Adherencia al consumo de suplementos de hierro y factores asociados en gestantes peruanas / Adherence to iron supplements consumption and associated factors in Peruvian pregnant women

Introducción: La anemia durante el embarazo se considera un problema de salud pública. La estrategia para su reducción incluye la administración de suplementos de hierro. Objetivo: Analizar la adherencia al suplemento de hierro en gestantes atendidas en los establecimientos de salud del Ministerio de Salud del Perú. Métodos: Se realizó un estudio transversal de vigilancia centinela de adherencia a sales de hierro en 1038 gestantes del Perú, atendidas en hospitales, centros de salud y puestos de salud, que recibieron suplementos de hierro. Se aplicó una entrevista estructurada para medir los factores a la adherencia y se determinó adherencia cuando el consumo de suplementos fuera > 75 por ciento. Se aplicó la estadística descriptiva y regresión logística. Resultados: El 42,3 por ciento de las gestantes fueron adherentes al suplemento de hierro. Se asociaron a la adherencia: tener educación universitaria (ORa 3,4; IC 95 por ciento 1,5:7,7), consumir alimentos ricos en hierro (ORa 1,6; IC 95 por ciento 1,1:2,5), no suspender el tratamiento por molestias (ORa: 2,8 IC 95 por ciento 1,7:4,6) y residir en una altitud entre 1001 m s. n. m. a 2000 m s. n. m. (ORa 4,0; IC 95 por ciento 1,6:10,1). Estos factores explican entre el 12 por ciento y el 16 por ciento de la adherencia, y fueron predictivos para identificar adherencia en gestantes con un área bajo la curva del 70,4 por ciento. Conclusiones: El tratamiento con sales de hierro en gestante es insuficiente, por lo que debe incluirse en su dieta, de manera integral y simultánea, el consumo de alimentos ricos en hierro y otros fortificados dirigidos básicamente a las embarazadas. Además, se deben trazar estrategias de salud que permitan identificar determinantes sociales, como el nivel educativo, que inciden en la adherencia al tratamiento, con vista a disminuir su influencia(AU)

Introduction: Anemia during pregnancy is considered a public health problem. The strategy for its reduction includes iron supplementation. Objective: Analyze adherence to iron supplements in pregnant women treated in health facilities of the Peruvian Ministry of Health. Methods: A cross-sectional sentinel surveillance study of adherence to iron salts was conducted in 1038 pregnant women from Peru, who were treated in hospitals, health centers and health posts, and who received iron supplements. A structured interview was applied to measure the factors to adherence, and adherence was determined when supplement consumption was > 75percent. Descriptive statistics and logistic regression were applied. Results: 42.3percent of the pregnant women were adherents to the iron supplement. Adherence was associated with: having a university education (ORa 3.4; CI 95percent 1.5:7.7), consumption of foods rich in iron (ORa 1.6; 95percent CI 1.1:2.5), do not discontinue the treatment due to discomfort (ORa: 2.8 CI 95percent 1.7:4.6) and living at an altitude between 1001 m.a.s.l to 2000 m.a.s.l (ORa 4.0; CI 95percent 1.6:10.1). These factors explain between 12percent and 16percent of the adherence rates, and were predictive to identify adherence in pregnant women with an area under the curve of 70.4percent. Conclusions: Treatment with iron salts in pregnant women is insufficient, so the consumption of foods rich in iron and other fortified foods basically aimed at pregnant women should be included in their diet, in a comprehensive and simultaneous way. In addition, health strategies must be drawn up to identify social determinants, such as educational level, that affect adherence to treatment, with a view to reduce their influence(AU)

Oral Iron Supplementation in Pregnancy: Current Recommendations and Evidence-Based Medicine Suplementação oral de ferro na gravidez: recomendações atuais e medicina baseada na evidência

Abstract Objective To review the evidence about universal iron supplementation in pregnancy to prevent maternal anemia. Methods Bibliographic research of randomized and controlled clinical trials, meta-analyses, systematic reviews, and clinical guidelines, published between August 2009 and August 2019, using the MeSH terms: iron; therapeutic use; pregnancy; anemia, prevention and control. Results We included six clinical guidelines, three meta-analyses and one randomized controlled clinical trial. Discussion Most articles point to the improvement of hematological parameters and reduction of maternal anemia risk, with supplementary iron. However, they do not correlate this improvement in pregnant women without previous anemia with the eventual improvement of clinical parameters. Conclusion Universal iron supplementation in pregnancy is controversial, so we attribute a SORT C recommendation strength.

