Management Of Anemia Research Articles

Efficacy of a pre-operative anaemia clinic in patients undergoing elective abdominal cancer surgery.

Pre-operative iron deficiency anaemia (IDA) is common in patients undergoing elective major abdominal surgery and is associated with increased risk of perioperative complications. However, widespread implementation of pre-operative anaemia management is lacking. Guidelines recommend investigation of anaemia preferably 4-6 weeks before surgery to allow time for correction. However, this is not always feasible in abdominal cancer surgery with short time to surgery and may be influenced by concomitant chemotherapy. The objective of this study was to assess the efficacy of implementing a pre-operative screening and treatment programme for IDA in elective abdominal cancer surgery patients, with short duration to surgery and concomitant use of chemotherapy. All patients scheduled for elective abdominal cancer surgery with IDA were included. Anaemia was defined according to the World Health Organization-criteria and iron deficiency as a transferrin saturation <0.20. The primary outcome was change in haemoglobin (Hb) between iron infusion and surgery in patients receiving pre-operative intravenous iron infusion. Of 178 diagnosed IDA patients 134 (75%) received intravenous iron, 103 pre-operatively (58%) at median day 17 (interquartile range: 9-27) before surgery while 31 (17%) received post-operative intravenous iron treatment. The pre-operative Hb increased 0.89 g/dL (95% CI: 0.64-1.13, p < .001) compared to a decrease of 0.4 g/dL (95% CI: 0.19-0.58, p < .001) in 75 patients not treated pre-operatively. Patients diagnosed with severe anaemia had the largest pre-operative Hb increase. Iron infusion >2 weeks pre-operatively resulted in a greater Hb increment of 1.13 g/dL (95% CI: 0.81-1.45) compared to iron infusion ≤2 weeks before surgery 0.48 g/dL (95% CI: 0.16-0.81). Hb increased by 0.64 g/dL (95% CI 0.19-1.21) in patients receiving chemotherapy ≤31 days prior to surgery. In patients scheduled for abdominal cancer surgery, including in patients with concomitant chemotherapy, pre-operative IDA management is feasible and results in a significant pre-operative Hb increase compared to patients not treated. On the day of surgery 25% patients treated pre-operatively were no longer anaemic.

Anaemia and quality of life in chronic kidney disease: a consensus document from the European Anaemia of CKD Alliance.

Anaemia is common in chronic kidney disease (CKD) and has a significant impact on quality of life (QoL), work productivity and outcomes. Current management includes oral or intravenous iron and erythropoiesis-stimulating agents (ESAs), to which hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been recently added, increasing the available therapeutic options. In randomised controlled trials, only intravenous iron improved cardiovascular outcome, while some ESAs were associated with increased adverse cardiovascular events. Despite therapeutic advances, several challenges and unmet needs remain in the current management of anaemia of CKD. In particular, clinical practice does not include an assessment of QoL, which prompted a group of European nephrologists and representatives of patient advocacy groups to revisit the current approach. In this consensus document, the authors propose a move towards a more holistic, personalised and long-term approach, based on existing evidence. The focus of treatment should be on improving QoL without increasing the risk of adverse cardiovascular events, and tailoring management strategies to the needs of the individual. In addition, the authors discuss the suitability of a currently available anaemia of CKD-specific health-related QoL measure for inclusion in the routine clinical management of anaemia of CKD. The authors also outline the logistics and challenges of incorporating such a measure into electronic health records and how it may be used to improve QoL for people with anaemia of CKD.

