[Effects of different doses of iron supplement on function of mitochondrial respiration of liver during exercise-induced hypochromic rats].

OBJECTIVE: To investigate the effects of iron supplement on function of mitochondrial respiratory of liver during exercise-induced hypochromic rats. METHOD: Forty healthy male Wistar rats were randomized into 5 groups (n = 8): static control (C), exercise-training (T), training with supplementation of small dose iron (S + T), training with supplementation of middle dose iron (M + T) and training with supplementation of large dose iron (L + T). Training performed incremental exercise for 8 weeks, 6 days/week, iron supplementation from the fifth week. Liver were prepared immediately after exhaustive running. Liver mitochondria were extracted by differential centrifugation. Spectrophotometric analysis was used to evaluate activities of electron transport chain complex (C) I-IV in liver mitochondria. RESULTS: (1) C I, CII and CIV activities in T group were increased significantly (P < 0.05, P < 0.01), CI - C IV activities in S + T, M + T and L + T groups were increased significantly (P < 0.05, P < 0.01) compared with those in C group. (2) CII activity in S + T group was increased remarkably (P < 0.05); CIII and CIV activities in M + T group were increased remarkably (P < 0.01); CI - CIV activities in L+ T group were increased remarkably (P < 0.05, P < 0.01) compared with those in T group. CONCLUSION: Large load exercise training composite iron supplementation can improve function of mitochondrial respiration of liver and the aerobic capacity. From the athletic ability , the middle dose iron supplementation is better during large load exercise training.

Allogeneic blood transfusion decreases with postoperative autotransfusion in hip and knee arthroplasty.

OBJECTIVES: We aimed to evaluate the effectiveness of postoperative autotransfusion method on prevention of the need of allogeneic blood transfusion in hip and knee arthroplasty. METHODS: Seventy-four patients who underwent 77 hip and knee arthroplasty operations were randomized into control and study groups, and evaluated prospectively. In the knee group (39 patients; 30 females, 9 males; mean age 66.6 years), cemented, cruciate retaining, and bicompartmental arthroplasty was performed under tourniquet control; whereas in the hip group (35 patients; 24 females, 11 males; mean age 59.3 years) cementless arthroplasty with posterolateral approach was performed. None of the patients received preoperative and intraoperative allogeneic blood transfusion. The collected blood in the surgical area was transfused with autotransfusion system to the patients in the study groups at the end of the fourth hour postoperatively. The mean amounts of autotransfused blood in hip and knee groups were 413 mL and 480 mL, respectively. Allogeneic blood transfusion was applied to the patients with hemoglobin level below 8 g/dL, hematocrit level below 25%, and clinical symptoms of anemia. RESULTS: Preoperative and postoperative hemoglobin-hematocrit levels did not differ significantly between study and control groups. Allogeneic blood transfusion was applied to one patient (5%) in study and 8 patients (38%) in control groups during knee arthroplasty (p=0.01); whereas 9 patients (53%) in study and 15 patients (79%) in control groups received allogeneic blood transfusion during hip arthroplasty (p=0.044). The amount of allogeneic blood transfusion in study groups was significantly lower than that in control groups (p=0.008 for knee arthroplasty, p=0.048 for hip arthroplasty). CONCLUSION: The need and amount of allogeneic transfusion were reduced with postoperative autotransfusion in both knee and hip arthroplasty groups with greater extent in knee arthroplasty.

Cancer-related anemia: pathogenesis, prevalence and treatment.

