Etiología y evolución de la anemia en pacientes sometidos a cirugía cardiovascular / Etiology and evolution of anemia in patients submitted to cardiovascular surgery

Resumen Objetivo: El objetivo del presente estudio es evaluar en nuestro medio la prevalencia de anemia en el preoperatorio de la cirugía cardiovascular, su incidencia postoperatoria y su evolución durante el primer mes. Métodos: Se realizó un estudio de cohorte prospectivo en el que se incluyeron todos los pacientes sometidos a cirugía cardiovascular central intervenidos durante el periodo del 01/09/2021 al 01/09/2022 en un hospital universitario. Se realizó seguimiento clínico y de laboratorio previo a la cirugía, al quinto y al día treinta del postoperatorio. Se comparó a los grupos con y sin anemia preoperatoria. Resultados: La prevalencia de anemia en el preoperatorio fue del 32.1%. La incidencia de anemia en el postoperatorio fue del 96% en el grupo de pacientes sin anemia previa. Al mes de la cirugía un 73 y un 90% de los pacientes, con y sin anemia preoperatoria respectivamente, persistían anémicos. Los pacientes con anemia preoperatoria tuvieron una menor recuperación de sus valores de hemoglobina al mes. Se observó una tendencia a mayor mortalidad y una mayor necesidad de derivación a centros de rehabilitación postegreso hospitalario en aquellos con anemia preoperatoria. Conclusiones: En este trabajo se evidenció una alta prevalencia e incidencia de anemia en el perioperatorio de las cirugías cardiovasculares. Así como su subtratamiento y elevada persistencia durante el mes posterior a la cirugía.

Abstract Objective: The aim of this study is to evaluate the prevalence of anemia in the preoperative period of cardiovascular surgery, its postoperative incidence and its evolution during the first month in our setting. Methods: A prospective cohort study was carried out in which all patients undergoing central cardiovascular surgery operated during the period 09/01/2021-09/01/2022 in a university hospital were included. Clinical and laboratory follow-up was carried out prior to surgery, on the fifth and on the 30th postoperative day. Groups with and without preoperative anemia were compared. Results: The prevalence of anemia in the preoperative period was 32.1%. The incidence of anemia in the postoperative period was 96% in the group of patients without previous anemia. One month after surgery, 73 and 90% of the patients, with and without preoperative anemia, respectively, remained anemic. Patients with preoperative anemia had less recovery of their hemoglobin values at one month. A trend towards higher mortality and a greater need for referral to post-hospital discharge rehabilitation centers was observed in those with preoperative anemia. Conclusions: In this work, a high prevalence and incidence of anemia in the perioperative period of cardiovascular surgeries was evidenced. As well as its subtreatment and high persistence during the month after surgery.

Factores asociados a anemia ferropénica en lactantes y preescolares / Factors associated with iron deficiency anemia in infants and preschoolers

Introducción: La anemia se define como una afección en la cual el número de glóbulos rojos o la concentración de hemoglobina dentro de estos se encuentran por debajo del límite inferior, 11 gr/dl para menores entre 6 a 59 meses. La OMS calcula que a nivel mundial la anemia presenta una prevalencia del 42% en los niños menores de 5 años. Objetivos: Realizar una revisión panorámica de diversas publicaciones científicas acerca de los factores asociados a la anemia ferropénica en preescolares. Materiales y métodos: La revisión se realizó a través de la búsqueda electrónica de diversos artículos científicos relacionados con el tema. Se utilizó la pregunta PEO: ¿Cuáles son los factores asociados a anemia ferropénica en lactantes y preescolares? Se seleccionaron los artículos publicados desde el 2017 hasta el 2022. Resultados: De los 48 artículos encontrados en la revisión, 33 fueron descartados por no cumplir con nuestros criterios de selección, quedando 15 artículos para esta revisión. Basado en 12 artículos revisados, se halló que los factores que se asocian a anemia en menores de 5 años eran por problemas socioeconómicos, déficit de micronutrientes altos en hierro en dieta, madre con antecedente de anemia, la edad materna, falta de educación, entre otros. Conclusión: Los factores predisponentes para la presencia de anemia ferropénica en los menores de 5 años más importantes fueron los relacionados con la edad materna, el nivel socioeconómico y educativo de la madre que conllevan el déficit de hierro del menor.

Introduction: Anemia is defined as a condition in which the number of red blood cells or the hemoglobin concentration within red blood cells is below the lower limit, 11 g/dL for children aged 6-59 months. The WHO estimates that worldwide anemia has a prevalence of 42% in children under 5 years of age. Objectives: To perform an overview review of various scientific publications on the factors associated with iron deficiency anemia in preschoolers. Materials and methods: The review was carried out through an electronic search of various scientific articles related to the subject. The PEO question was used: What are the factors associated with iron deficiency anemia in infants and preschoolers? Articles published from 2017 to 2022 were selected. Results: Of the 48 articles found in the review, 33 were discarded for not meeting our selection criteria, leaving 15 articles for this review. Based on 12 articles reviewed, it was found that the factors associated with anemia in children under 5 years of age were socioeconomic problems, deficiency of micronutrients high in iron in the diet, mothers with a history of anemia, maternal age, lack of education, among others. Conclusion: The most important predisposing factors for the presence of iron deficiency anemia in children under 5 years of age were those related to maternal age, socioeconomic and educational level of the mother that lead to iron deficiency in the child.

