Parenteral iron therapy in children with iron deficiency anemia

Iron deficiency anemia(IDA)continues to be a global public health problem.Oral iron is the universally accepted first-line therapy,and most children have a prompt and favorable response to oral formulations.In subsets of children who fail to respond due to intolerance,poor adherence,or inadequate intestinal absorption,parenteral iron is indicated.Despite numerous studies in adults with IDA of diverse etiologies,pediatric studies on parenteral iron use are very limited.Although mostly retrospective and small,these studies have documented the efficacy and safety profile of intravenous iron formulations.In this editorial the author comments on the most important published data and underscores the need to seriously consider parenteral iron use in children unresponsive to oral therapy.

TREATMENT OF IRON DEFICIENCY ANEMIA IN CHILDREN BY IRONSUPPLEMENTATION TWICE WEEKLY AND WEEKLY

Objective The effect of intermittent iron supplementation weekly and twice weekly was studied in children with iron deficiency anemia(IDA). Methods Subjects were 58 children who were randomly divided into two groups. One group received a dosage of 2mg/kg Fe every 3d for 9 weeks. The other group received the same dose Fe once a week for 12 weeks. Results Hemoglobin and serum ferrltin increased significantly after treatment in both groups (P <o.o5), and zinc protoporphyrin decreased significantly (P <o. o5). But serum rerrltin of both groups was different after 6 weeks of treatment (P<o. o1). The side effect of the group supplemented once every 3d was higher than that of the group once a week, but there was no statistically significant difference. Conclusion Iron supplementation every 3d has a similar effect to once a week for treatment of IDA. The former should be used for the serious patients for 6 weeks. The later should be used for infants and the patients whose resistance of intestines and stomach are not good.

Association between <i>Helicobacter pylori</i>Infection and Iron Deficiency Anemia among School-Age Children in Sohag University Hospital, Upper Egypt

Background: Helicobacter pylori (H. pylori) infection has been suggested as a cause of iron deficiency anemia (IDA) refractory to iron therapy. Objective: The aim of this work was to evaluate the association between H. pylori infection and IDA among school-age children. Subjects and Methods: This was a prospective case-control study conducted for one year starting from March 2015 and included 200 school-age children with IDA and 50 age and sex matched non-anemic controls, attending pediatric outpatient clinic at Sohag university Hospital, Sohag, Upper Egypt. All of participants were subjected to clinical evaluation and the following investigations: CBC, serum iron, total iron binding capacity, serum ferritin and a quantitative detection of H. pylori IgG antibodies. Results: Totally, 72 (36%) children with IDA and 6 (12%) non-anemic controls had positive level for H. pylori specific IgG (P = 0.036). H. pylori IgG antibody titer showed significant positive correlation with age and significant negative correlation with each of Hb level, MCV, HCT and serum ferritin. Age was higher (p H. pylori positive IDA cases in comparison to H. pylori negative IDA cases. Conclusion: The results of this study demonstrate significant association between positive serology for H. pylori infection and IDA in school-age children. Moreover, infection may increase the severity of anemia.

Effect of Vitamin C Supplementations on Iron Deficiency Anemia in Chinese Children

A total of 65 children with mild iron deficiency anemia (IDA) were divided into 5 groups, and received 0, 25, 50, 100 and 150 mg/day of vitamin C (VC) respectively every day for 8 weeks. Hemoglobin, serum ferritin, free erythrocyte and hematocrit were determined every week. At a daily average intake of about 30 mg of VC and 7.5 mg of Fe, the results of the study indicate that: (1) VC supplement alone could effectively control children's IDA, and a dose-dependant relationship was observed. (2) 50 mg/day of VC is the most efficient dosage and 6 weeks is the shortest time for an effective therapy. (3) With a diet predominately comprised of plant foods, it is suggested that appropriate dose of VC should be supplemented for the children during winter and spring in northeastern areas of China.

A new iron free treatment with oral fish cartilage polysaccharide for iron deficiency chronic anemia in inflammatory bowel diseases:A pilot study

