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1.
Rev. med. Chile ; 150(8): 1063-1074, ago. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1431876

ABSTRACT

Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Although there are several causes of anemia in IBD, the two most frequent etiologies are iron deficiency anemia and anemia of chronic disease. Despite the high prevalence of anemia in IBD and its significant impact on patient's quality of life, this complication is still underdiagnosed and undertreated by providers. Active screening for anemia, structured assessment, comprehensive management, and multidisciplinary collaboration are needed in IBD patients. The cornerstone of anemia management depends on the underlying etiology along with normalization of inflammatory activity. Although, oral iron is effective for the treatment of mild iron deficiency-related anemia, intravenous iron formulations have a good safety profile and can be used as first-line therapy in patients with active IBD, severe anemia and previous intolerance prior to oral iron. After proper treatment of anemia, careful monitoring is necessary to prevent its recurrence. Herein, we discuss the etiology, screening, diagnosis, therapy selection, and follow-up for anemia in IBD.


Subject(s)
Humans , Inflammatory Bowel Diseases/complications , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/etiology , Anemia/complications , Anemia/diagnosis , Quality of Life , Iron/therapeutic use
2.
Arq. gastroenterol ; 58(1): 48-54, Jan.-Mar. 2021. tab
Article in English | LILACS | ID: biblio-1248980

ABSTRACT

ABSTRACT BACKGROUND: The treatment of patients with inflammatory bowel disease (IBD) consists of the induction and maintenance remission of the disease. Iron status indicators would be useful for the diagnosis of iron deficiency anemia, whereas the inflammation indicators would be for the diagnosis of chronic disease anemia. OBJECTIVE: To assess body iron status indicators and inflammation indicators during the treatment of IBD, consisted of conventional or infliximab therapy in children and adolescents. METHODS: A case-control study of a sample of 116 individuals, of which 81 patients with IBD, 18 of them receiving conventional therapy, 20 infliximab therapy, and 43 who were in remission of the disease, and 35 healthy (control group) children and adolescents. Iron status and inflammation indicators were investigated at baseline, and 2 and 6 months of both therapies - conventional and infliximab. RESULTS: The mean age was 12.1±4.3 years. At baseline, both groups - conventional therapy and infliximab - presented significant differences in most markers studied compared to the control group. After 2 months of conventional therapy, hemoglobin and serum iron levels were lower than those of the control group; and red cells distribution width (RDW), total iron-binding capacity, transferrin receptor/ferritin ratio, and interleukin-6 were higher than the control group. After 2 months of infliximab treatment, hemoglobin and serum iron levels were lower than those of the control group; and RDW, soluble transferrin receptor, soluble transferrin receptor/ferritin ratio, and interleukin-6 were higher than the control group. After 6 months of conventional therapy, hemoglobin and serum iron levels were lower than those of the control group, and RDW and interleukin-6 were higher than those of the control group. After 6 months of infliximab treatment, the hemoglobin and serum iron levels were lower than the control group, and RDW, soluble transferrin receptor, soluble transferrin receptor/ferritin ratio, erythrocyte sedimentation rate, and platelets were higher than the control group. Regarding patients under treatment for at least one year (remission group), all markers studied, except transferrin, were similar to the control group. CONCLUSION: In conclusion, there were some contradictions among the different body iron status indicators and inflammation indicators at two and 6 months of treatment with conventional and infliximab therapy, however after one year of treatment, as shown by the remission group, all indicators studied, except transferrin, were similar to healthy children and adolescents.


RESUMO CONTEXTO: O tratamento de pacientes com doença inflamatória intestinal (DII) consiste na indução e manutenção da remissão da doença. Os indicadores do estado corporal do ferro seriam úteis para o diagnóstico da anemia por deficiência de ferro, enquanto os indicadores de inflamação para o diagnóstico da anemia da doença crônica. OBJETIVO: Avaliar os indicadores do estado corporal do ferro e os indicadores de inflamação durante o tratamento da doença inflamatória intestinal, com terapia convencional ou infliximabe em crianças e adolescentes. MÉTODOS: Estudo de caso-controle de uma amostra de 116 indivíduos, sendo 81 pacientes com DII, dos quais 18 com terapia convencional, 20 infliximabe e 43 em remissão da doença, e 35 crianças e adolescentes saudáveis (grupo controle). Os indicadores do estado do ferro e os indicadores de inflamação foram avaliados no início, 2 e 6 meses de dois tipos de tratamento - terapia convencional e terapia com infliximabe. RESULTADOS: A média de idade foi de 12,1±4,3 anos. No início do tratamento, ambos os grupos - terapia convencional e infliximabe - apresentaram diferenças significantes com relação à maioria dos marcadores estudados comparados ao grupo controle. Após 2 meses de terapia convencional, os níveis de hemoglobina e ferro sérico foram inferiores em comparação ao grupo controle; e amplitude de distribuição dos eritrócitos (RDW), capacidade total de ligação do ferro, razão entre o receptor de transferrina solúvel e ferritina e interleucina-6 foram superiores aos do grupo controle. Após 2 meses de tratamento com infliximabe os níveis de hemoglobina e ferro sérico foram inferiores em comparação ao grupo controle, e RDW, receptor de transferrina solúvel e interleucina-6 foram superiores aos do grupo controle. Após 6 meses de terapia convencional, os níveis de hemoglobina e ferro sérico foram inferiores aos do grupo controle, e RDW e interleucina-6 superiores aos do grupo controle. Após 6 meses de tratamento com infliximabe, os níveis de hemoglobina e ferro sérico foram inferiores comparados ao grupo controle, e RDW, receptor de transferrina solúvel, razão receptor de transferrina solúvel e ferritina, taxa de sedimentação de eritrócitos e plaquetas foram superiores ao do grupo controle. Quanto aos pacientes que estavam em tratamento há mais de um ano (grupo remissão), todos os marcadores, exceto a transferrina, foram similares ao grupo controle. CONCLUSÃO: Houve contradições entre os diferentes indicadores do estado corporal do ferro e dos indicadores de inflamação aos 2 e 6 meses de tratamento com terapia convencional e infliximabe, no entanto após um ano de tratamento, conforme observado pelo grupo em remissão, todos os indicadores estudados, exceto a transferrina, foram semelhantes aos das crianças e adolescentes saudáveis.