Study of the Efficacy and Safety of Darbepoetin Alfa versus Epoetin Alfa in the Treatment of Anemia in Pediatric Patients on Regular Hemodialysis

Abstract Background Anemia is a common comorbidity in patients with chronic kidney disease (CKD). That affects the vast majority and can have a significant impact on patient morbidity and mortality. Erythropoiesis-stimulating agents (ESAs) are the main lines in management of anemia in hemodialysis patients. Replacement therapy with recombinant human erythropoietin (r- HuEPO) has provided an effective treatment for patients with renal “Epoetin alfa” is a recombinant erythropoietin with the same amino acid sequence as human erythropoietin (EPO). In comparison to epoetin alfa, darbepoetin alfa (DPO) contains an increased amount of sialic acid-containing carbohydrate chains. It shows a much longer elimination half-life than epoetin alfa, with prolonged erythropoietic effect. Aim of the Work to evaluate whether darbpoetin and epopoetin alpha can be used interchangeably on the same patient, achieving the same desired effect and to detect any difference in the occurrence of side effects between both ESAs. Patient and Methods This was a crossover study that took place in the Pediatrics Dialysis unit, Children’s Hospital, Ain Shams University. The study was conducted on 40 children with end stage renal disease on regular hemodialysis over a period of 6 months. The patients were randomly put into two groups A and B, each group contained 20 patients. Each group received one type of ESA either ( darbpoetin alpha or epopoetin alpha )for 3 months and then shifted to the other type of ESA for another 3 months. The dosage of epoetin alfa used was (200 IU/kg/week) and a conversion rate of EPO: DPO, 300:1. A period of 6 weeks was agreed as a washout period after the first drug given in both groups in which no results were recorded but ESA was not stopped due to its essentiality. Blood tests (hemoglobin (Hb), serum urea, serum creatinine and iron profile; (S. iron, S. ferritin, TIBC, and transferrin saturation)) were withdrawn at the start and the end of the 3 months’ period of each drug. Results We found no difference on the Hb level with both drugs. The interchange between them did not yield any significant drop in the Hb levels. Hb target in both EPO and DPO was reached in 22.5% of total cases, and was not reached in 62.5%. This proved that both drugs give the same effect with nearly negligible difference. No serious Sside effect as convulsions, hypertension, and thrombosis were noticed in both groups. Conclusion The target Hb was not reached in most patients of both groups of ESRD on regular hemodialysis at the unit and none of both drugs showed superior results or less side effects than the other.

564 The Assessment and Management of Anaemia in Patients Who Underwent an Emergency Laparotomy

Abstract Aim Emergency Laparotomies (EmLap) carry a significant risk of morbidity and mortality. Peri and post-operative anaemia are associated with higher complication rates, delayed healing, and lethargy. This study aimed to assess the occurrence of anaemia in EmLap patients upon admission and discharge, as well as to evaluate its management. Method Data was collected from 260 participants undergoing EmLap from 2016 to 2019 that completed a follow up questionnaire in 2020, as part of PEEL 2 (Patients Experience of Emergency Laparotomy) in Cardiff, a retrospective cohort study. 34% of patients (n=90) had a Haemoglobin (Hb) level on admission and discharge and were included into the study. Information on transfusions and prescriptions of ferrous fumarate tablets during admission and on discharge were obtained from electronic records. Results 46.7% (n=42) were anaemic at time of admission and further 19 patients were anaemic after surgery. 61 patients (68%) were discharged with anaemia post EmLap. Of the 61 patients discharged with anaemia only 10 (16%) were given treatment; 7 (11%) were offered a blood transfusion, 2 (3%) were prescribed ferrous fumarate tablets and 1 (1.6%) received a combination of both. Discharge summaries did not highlight the issue and follow up advice was not given to GPs. Conclusions 2/3 of EmLap patients were discharged with anaemia and was not addressed. A greater understanding is needed to appreciate the impact of anaemia on EmLap patients’ such as fatigue levels. It can be avoided if a closer look at patients’ blood results is conducted and treated aligning with the NICE guidelines.

