Background: Iron (Fe) metabolism is dependent on heme biosynthesis in bone marrow erythroblasts and is strictly controlled. Failure of this process induces to absolute or functional iron deficiency anemia (IDA), which is common in general medical practice. Aim: This study summarizes the Fe role in normal and disturbed erythopoietic process and focuses on current biochemical indicators and available therapeutic options for Fe imbalance. Methods: A systematic review in PubMed, MedLine and MDConsult database was conducted. The research limits included English abstracts and full texts, referring to erythropoiesis, anemia and Fe during the last decade. Results: Erythrocyte delivers oxygen to the tissues, so the primary consequence of anemia is tissue hypoxia. Oxygen-sensing cells in kidney respond to hypoxia by increasing erythropoietin (EPO), the basic regulatory hormone of erythropoiesis. Fe is an essential micronutrient for adequate erythropoietic function. Anemia of chronic disease (ACD) and IDA are characterized by disturbances in Fe homeostasis. In addition, inflammatory disorders and renal insufficiency are complicated by severe depression of EPO levels. Red cell indices (hemoglobin, mean cell hemoglobin) and biochemical markers (ferritin, transferrin saturation and receptors) reflect hemoglobin biosynthesis and iron pathways. The therapy of underlying disease is essential in IDA and ACD, whereas adjuvant procedures are red blood cells transfusion, erythropoietic agents and Fe supplementation. Conclusion: The approach of Fe-deficient patient is complex and based on wide range of clinical and laboratory findings. The precise evaluation of them is critical for diagnosis and management modalities.

BACKGROUND:

In Latin America and the Caribbean, anemia has been a public health problem that affects mainly women of childbearing age and children under 6 years of age. However, the current prevalence of anemia in this region is unknown.

OBJECTIVE:

To examine the latest available prevalence data on anemia in Latin America and the Caribbean.

METHODS:

A systematic review was conducted in 2011 and updated in 2014. Studies determining the prevalence of anemia conducted in apparently healthy populations with national or regional representativeness were included in the review.

RESULTS:

The lowest prevalence rates of anemia among children under 6 years of age were found in Chile (4.0%), Costa Rica (4.0%), Argentina (7.6%), and Mexico (19.9%). In Nicaragua, Brazil, Ecuador, El Panama, and Honduras, anemia was a moderate public health problem, with prevalence ranging Salvador, Cuba, Colombia, the Dominican Republic, Peru, from 20.1% to 37.3%. Anemia was a severe public health problem in Guatemala, Haiti, and Bolivia. The prevalence of anemia among women of childbearing age was lowest in Chile (5.1%). In Colombia, El Salvador, Costa Rica, Nicaragua, Ecuador, Mexico, Peru, Honduras, and Argentina, anemia was a mild public health problem, with prevalence ranging from 7.6% to 18.7%. In Guatemala, Brazil, the Dominican Republic, and Bolivia, anemia was a moderate public health problem, with prevalence ranging from 21.4% to 38.3%. Panama and Haiti had the highest reported prevalence rates (40.0% and 45.5%, respectively), and anemia was considered a severe public health problem in those countries.

CONCLUSIONS:

Anemia remains a public health problem in children under 6 years of age and women of childbearing age in most Latin America and Caribbean countries for which data are available.

Este artículo no tiene resumen

Introducción: la anemia es una enfermedad nutricional de alta prevalencia en los países en desarrollo. En Salta la desnutrición coexiste con el sobrepeso y la obesidad. Objetivos: determinar la prevalencia de anemia y su relación con el estado nutricional en niños, adolescentes y adultos de Salta capital. Materiales y métodos: estudio transversal, base de datos secundaria (Encuesta Nutricional de Capitales del NOA, 2014). Muestra estratificada bietápica. Variables: sexo, edad, anemia, estado nutricional, IMC (tablas de puntuaje z OMS niños y adolescentes): normal > -2 <+1, desnutrición ≤ -2, sobrepeso ≥ + 1, obesidad ≥ + 2. Adultos: desnutrición <18,5; normal ≥18,5 <25; sobrepeso ≥25 y <30; obesidad ≥30. Estatura baja (≤ -2 puntuaje z de la OMS). Análisis: distribución de frecuencia (chi2 , Fisher), comparación media (ANOVA), nivel de significación p<0,05. Programas utilizados: EXCEL, SPSS V18 y Anthro V.1.0.4 Plus-OMS. Resultados: se evaluaron 147 niños de 6-59 meses, 170 de 5-11 años, 70 de 12-14 años y 533 ≥15 años de edad, de ambos sexos. La prevalencia general de anemia fue del 7%, los grupos más afectados fueron niños de 6-59 meses (12,9%) y ≥15 años (8,3%, diferencia significativa por sexo). Se encontró anemia leve en 78,1%, moderada en 20,3% y grave en 1,6% de los casos. No hubo asociación entre el estado nutricional y la prevalencia de anemia, sin embargo el 47,5% de los niños de 6-59 meses y el 56,8% de los ≥15 años con anemia presentaron sobrepeso/obesidad. Los valores medios de hemoglobina fueron: 12,18 mg/dl±1,09 (6-59 m), 13,39 mg/dl±0,74 (5-5-11 a); 13,93±0,85 (12-14 a) y 13,91 mg/dl±1,44 (≥15 a). Conclusiones: la prevalencia de anemia observada fue baja pero aún es un problema de Salud Pública relevante que también afecta a las personas con sobrepeso y obesidad.

