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2 . 2022

Clinical practice guidelines for the diagnosis and treatment of iron deficiency: the view from 2022

Abstract

The aim of the article was to focus the attention of obstetricians and gynecologists on the problem of diagnosis and treatment of iron deficiency anemia and iron deficiency, as well as to reflect the most important features of current clinical practice guidelines “Iron deficiency anemia” (2021).

Highlights. Iron deficiency anemia (IDA) is one of the most common diseases. Numerous data have been accumulated on an increase in frequency of reproductive system diseases and complications in pregnant women with iron deficiency. In September 2021, the Ministry of Health of the Russian Federation approved the clinical practice guidelines “Iron deficiency anemia”, which present classification of diseases, examination algorithm for patients with iron deficiency or IDA, describe etiological factors, features of differential diagnostics, an approach to select the most promising treatment, and also reflect primary and secondary prevention measures to prevent IDA development. The article discusses some controversial issues related to application of clinical practice guidelines in obstetric and gynecological practice.

Conclusion. The examination algorithms presented in clinical practice guidelines 2021 and recommended iron supplements (ferrous sulfate is one of the most commonly used) will improve efficiency of diagnosing and detecting iron deficiency, quickly and effectively replenish iron stores and improve quality of life of patients with IDA.

Keywords:iron deficiency; iron deficiency anemia; clinical practice guidelines; ferrous sulfate

Funding. The study had no sponsor/grant support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Baranov I.I., Salnikova I.A., Nesterova L.A. Clinical practice guidelines for the diagnosis and treatment of iron deficiency: the view from 2022. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2022; 10 (2): 56–64. DOI: https://doi.org/10.33029/2303-9698-2022-10-2-56-64 (in Russian)

REFERENCES

1. Clinical guidelines «Iron deficiency anemia» 2021-2022-2023 (09.09.2021), developed by the National Hematological Society, the National Society of Pediatric Hematologists and Oncologists – Approved by the Ministry of Health of the Russian Federation (in Russian)

2. Idel’son L.I., Vorob’yov P.A. iron deficiency anemia. In: V.I. Vorob’yov (ed.). Clinical Practice Guideline for Hematology. Moscow: Newdiamed, 2005. P. 171–90. (in Russian)

3. United Nations Children’s Fund, United Nations University, World Health Organization. Iron deficiency anemia: assessment, prevention and control. A guide for programme managers. 2011. 114 p.

4. Expert council resolution on iron-deficiency anemia in women. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2020; 8 (4): 28–36. DOI: https://doi.org/10.24411/2303-9698-2020-14004 (in Russian)

5. Volkova S.A., Mayansky N.A., Borovkov N.N., Balabanov A.S., Egorova T.V., Podsosova E.V., et al. Hemogram values in working adult population. Gematologiya i transfuziologiya [Hematology and Transfusiology]. 2008; 53 (1): 21–7. (in Russian)

6. Sel’chuk V.Yu., Chistyakov S.S., Toloknov B.O., Manzyuk L.V., Nikulin M.P., Yur’eva T.V., et al. Iron deficiency anemia: the current state of the problem. RMZh [Russian Medical Journal]. 2012; (17): 1–7. (in Russian)

7. Iron deficiency anemia in children : textbook. In: S.A. Gutsulyak; The Federal State Budgetary Educational Institution of Higher Education «Irkutsk State Medical University» of the Ministry of Health of the Russian Federation, Department of Pediatrics. Irkutsk: IGMU, 2020: 55 p. (in Russian)

8. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization, 2020.

9. World Health Organization. ICD-10: international statistical classification of diseases and related health problems: tenth revision. 2nd ed. Geneva: World Health Organization, 2004.