Frequency, Types, and Risk Factors of Anemia in Pediatric Inflammatory Bowel Disease

Objective: Inflammatory bowel disease patients are prone to be anemic at diagnosis and follow-up. As it is a common extra-intestinal manifestation, its early identification and treatment are essential. We aimed to evaluate the frequency, types, and predictors of anemia and its treatment in pediatric inflammatory bowel disease patients. Methods: The electronic records of pediatric IBD patients who attended our outpatient clinics between 1 April 2018 and 01 May 2019 were retrospectively evaluated. Patients who had the results of hemoglobin, hematocrit, mean corpuscular volume, iron indices, vitamin B12 level, folic acid level, reticulocyte count, C-reactive protein, and erythrocyte sedimentation rate at least once on a single day were included in the study. Laboratory results associated with anemia and disease activity index scores at three- and six-months follow-ups were recorded. Anemia was diagnosed according to WHO criteria in childhood. Anemia, risk factors, and management of anemia were determined. Results: Forty patients were included in the study. At first evaluation, anemia was observed in 38.1% of Crohn’s disease patients and 57.9% of ulcerative colitis patients. Iron deficiency anemia was the main type of anemia in both groups. The rate of anemia decreased at follow-up. Out of 40 patients, 21 had treatment at the initial evaluation. Active disease was the only predictor of iron deficiency anemia. Conclusion: Anemia was common in pediatric inflammatory bowel disease patients, ranging between 25-47.5% during the 6-month follow-up in our study. Iron deficiency anemia was the main type of anemia. Having active disease was the only risk factor for anemia. The treatment of anemia and iron deficiency without anemia should be kept in mind in parallel with anti-inflammatory treatment.

Comparative Analysis of Real-World Efficacy and Safety of Hypoxia-Inducible Factor Prolyl-Hydroxylase Inhibitors in Kidney Transplant Recipients Versus Nontransplant Individuals: A Single-Center Study

ObjectivesTo compare the efficacy and safety of hypoxia-inducible factor prolyl-hydroxylase inhibitors (HIF-PHis), a novel agent for management of anemia in chronic kidney disease (CKD), between transplant recipients and nontransplant individuals. MethodsA retrospective analysis was conducted on nondialysis-dependent CKD stage 3 to 5 patients treated with the HIF-PHi roxadustat or daprodustat at a single institution. Patients were categorized as kidney transplant recipients (KTRs) and non-KTRs. Efficacy outcomes (hemoglobin and creatinine levels) and safety profiles (rate of adverse events [AEs], descriptions, and discontinuations due to AEs) were assessed 3 months before and 6 months after HIF-PHi initiation within and then between the groups. ResultsThe study comprised 82 patients (KTR: 43, non-KTR: 39). Median ages significantly differed between the KTR (52.7 years) and non-KTR (82.9 years) groups (P < .001). Roxadustat was predominantly used in the KTR group (88.4%), while daprodustat was used in the non-KTR group (94.9%, P < .001). Both groups exhibited significant increases in Hb levels at 1, 3, and 6 months post-HIF-PHi initiation (P for trend, <.001), with a relative increase in Hb level at 6 months of 16% for KTRs and 13% for non-KTRs. Creatinine levels showed no significant changes over 6 months. Although no difference was observed in drug discontinuation due to AEs, the KTR group experienced a significantly higher rate of thrombotic events (18.6 vs 2.6%, P = .049). ConclusionsHIF-PHis demonstrate comparable efficacy for managing anemia in CKD, regardless of transplant status. However, heightened vigilance for thrombosis events is necessary during follow-up for KTRs.

Anemia and Iron Profile in Hemodialysis and Nonhemodialysis Patients with Chronic Kidney Disease

