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1.
Zhonghua Er Ke Za Zhi ; 58(3): 201-205, 2020 Mar 02.
Artigo em Chinês | MEDLINE | ID: mdl-32135591

RESUMO

Objective: To explore the predictive values of routine blood test results for iron deficiency (ID) screening in children. Methods: Routine blood test results and serum ferritin (SF) levels from 1 443 healthy children (862 boys, 581 girls) aged 6 months to 18 years, who were seen for well-child visits between June 2017 and May 2019 in Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. ID was defined as SF<20 µg/L, iron deficiency anemia (IDA) as ID with anemia (hemoglobin(Hb)<110 g/L at 6 months-5 years of age, Hb<120 g/L at 6-18 years of age), non-anemia ID as ID without anemia, non-ID anemia as SF≥20 µg/L with anemia, and healthy control subjects as those with SF≥20 µg/L but without anemia. The blood test results including Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), and the percentage of low hemoglobin density (LHD) of healthy control, non-anemia ID, non-ID anemia, and IDA groups were compared by analysis of variance (ANOVA) or non-parametric test, quantitative data were described as x±s or M(interquartile range), and receiver operating characteristic curve (ROC) analysis was applied to assess predictive values of routine blood test results and LHD for detecting IDA and ID. Results: Among 1 443 children with median age of 2.1(3.3) years, 1 061 children were in healthy control group, 292 in non-anemia ID group, 43 in non-ID anemia group and 47 in IDA group. The prevalence of ID was much higher than that of anemia (23.5% (339/1 443) vs. 6.2% (90/1 443) , χ(2)=169.76, P<0.01). Compared with control group, non-anemia ID group showed higher LHD (0.088 (0.093) vs.0.073 (0.068), P<0.01) and RDW (0.131±0.013 vs. 0.126±0.008, P<0.01), lower MCV ((80±4) vs. (83±4) fl, P<0.01) and MCHC values ((326±9) vs. (329±8) g/L, P<0.01). IDA group showed higher LHD (0.322(0.544)) and RDW (0.151±0.018), lower MCV ((73±6) fl) and MCHC values((309±14) g/L) than non-anemia ID group (all P<0.01). The area under curve (AUC) values of MCHC, LHD, RDW and MCV for detecting ID were 0.63 (95%CI: 0.60-0.67), 0.63 (95%CI:0.60-0.67), 0.67 (95%CI: 0.63-0.70) and 0.73 (95%CI: 0.69-0.76) respectively. With cutoff limits (MCV<80.2 fl, RDW>0.131 or MCHC<322 g/L), MCV, RDW and MCHC showed higher sensitivity for screening ID than hemoglobin (0.540, 0.469 and 0.336 vs. 0.139, χ(2)=121.70, 87.47, 35.56, all P<0.01). Conclusion: MCV, RDW and MCHC can be used to screen ID in primary health care settings.


Assuntos
Anemia Ferropriva/diagnóstico , Anemia/diagnóstico , Adolescente , Anemia/epidemiologia , Anemia Ferropriva/sangue , Anemia Ferropriva/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Índices de Eritrócitos , Eritrócitos/química , Feminino , Hemoglobinas/química , Humanos , Lactente , Ferro/sangue , Ferro/deficiência , Masculino , Estudos Retrospectivos
2.
J Assoc Physicians India ; 67(11): 36-39, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31793267

RESUMO

Background: Transferrin receptor (TfR) is a carrier protein for transferrin. It is regulated in response to intracellular iron concentration and plays a role for the import of iron into the cell. The transferring receptor 2 (TFR2) gene showed homology to transferrin receptor 1 (TFR1) gene and encodes a transmembrane protein with a large extracellular domain, which is able to bind transferrin. Mutations in transferrin receptors (TfR2 and TfR1) may alter the pathophysiology of iron deficiency anemia. Alteration in genes encoding transferring receptor cause change in iron homeostatsis and provides a tool for investigating the excess iron absorption and abnormal iron distribution in iron related disorders. However the clinical significance of the interaction of transferring mutations with iron deficiency anemia remains unclear. Thus, the objective of my study was to investigate the effect of TFR1 and TFR2 genotypes on pathophysiology of iron deficiency anemia. Study Design: Study subjects were 460 iron deficiency anemia patients and 500 age and sex-matched healthy controls. Transferrin receptor, ferritin and CRP analysis was done by ELISA method while ESR analysis was done according to Wintrobes's method. CBC analysis was done by auto-analyzer. TFR1-rs3817672 SNP and TFR2 (Y250X) mutation was analyzed by using PCR RFLP method. Results: Amongst the iron deficiency anemia patients, 13 were heterozygous and five were homozygous for rs3817672 SNP. TFR2 (Y250X) mutation was detected in 6 patients with heterozygous conditions. None of the patients were presenting homozygous condition while four controls were presenting heterozygous and one with homozygous condition. Controls were presenting 3% and 0.6% of TFR1 rs3817672 SNP heterozygosity respectively. Conclusion: TfR2 -Y250X and TfR1-rs3817672 SNP showed clinical association with iron deficiency anemia and screening for mutations of TFR2 is a new diagnostic tool that can be offered to patients who do not have HFE mutations or who have incomplete HFE genotypes. This results may have practical implications for the molecular diagnosis of hemochromatosis. Genotyping the TFR gene should be included in the disease diagnostic protocols.


