Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding:A systematic review

BACKGROUND Anemia is considered a public health issue and is often caused by iron deficiency.Iron-deficiency anemia(IDA)often originates from blood loss from lesions in the gastrointestinal tract in men and postmenopausal women,and its prevalence among patients with gastrointestinal bleeding has been estimated to be 61%.However,few guidelines regarding the appropriate investigation of patients with IDA due to gastrointestinal bleeding have been published.AIM To review current evidence and guidelines concerning IDA management in gastrointestinal bleeding patients to develop recommendations for its diagnosis and therapy.METHODS Five gastroenterology experts formed the Digestive Bleeding and Anemia Workgroup and conducted a systematic literature search in PubMed and professional association websites.MEDLINE(via PubMed)searches combined medical subject headings(MeSH)terms and the keywords“gastrointestinal bleeding”with“iron-deficiency anemia”and“diagnosis”or“treatment”or“management”or“prognosis”or“prevalence”or“safety”or“iron”or“transfusion”or“quality of life”,or other terms to identify relevant articles reporting the management of IDA in patients over the age of 18 years with gastrointestinal bleeding;retrieved studies were published in English between January 2003 and April 2019.Worldwide professional association websites were searched for clinical practice guidelines.Reference lists from guidelines were reviewed to identify additional relevant articles.The recommendations were developed by consensus during two meetings and were supported by the published literature identified during the systematic search.RESULTS From 494 Literature citations found during the initial literature search,17 original articles,one meta-analysis,and 13 clinical practice guidelines were analyzed.Based on the published evidence and clinical experience,the workgroup developed the following ten recommendations for the management of IDA in patients with gastrointestinal bleeding:(1)Evaluation of hemoglobin and iron status;(2)Laboratory testing;(3)Target treatment population identification;(4)Indications for erythrocyte transfusion;(5)Treatment targets for erythrocyte transfusion;(6)Indications for intravenous iron;(7)Dosages;(8)Monitoring;(9)Indications for intravenous ferric carboxymaltose treatment;and(10)Treatment targets and monitoring of patients.The workgroup also proposed a summary algorithm for the diagnosis and treatment of IDA in patients with acute or chronic gastrointestinal bleeding,which should be implemented during the hospital stay and follow-up visits after patient discharge.CONCLUSION These recommendations may serve as a starting point for clinicians to better diagnose and treat IDA in patients with gastrointestinal bleeding,which ultimately may improve health outcomes in these patients.

Efficacy and Safety of Iron Isomaltoside Compared with an Oral Iron Supplement in the Management of Patients with Iron Deficiency Anemia

Objective: To evaluate the treatment outcome of iron isomaltoside compared with an oral iron supplement in the management of iron deficiency anemia (IDA). Methods: The study included patients with IDA who visited the Outpatient Clinic of the Department of Hematology, the Affiliated Hospital of Qingdao University from October 2021 to August 2022 and met the inclusion and exclusion criteria. According to the actual application of iron supplementation, the patients were divided into two groups: iron isomaltoside treatment group and oral iron treatment group. Baseline measurements were collected before the start of treatment, and measurements were collected subsequently at intervals of 1 week, 1 month, and 3 months. The hematological parameters analyzed included Hemoglobin (Hb), Mean corpuscular hemoglobin (MCH), Mean Hemoglobin content (MCH), Mean corpuscular Hemoglobin concentration (MCHC), and Platelet (Plt). Safety data and adverse event profiles were recorded. Results: Intra-group comparisons: After 1 month of treatment, the Hb significantly improved (P 0.05). Inter-group comparisons: The biochemical parameters were significantly improved (P 0.05) in the iron isomaltoside group compared with those in the oral iron group after 1 month of iron supplementation in patients with mild and moderate anemia. Adverse reactions were tolerable for the patients in both iron isomaltoside group and oral iron group. Only 1 patient in iron isomaltoside group developed anaphylactic shock during medication and recovered after aggressive rescue. Conclusions: Iron isomaltoside which increases Hb more rapidly compared with the oral iron supplementation has few adverse reactions and good acceptance.

