Case Of Severe Anemia Research Articles

Association of Oral Manifestations with Iron Deficiency Anemia: A Case-Control Study

Insufficient iron levels cause oral signs of iron insufficiency. Iron is necessary for several biological activities, including oral tissue health. Low iron levels might alter oral tissues, causing particular symptoms. The aim of this study to detect the oral manifestations of iron deficiency anemia as well as to investigate the link between the severity of these manifestations and the degree of the iron deficiency. The study includes 100 patients with iron deficiency anemia at an Azadi Teaching Hospital, in Duhok City, North of Iraq, and 98 healthy persons. A full history was obtained, and complete blood count and serum ferritin were recorded. In terms of gender distribution, a clear dominance of females was observed, as they represented 94% of the total cases compared to only 6% for males. Regarding the severity of anemia, most patients had moderate to mild degrees, while severe anemia cases represented a smaller percentage (12%). The comparison between patients and healthy people showed highly significant statistical differences in all pathological changes of the oral mucosa. Complete absence of pathological changes was more common in healthy controls (85%) than in patients (34%). Some pathological changes were closely associated with iron deficiency anemia, such as atrophic glossitis and angular cheilitis. This study concludes by highlighting the strong correlation between iron deficiency anemia (IDA) and oral mucosal lesions, and the most common oral manifestations are present in patients with severe iron deficiency anemia.

Determinants of Prevalence and Factors Associated with Anemia among Pregnant Women in Gambia: A Multivariate Analysis using DHS Data

Background Anemia is a prevalent public health concern in The Gambia and other developing nations. While previous studies relied on binary logistic regression, the Multinomial Survey Logistic Regression Model was developed to address complexities in survey design, including sampling weights, stratification, and clustering. Multiple Imputation with Chained Equations (MICE) was employed to address missing data in variables such as anemia level, contraceptive use, and malaria drug intake during pregnancy. Aim/Objective This study aims to determine the prevalence and factors of anemia among pregnant women across eight local government areas in The Gambia. The research focuses on Kanifing, Kuntaur, Mansakonko, Kerewan, Janjanbureh, Basse, Brikama, and Banjul. Given the limited research on anemia among pregnant women in The Gambia, there is a need for further investigation into this topic. Methods MICE were utilized to address missing data due to their validity in handling uncertainty. This method generates multiple reasonable datasets for imputation and analyzes them accurately. A survey logistic regression model was employed to assess data fitness, considering the complex sample design. Anemia levels were measured among 11,865 pregnant women aged 15 to 49 using a systematic questionnaire. The multinomial survey logistic regression model was utilized to account for sampling weights, stratification, and clustering, relaxing the premise of observation independence violated by conventional logistic regression. Results The study involved 11,865 expectant mothers, revealing mild, moderate, and severe cases of anemia with a prevalence of 44.6%. Factors associated with anemia included place of residence, local government area, contraceptive use, age, literacy level, and current pregnancy status. Conclusion Socio-economic, demographic, and environmental factors significantly impact anemia levels among reproductive women in The Gambia. Addressing factors such as place of residence, local government areas, contraceptive use, literacy level, and current pregnancy status is crucial in mitigating anemia risk. Government initiatives, such as improving access to sanitation facilities and offering free check-ups, could effectively address this public health concern.

A Multicenter Retrospective Chart Review Study Estimating the Prevalence of Iron Deficiency Anemia Among Infants, Toddlers, and Children in Riyadh, Saudi Arabia.

Background Iron deficiency anemia (IDA) is a prevalent nutritional disorder affecting children worldwide, leading to potential long-term cognitive and developmental deficits. This study aimed to determine the prevalence of IDA among healthy children attending Dr. Sulaiman Al-Habib Hospital Group in Riyadh, SAU, and explore the relationship between IDA and various demographic factors, including age, gender, and nationality. Methodology A retrospective chart review was conducted from July 2023 to August 2023 at Dr. Sulaiman Al-Habib Hospital Group, in Riyadh, Saudi Arabia. The study included 498 children aged 0.58 to 17 years, selected through a cluster sampling technique. Data on demographic characteristics and laboratory results, including hemoglobin (Hb) levels, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), ferritin, and RBC, were collected. Iron deficiency anemia was diagnosed based on Hb levels and other hematological indices. Statistical analysis was performed using SPSS Statistics version 23.0 (IBM Corp., Armonk, NY, USA). Results The prevalence of IDA among the study population was 9.2%, with 72.3% of the cases classified as mild and 27.7% as moderate. No cases of severe anemia were found. Infants had the highest prevalence of IDA (16.9%), followed by toddlers (12.0%), preschool children (7.2%), and school-age children (0.8%). Gender analysis revealed a prevalence of 9.7% in males and 8.6% in females, with no significant difference between genders (p = 0.659). All non-Saudi participants were free of IDA, whereas 9.3% of Saudi participants had IDA, though this difference was not statistically significant (p = 0.761). Conclusion The study found a relatively low prevalence of IDA among healthy children attending Dr. Sulaiman Al-Habib Hospital Group in Riyadh, SAU, with the highest prevalence observed among infants. These findings highlight the need for targeted interventions to prevent IDA, particularly in younger children. Routine screening and early treatment are crucial to mitigate the potential long-term effects of IDA on child development. Further research with larger and more diverse samples is recommended to validate these findings and explore additional factors influencing IDA prevalence.

