Common Cause Of Anemia Research Articles

Acute Intravascular Hemolysis in the Critical Phase of Severe Dengue

Background: Dengue and severe dengue have various hemorrhagic manifestations ranging from mild presentations such as petechiae, bleeding from injection sites, ecchymosis, and gum bleeding to severe presentations like major mucosal bleeding such as hematemesis, melena, menorrhagia, and concealed internal bleeding. Common causes of anemia in dengue are due to blood loss (secondary to thrombocytopenia and/or coagulopathy), transient suppression of the bone marrow, and rarely, hemolytic anemia. Clinical Description: We describe a 5-year-old boy who presented to us in the critical phase of severe dengue with features of capillary leakage and cola-colored urine. Salient investigation reports were anemia, thrombocytopenia, normal reticulocyte count, absence of coagulopathy, indirect hyperbilirubinemia, deranged transaminase, highly elevated lactate dehydrogenase, and low haptoglobin levels, and hemoglobinuria, suggestive of acute intravascular hemolysis (AIVH). Autoimmune and microangiopathic hemolytic anemia, malaria, ingestion of dyes, snake bite, Glucose 6 phosphate dehydrogenase deficiency, and incompatible blood transfusions were excluded. Thus, the final diagnosis was severe dengue with hemolytic anemia and AIVH. Management: Oxygen delivery by the Heated Humidified High-Flow Nasal Cannula, strict input/output charting, appropriate fluid therapy, and diuretic infusion were the mainstays of management in an intensive setting. The aim was to maintain ventilation, perfusion, balance hydration, achieve optimal urine output and prevent fluid overload. Conclusion: Clinicians should consider Dengue as a possible cause for AIVH in children with severe dengue and cola-colored urine.

S3411 Profile of Anaemia in Patients With Acute-on-Chronic Liver Failure

Introduction: Acute-on-chronic liver failure (ACLF) is a syndrome associated with a very high short term mortality. Patients with ACLF are often anaemic which may be multifactorial. We aim to characterise anaemia in patients with ACLF and to identify the role of Hepcidin and Ferritin in predicting mortality in anaemic patients with ACLF. Methods: Patients with ACLF as defined by the European association for study of liver (EASL) – chronic liver failure (CLIF) were screened for presence of anaemia. Anaemia was defined by a Haemoglobin of less than 13 g/dL in males and less than 12 g/dL in females. All patients were prospectively followed for 30 days. Red Blood cell indices, peripheral smear, iron profile, vitamin B12 and folate levels, retic count, coombs test, and lactate dehydrogenase were done to characterise anaemia. In addition, serum hepcidin levels were measured in a subset of patients. These parameters were compared among survivors and non-survivors. Anaemia was labelled to be due to hypersplenism when no other etiology was identified. Results: A total of 135 patients with ACLF were screened, out of which 94 patients had anaemia and were recruited for the study. The median (IQR) age of the cohort was 47.5 (38 – 57) years. Majority were males (n=84; 89.36%). The most common etiology of liver disease was alcohol, seen in 70.21%. Macrocytic anaemia was the most common finding seen on peripheral smear (n=21; 52.5%). Most common cause of anaemia in ACLF was haemolytic anaemia, seen in 31.91% patients while least common was vitamin B12/folate deficiency. Serum hepcidin was done in 40 patients. Although hepcidin was elevated in non-survivors, it did not reach statistical significance. Overall mortality was 58.51% at 30-days. Baseline characteristics among survivors and non-survivors are provided in Table. On multivariate logistic regression analysis, MELD-Na was the only predictor of mortality. Conclusion: Macrocytic anaemia is a common finding in patients with ACLF which is most often due to haemolysis. Measuring serum levels of vitamin B12 and folate is not accurate as most of the patients have previously received vitamin supplements leading to spuriously normal levels.Table 1.: * - Median (interquartile range); † - Mean ± Standard Deviation Abbreviations : MCV - Mean Corpuscular Volume, MCHC - Mean corpuscular hemoglobin concentration; RDW - red cell distribution width; INR - International normalised ratio; CRP - C-reactive protein; MELD-Na - Model for end stage liver disease-sodium; IDA - Iron deficiency anemia Table - Baseline characteristics among survivors and non-survivors.

Identification of genomic loci regulating grain iron content in aus rice under two irrigation management systems.

