Iron Deficiency Anemia and Chronic Renal Insufficiency In An Oncology Population

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5152-5152
Author(s):  
Ralph Boccia ◽  
Betsy Lahue ◽  
Robert Hauser ◽  
Jessica Dioguardi
Keyword(s):  
Iron Deficiency ◽  
Renal Insufficiency ◽  
Iron Deficiency Anemia ◽  
Patient Population ◽  
Deficiency Anemia ◽  
Oncology Patients ◽  
Iron Treatment ◽  
Number Of Patients ◽  
Anemia Management ◽  
Iv Iron

Abstract Abstract 5152 Anemia in oncology patients is common and may negatively impact cancer treatment outcomes. Iron deficiency is a major contributor to anemia, which can be exacerbated by both underlying conditions and chemotherapeutic agents. Additionally, many oncology patients may have concomitant renal insufficiency or chronic kidney disease (CKD), increasing their susceptibility to iron deficiency. Therefore, recognizing renal insufficiency as well as iron deficiency may improve anemia management in oncology patients. To determine the proportion of oncology patients with iron deficiency anemia (IDA), potential renal insufficiency and the current utilization of IV iron treatment in these populations, a large electronic medical records database was examined. All patients treated with chemotherapy in a physician services oncology network from January 1, 2008 to August 1, 2010 were selected in order to determine the prevalence of an iron deficiency anemia (IDA) diagnosis (expressed as an ICD-9-CM 280.1-.9), and a diagnosis of CKD (expressed as either from a diagnosis code of CKD (585.1-.6) or estimated GFR <60 mL/min). Overall, 83,219 patients receiving a chemotherapeutic agent were selected. Of these patients, 36% (30,298) were diagnosed with IDA, 34% of whom were receiving IV iron treatment (9,971/30,298). These patients represented approximately 85% (9971/11,776) of the total IV iron treated population in the dataset. While only 8% (2,482/30,298) of patients with a diagnosis of IDA also had a diagnosis of CKD. Of the patients that did present with a GFR level, 49% of patients had a GFR level <60 mL/min. However, the true prevalence of CKD in this population was difficult to determine because a significant percentage of patients did not present with a GFR level available in their records. In this oncology patient population IDA is relatively common, with greater than 30% of patients diagnosed. While only one third of these patients were receiving IV iron treatment in the IDA patient population, it is unknown whether patients are not being treated for their iron deficiency or are being managed on oral iron therapy alone. Given recent controversies around ESA use, guidelines suggest that iron indices should be checked, and IV iron supplementation should be considered in patients receiving ESA therapy. Additionally, only a fraction of patients diagnosed with IDA are also diagnosed with CKD, even though analysis of GFR values suggests that a significant number of patients may have renal insufficiency. These data suggest that identification of patients with renal insufficiency may be suboptimal and that further treatment of IDA in this patient population may be warranted in order to optimize anemia management. Disclosures: Boccia: AMAG: Consultancy, Honoraria, Speakers Bureau. Lahue:AMAG: Employment. Hauser:AMAG: Research Funding. Dioguardi:AMAG: Employment.

scholarly journals Efficacy, tolerability and safety of intravenous iron sucrose in postpartum anaemia

2019 ◽  
Vol 1 (1) ◽  
pp. 21-24
Author(s):  
Rucha Rajput ◽  
Ashish Podey ◽  
Tushar Baheti ◽  
Bangal V B ◽  
Sarita Deshpande
Keyword(s):  
Iron Deficiency ◽  
Blood Transfusion ◽  
Iron Deficiency Anemia ◽  
Intravenous Iron ◽  
Iron Sucrose ◽  
Deficiency Anemia ◽  
Prospective Longitudinal Study ◽  
Number Of Patients ◽  
Iv Iron ◽  
Prospective Longitudinal

