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Frank R Greer - One of the best experts on this subject based on the ideXlab platform.
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clinical report diagnosis and prevention of Iron Deficiency and Iron Deficiency anemia in infants and young children 0 3 years of age
Pediatrics, 2010Co-Authors: Robert D Baker, Frank R GreerAbstract:This clinical report covers diagnosis and prevention of Iron Deficiency and Iron-Deficiency anemia in infants (both breastfed and formula fed) and toddlers from birth through 3 years of age. Results of recent basic research support the concerns that Iron-Deficiency anemia and Iron Deficiency without anemia during infancy and childhood can have long-lasting detrimental effects on neurodevelopment. Therefore, pediatricians and other health care providers should strive to eliminate Iron Deficiency and Iron-Deficiency anemia. Appropriate Iron intakes for infants and toddlers as well as methods for screening for Iron Deficiency and Iron-Deficiency anemia are presented.
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clinical report diagnosis and prevention of Iron Deficiency and Iron Deficiency anemia in infants and young children 0 3 years of age
Pediatrics, 2010Co-Authors: Robert D Baker, Frank R GreerAbstract:clinical report covers diagnosis and prevention of Iron Deficiency and Iron-Deficiency anemia in infants (both breastfed and formula fed) and toddlers from birth through 3 years of age. Results of recent basic research support the concerns that Iron-Deficiency anemia and Iron Deficiency without anemia during infancy and childhood can have long- lasting detrimental effects on neurodevelopment. Therefore, pediatri- cians and other health care providers should strive to eliminate Iron Deficiency and Iron-Deficiency anemia. Appropriate Iron intakes for infants and toddlers as well as methods for screening for Iron defi- ciency and Iron-Deficiency anemia are presented. Pediatrics 2010;126:
David Y Graham - One of the best experts on this subject based on the ideXlab platform.
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diagnosis and management of Iron Deficiency anemia in the 21st century
Therapeutic Advances in Gastroenterology, 2011Co-Authors: Terri D Johnsonwimbley, David Y GrahamAbstract:Iron Deficiency is the single most prevalent nutritional Deficiency worldwide. It accounts for anemia in 5% of American women and 2% of American men. The goal of this review article is to assist practitioners in understanding the physiology of Iron metabolism and to aid in accurately diagnosing Iron Deficiency anemia. The current first line of therapy for patients with Iron Deficiency anemia is oral Iron supplementation. Oral supplementation is cheap, safe, and effective at correcting Iron Deficiency anemia; however, it is not tolerated by some patients and in a subset of patients it is insufficient. Patients in whom the gastrointestinal blood loss exceeds the intestinal ability to absorb Iron (e.g. intestinal angiodysplasia) may develop Iron Deficiency anemia refractory to oral Iron supplementation. This population of patients proves to be the most challenging to manage. Historically, these patients have required numerous and frequent blood transfusions and suffer end-organ damage resultant from their refractory anemia. Intravenous Iron supplementation fell out of favor secondary to the presence of infrequent but serious side effects. Newer and safer intravenous Iron preparations are now available and are likely currently underutilized. This article discusses the possible use of intravenous Iron supplementation in the management of patients with severe Iron Deficiency anemia and those who have failed oral Iron supplementation.
