Treatment Of Iron Deficiency Anemia Research Articles

Differential Recovery of Macrophage Iron Deficiency By Oral Iron Formulations Determines Cell Inflammatory Response in Conditions of Iron Deficiency Anemia

Introduction: Sucrosomial iron (SI) is an innovative oral iron formulation which is absorbed intact through para and trans-cellular intestinal routes as well as via M-cells. Once in the circulation SI is internalized intact by reticulo-endothelial macrophages, which likely play a major role in iron recycling from the sucrosome shell and release into the bloodstream where iron joins the transferrin (Tf)-bound iron pool. By contrast, the common oral iron salt iron sulfate (FeSO4) is absorbed via the canonical inorganic iron pathway involving DMT1 and FPN and directly joins the Tf-bound iron pool. FeSO4 administration generates higher levels of free non-transferrin-bound iron (NTBI) to which macrophages can be exposed, leading to cell iron accumulation. Thus iron provided both as SI or FeSO4 can target macrophages. Recently, macrophage iron overload has been implicated in sterile inflammation through ROS-dependent cell pro-inflammatory activation. Here we investigated and compared how SI and FeSO4 shape the polarization status of macrophages and affect inflammation in conditions of iron deficiency anemia. Methods: To this aim, iron-deficient wild-type mice administered a low iron diet (<10ppm) were repeatedly treated with SI or FeSO4 every day for 2 weeks to correct their anemia, and hepatic and splenic macrophages were analyzed in term of cell iron status and inflammatory response. Results: Iron-deficient mice treated with SI showed an efficient but slightly slower recovery of anemia as monitored by blood parameters (e.g. Hb, RBC, HCT) compared to FeSO4-treated animals. The gradual anemia recovery by SI likely reflects the additional macrophage-dependent processing needed to recycle iron from the intact SI shell, which is not required following FeSO4 absorption. Indeed, Tf saturation and NTBI were more elevated in FeSO4-treated than SI-treated mice. Consistent with these observations, FeSO4 corrected intracellular iron deficiency in macrophages more rapidly than SI, as indicated by a more pronounced TfR1 suppression and bigger labile iron pool. This triggered more elevated ROS levels and increased apoptosis in macrophages from FeSO4-treated compared to SI-treated mice. Importantly, the faster cell iron deficiency recovery was associated with TNFα, IL1β and IL-6 release in macrophages from FeSO4-treated mice, which remained almost negligible in cells from SI-treated animals. In vivo findings are fully recapitulated in vitro in iron-deficient bone marrow-derived macrophages (BMDM) exposed to SI or FeSO4. FeSO4 corrected macrophage iron status faster than SI, as suggested by a quick rise in labile iron pool and suppression of TfR1 after 2h of treatment. By contrast, SI showed a slower and progressive ability to improve cell iron deficiency, modulating LIP and TfR1 after 5h of treatment, in agreement with a longer recycling process of iron from the SI shell. While FeSO4 exposure caused a massive increase in ROS levels and a significant elevation of inflammatory cytokines, SI minimally affected ROS and inflammatory cytokine production in BMDMs. Conclusions: Our data indicate that the gradual cell iron deficiency correction by SI exerts a protective effect in macrophages against iron-mediated inflammatory activation by limiting ROS formation, suggesting that the kinetic of cell iron accumulation determines macrophage inflammatory response. Overall, these studies show that SI is a superior oral iron formulation than iron salts in terms of reduced pro-oxidant and inflammatory action, with relevance for iron deficiency anemia treatment in individuals with pre-existing inflammatory conditions, including chronic kidney disease, anemia of cancer, inflammatory bowel disease, ulcerative colitis, post-operative anemia, celiac disease and obesity.

