Hematology Month in Review: September 2024

In the September 2024 hematology month-in-review, recent literature revealed the critical role of vitamin D in anemia prevention, widespread iron deficiency among adults in the US, the safety of rpFVIII for hemophilia, and the benefits of intravenous iron for pregnant women, while challenging the connection between pre-pregnancy body mass index (BMI) and anemia.

Check out our top 7 stories in hematology in September:

Women’s Health

Iron Deficiency Extremely Common by Third Trimester of Pregnancy

In one of the largest studies ever conducted to evaluate changes in iron status during pregnancy, no women were anemic in the first trimester, while more than 80% experienced iron deficiency by the third trimester. “This is concerning and draws attention to the benefit of screening for iron deficiency with hemoglobin and ferritin in defined low-risk populations,” investigators wrote.

International guidelines vary on the need for iron deficiency screening in pregnancy without agreed-upon diagnostic criteria—recent guidance from the US Preventive Services Task Force (USPSTF) deemed the current evidence ‘insufficient’ to assess the benefits and harm of screening for iron deficiency in pregnant women.

Pre-Pregnancy BMI Unrelated to Iron Deficiency During Pregnancy, Study Finds

Compared with normal pre-pregnancy weight, women with pre-pregnancy overweight or obesity did not exhibit an increased risk for iron deficiency or anemia during pregnancy. Using data collected from the National Health and Nutrition Examination Survey (NHANES) 1999-2010 cycle, pre-pregnancy overweight and obesity status showed no difference in iron status biomarkers.

“Although pre-pregnancy obesity is strongly linked to increased risk of adverse pregnancy outcomes, based on our results, it was not associated with iron deficiency or anemia, investigators wrote.

Intravenous Iron Outperforms Oral Tablets for Anemia in Pregnant Women

Intravenous ferric carboxymaltose proved superior to oral iron tablets for iron deficiency anemia in pregnant women. As reported in the IVON Trial, intravenous iron achieved better, faster outcomes than oral ferrous sulfate tablets, with a similar safety profile, among more than 1,000 pregnant women with anemia.

“These findings are reassuring because pregnant women often reject new medicines because of fear of harm to their babies,” said study author Ochuwa A. Babah, Karolinska Institutet. “We now have evidence that implementing the use of this new drip iron in regions where many pregnant women suffer anemia like Africa, will be a valuable step towards reducing the proportion of pregnant women who suffer from this condition and its complications.”

Anemia Impacts Dependence in Daily Activities of Living for Older Women

Anemia was correlated with the need for dependence in basic and instrumental activities of daily living, including cognitive dysfunction and malnutrition, among older female patients. Every 1 of 3 women presenting to an outpatient clinic demonstrated the blood disorder and were typically older and had a higher incidence of comorbid diseases.

“Anemia is associated with decreased functionality and increased falls, which is independent of all these factors,” investigators wrote. “Therefore, older women should routinely be tested for anemia.”

Public Health

Vitamin D May Play Key Role in Anemia Prevention, Study Finds

Serum 25-hydroxyvitamin D [25(OH)D] concentration and anemia risk were significantly inversely correlated after multivariable logistic regression analysis. A model, fully adjusted for demographics, comorbidities, and laboratory test findings, showed the risk of anemia decreased by 5% for every unit increase in 25(OH)D levels.

“These findings, which suggest that regulating 25(OH)D levels through supplementation or lifestyle modifications may be a useful tactic for reducing the prevalence of anemia, especially in susceptible populations, have significant therapeutic ramifications,” investigators wrote.

Absolute, Functional Iron Deficiency Affects Large Proportion of US Adults

Absolute and functional iron deficiency affected a notable portion of the United States between 2017 and 2020, even without anemia, heart failure, or chronic kidney disease. These results remained in line with European-based studies demonstrating increased rates of absolute iron deficiency in the general population.

“This cross-sectional study indicates that both absolute and functional iron deficiency affects a large proportion of adults in the US, especially among those without conditions often screened for iron deficiency,” investigators wrote.

Real-World Data Support Use of rpFVIII for Acquired Hemophilia A

Real-world data supported the use of recombinant porcine factor VIII (rpFVIII; susoctocog alfa) for the treatment of bleeding events in adults with acquired hemophilia A, remaining in line with previously reported Phase 2/3 findings. No adverse events (AEs) of hypersensitivity reactions or thromboembolic events, known safety concerns with the use of rpFVIII treatment, were reported in the data.

“The findings of this study support the use of rpFVIII as first-line treatment for acquired hemophilia A and align with findings from the Phase II/III clinical trial of rpFVIII in the treatment of bleeding events in adults with acquired hemophilia A,” investigators wrote.