Hepcidin and inflammation associated with iron deficiency in childhood obesity - A systematic review

Abstract Objectives: This paper aims to review data on the association of obesity and iron deficiency in children and adolescents, exposing the possible involvement of hepcidin and interleukin-6 (IL-6), obesity's inflammation biomarkers. Data source: Articles from PUBMED and WEB OF SCIENCE database with no chronological limit were reviewed to write this systematic review. Keywords such as children, obesity, iron deficiency, and hepcidin were used. After deleting duplicated and review articles, 91 were screened, and 39 were selected as eligible. Sixteen articles were included because they involved serum hepcidin levels in obese children and adolescents as outcomes. Summary of findings: Finally, those 16 articles were organized in two tables: one includes therapeutic interventions, and the other does not. As hepcidin was discovered in 2000, the first articles that presented serum hepcidin's quantification in obese children and adolescents, homeostasis iron markers, and their possible association with obesity's inflammatory environment began to be published in 2008. Conclusions: Obesity's chronic inflammation state leads to the production of IL-6, which acts as a signaling molecule for hepcidin synthesis, resulting in iron deficiency, which is common in obese children and adolescents who respond inadequately to iron supplementation. On the other hand, that population responds adequately to therapeutic intervention programs that lead to weight loss, guaranteeing iron homeostasis improvement. Therefore, perhaps it is time to discuss serum hepcidin level quantification as part of evaluating children and adolescents with iron deficiency, which could guide clinical choices that might lead to better therapeutic outcomes.

Riesgos y beneficios de la profilaxis con sulfato ferroso en lactantes nacidos a término con niveles de hemoglobina y ferremia desconocidos / Risks and benefits of iron supplementation in full-term infants with unknown hemoglobin and ferritin levels

La seguridad y eficacia de los programas de suplementación con hierro a lactantes, está actualmente en discusión. El objetivo de esta revisión fue identificar estudios sobre riesgos y beneficios de la suplementación con hierro profiláctico en lactantes menores de un año, nacidos a término, con niveles de hemoglobina (Hb) y ferremia desconocidos. Se realizó una búsqueda en Pubmed y Cochrane, identificando 3 revisiones sistemáticas y metaanálisis. Estos estudios arrojaron resultados que indican mejoras en los niveles séricos de hierro y hemoglobina como resultado de la suplementación con hierro. Sin embargo, no se observó un beneficio significativo en el desarrollo cognitivo de los lactantes. Los efectos adversos más reportados son los gastrointestinales, efectos en el crecimiento (menor ganancia de talla y peso) y menor absorción de zinc. En resumen, la evidencia en cuanto a la profilaxis con hierro en lactantes es limitada, lo que nos lleva a recomendar un seguimiento cercano de los lactantes que reciben suplementos de hierro, con el objetivo de detectar posibles eventos adversos. Es fundamental evaluar cuidadosamente los riesgos y beneficios de esta intervención antes de su implementación (AU)

The safety and efficacy of iron supplementation programs for infants are currently under discussion. The objective of this review was to identify studies on the risks and benefits of prophylactic iron supplementation in infants under one year of age, born at term, with unknown hemoglobin (Hb) and serum iron levels. The search was conducted on Pubmed and Cochrane, identifying three systematic reviews and meta-analyses. The results indicate improvements in serum iron and hemoglobin levels as a result of iron supplementation. However, a significant benefit in infant cognitive development was not observed. The most reported adverse effects were gastrointestinal, effects on growth (reduced height and weight gain), and reduced zinc absorption. In summary, the evidence regarding iron prophylaxis in infants is limited, leading us to recommend close monitoring of infants receiving iron supplements to detect potential adverse events. It is crucial to carefully assess the risks and benefits of this intervention before implementation (AU)

Uso de hierro intravenoso en el tratamiento de la anemia ferropénica en niños. A propósito de un caso

Introducción: el déficit de hierro es la causa más común de anemia debido a carencia nutricional. Su tratamiento consiste en proporcionar alimentos ricos en hierro biodisponible junto con la administración de hierro oral. En circunstancias definidas puede utilizarse el hierro intravenoso. Objetivo: describir el abordaje diagnóstico y terapéutico de un niño portador de anemia ferropénica severa secundaria a mala adherencia al hierro oral en el que se utilizó hierro intravenoso. Caso clínico: niño de 21 meses, raza blanca. Antecedente de anemia ferropénica severa, con repercusión hemodinámica que a los 14 meses requirió transfusión de sangre desplasmatizada. Sin controles de hemoglobina posteriores. Sin adherencia a profilaxis con hierro vía oral. Alto consumo de leche de vaca y bajo consumo de alimentos ricos en hierro. En el contexto de infección respiratoria aguda baja se constata anemia clínica con marcado decaimiento y anorexia, sin repercusión hemodinámica. Se confirma la anemia microcítica, hipocrómica severa, con ancho de distribución eritrocitaria elevado, con metabolismo de hierro alterado. Recibe hierro sacarato, intravenoso, por seis días con buena tolerancia y evolución. Discusión: se identificaron múltiples factores de riesgo para anemia ferropénica. La pobre respuesta al tratamiento con hierro oral debido a efectos adversos y olvidos de administración, junto al antecedente de anemia ferropénica severa, que requirió transfusión de sangre desplasmatizada, motivaron la indicación de hierro intravenoso. Su administración fue programada y monitorizada, sin complicaciones. Es necesario fortalecer la prevención en todos los controles pediátricos y abordar este problema de salud desde una mirada interdisciplinaria.

Summary: Introduction: iron deficiency is the most common cause of anemia due to nutritional deficiency. Its treatment consists of providing bioavailable iron rich food together with oral iron. In specific circumstances, intravenous iron may be used. Objective: of this study is to describe the diagnostic and therapeutic approach used with a child with severe iron deficiency anemia secondary to poor adherence to oral iron, in which intravenous iron was used. Clinical case: 21 month-old white patient. History of severe iron deficiency anemia, with hemodynamic repercussions that at 14 months of age required transfusion of deplasmatized blood. Without subsequent hemoglobin controls. No adherence to oral iron prophylaxis. High consumption of cow's milk and low of iron-rich foods. Within the context of acute lower respiratory infection, a clinical anemia with marked decline and anorexia were observed, without hemodynamic repercussions. Severe hypochromic microcytic anemia was confirmed, with an elevated erythrocyte distribution width and altered iron metabolism. He received iron saccharate, intravenously for 6 days with good tolerance and evolution. Discussion: multiple risk factors for iron deficiency anemia were identified. The poor response to treatment with oral iron resulting from adverse effects and lack of proper administration, together with a history of severe iron deficiency anemia, which required transfusion of deplasmatized blood, led to the prescription of intravenous iron. This administration was scheduled and monitored, occurring without complications. It is necessary to strengthen prevention of this condition in all pediatric check-ups and address this health problem from an interdisciplinary perspective.

