Deficiencia de hierro en enfermedad renal crónica

Contexto: la deficiencia de hierro es un trastorno frecuentemente observado en pacientes con enfermedad renal crónica (ERC), sobre todo en estadios avanzados. Su presencia se asocia a una mayor morbilidad y mortalidad. La deficiencia de hierro puede ser absoluta o funcional. La deficiencia absoluta se refiere a una ausencia o una reducción de las reservas de hierro, mientras que la deficiencia funcional se define por la presencia de depósitos de hierro adecuados pero con una disponibilidad insuficiente de hierro para su incorporación en los precursores eritroides. Varios factores de riesgo contribuyen a la deficiencia absoluta y funcional de hierro en ERC, incluyendo pérdidas hemáticas, absorción alterada de hierro e inflamación crónica. Objetivo: con esta revisión narrativa se pretende presentar las definiciones, los aspectos fisiopatológicos, los criterios diagnósticos y las medidas terapéuticas en el paciente con diagnóstico de ERC con deficiencia de hierro. Metodología: se realizó una revisión no sistemática de la literatura en la base de datos PubMed, incluyendo además las guías internacionales más utilizadas que abordan el tema de deficiencia de hierro en ERC. Resultados: se incluyeron un total de 30 referencias bibliográficas. La deficiencia de hierro puede ser absoluta o relativa y el déficit absoluto de hierro se produce con valores de ferritina 100 mcg/l, pero con una TSAT < 20 %. El tratamiento del déficit absoluto consta de reposición de hierro oral o endovenoso y en pacientes que aún no reciben diálisis, se puede hacer una prueba terapéutica con hierro oral, de no haber respuesta se optará por hierro endovenoso, mientras que en pacientes que sí reciben diálisis, la medida ideal es el hierro endovenoso, preferiblemente en preparaciones que permitan esquemas de altas dosis y bajas frecuencias de administración. Las metas propuestas por las distintas guías presentan variaciones entre 500 y 700 mcg/l de ferritina. Conclusiones: el déficit de hierro debe buscarse activamente en pacientes con ERC, ya que su presencia y la falta de intervención conlleva a un incremento en los desenlaces adversos. La terapia con hierro es el pilar del tratamiento y la elección del agente a utilizar dependerá de las características individuales del paciente y de la disponibilidad de las preparaciones de hierro oral o endovenoso.

Background: Iron deficiency is a disorder frequently observed in patients with chronic kidney disease (CKD), especially in advanced stages. Its presence is associated with increased morbidity and mortality. Iron deficiency can be absolute or functional. Absolute deficiency refers to absent or reduced iron stores, while functional deficiency is defined by the presence of adequate iron stores but insufficient iron availability for incorporation into erythroid precursors. Several risk factors contribute to absolute and functional iron deficiency in CKD, including blood fi, impaired iron absorption, and chronic inflammation. Purpose: With this narrative review, it is intended to present the details, pathophysiological aspects, diagnostic criteria and therapeutic options in patients diagnosed with chronic kidney disease with iron deficiency. Methodology: A non-systematic review of the fi ron ra was carried out, in the PubMed database, also including the most used international guidelines that address the issue fi ron deficiency in chronic kidney disease. Results: A total of 30 bibliographical references were included. Iron deficiency can be absolute or relative. The absolute iron deficiency occurs with ferritin values 100 mcg/l but with a TSAT <20 % Treatment of absolute deficiency consists of oral or intravenous iron replacement. In a patient who is not yet receiving dialysis, a therapeutic trial with oral iron can be done, if there is no response, intravenous iron will be chosen. In patients receiving dialysis, the ideal measure is intravenous iron, preferably in preparations that allow high-dose schemes and low frequencies of administration. The goals proposed by the different guidelines present variations between 500 and 700 mcg/l d ferritin. Conclusions: iron deficiency should be actively sought in patients with CKD, since its presence and lack of intervention leads to an increase in adverse outcomes. Iron therapy is the mainstay of treatment; the choice of the agent to be used depends on the individual characteristics of the patient and the availability of oral or intravenous iron preparations.

