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Pericardial effusion secondary to isolated severe iron-deficiency anaemia is an extremely rare condition. We present a case with severe anaemia presented with moderate pericardial effusion. Pericardial effusion completely resolved with correction of anaemia.

We report the case of a 27-year-old female patient from sub-Saharan Africa who presented with non-specific abdominal complaints, iron deficiency anaemia and multiple, large intra-abdominal cystic lesions on imaging. The lesions appeared to be a most unusual presentation of gastrointestinal stromal tumour (GIST). GIST is a sarcomatous tumour that comprises only 0.2% of all gastrointestinal (GI) tumours; it is the most common mesenchymal malignancy of the GI tract. Our patient had the succinate dehydrogenase-deficient (SDHD) subtype, identified in some 5%–10% of patients with GIST only, commonly found in women and younger patients. The differential diagnosis of intra-abdominal cystic lesions is briefly discussed, including the relevance of a correct pathological diagnosis. This impacts medical and surgical management decisions, including predicting response to targeted therapy. Tyrosine kinase inhibitor therapy has been a breakthrough in the treatment of GISTs, although with extensive disease, and certainly in case of the SDHD subtype, long-term outcome remains disappointing.

Introduction During pregnancy, women are at an increased risk of developing iron-deficiency anemia. Objective The objective of this study was to assess the diagnostic performance of the reticulocyte hemoglobin equivalent (RET-He) in the early detection of iron-deficiency anemia in a group of pregnant women and to establish a reference range for this parameter in a group of control individuals. Method: A total of 60 patients and 130 control subjects were included in the study. Blood samples collected from the subjects were submitted to a complete blood count and a serum ferritin test and the data were analyzed by comparing the groups and ROC curves. Results The reference range found for the RET-He was between 29.75pg and 38.24pg, with a median of 35pg. The receiver operating characteristic (ROC) curve analysis for the ferritin parameter showed an area under the curve of 0.732 for the RET-He, 0.586 for hemoglobin, 0.551 for the mean corpuscular hemoglobin concentration and 0.482 for the mean corpuscular volume. Conclusion Early diagnosis of iron deficiency anemia in pregnancy is essential to prevent damage to both maternal and fetal health. The RET-He presents an excellent potential as an auxiliary tool for the diagnosis of iron deficiency in pregnant women.

Iron deficiency (ID) is a common comorbidity in heart failure (HF). In these patients, intravenous iron administration can improve clinical outcomes and quality of life (QoL). However, data on ID are lacking in patients who have transitioned toward left ventricular assist device (LVAD) or heart transplantation (HTx). All patients who underwent LVAD (n = 84) surgery or HTx (n = 67) at our center between 2012 and 2019, aged ≥18 years with a follow-up of ≥3 months, were included. Retrospectively, the prevalence of ID up to 1 year preoperatively, and up to February 2020 postoperatively, as well as all iron administrations were assessed during this period. Iron status was assessed in 61% and 51% of the LVAD and HTx patients preoperatively, and 81% and 84%, respectively, postoperatively. Of these patients, 53% and 71% of the LVAD and HTx patients preoperatively were diagnosed with ID preoperatively, and 71% and 77%, respectively, postoperatively. ID was more frequently diagnosed >3 months postoperatively. Sixty-three percent of the LVAD (mostly intravenous) and 63% of the HTx patients (mostly oral) received iron administration. ID is highly prevalent pre- and post-LVAD and HTx. It is plausible that substitution can have similar QoL gains as in regular HF patients.

In the USA, as many as 20 % of recruits sustain stress fractures during basic training. In addition, approximately one-third of female recruits develop Fe deficiency upon completion of training. Fe is a cofactor in bone collagen formation and vitamin D activation, thus we hypothesised Fe deficiency may be contributing to altered bone microarchitecture and mechanics during 12-weeks of increased mechanical loading. Three-week old female Sprague Dawley rats were assigned to one of four groups: Fe-adequate sedentary, Fe-deficient sedentary, Fe-adequate exercise and Fe-deficient exercise. Exercise consisted of high-intensity treadmill running (54 min 3×/week). After 12-weeks, serum bone turnover markers, femoral geometry and microarchitecture, mechanical properties and fracture toughness and tibiae mineral composition and morphometry were measured. Fe deficiency increased the bone resorption markers C-terminal telopeptide type I collagen and tartate-resistant acid phosphatase 5b (TRAcP 5b). In exercised rats, Fe deficiency further increased bone TRAcP 5b, while in Fe-adequate rats, exercise increased the bone formation marker procollagen type I N-terminal propeptide. In the femur, exercise increased cortical thickness and maximum load. In the tibia, Fe deficiency increased the rate of bone formation, mineral apposition and Zn content. These data show that the femur and tibia structure and mechanical properties are not negatively impacted by Fe deficiency despite a decrease in tibiae Fe content and increase in serum bone resorption markers during 12-weeks of high-intensity running in young growing female rats.

Iron deficiency anaemia is a known complication of a large hiatal hernia in adults. It occurs as a result of erosions on the gastric mucosa secondary to traction at the hiatus during respiration and/or gastric acid-related injuries to the mucosa. Even though anaemia occurs as a result of chronic gastrointestinal blood loss, testing for faecal occult blood is often negative and upper gastrointestinal endoscopy normal as the bleeding is intermittent. In children, a hiatus hernia as a rare cause of iron deficiency anaemia and has been described only in case reports. Here, we describe a 5-year-old boy who presented with severe transfusion-dependent iron deficiency anaemia caused by a paraoesophageal hernia. Surgical repair of the hiatus hernia led to complete resolution of anaemia. One should consider a hiatus hernia as a diagnostic possibility when evaluating a child with refractory iron deficiency anaemia.

Background Diagnosis of iron deficiency is traditionally based on ferritin and other iron parameters becomes difficult in end stage renal disease patients due to the inflammatory condition which affects these markers and masks the iron deficiency. Serum soluble transferrin receptor (sTfR) is able to be a reliable indicator for assessing iron status, as it is not affected by inflammatory procedures. Aim To evaluate the usefulness of serum soluble transferrin receptors in iron deficiency anemia detection in comparison to the classic markers of iron status in prevalent hemodialysis patients. Methods This case-control study assessed sTfR in 80 prevalent ESRD patients on regular hemodialysis in 2 groups. Group A (N = 40): CRP >10 and group B (N = 40):CRP Results The cut of value of STFRs in hemodialysis patients was 12.5 mg\l. The prevalence of STFRs in patients with CRP10 was 92.5% (P-value 0.288). STFRs have high sensitivity 88.75, specificity 100, PPV100% and NPV 47.1%. The hemodialysis patients who have elevated STFRs have risk 1.22 times to have iron deficiency anemia if CRP 10 (odds ratio: 3.14). There was significant difference on comparing patients with CRP10 and control as regard Hb and STFR with P-value 0.0001 and 0.0001 respectively. Post Hoc analysis showed significant difference in both between the patients with CRP10 and control (p value 10 there was significant difference in STFRs p value 0.0001 despite no significant difference in hemoglobin (p value 0.642) and classic marker of iron deficiency (s.iron, TIBC, TSAT) with p value 0.701,0.192,0.382 respectively. Serum STFRs was negatively correlated with s.iron and Kt\v (r -0.372, P-value 0.018) and (r-0.416, p value 0.008) respectively in patients with CRP Conclusion Serum soluble transferrin receptor is highly sensitive and specific marker for iron deficiency in hemodialysis patients especially in patients with high CRP level.

