INTRODUCTION: Anemia is a frequent complication in patients with inflammatory bowel disease (IBD). The inflammation observed in IBD negatively impact absorption of iron. This could lead to increased hospitalizations, affect growth and development, and decrease overall quality of life. This is especially pronounced in the pediatric population. The screening and treatment of iron deficiency anemia (IDA) varies between centers, and as a result, roughly 40-60% of pediatric IBD patients are iron deficient. OBJECTIVES: The objective of this study is to assess the efficacy and safety profile of intravenous and enteral iron therapy in a population of iron deficient patients with IBD. The secondary aim of this study is to determine if oral or intravenous iron therapy can improve hematologic and iron parameters. We will also examine the longitudinal changes in gastrointestinal (GI) symptoms and quality of life in patients receiving oral and intravenous iron supplementation. METHODS: We conducted a prospective cohort study in pediatric patients with IBD admitted to the inpatient GI service at Boston Children’s Hospital from 09/05/2017 to 03/05/2018. Forty-six IBD patients were screened, and twenty-nine (63%) were identified as iron deficient and were consented for data collection through chart review and administration of the IMPACT-III quality of life questionnaire. RESULTS: Out of the twenty-nine IBD patients, eighteen (62%) received intravenous iron, seven (24%) received oral iron, and four (14%) were untreated and served as controls. The mean change in hemoglobin in patients receiving parenteral, oral, or no iron therapy was 1.6g/dl±0.5, 1.1g/dl±0.4, and 0.2g/dl±0.5, respectively. The change in hemoglobin was significant between the parenteral and oral iron group (P<0.05). The mean change in health-related quality of life scores in patients receiving parenteral or oral iron therapy was 11.6±11.4 and 3.8l±7.5, respectively. CONCLUSION: Our study demonstrates that intravenous iron therapy was more efficacious than oral iron in improving hematologic and iron parameters in IBD patients. This improvement was concomitant with higher scores on the IMPACT-III quality of life questionnaire, suggesting that iron supplementation improves health-related quality of life in IBD patients with iron deficiency anemia.

A normal pregnancy consumes 500–800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a “physiologic” anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation.

Iron depletion (ID) is the most common nutrient deficiency worldwide and is the leading cause of anemia. Chronic arsenic (As) exposure is a major public health problem in Bangladesh and triggers inflammatory responses that render iron status assessment challenging. We assessed the prevalence of ID and iron deficiency anemia (IDA) in 147 arsenic-exposed Bangladeshi women (75 skin lesion cases; 72 controls), ages 18-33 years, who were part of a skin lesion study. Hemoglobin (Hb) was measured in whole blood; ferritin and hs-c-reactive protein (CRP) were measured in serum. The prevalence of anemia (Hb<120g/L) was 18%. Although the prevalence of ID (ferritin≤12mcg/L) did not differ between cases and controls, anemia was more common among cases (25% vs. 10%; p=0.02). Of anemic women, 27% (N=7) also had ID (Hb<120g/L and ferritin≤12mcg/L), indicating IDA. Women with normal iron status had higher toenail arsenic compared to iron-depleted women (2.9 vs 1.4 µg As/g toenail; p=0.00), and their water arsenic concentration was higher than that of iron-depleted women (18.8 vs 6.2 µg As/L; p=0.03); every 1µg increase in toenail As was associated with a 45% lowered risk of ID (OR=0.55, 95%CI=0.33,0.94). Much of the anemia in this cohort appears unrelated to ID, but could be linked to other nutrients, such as folate and vitamin B12, which are involved in both hematopoiesis and arsenic metabolism. It is possible that arsenic exposure in this cohort compromised folate and vitamin B12 status.

