Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01178.X
R. Cançado, M. Muñoz
SUMMARY Lack of iron is one of the main causes of anemia in the general population and iron deficiency anemia (IDA) is associated with increased morbidity and mortality. Treatment of iron deficiency with oral iron supplements is a simple and inexpensive, but oral iron is a less-than-ideal treatment because of gastrointestinal side-effects and long treatment times needed to resolve anemia and replenish body iron stores. Nonadherence is common, and even in compliant patients poor intestinal absorption fails to compensate for the iron need in the presence of ongoing blood losses or inflammatory conditions. Modern intravenous (IV) iron formulations have emerged as safe and effective alternatives to oral iron for the treatment of IDA. Given their demonstrated effectiveness and favorable safety profile in a broad spectrum of diseases associated with IDA, the current paradigm that oral iron is first-line therapy should be reconsidered. In the past few years, three new IV iron compounds (ferric carboxymaltose, ferumoxytol and iron isomaltoside 1000) have been released for clinical use in patients with IDA. These new preparations with more favorable administration regimens have the potential to improve the convenience and cost-effectiveness of IV iron therapy.
{"title":"Iron replacement options: oral and intravenous formulations: IRON REPLACEMENT OPTIONS","authors":"R. Cançado, M. Muñoz","doi":"10.1111/J.1778-428X.2012.01178.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01178.X","url":null,"abstract":"SUMMARY \u0000Lack of iron is one of the main causes of anemia in the general population and iron deficiency anemia (IDA) is associated with increased morbidity and mortality. Treatment of iron deficiency with oral iron supplements is a simple and inexpensive, but oral iron is a less-than-ideal treatment because of gastrointestinal side-effects and long treatment times needed to resolve anemia and replenish body iron stores. Nonadherence is common, and even in compliant patients poor intestinal absorption fails to compensate for the iron need in the presence of ongoing blood losses or inflammatory conditions. Modern intravenous (IV) iron formulations have emerged as safe and effective alternatives to oral iron for the treatment of IDA. Given their demonstrated effectiveness and favorable safety profile in a broad spectrum of diseases associated with IDA, the current paradigm that oral iron is first-line therapy should be reconsidered. In the past few years, three new IV iron compounds (ferric carboxymaltose, ferumoxytol and iron isomaltoside 1000) have been released for clinical use in patients with IDA. These new preparations with more favorable administration regimens have the potential to improve the convenience and cost-effectiveness of IV iron therapy.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01178.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63390050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01162.X
M. Muñoz, R. Slappendel
SUMMARY Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are associated with a considerable amount of total blood loss. This results in a significant postoperative decline in hemoglobin levels, and thereby the use of allogeneic blood transfusion (ABT), which is not a risk-free therapy. Postoperative shed blood (PSB) salvage and retransfusion, after washing or filtering, was introduced as a unique blood saving concept to decrease perioperative blood loss, to maintain higher postoperative hemoglobin levels and to decrease the use of ABT. PSB reinfusion must be restricted to elective procedures with an anticipated postoperative blood loss between 750 mL and 1500 mL, allowing for the recovery of at least the equivalent of one unit of packed red cells, and used in conjunction with a defined ABT protocol. The results of a number of clinical and laboratory studies strongly suggest that reinfusion of unwashed PSB can reduce the requirements for ABT, and that most of the potential adverse effects of unwashed PSB are no more than theoretical. Therefore, reinfusion of unwashed PSB after THA and TKA is easy-to-use, safe, economic and clinically beneficial, as it may reduce ABT-associated risks. The superiority of washed PSB over unwashed PSB in these procedures has not been demonstrated. All these make widespread use of unwashed PSB available for all patients and justified.