A Community-Based Trial on The Comparison of Efficacy, Safety and Cost Effectiveness of Ferrous Sulphate and Ferrous Ascorbate for Anaemia in Pregnancy In Madhya Pradesh, India

Background: Anaemia has significant impact on health of the fetus as well as that of mother. Increased need of iron during pregnancy especially after 2nd trimester makes iron supplementation mandatory. Ferrous ascorbate is known to exist intact inside the gastrointestinal tract due to the stable chelation of iron with ascorbate. This compound does not dissociate due to any of the food inhibitors. The aim is to study the effec-tiveness of Ferrous Ascorbate and Ferrous sulphate in terms of compliance and cost effectiveness of manage-ment of anaemia in pregnancy. Methodology: Study design: Quasi Experimental study, Study area: District Vidisha, Study participants: Preg-nant women of first trimester registered during the study period in the selected Anganwadis/ Gram Arogya Kendra (GAK), Sample size: 240 antenatal mothers. Results: Baseline mean haemoglobin was 11.31±1.05 gm/dl. The mean increase in Ferrous Sulphate was 0.55 gm/dl, and in Ferrous ascorbate was 1.27 gm/dl. Ferrous Sulphate was less compliant than Ferrous ascorbate, and has higher efficacy and lesser side effects. Only Rs. 10.2 additional cost per antenatal mothers for increase of ≥1gm% in Hb will be borne by government if Ferrous Sulphate is replaced by Ferrous Ascorbate. Conclusions: Study results show statistically significant difference in rise of haemoglobin amongst the ante-natal mothers consuming Ferrous ascorbate over Ferrous Sulphate

A comparative study of oral versus intravenous iron in the treatment of moderately anaemic pregnant women

Background: Anemia, the decrease of haemoglobin (Hb) concentration is a common disorder complicating pregnancy mostly due to hemodilution, increased demand of iron and poor dietary intake of iron. The aim of this study was to evaluate whether parenteral iron sucrose can be used as an alternative to daily oral iron during pregnancy.Methods: It was a prospective interventional study conducted in the Department of Obstetrics and Gynaecology, Rohilkhand Medical College and Hospital, Bareilly involving pregnant women at 16-24 weeks with Hb 7-10 g/dl. They were randomly allocated to two groups I and II. Group I (oral group) was given oral iron tablets containing 100 mg of elemental iron and 0.5 mg of folic acid as per therapeutic requirement. Group II (parenteral group) were admitted as day care patients and given a total calculated dose of iron sucrose in divided doses of 200 mg each in 100 ml of normal saline as slow intravenous infusion. Hb, packed cell volume (PCV), blood indices were measured at the start, 2 weeks and 4 weeks of treatment. Any side-effects of treatment were also studied.Results: A statistically significant increase in values of Hb, hematocrit, reticulocyte count, red blood cells (RBC's) indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular hemoglobin (MCH) coupled with no serious side effects with iron sucrose as compared with oral iron.Conclusions: Intravenous iron sucrose complex is safe, convenient and effective alternative to oral iron for treatment of iron deficiency anemia in pregnancy.

Anaemia in pregnancy: prevalence and treatment response to various modalities: a prospective study

