Iron deficiency in healthy, term infants aged five months, in a pediatric outpatient clinic: a prospective study.

BACKGROUND: Iron deficiency (ID) is prevalent in Malaysian children. The incidence of ID in infants under 6 months of age is unknown. Our aim was to determine the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in healthy, term infants aged below 6 months in our hospital population. METHODS: A prospective longitudinal pilot study of mother-infant pairs was conducted on infants receiving routine immunizations in a mother and child clinic at a university hospital, in Kuala Lumpur, Malaysia. Mothers completed standardized questionnaires at 3- and 5-month postnatal visits. Maternal and infant full blood count, ferritin, and C-reactive protein (CRP) levels were measured at 3 months and for the infants repeated at 5 months. Infant anthropometric measurements were obtained at both visits. We conducted a univariate analysis to identify factors associated with ID and IDA. RESULTS: Altogether, 91 mother-infant pairs were enrolled, with 88 completing the study. No infant had ID or IDA at 3 months; the lowest ferritin level was 16.6 µg/L. At 5 months, 5.9% (5/85) of infants had ID, and 2.4% (2/85) had IDA. Median (interquartile range) infant ferritin levels significantly declined from 113.4 (65.0-183.6) µg/L at 3 months to 50.9 (29.2-70.4) µg/L at 5 months, p < 0.001. Exclusive breastfeeding until 3 or 5 months was significantly associated with ID at 5 months (p = 0.020, and p = 0.008, respectively) on univariate analysis. The drop in ferritin between 3-5 months was significantly associated with weight and length gains between 0-3 months (p = 0.018, p = 0.009, respectively). Altogether, 14.3% of infants exclusively breastfed until 5 months developed ID. At 5 months, 3.4% of infants were underweight, 1.1% stunted, and 10.2% wasted. CONCLUSIONS: In exclusively breastfed term infants, ID occurred by 5 months. Early introduction of iron-rich foods should be considered in exclusively breastfed babies. A high prevalence of wasting suggests a calorie deficit in this population and will lead to stunting if not addressed.

Iron deficiency and child psychomotor development in a rural region of Chota, Peru, 2022 / Deficiencia de hierro y desarrollo psicomotor infantil en una zona rural de Chota, Perú 2022 / Deficiência de ferro e desenvolvimento psicomotor infantil em uma área rural de Chota, Peru 2022

Introduction: Iron deficiency and psychomotor developmental delay are two public health problems that cause high childhood morbidity and mortality worldwide, which can be related to social, economic, cultural and health factors that affect the environment where children and their family live. Objective: To determine the relationship between iron deficiency anemia and psychomotor development in children aged 2 to 4 years treated at the Cuyumalca Clinic, Chota. Materials and methods: Relational, cross-sectional study conducted on 48 children, who underwent hemoglobin testing through a portable hemoglobinometer and were subjected to the Psychomotor Development Test. Results: 31.2% of the children displayed some type of anemia, with the most common being moderate anemia (17.7%). On average, 10.9% showed some type of psychomotor developmental delay, including coordination (6.3%), language (8.4%), motor skills (16.7%), and overall development (12.5%). 4.2% of the children who had minor to moderate anemia showed developmental delay risks in the three assessed areas as well as in their overall development. Conclusion: There is no statistically significant relationship between iron deficiency anemia and several domains of psychomotor development, including coordination, language, motor skills as well as overall development.

Introducción: La deficiencia de hierro y las alteraciones en el desarrollo psicomotor son dos problemas de salud pública que causan una alta morbimortalidad infantil alrededor del mundo. Los estudios apuntan a que esto se relaciona con los factores sociales, económicos, culturales y sanitarios en los que el niño y su familia vive. Objetivo: Determinar la relación entre anemia ferropénica y desarrollo psicomotor en niños de 2 a 4 años atendidos en el Puesto de Salud de Cuyumalca, Chota. Materiales y métodos: Estudio relacional, transversal, desarrollado con 48 niños a quienes se les realizó un dosaje de hemoglobina con hemoglobinómetro portátil y se les aplicó el Test de Desarrollo Psicomotor. Resultados: El 31,2% de niños presentaron algún tipo de anemia, siendo la anemia moderada la más frecuente (16,7%); en promedio 10,9% evidenciaron alguna alteración en el desarrollo psicomotor en coordinación (6,3%), lenguaje (8,4%), motricidad (16,7%) y desarrollo global (12,5%). El 4,2% de niños con riesgo para el desarrollo presentaron anemia leve o moderada en las tres áreas evaluadas, al igual que en el desarrollo global. Conclusión: No existe relación estadística significativa entre anemia ferropénica y desarrollo psicomotor para las áreas de coordinación, lenguaje y motricidad; además del desarrollo global.

Introdução: A deficiência de ferro e as alterações no desenvolvimento psicomotor são dois problemas de saúde pública que causam elevada morbidade e mortalidade infantil em todo o mundo. Estudos sugerem que isso está relacionado aos fatores sociais, econômicos, culturais e de saúde em que vivem a criança e sua família. Objetivo: Determinar a relação entre anemia ferropriva e desenvolvimento psicomotor em crianças de 2 a 4 anos atendidas no Posto de Saúde Cuyumalca, Chota. Materiais e métodos: Estudo relacional, transversal, desenvolvido com 48 crianças que realizaram dosagem de hemoglobina com hemoglobinômetro portátil e foi aplicado o Teste de Desenvolvimento Psicomotor. Resultados: 31,2% das crianças apresentaram algum tipo de anemia, sendo a anemia moderada a mais frequente (16,7%); em média, 10,9% apresentaram alguma alteração no desenvolvimento psicomotor na coordenação (6,3%), linguagem (8,4%), motricidade (16,7%) e desenvolvimento global (12,5%). 4,2% das crianças em risco de desenvolvimento apresentaram anemia leve ou moderada nas três áreas avaliadas, bem como no desenvolvimento global. Conclusão: Não há relação estatística significativa entre anemia ferropriva e desenvolvimento psicomotor para as áreas de coordenação, linguagem e motricidade; bem como o desenvolvimento global.

Incidence of Hypophosphatemia After Intravenous Administration of Iron: A Matching-Adjusted Indirect Comparison of Data from Japanese Randomized Controlled Trials.

