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Query: UMLS:C0240066 (iron deficiency)
 7,156 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infants of diabetic mothers frequently have polycythemia, elevated serum erythropoietin concentrations, and decreased serum iron and ferritin concentrations, likely representing a redistribution of fetal iron into erythrocytes to support augmented fetal hemoglobin synthesis. We hypothesized that fetal liver, heart, and brain iron concentrations are also reduced in these infants. After obtaining autopsy tissue from infants who had died before 7 days of age, we measured liver, heart, and brain iron concentrations using atomic absorption spectrophotometry. Seven infants of diabetic mothers and seven gestational age-matched control infants were studied. All infants of diabetic mothers had pancreatic islet cell hyperplasia, indicating fetal hyperglycemia and hyperinsulinemia. Liver iron concentrations in the infants of diabetic mothers were 6.6% of control values (489.0 +/- 154.4 vs 7379.7 +/- 1473.8 micrograms/gm dry tissue weight (mean +/- SEM); p less than 0.001), heart iron concentrations were 43.9% of control values (124.7 +/- 20.5 vs 284.1 +/- 34.8 micrograms/gm dry tissue weight; p less than 0.002), and brain iron concentrations were 60.6% of control values (106.1 +/- 13.7 vs 175.2 +/- 10.7 micrograms/gm dry tissue weight; p less than 0.003). Heart and brain iron concentrations were directly correlated with liver iron concentrations (r = 0.80 for both; p less than 0.001) and indicated that hepatic iron was greater than 75% depleted before heart and brain iron reduction. We conclude that severely affected infants of diabetic mothers have reduced liver, heart, and brain iron concentrations. The role of tissue iron deficiency in the genesis of the abnormal clinical findings in these infants deserves further consideration.
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PMID:Iron deficiency of liver, heart, and brain in newborn infants of diabetic mothers. 162 67

We have used recombinant human erythropoietin (rHuEPO) in a phase I/II clinical trial to evaluate its ability to reverse refractory anemia in hematologic disorders. rHuEPO was administered subcutaneously 5 days per week at escalating doses (50 to 150 U/kg per day). The aim of treatment was a hemoglobin (Hb) level greater than or equal to 10 g/dL without blood transfusion. Of 25 patients treated, 17 were evaluable, most of them with a regular need for transfusion. Eight of these had lymphoproliferative disorders (three cases of malignant lymphoma and five of monoclonal gammopathy) and were exposed to cytotoxic therapy. The other nine patients had hematopoietic stem cell disorders (four cases of myelodysplastic syndrome, three of idiopathic myelofibrosis, and two of chronic myelogenous leukemia). All patients with lymphoproliferative disorder had serum EPO levels inappropriately low for the degree of anemia, while patients with stem cell disorder showed variable values. Erythroid marrow activity was inadequate in all cases. Seven of eight patients with lymphoproliferative disorder responded to treatment maintaining Hb above 10 g/dL without transfusion. The median dose of rHuEPO required for correction of anemia was 75 U/kg. In four cases response was maintained with 50 U/kg, three times per week. There was no complete response among patients with hematopoietic stem cell disorder, although transfusion requirement was eliminated or reduced in four cases. Four patients developed functional iron deficiency during rHuEPO treatment and required iron supplementation to obtain response. Aggravation of splenomegaly was observed in two cases of myeloproliferative disorder. We conclude that: (1) subcutaneous administration of rHuEPO can be effective and safe in patients with lymphoproliferative disorder exposed to chemotherapy and showing inappropriate EPO response to anemia; (2) this is less likely in hematopoietic stem cell disorders, although favorable responses may be observed in occasional patients; and (3) functional iron deficiency as a cause of nonresponse to rHuEPO is frequent also in nonrenal anemia.
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PMID:Subcutaneous erythropoietin for treatment of refractory anemia in hematologic disorders. Results of a phase I/II clinical trial. 163 33

