 2nd and 3rd trimester of the pregnancy, respectively. Four (%3.4) of the patients had severe and 113 (%96.6) of the patients had moderate anemia. The median gestational age for iron sucrose administration was 31.1 weeks (26.8-34.3). The mean hemoglobin, hematocrit and ferritin levels before and after delivery were 10.8±1.3 gr/l; 9.9±1.3 gr/l, 33.5±4.0; 30.8±4.0 and 89.6±0.7 μg/L; 98.1±0.9 μg/L, respectively. All but 2 (1.8%) patients had elevated hemoglobin levels after iron sucrose therapy. When hemoglobin and hematocrit levels were compared between before iron sucrose therapy and before delivery, there was a 2.8 g/l and 7.8 % increase in the mean hemoglobin and hematocrit levels, respectively and the difference was statistically significant (p= 0.001 and p=0.001, respectively). Five patients (4.3%) reported mild hypersensitivity reaction to intravenous iron in the form of mild itching at the infusion site. No severe or life-threatening hypersensitivity reaction was reported.Conclusion: In this study, we found out that intravenous iron sucrose therapy for iron deficiency anemia is feasible, effective and has a good safety profile.

Experience in the therapy of iron deficiency anemia in pregnant women

There was executed the examination and treatment of 68 pregnant patients with diagnosed mild iron deficiency anemia (IDA) at gestational age from 12th to 34th weeks. There was estimated the efficacy of the combine preparation of iron and trace elements (iron gluconate, copper gluconate, manganese gluconate) in the treatment of IDA. Early detection of IDA, timely prevention and treatment with the use of this preparation allowed to reduce the rate of obstetric and perinatal complications.

Efficacy and Safety of Intravenous Ferric Carboxymaltose in Children with Iron Deficiency Anemia Unresponsive to Oral Iron Therapy

▪BackgroundThe standard first line therapy for iron deficiency anemia (IDA) is oral iron. Yet, many patients fail to respond to oral iron due to poor adherence and/or adverse effects. Intravenous (IV) iron is an effective means of treating IDA in patients with malabsorption of iron or who are non-adherent and/or experience adverse effects with oral iron. Some IV iron preparations carry an FDA-mandated black box warning and/or require a test dose or prolonged infusion. Ferric carboxymaltose (FCM, Injectafer®) is a relatively new IV iron preparation with demonstrated safety and efficacy in adults with IDA. The manufacturer recommended dosing is 15 mg/kg/dose (maximum 750 mg) x2 doses administered at least 7 days apart, and each individual infusion can be administered over 10 to 15 minutes, without the need for a test dose. Limited data exist on its use in children. Our objective was to assess the hematologic response and adverse effects of IV FCM in a diverse population of infants, children and adolescents with IDA who failed oral iron therapy.MethodAll children with IDA who received FCM at Children's Health from June 1, 2014 through June 10, 2015 were included. Subjects were identified via search of pharmacy records. All patients received at least one dose of FCM 15 mg/kg (maximum 750 mg) administered as a 15-minute IV infusion (without test dose or pre-medications). Patient characteristics, adverse effects and hematologic response were retrospectively collected from the electronic medical record.ResultsDuring the study frame, one hundred twenty-five infusions of FCM were administered to 87 patients (71% female) with a median age of 14 years (range 9 months to 20.8 years). The most common racial/ethnic group was Caucasian/White (Latino) at 45% followed by African American/Black and Caucasian/White (Non-Latino), each at 22%. The primary etiologies were heavy menstrual bleeding (38%), nutritional (24%), and GI bleeding and/or malabsorption (20%) with the remaining 18% representing other/mixed causes of IDA (e.g., inflammatory).The median dose administered during a single infusion was 750 mg (range 132 to 750 mg). No adverse effects were noted during or following the infusion in 77 subjects. Two patients had transient tingling, nausea and/or mild abdominal pain. Five others developed generalized pruritis and/or urticaria and received diphenhydramine and/or hydrocortisone, with prompt resolution. Two adolescents had more clinically significant reactions, 1 with nausea/vomiting post-infusion (likely psychogenic) requiring admission, and 1 with dyspnea 2 minutes into the infusion, requiring its immediate termination and administration of diphenhydramine, hydrocortisone and normal saline with prompt symptom resolution. One patient experienced asymptomatic extravasation during the second infusion which resulted in localized iron-staining of the skin.Median pre-infusion hemoglobin concentration for all patients was 9.1 g/dL (range 3.9 to 13.3 g/dL) (Table). A follow-up measurement was available for 76 patients at a median time of 6 weeks (range 1 to 30 weeks) post-initial infusion with a median hemoglobin increase of 3.3 g/dL (range -1.5 to 9.5 g/dL).ConclusionIntravenous FCM, administered in an outpatient infusion setting as one or two short IV infusions and without need for a test dose, was safe and effective in most children and adolescents with IDA refractory to oral iron therapy. Further clinical data are necessary to more fully characterize the extent of adverse effects in young patients. Prospective studies of IV FCM in children are indicated to assess clinical efficacy, including outcomes such as health related quality of life and fatigue.Table*Hematologic Response to FCMPre-Infusion**Post-InfusionHemoglobin concentration (g/dL) All Etiologies, Pre (n=87), Post (n=76) Heavy menstrual bleeding, Pre (n=33), Post (n=26) Nutritional, Pre (n=21), Post (n=20)- 9.1 (3.9 to 13.3) 9.3 (4.2 to 13.3) 8.8 (4.9 to 12.2)- 12.2 (7.1 to 16) 12.7 (8.8 to 16) 12.2 (10.5 to 13.7)Mean corpuscular volume (fl), Pre (n=87), Post (n=76)71.6 (49.5 to 97.4)80.9 (53.3 to 102)Serum ferritin (ng/mL), Pre (n=80), Post (n=60)5.2 (0.6 to 288.6)115.7 (2.3 to 679.3)*Median laboratory values are reported.**Follow-up laboratory testing occurred at median time of 6 weeks (range 1 to 30 weeks) post-infusion. DisclosuresPowers:Gensavis Pharmaceuticals, LLC: Research Funding. McCavit:Pfizer: Research Funding; Gensavis LLC: Research Funding; Novartis: Speakers Bureau. Adix:Gensavis Pharmaceuticals, LLC: Research Funding. Buchanan:Gensavis Pharmaceuticals, LLC: Research Funding.

