Железодефицитные новости

[Dr.Vad]

Изменения лаб. показателей на фоне лечения ЖДА: корррекция ЖДА сопровождалась повышением В12, фолата, глюкозы, холестерина (обшего и высокой плотности), билирубина, мочевой кислоты, уровень мочевины снижался:

A cohort of 35 young adult women with IDA was treated with oral iron. An haematological response was obtained in 97.2% at 4-month follow-up. Changes in serum vitamin B12, serum folate and other biochemical parameters were monitored. Treatment with iron increased significantly serum folate and vitamin B12 from baseline. This increase was also observed in vitamin B12 levels ≤200 pmol/L (six patients, 17.1%), in whom serum vitamin B12 was above 200 pmol/L at the end of the study in all cases. Other biochemical parameters also changed. Significant increases were seen for glucose (P = 0.012), uric acid (P < 0.001), total cholesterol (P = 0.023), HDL cholesterol (P = 0.026) and bilirubin (P < 0.001). Urea decreased significantly (P = 0.036).

Remacha AF, и соавт.
Vitamin B12 and folate levels increase during treatment of iron deficiency anaemia in young adult woman. Int J Lab Hematol. 2015 May 11.

[Dr.Vad]

Анемия у будущей мамы в третьем триместре (гемоглобин менее 100) в 2.5 раза повышает риск развития анемии у ребенка к 6 мес., в 1.5 и в 4 мес. сушеств. различий у детей, рожденных от матерей с анемией или без нее (гемоглобин более 110), между гемоглобином или др. параметрами не отмечалось:

This study aimed to analyze the iron deficiency index and erythrocyte parameters in anemic pregnant women and their newborns, and explore their implications for anemia during pregnancy. Pregnant women (70) in the third trimester with hemoglobin (Hb) <100 g/L who registered and delivered from June 2012-2013 were randomly selected as the observation group, 70 pregnant women at similar gestational ages with Hb >110 g/L were selected as the control group, and 70 newborns delivered by women in each group were included in corresponding offspring observation and control groups, respectively. Periodic physical examinations were conducted on the infants, and blood samples were drawn from the women and infants at birth, 42 days, 4 months, and 6 months old for detection of Hb and soluble transferrin receptor (sTfR) levels. Pregnant women and their 6-month-old infants in the observation group had significantly different Hb and sTfR levels compared to controls (P < 0.01). There were no significant differences in Hb and sTfR levels of infants at birth, 42 days, and 4 months old (P > 0.05). The detection rate of iron deficiency anemia (IDA) was significant, at 61.43% among 6-month-old infants in the observation group and 22.86% among controls (P < 0.01). There were no significant differences in the detection rate of IDA among infants at birth, 42 days, and 4 months old between observation and control groups (P > 0.05). Therefore, anemia during pregnancy is a major contributing factor of IDA and subclinical iron deficiency among 6-month-old infants.

Genet Mol Res. 2015 Apr 15;14(2):3501-8.
Study of the significance of iron deficiency indexes and erythrocyte parameters in anemic pregnant women and their newborns.
Liu L, и соавт.

[Dr.Vad]

ахлоргидрия как причина ЖДА - недавний обзор:

Am J Clin Nutr. 2015 May 20.
Is achlorhydria a cause of iron deficiency anemia?
Betesh AL et al.
We re-evaluated the old hypothesis that gastritis-induced achlorhydria is a cause of iron deficiency anemia (IDA) in humans. First, we analyzed the currently available research on the association between achlorhydria and IDA. When gastric acid secretion was measured after maximal stimulation, the frequency of achlorhydria (or severe hypochlorhydria) was 44% in patients with idiopathic IDA and 1.8% in healthy controls. In some patients with pernicious anemia, presumed achlorhydria preceded the development of IDA in time. However, we found no credible evidence that IDA caused gastritis or that IDA preceded the development of achlorhydria. Thus, correlational results favor achlorhydria as the causal factor in the association between achlorhydria and IDA. Second, we sought to determine whether gastritis and achlorhydria cause negative iron balance. When biosynthetic methods were used to isotopically label iron in food, achlorhydric patients were found to have severe malabsorption of nonheme iron, which persisted after the development of IDA. In 1 study, achlorhydria reduced the normal increase in heme-iron absorption from hemoglobin in response to iron deficiency. After an injection of isotopic iron into normal men, the physiologic loss of iron from the body was found to be 1 mg/d. Patients with chronic gastritis had excess fecal loss of isotopically tagged plasma iron. Calculations based on these results indicate that the absorption of iron from a typical Western diet by achlorhydric patients would be less than physiologic iron losses, creating a negative iron balance that could not be overcome by the adaptive increase in duodenal iron absorptive capacity that occurs in response to iron deficiency. The combination of results from these correlational and pathophysiologic studies supports the hypothesis that gastritis-induced achlorhydria can be an independent cause of IDA.