OBJECTIVES:

To describe a case of ceftriaxone-induced immune hemolytic anemia (CIIHA) in a 6 year-old boy with sickle cell disease (SCD) and perform a systematic literature review to delineate the clinical and laboratory features of this condition.

DATA SOURCES:

EMBASE (1947-January 2014), MEDLINE (1946-January 2014), and databases from the US Food and Drug Administration and Health Canada were searched, using anemia, hemolytic anemia, hemolysis, and ceftriaxone as search terms. Additional references were identified from a review of literature citations.

STUDY SELECTION AND DATA EXTRACTION:

All case reports and observational studies describing clinical and laboratory features of CIIHA were included.

DATA SYNTHESIS:

A total of 37 eligible reports of CIIHA were identified, including our index case, and 70% were children. Mortality was 30% in all age groups and 64% in children. The majority of patients had underlying conditions (70%), of which SCD was most commonly reported. Previous ceftriaxone exposure was reported in 65%. Common features included elevated lactate dehydrogenase (70%); early, new-onset hemoglobinuria (59%); acute renal failure (46%); positive direct antibody testing (70%); and anticeftriaxone antibodies (68%). Also, 32% had a preceding, unrecognized, hemolytic episode associated with ceftriaxone.

SUMMARY:

Given the common use of ceftriaxone worldwide, knowledge of CIIHA, which often goes undiagnosed until late in the course, is essential for clinicians. Based on the findings of this review, we suggest obtaining past history of ceftriaxone exposures and screening for new-onset hemoglobinuria during ceftriaxone therapy in selected patients as potential methods for early diagnosis of this rare but potentially fatal condition.

With the global scope of sickle-cell disease, knowledge of the countless clinical presentations and treatment of this disorder need to be familiar to generalists, haematologists, internists, and paediatricians alike. Additionally, an underlying grasp of sickle-cell pathophysiology, which has rapidly accrued new knowledge in areas related to erythrocyte and extra-erythrocyte events, is crucial to an understanding of the complexity of this molecular disease with protean manifestations. We highlight studies from past decades related to such translational research as the use of hydroxyurea in treatment, as well as the therapeutic promise of red-cell ion-channel blockers, and antiadhesion and anti-inflammatory therapy. The novel role of nitric oxide in sickle-cell pathophysiology and the range of its potential use in treatment are also reviewed. Understanding of disease as the result of a continuing interaction between basic scientists and clinical researchers is best exemplified by this entity.

BACKGROUND:

Postpartum anaemia is associated with breathlessness, tiredness, palpitations and maternal infections. Blood transfusions or iron supplementation have been used in the treatment of iron deficiency anaemia. Recently other anaemia treatments, in particular erythropoietin therapy, have also been used.

OBJECTIVES:

To assess the clinical effects of treatments for postpartum anaemia, including oral, intravenous or subcutaneous iron/folate supplementation and erythropoietin administration, and blood transfusion.

SEARCH METHODS:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to March 2003), Current Contents and ACP Journal Club (from inception to March 2003). We updated this search on 7 June 2012 and added the results to the awaiting classification section.

SELECTION CRITERIA:

Randomised controlled trials (RCTs) comparing therapy for postpartum iron deficiency anaemia (oral, intravenous or subcutaneous administration of iron, folate, erythropoietin or blood transfusion) with placebo, another treatment or no treatment.

DATA COLLECTION AND ANALYSIS:

Two reviewers independently assessed trial quality and extracted data.

MAIN RESULTS:

Six included RCTs involving 411 women described treatment with erythropoietin or iron as their primary interventions. No RCTs were identified that assessed treatment with blood transfusion. Few outcomes relating to clinical maternal and neonatal factors were reported: studies focused largely on surrogate outcomes such as haematological indices. Overall, the methodological quality of the included RCTs was reasonable; however, their usefulness in this review is restricted by the interventions and outcomes reported.
When compared with iron therapy only, erythropoietin increased the likelihood of lactation at discharge from hospital (1 RCT, n = 40; relative risk (RR) 1.90, 95% confidence interval (CI) 1.21 to 2.98). No apparent effect on need for blood transfusions was found, when erythropoietin plus iron was compared to treatment with iron only (2 RCTs, n = 100; RR 0.20, 95% CI 0.01 to 3.92), although the RCTs may have been of insufficient size to rule out important clinical differences. Haematological indices (haemoglobin and haemocrit) showed some increases when erythropoietin was compared to iron only, iron and folate, but not when compared with placebo.

