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2.
Int J Mol Sci ; 22(18)2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34576090

RESUMO

Iron deficiency is the most common mammalian nutritional disorder. However, among mammalian species iron deficiency anemia (IDA), occurs regularly only in pigs. To cure IDA, piglets are routinely injected with high amounts of iron dextran (FeDex), which can lead to perturbations in iron homeostasis. Here, we evaluate the therapeutic efficacy of non-invasive supplementation with Sucrosomial iron (SI), a highly bioavailable iron supplement preventing IDA in humans and mice and various iron oxide nanoparticles (IONPs). Analysis of red blood cell indices and plasma iron parameters shows that not all iron preparations used in the study efficiently counteracted IDA comparable to FeDex-based supplementation. We found no signs of iron toxicity of any tested iron compounds, as evaluated based on the measurement of several toxicological markers that could indicate the occurrence of oxidative stress or inflammation. Neither SI nor IONPs increased hepcidin expression with alterations in ferroportin (FPN) protein level. Finally, the analysis of the piglet gut microbiota indicates the individual pattern of bacterial diversity across taxonomic levels, independent of the type of supplementation. In light of our results, SI but not IONPs used in the experiment emerges as a promising nutritional iron supplement, with a high potential to correct IDA in piglets.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Suplementos Nutricionais , Compostos Férricos/administração & dosagem , Compostos Férricos/uso terapêutico , Nanopartículas Magnéticas de Óxido de Ferro/administração & dosagem , Nanopartículas Magnéticas de Óxido de Ferro/química , Administração Oral , Anemia Ferropriva/sangue , Animais , Animais Recém-Nascidos , Biomarcadores/metabolismo , Duodeno/metabolismo , Compostos Férricos/farmacologia , Compostos Ferrosos/uso terapêutico , Hepcidinas/sangue , Hepcidinas/genética , Masculino , Microbiota , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Suínos
3.
Nutrients ; 13(9)2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34578841

RESUMO

The objective of this study was to evaluate the serum levels of ferritin and the prevalence of iron deficiency in vegan and omnivorous individuals by taking into account the presence of elements that cause an elevation of ferritin levels, such as increased homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI), and high-sensitivity C-reactive protein (hs-CRP) values. The parameters were evaluated in 1340 individuals, i.e., 422 men and 225 women who do not menstruate and 693 women who do menstruate, based on omnivorous or vegetarian eating habits. The progressive increase in BMI, HOMA-IR, and inflammation caused an elevation in ferritin concentration, regardless of the eating habits in the groups studied. In the overall sample, omnivores had a higher prevalence of obesity, higher ferritin levels, and a lower prevalence of iron deficiency (ferritin < 30 ng/mL). However, after the exclusion of individuals with inflammation (with overweight/obesity and elevated hs-CRP levels), the actual iron deficiency was assessed and was not higher among vegetarians, except in women with regular menstrual cycles. Our data show that nutritional status and inflammation levels affect ferritin levels and may interfere with the correct diagnosis of iron deficiency in both vegetarian and omnivorous individuals. Compared to vegetarians, women who do not menstruate and men had the same prevalence of iron deficiency when following an omnivorous diet.


Assuntos
Anemia Ferropriva/sangue , Anemia Ferropriva/epidemiologia , Dieta/métodos , Ferritinas/sangue , Vegetarianos/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Dieta Vegetariana , Feminino , Humanos , Inflamação/sangue , Inflamação/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Adulto Jovem
4.
Nutrients ; 13(7)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34371850

RESUMO

Oral contraceptive use has been associated with decreased menstrual blood losses; thus, can independently reduce the risk of anemia and iron deficiency in women. Manufacturers have recently started to include supplemental iron in the non-hormonal placebo tablets of some contraceptives. The aims of this narrative review are: (i) to describe the relationship between oral contraceptive use and both anemia and iron status in women; (ii) to describe the current formulations of iron-containing oral contraceptives (ICOC) available on the market; and (iii) to systematically review the existing literature on the effect of ICOC on biomarkers of anemia and iron status in women. We discovered 21 brands of ICOC, most commonly including 25 mg elemental iron as ferrous fumarate, for seven days, per monthly tablet package. Our search identified one randomized trial evaluating the effectiveness of ICOC use compared to two non-ICOC on increasing hemoglobin (Hb) and iron status biomarker concentrations in women; whereafter 12 months of contraception use, there were no significant differences in Hb concentration nor markers of iron status between the groups. ICOC has the potential to be a cost-effective solution to address both family planning needs and iron deficiency anemia. Yet, more rigorous trials evaluating the effectiveness of ICOC on improving markers of anemia and iron deficiency, as well as investigating the safety of its consumption among iron-replete populations, are warranted.


