Iron physopathology and approach to iron deficiency anemia: new treatment strategies

Abstract

     

Anemia is a multifactorial disorder affecting the oxygen transport capacity of blood that can be seen at any age. Anemia is not a disease but the most common laboratory parameter disorder in the world. In all age groups, there is anemia with up to 10% with increasing age and 2/3 of iron deficiency, 1/3 anemia are in the women of reproductive age  in Turkey. Iron deficiency anemia is the most common cause of iron loss in the world with the most frequent loss of menstruation. Especially malignancy is a condition that should not be missed. The aim of this review is to look for causes of anemia, especially iron deficiency anemia, and to suggest new approaches in treatment.

Keywords

• Anemia,iron deficiency,malignancy,reproductive age,Celiac disease,treatment

Demir fizyopatolojisi ve demir eksikliği anemisine yaklaşım: yeni tedavi stratejileri

Abstract

      Anemi her yaşta görülebilen kanın oksijen taşıma kapasitesini etkileyen multifaktöriyel bir bozukluktur. Anemi bir hastalık olmayıp, dünyada en sık rastlanan laboratuvar parametre bozukluğudur. Tüm yaş gruplarında yaş ile birlikte artmakla birlikte %10’lara varan anemi vardır. Türkiye’de üreme  dönemindeki kadınların 2/3’ünde demir eksikliği, 1/3’ünde ise anemi vardır. Demir eksikliği anemisinin tüm dünyada en sık nedeni menstrüasyonla kaybedilen demirin yeterince alınamamasıdır. Demir kaybı menstrüasyon dışında başka pek çok nedene de bağlı gelişebilmektedir. Özellikle malignite tanıda atlanmaması gereken bir durumdur. Bu derlemede bu kadar sık görülen aneminin, özellikle de demir eksikliği anemisinin nedenlerine bakış ve tedavisinde yeni yaklaşım önerilerinde bulunulması amaçlanmıştır.

Keywords

• Anemi,demir eksikliği,malinite,üreme dönemi,Çölyak hastalığı,tedavi

References

1. 1. Kasper DL, Fauci SA, Hauser SL, Longo DL, Jameson JL, Loscalzo J, (Eds.) Red blood cell disorders. Harrison's Manual of Medicine 19th ed. Mc Graw Hill; 2016: 267-74.
2. 2. Goldman-Cecil Medicine. Lee Goldman, Andrew I. Schafer (eds) Goldmann L, Schaffer AL. 25th ed. 2015.
3. 3. Dallman PR, Siimes MA: Percentile curves for hemoglobin and red cell volume in infancy and childhood. J Pediatr 1979; 94: 26-31.
4. 4. Wallace DF. The regulation of iron absorption and homeostasis. Clin Biochem Rev 2016; 37: 51.
5. 5. Waldvogel-Abramowski S, Waeber G, Gassner C, et al. Physiology of iron metabolism. Transfusion Med Hemother 2014; 41: 213-21.
6. 6. Silva B, Faustino P. An overview of molecular basis of iron metabolism regulation and the associated pathologies. Biochimica et Biophysica Acta (BBA)-Molecular Basis Dis 2015; 1852: 1347-59.
7. 7. Paul BY, Hong CC, Sachidanandan C, et al. Dorsomorphin inhibits BMP signals required for embryogenesis and iron metabolism. Nature Chem Biol 2008; 4: 33.
8. 8. Meynard D, Babitt JL, Lin HY. The liver: conductor of systemic iron balance. Blood 2014; 123: 168-76.

9. 9. Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood 2003; 102: 783-8.
10. 10. Nemeth E, Ganz T. The role of hepcidin in iron metabolism. Acta Haematol 2009; 122: 78-86.
11. 11. Drysdale J, Dugast I, Papadopoulos P, Zappone E. Intracellular iron metabolism. In Biotechnology of Plasma Proteins 1991; 58: 148-52). Karger Publishers.
12. 12. Miglioranza LH, Breganó JW, Dichi I, Matsuo T, Dichi JB, Barbosa DS. Effectiveness of fortification of corn flour-derived products with hydrogen-reduced elemental iron on iron-deficiency anaemia in children and adolescents in southern Brazil. Public Health Nutr 2009; 12: 244-8.
13. 13. Kleven MD, Jue S, Enns CA. Transferrin Receptors TfR1 and TfR2 Bind Transferrin through Differing Mechanisms. Biochem 2018; 6; 57: 1552-9
14. 14. Zhang P, Wang S, Wang L, et al. Hepcidin is an endogenous protective factor for osteoporosis by reducing iron levels. J Mol Endocrinol 2018; 60: 298-306.
15. 15. Hallberg L. Iron absorption and iron deficiency. Hum Nutr Clin Nutr 1982; 36: 259-78.
16. 16. Karaoglu L, Pehlivan E, Eğri M, et al. Prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey. BMC Public Health 2010; 10: 329.
17. 17. Harrington M, Hotz C, Zeder C, et al.A comparison of the bioavailability of ferrous fumarate and ferrous sulfate in non-anemic Mexican women and children consuming a sweetened maize and milk drink. Randomized controlled trial. Eur J Clin Nutr 2011; 65: 20-5.
18. 18. Hurrell RF. Preventing iron deficiency through food fortification. Nutr Rev 1997: 55: 210-22.
19. 19. Berger J, Dillon JC. Control of iron deficiency in developing countries. Sante 2002;12: 22-30.
20. 20. Huma N, Salim-Ur-Rehman, Anjum FM, Murtaza MA, Sheikh MA.Food fortification strategy--preventing iron deficiency anemia: a review. Crit Rev Food Sci Nutr 2007; 47: 259-65.
21. 21. Freeman HJ. Iron deficiency anemia in celiac disease. World J Gastroenterol 2015; 21: 9233-8.
22. 22. Mody RJ, Brown PI, Wechsler DS. Refractory iron deficiency anemia as the primary clinical manifestation of celiac disease. J Pediatr Hematol Oncol 2003; 25: 169-72
23. 23. Züleyha Akkan Çetinkaya, Mesut Sezikli. Demir eksikliği anemili hastalarda gastrointestinal endoskopik inceleme sonuçları. Dicle Tıp Derg 2011; 38: 155-9.