Decrease In Hb Level Research Articles

The role of hepcidin as a biomarker for iron status in patients with chronic kidney disease (stage IV and V) with negative virology

Abstract Background Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Hepcidin, an acute phase reactant protein produced in the liver, is a key regulator of iron homeostasis. Aim of the Work to assess hepcidin level in 45 non-dialysis patients (CKD stage IV and V with negative virology) and its relation to iron parameters. Patients and Methods A cross sectional study was conducted at Nasser Institute for Treatment and Research on 45 patients with chronic kidney disease stage IV and V. All patients included in this study were subjected to the following: Careful history taking, full clinical examination and proper laboratory investigations. Results A statistically significant difference was found between CKD stage 4 and stage 5 according to Hb., iron, TIBC, Frerretin, serum and CRP. Also, there was a significant positive correlation of serum hepcidin with serum ferretin and hsCRP, while Hb and iron were significantly negatively correlated with hepcidin. We found statistically significant decrease in Hb level, serum Iron level, and TIBC in CKD stage 5 less than stage 4. We found statistically significant increase in Hepcidin level, serum ferritin, and hsCRP in CKD stage 5 more than stage 4. We found statistically significant Positive correlation between serum hepcidin with serum ferretin among patients with CKD stage 4 and 5. We found statistically significant Positive correlation between serum hepcidin with hsCRP among patients with CKD stage 4 and 5. We found statistically significant negative correlation between serum hepcidin with Hb among patients with CKD stage 4 and 5. A statistically significant Positive correlation between serum hepcidin with serum Iron among patients with CKD stage 4 and 5. Also we reported a statistically non-significant negative correlation between serum hepcidin and TIBC. Conclusion Elevated hepcidin can predict the need for parenteral iron to overcome hepcidin-mediated iron-restricted erythropoiesis and need for relatively higher rhEPO doses to suppress hepcidin in CKD patients with negative viral markers.

Hubungan KEK dengan Anemia Gravidarum pada Ibu Riwayat BBLR

KEK (Chronic Energy Deficiency) is a condition of the mother suffering from lack of calories and protein (malnutrition) that lasts chronic (chronic) at risk of causing complications in the mother one of which is anemia gravidarum. Anemia in pregnancy is a decrease in Hb levels, so that the carrying capacity of oxygen for the needs of vital organs in the mother and fetus is reduced. The purpose of this study is to determine the relationship of KEK with anemia gravidarum in mothers with low birth weigth history. The correlation analytic research design is a case control study approach, the population is 68 mothers with low birth weight history, using simple random sampling technique, the sample is calculated using Slovin formula, the number of 58 low birth weight history mothers fulfills the inclusion criteria. The research instrument used observation sheets to look at secondary data on cohorts of pregnant women, data analysis using the chi square test obtained a p value of 0, 001 means that p <0.05 indicates the relationship of KEK with anemia gravidarum in women with low birth weight history with a close relationship is sufficient. The value of the Contingency Coefficient in the Chronic Energy Deficiency variable is 0.39, which means that the relationship between KEK and anemia gravidarum is sufficient. The Odds Ratio (OR) value in the Chronic Energy Deficiency variable is 6.9, which means that pregnant women with nutritional status of Chronic Energy Deficiency have a 6.9 times greater risk of anemia during pregnancy than those who are not. Inadequate nutritional needs have a greater risk of anemia during pregnancy and the risk of giving birth to Low Birth Weight Babies. Researchers suggest providing counseling to women of adolescence, women of childbearing age and especially pregnant women so that they can add more information about the importance of nutritional status in pregnant women, the dangers of anemia during pregnancy and also the importance of consuming blood booster tablets during pregnancy. So that it is expected to reduce the incidence of anemia pregnant women case and low birth weight history.

The Prognostic Value of Pre-treatment Hemoglobin (Hb) in Patients With Advanced or Metastatic Gastric Cancer Treated With Immunotherapy.

