Estimates of total body iron indicate 19 mg and 38 mg oral iron are equivalent for the mitigation of iron deficiency in individuals experiencing repeated phlebotomy

Ferrinject( ferric carboxymaltose) is used extensively to provide rapid replacement of total body iron where oral treatment is inadequate or not well tolerated. Although it is thought to be safe we report a case of fatal bone marrow aplasia caused by a total of 3 infusions of ferrinject (3,000 mg given over a 3 month period and in keeping with calculation of total body iron using the Ganzoni formula. No other drugs could be implicated and the stages of aplasia were initially an amegakaryocytic period , then red cell aplasia in the marrow a month later and finally a fall in neutrophil counts over a 5 month period. after which death occurred. We have evidence that bone marrow aplasia/ extramedullary eryhtropoiesis has been reported in dogs given ferrinject three times a week A 48 year old lady with longstanding iron deficiency caused by menorrhagia was unable to take oral iron replacement. She was receiving lansoprazole for gastritis and had received venofer iron infusions 200mg monthly till October 2011 but continued to be anemic due to GI bleeding. Blood film appearance was iron deficiency. On 27/11/2012 Hb 67 wbc 3.4, plat 201 MCV 70.5. Previous blood counts showed iron deficiency with normal platelets. Serum Ferritin 3 gms/L. She received ferric carboxymaltose (Ferrinject )1000ug by 15 min i.v. infusion. On 09/01/2013 Ferritin was still low at 10 and a futher 1000ug of ferrinject was given on 16/01/2013. The platelets were noted to have fallen to 49 that day,Hb 62, wbc 5.8, neutrophils 4.5 MCV 85.4. On 01/02/2013 Ferritin was 282 and 3 units blood was transfused for further menorrhagia. Blood film showed normal sized platelets but a count of 10 and polychromatic macrocytes. In view of clinical bleeding and low platelets, on 8th and 9th Feb 2013 ,Iv Ig 90 gms and 70 mg prednisolone was started with no response. Bone marrow examination showed acquired amegakaryocytic thrombocytopenia with reduced red cell precursors. Investigations to rule out other causes of acquired amegakaryocytic thrombocytopenia were negative. Crp, 3, negative autoimmune screen, normal serum immunoglobulins and electrophoresis, normal LDH, ANCA neg HIV neg. Parvovirus Ig M negative. Bone marrow repeated 1 month after the last ferrinject was given showed aplasia in both red cell and megakaryocyte lineage with no evidence of recovery. Later the neutrophil series reduced as well. She was supported with blood and platelet transfusions as necessary and a bone marrow unrelated donor was sought however death supervened on 20/07/2013 without marrow recovery. Ferrinject (ferric carboxymaltose) is used extensively for treatment of iron deficiency anemia where oral iron supplementation cannot be used. In preclinical studies ferrinject given intravenously 3 times a week to dogs led to extramedullary haemopiesis which must indicate some form of marrow damage. No previous clinical cases of ferrinject induced bone marrow aplasia have been described but patients need to be alerted to this rare and severe side effect of treatment.We recommend that if a patients platelets fall on ferrinject treatment no further infusions should be considered. Viforpharma the suppliers of the intravenous iron infusion (ferrinject) have been alerted to this serious and rare adverse reaction to their product Disclosures: No relevant conflicts of interest to declare.

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Etiology of Anemia Among Women and Children in Rural Bangladesh: An Assessment of Nutritional and Non-nutritional Factors (P10-115-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-115-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Amanda Wendt ◽

Jillian Waid ◽

Sabine Gabrysch

Keyword(s):

Iron Deficiency ◽

Vitamin A ◽

Vitamin B ◽

Hemoglobin E ◽

Nutritional Factors ◽

Body Iron ◽

Iron Deficient ◽

Women And Children ◽

Vitamin B 12 ◽

Total Body

Abstract Objectives To examine the etiology of anemia among women and children in Habiganj District, Sylhet considering nutritional and non-nutritional factors. Methods We analyzed data from 366 non-pregnant women and 204 children (6–37 months) collected at the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial's 2015 baseline survey in 96 settlements. Blood samples were analyzed for anemia (hemoglobin), iron status (serum ferritin, serum transferrin receptor), vitamin A status (retinol binding protein (RBP)), inflammation (c-reactive protein and α-1-acid glycoprotein), vitamin B-12 status (methylmalonic acid (MMA)), and hemoglobinopathies (α-, β-thalassemia, Hemoglobin E and S). Logistic regression was conducted to identify factors associated with anemia, adjusting iron and vitamin A for inflammation using internal regression correction. Results Almost half of women and children were anemic (45% and 46%) though only 2% of women and 17% of children were iron-deficient (total body iron <0 mg/kg). Almost 20% of women and 60% of children had deficient or insufficient vitamin A levels (RBP <1.05 µmol/L). Vitamin B-12 deficiency (MMA: <210 nM) was high among women (27%) and children (70%). About 10% of women and children had any thalassemia or hemoglobinopathy; 5% had either β-thalassemia or HbE. Despite little iron deficiency among women, total body iron (mg/kg) was strongly associated with anemia, as was RBP (µmol/L) (OR (95% CI): iron: 0.8 (0.7, 0.8); vitamin A: 0.5 (0.3, 0.8)). In children, total body iron and age were also protective for anemia. In both women and children, having β-thalassemia or Hemoglobin E was associated with increased odds of anemia. Vitamin B-12 status was not associated with anemia. Conclusions Although iron deficiency was uncommon, there remained a strong association between total body iron and anemia. Vitamin A was also strongly associated with anemia and may be a key intervention strategy as Vitamin A levels were low. However, further research is still needed as a large proportion of anemia remains unexplained. Funding Sources The FAARM trial was supported by the Germany Ministry of Education and Research (BMBF). The first author received support from the Alexander von Humboldt Foundation and a Thrasher Research Fund Early Career Award.

