الفهرس 
Anemia In chronic Kidney DiseaseOnly 14 pages are availabe for public view
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Abstract
Adverse reactions to potential iron agents range from minor to life-threatening. Although the clinical features of reactions to iron agents have been reviewed extensively and listed in the literature, information on the incidence of the most severe reactions is limited, in part because reactions described as anaphylactic include manifestations that are relatively benign, the severity of reactions described as serious is difficult to assess objectively, and the study populations upon which estimates are based have been relatively small (Brian A. , 2005).
Moreover, because the pathogenesis of parenteral iron reactions is unknown, laboratory markers to distinguish degrees of severity are absent. Thus, reliable incidence information on the most severe reactions is critically needed to determine the proper role of iron dextran in anemia management and to evaluate and compare the safety of parenteral iron agents (Brian A. , 2005).
Iron dextran has been available in the United States for over four decades and in recent years; sales of intravenous iron therapy have increased steadily. The majority of that increased use has coincided with an increasing awareness of the need to use iron in combination with erythropoietic agents for optimal management of the anemia of chronic kidney disease .Three intravenous iron preparations are currently approved for use in the US: iron dextran, sodium ferric gluconate complex in sucrose and iron sucrose (Venofer) , allergic reactions may occur more often after the administration of iron dextran than after the other two preparations, and are more often associated with fatal and life-threatening outcomes ( George R. et al. ;2005).
The incidence of post-iron dextran immediate hypersensitivity reactions has been estimated as 1.1–3.2/100 treated population while the case fatality proportion for post-iron dextran allergic episodes has been calculated as 15.8% .The risk for morbidity or mortality, plus an ongoing suboptimal management of anemia in chronic kidney disease and end-stage renal disease, may have resulted in an inadequate therapeutic approach to anemia (George R. et al.; 2005).
Systemic reactions resembling anaphylaxis were occurred after i.v. iron dextran administration, a treatment modality that had acquired increase acceptance following the use of erythropoietin for the anemia of patients with chronic renal diseases. Three such patients sustained anaphylactoid reactions immediately after receiving i.v. test doses of iron dextran which were there only known exposures. In an effort to determine the mechanism of their reaction, they applied tests for (1) basophil degranulation by iron-dextran, basophil histamine release; (2) a type I anaphylactic reaction, specific IgE antibodies; and (3) an immune complex activation, specific IgG antibodies against iron-dextran (Novey S et al.; 1994).