Treatment Of Iron Deficiency Anemia Research Articles

Treatment of iron deficiency anemia after cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background Iron deficiency anemia (IDA) after cardiac surgery (CS) increases mortality, serious adverse events and length of stay. Aim of the study was to compare the efficacy of Sucrosomal Iron (SI) on IDA and hematinic deficiencies (HD) in patients (P) after CS, compared to i.v. Ferric Carboxymaltose (FCM). SI was chosen for its peculiar intestinal absorption properties such as to overcome the hepcidin's block. Methods 106 consecutive anemic P were tested for HD after the admission in Cardiac Rehabilitation and alternately treated with SI (56) or FCM (54). The study design included a single dose of 1000 mg of FCM at T1 (8-10 days CS) or a dose of 120 mg of SI per day from T1 to T2 (on the day of discharge 10 days after T1); since then the SI was reduced to 30 mg per day until T3 (follow-up, 10 days after T2). Measures of efficacy included changes from baseline in Hb, HD, natriuretic peptides (NP), C-reactive protein (CRP), and the 6-minute-walking-test (6MWT). Results The data are shown in the Table. At T1, two treatment groups did not show statistically significant differences. Hb increased significantly (p<0.001), with no differences between SI and FCM. Transferrin saturation and sideremia significantly increased, albeit more rapidly with FCM. Ferritin, elevated at baseline for inflammation due to CS, decreases to T3 with SI, while significantly increases in the FCM group. NP were reduced with both treatments, but not significantly; CRP, on the other hand, was significantly reduced over time. At 6MWT the distance increased significantly with no difference between SI and FCM. Conclusions SI and FCM show similar efficacy on HD, starting from Hb, in P with IDA, after CS. The quick response to treatment, comparable between SI and FCM, could support the choice of oral iron, with organizational and cost benefits. In addition, was shown a positive impact on functional capacity, assessed with the 6MWT, for the first time similar between an oral and i.v. iron. Inflammation was reduced, but only SI is able to recover Hb levels, avoiding the risk of hyperferritinemia.

Efficacy of Ferrous Fumarate in Comparison to Carbonyl Iron in the Treatment of Iron Deficiency Anaemia during Pregnancy in Rajshahi, Bangladesh

Introduction: Iron deficiency represents a spectrum ranging from iron depletion to iron deficiency anaemia. In iron depletion, the amount of stored iron is reduced but the amount of transport and functional iron may not be affected. Iron deficiency is a major problem worldwide especially in women of reproductive age. Objectives: This study was designed to compare efficacy of two commonly used oral iron preparations among anemic pregnant women in private chamber of gynecologists and outdoor of Rajshahi Medical college hospital, Rajshahi, Bangladesh. Methods: We conducted analysis of data collected from Pregnant women between 18 to 40 years of age, >8 weeks of gestation, having iron deficiency anaemia (serum hemoglobin levels <10 gm/dl or serum ferritin <30μg/l). The patients were divided into 2 groups (n=30) each and treated with Ferrous fumarate and carbonyl iron respectively. Hemoglobin gm/dl and serum Ferritin ng/dl were recorded after the interval of 3 months from baseline. Data was analyzed using SPSS 16. Efficacy variables between groups calculated using Chi square and T- test. Results: We observed that patients treated with Ferrous Fumarate (FF) showed significant rise in Hb 0.69(±0.83) which was greater than that of Carbonyl iron (CI) group 0.07(±1.11) g/dl. Mean (± SD) rise of serum ferritin was significantly higher in FF group (55.45 ±34.66) as compared to CI group (19.88 ±15.33) (t=5.14, df =58, P<0.001). Conclusion: It can be concluded that, ferrous fumarate still can be considered better effective medication than Carbonyl iron for the treatment of Iron deficiency anemia in pregnancy.

Intravenous iron for the treatment of iron deficiency anemia in China: a patient-level simulation model and cost-utility analysis comparing ferric derisomaltose with iron sucrose

