scholarly journals Comparison of iron status 28 d after provision of antimalarial treatment with iron therapy compared with antimalarial treatment alone in Ugandan children with severe malaria

2016 ◽  
Vol 103 (3) ◽  
pp. 919-925 ◽  
Author(s):  
Sarah E Cusick ◽  
Robert O Opoka ◽  
Andrew S Ssemata ◽  
Michael K Georgieff ◽  
Chandy C John
Keyword(s):  
Severe Malaria ◽  
Iron Status ◽  
Iron Therapy ◽  
Antimalarial Treatment

scholarly journals Malaria Incidence Does Not Differ with Immediate Compared to 28-day Delayed Iron Treatment in Children with Severe Malaria and Iron Deficiency (OR10-04-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Sarah Cusick ◽  
Robert Opoka ◽  
Andrew Ssemata ◽  
Michael Georgieff ◽  
Chandy John
Keyword(s):  
Iron Deficiency ◽  
Severe Malaria ◽  
Malaria Incidence ◽  
Iron Status ◽  
Iron Therapy ◽  
Zinc Protoporphyrin ◽  
Antimalarial Treatment ◽  
Group I ◽  
History Of ◽  
Malaria Episodes

Abstract Objectives We aimed to determine if delaying iron until 28 days after antimalarial treatment in children with severe malaria and iron deficiency leads to fewer subsequent clinical malaria episodes as compared to concurrent iron therapy. Methods The randomized controlled trial was conducted Ugandan children 18 mo-5 y with severe malaria [cerebral malaria (CM), n = 79; severe malarial anemia (SMA), n = 77] and healthy community children (CC, n = 83) at Mulago Hospital in Kampala, Uganda. All children with malaria received antimalarial treatment. Children with iron deficiency (defined by zinc protoporphyrin (ZPP) >= 80 µmol/mol heme) were randomized to start a 90-day course of ferrous sulfate (2 mg/kg/day) concurrently with antimalarial treatment on Day 0 (immediate group, I) or on Day 28 (delayed group, D). Incidence of malaria episodes over the 12-month follow-up period was assessed by sick-child visits to the study clinic. Malaria was defined as measured fever (T >37.5°C) plus Plasmodium falciparum on blood smear. Negative binomial regression was used to model counts of malaria episodes as a function of treatment group (I or D), controlling for age. Hazard ratios compared time to event between the I and D groups. Results All children with CM and SMA and 35 CC had high ZPP and were randomized to I or D iron. There were no differences in malaria incidence (defined with either measured fever or history of fever) with I vs. D treatment in any study group. The incidence of inpatient malaria episodes defined with history of fever was marginally statistically significant lower with D iron in the SMA group [incidence rate ratio (IRR) D/I (95% CI) = 0.38 (0.14, 1.1), P = 0.07). In the SMA group, children who received D iron tended to have a longer time to first inpatient event than children in the I group [Hazard ratio (95% CI) D/I: 0.37 (0.13, 1.1), P = 0.07]. Conclusions Delaying iron in children with severe malaria had no clear risk or benefit on subsequent malaria incidence or time-to-first episode as compared to immediate treatment. Given that previous analysis revealed that iron status was improved with delayed iron among children with SMA, the lack of difference in malaria incidence suggests that delaying iron therapy may be a safe way to improve iron status in this group. Funding Sources NIH/NICHD.

scholarly journals Delayed iron improves iron status without altering malaria risk in severe malarial anemia

2020 ◽  
Vol 111 (5) ◽  
pp. 1059-1067 ◽  
Author(s):  
Sarah E Cusick ◽  
Robert O Opoka ◽  
Andrew S Ssemata ◽  
Michael K Georgieff ◽  
Chandy C John
Keyword(s):  
Iron Deficiency ◽  
Severe Malaria ◽  
Malaria Incidence ◽  
Iron Status ◽  
Hemoglobin Concentration ◽  
Malaria Risk ◽  
Antimalarial Treatment ◽  
Severe Malarial Anemia ◽  
Iron Treatment ◽  
Malarial Anemia

