Current concepts in postpartum anemia management.

PURPOSE OF REVIEW: Postpartum anemia (PPA) is common in women after childbirth and affects about 50-80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment. RECENT FINDINGS: Iron deficiency as well as iron deficiency anemia (IDA) are common in the postpartum period and represent significant health problems in women of reproductive age. SUMMARY: Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.

Criteria for Iron Deficiency in Patients With Heart Failure.

BACKGROUND: Guidelines on heart failure (HF) define iron deficiency (ID) as a serum ferritin <100 ng/mL or, when 100-299 ng/mL, a transferrin saturation (TSAT) <20%. Inflammation (common in HF) may hinder interpretation of serum ferritin. OBJECTIVES: This study sought to investigate how different definitions of ID affect its prevalence and relationship to prognosis in ambulatory patients with chronic HF. METHODS: Prevalence, relationship with patients' characteristics, and outcomes of various ID definitions were evaluated among patients with HF referred to a regional clinic (Hull LifeLab) from 2001 to 2019. RESULTS: Of 4,422 patients with HF (median age 75 years [range: 68-82 years], 60% men, 32% with reduced left ventricular ejection fraction), 46% had TSAT <20%, 48% had serum iron ≤13 µmol/L, 57% had serum ferritin <100 ng/mL, and 68% fulfilled current guideline criteria for ID, of whom 35% had a TSAT >20%. Irrespective of definition, ID was more common in women and those with more severe symptoms, anemia, or preserved ejection fraction. TSAT <20% and serum iron ≤13 µmol/L, but not guideline criteria, were associated with higher 5-year mortality (HR: 1.27; 95% CI: 1.14-1.43; P < 0.001; and HR: 1.37; 95% CI: 1.22-1.54; P < 0.001, respectively). Serum ferritin <100 ng/mL tended to be associated with lower mortality (HR: 0.91; 95% CI: 0.81-1.01; P = 0.09). CONCLUSIONS: Different definitions of ID provide discordant results for prevalence and prognosis. Definitions lacking specificity may attenuate the benefits of intravenous iron observed in trials while definitions lacking sensitivity may exclude patients who should receive intravenous iron. Prespecified subgroup analyses of ongoing randomized trials should address this issue.

Evaluation of Hemoglobin Cutoff Levels to Define Anemia Among Healthy Individuals.

Importance: Anemia, defined as low hemoglobin (Hb) concentration insufficient to meet an individual's physiological needs, is the most common blood condition worldwide. Objective: To evaluate the current World Health Organization (WHO) Hb cutoffs for defining anemia among persons who are apparently healthy and to assess threshold validity with a biomarker of tissue iron deficiency and physiological indicator of erythropoiesis (soluble transferrin receptor [sTfR]) using multinational data. Design, Setting, and Participants: In this cross-sectional study, data were collected and evaluated from 30 household, population-based nutrition surveys of preschool children aged 6 to 59 months and nonpregnant women aged 15 to 49 years during 2005 to 2016 across 25 countries. Data analysis was performed from March 2020 to April 2021. Exposure: Anemia defined according to WHO Hb cutoffs. Main Outcomes and Measures: To define the healthy population, persons with iron deficiency (ferritin <12 ng/mL for children or <15 ng/mL for women), vitamin A deficiency (retinol-binding protein or retinol <20.1 µg/dL), inflammation (C-reactive protein >0.5 mg/dL or α-1-acid glycoprotein >1 g/L), or known malaria were excluded. Survey-specific, pooled Hb fifth percentile cutoffs were estimated. Among individuals with Hb and sTfR data, Hb-for-sTfR curve analysis was conducted to identify Hb inflection points that reflect tissue iron deficiency and increased erythropoiesis induced by anemia. Results: A total of 79 950 individuals were included in the original surveys. The final healthy sample was 13 445 children (39.9% of the original sample of 33 699 children; 6750 boys [50.2%]; mean [SD] age 32.9 [16.0] months) and 25 880 women (56.0% of the original sample of 46 251 women; mean [SD] age, 31.0 [9.5] years). Survey-specific Hb fifth percentile among children ranged from 7.90 g/dL (95% CI, 7.54-8.26 g/dL in Pakistan) to 11.23 g/dL (95% CI, 11.14-11.33 g/dL in the US), and among women from 8.83 g/dL (95% CI, 7.77-9.88 g/dL in Gujarat, India) to 12.09 g/dL (95% CI, 12.00-12.17 g/dL in the US). Intersurvey variance around the Hb fifth percentile was low (3.5% for women and 3.6% for children). Pooled fifth percentile estimates were 9.65 g/dL (95% CI, 9.26-10.04 g/dL) for children and 10.81 g/dL (95% CI, 10.35-11.27 g/dL) for women. The Hb-for-sTfR curve demonstrated curvilinear associations with sTfR inflection points occurring at Hb of 9.61 g/dL (95% CI, 9.55-9.67 g/dL) among children and 11.01 g/dL (95% CI, 10.95-11.09 g/dL) among women. Conclusions and Relevance: Current WHO cutoffs to define anemia are higher than the pooled fifth percentile of Hb among persons who are outwardly healthy and from nearly all survey-specific estimates. The lower proposed Hb cutoffs are statistically significant but also reflect compensatory increased erythropoiesis. More studies based on clinical outcomes could further confirm the validity of these Hb cutoffs for anemia.