Oral iron replacement therapy is often used as a first-line modality for the treatment of iron deficiency anemia (IDA). Oral iron replacement options include tablets, capsules, and liquid formulations. Esophagitis due to iron tablet administration is a well-documented phenomenon, yet peptic ulcer disease secondary to iron tablet administration is less well-known. An 83-year-old female with a past medical history of chronic kidney disease stage V, anemia of inflammatory disease, heart failure with preserved ejection fraction, and gastroesophageal reflux disease presented to the hospital with diffuse abdominal pain and dark red emesis. She was started on ferrous sulfate supplementation two weeks ago and described progressive abdominal pain and nausea since beginning the medication. She was not taking nonsteroidal anti-inflammatories (NSAIDs), antiplatelets, or anticoagulants. Six months ago, she had an unremarkable upper endoscopy performed for new-onset gastroesophageal reflux disease. Laboratory studies revealed a hemoglobin of 7.3 mg/dL and due to a concern for rapid blood loss, she was given one unit of packed red blood cells. A non-contrast computed tomography was performed showing wall thickening of the stomach and the first two portions of the duodenum. A possible ulcer was seen in the distal posterior stomach. The patient was made NPO, and twice daily intravenous pantoprazole was started. An upper endoscopy was performed which revealed a 2.5 cm clean-based ulcer in the duodenal bulb. Biopsies showed acute inflammation and positivity for iron debris but were negative for Helicobacter pylori. Once daily pantoprazole was continued, and her ferrous sulfate tablets were discontinued. Her symptoms did not return. Ferrous sulfate may erode and ulcerate the gastric and duodenal mucosa like that of a chemical burn. Iron deposits may be seen on biopsies performed with Prussian blue staining. Brown crystalline deposits may be seen on hematoxylin and eosin staining. Iron injury may be seen in pill or capsule formulations due to a concentration effect, but this is typically not seen with solution forms. Treatment includes discontinuation of tablet or capsule formulations and substitution with liquid forms.

No description available.

No description available.

Actualmente la anemia ferropénica, es un problema de salud a nivel mundial, con mayor prevalencia en la niñez, por lo tanto, la madre opta por conductas basadas en conocimientos, actitudes y prácticas. El objetivo general fue: Determinar la relación que existe entre conocimientos, actitudes y prácticas de alimentación y anemia ferropénica en niños de 6 a 24 meses, en el Centro de Salud San Ignacio- 2019. Fue de tipo cuantitativo, diseño no experimental, descriptivo correlacional. Se realizo en el centro de salud San Ignacio, con una población de 80 madres, la muestra fue censal, el muestreo por conveniencia. El instrumento fue un cuestionario validado por juicio de expertos según prueba V de Aiken=1, la confiabilidad se probó mediante alfa de Conbrach con puntaje de 0.794. se tuvieron en cuenta las consideraciones éticas de Belmont: En cuanto a la dimensión conocimientos 70% tiene nivel adecuado y 30% inadecuado; asimismo la dimensión actitudes 52.5% es inadecuado y 47,5% adecuado y la dimensión práctica predomina el nivel inadecuado con 57,5% 42,5% están en niveles adecuados. En lo que respecta al tipo de anemia ferropénica de los niños de 6 a 24 meses prevalece la anemia leve con 87,5%, 12,5% anemia moderada y 0% anemia severa. En conclusión, existe relación significativa entre la dimensión actitudes de alimentación de las madres de niños de 6 a 24 meses en cuanto a los niveles de anemia ferropénica con una significancia bilateral de 0,025; esto indica asociación inversa entre ambas variables. / Currently, iron deficiency anemia is a worldwide health problem, with a higher prevalence in children, therefore, the mother chooses behaviors based on knowledge, attitudes and practices. The general objective was: To determinate the relationship between knowledge, attitudes and feeding practices and iron deficiency anemia in children aged 6 to 24 months, at the San Ignacio Health Center – 2019. The study was quantitative, descriptive, non-experimental design, cross-sectional descriptive-correlational type. It was conducted in the San Ignacio Health Center, with a population of 80 mothers, the sample was census, convenience sampling. The instrument was a questionnaire validated by expert judgment according to Aiken’s V test = 1 and pilot test with Cronbach’s alpha, which yielded a score of 0.794. Belmont Ethical considerations. The results: Regarding the knowledge dimension, 70% have an adequate level and 30% inadequate; likewise, the attitudes dimension 52.5% is inadequate and 47.5% adequate and the practical dimension is dominated by the inadequate level with 57.5% and 42.5% represents adequate levels. Concerning the type of iron deficiency anemia in children aged 6 to 24 months, mild anemia prevails with 87.5%, 12.5% moderate anemia and 0% severe anemia. It is concluding mother have basic knowledge about nutrition and iron deficiency anemia, however, they have weaknesses in terms of attitudes and practices. In conclusion, there is a significant relationship between the feeding attitudes dimension of mothers of children from 6 to 24 months in terms of the levels of iron deficiency anemia with a bilateral significance of 0.025; This indicates an inverse association between both variables.

