Red blood cells need iron to form normally and carry oxygen around your body. Other parts of your body, such as your liver, bone marrow, and muscles, also need iron. Low levels of ferritin lead to iron-deficiency anemia.
This means you have too few red blood cells. Iron deficiency can come from a poor diet or blood loss. Or your body may have trouble absorbing iron from food. It would take a very poor diet for a healthy adult to get a nutritional iron deficiency.
But a low iron level is the most common nutritional deficiency in children. Children need extra iron during times of rapid growth.
In adults, low iron levels usually happen because of long-term chronic blood loss. If you have ulcers or tumors in your gut, intestinal bleeding, or very heavy menstrual periods, you could lose more iron than you take in and develop an iron deficiency. This can also happen if you are pregnant or breastfeeding. High levels of ferritin can damage your joints, heart, liver, and pancreas.
Too much iron is most often caused by an inherited disease called hemochromatosis. Many people with this disease never have any symptoms, especially women who lose iron through menstruation. But men and some women slowly build up excess iron over the years. They may begin to feel joint and belly pain in their 20s or 30s. Heavy alcohol use increases the amount of iron that is absorbed. Iron poisoning happens when a large amount of iron is taken in all at once.
This happens to children who accidentally take too many iron supplements. You may need this test if your healthcare provider thinks that you have low iron levels. Signs and symptoms include:.
Management of iron deficiency FBE, full blood examination; Hb, haemoglobin; IV, intravenous Folate, B12 and micronutrient deficiencies Historically, folate deficiency was the second most common cause of anaemia in pregnancy, but this is being overtaken by vitamin B12 deficiencies, particularly since folate supplementation in pregnancy is advised 17 and with routine food fortification.
Haemoglobinopathies Haemoglobinopathies can be divided into thalassaemias and haemoglobin variants such as sickle cell disease SCD. Table 2. Infections Although not as common, maternal helminthic infection with Ascaris lumbricoides , Trichuris trichuria or hookworms carries increased risk of anaemia during pregnancy.
Provenance and peer review: Not commissioned, externally peer reviewed. Create Quick log. References World Health Organization. The global prevalence of anaemia in Geneva: WHO, Available at www.
Anemia in pregnancy. Hematol Oncol Clin North Am ;25 2 — The management of anaemia and haematinic deficiencies in pregnancy and post-partum. Transfus Med ;28 2 — Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for — A systematic analysis of population-representative data.
Lancet Glob Health ;1 1 :e16— Factors affecting the quality of antenatal care provided to remote dwelling Aboriginal women in northern Australia. Midwifery ;30 3 — UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol ; 5 — Adelaide: SA Health, Search PubMed Breymann C. Iron deficiency anemia in pregnancy.
Semin Hematol ;52 4 — Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort. PloS One ;10 4 :e Maternal risk factors and anaemia in pregnancy: A prospective retrospective cohort study. J Obstet Gynecol ;30 2 — Prevalence of maternal anaemia and its predictors: A multi-centre study.
A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. J Intern Med ; 3 — Iron deficiency in early pregnancy using serum ferritin and soluble transferrin receptor concentrations are associated with pregnancy and birth outcomes. Eur J Clin Nutr ;70 3 — Nutrient reference values for Australia and New Zealand including recommended dietary intakes. Version 1. Iron supplementation during pregnancy and infancy: Uncertainties and implications for research and policy.
Nutrients ;9 Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: A systematic review. Transfus Med ;27 3 — Vitamin and mineral supplementation in pregnancy. Iron in pregnancy guideline. Based on the preponderance of data from prospective trials, they are all equally safe and efficacious. These agents are administered over five visits, while other iron products require only one visit to achieve the same effect.
The remaining options LMWID, FCM, iron isomaltoside, and ferumoxytol are all excellent formulations, but each requires different dosing and administration. Although it is an off-label usage, LMWID is routinely administered at 1, mg for one hour in pregnant women with iron deficiency. We have little evidence about ferumoxytol in the pregnant population, but, anecdotally, we have treated several hundred patients with ferumoxytol 1, mg administered in a minute infusion.
However, this is not routinely approved and then we routinely give ferumoxytol mg on two different days in three to five minutes because we know it to be safe. The drug was originally approved at a rapid infusion rate mg over 17 seconds , but the minute infusion time was adopted after a high rate of infusion reactions was observed. FCM is another excellent iron product. It can be given as a single 1,mg infusion in 15 minutes. There is a litany of evidence to support this dosing, but, in the U.
Because published evidence suggests giving more than 1, mg at once is not clinically beneficial, we are forced to use 1, mg of this drug to give a 1,mg dose. Boccia: We have used all three of these iron products and our experience with them in the pregnant population has been equally good.
Certain patients — especially women with iron deficiency who are in their menstrual years and may have heavy uterine bleeding — will need more IV iron than another patient. In all likelihood, the first patient would do better with a 1,mg dose, while the second patient would benefit from a 1,mg dose. If we had the luxury of having the European vial sizes of mg and 1, mg available in the U. In the U. So, other high-resource countries are paying a fraction of what U.
Boccia: FCM is a great, safe option, and it is nice to be able to administer an iron therapy in 15 minutes. At times, I use one vial of FCM, rather than using a second vial to deliver mg. Also, in lighter-weight patients, I will administer mg of a mg vial; then, if the patient appears to have an iron deficit lower than 1, mg, I will give them one mg dose and monitor their response over time. I might argue for the use of FCM in iron-deficient pregnant women, but, because of the costs, I think we have to explore other options for administering IV iron.
We recently compared the safety and efficacy of ferumoxytol 1, mg and FCM 1, mg in nearly 2, patients with iron-deficiency anemia and found that each product performed similarly. The efficacy also was equivalent, with baseline hemoglobin levels improving by 1.
These results were similar even though the FCM dose was nearly percent higher than the ferumoxytol dose. The trial also suggested that we are not able to use more than 1, mg in a short period of time. That is consistent with in vitro data. Auerbach: In the FIRM study, when we monitored Hb and transferrin levels five weeks from baseline and there was no difference between patients treated with FCM or ferumoxytol.
Boccia: And that is only at five weeks. To answer the clinically important questions that would guide our therapy choice in this population, we also need trials with longer follow-up.
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