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3.
Cochrane Database Syst Rev ; 8: CD012451, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32790892

RESUMO

BACKGROUND: Approximately 30% of adults undergoing non-cardiac surgery suffer from preoperative anaemia. Preoperative anaemia is a risk factor for mortality and adverse outcomes in different surgical specialties and is frequently the reason for blood transfusion. The most common causes are renal, chronic diseases, and iron deficiency. International guidelines recommend that the cause of anaemia guide preoperative anaemia treatment. Recombinant human erythropoietin (rHuEPO) with iron supplementation has frequently been used to increase preoperative haemoglobin concentrations in patients in order to avoid the need for perioperative allogeneic red blood cell (RBC) transfusion. OBJECTIVES: To evaluate the efficacy of preoperative rHuEPO therapy (subcutaneous or parenteral) with iron (enteral or parenteral) in reducing the need for allogeneic RBC transfusions in preoperatively anaemic adults undergoing non-cardiac surgery. SEARCH METHODS: We searched CENTRAL, Ovid MEDLINE(R), Ovid Embase, ISI Web of Science: SCI-EXPANDED and CPCI-S, and clinical trial registries WHO ICTRP and ClinicalTrials.gov on 29 August 2019. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) that compared preoperative rHuEPO + iron therapy to control treatment (placebo, no treatment, or standard of care with or without iron) for preoperatively anaemic adults undergoing non-cardiac surgery. We used the World Health Organization (WHO) definition of anaemia: haemoglobin concentration (g/dL) less than 13 g/dL for males, and 12 g/dL for non-pregnant females (decision of inclusion based on mean haemoglobin concentration). We defined two subgroups of rHuEPO dosage: 'low' for 150 to 300 international units (IU)/kg body weight, and 'high' for 500 to 600 IU/kg body weight. DATA COLLECTION AND ANALYSIS: Two review authors collected data from the included studies. Our primary outcome was the need for RBC transfusion (no autologous transfusion, fresh frozen plasma or platelets), measured in transfused participants during surgery (intraoperative) and up to five days after surgery. Secondary outcomes of interest were: haemoglobin concentration (directly before surgery), number of RBC units (where one unit contains 250 to 450 mL) transfused per participant (intraoperative and up to five days after surgery), mortality (within 30 days after surgery), length of hospital stay, and adverse events (e.g. renal dysfunction, thromboembolism, hypertension, allergic reaction, headache, fever, constipation). MAIN RESULTS: Most of the included trials were in orthopaedic, gastrointestinal, and gynaecological surgery and included participants with mild and moderate preoperative anaemia (haemoglobin from 10 to 12 g/dL). The duration of preoperative rHuEPO treatment varied across the trials, ranging from once a week to daily or a 5-to-10-day period, and in one trial preoperative rHuEPO was given on the morning of surgery and for five days postoperatively. We included 12 trials (participants = 1880) in the quantitative analysis of the need for RBC transfusion following preoperative treatment with rHuEPO + iron to correct preoperative anaemia in non-cardiac surgery; two studies were multiarmed trials with two different dose regimens. Preoperative rHuEPO + iron given to anaemic adults reduced the need RBC transfusion (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.38 to 0.80; participants = 1880; studies = 12; I2 = 84%; moderate-quality evidence due to inconsistency). This analysis suggests that on average, the combined administration of rHuEPO + iron will mean 231 fewer individuals will need transfusion for every 1000 individuals compared to the control group. Preoperative high-dose rHuEPO + iron given to anaemic adults increased the haemoglobin concentration (mean difference (MD) 1.87 g/dL, 95% CI 1.26 to 2.49; participants = 852; studies = 3; I2 = 89%; low-quality evidence due to inconsistency and risk of bias) but not low-dose rHuEPO + iron (MD 0.11 g/dL, 95% CI -0.46 to 0.69; participants = 334; studies = 4; I2 = 69%; low-quality evidence due to inconsistency and risk of bias). There was probably little or no difference in the number of RBC units when rHuEPO + iron was given preoperatively (MD -0.09, 95% CI -0.23 to 0.05; participants = 1420; studies = 6; I2 = 2%; moderate-quality evidence due to imprecision).  There was probably little or no difference in the risk of mortality within 30 days of surgery (RR 1.19, 95% CI 0.39 to 3.63; participants = 230; studies = 2; I2 = 0%; moderate-quality evidence due to imprecision) or of adverse events including local rash, fever, constipation, or transient hypertension (RR 0.93, 95% CI 0.68 to 1.28; participants = 1722; studies = 10; I2 = 0%; moderate-quality evidence due to imprecision). The administration of rHuEPO + iron before non-cardiac surgery did not clearly reduce the length of hospital stay of preoperative anaemic adults (MD -1.07, 95% CI -4.12 to 1.98; participants = 293; studies = 3; I2 = 87%; low-quality evidence due to inconsistency and imprecision). AUTHORS' CONCLUSIONS: Moderate-quality evidence suggests that preoperative rHuEPO + iron therapy for anaemic adults prior to non-cardiac surgery reduces the need for RBC transfusion and, when given at higher doses, increases the haemoglobin concentration preoperatively. The administration of rHuEPO + iron treatment did not decrease the mean number of units of RBC transfused per patient. There were no important differences in the risk of adverse events or mortality within 30 days, nor in length of hospital stay. Further, well-designed, adequately powered RCTs are required to estimate the impact of this combined treatment more precisely.