Abstract BACKGROUND: Chronic kidney disease (CKD) is a global health concern, with anemia being a significant complication. Anemia in CKD patients is multifactorial and often leads to poorer outcomes. Assessing the iron profile, including serum ferritin, iron, and transferrin saturation, is crucial for identifying absolute or functional iron deficiency anemia (IDA). An objective evaluation of the iron profile is essential for effective and comprehensive management of anemia. MATERIALS AND METHODS: The study involved 100 adult patients with CKD and anemia, who were divided into two groups based on age and sex. The patients were divided into two groups: one received regular hemodialysis (HD) 2–3 times per week, whereas the other received no dialysis or dialysis infrequently. Exclusion criteria included infections, inflammation, renal injury, neoplasms, acute hemolysis, and thalassemia. RESULTS: Anemia is a common complication in patients with CKD, both those on HD and non-HD. Among the types of anemia observed, 50% of HD patients and 72% of non-HD CKD patients have normochromic anemia. In addition, 46% of HD patients and 24% of non-HD patients have IDA. Specifically, 24% of HD patients have absolute IDA and 22% have functional IDA, compared to 12% of both absolute and functional IDA in non-HD CKD patients, with a significant statistical difference between the two groups. Furthermore, serum iron and transferrin saturation levels show significant differences between HD and non-HD CKD patients. CONCLUSION: Anemia, especially IDA in CKD patients undergoing HD, requires accurate diagnosis through transferrin saturation and serum iron levels, and customized treatment based on dialysis status and anemia type is crucial.

Physician and Patient Preferences for Treatment of Anemia Associated with Chronic Kidney Disease in Japan: A Survey Including Best-Worst Scaling.

Several treatment options are available for anemia associated with chronic kidney disease (CKD); however, there remains a lack of awareness of physician and patient preferences regarding these treatments. We aimed to explore physicians' and patients' perceptions and preferences regarding the management of anemia of CKD in Japan. A web-based survey, including best-worst scaling (BWS), was conducted with physicians who had treated ≥1 patient with anemia of CKD in the preceding year, and with patients with CKD who self-reported a clinical diagnosis of anemia of CKD or low hemoglobin levels. A three-step approach was used comprising cognitive interviews, a pilot survey, and a main survey. The BWS survey results were analyzed using multinomial logit and hierarchical Bayesian models. The survey was completed by 906 participants: 103 patients (average age 60.6 years; 77.7% male) and 803 physicians (166 nephrologists, 214 cardiologists, 137 diabetologists, and 286 general internists). Almost all (96.0%) physicians surveyed considered anemia of CKD to be an important condition to treat. Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors had the highest treatment satisfaction among physicians, whereas patients had the highest satisfaction with both erythropoietin-stimulating agent therapy and HIF-PH inhibitors. Approximately one-third (35.9%) of patients surveyed indicated that they were receiving treatment. When comparing the relative importance of attributes and levels, physicians favored efficacy (particularly improvement in hemoglobin levels), whereas patients favored safety (particularly a lower rate of severe adverse events). Although a majority of physicians consider treatment of CKD-related anemia important, differences in the perceptions and usage of medications exist between medical specialties. Preferences for the management of anemia of CKD vary between physicians and patients; therefore, patient involvement in treatment decisions may help optimize outcomes.

Frequency of Low Birth Weight in Babies Born to Anemic Pregnant Women at Term Gestation; A Cross-Sectional Study

OBJECTIVES To assess the potential impact of maternal health on the frequency of low birth weight in newborns of anemic pregnant women at term gestation. METHODOLOGY It is a cross-sectional (Descriptive) study in the Department of Obstetrics &amp; Gynecology, from 1st August 2022 to 31st July 2023. We recruited 169 pregnant ladies of any gravidity, 18-45 years of age at term gestation (37 ± 0 weeks to 41 ± 6 weeks), who presented with anemia and were included in this study. Patients who refused to participate in the study or had any other medical disorder leading to low birth weight, i.e., pregnancy-induced hypertension, chronic kidney disease, antiphospholipid syndrome, autoimmune conditions, and uteroplacental insufficiency, were excluded from the study. RESULTSOne hundred sixty-nine patients were enrolled in this study; 45 patients were between 18 and 27 years of age, 80 were between 28 and 37 years, and 44 were recorded at 37-45. Mean and Standard Deviations for age was 32 Years ± 6.68, for gestational Age 38 Weeks ±1.23, for Parity 3±1.31, for Hemoglobin Level it was 10.7 g/L ±14.95, and for Birth Weight, it was recorded as 2500 grams ± 279.24. The frequency of low birth weight was recorded in 36 (21.30% ) newborns of anemic pregnant women at term gestation. CONCLUSION The prevalence of low birth weight in newborns of anemic pregnant women at term was found to be high. A comprehensive approach regarding health education and anemia management in pregnant women is required.