Could ferritin, vitamin B12, and vitamin D play a role in the etiopathogenesis of fibromyalgia syndrome?

Introduction. Fibromyalgia syndrome (FS) comprises general body pain, sleep disturbances, and fatigue. Vitamin B12 (VB), vitamin D (VD), and iron deficiencies lead to similar complaints. First, this study aimed to evaluate the VB, VD, and ferritin levels of patients with FS. Second, it aimed to investigate whether there was a relationship between these parameters and FS severity. Material and methods. The study included 58 female patients with FS and 58 healthy females as a control group. The patients completed the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), fatigue questionnaire, Pittsburgh sleep quality scale, and the Short Form-36 (SF-36). This study examined the VD, VB, and ferritin levels of the patient and control groups. Results. The VB (240.0 [110.0-394.0] vs 291.0 [210.0-609.0] pg/ml, p<0.001), VD (12.5 [3.0-45.0] vs 20.0 [5.0-54.0] ng/ml, p=0.013), and ferritin levels (21.2 [4.0-86.0] vs 32.0 [7.1-120.0], ng/ml, p=0.009) of the FS patients were determined to be significantly lower than those of the control group. A negative correlation was determined between the number of tender points and VB, VD, and ferritin levels. In the regression analysis, we found low ferritin levels (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.015-1.058, p<0.001) and VB (OR 1.010, CI 1.002-1.018, p=0.010) to be an independent risk factor for FS. Conclusions. There may be a relationship between VB, VD, and ferritin levels and the number of tender points in patients with FS. Levels of iron and VB may play a vital role in FS etiopathogenesis. However, VD levels may not be a risk factor for FS etiopathogenesis.

Associations of maternal characteristics and dietary factors with anemia and iron-deficiency in pregnancy.

OBJECTIVE: Anemia and iron deficiency during pregnancy influence maternal and fetal health, birth outcomes, and the risk of chronic disease in offspring. This study aimed to examine the association with sociodemographic, maternal factors, supplement use and dietary intakes, and anemia and iron deficiency in pregnancy. METHODS: A cross-sectional study was conducted on 165 pregnant women aged between 19 and 45 years who were interviewed, and dietary intake was assessed by 24-hours dietary recall, supplement records and food frequency questionnaire. Learning Vector Quantization feature selection method which is one of the machine learning techniques was used to extract important variables from sociodemographic, maternal, and dietary factors. RESULTS: The prevalence of anemia was 15.2% and prevalence of iron deficiency was 65.5%. Total intake of iron, phosphorus, vitamin B1 and B2 were importance factors for iron deficiency while age, number of births, use of folic acid supplement, dietary folate equivalent and total iron intake were importance factors for anemia. CONCLUSIONS: Maternal and dietary characteristics were the most crucial risk factors for anemia while dietary factors were the most important risk factor for iron deficiency in pregnancy. The development of anemia and iron deficiency is associated with the coexistence of many nutrient deficiencies.

