Iron metabolism and iron supplementation in cancer patients

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Summary

Iron deficiency and iron deficiency-associated anemia are common complications in cancer patients. Most iron deficient cancer patients present with functional iron deficiency (FID), a status with adequate storage iron, but insufficient iron supply for erythroblasts and other iron dependent tissues. FID is the consequence of the cancer-associated cytokine release, while in absolute iron deficiency iron stores are depleted resulting in similar but often more severe symptoms of insufficient iron supply. Here we present a short review on the epidemiology, pathophysiology, diagnosis, clinical symptoms, and treatment of iron deficiency in cancer patients. Special emphasis is given to intravenous iron supplementation and on the benefits and limitations of different formulations. Based on these considerations and recommendations from current international guidelines we developed recommendations for clinical practice and classified the level of evidence and grade of recommendation according to the principles of evidence-based medicine.

Related collections

Most cited references 55

Record: found
Abstract: found
Article: not found

Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature.

Paul E Marik, Howard Corwin (2008)

Red blood cell (RBC) transfusions are common in intensive care unit, trauma, and surgical patients. However, the hematocrit that should be maintained in any particular patient because the risks of further transfusion of RBC outweigh the benefits remains unclear. A systematic review of the literature to determine the association between red blood cell transfusion, and morbidity and mortality in high-risk hospitalized patients. MEDLINE, Embase, Cochrane Register of Controlled Trials, and citation review of relevant primary and review articles. Cohort studies that assessed the independent effect of RBC transfusion on patient outcomes. From 571 articles screened, 45 met inclusion criteria and were included for data extraction. Forty-five studies including 272,596 were identified (the outcomes from one study were reported in four separate publications). The outcome measures were mortality, infections, multiorgan dysfunction syndrome, and acute respiratory distress syndrome. The overall risks vs. benefits of RBC transfusion on patient outcome in each study was classified as (i) risks outweigh benefits, (ii) neutral risk, and (iii) benefits outweigh risks. The odds ratio and 95% confidence interval for each outcome measure was recorded if available. The pooled odds ratios were determined using meta-analytic techniques. Forty-five observational studies with a median of 687 patients/study (range, 63-78,974) were analyzed. In 42 of the 45 studies the risks of RBC transfusion outweighed the benefits; the risk was neutral in two studies with the benefits outweighing the risks in a subgroup of a single study (elderly patients with an acute myocardial infarction and a hematocrit <30%). Seventeen of 18 studies, demonstrated that RBC transfusions were an independent predictor of death; the pooled odds ratio (12 studies) was 1.7 (95% confidence interval, 1.4-1.9). Twenty-two studies examined the association between RBC transfusion and nosocomial infection; in all these studies blood transfusion was an independent risk factor for infection. The pooled odds ratio (nine studies) for developing an infectious complication was 1.8 (95% confidence interval, 1.5-2.2). RBC transfusions similarly increased the risk of developing multi-organ dysfunction syndrome (three studies) and acute respiratory distress syndrome (six studies). The pooled odds ratio for developing acute respiratory distress syndrome was 2.5 (95% confidence interval, 1.6-3.3). Despite the inherent limitations in the analysis of cohort studies, our analysis suggests that in adult, intensive care unit, trauma, and surgical patients, RBC transfusions are associated with increased morbidity and mortality and therefore, current transfusion practices may require reevaluation. The risks and benefits of RBC transfusion should be assessed in every patient before transfusion.

0 comments Cited 206 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Assessing iron status: beyond serum ferritin and transferrin saturation.

Jay B. Wish (2006)

The increasing prevalence of multiple comorbidities among anemic patients with chronic kidney disease has made the use of serum ferritin and transferrin saturation more challenging in diagnosing iron deficiency. Because serum ferritin is an acute-phase reactant and because the inflammatory state may inhibit the mobilization of iron from reticuloendothelial stores, the scenario of patients with serum ferritin >800 ng/ml, suggesting iron overload, and transferrin saturation <20%, suggesting iron deficiency, has become more common. This article revisits the basis for the Kidney Disease Outcomes Quality Initiative recommendations regarding the use of serum ferritin and transferrin saturation in guiding iron therapy, then explores some of the newer alternative markers for iron status that may be useful when serum ferritin and transferrin saturation are insufficient. These newer tests include reticulocyte hemoglobin content, percentage of hypochromic red cells, and soluble transferrin receptor, all of which have shown some promise in limited studies. Finally, the role of hepcidin, a hepatic polypeptide, in the pathophysiology of iron mobilization is reviewed briefly.

0 comments Cited 176 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review.