Subject(s)
Humans , Child , Adolescent , Inflammatory Bowel Diseases/drug therapy , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/drug therapy , Case-Control Studies , Ferritins , Inflammation , Iron
3.
Arch. argent. pediatr ; 118(3): 187-: I-192, I, jun. 2020. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1104195

ABSTRACT

Introducción. La anemia en los primeros años de vida produce graves consecuencias psicomotoras, sociales y económicas. El objetivo fue determinar su prevalencia, causas y factores de riesgo y preventivos en lactantes de la ciudad de Necochea.Población y métodos. Estudio observacional, descriptivo y transversal. Se evaluaron lactantes sanos de 6 a 12 meses, que concurrieron espontáneamente por control de salud al sistema público y/o privado del distrito de Necochea durante el año 2017. Se solicitó consentimiento informado; se realizó una encuesta social y nutricional, evaluación del aporte de hierro de la dieta y medicamentoso, examen físico y pruebas de laboratorio.Resultados. Se incluyeron 239 participantes; el 50,6 % presentaban anemia y el 47,3 %, ferropenia. La media y mediana de hemoglobina coincidieron en 10,9 g/dl, (media de referencia 12,5 mg/dl). De los anémicos, el 54,4 % presentaba ferropenia; el 61,7 % no recibía aporte adecuado de hierro; el 44,3 % no había recibido hierro suplementario el día previo. De este porcentaje, el 24,5 % no había recibido indicación médica y, en el 9,1 %, no había suplemento en el centro de atención primaria de salud u hospital. El aporte adecuado de hierro resultó un factor protector para ferropenia (riesgo relativo ­RR­ 0,78 [intervalo de confianza ­IC­ del 95 %: 0,6-0,9]), y no fue así para la aparición de anemia (RR 1,08; [IC95%: 0,8-1,3]).Conclusiones. En la ciudad de Necochea, anemia y ferropenia son entidades con elevada prevalencia; el aporte de hierro dietario es pobre y el suplemento está subindicado.


Introduction. Anemia in the first years of life leads to severe psychomotor, social, and financial effects. The objective of this study was to determine its prevalence, causes, and risk and preventive factors among infants in the city of Necochea.Population and methods. Observational, descriptive, and cross-sectional study. Healthy infants aged 6-12 months who attended a spontaneous health checkup in a public and/or private facility in the district of Necochea during 2017 were assessed. An informed consent was obtained; a social and nutrition survey was administered; dietary and medicinal iron intake was assessed; and a physical examination and lab tests were done.Results. A total of 239 participants were included; 50.6 % had anemia and 47.3 %, iron deficiency. Mean and median hemoglobin levels were both 10.9 g/dL, (reference mean: 12.5 mg/dL). Among anemia patients, 54.4 % had iron deficiency; iron intake was inadequate in 61.7 %; and 44.3 % had not received iron supplementation the previous day. Among these, 24.5 % had not received a medical indication for it, and 9.1 % did not find iron supplementation available at their primary health care center or hospital. An adequate iron intake was a protective factor against iron deficiency (relative risk [RR]: 0.78 [95 % confidence interval {CI}: 0.6-0.9]), but not against the development of anemia (RR: 1.08; [95 % CI: 0.8-1.3]).Conclusions. In the city of Necochea, anemia and iron deficiency are highly prevalent conditions; dietary iron intake is insufficient and supplementation is under-prescribed.


Subject(s)
Humans , Male , Female , Infant , Anemia, Iron-Deficiency , Epidemiology, Descriptive , Cross-Sectional Studies , Iron, Dietary , Anemia/diagnosis , Iron/therapeutic use
4.
Rev. Assoc. Med. Bras. (1992) ; 66(6): 818-823, June 2020. tab, graf
Article in English | SES-SP, LILACS | ID: biblio-1136279

ABSTRACT

SUMMARY INTRODUCTION Celiac disease (CeD) is an autoimmune disease that can be delayed in diagnosis due to the presence of atypical and asymptomatic cases in adulthood. Herein we aimed to study the frequency of CeD and evaluate whether magnified endoscopy and magnified/FICE (flexible spectral imaging color enhancement) techniques contribute to the diagnosis in patients with serum iron and vitamin B12 deficiency. METHODS We evaluated 50 adult patients (10 males and 40 females) who had serum iron and vitamin B12 deficiency, prospectively. All the patients had undergone upper gastrointestinal system endoscopy by the same endoscopist. The second part of the duodenum was evaluated with white light, magnified, and magnified/FICE endoscopy. Biopsy specimens were evaluated by the same pathologist. The specimens diagnosed as CeD were classified according to the Modified Marsh-Oberhuber criteria. RESULTS 10 of 50 patients (20%) were diagnosed as CeD. The average age was 41±11 years (20-67 years). Thirty percent of CeD diagnosed patients had typical CeD symptoms. Six of 10 patients (60%) who were diagnosed as CeD had typical endoscopic images under white lighted endoscopy. All of these 10 patients (100%) showed villous irregularity, partial villous atrophy, or total villous atrophy consistent with CeD with magnified and magnified/FICE endoscopy. CONCLUSION The practical use of magnified/FICE endoscopy allows us to differentiate mucosal abnormalities of the duodenum and minimize false-negative results that indicate normal mucosal findings with conventional endoscopy.


RESUMO INTRODUÇÃO A doença celíaca (DC) é uma doença autoimune que pode ter seu diagnóstico atrasado devido à presença de casos atípicos e assintomáticos na idade adulta. Neste trabalho, objetivamos estudar a frequência de DC e avaliar se as técnicas de endoscopia magnificada e magnificada/Fice (flexible spectral imaging color enhancement) contribuem para o diagnóstico em pacientes com deficiência sérica de ferro e vitamina B12. MÉTODO Foram avaliados prospectivamente 50 pacientes adultos (10 homens e 40 mulheres) com deficiência sérica de ferro e vitamina B12. Todos os pacientes foram submetidos a endoscopia digestiva alta pelo mesmo endoscopista. A segunda parte do duodeno foi avaliada com endoscopia com luz branca, magnificada e magnificada/Fice. As amostras de biópsia foram avaliadas pelo mesmo patologista. Os espécimes diagnosticados como DC foram classificados de acordo com os critérios de Marsh-Oberhuber modificado. RESULTADOS Dez dos 50 pacientes (% 20) foram diagnosticados como DC. A idade média foi de 41±11 anos (20-67 anos). Trinta por cento dos pacientes diagnosticados com DC apresentaram sintomas típicos de DC. Seis dos dez pacientes (60%) diagnosticados com DC tinham imagens endoscópicas típicas sob endoscopia de luz branca. Todos esses dez pacientes (% 100) apresentaram irregularidade das vilosidades, atrofia das vilosidades parciais ou atrofia das vilosidades totais consistentes com a DC com endoscopia magnificada e magnificada/Fice. CONCLUSÃO O uso prático da endoscopia magnificada/Fice permite diferenciar anormalidades mucosas do duodeno e minimizar os resultados falso-negativos que apresentam achados mucosais normais com a endoscopia convencional.