Cancer-related anemia is a cytokine-mediated disorder resulting from complex interactions between tumor cells and the immune system. Overexpression of certain inflammatory cytokines results in shortened survival of red blood cells, suppression of erythroid progenitor cells, impaired iron utilization, and inadequate erythropoietin production. Numerous other factors may also contribute to the development of anemia in cancer patients. The European Cancer Anaemia Survey (ECAS) has provided the most current, comprehensive, prospectively collected data on the incidence and prevalence of anemia among cancer patients, as well as important perspectives on anemia treatment and relationship of hemoglobin and performance status. ECAS enrolled over 15,000 treated and untreated patients with various malignancies from cancer centers in 24 European countries and followed them for up to 6 months. The initial analysis of the ECAS data revealed that 39% of the total cancer patient population was anemic (hemoglobin <12.0 g/dl) at enrollment, although the rate varied according to tumor type, disease status, and cancer treatment status. Of the patients who were not anemic at enrollment and started cancer treatment during the survey, those undergoing chemotherapy--either alone or in combination with radiotherapy--had the highest incidence of anemia (63 and 42%, respectively). Low hemoglobin levels correlated with poor performance status and only 40% of patients who were anemic at some time during the survey received treatment for their anemia. These findings are noteworthy, since a growing body of clinical evidence indicates that the treatment of anemia can significantly improve patients' quality of life and may also improve the clinical outcome.

Iron deficiency. Current trends and fads.

Anaemia due to iron deficiency remains the commonest form of anaemia world-wide, predominantly due to blood loss, either associated with infestations such as hook worm or menstrual blood loss, or malnutrition. In Australia, iron deficiency anaemia is the commonest form of anaemia and is seen in pregnant and breastfeeding females where the iron balance is often in a negative state. Fads and fallacies abound, particularly in this group. Despite extensive knowledge of iron metabolism, diagnosis of iron deficiency often remains a difficult problem. The use of diagnostic tests available is discussed in this article.

Functional consequences of iron supplementation in iron-deficient female cotton mill workers in Beijing, China.

Eighty iron-deficient, nonpregnant female workers were randomly assigned to ferrous sulphate (60 or 120 mg Fe/d) or placebo treatment for 12 wk. Energy expenditure was estimated during 3 d by heart rate (HR) recording. Production efficiency (PE) was calculated as the ratio of productivity to energy expenditure. In the iron-treated group mean hemoglobin (Hb) increased from 114 to 127 g/L (P < 0.001), mean serum ferritin increased from 9.7 to 30.0 micrograms/L (P < 0.001), and mean free erythrocyte protoporphyrin decreased from 1.01 to 0.49 mumol/L (P < 0.001). Mean HR at work decreased from 95.5 to 91.1 beats/min (P < 0.001), which was inversely correlated with the change in Hb (r = -0.60, P < 0.001). PE increased significantly in the iron-treated group (P < 0.001) and its change paralleled the change in Hb (r = 0.58, P < 0.001). The results show that iron supplementation enabled these women to do the same work at a lower energy cost.

Effects of iron repletion on VO2max, endurance, and blood lactate in women.

To determine the effects of an 8-wk dietary iron supplementation (100 mg.d-1) on low plasma ferritin concentration (< 20 ng.ml-1) and endurance, 20 active women (19-35 yr) were studied while performing a VO2max test and an endurance test (80% VO2max) on a cycle ergometer. Subjects were randomly placed in an iron supplement (IG) or a placebo group (PG) using a double-blind method. After treatment in the IG, ferritin levels were higher (22.5 +/- 3.4 vs 14.3 +/- 2.2 ng.ml-1; P < 0.05), Hb increased (12.8 +/- 0.4 to 14.1 +/- 0.2 g.dl-1; P < 0.05), and TIBC decreased (366.2 +/- 24.8 to 293.8 +/- 14.0 micrograms.dl-1; P < 0.05). Also after treatment the IG's VO2max was significantly greater (P < 0.05) than the PG value and their postendurance blood lactate decreased (5.03 +/- 0.44 to 3.85 +/- 0.6 mM.l-1; P < 0.05). Endurance time to exhaustion increased 38% (37.28 +/- 5.03 to 51.4 +/- 7.45 min) following iron treatment; however, this change was not statistically significant. The results suggest that this level of iron supplementation can reverse mild anemia, increase VO2max, and reduce blood lactate concentration after submaximal exercise.