Hepcidin as a diagnostic marker of iron deficiency in blood donors.

BACKGROUND: Blood donors are prone to have iron deficiency. The aim of this study was to determine utility of serum hepcidin as an indicator of iron deficiency in blood donors. METHODS: A total of 200 voluntary, healthy blood donors were included in the study. Donors were categorized into four groups according to the donation frequency. Group I: (n = 50) who donated for the first time, or those who have not donated in the past 2 years (reactivated donors). Group II: (n = 50), who donated blood for the second time and had donated once in the previous 12 months. Group III: (n = 50), who donated blood for third time and had donated twice in the previous 12 months. Group IV: (n = 50) who donated blood for the fourth time and had donated thrice in the previous 12 months. Sera of study participants were evaluated for serum ferritin and serum hepcidin levels based on enzyme linked immunosorbent assay. RESULTS: Serum hepcidin concentration ranged 2.36-15734 pg/mL. Serum hepcidin and serum ferritin were found to be lowest in group IV donors. When serum ferritin concentration of less than 15 ng/mL was considered as gold standard for diagnosing iron deficiency, AUCROC for serum hepcidin as a diagnostic test of iron deficiency was found to be 0.715. Serum hepcidin showed statistical significant correlation with donation frequency(p = 0 .005) and serum ferritin (p = 0.01). Sensitivity and specificity of serum hepcidin was found to be 77.8 %, 79.6 % respectively. CONCLUSION: Effectiveness of Serum hepcidin as a diagnostic marker of iron deficiency still needs to be determined.

Serum hepcidin response as a marker of iron deficiency during second trimester of pregnancy: A multicenter cohort study in Lahore.

Iron deficiency diagnosis is a key health priority during pregnancy. The precise determination of indicators is needed for the evaluation of iron deficiency. In the present study, we investigated the diagnostic features of hepcidin concentration as an iron deficiency assay during the second trimester of pregnancy. We collected 401 venous blood samples of pregnant females from 4 separate birthing hospitals. All the females were within 13-26 weeks of their pregnancy and without any comorbid conditions. The complete blood count, total iron binding capacity, ferritin, serum iron and serum hepcidin were determined. The women were categorized as being non-iron deficient (N-ID), iron deficient (ID), or with iron deficiency anemia (IDA). The mean hepcidin values for examined groups were, i.e., non-iron deficiency was 31.45±4.70 (µg/L), iron deficiency 20.47±2.48 (µg/L) and iron deficiency anemia was 17.33±1.90 (µg/L). The N-ID's hemoglobin mean levels were 13.05±0.10g/dL, ID 12.66±0.05g/dL and the IDA 8.11±00.12g/dL. In this article variations in hepcidin levels between N-ID, ID and IDA women are uncovered and it is reported that the lower hepcidin levels diagnosed in IDA are closely linked to hemoglobin in Pakistani women. Hence it is concluded that hepcidin can be a valuable marker in identifying iron deficiency and iron deficiency anemia during the second trimester of pregnancy, according to the Pearson's correlation data.

Evaluation of Serum Ferritin and Anti-Thyroid Peroxidase Antibody Status in Newly Diagnosed Subclinical Cases of Hypothyroidism.

BACKGROUND: Serum ferritin concentrations are altered in hypothyroidism, but there is no available literature regarding the status of serum ferritin in anti-thyroid peroxidase (anti-TPO) positive hypothyroidism. The objectives of our study were to evaluate the titer of anti-TPO and serum ferritin in newly diagnosed hypothyroid patients and to find out any difference in serum ferritin concentration between antibody-positive and antibody-negative patients. METHODS: A total of 143 subjects above the age of 18 years were recruited, and serum Thyroid Stimulating Hormone (TSH), free T3, free T4, anti-TPO, and ferritin were assayed by chemiluminescence method. According to their serum analysis findings, three groups were made as Group 1 of 49 subjects with hypothyroidism and anti-TPO positive, Group 2 of 47 subjects with hypothyroidism and anti-TPO negative, and Group 3 of 47 euthyroid and anti-TPO negative controls. RESULTS: Kruskal Wallis H test was applied, and the difference in concentration of TSH, FT3, FT4, Ferritin, anti-TPO amongst the three groups was found to be significant. The relationship between anti-TPO levels and serum ferritin concentration was further studied by multinomial logistic regression. We have found that there is a significant difference between the concentrations of ferritin; hence, it is highly likely that those with a high level of anti-TPO antibody shall have a higher concentration of serum ferritin. CONCLUSION: Ferritin concentrations were decreased in anti-TPO negative hypothyroidism, but in the case of anti-TPO positive hypothyroidism the ferritin concentrations are raised. Hence, hypothyroidism should not always be considered as an iron deficiency state.