Iron (Fe) deficiency is one of the common causes of anaemia in humans. Improving grain Fe in rice, therefore, could have a positive impact for humans worldwide, especially for those people who consume rice as a staple food. In this study, 225–269 accessions of the Bengal and Assam Aus Panel (BAAP) were investigated for their accumulation of grain Fe in two consecutive years in a field experiment under alternative wetting and drying (AWD) and continuous flooded (CF) irrigation. AWD reduced straw Fe by 40% and grain Fe by 5.5–13%. Genotype differences accounted for 35% of the variation in grain Fe, while genotype by irrigation interaction accounted for 12% of the variation in straw and grain Fe in year 1, with no significant interactions detected in year 2. Twelve rice accessions were identified as having high grain Fe for both years regardless of irrigation treatment, half of which were from BAAP aus subgroup 3 which prominently comes from Bangladesh. On average, subgroup 3 had higher grain Fe than the other four subgroups of aus. Genome‐wide association mapping identified 6 genomic loci controlling natural variation of grain Fe concentration in plants grown under AWD. For one QTL, nicotianamine synthase OsNAS3 is proposed as candidate for controlling natural variation of grain Fe in rice. The BAAP contains three haplotypes of OsNAS3 where one haplotype (detected in 31% of the individuals) increased grain Fe up to 11%. Haplotype analysis of this gene in rice suggests that the ability to detect the QTL is enhanced in the BAAP because the high Fe allele is balanced in aus, unlike indica and japonica subgroups.

Iron Replacement Therapy with Oral Ferric Maltol: Review of the Evidence and Expert Opinion

Iron deficiency is the most common cause of anemia globally and is frequently reported in patients with underlying inflammatory conditions, such as inflammatory bowel disease (IBD) and chronic kidney disease (CKD). Ferric maltol is a new oral iron replacement therapy designed to optimize iron absorption while reducing the gastrointestinal adverse events associated with unabsorbed free iron. Ferric maltol has been studied in clinical trials involving almost 750 adults and adolescents with iron-deficiency anemia associated with IBD, CKD, and other underlying conditions, and it has been widely used in clinical practice. It is approved for the treatment of adults with iron deficiency with or without anemia, independent of the underlying condition, and is commercially available in Europe and the United States. We review the published evidence for ferric maltol, which demonstrates consistent and clinically meaningful improvements in hemoglobin and measures of iron availability (ferritin and transferrin saturation) and shows that it is well-tolerated over long-term treatment for up to 64 weeks—an important consideration in patients with chronic underlying conditions such as IBD and CKD. We believe that ferric maltol is an effective, convenient, and well-tolerated treatment option for iron deficiency and iron-deficiency anemia, especially when long-term management of chronic iron deficiency is required. Writing support was provided by Shield Therapeutics (Gateshead, UK).

Perioperative anemia

Over 10 million operations are performed each year in Russia. A successful surgical treatment demands assessment and mitigation of perioperative risks, one of which is anemia. Patients with low hemoglobin are at greater risk of developing complications and adverse outcomes. These patients more often stay longer at hospitals, have more in-hospital events and readmissions.Perioperative anemia may be present before surgery, low hemoglobin levels can result from surgery, and can persist after hospital discharge. Preoperative anemia is associated with inferior surgical outcomes and is also an independent risk factor for perioperative complications (acute kidney injury, infectious, thromboembolic, cardiovascular events) and death. Postoperative anemia impairs recovery and increases the risk of reoperations and readmissions.Absolute and functional iron deficiency is the most common cause of anemia in the perioperative period. The prescription of iron supplements is indicated in the presence of iron deficiency. If the operation is scheduled to be performed in 6 weeks and longer, the prescription of oral iron forms is recommended. If less than 6 weeks remain before surgery, parenteral iron therapy is prescribed. If hemoglobin levels increase insignificantly during such therapy, high-dose iron supplements are indicated. When it comes to emergency surgery and the anemia is not severe, it is recommended to intravenously administer high-dose iron supplements immediately before surgery. In case of severe anemia, blood transfusion is indicated. According to the patient’s blood management concept, blood transfusion should be minimized, including due to the use of high-dose iron supplements, one of which is ferric carboxymaltose.The choice of treatment for anemia in the postoperative period depends on its severity, the patient’s comorbidities, the type of surgery and the presence of surgical events. In most cases, early intravenous iron therapy is recommended, giving priority to single administration of high-dose iron supplements. Blood transfusion is indicated to patients who have severe anemia, are actively bleeding, and to patients with a severe anemia after the bleeding has been stopped. Iron therapy continues at the outpatient stage of treatment for a long time until the hemoglobin and ferritin levels are normalized, reflecting the replenishment of iron stores in the depot organs.

