title: Proton pump inhibitors use suppresses iron absorption in congenital dyserythropoietic anemia.
abstract: Congenital dyserythropoietic anemia type I (CDA I) is associated, as other anemic noninflammatory states, with ineffective erythropoiesis and increased iron absorption, which may lead to complication of iron overload. The latter complication requires iron-chelating therapy, which may be associated with adverse effects and toxicity. Gastric acid production is known to be an important factor that facilitates non-heme iron absorption. The purpose of this study was to examine whether treatment with proton pump inhibitors (PPIs) can decrease iron absorption in patients with CDA I. Eight CDA I patients (4 boys) aged 12-18 years with mild iron overload (not yet requiring chelating therapy) received 20 mg/d omeprazole for 6 months. Blood samples were obtained for ferritin, C-reactive protein, hemoglobin, calcium, and magnesium at baseline, at the end of months intervention and 6 months after its cessation. The mean ferritin level decreased from 585 ± 180 ng/ml at baseline to 522 ± 172 ng/ml at the end of 6-month treatment and 660 ± 256 ng/ml 6 months after cessation of omeprazole treatment (p  =  0.009). Omeprazole treatment caused a nonsignificant reduction in the mean iron level (iron 159 ± 42, 136 ± 54,167 ± 34 µg/dl, p  =  0.302). However, mean hemoglobin level was mildly but significantly reduced (Hg 10.0 ± 0.8, 9.55 ± 1.0, 10.4 ± 10.7 g/dl, p  =  0.002). No adverse effects were reported. Our investigation suggests that administration of PPI to patients with CDA I may reduce iron absorption and may lower iron overload and the need for chelation therapy.
authors.affiliation: a Pediatric Hematology , Soroka University Medical Center, Ben-Gurion University , Beer Sheva , Israel.
authors.forename: Hanna
authors.initials: H
authors.lastname: Shalev
authors.affiliation: a Pediatric Hematology , Soroka University Medical Center, Ben-Gurion University , Beer Sheva , Israel.
authors.forename: Abed Abu
authors.initials: AA
authors.lastname: Quider
authors.affiliation: a Pediatric Hematology , Soroka University Medical Center, Ben-Gurion University , Beer Sheva , Israel.
authors.forename: Miriam Ben
authors.initials: MB
authors.lastname: Harosh
authors.affiliation: a Pediatric Hematology , Soroka University Medical Center, Ben-Gurion University , Beer Sheva , Israel.
authors.forename: Josef
authors.initials: J
authors.lastname: Kapelushnik
mesh_terms: D000293:Adolescent; D000742:Anemia, Dyserythropoietic, Congenital / Q000097:blood / Q000150:complications / Q000188:drug therapy; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D002648:Child; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000097:blood*; D019190:Iron Overload / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D008274:Magnesium / Q000097:blood; D008297:Male; D009853:Omeprazole / Q000008:administration & dosage*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*
chemical_list: D006454:Hemoglobins; D054328:Proton Pump Inhibitors; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron; D008274:Magnesium; D009853:Omeprazole; D002118:Calcium
keywords: Anemia (congenital dyserythropoietic); Benign; hematology; iron overload