Determinação de cobre e outros minerais em caprinos e ovinos criados no sertão do vale do rio São Francisco, Pernambuco / Determination of copper and other minerals in goats and sheep of the San Francisco river valley in Pernambuco, Brazil

Para a determinação dos teores de cobre e de seus antagonistas, foram utilizadas 160 amostras de soro e de fígados, de caprinos e ovinos enviados ao matadouro municipal de Petrolina. As amostras de fígado e soro foram correlacionadas para o mesmo animal, a fim de evitar erros na obtenção dos dados. No soro a atividade da ceruloplasmina foi determinada por método colorimétrico. Para a determinação dos minerais, as amostras foram diluídas de seis a vinte vezes com água Milli-Q. Para determinação das concentrações dos elementos minerais no fígado, as amostras foram digeridas até que se obtivesse uma solução que mantivesse os minerais da amostra inicial e que fosse totalmente liquida, sem a presença de partículas sólidas que pudessem obstruir os capilares de sucção do espectrômetro e assim impedir as leituras das amostras. As concentrações de cobre, molibdênio, ferro e zinco foram determinadas através de espectrometria óptica por emissão de plasma (ICP). Desta forma, foi conduzido o experimento objetivando determinar a ocorrência e distribuição da carência de cobre no território do sertão do vale do rio São Francisco em Pernambuco. Foi observado que não houve carência de cobre nesta região do estado de Pernambuco, quando se avaliou os níveis médios de cobre hepático,. Os níveis de zinco estavam dentro de um padrão de normalidade, enquanto que os níveis de ferro foram mais elevados em ovinos, e os níveis de molibdênio mais reduzidos em caprinos. Verificou-se também que a atividade de ceruloplasmina foi um indicador dos níveis séricos de cobre...

For the determination of copper concentration and its antagonists, 160 serum and liver samples were used, from goat and sheep sent to the municipal slaughterhouse of Petrolina. The samples were correlated with the same animal, in order to prevent errors in data collection. Serum ceruloplasmin activity was determined by colorimetric method. For determination of minerals, the samples were diluted six to twenty times with Milli-Q water. For determining concentrations of mineral elements in the liver, the samples were digested until achieving a solution that maintained the initial sample and minerals totally liquid, without the presence of solid particles which could clog the capillary suction of the spectrometer and prevent reading of samples. The concentrations of copper, molybdenum, iron and zinc were determined by optical emission spectrometry (ICP). Thus, the experiment was conducted to determine the occurrence and distribution of copper deficiency in the San Francisco valley of Pernambuco. No copper deficiency was revealed in this region of the state of Pernambuco, when the mean levels of hepatic copper were evaluated. Zinc levels were within a normal range, whereas iron levels were higher in sheep, and lower levels of molybdenum in goats. It was also found that the activity of ceruloplasmin was an indicator of serum copper...

Anemia y deficiencia de hierro en mujeres en edad reproductiva usuarias del Hospital Regional de Villa Hayes, Paraguay / Anemia and iron deficiency in reproductive age womenattending the Regional Hospital of Villa Hayes, Paraguay