Resumo Objetivo Rever a evidência sobre a necessidade de suplementação universal de ferro na gravidez para prevenção de anemia materna. Métodos Pesquisa bibliográfica de ensaios clínicos aleatorizados e controlados, metanálises, revisões sistemáticas e normas de orientação clínica, publicados entre agosto de 2009 e agosto de 2019, utilizando os termos MeSH: iron, terapêuticas use; pregnancy; anemia, preventivos and control. Resultados Incluímos seis normas de orientação clínica, três metanálises e um ensaio clínico randomizado e controlado. Discussão A maioria dos artigos aponta para a melhoria dos parâmetros hematológicos e redução do risco de anemia materna por meio da suplementação com ferro. Conclusões A suplementação universal com ferro na gravidez é controversa, pelo que atribuímos uma força de recomendação SORT C.

Exploring the mechanism of Buxue Yimu Pill on hemorrhagic anemia through molecular docking, network pharmacology and experimental validation / 中国天然药物

Buxue Yimu Pill (BYP) is a classic gynecological medicine in China, which is composed of Angelica sinensis (Oliv.) Diels, Leonurus japonicus Houtt, Astragalus membranaceus (Fisch.) Bunge, Colla corii asini and Citrus reticulata Blanco. It has been widely used in clinical therapy with the function of enriching Blood, nourishing Qi, and removing blood stasis. The current study was designed to determine the bioactive molecules and therapeutic mechanism of BYP against hemorrhagic anemia. Herein, GC-MS and UPLC/Q-TOF-MS/MS were employed to identify the chemical compounds from BYP. The genecards database (https: //www.genecards.org/) was used to obtain the potential target proteins related to hemorrhagic anemia. Autodock/Vina was adopted to evaluate the binding ability of protein receptors and chemical ligands. Gene ontology and KEGG pathway enrichment analysis were conducted using the ClusterProfiler. As a result, a total of 62 candidate molecules were identified and 152 targets related to hemorrhagic anemia were obtained. Furthermore, 34 active molecules and 140 targets were obtained through the virtual screening experiment. The data of molecular-target (M-T), target-pathway (T-P), and molecular-target-pathway (M-T-P) network suggested that 32 active molecules enhanced hematopoiesis and activated the immune system by regulating 57 important targets. Pharmacological experiments showed that BYP significantly increased the counts of RBC, HGB, and HCT, and significantly down-regulated the expression of EPO, IL-6, CSF3, NOS2, VEGFA, PDGFRB, and TGFB1. The results also showed that leonurine, leonuriside B, leosibiricin, ononin, rutin, astragaloside I, riligustilide and levistolide A, were the active molecules closely related to enriching Blood. In conclusion, based on molecular docking, network pharmacology and validation experiment results, the enriching blood effect of BYP on hemorrhagic anemia may be associated with hematopoiesis, anti-inflammation, and immunity enhancement.

Anemia grave no puerpério / Severe anemia in the puerperium

A anemia no puerpério é bastante prevalente, estando principalmente relacionada à ocorrência de anemia não corrigida durante a gestação e às hemorragias agudas durante o parto. Essas situações aumentam significativamente a probabilidade de anemia grave no período pós-parto, gerando manifestações orgânicas e psicológicas que trazem prejuízo ao binômio materno-fetal. A forma grave da doença é caracterizada laboratorialmente por hemoglobina < 7 g/dL e suas manifestações clínicas variam na dependência de diversos fatores. O objetivo do tratamento é corrigir a hipóxia tecidual, revertendo as alterações adaptativas relacionadas à carência de oxigênio. Enquanto o tratamento agressivo de perdas volêmicas agudas diminui a morbimortalidade por esses eventos, políticas restritivas de transfusão sanguínea em pacientes hemodinamicamente estáveis mostram-se benéficas. Se não houver indicação de transfusão, a reposição de ferro atuará na correção das principais etiologias, pelas vias endovenosa ou oral, na dependência de disponibilidade, custo e tolerância individual aos medicamentos disponíveis.(AU)

