ABSTRACT
OBJECTIVE: The aim of this study was to assess the efficacy and safety of intravenous ferric carboxymaltose (FCM) following hospitalization for acute gastrointestinal bleeding (AGIB) in the context of a restrictive transfusion strategy. PATIENTS AND METHODS: A retrospective single-center study analyzed patients with AGIB (excluding AGIB secondary to portal hypertension) administered a single FCM dose with or without blood transfusion. RESULTS: Eighty-six episodes in 84 patients were analyzed. Seventy-nine patients had upper AGIB. Nineteen episodes were associated with hemodynamic instability. FCM was administered during hospitalization as a single dose of 1000 mg iron in 84/86 episodes and as a single dose of 500 mg iron in two episodes, with blood transfusion in 60/86 (69.8%) episodes. The mean hemoglobin (Hb) was 9.0 g/dl at admission, 7.6 g/dl at the lowest in-hospital value, 9.4 g/dl at discharge, and 12.7 g/dl at follow-up (mean: 55 days postdischarge) (P<0.001 for follow-up vs. all other timepoints). The lowest mean in-hospital Hb value was 7.2 and 8.8 g/dl, respectively, in patients with transfusion+FCM versus FCM alone; the mean Hb was 12.4 versus 13.7 g/dl at follow-up. In patients administered FCM alone, the mean Hb at follow-up in the subpopulations aged older than or equal to 75 years (n=33), Charlson comorbidity index of at least 3 (n=48), and Hb of up to 10 g/dl at admission (n=47) were 12.6, 13.1, and 13.3 g/dl, respectively. No adverse effects were detected. CONCLUSION: Treatment with FCM for AGIB is associated with a good erythropoietic response and anemia correction after hospitalization, even in severe episodes or when transfusion is needed. FCM is safe and well tolerated, and may support a restrictive transfusion policy.
Subject(s)
Anemia/drug therapy , Ferric Compounds/administration & dosage , Gastrointestinal Hemorrhage/complications , Hematinics/administration & dosage , Maltose/analogs & derivatives , Aged , Aged, 80 and over , Anemia/blood , Anemia/diagnosis , Anemia/etiology , Biomarkers/blood , Blood Transfusion , Erythropoiesis/drug effects , Female , Ferric Compounds/adverse effects , Gastrointestinal Hemorrhage/diagnosis , Hematinics/adverse effects , Hemoglobins/metabolism , Humans , Infusions, Intravenous , Length of Stay , Male , Maltose/administration & dosage , Maltose/adverse effects , Middle Aged , Patient Admission , Retrospective Studies , Spain , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Telomere length (TL) shortened occurs in colorectal carcinogenetic process. Our objective is to determine if it is only a local fact or there are alterations in normal colon cells and in other body cells. METHODS: TL of tumoral and normal mucosa and leukocytes of 40 patients operated of colorectal cancer (CRC) and 40 control patients with normal colonoscopy were measured by Southern-blot. Groups were matched by the same localization as tumors, sex, and age. RESULTS: In CRC patients, TRFL (Telomere Repeat Factor Length) leukocytes mean was 8.84 kpb, normal colonic mucosa 7.97 kpb, and tumoral mucosa 7.33 kpb (P < 0.001). In the 40 normal control patients, mean TRFL of colonic mucosa was 7.76 kpb, while in blood cells was 7.01 kpb (P < 0.001). We observed an inverse correlation between leukocytes TRFL and age (r(2) = 0.17, P = 0.008). Mucosa TRFL correlates significantly with patient's age (r(2) = 0.138, P = 0.018). TRFL of controls colonic mucosa correlates with TRFL of their blood cells (r(2) = 0.354, P < 0.001). CONCLUSIONS: Normal colonic mucosa and leukocytes in CCR patients presents telomere altered in respect to normal patients. Telomere length in normal leukocytes could be an initial marker for colorectal cancer.
Subject(s)
Biomarkers, Tumor/genetics , Blood Cells/pathology , Colon/metabolism , Colorectal Neoplasms/pathology , Telomere Homeostasis/genetics , Aged , Aged, 80 and over , Blood Cells/metabolism , Case-Control Studies , Colorectal Neoplasms/blood , Colorectal Neoplasms/genetics , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Staging , PrognosisABSTRACT
Background: colorectal cancer is the third cancer cause of death in Spain. It is important to investigate new tumoral markers for early diagnosis, disease monitoring and prevention strategies. Telomeres protect the chromosome from degradation by nucleases and endto- end fusion. The progressive loss of the telomeric ends of chromosomes is an important mechanism in the timing of human cellular aging. Telomeric Repeat Factor 1 (TRF1) is a protein that binds at telomere ends. Purpose: to measure the concentrations of TRF1 and the relationships among telomere length, telomerase activity, and TRF1 levels in tumor and normal colorectal mucosa. Method: from normal and tumoral samples of 83 patients who underwent surgery for colorectal cancer we analyzed TRF1 protein concentration by Western Blot, telomerase activity, by the fluorescent- telomeric repeat amplification protocol assay and telomere length by Southern Blot. Results: high levels of TRF1 were observed in 68.7% of tumor samples, while the majority of normal samples (59%) showed negative or weak TRF1 concentrations. Among the tumor samples, telomere length was significantly associated with TRF1 protein levels (p = 0.023). Conclusions: a relationship was found between telomere length and TRF1 abundance protein in tumor samples, which means that TRF1 is an important factor in the tumor progression and maybe a diagnostic factor(AU)
