RESUMEN
Objective: To investigate the clinical efficacy and safety of ferric derisomaltose injection versus iron sucrose injection in the treatment of iron deficiency anemia (IDA) . Methods: A total of 120 patients with iron deficiency anemia admitted from June 2021 to March 2023 were given intravenous iron supplementation with ferric derisomaltose to assess the efficacy and safety of hemoglobin (HGB) elevation before and after treatment. Simultaneously, the clinical effects of iron supplementation with iron sucrose were compared to those of inpatient patients during the same period. Results: Baseline values were comparable in both groups. Within 12 weeks of treatment, the elevated HGB level in the ferric derisomaltose group was higher than that of the iron sucrose group, with a statistical difference at all time points, and the proportion of HGB increased over 20 g/L in the patients treated for 4 weeks was higher (98.7%, 75.9% ). During the treatment with ferric derisomaltose and iron sucrose, the proportion of mild adverse reactions in the ferric derisomaltose group was slightly lower than that of the iron sucrose group, and neither group experienced any serious adverse reactions. The patients responded well to the infusion treatment, with no reports of pain or pigmentation at the injection site. Conclusion: The treatment of IDA patients with ferric derisomaltose has a satisfactory curative effect, with the advantages of rapidity, accuracy, and safety. Therefore, it is worthy of widespread clinical use.
Asunto(s)
Anemia Ferropénica , Disacáridos , Humanos , Sacarato de Óxido Férrico/uso terapéutico , Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/inducido químicamente , Infusiones Intravenosas , Estudios Retrospectivos , Compuestos Férricos/uso terapéutico , Compuestos Férricos/efectos adversos , Hierro , Hemoglobinas/análisis , Hemoglobinas/uso terapéuticoRESUMEN
Anemia remains an essential concern affecting the quality of life and the survival of cancer patients. Although there are different approaches to treating anemia in cancer patients, the number of studies reporting the efficacy of iron replacement in cancer patients is limited. In this study, the efficacy and safety of iron carboxymaltose, a parenteral iron treatment option, in the treatment of anemia, were examined retrospectively. A total of 1102 adult patients who received IV ferric carboxymaltose treatment at Hacettepe Oncology Hospital between 2014 and 2020 were included. The mean hemoglobin change observed at the end of the 12th week was 1.8 g/dL, and the rate of patients with an increase in hemoglobin of 1 g/dL or more was 72.1%. It was observed that the treatment demonstrated effectiveness in patients receiving active cancer treatment in all tumor types. The treatment was generally safe, and no grade 3-5 side effects were observed in the patients included in the study. According to one of the most extensive series published in the literature, iron carboxymaltose is an efficient and safe alternative for cancer patients with iron-deficiency anemia.
Asunto(s)
Anemia Ferropénica , Anemia , Neoplasias , Adulto , Humanos , Anemia Ferropénica/etiología , Anemia Ferropénica/inducido químicamente , Estudios Retrospectivos , Calidad de Vida , Compuestos Férricos/uso terapéutico , Hierro/uso terapéutico , Hemoglobinas/uso terapéutico , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológicoRESUMEN
AIM: Various research was conducted during the last decade, with inconsistent findings regarding iron death anaemia (IDA) perils vis-à-vis utilization of proton-pump inhibitors (PPIs). Consequently, recent systematic review and meta-analysis were implemented to evaluate IDA-related perils concerning the utilization of proton-pump inhibitors. METHODS: The databases of EBSCOhost, PubMed® and Cochrane Central were searched from the research outset until February 28, 2021 purposely to identify all research with objectives that align with the present research investigation. The Newcastle-Ottawa Scale (NOS) was utilized for the evaluation of the research investigation standard. The prime (1º) goal of the research was to gauge IDA peril among users of proton-pump inhibitors (PPI). For data processing, RevMan (Review Manager) version 5.4 was employed. RESULTS: In total, fourteen investigations research was employed in this systematic review and metaanalysis. The combined relative risk of nine research exhibited a numerically consequential interrelation betwixt the utilization of proton-pump inhibitors and IDA peril (RR 2.56 [95% CI 1.43-4.61], p < 0.00001). Contemporary systematic review and meta-analysis examination posit that proton-pump inhibitor consumers are prone to greater peril of coming down with IDA in comparison to non-PPI users. CONCLUSION: In keeping with the findings of my research, prescriber physicians should exercise caution when prescribing PPIs to individuals taking it for a long time to avoid the peril of IDA. Additionally, their serum iron level should be checked to ensure that proton-pump inhibitors are safe.