Background: Anemia is one of major contributing factor in maternal mortality and morbidity in third world countries and according to the WHO, contributes to 40% maternal deaths. Postpartum anemia is observed in up to 27% of women.It is a common problem throughout the world. Treatment of postpartum iron deficiency anemia includes oral and parenteral iron supplmentaion as well as blood transfusion in severe cases. Methods: This was a prospective longitudinal study carried out in Department of Obstetrics & Gynaecology of PRH, Loni. Total 80 women suffering from postpartum anemia of age above 18 years with haemoglobin (HB) level below 11gm/dl and above 6gm/dl were included for the study. After history taking, clinical examination and baseline Hb level, all of them were administered intravenous iron sucrose 200 mg per dose per day till the total calculated dose was administered. The post therapy evaluation was done with the estimation of Hb on day 1, day 7, day 14 and day 21. Results: 31.25% women belonged to the age group each of 19-21 years and 22-24 years. Maximum number of patients received 3 doses of IV Iron sucrose (i.e. total 600mg) followed by 2 doses (i.e. total 400mg), 4 doses (i.e. total 800mg) and 5 doses (i.e. total 1000mg) respectively. Hb level rises extremely significantly (p<0.001) after IV Iron Sucrose administration on day 1, 7, 14 & 21 as compared to corresponding values before delivery as analyzed by Friedman Test (Nonparametric Repeated Measures ANOVA) . 16 patients (20%) experienced thrombophlebitis to IV Iron Sucrose administration. About 12 (15%) patients experienced rigor followed by sweating in 10 patients (12.5%) and fever in 8 patients (10%). About 62 patients (77.5%) from total 80 reported well tolerability to IV Iron Sucrose while remaining 18 patients (22.5%) reported poor tolerability to IV Iron Sucrose Conclusion: Intravenous iron sucrose increases the haemoglobin more rapidly in first week as compared to second and third week in women with postpartum iron deficiency anemia. Hypersensitivity reaction, chest pain, dyspnoea reported with iron dextran and iron sorbitol citric acid were not observed with iron sucrose. Intravenous iron sucrose can be used safely to fill a rift between blood transfusion and oral iron in treatment of postpartum iron deficiency anemia.

scholarly journals P350 SAFIIR: Study of Anemia Following Intravenous Iron Repletion

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S371-S372
Author(s):  
L C Rioux ◽  
E J Bernard ◽  
M Bourgault ◽  
P Mondragon ◽  
V Rioux
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Transferrin Saturation ◽  
Real Life ◽  
Intravenous Iron ◽  
Deficiency Anemia ◽  
The Real ◽  
Iron Treatment ◽  
Life Impact ◽  
Iv Iron

Abstract Background The main objective of this study was to assess the prevalence of anemia and the secondary objectives aimed to evaluate the real-life impact of intravenous iron therapy on anemia correction in patients living with Inflammatory Bowel Disease (IBD). Methods We performed a retrospective cohort study of adult patients (18 to 80 years old) with a Crohn’s Disease or Ulcerative Colitis diagnosis who were followed at our clinic between January 2018 and March 2020. Clinical data were obtained from the patients’ electronic medical records. Iron-deficiency anemia was defined as hemoglobin (Hb) &lt; 12,0 g/dL and/or transferrin saturation (TSAT)&lt; 20 % and/or low serum iron (≤ 10 μmol/L). Intravenous (IV) iron treatment was defined as at least one infusion of iron isomaltoside, iron sucrose, or sodium ferric gluconate. The secondary analyses were performed in terms of IV iron treatments. Results Of the cohort of 556 IBD patients, 223 (40.1%) had an anemia diagnosis. Among the latter, 39 patients received an intravenous iron treatment and had laboratory results in the 8 weeks preceding and in the 8 weeks following the treatment. Table 1 shows the response to intravenous iron treatment in patients with baseline Hb &lt; 12,0 g/dL (n=28 patients, 47 IV iron infusions). Table 2 shows the changes in anemia-related laboratory values in the 8 weeks preceding and in the 8 weeks following intravenous iron treatment. Conclusion This was the first study to evaluate the prevalence of iron-deficiency anemia and the real-life impact of intravenous iron treatment among patients living with IBD in Quebec, Canada. The findings will serve as a baseline for subsequent interventions to improve the wellbeing and the quality of life of IBD patients with anemia.

Intravenous versus Oral iron for Iron-Deficiency Anemia in Pregnancy (IVIDA): A Randomized Controlled Trial

2021 ◽  
Author(s):  
Adam K. Lewkowitz ◽  
Molly J. Stout ◽  
Emily Cooke ◽  
Seon C. Deoni ◽  
Viren D'Sa ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Adverse Reactions ◽  
Controlled Trial ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Randomized Controlled ◽  
Iv Iron ◽  
Severe Adverse Reactions