Assuntos
Anticoncepcionais Orais/química , Compostos Ferrosos/sangue , Hemoglobinas/efeitos dos fármacos , Ferro/administração & dosagem , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/tratamento farmacológico , Biomarcadores/sangue , Anticoncepcionais Orais/administração & dosagem , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Ferro/análise
5.
Nutrients ; 13(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34444942

RESUMO

Celiac disease (CD) is an autoimmune chronic inflammatory disease occurring in genetically predisposed individuals in response to the intake of gluten. Clinical presentation can be heterogeneous. Iron-deficient anemia (IDA) is one of the most common extra-intestinal manifestations of CD. Although IDA usually reverts with a gluten-free diet (GFD), some patients show persistent IDA, the mechanisms of which are poorly understood. Recent studies suggest an association between the rs855791 polymorphism in the TMPRSS6 gene and persistent IDA in adults with CD. The current study aimed to assess the potential link between rs855791 and persistent IDA in pediatric patients with CD. The study included 106 children diagnosed with CD between 2015 and 2019. Clinical and blood parameters (including blood count, serum iron) were collected at diagnosis and after ≥12 months of GFD, and the rs855791 genotype was assessed for each patient. IDA was present at diagnosis in 25 patients (23.6%); only three (3%) had persistent IDA after GFD. The prevalence of rs855791 genotypes was 9% (n = 10) for TT, 53% (n = 56) for CT, and 38% (n = 40) for CC. There was a tendency toward a higher proportion of the T allele in patients with IDA and lower hemoglobin in the TT genotype but without statistical significance. An association between rs855791 and persistent IDA was not observed. These findings suggest that persistent IDA is uncommon in pediatric patients with CD. The prevalence of rs855791 in children with CD is reported for the first time.


Assuntos
Anemia Ferropriva/genética , Doença Celíaca/genética , Proteínas de Membrana/genética , Serina Endopeptidases/genética , Alelos , Anemia Ferropriva/sangue , Doença Celíaca/sangue , Doença Celíaca/dietoterapia , Criança , Dieta Livre de Glúten/métodos , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Ferro/sangue , Masculino , Polimorfismo de Nucleotídeo Único , Estudos Retrospectivos
7.
Lancet Haematol ; 8(8): e572-e582, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34329578

RESUMO

BACKGROUND: Serum ferritin concentrations are the most widely used indicator for iron deficiency. WHO determined that insufficient data are available to revise the serum ferritin thresholds of less than 12 µg/L for children and less than 15 µg/L for women, which were developed on the basis of expert opinion, to define iron deficiency. We aimed to derive new physiologically based serum ferritin concentration thresholds for iron deficiency in healthy young children and non-pregnant women using data from the US National Health and Nutrition Examination Survey (NHANES). METHODS: In this serial cross-sectional study, we examined the relationship of serum ferritin with two independent indicators of iron-deficient erythropoiesis, haemoglobin and soluble transferrin receptor (sTfR), in children (12-59 months) and non-pregnant women (15-49 years) using cross-sectional NHANES data from 2003-06, 2007-10, and 2015-18. NHANES is a US national stratified multistage probability sample that includes a household interview followed by a standardised physical examination in a mobile examination centre. We excluded individuals with missing serum ferritin, sTfR, haemoglobin, or white blood cell counts measurements; non-pregnant women with missing C-reactive protein (CRP), alanine aminotransferase (ALT) or aspartate aminotransferase (AST) data were also excluded. In addition, individuals with infection (white blood cell counts >10·0×109/L) and non-pregnant women with possible liver disease (ALT >70 IU/L or AST >70 IU/L) and inflammation (CRP >5·0 mg/L) were excluded. We examined distributions of haemoglobin and sTfR with serum ferritin and used restricted cubic spline regression models to determine serum ferritin thresholds for iron-deficient erythropoiesis. FINDINGS: 5964 children and 10 462 non-pregnant women had physical examinations and were screened for inclusion in the study, of whom 2569 (43·1%) children and 7498 (71·7%) non-pregnant women were included. At lower serum ferritin concentrations, median haemoglobin concentration decreased as sTfR concentration increased, with each varying in a curvilinear manner. Using restricted cubic spline plateau points to determine the onset of iron-deficient erythropoiesis, the serum ferritin thresholds identified by haemoglobin and sTfR concentrations were not different. For children, the haemoglobin identified serum ferritin threshold was 19·9 µg/L (95% CI 18·8-22·6) and the sTfR identified serum ferritin threshold was 20·0 µg/L (19·4-20·9; p=0·89). For women the haemoglobin identified serum ferritin threshold was 25·2 µg/L (24·2-26·2) and the sTfR identified serum ferritin threshold was 24·0 µg/L (23·3-24·6; p=0·05). INTERPRETATION: The association between two independent indicators of iron-deficient erythropoiesis, haemoglobin and sTfR, identified serum ferritin concentration thresholds of about 20 µg/L for children and 25 µg/L for non-pregnant women, providing physiological evidence of potential new thresholds for consideration when determining the prevalence and distribution of iron deficiency in populations. In healthy children and non-pregnant women, physiologically based thresholds for iron deficiency might be more clinically and epidemiologically relevant than those based on expert opinion. Validation of this physiologically based approach in non-US populations might help the international harmonisation of serum ferritin thresholds for iron deficiency. FUNDING: None.


