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A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases
Fernando Bermejo, Santiago García-López
World Journal of Gastroenterology , 2009,
Abstract: Iron deficiency (ID), with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by enteroscopy.
Suplementación temprana o tardía: similar evolución del estado de hierro durante el embarazo
Ribot,B.; Aranda,N.; Arija,V.;
Nutrición Hospitalaria , 2012,
Abstract: the highest iron demands during pregnancy occur in the third trimester, although preventive iron supplementation is recommended from early stages of the pregnancy. the aim of the study was to compare whether early supplementation with moderate iron doses better prevents the decrease of iron levels during gestation than the late supplementation. one hundred and eighty-four pregnant women participated. they received iron supplements before or after week 20 of pregnancy. at each quarter, serum ferritin (sf), transferrin saturation (ts) and hemoglobin (hb) were determined. gestational agestandardized hemoglobin (zhb) was calculated. the early supplementation group received a mean of 40.5 ± 15.7 mg/day and the late group 43.1 ± 11.9 mg/day. iron deficiency (impaired sf and ts) iron deficiency anemia increased as pregnancy progressed without significant differences between the early and late supplementation groups. more than half of the women ended up their pregnancy with iron deficiency and more than 20% with iron deficiency anemia. in conclusion, although early intake of iron supplements is recommended in pregnancy, no better preventive effect is observed on the decrease of iron levels with early supplementation as compared to late supplementation when moderate iron doses are used.
Efficacy and Safety of Iron Isomaltoside Compared with an Oral Iron Supplement in the Management of Patients with Iron Deficiency Anemia  [PDF]
Zhimin Wu, Chunxiao Zhou, Chunyan Wu, Qiao Song, Shilyu Chen, Wen Zhang, Shaoling Wu
Open Journal of Blood Diseases (OJBD) , 2024, DOI: 10.4236/ojbd.2024.141003
Abstract: Objective: To evaluate the treatment outcome of iron isomaltoside compared with an oral iron supplement in the management of iron deficiency anemia (IDA). Methods: The study included patients with IDA who visited the Outpatient Clinic of the Department of Hematology, the Affiliated Hospital of Qingdao University from October 2021 to August 2022 and met the inclusion and exclusion criteria. According to the actual application of iron supplementation, the patients were divided into two groups: iron isomaltoside treatment group and oral iron treatment group. Baseline measurements were collected before the start of treatment, and measurements were collected subsequently at intervals of 1 week, 1 month, and 3 months. The hematological parameters analyzed included Hemoglobin (Hb), Mean corpuscular hemoglobin (MCH), Mean Hemoglobin content (MCH), Mean corpuscular Hemoglobin concentration (MCHC), and Platelet (Plt). Safety data and adverse event profiles were recorded. Results: Intra-group comparisons: After 1 month of treatment, the Hb significantly improved (P < 0.05). Inter-group comparisons: The biochemical parameters were significantly improved (P < 0.05) in the iron isomaltoside group compared with those in the oral iron group after 1 month of iron supplementation in patients with mild and moderate anemia. Adverse reactions were tolerable for the patients in both iron isomaltoside group and oral iron group. Only 1 patient in iron isomaltoside group developed anaphylactic shock during medication and recovered after aggressive rescue. Conclusions: Iron isomaltoside which increases Hb more rapidly compared with the oral iron supplementation has few adverse reactions and good acceptance.
Variabilidade da frequência cardíaca em pacientes com anemia ferropriva
Tuncer, Mustafa;Gunes, Yilmaz;Guntekin, Unal;Gumrukcuoglu, Hasan Ali;Eryonucu, Beyhan;Guler, Niyazi;Dilek, Imdat;Demir, Cengiz;
Arquivos Brasileiros de Cardiologia , 2009, DOI: 10.1590/S0066-782X2009000500011
Abstract: background: heart rate variability (hrv) is associated with increased cardiac risk factor in several conditions. the iron status of an individual may play an important role in cardiovascular health. objective: to evaluate heart rate variability in patients with iron deficiency anemia. methods: twenty-three patients with iron deficiency anemia (mean hemoglobin (hb) 8.6±2.2 g/dl) and 10 healthy people (mean hb 13.9±1.2 g/dl) were assessed with 24-hour ambulatory holter recordings during in hospital course having limited physical activity. results: although mean heart rate was significantly higher in patients with anemia, there was no significant difference regarding hrv parameters compared to the healthy group. conclusion: there was no significant difference in hrv parameters between patients with iron deficiency anemia with limited physical activity and healthy ambulatory people.