Comparison of the use of intravenous iron sucrose with intravenous ferric Carboxymaltose for treatment of iron deficiency anaemia in pregnant patients

BACKGROUND &amp; OBJECTIVE: Iron deficiency results in major disabilities and death all over the world, about two billion people are suffering from anaemia at the moment. To compare intravenous iron sucrose with intravenous ferric carboxymaltose in terms of mean change in hemoglobin level and mean corpuscular volume (MCV) for treatment of iron deficiency anaemia in pregnant patients.&#x0D; METHODOLOGY: Prospective comparative study was conducted at the department of Obstetrics/ Gynecology of POF Hospital Wah Cantt and HIT Hospital Taxila Cantt. The study duration was 2 years, from January 2017-December 2018. A total of 80 patients were included in the study. Patients were randomly divided into two groups; in Group-A; 40 patients were given intravenous iron sucrose, and in Group B, 40 patients were given intravenous ferric carboxymaltose. Patients were observed for hemoglobin level and mean corpuscular volume (MCV). Data analysis was done with SPSS version 24. An Independent t-test was applied, and results with p-value ≤0.05 were found significant.&#x0D; RESULTS: Post-treatment hemoglobin means level in the iron sucrose group was 9.90±0.4SD, and in the intravenous ferric carboxymaltose group, post-treatment hemoglobin was 10.71±0.9SD (p≤0.001). In the iron sucrose group, the post-treatment mean corpuscular volume mean level was 81.94±6.0SD and in the intravenous ferric carboxymaltose group mean post-treatment mean corpuscular volume was 88.08±7.1SD (p≤0.001)&#x0D; CONCLUSION: Treatment with intravenous iron caboxymaltose is superior to intravenous iron sucrose with respect to hematological response, which seems to be safe, as very few severe side effects were observed.

Application progress of high-dose intravenous iron in the treatment of iron deficiency anemia

Application progress of high-dose intravenous iron in the treatment of iron deficiency anemia

Effect of inulin, galacto oligosaccharides and iron fortification on iron deficiency anemia among women of reproductive age; a randomized controlled trial

Iron supplementation and fortification are the well-known approaches to treat iron deficiency anemia (IDA) in women of reproductive age. The objective of the current randomized controlled trial (RCT) was to evaluate the cumulative effects of prebiotics and iron fortification among women of reproductive age. For this purpose, a total of 75 iron deficient women of childbearing age were recruited and randomly divided into 5 groups (4 treatment groups and 1 control group). Four different types of fortified wheat flour were prepared using two iron fortificants (NaFeEDTA and FeSO4) and two prebiotics [inulin and galacto oligosaccharides (GOS)], while control group was treated with iron fortified flour without any prebiotics. Blood samples were collected from overnight fasted women on monthly basis up to 90 days. Hematological indices such as Hemoglobin (Hb), Hematocrit, Red Blood Cell (RBC) Count and Mean Corpuscular Volume (MCV), as well as iron biomarkers including serum iron, ferritin, transferrin, and Total Iron Binding Capacity (TIBC) were evaluated for analyses. The results showed a considerable positive improvement in all iron biomarkers as well as hematological indices among the treatment groups (P-value < 0.05), as compared to the control group. A maximum Hb (11.86 ± 0.24 mg/dL) and hematocrit value (35.06 ± 1.32%), was reported in group G3 which was treated with fortified wheat flour at a dose of 963 mg/kg GOS + 15 ppm FeSO4. On the other hand, highest mean values for RBC Count (4.73 ± 0.41 mil/mm3), MCV (81.41 ± 3.21 fL), serum iron (75.62 ± 2.79 μg/dL), serum transferrin (16.82 ± 0.30 mg/dL), and TIBC (403.68 ± 7.27 μg/dL) were observed in G4 group receiving the fortified wheat flour at a dose of 963 mg/kg GOS + 30 ppm FeSO4 level. The study concluded that prebiotic fortification along with iron salts helps to enhance iron absorption among iron deficiency anemic women of reproductive age.

