Decrease In Hgb Research Articles

Exposure-Response Analysis of Tofacitinib in Active Psoriatic Arthritis: Results from Two Phase 3 Studies.

Tofacitinib is an oral Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA). These post hoc exposure-response (E-R) analyses of pooled data from two Phase 3 studies (NCT01877668 and NCT01882439) characterized the relationships between tofacitinib exposure and efficacy (American College of Rheumatology [ACR] criteria), and changes in hemoglobin (Hgb) in patients with PsA. Efficacy data for the proportion of patients receiving tofacitinib 5 or 10 mg twice daily, or placebo, achieving ACR ≥20%, ≥50%, or ≥70% response criteria (ACR20, ACR50, and ACR70, respectively) at Month 3, were modeled jointly using a four-category ordered categorical exposure-response model (ACR20 non-responder, ACR20 responder but not ACR50 responder, ACR50 responder but not ACR70 responder, and ACR70 responder). A maximum drug effect (Emax) model (using average concentrations of tofacitinib at steady state [Cavg]) adequately described the exposure-ACR response rate relationship. Model-predicted response rates for tofacitinib 5 and 10 mg twice daily were 51% and 58%, respectively, for ACR20; 29% and 36% for ACR50; and 15% and 20% for ACR70. The E-R relationship between tofacitinib exposure and changes in Hgb was assessed using an indirect response model, which generally predicted Hgb concentration-time profiles across treatments well. The proportions of patients experiencing a decrease in Hgb of >2 g/dL were similar with tofacitinib 5 mg twice daily or placebo. These results were generally consistent with previous analyses in rheumatoid arthritis and psoriasis, and support the use of tofacitinib 5 mg twice daily for active PsA.

Tranexamic Acid Led to Improved Safety of Total Knee Arthroplasty in Jehovah’s Witness Patients: A Multicentered Matched Study

BackgroundThis study aimed to evaluate the safety of total knee arthroplasty (TKA) in Jehovah’s Witness patients compared to non-Jehovah’s Witness patients using standard perioperative TKA protocols and assess the role of tranexamic acid (TXA) in managing blood loss in this population. MethodsPatients undergoing TKA between 2011 and 2021 at 2 tertiary academic centers were retrospectively reviewed. Patient demographics, preoperative and postoperative hematologic laboratory values, intraoperative TXA use, 90-day postoperative complications, and subsequent revisions were collected. These variables were then compared between propensity score–matched cohorts at a 2:1 ratio of those who did not identify as Jehovah’s Witness to those who did. Regression analysis was used to determine the effect of intraoperative TXA on hemoglobin (hgb) shift. ResultsAfter applying exclusion criteria and matching, the TKA outcomes of 316 non-Jehovah’s Witness patients and 152 Jehovah’s Witness patients were analyzed. Univariate analysis suggested that non-Jehovah’s Witness patients and Jehovah’s Witness patients had similar preoperative and postoperative hgb, hgb shift, and hematocrit. Only 1 (0.8%) Jehovah’s Witness patient reached an hgb < 8.0 mg/dL postoperatively. Multivariate logistic regression suggested that Jehovah’s Witness patients did not have increased odds of reaching an hgb < 8.0 mg/dL (odds ratio = 0.99 [0.96, 1.02]; P = 0.42). Multivariate linear regression suggested that intraoperative TXA was positively correlated with hgb shift and thus a smaller decrease in hgb from pre-TKA to post-TKA (β = 0.38 [0.06, 0.69]; P = 0.02). Additionally, Jehovah’s Witness patients had excellent revision-free (95% [91, 99]) and infection-free (98% [95, 100]) survival at 8 years. ConclusionsStandard perioperative TKA protocols are safe for Jehovah’s Witness patients who do not have the need for transfusion, especially with appropriate preoperative hgb levels and the use of intraoperative TXA. Furthermore, these patients have excellent survivorship at 5 and 8 years of follow-up. Level of EvidenceLevel III.

Compliance with Iron Supplementation Consumption in Pregnant Women on Hematological Profiles and Ret-He

Fetal growth will increase the mass of maternal and fetal erythrocytes resulting in an increase in iron requirements, causing a decrease in maternal iron stores.A decrease in iron in the body will disrupt the formation of hemoglobin, because one of the components that forms it is heme which contains iron. the aim of our research is to study the compliance of pregnant women in consuming iron supplements regarding hematological features and body iron reserves through the Ret-He examination. This research is a cross-sectional study in 30 pregnant women for complete blood count (CBC), Ret-He and estradiol. There were differences in the concentrations of Hgb and MCHC (P-value &lt; 0.05) and there were no differences in the concentrations of Hct, RBC, MCV, MCH, RDW, Ret-He and estradiol (P-value &gt; 0.05). It was found that there was a relationship between estradiol and Hgb (P-value = 0.047; r = 0.366). Pregnant women who do not comply with taking iron supplements experience a decrease in Hgb and MCHC. The decrease in Hgb levels is strongly correlated with E2 levels in pregnant women who adhere and do not comply with iron supplementation.