Background: Anaemia seen in pregnancy are largely preventable and easily treatable if detected in time, despite this, anaemia still continues to be a common cause of maternal and perinatal morbidity and mortality in India.Methods: A prospective observational study of 200 pregnant women with anaemia was carried out from Jun 2017 to December 2018 at a Tertiary care hospital with pan India population. Patients underwent clinical examination and laboratory tests to find out the severity and type of anaemia and were treated accordingly. Iron deficiency anaemia was treated with oral or intravenous iron therapy depending upon the hemoglobin concentration. Patients were followed up after 28 days of treatment and hemoglobin estimation was done to monitor the treatment response.Results: A total 36.49% pregnant women had hemoglobin less than 10 gm%. 151 out of 200 women had serum ferritin <12 ng/ml which indicates that iron deficiency anaemia is the commonest type of anaemia in pregnancy. Overall, out of 200 patients 5.5% patients were found to have hemoglobinopathies (β thalassemia trait). After 28 days of treatment mean increase in hemoglobin was 2.40 gm% and 4.24 gm% in patients receiving oral and intravenous iron therapy respectively.Conclusions: A total 36.49% pregnant women were found to have anaemia during pregnancy and iron deficiency anaemia is the commonest type of anaemia. Therefore, there is still a need for dietary counselling and health education in the community. 5.5% patients were found to have beta thalassemia trait which was detected only after conducting hemoglobin electrophoresis. Both oral and intravenous iron therapy are effective in treatment of iron deficiency anaemia but intravenous iron therapy results in a more rapid resolution of anaemia.

Clinical profile of hypochromic microcytic anemia in Chittoor district, India

Background: Anemia is not a diagnosis by itself like fever but merely is an objective sign of the presence of disease. The correct diagnostic terminology for a child with anemia requires the detection of etiology, pathology, and pathogenesis of the anemia. To evaluate the role of therapeutic oral iron therapy as a diagnostic approach to hypochromic microcytic anemia.Methods: The present study is a retrospective study conducted at the teaching hospital, Chittoor district from September 2019 to December 2019. A total number of 350 cases of anemia were studied from both inpatient and outpatient services in the age group 2 months to 12 years. Hemogram, Hb Electrophoresis, and bone marrow study as necessary based on individual cases.Results: From the above analysis, the mean Hb% at the time of entry to study was 7.36gms%. The mean Hb% after the iron therapy was 11.8gms%. The mean increase in Hb was 4.4gms%. In this study, the average RBC count was 2.9 million cells/cumm.Conclusions: A therapeutic trial of oral iron is an appropriate initial step in the diagnostic approach of hypochromic microcytic anemia. Costly investigations like Hb electrophoresis and bone marrow study are required only in selected cases.

Ocular Manifestations of ß -Thalassemia Patients with the Use of Oral Iron Chelating Agents

Background: Ocular involvement in β-thalassemia major is very common. Iron chelators like Desferrioxamine and Deferiprone avoid systemic complications but chelate metals in retina. Objectives: 1.To study the relation of oral iron chelator (Deferiprone) on various ocular manifestations in β-thalassemia major patients. 2. To study the relation of serum ferritin with various ocular manifestations. Methods: 100β-thalassemia major patients out of those attending our thalassemia clinic were selected for the study as per our inclusion and exclusion criteria. They were divided into two major groups based on whether they were taking oral iron chelator (Deferiprone) or not. Detailed history, examination and investigations were done and recorded. Results: The study revealed that 52% of the patients had ocular involvement with 86.5% of them taking Deferiprone (p<0.0001), 13% had retinal pigment epithelium (RPE) degeneration with 92.3% of them on Deferiprone (p=0.003) and 18% had RPE mottling with 88.8% of them taking Deferiprone (p=0.001). Other ocular changes like lens opacity, disc hyperemia, best corrected visual acuity (BCVA) and venous tortuosity showed some difference between the two groups but that was insignificant. Further the study also showed that higher serum ferritin levels were significantly associated with ocular changes like decreased BCVA (p<0.001), RPE degeneration (p<0.001), RPE mottling (p<0.001) and venous tortuosity (p<0.025). Conclusion: Ocular changes in β-thalassemia major increases with greater duration of the disease and increased number of blood transfusions due to increased serum ferritin levels. Using iron chelators may reduce iron overload but they causechelator induced ocular involvement.

