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Stratmann K, Hentschel V, Zeuzem S, Blumenstein I, Klaus J. [Iron supplementation in patients with chronic inflammatory bowel disease: recommendations for a practical approach]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1389-1396. [PMID: 38657618 DOI: 10.1055/a-2274-1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Iron deficiency is the predominant cause of anemia. Iron deficiency anemia plays a major role, especially in patients with inflammatory bowel disease (IBD), and is the most common extraintestinal manifestation and IBD-associated systemic complication. The presence of anemia leads to a reduction in quality of life in patients with IBD associated with limitations in physical, emotional, and cognitive function. In addition, it is associated with an increased hospitalization rate. For this reason, iron supplementation is of particular importance. Oral and intravenous iron supplements are used to treat iron deficiency. Due to the lack of absorption and gastrointestinal side effects of oral substitution, intravenous supplementation is becoming increasingly important. However, there are still certain concerns about intravenous administration.With the help of this review, we want to address the topic of iron substitution in patients with IBD, summarize current guideline recommendations, and provide a practical approach.
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Affiliation(s)
- Katharina Stratmann
- Universitätsklinikum, Medizinische Klinik 1, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | | | - Stefan Zeuzem
- Universitätsklinikum, Medizinische Klinik 1, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Irina Blumenstein
- Universitätsklinikum, Medizinische Klinik 1, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Jochen Klaus
- Klinik für Innere Medizin 1, Universitätsklinikum Ulm, Ulm, Germany
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2
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Lucas S, Garg M. Intravenous iron: an update. Intern Med J 2024; 54:26-34. [PMID: 37490496 DOI: 10.1111/imj.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/29/2023] [Indexed: 07/27/2023]
Abstract
Iron deficiency is the most common nutritional deficiency worldwide, with significant adverse health consequences in the presence or absence of anaemia. Total dose intravenous iron replacement is recommended for replacement of iron in patients with severe iron deficiency, especially in the presence of anaemia, intolerance or inefficacy following oral iron, or states of inflammation where upregulation of hepcidin may impair gastrointestinal absorption of iron. Currently, available intravenous iron formulations have been demonstrated to have an excellent overall safety profile, but potential adverse effects, including skin staining, infusion-related reactions and hypophosphataemia, have been described. Knowledge of differences in administration and safety profiles of currently available iron formulations will allow appropriate prescription, counselling, as well as recognition and management of adverse events in patients requiring intravenous iron.
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Affiliation(s)
- Sarah Lucas
- Northern Health, Melbourne, Victoria, Australia
| | - Mayur Garg
- Northern Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Ito K, Mitobe Y, Inoue R, Momoeda M. Impact of nausea/vomiting on EQ-5D-5L utility scores in patients taking iron preparations for heavy menstrual bleeding or anemia. BMC Womens Health 2023; 23:505. [PMID: 37735374 PMCID: PMC10512526 DOI: 10.1186/s12905-023-02652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The purpose of this study was to establish an estimating equation to predict the 5-level EQ-5D version (EQ-5D-5L) utility score in patients taking iron preparations for heavy menstrual bleeding (HMB) or anemia and to evaluate whether the presence of nausea or vomiting was a significant predictor of EQ-5D-5L-based quality of life. METHODS A cross-sectional survey was conducted to collect EQ-5D-5L utility scores and other patient reported outcomes from 385 patients taking iron preparations for HMB or anemia who were selected from the disease patient panel. Using the utility scores as objective variables, explanatory variable candidates were selected considering correlations, multicollinearity, and clinical validity. Predicting models were constructed using regression-based models (linear model, generalized linear model (GLM), Tobit model). Stepwise regression method was applied for selecting statistically significant (p < 0.05) predictors. Goodness-of-fit of models were assessed by mean absolute error and mean squared error (MSE). RESULTS The EQ-5D-5L utility scores (mean ± standard deviation) of 96 patients with nausea/vomiting and 289 patients without nausea/vomiting were 0.67 ± 0.16 and 0.84 ± 0.14, respectively (p < 0.001). The presence of nausea/vomiting was shown to be the most significant factor reducing the utility score in the statistical models using the explanatory variable candidates selected in the study. As the results of the goodness-of-fit test, GLM with the smallest MSE was selected to establish the estimating equation. CONCLUSION The estimating equation to predict the EQ-5D-5L utility scores in patients taking iron preparations for HMB or anemia was established. The presence of nausea/vomiting was found to be a factor significantly reducing utility scores, with a decrement of the value estimated to be -0.117. TRIAL REGISTRATION UMIN000045700 ( http://www.umin.ac.jp/ctr/ ). Registered on October 11, 2021.
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Affiliation(s)
- Kyoko Ito
- Medical Affairs Department, Torii Pharmaceutical Co., Ltd., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8439, Japan
| | - Yuko Mitobe
- Medical Affairs Department, Torii Pharmaceutical Co., Ltd., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8439, Japan
| | - Ryo Inoue
- Medical Affairs Department, Torii Pharmaceutical Co., Ltd., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8439, Japan
| | - Mikio Momoeda
- Aiiku Maternal and Child Health Center, Aiiku Hospital, 1-16-10 Shibaura, Minato-ku, Tokyo, 105-8321, Japan.
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Faysal H, Araji T, Ahmadzia HK. Recognizing who is at risk for postpartum hemorrhage: targeting anemic women and scoring systems for clinical use. Am J Obstet Gynecol MFM 2023; 5:100745. [PMID: 36075528 DOI: 10.1016/j.ajogmf.2022.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Iron deficiency anemia during pregnancy is a common concern, affecting 38% of women worldwide and up to 50% in developing countries. It is defined differently throughout all 3 trimesters. It has several detrimental effects on pregnancy outcomes for both the mother and the fetus, such as increasing the risk for postpartum depression, preterm delivery, cesarean delivery, preeclampsia, and low birthweight. Management of iron deficiency anemia is done classically via oral iron supplementation. However, recent evidence has shown that intravenous iron is a good alternative to oral iron if patients are unable to tolerate it, not responding, or present with a new diagnosis very late in pregnancy. Management of iron deficiency anemia was demonstrated to be protective against postpartum hemorrhage. Other ways to prevent postpartum hemorrhage include improving prediction tools that can identify those at risk. Several risk assessment kits have been developed to estimate the risk for postpartum hemorrhage among patients and have been proven useful in the prediction of patients at high risk for postpartum hemorrhage despite limitations among low-risk groups. More comprehensive tools are also being explored by determining clinically relevant factors through nomograms, with some proving their efficacy after implementation. Machine learning is also being used to develop more complete tools by including risk factors previously not accounted for. These newer tools, however, still require external validation before being adopted despite promising results under testing conditions.
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Affiliation(s)
- Hani Faysal
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Tarek Araji
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Homa K Ahmadzia
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
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Ying-ying G, Yan-fang W, Yan D, Su-ying Z, Dong L, Bin L, Xue W, Miao D, Rui-lin M, Xiao-hui L, Yu-pei J, Ai-jun S. Metabolomic mechanism and pharmacodynamic material basis of Buxue Yimu pills in the treatment of anaemia in women of reproductive age. Front Pharmacol 2023; 13:962850. [PMID: 36703727 PMCID: PMC9871362 DOI: 10.3389/fphar.2022.962850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Objective: To explore the pharmacological basis and mechanism of Buxue Yimu pills (BYP) in the treatment of anaemia in women from the perspective of metabolomics and network analysis. Materials and Methods: Forty-six women of reproductive age with haemoglobin 70-110 g/L were recruited. Blood samples were collected before and after 4 weeks of oral BYP treatment to assess the changes in haemoglobin, coagulation function, and iron metabolism indices. An integrated analysis of metabolomics (liquid chromatography mass spectrometry) and network analysis was performed to identify the potential pharmacodynamic mechanisms of BYP. Results: After BYP treatment, the haemoglobin level of patients significantly increased from 93.67 ± 9.77 g/L to 109.28 ± 12.62 g/L (p < 0.01), while no significant changes were found in iron metabolism and coagulation-related indicators. A total of 22 differential metabolites were identified after metabolomics analysis, which were mainly related to the inhibition of inflammation and oxidative stress. Integrating pharmacodynamics and metabolomics, a network of drug-active components-targets-metabolic pathways-metabolomics was established. Acetylcholinesterase, phospholipase A2 group IIA, and phospholipase A2 group IVA may be the most promising therapeutic targets. Conclusion: BYP can inhibit inflammation and oxidative stress as well as promote haematopoiesis, potentially improving anaemia.