INTRODUCTION: Intravenous (IV) administration of iron is considered a safe and efficacious treatment for iron deficiency anemia (IDA), recommended in patients requiring rapid replenishment of iron, or intolerant or unresponsive to oral administration of iron. Recent randomized controlled trials (RCTs) have shown high incidence of hypophosphatemia after administration of two IV iron preparations: saccharated ferric oxide (SFO) and ferric carboxymaltose (FCM). The present study aimed to conduct matching-adjusted indirect comparison (MAIC) of hypophosphatemia incidence with these iron formulations and ferric derisomaltose (FDI) based on data from head-to-head RCTs conducted in Japan. METHODS: A MAIC of hypophosphatemia incidence was conducted on the basis of data from two head-to-head RCTs. The relative odds of hypophosphatemia with FDI versus SFO were obtained from patient-level data from a recent RCT and adjusted for cumulative iron dose, while parametric models of serum phosphate levels from a separate RCT were used to estimate the relative odds of hypophosphatemia with FCM with SFO. An anchored MAIC was then conducted comparing FDI with FCM. RESULTS: The adjusted odds of experiencing hypophosphatemia were significantly lower with FDI than SFO [odds ratio (OR) of 0.02; 95% confidence interval (CI) 0.01-0.05]. The parametric models of serum phosphate from the RCT comparing FCM with SFO provided an estimated OR of 1.17 for the incidence of hypophosphatemia with FCM versus SFO. Combining the two estimates in the MAIC showed that the odds of experiencing hypophosphatemia would be 52.5 (95% CI 27.7-99.4) times higher with FCM than FDI in patients with IDA associated with heavy menstrual bleeding in Japan. CONCLUSIONS: Direct comparison of patient-level data and a MAIC from two RCTs in Japanese patients with heavy menstrual bleeding indicated that hypophosphatemia is less frequent in patients treated with FDI than those with FCM or SFO. Results are in agreement with RCTs comparing FDI and FCM in patients with various etiologies conducted in the USA and Europe.

[The efficacy and safety of intravenous sucrose iron therapy for recurrent iron deficiency anemia].

Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) µg/L, and 54% (14/26) of these patients had SF levels of ≥100 µg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) µg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 µg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.

Programa Nacional de Suplementação de Ferro nos primeiros mil dias de vida em Salvador (BA) / National Iron Supplementation Program in the first thousand days of life in Salvador (BA) / Programa Nacional de Suplementación de Hierro en los primeros mil días de vida en Salvador, Bahía

Os primeiros mil dias de vida correspondem ao período desde a concepção até os primeiros dois anos após o nascimento. Durante essa fase, as necessidades nutricionais são elevadas devido às aceleradas alterações fisiológicas inerentes ao período, e o ferro está entre os micronutrientes mais requisitados. Considerando que a anemia, em especial por deficiência de ferro, é um problema de saúde pública, principalmente nessa fase da vida, foi instituído em 2005 o Programa Nacional de Suplementação de Ferro (PNSF). No entanto, há uma lacuna de estudos que analisam sua execução em municípios da Bahia. Por esse motivo, este estudo observacional descritivo objetivou avaliar a cobertura real do PNSF entre gestantes e crianças de 6 a 24 meses de vida, público-alvo do programa, no município de Salvador (BA), entre os anos de 2017 e 2022, a partir da análise de dados secundários disponibilizados pelo Ministério da Saúde. A cobertura real do PNSF ocorreu de forma insatisfatória no município, alcançando quantidades inferiores a 7% das gestantes e 1% das crianças, entre os anos de 2019 e 2021, e valores iguais a 0% para ambos os grupos nos anos de 2017, 2018 e 2022. Tais resultados podem ser motivados por diferentes fatores, como problemas operacionais na gestão/monitoramento do programa e/ou a baixa adesão da população. Destaca-se, assim, a necessidade da constante avaliação do desempenho do PNSF no intuito de identificar suas limitações e propor melhorias em sua execução.

The first thousand days of life correspond to the period from conception to the first two years after birth. During this phase, nutritional needs are high due to the accelerated physiological changes inherent to the period, and iron is among the most required micronutrients. Considering that anemia, especially due to iron deficiency, is a public health problem, especially at this stage of life, the National Iron Supplementation Program (PNSF) was instituted in 2005. However, there is a lack of studies that analyze its execution on municipalities in Bahia (BA). For this reason, this descriptive observational study aimed to evaluate the coverage of the PNSF among pregnant women and children between 6 and 24 months of life, the target audience of the program, in the municipality of Salvador (BA), between 2017 and 2022, based on the analysis of secondary data provided by the Ministry of Health. The actual coverage of the PNSF occurred unsatisfactorily in the municipality, reaching numbers below 7% of pregnant women and 1% of children, between the years 2019 and 2021, and values equal to 0% for both groups in the years 2017, 2018, and 2022. Such results can be due to different factors, such as operational problems in the management/monitoring of the program and/or the low adherence of the population. Thus, we highlight the need for constant evaluation of the PNSF performance to identify its limitations and propose improvements in its execution.

Los primeros mil días de vida corresponden al período que va desde la concepción hasta los primeros dos años después del nacimiento. Durante esta fase, las necesidades nutricionales son elevadas, debido a los cambios fisiológicos acelerados propios del período, y el hierro es uno de los micronutrientes más requeridos. Como la anemia, especialmente por deficiencia de hierro, es un problema de salud pública, especialmente en esta etapa de la vida, en 2005 se instituyó el Programa Nacional de Suplementación con Hierro (PNSF, por sus siglas en portugués). Sin embargo, faltan estudios que analicen su ejecución en municipios de Bahía (Brasil). Por esta razón, este estudio observacional descriptivo tuvo por objetivo evaluar la cobertura real del PNSF en mujeres embarazadas y en niños de entre 6 y 24 meses de vida, público objetivo del programa, en la ciudad de Salvador (Bahía), entre 2017 y 2022, con base en el análisis de datos secundarios proporcionados por el Ministerio de Salud. La cobertura real del PNSF se presentó de manera insatisfactoria en el municipio, alcanzando cifras inferiores al 7% de embarazadas y al 1% de niños, entre los años 2019 y 2021, con valores iguales al 0% para ambos grupos analizados en los años 2017, 2018 y 2022. Estos resultados pueden ser causados por diferentes factores, entre ellos, problemas operativos en la gestión/seguimiento del programa y/o baja adherencia de la población. Así, se destaca la necesidad de una evaluación constante del desempeño del Programa para identificar sus limitaciones y proponer mejoras en su ejecución.