Anemia is quite prevalent in puerperium; in this population, the disease is mainly related to the occurrence of uncorrected anemia during pregnancy and to acute bleeding during childbirth. These situations significantly increase the likelihood of severe anemia in the postpartum period, generating organic and psychological manifestations that cause damage to the maternal-fetal binomial. The severe form of anemia is characterized by hemoglobin < 7 g/dL and its clinical manifestations vary depending on several factors. The goal of treatment is to correct tissue hypoxia, reversing adaptive changes related to oxygen deficiency. While the aggressive treatment of acute blood losses decreases the morbidity and mortality of these events, restrictive blood transfusion policies in hemodynamically stable patients are beneficial. If there is no indication for transfusion, iron replacement will act to correct the main etiologies, through the intravenous or oral routes, depending on availability, cost and individual tolerance to the available drugs.(AU)

Aportes de la biotecnología al diagnóstico y tratamiento de la enfermedad renal crónica y comorbilidades frecuentes / Biotechnology contribution to the diagnosis and treatment of chronic kidney disease and frequent comorbidities

Este trabajo tiene como objetivo revisar las contribuciones de la biotecnología, en relación con el tratamiento, diagnóstico y la monitorización de la enfermedad renal crónica (ERC) y sus comorbilidades más frecuentes, especialmente la anemia. En relación con los tratamientos, enfocamos el desarrollo de productos biofarmacéuticos como los agentes estimulantes de la eritropoyesis (ESA), que fueron los primeros biofármacos utilizados para el tratamiento de la anemia asociada a la ERC; analizamos sus características y utilización actual después de varios años de experiencia clínica, así como también otras alternativas en desarrollo. Revisamos distintos tipos de bioterapias, la utilización de las células estromales mesenquimales de médula ósea (MSC) y tratamientos alternativos con modificaciones dietarias, que se basan en la asociación entre la microbiota intestinal de los pacientes renales crónicos y sus condiciones fisiopatológicas. Finalmente, en relación con el diagnóstico y monitorización, nos referimos al estudio y validación de biomarcadores diagnósticos, predictivos y terapéuticos que han permitido optimizar los resultados clínicos en este tipo de pacientes. (AU)

The aim of this work is to review the contributions of biotechnology, in relation to the treatment, diagnosis and monitoring of chronic kidney disease (CKD) and its most frequent comorbidities, especially anemia. Regarding the treatment, we focus on the development of biopharmaceutical products such as erythropoiesis stimulating agents (ESA), which were the first biopharmaceuticals used to treat anemia associated with chronic kidney disease (CKD). We analyzed their characteristics and their current use after several years of clinical experience, as well as other alternatives in development. We also review different types of biotherapies, the use of bone marrow mesenchymal stromal cells (MSC) and alternative treatments with dietary modifications, which are based on the association between the intestinal microbiota of chronic kidney patients and their pathophysiological conditions. Finally, in relation to diagnosis and monitoring, we refer to the study and validation of diagnostic, predictive and therapeutic biomarkers that have made clinical results possible to be optimized in this type of patient. (AU)

Utilidad de la eritropoyetina en el paciente quemado grave con anemia. Revisión del tema / Usefulness of erythropoietin in seriously burned patient with anemia. Topic review

