Inflammatory bowel disease(IBD)is a relapsing chronic inflammatory disorder of the small and large gut with rising incidence and prevalence worldwide.Iron deficiency anemia is one of the most common extraintestinal ma...Inflammatory bowel disease(IBD)is a relapsing chronic inflammatory disorder of the small and large gut with rising incidence and prevalence worldwide.Iron deficiency anemia is one of the most common extraintestinal manifestations of IBD,which correlates with the disease activity and tendency to relapse even after successful management.Anemia affects various aspects of quality of life,such as physical,cognitive,emotional,and workability,as well as healthcare costs.The anemia in IBD can be due to iron deficiency(ID)or chronic disease.The relative frequency of ID in IBD is 60%,according to some studies,and only 14%receive treatment.The evaluation of ID is also tricky as ferritin,being an inflammatory marker,also rises in chronic inflammatory diseases like IBD.The review of anemia in IBD patients involves other investigations like transferrin saturation and exploration of other nutritional deficiencies to curb the marker asthenia with which these patients often present.It underscores the importance of timely investigation and treatment to prevent long-term sequelae.We can start oral iron therapy in certain circumstances.Still,as inflammation of the gut hampers iron absorption,an alternative route to bypass the inflamed gut is usually recommended to avoid the requirement for blood transfusions.展开更多
Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to...Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to chronic blood loss, and impaired iron absorption due to tissue inflammation. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with IBD must be regularly monitored for earlier detection of anemia. IDA in IBD is associated with poor quality of life, necessitating prompt diagnosis and appropriate treatment. IDA is often associated with inflammation in patients with IBD. Thus, commonly used labora-tory parameters are inadequate to diagnose IDA, and newer iron indices, such as reticulocyte hemoglobin content or percentage of hypochromic red cells or zinc protoporphyrin, are required to differentiate IDA from anemia of chronic disease. Oral iron preparations are available and are used in patients with mild disease activity. These preparations are inexpensive and con-venient, but can produce gastrointestinal side effects, such as abdominal pain and diarrhea, that limit their use and patient compliance. These preparations are partly absorbed due to inflammation. Non-absorbed iron can be toxic and worsen IBD disease activity. Although cost-effective intravenous iron formulations are widely available and have improved safety profiles, physicians are reluctant to use them. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.展开更多
AIM:To study the role of hepcidin in hereditary hyperferritinemia cataract syndrome(HHCS). METHODS:Six patients from two families with HHCS, confirmed by genetic analysis showing A to G mutation at position+40 in the ...AIM:To study the role of hepcidin in hereditary hyperferritinemia cataract syndrome(HHCS). METHODS:Six patients from two families with HHCS, confirmed by genetic analysis showing A to G mutation at position+40 in the L-ferritin gene,were recruited to undergo serum hepcidin and prohepcidin measurements using radioimmunoassay and enzyme linked immunoassay,respectively,and measurements were compared with levels in serum from 25 healthy volunteers(14 females),mean age 36±11.9 years.RESULTS:The serum hepcidin and prohepcidin levels in patients with HHCS were 19.1±18.6 and 187± 120.9 ng/mL,respectively.Serum ferritin was 1716.3± 376μg/L.Liver biopsy in one patient did not show any evidence of iron overload.Serum hepcidin and prohepcidin values in healthy controls(HCs)were 15.30±15.71 and 236.88±83.68 ng/mL,respectively,while serum ferritin was 110±128.08μg/L.There was no statistical difference in serum hepcidin level between the two cohorts(19.1±18.6 ng/mL vs 15.30±15.71 ng/mL,P= 0.612)using two-tailed t-test. CONCLUSION:Serum hepcidin levels in HHCS patients is similar to that in HCs.Our study suggests that circulating ferritin is not a factor influencing hepcidin synthesis and does not have a role in the iron-sensing mechanism in hepatocytes.展开更多