ABSTRACT Background WHO guidelines recommend concurrent iron and antimalarial treatment in children with malaria and iron deficiency, but iron may not be well absorbed or utilized during a malaria episode. Objectives We aimed to determine whether starting iron 28 d after antimalarial treatment in children with severe malaria and iron deficiency would improve iron status and lower malaria risk. Methods We conducted a randomized clinical trial on the effect of immediate compared with delayed iron treatment in Ugandan children 18 mo–5 y of age with 2 forms of severe malaria: cerebral malaria (CM; n = 79) or severe malarial anemia (SMA; n = 77). Asymptomatic community children (CC; n = 83) were enrolled as a comparison group. Children with iron deficiency, defined as zinc protoporphyrin (ZPP) ≥ 80 µmol/mol heme, were randomly assigned to receive a 3-mo course of daily oral ferrous sulfate (2 mg · kg–1 · d–1) either concurrently with antimalarial treatment (immediate arm) or 28 d after receiving antimalarial treatment (delayed arm). Children were followed for 12 mo. Results All children with CM or SMA, and 35 (42.2%) CC, were iron-deficient and were randomly assigned to immediate or delayed iron treatment. Immediate compared with delayed iron had no effect in any of the 3 study groups on the primary study outcomes (hemoglobin concentration and prevalence of ZPP ≥ 80 µmol/mol heme at 6 mo, malaria incidence over 12 mo). However, after 12 mo, children with SMA in the delayed compared with the immediate arm had a lower prevalence of iron deficiency defined by ZPP (29.4% compared with 65.6%, P = 0.006), a lower mean concentration of soluble transferrin receptor (6.1 compared with 7.8 mg/L, P = 0.03), and showed a trend toward fewer episodes of severe malaria (incidence rate ratio: 0.39; 95% CI: 0.14, 1.12). Conclusions In children with SMA, delayed iron treatment did not increase hemoglobin concentration, but did improve long-term iron status over 12 mo without affecting malaria incidence. This trial was registered at clinicaltrials.gov as NCT01093989.

Relationship Between Iron Indices and Iron Responsiveness Following IV Ferumoxytol or Oral Iron In Patients with CKD Not on Dialysis

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5149-5149
Author(s):  
John Adamson ◽  
Zhu Li ◽  
Paul Miller ◽  
Annamaria Kausz
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Status ◽  
Oral Iron ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Functional Iron Deficiency ◽  
Iron Stores ◽  
Iv Iron ◽  
Definition Of

Abstract Abstract 5149 BACKGROUND Iron deficiency anemia (IDA) is associated with reduced physical functioning, cardiovascular disease, and poor quality of life. The measurement of body iron stores is essential to the management of IDA, and the indices most commonly used to assess iron status are transferrin saturation (TSAT) and serum ferritin. Unfortunately, serum ferritin is not a reliable indicator of iron status, particularly in patients with chronic kidney disease (CKD), because it is an acute phase reactant and may be elevated in patients with iron deficiency in the presence of inflammation. Recent clinical trials have shown that patients with iron indices above a strict definition of iron deficiency (TSAT >15%, serum ferritin >100 ng/mL), do have a significant increase in hemoglobin (Hgb) when treated with iron. These results are consistent with recent changes to the National Cancer Comprehensive Network (NCCN) guidelines, which have expanded the definition of functional iron deficiency (relative iron deficiency) to include a serum ferritin <800 ng/mL; previously, the serum ferritin threshold was <300 ng/mL. Additionally, for patients who meet this expanded definition of functional iron deficiency (TSAT <20%, ferritin <800 ng/mL), it is now recommended that iron replacement therapy be considered in addition to erythropoiesis-stimulating agent (ESA) therapy. Ferumoxytol (Feraheme®) Injection, a novel IV iron therapeutic agent, is indicated for the treatment of IDA in adult patients with CKD. Ferumoxytol is composed of an iron oxide with a unique carbohydrate coating (polyglucose sorbitol carboxymethylether), is isotonic, has a neutral pH, and evidence of lower free iron than other IV irons. Ferumoxytol is administered as two IV injections of 510 mg (17 mL) 3 to 8 days apart for a total cumulative dose of 1.02 g; each IV injection can be administered at a rate up to 1 mL/sec, allowing for administration of a 510 mg dose in less than 1 minute. METHODS Data were combined from 2 identically designed and executed Phase III randomized, active-controlled, open-label studies conducted in 606 patients with CKD stages 1–5 not on dialysis. Patients were randomly assigned in a 3:1 ratio to receive a course of either 1.02 g IV ferumoxytol (n=453) administered as 2 doses of 510 mg each within 5±3 days or 200 mg of oral elemental iron (n=153) daily for 21 days. The main IDA inclusion criteria included a Hgb ≤11.0 g/dL, TSAT ≤30%, and serum ferritin ≤600 ng/mL. The mean baseline Hgb was approximately 10 g/dL, and ESAs were use by approximately 40% of patients. To further evaluate the relationship between baseline markers of iron stores and response to iron therapy, data from these trials were summarized by baseline TSAT and serum ferritin levels. RESULTS Overall, results from these two pooled trials show that ferumoxytol resulted in a statistically significant greater mean increase in Hgb relative to oral iron. When evaluated across the baseline iron indices examined, statistically significant (p<0.05) increases in Hgb at Day 35 were observed following ferumoxytol administration, even for subjects with baseline iron indices above levels traditionally used to define iron deficiency. Additionally, at each level of baseline iron indices, ferumoxytol produced a larger change in Hgb relative to oral iron. These data suggest that patients with CKD not on dialysis with a wide range of iron indices at baseline respond to IV iron therapy with an increase in Hgb. Additionally, ferumoxytol consistently resulted in larger increases in Hgb relative to oral iron across all levels of baseline iron indices examined. Disclosures: Adamson: VA Medical Center MC 111E: Honoraria, Membership on an entity's Board of Directors or advisory committees. Li:AMAG Pharmaceuticals, Inc.: Employment. Miller:AMAG Pharmaceuticals, Inc.: Employment. Kausz:AMAG Pharmaceuticals, Inc.: Employment.

