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Lamsal R, Walkup J. Should echocardiogram be undertaken routinely when a child has severe iron deficiency anaemia? Paediatr Int Child Health 2024; 44:34-38. [PMID: 38321653 DOI: 10.1080/20469047.2024.2310351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/22/2023] [Indexed: 02/08/2024]
Abstract
Iron deficiency anaemia (IDA) is common in children. Treatment usually consists of oral iron therapy and, if severe, inpatient hospitalisation with blood transfusion. Providers may also undertake an echocardiogram, depending on availability and the severity of anaemia. A male toddler with nutritional IDA, haemoglobin of 1.7 g/dL (the lowest level in the literature) and hypertension had left ventricular hypertrophy (LVH) on the initial echocardiogram. He was managed acutely with judicious blood transfusion, followed by oral iron supplementation and anti-hypertensive medication at discharge. Repeat echocardiogram a month later demonstrated slight improvement of the LVH but the hypertension persisted at follow-up 6 months later. There was complete resolution of the findings a year later. In chronic nutritional IDA, there can be structural cardiac changes which can affect the acute management and requires close follow-up. It is important to use echocardiography in such severe cases.Abbreviations: CHF: congestive heart failure; CM: cardiomyopathy; DCM: dilated cardiomyopathy; ICU: intensive care unit; IDA: iron deficiency anaemia; IVSd: interventricular septum in diastole; LA: left atrium; LV: left ventricle; LVEDD: left ventricular end-diastolic diameter; LVH: left ventricular hypertrophy; LVM: left ventricular mass; LVPWd: left ventricular posterior wall end-diastole; PRBC: packed red blood cells.
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Affiliation(s)
- Riwaaj Lamsal
- Department of Pediatrics, East Tennessee State University, Johnson City, Tennessee, USA
| | - Jerry Walkup
- Tri-City Pediatric Cardiology, Johnson City, TN, USA
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Gale SE, Willeford A, Sandquist K, Watson K. Intravenous iron in patients with iron deficiency and heart failure: a review of modern evidence. Curr Opin Cardiol 2024; 39:178-187. [PMID: 38353280 DOI: 10.1097/hco.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Iron deficiency is common in patients with heart failure, affecting up to half of ambulatory patients and an even greater percentage of patients admitted for acute decompensation. Iron deficiency in this population is also associated with poor outcomes, including worse quality of life in addition to increased hospitalizations for heart failure and mortality. Evidence suggests that patients with iron deficiency in heart failure may benefit from repletion with IV iron. RECENT FINDINGS In this review, we outline the etiology and pathophysiology of iron deficiency in heart failure as well as various iron formulations available. We discuss evidence for intravenous iron repletion with a particular focus on recent studies that have evaluated its effects on hospitalizations and mortality. Finally, we discuss areas of uncertainty and future study and provide practical guidance for iron repletion. SUMMARY In summary, there is overwhelming evidence that intravenous iron repletion in patients with iron deficiency in heart failure is both beneficial and safe. However, further evidence is needed to better identify which patients would most benefit from iron repletion as well as the ideal repletion strategy.
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Affiliation(s)
- Stormi E Gale
- Novant Health Heart and Vascular Institute, Huntersville, North Carolina
| | - Andrew Willeford
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California
| | | | - Kristin Watson
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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Luxford JC, Casey CE, Roberts PA, Irving CA. Iron deficiency and anemia in pediatric dilated cardiomyopathy are associated with clinical, biochemical, and hematological markers of severe disease and adverse outcomes. J Heart Lung Transplant 2024; 43:379-386. [PMID: 38012978 DOI: 10.1016/j.healun.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/21/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND There is limited evidence regarding the prevalence and impact of iron deficiency (ID) in children with dilated cardiomyopathy (DCM). METHODS Retrospective single-center review of all children between 2010 and 2020 with a diagnosis of DCM and complete iron studies. ID was defined as ≥2 of ferritin <20 μg/liter, iron <9 μmol/liter, transferrin >3 g/liter, or transferrin saturation (TSat) <15%. Clinical and laboratory indices and freedom from a composite adverse event (CAE) of mechanical circulatory support (MCS), heart transplant, or death were compared between children with and without ID. RESULTS Of 138 patients with DCM, 47 had available iron studies. Twenty-nine (62%) were iron deficient. Children with ID were more likely to be receiving inotropes (17, 59%, p = 0.005) or invasive/noninvasive ventilation (13, 45%, p = 0.016) than those who were iron replete. They had a higher incidence of anemia (22, 76%, p = 0.004) and higher NT-proBNP (1,590 pmol/liter, IQR 456-3,447, p = 0.001). Children with ID had significantly less freedom from the CAE at 1-year (54% ± 10%), 2-years (45 ± 10), and 5-years (37% ± 11%) than those without (p = 0.011). ID and anemia were the only significant predictors of the CAE on univariate Cox regression. CONCLUSIONS ID is highly prevalent in children with DCM. Iron studies are undermeasured in clinical practice, but ID is associated with severe heart failure (HF) and an increased risk of the CAE. The need for iron replacement therapy should be considered in children who present in HF with DCM.
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Affiliation(s)
- Jack C Luxford
- Heart Centre for Children, Children's Hospital at Westmead, Sydney, Australia; Childrens Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
| | - Charlene E Casey
- Heart Centre for Children, Children's Hospital at Westmead, Sydney, Australia
| | - Philip A Roberts
- Heart Centre for Children, Children's Hospital at Westmead, Sydney, Australia
| | - Claire A Irving
- Heart Centre for Children, Children's Hospital at Westmead, Sydney, Australia; Childrens Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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Berton PF, Gambero A. Hepcidin and inflammation associated with iron deficiency in childhood obesity - A systematic review. J Pediatr (Rio J) 2024; 100:124-131. [PMID: 37541648 PMCID: PMC10943301 DOI: 10.1016/j.jped.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES This paper aims to review data on the association of obesity and iron deficiency in children and adolescents, exposing the possible involvement of hepcidin and interleukin-6 (IL-6), obesity's inflammation biomarkers. DATA SOURCE Articles from PUBMED and WEB OF SCIENCE database with no chronological limit were reviewed to write this systematic review. Keywords such as children, obesity, iron deficiency, and hepcidin were used. After deleting duplicated and review articles, 91 were screened, and 39 were selected as eligible. Sixteen articles were included because they involved serum hepcidin levels in obese children and adolescents as outcomes. SUMMARY OF FINDINGS Finally, those 16 articles were organized in two tables: one includes therapeutic interventions, and the other does not. As hepcidin was discovered in 2000, the first articles that presented serum hepcidin's quantification in obese children and adolescents, homeostasis iron markers, and their possible association with obesity's inflammatory environment began to be published in 2008. CONCLUSIONS Obesity's chronic inflammation state leads to the production of IL-6, which acts as a signaling molecule for hepcidin synthesis, resulting in iron deficiency, which is common in obese children and adolescents who respond inadequately to iron supplementation. On the other hand, that population responds adequately to therapeutic intervention programs that lead to weight loss, guaranteeing iron homeostasis improvement. Therefore, perhaps it is time to discuss serum hepcidin level quantification as part of evaluating children and adolescents with iron deficiency, which could guide clinical choices that might lead to better therapeutic outcomes.
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Affiliation(s)
- Pedro Ferro Berton
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Alessandra Gambero
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil.
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Sandri BJ, Kim J, Lubach GR, Lock EF, Ennis-Czerniak K, Kling PJ, Georgieff MK, Coe CL, Rao RB. Prognostic Performance of Hematological and Serum Iron and Metabolite Indices for Detection of Early Iron Deficiency Induced Metabolic Brain Dysfunction in Infant Rhesus Monkeys. J Nutr 2024; 154:875-885. [PMID: 38072152 PMCID: PMC10942850 DOI: 10.1016/j.tjnut.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The current pediatric practice of monitoring for infantile iron deficiency (ID) via hemoglobin (Hgb) screening at one y of age does not identify preanemic ID nor protect against later neurocognitive deficits. OBJECTIVES To identify biomarkers of iron-related metabolic alterations in the serum and brain and determine the sensitivity of conventional iron and heme indices for predicting risk of brain metabolic dysfunction using a nonhuman primate model of infantile ID. METHODS Simultaneous serum iron and RBC indices, and serum and cerebrospinal fluid (CSF) metabolomic profiles were determined in 20 rhesus infants, comparing iron sufficient (IS; N = 10) and ID (N = 10) infants at 2 and 4 mo of age. RESULTS Reticulocyte hemoglobin (RET-He) was lower at 2 wk in the ID group. Significant IS compared with ID differences in serum iron indices were present at 2 mo, but Hgb and RBC indices differed only at 4 mo (P < 0.05). Serum and CSF metabolomic profiles of the ID and IS groups differed at 2 and 4 mo (P < 0.05). Key metabolites, including homostachydrine and stachydrine (4-5-fold lower at 4 mo in ID group, P < 0.05), were altered in both serum and CSF. Iron indices and RET-He at 2 mo, but not Hgb or other RBC indices, were correlated with altered CSF metabolic profile at 4 mo and had comparable predictive accuracy (area under the receiver operating characteristic curve scores, 0.75-0.80). CONCLUSIONS Preanemic ID at 2 mo was associated with metabolic alterations in serum and CSF in infant monkeys. Among the RBC indices, only RET-He predicted the future risk of abnormal CSF metabolic profile with a predictive accuracy comparable to serum iron indices. The concordance of homostachydrine and stachydrine changes in serum and CSF indicates their potential use as early biomarkers of brain metabolic dysfunction in infantile ID.
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Affiliation(s)
- Brian J Sandri
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan Kim
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Gabriele R Lubach
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Eric F Lock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kathleen Ennis-Czerniak
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Pamela J Kling
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, United States
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Christopher L Coe
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Raghavendra B Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States.
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Benedict RK, Pullum TW, Riese S, Milner E. Is child anemia associated with early childhood development? A cross-sectional analysis of nine Demographic and Health Surveys. PLoS One 2024; 19:e0298967. [PMID: 38416752 PMCID: PMC10901303 DOI: 10.1371/journal.pone.0298967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/01/2024] [Indexed: 03/01/2024] Open
Abstract
Anemia is a significant public health problem in many low- and middle-income countries (LMICs), with young children being especially vulnerable. Iron deficiency is a leading cause of anemia and prior studies have shown associations between low iron status/iron deficiency anemia and poor child development outcomes. In LMICs, 43% of children under the age of five years are at risk of not meeting their developmental potential. However, few studies have examined associations between anemia status and early childhood development (ECD) in large population-based surveys. We examined the associations between severe or moderate anemia and ECD domains (literacy-numeracy, physical, social-emotional, and learning) and an overall ECD index among children age 36-59 months. Nine Demographic and Health Surveys (DHS) from phase VII of The DHS Program (DHS-7) that included the ECD module and hemoglobin testing in children under age five years were used. Bivariate and multivariate logistic regressions were run for each of the five outcomes. Multivariate models controlled for early learning/interaction variables, child, maternal, and paternal characteristics, and socio-economic and household characteristics. Results showed almost no significant associations between anemia and ECD domains or the overall ECD index except for social-emotional development in Benin (AOR = 1.00 p < 0.05) and physical development in Maldives (AORs = 0.97 p < 0.05). Attendance at an early childhood education program was also significantly associated with the outcomes in many of the countries. Our findings reinforce the importance of the Nurturing Care Framework which describes a multi-sectoral approach to promote ECD in LMICs.
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Affiliation(s)
- Rukundo K. Benedict
- The Demographic and Health Surveys Program, ICF, Rockville, MD, United States of America
| | - Thomas W. Pullum
- The Demographic and Health Surveys Program, ICF, Rockville, MD, United States of America
| | - Sara Riese
- The Demographic and Health Surveys Program, ICF, Rockville, MD, United States of America
| | - Erin Milner
- Public Health Institute/ USAID Sustaining Technical and Analytical Resources, Washington, DC, United States of America
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Thew HZ, Ng CH, Loo CY. Iron overload in anaemia with underlying haemoglobin constant spring in an antenatal mother in primary care. BMJ Case Rep 2024; 17:e258526. [PMID: 38367998 PMCID: PMC10875542 DOI: 10.1136/bcr-2023-258526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
This is the case of a gravida 3 para 1 woman in her late 20s with underlying haemoglobin constant spring who visited a healthcare clinic for an antenatal check-up. Towards the end of her second trimester, she experienced lethargy. During her antenatal booking, she was diagnosed with mild asymptomatic anaemia, high serum ferritin, T saturation of 88% and abnormal liver function tests. She was referred to a hospital where an MRI scan revealed over 2 g of iron deposits in her liver, leading to a revised diagnosis of iron overload. Treatment included deferoxamine and expectant management throughout her antenatal period, and her delivery was uncomplicated. While iron deficiency anaemia is common in pregnancy, it is crucial not to overlook iron deposition and the distinction from acute fatty liver during pregnancy to prevent treatment delays.