Objectives Two intravenous (IV) iron formulations, ferric derisomaltose (FDI) and iron sucrose (IS), are currently available for the treatment of iron deficiency anemia (IDA) in China. Clinical studies have demonstrated that FDI has an improved efficacy and safety profile versus IS, while requiring fewer infusions to correct iron deficits. Based on these findings, the present study evaluated the costs and benefits of FDI and IS for the treatment of IDA, from a healthcare system and societal perspective in China. Methods A patient-level model was developed to project time to hematological response and incidence of cardiovascular adverse events and hypersensitivity reactions (HSRs) associated with FDI and IS over 5 years. Costs included iron acquisition, administration, and adverse event/HSR treatment costs, based on published studies, fee schedules, and a physician survey. Health state utilities associated with adverse events, HSRs, and the number of infusions were obtained from the literature and a time trade-off survey. Results From a healthcare system perspective, FDI was associated with incremental costs of RMB 1,934 (purchasing power parity USD 462) and incremental quality-adjusted life expectancy of 0.078 quality-adjusted life-years (QALYs) versus IS, yielding an incremental cost-utility ratio of RMB 24,901 (USD 5,949) in the base case scenario. From a societal perspective, FDI was associated with reduced total costs and therefore dominant versus IS. Limitations Limitations included the absence of clinical data specific to China and insufficient data to model persistence with treatment. Conclusions This was the first cost-utility analysis comparing FDI and IS for the treatment of IDA in China. Based on a patient-level model, FDI was found to improve quality of life and reduce administration and adverse events costs relative to IS. Using the 2020 Chinese gross domestic product per capita of RMB 72,447 (USD 17,307) as a cost-effectiveness threshold, FDI would be considered cost-effective in China.

MO523: The Differential Effect of Third-Generation Intravenous Iron Preparations (Ferric Carboxymaltose, Ferric Derisomaltose) on Hematinic and Renal Function Variables in Patients With Non-Dialysis Dependent CKD and Iron Deficiency Anemia

Abstract BACKGROUND AND AIMS Iron deficiency anemia is common in patients with non-dialysis dependent chronic kidney disease (CKD). Guidelines advocate the use of oral or intravenous (IV) iron, with IV iron offering a quicker and potentially more efficacious replenishment. The advent of third-generation IV iron products [such as ferric carboxymaltose (FCM) and ferric derisomaltose (FDI)] has allowed high doses of iron to be provided in a single sitting. Despite good evidence on their efficacy in replenishing iron stores and safety in terms of renal injury and inflammation when compared against placebo, oral iron or older iron compounds (such as iron sucrose and low molecular weight iron dextran), the two compounds have never before been compared head-to-head in CKD. METHOD As part of the single-center double-blinded exploratory randomized controlled trial ‘Iron and Phosphaturia—ExplorIRON-CKD’ that took place in a tertiary center in the UK, patients with iron deficiency with/without anemia and CKD stage 3a–5 but not on dialysis were recruited to receive FCM or FDI in two divided doses—1000 mg at baseline and 500–1000 mg in a 1-month interval to achieve replenishment. Iron deficiency was defined as serum ferritin (SF) <200 µg/L or transferrin saturation (TSAT) ≤20% and SF 200–299 µg/L. Markers of treatment response such as hemoglobin and iron parameters [serum ferritin (SF), transferrin saturation (TSAT)], renal function and injury [serum creatinine, estimated glomerular filtration rate (eGFR) and protein: creatinine ratio (PCR)] and inflammation (CRP) were monitored throughout the study. Hemoglobin, renal function and inflammation were monitored at baseline, 2 weeks, 1 month and 2 months following initial infusion. Iron response was assessed at baseline, 1–2 days, 2 weeks, 1 month post-initial infusion (and time of second infusion), 1–2 days after the second infusion and 2 months after initial administration. RESULTS A total of 26 patients were recruited; 14 were randomized to receive FDI and 12 to receive FCM. All patients received at least one iron dose (1000 mg), 10 patients received two FDI doses and 11 received two FCM doses. There was an increase in hemoglobin in both groups, with no significant difference between the groups at any given time point in the study [baseline: FDI: 99.2 (12.2) g/L versus FCM: 101.6 (15.3) g/L; P = .67; 2 months: FDI: 106.0 (13.3) g/L versus FCM: 109.1 (8.3) g/L; P = .526). Both groups had a median baseline SF <100 µg/L and TSAT <20%, and by the end of follow-up, iron repletion was similarly successful in both groups as indicated by a median SF > 400 µg/L and a TSAT >20% (Figure 1). A small numerical reduction was noted in median eGFR in the FCM group from baseline to the end of the study (baseline: 18.0 (11.3) mL/min/1.73 m2 versus 2 months: 16.5 (8.5) mL/min/1.73 m2); however, there was no significant difference between the two groups at any time point in the study (Figure 2). Urinary PCR, serum creatinine and CRP remained stable throughout the study and did not differ significantly between the two groups. CONCLUSION Third-generation IV iron preparations are efficacious in replenishing iron stores. There was no adverse short-term impact on renal function, injury or inflammation. In our cohort, the two compounds were equivocal for the parameters studied, with no significant difference identified in any of the areas examined. The population was small, therefore the results should be interpreted with caution; nonetheless, newer IV iron compounds appear to be equally efficacious in the treatment of iron deficiency anemia in non-dialysis-dependent CKD.

