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1.
Ann Hematol ; 99(1): 7-19, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31650290

RESUMEN

Myelodysplastic syndromes (MDS) are hematopoietic stem cell malignancies associated with an erythroid maturation defect, resulting in anemia. Treatments for MDS include erythropoiesis-stimulating agents (ESAs). The identification of prognostic markers is important to help predict response and improve outcomes. Various scoring systems have been developed to help predict response to ESAs. Despite limitations in its assessment, serum erythropoietin (sEPO) level is an important predictor of hematologic response to ESAs in patients with lower-risk MDS. Numerous studies have reported significantly lower sEPO levels among responders versus non-responders. Furthermore, treatment response is significantly more likely among those with sEPO levels below versus those above various cutoffs. Other prognostic indicators for response to ESAs include lower transfusion requirement, fewer bone marrow blasts, higher hemoglobin, lower serum ferritin, lower-risk MDS, and more normal cytogenetics. Studies of other MDS therapies (e.g., lenalidomide and luspatercept) have also reported that lower sEPO levels are indicative of hematologic response. In addition, lower sEPO levels (up to 500 IU/L) have been included in treatment algorithms for patients with lower-risk MDS to define whether ESAs are indicated. Lower sEPO levels are predictive of hematologic response-particularly to ESAs. Further, clinical trials should use sEPO thresholds to ensure more homogeneous cohorts.


Asunto(s)
Receptores de Activinas Tipo II/uso terapéutico , Eritropoyetina/sangre , Fragmentos Fc de Inmunoglobulinas/uso terapéutico , Lenalidomida/uso terapéutico , Síndromes Mielodisplásicos/sangre , Síndromes Mielodisplásicos/tratamiento farmacológico , Proteínas Recombinantes de Fusión/uso terapéutico , Células de la Médula Ósea/metabolismo , Células de la Médula Ósea/patología , Femenino , Ferritinas/sangre , Hemoglobinas/metabolismo , Humanos , Masculino , Síndromes Mielodisplásicos/diagnóstico , Síndromes Mielodisplásicos/patología , Pronóstico , Factores de Riesgo
2.
Br J Anaesth ; 124(1): 25-34, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31668348

RESUMEN

BACKGROUND: Iron deficiency is frequent in patients undergoing cardiac surgery. The relevance of iron deficiency, however, is ill defined. Therefore, our study aimed to investigate the impact of iron deficiency (ferritin <100 µg L-1) with or without concomitant anaemia on clinical outcome after cardiac surgery. METHODS: In this prospective observational study, 730 patients undergoing elective cardiac surgery were assigned into four groups according to their iron status and anaemia. Mortality, serious adverse events (SAEs), major cardiac and cerebrovascular events (MACCEs), allogenic blood transfusion requirements, and length of hospital stay were assessed during a 90-day follow-up period. The effect of iron deficiency on these outcomes was first calculated in models adjusting for anaemia only, followed by two multivariate models adjusting for anaemia and either the EuroSCORE II or any possible confounders. RESULTS: The presence of iron deficiency (ferritin <100 µg L-1) was associated with an increase in 90-day mortality from 2% to 5% in patients without anaemia, and from 4% to 14% in patients with anaemia. Logistic regression resulted in an odds ratio of 3.5 (95% confidence interval: 1.5-8.4); P=0.004. The effect persisted in both multivariate models. Moreover, iron deficiency was associated with an increased incidence of SAEs, MACCEs, transfusion, and prolonged hospital stay. CONCLUSIONS: Preoperative iron deficiency (ferritin <100 µg L-1) was independently associated with increased mortality, more SAEs, and prolonged hospital stay after cardiac surgery. These findings underline the importance of preoperative iron deficiency screening in the context of a comprehensive patient blood management programme, and highlight its importance as a research topic in cardiac surgery. CLINICAL TRIAL REGISTRATION: NCT02031289.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/mortalidad , Hierro/deficiencia , Adulto , Anciano , Anciano de 80 o más Años , Anemia Ferropénica/complicaciones , Anemia Ferropénica/mortalidad , Transfusión Sanguínea/estadística & datos numéricos , Trastornos Cerebrovasculares/mortalidad , Femenino , Ferritinas/sangre , Cardiopatías/mortalidad , Humanos , Incidencia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Resultado del Tratamiento
4.
Croat Med J ; 60(5): 405-413, 2019 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-31686454

RESUMEN

AIM: To determine whether serum ferritin, liver transaminases, and regularity and type of iron chelation protocol can be used to predict liver iron load as assessed by T2* magnetic resonance imaging (MRI) in patients with beta thalassemia major (TM). METHODS: This cross-sectional study, conducted from March 1, 2014 to March 1, 2015, involved 90 patients with beta TM on regular packed red blood cell transfusion. Liver and cardiac iron load were evaluated with T2* MRI. Compliance with iron-chelating agents, deferoxamine or deferasirox, and regularity of their use, as well as serum ferritin and liver transaminase levels were assessed. RESULTS: Patients with high serum ferritin were 2.068 times (95% confidence interval 1.26-3.37) more likely to have higher liver or cardiac iron load. High serum aspartate aminotransferases and irregular use of iron chelating agents, but not their type, predicted higher cardiac iron load. In a multiple regression model, serum ferritin level was the only significant predictor of liver and myocardial iron load. CONCLUSIONS: Higher serum ferritin strongly predicted the severity of cardiac and liver iron load. Irregular use of chelator drugs was associated with a higher risk of cardiac and liver iron load, regardless of the type of chelating agent.