Evaluation of micronutrient and nutritional status among preschool children in Jordan: results from a Nationwide survey.

Jordan faces various malnutrition challenges, including undernutrition, micronutrient deficiencies, overweight, obesity, and diet-related non-communicable diseases. The country has shifted from issues of undernutrition to rising rates of overweight and obesity, while still dealing with micronutrient deficiencies. The 2010 national survey revealed high rates of iron and vitamin D deficiencies among preschool children, with about 20% experiencing vitamin A deficiencies. The goals of the 2019 Jordan National Micronutrient & Nutrition Survey (JNMNS) include assessing feeding practices of infants and young children, determining the frequency of consuming micronutrient-rich foods, evaluating causes of anemia, assessing the health status of specific subgroups, and comparing findings to the 2010 survey. JNMNS 2019 was a comprehensive national cross-sectional survey structured across four strata. Within each stratum, 40 primary sampling units were chosen in proportion to their size based on the 2015 Jordan census. Subsequently, the Department of Statistics conducted household listings in each PSU. Separate response rates were assumed for households and target groups, encompassing interviews, anthropometric measurements, and specimen collection. The survey aimed to collect data from 2,210 households, including interviews and anthropometry for 1,232 preschool children, with blood samples obtained from 992 of them. The findings revealed no severe anemia cases, but 11% of preschoolers aged 12-59 months were anemic. Iron deficiency affected 22.4%, with 5% having iron deficiency anemia. Vitamin D deficiency increased to 22.9% in 2019. Stunting and wasting rates improved slightly to 6.3 and 0.1%, respectively. Overweight and obesity rates remained stable at 6.2 and 2.1%. Anemia decreased by 5-6%, but iron deficiency rose by 7%. Vitamin A deficiency decreased, but iron deficiency anemia remained largely unchanged. Undernutrition was rare, but vitamin D deficiency affected 27.7% of preschoolers, impacting growth and immunity. Iron deficiency, affecting 25% of children, poses a risk to cognitive development. Overweight or obesity affected 9% of children, a medium public health issue according to the WHO. While malnutrition rates are low, the persistent issues of vitamin D deficiency, iron deficiency, and childhood obesity require focused attention. The study highlights ongoing nutritional challenges among Jordanian preschoolers. Although severe anemia was rare, 11% were anemic, and 22.4% had iron deficiency, including 5% with iron deficiency anemia. Vitamin D deficiency affected 22.9%, impacting growth and immunity. While stunting and wasting improved, childhood overweight and obesity rates remained steady. Anemia decreased, but iron deficiency rose by 7%. Despite reduced vitamin A deficiency, stable iron deficiency anemia rates indicate ongoing concerns. Overall, undernutrition is uncommon, but vitamin D and iron deficiencies, along with childhood obesity, need sustained attention and targeted interventions to improve children's health in Jordan.

Anemia Status Changes Among Patients With Obesity Following Bariatric Surgery.

Objective This study aims to investigate trends in anemia severity among patients with pre-existing anemia who underwent bariatric surgery due to obesity. It also examines how different bariatric surgery techniques impact anemia outcomes. Methods This prospective study included 280 patients aged 18 to 65 with obesity who underwent bariatric surgery. The patients were categorized into three groups based on the type of surgery: sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass. Anemia severity was evaluated over a 12-month follow-up period. Chi-square tests were used to assess the homogeneity of baseline factors among the groups, and McNemar tests along with generalized estimating equations were used to compare anemia outcomes. Results Before surgery, the rates of moderate anemia across the three surgical groups ranged from 18.2% to 22.4%, with no cases of severe anemia observed. There was no significant difference among the groups (p=0.949). During the 12-month follow-up, the odds ratio for reducing anemia severity in the sleeve gastrectomy and Roux-en-Y gastric bypass groups were 2.13 and 1.91, respectively, compared to the one-anastomosis gastric bypass group. Additionally, the odds ratio for reducing anemia severity in patients with hypothyroidism was 1.84 compared to those without hypothyroidism. Conclusion The choice of bariatric surgery technique significantly affects anemia outcomes, with sleeve gastrectomy showing a higher success rate in reducing anemia severity. The role of hypothyroidism in anemia management also appears to be significant.

