Cuplul Fier-Cupru este Fiernecesar pentru preventia si tratamentul anemiei

Cuprins:

1 2 3

ANEMIA FERIPRIVA CUPLUL Fe -Cu FACTORI CARE INFLUENTEAZA ALEGEREA TRATAMENTULUI

Istoric:
WHO
1968: a condition in which the hemoglobin content of the blood is lower than normal as a result of a deficiency of one or more essential nutrients, regardless of the cause of such deficiency. Iron deficiency was present in 4099% of the pregnant women studied and was undoubtedly responsible for the major proportion of anemia 1989 Iron deficiency anaemia is the most prevalent nutritional disorder in the world today. . . Iron deficiency is by far the commonest nutritional cause of anaemia; it may be associated with a folate deficiency, especially during pregnancy. Other nutrient deficiencies, such as vitamin B-12, pyridoxine (PN) and copper are of little public health significance because of their infrequency. 2004 the prevalence of anaemia has often been used as a proxy for IDA. Although this approach may be useful in settings where iron deficiency is known to be the major cause of anaemia, it is not valid in settings where the etiology of anaemia is more complex

Cauze:
Dieta: la copii si la varstnici Absorbtie deficitara Utilizare crescuta ( de exemplu in caz de sarcina, alaptare sau in perioada de crestere) Utilizare deficitara (afectiuni cronice) Sangerare Deficienta altor micronutrienti: Cupru, B12, acid folic

Necesarul de Fier
Required iron intake 12 (mg Fe/1000 kcal)

Pregnancy

10 8 6 4 2 0 0 10 20 30 40 50

Men Women

60

70

Stoltzfus, 1997

Prevalenta anemiei feriprive

Copii de varsta prescolara:

Source: de Benoist B et al. Worldwide prevalence of anaemia 1993-2005: WHO Global Database on Anaemia. Geneva, World Health Organization, 2007 (in press).

Category of public health significance Normal (<5.0%) Mild (5.0-19.9%) Moderate (20.0-39.9%) Severe (40.0%) No data

Cuprins:

1 2 3

ANEMIA FERIPRIVA CUPLUL Fe -Cu FACTORI CARE INFLUENTEAZA ALEGEREA TRATAMENTULUI

Homeostazia Fierului si a Cuprului

Puncte de interactiune

James F Collins. Metabolic crossroads of iron and copper, Nutrition Reviews Vol. 68(3):133147

Transportul celular al Fe si al Cu
Puncte de interactiune

James F Collins. Metabolic crossroads of iron and copper, Nutrition Reviews Vol. 68(3):133147

Transportul celular al Fe si al Cu
Puncte de interactiune

James F Collins. Metabolic crossroads of iron and copper, Nutrition Reviews Vol. 68(3):133147

Cuplul Fier-Cupru
Metabolismul Fe Ceruloplasmina Absorb ia fierului prin mucoasa intestinal i, n special, transportul s u prin membrana bazolateral a enterocitelor Deplasarea fierului de la nivelul esuturilor n care este depozitat (ficat, mucoasa intestinal , etc), prin catalizarea reac iei Fe2+ Fe3+ Fixarea fierului de transferin i transportarea sa c tre m duva osoas , unde se produc hematiile

Deficienta de Fe si Cu determina anemie si afectarea transportului intestinal al fierului este asociata cu patologii care includ anemia afectiunilor cronice si hemocromatoza ereditara James F Collins

Cuplul Fier-Cupru
Sintezei hemoglobinei (citocrom oxidaz ) Catalizeaz reac ia Fe2+ hematiilor) Fe3+ n eritrobla ti (precursorii

Transferul fierului intracitoplasmatic c tre mitocondrii, urmat de ncorporarea sa n moleculele de hemoglobin Hematopoieza Cu2+ joac un rol esen ial n maturizarea celulelor hematopoietice stimulnd hematopoieza Aportul deficitar de Cu2+ cauzeaz anemie i neutropenie, ambele putnd fi corectate prin suplimentarea cu Cu2+

Deficitul de Cupru - femei insarcinate

Transportul Fe si Cu prin placenta

Ceruloplasmina este necesara pentru efluxul de Fe din ficatul matern Pacientii cu aceruloplasminemia au un nivel crescut de Fe in ficat Transferul fierulul la fat este compromis nivelul fierului seric si hepatic al fatului scade Given the high incidence of maternal anaemia during pregnancy, and that many of those who are prescribed iron supplements show no significant improvement, it is tempting to conclude that at least some of the cases are a consequence of low copper . when considering

supplementing iron, copper status must also be taken into account H. J. McArdle,Rowett Research Institute, Aberdeen, UK.