Asunto(s)
Anemia Ferropénica , Inhibidores de la Bomba de Protones , Humanos , Anemia Ferropénica/inducido químicamente , Anemia Ferropénica/epidemiología , Inhibidores de la Bomba de Protones/efectos adversos , RiesgoRESUMEN
Iron deficiency is a common but underestimated condition in the population. Its correlate is far from only sideropenic anemia, but is due to the variety of involvement of this element in a number of bio-chemical reactions; several other possible clinical manifestations can be expected. Appropriately selected oral supplementation is often necessary. Here, we should carefully consider the possible ratio of expected benefits and potential risks of side effects, or interaction with dietary components or concomitant medications. The available preparations are not equivalent; they differ not only in atomically different amounts of iron but also, above all, in the form that determines the way in which the iron will be absorbed. This ultimately defines the rate of adjustment for depletion and the tolerability of a particular product.
Asunto(s)
Anemia Ferropénica , Deficiencias de Hierro , Anemia Ferropénica/inducido químicamente , Anemia Ferropénica/tratamiento farmacológico , Hemo/uso terapéutico , Humanos , Hierro/efectos adversosRESUMEN
Randomized control trials (RCTs) have shown that certain intravenous iron preparations can induce high levels of fibroblast growth factor 23 (FGF-23) and persistent hypophosphatemia. Repeated iron infusions may lead to prolonged hypophosphatemia and osteomalacia events not captured by RCTs. Several previous case reports have described skeletal adverse effects after repeated iron infusions. To characterize these effects, we conducted a systematic review of case reports. MEDLINE, Embase, Web of Science, and Cochrane databases were searched in March 2021. We selected case reports of patients ≥16 years old. Study quality was assessed using the tool from Murad and colleagues. We report the results in a narrative summary. We identified 28 case reports, reporting 30 cases. Ages ranged from 28 to 80 years (median 50 years). Most patients (n = 18) received ferric carboxymaltose (FCM), whereas 8 received saccharated ferric oxide (SFO) and 3 received iron polymaltose (IPM). All but 2 cases had more than five infusions (range 2 to 198, median 17). The lowest phosphate levels ranged from 0.16 to 0.77 mmol/L (median 0.36 mmol/L). Intact FGF-23 (iFGF-23) was high when measured. Serum 25OH vitamin D was low in 10 of 21 cases measured and 1,25(OH)2 vitamin D in 12 of 18. Alkaline phosphatase was high in 18 of 22 cases. Bone or muscle pain was reported in 28 of the 30 cases. Twenty patients had pseudofractures, 9 had fractures, and 6 patients had both. All 15 available bone scans showed focal isotope uptake. Case reports tend to report severe cases, so potential reporting bias should be considered. Osteomalacia is a potential complication of repeated iron infusion, especially in patients with gastrointestinal disorders receiving prolonged therapy. Pain and fractures or pseudofractures are common clinical findings, associated with low phosphate, high iFGF-23, high alkaline phosphatase, and abnormal isotope bone scan. Discontinuing or switching the iron formulation was an effective intervention in most cases. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Asunto(s)
Anemia Ferropénica , Raquitismo Hipofosfatémico Familiar , Hipofosfatemia , Osteomalacia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fosfatasa Alcalina/uso terapéutico , Anemia Ferropénica/inducido químicamente , Anemia Ferropénica/complicaciones , Anemia Ferropénica/tratamiento farmacológico , Raquitismo Hipofosfatémico Familiar/complicaciones , Compuestos Férricos/efectos adversos , Factores de Crecimiento de Fibroblastos/uso terapéutico , Humanos , Hipofosfatemia/inducido químicamente , Hierro/efectos adversos , Persona de Mediana Edad , Minerales , Osteomalacia/inducido químicamente , Fosfatos , Vitamina D/uso terapéuticoRESUMEN
OBJECTIVES: To study the efficacy of intermittent iron supplementation in children with mild iron-deficiency anemia. METHODS: A total of 147 children with mild iron-deficiency anemia were enrolled in this prospective study. They were divided into an intermittent iron supplementation group (n=83) and a conventional iron supplementation group (n=64). The levels of hemoglobin were measured before treatment and after 1 and 3 months of treatment. The treat response rate and the incidence rate of adverse drug reactions were compared between the two groups. RESULTS: Both groups had a significant increase in the level of hemoglobin after iron supplementation (P<0.05). After 1 month of treatment, the conventional iron supplementation group had a significantly higher treatment response rate than the intermittent iron supplementation group (61% vs 42%, P<0.05). After 3 months of treatment, there was no significant difference in the treatment response between the two groups (86% vs 78%, P>0.05). The incidence rate of adverse drug reactions in the conventional iron supplementation group was significantly higher than that in the intermittent iron supplementation group (25% vs 8%, P<0.05). CONCLUSIONS: For children with mild iron-deficiency anemia, although intermittent iron supplementation is inferior to conventional iron supplementation in the short-term efficacy, there is no significant difference in the long-term efficacy between the two methods, and compared with conventional iron supplementation, intermittent iron supplementation can reduce the incidence of adverse drug reactions, alleviate family financial burdens, and improve treatment compliance of children, thus holding promise for clinical application.
