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1.
An overview of the relationship between anaemia, iron, and venous leg ulcers.
Ferris, AE, Harding, KG
International wound journal. 2019;(6):1323-1329
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Abstract
The factors preventing healing in venous leg ulcers are still not fully understood. Iron-mediated tissue damage has been hypothesised, yet anecdotally anaemia is also thought to have a negative effect on wound healing. This article summarises the current evidence for these theories and their likely effects in the context of venous ulceration. A comprehensive search of the literature was conducted. Studies suggest that a number of forms of iron including haemosiderin and ferritin are implicated in progression of venous disease, ulcer formation, and impaired healing, which is thought to be primarily free radical mediated. There is a paucity of evidence for the role of iron deficiency and anaemia on ulcer healing; however, there is likely to be a highly complex interplay between the damaging effects of iron on local tissues and the negative effects of anaemia-mediated tissue hypoxia. Studies looking at options to increase local oxygen delivery such as topical haemoglobin suggest that this may have an impact on some aspects of healing, but findings are generally inconclusive. There is growing evidence that locally elevated iron levels may have a detrimental effect on ulcer healing and formation; however, more robust research is needed.
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Oral iron-based interventions for prevention of critical outcomes in pregnancy and postnatal care: An overview and update of systematic reviews.
Abraha, I, Bonacini, MI, Montedori, A, Di Renzo, GC, Angelozzi, P, Micheli, M, Germani, A, Carloni, D, Scaccetti, A, Palmieri, G, et al
Journal of evidence-based medicine. 2019;(2):155-166
Abstract
OBJECTIVE The aim of this work was to summarize and update the evidence concerning oral iron-based interventions compared to placebo or no iron-based interventions to prevent critical outcomes in pregnancy or treat critical outcomes in the postpartum phase. METHOD Published systematic reviews (Feb 2018) and primary studies (from 2015 to March 2018) retrieved from MEDLINE, EMBASE, and the Cochrane Library were examined. The AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool was used to assess the quality of reviews. GRADE was used to rate the quality of the evidence for critical outcomes. RESULTS Antenatal care: Compared to placebo/no treatment, iron-based therapies reduced maternal anemia at term by 59% (seven trials at low risk of bias, RR 0.41, 95% CI 0.23-0.73; I2 = 86%; moderate-quality evidence) and maternal iron deficiency anemia by 67% (RR 0.33, 95% CI 0.16-0.69; I2 = 49%). There was no evidence of difference between iron-based therapies vs control in terms of side effects (RR 1.42, 95% CI 0.91-2.21), preterm delivery (13 studies: RR 0.93, 95% CI 0.84-1.03; low-quality evidence), low birthweight (RR 0.94, 95% CI 0.79-1.13; low-quality evidence) and infant mortality (RR 0.93, 0.72-1.20; low-quality evidence). POSTNATAL CARE There was insufficient evidence to determine whether iron-based therapies can reduce postpartum anemia. CONCLUSION Iron supplementation is effective in preventing maternal anemia at term but not low birthweight, preterm delivery or infant mortality.
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Treating Preoperative Anemia to Improve Patient Outcomes After Orthopaedic Surgery.
Shanbhag, SP, Solano, MA, Botros, MA, Khanuja, HS
The Journal of the American Academy of Orthopaedic Surgeons. 2019;(24):e1077-e1085
Abstract
For patients undergoing orthopaedic surgery, preoperative risk modification and control of comorbidities can maximize safety and improve outcomes. Anemia is common among orthopaedic patients, and its prevalence increases with patient age. Although surgeons are well versed in intraoperative blood conservation, preoperative anemia treatment is often deferred to primary care physicians, who may not understand the importance of a thorough assessment and treatment. Orthopaedic surgeons should understand the causes and treatments of anemia to advocate that patients receive appropriate preoperative care. Mean corpuscular volume and reticulocyte count can help determine the cause of anemia and assess the bone marrow's ability to produce red blood cells. These values can be used to aid in diagnosis and treatment plans. Iron deficiency anemia, the most common type, is a microcytic anemia easily treated with iron supplementation. In cases of trauma, anemia can be related to acute blood loss and underlying conditions. Fracture patterns and preexisting comorbidities should be assessed. The role of intravenous iron supplementation in this setting has not been clearly shown. Patients needing urgent procedures that might involve substantial blood loss should receive transfusions if they have hemoglobin levels <8 g/dL or symptomatic anemia.