BACKGROUND: Many women enter pregnancy with iron stores that are insufficient to maintain maternal iron balance and support fetal development and, consequently, often require iron supplements. However, the side effects associated with many currently available iron supplements can limit compliance. OBJECTIVE: This study aimed to test the safety and efficacy of a novel nanoparticulate iron supplement, a dietary ferritin analogue termed iron hydroxide adipate tartrate (IHAT), in pregnant mice. METHODS: Female C57BL/6 mice were maintained on either an iron deficient or a control diet for two weeks prior to timed mating to develop iron deficient or iron sufficient pregnancy models respectively. Mice from each model were then gavaged daily with 10 mg iron/kg body weight as either IHAT or ferrous sulfate, or with water only, beginning on embryonic day (E) 4.5. Mice were euthanized on E18.5 and maternal iron and hematological parameters were measured. The expression of genes encoding iron transporters and oxidative stress markers in the duodenum and placenta were determined, along with hepatic expression of the gene encoding the iron regulatory hormone hepcidin and fetal iron. RESULTS: Oral IHAT and ferrous sulfate were equally effective at increasing maternal hemoglobin (20.2% and 16.9% respectively) and hepatic iron (30.2% and 29.3% respectively), as well as total fetal iron (99.7% and 83.8% respectively), in iron deficient pregnant mice compared to those gavaged with water only, with no change in oxidative stress markers seen with either treatment. However, there was a significant increase in the placental expression of the oxidative stress marker heme oxygenase 1 in iron replete pregnant mice treated with ferrous sulfate when compared to iron replete pregnant mice gavaged with IHAT (96.9%, P

Iron deficiency anaemia is highly prevalent worldwide. In the surgical patient, anaemia of any cause implies higher morbidity and mortality in the post-operative period. This is especially important in patients with peripheral artery disease, as they have very high rates of anaemia due to iron deficiency or other causes. In intermittent claudication, anaemia is a predictor of death in the medium term. Patients with critical ischaemia have higher prevalence of anaemia and it is an indicator of amputation and death in the medium term. Specific protocols need to be developed for these patients since the natural history of their disease does not allow for the correction of anaemia before surgery.

Background Iron deficiency and depression are prevalent comorbidities in the setting of heart failure. Both conditions are associated with poorer patient outcomes including mortality, hospitalisation and quality of life. Iron replacement has come to the fore as a means to improve patient outcomes. This review aims to assess the current literature regarding the benefits of iron supplementation for iron deficient heart failure patients including potential improvements in depression. Methods and Results The databases of Medline, EMBASE, the Cochrane library of systematic reviews, Central Register of Controlled Trials, PubMed, Web of Science and ClinicalTrials.gov were searched for studies with relevant patient outcomes. A total of 18 studies were identified and included in the review. In essence, intravenous iron was found to be beneficial for New York Heart Association (NYHA) classification, quality of life measures, heart failure (HF) hospitalisation and aerobic capacity. Oral iron however was not beneficial. Research surrounding intravenous iron improving cardiovascular mortality, time to first hospitalisation and changes in depression status is lacking. Conclusions Further research is required to elucidate the advantages of intravenous iron for iron deficient heart failure patients on their depression, mortality and first admission to hospital. Consensus is required regarding which form of iron and the treatment regime that should be adopted for future clinical guidelines.

Aims The prevalence and the natural course of iron deficiency (ID) in acute heart failure (AHF) are still unclear. We investigated the prevalence of ID in unselected patients admitted with AHF on admission, at discharge and up to 3 months thereafter. Methods and results In this prospective, multicentre, observational study, 742 patients admitted with AHF were enrolled. The main study outcome was the percentage of patients with ID (ferritin

Мета: оцінити ефективність різних способів профілактики залізодефіцитних станів у дітей грудного віку. Матеріали та методи. У межах 30-кластерного регіонального епідеміологічного дослідження поширеності йодо- та залізодефіцитних станів у дітей було проведено аналіз результатів скринінгу на анемію 948 дітей, анкетування матерів, визначення концентрації заліза в грудному молоці. Ефективність профілактичних заходів оцінювали за показниками забезпеченості організму залізом у 96 дітей залежно від способу проведеної феропрофілактики. Результати дослідження. Встановлено, що застосування матір’ю під час лактації залізовмісних вітамінно-мінеральних комплексів не впливало на вміст заліза в грудному молоці. Доведено, що найефективнішим способом профілактики залізодефіцитних станів у дітей, які перебувають на виключно грудному вигодовуванні, є призначення сполуки гідроксиду заліза (III) з полімальтозою 1 мг/кг/добу протягом 2 місяців.

The paper presents the data on the prevalence and importance of iron-deficiency anemia for the health, physical and intellectual development of children of various ages. The possibilities and the best means for the correction of iron metabolism and treatment of diseases associated with iron deficiency are considered., В работе представлены данные о распространенности и значимости железодефицитной анемии для состояния здоровья, физического и интеллектуального развития детей различного возраста. Рассмотрены возможности и оптимальные средства для коррекции обмена железа и лечения заболеваний, связанных с его недостатком., У роботі представлені дані про поширеність і значущість залізодефіцитної анемії для стану здоров’я, фізичного та інтелектуального розвитку дітей різного віку. Розглянуто можливості та оптимальні засоби для корекції обміну заліза та лікування захворювань, пов’язаних із його нестачею.

The problem of iron deficiency is a common problem in developing countries, Indonesia being one of them. One of the targets for increasing iron is young women because it influences growth and development to become pregnant women. The purpose of this community service activity is to check hemoglobin levels and focus on increasing young women's understanding of the situation of iron deficiency anemia during the Covid 19 Pandemic. So that after sense emerges, it is hoped that they will be able to implement awareness to consume Fe tablets. The method used is to provide health education in the form of interactive lectures and check hemoglobin levels. The target of the implementation of this activity is all 20 students of SMP Terpadu Ishlahul Mubtadiin Cihaurbeuti Ciamis grades 7, 8, and 9. The results of laboratory examinations, most of the students did not experience anemia as much as 65%, but there were 35% of students who had anemia, either mild (20%), moderate (10%), and severe (5%). The results of the examination laboratories most big girls do not experience anemia as much as 65%, but there are 35% of students experiencing anemia both mild (20%), moderate (10 %), and weight (5%). Activity devotion people have managed to achieve the purpose of its implementation, namely the increase in understanding adolescent daughter against situation anemia, with the discovery of cases of anemia in target further increase the awareness of the target, especially teenage daughter in changing patterns of life, especially eating food that is nutritious as well pattern rest of the teenagers are.