La anemia es un problema de salud pública a nivel mundial. En Paraguay, existen datos limitados sobre la frecuencia de anemia en mujeres en edad reproductiva no gestantes. Este estudio piloto descriptivo de corte transverso tuvo como objetivo determinar la frecuencia de anemia y deficiencia de hierro, el estado nutricional, hábitos alimentarios y tóxicos en 99 mujeres no gestantes en edad reproductiva de 18 a 48 años que acudieron al Hospital Regional de Villa Hayes en Octubre del 2.014. La anemia se determinó tomando como punto de corte una concentración de hemoglobina <12 g/dL. La deficiencia de hierro se evaluó según la saturación de la transferrina. Además, se evaluó el índice de masa corporal (IMC) y los hábitos nutricionales a través de una encuesta. La frecuencia de anemia fue de 15,1% (IC95% 8,7-23,8%), de éste el 33,3% (IC95% 12,8-61,6%) correspondió a anemia ferropénica. Se observó asociación entre la presencia de anemia y los niveles disminuidos tanto del hematocrito (<38%) como del número de glóbulos rojos (<4,2x 106/uL). Todas las mujeres con anemia ferropénica tenían peso <64 kg e IMC <24,5 kg/m2. Además, se detectó una alta frecuencia de sobrepeso y obesidad (45,4%), alto consumo de grasas, y bajo consumo de legumbres, frutas y verduras. A partir de estos resultados, se sugiere mantener la vigilancia e implementar programas que incluyan a estas mujeres, tanto para evitar deficiencias nutricionales como excesos.

Anemia is a public health problem all around the world. In Paraguay, there are limiteddata on the prevalence of anemia in non-pregnant women of reproductive age. This pilotdescriptive cross-sectional study had as objective to determine the frequency of anemiaand iron deficiency, nutritional status, dietary and toxic habits in 99 non-pregnant womenof reproductive age of 18-48 years attending the Regional Hospital of Villa Hayes inOctober 2014. The anemia was established on the cutoff hemoglobin concentration of<12 g/dL. Iron deficiency was evaluated according to the transferrin saturation. Besides,the body mass index (BMI) and dietary habits were evaluated using a survey. The frequencyof anemia was 15.1% (CI95% 8.7-23.8%), of this 33.3% (CI95% 12.8-61.6%) wasiron-deficiency anemia. There was association between the cases of anemia and the decreasedlevels of hematocrit (<38%) and red blood cell count (<4.2 106 / uL). All womenwith iron deficiency anemia had a weight <64 kg and a BMI <24.5 kg /m2. In addition, a high frequency of overweight and obesity (45.4%), high consumption of fat, andlow consumption legumbres, fruits and vegetables were detected. From these results, itis suggested that it is important to maintain surveillance and implement programs includingthese women, both to avoid nutritional deficiencies and excesses.

NutriSUS: estratégia de fortificação da alimentação infantil com micronutrientes (vitaminas e minerais) em pó: guia de evidências / NutriSUS: strategy for infant feeding fortification with multiple micronutrients powders (vitamins and minerals): evidence guide

O Guia de evidências se propõe a apresentar uma série de evidências sobre o efeito e/ou impacto da fortificação com micronutrientes na saúde e na nutrição de crianças e espera-se, com este instrumento, apoiar estados e municípios na implantação da estratégia de fortificação da alimentação infantil com micronutrientes em pó – NutriSUS.

NutriSUS: estratégia de fortificação da alimentação infantil com micronutrientes (vitaminas e minerais) em pó: caderno de orientações / NutriSUS: strategy for infant feeding fortification with multiple micronutrients powders (vitamins and minerals): notebook guidelines

Considerando a prioridade de cuidado integral de crianças de 0 a 6 anos, o Ministério da Saúde lançou a Estratégia de Fortificação da Alimentação Infantil com Micronutrientes (vitaminas e minerais) em Pó – NutriSUS, que consiste na adição direta de nutrientes em pó aos alimentos. Essa estratégia visa potencializar o pleno desenvolvimento infantil, a prevenção e o controle das deficiências de vitaminas e minerais na infância. Assim, este Caderno de orientações tem como objetivo orientar e apoiar os profissionais da educação na operacionalização dessa estratégia.