Subject(s)
Humans , Male , Female , Adult , Vitamin B 12 Deficiency , Celiac Disease , Image Enhancement , Endoscopy, Digestive System , Endoscopy , Iron , Middle Aged
5.
Journal of Korean Neuropsychiatric Association ; : 13-19, 2020.
Article in Korean | WPRIM | ID: wpr-811247

ABSTRACT

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an urge to move the legs or arms and is associated with discomfort and paresthesia in the legs. RLS is diagnosed based on the clinical symptoms, and polysomnography is performed to quantify the periodic limb movements during sleep or in patients who undergo the suggested immobilization test. Determining the cause of RLS is important for accurately diagnosing and evaluating this condition. The treatment of RLS varies according to the etiology, severity, and frequency of the patients' symptoms. Accurate identification and treatment of the cause of RLS are important in patients with secondary RLS. Iron supplementation could be useful in patients with uremia, iron deficiency, and for RLS during pregnancy. Dopamine agonists have been used as the first-line treatment for primary RLS. On the other hand, augmentation is a known adverse effect associated with the long-term use of dopamine agonists. Therefore, recent treatment guidelines recommend the administration of anticonvulsants, such as pregabalin and gabapentin, to treat RLS. Iron, opioids, or benzodiazepines may be useful in patients refractory to anticonvulsants or dopamine agonists. RLS is a chronic condition. Therefore, it is essential to establish a long-term treatment plan, considering both the efficacy and adverse effects of therapeutic agents used in patients.


Subject(s)
Humans , Pregnancy , Analgesics, Opioid , Anticonvulsants , Arm , Benzodiazepines , Diagnosis , Dopamine Agonists , Extremities , Hand , Immobilization , Iron , Leg , Paresthesia , Polysomnography , Pregabalin , Restless Legs Syndrome , Sleep Wake Disorders , Uremia
6.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088700

ABSTRACT

La deficiencia de hierro es la causa más frecuente de anemia en pediatría. Su detección precoz, tratamiento correcto y profilaxis adecuada, constituyen una prioridad sanitaria en nuestro país. Objetivo: Describir el screening de hemoglobina realizado en lactantes con edades comprendidas entre 8 y 12 meses, usuarios de un centro de atención pediátrico de Montevideo, en el período comprendido entre 2 de mayo y 31 de octubre de 2015 y evaluar factores de riesgo de anemia ferropénica presentes. Se revisaron sus historias clínicas, consignando datos epidemiológicos, antecedentes perinatales, alimentación recibida y si recibieron suplementación con hierro adecuada. Se registró si se había realizado la medición de hemoglobina por punción digital y el valor medido. Se comparó la prevalencia de factores de riesgo entre niños con y sin anemia. En el período evaluado fueron asistidos 62 niños: 3 pretérminos de 34 semanas o menos; 15 con peso al nacer menor a 3000 gramos; 42 con lactancia materna exclusiva durante 6 meses; 54 con alimentación complementaria adecuada; 45 con suplementación de hierro. Se realizó la medición de hemoglobina por punción digital a 55 niños. Tenían anemia 28 niños (82 % leve). No se encontró asociación de padecer anemia con los factores de riesgo estudiados excepto el cumplimiento de la profilaxis con suplemento de hierro. Concluimos que la prevalencia de anemia en este grupo fue elevada y que la suplementación con hierro es importante para su prevención.


Iron deficiency is the most frequent cause of anemia in pediatrics. Its early detection, correct treatment and adequate prophylaxis, constitute a health priority in our country. Objective: Describe the hemoglobin screening performed in infants aged between 8 and 12 months, users of a pediatric care center from Montevideo, in the period covered between May 2 and October 31, 2015 and evaluate factors of Risk of iron deficiency anemia present. Their clinical histories were reviewed, including epidemiological data, perinatal records, and diet received and if they received adequate iron supplementation. It was recorded if the hemoglobin measurement had been performed by digital puncture and the measured value. The prevalence of risk factors among children with and without anemia was compared. In the evaluated period, 62 children were assisted: 3 preterm subjects of 34 weeks or less; 15 birth weight less than 3,000 grams; 42 exclusive breastfeeding for 6 months; 54 adequate complementary feeding; 45 iron supplementation. The hemoglobin was measured by digital puncture to 55 children. 28 of them had anemia (82 % mild). No association of anemia was found with the risk factors studied except compliance with prophylaxis with iron supplementation. We conclude that the prevalence of anemia in this group was high and that iron supplementation is important for its prevention.


A deficiência de ferro é a causa mais frequente de anemia em pediatria. Sua detecção precoce, tratamento correto e profilaxia adequada constituem uma prioridade de saúde em nosso país. O objetivo do presente trabalho é descrever a prevalência de anemia em um centro de atendimento de primeiro nível e os fatores de risco associados. Foi realizado um estudo observacional, descritivo, retrospectivo, incluindo crianças entre 8 e 12 meses de idade, que receberam controle sanitário entre maio e outubro de 2015. Suas histórias clínicas foram revisadas, incluindo dados epidemiológicos, registros perinatais e dieta recebida. e se receberam suplementação adequada de ferro. Foi registrado se a medição de hemoglobina foi realizada por punção digital e o valor medido. A prevalência de fatores de risco entre crianças com e sem anemia foi comparada. No período avaliado, 62 crianças foram atendidas: 3 prematuros de 34 semanas ou menos; 15 peso ao nascer inferior a 3000 g; 42 amamentação exclusiva por 6 meses; 54 alimentação complementar adequada; 45 suplementação de ferro. A hemoglobina foi medida por punção digital para 55 crianças. Eles tiveram 28 crianças anemia (82 % leve). Não foi encontrada associação de anemia com os fatores de risco estudados, exceto a adesão à profilaxia com suplementação de ferro. Conclui-se que a prevalência de anemia nesse grupo foi alta e que a suplementação de ferro é importante para sua prevenção.


Subject(s)
Humans , Male , Female , Infant , Hemoglobins/analysis , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/prevention & control , Dietary Supplements , Iron/therapeutic use , /diagnosis , Epidemiology, Descriptive , Prevalence , Retrospective Studies , Risk Factors , Anemia, Iron-Deficiency/epidemiology
7.
Article in Spanish | LILACS | ID: biblio-1396520

ABSTRACT

El Síndrome de piernas inquietas (SPI) o Enfermedad de Willis­Ekbom, es una condición neurológica que afecta al 2-4% de los niños en edad escolar. Etiológicamente se ha relacionado al metabolismo del hierro y a factores genéticos entre otros. En niños aun es una patología poco diagnosticada. Trabajo observacional descriptivo, en el cual se realiza caracterización clínica, según criterios internacionales, en 14 pacientes menores de 18 años, 9 varones. Edad promedio 8 años. Sintomatología inicial variada, desde resistencia a ir a la cama, hasta dibujar sus molestias. En 10 se comprobó déficit de hierro. En 11 pacientes se realizó un polisomnograma, 10 de ellos con un índice elevado de movimientos periódicos de extremidades. El uso de pregabalina y aporte de hierro fue el tratamiento más utilizado. Dos pacientes tenían padres diagnosticados con SPI.