“PREVALENCE OF BETA-THALASSEMIA TRAIT IN PREGNANT WOMEN ATTENDING ANTENATAL CLINIC”

INTRODUCTION- Iron deficiency anemia and thalassemia syndromes,especially beta thalassemia trait (BTT),are the two most commonly ccuring microcytic hypochromic anemias highly prevalent in countries like India. Iron deficiency anemia is the first most common cause of anemia in pregnancy,beta thalassemia trait is the second most frequent cause of anemia of pregnancy. Patients with thalassemia trait shows an increased incidence of anemia during the second trimester of pregnancy. Beta Thalassemia Trait (BTT) patients are usually asymptomatic and ignorant of their carrier state unless diagnosed by testing. Screening for thalassemia can be done by measuring HbA2 levels MATERIAL AND METHOD- This is a retrospective study. The data were collected from a clinic and associated st pathology in Shivpuri and a private maternity hospital in Gwalior from 1 January 2019 to 30 June 2021.94 patients were included in the study.All pregnant women between the age of 18-45 years and at any gestational age with hemoglobin level <10g/dL and microcytic hypochromic anemia (report of CBC) were included in the study. High-Performance Liquid Chromatography (HPLC) and serum ferritin report were collected. RESULTS- In our study the most common age group in which the anemia was found between 19-35 years (80.85%).Most of the patients were primigravida (44.68%),between 26-37 wks of gestational age (82.97%),from a rural area (70.21%). Only 2 patients had a family history (2.12%) of beta-thalassemia and 6 patients had a history (6.38%) of blood transfusion. In our study moderate anemia was found in 55.31% of cases followed by mild anemia 25.53% and severe anemia 19.14%. In our study iron deficiency anemia was found in 87.23% only minor Beta-thalassemia was found to be 4.25%, of the patient,and the coexistence of iron deficiency anemia and beta-thalassemia in pregnant women is 8.51%. In our study total of 12 patients (4 cases of only minor beta-thalassemia and 8 cases of minor beta-thalassemia associated with IDA) The prevalence rate of beta-thalassemia in our study was 7.8%. CONCLUSION- the recommendation is to diagnose beta-thalassemia in pregnant patients is essential to give proper treatment.The screening of pregnant patients prevents unnecessary parental iron therapy and iron overload in case of anemia.further studies are needed in this field and less expensive and accurate methods should come in place.

Critical iron deficiency anemia with record low hemoglobin: a case report

BackgroundAnemia is a serious global health problem that affects individuals of all ages but particularly women of reproductive age. Iron deficiency anemia is one of the most common causes of anemia seen in women, with menstruation being one of the leading causes. Excessive, prolonged, and irregular uterine bleeding, also known as menometrorrhagia, can lead to severe anemia. In this case report, we present a case of a premenopausal woman with menometrorrhagia leading to severe iron deficiency anemia with record low hemoglobin.Case presentationA 42-year-old Hispanic woman with no known past medical history presented with a chief complaint of increasing fatigue and dizziness for 2 weeks. Initial vitals revealed temperature of 36.1 °C, blood pressure 107/47 mmHg, heart rate 87 beats/minute, respiratory rate 17 breaths/minute, and oxygen saturation 100% on room air. She was fully alert and oriented without any neurological deficits. Physical examination was otherwise notable for findings typical of anemia, including: marked pallor with pale mucous membranes and conjunctiva, a systolic flow murmur, and koilonychia of her fingernails. Her initial laboratory results showed a critically low hemoglobin of 1.4 g/dL and severe iron deficiency. After further diagnostic workup, her profound anemia was likely attributed to a long history of menometrorrhagia, and her remarkably stable presentation was due to impressive, years-long compensation. Over the course of her hospital stay, she received blood transfusions and intravenous iron repletion. Her symptoms of fatigue and dizziness resolved by the end of her hospital course, and she returned to her baseline ambulatory and activity level upon discharge.ConclusionsCritically low hemoglobin levels are typically associated with significant symptoms, physical examination findings, and hemodynamic instability. To our knowledge, this is the lowest recorded hemoglobin in a hemodynamically stable patient not requiring cardiac or supplemental oxygen support.

