medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2025, Número 3

<< Anterior Siguiente >>

Ginecol Obstet Mex 2025; 93 (3)


Anemia por deficiencia de hierro: mecanismos, tratamientos y suplementación

Ramos PC, Álvarez AK, Ventura EY, Cordero HE, Martínez ME, Olarte CI, Gallardo RAG

Idioma: Español
Referencias bibliográficas: 76
Paginas: 86-102
Archivo PDF: 408.52 Kb.


RESUMEN

Antecedentes: La deficiencia de hierro es la principal causa de anemia en el mundo, afecta a un tercio de la población, sobre todo a niños menores de cinco años y mujeres en edad reproductiva. Esta deficiencia afecta la calidad de vida en cualquier edad y reduce, considerablemente, los años de vida saludable. La prevalencia varía, globalmente, pero aún entre los habitantes de países con acceso limitado a la atención médica y a programas de nutrición. En México, la anemia afecta al 27.8% de las mujeres embarazadas, con mayores tasas en las áreas rurales. La anemia de las madres repercute en la salud del recién nacido y, globalmente, contribuye con 115,000 muertes maternas anuales.
Objetivo: Explorar las principales características del mecanismo, tratamiento y formulaciones asociadas con la anemia por deficiencia de hierro.
Metodología: Búsqueda sistemática de la bibliografía de estudios retrospectivos y prospectivos en las bases de datos de PubMed, EMBASE y Cochrane de 1990 a 2024. Los criterios de selección incluyeron estudios de pacientes con anemia asociada con deficiencia de hierro que recibieron tratamiento oral, liposomal o con otro tipo de formulaciones, como las nuevas opciones terapéuticas.
Conclusiones: En años recientes ya se dispone de nuevas formulaciones basadas en el uso de liposomas para mejorar la absorción y reducir los eventos adversos, sobre todo los gastrointestinales. Estas nuevas formulaciones representan una opción prometedora para poblaciones de mujeres embarazadas y adultos mayores.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Brittenham GM, Moir-Meyer G, Abuga KM, Datta-Mitra A,et al. Biology of anemia: A Public Health Perspective. J Nutr 2023;153–28. http://doi: 10.1016/j.tjnut.2023.07.018.

  2. Pasricha SR, Drakesmith H, Black J, Hipgrave D, et. al. Controlof iron deficiency anemia in low- and middle-incomecountries. Blood 2013; 121 (14): 2607-17. http://doi.org/10.1182/blood-2012-09-453522

  3. Safiri S, Kolahi AA, Noori M, Nejadghaderi SA, et al. Burdenof anemia and its underlying causes in 204 countries andterritories, 1990-2019: results from the Global Burden ofDisease Study 2019. J Hematol Oncol 2021; 14 (1): 185.http://doi: 10.1186/s13045-021-01202-2.

  4. Mujica-Coopman MF, Brito A, López de Romaña D, Ríos-Castillo I, et al. Prevalence of anemia in Latin America andthe Caribbean. Food Nutr Bull 2015; 36 (2 Suppl): S119-28.http://doi.org/10.1177/0379572115585775

  5. Shamah-Levy T, Villalpando S, Rivera JA, Mejía-Rodríguez F,et. al. Anemia in Mexican women: a public health problem.Salud Publica Mex 2003; 45 Suppl 4: S499-507. http://doi.org/10.1590/s0036-36342003001000006

  6. Casanueva E, de Regil LM, Flores-Campuzano MF. Irondeficiency anemia among Mexican women on reproductiveage. History of an unresolved problem. Salud PublicaMex 2006; 48 (2): 166-75. http://doi.org/10.1590/s0036-36342006000200010

  7. Monárrez-Espino J, Martínez H, Greiner T. Iron deficiencyanemia in Tarahumara women of reproductive-age in northernMexico. Salud Publica Mex 2001; 43 (5): 392-401. http://doi.org/10.1590/s0036-36342001000500002

  8. McLean E, Cogswell M, Egli I, Wojdyla D, et al. Worldwideprevalence of anaemia, WHO Vitamin and MineralNutrition Information System, 1993-2005. Public HealthNutr 2009; 12 (4): 444-54. http://doi.org/10.1017/S1368980008002401

  9. Padmavathi, Narahari. Awareness of anemia in pregnancyamong the caregivers of pregnant women in SaveethaMedical College Hospital” International Journal of Scientificand Research Publications 2014; 5 (3).