Abstract. The Restless Legs Syndrome (RLS) or Willis-Ekbom Disease is a neurological condition that affects 2-4% of school-age children. Its etiology has been related to the metabolism of iron and genetic factors among others. In children it is still a frequently undiagnosed disorder. This is a descriptive observational report, in which clinical characterization is carried out according to international criteria in 14 patients under 18 years old, 9 boys. Average age is 8 years old. The initial symptomatology was varied, from resistance to comply with bedtime, to drawing their discomfort. In 9, iron deficiency was found. A polysomnogram was performed in 11 patients, 10 of which had a high periodic limb movements index. The use of pregabalin and supplementary iron were the most used treatments. Two patients had parents diagnosed with RLS.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/physiopathology , Restless Legs Syndrome/drug therapy , Cross-Sectional Studies , Polysomnography , Ferritins/analysis , Pregabalin/therapeutic use , Iron/therapeutic use
8.
Acta méd. costarric ; 60(4): 162-166, oct.-dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-973523

ABSTRACT

Resumen Justificación y objetivo: gran parte de los casos descritos de anemias microcíticas-hipocrómicas corresponden a anemias ferropénicas y síndromes talasémicos. El diagnóstico diferencial se complementa con pruebas de laboratorio como el hierro sérico, ferritina, entre otras; sin embargo, estas son de baja disponibilidad en países en vías de desarrollo. En Nicaragua, el diagnóstico de estas patologías se basa en el historial clínico y análisis hematológicos de rutina. El objetivo de este trabajo fue la implementación de la técnica de cuantificación de hemoglobina A2 en el diagnóstico clínico de β-talasemia. Métodos: se realizó un estudio transversal con 30 pacientes que mostraban microcitosis e hipocromía después de 3 meses de tratamiento con sales de hierro. Se realizó electroforesis de hemoglobina y se utilizó el kit de la casa comercial Beta-Thal HbA2 Quik Column para cuantificar la hemoglobina A2 en cada paciente. El análisis estadístico utilizado fue la prueba de t de student. Se consideraron significativas las diferencias a p<0,05. Esta investigación respetó los principios éticos que conciernen. Se contó con la aprobación del Comité de Ética Institucional, UNAN-Managua. Los participantes dieron su consentimiento informado. Resultados: al aplicar el método para cuantificación de hemoglobina A2, se obtuvo que el 67 % de las muestras presentaron una concentración de hemoglobina A2 mayor al valor de referencia establecido (3,3 %), siendo pacientes diagnosticados para β-talasemia menor. El 33 % restante presentó valores normales de hemoglobina A2 con microcitosis e hipocromía. Se encontraron diferencias estadísticamente significativas entre las medias de glóbulos rojos, volumen corpuscular medio, hemoglobina corpuscular media y hemoglobina A2, entre ambos grupos. Conclusión: el diagnóstico diferencial de anemias microcíticas hipocrómicas refractarias al tratamiento con hierro, se realiza inicialmente por el historial clínico del paciente, pero es necesario contar con pruebas diagnósticas como la cuantificación de hemoglobina A2 que permitan identificar las diversas patologías que cursan con microcitosis e hipocromía.


Abstract Justification and objective: much of the described cases of microcytic-hypochromic anemias are ferropenic anemias and Thalassemia syndromes. The differential diagnosis is complemented by laboratory tests as serum iron, ferritin, among others; However, these are of low availability in developing countries. In Nicaragua, the diagnosis of these diseases is based on clinical history and routine blood analysis. The objective of this work was to implement a technique for quantification of hemoglobin A2 in the clinical diagnosis of β-Thalassemia. Methods: We conducted a cross-sectional study with 30 patients showing hypochromia and microcytosis after 3 months of treatment with iron salts. Hemoglobin electrophoresis was performed, a kit from Beta-Thal HbA2 Quik Column was used to quantify the hemoglobin A2 in each patient. The statistical analysis used was the student's t test. The differences were considered significant at p < 0.05. This research respected ethical principles that concern. It had the approval of the committee of ethics institutional, UNAN-Managua and the participants gave their informed consent. Results: when applying the method for quantification of hemoglobin A2, 67% of samples presented a concentration of hemoglobin A2 greater than the reference value set at 3.3%, these patients were diagnosed with β-Thalassemia minor. The remaining 33% presented normal values of hemoglobin A2 with hypochromia and microcytosis. Statistically significant differences between the averages of red blood cells, mean corpuscular volume, mean corpuscular hemoglobin and hemoglobin A2 between the two groups was observed. Conclusion: The differential diagnosis of microcytic hypochromic anemias refractory to treatment with iron, is initially performed by the clinical history of the patient, but it is necessary to have diagnostic tests such as the quantification of hemoglobin A2, which allow the identification of patients with β-Thalassemia minor within this group. In our study 67% of the studied samples were identified as β-Thalassemia minor.


Subject(s)
Humans , beta-Thalassemia , Anemia, Iron-Deficiency/blood , Anemia, Hypochromic/blood , Anemia, Macrocytic/diagnosis , Iron/deficiency , Nicaragua
9.
Univ. salud ; 20(3): 292-303, sep.-dic. 2018. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-979539

ABSTRACT

Resumen Introducción: El contenido de hemoglobina de reticulocitos (CHr), es un parámetro en la biometría hematológica automatizada que proporciona información sobre el contenido de hierro, por ello se ha utilizado como un marcador de la biodisponibilidad del hierro en la eritropoyesis, permite su detección en una etapa temprana de la anemia ferropénica y otras patologías como inflamación crónica, enfermedad renal crónica; además realizar monitoreo de terapias con eritropoyetina y hierro. Objetivo: Exponer la aplicabilidad de la CHr como un parámetro en el diagnóstico precoz de la anemia por deficiencia de hierro, así como su medición e interpretación. Materiales y métodos: Se realizó la revisión de artículos científicos en inglés y español en las bases de datos PubMed, ScienceDirect, LILACS y Medline, usando descriptores validados en Medical Subject Headings (MeSH), considerando periodo de publicabilidad del 80% inferior a 5 años. Resultados: Se describe la importancia, aplicabilidad, determinación e interpretación de este parámetro como biomarcador específico hemático temprano en el diagnóstico de deficiencia de hierro antes de presentarse cambios morfológicos eritroides. Conclusiones: La CHr es un parámetro de gran utilidad en el diagnóstico temprano de anemia ferropénica y otras patologías como deficiencia funcional de hierro, estados de inflamación crónica y enfermedad renal crónica.