[Action of various immunomodulators on hematopoiesis]. / Deistvie nekotorykh immunomoduliatorov na gemopoéz.

In experiment on Wistar rats the effect of immunomodulators on hemopoiesis in cases of iron deficiency anemia under conditions of ferrotherapy was studied. Tactivine was shown to induce activation of granulocytopoiesis in combination with erythropoiesis inhibition. Sodium nucleinate led to some stimulation of erythrone and weak inhibition of leukopoiesis. Levamisole showed inhibitory effect on hemopoietic tissue. The data obtained are to be taken into account in immunocorrection of hemopoiesis disorders.

Reversal of developmental delays in iron-deficient anaemic infants treated with iron.

Iron-deficient anaemic infants perform worse in tests of mental and motor development than do iron-sufficient infants of a comparable age. A randomised, double-blind trial was done to monitor the effects of iron supplementation on performance in the Bayley scales of mental and motor development among 12-18-month-old infants in Indonesia. Iron-deficient anaemic infants (n = 50) were assigned randomly to receive dietary ferrous sulphate or placebo for 4 month. Similar treatment randomisation was done among nonanaemic iron-deficient (n = 29) and iron-sufficient (n = 47) infants. Before intervention, the mean mental and motor scores of the iron-deficient anaemic infants were significantly (p < 0.01) lower than those of the nonanaemic iron-deficient and iron-sufficient classes. After intervention, developmental delays were reversed among iron-deficient anaemic infants who had received iron but they remained the same among placebo-treated iron-deficient anaemic infants. Neither ferrous sulphate nor placebo had significant effects on the scores of the other two iron-status classes. The poor performance of 12-18-month-old iron-deficient anaemic infants in the Bayley scales of mental and motor development can be improved to the level of performance of iron-sufficient infants by treatment with ferrous sulphate.

Sports anemia, iron supplements, and blood doping.

1) Athletes tend to have lower hemoglobin concentrations than sedentary counterparts. This has been called sports anemia, a misnomer. 2) Sports anemia is a false anemia and a beneficial adaptation to aerobic exercise, caused by an expanded plasma volume that dilutes red blood cells. 3) Athletes, however, can also develop true anemia, most commonly caused by iron deficiency. True anemia curbs athletic performance, but nonanemic iron deficiency does not. 4) Iron supplements are useful for women endurance athletes who repeatedly develop iron deficiency anemia despite dietary advice. 5) Some endurance athletes today are blood doping by abusing recombinant human erythropoietin (rEPO). They risk dying to win.

Recombinant human erythropoietin, but not iron supplementation, improves anemia in rats with adjuvant-induced arthritis.

Pathophysiological and therapeutic properties of anemia in rats with adjuvant-induced arthritis (AA) were investigated. Both anemia and chronic inflammation were induced in rats by a single injection of Freund's complete adjuvant. This study confirmed other earlier data that these anemic rats with AA had reduced serum iron levels and that the anemia was characterized as mild, non-progressive, hypochromic, microcytic. In addition, our studies showed that these anemic rats had slightly but significantly enhanced erythropoietin titers, but not renal failure; there was no significant difference in blood urea nitrogen and creatinine levels in anemic and normal groups. The anemia in rats with AA was improved by recombinant human erythropoietin (r-HuEPO) at 30 and 100 U/kg/day, given i.v. for 5 days. In contrast, iron-chondroitin-sulfate colloid (10 mg/kg/day, i.v. for 5 days) failed to improve the anemia and to enhance the effects of r-HuEPO. These data suggest that anemia in rats with adjuvant-induced arthritis is distinguished, pathophysiologically and therapeutically, from iron deficiency anemia, hemolytic anemia, and renal anemia.

Iron levels in pregnancy, physiology or pathology? Assessing the need for supplements.

