Hemorrhage-Adjusted Iron Requirements, Hematinics and Hepcidin Define Hereditary Hemorrhagic Telangiectasia as a Model of Hemorrhagic Iron Deficiency

Study answer

What this study found

HAIR (hemorrhage-adjusted iron requirement) sums the usual dietary iron allowance with additional iron needed to replace quantified non-menstrual hemorrhagic losses. In 50 HHT participants, 86% met RDA but only 20% met HAIR, indicating under-replacement of hemorrhagic iron losses. Higher HAIR predicted lower hemoglobin, lower mean corpuscular hemoglobin content, lower serum iron and higher RDW. Ferritin and ferritin2 explained ~60% of variance in hepcidin; the hepcidin:ferritin ratio was similar to controls. Iron supplement use increased the proportion meeting HAIR and attenuated…

Study & population

Dietary/nosebleed questionnaire study: 50 hereditary hemorrhagic telangiectasia (HHT) patients; cross-sectional; assessed dietary iron intake with EPIC FFQ and nosebleed severity with Epistaxis Severity Score (ESS); 28 male (56%), 17 post-menopausal females (34%), 5 pre-menopausal females (10%); ages 20–80 (median 55).

Intervention

Oral iron supplementation regimens; ferrous sulfate 325 mg tablets taken twice daily; some used 325 mg once daily or ferrous fumarate; duration not specified.

Key limitation

Small, disease-specific samples; observational design with cross-sectional analyses; reliance on self-reported nosebleed volumes and dietary intake; analyses mainly observational with potential selection bias (online survey); lack of randomized control; generalizability to non-HHT populations is limited.

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Original abstract