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Increased Levels of Glycated Hemoglobin A1c and Iron Deficiency Anemia: A Review.
Guo, W, Zhou, Q, Jia, Y, Xu, J
Medical science monitor : international medical journal of experimental and clinical research. 2019;:8371-8378
Abstract
Worldwide, the prevalence of diabetes remains high. Studies have shown that iron deficiency anemia (IDA) is associated with increased levels of glycated hemoglobin A1c (HbA1c), but the mechanism remains unclear. Hematological changes, iron metabolism, study methodology, and other factors could affect the results of diagnostic investigations, leading to false results. Red blood cell turnover in the bone marrow and the quality and heterogeneity of erythrocytes may influence the rate of hemoglobin glycation. By changing the structure of hemoglobin and inducing peroxidation, iron deficiency accelerates glycation. This review aims to discuss the possible causes of the association between increased levels of HbA1c and IDA.
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Successful management of anemia with sirolimus in blue rubber bleb nevus syndrome: case report and update.
Fernández Gil, M, López Serrano, P, García García, E
Revista espanola de enfermedades digestivas. 2019;(8):643-647
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder with characteristic skin hemangiomas and vascular malformations, mostly in the gastrointestinal (GI) tract. The GI lesions are mainly located in the stomach and small intestine, usually more than a hundred, leading to gastrointestinal bleeding and severe chronic anemia. Parenteral iron infusions and scheduled transfusions are frequently necessary. We describe the case of a 21-year-old male with anemia secondary to BRBNS, who becomes unresponsive to octreotide and shows an excellent response to sirolimus (SRL), dismissing the intravenous iron supplementations and being free of transfusions. During the treatment, the patient presents avascular hip necrosis, which is adequately treated with an injection of stem cells with complete recovery, and without the suspension of SRL. Two years later, adequate response persists with no other relevant side effects.
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Recurrent aphthous stomatitis - Etiology, serum autoantibodies, anemia, hematinic deficiencies, and management.
Chiang, CP, Yu-Fong Chang, J, Wang, YP, Wu, YH, Wu, YC, Sun, A
Journal of the Formosan Medical Association = Taiwan yi zhi. 2019;(9):1279-1289
Abstract
Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases characterized by recurrent and painful ulcerations on the movable or nonkeratinized oral mucosae. Clinically, three types of RAS, namely minor, major, and herpetiform types, can be identified. RAS more commonly affects labial mucosa, buccal mucosa, and tongue. Previous studies indicate that RAS is a multifactorial T cell-mediated immune-dysregulated disease. Factors that modify the immunologic responses in RAS include genetic predisposition, viral and bacterial infections, food allergies, vitamin and microelement deficiencies, systemic diseases, hormonal imbalance, mechanical injuries, and stress. Our previous study found the presence of serum gastric parietal cell antibody, thyroglobulin antibody, and thyroid microsomal antibody in 13.0%, 19.4%, and 19.7% of 355 RAS patients, respectively. We also found anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in 20.9%, 20.1%, 4.8%, 2.6%, and 7.7% of 273 RAS patients, respectively. Therefore, it is very important to examine the complete blood count, serum autoantibody, hematinic, and homocysteine levels in RAS patients before we start to offer treatments for RAS. Because RAS is an immunologically-mediated disease, topical and systemic corticosteroid therapies are the main treatments of choice for RAS.
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Prolyl Hydroxylase Inhibitors: A Breakthrough in the Therapy of Anemia Associated with Chronic Diseases.
Joharapurkar, AA, Pandya, VB, Patel, VJ, Desai, RC, Jain, MR
Journal of medicinal chemistry. 2018;(16):6964-6982
Abstract
Chronic kidney disease, cancer, chronic inflammatory disorders, nutritional, and genetic deficiency can cause anemia. Hypoxia causes induction of hypoxia-inducible factor (HIF), which stimulates erythropoietin (EPO) synthesis. Prolyl hydroxylase domain (PHD) enzyme inhibition can stabilize hypoxia-inducible factor (HIF). HIF stabilization also decreases hepcidin, a hormone of hepatic origin, which regulates iron homeostasis. PHD inhibitors represent a novel pharmacological treatment of anemia associated with chronic diseases. Many orally active PHD inhibitors like roxadustat, molidustat, vadadustat, and desidustat are in late phase clinical trials. This review discusses the role of PHD inhibitors in the treatment of anemia associated with chronic diseases.
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Review of the nutrition situation in the Eastern Mediterranean Region.
