Treatment Of Iron Deficiency Research Articles

Screening and treatment of iron deficiency among heart failure patients with impaired ejection fraction: The impact of a pharmacist‐led protocol

AbstractBackgroundDespite guideline‐recommended routine screening and iron deficiency (ID) treatment among heart failure (HF) patients, these practices are often underutilized. Currently, limited data are available on the outcomes of pharmacists' programs to enhance ID screening and management. Accordingly, we sought to describe the frequency and yield of screening for ID and intravenous (IV) iron replacement rates among our cohort of HF patients and examined the impact of implementing a pharmacist‐led protocol (PLP) aimed at enhancing these rates.MethodsWe conducted a retrospective study involving HF patients with left ventricular ejection fraction (LVEF) <45% at a quaternary care hospital in the Middle East/Gulf region. The PLP was introduced in August 2022. Data on demographics, comorbidities, echocardiographic parameters, laboratory findings (including ID screening and its findings), and rates of treatment with IV iron replacement were analyzed and compared between the pre‐implementation group (n = 432, October 2015–February 2020) and the post‐implementation group (n = 154, August 2022–January 2023).ResultsBefore the PLP, 63.2% (n = 273) of eligible patients underwent ID screening, with 80.6% (n = 220) found to have ID. Following the implementation of the PLP, screening rates significantly increased to 86.4% (n = 133) (p = 0.03), with 53.4% (n = 71) diagnosed with ID. The rate of IV iron replacement in ID patients improved from 30.4% (n = 67) in the pre‐PLP group to 73% (n = 52) in the post‐PLP group (p < 0.001). Multivariable logistic regression identified baseline glomerular filtration rate (GFR) and hemoglobin levels as significant predictors of IV iron replacement in the pre‐PLP cohort.ConclusionsImplementing a pharmacist‐led protocol was significantly associated with enhancing the screening and treatment of ID in patients with HF and LVEF <45%. This study demonstrates the crucial role of pharmacists in optimizing guideline‐directed therapies, which can be replicated in various healthcare settings.

Association between iron deficiency and fertility.

This retrospective, observational cohort study investigated the association between treatment of iron deficiency with conception results and pregnancy outcomes in women with infertility and iron deficiency, before and after intravenous ferric carboxymaltose infusion. Data were collected from electronic health records from the Dextra Fertility Clinic (Helsinki, Finland) between 2015 and 2020. The cohort included 292 women (<43 years) with infertility and iron deficiency (s-ferritin ≤30 μg/L), treated with a ferric carboxymaltose infusion (Ferinject®, 500 mg i.v.). The main outcomes were live birth and miscarriage rates before and after treatment of iron deficiency. The main explanatory variable studied was the administered iron infusion. Mean s-ferritin levels increased from 16.2 ± 7.0 μg/L before to 81.5 ± 49.8 μg/L after iron infusion. The proportion of patients who conceived increased from 65% before to 77% after treatment of iron deficiency (p < 0.001). Of the study population, 28% of patients experienced miscarriages and 26% gave a live birth before iron infusion, and 13% and 51% after treatment of iron deficiency (p < 0.001). In the model adjusted for age, use of preimplantation genetic testing for aneuploidy, and repeated iron infusions, treatment of iron deficiency with iron infusion was associated with a higher live birth rate (OR = 3.19; 95% CI = 2.21-4.66; p < 0.001). In the model adjusted for age, reason for infertility, and total number of pregnancies, treatment of iron deficiency was associated with lower miscarriage rates (OR = 0.32; 95% Cl = 0.20-0.52; p < 0.001). Filling of depleted iron stores was positively associated with conception results (higher number of pregnancies) and pregnancy outcomes (higher live birth rates and lower miscarriage rates), regardless of the assisted reproductive technology method used. Screening of iron status seems to be important in patients seeking help for infertility problems.

Hereditary haemorrhagic telangiectasia.