Asunto(s)
Ferritinas/sangre , Quelantes del Hierro/uso terapéutico , Sobrecarga de Hierro , Talasemia beta , Estudios Transversales , Humanos , Sobrecarga de Hierro/sangre , Sobrecarga de Hierro/complicaciones , Sobrecarga de Hierro/epidemiología , Sobrecarga de Hierro/terapia , Hígado/química , Hígado/diagnóstico por imagen , Imagen por Resonancia Magnética , Cumplimiento de la Medicación/estadística & datos numéricos , Talasemia beta/sangre , Talasemia beta/complicaciones , Talasemia beta/epidemiología , Talasemia beta/terapia
5.
J Strength Cond Res ; 33(11): 2913-2919, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31658211

RESUMEN

Morris, KL, Widstrom, L, Goodrich, J, Poddar, S, Rueda, M, Holliday, M, San Millian, I, and Byrnes, WC. A retrospective analysis of collegiate athlete blood biomarkers at moderate altitude. J Strength Cond Res 33(11): 2913-2919, 2019-Blood biomarkers are used to assess overall health and determine positive/negative adaptations to training/environmental stimuli. This study aimed to describe the changes in blood biomarkers in collegiate football (FB) (n = 31) and cross-country (XC) (n = 29; 16 women [FXC], 13 men [MXC]) athletes across a competitive season while training and living at a moderate altitude (1,655 m). This study used a database of previously collected hematological (complete blood count and serum ferritin) and muscle damage (lactate dehydrogenase and creatine kinase) blood biomarkers. Data were analyzed both within and between groups using linear mixed-model and variance component analyses, alpha = 0.05. All 3 groups had significant but different patterns of change in the measured biomarkers. Hematological blood biomarkers increased at different time points but remained within the normal reference ranges with greater between-subject vs. within-subject variability, suggesting no significant decrements to oxygen-carrying capacity across the season for FB, MXC, or FXC. Muscle damage biomarkers increased over time and exceeded the normal reference ranges, indicating cell damage pathology. However, it is also possible that the demands of training and competition might alter baseline values in these athletes, although this cannot be confirmed with the current experimental design. The patterns of change in the hematological and muscle damage biomarkers varied by sport discipline, suggesting that the training/competitive environments of these athletes influence these changes. Further studies should assess how much training, altitude, and nutrition influence these changes by using a more comprehensive set of biomarkers and related performance parameters.


Asunto(s)
Aclimatación , Altitud , Biomarcadores/sangre , Deportes/fisiología , Atletas , Creatina Quinasa/sangre , Femenino , Ferritinas/sangre , Humanos , L-Lactato Deshidrogenasa/sangre , Masculino , Oxígeno , Estudios Retrospectivos , Universidades
6.
Isr Med Assoc J ; 21(10): 676-680, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31599510

RESUMEN

BACKGROUND: In developed countries, hepatitis A virus (HAV) infection occurs mainly in adults. It is usually symptomatic and may cause acute liver failure (ALF). In patients with chronic liver disease, serum ferritin levels (SFL) can predict short-term prognosis. OBJECTIVES: To determine whether admission SFL can serve as a prognostic marker in patients with HAV infection. METHODS: A retrospective analysis of 33 adults with HAV infection was conducted. Because none of our patients presented with ALF, the parameter "length of hospital stay," was used as a surrogate marker of disease severity. RESULTS: The mean (± SD) at admission SFL was 2529 ± 4336 ng/ml. SFL correlated with the levels of international normalized ratio (INR), liver enzymes, and degree of hemolysis that occurred during the disease course. SFL did not correlate with the levels of either albumin or bilirubin or with the length of the hospital stay. The mean length of hospital stay was 5.1 ± 2.0 days, which correlated with the levels of INR, albumin, and bilirubin as well as the degree of hemolysis. However, in multivariate analysis only albumin and bilirubin predicted the length of the hospital stay. Follow-up SFL, which were available only in eight patients, decreased during the hospital stay. CONCLUSIONS: In adults with acute HAV infection, SFL may be increased. SFL correlated with the degree of liver injury and hemolysis that occur during the disease. However, in our cohort of HAV patients, who had a relatively benign disease course, SFL were of no prognostic value.


