ABSTRACT
Introducción. La Organización Mundial de la Salud (OMS) estima que más del 40% de las mujeres embarazadas a nivel mundial tienen anemia, y la mitad de estas padecen deficiencia de hierro. La prevalencia en América Latina es del 40% y en Colombia del 44.7%. Fisiológicamente en el embarazo se produce una mal llamada "anemia dilucional", existen condiciones en la embarazada que la predisponen a tener una anemia patológica. Esta última es causada principalmente por un déficit de hierro, de allí la importancia de diagnosticar a tiempo esta entidad e iniciar el manejo. La administración de hierro es la base del tratamiento de la anemia por deficiencia de hierro. Puede ser administrado por vía oral, la cual es la preferida en la mayoría de las pacientes; sin embargo, cuando este no es posible administrarlo, es esencial recurrir al hierro parenteral. No obstante, el hierro parenteral es poco usado como primera línea en el manejo de la anemia gestacional. El presente artículo tiene como objetivo realizar una revisión que permita identificar la terapia con hierro parenteral como una alternativa eficaz de manejo para la anemia gestacional, teniendo en cuenta las características farmacológicas, la administración y el uso entre las diferentes moléculas disponibles en Colombia. Metodología. Corresponde a un estudio de revisión de literatura en bases de datos y bibliotecas electrónicas, los criterios que se tuvieron en cuenta fueron textos publicados entre 1996 y 2020, en español e inglés. Se obtuvo un resultado de 95 artículos, de los cuales se seleccionaron 49. Las palabras clave para su búsqueda fueron fisiología, hierro parenteral, anemia gestacional, déficit de hierro, complicaciones del embarazo, compuestos de hierro, farmacocinética, diagnóstico y tratamiento. División de temas tratados. Fisiología; ayudas diagnósticas; características farmacológicas del hierro parenteral; ventajas, indicaciones y contraindicaciones del hierro parenteral; efectos secundarios y forma de aplicación. Conclusiones. El hierro parenteral es un tratamiento seguro y eficaz para manejar la anemia en el embarazo, se debe tener en cuenta las indicaciones y la farmacología de las moléculas para elegir la más adecuada. Además, repone más rápidamente las reservas de hierro y los niveles de hemoglobina.
Introduction. The World Health Organization (WHO) estimates that more than 40% of pregnant women worldwide have anemia, and that half of them suffer from iron deficiency. The prevalence of this in Latin America is 40%, and in Colombia, 44.7%. Physiologically, a problem called "dilutional anemia" occurs during pregnancy. There are conditions in pregnant women that predispose them to suffering from pathological anemia. The latter is mainly caused by iron deficiency, hence the importance of diagnosing this entity on time and starting treatment. Iron administration is the basis of treatment of anemia caused by iron deficiency. It can be administered orally, which is the preferred option in the majority of patients. However, when this is not possible, parenteral iron must be used. However, parenteral iron is rarely used as the first line of treatment of gestational anemia. The objective of this article is to carry out a review that allows for the identification of therapy with parenteral iron as an efficient alternative for the treatment for gestational anemia, considering the pharmacological characteristics, administration, and use among the different molecules available in Colombia. Methodology. We carried out a search in databases and electronic libraries. The criteria considered were texts published between 1996 and 2020 in Spanish and English. 95 articles were obtained, of which 49 were selected. The keywords for their search were physiology, parenteral iron, gestational anemia, iron deficit, pregnancy complications, iron compounds, pharmacokinetics, diagnosis, and treatment. Division of Covered Topics. Physiology; diagnostic aids; pharmacological characteristics of parenteral iron; advantages, indications, and contraindications of parenteral iron; secondary effects and application method. Conclusions. Parenteral iron is a safe and efficient treatment to handle anemia during pregnancy. The indications and pharmacology of the molecules must be considered to choose the most appropriate option. In addition, it replaces iron reserves and hemoglobin levels more quickly.