AIM： To investigate the effect of a new oral preparation, highly concentrated in fish cartilage, in a group of inflammatory bowel diseases （IBD） patients with chronic iron deficient anemia. METHODS： In an open label pilot study, we supplemented a group of 25 patients （11 with Crohn＇s disease and 14 with ulcerative colitis） in stable clinical conditions and chronic anemia with a food supplement which does not contain iron but contains a standardized fraction of fish cartilage glycosaminoglycans and a mixture of antioxidants （Captafer Medestea, Turin, Italy）. Patients received 500 mg, twice a day during meals, for at least 4 mo. Patients were suggested to maintain their alimentary habit. At time 0 and after 2 and 4 too, emocrome, sideremia and ferritin were examined. Paired data were analyzed with Student＇s t test. RESULTS： Three patients relapsed during the study （2 in the 3^rd too, 1 in the 4^th too）, two patients were lost to follow up and two patients dropped out （1 for orticaria, 1 for gastric burning）. Of the remaining 18 patients, levels of serum iron started to rapidly increase within the 2^nd mo of treatment, P 〈 0.05）, whereas serum ferritin and hemoglobin needed a longer period to significantly improve their serum levels （too 4） P 〈 0.05. The product was safe, easy to administer and well tolerated by patients. CONCLUSION： These data suggest a potential new treatment for IBD patients with iron deficiency chronic anemia and warrant further larger controlled studies.

Autoimmune gastritis presenting as iron deficiency anemia in childhood

AIM: To characterize clinical, laboratorial, and histological profile of pediatric autoimmune gastritis in the setting of unexplained iron deficiency anemia investigation.

Emerging causes of iron deficiency anemia refractory to oral iron supplementation

While oral iron supplementation is commonly used throughout many clinical setting,treatment with intravenous(IV) iron has historically been reserved for specific settings,such as chronic kidney disease,gynecologic issues,and anemia associated with cancer and its treatments.However,the use of IV iron has begun to gain popularity in the treatment of iron deficiency anemia(IDA) associated with two conditions that are being seen more frequently than in years past:patients who are status post gastric bypass procedure and those with inflammatory bowel disease(IBD).The Roux-en-Y procedure involves connecting a gastric pouch to the jejunum,creating a blind loop consisting of distal stomach,duodenum,and proximal jejunum that connects to the Roux limb to form a common tract.IDA occurs in 6%-50% of patients who have undergone a gastric bypass,the etiology being multifactorial.The proximal gastric pouch,the primary site of gastric acid secretion,is bypassed,resulting in a decreased ability to metabolize molecular iron.Once metabolized,most iron is absorbed in the duodenum,which is entirely bypassed.After undergoing bypass procedures,most patients significantly limit their intake of red meat,another factor contributing to post-bypass IDA.Chronic anemia occurs in approximately 1/3 of patients who suffer from IBD,and almost half of all IBD patients are iron deficient.IBD leads to IDA through multiple mechanisms,including chronic intestinal blood loss,decreased absorption capabilities of the duodenum secondary to inflammation,and an inability of many IBD patients to tolerate the side effects of oral ferrous sulfate.In this study,we reviewed the charts of all patients who received IV iron at Sylvester Comprehensive Cancer Center/University of Miami Hospital Clinic from January 2007 to May 2012.The most common indications for IV iron were for issues related to cancer and its treatment(21.9%),IBD(20.1%),and gastric bypass(15.0%).Of the 262 patients who received IV iron,230 received iron sucrose and 36 received iron dextran.While doses of 100,200,300,and 400 mg of iron sucrose were given,100 and 200 mg were by far the most common dosages used,122 and 120 times,respectively.The number of dosages of iron sucrose given ranged from 1 to 46,with a mean of 5.5 and a median of 4 doses.The average dose of iron dextran given was 870.5 mg,with 1000 mg being the most common dosage used.Most patients(22 of 36) who received iron dextran only received one dose.While patients with traditional indications for IV iron,such as gynecologic issues and kidney disease,still were represented in this study,we expect to see a continued increase in physicians using IV iron for emerging gastrointestinal indications,especially considering the increased safety of new low-molecular formulations.

Physical Performance of Migrant Schoolchildren with Marginal and Severe Iron Deficiency in the Suburbs of Beijing

Objectives To investigate relationship between iron deficiency of different degrees and physical performance and habitual activity of migrant schoolchildren at the age of 11-14 years. Methods Ninety one randomly selected schoolchildren were divided into three groups according to their iron status. Iron status including hemoglobin （Hb）, serum ferritin （SF）, serum iron （SI） and sTfR was determined. Physical performance tests included maximum oxygen consumption （VO2max） and maximum work time. Energy expenditure （EE） and daily physical activity were estimated by recording 24-h heart rate （HR）. Dietary intake was assessed with frequency questionnaires, and physical activity level was estimated with frequency and physical activity questionnaires. Results Severe iron deficiency （IDA） impaired the aerobic capacity and habitual physical activity. When fat-free mass （FFM） was considered, VO2max （VO2max/FFM） was significantly lower in the iron-marginal group than in the iron-adequate groups among girls （P=0.02）, but such a deference was not found among boys （P=0.28）. Aerobic activity and EE at leisure were significantly lower in the severe iron deficient group than in the marginal iron deficient and iron adequate groups. Net HR at leisure time was correlated with lib, log SF, body weight, and FFM （P〈0.05）. Conclusion The functional effect of iron deficiency on physical performance and habitual physical activity rely on the degree of current iron deficiency. Severe iron deficiency significantly impairs both aerobic capacity and habitual physical activity. Iron-marginal deficiency impairs VO2max/FFM in girls, rather than in boys.

