Ikuta Katsuya
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University.
Rinsho Ketsueki. 2015 Oct;56(10):1903-13. doi: 10.11406/rinketsu.56.1903.
Most iron in the body is utilized as a component of hemoglobin that delivers oxygen to the entire body. Under normal conditions, the iron balance is tightly regulated. However, iron dysregulation does occasionally occur; total iron content reductions cause iron deficiency anemia and overexpression of the iron regulatory peptide hepcidin disturbs iron utilization resulting in anemia of chronic disease. Conversely, the presence of anemia may ultimately lead to iron overload; for example, thalassemia, a common hereditary anemia worldwide, often requires transfusion, but long-term transfusions cause iron accumulation that leads to organ damage and other poor outcomes. On the other hand, there is a possibility that iron overload itself can cause anemia; iron chelation therapy for the post-transfusion iron overload observed in myelodysplastic syndrome or aplastic anemia improves dependency on transfusions in some cases. These observations reflect the extremely close relationship between anemias and iron metabolism.
体内的大多数铁作为血红蛋白的组成部分被利用,血红蛋白将氧气输送到全身。在正常情况下,铁平衡受到严格调节。然而,铁调节异常偶尔也会发生;铁总含量降低会导致缺铁性贫血,铁调节肽铁调素的过度表达会干扰铁的利用,导致慢性病贫血。相反,贫血的存在最终可能导致铁过载;例如,地中海贫血是全球常见的遗传性贫血,通常需要输血,但长期输血会导致铁积累,从而导致器官损伤和其他不良后果。另一方面,铁过载本身有可能导致贫血;在骨髓增生异常综合征或再生障碍性贫血中观察到的输血后铁过载的铁螯合疗法在某些情况下可改善对输血的依赖。这些观察结果反映了贫血与铁代谢之间极其密切的关系。