Железодефицитные новости

[Dr.Vad]

врачи из Турции подметили, что лечение ЖДА у женщин ассоциируется со снижением окружности талии, веса и ИМТ, также было замечено повышение холестерина высокой плотности и снижение уровня триглицеридов:

Clin Ter. 2014 Mar-Apr;165(2):e87-9.
Treatment of iron deficiency anemia induces weight loss and improves metabolic parameters.
Aktas G, Alcelik A, Yalcin A, Karacay S, Kurt S, Akduman M, Savli H.
Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey.

BACKGROUND: The treatment of iron deficiency anemia is oral iron replacement which has side effects mostly related with gastrointestinal system. A significant rate of the patients that discontinuing the treatment complained of weight gain during treatment in our clinical practise, despite, oral iron preparations are not known to have such a side effect in adults. Therefore, we planned to investigate this myth whether iron preparations cause an increase in weight, waist circumference, body mass index and laboratory metabolic parameters that may accompany to weight gain.

MATERIALS AND METHODS: Twenty-one women admitted to our out-patient clinics with iron deficiency anemia were enrolled to the study. Waist circumference, body weight, body mass index, systolic and diastolic blood pressures, hemogram and other laboratory parameters assessed and recorded at the first visit and repeated 4 to 6 moths after initiation of treatment.

RESULTS: Waist circumference, body weight and BMI significantly reduced in patients after treatment compared to pre-treatment period. Moreover, HDL was increased and triglyceride was decreased significantly in after treatment compared to pre-treatment period.

CONCLUSIONS: We suggest that treatment of iron deficiency may improve not only haematological but also metabolic and anthropometric parameters. Due to the small study population of our cohort, larger prospective studies are needed to confirm our results.

[Dr.Vad]

Подробный обзор по теме как диагностировать/лечить непонятную ЖДА, резистентную к лечению пероральными препаратами железа, от гуру Хайма Хершко:

How I treat unexplained refractory iron deficiency anemia.
Blood. 2014 Jan 16;123(3):326-33.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Интересное наблюдение от чилийских врачей: в то время как у женщин с нормальным весом усвоение железа было примерно одинаковым, если оно давалось с витамином С или без, у женщин с избыточным весом назначение железа с витамином С ( в соотн. 1:2) увеличивало усвоение железа в полтора раза:

A cross sectional sample of 318 Chilean childbearing age women was studied. The women received either a single dose of 0.5mg of Fe (n=137, group 1) or 3mg of Fe plus ascorbic acid (1:2 molar ratio) (n=181, group 2), both as FeSO4 with labeled radioisotopes. Fe absorption was assessed through radio Fe erythrocyte incorporation. Fe status was determined by hemoglobin (Hb), mean corpuscular volume, serum Fe, total iron binding capacity, transferrin saturation, erythrocyte Zn protoporphyrin and serum ferritin (SF).

RESULTS: 29%, 47% and 24% of the women were classified as normal, overweight or obese, respectively. Fe absorption was significantly lower in obese women (p<0.05). In group 1, the geometric mean and range ±1 SD of the percentage of Fe absorption for normal-weight women was 32.9% vs. 19.7% in obese. For group 2, this percentage was 36% vs. 30%, respectively (2-way ANOVA: BMI classification and Fe dose p<0.05; interaction p=0.34). Although Fe absorption was lower in obese women, they had higher SF (p<0.01) and Hb (p<0.05) concentrations.
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J Trace Elem Med Biol. 2014 Apr 5.
Body mass index, iron absorption and iron status in childbearing age women.

[Dr.Vad]

...inflammation increased ferritin by ap 30% and was associated with a 14% (CI: 7%, 21%) underestimation of ID. Measures of both APP and CRP are needed to estimate the full effect of inflammation and can be used to correct ferritin concentrations.
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Am J Clin Nutr. 2010 Sep;92(3):546-55.
Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis.

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Статья из Германии, показывающая как улучшились симптомы связанные со слабостью, депрессивным настроением, головная боль, выпадение волос и др. у женщин с гинекологическими проблемами (плюс ЖДА или латентный ЖД) после введения феринжекта:

Treatment of Iron Deficiency with or without Anaemia with Intravenous Ferric Carboxymaltose in Gynaecological Practices – A Non-Interventional Study

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Депрессия, фобии и ежедневная физическая и умственная работоспособность у женщин с обильными месячными: целый год после успешного лечения потребовался, чтобы улучшить как показатели крови (гемоглобин), так и психоэмоциональное состояние, коррекция ферритина заняла 5 лет:

Acta Obstet Gynecol Scand. 2014 Jun 9.
Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding.
Peuranpää P и соавт.

OBJECTIVE: To assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in women treated for heavy menstrual bleeding (HMB).