scholarly journals Starting at the community: Treatment seeking pathways of children with suspected severe malaria in Uganda

2021 ◽  
Author(s):  
Nina C. Brunner ◽  
Aliya Karim ◽  
Proscovia Athieno ◽  
Joseph Kimera ◽  
Gloria Tumukunde ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Health Facility ◽  
Health Workers ◽  
Local Treatment ◽  
Public Health Facility ◽  
Private Clinic ◽  
Community Treatment ◽  
Treatment Seeking ◽  
Antimalarial Treatment ◽  
To Receive

AbstractIntroductionCommunity health workers (CHW) usually refer children with suspected severe malaria to the nearest public health facility or a designated public referral health facility (RHF). Caregivers do not always follow this recommendation. This study aimed at identifying post-referral treatment-seeking pathways that lead to appropriate antimalarial treatment for children less than five years with suspected severe malaria.MethodsAn observational study in Uganda enrolled children below five years presenting to CHWs with signs of severe malaria. Children were followed up 28 days after enrolment to assess their condition and treatment-seeking history, including referral advice and provision of antimalarial treatment from visited providers.ResultsOf 2211 children included in the analysis, 96% visited a second provider after attending a CHW. The majority of CHWs recommended caregivers to take their child to a designated RHF (65%); however, only 59% followed this recommendation. Many children were brought to a private clinic (33%), even though CHWs rarely recommended this type of provider (3%). Children who were brought to a private clinic were more likely to receive an injection than children brought to a RHF (78% vs 51%, p<0.001) and more likely to receive the second or third-line injectable antimalarial (artemether: 22% vs. 2%, p<0.001, quinine: 12% vs. 3%, p<0.001). Children who only went to non-RHF providers were less likely to receive an artemisinin-based combination therapy (ACT) than children who attended a RHF (odds ratio [OR] = 0.64, 95% CI 0.51–0.79, p<0.001). Children who did not go to any provider after seeing a CHW were the least likely to receive an ACT (OR = 0.21, 95% CI 0.14–0.34, p<0.001).ConclusionsHealth policies should recognise local treatment-seeking practices and ensure adequate quality of care at the various public and private sector providers where caregivers of children with suspected severe malaria actually seek care.

scholarly journals MO556TREATMENT OF ANAEMIA WITH ERYTHROPOIESIS STIMULATION AGENTS (ESAS) AND CONCOMITANT THERAPIES AMONG PATIENTS WITH NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE (NDD-CKD) IN GERMANY, SPAIN AND THE UK: A RETROSPECTIVE CHART REVIEW

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Danilo Fliser ◽  
Jose Portoles ◽  
Katherine Houghton ◽  
Claire Ainsworth ◽  
Martin Blogg ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Iron Therapy ◽  
Weekly Dose ◽  
Iv Iron ◽  
Recorded Data ◽  
The Uk ◽  
Esa Therapy ◽  
At Home