Introdução: a deficiência de ferro é a causa mais comum de anemia por deficiência nutricional. Seu tratamento consiste no fornecimento de alimentos ricos em ferro biodisponível, juntamente com a administração de ferro por via oral. Em circunstâncias especificas, pode ser utilizado ferro intravenoso. Objetivo: descrever a abordagem diagnóstica e terapêutica de uma criança com anemia ferropriva grave secundária a sua má adesão ao ferro oral, e o uso de ferro intravenoso. Caso clínico: 21 meses, raça branca. História de anemia ferropriva grave, com repercussão hemodinâmica que requiriu de transfusão de sangue desplasmatizada aos 14 meses. Não houve nenhum controle de hemoglobina subsequente. Nenhuma adesão à profilaxia oral com ferro. Alto consumo de leite de vaca e baixo consumo de alimentos ricos em ferro. No contexto de infecção respiratória inferior aguda, observa-se anemia clínica com acentuado emagrecimento e anorexia, sem repercussões hemodinâmicas. É confirmada anemia microcítica e hipocrômica grave, com largura de distribuição eritrocitária elevada e metabolismo alterado do ferro. Recebeu sacarose férrica intravenosa por 6 dias com boa tolerância e evolução. Discussão: foram identificados múltiplos fatores de risco para anemia ferropriva. A má resposta ao tratamento com ferro oral devido aos efeitos adversos e ao esquecimento da administração, aliás da história de anemia ferropriva grave, que exigiu transfusão de sangue desplasmatizada, motivaram a indicação do ferro intravenoso. Sua administração foi programada e monitorada, e aconteceu sem intercorrências. É preciso fortalecer a prevenção em todos os controles pediátricos e abordar este problema de saúde numa persectiva interdisciplinar.

Association between preoperative anemia optimization and major complications after non-cardiac surgery: a retrospective analysis

Abstract Background: Anemia is common in the preoperative setting and associated with increased postoperative complications and mortality. However, it is unclear if preoperative anemia optimization reduces postoperative complications. We aimed to assess the association between preoperative anemia optimization and a composite endpoint of major cardiovascular, renal, and pulmonary complications and all-cause mortality within 30 days after noncardiac surgery in adult patients. Methods: In this retrospective analysis preoperative anemia was defined as hemoglobin concentration below 12.0 g.dl−1 in women and 13.0 g.dl−1 in men within 6 months before surgery. A propensity score-based generalized estimating equation analysis was used to determine the association between preoperative anemia optimization and the primary outcome. Moreover, mediation analysis was conducted to investigate whether intraoperative red blood cell transfusion or duration of intraoperative hypotension were mediators of the relation between anemia optimization and the primary outcome. Results: Fifty-seven hundred anemia optimized, and 8721 non-optimized patients met study criteria. The proportion of patients having any component of the composite of major complications and all-cause mortality was 21.5% in the anemia-optimized versus 18.0% in the non-optimized, with confounder-adjusted odds ratio estimate of 0.99 (95% CI 0.86-1.15) for anemia optimization versus non-optimization, p = 0.90. Intraoperative red blood cell transfusion had a minor mediation effect on the relationship between preoperative anemia optimization and the primary outcome, whereas duration of intraoperative hypotension was not found to be a mediator. Conclusion: Preoperative anemia optimization did not appear to be associated with a composite outcome of major in-hospital postoperative cardiovascular, renal, and pulmonary complications and all-cause in-hospital mortality.

Anemia ferropénica en el embarazo: esquema de sulfato ferroso intermitente en comparación con el continuo / Iron deficiency anaemia in pregnancy: comparison of intermittent versus continuous ferrous sulphate regimen

Resumen OBJETIVO: Comparar las concentraciones de hemoglobina en embarazadas con anemia por deficiencia de hierro que recibieron un tratamiento intermitente en comparación con el continuo de 200 mg de sulfato ferroso por vía oral. Además, comparar la frecuencia de efectos secundarios del tratamiento intermitente con el continuo. MATERIALES Y MÉTODOS: Ensayo clínico, aleatorizado, no cegado, efectuado en la Unidad Médica de Alta Especialidad Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, IMSS, en pacientes de 18 a 35 años atendidas entre los meses de enero a marzo del 2023 con 30 o más semanas de embarazo, diagnóstico de anemia ferropénica (definida operativamente solo con una biometría hemática inferior a 11 g/dL, con hipocromía y microcitosis), sin antecedentes de enfermedad crónico-degenerativa. El análisis estadístico se procesó en el programa SPSS v21, la distribución y características de la muestra con análisis univariado, seguido de un análisis bivariado con t de Student y diferencia de medias. Se consideró con significación estadística el valor de p < 0.05. RESULTADOS: Se estudiaron 32 pacientes: 16 con esquema continuo y 16 con el intermitente. Ambos grupos con incremento de 1 g/dL entre la hemoglobina inicial y final (p < 0.01), con una diferencia de medias entre el aumento de los grupos con p = 0.4. Con disminución significativa de la epigastralgia y la náusea. CONCLUSIONES: El tratamiento intermitente con sulfato ferroso incrementa las concentraciones de hemoglobina igual que un esquema continuo, pero con menos efectos adversos.