Bilateral adrenal hemorrhage and severe anemia in a neonate.

Neonatal adrenal hemorrhage (NAH) occurs in up to 3% of infants and is the most common adrenal mass in newborns. The most common presentation of NAH is an asymptomatic palpable flank mass which resolves over time without intervention. In rare cases, NAH can present as hemorrhage, shock, or adrenal insufficiency. This case describes a preterm infant born with severe anemia in the setting of bilateral adrenal hemorrhages with resulting adrenal insufficiency. The infant was successfully treated with blood transfusions and steroids. This is a unique presentation of NAH as it was bilateral, presented with severe anemia, and resulted in prolonged adrenal insufficiency. Consider adrenal hemorrhage for cases of severe anemia at birth. Adrenal insufficiency is a rare complication of adrenal hemorrhage. Adrenal recovery can take months, if not years.

No Benefits from Glucocorticoid Maintenance Therapy in Patients with PNH

Introduction Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, complement-mediated hemolytic anemia resulting from a somatic phosphatidylinositol glycan class A ( PIGA) mutation which bugs the biosynthesis of glycosylphosphatidylinositol (GPI). The lack of GPI-anchored proteins, especially CD55 and CD59 molecules, prompts blood cells to be prone to complement attack and lysis. Targeted on the terminal complement inhibitor has been recommended as a first-line treatment, such as eculizumab (C5 inhibitors), which not only controls hemolytic anemia, reduces thrombosis and blood transfusion, but also improves the staging status of chronic kidney disease in PNH patients. Complement inhibitors are not yet widely administrated by Chinese PNH patients, so glucocorticoids are still mostly used for the first-line treatment. However, the efficacy of glucocorticoid maintenance therapy in PNH is uncertain. Methods We conducted a prospective self-controlled comparison of 40 PNH patients with high disease activity (HDA), collecting anemia, hemolysis, thrombosis and renal function indicators at baseline and 1st, 3rd and 6th month after treatment in the Chinese Eastern Collaboration Group of Anemia (CECGA). All enrolled patients were administrated with prednisone 1.0 mg/kg/d at first and then adjusted the dosage according to the situation. The clinical trial registration number is ChiCTR2100050945. Results A total of 40 patients with PNH were enrolled in this study, 21 (52.5%, 21/40) were male, 19 (47.5%, 19/40) were female and the median age was 33.5 years (range 18-69 years). 29 of 40 (72.5%) presented classical PNH and 11 patients (27.5%) were diagnosed as PNH associated with bone marrow disease (BMD)-10 were aplastic anemia and 1 was myelodysplastic syndrome. Four cases detected single-site thrombosis and one had multi-site thrombosis. The most common locations were portal vein thrombus (2/6, 33.33%) and lower extremity intermuscular thrombus (2/6, 33.33%), others included mesentery vein, hepatic vein, splenic vein and intracranial microthrombus. The laboratory indexes at baseline were presented in Table 1. Compared to the baseline (Table 2), at 1 st, 3 rd, and 6 th month after treatment, both hemoglobin and red blood cell (RBC) have improved, but hemoglobin and RBC didn't keep rising, and showed no difference when comparing 3 rd month with 1 st month and 6 th month with 3 rd month. 19 patients (19/40, 47.5%) required blood transfusion before treatment, and 11 patients (11/40, 27.5%) needed transfusion at 1 st month ( P=0.021). Then 13 patients (13/40, 32.5%) at 3 rd month, 15 patients (15/40, 37.5%) at 6 th month were transfusion dependent ( P=0.109; P=0.388). After 6-month treatment, 3 cases of severe anemia (Hb < 30 g/L) at baseline were still severe anemia (3/7, 42.86%), and 4 cases (4/7, 57.14%) were upgraded to moderate anemia (60 g/L ≤ Hb ≤ 90 g/L). Among the original moderate anemia, 20 (20/31, 64.52%) cases were still moderate anemia, 6 (6/31, 19.35%) cases decreased to severe anemia and 5 (5/31, 16.13%) cases were improved to mild anemia (Hb > 90 g/L). 1 (1/2, 50%) patient of mild anemia originally maintained mid anemia and one (1/2, 50%) patient decreased to moderate anemia. The levels of LDH, indirect bilirubin (IBIL) and reticulocyte (Ret) were not changed significantly at 1 st, 3 rd, 6 th month after treatment. At 1 st, 3 rd, 6 th month, only 1, 2 and 2 patients achieved hemolytic control (LDH < 1.5 ULN). The d-dimer and glomerular filtration rate (GFR) also were indicated no difference. At 1 st, 3 rd, 6 th month, 3 (3/11, 27.27%), 4 (4/11, 36.36%), 6 (6/11, 54.54%) patients were back to normal range, 1 (1/11, 9.09%), 2 (2/11, 18.18%), 4 (4/11, 36.36%) patient was newly elevated (D-dimer > 0.55 mg/L) separately. At baseline 2 patients' renal function was severely reduced (GFR＜60ml/min/1.73m 2), and at 1 st, 3 rd, 6 th month, 1, 1, 2 patients had declined respectively. Discussions and Conclusions The use of prednisone in PNH patients with HDA may initially improve anemia, but the improvement in anemia may also be due to self-remission after paroxysmal episodes of PNH itself, or transfusion. The maintenance therapy with prednisone cannot control hemolysis, improve thrombosis and renal function damage. Long-term glucocorticoid maintenance therapy for PNH is not recommended.