Iron Deficiency Anemia in Pregnancy.

Anemia is defined as a low red blood cell count, a low hematocrit, or a low hemoglobin concentration. In pregnancy, a hemoglobin concentration of less than 11.0 g/dL in the first trimester and less than 10.5 or 11.0 g/dL in the second or third trimester (depending on the guideline used) is considered anemia. Anemia is the most common hematologic abnormality in pregnancy. Maternal anemia is associated with adverse fetal, neonatal and childhood outcomes, but causality is not established. Maternal anemia increases the likelihood of transfusion at delivery. Besides hemodilution, iron deficiency is the most common cause of anemia in pregnancy. The American College of Obstetricians and Gynecologists recommends screening for anemia with a complete blood count in the first trimester and again at 24 0/7 to 28 6/7 weeks of gestation. Mild anemia, with a hemoglobin of 10.0 g/dL or higher and a mildly low or normal mean corpuscular volume (MCV) is likely iron deficiency anemia. A trial of oral iron can be both diagnostic and therapeutic. Mild anemia with a very low MCV, macrocytic anemia, moderate anemia (hemoglobin 7.0-9.9 g/dL) or severe anemia (hemoglobin 4.0-6.9 g/dL) requires further investigation. Once a diagnosis of iron deficiency anemia is confirmed, first-line treatment is oral iron. New evidence suggests that intermittent dosing is as effective as daily or twice-daily dosing with fewer side effects. For patients with iron deficiency anemia who cannot tolerate, cannot absorb, or do not respond to oral iron, intravenous iron is preferred. With contemporary formulations, allergic reactions are rare.

A STUDY ONCYTOPENIAS AND THE FACTORS ASSOCIATED WITH CYTOPENIAS AMONG HIV INFECTED PATIENTS ADMITTED AT A TERTIARY CARE HOSPITAL

Introduction: India has the third highest burden of HIV in the world. Haematological complications are common in HIV patients, of which cytopenias are the most frequently encountered. The cytopenias have been found to adversely affect the outcome of HIV patients with greater mortality and decreased quality of life. Aims and Objective: To assess the prevalence of cytopenias among patients admitted in a tertiary care hospital and to assess the factors associated with the cytopenias. Materials and Methods: The present study was conducted in the department of general medicine at a tertiary care hospital and 191 patients admitted in the hospital during the study period were taken for the study. The baseline investigations at the time of admission were taken into consideration. Patients were interviewed and charts reviewed to collect the data. The data collected was analysed with SPSS-2018. Continuous variables were expressed as mean +/- standard deviation and as median and interquartile ranges as appropriate. Categorical variables were expressed as percentages and frequencies. Comparisons between data was done by student’s t test and chi square. The factors associated with various cytopenias was assessed using log binomial regression. A p value of < 0.05 was taken as significant. Results: The overall prevalence of any cytopenia was found to be 85.9%. The most common cytopenia was anaemia with a prevalence of 78.5% followed by thrombocytopenia and leucopenia with prevalences of 28.8% and 24.1% respectively. Anaemia was found to be more prevalent among females with a prevalence ratio of 3.05 (95% CI: 1.39- 10.16, p value 0.009) when compared to males. The most common cause of anaemia was found to be B12 deficiency. There was significant association between leucopenia and CDC staging with the prevalence of leucopenia being higher among patient with CDC stage 3. [Prevalence ratio:1.46 (95% CI 0.67-3.17, p 0.024)]. No significant association was found with gender, duration of HIV, ART regimen, CDC stage or presence of opportunistic infections and thrombocytopenia. Conclusion: The prevalence of cytopenias among HIV patients was found to high – 85.9% especially compared to other developed countries. The most common cytopenia among the patients was found to be anaemia with a prevalence of 78%. The next most common cytopenia was thrombocytopenia, followed by leucopenia. The factors associated with these cytopenias can help to screen for patients at higher risk of developing these cytopenias and hence establish preventive strategies against them.

Prevalence of iron deficiency and red blood cell transfusions in surgical patients.