This paper re-examines the need for iron supplements among pregnant women by considering whether the changes they experience in iron levels are physiological or pathological. The literature reveals that changes in the blood leading to haemodilution are necessary adaptations to healthy pregnancy. These changes alter normal haematological values. Consequently, indices such as haemoglobin concentration lose their accuracy as measurements of iron status. Tests for iron stores such as serum ferritin are more likely to prove useful indicators of deficiency. Iron stores are greatly depleted early in pregnancy, whether or not supplements are taken, when absorption is low. They return to pre-pregnant levels quickly after delivery. Reasons for these phenomena are postulated. High levels of haemoglobin in pregnancy seem to be as undesirable as very low levels. As proved benefits from iron therapy are few, it is questionable whether the antenatal period is an appropriate time to supplement. However, the issue of physiology versus pathology remains unresolved. Pregnancy is assumed to be an abnormal variation of the non-pregnant state; its parameters being judged against those of the population at large. As most pregnancies form a normal part of a woman's life cycle, the physiological ranges for pregnancy itself need to be determined.

Impaired thermoregulation and thyroid function in iron-deficiency anemia.

Ten women with iron-deficiency anemia, 8 with depleted iron stores (nonanemic), and 12 control women, all of similar body fatness, were exposed to a 28 degrees C water bath to test the hypothesis that iron-deficiency anemia impairs thermoregulatory performance. The anemic women had lower rectal temperatures than did control women (36.0 +/- 0.2 vs 36.2 +/- 0.1 degree C, respectively, P = 0.001) and a lower rate of oxygen consumption (5.28 +/- 0.26 vs 5.99 +/- 0.29 mL.min-1.kg body wt-1, respectively, P = 0.04) at 100 min of cold exposure. Plasma thyroxine and triiodothyronine concentrations were significantly (P less than 0.002) lower in anemic than in control women at baseline and during cold exposure. Responses of iron-depleted subjects were similar to those of control subjects. Iron supplementation corrected the anemia, significantly (P = 0.03) improved rectal temperature at 100 min, and partially normalized plasma thyroid hormone concentrations. Plasma catecholamines were unaffected by iron status. This experiment demonstrates a functional consequence of iron-deficiency anemia in the balance of heat production and loss and suggests that thyroid-hormone metabolism may be responsible.

[Iron deficiency in pregnancy]. / Carence en fer au cours de la grossesse.

From the evaluation of losses and savings, the authors specify, according to the reserves before pregnancy and the true diet intake, the indications for therapeutic supplement during pregnancy.

[Nutritional anemia in children]. / Les anémies nutritionnelles de l'enfant.

The anaemia most frequently encountered in paediatrics is iron deficiency anaemia. The deficiency may be latent or patent. It may be responsible for repeated infections and interfere with the child's psychomotor development. The disease is most often due to a low intake of dietary iron, and it can be prevented by supplementing the mothers during pregnancy and by an adequate diet. Folic acid and vitamin B12 deficiencies are much rarely encountered. Vitamin E deficiency may result in haemolysis, notably in premature infants.

Iron deficiency in female athletes: its prevalence and impact on performance.

The prevalence of iron deficiency and its impact on performance have not been adequately investigated in non-endurance athletes. This study evaluated these factors in 100 female intercollegiate athletes in various sports, and in 66 non-athletes. All subjects had determinations of hemoglobin, ferritin, and transferrin saturation. Athletes reported on diet, menses, and symptoms. Athletes and coaches described mood and performance. Iron-deficient athletes were treated with iron; others received placebo. The same data were collected at season's end. Initially 31/100 (31%) athletes had iron deficiency (ferritin less than 12 ng.ml-1; transferrin saturation less than 16%, or both) compared to 30/66 (45.5%) controls (not statistically significant). Compared to normal athletes, iron-deficient athletes did not have more symptoms of iron deficiency or differences in mood state, but they considered their performance to be worse (P less than 0.05). Their total iron intakes were similar, as were menstrual blood losses. At re-evaluation, 7/45 (15.6%) initially normal athletes were iron-deficient; 14/22 (63.6%) initially iron-deficient athletes were normal. Athletes receiving an iron supplement and their coaches did not report a greater improvement in performance or mood than athletes receiving a placebo. Female college athletes frequently had iron deficiency that could be successfully treated during the season, while some untreated normal athletes became iron-deficient. Iron deficiency and its treatment had no significant impact on symptoms or mood, but affected subjective assessment of performance.

