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Iron Deficiency Anemia: An Updated Review
Abstract
Background:
Worldwide, iron deficiency anemia is the most prevalent nutritional deficiency disorder and the leading cause of anemia in children, especially in developing countries. When present in early childhood, especially if severe and prolonged, iron deficiency anemia can result in neurodevelopmental and cognitive deficits, which may not always be fully reversible even following the correction of iron deficiency anemia.
Objective:
This article aimed to familiarize physicians with the clinical manifestations, diagnosis, evaluation, prevention, and management of children with iron deficiency anemia.
Methods:
A PubMed search was conducted in February 2023 in Clinical Queries using the key term "iron deficiency anemia". The search strategy included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies (including case reports and case series), and reviews (including narrative reviews, clinical guidelines, and meta-analyses) published within the past 10 years. Google, UpToDate, and Wikipedia were also searched to enrich the review. Only papers published in the English literature were included in this review. The information retrieved from the search was used in the compilation of the present article.
Results:
Iron deficiency anemia is most common among children aged nine months to three years and during adolescence. Iron deficiency anemia can result from increased demand for iron, inadequate iron intake, decreased iron absorption (malabsorption), increased blood loss, and rarely, defective plasma iron transport. Most children with mild iron deficiency anemia are asymptomatic. Pallor is the most frequent presenting feature. In mild to moderate iron deficiency anemia, poor appetite, fatigability, lassitude, lethargy, exercise intolerance, irritability, and dizziness may be seen. In severe iron deficiency anemia, tachycardia, shortness of breath, diaphoresis, and poor capillary refilling may occur. When present in early childhood, especially if severe and prolonged, iron deficiency anemia can result in neurodevelopmental and cognitive deficits, which may not always be fully reversible even with the correction of iron deficiency anemia. A low hemoglobin and a peripheral blood film showing hypochromia, microcytosis, and marked anisocytosis, should arouse suspicion of iron deficiency anemia. A low serum ferritin level may confirm the diagnosis. Oral iron therapy is the first-line treatment for iron deficiency anemia. This can be achieved by oral administration of one of the ferrous preparations, which is the most cost-effective medication for the treatment of iron deficiency anemia. The optimal response can be achieved with a dosage of 3 to 6 mg/kg of elemental iron per day. Parenteral iron therapy or red blood cell transfusion is usually not necessary.
Conclusion:
In spite of a decline in prevalence, iron deficiency anemia remains a common cause of anemia in young children and adolescents, especially in developing countries; hence, its prevention is important. Primary prevention can be achieved by supplementary iron or iron fortification of staple foods. The importance of dietary counseling and nutritional education cannot be overemphasized. Secondary prevention involves screening for, diagnosing, and treating iron deficiency anemia. The American Academy of Pediatrics recommends universal laboratory screening for iron deficiency anemia at approximately one year of age for healthy children. Assessment of risk factors associated with iron deficiency anemia should be performed at this time. Selective laboratory screening should be performed at any age when risk factors for iron deficiency anemia have been identified.
... Iron deficiency anemia (IDA) is the most prevalent micronutrient deficiency among humans worldwide [1][2][3]. IDA results in significant reductions in work productivity and adds billions of dollars to the cost of health care, burdening already stressed medical systems [4]. To correct IDA, staple foods, especially cereal grain flours, are fortified with different forms of iron, including elemental and heme sources [5][6][7][8]. ...
... Treatment diets were prepared by adding iron (Fe) as heme iron powder (HIP) to the following baseline diet composition 1 . Alcohol-extracted, vitamin-free, casein.3 Ascorbic acid at 200 mg/kg diet.4 ...
... Values are mean values ± SEM (n = 9-12/group). 2 Different letters (a-e) are used to denote significant differences (p ≤ 0.05) from higher to lower mean values within a row.3 Hb Fe (mg) = BW (body weight; kg) × 0.067 × Grams Hb per mL × 3.35 mg Fe.4 HRE ratio = [Final Hb Fe (mg) − Initial Hb Fe (mg)]/Fe intake (mg total consumed). ...
Background/Objectives: Iron-fortified foods reduce the incidence of iron deficiency anemia. However, the nutritional efficacy of heme iron fortificants is unclear. Methods: In this study, we determined the hemoglobin regeneration efficiency (HRE) of a porcine-derived heme iron powder (HIP), treating anemic rats (hemoglobin (Hb) 3–6 g/dL) with 14-day repletion diets fortified with four different concentrations (12, 24, 36, or 48 mg iron/kg diets) of HIP or a control diet (“no added iron”); n = 9–12/group. Results: Our results demonstrate an inverse association between HRE and increasing dietary iron from the HIP. The HRE ratios of diets containing the HIP powder at 12, 24, 36, or 48 mg iron/kg were 0.508, 0.268, 0.273, and 0.223, respectively. Based on the mean final Hb values at 14 d, the HRE ratio of the 12 mg iron/kg diet was significantly higher (p ≤ 0.05) compared to the other HIP diet groups; however, only the HIP provided in the 36 and 48 mg iron/kg diets restored hemoglobin to high enough levels (mean Hb > 6 g/dL) to correct anemia. Conclusions: Our findings show that HIP at each of the concentrations tested increased Hb; moreover, when present at higher concentrations in the diet, the HIP is capable of restoring hemoglobin to resolve iron deficiency anemia.
... Anemia is a condition characterized by a decrease in the number of red blood cells (RBCs) or hemoglobin levels, leading to an inadequate oxygen supply to body tissues [1,2]. Anemia is a global public health problem that affects people of all ages in both developing and developed countries [3,4]. ...
... The analysis was conducted based on four detailed questions: (1) what type of studies have been conducted? (2) what types of anemia has SDT been used for? (3) what improvements did SDT make when applied to patients? ...
Background/Objectives: Anemia is a global health issue affecting diverse populations, particularly older adults, and conventional treatments often show limited efficacy. This study aimed to evaluate the utilization and effectiveness of Sipjeondaebotang (SDT), a prescription drug used in traditional East Asian medicine, in treating various types of anemia. Methods: A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Six electronic databases were searched for clinical studies on SDT, while focusing on human participants and excluding animal and cellular studies. Sixteen studies, including nine randomized controlled trials, two controlled clinical trials, two case series, and three case reports, involving 863 participants, were analyzed. These studies were primarily conducted in China, Korea, and Japan. Results: According to the analysis, SDT improved hemoglobin levels across all types of anemia studied, with all controlled studies showing significant improvements compared with the control groups. Additionally, SDT reduced blood loss, improved recovery times, and decreased transfusion requirements in patients with post-operative anemia, with lower adverse event rates than those in the control groups. These findings suggest that SDT may enhance hematological parameters and improve overall patient outcomes. Conclusions: In conclusion, SDT may be an effective treatment for anemia that improves hemoglobin levels and patient outcomes. However, further high-quality, large-scale studies are necessary to standardize SDT prescriptions, confirm the optimal treatment duration, and validate its efficacy and safety across different anemia types.
... Iron deficiency (ID) stands as the predominant aetiology of nutritional anaemia on a global scale, posing a substantial public health challenge, particularly in developing regions (1). Epidemiological investigations have revealed a concerning prevalence of anaemia among children in these settings, with reports indicating that around one-third of preschool-aged children and half of those aged 5-15 years suffer from this condition (2,3). The spectrum of ID encompasses a continuum ranging from ID without anaemia to the more severe form known as IDA. ...
... Notably, iron plays a critical role in brain development, particularly in children, influencing various processes such as monoamine neurotransmitter function, myelination, as well as glial and neuronal energy metabolism (5). Iron deficiency anaemia (IDA) typically remains asymptomatic unless it reaches severe levels. 2 In instances where IDA manifests in early childhood, especially in severe and prolonged forms, it can lead to neurodevelopmental and cognitive impairments, which may not be entirely reversible despite the correction of the underlying IDA (2,6). ...
Background/Aims: The existing literature lacks comprehensive data on the association between the severity of iron deficiency (ID) and pica prevalence in children and adolescents. The aim of this study was to explore the prevalence of pica in apparently healthy children and adolescents, and by comparing its occurrence between those diagnosed with ID and those with IDA. Methods: This prospective cross-sectional study was conducted at the outpatient paediatric clinic over a period of three months. A total of 504 children and adolescents were enrolled in the study. Participants were categorized into three groups based on primary laboratory findings: Group 1 (healthy), Group 2 (isolated ID), and Group 3 (IDA). Results: A pica prevalence rate of 5.35% was observed, with a significantly higher occurrence among children suffering from IDA compared to those with ID and their healthy counterparts (p:
... Based on the classification of the GBD study, nutritional deficiencies include proteinenergy malnutrition, iodine deficiency, vitamin A deficiency, and dietary iron deficiency [5]. Meanwhile, iron deficiency anemia is the most common nutritional deficiency in the world [6]. Harmful consequences of iron deficiency anemia, including a decrease in IQ, decrease in learning ability, impairment in physical growth, and ultimately a decrease in mental and physical capabilities, have endangered the development process of countries. ...
Background
Socioeconomic inequality in nutritional status as one of the main social determinants of health can lead to inequality in health outcomes. In the present study, the socioeconomic inequality in the burden of nutritional deficiencies among the countries of the world using Global Burden of Disease (GBD) data was investigated.
Methods
Burden data of nutritional deficiencies and its subsets including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, and dietary iron deficiency form GBD study and Human Development Index (HDI), a proxy for the socio-economic status of countries, from united nations database were collected. After descriptive statistics, the concentration index (CI) curve was used to measure socioeconomic inequality. CI for nutritional deficiencies was estimated based on Disability Adjusted Life Years (DALY), Years Lived with Disability (YLD), Years of Life Lost (YLL), prevalence, incidence and death indices. Moreover, CI of DALY and prevalence was estimated and reported for four nutritional deficiencies subgroups.
Results
CIs for DALY, YLD, YLL, prevalence, incidence and death rate show negative values and their, which indicates the concentration of nutritional deficiencies burden among lower HDI countries. The highest value of CI (lowest inequality) for DALY was related to iodine deficiency (-0.3401) and the lowest (highest inequality) was related to vitamin A deficiency (-0.5884). Also, the highest value of CI for prevalence was related to protein-energy malnutrition (-0.1403) and the lowest was related to vitamin A deficiency (-0.4308). Results also show the inequality in DALY was greater than the disparity in prevalence for all subgroups of nutritional deficiencies.
Conclusions
Inequality in burden of nutritional deficiencies and protein-energy malnutrition, iodine deficiency, vitamin A deficiency and dietary iron deficiency are concentrated in countries with low HDI, so there is pro- poor inequality. Findings indicate that although malnutrition occurs more in low-income countries, due to the weakness of health care systems in these countries, the inequality in the final consequences of malnutrition such as DALY becomes much deeper. More attention should be paid to the development of prevention and primary treatment measures in low HDI countries, such as improving nutrition-related health education, nutritional support and early aggressive treatment, and also eliminating hunger.
... Remaja putri sering terjadi anemia defisiensi zat besi akibat peningkatan kebutuhan zat besi untuk pertumbuhan, intake zat besi yang tidak adekuat, dan kehilangan darah saat menstruasi (Leung et al., 2024). Darah yang keluar saat menstruasi menyebabkan hilangnya zat besi sehingga menyebabkan anemia defisiensi zat besi yang paling sering dialami remaja putri. ...
Adolescent are individuals who experience rapid growth and development process. In adolescent girl in particular, there is a physiological process occurs called menstruations that caused bleeding every month in adolescent girl and known as menstrual cycle. As a result of the menstruation, young women become a vulnerable group to anemia. This study intends to determine the relationship between the menstrual cycle and the incidence of anemia in adolescent girl at MA Nurul Islam Mataram. This study is quantitative categorical analysis with a cohort retrospective approach. The sample in this study was 48 young women at MA Nurul Islam Mataram, divided into 24 people in the normal menstrual cycle group and 24 people in the abnormal menstrual cycle group. Sample selection was carried out using a consecutive sampling method that fulfilled the sample inclusion and exclusion criteria. Data analysis in this study was carried out using the chi-square test to see the relationship between the menstrual cycle and the incidence of anemia in adolescent girl at MA Nurul Islam Mataram. The result of this study data analysis using the chi-square hypothesis test obtained a p-value of 0.505 (p<0.05) which shows that there is no significant relationship between the menstrual cycle and the incidence of anemia in young women at MA Nurul Islam Mataram.
... Febrile seizures are defined as convulsions occurring in children aged 6 months to 5 years, associated with a fever exceeding 38°C, in the absence of central nervous system (CNS) infection, metabolic disturbances, or a prior history of afebrile seizures [3]. These seizures are categorized into two types: simple febrile seizures, characterized by generalized tonicclonic activity lasting less than 15 minutes and not recurring within 24 hours, and complex febrile seizures, which involve focal features, exceed 15 minutes in duration, or recur within 24 hours [4]. Although febrile seizures are generally not linked to long-term adverse outcomes, the risk of recurrence is notable. ...
... Ở bệnh nhân này, điều trị quan trọng và lâu dài là cần thay đổi chế độ dinh dưỡng với giai đoạn đầu sau ra viện trẻ cần bổ sung sắt nguyên tố đường uống đồng thời bổ sung loại sữa cao năng lượng nhằm bắt kịp tăng trưởng. Liệu pháp uống sắt được khuyến cáo với liều lượng sắt nguyên tố tối ưu là 3-6 mg/kg mỗi ngày [17]. ...
Anemia is a common symptom in children and has many different causes. Among the etiologies, improper nutrition is the most common reason for anemia in children. However, the severity of nutritional anemia is usually mild to moderate. We report a case of a 56-month-old female child admitted to the hospital with severe anemia with a blood hemoglobin concentration of 35 g/L, and the cause of the anemia was nutritional deficiency. We hope that this case will provide more information for pediatric clinicians when investigating possible causes of severe anemia in children.