Assuntos
Anemia/tratamento farmacológico , Eritropoetina/uso terapêutico , Ferro/uso terapêutico , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios , Adulto , Anemia/sangue , Procedimentos Cirúrgicos do Sistema Digestório , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Procedimentos Cirúrgicos em Ginecologia , Hemoglobina A/metabolismo , Humanos , Tempo de Internação , Masculino , Procedimentos Ortopédicos , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Proteínas Recombinantes/uso terapêutico , Procedimentos Cirúrgicos Operatórios/mortalidade
4.
s.l; Anaesthesia Critical Care & Pain Medicine; July 23, 2020. 10 p.
Não convencional em Inglês | BIGG - guias GRADE | ID: biblio-1117192

RESUMO

Anemia is very common in critical care patients, on admission (affecting about two thirds ofpatients), but also during and after their stay, due to repeated blood loss, the effects of inflammation onerythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated withseverity of illness and length of stay.Methods: A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT,evaluated three fields: (1) anaemia prevention, (2) transfusion strategies and (3) non-transfusiontreatment of anaemia. Population, Intervention, Comparison, and Outcome (PICO) questions werereviewed and updated as needed, and evidence profiles were generated. Analysis of the literature andformulation of recommendations were then conducted according to the GRADE1methodology.Results: The SFAR-SRLF guideline panel provided ten statements concerning the management of anemiain adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope ofthese recommendations. After two rounds of discussion and various amendments, a strong consensuswas reached for ten recommendations. Three of these recommendations had a high level of evidence(GRADE 1) and four had a low level of evidence (GRADE 2). No GRADE recommendation could be providedfor two questions in the absence of strong consensus.Conclusions: The experts reached a substantial consensus for several strong recommendations foroptimal patient management. The experts recommended phlebotomy reduction strategies, restrictivered blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless ofstorage time, treatment of anemic patients with erythropoietin, especially after trauma, in the absence ofcontraindications and avoidance of iron therapy (except in the context of erythropoietin therapy). C2020 The Author(s). Published by Elsevier Masson SAS on behalf of Socie ́te ́franc ̧aise d'anesthe ́sie et dere ́animation (Sfar).


Assuntos
Humanos , Adulto , Transfusão de Sangue/instrumentação , Eritropoetina/análise , Anemia/prevenção & controle , Anemia/sangue , Ferro/uso terapêutico
5.
J Assoc Physicians India ; 68(5): 39-41, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32610864

RESUMO

Aim: To assess effect of daily vis-a-vis alternate day oral iron therapy in terms of hemoglobin, reticulocyte hemoglobin equivalent (RET-He) and GI side effects using hepcidin as a biomarker. Methods: A hospital based randomized interventional two-arm analytical study was done among patients of IDA (20 in each group). The study population was divided into two groups by randomisation. Group 1 received oral iron supplements on alternate day and Group 2 received iron supplements daily. Hemoglobin, RET-He, Serum ferritin and Hepcidin level were assessed. Results: On day 2nd, the rise in Hepcidin was not significant from base line in alternate day therapy group but was significantly increased in daily therapy group. On day 3, the rise in hepcidin was significant from base line in both the groups but the mean change in hepcidin was more in daily therapy group. RET-He began increasing on day 2nd in both the groups. In alternate day therapy group, the rise in RET-He was significant from base line from the day 2nd onwards while the rise in RET-He in daily therapy group was not significant even on day 3. In alternate day iron therapy group, the mean increase in hemoglobin on day 21th (1.58 ±0.53 gm/dl) was significantly more than mean increase among daily therapy (0.41 ± 0.25 gm/dl, P <0.05). Conclusion: Alternate day single tablet dosing schedule of oral iron therapy (60mg of elemental iron, ferrous sulfate) was more effective and better tolerated (gastrointestinal side effects) compared to daily supplementation in IDA.


