scholarly journals Regulatory Mechanisms for Iron Homeostasis Are Present in Small Preterm Newborns

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2460-2460
Author(s):  
Carina Levin ◽  
Marina Marina Peniakov ◽  
Dan Reich ◽  
Scott Weiner ◽  
Jamal Hasnein ◽  
...  
Keyword(s):  
Birth Weight ◽  
Blood Transfusion ◽  
Preterm Infants ◽  
Iron Supplementation ◽  
Iron Homeostasis ◽  
Reticulocyte Count ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Regulatory Mechanisms ◽  
Vlbw Infants

Abstract Iron, an essential micronutrient, plays an important role in cellular functions. To prevent deficiency, iron supplementation is universally recommended for preterm infants; nevertheless, assessment of newborn iron stores is not currently recommended. Both iron deficiency and iron excess early in life can have adverse effects on neurodevelopment and outcomes, and therefore sensitive and specific methods for evaluating iron status and determining optimal iron supplementation are essential. The current study aimed to evaluate iron status and iron-supplementation efficacy/toxicity in preterm infants using new laboratory methods, and to correlate iron status with clinical, nutritional, laboratory and therapeutic factors, and the amount of blood extracted and transfused. We evaluated 50 very low birth weight (VLBW) preterm infants treated under standard protocols at the Emek Medical Center NICU, 26 (54%) male. Iron supplementation was administered enterally from 4 wk of age (4 mg elemental iron/kg body weight daily). Laboratory studies included CBC, reticulocyte count, reticulocyte hemoglobin (Hb) content, iron, transferrin, transferrin saturation, ferritin, erythropoietin, hepcidin, CRP and non-transferrin-bound iron (NTBI) (Aferrix, Israel). Samples were obtained at 3 different times during hospitalization: (-0) before starting oral iron supplementation, (-1) on d 4-7 of supplementation, and (-2) after at least 2 wk of supplementation. To better understand iron metabolism, the analyzed preterm population was divided into subgroups for comparison: infants who did not require blood transfusion (No-BT) vs. those who received one or more transfusions (BT); infants who did not show abnormal NTBI levels (≤0.19 μmol/L; No-NTBI) vs. those with abnormal NTBI levels (≥ 0.2 μmol/L in one or more samples; NTBI). Mean birth weight of the studied infants was 1264.5 ± 342 g, gestational age 29.1 ± 2.5 wk, age at hospital discharge 57.6 ± 20 d and weight at discharge, 2412 ± 421 g. The BT group included 35 (70%) infants. The mean birth weight was lower in the BT vs. No-BT group (1199 ± 351 g vs. 1416±273 g, P = 0.04). Mean red blood cell, Hb, and hematocrit were higher in the BT vs. No-BT group. Conversely, mean platelet count, reticulocyte count, and erythropoietin were higher in the No-BT vs. BT group, suggesting an erythropoietic response to lower Hb levels and utilization of iron through effective erythropoiesis. In the BT group, mean serum iron, ferritin, transferrin saturation and hepcidin were higher, whereas transferrin was lower than in the No-BT group. This reflects increased iron burden induced by the transfusions, making NTBI more likely to develop with potential toxicity. Regarding NTBI, 34 (68%) of the infants were in the No-NTBI group, and 16 (32%) showed increased NTBI levels. The Δiron (sum of iron from diet, supplementation and transfusion minus iron output via blood extractions) before starting supplementation was significantly higher in the NTBI vs. No-NTBI group. Mean transferrin saturation at -0 was higher, whereas transferrin at -2 was lower in the NTBI vs. No-NTBI group, demonstrating a higher iron burden in NTBI infants. The odds of developing NTBI rose 7.2% for each percent increment in transferrin saturation at -0 (O.R. 1.072, 95% CI, 1.005-1.143, P = 0.036), and a cutoff of 26% at -0 gave 80% sensitivity and 41% specificity for the presence of NTBI (AUC 0.68). Thus VLBW infants show evidence of regulatory mechanisms for iron homeostasis and iron utilization for erythropoiesis; however, the protective responses are not developed enough to limit the appearance of circulating free iron with potential toxic effects. Neither adverse effects nor presence of NTBI were associated with enteral iron supplementation. Premature infants who received blood transfusions had a positive iron balance, higher Hb and ferritin levels, and reduced erythropoiesis. Consequently, these babies are more likely to develop free iron. Conventional biomarkers are effective for evaluating iron status in VLBW infants. Transferrin saturation seems to be the most reliable and "physiological" biomarker, and a potential predictor of abnormal NTBI levels. These findings support an individualized approach to iron supplementation based on the characteristics of the specific preterm infant while taking into consideration past need for blood transfusion and the infant's iron status. Disclosures No relevant conflicts of interest to declare.