Hereditary haemorrhagic telangiectasia (HHT) is a vascular dysplasia inherited as an autosomal dominant trait and caused by loss-of-function pathogenic variants in genes encoding proteins of the BMP signalling pathway. Up to 90% of disease-causal variants are observed in ENG and ACVRL1, with SMAD4 and GDF2 less frequently responsible for HHT. In adults, the most frequent HHT manifestations relate to iron deficiency and anaemia owing to recurrent epistaxis (nosebleeds) or bleeding from gastrointestinal telangiectases. Arteriovenous malformations (AVMs) in the lungs, liver and the central nervous system cause additional major complications and often complex symptoms, primarily due to vascular shunting, which is right-to-left through pulmonary AVMs (causingischaemic stroke or cerebral abscess) and left-to-right through systemic AVMs(causing high cardiac output). Children usually experience isolated epistaxis; in rare cases, childhoodcomplications occur from large AVMs in the lungs or central nervous system. Management goals encompass control of epistaxis and intestinal bleeding from telangiectases, screening for and treatment of iron deficiency (with or without anaemia) and AVMs, genetic counselling and evaluation of at-risk family members. Novel therapeutics, such as systemic antiangiogenic therapies, are actively being investigated. Although HHT is associated with increased morbidity, the appropriate screening and treatment of visceral AVMs, and the effective management of bleeding and anaemia, improves quality of life and overall survival.

Comparison of Iron Bisglycinate to Iron Polymaltose for the Treatment of Iron Deficiency Anemia in Children

Abstract: Introduction: Different iron formulations are prescribed to correct iron deficiency anemia, however, there is a lack of head to head trials locally. Objective: To compare the efficacy of Iron Bisglycinate with Iron Polymaltose in treating iron deficiency anemia in children. Methodology: A parallel group randomized double blind study was carried out at Benazir Bhutto hospital from 1st July 2022 to 31st December 2022. A total of 132 children were enrolled. Participants were allocated 1:1 to either Group A or Group B. Group A was given iron bisglycinate and Group B received iron polymaltose. Patients were assessed at baseline and were followed up at 1 month and 3 months. At all these intervals hemoglobin levels, MCV, MCH, Serum ferritin and adverse effects were noted and outcomes were assessed. Results: The mean age of the patients in Group A versus B was 7±2.31 versus 6±2.33. The mean hemoglobin levels at baseline in Group A versus B was 9±0.48 versus 8.9±0.49 g/dl and at 3 months in Group A versus B was 10±0.43 versus 9.4±0.48 g/dl, respectively with p value of 0.000. The mean serum ferritin levels at baseline in Group A versus B was 9.1±1.31 versus 8.8±1.19 ng/ml and at 3 months was 29±5.65 ng/ml and in Group B was 23±1.87 ng/ml, respectively with p value of 0.000. Conclusion: In children with iron deficiency anemia, iron bisglycinate significantly increased hemoglobin, MCV, MCH and serum ferritin levels compared to iron polymaltose. Keywords: Anemia, Ferritin, Hemoglobin, Iron Bisglycinate, Iron Polymaltose, Iron Deficiency.

Effectiveness of diet therapy compared to medical pharmacological treatment for iron deficiency anemia in residents of the temporary shelter in the Jesús del Gran Poder neighborhood, aged 18 to 75 years, Santo Domingo

Introduction: food plays an essential role in the incorporation of iron, a mineral necessary for the growth and development of the body. Diet therapy is applied to people who suffer from a disease; in this case, iron deficiency anemia, consisting of a decrease in hemoglobin levels in the blood due to iron deprivation.Objective: to determine the effectiveness of diet therapy compared to pharmacological treatment to treat iron deficiency anemia in people from the Jesús del Gran Poder neighborhood, in the period February-May, Santo Domingo 2021Methods: quasi-experimental longitudinal study, for data collection a sociodemographic data sheet was used and a blood count was performed to corroborate the diagnosis. The sample was divided into a control and experimental group, each group of 15 participants. The control group was given 50 g of oral iron, once a day, and the experimental group received diet therapy workshops for three months.Results: at the end of the treatment, the results of the intervention showed that 53% of the experimental group had moderate anemia and 47% had mild anemia, while 80% of the control group had anemia and 20% had mild anemia. After the intervention, 100% of both groups significantly overcame anemia, demonstrating the effectiveness of the experimental treatment.Conclusions: a decrease in iron deficiency anemia was obtained compared to the control sample; although the difference between the levels was not significant, there was an efficacy in the application of the natural treatment

Cost-effectiveness of ferric citrate hydrate in patients with iron deficiency anemia.