Assuntos
Anemia Ferropriva , Ferro/uso terapêutico , Anemia Ferropriva/tratamento farmacológico , Biomarcadores , Suplementos Nutricionais , Hemoglobinas/análise , Hepcidinas , Humanos , Estudos Prospectivos
6.
Arch. argent. pediatr ; 118(3): 187-: I-192, I, jun. 2020. tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1104195

RESUMO

Introducción. La anemia en los primeros años de vida produce graves consecuencias psicomotoras, sociales y económicas. El objetivo fue determinar su prevalencia, causas y factores de riesgo y preventivos en lactantes de la ciudad de Necochea.Población y métodos. Estudio observacional, descriptivo y transversal. Se evaluaron lactantes sanos de 6 a 12 meses, que concurrieron espontáneamente por control de salud al sistema público y/o privado del distrito de Necochea durante el año 2017. Se solicitó consentimiento informado; se realizó una encuesta social y nutricional, evaluación del aporte de hierro de la dieta y medicamentoso, examen físico y pruebas de laboratorio.Resultados. Se incluyeron 239 participantes; el 50,6 % presentaban anemia y el 47,3 %, ferropenia. La media y mediana de hemoglobina coincidieron en 10,9 g/dl, (media de referencia 12,5 mg/dl). De los anémicos, el 54,4 % presentaba ferropenia; el 61,7 % no recibía aporte adecuado de hierro; el 44,3 % no había recibido hierro suplementario el día previo. De este porcentaje, el 24,5 % no había recibido indicación médica y, en el 9,1 %, no había suplemento en el centro de atención primaria de salud u hospital. El aporte adecuado de hierro resultó un factor protector para ferropenia (riesgo relativo ­RR­ 0,78 [intervalo de confianza ­IC­ del 95 %: 0,6-0,9]), y no fue así para la aparición de anemia (RR 1,08; [IC95%: 0,8-1,3]).Conclusiones. En la ciudad de Necochea, anemia y ferropenia son entidades con elevada prevalencia; el aporte de hierro dietario es pobre y el suplemento está subindicado.


Introduction. Anemia in the first years of life leads to severe psychomotor, social, and financial effects. The objective of this study was to determine its prevalence, causes, and risk and preventive factors among infants in the city of Necochea.Population and methods. Observational, descriptive, and cross-sectional study. Healthy infants aged 6-12 months who attended a spontaneous health checkup in a public and/or private facility in the district of Necochea during 2017 were assessed. An informed consent was obtained; a social and nutrition survey was administered; dietary and medicinal iron intake was assessed; and a physical examination and lab tests were done.Results. A total of 239 participants were included; 50.6 % had anemia and 47.3 %, iron deficiency. Mean and median hemoglobin levels were both 10.9 g/dL, (reference mean: 12.5 mg/dL). Among anemia patients, 54.4 % had iron deficiency; iron intake was inadequate in 61.7 %; and 44.3 % had not received iron supplementation the previous day. Among these, 24.5 % had not received a medical indication for it, and 9.1 % did not find iron supplementation available at their primary health care center or hospital. An adequate iron intake was a protective factor against iron deficiency (relative risk [RR]: 0.78 [95 % confidence interval {CI}: 0.6-0.9]), but not against the development of anemia (RR: 1.08; [95 % CI: 0.8-1.3]).Conclusions. In the city of Necochea, anemia and iron deficiency are highly prevalent conditions; dietary iron intake is insufficient and supplementation is under-prescribed.


Assuntos
Humanos , Masculino , Feminino , Lactente , Deficiência de Ferro , Anemia Ferropriva , Epidemiologia Descritiva , Estudos Transversais , Ferro na Dieta , Anemia/diagnóstico , Ferro/uso terapêutico
7.
PLoS One ; 15(5): e0232625, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365114

RESUMO

INTRODUCTION: Anemia during pregnancy has a significant adverse effect on both the mother and fetus. Iron and folic acid supplementation (IFAS) is the feasible and cost effective strategy to control and prevent anemia in pregnancy. However, the success of this strategy is suboptimal due to poor maternal adherences to the regimen. The aim of this study was to assess prevalence of anemia, rate of adherence to IFAS and associated factors among pregnant women at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. METHOD: Institution based cross sectional study was conducted among 250 pregnant women who were selected using systematic random sampling from antenatal care clinic (ANC) attendants of TASH. Data was collected through interview and medical chart review by using structured questionnaire. The data was analyzed by SPSS v.24. Binary logistic regression was used to identify the associated factors for IFAS and P < 0.05 was used to declare the association. RESULTS: The prevalence of anemia was 4.8% and half of the study participants were knowledgeable about anemia. The rate of adherence to IFAS was 63.6%. Forgetfulness and fear of side effect were the commonest reasons for poor adherence to IFAS. Gestational age at first ANC visit and educational level were significantly associated with adherence to IFAS. Thus, pregnant women who started their ANC follow up at first trimester (AOR = 1.87, 95% CI (1.18-3.36)) and education level of college and above (AOR = 4.236, 95% CI (1.35-13.25)) and completed secondary education (AOR = 4.09, 95% CI (1.39-12.02)) were more likely to be adherent to IFAS compared with their comparators. CONCLUSION: Even though anemia prevalence was very low among the study participants, adherence to IFAS was still a challenge during pregnancy. Therefore, counseling about IFAS and anemia prevention and promoting the benefits of early ANC visit are recommended to improve adherence to IFAS.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/epidemiologia , Suplementos Nutricionais , Ácido Fólico/uso terapêutico , Ferro/uso terapêutico , Complicações Hematológicas na Gravidez/epidemiologia , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Cooperação do Paciente , Educação de Pacientes como Assunto , Gravidez , Cuidado Pré-Natal , Prevalência , Análise de Regressão , Classe Social , Inquéritos e Questionários , Adulto Jovem
9.
Anaesthesia ; 75(8): 1039-1049, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32342498

