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Indian Pediatr 2017;54: 890 |
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Clippings
Theme: Hematology
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Deepak Bansal
Email:
[email protected]
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Serum ferritin for the diagnosis of cardiac and liver
iron overload in thalassemia (Br J Haematol. 2017 May 23. doi:
10.1111/bjh.14776. [Epub ahead of print])
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The aim of this study from 8 centers across Thailand was to assess the
accuracy of serum ferritin in the diagnosis of iron overload compared to
magnetic resonance imaging (MRI) in patients with thalassemia for
assessment of cardiac iron overload (CIO) and liver iron overload (LIO).
A total of 405 patients were included with a mean (SD) age of 18.8
(12.5) years; 296 (73%) had transfusion-dependent thalassemia, 61 (15%)
were not transfusion-dependent, and 48 (12%) were non-transfused. CIO
and LIO, respectively, were detected by MRI in 5% and 57% of cases.
Sensitivity of serum ferritin for CIO was excellent, but specificity was
relatively low. The overall positive predictive value was <10%,
indicating that serum ferritin was not appropriate for diagnosing CIO,
but was suitable for excluding CIO. For LIO, sensitivity of serum
ferritin was lower than for CIO, but specificity was better, indicating
that serum ferritin can be used to diagnose LIO. The diagnostic accuracy
of serum ferritin was sufficiently high to lead to a more efficient use
of MRI resources. In regions with limited access to MRI, serum ferritin
levels may be primarily used to rule out CIO and to rule in/diagnose
LIO.
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Low-dose ferrous sulfate vs iron
polysaccharide complex for treatment of nutritional
iron-deficiency anemia (JAMA. 2017;317:2297-304)
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The aim of this randomized controlled trial was to compare the effect of
ferrous sulfate with iron polysaccharide complex on hemoglobin
concentration in infants and children with nutritional iron deficiency
anemia (IDA) at a US tertiary care hospital. Children were administered
3 mg/kg of elemental iron once daily as either ferrous sulfate drops or
iron polysaccharide complex drops for 12 weeks. Of 80 randomized infants
and children, 59 completed the trial. From baseline to 12 weeks, mean
hemoglobin increased from 7.9 to 11.9 g/dL (ferrous sulfate group) vs
7.7 to 11.1 g/dL (iron polysaccharide complex group), a greater
difference of 1.0 g/dL (P<.001) with ferrous sulphate. Among
infants and children aged 9 to 48 months with IDA, ferrous sulphate
compared with iron polysaccharide complex resulted in a greater increase
in hemoglobin concentration at 12 weeks. Authors concluded that once
daily ferrous sulfate should be considered for children with nutritional
iron-deficiency anemia.
Another trial that reassures us to continue our trust with the
economical, though ‘non-glamorous’, ferrous sulphate for IDA in our
daily practice.
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Iron deficiency and Iron deficiency anemia in
breastfed healthy infants (Indian J Pediatr.
2017;84:505-8).
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There is often a dilemma regarding the age of starting iron
supplementation in healthy babies. The aim of this study from
Chandigarh, India, was to assess the prevalence of iron deficiency (ID)
and iron deficiency anemia (IDA) in predominantly breastfed, 3-5-mo-old
infants born at term with a birth weight e" 2.5 kg. Among 215 infants
enrolled, the prevalence of ID at 3, 4 and 5 mo of age was 5.4%, 21.4%
and 36.4%, while that of IDA was 4.6%, 16.7% and 11.4%, respectively.
Given the adverse neuro-cognitive and developmental outcomes of ID in
the developing brain, a prevalence of ID of 21.4% and 36.4% at the age
of 4 and 5 mo, respectively, is concerning.
It is crucial to run similar studies with a larger
sample size in different regions of India. If similar results are
observed, it would be reasonable to recommend iron supplementation at 4
months (as already recommended by American Academy of Pediatrics in the
USA), instead of the current practice of 6 months, recommended by
National Iron plus Initiative in India, in predominantly breastfed
‘healthy babies’.
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Episodic replacement of clotting factor
concentrates does not prevent bleeding or musculoskeletal damage
in haemophilia (Haemophilia. 2017; 23:538-46)
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A longitudinal study was carried out in 255 children from 10 centers in
nine developing countries over 5 years to assess the musculoskeletal
outcome of children on episodic factor replacement. The median (IQR) age
at the beginning of the study was 10 (7, 12) years. The study
demonstrated that with episodic factor replacement, there was no
meaningful reduction in the frequency of bleeding. Patients were still
likely to have significant joint disease by the time they reach their
teens or early adulthood. Authors concluded that episodic treatment with
clotting factor concentrates should not be recommended as a modality of
long-term management of hemophilia. The critical implication of the data
was that those patients in emerging countries who have access to >1000
IU/kg/year of clotting factors should be immediately shifted to a
prophylaxis regimen of at least 10-15 IU/kg twice a week. Authors
concluded that prophylaxis is the only way to preserve musculoskeletal
function in hemophilia.
A study with significant implications for decision makers of national
health policy, and for distribution of resources.
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