Effects of Nutrient Fortified Complementary Food Supplements on Anemia of Infants and Young Children in Poor Rural of Gansu

Objective To assess the effectiveness of complementary food supplements with protein and multi-micronutrients on hemoglobin and anemia in infants and young children. Methods In 5 poor counties of Gansu, 984 children aged 6-12 months were enrolled and divided into two groups. In addition to the usual home-made complementary food, all the children were fed one sachet of either Formula Ⅰ or Formula Ⅱ supplements each day. Protein and micronutrients were provided in Formula Ⅰ, while the same energy intake was secured in Formula Ⅱ as in Formula Ⅰ. A massive dose of vitamin A was supplemented to all the children every 6 months. Hemoglobin test was done at the same time. Results Prevalence of anemia was about 35% in both Formula Ⅰ and Formula Ⅱ group at baseline, and there were no differences in hemoglobin concentration between the two groups, During the 6-month and 12-month supplementation, hemoglobin of children in Formula Ⅰ group was higher than that in Formula Ⅱ group （P〈0.05）, and hemoglobin increase in Formula Ⅰ group was significantly higher than that in Formula Ⅱ group （P〈0.001）. After 6- and 12-mouth supplementation, the prevalence of anemia in Formula Ⅰ group dropped to 19.1% and 8.2% respectively, and it was 28.0% and 12.4% in Formula 2 group. The prevalence of anemia in Formula Ⅰ group was significantly lower than that in Formula Ⅱ group （P〈0.05）. After adjusting age and hemoglobin level at baseline, the hemoglobin increase at age of 24 months in formula 1 group was higher （10.7 g/L vs 7.9 g/L, P〈0.0001）. Conclusion Micronutrient fortified complementary food supplements, with large-dose vitamin A, is effective for children aged 6-12 months in terms of iron deficiency prevention.

Ferric carboxymaltose for anemia in Crohn’s disease patients at a tertiary center:A retrospective observational cohort study

BACKGROUND Although the gastrointestinal tract is the most affected by Crohn’s disease(CD),the condition triggers other consequent manifestations,and iron deficiency anemia(IDA)is one of the most common.Intravenous(IV)iron replacement is currently available through several drugs,such as ferric hydroxide sucrose and ferric carboxymaltose(FCM).However,the clinical management of these conditions can be challenging.AIM To elucidate the drug’s effectiveness,the present study analyzed,through medical records,the clinical and epidemiological data of a cohort of patients with active CD who received IV FCM for the IDA treatment.METHODS This retrospective observational study included 25 patients with active CD,severe anemia,and refractory to previous conventional treatments.Patients were evaluated two times:During the last treatment with ferric hydroxide sucrose and treatment with FCM.RESULTS After treatment with FCM,parameters of IDA assessment significantly improved,serum hemoglobin(Hb)levels increased in 93%of patients(P<0.0001),and in 44%,there was an increase of≥2 g/dL in a single application.In addition,86%of the patients showed an increase in serum iron(P<0.0001)and ferritin(P=0.0008)and 50%in transferrin saturation(P=0.01).The serum iron levels at baseline showed a negative association with the ileal and colonic CD and use of biologics and a positive association with patients who developed CD later in life after the age of 40(A3)and with a stenosing(B2)and fistulizing(B3)phenotype.The values of Hb and hematocrit after ferric hydroxide sucrose treatment remained similar to those found before treatment.CONCLUSION This study demonstrated that FCM is an important therapeutic strategy for treating IDA in CD patients,achieving satisfactory results in refractory cases.