Nasreddine, L, Ayoub, JJ, Al Jawaldeh, A
Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2018;(1):77-91
Abstract
This situation analysis for the World Health Organization Eastern Mediterranean Region focuses on specific nutrition indicators, namely low birth weight, exclusive breastfeeding, under- and overnutrition (anthropometric indicators) and anaemia. The regional average prevalence of low birth weight and exclusive breastfeeding was estimated at 19.31% and 29.3%, respectively. Stunting, wasting and underweight had an average prevalence of 28%, 8.69% and 18%, respectively. Afghanistan, Djibouti, Pakistan, Sudan and Yemen had the highest burden of stunting (> 30%). Prevalence of anaemia ranged from 7.4% to 88% in children aged < 5 years and from 19.9% to 63% in women of childbearing age. Of concern is the increasing trend in overweight and obesity among adults and children. Average prevalence of overweight and obesity was 27% and 24% in adults and 16.5% and 4.8% in school-aged children, respectively. The highest levels of obesity were reported from Bahrain, Kuwait, Qatar and the United Arab Emirates. This review highlights the double burden of malnutrition in countries of the Region and calls for the prioritization of policies aimed at improving the population's nutritional status.
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Intravenous iron and erythropoiesis-stimulating agents in haemodialysis: A systematic review and meta-analysis.
Roger, SD, Tio, M, Park, HC, Choong, HL, Goh, B, Cushway, TR, Stevens, V, Macdougall, IC
Nephrology (Carlton, Vic.). 2017;(12):969-976
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Abstract
AIM: Higher dosages of erythropoiesis-stimulating agents (ESAs) have been associated with adverse effects. Intravenous iron is used to optimize ESA response and reduces ESA doses in haemodialysis patients; this meta-analysis evaluates the magnitude of this effect. METHODS A literature search was performed using MEDLINE, Embase and the Cochrane Collaboration Central Register of Clinical Trials from inception until December 2014, to identify randomized controlled trials of intravenous iron and ESA, in patients undergoing haemodialysis for end-stage kidney disease. Dosing of IV iron in concordance with the Kidney Disease Improving Global Outcomes guidelines was considered optimal iron therapy. RESULTS Of the 28 randomized controlled trials identified, seven met the criteria for inclusion in the meta-analysis. Results of random-effects meta-analysis show a statistically significant weighted mean (95% CI) difference of -1733 [-3073, -392] units/week in ESA dose for optimal iron versus suboptimal iron. The weighted average change in ESA dose was a reduction of 23% (range -7% to -55%) attributable to appropriate dosing of intravenous iron. A comparison of intravenous iron versus oral iron/no iron (five trials) showed a greater reduction in ESA dose, although this did not reach statistical significance (weighted mean difference, 95% CI: -2,433 [-5183, 318] units/week). The weighted average change in ESA dose across the five trials was a reduction of 31% (range -8% to -55%). CONCLUSION Significant reductions in ESA dosing may be achieved with optimal intravenous iron usage in the haemodialysis population, and suboptimal iron use may require higher ESA dosing to manage anaemia.
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The available intravenous iron formulations: History, efficacy, and toxicology.
Auerbach, M, Macdougall, I
Hemodialysis international. International Symposium on Home Hemodialysis. 2017;:S83-S92
Abstract
A number of intravenous iron formulations have been developed over the past 65 years which rely on dextran or other compounds to prevent uncontrolled release of free iron to the circulation. High molecular weight dextran was associated with a number of serious adverse reactions and was removed from markets worldwide in 2009. The preponderance of published evidence suggests that the formulations of parenteral iron currently available in the United States, including low molecular weight iron dextran, are all safe and effective and there are no major, clinically important differences among them in terms of either efficacy or safety. For patients with chemotherapy induced anemia or with anemia of end stage renal disease who are being treated with hemodialysis, it is reasonable to use any of the iron formulations, including iron sucrose and ferric gluconate, as frequent patient encounters with health caregivers are a routine part of care and the need to administer multiple low doses of IV iron is not a major disadvantage. However, a single infusion of a total iron dose is as effective and safe when giving iron preparations containing low molecular weight iron dextran, ferumoxytol, iron isomaltoside, or ferric carboxymaltose. Use of a single total dose infusion results in a decreased number of intravenous infusions with a lower cumulative risk for infusion reactions or extravasations, a reduced need for multiple office visits and repeated utilization of medical staff, and increased convenience for physicians and patients.