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Affiliation(s)
- Hui Zhu Thew
- Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Chee Han Ng
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Cheng Yee Loo
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Al Hinai M, Jansen EC, Song PX, Peterson KE, Baylin A. Iron Deficiency and Vitamin D Deficiency Are Associated with Sleep in Females of Reproductive Age: An Analysis of NHANES 2005-2018 Data. J Nutr 2024; 154:648-657. [PMID: 38042351 PMCID: PMC10997906 DOI: 10.1016/j.tjnut.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Iron and vitamin D deficiencies have been implicated in sleep disturbance. Although females are more susceptible to these deficiencies and frequently report sleep-related issues, few studies have examined these associations in females. OBJECTIVE This study investigates the association of iron and vitamin D deficiencies on sleep in a nationally representative sample of females of reproductive age. METHODS We used 2 samples of 20-49-y-old non-pregnant females from National Health and Nutrition Examination Survey (NHANES) 2005-2008 (N = 2497) and NHANES 2005-2010 and 2015-2018 (N = 6731) to examine the associations of iron deficiency (ID), iron deficiency anemia (IDA), vitamin D deficiency (VDD), vitamin D inadequacy (VDI), and the joint association of both deficiencies with sleep duration, latency, and quality. Sleep outcomes were measured using a self-reported questionnaire. We used the body iron model based on serum ferritin and serum soluble transferrin receptor to identify ID, along with hemoglobin to identify IDA cases. In addition, 25-hydroxyvitamin D levels were used to determine VDD and VDI cases. Logistic regression was used to evaluate these associations, adjusting for potential confounders. In addition, we assessed the multiplicative and additive interactions of both deficiencies. RESULTS ID and IDA were associated with poor sleep quality, with 1.42 [95% confidence interval (CI): 1.02, 2.00)] and 2.08 (95% CI: 1.29, 3.38) higher odds, respectively, whereas VDD and VDI were significantly associated with short sleep duration, with 1.26 (95% CI: 1.02, 1.54) and 1.22 (95% CI: 1.04, 1.44) higher odds, respectively. Subjects with both nutritional deficiencies had significantly higher odds of poorer sleep quality compared with subjects with neither condition. For sleep quality, a significant multiplicative interaction was observed between ID and VDD (P value = 0.0005). No associations were observed between study exposures and sleep latency. CONCLUSIONS Among females of reproductive age, iron and vitamin D deficiencies are associated with sleep health outcomes. The potential synergistic effect of both deficiencies warrants further assessment.
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Affiliation(s)
- Maymona Al Hinai
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States; Department of Food Science and Human Nutrition, Sultan Qaboos University College of Agriculture and Marine Science, Muscat, Oman
| | - Erica C Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Peter Xk Song
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States; Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI United States
| | - Ana Baylin
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States.
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Ohori K, Yano T, Katano S, Nagaoka R, Numazawa R, Yamano K, Fujisawa Y, Kouzu H, Nagano N, Fujito T, Nishikawa R, Ohwada W, Sato T, Furuhashi M. Relationship between serum iron level and physical function in heart failure patients is lost by presence of diabetes. ESC Heart Fail 2024; 11:513-523. [PMID: 38088258 PMCID: PMC10804160 DOI: 10.1002/ehf2.14610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 01/24/2024] Open
Abstract
AIMS Iron deficiency (ID) is common in patients with heart failure (HF) and is reportedly associated with exercise intolerance and impaired quality of life. Iron supplementation therapy in HF patients with ID improves exercise capacity. Conversely, protective roles of iron depletion in the development of diabetes mellitus (DM) and its complications have been proposed. This study aimed to determine the impact of ID on physical function in HF patients with and without DM. METHODS AND RESULTS We enrolled consecutive patients who were admitted to our institute for HF diagnosis and management. The short physical performance battery (SPPB) was used to evaluate physical function, and low physical function was defined as an SPPB score of <10 points as individuals with SPPB scores of <10 points are most likely to be classified as frail and are at high risk for disability and future adverse events, including death. ID was defined as serum ferritin < 100 or 100-299 ng/mL when transferrin saturation (TSAT) was <20% according to the HF guidelines. Among the 562 HF patients (72 ± 14 years old; 56% male), 329 patients (58%) and 191 patients (34%) had ID and low physical function, respectively. Multivariate logistic regression analysis showed that TSAT as a continuous variable, but not ID, was a predictor of low physical function (odds ratio: 0.980, P = 0.024). Subgroup analysis showed that a significant association between low TSAT and low physical function was lost in HF patients with DM (P for interaction < 0.001). A spline dose-response curve for the relationship between TSAT and risk of low physical function with adjustments for covariates associated with low physical function in non-DM patients was almost linear with an increase in the risk of low physical function as the TSAT increased, but such a relationship was not found in the analyses of DM patients. A lack of close TSAT-SPPB relationship in HF patients with DM was confirmed also in a propensity-score-matched cohort. CONCLUSIONS TSAT as a continuous variable, but not ID, was independently associated with physical function in HF patients, and a significant association was lost in patients with HF and DM, suggesting a limited impact of iron supplementation therapy in HF patients with DM.
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Affiliation(s)
- Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporoJapan
- Department of CardiologyHokkaido Cardiovascular HospitalSapporoJapan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporoJapan
| | - Satoshi Katano
- Division of RehabilitationSapporo Medical University HospitalSapporoJapan
| | - Ryohei Nagaoka
- Division of RehabilitationSapporo Medical University HospitalSapporoJapan
| | - Ryo Numazawa
- Division of RehabilitationSapporo Medical University HospitalSapporoJapan
- Graduate School of MedicineSapporo Medical UniversitySapporoJapan
| | - Kotaro Yamano
- Division of RehabilitationSapporo Medical University HospitalSapporoJapan
| | - Yusuke Fujisawa
- Division of RehabilitationSapporo Medical University HospitalSapporoJapan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporoJapan
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporoJapan
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporoJapan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporoJapan
| | - Wataru Ohwada
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporoJapan
| | - Tatsuya Sato
- Department of Cellular Physiology and Signal TransductionSapporo Medical University School of MedicineSapporoJapan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporoJapan
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10
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Sari US, Kama Başci Ö. Association between anemia severity and migraine in iron deficiency anemia. Eur Rev Med Pharmacol Sci 2024; 28:995-1001. [PMID: 38375703 DOI: 10.26355/eurrev_202402_35335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Migraine is an episodic public health problem that usually occurs with a severe headache. Various mechanisms and outcomes have been reported between iron deficiency anemia (IDA) and migraine. We aimed to investigate the effect of the presence and severity of anemia and iron parameters on the frequency and severity of migraine attacks. PATIENTS AND METHODS The study included 104 patients with IDA and newly diagnosed migraine in the neurology outpatient clinic and 38 age and gender-matched controls with normal hemoglobin levels. Patients were divided into 3 subgroups (mild, moderate, and severe anemia) to determine a significant relationship between the severity of IDA and migraine attacks. All patients were asked validated questions with the Visual Analogue Scale (VAS), Headache Impact Test-6 (HIT-6), and the Hamilton Anxiety Rating Scale (HAM-A) face-to-face. RESULTS In this study, 85.6% of the participants were female, and 22 (14.6%) of them were male. Thirty-two mild anemia patients' mean age was 36.6 ± 12.5, 41 with moderate anemia was 46 ± 14.2, and 31 with severe anemia patients' mean age was 48 ± 14.1. There was no significant difference between the subgroups in VAS, HIT-6 score, headache type, and headache frequency. Menstrual migraine is associated with low hemoglobin levels. A significant increase was found in VAS and HIT-6 scores with low ferritin levels. CONCLUSIONS The presence and severity of anemia and iron deficiency do not affect the frequency and severity of migraine attacks in groups other than menstruation-related migraine. An inverse relationship was found between VAS, HIT-6, and ferritin levels. VAS was found to be more effective than HIT-6.
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Affiliation(s)
- U S Sari
- Department of Neurology, Faculty of Medicine, Balikesir University, Balıkesir, Turkey.
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11
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Anthony P, Wu M, Shanmugalingam A, Ng CH, Wright D. Preoperative iron infusion does not reduce the requirement for blood transfusion in colorectal cancer surgery. Minerva Surg 2024; 79:28-32. [PMID: 37705393 DOI: 10.23736/s2724-5691.23.09975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Allogeneic blood transfusions (BT) for patients undergoing colorectal cancer surgery have demonstrated to increase postoperative morbidity and mortality. It has been suggested that the utilization of preoperative iron infusions may reduce the requirement for allogeneic BT in these patients. The aim of this project is to ascertain whether the preoperative use of intravenous iron is significantly associated with a reduction in perioperative blood transfusion requirement. METHODS A retrospective study of 130 patients was conducted in Blacktown Hospital, Australia. Data pertaining to patient demographics, as well as quantity of preoperative iron infusion and perioperative blood transfusion was collected. RESULTS Twenty-six (20%) patients required perioperative BT. Twenty-seven underwent preoperative iron infusion, with 20 of them not requiring BT and seven requiring BT. There was no evidence to suggest preoperative iron infusion reduces blood transfusion requirement (RR 1.55, 95% CI 0.57-4.18, P=0.39). For elective procedures, no significance was also demonstrated (RR 1.20, 95% CI 0.29-4.92, P=0.80). CONCLUSIONS There is no evidence suggesting that preoperative iron infusion reduces the requirement for perioperative blood transfusion in colorectal cancer surgery.
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Affiliation(s)
| | - Mike Wu
- Blacktown Hospital, Department of Surgery, Blacktown, Australia
| | | | - Cheuk H Ng
- Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Danette Wright
- Blacktown Hospital, Department of Surgery, Blacktown, Australia
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Doumani G, Spanos G, Theofilis P, Vordoni A, Kalaitzidis RG. Cardiorenal syndrome and iron supplementation-more benefits than risks: a narrative review. Int Urol Nephrol 2024; 56:597-606. [PMID: 37606747 DOI: 10.1007/s11255-023-03741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023]
Abstract
Intravenous iron administration has emerged as a crucial intervention for managing patients with cardiorenal syndrome (CRS) and iron deficiency, with or without the presence of anemia. Multiple studies have demonstrated the benefits of intravenous iron supplementation in improving anemia, symptoms, and functional capacity in patients with HF and iron deficiency. Furthermore, iron supplementation has been associated with a reduction in hospitalizations for HF exacerbation and the improvement of patients' quality of life and clinical outcomes. In addition to its effects on HF management, emerging evidence suggests a potential positive impact on kidney function in patients with CRS. Studies have shown an increase in estimated glomerular filtration rate and improvements in renal function markers in patients receiving intravenous iron therapy, highlighting the potential of this intervention in patients with CRS. This paper reviews the existing literature on the impact of intravenous iron therapy in these patient populations and explores its effects on various clinical outcomes. Future research endeavors are eagerly awaited to further improve our understanding of its clinical implications and optimize patient outcomes.
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Affiliation(s)
- Georgia Doumani
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia, Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Georgios Spanos
- Department of Nephrology, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
| | - Panagiotis Theofilis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia, Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Aikaterini Vordoni
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia, Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Rigas G Kalaitzidis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia, Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece.
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Chakhunashvili DG, Chakhunashvili K, Kvirkvelia E. Visceral leishmaniasis misdiagnosed as an upper respiratory infection and iron-deficiency anemia in a 20-month-old male patient: a case report. J Med Case Rep 2024; 18:37. [PMID: 38291520 PMCID: PMC10829240 DOI: 10.1186/s13256-024-04356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Visceral Leishmaniasis should be suspected in every patient with a history of splenomegaly, fever, and pancytopenia. It is one of the most dangerous forms of infection and prompt recognition is the key to positive outcome. CASE PRESENTATION A 20-month-old Caucasian male patient was brought to our hospital as an outpatient with the complaint of persistent fever, which did not improve with empiric antibiotic treatment (> 96 hour after the initial dose). The antibiotic treatment had been prescribed by primary care physician at polyclinic, who also referred the patient to hematologist due to anemia, who prescribed iron supplement. Despite multiple subspecialist visits, bicytopenia was, unfortunately, left unidentified. Upon physical examination no specific signs were detected, however, spleen seemed slightly enlarged. Patient was admitted to the hospital for further work-up, management and evaluation. Abdominal ultrasound, complete blood count and c-reactive protein had been ordered. Hematologist and infectionist were involved, both advised to run serology for Epstein-Barr Virus and Visceral Leishmaniasis. The latter was positive; therefore, patient was transferred to the specialized clinic for specific management. CONCLUSION Both in endemic and non-endemic areas the awareness about VL should be increased among the medical professionals. We also recommend that our colleagues take the same approach when dealing with bicytopenia and fever, just as with pancytopenia and fever. The medical community should make sure that none of the cases of fever and pancytopenia are overlooked, especially if we have hepatomegaly and/or splenomegaly.