Asunto(s)
Anemia Ferropénica , Anemia Ferropénica/inducido químicamente , Anemia Ferropénica/tratamiento farmacológico , Anemia Ferropénica/epidemiología , Niño , Suplementos Dietéticos/efectos adversos , Hemoglobinas/análisis , Humanos , Hierro de la Dieta/efectos adversos , Estudios ProspectivosRESUMEN
Iron deficiency anaemia is a common disorder in the paediatric age-group. The association between iron deficiency and venous thrombosis in children without an underlying illness is rare. Two cases are described. A 17-year-old girl had been taking oestrogen-progestogen therapy for contraception for about 2 years and developed a lower-limb deep vein thrombosis associated with pulmonary embolism. A 3-year-old girl was admitted to the paediatric emergency department with pallor, weakness and vomiting, and a cerebral CT showed a recent cerebral venous thrombosis. Both cases had severe iron-deficiency anaemia which increases a thrombotic tendency and could be a further crucial trigger of venous thrombosis in patients at low risk; therefore, in cases of unexplained thrombosis, it must always be considered to be a risk factor.Abbreviations APCR: activated protein C resistance; CMV: cytomegalovirus; CT: computerised tomography; CVST: cerebral venous sinus thrombosis; CVT: cerebral venous thrombosis; DVT: deep vein thrombosis; DOACs: direct oral anticoagulants; EBV: Epstein-Barr virus; ID: iron deficiency; IDA: iron deficiency anaemia; LMWH: low molecular weight heparin; PE: pulmonary embolism; RDW: red blood cell distribution width; VT: venous thrombosis.
Asunto(s)
Anemia Ferropénica , Infecciones por Virus de Epstein-Barr , Trombosis Intracraneal , Embolia Pulmonar , Trombosis de la Vena , Adolescente , Anemia Ferropénica/inducido químicamente , Anemia Ferropénica/complicaciones , Anticoagulantes/uso terapéutico , Niño , Preescolar , Infecciones por Virus de Epstein-Barr/complicaciones , Femenino , Heparina de Bajo-Peso-Molecular/efectos adversos , Herpesvirus Humano 4 , Humanos , Trombosis Intracraneal/inducido químicamente , Trombosis Intracraneal/complicaciones , Embolia Pulmonar/inducido químicamente , Embolia Pulmonar/complicaciones , Factores de Riesgo , Trombosis de la Vena/complicaciones , Trombosis de la Vena/terapiaRESUMEN
BACKGROUND: The iron-chelating activities of polyphenols raise concern whether there is a risk of iron deficiency or anemia induced by polyphenol supplementation. Results from clinical trials regarding the effects of polyphenol supplementation on iron status and erythropoiesis are inconclusive. OBJECTIVE: We performed a systematic review and meta-analysis of randomized controlled trials to determine the effects of polyphenol supplementation on iron status and erythropoiesis. METHODS: Published articles were searched between May 1988 and 7 December, 2020. Finally, we identified 34 randomized controlled trials. Random-effects meta-analyses were performed to obtain the weighted mean difference of serum iron (SI), transferrin saturation (TS), ferritin, and hemoglobin concentration. Funnel plots and Egger's test were used to determine the risk of bias. The robustness of the effect sizes was examined by sensitivity analysis. RESULTS: Polyphenol supplementation had an inhibitory effect on the SI concentration (-13.72 µg/dL; 95% CI: -20.74, -6.71) and TS (-3.10%; 95% CI: -4.93, -1.27), with no effect on ferritin (-9.34 ng/mL; 95% CI: -28.55, 9.87). Polyphenols increased the hemoglobin concentration (8.53 g/L; 95% CI: 3.33, 13.73). In healthy participants, polyphenol reduced the TS (-3.83%; 95% CI: -7.47, -0.19) and increased the hemoglobin concentration (12.87 g/L; 95% CI: 1.61, 24.14). Similarly, polyphenol reduced the SI concentration (-8.60 µg/dL; 95% CI: -16.10, -1.10) and increased the hemoglobin concentration (8.50 g/L; 95% CI: 0.86, 16.15) in patients with metabolic diseases. In patients with ß-thalassemia, polyphenol decreased the SI concentration (-23.19 µg/dL; 95% CI: -35.84, -10.55), TS (-3.23%; 95% CI: -5.54, -0.91), and ferritin concentration (-223.62 ng/mL; 95% CI: -359.32, -87.91), but had no effect on the hemoglobin concentration. CONCLUSION: Healthy individuals and patients with metabolic diseases may benefit from the positive impact of polyphenols on erythropoiesis. Patients with ß-thalassemia may benefit from the effect of polyphenols on reducing SI. This trial was registered at PROSPERO (International prospective register of systematic reviews) as CRD42020161983.