RESUMO

In patients with pre-operative anaemia undergoing cardiac surgery, combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12 and oral folic acid reduces allogeneic blood product transfusions. It is unclear if certain types of anaemia particularly benefit from this treatment. We performed a post-hoc analysis of anaemic patients from a randomised trial on the 'Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery'. We used linear regression analyses to examine the efficacy of a combination anaemia treatment compared with placebo on the following deficiencies, each representing a part of the combination treatment: ferritin and transferrin saturation; endogenous erythropoietin; holotranscobalamine; and folic acid in erythrocytes. Efficacy was defined as change in reticulocyte count from baseline to the first, third and fifth postoperative days and represented erythropoietic activity in the immediate peri-operative recovery phase. In all 253 anaemic patients, iron deficiency was the most common cause of anaemia. Treatment significantly increased reticulocyte count in all regression analyses on postoperative days 1, 3 and 5 (all p < 0.001). Baseline ferritin and endogenous erythropoietin were negatively associated with change in reticulocyte count on postoperative day 5, with an unstandardised regression coefficient B of -0.08 (95%CI -0.14 to -0.02) and -0.14 (95%CI -0.23 to -0.06), respectively. Quadruple anaemia treatment was effective regardless of the cause of anaemia and its effect manifested early in the peri-operative recovery phase. The more pronounced a deficiency was, the stronger the subsequent boost to erythropoiesis may have been.


Assuntos
Anemia/tratamento farmacológico , Cuidados Pré-Operatórios/métodos , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/tratamento farmacológico , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/métodos , Método Duplo-Cego , Quimioterapia Combinada , Eritropoetina/administração & dosagem , Eritropoetina/uso terapêutico , Feminino , Ácido Fólico/administração & dosagem , Ácido Fólico/uso terapêutico , Hematínicos/administração & dosagem , Hematínicos/uso terapêutico , Humanos , Ferro/administração & dosagem , Ferro/uso terapêutico , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Contagem de Reticulócitos , Vitamina B 12/administração & dosagem , Vitamina B 12/uso terapêutico , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/uso terapêutico
10.
Nat Commun ; 11(1): 1857, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32312987

RESUMO

Despite its growing promise in cancer treatment, ferrotherapy has low therapeutic efficacy due to compromised Fenton catalytic efficiency in tumor milieu. We herein report a hybrid semiconducting nanozyme (HSN) with high photothermal conversion efficiency for photoacoustic (PA) imaging-guided second near-infrared photothermal ferrotherapy. HSN comprises an amphiphilic semiconducting polymer as photothermal converter, PA emitter and iron-chelating Fenton catalyst. Upon photoirradiation, HSN generates heat not only to induce cytotoxicity but also to enhance Fenton reaction. The increased ·OH generation promotes both ferroptosis and apoptosis, oxidizes HSN (42 nm) and transforms it into tiny segments (1.7 nm) with elevated intratumoral permeability. The non-invasive seamless synergism leads to amplified therapeutic effects including a deep ablation depth (9 mm), reduced expression of metastasis-related proteins and inhibition of metastasis from primary tumor to distant organs. Thereby, our study provides a generalized nanozyme strategy to compensate both ferrotherapy and phototherapeutics for complete tumor regression.


Assuntos
Ferro/uso terapêutico , Neoplasias/patologia , Neoplasias/terapia , Fototerapia/métodos , Polímeros/química , Semicondutores , Animais , Apoptose , Catálise , Linhagem Celular Tumoral , Quelantes , Ferroptose , Células HeLa , Humanos , Peróxido de Hidrogênio , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/patologia , Camundongos , Microscopia Confocal , Células NIH 3T3 , Nanomedicina/métodos , Nanopartículas/química , Metástase Neoplásica , Neoplasias/metabolismo , Oxigênio/química , Técnicas Fotoacústicas , Ratos , Espécies Reativas de Oxigênio/metabolismo
11.
BMC Public Health ; 20(1): 457, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32252698