Objective Iron-deficiency anemia (IDA) can have serious consequences for mothers and babies. Iron supplementation is recommended, but the administration route is controversial. We sought to conduct a randomized controlled trial (RCT) testing the effectiveness and safety of intravenous (IV) iron compared with oral iron on perinatal outcomes in pregnant women with IDA. Study Design This open-label RCT randomized patients with IDA (hemoglobin [hgb] <10 g/dL and ferritin <30 ng/mL) at 24 to 34 weeks' to oral iron or single 1,000-mg dose of IV low-molecular weight iron dextran over one hour. The primary outcome was maternal anemia at delivery (hgb < 11 g/dL). Secondary outcomes were mild/moderate or severe adverse reactions, maternal hgb and ferritin at delivery, blood transfusion, gestational age at delivery, birth weight, neonatal hgb and ferritin, and composite neonatal morbidity. Analysis was as per protocol. Results The trial was stopped early for logistical reasons, and the data analyzed as preliminary data to inform a larger, potentially externally funded, definitive trial. Of 55 patients approached, 38 consented. Of these, 15 were withdrawn: 5 received IV iron from their primary obstetrician after being randomized to oral iron and 10 declined to receive IV iron. Of the remaining 23 patients, who were included in the analytic population, 13 received oral iron and 10 received IV iron. The rate of maternal anemia at delivery (hgb < 11 g/dL) was high overall but significantly reduced with IV iron (40 vs. 85%, p = 0.039). Rates of maternal hgb < 10 g/dL were significantly lower in the IV iron group (10 vs. 54%, p = 0.029). There were no severe adverse reactions and similar rates of mild/moderate reactions between groups. Conclusion IV iron reduces rates of anemia at the time of admission for delivery, supporting a larger RCT comparing IV versus oral iron for the treatment of IDA of pregnancy powered for definitive clinical outcomes. However, issues uncovered in this RCT suggest that patient, clinician, and systems-level barriers associated with different IDA treatment modalities must be considered prior to conducting a larger RCT. This study is registered with clinicaltrials.gov with identifier no.: NCT03438227. Key Points

scholarly journals Excess Hemolysis in Subjects with Severe Iron Deficiency Anemia Associated and Nonassociated with Hookworm Infection

Blood ◽  
1965 ◽  
Vol 25 (1) ◽  
pp. 73-91 ◽  
Author(s):  
MIGUEL LAYRISSE ◽  
JESÚS LINARES ◽  
MARCEL ROCHE ◽  
Adelina Ojeda ◽  
Alvaro Carstens ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Cell Survival ◽  
Iron Deficiency Anemia ◽  
Red Cells ◽  
Deficiency Anemia ◽  
Intrinsic Defect ◽  
Red Cell ◽  
Hookworm Infection ◽  
Iron Treatment ◽  
Red Cell Survival

Abstract An excess hemolysis was found in subjects with iron deficiency anemia associated with hookworm infection. Red cell survival, measured with Cr51 and DFP32 in the subjects before deworming, showed a marked disproportion between the decrease of the survival and the amount of daily intestinal blood loss in most cases. Excess of hemolysis was still present after more than 90 per cent of the parasites were removed. Red cell survival became normal after correction of anemia through iron treatment. Excess of hemolysis was also present in noninfected subjects with iron deficiency anemia due to other causes. The reduction in the survival of the erythrocytes from infected subjects transfused into normal recipients shows that the hemolytic process is due to an intrinsic defect of the red cells. The low values of hemoglobinemia and the presence of haptoglobins in the plasma indicate that hemoglobin has not been liberated in excess intravascularly. Finally, the fact that the red cells from an infected patient taken after deworming survived normally in splenectomized recipients indicates that the spleen is probably the principal site of the red cell destruction. The clinical and autopsy findings suggest that splenic function is not pathologically increased, but rather that this organ is acting physiologically at a more rapid rate, "culling" the abnormal circulating red cells and thus leading to a decrease in red cell survival. The studies presented here also indicate that the hookworm infection per se does not induce hemolysis.

THE GASTROINTESTINAL EFFECTS OF IRON-DEFICIENCY ANEMIA

PEDIATRICS ◽  
1964 ◽  
Vol 33 (1) ◽  
pp. 83-99
Author(s):  
J. L. Naiman ◽  
F. A. Oski ◽  
L. K. Diamond ◽  
G. F. Vawter ◽  
H. Shwachman
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Deficiency Anemia ◽  
Control Group ◽  
Poor Correlation ◽  
Iron Treatment ◽  
High Incidence ◽  
Before And After ◽  
And Function ◽  
Duodenal Biopsies