10. Vorob’yov A.I., Al’-Radi L.S., Andreeva N.E. Rational pharmacotherapy and other diseases of the blood system: guidelines for clinicians. In: A.I. Vorob’yov (gen. ed.). Moscow: Litterra, 2009: 688 p. (in Russian)

11. Camaschella C. Iron deficiency. Blood. 2019; 133: 30–9. DOI: https://doi.org/10.1182/blood2018-05-815944

12. Malakhovsky Yu.E., Manerov F.K., Sarycheva E.G. Mild iron deficiency anemia and latent iron deficiency, boundary condition in children during the first two years of life. Pediatriya [Pediatrics]. 1988; (3): 27–34. (in Russian)

13. Markina L.Yu. Epidemiology, diagnosis and prevention of latent iron deficiency in adolescents: Autoabstract of Diss. Saratov, 1990: 14 p. (in Russian)

14. Diagnosis and management of iron deficiency anemia in children: a guide for physicians. In: A.G. Rumyantsev, I.N. Zakharova (eds). Moscow: KONTI PRINT, 2015. (in Russian)

15. Cappellini M.D., Musallam K.M., Taher A.T. Iron deficiency anaemia revisited. J Intern Med. 2020; 287 (2): 153–70. DOI: https://doi.org/10.1111/joim.13004

16. Lukina E.A., Dezhenkova A.V. Iron metabolism in normal and pathological conditions. Klinicheskaya onkogematologiya [Clinical Oncohematology]. 2015; 8 (4): 355–61. (in Russian)

17. Gafter-Gvili A., Schechter A., Rozen-Zvi B. Iron deficiency anemia in chronic kidney disease. Acta Haematol. 2019; 142: 44–50. DOI: https://doi.org/10.1159/000496492

18. Tarasova I.S., Chernov V.M., Lavrukhin D.B., Rumyantsev A.G. Evaluation of sensitivity and specificity of anemia and sideropenia symptoms. Gematologiya i transfuziologiya [Hematology and Transfusiology]. 2011; 56 (5): 6–13 (in Russian)

19. Goddard A.F., James M.W., McIntyre A.S., Scott B.B. Guidelines for the management of iron deficiency anaemia. Gut. 2011; 60: 1309–16. DOI: https://doi.org/10.1136/gut.2010.228874

20. Enns R.A., Hookey L., Armstrong D., Bernstein C.N., Heitman S.J., Teshima C., et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017; 152: 497–514. DOI: https://doi.org/10.1053/j.gastro.2016.12.032

21. Pennazio M., Spada C., Eliakim R., Keuchel M., May A., Mulder C.J., et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2015; 47: 352–76. DOI: https://doi.org/10.1055/s-0034-1391855

22. Baker R.D., Greer F.R. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010; 126: 1040–50. DOI: https://doi.org/10.1542/peds.2010-2576

23. Toblli J., Brignoli R. Iron (III)-hydroxide polymaltose complex in iron deficiency anemia. Arzneimittelforschung. 2011; 57: 431–8. DOI: https://doi.org/10.1055/s-0031-1296692

24. Ozhegov E.A., Tarasova I.S., Ozhegov A.M., et al. Comparative efficacy of two therapeutic plans for iron deficiency anemia treatment in children and adolescents. Voprosy gematologii/onkologii i immunologii v pediatrii [Problems of Hematology/Oncology and Immunology in Pediatrics]. 2005; 4 (1): 14–9. (in Russian)

25. Sadovnikova I.I. Iron deficiency anemia: pathogenesis, algorithm and treatment. RMZh [Russian Medical Journal]. 2010; (9): 540–3. (in Russian)

26. Resolution WHA65.6. Comprehensive implementation plan on maternal, infant and young child nutrition. In: Sixty-Fifth World Health Assembly, Geneva, 21–26 May 2012. Resolutions and Decisions, Annexes. Geneva: World Health Organization, 2012: 12–3. URL: http://www.who.int/nutrition/topics/WHA65.6_resolution_en.pdf (date of access January 12, 2020)

27. Weatherall D.J. The inherited disorders of haemoglobin: an increasingly neglected global health burden. Indian J Med Res. 2011; 134 (4): 493–7.

28. Langstaff F.J., et al. Treatment of iron-deficiency anaemia: a lower incidence of adverse effects with Ferrum Hausmann than ferrous sulphate. Br J Clin Res. 1993; 4: 191–8.