RESUMEN Fundamento: La quemadura grave representa el tipo de agresión biológica más severo que puede sufrir el organismo y ponen en peligro la vida del paciente por el permanente riesgo de sepsis y falla multisistémica progresiva. La anemia incide en la morbilidad y mortalidad del quemado en estado grave; su tratamiento ha pasado por diversos momentos en la historia y su corrección depende de las transfusiones sanguíneas que aumentan el riesgo de complicaciones y reacciones adversas. Objetivo: Actualizar los conocimientos sobre la utilidad de la eritropoyetina en el tratamiento de la anemia en el quemado grave. Desarrollo: La gravedad de la quemadura está determinada por la intensidad de la temperatura y la duración de la exposición. La anemia es una de las complicaciones más frecuentes en los quemados graves y su tratamiento en ocasiones se limita al uso de transfusiones de sangre, sin embrago la eritropoyetina es una alternativa terapéutica; pertenece a la familia de las citoquinas, alcanza la médula ósea, donde estimula células progenitoras cuyo objetivo es lograr su transformación en eritrocitos. La administración de eritropoyetina humana recombinante en el paciente quemado grave con anemia se considera eficaz, ya que al estimular los mecanismos de la eritropoyesis, produce una elevación paulatina pero mantenida del hematocrito acompañándose de otros efectos beneficiosos. Conclusiones: La eritropoyetina humana por sus características farmacológicas, se muestra como una opción de tratamiento para el paciente quemado grave con anemia al permitir la recuperación de manera sostenida de los valores de hemoglobina con un mínimo de complicaciones, disminuye el uso de transfusiones de sangre que pueden aumentar la morbilidad de estos enfermos.

ABSTRACT Background: The serious burn represents the most severe type of biological aggression the body can suffer and endangers the patient's life due to the permanent risk of sepsis and progressive multisystem failure. Anemia affects the morbidity and mortality of seriously burned patient in serious condition; its treatment has gone through different moments in history and its correction depends on blood transfusions that increase the risk of complications and adverse reactions. Objective: To update knowledge about the usefulness of erythropoietin in the treatment of anemia in seriously burned patient. Development: The severity of the burn is determined by the intensity of the temperature and the duration of the exposure. Anemia is one of the most frequent complications in seriously burned patient and its treatment is sometimes limited to the use of blood transfusions. However, erythropoietin is a therapeutic alternative; it belongs to the family of cytokines, reaches the spinal cord, where it stimulates progenitor cells with the objective of achieving their transformation into erythrocytes. The administration of recombinant human erythropoietin in seriously burned patient with anemia is considered effective, since by stimulating the mechanisms of erythropoiesis, it produces a gradual but sustained elevation of the hematocrit accompanied by other beneficial effects. Conclusions: Human erythropoietin, due to its pharmacological characteristics, is shown as a treatment option for seriously burned patient with anemia by allowing the sustained recovery of hemoglobin values with a minimum of complications, reducing the use of blood transfusions that can increase the morbidity of these patients.

Epoetin alfa resistance in hemodialysis patients with chronic kidney disease: a longitudinal study

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.

Validade do autorrelato de anemia e do uso terapêutico de sais de ferro durante a gestação: coorte de nascimentos de 2015 de Pelotas, Rio Grande do Sul, Brasil / Validity of patient-reported anemia and therapeutic use of iron supplements during pregnancy: 2015 Pelotas (Brazil) birth cohort / Validez del autoinforme de anemia y uso terapéutico de sales de hierro durante la gestación: cohorte de nacimientos de 2015 en Pelotas, Río Grande do Sul, Brasil

O objetivo deste estudo é investigar a validade do autorrelato de anemia e de uso terapêutico de sais de ferro, frente à informação de hemoglobina da carteira da gestante. O estudo utiliza dados da coorte de nascimentos de 2015 de Pelotas, Rio Grande do Sul, Brasil. Para a validação do autorrelato de anemia, foram incluídas todas as mães que tinham registro de hemoglobina na carteira da gestante (N = 3.419), ao passo que, para a validação do autorrelato de uso terapêutico de sais de ferro, foram incluídas as que tinham registro de exames de hemoglobina na carteira da gestante e que relataram haver utilizado algum medicamento com sulfato ferroso em sua composição durante a gestação. Anemia foi definida como, pelo menos, um registro de hemoglobina ≤ 11g/dL na carteira da gestante (padrão-ouro). A prevalência de anemia conforme padrão-ouro foi 35,9% (34,3-37,5), ao passo que a de anemia autorrelatada foi 42,2% (40,8-43,7), e o autorrelato de uso terapêutico de sais de ferro, 43,2% (41,3-45,1). A sensibilidade do autorrelato de anemia foi 75,2% (72,8-77,6) e a especificidade, 75,1% (73,3-76,9). Para o autorrelato de uso terapêutico de sais de ferro, a sensibilidade foi 66,4% (63,5-69,2) e a especificidade, 71,9% (69,7-74,0). A especificidade do autorrelato de anemia e do autorrelato de uso terapêutico de sais de ferro entre mães com ≥ 12 anos de escolaridade foi 78,4% (75,4-81,4) e 79,5% (76,1-82,9). Na população estudada, com alta prevalência de anemia, de cada cinco puérperas que relataram anemia ou uso terapêutico de sais de ferro, três relatavam a verdade. A especificidade de ambos os autorrelatos foi mais elevada entre mães com ≥ 12 anos de escolaridade.