Background Over the last decade, preoperative anemia has become recognized as a clinical condition in need of management. Although the etiology of preoperative anemia can be multifactorial, two-thirds of anemic elective surgical patients have iron deficiency anemia. At the same time, one-third of non-anemic elective surgical patients are also iron deficient. Methods Modified-RAND Delphi methodology was employed to identify areas of consensus among an expert panel regarding the management of iron deficiency in patients undergoing cardiac surgery. A list of statements was sent to panel members to respond to using a five-point Likert Scale. All panel members subsequently attended a face-to-face meeting. The initial survey was presented and discussed, and panel members responded to each statement on the Likert scale again. Based on the second survey, the panel came to a consensus on recommendations. Results The panel recommended all patients undergoing cardiac surgery be evaluated for iron deficiency, whether or not anemia is present. Evaluation should include iron studies and reticulocyte hemoglobin content. If iron deficiency is present, with or without anemia, patients should receive parenteral iron. Erythropoietin stimulating agents may be appropriate for some patients. Conclusions Consensus of an expert panel resulted in a standardized approach to diagnosing and managing iron deficiency in patients undergoing cardiac surgery.

Anemia is one of the most common problems in children with chronic kidney disease (CKD); it is almost universal in children with stage 5 CKD. The development of the first erythropoiesis stimulating agent (ESA), recombinant human erythropoietin, revolutionized the treatment of anemia in CKD, but anemia management remains challenging. Many management issues remain uncertain, including the ideal target hemoglobin. The development of ESAs with longer half-lives and less frequent dosing requirements offers potential management advantages. The increasing use of intravenous iron has allowed ESA doses to decrease, but raised new questions about appropriate utilization.

Background Pulmonary arterial hypertension (PAH) is a progressive disease with limited survival. Iron deficiency (ID) correlates with disease severity and mortality. While oral iron supplementation was shown to be insufficient in such patients, the potential impact of parenteral iron on clinical measures warrants further investigation. Methods We retrospectively analysed the long‐term effects of intravenous ferric carboxymaltose (FCM) on iron status and clinical measures in patients with PAH and ID [ferritin

Background: Blood donation is associated with a loss of hemoglobin (Hb)-bound iron. Hb levels recover relatively fast by using stored iron. However, it takes more time to replenish iron stores, potentially resulting in iron deficiency. Study design: Hb and ferritin levels were measured in 5056 new, first-time, and repeat whole blood donors. We investigated whether increasing numbers of donations are associated with lower ferritin levels. Furthermore, we tested whether low ferritin levels are associated with low-Hb deferral at the subsequent donation attempt by performing logistic regression adjusted for age and stratified by sex. Results: Whereas mean Hb levels are relatively stable, ferritin levels significantly decrease with increasing numbers of donations and were approximately 50% lower for donors with >50 donations compared with those with 2–10 donations. Despite the poor correlation of ferritin and Hb levels, cross-sectional, iron-deficient donors (ferritin

Disordered iron and mineral homeostasis are interrelated complications of chronic kidney disease that may influence cardiovascular and kidney outcomes. In a prospective analysis of 3747 participants in the Chronic Renal Insufficiency Cohort Study, we investigated risks of mortality, heart failure, end-stage kidney disease (ESKD), and atherosclerotic cardiovascular disease according to iron status, and tested for mediation by C-terminal fibroblast growth factor 23 (FGF23), hemoglobin and parathyroid hormone. Study participants were agnostically categorized based on quartiles of transferrin saturation and ferritin as: “Iron Replete” (27.1% of participants; referent group for all outcomes analyses), “Iron Deficiency” (11.1%), “Functional Iron Deficiency” (7.6%), “Mixed Iron Deficiency” (iron indices between the Iron Deficiency and Functional Iron Deficiency groups; 6.3%), “High Iron” (9.2%), or “Non-Classified” (the remaining 38.8% of participants). In multivariable-adjusted Cox models, Iron Deficiency independently associated with mortality (hazard ratio 1.28, 95% confidence interval 1.04–1.58) and heart failure (1.34, 1.05–1.72). Mixed Iron Deficiency associated with mortality (1.61, 1.27–2.04) and ESKD (1.33, 1.02–1.73). High Iron associated with mortality (1.54, 1.24–1.91), heart failure (1.58, 1.21–2.05), and ESKD (1.41, 1.13–1.77). Functional Iron Deficiency did not significantly associate with any outcome, and no iron group significantly associated with atherosclerotic cardiovascular disease. Among the candidate facilitators, FGF23 most significantly mediated the risks of mortality and heart failure conferred by Iron Deficiency. Thus, alterations in iron homeostasis associated with adverse cardiovascular and kidney outcomes in patients with chronic kidney disease.

Background Anemia can be categorized into micro-, normo- or macrocytic anemia based on the mean corpuscular volume (MCV). This categorization might help to define the etiology of anemia. Methods The cohort consisted of patients newly diagnosed with anaemia in primary care. Seven aetiologies of anaemia were defined, based on an extensive laboratory protocol. Two assumptions were tested: (i) MCV 100 fl (macrocytic) excludes iron deficiency anaemia, anaemia of chronic disease and renal anaemia as anaemia aetiology. Results Data of 4129 patients were analysed. One anaemia aetiology could be assigned to 2422 (59%) patients, more than one anaemia aetiology to 888 (22%) patients and uncertainty regarding the aetiology remained in 819 (20%) patients. MCV values were within the normal range in 3505 patients (85%). In 59 of 365 microcytic patients (16%), the anaemia aetiology was not in accordance with the first assumption. In 233 of 259 macrocytic patients (90%), the anaemia aetiology was not in accordance with the second assumption. Conclusions Anaemia aetiologies might be ruled out incorrectly if MCV guided classification is used as a first step in the diagnostic work-up of anaemia. We recommend using a broader set of laboratory tests, independent of MCV.

SUMMARY Iron deficiency without anaemia is common. Patients may present with unexplained, non-specific symptoms. Iron studies will usually show a low ferritin and low transferrin saturation with a normal haemoglobin concentration. The cause of the iron deficiency should be identified and managed. There is limited evidence about the benefits of giving iron to people who do not have anaemia. If there is iron deficiency, most people can be given oral iron supplements. Iron studies are repeated after 60–90 days of oral iron supplements. Further investigations are needed if the iron deficiency has not been corrected. Some patients, including those who have not responsed to oral supplements may benefit from intravenous iron. There is no role for intramuscular injections of iron.