  10. Iriarte-Gahete M, Tarancon-Diez L, Garrido-Rodríguez V,Leal M, et. al. Absolute and functional iron deficiency:Biomarkers, impact on immune system, and therapy. BloodRev 2024; 101227. http://doi: 10.1016/j.blre.2024.101227

  11. Barragán-Ibañez G, Santoyo-Sánchez A, Ramos-Peñafiel CO.Iron deficiency anaemia. Rev médica Hosp Gen Méx 2016;79 (2): 88-97. http://doi.org/10.1016/j.hgmx.2015.06.008

  12. DeLoughery TG. Iron deficiency anemia. Med Clin NorthAm 2017; 101 (2): 319-32. http://doi.org/10.1016/j.mcna.2016.09.00

  13. Chibanda Y, Brookes M, Churchill D, Al-Hassi H. The ferritin,hepcidin and cytokines link in the diagnoses of irondeficiency anaemia during pregnancy: a review. Int J MolSci 2023; 24 (17): 13323GUIA: 10.3390/ijms241713323.http://doi: 10.3390/ijms241713323

  14. Breymann C. Iron deficiency anemia in pregnancy. SeminHematol 2015; 52 (4): 339-47. http://doi.org/10.1053/j.seminhematol.2015.07.003

  15. Benson CS, Shah A, Frise MC, Frise CJ. Iron deficiencyanaemia in pregnancy: A contemporary review.Obstet Med 2021; 14 (2): 67-76. https://doi.org/10.1177/1753495X20932426.

  16. Means RT. Iron Deficiency and iron deficiency anemia:implications and impact in pregnancy, fetal development,and early childhood parameters. Nutrients 2020; 12 (2):447. https://doi.org/10.3390/nu12020447

  17. Piskin E, Cianciosi D, Gulec S, Tomas M, et al. Iron absorption:Factors, limitations, and improvement methods. ACSOmega 2022; 7 (24): 20441-56. http://doi.org/10.1021/acsomega.2c01833

  18. Yiannikourides A, Latunde-Dada GO. A short review ofiron metabolism and pathophysiology of iron disorders.Medicines (Basel) 2019; 6 (3): 85. http://doi.org/10.3390/medicines6030085

  19. Katsarou A, Pantopoulos K. Basics and principles of cellularand systemic iron homeostasis. Mol Aspects Med 2020:100866. https://doi.org/10.1016/j.mam.2020.100866

  20. Bhoot HR, Zamwar UM, Chakole S, Anjankar A. Dietarysources, bioavailability, and functions of ascorbic acid(Vitamin C) and its role in the common cold, tissue healing,and iron metabolism. Cureus 2023; 15 (11): e49308.https://doi.org/10.7759/cureus.49308

  21. Zijp IM, Korver O, Tijburg LB. Effect of tea andother dietary factors on iron absorption. Crit RevFood Sci Nutr 2000; 40 (5): 371-98. http://doi.org/10.1080/10408690091189194

  22. Saboor M, Zehra A, Hamali H, Mobarki A. Revisiting ironmetabolism, iron homeostasis and iron deficiency anemia.Clin Lab 2021; 67 (3-2021). http://doi.org/10.7754/clin.lab.2020.200742

  23. Camaschella C, Nai A, Silvestri L. Iron metabolism andiron disorders revisited in the hepcidin era. Haematologica2020; 105 (2): 260-72. http://doi: 10.3324/haematol.2019.232124

  24. Srivastava NK, Mukherjee S, Mishra VN. One advantageousreflection of iron metabolism in context ofnormal physiology and pathological phases. Clin NutrESPEN 2023; 58: 277-94. http://doi.org/10.1016/j.clnesp.2023.10.006

  25. Nemeth E, Ganz T. Hepcidin-ferroportin interaction controlssystemic iron homeostasis. Int J Mol Sci 2021; 22 (12): 6493.http://doi.org/10.3390/ijms22126493

  26. Ganz T, Nemeth E. Hepcidin and iron homeostasis. BiochimBiophys Acta 2012; 1823 (9): 1434-43. http://doi.org/10.1016/j.bbamcr.2012.01.014

  27. Xu Y, Alfaro-Magallanes VM, Babitt JL. Physiological andpathophysiological mechanisms of hepcidin regulation:clinical implications for iron disorders. Br J Haematol2021; 193 (5): 882-93. http://doi.org/10.1111/bjh.17252