Therapy for Myelodysplastic Syndromes Beyond the Front Line in 2024 in Canada

Management of anemia and/or transfusion dependence (TD) after failure of erythropoietic-stimulating agents (ESA) and therapeutic options after hypomethylating agent (HMA) failures remain the biggest challenges for physicians treating lower and higher-risk myelodysplastic syndromes (MDS), respectively. Fortunately, new therapies are available (or soon to be approved), and innovations in prognostic refinement using next-generation sequencing may also facilitate more precision medicine. This review highlights commercially available (or soon to be) options for the amelioration of anemia and transfusion dependence when ESA’s fail and the management of higher-risk MDS when hypomethylating agents fail or cease working. While not all of these agents are currently funded or approved in Canada, some are available for off-label access or purchase.

A Study of Drug Uses Evaluation of Anti Anemic Drugs in Pregnancy Patients at a Tertiary Care Teaching Hospital

Background: Anemia is a common condition among pregnant women and can have adverse effects on both maternal and fetal health. The use of antianemic drugs in pregnancy is essential to manage and treat anemia, but their efficacy and safety remain a topic of significant interest and concern. Objective: To study the drug use evaluation of anti anemic drugs in pregnancy patients in hospital. Cases were collected from OBG ward Methodology: A prospective observational study was conducted for three months from December 2023 to February 2024 in Navodaya medical college, hospital &amp; research centre with a sample size of 100. Data were collected from OBG ward. Result: Among the 100 cases collected, most of the anemic patients were in the age group of (18-25) years. Most common anti anemic drugs prescribed in anemic patients are Ferrous ascorbate and Folic acid. Conclusion: in evaluation of antianemic drug use in pregnancy is essential for ensuring the effective management of maternal anemia while minimizing risks to the fetus. By assessing prescribing practices, safety considerations, and adherence to clinical guidelines, healthcare providers can enhance the quality of care provided to pregnant women and contribute to better maternal and child health outcomes

Implementation of preconception care for preventing adverse pregnancy outcomes in rural and tribal areas of Nashik District, India

IntroductionThe World Health Organization has suggested preconception care to improve pregnancy outcomes. Hence, the study aimed to compare the effect of preconception care on pregnancy outcomes, particularly prematurity and low birth weight. MethodsWe carried out interventions in one tribal and one non-tribal block. For comparison, one adjacent tribal block and one non-tribal block were included in Nashik district, India. The total study period was from April 2018 to July 2021. All reproductive age group women desiring pregnancy within one year in selected four blocks participated in the study. The services included clinical examination, laboratory investigations, treatment, six-monthly deworming, anemia management, folic acid supplementation, family planning services, and behavioral change communication using different media. The existing healthcare workers provided services to the women until they became pregnant or until the end of the follow-up period (27 months). We monitored pregnancy outcomes, including abortion, stillbirth, and live birth; among live births, low birth weight, preterm birth, congenital physical anomaly, and neonatal death. ResultsThe study enrolled 7,875 women, and 3,601 had outcomes. The proportion of preterm births in the intervention and comparison block was 11.18 % and 14.99 %, respectively (p = 0.001), and the proportion of low-birth-weight babies was 9.23 % and 11.25 %, respectively (p = 0.01). The adjusted prevalence ratio showed that the risk of preterm births in the absence of intervention was 1.3 (CI: 1.1–1.6). Preterm birth was a mediator between preconception care and low birth weight. ConclusionReduction in proportion of low birth weight and preterm babies can be achieved through preconception care using minimal additional resources.

