Анемия и дефицит железа у онкологических больных: роль внутривенных препаратов железа (обзор литературы)

Сакаева Д.Д. Анемия и дефицит железа у онкологических больных: роль внутривенных препаратов железа (обзор литературы). Современная Онкология. 2022;24(4):468–476.
DOI: 10.26442/18151434.2022.4.202018

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Sakaeva DD. Anemia and iron deficiency in cancer patients: the role of intravenous iron supplements (a literature review). Journal of Modern Oncology. 2022;24(4):468–476.
DOI: 10.26442/18151434.2022.4.202018

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Аннотация

Анемия у пациентов со злокачественными опухолями – частая патология, которая оказывает заметное негативное влияние на качество жизни и общий прогноз. Патогенез анемии сложный и многофакторный, зависит от типа и стадии злокачественного новообразования, статуса питания, функции почек, возраста и пола, цитостатика, дозы и схемы введения химиотерапевтического препарата, при этом зачастую основным и потенциально поддающимся терапии фактором развития анемии является дефицит железа. У пациентов онкологического профиля он может быть вызван целым рядом сопутствующих механизмов, включая кровотечение (например, при злокачественных опухолях желудочно- кишечного тракта или после хирургического вмешательства), недостаточного питания, приема лекарственных средств и секвестрации железа в макрофагах, вызванной воздействием гепсидина, с последующим железодефицитным эритропоэзом. Разнообразие клинических проявлений анемии обусловливает трудности в установлении универсальных критериев, которые бы позволили выработать оптимальные методы лечения данной патологии. В настоящее время терапия анемии при злокачественных опухолях включают заместительную терапию препаратами железа, препаратами, стимулирующими эритропоэз (эритропоэтины), а также гемотрансфузии. При этом гемотрансфузии следует свести к минимуму из-за больших рисков и расходов. Доказано, что терапия препаратами железа является эффективным подходом в коррекции дефицита железа, может повышать эффективность препаратов, стимулирующих эритропоэз, и снижает потребность в гемотрансфузиях. В опубликованных руководствах предлагается широкое применение внутривенных препаратов железа. В данной статье мы обсуждаем некоторые возможные подходы к лечению дефицита железа у онкологических пациентов в различных клинических условиях. При этом мы основываемся на текущих рекомендациях и подчеркиваем необходимость дальнейших исследований в этом направлении.

Ключевые слова: функциональный дефицит железа, анемия, внутривенные препараты железа, злокачественные опухоли

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Anemia in patients with malignancies is a common disorder that has a markedly negative impact on quality of life and overall prognosis. The pathogenesis of anemia is complex and multifactorial, depending on the type and stage of malignancy, nutritional status, renal function, age and gender, cytostatic drug, dose, and chemotherapeutic regimen, with iron deficiency often being the main and potentially treatable factor for anemia. In cancer patients, it can be caused by various concomitant mechanisms, including bleeding (e.g., in malignant gastrointestinal tumors or after surgery), malnutrition, medication, and hepcidin-induced iron sequestration in macrophages, with subsequent iron-deficient erythropoiesis. The variety of clinical manifestations of anemia makes it challenging to establish universal criteria to develop optimal treatments. Current therapy for anemia in malignant tumors includes replacement therapy with an iron supplement, erythropoiesis-stimulating agents (erythropoietins), and blood transfusions. However, blood transfusions should be minimized due to the high risks and costs. Therapy with an iron supplement is an effective approach to correcting the iron deficiency. It can increase the efficacy of erythropoiesis-stimulating drugs and reduce the need for blood transfusions. Published guidelines suggest the wide use of intravenous iron supplements. This article discusses possible approaches to treating iron deficiency in cancer patients in various clinical settings. We build on current guidelines and emphasize the need for further research in this area.

Keywords: functional iron deficiency, anemia, intravenous iron supplements, malignant tumors

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Авторы

Д.Д. Сакаева*1,2

1 ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава России, Уфа, Россия;
2 ГК «Мать и дитя», Уфа, Россия
*d_sakaeva@mail.ru

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Dina D. Sakaeva*1,2

1 Bashkir State Medical University, Ufa, Russia;
2 GC “Mother and Child”, Ufa, Russia
*d_sakaeva@mail.ru

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