DESIGN: Secondary analysis of a randomized controlled trial.

SETTING: Five university hospitals in Finland.

SAMPLE: A total of 236 women referred for HMB.

METHODS: Women were randomized to treatment with hysterectomy or a levonorgestrel-releasing intrauterine system. We defined groups based on women's pretreatment hemoglobin [hemoglobin <120 g/L (anemic) vs. hemoglobin ≥120 g/L (nonanemic)] and serum ferritin (ferritin <15 μg/L vs. ≥15 μg/L) concentrations. HRQoL was compared between groups at baseline, 6 and 12 months after treatment. Hemoglobin and ferritin were followed for 5 years.

MAIN OUTCOME MEASURES: HRQoL was measured by the RAND 36-item health survey (RAND-36), 5-Dimensional EuroQol and two questionnaires of mental wellbeing.

RESULTS: At baseline, 63 women (27%) were anemic and 140 (60%) were severely iron deficient (ferritin <15 μg/L). Only 8% of the anemic women had taken iron supplementation. Twelve months after treatment hemoglobin had increased in both hemoglobin groups, but was still significantly lower (p < 0.001) in initially anemic women (128 g/L) compared with nonanemic women (136 g/L). Twelve months after treatment three domain scores of RAND-36 increased more (energy, p = 0.002; physical functioning, p = 0.04; social functioning, p = 0.05), and anxiety (p = 0.02) and depression scores (p = 0.002) decreased more in anemic compared with nonanemic women. Serum ferritin took 5 years to reach normal levels.

CONCLUSIONS: Improved HRQoL after treatment of HMB is associated with correction of anemia. Clinicians should actively screen for anemia in women with HMB and emphasize early iron substitution as an integral part of treatment.

[Dr.Vad]

Весьма неожиданные наблюдения от медиков из Катара: в/в назначение железа мужчинам с ЖДА (гемоглобин менее 100 г/л) улучшал их гормональный статус и показатели спермограммы:

Indian J Endocrinol Metab. 2014 May;18(3):310-6.
Intravenous iron replacement therapy in eugonadal males with iron-deficiency anemia: Effects on pituitary gonadal axis and sperm parameters; A pilot study.
Soliman A1, Yassin M2, De Sanctis V3.
1Department of Pediatric Endocrinology, Hamad Medical Center, Doha, Qatar.
2Department of Hematology, Hamad Medical Center, Doha, Qatar.
3Department of Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.

AIM OF THE STUDY: To evaluate semen parameters and to assess serum FSH, LH, Testosterone (T) concentrations before and 12 weeks after intravenous iron therapy (800-1200 mg elemental iron therapy - IVI) in adults with iron-deficiency anemia (IDA).

MATERIALS AND METHODS: We studied 11 eugonadal adults with IDA, aged 40 ± 5 years, due to defective intake of iron. Anemia was diagnosed when hemoglobin (Hb) was equal or below 10 g/dl. Serum iron, total iron-binding capacity (TIBC) and ferritin concentrations confirmed the diagnosis of IDA. Basal serum concentrations of FSH, LH, and T were measured. Semen parameters were evaluated before and 6-7 weeks after IVI therapy.

RESULTS: After IVI therapy and correction of anemia, a significant increase of Hb from 8.1 ± 1.17 g/dL to 13.1 ± 0.7 g/dL was observed and was associated with an increase of T (from 12.22 ± 1.4 nmol/L to 15.9 ± 0.96 nmol/L; P < 0.001), FSH (from 2.82 ± 0.87 to 3.82 ± 1.08 IU/L; P = 0.007), and LH (from 2.27 ± 0.9 to 3.82 ± 1.5 IU/L; P = 0.0002). Total sperm count (TSC) increased significantly from 72 ± 17.5 million/ml to 158 ± 49 million/mL (P < 0.001), rapid progressive sperm motility (RPM) increased from 22 ± 9.4 to 69 ± 30 million/ml (P < 0.001), and sperms with normal morphology (NM) increased from 33 ± 5 to 56 ± 7 million/ml (P < 0.001). Increment in Hb concentration was correlated significantly with LH, FSH, and T concentrations after IVI (r = 0.69 and r = 0.44, r = 0.75, respectively; P < 0.01). The increment in serum T was correlated significantly with increments in the TSC and total sperm motility and RPM (r = 0.66, 0.43, and 0.55, respectively; P < 0.001) but not with gonadotrophin levels.

CONCLUSION: Our study proved for the first time, to our knowledge, that correction of IDA with IVI is associated with significant enhancement of sperm parameters and increased concentrations of serum LH, FSH, and T. These effects on spermatogenesis are reached by an unknown mechanism and suggest a number of pathways that need further human and/or experimental studies.