Intravenous iron sucrose for children with iron deficiency anemia: a single institution study.

Intravenous iron sucrose is not recommended by its manufacturers for use in children despite extensive safety and efficacy data in adults. We reviewed the experience of our department between January, 2011 and February, 2014 with the use of intravenous iron sucrose in children ≤14 years of age who failed in oral iron therapy for iron deficiency anemia (IDA). Twelve children (6 females) aged 1.2-14 years (median age 8.9 years) received at least one dose of intravenous iron sucrose. Ten patients had IDA inadequately treated or non-responsive to oral iron therapy. One patient received therapy for blood transfusion avoidance and one for presumed iron refractory iron deficiency anemia (IRIDA). Iron sucrose infusions were given on alternate days up to three times per week. The number of infusions per patient ranged from 2 to 6 (median, 3), the individual doses from 100 mg to 200 mg (median, 200 mg), and the total doses from 200 mg to 1200 mg (median, 400 mg). Iron sucrose was effective in raising the hemoglobin concentration to normal in all patients with IDA, i.e., from 7.6±2.38 g/dL to 12.4±0.64 g/dL, within 31-42 days after the first infusion. The single patient with IRIDA demonstrated a 1.8 g/dL rise. Injection site disorders in three cases and transient taste perversion in one case were the only side effects. Intravenous iron sucrose appears to be safe and very effective in children with IDA who do not respond or cannot tolerate oral iron therapy.

Iron deficiency anemia in children.

Iron deficiency is not just anemia; it can be responsible for a long list of other manifestations. This topic is of great importance, especially in infancy and early childhood, for a variety of reasons. Firstly, iron need is maximum in this period. Secondly, diet in infancy is usually deficient in iron. Thirdly and most importantly, iron deficiency at this age can result in neurodevelopmental and cognitive deficits, which may not be reversible. Hypochromia and microcytosis in a complete blood count (CBC) makes iron deficiency anemia (IDA) most likely diagnosis. Absence of response to iron should make us look for other differential diagnosis like β thalassemia trait and anemia of chronic disease. Celiac disease is the most important cause of true IDA not responding to oral iron therapy. While oral ferrous sulphate is the cheapest and most effective therapy for IDA, simple nonpharmacological and pharmacological measures can go a long way in prevention of iron deficiency.