Helicobacter pylori infection and extragastric disorders in children: A critical update

Helicobacter pylori(H. pylori) is a highly prevalent, serious and chronic infection that has been associated causally with a diverse spectrum of extragastric disorders including iron deficiency anemia, chronic idiopathic thrombocytopenic purpura, growth retardation, and diabetes mellitus. The inverse relation of H. pylori prevalence and the increase in allergies, as reported from epidemiological studies, has stimulated research for elucidating potential underlying pathophysiological mechanisms. Although H. pylori is most frequently acquired during childhood in both developed and developing countries, clinicians are less familiar with the pediatric literature in the field. A better understanding of the H. pylori disease spectrum in childhood should lead to clearer recommendations about testing for and treating H. pylori infection in children who are more likely to develop clinical sequelae. A further clinical challenge is whether the progressive decrease of H. pylori in thelast decades, abetted by modern clinical practices, may have other health consequences.

Anemia and digestive diseases: An update for the clinician

Anemia and iron deficiency are so common in digestive diseases that often are underestimated and undertreated. Our goal is to review from classif ication to treatment of the diverse types of anemias in different digestive diseases to update our knowledge on diagnosis and treatment. With the goal of improving the prognosis and quality of life of digestive diseases patients, we will review current transfusion, intravenous iron, and erythropoietin roles in the treatment of anemia.

地中海贫血与缺铁性贫血患儿血常规红细胞参数检验价值分析

目的探讨地中海贫血与缺铁性贫血患儿血常规红细胞参数检验价值。方法在2022年1月—2023年3月本院治疗的患者中分别选取地中海贫血患儿作为A组(42例)和缺铁性贫血患儿作为B组(42例),并将42例健康体检儿童作为C组,对比三组血常规红细胞参数、铁元素相关指标。结果以C组红细胞参数为基准,A组Hb、RBC、MCHC均高于B组,MCH、RDW、MCV低于B组,数据对比差异有统计学意义(P<0.05);铁元素指标中,A组Fe、SF高于B组,数据对比差异有统计学意义(P<0.05)。结论血常规红细胞参数在区分地中海贫血与缺铁性贫血方面具有较高的准确性,可为临床诊断与治疗提供重要参考依据。

学前期儿童缺铁性贫血影响因素分析——条件Logistic回归模型的应用

本文利用条件Logistic回归模型的配合方法,探讨了学前期儿童缺铁性贫血的主要影响因素。通过81个1∶4病例一对照配对组,应用Newton-Raphson选代法,5个有显著性意义的影响因素参数值进入回归模型。结果表明,学前期儿童缺铁性贫血发病的主要影响因素分别为肉食、蔬菜、水果摄入较少,铝锅烹调及食欲铰差。

蛋白琥珀酸铁联合双歧杆菌三联活菌治疗小儿营养性缺铁性贫血的临床效果分析

目的:分析蛋白琥珀酸铁联合双歧杆菌三联活菌治疗小儿营养性缺铁性贫血的临床效果。方法:选取2022年3月—2023年10月泰安市妇幼保健院收治的小儿营养性缺铁性贫血患儿108例作为研究对象,按照随机数字表法分为对照组和试验组,各54例。对照组采用蛋白琥珀酸铁口服液治疗,试验组在对照组基础上联合双歧杆菌三联活菌治疗。比较两组治疗效果、贫血及免疫功能指标。结果:试验组治疗总有效率高于对照组,差异有统计学意义(P=0.004)。治疗前,两组血红蛋白(Hb)、红细胞(RBC)水平比较,差异无统计学意义(P>0.05);治疗后,两组Hb、RBC水平均高于治疗前,且试验组高于对照组,差异有统计学意义(P<0.05)。治疗前,两组CD3+、CD4+、CD4+/CD8+比较,差异无统计学意义(P>0.05);治疗后,两组CD3+、CD4+、CD4+/CD8+均高于治疗前,且试验组高于对照组,差异有统计学意义(P<0.05)。结论:蛋白琥珀酸铁口服液与双歧杆菌三联活菌联用治疗小儿营养性缺铁性贫血的临床效果较好,能够增强疗效,有效改善患儿贫血并增强免疫力。

儿童缺铁性贫血的影响因素分析

目的分析儿童缺铁性贫血的影响因素。方法采取整群分层抽样法选取济南市2021年接受健康体检的7899名7岁以下儿童为研究对象,收集血红蛋白检测数据,对儿童家长进行问卷调查,分析儿童缺铁性贫血的影响因素。结果共检出缺铁性贫血儿童417名,占比5.28%。多因素logistic回归分析显示,母亲学历高、家庭月收入高、及时添加含铁食物及家长知晓贫血相关知识是儿童缺铁性贫血的保护因素(P<0.05);早产、近2周有呼吸道感染史或腹泻史、辅食添加不及时是儿童缺铁性贫血的危险因素(P<0.05)。结论儿童缺铁性贫血受到多方面因素的影响,需从健康宣教、营养干预、预防常见病及铁缺乏等方面采取针对性措施,以进一步降低儿童缺铁性贫血的发病率。