We investigated the cost-effectiveness of treating iron deficiency anemia (IDA) with ferric citrate hydrate (FC) in Japan. We employed four treatment strategies: switching from sodium ferrous citrate (SF) to FC at (1) 500mg (approximately 120mg of iron) per day or (2) 1000mg (approximately 240mg of iron) per day in patients with SF-induced nausea/vomiting, or starting treatment with FC at (3) 500mg/day or (4) 1000mg/day. We evaluated the cost-effectiveness of these strategies compared with SF 100mg (100mg of iron) per day. Incremental effects over 26weeks relative to SF 100mg were 0.0052 quality-adjusted life years (QALYs) for (1) and (2), and 0.0044 QALYs for (3) and (4). From the payer's perspective, incremental cost-effectiveness ratios (ICERs: JPY/QALY) against SF 100mg were: (1) 1,107,780, (2) 2,257,477, (3) 5,588,430, and (4) 11,544,816. All four FC strategies were dominant (less costly and more effective) from a limited societal perspective. Treatment with FC for IDA was cost-effective (ICER ≤ JPY 5,000,000/QALY) when switching strategies from the payer perspective, and cost-saving (all FC strategies) from limited societal perspectives. Individual patients' characteristics and cost-effectiveness should be considered in treatment selection.

Comparison of the efficacy and safety between high-dose intravenous iron and oral iron in treating iron deficiency anemia: a multicenter, prospective, open-label, randomized controlled study

Objective: This study aimed to compare the efficacy and safety between high-dose intravenous iron and oral iron in treating iron deficiency anemia (IDA) . Methods: This prospective randomized controlled study (1∶1) enrolled 338 patients with IDA at The First Affiliated Hospital of Soochow University, Suzhou Hongci Hematology Hospital, and Huai'an Second People's Hospital from June 1, 2022, to January 19, 2024. Of all the patients, 169 received high-dose intravenous iron therapy and 169 received oral iron treatment for 12 weeks of observation. Focus on the hemoglobin (HGB) change from baseline to week 4, secondary focus was on the HGB and iron metabolism parameters (serum iron [SI], transferrin saturation [TSAT], total iron binding force [TIBC], serum ferritin [SF]), and changes in the fatigue score, efficacy, and treatment-related adverse effects were monitored throughout in the two treatment groups. Results: The HGB levels were improved in both treatments, but the HGB improved faster in the intravenous group compared with the oral group. HGB increased from (76.8±15.0) g/L to (118.0±13.3) g/L in the intravenous group and from (77.9±11.6) g/L to (104.3±15.0) g/L in the oral group after 4 weeks of treatment. The increase from baseline in the intravenous group (40.7±17.3) g/L was significantly higher than that in the oral group (27.2±17.5) g/L (P<0.001). The intravenous group demonstrated a more significant early effect than the oral group in terms of iron metabolism parameter improvement. SI, TSAT, TBIC, and SF increased better from baseline at 4 weeks in the intravenous group than in the oral group (P<0.001). Additionally, the intravenous group exhibited better fatigue scores for early improvement than the oral group (P<0.001). The incidence of total adverse effects was similar in the intravenous group as compared to the oral group (3.5% [6/169] vs 5.9% [10/169], P=0.442) . Conclusion: High doses of intravenous iron quickly boost HGB early, causing rapid improvement in SI, TSAT, TBIC, SF, and patient fatigue scores. The patient was well tolerated.