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Affiliation(s)
- Guo Ying-ying
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang Yan-fang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Deng Yan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhang Su-ying
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Liu Dong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China,Ministry of Education, Sichuan University, Chengdu, China
| | - Luo Bin
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China,Ministry of Education, Sichuan University, Chengdu, China
| | - Wang Xue
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Healthcare Hospital), Hangzhou, China
| | - Deng Miao
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Healthcare Hospital), Hangzhou, China
| | - Ma Rui-lin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liu Xiao-hui
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Jiao Yu-pei
- National Protein Science Technology Center, Tsinghua University, Beijing, China
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Falahati V, Ghasemi A, Ghaffari K, Eghbali A, Khodabakhshi S, Almasi-Hashiani A, Sadeghi-Sedeh B, Shanbehzadeh M. Comparison of the effect of ferrous sulfate and ferrous gluconate on prophylaxis of iron deficiency in toddlers 6-24 months old: A randomized clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:368. [PMID: 36618468 PMCID: PMC9818626 DOI: 10.4103/jehp.jehp_1764_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Iron deficiency anemia (IDA) is one of the most common anemias, especially in children 4-23 months. Therefore, prophylaxis is necessary to improve iron status as well as reduce IDA in Toddlers. The aim of this study was to compare the efficacy of daily supplementation with ferrous gluconate (FG) and ferrous sulfate (FS) on iron status in toddlers. MATERIALS AND METHODS A total of 120 healthy toddlers were divided randomly into 2 groups at the Amir-Kabir Hospital, Arak, Iran and received FS and FG from March 2020 to December 2020. Iron status was evaluated at baseline and after 6 months of supplementation. The statistical significance of the differences in iron status between FS and FG groups was calculated using Student's t-test and the Pearson' s Chi-square test for qualitative variables. SPSS software (version 16, Chicago, IL, USA) was used for statistical analysis. RESULTS Comparison of iron status of FS and FG groups toddlers at baseline and after 6 months of supplementation showed that there was a significant difference in hemoglobin (Hb) (10.46 vs. 12.45, P = 0.001) and ferritin level (28.08 vs. 59.63, P = 0.001). CONCLUSIONS Although prophylaxis with FG led to a higher Hb and ferritin levels, our study recommended that both FG and FS supplements were effective for prophylactic use in the prevention of IDA. However, FG was more effective than FS because FG group that received FG supplementation indicated a higher Hb and ferritin levels in comparison to the FS group that received FS supplementation.
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Affiliation(s)
- Vahid Falahati
- Clinical Research Development Center of Amirkabir Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Ali Ghasemi
- Department of Biochemistry and Hematology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Kazem Ghaffari
- Department of Basic and Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Aziz Eghbali
- Clinical Research Development Center of Aliasghar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Khodabakhshi
- Clinical Research Development Center of Amirkabir Hospital, Arak University of Medical Sciences, Arak, Iran
| | | | | | - Mostafa Shanbehzadeh
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
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Fisyun IV, Kuznetsova TA, Tkacheva YA, Yakubova EV. Results of Randomized Comparative Efficacy Study of Iron Deficiency Anemia Management in Children with Iron III Hydroxide Polymaltose Complex and Iron Sulfate. PEDIATRIC PHARMACOLOGY 2022. [DOI: 10.15690/pf.v19i4.2441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background. The guidelines on selection between iron preparations, iron sulfate (IS) and iron III hydroxide polymaltose complex (HPC), for iron deficiency anemia (IDA) management in pediatrics are contradictory. Objective. The aim of the study is to compare efficacy and safety of iron (III) HPC and IS for IDA treatment in children. Materials and methods. Randomization of children (aged from 1 month to 18 years) with IDA into 2 therapeutic groups was implemented in 2019-2020. on pediatric districts of children’s city outpatient's clinic: IS dosage of 3 mg/kg/day and iron (III) HPC dosage of 5 mg/kg/day. Hemogram monitoring was performed every 14 days. The efficacy was compared according to the rate of Hb level increase, erythrocytes indices, and serum ferritin (SF) level at the recorded moment of Hb normalization. For the safety — the rate of adverse effects. Results. 65 children with IDA were included in the study and randomized into 2 groups, the median age was 2.3 years (1st; 3rd quartile = 1.1; 4.3). Hb level increase was comparable in both groups (0.34 (0.23; 0.48) g/L/day and 0.24 (0.21; 0.30) g/L/day, р = 0.891). IS is more effective than iron (III) HPC in terms of average red blood cell volume by the time of Hb normalization (83.5 (80.0; 86.7) fl against 80.7 (79.0; 82.0) fl, р = 0.006), and mean cellular hemoglobin content (28.9 (SD = 2.0) pg against 27.4 (SD = 1.8) pg, р = 0.004). The timing of SF levels normalization did not differ. Adverse effects to iron III HPC treatment occurred 5.5 times more frequently than to IS (p = 0.0001). Conclusion. The efficacy of IS and iron III HPC at standard doses is comparable. The advantage in tolerability and recovery of erythrocytic indices justifies the feasibility of using IS preparations in the first line of treatment for children with IDA.
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Affiliation(s)
- Ivan V. Fisyun
- Orel State University named after I.S. Turgenev, Medical Institute
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Helfrich KK, Saini N, Kwan STC, Rivera OC, Hodges R, Smith SM. Gestational Iron Supplementation Improves Fetal Outcomes in a Rat Model of Prenatal Alcohol Exposure. Nutrients 2022; 14:nu14081653. [PMID: 35458215 PMCID: PMC9025692 DOI: 10.3390/nu14081653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 12/19/2022] Open
Abstract
Prenatal alcohol exposure causes neurodevelopmental disability and is associated with a functional iron deficiency in the fetus and neonate, even when the mother consumes an apparently iron-adequate diet. Here, we test whether gestational administration of the clinically relevant iron supplement Fer-In-Sol mitigates alcohol’s adverse impacts upon the fetus. Pregnant Long-Evans rats consumed an iron-adequate diet and received 5 g/kg alcohol by gavage for 7 days in late pregnancy. Concurrently, some mothers received 6 mg/kg oral iron. We measured maternal and fetal weights, hematology, tissue iron content, and oxidative damage on gestational day 20.5. Alcohol caused fetal anemia, decreased fetal body and brain weight, increased hepatic iron content, and modestly elevated hepatic malondialdehyde (p’s < 0.05). Supplemental iron normalized this brain weight reduction in alcohol-exposed males (p = 0.154) but not female littermates (p = 0.031). Iron also reversed the alcohol-induced fetal anemia and normalized both red blood cell numbers and hematocrit (p’s < 0.05). Iron had minimal adverse effects on the mother or fetus. These data show that gestational iron supplementation improves select fetal outcomes in prenatal alcohol exposure (PAE) including brain weight and hematology, suggesting that this may be a clinically feasible approach to improve prenatal iron status and fetal outcomes in alcohol-exposed pregnancies.
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Affiliation(s)
- Kaylee K. Helfrich
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA; (K.K.H.); (S.T.C.K.); (O.C.R.); (R.H.)
- Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
| | - Nipun Saini
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA; (K.K.H.); (S.T.C.K.); (O.C.R.); (R.H.)
- Correspondence: (N.S.); (S.M.S.)
| | - Sze Ting Cecilia Kwan
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA; (K.K.H.); (S.T.C.K.); (O.C.R.); (R.H.)
| | - Olivia C. Rivera
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA; (K.K.H.); (S.T.C.K.); (O.C.R.); (R.H.)
| | - Rachel Hodges
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA; (K.K.H.); (S.T.C.K.); (O.C.R.); (R.H.)
| | - Susan M. Smith
- UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA; (K.K.H.); (S.T.C.K.); (O.C.R.); (R.H.)
- Department of Nutrition, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
- Correspondence: (N.S.); (S.M.S.)
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Ahmad Fuzi SF, Su Peng L, Zabaha Zalbahar N, Ab. Manan N, Mohamad Alwi MN. Effect of vitamin D3-fortified fruit juice supplementation of 4000 IU daily on the recovery of iron status in childbearing-aged women with marginally low iron stores: Protocol for an 8-week, parallel group, double-blind randomized controlled trial. PLoS One 2022; 17:e0265772. [PMID: 35333885 PMCID: PMC8956161 DOI: 10.1371/journal.pone.0265772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In recent years, emerging evidence has highlighted the role of vitamin D as an iron absorption enhancer by suppressing hepcidin concentration, albeit with an unclear underlying mechanism. Dietary-based approach in improving iron status has been widely practised, however, there is a scarcity in randomized controlled trials (RCT) to elucidate the effect of vitamin D-fortified juice on iron status recovery. Therefore, this study aims to investigate the effect of an 8-week vitamin D3-fortified fruit juice supplementation on iron status indicators in childbearing-aged women with marginally low iron stores. METHODS In a placebo-controlled, double-blind, RCT, a total of 120 women aged between 19-40 with serum ferritin < 20 μg/l and fulfilled the eligibility criteria will be randomized into consuming either vitamin D3-fortified fruit juices containing 4000 IU (100 mcg) (vitamin D) or placebo-fruit juices (placebo) daily for eight weeks. At every 4-week interval, 10 ml fasting blood sample, information on dietary habit and anthropometric measurement will be collected. A mixed model repeated-measures analysis of variance will be performed to determine the effect of the intervention and the interaction with time points for all iron and vitamin D status blood biomarkers. DISCUSSION Vitamin D supplementation in food fortification as a novel iron absorption enhancer might be a future and relevant alternative management of iron deficiency as opposed to the oral iron therapy that has poor adherence. TRIAL REGISTRATION Clinicaltrials.gov: registration number NCT04618289, registration date October 28, 2020, protocol ID JKEUPM-2020-033.
