Treatment Of Iron Deficiency Anemia Research Articles

Pharmacotherapeutics for iron deficiency anemia in adults

Background: Iron deficiency anemia (IDA) is among the five greatest causes of disability globally. It can have various causes and may develop concurrently with other health issues. Recently, there have been advances in the treatment of IDA associated with various comorbidities.Current Concepts: The causes of IDA include chronic blood loss, inadequate iron absorption, and increased iron demand. Oral iron supplements are primarily recommended for the treatment of IDA. In cases where oral supplements are ineffective or cannot be used, parenteral iron supplements are administered.Discussion and Conclusion: Identifying the underlying reason for IDA is essential for determining the appropriate and effective treatment plan. In adults, it is important to be aware that gastrointestinal malignancies can be detected as a cause of IDA. Ferrous sulfate tablets are primarily recommended as oral supplements for treating IDA. Among the parenteral iron supplements available in South Korea, both iron sucrose and ferric carboxymaltose can be used relatively safely without significant side effects. Recently, ferric carboxymaltose was reported as being effective for treating iron deficiency associated with heart failure, chronic kidney disease, inflammatory bowel disease, and preoperative IDA.

Effectiveness of Lesser Known Homoeopathic Medicines in the Treatment of Iron Deficiency Anaemia

Anaemia is a major public health problem in India as it is estimated that most of the non-pregnant women of reproductive age group are anaemic. It occurs when there is decreased level of haemoglobin in red blood cells. The primary cause of anaemia is iron deficiency. Iron deficiency anaemia (IDA) may be present with other systemic diseases. People with mild and moderate iron deficiency anaemia may not have any sign and symptom. But more severe iron deficiency anaemia may cause fatigue, tiredness, shortness of breath or chest pain. Although Homoeopathy gives importance to the individualisation of the patients, for remedy selection, still then, some medicines are prescribed based on disease diagnostic features. Such medicines are not well proved, so they are known as rare/lesser-known medicines. Of course, their role in the management of certain diseases cannot be ignored. This article aims at showing the effectiveness of some lesser-known medicines in the treatment of iron deficiency anaemia.

Clinical effectiveness of ferric carboxymaltose (iv) versus iron sucrose (iv) in treatment of iron deficiency anaemia in pregnancy: A systematic review and meta-analysis.

Iron deficiency anaemia (IDA) during pregnancy is treated with oral and parenteral iron. The objective of this review was to compare the clinical effectiveness, safety, pregnancy and neonatal outcomes of intravenous (iv) ferric carboxymaltose (FCM) and iv iron sucrose (IS) in treating IDA in pregnancy. The Department of Health Research funded this study. PubMed, Cochrane Library, EMBASE and Scopus were searched to include studies published till November 2022. The protocol was registered in PROSPERO (CRD42022306092). Pregnant women (15-49 yr) in second and third trimesters, diagnosed with moderate-to-severe iron deficiency anaemia, treated with either of the drugs were included. The included studies were critically assessed using appropriate tools. We conducted a qualitative synthesis of the studies and meta-analysis for improvement in haematological parameters and incidence of adverse events. A total of 18 studies were included. The risk of bias was low to moderate. A rise in haemoglobin up to four weeks was higher with FCM than IS by 0.57 (0.24, 0.9) g/dl. Intravenous FCM is associated with fewer adverse events than IS [pooled odds ratio: 0.5 (0.32, 0.79)]. The included studies had limited evidence on pregnancy and neonatal outcomes after iv iron treatment. Intravenous FCM is effective and safer than intravenous IS in terms of haematological parameters, in treating IDA in pregnancy. Further research is required on the effects of iv FCM and iv IS on the pregnancy and neonatal outcomes when used for treating IDA in pregnancy.