Iron deficiency in women: ways to reduce prevalence

Iron deficiency states (IDSs) are common disorders at the nexus of various fields. The etiology and pathogenesis of IDSs have been well studied in recent decades, but their prevalence is still high. The highest incidence of IDSs is reported in women of reproductive age. The timely correction of iron deficiency improves women's quality of life and reduces pregnancy complications and infant morbidity. To achieve and maintain the improvement, caution in risk groups, early diagnosis, physiology-based therapy, and follow-up are necessary. Iron sulfate agents are well known as an effective way to treat iron deficiency anemia. However, the high rate of previously reported side effects posed significant challenges to the complete course of therapy. The development of a new molecule with prolonged iron release minimizes the complications of therapy, providing new prospects for iron deficiency treatment. The combination of folic acid to iron sulfate in one tablet simplifies prevention regimens and therapy for pregnant women and those planning to become pregnant and reduces the time to improve.

Protocol for a multicenter, double-blinded placebo-controlled randomized controlled trial comparing intravenous ferric derisomaltose to oral ferrous sulfate for the treatment of iron deficiency anemia in pregnancy: The IVIDA2 trial

BackgroundIron deficiency anemia (IDA) is common during pregnancy and associated with adverse maternal and neonatal outcomes. Treatment with iron supplementation is recommended during pregnancy, but the optimal delivery route is unclear. Oral iron risks has high risk of gastrointestinal side effects and low absorption. Intravenous iron is infused directly but is expensive. The American College of Obstetricians and Gynecologists currently recommends oral iron to treat IDA in pregnancy with intravenous iron reserved as second-line therapy, if needed. This approach is associated with persistent anemia, increasing the risk of peripartum blood transfusion. We aim to provide data on optimal route of iron repletion for IDA in pregnancy. MethodsIn IVIDA2, a double-blind, placebo controlled, multicenter randomized trial in the United States, 746 pregnant people with moderate-to-severe IDA (hemoglobin <10 g/dL and ferritin <30 ng/mL) at 24–28 weeks' gestation will be randomized 1:1 to either a single 1000 mg dose of intravenous ferric derisomaltose and oral placebo (1–3 times daily) or a single placebo infusion with 1–3 times daily 325 mg ferrous sulfate (65 mg elemental iron) tablet. The primary outcome is peripartum blood transfusion (blood transfusion from delivery to 7 days postpartum). Secondary outcomes include adverse medication reactions, maternal and neonatal hematologic indices, and offspring neurodevelopment. Ethics and disseminationA central ethical review board—Advarra—granted ethical approval (Pro00060930). Participating centers—Women & Infants Hospital of Rhode Island, University of Michigan Medical Center, Washington University School of Ethics and dissemination: A central ethical review board—Advarra—granted ethical approval (Pro00060930). Participating centers—Women & Infants Hospital of Rhode Island, University of Michigan Medical Center, Washington University School of.

Perceptions and experiences of intravenous iron treatment for anaemia in pregnancy in Malawi: a formative qualitative study.

The study objective was to explore opinions, identify experiences, and describe perspectives on the acceptability of intravenous (IV) iron to treat anaemia in pregnancy and identify potential barriers and facilitators of introducing IV iron in the Malawian healthcare system. We conducted 15 in-depth interviews and two focus group discussions with pregnant women, and seven in-depth interviews with health workers at a community-based health centre in Blantyre and a tertiary hospital in Zomba. Most women who used IV iron treatment during the second trimester of pregnancy reported feeling better and stronger after receiving the intervention. Women perceived that IV iron treatment worked faster than oral iron tablets and increased their haemoglobin count. However, cultural beliefs that IV iron treatment will cause miscarriage and the perception that study procedures involved Satanism and vampirism practices were barriers to acceptability. Health workers found IV iron treatment easy to administer because it is a single-dose treatment, simultaneously reducing the burden for pregnant women taking daily oral iron tablets. However, health workers expressed concerns about the costs and the need to train health workers before the large-scale implementation and integration of IV iron treatment into Malawi's routine care. Despite the perceived concerns and challenges experienced in participating in the first IV iron infusion trial in Malawi, participants' reflections suggest that IV iron infusion is acceptable for treating iron-deficiency anaemia in pregnancy. Participant advocate groups can offer a peer-to-peer education approach to sensitize and engage community members on the benefits of treatment and dispel concerns when the country contemplates integrating IV iron infusion for treating anaemia in pregnancy in Malawi.