MODERN ASPECTS OF THE TREATMENT MASSIVE OBSTETRIC BLEEDING ACCORDING TO THE DCR CONCEPT

The purpose of our study was to determine the effectiveness of thetherapymassiveobstetric bleeding (MOH), which arose under various etiological factors, with the introduction of the modern concept of resuscitation of damage control (DCR – Damage Control Resuscitation) and innovative methods of surgical hemostasis. Materials and research methods. During 2015 – 2023 years at clinical bases of the Department of Ob/Gyn. No1 of PL Shupyk NHU of Ukraine, 165 cases of MOH were analyzed. In all MOH cases, an integrated approach was used to stop bleeding using both drug therapy and modern methods of surgical hemostasis in accordance with the regulatory documents of the Ukrainian Ministry of Health. The main group – 59 women in labor with the MOH (2020-2023), who used in integrated approach to stopping bleeding and restoring blood loss according to the Concept of DCR with the priority of high-quality and rapid restoration of blood loss with blood products with minimization of infusion therapy. The comparison group consisted of 106 women in labor with MOH (2015-2019) and similar methods of stopping bleeding to restore blood loss in accordance with the order No. 205 of the Ukrainian Ministry of Health with the priority of rapid recovery of blood loss by crystalloids (during 2015-2019). Research results. The mean blood loss, time to stop bleeding, and duration of surgery in the intervention group were significantly lower than in the comparison group (p < 0.05). In the postpartum period, cases of severe anemia were significantly more often observed in the comparison group – 47.2% versus 11.9% in the main group (p < 0.01). The number of cases of hysterectomies was significantly higher in the comparison group – 50.9% versus 28.8% (p < 0.01). Early onset and significantly higher rate of fresh frozen plasma transfusions and erythromas in the main gr. – respectively 88.1% versus 38.7% (p < 0.001), which affected significantly lower blood loss, duration of surgery and average time to stop bleeding in the main group to the comparison group (p < 0.05). Conclusions. The use of modern uterotonic agents (carbetocin), tranexamic acid, innovative surgical technologies and early initiation of transfusion therapy with blood products with minimization of crystalloid infusion and according to the DCR concept in the MOH allows to reduce blood loss, frequency of severe postpartum complications, prevent severe maternal morbidity and mortality.

Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care.

Anemia is a common complication of chronic kidney disease (CKD), but limited awareness and treatment options may hinder its management among CKD patients followed in primary care. We evaluated adults with CKD stages 3-5 attending primary care in Stockholm, Sweden, 2012-2018. We assessed the incidence of anemia, clinical reactions, and association with subsequent major adverse cardiovascular events (MACE) and death. We identified 45,637 patients with CKD stages 3-5 free from anemia (mean age 78 years; 64% females; 79% CKD stage 3b). During a median follow-up of 2.4 years, 26% of patients developed anemia, and 10.4% developed severe anemia (hemoglobin <10g/dL). Within 6 months from the anemia event, iron tests were infrequent; ferritin and transferrin saturation were tested in 27% and 11% of anemia cases, respectively, and 49% and 24% of severe anemia cases. Few patients were recognized with a clinical diagnosis (15% of anemia cases; 68% of severe anemias). Only 19% of patients with anemia received treatment, primarily iron (10%) and blood transfusions (7%); erythropoietin-stimulating agent use was anecdotal (∼1%). Treatment rates for severe anemia were higher, but 43% of patients still failed to receive treatment. Developing anemia was associated with a higher risk of MACE and death. Anemia was common and associated with adverse outcomes among patients with CKD stages 3-5 managed in primary care. Iron stores were infrequently tested, and a large proportion of patients with anemia remained untreated/under-recognized.

