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.

Association of gestational anemia with pregnancy conditions and outcomes: A nested case-control study

BACKGROUND Gestational anemia is a serious public health problem that affects pregnant women worldwide.Pregnancy conditions and outcomes might be associated with the presence of gestational anemia.This study investigated the association of pregnancy characteristics with anemia,exploring the potential etiology of the disease.AIM To assess the association of pregnancy parameters with gestational anemia.METHODS A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project(CPWCS-PUMC).A total of 3172 women were included.Patient characteristics and gestational anemia occurrence were extracted,and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia.RESULTS Among the 3172 women,14.0% were anemic,46.4% were 25-30 years of age,21.9%resided in eastern,15.7%in middle,12.4%in western 18.0% in southern and 32.0%in northern regions of China.Most women(65.0%)had a normal prepregnancy body mass index.Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region[odds ratio(OR)=0.406,95%confidence interval(CI):0.309-0.533,P<0.001],higher in the northern than in the southern region(OR=7.169,95% CI:5.139-10.003,P<0.001),lower in full-term than in premature births(OR=0.491,95% CI:0.316-0.763,P=0.002),and higher in cases with premature membrane rupture(OR=1.404,95% CI:1.051-1.876,P=0.02).CONCLUSION Gestational anemia continues to be a health problem in China,and geographical factors may contribute to the situation.Premature birth and premature membrane rupture may be associated with gestational anemia.Therefore,we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women,which would potentially reduce the occurrence of gestational anemia.

Single vs. Double Dose Iron Supplementation for Prevention of Iron Deficiency Anemia in Twin Pregnancy: A Randomized Controlled Clinical Trial

Introduction: It is estimated that about 18% of pregnant women suffer from iron deficiency anemia throughout their whole pregnancy. In twin pregnancy, owing to the relatively greater feto-placental requirements and greater expansion in maternal plasma volume and red cell mass, iron requirements are magnified 1.8 times compared to singleton pregnancies. However, for prevention of iron deficiency in twin pregnancy, only sparse data exist regarding the sufficiency of the standard antenatal iron supplementation dose used in singleton pregnancies to meet the increased iron demand. In this study, we investigate the effect of single and double dose iron supplementation for prevention of iron deficiency anemia in twin pregnancy. Methods: A randomized controlled clinical trial was conducted at our center in the period between February 2019 and October 2020, and included 450 eligible healthy non-anemic women aged 18 - 35 years, with twin pregnancy at 12 - 16 weeks of gestation. After informed consent, eligible women were randomized to receive either single dose 27 mg, or double dose 54 mg elemental iron supplementation. Monitoring of hemoglobin concentration was done at fixed time points during gestation: at enrollment, 24 weeks, 32 weeks and before delivery. The primary outcome of the study was the incidence of iron deficiency anemia during follow up until delivery. Results: The incidence of iron deficiency anemia in the two groups did not differ significantly between the single dose group (19.1%) and the double dose group (24.0%). In women who did not develop Iron Deficiency Anemia, hemoglobin concentration varied significantly along the different gestational ages during the follow up period. In contrast, they did not show an overall statistically significant difference in the hemoglobin concentrations between the single or double dose groups. Conclusion: This clinical trial did not demonstrate an added benefit for doubling prophylactic iron supplementation dose in non-anemic women with twin pregnancy.

Prevalence and Factors Associated with Anemia Pregnancy in a Group of Moroccan Pregnant Women

Background: Pregnancy is typically accompanied by an increase of micronutrient requirements in general and especially iron. This increased need may be an additional risk factor for developing anemia. Purpose of the study: The aim of this study is to provide data on the prevalence of anemia of pregnancy in the maternity ward of the regional hospital in the city of Temara, and examine risk factors that may expose women to anemia during pregnancy. Materiel and Methods: A prospective cross-sectional study of a year was conducted to the hospital Sidi Lahcen in the city of Temara. Sociodemographic and nutritional data were collected through a questionnaire, obstetric and medical histories of women in labor and the results of biological tests were recorded from the patient obstetric file. Results: Among the 849 women surveyed, 690 (82%) had performed a blood count, and among these 117 (16.8%) were found anemic, with the following proportions: 57.6% had mild anemia, 41.5% had moderate anemia and a minority (0.8%) had severe anemia. The pregnant women aged over 35 years were the most exposed to anemia during pregnancy (47%) compared with younger women (p < 0.001). Women who had a history of anemia aside from pregnancy and those who had anemia in earlier pregnancies were more prone to developing anemia in the current pregnancy with a statistically significant difference (p < 0.001). The number of pregnancies, number of previous abortions and place of residence had no influence on the occurrence of anemia of pregnancy. The consumption of fortified flour with iron and vitamins as well as consuming iron rich foods was not a protective factor against the development of anemia of pregnancy. Tea consumption near the meal was not a factor exposing to anemia during pregnancy. Conclusion: Anemia is a public health problem in Morocco. Evidence from our study emphasizes the need to implement educational programs to improve the nutritional knowledge and sensitization of women.