Asunto(s)
Anemia Ferropénica/inducido químicamente , Eritropoyesis/efectos de los fármacos , Quelantes del Hierro/administración & dosificación , Hierro/metabolismo , Polifenoles/administración & dosificación , Suplementos Dietéticos , Humanos , Quelantes del Hierro/efectos adversos , Polifenoles/efectos adversosRESUMEN
Cadmium (Cd) is an environmental contaminant that triggers toxic effects in various tissues such as the kidney, liver, and lung. Cd can also cause abnormal iron metabolism, leading to anemia. Iron homeostasis is regulated by intestinal absorption. However, whether Cd affects the iron absorption pathway is unclear. We aimed to elucidate the relationship between the intestinal iron transporter system and Cd-induced iron deficiency anemia. C57BL/6J female and male mice, 129/Sv female mice, and DBA/2 female mice were given a single oral dose of CdCl2 by gavage. After 3 or 24 h, Cd decreased serum iron concentrations and inhibited the expression of iron transport-related genes in the duodenum. In particular, Cd decreased the levels of divalent metal transporter 1 and ferroportin 1 in the duodenum. In addition, human colon carcinoma Caco-2 cells were treated with CdCl2. After 72 h, Cd decreased the expression of iron transport-related factors in Caco-2 cells with a pattern similar to that seen in the murine duodenum. These findings suggest that Cd inhibits iron absorption through direct suppression of iron transport in duodenal enterocytes and contributes to abnormal iron metabolism.
Asunto(s)
Anemia Ferropénica/inducido químicamente , Cadmio/toxicidad , Duodeno/efectos de los fármacos , Duodeno/metabolismo , Hierro/metabolismo , Animales , Transporte Biológico Activo/efectos de los fármacos , Células CACO-2 , Cadmio/farmacocinética , Cloruro de Cadmio/toxicidad , Proteínas de Transporte de Catión/metabolismo , Femenino , Humanos , Hígado/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Endogámicos DBARESUMEN
Iron supplementation is ubiquitously prescribed and considered a benign means of therapy. However, side effects such as iron pill gastritis can be life threatening prompting discontinuation. We describe a case of a 71-year-old man who presents with severe iron deficiency anemia on oral iron therapy. Esophagogastroduodenoscopy revealed mucosal injury in the fundus, including erythema and ulceration. Biopsy of the area was significant for pill debris. After switching to intravenous iron supplementation, his gastric mucosa healed and anemia improved. This case demonstrates the rare life-threatening side effect of iron pills causing corrosive mucosal damage and significant anemia from gastrointestinal bleeding.
Asunto(s)
Anemia Ferropénica , Gastritis , Anciano , Anemia Ferropénica/inducido químicamente , Anemia Ferropénica/tratamiento farmacológico , Mucosa Gástrica , Gastritis/inducido químicamente , Hemorragia Gastrointestinal/inducido químicamente , Humanos , Hierro , MasculinoRESUMEN
Maternal anesthetic exposure during pregnancy is associated with an increased risk of cognitive impairment in offspring. The balance of cerebral iron metabolism is essential for the development of brain tissue. Iron deficiency affects the myelinogenesis and nerve tissue development, especially in fetus or infant, which has a key role in cognitive function. We aimed to investigate whether maternal sevoflurane (Sev) exposure caused cognitive impairment in offspring through inducing iron deficiency and inhibiting myelinogenesis. Pregnant mice (gestation stage day 14) were treated with 2% Sev for 6 h. Cognitive function of offspring mice was determined by the Morris water maze and Context fear conditioning test. Iron levels were assayed by Perl's iron staining and synchrotron imaging. Hippocampus and cortex tissues or cerebral microvascular endothelial cells of offspring mice (postnatal day 35) were harvested and subjected to Western blot and/or immunhistochemistry to assess ferritin, transferrin receptor 1(TfR1), Ferroportin-1 (FpN1), myelin basic protein (MBP), tight junction protein ZO-1, occludin, and claudin-5 levels. Beginning with postnatal day 30, the offspring were treated with iron therapy for 30 days, and the indicators above were tested. Our results showed Sev dramatically decreased the iron levels of brain and impaired cognitive function in offspring mice. Sev decreased the expression of heavy chain ferritin (FtH), light chain ferritin (FtL), MBP, ZO-1, occludin, claudin-5, and FpN1, and increased TfR1 in hippocampus and cortex or cerebral microvascular endothelial cells of offspring mice, indicating that Sev caused the iron deficiency and impaired the myelinogenesis in the brain of offspring. Interestingly, iron therapy prompted the myelinogenesis and improved impaired cognitive function at postnatal day 60. Our research uncovered a new mechanism which showed that iron deficiency induced by Sev and myelin formation disorder due to decreased iron of brain may be an important risk factor for cognitive impairment in offspring. It was necessary for offspring to be supplied iron supplement whose mother suffered exposure to sevoflurane during pregnancy.