Evaluation of Minimal Optimal Dose of Intravenous Ferric Carboxymaltose for Treatment of Iron Deficiency Anemia and Risk of Transient Hyperferritinemia.

Iron supplementation is administered orally or intravenously to treat iron-deficiency anemia (IDA). Ferric Carboxymaltose (FCM) "Ferinject®" is an intravenous (IV) iron preparation that has emerged as a safe therapeutic option for treating IDA in the past decade. This study aimed to evaluate safety and efficacy of carboxymaltose in a cohort of patients with IDA not responding to oral therapy. This 12-month retrospective study included 106 patients with IDA, with-or without bariatric surgery, who received (single or multiple doses) of Carboxymaltose 500mg/10mL. Data points included patients' demographics, baseline data for Hb, platelet, ferritin, and MCV pre-and at 1, 2, and 3 months following different doses of IV-Carboxymaltose. Changes in Hb, MCV, platelets, and ferritin levels were recorded in response to Carboxymaltose to assess the optimal dose, risk of hyperferritinemia, and hypophosphatemia. At three months (95 days) follow-up, the median change pre-and post-therapy in hemoglobin was from 9.5 to 11.9g/dL (p < 0.01), MCV 73.6-80.5fL (p < 0.01), and ferritin 5.3-93.8ng/mL. A significant difference was observed between platelet count of patients who underwent bariatric surgery and those who did not. An optimal ferritin response (>30ng/mL) was observed in 87.8% of patients who received first dose, and none of the full three doses showed no response. 37% of patients who received two doses developed hyperferritinemia. Serum phosphate levels were assessed in 28 cases, and hypophosphatemia was observed in 25% of these patients. Carboxymaltose is a reliable option for IDA. IV-FCM therapy helps achieve significant improvement in hemoglobin concentration and MCV from the first dose carrying a low reversible risk of hyperferritinemia following multiple doses. An interesting finding of this study is the discovery of a population of IDA patients requiring periodic assessment for iron reinfusion to sustain normal levels, mostly post-bariatric surgery. Changes in serum phosphate levels reported to occur consecutively with FCM treatment should be further studied.

Evaluation of Oral Therapy Based on Ferric Sodium EDTA, in Combination With Vitamin C, Folic Acid, Copper Gluconate, Zinc Gluconate and Selenomethionine, in Iron-Deficiency Anemia: A Real-Life Study

Iron deficiency (ID) and iron-deficiency anemia (IDA) are still frequent conditions in several patients’ settings. Oral iron supplementation is one of available treatments of IDA, representing a convenient strategy since is cost-saving, effective and does not require intravenous (IV) access. However, often traditional oral iron therapies, mainly based on ferrous sulphate, are poorly tolerated, and with low iron absorption, causing gastrointestinal adverse events and limiting adherence to treatment and efficacy. The aim of this study is to evaluate the efficacy and safety of a new oral iron supplementation based on Ferric Sodium EDTA, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) for IDA treatment in real-life clinical practice. Patients (N=103) were allocated to treatment with this new formulation at dosage of 1 tab/day, containing 30 mg of iron for 72 days. Patients were evaluated at basal conditions (T0), after 24 and 72 days of therapy (T1 and T2, respectively), collecting blood parameters of hemoglobin (Hb) and sideremia, evaluated as primary objective. The secondary outcomes were symptoms improvement (evaluated through a 4-points score) and safety profile of oral therapy. Treatment with Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel Forte®) showed improvements statistically significant (P &lt; 0.001) of Hb and sideremia levels both at time T1 and T2. Symptoms evaluation showed an almost total resolution of symptomatology after only 72 days of therapy, and treatment was safe and well tolerated. In conclusion, this study confirmed the efficacy and the safety of the new oral iron formulation evaluated, for IDA patients in real-life clinical practice.

