Demir eksikliği anemisi olan hastalarda intravenöz demir karboksimaltoz ve demir sükroz tedavilerinin hemoglobin artışı üzerine etkilerinin retrospektif olarak değerlendirilmesi
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Tarih
2020
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Düzce Üniversitesi
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info:eu-repo/semantics/openAccess
Özet
Giriş: Dünya Sağlık Örgütü (DSÖ)'ne göre anemi; hemoglobin (Hb) değerinin, 15 yaşın üstünde olan erkeklerde <13 g/dl, 15 yaşın üstünde ve gebe olmayan kadınlarda <12 g/dl, gebelerde ise <11 g/dl olması olarak tanımlanmaktadır. Demir eksikliği anemisi vücudun kaybettiği günlük demirin vücuda alınan demir ile kompanse edilemediği durumda ortaya çıkan anemidir. Dünya nüfusunun %30'undan fazlasında herhangi bir sebebe bağlı anemi görülmekte olup, demir eksikliği de aneminin en sık sebebi olarak karşımıza çıkmaktadır. Öte yandan, demir eksikliği oluşmaya başladığında, Hb düzeyleri korunmaya çalışılarak öncelikli olarak depo demiri azaldığından, anemi olmaksızın demir eksikliği sıklığı daha da fazladır. Bu yüzden özellikle kadınlarda olmak üzere, demir eksikliğinin önlenmesi ve tedavisi önemli bir halk sağlığı sorunudur. Tedavideki amaç hastaya ve altta yatan sebebe yönelik bireyselleştirilmiş tedavi uygulamak ve hastanın hemoglobin düzeylerini ve demir depolarını normale getirmektir. Demirin yerine konulmasında öncelikli oral tedaviler tercih edilmekle birlikte, başta oral tedavinin tolere edilememesi olmak üzere birçok endikasyonda parenteral demir preparatları kullanılmaktadır. Çalışmamızda parenteral demir preparatları olan demir sükroz ve demir karboksimaltozun hemoglobin düzeyindeki artışa etkisini karşılaştırmayı amaçlıyoruz. Gereç ve Yöntem: Düzce Üniversitesi Etik Kurulunun 2019/148 karar numaralı izni alınarak ve Helsinki Deklerasyonu prensiplerine uygun olarak gerçekleştirilen bu çalışmada, Mart 2016-Mart 2019 tarihleri arasında Düzce Üniversitesi Tıp Fakültesi Hastanesi dahiliye, hematoloji polikliniklerinde veya dahiliye servisinde görülüp demir eksikliği anemisi olarak değerlendirilmiş, intravenöz demir tedavisi verilmiş hastalar retrospektif olarak taranmıştır. 140 hasta çalışmaya dahil edilmiştir. Bu hastalar demir sukroz ve demir karboksimaltoz tedavileri almalarına göre 2 gruba ayrılmıştır. Her iki gruptaki hastalarda yaş, cinsiyet, hemoglobin, hematokrit, trombosit sayısı, demir, transferrin saturasyonu, ferritin ve yan etki profili tedavi öncesi, 1, 3, 6. aylarda olmak üzere dört farklı zaman diliminde karşılaştırılmıştır. Yan etki görülen hastalar ayrıca değerlendirilmiştir. Bulgular: Yaş ve cinsiyet açısından gruplar homojendir. Yaş ve cinsiyet açısından değerlendirildiğinde gruplar homojendir. Başvuru anında ölçülen Hb, Hct, MCV, trombosit, ferritin ve TS medyan değerleri açısından gruplar arasında anlamlı düzeyde fark yoktur. 1.ayda ölçülen Hb, Hct, ferritin düzeyleri ve Hb artış miktarları; demir karboksimaltoz grubunda, demir sükroz grubuna göre daha yüksek saptanmıştır. 3.ayda ölçülen Hb, MCV, ferritin düzeyleri; demir karboksimaltoz grubunda, demir sükroz grubuna göre daha yüksek saptanırken, 6.ayda ölçülen MCV, ferritin düzeyleri demir karboksimaltoz grubunda, demir sükroz grubuna göre daha yüksek saptanmıştır. TS ise demir sükroz grubunda, demir karboksimaltoz grubuna göre tüm zaman periyotlarında daha yüksek saptanmıştır. Demir sükroz grubunda yan etki görülen bireylerin oranı demir karboksimaltoz grubundan daha fazla saptanmıştır. Sonuç: İntravenöz demir tedavisi alan iki grubun başlangıç, 1, 3 ve 6.ayda ölçülen parametreleri karşılaştırıldığında demir karboksimaltoz tedavisi alan hasta grubunda hemoglobin artış hızının daha fazla olduğu ve tedaviye daha kısa sürede yanıt alındığı saptanmıştır. Her iki grupta da 6.ayda tedavi yanıtı alındığı, son durumdaki değerlerin normal aralıkta olduğu saptanmıştır. Yan etki oranı demir sükroz grubunda daha fazla görülse de hayati önem arz eden (grade 3-4) yan etkiler gözlenmemiştir.