Assuntos
Anemia Ferropriva , Antígenos CD , Hemocromatose , Receptores da Transferrina , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/genética , Antígenos CD/genética , Humanos , Polimorfismo de Nucleotídeo Único , Receptores da Transferrina/genética , Transferrina
4.
Turk J Pediatr ; 61(1): 102-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559729

RESUMO

Mantadakis E, Zikidou P, Tsouvala E, Thomaidis S, Chatzimichael A. Severe iron deficiency anemia and anasarca edema due to excessive cow`s milk intake. Turk J Pediatr 2019; 61: 102-106. The authors describe a 13-month-old girl who presented with progressively worsening anasarca edema that developed over the last three weeks along with increasing fatigue. Over the last several months she was consuming progressively increasing amounts of fresh cow`s milk. Laboratory examinations on admission showed severe microcytic and hypochromic anemia (hemoglobin 3.8 g/dl) and hypoferritenemia indicative of iron deficiency, while urinalyses showed no proteinuria. The child was transfused with 13ml/kg packed red blood cells and approximately 2g/kg intravenous albumin. On the second and fourth hospital days, she received 100 mg of iron sucrose intravenously that she tolerated well. Eight months after the described events, she is healthy with normal hemoglobin for age, while she has no laboratory evidence of cow`s milk protein allergy. Pediatricians should be aware of the association of severe iron deficiency anemia (IDA) and anasarca edema, and should screen infants in their practice for anemia at the age of 12 months or sooner, if risk factors are present.


Assuntos
Anemia Ferropriva/etiologia , Edema/etiologia , Leite/efeitos adversos , Anemia Ferropriva/diagnóstico , Animais , Fadiga/etiologia , Feminino , Humanos , Lactente
5.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519723

RESUMO

Intrauterine contraceptive device (IUCD) is a common birth control method. It is safe but can be associated with serious complications including migration into the peritoneal cavity and penetration into other intra-abdominal and pelvic viscera; most commonly the rectosigmoid colon. Different retrieval methods including endoscopy, laparoscopy or open abdominal surgery have been described. We report the case of 38-year-old woman who became pregnant shortly after insertion of the IUCD 6 years prior to presentation. She delivered vaginally and 'expulsion' of the device was assumed. Some 4 years later, she had another IUCD inserted and remained asymptomatic till she recently presented with iron-deficiency anaemia. As part of the investigation, diagnostic colonoscopy was performed. Surprisingly, the old IUCD was found penetrating into the midrectum. Uneventful endoscopic removal was performed and she remained well at 3-month follow-up. Migrating IUCD remains asymptomatic and may be discovered accidentally during routine investigation for some other symptoms.


Assuntos
Anemia Ferropriva/etiologia , Migração de Dispositivo Intrauterino/efeitos adversos , Dispositivos Intrauterinos/efeitos adversos , Reto/diagnóstico por imagem , Adulto , Anemia Ferropriva/diagnóstico , Colonoscopia/métodos , Endoscopia/métodos , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Achados Incidentais , Resultado do Tratamento
7.
BMJ Case Rep ; 12(7)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31371333

RESUMO

A 73-year-old man with an 8-week history of angina underwent an exercise tolerance test at the rapid access clinic, which indicated inducible ischaemia and he was subsequently referred for angiogram. His angiogram demonstrated no coronary pathology. It was later discovered that bloods taken on the day of the procedure showed a haemoglobin of 54 g/L (130-180 g/L). His haemoglobin used to book the angiogram 3 months before was 143 g/L. Following angiogram, a mass was identified in the right iliac fossa and CT scan confirmed a caecal tumour. The patient ultimately underwent a curative right hemicolectomy as an outpatient. The case is a reminder of the importance of basic preangiogram investigations, in particularly a full blood count, to rule-out angina secondary to anaemia through a low haemoglobin. Most importantly, it also questions when the appropriate time is for these investigations to be carried out, prior to coronary angiography.