This study aimed to investigate the validity of patient-reported anemia and therapeutic use of iron supplements, compared to hemoglobin values recorded on the patient's prenatal card. The study used data from the 2015 Pelotas (Brazil) birth cohort. For validation of self-reported anemia, we included all mothers with hemoglobin values recorded on their prenatal card (N = 3,419), while validation of self-reported therapeutic use of iron supplements included those who had hemoglobin values recorded on their prenatal care and who reported having used medicines containing ferrous sulfate during pregnancy. Anemia was defined as at least one record of hemoglobin ≤ 11g/dL on the prenatal card (gold standard). Prevalence of anemia according to the gold standard was 35.9% (34.3-37.5), while patient-reported anemia was 42.2% (40.8-43.7), and patient-reported therapeutic use of iron supplements was 43.2% (41.3-45.1). Sensitivity of patient-reported anemia was 75.2% (72.8-77.6) and specificity was 75.1% (73.3-76.9). For patient-reported therapeutic use of iron supplements, sensitivity was 66.4% (63.5-69.2) and specificity was 71.9% (69.7-74.0). Specificity of patient-reported anemia and patient-reported therapeutic use of iron supplements in mothers with ≥ 12 years of schooling was 78.4% (75.4-81.4) and 79.5% (76.1-82.9), respectively. In the study population, for every five postpartum women that reported anemia or therapeutic use of iron supplements, three were telling the truth. The specificity of both self-reports was high in mothers with ≥ 12 years of schooling.

El objetivo de este estudio es investigar la validez del autoinforme de anemia y uso terapéutico de sales de hierro, respecto a la información sobre la hemoglobina, presente la cartilla de la embarazada. El estudio utiliza datos de la cohorte de nacimientos en Pelotas, Rio Grande ddo Sul, Brasil, 2015. Para la validación del autoinforme de anemia, se incluyeron a todas las madres que tenían un registro de hemoglobina en la cartilla de la embarazada (N = 3.419), al mismo tiempo que, para la validación del autoinforme del uso terapéutico de sales de hierro, se incluyeron a quienes tenían registro de exámenes de hemoglobina en la cartilla de la embarazada, y que informaron haber utilizado algún medicamento con sulfato ferroso en su composición durante la gestación. La anemia se definió como, por lo menos, un registro de hemoglobina ≤ 11g/dL en la cartilla de la embarazada (patrón ideal). La prevalencia de anemia, según el patrón ideal, fue de un 35,9% (34,3-37,5), mientras que la de la anemia autoinformada fue de un 42,2% (40,8-43,7), y el autoinforme de uso terapéutico de sales de hierro, 43,2% (41,3-45,1). La sensibilidad del autoinforme de anemia fue de un 75,2% (72,8-77,6) y la especificidad, 75,1% (73,3-76,9). Para el autoinforme de uso terapéutico de sales de hierro, la sensibilidad fue 66,4% (63,5-69,2) y la especificidad, 71,9% (69,7-74,0). La especificidad del autoinforme de anemia y del autoinforme de uso terapéutico de sales de hierro entre madres con ≥ 12 años de escolaridad fue 78,4% (75,4-81,4) y 79,5% (76,1-82,9). En la población estudiada, con una alta prevalencia de anemia, de cada cinco puérperas que informaron anemia o uso terapéutico de sales de hierro, tres relataban la verdad. La especificidad de ambos autoinformes fue más elevada entre madres con ≥ 12 años de escolaridad.