Effect of prenatal iron deficiency on myelination in rat pups.

In this study, a histopathologic examination of the brain from iron-deficient or iron-supplemented rat pups was carried out. Pups were obtained from female rats, which were fed an iron-deficient or iron-supplemented diet during both pregnancy and lactation. Immediately after anesthesia and the collection of blood, pups were fixed by intracardiac infusion of 2% glutaraldehyde. Brain and cervical spinal cord were fixed, embedded in paraffin, and cut at 6-mu thickness. Myelin was identified using Luxol fast blue stain. As compared with controls (hematocrit, 30.8%), 11-day-old iron-deficient pups (hematocrit, 11.9%) showed reduced myelination in the spinal cord. Although myelination increased somewhat in the iron-deficient 17-day-old pups (hematocrit, 8.5%), the amount of myelin in the spinal cord and white matter of cerebellar folds was reduced as compared with that of the corresponding controls. These observations show the importance of prenatal iron adequacy in myelinogenesis.

Effects of iron deficiency on endurance and muscle enzyme activity in man.

The purpose of the present study was to evaluate the effects of iron deficiency on enzyme activities and endurance. Iron deficiency was induced in 9 healthy male subjects by repeated venesections. After a period of 9 wk (range, 8-11 wk) when the subjects had become iron deficient as defined by laboratory parameters, blood was retransfused to reestablish the control hemoglobin concentration. In this state it was possible to evaluate the effect of iron deficiency isolated from anemia. In samples secured by muscle biopsies, glycolytic, oxidative, and iron depending enzymes were analyzed in the control (C) and anemic (A) states and after retransfusion (R). There were no significant changes in the maximal activities of any of the enzymes studied. The capillary/fiber ratio remained unchanged between C (1.92) and R (1.94). Times to exhaustion on treadmill tests were 49 min, 11 s in C, 26 min, 33 s in A, and 52 min, 3 s in R. Vo2max was 4.55 1 X min-1 in C, 3.74 1 X min-1 in A, and 4.45 1 X min-1 in R. An artificially induced iron deficiency defined by conventional laboratory parameters did not affect endurance when transfusion of red blood cells was performed in order to exclude the influence of a low hemoglobin concentration. A 4-wk period of severely depleted or absent tissue iron stores did not affect the maximal activities of various enzymes in human skeletal muscle.

Iron deficiency anemia and educational achievement.

The present study investigates the effect of iron supplementation on measures of school performance among 78 iron-deficient anemic and 41 nonanemic children in an economically deprived rural area in Central Java, Indonesia. All the subjects were treated for ancylostomiasis before iron supplementation. They were randomly assigned to either an iron or placebo group. Hematological and behavioral measurements were obtained immediately before (T1) and after (T2) the iron and placebo treatments. Iron treatment for a 3-mo period resulted in substantive increases in mean Hgb, Hct, and transferrin saturation among the iron-deficient anemic children. Furthermore, changes in the iron status of iron-deficient anemic children were associated with significant changes in the school achievement test scores of iron-deficient anemic children. T2 evaluation of achievement test scores indicated that the difference between iron-treated anemic and nonanemic children was still statistically significant. However, when T1 scores were entered as a covariate, iron-deficient anemic subjects treated with iron obtained significantly higher delta achievement scores. Findings from the present study indicate that iron supplementation among iron-deficient anemic children benefits learning processes as measured by the school achievement test scores.