蛋白琥珀酸铁口服液治疗小儿缺铁性贫血的临床效果

目的分析对小儿缺铁性贫血采取蛋白琥珀酸铁口服液治疗的效果情况。方法选择2021年1月至2022年1月泉州市妇幼保健院儿童医院临床营养科的70例缺铁性贫血患儿作为研究对象,采用随机数字表法将所有患儿分成研究组(35例)和常规组(35例)。研究组采用蛋白琥珀酸铁口服液治疗,常规组采用马酸亚铁治疗。比较两组患儿不良反应、血红蛋白、红细胞总数及红细胞比容、血清铁总量(SF)、总铁结合力(TIBC)。结果研究组患儿不良反应发生率低于常规组,差异有统计学意义(P<0.05);研究组SF水平高于常规组,研究组患者TIBC水平低于常规组,差异有统计学意义(P<0.05);研究组血红蛋白、红细胞总数及红细胞比容高于常规组,差异有统计学意义(P<0.05)。结论对缺铁性贫血患儿施以蛋白琥珀酸铁口服液予以治疗,能够有效地改善患儿贫血的临床症状,不良反应发生率更少,临床效果显著。

儿童缺铁性贫血防治的研究进展

全世界有16亿人以上存在贫血,学龄前儿童的贫血患病率高达47%。缺铁性贫血(IDA)患病率高、分布广,严重影响儿童的生长发育和防病抗病能力,是我国重点防治的儿童常见病。控制IDA是达到贫血控制目标的关键。儿童IDA最主要的原因是膳食结构不科学、饮食安排不合理,导致铁摄入量不足;预防的重点是合理安排小儿饮食;用铁剂治疗IDA有特效。IDA的防治是近年婴幼儿保健关注的焦点。本文对儿童IDA防治的研究进展进行综述。

学龄前儿童缺铁性贫血影响因素的meta分析

目的系统评价我国3~6岁学龄前儿童缺铁性贫血(IDA)的影响因素,为防治和治疗提供科学依据。方法检索中国知网、万方、维普、PubMed、Web of Science、Cochrane等数据库,收集关于学龄前儿童IDA影响因素的相关中英文文献,检索时限为建库至2023年2月。采用Stata16.0软件进行meta分析。结果最终纳入10篇文献,涉及学龄前儿童37915例。meta分析结果显示,我国学龄前儿童IDA发生率为2.89%~13.85%,总体呈下降趋势,但地域差异仍然明显。年龄(OR=1.79,95%CI:1.39~2.31)、民族(OR=2.25,95%CI:1.61~3.14)、孕周(OR=1.39,95%CI:1.17~1.66)、家庭收入(OR=1.36,95%CI:1.17~1.59)、饮食习惯(OR=1.98,95%CI:1.63~2.40)、妊娠期贫血(OR=2.88,95%CI:1.27~6.55)、肠胃消化功能(OR=1.59,95%CI:1.21~2.10)、既往病史(OR=2.32,95%CI:2.06~2.62)、未补充铁元素(OR=1.93,95%CI:1.35~3.52)、肉蛋奶类食物摄入量(OR=1.60,95%CI:1.36~1.87)是我国学龄前儿童IDA的主要影响因素。结论年龄小、少数民族、孕周不足、家庭收入过低、不良饮食习惯、妊娠期贫血、肠胃消化功能不良、既往病史、未及时补充铁元素、蛋奶类食物摄入量过低会对我国学龄前儿童IDA发生率产生影响。

小儿生血糖浆联合右旋糖酐铁分散片治疗小儿营养性缺铁性贫血的效果观察

目的探讨分析小儿生血糖浆联合右旋糖酐铁分散片治疗小儿营养性缺铁性贫血的效果。方法择取2020年3月至2023年6月医院收治的100例营养性缺铁性贫血患儿,随机分为两组,各50例。对照组采用右旋糖酐铁分散片治疗,观察组采用小儿生血糖浆联合右旋糖酐铁分散片治疗。比较两组治疗效果、症状积分及血液指标。结果与对照组比较,观察组治疗总有效率明显更高,P<0.05。经治疗,观察组面色苍白、食欲不振、神疲乏力、腹泻便溏、唇舌色积分均较对照组低,P<0.05;观察组Hb、SI、RBC、SF水平均高于对照组,P<0.05。结论小儿生血糖浆联合右旋糖酐铁分散片治疗小儿营养性缺铁性贫血效果满意,患儿症状改善明显。