Iron deficiency anaemia: pathophysiology, assessment, practical management

A Multicenter Single-Arm Study of Switching to Ferric Citrate Hydrate for Iron Deficiency Anemia in Patients Intolerant to Oral Iron: RIO-SWITCH

INTRODUCTION

Treatment interruptions due to adverse drug reactions (ADRs) are common in iron deficiency anemia (IDA). We evaluated medication completion rates and quality of life (QoL) changes in patients with IDA after starting ferric citrate hydrate (FCH) treatment.

METHODS

This multicenter, open-label, uncontrolled, single-arm comparative study included 30 Japanese female patients with IDA who experienced nausea and/or vomiting (N/V) with previous oral iron preparations. Patients received FCH 500 mg orally daily (< 1000 mg/day). Those with hemoglobin levels ≥ 11.0 g/dl completed the study at week 4; others continued until week 8. The primary endpoint was medication completion rate. Secondary endpoints included medication compliance rate, treatment satisfaction scores, and QoL scores and changes.

RESULTS

Thirty patients initiated and completed treatment; 24 reached ≥ 11.0 g/dl hemoglobin at week 4 and ended treatment, while 6 continued until week 8. The medication compliance rate was 93.92% ± 8.11% (mean ± standard deviation [SD]), and the completion rate was 100.0% (95% confidence interval 88.4-100.0%). Questionnaire findings revealed that the most severe nausea score decreased from 5.7 ± 2.4 to 1.7 ± 2.1 (mean ± SD), N/V incidence decreased from 100.0 to 63.3%, and patients reporting that N/V did not interfere with daily life increased from 6.7 to 52.6% following the switch to FCH. Twenty-four patients (80.0%) reported a satisfactory experience with FCH versus their previous oral iron preparation. Scores for all eight subscales of the Short-Form 36-Item Health Survey v2 improved, with significant increases in six. Nine ADR events occurred in six patients (20.0%), including nausea in three (10.0%); none were serious or resulted in treatment discontinuation.

CONCLUSION

FCH treatment exhibited a satisfactory medication completion rate in patients with IDA. Switching to FCH reduced N/V incidence and improved N/V and QoL severity compared with previous oral iron preparations.

TRIAL REGISTRATION

jRCTs031210634. Registration date: March 01, 2022.

Causal associations between iron deficiency anemia and digestive system cancers: evidence from a bidirectional two-sample Mendelian randomization study

BACKGROUND & AIMS

Iron deficiency anemia (IDA) is associated with digestive system cancers (DSCs), but the causal relationship is poorly understood. This two-sample bidirectional Mendelian randomization (MR) study investigated the causal association between IDA and five types of DSCs.

METHODS

This study pooled data from a genome-wide association study of IDA (6,087 cases and 211,115 controls of European ancestry) and DSCs. IVW, weighted median, weighted mode, and MR-Egger regression were used to assess causal associations between IDA and DSCs. Sensitivity analysis included Cochran's Q test for heterogeneity, MR-PRESSO for pleiotropy, and leave-one-out method for robustness.

RESULTS

The MR analysis used 12 single-nucleotide polymorphisms (SNPs) associated with IDA as instrumental variables (IVs). In contrast, the reverse MR analysis used 20 SNPs associated with the five types of DSC as IVs. Genetic predictions revealed no significant association between IDA and the risk of DSCs: (odds ratio [OR]: 1.00; 95% confidence interval [CI] [0.76, 1.31]; P = 0.979), esophageal (OR: 0.94; 95% CI [0.67, 1.31]; P = 0.699), pancreatic (OR: 1.14; 95% CI [0.68, 1.92]; P = 0.615), liver (OR: 1.12; 95% CI [0.51, 2.47]; P = 0.776), and stomach (OR: 1.04; 95% CI [0.71, 1.54]; P = 0.830) cancers. Reverse MR also indicated no causal association between DSC and IDA. MR-Egger regression showed minimal heterogeneity impact except for colorectal cancer (heterogeneity P = 0.002). MR-PRESSO identified no outliers.

CONCLUSION

The present MR analysis shows no causal associations between IDA and the risk of DSCs.

Soil nutrient concentrations influence micronutrient concentrations in Eragrostis curvula seeds

Food insecurity often results in malnutrition, manifesting as micronutrient deficiencies that disproportionately affect children under five, impairing their cognitive and physical development. While staple crops supply necessary calories and basic nutrients required for life sustenance, they frequently lack essential micronutrients needed for overall health, necessitating alternative food sources to address food insecurity and malnutrition. This study investigated the potential of Eragrostis curvula seeds as a micronutrient-rich addition to existing food systems and used analyses of covariance to evaluate the influence of soil characteristics on seed nutrient concentrations between two grassland sites in South Africa's Gauteng province: Jameson Park and Kaydale. Populations of E. curvula were identified in Jameson Park and Kaydale, Heidelberg, where rhizosphere soils from selected plants and seeds were harvested for nutrient concentration and soil characteristics analysis. Eragrostis curvula seeds were rich in essential micronutrients, including phosphorus (5041.5-5921.7 mg/kg), iron (72.2-145.4 mg/kg), potassium (4490.5-5531.2 mg/kg), zinc (44.9-65.4 mg/kg), copper (8.6-10.2 mg/kg), calcium (2978.4-16339.1 mg/kg), magnesium (2265.7-2538.4 mg/kg), and manganese (130.2-141.8 mg/kg). Significant site-specific variations were observed: seeds from Jameson Park had higher potassium and calcium concentrations, while Kaydale seeds had higher zinc and iron concentrations. Soil analyses revealed no significant differences in phosphorus, nitrogen, zinc, copper, exchange acidity, or total cation concentrations between the sites. However, calcium levels were significantly higher in Jameson Park soils, while Kaydale soils showed higher potassium, magnesium, and manganese concentrations. Soil nutrient concentrations were found to have a significant influence on seed nutrients. These findings emphasise the potential of E. curvula seeds to improve food security and alleviate micronutrient deficiencies, particularly among vulnerable populations such as young children.

Socioeconomic inequality in the prevalence of anemia: decomposing analysis among Kurdish people

INTRODUCTION

Anemia is a prevalent public health issue affecting millions worldwide, particularly among vulnerable populations. This study examines anemia prevalence among Iran's Kurdish population, revealing socioeconomic inequality and emphasizing the need for targeted interventions.

MATERIALS & METHODS

A cross-sectional analysis was conducted in 2019 using baseline data from the Dehgolan Prospective Cohort Study, involving 3,869 adults aged 35-70. Anemia was defined according to WHO guidelines, and socioeconomic status was assessed through household asset indices and educational attainment. Logistic regression and concentration index methods were employed to analyze the data.

RESULTS

The prevalence of anemia was found to be 4.4%, with a higher rate in females (6.1%) compared to males (2.2%). Significant disparities were observed based on education and wealth, with illiterate individuals showing a prevalence of 5.5%. The analysis revealed that education and gender were the most influential factors contributing to socioeconomic inequality in anemia prevalence.

CONCLUSION

The study highlights the critical role of socioeconomic factors in the prevalence of anemia among the Kurdish population. Addressing these inequalities is essential for improving health outcomes and developing effective public health strategies.

Prevalence and patterns of testing for anaemia in primary care in England: a cohort study using an electronic health records database

BACKGROUND

Despite epidemiological data on anaemia being available on a global scale, the prevalence of anaemia in the UK is not well described.

AIM

To describe anaemia prevalence and testing patterns for haemoglobin and other blood parameters.

DESIGN AND SETTING

This study was a descriptive population-based cohort study using data drawn from the Clinical Practice Research Datalink Aurum database in 2019.

METHOD

Demographic data were extracted for each person who was registered at their current practice during 2019, including linked data on Index of Multiple Deprivation. Anaemia prevalence in 2019 was calculated based on World Health Organization-specified age and gender thresholds for haemoglobin. Anaemia was classified based on mean corpuscular volume and ferritin. People with anaemia were followed up for up to 1 year to investigate longitudinal testing patterns for haemoglobin.

RESULTS

The cohort contained 14 million people. Anaemia prevalence in England in 2019 was 4.1% (583 847/14 207 841) (5.1% [363 438/7 121 614] females and 3.1% [220 409/7 086 227] males). Prevalence was higher in people aged >65 years, people of Black and Asian ethnicities, and people living in areas with higher social deprivation. Only half of people with anaemia and a mean corpuscular volume of ≤100 fL had an accompanying ferritin value recorded. About half of people with anaemia had a follow-up haemoglobin test within 1 year, most of which still indicated anaemia.

CONCLUSION

Anaemia is prevalent in the UK with large disparities between levels of demographic variables. Investigation and follow-up of anaemia is suboptimal in many patients. Health interventions aimed at improving anaemia investigation and treatment are needed, particularly in the most at-risk groups.

A whole-body mechanistic physiologically-based pharmacokinetic modeling of intravenous iron

Iron is essential for every cell of the mammalian organism. Iron deficiency is a major public health issue worldwide. Intravenous (IV) iron therapy has been used to treat anemia. However, IV iron therapy is known far away from ideal because the quantitative relationship between the pharmacokinetics and biodistribution of IV iron under different iron statuses remains unclear. Patients are known to suffer adverse effects from excessive iron accumulation. Our objective was to develop a physiologically based pharmacokinetic (PBPK) model of iron in mice and validate its application for predicting iron disposition in rats and humans. Previously published data on iron were collected for constructing the PBPK model of iron in mice, and then extrapolated to rats and humans based on physiologically and chemically specific parameters relevant to each species. The PBPK model characterized the distribution of iron in mice successfully. The model based on extrapolation to rats accurately simulated the ferric carboxymaltose (FCM) PK profiles in rat tissues. Similarly, the observed and simulated serum PK of FCM in humans were in reasonable agreement. This mechanistic whole-body PBPK model is useful for understanding and predicting iron effects on different species. It also establishes a foundation for future research that incorporates iron kinetics and biodistribution, along with related clinical experiments. This approach could lead to the development of effective and personalized iron deficiency anemia treatments.