Helicobacter pylori infection in pregnant women:Gastrointestinal symptoms and pregnancy-related disorders

Helicobacter pylori(H.Pylori)is a gram-negative,flagellated and spiral-shaped bacterial pathogen that impacts approximately 46%among pregnant women globally and has been associated with various maternal-fetal complications.Iron deficiency anemia,fetal growth restriction,cardiovascular diseases,and insufficient nutrient absorption can be observed in pregnant women,as well as miscarriages and pregnancy-specific hypertensive disease,such as pre-eclampsia.Thus,the evidence supports the influence of H.pylori infection on fetal implantation/placentation failure,and positive strains of the cytotoxin-associated gene A of H.Pylori were reported as the most prevalent in these conditions.However,current knowledge indicates a relationship between this infection and the occurrence of hyperemesis gravidarum,characterized by frequent nausea and vomiting.Regarding the diagnosis of this bacterial infection,non-invasive approaches such as stool antigen test,urea breath test,and serological tests are more accepted during pregnancy,as they are easy to carry out and cost-effective.Finally,the bacteria eradication therapy should consider the risks and benefits for the pregnant woman and her child,with pharmacological intervention depending on the clinical presentation.

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.

Heme Iron Polypeptide in Iron Deficiency Anemia of Pregnancy: Current Evidence

Iron deficiency is the most common nutritional deficiency leading to anemia in pregnancy. Conventionally, non-heme form of iron salts has been the mainstay of treatment. However, patient compliance is an important concern with existing oral iron therapy due to gastrointestinal side effects. Heme iron, a better bioavailable and tolerable form of iron can be suitable form of iron for supplementation in pregnancy. Evidence suggests its utility in pregnancy for treatment of iron deficiency anemia with benefits extending to postpartum period. Effective transfer across placenta to fetus further supports its utility in pregnancy. This review discusses in details the absorption kinetics along with clinical evidence on efficacy, safety, and tolerability of heme-iron supplementation in iron deficiency anemia of pregnancy.

Direct antiglobulin test-negative autoimmune hemolytic anemia in a patient withβ-thalassemia minor during pregnancy:A case report

BACKGROUND Severe refractory anemia during pregnancy can cause serious maternal and fetal complications.If the cause cannot be identified in time and accurately,blind symptomatic support treatment may cause serious economic burden.Thalassemia minor pregnancy is commonly considered uneventful,and the condition of anemia rarely progresses during pregnancy.Autoimmune hemolytic anemia(AIHA)is rare during pregnancy with no exact incidence available.CASE SUMMARY We report the case of a 30-year-oldβ-thalassemia minor multiparous patient experiencing severe refractory anemia throughout pregnancy.We monitored the patient closely,carried out a full differential diagnosis,made a diagnosis of direct antiglobulin test-negative AIHA,and treated her with prednisone and intravenous immunoglobulin.The patient gave birth to a healthy full-term baby.CONCLUSION Coombs-negative AIHA should be suspected in cases of severe hemolytic anemia in pregnant patients with and without other hematological diseases.

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.

Benefit of Iron Supplementation with Ferric Sodium EDTA (NaFe ³⁺-EDTA) in the Treatment of Anemia during Pregnancy in Democratic Republic of Congo (FERARI Study)

