Железодефицитные новости

[Dr.Vad]

Риск латентного железодефицита, но не ЖД анемии, у детей возрастает при более длительном грудном вскармливании: железодефицит был в 1.7 раз чаще у детей, у которых грудное вскармливание было более 12 месяцев, по сравнению с теми, у кого грудное вскармливание было менее года, подробнее:

Included were 1647 healthy children (median age 36 months) with survey, anthropometric, and laboratory data. An association was found between increasing duration of breastfeeding and lower serum ferritin (P = .0015). Adjusted logistic regression analysis revealed the odds of iron deficiency increased by 4.8% (95% confidence interval: 2%-8%) for each additional month of breastfeeding. Exploratory analysis suggested an increasing cumulative probability of iron deficiency with longer total breastfeeding duration with an adjusted odds ratio of 1.71 (95% confidence interval: 1.05-2.79) for iron deficiency in children breastfed over versus under 12 months of age. The relationship between total breastfeeding duration and iron deficiency anemia did not meet statistical significance.
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Association Between Total Duration of Breastfeeding and Iron Deficiency. Pediatrics. 2013 Apr 15.

[Dr.Vad]

Eur J Clin Microbiol Infect Dis. 2013 Apr 18.
Iron deficiency and susceptibility to infections: evaluation of the clinical evidence.
Tansarli GS, Karageorgopoulos DE, Kapaskelis A, Gkegkes I, Falagas ME.
Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23, Marousi, Athens, Greece.

Iron is a fundamental nutrient for human and microbial life. We sought to examine the association of iron deficiency versus normal iron status with the susceptibility to infections. A systematic search in the PubMed and Scopus databases was performed to identify relevant clinical studies. Six studies (including a total of 1,422 participants) met the inclusion criteria: four prospective cohort (859 participants), one retrospective case-control (115 participants), and one retrospective cohort study (448 participants). Intensive care unit (ICU)-acquired and postoperative infections were more common in patients with iron deficiency than among those with normal iron status in two studies, while no difference was reported in another study. In one study examining pregnant women with normal mean iron values, higher soluble transferrin receptor values independently predicted vaginosis-like microflora. Iron deficiency anemia was an independent predictor of respiratory tract infections in one study, and postoperative urinary tract infections were more common in patients with iron deficiency anemia in another. The limited available evidence suggests that individuals with iron deficiency and those with iron deficiency anemia may be more susceptible to infections than patients with normal iron status. Future studies should elucidate further these findings.

[Dr.Vad]

Когда клинически необходимо введение железа в/в плюс обзор/сравнение имеющихся в/в препаратов железа:

Drug Des Devel Ther. 2011 Jan 20;5:51-60.
When is high-dose intravenous iron repletion needed? Assessing new treatment options.
Gozzard D.
Betsi Cadwaladr University Health Board, Llandudno, Wales, UK

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

25-летнее наблюдение за индивидами, которые были железодефицитны на первом году жизни - они чаще не заканчивают среднюю школу, не продолжают дальнейшее обучение, не обзаводятся семьей:

Adjusting for sex and socioeconomic status, a higher proportion of the group with chronic iron deficiency did not complete secondary school (58.1% vs 19.8% in iron-sufficient group; Wald value = 8.74; P = .003), were not pursuing further education/training (76.1% vs 31.5%; Wald value = 3.01; P = .08; suggestive trend), and were single (83.9% vs 23.7%, Wald value = 4.49; P = .03). They reported poorer emotional health and more negative emotions and feelings of dissociation/detachment.

J Pediatr. 2013 Jul 1.
Functional Significance of Early-Life Iron Deficiency: Outcomes at 25 Years.
Lozoff B, Smith JB, Kaciroti N, Clark KM, Guevara S, Jimenez E.
Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.

[Dr.Vad]

Готовка обогащенной железом еды в железных кастрюлях еще больше повышает содержание железа в пище, нежели в тефлоновой посуде, и на 8% повышает гемоглобин у дошкольников:

Indian J Pediatr. 2013 Jul 19.
Beneficial Effect of Iron Pot Cooking on Iron Status.
Kulkarni SA, Ekbote VH, Sonawane A, Jeyakumar A, Chiplonkar SA, Khadilkar AV.
Department of Dietetics, School of Health Sciences, University of Pune, Pune, India.

OBJECTIVES: To develop iron rich snacks using locally available iron rich foods and analyze their iron content when cooked in iron pots. Further, the efficacy of the developed snacks, cooked in iron pots was examined on the hemoglobin status of pre-school children through a three month randomized trial.