Risk Factors for Low Birth Weight Babies in Women Delivered in a Tertiarry Referral Hospital

Background: Low birth weight is an important indicator of reproductive health and general health status of population. LBW is considered as the single most important predictor of infant mortality, especially of deaths within the first month of life. It is also a significant determinant of infant and childhood morbidity, particularly of neurodevelopmental impairments such as mental retardation and learning disabilities. This study aimed to determine the risk factors associated with low birth weight. Material &amp; Methods: It was a prospective cross sectional observational study carried out in the Department of Obstetrics &amp; Gynaecology, Dhaka Medical College, Dhaka, during the period of January 2012 to June 2012. Total 308 samples were included in this study. All women ≥28 weeks of pregnancy who delivered a LBW baby during six months of study period were selected. The database was processed by the application of statistical package SPSS for windows version 24. Results: This study shows most frequent maternal age group was 20-25 years. The mean maternal age was 23.86±4.82 years. Fifty three percent (53%)were female and 46.76% were male babies. Low birth weight was associated with inadequate Antental care, pre-delivery weight &lt;55 kg, height &lt;145 cm, low socio-economic status, and anemia. ln LBW babies’ mother having regular antenatal care (23.8%\. The incidence of mild anemia was 10.71 o/o, moderate anemia 32.79% and there were 2.60% cases of severe anemia. Maternal factors including maternal height (27.92%), maternal weight (36.36%), anaemia (43.50%), placenta praevia (12.18%), eclampsia (20.29%), PROM (24.35%), preterm labour (15.42%), severe PET (8.12%), twin pregnancy (17.86%), heart disease (2.44%) and DM (1.620/o) were associated with low birth weight. 62.01% mothers had average food intake, 37.99o/o had poor food intake. Conclusion: The incidence of low birth weight is 19.05%. Maternal height, maternal weight, ANC, anemia, eclampsia, preeclampsia, PROM, preterm labor, sever PET, twin pregnancy and heart disease were associated with low birth weight. There is a need for national prospective research project to study the low birth weight problem at the national level. There is also a need to discourage teenage pregnancies and to encourage utilization of mother and child health services, and treat concomitant illnesses during pregnancy. Maternal malnutrition, inadequate antenatal care and poor weight gain during pregnancy are significant predictors for delivery of a low birth weight neonate.

Assessment of peripheral nerve conduction in iron deficiency anemia patients in Indian rural adult population attending a tertiary care hospital

Background: Iron deficiency anemia (IDA) is the most common nutritional deficiency anemia in India. Peripheral neuropathy can result due to iron deficiency as it disrupts myelination and neuronal energetics in neuronal functioning. Nerve conduction studies (NCS) can quantitatively detect peripheral nerve dysfunction. This study was conducted to observe effect of IDA on peripheral nerve conduction velocity in adults using neuroelectrophysiological techniques with the aim to recommend Complete Blood Count for serologic evaluation of patients with peripheral neuropathy in Indian population. Objectives: This study aims to compare motor and sensory nerve conduction study parameters between controls and IDA patients and evaluate the effect of various grades of IDA on motor and sensory nerves. Methodology: 30 newly diagnosed patients of IDA in age group of 20-45 yrs and 30 healthy controls in same age group were recruited in this study. NCS was conducted on bilateral motor and sensory median and ulnar nerves in Neurophysiology laboratory using Neurosoft machine. Neuroelectrophysiological data of both the groups was evaluated and analysed using Student’s unpaired t test. Also, patients were categorised as mild, moderate and severe anemia cases and one way ANOVA was used for comparison among patients with various grades of anemia. Results: CMAP (compound muscle action potential), SNAP (sensory nerve action potential) and nerve conduction velocity (NCV) of bilateral median and ulnar nerves was reduced and DL (distal latency) was increased in bilateral median and ulnar nerves in patients with IDA compared to controls. The results were statistically significant (p=0.001). A highly significant difference between motor and sensory nerve conduction values between mild, moderate and severe IDA patients was also observed (p=0.001). Conclusion: The results of the study confirmed peripheral nerves involvement in IDA patients. As severity of anemia increases, peripheral neuropathy worsens. These results can be extrapolated for screening patients with peripheral neuropathy for iron deficiency as a routine part of diagnostic approach for peripheral neuropathy.