Study on yolk iron transportation in chick embryo eggs based on transcriptomics

Chick embryo eggs have a complete system of iron release, delivery, and uptake and thus provide a useful tool to study the fast transportation and absorption of iron. Based on this, the regulatory genes and pathways of iron transportation and uptake at the four key stages of chick embryo incubation, days 6, 9, 12, and 15 (E6, E9, E12, and E15), were investigated. Throughout these four key stages, the iron content decreased in egg yolk, increased in chick embryos, and first increased and then decreased in the yolk sac membrane (YSM) with the highest value of 110.38 mg/kg at E12. A total of 87,499 expressed genes were detected by transcriptome, where the specifically expressed genes at E6, E9, E12, and E15 were 312, 466, 280, and 185 respectively. Mineral absorption pathways involved in mineral uptake, transportation, utilization, and metabolism were significantly enriched in stages E9 to E15. The expression of divalent metal transporter 1 (DMT1) and ferritin heavy chain 1 (FTH1) related to iron transportation was up-regulated considerably from E9 to E12. Heme oxygenase 1 (HMOX1), FTH1, Solute Carrier Family 40 Member 1 (SLC40A1), and hephaestin (HEPH) mainly responsible for the regulation of iron transportation and uptake were up-regulated from E12 to E15. Therefore, stage E9 to E12 was the crucial period for iron initiation and transportation, and DMT1 and FTH1 played an important role in regulating the initiation of iron transportation at the early stage of incubation.

Association Between the Anemia During Pregnancy and Maternal Intensive Care Unit Admissions: A Systematic Review and Meta-Analysis

Anemia during pregnancy is one of the most common conditions that may have adverse consequences on maternal and fetal health. Current evidence is inconsistent with regards to the effects of anemia on maternal ICU admissions. This meta-analysis aimed to examine the overall effect of anemia during pregnancy on maternal ICU admissions. We searched PubMed, Embase, Cochrane Library, and Web of Science for observational studies that compared the risk of ICU admission between anemic and non-anemic pregnant women. We pooled the odds ratios (ORs) for ICU admission using a random-effects model. Heterogeneity among studies was assessed using prediction intervals (PIs), Tau2 and I2 statistics. Sensitivity analysis by excluding outlier studies, meta-regression by sample size and age, and publication bias detection by LFK index and Doi plot was undertaken. Eight studies with a total of 21,997,574 participants in both anemic and non-anemic groups were included. Of them, meta-analysis was conducted in seven studies which yielded a pooled OR for anemia and ICU admission as 1.32 (95% CI 0.62-2.81). There was also a very high level of heterogeneity among studies (PI: 0.10-18.16, I2 = 100%). When an influential study was omitted, the pooled OR 1.16 (95% CI - 1.13; 1.20) for ICU admission was significant. The LFK index was - 3.64, indicating publication bias. Anemia in pregnant women might be associated with a higher risk of ICU admission, but it is essential to interpret this cautiously due to significant heterogeneity and potential publication bias. Registration : PROSPERO database (CRD42023466529).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12288-024-01849-0.

Impact of iron-deficiency anemia on short-term outcomes after resection of colorectal cancer liver metastasis: a US National (Nationwide) Inpatient Sample (NIS) analysis

PURPOSE

Colorectal cancer (CRC) often spreads to the liver, necessitating surgical treatment for CRC liver metastasis (CRLM). Iron-deficiency anemia is common in CRC patients and is associated with fatigue and weakness. This study investigated the effects of iron-deficiency anemia on the outcomes of surgical resection of CRLM.

METHODS

This population-based, retrospective study evaluated data from adults ≥20 years old with CRLM who underwent hepatic resection. All patient data were extracted from the 2005-2018 US National (Nationwide) Inpatient Sample (NIS) database. The outcome measures were in-hospital outcomes including 30-day mortality, unfavorable discharge, and prolonged length of hospital stay (LOS), and short-term complications such as bleeding and infection. Associations between iron-deficiency anemia and outcomes were determined using logistic regression analysis.

RESULTS

Data from 7,749 patients (representing 37,923 persons in the United States after weighting) were analyzed. Multivariable analysis revealed that iron-deficiency anemia was significantly associated with an increased risk of prolonged LOS (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 2.30-3.30), unfavorable discharge (aOR, 2.42; 95% CI, 1.83-3.19), bleeding (aOR, 5.05; 95% CI, 2.92-8.74), sepsis (aOR, 1.60; 95% CI, 1.04-2.46), pneumonia (aOR, 2.54; 95% CI, 1.72-3.74), and acute kidney injury (aOR, 1.71; 95% CI, 1.24-2.35). Subgroup analyses revealed consistent associations between iron-deficiency anemia and prolonged LOS across age, sex, and obesity status categories.

CONCLUSION

In patients undergoing hepatic resection for CRLM, iron-deficiency anemia is an independent risk factor for prolonged LOS, unfavorable discharge, and several critical postoperative complications. These findings underscore the need for proactive anemia management to optimize surgical outcomes.

Research progress on the relationship between Helicobacter pylori infection and iron deficiency anemia

Helicobacter pylori (H. pylori) infection affects around half of the global population and is a globally highly prevalent pathogen that is closely linked not only to gastrointestinal diseases such as chronic atrophic gastritis, functional dyspepsia and peptic ulcer but also to the development and progression of a variety of extra-gastrointestinal diseases. Numerous studies have shown the correlation between H. pylori infection and iron-deficiency anemia (IDA). The prevalence of H. pylori infection is higher in individuals with IDA, and the hemoglobin level of patients with IDA can be increased to different degrees or even returned to normal following active H. pylori eradication. However, this conclusion is still controversial. In this paper, a comprehensive literature search was conducted using the PubMed/MEDLINE/Web of Science database, combining the following terms: "Helicobacter pylori," "Helicobacter pylori infection," "iron deficiency anemia," "iron deficiency," "iron absorption," "iron malabsorption," "serum iron," "hemoglobin," "pathogenesis," "mechanism," and "eradication therapy." Through extensive literature searches, the correlation between H. pylori infection and IDA, its potential mechanism, and the efficacy of H. pylori eradication therapy in IDA patients have been comprehensively discussed. We conclude that the majority of existing studies have confirmed the correlation between H. pylori infection and IDA, indicating that patients with H. pylori infection are more likely to develop IDA and that the prevalence of H. pylori infection is higher in individuals with IDA. Compared with iron supplementation alone, combining H. pylori eradication with iron supplementation is more effective in treating IDA, particularly in unexplained or refractory IDA cases. These findings provide valuable insights for clinicians managing patients with unexplained or refractory IDA.

The ABCDs of Nutritional Assessment in Infectious Diseases Research

Malnutrition is the most common acquired cause of immunodeficiency worldwide. Nutritional deficiencies can blunt both the innate and adaptive immune response to pathogens. Furthermore, malnutrition is both a cause and consequence of infectious diseases. The bidirectional relationship between infectious diseases and undernutrition, as well as the inflammatory milieu of infectious diseases, can complicate nutritional assessment. This article aims to provide clinicians and researchers with an overview of commonly used tools to assess nutritional status, with a particular emphasis on their use in the context of infectious diseases. These tools include anthropometric, biochemical, clinical/physical, and dietary assessments to screen and evaluate undernutrition, diet quality, and food insecurity effectively.

Understanding and managing iron deficiency anaemia

Iron deficiency anaemia develops when there is not enough iron in the body to sustain normal red blood cell production. It is a major cause of morbidity worldwide and is linked to a range of comorbid conditions, including gastrointestinal cancer. In the UK, iron deficiency anaemia is the most common cause of anaemia identified in primary care and is estimated to affect 3% of men and 8% of women. Nurses can support the management of iron deficiency anaemia by identifying possible causes, ordering blood tests, advising on diet and iron supplementation, and referring patients for additional investigations as required. This article provides an overview of the pathophysiology, identification and diagnosis of iron deficiency anaemia, describes sources of dietary iron and factors influencing dietary iron absorption, and discusses patient management.

A practical review of iron deficiency in pregnancy

Iron deficiency is a highly prevalent nutritional deficiency and the most common cause of anemia worldwide. Pregnant individuals are particularly susceptible due to increased demands to support expanding maternal blood volume and fetal growth. Iron deficiency and iron deficiency anemia are associated with maternal and neonatal morbidity, including preterm birth, preeclampsia, postpartum hemorrhage, and low birth weight. Iron is essential to support the rapidly growing fetal brain. Maternal iron deficiency is linked to cognitive delays, motor impairment, and neuropsychiatric disease in the offspring with effects lasting beyond childhood. Despite its high prevalence and profound clinical implications, it remains underdiagnosed and undertreated in pregnancy. This is potentiated by a lack of consensus regarding laboratory diagnosis and recommendations for screening and treatment. Here, we review the physiology, clinical implications, diagnosis, and treatment of iron deficiency in pregnancy.