METHODS: Four iron rich snacks (mean iron content 2.1mg/serving) were cooked in iron pots and 27 preschool children (mean age 2.9 ± 0.9 y, 12 boys) were supplemented with the snacks for 4 mo. Anthropometry and dietary intake data were collected. Hemoglobin, serum iron and transferrin saturation were assessed.

RESULTS: An increase of 16.2 % in the iron content was found in the snacks cooked in iron pots than cooked in Teflon coated non-stick pots. After 4 mo of supplementation, a significant increase of 7.9 % was seen in the hemoglobin of the children.

CONCLUSION: This pilot study demonstrated that iron rich recipes cooked in iron pot have a beneficial effect on iron status of children.

[Dr.Vad]

ЖДА как фактор риска ишемического инсульта у детей: ЖДА (особенно с тромбоцитозом) повышает риск инсульта в 4 (10 раз):

This was a case-control study that included 21 stroke cases with patients who had previously been generally healthy, and matched with age and gender of 100 healthy control subjects. Patients were included if a diagnosis of definite stroke had been made and other known etiologies of childhood onset stroke were excluded. For all subjects, iron parameters including serum iron, ferritin, transferrin, total iron binding capacity, and transferrin saturation were assessed.... Our results showed that IDA was disclosed in 57.1 % of stroke cases with no identified cause, as compared to 26 % of controls. Our study suggest that previously healthy children who developed stroke are 3.8 times more likely to have IDA than healthy children, who do not develop stroke (OR, 3.8; 95 % CI:1.3-11.2 P = 0.005). In addition, there was significant interaction between IDA and thrombocytosis among studied cases (OR, 10.5; 95 % CI, 1.0-152 P = 0.02).

Ann Hematol. 2013 Oct 19. Iron deficiency anemia as a risk factor for cerebrovascular events in early childhood: a case-control study

[Dr.Vad]

Новый внутривенный препарат железа монофер так и не смог показать себя столь же эффективным как и старый добрый сульфат железа при лечении ЖДА у пациентов с воспалительными болезнями кишечника (болезнь Крона и язвенный колит):

Am J Gastroenterol. 2013 Oct 22.
A Randomized, Open-Label, Non-Inferiority Study of Intravenous Iron Isomaltoside 1,000 (Monofer) Compared With Oral Iron for Treatment of Anemia in IBD (PROCEED).
Reinisch W, Staun M, Tandon RK, Altorjay I, Thillainayagam AV, Gratzer C, Nijhawan S, Thomsen LL.
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Hospital, Vienna, Austria.

OBJECTIVES: In the largest head-to-head comparison between an oral and an intravenous (IV) iron compound in patients with inflammatory bowel disease (IBD) so far, we strived to determine whether IV iron isomaltoside 1,000 is non-inferior to oral iron sulfate in the treatment of iron deficiency anemia (IDA).

METHODS: This prospective, randomized, comparative, open-label, non-inferiority study was conducted at 36 sites in Europe and India. Patients with known intolerance to oral iron were excluded. A total of 338 IBD patients in clinical remission or with mild disease, a hemoglobin (Hb) <12 g/dl, and a transferrin saturation (TSAT) <20% were randomized 2:1 to receive either IV iron isomaltoside 1,000 according to the Ganzoni formula (225 patients) or oral iron sulfate 200 mg daily (equivalent to 200 mg elemental iron; 113 patients). An interactive web response system method was used to randomize the eligible patient to the treatment groups. The primary end point was change in Hb from baseline to week 8. Iron isomaltoside 1,000 and iron sulfate was compared by a non-inferiority assessment with a margin of -0.5 g/dl. The secondary end points, which tested for superiority, included change in Hb from baseline to weeks 2 and 4, change in s-ferritin, and TSAT to week 8, number of patients who discontinued study because of lack of response or intolerance of investigational drugs, change in total quality of life (QoL) score to weeks 4 and 8, and safety. Exploratory analyses included a responder analysis (proportion of patients with an increase in Hb ≥2 g/dl after 8 weeks), the effect of regional differences and total iron dose level, and other potential predictors of the treatment response.