Introduction: Anemia is defined as decrease in erythrocyte amount or hemoglobin concentration. Anemia, according to the World Health Organization (WHO), is described as hemoglobin (Hb) value <13 g / dl in men over 15 years of age, <12 g / dl in women over 15 years of age and non-pregnant women, and <11 g / dl in pregnant women. Iron deficiency anemia is anemia that occurs when daily iron lost from the body cannot be compensated with the iron taken into the body. More than 30% of the world's population has anemia due to any reason, and the frequency of iron deficiency without anemia is even higher. Therefore, prevention and treatment of iron deficiency is an important public health problem, especially in women. The aim of the treatment is to apply individualized treatment for the patient and the underlying cause, and to normalize hemoglobin levels and iron stores of the patient. Parenteral iron preparations are available for those who cannot tolerate oral iron treatment or do not respond to oral iron. In our study, we aim to compare the effect of iron sucrose and iron carboxymaltose, which are parenteral iron preperations, on the increase in hemoglobin level. Material and Method: In this study, which was carried out with the permission of the Ethics Committee of Duzce University with decision number 2019/148 and in accordance with the principles of Helsinki Declaration, patients admitted to internal medicine/hematology outpatient clinics or internal medicine ward of Duzce University between March 2016 and March 2019, evaluated as iron deficiency anemia and treated with ıntravenous iron were retrospectively scanned. 140 patients were included in the study and they were divided into two groups as those who received intravenous iron sucrose or intravenous iron carboxymaltose. In both groups; age, gender, hemoglobin, hematocrit, platelet count, iron, transferrin saturation, ferritin and side effect profile were compared in four different time periods as before treatment, at 1st, 3rd, and 6th months. Results: Groups are homogeneous in terms of age and gender. There was no significant difference between the groups in terms of Hb, Hct, MCV, platelet, ferritin and TS median values measured at the time of admission. Hb, Hct, ferritin levels and amount of Hb increase measured in 1. month was found higher in iron carboxymaltose group than iron sucrose group. While Hb, MCV and ferritin levels measured in 3rd month was found to be higher in iron carboxymaltosis than iron sucrose group, MCV and ferritin levels measured at 6 months were higher in iron carboxymaltosis group than iron sucrose group. On the other hand, TS was found to be higher in iron sucrose group than iron carboxymaltosis group in all time periods. The proportion of individuals with side effects in the iron sucrose group was higher than that of the iron carboxymaltosis group. Conclusion: When the parameters measured in the beginning, 1st, 3rd, and 6th months in two groups receiving intravenous iron therapy were compared, it was found that hemoglobin increase rate was higher and the response time to treatment was shorter in iron carboxymaltosis group. It was found that treatment response was obtained in 6 months in both groups, and the final values were in the normal range. Although the side effect rate is higher in iron sucrose group, these side effects are not life threatening and both treatments are considered safe and effective.
Introduction: Anemia is defined as decrease in erythrocyte amount or hemoglobin concentration. Anemia, according to the World Health Organization (WHO), is described as hemoglobin (Hb) value <13 g / dl in men over 15 years of age, <12 g / dl in women over 15 years of age and non-pregnant women, and <11 g / dl in pregnant women. Iron deficiency anemia is anemia that occurs when daily iron lost from the body cannot be compensated with the iron taken into the body. More than 30% of the world's population has anemia due to any reason, and the frequency of iron deficiency without anemia is even higher. Therefore, prevention and treatment of iron deficiency is an important public health problem, especially in women. The aim of the treatment is to apply individualized treatment for the patient and the underlying cause, and to normalize hemoglobin levels and iron stores of the patient. Parenteral iron preparations are available for those who cannot tolerate oral iron treatment or do not respond to oral iron. In our study, we aim to compare the effect of iron sucrose and iron carboxymaltose, which are parenteral iron preperations, on the increase in hemoglobin level. Material and Method: In this study, which was carried out with the permission of the Ethics Committee of Duzce University with decision number 2019/148 and in accordance with the principles of Helsinki Declaration, patients admitted to internal medicine/hematology outpatient clinics or internal medicine ward of Duzce University between March 2016 and March 2019, evaluated as iron deficiency anemia and treated with ıntravenous iron were retrospectively scanned. 140 patients were included in the study and they were divided into two groups as those who received intravenous iron sucrose or intravenous iron carboxymaltose. In both groups; age, gender, hemoglobin, hematocrit, platelet count, iron, transferrin saturation, ferritin and side effect profile were compared in four different time periods as before treatment, at 1st, 3rd, and 6th months. Results: Groups are homogeneous in terms of age and gender. There was no significant difference between the groups in terms of Hb, Hct, MCV, platelet, ferritin and TS median values measured at the time of admission. Hb, Hct, ferritin levels and amount of Hb increase measured in 1. month was found higher in iron carboxymaltose group than iron sucrose group. While Hb, MCV and ferritin levels measured in 3rd month was found to be higher in iron carboxymaltosis than iron sucrose group, MCV and ferritin levels measured at 6 months were higher in iron carboxymaltosis group than iron sucrose group. On the other hand, TS was found to be higher in iron sucrose group than iron carboxymaltosis group in all time periods. The proportion of individuals with side effects in the iron sucrose group was higher than that of the iron carboxymaltosis group. Conclusion: When the parameters measured in the beginning, 1st, 3rd, and 6th months in two groups receiving intravenous iron therapy were compared, it was found that hemoglobin increase rate was higher and the response time to treatment was shorter in iron carboxymaltosis group. It was found that treatment response was obtained in 6 months in both groups, and the final values were in the normal range. Although the side effect rate is higher in iron sucrose group, these side effects are not life threatening and both treatments are considered safe and effective.
Açıklama
YÖK Tez No: 639276
Anahtar Kelimeler
Hematoloji, Hematology, İç Hastalıkları, Internal diseases, Demir eksikliği anemisi, demir karboksimaltoz, demir sükroz, intravenöz demir, Iron deficiency anemia, iron carboxymaltose, iron sucrose, intravenous iron
