Deferasirox is a new oral iron chelator. It is the first oral iron chelator approved in USA by FDA for transfusion-dependent patients above 2 years suffering from severe chronic iron overload. It is also recommended as the initial therapy for patients over the age of 6 years who are suffering from beta-thalassaemia. The clinical study is developing in China. This review focuses the related studies and the latest progression about deferasirox. The phase II and III clinical trials and pharmacokinetics indicated that deferasirox is a safety and effective oral iron chelator, can significantly decrease the myocardial and hepatic iron load, also is easy to accept for patients. The common adverse reactions are gastrointestinal symptom and rash. But it was recently reported that deferasirox has some rare adverse events to which we must attach importance, especially for the special people. Besides the patients with chronic iron overload resulting from blood transfusions (transfusional hemosiderosis), the drug is also used for the patients who has accepted auto-SCT or suffered from reversible renal inadequacy caused by Fanconi syndrome. The standard dosage is not useful to every patient. The clinician should adjust dosage based on the patient's condition and related indexes. The serum ferritin is not one and reliable index to monitoring the effect and adjust the dosage. Otherwise, this review recommends some new characters of deferasirox, e.g. anti-fungus, anti-cell proliferation and so on.
Benzoates ; administration & dosage ; Clinical Trials as Topic ; Humans ; Iron Chelating Agents ; administration & dosage ; Triazoles ; administration & dosage

Administration, Intravenous ; Asian People ; Consensus ; Humans ; Iron ; Medicine, Chinese Traditional

OBJECTIVETo investigate calcium, iron and magnesium intakes of preterm infants' mothers before and during pregnancy and calcium, iron and magnesium levels of preterm infants and their mothers in order to provide basis for studying the effect of nutritional factors on the occurrence of prematurity.

METHODSTwo hundred and forty matched cases (preterm infants and their mothers) and controls (term infants and their mothers) were recruited. A nutritional survey of calcium, iron and magnesium intakes was performed in the mothers before and during pregnancy. Calcium, iron and magnesium levels in maternal plasma and in cord blood, placenta, breast milk, meconium, and amniotic fluid were measured with axial view inductively coupled plasma optical emission spectrometry (ICP-OES).

RESULTSIron and magnesium intakes in preterm infants' mothers were significantly less than those in term infants' mothers before pregnancy (P<0.05). Iron and calcium intakes in preterm infants' mothers were also significantly less than those in term infants' mothers during pregnancy (P<0.05). Multivariate analysis of variance showed that iron and calcium levels of preterm infants' mothers were significantly lower than those of term infants' mothers (P<0.05). The preterm infants showed significantly lower iron and magnesium levels than term infants (P<0.05). Plasma levels of calcium, iron and magnesium in infants were positively correlated to maternal plasma levels of calcium, iron and magnesium (r=0.517, 0.622, 0.518, respectively; P<0.05).

CONCLUSIONSThe iron and calcium levels of preterm infants' mothers were lower than those of term infants' mothers, and the iron and magnesium levels of preterm infants were lower than those of term infants. The exact relationship between calcium, iron and magnesium levels and intakes before and during pregnancy needs to be explored further.

Calcium ; blood ; Calcium, Dietary ; administration & dosage ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; blood ; Iron ; blood ; Iron, Dietary ; administration & dosage ; Magnesium ; administration & dosage ; blood ; Pregnancy ; blood

OBJECTIVETo explore the effect of vitamin A (VA) combined iron supplements on iron metabolic homeostasis for preschoolers.

METHODSAbout 445 preschoolers with aged 3-6 years old from eight kindergartens in Pixian county, Chengdu were recruited into this trial from March to September, 2011. All subjects met the inclusion criteria were randomly divided into four groups using random number table: sole VA supplementation group (VA group, a single oral dose of VA at about 200 000 units), sole iron supplementation group (FE group, daily oral supplementation with the element iron 1-2 mg·kg(-1)·d(-1) for five days a week, lasting for 6 months), the combined supplementation of VA and iron group (VF group) and control group (CO group, no VA and iron supplementation). The concentration of serum VA, serum ferritin (SF), serum transferring receptor (sTfR), C-reactive protein (CRP) and hemoglobin (Hb) were measured from 3 ml vein blood. The sTfR-SF index (TFR-F index) and total body iron content (TBIC) before and after intervention were calculated. The differences of these indexes between groups before and after intervention were analyzed.