Splenic Sequestration in Febrile Pediatric Sickle Cell Disease Patients

Introduction: Acute splenic sequestration is a rare complication of pediatric sickle cell disease (SCD). Acute splenic sequestration crisis (ASSC) is characterized by an acute decrease in hemoglobin and is associated with an increased risk for hypovolemic shock, often requiring blood transfusion during acute episodes and splenectomy to prevent recurrent episodes. Recent studies have also shown that chronic splenomegaly and resultant anemia (described as chronic or subacute sequestration) with potential benefit of splenectomy. However, non-life-threatening splenic sequestration in febrile, hospitalized children with SCD is a frequent occurrence that has not been well-described in current literature. Aim: To estimate the change in WBC, Hemoglobin, platelet count from inpatient and outpatient baseline to lowest recorded value (LRV) for each febrile hospitalization in sickle-cell disease patients while controlling for hydroxyurea use and patient age. Methods: A retrospective chart review was performed on febrile, hospitalized children with a diagnosis of SCD who presented to a tertiary care hospital from 2018-2021. Data including the magnitude of fever, presence of splenomegaly and trends in laboratory parameters such as complete blood count, and chemistries were recorded. Demographics, hydroxyurea use, transfusions and sickle cell phenotype were also recorded. For our primary outcome we estimated the change in Hgb, platelets, and WBC count from inpatient (first day of hospitalization) and outpatient (most recent outpatient values) baselines to the lowest recorded value (LRV) for each hospital encounter. We employed mixed models to account for within-subject correlation and adjusted for hydroxyurea use and categorized patient age. The beta coefficient and corresponding 95% confidence interval (CI) were reported for the model intercept and predictors. Results: Sixty-six unique patients (ages 0-17) accounted for a total of 117 hospital encounters. There was a statistically significant drop in WBC per microliter (-5.40, 95% CI: -6.89 - [-3.91]) , Hgb g/dL (-0.95, 95% CI : -1.25 - [-0.66]), and platelets per microliter (-60.95, 95% CI : -83.18 - [-38.71]) from the inpatient baseline to the LRV. There was a statistically significant drop in estimated Hgb g/dL (-1.83, 95% CI : -2.23 - [-1.42]) and platelets per microliter (-130.50, CI: -169.59 - [-91.41]) from outpatient baseline to the LRV. Hospital encounters with hydroxyurea had a significantly greater drop in estimated platelets per microliter from inpatient baseline to LRV (-54.43 CI : -93.64 - [-15.22]) but significantly greater increase in estimated Hgb g/dL from inpatient baseline to the LRV (1.11 CI : 0.45 - 1.78) compared to hospital encounters without hydroxyurea. Hospital encounters over the age of 8 were associated with a significantly greater decrease in HGB g/dL (-0.59 CI : -1.04 - [-0.14]) from inpatient baseline to the LRV compared to hospital encounters under the age of 8. Conclusion: Our study demonstrated features consistent with acute, non-life-threatening splenic sequestration in febrile pediatric SCD patients, as evidenced by a statistically significant drop in platelets, Hgb, and WBC count from the inpatient baseline. The largest acute drop was observed in platelets, which presents the strongest argument for sequestration, as drops in Hgb may be explained by rehydration or hyperhemolysis, and changes in WBC count may be related to infection. Hydroxyurea use may delay auto-infarction of the spleen, thus predisposing to splenic sequestration at an age later than classically associated with sequestration. The preservation of splenic function probably explains greater decrease in platelet count for patients on hydroxyurea. Our study has treatment implications: children with SCD experiencing non-life-threatening acute splenic sequestration recover spontaneously without the need for blood transfusion in many cases, thus avoiding long-term complications such as RBC alloimmunization or iron overload. Also, as the drop in WBC, hemoglobin, and platelets are not due to myelosuppression, they should not lead to modification of hydroxyurea therapy. Splenectomy should be reserved for the most severe and life-threatening episodes of sequestration. Further research may assist in correlating sickle cell phenotype and history of blood transfusion with the magnitude of sequestration in this population.

Ameliorative effect of resveratrol against cymoxanil-mancozeb induced toxicity in rats.