RESULTS: Non-inferiority in change of Hb to week 8 could not be demonstrated. There was a trend for oral iron sulfate being more effective in increasing Hb than iron isomaltoside 1,000. The estimated treatment effect was -0.37 (95% confidence interval (CI): -0.80, 0.06) with P=0.09 in the full analysis set (N=327) and -0.45 (95% CI: -0.88, -0.03) with P=0.04 in the per protocol analysis set (N=299). In patients treated with IV iron isomaltoside 1,000, the mean change in s-ferritin concentration was higher with an estimated treatment effect of 48.7 (95% CI: 18.6, 78.8) with P=0.002, whereas the mean change in TSAT was lower with an estimated treatment effect of -4.4 (95% CI: -7.4, -1.4) with P=0.005, compared with patients treated with oral iron. No differences in changes of QoL were observed. The safety profile was similar between the groups. The proportion of responders with Hb ≥2 g/dl (IV group: 67%; oral group: 61%) were comparable between the groups (P=0.32). Iron isomaltoside 1,000 was more efficacious with higher cumulative doses of >1,000 mg IV. Significant predictors of Hb response to IV iron treatment were baseline Hb and C-reactive protein (CRP).

CONCLUSIONS: We could not demonstrate non-inferiority of IV iron isomaltoside 1,000 compared with oral iron in this study. Based on the dose-response relationship observed with the IV iron compound, we suggest that the true iron demand of IV iron was underestimated by the Ganzoni formula in our study. Alternative calculations including Hb and CRP should be explored to gauge iron stores in patients with IBD.

[Dr.Vad]

Популяционное исследование показало, что предшествующая ЖДА умеренно повышает риск развития венозного тромбоза:

Blood Coagul Fibrinolysis. 2015 Feb 13.
Association between venous thromboembolism and iron-deficiency anemia: a population-based study.
Hung SH, Lin HC, Chung SD.
Although iron-deficiency anemia (IDA) as a rare cause of cerebral sinus thrombosis was supported by several studies, the relationship between IDA and venous thromboembolisms (VTEs) remains unclear. In this study, we evaluated the association between IDA and subsequent VTEs based on a population-based coverage database. We retrieved data for this case-control study from the Taiwan Longitudinal Health Insurance Database 2000. In total, 2522 cases with VTE and 12 610 randomly selected controls were included. A conditional logistic regression was used to examine the association of VTEs with previously diagnosed IDA. The χ test indicated that there was a significant difference in the prevalence of prior IDA between subjects with a VTE and the controls (3.41 vs. 2.06%, respectively, P < 0.001). The conditional logistic regression analysis showed that the odds ratio (OR) of previous IDA for subjects with a VTE was 1.43 [95% confidence interval (CI): 1.10-1.87] compared with the controls after adjusting for monthly income, geographic region, urbanization level, cancer, inflammatory bowel disease, heart failure, hypertension, diabetes, coronary heart disease, hyperlipidemia, renal disease, obesity, and whether or not a subject was hospitalized and whether or not a subject had suffered from a fracture within 1 year prior to the index date. The adjusted OR for prior IDA in subjects with deep-vein thrombosis was 1.43 (95% CI: 1.08-1.90) compared with the controls. However, there was no significant difference in the adjusted OR of prior IDA between subjects with a pulmonary embolism and the controls (OR: 1.10; 95% CI: 0.63-1.92). We concluded that there was an association between IDA and VTEs.

[Dr.Vad]

Интересные результаты работы применения больших доз железа (180-200 мг/сут) для лечения ЖДА были представлены на последней АSH-2014: прирост гемоглобина на >10 г/л за две недели говорил о хорошем терапевтическом ответе и, то что препараты железа следует принимать и далее, тогда как ответ в виде прироста менее 10 г/л - о плохом/недостаточном усвоении железа и желательности перехода на в/в введение:

Introduction: Oral iron supplementation is an effective means of iron replacement. Nevertheless, there is a frequent need to transition patients with iron deficiency anemia (IDA) from oral to intravenous (IV) iron therapy for inadequate response. No definitive guidance on the optimal timing for this change in therapy exists. Serum hepcidin may be a marker in predicting response to oral iron therapy, but currently, hepcidin assays are not commercially available. We evaluated the ability of various early response characteristics to accurately predict for an overall hemoglobin (Hb) response to oral iron. Our objective was to identify an early predictor of overall Hb response in patients on oral iron treatment as a guide to the decision to switch from oral to IV iron in patients unlikely to benefit from continued oral iron.