BackgroundBiomarkers such as prevailing PD-L1 expression and TMB have been proposed as a way of predicting the outcome of immunotherapy in patients with advanced gastric cancer (AGC) and metastatic gastric cancer (MGC). Our study aims to investigate whether there is a link between pretreatment hemoglobin (Hb) levels and survival to immunotherapy in patients with AGC and MGC.MethodsWe retrospectively reviewed patients with AGC or MGC treated at the oncology department of the Chinese PLA general hospital receiving PD-1 inhibitor. The Propensity Score Matching (PSM) (1:1) was performed to balance potential baseline confounding factors. Progression-free survival (PFS) and overall survival (OS) was analyzed among different Hb level (normal Hb group and decreased Hb group). Objective response rate (ORR), disease control rate (DCR) were also analyzed. Univariate analysis and multivariate analysis were performed further to validate the prognostic value of Hb level.ResultsWe included 137 patients with AGC and MGC who received PD-1 inhibitors (including Pembrolizumab, Nivolumab, Sintilimab, Toripalimab) in this study. After PSM matching, there were no significant differences between the two groups for baseline characteristics. Within the matched cohort, the median PFS was 7.8 months in the normal Hb level group and 4.3 months in the decreased Hb group (HR 95% CI 0.5(0.31, 0.81), P=0.004). The OS was 14.4 months with normal Hb level as compared with 8.2 months with decreased Hb level(HR 95% CI 0.59(0.37, 0.94), P=0.024). The ORR was 40.7% and DCR was 83.0% in the normal Hb group, while the ORR was 25.5% and DCR was 85.1% in the decreased Hb group. No significant differences were found in the ORR and DCR between the two groups (P=0.127, P=0.779). Univariate analysis and multivariate analysis showed that Hb level was only independent predictor for PFS and baseline Hb level was significant prognostic factor influencing the OS. Only when patients had normal Hb level, anti-pd-1 monotherapy or combined with chemotherapy was superior to anti-pd-1 plus anti-angiogenic therapy with respect to PFS (10.3 m vs 2.8 m, HR 95% CI 0.37(0.15, 0.95), P=0.031) and OS(15 m vs 5.7 m, HR 95% CI 0.21 (0.08, 0.58), P=0.001).ConclusionsOur study have demonstrated that pretreatment Hb level was an independent prognostic biomarker in term of PFS and OS with immunotherapy for AGC and MGC patients. Correction of anemia for GC patients as immunotherapy would be a strategy to improve the survival. More data was warranted to further influence this finding.

Comparison of Intra-Articular versus Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

Background: Total Knee Arthroplasty (TKA) is widely used in clinical applications. Considerable postoperative blood loss, however, is an unavoidable occurrence due to the extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. Besides, knee flexion and extension activities those begin the day after the operation adds to the problem. Aim of the Work: To compare between the intra-articular and the intravenous application of Tranexamic Acid (TXA) in total knee arthroplasty. Patients and Methods: It is a prospective Double-blinded Randomized controlled trial. This prospective study was conducted at El-Hussein University Hospital & El Agouza Hospital on 30 patients who undergo total knee arthroplasty and fulfill all inclusion and exclusion criteria. Results: The results were the average total blood loss in the drain after 48hrs. In the 1st group was 365±74.722 while average blood loss in the 2nd group was 575±88.976. This indicates a significant decrease in blood loss in the 1st group (intraarticular TXA group) than the 2nd group (intravenous TXA group) the P value <0.001 which is highly significant. It was found that The decrease in Hb level is less in the 1st group than in the 2nd group which indicates less postoperative anemia in the blood count, the P-value <0.05 considered significant.

Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and hemoglobin (Hb) predict immunotherapy outcomes in patients with advanced or metastatic gastric cancer.

e16075 Background: This study aimed to confirm the prognostic role of pretreatment neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), hemoglobin (Hb) levels as effective and convenient biomarkers for patients with advanced or metastatic gastric cancer (AGC or MGC) receiving immunotherapy. Methods: patients with AGC and MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and November 2020 were reviewed. The receiver operating characteristic analyses for predicting 6 months PFS by the NLR, PLR was used to identify an appropriate cut-off value. The study analyzed the association of NLR, PLR, Hb and overall survival (OS) or progression-free survival (PFS) and anti-tumor response rate with immunotherapy respectively. Results: 137 patients were included in the final analysis. 71 patients were administered immunotherapy in the first line and the rest of the patients in the second or further line. 92 patients had received immunotherapy combined with chemotherapy, whereas 45 patients had undertaken immunotherapy monotherapy or with anti-angiogenesis. The best cut-off value for NLR was 3.23 and for PLR was 816.43. NLR <3.23 was associated with longer OS (HR = 0.38, 95% CI, 0.26-0.57, p < 0.001) and PFS (HR = 0.42, 95% CI, 0.29-0.62, p < 0.001) in patients with AGC or MGC. Patients in PLR<816.43 group had prolonged PFS (7.9m vs 4.3m, p<0.001) and OS (11.1m vs9.2m, p<0.001) than in PLR>=816.43 group. The median PFS was 7.8m in the normal Hb level group (Hb>=110g/L) and 4.3m in the decreased Hb group (Hb<110g/L) (HR=0.5, 95% CI 0.31, 0.81, P=0.004). The OS was 14.4m with normal Hb level as compared with 8.2m with decreased Hb level( HR=0.59, 95% CI 0.37, 0.94, P=0.024). No significant difference was observed in objective response rate (ORR) and disease control rate (DCR) in the different NLR, PLR, Hb group, respectively. Univariate and multivariate analysis found that NLR, PLR, Hb were independent prognostic biomarkers for PFS and OS (p<0.05). Conclusions: pre-treatment NLR, PLR, Hb was significantly associated with PFS and OS in patients with AGC and MGC who received immunotherapy. Clinicians need to consider patients with elevated NLR and PLR or decreased Hb level for decisions on immunotherapy strategy.