Compare the safety and efficacy of intravenous iron supplementation with iron sucrose to the oral supplementation with ferrous ascorbate in subjects with post-partum anemia

Background: The post-partum period is challenging enough for most new mothers. Recovering from birth, learning to parent, and taking care of her child requires lot of energy. Having anemia in postpartum period can make this process much more difficult. According to WHO, in India incidence of anemia in postnatal mother is around 58% and according to ICMR prevalence of anemia in Tamil Nadu population 76% during pregnancy. The objective of this study was to compare the efficacy of intravenous iron supplementation with Iron sucrose to the oral supplementation with ferrous ascorbate in management of patient with post-partum anemia. To study the safety and side effects of these two preparations.Methods: This was a prospective study conducted on 100 post-partum anemic women in KG Hospital  in Coimbatore, October 2012 to November 2013 with hemoglobin less than 10g/dl but more than 6g/dl within 24-48 hours of delivery ,after satisfying inclusion and exclusion criteria were included in the study.Results: Mean hemoglobin of oral group was 8.49±0.75 and mean hemoglobin of IV group was 8.43±0.76; 24 hours after delivery. After treatment, that is after 4 weeks mean hemoglobin of oral group was 10.38±0.79 and mean hemoglobin of IV group was 11.20±0.71.on comparing both groups, the increase in hemoglobin in the IV groups was significant. Reticulocyte count and other parameters increased significantly after four wks of starting therapy in IV group compare to the oral group. No major side effects or anaphylactic reactions were noted during study period.Conclusions: Intravenous iron sucrose complex is safe, convenient and effective in postpartum anemic women as compared with the oral ferrous ascorbate. Intravenous iron sucrose have shorter treatment periods, increased likelihood of compliance, a lack of gastrointestinal side effects, and rapid replenishment of iron stores, making them superior to oral ferrous ascorbate.

Management of postpartum iron deficiency anemia: review of literature

Anemia is a condition in which either the number of circulating red blood cells or their hemoglobin concentration is decreased. As a result, there is decreased transport of oxygen from the lungs to peripheral tissues. The standard approach to treatment of postpartum iron deficiency anemia is oral iron supplementation, with blood transfusion reserved for more server or symptomatic cases. There are a number of hazards of allogenic blood transfusion including transfusion of the wrong blood, infection, anaphylaxis and lung injury, any of which will be devastating for a young mother. These hazards, together with the national shortage of blood products, mean that transfusion should be viewed as a last resort in otherwise young and healthy women. Currently, there are many iron preparations available containing different types of iron salts, including ferrous sulfate, ferrous fumarate, ferrous ascorbate but common adverse drug reactions found with these preparations are mainly gastrointestinal intolerance like nausea, vomiting, constipation, diarrhoea, abdominal pain, while ferrous bis-glycinate (fully reacted chelated amino acid form of iron) rarely make complication. Two types of intravenous (IV) preparations available are IV iron sucrose and IV ferric carboxymaltose. IV iron sucrose is safe, effective and economical. Reported incidence of adverse reactions with IV iron sucrose is less as compared to older iron preparations (Iron dextran, iron sorbitol), but it requires multiple doses and prolonged infusion time. Intramuscular iron sucrose complex is particularly contraindicated because of poor absorption. It was also stated that when iron dextran is given intravenously up to 30% of patients suffer from adverse effects which include arthritis, fever, urticaria and anaphylaxis.

Effect of directly observed oral iron supplementation during pregnancy on iron status in a rural population in Haryana: A randomized controlled trial