Iron homeostasis after blood transfusion in stable preterm infants – an observational study

2016 ◽  
Vol 44 (8) ◽  
Author(s):  
Jacky Herzlich ◽  
Ita Litmanovitz ◽  
Rivka Regev ◽  
Sofia Bauer ◽  
Gisela Sirota ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Preterm Infants ◽  
Iron Homeostasis ◽  
Reticulocyte Count ◽  
Iron Status ◽  
Venous Blood ◽  
Hemoglobin Concentration ◽  
Serum Levels ◽  
Positive Linear Correlation ◽  
Red Blood Cell Transfusions

AbstractAim:To evaluate the short-term effects of blood transfusion on iron status [hemoglobin, ferritin, soluble transferrin receptor (sTfR), and reticulocyte count], hepcidin, and erythropoietin in stable preterm infants.Method:Sixty-three preterm infants treated with red blood cell transfusions (RBCTs) were included. Venous blood samples were collected before and within 24 h after each transfusion.Results:Hemoglobin concentration increased after RBCT (7.2±1.2 g/dL vs. 13.7±2.3 g/dL, P=0.02), as well as ferritin [131 (63–110.4) ng/mL vs. 211 (125.7–299.2) ng/mL, P=0.05); reticulocyte count decreased. sTfR did not change. Hepcidin serum levels increased from 37.5 (21.3–84.7) ng/mL to 72.6 (31.3–126.2) ng/mL, (P=0.04) and erythropoietin decreased (48±19 pg/mL vs. 29±17 pg/mL, P=0.06) after RBCT. A positive linear correlation was found (RConclusion:Preterm infants can control iron levels by regulating hepcidin and decreasing erythropoietin. This ability varies with postnatal age.

scholarly journals Effect of Daily Iron Supplementation on Infantile Iron Homeostasis in Preterm Infants

2021 ◽  
Vol 9 ◽  
Author(s):  
Mingyan Li ◽  
Ying Lv ◽  
Jionghuan Ying ◽  
Lin Xu ◽  
Weijun Chen ◽  
...  
Keyword(s):  
Side Effects ◽  
Iron Deficiency ◽  
Blood Transfusion ◽  
Preterm Infants ◽  
Early Treatment ◽  
Iron Supplementation ◽  
Iron Homeostasis ◽  
Iron Status ◽  
Deficiency Anemia ◽  
Factors Affecting

Objective: The aim of this study was to investigate the effects of unified iron supplementation and identify the factors related to the iron homeostasis among preterm infants.Method: A total of 250 preterm infants were divided into neonatal anemic (NA, n = 154) and non-neonatal anemic group (NNA, n = 96). Iron supplements at a dose of 2 mg/kg per day were given from 40 weeks' gestational age to 6 months. Iron status parameters were measured at 3 and 6 months, respectively. Prevalence of iron deficiency (ID) and iron deficiency anemia (IDA), and the correlated factors were analyzed. Growth and side-effects were monitored.Results: There were no significant differences for the prevalence of ID or IDA between the two groups. Multivariate regression analyses showed that higher Hb at birth and early treatment of blood transfusion reduced the risk of ID/IDA at 3 months (all p < 0.05); while higher level of Hb at 3 months (p = 0.004) and formula feeding reduced the occurrence of ID/IDA at 6 months (p < 0.05); males had a 3.35 times higher risk to develop ID/IDA than girls (p = 0.021). No differences in growth and side effects were found.Conclusion: A daily dose of 2 mg/kg iron supplement is beneficial to maintain iron homeostasis in majority preterm infants within 6 months regardless of their neonatal anemia history. Under the routine iron supplementation, Hb level at birth and at 3 months, early treatment of blood transfusion, gender and feeding patterns are the major factors affecting the prevalence of ID/IDA among preterm infants in infancy.