Asunto(s)
Anemia Ferropénica/inducido químicamente , Anestésicos por Inhalación/toxicidad , Disfunción Cognitiva/inducido químicamente , Fibras Nerviosas Mielínicas/efectos de los fármacos , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Sevoflurano/toxicidad , Administración por Inhalación , Anemia Ferropénica/metabolismo , Anemia Ferropénica/patología , Anestésicos por Inhalación/administración & dosificación , Animales , Disfunción Cognitiva/metabolismo , Disfunción Cognitiva/patología , Femenino , Ratones , Ratones Endogámicos C57BL , Fibras Nerviosas Mielínicas/metabolismo , Fibras Nerviosas Mielínicas/patología , Embarazo , Efectos Tardíos de la Exposición Prenatal/metabolismo , Efectos Tardíos de la Exposición Prenatal/patología , Sevoflurano/administración & dosificaciónRESUMEN
Toxic elements exposure disturbs the homeostasis of essential elements in organisms, but the mechanism remains elusive. In this study, we demonstrated that Drosophila melanogaster exposed to Lead (Pb, a pervasive environmental threat to human health) exhibited various health defects, including retarded development, decreased survival rate, impaired mobility and reduced egg production. These phenotypes could be significantly modulated by either intervention of dietary iron levels or altering expression of genes involved in iron metabolism. Further study revealed that Pb exposure leads to systemic iron deficiency. Strikingly, reactive oxygen species (ROS) clearance significantly increased iron uptake by restoring the expression of iron metabolism genes in the midgut and subsequently attenuated Pb toxicity. This study highlights the role of ROS in Pb induced iron dyshomeostasis and provides unique insights into understanding the mechanism of Pb toxicity and suggests ideal ways to attenuate Pb toxicity by iron supplementation therapy or ROS clearance.
Asunto(s)
Anemia Ferropénica/etiología , Drosophila melanogaster/metabolismo , Plomo/toxicidad , Estrés Oxidativo/efectos de los fármacos , Anemia Ferropénica/inducido químicamente , Animales , Dieta , Drosophila melanogaster/efectos de los fármacos , Homeostasis , Humanos , Hierro/metabolismo , Plomo/metabolismo , Especies Reactivas de Oxígeno/metabolismoRESUMEN
PURPOSE: Anemia is common in oncology and negatively impacts quality of life. However, there is lack of knowledge about iron deficiency (ID) epidemiology. The aim of this study was to prospectively assess iron status in patients with locally advanced or metastatic cancer beginning chemotherapy. METHODS: In this prospective, multicenter cohort study, anemia and ID were evaluated in patients with locally advanced or metastatic solid tumors and lymphoma before starting chemotherapy. Blood samples were collected at inclusion (W0), 6 weeks (W6), and 12 weeks (W12). Prevalence was evaluated in the general population, according to tumor location and was correlated with tumor response. RESULTS: One hundred twenty-nine patients were enrolled between 2013 and 2015; 119 had solid tumors and 10 lymphomas. At W0, there were no significant difference between locations with a prevalence around 50-60% (range 47.2-70.4%) and only a trend for colorectal cancer (70.4%, P = 0.069) due to a higher prevalence of absolute ID (18.5%). Prevalence of ID+ decreased between W0 and W6 and remained stable until W12 due to the proportion of patients with ID and without anemia. However, anemia prevalence increased during W0 and W6 and remained stable to W6 from W12 due to patients with anemia but without ID. A significant correlation between tumor response and ID prevalence was found (P = 0.036). CONCLUSIONS: We confirm the high prevalence of ID and anemia in cancer patients. ID status is correlated to tumor response providing a strong rationale for iron monitoring during cancer management.