... The common manifestations of iron deficiency include anemia, fatigue, reduced concentration, dizziness, pallor, and headache. Additional signs may comprise alopecia, dry skin, flattened nails, and glossitis [99]. The role of iron in immune function has been underscored by clinical observations linking its deficiency to increased susceptibility to infections. ...
Recent insights into the influence of nutrition on immune system components have driven the development of dietary strategies targeting the prevention and management of major metabolic-inflammatory diseases. This review summarizes the bidirectional relationship between nutrition and immunocompetence, beginning with an overview of immune system components and their functions. It examines the effects of nutritional status, dietary patterns, and food bioactives on systemic inflammation, immune cell populations, and lymphoid tissues, as well as their associations with infectious and chronic disease pathogenesis. The mechanisms by which key nutrients influence immune constituents are delineated, focusing on vitamins A, D, E, C, and B, as well as minerals including zinc, iron, and selenium. Also highlighted are the immunomodulatory effects of polyunsaturated fatty acids as well as bioactive phenolic compounds and probiotics, given their expanding relevance. Each section addresses the implications of nutritional and nutraceutical interventions involving these nutrients within the broader context of major infectious, metabolic, and inflammatory diseases. This review further underscores that, while targeted nutrient supplementation can effectively restore immune function to optimal levels, caution is necessary in certain cases, as it may increase morbidity in specific diseases. In other instances, dietary counseling should be integrated to ensure that therapeutic goals are achieved safely and effectively.
... IDA is the most prevalent nutritional deficiency condition and the leading cause of childhood anaemia in underdeveloped nations [5]. The prevalence of IDA varies with factors, such as age, socioeconomic status, ethnic composition, criteria used for diagnosis and dietary habits [6]. The prevalence of IDA usually decreases among school-age children and then increases again during adolescence [7]. ...
Background
According to the WHO report and evaluations, Iran has a moderate prevalence of iron deficiency anaemia (IDA). The present study evaluates Iran’s IDA prevention and control policies by analysing the agenda-setting policy using the multiple streams framework (MSF).
Methods
The present study used Kingdon’s MSF model to analyse policies related to IDA in Iran qualitatively. First, the policy documents were reviewed (n = 12), and then in-depth interviews were conducted with key stakeholders (n = 33) using the framework analysis method. MAXQDA version 2020 was used to categorize the data codes of the interviews and extract related themes.
Results
The main factors of the problem stream were the prevalence of IDA among Iranian pregnant women, children and adolescents and its risk factors in Iran. The policy stream focuses on mounting the staff in health centres, preventing non-communicable diseases and parasites in the health system, and promoting health programs, such as supplementation, education and fortification. The current political stream regarding IDA shows that national and international support can provide the right political atmosphere for this issue. There are challenges and obstacles related to implementing these policies in Iran, including the preference for treatment over prevention in the health sector, the existence of many economic problems and the limitation of distribution and access to health services owing to some unforeseen issues, such as sanctions or the spread of coronavirus disease 2019 (COVID-19).
Conclusions
The topic of IDA prevention policymaking has entered a new phase. Responsible organizations, such as the Ministry of Health, should emphasize more in allocating budgets for preventive programs, and key organizations, such as the WHO, should support low- and middle-income countries to empower them towards important preventive strategies.
... IDA is a common type of anemia characterized by insufficient iron levels in the body, leading to a decreased number of red blood cells (RBCs) [1], [2]. This condition often results in symptoms such as fatigue, weakness, and impaired cognitive development, particularly affecting young children in resource-limited settings [3]- [5]. ...
Iron deficiency anemia (IDA) is a major public health issue, especially affecting young children, and demands efficient, non-invasive diagnostic methods. IDA, marked by low red blood cell (RBC) counts due to insufficient iron, can cause fatigue and hinder cognitive development, particularly in resource-limited areas. Traditional diagnostic approaches, which involve invasive and costly blood tests, are often impractical for children due to discomfort, the need for skilled personnel, and variability in results. Machine learning offers a promising alternative by using non-invasive imaging and automated analysis to provide quick and accurate diagnoses. This study explores the application of machine learning for diagnosing IDA using palpable palm images collected from hospitals in sub-Saharan Africa. The dataset comprises images of children aged five and under, categorized into anemic and non-anemic groups based on corresponding hemoglobin (HGB) values provided by laboratory tests. Techniques including image preprocessing (e.g., resizing, gray-scaling, mean-variance normalization), segmentation, feature extraction (e.g., color, texture with GLCM, edge detection), and data augmentation were employed to enhance dataset quality and balance class sizes. Comparative analysis is conducted using a set of recurrent networks, namely, Gated Recurrent Units (GRU), Projected GRU (PGRU), Long Short-Term Memory (LSTM), and Projected LSTM (PLSTM) models to assess diagnostic accuracy. All algorithms' hyperparameters were tuned based on generalization errors as an objective function of a Bayesian optimization algorithm. Results demonstrate the efficacy of GRU in accurately classifying IDA, with a recall of 100 0 /0, offering a promising approach for diagnosis in pediatric populations.
... There have been many critiques on the clinical decision limit used to define low ferritin in various pediatric ages with some experts providing a threshold of below 50 mcg/L, which is significantly higher than present thresholds [1][2][3]. Lower ferritin concentrations, even in the absence of anemia or microcytosis, have been ascribed to nonspecific symptoms such as fatigue, muscle weakness, difficulty concentrating, and decreased productivity that could be misconstrued as attention-deficit disorder [4][5][6]. As ferritin concentrations are not routinely evaluated in patients until anemia or microcytosis presents, it is difficult to objectively assess the prevalence of iron deficiency [7,8]. ...
Athletes are at high risk of iron deficiency even without anemia. In this systematic review and meta‐analysis that included 17,519 athletes in 122 references from 23 countries, participating in 62 unique sports over a 41‐year timeframe, approximately 53.9% of student‐athletes were found to be hypoferritinemic (ferritin concentration below 50 mcg/L) with 23.0% percent showing absolute iron deficiency based on current definitions (ferritin concentration below 20 mcg/L). These findings strongly suggest that changes in clinical practice guidelines are warranted to enable routine screening for iron deficiency among adolescent and collegiate athletes.
... 23,24,25 Individuals with CKD are also prone to developing a functional (or relative) iron deficiency, which is when the body's iron stores are unable to be mobilized effectively for the generation of hemoglobin in the bone marrow. 26 It is helpful to understand basic iron metabolism for discussions about relative iron deficiency; There are several excellent reviews of iron physiology. 26.27,28 Hepcidin is a hormone produced by the liver that is the key player in mediating the sequestration of iron. ...
Anemia is a frequent complication during the late stages of chronic kidney disease, reaching an almost universal prevalence among those with end stage kidney disease. There is a clear association between anemia and an increased risk for decline in the estimated glomerular filtration rate, cardiovascular events, and all-cause mortality. The main mechanisms for the development of anemia related to chronic kidney disease are a relative erythropoietin deficiency and disordered iron homeostasis related to chronic inflammation. Recent improvements in the understanding of the pathophysiology of anemia in chronic kidney disease have advanced the diagnosis and treatment of anemia in chronic kidney disease. While the cornerstone of the diagnosis of anemia related to chronic kidney disease remains excluding other etiologies of anemia, newer diagnostic resources include population-informed cutoffs for traditional measures of iron storage as well as evolving diagnostics of the reticulocyte hemoglobin index and percent hypochromic red blood cells in plasma. Intravenous iron has emerged as a novel tool for both the diagnosis and treatment of disordered iron homeostasis in the anemia of chronic kidney disease. Outside of iron replacement, the treatment of the anemia of chronic kidney disease has traditionally relied on erythropoiesis stimulating agents. A newer class of medications, the Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors, are an emerging therapy that work by stimulating the transcription of the erythropoietin gene in the Kidney and Liver. These agents are oral therapy, unlike erythropoiesis-stimulating agents, and are used in those who fail to respond to traditional therapy. Additional novel and experimental therapies include SGLT2 inhibitors, inhibitors of hepcidin production, and novel oral and intravenous iron formulations. This review encompasses the highlights of the epidemiology, pathophysiology, and the recent diagnostic and therapeutic advancements for anemia in chronic kidney disease.
... Gender predominance found during current study is agreement with the reported gender distribution by Malik et al. 9 They studied 142 children; 87 (61%) were males and 55 (39%) were females. Mean Haemoglobin before treatment was 7.85±0.78gm/dl ...
Objective: To evaluates the efficacy and safety of intravenous iron sucrose in paediatric patients with IDA who have not responded to or tolerated oral iron therapy.Methodology: This observational study was conducted at Department of Paediatrics, Pakistan aeronautical complex (PAC) Hospital Kamra, from October 2023 to April 2024. Iron sucrose (Venofer®) was administered at a dose of 0.35 ml/kg, providing 100 to 200 mg of elemental iron per dose, on alternate days for three doses. Haemoglobin (Hb) and serum ferritin levels were measured 4 weeks post-treatment to evaluate response.Results: Among the participants, 70 (70%) were male and 30 (30%) were female, with a mean age of 34.23 ±19.54 months. Results showed a significant increase in mean Hb from 7.92 ± 0.74 g/dl before treatment to 10.46 ± 0.94 g/dl after treatment (p = 0.001)Conclusion: Clinicians should consider intravenous iron therapy to enhance patient outcomes, improve quality of life, and potentially reduce healthcare costs. Keywords: Iron Deficiency Anaemia (IDA), Anaemia, Haemoglobin (Hb), Oral Iron, Intravenous Iron.
... For the experiment, we used 2.5% fat-sterilized milk produced by the Nalchik Dairy Plant (Nalchik, Russia). Fortification of milk increased the iron content to 1.0 mg/100 mL and ascorbic acid to 3.0 mg/100 mL, which meets the requirements for iron and ascorbic acid levels in children's nutrition [22]. An in vivo experiment was performed on 42 male rats of the Wistar line with an initial body weight of 120-240 g. ...
... Processed foods are often enriched and fortified with different forms of elemental iron powders to reduce the incidence of iron deficiency anemia, the most common cause of micronutrient-related anemia worldwide [1]. To minimize oxidative and rancidity-based food spoilage, reduce adverse flavor and aroma profile changes, and extend the shelf-life of food products, elemental iron powders are commonly the iron fortificant of choice. ...
Elemental iron powders are used as food fortificants to reduce the incidence of iron deficiency anemia. However, many commercially available iron powders are relatively untested in vivo. The purpose of this study was to determine the hemoglobin regeneration efficiency (HRE) and relative iron bioavailability (RBV) of an electrolytic elemental iron powder (EIP), by treating anemic rats with 14 d iron repletion diets fortified with four different concentrations (12, 24, 36, or 48 mg iron/kg diet) of EIP and bakery-grade ferrous sulfate monohydrate (FS; FeSO4•H2O), or no added iron (control); n = 9–12/group. The HRE of FS was significantly higher (p ≤ 0.05) than EIP at each concentration of dietary iron tested. For EIP, the HREs (ratios) of diets containing 12, 24, 36, and 48 mg iron/kg were 0.356, 0.205, 0.197, and 0.163, respectively. For both EIP and FS, HRE was inversely associated with increasing dietary iron. The RBVs (%) of iron from EIP in diets at 12, 24, 36, and 48 mg iron/kg as compared to FS were 64.5, 59.1, 50.6, and 54.3%, respectively. Overall, findings show that at the concentrations of iron tested, EIP has RBVs greater than 50% and is an effective fortification agent to replenish hemoglobin and correct iron deficiency anemia.
... Ahora bien, primero es importante entender que la anemia es aquella condición en la que la cantidad de glóbulos rojos circulando, la concentración de hemoglobina o el porcentaje de concentración de estas células está por debajo de lo normal (OMS, 2017). Algunos síntomas de la anemia dependiendo de su intensidad pueden ser desde la palidez de la piel o la fatiga hasta la insuficiencia cardiaca o problemas en el desarrollo cerebral (Killip et al., 1962), sin embargo, los síntomas no siempre son identificables y por ende no es diagnosticada y tratada desde un inicio (Leung et al., 2024). La anemia ferropriva puede tener diversas causas, las más comunes según la Organización mundial de la salud son la deficiencia de hierro, patologías hereditarias relacionadas con la hemoglobina y la malaria(Organización Mundial de la Salud, 2009). ...
Introducción: Es fundamental determinar el nivel de cumplimiento de las actividades para mitigar la anemia implementadas por el área de nutrición en poblaciones vulnerables. Esta información permitirá monitorear el avance en la lucha contra la anemia, identificar áreas de mejora y optimizar estrategias, fortalecer la toma de decisiones basadas en evidencia y demostrar el compromiso con la salud pública. Objetivo: Determinar la productividad preventiva y promocional del servicio de nutrición de un establecimiento de salud perteneciente a la Red Melgar en el contexto de la mitigación de la anemia en niños menores de 5 años durante el periodo comprendido entre los años 2020 y 2022. Metodología: Se llevó a cabo un estudio descriptivo, observacional, transversal y retrospectivo. La técnica de documentación se empleó para recopilar información de los registros de atenciones e historias clínicas. En concreto, se analizaron los datos referentes a las visitas domiciliarias, sesiones de consejería, sesiones demostrativas y suplementaciones con sulfato ferroso recibidas y reportadas. Resultados: En cuanto a las actividades preventivas y promocionales que reflejan la productividad del personal de salud, el año con más visitas domiciliarias en niños fue 2022. En relación con las sesiones demostrativas, el año con más actividades fue 2021. El año con más sesiones de consejería nutricional fue 2022. Conclusiones: Los datos muestran una distribución desigual de las estrategias implementadas, lo que requiere un estudio más profundo. Además, es necesario aumentar las plazas para profesionales de nutrición para satisfacer las necesidades de los pacientes.