scholarly journals Iron Supplementation Effects on Redox Status following Aseptic Skeletal Muscle Trauma in Adults and Children

2017 ◽  
Vol 2017 ◽  
pp. 1-13 ◽  
Author(s):  
Chariklia K. Deli ◽  
Ioannis G. Fatouros ◽  
Vassilis Paschalis ◽  
Athanasios Tsiokanos ◽  
Kalliopi Georgakouli ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Eccentric Exercise ◽  
Iron Supplementation ◽  
Iron Homeostasis ◽  
Iron Status ◽  
Iron Concentration ◽  
Transferrin Saturation ◽  
Redox Status ◽  
Placebo Condition ◽  
Adults And Children

Exercise-induced skeletal muscle microtrauma is characterized by loss of muscle cell integrity, marked aseptic inflammatory response, and oxidative stress. We examined if iron supplementation would alter redox status after eccentric exercise. In a randomized, double blind crossover study, that was conducted in two cycles, healthy adults (n=14) and children (n=11) received daily either 37 mg of elemental iron or placebo for 3 weeks prior to and up to 72 h after an acute eccentric exercise bout. Blood was drawn at baseline, before exercise, and 72 h after exercise for the assessment of iron status, creatine kinase activity (CK), and redox status. Iron supplementation at rest increased iron concentration and transferrin saturation (p<0.01). In adults, CK activity increased at 72 h after exercise, while no changes occurred in children. Iron supplementation increased TBARS at 72 h after exercise in both adults and children; no changes occurred under placebo condition. Eccentric exercise decreased bilirubin concentration at 72 h in all groups. Iron supplementation can alter redox responses after muscle-damaging exercise in both adults and children. This could be of great importance not only for healthy exercising individuals, but also in clinical conditions which are characterized by skeletal muscle injury and inflammation, yet iron supplementation is crucial for maintaining iron homeostasis. This study was registered at Clinicaltrials.gov Identifier:NCT02374619.

scholarly journals Iron supplementation in preterm and low-birth-weight infants: a systematic review of intervention studies

2019 ◽  
Vol 77 (12) ◽  
pp. 865-877 ◽  
Author(s):  
Elaine K McCarthy ◽  
Eugene M Dempsey ◽  
Mairead E Kiely
Keyword(s):  
Systematic Review ◽  
Birth Weight ◽  
Iron Deficiency ◽  
Low Birth Weight ◽  
Iron Overload ◽  
Preterm Infants ◽  
Iron Supplementation ◽  
Iron Status ◽  
Neurological Development

Abstract Context Enteral iron supplementation in preterm infants is recommended to supply sufficient iron for growth and development without increasing the risk of iron overload. However, the current recommendations date from 2010 and are based on limited evidence. Objective This systematic review aimed to investigate the effects of enteral iron supplementation on iron status, growth, neurological development, and adverse clinical outcomes in preterm (&lt;37 weeks’ gestation) and low-birth-weight (LBW, &lt;2500 g) infants. Data sources The PubMed/Medline and Cochrane Library databases were searched to 31 October 2018. Data extraction Of the 684 records identified, 27 articles, describing 18 randomized controlled trials (RCTs) plus 4 nonrandomized interventions, were included. Using the Cochrane Collaboration’s criteria, study quality was found to be poor to fair overall. Results Most articles (23/27) reported iron status indices; supplementation for ≥8 weeks resulted in increased hemoglobin and ferritin concentrations and a reduction in iron deficiency and anemia. No article reported on iron overload. Growth-related parameters reported in 12 articles were not affected by supplementation. Among the 7 articles on neurological development, a positive effect on behavior at 3.5 and 7 years was observed in one Swedish RCT. No association was found between supplementation and adverse clinical outcomes in the 9 articles reporting on studies in which such data was collected. Conclusions Long-term iron supplementation appears to result in improved iron status and a reduction in iron deficiency and anemia in preterm and LBW infants. However, high-quality evidence regarding the long-term effects of supplementation on functional health outcomes is lacking. Iron overload has largely been ignored. Well-designed, long-term, dose-response RCTs are required to ascertain the optimal dose and delivery method for the provision of dietary iron in preterm infants, with consideration of short- and long-term health effects. Systematic Review Registration PROSPERO registration no. CRD42018085214.