Abstract OBJECTIVE: To compare hemoglobin concentrations in pregnant women with iron deficiency anemia who received intermittent versus continuous treatment with 200 mg oral ferrous sulfate. In addition, to compare the incidence of side effects of intermittent versus continuous treatment. MATERIALS AND METHODS: Randomized, non-blinded, clinical trial conducted at the Unidad Médica de Alta Especialidad Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, IMSS, in patients aged 18 to 35 years attended between January and March 2023 with 30 or more weeks of pregnancy, diagnosis of iron deficiency anemia (operationally defined only with a blood biometry lower than 11 g/dL, with hypochromia and microcytosis), without a history of chronic degenerative disease. Statistical analysis was performed in SPSS v21 program, distribution and characteristics of the sample with univariate analysis, followed by bivariate analysis with Student's t and mean difference. A value of p < 0.05 was considered statistically significant. RESULTS: Thirty-two patients were studied: 16 with continuous and 16 with intermittent regimen. Both groups with increase of 1 g/dL between initial and final hemoglobin (p < 0.01), with a mean difference between groups increase with p = 0.4. With significant reduction in epigastralgia and nausea. CONCLUSIONS: Intermittent treatment with ferrous sulfate increases hemoglobin concentrations.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Preoperative Phase - Preoperative management of the patient's anemia

Abstract Managing anemia before surgery is extremely important as it is a clinical condition that can significantly increase surgical risk and affect patient outcomes. Anemia is characterized by a reduction in the number of red blood cells or hemoglobin levels leading to a lower oxygen-carrying capacity of the blood. Proper treatment requires a multifaceted approach to ensure patients are in the best possible condition for surgery and to minimize potential complications. The challenge is recognizing anemia early and implementing a timely intervention to correct it. Anemic patients are more susceptible to surgical complications such as increased infection rates, slower wound healing and increased risk of cardiovascular events during and after surgery. Additionally, anemia can exacerbate existing medical conditions, causing greater strain on organs and organ systems. To correct anemia and optimize patient outcomes, several essential measures must be taken with the most common being identifying and correcting iron deficiency.

Iron deficiency anemia as a risk factor for pulp disease in children from the central Peruvian jungle: a case‒control study

Abstract Aim To investigate iron-deficiency anemia as a risk factor for dental pulp disease in children from the central Peruvian jungle. Methodology A case-control study was carried out with 270 children, of which 90 referred to cases and 180, to controls. Patients with pulp disease were diagnosed according to the criteria of the Association of Endodontists and the American Board of Endodontics. A specific questionnaire was used to assess ferrous sulfate consumption, maternal education level, maternal age, occupation, and household income. Data were analyzed using Pearson's correlation coefficient and a binary logistic regression. Results Iron deficiency anemia offers a risk factor for pulp disease in children (OR 7.44, IC 95% 4.0-13.8). According to multivariate analysis using binary logistic regression, ferrous sulfate consumption (OR 13.8, IC 95% 5.6.33.9), maternal education level (OR 2.4, IC 95% 1.1-5.3), maternal age (OR 7.5, IC 95% 2.9-19.4), household income (OR 4.0, IC 95% 1.6-9.6), and caries (OR 10.7, IC 95% 4.5-25.7) configured independent factors that were statistically associated with pulp disease. Conclusion Iron deficiency anemia, ferrous sulfate consumption, maternal education level, maternal age, household income, and dental caries were positively associated with pulp disease in children

A meta-analysis of ferric carboxymaltose versus other intravenous iron preparations for the management of iron deficiency anemia during pregnancy

Abstract Objective: We conducted a meta-analysis of randomized clinical trials evaluating the clinical effects of ferric carboxymaltose therapy compared to other intravenous iron in improving hemoglobin and serum ferritin in pregnant women. We also assessed the safety of ferric carboxymaltose vs. other intravenous iron. Data source: EMBASE, PubMed, and Web of Science were searched for trials related to ferric carboxymaltose in pregnant women, published between 2005 and 2021. We also reviewed articles from google scholar. The keywords "ferric carboxymaltose," "FCM," "intravenous," "randomized," "pregnancy," "quality of life," and "neonatal outcomes" were used to search the literature. The search was limited to pregnant women. Selection of studies: Studies related to ferric carboxymaltose in pregnancy were scanned. Observational studies, review articles, and case reports were excluded. Randomized studies in pregnant women involving ferric carboxymaltose and other intravenous iron formulations were shortlisted. Of 256 studies, nine randomized control trials were selected. Data collection: Two reviewers independently extracted data from nine selected trials Data synthesis: The final effect size for increase in hemoglobin after treatment was significant for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 0.89g/dl [95% confidence interval 0.27,1.51]). The final effect size for the increase in ferritin after treatment was more for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 22.53µg/L [-7.26, 52.33]). No serious adverse events were reported with ferric carboxymaltose or other intravenous iron. Conclusion: Ferric carboxymaltose demonstrated better efficacy than other intravenous iron in increasing hemoglobin and ferritin levels in treating iron deficiency anemia in pregnant women.

Iron deficiency and child psychomotor development in a rural region of Chota, Peru, 2022 / Deficiencia de hierro y desarrollo psicomotor infantil en una zona rural de Chota, Perú 2022 / Deficiência de ferro e desenvolvimento psicomotor infantil em uma área rural de Chota, Peru 2022

Introduction: Iron deficiency and psychomotor developmental delay are two public health problems that cause high childhood morbidity and mortality worldwide, which can be related to social, economic, cultural and health factors that affect the environment where children and their family live. Objective: To determine the relationship between iron deficiency anemia and psychomotor development in children aged 2 to 4 years treated at the Cuyumalca Clinic, Chota. Materials and methods: Relational, cross-sectional study conducted on 48 children, who underwent hemoglobin testing through a portable hemoglobinometer and were subjected to the Psychomotor Development Test. Results: 31.2% of the children displayed some type of anemia, with the most common being moderate anemia (17.7%). On average, 10.9% showed some type of psychomotor developmental delay, including coordination (6.3%), language (8.4%), motor skills (16.7%), and overall development (12.5%). 4.2% of the children who had minor to moderate anemia showed developmental delay risks in the three assessed areas as well as in their overall development. Conclusion: There is no statistically significant relationship between iron deficiency anemia and several domains of psychomotor development, including coordination, language, motor skills as well as overall development.