Management of anaemia and prognosis of patients undergoing maintenance peritoneal dialysis: A nationwide cohort study.

Clinical data supporting the target haemoglobin range in patients undergoing peritoneal dialysis (PD) are scarce. This study investigated the association between haemoglobin levels and all-cause mortality in Japanese patients undergoing PD using data from a nationwide dialysis registry. A total of 4875 patients aged ≥18 years who were undergoing PD at the end of 2012 were analysed. Patients receiving combination therapy with haemodialysis or missing haemoglobin data were excluded. Haemoglobin values were categorised into six groups (<9.0, 9.0-9.9, 10.0-10.9, 11.0-11.9, 12.0-12.9 and ≥13.0 g/dL) and their association with mortality evaluated. Patients' mean age was 63 years, and 62% were men. The mean haemoglobin level was 10.7 g/dL, and 14% were anuric. Erythropoiesis-stimulating agents were used in 89%. During a median follow-up of 3.5 years, 1586 patients died. Haemoglobin levels <9.0 and ≥13.0 g/dL were significantly associated with mortality, as compared with levels of 10.0-10.9 g/dL (adjusted hazard ratios [95% confidence intervals]: 1.25 [1.06-1.48] and 1.45 [1.13-1.88], respectively). Restricted cubic spline analysis revealed a U-shaped association between haemoglobin levels and mortality. A haemoglobin level ≥12 g/dL was associated with mortality in patients with a history of cardiovascular disease (p interaction = 0.023). We provide important insights into the target haemoglobin in patients undergoing PD. Our findings suggest that setting a lower upper limit for haemoglobin levels may be beneficial for patients with a history of cardiovascular disease.

Prevalence of pre-operative anemia in elective surgical patients: A retrospective, observational study at a university hospital

BackgroundAnemia is the most hematological condition found in surgical patients. Pieces of empirical evidence shows that pre-operative anemia accounts for one- third of surgical patients. Yet, pre-operative anemia & blood transfusion for surgical patients has been associated with many complications such as lengthy hospital stay, post operation surgical wound infections, mortality and morbidity. PurposeThis Pilot preliminary study sought to determine the prevalence of pre-operative anemia in elective surgical patients and to assess health workers’ awareness and knowledge regarding patient blood management in Saudi Arabia. Material and methodsA questionnaire was used to collect data from the 129 healthcare workers in a selected hospital in Saudi Arabia. Additional data was obtained from the hospital electronic data records regarding the incidences of pre-operative anemia. Therefore, the study applied both retrospective and cross-sectional designs. The collected data was then analyzed using the Statistical Package for Social Services [SPSS]. ResultsThis study established the prevalence of pre-operative anemia in elective surgical patients to be 30 % (291 out of 970). In addition, 129 participants completed the questionnaires, from different hospital departments. From the questionnaire, it was noted that 74.2 % of the of physicians had the knowledge about patient blood management while 65 % (n = 50) were aware of the written protocol for the management of pre-operative anemia. This study also found out that 48.1 % of physicians rarely get to meet their patients assessed for possible anemia 4–8 weeks prior surgical operation. In addition, a relatively high number of physicians (42.6, n = 55 rarely investigate the cause of anemia after it has been established while 45.7 % confirm to rarely transfer their patient to pre-operative clinic for anemia management. Low intervention in correction of anemia of low iron origin by the physicians was established to be 44.2 %, and the most preferred hematology analyzer for point of care management was CBC Analyzer Sysmex (79.8 %). ConclusionThis study finds a significant lack of knowledge about pre-operative anemia management in line with the patient blood management protocol. Also, majority of physicians fail to follow the guidelines for anemia management despite the high incidence.

How anti-c in a D- patient prompted lifesaving work between a transfusion service and a blood center reference laboratory.