scholarly journals Assessment of Gastrointestinal Symptoms and Non-transferrin Bound Iron After Oral Ferrous Sulfate and Iron-enriched Aspergillus Oryzae Supplementation in Women (P24-039-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Amanda Bries ◽  
Chong Wang ◽  
Brian Wels ◽  
Isaac Agbemafle ◽  
Olivia Meier ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Side Effects ◽  
Ferrous Sulfate ◽  
Serum Iron ◽  
Iron Supplementation ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Iron Supplements

Abstract Objectives Iron deficiency anemia (IDA) is a widespread nutritional deficiency. Iron supplementation with ferrous sulfate (FeSO4) is the most common strategy to treat IDA; however, the compliance with daily FeSO4 administration is poor, due to contraindicating side effects. Previously, we have reported that A. oryzae (Ultimine®; ULT) is a novel iron source. Therefore, the objective of this study was to determine the biochemical assessment, non-transferrin bound iron (NTBI) and commonly related gastrointestinal side effects to assess the safety of A. oryzae compared to FeSO4. Methods Female participants (n = 16) with serum ferritin concentrations 40 µg/L were randomized to a double-blind, 9-wk cross-over study with a 3-wk placebo washout period between treatments. Oral iron supplements (65 mg Fe), FeSO4 and ULT were administered for 21 consecutive days for each subject. Side effect questionnaires were collected 3d/wk over the 9-wk study period. Side effects and biochemical markers (nausea, heartburn, abdominal pain, fatigue, headache, diarrhea, constipation, oxidative stress and liver and kidney function) from iron supplementation were evaluated, along with serum iron, % transferrin saturation (TS) and NBTI 8 h curves. Results Serum iron, TS, and NTBI were all markedly higher with FeSO4 at each time-point from 2–8 hours (P < 0.001) compared to ULT, whereas NTBI was undetected. Among treatments, FeSO4 resulted in higher inflammation, though not statistically significant. Compliance based on returned pills was higher with ULT (97.3%) than placebo and FeSO4 (95.2% and 93.2%, respectively). Subjects taking FeSO4 reported abdominal discomfort 2% more than ULT, which was not significantly different. FeSO4 caused marginally higher incidence of combined nauseation, constipation and diarrhea when subjects were taking FeSO4 (P < 0.07). Iron status was maintained similarly by both oral iron supplements. Oxidative stress, inflammation, kidney and liver function markers were not elevated with ULT supplementation, suggesting safety of its consumption. Conclusions Better compliance and less gastrointestinal related side effects were reported with ULT compared to FeSO4, while maintaining normal iron status. Our data suggests ULT is a safe oral iron supplement for treatment of IDA. Funding Sources Cura Global Health, Inc.

scholarly journals The Potential Effects of Human Milk on Morbidity in Very-Low-Birth-Weight Preterm Infants

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1882
Author(s):  
Paola Roggero ◽  
Nadia Liotto ◽  
Orsola Amato ◽  
Fabio Mosca
Keyword(s):  
Quality Of Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Very Low Birth Weight ◽  
Mortality And Morbidity ◽  
Vlbw Infants