[Dr.Vad]

Iron Deficiency Anemia: A Guide to Oral Iron Supplements

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Еще одна презентация, указывающая, что синдром постуральной тахикардии ассоциируется со сниженным ферритином у женшин плюс у них выше % головных болей, ЖКТ дистресса, периферич. нейропатий, боязливости/фобий и концентрации внимания:

BACKGROUND: POTS is a condition caused by an underlying autonomic dysfunction. The dysfunction of the sympathetic system leads to an insufficient cardiac and vascular tone upon standing and patients often present with frequent episodes of syncope and presyncope.
DESIGN/METHODS: Medical records of autonomic dysfunction female patients from a single urban clinic diagnosed with POTS (n = 33) and without POTS (n = 53) between 2006 and 2012 were reviewed for serum ferritin values and the presence of co-morbid conditions. Mean serum ferritin values were compared between groups using a two-sample t-test. Co-morbid conditions were also tabulated.
RESULTS: The mean serum ferritin level of 37.1 ng/mL (SD = 35.0) in POTS patients was clinically relevant but borderline significantly lower than the mean serum ferritin level of 57.8 ng/mL (SD = 55.5) in patients without POTS (p=0.037). Patients with serum ferritin below 50 ng/mL were 2.85 times more likely to exhibit POTS than patients above 50 ng/mL. Patients with POTS also had an increased prevalence of headaches (61%, p=0.23), peripheral neuropathy (79%, p =0.28), GI distress (67%, p=0.11) anxiety (33%, p=0.08) and concentration issues (30%, p=0.0001).
CONCLUSIONS: Decreased serum ferritin levels indicate a potential mechanistic relationship between low serum ferritin and POTS.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

В/в назначение железа и транзиторная гипофосфатемия - чем выше доза введения за 1 раз, чем выше риск ее развития:

Intravenous Iron Administration and Hypophosphatemia in Clinical Practice
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

METABOLISM OF IRON STORES

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Питание и дефицит железа у молодых жительниц в индустриальных странах подробно в обзоре:

Dietary determinants of and possible solutions to iron deficiency for young women living in industrialized countries: a review.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Век живи и век учись... выделение неизмененного по цвету пигмента (бетанина) с мочой после поедания вареной свеклы (салатов с ней) /битурия, beeturia/ может быть косвенным признаком дефицита железа - в то время кактакое наблюдается у 10-15% здоровых людей, то при дефиците железа битурия отмечается у 50-80% людей, окисление бетанина с потерей цвета только возможно в присутствии достат. количества ионов железа (подсмотрено в аптудейте, публикации по теме в пабмеде датируются 60-90-ми годами).

[Dr.Vad]

У детей первых лет жизни выраженная (гемоглобин менее 80) ЖДА (средние цифры гемоглобина 55 г/л) ассоциируется с 40% госпитализацией из-за нарушений нервного развития, сердечной недостаточностью, церебральными тромбозами; в питании таких детей преобладает избыток коровьего молока (более 1 л в сутки), а также более частое прикладывание к бутылочке днем и в ночное время:

Children with severe IDA (n=201, mean Hb 55 g/l) experienced substantial morbidity (including developmental delay, heart failure, cerebral thrombosis) and health-care utilization (including a 42 % hospitalization rate). Compared with children with Fe sufficiency (n=597, mean Hb 122 g/l), children with severe IDA consumed a larger volume of cow's milk daily (median 1065 ml v. 500 ml, P<0.001) and were more likely to be using a bottle during the day (78 % v. 43 %, OR=6·0; 95 % CI 4·0, 8·9) and also in bed (60 % v. 21 %, OR=6·5; 95 % CI 4·4, 9·5).
Severe IDA is associated with substantial morbidity and may be preventable. Three potentially modifiable feeding practices are associated with IDA: (i) cow's milk consumption greater than 500 ml/d; (ii) daytime bottle use beyond 12 months of age; and (iii) bottle use in bed.
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Parkin PC, и соавт. Severe iron-deficiency anaemia and feeding practices in young children. Public Health Nutr. 2015 Jun 1:1-7.