Introducción: La deficiencia de hierro y las alteraciones en el desarrollo psicomotor son dos problemas de salud pública que causan una alta morbimortalidad infantil alrededor del mundo. Los estudios apuntan a que esto se relaciona con los factores sociales, económicos, culturales y sanitarios en los que el niño y su familia vive. Objetivo: Determinar la relación entre anemia ferropénica y desarrollo psicomotor en niños de 2 a 4 años atendidos en el Puesto de Salud de Cuyumalca, Chota. Materiales y métodos: Estudio relacional, transversal, desarrollado con 48 niños a quienes se les realizó un dosaje de hemoglobina con hemoglobinómetro portátil y se les aplicó el Test de Desarrollo Psicomotor. Resultados: El 31,2% de niños presentaron algún tipo de anemia, siendo la anemia moderada la más frecuente (16,7%); en promedio 10,9% evidenciaron alguna alteración en el desarrollo psicomotor en coordinación (6,3%), lenguaje (8,4%), motricidad (16,7%) y desarrollo global (12,5%). El 4,2% de niños con riesgo para el desarrollo presentaron anemia leve o moderada en las tres áreas evaluadas, al igual que en el desarrollo global. Conclusión: No existe relación estadística significativa entre anemia ferropénica y desarrollo psicomotor para las áreas de coordinación, lenguaje y motricidad; además del desarrollo global.

Introdução: A deficiência de ferro e as alterações no desenvolvimento psicomotor são dois problemas de saúde pública que causam elevada morbidade e mortalidade infantil em todo o mundo. Estudos sugerem que isso está relacionado aos fatores sociais, econômicos, culturais e de saúde em que vivem a criança e sua família. Objetivo: Determinar a relação entre anemia ferropriva e desenvolvimento psicomotor em crianças de 2 a 4 anos atendidas no Posto de Saúde Cuyumalca, Chota. Materiais e métodos: Estudo relacional, transversal, desenvolvido com 48 crianças que realizaram dosagem de hemoglobina com hemoglobinômetro portátil e foi aplicado o Teste de Desenvolvimento Psicomotor. Resultados: 31,2% das crianças apresentaram algum tipo de anemia, sendo a anemia moderada a mais frequente (16,7%); em média, 10,9% apresentaram alguma alteração no desenvolvimento psicomotor na coordenação (6,3%), linguagem (8,4%), motricidade (16,7%) e desenvolvimento global (12,5%). 4,2% das crianças em risco de desenvolvimento apresentaram anemia leve ou moderada nas três áreas avaliadas, bem como no desenvolvimento global. Conclusão: Não há relação estatística significativa entre anemia ferropriva e desenvolvimento psicomotor para as áreas de coordenação, linguagem e motricidade; bem como o desenvolvimento global.

Estado de hierro y propuesta de ajuste de hemoglobina por altitud en niños de 6 a 8 meses residentes en Lima, Arequipa, Cusco y Puno / Iron status and hemoglobin adjustment by altitude to define anemia in children aged 6 to 8 months living in Lima, Arequipa, Cusco and Puno

RESUMEN Objetivos. Caracterizar el estado del hierro y proponer factores de ajuste de hemoglobina por altitud, en niños de 6 a 8 meses de Lima, Arequipa, Cusco y Puno. Materiales y métodos. Estudio transversal en niños de 6 a 8 meses de edad en cuatro ciudades, se midió hemoglobina y otros biomarcadores de hierro, Proteína C reactiva (PCR), entre otros. Para estimar la ecuación de ajuste, se aplicó una regresión exponencial y excluimos a los niños con deficiencia de hierro (DH) y/o inflamación. Resultados. Las proporciones de DH fueron mayores en Puno y Arequipa, mientras que la inflamación no superó el 19% en ninguna de las ciudades. La hemoglobina mostró un incremento exponencial a mayor altitud. La ecuación de ajuste fue: 10,34249 x (1,00007 ^ Alt). Conclusiones. Los niños residentes en Arequipa y Puno mostraron mayores proporciones de DH y menores reservas de hierro; además el aumento de la hemoglobina por altitud fue exponencial evidenciando la necesidad de ajustar la hemoglobina en altura.

ABSTRACT Objective. To describe the iron status profile and to propose hemoglobin adjustment factors for altitude for children aged 6 to 8 months in Lima, Arequipa, Cusco and Puno. Materials and methods. Cross-sectional study in children aged 6 to 8 months from four cities. We measured hemoglobin and other iron biomarkers, C-reactive protein (CRP), among others. To estimate the adjustment equation, we applied an exponential regression. We excluded children with iron deficiency (ID) and/or inflammation. Results. The proportions of ID were higher in Puno and Arequipa, while inflammation did not exceed 19% in any of the cities. Hemoglobin showed an exponential increase at higher altitude. The adjustment equation was: 10.34249 x (1.00007 ^ Alt). Conclusions. Children residing in Arequipa and Puno showed higher rates of ID and lower iron reserves; furthermore, the increase in hemoglobin by altitude was exponential, showing the need to adjust hemoglobin at altitude.