Assuntos
Anemia Ferropriva/diagnóstico , Angina Pectoris/diagnóstico , Neoplasias do Ceco/diagnóstico , Idoso , Anemia Ferropriva/etiologia , Angina Pectoris/etiologia , Neoplasias do Ceco/complicações , Diagnóstico Diferencial , Humanos , Masculino
8.
PLoS Med ; 16(8): e1002867, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31430296

RESUMO

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.


Assuntos
Anemia Ferropriva/complicações , Complicações na Gravidez/diagnóstico , Melhoria de Qualidade , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/terapia , Estudos Controlados Antes e Depois , Procedimentos Clínicos , Transfusão de Eritrócitos , Feminino , Ferritinas/sangue , Humanos , Assistência Perinatal/métodos , Gravidez , Complicações na Gravidez/terapia
9.
J Stroke Cerebrovasc Dis ; 28(11): 104338, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31444045

RESUMO

A 57-year-old male presented with generalized seizure who received red blood cell (RBC) transfusion for the treatment of iron deficiency anemia (IDA). Neuroradiological findings revealed cerebral venous thrombosis (CVT) on the left frontal vein. He received anticoagulants, anticonvulsants, and iron supplements. He discharged without any neurological deficit. It should be noted that RBC transfusion might increase the risk of CVT in patients with IDA.


Assuntos
Anemia Ferropriva/terapia , Transfusão de Eritrócitos/efeitos adversos , Trombose Intracraniana/etiologia , Trombose Venosa/etiologia , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Anticoagulantes/uso terapêutico , Anticonvulsivantes/uso terapêutico , Suplementos Nutricionais , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Convulsões/tratamento farmacológico , Convulsões/etiologia , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
10.
Ann Hematol ; 98(10): 2299-2302, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31444663

RESUMO

Iron deficiency anemia (IDA) is often associated with mild to moderate thrombocytosis, and iron deficiency-associated thrombocytopenia (IDAT) is much more uncommon and often misdiagnosed as immune thrombocytopenia (ITP). To better describe the features of IDAT, we conducted a retrospective multicenter case-control study. We identified 10 patients (9 women) with a definite diagnosis IDAT, with a median age of 43.5 [range, 16-72] years and a median platelet count of 30.5 × 109/L [range, 21-80], and 7 patients with a possible diagnosis of IDAT. Bleeding manifestations were absent in all patients but one. All the patients recovered (platelet count ≥ 150 × 109/L) upon iron therapy ± red blood cell transfusion after a median time of 6 [4-39] days. When compared with 30 randomly newly diagnosed ITP patients matched on age, the baseline platelet count was significantly lower in ITP (median = 7 × 109/L [4-59], p < 0.001) whereas MPV was higher (10.5 fL [9,4-13,8] vs 8.2 fL, for IDAT p < 0.001). The median platelet count on day 7 was 337 × 109/L [113-1000] for IDAT cases vs 72 × 109/L [13-212] for ITP controls (p < 0.001). IDAT is potentially an under-recognized cause of thrombocytopenia that may be easily managed with iron therapy.


Assuntos
Anemia Ferropriva , Trombocitopenia , Adolescente , Adulto , Fatores Etários , Idoso , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/sangue , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/epidemiologia , Púrpura Trombocitopênica Idiopática/etiologia , Estudos Retrospectivos , Trombocitopenia/sangue , Trombocitopenia/diagnóstico , Trombocitopenia/epidemiologia , Trombocitopenia/etiologia
11.
Pan Afr Med J ; 33: 48, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448011

RESUMO

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.