Asunto(s)
Ferritinas/sangre , Hepatitis A/sangre , Evaluación del Resultado de la Atención al Paciente , Adolescente , Adulto , Anciano , Femenino , Hepatitis A/complicaciones , Humanos , Israel , Tiempo de Internación/estadística & datos numéricos , Fallo Hepático Agudo/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto Joven
7.
Medicine (Baltimore) ; 98(40): e17406, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31577751

RESUMEN

Serum ferritin (SF) has been identified as a potential prognostic factor for patients undergoing stem cell transplantation, but the prognostic value of SF in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) patients and the impact of iron chelation therapy (ICT) on MDS patients are controversial. The present meta-analysis aimed to better elucidate these relationships.Three electronic databases were searched systematically to identify reports on the prognostic role of SF in MDS and AML patients, and those investigating the impact of ICT on prognosis of MDS patients. The hazard ratios (HRs) and its 95% confidence interval (95%CI) were extracted from the identified studies using Cox proportional hazard regression model for overall survival (OS) and progression of MDS to AML.Twenty reports including 1066 AML patients and 4054 MDS patients were included in present study. The overall pooled HRs for OS of AML and MDS patients with elevated SF prior to transplantation was 1.73 (1.40-2.14), subgroup analyses stratified by the cut-off value of SF ≥1400/1000 ng/mL showed that the pooled HRs were 1.45 (0.98-2.15) and 1.65 (1.30-2.10), respectively. The pooled HRs for ICT in MDS patients was 0.30 (0.23-0.40). For ICT, the pooled HRs for the progression of MDS to AML was 0.84 (0.61-1.61).SF has a negative impact on the OS of AML and MDS patients when it is higher than 1000 ng/mL. ICT can improve the OS of MDS patients with iron overload but it is not associated with the progression of MDS to AML.


Asunto(s)
Terapia por Quelación/métodos , Ferritinas/sangre , Sobrecarga de Hierro/tratamiento farmacológico , Sobrecarga de Hierro/etiología , Leucemia Mieloide Aguda/complicaciones , Síndromes Mielodisplásicos/complicaciones , Adulto , Anciano , Progresión de la Enfermedad , Femenino , Humanos , Leucemia Mieloide Aguda/sangre , Masculino , Persona de Mediana Edad , Síndromes Mielodisplásicos/sangre , Síndromes Mielodisplásicos/epidemiología , Síndromes Mielodisplásicos/fisiopatología , Estudios Observacionales como Asunto , Pronóstico , Modelos de Riesgos Proporcionales , Proyectos de Investigación , Trasplante de Células Madre/métodos , Análisis de Supervivencia
9.
J Int Soc Sports Nutr ; 16(1): 42, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533743

RESUMEN

BACKGROUND: The purpose of this study was to examine relationships among biomarkers of iron status, athletic performance, growth and development, and dietary intakes in pre-adolescent and adolescent male and female athletes. METHODS: Two-hundred and forty-nine male (n = 179) (mean ± standard deviation for age = 12.0 ± 2.1 years, height = 156.3 ± 13.9 cm, and weight = 49.1 ± 16.5 kg) and female (n = 70) (12.0 ± 2.2 years, 152.4 ± 12.3 cm, 45.3 ± 14.5 kg) athletes volunteered for capillary blood sample, anthropometric, athletic performance, and dietary intake assessments. Outcomes included maturity offset from peak height velocity, percent body fat, estimated muscle cross-sectional areas, vertical jump height (VJ), broad jump distance (BJ), pro-agility time (PA), L-cone time, 20-yard dash time (20YD), power push up (PPU) force, dietary intakes, and ferritin, soluble transferrin receptor (sTfR), and hemoglobin (Hb) concentrations. RESULTS: Athletic performance was consistently correlated with Hb in males (r = .237-.375, p < 0.001-0.05) and with sTfR (r = .521-.649, p < 0.001-0.004) and iron intake (r = .397-.568, p = 0.001-0.027) in females. There were no relationships between dietary intakes and ferritin, sTfR, or Hb (p > 0.05). After partialing out age and height, VJ, PA, LC, and 20YD remained correlated with Hb in males (|rHb,y.Age| = .208-.322, p = 0.001-0.041; |rHb,y.Height| = .211-.321, p = 0.001-0.038). After partialing out iron intake, PA and LC remained correlated with sTfR in females (|rsTfR,y.ironintake| = .516-.569, p = 0.014-0.028). CONCLUSIONS: Iron status biomarkers demonstrated sex-specific relationships with anaerobic exercise performance in youth athletes, which may be more dependent on maturity status and dietary intake than age. Moderate relationships between sTfR and athletic performance in adolescent female athletes emphasizes the importance of iron intake in this demographic.