Severe Anemia among Blood Donors in an Area Where Blood Donation Is Sought to Save the Lives of Children with Severe Malaria—Anemia in Blood Donors

Introduction: Severe anemia caused by severe malaria remains concentrated in children under 5 years old in Africa. In addition to blood-transfusion-related infections that pose a health concern, transfusion of severely anemic blood to a patient with severe anemia is another important concern. Method: Following the observation of a case of severe anemia in a blood donor, we conducted a secondary data analysis from a previous study to assess the frequency of anemia in blood donors in San, Mali. Results: In total, out of 140 volunteers, 13 (9%, 95% CI: 5.43–15.41) blood donors had moderate to severe anemia, based on Mali hemoglobin (Hb) normal values (10.5–16.5 g/dL, MRTC-GLP laboratory). In particular, we observed one case of severe anemia with an Hb level of 6.5 g/dL. Conclusions: To the best of our knowledge, this is the first report of severe anemia in blood donors in a malaria endemic area in Mali.

A296 Preventable long-term sequela of bariatric surgery – A case of severe anemia

A296 Preventable long-term sequela of bariatric surgery – A case of severe anemia

Severe Anemia in Sprague-Dawley Rats After Roux-en-Y Gastric Bypass Surgery.

Roux-en-Y gastric bypass (RYGB) surgery is one of the most commonly performed bariatric procedures for weight loss in humans. However, this procedure is not risk-free, and patients may experience complications that include small bowel obstruction, gastrointestinal bleeding, chronic diarrhea, ulcers, malnutrition, and anemia. In particular, anemia is a recognized long-term complication and can be severe. Rats have been used as a model to study the effects of gastric bypass surgeries. They can experience similar complications as people, but the development of severe anemia has not previously been reported in rats. We observed 2 cases of severe anemia in female Sprague-Dawley rats after RYGB surgery. These cases prompted us to further investigate the frequency and severity of anemia after RYGB in rats. Blood work and necropsies were performed on 9 additional female Sprague-Dawley rats (5 with RYGB, 4 with sham surgery). In these 9 rats, only one had signs of clinical anemia. These 3 anemic rats displayed moderate to severe pallor of the eyes and ears. Necropsy findings in anemic RYGB rats included pale internal organs and eccentric heart enlargement, which led to a significantly higher heart:body weight ratio in RYGB rats as compared with sham controls. Anemic rats had either a macrocytic normochromic anemia, consistent with vitamin B12 or folate deficiency, or microcytic hypochromic anemia, indicative of iron deficiency. Researchers who perform RYGB surgery in rats should be aware of the potential complication of severe anemia. Plans for the diagnosis and management of this complication and the development of criteria for humane endpoints for severe anemia are recommended as a refinement to these studies.

Severe Microcytic Anemia Caused by Complex Hereditary Spherocytosis and X-Linked Sideroblastic Anemia with Mutations in SPTB and ALAS2 Genes

We report a case of severe anemia caused by complex hereditary spherocytosis (HS) and X-linked sideroblastic anemia (XLSA) with two mutations in the spectrin beta (SPTB) and 5-aminolevulinic acid synthase (ALAS2) genes. The proband was a 16-year-old male with severe jaundice and microcytic hypochromic anemia since his childhood. He had more severe anemia requiring erythrocyte transfusion, and had no response to vitamin B6 treatment. Next-generation sequencing (NGS) revealed double heterozygous mutations, one in exon 19 (c.3936G > A:p.W1312X) of the SPTB gene and another in exon 2 (c.37A > G:p.K13E) of the ALAS2 gene, and confirmed again by Sanger sequencing. The mutation of ALAS2 (c.37A > G) is inherited from his asymptomatic heterozygous mother, causing amino acid p.K13E, and the mutation has not yet been reported. The mutation of SPTB (c.3936G > A) is a nonsense mutation, leading to a premature termination codon in exon 19, and the mutation in the SPTB gene is not found in any of his relatives, which indicates a de novo monoallelic mutation. Conclusions: The double heterozygous mutations in the SPTB and ALAS2 genes lead to the joint occurrence of HS and XLSA in this patient, and are implicated in the more severe clinical phenotypes.