Retroperitoneal hyaline-vascular variant Castleman Disease in a patient with iron-deficiency anemia and sinus bradycardia:a case report

Objective Castleman disease, also known as giant lymph node hyperplasia, involves lesions in the lymph nodes usually located in the chest_ENREF_1, particularly in the mediastinum. Meanwhile, sinus bradycardia is a sinus rhythm slower than 60 beats per min, and it can occur in both healthy and sick individuals. However, the comorbidity of these two disorders has not been previously reported. In this paper, we report a case of a 46-year-old woman who presented with persistent sinus bradycardia and irondeficiency anemia. Diagnostic work-up revealed hepatosplenomegaly and a giant mass near the splenic hilum. The mass was removed surgically; after which, the patient's bradycardia resolved immediately, while her anemia was corrected after subsequent chemotherapy. Pathological examination revealed lymph nodes with benign lesions, and the patient was diagnosed with hyaline-vascular variant of Castleman disease. This is the first documented case of sinus bradycardia associated with Castleman disease. In this paper, we describe the case characteristics, discuss the possible pathogenesis, and consider the appropriate treatment of symptomatic sinus bradycardia accompanying Castleman disease.

Susceptibility-weighted imaging is suitable for evaluating signal strength in different brain regions of a rabbit model of acute hemorrhagic anemia

Acute hemorrhagic anemia can decrease blood flow and oxygen supply to brain, and affect its physiological function. While detecting changes in brain function in patients with acute hemorrhagic anemia is helpful for preventing neurological complications and evaluating therapeutic effects, clinical changes in the nervous systems of these patients have not received much attention. In part, this is because current techniques can only indirectly detect changes in brain function following onset of anemia, which leads to lags between real changes in brain function and their detection.

A Novel Regression Based Model for Detecting Anemia Using Color Microscopic Blood Images

Modeling human blood components and disorders is a complicated task. Few researchers have attempted to automate the process of detecting anemia in human blood. These attempts have produced satisfactory but not highly accurate results. In this paper, we present an efficient method to estimate hemoglobin value in human blood and detect anemia using microscopic color image data. We have developed a logit regression model using one thousand (1000) blood samples that were collected from Prince George Hospital laboratory. The output results of our model are compared with the results of the same sample set using CELL-DYN 3200 System in Prince George Hospital laboratory, and found to be near identical. These results exceed those reported in the literature. Moreover, the proposed method can be im-plemented in hardware with minimal circuitry and nominal cost.

Using of Color Model and Contrast Variation in Wavelet Ideology for Study <i>Megaloblastic Anemia Cells</i>

Processing and analyzing of medical images is one of the priority research areas. At the same time, the processing of images of cells occupies a special place. This is due to the fact that such studies allow for a comprehensive diagnosis of the state of human health, identify and prevent the development of diseases in the early stages. We investigate the effectiveness of using wavelet analysis in color models, taking into account the preliminary change in the contrast of the input image. We consider the HSV color model and the image contrast modification procedure, which is based on the histogram change in the specified range with gamma correction. As a criterion for choosing parameters for changing the contrast of the image, we consider the entropy of the image. We also showed the advisability of using the value of the entropy index for the subsequent improvement of image analysis based on the wavelet ideology. We examined the general sequence of action for the analysis of image of megaloblastic anemia cells. This sequence is based on the choice of parameters for changing the contrast of the image and application of wavelet ideology.

Flammulina velutipes polysaccharide-iron (Ⅲ) complex used to treat iron deficiency anemia after being absorbed via GLUT2 and SGLT1 transporters

Iron deficiency anemia(IDA)is a common nutritional problem, but traditional iron supplements cause many adverse reactions. Thus, the development of a novel iron supplement might be significant for the treatment of IDA. This study aimed to study the transport mechanism of Flammulina velutipes polysaccharide-iron complex(FVP1-Fe(Ⅲ))in Caco-2 cells and the therapeutic effect on IDA rats, as well as the influence on gut microbiota in vivo. These results showed that in vitro, the uptake of FVP1-Fe(Ⅲ)was mediated by sodium-dependent glucose transporter-1(SGLT1)and facilitated glucose transporter-2(GLUT2)and GLUT2 played a dominant function. The multidrug resistance-associated protein-2(MRP-2)was involved in the efflux of FVP1-Fe(Ⅲ)across the Caco-2 cells. In vivo, FVP1-Fe(Ⅲ)had a better restorative effect on blood parameters and iron status indicators in rats with IDA as compared with FeSO_4 and exerted this effect by downregulating the expression of hepcidin. FVP1-Fe(Ⅲ)could also regulate gut microbiota dysbiosis in iron deficiency rats by returning the relative abundance of gut microbiota to the normal level. Besides, as a dietary factor, vitamin C(vit C)could enhance the therapeutic effect of FVP1-Fe(Ⅲ). These present findings showed that FVP1-Fe(Ⅲ)could be exploited as a novel iron supplement to treat IDA.