Anemia management: a historical perspective

The capacity of blood to carry oxygen throughout the body depends on circulating red blood cells (RBCs) and the hemoglobin (Hb) protein they contain. Decreased Hb levels result in anemia, defined in the general adult population as an Hb level of ≤13 g/dl in men and ≤12 g/dl in nonpregnant women.1 Symptoms of anemia include fatigue, dyspnea, and weakness.2

The Effect Of Fe Tablet And Date Palm On Improving Hemoglobin Level Among Pregnant Women In The Third Semester

Anemia is a nutritional problem with a high prevalence in the world. Basic Health Reseacrch in 2018, around 48,9% of pregnant women in Indonesia experience anemia. This shows that anemia in pregnant women is still a public health problem because the proportion is quite high compared to the results of the 2013 Basic Health Research, which amounted to 37,1%. This research aims to identify the effect of Fe tablet and date palm on improving hemoglobin level among pregnant women in the third semester at the Rita Marningsih Clinic 2020. This study was quasy-experiment by using two group pre-test and post-test and used dependent t test with control group. There were 30 respondents and purposive sampling was conducted, and an independent t-test was used to data analyzed.The Result revealed that the experimental group the number of pregnant women whose Hb levels increased by 14 people (93,33%) and which decreased by 1 respondent (6,67%) and in the control group 13 respondents experienced an increase (86,67%) and 2 respondents (13,33%) decreased Hb levels. The bivariate result showed that the p value was 0,044<0,05, which means that there was an effect of giving Fe tablets and dates to the hemoglobin levels of pregnant women. Conclusion and recommendation : Fe tablets and dates affect the increase in hemoglobin levels. For pregnant women it is recommended to consume Fe tablets regularly and maintain the nutrition of their food, one of which adds dates to food consumed.

Angiotensin receptor blockers significantly reduce hemoglobin level in patients with type 2 diabetes mellitus not suffered chronic cardiac failure and chronic kidney disease.

Anemia due to angiotensin receptor blocker (ARB) therapy has been previously reported in patients with diabetes mellitus with glomerular filtration rates of <60 mL min-1/1.73 m2. However, whether Japanese patients with type 2 diabetes mellitus (T2DM) receiving ARB therapy for chronic cardiac failure and chronic kidney disease develop reduced hemoglobin (Hb) levels has not been elucidated. Thus, this cross-sectional study was conducted, and Hb levels were compared between patients with T2DM with and without ARB administration. No significant difference in the prescribed proportion of antidiabetic medicines such as biguanide, sodium glucose co-transporter 2 inhibitors, and α-glucosidase inhibitors was found between the group treated with ARBs and the group without ARBs. Thus, we considered that the effects of antidiabetic medicines on the results were minimum. In this study, the Hb levels of patients who received ARBs (13.8 ± 1.7 g/dL) were significantly lower than those of patients without ARBs (14.9 ± 1.35 g/dL) (p = 0.034). The difference between this study and a previous study relies on eGFR levels. Thus, the eGFR levels of the patients in this study and the previous study were above 60 and below 60 mL min-1/1.73 m2, respectively. Despite those differences, both studies showed that the use of ARBs was associated with a decrease in Hb levels in patients with T2DM. Thus, the evaluation of glycated Hb levels should be focused on whether ARBs are prescribed for patients with T2DM.

Decrease in hemoglobin level predicts increased risk for severe respiratory failure in COVID-19 patients with pneumonia.

BackgroundIn December 2019, the coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, and has since spread throughout the world. This study aimed to investigate the association between the change in laboratory markers during the three days after pneumonia diagnosis and severe respiratory failure in COVID-19 patients.MethodsData of 23 COVID-19 patients with pneumonia, admitted to the Kumamoto City Hospital between February and April 2020 were retrospectively analyzed.ResultsAmong the 23 patients, eight patients received mechanical ventilation (MV) (MV group), and the remaining 15 comprised the non-MV group. The levels of hemoglobin (Hb) and albumin (Alb) decreased in the MV group during the three days after pneumonia diagnosis more than in the non-MV group (median Hb: 1.40 vs. −0.10 g/dL, P = 0.015; median Alb: 0.85 vs. −0.30 g/dL, P = 0.020). Univariate logistic regression analysis showed that the decrease in Hb was associated with receiving MV care (odds ratio: 0.313, 95% confidence interval: 0.100–0.976, P = 0.045). Receiver operating characteristic curve analyses showed that the optimal cut-off value for the decrease in Hb level was −1.25 g/dL, with sensitivity and specificity values of 0.867 and 0.750, respectively.ConclusionsThe decrease in Hb level during the short period after pneumonia diagnosis might be a predictor of worsening pneumonia in COVID-19 patients.