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Affiliation(s)
- Davit G Chakhunashvili
- Department of Pediatrics, Alte University, Tbilisi, Georgia
- Children's Clinic After I. Tsitsishvili, Tbilisi, Georgia
| | - Konstantine Chakhunashvili
- Department of Pediatrics, The University of Georgia, Tbilisi, Georgia.
- Children's Clinic After I. Tsitsishvili, Tbilisi, Georgia.
| | - Eka Kvirkvelia
- Department of Gynecology, Caucasus University, Tbilisi, Georgia
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14
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Özbilen M. Coexistence of multiple causes in patients with iron deficiency. Eur Rev Med Pharmacol Sci 2024; 28:469-476. [PMID: 38305594 DOI: 10.26355/eurrev_202401_35046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The etiology of disorders may be attributable to multiple causal factors simultaneously. This study sought to investigate how frequently, and which causes coexist in patients with iron deficiency. PATIENTS AND METHODS All patients who applied to the Iron Deficiency Outpatient Clinic between January and December 2021 were included in this cross-sectional study. The causes of iron deficiency were extracted from patient files. Analyses were conducted on the entire population as well as three subgroups: women of reproductive age, postmenopausal women, and males. Numbers and frequencies of causes of iron deficiency were calculated. The subgroups were compared using the Jamovi software. RESULTS The study sample comprised a total of 331 patients. Women of reproductive age were the majority of patients admitted to the clinic (86.7%, n=287). Men represented 6.3% of the sample (n=21), and postmenopausal women accounted for 7.0% (n=23). The mean ages were 37.6±9.05, 49.2±15.49 and 57.8±10.84 years, respectively. The overall sample's rate of multiple iron deficiency causes coexisting was 33.5% (n=111) and the subgroups showed similar frequencies for the coexistence of multiple causes. Statistically, the number of simultaneous multiple causes varied between subgroups (χ2=118, df=10, p<0.001). Heavy menstrual bleeding and nonsteroidal anti-inflammatory drug use were the most common dual causes of multiple coexisting conditions (n=46, 41.4%). In terms of the number of causes, the coexistence of two causes of iron deficiency in women was notable, whereas the coexistence of three causes in males was remarkable. Furthermore, it has been found that some patients have up to five coexisting causes of iron deficiency. CONCLUSIONS Some iron deficiency causes may coexist, and this must be taken into account for the effective management of iron deficiency.
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Affiliation(s)
- M Özbilen
- Department of Internal Medicine, Faculty of Medicine, Ordu University Ordu, Türkiye.
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15
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Sutil-Vega M, Rizzo M, Colomer-Asenjo Í, Taibi F, Castaldo F, Del Castillo-Vázquez P, Mallofré N, Torres-Ruiz G, Rojas P, Martínez-Rubio A. Early improvement of global longitudinal strain after iron deficiency correction in heart failure with reduced ejection fraction. Echocardiography 2024; 41:e15726. [PMID: 38078698 DOI: 10.1111/echo.15726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Iron deficiency correction with ferric carboxymaltose improves symptoms and reduces rehospitalization in patients with reduced left ventricular ejection fraction. The mechanisms underlying these improvements are poorly understood. This study aimed to determine changes in left ventricular contractility after iron treatment as reflected in global longitudinal strain. METHODS Prospective single-center study including 43 adults with reduced ejection fraction, non-anemic iron deficiency, and functional class II-III heart failure despite optimal medical treatment. Global longitudinal strain through speckle-tracking echocardiography was measured at baseline and 4 weeks after ferric carboxymaltose. RESULTS A significant improvement in global longitudinal strain was detected (from -12.3% ± 4.0% at baseline to -15.6% ± 4.1%, p < .001); ferritin and transferrin saturation index had increased, but ejection fraction presented no significant changes (baseline 35.7% ± 4.6%, follow-up 37.2% ± 6.6%, p = .073). CONCLUSIONS In patients with heart failure and reduced ejection fraction, the correction of iron deficiency with ferric carboxymaltose is associated with an early improvement in global longitudinal strain, possibly suggesting a direct effect of iron correction on myocardial contractility.
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Affiliation(s)
- Mario Sutil-Vega
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Marcelo Rizzo
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Íngrid Colomer-Asenjo
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Fadwa Taibi
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Francesca Castaldo
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Pablo Del Castillo-Vázquez
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Núria Mallofré
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Gabriel Torres-Ruiz
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Paola Rojas
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Antonio Martínez-Rubio
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
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Ponikowski P, Mentz RJ, Hernandez AF, Butler J, Khan MS, van Veldhuisen DJ, Roubert B, Blackman N, Friede T, Jankowska EA, Anker SD. Efficacy of ferric carboxymaltose in heart failure with iron deficiency: an individual patient data meta-analysis. Eur Heart J 2023; 44:5077-5091. [PMID: 37632415 PMCID: PMC10733736 DOI: 10.1093/eurheartj/ehad586] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND AND AIMS Whereas a beneficial effect of intravenous ferric carboxymaltose (FCM) on symptoms and exercise capacity among patients with iron deficiency and heart failure (HF) has been consistently demonstrated, the effects of treatment on clinical events remain the subject of research. This meta-analysis aimed to characterize the effects of FCM therapy on hospitalizations and mortality. METHODS Patient-level data from randomized, placebo-controlled FCM trials including adults with HF and iron deficiency with ≥52 weeks follow-up were analysed. The co-primary efficacy endpoints were (i) composite of total/recurrent cardiovascular hospitalizations and cardiovascular death and (ii) composite of total HF hospitalizations and cardiovascular death, through 52 weeks. Key secondary endpoints included individual composite endpoint components. Event rates were analysed using a negative binomial model. Treatment-emergent adverse events were also examined. RESULTS Three FCM trials with a total of 4501 patients were included. Ferric carboxymaltose was associated with a significantly reduced risk of co-primary endpoint 1 (rate ratio 0.86; 95% confidence interval 0.75-0.98; P = .029; Cochran Q: 0.008), with a trend towards a reduction of co-primary endpoint 2 (rate ratio 0.87; 95% confidence interval 0.75-1.01; P = .076; Cochran Q: 0.024). Treatment effects appeared to result from reduced hospitalization rates, not improved survival. Treatment appeared to have a good safety profile and was well tolerated. CONCLUSIONS In iron-deficient patients with HF with reduced left ventricular ejection fraction, intravenous FCM was associated with significantly reduced risk of hospital admissions for HF and cardiovascular causes, with no apparent effect on mortality.
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Affiliation(s)
- Piotr Ponikowski
- Institute for Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | | | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard Roubert
- Research, Development, and Sciences, CSL Vifor, Glattbrugg, Switzerland
| | - Nicole Blackman
- Quantitative Sciences, American Regent, Inc., Shirley, NY, USA
| | - Tim Friede
- Department of Medical Statistics and DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, University Medical Center Göttingen, Göttingen, Germany
| | - Ewa A Jankowska
- Institute for Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
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17
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Gong W, Huang J, Zhu T, Lin S, Hao C, Zhang M. Functional iron deficiency anemia was associated with higher mortality in chronic kidney disease patients: the NHANES III follow-up study. Ren Fail 2023; 45:2290926. [PMID: 38059456 PMCID: PMC11001329 DOI: 10.1080/0886022x.2023.2290926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
Anemia, a common complication of chronic kidney disease (CKD), is associated with poor prognosis. However, it is not completely clear whether this association is caused by anemia per se or other comorbidities. Whether different types of iron deficiency anemia can predict the outcomes of CKD remains unclear. The dataset from NHANES III was analyzed and Cox multivariate regression models and propensity score matching (PSM) method were used to evaluate the effect of anemia on mortality. Of 4103 patients with CKD, 14.6% had anemia. Among those with anemia, 38.8% had absolute iron deficiency (AID), and 19.8% had functional iron deficiency (FID). During the median follow-up time of 13.8 years, 2964 deaths and 804 cardiovascular deaths were observed. Anemia was robustly associated with a high risk of all-cause mortality in CKD patients after adjusting covariates by two multivariate regression models (Model 1: HR = 1.485, 95%CI:1.340-1.647, p < 0.001; Model 2: HR = 1.391, 95%CI:1.250-1.546, p < 0.001). In the PSM cohort, anemia was still an independent risk factor for all-cause mortality (Model 1: HR = 1.443, 95%CI: 1.256-1.656, p < 0.001; Model 2: HR = 1.357, 95%CI:1.177-1.564, p < 0.001). In the CKD population, anemia patients with FID had the highest risk of mortality than the other anemia groups (p < 0.05), while AID had a mortality rate similar to those without anemia (p > 0.05). In conclusion, anemia was associated with a worse prognosis in patients with CKD, which may be attributed to the higher mortality risk of FID rather than AID. AID wasn't associated with a higher mortality rate compared with CKD patients without anemia.
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Affiliation(s)
- Weiyuan Gong
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- Nephrology Research Institute, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiaofeng Huang
- Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- Nephrology Research Institute, Huashan Hospital, Fudan University, Shanghai, China
| | - Su Lin
- Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- Nephrology Research Institute, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Zhang
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- Nephrology Research Institute, Huashan Hospital, Fudan University, Shanghai, China
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18
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Dorsey AF, Miller EM. Revisiting geophagy: An evolved sickness behavior to microbiome-mediated gastrointestinal inflammation. Evol Anthropol 2023; 32:325-335. [PMID: 37661330 DOI: 10.1002/evan.22004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
Geophagy, the consumption of clay or similar substances, is known as an evolved behavior that protects vulnerable populations, such as pregnant women and children, against gastrointestinal injury. However, perplexing questions remain, like the presence of geophagy in the absence of overt gastrointestinal infection and the potential causal relationship between geophagy and iron deficiency anemia. In this review, we hypothesize that geophagy is an inflammation-mediated sickness behavior regulated via the vagus nerve. We further hypothesize that the gut microbiome plays a critical role in mediating the relationship between inflammation and geophagy. By including inflammation and the microbiome within the existing protection hypothesis, we can explain how subclinical gastrointestinal states induce geophagy. Furthermore, we can explain how gastrointestinal inflammation is responsible for both geophagy and iron-deficiency anemia, explaining why the two phenomena frequently co-occur. Ultimately, defining geophagy as a sickness behavior allows us to integrate the gut-brain axis into geophagy research.
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Affiliation(s)
- Achsah F Dorsey
- Department of Anthropology, University of Massachusetts, Amherst, Massachusetts, USA
| | - Elizabeth M Miller
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
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19
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Chatad D, Monas A, Rodriguez AN, Roth E, Erez O, Razi AE. Trends and risk factors for readmissions following press-fit total knee arthroplasty for the treatment of end-stage osteoarthritis of the knee: a five-year analysis. Eur J Orthop Surg Traumatol 2023; 33:3495-3499. [PMID: 37195308 DOI: 10.1007/s00590-023-03578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION The development of new prostheses with improved osseointegration, bone preservation, and reduced cost has renewed interest in uncemented total knee arthroplasty (UCTKA). In the current study, we aimed to: (1) assess demographic data of patients who were and were not readmitted and (2) identify patient-specific risk factors associated with readmission. METHODS A retrospective query from the PearlDiver database was performed from January 1, 2015, to October 31, 2020. International Classification of Disease, Ninth Revision (ICD-9), ICD-10, or Current Procedural Terminology (CPT) coding was used to distinguish cohorts of patients who had osteoarthritis of the knee and underwent UCTKA. Patients readmitted within 90 days were classified as the study population, while those who were not readmitted were classified as control. A linear regression model was utilized to analyze readmission risk factors. RESULTS The query yielded 14,575 patients, with 986 (6.8%) being readmitted. Patient demographics such as age (P < 0.0001), sex (P < 0.009), and comorbidity (P < 0.0001) were associated with annual 90-day readmission. Patient-specific risk factors associated with 90-day readmission following press-fit total knee arthroplasty were: arrhythmia (OR: 1.29, 95% CI: 1.11-1.49, P < 0.0005), coagulopathy (OR: 1.36, 95% CI: 1.13-1.63, P < 0.0007), fluid and electrolyte abnormalities (OR: 1.59, 95% CI: 1.38-1.84, P < 0.0001), iron deficiency anemia (OR: 1.49, 95% CI: 1.27-1.73, P < 0.0001), and obesity (OR: 1.37, 95% CI: 1.18-1.60, P < 0.0001). DISCUSSION This study demonstrates that patients with comorbidities, such as fluid and electrolyte problems, iron deficiency anemia, and obesity, were at an increased risk of readmission after having an uncemented total knee replacement. The risks of readmission following an uncemented total knee arthroplasty can be discussed with patients who have certain comorbidities by arthroplasty surgeons.