Abstract Background and Aims Among patients with CKD, prevalence of anaemia increases with CKD severity,1 and is accompanied by elevated risk of hospitalisation and mortality.2 Treatment options include iron therapy and ESAs; international guidelines recommend initiating ESA therapy when haemoglobin (Hb) declines &lt;10 g/dL, and to monitor Hb and iron status every 3 months during ESA treatment.3 This study aimed to describe the routine clinical management of patients with NDD-CKD and anaemia following ESA initiation, in Germany, Spain and the UK. Method This was a non-interventional, retrospective cohort study of adults with NDD-CKD stages 3b–5 (as defined in KDIGO 2012 guidelines)1 diagnosed with anaemia (Hb &lt;13.0 g/dL [males] or &lt;12.0 g/dL [females]), who began ESA treatment 01 Jan 2015–31 Dec 2015 inclusive. Data for ≤24 months after ESA initiation were extracted from medical records: patient characteristics; anaemia diagnosis and treatment (including iron and ESA use); Hb, serum ferritin and transferrin saturation (TSAT) measurements; and CKD-related outcomes. Patients were excluded if they had been diagnosed with end-stage kidney disease at baseline, or previously received a kidney transplant or dialysis. Results In total, 848 patient records (Germany, 211; Spain, 430; UK, 207) were included. Average age was 66 years (Table). Most patients were white and almost half had &gt;2 comorbidities. Prior to ESA initiation, at least half of all patients in each country received either oral or intravenous (IV) iron therapy. The average (mean ± SD) number of months between anaemia diagnosis and initiation of ESA therapy was 8.4 ± 19.2. Hb levels were recorded at ESA initiation for almost all (91.3%) patients and averaged 9.8 ± 1.0 g/dL for the total cohort; this initial Hb level was similar between countries (Table). Mean ± SD estimated glomerular filtration rate (eGFR) at ESA initiation was 28.0 ± 10.4 ml/min/1.73m2. Across countries, 72–88% of patients received ESAs at home. The mean ± SD duration of therapy (at the time of data collection) was 41.2 ± 18.2 months, and the median weekly dose of short-acting and long-acting ESAs was 3238 IU and 20 μg, respectively. During their initial course of therapy, three-quarters of patients had either an increase or decrease in ESA dose. Less than 10% of patients switched ESAs, while approximately one-third discontinued within 2 years of initiation. At 3 and 6 months post-ESA initiation, only 64.7% of the sample had a documented Hb measurement despite continuing ESA treatment; this proportion was further reduced to 60.0% by 12 months after initiation. The Hb target was maintained by 88.7%, 74.6% and 49.4% of patients at 3, 6 and 12 months, respectively. Mean ferritin levels were 167.3 ng/mL at initiation and 198.7 ng/mL at 12 months (among the 85% and 48% of the sample, respectively, with recorded data). Mean TSAT was 22.1% at initiation and 25.6% at 12 months (among the 67% and 38%, respectively, with recorded data). Approximately three-quarters of patients (77.3%) received iron therapy concomitantly with ESA treatment; in the UK, most of these received IV iron, while in Germany and Spain, a majority received oral iron (Table). Blood transfusions were more common in Spain (24.2%) than in Germany (5.1%) or the UK (8.4%). Approximately one-fifth of patients required dialysis. Conclusion Initiation of ESAs to treat anaemia among patients with NDD-CKD in Germany, Spain and the UK follows current guidelines. However, recommendations to regularly monitor Hb were not routinely followed or were poorly documented. As most patients with NDD-CKD anaemia were treated at home, oral therapies may be of benefit to these patients

Serum Ferritin Is Not Sensitive or Specific for the Diagnosis of Iron Deficiency in Patients with Normocytic Anemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 955-955 ◽  
Author(s):  
Justin CL Ho ◽  
Ivan Stevic ◽  
Anthony Chan ◽  
Keith KH Lau ◽  
Howard H.W. Chan
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Status ◽  
Iron Therapy ◽  
Normocytic Anemia ◽  
Therapeutic Trial ◽  
Retrospective Case ◽  
The Mean ◽  
Pre Treatment ◽  
Iron Replacement