Ex-Vivo FT-4202 Treatment Improves Hemoglobin Oxygen Affinity and Membrane Health in Red Blood Cells of Patients with Hemoglobin SS and Hemoglobin SC Disease Irrespective of Prior Hydroxyurea Use

The two most common genotypes causing sickle cell disease (SCD) are homozygous bsbs producing hemoglobin S (HbSS), and compound heterozygous bsbc producing HbS and HbC (HbSC). HbS polymerizes in both, when deoxygenated. Patients with HbSC have distinct hematologic characteristics such as higher Hb levels but lower fetal hemoglobin (HbF); increased corpuscular Hb concentration, due to pronounced red blood cell (RBC) K+ loss and dehydration, contributes to HbS polymerization. While hydroxyurea (HU) as a HbF-inducing agent clearly improves HbSS phenotype, targeting of other pathogenetic mechanisms in SCD may offer additional benefit in both HbSS and HbSC patients. The RBC metabolism depends on anaerobic glycolysis for ATP production. Key RBC functions are intricately linked to metabolism: hemoglobin-oxygen (Hb-O2) affinity is modulated by 2,3-diphosphoglycerate (2,3-DPG), RBC membrane health depends on adequate synthesis of ATP, and heme-iron is maintained in the functional reduced state by the synthesis of antioxidants, such as GSH, supplying NADH to methemoglobin reductase. Erythrocyte pyruvate kinase (PKR) performs a rate limiting step in RBC glycolysis, converting phosphoenolpyruvate to pyruvate and generating ATP. Insufficient PKR activity due to any of a variety of causes, including excessive energy demand, can alter the abundance of metabolic products and intermediates, including ATP and 2,3-DPG, adversely affecting RBC function. We assessed baseline 2,3-DPG and ATP levels in whole blood of patients with HbSS (N=18) by LC/MS analysis. As well-reported, hemoglobin (Hb) levels were significantly decreased in patients with HbSS compared to healthy volunteers (9.68 ± 0.32 g/dL vs 14.88 ± 0.27 g/dL, p&amp;lt;0.0001). After normalizing to the decreased Hb levels, 2,3-DPG levels were significantly increased (4842.78 ± 182.98 vs 4327.73 ± 126.60 µg/g Hb, p&amp;lt;0.05) and ATP levels were significantly decreased (1621.27 ± 133.02 vs 1995.37 ± 60.80 µg/g Hb, p&amp;lt;0.05) in whole blood specimens of patients with HbSS compared to healthy volunteers. FT-4202 is a potent, selective, and orally bioavailable allosteric activator of PKR which is in Phase 1 clinical trial for the treatment of SCD (NCT03815695). We have previously shown that FT-4202 decreases 2,3-DPG within 24 hr of single dose and increases ATP after 14 days of multiple dosing in healthy volunteers (Blood, 2019, 134, Supplement_1:616). Here, we hypothesized that, by reducing 2,3-DPG and increasing ATP, FT-4202 may improve oxygen affinity and membrane health in both HbSS and HbSC RBCs irrespective of hydroxyurea use and HbF expression. Whole blood samples in K2EDTA were collected from donors with confirmed HbSS or HbSC disease in accordance with an approved IRB protocol in Cincinnati Children's Hospital. % HbF and % F-cells were measured for each sample. Packed RBCs were washed, resuspended to 20% v/v (20% hematocrit), and then incubated for 4 hr at 37oC with 20 μM FT-4202 or equivalent volume of vehicle control DMSO. P50 representing the partial pressure of oxygen at which Hb is 50% saturated with oxygen, was determined using non-linear regression analysis of hemoglobin-oxygen equilibrium curves obtained on a HEMOX Analyzer (TCS Scientific). RBC deformability as a function of oxygen pressure, or Oxygenscan, was measured using Lorrca® (RR Mechatronics) (Rab et al., 2019, Am J Hematol). Point of Sickling (PoS) was calculated as the pO2 at which RBC deformability is decreased by 5% of maximum value during deoxygenation. The P50 and PoS values in FT-4202 versus DMSO-treated HbSC or HbSS RBCs from patients treated with or without HU were analyzed by paired Wilcoxon test. FT-4202 treatment significantly decreased P50 in both HU-treated and not HU-treated HbSS RBCs, as well as in HbSC RBCs, as detailed in Table below showing mean ± se (*p&amp;lt;0.05, **p&amp;lt;0.002, ***p&amp;lt;0.0005 for FT-4202 versus vehicle). The decrease in P50 was significantly higher in not HU- versus HU-treated HbSS RBCs (###p&amp;lt;0.001 by two-way ANOVA) likely due to the increased HbF with baseline decreased P50 in HU-treated RBCs (23.6 ± 2.3 %HbF) versus non-HU treated RBCs (10 ± 1.9 %HbF). PoS was decreased after FT-4202 treatment both in HbSS and HbSC RBCs (p&amp;lt;0.05). These data suggest that increasing flux through the glycolytic pathway by FT-4202 treatment may offer dual beneficial effects of increased Hb-O2 affinity and membrane flexibility in HbSC as well as in HbSS RBCs irrespective of HU use. Figure Disclosures Fulzele: FORMA Therapeutics, Inc: Current Employment, Other: Shareholder of Forma Therapeutics. Guichard:FORMA Therapeutics, Inc: Current Employment, Other: Shareholder of Forma Therapeutics; AstraZeneca: Other: Shareholder. Kalfa:Agios Pharmaceuticals, Inc: Consultancy, Research Funding; Forma Therapeutics, Inc: Research Funding.