Improvements in quality of care have led to a significant reduction in mortality and morbidity in preterm infants, especially very-low-birth-weight (VLBW) infants [...]

scholarly journals Iron Supplementation Confers Protection on Disease Severity in Dextran Sodium Sulfate (DSS)-Induced Colitis in Rats (OR15-05-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Amanda Bries ◽  
Rachel Derscheid ◽  
Paige Curry ◽  
Joe Webb ◽  
Olivia Meier ◽  
...  
Keyword(s):  
Disease Activity ◽  
Iron Supplementation ◽  
Iron Homeostasis ◽  
Iron Status ◽  
Fold Increase ◽  
Deficiency Anemia ◽  
State University ◽  
Sprague Dawley ◽  
Beneficial Effects ◽  
Funding Sources

Abstract Objectives Koji iron, enriched with FeSO4 (Ultimine®; ULT), is a novel source of supplemental iron. Previously, we reported ULT had similar absorption as ferrous sulfate (FeSO4), while resulting in less reported adverse effects in women. Iron deficiency anemia is a common manifestation of inflammatory bowel disease (IBD) due to malabsorption and gastrointestinal (GI) bleeding. Therefore, the objective of our study was to identify the efficacy of 2 forms of iron supplementation on impaired GI integrity and anemia caused by dextran sulfate sodium (DSS)-induced colitis. Methods Six wk old Sprague Dawley rats (n = 40) were randomly assigned to one of four treatment groups (n = 10/group): 1) Control with no DSS; 2) Control + DSS only (Nfe); 3) DSS + ULT; 4) DSS + FeSO4. Animals were maintained on the AIN-93 G diets for 7 d. Colitis was induced by administering fresh 3.5% (w/v) DSS ad lib throughout the study. Daily iron supplementation (6 mg Fe/kg BW) was provided in a pulverized treat, and disease activity indices were observed (gross bleeding, stool consistency and weight loss). Histological scoring of colonic ulcerations, inflammation and grade were assessed. Iron status indicators and liver hepcidin were detected using ELISA and qRT-PCR, respectively. Results The severity score of IBD was significantly higher in the animals without iron supplementation than those treated with iron (P < 0.0001). Moreover, iron supplementation protected against diminished hemoglobin and hematocrit levels as a result of DSS treatment (P = 0.001 and P = 0.03, respectively); whereas, these parameters were not significantly (NS) different between ULT and FeSO4. Improvement was found with post mortem disease score of DSS-induced rats with ULT compared to FeSO4 and Nfe by 14% and 39%, respectively (NS). Compared to healthy controls, FeSO4 resulted in a 3.5-fold increase in liver hepcidin gene expression, whereas ULT caused no change. Conclusions The results of this study highlight the beneficial effects iron supplementation has on the disease activity evoked by severe GI inflammation. Furthermore, this data suggests ULT attenuates the progression of IBD by supporting iron homeostasis. Additional analyses will explore the possible mechanisms of these results by identifying the systemic inflammation. Funding Sources College of Human Sciences, Iowa State University Collaborative Seed Grant Program.

P0673INVERSE ASSOCIATION OF TRANSFERRIN SATURATION WITH MORTALITY RISK IN CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Xin Li ◽  
Kristin Danielson ◽  
Innas Forsal ◽  
Ken Iseri ◽  
Lu Dai ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Transplantation ◽  
Kidney Disease ◽  
Mortality Risk ◽  
Iron Supplementation ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Resistance Index ◽  
Competing Risk ◽  
Dialysis Patients