Assuntos
Anemia Ferropriva/diagnóstico , Ferro/deficiência , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Argélia , Anemia/diagnóstico , Anemia/terapia , Anemia Ferropriva/terapia , Estudos Transversais , Feminino , Ferritinas/sangue , Pesquisas sobre Serviços de Saúde , Hemoglobinas/análise , Humanos , Ferro/administração & dosagem , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Saudi J Kidney Dis Transpl ; 30(4): 932-942, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464252

RESUMO

A retrospective study was conducted over seven years and it aimed to find out various causes of anemia among patients with chronic kidney disease (CKD). The study included nondialysis-dependent adult CKD patients who underwent anemia evaluation. A total of 584 patients were studied. Three hundred and twenty-one (55%) patients were male and 263 (45%) were female. The mean age of the patients was 55.5 ± 14 years. One hundred and seventy-eight (30.5%) had a diabetic CKD and 406 (69.5%) had a nondiabetic CKD. Seventy-two (12.3%) patients were in CKD Stage 3, 193 (33%) patients in CKD Stage 4, and 319 (54.6%) patients in CKD Stage 5. The mean hemoglobin was 9.2 ± 2.2 g/dL. There was a progressive fall in hemoglobin with increasing severity of CKD and in CKD Stage 3, 4, and 5 the mean hemoglobin was 10 ± 2.2, 9.4 ± 2.1, and 8.4 ± 1.9 g/dL, respectively (P = 0.001). Most (47.4%) patients had moderate anemia followed by anemia of mild (31.4%) and severe (21.4%) degrees. Three hundred and seven (52.6%) patients had percent transferrin saturation (TSAT) <20% (functional iron deficiency). One hundred and sixty-two (27.7%) patients had serum ferritin <100 ng/mL (absolute iron deficiency); 334 (57.2%) patients had serum ferritin 100-500 ng/mL, but in 175 (52.4%) of them, TSAT was <20%; 88 (15.1%) patients had serum ferritin >500 ng/mL (58 (65.6%) were C-reactive protein (CRP) + and 55 (62.5%) had TSAT <20%). Overall, 392 (67.1%) patients had functional or absolute iron deficiency. One-third of the patients had elevated CRP levels. The anemia was macrocytic in 20.4% suggesting deficiency of folic acid and/or Vitamin B12. A high proportion (74.6%) of patients with normocytic anemia had iron deficiency. In the majority of nondialysis-dependent CKD patients, the etiology of anemia may be multifactorial; therefore, the treatment should be determined by documented causes of anemia.


Assuntos
Anemia/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Anemia/sangue , Anemia/diagnóstico , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Anemia Macrocítica/sangue , Anemia Macrocítica/diagnóstico , Anemia Macrocítica/epidemiologia , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Ferritinas/sangue , Hemoglobinas/metabolismo , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Transferrina/análise
14.
Egypt J Immunol ; 26(1): 141-150, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31333004

RESUMO

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.


Assuntos
Anemia Ferropriva/diagnóstico , Artrite Reumatoide/complicações , Ferritinas/sangue , Transferrina/análise , Anemia/diagnóstico , Estudos de Casos e Controles , Doença Crônica , Diagnóstico Diferencial , Humanos , Ferro
15.
Folia Med (Plovdiv) ; 61(2): 223-230, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301666

RESUMO

AIM: Iron deficiency anemia (IDA) is a common medical condition, yet there is still some diagnostic uncertainty in this respect. The aim of this study was to compare the clinical significance of biomarkers of iron deficiency (ID) in diagnosing IDA and iron-deficient erythropoiesis in anemic patients. MATERIALS AND METHODS: A total of 103 untreated patients with non-hemolytic anemia were included. Blood count, reticulocyte hemoglobin content (CHr), iron, transferrin saturation (TSAT), ferritin (Ferr), soluble transferrin receptor (sTfR) and sTfR/logFerr index (sTfR-F index) were determined in the patients. RESULTS: TSAT<16% diagnosed 79 patients with IDA (76.6%), Ferr<30 µg/l - 50 patients with IDA (48.5%). Thomas-plot analysis found 76 patients with ID (73.8%) and 56 of them were with iron-restricted erythropoiesis and IDA (54.4%). Biomarkers of ID were significantly different in anemic patients with iron-deficient erythropoiesis (CHr<28 pg) compared with patients with normal hemoglobinisation (p<0.001). With regard to the predictive value of the parameters of ID for iron-deficient erythropoiesis in anemia, their mutually controlled influence proved sTfR-F index only as independent statistically significant (p=0.011). The optimal cut-off value of sTfR-F index from the ROC curve analysis for detecting iron-deficient erythropoiesis in anemia (CHr<28 pg) was 1.35, with sensitivity of 82.1% and specificity of 80.9% (AUC 0.866; p<0.001). CONCLUSIONS: Diagnosis of IDA depends on the applied biomarkers of ID, and TSAT or ferritin when used alone may lead to diagnostic difficulties. Combining sTfR-F index and CHr to evaluate iron-deficient erythropoiesis in patients with anemia in addition to ferritin and TSAT could contribute to improving the diagnosis of IDA in clinical practice.


