フェリチン12ng/mL未満で隠れ貧血/無事日直終了
・すごーーく昔に「鉄欠乏性貧血」の勉強していて、フェリチンが一桁ng/1ｍLなら二桁になるまでは治療すべきという論文かテキストを読みました．また、その後の日常診療でHbが正常でもなんか鉄欠乏性貧血のような症状を呈している人を何人か経験しております．で、ずーーーーっとそれについて調べてみようと思ってほったらかしにしていましたが、医学界新聞に↓のような寄稿があり、スッキリしました．
あなたも見逃している！？”隠れ貧血”
↑の本文で、
それでは，体内の貯蔵鉄が減少すると，Hbが正常範囲内であっても全身倦怠感や精神症状を生じるのはなぜでしょうか。それは，体内での鉄の役割が，赤血球の構成だけではないからです。鉄は筋肉に存在するミオグロビンの成分にもなり，鉄欠乏があると筋力低下や疲労感を生じます。またさまざまな酵素の活性化や酵素の構成，コラーゲン合成，エネルギー産生，神経伝達にもかかわり，セロトニンやドーパミンが生合成される際の補酵素としても働きます。
と書かれており、なるほどそうかと納得しました．
・ついでに↑の寄稿文が引用している英語文献のひとつが↓で、無料で読めます．
Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration
Pierre-Alexandre Krayenbuehl , Edouard Battegay, Christian Breymann, Joerg Furrer, Georg Schulthess
Blood. 2011 Sep 22;118(12):3222-7. doi: 10.1182/blood-2011-04-346304. Epub 2011 Jun 24.
Abstract
This is the first study to investigate the efficacy of intravenous iron in treating fatigue in nonanemic patients with low serum ferritin concentration. In a randomized, double-blinded, placebo-controlled study, 90 premenopausal women presenting with fatigue, serum ferritin ≤ 50 ng/mL, and hemoglobin ≥ 120 g/L were randomized to receive either 800 mg of intravenous iron (III)–hydroxide sucrose or intravenous placebo. Fatigue and serum iron status were assessed at baseline and after 6 and 12 weeks. Median fatigue at baseline was 4.5 (on a 0-10 scale). Fatigue decreased during the initial 6 weeks by 1.1 in the iron group compared with 0.7 in the placebo group (P = .07). Efficacy of iron was bound to depleted iron stores: In patients with baseline serum ferritin ≤ 15 ng/mL, fatigue decreased by 1.8 in the iron group compared with 0.4 in the placebo group (P = .005), and 82% of iron-treated compared with 47% of placebo-treated patients reported improved fatigue (P = .03). Drug-associated adverse events were observed in 21% of iron-treated patients and in 7% of placebo-treated patients (P = .05); none of these events was serious. Intravenous administration of iron improved fatigue in iron-deficient, nonanemic women with a good safety and tolerability profile. The efficacy of intravenous iron was bound to a serum ferritin concentration ≤ 15 ng/mL. This study was registered at the International Standard Randomized Controlled Trial Number Register (www.isrctn.org) as ISRCTN78430425.
・余談ですが、最初の寄稿文の引用文献となっている『 鉄剤の適正使用による貧血治療指針 改訂第3版』はアマゾンや楽天、その他ネット上では品切れになっているようです．全てのネット販売を確認したわけではありませんが）また、↑の英語論文の引用文献24（WHOのサイト）
24 World Health Organization, United Nations Children's Fund, United Nations University, Iron Deficiency Anaemia: Assessment, Prevention, and Control. A Guide for Programme Managers, 2010GenevaWorld Health Organization Available from: http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/en/ida_assessment_prevention_control.pdf
は、This page cannot be foundとなっておりました．ナンデヤネン．
以下日記
・本日10/23（日）はゆっくりと６時半起床．朝勉は↓
・８時２０分に家を出て病院へ．本日は９時から１７時３０分まで日直でした．日直中計画停電が２時間あり、少しだけ不便でしたが、大きな事はありませんでした．日直中宿直室にこもって１３時から１６時半くらいまで、戦医研↓（戦争と医学医療研究会）の第４３回定例研究会をZOOMで視聴しておりました．当然途中時々コールがあってぬけましたが．．．
・帰宅は１８時５分．いつものようにネコたちに餌やってお風呂入って、夕食．アルコールをいただきました、今もいただいております．まだ２１時前ですが、寝ようかどうか迷っております．・・・そうそう眠たくなるまで↓を読みましょう．
2022-10-23 20:31
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