... Elemental iron powders (EIPs) are often used to fortify staple foods because they are a cost-effective approach to reducing iron deficiency anemia, the most prevalent micronutrient deficiency worldwide [1]. EIPs are often preferred as fortification agents because they do not promote unfavorable sensory or organoleptic changes in food during storage. ...
Effective food fortification strategies using elemental iron powders (EIPs) are needed to combat iron deficiency anemia. The purpose of this study was to determine hemoglobin regeneration efficiency (HRE) and relative iron bioavailability (RBV) of four food-grade EIPs (El-Lyte (EL), Hi-Sol (HS), H-325 (H3), and A-131 (A1)) by treating anemic rats with 14 d iron repletion diets (uncooked and cooked), fortified with a 12, 24, or 36 mg iron/kg diet of the EIPs, ferrous sulfate monohydrate (FS, FeSO4•H2O), or no added iron (control), n = 9–12/group. The ability of EL and HS to maintain hemoglobin for 6 weeks on the 6 mg iron/kg diet was also studied. The dissolution rate of iron from the EIPs was measured in hydrochloric acid at pH 1.0. Compared to FS, the EL, HS, and A1 EIPs had >50% overall RBV, with the following order: HS > A1 > EL > H3 (p ≤ 0.05); the effect of cooking was not significant (p > 0.05). Dissolution testing revealed that the mean RBV of the EIPs was positively associated with the percentage of iron solubility. In the 6-week maintenance study, EL and HS maintained hemoglobin as well as FS. Overall, the findings show that at the concentrations of iron tested, these EIPs are effective fortification agents to replenish hemoglobin and correct iron deficiency anemia.
... 8 Según lo expuesto, se plantea la necesidad de investigar la prevalencia de anemia y su gravedad en lactantes ecuatorianos hospitalizados, con el fin de proveer información actualizada sobre el impacto de esta condición, de manera que impulse al diseño de estrategias sanitarias y de alimentación para la reducción de la desnutrición infantil; la promoción de la lactancia materna como fuente primordial de hierro biodisponible; la mejora de las intervenciones en salud pública y la proporción de tratamientos oportunos. 11,12 METODOLOGÍA Diseño de estudio Estudio observacional descriptivo de corte transversal con datos obtenidos de fuente secundaria anonimizada en el origen, con análisis de variables cualitativas y cuantitativas. ...
La anemia es una condición sanguínea que afecta a individuos de todas las edades, pero tiene un impacto significativo en la población infantil. Se caracteriza por niveles bajos de hemoglobina en la sangre, que caen por debajo de dos desviaciones estándar del promedio considerado normal. Métodos: se realizó una investigación observacional y descriptiva utilizando datos anónimos de una fuente secundaria. El objetivo era determinar la prevalencia de la anemia en lactantes ingresados en un Hospital Pediátrico de Quito, durante el periodo de enero a diciembre de 2022. Resultados: El 38% de los lactantes tenían anemia, principalmente en forma leve, con un porcentaje del 46.1%. La forma más común de anemia fue la normocítica normocrómica, presente en el 63.2% de los casos. Se observó que la prevalencia de anemia era más alta a los 12 meses, alcanzando el 31.6% de los casos. Los varones mostraron una prevalencia de anemia del 61.8%. La mayoría de los casos de anemia se registraron en zonas urbanas, alcanzando el 52.6%. La neumonía fue la patología más común asociada a la anemia, con un 38.2% de los casos. Conclusión: La prevalencia de anemia en lactantes hospitalizados es un problema de salud de magnitud moderada. Además, se destacó la importancia de la lactancia materna como medida efectiva para reducir la anemia. Se recomendó el uso de pruebas de laboratorio como medida preventiva y para el diagnóstico oportuno de esta condición, con el fin de mejorar la calidad de vida de los pacientes.
... Iron as a trace metal in physiological amounts is beneficial [166,167] due to excellent measures that provide iron homeostasis, as comprehensively reviewed [167]. However, iron deficiency may be hazardous to human health due to anemia and various clinical manifestations [186], easily seen externally by pale skin and cheilitis [187,188]. Iron may also be injurious when present in excess due to acute and chronic intoxication by exogenous iron or in the course of genetic hemochromatosis with a hepatic overload of iron due to uncontrolled intestinal iron uptake [66,[169][170][171][172], which is to be clinically differentiated from hemosiderosis with iron excess in the hepatic Kupffer cells due to a chronic release of iron from injured blood red cells as a consequence of genetic hemolytic disorders [189,190]. ...
Humans are continuously exposed to various heavy metals including copper, iron, cadmium, and arsenic, which were specifically selected for the current analysis because they are among the most frequently encountered environmental mankind and industrial pollutants potentially causing human health hazards and liver injury. So far, these issues were poorly assessed and remained a matter of debate, also due to inconsistent results. The aim of the actual report is to thoroughly analyze the positive as well as negative effects of these four heavy metals on human health. Copper and iron are correctly viewed as pollutant elements essential for maintaining human health because they are part of important enzymes and metabolic pathways. Healthy individuals are prepared through various genetically based mechanisms to maintain cellular copper and iron homeostasis, thereby circumventing or reducing hazardous liver and organ injury due to excessive amounts of these metals continuously entering the human body. In a few humans with gene aberration, however, liver and organ injury may develop because excessively accumulated copper can lead to Wilson disease and substantial iron deposition to hemochromatosis. At the molecular level, toxicities of some heavy metals are traced back to the Haber Weiss and Fenton reactions involving reactive oxygen species formed in the course of oxidative stress. On the other hand, cellular homeostasis for cadmium and arsenic cannot be provided, causing their life-long excessive deposition in the liver and other organs. Consequently, cadmium and arsenic represent health hazards leading to higher disability-adjusted life years and increased mortality rates due to cancer and non-cancer diseases. For unknown reasons, however, liver injury in humans exposed to cadmium and arsenic is rarely observed. In sum, copper and iron are good for the human health of most individuals except for those with Wilson disease or hemochromatosis at risk of liver injury through radical formation, while cadmium and arsenic lack any beneficial effects but rather are potentially hazardous to human health with a focus on increased disability potential and risk for cancer. Primary efforts should focus on reducing the industrial emission of hazardous heavy metals.
... The most common causes of iron deficiency anaemia are bleeding disorders, gastrointestinal bleeding, and nutritional deficiencies [7]. It is also caused by increased demand and decreased supply, as usually occurs in pregnancy, children, and adolescence [8]. ...
Background: In Pakistan, iron deficiency anaemia (IDA) is the leading blood disorder due to dietary deficiencies, which is defined by the WHO as low Haemoglobin levels and low red cell death due to a deficiency of iron in the body. This is especially true for lower socioeconomic groups because of cultural influences and a lack of resources. All genders and age groups are affected by iron deficiency anemia (IDA), which can cause microcytic and hypochromic disease with a range of clinical consequences. According to many recent studies, there may be a connection between blood types and IDA, with those who belong to blood groups O and B perhaps at higher risk of developing the anemia. Confirmation of these links and comprehension of the underlying mechanisms need more study. Materials and Methods: This was a cross-sectional study, conducted at the emergency department of Liaquat University Hospital from June to August 2022 that involved 400 patients who were divided into two groups: a control group comprising 285 patients who were not suffering from iron deficiency anaemia and a study group comprising 415 patients suffering from iron deficiency anemia excluding those with other diseases. A formal consent preceded comprehensive clinical examinations, including blood pressure, pulse rate, and oxygen saturation measurements. Blood group determination employed the glass slide agglutination method, distinguishing A, B, AB, and O groups. Haemoglobin levels were assessed using Sahli's hemoglobinometer, while the complete blood picture was obtained by the blood CP report of the hospital laboratory. Statistical analyses, including Fischer's exact test, were performed using GraphPad 9 prism. Specificity/sensitivity, likelihood ratios, and odds ratios were calculated for further analysis. Conclusion: This study shows a significant relationship between various blood groups and the prevalence of anaemia in the population.
... The most common causes of iron deficiency anaemia are bleeding disorders, gastrointestinal bleeding, and nutritional deficiencies [7]. It is also caused by increased demand and decreased supply, as usually occurs in pregnancy, children, and adolescence [8]. ...
dietary deficiencies, which is defined by the WHO as low Haemoglobin levels and low red cell death due to a deficiency of iron in the body. This is especially true for lower socioeconomic groups because of cultural influences and a lack of resources. All genders and age groups are affected by iron deficiency anemia (IDA), which can cause microcytic and hypochromic disease with a range of clinical consequences. According to many recent studies, there may be a connection between blood types and IDA, with those who belong to blood groups O and B perhaps at higher risk of developing the anemia. Confirmation of these links and comprehension of the underlying mechanisms need more study. Materials and Methods: This was a cross-sectional study, conducted at the emergency department of Liaquat University Hospital from June to August 2022 that involved 400 patients who were divided into two groups: a control group comprising 285 patients who were not suffering from iron deficiency anaemia and a study group comprising 415 patients suffering from iron deficiency anemia excluding those with other diseases. A formal consent preceded comprehensive clinical examinations, including blood pressure, pulse rate, and oxygen saturation measurements. Blood group determination employed the glass slide agglutination method, distinguishing A, B, AB, and O groups. Haemoglobin levels were assessed using Sahli's hemoglobinometer, while the complete blood picture was obtained by the blood CP report of the hospital laboratory. Statistical analyses, including Fischer's exact test, were performed using GraphPad 9 prism. Specificity/sensitivity, likelihood ratios, and odds ratios were calculated for further analysis. Conclusion: This study shows a significant relationship between various blood groups and the prevalence of anaemia in the population.
... Iron deficiency anaemia (IDA) results from decreased availability of iron needed for erythropoiesis. The underlying reasons for IDA include poor dietary intake of iron, decreased iron absorp- 3 tion, and increased blood loss. Many medical conditions such as obesity, diabetes mellitus (DM), cancer, heart failure, lung disease, acquired immunodeficiency syndrome (AIDS), rheumatoid arthritis (RA), inflammatory bowel disease (IBD) and severe trauma are known to cause inflammation and thus anaemia of inflammation (AI). ...
... Most commonly, iron deficiency anemia (IDA) is asymptomatic or causes minor signs and symptoms, while severe anemia presenting with pallor, irritability, lethargy, tachypnoea, and tachycardia is far less frequent [5]. If unrecognized, IDA can be associated with multiple deficits, including impaired neurodevelopment, growth, and immunity [6]. ...
Background: Given the high prevalence of unrecognized iron deficiency anemia (IDA) in Croatia and its negative impact on children’s somatic and neurological outcomes, a comprehensive preventive and treatment approach is a necessity.
Methods: This was an observational, cross-sectional study of pediatric patients referred to the Children's Hospital Zagreb, Croatia, from 2017 to 2021, for IDA. Epidemiological and clinical data were extracted. Laboratory workup and therapeutic actions in the primary and tertiary care settings were recorded. The need for transfusion, parenteral iron therapy, and hospital admission was noted.
Results: A total of 299 patients (52.2% female, median five years) were seen by the hematologist in the five-year study period. Almost half (45.1%) were referred by the primary care pediatrician. Only half of the patients (56.6%) received oral iron therapy prior to referral. The preferred preparation was Dextriferron (67.7%) during the mean period of 5.8 months, but more than one-third of the patients (36.5%) were non-compliant. Every 10th child seen by the hematologist for IDA was admitted to the hospital; 6.4% required transfusion therapy, and in only one patient, parenteral iron was administered.
Conclusions: The results of this survey established that IDA still represents an excessive burden in a tertiary care setting of a high-income country. Therefore, consistent implementation of national guidelines and additional education of primary healthcare providers is crucial to ameliorate this significant public health concern.
Recently, non-invasive hemoglobin measurement (SpHb) using Pulse CO-Oximeter Rad-67™ Spot-check (Rad-67) has been validated although anemia diagnosis typically relies on blood hemoglobin concentration measurement. In this large-scale survey of Japanese children aged 1-5 years, we evaluated SpHb distribution to understand the prevalence of suspected anemia, and further examined the relationship between SpHb and background factors. Children were recruited from large retail stores in Japan between November 2022 and August 2023. SpHb was measured by nutritionists or registered dietitians using Rad-67. 4133 participants were included and stratified by age and sex. The prevalence of children below the WHO threshold value for anemia was found to be 5.2% in total (ranging between 2.6-7.8% in subgroups). Mean SpHb values increased with age, and were higher in boys. Age and sex were independently related to SpHb. Overall, this study shows that approximately 3-8% of young children in Japan are suspected to be anemic.
Iron deficiency anemia (IDA) is a common health problem that affects about 1.24 billion people around the world, mostly children and women of childbearing age. IDA happens when the body doesn't get enough iron, loses too much iron, or can't absorb it properly. This makes erythropoiesis, cellular metabolism, and immune function worse. The World Health Organization says that 40% of women who are pregnant and 32.5% of women who are not pregnant have anemia. People with IDA often feel tired, weak, pale, and have trouble thinking clearly. Lab tests, such as hemoglobin, blood ferritin, and transferrin saturation, are used to make the diagnosis. You can treat the condition in two ways: by taking iron supplements by mouth, such as ferrous sulfate, ferrous gluconate, and ferrous fumarate; or, for serious cases, by giving iron through an IV. Strategies for prevention depend on increasing the amount of iron you get from food, making it more bioavailable, and keeping infections under control. Food addition and fortification programs have been shown to help lower the number of people with IDA. However, problems still exist, especially in areas with poor economies. Recent advance in acknowledging how iron is used and controlled has implications for creating targeted therapeutic approaches. A key regulator of iron balance, hepcidin, is a key player in the pathophysiology of IDA. This review shows how complicated IDA is and how important it is to have treatment plans that consider underlying causes, dietary factors, and socioeconomic factors. Keywords: Iron Deficiency Anemia (IDA), Erythropoiesis, Hemoglobin, Nutritional Deficiencies, Neurological Disorders, Iron Supplements.