AUTHORS' CONCLUSIONS:

There is some limited evidence of favourable outcomes for treatment of postpartum anaemia with erythropoietin. However, most of the available literature focuses on laboratory haematological indices, rather than clinical outcomes. Further high-quality trials assessing the treatment of postpartum anaemia with iron supplementation and blood transfusions are required. Future trials may also examine the significance of the severity of anaemia in relation to treatment, and an iron-rich diet as an intervention.
[Note: The 27 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

ANTECEDENTES:

La anemia de células falciformes es un trastorno que se presenta en todo el mundo, con la incidencia más elevada en áreas de África donde el paludismo es endémico. En algunas áreas de África, afecta hasta 1 de 60 lactantes. Existen varias complicaciones potencialmente graves asociadas con esta afección y se sugiere que el tratamiento temprano (antes de que se desarrollen los síntomas) puede mejorar tanto la morbilidad como la mortalidad. La detección de la afección en el período neonatal permitiría el diagnóstico temprano y, por consiguiente, el tratamiento temprano.

OBJETIVOS:

Evaluar si existen pruebas de que la detección neonatal de la anemia de células falciformes, en lugar del diagnóstico sintomático, reduce los resultados adversos a corto y largo plazo para quienes se les detecta la enfermedad, sin resultados adversos en la población sometida al cribaje (screening).

ESTRATEGIA DE BÚSQUEDA:

Se realizaron búsquedas en el registro de ensayos de hemoglobinopatías del Grupo Cochrane de Fibrosis Quística (Cochrane Cystic Fibrosis and Genetic Disorders Group). Se estableció contacto con expertos en el tema en busca de cualquier trabajo aún no publicado. También se hicieron búsquedas en las listas de referencias de estudios publicados.

FECHA DE LA BÚSQUEDA MÁS RECIENTE EN EL REGISTRO DE ENSAYOS DEL GRUPO:

Noviembre 2003.

CRITERIOS DE SELECCIÓN:

Cualquier ensayo aleatorio o cuasialeatorio, publicado o no publicado, que comparaba el diagnóstico mediante el cribaje (screening) del diagnóstico clínico, sería considerado elegible para la inclusión.

RECOPILACIÓN Y ANÁLISIS DE DATOS:

No se encontraron ensayos de detección neonatal de la anemia de células falciformes.

RESULTADOS PRINCIPALES:

No se encontraron ensayos de detección neonatal de la anemia de células falciformes.

CONCLUSIONES DE LOS AUTORES:

Faltan pruebas de ensayos de detección neonatal de la anemia de células falciformes.
Existen pruebas del beneficio derivado del tratamiento temprano, que es posible por la detección, y existen algunas revisiones y análisis económicos de la bibliografía no procedentes de ensayos, que sugieren que la detección es apropiada. Por lo tanto, los profesionales de atención sanitaria deben evaluar si la información proporcionada por estos documentos es pertinente a su práctica y a la situación cuando toman decisiones con respecto a la detección neonatal de la anemia de células falciformes.
Deben tenerse en cuenta las revisiones sistemáticas de intervenciones / tratamientos tempranos, que incluyen la profilaxis con penicilina, la vacuna neumocócica y la educación de los padres.

ANTECEDENTES:

La transfusión de sangre se usa en pacientes con anemia palúdica grave, pero pone en riesgo de reacciones adversas, la transmisión de la enfermedad y es complicado organizarla en los países en desarrollo.

OBJETIVOS:

Esta revisión evalúa los efectos de la transfusión de sangre sistemática para la anemia grave con respecto a la muerte y los resultados adversos en áreas de paludismo.

ESTRATEGIA DE BÚSQUEDA:

Se realizaron búsquedas en el registro especializado del Grupo Cochrane de Enfermedades Infecciosas (Cochrane Infectious Diseases Group) (mayo de 2004), Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials, CENTRAL) ( Número 2, 2004), MEDLINE (desde 1966 hasta mayo de 2004), EMBASE (desde1980 hasta mayo de 2004), LILACS (mayo de 2004), y en las listas de referencias de los artículos pertinentes. Se estableció contacto con los investigadores y organizaciones que trabajan en el tema.

CRITERIOS DE SELECCIÓN:

Ensayos aleatorios y cuasialeatorios de la transfusión de sangre comparada con el tratamiento conservador en la anemia grave asociada al paludismo.