Background: Oral iron supplements, usually in the form of ferrous salts, are associated with gastric side effects, poor compliance and failure of anemia treatment. To make iron more bioavailable, reduce the gastric side effects and increase the patient compliance, newer iron form, Ferric Sodium EDTA, has become available on the market. Objective: To assess the change in hemoglobin level after iron supplementation with Ferric Sodium EDTA during pregnancy. Materials and Methods: This is a longitudinal study concerning 337 women attending antenatal care in maternity hospitals in the Democratic Republic of Congo from May to December 2020. The study included sociodemographic and anthropometric variables along with type of feed, hemoglobin level at recruitment and after three weeks of taking iron supplement with Ferric Sodium EDTA (Hemoforce Plus Zinc® syrup). For statistical analysis, we used t-test or ANOVA and chi-square test, the significance being stated at p < 0.05. Results: The frequency of pregnancy anemia was 51.4%. The mean hemoglobin value of the overall study group was 8.7 ± 0.5 g/dL. The mean maternal age and weight were 28.9 ± 6.2 years and 65.3 ± 11.7 kg, respectively. Most pregnant women (83.1%) had a diet consisting of food of plant and animal origin in equal proportions. Mean of Body Mass Index (BMI) was 24.6 ± 4.6 Kg/m2 and 44.3% were overweight and obese. The co-morbidities associated were malaria and intestinal parasitosis found in 45% and 5.9% of cases, respectively. After iron treatment with Ferric Sodium EDTA, the average hemoglobin level increased to 11.2 g/dL with mean gain of 2.5 g/dL (p < 0.001). Pregnant women with excess weight (≥90 kg) and malaria as a comorbidity achieved a significantly lower mean hemoglobin gain (p = 0.014 and p = 0.022, respectively). Majority of women (91.2%) had not experienced the metallic taste of the syrup. Conclusion: Ferric Sodium EDTA as a novel iron formulation (Hemoforce Plus Zinc®) has shown a rapid increase in hemoglobin levels in pregnant women suffering from anemia. The speedy rise in hemoglobin is related to the property of Ferric Sodium EDTA to enhance the iron absorption by inhibiting the dietary iron inhibitors. Thus, Ferric Sodium EDTA should be used as an effective and promising iron supplement in pregnant women with iron deficiency anemia.

Helicobacter pylori and pregnancy-related disorders

Helicobacter pylori (H. pylori) infection is investigated in gastric diseases even during pregnancy. In particular, this Gram-negative bacterium seems to be associated with hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy. During the last decade, the relationship among H. pylori and several extra-gastric diseases strongly emerged in literature. The correlation among H. pylori infection and pregnancy-related disorders was mainly focused on iron deficiency anemia, thrombocytopenia, fetal malformations, miscarriage, pre-eclampsia and fetal growth restriction. H. pylori infection may have a role in the pathogenesis of various pregnancy-related disorders through different mechanisms: depletion of micronutrients (iron and vitamin B12) in maternal anemia and fetal neural tube defects; local or systemic induction of pro-inflammatory cytokines release and oxidative stress in gastrointestinal disorders and pre-eclampsia; cross-reaction between specific anti-H. pylori antibodies and antigens localized in placental tissue and endothelial cells (pre-eclampsia, fetal growth restriction, miscarriage). Since H. pylori infection is most likely acquired before pregnancy, it is widely believed that hormonal and immunological changes occurring during pregnancy could activate latent H. pylori with a negative impact not only on maternal health (nutritional deficiency, organ injury, death), but also on the fetus (insufficient growth, malformation, death) and sometime consequences can be observed later in life. Another important issue addressed by investigators was to determine whether it is possible to transmit H. pylori infection from mother to child and whether maternal anti-H. pylori antibodies could prevent infant’s infection. Studies on novel diagnostic and therapeutic methods for H. pylori are no less important, since these are particularly sensitive topics in pregnancy conditions. It could be interesting to study the possible correlation between H. pylori infection and other pregnancy-related diseases of unknown etiology, such as gestational diabetes mellitus, obstetric cholestasis and spontaneous preterm delivery. Since H. pylori infection is treatable, the demonstration of its causative role in pregnancy-related disorders will have important social-economic implications.

Kaolin Clay Consumption and Pregnancy:Prevalence,Hematological Consequences and Outcome of Labour in the Douala