A group of 14 infants and children with nutritional iron-deficiency anemia were studied with respect to gastrointestinal function and structure both before and after iron treatment. A high incidence of abnormalities was found, consisting of gastric achlorhydria, impaired absorption of xylose and vitamin A, and steatorrhea. Duodenal biopsies revealed varying degrees of chronic duodenitis and mucosal atrophy. There was poor correlation between structure and function. Following treatment with oral iron most of the abnormalities reverted to normal. A control group of 8 children with long-standing anemias not due to iron deficiency were subjected to similar studies, most of which yielded normal results. These observations indicate a diffuse and reversible enteropathy in children as a result of iron deficiency. The pathogenesis and practical implications are discussed.

scholarly journals Management of postpartum iron deficiency anemia: review of literature

2018 ◽  
Vol 8 (1) ◽  
pp. 338
Author(s):  
Mohamed Saber ◽  
Mohamed Khalaf ◽  
Ahmed M. Abbas ◽  
Sayed A. Abdullah
Keyword(s):  
Iron Deficiency ◽  
Blood Transfusion ◽  
Iron Deficiency Anemia ◽  
Iron Sucrose ◽  
Deficiency Anemia ◽  
Ferric Carboxymaltose ◽  
Allogenic Blood Transfusion ◽  
Iron Dextran ◽  
Peripheral Tissues ◽  
Iv Iron

Anemia is a condition in which either the number of circulating red blood cells or their hemoglobin concentration is decreased. As a result, there is decreased transport of oxygen from the lungs to peripheral tissues. The standard approach to treatment of postpartum iron deficiency anemia is oral iron supplementation, with blood transfusion reserved for more server or symptomatic cases. There are a number of hazards of allogenic blood transfusion including transfusion of the wrong blood, infection, anaphylaxis and lung injury, any of which will be devastating for a young mother. These hazards, together with the national shortage of blood products, mean that transfusion should be viewed as a last resort in otherwise young and healthy women. Currently, there are many iron preparations available containing different types of iron salts, including ferrous sulfate, ferrous fumarate, ferrous ascorbate but common adverse drug reactions found with these preparations are mainly gastrointestinal intolerance like nausea, vomiting, constipation, diarrhoea, abdominal pain, while ferrous bis-glycinate (fully reacted chelated amino acid form of iron) rarely make complication. Two types of intravenous (IV) preparations available are IV iron sucrose and IV ferric carboxymaltose. IV iron sucrose is safe, effective and economical. Reported incidence of adverse reactions with IV iron sucrose is less as compared to older iron preparations (Iron dextran, iron sorbitol), but it requires multiple doses and prolonged infusion time. Intramuscular iron sucrose complex is particularly contraindicated because of poor absorption. It was also stated that when iron dextran is given intravenously up to 30% of patients suffer from adverse effects which include arthritis, fever, urticaria and anaphylaxis.

Treatment of Iron Deficiency Anemia in Pregnancy with Intravenous versus Oral Iron: Systematic Review and Meta-Analysis

2018 ◽  
Vol 36 (04) ◽  
pp. 366-376 ◽  
Author(s):  
Richard Burwick ◽  
Shravya Govindappagari
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Meta Analysis ◽  
Oral Iron ◽  
Sensitivity Analyses ◽  
Deficiency Anemia ◽  
Iv Iron ◽  
Anemia In Pregnancy ◽  
In Pregnancy

Objective To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the benefits of intravenous (IV) iron in pregnancy. Study Design Systematic review was registered with PROSPERO and performed using PRISMA guidelines. PubMed, MEDLINE, Web of Science, ClinicalTrials.gov, Cochrane Library, and Google Scholar were searched. Eleven RCTs, comparing IV to oral iron for treatment of iron-deficiency anemia in pregnancy, were included. Meta-analyses were performed with Stata software (College Station, TX), utilizing random effects model and method of DerSimonian and Laird. Outcomes were assessed by pooled odds ratios (OR) or pooled weighted mean difference (WMD). Sensitivity analyses were performed for heterogeneity. Results We found that pregnant women receiving IV iron, compared with oral iron, had the following benefits: (1) Achieved target hemoglobin more often, pooled OR 2.66 (95% confidence interval [CI]: 1.71–4.15), p < 0.001; (2) Increased hemoglobin level after 4 weeks, pooled WMD 0.84 g/dL (95% CI: 0.59–1.09), p < 0.001; (3) Decreased adverse reactions, pooled OR 0.35 (95% CI: 0.18–0.67), p = 0.001. Results were unchanged following sensitivity analyses. Conclusion In this meta-analysis, IV iron is superior to oral iron for treatment of iron-deficiency anemia in pregnancy. Women receiving IV iron more often achieve desired hemoglobin targets, faster and with fewer side effects.

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