MO525: Iron absorption and phosphate-lowering effects of ferric citrate hydrate are not influenced by gastric secretion inhibitors in patients with chronic kidney disease

Abstract BACKGROUND AND AIMS Ferric citrate hydrate (FC, Riona®), an oral iron-based phosphate binder in chronic kidney disease (CKD) patients, is also approved as an iron preparation for iron-deficiency anemia (IDA) in Japan. In the USA, ferric citrate (Auryxia®) is approved as a phosphate binder for dialysis-dependent CKD and an iron replacement product for the treatment of IDA in patients with CKD not on dialysis. Ingested iron is dissolved at a low pH of the secreted gastric acid in the stomach, which is an important process for its effective absorption [1]. Patients taking gastric acid secretion inhibitors (GASI), such as proton pump inhibitors and histamine-2 receptor antagonists, showed decreased iron absorption and increased risk of iron deficiency, which were dose- and treatment-duration-dependent [2]. The increase in the intragastric pH by concomitantly use of GASI might be affected on FC's iron absorption effect. METHOD We have conducted a retrospective study using data from two previous clinical studies to investigate FC in CKD patients with hyperphosphatemia. A 12-week, phase 3, multicenter, randomized, double-blind, placebo-controlled study in non–dialysis-dependent (ND) CKD patients (FC, n = 60, ; placebo, n = 30) (CTI-111 435) [3], and a 52-week, phase 3, multicenter, open-label, dose-titration study in CKD patients undergoing hemodialysis (HD) (FC, n = 180) (CTI-111 437) [4] were divided into with or without GASI, and levels of iron and phosphate related parameters were analyzed. RESULTS In ND patients, approximately 25% in FC (n = 14) and 50% (n = 14) in placebo used GASI. Mean [standard deviation (SD)] changes from baseline to end of treatment (EOT) in serum ferritin (ng/mL) were 109.83 (104.46) in FC with GASI, 142.68 (94.28) in FC without GASI, −22.49 (74.85) in placebo with GASI, and −3.43 (43.58) in placebo without GASI (Fig. 1a). Those in transferrin saturation (TSAT, %) were 16.64 (30.13) in FC with GASI, 17.07 (17.56) in FC without GASI, 2.86 (14.68) in placebo with GASI, and 1.31 (9.75) in placebo without GASI (Figure 1b). The mean (SD) dose of FC with or without GASI were 3240 mg/day (approximately 778 mg ferric iron) with GASI (n = 14) and 3445 mg/day (approximately 827 mg ferric iron) without GASI (n = 46), respectively. In HD patients, approximately 50% (n = 95) used GASI. Mean changes (SD) from baseline to EOT in serum ferritin (ng/mL) were 166.32 (153.70) with GASI and 155.16 (139.47) without GASI, and in TSAT (%) were 16.60 (19.44) with GASI and 16.02 (18.81) without GASI, respectively. The mean (SD) dose of FC with or without GASI were 2619 mg/day (approximately 629 mg of ferric iron) with GASI (n = 95) and 2854 mg/day (approximately 685 mg or ferric iron) without GASI (n = 85), respectively. In both studies, there were no differences in the changes from baseline to EOT in serum phosphate between with or without GASI. CONCLUSION GASI did not interfere with iron absorption and phosphate-lowering effects of FC in CKD patients with hyperphosphatemia.

MO519: Ferric Citrate Hydrate Improves Levels of Transferrin Saturation in Hemodialysis Patients With Lower Levels of Transferrin Saturation

Abstract BACKGROUND AND AIMS Iron deficiency identified by transferrin saturation (TSAT) is reported as a risk factor for all-cause mortality and cardiovascular events in non-dialysis dependent (NDD) chronic kidney disease (CKD) [1, 2] and for all-cause mortality in hemodialysis patients [3]. Ferric citrate hydrate (FC, Riona®), an oral iron-based phosphate binder in CKD patients, is also approved as an iron preparation for iron-deficiency anemia (IDA) in Japan in 2021. In the USA, ferric citrate (Auryxia®) is approved as a phosphate binder for dialysis-dependent CKD and an iron replacement product for the treatment of IDA in patients with NDD-CKD. FC or ferric citrate increased TSAT in patients with NDD-CKD and IDA [4]. However, a few data show that whether FC or ferric citrate has the similar effect in hemodialysis patients whose TSAT is <20%. Considering the additional indication of IDA in Japan, we investigated the FC's effect on TSAT by using the data obtained from the ASTRIO study [5], which was conducted in Japanese hemodialysis (HD) patients. METHOD We conducted a retrospective study using the data of ASTRIO study [5], which is a randomized, prospective, open-label, multicenter 24-week study to investigate the FC's effect on anemia management compared with non-iron-based phosphate binders (PBs) in Japanese HD patients with hyperphosphatemia. Ninety-three patients taking non-iron-based PBs were randomized 1:1 to continue PBs (control) or switch to FC. During 24-week study, serum phosphate and hemoglobin were controlled, 3.5–6.0 mg/dL and 10–12 g/dL, respectively. From 93 patients (FC, n = 48; control, n = 45), we extracted 41 patients (FC, n = 21; control, n = 20) whose TSAT at baseline was <20% and compared the levels of TSAT and other iron related parameters between FC group and control group. RESULTS In the ASTRIO study, the mean (SD) levels of TSAT (%) was 14.3 (4.0) at baseline and rapidly increased to 25.0 (11.1) at 4 weeks in the FC group. After that, the levels of TSAT were almost unchanged in the FC group, whereas, in the control group, the mean (SD) levels of TSAT were almost unchanged during the 24-week study. The mean (SD) levels of serum ferritin gradually increased until week 12 and subsequently showed to be stabilized in the FC group, whereas, in the control group, these were almost unchanged during the 24-week study (Table 1). CONCLUSION In Japanese HD patients whose TSAT was <20%, FC rapidly increased TSAT compared with control. We will also investigate the FC's effect on TSAT in HD patients from the post-marketing surveillance study, the prospective, multicenter and observational, up to maximum 2 years treatment.