Experiencia de uso de hierro intravenoso para el tratamiento de la anemia en niños y adolescentes. Respuesta terapéutica y evolución / Experience in using intravenous iron for the treatment of anemia in children and adolescents. Therapeutic response and evolution

Introducción: El hierro de administración intravenosa (iv) está indicado en los casos en que el tratamiento oral no es posible. El objetivo de este trabajo fue describir el perfil de uso, respuesta terapéutica y seguridad de la administración de hierro iv en el tratamiento de la anemia ferropénica en niños, niñas y adolescentes (NNA) asistidos en un centro de referencia de Uruguay entre 2018 y 2023. Método: Estudio retrospectivo mediante revisión de historias. Incluyó todos los NNA que recibieron hierro iv. Se registraron variables sociodemográficas, comorbilidades, clínica y severidad de la anemia. Se evaluó: motivos de la indicación y tipo de hierro iv, dosis, tiempo de infusión, respuesta terapéutica y efectos adversos. Resultados: Se incluyeron 35 pacientes, mediana de edad 4 años; 51,4% de sexo masculino, con comorbilidades 37,1%. Todos los menores de 3 años presentaban factores de riesgo para anemia ferropénica, la falta de adherencia al hierro oral se asoció con mayor severidad de la anemia (p<0,05). El motivo principal de indicación de hierro iv fue la severidad de la anemia e inadecuada respuesta al hierro oral concomitante en 37,1%. Todos recibieron hierro sacarato; mediana de dosis: 2 mg/kg y de tiempo de infusión: 1 hora. Se registró un caso de edema y exantema de cara vinculado a la rápida infusión. La evolución fue satisfactoria. Conclusiones: La administración de hierro iv fue segura. Es necesario establecer consensos respecto a la posología y monitorización. Se requieren nuevos estudios para continuar evaluando la eficacia y seguridad del hierro iv en sus diversas formulaciones.

Introduction: Intravenous (IV) iron administration it is indicated in cases where oral treatment is impossible. The objective of this work was to describe the profile of use, therapeutic response, and safety of the iron IV administration in treating anemia in children and adolescents (NNA) assisted in a reference center in Uruguay between 2018 and 2023. Method: Retrospective study through review of histories. It included all children and adolescents who received IV iron. Sociodemographic variables, comorbidities, clinical symptoms, and severity of anemia they were recorded. They were evaluated: reasons for the indication and type of IV iron, dose, infusion time, therapeutic response, and adverse effects. Results: we included 35 patients, with a median age of four years; 51.4% were male, and 37.1% had comorbidities. All children under three years of age had risk factors for iron deficiency anemia; greater severity of anemia was associated with lack of adherence to oral iron (p<0.05). The main reason for the indication of IV iron was the severity of anemia and inadequate response to concomitant oral iron at 37.1%. All received iron saccharate; median dose: 2 mg/kg and infusion time: 1 hour. A case of facial edema and rash linked to rapid infusion was recorded. The evolution was satisfactory. Conclusions: The administration of IV iron was safe. It is necessary to establish a consensus regarding dosage and monitoring. New studies are required to continue evaluating the efficacy and safety of IV iron in its various formulations.

Programa Nacional de Suplementação de Ferro nos primeiros mil dias de vida em Salvador (BA) / National Iron Supplementation Program in the first thousand days of life in Salvador (BA) / Programa Nacional de Suplementación de Hierro en los primeros mil días de vida en Salvador, Bahía

Os primeiros mil dias de vida correspondem ao período desde a concepção até os primeiros dois anos após o nascimento. Durante essa fase, as necessidades nutricionais são elevadas devido às aceleradas alterações fisiológicas inerentes ao período, e o ferro está entre os micronutrientes mais requisitados. Considerando que a anemia, em especial por deficiência de ferro, é um problema de saúde pública, principalmente nessa fase da vida, foi instituído em 2005 o Programa Nacional de Suplementação de Ferro (PNSF). No entanto, há uma lacuna de estudos que analisam sua execução em municípios da Bahia. Por esse motivo, este estudo observacional descritivo objetivou avaliar a cobertura real do PNSF entre gestantes e crianças de 6 a 24 meses de vida, público-alvo do programa, no município de Salvador (BA), entre os anos de 2017 e 2022, a partir da análise de dados secundários disponibilizados pelo Ministério da Saúde. A cobertura real do PNSF ocorreu de forma insatisfatória no município, alcançando quantidades inferiores a 7% das gestantes e 1% das crianças, entre os anos de 2019 e 2021, e valores iguais a 0% para ambos os grupos nos anos de 2017, 2018 e 2022. Tais resultados podem ser motivados por diferentes fatores, como problemas operacionais na gestão/monitoramento do programa e/ou a baixa adesão da população. Destaca-se, assim, a necessidade da constante avaliação do desempenho do PNSF no intuito de identificar suas limitações e propor melhorias em sua execução.

The first thousand days of life correspond to the period from conception to the first two years after birth. During this phase, nutritional needs are high due to the accelerated physiological changes inherent to the period, and iron is among the most required micronutrients. Considering that anemia, especially due to iron deficiency, is a public health problem, especially at this stage of life, the National Iron Supplementation Program (PNSF) was instituted in 2005. However, there is a lack of studies that analyze its execution on municipalities in Bahia (BA). For this reason, this descriptive observational study aimed to evaluate the coverage of the PNSF among pregnant women and children between 6 and 24 months of life, the target audience of the program, in the municipality of Salvador (BA), between 2017 and 2022, based on the analysis of secondary data provided by the Ministry of Health. The actual coverage of the PNSF occurred unsatisfactorily in the municipality, reaching numbers below 7% of pregnant women and 1% of children, between the years 2019 and 2021, and values equal to 0% for both groups in the years 2017, 2018, and 2022. Such results can be due to different factors, such as operational problems in the management/monitoring of the program and/or the low adherence of the population. Thus, we highlight the need for constant evaluation of the PNSF performance to identify its limitations and propose improvements in its execution.