EFFECT OF TOPICAL USE OF TRANEXAMIC ACID IN PATIENTS WITH THORACOLUMBAR FRACTURE UNDERGOING POSTERIOR SPINAL FIXATION AND FUSION

Thoracic and lumbar spine trauma (TLST) is frequently associated with chest and abdominal injuries. Multilevel spinal fusions require a longer operative time, with significant soft tissue stripping as well as blood loss, which frequently leads to allogenic blood transfusion. Topical TXA might enhance patient safety, reducing excessive postoperative bleeding. To evaluate effect of topically applied 1 g TXA on postoperative whole blood transfusion and blood loss in neurologically intact patients with thoracolumbar spine fracture. A clinical prospective randomized study is done on 30 patients with thoracolumbar fracture, undergoing primary posterior instrumented fixation and fusion. Patients were randomized to 2 groups, first group (15 patients) was injected with saline only and second group (15 patients) was injected with mixture of tranexamic acid and saline. Patients were operated under general anesthesia, using a standard midline incision. Wounds are closed in layers over a 16 gauge suction drain; injection cocktail was delivered retrograde into the drain which was then closed for 2 hours. There was a highly significant decrease in blood loss in Group 2. The decrease in Hb level is less in the 2nd group than in the 1st group, indicating less postoperative anemia in the blood count (highly significant). Use of topically administered 1 g of TXA (20 mL) in thoracic and lumbar spinal trauma cases undergoing posterior instrumented fixation and fusion effectively decreased postoperative transfusion requirements. Treatment also reduced total drainage volume, time until drain removal, and length of postoperative hospital stay.

Hemoglobin Level Decrease after Open Heart Surgery in a Tertiary Hospital in Indonesia

Background: Open heart surgery is usually performed by connecting the heart to a cardiopulmonary bypass (CPB) machine. The use of the CPB machine may decrease the hemoglobin level and a very low hemoglobin levelcould cause seriouscomplications.This study aimed to explore the decrease in hemoglobin level after open heart surgery. Methods: A cross-sectional retrospective descriptive study was conducted on medical records of patients underwent coronary artery bypass graft (CABG) surgery and heart valve surgery in a tertiary hospital in Indonesia in 2018. The total sampling method was deployed to all medical records of patients underwent CABG surgery (n=25) and patients underwent heart valve surgery (n=3). Results: The decrease in hemoglobin level among young-adult female patients after heart valve surgery was 6.8 g/dl. The average decrease in mid-adult male and female patients after CABG surgery were 6 g/dl and 5.8 g/dl, respectively, and, after the heart valve surgery, the levels were 8.5 g/dl and 5.4 g/dl, respectively. The average decrease in Hb level among late-adult male and female patients after CABG surgery was 6.1 g/dl and 5.4 g/dl, respectively. Conclusion: Hemoglobin level decreases after an open heart surgery. Therefore, observation on the hemoglobin level to prevent complications and to facilitate early treatment is necessary.

Ameliorative effect of Fennel (Foeniculum vulgare) essential oil on chlorpyrifos toxicity in Cyprinus carpio.

