scholarly journals Blood Transfusion, Serum Ferritin, and Iron in Hemodialysis Patients in Africa

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Leonard Kouegnigan Rerambiah ◽  
Laurence Essola Rerambiah ◽  
Armel Mbourou Etomba ◽  
Rose Marlène Mouguiama ◽  
Phanie Brunelle Issanga ◽  
...  
Keyword(s):  
Iron Overload ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Hemodialysis Patients ◽  
Oral Iron ◽  
Sub Saharan Africa ◽  
Iron Therapy ◽  
Blood Transfusions ◽  
Oral Iron Therapy ◽  
Weak Association

Background and Objectives. There is no data analyzing the outcome of blood transfusions and oral iron therapy in patients with kidneys failure in sub-Saharan Africa. The present study aimed to fill that gap and assess the value of ferritin in the diagnosis of iron overload and deficiency. Design. From January to February 2012, we prospectively studied 85 hemodialysis patients (78% of males and 22% of females aged 20 to 79 years) attending the Gabonese National Hemodialysis Centre. Results. Correlation studies showed (a) a strong positive linear relationship between the number of blood transfusions and high serum ferritin in hemodialysis patient (Spearman r:0.74; P value: 0.0001); (b) a weak association between the number of blood transfusions and serum iron concentrations (Spearman r:0.32; P value: 0.04); (c) a weak association between serum ferritin and serum iron (Spearman r:0.32; P value: 0.003). Also, the strength of agreement beyond chance between the levels of ferritin and iron in the serum was poor (κ=0.14). The prevalence of iron overload was 10.6%, whereas the prevalence of iron deficiency was 2.3%, comparing (1) patients with a maximum of one transfusion not on iron therapy; (2) patients with a maximum of one transfusion on iron therapy; (3) polytransfused patients not on iron therapy; and (4) polytransfused patients on oral iron therapy. The “Kruskal-Wallis test” showed that ferritin levels varied significantly between the groups (P value: 0.0001). Conclusion. Serum ferritin is not reliable as a marker of iron overload. For patients undergoing regular transfusion we recommend routine serum ferritin measurement and yearly measurement of LIC.

Relative Anemia and Iron Deficiency in Cystic Fibrosis

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 810-814
Author(s):  
Joann L. Ater ◽  
John J. Herbst ◽  
Stephen A. Landaw ◽  
Richard T. O'Brien
Keyword(s):  
Cystic Fibrosis ◽  
Vitamin E ◽  
Iron Deficiency ◽  
Serum Ferritin ◽  
Binding Capacity ◽  
Hemoglobin Concentration ◽  
Oral Iron ◽  
Iron Therapy ◽  
Therapeutic Trial ◽  
Oral Iron Therapy

Significant alterations in hemotologic function in cystic fibrosis are suggested by the observation that polycythemia is uncommon, even among cyanotic patients. To elucidate those factors that influence hematologic equilibrium, 39 stable patients with cystic fibrosis were evalulated with regard to hemoglobin, hematocrit, RBC indices, reticulocyte count, serum iron and total iron binding capacity, serum ferritin, vitamin E, and carboxyhemoglobin levels. Hemoglobin concentrations were below the 50th percentile for age in 90% of the patients, including the 23% who were cyanotic. Serum ferritin levels were below the mean for age in 85% and below 12 ng/mL in 33% of patients. Vitamin E levels were less than 5 µg/dL in 33%, indicating deficiency. Carboxyhemoglobin values were elevated in 64% of the patients. These data indicate that relative anemia is common in cystic fibrosis and suggest that iron and vitamin E deficiency may contribute to that anemia. Twenty-two patients with cystic fibrosis were then given 2 weeks of oral iron therapy followed by two to three additional weeks of iron and vitamin E. This therapeutic trial resulted in an increase in mean hemoglobin concentration from 13.87 to 14.50 g/dL (P < 0.01) associated with a significant increase in levels of serum ferritin (P < 0.001). The increase in hemoglobin occurred primarily during the second 2 weeks when patients were receiving both iron and vitamin E. However, we were unable to document evidence of increased hemolysis when patients were receiving iron therapy alone. This response to oral iron therapy is confirmation that iron deficiency contributes to the failure of some patients with cystic fibrosis to compensate hemotologically for hypoxia.