Aim: To study the clinical effect and safety of iron supplementation in the treatment of mild thalassemia complicated by iron deficiency in late pregnancy. Methods: 376 patients with mild thalassemia complicated by iron deficiency in late pregnancy treated in our hospital from July 2019 to June 2021 were selected and recruited in the research group, and 200 normal pregnant women treated in the same period were selected and recruited in the control group. Hemoglobin (Hb), reticulocyte blood, red blood protein (RET he) level, ferritin (SF) level, soluble transferrin receptor (sTfR) level, adverse maternal and infant outcomes, etc. were analyzed. Results: There was no significant difference in the levels of SF, Hb, RET he and sTfR between the two groups before treatment. After treatment, the levels of SF, Hb, RET he and sTfR in the research group were significantly improved, which was statistically significant compared with the control group. The frequencies of intrapartum hemorrhage, premature delivery, stillbirth, hemorrhagic shock, and neonatal asphyxia in the research group were 289±47.88, 36 (9.57%), 0 (0.00%), 25 (6.65%), and 6 (1.26%), respectively. The frequencies of intrapartum hemorrhage, premature delivery, stillbirth, hemorrhagic shock, and neonatal asphyxia in the control group were 284 ± 46.99, 7 (3.50%), 0 (0.00%), 6 (3.00%), and 0 (0.00%), respectively. There were significant differences in preterm delivery and hemorrhagic shock, and there was no significant difference in other delivery outcomes. Conclusions: Under the premise of strictly controlling the iron reserve in pregnant women, continuous medication until the end of delivery may be conducive to the control of maternal thalassemia complicated by iron deficiency and the improvement of pregnancy outcome.

BACKGROUND AND OBJECTIVES The present study was planned to assess the clinical utility of reticulocyte haemoglobin content (CHr) and immature reticulocyte fraction (IRF) in the early detection of latent iron deficiency in blood donors. MATERIALS AND METHODS The prospective longitudinal observational study was conducted using the purposive sampling method. Written informed consent was obtained and donors were allocated into the first-time (FTD) and regular donor (RD) group. The enrolled blood donors (n = 205 in each group) were followed up for two subsequent whole blood donations. Haemoglobin (Hb), CHr, IRF and serum ferritin values were recorded at enrolment and two follow-ups. RESULTS The sensitivity of CHr in detecting iron-deficient erythropoiesis (serum ferritin values ≤ 26 μg/dl) was 45% and 56.7%, specificity 96.7%, positive predictive value (PPV) 85.6% and 90.8% and negative predictive value (NPV) 80.1% and 78.7%, respectively in FTD and RD cohorts. The sensitivity of IRF was 45.1% and 44.8%, specificity 93.4% and 97.1%, PPV 74.8% and 90.4% and NPV 79.6% and 74.5%, respectively in both the cohorts. The sensitivity of CHr in detecting absent iron stores (serum ferritin values ≤ 15 μg/dl) was 66.2% and 74.4%, specificity 92% and 90.6%, PPV 56.7% and 68.7% and NPV 94.5% and 92.8% among FTD and RD cohort, respectively. The sensitivity of IRF was 72.7% and 65.3%, specificity 90.3% and 94.3%, PPV 54.4% and 76% and NPV 95.4% and 90.8%, respectively in both the cohorts. CONCLUSION Reticulocyte hemoglobin content and IRF can be used along with complete blood count for early detection of iron deficiency in blood donors using the same blood sample at no extra cost.

OBJECTIVES To register all symptoms reported by non-anemic menstruating women, and examine the links between these symptoms and iron status parameters available including serum ferritin (SF) in primary care. SUBJECTS AND METHODS In this cross-sectional study, we collected clinical and biological data from 780 French menstruating women aged 18-50 years. The data included an anonymous questionnaire (biometric information, physical and cognitive symptoms, reduction in physical performance, current quality of life with SF-36 questionnaire) and seven biological parameters available in primary care. We excluded women with anemia (hemoglobin

Introduction:Chronic blood loss and intestinal malabsorption of iron are two important causes of iron deficiency in adult patients.We evaluated the demographic data and endoscopy findings of patients who underwent endoscopic examination due to iron deficiency. Materials and Method:The study was designed retrospectively.The database of patients who underwent endoscopic examination due to ID and/or IDA in the endoscopy unit of our hospital between June 2017-April 2020 were found through the database scan. After exclusion of patients with active bleeding finding, remaining 326 patients were evaluated. Findings:Median age of the patients was 58 years. The participants included 182 males and 144 females. Ninety three patients were below 50 years of age whereas 133 patients were above 50 years of age. Endoscopy was performed in 13.2% of the patients; colonoscopy was performed in 2.5% of the patients; and endoscopy + colonoscopy (dual procedure) was performed in 84.4% of the patients. Endoscopic examinations revealed pathological findings that may cause ID/IDA in 69.3% of the patients; however, no gastrointestinal pathology that may cause ID/IDA was detected in 30.7% of the patients.Twelve patients were diagnosed with malign diseases. Detection of any pathology that may cause ID/IDA during endoscopic examinations was significantly more in the dual examination group when compared to patients who had EGD or colonoscopy (p

Background: There is no clear-cut evidence in the existing medical literature of an association between iron deficiency and nonscarring alopecia. Objective: The objective of the study was to conduct a systematic review of the medical literature on the prevalence of iron deficiency in women with nonscarring alopecia and compare their ferritin levels with those of women without this condition. Methods: The electronic databases PubMed, Scopus, and Web of Science were searched between June 15, 2019, and July 24, 2019. Studies that evaluated the prevalence of iron deficiency in women with nonscarring alopecia and/or compared ferritin levels in women with and without this condition were entered into the meta-analysis. Thirty-six of 928 identified studies entered the systematic meta-analysis. The meta-analysis was performed using the random-effects method. Results: The overall number of participants was 10,029. The prevalence of ferritin levels from 10 to 15 ng/dL and below was 21% (12; 29). Women with nonscarring alopecia had lower ferritin values at MD = −18.51 ng/dL (−25.85; −11.16, p < 0.01). Conclusion: Women with hair loss can benefit from higher ferritin levels.