RESULTSThe level of sTfR before intervention in VA group ((1.78 ± 0.17) mg/L) was significantly higher than that of after intervention ((1.18 ± 0.11)mg/L) (t = 28.88, P < 0.01). The levels of TFR-F index and TBIC in FE and VF groups before intervention ( (1.59 ± 0.37), (1.63 ± 0.40) and (9.04 ± 2.71), (9.26 ± 2.33) mg/kg, respectively) were all lower than those of after intervention (TFR-F index:(1.84 ± 0.51), (1.87 ± 0.45) and TBIC:(12.42 ± 3.49), (13.01 ± 2.98)mg/kg) (t values were 3.93, 3.78, 7.57 and 9.41, respectively, all P values were <0.01). The incidence of iron deficiency in VA, FE, and VF groups before intervention were 26% (25/95), 31% (30/98) and 31% (28/90) and were 41% (39/95), 10% (10/98) and 18% (16/90) for after intervention, respectively. The difference of this index in VA, FE and VF groups were significant (χ(2) values were 4.59, 12.50 and 4.31, respectively, all the P values were <0.05).

CONCLUSIONCombined VA and iron was as effective as VA alone or iron alone in decreasing the iron deficiency, the impact of VA intervention on iron metabolic homeostasis was mainly manifested in iron usage and mobilization, but showed no effect on total body iron content.

Anemia, Iron-Deficiency ; epidemiology ; Child ; Child, Preschool ; Dietary Supplements ; Female ; Homeostasis ; Humans ; Iron ; administration & dosage ; metabolism ; Male ; Nutritional Status ; Vitamin A ; administration & dosage ; pharmacology

OBJECTIVE: This study was performed to evaluate the effects of oral administration of iron supplements during pregnancy on maternal hemoglobin concentrations and birth weights. METHOD: Data from clinical records of 141 pregnant women and their babies were analysed. Studied mothers were classified to 3 groups such as non iron supplement group (groupI), 2-3 months supplement group (group II), and over 4 months supplement group (group III) by the duration (months) of oral supplement prescribed. RESULTS: There was positive correlation between hemoglobin levels and iron supplement duration. Proportions of anemia showed decreasing basis with the increasing iron supplement duration. The maternal hemoglobin levels showed decreasing basis with the increasing birth weight. There was positive correlation between iron supplement duration and maternal hemoglobin levels, but there was no significant correlation between iron supplement duration and birth weight. For the groupI(non-supplement group), maternal hemoglobin levels were decreased with the increasing birth weight but there was no significant correlations between hemoglobin levels and birth weights with increased iron supplement duration. CONCLUSION: There was a significant inverse correlation between maternal hemoglobin levels and birth weight in non-iron supplement group but there was no significant correlations between hemoglobin levels and birth weights with increased iron supplement duration.
Administration, Oral* ; Anemia ; Birth Weight* ; Female ; Humans ; Iron* ; Mothers ; Parturition* ; Pregnancy* ; Pregnant Women