Methods: Proprietary datasets from 6 published randomized studies in which oral iron (325 mg of ferrous sulfate containing 65 mg of elemental iron, t.i.d.[4 studies], 304.3 mg capsules containing 100 mg bivalent iron b.i.d [1 study] and as prescribed by the investigator [1 study]) was used as a comparator to ferric carboxymaltose were analyzed. Five studies were pooled into one primary analysis dataset and one study was analyzed separately due to differences in study design that precluded pooling. Patients were grouped by the underlying etiology of their IDA (postpartum, heavy uterine bleeding, gastrointestinal, and others) and stratified by those who had ≥ 1 g/dL Hb change after 14 days of oral iron therapy (responders) and those who did not (non-responders). Further analyses evaluated Hb response at various time points based on initial 14 day Hb response (≥ 1 g/dL change vs < 1 g/dL). We systemically evaluated changes in hemoglobin, absolute reticulocyte count, % reticulocyte count, ferritin, and transferrin saturation at specific time points to determine their ability to predict overall Hb response.

Results: A total of 738 patients who were randomized to oral iron were included in the pooled study analysis. In the separate study, a total of 253 patients, all non-responders, were included. The mean baseline values for the 6 studies were Hb 9.9 g/dL, ferritin 19.9 ng/mL, and TSAT 16.9%. The vast majority of patients (96%) were females with a mean age of 36 years. In the pooled analysis, by day 14 of oral iron treatment, 27.2% (201/738) of patients had a Hb increase of < 1 g/dL (non-responders). Of these 201 patients, less than half (46.8%, 94/201) achieved an increase in Hb ≥ 1 g/dL from baseline after 2 additional weeks of oral iron (by day 28) and only 63.2% (127/201) had an increase in Hb ≥ 1g/dL from baseline after 6 to 8 weeks of oral iron (42 to 56 days). Furthermore, only 27.4% (55/201) and 5.5% (11/201) had an increase in Hb of 2 or 3 g/dL respectively at the Day 42 or 56 measurement. In comparison, responders (those who had a Hb increase ≥ 1 g/dL by 14 days of treatment) sustained a robust Hb response with continued dosing of oral iron. After 4 weeks of oral iron (28 days), 84.9% of the responders had a ≥ 2 g/dL increase in Hb from baseline. After 6 to 8 weeks of oral iron (42 or 56 days), 92.9% of the patients had ≥ 2 g/dL Hb increase from baseline, significantly different from non-responders (p < 0.0001). Patients with etiology of postpartum anemia had the most robust Hb response to oral iron. Results observed in the sixth study were similar to the pooled analysis. Only 10.2% (17/167) of non-responders who continued oral iron after day 14 achieved a Hb ≥ 2g/dL by Day 35, whereas 38.8% (57/147) who were switched to IV ferric carboxymaltose achieved a Hb > 2/dL by Day 35 (p =0.0001). Hb response after 14 days of oral iron was a strong predictor of overall response (sensitivity = 90.1%, specificity = 79.3%, positive predictive value = 92.9%, negative predictive value= 72.7%), surpassing other parameters evaluated in this study.

Conclusion: In the absence of significant continuous blood loss, Hb measurements taken 14 days after initiation of oral iron therapy can reliably predict overall response in Hb to oral iron therapy. Accordingly, day 14 Hb may be a useful tool for clinicians in determining when to switch patients from oral to IV iron.

Abstract 211
Clinical Criteria for Transitioning from Oral to IV Iron Replacement Therapy in Patients with Iron Deficiency Anemia

[Dr.Vad]

Нормоцитарная анемия (при подтверждении отсутствия сочетания микро/макроцитоза, увеличения ретикулоцитов или низкого эритропоэтина) в разных клинических ситуациях в 80-90% отвечала ВОЗ-критерию железодефицитной (прирост гемоглобина на >5 г/л на фоне приема железа внутрь или в/в) несмотря на нормальный уровень ферритина (в среднем 127 мкг/л ; медиана: 85 - от 3 до 581 мкг/л); коррекция анемии зависела от исходного уровня гемоглобина: ~80% если он был снижен на <10 г/л и 25-40% если снижение было более выраженным:

Introduction
Normocytic anemia is a common type of anemia, with increasing prevalence in old age. However, diagnosing the etiology of normocytic anemia can be a challenge, as it is a clinical presentation for a vast variety of diseases. Physicians often commence extensive laboratory testing to exclude other differential diagnosis. Although nutritional (iron or vitamin B12/folate) deficiencies are typically associated with microcytic or macrocytic anemia, these deficiencies are readily treatable and iron deficiency is the most common form of anemia worldwide. Therefore, we would like to evaluate the prevalence of iron deficiency in patients initially presented with normocytic anemia.