BACKGROUND The incidence of early-onset colorectal cancer(EO-CRC)is rising in the United States,and is often diagnosed at advanced stages.Low serum ferritin is often incidentally discovered in young adults,however,the...BACKGROUND The incidence of early-onset colorectal cancer(EO-CRC)is rising in the United States,and is often diagnosed at advanced stages.Low serum ferritin is often incidentally discovered in young adults,however,the indication for endoscopy in EO-CRC is unclear.AIM To compare serum ferritin between patients with EO-CRC and healthy controls(HCs),and examine the association of serum ferritin in EO-CRC with patient-and disease-specific characteristics.METHODS A retrospective study of patients<50 years with newly-diagnosed EO-CRC was conducted from 1/2013-12/2023.Patients were included if serum ferritin was measured within 2 years prior to 1 year following CRC histologic diagnosis.To supplement the analysis,a cohort of HCs meeting similar inclusion and exclusion criteria were identified for comparison.A sensitivity analysis including only patients with serum ferritin obtained at or before diagnosis was separately performed to minimize risk of confounding.RESULTS Among 85 patients identified with EO-CRC(48 females),the median serum ferritin level was 26 ng/mL(range<1-2759 ng/mL).Compared to HCs(n=80211),there were a higher proportion of individuals with EO-CRC with serum ferritin<20 ng/mL(female 65%,male 40%)versus HCs(female 32.1%,male 7.2%)age 29-39 years(P=0.002 and P<0.00001,respectively).Stage IV disease was associated with significantly higher serum ferritin compared to less advanced stages(P<0.001).Serum ferritin obtained before or at the time of diagnosis was lower than levels obtained after diagnosis.Similar findings were confirmed in the sensitivity analysis.CONCLUSION Severe iron deficiency may indicate an increased risk of EO-CRC,particularly at earlier stages.Further studies defining the optimal serum ferritin threshold and routine incorporation of serum ferritin in screening algorithms is essential to develop more effective screening strategies for EO-CRC.展开更多
BACKGROUND Liver transplantation(LT)is the best treatment for patients with liver cancer or end stage cirrhosis,but it is still associated with a significant mortality.Therefore identifying factors associated with mor...BACKGROUND Liver transplantation(LT)is the best treatment for patients with liver cancer or end stage cirrhosis,but it is still associated with a significant mortality.Therefore identifying factors associated with mortality could help improve patient management.The impact of iron metabolism,which could be a relevant therapeutic target,yield discrepant results in this setting.Previous studies suggest that increased serum ferritin is associated with higher mortality.Surprisingly iron deficiency which is a well described risk factor in critically ill patients has not been considered.AIM To assess the impact of pre-transplant iron metabolism parameters on posttransplant survival.METHODS From 2001 to 2011,553 patients who underwent LT with iron metabolism parameters available at LT evaluation were included.Data were prospectively recorded at the time of evaluation and at the time of LT regarding donor and recipient.Serum ferritin(SF)and transferrin saturation(TS)were studied as continuous and categorical variable.Cox regression analysis was used to determine mortality risks factors.Follow-up data were obtained from the local and national database regarding causes of death.RESULTS At the end of a 95-mo median follow-up,196 patients were dead,38 of them because of infections.In multivariate analysis,overall mortality was significantly associated with TS>75%[HR:1.73(1.14;2.63)],SF<100μg/L[HR:1.62(1.12;2.35)],hepatocellular carcinoma[HR:1.58(1.15;2.26)],estimated glomerular filtration rate(CKD EPI Cystatin C)[HR:0.99(0.98;0.99)],and packed red blood cell transfusion[HR:1.05(1.03;1.08)].Kaplan Meier curves show that patients with low SF(<100μg/L)or high SF(>400μg/L)have lower survival rates at 36 mo than patients with normal SF(P=0.008 and P=0.016 respectively).Patients with TS higher than 75%had higher mortality at 12 mo(91.4%±1.4%vs 84.6%±3.1%,P=0.039).TS>75%was significantly associated with infection related death[HR:3.06(1.13;8.23)].CONCLUSION Our results show that iron metabolism imbalance(either deficiency or overload)is associated with post-transplant overall and infectious mortality.Impact of iron supplementation or depletion should be assessed in prospective study.展开更多
BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy child...BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.METHODS A total of 1565 children with attention deficit hyperactivity disorder(ADHD),1694 children with tic disorder(TD),93 children with ASD and 1997 healthy control children were included between January 1,2020,and December 31,2021 at Beijing Children's Hospital.We describe the differences in age levels and ferritin levels between different disease groups and their sex differences.The differences between the sexes in each disease were analyzed using the t test.The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups.A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group.Analysis of variance was used for comparisons between subgroups,and regression analysis was used for confounding factor control.RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 36.82±20.64μg/L and 35.64±18.56μg/L,respectively.A total of 1694 TD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 