Los primeros mil días de vida corresponden al período que va desde la concepción hasta los primeros dos años después del nacimiento. Durante esta fase, las necesidades nutricionales son elevadas, debido a los cambios fisiológicos acelerados propios del período, y el hierro es uno de los micronutrientes más requeridos. Como la anemia, especialmente por deficiencia de hierro, es un problema de salud pública, especialmente en esta etapa de la vida, en 2005 se instituyó el Programa Nacional de Suplementación con Hierro (PNSF, por sus siglas en portugués). Sin embargo, faltan estudios que analicen su ejecución en municipios de Bahía (Brasil). Por esta razón, este estudio observacional descriptivo tuvo por objetivo evaluar la cobertura real del PNSF en mujeres embarazadas y en niños de entre 6 y 24 meses de vida, público objetivo del programa, en la ciudad de Salvador (Bahía), entre 2017 y 2022, con base en el análisis de datos secundarios proporcionados por el Ministerio de Salud. La cobertura real del PNSF se presentó de manera insatisfactoria en el municipio, alcanzando cifras inferiores al 7% de embarazadas y al 1% de niños, entre los años 2019 y 2021, con valores iguales al 0% para ambos grupos analizados en los años 2017, 2018 y 2022. Estos resultados pueden ser causados por diferentes factores, entre ellos, problemas operativos en la gestión/seguimiento del programa y/o baja adherencia de la población. Así, se destaca la necesidad de una evaluación constante del desempeño del Programa para identificar sus limitaciones y proponer mejoras en su ejecución.

Uso de carboximaltose férrica no tratamento de deficiência de ferro em pacientes com insuficiência cardíaca na perspectiva da saúde suplementar: análise de custo-efetividade e impacto orçamentário / Ferric carboxymaltose for treatment of iron deficiency in heart failure patients from the supplementary health care system perspective: cost-effectiveness and budgetary impact analysis

Objetivo: Avaliar a relação de custo-efetividade e impacto orçamentário (AIO) do tratamento de deficiência de ferro (DF), com ou sem anemia, em pacientes com insuficiência cardíaca (IC) com fração de ejeção reduzida NYHA II e III, com uso de carboximaltose férrica (CMF), comparada ao placebo (não intervenção), sob a perspectiva pagadora da saúde suplementar (SS). Métodos: No modelo econômico, foi utilizada a árvore de decisão, no horizonte temporal de 52 semanas, na perspectiva da SS, sendo mensurados os benefícios clínicos e os custos associados à intervenção. Também foram executadas análises de sensibilidade determinística e probabilística para avaliar possíveis incertezas futuras. A elaboração da AIO foi realizada considerando o horizonte temporal de cinco anos, a população a ser tratada, os diferentes cenários de market share e os custos diretos envolvidos no tratamento atual e no tratamento proposto. Resultados: A razão de custo-efetividade incremental (RCEI) foi de -R$ 20.517,07 para um ano de vida ajustado pela qualidade (QALYs). O impacto da incorporação da CMF na SS gerou uma economia em cinco anos de -R$ 43.945.225. Conclusões: A análise apresentada mostrou que o tratamento com CMF reduziu o custo de hospitalização, o número de consultas ambulatoriais e o custo de outros medicamentos relacionados à IC e proporcionou uma economia anual. Considerando um horizonte de tempo de 52 semanas, a terapia intravenosa com CMF resultou em uma estratégia de redução de custos, quando comparada ao tratamento proposto para a DF em pacientes com IC.

Objective: This study aims to evaluate the cost-effectiveness and budget impact (AIO) of iron carboxymaltose (CMF) for treatment of iron deficiency (ID), with or without anemia, in patients with heart failure (HF) and reduced ejection fraction NYHA II and III compared to placebo (non-intervention), from the perspective of paying supplementary health (SS). Methods: In the economic model, the decision tree was used, with a time horizon of 52 weeks, from the SS perspective, measuring the clinical benefits and costs associated with the intervention. Deterministic and probabilistic sensitivity analyzes were also performed to assess possible future uncertainties. The elaboration of the AIO was carried out considering a time horizon of five years, population to be treated, different market share scenarios and direct costs involved in the current treatment and in the proposed treatment. Results: The incremental cost effectiveness ratio (ICER) was -R$ 20,517.07 for 1 quality-adjusted life year (QALY). The budget impact of incorporation of the CMF in SSprovided savings in five years of -R$ 43,945,225. Conclusions: The presented analysis showed that treatment with CMF reduced the cost of hospitalization, the number of outpatient visits and the cost of other HF-related medications and provided annual savings. Considering a time horizon of 52 weeks, intravenous therapy with CMF resulted in a cost-saving strategy when compared to the proposed treatment for DF in patients with HF.

Granuloma piogénico oral de comportamiento agresivo: Reporte de un caso

El granuloma piogénico es una lesión vascular reactiva benigna del tejido blando que surge en respuesta a irritantes crónicos de bajo grado. Rara vez crece más de 2 cm de diámetro y por lo general, no provoca cambios en el hueso alveolar. Presentamos un caso inusual de granuloma piógeno en una mujer de 19 años, de extenso tamaño y comportamiento agresivo, asociado a resorción ósea severa, movilidad dentaria, hemorragia, anemia ferropénica y recurrencias.

Pyogenic granuloma is a benign reactive vascular lesion of the soft tissue that arises in response to chronic low-grade irritants. It rarely grows more than 2 cm in diameter and usually does not cause changes in the alveolar bone. We present the case of a 19-year-old woman with an unusual pyogenic granuloma of extensive size and aggressive behavior, associated with severe bone resorption, tooth mobility, hemorrhage, iron deficiency anemia and recurrences.

Prevalência de anemia em gestantes das Américas: uma revisão rápida com metanálise / Prevalence of anemia in pregnant women in the Americas: a rapid review with meta-analysis

A anemia em gestantes é um relevante problema de ampla expansão geográfica, típica de grandes centros urbanos que atinge diversos países, como os da América. Estimar a prevalência nas Américas de anemia materna e anemia ferropriva em gestantes.Revisão rápida com busca no Medline, via PubMed, Scopus, Web of Science, SciELO, Lilacs e Open Grey. Incluíram-se estudos do tipo transversal, que estimassem a prevalência de anemia materna e anemia ferropriva. Foram realizadas metanálises com efeito randômico. 5.148 artigos foram encontrados, apenas 39 atenderam aos critérios de elegibilidade. As metanálises apresentaram prevalência de 30% (IC95%: 28%; 32%. I2: 99,4%) para anemia materna e frequência de 32% (IC95%: 25%; 40%. I2: 96,6%) para anemia ferropriva.Anemia materna é um evento frequente na população das Américas, com 30% para anemia materna e 32% para anemia ferropriva, destacando a necessidade de medidas de prevenção e promoção à saúde mais eficazes.