Diagnosis and treatment of iron deficiency anemia

The causes of iron deficiency anemia include blood loss, increased demand, insufficient dietary intake, and disorders affecting iron absorption. In certain circumstances, atrophic gastritis, either autoimmune or due to Helicobacter pylori infection, may contribute. On very rare occasions, iron-refractory iron deficiency anemia can develop as a consequence of TMPRSS6 mutations. Iron deficiency anemia is diagnosed by identification of microcytic hypochromic anemia with low serum ferritin levels. In cases of chronic disorders such as chronic kidney disease, chronic heart failure, and chronic inflammatory disorders, the diagnosis may also incorporate transferrin saturation. Treatment of underlying diseases is recommended along with iron supplementation. While oral iron supplements are the first choice, intravenous iron may be considered when oral administration is impractical, iron absorption is impaired, or rapid iron replenishment is necessary. Recently, high-dose intravenous iron formulations became available in Japan, but their use requires caution due to potential risks of allergic reactions, hypophosphatemia/osteomalacia, iron overload, and vascular leakage. Notably, the benefits of high-dose intravenous iron for patients with heart failure and iron deficiency are recognized in the field of cardiology. This article provides an overview, incorporating recent developments in the field of iron deficiency anemia.

Iron deficiency anemia: a critical review on iron absorption, supplementation and its influence on gut microbiota.

Iron deficiency anemia (IDA) caused by micronutrient iron deficiency has attracted global attention due to its adverse health effects. The regulation of iron uptake and metabolism is finely controlled by various transporters and hormones in the body. Dietary iron intake and regulation are essential in maintaining human health and iron requirements. The review aims to investigate literature concerning dietary iron intake and systemic regulation. Besides, recent IDA treatment and dietary iron supplementation are discussed. Considering the importance of the gut microbiome, the interaction between bacteria and micronutrient iron in the gut is also a focus of this review. The iron absorption efficiency varies considerably according to iron type and dietary factors. Iron fortification remains the cost-effective strategy, although challenges exist in developing suitable iron fortificants and food vehicles regarding bioavailability and acceptability. Iron deficiency may alter the microbiome structure and promote the growth of pathogenic bacteria in the gut, affecting immune balance and human health.

Comparative study of oral iron and intravenous iron sucrose for the treatment of iron-deficiency anemia in pregnancy

Background: The most prevalent nutritional disorder during pregnancy is iron-deficiency anemia (IDA). Management of anemia can be done by either oral, parenteral, or blood transfusion, depending on the severity. Oral iron (OI) replacements can be taken as they are safe, effective, and lower cost. However, one disadvantage is poor tolerability, as they cause gastrointestinal complications. Iron sucrose complex is a relatively new drug used intravenously (IV) for the correction of IDA. Aims and Objectives: This research compared the safety and effectiveness of OI versus iron sucrose in the treatment of IDA during pregnancy. Materials and Methods: A prospective observational study was performed involving 60 patients who attended the antenatal clinic from June 2019 to November 2019 at Bidar Institute of Medical Science between 24 and 36 weeks of gestation and hemoglobin levels between 7 and 10 g/dL. In the IV group, 200 mg of iron sucrose was administered in 100 mL of 0.9% normal saline over 15–20 min on alternate days. In the oral group, 200 mg of ferrous ascorbate per day for 4 weeks was prescribed. All patients were monitored for laboratory responses and adverse effects. An unpaired “t” test was used for statistical analysis. P < 0.05 was considered significance. Results: There was an increase in hemoglobin in both groups, but there was a significant increase in hemoglobin in the IV group. The other laboratory parameters also showed a significant increase in the IV group than in the oral group. The IV group had no major side effects. Conclusion: The IV iron sucrose formulation was more effective than the oral formulation for anemia correction in pregnancy.