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A Randomized Feeding Trial of Iron-Biofortified Beans on School Children in Mexico

Nutrients ◽

10.3390/nu11020381 ◽

2019 ◽

Vol 11 (2) ◽

pp. 381 ◽

Cited By ~ 5

Author(s):

Julia Finkelstein ◽

Saurabh Mehta ◽

Salvador Villalpando ◽

Veronica Mundo-Rosas ◽

Sarah Luna ◽

...

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Status ◽

Efficacy Trial ◽

Feeding Trial ◽

Control Groups ◽

Body Iron ◽

Total Body ◽

Cluster Randomized ◽

And Control

Iron deficiency is a major public health problem worldwide, with the highest burden among children. The objective of this randomized efficacy feeding trial was to determine the effects of consuming iron-biofortified beans (Fe-Beans) on the iron status in children, compared to control beans (Control-Beans). A cluster-randomized trial of biofortified beans (Phaseolus vulgaris L), bred to enhance iron content, was conducted over 6 months. The participants were school-aged children (n = 574; 5–12 years), attending 20 rural public boarding schools in the Mexican state of Oaxaca. Double-blind randomization was conducted at the school level; 20 schools were randomized to receive either Fe-Beans (n = 10 schools, n = 304 students) or Control-Beans (n = 10 schools, n = 366 students). School administrators, children, and research and laboratory staff were blinded to the intervention group. Iron status (hemoglobin (Hb), serum ferritin (SF), soluble transferrin receptor (sTfR), total body iron (TBI), inflammatory biomarkers C-reactive protein (CRP) and -1-acid glycoprotein (AGP)), and anthropometric indices for individuals were evaluated at the enrollment and at the end of the trial. The hemoglobin concentrations were adjusted for altitude, and anemia was defined in accordance with age-specific World Health Organization (WHO) criteria (i.e., Hb <115 g/L for <12 years and Hb <120 g/L for 12 years). Serum ferritin concentrations were adjusted for inflammation using BRINDA methods, and iron deficiency was defined as serum ferritin at less than 15.0 µg/L. Total body iron was calculated using Cook’s equation. Mixed models were used to examine the effects of Fe-Beans on hematological outcomes, compared to Control-Beans, adjusting for the baseline indicator, with school as a random effect. An analysis was conducted in 10 schools (n = 269 students) in the Fe-Beans group and in 10 schools (n = 305 students) in the Control-Beans group that completed the follow-up. At baseline, 17.8% of the children were anemic and 11.3% were iron deficient (15.9%, BRINDA-adjusted). A total of 6.3% of children had elevated CRP (>5.0 mg/L), and 11.6% had elevated AGP (>1.0 g/L) concentrations at baseline. During the 104 days when feeding was monitored, the total mean individual iron intake from the study beans (Fe-bean group) was 504 mg (IQR: 352, 616) over 68 mean feeding days, and 295 mg (IQR: 197, 341) over 67 mean feeding days in the control group (p < 0.01). During the cluster-randomized efficacy trial, indicators of iron status, including hemoglobin, serum ferritin, soluble transferrin receptor, and total body iron concentrations improved from the baseline to endline (6 months) in both the intervention and control groups. However, Fe-Beans did not significantly improve the iron status indicators, compared to Control-Beans. Similarly, there were no significant effects of Fe-Beans on dichotomous outcomes, including anemia and iron deficiency, compared to Control-Beans. In this 6-month cluster-randomized efficacy trial of iron-biofortified beans in school children in Mexico, indicators of iron status improved in both the intervention and control groups. However, there were no significant effects of Fe-Beans on iron biomarkers, compared to Control-Beans. This trial was registered at clinicaltrials.gov as NCT03835377.