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Affiliation(s)
- Salma Faeza Ahmad Fuzi
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Loh Su Peng
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nurzalinda Zabaha Zalbahar
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norhafizah Ab. Manan
- Department of Public Health, Faculty of Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya, Selangor, Malaysia
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Mwangi MN, Mzembe G, Moya E, Braat S, Harding R, Robberstad B, Simpson J, Stones W, Rogerson S, Biselele K, Chinkhumba J, Larson L, Ataíde R, Phiri KS, Pasricha SR. Protocol for a multicentre, parallel-group, open-label randomised controlled trial comparing ferric carboxymaltose with the standard of care in anaemic Malawian pregnant women: the REVAMP trial. BMJ Open 2021; 11:e053288. [PMID: 34815287 PMCID: PMC8611444 DOI: 10.1136/bmjopen-2021-053288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Anaemia in pregnancy remains a critical global health problem, affecting 46% of pregnant women in Africa and 49% in Asia. Oral iron therapy requires extended adherence to achieve correction of anaemia and replenishment of iron stores. Ferric carboxymaltose (FCM) is a recently established intravenous iron formulation associated with substantial advantages in safety, speed of delivery and total dose deliverable in a single infusion. We aim to determine whether FCM given once during the second trimester of pregnancy compared with standard oral iron distributed through routine antenatal services is effective and safe for treatment of moderate to severe maternal anaemia in sub-Saharan Africa. METHODS AND ANALYSIS The randomized controlled trial of the effect of intravenous iron on anaemia in Malawian pregnant women (REVAMP) is a two-arm confirmatory individually randomised trial set in Blantyre and Zomba districts in Malawi. The trial will randomise 862 women in the second trimester of pregnancy with a capillary haemoglobin concentration below 100.0 g/L. The study comprises two arms: (a) intravenous FCM (20 mg/kg up to 1000 mg) given once at randomisation, and (b) standard of care oral iron (65 mg elemental iron two times per day) for 90 days (or the duration of pregnancy, whichever is shorter) provided according to local healthcare practices. Both arms receive sulfadoxine-pyrimethamine as intermittent preventive treatment in pregnancy. The primary outcome is the prevalence of anaemia (Hb <110.0 g/L) at 36 weeks' gestation. Secondary outcomes include birth weight, gestation duration and safety outcomes, including clinical malaria, serious perinatal events and postpartum haematologic and health-related outcomes in the mother and child. ETHICS AND DISSEMINATION Ethical approval was granted by the Research Ethics Committee (COMREC P.02/18/2357) in Malawi and the Human Research Ethics Committee (WEHI: 18/02), Melbourne, Australia. The protocol is registered with the Australian and New Zealand Clinical Trials Registry. The results will be shared with the local community that enabled the research, and also to the international fora. TRIAL REGISTRATION NUMBER ACTRN12618001268235; Pre-results.
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Affiliation(s)
- Martin N Mwangi
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Department of Nutrition and Infectious Diseases, Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
| | - Glory Mzembe
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Department of Nutrition and Infectious Diseases, Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
| | - Ernest Moya
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Department of Nutrition and Infectious Diseases, Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Harding
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Bjarne Robberstad
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Julie Simpson
- Centre for Epidemiology and Biostatistics, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - William Stones
- Department of Obstetrics and Gynaecology, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Stephen Rogerson
- Department of Infectious Diseases, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Kabeya Biselele
- Department of Obstetrics and Gynaecology, Zomba Central Hospital, Zomba, Malawi
| | - Jobiba Chinkhumba
- Malaria Alert Centre, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Leila Larson
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Ricardo Ataíde
- Department of Infectious Diseases, The University of Melbourne, Melbourne, Victoria, Australia
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Kamija S Phiri
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Department of Nutrition and Infectious Diseases, Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
- Diagnostic Haematology and Clinical Haematology, The Peter MacCallum Cancer Centre, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Rogozińska E, Daru J, Nicolaides M, Amezcua-Prieto C, Robinson S, Wang R, Godolphin PJ, Saborido CM, Zamora J, Khan KS, Thangaratinam S. Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis. Lancet Haematol 2021; 8:e503-e512. [PMID: 34171281 PMCID: PMC7612251 DOI: 10.1016/s2352-3026(21)00137-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Numerous iron preparations are available for the treatment of iron deficiency anaemia in pregnancy. We aimed to provide a summary of the effectiveness and safety of iron preparations used in this setting. METHODS We did a systematic review and network meta-analysis of randomised trials. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, trial registers, and grey literature for trials published in any language from Jan 1, 2011, to Feb 28, 2021. We included trials including pregnant women with iron deficiency anaemia and evaluating iron preparations, irrespective of administration route, with at least 60 mg of elemental iron, in comparison with another iron or non-iron preparation. Three authors independently selected studies, extracted data, and did a risk of bias assessment using the Cochrane tool (version 1.0). The primary outcome was the effectiveness of iron preparations, evaluated by changes in haemoglobin concentration at 4 weeks from baseline. The secondary outcomes were change in serum ferritin concentration at 4 weeks from baseline and treatment-related severe and non-severe adverse events. We did random-effects pairwise and network meta-analyses. Side-effects were reported descriptively for each trial. This study is registered with PROSPERO, CRD42018100822. FINDINGS Among 3037 records screened, 128 full-text articles were further assessed for eligibility. Of the 53 eligible trials (reporting on 9145 women), 30 (15 interventions; 3243 women) contributed data to the network meta-analysis for haemoglobin and 15 (nine interventions; 1396 women) for serum ferritin. The risk of bias varied across the trials contributing to network meta-analysis, with 22 of 30 trials in the network meta-analysis for haemoglobin judged to have a high or medium global risk of bias. Compared with oral ferrous sulfate, intravenous iron sucrose improved both haemoglobin (mean difference 7·17 g/L, 95% CI 2·62-11·73; seven trials) and serum ferritin (mean difference 49·66 μg/L, 13·63-85·69; four trials), and intravenous ferric carboxymaltose improved haemoglobin (mean difference 8·52 g/L, 0·51-16·53; one trial). The evidence for other interventions compared with ferrous sulfate was insufficient. The most common side-effects with oral iron preparations were gastrointestinal effects (nausea, vomiting, and altered bowel movements). Side-effects were less common with parenteral iron preparations, although these included local pain, skin irratation, and, on rare occasions, allergic reactions. INTERPRETATION Iron preparations for treatment of iron deficiency anaemia in pregnancy vary in effectiveness, with good evidence of benefit for intravenous iron sucrose and some evidence for intravenous ferric carboxymaltose. Clinicians and policy makers should consider the effectiveness of individual preparations before administration, to ensure effective treatment. FUNDING None.
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Affiliation(s)
| | - Jahnavi Daru
- Institute for Population Health Science, Queen Mary University of London, London, UK.
| | - Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Susan Robinson
- Department of Haematology, Guy's and St Thomas' Hospital, London, UK
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Peter J Godolphin
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Carlos Martín Saborido
- Department of Health Planning and Economics, National School of Public Health, Institute of Health Carlos III, Madrid, Spain
| | - Javier Zamora
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Hospital Universitario Ramón y Cajal (IRYCIS), CIBERESP, Madrid, Spain
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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12
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Mohd Rosli RR, Norhayati MN, Ismail SB. Effectiveness of iron polymaltose complex in treatment and prevention of iron deficiency anemia in children: a systematic review and meta-analysis. PeerJ 2021; 9:e10527. [PMID: 33520436 PMCID: PMC7811280 DOI: 10.7717/peerj.10527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/18/2020] [Indexed: 01/04/2023] Open
Abstract
Background Iron deficiency anemia (IDA) is commonly treated with iron formulations. Despite the expanding acceptance of iron polymaltose complex (IPC) among clinicians, there is sparse and contradictory evidence regarding its efficacy in the management of IDA in children. This systematic review and meta-analysis aimed to assess the effectiveness of IPC in the treatment and prevention of IDA in children. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE and Epistemonikos for all randomized control trials (RCTs) comparing oral IPC with standard oral iron supplementation for the treatment or prevention of IDA in children. We independently screened the titles and abstracts of identified trials before the full text of relevant trials was evaluated for eligibility. We then independently extracted data on the methods, interventions, outcomes, and risk of bias from the included trials. A random-effects model was used to estimate the risk ratios and mean differences with 95% confidence intervals. Results Eight trials comprising 493 randomized patients were included and analyzed using three comparison groups. The comparison group of which was used to evaluate IPC and ferrous sulphate (FS) for treatment of IDA showed that IPC is less effective in increasing Hb (MD −0.81, 95% CI −1.08 to −0.53; I2 = 48%, P < 0.001; six studies, 368 participants; high certainty of evidence), ferritin (MD −21.24, 95% CI −39.26 to −3.23, random-effects; I2 = 65%, P = 0.020; 3 studies, 183 participants; moderate certainty of evidence) and MCV levels (MD −3.20, 95% CI −5.35 to −1.05; P = 0.003; one study, 103 participants; low certainty of evidence). There was no difference in the occurrence of side effects between IPC and FS group (MD 0.78, 95% CI 0.47 to 1.31; I2 = 4%, P = 0.35; three studies, 274 participants; high certainty of evidence). Conclusions There was moderate to high certainty evidence that FS is superior to IPC with a clinically meaningful difference in improving the Hb and ferritin levels in the treatment of IDA in children. There was no difference in the occurrence of gastrointestinal side effects with high certainty evidence between the IPC and FS groups. The body of evidence did not allow a clear conclusion regarding the effectiveness of IPC with iron gluconate and iron bisglycinate in the prevention and treatment of IDA. The certainty of evidence was low. Adequately powered and high-quality trials with large sample sizes that assess both hematological and clinical outcomes are required. PROSPERO registration number: CRD42019145020
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Affiliation(s)
- Ritzzaleena Rosli Mohd Rosli
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Shaiful Bahari Ismail
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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13
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Chen K, Zhang G, Chen H, Cao Y, Dong X, Li H, Liu C. Dose Effect of Bovine Lactoferrin Fortification on Iron Metabolism of Anemic Infants. J Nutr Sci Vitaminol (Tokyo) 2020; 66:24-31. [PMID: 32115450 DOI: 10.3177/jnsv.66.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To evaluate the effect of iron-fortified formula with different concentrations of bovine lactoferrin (bLF) on improvement of anemic status in term infants who were previously breast-fed. A randomized, controlled, open, and post-market intervention study. A total of 108 infants aged 6-9 mo who were previously breast-fed and weaned were selected. The subjects were divided into three groups with the sequence of outpatient: fortified group 1 (FG1) with a bLF concentration of 38 mg/100 g, FG2 with 76 mg/100 g bLF, FG0 with no bLF. The intervention duration was 3 mo. Weight, height, head circumference and the concentration of hemoglobin (Hb), serum ferritin (SF), serum transferring receptor (sTfR) were measured and sTfR-SF index (TFR-F index) and total body iron content (TBIC) were computed before and after intervention. The primary outcome measures were obtained from 96 infants (35, 33 and 28 for FG0, FG1 and FG2, respectively). After 1 mo of intervention, the changes of Hb level showed no significant difference (p>0.05) among the three groups, however, the Hb level of infants in FG2 were significantly higher than those of infants in the other two groups after 3 mo of intervention (p<0.05). The present data indicated that the formula fortified with 76 mg/100 g bLF positively affected the Hb of anemic infants who were previously breastfed when compared with fortification with 38 mg/100 g bLF and no bLF fortification.
