MDNG Primary CareNovember 2010
Volume 12
Issue 11

Medical WebsitesPutting Prevention into Practice: Screening for Iron Deficiency Anemia

Originally published in American Family Physician in 2009, the article featured on this site provides important information on screening for iron deficiency anemia in pregnant women and young children. Written by Iris R. Mabry-Hernandez, MD, MPH, of the Agency for Healthcare Research and Quality, the piece begins with the case study of a 25-year-old pregnant woman with a family history of anemia who asks if she should be taking an iron supplement. After reading the case study, visitors can test their knowledge of the subject by answering three questions and reading the explanations for each.

The Educated PatientAre Iron Injections Right for You?

One of several features articles featured on the website for the National Anemia Action Council, this page helps patients determine whether they should consider taking iron injections to treat an iron deficiency. Visitors can also learn why the body needs iron, what happens when iron levels drop too low, what are the side effects of over-the-counter iron pills, what types of patients are eligible for iron injections, what are the different forms of injections, what are the possible side effects, and how doses are managed. Links are also included to other informative pages, such as “Anemia FAQs,” “Anemia and Nutrition: The Importance of Iron,” and “A Patient’s Guide to Oral Iron Supplements.”

Iron-Deficiency Anemia

Because this site is offered by the National Heart Lung and Blood Institute, part of the National Institutes of Health, you can be sure that the content is reliable. Recommend this resource to patients who aren’t familiar with iron-deficiency anemia, “a common, easily treated condition.” Here, they can obtain information about the causes of iron-deficiency anemia, signs and symptoms of both anemia and iron-deficiency anemia, the tests and procedures used to diagnose the conditions, treatment options available, and how iron-deficiency anemia can be prevented in infants, young children, and women.

CMEAnemia in Your Office 2009-2010Credits: 1.00

Fee: None

Expires: June 2, 2013

Multimedia: Audio/Video

The ability to accurately diagnose the reason for anemia, one of the most common findings in clinical medicine, is a “critical element of patient evaluation.” In this webcast, Robert T. Means, Jr., MD, of the University of Kentucky, will discuss how physicians can more effectively develop a logical approach the diagnosis of anemia, and learn to distinguish anemia syndromes which can be managed in the primary care practice from those requiring a specialist referral.

Improving Upon the Established Practice Parameter for CKD-Related Anemia: Where Are We in Maintaining Target Hemoglobin Levels?Credits: 0.50

Fee: None

Expires: April 27, 2011

Multimedia: Audio/Slides

In this two-part activity, experts from the University of Pennsylvania School of Medicine will discuss current issues pertaining to the management of chronic kidney disease-related anemia. Included is an overview of available therapies for the treatment of CKD-related anemia; a discussion of the various factors that may be responsible for hemoglobin variability and hyporesponsiveness to erythropoiesis stimulating agents; and an assessment of the risk of cardiovascular disease in patients with CKD-related anemia and how inflammation and ESA treatment might impact the risk.

PodcastsSickle Cell and the Influence of Chronic Therapies on Bone Mineral Density

This Medical University of South Carolina podcast describes an observational study of bone health in adult and pediatric patients with sickle cell anemia, who have been shown to have high rates of osteoporosis. Liz Walsh, MD, a fellow in pediatric endocrinology, also talks about why these patients tend to have weak bones, and how this can potentially be managed.

Clinical TrialsEfficacy and Safety of Intravenous Ferric Carboxymaltose in Patients with Iron Deficiency AnemiaStudy Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: Vital Prospects Clinical Research Institute

Purpose: This multi-center, randomized, active-controlled study is being conducted to assess the efficacy and safety of intravenous ferric carboxymaltose (FCM) in patients with iron deficiency anemia (IDA). Subjects who meet the initial screening criteria will be given oral iron for a two-week period to test their response; those still eligible after that will then be randomized to receive an IV infusion of FCM or venofer or continue with oral ferrous sulfate. Participation in the study requires eight visits over a four-month period.

