Demir Eksikliği Anemili Kadın Hastalarda İntravenöz Demir Tedavisinin Etkinliği

Öz

Bu çalışmada, dünyada ve Türkiye'de prevalansının yüksek olması nedeniyle bir halk sağlığı sorunu olan demir eksikliği anemisinde (DEA) intravenöz (İV) ferrik karboksimaltoz tedavisinin etkinliğinin gösterilmesi amaçlandı. Bölgedeki ilk çalışma olması nedeniyle önemi daha da artmaktadır. Haziran 2018-Eylül 2019 tarihleri arasında Siirt Eğitim ve Araştırma Hastanesi İç Hastalıkları Polikliniği'ne başvuran, DEA tanılı ve İV demir karboksimaltoz tedavisi uygulanan 80 kadın çalışmaya dahil edildi. Kadın hastalardan gönüllü onam alındıktan sonra tedavi öncesi ve sonrası biyokimyasal veriler retrospektif olarak çalışmaya dahil edildi. Tedavi sonrası hemoglobin (HGB), hematokrit (HTC), ortalama hücre hacmi (MCV), ferritin, demir ve B12 değerleri istatistiksel olarak arttı (p<0.05). (p<0.05). Ayrıca trombosit (PLT), toplam demir bağlama kapasitesi (TIBC) ve folat değerleri istatistiksel olarak anlamlı derecede düşüktü (p<0.05). Çalışma bölgedeki kadın DEA profilini ortaya koyması ve İV demir tedavisi verilerinin olumlu sonuçlarını göstermesi açısından önemlidir. Çalışmanın DEA tedavi protokolleri oluşturulurken akılcı olmayan ilaç kullanımına, tedavi süresinin uzamasına ve yüksek tedavi harcamalarına çözüm bulunmasında yol gösterici olabileceği düşünülmektedir.

Anahtar Kelimeler

• Demir eksikliği anemisi
• Demir replasmanı
• İntravenoz karboksimaltoz
• Serum TIBC
• Serum folat

Efficacy of Intravenous Iron Therapy in Female Patients with Iron Deficiency Anemia

Öz

Abstract: In this study, it was aimed to show the efficacy of intravenous (IV) ferric carboxymaltose treatment for iron deficiency anemia (IDA), which is a public health problem due to its high prevalence in the world and in Turkey. Since it is the first study in the region, its importance is increasing even more. Eighty female diagnosed with IDA and treated with IV iron carboxymaltose, who applied to Siirt Training and Research Hospital Internal Diseases Polyclinics between June 2018 and September 2019, were included in the study. After obtaining voluntary consent of female patients, biochemical data of pre- and post-treatment were included in the study retrospectively. After treatment, hemoglobin (HGB), hematocrit (HTC), mean cell volume (MCV), ferritin, iron and B12 values increased statistically (p<0.05). In addition, platelet (PLT), total iron binding capacity (TIBC) and folate values were statistically significantly lower (p<0.05). The study is important in terms of revealing the female IDA profile in the region and showing the positive results of IV iron therapy data. It is thought that the study can be a guide in finding solutions to irrational drug use, prolongation of the treatment period and high expenditures while creating IDA treatment protocols.

Anahtar Kelimeler

• Iron deficiency anemia
• Iron replacement
• Intravenous carboxymaltose
• Serum TIBC
• Serum folate

Kaynakça

1. Bainton DF, Finch CA. The diagnosis of iron deficiency anemia. Am J Med, 1967;37:62-69.
2. DeMaeyer E, Adiels-Tegman M. The prevelance of anemia in the world. World Health Stat Q 1985;38:302-306.
3. Frewin R, Henson A, Provan D. Iron deficiency anemia. BMJ 1997;314:360-363.
4. T.C. Sağlık Bakanlığı, Anne Çocuk Sağlığı Genel Müdürlüğü. 12- 23 aylık çocuklarda demir kullanımı araştırması raporu, Ankara; 2008.
5. Danielson BG, Geisser P, Schneider W. [eds]. Iron therapy with special emphasis on intravenous administration. 1st ed. St. Gallen, Switzerland: Vifor (International) Inc; 1996.
6. Huch R, Breymann C. Anaemia in pregnancy and postpartum. 2nd ed. Bremen, Germany: Uni-Med Science Verlag; 2006.
7. Chamate E. Treatment of iron deficiency anemia in pregnancy and the immediate puerperium and other ferropenic conditions with saccharated iron administered intravenously in fractionated doses. Abstract at XIVth International Congress of Haematology; Sao Paolo, Brasil; 1972.
8. Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ, et al. Anemia and mortality in heart failure patients a systematic review and meta-analysis. Journal of the American College of Cardiology, 2008;52(10),818–827.