An Overview on Iron Deficiency Anaemia

"Anaemia’’ is defined as a collection of disorders caused by erythropoietin tissues' incapacity to maintain normal haemoglobin concentration due to insufficient availability of one or more nutrients, which lowers the amount of haemoglobin in circulation overall. It can be brought on by a poor vegetarian diet, iron malabsorption, hookworm infections, profuse bleeding during menstruation, or childbirth.Low birth weight, decreased immunological function, poor cognitive development, behavioural issues, decreased job ability, and maternal mortality are among the negative outcomes of anaemia. The most popular and sensitive initial diagnostic test for IDA is serum ferritin. The most effective methods of treating iron deficiency anaemia include dietary variety, supplementation, fortification of staple foods, and nutrition education. Keywords: Anaemia, iron deficiency, micronutrient deficiency, nutritional anaemia

S55 Ironing Out the Efficacy and Safety Profile of Ferric Carboxymaltose Infusions for the Treatment of Iron Deficiency and Iron-Deficiency Anemia in Pediatric Inflammatory Bowel Disease

S55 Ironing Out the Efficacy and Safety Profile of Ferric Carboxymaltose Infusions for the Treatment of Iron Deficiency and Iron-Deficiency Anemia in Pediatric Inflammatory Bowel Disease

Safety and Efficacy of Ferric Carboxymaltose for Iron Deficiency Anemia in Inflammatory Bowel Disease: A Systematic Review.

Ulcerative colitis and Crohn's disease, two types of inflammatory bowel disease (IBD), often cause anemia, primarily due to iron deficiency and chronic inflammation. Anemia negatively affects patients' daily functioning and quality of life, causing symptoms including headaches, exhaustion, and dyspnea. In IBD, iron deficiency arises from reduced intake, chronic blood loss, and impaired absorption. While oral iron supplements are commonly used, their poor absorption and gastrointestinal side effects limit their effectiveness, especially in IBD patients. The European Crohn's and Colitis Organization (ECCO) recommends intravenous iron, such as ferric carboxymaltose (FCM), as iron deficiency anemia in IBD can be managed using a safe and efficient substitute. With regard to treating iron deficiency anemia in patients with IBD, the purpose of this study is to investigate the safety and effectiveness of intravenous ferric carboxymaltose. We conducted a thorough search of medical databases, such as the Cochrane library, PubMed, and ResearchGate, to gather relevant literature. Using the databases, we found a total of 297 relevant articles. The identified studies have been screened, eligibility criteria have been introduced, and 14 research studies were selected for inclusion. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, with quality assessments conducted using the Cochrane risk of bias 2 scale for randomized tests and the Newcastle-Ottawa scale for observational examination. We reviewed 14 research articles involving 2,493 patients. Among these, five were randomized controlled trials (RCTs), and the remaining nine were observational studies. The primary outcomes assessed were the therapeutic response (defined as hemoglobin ≥2 g/dL rise or normalization, improvement in iron profile parameters) and any adverse effects after FCM is administered to IBD patients. FCM was found to be highly effective in improving hemoglobin and iron profile parameters, with a generally good safety profile. Ferric carboxymaltose was the most efficient and well-tolerated intravenous (IV) iron formulation, proving safer and more effective than other iron therapies in patients suffering from IBD. However, severe hypophosphatemia can lead to serious complications, including heart failure, pulmonary failure, rhabdomyolysis, fractures, and osteomalacia, which may worsen its long-term impact. Therefore, the risk of hypophosphatemia associated with prolonged FCM use requires careful monitoring and further research to ensure its long-term safety and assess its effects on patients' quality of life.

Prebiotics and iron fortification among women of reproductive age group - Is there an association with liver and renal function tests?