Bilateral interstitial keratitis in a patient with presumed brain tuberculoma / Ceratite intersticial bilateral em um paciente com tuberculoma cerebral presumido

ABSTRACT Interstitial keratitis is an inflammation of the corneal stroma without epithelium or endothelium involvement. The underlying causes are mostly infectious or immune mediated. Brazil has one of the highest incidence rates of tuberculosis in the world. Tuberculosis is considered one of the causes of interstitial keratitis. Malnutrition and anemia are risk factors of the disseminated disease. This is a case report of a 10-year-old child who presented with decreased visual acuity and a clinical diagnosis of bilateral interstitial keratitis and sclero-uveitis. The patient had been treated with topical steroids with partial improvement. Examinations revealed severe iron deficiency anemia, negative serologies for human immunodeficiency virus and syphilis, positivity for cytomegalovirus- and herpes simplex-specific IgG, and purified protein derivative of 17 mm. During the follow-up, the patient presented with tonic-clonic seizures, and magnetic resonance imaging findings suggested a central nervous system tuberculoma. Interstitial keratitis improvement was observed after specific tuberculosis treatment. This is the first case report describing the association of interstitial keratitis and central nervous system tuberculoma.

RESUMO A ceratite intersticial é uma inflamação do estroma corneano sem envolvimento epitelial ou endotelial causada principalmente por doenças infecciosas e imunomediadas. O Brasil tem altas taxas de tuberculose que deve ser lembrada como causa de ceratite intersticial. Desnutrição e anemia são fatores de risco da forma disseminada da tuberculose. Este é um relato de uma criança de 10 anos com redução de acuidade visual e diagnóstico clínico de ceratite intersticial bilateral e esclerouveíte. O paciente obteve melhora parcial da ceratite com corticoide tópico. Exames laboratoriais mostraram anemia ferropriva grave, sorologias negativas para HIV e sífilis; IgM negativo e IgG positivo para citomegalovírus e herpes simplex e PPD positivo (17 mm). Ele evoluiu com crises tônico-clônicas e a ressonância nuclear magnética revelou tuberculoma do sistema nervoso central. A melhora da ceratite intersticial foi observada após tratamento para tuberculose. Este é o primeiro caso que descreve a associação de ceratite intersticial e tuberculoma do sistema nervoso central.

The efficacy and safety of intravenous sucrose iron therapy for recurrent iron deficiency anemia / 中华血液学杂志

Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) μg/L, and 54% (14/26) of these patients had SF levels of ≥100 μg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) μg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 μg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.

Prevalencia de anemia ferropénica y factores asociados en embarazadas peruanas / Prevalence of iron deficiency anemia and associated factors in Peruvian pregnant women

Objetivo: Evaluar la prevalencia de la anemia ferropénica y los factores asociados en embarazadas peruanas, 2021. Métodos: Estudio observacional de diseño transversal retrospectivo y analítico, por medio de un análisis secundario de la base de datos de la Encuesta Demográfica y de Salud Familiar a 1070 gestantes para evaluar la anemia y sus posibles factores. Se realizó un análisis estadístico con una regresión logística binaria y multivariada. Resultados: La prevalencia de anemia en las gestantes fue de 29,7% y se asoció con el trabajo actual de la gestante (PRa: 0,53), el trabajo de la pareja en ventas o servicios (PRa: 4,15), el segundo trimestre de gestación (PRa: 2,07), la obesidad (PRa: 0,48) y el consumo de agua de la naturaleza (PRa: 2,23). Conclusiones: La prevalencia de anemia en Perú revela un problema moderado de salud pública y sus factores asociados son el trabajo de la pareja en ventas, el estar en el segundo trimestre de gestación y al consumo de agua de la naturaleza. Asimismo, los factores con menos posibilidad a tener anemia son el trabajo actual de la gestante y la obesidad. Por ende, las políticas y programas multidisciplinarios deben enfocarse a estos factores.(AU)

Objective: To evaluate the prevalence of iron deficiency anemia and associated factors in Peruvian pregnant women, 2021. Methods: Observational study of retrospective and analytical cross-sectional design, through a secondary analysis of the database of the Demographic and Family Health Survey of 1070 pregnant women to evaluate anemia and its possible factors. A statistical analysis was performed with a binary and multivariate logistic regression. Results: The prevalence of anemia in pregnant women was 29.7% and was associated with the current job of the pregnant woman (PRa: 0.53), the job of the partner in sales or services (PRa: 4.15), the second trimester of gestation (PRa: 2.07), obesity (PRa: 0.48) and water consumption from nature (PRa: 2.23). Conclusions: The prevalence of anemia in Peru reveals a moderate public health problem and its associated factors are the work of the couple in sales, being in the second trimester of pregnancy and the consumption of water from nature. Likewise, the factors with the least possibility of having anemia are the current job of the pregnant woman and obesity. Therefore, multidisciplinary policies and programs should focus on these factors.(AU)

Prevalence and correlates of childhood anemia in the MINA-Brazil birth cohort study / Prevalência e preditores de anemia na infância no estudo de coorte de nascimentos MINA-Brasil

ABSTRACT OBJECTIVE: This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study. METHODS: Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]). RESULTS: The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0-21.0%), 42.6% (38.0-47.2%), and 8.7% (6.3-11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7-45.8%) of the study children were anemic, 38.4% (34.6-42.3%) were iron-deficient, and 26.3 (23.0-29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6-15.2%), 18.1% (15.5-21.1%), and 4.1% (2.8-5.7%), respectively; at five years of age (n = 655), 5.2% (3.6-7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84-2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14-2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17-2.39), malaria since birth (2.25; 1.30-3.87), and iron deficiency (2.15; 1.47-3.15), after adjusting for children's age and household wealth index. CONCLUSIONS: Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children.