Background: In India, more than half of the pregnant women suffer from anemia. Low compliance to iron supplementation is one of the important reasons. Objectives: The objective of the study is to estimate the reduction in the prevalence of anemia, improvement in iron status, and to compare the compliance to oral iron supplementation during pregnancy between directly observed iron-folic acid (IFA) supplementation group and control group. Methods: This was a community-based open labeled parallel block-randomized controlled trial including 400 pregnant women in a rural setting of north India. In the intervention group, the first dose of IFA every week was supervised by ASHA and women were instructed to take the remaining tablets during the week as per the prescription. In control group, IFA tablets were supplemented without direct supervision. Results: After 100 days of IFA supplementation, the reduction in anemia in the intervention group was 6% higher as compared to control group (P = 0.219). The increase in the mean hemoglobin level over and above control group was 0.52 g/dl in intervention group (P < 0.001). However, the mean increase in serum ferritin level in the intervention group was similar to the control group. The mean percentage compliance in the intervention group was almost 9% higher than that of control group (P = 0.001). Conclusion: Directly supervised oral iron (IFA) supplementation improves compliance to oral iron (IFA) supplementation and also improves hemoglobin status among pregnant women. However, the mean increase in serum ferritin and reduction in the prevalence of anemia in the intervention group were not higher than the control group.

Hepatic and Cardiac Iron-load in Children on Long-term Chelation with Deferiprone for Thalassemia Major

Objective: To evaluate the efficacy of prolonged deferiprone monotherapy in patients with ?-thalassemia major. Methods: This cross-sectional study included 40 patients (age range 9 to38 years) with thalassemia major receiving deferiprone for ?5 years. Serum ferritin, andmyocardial iron concentration (MIC) and liver iron concentration (LIC) assessed by T2*MRIwere recorded. Results: The patients were receiving deferiprone for a mean (SD) duration of12.1 (4.7) years. The median (IQR) dose of deferiprone was 85 (74.3, 95) mg/kg/day. TheMIC was normal or had a mild, moderate or severe elevation in 29 (72.5%), 3 (7.5%), 3(7.5%), and 5 (12.5%) patients. The LIC was normal or had a mild, moderate or severeelevation in 2 (5%), 4 (10%), 11 (27.5%) and 23 (57.5%) patients. Conclusions: The majorityof patients receiving deferiprone had a moderate/severe hepatic but normal cardiac iron load.Prolonged deferiprone monotherapy was suboptimal for hepatic iron load in the majority.

A concurrent parallel study to compare the efficacy and safety of oral iron chelators, defrasirox and defriprone in patients of beta thalassaemia major

Background: This study was planned to evaluate all the cases of ? thalassaemia major, already receiving one of the oral iron chelators for a comparison among the efficacy, safety and economy of deferasirox and deferiprone to establish the better option in an Indian scenario.Methods: We identified two groups of patients: 38 treated with deferasirox and 35 treated with deferiprone. Laboratory parameters such as serum ferritin, creatinine, SGPT, Hb, CBC and urine were recorded at the time of inclusion and at 1, 3 and 6 months after the inclusion. The primary outcome variable was serum Ferritin level at the start and at the end of study. Serum ferritin level was carried out by microparticle enzyme linked immunoassay.Results: Before the study, the mean hemoglobin level was 7.32±1.50mg/dL ranged from 4 to 10.8 in deferasirox group and 7.54±1.15mg/dL ranged from 5.5 to 8.8 in deferiprone group. At the time of inclusion, study population was characterized by a mean serum ferritin value of 4735.11±450.01 SE in deferasirox and 4315.97±340.75 SE in deferiprone group. After one month the mean serum ferritin increases to 4578.66±371.96 in deferasirox and 4388.82±316.16 in deferiprone group. After three month the mean serum ferritin reduces to 4295.60±377.37 in deferasirox and 3988.88±349.84 in Deferiprone group.Conclusions: Thus, we conclude that deferasirox and deferiprone are well tolerated, have few adverse effects and almost have a comparable effect in lowering of the patient's serum ferritin level. Deferiprone is more cost effective but needs a strict control on compliance owing to requirement in three divided doses per day.

Study of Coulter Indices After Oral & Parenteral Iron Therapy In Iron Deficiency Anaemia.