Glycoprotein Matrix-Bound Iron Improves Absorption Compared to Ferrous Bisglycinate Chelate and Ferrous Fumarate: A Randomized Crossover Trial

Introduction The biotransformation of minerals through glycosylation by microorganisms, such as yeast or probiotics, can produce nutrients bound to a food matrix, potentially enhancing their bioavailability. This study aimed to compare the absorption kinetics of iron bound to a glycoprotein matrix (GPM) with those of ferrous bisglycinate chelate (FBC) and ferrous fumarate (FF). Methods In a double-blind, crossover design, 17 participants ingested 11 mg of iron in one of three forms: GPM (Pharmachem Innovation, Kearny, NJ, USA), FBC (Ferrochel®, Balchem Corp., Montvale, NJ, USA), or FF (FerroPharma Chemicals Ltd, Hungary). Blood samples were collected at baseline and 30-, 60-, 90-, 120-, 180-, 240-, 300-, 360-, 420-, and 480-minutes post-ingestion. Water intake was standardized throughout the protocol, and an iron-free snack was provided at four hours post-ingestion. Pharmacokinetic analysis was performed, with key outcome variables including the incremental area under the concentration vs. time curve (iAUC), maximum concentration (Cmax), and time to maximum concentration (Tmax). The a priori significance level was set at p < 0.05. Results Linear mixed-effects models indicated statistically significant effects of the GPM condition for both raw iron concentrations and changes from baseline (p = 0.03). On average, participants had iron concentrations that were 27.1 mcg/dL (95% CI: 2.8 to 51.4) higher after consuming GPM iron compared to the FF reference condition. Changes in iron concentrations from the baseline were 16.6 mcg/dL (95% CI: 1.5 to 31.7) higher after GPM consumption compared to FF. In contrast, iron concentrations and changes in iron levels after FBC consumption did not significantly differ from those observed with FF. Significant effects of time were also observed in both linear mixed-effects models. When expressed as percentage changes from baseline, iron concentrations in the GPM condition were 9.4% to 35.0% higher than FF and 5.9% to 32.6% higher than FBC. Pharmacokinetic analysis revealed a significant effect of condition on the iAUC (p = 0.047), but no significant effects for Cmax (p = 0.15) or Tmax (p = 0.81). Post hoc tests for the iAUC indicated a trend (p = 0.07) for a difference between the GPM and FBC conditions, but no significant differences between GPM and FF (p = 0.17) or FBC and FF (p = 0.75). Conclusion These findings suggest that iron bound to a glycoprotein matrix can improve absorption kinetics without any associated side effects. This data could have important implications for addressing iron deficiency or absorption disorders in a variety of populations.

Systematic Review and Meta-Analysis: Iron Deficiency and Iron Deficiency Anemia Among Military Recruits Undergoing Basic Combat Training

INTRODUCTION

The first period of military service consists of a physically and mentally challenging basic combat training (BCT) program. Factors like demanding physical exercise, limited recovery time, and restricted diet choice and food intake may challenge iron intake and homeostasis in recruits undergoing BCT. Iron-deficient individuals may experience reduced work capacity, fatigue, weakness, frequent infections, and increased injury risk. Limited knowledge is available on the extent of this potential health risk among military recruits. The aim of the present study was to systematically review published studies on the prevalence and change in prevalence of anemia, iron deficiency (ID), and ID anemia (IDA) among recruits undergoing BCT.

MATERIALS AND METHODS

Electronic searches were conducted in the databases Medline (Ovid), Embase (Embase.com), and Web of Science (Clarivate Analytics) from database inception up until April 16, 2024. Inclusion criteria were observational studies with both cross-sectional and observational longitudinal designs that examined the effects of BCT (intervention) on iron status (outcome) in military recruits (population). Extracted data were the number of participants (n), age, sex, country/population, BCT duration, and relevant measures of prevalence and changes in prevalence of anemia, ID, and IDA (primary outcome) and physical performance, mood state, stress fractures, attrition rate, and nutritional supplements (secondary outcomes). The study quality and risk of bias were assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data and The National Institutes of Health Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Meta-analyses were performed using restricted maximum-likelihood models, and the effect size was calculated as Cohen's h with 95% CI.

RESULTS

Twenty-two articles were systematically reviewed (n = 111,764 men and 12,650 women), and six of these papers (n = 388 men and 773 women) were included in the meta-analysis. There was a varying prevalence of anemia, ID, and IDA among military recruits at the start of BCT. Results from meta-analyses showed negligible and nonsignificant effects of BCT on the prevalence of anemia, ID, and IDA. The quality of the included cross-sectional studies ranging from fair to good, whereas a large proportion of the included longitudinal studies were classified as poor. No sign of publication bias was found.

CONCLUSIONS

The prevalence of anemia, ID, and IDA in military recruits seems not to be affected by the completion of BCT shorter than 16 weeks, whereas the effects of longer BCT durations remain unclear. Even though body iron homeostasis seems unaffected, adequate energy and nutritional intake should remain a priority. Future research could focus on dietary interventions to determine the optimal diet among female recruits in specifically exposed populations.

Anemia in inflammatory bowel disease-A comprehensive review

Anemia is a frequent complication in inflammatory bowel disease (IBD) patients. The etiology is multifactorial, with iron deficiency and anemia of chronic disease being the main reasons. Other causes include vitamin B12 and folate deficiency, hemolytic anemia and medications such as azathioprine and sulfasalazine. Apart from physical symptoms, it is associated with several negative outcomes, including poor quality of life, increased risk of hospital admission, increased risk of surgery and higher treatment costs. Diagnostic evaluation aims to identify the underlying cause and severity to determine the appropriate therapeutic strategy. Investigations include a complete blood count, iron indices, inflammatory markers and vitamin B12 and folate levels. Patients with iron deficiency need adequate replacement therapy to improve hemoglobin and replenish iron stores. Those with moderate to severe anemia and/or active disease need intravenous iron, while mild anemia can be treated with oral iron. Multiple parenteral iron formulations are available which differ in dose and frequency of administration. Traditional oral iron supplements are available in ferrous forms, which, although effective, are associated with gastrointestinal side effects. Newer oral iron formulations have helped reduce these adverse effects but are expensive. Anemia of chronic disease is mainly driven by the effects of inflammatory mediators on iron metabolism and erythropoiesis and treatment requires control of disease activity. Relapse of anemia after therapy is frequent; hence, patients need to be closely followed up for early detection and appropriate management. Significant advances have been made in understanding the pathophysiology of anemia in IBD and better and safer iron formulations are available. However, a significant proportion of IBD patients with anemia go undetected or untreated and there is a need for improved recognition and better management practices. This review discusses various aspects of anemia in IBD and the current approach to diagnosis and management.

Magnetite nanoparticles (Fe3O4NPs) promote drought tolerance and improve plant health, grain quality and yield in kidney bean (Phaseolus vulgaris L.)

As a primary abiotic constraint for bean cultivation in semi-arid regions, drought stress significantly impacts both the yield and quality of beans. Foliar application of nanofertilizer has been shown to effectively improve crop yield and nutritional quality while mitigating environmental pollution associated with fertilizer runoff. In this study, we conducted a semi-field study using magnetite nanoparticles (Fe3O4NPs) to evaluate its effects on the growth, yield, nutrient quality, photosynthetic parameters, and physiological traits in kidney bean (Phaseolus vulgaris L.) subjected to drought stress and compared with ferrous sulfate (FeSO4; ionic Fe). Our findings revealed that moderate drought stress (50 % field water capacity) severely impaired growth and photosynthetic activity in kidney bean in untreated control plants. Notably, application of 500-1000 mg Fe L-1 as Fe3O4NPs, in contrast to 1000 mg Fe L-1 of ionic Fe, resulted in increased yield (29-72 %), grain quality (protein 7-17 % and iron 10-45 %), and photosynthetic apparatus (245-259 % for Chla; 203-260 % for Chlb), under drough condition. Furthermore, foliar applications of Fe3O4NPs promoted drought tolerance by increasing relative water content and proline levels, vis-à-vis reducing membrane lipid peroxidation and electrolyte leakage. It is concluded that Fe3O4NPs at 500-1000 mg L-1 could significantly promote growth, quality, and physiological attributes in kidney bean under moderate drought stress, underscoring the potential advantages of using nano‑iron over ionic iron fertilizers for improved agriculture production.

Relationship Between Anemia and Telogen Effluvium in Post-COVID-19 Survivors

INTRODUCTION

There are insufficient studies in the literature on the relationship between the acute severity of disease and the occurrence of anemia and telogen effluvium (TE) in the post-coronavirus disease 2019 (COVID-19) period.

OBJECTIVES

The purpose of this study was to investigate the relationship between anemia and TE in individuals who had experienced COVID-19 during the post-COVID period.

METHOD

The study has a retrospective cross-sectional design and was conducted on patients presenting to a tertiary care hospital for COVID-19 follow-up. Patient data, including demographic parameters, data regarding smoking history, comorbidities, symptoms, and laboratory panel at presentation, were evaluated.

RESULTS

Out of 672 patients, 249 had TE complaints. TE was more common in females, those under the average age of this patient group, and those with a body mass index of under 25. Anemia was identified in 80 patients. Among individuals with anemia, TE was observed in 47.3%, whereas among those without anemia, the occurrence of TE was noted at a rate of 35.5%. When the severity of infection in the acute phase was examined in relation to the presence of TE in the post-COVID period, TE was observed in 45.1% of those receiving outpatient treatment, 37.0% of those hospitalized, and 30.7% of those in intensive care.

CONCLUSION

The results obtained in this study group indicate that TE complaints after COVID-19 are more common in those with anemia, but the fact that they did not correlate with the acute disease's severity requires consideration of other causes besides the virus effect.

Impact of neutrophil percentage-to-albumin ratio on mortality in iron-deficiency anemia patients: a retrospective study using MIMIC-IV database

BACKGROUND

In the intensive care unit (ICU), the incidence of iron-deficiency anemia (IDA) is relatively high and is associated with various adverse clinical outcomes. Therefore, it is crucial to identify simple and practical indicators to assess the mortality risk in ICU patients with IDA. This study aims to investigate the relationship between the Neutrophil Percentage-to-Albumin Ratio (NPAR) levels in patients with IDA in the ICU and their all-cause mortality at 30 and 365 days.

MATERIALS AND METHODS

We analyzed data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) 3.0 database spanning the years 2008-2022 and identified a cohort of 817 patients with IDA who met our inclusion criteria. Through multivariate Cox regression analysis, the relationship between NPAR levels and 30-day and 365-day mortality risks was assessed, and restricted cubic splines (RCS) models were used to explore potential nonlinear relationships. Additionally, an inflection point analysis was conducted to evaluate the potential of NPAR levels in predicting short- and long-term mortality risks.

RESULTS

The study found that high NPAR levels were significantly associated with an increased risk of 30-day and 365-day mortality in patients with IDA (hazard ratio [HR] range 1.49-2.23, p < 0.001 for all). The relationship between natural logarithmic transformation (ln) NPAR levels and 30-day and 365-day mortality risks exhibited an inverse "L" shaped pattern. Patient mortality risk increased significantly when ln-transformed NPAR levels exceeded 1.2 (HR range 3.366-4.304, p < 0.001 for all). Additionally, subgroup analyses did not reveal any significant interactions, indicating that the predictive effect of NPAR on mortality risk is relatively consistent across different subgroups.