RESUMO OBJETIVO: O objetivo deste estudo foi descrever a prevalência e os preditores de anemia na infância em um estudo de coorte de nascimentos de base populacional amazônica. MÉTODOS: Estimou-se a prevalência de anemia materna no parto (concentração de hemoglobina [Hb] < 110 g/L) em mulheres participantes do estudo de coorte de nascimentos MINA-Brasil e em seus filhos, examinados nas idades um, dois (Hb < 110 g/L) e cinco anos (Hb < 115 g/L). Além disso, as concentrações de ferritina, receptor solúvel de transferrina e proteína C reativa foram medidas em mães no parto e em seus filhos de 1 e 2 anos de idade para estimar a prevalência de deficiência de ferro e sua contribuição para anemia, ajustando para potenciais fatores de confusão por análise de regressão múltipla de Poisson (risco relativo ajustado [RRa]). RESULTADOS: As prevalências com intervalo de confiança (IC) de 95% de anemia materna, deficiência de ferro e anemia ferropriva no parto foram de 17,3% (14,0-21,0%), 42,6% (38,0-47,2%) e 8,7% (6,3-11,6%), respectivamente (n = 462). No primeiro ano de idade (n = 646), 42,2% (38,7-45,8%) das crianças estudadas eram anêmicas, 38,4% (34,6-42,3%) eram deficientes em ferro e 26,3 (23,0-29,9%) tinham anemia ferropriva. Aos dois anos de idade (n = 761), esses valores diminuíram para 12,8% (10,6-15,2%), 18,1% (15,5-21,1%) e 4,1% (2,8-5,7%), respectivamente; aos cinco anos de idade (n = 655), 5,2% (3,6-7,2%) eram anêmicos. A deficiência de ferro (RRa = 2,19, IC95%: 1,84-2,60) e consumo de alimentos ultraprocessados (AUP) (RRa = 1,56, IC95%: 1,14-2,13) foram contribuintes significantes para anemia no 1° ano de idade, após ajuste para escolaridade materna. Aos 2 anos, a anemia associou-se significativamente à anemia materna no parto (RRa = 1,67; IC95%: 1,17-2,39), malária desde o nascimento (2,25; 1,30-3,87) e deficiência de ferro (2,15; 1,47-3,15), após ajuste para idade das crianças e índice de riqueza familiar. CONCLUSÕES: A anemia continua sendo altamente prevalente durante a gravidez e a primeira infância na Amazônia. Políticas públicas de saúde devem abordar a deficiência de ferro, o consumo de AUP, a anemia materna e a malária para prevenir e tratar a anemia em crianças amazônicas.

Developmental status of iron deficiency anemia and factors among preschool children in Dongguan / 中国学校卫生

Objective@#To analyze the influencing factors and physical and mental development of preschool children with iron deficiency anemia in Dongguan, so as to provide a reference for the prevention of iron deficiency anemia among preschool children.@*Methods@#A total of 118 preschool children with iron deficiency anemia who were examined in Dongguan Maternal and Child Health Center from January 2022 to December 2022 were enrolled in the anemia group, and 118 preschool healthy children who were examined in the hospital at the same time were enrolled in the control group. The physical and mental development of the children were evalucded in both groups. Demographic information and household per capita income were collected. The relationship between risk factors and iron deficiency anemia was analyzed by univariate analysis and multiple Logistic regression.@*Results@#The scores of fine motor skills, gross motor skills, adaptability, social communication, language ability and developmental quotient of children in anemia group were significantly lower than those in control group ( t =4.14, 5.46, 5.60, 5.50, 4.90, 5.83, P <0.01). The difference in scores of adaptability, fine motor skills, gross motor skills language ability, social communication and developmental quotient between the two groups increased with age ( F =390.56, 414.63, 437.35, 409.68, 407.20, 404.54, P < 0.05 ). Multivariate Logistic regression analysis showed that household income, history of past digestive disease, gestational age, maternal anemia during pregnancy, maternal education, consumption of meat, eggs and milk, and intake of nuts were all associated with iron deficiency anemia among preschool children in Dongguan ( OR =2.23，2.99，3.99，3.56，3.11，1.68，1.61, P < 0.05 ).@*Conclusion@#The physical and mental development of preschool children with iron deficiency anemia in Dongguan is slower than that of non anemia children of the same age, and the development delay becomes more obvious with increasing age. Attention should be paid to the prevention of iron deficiency anemia among preschool children. It is important to provide reasonable dietary guidance for children with high risk factors such as digestive disease history and prematurity.

Effects of Iron Sucrose and Erythropoietin on Transfusion Requirements in Patients with Preoperative Iron Deficiency Anemia Undergoing on-Pump Coronary Artery Bypass Graft.

Background: Preoperative anemia is an independent risk factor for higher rates of blood transfusion in cardiac surgery. This study aimed to evaluate the effects of intravenous iron sucrose and erythropoietin on transfusion requirements in patients with preoperative iron deficiency anemia (IDA) undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods: In this open-label, randomized clinical trial, patients with preoperative IDA who were candidates for on-pump CABG were randomized into intervention (iron plus erythropoietin) or control groups. Iron sucrose was administered as a 200 mg intravenous dose and erythropoietin as a 100 IU/kg bolus 1 to 2 days before surgery. The primary outcome was the amount of blood transfusion during the first 4 postoperative days. Results: The study population consisted of 114 patients. The mean age was 64.11±8.18 years in the intervention group and 63.35±8.70 years in the control group. Twenty-seven patients (47.4%) in the intervention group and 25 (43.9%) in the control group were males. The number of red blood cell units transfused per patient exhibited a significant fall in the intervention group compared with the control group (P˂0.001). The ferritin level showed a significant rise in the intervention group on postoperative day 7 (P=0.027). The length of stay in the intensive care unit and the hospital was significantly lower in the intervention arm (P=0.041 and P=0.006, respectively). No adverse events were reported in both groups. Conclusion: The use of erythropoietin and iron sucrose 1 to 2 days before surgery significantly decreased the need for blood transfusion in patients with IDA undergoing CABG without any significant adverse events.