Short-term treatment of iron deficiency anemia after cardiac surgery.

Iron deficiency anemia (IDA) is frequent after cardiac surgery and is associated with increased morbidity and mortality. In a retrospective study, we analyzed 106 patients with IDA (hemoglobin [Hb] ≤ 12 g/dl in women and ≤ 13 g/dl in men, transferrin saturation [TSAT] ≤ 20%) on admission to a Cardiac Rehabilitation Unit after cardiac surgery. The patients were divided into two groups, one was treated with oral sucrosomial iron (SI) and the other with intravenous ferric carboxymaltose (FCM). Patients received a single 1000 mg dose of FCM from the day after admission to rehabilitation (T1), or a 120 mg/day dose of SI from T1 until discharge (T2); after discharge, SI was reduced to 30 mg/day until the end of follow-up (T3). Hb was evaluated at T1, T2 and T3; the other hematological parameters at T1 and T3; natriuretic peptides at T1, T2 and T3; 6-minute walk test (6MWT) at T1 and T2. Folate, vitamin B12 and reticulocytes were sampled on admission. Folate deficiency was documented in 60.4% of patients. Hb increased in both groups with no significant differences between the two treatments (p = 0.397). The other iron metabolism parameters (sideremia, transferrin, TSAT) displayed similar behavior, showing a significant increase at T3 (p < 0.001) with both therapies, although the increase was faster with FCM. Ferritin – high on admission – decreased at T3 in the SI group and rose significantly in the FCM group (SI 219.5 vs. FCM 689 ng/ml p < 0.0001). The 6MWT increased significantly at T2, with an overlap between SI and FCM. In conclusion, the results of this study show that SI and FCM exhibit the same effectiveness on IDA; the response time to therapy of both treatments is also equally fast. SI and FCM induce a similar increase in functional capacity. The study shows that SI can be a viable alternative to FCM after cardiac surgery in terms of effectiveness and tolerability.

Screening, Treatment, and Monitoring of Iron Deficiency Anemia in Pregnancy and Postpartum

Iron deficiency anemia is the most prevalent form of anemia worldwide. In the United States, clinicians routinely screen for iron deficiency anemia upon initiation of prenatal care, at the start of the third trimester, and prior to birth. Treatment of iron deficiency anemia generally begins with oral supplementation of elemental iron, which is associated with adverse gastrointestinal effects. These adverse effects can decrease adherence, leading to subtherapeutic treatment. Newer evidence highlights the benefits of early screening for iron deficiency before the onset of anemia, as well as the use of intravenous iron to expedite the treatment of iron deficiency anemia. More research is needed on the potential consequences of over-supplementation and iron deficiency without anemia to guide treatment. This article reviews the evidence for best practices for screening, treatment, and continued monitoring of iron deficiency anemia during pregnancy and postpartum. Maternal, fetal, and neonatal implications are reviewed, as well as the risks and benefits of treatment options. Finally, an evidence-based algorithm is proposed to guide clinicians on continued monitoring after treatment.