Chlorpyrifos (CPF) is an organophosphate pesticide that is frequently and widely used to control both agricultural and domestic pests worldwide. In this study, the protective effect of Fennel (Foeniculum vulgare) essential oil (FEO) was investigated in carp (Cyprinus carpio) exposed to CPF. The fish were divided into six groups that one control group (no treatment) and five experimental groups (FEO (3ml/100g diet) group, CPF1 (0.023 mg/l) group CPF2 (0.046 mg/l) group, CPF1 (0.023 mg/l) plus FEO (3ml/100g diet) group, CPF2 (0.046 mg/l) plus FEO (3ml/100g diet) group). Blood and tissue (liver, kidney, gill, and brain) samples were taken from the fish at the end of 14 days of application. Hemoglobin (Hb) level, nitoblue tetrazolium (NBT) activity, and total immunoglobulin (TI) level were measured in blood samples of fish. Acetylcholinesterase (AChE) activity was determined in brain tissue while malondialdehyde (MDA) level, reduced glutathione (GSH) level, catalase (CAT), and glutathione peroxidase (GPx) activity were determined in liver, kidney, and gill tissues. The results showed that there was a significant decrease in Hb level, NBT activity, and TI levels in CPF-treated fish compared to the control group. In addition, increased in MDA levels and significant decreases in GSH level, AChE, CAT, and GPx activities were observed in CPF-treated groups. However, FEO-treated was showed a significant improvement in all parameters except AChE activity compared to CPF groups. These study findings showed that FEO could improve CPF-induced toxicity in C. carpio, except inhibition of AChE activity.

Use of bone wax reduces blood loss and transfusion rates after total knee arthroplasty

BackgroundUnnecessary costs and complications can be reduced by minimizing blood loss and allogeneic blood transfusion in cases of total knee arthroplasty (TKA). This study evaluated the effectiveness of bone wax in reducing blood loss and transfusion rates after TKA. MethodsA total of 674 consecutive TKAs performed for degenerative osteoarthritis were retrospectively reviewed. Propensity score-matching and inverse probability of treatment weighting analyses were performed for demographics, comorbidities, use of medications, preoperative laboratory findings and radiologic prosthetic coverage of osteotomy surface. In the bone wax group, bone wax (2.5 g) was applied to the uncovered bone section around the prostheses along with the topical administration of tranexamic acid, whereas hemostasis was achieved in the control group with the topical administration of tranexamic acid. Intergroup comparisons of estimated blood loss, decreases in hemoglobin (Hb) levels, and transfusion rates were performed. ResultsThe mean estimated blood loss and volume of postoperative drainage were reduced in the bone wax group. The maximum decreases in Hb levels on postoperative days 1, 3, 5, and 7 were 1.8 ± 0.7 ml, 2.5 ± 0.8 ml, 2.7 ± 0.8 ml, and 2.8 ± 0.8 ml in the bone wax group and 2.1 ± 1.0 ml, 3.0 ± 1.2 ml, 3.1 ± 1.1 ml, and 3.2 ± 1.1 ml in the control group, respectively. The postoperative transfusion rates decreased markedly from 8.8% to 2.0% when bone wax was used. ConclusionsThe use of bone wax significantly reduced blood loss, decreased Hb levels, and the risk of transfusion.Level of evidence: Level III, Therapeutic studies.

Correlation Between Hemoglobin Levels and the Prognosis of First-Line Chemotherapy in Patients with Advanced Gastric Cancer.

BackgroundThis retrospective study evaluated the prognostic significance of hemoglobin (Hb) levels in patients (pts) with unresectable locally advanced or metastatic gastric cancer who have not previously received chemotherapy.Patients and MethodsWe screened 249 pts with advanced gastric cancer, who were categorized into four groups, namely, non-anemia (normal Hb levels), mild (10 g/dl to normal), moderate (8–10 g/dl), and severe anemia groups (<8 g/dl), to study the prognostic significance of Hb levels. We also examined the correlation between changes in Hb levels and treatment effects via imaging during the treatment course.ResultsThe objective response rate (ORR) was 47.4% for pts with anemia versus 43.4% for pts without anemia (P=0.536). Hemoglobin levels were reduced by 0.51 ± 1.86 and 1.93 ± 1.33 g/dl after chemotherapy versus before chemotherapy in the disease control group and progressive groups, respectively (P=0.002). The median progression-free survival (mPFS) of first-line chemotherapy in all pts was 6.3 months. Specifically, the mPFS was 5.7 months in pts with severe anemia, compared with 6.4 months for pts with non-severe anemia (Hb≥8g/dl). The median overall survival (mOS) of all pts was 14.0 months. In particular, the mOS was 15.0 months for pts with non-anemia and mild anemia (Hb≥10g/dl) versus 11.5 months for pts with moderate or severe anemia. In multivariate analysis, ascites and decreased Hb post-chemotherapy were identified as independent prognostic indicators for PFS and OS.ConclusionOur findings indicate that Hb levels are associated with the prognosis in the first-line chemotherapy for pts with advanced gastric cancer. Pts with progressive disease experience a larger decrease in Hb levels, and those with baseline Hb levels ≥10 g/dl experience longer OS.