  28. Okazaki Y. Iron from the gut: the role of divalent metaltransporter 1. J Clin Biochem Nutr 2024; 74 (1): 1-8. http://doi.org/10.3164/jcbn.23-4

  29. Castel R, Tax MGHM, Droogendijk J, Leers MPG, Beukers R,Levin M-D, et al. The transferrin/log(ferritin) ratio: a newtool for the diagnosis of iron deficiency anemia. Clin ChemLab Med 2012;50(8):1343–9. http://doi.org/10.1515/cclm-2011-0594

  30. Skolmowska D, Głąbska D, Kołota A, Guzek D. Effectivenessof dietary interventions to treat iron-deficiency anemiain women: A systematic review of randomized controlledtrials. Nutrients 2022;14(13):2724. http://doi.org/10.3390/nu14132724

  31. Hurrell RF. Ensuring the efficacious iron fortification of foods:a tale of two barriers. Nutrients. 2022 Apr 12;14(8):1609.http://doi.org/10.3390/nu14081609

  32. Sánchez-Pimienta TG, López-Olmedo N, Rodríguez-RamírezS, et al. High prevalence of inadequate calcium and ironintakes by Mexican population groups as assessed by 24-hour recalls. J Nutr 2016;146(9):1874S-80S. http://doi.org/10.3945/jn.115.227074

  33. Briguglio M, Hrelia S, Malaguti M, Lombardi G, Riso P,et. al. The Central Role of Iron in Human Nutrition: FromFolk to Contemporary Medicine. Nutrients. 2020 Jun12;12(6):1761. http://doi: 10.3390/nu12061761

  34. Skolmowska D, Głąbska D, Kołota A, Guzek D. Effectivenessof Dietary Interventions to Treat Iron-Deficiency Anemia inWomen: A Systematic Review of Randomized ControlledTrials. Nutrients. 2022 Jun 30;14(13):2724. http://doi:10.3390/nu14132724

  35. Al-Naseem A, Sallam A, Choudhury S, Thachil J. Irondeficiency without anaemia: a diagnosis that matters.Clin Med 2021;21(2):107–13. http://doi.org/10.7861/clinmed.2020-0582

  36. Ng O, Keeler BD, Mishra A, Simpson JA, et al. Iron therapy forpreoperative anaemia. Cochrane Database Syst Rev 2019;12 (12): CD011588. http://doi.org/10.1002/14651858.CD011588.pub3

  37. Stoffel NU, von Siebenthal HK, Moretti D, ZimmermannMB. Oral iron supplementation in iron-deficientwomen: How much and how often? Mol Aspects Med2020; 75 (100865): 100865. http://doi.org/10.1016/j.mam.2020.100865

  38. Bellad MB, Patted A, Derman RJ. Is it time to alter thestandard of care for iron deficiency/iron deficiency anemiain reproductive-age women? Biomedicines 2024;12(2).http://doi.org/10.3390/biomedicines12020278

  39. Auerbach M. Commentary: Iron deficiency of pregnancy - anew approach involving intravenous iron. Reprod Health2018;15(Suppl 1):96. http://doi.org/10.1186/s12978-018-0536-1

  40. Auerbach M. Optimizing diagnosis and treatment of irondeficiency and iron deficiency anemia in women andgirls of reproductive age: Clinical opinion. Int J GynaecolObstet 2023;162 Suppl 2:68–77. http://doi.org/10.1002/ijgo.14949

  41. Low MSY, Speedy J, Styles CE, De-Regil LM, et. al. Dailyiron supplementation for improving anaemia, iron statusand health in menstruating women. CochraneDatabase Syst Rev 2016;4(4):CD009747. http://doi.org/10.1002/14651858.CD009747.pub2

  42. Bairwa M, Ahamed F, Sinha S, Yadav K, Kant S, et. al. Directlyobserved iron supplementation for control of irondeficiency anemia. Indian J Public Health 2017; 61 (1):37-42. http://doi.org/10.4103/0019-557X.200250

  43. Okam MM, Koch TA, Tran M-H. Iron supplementation,response in iron-deficiency anemia: Analysis of five trials.Am J Med 2017; 130 (8): 991.e1-991.e8. http://doi.org/10.1016/j.amjmed.2017.03.045

  44. Jongkraijakra S, Doungngern T, Sripakdee W, LekhakulaA. A randomized controlled trial of thrice-weekly versusthrice-daily oral ferrous fumarate treatment in adultpatients with iron-deficiency anemia. Ann Hematol 2023;102 (6): 1333–40. http://doi.org/10.1007/s00277-023-05198-2