Methods

This study is a retrospective chart review of patients being referred to an academic hematology clinic from 2003 to 2014 for further evaluation of chronic normocytic anemia without abnormalities in other cell lines. Following initial workup to ensure the absence of 1) mixed microcytic-macrocytic anemia, 2) reticulocytosis, and 3) low erythropoietin level, all patients received a therapeutic trial of iron orally or intravenously. A total of 125 patients (median age: 71 years, range: 24 – 97) had complete records before and after iron therapy for further analysis to determine the changes in hematological parameters and iron indexes.

The patients were categorized by the severity of their anemia, as defined by pretreatment hemoglobin levels below a given age and gender-specific normal range: (1) Hb ≤ 10.0 g/L below normal (n = 54), (2) Hb 10.1 – 20.0 g/L below normal (n = 37), Hb 20.1 – 30.0 g/L below normal (n = 21) and Hb > 30.1 g/L below normal (n = 14). Furthermore, the WHO definition of an increase of Hb ≥ 5.0 g/L was used to signify a response to iron replacement, which might be associated with a subjective improvement in general well-beings.

Results

The overall response rate to iron replacement therapy was 85.6%, and the anemia was fully corrected in 54.4% of the patients. The average pretreatment ferritin level for these patients was 127 μg/L (median: 85 μg/L, range 3 – 581 μg/L), which would generally not be considered indicative of iron deficiency. Additionally, the response rates among different subgroups were from 83% to 93%, where the percentage of responders was similar when comparing the mild anemic group (Hb ≤ 10.0 g/L below normal) and the more severe anemic groups. In contrast, although more than 80% of patients with mild normocytic anemia achieved a normal Hb after iron replacement, only 30-40% of patients with moderate to severe anemia (> 10 g/L below normal) experienced a normalization of Hb after iron therapy.

Conclusion

This retrospective case series illustrates that iron deficiency is a common and treatable cause in patients with chronic normocytic anemia. Despite the dogma that patients are unlikely to be iron deficient with a ferritin level ≥ 100 ug/L, more than 80% of patients in this study had an increase in Hb ≥ 5 g/L when iron stores were replenished. The data also suggests that a therapeutic trial of iron replacement should be considered in patients with mild normocytic anemia before extensive workup. However, as the anemia was likely multifactorial in patients with more severe normocytic anemia (with Hb > 10 g/L below the normal range) the benefits of an iron replacement trial should be balanced against the risks of iron overload if patients ultimately require regular blood transfusion for other concomitant hematological disorders.

Abstract 4032
Iron Deficiency As a Common Treatable Cause of Chronic Normocytic Anemia

[Dr.Vad]

Железа сульфат, принимаемый внутрь для лечения ЖДА, повышает риск побочных эффектов со стороны ЖКТ в 2.5-3 раза по сравнению с плацебо или в/в введением препарата железа, и риск этих поб. явлений не зависит от дозы; подробнее

Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

диагноз ЖДА и выявление злокачественных опухолей через 5 лет или позже: повышен в 1.5-2 раза риск развития рака поджелудочной, печени, почек, мочевого пузыря - результаты популяционного исследования из Тайваня:

PLoS One. 2015 Mar 17;10(3):e0119647.
Risk of Cancer in Patients with Iron Deficiency Anemia: A Nationwide Population-Based Study.
Hung N и соавт.
OBJECTIVE: This study evaluated the risk of cancer among patients with iron deficiency anemia (IDA) by using a nationwide population-based data set.
METHOD: Patients newly diagnosed with IDA and without antecedent cancer between 2000 and 2010 were recruited from the Taiwan National Health Insurance Research Database. The standardized incidence ratios (SIRs) of cancer types among patients with IDA were calculated.
RESULTS: Patients with IDA exhibited an increased overall cancer risk (SIR: 2.15). Subgroup analysis showed that patients of both sexes and in all age groups had an increased SIR. After we excluded patients diagnosed with cancer within the first and first 5 years of IDA diagnosis, the SIRs remained significantly elevated at 1.43 and 1.30, respectively. In addition, the risks of pancreatic (SIR: 2.31), kidney (SIR: 2.23), liver (SIR: 1.94), and bladder cancers (SIR: 1.74) remained significantly increased after exclusion of patients diagnosed with cancer within 5 years after IDA diagnosis.
CONCLUSION: The overall cancer risk was significantly elevated among patients with IDA. After we excluded patients diagnosed with IDA and cancer within 1 and 5 years, the SIRs remained significantly elevated compared with those of the general population. The increased risk of cancer was not confined to gastrointestinal cancer when the SIRs of pancreatic, kidney, liver, and bladder cancers significantly increased after exclusion of patients diagnosed with IDA and cancer within the first 5 years. This finding may be caused by immune activities altered by IDA. Further study is necessary to determine the association between IDA and cancer risk.