MP14-19 MAGNETIC CLEARANCE OF KIDNEY STONE FRAGMENTS: INITIAL IN VITRO EXPERIENCE

You have accessJournal of UrologyCME1 May 2022MP14-19 MAGNETIC CLEARANCE OF KIDNEY STONE FRAGMENTS: INITIAL IN VITRO EXPERIENCE Tianjia Jessie Ge, Timothy Chang, Kathy Mach, Shan Wang, Kunj Sheth, Simon Conti, and Joseph Liao Tianjia Jessie GeTianjia Jessie Ge More articles by this author , Timothy ChangTimothy Chang More articles by this author , Kathy MachKathy Mach More articles by this author , Shan WangShan Wang More articles by this author , Kunj ShethKunj Sheth More articles by this author , Simon ContiSimon Conti More articles by this author , and Joseph LiaoJoseph Liao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002543.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical management of stone disease aims for complete clearance. Residual stone fragments are associated with more complications, yet only 60-75% of ureteroscopic treatments achieve complete stone-free status. While residual fragments <2 mm in size are commonly deemed insignificant, up to 30% patients with “clinically insignificant fragments” experience stone-related complications. We propose a system to improve stone-free rates and surgical efficiency, in which fragments are rendered superparamagnetic and retrieved en masse with a magnetic guidewire. METHODS: Human kidney stone fragments obtained from lithotripsy (calcium phosphate (CaPO4), calcium oxalate monohydrate (CaOxM), uric acid, and struvite) were separated by size. Fragments (10-15 mg by dry weight) were rehydrated with normal saline and incubated with superparamagnetic iron oxide particles (range 7 nm to 4.5 µm diameter) possessing carboxylic acid surface chemistry for 3 minutes at 37C. A magnetic guidewire was fabricated from individual magnets within a plastic sheath (0.75 mm total diameter) and captured magnetically labeled fragments along its length in vitro. The fragments were dried and weighed to determine the capture efficiency. The speed of fragment retrieval was compared between the magnetic system and a conventional basket. RESULTS: The magnetic system cleared small fragments (<1 mm) up to twenty times faster than a standard basket in our in vitro experiments. The 7 nm nanoparticle, ferumoxytol, is FDA-approved for the treatment of iron deficiency anemia, and performed satisfactorily in capturing small calcium phosphate fragments. Larger 1 micron particles performed more consistently across different stone compositions. Capture efficiency decreases with increasing stone fragment size, owing to larger gravitational forces counteracting the magnetic attraction. CONCLUSIONS: Iron oxide particles with carboxylic acid surface chemistries, including an FDA-approved nanoparticle, bind to a variety of calcium-based kidney stones. This approach can facilitate the efficient magnetic retrieval of small stone fragments which are difficult to basket, and lead to improved stone-free rates. Further optimization of particle chemistry and magnetic forces will allow for capture of larger fragments and clinical translation. Source of Funding: Stanford Coulter Translational Grant, NIH R21 DK131776 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e240 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tianjia Jessie Ge More articles by this author Timothy Chang More articles by this author Kathy Mach More articles by this author Shan Wang More articles by this author Kunj Sheth More articles by this author Simon Conti More articles by this author Joseph Liao More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comparison of Efficacy and Tolerability of Ferrous Sulfate and Carbonyl Iron in Iron Deficiency Anemia in Pregnant Woman

Introduction: Iron deficiency anemia in pregnancy is common and causes a huge burden globally. Bangladesh is known to have a high prevalence of iron deficiency anemia in pregnant women. Hence, it is important to evaluate the efficacy and tolerability of drugs in treatment of iron deficiency anemia in pregnancy.&#x0D; Objective: The purpose of present study was to compare the efficacy and tolerability of Ferrous Sulfate and Carbonyl Iron in Iron Deficiency Anemia in pregnant women.&#x0D; Methodology: An observational prospective study was conducted in obstetric and gynae out – patient department of Sir Salimullah Medical College and Mitford Hospital. Woman between 16 – 28 weeks of pregnancy with haemoglobin level 7 – 10 g/dl with microcytic hypochromic blood film were included in this study. Pregnant women in 1st and 3rd trimester of pregnancy were excluded from the study. Among the study population one group was given Tablet Ferrous Sulfate and another group was given Capsule Carbonyl Iron.&#x0D; Results: There was significant and comparable rise in HB in 4th, 8th and 12th week in the two group. (p&lt;0.001). Carbonyl iron showed significantly more rise in Hb as compared to Ferrous Sulfate. Adverse effects were seen more in number and intensity with Ferrous Sulfate. Individual efficacy of both compounds was good but Carbonyl Iron was better tolerated.&#x0D; Conclusion: Carbonyl Iron is more effective and tolerable than Ferrous Sulfate in treatment of iron deficiency anemia in pregnancy.&#x0D; Sir Salimullah Med Coll J 2022; 30: 83-88

Efficacy and safety of intravenous iron sucrose for treatment of iron deficiency anemia in pregnancy