RESUMO

BACKGROUND: To reduce the prevalence of anemia, the Indian government recommends daily iron and folic acid supplements (iron supplements) for pregnant women and weekly iron supplements for adolescents and all women of reproductive age. The government has distributed free iron supplements to adolescents and pregnant women for over four decades. However, initial uptake and adherence remain inadequate and non-pregnant women of reproductive age are largely ignored. The aim of this study is to examine the multilevel barriers to iron supplement use and to subsequently identify promising areas to intervene. METHODS: We conducted a qualitative study in the state of Odisha, India. Data collection included key informant interviews, focus group discussions with women, husbands, and mothers-in-law, and direct observations in health centers, pharmacies and village health and nutrition days. RESULTS: We found that at the individual level, participants knew that iron supplements prevent anemia but underestimated anemia prevalence and risk in their community. Participants also believed that taking too many iron supplements during pregnancy would "make your baby big" causing a painful birth and a costly cesarean section. At the interpersonal level, mothers-in-law were not supportive of their daughters-in-law taking regular iron supplements during pregnancy but husbands were more supportive. At the community level, participants reported that only pregnant women and adolescents are taking iron supplements, ignoring non-pregnant women altogether. Unequal gender norms are also an upstream barrier for non-pregnant women to prioritize their health to obtain iron supplements. At the policy level, frontline health workers distribute iron supplements to pregnant women only and do not follow up on adherence. CONCLUSIONS: Interventions should address multiple barriers to iron supplement use along the socio-ecological model. They should also be tailored to a woman's reproductive life course stage: adolescents, pregnancy, and non-pregnant women of reproductive age because social norms and available services differ between the subpopulations.


Assuntos
Anemia/prevenção & controle , Suplementos Nutricionais/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Ferro/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Anemia/epidemiologia , Anemia/psicologia , Feminino , Grupos Focais , Ácido Fólico/uso terapêutico , Humanos , Índia/epidemiologia , Ferro/deficiência , Masculino , Análise Multinível , Gravidez , Complicações Hematológicas na Gravidez/epidemiologia , Complicações Hematológicas na Gravidez/prevenção & controle , Complicações Hematológicas na Gravidez/psicologia , Cuidado Pré-Natal/psicologia , Prevalência , Pesquisa Qualitativa , Adulto Jovem
12.
Am J Obstet Gynecol ; 223(4): 516-524, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32184147

RESUMO

Iron is essential for the function of all cells through its roles in oxygen delivery, electron transport, and enzymatic activity. Cells with high metabolic rates require more iron and are at greater risk for dysfunction during iron deficiency. Iron requirements during pregnancy increase dramatically, as the mother's blood volume expands and the fetus grows and develops. Thus, pregnancy is a condition of impending or existing iron deficiency, which may be difficult to diagnose because of limitations to commonly used biomarkers such as hemoglobin and ferritin concentrations. Iron deficiency is associated with adverse pregnancy outcomes, including increased maternal illness, low birthweight, prematurity, and intrauterine growth restriction. The rapidly developing fetal brain is at particular risk of iron deficiency, which can occur because of maternal iron deficiency, hypertension, smoking, or glucose intolerance. Low maternal gestational iron intake is associated with autism, schizophrenia, and abnormal brain structure in the offspring. Newborns with iron deficiency have compromised recognition memory, slower speed of processing, and poorer bonding that persist despite postnatal iron repletion. Preclinical models of fetal iron deficiency confirm that expected iron-dependent processes such as monoamine neurotransmission, neuronal growth and differentiation, myelination, and gene expression are all compromised acutely and long term into adulthood. This review outlines strategies to diagnose and prevent iron deficiency in pregnancy. It describes the neurocognitive and mental health consequences of fetal iron deficiency. It emphasizes that fetal iron is a key nutrient that influences brain development and function across the lifespan.


Assuntos
Desenvolvimento Fetal/fisiologia , Distúrbios do Metabolismo do Ferro/tratamento farmacológico , Ferro/deficiência , Complicações na Gravidez/tratamento farmacológico , Oligoelementos/uso terapêutico , Encéfalo/embriologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/metabolismo , Feminino , Humanos , Ferro/metabolismo , Ferro/fisiologia , Ferro/uso terapêutico , Distúrbios do Metabolismo do Ferro/epidemiologia , Distúrbios do Metabolismo do Ferro/metabolismo , Distúrbios do Metabolismo do Ferro/fisiopatologia , Transtornos Mentais/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/metabolismo , Complicações na Gravidez/fisiopatologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia
13.
Acta Haematol ; 143(5): 496-499, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182610

RESUMO

Iron deficiency is the main cause of anemia in both sexes, with women being more commonly affected. Iron therapy is currently considered an effective and safe remedy to replenish the iron storages. Iron can be administrated both orally and intravenously. In particular, intravenous (IV) iron therapy is widely used when oral iron preparations are either not tolerated or ineffective. Indeed, IV iron improves iron stores more rapidly. Two main immunological responses have been described for iron hypersensitivity reactions (HSRs): IgE-mediated allergy and complement activation-related pseudo-allergy. Here, we report 3 cases of adult patients with iron allergy, who were successfully treated with two different desensitization procedures, respectively. Analysis of these cases demonstrates that, in the presence of HSRs to iron products, desensitization is an effective and safe procedure that prevents treatment discontinuation and hence allows therapeutic target achievement.