PURPOSE: To compare liver hemangioma with hepatocellular carcinoma (HCC), as seen on superparamagneticiron oxide (SPIO)-enhanced MR images. MATERIALS AND METHODS: The study involved 30 patients with 51 focal hepatic mass lesions (31 hemangiomas, 20 HCCs). Breath-hold T1-weighted fast low angle shot (FLASH) and respiratory-triggered T2-weighted turbo-spin echo (TSE) images were obtained at 1.5 T before and after intravenous administration of SPIO particles. For quantitative analysis, percentage signal intensity change (PSIC) and contrast-to-noise ratio (CNR) of the lesions were calculated for T1-weighted FLASH and T2-weighted TSE before and after intravenous administration of SPIO particles. In addition, lesion conspicuity and imaging artifacts were analyzed qualitatively. RESULTS: After SPIO administration, percentage signal intensity increase on T1-weighted FLASH images was 73.0 +/-22.1% for hemangiomas and 21.8 +/-12.6% for HCCs, the difference being significant (p < 0.05). Taking a signal increase of 40% on postcontrast T1-weighted FLASH as the cut-off value, sensitivity and specificity for hemangiomas were 96.8% and 100%, respectively. In addition, the percentages of signal intensity loss on T2-weighted TSE images for hemangiomas and HCCs were 35.5 +/-17.2% and 0.2 +/-10.5%, respectively (p < 0.05). A comparison of lesion to liver CNR before and after SPIO infusion showed readings-for hemangiomas and HCCs, respectively - of 15.4 +/-6.0 and 4.7 +/-4.4 on T1-weighted FLASH images, and -2.6 +/-0.7 and 2.7 +/-4.4 on T2-weighted TSE images (p < 0.05). Qualitative analysis indicated that the conspicuity of HCCs was noticeably greater on postcontrast T2-weighted TSE images than on precontrast images (p < 0.05). CONCLUSION: The positive enhancement seen on T1-weighted FLASH images and the negative enhancement on T2 weighted TSE observed in liver hemangiomas after the administration of SPIO particles are valuable diagnostic features that can help characterize hemangiomas and differentiate them from HCCs.
Administration, Intravenous ; Artifacts ; Carcinoma, Hepatocellular* ; Hemangioma* ; Humans ; Iron* ; Liver ; Magnetic Resonance Imaging* ; Sensitivity and Specificity

This study was aimed to explore the potential therapy of Gambogic acid (GA) combined with magnetic nanoparticle of Fe3O4 (Fe3O4-MNP) on leukemia. The proliferation of U937 cells and the cytotoxicity were evaluated by MTT assay. Cell apoptosis was observed and analyzed by microscopy and flow cytometry respectively. The expressions of gene and protein were detected by quantitative real-time polymerase chain reaction and Western blot respectively. The results showed that GA enhanced the cytotoxicity for U937 cells in dose- and time-dependent manners. The Fe3O4-MNP itself had not cytotoxicity, but could enhance the inhibitory effect of GA on proliferation of U937 cells. The apoptotic rate of U937 cells induced by combination of GA with Fe3O4-MNP was higher than that by GA alone. The typical apoptotic features of cells treated with GA and Fe3O4-MNP were observed. The expression levels of caspase-3 and bax after co-treatment of GA and Fe3O4-MNP were higher than that exposed to GA or Fe3O4-MNP alone, but the expressions of bcl-2, NF-kappaB and survivin were down-regulated. It is concluded that Fe3O4-MNP can promote GA-induced apoptosis in U937 cells, and the combination of GA with Fe3O4-MNP may be a safer and less toxic new therapy for leukemia.
Apoptosis ; drug effects ; Humans ; Iron Compounds ; administration & dosage ; pharmacology ; Magnetics ; Nanoparticles ; U937 Cells ; Xanthones ; pharmacology

We report a casewith altered biodistribution of (99m)Tc-dicarboxypropane diphosphonate ((99m)Tc-DPD) on whole body bone scan after intravenous iron supplement therapy. A 47-year-old male patient who had recently been detected with a hepatic mass suggestive of hepatocellular carcinoma underwent bone scan as staging work-up before surgery. Bone scan images at 3 h after injection of (99m)Tc-DPD demonstrated unusually increased blood pool activities in the heart, liver, and spleen with usual skeletal uptakes. The patient had been treated for severe anemia from hemorrhoid with two intravenous administration of ferric hydroxide carboxymaltose complex at approximately 22 h and 2 h prior to the (99m)Tc-DPD injection, which we consider as themost probable cause of altered biodistribution of (99m)Tc-DPD.
Administration, Intravenous ; Anemia ; Carcinoma, Hepatocellular ; Heart ; Hemorrhoids ; Humans ; Iron ; Liver ; Male ; Middle Aged ; Spleen