慢性肾功能衰竭腹膜透析患者发生肾性贫血的风险及其预测模型构建

目的探究慢性肾功能衰竭(CRF)腹膜透析患者发生肾性贫血的风险,并建立风险预测模型。方法回顾性分析2018年7月至2021年6月吉安市中心人民医院收治的106例行腹膜透析CRF患者的临床资料,根据肾性贫血发生情况分为肾性贫血组与未发生肾性贫血组,各53例。比较两组肾性贫血相关因子水平[红细胞计数(RBC)、血红蛋白(Hb)、白蛋白(Alb)、C反应蛋白(CRP)、转铁蛋白(TRF)、转铁蛋白饱和度(TSAT)、血清总铁结合力(TIBC)、不饱和铁结合力(UIBC)],Logistic回归分析腹膜透析患者发生肾性贫血的危险因素,建立预测模型并评估其预测效能。结果肾性贫血组RBC、Hb、Alb、CRP、TRF、TSAT、TIBC、UIBC水平均低于未发生肾性贫血组,差异有统计学意义(P<0.05)。Logistic回归分析显示,TRF、TIBC、UIBC是发生肾性贫血的危险因素(P<0.05),ROC曲线显示AUC分别为0.815、0.919和0.826。肾性贫血风险预测模型验证结果显示,74例患者TRF、TIBC、UIBC的准确度为85.1%、86.5%、89.2%。结论TRF、TIBC、UIBC是发生肾性贫血的危险因素,且风险预测模型对肾性贫血发生预测效能较好。

补脾肾与补气血为主治疗再生障碍性贫血的临床疗效预测因素分析及预测模型构建

[目的]探究补脾肾与补气血为主治疗再生障碍性贫血(aplastic anemia,AA)的疗效相关的临床预测因素,并构建一个可以预测补脾肾与补气血为主治疗AA有效的列线图。[方法]收集2018年5月至2021年6月就诊于全国19家医院的585例补脾肾与补气血为主治疗AA患者的临床资料及随访信息并进行回顾性观察研究,本研究最终纳入243例患者,根据患者短期治疗是否有效分为有效组和无效组;单因素分析探究AA补脾肾与补气血为主治疗有效的临床预测因素,采取二元Logistic回归分析相关临床预测因素,利用R语言制作列线图预测模型并建立动态列线图。采用Bootstrap自抽样法进行内部验证,C指数、校正曲线、Hosmer-Lemeshow拟合优度检验分析评估模型的区分度及校准度,DCA决策曲线评估模型的临床有效性。[结果]多因素Logistic回归筛选出5个预测因素:病程、AA分型、BMI≥25、中医治疗方案和输血依赖,本研究构建的列线图由以上5个变量组成。本研究构建的预测模型C指数及ROC曲线下面积(AUC)均为0.754(95%CI:0.677~0.830);校正曲线及拟合优度检验(χ2=3.525,P=0.897)显示了良好的一致性;决策曲线显示阈值概率为32%~94%时,具有较高的净获益值。[结论]本研究构建的预测模型具备良好的预测再生障碍性贫血患者中西医结合治疗有效的能力。

常见自身免疫性疾病动物模型研究进展

自身免疫性疾病是由免疫系统对自身抗原发起攻击,导致细胞破坏、组织损伤或器官功能障碍而引起的慢性疾病。自身免疫性疾病患者的生活质量和劳动能力显著降低。因此建立与人类自身免疫性疾病相似的动物模型对研究该疾病的发病机制及治疗至关重要。本文总结了几种常见自身免疫性疾病的动物模型,包括再生障碍性贫血,类风湿性关节炎、系统性红斑狼疮以及银屑病,以期为自身免疫性疾病的实验和临床研究提供有益参考。

多发性骨髓瘤患者贫血发生风险列线图预测模型的构建及验证

目的分析多发性骨髓瘤患者贫血发生的风险因素,据此构建列线图预测模型,并评估其预测价值。方法收集130例多发性骨髓瘤患者的临床资料,根据是否发生贫血分为贫血组(n=56)与非贫血组(n=74)。多发性骨髓瘤患者贫血发生的影响因素采用多因素Logistic回归分析,依据影响因素构建预测多发性骨髓瘤患者贫血发生风险的列线图预测模型。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估列线图预测模型对多发性骨髓瘤患者贫血发生风险的预测价值。采用校准曲线评估列线图预测模型的可靠性和准确性,采用决策曲线分析(DCA)评估列线图预测模型的临床应用价值。结果多因素Logistic回归分析结果显示,血小板计数降低、骨髓浆细胞比例升高、血肌酐水平升高以及白细胞介素-6(IL-6)水平升高均为多发性骨髓瘤患者贫血发生的独立危险因素(P﹤0.05),据此构建列线图预测模型。ROC曲线显示,列线图预测模型预测多发性骨髓瘤患者贫血发生风险的AUC为0.951,预测价值较高。校准曲线显示,该列线图模型预测多发性骨髓瘤患者贫血发生风险的C指数为0.778(95%CI:0.741~0.815),表明该列线图模型预测贫血发生风险的观测值与实际观测结果吻合度较好。DCA曲线显示,该列线图预测模型对多发性骨髓瘤患者贫血发生风险的预测有临床意义,临床净效益较高。结论多发性骨髓瘤患者贫血发生风险与血小板计数降低、骨髓浆细胞比例升高、血肌酐水平和IL-6水平升高密切相关,基于这些风险因素所构建的列线图预测模型对多发性骨髓瘤患者贫血发生风险的预测准确度较高。