Iron fortification compounds are of special interest to treat iron deficiency anemia, however, the dose-response effects of these fortificants on liver and renal functions have not been extensively reported in human subjects. The present study determines the effects of prebiotics and iron fortificants on liver function tests (LFTs) and renal function tests (RFTs) among women of reproductive age (WRA). A double-blind randomized controlled trial was performed for the duration of 90 days. A total of 75 iron-deficient women were selected and randomly divided into 5 groups (4 treatment groups and 1 control group). For this purpose, four different types of fortified wheat flour were prepared using two iron fortificants (NaFeEDTA and FeSO4) and two prebiotics (Inulin and Galacto oligosaccharides) were given to four treatment groups, while control groups were only given iron-fortified flour without the addition of prebiotics. Blood samples were collected every month to evaluate Liver Function Tests, including Alanine Transaminase (ALT), Aspartate Transaminase (AST), Alkaline Phosphatase (ALP), total bilirubin and Renal Function Tests, including serum urea and creatinine. Our results found that prebiotic and iron-fortified diets increased ALT, AST and total bilirubin levels among WRA. For AST, ALP and total bilirubin, our results found the highest increase in the treatment groups treated with prebiotics and iron fortificants at 963 mg/kg GOS + 15 ppm FeSO4. Moreover, the highest values of ALT and serum creatine were seen in groups treated with 963 mg/kg Inulin + 20 ppm NaFeEDTA, while maximum value for serum urea could be seen in the group given 963 mg/kg GOS + 30 ppm FeSO4. The study concluded that prebiotic and iron-fortified diets increased ALT, AST and total bilirubin levels among WRA.

Therapeutic intervention with intravenous ferric carboxy-maltose: addressing iron deficiency among heart failure patients.

Dear editor, Heart failure is a debilitating life sentence plagued with multifactorial variables that greatly influence the morbidity and mortality of the patient. Iron deficiency, one of these variables, is a leading contributor to anaemia among individuals with stable chronic heart failure, affecting approximately 30% to 50% of this population irrespective of left ventricular ejection fraction or demographic variables such as gender and race.(1,2) Intriguingly, even among those without overt anaemia, more than 40% display laboratory evidence of depleted iron stores. Moreover, in acute decompensated heart failure (HF), iron deficiency (ID) can be identified in as many as 80% of assessed patients, emphasizing the significance of research initiatives aimed at understanding the underlying cause of ID in HF patients and enhancing their clinical management.(3) A survey conducted in the region of South Asia revealed that 46% of Pakistani heart failure patients and 58.8% of those in India were affected by iron deficiency(4). Implementing simple practices to treat the underlying anaemia can massively improve the quality of life and reduce rehospitalization rates.(1–3,5) Notably, in Pakistan, the rehospitalization rate sits at a staggering 81%. Ferric carboxy-maltose is an intravenous iron formulation which has been extensively explored in clinical studies such as the IRON-CRT, IRONMAN and AFFIRM-AHF trials. The trials displayed promising outcomes with marked improvement in general well-being and physical capacities including 6-minute exercise tolerance as well as lowering the need for hospitalisation independent of baseline haemoglobin levels.(1,2,5) Ferric carboxy-maltose has demonstrated superiority over oral iron supplements and other treatments, such as erythropoietin stimulating medications, making it a recommended and successful alternative for iron deficiency therapy according to both European and American guidelines.(1–3,5) The latest heart failure guidelines emphasize the importance of screening for iron deficiency in every patient diagnosed with heart failure.(2) Unfortunately, the implementation of this practice is not consistently applied in developing countries, as observed in our own experiences in Pakistan. In conclusion, establishing Ferric Carboxy-maltose as the standard treatment for iron deficiency is recommended due to its cost-effective nature and the near instant improvement in patients health and morale. This approach would contribute to a more productive and fulfilling life for patients, even enabling them to regain some level of autonomy in their daily activities. ---Continue

Obesity and iron deficiency: what is the connection and how to treat?

The article presents a review of the literature and our own data on the etiology and pathogenesis of iron deficiency and iron deficiency anemia in patients with obesity. Obesity is considered as a subclinical systemic chronic inflammation, which is associated with an increase in the level of hepcidin, which is a key mediator of anemia during inflammation. Patients with obesity should undergo periodic screening of iron status and ferrokinetic parameters. Today, new oral iron preparations with increased tolerability and improved absorption are used in clinical practice. These include sucrosomial iron preparations. Sucrosomial iron (SI) is an innovative oral iron-containing carrier in which iron pyrophosphate is enclosed in a phospholipid matrix coated with sucrester, which protects sucrosomial iron from the effects of gastric juice, excluding contact with the mucous membrane of the gastrointestinal tract. Resistance to the action of gastric juice allows intact sucrosomes to reach the mucous membrane of the small intestine, where they are absorbed through special M cells, followed by the release of iron in liver cells. This allows prescribing SI to patients with iron deficiency and inflammatory bowel diseases, celiac disease, cancer and patients with obesity. Sucrosomial iron should be considered as an alternative treatment for iron deficiency in obese women. SI is innovative, allowing to bypass the “hepcidin barrier”, convenient for administration, effective for treatment, well tolerated than traditional oral iron salts.

