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British Journal of Haematology Aug 2018Immune-mediated disorders affecting the gastrointestinal (GI) tract may compromise GI integrity, interfere with the absorption of nutrients and cause bleeding and... (Review)
Review
Immune-mediated disorders affecting the gastrointestinal (GI) tract may compromise GI integrity, interfere with the absorption of nutrients and cause bleeding and inflammation. All these features contribute to the pathogenesis of anaemia, the most prevalent extra-intestinal manifestation of immune-mediated GI disorders. Anaemia is most commonly due to iron deficiency and/or inflammation, but vitamin deficiencies and, more infrequently, autoimmune haemolysis or drug-induced myelosuppression can be involved. Here we address several issues related to the differential diagnosis and treatment of anaemia in immune-mediated GI disorders, giving particular relevance to the problem of iron deficiency anaemia associated with inflammation. It is emphasized how, in most cases, anaemias due to iron or vitamin deficiencies are best treated by parenteral administration of the deficient factor(s), and how the available high dose intravenous (IV) iron formulations can reduce ambulatory and social costs of IV iron supplementation, while improving patient's compliance to treatment. Actual and future treatment possibilities for anaemia of inflammation, involving the use of erythropoiesis stimulating agents, biologicals and hepcidin inhibitors are discussed.
Topics: Anemia; Autoimmune Diseases; Celiac Disease; Diagnosis, Differential; Gastritis, Atrophic; Gastrointestinal Diseases; Humans; Inflammatory Bowel Diseases
PubMed: 29732532
DOI: 10.1111/bjh.15254 -
Malaria Journal Apr 2012Plasmodium vivax threatens nearly half the world's population and is a significant impediment to achievement of the millennium development goals. It is an important, but... (Review)
Review
Plasmodium vivax threatens nearly half the world's population and is a significant impediment to achievement of the millennium development goals. It is an important, but incompletely understood, cause of anaemia. This review synthesizes current evidence on the epidemiology, pathogenesis, treatment and consequences of vivax-associated anaemia. Young children are at high risk of clinically significant and potentially severe vivax-associated anaemia, particularly in countries where transmission is intense and relapses are frequent. Despite reaching lower densities than Plasmodium falciparum, Plasmodium vivax causes similar absolute reduction in red blood cell mass because it results in proportionately greater removal of uninfected red blood cells. Severe vivax anaemia is associated with substantial indirect mortality and morbidity through impaired resilience to co-morbidities, obstetric complications and requirement for blood transfusion. Anaemia can be averted by early and effective anti-malarial treatment.
Topics: Anemia; Antimalarials; Humans; Malaria, Vivax; Plasmodium vivax
PubMed: 22540175
DOI: 10.1186/1475-2875-11-135 -
Annals of Agricultural and... Mar 2024Iron is an essential trace element for various cellular proteins and for biological processes in all cells. Severe iron deficiency (ID) impairs haem synthesis, reduces... (Review)
Review
Iron is an essential trace element for various cellular proteins and for biological processes in all cells. Severe iron deficiency (ID) impairs haem synthesis, reduces erythropoiesis and causes iron deficiency anaemia (IDA). Iron restriction in anaemia of inflammation is mainly due to retention of iron in macrophages. This condition is known as 'functional iron deficiency'. A review of studies performed in Europe shows that the prevalence of ID and IDA in young children varies by region. It is more common in eastern than western European countries. This overview summarises information on the need for iron supplementation in children, and the current understanding of the regulatory mechanisms of iron homeostasis and ironrestricted erythropoiesis. The causes of anaemia during infection and the usefulness of classical and new indicators to distinguish absolute from functional iron deficiency are discussed.
Topics: Child; Humans; Child, Preschool; Anemia, Iron-Deficiency; Iron Deficiencies; Anemia; Iron; Inflammation; Prevalence
PubMed: 38549491
DOI: 10.26444/aaem/171121 -
Anaesthesia Jan 2016Peri-operative anaemia, blood loss and allogeneic blood transfusion are associated with increased postoperative morbidity and mortality, and prolonged hospital stay. A... (Review)
Review
Peri-operative anaemia, blood loss and allogeneic blood transfusion are associated with increased postoperative morbidity and mortality, and prolonged hospital stay. A multidisciplinary, multimodal, individualised strategy, collectively termed 'patient blood management', may reduce or eliminate allogeneic blood transfusion and improve outcomes. This approach has three objectives: the detection and treatment of peri-operative anaemia; the reduction of peri-operative bleeding and coagulopathy; and harnessing and optimising the physiological tolerance of anaemia. This review focuses on the pre-operative evaluation of erythropoiesis, coagulation status and platelet function. Where possible, evidence is graded systematically and recommended therapies follow recently published consensus guidance.