Dynamic changes in full blood count (FBC) occurring in patients treated with immune checkpoint inhibitors (ICIs) to predict responses in patients with metastatic renal cell carcinoma (mRCC).

e17110 Background: ICI transformed the treatment of 1L mRCC, yet early clinical predictors of response are still unknown. Methods: Retrospective database analysis from Barts Cancer Institute, London was carried out. Patients with treatment naïve mRCC were identified and grouped according to their 1L treatment: 1: VEGF inhibitor 2: IO/IO 3: IO/VEGF Data on hemoglobin, neutrophil-to-lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) at baseline, 6weeks and 12weeks after treatment initiation was correlated with outcome. Results: Between Jan 2014 - Dec 2019; 28, 29 and 21 patients received 1L VEGF, IO/IO or IO/VEGF respectively. Patient receiving 1L VEGF inhibitors showed a decrease in Hb levels both in responding and non-responding groups (significant group effect: F(1,6) = 6.6, p = 0.04); significant time effect:F(2,12) = 12.4, p = 0.001). Group x time interaction was not significant. NLR levels decreased both in responding and non-responding groups over time (significant time effect: F(2,12) = 16.7, p = 0.001. PLR levels in non-responders increased over time, whereas in responding group, PLR levels steadily decreased over 6 and 12 weeks (significant time effect: F(2,12) = 0.3, 0.044). Patients receiving IO/IO combination therapy; within the non-responder group, Hb levels didn’t change significantly whereas in the responding group Hb levels increased significantly and overtook Hb levels of non-responding group (P = 0.001). NLR levels significantly decreased in the responding group (0.041) and a similar trend was observed at 12 weeks with a decrease in PLR among non-responders, with a significant group affect (F(1,5) = 0.18, 0.035). In patient treated with 1L IO/VEGF, among non-responders Hb levels increased slightly, only to return to baseline levels again at 12 weeks after treatment initiation. Whereas, Hb levels in the responding group increased significantly in both 6weeks and 12weeks after starting therapy. Significant time effect:F(2,20) = 3.65, p = 0.044. NLR levels in the responding group presented a steady decrease over time with a significant group and time effect. Both responders and non-responders experienced an increase in PLR over time. However, while PLR decreased at 12 weeks among responders, it continued to increase among non responders (significant time effect: F(2,20) = 0.3, 0.03), (significant group effect: F(1,10) = 0.05, 0.005) and significant interaction: F(2,20) = 0.1, 0.01) Conclusions: Close monitoring of FBC changes may predict response to ICI.

Thalidomide for Patients with β-Thalassemia: A Multicenter Experience.

ObjectiveThis study focused on the efficacy and safety of thalidomide for patients with β-thalassemia in a multicenter trial.MethodsPatients with non-transfusion-dependent thalassemia (NTDT) or transfusion-dependent thalassemia (TDT), who were unable to pursue conventional therapy with transfusion and chelation, were recruited over 3 years in three centers in southern China. We evaluated the efficacy and safety of thalidomide in the short-term (three months) and long-term follow-up (12 and 24 months). Response to thalidomide was defined as follows: Main Responder (MaR) showing an increase in hemoglobin (Hb) level of >2.0 g/dl or free from blood transfusion and Minor Responder (MiR) achieving elevated Hb level of 1.0–2.0 g/dl or ≥50% reduction in blood transfusion frequency.ResultsThe overall response rate (ORR) was 93.5%, with MaR and MiR rates accounting for 62.9% and 30.6% in short-term follow-up. For patients with NTDT, the Hb level increased from a baseline mean of 6.8±1.1 g/dl to 9.7±1.9 g/dl (P<0.001). Elevated Hb was mainly attributable to increased fetal hemoglobin (HbF) levels. Among patients with TDT, while an increase in the average Hb concentration was observed, there was a significant drop in yearly transfusions from 20.7±7.7 to 5.8±6.8 blood units per year (P<0.001). The response of patients in both categories was sustained even after an average follow up of 14.6±9.6 months (3–37 months). Minimal side-effects were documented throughout, except peripheral neurotoxicity in one patient. Logistic regression analysis identified the ratio of HbF at baseline (P=0.038, OR=1.111, 95% CI: 1.006–1.226) as an independent risk factor for the primary response to thalidomide.ConclusionThalidomide had significant therapeutic effects on patients with β-thalassemia with a sustained response. Peripheral neuropathy is one of the most feared complications. While these preliminary results support the potential long-term efficacy of thalidomide as a therapeutic agent for β-thalassemia, several issues need to be addressed before its application in the clinic.