CONCLUSION

We found an inverse "L" shaped relationship between ln-transformed NPAR levels and 30-day and 365-day mortality risks, particularly when ln-transformed NPAR values exceed 1.2, which is significantly associated with an increased risk of death within 30 and 365 days for patients.

Iron deficiency anemia in patients with heavy menstrual bleeding: The patients' perspective from diagnosis to treatment

BACKGROUND

Heavy menstrual bleeding (HMB) associated with iron deficiency anemia (IDA) negatively affects quality of life (QoL). Management of IDA usually begins with oral iron supplementation or, if ineffective/poorly tolerated, then intravenous iron (IVI) is given; however, no guidance exists on transitioning from oral to IVI in patients with HMB. While various IVI products exist, safety profiles and distinct properties affecting treatment logistics make product choice important.

OBJECTIVES

Assess the IVI treatment journey for patients with HMB and IDA.

DESIGN

A survey was designed to assess multiple aspects of IVI treatment to evaluate patient perspectives.

METHODS

Patients (⩾18 years) from the United States with IDA currently prescribed IVI completed a survey conducted by The Harris Poll in 2023. Questions covered symptoms, time to diagnosis/treatment, IVI appointment logistics, IVI infusion experience, impact on daily activities, and patient preferences.

RESULTS

Of 323 respondents, 71 (22.0%) were prescribed IVI for HMB and received ⩾2 IVI infusions monthly. The mean age for these patients was 33.5 years; they experienced a mean of 2.9 years from symptom onset until IDA diagnosis, and 1.4 years between diagnosis and IVI treatment. Most patients agreed that navigating IVI treatment logistics interfered with productivity and social commitments, and felt they must schedule their life around treatment. Patients who were also diagnosed with hypophosphatemia following IVI (12/71; 16.9%) reported a mean of 8.2 additional hospital visits. Furthermore, 36.6% of patients missed an IVI dose; of these, 80.8% preferred single-dose IVI.

CONCLUSION

Patients with IDA and HMB experienced substantial delays from symptom onset to subsequent IVI treatment, demonstrating a gap in management. Therefore, oral iron may not be an appropriate first-line treatment for some of these patients. Multiple-dose IVI and associated appointment logistics can negatively impact patients' perspectives on treatment. Single-dose IVI preferences should be considered to improve patients' adherence and QoL.

The Influence of Pelvic Bone Dose-volume Parameters on Bone Marrow Suppression During Radiation Therapy in Patients With Stage I to III Rectal Cancer Based on Real-world Data

Purpose

The aim of this study was to evaluate the effect of pelvic bone dose-volume parameters on bone marrow suppression during radiation therapy (RT) in patients with rectal cancer stage I to III disease receiving either neoadjuvant radiation therapy (neo-RT) or curative-intent radiation therapy (cur-RT).

Methods and Materials

This was a retrospective study with data mined from an electronic medical record review at a single institution. Between January 2016 and September 2022, patients with rectal cancer who consecutively received neo-RT or cur-RT in our department were included. The data collected included complete baseline peripheral blood counts and hematologic toxicity (HT) data collected during RT. The radiation dose-volume parameters of 3 pelvic bone marrow subsites (iliac bone marrow [IBM], lumbosacral bone marrow, and lower pelvis bone marrow) were collected. The primary endpoint was grade ≥ 2 HT (HT2+), including leukopenia, neutropenia, anemia, thrombocytopenia, and total HTs. Logistic regression was employed to analyze the associations of HT2+ with dosimetric parameters and clinicopathologic characteristics. Receiver operating characteristic curves and the area under the curve (AUC) were generated to verify the prediction efficacy of the pelvic bone dose-volume parameters combined with clinicopathologic indices.

Results

A total of 130 patients with stage I to III rectal cancer with complete clinical data were included. During neo-RT and cur-RT, 57 (43.8%) of these patients experienced HT2+. Multivariate analysis revealed that gender, the IBM-Dmean, the IBM-V15, and the IBM-V40 were significantly associated with grade 2+ leukopenia (P < .05), and the AUC of gender combined with the IBM-Dmean, the IBM-V15, and the IBM-V40 in predicting grade 2+ leukopenia was 0.834. The optimal cutoff values were an IBM-Dmean = 2692.75 cGy, an IBM-V15 = 86.65%, and an IBM-V40 = 20.75%. Patients who received oxaliplatin-containing concurrent chemotherapy (ChT) regimens were more likely to experience grade 2+ thrombocytopenia (P = .054). The AUC of concurrent ChT regimens in predicting grade 2+ thrombocytopenia was 0.678. Female gender was significantly associated with grade 2+ anemia and total HT2+ status.

Conclusions

Among patients with rectal cancer stage I to III disease who received neo-RT or cur-RT, female patients with higher IBM-Dmean, IBM-V15, and IBM-V40 were more likely to experience grade 2+ leukopenia, and oxaliplatin-containing concurrent ChT regimens were identified as a potential factor for increasing the incidence of grade 2+ thrombocytopenia.

Restrictive Blood Transfusion Policy for the Management of Anemia in Palliative Care in Finland

Objectives

Restrictive blood transfusion policy has been shown to be effective in managing anemia. However, treatment of anemia in palliative (PC) and end-of-life (EOL) care remains understudied. The aim of this study was to examine Finnish PC physicians' attitudes and practices in the management of anemia.

Methods

A structured questionnaire asking clinicians about how they treat anemia in PC was developed with a focus on blood transfusion. In addition, a previously published collection of clinical case scenarios was included. Physician's recall of their use of red blood cell (RBC) transfusions in 2021 was also asked. The questionnaire was first delivered at an annual meeting of the Finnish Association for Palliative Medicine in 2022 and subsequently, a Webpropol form was emailed to the members of the society.

Results

A total of 94 (28%) doctors at an average age of 46.5 years responded. Of these 80% were specialists and 75% had a special competence in palliative medicine. RBC transfusions were given in less than 25% of patients, average hemoglobin was b ≤ 78 g/L. Transfusions were given for clinical symptoms such as fatigue, angina, and weakness without systematic measurement of symptom severity. Hematinic levels were investigated, but iron was given seldom. Clinical scenarios were answered similarly as previously in the UK. National guidelines for anemia in early PC or EOL care are lacking but would be deemed to be helpful by one-third of those who completed the questionnaire.

Conclusion

Physicians apply the restrictive policy in blood transfusions for PC patients in Finland. Other treatments for anemia are not often used. Both prospective studies and national guidelines are needed.

The Impact of Iron on Cancer-Related Immune Functions in Oncology: Molecular Mechanisms and Clinical Evidence

Iron metabolism plays a dual role in cancer, serving as an essential nutrient for cellular functions and a potential catalyst for tumor growth and immune evasion. Here, we cover the complex interplay between iron levels within the serum or in the microenvironment and cancer therapy, focusing on how iron deficiency and overload can impact immune function, tumor progression, and treatment efficacy. On the one hand, we highlight iron deficiency as a factor of primary immune responses and its adverse effects on anti-cancer immunotherapy efficacy. On the other hand, we also stress the impact of iron overload as an essential factor contributing to tumor growth, creating a suppressive tumor microenvironment that hinders immune checkpoint inhibitor immunotherapy. Overall, we emphasize the necessity of the personalized management of iron levels in oncology patients as a critical element in treatment optimization to achieve favorable outcomes. Based on these considerations, we believe that close and careful monitoring and the tailored balancing of iron supplementation strategies should be the subject of further clinical studies, and routine iron management should be implemented in oncology clinical practice and integrated into cancer therapy protocols.

Multifaceted determinants of micronutrient status in early childhood in Iran : National food and nutrition surveillance

PURPOSE

This study examined the status and determinants of key micronutrients among 24-60 month children in underprivileged provinces of Iran, highlighting ongoing challenges despite intervention efforts.

METHODS

This study analyzed data from the National Food and Nutrition Surveillance program. A multistage cluster sampling method was used, recruiting 280 children per province from Khuzestan, Kerman, Ilam, Bushehr, Hormozgan, Kohgiluyeh va Boyerahmad, Sistan va Baluchestan and South Khorasan. Demographic, dietary, and anthropometric data were collected, and micronutrient status was assessed through hemoglobin, serum ferritin, zinc, retinol and 25-hydroxycalciferol assays.

RESULTS

This study included 2,247 children (42.2 ± 0.3 months). About 40% of children had low dietary diversity, and 48.4% were from low socioeconomic status (SES) families. Anemia was found in 24% of the children. Vitamin D and A deficiency affected 74%, and 22.3% of children, respectively. Notably, 39.1% had multiple micronutrient deficiencies. Father's occupation (odds ratio [OR] (95% confidence interval [CI]; freelance vs. employed: 1.86 (1.13, 3.06), worker vs. employed: 2.3 (1.43, 3.69)) and SES (middle vs. high: 2.15 (1.09, 4.2)) were significant predictors of anemia. Urban living and higher paternal education were protective against low ferritin. Children in lower SES categories and those with poor vitamin D status were more likely to have iron (1.53 (1.12, 2.09), p = 0.007) and zinc deficiencies (2.19 (1.46, 3.29) p < 0.001). Vitamin A and D statuses were mainly influenced by SES, food security, and supplement intake, respectively.

CONCLUSION

Our findings revealed high prevalence of micronutrient deficiencies among 24-60 month children residing in eight underprivileged provinces of Iran. Parental education, household SES and food security were the main determinants of micronutrient deficiencies among the studied children. Improvement of the households' food access through betterment of economic condition seems inevitable which in turn necessitates an inter-sectorial collaboration.