Abstract
Objective: Iron and other biologically important metals are essential to mitochondrial function but are not routinely evaluated. Their equilibrium is critical to the optimal performance of cells with high metabolic activity such as neurons, cardiomyocytes, and skeletal myocytes. Teenagers are at a high risk of iron deficiency even without anemia. Metal ion imbalances can cause cognitive impairments, muscle weakness, and sudden cardiac death. We aim to assess the current prevalence of iron deficiency among collegiate athletes in the Upper Midwest.
Methods: Our study is a multicenter, retrospective chart review of outpatient clinics in a regional healthcare system between January 2012 and December 2023, and a national public database between 2017 and March 2020. We reviewed the ferritin concentrations of regional collegiate athletes having preparticipation sport evaluations and nationally in the NHANES database.
Results: We identified 643 unique individuals aged 16-21 years with 253 having ferritin screening. Iron deficiency (ferritin <20 mcg/L) was present in 24.5% and hypoferritinemia (ferritin <50 mcg/L) was present in 66.7% of collegiate athletes. From the NHANES database, 12.7% of active sampled participants aged 16-21 years were iron deficient.
Conclusion: Our study findings suggest the need for universal screening for iron deficiency among collegiate athletes given the high prevalence of iron deficiency in both the retrospective chart review and NHANES database analysis. Given the critical role of metal ion homeostasis to optimal mitochondrial function, these findings may warrant the inclusion of ferritin testing in cardiac, neurological, and skeletal muscle evaluations.
Anemia affects a third of the world’s population and contributes to increased morbidity and mortality, decreased work productivity, and impaired neurological development. In recent years, many studies have found a possible association between anemia and sensorineural hearing loss (SNHL), especially in various types of nutritional deficiency and hemoglobin disorders anemia. Anemia may affect hearing through various mechanisms, including affecting microcirculation in the ear, causing tissue hypoxia in the ear, and through inflammatory and oxidative stress pathways. This review aims to comprehensively analyze the association between various types of anemia and SNHL, including possible biological mechanisms, clinical features, and treatment strategies, and clarify the importance of anemia treatment and management in preventing SNHL.
We investigated the mRNA expression of 124 cuproptosis-associated genes in 7489 biopsies from 20 different tumor types of The Cancer Genome Atlas (TCGA). The KM plotter algorithm has been used to calculate Kaplan–Meier statistics and false discovery rate (FDR) corrections. Interaction networks have been generated using Ingenuity Pathway Analysis (IPA). High mRNA expression of 63 out of 124 genes significantly correlated with shorter survival times of cancer patients across all 20 tumor types. IPA analyses revealed that their gene products were interconnected in canonical pathways (e.g., cancer, cell death, cell cycle, cell signaling). Four tumor entities showed a higher accumulation of genes than the other cancer types, i.e., renal clear cell carcinoma (n = 21), renal papillary carcinoma (n = 13), kidney hepatocellular carcinoma (n = 13), and lung adenocarcinoma (n = 9). These gene clusters may serve as prognostic signatures for patient survival. These signatures were also of prognostic value for tumors with high mutational rates and neoantigen loads. Cuproptosis is of prognostic significance for the survival of cancer patients. The identification of specific gene signatures deserves further exploration for their clinical utility in routine diagnostics.
Iron deficiency anemia (IDA) is a common health issue, and researchers are interested in overcoming it. Nanotechnology green synthesis is one of the recent approaches to making efficient drugs. In this study, we modeled curcumin-coated iron oxide nanoparticles (cur-IONPs) to study their predicted toxicity and drug-likeness properties, then to investigate mucoadhesive behavior by docking cur-IONPs with two main mucin proteins in gastrointestinal tract (GIT) mucosa (muc 5AC and muc 2). Furthermore, the stability of cur-IONPs/protein complexes was assessed by molecular dynamics. Our in-silico studies results showed that cur-IONPs were predicted to be potential candidates to treat IDA due to its mucoadhesive properties, which could enhance the bioavailability, time residency, and iron absorbance through GIT, in addition to its high safety profile with high drug-likeness properties and oral bioavailability. Finally, molecular dynamic simulation studies revealed stable complexes supporting strength docking studies. Our results focus on the high importance of in-silico drug design studies; however, they need to be supported with in vitro and in vivo studies to reveal the efficacy, toxicity, and bioavailability of cur-IONPs.
Background
Obesity is associated with various health and nutritional issues, including impaired iron metabolism. However, the causal relationship is debatable, and the connection between obesity and iron metabolism remains inconclusive. This study aimed to investigate the relationship between obesity and iron metabolism using an observational cohort study and Mendelian randomization (MR).
Methods
A total of 4,981 individuals were included in the cohort study after screening participants from the National Health and Nutrition Examination Survey (NHANES) cycles of 2003–2006 and 2017–2018. A multivariable linear regression model was used to analyze the association between body mass index (BMI) and iron metabolism indicators (serum iron [SI], serum ferritin [SF], transferrin saturation [TSAT], total iron binding capacity [TIBC], and soluble transferrin receptor [sTfR]). Then, a two-sample MR analysis was conducted to verify causality.
Results
The results showed that SI and TSAT were lower, while SF and sTfR were higher in the obesity group compared to normal-weight individuals. After adjusting for confounding factors in the multivariable linear regression models, BMI was found to be significantly negatively correlated with SI (β = -0.15, 95% CI: -0.17 to -0.12, P < 0.001) and TSAT (β = -0.23, 95% CI: -0.28 to -0.19, P < 0.001), and positively associated with SF (β = 0.57, 95% CI: -0.15 to 1.29, P = 0.120) and sTfR (β = 0.02, 95% CI: 0.02 to 0.03, P < 0.001). However, the difference between BMI and TIBC was not statistically significant (β = 0.02, 95% CI: -0.02 to 0.06, P = 0.328). The MR findings suggested that genetically predisposed BMI was linked to reduced levels of SI (β = -0.073, 95% CI: -0.140 to 0.004, P = 0.036) and TSAT (β = -0.11, 95% CI: -0.18 to -0.04, P = 0.001), and increased levels of SF (β = 0.14, 95% CI: 0.069 to 0.21, P = 0.035), but no causality between BMI and sTfR. Genetically determined iron levels did not show any association with BMI.
Conclusion
Although altered iron status may not increase the risk of obesity, a correlation and causal relationship between obesity and iron metabolism was observed.
The supply and control of iron is essential for all cells and vital for many physiological processes. All functions and activities of iron are expressed in conjunction with iron-binding molecules. For example, natural chelators such as transferrin and chelator–iron complexes such as haem play major roles in iron metabolism and human physiology. Similarly, the mainstay treatments of the most common diseases of iron metabolism, namely iron deficiency anaemia and iron overload, involve many iron–chelator complexes and the iron-chelating drugs deferiprone (L1), deferoxamine (DF) and deferasirox. Endogenous chelators such as citric acid and glutathione and exogenous chelators such as ascorbic acid also play important roles in iron metabolism and iron homeostasis. Recent advances in the treatment of iron deficiency anaemia with effective iron complexes such as the ferric iron tri-maltol complex (feraccru or accrufer) and the effective treatment of transfusional iron overload using L1 and L1/DF combinations have decreased associated mortality and morbidity and also improved the quality of life of millions of patients. Many other chelating drugs such as ciclopirox, dexrazoxane and EDTA are used daily by millions of patients in other diseases. Similarly, many other drugs or their metabolites with iron-chelation capacity such as hydroxyurea, tetracyclines, anthracyclines and aspirin, as well as dietary molecules such as gallic acid, caffeic acid, quercetin, ellagic acid, maltol and many other phytochelators, are known to interact with iron and affect iron metabolism and related diseases. Different interactions are also observed in the presence of essential, xenobiotic, diagnostic and theranostic metal ions competing with iron. Clinical trials using L1 in Parkinson’s, Alzheimer’s and other neurodegenerative diseases, as well as HIV and other infections, cancer, diabetic nephropathy and anaemia of inflammation, highlight the importance of chelation therapy in many other clinical conditions. The proposed use of iron chelators for modulating ferroptosis signifies a new era in the design of new therapeutic chelation strategies in many other diseases. The introduction of artificial intelligence guidance for optimal chelation therapeutic outcomes in personalised medicine is expected to increase further the impact of chelation in medicine, as well as the survival and quality of life of millions of patients with iron metabolic disorders and also other diseases.
Purpose
Iron deficiency anemia (IDA) is the most common nutritional anemia in the world and a pervasive health problem, especially in developing countries. Children under two years of age are more prone to be affected by IDA. The best strategy to prevent and treat IDA is to use iron supplements. This study aims to examine the factors associated with noncompliance (such as non-utilization or inconsistent usage) of iron drop supplementation among infants between 6 and 24 months old.
Design/methodology/approach
Online databases (PubMed, Scopus and SID) were searched to retrieve relevant articles published from inception up to July 2023. Among the 2,177 articles detected, after removing duplicate and irrelevant titles, 21 cross-sectional studies that met the authors’ inclusion criteria were included. Screening for articles and data extraction were conducted separately by two researchers.
Findings
The findings suggest that some factors related to mothers, such as education, knowledge, attitude and performance; some factors associated with child such as child’s gastrointestinal and dental complications; taste and smell of iron drops; and birth order and gender are the main determinants of adherence to iron supplementation.
Originality/value
It can be proposed that the most significant factors affecting the feeding of iron drops to children under the age of two include: the level of mother’s awareness, socio-economic status of the household and the occurrence of digestive complications following the supplementation. Given these observations, adopting proper policies toward improving the nutritional awareness of mothers and producing iron supplements with minimal side effects seems crucial.
Many epidemiological studies and meta-analyses show that persistent Helicobacter pylori infection in the gastric mucosa can lead to iron deficiency or iron deficiency anemia (IDA), particularly in certain populations of children and adolescents. Moreover, it has been demonstrated that H. pylori infection can lead to and be closely associated with recurrent and/or refractory iron deficiency and IDA. However, the pathogenesis and specific risk factors leading to this clinical outcome in H. pylori-infected children remain poorly understood. In general, most of pediatric patients with H. pylori-associated IDA do not show evidence of overt blood loss due to gastrointestinal hemorrhagic lesions. In adult populations, H. pylori atrophic gastritis is reported to cause impaired iron absorption due to impaired gastric acid secretion, which, subsequently, results in IDA. However, significant gastric atrophy, and the resultant substantial reduction in gastric acid secretion, has not been shown in H. pylori-infected children. Recently, it has been hypothesized that competition between H. pylori and humans for iron availability in the upper gastrointestinal tract could lead to IDA. Many genes, including those encoding major outer membrane proteins (OMPs), are known to be involved in iron-uptake mechanisms in H. pylori. Recent studies have been published that describe H. pylori virulence factors, including specific OMP genes that may be associated with the pathogenesis of IDA. Daily iron demand substantively increases in children as they begin pubertal development starting with the associated growth spurt, and this important physiological mechanism may play a synergistic role for the microorganisms as a host pathogenetic factor of IDA. Like in the most recent pediatric guidelines, a test-and-treat strategy in H. pylori infection should be considered, especially for children and adolescents in whom IDA is recurrent or refractory to iron supplementation and other definitive causes have not been identified. This review will focus on providing the evidence that supports a clear biological plausibility for H. pylori infection and iron deficiency, as well as IDA.
Objective:
The aim of this study was to describe the prevalence of anemia and iron deficiency anemia (IDA) in infants and verify the association of iron deficiency with nutritional status.
Methods:
This cross-sectional and observational study included 104 infants aged between 7 and 9 months, assisted from August to September 2021 by the Family Health Strategy program in Sousa municipality (Paraíba, Brazil). Clinical and anthropometric data were collected, and a 24-h food recall questionnaire was applied using the DietPro software (version 5.0) in order to verify food consumption and assess iron intake. Variables associated with iron deficiency (p<0.05) were analyzed using multiple logistic regression.
Results:
Anemia and IDA were observed in 40.4% and 19.2% of infants, respectively. Only one infant was taking prophylactic supplementation (ferrous sulfate). Infants with IDA presented reduced hemoglobin (p<0.001) and ferritin (p<0.001) and increased Z-scores of body mass index-for-age (Z-BMI) (p=0.027), weight-for-height (p=0.007), and weight-for-age (p=0.032). All Z-scores were inversely correlated with ferritin (Z-BMI [rho: -0.37; p<0.001], weight-for-height [rho: -0.37; p<0.001], and weight-for-age [rho: -0.29; p=0.002]). Ferritin was also directly correlated with daily iron intake (rho: 0.22; p=0.018). Finally, multiple logistic regression showed a significant and direct association of iron deficiency with weight-for-height Z-score (odds ratio: 2.86; 95% confidence interval: 1.38-5.64; p=0.004).
Conclusion:
About 60% of infants presented anemia or IDA. Iron deficiency was associated with the weight-for-height Z-score, showing the vulnerability of infants during the introduction of complementary feeding.
Objectives:
Iron-deficiency anemia (IDA) is a global cause of morbidity in children under five, particularly in sub-Saharan Africa. In southeast Nigeria, poor dietary intake and caregiver knowledge about childhood anemia are observed; however, there is no consensus on how to best prevent it. This study seeks to test the effectiveness of caregiver education on improving anemia knowledge and dietary prevention strategies and promoting sustainable lifestyle changes to reduce the prevalence of childhood IDA.