{"title":"Unwashed blood: is widespread use justified? A review of current knowledge: SAFE USE OF UNWASHED BLOOD","authors":"M. Muñoz, R. Slappendel","doi":"10.1111/J.1778-428X.2012.01162.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01162.X","url":null,"abstract":"SUMMARY \u0000 \u0000Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are associated with a considerable amount of total blood loss. This results in a significant postoperative decline in hemoglobin levels, and thereby the use of allogeneic blood transfusion (ABT), which is not a risk-free therapy. Postoperative shed blood (PSB) salvage and retransfusion, after washing or filtering, was introduced as a unique blood saving concept to decrease perioperative blood loss, to maintain higher postoperative hemoglobin levels and to decrease the use of ABT. PSB reinfusion must be restricted to elective procedures with an anticipated postoperative blood loss between 750 mL and 1500 mL, allowing for the recovery of at least the equivalent of one unit of packed red cells, and used in conjunction with a defined ABT protocol. The results of a number of clinical and laboratory studies strongly suggest that reinfusion of unwashed PSB can reduce the requirements for ABT, and that most of the potential adverse effects of unwashed PSB are no more than theoretical. Therefore, reinfusion of unwashed PSB after THA and TKA is easy-to-use, safe, economic and clinically beneficial, as it may reduce ABT-associated risks. The superiority of washed PSB over unwashed PSB in these procedures has not been demonstrated. All these make widespread use of unwashed PSB available for all patients and justified.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01162.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63397350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01174.X
J. García-Erce, G. Cantanhede, J. Cuenca, A. Herrera
SUMMARY In the surgical setting, anemia is a common feature and an independent risk factor for blood transfusion, inpatient complications, delayed hospital discharge and poorer functional recovery. Despite adverse side effects and the increasing costs to health systems, allogeneic blood transfusion is the standard of care for anemia. Within this context, NATA (Network for the Advancement of Transfusion Alternatives) guidelines advocate steps towards prevention, diagnosis of anemia and stimulation of erythropoiesis in surgical patients. These include iron – p.o. and i.v. formulations – and recombinant human erythropoietin (rHuEPO) as viable alternatives pre-, peri- and/or postoperatively. The combination of these methods with restrictive transfusion triggers, tranexamic acid and blood salvage techniques may reduce perioperative transfusion rates. The main objective of this article is to briefly review the use of iron in surgical patients, with special focus on orthopedic surgery. From the analyzed information, it can be concluded that, despite the lack of large randomized controlled trials, results indicate that because of the low incidence of serious side effects and the rapid increase of hemoglobin levels, i.v. iron emerges as a safe and effective drug for treating and preventing perioperative anemia. In addition, i.v. iron administration reduces rHuEPO dose requirements. The use of new i.v. iron formulations will allow the administration of large doses in a single session, thus facilitating a more widespread use of this therapeutic option.
{"title":"Perioperative iron administration as an alternative to blood transfusion in major surgery: PERIOPERATIVE I.V. IRON ADMINISTRATION IN MAJOR SURGERY","authors":"J. García-Erce, G. Cantanhede, J. Cuenca, A. Herrera","doi":"10.1111/J.1778-428X.2012.01174.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01174.X","url":null,"abstract":"SUMMARY \u0000 \u0000In the surgical setting, anemia is a common feature and an independent risk factor for blood transfusion, inpatient complications, delayed hospital discharge and poorer functional recovery. Despite adverse side effects and the increasing costs to health systems, allogeneic blood transfusion is the standard of care for anemia. Within this context, NATA (Network for the Advancement of Transfusion Alternatives) guidelines advocate steps towards prevention, diagnosis of anemia and stimulation of erythropoiesis in surgical patients. These include iron – p.o. and i.v. formulations – and recombinant human erythropoietin (rHuEPO) as viable alternatives pre-, peri- and/or postoperatively. The combination of these methods with restrictive transfusion triggers, tranexamic acid and blood salvage techniques may reduce perioperative transfusion rates. The main objective of this article is to briefly review the use of iron in surgical patients, with special focus on orthopedic surgery. From the analyzed information, it can be concluded that, despite the lack of large randomized controlled trials, results indicate that because of the low incidence of serious side effects and the rapid increase of hemoglobin levels, i.v. iron emerges as a safe and effective drug for treating and preventing perioperative anemia. In addition, i.v. iron administration reduces rHuEPO dose requirements. The use of new i.v. iron formulations will allow the administration of large doses in a single session, thus facilitating a more widespread use of this therapeutic option.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01174.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01157.X
Sanjana Dontula, Ankit Mathur, T. Kamaladoss, Siddappa Adimurthy, L. Jagannathan
SUMMARY Informing blood donors about their reactive test results of viral transfusion transmissible infections (TTI) is an important aspect of donor care. Rotary Bangalore TTK Blood Bank offers counseling and referrals to donors to enable them to avail of timely treatment options. Recognizing that donor disclosure is an important public health issue that especially impacts blood safety, we started a program for donor disclosure, counseling and referrals. The number of enzyme-linked immunosorbent assay reactive units in our blood bank in 2007 and 2008 were 0.78% [hepatitis B virus (HBV)], 0.12% [human immunodeficiency virus (HIV)], 0.18% [hepatitis C virus (HCV)], and 0.73% (HBV), 0.16% (HIV) and 0.18% (HCV), respectively. The reactive donors were informed of their test results and called for counseling. Overall, 41.18% and 48.17% of HBV reactive donors attended counseling in 2007 and 2008, respectively. Only 11.11% and 16.22% of HIV reactive donors attending counseling in 2007 and 2008, respectively. The HCV reactive donors who attended counseling were 14.63% for both years. All reactive donors who attended counseling were referred to gastroenterologist or physician for confirmatory testing and further management. This study describes our experiences in counseling donors who were enzyme-linked immunosorbent assay reactive for viral TTI, and challenges faced in implementing the donor disclosure program in a resource-limited environment.