  45. Haidar J, Omwega AM, Muroki NM, Ayana G. Daily versusweekly iron supplementation and prevention of iron deficiencyanaemia in lactating women. East Afr Med J 2003; 80(1): 11–6. http://doi.org/10.4314/eamj.v80i1.8661

  46. Fernández-Gaxiola AC, De-Regil LM. Intermittent ironsupplementation for reducing anaemia and its associatedimpairments in adolescent and adult menstruating women.Cochrane Database Syst Rev 2019; 1: CD009218. http://doi.org/10.1002/14651858.CD009218.pub3

  47. Pasupathy E, Kandasamy R, Thomas K, Basheer A. Alternateday versus daily oral iron for treatment of iron deficiencyanemia: a randomized controlled trial. Sci Rep 2023; 13 (1):1818. http://doi.org/10.1038/s41598-023-29034-9

  48. Kamath S, Parveen RS, Hegde S, Mathias EG, et. al. A. Dailyversus alternate day oral iron therapy in iron deficiencyanemia: a systematic review. Naunyn Schmiedebergs ArchPharmacol 2024; 397 (5): 2701-14. http://doi.org/10.1007/s00210-023-02817-7

  49. Cohen J, Khudanyan A, Lu J, Wing J, et al. A multicenterstudy evaluating the effectiveness and safety of singledoselow molecular weight iron dextran vs single-doseferumoxytol for the treatment of iron deficiency. Am JHematol 2020; 95 (12): 1572-7. http://doi.org/10.1002/ajh.25995

  50. Schaefer B, Meindl E, Wagner S, Tilg H, et al. Intravenousiron supplementation therapy. Mol Aspects Med2020; 75 (100862): 100862. http://doi.org/10.1016/j.mam.2020.100862

  51. Lucas S, Garg M. Intravenous iron: an update. InternMed J 2024; 54 (1): 26-34. http://doi.org/10.1111/imj.16184

  52. Boucher AA, Bedel A, Jones S, Lenahan SF, et al. A retrospectivestudy of the safety and efficacy of low molecularweight iron dextran for children with iron deficiency anemia.Pediatr Blood Cancer 2021; 68 (7): e29024. http://doi.org/10.1002/pbc.29024

  53. Vaughn CJ. Drugs and Lactation Database: LactMed. JElectron Resour Med Libr 2012; 9 (4): 272-7. http://doi.org/10.1080/15424065.2012.735134. PMID: 33927444

  54. Aung T, Coleman J, Davidson PW, Hetzel DJ, et al. Intravenousiron infusion and newer non-dextran formulations.N Z Med J 2021; 134 (1534): 118-27. https://pubmed.ncbi.nlm.nih.gov/33927444/

  55. Fortier JC, Singhal R, Rajasekhar A, Mathew C. Reducing unnecessarypremedication prior to parenteral iron therapy:A quality improvement project. Transfusion 2023; 63 (9):1685-91. http://doi.org/10.1111/trf.17502

  56. Arastu AH, Elstrott BK, Martens KL, Cohen JL, et al. Analysisof Adverse Events and Intravenous Iron Infusion Formulationsin Adults With and Without Prior Infusion Reactions.JAMA Netw Open. 2022 Mar 1; 5 (3): e224488. doi:10.1001/jamanetworkopen.2022.4488. Erratum in: JAMANetw Open. 2022 (6): e2221567. http://doi.org/10.1001/jamanetworkopen.2022.21567

  57. Ning S, Zeller MP. Management of iron deficiency. HematologyAm Soc Hematol Educ Program 2019; 2019 (1): 315-22.http://doi.org/10.1182/hematology.2019000034

  58. Aung T, Thein H, Aung ST, Soe BTA, et al. Intravenousiron therapy: Re-administration after prior adverse reaction.Korean J Fam Med 2023; 44 (6): 350-4. http://doi.org/10.4082/kjfm.23.0039

  59. Arastu AH, Elstrott BK, Martens KL, Cohen JL, et al. Analysisof adverse events and intravenous iron infusion formulationsin adults with and without prior infusion reactions.JAMA Netw Open 2022; 5 (3): e224488. http://doi.org/10.1001/jamanetworkopen.2022.4488

  60. 60. Stojanovic S, Graudins LV, Aung AK, Grannell L, et. al.Safety of intravenous iron following infusion reactions. JAllergy Clin Immunol Pract 2021; 9 (4): 1660-6. http://doi.org/10.1016/j.jaip.2020.11.028