This study was conducted to evaluate the cymoxanil-mancozeb (CM) toxicity and investigate the ameliorative effect of resveratrol (Res) against cymoxanil-mancozeb toxicity. Forty rats were divided into four groups; the first group was used as a control group, the second group was exposed to Res only at a dose of 20 mg/kg body weight for 4 weeks, and the third group was administered CM only at a dose of 799 mg/kg body weight for 4 weeks, The fourth group was co-treated with Res+CM for 4 weeks. Blood samples were analyzed for hematological and biochemical parameters. The comet assay was done on liver and blood specimens and histopathological examinations of the liver and intestine. The results demonstrated that CM exposure caused a significant increase in WBCs, lymphocytes, granulocytes, monocytes ALT, AST, ALP, and GGT, and total cholesterol and triglycerides levels accompanied by a decrease in HGB, HCT, RBCs and MCV, MCH, MCHC, HDL and glucose levels with no significant DNA damage in liver and blood. CM mixture induced severe pathological changes in small intestine and liver. Co-treatment of Res with CM improved hematological picture, lipid and glucose profiles also liver enzymes and decreased changes in the architecture of the liver and intestine.

Perioperative Outcomes of Patients Treated in an Anemia Clinic before Spine Surgery

BACKGROUND: Patients with preoperative anemia are at increased risk of postoperative blood transfusion, as well as other adverse outcomes, including infection, prolonged length of stay (LOS), and death. Requirement of intraoperative transfusions may be an independent risk factor for mortality among patients undergoing noncardiac surgery. As such, efforts have emerged internationally to establish clinical decision support tools, dedicated preoperative anemia clinics, and clinical trials studying the effects of preoperative treatment of patients to improve outcomes after surgery. While studies to date have shown mixed results, some suggest that treatment with intravenous (IV) iron improves anemia and decreases transfusion requirements. Treatment with erythropoietin-stimulating agents (ESA) has also been associated with fewer transfusions in patients undergoing orthopedic surgery. METHODS: We established a preoperative clinic in 2019 with a pilot for patients undergoing spine surgery. Patients who were found to have a hemoglobin (Hgb) < 13.0 g/dL on preadmission testing were automatically referred, and when possible, had iron studies reflexively added on to their samples. Patients were offered an appointment with a nurse practitioner or physician in Hematology and treated with IV iron or a combination of IV iron and ESA at the discretion of the provider. Importantly, if time did not allow for a visit or the patient declined an appointment or preoperative treatment, surgeries were not cancelled or delayed. This retrospective study included patients undergoing elective spine surgeries between August 1, 2019 and June 1, 2021 at Thomas Jefferson University Hospital and Jefferson Hospital for Neuroscience. Patients were eligible if they were automatically referred to the preoperative anemia clinic based on preadmission testing results. The primary outcome was postoperative allogeneic red blood cell (RBC) transfusion during the index admission. Secondary outcomes included decrease in Hgb postoperatively, LOS, and 30-day readmission rate. RESULTS: The study included 108 patients (53.7% female) who underwent a total of 112 distinct elective spine surgeries. The median age at the time of surgery was 65 years. The most common surgery was decompression and fusion (73.2%), followed by decompression (17.0%) and fusion (9.8%). 16.1% of surgeries were revisions of a prior surgery. The median preoperative Hgb was 11.6 g/dL. Prior to the 112 surgeries, 45 (40.2%) patients were seen by a Hematology provider and 37 (33.0%) received preoperative treatment for anemia, including 28 (25.0%) who got IV iron plus ESA, 8 (7.1%) IV iron alone, and 1 (0.9%) ESA alone. The final treatment was given a median of 5 days before surgery (IQR 3-9.5 days). There was a nonsignificant trend toward lower mean preoperative Hgb in patients who were treated before surgery and those who were not (mean 11.2 vs 11.6 g/dL, p=.162) and greater mean estimated blood loss during surgery when reported (392 vs 315 mL, p=.462). Compared to untreated patients, those who were treated before surgery were significantly more likely to be iron deficient (ferritin < 30 ng/mL or iron saturation < 15%) (45.9% vs 26.7%, p=.041). The primary outcome of allogeneic RBC transfusion occurred in 18.9% of patients who received pre-treatment and 9.3% of those who did not (p=.149). The degree of initial Hgb drop postoperatively from last pre-op value was significantly lesser in pre-treated patients (-0.93 vs -1.56 g/dL, p=.015), and a nonsignificant improvement was observed in the change from baseline to nadir Hgb during the index admission (-1.54 vs -2.15 g/dL, p=.074). A trend toward shorter LOS was observed in pre-treated patients (3.30 vs 3.47 days, p=.739), though that group also experienced more 30-day inpatient readmissions (18.9 vs 12.0%, p=.325). No deaths were observed during the study period. CONCLUSION: In this preoperative anemia clinic pilot, treatment with IV iron and/or ESA before major spine surgery was not associated with a reduction in allogeneic RBC transfusions or hospital readmission. However, those who received pre-treatment had significantly lesser declines in Hgb after surgery and a trend toward shorter LOS. Patients who received treatment were significantly more likely to be iron deficient before surgery and had lower mean Hgb levels, which confounds the results. Larger prospective studies of preoperative anemia therapy are needed. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