Introdução. A Organização Mundial de Saúde (OMS) estima que mais de 40% das mulheres grávidas em todo o mundo são anêmicas, e metade delas sofre de deficiência de ferro. A prevalência na América Latina é de 40% e na Colômbia de 44.7%. Fisiologicamente na gravidez ocorre a chamada "anemia dilucional", e existem condições na gestante que a predispõem a ter uma anemia patológica. Esta última é causada principalmente por deficiência de ferro, daí a importância de diagnosticar esta entidade a tempo e iniciar o manejo. A administração de ferro é a base do tratamento da anemia por deficiência de ferro. Pode ser administrado por via oral, o que é preferido pela maioria das pacientes; porém, quando não for possível administrá-lo dessa forma, é imprescindível recorrer ao ferro parenteral. No entanto, o ferro parenteral é raramente usado como primeira linha no manejo da anemia gestacional. O objetivo deste artigo é realizar uma revisão que permita identificar a terapia com ferro parenteral como uma alternativa eficaz de tratamento da anemia gestacional, levando em consideração as características farmacológicas, administração e uso entre as diferentes moléculas disponíveis na Colômbia. Metodologia. Foi realizada uma busca em bases de dados e bibliotecas eletrônicas, os critérios levados em consideração foram textos publicados entre 1996 e 2020, em espanhol e inglês. Foi obtido um total de 95 artigos, dos quais 49 foram selecionados. As palavras-chave para a busca foram fisiologia, ferro parenteral, anemia gestacional, deficiência de ferro, complicações na gravidez, compostos de ferro, farmacocinética, diagnóstico e tratamento. Divisão dos temas abordados. Fisiologia; auxiliares de diagnóstico; características farmacológicas do ferro parenteral; vantagens, indicações e contraindicações do ferro parenteral; efeitos colaterais e método de aplicação. Conclusões. O ferro parenteral é um tratamento seguro e eficaz para o manejo da anemia na gravidez, as indicações e farmacologia das moléculas devem ser levadas em consideração a fim de escolher a mais adequada. Além disso, reabastece mais rapidamente as reservas de ferro e os níveis de hemoglobina.
Subject(s)
Maternal Nutritional Physiological Phenomena , Anemia , Pregnancy Complications , Pharmacokinetics , Iron Compounds , Iron DeficienciesABSTRACT
Hypophosphatemia is a relatively frequent and a potentially serious adverse drug effect. Clinically it is characterized by bone pain and muscle weakness. There are several mechanisms by which a drug can induce hypophosphatemia and they can be classified according to whether or not they are mediated by an excess of Fibroblast Growth Factor 23 (FGF23). We report two patients with the condition: (i) A 49-year-old woman with Chronic Myeloid Leukemia (CML) and gastric sleeve surgery at 46 years of age. After receiving intravenous carboxymaltose iron in one occasion due to refractory anemia, she developed symptomatic hypophosphatemia. Urinary phosphate losses associated with high FGF23 levels were confirmed. Plasma phosphate returned to normal values 90 days after the iron administration. (ii) A 40-year-old man with a history of CML in whom imatinib was started. He developed symptomatic hypophosphatemia due to non FGF23-mediated hyperphosphaturia. As treatment with imatinib could not be interrupted, hypophosphatemia and its symptoms resolved with oral phosphate intake. These cases illustrate the importance of recognizing and treating drug-induced hypophosphatemia in a timely manner, and thus avoid the morbidity associated with this entity.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Hypophosphatemia , Phosphates , Administration, Intravenous , Imatinib Mesylate , IronABSTRACT
Objective To discuss the effect of intravenous iron sucrose in the treatment of elderly heart failure with preserved ejection fraction(HFpEF)and iron deficiency(ID).Methods From June 2016 to December 2016,89 elderly patients with HFpEF and ID(age≥65 years old)in Anyang Prefecture Hospital were randomly divided into treatment group (n＝45)and control group(n＝44).The two groups were treated with routine drugs for heart failure. The treatment group was intravenously given iron sucrose injection once a week on the basis of conventional treatment. The SF,TS and Hb were tested in the two groups every month.The echocardiography Doppler,six minutes walk test (6MWT)and N－terminal probrain natriuretic peptide(NT－proBNP)before and after experiment were examined in two groups.The changes of left artial diameter(LAD),the mitral valve early flow velocitye/the late diastolic blood flow velocity ratio(E/A),left ventricular end diastolic(LVEDD),6MWT,NT－proBNP were observed in the two groups before and after six months treatment.Results Before treatment,the levels of ST,TS,Hb,LAD,LVEDD,NT－proB-NP,E/A,6MWT in the two groups had no statistically significant differences (P ＞0.05 ).After treatment for 6 months,the levels of ST,TS and Hb in the treatment group were significantly higher than those in the control group [(244.23 ±1.69)μg/L vs.