Cribra orbitalia represents one of the most frequent bone pathologies in skeletal remains of past populations. This lesion is characterised by porous, furrowed even trabecular disruption on the outer table of the compact bone on the orbital roof. Although the origin of cribra orbitalia is linked to marrow hyperplasia as a consequence of iron deficiency anemia, even other causes are not ruled out. Both occurences cribra orbitalia alone and coincidence with other signs of diseases have been recorded. Research of this study applies to cribra orbitalia as a long- term stress indicator on the skeleton and a symptom of specific diseases or anemic syndroms. Skeletal remains from Czech medieval sites with presence of cribra orbitalia as well as whole graveyard from Oškobrh were analysed. Macroscopical investigation did not demonstrate periodic coincidence of cribra orbitalia and specific bone signs of the diseases. However, the following bone changes have been observed: hyperostosis porotica, increased vascularization, supranasal porosity, inflammatory- hemorrhagic reaction on the endocranium which can in terms of differential diagnosis help to clarify the nature and/or cause of the origin of cribra orbitalia. Comparison of the population from Oškobrh with other medieval graveyards showed that frequency of...

A anemia ferropriva no Brasil é o problema carencial de maior magnitude tendo como principal fator a insuficiência de alimentos fontes de ferro na dieta. O objetivo deste estudo foi analisar, por meio de um exercício teórico, a capacidade da alimentação atender à recomendação e necessidade de ferro levando em consideração a legislação para fortificação das farinhas de trigo e de milho com o mineral vigente no Brasil desde junho de 2004. Para esse exercício foram utilizados os dados secundários referidos em relação à aquisição alimentar domiciliar pela população brasileira na Pesquisa de Orçamentos Familiares 2002/2003, destacando as macrorregiões e, entre as classes de rendimento, exclusivamente os dados referentes às famílias com rendimento mensal inferior a dois salários mínimos. Os valores encontrados foram organizados para estimar a disponibilidade e biodisponibilidade do ferro na alimentação adquirida e realizar o cálculo da densidade de ferro e densidade de ferro biodisponível. A partir da aquisição alimentar domiciliar verificou-se um valor calórico diário insuficiente para atender à necessidade energética. Verificou-se que o baixo teor de ferro proveniente dos alimentos naturalmente fontes do mineral feijão e carnes foi acrescido em 45% com o ferro dos alimentos derivados das farinhas de trigo e de milho fortificadas. Entre as famílias com renda mensal inferior a dois salários mínimos o aumento foi de 40%. Mesmo com a fortificação, a quantidade de ferro veiculada pela alimentação nacional está longe de atingir a recomendação de 14mg Fe/dia. O valor encontrado atende a recomendação marcial para o homem, mas representa apenas 55% do recomendado para a mulher. A densidade do ferro biodisponível de 0,360mg/1000 Kcal também não atendeu à necessidade diária do homem (1,0 mg/dia) e muito menos da mulher (2,2 mg/dia). A elevada prevalência com que essa deficiência ocorre, justificada pelo baixo consumo do mineral, acarreta à Saúde Pública elevados custos diretos e indiretos. A fortificação das farinhas com ferro é uma medida destinada a grandes segmentos populacionais e visa principalmente à prevenção e controle da deficiência marcial. / The iron deficiency anemia in Brazil is a fundamental problem of greater magnitude, and its main factor is that in the Brazilian diet there is insufficient use of foods that provide sources of iron. The objective of this piece of work is, by means of a theoretical work, to analyze if the diet is able to meet the recommendation / need of iron taking into account the legislation of fortification of wheat flour and corn with the current mineral in Brazil since June, 2004. For this matter, secondary data referring the domestic food acquisition by the Brazilian population in the \"Pesquisa de Orçamentos Familiares\" household budget survey 2002 / 2003 were used, focusing on the biggest regions and the income classes, especially the ones with monthly income inferior to two minimal salaries. The values found were organized to estimate the availability and the bioavailability of iron in the diet and to calculate the density of iron and of bioavailable iron. Based on the domestic food acquisition, a caloric value, which was insufficient to meet the needs of energy consumption, was observed. It was also noticed that the low amount of iron coming from foods naturally found in beans and meat was increased by 45% with the iron derived from fortified wheat flour and corn. Among families whose income was inferior to two minimal salaries, the increase was 40%. Even with the fortification, the quantity of iron available in the usual diet of the country is far behind the recommended 14mg per day. The amount meets the recommended for male, but it only adds up to 55% of what is recommended for the females. The density of boiavailable iron, which was 0.360 mg / 1000kcal, was also unable to meet the daily need of a male (1.0mg per day) and most notably of a female (2.2mg per day). The high prevalence that this deficiency happens, justify by the low consumption of this mineral, brings very high direct and indirect expenses to the Brazilian Department of Public Health Public. The fortification of flour with iron is a measure destined to great population segments and is aimed specifically at the prevention and control of martial deficiency.