Comparison of Ferrous Sulphate Versus Iron Polymaltose Complex in the Treatment of Iron Deficiency Anemia in Children

Objective: To compare the efficacy of ferrous sulphate versus iron Polymaltose complex (IPC) in the treatment of iron deficiency anemia (IDA) in children. Study Design: Randomized controlled trial. Place and Duration: Department of Pediatrics, Combined Military Hospital, Kharian Pakistan from Jan 2019 to Mar 2020. Methodology: A total of 150 children with IDA were included. At baseline, blood sample was obtained for assessment of hemoglobin level. Then children were randomly divided in two groups. In Group-A (n=75), patients were given ferrous sulphate while in In Group-B (n=75), IPC was given. After 12-weeks of treatment, hemoglobin level was assessed. Efficacy was labeled as “yes” if there was 2 g/dl hemoglobin improvement. Results: In a total of 150 children, the mean age in Group-A was 6.56±2.33 years and 6.05±2.78 years in Group-B. In group A, there were 37 (49.3%) males and 38 (50.7%) females while in Group-B there were 35 (46.7%) males and 40 (53.3%) females. At baseline in group A, the mean hemoglobin level was 6.07±1.12 g/dl while in group B, it was 6.16±1.14 g/dl. After 12-weeks, in Group-A the mean hemoglobin level was 9.44±1.61 g/dl whereas in Group-B, it was 8.83±2.01 g/dl (p=0.0420). There was insignificant difference observed for efficacy in both groups (p-value = 0.051). Practical Implications: Both IPC and ferrous sulphate resulted in significant rise in hemoglobin levels but ferrous sulphate showed better results in comparison to IPC. Conclusion: Although in comparison to IPC, ferrous sulphate resulted in significantly better rise in hemoglobin levels among children with IDA, but overall efficacy between the two studied drugs was relatively similar. Keywords: Ferrous sulphate, iron Polymaltose complex, iron deficiency anemia.

Iron Therapies For Iron Deficiency In Chronic Kidney Disease: A Literature Review

Chronic kidney disease is a condition when kidney function fails gradually due to kidney damage. One of the causes of anemia in CKD is iron deficiency. Conventional oral iron treatment is not effective to treat iron deficiency anemia due to poor absorption and various side effects. Newer oral iron therapies with better tolerability and offer the potential to normalize iron without the need for intravenous iron. To review the currently available status oral iron therapies and summarizes the latest clinical trial evidence for their use. We researched Google Scholar and PubMed using keyword "iron" OR "ferri" OR "Ferro" OR "iron therapy" AND "Iron deficiency" AND "renal insufficiency, chronic" OR "chronic kidney disease" OR "kidney failure, chronic" OR "chronic renal disease" of last ten years. Total 8 articles recorded the identification stage by the criteria for inclusion. The articles are randomized controlled trials. Total 2.674 patients CKD of various types with or without anemia, age range 18-72 years were treated with oral iron therapies (ferric citrate, ferrous sulfate, sucroferric oxyhydroxide, ferric carboxymaltose) with varying doses. The most side effects of the therapies are gastrointestinal intolerance. Oral iron therapies are considered safe but drug development is still needed to minimize side effects.

Antioxidant and Biological Activities of the Lotus Root Polysaccharide-Iron (III) Complex.

