Intravenous iron therapy for severe pregnancy anemia with high erythropoietin levels.

BACKGROUND: To demonstrate that intravenous (IV) iron therapy rapidly can secure the physiologic correction of severe nonhemorrhagic anemia more safely than blood component therapy and recombinant erythropoietin treatment. CASE: An 18-year-old woman with beta-thalassemia in her 33rd week of gestation had a hemoglobin level of 4.8 g/dL and an erythropoietin value of 191 mU/mL. After IV iron administration, erythropoietin rapidly decreased and hemoglobin increased to 8.1 g/dL in correlation with estriol elevation. A healthy infant with normal hemoglobin and ferritin levels was delivered at 42 weeks by cesarean. CONCLUSION: Intravenous iron administration rapidly corrected severe nonhemorrhagic anemia in a pregnant patient and may produce an improvement in fetal indices. High erythropoietin levels predict a good response to iron and may obviate the need for blood transfusions and recombinant erythropoietin administration, at least until this therapy is tried.

[Combination of beta-interferon and laser-CO2 therapy in female HPV genitalis]. / Associazione del beta-interferone alla terapia con laser-CO2 nell'HPV genitalis femminile.

230 women affected by HPV genital infection diagnosed by macroscopic examination, colposcopy and Pap test, were divided into two groups, of 95 and 135 people respectively, homogeneous for lesion localization and extension. The first group was treated with laser CO2 and the second group was treated with laser CO2 and intramuscular beta-interferon. We evaluated the side effects, the clinical results and the incidence of recurrences after 1, 6 and 12 months after the complete destruction of the lesions. At the first control, in both groups, we found no persistence of the lesions. At the second control after 6 months recurrences were present in 19 patients of the first group and in 7 patients of the second group. 51 recurrences were present after 12 months in the first group and 14 in the second group. The difference, evaluated with the chi 2 test, was found to be statistically significant (p < 0.01 after 6 months and p < 0.001 after 12 months).

Relation between erythropoietin and vitamin B12 in normal and anemic pregnant women.

In this cross-sectional study of 178 pregnant women between the 7th and 42nd week of pregnancy, we analyzed correlations between erythropoietin (EPO) and vitamin B12 (B12) in different stages of pregnancy and in relation to hemoglobin (Hb) levels. Patients with hypertension, fetal growth retardation and severe systemic diseases were excluded. EPO (by ELISA), B12 (by RIA) and Hb were assayed in the same blood sample taken on admission. On the basis of weeks of pregnancy, EPO levels and B12 levels, the 178 subjects were found to fall into two clusters, before and after the 27th week of gestation. The correlation coefficient between EPO and B12 was highly significant in the first group but not in the second (R = -0.33; p < 0.01). When the patients were divided on the basis of Hb levels (< or = or > 11 g/dl), a significant correlation was found only in the 88 patients with Hb > 11 g/dl (R = -0.44; p < 0.001) and not in the 72 anemic subjects. Moreover, in the former group the correlation between EPO and B12 was high before and after the 27th week, unlike in the latter group for which no significant correlation was found. These results suggest that EPO and B12 act together to establish normal erythropoiesis in pregnancy.

Pattern of vitamin B12 and folic acid during pregnancy.

The aim of this study was to evaluate folate and vitamin B12 serum concentrations and their reciprocal relationships during pregnancy in relation to gestational age and levels of hemoglobin. Serum levels of vitamin B12 (B12) and folic acid (FA) were assessed by RIA in 213 women between the 6th and 43rd week of pregnancy. For 195 of these subjects, hemoglobin and hematocrit values were available. The logarithm (log) of B12 levels was found to be inversely correlated with weeks of pregnancy (R = -0.261; p < 0.001). A decrease in B12 levels occurred before the 27th week and was significant only in the subgroup of patients having hemoglobin levels above 11 g/dl. The log FA concentrations did not show any significant correlation with weeks of pregnancy irrespective of Hb levels. There was also a highly significant correlation between log B12 and log FA after 27 weeks and in the subgroups divided according to Hb levels (< or = and > 11 g/dl). It is therefore concluded that: (1) the demand for vitamin B12 is high in the first 27 weeks of pregnancy due to increasing maternal and embryo-fetal erythropoiesis and in order to sustain normal maternal Hb levels in the last weeks of pregnancy; (2) vitamin B12 might favor the absorption and utilization of FA after 27 weeks of pregnancy.

Erythropoietin and transferrin concentrations during pregnancy in relation to hemoglobin levels.

Serum levels of erythropoietin (EPO) were assayed by ELISA at the same time as red blood cells (RBC), hemoglobin (Hb), hematocrit (Hct), serum iron and transferrin in 136 pregnant women, divided on the basis of hemoglobin values (> or < or = 10.5 g/dl) and weeks of pregnancy (< or > or = 27th week). In the overall population, a parallel increase with weeks of pregnancy was shown by serum concentrations of EPO expressed as a logarithm (multiple R = 0.367, P < 0.0001), and transferrin levels (multiple R = 0.529, P < 0.0001). It was found that EPO levels did not differ significantly between anemic and non-anemic patients before the 27th week, but the difference became highly significant (P < 0.01) after the 27th week in favour of anemic patients. Before the 27th week, the correlations between log EPO and RBC, Hct, Hb and iron were not significant, whereas the correlation between log EPO and transferrin was significant (P < 0.01); after the 27th week, the correlations and significance of the regression found were: log EPO vs Hb (Pearson coefficient = -0.384; P < 0.001), vs Hct (Pearson coefficient = -0.370; P < 0.01), vs transferrin (Pearson coefficient = 0.392; P < 0.0001), vs iron (Pearson coefficient = -0.274, P < 0.05). In the population divided according to Hb levels, the correlation was positive and significant in both groups between log EPO and transferrin (Hb > 10.5 g/dl: Pearson coefficient = 0.524, P < 0.0001; Hb < or = 10.5: Pearson coefficient = 0.614, P < 0.0001), but was inverse and significant only in the group with Hb < or = 10.5 g/dl between log EPO and serum iron (Pearson coefficient = -0.481, P < 0.01). The variations in EPO were related to Hb levels after the 27th week of pregnancy and were closely correlated with transferrin over the whole period. The physiological mechanism of these changes is discussed.