The role of iron repletion in adult iron deficiency anemia and other diseases

Elstrott, Benjamin; Khan, Lubna; Olson, Sven R.; Raghunathan, Vikram; DeLoughery, Thomas G.; Shatzel, Joseph J.

doi:10.1111/ejh.13345

Cited by 102 publications

(99 citation statements)

References 93 publications

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“…Heavy menstrual bleeding has been reported by 12.6%-36.7% of female athletes 17,18 and is a condition that can lead to iron deficiency and iron deficiency anemia. 19 Many athletes routinely take iron supplements for suspected iron deficiency. 17 The intake of oral iron tablets is most common and is accompanied by a slow and gradual increase in erythropoiesis that normally does not interfere with the ABP.…”

Section: Introductionmentioning

confidence: 99%

Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle

Mullen

Bækken²,

Bergström

et al. 2020

Drug Testing and Analysis

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The interpretation of athlete biological passport (ABP) is strengthened by understanding the natural fluctuations in its biological parameters. Here we have assessed the influence of the menstrual cycle on the hematological module of the ABP. Seventeen women with regular menses were included. Blood samples were collected once a week for two consecutive cycles and analyzed for hematological parameters. Menstrual phases were hormonally determined. The intra‐individual variation in the hematological parameters was similar between the two cycles. Reticulocyte percentage was significantly lower in the follicle phase (median 0.95%) than in the ovulatory (median 1.10%) and luteal phases (median 1.16%), P = 0.006, whereas no differences were found in hemoglobin concentration, hematocrit, red blood cell count, or red blood cell indices. When the values were entered into the ABP model, findings outside the program‐calculated individual thresholds were identified in two participants. One woman showed an atypical low OFF‐score in the last sample collected, mainly because of increased reticulocyte percentage. This was likely a response to treated insufficient iron stores. One woman displayed an atypical hemoglobin value at the lower limit 2 weeks after ovulation, which was likely due to fluctuations in plasma volume. In conclusion, the ABP parameters in general are stable throughout the menstrual cycle. Significant differences between the menstrual phases were found in reticulocytes; however, the variation was not related to findings outside the individual thresholds, except in one individual. Moreover, our results highlight the importance of having information about iron supplementation available when evaluating hematological passports.

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Section: Introductionmentioning

confidence: 99%

Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle

Mullen

Bækken²,

Bergström

et al. 2020

Drug Testing and Analysis

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“…There are no common criteria for identifying IDA in the literature. According to a review published in 2020 in the European Journal of Hematology, ferritin concentrations <12-50 ng/mL and transferrin saturation (TSAT) <16% were given as diagnostic criteria for IDA [7]. In turn, the publication of the American Society of Hematology in December 2019 proposed to diagnose IDA with ferritin <20 ng/mL and TSAT <20% [10].…”

Section: Diagnosticsmentioning

confidence: 99%

“…FID is a state of unavailability of sufficient iron for erythropoiesis despite adequate reserves in the body and occurs in anemia of chronic disease (ACD) or in the course of IRIDA [10]. FID in the course of IRIDA is diagnosed when serum iron concentration is decreased and TSAT <10%, but at different ferritin concentrations [7]. ACD with iron deficiency is diagnosed in patients with increased levels of inflammatory response markers and TSAT <20%, while serum ferritin concentrations are 30-100 ng/mL [16,17] or at 20-100 ng/mL according to some authors.…”

Section: Diagnosticsmentioning

confidence: 99%

“…Iron deficiency may appear in the course of many diseases, e.g., inflammatory bowel disease, chronic circulatory failure, chronic kidney disease, cancer, rheumatoid arthritis, and obesity. A rare, genetically determined form of IDA is ironrefractory iron deficiency anemia (IRIDA) [6][7][8][9][10]. Hepcidin, which is a direct inhibitor of ferroportin, plays a central role in the pathogenesis of iron metabolism disorders.…”

Section: Introductionmentioning

confidence: 99%

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Iron deficiency anemia – new possibilities of iron supplementation in various clinical conditions