Assuntos
Anemia Ferropriva/diagnóstico , Hipersensibilidade/diagnóstico , Ferro/efeitos adversos , Adulto , Anemia Ferropriva/tratamento farmacológico , Clorfeniramina/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Compostos Férricos/uso terapêutico , Hematínicos/uso terapêutico , Humanos , Hipersensibilidade/etiologia , Ferro/uso terapêutico , Maltose/análogos & derivados , Maltose/uso terapêutico , Pessoa de Meia-Idade , Testes Cutâneos
14.
Hemodial Int ; 24(2): 188-194, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32048444

RESUMO

INTRODUCTION: Hepcidin is a key factor that regulates iron homeostasis. In hemodialysis patients (HD), a high hepcidin level may decrease intestinal iron absorption and reduce the efficacy of Oral iron vs Intravenous iron therapy. Whether the hepcidin level in HD could guide oral iron therapy is unclear. METHODS: We report a monocentric study on nine "erythropoietin (EPO)-free" patients (without recombinant human EPO [rHU-EPO] for at least 6 months) and normal hepcidin level (<20 ng mL) during the study. After 15 days of washout, oral iron (ferrous sulfate 80 mg/day) was introduced. The primary end point was the hemoglobin response and iron store at 3 months. FINDINGS: Nine patients (8 men, 1 woman) with a median age of 62 years (range 42-79) were included. After 1 week of treatment, the median transferrin saturation index increased from 15% (range 6-61) to 34% (range 13-42), P = 0.62, reflecting intestinal absorption. The median ferritin level remained stable 80 µg/L (35-293) vs 82 µg/L (range 37-496) between M0 and M3, P = 0.43. During the 3-month study, median hemoglobin level increased from 11.5 d/dL (range10.4-13.7) to 12.8 g/dL (range 11.1-15.2), P = 0.01. No major side effects were observed. Quality of life assessed by the SF-36 criteria was similar during the 3-month study. DISCUSSION: Oral iron therapy is effective and safe in EPO-free patients with normal hepcidin levels. These findings suggest that serum hepcidin may be a marker for defining iron therapy strategies in HD patients. HD patients treated with rHU-EPO and with normal hepcidin levels could benefit from oral iron treatment.


Assuntos
Biomarcadores/sangue , Hepcidinas/uso terapêutico , Ferro/uso terapêutico , Diálise Renal/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Ferro/administração & dosagem , Masculino , Pessoa de Meia-Idade , Projetos Piloto
15.
Monaldi Arch Chest Dis ; 90(1)2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32072798

RESUMO

Non-anemic iron deficiency has been studied in heart failure, but studies are lacking in chronic obstructive pulmonary disease (COPD). The potential clinical implications of association of iron deficiency with the severity of COPD warrant research in this direction. This was an observational, cross-sectional study on patients with COPD to compare disease severity, functional status and quality of life in non-anemic patients with COPD between two groups - iron deficient and non-iron deficient. Stable non-anemic COPD with no cause of bleeding were evaluated for serum iron levels, ferritin levels, TIBC, 6MWD, SGRQ, spirometry, and CAT questionnaire. The study patients were divided into iron replete (IR) and iron deficient (ID) groups. A total of 79 patients were studied, out of which 72 were men and seven were women. The mean age was 61.5±8.42 years. Of these, 36 (45.5%; 95% CI, 34.3-56.8%) had iron deficiency. Mean 6-minute-walk distance was significantly shorter in ID (354.28±82.4 meters vs 432.5±47.21 meters; p=0.001). A number of exacerbations in a year were more in ID group (p=0.003), and more patients in ID had at least two exacerbations of COPD within a year (p=0.001). However, the resting pO2, SaO2, and SpO2 levels did not differ significantly between the two groups (p=0.15 and p=0.52, respectively). Also, there was no significant difference in the distribution of patients of a different class of airflow limitations between the two groups. Non-anemic iron deficiency (NAID) is an ignored, yet easily correctable comorbidity in COPD. Patients with iron deficiency have a more severe grade of COPD, had lesser exercise capacity and more exacerbations in a year as compared to non-iron deficient patients. So, foraying into the avenue of iron supplementation, which has shown promising results in improving functional capacity in heart failure and pulmonary hypertension, may well lead to revolutionary changes in the treatment of COPD.


