The gastrointestinal (GI) tract is a common site of bleeding that may lead to iron deficiency anemia (IDA). Treatment of IDA depends on severity and acuity of patients’ signs and symptoms. While red blood cell transf...The gastrointestinal (GI) tract is a common site of bleeding that may lead to iron deficiency anemia (IDA). Treatment of IDA depends on severity and acuity of patients’ signs and symptoms. While red blood cell transfusions may be required in hemodynamically unstable patients, transfusions should be avoided in chronically anemic patients due to their potential side effects and cost. Iron studies need to be performed after episodes of GI bleeding and stores need to be replenished before anemia develops. Oral iron preparations are efficacious but poorly tolerated due to non-absorbed iron-mediated GI side effects. However, oral iron dose may be reduced with no effect on its efficacy while decreasing side effects and patient discontinuation rates. Parenteral iron therapy replenishes iron stores quicker and is better tolerated than oral therapy. Serious hypersensitive reactions are very rare with new intravenous preparations. While data on worsening of inflammatory bowel disease (IBD) activity by oral iron therapy are not conclusive, parenteral iron therapy still seems to be advantageous in the treatment of IDA in patients with IBD, because oral iron may not be sufficient to overcome the chronic blood loss and GI side effects of oral iron which may mimic IBD exacerbation. Finally, we believe the choice of oral vs parenteral iron therapy in patients with IBD should primarily depend on acuity and severity of patients’ signs and symptoms.展开更多
The prevalence of anemia across studies on patients with inflammatory bowel disease (IBD) is high (30%). Both iron defi ciency (ID) and anemia of chronic disease contribute most to the development of anemia in IBD. Th...The prevalence of anemia across studies on patients with inflammatory bowel disease (IBD) is high (30%). Both iron defi ciency (ID) and anemia of chronic disease contribute most to the development of anemia in IBD. The prevalence of ID is even higher (45%). Anemia and ID negatively impact the patient's quality of life. Therefore, together with an adequate control of disease activity, iron replacement therapy should start as soon as anemia or ID is detected to attain a normal hemoglobin (Hb) and iron status. Many patients will respond to oral iron, but compliance may be poor, whereas intravenous (IV) compounds are safe, provide a faster Hb increase and iron store repletion, and presents a lower rate of treatment discontinuation. Absolute indications for IV iron treatment should include severe anemia, intolerance or inappropriate response to oral iron, severe intestinal disease activity, or use of an erythropoietic stimulating agent. Four different products are principally used in clinical practice, which differ in their pharmacokinetic properties and safety profi les: iron gluconate and iron sucrose (lower single doses), and iron dextran and ferric carboxymaltose (higher single doses). After the initial resolution of anemia and the repletion of iron stores, the patient's hematological and iron parameters should be carefully and periodically monitored, and maintenance iron treatment should be provided as required. New IV preparations that allow for giving 1000-1500 mg in a single session, thus facilitating patient management,provide an excellent tool to prevent or treat anemia and ID in this patient population, which in turn avoids allogeneic blood transfusion and improves their quality of life.展开更多