Assuntos
Anemia Ferropriva/diagnóstico , Ferritinas/metabolismo , Hemoglobinas/metabolismo , Ferro/metabolismo , Receptores da Transferrina/metabolismo , Reticulócitos/metabolismo , Transferrina/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/metabolismo , Biomarcadores/metabolismo , Eritropoese , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Nutrients ; 11(8)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31357549

RESUMO

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.


Assuntos
Anemia Ferropriva/sangue , Dieta Vegetariana , Ferro/sangue , Estado Nutricional , Valor Nutritivo , Vegetarianos , Adulto , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/prevenção & controle , Biomarcadores/sangue , Dieta Vegana , Dieta Vegetariana/efeitos adversos , Suplementos Nutricionais , Feminino , Ferritinas/sangue , Humanos , Ferro/administração & dosagem , Ferro/deficiência , Masculino , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Transferrina/metabolismo , Veganos , Adulto Jovem
17.
Klin Lab Diagn ; 64(5): 277-283, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31185150

RESUMO

Evaluation of anemic syndrome (AS) was performed in 79 patients with advanced stages of Hodgkin's lymphoma (LH) at various stages of chemotherapy (CT) according to the EACOPP-14 scheme. Against the background of the treatment, the number of erythrocytes and, accordingly, the HCT indices decreased with each subsequent cycle of chemotherapy (CTC) and reached the maximum reduction to 5, 6 th CCT. Absolute iron deficiency (IDA), which was combined with a low level of EPO and an inadequate degree of anemia, was found in a few LH patients (5 people, 6.3%). Functional iron deficiency (FDZH) was diagnosed in 9 patients (11.4%), had the same morphological signs as IDA. Namely, microcytosis, erythrocyte hypochromia and low hemoglobin content in reticulocytes (RET-HE). In contrast to IDA, patients with FDZh concentration of FR, GP-25 and IL-6 were high. Despite the fairly large reserves of iron, the level of rRTF testified to the "iron hunger" of the erythrocariocytes of the bone marrow, its index exceeded the upper limit of the norm, while RET-HE was low. In 34 (43%) patients, LH revealed a deficiency of endogenous erythropoietin (EPO), which was observed not only in patients with AHZ, but also in patients with IDA. Lower levels of EPO were detected in patients with leukopenia and very low erythropoietic activity of the bone marrow.


Assuntos
Anemia Ferropriva/diagnóstico , Anemia/diagnóstico , Doença de Hodgkin/complicações , Anemia/complicações , Anemia Ferropriva/complicações , Eritropoetina/sangue , Doença de Hodgkin/tratamento farmacológico , Humanos , Reticulócitos/química
18.
World J Gastroenterol ; 25(21): 2549-2564, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31210709

RESUMO

Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes; nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient's quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.


Assuntos
Anemia Ferropriva/terapia , Angiodisplasia/diagnóstico , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/etiologia , Angiodisplasia/complicações , Angiodisplasia/terapia , Transfusão de Sangue , Endoscopia por Cápsula , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemostáticos/administração & dosagem , Humanos , Intestino Delgado/irrigação sanguínea , Intestino Delgado/diagnóstico por imagem , Ferro/administração & dosagem , Fatores de Risco , Prevenção Secundária/métodos , Resultado do Tratamento
19.
PLoS Med ; 16(6): e1002818, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170159