Analyzing the role of ferroptosis in ribosome-related bone marrow failure disorders: From pathophysiology to potential pharmacological exploitation

Within the last decade, the scientific community has witnessed the importance of ferroptosis as a novel cascade of molecular events leading to cellular decisions of death distinct from apoptosis and other known forms of cell death. Notably, such non- apoptotic and iron-dependent regulated cell death has been found to be intricately linked to several physiological processes as well as to the pathogenesis of various diseases. To this end, recent data support the notion that a potential molecular connection between ferroptosis and inherited bone marrow failure (IBMF) in individuals with ribosomopathies may exist. In this review, we suggest that in ribosome-related IBMFs the identified mutations in ribosomal proteins lead to changes in the ribosome composition of the hematopoietic progenitors, changes that seem to affect ribosomal function, thus enhancing the expression of some mRNAs subgroups while reducing the expression of others. These events lead to an imbalance inside the cell as some molecular pathways are promoted while others are inhibited. This disturbance is accompanied by ROS production and lipid peroxidation, while an additional finding in most of them is iron accumulation. Once lipid peroxidation and iron accumulation are the two main characteristics of ferroptosis, it is possible that this mechanism plays a key role in the manifestation of IBMF in this type of disease. If this molecular mechanism is further confirmed, new pharmacological targets such as ferroptosis inhibitors that are already exploited for the treatment of other diseases, could be utilized to improve the treatment of ribosomopathies.

The Prevalence and Characteristics of Anemia in Romanian Patients with Type 2 Diabetes: A Cross-Sectional Study

Background/Objectives: Anemia is a prevalent comorbidity of diabetes, and although various mechanisms have been shown to link these two conditions, their interaction has not been sufficiently explored. Our cross-sectional, non-interventional study aimed to evaluate the prevalence of anemia and its subtypes, as well as their interactions, in patients with type 2 diabetes (T2D). Methods: A total of 227 patients previously diagnosed with T2D were enrolled. These patients were assessed regarding their medical history and the evolution of their diabetes, and were screened for anemia. Results: Anemia was encountered in 32.6% of the 227 hospitalized patients previously diagnosed with T2D enrolled in this study. Its presence was associated with a higher prevalence of complications and comorbidities, such as chronic kidney disease (CKD), retinopathy, and atrial fibrillation. The most common types of anemia observed were those associated with CKD, other chronic conditions, and iron deficiency. A moderate, positive correlation (r = 0.307; p < 0.0001) has been observed between estimated glomerular filtration rate (eGFR) and hemoglobin, and a moderate, negative correlation has been observed between age and hemoglobin (r = -0.351; p < 0.0001), with the results also analyzed using multiple regression and ROC curve analysis. Additionally, a weak, positive, yet statistically significant correlation was observed between glycemic values and hemoglobin levels, which requires further research. Conclusions: Anemia is frequently encountered in patients with T2D, especially in those with increased age, decreased eGFR, and additional chronic degenerative complications or other comorbidities; thus, a systematic screening for an early diagnosis and interdisciplinary management is recommended for improved outcomes related to morbidity, mortality, and quality of life.

A Cost-Utility Analysis of Ferric Derisomaltose Versus Ferric Carboxymaltose in Patients with Iron Deficiency Anemia in China

INTRODUCTION

Intravenous (IV) iron is the recommended treatment for patients with iron deficiency anemia (IDA) unresponsive to oral iron treatment, in whom oral iron is contraindicated, or where rapid iron replenishment is required. Ferric derisomaltose (FDI) and ferric carboxymaltose (FCM) are high-dose, rapid-infusion, IV iron formulations that have recently been compared in three head-to-head randomized controlled trials (RCTs), which showed significantly higher incidence of hypophosphatemia after administration of FCM than FDI. The present study objective was to evaluate the cost-utility of FDI versus FCM in a population of patients with IDA in China.

METHODS

A previously-published patient-level simulation model was used to model the cost-utility of FDI versus FCM in China. The number of infusions of FDI and FCM was modeled based on the approved posology of the respective formulations using simplified tables of iron need in a population of patients with body weight and hemoglobin levels informed by a Chinese RCT of FCM. Data on the incidence of hypophosphatemia was obtained from the PHOSPHARE-IDA RCT, while data on disease-related quality of life were obtained from SF-36v2 data from the PHOSPHARE-IBD RCT.

RESULTS

Over the 5-year time horizon, patients received 3.98 courses of iron treatment on average, requiring 0.90 fewer infusions of FDI than FCM (7.69 vs. 6.79). This resulted in iron procurement and administration cost savings of renminbi (RMB) 206 with FDI (RMB 3,519 vs. RMB 3,312). Reduced incidence of hypophosphatemia-related fatigue resulted in an increase of 0.07 quality-adjusted life years and further cost savings of RMB 782 over 5 years, driven by reduced need for phosphate testing and replenishment. FDI was therefore the dominant intervention.

CONCLUSIONS

The results showed that FDI would improve patient quality of life and reduce direct healthcare expenditure versus FCM in patients with IDA in China.

Diagnosis and Treatment of Perioperative Anemia: A Society for Perioperative Assessment and Quality Improvement Collaborative Review

Anemia is common in presurgical patients and is associated with poor clinical outcomes, even without erythrocyte transfusion. Structured preoperative programs for anemia management are associated with fewer blood transfusions, increased hemoglobin concentrations, and improved outcomes.

Assessment of fetal cardiac function in pregnant women with anemia: prospective case-control study

OBJECTIVE

To compare fetal cardiac function in pregnant women with iron deficiency anemia (IDA) vs healthy pregnant controls.

METHODS

This was a single-center, prospective, case-control study conducted in a tertiary hospital between November 2022 and September 2023. Women diagnosed with IDA who attended as outpatients at the pregnancy follow-up clinic at 30-34 weeks' gestation or who were hospitalized for intravenous iron treatment owing to profound anemia were included. The control group consisted of randomly selected gestational-age-matched pregnant women with no obstetric complications or comorbidities and who did not have anemia. Patients underwent two-dimensional imaging, followed by pulsed-wave Doppler and M-mode and tissue Doppler imaging (TDI) to evaluate fetal cardiac function. A fetal cardiac score was calculated using systolic, diastolic and global hemodynamic function parameters, and was compared between patients with IDA and those without. The fetal cardiac score was also assessed according to the severity of anemia in the IDA group.

RESULTS

A total of 150 patients, comprising 50 patients with IDA and 100 healthy pregnant women at 30-34 weeks' gestation, were included in the study. Of the patients with IDA, 20 had mild, 18 had moderate and 12 had severe anemia. The fetal myocardial performance index and isovolumetric relaxation time were significantly higher in the IDA group compared with the control group (P < 0.0001 for both), while isovolumetric contraction time was similar. Among the fetal tricuspid and mitral valve diastolic parameters, the E, A and E/A values were significantly lower in the IDA group (P < 0.05 for all). Mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursions were significantly lower in the IDA group (P < 0.05 for both). The IDA group also had significantly lower values for the TDI parameters mitral and tricuspid E', A', S' and E'/A' ratio and a significantly higher E/E' ratio (P < 0.05 for all). Among the IDA subgroups, a significant decrease was observed in the tricuspid and mitral A, E and E/A ratio in fetuses whose mothers had severe anemia (P = 0.001). M-mode Doppler analysis revealed significantly lower fetal TAPSE and MAPSE in the patient group with severe maternal anemia (P = 0.001 for both). According to the subgroup comparison of TDI findings, the fetuses of mothers with severe anemia had significantly lower tricuspid and mitral E', A', S' and E'/A' ratio values and a significantly higher E/E' ratio (P < 0.05 for all). The fetal cardiac score was significantly higher in the maternal IDA group compared with the control group (P < 0.001). A significant negative correlation was found between maternal hemoglobin level and fetal cardiac score (P < 0.001).

CONCLUSIONS

We observed differences in fetal systolic and diastolic cardiac function in pregnancies with maternal IDA. Fetal cardiac function was affected more among patients with severe anemia. This study found an increased E/E' ratio in the fetuses of pregnant women with IDA, suggesting decreased fetal heart maturation. Prenatal fetal cardiac evaluation, especially in women with severe anemia, can facilitate a more seamless transition to the postnatal period for these newborns. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Exploration of iron deficiency anemia and its associated factors among pregnant women seeking antenatal care in public health facilities of southwestern Ethiopia. A mixed study

BACKGROUND

Anemia is a major problem in Ethiopia, affecting a large part of the population. Despite the importance of the problem, the causes of anemia, especially iron deficiency anemia, among pregnant women attending antenatal care (ANC) in the study area have been little studied. Therefore, the aim of this study was to investigate iron deficiency anemia and its associated factors in pregnant women seeking antenatal care in public health facilities in Southwest Ethiopia in 2023.

METHODS AND MATERIALS

A mixed facility-based cross-sectional study was conducted involving 364 pregnant women from selected health facilities in Ilubabor and Buno Bedele zones. Backward multiple logistic regression was used to analyze the relationship between dependent and independent variables, with statistical significance set at a P value less than .05.

RESULTS

In this study, the prevalence of iron deficiency anemia was found to be 21.4%. Several factors have been significantly associated with iron deficiency anemia including; presence of malaria parasite [AOR=15.8, CI=5.1-48.4], presence of Helminthes [AOR=8.1, CI=2.8-23.9], consumption of leafy vegetables less than once a day [AOR=3.4, CI = 1.5-13.3] and not taking iron supplements/consumption [AOR=2.2, CI=1.1-4.4].

CONCLUSION AND RECOMMENDATIONS

The overall prevalence of iron deficiency anemia in the study area suggests that, it is a moderate public health problem. In order to improve the nutritional status of women, routine and consistent nutritional advice, the establishment of regular preventive systems and the implementation of feedback mechanisms are recommended.