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"EVALUATION OF INTRAVENOUS IRON VERSUS ORAL IRON IN MANAGEMENT OF IRON DEFICIENCY ANEMIA IN PREGNANCY WITH SPECIFIC REFERENCE TO BODY IRON STORE”

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/612 ◽

2013 ◽

Vol 2 (16) ◽

pp. 2750-2755 ◽

Cited By ~ 2

Author(s):

Richa Bhargava ◽

Manju Maheshwari

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Intravenous Iron ◽

Oral Iron ◽

Deficiency Anemia ◽

Specific Reference ◽

Iron Store ◽

Body Iron ◽

Body Iron Store ◽

In Pregnancy

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Serum ferritin, soluble transferrin receptor, and total body iron for the detection of iron deficiency in early pregnancy: a multiethnic population-based study with low use of iron supplements

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy366 ◽

2019 ◽

Vol 109 (3) ◽

pp. 566-575 ◽

Cited By ~ 3

Author(s):

Marthe-Lise Næss-Andresen ◽

Åse Ruth Eggemoen ◽

Jens Petter Berg ◽

Ragnhild Sørum Falk ◽

Anne Karen Jenum

Keyword(s):

Iron Deficiency ◽

South Asian ◽

Transferrin Receptor ◽

Iron Status ◽

Middle Eastern ◽

Population Based ◽

Soluble Transferrin Receptor ◽

Body Iron ◽

Sub Saharan ◽

Total Body

ABSTRACTBackgroundWhich blood-based indicator best reflects the iron status in pregnant women is unclear. Better assessments of iron status in today's multiethnic populations are needed to optimize treatment and clinical recommendations.ObjectivesWe aimed to determine the prevalence of anemia (hemoglobin <11.0 g/dL in first and <10.5 g/dL in second trimester) and iron deficiency (ID) by the iron indicators serum ferritin <15 µg/L, serum soluble transferrin receptor (sTfR) >4.4 mg/L, and calculated total body iron <0 mg/kg, and their associations with ethnicity.MethodsThis was a population-based cross-sectional study from primary antenatal care of 792 healthy women in early pregnancy in Oslo, Norway. We categorized the women into 6 ethnic groups: Western European, South Asian, Middle Eastern, Sub-Saharan African, East Asian, and Eastern European.ResultsAnemia was found in 5.9% of women (Western Europeans: 1.8%; non-Western: 0–14%, P < 0.05). ID from ferritin was found in 33% (Western Europeans: 15%; non-Western: 27–55%, P < 0.05). ID from sTfR was found in 6.5% (Western Europeans: 0.3%; non-Western: 0–20%, P < 0.01). Calculated total body iron indicated ID in 11% (Western Europeans: 0.6%, non-Western: 7.0–28%, P < 0.01). The prevalence of ID was significantly higher by all measures in South Asian, Sub-Saharan African, and Middle Eastern than in Western European women, and the ethnic differences persisted after adjusting for confounders. South Asians, Sub-Saharan Africans, and Middle Easterners had lower iron concentrations by all measures for all hemoglobin intervals. Anemia related to ID varied from 35% (sTfR) to 46% (total body iron) and 72% (ferritin) depending on the iron indicator used.ConclusionsWomen at the highest risk of ID and anemia were of South Asian, Middle Eastern, and Sub-Saharan African origin. The prevalence of ID differed considerably depending on the iron indicator used.

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The Oral Iron on the Prevention of Iron Deficiency Anemia in Obese Pregnant

Case Medical Research ◽

10.31525/ct1-nct04101461 ◽

2019 ◽

Author(s):

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Oral Iron ◽

Deficiency Anemia

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Intravenous iron is non-inferior to oral iron regarding cell growth and iron metabolism in colorectal cancer associated with iron-deficiency anaemia

Scientific Reports ◽

10.1038/s41598-021-93155-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hafid O. Al-Hassi ◽

Oliver Ng ◽

Rayko Evstatiev ◽

Manel Mangalika ◽

Natalie Worton ◽

...

Keyword(s):

Colorectal Cancer ◽

Iron Deficiency ◽

Iron Metabolism ◽

Iron Deficiency Anaemia ◽

Iron Transport ◽

Intravenous Iron ◽

Oral Iron ◽

Iron Loading ◽

Deficiency Anaemia ◽

Iron Treatment

AbstractOral iron promotes intestinal tumourigenesis in animal models. In humans, expression of iron transport proteins are altered in colorectal cancer. This study examined whether the route of iron therapy alters iron transport and tumour growth. Colorectal adenocarcinoma patients with pre-operative iron deficiency anaemia received oral ferrous sulphate (n = 15), or intravenous ferric carboxymaltose (n = 15). Paired (normal and tumour tissues) samples were compared for expression of iron loading, iron transporters, proliferation, apoptosis and Wnt signalling using immunohistochemistry and RT-PCR. Iron loading was increased in tumour and distributed to the stroma in intravenous treatment and to the epithelium in oral treatment. Protein and mRNA expression of proliferation and iron transporters were increased in tumours compared to normal tissues but there were no significant differences between the treatment groups. However, intravenous iron treatment reduced ferritin mRNA levels in tumours and replenished body iron stores. Iron distribution to non-epithelial cells in intravenous iron suggests that iron is less bioavailable to tumour cells. Therefore, intravenous iron may be a better option in the treatment of colorectal cancer patients with iron deficiency anaemia due to its efficiency in replenishing iron levels while its effect on proliferation and iron metabolism is similar to that of oral iron treatment.

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