Clinical features of anemia in membranous nephropathy patients: a Chinese cohort study

Background Anemia is a common complication in patients with progressive chronic kidney disease. This cohort study evaluated the prevalence, clinical features and prognosis of membranous nephropathy (MN) with anemia. Methods We retrospectively analyzed a cohort of MN patients diagnosed using renal biopsy between February 2012 and February 2018. The clinical and pathological characteristics at baseline were recorded, and the outcomes (hemoglobin, proteinuria and renal function) during follow-ups were also evaluated. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for anemia in MN patients. The MN patients were divided according to the therapeutic effect they experienced as follows: without-anemia, completely corrected anemia, standard anemia treatment and nonstandard anemia treatment groups. We compared the rate of complete remission of MN and renal end-point events among the four groups. Results The median age of 483 patients was 42.43 (26.59, 50.20) years at the time of MN diagnosis. The prevalence of anemia at baseline was 23.81%, and the cumulative prevalence was 50.72%. There were 133 cases of mild anemia, 103 cases of moderate anemia and 9 cases of severe anemia; in addition, there were 228 cases of normocytic anemia and 17 cases of microcytic hypochromic anemia. Multivariate logistic regression indicated that acute renal tubule injury >5% (OR = 1.634, 95% CI 1.034, 2.581; p = 0.035), total protein level (OR = 0.949, 95% CI 0.923, 0.975; p < 0.001), cholesterol level (OR = 0.833, 95% CI 0.749, 0.926, p = 0.001), hypokalemia (OR = 2.612, 95% CI 1.227, 5.560, p = 0.013) and hypophosphatemia (OR = 2.653, 95% CI 1.303, 5.403, p = 0.007) were independent risk factors for anemia in MN patients. The complete remission rate of MN patients without anemia was significantly higher than that of anemia patients who exhibited treatment failure. The incidence of renal endpoint events was different among the four groups. Conclusion The anemia experienced by MN patients is mainly mild and moderate, normocytic anemia. The pathological features of acute renal tubular injury and clinical nutritional status are independent risk factors for anemia. There were differences in renal prognosis among anemia patients with different treatment outcomes.

Anti-RH1 alloimmunization: At what maternal antibody threshold is there a risk of severe fetal anemia?

To define a threshold of maternal antibodies at risk of severe fetal anemia in patients followed for anti-RH1 alloimmunization (AI). We conducted a retrospective study of patients followed for anti-RH1 AI at the Lille University Hospital. The first group, severe anemia, included patients who received one or more in utero transfusions (IUT) or who were induced before 37 weeks of pregnancy for suspected severe fetal anemia. The second group, absence of severe anemia, corresponded to patients without intervention during pregnancy related to AI. Sensitivities, specificities, and positive and negative predictive values for screening for severe fetal anemia were calculated for the antibody thresholds of 3.5 and 5IU/ml for the quantification. Between 2000 and 2018, 207 patients were included 135 in the severe anemia group and 72 in the no severe anemia group. No severe anemia was observed for an antibody titer below 16. For an antibody threshold of 3.5IU/ml, the sensitivity was 98.2%, with 30.2% false positives. All severe anemias were detected in the second trimester; two cases of severe anemia were not detected in the third trimester. For an antibody threshold of 5IU/ml, the sensitivity was lower at 95.6%, with five cases of severe anemia not detected. The antibody threshold of 3.5IU/ml for the quantification and 16 for the titration allow targeting patients requiring close monitoring by an experienced team in case of anti-RH1 AI.

Analysis of the anemia characteristics in early pregnancy and outcomes of pregnant women with hemoglobin H disease.

This study aimed to analyze the anemia characteristics in early pregnancy of pregnant women with hemoglobin H (Hb H) disease and their pregnancy outcomes, and to provide reference to the pregnancy management and treatment of these women. Twenty-eight cases of pregnant women who had been diagnosed with Hb H disease in the Second Affiliated Hospital of Guangxi Medical University from August 2018 to March 2022 were retrospectively analyzed. Moreover, 28 cases of normal pregnant women in the same period were randomly enrolled as a control group for comparison. The means and percentages of the anemia characteristics in early pregnancy and the pregnancy outcomes were calculated and the analysis of variance, Chi-square test, and Fisher's exact test were applied for comparison. A total of 13 cases of missing type (46.43%) and 15 cases of non-missing type (53.57%) were observed in the 28 cases of pregnant women with Hb H disease. The genotypes were as follows: 8 cases of -α3.7/--SEA (28.57%), 4 cases of -α4.2/--SEA (14.29%), 1 case of -α4.2/--THAI (3.57%), 9 cases of αCSα/--SEA (32.14%), 5 cases of αWSα/--SEA (17.86%), and 1 case of αQSα/--SEA (3.57%). Twenty-seven patients with Hb H disease (96.43%) were anemic, including 5 cases of mild anemia (17.86%), 18 cases of moderate anemia (64.28%), 4 cases of severe anemia (14.29%), and 1 case of non-anemia (3.57%). Compared with the control group, the Hb H group had significantly higher red blood cell count and significantly lower Hb, mean corpuscular volume, and mean corpuscular hemoglobin, and the differences were statistically significant (p < 0.05). The Hb H group had higher incidence rates of blood transfusion during pregnancy (BTDP), oligohydramnios fetal growth restrictions (FGR), and fetal distress than the control group. The weights of neonates were lower in the Hb H group than in the control group. Statistically significant differences were found between these two groups (p < 0.05). The genotype missing type of pregnant women with Hb H disease was mainly -α3.7/--SEA and the non-missing type was mainly αCSα/--SEA. Hb H disease can easily cause various degrees of anemia (mainly moderate anemia in this study). Moreover, it can increase the incidence rate of pregnancy complications such as BTDP, oligohydramnios, FGR, and fetal distress, which will reduce the weight of neonates and seriously affect maternal and infant safety. Therefore, maternal anemia and fetal growth and development should be monitored during pregnancy and delivery, and transfusion therapy should be used to improve adverse pregnancy outcomes caused by anemia when necessary.