Sequential swallows have no influence on esophageal contractions of patients with iron deficiency anemia
Dantas, Roberto Oliveira;Miranda, Adriana Leonarda Martins;
Arquivos de Gastroenterologia , 2004, DOI: 10.1590/S0004-28032004000100006
Abstract: background: an experimental study showed that thyropharyngeal, cricopharyngeal and cervical esophageal muscles of rabbits with iron deficiency anemia had morphological changes similar to those observed in muscular dystrophy, causing myastenic changes in muscles involved in swallowing. our hypothesis is that patients with iron deficiency anemia may have a decrease in esophageal contractions with successive swallows. patients and method: we studied the esophageal motility of 12 women with iron deficiency anemia aged 31 to 50 years (median 36 years) with serum iron from 11 to 40 mg/dl (median 21 mg/dl), and 13 asymptomatic women aged 26 to 49 years (median 35 years) with serum iron over 60 mg/dl. we used the manometric method with continuous perfusion. the esophageal contractions were measured at 3, 9 and 15 cm from the upper margin of a sleeve that straddled the lower esophageal sphincter. each subject performed 10 swallows of a 2 ml bolus of water alternated with 10 swallows of a 7 ml bolus, with an interval of 30 seconds between swallows. we measured the amplitude, duration, velocity and area under the curve of contractions. results: there was no difference between the swallows of a 2 ml or 7 ml bolus. the amplitude, duration and area under the curve were lower in patients with iron deficiency than in asymptomatic volunteers, mainly in the proximal and middle esophageal body. there was no difference in velocity. sequential swallows did not change contraction amplitude, duration, velocity or area under curve in patients and volunteers. conclusion: although the power of esophageal contractions was decreased in patients with iron deficiency anemia, sequential swallows did not cause further impairment.
Deficiência de ferro no paciente submetido à ressec？？o gástrica ou intestinal: prevalência, causas, repercuss？es clínicas, abordagem diagnóstica e preven？？o
Traina, Fabíola;
Revista Brasileira de Hematologia e Hemoterapia , 2010, DOI: 10.1590/S1516-84842010005000071
Abstract: iron deficiency anemia is associated with gastrectomy used in the treatment of peptic ulcers and gastric cancer, and also in bariatric surgery for the treatment of obesity. bariatric surgery involves restrictive and bypass procedures, gastrectomy and small intestine resection. there are several reasons why iron deficiency occurs in these patients including: (1) diminished iron intake due to meat intolerance (2) diminished gastric acid secretion due to loss of parietal cells which impairs the solubilization of ferric iron to form ferrous iron and (3) exclusion of the duodenum with consequent elimination of the main site of iron absorption and restriction in the action of pancreatic enzymes to release iron bound to the heme. early clinical evaluation and use of iron supplements may be effective to prevent iron deficiency anemia in this population. patients who remain refractory to oral supplementation may require parenteral iron administration. all patients require periodical and lifelong follow-up of hematological and iron parameters.
Anemia ferropriva e estado nutricional de crian？as com idade de 12 a 60 meses do município de Vi？osa, MG
Miranda, Adriana da Silva;Franceschini, Sylvia do Carmo Castro;Priore, Silvia Eloiza;Euclydes, Marilene Pinheiro;Araújo, Raquel Maria Amaral;Ribeiro, S？nia Machado Rocha;Netto, Michele Pereira;Fonseca, Marília Machado;Rocha, Daniela da Silva;Silva, Danielle Góes da;Lima, Nerilda Martins Miranda;Maffia, úrsula Comastre de Castro;
Revista de Nutri？？o , 2003, DOI: 10.1590/S1415-52732003000200003
Abstract: this cross sectional study included children aged 12 to 60 months attended by the public health service in the city of vi？osa, state of minas gerais. the objective was to evaluate the prevalences of anemia and serious anemia, the hemoglobin levels and the relation between nutritional status and iron deficiency anemia in these children. for the diagnosis of anemia, (hemocue) was used, and the cutoff point of 11.0 g/dl proposed by the world health organization for anemia, and was adopted serious anemia, was adopted 9,5g/dl. a total of 171 children was evaluated; 62.2% were anemic and 43.5% of these were seriously anemic. analyzing the nutritional status, a high percentage of under nourished children was found, according to the indexes weight/age, weight/height and height/age (11.7%, 7.0% and 5.8%, respectively). a high prevalence of anemia was observed among the earlier groups. no association was verified between anemia and nutritional status. therefore, it is necessary to work towards anemia prevention and to alert the health professionals to an early diagnosis, prophylaxis and treatment.