Laboratory evidence for the hematopoietic potential of Beta vulgaris leaf and stalk extract in a phenylhydrazine model of anemia

This study was designed to provide laboratory evidence supporting the hematopoietic effect of Beta vulgaris (beet) leaf aqueous extract in phenylhydrazine-induced anemia model in albino rats. Extraction of the leaves/stalks was done by maceration in 30% hydro-ethanol for 48 h. An intraperitoneal injection of 20 mg/kg phenylhydrazine was applied for two consecutive days to develop hemolytic anemia on the 4th day after the 1st injection in 24 of 30 male albino rats. The animals were divided into 5 groups and received the following treatments: standard (ferrous ascorbate + folic acid; 13.5 + 0.135 mg/kg), B. vulgaris extract (100 and 200 mg/kg), or left untreated (normal and diseased controls). Blood samples were taken at 0, 4, 8, and 12 days of the experiment for hematological and clinico-chemical analysis. Beet leaf extract significantly restored the levels of red blood cells, white blood cells, hemoglobin, and hematocrit in dose- and time-dependent manners. Blood indices have been significantly corrected. Erythropoietin level was maintained at higher levels. Erythrocytic membrane oxidation biomarker (malondialdehyde) level was significantly reduced compared to the anemic untreated group. The extract exhibited potent, concentration (4-512 μg/mL)-dependent antioxidant activity indicated by the 2,2-diphenyl-1-picryl-hydrazyl (DPPH) assay, with IC50 value of 37.91 μg/mL. Beet leaf extract resulted in detection of flavonoid and phenolic compounds that may underlie its hematinic properties. These findings may indicate B. vulgaris as a good natural source for pharmaceutical preparations with hematopoietic effects and treatment of anemia and/or associated conditions.

Fosfatasa alcalina ósea sérica elevada no mediada por metástasis en un paciente con cáncer renal / Elevated bone alkaline phosphatase not mediated by metastasis in a patient with renal cancer

Presentamos un paciente de 63 años con cáncer renal y aumento de fosfatasa alcalina sérica de tipo óseo de acuerdo con su reactividad con anticuerpos monoclonales específicos. Se descartaron las causas conocidas de aumento de la isoenzima, incluyendo metástasis óseas. Los niveles enzimáticos cayeron abruptamente con la remoción del tumor, por lo que consideramos a este último como su origen. Diversas isoenzimas de fosfatasa alcalina pueden ser producidas y secretadas por tumores como manifestación paraneoplásica. El conocimiento de esto puede, en ocasiones, orientarnos hacia la presencia de una neoplasia oculta. Además, los cambios en los niveles séricos de esas isoenzimas pueden ser indicadores de respuesta al tratamiento o de recidiva tumoral. (AU)

A 63-year old man was seen in the outpatient clinic because of renal cancer and elevation in bone alkaline phosphatase measured by monoclonal antibodies assay. Known causes of bone isoenzyme augmentation, including bone metastases, were ruled out. The tumoral origin of the isoenzyme was diagnosed because after removal of the tumor the enzymatic levels fell sharply. Several alkaline phosphatase isoenzymes can be produced and secreted by tumors as a paraneoplasic manifestation and their elevation could be a manifestation of an occult neoplasia. Furthermore the monitoring of their blood levels can be useful means of treatment response and a tool to monitoring recurrence if a sharp decrease after removal of the tumor is observed. (AU)

Inflamação e má resposta ao uso de eritropoetina na doença renal crônica / Inflammation and poor response to treatment with erythropoietin in chronic kidney disease

Resumo A prevalência da doença renal crônica (DRC) tem aumentado nos últimos anos e vários fatores estão associados à instalação e progressão da DRC, tais como obesidade, hipertensão arterial e diabetes mellitus. Uma das complicações da DRC é a anemia causada principalmente pela deficiência de ferro e de eritropoetina (EPO). Um dos tratamentos para este tipo de anemia é uso de eritropoetina exógena. O paciente com DRC submetido à diálise apresenta um estado inflamatório crônico, provocando uma situação de má resposta à ação medular da EPO, causando anemia, desnutrição, agravamento da aterosclerose e aumento da mortalidade. O objetivo deste artigo foi revisar as evidências científicas referentes à associação da má resposta clínica ao uso de EPO e a presença de inflamação na DRC.

