Wos Açık Erişimli Yayınlar

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search.filters.applied.f.publicationcategory: search.filters.publicationcategory.Makale - Uluslararası Hakemli DergiSubject: search.filters.subject.anemia

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    The Effect of Treatment of Iron Deficiency Anemia on Thyroid Volume
    (2019) Etik, Digdem Ozer; Erdogan, Murat Faik
    Objective: Iron and iodine, which are the two important micronutrients, are still deficient in a large number of women worldwide. This study aimed to examine the thyroid volumes of iron deficient, anemic women before and after correction of the anemia in a mildly iodine deficient environment. Material and Methods: Sixty six women aged 18-45 years were prospectively enrolled in this study. Inclusion criteria included serum hemoglobin (Hb) level <11.0 g/dL, ferritin level <13 ng/mL, thyroid hormones within normal reference ranges and negative thyroid antibodies. Oral iron supplement (567 mg ferrous sulfate, twice a day) for six months was prescribed and strongly recommended. All patients were re-evaluated at the end of the iron treatment. Results: Initially, the median (minimum/maximum) Hb and ferritin levels of patients were 10.2 g/dL (5.6/11.1) and 3.95 ng/mL (0.44/10.7), respectively. Six months later, median Hb and ferritin values increased significantly to 13.15 g/dL (9.3/15.6) (p<0.001) and 19.575 ng/mL (3.74/79) (p<0.001) respectively. Median thyroid volume decreased significantly from 15.705 mL (7.15/54.2) to 13.212 mL (6.11/52.8) (p<0.001). The patients were grouped according to the improvements in Hb and ferritin levels, initial thyroid gland volume, and response to the treatment. The reduction in thyroid gland size, at the end of the treatment, was more significant in patients with improvement in both Hb and ferritin levels as compared to those with improvement only in Hb levels (p<0.05). Conclusion: Iron may be responsible for efficient organification of iodine, active iodine utilization from thyroglobulin, and control of hyperkinetic blood-flow to the thyroid gland. The findings of this study support that other than iodine, iron supplementation has a significant effect on the regression of thyroid volume in women with iron deficiency anemia.
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    Assessment of Hemoglobin Stability in Chronic Hemodialysis Patients Receiving Erythropoietin Therapy and the Effect of Hemoglobin Stability on Risk of Cardiovascular Disease
    (2019) Guncan, Melda Ulas; Guncan, Sabri; Torun, Dilek
    Objective: Anemia is one of the most important factors that decrease the quality of life in patients with end-stage renal desease receiving hemodialysis treatment. In these patients, Erythropoietin stimulating agents (ESAs) are used in the treatment of anemia. Although the target hemoglobin (Hb) value in chronic renal failure is 11-12 gr/dL, it is suggested that hemoglobin values fluctuate between normal, high and low values in the great majority, leading to cardiovascular structural changes which increase mortality. In this study, we investigated the effect of anemia and hemoglobin fluctuations on mortality rate and the risk of cardiovascular disease in chronic hemodialysis patients who received ESA thearapy. Materials and Methods: Hemoglobin values for 12 months of 181 patients were examined. The target Hb level was 11-12 gr/dL interval and the patients were divided into 6 groups according to the hemoglobin values; persistently low, low-normal, target, normal-high, low-high and persistently high. According to the variability in hemoglobin level, groups were compared in terms of demographic, laboratory characteristics, treatment, risk of cardiovascular disease, hospitalization and death frequency and causes. Result: The total of 181 patients were classified according to Hb levels; 22 (12.2%) patients were persistently-low, 72 (39.8%) were low-normal, 10 (5.5%) were normal-high and 77 (42.5%) patients were low-high Hb group. During the 12 month fallow up, there were no patients in target and high Hb group. The groups were similar in terms of the presence of comorbid diseases such as diabetes, hypertension, coronary artery disease and other demographic characteristics, and there was no difference between groups in terms of cardiovascular disease development. ESA doses and blood transfusion counts and mortality rates were significantly higher in the persistently-low hemoglobin group compared to the other groups. Conclusion: In our study, high rate of anemia and hemoglobin fluctuations were shown in chronic hemodialysis patients and anemia was associated with mortality. However, the possible association of these variables with cardiovascular diseases was not observed. Further studies are needed in the larger hemodialysis patient group to investigate the relationship between hemoglobin fluctuation and mortality and cardiovascular risk.