Is It Safe to Correct Iron Deficiency Anemia with Intravenous Iron in Pregnancy? a Systematic Review and Meta-Analysis

Background: Iron deficiency anemia is common among pregnant patients. There is lack of consensus on the approach to management of iron deficiency anemia in pregnancy and controversy remains surrounding the risks associated with its correction. Previous systematic reviews have examined the effectiveness of various management strategies for iron deficiency anemia in pregnancy; however, severe adverse maternal and neonatal effects have not been systematically described. The aim of this systematic review and meta-analysis was to evaluate for adverse maternal and neonatal effects with intravenous (IV) versus oral iron in pregnancy. Methods: A comprehensive search in MEDLINE, Embase, and CENTRAL from database inception to January 2024 was performed. Articles were eligible for inclusion if they were 1) randomized controlled trials or cohort studies; 2) included pregnant individuals with iron deficiency anemia; 3) comparing patients who received IV iron with those who received oral iron and 4) examining for severe adverse effects in mothers and neonates. IV iron formulations with known safety concerns such as high molecular weight iron dextran were excluded. The primary outcome was preterm birth. Secondary outcomes included neonatal outcomes (e.g., intrauterine growth restriction (IUGR), Apgar scores, admission to the neonatal intensive care unit, stillbirths and neonatal deaths) and maternal outcomes (e.g., red blood cell (RBC) transfusions, postpartum hemorrhage, maternal intensive care unit admission, hysterectomy, unplanned C-section, postpartum depression and maternal death). Data from included studies were extracted by two reviewers independently and in-duplicate, using a standardized data collection form. Disagreements were adjudicated by a third reviewer. Risk of bias assessments were conducted using standard study design specific tools. Inverse variance random effect meta-analyses were used to pool effect estimates using RevMan 5.4. Results: A total of 1,568 citations were initially obtained of which 28 studies met inclusion criteria and 24 were randomized controlled trials. In total, 3,402 pregnant patients received IV iron and 3,640 pregnant patients received oral iron. All studies administered IV iron or oral iron within the second or third trimester of pregnancy. The most frequently reported IV iron formulations were iron sucrose and ferric carboxymaltose. The most frequently reported oral iron formulation was ferrous sulphate. There was no difference in risk of premature birth between IV and oral iron formulation groups (risk ratio (RR): 0.98, 95% Cl: 0.83 to 1.15, p=0.78, I2=0%). Rates of IUGR (RR:0.88, 95% Cl: 0.74 to 1.03, p=0.12, I2=0%), stillbirths (RR:0.93, 95% Cl: 0.56 to 1.52, p=0.76, I2=0%) and neonatal deaths (RR: 0.72, 0.45 to 1.17, p=0.19, I2=0%) were also similar between IV and oral formulation groups. Rates of adverse maternal outcomes (RBC transfusion (RR:1.00, 95% Cl: 0.57 to 1.76, p=1.00, I2=17%), postpartum hemorrhage (RR: 0.92, 95% Cl: 0.62 to 1.35, p=0.65, I2=0%), unplanned C-sections (RR: 1.33, 95% Cl: 0.99 to 1.78, p=0.06, I2=0%)) were also similar between formulation groups. No studies examined for differences in rates of postpartum depression. Meta-analyses could not be generated for Apgar score &amp;lt;7 at 5 minutes, admissions to the neonatal intensive care unit, maternal admissions to the intensive care unit and maternal death due to an insufficient number of studies reporting these outcomes. Conclusions: This systematic review and meta-analysis found no difference in risk of adverse neonatal nor maternal outcomes for IV iron compared with oral iron when used to treat iron deficiency anemia of pregnancy. This suggests that IV iron should not be avoided in pregnancy for fear of severe adverse neonatal or maternal events, and provided if deemed clinically appropriate.