Background and ObjectivesWhile iron deficiency (ID) is the most common cause of anaemia, little is known about the prevalence and type of ID in preoperative surgical patients. The aims of the present study were to investigate the prevalence and types of ID in a large cohort of surgical patients, and how these are related to perioperative blood use after correction for confounders such as haemoglobin level.Materials and MethodsData were retrospectively extracted from electronic case records of all patients who underwent elective surgery between September 2016 and November 2017 (n = 2711). Iron parameters, haemoglobin and details of perioperative red cell transfusions were collected.ResultsOf 2711 patients, 618 (22.8%) were iron deficient (= transferrin saturation [TSAT] < 16%) preoperatively, 173 (6.4% of the cohort) had an absolute iron deficiency (AID; TSAT < 16% and ferritin < 30 μg/L) and 445 (16.4%) had functional/mixed ID (TSAT < 16% and ferritin ≥ 30 μg/L). Corrected for Hb level, iron‐deficient patients received significantly more red cell units than patients without ID (p = 0.026). AID was not associated with a significantly higher incidence of transfusions (7.5% of patients transfused; p = 0.12 after correction for Hb) than patients without ID, whereas patients with functional/mixed deficiency did receive significantly more transfusions (6.1%; p = 0.021) as compared to patients without ID (1.7%).ConclusionPreoperative ID, in particular the functional/mixed type, was associated with a higher risk of receiving perioperative red cell transfusions as compared to patients without ID. Adequately treating ID might, therefore, reduce the need for perioperative red cell transfusions.

The Relationship between Iron Intake and Anemia in Elementary School Children in the Working Area of the Air Beliti Public Health Center, Musi Rawas Regency

Anemia is a health problem that often occurs in school-age children. Low iron intake is the most common cause of anemia in children. Anemia has an impact on physical growth disorders and decreased body resistance. The purpose of this study was to analyze the relationship between iron intake and the incidence of anemia in schoolchildren. This research is an analytic observational study with a cross-sectional design. The Hb examination was carried out to find out the anemia while the iron intake data was assessed by observation on a 24-hour dietary recall. The sample in this study was 80 elementary school children, with a simple random sampling method at five schools in the working area of Air Beliti Public Health Center. The HB examination result showed that 51.2% of respondents had anemia, while the dietary recall showed that 26.2% of children had insufficient iron intake. The statistical test showed that 81.0% of children with insufficient iron intake suffered from anemia. There was a significant relationship between iron intake and the incidence of anemia in elementary school-aged children in the working area of Air Beliti Public Health Center, Musi Rawas Regency (p=0,004; OR=6.198). Based on the results of the study, it can be concluded that there is a significant relationship between iron intake and the incidence of anemia in schoolchildren. Children with low iron intake are 6.198 times more likely to suffer from anemia. Therefore, it is recommended for parents to maintain a balanced nutritional and iron-rich food intake to prevent the incidence of anemia in children. As for the public health center to improve health education and socialization for parents regarding balanced nutrition and foods containing iron for schoolchildren.

Anemia in Pregnancy: ACOG Practice Bulletin, Number 233.

Anemia, the most common hematologic abnormality, is a reduction in the concentration of erythrocytes or hemoglobin in blood. The two most common causes of anemia in pregnancy and the puerperium are iron deficiency and acute blood loss. Iron requirements increase during pregnancy, and a failure to maintain sufficient levels of iron may result in adverse maternal-fetal consequences. The purpose of this document is to provide a brief overview of the causes of anemia in pregnancy, review iron requirements, and provide recommendations for screening and clinical management of anemia during pregnancy.

A simplified diagnostic pathway for the differential diagnosis of iron deficiency anaemia and anaemia of chronic disease.

Iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are common causes of anaemia with similar clinical and laboratory features. IDA is caused by low iron stores while ACD is due to iron-restricted erythropoiesis occurring in inflammatory states. Differential diagnosis requires analysis of multiple biochemical and haematological parameters. IDA can occur simultaneously to ACD (mixed aetiology). It is essential that true iron deficiency is identified, as these patients will require iron therapy. This preliminary study investigated whether hepcidin, the master regulator of iron homeostasis, in conjunction with reticulocyte haemoglobin equivalent (RetHe) has the potential to differentiate IDA from ACD, and to exclude IDA in patients with mixed aetiology. Hepcidin concentration (measured using a commercially available ELISA method), RetHe, and iron parameters along with C-reactive protein (CRP) were analysed in 77 Gastroenterology patients with anaemia in a secondary care setting. Receiver operator characteristic (ROC) analysis showed that hepcidin at an optimal cut-off concentration of <6ng/ml could identify IDA with a sensitivity and specificity of 88.9% and 90.6% respectively and could distinguish ACD from IDA with both a sensitivity and specificity of 100% at a cut-off of >46ng/ml. Identifying true IDA in mixed aetiology patients could be achieved by RetHe analysis and applying an optimal cut-off of <30pg. Hepcidin, in conjunction with RetHe, offers a new simplified diagnostic pathway for differential diagnosis of IDA and ACD, thereby reducing the diagnostic turnaround time and allowing appropriate treatment of patients with a true iron deficiency.

Anemia in Indian Children and Management

Anemia is defined as hemoglobin level of less than the 5th percentile for age [1]. It is a common condition in children seen in everyday practice. It has to be detected early to prevent complications. Anemia is more common in children below 2 years of age. Most children with mild anemia are asymptomatic. Hence, in many countries where the prevalence of anemia is very high it is common practice to screen for anemia at 1 year of age. Most cases of anemia in our country are caused by nutritional deficiency of iron, and or vitamins. Simple investigations and treatment are adequate to diagnose and manage most of the cases of anemia. Medical practitioners should have a thorough knowledge about the common causes of anemia and their management. Referral to a Pediatric Hematologist is required only in some cases. Before arriving at a conclusion we should compare the blood results with normal values for that age. Anemia in the newborn may be due to blood loss, hemolysis caused by blood group incompatibilities or abnormalities of the cell membranes of the RBCs or its enzymes. During infancy and childhood the commonest cause of Anemia is nutritional, of which iron deficiency is more common. Folic acid and B12 deficiency can also cause anemia. Thalassemia major and severe forms of hereditary spherocytosis cause anemia and jaundice requiring blood transfusion and iron chelation and folic acid therapy. Autoimmune hemolytic anemia is not common in children. In some inherited diseases like Thalassemia Hematopoietic Stem Cell Transplantation offers the best hope for cure.

The Value of Duodenal Biopsies in the Evaluation of Megaloblastic Anemia.

Introduction Megaloblastic anemia is one of the common causes of anemia in India. Duodenal biopsies are routinely performed in the investigation of megaloblastic anemia. The present study was undertaken to analyze the value of duodenal biopsy in megaloblastic anemia and to correlate endoscopic findings with biopsy. As a secondary aim, the study has also analyzed the hematological profile and vitamin B 12 and folate status of these patients. Materials and Methods All the cases of megaloblastic anemia with bone marrow studies diagnosed at PSG Institute of Medical Sciences and Research during the two year period from January 2016 to December 2017 were retrieved. Clinical and laboratory findings (serum vitamin B 12 and folate levels) and endoscopic findings were retrieved from hospital records of the patients. Duodenal biopsies of these patients reported in the histopathology department were retrieved and reviewed. Statistical analysis was done using SPSS software 20.0. Results There were 93 cases of megaloblastic anemia diagnosed on bone marrow biopsies. Tropical sprue was diagnosed in 49.5% of cases, followed by intraepithelial lymphocytosis (17.2%), peptic duodenitis (17.2%), and no significant pathology in 16% of cases. Pancytopenia was present in 54.8% of cases. Isolated vitamin B 12 deficiency including low levels was present in 48.38% and folate deficiency was seen in 4.3% cases; 34.48% cases had both vitamin B 12 and folate deficiency. Conclusion The incidence of tropical sprue in megaloblastic anemia is 49.5% in the study. Duodenal biopsy is valuable in the work up of megaloblastic anemia, irrespective of the endoscopic changes in identifying the etiology.