Abstract Introduction: The reticulocyte hemoglobin content (CHr) is a parameter in automated hematological biometrics, which can provide information on the iron content. So it has been used as a marker of the bioavailability of iron in the erythropoiesis, it allows its detection at an early stage of iron deficiency anemia and other pathologies such as chronic inflammation, chronic kidney disease; in addition to monitoring therapy with erythropoietin and iron. Objective: To expose the applicability of CHr as a parameter in the early diagnosis of iron deficiency anemia, as well as its measurement and interpretation. Materials and methods: The review of scientific articles in English and Spanish was carried out in the PubMed, ScienceDirect, LILACS and Medline databases, using descriptors validated in Medical Subject Headings (MeSH), considering the publication period of 80% less than 5 years. Results: The importance, applicability, determination and interpretation of this parameter is described as an early specific biomarker in the blood in the diagnosis of iron deficiency before presenting morphological changes occurring during terminal erythroid differentiation. Conclusions: CHr is a very useful parameter in the early diagnosis of iron deficiency anemia and other pathologies such as functional deficiency, chronic inflammation states and chronic renal disease.


Subject(s)
Reticulocytes , Biomarkers , Anemia , Iron
10.
Braz. j. med. biol. res ; 51(7): e7288, 2018. tab, graf
Article in English | LILACS | ID: biblio-889124

ABSTRACT

Anemia is an inevitable complication of hemodialysis, and the primary cause is erythropoietin deficiency. After diagnosis, treatment begins with an erythropoiesis-stimulating agent (ESA). However, some patients remain anemic even after receiving this medication. This study aimed to investigate the factors associated with resistance to recombinant human erythropoietin therapy with epoetin alfa (αEPO). We performed a prospective, longitudinal study of hemodialysis patients receiving treatment with αEPO at our reference hospital from July 2015 to June 2016. Clinical data was collected, and the response to αEPO treatment was evaluated using the erythropoietin resistance index (ERI). The ERI was defined as the weekly weight-adjusted αEPO dose (U/kg per week)/hemoglobin level (g/dL). A longitudinal linear regression model was fitted with random effects to verify the relationships between clinical and laboratory data and ERI. We enrolled 99 patients (average age, 45.7 (±17.6) years; male, 51.5%; 86.8% with hypertension). The ERI showed a significant positive association with serum ferritin and C-reactive protein, percentage interdialytic weight gain, and continuous usage of angiotensin receptor blocker (ARB) hypertension medication. The ERI was negatively associated with serum iron and albumin, age, urea reduction ratio, and body mass index. Our findings indicate that resistance to αEPO was related to a low serum iron reserve, an inflammatory state, poor nutritional status, and continuous usage of ARBs.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anemia/drug therapy , Anemia/etiology , Drug Resistance/drug effects , Epoetin Alfa/therapeutic use , Hematinics/therapeutic use , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/therapy , Body Mass Index , Erythropoiesis/drug effects , Erythropoietin/deficiency , Hemoglobins/analysis , Iron/blood , Linear Models , Longitudinal Studies , Prospective Studies , Reference Values , Renal Insufficiency, Chronic/complications , Risk Factors , Time Factors , Treatment Outcome
11.
Egyptian Journal of Hospital Medicine [The]. 2018; 71 (4): 2851-2857
in English | IMEMR | ID: emr-192539

ABSTRACT

Background: Anemia is a common medical disorder affecting a lot of women in pregnancy in the developing countries. Anemia is the second indirect obstetric cause of death after cardiac causes


Aims: To compare the safety, tolerability, efficacy and hematological response of lactoferrin in treatment of iron deficiency anemia during pregnancy versus ferrous sulfate capsules


Methodology: Hematological Response to lactoferrin versus ferrous sulfate in Treatment of Anemia with Pregnancy". Study site: Ain Shams University hospital. Study design: A double blind clinical trial. Study population: The study was included Two-hundred pregnant females with iron deficiency anemia attending the outpatient clinics of Ain shams university maternity hospital for routine antenatal care. For each pregnant woman, age, parity and gestational history were taken before treatment. All pregnant women took their allocated treatment regularly for eight weeks after diagnosis of iron deficiency anemia with hemoglobin level and serum ferritin level and followed up after four and eight weeks. Also, epigastric pain, diarrhea, constipation, nausea, vomiting or gastric distress reported to assess tolerability of the drugs


Results: The study included 200 pregnant women in a double blind study: Group I [lactoferrin]: 100 cases were received 100mg of bovine lactoferrin [Pravotin sachets, Hygint, Egypt] twice a day. Group II [ferrous sulfate]: 100 cases were received 150 mg of dried ferrous sulphate + folic acid [vitamin B9] 0.50mg [Ferrofol, E.I.P.I.C.O, Egypt] three capsules per day


Conclusion: lactoferrin is more tolerable than ferrous sulphate. It has lesser GIT side effects and seems to icrease both hemoglobin and serum ferritin more than iron salts


Recommendations: Lactoferrin is recommended for patients with iron deficiency anemia


Subject(s)
Humans , Female , Adult , Anemia, Iron-Deficiency/drug therapy , Iron/deficiency , Pregnant Women , Homeostasis , Iron , Administration, Oral , Ferrous Compounds , Hematology , Safety , Double-Blind Method
12.
Psychiatry Investigation ; : 390-395, 2018.
Article in English | WPRIM | ID: wpr-714294

ABSTRACT

OBJECTIVE: The aim of this study was to determine the clinical course of restless legs syndrome (RLS) and potential risk factors for the persistence of RLS symptoms after iron normalization in women with RLS and low serum ferritin (<50 μg/L). METHODS: We reviewed 39 women with RLS and iron deficiency, who achieved iron normalization after oral iron replacement for three months. Risk factors contributing to symptom persistence were estimated by logistic regression analyses. Remission was defined as no RLS symptoms for at least 6 months after the iron normalization. RESULTS: Over the observation period of 2.5±1.4 years, 15 patients reported no RLS symptom whereas 24 patients still complained of RLS symptoms. The remission rate of RLS with iron replacement was 38.5%. The relative risk of symptom persistence was increased by the duration of RLS symptoms (OR: 1.88, 95% CI: 1.01–3.49) or by the age at RLS diagnosis (OR: 1.25, 95% CI: 1.01–1.56). CONCLUSION: Almost two-third of RLS patients with iron deficiency showed persistence of the symptom even after iron normalization. Considering that longer duration of RLS symptoms and older age at RLS diagnosis were risk factors for symptom persistence, early intervention of iron deficiency in RLS is warranted.


Subject(s)
Female , Humans , Diagnosis , Early Intervention, Educational , Ferritins , Iron , Logistic Models , Restless Legs Syndrome , Risk Factors
13.
Chinese Journal of Contemporary Pediatrics ; (12): 1070-1074, 2018.
Article in Chinese | WPRIM | ID: wpr-776665

ABSTRACT

Iron deficiency (ID) is the most common micronutrient deficiency in children. Due to insufficient iron storage at birth and rapid catch-up growth after birth, preterm infants tend to have a high incidence rate of ID. During the critical period of brain development, ID alters iron-dependent neurometabolism, neurochemistry, neuroanatomy, and gene/protein profiles. This affects the central nervous system and causes the change in neurocognitive and behavioral development. Iron supplementation in infancy cannot reverse neurodevelopmental impairment caused by perinatal ID. The influence of ID on neurodevelopment is time- and region-specific, and in the high-risk population, early diagnosis and optimal iron treatment may help with the recovery of brain function and improve quality of life and long-term prognosis in preterm infants.