[Dr.Vad]

Физическая активность (5 дней в неделю по 25 минут) у железодефицитных женщин замедляет коррекцию ферритина по сравнению с теми, кто не нагружает себя таковыми упражнениями: через 8 недель приема 42 мг железа в день ферритин у первых был в полтора раза ниже (32 против 48 мкг/л), подробнее:

72 iron-depleted, nonanemic Chinese women [serum ferritin (sFer) <25 μg/L and hemoglobin >110 g/L] were included in an 8-wk, partially blinded, randomized controlled trial with a 2 × 2 factorial design including iron supplements (42 mg elemental Fe/d) or placebo and aerobic training (five 25-min sessions/wk at 75-85% of maximum heart rate) or no training. Linear mixed models were used to evaluate the relation between supplement type, training, and changes in iron status over time, measured by sFer, hemoglobin, soluble transferrin receptor (sTfR), and estimated total body iron.Results: After treatment, both the iron-supplemented trained and untrained groups showed significantly improved sFer, sTfR, and body iron values compared with either of the placebo groups. Similarly, trained participants had significantly higher aerobic fitness measures than untrained participants. Training modified the sFer response to supplementation (training by supplement interaction, P = 0.07), with the iron-supplemented trained group having significantly lower sFer than the iron-supplemented untrained group at week 8 (mean ± SD: 31.8 ± 13.5 and 47.6 ± 15.7 μg/L, respectively; P = 0.042), whereas there was no significant difference between the placebo trained and untrained groups (21.3 ± 12.2 and 20.3 ± 7.0 μg/L, respectively; P = 1.00).
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Am J Clin Nutr. 2017 Nov 1.
Efficacy of iron supplementation may be misinterpreted using conventional measures of iron status in iron-depleted, nonanemic women undergoing aerobic exercise training.

[Dr.Vad]

Однократное введение монофера после родов снижало усталость и депрессивное настроение лучше, чем пероральный прием железа:

Participants received intravenous iron (n = 97) or oral iron (n = 99), and completed the Multidimensional Fatigue Inventory and Edinburgh Postnatal Depression Scale, and haematological and iron parameters were measured. Primary outcome was the aggregated change in physical fatigue score from baseline to 12 weeks postpartum.

The difference in physical fatigue score was -0·97 (95% CI: -1·65; -0·28, P = 0·006) in favour of intravenous iron, but did not meet the predefined difference of 1·8. Across visits, we found statistically significant differences in fatigue and depression scores, as well as in haematological and iron parameters, all in favour of intravenous iron.

Vox Sang. 2017 Apr;112(3):219-228.
Single-dose intravenous iron infusion or oral iron for treatment of fatigue after postpartum haemorrhage: a randomized controlled trial.
Holm C et al.

[Dr.Vad]

Пpием железа после родов способствовал снижению послеродовой депрессии, слабый ответ на лечение был у тех, у кого ферритин не поднимался выше 45-50:

his randomized, double-blind, placebo-controlled trial evaluated 70 mothers with PPD. One week after delivery, the mothers were randomly allocated in the iron-treated (50 mg elemental iron/daily) and placebo-treated groups. After 6 weeks, the improvement of PPD symptoms was compared between the groups.

Ferritin significantly increased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.09). After intervention, ferritin was higher in the iron-treated group (medians: 78.2 vs. 37 mg/dl, p = 0.01). The rate of iron deficiency significantly decreased in the iron-treated group (p = 0.009), but not in the placebo group (p = 0.4). After intervention, the rate of iron deficiency was higher in the placebo group (31.4 vs. 8.5 %, p = 0.01). The Edinburgh Postnatal Depression Scale (EPDS) score significantly decreased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.13). After intervention, the EPDS score was lower in the iron-treated group (medians 9 vs. 12, p = 0.01). The improvement rate for PPD was significantly higher in the iron-treated group (42.8 vs. 20 %, p = 0.03). After intervention, mothers with continued PPD had lower ferritin than the improved mothers (41.8 vs. 67 mg/dl, p = 0.03). Mothers with continued depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p = 0.02).
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Eur J Nutr. 2017 Mar;56(2):901-908.
The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial.
Sheikh M. et al.