Objective: To determine the prevalence, haematological repercussions and prognosis of childbirth in the event of consumption of kaolin during pregnancy. Materials and Methods: It was a study over a period of 3 months at the Laquintinie Hospital Douala. It compared two groups of women, one of whom had consumed kaolin during pregnancy (exposed group) and the other had not consumed it (non-exposed group). Results: A total of 342 women were included in our study, 121 (35.4%) of whom had consumed kaolin during pregnancy. Women exposed to this consumption (P < 0.05) after univariate analysis were those of pregnant women from the Far North (OR = 3.37, CI: 1.29 - 8.79, P = 0.013), single (OR = 1.65, CI = 1.05 - 2.59, P = 0.029), those with primary education (OR = 2.25, CI = 1.06 - 4.79, P = 0.035) and those with HIV (OR = 2.75, IC = 1.02-7.43, P = 0.045). Consumption was more frequent in the first trimester of pregnancy (37%) and in the third quarter (34%), at a predominantly weekly rate (47.9%). The most frequently cited reasons were envy (82%), and nausea (45%). This consumption was associated with a risk of premature delivery (RR = 2.26, IC = 1.27 - 4.05, P = 0.001), yellowish amniotic fluid (RR = 4.66, IC = 1.81 - 11, P = 0.001), birth weight < 2500 g in newborns (RR = 1.72, IC = 3.36 - 9.56, P = 0.025), but increased the probability of delivery (RR = 1.94, IC = 0.96 - 3.90, P = 0.039). For the hematological aspect, the occurrence of anemia (RR = 1.55, IC = 0.97 - 2.31, P = 0.003) and a decrease in mean hemoglobin concentration (RR = 1.29, IC = 0.83 - 2.03, P = 0.041) were associated with kaolin in pregnancy. After multivariate logistic regression, the complications included premature delivery, yellowish colour of the amniotic fluid and decreased hemoglobin. Conclusion: The use of kaolin is a frequent feeding behavior in pregnancy, mainly motivated by envy, which nevertheless presents serious maternal and fetal complications.

Cohort Study on Benefit of Martial Supplementation with EDTA Sodium Iron in Management of Gravidic Anemia at the University Clinics of Kinshasa

Background: Anemia is mainly attributed to nutritional deficiency, especially iron deficiency, which predominates during pregnancy, and is associated with parasitic diseases such as malaria and intestinal parasitosis, acute or chronic diseases such as sickle cell disease, tuberculosis, HIV infection and various micronutrients disorders. It is associated with an increased risk of low birth weight and prematurity and can contribute to impaired cognitive development in early childhood, as well as to maternal mortality. The impact on the fetus is even greater if maternal anemia onset is at an early stage, or prior to pregnancy. Iron salts, such as sulfate or fumarate, are widely used in the treatment of gravidic anemia, but due to various gastrointestinal side effects, many pregnant women are not compliant with treatment. Sodium iron EDTA, on the other hand, is highly absorbable and bioavailable. The latter improves hematological values and appears to be free from the usual iron-related side effects, hence compliance with this supplementation. Objectives: To evaluate the evolution of hemoglobin levels after sodium iron EDTA supplementation at the university Clinics of Kinshasa, to determine the frequency of gravidic anemia, the dose-dependent benefit of sodium iron EDTA supplementation in pregnant women and to identify factors associated with insufficient hemoglobin gain after supplementation. Methods: This longitudinal cohort will take place in the gynecology department of the University Clinics of Kinshasa from September 2022 to August 2023 and will include at least 54 pregnant women with anemia. Conclusion: The study will enable us to better assess the benefits of sodium iron EDTA in improving hematological values, as well as its tolerability in pregnant women suffering from anemia during pregnancy in our environment.

“菊苓方”纱布敷料对妊娠合并贫血患者剖宫产术后切口愈合疗效研究

目的观察“菊苓方”纱布敷料对妊娠合并贫血患者剖宫产术后切口愈合的影响。方法将172例妊娠合并贫血的剖宫产患者随机分为治疗组和对照组,每组86人。治疗组选用“菊苓方”纱布敷料为患者腹部切口换药,对照组选用无菌纱布敷料换药。记录患者术后第3天切口局部(颜色、肿胀、灼热、疼痛)的评分,切口愈合等级,切口愈合不良发生率等,对比两组的疗效。结果治疗组患者在术后第3天腹部切口愈合的情况中,在切口肿胀、切口颜色、切口疼痛缓解等方面明显优于对照组,差异均有统计学意义(均P<0.05);治疗组切口愈合不良发生率小于对照组(1.16%vs 9.30%)。结论“菊苓方”纱布敷料明显提高妊娠合并贫血患者剖宫产术后切口愈合质量,同时提高切口愈合率,提升患者生活质量,达到整体快速康复的目的。