A deficiência de ferro e anemia ferropriva são problemas de ordem mundial. Para as mulheres no período gestacional, a preocupação com o estado do ferro no organismo deve ser ainda maior, pois a deficiência desse elemento pode causar prejuízo na formação dos bebês. O objetivo do projeto é avaliar a evolução da freqüência de deficiência de ferro e anemia ferropriva e os parâmetros de ferro no organismo de mulheres grávidas durante toda a gestação e relacionar com dados da dieta e suplementação de ferro. Também avaliamos os dados sócio-demográficos e nutricionais maternos, além dos parâmetros de ferro, com o peso dos seus recém nascidos. Participaram do estudo 183 gestantes, 103 terminaram o protocolo e das quais foram colhidas amostras de sangue nas idades gestacionais de 16, 28 e 36 semanas. Para avaliação nutricional foram aplicados três inquéritos recordatórios de 24 horas no dia da coleta. Foram realizadas as determinações de ferro sérico, saturação de transferrina, ferritina sérica, capacidade total de ligação ao ferro (CTLF) e concentração sérica do receptor de transferrina (sTfR), além da dosagem da concentração de hemoglobina. As gestantes foram classificadas em seis grupos conforme a suplementação com ferro em cada idade gestacional: as mulheres que não utilizaram essa suplementação foram incluídas no grupo 1 (N=21); enquanto as participantes que fizeram o uso de suplementação em todas as idades gestacionais, até 16 semanas de gravidez e com 28 e 36 semanas de gestação foram incluídas nos grupos 2 (N= 17), 3 (N=12) e 4 (N=24), respectivamente. Os outros 2 grupos foram constituídos por mulheres que utilizaram a suplementação somente com 28 semanas de gestação (Grupo 5, N= 19) e com 36 semanas de gestação (grupo 6 , N= 10). Não houve correlação entre os consumo de ferro da dieta e os parâmetros que avaliam o estado do ferro no sangue. Houve aumento da freqüência de deficiência de ferro em todos os grupos estudados, mas não ocorreu aumento da freqüência de anemia e nem anemia ferropriva. / Iron deficiency and iron deficiency anemia are worldwilde problems. For women during pregnancy, concern about the iron status should be even higher, because the iron deficiency may impair the formation of newborn. The objectives of this work was evaluate the frequency of iron deficiency and iron deficiency anemia and iron status markers of pregnant women during pregnancy and correlate with diet intake and iron supplementation. We also assess the socio-demographic, maternal nutrition and iron status with birth weight of their newborns. The study included 183 women, 103 completed the protocol. Blood samples was collected at gestational ages of 16, 28 and 36 weeks. Nutrient intake was assessed by 24 hour dietary recall applied at the same time of blood samples. We analyzed serum iron, transferrin saturation, serum ferritin, total iron binding capacity (TIBC), serum transferrin receptor (sTfR), and hemoglobin. Patients were classified into six groups according to iron supplementation: women who did not use this supplement were included in group 1 (N = 21), while the participants who made use of supplementation in all gestational ages, up to 16 weeks of gestation, in 28 and 36 weeks of gestation were included in group 2 (N = 17), 3 (N = 12) and 4 (N = 24), respectively. The other 2 groups consisted of women who used supplement in 28 weeks of gestation (Group 5, N = 19) and 36 weeks of gestation (group 6, N = 10). There was no correlationship between diet intake of iron and iron status markers. The frequencies of iron deficiency increased during pregnancy in all groups , however the frequencies of anemia and iron deficiency anemia did not.