Deficitul de Cupru -adulti

Procent important de anemii neexplicate dar asociate cu deficit de Cupru Un numar semnificativ de pacienti care au fost diagnosticati cu anterior cu deficit de vitamina B12 au deasemenea hipocrupemie nediagnosticata
Calin I. Prodan, Hypocupremia Associated With Prior Vitamin B12 Deficiency, American Journal of Hematology 82:288290 (2007)

Deficitul de Cupru - copii

Aport neadecvat Prematuritate Malabsorbtie Pierdere excesiva de Cupru Doze mari de Fier

Manganul
Rol :
Activarea diverselor sisteme enzimatice i, n consecin , n diverse tipuri de metabolism celular de la nivelul oaselor, lipidelor, carbohidra ilor i proteinelor. In protejarea mpotriva radicalilor liberi o Catalizeaz reac ia de dismuta ie a peroxidului de hidrogen (H2O2) n ap i oxigen (superoxid dismutaz ) Manganul interfera cu metabolismul fierului si al cuprului este importanta suplimentarea cu mangan cand se administreaza Fe + Cu
Abraham J. & Giachetti I. (1992). Apports nutritionnels conseills pour la population franaise. Technique et documentation, Paris. Finley J. W. and Davis A. C. D. Manganese deficiency and toxicity: Are high or low dietary amounts of manganese cause for concern? BioFactors, 1999, vol. 10. no1, pp. 15-24.

Cuprins:

1 2 3

ANEMIA FERIPRIVA CUPLUL Fe -Cu FACTORI CARE INFLUENTEAZA ALEGEREA TRATAMENTULUI

Ce tratament alegem?
1 2 3 4 Fier sau Fier + Cu + ? Saruri feroase vs saruri ferice? Solutie sau tablete? Eficienta si complianta

This is a placeholder which can be replaced your own texts. This is a placeholder which can be replaced your own texts. This is a placeholder which can be replaced your own texts.

Fe sau Fe +Cu?

Time course of papers published on the copper/iron connection. The papers represent the authors non-systematic, and certainly incomplete, collection of references that primarily concern both iron and copper metabolism (534 articles through February, 2002)
P. Fox- The copper-iron chronicles: The story of an intimate relationship, Biometals 2003

Fe sau Fe +Cu?
Combinatia Fier- Cupru in tratamentul anemiei a fost studiata clinic inca din 1928
Combinatia Fier- Cupru a determinat un raspuns maxim in regenerarea hemoglobinei, fata de monoterapia cu Fier, care a determinat un raspuns neadecvat, printr-o crestere moderata a hemoglobinei.

Curves showing the ineffectiveness of therapy during the first few weeks of life (cases 1 and 2) and curves showing the interference by infection with the effect of treatment (cases 3, 4 and 5).

(C. A. ELVEHJEM, IRON VERSUS IRON AND COPPER IN THE TREATMENT OF ANEMIA IN INFANTS, American Journal of Disease of Children, 1937

Fe sau Fe +Cu?

Curves comparing the hemoglobin response to 25 mg. of iron plus 1 mg. of copper with that to 25 mg. of iron alone

(C. A. ELVEHJEM, IRON VERSUS IRON AND COPPER IN THE TREATMENT OF ANEMIA IN INFANTS, American Journal of Disease of Children, 1937

Saruri feroase vs saruri ferice?

Sarurile ferice sunt disociate Fe2+ sau Fe3+

Fierul se absoarbe sub forma de Fe2+ It has been shown that preparations containing ferrous salts (+2) are more easily absorbed than those containing ferric salts (+3) since the former can be immediately absorbed by the duodenal mucosa. The study reported here reveals that oral ferrous gluconate in liquid form is more effective and above all better tolerated than other solid or liquid formulations containing elementary iron. ( Casparis, Minerva Ginecol 1996) Gluconatul feros in forma lichida este mai eficient si mai bine tolerat decat alte formulari solide sau lichide de fier (Ghidul Societatii Britanice de Gastroenterologie 2005)

Solutie sau tablete?