35.72±20.15μg/L and 34.54±22.12μg/L,respectively.As age increased,the incidence of low serum ferritin in ADHD and TD first decreased and then increased,and 10 years old was the turning point of rising levels.The incidence of ADHD with low serum ferritin was 8.37%,the incidence of TD with low serum ferritin was 11.04%,and the incidence of the healthy control group with low serum ferritin was 8.61%,among which male children with TD accounted for 9.25%and female children with TD accounted for 11.62%.There was a significant difference among the three groups(P<0.05).In addition,there were 93 children with ASD with an average serum ferritin level of 30.99±18.11μg/L and a serum ferritin incidence of 15.05%.CONCLUSION In conclusion,low serum ferritin is not a risk factor for ADHD or TD.The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.展开更多
文摘Inflammatory bowel disease(IBD)is a relapsing chronic inflammatory disorder of the small and large gut with rising incidence and prevalence worldwide.Iron deficiency anemia is one of the most common extraintestinal manifestations of IBD,which correlates with the disease activity and tendency to relapse even after successful management.Anemia affects various aspects of quality of life,such as physical,cognitive,emotional,and workability,as well as healthcare costs.The anemia in IBD can be due to iron deficiency(ID)or chronic disease.The relative frequency of ID in IBD is 60%,according to some studies,and only 14%receive treatment.The evaluation of ID is also tricky as ferritin,being an inflammatory marker,also rises in chronic inflammatory diseases like IBD.The review of anemia in IBD patients involves other investigations like transferrin saturation and exploration of other nutritional deficiencies to curb the marker asthenia with which these patients often present.It underscores the importance of timely investigation and treatment to prevent long-term sequelae.We can start oral iron therapy in certain circumstances.Still,as inflammation of the gut hampers iron absorption,an alternative route to bypass the inflamed gut is usually recommended to avoid the requirement for blood transfusions.
文摘Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to chronic blood loss, and impaired iron absorption due to tissue inflammation. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with IBD must be regularly monitored for earlier detection of anemia. IDA in IBD is associated with poor quality of life, necessitating prompt diagnosis and appropriate treatment. IDA is often associated with inflammation in patients with IBD. Thus, commonly used labora-tory parameters are inadequate to diagnose IDA, and newer iron indices, such as reticulocyte hemoglobin content or percentage of hypochromic red cells or zinc protoporphyrin, are required to differentiate IDA from anemia of chronic disease. Oral iron preparations are available and are used in patients with mild disease activity. These preparations are inexpensive and con-venient, but can produce gastrointestinal side effects, such as abdominal pain and diarrhea, that limit their use and patient compliance. These preparations are partly absorbed due to inflammation. Non-absorbed iron can be toxic and worsen IBD disease activity. Although cost-effective intravenous iron formulations are widely available and have improved safety profiles, physicians are reluctant to use them. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.
基金Supported by Research and Development Department,Ealing Hospital NHS Trust,Uxbridge Road,Southall,London,UB13HW,United Kingdom
文摘AIM:To study the role of hepcidin in hereditary hyperferritinemia cataract syndrome(HHCS). METHODS:Six patients from two families with HHCS, confirmed by genetic analysis showing A to G mutation at position+40 in the L-ferritin gene,were recruited to undergo serum hepcidin and prohepcidin measurements using radioimmunoassay and enzyme linked immunoassay,respectively,and measurements were compared with levels in serum from 25 healthy volunteers(14 females),mean age 36±11.9 years.RESULTS:The serum hepcidin and prohepcidin levels in patients with HHCS were 19.1±18.6 and 187± 120.9 ng/mL,respectively.Serum ferritin was 1716.3± 376μg/L.Liver biopsy in one patient did not show any evidence of iron overload.Serum hepcidin and prohepcidin values in healthy controls(HCs)were 15.30±15.71 and 236.88±83.68 ng/mL,respectively,while serum ferritin was 110±128.08μg/L.There was no statistical difference in serum hepcidin level between the two cohorts(19.1±18.6 ng/mL vs 15.30±15.71 ng/mL,P= 0.612)using two-tailed t-test. CONCLUSION:Serum hepcidin levels in HHCS patients is similar to that in HCs.Our study suggests that circulating ferritin is not a factor influencing hepcidin synthesis and does not have a role in the iron-sensing mechanism in hepatocytes.
基金Supported by the Oregon Health&Sciences(OHSU)Institutional Review Board,No.STUDY00026428.