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Affiliation(s)
- Derrick Chatad
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Arie Monas
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Ariel N Rodriguez
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA.
| | - Eric Roth
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Orry Erez
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Afshin E Razi
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
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Ramasamy J, Jagadish C, Sukumaran A, Varghese J, Mani T, Joseph AJ, Simon EG, Jacob M. Low Serum Hepcidin Levels in Patients with Ulcerative Colitis - Implications for Treatment of Co-existent Iron-Deficiency Anemia. Inflammation 2023; 46:2209-2222. [PMID: 37486527 DOI: 10.1007/s10753-023-01872-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
Ulcerative colitis (UC) is often associated with anemia. Hepcidin, the central regulator of iron homeostasis, is known to be induced by inflammation and suppressed by anemia. It is not clear how hepcidin is affected in those with UC, when both inflammation and anemia may co-exist.Such knowledge may hold implications for treatment. Hematological and iron-related parameters, C-reactive protein (CRP), growth differentiation factor 15 (GDF-15) and erythroferrone (ERFE) (erythroid regulators of hepcidin) levels were estimated in blood from those with UC and in control subjects. Values for hematological and iron-related parameters showed evidence of iron-deficiency and resultant anemia, in patients with UC. The presence of UC was significantly associated with inflammation. Serum levels of ERFE, but not of GDF-15, were significantly higher in patients with UC than in control patients, while hepcidin levels were significantly lower. Serum hepcidin concentrations in patients with UC correlated positively with serum iron, ferritin and GDF-15, and negatively with serum ERFE. The iron status and serum hepcidin levels in UC patients with co-existent anemia were significantly lower and serum ERFE values significantly higher than in those with UC without anemia. The effect of anemia on hepcidin predominated over that of inflammation in patients with UC, resulting in suppressed hepcidin levels. This effect is possibly mediated through erythroferrone. We suggest that a serum hepcidin-guided approach may be useful to guide use of oral iron supplements to treat co-existent iron-deficiency anemia in patients with UC and other chronic inflammatory diseases.
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Affiliation(s)
- Jagadish Ramasamy
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India
- Department of Biochemistry, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, 625009, India
| | - Chinmai Jagadish
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India
- Department of Biochemistry, Dr. Chandramma Dayanada Sagar Institute of Medical Education and Research, Deverakaggalahalli, Karnataka, 562112, India
| | - Abitha Sukumaran
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joe Varghese
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - Thenmozhi Mani
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - A J Joseph
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632002, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632002, India
| | - Molly Jacob
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India.
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Sharma V, Bagrodia V, Modi N, Parchwani T. Marked reactive thrombocytosis in a female with iron deficiency anaemia. BMJ Case Rep 2023; 16:e256738. [PMID: 37945277 PMCID: PMC10649673 DOI: 10.1136/bcr-2023-256738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
This case report presents the clinical evaluation and management of a female patient from a rural background who presented with leg pain, headache, weakness and irritability. Initial investigations revealed iron deficiency anaemia accompanied by a significantly elevated platelet count, prompting suspicion of an underlying myeloproliferative neoplastic disorder. However, subsequent genetic testing ruled out these mutations, suggesting a reactive response to iron deficiency anaemia rather than an independent neoplastic process. Treatment was focused on addressing the underlying iron deficiency anaemia, resulting in significant improvement in the patient's blood profile and resolution of symptoms. Follow-up assessments demonstrated a complete normalisation of the blood profile and platelet counts, further supporting the efficacy of the treatment. This case highlights the importance of considering reactive thrombocytosis in the context of iron deficiency anaemia and emphasises the favourable response achieved through appropriate management strategies.
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Affiliation(s)
- Vishnu Sharma
- Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Vansh Bagrodia
- Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Naman Modi
- Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Tanishk Parchwani
- Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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Amaral-Moreira CDFA, Redezuk G, Pereira BG, Borovac-Pinheiro A, Rehder PM. Iron Deficiency Anemia in Pregnancy after Bariatric Surgery: Etiology, Risk Factors, and How to Manage It. Rev Bras Ginecol Obstet 2023; 45:e562-e567. [PMID: 37944922 PMCID: PMC10635785 DOI: 10.1055/s-0043-1776026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 08/01/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Pregnancy after bariatric surgery is a reality of the 21st century and therefore is essential that all obstetricians know how to manage it. The most prevalent nutritional deficiency is iron deficiency and, consequently, anemia. Although bariatric surgery and pregnancy are already risk factors for anemia, we evaluated in our study if there were any other risk factors and actions to improve hemoglobin levels in this population. METHODS We performed a retrospective cohort study, and performed frequency measurements and analyzes of odds ratio, X2 and Fisher exact test to evaluate the risk factors. RESULTS We evaluated 44 pregnancies after bariatric surgery, with an incidence of anemia of 62%, and the only identifiable risk factor for anemia was being black. As for the treatment, the iron salt used for oral supplementation did not associate with anemia risk, and in 27% of the patients, the adjustment of the oral dosage was enough for improvement in hemoglobin levels, but in 36% supplementation with intravenous iron was necessary. CONCLUSION Being black is a risk factor for anemia. The type of iron salt does not correlate with the incidence of anemia, and for the treatment and improvement of iron dosages, it seems an effective increase in iron intake.
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Affiliation(s)
| | - Guilherme Redezuk
- Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Belmiro Gonçalves Pereira
- Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Anderson Borovac-Pinheiro
- Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Patricia Moretti Rehder
- Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Graham FJ, Pellicori P, Masini G, Cuthbert JJ, Clark AL, Cleland JGF. Influence of serum transferrin concentration on diagnostic criteria for iron deficiency in chronic heart failure. ESC Heart Fail 2023; 10:2826-2836. [PMID: 37400990 PMCID: PMC10567655 DOI: 10.1002/ehf2.14438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/23/2023] [Accepted: 05/29/2023] [Indexed: 07/05/2023] Open
Abstract
AIMS Transferrin saturation (TSAT), a marker of iron deficiency, reflects both serum concentrations of iron (SIC) and transferrin (STC). TSAT is susceptible to changes in each of these biomarkers. Little is known about determinants of STC and its influence on TSAT and mortality in patients with heart failure. Accordingly, we studied the relationship of STC to clinical characteristics, to markers of iron deficiency and inflammation and to mortality in chronic heart failure (CHF). METHODS AND RESULTS Prospective cohort of patients with CHF attending a clinic serving a large local population. A total of 4422 patients were included (median age 75 (68-82) years; 40% women; 32% with left ventricular ejection fraction ≤40%). STC ≤ 2.3 g/L (lowest quartile) was associated with older age, lower SIC and haemoglobin and higher high-sensitivity C-reactive protein, ferritin and N-terminal pro-brain natriuretic peptide compared with those with STC > 2.3 g/L. In the lowest STC quartile, 624 (52%) patients had SIC ≤13 μmol/L, of whom 38% had TSAT ≥20%. For patients in the highest STC quartile, TSAT was <20% when SIC was >13 μmol/L in 185 (17%) patients. STC correlated inversely with ferritin (r = -0.52) and high-sensitivity C-reactive protein (r = -0.17) and directly with albumin (r = 0.29); all P < 0.001. In models adjusted for age, N-terminal pro-brain natriuretic peptide and haemoglobin, both higher SIC (hazard ratio 0.87 [95% CI: 0.81-0.95]) and STC (hazard ratio 0.82 [95% CI: 0.73-0.91]) were associated with lower mortality. SIC was more strongly associated with both anaemia and mortality than either STC or TSAT. CONCLUSIONS Many patients with CHF and a low STC have low SIC even when TSAT is >20% and serum ferritin >100 μg/L; such patients have a high prevalence of anaemia and a poor prognosis and might have iron deficiency but are currently excluded from clinical trials of iron repletion.
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Affiliation(s)
- Fraser J. Graham
- British Heart Foundation Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Pierpaolo Pellicori
- British Heart Foundation Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Gabriele Masini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | | | | | - John G. F. Cleland
- British Heart Foundation Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
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Serati M, Espuña-Pons M, Mouton-Puglisi A, Padoa A. Iron deficiency and sexual dysfunction in women. Sex Med Rev 2023; 11:342-348. [PMID: 37433756 DOI: 10.1093/sxmrev/qead028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Sexual dysfunction negatively affects approximately 40% to 50% of adult women across various stages of life. Common risk factors include sexual traumas, relationship problems, chronic conditions, medication side effects, and poor physical health, including iron deficiency. OBJECTIVES This review summarizes a presentation from a symposium that discussed the types and causes of sexual dysfunction at key times in women's lives, focusing on the relationship between iron deficiency and sexual dysfunction. METHODS The symposium was held at the XV Annual European Urogynaecological Association Congress, Antibes, France, in October 2022. Symposium content was identified through literature searches of PubMed. Original research, review articles, and Cochrane analyses discussing sexual dysfunction in association with iron deficiency/anemia were included. RESULTS Iron deficiency in women is commonly caused by abnormal uterine bleeding, but women may develop iron deficiency anemia (IDA) because of increased iron needs or reduced iron intake/absorption. Treatment with oral iron supplementation has been shown to improve sexual function in women with IDA. Ferrous sulphate is considered as a standard of care for oral iron treatment; prolonged-release iron formulations have improved tolerability, enabling lower doses and better tolerability. CONCLUSION IDA and sexual dysfunction are related, so the identification of sexual dysfunction or iron deficiency in a woman should prompt an investigation of the other condition. Testing for iron deficiency is an inexpensive and simple step that can be routinely included in the workup of women with sexual dysfunction. Once identified, IDA and sexual dysfunction in women should be treated and followed to optimize quality of life.
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Affiliation(s)
- Maurizio Serati
- Urogynaecology Unit, Department of Obstetrics and Gynaecology, University of Insubria, 21100 Varese, Italy
| | - Montserrat Espuña-Pons
- Department of Obstetrics and Gynecology, University of Barcelona, 08036 Barcelona, Spain
| | | | - Anna Padoa
- Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, 7033001 Tsrifin, Israel
- Sackler School of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel
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25
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Lee HJ, Pak H, Han JJ, Chang MH. Comprehensive Analysis of Iron Deficiency Anemia and Its Related Disorders in Premenopausal Women Based on a Propensity Score Matching Case Control Study Using National Health Insurance Service Database in Korea. J Korean Med Sci 2023; 38:e299. [PMID: 37724497 PMCID: PMC10506900 DOI: 10.3346/jkms.2023.38.e299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/25/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Menorrhagia is a common cause of iron deficiency anemia (IDA) in premenopausal women. However, the effects of menorrhagia on IDA in premenopausal women have been underestimated compared to those on other IDA-related disorders (IRDs) such as gastrointestinal malignancies (GIMs). To better understand the relationship between menorrhagia and IDA in premenopausal women, we analyzed the National Health Insurance Service-National Health Information Database (NHIS-NHID). METHODS From 2005 to 2008, data about women between the age of 20 and 59 years were extracted from the NHIS-NHID to create a propensity score-matched case (IDA) and control group. The annual incidence of IDA was calculated per age group. A 10-year follow up of the study population was determined to detect IRDs in case and control groups. We compared the risk of detection (ROD) of IRDs, including GIM and gynecological disorders associated with menorrhagia - leiomyoma of uterus (LM) and adenomyosis (AM), in the case and the control group. RESULTS From 2005 to 2008, women diagnosed with IDA (n = 535,249) and healthy women as a control group (n = 1,070,498) were identified from the NHIS-NHID. The annual incidence of IDA was 767.4 (2005), 948.7 (2006), 981.6 (2007), and 897.7 (2008) per 100,000 women. The age distribution of IDA was similar each year; IDA was common in women aged 30-39 years (36-37%) and 40-49 years (30-32%), and its incidence was significantly decreased in women aged 50-59 years (< 10%). The ROD of IRDs were significantly higher in the IDA group than in the control group (LM: 20.8% vs. 6.9%, AM: 5.6% vs. 1.6%, and GIM: 2.6% vs. 0.7%). The corresponding hazard ratios were 3.89 (95% confidence interval [CI], 3.85-3.93) for LM, 4.99 (95% CI, 4.90-5.09) for AM, and 3.43 (95% CI, 3.32-3.55) for GIM. The ROD of the IRDs varied; the ROD of LM in the IDA group increased with age and decreased in the age group 50-59 years. AM was more frequently detected in women with IDA aged 30-39 years and less in women older than 40 years. The frequency of GIM increased with age. CONCLUSION In this study, we found that the gynecologic disease is the main cause of IDA in premenopausal women. Gynecological evaluations should be performed more actively in the clinic to prevent and control IDA and IRDs.