Assuntos
Anemia Ferropriva/diagnóstico , Biomarcadores/sangue , Ferritinas/sangue , Inquéritos Nutricionais/estatística & dados numéricos , Adolescente , Adulto , Anemia Ferropriva/sangue , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Prognóstico , Adulto Jovem
8.
J Am Soc Nephrol ; 32(8): 2020-2030, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34244326

RESUMO

BACKGROUND: Approximately 30%-45% of patients with nondialysis CKD have iron deficiency. Iron therapy in CKD has focused primarily on supporting erythropoiesis. In patients with or without anemia, there has not been a comprehensive approach to estimating the association between serum biomarkers of iron stores, and mortality and cardiovascular event risks. METHODS: The study included 5145 patients from Brazil, France, the United States, and Germany enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study, with first available transferrin saturation (TSAT) and ferritin levels as exposure variables. We used Cox models to estimate hazard ratios (HRs) for all-cause mortality and major adverse cardiovascular events (MACE), with progressive adjustment for potentially confounding variables. We also used linear spline models to further evaluate functional forms of the exposure-outcome associations. RESULTS: Compared with patients with a TSAT of 26%-35%, those with a TSAT ≤15% had the highest adjusted risks for all-cause mortality and MACE. Spline analysis found the lowest risk at TSAT 40% for all-cause mortality and MACE. Risk of all-cause mortality, but not MACE, was also elevated at TSAT ≥46%. Effect estimates were similar after adjustment for hemoglobin. For ferritin, no directional associations were apparent, except for elevated all-cause mortality at ferritin ≥300 ng/ml. CONCLUSIONS: Iron deficiency, as captured by TSAT, is associated with higher risk of all-cause mortality and MACE in patients with nondialysis CKD, with or without anemia. Interventional studies evaluating the effect on clinical outcomes of iron supplementation and therapies for alternative targets are needed to better inform strategies for administering exogenous iron.


Assuntos
Anemia Ferropriva/sangue , Doenças Cardiovasculares/epidemiologia , Ferritinas/sangue , Insuficiência Renal Crônica/sangue , Transferrina/metabolismo , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/etiologia , Biomarcadores/sangue , Brasil/epidemiologia , Feminino , França/epidemiologia , Alemanha/epidemiologia , Humanos , Masculino , Mortalidade , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/complicações , Fatores de Risco , Estados Unidos/epidemiologia
9.
Blood Coagul Fibrinolysis ; 32(7): 451-457, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34148983

RESUMO

Oxidative stress is a potential mechanism involved in the pathogenesis of iron deficiency anaemia (IDA). Although a tendency for hypercoagulability has been reported in IDA, its underlying mechanism is yet to be elucidated. This study investigated the probable relationship between oxidative stress and hypercoagulability in children with IDA. This study included 57 children diagnosed with IDA (IDA group) between October 2016 and October 2017 in addition to 48 healthy children (control group). The maximum clot firmness (MCF) index, and clot formation time (CFT) index, which are indicators of hypercoagulability in rotational thromboelastometry assays [intrinsic TEM (INTEM) and extrinsic TEM (EXTEM)] derived from our previous study, were recorded. Total oxidant status (TOS), total antioxidant capacity (TAC) and oxidative stress index (OSI) were analysed from serum samples of the individuals. In IDA group, OSI and TOS levels were higher and TAC level was lower compared to the control group (P < 0.001, for all). The EXTEM and INTEM MCF in the IDA group was higher than in the control group, while the INTEM CFT was lower than in the control group (P < 0.001, P < 0.001, P < 0.05, published data).TOS and OSI had a negative correlation with INTEM CFT (r:-0.361, P < 0.001 and r:-0.333, P = 0.001) and a positive correlation with INTEM MCF (r:+0.420, P < 0.001 and r:+0.367, P < 0.001) and EXTEM MCF (r:+0.476, P < 0.001 and r:+0.403, P < 0.001). However, TAC demonstrated no correlation with CFT and MCF index. The oxidant-antioxidant balance is disrupted in favour of oxidative stress in children with IDA. In addition, TOS and OSI, which are parameters of oxidative stress, are correlated with CFT and MCF indices. Oxidative stress appears to be an important factor for the development of tendency to hypercoagulability in IDA.


Assuntos
Anemia Ferropriva/complicações , Trombofilia/complicações , Adolescente , Anemia Ferropriva/sangue , Anemia Ferropriva/metabolismo , Coagulação Sanguínea , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estresse Oxidativo , Trombofilia/sangue , Trombofilia/metabolismo
10.
Am J Cardiol ; 152: 138-145, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34162484