Comparative analysis of ferric carboxymaltose and iron sucrose in treating iron deficiency anemia in perimenopausal women with heavy menstrual bleeding: a randomized controlled trial.

To evaluate the impact of intravenous ferric carboxymaltose (FCM) compared to iron sucrose (ISC) in perimenopausal women with heavy menstrual bleeding (HMB) and anemia. This prospective, open-label, randomized controlled trial enrolled perimenopausal women (40-50 years) with HMB and hemoglobin levels between 6-10 g/dL, intolerant or non-compliant to oral iron therapy. The study compared FCM and ISC by assessing hematological parameters, including hemoglobin, ferritin, and iron levels, over a 12-week period. The patients were followed up at 3, 6, and 12 weeks after initiation. The adverse effects were also evaluated. The study included 60 perimenopausal women, with 30 in each group. The baseline patient characteristics were comparable. FCM demonstrated a statistically significant higher mean increase in hemoglobin (4.97 g/dL) than ISC (4.63 g/dL) over 12 weeks. The proportion of patients achieving correction of anemia (hemoglobin ≥12 g/dL) was higher in the FCM group (75.9% vs. 65.5%). Serum ferritin levels were significantly higher in the FCM group after 3 weeks. Adverse effects were minimal and comparable between the groups. Although the direct cost of FCM is high, its ability to be administered in larger doses may result in lower total costs. In perimenopausal women with heavy menstrual bleeding and iron deficiency anemia, FCM and ISC show comparable efficacy in increasing hemoglobin levels with similar side effect profiles. This study highlights the potential benefits of FCM and calls for further exploration of these therapies in diverse patient populations.

Iron deficiency anemia in pregnancy and the postpartum: a practical approach by the Italian GOAL Working Group.

Iron deficiency and iron deficiency anemia represent global health issues, particularly during pregnancy and the postpartum. The present paper aims to summarize the appropriate management of these conditions in order to try to improve how clinicians perceive, diagnose and treat iron deficiency and iron deficiency anemia. An expert panel of Italian obstetricians of Lazio region was convened to evaluate the available literature on iron deficiency and iron deficiency anemia during pregnancy and the post-partum in order to try to define a flow chart on the appropriate management of such conditions; aspects related to the patient blood management have also been investigated. According to both hemoglobin level and ferritin values, five the flow charts on the appropriate management of iron deficiency and iron deficiency anemia have been drawn. It is desired to define appropriate flow charts to treat iron deficiency and iron deficiency anemia, which are too often not promptly diagnosed and managed, in order to try to improve antenatal care.

Correction of iron deficiency and iron deficiency anemia in women of reproductive age: choice of a drug within framework of concept of patient blood management

The article presents a review of the literature and our own data on the problem of prevention, diagnosis and treatment of iron deficiency and iron deficiency anemia in patients of reproductive age with a burdened somatic status with the development of a chronic inflammatory process. In the concept of patient blood management (PBM), the diagnosis and treatment of anemia in patients with gynecological diseases requiring subsequent surgical treatment is given paramount importance, since anemia and iron deficiency are considered risk factors for worse treatment outcomes for patients. Women with gynecological pathology often have diseases that are accompanied by the development of a systemic inflammatory response, which leads to activation of hepcidin protein synthesis and the development of so-called anemia of inflammatory diseases. Data are presented indicating the effectiveness and safety of the sucrosomial iron drug (SiderAL® Forte) in obstetric and gynecological patients with increased levels of C-reactive protein in combination with iron deficiency and iron deficiency anemia. The increase in ferrokinetic parameters in patients receiving sucrosomial iron is due to the unique physicochemical and pharmacokinetic characteristics of sucrosome, which provides protection of sucrosomial iron from the effects of gastric juice, excluding contact with the mucous membrane of the gastrointestinal tract and its absorption through special M-cells of the small intestinal mucosa followed by the release of iron in liver cells. Sucrosomial iron is novel, convenient, effective, and well tolerated compared with traditional oral iron supplements.

