Ikuta Katsuya
Program Promotion Department, Hokkaido Blood Center.
Technical Department Blood Service Headquarters, Medical Affairs and Blood Collection.
Rinsho Ketsueki. 2022;63(9):1026-1034. doi: 10.11406/rinketsu.63.1026.
The body does not possess an active export system for iron. Therefore, the amount of iron uptake is usually small; iron metabolism in the body should be considered a "semi-closed system." However, iron needed for erythropoiesis can be lacking in the case of continuous bleeding, and thus, iron deficiency anemia (IDA) would occur. IDA is the most common form of anemia; approximately 70% of anemia is IDA. Therefore, upper and lower endoscopies or gynecological procedures should be used to treat bleeding sites; in addition, the small intestine can now be widely observed and treated by double-balloon and capsule endoscopies. Iron replacement therapy for IDA is also important; however, oral iron administration frequently causes adverse events in the gastrointestinal tract, such as nausea and vomiting, making long-term oral iron administration difficult. Newly approved ferric citrate hydrate causes fewer adverse events for the gastrointestinal tract. For a long time, concerning intravenous (IV) iron formulation, saccharated ferric iron oxide has been the only available IV iron formulation in Japan. However, ferric carboxymaltose was recently approved, and administration at a dose of 500 mg/day can achieve a certain iron replacement with less administration. Thus, more effective treatment for patients with IDA might be achieved by these new procedures as well as oral and IV iron preparations.
人体没有活跃的铁输出系统。因此，铁的摄入量通常很少；人体的铁代谢应被视为一个“半封闭系统”。然而，在持续出血的情况下，红细胞生成所需的铁可能会缺乏，从而导致缺铁性贫血（IDA）。IDA是最常见的贫血形式；约70%的贫血为IDA。因此，应采用上、下消化道内镜检查或妇科手术来治疗出血部位；此外，现在可以通过双气囊和胶囊内镜对小肠进行广泛观察和治疗。IDA的铁替代疗法也很重要；然而，口服铁剂经常会引起胃肠道不良反应，如恶心和呕吐，使得长期口服铁剂变得困难。新批准的水合柠檬酸铁引起的胃肠道不良反应较少。长期以来，关于静脉注射（IV）铁制剂，含糖氧化铁一直是日本唯一可用的IV铁制剂。然而，羧基麦芽糖铁最近被批准，每天500毫克的剂量给药可以用较少的给药量实现一定的铁替代。因此，通过这些新程序以及口服和静脉铁制剂，可能会为IDA患者实现更有效的治疗。