THE PROTECTIVE ROLE OF N-ACETYL CYSTEINE (NAC) ON BROILERS EXPOSED TO CHRONIC HEAT STRESS

In hot areas, heat stress (HS) is one of the most prominent stressors in the broiler industry. To provide comprehensive information about the effect of N-acetyl cysteine (NAC) on hamartiology, biochemistry, and thyroid hormones in broilers under thermoneutral (TN) (22 4 ° C) and heat stress (HS) (34 2 ° C), The current study was carried out. A total of 80 one-day-old Cobb broiler chicks were used, with 20 birds in each group receiving either a control (basal diet) or a NAC (100 mg/Kg diet). Chronic HS at 42 days resulted in a considerable decrease in HGB, PCV, RBCs, total protein, Albumin, serum T3 and T4, while greatly increasing H/L, triglycerides, cholesterol, LDL-cholesterol, uric acid, AST, ALT, ALP, TBIL, DBIL, and creatinine. When compared to HSC broilers at 42 d old, NAC supplementation greatly increased PCV content with a substantial decrease in total leukocytic count, heterophils, and H/L ratio with an increase in lymphocytes and monocytes. When compared to HSC population, chickens given NAC had a significant decrease in serum AST, ALP, ALT and triglyceride levels, as well as a significant increase in serum T3 concentration.

THE PROTECTIVE ROLE OF TURMERIC (CURCUMA LONGA) ON BROILERS EXPOSED TO CHRONIC HEAT STRESS

Heat stress (HS) is one of the most significant stressors in the broiler industry in hot regions. In order to provide complete information on the impact of turmeric powder (TP) on hamartiology, biochemistry and thyroid hormones of broilers under thermoneutral conditions (TN) (22 ± 4 °C) and heat stress (HS) (34 ± 2° C), the present research was carried out. A 60 of one-day-old (Cobb) broiler chicks, 15 birds in each replicate either control (basal diet) or 0.5% turmeric. Chronic HS at 42 d of age resulted in significant decrease in HGB, PCV, RBCs, total protein, Albumin, serum T3 and T4, whereas increased H/L, triglycerides, cholesterol, LDL-cholesterol, uric acid, AST, ALT, ALP, TBIL, DBIL and creatinine significantly. Supplementation of 0.5% TP significantly increased HGB, PCV, total protein, while significant decrease in AST, ALT, ALP, uric acid, total cholesterol and triglycerides. Results indicated that groups receiving turmeric have improved lipid profile.

INTRAARTICULAR EPSILON AMINOCAPROIC ACID VERSUS TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY.

ABSTRACTObjective: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). Methods: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. Results: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. Conclusions: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

P722 Upadacitinib was not associated with anaemia in patients with moderately to severely active ulcerative colitis: Results from the U-ACHIEVE study