Iron deficiency anemia and levels of oxidative stress induced by treatment modality

The effects of iron deficiency anemia (IDA) and its treatment on plasma total antioxidant capacity (TAOC) were investigated. Sixty patients with IDA and 20 healthy controls were divided into four subgroups: an oral (per os: PO) group (n = 20); an intramuscular (IM) group (n = 20); an intravenous (IV) group (n = 20); and the control group (n = 20). Blood samples were obtained from all patients before treatment, and at 24 h, 7 days, 6 and 13 weeks after initiation of IDA therapy. TAOC in the IDA group was low when compared with the control group (P < 0.001). Although TAOC at 24 h in the PO group was not different from the control group, the TAOC in the IM and IV groups was relatively lower (P < 0.001). The TAOC in the PO group at 7 days, and at 6 and 13 weeks was closest to the control group level. The mean TAOC in the IV group at 13 weeks was clearly lower relative to the PO and IM groups. Oxidative stress was minimally induced with oral therapy, while IM and IV therapies induced higher levels of oxidative stress, in increasing order of intensity.

New rat models of iron sucrose-induced iron overload

The majority of murine models of iron sucrose-induced iron overload were carried out in adult subjects. This cannot reflect the high risk of iron overload in children who have an increased need for iron. In this study, we developed four experimental iron overload models in young rats using iron sucrose and evaluated different markers of iron overload, tissue oxidative stress and inflammation as its consequences. Iron overload was observed in all iron-treated rats, as evidenced by significant increases in serum iron indices, expression of liver hepcidin gene and total tissue iron content compared with control rats. We also showed that total tissue iron content was mainly associated with the dose of iron whereas serum iron indices depended essentially on the duration of iron administration. However, no differences in tissue inflammatory and antioxidant parameters from controls were observed. Furthermore, only rats exposed to daily iron injection at a dose of 75 mg/kg body weight for one week revealed a significant increase in lipid peroxidation in iron-treated rats compared with their controls. The present results suggest a correlation between iron overload levels and the dose of iron, as well as the duration and frequency of iron injection and confirm that iron sucrose may not play a crucial role in inflammation and oxidative stress. This study provides important information about iron sucrose-induced iron overload in rats and may be useful for iron sucrose therapy for iron deficiency anemia as well as for the prevention and diagnosis of iron sucrose-induced iron overload in pediatric patients.

Should intravenous iron be upfront therapy for iron deficiency anemia?

Should intravenous iron be upfront therapy for iron deficiency anemia?

Assessment of the Efficacy of Intravenous Iron Therapy (Venofer®) in the Treatment of Iron Deficiency Anemia (IDA)

AbstractAbstract 4229 Introduction:Patients with iron deficiency anemia (IDA) who need intravenous iron are normally treated with iron dextran. One of the major side effects of iron dextran is severe (sometimes fatal) anaphylactic reaction, which can develop in about 1% of patients. On the other hand, iron sucrose (Venofer®) another intravenous iron preparation that has improved safety and ease of administration. This preparation is being used in dialysis patients with very good results. But this has never been formally evaluated in non-dialysis-dependent patients. In view of these issues with iron dextran, some non-dialysis dependent patients in the Hematology/Oncology clinic at Coney Island hospital with IDA who needed parental iron therapy for IDA (due to intolerance or poor response to oral iron) were offered treatment with Venofer®. Our study is done to assess the response of intravenous iron therapy Venofer® in non-dialysis dependent patients with IDA. Methods:Consecutive patients who were treated with Venofer® for IDA in the Hematology/Oncology clinic in Coney Island Hospital, Brooklyn, New York, USA were obtained medical records. The number of cases included in the study was 42. Charts of these patients were reviewed and key data were collected before the start of treatment and weekly after starting the treatment. Response was defined as an increase in the hemoglobin level of 2 g/dl or greater after starting the treatment. At the same time, the reason for starting the IV iron therapy and the toxicity associated with treatment was evaluated. The paired t test was used to assess hemoglobin response. Results:Patients received 200 mg by of Venofer® by slow IV push every week. Analysis showed that 35 out of 42 patients (83.3%) received 4 doses. The mean increase in hemoglobin level after 4 doses was 1.65±0.98 g/dl (P=0.00002). 7 out of 35 patients achieved increase of 2 g/dl or greater in hemoglobin level (response rate of 20%). 13 out of 42 patients (30.9%) continued to receive Venofer® up to 8 doses. The mean increase in hemoglobin level after 8 doses of treatment was 2.66±1.73 g/dl (P=0.00001). 11 out of 13 patients who received 8 doses achieved a hemoglobin increase of 2 g/dl or greater (response rate of 84.6%). Indications for starting IV iron for 12 patients was intolerance to oral iron due to GI side effects, for 24 patients it was no response with oral therapy, for 3 patients it was general malabsorption and other 3 patients due to non-compliance. Among all the patients studied, none had any complications related to intravenous iron. Background:Our data showed that intravenous the iron prepration, Venofer®, which is currently not the standard of care for treatment of IDA in non-dialysis-dependent patients has very good response (response rate of 20% after 4 cycles and 84.6 % after 8 cycles). It is well tolerated and has no major side effects. More studies needs to be done with larger number of patients, with attention to both medical and economic impact, before this can become a stanadard of care for non-dialysis-dependent patients with IDA, who do not respond or have intolerance to oral iron preprations. Disclosures:Off Label Use: Venofer® for iron deficiency anemia in non-dialysis dependent patients.

Diagnosis and Therapy of Iron Deficiency Anemia in the Patients With Chronic Heart Failure

Diagnosis and Therapy of Iron Deficiency Anemia in the Patients With Chronic Heart Failure

Safety, therapeutic effectiveness, and cost of parenteral iron therapy

Patients have to discontinue the use of oral iron therapy due to the development of side effects and lack of long-term adherence to medication for iron deficiency anemia. This study aimed to evaluate the therapeutic effectiveness, safety, and cost of intravenous iron sucrose therapy. The computerized database and medical records of 453 patients diagnosed with iron deficiency anemia who received intravenous iron sucrose therapy for iron deficiency anemia between 2004 and 2008 were reviewed. The improvement of hematologic parameters and cost of therapy were evaluated 4 weeks after therapy. 453 patients (443 females, 10 males; age: 44.2 +/- 12.3 years) received iron sucrose therapy. Mean hemoglobin, hematocrit, and mean corpuscular volume values were 8.2 +/- 1.4 g/dL, 26.9 +/- 3.8%, and 66.1 +/- 7.8 fL, respectively, before therapy and 11.5 +/- 1.0 g/dL, 35.8 +/- 2.5%, 76.5 +/- 6.1 fL, respectively, after therapy (P < 0.001). A mean ferritin level of 3.4 +/- 2.4 ng/mL before therapy increased to 65.9 +/- 40.6 ng/mL after therapy (P < 0.001). All patients responded to intravenous iron therapy (transferrin saturation values of the patients were >50%). The mean cost of therapy was 143.07 +/- 29.13 US dollars. The therapy was well tolerated. Although the cost of intravenous iron sucrose therapy may seem high, a lack of adherence to therapy and side effects including gastrointestinal irritation during oral iron therapy were not experienced during intravenous therapy.

Avaliação da anemia em crianças da cidade de Campina Grande, Paraíba, Brasil

A anemia e uma condicao definida como a reducao da concentracao de hemoglobina circulante a um valor inferior ao considerado pela Organizacao Mundial da Saude em13 g/dl, 12 g/dl e 11 g/dl para homens, mulheres e criancas, respectivamente. E considerada a principal consequencia da deficiencia de ferro - um nutriente que atua principalmente na sintese das celulas vermelhas do sangue e no transporte de oxigenio para as demais celulas do corpo. Este trabalho, realizado nos meses de marco e abril de 2007, teve como objetivo avaliar as alteracoes hematologicas e os niveis de ferro serico em criancas de 6 a 59 meses de idade na cidade de Campina Grande-PB. A prevalencia de anemia observada foi de 31,73%, e, dentre as criancas anemicas, 91% apresentaram quadro de anemia leve (Hb 9,0 g/dl). A faixa etaria predominante em que se observou a menor concentracao de hemoglobina foi de 6 a 12 meses (10,26 ± 1,27 g/dl). Considerando-se os varios parâmetros do hemograma para avaliar a etiologia ferropriva entre os anemicos, o RDW (amplitude de distribuicao dos eritrocitos) foi o que mais apresentou especificidade no diagnostico laboratorial da anemia por deficiencia de ferro. Dessa forma, a investigacao laboratorial e essencial para o diagnostico precoce e para o acompanhamento terapeutico eficiente da anemia ferropriva em criancas.