Asunto(s)
Anemia Ferropénica/epidemiología , Deficiencias de Hierro , Trastornos del Metabolismo del Hierro/epidemiología , Neoplasias/tratamiento farmacológico , Neoplasias/epidemiología , Anciano , Anciano de 80 o más Años , Anemia Ferropénica/sangre , Anemia Ferropénica/inducido químicamente , Estudios de Cohortes , Femenino , Humanos , Trastornos del Metabolismo del Hierro/sangre , Trastornos del Metabolismo del Hierro/inducido químicamente , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Calidad de VidaRESUMEN
Proton pump inhibitors (PPIs) have been used worldwide to treat gastrointestinal disorders. A recent study showed that long-term use of PPIs caused iron deficiency; however, it is unclear whether PPIs affect iron metabolism directly. We investigated the effect of PPIs on the peptide hepcidin, an important iron regulatory hormone. First, we used the FDA Adverse Event Reporting System database and analyzed the influence of PPIs. We found that PPIs, as well as H2 blockers, increased the odds ratio of iron-deficient anemia. Next, HepG2 cells were used to examine the action of PPIs and H2 blockers on hepcidin. PPIs augmented hepcidin expression, while H2 blockers did not. In fact, the PPI omeprazole increased hepcidin secretion, and omeprazole-induced hepcidin upregulation was inhibited by gene silencing or the pharmacological inhibition of the aryl hydrocarbon receptor. In mouse experiments, omeprazole also increased hepatic hepcidin mRNA expression and blood hepcidin levels. In mice treated with omeprazole, protein levels of duodenal and splenic ferroportin decreased. Taken together, PPIs directly affect iron metabolism by suppressing iron absorption through the inhibition of duodenal ferroportin via hepcidin upregulation. These findings provide a new insight into the molecular mechanism of PPI-induced iron deficiency.
Asunto(s)
Anemia Ferropénica/inducido químicamente , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico/metabolismo , Duodeno/efectos de los fármacos , Hepatocitos/efectos de los fármacos , Hepcidinas/metabolismo , Absorción Intestinal/efectos de los fármacos , Hierro/sangre , Inhibidores de la Bomba de Protones/toxicidad , Receptores de Hidrocarburo de Aril/metabolismo , Anemia Ferropénica/sangre , Anemia Ferropénica/fisiopatología , Animales , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico/genética , Proteínas de Transporte de Catión/metabolismo , Duodeno/metabolismo , Duodeno/fisiopatología , Células Hep G2 , Hepatocitos/metabolismo , Antagonistas de los Receptores H2 de la Histamina/toxicidad , Humanos , Deficiencias de Hierro , Masculino , Ratones Endogámicos C57BL , Receptores de Hidrocarburo de Aril/genéticaAsunto(s)
Curcuma , Suplementos Dietéticos , Adulto , Anemia Ferropénica/inducido químicamente , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Curcumina/efectos adversos , Curcumina/uso terapéutico , Suplementos Dietéticos/efectos adversos , Femenino , Humanos , EmbarazoRESUMEN
AIMS: Iron deficiency (ID) is common in heart failure (HF) patients and negatively impacts symptoms and prognosis. The aetiology of ID in HF is largely unknown. We studied determinants and the biomarker profile of ID in a large international HF cohort. METHODS AND RESULTS: We studied 2357 worsening HF patients from the BIOSTAT-CHF cohort. ID was defined as transferrin saturation <20%. Univariable and multivariable logistic regression models were constructed to identify determinants for ID. We measured 92 cardiovascular markers (Olink Cardiovascular III) to establish a biomarker profile of ID. The primary endpoint was the composite of all-cause mortality and first HF rehospitalization. Mean age (±standard deviation) of all patients was 69 ± 12.0 years, 26.1% were female and median N-terminal pro B-type natriuretic peptide levels (+interquartile range) were 4305 (2360-8329) ng/L. Iron deficiency was present in 1453 patients (61.6%), with highest prevalence in females (71.1% vs. 58.3%; P < 0.001). Independent determinants of ID were female sex, lower estimated protein intake, higher heart rate, presence of peripheral oedema and orthopnoea, chronic kidney disease, lower haemoglobin, higher C-reactive protein levels, lower serum albumin levels, and P2Y12 inhibitor use (all P < 0.05). None of these determinants were sex-specific. The biomarker profile of ID largely consisted of pro-inflammatory markers, including paraoxonase 3 (PON3) and tartrate-resistant acid phosphatase type 5. In multivariable Cox proportional hazard regression analyses, ID was associated to worse outcome, independently of predictors of ID (hazard ratio 1.25, 95% confidence interval 1.06-1.46; P = 0.007). CONCLUSION: Our data suggest that the aetiology of ID in worsening HF is complex, multifactorial and seems to consist of a combination of reduced iron uptake (malnutrition, fluid overload), impaired iron storage (inflammation, chronic kidney disease), and iron loss (antiplatelets).