{"title":"Donor disclosure – a donor's right and blood bank's responsibility","authors":"Sanjana Dontula, Ankit Mathur, T. Kamaladoss, Siddappa Adimurthy, L. Jagannathan","doi":"10.1111/J.1778-428X.2012.01157.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01157.X","url":null,"abstract":"SUMMARY \u0000 \u0000Informing blood donors about their reactive test results of viral transfusion transmissible infections (TTI) is an important aspect of donor care. Rotary Bangalore TTK Blood Bank offers counseling and referrals to donors to enable them to avail of timely treatment options. Recognizing that donor disclosure is an important public health issue that especially impacts blood safety, we started a program for donor disclosure, counseling and referrals. The number of enzyme-linked immunosorbent assay reactive units in our blood bank in 2007 and 2008 were 0.78% [hepatitis B virus (HBV)], 0.12% [human immunodeficiency virus (HIV)], 0.18% [hepatitis C virus (HCV)], and 0.73% (HBV), 0.16% (HIV) and 0.18% (HCV), respectively. The reactive donors were informed of their test results and called for counseling. \u0000 \u0000 \u0000 \u0000Overall, 41.18% and 48.17% of HBV reactive donors attended counseling in 2007 and 2008, respectively. Only 11.11% and 16.22% of HIV reactive donors attending counseling in 2007 and 2008, respectively. The HCV reactive donors who attended counseling were 14.63% for both years. All reactive donors who attended counseling were referred to gastroenterologist or physician for confirmatory testing and further management. This study describes our experiences in counseling donors who were enzyme-linked immunosorbent assay reactive for viral TTI, and challenges faced in implementing the donor disclosure program in a resource-limited environment.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01157.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63397233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01159.X
M. Cladellas, J. Bruguera, J. Comín-Colet
SUMMARY Anemia has been associated to poor outcomes in the whole spectrum of patients with heart disease. The etiology of this comorbidity in cardiac patients is multifactorial but acute bleeding or chronic occult blood loss, iron deficiency and inflammation are common causes in these patients. Abnormal handling or availability of iron and inadequate response to endogenous erythropoietin have both raised the interest of researchers and clinicians to explore the therapeutic role of these agents either alone or in combination. In this review, we analyze the most recent research evaluating the role of iron alone or in combination with erythropoietin in the management of anemia of cardiac patients ranging from those patients that undergo cardiac surgery to those more advanced patients with chronic heart failure.