RESUMO

Ferric derisomaltose (FDI) is an intravenous (IV) high-dose iron formulation approved in the US for the treatment of iron deficiency anemia in adults who are intolerant of/have had an unsatisfactory response to oral iron, or who have non-dialysis-dependent chronic kidney disease (NDD-CKD). FERWON-NEPHRO was a randomized, open-label, multicenter clinical trial evaluating the safety and efficacy of a single infusion of FDI 1,000 mg versus up to 5 doses of iron sucrose (IS) 200 mg (recommended cumulative dose, 1,000 mg) over 8 weeks in patients with NDD-CKD and iron deficiency anemia. Of 1,525 patients included in the safety analysis, 244 (16%) had a history of heart failure (HF). Overall, the rate of serious or severe hypersensitivity reactions was low and did not differ between treatment groups. Cardiovascular adverse events (AEs) were reported for 9.4% of patients who had HF and 4.2% who did not. Time to first cardiovascular AE was longer following administration of FDI compared with IS (hazard ratio: 0.59 [95% CI: 0.37, 0.92]; p=0.0185), a difference that was similar in patients with or without HF (p=0.908 for interaction). Patients achieved a faster hematological response (assessed by changes in hemoglobin and ferritin concentrations, and increase in transferrin saturation) with FDI versus IS. In conclusion, in patients with NDD-CKD, a single infusion of FDI was safe, well tolerated, and was associated with fewer cardiovascular AEs and a faster hematological response, compared to multiple doses of IS. These effects were similar for patients with and without HF.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Dissacarídeos/uso terapêutico , Óxido de Ferro Sacarado/uso terapêutico , Insuficiência Cardíaca/sangue , Hematínicos/uso terapêutico , Insuficiência Renal Crônica/sangue , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Estudos de Casos e Controles , Feminino , Compostos Férricos/uso terapêutico , Ferritinas/sangue , Insuficiência Cardíaca/complicações , Hemoglobinas/metabolismo , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/complicações , Índice de Gravidade de Doença , Transferrina/metabolismo , Resultado do Tratamento
11.
Sci Rep ; 11(1): 13055, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-34158616

RESUMO

Iron deficiency anaemia (IDA) is common in colorectal cancer (CRC), especially, in right-sided CRC which is known to have an overall worse prognosis. The associations between diagnostic pathway (Bowel Cancer Screening Programme (BCSP), IDA, symptomatic) and tumour side/stage was assessed using logistic regression models in 1138 CRC cases presenting during 2010-2016 at a single secondary-care centre in the UK. In the IDA sub-group, the relationship between CRC stage and the event of having a blood count prior to CRC diagnosis was examined using Bayesian parametric survival model. IDA was found as the only significant predictor of right-sided CRC (OR 10.61, 95% CI 7.02-16.52). Early-stage CRC was associated with both the IDA (OR 1.65, 95% CI 1.18-2.29) and BCSP pathway (OR 2.42, 95% CI 1.75-3.37). At any age, the risk of detecting CRC at late-stage was higher in those without a previous blood count check (hazard ratio 1.53, 95% credibility interval 1.08-2.14). The findings of this retrospective observational study suggest a benefit from diagnosing CRC through the detection of IDA, and warrant further research into the prognosis benefit of systematic approach to blood count monitoring of the at-risk population.


Assuntos
Anemia Ferropriva/diagnóstico , Neoplasias Colorretais/diagnóstico , Idoso , Anemia Ferropriva/sangue , Neoplasias Colorretais/sangue , Detecção Precoce de Câncer , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Análise de Sobrevida
12.
S Afr Med J ; 111(4): 327-332, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33944765

RESUMO

BACKGROUND: Accurate laboratory reference intervals (RIs) are essential to differentiate between health and disease. There are variations in haematological indices within populations relating to gender, age, ethnicity and environment. Iron deficiency is common, has a wide range of clinical morbidities and affects red cell indices. Locally derived RIs for full blood count (FBC) parameters are needed for the Western Cape region of South Africa, after the exclusion of iron deficiency. In addition, information regarding the prevalence of iron deficiency in first-time blood donors would inform blood transfusion services regarding policies to screen for and treat iron deficiency. OBJECTIVES: To establish locally derived RIs for FBC and white blood cell (WBC) differential count parameters in healthy adults in the Cape Town area, by including first-time blood donors and excluding those with iron deficiency and thalassaemic indices. These new locally established RIs could update those in use by the local National Health Laboratory Service. A secondary objective was to establish the prevalence of iron deficiency in first-time blood donors. This would inform blood donation policies regarding screening and appropriate iron supplementation in high-risk groups prior to blood donation. METHODS: This was a prospective, descriptive study with direct convenience sampling. Participants were prospective voluntary blood donors aged between 18 and 60 years, presenting for first-time blood donation. Ethnicity was self-identified. Participants who tested positive for HIV or hepatitis B and/or C viruses were excluded. Prospective participants with iron deficiency, defined by serum ferritin levels below the RI, and those with red cell indices suggestive of an underlying thalassaemia trait were excluded. FBC samples were analysed using a Sysmex XN-1000 cell counter. Statistical non-parametric methods were used to calculate the RIs, according to international guidelines. RESULTS: Of the 774 participants screened, 82 (11%) had iron deficiency and were excluded. Six hundred and sixty-two patients were included for analysis, 409 (62%) female and 253 (38%) male. The majority of the participants, 348 (53%), were between 20 and 29 years of age, with a mean age of 29 years for females and 28 years for males. Participants comprised a mix of the various ethnic groups residing in Western Cape Province. The mean haemoglobin concentration for females was lower than that for males (p<0.0001). There were significant gender differences for total WBC count, absolute neutrophil count and platelet count, with females having higher counts than males. CONCLUSIONS: Locally established, population-specific RIs are essential for the accurate interpretation of haematological indices. This study established locally derived gender-specific RIs for the Cape Town region, after exclusion of iron deficiency. These new RIs have implications for the accurate diagnoses of cytopenias, cytoses and other blood count abnormalities. Iron deficiency is common in first-time blood donors, and screening for iron deficiency using point-of-care testing should be considered.