Study design:
A questionnaire was administered to the primary caregivers of 41 patients under age five with anemia in southeast Nigeria regarding socioeconomic status (SES), diet diversity, and risk factors for anemia. Caregivers were administered a preeducation questionnaire, poster education on anemia and iron-rich foods, and a posteducation questionnaire. All patients underwent a medical exam to confirm a diagnosis of anemia or anemia-related conditions.
Results:
Ninety-five percent of patients had moderate diet diversity, but there was no correlation between diet diversity and SES. Barriers to healthier diets were associated with SES. Preeducation scores were not associated with caregivers' education levels; however, posteducation scores were significantly higher in university-educated than technical-trained caregivers. Caregiver-reported self-efficacy increased after the education program.
Conclusion:
Caregivers' SES was associated with financial and knowledge barriers to a healthier diet but not diet diversity, suggesting that nutritional education could benefit all SES groups. Overall, the education program increased caregivers' anemia knowledge across educational levels. A community-based health education program could improve caregivers' anemia knowledge and self-efficacy in applying this information and potentially reduce this area's pediatric IDA.
Dopamine-related abnormalities in the basal ganglia have been implicated in attention-deficit/hyperactivity disorder (ADHD). Iron plays a critical role in supporting dopaminergic function, and reduced brain iron and serum ferritin levels have been linked to ADHD symptom severity in children. Furthermore, the basal ganglia is a central brain region implicated in ADHD psychopathology and involved in motor and reward functions as well as emotional responding. The present study repurposed diffusion tensor imaging (DTI) to examine effects of an ADHD diagnosis and sex on iron deposition within the basal ganglia in children ages 8–12 years. We further explored associations between brain iron levels and ADHD symptom severity and affective symptoms. We observed reduced iron levels in children with ADHD in the bilateral limbic region of the striatum, as well as reduced levels of iron-deposition in males in the sensorimotor striatal subregion, regardless of diagnosis. Across the whole sample, iron-deposition increased with age in all regions. Brain-behavior analyses revealed that, across diagnostic groups, lower tissue-iron levels in bilateral limbic striatum correlated with greater ADHD symptom severity, whereas lower tissue-iron levels in the left limbic striatum only correlated with anxious, depressive and affective symptom severity. This study sheds light on the neurobiological underpinnings of ADHD, specifically highlighting the localization of tissue-iron deficiency in limbic regions, and providing support for repurposing DTI for brain iron analyses. Our findings highlight the need for further investigation of iron as a biomarker in the diagnosis and treatment of ADHD and sex differences.
Iron deficiency anemia in children is a public health problem. Although oral iron treatment is the first choice, common side effects and compliance problems can cause the treatment to be interrupted. This study retrospectively evaluated children treated with intravenous (IV) iron sucrose or ferric carboxymaltose (FCM) and compared the treatment processes and efficacy. The demographic characteristics and treatment details of the 44 children with iron deficiency anemia were retrospectively evaluated. Iron sucrose was administered to 25 patients and FCM was administered to 19 patients. The IV iron infusion was applied to 64% of the patients because of unresponsiveness to oral treatment, 25% of the patients because of compliance problems, and 11% of the patients because of severe anemia. IV iron therapy increased hemoglobin, mean corpuscular
volume, mean corpuscular hemoglobin, red-cell distribution width, and serum ferritin levels and decreased platelet count. The mean number of infusions per patient in the FCM group was lower, and the total treatment time was shorter. In conclusion, IV iron sucrose or FCM can be used in children with nonadherence to oral therapy and severe anemia in addition to specific indications.
Iron deficiency anemia (IDA) is a worldwide public health problem affecting millions, with developing nations accruing a significant disease burden. Helicobacter pylori (H. pylori) has been proposed in many studies as a causative factor for unexplained iron deficiency anemia. In this systematic review, we searched PubMed, Google Scholar, and ScienceDirect to come up with five cross-sectional studies and five Randomized Controlled Trials (RCTs), which evaluated the association between H. pylori and unexplained iron deficiency anemia and the response of IDA to anti-H. pylori therapy. H. pylori eradication therapy included triple therapy (proton pump inhibitor, clarithromycin, amoxicillin) or quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) for 10-14 days. Quadruple therapy was used if there is a penicillin allergy or a local antibiotic resistance level of more than 15% to clarithromycin. The cross-sectional studies concluded that H. pylori infection was associated with low serum ferritin levels. The RCTs confirmed that H. pylori are associated with iron deficiency anemia by demonstrating improvement in markers of iron status (ferritin, hemoglobin, Mean Corpuscular Volume (MCV), serum transferrin receptor levels) with H. pylori eradication therapy. In a nutshell, this systematic review concludes that H. pylori testing and treatment must be considered as a differential diagnosis of unexplained IDA in all age groups and serves as a benchmark for more randomized clinical trials to prove causation.
Iron deficiency anemia (IDA) has reached epidemic proportions in developing countries and has become a major global public health problem, affecting mainly 0–5-year-old children and young women of childbearing age, especially during pregnancy. Iron deficiency can lead to life-threatening loss of red blood cells, muscle function, and energy production. Therefore, the pathogenic features associated with IDA are weakness and impaired growth, motor, and cognitive performance. IDA affects the well-being of the young generation and the economic advancement of developing countries, such as India. The imbalance between iron intake/absorption/storage and iron utilization/loss culminates into IDA. However, numerous strategic programs aimed to increase iron intake have shown that improvement of iron intake alone has not been sufficient to mitigate IDA. Emerging critical risk factors for IDA include a composition of cultural diets, infections, genetics, inflammatory conditions, metabolic diseases, dysbiosis, and socioeconomic parameters. In this review, we discuss numerous IDA mitigation programs in India and their limitations. The new multifactorial mechanism of IDA pathogenesis opens perspectives for the improvement of mitigation programs and relief of IDA in India and worldwide.
Case series
Patients: Male, 20-month-old • Female, 6-month-old
Final Diagnosis: Iron deficiency anemia
Symptoms: Pallor
Medication: —
Clinical Procedure: —
Specialty: Pediatrics and Neonatology
Objective
Unusual clinical course
Background
Iron deficiency anemia is the most widespread, preventable, and treatable cause of anemia in children. Potential causes of iron deficiency anemia are prolonged breastfeeding with poor quality of introduced solid food and the use of whole cow milk instead of iron-rich formula. We describe 2 unusual cases of nutritional iron deficiency anemia with profound low level of hemoglobin around 1 g/dl, with similar diagnosis and different hospital course.
Case Reports: First case
A 20-month-old Saudi boy presented with symptoms of acute gastroenteritis. He was noted to be very pale, with extremely low hemoglobin value of 1.1 g/dl. His nutritional status mostly consists of breast-feeding, with poor iron-rich food. He was admitted to the pediatric intensive care unit with a complicated hospital course of reversible cardiomyopathy and gut involvement.
Second case
A 26-month-old Saudi girl presented with complaints of severe pallor and fatigability for 2 months, with critical result of extreme low level of hemoglobin 1.2 g/dl. A detailed nutritional history revealed being exclusively on pasteurized cow’s milk with no solid food intake for 6 months.
Conclusions
Neglected cases of nutritional iron deficiency anemia may lead to profoundly low levels of hemoglobin. Possible manifestations include heart failure and gastrointestinal involvement in the form of leaky gut syndrome or exudative enteropathy. IV iron therapy was a very effective treatment in both patients. To our knowledge, probably no reported cases of severe iron deficiency anemia reaching this extremely low level of hemoglobin with multiple associated complications exist in the pediatric literature.
Background: Pediculosis capitis is a common human parasitic infestation in childhood. This article aims to provide a narrative updated review on the management of pediculosis capitis.
Methods: A PubMed search was performed with Clinical Queries using the key terms “pediculosis capitis” OR “head lice” OR “head louse”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews published within the past 10 years. The search was restricted to articles published in English literature. The information retrieved from the search was used in the compilation of the present article.
Results: Topical permethrin and pyrethrin formulated with piperonyl butoxide are the pediculicides of choice in areas where resistance to these products is low. When resistance to these products is suspected based on local levels of resistance or when treatment with these products fails despite their correct use, and reinfestation does not seem to be responsible, other topical treatment options include malathion, benzyl alcohol, dimethicone, spinosad and ivermectin. Wet combing should be considered for children younger than 2 years. Oral ivermectin and trimethoprim/sulfamethoxazole should be reserved for patients who do not respond to appropriate topical pediculicides.
Conclusion: Many topical pediculicides are effective for the treatment of pediculosis capitis. The use of some of these pediculicides is limited for safety reasons, especially in children younger than 2 years. Resistance to pediculicides, especially those with a neurotoxic mode of action, is another concern which may limit the use of some of these pediculicides. New products should be evaluated for effectiveness and safety. Wet combing is time-consuming and should not be used as the sole intervention in the general population.
Introduction
Both diabetes mellitus (DM) and iron deficiency anemia (IDA) are prevalent in every area of the world, and so, the possibility of these two diseases co-existing is also very high. It is our belief that clinical results of any correlation between iron status of the body and glycosylated haemoglobin (HbA1c) would be beneficial to many patients, therefore in this study, the effect of IDA on HbA1c was investigated.
Materials – methods
A total of 146 patients with DM and IDA were evaluated prospectively. While the patients were administered 270 mg/day of ferrous sulphate (80 mg elemental iron) orally for three months for the treatment of IDA, no interventions were made for the treatment of DM. Patient levels of hemoglobin (Hb), hematocrit, red blood cells (RBC), mean corpuscular volume (MCV), platelet, white blood cells (WBC), serum iron, serum iron binding capacity (SIBC), ferritin, fasting plasma glucose (FPG), HbA1c, body mass index (BMI), C-reactive protein (CRP) values were measured at baseline and at the third month of treatment with iron, and were compared.
Results
The median age of our patients was 45 (40–50) and median duration of diabetes was 3 years (1,75–5). While the baseline median Hb was 10.4 (mg/dL) (9.5–11.1), MCV was 74 (fL) (70.8–77), ferritin was 4 (ug/L) (3–6) at three months, Hb was measured at 12.6 (mg/dL) (12.1–13.2), MCV was measured at 82 (fL) (80–86), ferritin was measured at 15 (ug/L) (9–21.2) and was significantly higher compared to baseline values (p < 0.001). The baseline median HBA1c of patients was 7.09 ± 0.51 (%) and three month HBA1c was 6.69 ± 0.53 (%), which was significantly lower than when comparing baseline values with values at third month (p < 0.001). Baseline and three month values for FPG were 118 (mg/dL) (108–132) and 116 (mg/dL) (106–125) respectively, and there was no significant difference (p:0.07). A 2.2 mg/dL (1.5–3.5) increase in median Hb level accompanied a 0.4 % (0.2–0.6) decrease in median HbA1c levels (Spearman rho = −0.362; p < 0.001).
Conclusion
Our study has shown conclusivly that IDA is related to increased HbA1c concentrations and HbA1c decreases significantly following treatment with iron. IDA should be considered before making any decisions regarding diagnosis or treatment according to HbA1c.
Purpose
This study evaluated the peripheral hearing and central auditory processing abilities in Indian adolescent girls with iron deficiency anemia (IDA).
Method
The participants consisted of 75 adolescent girls with IDA, 50 adolescent girls without IDA, and 50 adolescent boys without IDA. Participants underwent a test battery to evaluate auditory processing and peripheral hearing assessment. In this study, central auditory processing abilities were assessed using Speech Perception in Noise test in Kannada (SPIN-K) and quick speech perception in noise tests in Kannada, dichotic consonant–vowel test, gap detection threshold (GDT), and auditory digit sequencing and auditory digit span tests.
Results
Results showed that the hearing thresholds at extremely low and high frequencies (250 and 8000 Hz), although within clinically normal limits, were poorer in girls with IDA than in the control groups. Also, girls with IDA performed poorly in SPIN-K of the right ear, GDT, and auditory backward digit span tests.
Conclusion
These subtle auditory deficiencies may be attributed to the compromised blood supply to the central auditory nervous system, as observed in the current study.
(1) Background: Anemia has comprehensive adverse effects on the growth and development of children. In this study, we analyzed the potential effects of different types of anemia on early-life neurobehavioral development. (2) Methods: A total of 2601 children aged 6–24 months, whose parents agreed to participate in this study, underwent routine blood tests and neurobehavioral development assessment. The children’s parents or other primary caregivers were interviewed with a face-to-face questionnaire at the time of enrollment in the study. Anemia was determined by hemoglobin < 110 g/L and classified into iron-deficiency and non-iron-deficiency anemia according to the levels of serum ferritin, C-reactive protein, and alpha-1-acid glycoprotein. Neurobehavioral development was assessed by the China Developmental Scale for Children and divided into five domains: gross motor, fine movement, adaptability, language, and social behavior. The development quotient (DQ) was used to measure the level of total neurobehavioral development and each domain of neurobehavioral development. (3) Results: The prevalence of anemia in children aged 6–24 months was 26.45%, of which iron-deficiency anemia only accounted for 27.33%. Compared with children without anemia, those with iron-deficiency anemia had a significantly lower developmental quotient (DQ) for total neurobehavioral development and gross motor and adaptability development. The partial regression coefficients were −1.33 (95% CI −2.36, −0.29; p = 0.012), −1.88 (95% CI −3.74, −0.03; p = 0.047), and 1.48 (95% CI −2.92, −0.05; p = 0.042), respectively. Children with non-iron-deficiency anemia had significantly lower DQ for total neurobehavioral development and gross motor and fine movement development than those without anemia. The partial regression coefficients were −0.94 (95% CI −1.64, −0.25; p = 0.008), −1.25 (95% CI −2.48, −0.03; p = 0.044), and −1.18 (95% CI −2.15, −0.21; p = 0.017), respectively. There were no statistically significant differences in total neurobehavioral development and the five domains of neurobehavioral development between children with non-iron-deficiency and iron-deficiency anemia. The partial β values were 0.40 (95% CI −1.53, 2.33; p = 0.684), 0.21 (95% CI −1.39, 1.81; p = 0.795), 0.63 (95% CI −1.03, 2.28; p = 0.457), 0.16 (95% CI −1.78, 2.10; p = 0.871), 0.35 (95% CI −1.32, 2.01; p = 0.684), and 0.34 (95% CI −0.77, 1.46; p = 0.545), respectively. (4) Conclusions: Both iron-deficiency anemia and non-iron-deficiency anemia were negatively correlated with the neurobehavioral development of children. Negative correlations were found between iron-deficiency anemia and gross motor and adaptability development and between non-iron-deficiency anemia and gross motor and fine movement development.