Prevalência de anemia e deficiência de ferro em adolescentes do sexo feminino - Tabo？o da Serra, SP, Brasil
Fujimori, Elizabeth;Szarfarc, Sophia C;Oliveira, Ida Maria Vianna de;
Revista Latino-Americana de Enfermagem , 1996, DOI: 10.1590/S0104-11691996000300005
Abstract: it was studied an equiprobabilistic sample of 262 female teenagers living in the city of tabo？o da serra, brazil, with the aim of evaluating the prevalence of anemia and iron-deficiency. anemia was identified by the hemoglobin level and the prevalence of iron-deficiency was determined through the concentration of free erythrocyte protoporphyrin. it was observed a prevalence of 17,6% of anemia, and its occurrence was inversely related to factors indicative of the economic-social level: income, schooling of parents and home's characteristics. the presence of anemia was higher in the group that did not have reached menarche, and its occurrence did not show relation with the interval between menstrual cycle. the prevalence of iron-deficiency was of 29,4% and it was not verified correlation between the bloody hemoglobin and the free erythrocyte protoporphyrin, except in severe cases of anemia.
Pica en "Don Quijote"
Larraín A,Camilo;
Revista médica de Chile , 2005, DOI: 10.4067/S0034-98872005000500016
Abstract: pica, the compulsive eating of non edible substances, is known by the medical profession for centuries. in the novel by miguel de cervantes "adventures of the famous knight don quixote de la mancha'', there is a history in which "women that by caprice eat soil, plaster coal and other disgusting substances'' are mentioned. this description configures the clinical diagnosis of pica. this fact has not attracted the attention of the critics of cervantes' novel, up to now. this unequivocal reference of pica suggests that iron deficiency anemia, caused by chronic hemorrhages in adults, was frequent in 1605, when the book was first published
Relationship Between Helicobacter Pylori Infection and Serum Ferritin Level in Primary School Children in Tehran-Iran
Ali Zamani,Mamak Shariat,Zohreh Oloomi Yazdi,Shahla Bahremand
Acta Medica Iranica , 2011,
Abstract: Iron deficiency can cause cognitive and functional learning disorders in children. Some studies have reported a relationship between low serum ferritin levels in patients with anemia and Helicobacter pylori (H. pylori) infection. Therefore, we aimed to determine the relationship between these two common diseases. This descriptive analytical cross-sectional study was performed to assess serum ferritin levels and H. pylori antibody titers (IgG) among 6-12 year old healthy primary school children in Tehran during the academic year 2005-2006. Specimen collection was done by cluster and randomization methods (multistage sampling). Personal information and laboratory results were compiled in questionnaires and data were analyzed by descriptive and analytical statistics via SPSS software. 165 primary school children (43% boys, 57% girls) with mean age 9.2 ± 1.5 years were enrolled in the study. H. pylori IgG antibody titer was positive in 26% of cases with mean values of 0.79 ± 0.42 units in boys and 0.75 ± 0.39 units in girls, which showed a significant statistical difference (P=0.004). H. pylori infection was more common among children of large families or those with low economic status (P=0.002). 29% of children had low serum ferritin levels. Out of the children with low serum ferritin levels, 71% and 28% had negative and positive anti H. pylori antibody titers (IgG levels), respectively. Also, 296 children (25%) with normal ferritin levels had H. pylori infection. We did not find a significant relationship between H. pylori infection and low serum ferritin levels or iron deficiency anemia.
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