Introduction: Following the seminal study by Guyatt et al., serum ferritin has been widely accepted as the most accurate surrogate marker for iron deficiency, particularly if ferritin levels are < 45 mg/L. However, as an acute-phase reactant, ferritin levels rise with a number of conditions, including obesity, age, liver disorders, and inflammation. Elevated ferritin levels due to these concomitant clinical conditions may mask the underlying iron deficiency, thus rendering serum ferritin an unreliable marker for iron status. Therefore, the aim of this study is to evaluate the sensitivity and specificity of ferritin for the diagnosis of iron deficiency in patients presenting with normocytic anemia, when response to iron replacement was used as the gold standard for the diagnosis of iron deficiency. Methods: This study is a retrospective case review involving patients referred to an academic hematology clinic from 2003 to 2015 for further evaluation of chronic normocytic anemia without other cell lines abnormalities. Following initial workup to ensure the absence of 1) mixed microcytic-macrocytic anemia, 2) reticulocytosis suggesting acute blood loss or hemolysis, and 3) suboptimally low erythropoietin level, 59 patients received a therapeutic trial of oral ferrous gluconate. Intravenous iron sucrose was provided if patients could not tolerate or were refractory to oral iron therapy. All 59 patients (median age: 71 years, range: 24-93, male:female ratio 23:36) underwent a complete review of records before and after iron therapy for changes in haematological parameters and iron indexes. An increase of Hb ≥ 10.0 g/L from baseline was defined as a response to iron therapy, according to the WHO criteria. Results: The mean pre-treatment ferritin level of the cohort was 110 μg/L (median: 61 μg/L), which was higher than the generally accepted cut-off for iron deficiency. Following iron replacement therapy, the mean ferritin concentration of the cohort was raised to 257 μg/L, thus confirming the efficacy of iron therapy. Overall, 33 patients (56%) responded to iron therapy, experiencing an increase in Hb ≥ 10.0 g/L. Interestingly, 19 (58%) of these 33 patients had a pre-treatment ferritin value > 45 μg/L. Receiver operating characteristic (ROC) analysis of response rates to iron therapy and pre-treatment ferritin levels revealed an area under the curve (AUC) of only 0.492, indicating poor performance of ferritin tests in predicting the response to iron therapy. As such, serum ferritin is inadequate in predicting response to iron therapy in patients presenting with normocytic anemia. Conclusion: Despite the prevailing notion that low ferritin levels are diagnostic of iron deficiency, this retrospective case study exhibited the shortcomings of using ferritin as the sole determinant of iron status. Consequently, patients with normocytic anemia having a normal or high ferritin should not be excluded from a therapeutic trial of iron therapy. Disclosures No relevant conflicts of interest to declare.

scholarly journals Iron status, inflammation and hepcidin in ESRD patients: The confounding role of intravenous iron therapy

2010 ◽  
Vol 20 (3) ◽  
pp. 125 ◽  
Author(s):  
V Jha ◽  
A Jairam ◽  
PK Aggarwal ◽  
HS Kohli ◽  
KL Gupta ◽  
...  
Keyword(s):  
Iron Status ◽  
Intravenous Iron ◽  
Iron Therapy ◽  
Intravenous Iron Therapy ◽  
Esrd Patients

scholarly journals Behavior of elementary schoolchildren with iron deficiency anemia after iron therapy

2009 ◽  
Vol 49 (5) ◽  
pp. 276
Author(s):  
Rina A.C. Saragih ◽  
T. Mirda Zulaicha ◽  
Sri Sofyani ◽  
Bidasari Lubis ◽  
Iskandar Z. Lubis
Keyword(s):  
Placebo Group ◽  
Treatment Group ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Controlled Clinical Trial ◽  
Significant Difference ◽  
Child Behavior Check List

Background Some studies had been performed to determine theassociation between iron status and children's behavior yet it isstill controversial.Objective To investigate whether iron therapy has an effect onthe behavior of children with iron deficiency anemia (IDA).Method A randomized placebo-controlled clinical trial wasconducted in Labuhan Batu on November 2006-April2007. IDAwas defined as Hb < 12 g/dl, MCHC< 31%, ROW index > 220and Mentzer index> 13. Elementary school children (6-12 yearsold) with IDA were randomly assigned to the treatment groupwith a daily therapy of 6 mg iron/kg/day or placebo group for three months. The subjects' behavior was evaluated with child behavior check list (CBCL) before and six months after intervention.Results After six months, 110 subjects completed the therapy.Scores of CBCL in iron group after intervention were internalizing42.64 (SO 9.95), externalizing 37.13 (SO 9.04) & total score 38.24 (SO 10.20). There was significant decreased on externalizing and total problems score in the treatment group after intervention (P< 0.05). However, there was no significant difference on scores between groups.Conclusion Iron therapy had significantly decrease CBCL scoreon externalizing and total problems in the treatment group,however there was no significant difference on scores if comparedwith placebo group.

Sign in / Sign up

Export Citation Format

Share Document