scholarly journals Secondary Hemochromatosis

Blood ◽  
1953 ◽  
Vol 8 (9) ◽  
pp. 824-836 ◽  
Author(s):  
ARTHUR C. AUFDERHEIDE ◽  
HOWARD L. HORNS ◽  
ROBERT J. GOLDISH
Keyword(s):  
Iron Content ◽  
Iron Absorption ◽  
Oral Iron ◽  
Cirrhosis Of The Liver ◽  
Iron Therapy ◽  
Etiologic Factor ◽  
Blood Transfusions ◽  
Portal Cirrhosis ◽  
Oral Iron Therapy ◽  
Total Body

Abstract 1. Secondary hemochromatosis has been sharply separated from simple hemosiderosis by defining the former as "a condition acquired as a consequence of anemia, blood transfusions, or both, and characterized by increased hepatic and total body iron content and unequivocal portal cirrhosis of the liver." 2. Previously reported cases are critically reviewed in the light of this definition. 3. Two new cases of secondary (exogenous) hemochromatosis are reported. 4. Anemia is postulated as the basic etiologic factor in secondary hemochromatosis by causing increased iron absorption; iron introduced in the form of blood transfusions probably only accelerates a process already in progress. 5. Prolonged futile oral iron therapy may be harmful. 6. A plea is made for a strict concept of secondary hemochromatosis as well as for thorough documentation of future reports.

scholarly journals Coexisting Iron Deficiency Anemia and Beta Thalassemia Trait: Effect of Iron Therapy on Red Cell Parameters and Hemoglobin Subtypes

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Sarika Verma ◽  
Ruchika Gupta ◽  
Madhur Kudesia ◽  
Alka Mathur ◽  
Gopal Krishan ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Serum Iron ◽  
Oral Iron ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Beta Thalassemia ◽  
Red Cell ◽  
Oral Iron Therapy ◽  
Thalassemia Trait

Background. Coexistence of iron deficiency anemia (IDA) and beta thalassemia trait (BTT) has been the topic of few studies. However, no study from our country was found evaluating the effect of iron therapy in patients with concomitant IDA and BTT. Methods. Over a period of two years, 30 patients with concomitant IDA and BTT were included. All the patients had a complete blood count, serum iron studies, and thalassemia screening using BIORADTM hemoglobin testing system. The patients received oral iron therapy in appropriate dosages for a period of twenty weeks, after which all the investigations were repeated. Appropriate statistical methods were applied for comparison of pre- and posttherapy data. Results. All except two patients were adults with a marked female preponderance. Oral iron therapy led to statistically significant improvement in hemoglobin, red cell indices (P<0.05), and marked change in serum iron, ferritin, and HbA2 levels (P<0.001). There was a significant reduction in the total iron binding capacity levels. Conclusion. The present study shows the frequent occurrence of iron deficiency anemia in patients with beta thalassemia trait, which can potentially confound the diagnosis of the latter. Hence, iron deficiency should be identified and rectified in patients with suspicion of beta thalassemia trait.

Intradialytic Oral Iron Therapy

1994 ◽  
Vol 17 (5) ◽  
pp. 261-264 ◽  
Author(s):  
G. Dunea ◽  
M.A. Swagel ◽  
U. Bodiwala ◽  
J.A.L. Arruda
Keyword(s):  
Inner City ◽  
Ferrous Sulfate ◽  
Observational Studies ◽  
Transferrin Saturation ◽  
Intravenous Iron ◽  
Hemodialysis Patients ◽  
Oral Iron ◽  
Iron Therapy ◽  
Dialysis Unit ◽  
Oral Iron Therapy

In order to test the limits of what can be achieved with oral iron therapy and eliminate the factor of noncompliance, we conducted a series of observational studies in an 140-patient inner city dialysis unit. In these studies the patients received supervised iron therapy as 3-4 ferrous sulfate (325 mg) tablets during each dialysis. Acceptance and tolerance was high, less than 10% refusing to take the tablets. In two separate observational studies oral intradialytic iron yielded a hematocrit 28% in 69% of patients and 30% in 42-52%. There was no correlation between the final hematocrit and serum ferritin or transferrin saturation. The response to iron therapy could frequently not be predicted by the ferritin levels or transferrin saturation. We conclude that in view of the known hazards of intravenous iron dextran, oral intradialityc therapy should be tried first and that a good response can be expected in one half to two thirds of hemodialysis patients.