Evaluation of leukocyte count and its subgroubs in iron-deficiency anemic patients

Background Anemia is a common blood disease in which the hemoglobin concentration is less than the normal hemoglobin concentration for age, sex, physiological condition, and altitude. Iron-deficiency anemia (IDA) is the most common cause of anemia. IDA is one of the most common and prevalent, nutritional health problems in infants and young children across the world. Across the globe 1200 million people are anemic. IDA is the most common disease in the world, affecting negatively both the health and well-being of children according to the WHO report. Objective The aim was to evaluate the effect of IDA in anemic patients on leukocyte count and its subgroups. Patients and methods The study was conducted on 50 patients with IDA, 29 men and 21 women aged from 4 to 14 years selected from the Hematology Outpatient Clinic, Assuit University Children Hospital, during the period from July 1, 2017 to June 30, 2018. All cases and controls were subjected to complete blood count, serum iron, total iron binding capacity, and serum ferritin. Results The results of the study showed positive correlation between serum ferritin with neutrophil and monocyte counts and negative correlation between serum ferritin and lymphocyte count.

Shaping the bone through iron and iron-related proteins

Well-controlled iron levels are indispensable for health. Iron deficiency is the most common cause of anemia, whereas iron overload, either hereditary or secondary due to disorders of ineffective erythropoiesis, causes widespread organ failure. Bone is particularly sensitive to fluctuations in systemic iron levels as both iron deficiency and overload are associated with low bone mineral density and fragility. Recent studies have shown that not only iron itself, but also iron-regulatory proteins that are mutated in hereditary hemochromatosis can control bone mass. This review will summarize the current knowledge on the effects of iron on bone homeostasis and bone cell activities, and on the role of proteins that regulate iron homeostasis, i.e. hemochromatosis proteins and proteins of the bone morphogenetic protein pathway, on bone remodeling. As disorders of iron homeostasis are closely linked to bone fragility, deeper insights into common regulatory mechanisms may provide new opportunities to concurrently treat disorders affecting iron homeostasis and bone.

Real World Outcomes of Ferric Carboxymaltose and Ferumoxytol Iron Replacement Therapy: A Retrospective Analysis of Electronic Health Records

Introduction:Iron deficiency anemia is the most common cause of anemia in the US and it is often observed in patients with chronic diseases and inflammation. Although iron deficiency anemia is often treated with oral iron supplementation, parenteral iron replacement therapy is needed for patients who cannot tolerate or are nonresponsive to oral iron, or who have chronic kidney disease. This study examined the effectiveness of two parenteral iron formulations (ferric carboxymaltose [FCM] and ferumoxytol [FM]) in the real world setting.Methods:A retrospective cohort analysis was conducted using the QuintilesIMS Real-World Data Electronic Medical Records - US database. Adult patients treated with FCM and FM from August 2014 to June 2016 were identified using Current Procedural Terminology (CPT) codes. Index date was defined as the first date FCM or FM was received. Patients who received any parenteral iron therapy six weeks prior to index date were excluded. Baseline hemogloblin [Hgb] level was determined by the latest Hgb value within the 30-day period before and including the index date. Only patients who had lower than normal Hgb (<12 g/dL [female] or <13.5g/dL [male]) at baseline, and Hgb data recorded in the database during the 3 months post-index were included in the analysis. Generalized linear model was used to compare mean change from baseline Hgb value at 3 months between treatments controlling for baseline Hgb level and gender. Logistic regression was used to test for difference in the proportion of patients achieving normal Hgb level between treatment groups controlling for baseline Hgb level and gender.Results:121 FCM patients and 134 FM patients were included in the analysis. Age distributions were similar between FCM (58.7% >65 years) and FM (54.5% >65 years) groups (P =0.499), but there were more female patients in the FCM group (72.7%) than the FM group (54.5%) (P =0.003). The FCM group had fewer patients with chronic kidney disease (24.8% vs. 86.6%, p<0.001) and congestive heart failure (2.48% vs. 8.21%, p=0.045), more patients with cancer (28.1% vs. 9.70%, P <0.001) and similar proportion of patients with inflammatory bowel disease (2.48% vs. 0.75%, P =0.266) compared to FM group. The proportions of patients receiving prescription oral iron therapy in the six months prior to index date (24.0% FCM, 18.7% FM, P =0.300) and follow-up (9.09% FCM, 7.46% FM, P =0.637) were similar between treatment groups. Utilization of FCM and FM was similar, with 28.1% FCM and 27.6% FM patients receiving one dose of index iron injection/infusion, 66.9% FCM and 65.7% FM patients receiving two doses, and 4.96% FCM and 6.72% FM patients receiving 3 doses or more during the 3-month follow-up period (P =0.84). Mean (SD) Hgb at baseline was 9.86 (1.37) g/dL for FCM and 9.67 (1.01) g/dL for FM (P =0.189). At 3 months post-index, more FCM patients (45.5%) than FM patients (14.9%) achieved Hgb normalization (adjusted p<0.001). Mean (SD) change from baseline Hgb was 2.01 (1.73) for FCM, compared to 1.28 (1.48) for FM (adjusted P -value <0.001).Conclusion:This retrospective study of electronic health records provided real world evidence suggesting ferric carboxymaltose may provide better Hgb improvement compared to ferumoxytol in a diverse group of patients with various medical conditions. Future research using a larger sample size that allows for sufficient adjustment of baseline characteristics and potential confounders is needed to confirm current study findings. DisclosuresQian:Daiichi Sankyo, Inc.: Employment. Kwong:Daiichi Sankyo, Inc.: Employment.