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Affiliation(s)
- Ke Chen
- Department of Nutrition, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China.,Department of Child Health Care, New Century Women's and Children's Hospital
| | - Guoying Zhang
- Department of Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China
| | - Haixia Chen
- Department of Disease Prevention and Control, Center for Disease Control and Prevention of Baoxing County
| | - Yanmei Cao
- Department of Child Health Care, Dayi Maternal and Child Health Care Hospital
| | - Xiaobing Dong
- Department of Child Health Care, Hehuachi Community Health Service Center
| | - Hua Li
- Department of Child Hygiene, Qingbaijiang Maternal and Child Health Care Hospital
| | - Changqi Liu
- School of Exercise and Nutritional Sciences, San Diego State University
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14
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Oskovi-Kaplan ZA, Kilickiran H, Buyuk GN, Ozyer S, Keskin HL, Engin-Ustun Y. Comparison of the maternal and neonatal outcomes of pregnant women whose anemia was not corrected before delivery and pregnant women who were treated with intravenous iron in the third trimester. Arch Gynecol Obstet 2020; 303:715-719. [PMID: 32990783 DOI: 10.1007/s00404-020-05817-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
AIM Anemia is one of the most common problems of pregnancy. In this study, we aimed to compare the maternal and fetal outcomes in labor and delivery in women whose anemia was treated with intravenous iron and women who delivered with uncorrected anemia. MATERIALS METHODS: This retrospective case-control study was carried out in a tertiary obstetric care center. Term (> 37 weeks), singleton, low-risk pregnant women who were admitted for delivery were evaluated. Seventy-two pregnant women who had intravenous ferric carboxymaltose treatment in the third trimester were compared with 72 women who were anemic (Hb < 10 g/dL) at the time Queryof admission for delivery. RESULTS The groups were similar in terms of age, parity, and gestational age. The mean gestational age of the study group was 38.6 weeks. Their mean Hb of 8.2 ± 0.8 g/dL improved to 11.1 ± 1.3 g/dL prior birth. The mean Hb of the anemic group was 9.1 ± 0.5 g/dL upon admission for birth. The mean APGAR scores, admission to neonatal intensive care unit, and the rates of preterm delivery, small for gestational age, and low-birth weight infant were similar between groups. The primary cesarean section rate was significantly higher in anemic women (4.2% vs. 19.4%; p < 0.001) and the need for postpartum blood transfusion also decreased with iv iron treatment (8.3% vs. 29.2%; p = 0.02). CONCLUSION Correction of anemia with intravenous ferric carboxymaltose in the third trimester does not significantly change neonatal outcomes but it is effective in reducing maternal morbidity.
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Affiliation(s)
- Z Asli Oskovi-Kaplan
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Harun Kilickiran
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Gul Nihal Buyuk
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Sebnem Ozyer
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - H Levent Keskin
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
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15
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Garzon S, Cacciato PM, Certelli C, Salvaggio C, Magliarditi M, Rizzo G. Iron Deficiency Anemia in Pregnancy: Novel Approaches for an Old Problem. Oman Med J 2020; 35:e166. [PMID: 32953141 PMCID: PMC7477519 DOI: 10.5001/omj.2020.108] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/27/2019] [Indexed: 12/13/2022] Open
Abstract
Iron needs increase exponentially during pregnancy to meet the increased demands of the fetoplacental unit, to expand maternal erythrocyte mass, and to compensate for iron loss at delivery. In more than 80% of countries in the world, the prevalence of anemia in pregnancy is > 20% and could be considered a major public health problem. The global prevalence of anemia in pregnancy is estimated to be approximately 41.8%. Undiagnosed and untreated iron deficiency anemia (IDA) can have a great impact on maternal and fetal health. Indeed, chronic iron deficiency can affect the general wellbeing of the mother and leads to fatigue and reduced working capacity. Given the significant adverse impact on maternal-fetal outcomes, early recognition and treatment of this clinical condition is fundamental. Therefore, the laboratory assays are recommended from the first trimester to evaluate the iron status. Oral iron supplementation is the first line of treatment in cases of mild anemia. However, considering the numerous gastrointestinal side effects that often lead to poor compliance, other therapeutic strategies should be evaluated. This review aims to provide an overview of the current evidence about the management of IDA in pregnancy and available treatment options.
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Affiliation(s)
- Simone Garzon
- Department of Obstetrics and Gynecology, University of Insubria, Filippo Del Ponte Hospital, Varese, Italy
| | | | - Camilla Certelli
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Calogero Salvaggio
- Azienda Sanitaria Provinciale 2 Caltanissetta, Sant'Elia Hospital, Caltanissetta, Italy
| | - Maria Magliarditi
- Department of Obstetrics and Gynecology, Policlinico Universitario Gazzi, University of Messina, Messina, Italy
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Briguglio M, Hrelia S, Malaguti M, Lombardi G, Riso P, Porrini M, Perazzo P, Banfi G. The Central Role of Iron in Human Nutrition: From Folk to Contemporary Medicine. Nutrients 2020; 12:nu12061761. [PMID: 32545511 PMCID: PMC7353323 DOI: 10.3390/nu12061761] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Iron is a fundamental element in human history, from the dawn of civilization to contemporary days. The ancients used the metal to shape tools, to forge weapons, and even as a dietary supplement. This last indication has been handed down until today, when martial therapy is considered fundamental to correct deficiency states of anemia. The improvement of the martial status is mainly targeted with dietary supplements that often couple diverse co-factors, but other methods are available, such as parenteral preparations, dietary interventions, or real-world approaches. The oral absorption of this metal occurs in the duodenum and is highly dependent upon its oxidation state, with many absorption influencers possibly interfering with the intestinal uptake. Bone marrow and spleen represent the initial and ultimate step of iron metabolism, respectively, and the most part of body iron circulates bound to specific proteins and mainly serves to synthesize hemoglobin for new red blood cells. Whatever the martial status is, today’s knowledge about iron biochemistry allows us to embrace exceedingly personalized interventions, which however owe their success to the mythical and historical events that always accompanied this metal.