(30.70 ±7.11)μg/L,(26.17 ±1.15)% vs.(10.10 ±9.31)%,(132.08 ±3.15)g/L vs.(111.0 ±0.08)g/L](t＝32.661,9.881,25.123,all P＜0.05).The levels of LVEDD,LAD and NT－proBNP of the treatment group were significantly lower than those of the control group [(50.70 ±7.11)mm vs.(54.23 ± 1.69)mm,(32.17 ±0.35)mm vs.(36.10 ±3.31)mm,(1077.17 ±9.35)ng/L vs.(1636.10 ±0.31)ng/L](t＝ 8.123,6.984,11.484,all P＜0.05).The levels of E/A,6MWT of the treatment group were significantly higher than those of the control group[(1.18 ±0.15)vs.(0.97 ±0.33),(414.23 ±5.69)m vs (350.70 ±7.11)m](t＝4.168,12.123,all P＜0.05 ).Conclusion Intravenous iron sucrose can improve cardiac function in the elderly patients with HFpEF and ID.
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Purpose To prepare superparamagnetic iron oxide nanoparticles (SPION) probe targeted and modified by MUC1 murin (MUC1) in order to explore its MRI characteristics in pancreatic cancer transplantation model.Materials and Methods Chemical conjugate method was adopted for coupled response of MUC1 and SPION to construct targeted probe and tested its basic physical properties,including water and diameter,surface charge and MR signal measuring.Meanwhile,nude mice model of pancreatic cancer transplant subcutaneous sarcoma was set up to study imaging effect inside the nude mice.Transplant sarcoma specimen was taken and immunohistochemical and Western blot were adopted to measure MUC1 expression.Results Partial size of the prepared particle probe was approximately 63.5 nm and surface charge was about 10.2 mV.The probe solution could obviously decrease MR transverse relaxation time (T2 value).In vitro experiment,MUC 1 could selectively gather on nude mice transplant sarcoma model could greatly lower T2 signal intensity.Conclusion Prepared probe has small partial size,superparamagnetic and other advantages.It can realize combination with pancreatic cancer tissue specificity and provide reliable in vivo iconology in early stage for disease diagnosis through vitro imaging.
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Ferric carboxymaltose is a non-dextran?iron complex used in patients with iron deficiency. However, iron injections may lead to long-lasting brown discoloration secondary to extravasation at the injection site. We herein report a case involving a patient who developed pigmentation after intravenous iron injection and was successfully treated with combined laser therapy. A 36-year-old woman presented with circumscript pigmentation on her left arm after having undergone intravenous iron injection for the treatment of iron deficiency anemia. Histopathologic examination revealed basal hypermelanosis and dermal infiltration of siderophages. Combined therapy with 1064 nm Nd:YAG laser and 595 nm pulsed dye laser was performed to treat the lesion, and marked improvement was noted after five sessions.
Subject(s)
Adult , Female , Humans , Anemia, Iron-Deficiency , Arm , Hyperpigmentation , Iron Compounds , Iron , Laser Therapy , Lasers, Dye , PigmentationABSTRACT
Ferric carboxymaltose is a non-dextran?iron complex used in patients with iron deficiency. However, iron injections may lead to long-lasting brown discoloration secondary to extravasation at the injection site. We herein report a case involving a patient who developed pigmentation after intravenous iron injection and was successfully treated with combined laser therapy. A 36-year-old woman presented with circumscript pigmentation on her left arm after having undergone intravenous iron injection for the treatment of iron deficiency anemia. Histopathologic examination revealed basal hypermelanosis and dermal infiltration of siderophages. Combined therapy with 1064 nm Nd:YAG laser and 595 nm pulsed dye laser was performed to treat the lesion, and marked improvement was noted after five sessions.