Topics: Anemia; Blood Coagulation Disorders; Blood Loss, Surgical; Humans; Postoperative Complications; Preoperative Care
PubMed: 26620143
DOI: 10.1111/anae.13304 -
British Journal of Hospital Medicine... Aug 2022Anaemia affects a third of surgical patients and is associated with increased morbidity and mortality. Iron deficiency is the most common cause of anaemia and can be...
Anaemia affects a third of surgical patients and is associated with increased morbidity and mortality. Iron deficiency is the most common cause of anaemia and can be absolute or functional. Patients may require treatment with oral or intravenous iron.
Topics: Administration, Intravenous; Anemia; Anemia, Iron-Deficiency; Humans; Iron; Iron Deficiencies
PubMed: 36066297
DOI: 10.12968/hmed.2022.0040 -
BMC Public Health Jul 2023Anaemia is a reduction in haemoglobin concentration below a threshold, resulting from various factors including severe blood loss during and after childbirth. Symptoms... (Review)
Review
BACKGROUND
Anaemia is a reduction in haemoglobin concentration below a threshold, resulting from various factors including severe blood loss during and after childbirth. Symptoms of anaemia include fatigue and weakness, among others, affecting health and quality of life. Anaemic pregnant women have an increased risk of premature delivery, a low-birthweight infant, and postpartum depression. They are also more likely to have anaemia in the postpartum period which can lead to an ongoing condition and affect subsequent pregnancies. In 2019 nearly 37% of pregnant women globally had anaemia, and estimates suggest that 50-80% of postpartum women in low- and middle-income countries have anaemia, but currently there is no standard measurement or classification for postpartum anaemia.
METHODS
A rapid landscape review was conducted to identify and characterize postpartum anaemia measurement searching references within three published systematic reviews of anaemia, including studies published between 2012 and 2021. We then conducted a new search for relevant literature from February 2021 to April 2022 in EMBASE and MEDLINE using a similar search strategy as used in the published reviews.
RESULTS
In total, we identified 53 relevant studies. The timing of haemoglobin measurement ranged from within the immediate postpartum period to over 6 weeks. The thresholds used to diagnose anaemia in postpartum women varied considerably, with < 120, < 110, < 100 and < 80 g/L the most frequently reported. Other laboratory results frequently reported included ferritin and transferrin receptor. Clinical outcomes reported in 32 out of 53 studies included postpartum depression, quality of life, and fatigue. Haemoglobin measurements were performed in a laboratory, although it is unclear from the studies if venous samples and automatic analysers were used in all cases.
CONCLUSIONS
This review demonstrates the need for improving postpartum anaemia measurement given the variability observed in published measures. With the high prevalence of anaemia, the relatively simple treatment for non-severe cases of iron deficiency anaemia, and its importance to public health with multi-generational effects, it is crucial to develop common measures for women in the postpartum period and promote rapid uptake and reporting.
Topics: Female; Humans; Pregnancy; Iron; Depression, Postpartum; Quality of Life; Anemia, Iron-Deficiency; Anemia; Postpartum Period; Fatigue; Hemoglobins
PubMed: 37518003
DOI: 10.1186/s12889-023-16383-3 -
The British Journal of Surgery Oct 2015Preoperative anaemia and perioperative blood transfusion are both identifiable and preventable surgical risks. Patient blood management is a multimodal approach to... (Review)
Review
BACKGROUND
Preoperative anaemia and perioperative blood transfusion are both identifiable and preventable surgical risks. Patient blood management is a multimodal approach to address this issue. It focuses on three pillars of care: the detection and treatment of preoperative anaemia; the reduction of perioperative blood loss; and harnessing and optimizing the patient-specific physiological reserve of anaemia, including restrictive haemoglobin transfusion triggers. This article reviews why patient blood management is needed and strategies for its incorporation into surgical pathways.
METHODS
Studies investigating the three pillars of patient blood management were identified using PubMed, focusing on recent evidence-based guidance for perioperative management.
