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.

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.

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.

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.

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.

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.

A study of anemia in women with asymptomatic malaria parasitaemia at their first antenatal care visit at the General Hospital,Ikot Ekpene,Akwa Ibom State,Nigeria

Objective:To assess the prevalence of anemia and asymptomatia malaria parasitemia and the effect of prior antimalarials therapy on the parasite density in pregnant women at their first antenatal visit at the secondary level health care facility in Nigeria.Methods:This cross sectional observational study was carried out in the antenatal clinic of General Hospital,Ikot Ekpene,Akwa Ibom State,Nigeria for 3 months period(1st June to 31st August,2009).Five hundred and fourteen women attending their first antenatal registration visits in the hospital were recruited in the study.Socio-demographic information was obtained using pre-tested questionnaires.The malaria parasite was obtained by examining thick and thin blood films prepared on 2 glass slides while the hematocrit was obtained through 2 capillary tubes read by a Hawksleys microhematocrit reader.Results:A total of 514 pregnant women participated in the study with a mean maternal age of 21.4 years and a mean gestational age at booking of 18.3 weeks.The primigravid women booked at significantly lower gestational age than multigravidae （16.2 weeks vs 21.6 weeks）.Most of the women（59.3%） were anemic,out of which 60.4%were primigravida.More than half of the women had moderate to high parasite density and only 6.8% had no malaria parasitemia.All patients with severe anemia were parasitemic.Out of the 479 （93.2%） women with parasitemia,a third had taken antimalarial drugs.A majority（60.3%） of those without prior antimalarial drugs had moderate to high density parasitemia.Conclusions: This study shows high prevalence of anemia in women with asymptomatic malarial parasitemia, particularly the primigravida.The severity of anemia is directly related to the density of malaria parasitemia.Those with effective antimalarial therapy appear to have low density parasitemia and therefore mild anemia.Routine screening for anemia and malaria parasites at booking,prompt parasite clearance and correction of anemia would reduce the associated maternal and perinatal complications.

Liposomal Iron for Iron Deficiency Anemia in Women of Reproductive Age: Review of Current Evidence

Iron deficiency anemia is the most frequent nutritional deficiency disorder. Conventionally administered oral iron is associated with gastrointestinal intolerance that affects the outcomes and compliance. Liposomal iron is associated with increased absorption without causing significant adverse effects. In this review, we have discussed the technology of liposomal iron preparation, mechanisms of its absorption and clinical evidence on its utility in iron deficiency states in pregnant and non-pregnant women. Based on the available evidence, we compared liposomal iron to conventional oral iron. Encapsulation of micronized iron in liposomes is associated with lesser exposure to gastric contents, lesser interaction with food contents, no exposure to different digestive juices, targeted delivery of iron and allows lower doses to be administered in lieu of direct absorption without need for protein carriers. The available evidence suggests that liposomal iron significantly increases hemoglobin, ferritin levels in pregnant women as well as in women with iron deficiency.

Prevalence of Iron Deficiency Anemia among Moroccan Pregnant Women

Background: Iron deficiency anemia in pregnant women is a serious public health problem, especially in developing countries. Aim: The objective of this study is to determine the prevalence of iron deficiency anemia and its associated factors during pregnancy in the south of Morocco. Methods: A cross-sectional study was carried in the regional Hospital Center Hassan II (RHC) from April to august 2021 in all the pregnant women coming for consultation in the maternity service. 500 pregnant women were randomly recruited for the study. A complete blood count and serum ferritin was performed in every case. They have been the subjects of a questionnaire containing their background and health data. The analysis of our data was done by the IBM SPSS Statistics 25 software. Results: The prevalence of iron deficiency anemia was 20% with a CI of (44.7% - 53.5%). The most affected age group was 25 to 35 years with a rate of 42.86%. The majority of women had mild anemia (84.61%) followed by moderate anemia (11.54%) and severe anemia (3.85%). 57.14% of the anemic pregnant women were primigravida. The results of serum ferritin made it possible to identify 70% of women deficient, with a dominance of normocytic normochromic anemia. The influence of geographic origin and place of birth was not significant. Conclusion: The prevalence of iron deficiency anemia is more or less low in our study. However, there is a high prevalence of iron deficiency and anemia during pregnancy. Statistically, there was no significant association between iron deficiency anemia and the various parameters studied, such as age, parity, origin and place of birth.

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.

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.