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Leading cause of anemia is due to thedeficiency of iron in pregnant women. The aim of the study was to evaluate the efficacy of intravenous iron sucrose for the treatment of iron deficiency anemia in pregnancy particularly for those who had unsatisfactory response to oral iron therapy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is an open label, observational study that was carried out in Jamal Noor Hospital, Karachi for 6 months by using non-probability consecutive sampling technique, after taking ethical approval. Seventy two pregnant women with level of Hb equivalent to or &amp;lt;10 g/dl, Serum ferritin level equivalent to or &amp;lt;10 μg/l with the age ranging from 18-40 years, Gestational age 16 weeks or above were included in the study. A two times-weekly dose of 200 mg of iron sucrose (Axifer) intravenously were infused to pregnant women. However, the dose was calculated for every patient through total iron deficit. SPSS version 22 was used to analyze the data.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study results showed that the mean age of the pregnant womenwas 25.83±5.03 years, their mean weight was 59.50±10.28 kg, and their mean gestational week was 28.88±4.09. It showed that both the haemoglobin (9.01±0.74 mg/dl versus 11.92±11.07 mg/dl), (p&amp;lt;0.001) and ferritin levels (9.85±12.38 ng/ml versus 50.74±59.42 ng/ml), (p&amp;lt;0.001)were significantly increased at term after receiving intravenous iron sucrose as compared to the baseline.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study concluded that the administration of iron sucrose (Axifer) intravenously is a secure and effective choice in the management of iron deficiency anemia in pregnant women particularly for those who had inadequate response to oral iron supplementation.&lt;/p&gt;

Intravenous Ferric Carboxymaltose Improves Response to Postoperative Anemia Following Total Knee Arthroplasty: A Prospective Randomized Controlled Trial in Asian Cohort.

Background: Ferric carboxymaltose (FCM) is an intravenous (IV) high-dose iron that is effective in the treatment of iron deficiency anemia. This study was performed to determine whether postoperative FCM infusion is effective at improving hemoglobin (Hb) responders, Hb and iron profiles, and the patient’s quality of life (QOL). Methods: A total of 110 patients with postoperative anemia, defined by a Hb < 10 g/dL within 3 days of unilateral primary TKA, between June 2018 and February 2020 were randomized into either the FCM or Control group. On postoperative day 3, the FCM group (55 patients) received IV FCM while the Control group (55 patients) did not. The Hb responders (Hb increase ≥ 2 g/dL compared to baseline), Hb level, iron profiles (ferritin, total iron-binding capacity (TIBC), transferrin saturation (TSAT)), and EQ-5D scores were compared at weeks 2, 4, and 8. Results: The FCM group demonstrated a significantly greater number of Hb responders (p < 0.001) and a higher Hb level (p = 0.008) at 2 weeks postoperative than did the Control group. The FCM group recovered its preoperative Hb level between 4 and 8 weeks. In contrast, the Control group did not recover its preoperative level until 8 weeks. The FCM infusion group also had higher serum ferritin, iron and TSAT, and lower TIBC levels than those of the Control group between 2 and 8 weeks (all p < 0.001). However, there was no significant difference in the postoperative transfusion rate (p = 0.741) or EQ-5D score between the two groups (all p > 0.05). Discussion: In postoperative anemia following TKA, IV FCM increases the Hb response and improves Hb and iron metabolism variables, however, it does not affect the transfusion rate or QOL.

Development of the emulsion composition and technology based on iron oleate micelles

This paper addresses the problem of drugs for the treatment of iron deficiency anemia (IDA). Iron deficiency anemia is a clinical and hematological syndrome based on a violation of hemoglobin synthesis resulting from iron deficiency. Clinically, IDA is manifested by symptoms of anemia and sideropenia. The aim of the study is to develop new drugs for the treatment of IDA based on lipophilic iron compounds with oleic acid in the form of a microemulsion. Analogues of the developed compounds are presented on the pharmaceutical market, being registered exclusively as biologically active food additives (Lipofer, Sideral Forte). During the study, the following materials and methods were used: iron (III) oleate with an iron ion concentration of 25 mg/g was obtained by mixing 1.1 g (0.03 mol) of iron nitrate with 6.0 g (0.21 mol) of oleic acids. After that, the mixture was heated to 90℃ for 24 hours under constant stirring. To 3 g of the previously obtained iron (III) oleate solution, 0.56 g of ascorbyl palmitate was added in an equimolar ratio to the iron ion. The mixture was stirred for 24 hours at 90℃. The resulting iron (II) oleate emulsion showed the presence of divalent ions at a concentration of 4.77 mg/g. The total concentration of iron ions in the analyzed oleates of both types was the same. Recalculation for the initial solution in oleic acid showed that the concentration was close to the expected values. Solutions for quantifying the concentrations of the active substances of the drugs under development have been presented. The fundamental possibility of carrying out the in situ reduction of the iron ion in oleic acid using a lipophilic reducing agent, ascorbyl palmitate, has been demonstrated.