{"title":"Iron therapy alone or in combination with erythropoietin in surgical and medical cardiac patients","authors":"M. Cladellas, J. Bruguera, J. Comín-Colet","doi":"10.1111/J.1778-428X.2012.01159.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01159.X","url":null,"abstract":"SUMMARY \u0000 \u0000Anemia has been associated to poor outcomes in the whole spectrum of patients with heart disease. The etiology of this comorbidity in cardiac patients is multifactorial but acute bleeding or chronic occult blood loss, iron deficiency and inflammation are common causes in these patients. Abnormal handling or availability of iron and inadequate response to endogenous erythropoietin have both raised the interest of researchers and clinicians to explore the therapeutic role of these agents either alone or in combination. In this review, we analyze the most recent research evaluating the role of iron alone or in combination with erythropoietin in the management of anemia of cardiac patients ranging from those patients that undergo cardiac surgery to those more advanced patients with chronic heart failure.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01159.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63397246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01169.X
KP Mulavisala, V. Kulkarni, R. Mudunuri, Voleti Venkata Raja Viswanath, J. R. Byalal, Palepu B Gopal, S. Kulkarni
SUMMARY Volume therapy and maintenance of stable hemodynamics is crucial in children undergoing cardiac surgery on cardiopulmonary bypass (CPB). The clinical use of hydroxyethyl starch (HES) 130/0.4 is limited by the possibility of adverse hemostatic effects which could potentially increase the risk of perioperative bleeding and transfusion requirements. We conducted this study to evaluate the safety and efficacy of HES in comparison with modified succinylated gelatin (MSG). Forty-nine children were randomly assigned to receive either HES (n = 28) or MSG (n = 21) during the pre-bypass period. Coagulation was assessed with thromboelastography (TEG) and the transfusion requirements up to the first postoperative day were documented. Both groups were comparable with respect to age, weight, CPB duration as well as hematological and biochemical laboratory investigations. TEG parameters were not deranged up to the first postoperative period in either group and there was a trend of reduced blood loss and transfusion requirements in HES groups although there was no statistically significant difference. Our study shows that HES 130/0.4 is safe and effective for volume replacement in pediatric cardiac surgery patients.
{"title":"Hydroxyethyl starch 130/0.4 versus modified succinylated gelatin for volume expansion in pediatric cardiac surgery patients: the effects on perioperative bleeding and transfusion needs","authors":"KP Mulavisala, V. Kulkarni, R. Mudunuri, Voleti Venkata Raja Viswanath, J. R. Byalal, Palepu B Gopal, S. Kulkarni","doi":"10.1111/J.1778-428X.2012.01169.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01169.X","url":null,"abstract":"SUMMARY \u0000 \u0000Volume therapy and maintenance of stable hemodynamics is crucial in children undergoing cardiac surgery on cardiopulmonary bypass (CPB). The clinical use of hydroxyethyl starch (HES) 130/0.4 is limited by the possibility of adverse hemostatic effects which could potentially increase the risk of perioperative bleeding and transfusion requirements. We conducted this study to evaluate the safety and efficacy of HES in comparison with modified succinylated gelatin (MSG). Forty-nine children were randomly assigned to receive either HES (n = 28) or MSG (n = 21) during the pre-bypass period. Coagulation was assessed with thromboelastography (TEG) and the transfusion requirements up to the first postoperative day were documented. Both groups were comparable with respect to age, weight, CPB duration as well as hematological and biochemical laboratory investigations. TEG parameters were not deranged up to the first postoperative period in either group and there was a trend of reduced blood loss and transfusion requirements in HES groups although there was no statistically significant difference. Our study shows that HES 130/0.4 is safe and effective for volume replacement in pediatric cardiac surgery patients.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01169.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63397544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01161.X
A. Agrawal
{"title":"Dengue crisis: blood banks to the rescue","authors":"A. Agrawal","doi":"10.1111/J.1778-428X.2012.01161.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01161.X","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01161.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63397299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01175.X
Dafydd Thomas
{"title":"Editorial: controversial issues in cell salvage","authors":"Dafydd Thomas","doi":"10.1111/J.1778-428X.2012.01175.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01175.X","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01175.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1111/J.1778-428X.2012.01177.X
Á. Remacha, M. Sardá, M. C. Fernández, M. Murga
SUMMARY Worldwide, iron deficiency (ID) is the leading risk factor for disability and mortality, affecting both developing and developed countries with major consequences for human health as well as social and economic development. ID results from any situation in which dietary iron intake does not balance iron demands because of increased iron requirements, limited external supply and/or increased blood loss. In absolute ID, ferritin stores are progressively diminished; the supply of iron to transferrin is compromised, and as a consequence transferrin saturation is decreased. In functional ID (FID), iron stores cannot be mobilized as fast as necessary from the repleted macrophages of the reticuloendothelial system to the bone marrow. This condition is typical of the anemia of chronic diseases (ACD) because of inflammation-induced increased hepcidin levels. Both absolute and functional ID may evolve to ID anemia (IDA). The diagnosis of ACD + IDA remains challenging. In addition to a soluble transferrin receptor (sTfR)/log ferritin ratio > 2, there are several important hematological indices that may help in the diagnosis of absolute ID in ACD, such as the reticulocyte hemoglobin content and the percentage of hypochromic red blood cells. In this paper we review the causes of ID, the different laboratory tests available and how to combine them to establish a correct diagnosis of ID, FID, IDA, ACD and ACD + IDA.