In this study, the synthesis parameters of the lotus root polysaccharide iron complex (LRPF) were determined and optimized by response surface methodology. Under the optimum preparation conditions, the pH of the solution was 9, the ratio of M (trisodium citrate): m (lotus root polysaccharide) was 0.45, the reaction time was 3 h. UV spectroscopy, thermogravimetry, FT-IR spectroscopy, X-ray diffraction, CD, and NMR were used for the characterization of the LRPF. LRPF has good stability and easily releases iron ions under artificial gastrointestinal conditions. LRPF exhibited antioxidant activity in vitro and can significantly improve the antioxidant activity in vivo. In addition, LRPF has a good effect in the treatment of iron deficiency anemia in model mice, impacts the gut microbiome, and reduces the iron deficiency-induced perniciousness by regulating steroid hormone biosynthesis. Therefore, LRPF can be used as a nutritional supplement to treat and prevent iron-deficiency anemia and improve human immunity.

Fe(III)-Rhamnoxylan-A Novel High Spin Fe(III) Octahedral Complex Having Versatile Physical and Biological Properties.

An iron (III) complex with rhamnoxylan, a hemicellulose from Salvia plebeia seeds, was synthesized and characterized by elemental analysis, spectroscopic and magnetic susceptibility measurements, thermal analysis and scanning electron microscopy. The rhamnoxylan was found to be a branched hemicellulose consisting of β-1,4-linked xylose main chain and rhamnose attached to the chain at β-1,3 positions. The complex was found to contain 18.8% w/w iron. A high-spin octahedral geometry of Fe3+ was indicated by the electronic absorption spectrum of the complex. In other experiments, the complex exhibited good electrical and magnetic properties. In vivo efficacy, as hematinic, of the complex in induced anemia was demonstrated equivalent to that of iron protein succinylate (taken as standard) as evidenced by raised red blood cell count, hemoglobin, hematocrit and total iron in rabbit. The complex was found to be non-toxic with LD50 > 5000 mg kg−1 body weight in rabbit. Thus, iron(III)-rhamnoxylan hold the potential for application as hematinic for treatment of iron deficiency anemia.

Blood management in patients with uterine myoma and anemia in the perioperative period

Introduction. In the structure of gynecological diseases, uterine myoma occupies one of the leading places and is accompanied by abnormal uterine bleeding, anemia, hemodynamic and hemostasiological disorders. Purpose. To optimize the management of the perioperative period in patients with uterine myoma and iron deficiency anemia (IDA) using methods of patient blood management (PBM). Materials and methods. The study group consisted of 94 patients with uterine myoma and IDA, who were examined and treated at the Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology. Of these, 74 patients made up the first, prospective group, who received IDA treatment with intravenous administration of ferric carboxymaltose during the perioperative period and during surgical treatment (laparoscopy / laparotomy and myomectomy), they underwent intraoperative autologous blood transfusion (IABT) using the cell salvage with Cell Saver 5+ apparatus. 20 women with myoma uterine and IDA constituted a comparison group (retrospective) who did not receive intravenous iron therapy in the perioperative period and did not undergo IABT. During surgical intervention (laparoscopy / laparotomy and myomectomy) or in the postoperative period, they received transfusion of donor erythrocyte-containing blood components according to indications. Results. All patients underwent surgical treatment in the amount of laparoscopy / laparotomy and myomectomy. During the operation, 74 patients of the main group underwent IABT in an average volume of 467.4 ± 327.8 ml. In the postoperative period, the patients of the main group continued to receive anemia therapy with intravenous administration of ferric carboxymaltose. And blood transfusions were not required in any patient of the main group. In patients of the second group, two (10 %) patients received donor erythrocyte suspension in an average volume of 358.2 ± 85.8 ml. Infectious and inflammatory complications: fever, inflammation of the postoperative suture, parametritis occurred in 6.8 % of women in the main group; in the comparison group – in 15 % of patients. Conclusions. Introduction into clinical practice of modern methods of blood management in patients with uterine myoma and IDA: the Infusion of intravenous high-dose ferric preparationsin the perioperative period, the use of Cell Saver devices for intra-operative autologous blood transfusion, helps to reduce the time of therapy, minimize transfusions of donor erythrocytes, reducing the frequency of infectious and inflammatory complications.

