Железодефицитные синдромы как основа персонифицированного подхода к лечению анемий в педиатрической практике
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Demikhov V.G., Lebedev V.V., Demikhova E.V. et al. Iron deficiency syndromes are the basis of a personalized approach to the treatment of anemia in pediatric practice. Pediatrics. Consilium Medicum. 2020; 2: 80–84. DOI: 10.26442/26586630.2020.2.200242
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Ключевые слова: железодефицитные синдромы, анемия, абсолютный дефицит железа, функциональный дефицит железа, депонирование железа, дети, ферротерапия.
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The erythron’s physiological function is possible only with the normal bone marrow, adequate renal production of erythropoietin and sufficient supply of substrate (iron, protein) to erythroid bone marrow progenitor cells. Any defects of these factors can lead to the development of anemia. Iron deficiency is one of the most common causes of anemia in children. The causes of iron-deficiency erythropoiesis and anemia are different and are called iron-deficiency syndromes (IDS). Allocate absolute iron deficiency, a functional deficiency of iron, iron sequestration and hereditary IDS. Absolute iron deficiency leads to iron deficiency anemia (IDA), iron sequestration to anemia of inflammation, and individual mutations of genes encoding iron metabolism lead to hereditary forms of IDA. In clinical practice, the cause of anemia can be either one iron deficiency syndrome, or a combination of several IDS at once. Complex disorders of erythropoiesis and iron metabolism in patients with anemia can be the cause of resistance to oral iron. Differential diagnosis of the main IDS in individual case allows to choose the more optimal available therapeutic options.
Key words: iron deficiency syndromes, anemia, absolute iron deficiency, functional iron deficiency, iron sequestration, children.
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3. Rumyantsev A.G., Morshchakova E.F., Pavlov A.D. Erythropoietin: biological properties, age-related regulation of erythropoiesis, clinical use. Moscow: GEOTAR-MED, 2003 (in Russian).
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5. Finch CA, Huebers H. Perspectives in iron metabolism. N Engl J Med 1982; 306: 1520–8.
6. Auerbach M, Ballard H, Trout JR et al. Intravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy-related anemia: a multicenter, open-label, randomized trial. J Clin Oncol 2004; 22: 1301–7.
7. Henry DH, Dahl NV, Auerbach M et al. Intravenous ferric gluconate significantly improves response to epoetin alfa versus oral iron or no iron in anemic patients with cancer receiving chemotherapy. Oncologist 2007; 12: 231–42.
8. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med 2005; 352: 1011–23.
9. Demikhov V.G., Morshchakova E.F., Pavlov A.D. Rol' geptsidina v patogeneze anemii khronicheskikh boleznei. Gematologiia i transfuziologiia. 2006; 5: 31–4 (in Russian).
10. Finberg KE. Iron-refractory iron deficiency anemia. Semin Hematol 2009; 46: 378–86.
11. Capra AP, Ferro E, Cannavò L et al. A Child With Severe Iron-Deficiency Anemia and a Complex TMPRSS6 Genotype. Hematology 2017; 22 (9): 559–64.
12. Bregman DB, Morris D, Koch TA et al. Hepcidin levels predict nonresponciveness to oral iron therapy in patients with iron deficiency anemia. Am J Hematol 2013; 88: 97–101.
13. Aiari M., Demikhov V.G., Mirov I.M. et al. Rol' geptsidina pri osnovnykh zhelezodefitsitnykh sindromakh u beremennykh. Ros. mediko-biologich. vestn. im. akad. I.P. Pavlova. 2016; 24 (4): 96–103 (in Russian).
14. Zakharova I.N., Tarasova I.S., Chernov V.M. et al. Retikulotsitarnye indeksy v diagnostike i kontrole effektivnosti lecheniia zhelezodefitsitnykh sostoianii u detei. Pediatricheskaia farmakologiia. 2015; 12 (6) (in Russian).
15. Luniakova M.A., Beznoshchenko A.G., Demikhov V.G. et al. Urovni syvorotochnogo eritropoetina pri anemiiakh u detei s ostrym limfoblastnym leikozom do nachala khimioterapii. Onkogematologiia. 2008; 4 (in Russian).
ФГБОУ ВО «Рязанский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России, Рязань, Россия
*demix777@ya.ru
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Valerii G. Demikhov*, Viacheslav V. Lebedev, Elena V. Demikhova, Yulia V. Abalenikhina, Andrei V. Dmitriev
Pavlov Ryazan State Medical University, Ryazan, Russia
*demix777@ya.ru