Assuntos
Contagem de Células Sanguíneas/normas , Contagem de Leucócitos/normas , Adolescente , Adulto , Fatores Etários , Anemia Ferropriva/sangue , Contagem de Eritrócitos/normas , Feminino , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas/normas , Valores de Referência , Fatores Sexuais , África do Sul , Adulto Jovem
13.
Mayo Clin Proc ; 96(6): 1510-1519, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33952394

RESUMO

OBJECTIVE: To assess the accuracy of a simplified approach for the diagnosis of iron deficiency anemia (IDA) based on the complete blood cell count (CBC) and reticulocyte analysis. PATIENTS AND METHODS: Five hundred fifty-six consecutive, nonselected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of reticulocyte hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. Complete blood count, serum ferritin, iron, and transferrin saturation were performed as clinically indicated. Reticulocyte hemoglobin equivalent was measured with a Sysmex XN-450 analyzer on the residual CBC sample. The study period was from September 20, 2017, through and including November 15, 2018. RESULTS: Patients (N=556) were studied at baseline, of whom 150 were subsequently treated with intravenous iron. Receiver operating characteristic analysis yielded an RET-He cut-off of 30.7 pg to identify IDA (area under curve, 0.733; 95% CI, 0.692 to 0.775), with 68.2% sensitivity and 69.7% specificity. Patients (n=240) were seen at follow-up, with 57 treated and 183 not treated with intravenous iron. Responsiveness was defined as a hemoglobin increase of ≥1.0 g: a combination of RET-He <28.5 pg and hemoglobin value <10.3 g/dL had 84% sensitivity and 78% specificity as response predictor (area under the curve, 0.749; 95% CI, 0.622 to 0.875). CONCLUSION: Data from CBC and RET-He can identify patients with IDA, determine need for and responsiveness to intravenous iron, and reduce time for therapeutic decisions. Limitations of this study are uncontrolled design, its single-site and retrospective nature, and that it requires prospective validation.


Assuntos
Anemia Ferropriva/diagnóstico , Hemoglobinas/análise , Compostos de Ferro/uso terapêutico , Reticulócitos/química , Idoso , Anemia Ferropriva/sangue , Anemia Ferropriva/tratamento farmacológico , Biomarcadores/sangue , Contagem de Células Sanguíneas , Feminino , Ferritinas/sangue , Humanos , Infusões Intravenosas , Compostos de Ferro/administração & dosagem , Compostos de Ferro/sangue , Masculino , Transferrina/análise , Resultado do Tratamento
14.
Sci Rep ; 11(1): 10549, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34006867

RESUMO

Anemia is commonly present in hemodialysis (HD) patients and significantly affects their survival and quality of life. NIR spectroscopy and machine learning were used as a method to detect anemia in hemodialysis patients. The aim of this investigation has been to evaluate the near-infrared spectroscopy (NIRS) as a method for non-invasive on-line detection of anemia parameters from HD effluent by assessing the correlation between the spectrum of spent dialysate in the wavelength range of 700-1700 nm and the levels of hemoglobin (Hb), red blood cells (RBC), hematocrit (Hct), iron (Fe), total iron binding capacity (TIBC), ferritin (FER), mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) in patient blood. The obtained correlation coefficient (R) for RBC was 0.93, for Hb 0.92, for Fe 0.94, for TIBC 0.96, for FER 0.91, for Hct 0.94, for MCV 0.92, for MCHC 0.92 and for MCH 0.93. The observed high correlations between the NIR spectrum of the dialysate fluid and the levels of the studied variables support the use of NIRS as a promising method for on-line monitoring of anemia and iron saturation parameters in HD patients.


Assuntos
Anemia Ferropriva/terapia , Diálise Renal , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Anemia Ferropriva/sangue , Índices de Eritrócitos , Hemoglobinas/análise , Humanos , Monitorização Fisiológica/métodos , Qualidade de Vida
15.
Cochrane Database Syst Rev ; 5: CD011817, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34028001