Intervención educativa virtual sobre anemia en gestantes / Intervenção educativa virtual sobre anemia em gestantes / Virtual educational intervention on anemia for pregnant women

Objetivo: evaluar la efectividad de una intervención educativa virtual en los conocimientos sobre la anemia ferropénica en gestantes. Materiales y método: estudio preexperimental pretest-postest mono grupo, realizado en un centro de salud ubicado en Lima Norte (Perú) con una población de 30 gestantes. Después del pretest se planificó y realizó la intervención educativa, usando medios digitales y videoconferencia. Luego de dos semanas se aplicó el postest. La prueba de Kolmogorov-Smirnov fue empleada para determinar la distribución de normalidad de la variable de conocimientos sobre anemia ferropénica. Posteriormente, se aplicó la estadística descriptiva para evaluar las características sociodemográficas y obstétricas y la estadística inferencial para comprobar la hipótesis de la investigación mediante la prueba t de Student pareada. Resultados: la media de edad fue de 27,33 años y el 43,33 % de la muestra presentó anemia. Asimismo, la mayoría de las participantes reportó haber alcanzado la educación secundaria (60 %), no contar con una ocupación remunerada (66,67 %), encontrarse en el segundo trimestre de embarazo (63,33 %), haber asistido solo a dos controles prenatales (50 %) y tener más de un hijo (60 %). Se observó un aumento de los conocimientos sobre la anemia ferropénica después de la intervención (media de la diferencia: 2,1 puntos, p< 0,001). De igual forma, se observó un aumento de puntaje en las dimensiones sobre las generalidades de la anemia, sus consecuencias y una alimentación saludable. Conclusiones: la intervención educativa virtual es efectiva en el aumento de conocimientos sobre anemia ferropénica de las gestantes. Por lo tanto, se recomienda que de manera habitual el profesional de enfermería aplique esta intervención en una población más amplia de gestantes.

Objetivo: avaliar a eficácia de uma intervenção educativa virtual sobre o conhecimento da anemia por deficiência de ferro em mulheres grávidas. Materiais e método: estudo pré-experimental, pré e pós-teste, num único grupo, realizado num centro de saúde localizado no norte de Lima, Peru. A população consistiu em 30 mulheres grávidas. Após o pré-teste, a intervenção educacional foi planejada e realizada com a utilização de meios digitais e videoconferência. Após algumas semanas, o pós-teste foi aplicado. O teste Kolmogorov-Smirnov foi utilizado para determinar a distribuição de normalidade da variável "conhecimento da anemia por deficiência de ferro". Posteriormente, aplicaramse a estatística descritiva para avaliar as características sociodemográficas e obstétricas, e a estatística inferencial para testar a hipótese de pesquisa por meio do teste t de Student pareado. Resultados: a idade média foi de 27,33 anos e 43,33% esteve anêmica. Além disso, a maioria teve estudos secundários (60%), não teve qualquer ocupação remunerada (66,67%), esteve no segundo trimestre de gravidez (63,33%), frequentou apenas dois exames pré-natais (50%) e teve mais do que um filho (60%). Houve um aumento no conhecimento da anemia por deficiência de ferro após a intervenção (diferença média: 2,1 pontos, p < 0,001). Do mesmo modo, observou-se um aumento das pontuações nas dimensões "generalidades da anemia", "consequências" e "alimentação saudável". Conclusões: a intervenção educativa virtual é eficaz no aumento do conhecimento da anemia por deficiência de ferro em mulheres grávidas. Portanto, recomendase que o profissional de enfermagem aplique regularmente essa intervenção a uma população mais ampla de gestantes.

Objective: To evaluate the effectiveness of a virtual educational intervention on the knowledge regarding iron deficiency anemia in pregnant women. Materials and method: Pre-experimental pretest-posttest monogroup study carried in a health center in North Lima (Peru) with a population of 30 pregnant women. After the pretest, the educational intervention was planned and conducted using digital media and videoconference. After two weeks, the posttest was applied. The Kolmogorov-Smirnov test was used to determine the normal distribution of the variable knowledge about iron deficiency anemia. Subsequently, descriptive statistics were applied to evaluate participants' sociodemographic and obstetric characteristics, and inferential statistics to test the research hypothesis using the paired Student's t-test. Results: Participants' mean age was 27.33 years and 43.33% of them reported anemia. Most of the individuals in the sample had secondary education (60%), did not have a remunerative occupation (66.67%), were in the second trimester of pregnancy (63.33%), had attended only two prenatal controls (50%), and had more than one child (60%). An increase in knowledge about iron deficiency anemia was observed after the intervention (mean difference: 2.1 points, p < 0.001). Similarly, an increase in scores was observed in the dimensions of generalities of anemia, its consequences, and healthy eating habits. Conclusions: The virtual educational intervention is effective in increasing knowledge about iron deficiency anemia in pregnant women. Therefore, it is recommended that nursing professionals consistently apply this intervention to a broader population of pregnant women.

[Anemia in Chronic Kidney Disease: The State of the Art]. / Anemia da Doença Renal Crónica: O Estado da Arte.

The aging of the population has led to an increased prevalence of chronic diseases such as chronic kidney disease. Anemia is one of the most frequent complications of chronic kidney disease, with an impact not only on the quality of life but also on the patient's prognosis and associated costs. Knowledge in this therapeutic area has increased significantly: from the appearance of recombinant erythropoietin in 1989, through the use of increasing doses of parenteral iron and, more recently, to new molecules such as hypoxia-inducible factor inhibitors. The aim of this article is to present a pragmatic review of the state of the art in the epidemiology, pathophysiology, diagnosis and treatment of anemia associated with chronic kidney disease.

O envelhecimento populacional tem-se traduzido no aumento de prevalência de doenças crónicas como a doença renal crónica. A anemia é uma das complicações mais frequentes da doença renal crónica, com impacto não só na qualidade de vida como no prognóstico do doente e nos custos associados. O conhecimento nesta área terapêutica tem aumentado de forma significativa: desde o aparecimento da eritropoietina recombinante em 1989, passando pelo uso de doses crescentes de ferro parentérico e, mais recentemente, a novas moléculas como os inibidores do hypoxia-inducible factor. Os autores pretendem rever, de uma forma pragmática, o estado da arte da anemia associada à doença renal crónica, desde a epidemiologia, à fisiopatologia, ao diagnóstico e ao tratamento.

Improving Awareness about Patient Blood Management in Portugal: A Call for Action Arising from a Delphi Panel.