RECOPILACIÓN Y ANÁLISIS DE DATOS:

Un solo revisor (MM) identificó los ensayos y extrajo los datos y un segundo revisor (HS) los verificó. Ambos revisores, de forma independiente, aplicaron los criterios de inclusión y extrajeron los datos.

RESULTADOS PRINCIPALES:

Se incluyeron dos ensayos aleatorios con 230 niños. En el grupo de transfusión, hubo una tendencia no significativa hacia una menor cantidad de muertes (RR 0,41; IC del 95%: 0,06 a 2,70), pero una tendencia hacia eventos adversos más graves (RR 8,60; IC del 95%: 1,11 a 66,43). En un ensayo realizado por Bojang (1997a) la dificultad respiratoria fue menos frecuente y la estancia hospitalaria fue más corta en el grupo de transfusión (DMP 1,88 días, IC del 95%: 2,41 a 1,35). La necesidad posterior de una transfusión sanguínea de urgencia fue menos frecuente en el grupo de transfusión (RR 0,12; IC del 95%: 0,02 a 0,68). Al día 28, el volumen del concentrado celular fue menor en el grupo de transfusión (DMP -1,34; IC del 95%: -2,57 a -0,11). No hubo información sobre la transmisión del virus VIH o de la hepatitis B.

CONCLUSIONES DE LOS AUTORES:

No hay datos suficientes para asegurar que el administrar sangre en forma sistemática a niños clínicamente estables con anemia grave en áreas de paludismo endémicas reduce la muerte, o resulta en un hematocrito más elevado medido al mes.

BACKGROUND:

Erythropoiesis-stimulating agents are used to treat anaemia in people with chronic kidney disease (CKD). Several agents are available including epoetin alfa or beta as well as agents with a longer duration of action, darbepoetin alfa and methoxy polyethylene glycol-epoetin beta.

OBJECTIVES:

To assess the benefits and harms of darbepoetin alfa to treat anaemia in adults and children with CKD (stages 3 to 5, 5D, and kidney transplant recipients).

SEARCH METHODS:

We searched the Cochrane Renal Group's Specialised Register (to 13 January 2014) through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE.

SELECTION CRITERIA:

We included randomised controlled trials of any darbepoetin alfa treatment of at least three months duration in adults or children with CKD (any stage).

DATA COLLECTION AND ANALYSIS:

Data were extracted by two independent investigators. Patient-centred outcomes (need for blood transfusion, iron therapy, progression of kidney disease, total and cardiovascular mortality, cardiovascular events, cancer, hypertension, seizures, and health-related quality of life) and other outcomes (haemoglobin levels) were assessed using random effects meta-analysis. We calculated risk ratios for dichotomous outcomes and mean differences for continuous outcomes, both with 95% confidence intervals.

MAIN RESULTS:

We identified 32 studies comprising 9414 participants; 21 studies in 8328 participants could be included in our meta-analyses. One study (4038 participants) compared darbepoetin alfa to placebo, 16 studies (2955 participants) compared darbepoetin alfa to epoetin alfa or beta, four studies (1198 participants) compared darbepoetin alfa to methoxy polyethylene glycol-epoetin beta, three studies (420 participants) compared more frequent with less frequent darbepoetin alfa administration and four studies (303 participants) compared intravenous with subcutaneous darbepoetin alfa administration.
In a single large study, darbepoetin alfa reduced the need for blood transfusion and iron therapy compared with placebo in adults with CKD stage 3 to 5, but had little or no effect on survival, increased risks of hypertension, and had uncertain effects on quality of life. Data comparing darbepoetin alfa with epoetin alfa or beta or methoxy polyethylene glycol-epoetin beta were sparse and inconclusive. Comparisons of differing dosing schedules and routes of administration were compared in small numbers of participants and studies. Evidence for treatment effects of darbepoetin alfa were particularly limited for children with CKD, adults with CKD stage 5D, and recipients of a kidney transplant.
Studies included in this review were generally at high or unclear risk of bias for all items (random sequence generation, allocation concealment, incomplete outcome data, blinding of participants and personnel, blinding of outcome assessment, selective outcome reporting, intention to treat analysis and other sources of bias). One large study comparing darbepoetin alfa with placebo was at low risk of bias for most items assessed.

AUTHORS' CONCLUSIONS:

Data suggest that darbepoetin alfa effectively reduces need for blood transfusions in adults with CKD stage 3 to 5, but has little or no effect on mortality or quality of life. The effects of darbepoetin alfa in adults with CKD stage 5D and kidney transplant recipients and children with CKD remain uncertain as do the relative benefits and harms of darbepoetin alfa compared with other ESAs (epoetin alfa or beta and methoxy polyethylene glycol-epoetin beta).