Indiferent de varsta, se recomanda forma lichida
Iron deposition in the upper GI tract is common in patients taking iron tablets. It is frequently associated with mucosal disruption in the oesophagus and stomach

(Kaye P, Abdulla K, Wood J, James P, Foley S, Ragunath K & Atherton J (2008) Histopathology 53, 311317)

Patterns of iron deposition. A, Oesophageal ulcer showing crystalline iron coating the surface (pattern A) and haemosiderin in granulation tissue (pattern B) (H&E). B, Gastric biopsy specimen showing surface iron (pattern A) with underlying reactive gastritis (H&E). C, Gastric biopsy specimen with haemosiderin in lamina propria (pattern B) (H&E). D, Gastric biopsy specimen showing more subtle focal iron deposition engulfed by foreign body giant cell (H&E). E, Perls Prussian Blue stain showing iron (blue) in glandular epithelium (pattern C). F, Duodenal biopsy specimen showing haemosiderin in histiocytes at villous tips (pattern D) (H&E)

Eficienta
Iron Polymaltose Versus Ferrous Gluconate in the Prevention of Iron Deficiency Anemia of Infancy Studiu randomizat
Fier preventiv de la 4-6 luni pana la 12 luni

Valoarea medie a Hb semnificativ mai mare in grupul tratat cu gluconat feros (12.04 0.09 g/dL vs. 11.68 0.11, p>0.014) Valoarea Hb <11 g/dL a fost detectata la 3 copii din grupul GF si la 10 din grulul FP (P<0.04).
Lutfi Jaber, MD J Pediatr Hematol Oncol 2010;32:585588

Eficienta si Complianta
Efficacy of Tothema in the treatment of iron deficiency anemia in early childhood with concomitant copper deficiency

Protocol:
Tothma 5mg/kg/zi pn la normalizarea Hb i apoi 2 mg/kg/zi, pana la 3 luni

Criterii de includere:
42 pacienti 0,4 i 3 ani grupa I : prematuri (n = 16) grupa II : copii n scu i la termen, cu diaree prelungit i natural (n = 11) grupa III : copii n scu i la termen, care nu prezint diaree Grupa martor: copii de aceea i vrst , dar s n to i (n = 24).

Criterii de evaluare:
- Bilan uri clinice i biologice (Hematologic: Hb, eritrocite, reticulocite, morfoeritrogram ; - Biochimice: fier seric, CTF, cupru, ceruloplasmin ; Radio-imunologice : feritin realizate nainte i dup tratament.
Mtvarelidze Z et al. Georgian Med News 2005; (121):68-71

Eficienta si Complianta
Rezultate:
Eficacitate clinic : - ameliorarea st rii generale - diminuarea rapid a simptomelor de anemie Eficacitate paraclinic : - normalizarea complet a parametrilor hematologici, biochimici i a feritinei dup 3 luni de tratament

Concluzie:
Tothma este un medicament eficace n tratamentul anemiei prin caren de fier la copiii de vrst mic , care prezint o caren de cupru asociat Tothma permite corectarea nivelului rezervelor de fier dar i de cupru Tothma previne apari ia formelor rezistente de anemie prin caren de fier Tothma administrat copiilor de vrst mic este bine tolerat, cu efecte nedorite rare i trec toare

Eficienta si Complianta
93 Copii de la 6 luni -16 ani Grup 1-Hb : 95.5+/- 0.12 Grup 2 Hb : 78.9+/- 0.34 g/l Evaluarea eficientei clinice (simptome) si de laborator (Hb) dupa tratamentul cu Tothema

Anmouth S.Y. New developments in the treatment of iron deficiency anaemia in children Medical journal Of Diseases, Newborns and Children, 2001

Eficienta si Complianta
Rezultate:
Tratament eficient in tratamentul atat la copii mici cat si la adolencenti Crestere rapida si semnificativa a Hb atat in cazurile moderate cat si cele mai severe Bine tolerat

Profilaxia si Tratamentul Anemiei Feriprive

Gluconat Feros 50 mg Gluconat de Cupru 0.7 mg

IDA :Deficienta

TOT`HEMA
Eficienta, Complianta

multipla
Cuplu Fe-Cu

Gluconat de Mangan 1.33 mg

1 2
Saruri feroase

4 3

Solutie