Asunto(s)
Rendimiento Atlético , Hierro/sangre , Adolescente , Antropometría , Atletas , Biomarcadores/sangre , Niño , Estudios Transversales , Femenino , Ferritinas/sangre , Hemoglobinas/análisis , Humanos , Masculino , Evaluación Nutricional , Factores Sexuales , Fenómenos Fisiológicos en la Nutrición Deportiva
10.
Invest Ophthalmol Vis Sci ; 60(12): 3887-3896, 2019 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-31529120

RESUMEN

Purpose: To investigate foveal avascular zone (FAZ) changes in the superficial (SCP) and deep (DCP) capillary plexuses in beta-thalassemia major (BTM) patients, as shown in optical coherence tomography angiography. Methods: Nonrandomized, comparative case series of 54 eyes of 27 BTM patients and 46 eyes of 23 healthy controls, utilizing an automated FAZ detection algorithm. Measurements included FAZ area and FAZ shape descriptors (convexity, circularity, and contour temperature). Results were compared between the two groups, and correlated to iron load and chelation therapy parameters. Results: SCP and DCP FAZ area were not significantly different between the control and BTM groups (P = 0.778 and P = 0.408, respectively). The same was true regarding SCP FAZ convexity (P = 0.946), circularity (P = 0.838), and contour temperature (P = 0.907). In contrast, a statistically significant difference was detected between controls and BTM group regarding DCP FAZ convexity (P = 0.013), circularity (P = 0.010), and contour temperature (P = 0.014). Desferrioxamine dosage was strongly correlated to the DCP area (r = 0.650, P = 0.05) and liver magnetic resonance imaging/T2-star to DCP circularity (r = -0.492, P = 0.038). Correlations were also revealed between urine Fe excretion and DCP convexity (r = 0.531, P = 0.019), circularity (r = 0.661, P = 0.002), and contour temperature (r = -0.591, P = 0.008). Conclusions: Retinal capillary plexuses and especially DCP seem to present unique morphologic changes in BTM patients, not in the FAZ area, but in specific shape descriptors, indicating minor but detectable FAZ changes. These changes correlate well with iron load and chelation therapy parameters. Their clinical importance and pathophysiologic implications remain to be elucidated through further studies.


Asunto(s)
Fóvea Central/irrigación sanguínea , Vasos Retinianos/patología , Talasemia beta/diagnóstico , Adulto , Capilares/patología , Deferoxamina/administración & dosificación , Femenino , Ferritinas/sangre , Angiografía con Fluoresceína/métodos , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Vasos Retinianos/diagnóstico por imagen , Sideróforos/administración & dosificación , Tomografía de Coherencia Óptica/métodos , Talasemia beta/sangre , Talasemia beta/tratamiento farmacológico
11.
Klin Lab Diagn ; 64(8): 477-480, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31479602

RESUMEN

This research paper presents the results of a study of some indicators of iron metabolism in anaemia in pregnant women. The venous blood of 39 pregnant women with anaemia was examined. Serum ferritin, ferroportin and hepcidin were investigated for this purpose. The comparison group consisted of 19 pregnant women without anaemia. The haemoglobin concentration was measured by using «Mythic-18¼ haematological autoanalyzer. The concentrations of hepcidin and ferroportin were determined by using «Cloud-Clone Corp.¼ (USA), and ferritin concentrations were determined by using «Pishtaz teb¼ (Iran) reagents through enzyme-linked immunosorbent assay (ELISA) method. The study revealed a significant decrease in the level of ferritin, hepcidin and a significant increase in ferroportin level. A comprehensive definition of various indicators of iron metabolism provides important information not only for understanding the pathogenesis of iron deficiency anaemia in pregnant women but also for early diagnosis of the disease and the appointment of the correct treatment.


Asunto(s)
Anemia Ferropénica/sangre , Citocinas/sangre , Hierro/metabolismo , Complicaciones Hematológicas del Embarazo/sangre , Femenino , Ferritinas/sangre , Hepcidinas/sangre , Humanos , Embarazo
12.
J Strength Cond Res ; 33(10): 2622-2628, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31403576

RESUMEN

Walker, AJ, McFadden, BA, Sanders, DJ, Rabideau, MM, Hofacker, ML, and Arent, SM. Biomarker response to a competitive season in Division I female soccer players. J Strength Cond Res 33(10): 2622-2628, 2019-The purpose of this study was to evaluate effects of training load (TL) on performance and biomarkers of health, performance, and recovery in Division I female soccer players throughout a competitive season. Subjects (N = 25, Mage = 20 ± 1.1 years) were monitored before the start of preseason and every 4-weeks thereafter (T1-T5). A battery of performance tests was administered before the start of preseason (P1) and end-of-season (P2), including body composition (percent body fat [%BF], fat free mass [FFM], and fat mass), vertical jump (VJ), and VO2max. Blood draws were conducted at every time point (T1-T5) to assess free and total cortisol (CORTF and CORTT), prolactin (PRL), T3, IL-6, creatine kinase (CK), sex-hormone binding globulin, omega-3 (n-3FA), vitamin-D (Vit-D), iron (Fe), hematocrit (HcT), ferritin (Fer), percent saturation (%Sat), and total iron-binding capacity (TIBC). Daily exercise energy expenditure (EEE) and TL were determined. There were significant declines in VO2max, VJ, weight, and %BF from P1-P2 (p < 0.05) with no significant differences in FFM. Training load and EEE significantly decreased from T1-T3 (p < 0.05). Significant increases were seen in CORTT, CORTF, PRL, T3, IL-6, CK, and TIBC throughout the season (p < 0.05). Significant decreases were seen in n-3FA, Fe, Fer, %Sat, and Hct throughout the season (p < 0.05). Female athletes experience significant physiological changes following high TL and EEE associated with preseason and appear to be further exacerbated by the cumulative effects of the season. Unique insights provided by biomarkers enable athletes and coaches to be cognizant of the physiological changes that are occurring throughout the season.