Results of Randomized Comparative Efficacy Study of Iron Deficiency Anemia Management in Children with Iron III Hydroxide Polymaltose Complex and Iron Sulfate

Background. The guidelines on selection between iron preparations, iron sulfate (IS) and iron III hydroxide polymaltose complex (HPC), for iron deficiency anemia (IDA) management in pediatrics are contradictory. Objective. The aim of the study is to compare efficacy and safety of iron (III) HPC and IS for IDA treatment in children. Materials and methods. Randomization of children (aged from 1 month to 18 years) with IDA into 2 therapeutic groups was implemented in 2019-2020. on pediatric districts of children’s city outpatient's clinic: IS dosage of 3 mg/kg/day and iron (III) HPC dosage of 5 mg/kg/day. Hemogram monitoring was performed every 14 days. The efficacy was compared according to the rate of Hb level increase, erythrocytes indices, and serum ferritin (SF) level at the recorded moment of Hb normalization. For the safety — the rate of adverse effects. Results. 65 children with IDA were included in the study and randomized into 2 groups, the median age was 2.3 years (1st; 3rd quartile = 1.1; 4.3). Hb level increase was comparable in both groups (0.34 (0.23; 0.48) g/L/day and 0.24 (0.21; 0.30) g/L/day, р = 0.891). IS is more effective than iron (III) HPC in terms of average red blood cell volume by the time of Hb normalization (83.5 (80.0; 86.7) fl against 80.7 (79.0; 82.0) fl, р = 0.006), and mean cellular hemoglobin content (28.9 (SD = 2.0) pg against 27.4 (SD = 1.8) pg, р = 0.004). The timing of SF levels normalization did not differ. Adverse effects to iron III HPC treatment occurred 5.5 times more frequently than to IS (p = 0.0001). Conclusion. The efficacy of IS and iron III HPC at standard doses is comparable. The advantage in tolerability and recovery of erythrocytic indices justifies the feasibility of using IS preparations in the first line of treatment for children with IDA.

PUMPING IRON: A QUALITY IMPROVEMENT STUDY FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA IN AMBULATORY HEART FAILURE PATIENTS

PUMPING IRON: A QUALITY IMPROVEMENT STUDY FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA IN AMBULATORY HEART FAILURE PATIENTS

Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric Hematology-Oncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics

Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.

An insight into homoeo-pathogenesis and management of microcytic hypochromic anaemia in apis mellifica: A scientific review of lesser known aspect of apis mellifica

Apis Mellifica is a polychrest medicine prepared from honey bee. Its therapeutic use from urticaria, erysipelatous inflammation, dropsical effusions to renal failure is well known but its role in treating iron deficiency anaemia has not been fully explored though it happens to be the only medicine for having action on the size of the R.B.C. Boericke’s Materia Medica mentions its prominent action on cellular tissue which is further cleared by studying Homeopathic Medical Repertory by Robin Murphy where its specific action is mentioned on ‘irregular and small sized R.B.C’. Thus, the diagnostic hypochromic microcytic P.B.F of iron deficiency anaemia matches with small sized R.B.C of Apis Mellifica making it pathological similimum for iron deficiency anaemia whether dietary or secondary to inflammations.

Evaluation of clinical use of intravenous iron: Utilization, efficacy, and safety in the management of cancer and chemotherapy-induced anemia in GI oncology.