老年膝关节置换术后患者发生贫血的影响因素分析及预测模型构建

目的探究老年膝关节置换术后患者发生贫血的影响因素,并构建预测模型。方法选择2021年10月—2023年8月在山东大学齐鲁医院行膝关节置换术的229例老年患者,按照术后是否贫血将患者分为无贫血组与贫血组。采用Lasso回归、logistic回归分析筛选术后发生贫血的独立危险因素,由此构建预测模型并评估模型的准确性。结果Lasso回归及多因素logistic回归结果显示,中度衰弱(OR=5.195,95%CI:1.462~18.456,P=0.011)、术前贫血(OR=21.754,95%CI:2.680~176.608,P=0.027)、尿素氮异常(OR=3.021,95%CI:1.214~7.518,P=0.017)是术后发生贫血的危险因素。将这些因素纳入预测模型并绘制列线图。受试者工作特征曲线显示该预测模型具有良好的区分度,其曲线下面积为0.714(95%CI:0.644~0.785)。校准曲线证实模型与实际观测结果具有较好的一致。临床决策曲线表明,当术后贫血发生概率为0.18~0.74时,使用本研究得出的列线图具有临床有效性。结论中度衰弱、术前贫血及尿素氮异常是老年患者膝关节置换术后发生贫血的影响因素,基于上述因素构建的临床预测模型对患者术后贫血的发生具有一定的预测价值。

长期卧床老年患者营养不良危险因素及风险预测模型构建

目的分析长期卧床老年患者发生营养不良(malnutrition,MN)的危险因素,并构建MN风险预测模型。方法回顾性选取雅安市第四人民医院老年科2016年1月至2024年1月收治的长期卧床老年患者,并收集患者临床资料。根据7∶3比例,随机将长期卧床老年患者分为训练集和验证集,根据是否发生MN分为MN组和非MN组。在训练集中,采用单因素分析(t检验、卡方检验或Fisher's精确检验)比较临床资料组间差异,采用逐步多因素Logistic回归分析患者发生MN的危险因素,并构建风险预测模型,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)及其曲线下面积(areaundercurve,AUC)、校准曲线和决策曲线评估和验证风险预测模型的预测效能。结果共纳入896例长期卧床老年患者,MN发生率为46.43%。训练集627例,验证集269例。多因素Logistic回归分析显示,卧床时间长[OR=1.259,95%CI(1.197,1.324)]、脑卒中[OR=2.866,95%CI(1.621,5.067)]、贫血[OR=2.479,95%CI(1.162,5.288)]是长期卧床老年患者发生MN的危险因素,Barthel指数评分高[OR=0.921,95%CI(0.905,0.938)]是其保护因素(P<0.05)。MN风险预测模型预测效能较高,训练集和验证集的AUC(95%CI)分别为0.955(0.939,0.970)和0.952(0.934,0.971)。训练集和验证集中,校准曲线提示MN风险预测模型“预测MN概率”和“实际MN概率”高度吻合;决策曲线提示MN风险预测模型在一定风险阈值范围内可使临床获益。结论临床实践中应重点关注长期卧床、脑卒中、贫血、日常生活能力状态不佳的长期卧床老年患者的MN发生风险,本研究构建的MN风险预测模型可为识别长期卧床老年患者高危MN人群提供一定参考。

Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis

AIM:To perform a meta-analysis of observational studies and randomized controlled trials(RCTs)on the association between Helicobacter pylori(H.pylori)and iron deficiency anemia(IDA).METHODS:A defined search strategy was used to search Medline,Embase,the Cochrane Library,Clinical Trials,Cochrane Central Register of Controlled Trials,Premedline and Healthstar.Odds ratio(OR)was used to evaluate observational epidemiology studies,and weighted mean difference(WMD)was used to demonstrate the difference between control and intervention groups.RESULTS:Fifteen observational studies and 5 RCTs were identified and used for calculation.The pooled OR for observational studies was 2.22(95%CI:1.52-3.24,P<0.0001).The WMD for hemoglobin(HB) was 4.06 g/L(95%CI:-2.57-10.69,P=0.01),and the WMD for serum ferritin(SF)was 9.47μg/L(95%CI:-0.50-19.43,P<0.0001).Results were heterogeneous for all comparisons.CONCLUSION:This meta-analysis on observational studies suggests an association between H.pylori and IDA.In RCTs,eradication of H.pylori can improve HB and SF levels but not significantly.