Abstract Background and Aims Transferrin saturation (TSAT) is an indicator of iron deficiency or overload, but its relationship with mortality in patients with different stages of chronic kidney disease (CKD) is unclear. We investigated the association of TSAT with mortality in CKD patients. Method In 479 CKD patients (97 CKD3-4 patients, 298 CKD5 non-dialysis patients and 84 peritoneal dialysis patients; median age 58 years, 67% males, 33% cardiovascular disease, CVD, and 29% diabetes), biomarkers of iron status (plasma iron, TSAT, transferrin and ferritin), systemic inflammation (high sensitivity C-reactive protein, hsCRP, and interleukin-6, IL-6) and nutritional status were assessed. During median follow-up of 35.6 months, 139 (29%) patients died, and 176 (37%) patients underwent renal transplantation. Patients were stratified into low (n=157) and high (n=322) TSAT tertile groups. All-cause and CVD mortality risk were analyzed with competing risk regression with renal transplantation as competing risk. Results TSAT [median 23% (IQR 17-30%)] was negatively associated with presence of DM and CVD, body mass index, hsCRP, IL-6, Framingham´s CVD risk score (FRS), erythropoietin resistance index (ERI) and iron supplementation, and positively associated with hemoglobin, ferritin and s-albumin. In competing risk analysis, low tertile of TSAT was independently associated with increased all-cause mortality risk (sHR=1.50, 95%CI 1.05-2.14) after adjusting for CKD stages, 1-SD of FRS, 1-SD of hemoglobin, 1-SD of hsCRP, 1-SD of ESA dose and iron supplementation (Figure 1). Conclusion TSAT was inversely associated with mortality risk in CKD patients. When evaluating clinical outcomes of CKD patients, iron status using TSAT as a predictive marker, should be considered.

High Prevalence of Iron Deficiency In Anemic and Non Anemic Patients with Various Types of Cancer

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5145-5145
Author(s):  
Heinz Ludwig ◽  
Georg Endler ◽  
Brigitte Klement ◽  
Wolfgang Hüubl ◽  
Tim Cushway
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Multiple Testing ◽  
Serum Iron ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Clinical Symptoms ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Patients With Cancer

Abstract Abstract 5145 Introduction and aims: Iron deficiency as a major component in the pathogenesis of anemia in cancer is not acknowledged by most oncologists, possibly except when arising from GI blood loss. Iron deficiency is associated with clinical symptoms such as cognitive impairment, fatigue, and reduced exercise performance. New iron formulations are available that allow rapid iron supplementation with single infusions. This treatment could ameliorate symptoms of iron deficiency and correct anemia. Here, we studied iron parameters and their correlation with erythropoiesis and inflammatory markers in a large unselected cohort of patients with cancer. In addition, we investigated the suitability of serum ferritin and transferrin saturation (TSAT) as parameter for assessment of the iron status. Patients and methods: Data from 1627 patients (median age: 66.4 years, range: 20–97 years) presenting sequentially at the Center for Oncology and Hematology, Wilhelminenspital, Vienna between October 01, 2009 and January 26, 2010, have retrospectively been analyzed. Patients were at different stages of their disease or may not have had an established diagnosis at the time of testing. In patients with multiple testing during this period only the first sample taken was included. TSAT (n=1516), serum ferritin (n=887), serum iron, CRP, and complete blood count, were determined by using standard techniques. Commonly used definitions for absolute iron deficiency (AID), [TSAT <20% and serum ferritin <30ng/ml, in case serum ferritin was not available TSAT <10%] and for functional iron deficiency (FID), [TSAT <20% and serum ferritin ≥30ng/ml, in case serum ferritin was not available TSAT between 10 and 20%] have been applied. Fisher's exact test was used for comparison of frequencies and Pearson's product moment correlation coefficient for evaluation of correlation. Results: Table 1 shows the distribution of TSAT and serum ferritin categories in 1627 patients with cancer. AID was found in 116 patients (7.7%) of the 1516 patients for whom TSAT was available. Eighty-three (72%) of the AID patients presented with anemia (defined by hemoglobin <12g/dl). AID was most common in patients with colorectal and pancreatic cancer (12% and 11%, respectively), and not present in patients with testicular and prostate cancer (p=0.013). FID was diagnosed in 530 patients (35%) and 222 (42%) of them were found to be also anemic. Multivariate analysis revealed a statistically significant correlation between TSAT and serum ferritin (R=0.286, p<0.001), serum iron (R=0.874, p<0.001), hemoglobin (R=0.201, p<0.001) and CRP (R=-0.205, p<0.001) (figure 1). Serum ferritin, in contrast, did not correlate with serum iron (R=0.051, p=0.132), but correlated with hemoglobin (R=-0.259, p<0.001), TSAT (R=0.286, p<0.001), and CRP (R=0.396, p<0.001). Conclusion: AID (7.7%) and even more so FID (35%) are frequent co-morbidities in patients with various types of cancer. Seventy-two percent of patients with AID and 42% with FID presented with overt anemia. TSAT correlated closely with serum iron and hemoglobin levels and seems to be the preferred parameter for assessment of iron status in patients with chronic diseases often complicated by increased inflammation. Serum ferritin was found to be an inadequate parameter for assessment and monitoring of iron status. As iron deficiency has been linked with various symptoms, the question arises whether iron supplementation would benefit patients with FID without overt anemia. Future studies should evaluate the role of novel intravenous iron preparations in ameliorating the symptoms of iron deficiency with or without anemia. Disclosures: Klement: Vifor Pharma Ltd: Employment. Cushway:Vifor Pharma Ltd.: Employment.