Demir Eksikliği Anemili Kadın Hastalarda İntravenöz Demir Tedavisinin Etkinliği

Abstract: In this study, it was aimed to show the efficacy of intravenous (IV) ferric carboxymaltose treatment for iron deficiency anemia (IDA), which is a public health problem due to its high prevalence in the world and in Turkey. Since it is the first study in the region, its importance is increasing even more. Eighty female diagnosed with IDA and treated with IV iron carboxymaltose, who applied to Siirt Training and Research Hospital Internal Diseases Polyclinics between June 2018 and September 2019, were included in the study. After obtaining voluntary consent of female patients, biochemical data of pre- and post-treatment were included in the study retrospectively. After treatment, hemoglobin (HGB), hematocrit (HTC), mean cell volume (MCV), ferritin, iron and B12 values increased statistically (p

Mechanism of Action and Validation of the Traditional Medicinal use of Grewia Tenax Fruits in Sudan to Encounter Iron Deficiency Anemia

Introduction: In Sudan, Grewia tenax fruits, are known commonly as Goddaim. The fruit’s pericarp is used traditionally for a long time as a juice or a porridge to treat iron deficiency anemia (IDA). Traditional Goddaim users have a very strong belief in its effectiveness. However, the pattern of hemoglobin improvement follows an initial fast increase followed by a decline upon continuing its use. Some previous studies have attributed its effect to high iron content, while the iron quantity was too small. This work attempts to find an explanation for its mechanism of action by screening the fruit extract and its respective fractions for secondary metabolites, minerals, vitamins, and fibre. Methods: Entailed three methodologies: Chemical analysis to identify quantified minerals, ascorbic acid and non-digestible fibers, Phytochemical Analysis to separate and identify secondary metabolites using high-performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS-MS technique), and estimation of radical scavenging activities of crude fruit extract and its respective chloroform and ethyl acetate fractions by inhibition of the 2,2-diphenylpicrylhydrazyl (DPPH). Results: Ascorbic acid and indigestible fibres were revealed in the aqueous extract. Secondary metabolites were flavonoids (e.g., quercetin, kaempferol), organic acids (e.g., ferulic acid, chlorogenic acid), β-carboline alkaloids (e.g., 3-hydroxy-tetrahydroharman) identified in the chloroform, and ethyl acetate fractions. The in vitro antioxidant activity of G. tenax fruit extract was confirmed spectrophotometrically. Conclusion: It can be concluded that the initial enhancement of iron absorption through ascorbic acid and fibres, followed by iron uptake inhibition, could be explained by iron chelation by the chelators in the fruits. This paradoxical effect may qualify G. tenax fruits as a safety gauge for improving haemoglobin levels without compromising iron excess once iron stores are filled by keeping the oxidative stress in check. This may present G. tenax fruits as a good and safe remedy that optimizes the treatment of IDA.

Relation of Iron Deficiency Anemia in Pre-Menopause Women with Calcium and Vitamin D Levels at Teaching Hospital

Background: Iron deficiency anemia (IDA) is a common condition influenced by various factors, such as age, symptom duration, and other biochemical markers. Premenopausal women often experience premenstrual syndrome (PMS), which is frequently associated with reduced blood levels of calcium and vitamin D. Given the worldwide public health concern of osteoporosis, understanding lifetime preventive measures is crucial. Methods: This study aimed to explore the relationship between IDA and various clinical characteristics in 161 participants. We evaluated parameters including age, symptom duration, and levels of calcium and vitamin D to identify potential associations with IDA. Data for the 161 patients were collected using a predesigned proforma, as approved by the ethics committee. The Chi-square test was employed to determine statistical significance, with a P-value threshold set at 0.05. Results: The average age of participants was 38.6 years, with the majority (58.4%) reporting symptoms for an average duration of 58.4 months. Among them, 54% had confirmed cases of IDA. However, there was no significant age-related correlation with IDA. Notably, a strong correlation was observed between IDA and low vitamin D levels, which were present in 79.8% of the patients. Conversely, no significant relationship was found between calcium levels and IDA. Conclusion: Current research underscores the complex interplay between IDA and various clinical factors. Low vitamin D levels appear to be strongly linked with IDA, whereas age and symptom duration are not reliable indicators of the condition. This emphasizes the importance of considering multiple factors in the diagnosis and treatment of IDA, particularly focusing on the potential role of vitamin D in its pathogenesis. Further prospective studies are needed to confirm and expand upon these findings, potentially leading to improved treatment and diagnostic strategies for patients with IDA.

Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines.

Iron deficiency anemia (IDA) in pregnancy is a common diagnosis that is associated with adverse obstetric and neonatal outcomes. There remains uncertainty regarding how best to screen for, prevent, and treat established IDA in pregnancy. There is no consensus on the benefits of routine iron supplementation in pregnancy, with concerns regarding potential harmful effects of routine iron supplementation in women who are iron replete. Fourteen international guidelines were selected and appraised and compared by a multidisciplinary team. The AGREE II GRS tool was used. Each reviewer independently made their own assessment, and the scores from 1 to 7 were also collated and averaged for an overall score incorporating seven domains: process of development, clarity of presentation, completeness of reporting, clinical validity, and overall quality. The reviewers' scores were also individually compared according to discipline. The mean score across all the guidelines was 4.4 (range 3.5-6.5). Only half of the guidelines recommend routine iron in pregnancy. In terms of screening recommendations, five guidelines recommend screening with ferritin in addition to a full blood count in pregnancy, two recommend selective screening with ferritin for at risk groups only, and one guideline suggests using ferritin where feasible. Although many of the guidelines recommend similar doses of oral elemental iron of 100-200 mg daily for the treatment of established IDA in pregnancy, two recommend twice or three times daily dosing. Only five guidelines give hemoglobin rises to expect within specific timeframes. There remains a need to clarify the optimal screening method, dosing regimen, timing, and route of iron supplementation in pregnancy. Robust randomized controlled data are needed to guide appropriate prevention and management.

IV iron formulations and use in adults.

Intravenous iron has become a major component of the therapeutic armamentarium for iron deficiency and iron deficiency anemia. The earliest formulations were associated with unacceptable toxicity. Newer formulations, with complex carbohydrate cores that bind elemental iron more tightly, allow the administration of full therapeutic doses in 15 to 60 minutes. Nonetheless, a folklore of danger, fueled by earlier formulations no longer available, continues to foment caution. Complement-mediated minor infusion reactions, referred to as complement activation-related pseudo-allergy, resolve without therapy. Inappropriate intervention with vasopressors and H1 blockers converts these minor reactions into hemodynamically significant adverse events. Four new formulations, low-molecular-weight iron dextran, ferumoxytol, ferric carboxymaltose, and ferric derisomaltose, all approved for the treatment of iron deficiency in a host of conditions, are now widely used with an excellent safety profile. Herein, the administration, safety, indications, and management of infusion reactions are discussed. Treatment-emergent hypophosphatemia, a newly recognized side effect for some formulations, is also reviewed. Based on the preponderance of published evidence, intravenous iron should be moved up-front for the treatment of iron deficiency and iron deficiency anemia in those conditions in which oral iron is suboptimal.

Identifying and treating iron deficiency anemia in pregnancy.

Anemia is common during pregnancy, and while most anemia is physiologic, the most common pathologic cause is iron deficiency. The American College of Obstetricians and Gynecologists (ACOG) recommends confirmation of iron deficiency anemia with iron studies when anemia is diagnosed during pregnancy but acknowledges that presumptive treatment for suspected iron deficiency anemia is common in practice. Currently ACOG does not recommend treating iron deficiency without anemia during pregnancy. Though the benefits of treating iron deficiency anemia during pregnancy are clear, the optimal route of iron repletion remains uncertain. Results of ongoing large, randomized trials will help define the optimal route of iron treatment for pregnant patients diagnosed with iron deficiency anemia.