A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

Iron deficiency （ID）, with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by

Large pedinculated antral hyperplastic gastric polyp traversed the bulbus causing outlet obstruction and iron deficiency anemia: endoscopic removal

We present here a large (3 cm) hyperplastic gastric polyp prolapsed into duodenum and caused outlet obstruction and iron deficiency anemia in 60 years old male patient.Endoscopic removal was performed successfully.

Electrophysiological changes of autonomic cells in left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with chronic heart failure

Objective: To investigate the electrophysiological changes of autonomic cells in left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with chronic heart failure.Methods: Guinea pigs model of iron deficiency anemia complicated with chronic heart failure in 10 guinea pigs of the experimental group was made by feeding a low iron diet,pure water and subcutaneous injection of isoproterenol. The control group consisting of 11 guinea pigs was given normal food, normal water and injected with normal saline. The left ventricular outflow tract model specimen was also prepared. The standard microelectrode technique was used to observe electrophysiological changes of autonomic cells in the outflow tract of left ventricular heart failure complicated with iron deficiency anemia in guinea pig model. The indicators of observation were maximal diastolic potential, action potential amplitude, 0 phase maximal depolarization velocity, 4 phase automatic depolarization velocity, repolarization 50% and 90%, and spontaneous discharge frequency.Results: Compared with the control group, 4 phase automatic depolarization velocity,spontaneous discharge frequency and 0 phase maximal depolarization velocity decreased significantly(P < 0.01) and action potential amplitude reduced(P < 0.01) in model group. Moreover, repolarization 50% and 90% increased(P < 0.01).Conclusions: There are electrophysiological abnormalities of the left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with heart failure.

Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

AIM To investigate the cost effectiveness of routine small bowel biopsies(SBBs) in patients with iron deficiency anemia(IDA) independent of their celiac disease(CD) serology test results.METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy(EGD) in all patients with IDA regardless their celiac serology status(strategy A) vs SBBs only in IDA patients with positive serology(strategy B). The main outcomes were quality adjusted life years(QALY),average cost and the incremental cost effectiveness ratio(ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results,a Monte Carlo simulation of 100 sample trials with 10,and an acceptability curve were performed.RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness,strategy A was the dominant strategy,as long as the cost of SBBs stayed less than $67. In addition,the ICER of strategy A was preferable,providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA,regardless of their celiac antibody status.

Effects of Zaizhang－Ⅰ，a Traditional Chinese Medicine，on Immunologically Mediated Aplastic Anemia in Mice

Immunologically mediated aplastic anemia in mice were used as animal models to study the the curative effect of Zaizhang-Ⅰin term of the changes of two pathogenetic aspects in aplastic mice,namely the defciency of hematopoietic stem cells and the disturbance of immunology. Our results demonstrated that in aplastic mice, after treatment by Zaizhang-Ⅰ,the loss of mature hematopoietice cells (WBC, RBC, Plt) were reduced, and marrow cellular cytosis,and their clinical findings were improved, indicating a partial remission. The present data show that its curative mechanism lies in the action of promoting the recovery of colony forming unit-spleen (CFU-S) and reversing immunologically-induced plasma colony forming unit granulocyte/macrophage (CFU-GM ) inhibitory activity. Natural killer cells activity (Nka) and interleukin-2 tumor necrosis factors (TNF) were also examined to further understand the mechanism by which Zaizhang-Ⅰreverse plasma hematopoietic activity.

Immune Control of Equine Infectious Anemia Virus Infection by Cell-Mediated and Humoral Responses

Equine Infectious Anemia Virus (EIAV) is a retrovirus that establishes a persistent infection in horses and ponies. The virus is in the same lentivirus subgroup that includes human immunodeficiency virus (HIV). The similarities between these two viruses make the study of the immune response to EIAV relevant to research on HIV. We developed a mathematical model of within-host EIAV infection dynamics that contains both humoral and cell-mediated immune responses. Analysis of the model yields results on thresholds that would be necessary for a combined immune response to successfully control infection. Numerical simulations are presented to illustrate the results. These findings have the potential to lead to immunological control measures for lentiviral infection.