Anemia in pregnant women is a relevant problem of wide geographical expansion, typical of large urban centers and that affects several countries, such as America. To estimate the prevalence of maternal anemia and iron deficiency anemia in pregnant women in the Americas.Rapid review with search in Medline, Pubmed, Scopus, Web of Science, SciELO, Lilacs and Open Grey databases. Cross-sectional studies that estimated the prevalence of maternal anemia and iron deficiency anemia were included. Random-effects meta-analyses were conducted. 5148 articles were found, only 30 met the eligibility criteria. Meta-analyses showed a prevalence of 30% (95%CI: 28%; 32%. I2: 99.4%) for maternal anemia and a frequency of 32% (95%CI: 25%; 40%. I2: 96.6%) for iron deficiency anemia. Maternal anemia is a frequent event in the population of the Americas, with prevalence of 30% for maternal anemia and 32% for iron deficiency anemia, highlighting the need for more effective prevention and health promotion measures.

Bilateral interstitial keratitis in a patient with presumed brain tuberculoma / Ceratite intersticial bilateral em um paciente com tuberculoma cerebral presumido

ABSTRACT Interstitial keratitis is an inflammation of the corneal stroma without epithelium or endothelium involvement. The underlying causes are mostly infectious or immune mediated. Brazil has one of the highest incidence rates of tuberculosis in the world. Tuberculosis is considered one of the causes of interstitial keratitis. Malnutrition and anemia are risk factors of the disseminated disease. This is a case report of a 10-year-old child who presented with decreased visual acuity and a clinical diagnosis of bilateral interstitial keratitis and sclero-uveitis. The patient had been treated with topical steroids with partial improvement. Examinations revealed severe iron deficiency anemia, negative serologies for human immunodeficiency virus and syphilis, positivity for cytomegalovirus- and herpes simplex-specific IgG, and purified protein derivative of 17 mm. During the follow-up, the patient presented with tonic-clonic seizures, and magnetic resonance imaging findings suggested a central nervous system tuberculoma. Interstitial keratitis improvement was observed after specific tuberculosis treatment. This is the first case report describing the association of interstitial keratitis and central nervous system tuberculoma.

RESUMO A ceratite intersticial é uma inflamação do estroma corneano sem envolvimento epitelial ou endotelial causada principalmente por doenças infecciosas e imunomediadas. O Brasil tem altas taxas de tuberculose que deve ser lembrada como causa de ceratite intersticial. Desnutrição e anemia são fatores de risco da forma disseminada da tuberculose. Este é um relato de uma criança de 10 anos com redução de acuidade visual e diagnóstico clínico de ceratite intersticial bilateral e esclerouveíte. O paciente obteve melhora parcial da ceratite com corticoide tópico. Exames laboratoriais mostraram anemia ferropriva grave, sorologias negativas para HIV e sífilis; IgM negativo e IgG positivo para citomegalovírus e herpes simplex e PPD positivo (17 mm). Ele evoluiu com crises tônico-clônicas e a ressonância nuclear magnética revelou tuberculoma do sistema nervoso central. A melhora da ceratite intersticial foi observada após tratamento para tuberculose. Este é o primeiro caso que descreve a associação de ceratite intersticial e tuberculoma do sistema nervoso central.

Anemia por uncinarias, una infección subestimada por el clínico / Hookworm anemia, an infection underestimated by clinician

La uncinariasis fue descrita por primera vez por Dubini en 1838. Es una helmintiasis intestinal causada por el Necator americanus y/o Ancylostoma duodenale. Frecuentemente son endémicas de áreas tropicales y subtropicales; afecta tanto a niños como a adultos. La transmisión asciende cuando existen entornos socioculturales y demográficos que favorecen la contaminación fecal, por lo que es considerado un problema de salud pública en el mundo. Se presenta el caso de un paciente masculino de 20 años que acudió a urgencias por astenia, adinamia, taquicardia y palidez mucocutánea generalizada; el hemograma reportó anemia severa y eosinofilia. Se requirió transfusión de 4 UI de glóbulos rojos y sulfato ferroso. El examen coprológico mostró infección por Necator americanus, que fue tratada con albendazol y, posteriormente, fue egresado de la institución sanitaria. La infección por uncinarias constituye una causa olvidada para el clínico de hemorragia de las vías digestivas y desarrollo de anemia. Por tanto, el presente estudio destaca que esta parasitosis es una causa importante en el diagnóstico diferencial. Además, se ofrece mayor importancia a las estrategias preventivas como la capacitación a profesionales de salud, el refuerzo de técnicas de aseo, la disminución de la contaminación y el aumento de la higiene personal(AU)

Hookworm infection was first described by Dubini in 1838. It is an intestinal helminth infection caused by Necator americanus and/or Ancylostoma duodenale. They are frequently endemic to tropical and subtropical areas and affect both children and adults. Transmission increases when there are socio-cultural and demographic environments that favor fecal contamination; therefore, it is a public health problem worldwide. We describe the case of a 20-year-old male patient who presented to the emergency department with asthenia, adynamia, tachycardia, and generalized mucocutaneous pallor. The blood test showed severe anemia and eosinophilia. Transfusion of 4 IU of red blood cells and ferrous sulphate was required. The coprological test showed infection by Necator americanus, which was treated with albendazole. Afterwards, the patient was discharged from the health institution. Hookworm infection is a neglected cause of gastrointestinal bleeding and anemia by the clinician. Therefore, the present study highlights this parasitosis as an important cause in the differential diagnosis. In addition, greater importance is given to preventive strategies such as training the health professionals, reinforcement of hygiene techniques, decrease of contamination and increase of proper personal hygiene(AU)

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.