EE418 Cost-Utility Analysis of Ferric Derisomaltose Versus Ferric Carboxymaltose in Treating Iron Deficiency Anemia in Norwegian Patients With Inflammatory Bowel Disease

EE418 Cost-Utility Analysis of Ferric Derisomaltose Versus Ferric Carboxymaltose in Treating Iron Deficiency Anemia in Norwegian Patients With Inflammatory Bowel Disease

Efficacy of Ferrous Bis-Glycinate versus Ferrous Sulphate in Children with Iron Deficiency Anemia

Iron deficiency anemia is a common pediatric disease and oral iron supplementation is the usual treatment. Newer formulations has been developed to treat iron deficiency anemia in children. Objective: To compare the efficacy of ferrous Bis-Glycinate in children with iron deficiency anemia to the conventional therapy with ferrous sulphate. Methods: In this open labelled prospective clinical trial was performed in children with iron deficiency anemia. Two groups were made, one group was given ferrous sulphate and the other group ferrous bis-glycinate at a dose of 5 mg/kg/day, single daily dose. Patient were followed 04 weekly till 12 weeks and then baselines reviewed. Results: Out of these total 108 children, 64 (59.3%) were male while the remaining 40.7% were female, with mean age was 27.48 in months with SD of 14.1. Iron therapy succefully raised Hb by 3.49 gm/dl as a whole with in Iron Bis –glycinate group as 3.85d/dl while 3.13gm /dl in ferrous sulphate group. The frequency of gastrointestinal adverse symptoms were less in bis-glycinate group. Conclusions: It was concluded that ferrous bis-glyicante has better efficacy to ferrous sulphate in term of Hb rising and has less gastrointestinal side effects.

Characteristics and molecular properties of crude hemeproteins extracted from Asian seabass gills using an ultrasound-assisted process.

The development of a safe and effective iron supplement is important for the treatment of iron-deficient anemia. Therefore, the crude hemeprotein extract (CHPE) from Asian seabass gills wasextracted without (CON) and with ultrasound (US)-assisted process, followed by freeze-drying. The resulting freeze-dried crude hemeprotein extract (FDCHPE) powders were determined for trace mineral content, color, secondary structure, protein pattern, size distribution, volatile compounds, and amino acid composition. The extraction yields of CON-FDCHPE and US-FDCHPE were 6.76% and 13.65%, respectively. Highest heme iron (0.485 mg/mL) and non-heme iron (0.023 mg/mL) contents were found when US at 70% amplitude for 10 min (US 70/10) was applied. Both CON-FDCHPE and US-FDCHPE had no heavy metals, but higher iron content (432.8 mg/kg) was found in US-FDCHPE (P < 0.05). Typical red color was observed in CON-FDCHPE and US-FDCHPE with a*-values of 9.72 and 10.60, respectively. Ultrasonication affected protein structure, in which β-sheet upsurged, whereas random coil, α-helix, and β-turn were reduced. Protein pattern confirmed that both samples had myoglobin as the major protein. US-FDCHPE also showed a higher abundance of volatile compounds, especially propanal, hexanal, heptanal, and so forth, compared to CON-FDCHPE. Amino acid composition of US-FDCHPE was comparable to Food and Agriculture Organization of the United Nations (FAO) values. Overall, FDCHPE extracted using ultrasonication could be safe and effective for fortification in food products as an iron supplement to alleviate iron-deficient anemia. Additionally, gills as leftovers could be better exploited rather than being disposed. © 2023 Society of Chemical Industry.

Association between Iron Deficiency Anemia and Thrombosis, a Population Based Study

