Severe iron deficiency anemia: red blood cell transfusion or intravenous iron?
Severe iron deficiency anemia: red blood cell transfusion or intravenous iron?
复制标题
严重缺铁性贫血：输红细胞还是静脉补铁？
DOI：
10.1111/trf.14819
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发表时间：
2018
期刊：
影响因子：
2.9
通讯作者：
Sweeney,JosephD
中科院分区：
文献类型：
--
作者：
Nixon,ChristianP;Sweeney,JosephD
缺铁（ID）被认为影响全球20亿人1，缺铁性贫血（IDA）仍然是经济发达国家和欠发达国家贫血的常见原因。2，3易患ID和IDA的人群为学龄前儿童、青少年（尤其是女性）、育龄期女性、孕妇和老年人。发达国家和不发达国家以及发达国家的风险群体之间的IDA机制有所不同。关于这些方面的更多细节可在其他地方查阅。4-9 IDA可通过标准实验室检测10确定，并使用Ganzoni公式（铁缺乏（mg）=患者体重（Kg）×（目标-实际血红蛋白）× 2.4+ 500）或该公式的衍生物测量铁缺乏的程度。[12]需要强调的是，缺铁性贫血不是一种诊断，而是潜在异常存在的继发表现，其原因也需要阐明。13治疗需要针对铁的补充和纠正病因异常。严重的IDA没有明确的血红蛋白阈值，可能与贫血的典型特征（如疲劳和苍白）有关，也可能与之无关。然而，严重的IDA与输血医学有关，因为它引起了使用同种异体红细胞作为铁补充来源的幽灵。一个单位的红细胞提供150-200毫克的元素铁，但也血红蛋白允许，原则上，更迅速地纠正微血管低氧血症。因此，当患有严重IDA的患者出现心绞痛、神经症状、指示心力衰竭的临床特征或血流动力学不稳定时，通常给予红细胞输注。在这些情况下使用红细胞可能是不利的。14–16
Iron deficiency (ID) is considered to affect two billion people worldwide1 and iron deficiency anemia (IDA) remains the common cause of anemia in both economically developed and underdeveloped countries. 2, 3 Groups at risk for ID and IDA are preschool children, adolescents, especially female, females during the reproductive years, pregnant females and the elderly. The mechanisms of IDA differ between developed and underdeveloped countries and between the groups at risk in developed countries. More details on these aspects are available elsewhere. 4–9 IDA can be determined by standard laboratory testing10 and the extent of the iron deficit measured using the Ganzoni formula (iron deficit (mg)= patient weight (Kg)×(target–actual hemoglobin)× 2.4+ 500) or a derivative of this formula. 12 It needs to be emphasized that IDA is not a diagnosis but rather a secondary manifestation of the presence of an underlying abnormality, the cause of which needs also to be elucidated. 13 Treatment needs to be directed at both iron repletion and correction of the causative abnormality.Severe IDA has no clear threshold hemoglobin and may or may not be associated with the classic features of anemia such as fatigue and pallor. Severe IDA, however, is relevant to Transfusion Medicine since it raises the specter of using allogeneic red blood cells as the source of iron repletion. A unit of red blood cells supplies between 150–200 mg of elemental iron but also hemoglobin allowing, in principle, a more rapid correction of microvascular hypoxemia. For this reason, red blood cell transfusion is commonly administered when patients with severe IDA present with angina, neurologic symptoms, clinical features indicative of heart failure or are hemodynamically unstable. The use of red blood cells in some of these scenarios may paradoxically be detrimental. 14–16