Clénin German E
Sportmedizinisches Zentrum Ittigen bei Bern, Ittigen, Switzerland.
Swiss Med Wkly. 2017 Jun 14;147:w14434. doi: 10.4414/smw.2017.14434. eCollection 2017.
Iron deficiency is the most widespread and frequent nutritional disorder in the world. It affects a high proportion of children and women in developing countries and is also significantly prevalent in the industrialised world, with a clear predominance in adolescents and menstruating females. Iron is essential for optimal cognitive function and physical performance, not only as a binding site of oxygen but also as a critical constituent of many enzymes. Therefore iron deficiency at all its levels - nonanaemic iron deficiency, iron deficiency with microcytosis or hypochromia and iron deficiency anaemia - should be treated. In the presence of normal stores, however, preventative iron administration is inefficient, has side effects and seems to be harmful. In symptomatic patients with fatigue or in a population at risk for iron deficiency (adolescence, heavy or prolonged menstruation, high performance sport, vegetarian or vegan diet, eating disorder, underweight), a baseline set of blood tests including haemoglobin concentration, haematocrit, mean cellular volume, mean cellular haemoglobin, percentage of hypochromic erythrocytes and serum ferritin levels are important to monitor iron deficiency. To avoid false negative results (high ferritin levels in spite of iron deficiency), an acute phase reaction should be excluded by history and measurement of C-reactive protein. An algorithm leads through this diagnostic process and the decision making for a possible treatment. For healthy males and females aged >15 years, a ferritin cut-off of 30 µg/l is appropriate. For children from 6-12 years and younger adolescents from 12-15 years, cut-offs of 15 and 20 µg/l, respectively, are recommended. As a first step in treatment, counselling and oral iron therapy are usually combined. Integrating haem and free iron regularly into the diet, looking for enhancers and avoiding inhibitors of iron uptake is beneficial. In order to prevent reduced compliance, mainly as a result of gastrointestinal side effects of oral treatment, the use of preparations with reasonable but not excessive elemental iron content (28-50 mg) seems appropriate. Only in exceptional cases will an intravenous injection be necessary (e.g., concomitant disease needing urgent treatment, repeated failure of first-step therapy).To measure the success of treatment, the basic blood tests should be repeated after 8 to 10 weeks. Patients with repeatedly low ferritin will benefit from intermittent oral substitution to preserve iron stores and from long term follow-up, with the basic blood tests repeated every 6 or 12 months to monitor iron stores. Long-term daily oral or intravenous iron supplementation in the presence of normal or even high ferritin values is, however, not recommended and is potentially harmful.
缺铁是世界上最普遍且常见的营养失调问题。它在发展中国家影响着很大比例的儿童和妇女，在工业化国家也相当普遍，在青少年和经期女性中尤为突出。铁对于最佳认知功能和身体机能至关重要，不仅作为氧气的结合位点，也是许多酶的关键组成部分。因此，各个层面的缺铁情况——非贫血性缺铁、伴有小红细胞症或低色素血症的缺铁以及缺铁性贫血——都应予以治疗。然而，在铁储备正常的情况下，预防性补铁效率低下、有副作用且似乎有害。对于有疲劳症状的患者或缺铁风险人群（青少年、月经量多或经期延长、从事高强度运动、素食或纯素食饮食、饮食失调、体重过轻），一套包括血红蛋白浓度、血细胞比容、平均红细胞体积、平均红细胞血红蛋白、低色素红细胞百分比和血清铁蛋白水平的基础血液检查对于监测缺铁情况很重要。为避免假阴性结果（尽管缺铁但铁蛋白水平高），应通过病史和测量C反应蛋白排除急性期反应。一种算法可引导这一诊断过程以及做出可能治疗的决策。对于年龄大于15岁的健康男性和女性，铁蛋白临界值设定为30μg/l是合适的。对于6至12岁的儿童和12至15岁的青少年，建议的临界值分别为15μg/l和20μg/l。作为治疗的第一步，通常将咨询和口服铁剂治疗相结合。将血红素和游离铁定期纳入饮食、寻找铁吸收增强剂并避免铁吸收抑制剂是有益的。为防止依从性降低，主要是由于口服治疗的胃肠道副作用，使用元素铁含量合理但不过量（28 - 50mg）的制剂似乎是合适的。只有在特殊情况下才需要静脉注射（例如，伴有需要紧急治疗的疾病、第一步治疗反复失败）。为衡量治疗效果，应在8至10周后重复进行基础血液检查。铁蛋白反复偏低的患者将受益于间歇性口服替代以维持铁储备以及长期随访，每6或12个月重复进行基础血液检查以监测铁储备。然而，在铁蛋白值正常甚至偏高的情况下长期每日口服或静脉补铁是不推荐的，且可能有害。