This case report showcases an extraordinary collaboration to support the transfusion needs of a patient with a rare phenotype and long-standing anemia due to gastrointestinal bleeding. This report describes the Immunohematology Reference Laboratory testing and logistics of rare blood provision over an 11-year period, as well as a summary of the hematologic, gastroenterologic, and surgical interventions. This case illustrates how a strong collaboration among the clinical team, laboratory, blood center, and the rare donor community facilitated successful management of this patient's anemia until the patient could receive life-changing treatment.

Ferric carboxymaltose: A game changer in the management of iron deficiency anaemia in pregnancy.

A single-arm prospective cohort (before-after) study among 60 antenatal women with moderate to severe anaemia in the second and third trimesters was conducted from December 2020 to December 2022, and the eligible women were given 1000 mg of intravenous FCM injection. Efficacy was assessed by rate of improvement in haemoglobin and ferritin at 2 weeks post infusion. Safety analysis was done by assessing adverse drug reactions and foetal heart monitoring during the infusion. A total 60 antenatal women with a median gestational age of 32.5 weeks at presentation received 1000 mg of intravenous FCM. There was a rise in mean haemoglobin from 8.05 gm% pre-infusion to 10.93 gm% 2 weeks post infusion, showing a mean rise of 2.88 gm%. Similar improvement was noted in mean serum ferritin levels from 25.92 pre-infusion to 253.96 post FCM infusion. There were no reports of drug-related major adverse effects in the mother or the foetus. FCM is found to be safe and effective treatment with rapid replenishment of haemoglobin and ferritin levels in a single dose, which makes it suitable and compels consideration as the first choice for treatment of iron-deficiency anaemia.

Do Spiritual Well-Being and Pain Intensity Predict Physical or Mental Components of Health-Related Quality-of-Life Scale in Patients With Multiple Myeloma?

BackgroundMultiple myeloma is a complex disease and supportive care is important for improving quality of life. Management of disease treatment symptoms, bone disease, renal dysfunction, infection, anemia, pain, and coagulation disorder are specific issues. Spirituality, or spiritual well-being, is one of the most fundamental and essential concepts for coping with the difficulties and stress caused by cancer. AimsThis study explores whether spiritual well-being, pain, and other demographic factors predict the physical and mental components of quality of life in MM subjects. MethodsThis cross-sectional descriptive study was conducted with 92 multiple myeloma patients registered with the Cancer Warriors Association in Turkey. The data were collected using the Personal Information Form, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12, the Numeric Rating Scale for Pain, and the Short Form-12 Health-Related Quality of Life Scale. ResultsThe mean age of the patients was 54.4 ± 10.7 years. It was found that the mean total pain score in the previous week was 3.9 ± 2.6, while the mean total The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 score was 28.1 ± 9.8. Their mean Short Form-12 total physical component score was 39.1 ± 25.4; whereas the Short Form-12 total mental component score was 45.5 ± 24.8. According to this model, 56.7% of the physical component score was explained by vertebroplasty, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 total score and subscale of peace and the pain intensity experienced in the previous week. According to multiple linear regression analysis, bone-sparing therapy and FACIT-Sp-12-Total and subscale peace significantly predicted the Mental component score (p < .05). ConclusionsCancer pain remains undertreated, and patients with myeloma are no exception. Pain and spiritual well-being scores were significant predictors of physical and mental component scores of quality of life in this group of patients. According to this result, pain-reducing practices should be implemented to improve the quality of life in MM patients and the spiritual needs of the patients should be met.

Perfusion Measures and Outcomes (PERForm) registry: First annual report.

The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology. This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (≥18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized. Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported. A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 hospitals. Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years. Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time. The use of conventional ultrafiltration decreased over the study period (2019 vs. 2022; 27.1% vs. 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs. 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs. 75.9%). Few robust clinical registries exist to collect data regarding the practice of CPB. Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.