Despite a fingerstick hemoglobin requirement and 56-day minimum donation interval, repeat blood donation continues to cause and exacerbate iron deficiency.Using data from the REDS-II Donor Iron Status Evaluation study, we developed multiclass prediction models to estimate the competing risk of hemoglobin deferral and collecting blood from a donor with sufficient hemoglobin but low or absent underlying iron stores. We compared models developed with and without two biomarkers not routinely measured in most blood centers: ferritin and soluble transferrin receptor. We generated and analyzed "individual risk trajectories": estimates of how each donors' risk developed as a function of the time interval until their next donation attempt.With standard biomarkers, the top model had a multiclass area under the receiver operator characteristic curve (AUC) of 77.6% (95% CI [77.3%-77.8%]). With extra biomarkers, multiclass AUC increased to 82.8% (95% CI [82.5%-83.1%]). In the extra biomarkers model, ferritin was the single most important variable, followed by the donation interval. We identified three risk archetypes: "fast recoverers" (10% risk of any adverse outcome on post-donation day 56), "slow recoverers" (60% adverse outcome risk on day 56 that declines to35% by day 250), and "chronic high-risk" (85% risk of the adverse outcome on day 250).A longer donation interval reduced the estimated risk of iron-related adverse outcomesfor most donors, but risk remained high for some. Tailoring safeguards to individual risk estimates could reduce blood collections from donors with low or absent iron stores.

The aim of the study was to investigate the effect of iron deficiency anaemia on certain cytokine fractions (IL-2, INF-γ, TNF-α) in children aged 6 months to 5 years in Azerbaijan. Methods. The study involved 123 children. According to the hematological and biochemical blood parameters of children aged 6 months to 5 years, 95 children (58 boys, 37 girls) were diagnosed as having anaemia of varying degrees: 32 children had mild iron deficiency anaemia, 37 children had moderate iron deficiency anaemia, and 26 children had severe iron deficiency anaemia. Results. The study demonstrates the level of INF-γ is lower in the general group of children with iron deficiency anaemia compared to the control group (2.5±1.2 pg/ml and 3.9±1.6 pg/ml, respectively). In the general group of children with iron deficiency anaemia, the average correlation coefficient (r=+0.7) between INF-γ with haemoglobin and with serum ferritin (r=+0.6) has been shown. Taking into account the weakening of INF-γ in children with iron deficiency anaemia during the study period, we investigated the annual incidence of acute respiratory viral infections among the general group of children with iron deficiency anaemia and the control group (63.2% and 25%, respectively). There were no significant changes in TNF-α value ​​in children of the general group with iron deficiency anaemia compared to the control group (2.7±1.5 pg / ml, 2.7±1.1 pg / ml, respectively). The IL-2 index in the general group was lower than in the control group (1.6±1.0 pg / ml, 2.9±1.6 pg / ml, respectively). Children in the general group with iron deficiency anaemia had an average correlation coefficient (r=+0.65) IL-2 with haemoglobin and a high correlation coefficient with serum ferritin (r=+0.8). The incidence of pneumonia in the group of children with iron deficiency anaemia was 17.9%. Conclusion. The obtained lowered results of İNF-γ and İL-2 in comparison with the control group and an increased incidence of respiratory diseases indicate a possible reduction in cellular immunity.

Iron deficiency is the most common cause of anaemia worldwide and is associated with significant maternal and fetal morbidity. Current options for treatment include oral iron supplementation which can be ineffective and poorly tolerated, intravenous iron which can be used in patients who are intolerant to or unresponsive to oral iron and red blood cell transfusions which carry an inherent risk because of which it should be avoided. Intravenous iron therapy may reduce the requirement for allogenic blood transfusion. Ferric carboxymaltose is a new intravenous iron formulation promising to be more effective and as safe as iron sucrose. It may even have a better compliance as it offers the administration of a much higher iron dosage at a time.The study was designed to compare the efficacy and safety of IV ferric carboxymaltose versus iron sucrose in the treatment of iron deficiency anaemia of pregnant women with moderate anaemia in the second and third trimester.A hospital based randomized prospective study was done from July 2013 to June 2015 in the department of Obstetrics and Gynaecology, A.J. Institute of Medical Sciences, Mangalore. Baseline haemoglobin, peripheral smear and serum ferritin levels were measured to diagnose iron deficiency anaemia. 60 pregnant women who met the inclusion criteria and who formed the study subjects were randomly allocated into two groups comprising of 30 in Group C (Received ferric carboxymaltose) and 30 in Group S (Received iron sucrose). Outcome was assessed by measuring haemoglobin 3 weeks after treatment and a comparison of the safety and efficacy between the two groups was made. In the present study the commonest age group was 21 to 30 years: 80% in group C and 73.3% in group S and mean age of the study population in group C and S was comparable (25.2±3.54 vs 24.8±4.58 years). The socio demographic characteristics, obstetric history, vitals and pretreatment haemoglobin were comparable in both the groups (p>0.050). The post treatment haemoglobin levels in 63.3% of the women in group C compared to 46.7% in group S were found to be 11 or more and mean post treatment haemoglobin levels were comparable in group C and group S (11.016±0.789 vs 10.73±0.821 gm%; p=0.174). In the present study, post treatment mean increase in haemoglobin levels was noted between 2.0 to 2.5 gm% in 43.3% of the women in group C compared to 50.0% in group S. Ferric carboxymaltose administration in pregnant women in the second and third trimesters is well tolerated and is not associated with any clinical safety concerns. Both ferric carboxymaltose and iron sucrose have a comparable safety profile even when ferric carboxymaltose was administered in a much higher dosage compared to iron sucrose. Ferric carboxymaltose should be considered as the drug of choice, if i.v. iron treatment becomes necessary in the second or third trimester of pregnancy.

Background Phlebotomy-induced anemia (PIA) is universal and variable in degree among preterm infants and may contribute to neurodevelopmental risk. In mice, PIA causes brain tissue hypoxia, iron deficiency, and long-term sex-dependent neurobehavioral abnormalities. The neuroregulatory molecular pathways disrupted by PIA underlying these effects are unknown. Methods Male and female pups were phlebotomized daily from postnatal day (P)3-P14 via facial venipuncture to target hematocrits of 25% (moderate, mPIA) and 18% (severe, sPIA). P14 hippocampal RNA from non-bled control and PIA mice was sequenced by next-generation sequencing to identify differentially expressed genes (DEGs) that were analyzed using Ingenuity Pathway Analysis. Results mPIA females showed the least DEGs (0.5% of >22,000 genes) whereas sPIA females had the most (8.6%), indicating a dose-dependent effect. mPIA and sPIA males showed similar changes in gene expression (5.3% and 4.7%, respectively), indicating a threshold effect at mPIA. The pattern of altered genes induced by PIA indicates sex-specific and anemia-dose-dependent effects with increased pro-inflammation in females and decreased neurodevelopment in males. Conclusion These gene-expression changes may underlie the reduced recognition memory function in male and abnormal social-cognitive behavior in female adult mice following neonatal PIA. These results parallel clinical studies demonstrating sex-specific behavioral outcomes as a function of neonatal anemia. Impact Phlebotomy-induced anemia (PIA) in neonatal mice results in an altered hippocampal transcriptome and the severity of changes are dependent upon degree of anemia and sex of neonatal mice. The reported findings provide context to the sex-specific outcomes that have been reported in transfusion threshold clinical trials of preterm infants and therefore may inform treatment strategies that may be based on sex. These data advance the field by showing that consequences of PIA may be based in sex-specific transcriptomic alterations. Such changes may also result from other causes of neonatal anemia that also affect term infants.