Background: Nutritional iron deficiency anaemia is prevalent. It responds promptly to iron therapy. Parenteral iron therapy is considered to be better for rapid correction of anaemia, than oral form. Methodology: The haematological response, of 47 severely iron deficient patients, to orally administered iron was compared to that of 40 patients given parenteral iron sorbitol. The haematological response was assessed with the help of Coulter indices. Results: No significant difference in the rate of change of haematological parameters was observed in oral & parenteral form of iron therapy. Conclusion: Earliest response & completion of therapy both can be judged by Red cell Distribution Width (RDW) levels in either form of iron replacement. Red Blood Cells histogram best reflects an evolution of response and overt attainment of normal contours & placement reflects the adequacy of treatment.

Efifcacy observation of intravenous iron and oral iron on anemia patients with chronic hemodialysis and study on the difference of oxidative stress reaction / 中国生化药物杂志

Objective To explore the safety and efifciency of oral iron therapy and intravenous iron therapy in anemia patients with maintenance hemodialysis,in order to gain experience for clinical treatment of this disease. Methods 88 cases collected in the ifrst people's hospital of Changshu city from July 2010 to March 2013 were divided into research group(n=44) and control group(n=44) by random number table. Control group was given oral iron therapy, and research group was t given intravenous iron. The differences of hemoglobin (Hb), reticulocyte, serum ferritin content, superoxide dismutase (SOD) and serum malondialdehyde (MDA) before and after treatment between two goups were recorded and compared. Results The differences of Hb, serum ferritin and reticulocyte numerical before treatment between two groups were not signiifcant, but signiifcant four weeks after treatment, with higher level in research group(P<0.05).The difference of oxidative stress status before treatment between two groups was not signiifcant, but after treatment, the MDA level in research group was higher than control group(P<0.05),while SOD level was lower than control group(P<0.05). Conclusion Compared with oral iron therapy, intravenous iron has better results in improving anemia, but easy to induce oxidative stress reaction.

Comparison of Oral and Intravenous Iron for Treatment of Iron Deficiency Anaemia in Pregnancy.

Oral iron supplementation is standard obstetrical practice. But programmes of anaemia prophylaxis based on oral iron supplementation still remain a failure. Whether or not there is need for parenteral iron may be debated. Parenteral iron is indicated when oral iron supplementation is not possible or fails. Intravenous iron could be a good alternative in pregnant women to ensure compliance. Many workers have shown that parenteral iron therapy supplies enough iron for erythropoiesis. Therefore, In the present review, we assessed oral iron supplementation with intravenous (IV) iron sucrose in the management of iron deficiency anaemia in pregnancy. Intravenous iron sucrose appears a good alternative to oral iron in patients who are either intolerant to oral iron or are non compliant and may also reduce the incidence of blood transfusion and its associated risks.

In vitro Studies of Iron Chelation Activity of Purified Active Ingredients Extracted from Triticum aestivum Linn. (Wheat Grass).

Objective: Seven to eight days germinated plants of Triticum aestivum (wheat grass) are a rich source of vitamin A, C, calcium, magnesium, phosphorus, potassium, sodium, sulphur, cobalt, zinc and protein. Traditionally the aqueous extract of T. aestivum was reported to be used as a health tonic in folk and ayurvedic medicine. We previously reported that aqueous extract of T. aestivum was found to reduce the blood transfusion requirement in iron overloaded Thalassemia and Myelodysplastic syndrome patients. Our objective was to extract and purify active ingredients from wheat grass and study their mode of action in stabilizing hemoglobin level in those patients. Design and Method: Active ingredients of wheat grass were extracted and purified by cation exchange column chromatography followed by High Performance Liquid Chromatography. In vitro experiments with phenylhydrazine treated red blood cell hemolysate were carried out before and after treatment of purified fraction of T. aestivum to study iron chelating activity. Result: Purified fraction of T. aestivum treated red blood cell showed significant inhibition of free reactive iron production and formation of thio-barbituric acid reactive substances when compared to desferrioxamine treated hemolysate. Conclusion: Iron chelating activity of purified fraction of T. aestivum, an inexpensive, easily available source, is very promising for further clinical trial and development of oral iron chelator drug for Thalassemia, Myelodysplastic syndrome and other iron overloaded diseases.