Objective
To determine whether iron deficiency in infancy is associated with sluggish cognitive tempo (SCT) or attention-deficit/hyperactive-impulsive (AD-HI) symptoms in childhood and adolescence, and whether such behaviors contribute concurrently and predictively to lower verbal and mathematical abilities.
Method
Chilean children (N = 959; 50% male, of Spanish or indigenous descent from working-class backgrounds) were rated by mothers for SCT or AD-HI symptoms at ages 5, 10, and 16 years. Children completed standardized tests assessing verbal and mathematical abilities at ages 5, 10, and 16. At ages 12 and 18 months, children were assessed for iron deficiency.
Results
Adjusting for a comprehensive panel of covariates, greater severity of iron deficiency in infancy was associated with more frequent SCT and AD-HI symptoms at all ages studied. Most effects of iron deficiency on children’s verbal and math skills were indirect, mediated through AD-HI behaviors. Children’s AD-HI symptoms related to lower verbal and math test scores within age and across age.
Conclusions
The long-term associations found between infant iron deficiency and SCT and AD-HI behaviors suggest that the neurodevelopmental alterations that stem from postnatal iron deficiency might play an etiological role in the development of ADHD. Screening for early-life nutritional deficiencies among children with SCT or ADHD symptoms might prove useful, and behavioral screening of children with a history of iron deficiency seems warranted. Interventions that support brain development after early nutritional deprivation also would be beneficial.
Introduction
Iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are common causes of anaemia with similar clinical and laboratory features. IDA is caused by low iron stores while ACD is due to iron-restricted erythropoiesis occurring in inflammatory states. Differential diagnosis requires analysis of multiple biochemical and haematological parameters. IDA can occur simultaneously to ACD (mixed aetiology). It is essential that true iron deficiency is identified, as these patients will require iron therapy. This preliminary study investigated whether hepcidin, the master regulator of iron homeostasis, in conjunction with reticulocyte haemoglobin equivalent (RetHe) has the potential to differentiate IDA from ACD, and to exclude IDA in patients with mixed aetiology.
Methods
Hepcidin concentration (measured using a commercially available ELISA method), RetHe, and iron parameters along with C-reactive protein (CRP) were analysed in 77 Gastroenterology patients with anaemia in a secondary care setting.
Results
Receiver operator characteristic (ROC) analysis showed that hepcidin at an optimal cut-off concentration of <6ng/ml could identify IDA with a sensitivity and specificity of 88.9% and 90.6% respectively and could distinguish ACD from IDA with both a sensitivity and specificity of 100% at a cut-off of >46ng/ml. Identifying true IDA in mixed aetiology patients could be achieved by RetHe analysis and applying an optimal cut-off of <30pg.
Conclusion
Hepcidin, in conjunction with RetHe, offers a new simplified diagnostic pathway for differential diagnosis of IDA and ACD, thereby reducing the diagnostic turnaround time and allowing appropriate treatment of patients with a true iron deficiency.
Iron deficiency anemia (IDA) is common among children with cerebral palsy (CP), and studies on the efficacy of lactoferrin (Lf) in the treatment of IDA are limited. This study aimed to compare the efficacy of Lf with that of iron hydroxide polymaltose complex (IPC) in the treatment of IDA in children with CP. This randomized controlled study, conducted at Alexandria University Children’s Hospital, enrolled 70 children aged 1–10 years with CP and IDA; 35 children randomly received IPC, whereas the other 35 received Lf. Four children withdrew from the study; thus, only 66 children were analyzed (32 in the IPC group and 34 in the Lf group). At baseline, the hemoglobin level and other blood parameters were similar between the two intervention groups. After four weeks of treatment, both the IPC and Lf groups showed significant improvements in hemoglobin (Hb), serum ferritin (SF), serum iron, total iron-binding capacity, mean corpuscular volume, and mean corpuscular hemoglobin from baseline. Upon comparing the two treatment groups, adjusted mean Hb and SF changes in the Lf group were significantly higher than that of the IPC group (p =0.001and p= 0.033, respectively), and constipation was less likely to occur in the Lf group than the IPC group (p = 0.049 ).Conclusion: Lactoferrin is effective and superior to IPC as an oral iron replacement therapy in children with CP and IDA, as it has fewer side effects.
What is Known:
• Lactoferrin (LF) is a natural glycoprotein capable of treating iron deficiency anemia (IDA).
• Studies on the efficacy of Lf in the treatment of IDA in children with cerebral palsy (CP) are limited.
What is New?
• This trial compared the efficacy of Lf and iron hydroxide polymaltose complex (IPC) as treatments of IDA in children with CP.
• Lf is effective and even better than IPC as a treatment of IDA in children with CP, as it has fewer side effects.
Background: Febrile seizure is the most common cause of seizure in children. Iron deficiency, by lowering seizure threshold, is proposed to be one of the risk factors for febrile seizure. Many studies have been done to determine the association of iron deficiency anemia with febrile seizure but the results are controversial. Hence, the present study was conducted to evaluate the association of iron deficiency anemia with febrile seizure in Nepalese children.
Methods: A prospective age and sex matched case control study was performed in 68 cases of febrile seizures and 68 controls of febrile illness without seizure after calculating the sample size. The study was conducted from October 21, 2019 to October 20, 2020 in Pediatric ward and intensive care unit of College of Medical Sciences, Bharatpur, Nepal after obtaining ethical clearance from institutional review committee. Data entry was done in statistical packages for the social science version 20.
Results: Mean of haematological parameters (haemoglobin and mean corpuscular volume) as well as mean of serum iron, ferritin and transferrin saturation were significantly less and total iron binding capacity was significantly high in cases as compared to controls (P
Objective
The objective of this single‐center observational study was to determine the clinical and hematologic responses to intravenous ferric carboxymaltose (FCM) in a cohort of pediatric patients with poor response to oral iron therapy. The occurrence of adverse events was systematically recorded for up to 96 hours after infusion.
Study design
A retrospective cohort of 144 consecutive patients aged 18 months to < 18 years with iron deficiency anemia (IDA) or iron deficiency (ID) without anemia was investigated. All patients had failed oral iron therapy. The assessments before and after FCM treatment followed a predefined protocol.
Results
One hundred of 117 (85 %) of patients with complete data achieved the target ferritin level ≥ 30 µg/L after a single FCM dose. Of 77 patients with IDA and complete data, 38 (49%) showed a complete hematological response within 6‐12 weeks; a complete or partial response was achieved by 83%. Clinical symptoms improved in 85% of all patients. In 92% of patients (n = 133 /144), FCM infusion was uneventful. During the 96‐hour follow‐up, five patients reported potentially related symptoms. No serious adverse events occurred.
Conclusion
The study confirms the safety and efficacy of FCM in children (aged 18 months and older) and adolescents unresponsive to oral therapy, in real‐world experience. Single‐dose FCM treatment was followed by clinical improvement with advantages of safety, compliance, and lower cost compared with previous generation parenteral iron preparations that had to be administered in fractionated sessions.
Systemic iron homeostasis is regulated by the interaction of the peptide hormone, hepcidin and the iron exporter, ferroportin. The objective was to investigate the relationship between the consumption of cow’s milk and iron deficiency anemia in children 2–10 years old and its association with the hepcidin-25 and ferroportin concentrations. The study population consisted of 187 prepubescent children of similar ideal body weight (IBW:90–120%); 82 children with iron deficiency anemia (37girls and 45boys; 4.27 ± 0.28 years) and 105 (47girls and 58boys; 4.25 ± 0.34 years) healthy age-sex-matched controls. Serum fasting hepcidin-25/ferroportin concentrations were measured by enzyme immunoassay in all subjects. Mean cow’s milk consumption in the anemic group (373 ± 248 mL/d) tended to be higher than that in the control group (320 ± 226 mL/d), but the result was not statistically significant (p = 0.063).The mean hepcidin-25 level was significantly higher in the anemic group (19.5 ± 18.4 ng/mL) than in the healthy controls (11.0 ± 10.7, p < 0.001). The mean ferroportin level was lower in the anemic group (21.04 ± 5.74 ng/mL) than in the healthy controls (22.68 ± 4.77 ng/ml, p = 0.037). Consuming cow’s milk was not associated with IDA in prepubertal children, provided that it was adequately supplemented with iron-enriched foods. We observed a significant increase in hepcidin-25 levels and a decrease in ferroportin levels in children with iron deficiency anemia compared with healthy controls. Children who consumed more cow’s milk had higher levels of hepcidin-25. Iron deficiency anemia is not a concern when cow’s milk is given to children if the complementary foods are rich in iron.
Background: Iron deficiency may impair adaptive immunity and is common among African infants at time of vaccination. Whether iron deficiency impairs vaccine response and whether iron supplementation improves humoral vaccine response is uncertain.
Methods: We performed two studies in southern coastal Kenya. In a birth cohort study, we followed infants to age 18 mo and assessed whether anemia or iron deficiency at time of vaccination predicted vaccine response to three-valent oral polio, diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine, ten-valent pneumococcal-conjugate vaccine and measles vaccine. Primary outcomes were anti-vaccine-IgG and seroconversion at age 24 wk and 18 mo. In a randomized trial cohort follow-up, children received a micronutrient powder (MNP) with 5 mg iron daily or a MNP without iron for 4 mo starting at age 7.5 mo and received measles vaccine at 9 and 18 mo; primary outcomes were anti-measles IgG, seroconversion and avidity at age 11.5 mo and 4.5 y.
Findings: In the birth cohort study, 573 infants were enrolled and 303 completed the study. Controlling for sex, birthweight, anthropometric indices and maternal antibodies, hemoglobin at time of vaccination was the strongest positive predictor of: (A) anti-diphtheria and anti-pertussis-IgG at 24 wk (p = 0.0071, p = 0.0339) and 18 mo (p = 0.0182, p = 0.0360); (B) anti-pertussis filamentous hemagglutinin-IgG at 24 wk (p = 0.0423); and (C) anti-pneumococcus 19 IgG at 18 mo (p = 0.0129). Anemia and serum transferrin receptor at time of vaccination were the strongest predictors of seroconversion against diphtheria (p = 0.0484, p = 0.0439) and pneumococcus 19 at 18 mo (p = 0.0199, p = 0.0327). In the randomized trial, 155 infants were recruited, 127 and 88 were assessed at age 11.5 mo and 4.5 y. Compared to infants that did not receive iron, those who received iron at time of vaccination had higher anti-measles-IgG (p = 0.0415), seroconversion (p = 0.0531) and IgG avidity (p = 0.0425) at 11.5 mo.
Interpretation: In Kenyan infants, anemia and iron deficiency at time of vaccination predict decreased response to diphtheria, pertussis and pneumococcal vaccines. Primary response to measles vaccine may be increased by iron supplementation at time of vaccination. These findings argue that correction of iron deficiency during early infancy may improve vaccine response.
Despite improvements in nutritional status, iron deficiency anemia (IDA) remains a debilitating nutritional problem worldwide. We estimate annual IDA prevalence rates by sex and age and the trends therein in Korea. We also calculate the health expenditures of IDA and its co-morbidities by analyzing claims data in the National Health Information Database from 2002 to 2013. All analyses were performed based on diagnosis codes of IDA (D50, D50.0, D50.8, and D50.9) regardless of whether IDA was the principal or a coexisting disease. Trends in IDA prevalence rates were evaluated by calculating annual percent changes (APCs) in prevalence. The health expenditures of IDA were calculated based on the direct medical costs (outpatient and hospitalization costs, pharmaceutical costs) and direct non-medical costs (travel costs). The overall IDA prevalence in both sexes increased approximately 2.3-fold from 2002 to 2013; the APC was +7.6%. In females, the prevalence of IDA was highest in aged 30–39 and 40–49 years. The APC was highest in those aged <10 years (+18.2%), followed by those aged ≥80 (+14.7%) and 70–79 (+9.8%) years. In males, the prevalence rates were highest in aged <10 years, followed by those aged ≥60 years. The APC was highest in those aged <10 years (+19.1%), followed by those aged ≥80 years (+10.5%). The total health expenditures increased 2.8-fold during 12 years. Diseases of the respiratory or gastrointestinal tract were the most prevalent co-morbidities in both males and females. The annual prevalence of IDA continues to rise in association with adverse health expenditures and co-morbidities in spite of improvements in nutritional status. Most importantly, infants and young children, the elderly, and females aged 30–49 years are at highest risk of IDA. A national, prospective, and well-organized effort to improve iron status and to manage IDA is required.