9. Goddard AF, McIntyre AS, & Scott BB. Guidelines for the management of iron deficiency anaemia. British Society of Gastroenterology. Gut, 46 Suppl 3-4 (Suppl 4), IV1–IV5; 2000.
10. Punnonen K, Irjala K, Rajama A. Serum Transferrin Receptor and Its Ratio to Serum Ferritin in the Diagnosis of Iron Deficiency. Blood 1997;89:1052-1057.
11. Iron Deficiency - Investigation and Management Effective Date: June 15, British Columbia Guidelines & protocols advisory commitee, 2010.
12. Cook JD. Diagnosis and management of iron-deficiency anaemia. Best Pract Res Clin Haematol 2005;18:319.
13. Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med 2008;121:943.
14. Seid MH, Mangione A, Valaoras TG, Anthony LB, Barish CF. Safety profile of iron carboxymaltose, a new high dose intravenous iron in patients with iron deficiency anemia. Blood. 2006;108(11):3739.
15. Breymann C, Honegger C, Holzgreve W, Surbek D. Diagnosis and treatment of iron deficiency anaemia during pregnancy and postpartum. Arch Gynecol Obstet. 2010;282:577-80.
16. Van Wyck DB, Martens MG, Seid MH, Baker JB, Mangione A. Intravenous ferric carboxymaltose compared with oral iron in the treatment of postpartum anemia: A randomized controlled trial. Obstet Gynecol. 2007;110:267-78.
17. Breymann C, Gliga F, Bejenariu C, Strizhova N. Comparative efficacy and safety of intravenous ferric carboxymaltose in the treatment of postpartum iron deficiency anemia. International Journal of Gynecology and Obstetrics. 2008;101:67-73.
18. Kadiroğulları P, Seçkin KD, Bafalı Oİ, Polat İ. Postpartum Dönemde Demir Eksikliği Anemisi Olan Hastalarda İntravenöz ve Oral Demir Tedavisinin Karşılaştırması. Turk J Clin Lab. 2018;4:336-341.
19. Auerbach M, Coyne D, Ballard H. Intravenous iron: from anathema to standard of care. Am J Hematol. 2008;83:580–88.
20. Avni T, Bieber A, Grossman A, Green H, Leibovici L, Gafter-Gvili A. The safety of intravenous iron preparations: systematic review and meta analysis. Mayo Clin Proc. 2015;90(1):12-23.
21. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066-1074.
22. Vural T, Özcan A, Sancı M. Güncel bilgiler ışığında gebelikte demir eksikliği anemisi: Demir desteği kime? Ne zaman? Ne kadar? Van Tıp Dergisi. 2016;23(4):369-376.
23. Christoph P, Schuller C, Studer H, Irion O, De Tejada BM, Surbek D. Intravenous iron treatment in pregnancy: comparison of high-dose ferric carboxymaltose vs. iron sucrose. J Perinat Med. 2012;40(5):469–74.
24. Barut A, Harma M. Intravenous iron treatment for iron deficiency anaemia in pregnancy. J Turk Ger Gynecol Assoc. 2009;10:109–115.
25. Milman N. Anemia-still a major health problem in many parts of the world! Ann Haematol. 2011;90(4):369-377.
26. Murray-Kolb L. Maternal mortality, child mortality, perinatal mortality, child cognition, and estimates of prevalence of anemia due to iron deficiency. Baltimore: CHERG; 2012.
27. Memişoğulları R, Ak Yıldırım H, Uçgun T, Erkan ME, Güneş C, Erbaş M, et al. Prevalence and etiology of anemias in the adult Turkish population. Turkish Journal of Medical Sciences. 2012;42:957-63.
28. Awidi M., Bawaneh H., Zureigat H., AlHusban M., & Awidi A. Contributing factors to iron deficiency anemia in women in Jordan: A single-center cross-sectional study. PLoS One, 2018;13(11),e0205868.
29. Kefeli M., Örnek Z., Kardeş H., & Ekemen C. Okul çağındaki çocuklarda vitamin B12, folat ve demir eksikliği prevalansının değerlendirilmesi. Ege Tıp Dergisi, 2021;60(3),244-251.