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Affiliation(s)
- Hyun Jung Lee
- Department of Hematology and Medical Oncology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Haeyong Pak
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jae Joon Han
- Department of Hematology and Medical Oncology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Hee Chang
- Division of Oncology-Hematology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Bae H, Cho YW, Kim KT, Li X, Earley CJ. Ferric carboxymaltose effects on restless legs syndrome and on brain iron in patients with iron deficiency anemia. Sleep Med 2023; 109:128-131. [PMID: 37437492 PMCID: PMC10528926 DOI: 10.1016/j.sleep.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Brain iron status is fundamental in RLS pathogenesis. The aim of this study was to determine the clinical efficacy and brain iron concentration improvement in RLS patients with IDA, using 1500 mg FCM. METHODS This is a randomized, double-blinded, placebo-controlled study. RLS patients with IDA were grouped into either 1500 mg FCM or placebo. The primary outcomes were the change from baseline on the International Restless Legs Syndrome Study Group scale (IRLS) and brain iron measured by QSM and R2∗. RESULTS A total of 18 RLS patients with IDA were enrolled, 10 in the FCM group and 8 in the placebo. At the week 6 endpoint, the FCM group showed significant improvement in both IRLS (-13.60 ± 9.47 vs. -3.63 ± 5.40, p = 0.011) and VAS (-40.50 ± 28.81 vs. -0.63 ± 28.28, p = 0.004) from baseline. Change from baseline with R2∗ techniques showed a treatment effect for the thalamus and QSM technique for both the substantia nigra and pulvinar. A correlation was proved between the IRLS difference and the difference of QSM in thalamus (p = 0.028). CONCLUSION This study demonstrates that 1500 mg FCM effectively treats RLS symptoms in IDA patients over six weeks, with MRI measurements of improved brain iron content serving as a potential biomarker for RLS patients.
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Affiliation(s)
- Hyoeun Bae
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Won Cho
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
| | - Keun Tae Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Xu Li
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA
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Benotti PN, Wood GC, Dove J, Kaberi-Otarod J, Still CD, Gerhard GS, Bistrian BR. Clinical significance of iron deficiency among candidates for metabolic surgery. Surg Obes Relat Dis 2023; 19:981-989. [PMID: 37253650 DOI: 10.1016/j.soard.2023.04.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/20/2023] [Accepted: 04/23/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Iron deficiency (ID), a known complication after metabolic surgery, is common among preoperative patients in the presence of inflammation. Evidence is now accumulating that preoperative ID may adversely affect perioperative outcomes. OBJECTIVES To investigate the relationship between preoperative iron status and the risk of postoperative severe anemia. In addition, this study investigates the relationship between preoperative iron status and length of surgical stay SETTING: A large regional tertiary health system. METHODS Among patients who underwent metabolic surgery between 2004 and 2020, 5171 patients had a full iron nutritional assessment prior to surgery. Study patients were divided into multiple smaller groups (10 female groups and 7 male groups) on the basis of levels of serum ferritin and Transferrin Saturation (T Sat) < or ≥20%. Study patients were followed after surgery and the time to the development of severe anemia (hemoglobin < 8 gm/dL) was recorded. Hospital length of stay (LOS) was analyzed in relation to preoperative iron status. RESULTS Lower ferritin levels were associated with older age in males (P = .0001) and younger age in females (P < .0001). For males, after adjustment for age, body mass index (BMI), and year of surgery, surgical LOS was prolonged in those with T Sat <20% (P = .0041). For females the time until the development of severe anemia was associated with baseline iron status (P < .0001). CONCLUSIONS Male preoperative patients for metabolic surgery with T Sat <20% are at risk for increased surgical LOS. Females with low ferritin levels consistent with ID are at increased risk for the development of postoperative severe anemia.
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Affiliation(s)
- Peter N Benotti
- The Center for Obesity and Metabolic Research, Geisinger Obesity Institute, Danville, Pennsylvania.
| | - G Craig Wood
- The Center for Obesity and Metabolic Research, Geisinger Obesity Institute, Danville, Pennsylvania
| | - James Dove
- The Center for Obesity and Metabolic Research, Geisinger Obesity Institute, Danville, Pennsylvania
| | - Jila Kaberi-Otarod
- Department of Nutrition and Weight Management, Geisinger Health System Northeast, Wilkes Barre, Pennsylvania
| | - Christopher D Still
- The Center for Obesity and Metabolic Research, Geisinger Obesity Institute, Danville, Pennsylvania
| | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biology, Lewis, Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Bruce R Bistrian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Carson JL, Brittenham GM. How I treat anemia with red blood cell transfusion and iron. Blood 2023; 142:777-785. [PMID: 36315909 PMCID: PMC10485845 DOI: 10.1182/blood.2022018521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Severe anemia is commonly treated with red blood cell transfusion. Clinical trials have demonstrated that a restrictive transfusion strategy of 7 to 8 g/dL is as safe as a liberal transfusion strategy of 9 to 10 g/dL in many clinical settings. Evidence is lacking for subgroups of patients, including those with preexisting coronary artery disease, acute myocardial infarction, congestive heart failure, and myelodysplastic neoplasms. We present 3 clinical vignettes that highlight the clinical challenges in caring for patients with coronary artery disease with gastrointestinal bleeding, congestive heart failure, or myelodysplastic neoplasms. We emphasize that transfusion practice should be guided by patient symptoms and preferences in conjunction with the patient's hemoglobin concentration. Along with the transfusion decision, evaluation and management of the etiology of the anemia is essential. Iron-restricted erythropoiesis is a common cause of anemia severe enough to be considered for red blood cell transfusion but diagnosis and management of absolute iron deficiency anemia, the anemia of inflammation with functional iron deficiency, or their combination may be problematic. Intravenous iron therapy is generally the treatment of choice for absolute iron deficiency in patients with complex medical disorders, with or without coexisting functional iron deficiency.
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Affiliation(s)
- Jeffrey L. Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Gary M. Brittenham
- Departments of Pediatrics and Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Mochizuki T, Ryu B, Kushi K, Shima S, Sato S, Inoue T, Okada Y, Niimi Y. Cerebral venous thrombosis associated with hyperhomocysteinemia and iron-deficiency anemia induced by autoimmune gastritis: A case report and literature review. Neuroradiol J 2023; 36:491-495. [PMID: 36536603 PMCID: PMC10588603 DOI: 10.1177/19714009221147224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare disease, occurring in 0.5%-1% of all patients with strokes. Systemic and hereditary diseases and traumas are potential causes of CVT. We report a case of CVT and systemic thromboembolism complicated with hyperhomocysteinemia and iron-deficiency anemia caused by autoimmune gastritis. A 47-year-old female patient was admitted to the emergency department due to difficulty in movement, impaired consciousness, and urinary incontinence. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed bilateral thalamic edema associated with venous sinus thrombosis and embolic cerebral infarction in the deep white matter of the bilateral cerebral hemispheres. In addition, contrast enhanced whole-trunk CT scan showed deep femoral thrombosis and pulmonary artery embolism. She had no medical history of diseases or drug use that may cause thrombosis. Blood test results revealed iron-deficiency anemia and hyperhomocysteinemia, which were determined to be the cause of systemic thromboembolism. The patient tested positive for intrinsic factor antibodies. Moreover, the patient was diagnosed with autoimmune gastritis by gastrointestinal endoscopy. Therapies including anticoagulant and replacement with iron and vitamin B12 were administered. The patient was discharged from the hospital without neurological deficits. A favorable clinical course was achieved with anticoagulant administration and replacement therapy with iron and vitamin B12 for cerebral arteriovenous embolism that developed due to autoimmune gastritis.
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Affiliation(s)
- Tatsuki Mochizuki
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Bikei Ryu
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
| | - Kazuki Kushi
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Shogo Shima
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
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Georgieff MK. The importance of iron deficiency in pregnancy on fetal, neonatal, and infant neurodevelopmental outcomes. Int J Gynaecol Obstet 2023; 162 Suppl 2:83-88. [PMID: 37538010 PMCID: PMC10421617 DOI: 10.1002/ijgo.14951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The role of iron in neurodevelopment has long been recognized, and the adverse effects of early-life iron deficiency on brain development and subsequent function across the lifespan continue to be a subject of research. A greater appreciation of the contribution of maternal preconceptional iron status and fetal iron accretion to offspring, postnatal iron status, and brain health across the lifespan has occurred over the past decade. This paradigm shift in thinking links two previously relatively siloed literatures: neonatal iron deficiency and postnatal iron deficiency. The understanding that iron accretion during the fetal period strongly influences postnatal iron balance has led to an appreciation of the importance and value of ensuring proper fetal iron loading. This article reviews the dynamics of fetal iron metabolism, the role of iron in the developing fetal brain, the short- and long-term neurobehavioral consequences of fetal iron underloading, and the potential mechanisms that account for the long-term effects of fetal/neonatal iron deficiency.
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Habib A, Kureishy S, Soofi S, Hussain I, Rizvi A, Ahmed I, Ahmed KM, Achakzai ABK, Bhutta ZA. Prevalence and Risk Factors for Iron Deficiency Anemia among Children under Five and Women of Reproductive Age in Pakistan: Findings from the National Nutrition Survey 2018. Nutrients 2023; 15:3361. [PMID: 37571298 PMCID: PMC10421143 DOI: 10.3390/nu15153361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Anemia remains a global public health problem, especially in developing countries. It affects primarily children under five (CU5), women of reproductive age (WRA), and pregnant women due to their higher need for iron. The most common form of anemia is iron-deficiency anemia (IDA). IDA is estimated to cause half of all anemia cases and one million deaths per year worldwide. However, there remains a lack of well-documented and biochemically assessed prevalence of IDA based on the representative population-based samples globally and regionally. In this study, we aimed to assess the National Nutrition Survey (NNS) 2018 to identify the prevalence and risk factors of IDA in Pakistani CU5 and WRA. METHODS Secondary analysis was conducted on the NNS 2018, a cross-sectional survey, which collected data on dietary practices, malnutrition, and food insecurity. Anemia was defined as hemoglobin levels < 11.0 g/dL in children and 12.0 g/dL in women. IDA was defined as low hemoglobin and low ferritin (<12 ng/mL) levels, adjusted for inflammation using AGP and CRP biomarkers in CU5 and WRA. Univariate and multivariable logistic regressions were conducted using Stata statistical software (version 16). We also compared the IDA rates of NNS 2018 and 2011. RESULTS A total of 17,814 CU5 and 22,114 WRA were included in the analysis. Of the CU5, 28.9% had IDA, while 18.4% of WRA reported to experience IDA. Among the CU5, IDA was most prevalent among male children aged 6-23 months living in rural areas and with the presence of diarrhea and fevers in the last 2 weeks. Children whose mothers had no education, were aged 20-34 years, and employed, had a higher prevalence of IDA. Married WRA, who are employed, living in rural areas, and with no education, had a higher prevalence of IDA. In the multivariable logistic regression, children aged 6-23 months (AOR = 1.19, 95% CI [1.08-1.33], p < 0.001) and with the presence of diarrhea in the last 2 weeks (AOR = 1.32, 95% CI [1.13-1.54], p < 0.001) or fever (AOR = 1.16, 95% CI [1.02-1.32], p = 0.02) had higher odds of IDA. At the household level, the odds of IDA among CU5 were higher in the poorest households (AOR = 1.27, 95% CI [1.08-1.50], p = 0.005), with ≥5 CU5 (AOR = 1.99, 95% CI [1.28-3.11], p = 0.002), and with no access to improved sanitation facilities (AOR = 1.17, 95% CI [1.02-1.34], p = 0.026). For WRA, the multivariable logistic regression found that the odds of IDA were higher among women with vitamin A deficiency (Severe: AOR = 1.26, 95% CI [1.05-1.52], p = 0.013; Mild: AOR = 1.36, 95% CI [1.23-1.51], p < 0.001), zinc deficiency (AOR = 1.42, 95% CI [1.28-1.57], p < 0.001), no education (AOR = 1.53, 95% CI [1.30-1.81], p < 0.001), and from severely food insecure households (AOR = 1.20, 95% CI [1.07-1.34], p = 0.001). The odds of IDA were lower among women whose body mass index was overweight (AOR = 0.77, 95% CI [0.69-0.86], p < 0.001) or obese (AOR = 0.71, 95% CI [0.62-0.81], p < 0.001). CONCLUSIONS The child's age, presence of diarrhea or fever, place of residence, household size, wealth status, and access to sanitation facilities were significantly associated with IDA among CU5 in Pakistan. For WRA, education, body mass index, vitamin A and zinc status, household food security status, wealth status, and access to sanitation facilities were significantly associated with IDA. Large, well-established, government-funded programmes focused on micronutrient supplementation, food fortification, the diversification of food supplies, and the treatment and prevention of infectious and parasitic diseases are needed to prevent IDA and all forms of anemia among children and women in Pakistan.