Recombinant human erythropoietin 50 units/kg intravenous twice a week was given to 9 anemic patients and end stage renal disease (ESRD) who were undergoing dialysis at the Kidney Centre. Of the total, 8 required no transfusion since the initiation of therapy and their haematocrit increased to approximately 29% or more with the improvement in general condition, sense of well being and exercise tolerance. One patient showed an increase in serum creatinine and two iron deficiency during therapy. In all cases blood pressure remained adequately controlled. No organ dysfunction or any other complication was observed.
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PMID:Experience of erythropoietin in anemia of end stage renal disease. 177 May 62

We studied 7 patients on chronic hemodialysis before and after 12 weeks of therapy with human recombinant erythropoietin. The drug was administered intravenously, 3 times a week at doses increasing from 50 to 125 U/kg. Dialysis was performed for 4 hr, 3 times a week and no blood transfusions were used during the study. An increased tolerance to daily physical activities was observed in all patients. Hematocrit increased from 19 +/- 3.4 to 28 +/- 4.1 and hemoglobin from 6.7 +/- 1.3 to 9.4 +/- 1.5, p less than 0.01. No changes were detected in blood pressure, weight, liver function tests and nutritional values. No patient developed either absolute (ferritin less than 30 ng/ml) or relative iron deficiency (transferrin saturation less than 20%) during the study. Efficiency of dialysis remained unaltered. No secondary effects from the drug were observed. Thus, this study confirms the clinical usefulness of human recombinant erythropoietin in patients with chronic renal failure and anemia on chronic dialysis.
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PMID:[Human recombinant erythropoietin (rH-EPO) in chronic hemodialysis patients]. 177 83

The effect of iron supplementation, 66 mg elemental iron daily, from the 16th week of gestation to delivery, on iron status markers during uncomplicated pregnancies was assessed in a randomised, double-blind, placebo controlled study of 207 healthy women (100 iron treated, 107 placebo treated) and their newborn babies. Haemoglobin (Hb) and serum (S-) human placental lactogen (HPL) were measured in all 207 females, while transferrin saturation, S-ferritin and S-erythropoietin (EPO) were measured in 120 females at monthly intervals. Hb: from 27th week of gestation to eight weeks post partum, the placebo treated group had significantly lower Hb levels than the iron treated group (p less than 0.001). Iron status markers: in the placebo group (n = 57), 92% developed exhausted iron stores (i.e. S-ferritin less than or equal to 20 micrograms/l), 65% latent iron deficiency (i.e. S-ferritin less than or equal to 20 micrograms/l and transferrin saturation less than 15%), and 18% iron deficiency anaemia (i.e. S-ferritin less than or equal to 20 micrograms/l, transferrin saturation less than 15% and Hb less than 110 g/l). In the iron treated group (n = 63), 54% developed exhausted iron stores, 6% latent iron deficiency, and none iron deficiency anaemia. S-EPO: the placebo group had significantly higher values than the iron treated group from the 27th week of gestation to one week post partum (p less than 0.01). S-HPL: levels were identical in placebo and iron treated females. Babies of iron treated mothers had higher S-ferritin than babies of placebo treated mothers (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. 180 36

The efficacy of recombinant human erythropoietin in correcting the anemia of the uraemic patient has been thoroughly confirmed. Iron deficiency, aluminum intoxication, severe hyperparathyroidism and infections are some of the main factors limiting patients' response to the drug. Worsening or de novo formation of arterial hypertension generally makes it necessary to diminish the degree of correction of anaemia. It is commonly accepted that anaemia should be only partially corrected and that the target haemoglobin level should be defined patient by patient.
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PMID:[Factors limiting the correction of anemia with recombinant human erythropoietin]. 181 32

In 81 patients with failing kidney transplant, plasma levels of erythropoietin, iron, ferritin and TIBC were assessed. Progression of failure of the excretory function of the kidney transplant was accompanied by decreasing Hb and Ht values but increasing plasma levels of erythropoietin. In all examined patients presence of iron deficiency could be excluded. Results obtained in this study suggest that relative erythropoietin deficiency is the major cause of anaemia in patient with a failing kidney transplant.
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PMID:[Plasma erythropoietin levels in kidney transplant patients with impaired function of the renal graft]. 189