Subject(s)
Adult , Female , Humans , Anemia, Iron-Deficiency , Arm , Hyperpigmentation , Iron Compounds , Iron , Laser Therapy , Lasers, Dye , PigmentationABSTRACT
BACKGROUND: Iron deficiency is the most common disorder in the world, affecting approximately 25 percent of the world`s population and the most common cause of anemia. OBJECTIVE: To evaluate the efficacy and safety of intravenous iron sucrose (IS) in the treatment of adults with iron deficiency anemia METHODS: Eighty-six adult patients with iron deficiency anemia, who had intolerance or showed no effect with oral iron therapy, received a weekly dose of 200 mg of intravenous iron sucrose until the hemoglobin level was corrected or until receiving the total dose of intravenous iron calculated for each patient RESULTS: The mean hemoglobin and serum ferritin levels were 8.54 g/dL and 7.63 ng/mL (pre-treatment) and 12.1 g/dL and 99.0 ng/mL (post-treatment) (p-value < 0.0001), respectively. The average increases in hemoglobin levels were 3.29 g/dL for women and 4.58 g/dL for men; 94 percent of male and 84 percent of female patients responded (hemoglobin increased by at least 2 g/dL) to intravenous iron therapy. Correction of anemia was obtained in 47 of 69 (68.1 percent) female patients and in 12 of 17 male (70.6 percent) patients. A total of 515 intravenous infusions of iron sucrose were administered and iron sucrose was generally well tolerated with no moderate or serious adverse drug reactions recorded by the investigators. CONCLUSIONS: Our data confirm that the use of intravenous iron sucrose is a safe and effective option in the treatment of adult patients with iron deficiency anemia who lack satisfactory response to oral iron therapy. Intravenous iron sucrose is well tolerated and with a clinically manageable safety profile when using appropriate dosing and monitoring. The availability of intravenous iron sucrose would potentially improve compliance and thereby reduce morbidities from iron deficiency.
Subject(s)
Humans , Male , Female , Adult , Anemia, Iron-Deficiency , Iron/therapeutic use , Injections, IntravenousABSTRACT
Oral iron supplementation is usually the first choice for the treatment of iron deficiency anemia (IDA) because of its effectiveness and low cost. But unfortunately in many iron deficient conditions, oral iron is a less than the ideal treatment mainly because of adverse events related to the gastrointestinal tract as well as the long course required to treat anemia and replenish body iron stores. The first iron product for intravenous use was high-molecular-weight iron dextran. However, dextran-containing intravenous iron preparations are associated with an elevated risk of anaphylactic reactions, which made physicians reluctant to prescribe intravenous iron in the treatment of iron deficiency anemia for many years. In 1999 and 2001, two new intravenous iron preparations (ferric gluconate and iron sucrose) were introduced into the market as safer alternatives to iron dextran. Over the last five years, three new intravenous iron dextran-free preparations have been developed and have better safety profiles than the more traditional intravenous compounds, as none require test doses and all these products are promising in respect to a more rapid replacement of body iron stores (15-60 minutes/infusion) as they can be given at higher doses (from 500 mg to more than 1000 mg/infusion). The purpose of this review is to discuss some pertinent issues in relation to the history, pharmacology, administration, efficacy, safety profile and toxicity of intravenous iron for the treatment of iron deficiency anemia.
Subject(s)
Humans , Iron/therapeutic use , Injections, IntravenousABSTRACT
Objective To compare of treatment effects of intravenous iron and oral iron on hemodialysis ane- mia in patients with erythropoietin.Methods The oral dosage of ferrous succinate was 200mg dose,3 times a day for 2 months.After washing out for 2 months.Then these patients were given intravenous iron dextran with a dosage of 100mg twice a week for 5 weeks.During the treatment,hemoglobin (Hb),hematocrit (Hct),serum ferritin (SF) and trasferrin saturation(TSAT) were monitored.Results The efficacy of oral iron was 20 % ,the efficacy of intra- venous iron was 60 %.The Hb,Hct,SF and TSATS level increased obviously in the efficacy of intravenous iron,sta- tistical analysis showed a very significant difference(P