Asunto(s)
Rendimiento Atlético/fisiología , Ejercicio/fisiología , Esfuerzo Físico/fisiología , Fútbol/fisiología , Adolescente , Biomarcadores/sangre , Composición Corporal , Peso Corporal , Creatina Quinasa/sangre , Prueba de Esfuerzo , Ácidos Grasos Omega-3/sangre , Femenino , Ferritinas/sangre , Hematócrito , Humanos , Hidrocortisona/sangre , Interleucina-6/sangre , Hierro/sangre , Oxígeno/sangre , Consumo de Oxígeno , Acondicionamiento Físico Humano/fisiología , Prolactina/sangre , Globulina de Unión a Hormona Sexual/metabolismo , Triyodotironina/sangre , Vitamina D/sangre , Adulto Joven
13.
Lancet Haematol ; 6(10): e510-e520, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31383583

RESUMEN

BACKGROUND: The INTERVAL trial showed that, over a 2-year period, inter-donation intervals for whole blood donation can be safely reduced to meet blood shortages. We extended the INTERVAL trial for a further 2 years to evaluate the longer-term risks and benefits of varying inter-donation intervals, and to compare routine versus more intensive reminders to help donors keep appointments. METHODS: The INTERVAL trial was a parallel group, pragmatic, randomised trial that recruited blood donors aged 18 years or older from 25 static donor centres of NHS Blood and Transplant across England, UK. Here we report on the prespecified analyses after 4 years of follow-up. Participants were whole blood donors who agreed to continue trial participation on their originally allocated inter-donation intervals (men: 12, 10, and 8 weeks; women: 16, 14, and 12 weeks). They were further block-randomised (1:1) to routine versus more intensive reminders using computer-generated random sequences. The prespecified primary outcome was units of blood collected per year analysed in the intention-to-treat population. Secondary outcomes related to safety were quality of life, self-reported symptoms potentially related to donation, haemoglobin and ferritin concentrations, and deferrals because of low haemoglobin and other factors. This trial is registered with ISRCTN, number ISRCTN24760606, and has completed. FINDINGS: Between Oct 19, 2014, and May 3, 2016, 20 757 of the 38 035 invited blood donors (10 843 [58%] men, 9914 [51%] women) participated in the extension study. 10 378 (50%) were randomly assigned to routine reminders and 10 379 (50%) were randomly assigned to more intensive reminders. Median follow-up was 1·1 years (IQR 0·7-1·3). Compared with routine reminders, more intensive reminders increased blood collection by a mean of 0·11 units per year (95% CI 0·04-0·17; p=0·0003) in men and 0·06 units per year (0·01-0·11; p=0·0094) in women. During the extension study, each week shorter inter-donation interval increased blood collection by a mean of 0·23 units per year (0·21-0·25) in men and 0·14 units per year (0·12-0·15) in women (both p<0·0001). More frequent donation resulted in more deferrals for low haemoglobin (odds ratio per week shorter inter-donation interval 1·19 [95% CI 1·15-1·22] in men and 1·10 [1·06-1·14] in women), and lower mean haemoglobin (difference per week shorter inter-donation interval -0·84 g/L [95% CI -0·99 to -0·70] in men and -0·45 g/L [-0·59 to -0·31] in women) and ferritin concentrations (percentage difference per week shorter inter-donation interval -6·5% [95% CI -7·6 to -5·5] in men and -5·3% [-6·5 to -4·2] in women; all p<0·0001). No differences were observed in quality of life, serious adverse events, or self-reported symptoms (p>0.0001 for tests of linear trend by inter-donation intervals) other than a higher reported frequency of doctor-diagnosed low iron concentrations and prescription of iron supplements in men (p<0·0001). INTERPRETATION: During a period of up to 4 years, shorter inter-donation intervals and more intensive reminders resulted in more blood being collected without a detectable effect on donors' mental and physical wellbeing. However, donors had decreased haemoglobin concentrations and more self-reported symptoms compared with the initial 2 years of the trial. Our findings suggest that blood collection services could safely use shorter donation intervals and more intensive reminders to meet shortages, for donors who maintain adequate haemoglobin concentrations and iron stores. FUNDING: NHS Blood and Transplant, UK National Institute for Health Research, UK Medical Research Council, and British Heart Foundation.


Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Adolescente , Adulto , Anemia Ferropénica/prevención & control , Donantes de Sangre/provisión & distribución , Eficiencia , Femenino , Ferritinas/sangre , Hemoglobinas/análisis , Humanos , Hierro/sangre , Masculino , Seguridad del Paciente , Calidad de Vida , Medición de Riesgo , Factores Sexuales , Factores de Tiempo , Adulto Joven
14.
Niger J Clin Pract ; 22(8): 1132-1139, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31417058

RESUMEN

Background: The International Nutritional Anaemia Consultative Group has recommended a twice daily dose of 65 mg elemental iron supplementation in pregnant women living in areas where anaemia is prevalent contrary to the World Health Organization (WHO) universal recommendation of a daily dose of 60 mg. Whether twice or daily dose schedules proffer a better outcome is a subject of on-going research. Objective: To compare the effectiveness of the once versus twice daily doses of ferrous sulphate in the prevention of iron deficiency anaemia in pregnancy. Methods: There are about one hundred and eighty two (182) pregnant women at gestational ages of 14-24 weeks with haemoglobin (Hb) levels ≥10 g/dl but ≤14.5 g/dl were recruited during the antenatal booking clinic. They were randomized into receiving either once daily dose (65 mg of elemental iron) or twice daily dose (130 mg of elemental iron) of ferrous sulphate. Pre and post- supplementation haemoglobin, serum iron and ferritin levels were assessed at recruitment and at 37 weeks gestation respectively. Results: Eighty-four (84) and 80 women respectively in the once and twice daily dose groups were analysed. The serum haemoglobin was significantly lower (P = 0.002) among those on once daily than those on twice daily supplementation. The side effects were however, significantly higher in the twice daily group (P = 0.005, P = 0.043 and P = 0.004 respectively). There were no differences between the serum ferritin levels pre and post supplementation in both groups just as they were no reported significant differences in both birth weight of neonates (P = 0.936) and average gestational age at delivery (P = 0.469) between the two groups. Conclusion: Once daily (65 mg elemental iron) ferrous sulphate is as effective as twice daily (130 mg elemental iron) dose regimen in prevention of Anaemia in pregnancy in a developing economy like Nigeria. Once daily dose possesses fewer side effects and guarantees better compliance in this study.


Asunto(s)
Anemia Ferropénica/prevención & control , Compuestos Ferrosos/administración & dosificación , Complicaciones Hematológicas del Embarazo/prevención & control , Adulto , Suplementos Dietéticos , Esquema de Medicación , Femenino , Ferritinas/sangre , Compuestos Ferrosos/uso terapéutico , Hemoglobinas/análisis , Humanos , Recién Nacido , Hierro/sangre , Nigeria , Embarazo , Tercer Trimestre del Embarazo , Mujeres Embarazadas , Resultado del Tratamiento , Adulto Joven
15.
Pan Afr Med J ; 33: 48, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31448011

RESUMEN

Introduction: diagnostic methods and management of iron deficiency and iron deficiency anemia in clinical practice in Algeria is poorly known. Methods: we conducted a cross-sectional survey among doctors in different specialties treating patients with iron deficiency anemia in 2016. Results: data analysis was based on 349 questionnaires which were validated (anesthesia/resuscitation: 39; obstetrics and gynaecology: 111; oncology/Hematology: 71; hepato-gastroenterology: 64; cardiology: 36; internal medicine: 28). All specialties combined, 73% (254/349) of physicians thought that at least 30% of their patients had iron deficiency anemia; 65% of physicians (226/349) thought that at least 30% of their patients had iron deficiency. Iron deficiency was investigated systematically by 57% (63/111) of physicians of the group obstetrics and gynaecology, but only by 11% (26/238) of the remaining doctors; indeed, 82% (195/238) of physicians investigated it only in patients with anemia. The assessment of iron deficiency showed that the hemoglobin (Hb) was almost always determined (89%; 310/349) while laboratory tests to explore iron metabolism were inadequate: 70% (244/349) of physicians performed serum ferritin test and only 37% (128/349) performed transferrin saturation. Patients with iron deficiency (with or without anemia) received oral iron therapy (prescribed by 92% (322/349) of physicians) and iron injections therapy depending on Hb level (prescribed by 36% (127/349) of physicians). Conclusion: this survey shows that iron deficiency is evaluated only in patients with anemia. In particular, laboratory tests to measure iron deficiency are insufficiently prescribed.


Asunto(s)
Anemia Ferropénica/diagnóstico , Hierro/deficiencia , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Argelia , Anemia/diagnóstico , Anemia/terapia , Anemia Ferropénica/terapia , Estudios Transversales , Femenino , Ferritinas/sangre , Encuestas de Atención de la Salud , Hemoglobinas/análisis , Humanos , Hierro/administración & dosificación , Masculino , Persona de Mediana Edad , Adulto Joven
16.
PLoS Med ; 16(8): e1002867, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31430296