Subject(s)
Humans , Infant , Infant, Newborn , Anemia, Iron-Deficiency , Infant, Premature , Iron , Premature Birth , Quality of Life
14.
Journal of Nutrition and Health ; : 307-315, 2018.
Article in Korean | WPRIM | ID: wpr-716209

ABSTRACT

PURPOSE: This study evaluated the effects of personalized nutrition intervention for increasing hospital meal intake by elderly patients with malnutrition. METHODS: The subjects were 30 elderly patients with malnutrition who visited a general hospital located in Daegu. An individual nutrition intervention such as change of meal types or special meal service was given to the patients according to nutrition diagnosis related to inadequate intake of hospital meals. Nutritional intake status of the subjects was assessed by analyzing energy intake, protein intake, index of nutritional quality (INQ), nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR). RESULTS: The causes of inadequate intake in the subjects were poor appetite or preference problems (46.7%), symptom-related problems (30.0%) and mastication problems (23.3%). The INQ of protein in the subjects was significantly increased from 0.81 ±0.17 to 1.41 ±0.25 after the nutrition intervention (p < 0.05). The NAR of protein (before 0.50 ±0.21, after 0.58 ±0.17), iron (before 0.72 ±0.30, after 0.84 ±0.29) and vitamin B2 (before 0.31 ±0.16, after 0.37 ±0.14) was also increased after the nutrition intervention (p < 0.05). The MAR of five nutrients, protein, calcium, iron, vitamin A and vitamin B2, was significantly increased by the nutrition intervention (p < 0.05). CONCLUSION: Personalized nutrition intervention according to nutrition diagnosis related to inadequate intake of hospital meals may improve the intake amount of elderly patients with malnutrition.


Subject(s)
Aged , Humans , Appetite , Calcium , Diagnosis , Energy Intake , Hospitals, General , Iron , Malnutrition , Mastication , Meals , Nutritive Value , Riboflavin , Vitamin A
15.
Lima; IETSI; 1 dic. 2017. 79 p.
Non-conventional in Spanish | BIGG, LILACS | ID: biblio-1367362

ABSTRACT

La Guía de Práctica Clínica (GPC) tratará sobre la el diagnóstico y manejo de la anemia asociada a ERC en el paciente adulto, en el ámbito de todos los niveles de atención, servicios o unidades que presten servicios de a pacientes con Enfermedad Renal Crónica, en lo que corresponda a cada nivel.


Subject(s)
Humans , Anemia, Iron-Deficiency/drug therapy , Renal Insufficiency, Chronic/complications , Anemia, Iron-Deficiency/diagnosis , Epoetin Alfa/therapeutic use , Iron/administration & dosage
16.
Rev. peru. med. exp. salud publica ; 34(4): 699-708, oct.-dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-1043258

ABSTRACT

Tanto la deficiencia como la sobrecarga de hierro son situaciones que ponen en riesgo la salud y la vida de las personas, por lo que es importante mantener su homeostasis. Como la hemoglobina contiene 70% del hierro del organismo, la OMS recomienda su medición para determinar la prevalencia de anemia por deficiencia de hierro (ID), a pesar que ellos mismos reconocen que la anemia no es específica de ID. Como la hemoglobina aumenta con la altitud de residencia, la OMS recomienda corregir el punto de corte para definir anemia en la altura. Una objeción a esta corrección es que el aumento de la hemoglobina en la altura no es universal ni aumenta de manera lineal. Además, las poblaciones de mayor antigüedad generacional tienen menos hemoglobina que las más recientes. En infantes, niños, gestantes y adultos, la prevalencia de anemia usando hemoglobina corregida es 3-5 veces mayor que usando marcadores del estatus de hierro. Los programas estatales buscan combatir la anemia mediante la suplementación de hierro; no obstante, resultan ineficaces, especialmente en las poblaciones de altura. Entonces, ¿hay deficiencia de hierro en la altura? Los niveles de hepcidina sérica, hormona que regula la disponibilidad de hierro, son similares a los de nivel del mar indicando que en la altura no hay deficiencia de hierro. Un problema adicional al corregir la hemoglobina por la altura, es que las prevalencias de eritrocitosis disminuyen. En conclusión, la corrección del punto de corte de la hemoglobina en la altura para determinar deficiencia de hierro es inadecuada.


Iron deficiency and overload are risk factors for numerous poor health outcomes, and thus the maintenance of iron homeostasis is vital. Considering that hemoglobin contains 70% of the total iron in the body, the World Health Organization (WHO) recommends the measurement of iron levels to calculate the rate of iron deficiency anemia (IDA), although WHO recognizes that IDA is not the only cause of anemia. As hemoglobin increases with altitude, WHO recommends correcting the cut-off point to define anemia at high altitudes. An objection to this correction is that the increase in hemoglobin at high altitudes is not universal and is not linear. In addition, individuals in older age groups have lower hemoglobin levels than those in younger age groups. In infants, children, pregnant women, and adults, the prevalence of anemia using corrected hemoglobin is 3-5 times higher than that using markers of iron status. State programs seek to control anemia by means of iron supplementation. However, these programs are ineffective, particularly for high-altitude populations. Therefore, the occurrence of iron deficiency at high altitudes is controversial. The serum levels of the hormone hepcidin, which regulates iron availability, are similar in individuals at high altitudes to those of individuals at sea level, indicating that iron deficiency does not occur at high altitudes. An additional problem when correcting hemoglobin at high altitudes is that the frequency of erythrocytosis is decreased. In conclusion, the correction of the cut-off point of hemoglobin at high altitudes to determine iron deficiency is inadequate.


