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Leal-Noval, Manuel Muñoz Gómez, Manuel Casado Méndez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Santiago R." "apellidos" => "Leal-Noval" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Muñoz Gómez" ] 2 => array:2 [ "nombre" => "Manuel" "apellidos" => "Casado Méndez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775317307935" "doi" => "10.1016/j.medcli.2017.09.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317307935?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618300834?idApp=UINPBA00004N" "url" => "/23870206/0000015000000008/v1_201805060427/S2387020618300834/v1_201805060427/en/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "328" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "David Beneitez Pastor" "autores" => array:1 [ 0 => array:3 [ "nombre" => "David" "apellidos" => "Beneitez Pastor" "email" => array:1 [ 0 => "dbeneite@vhebron.net" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Anemias, Eritropatología y Patología Congénita Serie Roja, Servicio de Hematología Clínica, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It is difficult to address all the different uses of intravenous iron (IV Fe) in an editorial, and, in the case of intensive care patients, it certainly requires a separate discussion, since anaemia is very common, multifactorial most of the time, and requires careful management due to the patient's clinical situation, with multiple factors to assess. The very instability of the intensive care patient often requires rapid treatment options, in particular, the correction of anaemia. It should not be forgotten that the effect of IV Fe treatment is not immediate, unlike a transfusion of packed red blood cells, and this will be important when determining the use of IV Fe or other measures in certain intensive care patients. At times, IV Fe administration may be a strategy at the time of intensive care unit discharge, more than during the stay in the unit.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is true that, from a theoretical perspective, the use of IV Fe could be indicated due to inflammation-induced iron deficiency, but we will have to take into account the anaemia recovery needs as soon as possible, since it is a risk factor <span class="elsevierStyleItalic">per se</span> to worsen underlying diseases with moderate degrees of anaemia, and in addition, its correction can improve homeostasis with the improvement of the haematocrit.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The multifactorial nature of anaemia, the unstable clinical situation of the intensive care patient, the need for rapid correction of anaemia to improve different aspects may explain why, despite using IV Fe in these patients, the number of transfusions do not decrease (as mentioned in the referenced meta-analysis,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> although I agree with the bias in the studies), but probably in a group of selected patients, especially those more stable, the number of transfusions could be reduced, as supported by the IRONMAN study.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Another important aspect, and especially in an intensive care unit is, as the authors point out, the role of IV Fe and the risk of a greater number of infections or worsening of existing ones; in fact, in the Summary of Product Characteristics the use of IV Fe with an active infection is a contraindication, since microorganisms also require iron for their cellular processes, especially certain bacteria, which are highly sensitive to iron. Despite this, the studies mentioned do not demonstrate a greater number of infections, so it would have to be assessed in each case according to risk/benefit.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, I agree that it is a complex group of patients. Perhaps, subgroups that could benefit from treatment with IV Fe could be defined. I do not think an increased risk of infection due to the concomitant use of IV Fe will be proven, although further studies will be needed to better assess this point.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-13" "fechaAceptado" => "2017-11-02" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Beneitez Pastor D. Respuesta. Med Clin (Barc). 2018;150:328.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Iron supplementation in adult critical care patients: a systematic review and metaanalysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Shah" 1 => "N.B. Roy" 2 => "S. McKechnie" 3 => "C. Doree" 4 => "S.A. Fisher" 5 => "S.J. Stanworth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-016-1486-z" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2016" "volumen" => "20" "paginaInicial" => "306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27681259" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous iron or placebo for anaemia in intensive care: the IRONMAN multicentre randomised blinded trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "The IRONMAN Investigators" "etal" => true "autores" => array:6 [ 0 => "E. Litton" 1 => "S. Baker" 2 => "W.N. Erber" 3 => "S. Farmer" 4 => "J. Ferrier" 5 => "C. French" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-016-4465-6" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "1715" "paginaFinal" => "1722" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27686346" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015000000008/v1_201805060427/S238702061830086X/v1_201805060427/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015000000008/v1_201805060427/S238702061830086X/v1_201805060427/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061830086X?idApp=UINPBA00004N" ]