  61. Intravenous iron-containing medicinal products. ReferralEuropean Medicines Agency (EMA). https://www.ema.europa.eu/en/medicines/human/referrals/intravenousiron-containing-medicinal-products

  62. Boots JMM, Quax RAM. High-dose intravenous iron witheither ferric carboxymaltose or ferric derisomaltose: Abenefit-risk assessment. Drug Saf 2022; 45 (10): 1019-36.http://doi.org/10.1007/s40264-022-01216-

  63. Dave CV, Brittenham GM, Carson JL, Setoguchi S. Risksfor anaphylaxis with intravenous iron formulations. Aretrospective cohort study. Ann Intern Med 2022; 175 (5):656-64. http://doi.org/10.7326/M21-4009

  64. Dave CV, Brittenham GM, Carson JL, Setoguchi S. Risks foranaphylaxis with intravenous iron formulations: a retrospectivecohort study. Ann Intern Med. 2022 May; 175 (5):

  65. 656-664. http://doi.org/10.7326/M21-400965. Simons FER, Ardusso LRF, Bilò MB, Dimov V, et al. 2012Update: World Allergy Organization Guidelines for theassessment and management of anaphylaxis. Curr OpinAllergy Clin Immunol 2012; 12 (4): 389-99. http://doi.org/10.1097/ACI.0b013e328355b7e4

  66. Blumenstein I, Shanbhag S, Langguth P, Kalra PA, et. al.Newer formulations of intravenous iron: a review of theirchemistry and key safety aspects - hypersensitivity, hypophosphatemia,and cardiovascular safety. Expert Opin DrugSaf 2021; 20 (7): 757-69. http://doi.org/10.1080/14740338.2021.1912010

  67. Samad A, Sultana Y, Aqil M. Liposomal drug delivery systems:an update review. Curr Drug Deliv 2007; 4 (4): 297-305.http://doi.org/10.2174/156720107782151269

  68. Lian T, Ho RJ. Trends and developments in liposome drugdelivery systems. J Pharm Sci 2001; 90 (6): 667-80. http://doi.org/10.1002/jps.1023

  69. Voinea M, Simionescu M. Designing of “intelligent” liposomesfor efficient delivery of drugs. J Cell Mol Med 2002; 6 (4):465-74. http://doi.org/10.1111/j.1582-4934.2002.tb00450.x

  70. Battistelli M, Salucci S, Falcieri E. Morphological evaluationof liposomal iron carriers. Microsc Res Tech 2018; 81 (11):1295-300. http://doi.org/10.1002/jemt.23137

  71. Kosaraju SL, Tran C, Lawrence A. Liposomal delivery systemsfor encapsulation of ferrous sulfate: Preparation and characterization.J Liposome Res 2006; 16 (4): 347-58. http://doi.org/10.1080/08982100600992351

  72. Bochicchio S, Dalmoro A, Lamberti G, Barba AA. Advancesin nanoliposomes production for ferrous sulfate delivery.Pharmaceutics 2020; 12 (5): 445. http://doi.org/10.3390/pharmaceutics12050445

  73. Prichapan N, McClements DJ, Klinkesorn U. Iron encapsulationin water-in-oil emulsions: Effect of ferroussulfate concentration and fat crystal formation on oxidativestability. J Food Sci 2018; 83 (2): 309-17. http://doi.org/10.1111/1750-3841.14034

  74. Bao Y, Pignitter M. Mechanisms of lipid oxidation inwater-in-oil emulsions and oxidomics-guided discovery oftargeted protective approaches. Compr Rev Food Sci FoodSaf 2023; 22 (4): 2678-705. http://doi.org/10.1111/1541-4337.13158

  75. Pisani A, Riccio E, Sabbatini M, Andreucci M, et.al. Effect oforal liposomal iron versus intravenous iron for treatmentof iron deficiency anaemia in CKD patients: a randomizedtrial. Nephrol Dial Transplant 2015; 30 (4): 645-52. http://doi.org/10.1093/ndt/gfu357

  76. Cesarano D, Borrelli S, Campilongo G, D’Ambra A, et al.Efficacy and safety of oral supplementation with liposomaliron in non-dialysis chronic kidney disease patientswith iron deficiency. Nutrients 2024; 16 (9). http://doi.org/10.3390/nu16091255




2020     |     www.medigraphic.com