Association of iron deficiency anaemia with the hospitalization and mortality rate of patients with COVID‑19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness led to the coronavirus disease 2019 (COVID-19) pandemic, which has caused enormous health and financial losses, as well as challenges to global health. Iron deficiency anaemia (IDA) has been linked to adverse outcomes in patients infected with SARS-COV-2. The present study aimed to assess the association between IDA and the severity of COVID-19 in hospitalized patients. For this purpose, a retrospective data analysis of 100 patients with COVID-19 was conducted. Data of patients hospitalized with SARS-COV-2 infection confirmed by RT-PCR were collected between June, 2021 and March, 2022. The collected data included patient demographics, comorbidities, clinical signs, symptoms and IDA medical laboratory findings, including complete blood count and iron profiles. The results revealed that patients with COVID-19 admitted to the isolation unit represented 61.0% of the study sample, whereas 39.0% were admitted to the intensive care unit (ICU). No patients had stage I IDA, whereas 4 patients (4%) had stage II IDA. Furthermore, 19 patients (19.0%) had stage III IDA. A significantly higher proportion of patients with IDA (69.6%) were admitted to the ICU compared with those without IDA (29.9%, P<0.001). Additionally, patients with IDA had a higher proportion of a history of stroke compared with those without IDA (17.4 vs. 2.6%, respectively, P=0.024). The most common comorbidities identified were hypertension (29%), diabetes (23%) and heart problems (17%). On the whole, the present study demonstrates significant associations between IDA and a longer hospitalization period. A greater incidence of complications was observed in the hospitalized patients who were SARS-COV-2-positive. Although further studies with larger sample sizes are required to confirm these findings, the results presented herein may provide insight for physicians as regards the prevention and treatment of patients with IDA who are infected with coronavirus.

Iron Level in Pregnant Rats is Associated with Caries Susceptibility in Offsprings

Iron deficiency anemia (IDA) is a prevalent issue in pregnant women and children. However, the causal relationship between IDA in pregnancy and caries susceptivity in offspring remains unclear. This study aimed to explore the role of iron level during pregnancy on caries susceptivity of offsprings. Here, low-iron (LI) and high-iron (HI) models were established in maternal rats, and iron-related characteristics were examined in maternal rats and their offsprings. After induction of caries in rat offsprings, the carious lesions were evaluated by the Keyes scores, and microstructural damages in molars were observed by scanning electron microscopy. The results showed that LI in maternal rats induced IDA in rat offsprings, and HI only increased serum ferritin in offsprings. LI and HI in maternal rats had no effect on the morphological structure of salivary glands in rat offsprings. After inducing caries, rat offsprings in the LI group exhibited significant increase in enamel lesions at the smooth surface, and on enamel, slight dentinal, and moderate dentinal lesions at the sulcal surface. Only enamel lesions at the sulcal surface were significantly weakened in the HI group. Additionally, visible enamel damages were observed in the LI group. To sum up, iron deficiency during pregnancy enhances caries susceptibility in rat offsprings.

A common variant in the iron regulatory gene (Hfe) alters the metabolic and transcriptional landscape in brain regions vulnerable to neurodegeneration

The role of iron dyshomeostasis in neurodegenerative disease has implicated the involvement of genes that regulate brain iron. The homeostatic iron regulatory gene (HFE) has been at the forefront of these studies given the role of the H63D variant (H67D in mice) in increasing brain iron load. Despite iron's role in oxidative stress production, H67D mice have shown robust protection against neurotoxins and improved recovery from intracerebral hemorrhage. Previous data support the notion that H67D mice adapt to the increased brain iron concentrations and hence develop a neuroprotective environment. This adaptation is particularly evident in the lumbar spinal cord (LSC) and ventral midbrain (VM), both relevant to neurodegeneration. We studied C57BL6/129 mice with homozygous H67D compared to WT HFE. Immunohistochemistry was used to analyze dopaminergic (in the VM) and motor (in the LSC) neuron population maturation in the first 3 months. Immunoblotting was used to measure protein carbonyl content and the expression of oxidative phosphorylation complexes. Seahorse assay was used to analyze metabolism of mitochondria isolated from the LSC and VM. Finally, a Nanostring transcriptomic analysis of genes relevant to neurodegeneration within these regions was performed. Compared to WT mice, we found no difference in the viability of motor neurons in the LSC, but the dopaminergic neurons in H67D mice experienced significant decline before 3 months of age. Both regions in H67D mice had alterations in oxidative phosphorylation complex expression indicative of stress adaptation. Mitochondria from both regions of H67D mice demonstrated metabolic differences compared to WT. Transcriptional differences in these regions of H67D mice were related to cell structure and adhesion as well as cell signaling. Overall, we found that the LSC and VM undergo significant and distinct metabolic and transcriptional changes in adaptation to iron-related stress induced by the H67D HFE gene variant.

A Study of the Clinical Profile of Iron Deficiency Anemia in Children With Sickle Cell Disease in a Tertiary Care Center

Background Sickle cell disease (SCD) and iron deficiency anemia (IDA) are significant global health concerns, particularly in pediatric populations. This study investigates the prevalence, clinical impact, and management challenges of IDA in children with SCD. Methods A prospective observational study was conducted at the Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC) and Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, from June 2022 to May 2024. The study included 60 children diagnosed with SCD. Comprehensive assessments were performed, including medical histories, physical examinations, and hematological investigations. Diagnosis of IDA was based on hemoglobin levels, mean corpuscular volume (MCV), red cell distribution width (RDW), peripheral blood smears, serum iron levels, and serum ferritin concentrations. Results Of the 60 participants, 15% exhibited iron deficiency. No significant gender differences were found in iron deficiency status. A significant association was observed between SCD type and the presence of pallor (p = 0.025) and sickle cell crises (p = 0.023). The study also found no significant association between SCD type and the presence of organomegaly (p = 0.079) or iron deficiency status (p = 0.675). The mean hemoglobin levels varied across SCD types, with sickle cell anemia patients showing lower levels than those with sickle cell trait or disease. Conclusion Diagnosing and managing IDA in children with SCD is complex due to overlapping hematological features and the risk of iron overload from frequent transfusions. Tailored diagnostic and therapeutic approaches are essential to improving hemoglobin levels, reducing complications, and enhancing the quality of life for affected children. This study provides valuable insights for refining clinical practices and emphasizes the need for a multidisciplinary approach to managing these intertwined conditions.

Gastric stability of bare and chitosan-fabricated ferritin and its bio-mineral: implication for potential dietary iron supplements

Iron deficiency anaemia (IDA), the most widespread nutritional disorder, is a persistent global health issue affecting millions, especially in resource-limited geographies. Oral iron supplementation is usually the first choice for exogenous iron administration owing to its convenience, effectiveness and low cost. However, commercially available iron supplementations are often associated with oxidative stress, gastrointestinal side effects, infections and solubility issues. Herein, we aim to address these limitations by employing ferritin proteins-self-assembled nanocaged architectures functioning as a soluble cellular iron repository-as a non-toxic and biocompatible alternative. Our in vitro studies based on PAGE and TEM indicate that bare ferritin proteins are resistant to gastric conditions but their cage integrity is compromised under longer incubation periods and at higher concentrations of pepsin, which is a critical component of gastric juice. To ensure the safe delivery of encapsulated iron cargo, with minimal cage disintegration/degradation and iron leakage along the gastrointestinal tract, we fabricated the surface of ferritin with chitosan. Further, the stoichiometry and absorptivity of iron-chelator complexes at both gastric and circumneutral pH were estimated using Job's plot. Unlike bipyridyl, deferiprone exhibited pH dependency. In vitro kinetics was studied to evaluate iron release from bare and chitosan-fabricated ferritins employing both reductive (in the presence of ascorbate and bipyridyl) and non-reductive (direct chelation by deferiprone) pathways to determine their bio-mineral stabilities. Chitosan-decorated ferritin displayed superior cage integrity and iron retention capability over bare ferritin in simulated gastric fluid. The ability of ferritins to naturally facilitate controlled iron release in conjugation with enteric coating provided by chitosan may mitigate the aforementioned side effects and enhance iron absorption in the intestine. The results of the current study could pave the way for the development of an oral formulation based on ferritin-caged iron bio-mineral that can be a promising alternative for the treatment of IDA, offering better therapeutic outcomes.

The Cdc42/Rac1 pathway: a molecular mechanism behind iron-deficiency-driven aortic medial degeneration

OBJECTIVE

To elucidate the underlying mechanism of iron deficiency augmented Angiotensin II-induced aortic medial degeneration.

METHODS

ApoE-/- mice were randomly divided into four groups: normal control group (NC group), Angiotensin II (Ang II) subcutaneous pumped alone Group (Ang II group), iron deficiency (ID) group (ID group) and ID+Ang II group. The survival time, systolic blood pressure (SBP), and aortic medial degeneration (AMD) formation were monitored. Iron deposition in the aortas was assessed using Prussian blue iron staining. The expression of iron metabolism indicators, aortopathies and the cytoskeleton of vascular smooth muscle cells (VSMCs) were analyzed. In an in vitro setting, deferoxamine (DFO) was employed to mimic ID to examine the effects of Ang II on the cytoskeletal and contractile function of VSMCs during ID. Ras-related C3 botulinum toxin substrate 1 (Rac-1) expression was inhibited with EHT1864 to verify the role of Cdc42/Rac1 pathway in this pathological process. Blood samples were collected from 150 patients with aortic dissection (AD) and 60 patients with hypertension who were admitted to the Department of Cardiovascular Surgery at Renmin Hospital of Wuhan University between June 2018 and September 2019. The aortic tissues were obtained during the surgical treatment of Stanford type A AD patients and the heart donor. The iron metabolism status in plasma and aortic tissue was analyzed.

RESULTS

In vivo experiments revealed that, in comparison to the NC and ID groups, mice in the Ang II and ID+Ang II groups exhibited increased SBP, significantly reduced survival time, and an expanded range of aortic dissection (P < 0.05). ID feeding augmented the Ang II-induced aortopathies. Both in vitro and in vivo results indicated that ID led to diminished expression of phosphorylated myosin light chain (p-MLC) and recombinant Cell Division Cycle Protein 42 (Cdc42) in VSMCs, while Rac-1 expression increased. The clinical sample testing data further confirmed the discovery that individuals diagnosed with AD display ID in both the plasma and the diseased aortas.

CONCLUSIONS

The Cdc42/Rac1 pathway plays a crucial role in disrupting the cytoskeleton of vascular smooth muscle cells during iron deficiency, which leads to aortic medial degeneration both in vivo and in vitro.