Serum Prohepcidin and Iron Homeostasis in Patients with Breast Cancer

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5291-5291
Author(s):  
Janet G. Grudeva ◽  
Ivanka Slavejnova Nenova ◽  
Dora Dimitrova Terzieva ◽  
Maria Ivanova Spasova ◽  
Nikolay Petrov Boyadjiev
Keyword(s):  
Breast Cancer ◽  
Iron Homeostasis ◽  
Conflicts Of Interest ◽  
Iron Status ◽  
Transferrin Saturation ◽  
University Hospital ◽  
Direct Result ◽  
Full Blood Count ◽  
Normocytic Anemia ◽  
Cytotoxic Treatment

Abstract Abstract 5291 Introduction: Cancer-related anemia (CRA) has multifactorial etiology and complex pathogenesis. It is defined as normochromic, normocytic anemia with reticulocyto-penia and hypoferremia. Hepcidin is recognized as the central factor in causing CRA. Objective: To investigate the changes in the serum levels of prohepcidin (pHp) and markers of iron homeostasis for gathering more data on the pathogenesis of CRA. Patients and Methods: The authors analyzed prospectively 46 newly diagnosed women with breast cancer, aged 29–72 years (average 47.5±9.0 SD), who had the same clinical stage, histology and hormonal status. They were diagnosed and treated in the Clinic of Oncology and Hematology - University Hospital for a 2-year period (2009–2010). Serum pHp levels and common markers of iron status including serum iron (sFe), transferrin saturation, soluble tranferrin receptor (sTfR), Zn-protoporphyrin (ZPP), ferritin as well as vitamin B12 and folate were measured before treatment initiation and two months afterwards. Serum pHp was determined by a competitive immunotest. All statistical data was computed by the methods of variational and correlation analyses. Results and Discussion: For the two-month follow up interval parameters of full blood count remained without statistically significant deviation. Although the analyzed parameters in the first and second blood samples remained within the reference intervals, the decrease of pHp and the changes of iron-containing substances and ZPP in red blood cells cannot be neglected. However the correlation coefficient (R) between decreased pHp, increased sFe (R=0.314), sTfR (R=0.258), ZPP (R=0.118) and decreased ferritin (R=0.099), were low instead of the expected higher relationship. The obtained results do not support the idea that iron increase and other changes of iron homeostasis in these patients is a direct result of regulatory decrease of pHp. The two-month interval is likely short enough to rule out a potential direct suppressive effect of the specific cytotoxic treatment, and therefore we do not discuss such potential influence on iron homeostasis. Conclusion: Iron homeostasis dysregulation is one of CRA components. In its complex pathogenesis several other factors interfere e.g. such related to the disease; therapy related factors; altered erythropoietin production; activation of cytokines (IL-6 is the major promoter of hepcidin production). Disclosures: No relevant conflicts of interest to declare.

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