高原地区妊娠期贫血孕妇孕晚期红细胞、铁参数对妊娠结局的预测价值

目的 探究高原地区妊娠期贫血孕妇孕晚期红细胞、铁参数对妊娠结局的预测价值。方法 回顾性分析2021年1月至2023年1月阿坝藏族羌族自治州人民医院接收的390例高原地区妊娠期孕妇的临床资料,根据孕妇妊娠期贫血情况将其分为研究组(妊娠期贫血孕妇)和对照组(妊娠期血红蛋白正常孕妇),比较两组孕妇孕晚期血清红细胞(RBC)水平、血红蛋白(Hb)、铁蛋白(SF)水平,再根据孕妇妊娠结局情况将研究组分为正常妊娠组(正常妊娠孕妇)与不良妊娠组(不良妊娠孕妇),比较两亚组孕妇孕晚期血清RBC、Hb、SF水平,采用ROC曲线分析孕晚期血清RBC、Hb、SF水平对高原地区妊娠期贫血孕妇妊娠结局的预测效能。结果 390例高原地区妊娠期孕妇中,共确诊妊娠期贫血孕妇107例,高原地区孕妇妊娠期贫血发病率为27.43%。研究组孕晚期血清RBC、Hb、SF水平均低于对照组,差异有统计学意义(P<0.05)。107例妊娠期贫血孕妇中,65例孕妇正常妊娠,42例孕妇出现非正常妊娠,正常妊娠组孕晚期血清RBC、Hb水平均高于不良妊娠组,差异有统计学意义(P<0.05),两亚组孕晚期SF水平比较差异无统计学意义(P>0.05)。孕晚期血清RBC、Hb水平均对高原地区妊娠期贫血孕妇妊娠结局有一定预测价值(AUC>0.5),其cut-off值分别为312.88×10^(12)/L、80.53 g/L。结论 高原地区妊娠期贫血孕妇孕晚期RBC、Hb水平对不良妊娠结局有一定预测价值,临床应加强孕晚期孕妇血清RBC、Hb水平的监测,及时补充,避免不良妊娠结局的出现。

阿胶治疗β-地中海贫血孕妇疗效及对EGR2表达的影响

【目的】观察阿胶治疗β-地中海贫血(简称β-地贫)患者妊娠期贫血的疗效及对早期生长反应因子2(EGR2)表达的影响。【方法】转录组测序(RNA-seq):将20例β-地贫孕妇按3∶1比例随机分配到治疗组15例(其中脱落1例,最终纳入14例)和对照组5例,治疗组口服阿胶粉,对照组不予干预,疗程为4周。采集2组孕妇治疗前后的外周血进行RNA-seq分析,确定候选靶标。随后开展前瞻性临床随机对照试验(RCT):招募41例β-地贫孕妇,按3∶2比例随机分配到治疗组24例和对照组17例,治疗组口服阿胶粉,对照组口服阿胶粉模拟剂,疗程为4周。检测2组孕妇治疗前后的血液学参数,并采用实时聚合酶链反应(Real-time PCR)及蛋白免疫印迹(Western Blotting)法检测候选靶标的mRNA及蛋白表达量。【结果】(1)RNA-seq分析:基因型为βCD41-42(-TTCT)/β^(N)的治疗组治疗后EGR2表达显著上调(log2 FC=1.915;校正P值=9.84E-03),确定EGR2为候选靶标。(2)RCT试验:(1)治疗后,2组β-地贫孕妇平均血红蛋白(Hb)浓度变化无统计学差异(P>0.05),但基因类型为βCD41-42(-TTCT)/β^(N)的治疗组患者Hb浓度平均升高(6.54±4.74)g/L,较其他基因类型的β-地贫孕妇有显著性升高(P<0.05)。(2)基因类型为βCD41-42(-TTCT)/β^(N)的治疗组患者治疗后外周血EGR2 mRNA及蛋白表达量均显著升高(P<0.05);且2组β-地贫孕妇治疗前后Hb浓度差值与EGR2 mRNA及蛋白表达量差值均存在显著正相关关系,相关系数分别为0.701、0.683(P<0.001)。【结论】基因类型为βCD41-42(-TTCT)/β^(N)的地贫孕妇口服阿胶治疗效果最佳,其疗效可能与上调EGR2表达,激活RNA聚合酶Ⅱ启动子,促进核酸结合等发挥珠蛋白基因转录调控作用有关,从而最终有效改善贫血。