Inflamação induzida por Adjuvante de Freund: achados clínicos e efeitos sobre a expressão do RNAm da hepcidina em equinos / Freund's adjuvant-induced inflammation: clinical findings and its effect on hepcidin mRNA expression in horses

Hypoferremia observed during systemic inflammatory disorders is regulated by hepcidin. Hepcidin up-regulation is particularly important during acute inflammation, as it restricts the availability of iron, which is necessary for pathogenic microorganism growth before adaptive immunity occurs. The aim of this study was to evaluate the clinical findings and hepatic hepcidin mRNA expression in horses using a Freund's complete adjuvant (FCA) model of inflammation. The expression of hepcidin mRNA in the liver was determined in healthy horses following two intramuscular injections of FCA at 0 h and 12 h. Plasma iron and fibrinogen concentrations were measured at multiple time points between 0 h and 240 h post-FCA injection (PI). Hepcidin mRNA expression was determined by RT-qPCR using liver biopsy samples performed at 0 h (control), 6 h and 18 h PI. The mean plasma fibrinogen level was significantly different from the control values only between 120 and 216 h PI. The mean plasma iron level was significantly lower than the control between 16 and 72 h PI, reaching the lowest levels at 30 h PI (33 % of the initial value), and returned to the reference value from 96 h PI to the end of the experiment. Hepcidin mRNA expression increased at 6 h PI and remained high at 18 h PI. The iron plasma concentration was an earlier indicator of inflammatory processes in horses when compared with fibrinogen and might be useful for the early detection of inflammation in the horse. FCA administration caused the rapid onset of hypoferremia, and this effect was likely the result of up-regulated hepatic hepcidin gene expression. This study emphasizes the importance of hepcidin and iron metabolism during inflammation in horses.

A hipoferremia observada durante os processos inflamatórios sistêmicos é mediada pela hepcidina. O aumento da expressão da hepcidina é particularmente importante durante a inflamação aguda, por restringir a disponibilidade de ferro necessária para o crescimento de microrganismos patogênicos antes que a imunidade adaptativa ocorra. O objetivo deste estudo foi avaliar os achados clínicos e a expressão hepática do RNA mensageiro (RNAm) da hepcidina em cavalos após a indução da inflamação com Adjuvante completo de Freund (FCA). A expressão hepática do RNAm da hepcidina foi determinada em cavalos sadios após duas administrações intramusculares de FCA às 0 h (M0) e 12 h (M12). As concentrações plasmáticas de ferro e fibrinogênio foram mensuradas em múltiplos momentos entre 0 h e 240 h (M240) após a primeira administração de FCA (PI). A expressão do RNAm da hepcidina foi determinada por RT-qPCR usando amostras de biopsias hepáticas colhidas as 0 h (controle), 6 h (M6) e 18 h (M18) PI. A concentração plasmática média de fibrinogênio foi estatisticamente diferente do M0 entre 120 h e 216 h PI. A concentração plasmática média de ferro foi significantemente menor que o controle entre 16 h e 72 h PI, alcançou o nível mais baixo às 30 h PI (33% do valor inicial) e retornou aos valores de referência entre 96 h PI e até o final do experimento. A expressão do RNAm da hepcidina aumentou no M6 e permaneceu alta no M18. A concentração plasmática de ferro foi um indicador precoce da inflamação quando comparada com o fibrinogênio e pode ser útil na detecção precoce da inflamação em cavalos. A administração do FCA causou um rápido início da hipoferremia, e isto foi resultante do aumento da expressão hepática da hepcidina. Estes resultados enfatizam a importância da hepcidina e do metabolismo do ferro durante a inflamação em cavalos.

Aspectos relacionados ao diagnóstico laboratorial da deficiência de ferro em crianças / Aspects related to the laboratory diagnosis of child iron deficiency