Effect of ART 2 treatment on biochemical profile during treatment of second line ART

Background: AIDS was the first recognized in U.S in summer of 1981 at centers for disease control and prevention reported the unexplained occurrence of pneumocystis jiroveci in previously healthy homosexual men in Los Angeles and Kaposi. First time in 1983 HIV syndrome was isolated from a patient of lymphadenopathy. Person with positive HIV serology who have ever had a CD4 lymphocyte count below 200celles/mcl and CD4 lymphocyte percentage below 14% are considered to have AIDS (CMDT 2017).Methods: This study was continuous longitudinal, prospective and retrospective, observational, at ART plus Centre, Kanpur K.P.S. institute of medicine (G.S.V.M. medical college) included the all patients on ART1 attending in Centre were screened for treatment failure based on clinical, immunological and virological criteria’s as decided by SACEP from 2016 to 2018.Results: Total numbers of patients are 118 among them 71 female and 47 males, age groups between 30-40 there are 54 patients. In study treatment with ART patients Hb levels more than 10%, Mean value before 10.85±1.31 and mean value after treatment was 10.5±1.31, TLC before 6970.94±6309.93 after treatment 6800.25±2522.99, Serum Bilirubin before and after treatment 0.69±0.49 and 0.95±1.13. Mean value of before and after treatment serum creatinin1.80±11.34 and 0.88±0.38.Conclusions: There is increased in serum creatinine and SGPT /SGOT and decrease in Hb levels in treatment of second line ART treatment so it should be monitored every monthly interval.

Genetic Regulation of Redox Balance in β-Thalassemia Trait

β-Thalassemia (β-thal) trait is a heterogeneous group of genetic defects leading to decreased β-globin production, ineffective erythropoiesis, and oxidative stress. The aim is to evaluate the cytoprotective response, at transcriptional and systemic levels, of the variations of global redox balance in β-thal trait patients. Sixty-six subjects (40 healthy and 26 with β-thal trait) were analyzed at the Universidad Nacional de Tucumán, Tucumán, Argentina, between 2016 and 2017. The following parameters were evaluated: complete blood count, iron status, hemoglobin (Hb) electrophoresis, Hb A2, thiobarbituric acid reactive species (TBARS), serum catalase (CAT), and superoxide dismutase (SOD) activity, FOXO3a, NRF2, SOD, PRDX2, CAT, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) gene expression. The β-thal trait group showed a decrease in Hb levels, MCV, and MCH with higher TBARS levels. The SOD activity was significantly increased by 32.0% in β-thal trait patients respect to the control group. Relative expression of NRF2 was 4.7-fold higher in β-thal trait than in the control group, while FOXO3a expression was similar in both groups. The SOD, PRDX2, and proinflammatory cytokines transcriptional expression was significantly upregulated in β-thal trait patients. This is the first study on the genetic regulation of redox balance in β-thal trait patients in which interesting modifications were observed in the transcript levels of some redox regulators that could be associated with changes in the erythrocyte proteome in this disorder. A better understanding of the pathophysiological mechanisms present in these heterozygous patients would allow adequate therapy in situations such as growth, pregnancy, or high performance sports, favoring a personalized treatment.

Impact of Routine Laboratory Parameters in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: A Long-Term Follow-Up

Objectives: Patients’ oncological outcome after radical cystectomy (RC) due to urothelial carcinoma of the urinary bladder (UCB) is always up for debate. There is accumulating evidence on the influence of routine blood parameters. We aimed to identify reasonable and easy-to-detect biomarkers, such as preoperative C-reactive protein (CRP) and hemoglobin (Hb) levels, as predictors of overall survival (OS) and cancer-specific survival (CSS) in patients undergoing RC for UCB. Materials and Methods: This is a large single-center study in which both preoperative CRP and Hb levels were available in 1,043 patients undergoing RC for UCB from 2004 to 2018 with a median follow-up time of 22 months (mean 38, max. 170). We used the Kaplan-Meier method, log-rank test, and Cox regression models for assessment of OS and CSS. Using our data, we validated an existing outcome prediction score (TNR-C). Results: Median CRP level was 0.5 mg/dL (IQR 0.2–1.4), and median Hb level was 13.4 g/dL (IQR 11.9–14.7). We found that patients with CRP values above the median reached a significantly lower median survival than those with CRP values below the median (23 vs. 83 months, p < 0.001). The TNR-C score was successfully validated, and we discriminated between 3 risk groups (5-year CSS: 76, 40, and 16% for low, intermediate, and high risk, respectively). We observed a similar outcome for patients with a Hb level below the median: CSS was significantly poorer than with Hb levels above the median (median CSS 27 vs. 91 months, p < 0.001). Multivariant analysis showed CRP and Hb levels to be independent prognostic parameters for CSS and OS. Conclusions: We found elevated preoperative CRP levels and decreased Hb levels to be independent prognostic factors indicating an unfavorable outcome in patients undergoing RC for UCB and were able to validate the TNR-C score in a large patient cohort. We propose using these routine biomarkers for individual risk stratification and optimization of therapeutic strategies in patients undergoing RC for UCB.