359 Background: National Comprehensive Cancer Network recommends intravenous (IV) iron therapy for management of cancer and chemotherapy induced anemia without mentioning agent preference. Currently at Dana-Farber Cancer Institute (DFCI), all IV iron formulations can be utilized in management of iron deficiency anemia. This study was performed to evaluate the utilization, efficacy, and safety of IV iron formulations in management of cancer and chemotherapy induced iron deficiency anemia in patients with gastrointestinal (GI) cancer. Methods: Retrospective chart review was performed on DFCI patients with GI cancer undergoing palliative or adjuvant chemotherapy who received ferric gluconate, ferumoxytol, or iron sucrose between January 2021 and January 2022. Patients were identified using electronic medical record reports. Data was collected on cancer diagnosis, chemotherapy regimen, total IV iron dose and frequency, infusion reactions, laboratory values including hemoglobin, mean corpuscular volume (MCV), and iron status parameters (serum iron, ferritin, transferrin, iron-binding capacity, transferrin saturation) at baseline and 4-6 weeks after the last dose. The primary outcome was to assess the utilization of different IV iron formulations. Secondary outcomes were efficacy defined as mean absolute change from baseline in Hemoglobin levels and safety defined as incidence of hypersensitivity reactions. Results: 102 patients were evaluated of which 61 received ferumoxytol, 36 ferric gluconate and 5 iron sucrose. All patients had baseline hemoglobin (≤11 g/dL) and MCV collected. 89 patients had baseline iron status parameters (serum iron, ferritin, transferrin, iron-binding capacity, transferrin saturation). Most patients (N = 70) had diagnosis of colorectal cancer and received chemotherapy every 2 weeks. All patients received recommend total dose of IV iron on days of chemotherapy which was outside the recommended schedule of the IV iron formulations. A gradual increase in Hemoglobin concentrations in patients treated with IV iron was observed. Conclusions: Ferumoxytol and Ferric Gluconate were the most utilized IV iron formulation at DFCI GI oncology patients. All patients received recommended IV iron dosing but did not follow the recommended schedule. All patients had hemoglobin and MCV checked before each IV iron therapy. IV iron therapy was well tolerated and effective in treatment of iron-deficiency anemia in patients with gastrointestinal cancer undergoing chemotherapy.[Table: see text]

Role of oral lactoferrin as a source of iron supplementation in correction of anemia in pediatric patients with chronic kidney disease stages 2–4

Background Children with chronic kidney disease (CKD) have multiple risk factors for anemia such as primary erythropoietin deficiency, blood loss, decreased red blood cell (RBC) survival, bone marrow suppression, iron deficiency, inflammation and infection, malnutrition, hyperparathyroidism, vitamin B12 and folate deficiency, aluminum toxicity, and carnitine deficiency. This study was performed to evaluate the effect of oral bovine lactoferrin on patients with iron deficiency with CKD stages 2–4. Patients and methods This follow-up cohort clinical study was conducted on children with CKD in the conservative clinic, Pediatric Nephrology Unit, Children's Hospital, Ain Shams University. It included 45 pediatric patients with CKD stages from 2 to 4 for 6 months without a control group. This is a follow-up case study in which all the included patients were on erythropoietin therapy ranging from 150 to 300 IU/kg once per week. The patients were subjected to history and laboratory evaluation, including hemoglobin (Hb), serum iron, serum ferritin, and total iron-binding capacity (TIBC), which were done for the patients at baseline and 6 months after treatment with bovine lactoferrin for 6 months. Results Blood Hb and RBC volume were significantly increased beginning from first month after oral lactoferrin therapy, serum iron and serum ferritin were significantly increased 6 months after intervention, and serum TIBC was significantly decreased after intervention. The current study had shown no significant difference between males and females regarding laboratory changes 6 months after intervention. Laboratory improvements were significantly lowest among cases with stage 4, followed by stage 3, and the highest among cases with stage 2. There was a decrease in all anemia clinical manifestations after 6 months of lactoferrin administration; the differences were significant only in easy fatigability, constipation, and gastrointestinal upset, which were the most frequent adverse effects. Conclusion Oral lactoferrin was found to be effective in treating iron-deficiency anemia regarding blood Hb, blood RBCs, serum iron, serum ferritin, and TIBC in association with erythropoietin therapy. The effect declines with the progression of CKD.