Frequency, Types, and Risk Factors of Anemia in Pediatric Inflammatory Bowel Disease

Objective: Inflammatory bowel disease patients are prone to be anemic at diagnosis and follow-up. As it is a common extra-intestinal manifestation, its early identification and treatment are essential. We aimed to evaluate the frequency, types, and predictors of anemia and its treatment in pediatric inflammatory bowel disease patients. Methods: The electronic records of pediatric IBD patients who attended our outpatient clinics between 1 April 2018 and 01 May 2019 were retrospectively evaluated. Patients who had the results of hemoglobin, hematocrit, mean corpuscular volume, iron indices, vitamin B12 level, folic acid level, reticulocyte count, C-reactive protein, and erythrocyte sedimentation rate at least once on a single day were included in the study. Laboratory results associated with anemia and disease activity index scores at three- and six-months follow-ups were recorded. Anemia was diagnosed according to WHO criteria in childhood. Anemia, risk factors, and management of anemia were determined. Results: Forty patients were included in the study. At first evaluation, anemia was observed in 38.1% of Crohn’s disease patients and 57.9% of ulcerative colitis patients. Iron deficiency anemia was the main type of anemia in both groups. The rate of anemia decreased at follow-up. Out of 40 patients, 21 had treatment at the initial evaluation. Active disease was the only predictor of iron deficiency anemia. Conclusion: Anemia was common in pediatric inflammatory bowel disease patients, ranging between 25-47.5% during the 6-month follow-up in our study. Iron deficiency anemia was the main type of anemia. Having active disease was the only risk factor for anemia. The treatment of anemia and iron deficiency without anemia should be kept in mind in parallel with anti-inflammatory treatment.

Diagnosis and Treatment of Iron Deficiency and Iron Deficiency Anemia in Children and Adolescents: Recommendations of the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Society of Neonatology, and the Polish Society of Family Medicine.

Background/Objectives. Iron deficiency is one of the most common nutritional deficiencies worldwide and is the leading cause of anemia in the pediatric population (microcytic, hypochromic anemia due to iron deficiency). Moreover, untreated iron deficiency can lead to various systemic consequences and can disrupt the child's development. Methods/Results. Therefore, a team of experts from the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Neonatology Society, and the Polish Society of Family Medicine, based on a review of the current literature, their own clinical experience, and critical discussion, has developed updated guidelines for the diagnosis, prevention, and treatment of iron deficiency in children from birth to 18 years of age. These recommendations apply to the general population and do not take into account the specifics of individual conditions and diseases.

Hepcidin Modulators: A Potential Alternative Treatment of Iron Deficiency and Iron Deficiency Anemia in Heart Failure

Heart failure affects roughly 6.7 million Americans and is associated with many comorbidities and complications, including iron deficiency and anemia. Iron homeostasis is integral to optimal body function. Hepcidin, a hepatically produced peptide, is a major modulator in iron homeostasis. Its synthesis is induced in part by inflammatory states. Iron deficiency in heart failure is currently diagnosed with the assessment of serum ferritin and percent of transferrin saturation. Iron deficiency in the setting of hepcidin excess in inflammatory conditions, such as heart failure, is discussed in this literature review. Iron deficiency is associated with worse prognosis and poorer outcomes in heart failure patients. Targeted treatment of iron deficiency and iron deficiency anemia may provide improved quality of life and decrease mortality and morbidity among heart failure patients. Current treatment options for iron deficiency and anemia include intravenous and oral iron supplementation, as well as other erythropoiesis-stimulating agents. However, concerns regarding safety have been raised in regards to these options. An emerging possibility for the treatment of iron deficiency in the setting of hepcidin overload is hepcidin modulators, including hepcidin antagonists or inhibitors. This review has addressed iron deficiency and anemia in heart failure and suggests that hepcidin antagonists/inhibitors may provide a viable alternative to the classic treatment methods.