Pharmacoeconomic analysis of using Monofer in patients with iron deficiency anemia as part of the provision of medical care under the state guarantees program in the health care system of the Russian Federation

Objective: comparative pharmacoeconomic analysis of iron preparations for intravenous infusion in the treatment of iron deficiency anemia (IDA) within the concept of patient blood management program.Material and methods. A retrospective pharmacoeconomic study was carried out using methods of analysis of efficiency, costs and costeffectiveness. Comparison of preparations of oligoisomaltose iron [III] (Monofer) and carboxymaltose iron [III] (Ferinject®) was carried out.Results. In general, Monofer and Ferinject® are characterized by comparable efficacy in terms of hematological response. Using a dosiological model of an increase in hemoglobin blood levels over time in treatment with the drugs under consideration the frequencies of the hematological response were calculated (Monofer – 79%, Ferinject® – 70%). The cost of treating one patient with an average body weight of 88.3 kg and an initial hemoglobin level of 100 g/l was 13,097 rubles for Monofer and 15,681 rubles for Ferinject®. The values of the cost-effectiveness indicator calculated in accordance with the criterion of the effectiveness of the hematological response amounted to 16,578 rubles (Monofer) and 22,402 rubles (Ferinject®), which allows to consider Monofer as strictly preferred. With the colorectal surgery as an example, it has been shown that the use of this drug in patients blood management can reduce the total cost of treatment (in particular, by reducing the required number of portions of red blood cells).Conclusion. The wider use of iron preparations for intravenous infusion in IDA has reasonable economic advantages. The preparation of oligoisomaltose iron Monofer is strictly preferred in relation to the preparation of carboxymaltose iron.

A Randomised Controlled Trial to Compare Injection Ferric Carboxymaltose and Oral Iron in Treating Iron Deficiency Anemia During Pregnancy.

Iron deficiency anemia (IDA) in pregnancy has a prevalence as high as 40-60% in different countries of the world. Oral iron is used to treat his commonest medical disorder in pregnancy. Ferrous sulphate is associated with considerable side effects. Ferric carboxymaltose (FCM) is a newer iron preparation which allows for single and higher dose (up to 1000mg) of IV iron infusion. This study was conducted to compare the efficacy of FCM and FS in treating IDA during pregnancy. A randomised control trial was done at a tertiary care centres involving 362 women (181 women each in FS and FCM group). The pregnant anemic women with IDA were enrolled between 18 and 34weeks of pregnancy. They were given 1000mg of FCM iv as single dose or were given FS tablets twice daily (120mg iron daily). The data were collected for rise in the Hb and serum ferritin over a period of 6weeks. Nine and 18 patients were lost to follow-up in the FCM and FS group, respectively. The data were analysed as per protocol analysis. FCM group women showed 2.6gm% rise in Hb compared to 1.7gm% of FS group. One hundred and sixty-six out of 172 women in FS group achieved anemia correction at 6weeks. No difference was observed in the neonatal outcome. No major side effects were observed in the either group. In our study, FCM was more effective than oral FS in increasing Hb in women with IDA during pregnancy. This clinical benefit with FCM was achieved without the concerns for safety and tolerability of the drug.

Ayurveda in Management of Iron Deficiency Anemia: A Case Report

Nutritional iron deficiency anemia is the most common cause of anemia and a global public health problem among young children and pregnant women. Blood loss, malabsorption is the common cause of iron deficiency anemia. Pandu roga is a clinical entity with great resemblance to iron deficiency anemia. Pandu roga is Pitta pradhan vyadhi. In Pandu roga tissue metabolism gets affected due to vitiated Doshas which in turn into Dhatu- shyathilya in all Dhatu. There is a predominance of paleness all over the body. Rasavaha and Raktavahasrotasas are chiefly involved in the pathogenesis of Pandu. So, here is a case report of 21 years old female patient with iron deficiency anemia who was given Ayurvedic formulations in the line of treatment of Pandu roga along with dietary supplements rich in iron for a period of one month and marked improvement in symptoms (i.e., swelling was reduced, pallor absent, she was feeling energetic, hair fall (10 strands/day), palpitation had also decreased) with increase in hemoglobin level (i.e., from 8.6g/dl to 12.7g/dl) in a very short duration of time. The formulations help in breaking the Samprapti of Pandu roga. This shows the efficacy of Ayurvedic medicine in the treatment of iron deficiency anemia (Pandu).

Iron deficiency anemia in pregnancy.

