Lecoq Anne-Lise, Dong Catherine, Carbonnel Franck, Becquemont Laurent
Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Bicêtre, Centre de Recherche Clinique AP-HP, université Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
Service de Gastro-Entérologie, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France.
Therapie. 2021 Nov-Dec;76(6):705-714. doi: 10.1016/j.therap.2021.04.008. Epub 2021 Apr 21.
Iron deficiency and iron-deficiency anemia are common medical conditions. Management of the etiology and iron supplementation are both necessary to treat this condition. Use of intravenous iron preparations is increasing due to its advantages over oral iron. Indeed, the total dose required can be provided in a single infusion, and it is more effective and increases hemoglobin levels more quickly than oral iron. Hypophosphatemia, sometimes severe, following intravenous iron administration, has been described in literature these past years, in particular with ferric carboxymaltose. We report here a case of severe hypophosphatemia with ferric carboxymaltose and carry out a literature review to determine the incidence of hypophosphatemia and to precise its clinical presentation, its pathophysiological mechanisms and its treatment. We found that hypophosphatemia is frequent with ferric carboxymaltose. Most of the time, there are no clinical manifestations, but cases of symptomatic osteomalacia have been described. Duration of hypophosphatemia is variable, from a few weeks to several months in case of prolonged administration. Hypophosphatemia owing to renal phosphate wasting is caused by an increase in intact fibroblast growth factor 23 (FGF-23) levels. However, the mechanism of ferric carboxymaltose- induced increase in intact FGF-23 is still unknown.
缺铁和缺铁性贫血是常见的医学病症。治疗该病症时，病因管理和铁补充都很有必要。由于静脉铁制剂相较于口服铁具有优势，其使用正在增加。的确，所需的总剂量可以在一次输注中提供，而且它比口服铁更有效，能更快地提高血红蛋白水平。过去几年，文献中描述了静脉注射铁剂后出现的低磷血症，有时较为严重，尤其是使用羧基麦芽糖铁时。我们在此报告一例使用羧基麦芽糖铁后出现严重低磷血症的病例，并进行文献综述，以确定低磷血症的发生率，明确其临床表现、病理生理机制及治疗方法。我们发现使用羧基麦芽糖铁时低磷血症很常见。大多数情况下没有临床表现，但有症状性骨软化症的病例已有描述。低磷血症的持续时间各不相同，长期给药时从几周至几个月不等。因肾磷酸盐流失导致的低磷血症是由完整的成纤维细胞生长因子23（FGF - 23）水平升高引起的。然而，羧基麦芽糖铁诱导完整FGF - 23升高的机制仍不清楚。