The use of recombinant human erythropoietin (rhEPO) for the treatment of renal anemia is well accepted. However, the lowest effective dose for subcutaneous (SC) administration has not been determined. This study documents that a dose of 50 U/kg administered three times a week was effective in 10 children (age range, 13 days to 18.6 years) receiving continuous cycling peritoneal dialysis (CCPD) for a period ranging from 0.25 to 23.5 months. Their hematocrit (hct) increased at an average rate of 0.26% points per day from a baseline of 19.8% +/- 3.1% to a value of at least 30% after a mean of 7.4 +/- 2.5 weeks of treatment. When compared with other studies, this response was more rapid than what has been observed with the same dose administered intravenously (IV). This response was similar to that seen with larger IV doses. Hypertension and functional iron deficiency were the most common complications. Two patients with previously controlled hypertension developed elevation in blood pressure that was easily controlled by oral antihypertensives. Six patients required IV iron dextran to reestablish treatment response. A SC rhEPO dose less than 50 U/kg three times a week may be effective in children and should be investigated.
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PMID:Use of low-dose subcutaneous recombinant human erythropoietin in end-stage renal disease: experience with children receiving continuous cycling peritoneal dialysis. 192 63

The absence of any response to the administration of recombinant human erythropoietin (rHuEpo) is exceptional in uremic patients with anemia. Initial "nonresponders" generally respond to higher doses of the hormone. However, a small number of patients may remain unresponsive. The most common cause of limited response is mild to moderate iron deficiency, either at the start of treatment or secondary to enhanced iron utilization by newly formed erythrocytes. Another common cause of resistance is the presence of an overt or, more often, an unrecognized inflammatory state, including acute or chronic infection. Marked aluminum overload and severe hyperparathyroidism also have been shown to induce resistance in at least some patients. Other factors may contribute to the severity of anemia and hence increase rHuEpo requirements, such as acute or chronic hemolytic conditions or blood loss, folate deficiency, hemoglobinopathies, and still poorly defined uremic toxins. In patients who show a resistance to the effect of the recombinant hormone, these should be sought and eliminated, if possible.
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PMID:Modulating factors in the hematopoietic response to erythropoietin. 192 86

To study the safety and efficacy of administering human recombinant erythropoietin (rHuEPO) to infants with anaemia of prematurity, a combined phase I/II trial of weekly intravenous injections for 4 weeks was undertaken. We treated 16 infants with 10, 25, 50, 100 or 200 units/kg body weight in groups of two to four patients per dose level. They were all born prematurely (mean gestational age: 29 weeks; range 27-32), had a mean post-natal age of 42 days (range: 25-59) and haemoglobin concentration of 87 g/l (range: 72-94) when treatment was started. Four patients (25%) needed a transfusion during the trial, one at day 7 treated with 10 units/kg and 3 at days 15, 25, 29 with 100 units/kg. In the others, a progressive rise in mean haemoglobin values was seen in each group after 21 days of treatment, without a dose-dependent effect. A positive change in absolute reticulocyte counts with a peak after 7-14 days of therapy was observed with low (25-50 units/kg) but not with higher doses, with a significant difference at day 14 between 25 and 100 units/kg (P less than 0.01). A dose-limiting severe neutropenia (absolute neutrophil count less than 0.5 x 10(9)/l) occurred transiently in five patients, with doses greater than 25 units/kg. No infectious complication and no sign of iron deficiency were observed. Weekly low doses of rHuEPO appear safe, convenient to administer and able to induce a reticulocytic response in infants with anaemia of prematurity. A phase III placebo-controlled trial is needed to confirm these results. Neutropenia associated with rHuEPO administration in infants might be related to their stage of human ontogeny.
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PMID:Weekly intravenous administration of recombinant human erythropoietin in infants with the anaemia of prematurity. 195 38


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