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Affiliation(s)
- Atif Habib
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Sumra Kureishy
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Sajid Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Imtiaz Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Arjumand Rizvi
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Khawaja Masuood Ahmed
- Ministry of Health Services Regulation & Coordination, Islamabad 44020, Pakistan (A.B.K.A.)
| | | | - Zulfiqar A. Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan
- Lawson Centre for Nutrition, University of Toronto, Toronto, ON M5S 1A8, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Singer CE, Biciuşcă V, Abdul-Razzak J, Popescu IAS, Geormăneanu C, Singer MM, Mărginean CM, Popescu M. Associated factors in pediatric patients admitted with severe iron-deficiency anemia in the last seven years - the experience of a single pediatric unit. Rom J Morphol Embryol 2023; 64:419-426. [PMID: 37867359 PMCID: PMC10720942 DOI: 10.47162/rjme.64.3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES To study the causes of iron deficiency, laboratory findings and clinical manifestation of infants aged 6-12 months and children aged 1-3 years diagnosed with severe iron-deficiency anemia. PATIENTS, MATERIALS AND METHODS We conducted an observational, retrospective single tertiary center study between January 2015 and April 2022, which included 142 children. The control group (patients with no diagnosis of severe iron-deficiency anemia) included 71 patients and the study group (patients diagnosed with severe iron-deficiency anemia) included also 71 patients. Clinical data were retrospectively collected from hospital medical records. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) 25.0 software. RESULTS Seventy-one children had hemoglobin <7 g∕dL and low values of ferritin/serum iron (22 infants aged 6-12 months and 49 children aged 1-3 years). In both the study and control groups, the male gender was slightly more prevalent. Mother's age at birth and living standard is significantly lower in the study group. We note a higher frequency of premature births (14.08%) in children identified with anemia compared to control group (8.45%). We found a statistically significant distribution of cow's milk consumption among the two groups (p<0.001). Pearson's correlation test revealed a significant positive correlation, indicating that anemia is directly proportional to cow's milk consumption. CONCLUSIONS The most frequent cause of iron-deficiency anemia in infants and children 1-3 years old was the consumption of cow's milk following incorrect diversification and incomplete prophylaxis of iron-deficiency anemia.
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Affiliation(s)
- Cristina Elena Singer
- Department of Mother and Baby, University of Medicine and Pharmacy of Craiova, Romania
| | - Viorel Biciuşcă
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | | | | | - Cristiana Geormăneanu
- Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, Romania
| | - Maria Mădălina Singer
- Resident Physician, Department of Dermatology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | | | - Mihaela Popescu
- Department of Endocrinology, University of Medicine and Pharmacy of Craiova, Romania
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Hamdeh S, Fathallah J, Zhang H, Charoen A, Altamimi BA, Odufalu FD, Dave D, Sayed AE, Glick LR, Grisolano S, Hachem C, Hammami MB, Mahmoud KH, Levy AN, Rao VL, Shim HG, Semrad C, Olyaee M, Micic D. Predictive Model for Positive Video Capsule Endoscopy in Iron Deficiency Anemia. Dig Dis Sci 2023; 68:3083-3091. [PMID: 36917313 DOI: 10.1007/s10620-023-07918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND AIMS Bleeding from the gastrointestinal tract can contribute to the development of iron deficiency anemia (IDA) among individuals without another obvious source of bleeding. In order to identify patients most likely to benefit from examination of the small bowel, our aim was to create a risk score for positive video capsule endoscopy (VCE) in IDA utilizing a multicenter collection of studies. METHODS We performed a retrospective multicenter study utilizing VCE studies performed for an indication of IDA between 1/1/2005 and 7/31/2018. VCE findings were graded based on the P0-P2 grading system. The primary outcome of interest was a positive (P2) VCE. Data were analyzed with Student's t test for continuous variables and the Fisher's exact test for categorical variables. Logistic regression was used to identify independent associations with positive VCE. RESULTS In total, 765 VCE procedures were included with 355 (46.5%) male subjects and a median age of 63.2 (SD 15.3) years. One hundred ninety studies (24.8%) were positive (P2) for small bowel bleeding. Four variables associated with positive VCE which were incorporated into a point scoring system: (+) 1 for age ≥ 66 years, active smoking and cardiac arrythmia and (-) 1 for preceding hemoglobin level ≥ 8.5. The risk probabilities for positive VCE-assigned scores - 1, 0, 1, and 2 + were 12.3% (95% CI 7.3-17.3%), 20% (14.9-25.1%), 34.8% (28.6-41%), and 39% (30-47.8%). CONCLUSION In order to improve the diagnostic yield of capsule examinations, risk factors should be applied to clinical decision-making. We created a risk score for positive VCE in IDA, including the risk factors of age, smoking, history of cardiac arrythmia, and preceding hemoglobin level.
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Affiliation(s)
- Shadi Hamdeh
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jihan Fathallah
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hui Zhang
- The Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
| | - Amber Charoen
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barakat Aburajab Altamimi
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Florence-Damilola Odufalu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Devashree Dave
- Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Amer El Sayed
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Laura R Glick
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA
| | - Scott Grisolano
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, KS, USA
| | - Christine Hachem
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Muhammad Bader Hammami
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Khaldoun Haj Mahmoud
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alexander N Levy
- Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, MA, USA
| | - Vijaya L Rao
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA
| | - Hong Gi Shim
- Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, MA, USA
| | - Carol Semrad
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA
| | - Mojtaba Olyaee
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, MC4076, Chicago, IL, 60637, USA.
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Martens P, Yu S, Larive B, Borlaug BA, Erzurum SC, Farha S, Finet JE, Grunig G, Hemnes AR, Hill NS, Horn EM, Jacob M, Kwon DH, Park MM, Rischard FP, Rosenzweig EB, Wilcox JD, Tang WHW. Iron deficiency in pulmonary vascular disease: pathophysiological and clinical implications. Eur Heart J 2023; 44:1979-1991. [PMID: 36879444 PMCID: PMC10474927 DOI: 10.1093/eurheartj/ehad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
AIMS Iron deficiency is common in pulmonary hypertension, but its clinical significance and optimal definition remain unclear. METHODS AND RESULTS Phenotypic data for 1028 patients enrolled in the Redefining Pulmonary Hypertension through Pulmonary Vascular Disease Phenomics study were analyzed. Iron deficiency was defined using the conventional heart failure definition and also based upon optimal cut-points associated with impaired peak oxygen consumption (peakVO2), 6-min walk test distance, and 36-Item Short Form Survey (SF-36) scores. The relationships between iron deficiency and cardiac and pulmonary vascular function and structure and outcomes were assessed. The heart failure definition of iron deficiency endorsed by pulmonary hypertension guidelines did not identify patients with reduced peakVO2, 6-min walk test, and SF-36 (P > 0.208 for all), but defining iron deficiency as transferrin saturation (TSAT) <21% did. Compared to those with TSAT ≥21%, patients with TSAT <21% demonstrated lower peakVO2 [absolute difference: -1.89 (-2.73 to -1.04) mL/kg/min], 6-min walk test distance [absolute difference: -34 (-51 to -17) m], and SF-36 physical component score [absolute difference: -2.5 (-1.3 to -3.8)] after adjusting for age, sex, and hemoglobin (all P < 0.001). Patients with a TSAT <21% had more right ventricular remodeling on cardiac magnetic resonance but similar pulmonary vascular resistance on catheterization. Transferrin saturation <21% was also associated with increased mortality risk (hazard ratio 1.63, 95% confidence interval 1.13-2.34; P = 0.009) after adjusting for sex, age, hemoglobin, and N-terminal pro-B-type natriuretic peptide. CONCLUSION The definition of iron deficiency in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) pulmonary hypertension guidelines does not identify patients with lower exercise capacity or functional status, while a definition of TSAT <21% identifies patients with lower exercise capacity, worse functional status, right heart remodeling, and adverse clinical outcomes.
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Affiliation(s)
- Pieter Martens
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Shilin Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Brett Larive
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Samar Farha
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - J Emanuel Finet
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Gabriele Grunig
- Department of Medicine & Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
| | - Evelyn M Horn
- Perkin Heart Failure Center, Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | - Miriam Jacob
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Deborah H Kwon
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Margaret M Park
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
| | - Franz P Rischard
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ, USA
| | - Erika B Rosenzweig
- Department of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Jennifer D Wilcox
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Wai Hong Wilson Tang
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
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35
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Affiliation(s)
- John G F Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, University Avenue, Glasgow, UK. G12 8QQ, UK
| | - Pierpaolo Pellicori
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, University Avenue, Glasgow, UK. G12 8QQ, UK
| | - Fraser J Graham
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, University Avenue, Glasgow, UK. G12 8QQ, UK
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Kadhim EJ. Iron-deficiency anemia in relation to body mass index among Iraqi primigravida women. J Med Life 2023; 16:868-872. [PMID: 37675168 PMCID: PMC10478663 DOI: 10.25122/jml-2023-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/26/2023] [Indexed: 09/08/2023] Open
Abstract
Anemia affects approximately half a billion women of reproductive age worldwide, with 31% of pregnant women in Iraq aged 15-49 years experiencing anemia. This condition is associated with increased risks of maternal and fetal morbidity and mortality, including stillbirths, miscarriages, prematurity, and low birth weight. This study investigated the correlation between iron-deficiency anemia (IDA) and body mass index (BMI) among primigravidae in Iraq. One hundred primiparous women in their third trimester were recruited from Baghdad Medical City Teaching Hospital and Teaching Hospital of Obstetrics and Gynecology in Karbala. Participants were categorized into four groups based on BMI: underweight (BMI < 18.5 kg/m^2), normal weight (BMI 18.5-24.9 kg/m^2), overweight (BMI 25-29.9 kg/m^2), and obese (BMI ≥ 30 kg/m^2). Demographic and medical history data were collected from the participants, and hematological investigations were conducted to measure hemoglobin (Hb), packed cell volume (PCV), mean corpuscular volume (MCV), and serum ferritin levels. Statistical significance was determined at p<0.05. The study enrolled 100 primiparous women, including 10 underweight, 24 normal weight, 28 overweight, and 38 obese participants. Analysis revealed a significant decrease in Hb levels among obese individuals compared to the normal weight group. Moreover, a significant difference in serum ferritin levels was observed between the obese and the other three groups (underweight, normal weight, and overweight). The findings indicated an inverse correlation between high BMI and serum ferritin and Hb levels. The study concluded that anemia is more common in obese pregnant women compared to normal-weight women. Furthermore, it demonstrates varying trends of iron-deficiency anemia (IDA) in relation to the body mass index (BMI) of pregnant women.
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Affiliation(s)
- Ekhlas Jabbar Kadhim
- Department of Obstetrics and Gynecology, College of Medicine, University of Baghdad, Baghdad, Iraq
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37
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Hess SY, Owais A, Jefferds MED, Young MF, Cahill A, Rogers LM. Accelerating action to reduce anemia: Review of causes and risk factors and related data needs. Ann N Y Acad Sci 2023; 1523:11-23. [PMID: 36987993 PMCID: PMC10918744 DOI: 10.1111/nyas.14985] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Anemia is a major public health concern. Young children, menstruating adolescent girls and women, and pregnant women are among the most vulnerable. Anemia is the consequence of a wide range of causes, including biological, socioeconomic, and ecological risk factors. Primary causes include: iron deficiency; inherited red blood cell disorders; infections, such as soil-transmitted helminthiasis, schistosomiasis, and malaria; gynecological and obstetric conditions; and other chronic diseases that lead to blood loss, decreased erythropoiesis, or destruction of erythrocytes. The most vulnerable population groups in low- and middle-income countries are often at the greatest risk to suffer from several of these causes simultaneously as low socioeconomic status is linked with an increased risk of anemia through multiple pathways. Targeted and effective action is needed to prevent anemia. Understanding the causes and risk factors of anemia for different population subgroups within a country guides the design and implementation of effective strategies to prevent and treat anemia. A coordinated approach across various expert groups and programs could make the best use of existing data or could help to determine when newer and more relevant data may need to be collected, especially in countries with a high anemia burden and limited information on the etiology of anemia.
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Affiliation(s)
- Sonja Y. Hess
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, California, USA
- Micronutrient Forum, Washington, DC, USA
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children on behalf of Exemplars in Global Health, Toronto, Ontario, Canada
| | | | - Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrew Cahill
- Gates Ventures on behalf of Exemplars in Global Health, Seattle, Washington, USA
| | - Lisa M. Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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38
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Sano M. A Role of Sodium-Glucose Co-Transporter 2 in Cardiorenal Anemia Iron Deficiency Syndrome. Int J Mol Sci 2023; 24:5983. [PMID: 36983057 PMCID: PMC10057380 DOI: 10.3390/ijms24065983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Heart failure, renal dysfunction, anemia, and iron deficiency affect each other and form a vicious cycle, a condition referred to as cardiorenal anemia iron deficiency syndrome. The presence of diabetes further accelerates this vicious cycle. Surprisingly, simply inhibiting sodium-glucose co-transporter 2 (SGLT2), which is expressed almost exclusively in the proximal tubular epithelial cells of the kidney, not only increases glucose excretion into the urine and effectively controls blood glucose levels in diabetes but can also correct the vicious cycle of cardiorenal anemia iron deficiency syndrome. This review describes how SGLT2 is involved in energy metabolism regulation, hemodynamics (i.e., circulating blood volume and sympathetic nervous system activity), erythropoiesis, iron bioavailability, and inflammatory set points in diabetes, heart failure, and renal dysfunction.