Skin and Blood Research Samples from Healthy Volunteers and Sickle Cell Anemia PatientsStudy Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: Washington University School of Medicine

Purpose: Using skin and blood samples from healthy volunteers and patients with sickle cell anemia, investigators aim to “use homologous recombination to correct β-globin gene mutations in therapeutically useful cells, like autologous-induced pluripotent stem cells from sickle cell anemia patients.” They also aim to confirm genetic mutations in sickle cell anemia patients.

eAbstractsMotor Development in 9-month-old Infants in Relation to Cultural Differences and Iron StatusJournal: Developmental Psychobiology (October 28, 2010)

Authors: Angulo-Barroso R, Schapiro L, Liang W, et al

Purpose: To compare fine and gross motor development in 209 nine-month-old infants from urban areas of China, Ghana, and the United States (African-Americans) and consider the effects of iron status. The authors hypothesized that motor development can be influenced by cultural practices and nutritional factors, such as iron deficiency.

Results: Iron deficiency anemia was most common in the Ghana sample (55%); when controlling for iron status, the authors found that “Ghanaian infants displayed precocity in gross motor development and most fine-motor reach-and-grasp tasks, while African-Americans from the US performed the poorest in all tasks except bimanual coordination and the large ball. When controlling for cultural site, they found that iron status showed linear trends for gross motor milestones and fine motor skills with small objects. These results, they said, “indicate the need to consider nutritional factors when examining cultural differences in infant development.”

Optimization of Therapy for Severe Aplastic Anemia Based on Clinical, Biological and Treatment Response ParametersJournal: Biology of Blood and Marrow Transplantation (October 26, 2010)

Authors: Pulsipher M, Young N, Tolar J, et al

Purpose: The Blood and Marrow Transplant Clinical Trials Network convened a group of international experts in March 2010 to define the most important questions in the basic science, immunosuppressive therapy (IST), and bone marrow transplantation (BMT) of severe aplastic anemia (SAA) and propose initiatives to facilitate clinical and biologic research.

Results: Key conclusions, according to the study, included the following: “1) new patients should obtain accurate, expert diagnosis and early identification of biological risk; 2) a population-based SAA outcomes registry should be established in North America to collect data on patients longitudinally from diagnosis through and after treatment; 3) a repository of biologic samples linked to the clinical data in the outcomes registry should be developed; 4) innovative approaches to unrelated donor BMT that decrease graft vs. host disease are needed, and 5) alternative donor transplantation approaches for patients lacking HLA-matched unrelated donors must be improved.” The researchers plan to develop initiatives and partner with advocacy and funding organizations to help address these challenges.

Pharma Focus

Feraheme (ferumoxytol) injection

A Trial of Ferumoxytol for the Treatment of Iron Deficiency AnemiaStudy Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: AMAG Pharmaceuticals, Inc.

Purpose: This phase III, randomized trial is being conducted to evaluate the safety and efficacy of ferumoxytol compared with placebo for the treatment of iron deficiency anemia. The primary outcome measure for patients will be hemoglobin changes.

Plasma Pharmacokinetics of Two Consecutive Doses of Ferumoxytol in Healthy SubjectsJournal: Clinical Pharmacology & Therapeutics (August 2010)

Authors: Pai A, Nielsen J, Kausz A, et al

Purpose: To ascertain the efficacy and safety of two doses of ferumoxytol, an iron formulation administered rapidly as two IV boluses of 510 mg each, 24 hours apart, in 58 healthy subjects.

Results: Researchers conducted population pharmacokinetics analysis, and determined that “a two-compartment open model with zero-order input and Michaelis-Menten elimination” best described the data. They concluded that ferumoxytol given as two consecutive 510-mg doses was well tolerated for the treatment of iron-deficiency anemia.

From the NetworkTurns out Popeye Was on to Something

Although iron deficiency is a common problem that has long-term implications for children’s development and behavior, it is frequently undetected, according to a clinical report published in Pediatrics, which provides guidelines for the diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and toddlers from birth through 3 years of age.

The American Journal of Managed Care

The Role of Erythropoiesis-Stimulating Agents in the Treatment of Anemia

Although erythropoiesis-stimulating agents are the most common treatment for anemia, the guidelines associated with these agents “can cause confusion for those tasked with prescribing them, so it is imperative that clinicians be more cognizant of the treatment recommendations for different patient populations to make the proper treatment decisions.”

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