目的探讨淫羊藿苷(icariin,ICA)对人口腔鳞癌细胞系CAL27细胞铁死亡的影响及其可能的作用机制。方法用不同浓度ICA处理人口腔鳞癌细胞系CAL27,用CCK-8法检测细胞增殖情况以选取最佳浓度;用不同浓度铁死亡抑制剂处理CAL27细胞,用CCK-8法...目的探讨淫羊藿苷(icariin,ICA)对人口腔鳞癌细胞系CAL27细胞铁死亡的影响及其可能的作用机制。方法用不同浓度ICA处理人口腔鳞癌细胞系CAL27,用CCK-8法检测细胞增殖情况以选取最佳浓度;用不同浓度铁死亡抑制剂处理CAL27细胞,用CCK-8法检测铁死亡抑制剂对细胞的毒性作用以选取最佳浓度;将CAL27细胞随机分为对照组、ICA组和ICA联合铁死亡抑制剂组。用Transwell小室实验检测细胞迁移和侵袭能力;检测各组细胞超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)和谷胱甘肽(glutathione,GSH)水平;用实时荧光定量聚合酶链式反应(quantitative real time polymerase chain reaction,RT-PCR)检测细胞铁死亡影响因子重链亚基溶质载体家族7成员11(solute vector family 7 member 11,SLC7A11)、谷胱甘肽过氧化物酶4(glutathione peroxidase 4,GPX4)和铁蛋白重链(ferritin heavy chain,FTH1)mRNA的表达情况;用蛋白印迹法(Western blotting)检测c-Jun氨基末端激酶(c-Jun amino terminal kinase,JNK)和p53蛋白(protein 53,p53)的表达情况。结果CAL27细胞增殖能力随着ICA和铁死亡抑制剂浓度的升高而降低(P<0.05);与对照组比较,ICA组CAL27细胞侵袭数量、细胞迁移数量、SOD、GSH、SLC7A11和GPX4 mRNA的表达水平降低,MDA和FTH1 mRNA、JNK和p53蛋白的表达水平升高(P<0.05);与ICA组比较,ICA联合铁死亡抑制剂组CAL27细胞侵袭数量、细胞迁移数量、SOD、GSH、SLC7A11和GPX4 mRNA的表达水平升高,MDA、FTH1 mRNA表达水平、JNK和p53蛋白的表达水平降低(P<0.05)。结论ICA对口腔鳞癌细胞CAL27增殖、侵袭和迁移能力有一定的抑制作用,可能是通过激活JNK/p53通路提高细胞内铁死亡相关因子水平,降低细胞抗氧化能力发挥作用的。展开更多
Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to...Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to chronic blood loss, and impaired iron absorption due to tissue inflammation. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with IBD must be regularly monitored for earlier detection of anemia. IDA in IBD is associated with poor quality of life, necessitating prompt diagnosis and appropriate treatment. IDA is often associated with inflammation in patients with IBD. Thus, commonly used labora-tory parameters are inadequate to diagnose IDA, and newer iron indices, such as reticulocyte hemoglobin content or percentage of hypochromic red cells or zinc protoporphyrin, are required to differentiate IDA from anemia of chronic disease. Oral iron preparations are available and are used in patients with mild disease activity. These preparations are inexpensive and con-venient, but can produce gastrointestinal side effects, such as abdominal pain and diarrhea, that limit their use and patient compliance. These preparations are partly absorbed due to inflammation. Non-absorbed iron can be toxic and worsen IBD disease activity. Although cost-effective intravenous iron formulations are widely available and have improved safety profiles, physicians are reluctant to use them. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.展开更多
文摘The gastrointestinal (GI) tract is a common site of bleeding that may lead to iron deficiency anemia (IDA). Treatment of IDA depends on severity and acuity of patients’ signs and symptoms. While red blood cell transfusions may be required in hemodynamically unstable patients, transfusions should be avoided in chronically anemic patients due to their potential side effects and cost. Iron studies need to be performed after episodes of GI bleeding and stores need to be replenished before anemia develops. Oral iron preparations are efficacious but poorly tolerated due to non-absorbed iron-mediated GI side effects. However, oral iron dose may be reduced with no effect on its efficacy while decreasing side effects and patient discontinuation rates. Parenteral iron therapy replenishes iron stores quicker and is better tolerated than oral therapy. Serious hypersensitive reactions are very rare with new intravenous preparations. While data on worsening of inflammatory bowel disease (IBD) activity by oral iron therapy are not conclusive, parenteral iron therapy still seems to be advantageous in the treatment of IDA in patients with IBD, because oral iron may not be sufficient to overcome the chronic blood loss and GI side effects of oral iron which may mimic IBD exacerbation. Finally, we believe the choice of oral vs parenteral iron therapy in patients with IBD should primarily depend on acuity and severity of patients’ signs and symptoms.