Assuntos
Anemia Ferropriva/complicações , Ferro/deficiência , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Anemia Ferropriva/fisiopatologia , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Progressão da Doença , Tolerância ao Exercício/fisiologia , Feminino , Humanos , Índia/epidemiologia , Ferro/sangue , Ferro/uso terapêutico , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença , Espirometria/métodos , Teste de Caminhada/métodos
16.
Transfusion ; 60(4): 759-768, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32073674

RESUMO

BACKGROUND: Most single-donor platelet (SDP) donors transition to plateletpheresis after prior red blood cell (RBC) donation. Recruitment may follow identification of a high platelet count, a marker associated with iron depletion (ID). SDP donors may have underrecognized risk for iron depletion. STUDY DESIGN AND METHODS: To assess the prevalence of ID, we performed ferritin testing on male plateletpheresis donors with hemoglobin levels less than 13.5 g/dL. Multivariable logistic regression identified risk factors for low ferritin (LF; ferritin ≤26 ng/mL) and absent iron stores (AIS; ferritin <12 ng/mL). To assess the impact of notifying donors of LF results, we compared donation behavior of "Test" subjects before and after sending an LF notification letter to that of "Control" subjects before and after increasing the minimum hemoglobin for male donors. An electronic survey to Test donors inquired about iron supplementation practices. RESULTS: Prevalence of LF was 50% and AIS was 23%, with increase in risk associated with more frequent SDP donation, both controlling for RBC donation and in donors with no recent RBC donations. Donation frequency after intervention declined less in 1272 Test donors (19%, from 13.9 to 11.2 annualized donations) than in 878 Control donors (49%, from 12.3 to 6.3 donations). Only 20% of Test donors reported taking supplemental iron when they received the LF letter; 64% of those not taking iron initiated iron supplementation following the letter. CONCLUSIONS: Donors were responsive to notification of LF and attendant messaging on iron supplementation. Ferritin testing potentially benefits donor health and a stable platelet supply.


Assuntos
Anemia Ferropriva/prevenção & controle , Doadores de Sangue/provisão & distribução , Plaquetoferese/efeitos adversos , Adulto , Anemia Ferropriva/etiologia , Suplementos Nutricionais , Ferritinas/sangue , Ferritinas/deficiência , Humanos , Ferro/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
17.
Nutrients ; 12(2)2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32024027

RESUMO

Altered martial indices before orthopedic surgery are associated with higher rates of complications and greatly affect the patient's functional ability. Oral supplements can optimize the preoperative martial status, with clinical efficacy and the patient's tolerability being highly dependent on the pharmaceutical formula. Patients undergoing elective hip/knee arthroplasty were randomized to be supplemented with a 30-day oral therapy of sucrosomial ferric pyrophosphate plus L-ascorbic acid. The tolerability was 2.7% among treated patients. Adjustments for confounding factors, such as iron absorption influencers, showed a relevant response limited to older patients (≥ 65 years old), whose uncharacterized Hb loss was averted upon treatment with iron formula. Older patients with no support lost -2.8 ± 5.1%, while the intervention group gained +0.7 ± 4.6% of circulating hemoglobin from baseline (p = 0.019). Gastrointestinal diseases, medications, and possible dietary factors could affect the efficacy of iron supplements. Future opportunities may consider to couple ferric pyrophosphate with other nutrients, to pay attention in avoiding absorption disruptors, or to implement interventions to obtain an earlier martial status optimization at the population level.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Artroplastia de Substituição , Ácido Ascórbico/uso terapêutico , Difosfatos/uso terapêutico , Compostos Férricos/uso terapêutico , Hemoglobinas/metabolismo , Ferro/uso terapêutico , Cuidados Pré-Operatórios , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/sangue , Artroplastia de Substituição/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Ácido Ascórbico/farmacologia , Suplementos Nutricionais , Difosfatos/farmacologia , Feminino , Compostos Férricos/farmacologia , Hematínicos/farmacologia , Hematínicos/uso terapêutico , Hematologia , Humanos , Ferro/sangue , Ferro/farmacologia , Masculino , Pessoa de Meia-Idade
18.
Int J Colorectal Dis ; 35(3): 521-527, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31930457

RESUMO

PURPOSE: Iron deficiency anemia is common in colorectal cancer patients and is related to poor surgical outcome. Increasing evidence supports preoperative use of intravenous iron (IVI) to correct anemia. Our study investigates effect of preoperative IVI on hemoglobin level. METHODS: From August 2017 to March 2019, colorectal cancer patients with iron deficiency anemia received intravenous iron at least 2 weeks before their scheduled operations (IVI group). These patients' prospectively collected data were compared to a historic cohort of anemic patients who received elective colorectal surgery within 3 years before the study period (non-IVI). RESULTS: Forty-six patients were included after receiving intravenous iron. After propensity score matching on 1:2 ratio, 38 patients in IVI group were matched with 62 patients from non-IVI group. There was no statistical difference for preoperative mean hemoglobin level between the two groups (8.43 g/dL in IVI, 8.79 g/dL in non-IVI, p = 0.117), but IVI group has significantly higher mean hemoglobin level on admission (10.63 g/dL in IVI, 9.46 g/dL in non-IVI, p = < 0.001). IVI group had higher median hemoglobin rise (1.9 in IVI, 0.6 in non-IVI, p = <0.001) and significantly less red cell transfusion (8 patients in IVI, 30 in non-IVI, p = 0.006). Subgroup analysis showed that less patients in IVI group required transfusions in preoperative period (1 in IVI group, 20 in non-IVI, p < 0.001). CONCLUSION: Our data suggested that IVI can significantly increase hemoglobin level in iron deficiency anemic patients before colorectal surgery, with reduction in red cell transfusions.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/etiologia , Neoplasias Colorretais/complicações , Ferro/administração & dosagem , Ferro/uso terapêutico , Pontuação de Propensão , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Hemoglobinas/metabolismo , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade
19.
Br J Anaesth ; 124(3): 243-250, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31902590

RESUMO

BACKGROUND: Preoperative anaemia affects one third of patients undergoing cardiac surgery and is associated with increased mortality and morbidity. Although it is recommended that perioperative teams should identify and treat patients with preoperative anaemia before surgery, introducing new treatment protocols can be challenging in surgical pathways. The aim of this study was to assess the feasibility and effectiveness of introducing a preoperative intravenous iron service as a national initiative in cardiac surgery. METHODS: We performed a multicentre, stepped, observational study using the UK Association of Cardiothoracic Anaesthesia and Critical Care Research Network. The primary feasibility outcome was the ability to set up an anaemia and intravenous iron clinic at each site. The primary efficacy outcome was change in haemoglobin (Hb) concentration between intervention and operation. Secondary outcomes included blood transfusion and hospital stay. Patients with anaemia were compared with non-anaemic patients and with those who received intravenous iron as part of their routine treatment protocol. RESULTS: Seven out of 11 NHS hospitals successfully set up iron clinics over 2 yr, and 228 patients were recruited into this study. Patients with anaemia who received intravenous iron were at higher surgical risk, were more likely to have a known previous history of iron deficiency or anaemia, had a higher rate of chronic kidney disease, and were slightly more anaemic than the non-treated group. Intravenous iron was administered a median (inter-quartile range, IQR [range]) of 33 (15-53 [4-303]) days before surgery. Preoperative intravenous iron increased [Hb] from baseline to pre-surgery; mean (95% confidence interval) change was +8.4 (5.0-11.8) g L-1 (P<0.001). Overall, anaemic compared with non-anaemic patients were more likely to be transfused (49% [59/136] vs 27% (22/92), P=0.001) and stayed longer in hospital (median days [IQR], 9 [7-15] vs 8 [6-11]; P=0.014). The number of days alive and at home was lower in the anaemic group (median days [IQR], 20 [14-22] vs 21 [17-23]; P=0.033). CONCLUSION: The development of an intravenous iron pathway is feasible but appears limited to selected high-risk cardiac patients in routine NHS practise. Although intravenous iron increased [Hb], there is a need for an appropriately powered clinical trial to assess the clinical effect of intravenous iron on patient-centred outcomes.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Procedimentos Cirúrgicos Cardíacos , Ferro/administração & dosagem , Cuidados Pré-Operatórios/métodos , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Estudos de Viabilidade , Feminino , Hemoglobinas/metabolismo , Humanos , Ferro/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Medicina Estatal/organização & administração
20.
PLoS One ; 15(1): e0227351, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923240

RESUMO

INTRODUCTION: Iron and Folic Acid Supplementation (IFAS) is an essential and affordable intervention strategy for prevention of anaemia during pregnancy. The supplements are currently provided for free to pregnant women in Kenya during antenatal care (ANC), but compliance remains low over the years. There is need for diversification of IFAS programme implementation by exploring other distribution channels to complement existing antenatal distribution and ensure consistent access to IFAS supplements. OBJECTIVES: To determine the effect of a community-based approach of IFAS distribution on compliance and assess side-effects experienced and their mitigation by pregnant women in Kiambu County. METHODOLOGY: A pretest-posttest quasi-experimental study design was used, consisting of an intervention and a control group, among 340 pregnant women 15-49 years, in five health facilities in Lari Sub-County in Kiambu County, between June 2016 and March 2017. Community health volunteers provided IFAS supplements, counselling and weekly follow-up to pregnant women in the intervention group while the control group followed standard practice from health facilities. Baseline and endline data were collected during antenatal care and compared. Quantitative data was analyzed using STATA version 14. Analysis of effect of intervention was done using Difference-In-Difference regression approach. RESULTS: Levels of compliance increased by 8% in intervention group and 6% in control group. There was increased awareness of IFAS side-effects across groups. The intervention group reported experiencing less side-effects and were better able to manage them compared to the control group. CONCLUSION: Implementation a community-based approach improved maternal compliance with IFAS, awareness of IFAS side effects and their management, with better improvement being recorded in the intervention group. Hence, there is need to integrate community-based approach with antenatal distribution of IFAS to improve supplementation.


Assuntos
Anemia/prevenção & controle , Ácido Fólico/uso terapêutico , Ferro/uso terapêutico , Gestantes , Adolescente , Adulto , Estudos de Casos e Controles , Serviços de Saúde Comunitária/normas , Suplementos Nutricionais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia , Pessoa de Meia-Idade , Cooperação do Paciente , Gravidez , Cuidado Pré-Natal , Adulto Jovem
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