Michalak

2020

Acta Haematologica Polonica

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Iron deficiency anemia (IDA) treatment is done to eliminate the causes of iron deficiency, iron supplementation, and rarely red blood cell transfusion. Divalent iron salts are the first line of oral treatment, but their use lead to frequent gastrointestinal adverse reactions. Iron is administered intravenously in the event of contraindications, intolerance, or inefficiency of oral therapy, but the parenteral route of drug delivery is not easily accepted by the patients. Intravenous preparations for single administration of a large dose of iron have a good therapy safety profile, but are more expensive than oral and are usually administered in a hospital setting. The availability of new iron compounds: sucrosomial iron, ferric citrate complexes, and ferric maltol widen the possibilities of IDA therapy and enable the better selection of iron preparations in various clinical situations. The innovative structure of sucrosomial iron leads to absorption in different ways (through endocytosis, the paracellular pathway, M cells of Peyer's patches), ensures high bioavailability, and good tolerance of therapy. Ferric citrate, in addition to iron supplementation, reduces phosphate levels, and is beneficial to chronic kidney disease. Ferric maltol is currently being studied for IDA treatment with various comorbidities. Some studies indicate that new iron formulas may be used where intravenous intake has been recommended so far. So, we can expect treatment with iron nanoparticles and drugs that affect the intestinal microflora in the future. The paper presents current knowledge about new iron preparations that are already available in everyday practice, but also those that are at various stages of pre-clinical and clinical studies.

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“…If the iron stores are emptied, it may take several months to restore them by per oral iron supplements [7]. Intravenous iron treatment is a safe procedure that restores iron stores in less time, but access to this treatment can be limited due to financial and organizational causes [9,33,34]. In studies published thus far, the indications for intravenous iron treatment after bariatric surgery have been anaemia or per oral iron treatment failure, and less than 10% of the patients have received this treatment after RYGB [6,35,36].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Iron Treatment in the Prevention of Iron Deficiency and Anaemia After Roux-en-Y Gastric Bypass

et al. 2020

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Background Iron absorption is disturbed after Roux-en-Y gastric bypass (RYGB) and iron deficiency with or without anaemia affects almost half of all patients. Intravenous iron is an option when per oral iron is insufficient or not tolerated. This study explores whether routinely offering intravenous iron treatment when iron stores are empty can prevent anaemia and iron deficiency after RYGB. Methods This is a study of prospectively registered data on clinical information, haematological tests and intravenous iron treatment from 644 RYGB patients who underwent surgery between 2004 and 2013, postoperatively followed more than 5 years. Intravenous iron treatment was offered to patients with ferritin ≤ 15 μg/L. Results Clinical information was available for all patients at baseline and for 553/644 patients at 5 years; laboratory results were available for 540/644 patients at baseline and 411/644 patients after 5 years. The mean age was 39.8 (± 9.7) years. Overall, 187/483 (38.7%) women and 9/161 (5.6%) men were given intravenous iron treatment in the observation period. From baseline to 5 years, mean haemoglobin decreased by 0.3 g/dL in both men and women. Anaemia occurred in 18/311 (5.8%) women and 9/100 (9%) men at 5 years. Depleted iron stores (ferritin ≤ 15 μg/L) were seen among 44/323(13.6%) women and 3/102 (2.9%) men, and low iron stores (ferritin 16-50 μg/L) occurred in 144/326 (44.6%) women and 38/102 (37.3%) men 5 years after RYGB. Conclusion By routinely offering intravenous iron treatment to patients with depleted iron stores after RYGB, haemoglobin levels were preserved. Half of the patients experienced low or depleted iron stores at 5 years.

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The role of iron repletion in adult iron deficiency anemia and other diseases

Cited by 102 publications

References 93 publications

Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle

Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle

Iron deficiency anemia – new possibilities of iron supplementation in various clinical conditions

Intravenous Iron Treatment in the Prevention of Iron Deficiency and Anaemia After Roux-en-Y Gastric Bypass

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