Asunto(s)
Anemia Ferropénica/complicaciones , Líquidos Corporales/fisiología , Insuficiencia Cardíaca/metabolismo , Inflamación/metabolismo , Deficiencias de Hierro , Inhibidores de Agregación Plaquetaria/efectos adversos , Anciano , Anemia Ferropénica/inducido químicamente , Anemia Ferropénica/metabolismo , Arildialquilfosfatasa/metabolismo , Biomarcadores/sangre , Líquidos Corporales/metabolismo , Ingestión de Alimentos/fisiología , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/metabolismo , Readmisión del Paciente/estadística & datos numéricos , Fragmentos de Péptidos/metabolismo , Prevalencia , Pronóstico , Proteínas/provisión & distribución , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/metabolismo , Volumen Sistólico/fisiología , Fosfatasa Ácida Tartratorresistente/metabolismo , Transferrina/metabolismoRESUMEN
BACKGROUND: Iron deficiency anemia and iron deficiency are commonly seen after bariatric surgery. Gastroesophageal reflux disease is commonly associated with sleeve resections and warrants postoperative acid reducing therapy. OBJECTIVE: To analyze the impact of long-term proton pump inhibitors on iron deficiency or iron deficiency anemia in laparoscopic sleeve gastrectomy (LSG) patients. SETTING: University hospital, USA. METHODS: A single-institution case control study included 2 groups of bariatric patients who underwent LSG. Patient characteristics such as age, sex, American Society of Anesthesiologists risk, body mass index, nutritional status, and co-morbidities were comparable. Postoperative follow-up was scheduled at 1-week, and 1-, 3-, 6-, and 12-month durations. All received standard postoperative iron, multivitamin therapy, and nutritional screening and evaluation. All patients were placed on postoperative proton pump inhibitors (PPI) therapy for at least 3 months. At third postoperative visit, anemia indicators were assessed by serum iron concentration, total iron binding capacity, transferrin saturation, red blood cell count, hemoglobin concentration, mean corpuscular volume, and mean corpuscular hemoglobin concentration. Postoperative hemoglobin and serum iron levels were compared between those patients still taking PPIs to those not taking PPIs at 12 months. RESULTS: A total of 287 patients underwent LSG from January 2016 to December 2017, 203 were included and 84 patients were excluded. Patients taking long-term PPIs (>12 mo, n = 85) were compared with those not taking PPIs (n = 118) and outcomes were respectively as follows: mean pre- and postoperative hemoglobin levels (in g/DL) were 13.2 and 10.7, and 13.3 and 13.7; mean postoperative serum iron levels (in µg/DL) were 41.7 and 88.7. Results were computed using paired t test and odds ratio that showed iron deficiency anemia in 12.9% (11/85) in PPI group compared with 4.23% (5/118) in the non-PPI group (odds ratio of 3.3, 95% confidence interval [1.21-10], and P = .03). Iron deficiency was seen in 22.3% (19/85) in the PPI group and 11% (13/118) in the non-PPI group (odds ratio of 2.3, 95% confidence interval [1.07-5.02] and P = .031). CONCLUSIONS: Our study indicates that PPIs can increase the severity of iron deficiency and iron deficiency anemia in patients who underwent LSG. Aggressive surveillance is needed in those taking long-term PPIs after LSG. It is encouraged to further analyze these findings in a larger randomized study model design.
Asunto(s)
Anemia Ferropénica , Gastrectomía , Hemoglobinas/análisis , Complicaciones Posoperatorias , Inhibidores de la Bomba de Protones/efectos adversos , Adulto , Anemia Ferropénica/sangre , Anemia Ferropénica/inducido químicamente , Anemia Ferropénica/epidemiología , Cirugía Bariátrica , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/tratamiento farmacológico , Humanos , Hierro/sangre , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/cirugía , Cuidados Posoperatorios/efectos adversos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/epidemiología , Inhibidores de la Bomba de Protones/uso terapéutico , Estudios RetrospectivosRESUMEN
Anemia is frequently encountered in patients with inflammatory bowel disease (IBD), decreasing the quality of life and significantly worsening the prognosis of the disease. The pathogenesis of anemia in IBD is multifactorial and results mainly from intestinal blood loss in inflamed mucosa and impaired dietary iron absorption. Multiple studies have proposed the use of the polyphenolic compound curcumin to counteract IBD pathogenesis since it has significant preventive and therapeutic properties as an anti-inflammatory agent and very low toxicity, even at high dosages. However, curcumin has been shown to possess properties consistent with those of an iron-chelator, such as the ability to modulate proteins of iron metabolism and decrease spleen and liver iron content. Thus, this property may further contribute to the development and severity of anemia of inflammation and iron deficiency in IBD. Herein, we evaluate the effects of curcumin on systemic iron balance in the dextran sodium sulfate (DSS) model of colitis in C57Bl/6 and BALB/c mouse strains that were fed an iron-sufficient diet. In these conditions, curcumin supplementation caused mild anemia, lowered iron stores, worsened colitis and significantly decreased overall survival, independent of the mouse strain. These findings suggest that curcumin usage as an anti-inflammatory supplement should be accompanied by monitoring of erythroid parameters to avoid exacerbation of iron deficiency anemia in IBD.