Effects of Indigenous Diet Iron Content and Location on Hemoglobin Levels of Ghanaians

ObjectivesIron deficiency is the most common cause of anemia, the most common micronutrient deficiency worldwide. Multiple studies have demonstrated strong links between diet and anemia, but few have explored the impact of specific food groups on hemoglobin (Hb) levels. We analyzed the correlation between Ghanian diet and Hb to explore reduction of anemia prevalence through dietary interventions that align with current local consumption practices. MethodsDemographics, food frequency questionnaires (FFQ), and blood samples were obtained from 140 volunteers (ages 18–65) in five locations across Ghana. Hb was measured and estimated iron consumption was calculated. Anemia prevalence was estimated based on the World Health Organization guidelines. FFQ items were grouped by food type, and a regression equation was formed for Hb based on the estimated amount of calories consumed from each food group. Results47% of total participants were anemic based on Hb levels; 64% of women and 28% of men. This aligned with previous studies which estimate anemia prevalence in Ghana to be around 40%. The area with the highest average Hb was Mole (13.9 g/dL, SD = ±1.9), with the lowest mean in Larabanga (11.9 g/dL ± 1.9). Post-hoc analysis revealed that location was significant with a p-value of 0.01. The regression model revealed a 62.7% adjusted correlation between food groups and Hb levels. Animal foods (β = 0.016, t = 5.08, p < 0.01) and plant protein (β = 0.013, t = 2.86, p < 0.01) were the most influential food groups on Hb levels. ConclusionsIt is of vital importance to emphasize the benefits of consuming animal foods and plant proteins within the Ghanian population. The ease of access to plant proteins, and prevalence within the current diet, makes it likely that this food group will be most influential and have the greatest impact in reduction of anemia in the Ghanaian population if consumption is increased. Funding SourcesWeber State University Research, Scholarship, and Professional Growth Committee.

Rationale and design of the intravenous iron for treatment of anemia before cardiac surgery trial

Background Approximately 20% to 30% of patients awaiting cardiac surgery are anemic. Anemia increases the likelihood of requiring a red cell transfusion and is associated with increased complications, intensive care, and hospital stay following surgery. Iron deficiency is the commonest cause of anemia and preoperative intravenous (IV) iron therapy thus may improve anemia and therefore patient outcome following cardiac surgery. We have initiated the intravenous iron for treatment of anemia before cardiac surgery (ITACS) Trial to test the hypothesis that in patients with anemia awaiting elective cardiac surgery, IV iron will reduce complications, and facilitate recovery after surgery. Methods ITACS is a 1,000 patient, international randomized trial in patients with anemia undergoing elective cardiac surgery. The patients, health care providers, data collectors, and statistician are blinded to whether patients receive IV iron 1,000 mg, or placebo, at 1-26 weeks before their planned date of surgery. The primary endpoint is the number of days alive and at home up to 90 days after surgery. Results To date, ITACS has enrolled 615 patients in 30 hospitals in 9 countries. Patient mean (SD) age is 66 (12) years, 63% are male, with a mean (SD) hemoglobin at baseline of 118 (12) g/L; 40% have evidence (ferritin <100 ng/mL and/or transferrin saturation <25%) suggestive of iron deficiency. Most (59%) patients have undergone coronary artery surgery with or without valve surgery. Conclusions The ITACS Trial will be the largest study yet conducted to ascertain the benefits and risks of IV iron administration in anemic patients awaiting cardiac surgery.