RESUMEN

BACKGROUND: Iron deficiency (ID) in pregnancy is a common problem that can compromise both maternal and fetal health. Although daily iron supplementation is a simple and effective means of treating ID in pregnancy, ID and ID anemia (IDA) often go unrecognized and untreated due to lack of knowledge of their implications and competing clinical priorities. METHODS AND FINDINGS: In order to enhance screening and management of ID and IDA in pregnancy, we developed a novel quality-improvement toolkit: ID in pregnancy with maternal iron optimization (IRON MOM), implemented at St. Michael's Hospital in Toronto, Canada. It included clinical pathways for diagnosis and management, educational resources for clinicians and patients, templated laboratory requisitions, and standardized oral iron prescriptions. To assess the impact of IRON MOM, we retrospectively extracted laboratory data of all women seen in both the obstetrics clinic and the inpatient delivery ward settings from the electronic patient record (EPR) to compare measures pre- and post-implementation of the toolkit: a process measure of the rates of ferritin testing, and outcome measures of the proportion of women with an antenatal (predelivery) hemoglobin value below 100 g/L (anemia), the proportion of women who received a red blood cell (RBC) transfusion during pregnancy, and the proportion of women who received an RBC transfusion immediately following delivery or in the 8-week postpartum period. The pre-intervention period was from January 2012 to December 2016, and the post-intervention period was from January 2017 to December 2017. From the EPR, 1,292 and 2,400 ferritin tests and 16,603 and 3,282 antenatal hemoglobin results were extracted pre- and post-intervention, respectively. One year after implementation of IRON MOM, we found a 10-fold increase in the rate of ferritin testing in the obstetric clinics at our hospital and a lower risk of antenatal hemoglobin values below 100 g/L (pre-intervention 13.5% [95% confidence interval (CI) 13.0%-14.11%]; post-intervention 10.6% [95% CI 9.6%-11.7%], p < 0.0001). In addition, a significantly lower proportion of women received an RBC transfusion during their pregnancy (1.2% pre-intervention versus 0.8% post-intervention, p = 0.0499) or immediately following delivery and in the 8 weeks following (2.3% pre-intervention versus 1.6% post-intervention, p = 0.0214). Limitations of this study include the use of aggregate data extracted from the EPR, and lack of a control group. CONCLUSIONS: The introduction of a standardized toolkit including diagnostic and management pathways as well as other aids increased ferritin testing and decreased the incidence of anemia among women presenting for delivery at our site. This strategy also resulted in reduced proportions of women receiving RBC transfusion during pregnancy and in the first 8 weeks postpartum. The IRON MOM toolkit is a low-tech strategy that could be easily scaled to other settings.


Asunto(s)
Anemia Ferropénica/complicaciones , Complicaciones del Embarazo/diagnóstico , Mejoramiento de la Calidad , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/terapia , Estudios Controlados Antes y Después , Vías Clínicas , Transfusión de Eritrocitos , Femenino , Ferritinas/sangre , Humanos , Atención Perinatal/métodos , Embarazo , Complicaciones del Embarazo/terapia
17.
Egypt J Immunol ; 26(1): 141-150, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31333004

RESUMEN

The most common types of anemia in rheumatoid arthritis (RA) are iron deficiency anemia (IDA) and anemia of chronic disease (ACD).The differentiation between both is important and challenging. Our objective is to select the most accurate method that differentiates IDA from ACD in RA patients. This case control study was carried out on 80 RA patients. 40 RA patients with anemia and 40 RA patients without anemia, complete blood count, assessment of disease activity using DAS 28 score, serum iron, transferrin level, transferrin saturation (TSAT), serum ferritin, log ferritin and transferrin /log ferritin were tested, anemic patients were divided into 2 subgroups according to TSAT: group Ia (with low TSAT) and group Ib (with normal TSAT). There was a statistically significant difference between anemic and non-anemic RA patients as regard serum iron level and transferrin saturation. Among the anemic group 67.5% had low TSAT (IDA) and 32.5% had normal TSAT (ACD). In these 2 subgroups there was no significant differences as regard DAS28 score, blood indices, serum ferritin and transferrin /log ferritin) and there was a positive correlation between TSAT and ferritin and log ferritin and a significant negative correlation between TSAT and transferrin/log ferritin. In conclusions, Iron deficiency anemia is prevalent in RA patients. A combination of serum ferritin and TSAT is simple and accurate parameter to differentiate both. Log ferritin and transferrin /log ferritin may be promising new parameters in diagnosis of IDA in general population but their use in inflammatory diseases like RA still has a limitation.


Asunto(s)
Anemia Ferropénica/diagnóstico , Artritis Reumatoide/complicaciones , Ferritinas/sangre , Transferrina/análisis , Anemia/diagnóstico , Estudios de Casos y Controles , Enfermedad Crónica , Diagnóstico Diferencial , Humanos , Hierro
18.
Nutrients ; 11(8)2019 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-31357549

RESUMEN

Vegetarian diets may compromise iron status, as they provide non-haem iron which has low bioavailability. Spanish lacto-ovo vegetarians (n = 49) and vegans (n = 55) were recruited and haematological and biochemical iron parameters were analysed. Food and supplements consumption, body composition, physical activity, menstrual blood losses and hormonal contraceptive use were assessed. Four groups were studied: Iron deficiency anaemia (IDA), iron depletion (ferritin <15 ng/mL), iron deficiency (ferritin ≥15 to ≤30 ng/mL), and iron sufficiency (ferritin >30 ng/mL). IDA was uncommon (n = 5, 4.8%), 27.9% of participants were iron-depleted, and 30.8% were iron-deficient. Serum ferritin was lower in women than men (p < 0.001) and IDA and iron depleted individuals were all women. There were no differences attributed to diet type, time being vegetarian or physical activity. The menstrual period length was negatively associated with transferrin saturation ( = -0.364, p = 0.001) and hormonal contraceptive use ( = -0.276, p = 0.014). Iron supplements were consumed most frequently by IDA and iron-deficient subjects (p = 0.031). Conclusions: Iron status did not vary between lacto-ovo vegetarians and vegans and there was not an influence of the time following a vegetarian diet. Although men were iron-sufficient, iron deficiency was frequent in women, who should apply strategies to increase iron bioavailability, especially if they experience intense menstrual blood losses.