Asunto(s)
Anemia Ferropénica/inducido químicamente , Antiinflamatorios no Esteroideos/efectos adversos , Colitis/tratamiento farmacológico , Curcumina/efectos adversos , Anemia Ferropénica/metabolismo , Anemia Ferropénica/patología , Animales , Antiinflamatorios no Esteroideos/uso terapéutico , Colitis/inducido químicamente , Colitis/patología , Curcumina/uso terapéutico , Sulfato de Dextran , Femenino , Hierro de la Dieta/metabolismo , Ratones Endogámicos BALB C , Ratones Endogámicos C57BLRESUMEN
RESUMEN Objetivos Determinar efecto del consumo del extracto de quinua en anemia ferropénica inducida, en ratones. Material y Métodos Se utilizaron treinta ratones albinos M. musculus de la cepa Bal-b/c, machos de peso promedio 24±32,7 g. Se formó tres grupos de diez ratones cada uno: a) grupo control negativo hierro suficiente(HS),recibió 40g/d de alimento balanceado durante siete semanas; b)grupo control positivo hierro deficiente (HD), recibió 40g/d de dieta ferropénica durante siete semanas; y, c) grupo experimental hierro defi-ciente(HD), recibió 40g/d de dieta ferropénica durante siete semanas y a partir de la semana cinco se agregó 20g/d de extracto de quinua(EQ). Se midió el nivel de hemoglobina. Resultados Al finalizar el tratamiento, se observó diferencia significativa en los niveles de hemoglobina entre los grupos control positivo (8,9±1,1g/dL) HD y experimental (11,4±0,5 g/dL.) HD+EQ (t student, p<0,05). No se encontró diferencia significativa en los niveles de hemoglobina, al término del periodo de inducción entre los grupos control positivo (9,1±1,1) HD y experimental (9,3±0,7) HD (t student, p>0,05). Conclusiones En condiciones experimentales, la quinua presenta efecto antianémico, sustentado en los resultados de los niveles de hemoglobina.(AU)
ABSTRACT Objectives To determine the effect of quinoa extract consumption on iron deficiency-induced anemia in mice. Materials and Methods Thirty male M. musculus albino mice of the Balb/c strain, with an average weight of 24±32.7 g, were used. Three groups of ten mice each were formed: 1) a negative control group of iron-sufficient (IS) mice that received 40g/d of balanced feed for 7 weeks; 2) a positive control group of iron-deficient (ID) mice that received 40g/d of feed rich in iron for 7 weeks; and 3) an experimental group of ID mice that received 40 g/d of feed rich in iron for 7 weeks and 20 g/d of quinoa extract (QE) from week 5. Hemoglobin levels were measured. Results At the end of the treatment, a significant difference was found in hemoglobin levels between the positive (ID mice: 8.9±1.1 g/dL) and experimental (ID+QU mice: 11.4±0.5 g/dL) groups (student's t, p<0.05). No significant difference was found in hemoglobin levels at the end of the induction period between the positive (IS mice: 9.1±1.1) and experimental (ID mice: 9.3±0.7) groups (student's t, p>0.05). Conclusions Under experimental conditions, quinoa has an antianemic effect based on the results of hemoglobin levels.(AU)
Asunto(s)
Animales , Ratas , Hemoglobinas/análisis , Anemia Ferropénica/inducido químicamente , Chenopodium quinoa/efectos de los fármacos , Ratas Endogámicas , Ensayo ClínicoRESUMEN
Lanthanum carbonate is a phosphate binder that is used to reduce serum phosphate levels in patients with end-stage renal disease (ESRD). Lanthanum forms insoluble lanthanum phosphate complexes that are supposed to pass through the gastrointestinal (GI) tract unabsorbed. Phosphate binders have been reported to deposit in the GI tract and can cause mucosal injury. There are few case reports of GI bleeding associated with phosphate binder deposits. This case report presents a patient with iron deficiency anaemia secondary to biopsy-proven lanthanum deposits in the upper GI tract. There were no overt signs of active GI bleeding. Patient's anaemia improved with discontinuation of the phosphate binder. Lanthanum could be a hidden cause of resistant anaemia among patients with ESRD through asymptomatic GI blood loss.