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Altitude , Anemia/diagnosis , Peru/epidemiology , Hemoglobins/analysis , Prevalence , Anemia, Iron-Deficiency/diagnosis , Anemia/blood , Anemia/epidemiology , Iron/physiology
17.
Arch. pediatr. Urug ; 88(5): 254-260, oct. 2017. tab
Article in Spanish | LILACS | ID: biblio-887790

ABSTRACT

Resumen Introducción: la anemia ferropénica es un problema de salud nacional. Existen recomendaciones para su prevención. Para su diagnóstico temprano se incorporó a partir de 2014 la medición de la hemoglobina por punción digital entre los 8-12 meses de edad. Objetivo: determinar la prevalencia de anemia en lactantes usuarios de CASMU-IAMPP e identificar factores asociados. Material y métodos: se estudiaron lactantes entre 8-12 meses, a quienes se realizó medición de hemoglobina por punción digital, entre julio-diciembre 2014. Se describió la prevalencia de anemia. Se describieron las características de los niños con anemia y se compararon con las de un grupo control de niños sin anemia. Resultados: en el período evaluado se realizó hemoglobina digital a 95% de los lactantes entre 8-12 meses, 18,3% presentaba anemia. El 65,9% incorporó carne a la alimentación en forma tardía, 28,6% recibía dosis incorrecta de hierro suplementario y 23,4% no adhería al tratamiento. Los niños con anemia, en comparación con el grupo control, no presentaron mayor prevalencia de prematurez, peso al nacer menor a 3000 g, embarazo gemelar, anemia en el embarazo, suplementación con hierro en el embarazo, pecho directo exclusivo durante 6 meses, o inicio adecuado de alimentación complementaria. En los niños con anemia se detectó una falla en el inicio oportuno de la suplementación con hierro en dosis adecuada así como una mala adherencia al tratamiento. Discusión: debe alertar un 20% de niños con anemia en una población seleccionada en general con recursos económicos adecuados. Se debe insistir en la incorporación temprana de carne a la alimentación e inicio adecuado de la suplementación con hierro en dosis adecuada recomendando una buena adherencia al tratamiento.


Summary Introduction: iron deficiency anemia is a health problem in Uruguay. In 2014, hemoglobin measurement by digital puncture in infants between 8 and 12 months was introduced as a screening method for early diagnosis. Objective: to determine anemia prevalence in infants between 8 and 12 months in the institution (CASMU-IAMPP), and to identify associated factors. Method: infants between 8 and 12 months were studied with hemoglobin measurement by digital puncture from July to December of 2014. The characteristics of the children with anemia were described and compared with the control group. The data were obtained from the medical record and by means of a telephone survey. Results: 804 children were evaluated with hemoglobin measurement by digital puncture, 145 presented anemia (18.03%). The characteristics presented by children with anemia (n=143) were compared with the control group of children without anemia (n=143). There was no significant difference in the distribution by sex, prematurity prevalence, weight under 3.000 g, twin pregnancy, exclusive breastfeeding, and adequate initiation of replacement treatment. Children with anemia presented problems in the initiation of iron supplementation, doses of supplementary iron were adequate, although adherence to treatment was bad (p<0.05). Discussion: the fact that 20% of children from a socio-economic sector with adequate resources have anemia is rather alarming. Early consumption of meat and adequate initiation of iron supplementation in the right doses must be encouraged, as well as a good adherence to treatment.


Subject(s)
Humans , Male , Risk Factors , Anemia, Iron-Deficiency/epidemiology , Trace Elements/therapeutic use , Hemoglobin A/analysis , Demography , Prevalence , Cross-Sectional Studies , Anemia, Iron-Deficiency , Anemia, Iron-Deficiency/diagnosis , Iron/therapeutic use
18.
Acta bioquím. clín. latinoam ; 51(3): 375-378, set. 2017.
Article in Spanish | LILACS | ID: biblio-886132

ABSTRACT

En las últimas décadas se ha avanzado en el conocimiento de la regulación del metabolismo del Hierro (Fe). La Hepcidina (Hp), producida por los hepatocitos, regula la absorción de hierro desde el tubo digestivo y la liberación desde los depósitos del sistema macrofágico y del hígado. En caso de deficiencia de Fe, la Hp está disminuida entregando Fe a la transferrina (Tf). El aumento de Fe y de las citoquinas de la inflamación estimulan la producción de Hp. El ejecutor de la Hp es la Ferroportina (FP), único exportador de Fe. Hay reguladores naturales de la Hp, como la Matriptasa 2. Las mutaciones que limitan su expresión inducen dificultades en la disponibilidad de Fe (IRIDA, sobrecarga de Fe). En los últimos años se ha identificado la Eritroferrona, producida por los eritroblastos activos en la eritropoyesis. Inhibe la síntesis de Hp, permitiendo la liberación del hierro de los depósitos y su absorción por el tubo digestivo, para facilitar la disponibilidad de Fe para la eritropoyesis. Aún no está definido cómo se podrán utilizar estos elementos en el campo diagnóstico, su estandarización y su aplicación terapéutica, pero es probable que resulten de gran utilidad.


In the last decades, a lot of progress has been made on the knowledge of iron (Fe) metabolism regulation. Hepcidin (Hp) is produced by hepatocytes and it regulates the iron absorption from the duodenum and the liberation from macrophages and from the liver. When there is iron deficiency, Hp, which delivers iron to transferrin (Tf), is low. Iron overload and inflammation cytokines stimulate Hp production. The Hp natural executor is Ferroportin (FP), which is the only iron exporter from the cells. One of the natural regulators of Hp is Matriptasa 2, which down regulates Hp. Mutations that limit their expression induce iron overload and anemia (IRIDA). In the last few years, Erythroferrone (ERFE) was discovered. ERFE is produced by active erythroblasts: it inhibits Hp synthesis, allowing the iron liberation from deposits and its duodenal absorption, and also the iron release from macrophages facilitating the erythroid production. The erythroblastic activity, even ineffective, acts as a stimulus of ERFE synthesis. Until now, it has not been defined yethow these different variables could be used for diagnosis, its standardization, or for therapeutic applications, but it is highly probable that they will improve our knowledge and managements kills in this field.


Nas últimas décadas háavanços no conhecimento da regulação do metabolismo do Ferro (Fe). A Hepcidina (Hp), produzida pelos hepatócitos, regula a absorção do ferro desde o tubo digestivo e a liberação desde os depósitos do sistema macrofágico e do fígado. Em caso de deficiência de Fe, a Hp está diminuída entregando Fe à transferrina (Tf). O aumento de Fe e as citoquinas da inflamação estimulam a produção de Hp. O executor da Hp é a Ferroportina (Fp), único exportador de Fe. Há reguladores naturais da Hp, como a Matriptase 2. As mutações que limitam sua expressão induzem dificultades na disponibilidade de Fe (IRIDA, sobrecarga de Fe). Nos últimos anos se identificou que a Eritroferrona, produzida pelos eritroblastosativos na eritropoiese inibe a síntese de Hp, permitindo a liberação de ferro dos depósitos e a absorção pelo tubo digestivo, para facilitar a disponibilidade de Fe para a eritropoiese. Ain da não sedefiniu como poderãoser utilizadosestes elementos no campo diagnóstico, sua padronização e sua aplicação terapêutica, mas é provável que sejam de grande utilidade.