Scarlet M Salas, Jaime Caro, Greg G. Goss … (2001)

Anemia is common in cancer patients, although the prevalence is influenced both by the type of malignancy and the choice of treatment. Individual studies have compared the survival of patients with and without anemia and have shown reduced survival times in patients with various malignancies, including carcinoma of the lung, cervix, head and neck, prostate, lymphoma, and multiple myeloma. The objective of this study was to systematically review, to summarize, and to obtain an overall estimate of the effect of anemia on survival in patients with malignant disease. A comprehensive literature review was carried out using the MEDLINE data base and reviewing the reference lists from published studies. Two hundred papers were identified. Of these, 60 papers that reported the survival of cancer patients according to either hemoglobin levels or the presence of anemia were included. Among these papers, 25% related to patients with lung carcinoma, 17% related to patients with head and neck carcinoma, 12% related to patients with multiple myeloma, 10% related to patients with prostate carcinoma, 8% related to patients with cervicouterine carcinoma, 7% related to patients with leukemia, 5% related to patients with lymphoma, and 16% related to patients with other types of malignancies. The relative risk of death increased by 19% (95% confidence interval, 10-29%) in anemic patients with lung carcinoma, by 75% (37-123%) in anemic patients with head and neck carcinoma, by 47% (21-78%) in anemic patients with prostate carcinoma, and by 67% (30-113%) in anemic patients with lymphoma. The overall estimate increase in risk was 65% (54-77%). Anemia is associated with shorter survival times for patients with lung carcinoma, cervicouterine carcinoma, head and neck carcinoma, prostate carcinoma, lymphoma, and multiple myeloma. Copyright 2001 American Cancer Society.

0 comments Cited 163 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Heinz Ludwig: +43-1-49150-2195 , heinz.ludwig@aon.at , heinz.ludwig@wienkav.at

Journal

Journal ID (nlm-ta): Wien Klin Wochenschr

Journal ID (iso-abbrev): Wien. Klin. Wochenschr

Title: Wiener Klinische Wochenschrift

Publisher: Springer Vienna (Vienna )

ISSN (Print): 0043-5325

ISSN (Electronic): 1613-7671

Publication date (Electronic): 15 September 2015

Publication date PMC-release: 15 September 2015

Publication date (Print): 2015

Volume: 127

Pages: 907-919

Affiliations

[ ]c/o 1. Medizinische Abteilung, Zentrum für Onkologie, Wilhelminen-Krebsforschungsinstitut, Wilhelminenspital, Montleartstraße 37, 1160 Wien, Austria

[ ]Universitätsklinik für Innere Medizin III, MedUni, Wien, Austria

[ ]Universitätsklinik für Innere Medizin I, MedUni, Wien, Austria

[ ]Institut Multidisciplinaire d’Oncologie IMO, Clinique de Genolier, Genolier, Switzerland

[ ]Universitätsklinik für Innere Medizin, MedUni, Graz, Austria

[ ]Abteilung Interne 1, KH der Elisabethinen, Linz, Austria

[ ]Abteilung Interne 3, AKH, Linz, Austria

[ ]1. Medizinische Abteilung, Klinikum Klagenfurt, Klagenfurt, Austria

[ ]5. Medizinische Abteilung, Krankenhaus Hietzing, Wien, Austria

[ ]3. Medizinische Abteilung, Hanusch-Krankenhaus, Wien, Austria

[ ]1. Medizinische Abteilung, Landesklinikum St. Pölten, Pölten, Austria

[ ]Abteilung für Innere Medizin, Landeskrankenhaus Feldkirch, Feldkirch, Austria

[ ]Abteilung für Interne 1, Krankenhaus der Barmherzigen Schwestern, Linz, Austria

[ ]Universitätsklinik für Innere Medizin V, MedUni Innsbruck, Innsbruck, Austria

[ ]Bristol-Myers Squibb, Wien, Austia

[ ]Medizinische Klinik I, Westpfalz-Klinikum, Kaiserslautern, Germany

Article

Publisher ID: 842

DOI: 10.1007/s00508-015-0842-3

PMC ID: 4679104

PubMed ID: 26373748

SO-VID: f2ec2e97-3284-46cb-ba4a-228112082458

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date received : 5 May 2014

Date accepted : 29 July 2015

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: iron deficiency,functional and absolute iron deficiency,tumor anemia,iron supplementation,recommendations for clinical practice

Data availability:

ScienceOpen disciplines: Medicine

Keywords: iron deficiency, functional and absolute iron deficiency, tumor anemia, iron supplementation, recommendations for clinical practice

Iron metabolism and iron supplementation in cancer patients

Read this article at

Summary

Related collections

Cancer Metabolism

Most cited references 55

Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature.

Assessing iron status: beyond serum ferritin and transferrin saturation.

Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review.

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 1,027

Cited by 41

Most referenced authors 915