Anemia of chronic diseases is a condition that accompanies a specific underlying disease, in which there is a decrease in hemoglobin, hematocrit and erythrocyte counts due to a complex process, usually initiated by cellular immunity mechanisms and pro-inflammatory cytokines and hepcidin. This is the second most common type of anemia after iron deficiency anemia in the world. Its severity generally correlates with the severity of the underlying disease. This disease most often coexists with chronic inflammation, autoimmune diseases, cancer, and kidney failure. Before starting treatment, one should undertake in-depth diagnostics, which includes not only assessment of complete blood count and biochemical parameters, but also severity of the underlying disease. The differential diagnosis of anemia of chronic diseases is primarily based on the exclusion of other types of anemia, in particular iron deficiency. The main features of anemia of chronic diseases include mild to moderate lowering of hemoglobin level, decreased percentage of reticulocyte count, low iron and transferrin concentration, but increased ferritin. Due to the increasingly better knowledge of the pathomechanism of chronic diseases and cancer biology, the diagnosis of this anemia is constantly expanding with new biochemical indicators. These include: the concentration of other hematopoietic factors (folic acid, vitamin B12), hepcidin, creatinine and erythropoietin. The basic form of treatment of anemia of chronic diseases remains supplementation with iron, folic acid and vitamin B12 as well as a diet rich in the above-mentioned hematopoietic factors. The route of administration (oral, intramuscular or intravenous) requires careful consideration of the benefits and possible side effects, and assessment of the patient’s clinical status. New methods of treating both the underlying disease and anemia are raising hopes. The novel methods are associated not only with supplementing deficiencies, but also with the administration of drugs molecularly targeted to specific proteins or receptors involved in the development of anemia of chronic diseases.
Objective:
To analyze the association of anemia with the socioeconomic vulnerability of preschoolers in public day care centers, in the city of Taubaté, SP, Brazil.
Methods:
This is a cross-sectional study with a probabilistic sample that analyzed 363 children assisted in public day care centres in low-income and high-income areas of Taubaté, SP, Brazil. The hemoglobin concentration (Hb), dependent variable, was obtained by digital puncture, considering anemic children with Hb concentration <11.0 g/dL. The independent variables such as socioeconomic and demographic conditions were collected by a semi-structured questionnaire.
Results:
The prevalence of iron deficiency anemia was 19.3% among preschoolers. Children from day care centers with high socioeconomic vulnerability had lower Hb concentration than those from a non-vulnerable area (p<0.05).
Conclusions:
The lower concentration of hemoglobin in preschoolers is associated with the location of day care centers in an area of socioeconomic vulnerability. Children attending these day care centers face adverse family conditions such as low income, working mothers, and mothers with low schooling, though they receive social benefits and monitoring by public health services.
Anemia, defined as a low blood hemoglobin concentration, is a major global public health problem. Identification of anemia is crucial to public health interventions. It is estimated globally that 273 million children under 5 years of age were anemic in 2011, and about ~50% of those cases were attributable to iron deficiency (Lancet Global Health 1:e16–e25, 2013). Iron-deficiency anemia (IDA) in infants adversely impacts short-term hematological indices and long-term neuro-cognitive functions of learning and memory that result in both fatigue and low economic productivity. IDA contributes to death and disability and is an important risk factor for maternal and perinatal mortality, including the risks for stillbirths, prematurity, and low birth weight (Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Ch. 3 (World Health Organization, Geneva, 2004)). Reduction in early infantile anemia and newborn mortality rates is possible with easily implemented, low- to no-cost intervention such as delayed cord clamping (DCC). DCC until 1–3 min after birth facilitates placental transfusion and iron-rich blood flow to the newborn. DCC, an effective anemia prevention strategy, requires cooperation among health providers involved in childbirth, and a participatory culture change in public health. Public intervention strategies must consider multiple factors associated with anemia listed in this review before designing intervention studies that aim to reduce anemia prevalence in infants and toddlers.
Anemia, defined as a low blood hemoglobin concentration, is a major global public health problem and identification of anemia is crucial to public health interventions.
Delayed cord clamping (DCC) until 1–3 min after birth facilitates placental transfusion and iron-rich blood flow to the newborn.
Reduction in early infantile anemia and newborn mortality rates is possible with easily implemented, low- to no-cost intervention such as DCC.
Background:
Iron deficiency anemia (IDA) is highly prevalent in the Cote d'Ivoire and has severe health and economic consequences. In this paper, we apply a health economic model to quantify the burden of IDA, and the contribution of nationwide mandatory iron fortification of wheat flour and voluntary iron fortification of condiments to the reduction of this burden.
Methods:
The analysis for the population from 6 months to 64 years builds on published reviews and publicly available datasets and is stratified by age-groups and socioeconomic strata using comparative risk assessment model.
Results:
Without the impact of these fortification strategies, the annual burden of IDA is estimated at 242,100 disability adjusted life years (DALYs) and 978.1 million USD. Wheat flour and condiment fortification contributed to a reduction of the IDA burden by approximately 5% each.
Conclusion:
In places with high prevalence of malaria and other infectious diseases, such as the Côte D'Ivoire, food fortification as a nutritional intervention should be accompanied with infectious disease prevention and control. The findings of this study provide additional input for policy makers about the magnitude of the impact and can support the conception of future fortification strategies.
Congenital atransferrinemia is an extremely rare autosomal recessive disorder resulting in the complete absence or extremely reduced amount of transferrin. In this study, we describe the first case of congenital atransferrinemia in Tunisia and the 18th patient in the reported data. The patient was referred to our hospital to explore a severe hypochromic and microcytic anemia. The laboratory evaluation including hematological and biochemical examination was performed in the proband and her parents. All exons of the transferrin gene were PCR amplified. The products were screened for mutations by direct sequencing. Based on laboratory and clinical findings, diagnosis of congenital atransferrinemia was confirmed. DNA sequencing revealed the presence of a novel homozygous deletion (c.293-63del) in the intron 13. This mutation is predicted to generate a higher score cryptic branch point leading to the production of an altered mRNA molecule. The second previously reported missense mutation p.Arg609Trp. Crystallographic structure analyzes demonstrate that the mutation would probably lead to significant conformational change not allowing the expression of transferrin protein. Current molecular characterization of this novel transferrin abnormality puts to the proof the variability in onset, first blood transfusion, and phenotypic expression in atransferrinemic patients.
Background:
Iron deficiency (ID) and ID anemia (IDA) are common in the member states of the Gulf Cooperation Council (GCC). The unique genetic and lifestyle factors of the patient population in the region have necessitated the development of recommendations to help educate health-care professionals on appropriate diagnosis and management of ID/IDA.
Methods:
A panel of regional experts, including gastroenterologists and hematologists with expertise in the treatment of IDA, was convened to develop regional practice recommendations for ID/IDA. After reviewing the regional and international literature, the expert panel developed consensus recommendations for screening, diagnosis, and treatment of patients with IDA in the GCC region.
Results:
The recommendations proposed were customized to the patient population keeping in view the increasingly recognized burden of coeliac disease, high fertility and obesity rates, high prevalence of alpha- and beta-thalassemia traits, and poor tolerance and low treatment compliance with oral iron therapy.
Conclusions:
This consensus statement proposes recommendations for screening, diagnosis, and treatment of IDA in the GCC region.
Screening and diagnosis of iron deficiency anemia (IDA) is cumbersome as it may require testing for hemoglobin, ferritin, and an inflammatory biomarker. The aim of this study was to compare the diagnostic capacity of hematologic biomarkers to detect IDA among pregnant women in Tanzania.
We pooled data from an iron supplementation trial of 1500 iron-replete pregnant woman and a prospective cohort of 600 iron-deficient pregnant women. Receiver operating characteristic curves (ROC) for hematologic biomarkers were used to assess the sensitivity, specificity, and area under the curve (AUC) for iron deficiency (ID) and iron deficiency anemia (IDA), crude, or corrected for inflammation. Regression models assessed the relationship of baseline biomarker categories (gestational age <27 weeks) and IDA at delivery.
Hemoglobin had the largest AUC for crude ID (0.96), while hepcidin had the largest AUC for corrected ID (0.80). The optimal hepcidin cutoff for the diagnosis of corrected IDA based on maximal sensitivity and specificity was ≤1.6 µg/L. An hepcidin cutoff of <4.3 µg/L had a sensitivity of 95% for regression-corrected ID. Among iron-replete women who did not receive iron, the association of baseline hemoglobin >110 g/L with IDA at delivery (RR = 0.73; 95% CI: 0.47, 1.13) was attenuated. Baseline hepcidin >1.6 µg/L was associated with reduced risk of anemia at delivery by 49% (95% CI: 27%, 45%).
Ascertaining hemoglobin and hepcidin levels may improve the targeting of iron supplementation programs in resource-limited countries, though hepcidin’s high costs may limit its use.
Aim
To study the frequency of iron deficiency anemia (IDA) in individuals with type 2 diabetes mellitus (T2DM) seen at tertiary diabetes care centres across India.
Methods
This is a retrospective study (January 1, 2017–December 31, 2019), which included 1137 individuals with T2DM, aged ≥18 years, for whom data on glycemic, lipid and haematological parameters were available. Anthropometric measurements were done using standardized techniques. Biochemical investigations included fasting plasma glucose[FPG], post prandial plasma glucose, HbA1c, lipids and serum ferritin and iron wherever feasible.
Results
Of the 1137 individuals included for the study, 117 (10.3%) were categorized as no ‘iron deficiency’ (ID) group [normal hemoglobin: male ≥13 g/dl, female ≥12 g/dl and normal serum ferritin ≥70 μg/L], 123 (10.8%) as ID group [normal hemoglobin and low serum ferritin <70 μg/L)], 447 (39.3%) as IDA group [low haemoglobin: male <13 g/dl, female <12 g/dl and low serum ferritin] and 450 (39.6%) as ‘anemia of chronic disease’ (ACD) group [low hemoglobin and normal serum ferritin]. The percentage of women having ID (57.7%) and IDA (65.3%) was significantly higher than their male counterparts. ID was most prevalent (61.7%) in the individuals with duration of diabetes <5 years whereas ACD was most prevalent (50.5%) in individuals with long standing diabetes (>10 years). Independent risk factors for IDA were female gender (OR 3.3,95% CI:1.75–6.23, p < 0.001), duration of diabetes (OR 1.05, 95% CI 1.01–1.11, p = 0.028) and FPG (OR 1.01, 95% CI 0.99–1.00, p = 0.018).
Conclusions
There is a need of identifying and monitoring iron status and anemia in patients with T2DM.
Malnutrition is among the top 6 risk factors for death in India, and iron deficiency anemia (IDA) is regarded as one of the major contributors, with nationwide prevalence >60% among women. Nutritional anemia accounts for ∼70% anemia prevalence among Indian children and adolescents, specifically in females. Evidence suggests that current supplementation and fortification practices alone may make little difference in reducing the risk of IDA. Sustainable food-based strategies need to be determined. This review provides an overview of IDA in India and elaborates the food-based solutions. Factors that affect iron bioavailability have been discussed while exploring different plant-based food synergies to improve iron absorption. Nutritional and non-nutritional challenges have been highlighted. A case study has been incorporated that analyses Health Management Information System data for certain pregnancy outcomes among severely anemic pregnant women. It highlights the need for implementing alternative food-based strategies apart from the government programs. Iron-rich plant sources, with appropriate ratios of bioavailability enhancers and inhibitors can be utilized to develop effective products. However, this cannot be easily achieved. Obtaining higher concentrations of iron from food sources alone is challenging. Processing techniques may lower antinutrient content but risk mineral loss and vitamin degradation from the food matrix. Most studies focus on increasing iron content via fortification rather than enhancing its bioavailability. Safety, accessibility, and affordability issues of previous approaches need to be addressed. It is essential to understand the chemistry behind iron bio-accessibility and absorption to develop ready-to-eat plant-based food formulations, with highly bioavailable iron, which could be a plausible solution.
Study Objective
To examine the clinical characteristics and prevalence of congenital bleeding disorders (CBDs), with emphasis on congenital factor VII (FVII) deficiency and other rare bleeding disorders, in adolescent and young adult females referred to a Hemophilia Treatment Center (HTC) for evaluation and management of heavy menstrual bleeding (HMB) and iron deficiency anemia (IDA).
Design
This single-center retrospective study reviewed the clinical characteristics and prevalence of CBDs in post-menarcheal females, younger than 22-years-of-age, referred to an HTC from 2015 to 2021 for evaluation of HMB with or without IDA.
Results
One hundred females, mean age of 15 years (range 9 to 20 years), met initial study criteria with 95 included in the final analysis. Forty-five (47%) females were ultimately diagnosed with a CBD. The most prevalent diagnoses were FVII deficiency and type 1 von Willebrand disease (VWD) (42.3%, n= 19 each). Forty-two percent of FVII deficient patients had a low-for-age FVII activity level, 21.1% were only positive for the FVII R353Q variant associated with borderline FVII levels, whereas 36.8% had both a low-for-age FVII activity level and a positive R353Q variant. Eighty percent of patients with a CBD were found to have relatives with abnormal bleeding symptoms.
Conclusions
Congenital FVII deficiency is prevalent among female adolescents experiencing HMB with or without IDA. In addition to VWD, evaluation for this specific factor deficiency should be considered as part of the initial CBD workup. Presence of abnormal bleeding history in the family may also help to predict presence of a CBD.
Purpose of review:
Anemia in pregnancy is associated with increased maternal and neonatal morbidity. There is increasing awareness amongst obstetricians about the need to screen for iron deficiency anemia (IDA), as well as growing literature on diagnosis and treatment. This review aims to summarize causes, consequences, treatment, and evaluation of IDA in pregnancy.
Recent findings:
National guidelines provide varying guidance on diagnosis and treatment of IDA in pregnancy. Serum ferritin is a helpful adjunct for the diagnosis of IDA. Oral iron remains an option for treatment; absorption is improved with every other day dosing and is effective for patients able to tolerate. Emerging studies on modern generations of intravenous (IV) iron demonstrate shorter infusion times and improved safety profiles. Notably, recent UK guidelines provide consideration for universal IV iron supplementation for treatment of anemia beyond 34 weeks of pregnancy.
Summary:
Iron, in dietary, oral, and IV forms, has been found effective in resolving anemia in pregnancy. Pregnant people with IDA in the third trimester are more likely to benefit from IV iron. Future studies designed and powered to assess maternal and perinatal morbidity indicators and blood transfusion rates can strengthen recommendations.