文摘The prevalence of anemia across studies on patients with inflammatory bowel disease (IBD) is high (30%). Both iron defi ciency (ID) and anemia of chronic disease contribute most to the development of anemia in IBD. The prevalence of ID is even higher (45%). Anemia and ID negatively impact the patient's quality of life. Therefore, together with an adequate control of disease activity, iron replacement therapy should start as soon as anemia or ID is detected to attain a normal hemoglobin (Hb) and iron status. Many patients will respond to oral iron, but compliance may be poor, whereas intravenous (IV) compounds are safe, provide a faster Hb increase and iron store repletion, and presents a lower rate of treatment discontinuation. Absolute indications for IV iron treatment should include severe anemia, intolerance or inappropriate response to oral iron, severe intestinal disease activity, or use of an erythropoietic stimulating agent. Four different products are principally used in clinical practice, which differ in their pharmacokinetic properties and safety profi les: iron gluconate and iron sucrose (lower single doses), and iron dextran and ferric carboxymaltose (higher single doses). After the initial resolution of anemia and the repletion of iron stores, the patient's hematological and iron parameters should be carefully and periodically monitored, and maintenance iron treatment should be provided as required. New IV preparations that allow for giving 1000-1500 mg in a single session, thus facilitating patient management,provide an excellent tool to prevent or treat anemia and ID in this patient population, which in turn avoids allogeneic blood transfusion and improves their quality of life.
文摘目的探讨淫羊藿苷(icariin,ICA)对人口腔鳞癌细胞系CAL27细胞铁死亡的影响及其可能的作用机制。方法用不同浓度ICA处理人口腔鳞癌细胞系CAL27,用CCK-8法检测细胞增殖情况以选取最佳浓度;用不同浓度铁死亡抑制剂处理CAL27细胞,用CCK-8法检测铁死亡抑制剂对细胞的毒性作用以选取最佳浓度;将CAL27细胞随机分为对照组、ICA组和ICA联合铁死亡抑制剂组。用Transwell小室实验检测细胞迁移和侵袭能力;检测各组细胞超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)和谷胱甘肽(glutathione,GSH)水平;用实时荧光定量聚合酶链式反应(quantitative real time polymerase chain reaction,RT-PCR)检测细胞铁死亡影响因子重链亚基溶质载体家族7成员11(solute vector family 7 member 11,SLC7A11)、谷胱甘肽过氧化物酶4(glutathione peroxidase 4,GPX4)和铁蛋白重链(ferritin heavy chain,FTH1)mRNA的表达情况;用蛋白印迹法(Western blotting)检测c-Jun氨基末端激酶(c-Jun amino terminal kinase,JNK)和p53蛋白(protein 53,p53)的表达情况。结果CAL27细胞增殖能力随着ICA和铁死亡抑制剂浓度的升高而降低(P<0.05);与对照组比较,ICA组CAL27细胞侵袭数量、细胞迁移数量、SOD、GSH、SLC7A11和GPX4 mRNA的表达水平降低,MDA和FTH1 mRNA、JNK和p53蛋白的表达水平升高(P<0.05);与ICA组比较,ICA联合铁死亡抑制剂组CAL27细胞侵袭数量、细胞迁移数量、SOD、GSH、SLC7A11和GPX4 mRNA的表达水平升高,MDA、FTH1 mRNA表达水平、JNK和p53蛋白的表达水平降低(P<0.05)。结论ICA对口腔鳞癌细胞CAL27增殖、侵袭和迁移能力有一定的抑制作用,可能是通过激活JNK/p53通路提高细胞内铁死亡相关因子水平,降低细胞抗氧化能力发挥作用的。
文摘Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to chronic blood loss, and impaired iron absorption due to tissue inflammation. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with IBD must be regularly monitored for earlier detection of anemia. IDA in IBD is associated with poor quality of life, necessitating prompt diagnosis and appropriate treatment. IDA is often associated with inflammation in patients with IBD. Thus, commonly used labora-tory parameters are inadequate to diagnose IDA, and newer iron indices, such as reticulocyte hemoglobin content or percentage of hypochromic red cells or zinc protoporphyrin, are required to differentiate IDA from anemia of chronic disease. Oral iron preparations are available and are used in patients with mild disease activity. These preparations are inexpensive and con-venient, but can produce gastrointestinal side effects, such as abdominal pain and diarrhea, that limit their use and patient compliance. These preparations are partly absorbed due to inflammation. Non-absorbed iron can be toxic and worsen IBD disease activity. Although cost-effective intravenous iron formulations are widely available and have improved safety profiles, physicians are reluctant to use them. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.