Highly Sensitive and Selective Recognition of Zn2⁺ and Fe2⁺ Ions Using a Novel Thiophene-Derived Hydrazone Dual Fluorometric Sensor

The selective detection of Zn2⁺ and Fe2⁺ ions is critical in environmental and biological studies. Schiff base chemosensors hold promise, but exploration of thiophene-derived variants remains limited. This work introduces a novel thiophene-derived Schiff base sensor (TBH), synthesized through the condensation reaction of thiophene-2-carboxaldehyde with benzil-bis-hydrazone, for the selective detection of Zn2⁺ and Fe2⁺ ions. TBH exhibits remarkable selectivity, with a significant 185-fold fluorescence enhancement for Zn2⁺ and complete quenching 99% for Fe2⁺, allowing for distinct detection of both ions. Notably, TBH demonstrates high binding affinity towards Zn2⁺ and Fe2⁺, even in the presence of competing cations, forming stable 1:1 complexes. This finding is supported by absorption and emission titration studies and FT-IR analysis as well. This easily synthesized, rapid and cost-effective sensor offers a promising approach for sensitive and differentiated dual detection of Zn2⁺ and Fe2⁺ in environmental and biological systems.

Pathophysiology and management of iron deficiency anaemia in pregnancy: a review

According to World Health Organization (WHO), iron deficiency anaemia (IDA) is considered the most prevalent nutritional deficiency worldwide, affecting approximately 30% of the global population. While gastrointestinal bleeding and menstruation in women are the primary causes of IDA, insufficient dietary iron intake and reduced iron absorption contribute to the condition. The aim of IDA treatment is to restore iron stores and normalise haemoglobin levels in affected patients. Iron plays a critical role in various cellular mechanisms, including oxygen delivery, electron transport, and enzymatic activity. During pregnancy, the mother's blood volume increases, and the growing foetus requires a significant increase in iron. Iron deficiency during pregnancy is associated with adverse outcomes such as maternal illness, low birth weight, preterm birth, and intrauterine growth restriction. Iron supplementation is commonly used to treat IDA; however, not all patients benefit from this therapy due to factors such as low compliance and ineffectiveness. In the past, IV iron therapy was underutilised due to its unfavourable and occasionally unsafe side effects. Nevertheless, the development of new type II and III iron complexes has improved compliance, tolerability, efficacy, and safety profiles. This article aims to provide an updated overview of the diagnosis and management of IDA during pregnancy. It will discuss the advantages and limitations of oral versus intravenous iron and the pathophysiology, diagnosis, treatment, and overall management of IDA in pregnancy.

Unearthing the therapeutic benefits of culinary-medicinal mushrooms for humans: Emerging sustainable bioresources of 21st century

Global interest in mushroom farming techniques has grown in the last few years. Despite not making up a large amount of the human diet at the moment, the nutritional worth of mushrooms has prompted their usage. The three main segments of the global mushroom industry are wild, culinary (edible), and medicinal mushrooms. The quality food that mushrooms provide can be utilized to build agricultural ecosystems that are more sustainable for increasing productivity and enhancing the effectiveness of resource usage. This is mostly because mushrooms can be utilized for the recycling of biomass and remains from crop production. Culinary-medicinal mushrooms are becoming more and more important because of their nutrient density, dietary value, and health advantages. Given its many bioactive components, which include polysaccharides, proteins, vitamins, minerals, dietary fiber, and secondary metabolites, mushrooms have been utilized extensively as health foods. These mushrooms exhibit pharmacological activities and possess prebiotic and antibacterial capabilities. This review provides information on the latest advancements in the sustainable cultivation of mushrooms, particularly with nontraditional substrates, and their potential therapeutic uses. Furthermore, some of the newest developments and difficulties in the production of mushrooms are explored.

Preparation of Rehmanniae Radix Praeparata Polysaccharide Iron(III) Complex and Evaluation of Its Biological Activity

This study extracted and purified a polysaccharide from Rehmanniae radix praeparata (RGP) with an average molecular weight. The structural characteristics of RGP and its iron (III) complex, RGP-Fe(III), were examined for their antioxidant properties and potential in treating iron deficiency anemia (IDA). Analysis revealed that RGP comprised Man, Rha, Gal, and Xyl, with a sugar residue skeleton featuring 1→3; 1→2, 3; and 1→2, 3, 4 linkages, among others. RGP-Fe(III) had a molecular weight of 4.39×104 Da. Notably, RGP-Fe(III) exhibited superior antioxidant activity compared to RGP alone. In IDA rat models, treatment with RGP-Fe(III) led to increased weight gain, restoration of key blood parameters including hemoglobin, red blood cells, and mean hemoglobin content, elevated serum iron levels, and decreased total iron-binding capacity. Histological examination revealed no observable toxic effects of RGP-Fe(III) on the liver and spleen. These findings suggest the potential of RGP-Fe(III) as a therapeutic agent for managing IDA and highlight its promising antioxidant properties.

Outcomes and complications of heart failure with iron deficiency anemia: a nationwide analysis

INTRODUCTION

Heart failure is a pressing public health concern, affecting millions in the United States and projected to rise significantly by 2030. Iron deficiency, prevalent in nearly half of ambulatory heart failure patients, contributes to anemia and diminishes patient outcomes. In this study, we aim to evaluate the impact of iron deficiency anemia on acute heart failure hospitalizations outcomes.

METHODS

Utilizing the 2019 National Inpatient Sample (NIS) database, a retrospective observational study assessed 112,864 adult patients hospitalized with heart failure and 7,865 cases also had a concomitant diagnosis of iron deficiency anemia (IDA).

RESULTS

Among 112,864 heart failure hospitalizations in 2019, approximately 7% had concomitant iron deficiency anemia (IDA). Heart failure patients with IDA exhibited distinct demographic characteristics, with females comprising 51.1% (p < 0.01) and higher rates of complicated hypertension (p < 0.01), complicated diabetes (p < 0.01), and peripheral vascular disease (p < 0.01). Adjusted mean LOS for patients with IDA was significantly longer at 1.31 days (95% CI 0.71-1.47; p < 0.01), persisting in both HFpEF and HFrEF subgroups. While total hospital charges were comparable in HFpEF, HFrEF patients with IDA incurred significantly higher charges ($13427.32, 95% CI: 1463.35-$25391.29, p = 0.03) than those without IDA. Complications such as atrial fibrillation and acute kidney injury were notably more prevalent in HFpEF and HFrEF patients with IDA.

CONCLUSION

The study highlighted that iron deficiency in heart failure patients leads to extended hospital stays, increased costs, and heightened risks of specific complications, particularly in HFrEF. Our study emphasized the implications of IDA in patients with heart failure ranging from prolonged hospitalizations and increased costs. Addressing iron deficiency is crucial, given its substantial impact on heart failure hospitalizations and outcomes, emphasizing the need for proactive diagnosis and management.

A new effect of intravenous iron treatment in pregnancy: contraction in nonstress test and timing of labor

OBJECTIVE

The aim of this study was to elucidate the cause and results of contractions occurring in term pregnant women receiving intravenous iron therapy.

METHODS

During 2019-2020, 136 pregnant women beyond 35 weeks of gestation, who received intravenous iron treatment due to iron deficiency anemia, were included through retrospective screening. Iron deficiency anemia was defined as having hemoglobin levels <10 g/dL and ferritin levels <15 ng/mL, and the pregnant women underwent nonstress test before and after treatment.

RESULTS

The average treatment week for the pregnant women was 36.82±0.74, and the presence of regular contractions in post-treatment follow-up nonstress tests was 72.1% (n=98). The average week of birth was 38.48±1.60. Pregnant women with contractions who had previous cesarean were found to have a mean delivery week of 36.82±0.67, which was statistically significant earlier than for nulliparous and multiparous women (p<0.001).

CONCLUSION

In pregnant women with iron deficiency anemia who were beyond 35 weeks, temporary regular contractions may be observed in the nonstress test following intravenous iron replacement. We think that this effect may lead to early term birth in pregnant women with a history of cesarean section. It needs to be confirmed by further prospective studies and animal studies.

Changes of Target Essential Trace Elements in Multiple Sclerosis: A Systematic Review and Meta-Analysis

(1) Background: Multiple sclerosis (MS) is a chronic, complex, and demyelinating disease closely associated with altered levels of trace elements. Although the first studies into the role of trace elements in MS were published in the 1970s, for five decades it has remained unknown whether trace elements can be part of this heterogeneous neurological disease. (2) Materials and methods: To drive toward at a potential solution, we conducted a systematic review and meta-analysis to elucidate whether there were differences in circulating levels of neurologically important essential trace elements (Zn, Fe, Co, Cu, Mn, and Se) between MS cases and controls. (3) Results: This study revealed significantly lower serum/plasma Zn and Fe levels and higher Cu levels in MS-affected individuals compared to controls. At the same time, no significant differences were found between the MS cases and controls regarding their serum/plasma levels of Co, Mn, or Se. Thus, the loss of Fe and Zn should be considered in supplementation/nutrition strategies for MS patients. On the other hand, since high serum Cu levels indicate a burden on the bloodstreams of MS patients, Cu should be excluded from mineral supplement strategies. Furthermore, all three trace elements (Fe, Zn, and Cu) should be considered from an etiological point of view, and, most importantly, their levels in the bloodstreams of MS patients should be monitored. (4) Conclusions: This study highlights the way for personalized and targeted strategies in the management of MS.

Immunological Insights Into Nutritional Deficiency Disorders

Essential nutrients play a vital role in influencing immune cell development. This chapter explores the crucial relationship between nutrition and the immune system, delving into the profound impact of dietary choices on overall health. Research highlights the benefits of nutrient-rich foods in supporting optimal immune function, while deficiencies in key nutrients (vitamins A, D, zinc, and iron) compromise immune responses, increasing susceptibility to infections. The bidirectional nature of the relationship is emphasized, underscoring the critical role of a balanced diet in supporting immune cell development, activation, and function. Case studies illustrate immunological vulnerabilities linked to inadequate nutritional status, stressing the importance of maintaining optimal nutrient levels for a robust immune system. In summary, an individual's nutritional status significantly influences immune response effectiveness. Addressing deficiencies through supplementation, dietary interventions, and public health initiatives is crucial for improving immune function.

[Semmelweis University Iron Board - Consensus statement of iron treatment]

A vashiány a leggyakoribb nyomelemhiány a világon, ezáltal jelentős globális egészségi problémát okoz mind a felnőttek, mind a gyermekek egészségügyi ellátásában. A vashiány számos társbetegséggel jár együtt, és jelentősen befolyásolja az életminőséget. Az anaemia kialakulása előtti felismerésével a tünetek és az életminőség javítható már korai stádiumban. Diagnosztizálásában és kezelésében számos orvosi terület érintett, ennek ellenére egyik diszciplína sem vállalja igazán magára a feladatot. A jelen konszenzusdokumentum célja egy egységes, diagnosztikus és terápiás útmutató létrehozása a vashiány miatt leginkább érintett orvosi területeken. A konszenzusos dokumentumot hematológiai, gasztroenterológiai, szülészet-nőgyógyászati, kardiológiai, gyermekgyógyászati és sportorvostani szakterületen jártas orvosok dolgozták ki, akik a Semmelweis Egyetem Iron Board tagjai. A konszenzusdokumentum szakterületenként tartalmazza a legfrissebb szakmai ajánlást. A vashiánybetegség különböző stádiumainak diagnosztikájához a vérképnek és a vasanyagcserét mutató paramétereknek (szérumvas, transzferrin, transzferrinszaturáció, ferritin) a vizsgálata szükséges. Az anaemia diagnózisához szükséges hemoglobinszint egyértelműen meghatározott, mely minden felnőtt betegcsoportra egyaránt érvényes: férfiaknál <130 g/l, nőknél <120 g/l, míg gyermekeknél életkortól függően változik. Az elsődleges cél a vashiánybetegség okának megállapítása és annak célzott kezelése. Az orális vaskezelés az első vonalbeli terápia a legtöbb esetben, mely biztonságos és hatékony a tünetes vagy anaemia kialakulására nagy kockázatú betegek esetén. Vas(II)-sók alkalmazásakor a készítmény másnaponkénti adagolása javítja az együttműködést, a tolerálhatóságot és a felszívódást. A vas(III)-hidroxid-polimaltóz előnye, hogy nem szükséges éhgyomorra bevenni, emellett már kora terhességben és gyerekeknél is biztonságosan alkalmazható. A C-vitamin használata a felszívódás növelése érdekében a legújabb klinikai vizsgálatok szerint nem jár előnnyel. Intravénás vaspótlás javasolt, ha a vasháztartás gyors rendezése szükséges, ha az orális kezelés nem tolerálható vagy nagy valószínűséggel hatástalan lesz, továbbá elsősorban pangásos szívelégtelenség, várandósság, gyulladásos bélbetegség, felszívódási zavar és preoperatív állapot esetén. Orv Hetil. 2024; 165(27): 1027–1038.

Intravenous Iron Versus Oral Iron Administration for the Treatment of Iron Deficiency Anemia: A Patient-Preference Study

BACKGROUND

Intravenous iron supplementation has been reported to provide a superior safety profile and effectiveness in the treatment of iron deficiency anemia (IDA) compared to traditional oral iron supplements.

AIM

To assess preference for intravenous iron versus oral iron among patients with IDA at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

METHODS

This observational cross-sectional study included 267 adults diagnosed with IDA or on treatment for IDA at King Abdulaziz University Hospital between February 2023 and March 2024. A specially modified questionnaire was used for the collection of data, which included demographic and treatment-related data. The values of the variables are presented as mean and standard deviation or median and interquartile range. Differences with an asymptotic two-tailed P-value of less than 0.05 were considered to be statistically significant.

RESULTS

The majority of the included patients were women (95.5%), Saudi nationals (90.6%), and from the Western region (98.1%). About half of the included patients were receiving intravenous iron supplementation (51.7%), and the other half were receiving oral iron supplements (48.3%). However, the majority of the patients (74.9%) reported that they preferred intravenous iron treatment. With regard to factors that affected their preference, education level (P = 0.044), employment status (P = 0.009), and income level (P = 0.007) were identified as significant predictors. Among the patients who preferred oral iron therapy, the reason cited by the majority, that is, 79.1%, was that tablets were easier to adhere to than needles, while 50.7% stated that tablets had fewer side effects than needles and 64.2% reported a fear of needles. Among the patients who preferred intravenous iron therapy, the majority, that is, 82.4%, stated that intravenous administration was easier for them. Further, 73.5% were of the opinion that intravenous iron therapy had fewer side effects (73.5%), 27.7% reported that they were unable to swallow iron tablets, and 52.5% reported that they had difficulty remembering to take iron tablets. About a third of patients discontinued oral iron therapy due to changes in bowel habits (35%). Although 18.7% of the patients reported feeling pain with intravenous iron therapy, the majority were satisfied (79.4%) and recommended intravenous iron treatment for anemia to friends and family members (84.6%). In contrast, more than half of the patients on oral therapy were uncomfortable (56.2%) with the treatment. Further, 37.1% were not satisfied with their iron tablets, and 25.1% of patients stated that they would not recommend iron tablets for anemia treatment to their friends or family members.

CONCLUSION

The majority of the patients preferred intravenous iron therapy to correct IDA because oral therapy was associated with difficulties related to swallowing iron tablets and remembering to take the tablets. Although the results indicate that both therapies have similar effectiveness, patients receiving intravenous treatment appeared to be more satisfied with the treatment and recommended it to friends and family.

Prevalence of Anemia in Type 2 Diabetic Patients and ‎correlation with Body Mass Index and Kidney ‎function in Palestine

Background

The objective of this study was to determine the prevalence of anemia in patients with type 2 diabetes mellitus and ‎to identify the set of anthropometric and biochemical factors that jointly influence ‎the diabetic and anemic patients including ‎body mass index and kidney function.‎‎.

Methods

A retrospective cross-sectional design study that was carried out in a private medical center ‎in Palestine. The study included a total of 453 patients with type 2 diabetes. Inclusion criteria ‎included all patients (18 years or older) suffering from type 2 Diabetes mellitus attended the ‎diabetic clinic from the 1st of January 2018, till 30th of December 2018.‎.

Results

A total number of 453 diabetic patients were recruited in the study. Male constituted 48.5% ‎‎(n=220) of the study sample and 51.4% (n=233) were female. Of total 453 diabetic patients, ‎‎38.4% (95% CI, 34%-43%) had anemia. The results of statistical modeling showed that female ‎gender (AOR 18.5; 95% CI 9.35-21.97), presence of hypertension (AOR 2.11; 95% CI 1.98- ‎‎4.25), high BMI (AOR 1.101; 95% CI 1.045-1.159), high Serum Creatinine (AOR 1.72; 95% ‎CI 1.22-2.13), high BUN level (AOR 1.22; 95% CI 1.145-1.301) and low e-GFR (AOR ‎‎0.571; 95% CI 0.271-0.872) are strong determents of anemia in type 2 diabetic patients.‎.

Conclusion

The results of the current study revealed a high prevalence of Anemia among type 2 diabetes ‎Mellitus patients. A significant association was reported between Anemia, kidney functions and ‎body mass index.‎.

Dietary micronutrients intake and its effect on haemoglobin levels of pregnant women for clinic visit in the Mount Cameroon health area: a cross-sectional study

Background

Nutritional deficiencies and its consequences such as anaemia are frequent among pregnant women residing in under resource settings. Hence, this study sought to investigate specific dietary micronutrient inadequacy and its effect on maternal haemoglobin levels.

Methods

This institution based cross-sectional survey enrolled 1,014 consenting pregnant women consecutively. Data on socio-demographic, economic and antenatal characteristics were recorded using a structured questionnaire. Minimum dietary diversity for women (MDD-W) was assessed using the 24-h recall method and haemoglobin (Hb) concentration (g/dL) determined using a portable Hb metre. Significant levels between associations was set at p < 0.05.

Results

Among those enrolled, 40.9% were anaemic while 89.6% had inadequate dietary nutrient intake. In addition, uptake of blood supplements, haem iron, plant and animal-based foods rich in vitamin A were 71.5, 86.2, 35.5 and 12.6%, respectively. Moreover, anaemia prevalence was significantly (p < 0.05) lower in women who took iron-folic acid along with food groups rich in haem iron (38.5%) or both plant and animal vitamin A (29.0%). Besides, mean maternal Hb levels was significantly (p < 0.001) higher in women who consumed haem iron (11.08 ± 1.35) and vitamin A food groups (11.34 ± 1.30) when compared with their counterparts who did not consume haem iron (10.54 ± 1.19) and vitamin A food groups (10.74 ± 1.31).

Conclusion

Dietary uptake of foods rich in haem-iron and vitamin A significantly improves Hb levels in Cameroonian pregnant women. Our findings underscore the importance of improving maternal nutritional awareness and counselling during antenatal period to reduce the anaemia burden.

Parenteral iron therapy in children with iron deficiency anemia

Iron deficiency anemia (IDA) continues to be a global public health problem. Oral iron is the universally accepted first-line therapy, and most children have a prompt and favorable response to oral formulations. In subsets of children who fail to respond due to intolerance, poor adherence, or inadequate intestinal absorption, parenteral iron is indicated. Despite numerous studies in adults with IDA of diverse etiologies, pediatric studies on parenteral iron use are very limited. Although mostly retrospective and small, these studies have documented the efficacy and safety profile of intravenous iron formulations. In this editorial the author comments on the most important published data and underscores the need to seriously consider parenteral iron use in children unresponsive to oral therapy.

Iron Deficiency Related to Obesity

There is a direct correlation between being overweight and iron deficiency. Physiological changes occur in obese adipose cells that contribute to the development of iron deficiency (ID) and iron deficiency anemia (IDA). These changes disrupt the normal iron metabolic checks and balances. Furthermore, bariatric surgery can lead to long-term ID and IDA. Oral iron supplementation may not be effective for many of these patients. Intravenous iron infusions can significantly increase the quality of life for individuals experiencing this condition but are also associated with potentially serious complications. Adequate knowledge about intravenous (IV) iron administration can greatly increase the safety of this beneficial therapy. This review article explains the relationship between obesity, ID/IDA, bariatric surgery and the safe administration of IV iron.