RESUMO

BACKGROUND: Reference standard indices of iron deficiency and iron overload are generally invasive, expensive, and can be unpleasant or occasionally risky. Ferritin is an iron storage protein and its concentration in the plasma or serum reflects iron stores; low ferritin indicates iron deficiency, while elevated ferritin reflects risk of iron overload. However, ferritin is also an acute-phase protein and its levels are elevated in inflammation and infection. The use of ferritin as a diagnostic test of iron deficiency and overload is a common clinical practice. OBJECTIVES: To determine the diagnostic accuracy of ferritin concentrations (serum or plasma) for detecting iron deficiency and risk of iron overload in primary and secondary iron-loading syndromes. SEARCH METHODS: We searched the following databases (10 June 2020): DARE (Cochrane Library) Issue 2 of 4 2015, HTA (Cochrane Library) Issue 4 of 4 2016, CENTRAL (Cochrane Library) Issue 6 of 12 2020, MEDLINE (OVID) 1946 to 9 June 2020, Embase (OVID) 1947 to week 23 2020, CINAHL (Ebsco) 1982 to June 2020, Web of Science (ISI) SCI, SSCI, CPCI-exp & CPCI-SSH to June 2020, POPLINE 16/8/18, Open Grey (10/6/20), TRoPHI (10/6/20), Bibliomap (10/6/20), IBECS (10/6/20), SCIELO (10/6/20), Global Index Medicus (10/6/20) AIM, IMSEAR, WPRIM, IMEMR, LILACS (10/6/20), PAHO (10/6/20), WHOLIS 10/6/20, IndMED (16/8/18) and Native Health Research Database (10/6/20). We also searched two trials registers and contacted relevant organisations for unpublished studies. SELECTION CRITERIA: We included all study designs seeking to evaluate serum or plasma ferritin concentrations measured by any current or previously available quantitative assay as an index of iron status in individuals of any age, sex, clinical and physiological status from any country. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. We designed the data extraction form to record results for ferritin concentration as the index test, and bone marrow iron content for iron deficiency and liver iron content for iron overload as the reference standards. Two other authors further extracted and validated the number of true positive, true negative, false positive, false negative cases, and extracted or derived the sensitivity, specificity, positive and negative predictive values for each threshold presented for iron deficiency and iron overload in included studies. We assessed risk of bias and applicability using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. We used GRADE assessment to enable the quality of evidence and hence strength of evidence for our conclusions. MAIN RESULTS: Our search was conducted initially in 2014 and updated in 2017, 2018 and 2020 (10 June). We identified 21,217 records and screened 14,244 records after duplicates were removed. We assessed 316 records in full text. We excluded 190 studies (193 records) with reasons and included 108 studies (111 records) in the qualitative and quantitative analysis. There were 11 studies (12 records) that we screened from the last search update and appeared eligible for a future analysis. We decided to enter these as awaiting classification. We stratified the analysis first by participant clinical status: apparently healthy and non-healthy populations. We then stratified by age and pregnancy status as: infants and children, adolescents, pregnant women, and adults. Iron deficiency We included 72 studies (75 records) involving 6059 participants. Apparently healthy populations Five studies screened for iron deficiency in people without apparent illness. In the general adult population, three studies reported sensitivities of 63% to 100% at the optimum cutoff for ferritin, with corresponding specificities of 92% to 98%, but the ferritin cutoffs varied between studies. One study in healthy children reported a sensitivity of 74% and a specificity of 77%. One study in pregnant women reported a sensitivity of 88% and a specificity of 100%. Overall confidence in these estimates was very low because of potential bias, indirectness, and sparse and heterogenous evidence. No studies screened for iron overload in apparently healthy people. People presenting for medical care There were 63 studies among adults presenting for medical care (5042 participants). For a sample of 1000 subjects with a 35% prevalence of iron deficiency (of the included studies in this category) and supposing a 85% specificity, there would be 315 iron-deficient subjects correctly classified as having iron deficiency and 35 iron-deficient subjects incorrectly classified as not having iron deficiency, leading to a 90% sensitivity. Thresholds proposed by the authors of the included studies ranged between 12 to 200 µg/L. The estimated diagnostic odds ratio was 50. Among non-healthy adults using a fixed threshold of 30 µg/L (nine studies, 512 participants, low-certainty evidence), the pooled estimate for sensitivity was 79% with a 95% confidence interval of (58%, 91%) and specificity of 98%, with a 95% confidence interval of (91%, 100%). The estimated diagnostic odds ratio was 140, a relatively highly informative test. Iron overload We included 36 studies (36 records) involving 1927 participants. All studies concerned non-healthy populations. There were no studies targeting either infants, children, or pregnant women. Among all populations (one threshold for males and females; 36 studies, 1927 participants, very low-certainty evidence): for a sample of 1000 subjects with a 42% prevalence of iron overload (of the included studies in this category) and supposing a 65% specificity, there would be 332 iron-overloaded subjects correctly classified as having iron overload and 85 iron-overloaded subjects incorrectly classified as not having iron overload, leading to a 80% sensitivity. The estimated diagnostic odds ratio was 8. AUTHORS' CONCLUSIONS: At a threshold of 30 micrograms/L, there is low-certainty evidence that blood ferritin concentration is reasonably sensitive and a very specific test for iron deficiency in people presenting for medical care. There is very low certainty that high concentrations of ferritin provide a sensitive test for iron overload in people where this condition is suspected. There is insufficient evidence to know whether ferritin concentration performs similarly when screening asymptomatic people for iron deficiency or overload.