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Iron Deficiency and helicobacter pylori infection in the united states
American Journal of Epidemiology, 2006Co-Authors: Victor M Cardenas, Zuber D Mulla, Melchor Ortiz, David Y GrahamAbstract:Using data from the current National Health and Nutrition Examination Survey (1999–2000), the authors assessed whether Helicobacter pylori infection is associated with Iron Deficiency and Iron-Deficiency anemia (IDA) in the United States. Iron Deficiency was defined as at least two abnormal results out of three biomarkers of Iron stores. IDA was defined as a low hemoglobin level in the presence of Iron Deficiency. H. pylori infection was measured by serology. Complex survey estimators were used in the analysis. For 7,462 survey participants aged � 3 years, H. pylori infection was associated with decreased serum ferritin levels (percent change ¼� 13.9%, 95% confidence interval (CI): � 19.5, � 8.0) but not with levels of free erythrocyte protoporphyrin, transferrin saturation, or hemoglobin (percent change ¼ 1.5%, � 2.8%, and � 1.1%, respectively). Multinomial logistic regression analyses indicated that H. pylori infection was associated with the prevalence of IDA (prevalence odds ratio (POR) ¼ 2.6, 95% CI: 1.5, 4.6) and, to a lesser degree, other types of anemia (POR ¼ 1.3, 95% CI: 1.0, 1.7). H. pylori infection was associated with a 40% increase in the prevalence of Iron Deficiency (POR ¼ 1.4, 95% CI: 0.9, 2.0) after controlling for relevant covariates. In the United States, H. pylori infection was associated with Iron Deficiency/ IDA regardless of the presence or absence of peptic ulcer disease. anemia; anemia, Iron Deficiency; Helicobacter pylori ; Iron; peptic ulcer
Pankaj Gupta - One of the best experts on this subject based on the ideXlab platform.
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anemia and Iron Deficiency in heart failure current concepts and emerging therapies
Circulation, 2018Co-Authors: Inder S Anand, Pankaj GuptaAbstract:Anemia and Iron Deficiency are important and common comorbidities that often coexist in patients with heart failure. Both conditions, together or independently, are associated with poor clinical status and worse outcomes. Whether anemia and Iron Deficiency are just markers of heart failure severity or whether they mediate heart failure progression and outcomes and therefore should be treated is not entirely clear. Treatment of anemia in patients with heart failure with erythropoiesis-stimulating agents has been evaluated intensively during the past several years. Unfortunately, these agents did not improve outcomes but were associated with a higher risk of adverse events. Iron Deficiency in patients with heart failure can be absolute, when total body Iron is decreased, or functional, when total body Iron is normal or increased but is inadequate to meet the needs of target tissues because of sequestration in the storage pool. Whereas Iron replacement is appropriate in patients with anemia resulting from absolute Iron Deficiency, it has been unclear whether and how absolute or functional Iron Deficiency should be treated in nonanemic patients with heart failure. Recently, small studies found that administration of intravenous Iron in patients with heart failure and absolute or functional Iron Deficiency with or without anemia improves symptoms and exercise capacity, but long-term outcomes and safety data are not yet available. In this review, we discuss the causes and pathogenesis of and treatment options for anemia and Iron Deficiency in patients with heart failure.
Carlo Brugnara - One of the best experts on this subject based on the ideXlab platform.
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screening healthy infants for Iron Deficiency using reticulocyte hemoglobin content
JAMA, 2005Co-Authors: Christina Ullrich, C C Armsby, Sarah Rieber, Sarah Wingerter, Carlo Brugnara, David E Shapiro, Henry H BernsteinAbstract:ContextCurrent clinical practice relies on hemoglobin to detect Iron Deficiency, which misses infants not yet anemic and places them at higher risk for neurocognitive impairment. Reticulocyte hemoglobin content (CHr) has never been compared with hemoglobin for screening healthy infants.ObjectivesTo evaluate CHr for detecting Iron Deficiency without anemia in healthy 9- to 12-month-old infants and to compare CHr with hemoglobin in screening for Iron Deficiency in this population. A secondary objective was to explore the association between CHr and subsequent development of anemia.Design, Setting, and PatientsA prospective observational cohort study of 202 healthy 9- to 12-month-old infants from an urban, hospital-based, primary care clinic in Boston, Mass, who were screened for Iron Deficiency between June 2000 and April 2003, and followed up for a median of 5.6 months.Main Outcome MeasuresIron Deficiency (transferrin saturation <10%) and anemia (hemoglobin <11 g/dL).ResultsOf 202 infants enrolled, 23 (11.4%) had Iron Deficiency and 6 (3%) had Iron Deficiency and anemia. Iron-deficient and non–Iron-deficient infants had significantly different values for all measured hematological and biochemical markers for Iron Deficiency. Optimal CHr cutoff for detecting Iron Deficiency was 27.5 pg (sensitivity, 83% and specificity, 72%); a hemoglobin level of less than 11 g/dL resulted in a sensitivity of 26% and a specificity of 95%. Reticulocyte hemoglobin content was more accurate overall than hemoglobin was for detecting Iron Deficiency (area under the receiver operating characteristic curve, 0.85 vs 0.73; P = .007). A CHr of less than 27.5 pg without anemia at initial screening was associated with subsequent anemia when screened again in the second year of life (risk ratio, 9.1; 95% confidence interval, 1.04-78.9; P = .01).ConclusionsA CHr of less than 27.5 pg is a more accurate hematological indicator of Iron Deficiency compared with hemoglobin of less than 11 g/dL in these healthy 9- to 12-month-old infants. Further studies are warranted to determine whether CHr should be the preferred screening tool in the early detection of Iron Deficiency in infants.