Anemia in pregnancy is associated with increased maternal and neonatal morbidity. There is increasing awareness amongst obstetricians about the need to screen for iron deficiency anemia (IDA), as well as growing literature on diagnosis and treatment. This review aims to summarize causes, consequences, treatment, and evaluation of IDA in pregnancy. National guidelines provide varying guidance on diagnosis and treatment of IDA in pregnancy. Serum ferritin is a helpful adjunct for the diagnosis of IDA. Oral iron remains an option for treatment; absorption is improved with every other day dosing and is effective for patients able to tolerate. Emerging studies on modern generations of intravenous (IV) iron demonstrate shorter infusion times and improved safety profiles. Notably, recent UK guidelines provide consideration for universal IV iron supplementation for treatment of anemia beyond 34 weeks of pregnancy. Iron, in dietary, oral, and IV forms, has been found effective in resolving anemia in pregnancy. Pregnant people with IDA in the third trimester are more likely to benefit from IV iron. Future studies designed and powered to assess maternal and perinatal morbidity indicators and blood transfusion rates can strengthen recommendations.

Iron Deficiency Anemia: Cause, Plant Based Iron, Fortification and Impact on Lifestyle and Socioeconomic Parameters

Micronutrient deficiency is prevelant in both high income and low-income countries globally causing major health issues, especially iron deficiency which causes hypoproliferative microcytic anemia. Iron deficieny anemiais effecting more than two billion population on earth especially pregnant woman, infants and woman of reproductive. Iron plays a key role in the formation of red blood cells and reactions occurring in the human body. Food is one of the best and safe options to prevent and cure iron deficiency anemia. In the present study, we highlighted different foods with special reference to plant-based foods for the treatment and prevention of iron deficiency anemia. Literature revealed that major cereal flours, cumin seeds, green leafy vegetables, moringa leaves, papaya with supplements, beet root, apples, pomegranate, bael, sugar molasses and berries are best sources of iron due to presence of ascorbic acid. Prebiotics and probiotics fortification can also increase the iron absorption in the gut by providing optimum pH for absorption. In addition to change in dietary patterns, fortification of major crops, flours and salt should be made mandatory by as in many countries. Moreover, Iron fortified formulas, complementary food, beverages, baked items (cookies) and confectionary are best ways to prevent and cure iron deficiency anemia in children and adults. Similarly, sugar molasses from sugar industry is one of the superabundant sources of iron which can be used as supplement for value addition. However, human research is required to check the efficacy of fortified products to prevent iron deficiency anemia in future generations.

Evalutating the Effect of Animal-Based Iron Sources on Iron Deficiency Anemia

Iron deficiency anemia is widely spread throughout the world both in developing as well as developed countries irrespective of age and gender. There is a strong relationship between dietary intake and the nutritive status of a body. Maintaining a balanced diet having a standard iron (Fe) level and high bioavailability is challenging. Dietary source of good quality and quantity of iron is red meat from bovine, camel, goat, sheep, poultry, egg, quail, turkey, rabbit, fish, oysters, clams, prawns, shrimps, algae, and mushrooms. In the current study, animal-based iron sources were overviewed. The heme iron present in beef is the highest (1.06–2.63 mg/100 g) than in pork (0.30–0.61 mg/100 g), fish (0.46 mg/100 g), and chicken (0.17–0.49 mg/100 g). However, Iron is abundantly found in meat and poultry's liver, kidney, and heart. The liver contains the highest concentrations of iron, three to four times than meat. Camel meat contains the superabundant amount of iron 45.5 mg 100-1g in contrast to mutton 4.05mg 100-1g, beef 1.8mg 100-1g, and poultry 0.4mg 100-1g. Goat meat contains a large amount of micronutrients mainly Fe and vitamin B12 which can be utilized to prevent and cure iron deficiency anemia in a woman. Moreover, Quail egg exhibited a high amount of micronutrients especially iron and zinc (57.2 µg/g and zinc 30.5 µg/g). Meat bone paste and the raw materials of the meat industry can be utilized to form iron fortified products. Conclusively, iron from animal-based foods can be utilized to prevent and treat iron-deficiency anemia for improving human health and lifestyle

Oxidation of ferumoxytol by ionizing radiation releases iron. An electron paramagnetic resonance study.

Ferumoxytol (FMX) is an iron oxide nanoparticle that is FDA approved for the treatment of iron deficiency anemia. FMX contains an Fe3O4 core. Currently, the redox chemistry of Fe3O4 nanoparticles remains relatively unexplored. FMX has recently gained interest as an anti-cancer agent. Ionizing radiation (IR) is a treatment modality employed to treat several types of cancer. Utilizing electron paramagnetic resonance (EPR) spectroscopy, we found that the products produced from the radiolysis of water can oxidize the Fe3O4 core of FMX. Because of the limited diffusion of the HO2• and HO• produced, these highly oxidizing species have little direct effect on FMX oxidation. We have determined that H2O2 is the primary oxidant of FMX. In the presence of labile Fe2+, we found that reducing species generated from the radiolysis of H2O are able to reduce the Fe3+ sites of the Fe3O4 core. Importantly, we also have shown that IR stimulates the release of ferric iron from FMX. Because of its release of iron, FMX may serve as an adjuvant to enhance radiotherapy.