China
Africa
Explore chapters and articles related to this topic
The Legal Duties of Doctors to Children in Their Care
Published in Jo Bridgeman, Medical Treatment of Children and the Law, 2020
In the most recent case, at the time of writing, Cardiff and Vale University Health Board v T and H,35 MacDonald J granted the application permitting the administration of blood to three-and-a-half-week old, T, who was ventilator dependent with cardiac failure and reduced lung function due to a congenital disorder. His mother had been told earlier that week that T would need a blood transfusion in the near future and was told the day before the application that the administration of blood should not be delayed. An iron preparation had not improved his condition. That morning, T had suffered a cardiac arrest, and the multi-disciplinary team caring for him considered that administration of blood was urgently required to prevent further cardiac arrest and address the potentially fatal complications of anaemia and low blood pressure. The evidence before the court from his consultant neonatologist was that they were minimising the administration of blood and had let his haemoglobin levels fall lower than usual, but that modifying the treatment provided to accommodate parental beliefs had led to T becoming acutely unwell, and his treating team was of the view that without a transfusion, T’s life was at a very significant risk.36
The twentieth century
Published in Michael J. O’Dowd, The History of Medications for Women, 2020
The possible prevention of neural tube defects (NTD) by periconceptional vitamin supplementation was reported on by the researchers R.W. Smithells and colleagues (1980, 1983). They detailed the results of a trial on multivitamin supplementation where one of 178 (0.6%) infants of fully-supplemented mothers had an NTD; 13 of 260 (5%) infants of unsupplemented mothers, however, were affected. The ‘study mothers’ were prescribed Pregnavite forte F, a multivitamin and iron preparation that contained 0.36 mg folic acid with ascorbic acid, calcium phosphate, ferrous sulfate, iron, nicotinamide, riboflavin, thiamin, vitamin A and vitamin D. The research team concluded that vitamin supplementation had prevented some NTDs: ‘This is the most straight-forward interpretation and is consistent with the circumstantial evidence linking nutrition with NTDs ... We hope that the data presented will encourage others to initiate similar and related studies.’
Pharmacologic alternatives to blood
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
Ferric gluconate (Ferrlecit, Schein Pharm Corp, Florham Park, NJ) was approved for use in the USA in February 1999 as an intravenous iron preparation in renal dialysis patients.54 The rate of allergic reactions (3.3 episodes per million doses) appears to be lower than that of iron dextran (8.7 episodes per million doses), and the safety profile of iron gluconate is substantially better; in the period 1976–1996, among 74 adverse events reported as severe, there were no deaths.50 Adverse events that have been reported to be associated with ferric gluconate include hypotension, rash, chest or abdominal pain, with an incidence of less than 5%.55 Another potential adverse effect of intravenous iron therapy is a clinical syndrome of acute iron toxicity (nausea, facial reddening, and hypotension), which has been attributed to oversaturation (>100%) of transferrin. This has been described with rapid infusion of ferric gluconate (62.5–125 mg within 30 minutes) in a study of 20 dialysis patients.56 However, the existence of this effect has been disputed – two laboratory assays for measurement of serum iron yield misleading results for transferrin saturation if performed within 24 hours after infusion.57 Serious reactions, including one hypotensive event, were reported in only three (1.3%) of 226 patients undergoing renal dialysis while treated with ferric gluconate in one European study.58
Re-defining iron deficiency in patients with heart failure
Published in Expert Review of Cardiovascular Therapy, 2022
J. J. Cuthbert, N. Ransome, A. L. Clark
Iron salts have been used to treat disease since the 17th century [66], and iron sulfate has been available in pill form since the early 19th century [67]. However, it was not until the 1930s that Scottish pediatrician Helen Mackay (the first female Fellow of the Royal College of Physicians in the UK) discovered the link between iron deficiency and anemia [68]. The use of iron salts became widespread, but gastrointestinal side effects were common. Early attempts at developing a parenteral iron preparation were marred by high rates of severe analphylactoid reactions due to the highly toxic effect of unbound iron [69]. The development of iron preparations using a carbohydrate shell – iron dextran – in the 1940s allowed parenteral iron treatment to become a realistic prospect (Figure 4) [70]. Dextrans were associated with intolerable local side effects when given subcutaneously or intramuscularly, and so IV administration became the preferred route [68].
Observations from a peculiar case of volatile substance dependence–A case report
Published in Journal of Addictive Diseases, 2020
Dhruv Bardolia, Urvika Parikh, Saumitra Nemlekar, Rajat Oswal
In view of the severe iron deficiency, a parenteral iron preparation was prescribed. She was treated with Injection Iron Sucrose 200 mg intravenously. For her depressive symptoms we started her on Sertraline 25 mg and Clonazepam 0.5 mg for sleep. We observed for any risk of bleeding tendencies inherent with the use of selective serotonin reuptake inhibitors (SSRIs). She received a set of five infusions of parenteral iron over a period of two weeks. After eight weeks she reported significant clinical improvement, with no depression as per the HAM D scale (HAM-D score = 8). With parenteral iron therapy her hemoglobin had improved to 8.8 gm/dL (12.0–15.0 g/dL)/5.5 mmol/L (7.45–9.30 mmol/L). She reported no craving for the use of inhalants. This coincided with the correction of anemia and marked improvement in her depressive features. Patient was further advised to come for regular follow ups. The plan of action was to provide supportive care and cognitive behavior therapy to maintain the abstinence. She was counseled for healthy dietary practices.
Calciphylaxis-as a drug induced adverse event
Published in Expert Opinion on Drug Safety, 2019
Ignacio Portales-Castillo, Daniela Kroshinsky, Cindy K. Malhotra, Roberta Culber-Costley, Mario Gennaro Cozzolino, Shelly Karparis, Charles L. Halasz, Jeremy Goverman, Harold J. Manley, Rajeev Malhotra, Sagar U. Nigwekar
Initial concerns about the role of iron in arterial calcification came from Professor Selye’s studies in rats, where iron was one of the ‘challenger’ agents in the 2-hit hypothesis [8]. Subsequent case reports implicated iron overload as a possibly important precipitant of calciphylaxis [63]. Chronic iron administration has been associated with vascular oxidative stress and thus it is conceivable that iron supplementation could increase the risk of vascular damage. In a single center study that evaluated skin biopsies from calciphylaxis patients, all samples from patients affected with calciphylaxis (n = 12) had iron deposits in the microvasculature and no iron deposits were present in vessels of unaffected patients [64]. However this does not prove cause and effect and the findings could be related to thrombosis or bleeding. On the other hand, iron citrate may be protective against vascular calcification in vitro [65]. With these observational and experimental studies, one can conclude that iron administration may favor the development of calciphylaxis in the right setting, but this is rare and might depend on the type of iron preparation and renal function since low molecular weight iron is very rapidly cleared with normal kidney function [66]. For the majority of end stage renal disease patients without calciphylaxis, iron should be prescribed as indicated by guidelines [67]. If calciphylaxis develops, experts suggest stopping iron (particularly intravenous formulations) administration.