INTRODUCTION: Anaemia and iron deficiency are associated with increased mortality and poor surgical outcomes. Consensus in their definitions is expected to optimize their management, which is encompassed by patient blood management, providing patient-centred care while improving patient safety and clinical outcomes. Patient blood management implementation is even more relevant in contingency times and faces barriers due to lack of standardization, among others. The aim is to establish a consensus on these diagnoses and implement patient blood management principles in clinical practice in Portugal. MATERIAL AND METHODS: Eight experts in Transfusion Medicine, Haematology, Anaesthesiology, Internal Medicine, and Obstetrics/Gynaecology were assembled; a focus group was conducted, defining 33 statements. A Delphi panel was conducted, with experts from the clinical specialities named above as well as from General Surgery, Urology, and Orthopaedics. RESULTS: The Delphi panel's rounds had 70 (Round 1) and 46 (Round 2) respondents. Specialists were consensual in only two statements, on the existence of a preoperative patient blood management consultation for candidates to elective surgeries in which the use of blood derivatives is anticipated and, on the importance of the correction of postoperative anaemia and iron deficiency. Of the remaining 31 statements, 27 reached high agreement or disagreement by the respondents. CONCLUSION: Consensus was reached in only two (6%) of the 33 statements. There was a consensual agreement on the relevance of establishing patient blood management as the standard of care and of valuing preoperative and postoperative patient blood management interventions. Nevertheless, our results point to the lack of awareness regarding patient blood management principles - which could result in better postoperative outcomes, shorter hospitalizations, reduced costs and increased availability of beds. Training and literacy initiatives could help further implement patient blood management standards in Portuguese hospitals.

Introdução: A anemia e ferropenia estão associadas a um aumento da mortalidade e a piores resultados no período pós-operatório. Consensualizar as suas definições permitirá otimizar a sua gestão. O patient blood management engloba essa gestão, com relevo acrescido em situações de contingência, focado nos cuidados centrados no doente e na melhoria da segurança e dos outcomes. As barreiras à implementação de princípios patient blood management prendem-se, entre outras, com falta de padronização. Pretende--se estabelecer um consenso sobre estes diagnósticos e implementação de patient blood management na prática clínica em Portugal. Material e Métodos: Foram reunidos oito especialistas em Imuno-hemoterapia, Hematologia Clínica, Anestesiologia, Medicina Interna e Obstetrícia/ Ginecologia. Foi realizado um focus group, onde foram definidas 33 afirmações. Além disso, foi realizado um painel Delphi, com especialistas das áreas mencionadas acima, assim como de Cirurgia Geral, Urologia e Ortopedia. Resultados: As duas rondas do painel Delphi tiveram, respetivamente, 70 e 46 respondedores. Estes foram consensuais em apenas duas afirmações, na existência de consulta pré-operatória de patient blood management para os candidatos a cirurgias eletivas em que se antecipa o uso de hemoderivados e, na importância da correção da anemia e ferropenia pós-operatórias. Das 31 afirmações restantes, 27 atingiram alta concordância ou discordância pelos respondentes. Conclusão: Foi alcançado consenso em apenas duas (6%) das 33 afirmações. Houve consenso sobre a relevância de estabelecer o patient blood management como standard of care e a valorização das intervenções de patient blood management pré e pós-operatórias. No entanto, os resultados indiciam falta de consciencialização sobre os princípios de patient blood management ­ que poderiam levar a melhores resultados pós-operatórios, com redução do tempo de hospitalização e dos custos e maior disponibilidade de camas. Iniciativas de formação e literacia poderiam ajudar a uma melhor implementação dos princípios de patient blood management nos hospitais portugueses.

[Nutritionnal complications and patients follow-up after bariatric surgery]. / Complications nutritionnelles de la chirurgie bariatrique et surveillance des patients opérés.

NUTRITIONNAL COMPLICATIONS AND PATIENTS FOLLOW-UP AFTER BARIATRIC SURGERYBariatric surgery is the most consistently effective method for sustained weight reduction and can result in a substantial improvement in overall survival in patients with severe obesity. Complex mechanisms underlying metabolic benefits could also drive preventable, but potentially life-threatening, long-term nutritional complications. Consequently, physicians should be familiar with the lifelong monitoring of patients after bariatric surgery and the potential long-term complications in this paradoxical situation where the long-awaited weight loss can lead to severe nutritional complications.

COMPLICATIONS NUTRITIONNELLES DE LA CHIRURGIE BARIATRIQUE ET SURVEILLANCE DES PATIENTS OPÉRÉS La chirurgie bariatrique est le traitement le plus efficace en termes de perte pondérale durable et de réduction de la morbi-mortalité en cas d'obésité sévère. Cependant, les modifications profondes de la physiologie digestive qui sous-tendent ces bénéfices métaboliques peuvent entraîner des carences nutritionnelles qui peuvent induire des complications sévères et irréversibles. La population des patients bariatriques étant en constante augmentation, tout médecin peut être amené à prendre un charge un patient opéré. Il devrait donc connaître les principes de la surveillance à vie et les possibles complications à long terme dans cette situation si paradoxale où la perte de poids tant attendue peut aussi s'associer à des carences potentiellement sévères.

Avances en el diagnóstico y tratamiento de deficiencia de hierro y anemia ferropenica / Advances in the diagnosis and treatment of iron deficiency and iron deficiency anemia

RESUMEN Deficiencia de hierro (DH) y anemia ferropénica (AF) continúan siendo problemas de salud de magnitud en el mundo y afectan especialmente a niños preescolares y mujeres embarazadas. Este artículo tiene como objetivos: a) Describir las pruebas de laboratorio diagnóstico de AF y los factores que influyen en los niveles de ferritina y otros biomarcadores del estado del hierro; b) Presentar avances en el metabolismo del hierro, i.e. el rol regulador esencial de la hepcidina en la absorción y utilización del hierro; c) Describir el impacto que estos avances han tenido en el diseño de investigaciones clínicas comparando la absorción del hierro asociada con esquemas de ingesta diaria versus días alternados; d) Describir las situaciones clínicas en las cuales hierro endovenoso está indicado como tratamiento secundario o de primera línea. Los conceptos y sugerencias expresados en este artículo están basados en literatura actualizada y la experiencia clínica de los autores.

