Железодефицитные новости

[Dr.Vad]

апдейт по в/в препаратам железа из Австралии - открытый доступ к полному тексту обзора:

Intravenous iron: an update 2023

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[Dr.Vad]

обзор вышел 3 года назад, но на глаза попалась только сейчас - полная версия по ссылке:

Conclusions
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The bioavailability and side effect profile of ferrous iron salts are similar, but their elemental iron content and cost varies; thus, choice should generally be based on the amount of iron and cost.

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Compared to ferric Fe3+ salts, ferrous Fe2+ salts are generally better absorbed.

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Absorption of oral iron, particularly when taken with meals, will be higher if given with ascorbic acid at a molar ratio of ≥2:1 to iron; that is, about 6 mg of ascorbic acid for each 1 mg of iron.

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Although WHO has recommended intermittent iron supplementation (WHO, 2011), proposing as the rationale a mucosal block in enterocytes lasting for 5–6 days, our data clearly indicate that 48 h, not 5 or 6 days, is sufficient time for iron absorption to return to baseline.

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Given as ferrous sulfate, oral iron doses ≥60 mg in non-anemic women with iron deficiency and ≥100 mg in women with IDA trigger an increase in circulating hepcidin that persists 24 h after the dose, but subsides by 48 h. It appears oral iron doses ≤40 mg do not trigger an acute increase in circulating hepcidin in iron-deficient subjects. This suggests the optimal dosing schedule to maximize fractional iron absorption in women with iron deficiency and mild IDA is to give oral doses ≤40 mg daily and give doses ≥60 mg on alternate days.

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There is a circadian increase in circulating hepcidin over the day and this is augmented by a morning iron dose; therefore, iron doses should not be given in the afternoon or evening after a morning dose.

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If rate of Hb response is important, twice the target daily iron dose can be given on alternate days. However, because fractional iron absorption decreases sharply with increasing iron doses, and unabsorbed luminal iron likely has adverse effects on the gut, lower doses may be better tolerated and improve compliance.
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Oral iron supplementation in iron-deficient women: How much and how often?
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[Dr.Vad]

Длительная терапия железом у пациентов с риском редидива ЖД из-за мальабсорбции или потерь - варианты лечения/мониторинг анализами крови и др.

CHRONIC IRON NEED

There are many populations who will require ongoing iron supplementation beyond initial iron repletion as a maintenance iron therapy. Such populations include those with inflammatory bowel disease and malabsorption (e.g., bariatric surgery) or ongoing GI blood loss (e.g., abnormal uterine bleeding refractory to or awaiting gynecologic intervention).

Current guidelines recommend routinely rechecking complete blood count, reticulocytes, reticulated-Hb content, and iron parameters 3–6 months after initial iron repletion to determine whether ongoing iron supplementation is required and to establish the optimal route, dose, and frequency. For some patients (e.g., women with HBM), asymptomatic outpatients with mild ID/IDA in whom there is no inflammation and in whom oral iron is well tolerated, we are successful in maintaining normal iron stores and Hb levels using once-per-day or every-other-day oral iron. In other patients, a regimen of once per month, once every 3 months, or once every 6 months IV of iron is required, with the goal of maintaining normal iron status (ferritin >30 mg/L; TSAT >20%)
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из Iron deficiency anemia in women: pathophysiological, diagnosis, and practical management.
Cançado RD.
Rev Assoc Med Bras (1992). 2023 Aug 4;69(suppl 1):e2023S112.

[Dr.Vad]

Американский опыт лечения ЖДА в/в феринджектом - оценка некоторых показателей шкал здоровья до и спустя 3 мес. лечения (гемоглобин повысился с 102 до 128 г/л)

total of 152 patients were enrolled.
Mean age was 47.4 ± 16.0 years and 82.2% were female.
All patients were treated with at least one FCM dose at baseline, with 77.6% receiving a two-dose treatment course.
A minimum 5-point improvement, pre-defined as clinically meaningful, was seen in the
FACIT-Fatigue for 73%,
PROMIS Global Physical Health = 53%,
Global Mental Health = 42%,
PROMIS Physical Function scores = 40% of patients at 3 months...
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Int J Gen Med.. 2023 Aug 2;16:3291-3300.
Patient-Reported Outcomes After Ferric Carboxymaltose Treatment for Iron Deficiency Anemia: A Prospective Observational Study

[Dr.Vad]

Железо в лечении психиатрических пациентов - полный текст в журнале "Современная психиатрия" - фрагменты оттуда:

Iron deficiency is common and can cause or contribute to psychiatric symptoms
and disorders. Consider screening patients for iron deficiency and treating it with
oral supplementation in individuals without any comorbidities...

Clinical Point
We suggest aiming for a serum ferritin level >100 ug/L and monitoring every 4 to 6 weeks

Iron deficiency in psychiatric patients
Current Psychiatry. 2023 March;22(3):25-29,34 | doi: 10.12788/cp.0337
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[Dr.Vad]

ферритин при дефиците или избытке железа плюс другие маркеры обмена железа, некоторые моменты о ферритин-связанном железе

Re-examining ferritin-bound iron: current and developing clinical tools
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[Dr.Vad]

Intravenous iron феринджект – personal experience of 1000 consecutive
infusions

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