Objetivo: investigar parâmetros laboratoriais utilizados no diagnóstico do estado nutricional de ferro em uma população de crianças pré-escolares com elevada prevalência de anemia, visando avaliar o modelo explicativo vigente. Métodos: foram avaliadas 119 crianças de 12 a 72 meses nas duas únicas creches públicas da cidade de Pontal-SP, dosando-se hemoglobina, ferro sérico, capacidade total de ligação do ferro, ferritina sérica, receptor de transferrina e realizando-se teste de falcização. Resultados: 81 crianças foram diagnosticadas como anêmicas com prevalência de 68,1%, sendo que 61 delas (75,3%) apresentaram pelo menos um indicador de deficiência de ferro. No subgrupo de 20 crianças com anemia e sem sinais de deficiência de ferro, 19 apresentaram normocitose, tornando improvável a presença de doença talassêmica. Nesse grupo foram encontradas quatro crianças com possibilidade de processo inflamatório, sendo uma com ferritina acima de 120 ng/mL e três com CTLF inferior a 200 microg/dL. Além disso, uma única criança apresentou microcitose com valores de CTLF e ferritina dentro da normalidade. Nas demais 15 crianças o diagnóstico preciso da anemia não pôde ser determinado pelos exames realizados. Conclusões: os dados apresentados remetem para a necessidade de aprimoramento nas técnicas diagnósticas de anemia e deficiência de ferro em crianças. A utilização do modelo diagnóstico atual inclui significativo número de crianças anêmicas sem diagnóstico causal preciso, o que é altamente relevante do ponto de vista clínico e de saúde pública...

Objetivo: investigar parâmetros laboratoriais utilizados no diagnóstico do estado nutricional de ferro em uma população de crianças pré-escolares com elevada prevalência de anemia, visando avaliar o modelo explicativo vigente. Métodos: foram avaliadas 119 crianças de 12 a 72 meses nas duas únicas creches públicas da cidade de Pontal-SP, dosando-se hemoglobina, ferro sérico, capacidade total de ligação do ferro, ferritina sérica, receptor de transferrina e realizando-se teste de falcização. Resultados: 81 crianças foram diagnosticadas como anêmicas com prevalência de 68,1%, sendo que 61 delas (75,3%) apresentaram pelo menos um indicador de deficiência de ferro. No subgrupo de 20 crianças com anemia e sem sinais de deficiência de ferro, 19 apresentaram normocitose, tornando improvável a presença de doença talassêmica. Nesse grupo foram encontradas quatro crianças com possibilidade de processo inflamatório, sendo uma com ferritina acima de 120 ng/mL e três com CTLF inferior a 200 microg/dL. Além disso, uma única criança apresentou microcitose com valores de CTLF e ferritina dentro da normalidade. Nas demais 15 crianças o diagnóstico preciso da anemia não pôde ser determinado pelos exames realizados. Conclusões: os dados apresentados remetem para a necessidade de aprimoramento nas técnicas diagnósticas de anemia e deficiência de ferro em crianças. A utilização do modelo diagnóstico atual inclui significativo número de crianças anêmicas sem diagnóstico causal preciso, o que é altamente relevante do ponto de vista clínico e de saúde pública...

Deficiência de ferro na adolescência: [revisão] / Iron deficiency in adolescence: [review]

A deficiência de ferro é o distúrbio nutricional mais comum no mundo e constitui a maior causa de anemia associada às condições onde há erro alimentar, perda crônica de sangue ou quando ocorre o crescimento rápido, como na infância, na gravidez e na adolescência. Esta deficiência acarreta prejuízos no desenvolvimento neuropsicomotor, na capacidade de aprendizagem, no apetite, no crescimento e na resposta do sistema imunológico. Na adolescência, além de com frequência observarmos hábitos alimentares inadequados, estão presentes intensas mudanças fisiológicas e psicossociais que, em associação, podem comprometer o crescimento e aumentar o risco do desenvolvimento de deficiência de ferro e outras carências nutricionais, sobretudo na fase púbere. Desta forma, o diagnóstico de deficiência de ferro entre os adolescentes deve ser lembrado a fim de que medidas possam ser tomadas para diminuir a incidência de anemia, do comprometimento do rendimento escolar e do sistema imunológico, neste período da vida.

Iron deficiency is the most common nutritional disorder in the world and is a major cause of anemia associated with situations involving chronic blood loss or rapid growth such as during infancy, pregnancy and adolescence. This deficiency leads to impairment in psychomotor development, learning ability, appetite, growth and immune response. In adolescence, inadequate dietary habits are often observed and intensive physiological and psychological changes are seen that when combined can impair growth and increase the risk of developing iron deficiency or other nutritional disorders, especially during puberty. Thus, the diagnosis of iron deficiency among adolescents should always be considered so that measures can be taken to reduce the incidence of anemia, impairment of the immune system and improve school performance.