Asunto(s)
Anemia Ferropénica/sangre , Dieta Vegetariana , Hierro/sangre , Estado Nutricional , Valor Nutritivo , Vegetarianos , Adulto , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/epidemiología , Anemia Ferropénica/prevención & control , Biomarcadores/sangre , Dieta Vegana , Dieta Vegetariana/efectos adversos , Suplementos Dietéticos , Femenino , Ferritinas/sangre , Humanos , Hierro/administración & dosificación , Hierro/deficiencia , Masculino , Factores de Riesgo , Factores Sexuales , España/epidemiología , Transferrina/metabolismo , Veganos , Adulto Joven
19.
Tohoku J Exp Med ; 248(2): 63-71, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31178527

RESUMEN

Oxidative stress (OS) frequently contributes to the development of acute kidney injury (AKI). Iron can promote oxidative stress and tissue injury by catalyzing free reactive oxygen species (ROS) generation and increasing the steady-state concentration of these potent oxidants. The anticipated role of ferritin is to protect from OS by sequestering iron and limiting its involvement in reactions that generate ROS. In this prospective study, we aimed to investigate the association between serum ferritin levels and kidney function recovery among patients with AKI. Renal recovery was determined as a return of serum creatinine to less than 1.25 times the baseline value after 90 days of follow-up. One hundred twelve patients (72 males and 40 females, 63.68 ± 10.6 years old) were included in the final analysis. They were divided into AKI recovery (n = 76) and non-recovery groups (n = 36). Ferritin levels on admission were higher in AKI recovery group [284 (IQR 153-525) ng/mL] compared with the non-recovery group [127.4 (IQR 30-243) ng/mL], p < 0.001. Serum ferritin levels and the renal recovery significantly positively correlated (r = 0.72, p < 0.001). In multiple linear regression analysis, higher serum ferritin was associated with renal function recovery (OR 3.68, CI 2.02-3.97, p < 0.001). The optimal cut-off point of 240.5 ng/mL was determined for serum ferritin, which showed a sensitivity of 75.8% and a positive predictive value of 90%. In conclusion, serum ferritin levels on admission may be used as a prognostic marker for predicting renal recovery in AKI patients.


Asunto(s)
Lesión Renal Aguda/sangre , Lesión Renal Aguda/fisiopatología , Ferritinas/sangre , Pruebas de Función Renal , Recuperación de la Función , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hierro/metabolismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Curva ROC
20.
Artículo en Inglés | MEDLINE | ID: mdl-31195607

RESUMEN

The aim of this study was to assess the influence of active tobacco smoke exposure in utero on the concentration of hepcidin and selected iron markers in umbilical cord blood and to evaluate the relationships between these parameters. Newborns of smoking mothers had significantly lower concentrations of serum hepcidin (p < 0.001), iron, and ferritin (p = 0.043; p = 0.042, respectively), but higher levels of erythropoietin (EPO, p < 0.001) and soluble transferrin receptor (sTfR, p = 0.011) compared with newborns of non-smoking women. Negative correlations between cotinine and the number of cigarettes smoked per day with hepcidin serum level (r = -0.33, p = 0.033, r = -0.32, p = 0.041, respectively) and EPO (r = 0.47, p = 0.002; r = 0.46, p = 0.003, respectively) were found. Univariate analysis defined for the whole group of children revealed significant associations between the concentration of hepcidin and other iron status parameters. In the models estimated separately for smokers and non-smokers, we found relations between the level of hepcidin and erythropoietin (B = -0.23, p = 0.004; B = -0.46, p = 0.01, respectively). In the multivariate regression model, a negative association between hepcidin and EPO concentrations in the whole group of newborns (ß = -0.53; p = 0.001) and in the group of smokers (ß = -0.57; p = 0.011) was confirmed. The present study shows significant relations between smoking during pregnancy and hepcidin levels in children born at term. Decreased cord serum concentrations of hepcidin associated with high erythropoietin levels suggest induced fetal erythropoiesis, probably due to the hypoxic effects imposed by maternal smoking.


Asunto(s)
Hepcidinas/sangre , Hierro/sangre , Intercambio Materno-Fetal , Contaminación por Humo de Tabaco , Adulto , Cotinina/sangre , Eritropoyetina/sangre , Femenino , Ferritinas/sangre , Sangre Fetal/química , Humanos , Recién Nacido , Masculino , Embarazo , Receptores de Transferrina/sangre , Fumar , Adulto Joven
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