{"title":"Laboratory diagnosis of iron deficiency: IRON DEFICIENCY ASSESSMENT","authors":"Á. Remacha, M. Sardá, M. C. Fernández, M. Murga","doi":"10.1111/J.1778-428X.2012.01177.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2012.01177.X","url":null,"abstract":"SUMMARY \u0000 \u0000Worldwide, iron deficiency (ID) is the leading risk factor for disability and mortality, affecting both developing and developed countries with major consequences for human health as well as social and economic development. ID results from any situation in which dietary iron intake does not balance iron demands because of increased iron requirements, limited external supply and/or increased blood loss. In absolute ID, ferritin stores are progressively diminished; the supply of iron to transferrin is compromised, and as a consequence transferrin saturation is decreased. In functional ID (FID), iron stores cannot be mobilized as fast as necessary from the repleted macrophages of the reticuloendothelial system to the bone marrow. This condition is typical of the anemia of chronic diseases (ACD) because of inflammation-induced increased hepcidin levels. Both absolute and functional ID may evolve to ID anemia (IDA). The diagnosis of ACD + IDA remains challenging. In addition to a soluble transferrin receptor (sTfR)/log ferritin ratio > 2, there are several important hematological indices that may help in the diagnosis of absolute ID in ACD, such as the reticulocyte hemoglobin content and the percentage of hypochromic red blood cells. In this paper we review the causes of ID, the different laboratory tests available and how to combine them to establish a correct diagnosis of ID, FID, IDA, ACD and ACD + IDA.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2012.01177.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63390001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-05DOI: 10.1111/j.1778-428X.2012.01156.x
Sunil Bhandari MBChB, Frcp, M. Edu
SUMMARY Iron deficiency, both functional and absolute, is common in patients with chronic kidney disease and in those requiring dialysis. The Renal National Service Framework and National Institute for Health and Clinical Excellence advocate treatment of anemia in patients with chronic kidney disease. Oral iron is often both insufficient and slow to improve hemoglobin levels while intravenous supplementation replenishes and maintains iron stores more effectively. This leads to a reduction in the use of erythropoietin stimulating agents. This reduction in erythropoietin stimulating agents use may be potentially beneficial in certain cases in particularly reducing stroke risk. In contrast, intravenous iron has the potential to improve quality of life, reduce cardiovascular risk and produce cost savings. However, long-term clinical data are needed to reassure one of the effectiveness of parenteral iron therapy and exclude potential long-term cellular and systemic adverse effects.
{"title":"Iron therapy in patients with chronic kidney disease","authors":"Sunil Bhandari MBChB, Frcp, M. Edu","doi":"10.1111/j.1778-428X.2012.01156.x","DOIUrl":"https://doi.org/10.1111/j.1778-428X.2012.01156.x","url":null,"abstract":"SUMMARY \u0000 \u0000Iron deficiency, both functional and absolute, is common in patients with chronic kidney disease and in those requiring dialysis. The Renal National Service Framework and National Institute for Health and Clinical Excellence advocate treatment of anemia in patients with chronic kidney disease. Oral iron is often both insufficient and slow to improve hemoglobin levels while intravenous supplementation replenishes and maintains iron stores more effectively. This leads to a reduction in the use of erythropoietin stimulating agents. This reduction in erythropoietin stimulating agents use may be potentially beneficial in certain cases in particularly reducing stroke risk. In contrast, intravenous iron has the potential to improve quality of life, reduce cardiovascular risk and produce cost savings. However, long-term clinical data are needed to reassure one of the effectiveness of parenteral iron therapy and exclude potential long-term cellular and systemic adverse effects.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1778-428X.2012.01156.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63397192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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