Assessing Iron Status

Wish, Jay B.

doi:10.2215/cjn.01490506

Cited by 504 publications

(470 citation statements)

References 15 publications

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“…iron have been carried out in patients with ferritin levels Ͼ500 ng/ml, and evidence of efficacy in this group was limited or nonexistent until the Dialysis Patients Response to IV Iron with Elevated Ferritin (DRIVE) study was performed in three stages [34 -36]. The results of that study and epidemiologic observations indicate that the greater prevalence of multiple comorbidities among anemic patients with CKD has made the use of serum ferritin and transferrin saturation more challenging in diagnosing iron deficiency [37]. Because the inflammatory state inhibits the mobilization of iron from reticuloendothelial stores, many patients have a serum ferritin level Ͼ800 ng/ml, suggesting iron overload, and transferrin saturation Ͻ20%, suggesting iron deficiency.…”

Section: Efficacy and Safety Of IV And Oral Iron In Ckd Patients Nomentioning

confidence: 99%

Iron Metabolism, Iron Deficiency, Thrombocytosis, and the Cardiorenal Anemia Syndrome

2009

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In treating moderate to severe anemia of chronic kidney disease (CKD), oral iron is effective only in a minority of nondialysis patients. Intravenous iron is more effective and can raise levels of hemoglobin even without the use of erythropoiesis-stimulating agents (ESAs). Unfortunately, the current assays of iron status that are presently widely available are not especially helpful in predicting response. In patients on dialysis, i.v. iron is effective over a wide range of serum ferritin from <100 ng/ml to 800 ng/ml. None of the three available randomized controlled trials comparing oral with i.v. iron showed evidence of nephrotoxicity caused by i.v. iron.Iron deficiency is a risk factor for thrombocytosis and should, wherever possible, be avoided. Optimal coadministration of iron may reduce the risk for ESA-driven cardiovascular events. Increased total body iron stores (imperfectly reflected by serum ferritin levels in CKD) do not appear to be related to such events or hospitalization in CKD; it is unclear what other risk factors and mechanisms need to be considered.In the appreciable proportion of patients with both renal and cardiac dysfunction, management is further complicated by a vicious circle (which can be characterized as cardiorenal anemia syndrome) in which CKD, heart failure, and anemia exacerbate each other. In such patients, correction of anemia appears to improve cardiac function and quality of life without a greater risk for adverse events. The Oncologist 2009;14(suppl 1):22-33

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Section: Efficacy and Safety Of IV And Oral Iron In Ckd Patients Nomentioning

confidence: 99%

Iron Metabolism, Iron Deficiency, Thrombocytosis, and the Cardiorenal Anemia Syndrome

2009

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“…This is especially relevant in haemodialysis patients, who have high inflammatory burdens. Serum concentrations of pro-inflammatory cytokines are highly elevated in haemodialysis patients, and this is associated with upregulation of hepcidin, a 25-amino-acid protein, which inhibits transport of iron from ferritin to transferrin, resulting in a syndrome known as reticuloendothelial blockade [7]. In the current ferumoxytol PK analysis, plasma concentrations of ferumoxytol increased slightly in haemodialysis patients post-administration [5].…”

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confidence: 78%

“…transferrin saturation) and storage (i.e. ferritin) are actually of little value in assessing overall iron status [7]. Ferritin is an acute phase reactant and thus can be spuriously elevated in states of chronic inflammation, such as CKD [7].…”

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confidence: 99%

Evaluating Plasma Pharmacokinetics of Intravenous Iron Formulations: Judging Books by Their Covers?

Pai

2014

Clin Pharmacokinet

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“…Although no universal definition exists, functional iron deficiency (also known as iron-restricted erythropoiesis) can be classified as a TSAT value of <20 %, but with normal or elevated serum ferritin (≥100 ng/ml); further, as discussed below, ferritin levels can be falsely elevated in cancer patients. 15 In functional iron deficiency, there are adequate iron stores in the body but there are problems with mobilization and transport of the iron and this in turn affects erythropoiesis.…”

Section: Absolute Iron Deficiency Versus Functional Iron Deficiencymentioning

confidence: 99%

Iron Deficiency Anemia in Cancer Patients

Janis¹

2012

Oncology &Amp; Hematology Review (US)

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Anemia is defined by the World Health Organization as a hemoglobin (Hb) level <13 g/dl for men and <12 g/dl for women, 1 and can be further subcategorized into mild (>10 g/dl), moderate (8-10 g/dl), severe (6.5-8 g/dl), and life-threatening (<6.5 g/dl) ranges. Anemia is a common comorbidity in cancer patients. In the previously mentioned ECAS study, cancer-related anemia was most frequently reported in patients with gynecological cancer (81.4 %), lung cancer (77 %), and lymphoma/myeloma (72.9 %). 2 In addition, this study indicated that the longer patients received chemotherapy, the higher their risk of becoming anemic. Anemia is also a recognized complication of myelosuppressive chemotherapy in cancer patients. AbstractAnemia is highly prevalent, affecting approximately 40 % of cancer patients, and results in a significant decrease in health-related quality of life while also being associated with shorter cancer survival times. A recent survey of 15,000 cancer patients in Europe found that 39 % were anemic at the time of enrolment. In addition, anemia is a recognized complication of myelosuppressive chemotherapy, and it has been estimated that, in the US, around 1.3 million cancer patients who are not anemic at the time of diagnosis will develop anemia during the course of their disease. The etiology of anemia in cancer patients is variable and often multifactorial, and may be the result of an absolute or a functional iron deficiency. Cancer produces an enhanced inflammatory state within the body-causing hepcidin levels to increase and erythropoietin production to decrease-and results in a reduction in erythropoiesis due to impaired iron transport. This type of anemia is known as functional iron deficiency, where the body has adequate iron stores but there are problems with mobilization and transport of the iron. Absolute iron deficiency is when both iron stores and iron transport are low. The National Comprehensive Cancer Network (NCCN) treatment guidelines for cancer-related anemia recommend intravenous (IV) iron products alone for iron repletion in cancer patients with absolute iron deficiency, and erythropoiesis-stimulating agents (ESAs) in combination with IV iron in cancer patients (currently undergoing palliative chemotherapy) with functional iron deficiency. Although IV iron has been demonstrated to enhance the hematopoietic response to ESA therapy, the use of supplemental iron has not yet been optimized in oncology. Here we discuss the significance of iron deficiency anemia in cancer patients and the need to implement tools to properly diagnose this condition, and we provide an overview of the management strategies and recommendations for patients with iron deficiency anemia as outlined in the NCCN guidelines.

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Assessing Iron Status

Cited by 504 publications

References 15 publications

Iron Metabolism, Iron Deficiency, Thrombocytosis, and the Cardiorenal Anemia Syndrome

Iron Metabolism, Iron Deficiency, Thrombocytosis, and the Cardiorenal Anemia Syndrome

Evaluating Plasma Pharmacokinetics of Intravenous Iron Formulations: Judging Books by Their Covers?

Iron Deficiency Anemia in Cancer Patients

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