Subject(s)
Humans , Iron Metabolism Disorders/diagnosis , Hepcidins , Iron/metabolism , Anemia , Iron
19.
Arch. argent. pediatr ; 115(2): 125-132, abr. 2017. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-838338

ABSTRACT

Objetivo. Evaluar la eficacia del receptor soluble de transferrina (RST) en el diagnóstico de la anemia ferropénica (AF) y en la evaluación de la respuesta al hierro en los lactantes con desnutrición aguda moderada (DAM). Población y métodos. Se reclutó a lactantes con valores de hemoglobina (Hb) inferiores a los valores umbrales de anemia para su edad y con anemia hipocrómica/microcítica observada en el frotis de sangre periférica. La DAM se definió como un puntaje Z de peso/estatura de entre < -2 y -3. Se compararon los valores del hemograma, los parámetros férricos y el RST entre 41 lactantes con DAM y anemia (grupo DA), 32 lactantes con anemia sin DAM (grupo A) y controles saludables (n= 30). Una vez completado el tratamiento de la anemia y la desnutrición, se repitieron las evaluaciones. Resultados. Además de los índices hematológicos compatibles con AF, los valores de hierro sérico (Fe) y saturación de transferrina (ST) eran significativamente menores, mientras que el valor de transferrina era significativamente mayor en los grupos DA y A en comparación con los controles (p < 0,001). Los valores de ferritina y proteína C-reactiva (PCR) eran significativamente más elevados en el grupo DA (p < 0,05 para la ferritina, p < 0,01 para la PCR). El valor medio del RST fue similar en ambos grupos (DA y A) (p > 0,05) y significativamente mayor que en los controles (p < 0,001). Después del tratamiento con hierro, el RST disminuyó en los grupos DA y A (p < 0,001) a valores similares a los observados en los controles. El RST se correlacionó negativamente con la Hb durante todo el estudio (grupo DA: r= -0,350, p < 0,05; grupo A: r= -0,683, p < 0,01). Conclusiones. Dado que los valores del RST en los grupos DA y A disminuyeron después del tratamiento con hierro, consideramos que este parámetro no estuvo afectado por la DAM ni la inflamación y puede usarse, por sí solo, para detectar la AF y supervisar la respuesta al tratamiento en los lactantes con DAM.


Objective. To evaluate the efficacy of soluble transferrin receptor (sTfR) in diagnosing iron deficiency anemia (IDA) and evaluating iron response in infants with moderate acute malnutrition (MAM). Population and methods. Infants withhemoglobin (Hb) levels lower than threshold values for anemia for their ages and hypochromic/ microcytic anemia on peripheral smear were recruited. MAM was defined as weight/height z score < -2 to -3. Complete blood count (CBC), iron parameters and sTfR were compared among 41 infants with MAM and anemia (MA group), 32 infants with anemia without MAM (group A), and healthy controls (n= 30). Following anemia and malnutrition treatment, tests were repeated. Results. Besides hematological indices compatible with IDA, serum iron (Fe) and transferrin saturation (TS) were significantly lower, while transferrin was significantly higher in MA and A groups compared to controls (p <0.001). Ferritin and C-reactive protein (CRP) were significantly higher in MA group (p <0.05 ferritin, p <0.01 for CRP). Mean sTfR was similar in both MA and A groups (p >0.05) and significantly higher than controls (p <0.001). Following iron treatment, sTfR decreased inboth MA and A groups (p <0.001) to similar values as controls. sTfR was negatively correlated to Hb throughout the study (for MA group, r= -0.350, p <0.05; for A group, r= -0.683, p <0.01). Conclusions. As sTfR values in both MA and A groups decreased following iron treatment, we believe that this parameter was not influenced by MAM or inflammation; and it alone can be used to detect IDA and monitor treatment response in infants with MAM.


Subject(s)
Humans , Male , Female , Infant , Receptors, Transferrin/blood , Anemia, Iron-Deficiency/drug therapy , Anemia, Iron-Deficiency/blood , Malnutrition/blood , Iron/therapeutic use , Severity of Illness Index , Prospective Studies , Treatment Outcome , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/diagnosis , Malnutrition/complications , Malnutrition/therapy
20.
ARS med. (Santiago, En línea) ; 42(1): 61-67, 2017. Tab
Article in Spanish | LILACS | ID: biblio-1016384

ABSTRACT

La anemia es una condición altamente prevalente a nivel mundial y, el déficit de hierro, la causa más frecuente, sin excepción; la mujer embarazada está particularmente en riesgo dada la mayor demanda de hierro que la gestación significa. La anemia se asocia a mayor morbilidad y mortalidad materno-perinatal. En mujeres embarazadas sin anemia, la prevención, mediante el uso de multivitamínicos que contienen hierro en dosis de 30-60 mg de hierro elemental, ha demostrado ser efectiva y se recomienda durante todo el embarazo. En casos de anemia, el diagnóstico de déficit de hierro se establece cuando la ferritina es menor a 30 mg/L y/o la saturación de transferrina es menor a 20 por ciento. La severidad de la anemia y la situación temporal en el embarazo, son factores modificantes del tratamiento. En mujeres embarazadas, con hemoglobina ≥9.0 g/dL y que tengan <34 semanas de embarazo, la indicación es tratamiento con hierro oral, en dosis de 100 mg al día, en días alternos, hasta normalizar los parámetros antes mencionados. Si la hemoglobina es <9.0 g/dL, o el embarazo es ≥34 semanas, el uso de hierro intravenoso ha demostrado ser más efectivo en corregir la anemia y el déficit de hierro y en disminuir la morbilidad materno-perinatal. En estos casos, sugerimos el uso del hierro carboximaltosa, dado su perfil de seguridad y efectividad favorable. Recomendamos conocer y practicar estas recomendaciones para el diagnóstico y manejo de la anemia por déficit de hierro durante el embarazo.(AU)


Anemia is a highly prevalent condition worldwide, and iron deficiency the most frequent cause, without exception; pregnant women are particularly at risk given the increased iron demand of gestation. Additionally, anemia directly correlates with increased maternal-perinatal morbidity and mortality. For non-anemic pregnant women, prevention using 30-60mg of elemental iron-containing multivitamins, has proven effective, and is recommended throughout all pregnancy. In the case of anemia, the diagnosis of iron deficiency is established when ferritin is under 30 mg/L or when transferrin saturation is under 20 percent. The severity of the anemia and the time course of pregnancy, are treatment determining factors. Pregnant women, with hemoglobin ≥9.0 g/dL, and <34 weeks-pregnant, are best treated with oral iron, at dose of 100 mg of elemental iron, on alternate days, until all altered parameters are corrected. Otherwise, when hemoglobin is <9.0 g/dL, or pregnancy is ≥34 weeks, intravenous iron has demonstrated to be more effective to normalize anemia, iron deficiency and diminish maternal-perinatal morbidity. In those cases, we suggest the use of carboximaltose iron, due to its favorable safety and efficiency profile. We recommend knowing and practicing these recommendations for the diagnosis and management of iron deficiency anemia during pregnancy.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy , Anemia , Chile , Disease Management , Diagnosis , Ferritins , Iron
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