Background: Anemia appears in the early stages of CKD and its prevalence increases as kidney function declines. Ret-HE can be used to diagnose iron-deficiency anemia. Indonesia does not yet have appropriate research data on RET-He levels in CKD patients undergoing hemodialysis as a parameter to assess iron. Therefore, this study aims to examine the ability of RET-He as an alternative parameter to assess iron deficiency in hemodialysis patients. Method: This research is a correlation analytic study with a cross-sectional design, carried out in February-May 2021 at the Hemodialysis Installation of H. Adam Malik Hospital. Blood sample collection and examination are carried out at the Clinical Pathology Laboratory. Primary and secondary data were collected from interviews, questionnaires, or patient medical records. The data will be analyzed by Pearson correlation test using SPSS software. Results: A total of 41 samples consisted of 31 anemic patients and 10 anemic patients with normal RET-He levels. Demographic characteristics based on age group with an average of 47±13.28 years. The correlation of Ret-HE and TSAT levels in CKD patients undergoing hemodialysis shows a significance value of 0.000, so it can be concluded that there is a correlation between RET-HE and TSAT levels with a significance value of

Key Points ID affects more than one-half of pregnancies in a high-resource setting, yet screening for ID is missed in 40% of pregnancies.Females of lower socioeconomic status (SES) have a lower odds of ID screening in pregnancy compared with higher SES counterparts., Visual Abstract, Iron deficiency (ID) anemia in pregnancy is associated with poor maternal and childhood outcomes, yet ferritin testing, the standard test for ID, is not considered part of routine prenatal bloodwork in Canada. We conducted a retrospective cohort study of 44 552 pregnant patients with prenatal testing at community laboratories in Ontario, Canada, to determine the prevalence of ferritin testing over 5 years. Secondary objectives were to determine the prevalence and severity of ID and to identify clinical and demographic variables that influence the likelihood of ID screening. A total of 59.4% of patients had a ferritin checked during pregnancy; 71.4% were ordered in the first trimester, when the risk of ID is lowest. Excluding patients with abnormally elevated ferritins, 25.2% were iron insufficient (30-44 µg/L) and 52.8% were iron deficient (≤29 µg/L) at least once in pregnancy. A total of 8.3% were anemic (hemoglobin

Purpose of the Review Iron deficiency in heart failure has been associated with impaired functional capacity and quality of life. The purpose of this paper is to review mechanisms of iron homeostasis and current clinical data exploring mechanisms of iron repletion in heart failure. Recent Finding Multiple international societies now advise iron repletion for symptomatic heart failure patients with iron deficiency. Due to the chronic inflammation in heart failure, iron deficiency in heart failure is classically defined as ferritin

Iron deficiency and iron-deficiency anemia are common medical conditions. Management of the etiology and iron supplementation are both necessary to treat this condition. Use of intravenous iron preparations is increasing due to its advantages over oral iron. Indeed, the total dose required can be provided in a single infusion, and it is more effective and increases hemoglobin levels more quickly than oral iron. Hypophosphatemia, sometimes severe, following intravenous iron administration, has been described in literature these past years, in particular with ferric carboxymaltose. We report here a case of severe hypophosphatemia with ferric carboxymaltose and carry out a literature review to determine the incidence of hypophosphatemia and to precise its clinical presentation, its pathophysiological mechanisms and its treatment. We found that hypophosphatemia is frequent with ferric carboxymaltose. Most of the time, there are no clinical manifestations, but cases of symptomatic osteomalacia have been described. Duration of hypophosphatemia is variable, from a few weeks to several months in case of prolonged administration. Hypophosphatemia owing to renal phosphate wasting is caused by an increase in intact fibroblast growth factor 23 (FGF-23) levels. However, the mechanism of ferric carboxymaltose- induced increase in intact FGF-23 is still unknown.

Anemia is a form of the body's compensation mechanism for decreasing hemoglobin levels. Anemia in pregnancy is a condition in which hemoglobin is below normal, which is below 11 g/dl. The most common cause of anemia in pregnancy is iron deficiency. Moringa leaves are one type of food that is rich in iron which can overcome anemia. The purpose of the study was to determine the effect of giving Moringa leaf soup on hemoglobin levels of pregnant women in the third trimester at the Oepoi Health Center, Kupang City in 2021. Quasy Experimental research design with a two group pre-test and post-test design. The study population was all pregnant women. The sampling technique is purposive sampling. The sample was 32 pregnant women. Statistical test using t-test. The location of this research was carried out at the Oepoi Health Center, Kupang City from July to August 2021. The research instrument was observation sheet and Hb measuring instrument. The results showed that the average hemoglobin of pregnant women before the intervention in the experimental group was 9.813 g/dl with a standard deviation of 0.57. The hemoglobin level of pregnant women after being given Moringa leaf soup in the experimental group was 11.494 g/dl with a standard deviation of 1.24. The average hemoglobin in pregnant women before intervention in the control group was 9.825 g/dl with a standard deviation of 0.61. The average hemoglobin in pregnant women after the intervention in the control group was 9.675 g/dl with a standard deviation of 1.28. Analysis using the t-test obtained a significance value of 0.000

BACKGROUND: Iron deficiency (ID) anemia remains a common cause of anemia in young children. However, the more significant than anemia itself is the ID without anemia that also adversely affect neurocognitive development and unfortunately some of these effects may be irreversible. AIM: This study is a cross-sectional study aimed to asses iron status in preschool children with normal hemoglobin (Hgb) level attending Assiut University Children Hospital. METHODS: The cross-sectional study including 68 apparently healthy children aged 1–6 years old during the period from January 1, 2015 to June 30, 2015, They were subjected to detailed history, physical examination, and the following laboratory investigations: Complete blood count, Serum iron, Total Iron Binding Capacity, Serum ferritin, and Transferrin saturation. RESULTS: Low serum ferritin and low transferrin saturation were detected in 41.2% and 47% respectively of our studied children who have normal Hgb levels. CONCLUSION: Normal Hgb doesn’t exclude ID that should be screened in healthy children to prevent the possible long-term effects of ID on their cognation and mental development.