[Dr.Vad]

Исследователи из Турции обнаружили почти двоекратное снижение усвоения железа у более пожилых людей с ЖДА: б0льшие дозы железа внутрь или eгo в/в введение может быть более рациональным при лечении ЖДА у пожилых

Eur Rev Med Pharmacol Sci. 2015 Sep;19(17):3142-5.
The status of iron absorption in older patients with iron deficiency anemia.
Silay K, Akinci S, Yalcin A, Guney T, Ulas A, Ozer O, Ozbek S, Dilek I.

OBJECTIVE:
The aim of this study is to evaluate the iron absorption status by using the oral iron absorption test (OIAT) in older patients with iron deficiency anemia (IDA) in comparison with younger patients.

PATIENTS AND METHODS:
This is a cross-sectional study including 100 patients with iron deficiency anemia. Patients were divided in two groups; group 1 who is 65 and older and group 2 who is younger than 65. OIAT in which a fasting serum iron level is compared with a second serum iron level obtained three hours following oral ingestion of iron sulfate was performed. An increase in serum iron of at least 100 mcg/dL indicates that oral iron absorption is adequate. The Independent-Samples t-test was used to show the statistical difference between the means of two groups.

RESULTS:
There were 100 patients in the study; 69 of them have completed the study. The means of the oral iron absorption test results of the groups was compared with an independent t-test, which showed that the mean of group 1 was lower than group 2 and this was statistically significant (p = 0.001). The mean of OIAT results was 86.1 and 163.5 in group 1 and 2 respectively.

CONCLUSIONS:
In our knowledge, the present study is among the first that shows the status of iron absorption objectively by using OIAT in older patients. Our study shows iron absorption is decreased in older patients with IDA in comparison with younger patients. In the light of this finding; OIAT should be offered before initiating treatment in older patients when IDA is diagnosed and intravenous iron treatment should be considered more on the base of results.

[Dr.Vad]

Чрезмерное поедание изюма как причина ЖДА - ежедневное употребление 100-150 г изюма нарушало усвоение железа из ЖКТ и привело к рецидивир. ЖДА:

A Case of Pica-like, Nutrient-induced, Severe Iron-deficiency Anemia [Ссылки доступны только зарегистрированным пользователям ]

еще о пике при ЖДА:

Pica in iron deficiency: a case series [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Iron and the female athlete: a review of dietary treatment methods for improving iron status and exercise performance
J Int Soc Sports Nutr. 2015 Oct 6;12:38.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

пилотное исследование из Швейцарии об эффекте однократного введения 500-700 мг железа в/в беременным в третьем триместре для коррекции синдрома беспокойных ног:

19 women in the third trimester of pregnancy with moderate-to-severe RLS and serum ferritin levels <35 µg/l or hemoglobin (Hb) < 11.0 g/dl were included in the study. RLS was graded according to the International Restless Legs Syndrome (IRLS) Study Group rating scale. All participants had a score of ≥20 or had RLS ≥3 times/week. Based on the Hb levels, 500 or 700 mg of FCM was administered over 20 min. The primary end point was a ≥ 50% reduction in the mean IRLS score one week after FCM infusion. The secondary end points included periodic limb movements (PLMs; assessed using nocturnal foot actigraphy), sleep quality (assessed using the Pittsburgh Sleep Quality Index), and safety.

The IRLS score decreased from 23 ± 7 (baseline) to 13 ± 7 (P <0.01), whereas the PLM index decreased from 35 ± 26 (baseline) to 25 ± 20 (P <0.001). Significant improvement in sleep quality was also reported (P <0.029), and treatment was well tolerated. Three serious adverse events were reported, but they were considered unrelated to treatment.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Дефицит железа у спортсменов: швейцарский консенсус

In healthy male and female athletes >15 years, ferritin values <15 mcg are equivalent to empty, values from 15 to 30 mcg/l to low iron stores. Therefore a cut-off of 30 mcg/l is appropriate. For children aged from 6–12 years and younger adolescents from 12–15 years, cut-offs of 15 and 20 mcg/l, respectively, are recommended. As an exception in adult elite sports, a ferritin value of 50 mcg/l should be attained in athletes prior to altitude training, as iron demands in these situations are increased.

Полный текст
Iron deficiency in sports – definition, influence on performance and therapy.
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