Abstract The prevalence of kidney chronic disease (CKD) has increased in recent years and several risk factors have been associated with the onset and progression of CDK, such as obesity, hypertension and diabetes mellitus. In addition, anemia is one of the complications of CRD, mainly by iron and erythropoietin (EPO) deficiency and the management of this situation is with exogenous erythropoietin, but patients undergoing dialysis present chronic inflammatory process followed by EPO resistance and anemia, malnutrition, worse of atherosclerosis and increased mortality ratio. The aim of this study was to review the association of erythropoietin resistance and chronic inflammatory process in patients with chronic renal disease.

Erythropoietin resistance in end-stage renal disease patient with gastric antral vascular ectasia / Resistência à eritropoetina em paciente com IRC e ectasia vascular gástrica

Abstract We observed a case of recombinant human erythropoietin resistance caused by Gastric Antral Vascular Ectasia in a 40-year-old female with ESRD on hemodialysis. Some associated factors such as autoimmune disease, hemolysis, heart and liver disease were discarded on physical examination and complementary tests. The diagnosis is based on the clinical history and endoscopic appearance of watermelon stomach. The histologic findings are fibromuscular proliferation and capillary ectasia with microvascular thrombosis of the lamina propria. However, these histologic findings are not necessary to confirm the diagnosis. Gastric Antral Vascular Ectasia is a serious condition and should be considered in ESRD patients on hemodialysis with anemia and resistance to recombinant human erythropoietin because GAVE is potentially curable with specific endoscopic treatment method or through surgical procedure.

Resumo Observou-se um caso de resistência à eritropoetina recombinante humana causada por Ectasia Vascular Antral Gástrica em uma mulher de 40 anos de idade, com doença renal terminal em hemodiálise. Alguns fatores associados, tais como a doença autoimune, hemólise, doenças cardíacas e hepáticas foram descartados no exame físico e exames complementares. O diagnóstico é baseado na história clínica e aspecto endoscópico de estômago em melancia. Os achados histológicos são proliferação fibromuscular e ectasia capilar com trombose microvascular da lâmina própria. No entanto, esses achados histológicos não são necessários para confirmar o diagnóstico. Ectasia Vascular Antral Gástrica é uma condição séria e deve ser considerada em pacientes com insuficiência renal terminal em hemodiálise com anemia refratária e resistência à eritropoetina humana recombinante porque é potencialmente curável com o método de tratamento endoscópico específico ou através de procedimento cirúrgico.

Management of Anemia in Patients with Inflammatory Bowel Disease / 대한소화기학회지

Anemia is one of the commonest extraintestinal manifestations of inflammatory bowel disease (IBD). The pathogenesis of anemia in IBD is complex but iron deficiency combined with inflammation is the most common factor related to the development of anemia. However, other causes such as vitamin B12 and folate deficiency, hemolysis, myelosuppression and drug also should not be overlooked. In addition to ferritin, inflammatory markers and new biochemical parameters such as hepcidin and ferritin index are being tested as diagnostic a tool. First step for treatment is disease activity control and iron supplementation. Although oral iron is widely used, intravenous iron therapy should be considered in patients who are intolerant to oral iron therapy, have severe and refractory anemia or are in active disease state. Recently, new intravenous iron formulations have been introduced and due to their safety and easy usage, they have become the standard treatment modality for managing anemia in IBD. Erythropoietin and transfusion can be considered in specific situations. Vitamin B12 and folate supplementation is also important in patients who are deficient of these micronutrients. Since anemia in IBD patients could significantly influence the disease outcome, further studies and standard guideline for IBD are needed.

