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Response to intravenous iron in patients with iron deficiency anemia (IDA) and restless leg syndrome (Willis-Ekbom disease).
Sleep Med 2014; 15(12):1473-6SM

Abstract

OBJECTIVES

Iron deficiency anemia (IDA) engenders restless legs syndrome (RLS, aka Willis-Ekbom disease). Intravenous (IV) iron can rapidly reverse IDA and would be expected to similarly reverse RLS caused by IDA. This is the first consecutive case series evaluating the effects of IV iron therapy on RLS occurring with IDA (RLS-IDA).

METHODS

RLS-IDA patients were evaluated before and 7-12 months after a 1000-mg IV infusion of low-molecular-weight iron dextran (INFeD(@)) using validated questionnaires and standardized telephone interview. Patients were classified as respondent versus nonrespondent for RLS improvement.

RESULTS

Follow-up data were obtained on 42 (70%) of 60 consecutive RLS-IDA patients. The symptoms of RLS were reduced in 76% (32/42) with 47% (20/42) showing an extended response lasting >6 months. The response did not relate to age or gender, but tended to be less among African-Americans than Whites (40% (2/5) vs. 81% (30/37), p = 0.078). White respondents versus nonrespondents had higher hemoglobin levels after treatment (12.1 vs. 11.3 g/dl, p = 0.03).

CONCLUSIONS

RLS-IDA is reduced after administration of IV iron in most cases, but the 24% failing to respond was higher than expected. The nonrespondents all showed below-normal hemoglobin levels (<12.5 g/dl) suggesting a failure of adequate treatment of the iron deficiency. IV iron treatment of the RLS with IDA likely requires ensuring more than minimally adequate body iron stores to support iron delivery to the brain. For some, this may require a dose higher than the customary 1000-mg IV iron used for the treatment of either IDA or RLS alone.

Authors+Show Affiliations

Division of Transfusion Medicine, Department Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.Department of Medicine, Georgetown University, Washington DC, USA; Private Practice, Baltimore, MD, USA.Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.Department of Neurology, Johns Hopkins University, Baltimore, MD, USA. Electronic address: richardjhu@mac.com.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

25441748

Citation

Mehmood, Tahir, et al. "Response to Intravenous Iron in Patients With Iron Deficiency Anemia (IDA) and Restless Leg Syndrome (Willis-Ekbom Disease)." Sleep Medicine, vol. 15, no. 12, 2014, pp. 1473-6.
Mehmood T, Auerbach M, Earley CJ, et al. Response to intravenous iron in patients with iron deficiency anemia (IDA) and restless leg syndrome (Willis-Ekbom disease). Sleep Med. 2014;15(12):1473-6.
Mehmood, T., Auerbach, M., Earley, C. J., & Allen, R. P. (2014). Response to intravenous iron in patients with iron deficiency anemia (IDA) and restless leg syndrome (Willis-Ekbom disease). Sleep Medicine, 15(12), pp. 1473-6. doi:10.1016/j.sleep.2014.08.012.
Mehmood T, et al. Response to Intravenous Iron in Patients With Iron Deficiency Anemia (IDA) and Restless Leg Syndrome (Willis-Ekbom Disease). Sleep Med. 2014;15(12):1473-6. PubMed PMID: 25441748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Response to intravenous iron in patients with iron deficiency anemia (IDA) and restless leg syndrome (Willis-Ekbom disease). AU - Mehmood,Tahir, AU - Auerbach,Michael, AU - Earley,Christopher J, AU - Allen,Richard P, Y1 - 2014/09/10/ PY - 2013/12/23/received PY - 2014/08/24/revised PY - 2014/08/28/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/12/15/medline KW - INFeD KW - IV iron KW - Iron deficiency anemia KW - Low-molecular-weight dextran KW - Restless legs syndrome (RLS) KW - Sleep KW - Willis–Ekbom disease (WED) SP - 1473 EP - 6 JF - Sleep medicine JO - Sleep Med. VL - 15 IS - 12 N2 - OBJECTIVES: Iron deficiency anemia (IDA) engenders restless legs syndrome (RLS, aka Willis-Ekbom disease). Intravenous (IV) iron can rapidly reverse IDA and would be expected to similarly reverse RLS caused by IDA. This is the first consecutive case series evaluating the effects of IV iron therapy on RLS occurring with IDA (RLS-IDA). METHODS: RLS-IDA patients were evaluated before and 7-12 months after a 1000-mg IV infusion of low-molecular-weight iron dextran (INFeD(@)) using validated questionnaires and standardized telephone interview. Patients were classified as respondent versus nonrespondent for RLS improvement. RESULTS: Follow-up data were obtained on 42 (70%) of 60 consecutive RLS-IDA patients. The symptoms of RLS were reduced in 76% (32/42) with 47% (20/42) showing an extended response lasting >6 months. The response did not relate to age or gender, but tended to be less among African-Americans than Whites (40% (2/5) vs. 81% (30/37), p = 0.078). White respondents versus nonrespondents had higher hemoglobin levels after treatment (12.1 vs. 11.3 g/dl, p = 0.03). CONCLUSIONS: RLS-IDA is reduced after administration of IV iron in most cases, but the 24% failing to respond was higher than expected. The nonrespondents all showed below-normal hemoglobin levels (<12.5 g/dl) suggesting a failure of adequate treatment of the iron deficiency. IV iron treatment of the RLS with IDA likely requires ensuring more than minimally adequate body iron stores to support iron delivery to the brain. For some, this may require a dose higher than the customary 1000-mg IV iron used for the treatment of either IDA or RLS alone. SN - 1878-5506 UR - https://www.unboundmedicine.com/medline/citation/25441748/Response_to_intravenous_iron_in_patients_with_iron_deficiency_anemia__IDA__and_restless_leg_syndrome__Willis_Ekbom_disease__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1389-9457(14)00357-8 DB - PRIME DP - Unbound Medicine ER -