Patient (pt) experience with and perceptions of transfusion-dependent (TD) and transfusion-independent (TI) myelofibrosis (MF): A qualitative interview study.

e23110 Background: MF is a rare myeloproliferative neoplasm for which Janus kinase inhibitors are the standard of care. Some Janus kinase inhibitors can exacerbate anemia, a hallmark feature of MF that increases in severity with disease progression. Red blood cell transfusions are an important component of anemia management, but transfusion dependence is an independent predictor of poor survival outcomes and is inversely correlated with quality of life (QOL). The current study aimed to elicit the perceived direct and indirect burden of transfusion dependence and its impact on pts with MF. Methods: Concept elicitation interviews were conducted remotely with Janus kinase inhibitor–experienced and symptomatic (MF Symptom Assessment Form v4.0 Total Symptom Score [TSS] ≥10) pts with MF across the US, UK, Germany, Italy, Spain, and Poland (N = 20). Five TD pts (≥2 blood transfusions in any 1 mo over the last 3 mo) and 15 TI pts (≤1 blood transfusion in any 1 mo over the last 3 mo) participated in 60-minute interviews, which followed a semistructured guide including open-ended questions and completion of ranking exercises and sociodemographic and clinical forms. Results: Of 20 pts, mean age was 59 years, 50% were male, and85% received a diagnosis of anemia after their MF diagnosis. Pts with anemia experienced a range of related symptoms, including fatigue (94%), weakness (53%), and night sweats (29%). These symptoms impacted several QOL domains, including emotional (88%) and physical (71%) health and social life (71%). Most pts (18 of 20) had received a transfusion in the past, of whom 5 were TD. In addition to higher transfusion burden, TD pts had higher symptom burden than TI pts (mean TSS, 30.8 vs 27.9).TD pts endorsed challenges with frequent transfusions relating to clinical concerns/safety (100%), convenience (100%), and travel (80%), all of which remained concerns when thinking about being TD in the future (40% each). These challenges resulted in emotional (80%) and physical (60%) impacts and impacts to activities of daily living (60%). Four of 5 (80%) reported that going ≥12 weeks without a transfusion would be helpful and positively impact their QOL. Similarly, TI pts felt it was important to remain TI, with 73% expressing concerns about becoming TD in the future. Regarding the most important MF treatment outcomes, MF symptom reduction and overall survival were the most common (40% each) among TD pts, and reduction/avoidance of transfusion was the most common (40%) among TI pts. Conclusions: These interviews characterize the substantial negative experiences with and perceptions of anemia and transfusions in pts with MF who are TD and those who are TI but concerned about becoming TD in the future. These findings highlight the value of treatment options that reduce/eliminate transfusion burden and prevent future transfusions in improving the experiences of pts with MF.

Clinical management of iron deficiency anemia in Japan: iron prescription patterns, treatment effectiveness, and assessments

Iron deficiency anemia is one of the most common types of anemia, but real-world clinical management practices in Japan are unclear. This study retrospectively explored iron prescription patterns, treatment effectiveness, and assessments. Patients with at least one treatment period between September 2020 and September 2022 were included and classified into three groups (ferric carboxymaltose [FCM]: 7437 patients, saccharated ferric oxide [SFO]: 98,648 patients, and oral iron: 359,547 patients). Iron-related laboratory values over time and testing proportions were evaluated. Median baseline hemoglobin levels were lowest with FCM (FCM: 8.10 g/dL, SFO: 8.70 g/dL, oral iron: 9.70 g/dL), but changes in hemoglobin levels by 12 weeks were greatest with FCM (FCM: 3.20 g/dL, SFO: 2.60 g/dL, oral iron: 1.70 g/dL). The median serum ferritin level at 8 weeks after FCM treatment was 43.70 ng/mL for ≤500 mg, versus 123.30 ng/mL for >500 to ≤1500 mg. All groups had a low proportion of serum ferritin and transferrin saturation (TSAT) testing at diagnosis (<38%), which decreased further for post-treatment assessment (<24%). This study suggests the importance of prescribing an appropriate total iron cumulative dose per the package insert, along with diagnosis and assessments based on serum ferritin/TSAT.