ABSTRACT Iron deficiency (ID) and iron deficiency anemia (IDA) are still major health problems worldwide, affecting especially preschool children and pregnant women. The objectives of this article are: a) To describe the laboratory tests for diagnosing IDA and the factors that may influence results of the serum ferritin and the other iron biomarkers ; b) To present advances in iron metabolism, i.e. the critical regulatory role of hepcidin in the absorption and utilization of iron ; c) To describe the impact this new knowledge has had in the design of clinical investigations comparing the absorption of iron following oral supplementation given in consecutive days vs. alternate days schedules; and, d) To describe the clinical situations in which intravenous iron is indicated as secondary or first-line treatment. The concepts expressed and the suggestions made in this article are based on updated literature and the clinical experience of the authors.

Helicobacter pylori infection and iron deficiency in non-elderly adults participating in a health check-up program.

BACKGROUND/AIMS: Helicobacter pylori infection is presumably associated with iron deficiency and iron deficiency anemia (IDA). This study aimed to evaluate the relationship between H. pylori infection and the decline in iron stores in non-elderly adults during their health check-ups. METHODS: We identified a total of 1,069 subjects who were tested for iron, ferritin, and total iron-binding capacity during their health check-ups, from January 2016 to May 2017. Of these, subjects who underwent endoscopy via rapid urease test and those aged 65 years or below were finally enrolled. RESULTS: Overall, 281 subjects were enrolled, and 187 patients (66.5%) tested positive for H. pylori. The mean age was 36.1 years (range, 22 to 65), and 176 subjects (62.6%) were male. The mean levels of hemoglobin (14.1 ± 1.7 g/dL vs. 14.6 ± 1.4 g/dL, p = 0.019) and ferritin (121.7 ± 106.9 ng/mL vs. 151.8 ± 107.8 ng/mL, p = 0.027) in the H. pylori-positive group were significantly lower than those in the H. pylori-negative group. Iron deficiency (ferritin < 30 ng/mL) was more common in patients with H. pylori infection (p = 0.002). There was no significant difference in anemia (hemoglobin < 13 g/dL in men, < 12 g/dL in women) or IDA (anemia, ferritin < 10 ng/mL, and transferrin saturation < 16%) with H. pylori. Logistic regression analysis demonstrated that female sex (odds ratio, 197.559; 95% confidence interval, 26.461 to 1,475.015) and H. pylori infection (odds ratio, 3.033; 95% confidence interval, 1.216 to 7.567) were factors associated with iron deficiency. CONCLUSION: H. pylori infection is associated with iron deficiency, suggesting a decline in iron stores among infected non-elderly adults.

A mutação do gene SLC11A2 está associada à anemia por deficiência de ferro refratária após cirurgia bariátrica? / Does slc11a2 gene mutation associate with iron-refractory iron-deficiency anemia after bariatric surgery?

ABSTRACT - BACKGROUND: After bariatric surgery, if there is iron-refractory iron-deficiency anemia (IRIDA) and does not respond to supplemental iron therapy, excluding other possible etiologies, genetic changes involved in iron metabolism should be considered. AIM: This study aimed to investigate the association of both mutations 1285G-C and 1246C-T, in the SLC11A2 gene, and the etiopathogenesis of anemia refractory to iron supplementation in patients undergoing bariatric surgery using Roux-en-Y gastric bypass (RYGB). METHODS: A case-control study was conducted, in which 100 patients were evaluated as Cases Group [subdivided into (i) with Anemia and (ii) without Anemia] and 100 individuals as Controls, comprising both sexes. Inherited and acquired causes of IRIDA were excluded. DNA was extracted from leukocytes of peripheral blood, and the regions that cover both mutations have been amplified by the molecular techniques such as polymerase chain reaction/restriction fragment length polymorphism. RESULTS: The 1285G-C mutation was not determined in any of the 400 alleles analyzed. Regarding the 1246C-T mutation, the wild CC genotype was found with a higher prevalence in the Control Group (34%) (OR 0.5475; 95%CI 0.2920-1.027; p=0.0827). The mutant TT genotype was found only in the Cases Group I (with Anemia) (13%). CONCLUSION: The results show the association between 1246C-T mutation, in the SLC11A2 gene, and the etiopathogenesis of IRIDA to iron supplementation in the evaluated sample. There are differences, at the molecular level, in patients with and without IRIDA after bariatric surgery using RYGB.

RESUMO - RACIONAL: Após cirurgia bariátrica, se houver anemia por deficiência de ferro e não responder à terapia de ferro suplementar, excluindo-se outras possíveis etiologias, alterações genéticas envolvidas no metabolismo férrico devem ser consideradas. OBJETIVO: Investigar a associação das mutações 1285G-C e 1246C-T, no gene SLC11A2, e a etiopatogênese da anemia refratária à suplementação de ferro em pacientes submetidos à cirurgia bariátrica pela técnica de derivação gástrica em Y-de-Roux. MÉTODOS: Estudo de caso-controle, no qual forma avaliados 100 pacientes em Grupos de Casos (subdividido em Grupo I - com Anemia e Grupo II - sem Anemia) e 100 indivíduos como Controles, de ambos os sexos. Causas hereditárias e adquiridas de anemia ferropriva refratária ao ferro, foram excluídas. O DNA foi extraído de leucócitos de sangue periférico e as regiões que abrangem ambas as mutações foram amplificadas pelas técnicas moleculares de Reação em Cadeia da Polimerase/Polimorfismo do Comprimento do Fragmento de Restrição. RESULTADOS: A mutação 1285G-C não foi determinada em quaisquer dos 400 alelos analisados. Em relação à mutação 1246C-T, o genótipo homozigoto selvagem CC foi encontrado com maior prevalência nos Controles (34%) (OR: 0,5475; 95%IC: 0,2920-1,027; p=0,0827). O genótipo homozigoto mutante TT foi encontrado apenas no Grupo I - com Anemia (13%). CONCLUSÃO: Os resultados demonstram a associação da mutação 1246C-T, no gene SLC11A2, e a etiopatogênese da anemia ferropriva refratária e persistente à suplementação de ferro, nesta amostra de pacientes. Há diferenças, em nível molecular, em pacientes com e sem anemia ferropriva refratária ao ferro após cirurgia bariátrica por derivação gástrica em Y-de-Roux.