Objectives
Iron amino acid chelates have been developed to be used as food fortificants and therapeutic agents in the treatment of iron deficiency anemia.
Purpose
To compare the efficacy of Oral iron bisglycinate chelate (FeBC), lactoferrin (LF), lactoferrin with iron and iron polymaltose complex (IPC) in treatment of iron deficiency anemia (IDA).
Methods: a comparative study was conducted on 120 children with IDA, they attended to outpatient clinic at Menoufia University Hospitals within a period from April to November 2019. All subjects were classified into FeBC Group (30 children received iron bisglycinate), LF Group (30 children received lactoferrin 100 mg), LF with iron Group (30 children received 30% iron saturated lactoferrin) and IPC Group (30 children received iron polymaltose complex with elemental iron of6 mg/kg/day). Serum iron, serum ferritin, transferrin saturation was investigated.
Results
After treatment serum iron, serum ferritin and transferrin saturation improved in FeBC group than LF group, in LF with iron group than LF group, and in IPC group than LF group. Serum ferritin improved in LF with iron group than IPC group. Side effects of drugs were higher in FeBC group than LF group, and higher in LF with iron group than FeBC group.
Conclusions
Adding lactoferrin to iron helps increasing iron stores more than using iron alone in treatment of iron deficiency anemia. Lactoferrin is less effective than lactoferrin with iron, iron bisglycinate chelate and iron polymaltose complex in treatment of iron deficiency anemia.
Keywords
Children
Iron bisglycinate chelate
Iron deficiency anemia
Lactoferrin
To study trends of anemia among middle-class children, we collected 6,162 hematocrit measurements from the medical records of 2,432 children, ages 9 months through 6 years, as seen at a private pediatric clinic during the past 18 years. A decline in prevalence of anemia was observed during that period. The overall age-adjusted rate of anemia decreased from 6.2% in 1969 to 1973, 5.8% in 1974 to 1977, 3.8% in 1978 to 1981, and 2.7% in 1982 to 1986. The decline was also observed when trends were determined for three age groups using a single hematocrit measurement per child. The 1982 to 1986 prevalences of anemia for various age groups among this middle-class pediatric population were relatively low: 2.8% among 9- to 23-month-old children, 2.4% among 24- to 47-month-old children, and 2.7% among 48- to 83-month-old children. Most of these recent cases of anemia were mild—most were only slightly less than the hematocrit values used to define anemia—and most did not show strong evidence of iron deficiency based on elevated levels of erythrocyte protoporphyrin. We conclude that iron deficiency is now mild and uncommon in these middle-class children. This improved nutritional status with regard to iron is probably related to increased intake of iron among infants and young children during the past two decades. These findings suggest that the recommended screening schedule for iron deficiency with hemoglobin or hematocrit measurements may need to be reassessed for well-defined populations of low-risk children.
Introduction
The pattern of anemia in infancy is changing in North America. The major factors contributing to anemia include iron endowment at birth, adequacy of dietary iron, frequency of infection, and the genetic background of a child. The characteristics of all of these factors are changing in the pediatric population. As more premature infants survive, their inadequate birth endowment of iron results in iron deficiency at an earlier age. Because of widespread use of iron-fortified formulas or iron supplementation with breastfeeding, iron deficiency now causes less anemia in the first year of life. As iron nutrition of infants has improved, anemia associated with infection has been identified more frequently. Increased work force participation of mothers has resulted in more exposure to infections by infants in child care. An increase in the percentage of children who are of Asian and African genetic backgrounds has increased the prevalence of inherited hemoglobin disorders among children. Newborn screening for hemoglobinopathies has resulted in more frequent identification of these disorders.
Decline in the socioeconomic status of children in the United States adds to the complexity of this picture. More than one factor often produces anemia in an infant from a poor family, and the anemia may have a greater impact on the psychosocial development of a child from a low-income background.
Anemia is defined as a low red blood cell count, a low hematocrit, or a low hemoglobin concentration. In pregnancy, a hemoglobin concentration of less than 11.0 g/dL in the first trimester and less than 10.5 or 11.0 g/dL in the second or third trimester (depending on the guideline used) is considered anemia. Anemia is the most common hematologic abnormality in pregnancy. Maternal anemia is associated with adverse fetal, neonatal and childhood outcomes, but causality is not established. Maternal anemia increases the likelihood of transfusion at delivery. Besides hemodilution, iron deficiency is the most common cause of anemia in pregnancy. The American College of Obstetricians and Gynecologists recommends screening for anemia with a complete blood count in the first trimester and again at 24 0/7 to 28 6/7 weeks of gestation. Mild anemia, with a hemoglobin of 10.0 g/dL or higher and a mildly low or normal mean corpuscular volume (MCV) is likely iron deficiency anemia. A trial of oral iron can be both diagnostic and therapeutic. Mild anemia with a very low MCV, macrocytic anemia, moderate anemia (hemoglobin 7.0-9.9 g/dL) or severe anemia (hemoglobin 4.0-6.9 g/dL) requires further investigation. Once a diagnosis of iron deficiency anemia is confirmed, first-line treatment is oral iron. New evidence suggests that intermittent dosing is as effective as daily or twice-daily dosing with fewer side effects. For patients with iron deficiency anemia who cannot tolerate, cannot absorb, or do not respond to oral iron, intravenous iron is preferred. With contemporary formulations, allergic reactions are rare.
1. Based on level A epidemiologic data, the epidemiology of the gold standard for assessing lead (Pb) exposure and absorption in young children, blood Pb levels (BLLs), shows a public health success story during the past 50 years. 2. However, during the same period, our knowledge about Pb toxicity has pushed the BLL of concern lower and lower. We still do not have a safe BLL below which we cannot demonstrate toxicity. Based on level A observational studies, some Pb effects on the brain are permanent. 3. Based on level A epidemiologic evidence, in lieu of a BLL toxicity threshold, the CDC has chosen to direct intervention efforts at children with the highest levels, which in a 2010 nationally representative cohort was at least 5 lg/dL (2.17 mmol/L), chelation therapy. 5. Although the magnitude of Pb poisoning in the United States has been reduced, new sources of exposure are continually being discovered, as well as old sources in new locations, such as water fountains and walls in schools. Based on level A evidence from epidemiologic data, because enormous amounts of Pb have been disseminated throughout the United States, millions of children likely will continue to become Pb poisoned in the coming decades. Based on level A evidence from epidemiologic studies, in other countries, Pb poisoning still has lethal outcomes. 6. Based on level D evidence, the primary care provider is in the prime position to prevent the possibility of Pb poisoning from becoming a reality through assessments of patients, education of caregivers, and advocacy to eliminate exposure.
Background
Although intravenous ferric carboxymaltose (FCM) is effective in treating iron deficiency anemia (IDA) in paediatric inflammatory bowel disease (pIBD), no data are available on its post-infusion related risks.
Aims
We assessed the efficacy of FCM and the rate of post-infusion hypophosphatemia in a large cohort of children with IBD and IDA.
Methods
All children with IBD with IDA treated with FCM over 5-year period were reviewed. Disease activity, biohumoral assessment and treatments were evaluated at baseline, 4–6 and 12 weeks after each infusion.
Results
128 patients [median age at first infusion: 13 years] were identified, 81 (63.3%) were <14 years, 10 (7.8%) <6 years. Eighty-three children (64.8%) received one infusion, whilst 45 (35.2%) repeated infusions. A significant increase in Hb (p<0.001), iron (p<0.001) and ferritin (p<0.001) was observed 4–6 and 12 weeks post-infusion. Hb gain was unrelated to disease severity. Low baseline iron was the main predicting factor for repeated infusions (p<0.05). Three patients reported infusion reactions, none <6 years. Twenty-five children had low post-infusion serum phosphate (11 were <14 years, 3 <6 years). Two children developed severe hypophosphatemia.
Conclusions
FCM administration is effective for IDA management in pIBD, including children <6 years. Due to the high prevalence of post-infusion hypophosphatemia, serum phosphate monitoring should be mandatory.
Background:
Iron deficiency anemia (IDA) affects millions of children worldwide. Oral iron replacement is effective but often poorly tolerated. Intravenous iron has been demonstrated to have utility in all ages, but pediatric use remains limited. Low molecular weight iron dextran (LMWID) has a dosing range capable of replacing iron deficits in a single infusion and has been evaluated in small pediatric cohorts, but additional safety and efficacy data are limited. Here, we evaluate the safety and efficacy of LMWID in association with an electronic medical record (EMR)-based effort to optimize dosing.
Procedure:
A retrospective IRB-approved investigation of LMWID utilization at a tertiary pediatric hospital between January 1, 2016 and March 31, 2020 was undertaken to evaluate the therapeutic efficacy and frequency/severity of infusion-related adverse event (AE) in children and adolescents receiving LMWID. Patient demographics and LMWID dosing characteristics were collected, and primary outcome measures included laboratory response and the incidence/severity of any infusion-related events. The utilization of an EMR-based nomogram for LMWID dosing was also evaluated.
Results:
A total of 254 infusions for 191 patients were included (ages 0.7-20.9 years), most with IDA. LMWID replaced at least 75% of the estimated iron deficit in a single infusion for 76% of patients. The mean hemoglobin and ferritin increases were 2.1 g/dl and >100 ng/ml, respectively. Infusion-related AEs were rare, occurring in only 12/254 (4.7%) of infusions and 67% during the test dose; each rapidly resolved without long-term sequelae. No AEs occurred in those <10 years of age. Premedication use markedly decreased with nomogram use without a change in AE rate.
Conclusions:
In a large institutional cohort, LMWID was well tolerated in children and adolescents, with most patients having their total iron deficits relieved in a single infusion. These data support expanded use of LMWID in the management of pediatric iron deficiency.
Background:
Iron deficiency anemia (IDA) in children may be confounded with the beta-thalassemia trait (BTT). This study aimed to reevaluate the role of the red blood cell distribution width index (RDWI) in distinguishing BTT from IDA.
Research design and methods:
This cross-sectional study was conducted from June 2018 to February 2019 in two pediatric teaching hospitals in Mosul, Iraq. Two sets of patients with hypochromic microcytic anemia in the age range 6 months-12 years were included. The receiver-operating characteristics curve was used to identify the test best distinguishing BTT from IDA.
Results:
In the first patient set, 54 (51.92%) had IDA and 50 (48.07%) had BTT. The area under the curve (AUC) for the RDWI was larger than for other parameters at 0.963, suggesting a discriminant tool to detect cases of BTT (p-value < 0.0001) . In the second patient set, 25 (42.85%) IDA cases and 20 (57.14%) BTT cases were analyzed, and the RDWI still had the highest AUC when compared with other parameters (p-value < 0.0001). An RDWI cutoff value suggested to differentiate BTT from IDA was 200.18 and 200.35 respectively for both groups.
Conclusions:
RDWI may be a useful screening parameter in differentiating BTT from IDA.
Introduction
Red blood cells (RBCs) in patients with thalassemia and iron deficiency anemia (IDA) exhibit different patterns of morphological changes. However, manual quantitative analysis of the morphological changes in the RBCs is time‐consuming and subjective, limiting its use in differential diagnosis. The aim of this study was to evaluate the CellaVision Advanced RBC software as a prescreening tool for differential diagnosis of thalassemia and IDA.
Methods
The study cohort consisted of 54 thalassemia and 46 IDA cases in the training group and 36 thalassemia and 31 IDA patients in the validation group. The CellaVision DM96 Advanced RBC software was used to analyze the RBC morphology.
Results and Conclusion
Specific patterns of quantitative changes in RBC shapes were found in thalassemia and IDA patients. As a single parameter, target cell was the best morphological cell type to distinguish thalassemia from IDA, with an area under the curve (AUC) of 0.79, followed by hypochromatic cells with an AUC of 0.70. Combination of target and hypochromatic cells expressed as a ratio of the percentage of target cells to percentage of hypochromatic cells (T/H ratio) presented better differential diagnostic ability with an AUC of 0.88. A cutoff value of 1.755 for T/H ratio showed a sensitivity and specificity of 80.43% and 81.48% in the training group and 88.89% and 80.65% in the validation group, respectively.
Assessment of the T/H ratio using the CellaVision Advanced RBC software represents a relatively simple and economical screening procedure for diagnostic testing of thalassemia and IDA.
Objectives:
The pathophysiology and mechanism of Breath-Holding Spells (BHS) remain controversial, and the relationship between BHS and anemia has not been clarified, although iron supplementation appears to be effective in many patients. We aimed to assess the probable relation of iron level with initiation of these spells in children.
Materials & methods:
Overall, 42 children with a diagnosis of BHS, aged between 6 months to 2 yr were enrolled during Mar 2015 to Dec 2016 at Rasht 17th Shahrivar Hospital, Rasht, northern Iran. Ferrous sulfate solution prescribed 6 mg/kg/d, 3 times daily, for all of cases, regardless of their iron levels, and the response to the treatment was evaluated.
Results:
Twenty-five patients were boys (59.52%). The mean age for all patients was 11.71±4.63 months. Positive family history detected in 33.33%; iron deficiency anemia in 21.42%, depletion of iron stores in 52.38%, and normal iron status in 26.19% of cases. Simple spells showed significantly higher mean of Hb in comparison with severe spells (P=0.008); also increased number of spells per month significantly decreased the mean of Hb (P=0.007). Mean frequency of spells was 40.14±47.08 before and 11.14±31.10 after iron therapy, per month (P<0.0001). Overall, 32 patients (76.19%) had complete control of spells, 7 patients (16.66%) partial, 2 cases (4.76%) weak, and 1 child (2.38%) no response after iron therapy.
Conclusion:
Iron deficiency anemia may have an important role in BHS, and treatment of anemia may decrease number of the spells.