Background: Iron deficiency anaemia is one of the most common anaemia striking in our country. The level up to which blood sugar level is regulated is measured by HbA1c. HbA1c represents sugar level in the blood for 120 days. HbA1c could be dependent upon an assemblage of factors like variants of haemoglobinopathies, haemolytic anaemia, other deficiency anaemia, acute loss of blood, uraemia, and pregnancy. Thus, it is crucial to determine the role of HbA1c in iron deficiency anemia in diabetics and non-diabetics before treating the patients. Methods: Total of 58 articles were collected and based on our study objective total of 19 articles were included in this study. Iron deficiency anaemia, HbA1c, diabetics and non-diabetics has been added in pub med advanced searches and Google scholar. Original articles which compare the correlation between these two were taken. All the information was gathered from original and review articles. Articles which were qualified for review, their inclusion criteria, exclusion criteria, quality of assessment and data collections were taken into consideration. Structure of heme particle, basic mechanism of HbA1c formation in RBCs is elaborated. Review articles which were taken include RCT, retrospective analysis and observational studies. The results were all compared and concluded of each articles. Basic mechanism of formation of HbA1c in RBCs is shown. Also necessary conclusions were derived from each study. Results: In a wide range of studies, HbA1c was found to be raised in IDA. After iron supplements, studies showed a decrease in HbA1c. Our study showed there is a need to correct anemia in diabetic patients before starting treatment. Conclusions: Strict HbA1c control is not a prerequisite and prior anaemia correction should be done. Nevertheless, a study which will be conducted in representative population matching to the prevalence and incident of disease in our country also which should be interventional is required for the highest correction value of HbA1c in DM and NDM population.

Iron restriction during pregnancy can lead to iron deficiency and changes in the dopaminergic system in the adulthood of offspring, and restless legs syndrome (RLS) is closely related to these changes. Objectives: Analyze whether iron restriction during pregnancy would cause changes in the behavior, sleep, and dopaminergic system of the male offspring. In addition, we aimed to assess whether exercise would be able to modulate these variables. The pregnant rats (Wistar) were divided into four groups with different concentrations of iron in the diet: standard (St), supplementation (Su), restriction since weaning (R1), and restriction only during pregnancy (R2). After birth, the offspring were assigned to their respective groups according to the dams diet (St, Su, R1, and R2) and distributed into sedentary (SD) and exercised (EX) (for 8 weeks of training), reaching eight groups of offspring (O): OSt SD, OSt EX, OSu SD, OSu EX, OR1 SD, OR1 EX, OR2 SD, and OR2 EX. Sleep, behavior, and analysis of key genes of dopaminergic system (D2, DAT) were performed after 8 weeks. The results for trained offspring that the mother received supplementation diet were the most expressive, with increased freezing and the OR1 SD group showed an increase in DAT protein content. These changes may have been due to the association between the dams diet during pregnancy and the practice of exercise by the offspring. The different concentrations of iron during pregnancy caused changes in the offspring, however, they were not associated with fetal programming in the context of RLS.

Introduction:Iron deficiency is associated with worse outcomes in children and adults with systolic heart failure. While oral iron replacement has been shown to be ineffective in adults with heart failure, its efficacy in children with heart failure is unknown. We hypothesised that oral iron would be ineffective in replenishing iron stores in ≥50% of children with heart failure.Methods:We performed a single-centre retrospective cohort study of patients aged ≤21 years with systolic heart failure and iron deficiency who received oral iron between 01/2013 and 04/2019. Iron deficiency was defined as ≥2 of the following: serum iron 300 ng/mL, transferrin saturation Results:Fifty-one children with systolic heart failure and iron deficiency (median age 11 years, 49% female) met inclusion criteria. Heart failure aetiologies included cardiomyopathy (51%), congenital heart disease (37%), and history of heart transplantation with graft dysfunction (12%). Median dose of oral iron therapy was 2.9 mg/kg/day of elemental iron, prescribed for a median duration of 96 days. Follow-up iron testing was available for 20 patients, of whom 55% (11/20) remained iron deficient despite oral iron therapy.Conclusions:This is the first report on the efficacy of oral iron therapy in children with heart failure. Over half of the children with heart failure did not respond to oral iron and remained iron deficient.

Anemia in pregnancy is anemia due to iron deficiency. The incidence of anemia in pregnant women ranges from 20% to 89%. As many as 40% of maternal deaths in developing countries are related to anemia in pregnancy and most often occur in developing countries, including Indonesia. In Indonesia, efforts made to overcome the problem of anemia in pregnant women are the administration of iron (Fe) tablets. This study aims to explain and analyse the relationship of adherence to Fe tablet consumption with anemia in pregnant women. This study uses a meta-analysis study. Researchers carried out research data collection by browsing online journals, using the Scopus and Google Scholar databases. In the meta-analysis process using the RevMan (Review Manager) 5.3 application, the results obtained Effect size (In Odds Ratio) of 2.44 (95% CI 1.30-4.60), which means that pregnant women who do not adhere to consuming Fe tablets have a risk 2.44 times affected by anemia compared to obedient pregnant women. There is a significant relationship between consuming Fe tablets and the incidence of anemia in pregnant women. Keywords: adherence, Fe tablets, anemia.

Background. The purpose was to theoretically and practically substantiate the existing approaches to the problem of prevalence, causes, clinical manifestations, as well as diagnosis and use of the latest methods of treatment of iron deficiency anemia (IDA) based on studying scientific ideas. Materials and methods. We used systematic analysis, synthesis, and generalization of scientific and medical literature to make it possible to consider modern views on the problem of IDA among different populations in terms of its epidemiology, etiology, presentation of iron metabolism in the body, and pathogenetic mechanisms of clinical and laboratory symptoms as well as modern methods of laboratory diagnosis of anemia and conclusions on a comprehensive approach to the treatment and prevention. Results. The most common blood disease is iron deficiency anemia. Iron deficiency occurs as a result of a mismatch between the body’s needs for iron and its intake or loss. According to the WHO, more than half of the population in different countries suffers from iron deficiency anemia. It covers all age groups but is most common in children, adolescents, and pregnant women. The symptoms of anemia are pale skin, fatigue, dizziness, shortness of breath, loss of consciousness, dysfunction of many organs. The most common causes of iron deficiency anemia are bleeding from wounds or peptic ulcers, hemorrhoidal bleeding, excessive blood loss during menstruation, uterine fibroids, ulcerative colitis, malignant tumors, gastrectomy, and others. In this disease, the iron depot in the body decreases. According to data from domestic and foreign scientists, as well as the WHO, IDA of varying severity is observed in 20 % of the population. The treatment of IDA should first eliminate the cause of bleeding, prescribe a protein-enriched diet, vitamins, and trace elements. In many countries, the prevention and treatment of anemia are becoming a social challenge. The presence of iron deficiency reduces the quality of life of patients, disrupts their ability to work, causes functional disorders of many organs and systems. To prevent and eliminate iron deficiency, a whole group of iron-containing drugs is successfully used, the range of which is constantly replenishing and updating, as well as a comprehensive approach to treatment with modern iron drugs is discussing. Conclusions. The main pathological and physiological conditions that lead to the development of iron deficiency in different population groups are analyzed. Therefore, the treatment of IDA is aimed not only at eliminating anemia as a symptom, but also at eliminating iron deficiency and replenishing its reserves in the body, which can be achieved by taking a liposomal form of iron.