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Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20161 Milan, Italy;
- Correspondence:
| | - Silvana Hrelia
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy; (S.H.); (M.M.)
| | - Marco Malaguti
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy; (S.H.); (M.M.)
| | - Giovanni Lombardi
- IRCCS Orthopedic Institute Galeazzi, Laboratory of Experimental Biochemistry and Molecular Biology, 20161 Milan, Italy;
- Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, 61-871 Poznań, Poland
| | - Patrizia Riso
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Division of Human Nutrition, University of Milan, 20133 Milan, Italy; (P.R.); (M.P.)
| | - Marisa Porrini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Division of Human Nutrition, University of Milan, 20133 Milan, Italy; (P.R.); (M.P.)
| | - Paolo Perazzo
- IRCCS Orthopedic Institute Galeazzi, Postoperative Intensive Care Unit & Anesthesia, 20161 Milan, Italy;
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20161 Milan, Italy;
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
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17
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Di Francesco T, Delafontaine L, Philipp E, Lechat E, Borchard G. Iron polymaltose complexes: Could we spot physicochemical differences in medicines sharing the same active pharmaceutical ingredient? Eur J Pharm Sci 2020; 143:105180. [DOI: 10.1016/j.ejps.2019.105180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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Briguglio M, Hrelia S, Malaguti M, De Vecchi E, Lombardi G, Banfi G, Riso P, Porrini M, Romagnoli S, Pino F, Crespi T, Perazzo P. Oral Supplementation with Sucrosomial Ferric Pyrophosphate Plus L-Ascorbic Acid to Ameliorate the Martial Status: A Randomized Controlled Trial. Nutrients 2020; 12:nu12020386. [PMID: 32024027 PMCID: PMC7071340 DOI: 10.3390/nu12020386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/25/2020] [Accepted: 01/30/2020] [Indexed: 12/13/2022] Open
Abstract
Altered martial indices before orthopedic surgery are associated with higher rates of complications and greatly affect the patient’s functional ability. Oral supplements can optimize the preoperative martial status, with clinical efficacy and the patient’s tolerability being highly dependent on the pharmaceutical formula. Patients undergoing elective hip/knee arthroplasty were randomized to be supplemented with a 30-day oral therapy of sucrosomial ferric pyrophosphate plus L-ascorbic acid. The tolerability was 2.7% among treated patients. Adjustments for confounding factors, such as iron absorption influencers, showed a relevant response limited to older patients (≥ 65 years old), whose uncharacterized Hb loss was averted upon treatment with iron formula. Older patients with no support lost −2.8 ± 5.1%, while the intervention group gained +0.7 ± 4.6% of circulating hemoglobin from baseline (p = 0.019). Gastrointestinal diseases, medications, and possible dietary factors could affect the efficacy of iron supplements. Future opportunities may consider to couple ferric pyrophosphate with other nutrients, to pay attention in avoiding absorption disruptors, or to implement interventions to obtain an earlier martial status optimization at the population level.
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Affiliation(s)
- Matteo Briguglio
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy;
- Correspondence:
| | - Silvana Hrelia
- Department for Life Quality Studies, University of Bologna, Corso d’Augusto 237, 47921 Rimini, Italy; (S.H.); (M.M.)
| | - Marco Malaguti
- Department for Life Quality Studies, University of Bologna, Corso d’Augusto 237, 47921 Rimini, Italy; (S.H.); (M.M.)
| | - Elena De Vecchi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy;
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy;
- Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Królowej Jadwigi 27/39, 61-871 Poznań, Poland
| | - Giuseppe Banfi
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy;
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Patrizia Riso
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Mangiagalli 25, 20133 Milan, Italy; (P.R.); (M.P.)
| | - Marisa Porrini
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Mangiagalli 25, 20133 Milan, Italy; (P.R.); (M.P.)
| | - Sergio Romagnoli
- Joint Replacement Department, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy;
| | - Fabio Pino
- Post-operative Intensive Care Unit & Anesthesia, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (F.P.); (T.C.); (P.P.)
| | - Tiziano Crespi
- Post-operative Intensive Care Unit & Anesthesia, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (F.P.); (T.C.); (P.P.)
| | - Paolo Perazzo
- Post-operative Intensive Care Unit & Anesthesia, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (F.P.); (T.C.); (P.P.)
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Srivastava R, Kant S, Singh AK, Saxena R, Yadav K, Pandav CS. Effect of iron and folic acid tablet versus capsule formulation on treatment compliance and iron status among pregnant women: A randomized controlled trial. J Family Med Prim Care 2019; 8:378-384. [PMID: 30984642 PMCID: PMC6436276 DOI: 10.4103/jfmpc.jfmpc_339_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Iron supplementation during pregnancy in programmatic settings has failed to produce desired results. Formulation of iron supplementation may have a role in compliance and hematological parameters. Objective We did this study to compare the compliance to iron supplementation, change in mean hemoglobin and serum ferritin level after iron supplementation in capsule form and tablet form during pregnancy. Materials and Methods In this single-blinded (investigator blinded), active comparator, randomized controlled trial we enrolled pregnant women (aged ≥18 years) from May to November 2014 during second trimester to receive iron supplementation either as capsule (ferrous fumarate) or tablet (ferrous sulphate) during entire pregnancy. The outcome was compliance (good compliance ≥ 90%) to iron supplementation assessed by pill count and change in mean hemoglobin and serum ferritin. Statistical significance was tested using Chi-square test and Student's t test. Results We enrolled and randomized 204 pregnant women for iron supplementation; capsule form (n = 100) and tablet form (n = 104). Out of which 52 (25.5%) women (23 in capsule arm and 29 in tablet arm) were lost to follow up. As compared to tablet arm, the capsule arm had higher good compliance (22% vs 16.8%), increase in mean hemoglobin (0.79 vs 0.44 gm/dL) and increase in mean serum ferritin (2.50 vs -2.14 ng/mL), but the difference was not statistically significant. Conclusion Pregnant women who received either of the formulation reported a low compliance. Iron supplementation in capsule formulation resulted in more increase in blood hemoglobin level, though clinically insignificant.
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Affiliation(s)
- Rahul Srivastava
- Independent Researcher, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind K Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Renu Saxena
- Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrakant S Pandav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Tandon R, Jain A, Malhotra P. Management of Iron Deficiency Anemia in Pregnancy in India. Indian J Hematol Blood Transfus 2018; 34:204-215. [PMID: 29622861 PMCID: PMC5885006 DOI: 10.1007/s12288-018-0949-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/08/2018] [Indexed: 01/28/2023] Open
Abstract
Iron deficiency anemia (IDA) continues to be the commonest etiology of anemia in pregnancy. The prevalence of iron deficiency (ID) in pregnant Indian women is amongst the highest in the world. Untreated iron deficiency (ID) has significant adverse feto-maternal consequences. Plethora of investigations are available for diagnosis of IDA, each having specific advantages and disadvantages when used in the pregnancy setting. Therapy for ID includes dietary modification, oral iron supplementation, intravenous iron and blood transfusion. Newer parenteral iron preparations are safe and there is mounting evidence to suggest their use in frontline settings for pregnancy associated IDA in the second and third trimester. Through this review, we suggest an algorithm for diagnosis and treatment of IDA in pregnancy depending on the severity of anemia and period of gestation suited for widespread use in resource limited settings. Also, we recommend ways for increasing public awareness and tackling this health issue including the observance of "National Anemia Awareness and Treatment Day."
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Affiliation(s)
- Rimpy Tandon
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital-32, Chandigarh, India
| | - Arihant Jain
- Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh, India
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Name JJ, Vasconcelos AR, Valzachi Rocha Maluf MC. Iron Bisglycinate Chelate and Polymaltose Iron for the Treatment of Iron Deficiency Anemia: A Pilot Randomized Trial. Curr Pediatr Rev 2018; 14:261-268. [PMID: 30280670 PMCID: PMC6416187 DOI: 10.2174/1573396314666181002170040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Iron Deficiency Anemia (IDA) is a major public health problem worldwide. Iron Bisglycinate Chelate (FeBC) and polymaltose iron (FeP) are used for the treatment of IDA and exhibit good tolerability with a low incidence of adverse effects. However, these compounds have important differences in their structures and bioavailability. OBJECTIVE To compare the efficacy of oral supplementation with FeBC and FeP in anemic children. METHODS In this double-blind study, children aged 1 to 13 years who were diagnosed with IDA were randomly divided into two groups: i) FeBC, supplemented with iron bisglycinate chelate, and ii) FeP, supplemented with polymaltose iron (3.0 mg iron/kg body weight/day for 45 days for both groups). RESULTS Both treatments resulted in significant increases in hemoglobin levels, Mean Corpuscular Volume (MCV) and Cell Distribution Width (RDW) and in a reduction of transferrin levels, relative to initial values. However, only FeBC treatment significantly increased ferritin and Mean Corpuscular Hemoglobin (MCH) levels. A significant negative correlation was observed between the increase in ferritin and initial hemoglobin levels in the FeBC group, indicating that the absorption of FeBC is regulated by the body iron demand. CONCLUSION These results provide preliminary evidence to suggest a greater efficacy of FeBC than FeP in increasing iron stores.
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Affiliation(s)
- José João Name
- Kilyos Assessoria, Consultoria, Cursos e Palestras, Sao Paulo, 01311-100, Brazil
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22
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Breymann C, Auerbach M. Iron deficiency in gynecology and obstetrics: clinical implications and management. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:152-159. [PMID: 29222250 PMCID: PMC6142528 DOI: 10.1182/asheducation-2017.1.152] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Iron deficiency is the commonest cause of anemia during pregnancy; however, its prevalence is highly determined by nutritional and socioeconomic status. Oral iron is the frontline therapy, but is often poorly tolerated. Awareness of the available intravenous formulations is essential for management. Before delivery, risk factors such as multiparity and heavy uterine bleeding increase the prevalence of iron deficiency and should be motivation for early diagnosis and treatment. Neonates born with iron deficiency have a statistically significant increment in both cognitive and behavioral abnormalities that persist after repletion, highlighting the need for heightened awareness of the diagnosis. A smartphone application providing information on nutrition and treatment is provided. New formulations of intravenous iron with carbohydrate cores, which bind elemental iron more tightly, minimize the release of labile free iron to allow complete replacement doses of intravenous iron in 15 to 60 minutes, facilitating and simplifying care.
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Affiliation(s)
- Christian Breymann
- Obstetric Research–Feto Maternal Hematology Unit, University Hospital Zurich, Zurich, Switzerland
| | - Michael Auerbach
- Department of Medicine, Georgetown University School of Medicine, Washington, DC; and
- Auerbach Hematology and Oncology, Baltimore, MD
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23
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Rosa L, Cutone A, Lepanto MS, Paesano R, Valenti P. Lactoferrin: A Natural Glycoprotein Involved in Iron and Inflammatory Homeostasis. Int J Mol Sci 2017; 18:1985. [PMID: 28914813 PMCID: PMC5618634 DOI: 10.3390/ijms18091985&n948647=v984776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Human lactoferrin (hLf), an iron-binding multifunctional cationic glycoprotein secreted by exocrine glands and by neutrophils, is a key element of host defenses. HLf and bovine Lf (bLf), possessing high sequence homology and identical functions, inhibit bacterial growth and biofilm dependently from iron binding ability while, independently, bacterial adhesion to and the entry into cells. In infected/inflamed host cells, bLf exerts an anti-inflammatory activity against interleukin-6 (IL-6), thus up-regulating ferroportin (Fpn) and transferrin receptor 1 (TfR1) and down-regulating ferritin (Ftn), pivotal actors of iron and inflammatory homeostasis (IIH). Consequently, bLf inhibits intracellular iron overload, an unsafe condition enhancing in vivo susceptibility to infections, as well as anemia of inflammation (AI), re-establishing IIH. In pregnant women, affected by AI, bLf oral administration decreases IL-6 and increases hematological parameters. This surprising effect is unrelated to iron supplementation by bLf (80 μg instead of 1-2 mg/day), but to its role on IIH. AI is unrelated to the lack of iron, but to iron delocalization: cellular/tissue overload and blood deficiency. BLf cures AI by restoring iron from cells to blood through Fpn up-expression. Indeed, anti-inflammatory activity of oral and intravaginal bLf prevents preterm delivery. Promising bLf treatments can prevent/cure transitory inflammation/anemia/oral pathologies in athletes.
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Affiliation(s)
- Luigi Rosa
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00185 Rome, Italy.
| | - Antimo Cutone
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00185 Rome, Italy.
| | - Maria Stefania Lepanto
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00185 Rome, Italy.
| | - Rosalba Paesano
- Department of Gynecological-Obstetric and Urological Sciences, University of Rome La Sapienza, 00185 Rome, Italy.
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00185 Rome, Italy.
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24
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Rosa L, Cutone A, Lepanto MS, Paesano R, Valenti P. Lactoferrin: A Natural Glycoprotein Involved in Iron and Inflammatory Homeostasis. Int J Mol Sci 2017; 18:E1985. [PMID: 28914813 PMCID: PMC5618634 DOI: 10.3390/ijms18091985] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 02/07/2023] Open
Abstract
Human lactoferrin (hLf), an iron-binding multifunctional cationic glycoprotein secreted by exocrine glands and by neutrophils, is a key element of host defenses. HLf and bovine Lf (bLf), possessing high sequence homology and identical functions, inhibit bacterial growth and biofilm dependently from iron binding ability while, independently, bacterial adhesion to and the entry into cells. In infected/inflamed host cells, bLf exerts an anti-inflammatory activity against interleukin-6 (IL-6), thus up-regulating ferroportin (Fpn) and transferrin receptor 1 (TfR1) and down-regulating ferritin (Ftn), pivotal actors of iron and inflammatory homeostasis (IIH). Consequently, bLf inhibits intracellular iron overload, an unsafe condition enhancing in vivo susceptibility to infections, as well as anemia of inflammation (AI), re-establishing IIH. In pregnant women, affected by AI, bLf oral administration decreases IL-6 and increases hematological parameters. This surprising effect is unrelated to iron supplementation by bLf (80 μg instead of 1-2 mg/day), but to its role on IIH. AI is unrelated to the lack of iron, but to iron delocalization: cellular/tissue overload and blood deficiency. BLf cures AI by restoring iron from cells to blood through Fpn up-expression. Indeed, anti-inflammatory activity of oral and intravaginal bLf prevents preterm delivery. Promising bLf treatments can prevent/cure transitory inflammation/anemia/oral pathologies in athletes.
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Affiliation(s)
- Luigi Rosa
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00185 Rome, Italy.
| | - Antimo Cutone
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00185 Rome, Italy.
| | - Maria Stefania Lepanto
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00185 Rome, Italy.
| | - Rosalba Paesano
- Department of Gynecological-Obstetric and Urological Sciences, University of Rome La Sapienza, 00185 Rome, Italy.
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00185 Rome, Italy.
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Черно НК, Озоліна СО, Нікітіна ОВ. ТЕХНОЛОГІЯ ОТРИМАННЯ ЗАЛІЗОВМІСНОГО КОМПЛЕКСУ НА ОСНОВІ ПОЛІСАХАРИДІВ ПЕЧЕРИЦІ ДВОСПОРОВОЇ. FOOD SCIENCE AND TECHNOLOGY 2016. [DOI: 10.15673/fst.v10i2.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Розроблено технологію отримання залізовмісного комплексу на основі полісахаридів печериці дво-спорової, яка складається з двох стадій: вилучення полісахаридів та формування залізовмісного комплексу. Встанов-лено, що одержувати полісахариди з сировини доцільно екстракцією 3 % розчином натрій гідроксиду протягом 4 год зподальшою очисткою від речовин невуглеводної природи. У складі полісахаридів домінує галактоглюкан. Раціональ-ними умовами отримання залізовмісного комплексу на основі полісахаридів грибів є суміщення розчинів ферум (III)хлориду та полісахаридів; концентрації реагуючих речовин становлять: Fe3+ – 0,075 %, полісахаридів – 0,113 %, масо-ве співвідношення залізо : полісахариди 1,0 : 1,5, рН середовища – 11,5. Комплекс стійкий до дії агресивних середо-вищ травного тракту, є мікробіологічно безпечним та залишається доброякісним протягом 12 місяців зберігання. Він єефективним протианемічним засобом.
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26
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Goldman M, Magnussen K, Gorlin J, Lozano M, Speedy J, Keller A, Pink J, Leung JNS, Chu CCY, Lee CK, Faed J, Chay J, Tan HH, Teo D, Djoudi R, Woimant G, Fillet AM, Castrén J, Miflin G, Vandewalle GC, Compernolle V, Cardenas JM, Infanti L, Holbro A, Buser A, van den Hurk K, Yahalom VJ, Gendelman V, Shinar E, Eder AF, Steele WR, O'Neill EM, Kamel H, Vassallo R, Delage G, Lebrun A, Robillard P, Germain M, Gandhi M, West KA, Klein HG. International Forum regarding practices related to donor haemoglobin and iron. Vox Sang 2016; 111:449-455. [DOI: 10.1111/vox.12431] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Goldman
- Medical Services and Innovation; Canadian Blood Services; Ottawa ON Canada
| | - K. Magnussen
- Clinical Immunology/Blood Centre; Copenhagen University Hospital; Hvidovre Denmark
| | - J. Gorlin
- Physician Services; Innovative Blood Centers; St. Paul MN USA
| | - M. Lozano
- Hospital Clinic; Department of Hemotherapy and Hemostasis; Barcelona Spain
| | - J. Speedy
- Australian Red Cross Blood Service; Adelaide South Australia Australia
| | - A. Keller
- Australian Red Cross; Perth Western Australia Australia
| | - J. Pink
- Australian Red Cross Blood Service; Stafford Queensland Australia
| | - J. N. S. Leung
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - C. C. Y. Chu
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - C.-K. Lee
- Blood Collection and Donor Recruitment Department; Hong Kong Red Cross Blood Transfusion Service; Kowloon Hong Kong
| | - J. Faed
- Otago Site, New Zealand Blood Service; Department of Haematology; University of Otago; Dunedin New Zealand
| | - J. Chay
- Blood Services Group; Health Sciences Authority; 11 Outram Road Singapore City 169078 Singapore
| | - H. H. Tan
- Blood Services Group; Health Sciences Authority; 11 Outram Road Singapore City 169078 Singapore
| | - D. Teo
- Centre for Transfusion Medicine; Singapore City Singapore
| | - R. Djoudi
- Qualification Biologique du Don; Etablissement Français du Sang; St. Denis France
| | - G. Woimant
- EFS, Médecine, la Recherche et l'Innovation; La Plaine Saint-Denis France
| | - A.-M. Fillet
- Medical Department; Etablisement Français du Sang; 20 Avenue du Stade de France La Plaine Saint-Denis 93218 France
| | - J. Castrén
- Medical Support in Blood Donation; Finnish Red Cross Blood Service; Kivihaantie 7 Helsinki FI-00310 Finland
| | - G. Miflin
- NHS Blood and Transplant; Watford UK
| | | | - V. Compernolle
- Blood Services; Belgian Red Cross; Ottergemsesteenweg 413 Ghent B-9000 Belgium
| | - J. M. Cardenas
- Tejidos Humanos; Centro Vasco de Transfusion y Tejidos Humanos; Labeaga s/n Galdakao 48960 Spain
| | - L. Infanti
- Blood Donation Center; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
| | - A. Holbro
- Blood Transfusion Centre; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
- Department of Hematology; University Hospital Basel; Basel Switzerland
| | - A. Buser
- Blood Transfusion Centre; Swiss Red Cross; Hebelstrasse 10 Basel CH-4031 Switzerland
- Department of Hematology; University Hospital Basel; Basel Switzerland
| | - K. van den Hurk
- Donor Studies; Sanquin Research; Plesmanlaan 125 Amsterdam 1066 CX The Netherlands
| | - V. J. Yahalom
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - V. Gendelman
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - E. Shinar
- National Blood Services; Magen David Adom-National Blood Services; Ramat Gan 5262100 Israel
| | - A. F. Eder
- Biomedical Headquarters; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - W. R. Steele
- Transmissible Disease Department; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - E. M. O'Neill
- National Headquarters; Biomedical Services; American Red Cross; 15601 Crabbs Branch Way Rockville MD 20855 USA
| | - H. Kamel
- Medical Affairs; Blood Systems, Inc.; 6210 E. Oak Street Scottsdale AZ 85257 USA
| | - R. Vassallo
- Blood Systems, Inc.; 6210 E. Oak Street Scottsdale AZ 85257 USA
| | - G. Delage
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - A. Lebrun
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - P. Robillard
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - M. Germain
- Medical Affairs; Héma-Quebec; 4045 boul. Cote-Vertu, Ville Saint-Laurent Montreal QC Canada
| | - M. Gandhi
- Laboratory of Medicine and Pathology; Mayo Clinic Minnesota; 200 1st Street SW Rochester MN 55905 USA
| | - K. A. West
- Department of Transfusion Medicine; National Institutes of Health Clinical Center; 10 Center Drive, Room 1N226 Bethesda MD 20892 USA
| | - H. G. Klein
- Department of Transfusion Medicine; National Institute of Health; Warren G. Magnuson Clinical Center; 10 Center Drive, Room IC711 Bethesda MD 20892 USA
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27
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Mukhija K, Singhal K, Angmo S, Yadav K, Yadav H, Sandhir R, Singhal NK. Potential of Alginate Encapsulated Ferric Saccharate Microemulsions to Ameliorate Iron Deficiency in Mice. Biol Trace Elem Res 2016; 172:179-192. [PMID: 26637994 DOI: 10.1007/s12011-015-0564-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/05/2015] [Indexed: 11/26/2022]
Abstract
Iron deficiency is one of the most prominent mineral deficiencies around the world, which especially affects large population of women and children. Development of new technologies to combat iron deficiency is on high demand. Therefore, we developed alginate microcapsule with encapsulated iron that had better oral iron bioavailability. Microcapsules containing iron with varying ratios of sodium alginate ferric(III)-saccharide were prepared using emulsification method. In vitro studies with Caco-2 cells suggested that newly synthesized microemulsions had better iron bioavailability as compared to commercially available iron dextran formulations. Ferrozine in vitro assay showed that alginate-encapsulated ferric galactose microemulsion (AFGM) had highest iron bioavailability in comparison to other four ferric saccharate microemulsions, namely AFGlM, AFMM, AFSM, and AFFM synthesized in our laboratory. Mice studies also suggested that AFGM showed higher iron absorption as indicated by increased serum iron, hemoglobin, and other hematopoietic measures with almost no toxicity at tested doses. Development of iron-loaded microemulsions leads to higher bioavailability of iron and can provide alternative strategies to treat iron deficiency.
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Affiliation(s)
- Kimmi Mukhija
- Department of Biochemistry, Panjab University, Chandigarh, Punjab, India
| | - Kirti Singhal
- Department of Biochemistry, Panjab University, Chandigarh, Punjab, India
| | - Stanzin Angmo
- National Agri Food Biotechnology Institute, Mohali, Punjab, India
| | - Kamalendra Yadav
- National Agri Food Biotechnology Institute, Mohali, Punjab, India
| | - Hariom Yadav
- National Agri Food Biotechnology Institute, Mohali, Punjab, India
- Present Address: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Rajat Sandhir
- Department of Biochemistry, Panjab University, Chandigarh, Punjab, India
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Daru J, Cooper NAM, Khan KS. Systematic review of randomized trials of the effect of iron supplementation on iron stores and oxygen carrying capacity in pregnancy. Acta Obstet Gynecol Scand 2015; 95:270-9. [PMID: 26509354 DOI: 10.1111/aogs.12812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/18/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Anemia in pregnancy affects 25% of all pregnancies in Europe with iron deficiency affecting even more. Despite supplementation, iron deficiency persists. This review will assess the effect on serum ferritin (iron stores) and hemoglobin (oxygen-carrying capacity) following iron supplementation in pregnant women with anemic and non-anemic iron deficiency. MATERIAL AND METHODS A systemic search of electronic databases and trial registers was conducted from inception to January 2014. Randomized controlled trials of iron supplementation that measured serum ferritin and hemoglobin levels before and after supplementation were selected. Two independent reviewers selected studies, extracted data and assessed quality. Descriptive analyses were carried out. RESULTS The review included 23 randomized controlled trials (3525 women). In iron deficiency anemia, more studies described statistically significant increases in serum ferritin levels than in hemoglobin levels following intravenous iron supplementation. In non-anemic iron deficiency there were more statistically significant increases in serum ferritin levels than in hemoglobin levels following oral supplementation. There were no studies reporting maternal quality of life outcomes. CONCLUSIONS Serum ferritin appears to change more than hemoglobin following iron supplementation. The clinical effects of this need further investigation.
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Affiliation(s)
- Jahnavi Daru
- Women's Health Research Unit, Barts and the London School of Medicine, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
| | - Natalie A M Cooper
- Women's Health Research Unit, Barts and the London School of Medicine, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
| | - Khalid S Khan
- Women's Health Research Unit, Barts and the London School of Medicine, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
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Api O, Breyman C, Çetiner M, Demir C, Ecder T. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report. Turk J Obstet Gynecol 2015; 12:173-181. [PMID: 28913064 PMCID: PMC5558393 DOI: 10.4274/tjod.01700] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/02/2015] [Indexed: 12/31/2022] Open
Abstract
According to the World Health Organization (WHO), anemia is the most common disease, affecting >1.5 billion people worldwide. Furthermore, iron deficiency anemia (IDA) accounts for 50% of cases of anemia. IDA is common during pregnancy and the postpartum period, and can lead to serious maternal and fetal complications. The aim of this report was to present the experiences of a multidisciplinary expert group, and to establish reference guidelines for the optimal diagnosis and treatment of IDA during pregnancy and the postpartum period. Studies and guidelines on the diagnosis and treatment of IDA published in Turkish and international journals were reviewed. Conclusive recommendations were made by an expert panel aiming for a scientific consensus. Measurement of serum ferritin has the highest sensitivity and specificity for diagnosis of IDA unless there is a concurrent inflammatory condition. The lower threshold value for hemoglobin (Hb) in pregnant women is <11 g/dL during the 1st and 3rd trimesters, and <10.5 g/dL during the 2nd trimester. In postpartum period a Hb concentration <10 g/dL indicates clinically significant anemia. Oral iron therapy is given as the first-line treatment for IDA. Although current data are limited, intravenous (IV) iron therapy is an alternative therapeutic option in patients who do not respond to oral iron therapy, have adverse reactions, do not comply with oral iron treatment, have a very low Hb concentration, and require rapid iron repletion. IV iron preparations can be safely used for the treatment of IDA during pregnancy and the postpartum period, and are more beneficial than oral iron preparations in specific indications.
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Affiliation(s)
- Olus Api
- Yeditepe University Hospital, Clinic of Gynecology and Obstetrics, İstanbul, Turkey
| | - Christian Breyman
- Zurich University Hospital, Feto Maternal Hematology Unit, Zurich, Switzerland
| | - Mustafa Çetiner
- Koç University Faculty of Medicine American Hospital, Department of Hematology, İstanbul, Turkey
| | - Cansun Demir
- Çukurova University Faculty of Medicine, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Tevfik Ecder
- İstanbul Bilim University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, İstanbul, Turkey
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Abstract
Anemia is a common problem in obstetrics and perinatal care. Any hemoglobin below 10.5 g/dL can be regarded as true anemia regardless of gestational age. Reasons for anemia in pregnancy are mainly nutritional deficiencies, parasitic and bacterial diseases, and inborn red blood cell disorders such as thalassemias. The main cause of anemia in obstetrics is iron deficiency, which has a worldwide prevalence between estimated 20%-80% and consists of a primarily female population. Stages of iron deficiency are depletion of iron stores, iron-deficient erythropoiesis without anemia, and iron deficiency anemia, the most pronounced form of iron deficiency. Pregnancy anemia can be aggravated by various conditions such as uterine or placental bleedings, gastrointestinal bleedings, and peripartum blood loss. In addition to the general consequences of anemia, there are specific risks during pregnancy for the mother and the fetus such as intrauterine growth retardation, prematurity, feto-placental miss ratio, and higher risk for peripartum blood transfusion. Besides the importance of prophylaxis of iron deficiency, the main therapy options for the treatment of pregnancy anemia are oral iron and intravenous iron preparations.
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Affiliation(s)
- Christian Breymann
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Obstetric Research, Feto- Maternal Haematology Research Group, Zurich, Switzerland.
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31
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Iron metabolism in infants: influence of bovine lactoferrin from iron-fortified formula. Nutrition 2015; 31:304-9. [DOI: 10.1016/j.nut.2014.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 07/09/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022]
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32
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Oral iron therapies in development for iron deficiency in chronic kidney disease. ACTA ACUST UNITED AC 2014. [DOI: 10.4155/cli.14.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Koskenkorva-Frank TS, Weiss G, Koppenol WH, Burckhardt S. The complex interplay of iron metabolism, reactive oxygen species, and reactive nitrogen species: insights into the potential of various iron therapies to induce oxidative and nitrosative stress. Free Radic Biol Med 2013; 65:1174-1194. [PMID: 24036104 DOI: 10.1016/j.freeradbiomed.2013.09.001] [Citation(s) in RCA: 293] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/05/2013] [Accepted: 09/05/2013] [Indexed: 02/07/2023]
Abstract
Production of minute concentrations of superoxide (O2(*-)) and nitrogen monoxide (nitric oxide, NO*) plays important roles in several aspects of cellular signaling and metabolic regulation. However, in an inflammatory environment, the concentrations of these radicals can drastically increase and the antioxidant defenses may become overwhelmed. Thus, biological damage may occur owing to redox imbalance-a condition called oxidative and/or nitrosative stress. A complex interplay exists between iron metabolism, O2(*-), hydrogen peroxide (H2O2), and NO*. Iron is involved in both the formation and the scavenging of these species. Iron deficiency (anemia) (ID(A)) is associated with oxidative stress, but its role in the induction of nitrosative stress is largely unclear. Moreover, oral as well as intravenous (iv) iron preparations used for the treatment of ID(A) may also induce oxidative and/or nitrosative stress. Oral administration of ferrous salts may lead to high transferrin saturation levels and, thus, formation of non-transferrin-bound iron, a potentially toxic form of iron with a propensity to induce oxidative stress. One of the factors that determine the likelihood of oxidative and nitrosative stress induced upon administration of an iv iron complex is the amount of labile (or weakly-bound) iron present in the complex. Stable dextran-based iron complexes used for iv therapy, although they contain only negligible amounts of labile iron, can induce oxidative and/or nitrosative stress through so far unknown mechanisms. In this review, after summarizing the main features of iron metabolism and its complex interplay with O2(*-), H2O2, NO*, and other more reactive compounds derived from these species, the potential of various iron therapies to induce oxidative and nitrosative stress is discussed and possible underlying mechanisms are proposed. Understanding the mechanisms, by which various iron formulations may induce oxidative and nitrosative stress, will help us develop better tolerated and more efficient therapies for various dysfunctions of iron metabolism.
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Affiliation(s)
- Taija S Koskenkorva-Frank
- Chemical and Preclinical Research and Development, Vifor (International) Ltd., CH-9001 St. Gallen, Switzerland
| | - Günter Weiss
- Department of Internal Medicine VI, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - Willem H Koppenol
- Institute of Inorganic Chemistry, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Susanna Burckhardt
- Chemical and Preclinical Research and Development, Vifor (International) Ltd., CH-9001 St. Gallen, Switzerland; Institute of Inorganic Chemistry, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland.
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Paesano R, Natalizi T, Berlutti F, Valenti P. Body iron delocalization: the serious drawback in iron disorders in both developing and developed countries. Pathog Glob Health 2013; 106:200-16. [PMID: 23265420 DOI: 10.1179/2047773212y.0000000043] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Over 2 billion people in both developing as well as developed countries - over 30% of the world's population - are anaemic. With the classical preconception that oral iron administration or the intake of foods rich in iron increase haemoglobin concentration and reduce the prevalence of anaemia, specific programs have been designed, but iron supplementations have been less effective than expected. Of note, this hazardous simplification on iron status neglects its distribution in the body. The correct balance of iron, defined iron homeostasis, involves a physiological ratio of iron between tissues/secretions and blood, thus avoiding its delocalization as iron accumulation in tissues/secretions and iron deficiency in blood. Changes in iron status can affect the inflammatory response in multiple ways, particularly in the context of infection, an idea that is worth remembering when considering the value of iron supplementation in areas of the world where infections are highly prevalent. The enhanced availability of free iron can increase susceptibility and severity of microbial and parasitic infections. The discovery of the hepcidin-ferroportin (Fpn) complex, which greatly clarified the enigmatic mechanism that supervises the iron homeostasis, should prompt to a critical review on iron supplementation, ineffective on the expression of the most important proteins of iron metabolism. Therefore, it is imperative to consider new safe and efficient therapeutic interventions to cure iron deficiency (ID) and ID anaemia (IDA) associated or not to the inflammation. In this respect, lactoferrin (Lf) is emerging as an important regulator of both iron and inflammatory homeostasis. Oral administration of Lf in subjects suffering of ID and IDA is safe and effective in significantly increasing haematological parameters and contemporary decreasing serum IL-6 levels, thus restoring iron localization through the direct or indirect modulation of hepcidin and ferroportin synthesis. Of note, the nuclear localization of Lf suggests that this molecule may be involved in the transcriptional regulation of some genes of host inflammatory response. We recently also reported that combined administration of oral and intravaginal Lf on ID and IDA pregnant women with preterm delivery threat, significantly increased haematological parameters, reduced IL-6 levels in both serum and cervicovaginal fluid, cervicovaginal prostaglandin PGF2α, and suppressed uterine contractility. Moreover, Lf combined administration blocked further the shortening of cervical length and the increase of foetal fibronectin, thus prolonging the length of pregnancy until the 37th-38th week of gestation. These new Lf functions effective in curing ID and IDA through the restoring of iron and inflammatory homeostasis and in preventing preterm delivery, could have a great relevance in developing countries, where ID and IDA and inflammation-associated anaemia represent the major risk factors of preterm delivery and maternal and neonatal death.
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Affiliation(s)
- R Paesano
- Department of Woman Health and Territorial Medicine, Sapienza University of Rome, Italy
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Milman N. Oral iron prophylaxis in pregnancy: not too little and not too much! J Pregnancy 2012; 2012:514345. [PMID: 22888432 PMCID: PMC3409554 DOI: 10.1155/2012/514345] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/08/2012] [Indexed: 11/17/2022] Open
Abstract
An adequate supply of iron is essential for normal development of the fetus and newborn child. Iron deficiency and iron deficiency anemia (IDA) during pregnancy increase the risk of preterm birth and low birth weight. Iron is important for development of the fetal brain and cognitive abilities of the newborn. Children born to iron-deficient mothers will start their lives suffering from iron deficiency or even IDA. Oral iron prophylaxis to pregnant women improves iron status and prevents development of IDA. The Danish National Board of Health has since 1992 recommended prophylactic oral iron supplements to all pregnant women and the currently advocated dose is 40-50 mg ferrous iron taken between meals from 10 weeks gestation to delivery. However, 30-40 mg ferrous iron is probably an adequate dose in most affluent societies. In developed countries, individual iron prophylaxis guided by iron status (serum ferritin) has physiological advantages compared to general iron prophylaxis. In contrast, in most developing countries, general iron prophylaxis is indicated, and higher doses of oral iron, for example, 60 mg ferrous iron or even more should be recommended, according to the present iron status situation in the specific populations of women of fertile age and pregnant women.
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Affiliation(s)
- Nils Milman
- Department of Obstetrics, Næstved Hospital, DK-4700 Næstved, Denmark
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Efficacy, Tolerability, and Acceptability of Iron Hydroxide Polymaltose Complex versus Ferrous Sulfate: A Randomized Trial in Pediatric Patients with Iron Deficiency Anemia. Int J Pediatr 2011; 2011:524520. [PMID: 22121379 PMCID: PMC3206382 DOI: 10.1155/2011/524520] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022] Open
Abstract
Iron polymaltose complex (IPC) offers similar efficacy with superior tolerability to ferrous sulfate in adults, but randomized trials in children are rare. In a prospective, open-label, 4-month study, 103 children aged >6 months with iron deficiency anemia (IDA) were randomized to IPC once daily or ferrous sulfate twice daily, (both 5 mg iron/kg/day). Mean increases in Hb to months 1 and 4 with IPC were 1.2 ± 0.9 g/dL and 2.3 ± 1.3 g/dL, respectively, (both P = 0.001 versus baseline) and 1.8 ± 1.7 g/dL and 3.0 ± 2.3 g/dL with ferrous sulfate (both P = 0.001 versus baseline) (n.s. between groups). Gastrointestinal adverse events occurred in 26.9% and 50.9% of IPC and ferrous sulfate patients, respectively (P = 0.012). Mean acceptability score at month 4 was superior with IPC versus ferrous sulfate (1.63 ± 0.56 versus 2.14 ± 0.75, P = 0.001). Efficacy was comparable with IPC and ferrous sulfate over a four-month period in children with IDA, but IPC was associated with fewer gastrointestinal adverse events and better treatment acceptability.
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