RESULTS
Anaemia is common in surgical practice. Both anaemia and blood transfusion are independently associated with adverse outcomes. Functional iron deficiency (iron restriction due to increased levels of hepcidin) is the most common cause of preoperative anaemia, and should be treated with intravenous iron. Intraoperative blood loss can be reduced with antifibrinolytic drugs such as tranexamic acid, and cell salvage should be used. A restrictive transfusion practice should be the standard of care after surgery.
CONCLUSION
The significance of preoperative anaemia appears underappreciated, and its detection should lead to routine investigation and treatment before elective surgery. The risks of unnecessary blood transfusion are increasingly being recognized. Strategic adoption of patient blood management in surgical practice is recommended, and will reduce costs and improve outcomes in surgery.
Topics: Anemia; Blood Loss, Surgical; Combined Modality Therapy; Elective Surgical Procedures; Humans; Postoperative Complications; Preoperative Care; Preoperative Period; Risk Factors; Transfusion Reaction
PubMed: 26313653
DOI: 10.1002/bjs.9898 -
British Journal of Anaesthesia Aug 2022
Topics: Aged; Anemia; Cardiac Surgical Procedures; Disabled Persons; Humans; Postoperative Period
PubMed: 35637022
DOI: 10.1016/j.bja.2022.04.017 -
Advances in Nutrition (Bethesda, Md.) May 2017Anemia can be related to decreased production or increased loss of erythrocytes, or both, leading to many underlying and often overlapping causes. A largely cereal-based... (Review)
Review
Anemia can be related to decreased production or increased loss of erythrocytes, or both, leading to many underlying and often overlapping causes. A largely cereal-based diet with plenty of phytates, polyphenols, and other ligands that inhibit intestinal iron absorption predominated in preindustrial Europe and predominates in present-day developing countries alike. In both situations, we find poor hygienic conditions, which frequently lead to anemia of inflammation. The large number of possible causes and their interaction shows why it is so difficult to mitigate anemia prevalence. Diagnostic biomarkers are required to differentiate the different types of anemia and to treat them appropriately. Some of them are well established in adults [e.g., concentrations of serum ferritin, soluble transferrin receptor (sTfR), and serum iron or the ratio of sTfR to log ferritin]. Others, such as serum hepcidin, hold considerable promise, although they are not yet widely used. A particular issue is to establish reference values for biomarkers in infants and children at different ages. The fact that resource-rich postindustrial societies have a very low prevalence of iron-deficiency anemia offers hope that common types of anemia can be eliminated. In contrast, inborn forms of anemia, such as thalassemia, and anemias related to underlying diseases (e.g., bleeding tumors or peptic ulcers, gynecologic blood losses, or renal diseases) require an operational health system to be addressed appropriately.
Topics: Anemia; Biomarkers; Global Health; Hepcidins; Humans; Iron; Iron Deficiencies; Prevalence
PubMed: 28507005
DOI: 10.3945/an.116.013847 -
Blood Apr 2011Under evolutionary pressure to counter the toxicity of iron and to maintain adequate iron supply for hemoglobin synthesis and essential metabolic functions, humans and... (Review)
Review
Under evolutionary pressure to counter the toxicity of iron and to maintain adequate iron supply for hemoglobin synthesis and essential metabolic functions, humans and other vertebrates have effective mechanisms to conserve iron and to regulate its concentration, storage, and distribution in tissues. The iron-regulatory hormone hepcidin, first described 10 years ago, and its receptor and iron channel ferroportin control the dietary absorption, storage, and tissue distribution of iron. Hepcidin causes ferroportin internalization and degradation, thereby decreasing iron transfer into blood plasma from the duodenum, from macrophages involved in recycling senescent erythrocytes, and from iron-storing hepatocytes. Hepcidin is feedback regulated by iron concentrations in plasma and the liver and by erythropoietic demand for iron. Genetic malfunctions affecting the hepcidin-ferroportin axis are a main cause of iron overload disorders but can also cause iron-restricted anemias. Modulation of hepcidin and ferroportin expression during infection and inflammation couples iron metabolism to host defense and decreases iron availability to invading pathogens. This response also restricts the iron supply to erythropoietic precursors and may cause or contribute to the anemia associated with infections and inflammatory disorders.
Topics: Anemia; Antimicrobial Cationic Peptides; Cation Transport Proteins; Feedback, Physiological; Hepcidins; Humans; Iron
PubMed: 21346250
DOI: 10.1182/blood-2011-01-258467