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Affiliation(s)
- Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Seo H, Yoon SY, ul-Haq A, Jo S, Kim S, Rahim MA, Park HA, Ghorbanian F, Kim MJ, Lee MY, Kim KH, Lee N, Won JH, Song HY. The Effects of Iron Deficiency on the Gut Microbiota in Women of Childbearing Age. Nutrients 2023; 15:nu15030691. [PMID: 36771397 PMCID: PMC9919165 DOI: 10.3390/nu15030691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Iron deficiency anemia (IDA) is the most prevalent and common nutritional deficiency worldwide and is a global health problem with significant risk, particularly among women of reproductive age. Oral iron supplementation is the most widely used and cost-effective treatment for iron deficiency and IDA. However, there are limitations regarding side effects such as enteritis, treatment compliance, and bioavailability. Intestinal microbiome characteristic research has been recently conducted to overcome these issues, but more is needed. Against this background, a metagenomics study on the 16S gene in the feces of young women vulnerable to IDA was conducted. As a result of analyzing 16 normal subjects and 15 IDA patients, significant differences in bacterial community distribution were identified. In particular, a significant decrease in Faecalibacterium was characteristic in IDA patients compared with normal subjects. Furthermore, in the case of patients who recovered from IDA following iron supplementation treatment, it was confirmed that Faecalibacterium significantly recovered to normal levels. However, no significance in beta diversity was seen compared with before treatment. There were also no differences in the beta diversity results between the recovered and normal subjects. Therefore, intestinal dysbiosis during the disease state was considered to be restored as IDA improved. Although the results were derived from a limited number of subjects and additional research is needed, the results of this study are expected to be the basis for developing treatment and prevention strategies based on host-microbiome crosstalk in IDA.
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Affiliation(s)
- Hoonhee Seo
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan-si 31538, Republic of Korea
| | - Seug Yun Yoon
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Asad ul-Haq
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan-si 31538, Republic of Korea
| | - Sujin Jo
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
| | - Sukyung Kim
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan-si 31538, Republic of Korea
| | - Md Abdur Rahim
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
| | - Hyun-A Park
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
| | - Fatemeh Ghorbanian
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
| | - Min Jung Kim
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Min-Young Lee
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Kyoung Ha Kim
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Namsu Lee
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Jong-Ho Won
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
- Correspondence: (J.-H.W.); (H.-Y.S.)
| | - Ho-Yeon Song
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan-si 31538, Republic of Korea
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
- Correspondence: (J.-H.W.); (H.-Y.S.)
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40
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Hirota Y, Xu Y, Yamamoto A, Matsuoka A, Dunn TC, Ogawa W. Type 1 diabetes iron-deficiency anaemia case report and the clinical relevance of red blood cell lifespan-adjusted glycated haemoglobin. Diabetes Obes Metab 2023; 25:319-322. [PMID: 36071680 PMCID: PMC10087357 DOI: 10.1111/dom.14860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Yushi Hirota
- Division of Diabetes and endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yongjin Xu
- Abbott Diabetes Care, Alameda, California
| | - Akane Yamamoto
- Division of Diabetes and endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuko Matsuoka
- Division of Diabetes and endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Wataru Ogawa
- Division of Diabetes and endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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41
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Kalra PR, Cleland JGF, Petrie MC, Thomson EA, Kalra PA, Squire IB, Ahmed FZ, Al-Mohammad A, Cowburn PJ, Foley PWX, Graham FJ, Japp AG, Lane RE, Lang NN, Ludman AJ, Macdougall IC, Pellicori P, Ray R, Robertson M, Seed A, Ford I. Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial. Lancet 2022; 400:2199-2209. [PMID: 36347265 DOI: 10.1016/s0140-6736(22)02083-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND For patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric carboxymaltose administration improves quality of life and exercise capacity in the short-term and reduces hospital admissions for heart failure up to 1 year. We aimed to evaluate the longer-term effects of intravenous ferric derisomaltose on cardiovascular events in patients with heart failure. METHODS IRONMAN was a prospective, randomised, open-label, blinded-endpoint trial done at 70 hospitals in the UK. Patients aged 18 years or older with heart failure (left ventricular ejection fraction ≤45%) and transferrin saturation less than 20% or serum ferritin less than 100 μg/L were eligible. Participants were randomly assigned (1:1) using a web-based system to intravenous ferric derisomaltose or usual care, stratified by recruitment context and trial site. The trial was open label, with masked adjudication of the outcomes. Intravenous ferric derisomaltose dose was determined by patient bodyweight and haemoglobin concentration. The primary outcome was recurrent hospital admissions for heart failure and cardiovascular death, assessed in all validly randomly assigned patients. Safety was assessed in all patients assigned to ferric derisomaltose who received at least one infusion and all patients assigned to usual care. A COVID-19 sensitivity analysis censoring follow-up on Sept 30, 2020, was prespecified. IRONMAN is registered with ClinicalTrials.gov, NCT02642562. FINDINGS Between Aug 25, 2016, and Oct 15, 2021, 1869 patients were screened for eligibility, of whom 1137 were randomly assigned to receive intravenous ferric derisomaltose (n=569) or usual care (n=568). Median follow-up was 2·7 years (IQR 1·8-3·6). 336 primary endpoints (22·4 per 100 patient-years) occurred in the ferric derisomaltose group and 411 (27·5 per 100 patient-years) occurred in the usual care group (rate ratio [RR] 0·82 [95% CI 0·66 to 1·02]; p=0·070). In the COVID-19 analysis, 210 primary endpoints (22·3 per 100 patient-years) occurred in the ferric derisomaltose group compared with 280 (29·3 per 100 patient-years) in the usual care group (RR 0·76 [95% CI 0·58 to 1·00]; p=0·047). No between-group differences in deaths or hospitalisations due to infections were observed. Fewer patients in the ferric derisomaltose group had cardiac serious adverse events (200 [36%]) than in the usual care group (243 [43%]; difference -7·00% [95% CI -12·69 to -1·32]; p=0·016). INTERPRETATION For a broad range of patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric derisomaltose administration was associated with a lower risk of hospital admissions for heart failure and cardiovascular death, further supporting the benefit of iron repletion in this population. FUNDING British Heart Foundation and Pharmacosmos.
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Affiliation(s)
- Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK; College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | - Philip A Kalra
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Fozia Z Ahmed
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Abdallah Al-Mohammad
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Peter J Cowburn
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul W X Foley
- Wiltshire Cardiac Centre, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Fraser J Graham
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Alan G Japp
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rebecca E Lane
- Department of Cardiology, Royal Brompton and Harefield Hospitals, London, UK
| | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew J Ludman
- Department of Cardiology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Robin Ray
- Cardiology Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Michele Robertson
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Alison Seed
- Department of Cardiology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
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Juginović A. Intravenous iron therapy alleviates symptoms of sleep-related movement disorders in children with minimal side effects. J Clin Sleep Med 2022; 18:2525-2526. [PMID: 36073847 PMCID: PMC9622980 DOI: 10.5664/jcsm.10292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Alen Juginović
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts
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Bakosova M, Krejci J, Godava J, Ozabalova E, Poloczkova H, Honek T, Hude P, Machal J, Bedanova H, Nemec P, Spinarova L. Iron Deficiency in Patients with Advanced Heart Failure. Medicina (Kaunas) 2022; 58:1569. [PMID: 36363528 PMCID: PMC9697608 DOI: 10.3390/medicina58111569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Background and Objectives: Iron deficiency (ID) is a common comorbidity in patients with heart failure. It is associated with reduced physical performance, frequent hospitalisations for heart failure decompensation, and high cardiovascular and overall mortality. The aim was to determine the prevalence of ID in patients with advanced heart failure on the waiting list for heart transplantation. Methods and Materials: We included 52 patients placed on the waiting list for heart transplantation in 2021 at our centre. The cohort included seven patients with LVAD (left ventricle assist device) as a bridge to transplantation implanted before the time of results collection. In addition to standard tests, the parameters of iron metabolism were monitored. ID was defined as a ferritin value <100 µg/L, or 100−299 µg/L if transferrin saturation (T-sat) is <20%. Results: ID was present in 79% of all subjects, but only in 35% of these patients anaemia was expressed. In the group without LVAD, ID was present in 82%, a median (lower−upper quartile) of ferritin level was 95.4 (62.2−152.1) µg/mL and mean T-sat was 0.18 ± 0.09. In LVAD group, ID was present in 57%, ferritin level was 268 (106−368) µg/mL and mean T-sat was 0.14 ± 0.04. Haemoglobin concentration was the same in patients with or without ID (133 ± 16) vs. (133 ± 23). ID was not associated with anaemia defined with regard to patient’s gender. In 40.5% of cases, iron deficiency was accompanied by chronic renal insufficiency, compared to 12.5% of the patients without ID. In the patients with LVAD, ID was present in four out of seven patients, but the group was too small for reliable statistical testing due to low statistical power. Conclusions: ID was present in the majority of patients with advanced heart failure and was not always accompanied by anaemia and renal insufficiency. Research on optimal markers for the diagnosis of iron deficiency, especially for specific groups of patients with heart failure, is still ongoing.
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Affiliation(s)
- Maria Bakosova
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic
| | - Jan Krejci
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic
| | - Julius Godava
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
| | - Eva Ozabalova
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
| | - Hana Poloczkova
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic
| | - Tomas Honek
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
| | - Peter Hude
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
| | - Jan Machal
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic
- International Clinical Research Center, St Anne's University Hospital, 60200 Brno, Czech Republic
| | - Helena Bedanova
- Center for Cardiovascular and Transplant Surgery, 65691 Brno, Czech Republic
| | - Petr Nemec
- Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic
- Center for Cardiovascular and Transplant Surgery, 65691 Brno, Czech Republic
| | - Lenka Spinarova
- 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital, 60200 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic
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44
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Chandra J, Dewan P, Kumar P, Mahajan A, Singh P, Dhingra B, Radhakrishnan N, Sharma R, Manglani M, Rawat AK, Gupta P, Gomber S, Bhat S, Gaikwad P, Elizabeth KE, Bansal D, Dubey AP, Shah N, Kini P, Trehan A, Datta K, Basavraja GV, Saxena V, Kumar RR. Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric Hematology-Oncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics. Indian Pediatr 2022; 59:782-801. [PMID: 36263494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
JUSTIFICATION Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. OBJECTIVE To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. PROCESS These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. RECOMMENDATIONS We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.
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Affiliation(s)
- Jagdish Chandra
- Department of Pediatrics, PGIMSR and ESIC Model Hospital, Basaidarapur, New Delhi. Correspondence to: Dr Jagdish Chandra, Professor of Pediatrics, PGIMSR and ESIC Model Hospital, Basaidarapur, New Delhi.
| | - Pooja Dewan
- Department of Pediatrics, UCMS and GTB Hospital, Delhi
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi
| | - Amita Mahajan
- Department of Pediatrics, Department of Pediatric Hematology and Oncology, Indraprastha Apollo Hospital, Delhi
| | - Preeti Singh
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi
| | | | - Nita Radhakrishnan
- Department of Pediatrics, Pediatric Hematology Oncology, Post Graduate Institute of Child Health. NOIDA, Uttar Pradesh
| | - Ratna Sharma
- Department of Pediatrics, MCGM- Comprehensive Thalassemia Care, Pediatric Hematology-Oncology and BMT Centre, Mumbai, Maharashtra
| | - Mamta Manglani
- Department of Pediatrics, MCGM- Comprehensive Thalassemia Care, Pediatric Hematology-Oncology and BMT Centre, Mumbai, Maharashtra
| | - Ashok Kumar Rawat
- Department of Pediatrics, PAN Society, Indian Academy of Pediatrics (IAP)
| | - Piyush Gupta
- Department of Pediatrics, UCMS and GTB Hospital, Delhi
| | - Sunil Gomber
- Department of Pediatrics, UCMS and GTB Hospital, Delhi
| | - Sunil Bhat
- Department of Pediatrics, UCMS and GTB Hospital, Delhi
| | - Parag Gaikwad
- Department of Pediatrics, National Secretary - Nutrition Chapter of IAP
| | - K E Elizabeth
- Department of Pediatrics, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari, Tamilnadu
| | - Deepak Bansal
- Department of Pediatrics, Hematology-Oncology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Anand Prakash Dubey
- Department of Pediatrics, PGIMSR and ESIC Model Hospital, Basaidarapur, New Delhi
| | - Nitin Shah
- Department of Pediatrics, BJ Wadia Hospital for Children, Mumbai and PD Hinduja Hospital, Mumbai
| | - Pranoti Kini
- MCGM- Comprehensive Thalassemia Care, Pediatric Hematology-Oncology and BMT Centre, Mumbai, Maharashtra
| | - Amita Trehan
- Hematology-Oncology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Kalpana Datta
- Department of Pediatrics Medical College, Kolkata, West Bengal
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Abstract
Growing evidence indicates that a suboptimal intrauterine environment confers risk for schizophrenia. The developmental model of schizophrenia posits that aberrant brain growth during early brain development and adolescence may interact to contribute to this psychiatric disease in adulthood. Although a variety of factors may perturb the environment of the developing fetus and predispose for schizophrenia later, a common mechanism has yet to be elucidated. Micronutrient deficiencies during the perinatal period are known to induce potent effects on brain development by altering neurodevelopmental processes. Iron is an important candidate nutrient to consider because of its role in energy metabolism, monoamine synthesis, synaptogenesis, myelination, and the high prevalence of iron deficiency (ID) in the mother-infant dyad. Understanding the current state of science regarding perinatal ID as an early risk factor for schizophrenia is imperative to inform empirical work investigating the etiology of schizophrenia and develop prevention and intervention programs. In this narrative review, we focus on perinatal ID as a common mechanism underlying the fetal programming of schizophrenia. First, we review the neural aberrations associated with perinatal ID that indicate risk for schizophrenia in adulthood, including disruptions in dopaminergic neurotransmission, hippocampal-dependent learning and memory, and sensorimotor gating. Second, we review the pathophysiology of perinatal ID as a function of maternal ID during pregnancy and use epidemiological and cohort studies to link perinatal ID with risk of schizophrenia. Finally, we review potential confounding phenotypes, including nonanemic causes of perinatal brain ID and future risk of schizophrenia.