The aim of the study was to determine, for the first time, in a prospective cross‐sectional multicenter study, the prevalence of iron deficiency (ID) in an Austrian pregnant population. A cohort of 425 pregnant women was classified into four groups of different weeks of gestation. Group 1 was monitored longitudinally, while groups 2–4, iron status, were sampled only once. Evaluation of the prevalence of ID was performed by comparing the diagnostic criteria of the WHO to the cutoff proposed by Achebe MM and Gafter‐Gvili A (Achebe) and the Austrian Nutrition Report (ANR). In comparison with the ANR, the prevalence of ID was lower in group 1 and higher in groups 2–4 (17.2% vs. 12.17%, 25.84%, 35.29%, and 41.76%, respectively) (p‐values, The aim of the study was to determine, for the first time, in a prospective cross‐sectional multicenter study the prevalence of iron deficiency (ID) in Austrian pregnant population. This study showed a prevalence of around 12% at the beginning of pregnancy, which increased during pregnancy up to 65%. ID can have a massive impact on the quality of life, so that screening would be entirely justified, as iron deficiency would be easy to diagnose and treat.

Background: Anaemia is one of the major public health problems worldwide. Commonest nutritional deficiency affecting more than 1.2 billion individuals worldwide 1. Iron deficiency anaemia is associated with a reduction in physical well being and decreased exercise capacity. The prevalence of anaemia is 30% in stable heart failure and 50% in hospitalized heart failure patients, compared with less than 10% in the general population 2.In iron deficiency anaemia, to maintain adequate oxygen delivery, cardiac output can increase by the compensatory increase in blood volume, preload, heart rate, and stroke volume, and decrease in afterload.If severe iron deficiency anaemia left untreated, it could cause secondary organ damage. Chronic severe iron deficiency anaemia causes cardiac remodelling, cardiomegaly, arrhythmia, left ventricular hypertrophy, and heart failure. Aim: To study the left ventricular dysfunction in patients with severe iron deficiency admitted in a tertiary care hospital. Materials and Methods: A Hospital-based Prospective study was conducted in the Department of Medicine, Santhiram medical college & general hospital for a 2 year period. Universal Sampling Technique was used for the selection of study subjects. All the patients coming to the medicine department during the study period with age > 18years with informed written consent taken from the patient,Hemoglobin< 6gm/dl (according to WHO criteria) and Red cell indices suggestive of iron deficiency anaemia The final sample size was 100 subjects. Results: Out of 100 patients, 62% were females, and 38% were males in the study group. The mean age in the study population was 40.68±12.5 years, with the minimum age being 18 years and maximum age is 70 years. The prevalence of LV dysfunction in the study group was 61%.51% of the total population had systolic dysfunction and 10% had diastolic dysfunction.39% of the total population had normal LV function. In patients with systolic dysfunction, 72.5% were females, and 27.5% were males. In diastolic dysfunction, 50% were males, and 50% were females. Conclusion: As iron deficiency anaemia is more prevalent globally, its consequences on the cardiovascular system were studied. Iron deficiency anaemia is a major public health problem in developing countries, and it causes major cardiovascular morbidity and mortality. Severe iron deficiency anaemia causes structural changes in the left ventricle leading to eccentric or concentric hypertrophy, which predisposes the patients to develop left ventricular dysfunction. Hence, early diagnosis and management of iron deficiency anaemia can reverse remodelling and prevent left ventricular dysfunction. Thus, reducing major cardiovascular morbidity and mortality.

The presence of chronic low-grade inflammation, commonly identified in patients with severe obesity, alters iron homeostasis and indicators of iron status, fostering the development of updated guidelines for the diagnosis of iron deficiency (ID). Current recommended diagnostic thresholds for ID in obesity derived from expert opinion include a ferritin level of30 ng/mL and/or transferrin saturation (TSAT)20%. Earlier studies of ID among candidates for metabolic surgery using low levels of ferritin or iron as diagnostic thresholds demonstrated a prevalence of 5%-20%.Using the current recommended diagnostic thresholds for ID, this study measures the prevalence of ID in a large cohort of surgical candidates and its relationship to surgical outcomes.Geisinger Medical Center, Danville, Pennsylvania.The study cohort included 3,723 patients who underwent pre- operative nutritional assessment which included markers of iron nutrition over the period 2004-2018.The cohort included 2,988 women (80.3%) and 735 men (19.7%); body mass index: 49.4 ± 9 kg/mThe prevalence of ID among surgical candidates (45.4%) is more than twice that identified as ID in earlier studies. ID was commonly identified in the absence of anemia. The most severe ID was found in those with a serum ferritin level30 ng/mL and TSAT20%. ID in the presence of inflammation is often unrecognized and has implications regarding surgical outcomes after metabolic surgery.

Background Iron deficiency (ID) has been associated with adverse pregnancy outcomes, maternal anaemia, and altered susceptibility to infection. In Papua New Guinea (PNG), monthly treatment with sulphadoxine-pyrimethamine plus azithromycin (SPAZ) prevented low birthweight (LBW; Methods Plasma ferritin levels measured at antenatal enrolment in a cohort of 1892 women were adjusted for concomitant inflammation using C-reactive protein and α-1-acid glycoprotein. Associations of ID (defined as ferritin Results At first antenatal visit (median gestational age, 22 weeks), 1256 women (66.4%) had ID. Overall, ID or ferritin levels at first antenatal visit were not associated with birth outcomes. There was effect modification by treatment arm. Amongst SPCQ recipients, ID was associated with a 81-g higher mean birthweight (95% confidence interval [CI] 10, 152; P = 0.025), and a twofold increase in ferritin levels was associated with increased odds of SGA (adjusted odds ratio [aOR] 1.25; 95% CI 1.06, 1.46; P = 0.007). By contrast, amongst SPAZ recipients, a twofold increase in ferritin was associated with reduced odds of LBW (aOR 0.80; 95% CI 0.67, 0.94; P = 0.009). Mediation analyses suggested that malaria infection or haemoglobin levels during pregnancy do not substantially mediate the association of ID with birth outcomes amongst SPCQ recipients. Conclusions Improved antenatal iron stores do not confer a benefit for the prevention of adverse birth outcomes in the context of malaria chemoprevention strategies that lack the non-malarial properties of monthly SPAZ. Research to determine the mechanisms by which ID protects from suboptimal foetal growth is needed to guide the design of new malaria prevention strategies and to inform iron supplementation policy in malaria-endemic settings. Trial registration ClinicalTrials.gov NCT01136850.