Therapeutic effect of erythropoietin combined oral iron in patients with chronic heart failure accompanied by anemia / 中国综合临床

Objective To explore the therapeutic effect of erythropoietin (EPO)combined oral iron in patients with chronic congestive heart failure( CHF)accompanied by anemia. MethodsNinety six patients with CHF accompanied by anemia, whom were consecutively hospitalized from January 2007 to December 2009, were enrolled into this study. They were randomly divided into treatment group accepted routine anti-heart failure therapy combined EPO and oral iron, and control group solely accepted routine anti-heart failure therapy. After 6 months follow up, the changes of hemoglobin ( Hb ), cardiac function classification, left ventricular ejection fraction(LVEF) ,6-minute walking distance,readmission rate of CHF and cardiac death were compared between two groups. ResultsCompared with those before therapy, we found significant improvements of hemoglobin level ( [ 120. 12 ± 10. 42 ] g/L vs [ 86.40 ± 14. 30 ] g/L, P ＜ 0. 01 ), cardiac function classification ( 2. 65 ± 0. 67 vs 3. 13 ±0. 61, P ＜ 0. 01 ), LVEF ( [ 37.21 ± 4. 96 ]％ vs [ 33. 92 ± 7. 28 ]％, P ＜ 0. 01 ), 6-minute walking distance ( [ 443.52 ± 97. 39 ] mvs [ 379. 15 ± 59. 34 ] m, P ＜ 0. 01 ) in treatment group after EPO combined oral iron administration. After 6 months follow up, we also found significant improvements of Hb level ( [ 120. 12 ±10. 42 ] g/L vs [ 86. 40 ± 14. 30 ] g/L, P ＜ 0. 01 ), cardiac function classification ( 2.65 ± 0. 67 vs 2. 98 ± 0. 81,P＜0.01),LVEF([37.21 ± 4.96]％ vs [34.67 ±4.10]％,P ＜ 0. 01),6-minute walking distance ( [443.52 ±97. 39 ] mvs [ 379. 15 ± 59. 34 ] m, P ＜ 0. 01 ) in the comparison between treatment and control group. The readmission rate of CHF fell significantly in treatment group compared to control (20. 83％ vs 39. 58％ ,P ＜ 0. 05 ). However, we found no significant difference in cardiac death rate ( 0％ vs 4. 17％, P ＞0. 05). ConclusionTreatment of EPO combined oral iron could significantly improve the cardiac function,increase exercise tolerance,lower the readmission rate of CHF in patients with chronic congestive heart failure (CHF)accompanied by anemia.

Comparison of Hemoglobin Levels between Iron-Supplemented Group and Non-Iron-Supplemented Group in Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Anemia associated with pregnancy is keen of interest to both the mother and the obstetrician and oral iron supplementation for iron deficiency anemia(IDA) during pregnancy is commonpiece. The purpose of this study is to compare the changes in hematologic parameters between iron supplemented and non-iron supplemented women just prior to and 24 hours after delivery. METHODS: A comparative study was conducted concerning the difference in hematologic changes between 30 iron-supplemented and non-iron-supplemented women, who have delivered at Yonsei University Medical School Yongdong Severance Hospital from 1999. 11. 1 from 2000. 1. 18. RESULTS: Between the iron-supplemented and the non-iron-supplemented group, no statistically significant difference was observed for the duration of gestation, neonatal birth weight and maternal age. However, the mean hemoglobin levels were 11.78mg% and 10.34mg% prior to delivery(p<0.001) and 10.52mg% and 9.59mg% 24 hours after delivery, respectively, thus showing a statistically significant decrease in the non-iron-supplemented group(p<0.001). CONCLUSION: Adequate iron supplementation during the antenatal period significantly improves the hematologic status of the mother.