Iron deficiency anemia (IDA) frequently occurs in infants and adolescents. IDA is the result of an interplay between increased host requirements, limited external supply, and increased blood loss. In outpatient clinics, we often see children with iron deficiency anemia. Most cases in children are caused by incomplete nutrient supplements and growth spurts. However, we can occasionally see patients with poor response despite iron supplementation. Failure of iron therapy occurs when a child does not receive the prescribed medication, when iron is given in a form that is poorly absorbed, or when there is a continuing unrecognized blood loss such as intestinal or pulmonary loss, or loss with menstrual periods. In addition, the therapeutic failure of iron medication may indicate that the original diagnosis of nutritional iron deficiency was incorrect. In this situation, we have to evaluate other etiologies of anemia. Recently, many cases relating H.pylori infection to iron deficiency anemia have been described in the literature and H.pylori infection has emerged as a cause of refractory iron deficiency anemia that is unresponsive to oral iron therapy. Also, iron deficiency anemia induced by athletics in adolescent females has been reported several times. In this article, the author reviews various etiologies of childhood iron deficiency anemia. The most important consideration in treatment of iron deficiency anemia is disclosure of the underlying cause and its recovery. Dietary habits should also be corrected. To supplement iron, 6 mg/kg of oral iron supplements (elemental iron) is recommended in ferrous salt form. If oral administration is not feasible, intravenous supplementation is recommended using forms such as iron dextran, iron gluconate, or iron sucrose.
Administration, Oral ; Adolescent ; Ambulatory Care Facilities ; Anemia ; Anemia, Iron-Deficiency ; Child ; Dextrans ; Disclosure ; Female ; Ferric Compounds ; Food Habits ; Glucaric Acid ; Gluconates ; Humans ; Infant ; Iron ; Sports ; Sucrose

OBJECTIVETo analyze the effects to iron status who were given preventive iron supplements for two months from when they were breast-fed to four-month-old.

METHODSA total of 123 infants in four-month-old age who were breast-fed were randomly divided into iron supplementation group (63 cases) and control group (60 cases), iron supplementation group was supplied with low-dose iron (1 mg×kg⁻¹×d⁻¹) for two months with no intervention for control group. Blood samples were collected to test C reactive protein and iron status indicators in six-month-old age group infants, and the growth indices were measured and compared on the gender difference of iron status at and 6 months.

RESULTSAfter 2 months of low-dose iron supplementation, the hemoglobin of iron supplementation group (26 cases) increased about 5.5 g/L while the control group (34 cases) increases about 0.0 g/L (median), 95% confidence intervals were -7.0 - 13.0 g/L and -9.0 - 15.0 g/L, respectively. The hemoglobin increase of iron supplementation group was higher than the control group, the difference was statistically significant (u = -2.326, P < 0.05). The other iron nutritional status and the growth did not show any significant difference between iron supplementation group and control group (P > 0.05). At age 6 month, the MCV of the boys were (75.89 ± 3.34) fl, while the girls were (77.20 ± 3.17) fl. The boys had lower values of MCV than the girls, and the gender difference was statistically significant (t = 4.73, P < 0.05). The other iron nutritional status did not show any significant gender difference (P > 0.05).

CONCLUSIONLow-dose iron supplementation of breast-fed infants at 4-month-old can increase the hemoglobin level when they were 6-month-old, and had no measurable side effect on growth.

Anemia, Iron-Deficiency ; prevention & control ; Breast Feeding ; Dietary Supplements ; Female ; Humans ; Infant ; Infant, Newborn ; Iron, Dietary ; administration & dosage ; therapeutic use ; Male ; Nutritional Status