RESUMO

BACKGROUND: Emerging data in chronic kidney disease (CKD) patients suggest that iron deficiency and higher circulating levels of erythropoietin (EPO) stimulate the expression and concomitant cleavage of the osteocyte-derived, phosphate-regulating hormone fibroblast growth factor 23 (FGF23), a risk factor for premature mortality. To date, clinical implications of iron deficiency and high EPO levels in the general population, and the potential downstream role of FGF23, are unclear. Therefore, we aimed to determine the associations between iron deficiency and higher EPO levels with mortality, and the potential mediating role of FGF23, in a cohort of community-dwelling subjects. METHODS AND FINDINGS: We analyzed 6,544 community-dwelling subjects (age 53 ± 12 years; 50% males) who participated in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study-a prospective population-based cohort study, of which we used the second survey (2001-2003)-and follow-up was performed for a median of 8 years. We measured circulating parameters of iron status, EPO levels, and plasma total FGF23 levels. Our primary outcome was all-cause mortality. In multivariable linear regression analyses, ferritin (ß = -0.43), transferrin saturation (TSAT) (ß = -0.17), hepcidin (ß = -0.36), soluble transferrin receptor (sTfR; ß = 0.33), and EPO (ß = 0.28) were associated with FGF23 level, independent of potential confounders. During median (interquartile range [IQR]) follow-up of 8.2 (7.7-8.8) years, 379 (6%) subjects died. In multivariable Cox regression analyses, lower levels of TSAT (hazard ratio [HR] per 1 standard deviation [SD], 0.84; 95% confidence interval [CI], 0.75-0.95; P = 0.004) and higher levels of sTfR (HR, 1.15; 95% CI 1.03-1.28; P = 0.01), EPO (HR, 1.17; 95% CI 1.05-1.29; P = 0.004), and FGF23 (HR, 1.20; 95% CI 1.10-1.32; P < 0.001) were each significantly associated with an increased risk of death, independent of potential confounders. Adjustment for FGF23 levels markedly attenuated the associations of TSAT (HR, 0.89; 95% CI 0.78-1.01; P = 0.06), sTfR (HR, 1.08; 95% CI 0.96-1.20; P = 0.19), and EPO (HR, 1.10; 95% CI 0.99-1.22; P = 0.08) with mortality. FGF23 remained associated with mortality (HR, 1.15; 95% CI 1.04-1.27; P = 0.008) after adjustment for TSAT, sTfR, and EPO levels. Mediation analysis indicated that FGF23 explained 31% of the association between TSAT and mortality; similarly, FGF23 explained 32% of the association between sTfR and mortality and 48% of the association between EPO and mortality (indirect effect P < 0.05 for all analyses). The main limitations of this study were the observational study design and the absence of data on intact FGF23 (iFGF23), precluding us from discerning whether the current results are attributable to an increase in iFGF23 or in C-terminal FGF23 fragments. CONCLUSIONS AND RELEVANCE: In this study, we found that functional iron deficiency and higher EPO levels were each associated with an increased risk of death in the general population. Our findings suggest that FGF23 could be involved in the association between functional iron deficiency and increased EPO levels and death. Investigation of strategies aimed at correcting iron deficiency and reducing FGF23 levels is warranted.


Assuntos
Anemia Ferropriva/sangue , Anemia Ferropriva/mortalidade , Eritropoetina/sangue , Fatores de Crescimento de Fibroblastos/sangue , Vigilância da População , Adulto , Idoso , Anemia Ferropriva/diagnóstico , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Países Baixos , Vigilância da População/métodos
20.
BMJ Case Rep ; 12(5)2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31147407

RESUMO

A 50-year-old woman presented with worsening fatigue and shortness of breath. For 2 months, she has been having increased craving for unpeeled lemons and was seen in clinic about a month prior to presentation at the emergency room. At that time, she was asymptomatic except for endorsing craving for lemons. Physical exam findings at presentation noted obesity, sinus tachycardia, pallor, mild scleral jaundice and no other stigmata for chronic liver disease. Her labs suggested iron-deficiency anaemia (IDA), elevated liver enzymes and positive antimitochondrial antibody titre. Abdominal ultrasound and CT scan showed mild scarring. She was diagnosed with primary biliary cholangitis with portal hypertension complicated by oesophageal varices and IDA. Interventions included blood transfusion, oesophageal banding and treatment with ursodeoxycholic acid. Her craving for lemons, shortness of breath and fatigue resolved within 1 week. With ongoing outpatient follow-up and oesophageal variceal surveillance, she continues to do well.


Assuntos
Anemia Ferropriva/diagnóstico , Varizes Esofágicas e Gástricas/diagnóstico , Hipertensão Portal/diagnóstico , Cirrose Hepática Biliar/diagnóstico , Pica , Administração Oral , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Transfusão de Sangue , Colagogos e Coleréticos/administração & dosagem , Colagogos e Coleréticos/uso terapêutico , Diagnóstico Diferencial , Procedimentos Cirúrgicos do Sistema Digestório , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/terapia , Ferro/administração & dosagem , Ferro/uso terapêutico , Cirrose Hepática Biliar/complicações , Cirrose Hepática Biliar/diagnóstico por imagem , Cirrose Hepática Biliar/terapia , Pessoa de Meia-Idade , Ultrassonografia , Ácido Ursodesoxicólico/administração & dosagem , Ácido Ursodesoxicólico/uso terapêutico
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