Iron deficiency anemia (IDA) has been associated with thrombosis in children, but this association has not been appropriately studied in other age groups. We hypothesize that IDA is a risk factor for thrombosis in all populations. The aim of our study is to evaluate the association between iron deficiency anemia and different types of thrombosis in all patients. Methods: We searched the medical records of all patients evaluated at a large hospital and outpatient medical center in Tampa, Florida utilizing the International Classification of Diseases 10th Edition (ICD-10). This coding system assigns standard acronyms to conditions, symptoms, and other factors of disease. We used the codes for iron deficiency anemia of all types, venous embolism and thrombosis, cerebrovascular disease, and retinal vascular occlusion. We then combined the codes in the database search to obtain the total number of patients with these conditions. Finally, we performed simple statistical analysis to compare the number and percentage of patients with thrombosis and IDA to patients with thrombosis and without IDA. Results: 2,539,231 patients were included in our database between 2010 and July 31st 2023. The age of this population was between 0-102 years-old. IDA was present in 66,693 patients (2.63%), venous embolism and thrombosis was present in 36,523 individuals (1.43%), cerebrovascular thrombosis was present in 14,159 patients (0.56%), and retinal vascular occlusion was present in 1,506 individuals (0.06%). Out of the 66,693 patients with IDA, 7,554 (11.3%) had venous embolism and thrombosis, 14,159 (0.56%) had cerebrovascular thrombosis, and 1,506 (0.06%) had retinal vascular occlusion. Out of the 2,472,538 patients without IDA, 28,969 (1.17%) had venous embolism and thrombosis, 12,172 (0.49%) had cerebrovascular thrombosis, and 1,276 (0.05%) had retinal vascular occlusion. When comparing the percentage of patients with IDA versus no-IDA, venous embolism and thrombosis was 10 times more prevalent, cerebrovascular thrombosis was 6 times more prevalent, and retinal vascular occlusion 6 times more prevalent in patients with IDA than in those without IDA in all age groups combined. Conclusions: In this population based study, the incidence of thrombosis was 6-10 times greater in patients with IDA compared to no-IDA. Our data suggests that IDA is a risk factor for thrombosis in all patients. Prospective studies might be needed to confirm our findings. Finally, our data suggests that treatment of IDA might decrease the risk of thrombosis.

Optimizing Preoperative Iron Deficiency Anemia in Patients Undergoing Cardiac Surgery

Background: Preoperative anemia is common in patients undergoing cardiac surgery, with iron deficiency being the most common cause of anemia in these patients. Patients who are anemic in the preoperative setting have worse perioperative outcomes than patients with normal hemoglobin levels including higher rates of red cell transfusions, acute kidney injury, increased length of stay, and increased mortality. At the University of Virginia (UVA) Medical Center, there was no institutional process in place to identify and treat iron deficiency anemia in patients planned to undergo cardiac surgery. Objective: The UVA Perioperative Blood Management Committee is a newly-formed multidisciplinary group consisting of members from the departments of Hematology, Anesthesiology, Thoracic and Cardiovascular Surgery, Perfusion, and Blood Bank who work together to improve perioperative patient outcomes and blood product utilization. We set out to implement a testing algorithm with the purpose of improving the proportion of anemic patients undergoing cardiac surgery who have iron studies performed in the outpatient setting, thereby improving the percentage of patients receiving intravenous (IV) iron preoperatively. Methods: We adapted two published perioperative treatment algorithms (Lin, Hematology Am Soc Hematol Educ Program 2019; Munting and Klein, Anaesthesia 2019) which recommend iron therapy in patients with hemoglobin &amp;lt; 13 g/dL, ferritin &amp;lt; 100 µg/L, and/or transferrin saturation &amp;lt; 20% for our cardiac surgery preoperative clinic. In November 2022, we implemented a reflex test within Epic electronic medical record that automatically sent ferritin, iron, and transferrin for patients with hemoglobin &amp;lt; 13 g/dL to evaluate for iron deficiency. Patients meeting parameters for iron deficiency (ferritin &amp;lt; 30 ng/mL and/or transferrin saturation &amp;lt; 20%) were then scheduled for iron infusions. We compared the percentage of patients undergoing testing for iron deficiency, as well as the percentage of anemic patients receiving iron infusion preoperatively, to those from a six month period prior to our start date. Results: Between May 31, 2022 and October 31, 2022, 19% of cardiac surgery patients at UVA with hemoglobin values &amp;lt; 13 g/dL had iron studies drawn in the three months prior to surgery. After implementing outpatient reflex iron testing, that number increased to 42% between November 2022 and May 2023 (p &amp;lt; 0.001). In the six months prior to implementation, four iron deficient cardiac surgery patients received preoperative IV iron an average of one day prior to surgery. Between November 1, 2022 and May 29, 2023, fifteen patients received IV iron an average of 5.7 days prior to surgery. The patients who received IV iron had lower rates of blood transfusions than anemic patients who did not receive IV iron (53% vs. 65%) and fewer units of blood transfused per patient who received blood (3.1 vs. 5.7). Conclusions: Results from the first seven months of this project suggest that using a standardized testing methodology in the outpatient setting can increase the uptake of iron testing and thereby treatment of iron deficiency anemia in the preoperative setting. Patients who received IV iron had lower rates of blood transfusions and received fewer units of blood on average than anemic patients who did not receive IV iron. We next plan to implement an iron testing strategy in cardiac surgery inpatients to further improve rates of iron testing and iron infusions in this population. We have created an IRB-approved database to study more patient-centered outcomes such as acute kidney injury, stroke, length of stay, readmissions, and mortality to determine if we can detect a measurable impact from IV iron administration in our patient population.