29. Martynov A.I., Gorokhovskaya G.N., Soboleva V.V. Five-year experience with the drug Sorbifer durules the treatment of iron deficiency conditions. RMZh [Russian Medical Journal]. 2002; 10 (28): 1304–7. (in Russian)

30. Lomova N.A., Dubrovina N.V., Kan N.E., Tyutyunnik V.L. Current modalities for rapid correction of iron deficiency in pregnancy. RMZh [Russian Medical Journal]. 2017; (2): 121–4. (in Russian)

31. Kolosova N.G. Correction of the deficiency of iron in children. Lvrach.ru. 2012: (8). URL: https://www.lvrach.ru/2012/08/15435499 (in Russian)

REFERENCES

1. Clinical guidelines «Iron deficiency anemia» 2021-2022-2023 (09.09.2021), developed by the National Hematological Society, the National Society of Pediatric Hematologists and Oncologists – Approved by the Ministry of Health of the Russian Federation (in Russian)

2. Idel’son L.I., Vorob’yov P.A. iron deficiency anemia. In: V.I. Vorob’yov (ed.). Clinical Practice Guideline for Hematology. Moscow: Newdiamed, 2005. P. 171–90. (in Russian)

3. United Nations Children’s Fund, United Nations University, World Health Organization. Iron deficiency anemia: assessment, prevention and control. A guide for programme managers. 2011. 114 p.

4. Expert council resolution on iron-deficiency anemia in women. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2020; 8 (4): 28–36. DOI: https://doi.org/10.24411/2303-9698-2020-14004 (in Russian)

5. Volkova S.A., Mayansky N.A., Borovkov N.N., Balabanov A.S., Egorova T.V., Podsosova E.V., et al. Hemogram values in working adult population. Gematologiya i transfuziologiya [Hematology and Transfusiology]. 2008; 53 (1): 21–7. (in Russian)

6. Sel’chuk V.Yu., Chistyakov S.S., Toloknov B.O., Manzyuk L.V., Nikulin M.P., Yur’eva T.V., et al. Iron deficiency anemia: the current state of the problem. RMZh [Russian Medical Journal]. 2012; (17): 1–7. (in Russian)

7. Iron deficiency anemia in children : textbook. In: S.A. Gutsulyak; The Federal State Budgetary Educational Institution of Higher Education «Irkutsk State Medical University» of the Ministry of Health of the Russian Federation, Department of Pediatrics. Irkutsk: IGMU, 2020: 55 p. (in Russian)

8. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization, 2020.

9. World Health Organization. ICD-10: international statistical classification of diseases and related health problems: tenth revision. 2nd ed. Geneva: World Health Organization, 2004.

10. Vorob’yov A.I., Al’-Radi L.S., Andreeva N.E. Rational pharmacotherapy and other diseases of the blood system: guidelines for clinicians. In: A.I. Vorob’yov (gen. ed.). Moscow: Litterra, 2009: 688 p. (in Russian)

11. Camaschella C. Iron deficiency. Blood. 2019; 133: 30–9. DOI: https://doi.org/10.1182/blood2018-05-815944

12. Malakhovsky Yu.E., Manerov F.K., Sarycheva E.G. Mild iron deficiency anemia and latent iron deficiency, boundary condition in children during the first two years of life. Pediatriya [Pediatrics]. 1988; (3): 27–34. (in Russian)

13. Markina L.Yu. Epidemiology, diagnosis and prevention of latent iron deficiency in adolescents: Autoabstract of Diss. Saratov, 1990: 14 p. (in Russian)

14. Diagnosis and management of iron deficiency anemia in children: a guide for physicians. In: A.G. Rumyantsev, I.N. Zakharova (eds). Moscow: KONTI PRINT, 2015. (in Russian)

15. Cappellini M.D., Musallam K.M., Taher A.T. Iron deficiency anaemia revisited. J Intern Med. 2020; 287 (2): 153–70. DOI: https://doi.org/10.1111/joim.13004