文摘BACKGROUND The incidence of early-onset colorectal cancer(EO-CRC)is rising in the United States,and is often diagnosed at advanced stages.Low serum ferritin is often incidentally discovered in young adults,however,the indication for endoscopy in EO-CRC is unclear.AIM To compare serum ferritin between patients with EO-CRC and healthy controls(HCs),and examine the association of serum ferritin in EO-CRC with patient-and disease-specific characteristics.METHODS A retrospective study of patients<50 years with newly-diagnosed EO-CRC was conducted from 1/2013-12/2023.Patients were included if serum ferritin was measured within 2 years prior to 1 year following CRC histologic diagnosis.To supplement the analysis,a cohort of HCs meeting similar inclusion and exclusion criteria were identified for comparison.A sensitivity analysis including only patients with serum ferritin obtained at or before diagnosis was separately performed to minimize risk of confounding.RESULTS Among 85 patients identified with EO-CRC(48 females),the median serum ferritin level was 26 ng/mL(range<1-2759 ng/mL).Compared to HCs(n=80211),there were a higher proportion of individuals with EO-CRC with serum ferritin<20 ng/mL(female 65%,male 40%)versus HCs(female 32.1%,male 7.2%)age 29-39 years(P=0.002 and P<0.00001,respectively).Stage IV disease was associated with significantly higher serum ferritin compared to less advanced stages(P<0.001).Serum ferritin obtained before or at the time of diagnosis was lower than levels obtained after diagnosis.Similar findings were confirmed in the sensitivity analysis.CONCLUSION Severe iron deficiency may indicate an increased risk of EO-CRC,particularly at earlier stages.Further studies defining the optimal serum ferritin threshold and routine incorporation of serum ferritin in screening algorithms is essential to develop more effective screening strategies for EO-CRC.
文摘BACKGROUND Liver transplantation(LT)is the best treatment for patients with liver cancer or end stage cirrhosis,but it is still associated with a significant mortality.Therefore identifying factors associated with mortality could help improve patient management.The impact of iron metabolism,which could be a relevant therapeutic target,yield discrepant results in this setting.Previous studies suggest that increased serum ferritin is associated with higher mortality.Surprisingly iron deficiency which is a well described risk factor in critically ill patients has not been considered.AIM To assess the impact of pre-transplant iron metabolism parameters on posttransplant survival.METHODS From 2001 to 2011,553 patients who underwent LT with iron metabolism parameters available at LT evaluation were included.Data were prospectively recorded at the time of evaluation and at the time of LT regarding donor and recipient.Serum ferritin(SF)and transferrin saturation(TS)were studied as continuous and categorical variable.Cox regression analysis was used to determine mortality risks factors.Follow-up data were obtained from the local and national database regarding causes of death.RESULTS At the end of a 95-mo median follow-up,196 patients were dead,38 of them because of infections.In multivariate analysis,overall mortality was significantly associated with TS>75%[HR:1.73(1.14;2.63)],SF<100μg/L[HR:1.62(1.12;2.35)],hepatocellular carcinoma[HR:1.58(1.15;2.26)],estimated glomerular filtration rate(CKD EPI Cystatin C)[HR:0.99(0.98;0.99)],and packed red blood cell transfusion[HR:1.05(1.03;1.08)].Kaplan Meier curves show that patients with low SF(<100μg/L)or high SF(>400μg/L)have lower survival rates at 36 mo than patients with normal SF(P=0.008 and P=0.016 respectively).Patients with TS higher than 75%had higher mortality at 12 mo(91.4%±1.4%vs 84.6%±3.1%,P=0.039).TS>75%was significantly associated with infection related death[HR:3.06(1.13;8.23)].CONCLUSION Our results show that iron metabolism imbalance(either deficiency or overload)is associated with post-transplant overall and infectious mortality.Impact of iron supplementation or depletion should be assessed in prospective study.
文摘BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.METHODS A total of 1565 children with attention deficit hyperactivity disorder(ADHD),1694 children with tic disorder(TD),93 children with ASD and 1997 healthy control children were included between January 1,2020,and December 31,2021 at Beijing Children's Hospital.We describe the differences in age levels and ferritin levels between different disease groups and their sex differences.The differences between the sexes in each disease were analyzed using the t test.The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups.A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group.Analysis of variance was used for comparisons between subgroups,and regression analysis was used for confounding factor control.RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 36.82±20.64μg/L and 35.64±18.56μg/L,respectively.A total of 1694 TD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 35.72±20.15μg/L and 34.54±22.12μg/L,respectively.As age increased,the incidence of low serum ferritin in ADHD and TD first decreased and then increased,and 10 years old was the turning point of rising levels.The incidence of ADHD with low serum ferritin was 8.37%,the incidence of TD with low serum ferritin was 11.04%,and the incidence of the healthy control group with low serum ferritin was 8.61%,among which male children with TD accounted for 9.25%and female children with TD accounted for 11.62%.There was a significant difference among the three groups(P<0.05).In addition,there were 93 children with ASD with an average serum ferritin level of 30.99±18.11μg/L and a serum ferritin incidence of 15.05%.CONCLUSION In conclusion,low serum ferritin is not a risk factor for ADHD or TD.The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.