Efficacy of Vitamin C with Iron Supplementation in Iron Deficiency Anemia Patients: A Systematic Review and Meta-Analysis

Background Oral iron supplementation is one of the mainstays of treatment for iron deficiency anemia (IDA) but can be complicated by poor absorption. Vitamin C is hypothesized to increase the acidity of the GI tract and enhance the conversion of non-absorbable ferric iron (Fe 3+) to its absorbable ferrous (Fe 2+) state for improved absorption and is often prescribed with iron. However, whether vitamin C supplementation translates to clinically relevant differences, such as sufficient improvements in hemoglobin, remains unclear and a synthesis of available evidence is lacking. Therefore, the present systematic review and meta-analysis aims to compare oral iron with or without vitamin C supplementation in patients with IDA. Methods MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials were searched from database inception to July 2023 for randomized controlled trials (RCTs) and non-randomized studies (NRSs) that investigated the use of oral iron supplements with vitamin C compared to oral iron supplements only in patients with IDA. Title &amp; abstract, full text review and data extraction were conducted independently and in duplicate. The primary outcome was the change in serum hemoglobin levels in g/dL. Secondary outcomes include change in serum ferritin, change in transferrin saturation, change in reticulocyte percentage, and incidence of adverse events including constipation, nausea/vomiting, GI upset and poor taste. The Mantel-Haenszel fixed effects model was utilized for the meta-analysis. The calculated effect sizes were represented by odds ratios (OR) and mean differences (MD) for binary endpoints and continuous endpoints, respectively, with 95% confidence intervals (CI). Results 2231 studies were retrieved from electronic databases. 12 RCTs and one prospective cohort study comprising 2240 patients were included. There was a small but statistically significant increase in serum hemoglobin level (MD 0.14 g/dL [95%CI 0.08, 0.20]) and serum ferritin levels (MD 3.23 µg/L [95%CI 1.63, 4.84]) in the iron + vitamin C group compared to the iron only group. There was a greater reduction in serum transferrin saturation associated with vitamin C supplementation (MD -2.01% [95%CI -3.31, -0.71%]) but the pool of evidence consists of only two studies. Reticulocyte percentage (MD 0.22% [95%CI 0.08, 0.36]) was higher in the iron + vitamin C group than in the iron only group. There were no significant differences between the iron + vitamin C group and the iron only group in overall incidence of adverse effects (OR 0.71 [95%CI 0.50, 1.00]), constipation (odds ratio (OR) 0.83 [95%CI 0.35, 1.96]), or nausea/vomiting (OR 0.80 [95%CI 0.52, 1.24]). The risk of GI upset is lower in the iron + vitamin C group (OR 0.40 [95%CI 0.18, 0.92]). Nevertheless, only three primary studies reported on incidence of adverse events. Conclusion The addition of vitamin C to iron supplementation in the management of IDA was associated with a statistically significant, but likely clinically unimportant, increase in serum hemoglobin of 0.14 g/dL. Similarly, a statistically significant increase in serum ferritin levels by 3.23 µg/L was observed, but its clinical relevance remains uncertain. A strength of the present analysis is the number of RCTs included; however, its conclusions are limited by the heterogeneity of interventions (e.g. different formulations/dosage) across studies. Our results do not provide strong evidence for adding vitamin C to iron supplementation.