Features of anemia in patients with alcoholic liver cirrhosis / 临床肝胆病杂志

Objective To investigate the laboratory and clinical features of anemia in patients with alcoholic liver cirrhosis. Methods A retrospective analysis was performed for the patients who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from December 2020 to May 2021 and were found to have anemia based on reticulocyte hemoglobin (Hb) content (Ret-He) and whole blood cell analysis, and 106 patients with the discharge diagnosis of alcoholic liver cirrhosis who had no history of upper gastrointestinal bleeding or blood transfusion were screened out as subjects. Clinical features and related influencing factors were retrospectively analyzed based on the severity of anemia, the cytomorphological classification of anemia, and Ret-He. The independent samples t -test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK- q test and the least significant difference t -test were used for further comparison between two groups. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was performed to investigate the correlation of different classification criteria for anemia with laboratory markers and clinical features. Results Among the 106 patients, there were 103 male patients (97.2%), with a mean age of 55.07±10.18 years and a mean Hb level of 87.16±18.55 g/L; there were 49 patients (46.2%) with mild anemia, 49 (46.2%) with moderate anemia, and 8(7.5%) with severe anemia; mean Ret-He was 33.65(13.3-46.4) pg, and there were 33 patients (31.1%) with ≤29 pg and 73 patients (68.9%) with Ret-He > 29 pg; among these patients, 46(43.4%) had macrocytic anemia, 34(32.1%) had normocytic anemia, 2(1.9%) had simple microcytic anemia, and 24 (22.6%) had microcytic hypochromic anemia; among these patients, 87(82.1%) had ascites and/or intra-abdominal infection, 82(77.4%) had splenomegaly and/or hypersplenism, 65(61.3%) had esophageal and gastric varices, and 31(29.2%) had hepatic encephalopathy. Compared with the control group (moderate/severe anemia), the mild anemia group had significantly higher Ret-He, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular-hemoglobin concentration (MCHC), serum iron (SI), and transferrin saturation (TS) (all P 29 pg (83.7% vs 56.1%, P =0.002) or normocytic anemia (44.9% vs 21.1%, P =0.009), a significantly lower unsaturated iron-binding capacity (UIBC) ( P 29 pg group, the Ret-He ≤29 pg group had significantly lower Hb, MCV, MCH, MCHC, SI, TS, and proportion of patients with mild anemia or ascites and/or intra-abdominal infection (all P < 0.05), a significantly higher UIBC ( P < 0.05), and a significantly higher proportion of patients with microcytic hypochromic anemia or esophageal and gastric varices ( P < 0.05). Hb, Ret-He, MCV, MCH, MCHC, UIBC, SI, and TS were correlated with the severity of anemia, the cytomorphological classification of anemia, and iron deficiency (all P < 0.05), and esophageal and gastric varices and ascites and/or abdominal infection were correlated with the cytomorphological classification of anemia and iron deficiency (all P < 0.05). Conclusion The degree of anemia is mostly mild and moderate in the decompensated stage of alcoholic liver cirrhosis, and macrocytic anemia and normocytic anemia are more common. The incidence rate of iron deficiency increases with the severity of anemia, and esophageal and gastric varices and ascites and/or intra-abdominal infection are correlated with the cytomorphological classification of anemia and iron deficiency; therefore, it is necessary to enhance the monitoring of iron deficiency anemia in such patients in clinical practice.

Anemia ferropénica en lactantes ingresados en un servicio de Pediatría / Iron deficiency anemia in infants admitted to a Pediatric service

RESUMEN Fundamento: la anemia se define como una reducción de la concentración de hemoglobina por debajo de los valores registrados en las personas sanas. En Cuba, al igual que en el resto del mundo, la anemia ferropénica constituye un problema de salud, con elevada frecuencia en pacientes pediátricos. Objetivo: identificar dentro de un conjunto de factores de riesgo biológicos, cuáles tienen mayor asociación a la anemia ferropénica en lactantes hospitalizados en sala de pediatría del Hospital Luis Díaz Soto. Métodos: estudio descriptivo, de corte transversal. El universo estuvo conformado por 384 lactantes y la muestra la constituyeron 105 pacientes. Se realizó un muestreo aleatorio simple. Para identificar dentro de un grupo de factores de riesgo biológico sobre la aparición de anemia ferropénica, se realizó análisis univariado mediante la prueba de independencia X2. Se calculó el OR para aquellas variables que según prueba de X2 se mostraron estadísticamente significativas. Resultados: se constató prevalencia de anemia ferropénica en lactantes ingresados en más de la mitad de la muestra estudiada (61 %). Se determinó que la lactancia materna exclusiva por menos de seis meses (OR: 2,1; IC: 1,9-2,5) y la alimentación complementaria (OR: 1,5; IC: 1,3-2,4) constituyen factores de riesgo en el lactante ingresado para la aparición de anemia ferropénica. Conclusiones: la prevalencia de anemia ferropénica en lactantes ingresados en sala de pediatría del Hospital Luis Díaz Soto en el periodo de mayo a 2019 a mayo de 2020, fue alta y se comportó entre los valores esperados en lactantes hospitalizados.

ABSTRACT Background: anemia is defined as a reduction in hemoglobin concentration below the values recorded in healthy persons. In Cuba, as in the rest of the world, iron deficiency anemia is a health problem, with a high frequency in pediatric patients. Objective: to identify within a group of biological risk factors, which ones have a greater association with iron deficiency anemia in infants hospitalized in the pediatric ward of the Luis Díaz Soto Hospital. Methods: a descriptive, cross-sectional study was carried out. The universe was made up of 384 infants and the sample was made up of 105 patients. A simple random sampling was made. In order to identify within a group of biological risk factors on the appearance of iron-deficiency anemia, unvaried analysis was carried out by means of the X2 independence test. The OR was calculated for those variables which, according to the X2 test, were statistically significant. Results: prevalence of iron-deficiency anemia was found in infants admitted in more than half of the studied sample (61 %). It was determined that exclusive breastfeeding for less than six months (OR: 2,1; IC: 1,9-2,5) and complementary feeding (OR: 1,5; IC: 1,3-2,4) were risk factors for iron-deficiency anemia in the infant admitted. Conclusions: the prevalence of iron-deficiency anemia in infants admitted to the pediatric ward of the Luis Díaz Soto Hospital during the period May 2019 to May 2020 is high and is among the expected values in hospitalized infants.