16. Lukina E.A., Dezhenkova A.V. Iron metabolism in normal and pathological conditions. Klinicheskaya onkogematologiya [Clinical Oncohematology]. 2015; 8 (4): 355–61. (in Russian)

17. Gafter-Gvili A., Schechter A., Rozen-Zvi B. Iron deficiency anemia in chronic kidney disease. Acta Haematol. 2019; 142: 44–50. DOI: https://doi.org/10.1159/000496492

18. Tarasova I.S., Chernov V.M., Lavrukhin D.B., Rumyantsev A.G. Evaluation of sensitivity and specificity of anemia and sideropenia symptoms. Gematologiya i transfuziologiya [Hematology and Transfusiology]. 2011; 56 (5): 6–13 (in Russian)

19. Goddard A.F., James M.W., McIntyre A.S., Scott B.B. Guidelines for the management of iron deficiency anaemia. Gut. 2011; 60: 1309–16. DOI: https://doi.org/10.1136/gut.2010.228874

20. Enns R.A., Hookey L., Armstrong D., Bernstein C.N., Heitman S.J., Teshima C., et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017; 152: 497–514. DOI: https://doi.org/10.1053/j.gastro.2016.12.032

21. Pennazio M., Spada C., Eliakim R., Keuchel M., May A., Mulder C.J., et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2015; 47: 352–76. DOI: https://doi.org/10.1055/s-0034-1391855

22. Baker R.D., Greer F.R. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010; 126: 1040–50. DOI: https://doi.org/10.1542/peds.2010-2576

23. Toblli J., Brignoli R. Iron (III)-hydroxide polymaltose complex in iron deficiency anemia. Arzneimittelforschung. 2011; 57: 431–8. DOI: https://doi.org/10.1055/s-0031-1296692

24. Ozhegov E.A., Tarasova I.S., Ozhegov A.M., et al. Comparative efficacy of two therapeutic plans for iron deficiency anemia treatment in children and adolescents. Voprosy gematologii/onkologii i immunologii v pediatrii [Problems of Hematology/Oncology and Immunology in Pediatrics]. 2005; 4 (1): 14–9. (in Russian)

25. Sadovnikova I.I. Iron deficiency anemia: pathogenesis, algorithm and treatment. RMZh [Russian Medical Journal]. 2010; (9): 540–3. (in Russian)

26. Resolution WHA65.6. Comprehensive implementation plan on maternal, infant and young child nutrition. In: Sixty-Fifth World Health Assembly, Geneva, 21–26 May 2012. Resolutions and Decisions, Annexes. Geneva: World Health Organization, 2012: 12–3. URL: http://www.who.int/nutrition/topics/WHA65.6_resolution_en.pdf (date of access January 12, 2020)

27. Weatherall D.J. The inherited disorders of haemoglobin: an increasingly neglected global health burden. Indian J Med Res. 2011; 134 (4): 493–7.

28. Langstaff F.J., et al. Treatment of iron-deficiency anaemia: a lower incidence of adverse effects with Ferrum Hausmann than ferrous sulphate. Br J Clin Res. 1993; 4: 191–8.

29. Martynov A.I., Gorokhovskaya G.N., Soboleva V.V. Five-year experience with the drug Sorbifer durules the treatment of iron deficiency conditions. RMZh [Russian Medical Journal]. 2002; 10 (28): 1304–7. (in Russian)

30. Lomova N.A., Dubrovina N.V., Kan N.E., Tyutyunnik V.L. Current modalities for rapid correction of iron deficiency in pregnancy. RMZh [Russian Medical Journal]. 2017; (2): 121–4. (in Russian)

31. Kolosova N.G. Correction of the deficiency of iron in children. Lvrach.ru. 2012: (8). URL: https://www.lvrach.ru/2012/08/15435499 (in Russian)

CHIEF EDITORS
CHIEF EDITOR
Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
CHIEF EDITOR
Savel'eva Galina Mikhailovna
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology of the Pediatric Department of the N.I. Pirogov Russian National Scientific Research Medical University under the Ministry of Health of Russia
CHIEF EDITOR
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Department in the Russian People?s Friendship University
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