Implications of Iron Deficiency Anaemia on Glycemic Dynamics in Diabetes Mellitus: A Critical Risk Factor in Cardiovascular Disease.

Iron deficiency anemia (IDA) is a highly prevalent comorbidity in patients with diabetes, with rates estimated between 13% and 47% across studies. Iron deficiency anemia may potentially influence hemoglobin A1c (HbA1c) values, which are routinely measured to monitor long-term glycemic control in diabetes. Some evidence suggests that HbA1c may be lower in diabetics with IDA due to increased red blood cell turnover. However, current evidence elucidating the effects of IDA on HbA1c and diabetes outcomes remains inconsistent and inconclusive. This cross-sectional study aimed to evaluate the relationship between IDA, HbA1c levels, and glycemic dynamics in patients with diabetes mellitus. The study sample included 143 adult patients diagnosed with diabetes, recruited from outpatient clinics in Saudi Arabia. Iron deficiency anemia was identified through serum ferritin <100 ng/mL, transferrin saturation <20%, and hematologic parameters. The HbA1c levels were measured using standardized laboratory methods. Daily glucose profiles were obtained by continuous glucose monitoring (CGM) in a subset of patients to assess glycemic dynamics. The prevalence of IDA was 39.9% among the diabetic cohort. Patients with IDA had a numerically higher mean HbA1c of 7.2% compared to 6.8% in non-anemic diabetics, suggesting a potential effect of IDA on HbA1c. Those with IDA also spent more time in hyperglycemic ranges, along with greater glucose variability based on CGM data. Iron deficiency measures, including low ferritin and high red cell distribution width (RDW), showed weak positive correlations with HbA1c levels. Iron deficiency anemia is highly prevalent among Saudi diabetic patients and is potentially associated with inaccurate HbA1c values and poor short-term glycemic control. However, larger controlled studies are warranted to conclusively investigate mechanisms linking IDA to alterations in HbA1c and glycemic dynamics. Optimized screening and treatment of IDA may lead to more accurate diabetes monitoring and improved outcomes.

Safety and Efficacy of FCM in the Management of Iron Deficiency Anaemia: a Multi-centre Cohort-based Study

This study investigated the efficacy and safety of ferric carboxymaltose (FCM) in the treatment of iron deficiency anaemia (IDA) in a cohort of 100 patients across four locations in West Bengal, India. The results demonstrated significant improvements in various hematological parameters, including a substantial increase in haemoglobin levels, following FCM administration. The study also highlighted the absence of adverse events, showcasing a favorable safety profile of FCM in this population. The use of FCM, a third-generation parenteral iron formulation, proved effective in addressing moderate-to-severe IDA, aligning with existing evidence supporting its efficacy and safety. The rapid and substantial improvement in haemoglobin levels observed within four weeks of FCM administration emphasizes its efficiency in iron repletion, particularly in cases where oral preparations may be insufficient. The absence of adverse effects further supports the tolerability of FCM, a crucial factor in its consideration for widespread use. The study contributes valuable real-world data, especially in the context of the high prevalence of anaemia in India. The findings underscore the potential of FCM as a cornerstone in the treatment of severe anaemia, advocating for its inclusion in targeted interventions and public health initiatives. Overall, this study adds to the growing body of evidence supporting FCM as a promising option in the management of iron deficiency anaemia.