Overlooked Management and Risk Factors for Anemia in Patients with Intestinal Behcet's Disease in Actual Clinical Practice

BACKGROUND/AIMS: Anemia in patients with inflammatory bowel disease significantly affects the quality of life. The aim of this study was to investigate the frequency of and risk factors for anemia and to describe the management of anemia in patients with intestinal Behcet's disease (BD) in actual clinical practice. METHODS: We included 64 patients with intestinal BD who visited the outpatient clinic of a tertiary referral center in June 2011 and had available laboratory data for the subsequent 6 months. RESULTS: Anemia was detected in 26 patients (40.6%). After 6 months, anemia was still present in 14 of these patients (53.8%). The cause of anemia was investigated in eight patients (30.8%), and oral iron supplementation was prescribed to four patients (15.4%). Of these four patients, two (50%) recovered completely within 6 months. Anemia was associated with a high Disease Activity Index for Intestinal Behcet's Disease (DAIBD, p=0.024), erythrocyte sedimentation rate (p=0.003), and C-reactive protein (p=0.049) in univariate analysis. In multivariate analysis, the factor predictive for anemia in patients with intestinal BD was a higher DAIBD (> or =40; odds ratio, 4.08; 95% confidence interval, 1.21 to 13.71; p=0.023). CONCLUSIONS: Although anemia is common in intestinal BD patients, its clinical importance is overlooked in daily practice. Moderate to severe disease activity is predictive of anemia.

Randomized double-blind clinical trial of a new human epoetin versus a commercially available formula for anemia control in patients on hemodialysis

OBJECTIVES: Anemia is a common complication among chronic kidney disease patients on hemodialysis, occurring mostly due to erythropoietin deficiency. This randomized noninferiority trial sought to compare the efficacy and safety of a new epoetin formulation developed by Bio-Manguinhos, a biologics manufacturer affiliated with the Brazilian government, with those of a commercially available product currently used in Brazil (a biosimilar epoetin formulation). METHODS: The sample size needed to enable demonstration of noninferiority with a statistical power of 85% for a between-group difference in hemoglobin levels of no more than 1.5 g/dL was calculated. In total, 74 patients were randomly assigned to receive the epoetin formulation from Bio-Manguinhos (n = 36) or the biosimilar epoetin formulation (n = 38) in a double-blind fashion. The inclusion criteria were current epoetin therapy and stable hemoglobin levels for at least 3 months prior to the study. The primary and secondary outcomes were mean monthly hemoglobin levels and safety, respectively. The dose was calculated according to international criteria and adjusted monthly in both groups according to hemoglobin levels and at the assistant physicians' discretion. Iron storage was estimated at baseline and once monthly. Clinicaltrials.gov: NCT01184495. RESULTS: The study was conducted for 6 months after randomization. The mean baseline hemoglobin levels were 10.9±1.2 and 10.96±1.2 g/dL (p = 0.89) in the Bio-Manguinhos epoetin and biosimilar epoetin groups, respectively. During the study period, there was no significant change in hemoglobin levels in either group (p = 0.055, ANOVA). The epoetin from Bio-Manguinhos was slightly superior in the last 3 months of follow-up. The adverse event profiles of the two formulations were also similar. CONCLUSIONS: The epoetin formulations tested in this study are equivalent in efficacy ...

Efficacy of Ferric Carboxymaltose in Anaemia of Malignancy - A Pilot Study.

Anaemia is an important problem in malignancy. It may be due to chronic causes like malnutrition, marrow infiltration, associated renal or endocrine disorders and it may be complicated with blood loss. Measures like blood transfusion, erythropoietin injections often pose a logistical problem. Parenteral iron injections have proved to be useful in fighting anaemia in some chronic conditions e.g. patients on hemodialysis. Aims and Objectives: Primarily to see the observable change in hemoglobin (Hb) level with ferric carboxymaltose (FCM) in treating patients of malignancy on anti-cancer treatment. Materials and Methods: Twenty seven patients were enrolled for this study who were suffering from various malignancies. The baseline Hb level was estimated and FCM injection was administered as per the schedule of 500 mg intravenously (IV) weekly once. The overall results of increase in Hb level was noted during the middle of the treatment (chemotherapy or radiotherapy) and later 3-4 weeks after treatment completion. The results were analysed using SPSS and the mean values of initial Hb and after treatment were analysed. Level of significance (p value) was noted using t test. Results: In 27 patients the mean initial Hb level was 8.09 g/dl before treatment which increased to 10.28 g/dl after FCM treatment (p <0.0001). Conclusion: Treatment with FCM definitely led to a significant increase in Hb level in patients of malignancy undergoing treatment. However, further detailed study is needed to establish its definite role in improving the body iron parameters.