Deficiência de ferro na mulher adulta: [revisão] / The iron deficiency in adult woman: [review]

A anemia ferropriva é a doença nutricional de maior prevalência no mundo, atingindo 20 por cento a 30 por cento da população. As mulheres, gestantes ou não, fazem parte dos grupos considerados vulneráveis. Entre as possíveis causas da anemia por deficiência de ferro, as perdas sanguíneas menstruais constituem o principal fator de anemia ferropriva da mulher adulta. A proposta deste estudo é rever as causas da anemia na mulher adulta, principalmente decorrente de sangramentos uterinos, assim como o diagnóstico e adoção de medidas preventivas.

Iron-deficiency anemia is the most common nutritional disease in the world, affecting from 20 to 30 percent of the population. Women, both pregnant and otherwise, are included as groups considered vulnerable. Among the possible causes of iron-deficiency anemia, menstruation blood loss is the main cause of iron-deficiency anemia in adult women. The purpose of this study was to review the causes of anemia in adult women, in particular in relation to uterine blood loss including the diagnosis and the adoption of preventive measures.

Deficiência de ferro no paciente submetido à ressecção gástrica ou intestinal: prevalência, causas, repercussões clínicas, abordagem diagnóstica e prevenção: [revisão] / Iron deficiency anemia in patients submitted to gastric or small intestine resection: prevalence, cause, clinical outcome, diagnostic workup and prevention: [review]

Anemia ferropriva é frequente em pacientes submetidos à ressecção gástrica, para o tratamento de úlcera péptica ou câncer gástrico, e à cirurgia bariátrica, para o tratamento de obesidade. As cirurgias bariátricas podem ter como consequência a restrição do estômago, sem necessariamente ressecção gástrica, ou ressecção gástrica associada ou não a ressecção intestinal. As causas da deficiência de ferro nestes pacientes são multifatoriais e incluem: (1) baixa ingestão de ferro oral por intolerância a alimentos ricos em ferro; (2) redução da acidez gástrica pela perda de células parietais, dificultando a conversão do ferro férrico para a forma ferrosa; (3) exclusão do duodeno com consequente exclusão do principal sítio de absorção do ferro e restrição da ação das enzimas pancreáticas na liberação do ferro ligado ao heme. A investigação e a reposição de ferro de forma eficaz e precoce pode evitar essa complicação. Pacientes refratários ao ferro oral podem necessitar de reposição de ferro parenteral e todos os pacientes requerem acompanhamento periódico com hemograma e estoques de ferro por toda a vida.

Iron deficiency anemia is associated with gastrectomy used in the treatment of peptic ulcers and gastric cancer, and also in bariatric surgery for the treatment of obesity. Bariatric surgery involves restrictive and bypass procedures, gastrectomy and small intestine resection. There are several reasons why iron deficiency occurs in these patients including: (1) diminished iron intake due to meat intolerance (2) diminished gastric acid secretion due to loss of parietal cells which impairs the solubilization of ferric iron to form ferrous iron and (3) exclusion of the duodenum with consequent elimination of the main site of iron absorption and restriction in the action of pancreatic enzymes to release iron bound to the heme. Early clinical evaluation and use of iron supplements may be effective to prevent iron deficiency anemia in this population. Patients who remain refractory to oral supplementation may require parenteral iron administration. All patients require periodical and lifelong follow-up of hematological and iron parameters.

Anemias / Anemia

As anemias constituem as doenças do sangue mais frequentes. O termo anemia significa redução da hemoglobina por unidade de volume de sangue, de acordo com a idade, sexo e tensão de oxigênio do ambiente. Pode referir-se ainda a uma síndrome clínica ou a um quadro laboratorial. As anemias podem ser provocadas por vários fatores e se classificam segundo os critérios morfológicos (normocítica/normocrômica microcítica/hipocrômica macrocítica/normocrômica) ou fisiopatológicos, considerando-se a etiologia, em anemias por falta de produção - hipoproliferação, por sobrevida diminuída dos eritrócitos - hemólise ou por perda sanguínea - hemorragia. As avaliações clínica e laboratorial são de fundamental importância para a elucidação diagnóstica e tratamento adequado.