Factors Affecting Anemia in Pregnancy Women in Ibeju-Lekki, Lagos State, Nigeria.

Anemia progresses due to low red blood cells counts or hemoglobin. The World Health Organization (WHO) has suggested the condition to be a serious global public health problem that affects pregnant women worldwide. Anemic pregnant women may suffer post-partum hemorrhage, pre-term delivery, seizures, and severe cases of anemia that potentially lead to cardiac failure or death. However, it is pertinent for pregnant women and health service providers to have the adequate knowledge about the factors associated with anemia in pregnancy. Thus, this study assessed the factors associated with anemia in pregnancy women attending primary healthcare (PHC) centers in Ibeju-Lekki Local government area, Lagos state. This study employed descriptive cross-sectional design using multi-stage sampling method to recruit 295 pregnant women into the study. Data were collected using a semi-structured, self-administered questionnaire. The recruited participants (56.6%) were majorly in their third trimester, of which their mean age was 28.7 ± 5.9 years. About 80.7% of the participants were married, having a mean knowledge score of 6.6 ± 3.2. More than half of respondents (56.3%) were anemic and had a poor knowledge (50.5%) of anemia in pregnancy. The mean hemoglobin concentration within the population was 11.06 ± 0.73 g/dl with a range of 8.3 to 12.0. There was no significant association between the respondents' knowledge of anemia in pregnancy and anemic status (X2 = 0.549; P = .45). However, this study observed a significant association between dietary diversity score and anemic status (X2 = 8.66; P = .01) and the trimester status of respondents' first antenatal visit (X2 = 9.603; P = .008). The study concluded that anemia in pregnancy was associated with maternal factors such as their first antenatal visit and the dietary diversity score. Due to this, proper education of pregnant women on anemia by health workers during antenatal clinics or visits should be prioritize to improve their anemia status.

Severe anemia and neutrophilic leukocytosis resembling Sweet’s syndrome in a dog

Sweet’s syndrome is a rare inflammatory condition characterized by the presence of neutrophilic infiltrate of the skin. We describe a case of severe anemia and neutrophilia with post-mortem findings resembling Sweet's syndrome in a five-years-old female Labrador Retriever with bilateral epistaxis, hematemesis, hyporexia, pale oral mucosa, and fever. Laboratory analysis evidenced severe unresponsive anemia, thrombocytopenia, and leukocytosis. Biochemistry showed hypoalbuminemia and increased ALT and SAP activities. The patient was transfused and received doxycycline and prednisone for one week without improvement. Two further blood transfusions were administered. Bone marrow analysis showed a mild erythroid hypoplasia, granulocytic hyperplasia, myeloid to erythroid ratio of 6.01:1 (reference: 0.9:1 – 1.76:1) without dysplasia, mild megakaryocytic hyperplasia, and increased iron stores. Macrophages were slightly increased in number with erythrophagocytosis, and immune-mediated anemia was considered. Immunosuppressive treatment was prescribed to reduce red blood cell destruction, but no improvement after one week was observed, and euthanasia was performed. Necroscopic findings resembled those described for the systemic form of Sweet's Syndrome. Bone marrow histopathology showed remarkably increased granulopoiesis and destruction of platelets and erythrocytes. Sweet's syndrome is frequently associated with hematologic malignancy or drug exposure. Leukemia was excluded after bone marrow analysis because no increase in blast population was seen as well as no signs of dysplasia. Previous treatment could be related to the development of Sweet's syndrome, which might be the primary event. Although rare, this syndrome should be considered in the differential diagnosis of dermatosis and leukocytosis when infectious agents are not identified.