Iron Parameters in 84 MDS Patients Enrolled in a Deferasirox (Exjade®, ICL670) Multicenter Trial.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4847-4847 ◽  
Author(s):  
Alan F. List ◽  
Jason Esposito ◽  
Jodie Decker ◽  
Maria R. Baer ◽  
Bayard Powell ◽  
...  
Keyword(s):  
Iron Overload ◽  
Creatinine Clearance ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Transferrin Saturation ◽  
Iron Chelator ◽  
Oral Iron ◽  
Calculated Creatinine Clearance ◽  
Oral Iron Chelator

Abstract Introduction: Recent reviews indicate that transfusional hemosiderosis may be associated with an increased risk of mortality in lower-risk pts with MDS. This trial is designed to evaluate the efficacy and long-term safety of deferasirox (Exjade®, ICL670) in MDS. Deferasirox is an oral iron chelator approved for use in pts with transfusional iron overload. Methods: This is a Phase II, open-label, 3-yr clinical trial in 55 US centers, enrolling 150 pts (aged ≥18 years) with Low- or Int-1-risk MDS (by IPSS criteria) and transfusional iron overload (serum ferritin ≥1000 ng/mL and &gt;20 units RBC transfusions). Deferasirox dosing is 20–30 mg/kg/day. Serum ferritin, iron, transferrin and transferrin saturation are being assessed at screening and monthly in yr 1, then quarterly in yrs 2 and 3, while labile plasma iron (LPI) is assessed quarterly in yr 1. In addition, creatinine, calculated creatinine clearance, echocardiograms and endocrine and hematological status are being assessed. This report describes baseline data in these pts. Results: As of June 2006, 84 pts have enrolled. Demographic data are available from 79 pts: median age 71 years (range 47–87); sex (52 male, 27 female); ethnicity (74 Caucasian, 2 Black, 2 Hispanic, 1 Oriental); and IPSS Risk Group (Low: 22 pts; Int-1: 56 pts). Iron status is summarized in the table: Parameter n Mean ± SD Median Range Normal range n/a, not applicable Serum ferritin,μg/L 84 3779 ± 4070 2951 1160–36280 12–370 Serum iron, μg/dL 84 205 ± 64 201 48–409 37–180 Transferrin, mg/dL 82 153 ± 31 152 83–244 190–375 Transferrin saturation, % 83 85 ± 15 91 20–94 15–50 LPI, μmol/L 38 0.52 ± 0.63 0.25 0–2.9 0 Total transfusions, n 78 63.3 ± 66.3 41.5 14–435 n/a Years of transfusion 75 3.4 ± 1.9 3 1–12 n/a Baseline concurrent therapies: 5-azacytidine (Vidaza): 5 pts; lenalidomide (Revlimid): 1 pt. Calculated creatinine clearance: normal (&gt;80 mL/min): 37 pts; mildly abnormal (51–80 mL/min): 30 pts; moderately abnormal (30–50 mL/min): 9 pts. Hematological parameters: Anemia was present in all pts; other cytopenias included: neutropenia (&lt;1800/μL): 13 pts, thrombocytopenia (&lt;100,000/μL): 15 pts; neutropenia and thrombocytopenia: 12 pts. A total of 53 pts had received chelation prior to enrolling: 51 deferoxamine (Desferal®); and 2 deferasirox. Conclusions: Despite the prior availability of deferoxamine, these baseline data demonstrate significant levels of iron overload among transfused pts with myelodysplasia. Serum iron, ferritin and LPI are all well above the clinically significant thresholds associated with increased complications. Since recent data has suggested that iron overload may be a poor prognostic indicator in MDS, increased attention to maintaining appropriate iron balance is warranted. The recent availability of an oral iron chelator may be more acceptable to MDS pts and their physicians. This ongoing trial is designed to assess the long-term efficacy, safety, and clinical benefits of deferasirox in pts with MDS.

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