Schatz U, Arneth B, Siegert G, Siegels D, Fischer S, Julius U, Bornstein S R
Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Atheroscler Suppl. 2013 Jan;14(1):115-22. doi: 10.1016/j.atherosclerosissup.2012.10.012.
There is evidence of iron deficiency (ID) in patients treated with lipoprotein apheresis. Aim of this study was to assess ID in apheresis patients and to study its management comparing safety and efficacy of two approved intravenous (i.v.) iron formulations.
Inclusion criteria were defined as a) serum ferritin < 300 μg/l and transferrin saturation < 20%, b) ferritin < 100 μg/l. Both iron deficient alone and ID anemic (IDA) patients were included. Other causes for anemia were ruled out by thorough history-taking and examination/blood tests. Patients were treated with six different lipoprotein apheresis methods: DALI, Liposorber D, TheraSorb LDL, HELP, MONET and Lipidfiltration. 50 patients were randomized to either ferric carboxymaltose (FCM, 500-1000 mg as single shot infusion over 20 min) or ferric gluconate (FG, 62.5 mg once weekly).
50 of 67 patients of our Lipoprotein Apheresis Center showed iron deficiency. Both i.v. iron formulations studied were equally safe (no serious adverse events (SAEs), 6 patients/group showed adverse events (AEs)) and both effective (clinically and with respect to laboratory data) in lipoprotein apheresis patients, however FCM led to a more rapid and steeper rise of iron parameters.
ID and IDA are common findings in lipoprotein apheresis patients. The pathogenesis remains yet poorly understood and is probably multifactorial. Differential diagnosis of ID/IDA is as essential as differential therapy. Handled with care, older i.v. iron preparations like FG appear to be safe and effective in lipoprotein apheresis patients. However, novel formulations like FCM can be administered rapidly at higher doses due to high complex stability, allowing faster filling of iron stores. Newer laboratory parameters (Reticulocyte-He, low/medium/high fluorescence reticulocytes (LFR/MFR/HFR)) assessing iron status may be helpful in early detection of ID and in monitoring iron replacement therapy.
有证据表明接受脂蛋白分离术治疗的患者存在缺铁（ID）情况。本研究的目的是评估接受分离术患者的缺铁情况，并比较两种已获批的静脉注射铁制剂的安全性和有效性，研究其管理方法。
纳入标准定义为：a）血清铁蛋白<300μg/L且转铁蛋白饱和度<20%，b）铁蛋白<100μg/L。单独缺铁和缺铁性贫血（IDA）患者均被纳入。通过详细的病史采集、检查/血液检测排除其他贫血原因。患者采用六种不同的脂蛋白分离术方法进行治疗：DALI、Liposorber D、TheraSorb LDL、HELP、MONET和脂质过滤。50例患者被随机分为接受羧基麦芽糖铁（FCM，500 - 1000mg，20分钟内单次静脉输注）或葡萄糖酸铁（FG，62.5mg，每周一次）治疗。
我们脂蛋白分离术中心的67例患者中有50例存在缺铁情况。研究的两种静脉注射铁制剂在脂蛋白分离术患者中同样安全（无严重不良事件（SAEs），每组6例患者出现不良事件（AEs））且均有效（临床及实验室数据方面），然而FCM使铁参数升高更快、幅度更大。
ID和IDA在脂蛋白分离术患者中是常见表现。其发病机制仍了解不足，可能是多因素的。ID/IDA的鉴别诊断与鉴别治疗同样重要。谨慎使用的话，像FG这样的老一代静脉注射铁制剂在脂蛋白分离术患者中似乎是安全有效的。然而，由于高络合物稳定性，像FCM这样的新型制剂可以更高剂量快速给药，从而更快地补充铁储备。评估铁状态的更新的实验室参数（网织红细胞血红蛋白含量、低/中/高荧光网织红细胞（LFR/MFR/HFR））可能有助于早期诊断ID及监测铁替代治疗。