健脾生血颗粒联合琥珀酸亚铁治疗妊娠期缺铁性贫血的效果及对铁代谢指标的影响

目的分析健脾生血颗粒联合琥珀酸亚铁治疗妊娠期缺铁性贫血的效果及对铁代谢指标的影响。方法选择2021年3月至2022年3月收治的100例妊娠期缺铁性贫血孕产妇作为研究对象,以随机法将其分为常规组和观察组,各50例。常规组给予琥珀酸亚铁治疗,观察组给予健脾生血颗粒联合琥珀酸亚铁治疗。比较两组的治疗效果。结果治疗后,观察组的血清铁(SI)、血清铁蛋白(SF)、转铁蛋白饱和度(TS)、转铁蛋白(TRF)、铁调素(HEPC)水平显著高于常规组,总铁结合力(TIBC)水平显著低于常规组,差异具有统计学意义(P<0.05)。治疗后,观察组的血红蛋白(HGB)、红细胞计数(RBC)、平均红细胞体积(MCV)、平均血红蛋白浓度(MCHC)水平高于常规组,差异具有统计学意义(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。观察组的不良妊娠结局总发生率显著低于常规组,差异具有统计学意义(P<0.05)。结论健脾生血颗粒联合琥珀酸亚铁治疗妊娠期缺铁性贫血孕产妇可取得理想疗效。

孕期血红蛋白水平变化与双胎围产儿结局相关性研究

目的研究孕期母体血红蛋白水平及其变化与双胎围产儿结局的相关性。方法回顾性分析2015年5月至2022年11月行产前检查及分娩的双胎妊娠产妇的临床资料。结果纳入分析2524例双胎妊娠产妇,早孕期平均血红蛋白(Hb)为(118.0±10.9)g/L,高于晚孕期的(116.6±13.0)g/L,差异有统计学意义(P<0.01)。早孕期缺铁性贫血的发生率为22.1%,晚孕期为27.7%。高Hb(Hb>130 g/L)可能与新生儿窒息(AOR=2.10,95%CI:1.13~3.87)和小于胎龄儿(AOR=1.39,95%CI:1.09~1.98)的发生风险增加相关。早孕期中重度贫血可能增加了小于胎龄儿(AOR=2.61,95%CI:1.52~4.49)的发生风险。早孕期轻度贫血并未增加围产儿不良结局的发生风险。早孕期轻度贫血在晚孕期如得到纠正,新生儿窒息(AOR=0.27,95%CI:0.07~0.97)风险较持续贫血者可能降低,且双胎之大胎儿出生体重较高(P<0.05)。结论与双胎妊娠持续贫血者相比,晚孕期贫血纠正者可能减少了新生儿窒息的风险。因此,需强调对双胎妊娠贫血孕妇孕期补铁及Hb监测的必要性。

妇女围受孕期服用营养补充剂与孕早期贫血的关系

目的了解北京市通州区妇女孕早期贫血患病率,评价围受孕期服用单纯叶酸片(PFA)或含叶酸的多种微量营养素补充剂(MMFA)与孕早期贫血的关系。方法以2013—2018年37034例在通州区妇幼保健院分娩妇女的孕期保健和孕早期血常规化验数据为基础进行研究,采用Logistic回归模型分析围受孕期PFA或MMFA服用情况与孕早期贫血的关系。结果妇女孕早期贫血患病率为1.8%,以轻度及小细胞低色素性贫血为主。与服用PFA妇女相比,服用MMFA者孕早期患贫血(aOR=0.79,95%CI:0.66~0.95)和小细胞低色素性贫血风险(aOR=0.69,95%CI:0.53~0.91)均更低。在服用MMFA的妇女中,孕前开始服用者较孕后开始服用者总贫血和小细胞低色素性贫血风险低,aOR分别为0.69(95%CI:0.53~0.90)和0.47(95%CI:0.30~0.75),且高频服用MMFA者较未服用者总贫血和小细胞低色素性贫血风险低,aOR分别为0.59(95%CI:0.41~0.86)和0.42(95%CI:0.23~0.76)。在服用MMFA的妇女中,孕前开始服用者血清铁水平更高(aβ=4.25,95%CI:1.70~6.80)。结论2013—2018年北京市通州区妇女孕早期贫血患病率较低。妇女围受孕期服用MMFA可降低孕早期贫血,尤其是小细胞低色素性贫血患病风险。

Establishment of an Iron Deficiency Model by Iron Depletion in Pregnant Rats

Anemia,a global public health problem,has significant adverse consequences on the cognitive development of children and the work capacity of adults;affecting social and economic development.Globally,roughly 43%of children under five years of age,38%of pregnant women,and 29%of nonpregnant women had anemia.Anemia during pregnancy significantly increases the risk of low birth weight and preterm birth.A 10 g/L increase in hemoglobin has been estimated to decrease the risk of maternal and perinatal mortality by 29%and 28%.