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Affiliation(s)
- Andrea M. Maxwell
- Medical Scientist Training Program, University of Minnesota, Minneapolis, MN 55455 (USA)
| | - Raghavendra B. Rao
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN 55455 (USA)
- Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN 55455 (USA)
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46
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McWilliams S, Singh I, Leung W, Stockler S, Ipsiroglu OS. Iron deficiency and common neurodevelopmental disorders—A scoping review. PLoS One 2022; 17:e0273819. [PMID: 36173945 PMCID: PMC9522276 DOI: 10.1371/journal.pone.0273819] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background A wealth of human and experimental studies document a causal and aggravating role of iron deficiency in neurodevelopmental disorders. While pre-, peri-, and early postnatal iron deficiency sets the stage for the risk of developing neurodevelopmental disorders, iron deficiency acquired at later ages aggravates pre-existing neurodevelopmental disorders. Yet, the association of iron deficiency and neurodevelopmental disorders in childhood and adolescence has not yet been explored comprehensively. In this scoping review, we investigate 1) the association of iron deficiency in children and adolescents with the most frequent neurodevelopmental disorders, ADHD, ASD, and FASD, and 2) whether iron supplementation improves outcomes in these disorders. Method Scoping review of studies published between 1994 and 2021 using “iron deficiency / iron deficiency anemia” AND “ADHD” OR “autism” OR “FASD” in four biomedical databases. The main inclusion criterion was that articles needed to have quantitative determination of iron status at any postnatal age with primary iron markers such as serum ferritin being reported in association with ADHD, ASD, or FASD. Results For ADHD, 22/30 studies and 4/4 systematic reviews showed an association of ADHD occurrence or severity with iron deficiency; 6/6 treatment studies including 2 randomized controlled trials demonstrated positive effects of iron supplementation. For ASD, 3/6 studies showed an association with iron deficiency, while 3/6 and 1/1 systematic literature review did not; 4 studies showed a variety of prevalence rates of iron deficiency in ASD populations; 1 randomized controlled trial found no positive effect of iron supplementation on behavioural symptoms of ASD. For FASD, 2/2 studies showed an association of iron deficiency with growth retardation in infants and children with prenatal alcohol exposure. Conclusion Evidence in favor of screening for iron deficiency and using iron supplementation for pediatric neurodevelopmental disorders comes primarily from ADHD studies and needs to be further investigated for ASD and FASD. Further analysis of study methodologies employed and populations investigated is needed to compare studies against each other and further substantiate the evidence created.
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Affiliation(s)
- Scout McWilliams
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Ishmeet Singh
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Wayne Leung
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Sylvia Stockler
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Division of Biochemical Diseases, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Osman S. Ipsiroglu
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Divisions of Child & Adolescent Psychiatry, Developmental Pediatrics and Respirology, Department of Pediatrics, Sleep/Wake-Behaviour Clinic at Sleep Program, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
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47
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Mi HC, Cui F, DU YT, Wang RT, Zhang R, Shi M. [Research progress on the regulation mechanisms of iron metabolism in anemia of chronic disease]. Sheng Li Xue Bao 2022; 74:639-647. [PMID: 35993215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Anemia of chronic disease (ACD), complicated by various chronic inflammatory diseases, is the second most prevalent type of anemia after iron deficiency anemia in the world. ACD significantly reduces the life quality of patients with chronic diseases, and represents an independent poor prognostic factor in certain chronic diseases. A large body of studies has demonstrated that most of anemia is related to abnormal iron metabolism. In the past decade, hepcidin, as a key factor in regulating iron metabolism, has attracted enormous attention due to its important role in the pathogenesis of ACD. This article reviews the research progress on the role and underlying regulatory mechanisms of hepcidin in ACD. We also discuss the potential of hepcidin as an effective therapeutic target for ACD treatment, in order to provide a new maneuver for improving the quality of ACD patients' life.
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Affiliation(s)
- Hai-Chao Mi
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Fang Cui
- Department of Electron Microscopy Laboratory Centre, Hebei Medical University, Shijiazhuang 050017, China
| | - Yu-Tao DU
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Ruo-Tong Wang
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Rui Zhang
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Min Shi
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
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48
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Malesza IJ, Bartkowiak-Wieczorek J, Winkler-Galicki J, Nowicka A, Dzięciołowska D, Błaszczyk M, Gajniak P, Słowińska K, Niepolski L, Walkowiak J, Mądry E. The Dark Side of Iron: The Relationship between Iron, Inflammation and Gut Microbiota in Selected Diseases Associated with Iron Deficiency Anaemia—A Narrative Review. Nutrients 2022; 14:nu14173478. [PMID: 36079734 PMCID: PMC9458173 DOI: 10.3390/nu14173478] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 12/21/2022] Open
Abstract
Iron is an indispensable nutrient for life. A lack of it leads to iron deficiency anaemia (IDA), which currently affects about 1.2 billion people worldwide. The primary means of IDA treatment is oral or parenteral iron supplementation. This can be burdened with numerous side effects such as oxidative stress, systemic and local-intestinal inflammation, dysbiosis, carcinogenic processes and gastrointestinal adverse events. Therefore, this review aimed to provide insight into the physiological mechanisms of iron management and investigate the state of knowledge of the relationship between iron supplementation, inflammatory status and changes in gut microbiota milieu in diseases typically complicated with IDA and considered as having an inflammatory background such as in inflammatory bowel disease, colorectal cancer or obesity. Understanding the precise mechanisms critical to iron metabolism and the awareness of serious adverse effects associated with iron supplementation may lead to the provision of better IDA treatment. Well-planned research, specific to each patient category and disease, is needed to find measures and methods to optimise iron treatment and reduce adverse effects.
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Affiliation(s)
- Ida J. Malesza
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | | | - Jakub Winkler-Galicki
- Department of Physiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Aleksandra Nowicka
- Department of Physiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | | | - Marta Błaszczyk
- Department of Physiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Paulina Gajniak
- Department of Physiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Karolina Słowińska
- Department of Physiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Leszek Niepolski
- Department of Physiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Edyta Mądry
- Department of Physiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Correspondence:
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49
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Mart G, Malkan UY, Buyukasik Y. Determination of etiology in patients admitted due to isolated leukopenia. Medicine (Baltimore) 2022; 101:e30116. [PMID: 35984149 PMCID: PMC9387957 DOI: 10.1097/md.0000000000030116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Patients with isolated leukopenia pose difficulties in diagnosis because there is no related guideline in the literature. In this study, our aim was to evaluate the clinical and laboratory associations of isolated, nonspecific (not related to neutropenia) leukopenia. In this retrospective data review study, patients who were admitted to Hacettepe University Hematology Outpatient Clinic between 2014 and 2019 due to leukopenia were evaluated. The patients with anemia (other than iron deficiency) or thrombocytopenia were excluded. Clinical and laboratory data and the final diagnoses (if present) of the remaining cases and especially of those without neutropenia (the most difficult group to diagnose) were evaluated. One hundred sixty-nine patients were included in the study. One hundred forty-four (85.2%) patients were female and 25 (14.8%) were male. One hundred ten of them had 1500/µL or higher neutrophil count. In these nonneutropenic cases, the etiological factors contributing to leukopenia were as follows: iron deficiency anemia (21.8%), other autoimmune/autoinflammatory diseases (17.3%), autoimmune thyroid disease (21.8%), autoimmune laboratory tests (2.7%), drugs (12.7%), infection (5.5%), hematopoietic disorder (2.7%), hypersplenism (2.7%), radiotherapy sequel (1.8%), and B12 deficiency (1.8%). No etiology was recognized in 44 patients. On the other hand, the etiological factors in patients with neutrophil count <1500/µL were as follows; iron deficiency anemia (10.2%), other autoimmune/autoinflammatory diseases (17%), autoimmune thyroid disease (5.1%), autoimmune laboratory tests (8.5%), drugs (8.5%), infection (6.8%), hematopoietic disorder (11.9%), hypersplenism (1.7%), radiotherapy sequel (1.7%), and B12 deficiency (1.7%). No etiology was recognized in 25 patients. Physicians ordered bone marrow examination more frequently in patients with neutropenia. If isolated antinuclear antibody positivity was also considered in favor of autoimmunity, 91/169 (53.8%) cases had an autoimmune diagnosis or laboratory finding. In the present study, the most frequent reasons of isolated leukopenia in nonneutropenic patients are found as iron deficiency anemia, other autoimmune/autoinflammatory diseases, and autoimmune thyroid disease. In neutropenic patients, the most frequent reasons of isolated leukopenia are found as iron deficiency anemia, autoimmune/autoinflammatory diseases, and hematopoietic disorders. Therefore, autoimmunity is detected as an important factor leading to isolated leukopenia.
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Affiliation(s)
- Gulay Mart
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Umit Y. Malkan
- Faculty of Medicine, Department of Hematology, Hacettepe University, Ankara, Turkey
- *Correspondence: Umit Y. Malkan, Faculty of Medicine, Department of Hematology, Hacettepe University, Sihhiye 06100, Ankara, Turkey (e-mail: )
| | - Yahya Buyukasik
- Faculty of Medicine, Department of Hematology, Hacettepe University, Ankara, Turkey
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50
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Lambrecht NJ, Bridges D, Wilson ML, Adu B, Eisenberg JNS, Folson G, Baylin A, Jones AD. Associations of bacterial enteropathogens with systemic inflammation, iron deficiency, and anemia in preschool-age children in southern Ghana. PLoS One 2022; 17:e0271099. [PMID: 35802561 PMCID: PMC9269377 DOI: 10.1371/journal.pone.0271099] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Anemia remains a pervasive public health problem among preschool-age children in Ghana. Recent analyses have found that anemia in Ghanaian children, particularly in Southern regions, is largely attributable to infectious causes, rather than nutritional factors. Infections with enteropathogens can reduce iron absorption and increase systemic inflammation, but few studies have examined direct links between enteropathogens and anemia. This study investigated associations between detection of individual bacterial enteropathogens and systemic inflammation, iron deficiency, and anemia among 6- to 59-month-old children in Greater Accra, Ghana. Serum samples were analyzed from a cross-sectional sample of 262 children for concentrations of hemoglobin (Hb), biomarkers of systemic inflammation [C-reactive protein (CRP) and α-1-acid glycoprotein (AGP)], and biomarkers of iron status [serum ferritin (SF) and serum transferrin receptor (sTfR)]. Stool samples were analyzed for ten bacterial enteropathogens using qPCR. We estimated associations between presence of each enteropathogen and elevated systemic inflammation (CRP > 5 mg/L and AGP > 1 g/L), iron deficiency (SF < 12 μg/L and sTfR > 8.3 mg/L) and anemia (Hb < 110 g/L). Enteropathogens were detected in 87% of children’s stool despite a low prevalence of diarrhea (6.5%). Almost half (46%) of children had anemia while one-quarter (24%) had iron deficiency (low SF). Despite finding no associations with illness symptoms, Campylobacter jejuni/coli detection was strongly associated with elevated CRP [Odds Ratio (95% CI): 3.49 (1.45, 8.41)] and elevated AGP [4.27 (1.85, 9.84)]. Of the pathogens examined, only enteroinvasive Escherichia coli/Shigella spp. (EIEC/Shigella) was associated with iron deficiency, and enteroaggregative Escherichia coli (EAEC) [1.69 (1.01, 2.84)] and EIEC/Shigella [2.34 (1.15, 4.76)] were associated with anemia. These results suggest that certain enteroinvasive pathogenic bacteria may contribute to child anemia. Reducing exposure to enteropathogens through improved water, sanitation, and hygiene practices may help reduce the burden of anemia in young Ghanaian children.
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Affiliation(s)
- Nathalie J. Lambrecht
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute of Public Health, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- * E-mail:
| | - Dave Bridges
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Mark L. Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Bright Adu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Joseph N. S. Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gloria Folson
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
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