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Iron Deficiency and erythropoiesis new diagnostic approaches
Clinical Chemistry, 2003Co-Authors: Carlo BrugnaraAbstract:Iron Deficiency anemia is one of the most common diseases worldwide. In the majority of cases, the presence of hypochromic microcytic anemia and biochemical evidence for depletion of body Iron stores makes the diagnosis relatively straightforward. However, in several clinical conditions, classic biochemical indices such as serum Iron, transferrin saturation, and ferritin may not be informative or may not change rapidly enough to reflect transient Iron-deficient states (functional Iron Deficiency), such as the ones that develop during recombinant human erythropoietin (r-HuEPO) therapy. The identification and treatment of Iron Deficiency in settings such as r-HuEPO therapy, anemia of chronic disease, and Iron Deficiency of early childhood may be improved by the use of red cell and reticulocyte cellular indices, which reflect in almost real time the development of Iron Deficiency and the response to Iron therapy. In the anemia of chronic disease, measurements of plasma cytokines and Iron metabolism regulators such as hepcidin (when available) may be helpful in the characterization of the pathophysiologic basis of this condition. The ratio of serum transferrin receptor (sTfR) to serum ferritin (R/F ratio) has been shown to have excellent performance in estimating body Iron stores, but it cannot be used widely because of the lack of standardization for sTfR assays. The combination of hematologic markers such as reticulocyte hemoglobin content, which decreases with Iron Deficiency, and R/F ratio may allow for a more precise classification of anemias.
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current literature reticulocyte hemoglobin content to diagnose Iron Deficiency in children
Nutrition in Clinical Practice, 2000Co-Authors: Carlo Brugnara, David Zurakowski, James DicanzioAbstract:Context: Early identification of Iron Deficiency in children is essential to prevent the damaging long-term consequences of this disease. However, it is not clear which indices should be included in a diagnostic panel for Iron Deficiency and Iron Deficiency anemia in children. Objectiiv: To develop an effective approach for the diagnosis of Iron Deficiency and Iron Deficiency anemia in young children. Design and Setting: Retro spective laboratory analysis, carried out over 7 weeks in 1996, using blood samples ordered by pediatricians and sent to a large metropolitan hospital for analysis. Patients: A total of 210 children (mean [SD] age, 2.9 (2.0] years; 120 were male) who had a lead screening test (complete blood cell count and plasma lead level) ordered by a primary care pediatrician. Main Outcome Measures: Levels of hemoglobin (Hb), Iron, transferrin, transferrin saturation (Tfsat), ferritin, and circulating transferrin receptor (TfR) and reticulocyte Hb content (CHr) among patients with and without ir...
