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.

关注妊娠合并缺铁性贫血

缺铁性贫血是妊娠期最常见的合并症之一,全世界患病率水平差距较大。研究表明,妊娠合并缺铁性贫血对于孕妇和胎儿、新生儿均有不良影响。在临床上,缺铁性贫血以及铁缺乏是依据血常规和血清铁蛋白的测定进行评估,建议在妊娠期间适度地关注和检查,合理评估补铁治疗的适应证。有指征的采用口服补铁的方式、是否采取静脉补铁方式目前尚有争议。本文就妊娠合并缺铁性贫血的诊断和治疗进行评析,旨在为临床医师的决策提供借鉴与参考。

血液荧光测定仪性能评价及其在IDA诊断中的应用

目的评价进口AVIV206D型血液荧光测定仪性能,并探讨血液锌原卟啉(ZPP)在健康人群中的分布及ZPP在住院病人缺铁性贫血(IDA)诊断中的应用价值。方法对进口AVIV206D型血液荧光测定仪的精密度及静脉血样本ZPP稳定性进行评价;收集1 908名健康体检者和100名住院病人静脉血,测定其ZPP水平,同时收集其血常规和生化常规结果。结果本仪器测定ZPP低、中、高水平的批内精密度(CV%)分别为6.9%、9.4%、4.3%,批间精密度(CV%)分别为9.8%、5.4%、2.7%;样本置于室温保存24 h、48 h,4℃保存7 d和14 d后测定,结果与立即测定结果间无显著性差异;ZPP在健康成人中呈非正态分布,且存在性别差异(t=12.106,P<0.000 1),其中男性较女性低;健康成人和住院贫血病人ZPP水平存在统计学差异(t=12.342,P<0.000 1);在贫血病人和健康人群中,ZPP与Hb均呈显著负相关,相关系数分别为r=-0.516(P<0.000 1)和-0.306(P<0.000 1);分别以TIBC、MCV、SI和ZPP为IDA诊断指标绘制受试者工作(ROC)曲线,各指标曲线下面积(AUC)分别为0.862、0.812、0.750、0.629。结论 AVIV 206D型血液荧光测定仪性能较好,在健康人群IDA筛查中具有一定价值,但应注意ZPP用于住院病人IDA诊断时存在一些干扰因素。

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.

Syrup versus Drops of Iron III Hydroxide Polymaltose in the Treatment of Iron Deficiency Anemia of Infancy

Background: Iron deficiency anemia in infants is the most common micronutrient deficiency worldwide. The main cause is low iron intake in the presence of accelerated physiologic growth rate. Objective: The current study aimed at prospectively comparing the efficacy of iron III hydroxide polymaltose syrup (IPS) versus iron III hydroxide polymaltose drops (IPD) in treating iron deficiency among infants attending the hematology outpatient clinic. Our hypothesis was that IPS would be less effective possibly related to the difficulty of giving the medication. Methods: Participants diagnosed with iron deficiency anemia between 11-24 months were randomly assigned to receive either IPS or IPD for 3 months. The main outcome parameter was hemoglobin blood level, while the secondary outcome parameters were: 1) iron;2) ferritin;3) transferrin (i.e.?total iron binding capacity);4) mean corpuscular volume;and 5) red blood cell distribution width. Results: Out of the 104 recruited infants, 55 (52%) completed the study: 29 in the IPS group and26 inthe IPD group. There was no significant difference in the main outcome parameter at either 1 or 3 months of treatment: mean hemoglobin was 10.5 versus 10.7 g/dL within a 1 month treatment, P = 0.4;mean hemoglobin was 11.0 versus 11.1 g/dL within a 3 months of treatment, P = 0.59. Likewise, no significant differences were found with respect to the occurrence of side effects. Conclusion: Oral IPD and IPS are equally effective in treating iron deficiency anemia in infants aged 11 - 24 months.

The Potentials of Locally Available Fruits Rich in Iron to Mitigate Iron Deficiency Anemia in Least Developing Countries （LSD）

The objective of this study was to compare effects of natal plum fruits （Carissa grandiflora） on hemoglobin （HB） levels in comparison to ferrous sulfate tablets to 201 anemic children aging from 5 to 12 years in rural area in Somalia. The study was designed as randomized clinical intervention to explore the potentials of natal plum to combat against IDA （iron deficiency anemia）/anemia using mean HB gains as a parameter. The research was carried out in rural setting near Somalia capital where local NGOs （non governmental organizations） work in the absence of local/central authorities. Only HB levels of the subject children were measured as other confirmatory analyses were not available due to the civil wars at the time of the intervention. The baseline HB levels of both groups were similar. However, after the intervention the cumulative HB levels of the natal fruits group was higher than the control group of ferrous sulfate by at least 31% （P 〈 0.008, equal variances not assumed）. Dietary interventions to mitigate IDA/anemia using locally available foods rich in iron, vitamins C and A seem to promise in the developing countries where chronic inadequate resources seem to affect the public health nutrition especially vulnerable groups like growing children.

Iron Deficiency Anemia in School Age Children in District Karak Khyber Pakhtunkhwa Province, Pakistan

The present study aimed to estimate the prevalence of iron deficiency anemia (IDA) in school-going children. Both Iron deficiency and iron deficiency anemia have considerable adverse effect on human health. Among the different negative health concerns, including stunt development, less developed immunity, lower IQ level, no proper physical work capacity, more fatigue, maternal mortality rates, young ones born with low birth weight, birth complications and infant mortality rates are some of the remarkable health concerns posed by iron deficiency level. Our study sample was consisting of 420 school age children of both genders. The blood samples were collected in EDTA (Ethylenediaminetetraacetic acid) tubes from different school and health maternity centres by trained and veteran persons. Questionnaires were utilised for the data collection, at the time of blood samples collection. Hemoglobin (Hb), hematocrite (Hct), Mean Corpuscular Volume (MCV), Mean Corpuscular hemoglobin concentration (MCHC), white blood cell and red blood cell (RBC) were determine by automatic hematological analyzer model Symex Ks-21 having two reagents, cell pack and Stromatolyser-wwt 500 ml. The total percentage of anemia recorded in school age children was 34.0%. In tehsil Banda Daud Shah, the incidence of anemia was high up to 43.6% while in tehsil Takhti Nasrati and Karak was 32.1% and 26.4% respectively. The percentage was higher in girls (38.9%) than in boys (31.0%). The anemia percentage was recorded high (55.8%) in lower socioeconomic family children, than middle class (32.2%) and upper class (17%). The percentage of anemic children was also high (40%) in age group of 10 - 12 years. Pale skin was the most common symptom of anemia.

Potential Mechanism of Danggui Buxue Decoction in Treating Iron Deficiency Anemia Based on Network Pharmacology and Molecular Docking Technology

[Objectives]To explore the potential mechanism of Danggui Buxue Decoction in treating the iron deficiency anemia(IDA)based on network pharmacology and molecular docking technology.[Methods]The active components and target proteins of Danggui Buxue Decoction were searched in databases such as TCMSP,OMIM,GeneCards,Drugbank,String,Metascape,etc.,and the target proteins shared with IDA were screened out,and the information about the signal pathways and biological functions of these target proteins was obtained.[Results]17 active components of Danggui Buxue Decoction and 24 potential targets for the treatment of IDA were obtained.With the aid of String database and Cytoscape software,the protein interaction network was obtained and the network topology analysis was performed.Four potential core targets with higher scores were obtained,namely F2,NOS2,NOS3,and PPARG.Using the Metascape database,GO function enrichment analysis and KEGG pathway enrichment analysis were performed on the potential targets of Danggui Buxue Decoction in the treatment of IDA,and the important biological processes,cell composition,molecular functions and signal pathways related to the target were screened through the R language.The results show that biological processes are related to positive regulation of growth,cell composition is related to membrane microdomain,and molecular functions are related to oxidoreductase activity.The signal pathways involved are mainly AGE-RAGE signal pathway,TNF signal pathway and IL-17 signal pathway.Finally,the molecular docking results confirmed that the active components of Danggui Buxue Decoction have a good binding ability with the target.[Conclusions]Danggui Buxue Decoction treats the IDA through multiple components,multiple targets,multiple signal pathways,and multiple biological functions.

Mechanism of iron deficiency anemia and treatment with integrated traditional Chinese and western medicine

Iron-deficiency anemia(IDA)is one of the most common anemia diseases in China,and its patients are mostly children and women of childbearing age.Among the four major anemia,IDA belongs to benign anemia,which presents as a series of compensatory symptoms due to iron deficiency affecting hemoglobin synthesis.The insufficient oxygen supply of cells and tissues in the human body is closely related to iron and hemoglobin.However,there is a lack of systematic research on the treatment of IDA with integrated traditional Chinese and western medicine and its mechanism.This paper explores the mechanism of integrated traditional Chinese and western medicine for IDA in order to lay a theoretical foundation for the treatment of IDA with integrated traditional Chinese and western medicine.

新型网织红细胞参数在缺铁性贫血疗效观察中的应用

目的 观察网织红细胞绝对数 (RET #)、网织红细胞内血红蛋白量 (CHr)、平均网织红细胞体积 (MCVr)及网织红细胞内血红蛋白浓度 (CHCMr)等网红参数在缺铁性贫血 (IDA)患者铁剂治疗中的动态变化 ,确定骨髓对铁剂治疗反应的早期指标。方法 用Advia 12 0血细胞分析仪对 13例缺铁性贫血患者在治疗过程中网红参数的变化进行了动态观察。结果 缺铁性贫血患者在铁剂治疗后 ,网红参数RET #、CHr、MCVr于第 4天明显升高 (P <0 0 1) ,第七天恢复正常 ;血红蛋白于第 14天明显升高 (P <0 0 1) ,第 2 8天恢复正常 ;CH、MCV、CHCM于第 2 8天明显升高 (P <0 0 1) ,第 4 9天后恢复正常 ;RDW于第 7天明显升高 (P <0 0 1) ,14天后又逐渐降低 ,第 12 0天恢复正常。结论 网红参数RET #、CHr。

螺旋藻对缺铁性贫血的恢复实验

选纯种Ｗｉｓｔａｒ大鼠，用低铁饮食法复制缺铁性贫血（ＩＤＡ）模型，之后，用螺旋藻（ＳＰ）进行恢复试验。以硫酸亚铁为阳性对照组，以低铁饲料为阴性对照组，按ＳＰ含量由小到大分为３个实验组即实验１组（含ＳＰ１％）、实验２组（含ＳＰ８％）及实验３组（含ＳＰ１５％）。经过４周的恢复试验，结果：实验２组和实验３组贫血恢复速度最快，其次是实验１组。实验２组和实验３组体重高于阳性对照组，实验１组体重与阳性对照组接近，阳性对照组体重高于阴性对照组。提示：（１）单纯性缺铁可影响大鼠生长，致大鼠体重增长缓慢；（２）螺旋藻似具有加速大鼠体重增长的作用；（３）螺旋藻用于恢复大鼠ＩＤＡ效果显著，而且用量有一个最适宜的范围．

孕中期妇女缺铁性贫血危险因素分析

对４９７例孕中期妇女（其中１５２例诊断为缺铁性贫血）进行了成组病例—对照研究，采用非条件Ｌｏｇｉｓｔｉｃ回归分析方法分析了影响孕中期缺铁性贫血的各因素。研究结果表明：孕妇末次月经月份处于春季、肉类及鱼虾类摄取量少、多孕次、孕前月经排出量多及不经常用生铁锅烹调是影响孕期缺铁性贫血发病的主要危险因素。

乌梅消食颗粒治疗缺铁性贫血50例疗效观察

目的:观察乌梅消食颗粒治疗缺铁性贫血(IDA)的临床疗效,并初步探讨其作用机制。方法:50例缺铁性贫血,中医辨证分型为脾胃虚弱、气血两虚证候患者,随机分为治疗组和对照组。治疗组在给予铁剂同时给予乌梅消食颗粒,对照组给予铁剂同时给予外观相同颗粒剂。结果:两组患者治疗后症状、体征、贫血及铁生化指标、铁蛋白均有不同程度改善(与治疗前相比P<0.01)。治疗组IDA的症状、体征、贫血及缺铁状态改善均明显优于对照组(P<0.05)。且在治疗过程中,其不良反应积分均值明显低于对照组(P<0.05)。结论:乌梅消食颗粒可以促进缺铁性贫血患者对铁的吸收利用,同时可以有效减轻服用铁剂所造成的不良反应。

芹菜叶绿素铁钠与其他补血药物功效的比较研究

目的:探讨芹菜叶绿素铁钠与其他补血剂对大鼠缺铁性贫血的效果。方法:采用低铁饲料建立大鼠缺铁性贫血(IDA)模型,给予叶绿素铁钠、血红素铁、NaFeEDTA和FeSO4,通过测定大鼠血液指标血红蛋白(Hb)含量、红细胞(RBC)数和红细胞压积(HCT),观察补血疗效。结果:在实验30d时,与模型组和FeSO4组相比,叶绿素铁钠组的Hb、RBC、HCT显著增加(P<0.05);与血红素铁组和NaFeEDTA组相比,差异不显著。结论:芹菜叶绿素铁钠对治疗实验贫血鼠有明显的效果。

生血宁治疗缺铁性贫血的临床研究

蚕砂中提取叶绿素、经皂化、铁代精制成铁叶绿酸钠,并以此为原料制成生血宁片,治疗缺铁性贫血180例,以硫酸亚铁片作对照。结果成人治疗组120例,治愈108例占90％,显效12例占10％;成人对照组30例治愈10例,占33.33％,显效8例占26.67％,有效6例占20％,无效6例占20％。儿童治疗组60例,治愈52例占86.67％,显效8例占13.33％。儿童对照组30例,治愈13例占43.33％,显效5例占16.67％,有效4例占13.33％,无效8例占26.67％,生血宁片疗效明显优于硫酸亚铁片,且无明显毒副反应,易为广大病人接受值得推广应用。

鱿鱼墨黑色素铁对大鼠缺铁性贫血的治疗作用

目的:探讨鱿鱼墨黑色素铁对缺铁性贫血(IDA)模型大鼠的治疗作用。方法:采用低铁饲料并辅以尾静脉定期放血法建立IDA模型,灌胃给予不同剂量的鱿鱼墨黑色素铁,分别检测IDA大鼠外周血血红蛋白(Hb)含量、红细胞(RBC)数、红细胞压积(HCT)、红细胞平均体积(MCV)和血清铁(SI)含量及红细胞内游离原卟啉(FEP)浓度。结果:鱿鱼墨黑色素铁能够显著提高IDA大鼠Hb、RBC、HCT、MCV和SI数量,有效降低FEP浓度,显著促进IDA大鼠贫血症状的恢复。与无机铁剂相比,生物利用度高且不影响大鼠正常生长。结论:鱿鱼墨黑色素对IDA大鼠贫血症状具有显著的治疗作用。