Assuntos
Anemia Ferropriva/sangue , Ferritinas/sangue , Sobrecarga de Ferro/sangue , Adolescente , Adulto , Idoso , Anemia Ferropriva/diagnóstico , Viés , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Sobrecarga de Ferro/diagnóstico , Masculino , Pessoa de Meia-Idade , Gravidez , Gestantes , Sensibilidade e Especificidade , Adulto Jovem
16.
PLoS One ; 16(5): e0251335, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34010354

RESUMO

BACKGROUND: Good nutritional status of school-aged children is crucial in achieving improved cognition. The objective of this study was to assess the relationship between nutritional status and cognition of school-aged children in the Kumasi metropolis, Ghana. METHODS: 389 children were selected from ten government-owned schools. Socio-demographic and anthropometric data were collected. Blood samples were collected and analyzed for nutrients levels. Dietary intakes were assessed using food frequency questionnaire and previous day's nutrients intake. Cognition test was performed using the Ravens Colored Progressive Matrix (RCPM). RESULTS: Mean age of participants was 8.9±1.4 years, mean RCPM score was 17.9±5.4. More girls scored RCPM below the 40th percentile (45.5%) than boys (33.7%), while mother's level of education significantly associated with RCPM percentiles of the children (p = 0.037). Four dietary patterns were generated from food frequency data, and scores of the second pattern, depicting vegetables, non-fruits, bread and cereals, showed a weak negative correlation (r = -0.132, p = 0.026) with previous day's dietary zinc intake. Cognitive status did not vary by anthropometric and dietary patterns. More anemic (54.4%) than non-anemic (33.3%) children were below the 40th RCPM percentile. Mean previous day's intake for folate (p<0.001), vitamin B6 (p = 0.018), iron (p<0.001), and zinc (p = 0.001) differed significantly between the cognitive test score percentiles of the children. Spearman rank correlation showed weak positive associations between RCPM score and hemoglobin (r = 0.246, p = 0.003) and serum ferritin (r = 0.176, p = 0.036). Binary regression analysis showed anemic children (aOR = 0.4; 95%CI = 0.2-0.8, p = 0.014), compared with non-anemic had decreased odds, while boys, compared with girls had increased odds (aOR = 2.0 95%CI = 1.0-4.0, p = 0.035) for scoring above the 50th RCPM percentile. CONCLUSIONS: Iron status, especially hemoglobin levels, correlated with the cognitive performance of school-aged children in the metropolis. Thus nutritional strategies aimed at reducing iron deficiency anemia are needed.


Assuntos
Cognição/fisiologia , Ferro/sangue , Anemia Ferropriva/sangue , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/psicologia , Criança , Estudos Transversais , Dieta , Feminino , Ferritinas/sangue , Gana/epidemiologia , Hemoglobinas/metabolismo , Humanos , Masculino , Testes Neuropsicológicos , Estado Nutricional , Instituições Acadêmicas , Classe Social , População Urbana , Zinco/sangue
17.
Medicine (Baltimore) ; 100(20): e24571, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011020

RESUMO

INTRODUCTION: Iron deficiency anemia (IDA) is common among obstetric and gynecologic patients. This systematic review aimed to assess the comparative efficacy and safety of commonly used intravenous (IV) iron formulations, ferric carboxymaltose (FCM), and iron sucrose (IS) in the treatment of IDA in obstetric and gynecologic patients. METHODS: We systematically searched PubMed, EMBASE, Cochrane CENTRAL, and Google Scholar for eligible randomized controlled trials (RCTs) comparing IV iron replacement using FCM and IS up to October 2019. The primary outcome was to compare the efficacy of FCM and IS, assessed by measuring serum hemoglobin (Hb) and ferritin levels before and after iron replacement. The secondary outcome was to compare the safety of FCM and IS, assessed by the incidence of adverse events during iron replacement. The meta-analysis was performed using RevMan 5.3. RESULTS: We identified 9 RCTs with 910 patients (FCM group, n = 456; IS group, n = 454). Before iron replacement, FCM and IS group patients had similar baseline Hb (mean difference [MD], 0.04 g/dL; 95% confidence interval [CI], -0.07 to 015; I2 = 0%; P = 0.48) and ferritin levels (MD, -0.42 ng/mL; 95% CI, -1.61 to 0.78; I2 = 45%; P = 0.49). Following iron replacement, patients who received FCM had higher Hb (MD, 0.67; 95% CI, 0.25-1.08; I2 = 92%; P = 0.002) and ferritin levels (MD, 24.41; 95% CI, 12.06-36.76; I2 = 75%; P = 0.0001) than patients who received IS. FCM group showed a lower incidence of adverse events following iron replacement than IS group (risk ratio, 0.53; 95% CI, 0.35-0.80; I2 = 0%; P = 0.003). Serious adverse events were not reported in any group. CONCLUSION: FCM group showed better efficacy in increasing Hb and ferritin levels and a favorable safety profile with fewer adverse events compared with IS group for IDA treatment among obstetric and gynecologic patients. However, this meta-analysis was limited by the small number of RCTs and high heterogeneity. TRIAL REGISTRATION: The review was prospectively registered with the International Prospective Registry of Systematic Reviews (https://www.crd.york.ac.uk/prospero/, registration number CRD42019148905).


Assuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Férricos/administração & dosagem , Óxido de Ferro Sacarado/administração & dosagem , Hematínicos/administração & dosagem , Maltose/análogos & derivados , Complicações Hematológicas na Gravidez/tratamento farmacológico , Administração Intravenosa , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/etiologia , Feminino , Compostos Férricos/efeitos adversos , Óxido de Ferro Sacarado/efeitos adversos , Ferritinas/sangue , Hematínicos/efeitos adversos , Hemoglobinas/análise , Humanos , Maltose/administração & dosagem , Maltose/efeitos adversos , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
19.
Acta Obstet Gynecol Scand ; 100(9): 1602-1610, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33880752

RESUMO

INTRODUCTION: Iron deficiency during pregnancy is a global health problem and is associated with adverse pregnancy outcomes. The aim of this randomized, double-blind, placebo-controlled study was to evaluate the effect of Lactiplantibacillus plantarum 299v (Lp299v, 1010 colony forming units), 4.2 mg iron, 12 mg ascorbic acid and 30 µg folic acid (Lp) on iron status in healthy, non-anemic, pregnant Swedish women. MATERIAL AND METHODS: A total of 326 women were randomized to receive Lp (n = 161) or placebo (n = 165) twice daily from gestational week 10-12 until end of pregnancy or until the potential start of iron therapy. The primary endpoint was serum ferritin at week 28. RESULTS: Intake of Lp attenuated the decrease in serum ferritin from baseline to week 28 (p = 0.003) and week 35 (p Ë‚ 0.001) and resulted in reduced prevalence of iron deficiency (59% vs 78%, p = 0.017) and iron deficiency anemia (7.4% vs 21%, p = 0.023) at week 35. Intake of Lp also resulted in beneficial effects on the soluble transferrin receptor (p = 0.011) and total body iron (p Ë‚ 0.001) at week 35. Gestational length and birthweight were comparable between groups. The proportion of women reporting adverse events during the study was comparable between groups. CONCLUSIONS: Intake of Lp from early pregnancy was safe, attenuated the loss of iron stores and improved iron status in healthy pregnant women.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Ferro/uso terapêutico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal , Probióticos/uso terapêutico , Administração Oral , Adolescente , Adulto , Anemia Ferropriva/sangue , Suplementos Nutricionais , Feminino , Ferritinas/sangue , Humanos , Ferro/administração & dosagem , Gravidez , Complicações Hematológicas na Gravidez/sangue , Resultado da Gravidez , Probióticos/administração & dosagem , Resultado do Tratamento , Adulto Jovem
20.
Acta Sci Pol Technol Aliment ; 20(2): 213-222, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33884858

RESUMO

BACKGROUND: Little is known about the relation between iron and folic acid (FA) supplementation and inflammation. The aim of this study was to evaluate the effects of iron and folate deficiency and supplementation on blood morphology parameters, and to assess the role of iron and folate transporters in inflammation. METHODS: A four-week period of FA and iron deficiency in Wistar rats was followed by randomization into a group fed with a diet deficient in FA and supplemented with Fe (DFE), a group fed a diet deficient in Fe and supplemented with FA (DFOL), a group fed a diet supplemented with Fe and FA (FEFOL), a group fed a diet deficient in Fe and FA (D), and a group fed a control diet (C). The blood Crp concentration and blood count were determined. The expression of SLC11A2, SLC46A1, SLC19A1, and TFR2 proteins was assessed using the western blot method. RESULTS: After ten days on the experimental diets, the rats in the DFOL group had a 21% higher concentration of white blood cells (WBC) than the FEFOL group did (p < 0.05). We did not observe any differences between the groups in terms of C-reactive protein (Crp) concentration. We also did not find any other differences between the groups in other morphological parameters. Analysis of the correlation between blood count parameters and the expression of iron and folate transporters gave conflicting results. CONCLUSIONS: To conclude, iron and folate supplementation may affect WBC concentration in the blood.


Assuntos
Anemia Ferropriva , Suplementos Nutricionais , Deficiência de Ácido Fólico , Ácido Fólico , Inflamação/sangue , Ferro , Leucócitos/metabolismo , Anemia Ferropriva/sangue , Anemia Ferropriva/tratamento farmacológico , Animais , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Proteínas de Transporte de Cátions/sangue , Dieta , Feminino , Ácido Fólico/sangue , Ácido Fólico/uso terapêutico , Deficiência de Ácido Fólico/sangue , Deficiência de Ácido Fólico/tratamento farmacológico , Ferro/sangue , Ferro/uso terapêutico , Contagem de Leucócitos , Proteínas de Membrana Transportadoras/sangue , Antígenos de Histocompatibilidade Menor/sangue , Transportador de Folato Acoplado a Próton/sangue , Distribuição Aleatória , Ratos Wistar , Proteína Carregadora de Folato Reduzido/sangue
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