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reticulocyte hemoglobin content to diagnose Iron Deficiency in children
JAMA, 1999Co-Authors: Carlo Brugnara, David Zurakowski, James Dicanzio, Theonia K Boyd, Orah S PlattAbstract:ContextEarly identification of Iron Deficiency in children is essential to prevent the damaging long-term consequences of this disease. However, it is not clear which indices should be included in a diagnostic panel for Iron Deficiency and Iron Deficiency anemia in children.ObjectiveTo develop an effective approach for the diagnosis of Iron Deficiency and Iron Deficiency anemia in young children.Design and SettingRetrospective laboratory analysis, carried out over 7 weeks in 1996, using blood samples ordered by pediatricians and sent to a large metropolitan hospital for analysis.PatientsA total of 210 children (mean [SD] age, 2.9 [2.0] years; 120 were male) who had a lead screening test (complete blood cell count and plasma lead level) ordered by a primary care pediatrician.Main Outcome MeasuresLevels of hemoglobin (Hb), Iron, transferrin, transferrin saturation (Tfsat), ferritin, and circulating transferrin receptor and reticulocyte Hb content (CHr) among patients with and without Iron Deficiency, defined as Tfsat of less than 20%, and Iron Deficiency anemia, defined as Tfsat of less than 20% and Hb level of less than 110 g/L.ResultsOf the 210 subjects, 43 (20.5%) were Iron deficient; 24 of these had Iron Deficiency anemia. Reticulocyte Hb content and Hb levels were the only significant predictors of Iron Deficiency (likelihood ratio test [LRT]=15.96; P<.001 for CHr, and LRT=6.59; P=.01 for Hb), and CHr was the only significant multivariate predictor of Iron Deficiency anemia (LRT=30.43; P<.001). Plasma ferritin level had no predictive value (P=.97). Subjects with CHr of less than 26 pg (optimal cutoff value based on sensitivity/specificity analysis) had lower Hb level, mean corpuscular volume, mean corpuscular Hb level, serum Iron level, and Tfsat, and increased red blood cell distribution width vs those with CHr of 26 pg or more (P<.001 for all).ConclusionsReticulocyte Hb content level was the strongest predictor of Iron Deficiency and Iron Deficiency anemia in children. It holds promise as an alternative to biochemical Iron studies in diagnosis.
Robert D Baker - One of the best experts on this subject based on the ideXlab platform.
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clinical report diagnosis and prevention of Iron Deficiency and Iron Deficiency anemia in infants and young children 0 3 years of age
Pediatrics, 2010Co-Authors: Robert D Baker, Frank R GreerAbstract:This clinical report covers diagnosis and prevention of Iron Deficiency and Iron-Deficiency anemia in infants (both breastfed and formula fed) and toddlers from birth through 3 years of age. Results of recent basic research support the concerns that Iron-Deficiency anemia and Iron Deficiency without anemia during infancy and childhood can have long-lasting detrimental effects on neurodevelopment. Therefore, pediatricians and other health care providers should strive to eliminate Iron Deficiency and Iron-Deficiency anemia. Appropriate Iron intakes for infants and toddlers as well as methods for screening for Iron Deficiency and Iron-Deficiency anemia are presented.
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clinical report diagnosis and prevention of Iron Deficiency and Iron Deficiency anemia in infants and young children 0 3 years of age
Pediatrics, 2010Co-Authors: Robert D Baker, Frank R GreerAbstract:clinical report covers diagnosis and prevention of Iron Deficiency and Iron-Deficiency anemia in infants (both breastfed and formula fed) and toddlers from birth through 3 years of age. Results of recent basic research support the concerns that Iron-Deficiency anemia and Iron Deficiency without anemia during infancy and childhood can have long- lasting detrimental effects on neurodevelopment. Therefore, pediatri- cians and other health care providers should strive to eliminate Iron Deficiency and Iron-Deficiency anemia. Appropriate Iron intakes for infants and toddlers as well as methods for screening for Iron defi- ciency and Iron-Deficiency anemia are presented. Pediatrics 2010;126:
