Prescribing Iron? Think Safety

Crosby, William H.

doi:10.1001/archinte.1978.03630290062020

Cited by 12 publications

(2 citation statements)

References 5 publications

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“…25, 2007 Panjrath et al June 26, 2007June 26, :2457 Iron in Doxorubicin Cardiotoxicity iron loading results in massive tissue iron overload, with multiorgan damage and toxicity, while oral feeding results only in a relatively modest increase in body iron content without overt signs of end-organ damage. Carbonyl iron is better absorbed and results in less gastrointestinal and systemic toxicity compared with ionic iron (32,33). Dietary carbonyl iron may result in pattern of iron overload similar to that of subclinical iron overload in man.…”

Section: Discussionmentioning

confidence: 99%

Potentiation of Doxorubicin Cardiotoxicity by Iron Loading in a Rodent Model

Panjrath

Patel

Valdiviezo

et al. 2007

Journal of the American College of Cardiology

111

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Section: Discussionmentioning

confidence: 99%

Potentiation of Doxorubicin Cardiotoxicity by Iron Loading in a Rodent Model

Panjrath

Patel

Valdiviezo

et al. 2007

Journal of the American College of Cardiology

111

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“…These results suggest that a 39 or 40 mg of iron sulfate dose (or equivalent carbonyl iron dose) for 8 weeks would be effective in the replacement of lost iron with minimal, if any, significant side effects. Carbonyl iron is safer than ferrous salt iron, 110,118 , 119 but this additional safety may not be necessary due to unit‐dose packaging (see below). Simon and colleagues 75 also showed that iron supplementation (39 mg of elemental iron/day for 8 weeks) led to significant improvements in maintaining or increasing Hb and the ability to donate in comparison to control groups.…”

Section: Short‐term Iron Replacement With Oral Iron: Supplementation mentioning

confidence: 99%

Iron depletion by whole‐blood donation harms menstruating females: The current whole‐blood‐collection paradigm needs to be changed

Newman

2006

Transfusion

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ABBREVIATIONS: log(TfR/F) = mean log of the serum transferrin receptor factor/ferritin; sTfR = serum transferrin receptor. From the American Red Cross, Southeastern Michigan Region, Detroit, Michigan.Address reprint requests to: Bruce Newman, MD, American Red Cross, Southeastern Michigan Region-he collection of 450 or 500 mL of whole blood, plus an additional 30 to 50 mL for blood tests, results in 480 to 550 mL of blood loss per wholeblood donation. These losses leads to a 60-to 88-g loss of hemoglobin (Hb) per whole-blood donation in women, based on a Hb range of 12.5 to 16.0 g per dL, and 204 to 299 mg of iron loss, based on 3.4 mg of iron per gram of Hb. 1 This iron loss is 9 to 13 percent of the total body iron in an average woman (2300 mg), 2 and it is 66 to 97 percent of the total stored iron in an average menstruating woman (309 mg). 3 Therefore, whole-blood donation is an iron depletion event that causes significant iron loss in women.Menstruating women, even before blood donation, are at risk for iron depletion because of ongoing blood loss, recent pregnancies, and inadequate dietary iron. In Caucasian women, nonanemic iron deficiency is quantitatively defined as normal Hb concentration (≥12 g/dL), low ferritin (≤12 µg/L), and a second test that is consistent with iron deficiency. 4 Iron-deficiency anemia is defined as the same, except the Hb concentration is less than 12 g per dL. A number of studies have been performed, mainly on adult women, to determine the effect of iron-deficiency anemia or nonanemic iron deficiency on one's health. These studies have evaluated the effect of these two conditions on fatigue, 5-15 physical endurance and work capac-T ity, 16-28 restless leg syndrome, 29-37 adverse events related to pregnancy, 38-48 and cognitive changes. 12,13,14,15,[49][50][51][52][53][54][55][56] Many of these studies have shown harm from iron-deficiency anemia and nonanemic iron deficiency.The status of the current whole-blood-collection paradigm is to have a Hb cutoff that is slightly above the low end of normal in women and to not replace the iron that is lost during donation. This paradigm prevents severe anemia, but it does not prevent iron-deficiency anemia or nonanemic iron deficiency and their associated harms. A superior paradigm would be short-term iron replacement for menstruating women donors after successful wholeblood donation.The present commentary will review the topic of iron deficiency in women, iron deficiency induced by wholeblood donation, and the harmful effects of the present collection paradigm (no iron replacement) on female donor health. It will then review early and recent studies on the use of oral iron supplements to replace iron after whole-blood donation, discuss an iron-rich diet versus short-term oral iron supplements, review issues related to iron supplementation, and review the potential of iron supplementation coupled with slightly lower Hb acceptance standards for women to increase the whole-blood supply. IRON DEPLETION IN WOMENFortification of food with iron ha...

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