Abstract Background Anaemia is a frequent complication in patients with Crohn’s disease and ulcerative colitis (UC), and patients who respond to treatment generally show improvement in anaemia. Decrease in haemoglobin (Hgb) levels and anaemia may be associated with Janus kinase (JAK) inhibitors. Upadacitinib (UPA), an oral JAK1 selective inhibitor, has demonstrated favourable dose-dependent efficacy in patients with moderately to severely active UC.1 This analysis of data from the U-ACHIEVE study addressed effects of UPA treatment on Hgb levels in patients with UC. Methods U-ACHIEVE (NCT02819635) was a randomised, double-blind, placebo (PBO)-controlled phase 2b clinical trial. Adults with moderately to severely active UC were randomised to receive 7.5, 15, 30, or 45 mg UPA or PBO once daily (QD) for 8 weeks. Hgb levels were measured for all groups at baseline (BL) and weeks 2, 4, 6, and 8. Mean change from BL was calculated for each group. p-values for comparison between UPA and PBO groups were calculated using one-way ANOVA; no multiplicity adjustment was applied. Percentage of patients with Hgb values grade 2 (15–20 g/l Hgb decrease from BL), grade 3 (&amp;lt;80 g/l Hgb level or 21–29 g/l Hgb decrease from BL), and grade 4 (&amp;lt;70 g/l Hgb level or &amp;gt;29 g/l Hgb decrease BL) anaemia were determined for all treatment groups using the Common Terminology Criteria for Adverse Events version 5. Adverse events (AE) were reported by investigators. Results Included in the analysis were 250 patients (mean age ± SD, 42.3 ± 14.2 years; disease duration, 8.2 ± 2.5 years). At BL, most treatment groups had similar mean Hgb levels, except for the 15 mg UPA group, which had significantly lower Hgb levels vs. PBO group (Table). Increased or stable mean levels of Hgb at week 8 vs. BL were observed in most UPA treatment groups. The PBO group had the greatest decrease in Hgb vs. BL at week 8 compared with UPA treatment groups (Figure). Grade ≥2 anaemia was reported in 17.4% of patients receiving PBO and 14.4% of all patients receiving UPA (14.9%, 12.2%, 12.0%, and 17.9% of patients receiving 7.5, 15, 30, and 45 mg UPA, respectively). Grade ≥3 anaemia was reported in 8.7% of patients receiving PBO and 5% of all patients receiving UPA (6.4%, 6.1%, 6.0%, and 1.8% of patients receiving 7.5, 15, 30, and 45 mg UPA, respectively). One subject receiving 7.5 mg QD UPA had grade 4 anaemia. AE of anaemia was reported in 6.5% of patients receiving PBO and in 2.1%, 8.2%, and 3.8% of patients receiving 7.5, 15, and 30 mg UPA, respectively, but not in the 45 mg UPA group. Conclusion Decreased Hgb levels over time were observed more frequently in the PBO group. The maintenance of Hgb levels in patients receiving UPA was likely because of improvement of underlying UC. Reference

Comparison of the Effects of Intravenous and Oral Tranexamic Acid on Perioperative Hemoglobin Levels During Total Knee Arthroplasty.

Background: Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce perioperative blood loss in patients undergoing total knee arthroplasty (TKA), but there are limited data regarding the efficacy of intravenous (IV) in comparison to oral (PO) TXA. Objective: The purpose of this research was to compare the effects of IV and PO TXA on perioperative hemoglobin (Hgb) levels in patients who have undergone TKA. Methods: In this single-center, retrospective chart review, patients at least 18 years of age who received IV or PO TXA following medical center protocol from 1 of 3 orthopedic surgeons were included. The primary outcome was the change in Hgb within 24 hours following TKA. Secondary outcomes included comparisons of postsurgical complications and hospital length of stay. Results: The IV TXA group contained 62 participants, and the PO TXA group contained 61 participants. Patients receiving PO therapy had a larger decrease in Hgb compared with the IV TXA group (-2.382 vs -1.908, P = 0.02), but there were no statistically significant differences in mean length of stay (3.13 vs 2.95, P = 0.27), venous thromboembolism (VTE) occurrence (0 vs 0, P = 1), or requirement for transfusions (6 vs 5, P = 0.76). Conclusions and Relevance: IV and PO TXA may not be equivalent in outcomes for patients undergoing TKA. This study found a statistically significant decrease in the mean change of Hgb in patients receiving PO TXA compared with IV TXA. However, the rate of transfusions, mean length of stay, and rate of VTE were similar between groups.

Blood Loss Measurement Technique That Predicts Decrease in Hemoglobin After Cesarean Delivery [17F

INTRODUCTION: To identify the blood loss technique that best predicts a decrease in hemoglobin (Hgb) >3 g/dL 24 hours after cesarean delivery (CD). METHODS: This was an IRB approved, retrospective review of women with singleton pregnancies who underwent cesarean delivery at >=34 weeks' gestation between July 1, 2017 and June 30, 2018. Women had blood loss measured by visually estimation (EBL), gravimetric estimation (QBL), Gauss Surgical's Triton (TBL) and a 24-hour postoperative complete blood count. The primary outcome was the optimal threshold for decrease in Hgb >3 g/dL by the area under the receiver-operating characteristic (ROC) curve (AUC) using blood loss estimation technique. RESULTS: Of the 446 women meeting inclusion criteria, 65 (15%) had a decrease in Hgb >3 g/dL. Women who had a decrease in Hgb >3 g/dL compared to women without a decreased in Hgb >3 g/dL were more likely to have increased gestational age, postoperative tachycardia (heart rate >100 beats per minute) at 12 and 24 hours post CD, postpartum hemorrhage by QBL and TBL and require blood product transfusion, (all P<0.05). None of the blood loss measurement techniques had a high AUC for predicting women with decrease in Hgb >3 g/dL (EBL 0.64 [95% CI 0.56-0.71], QBL 0.67 [95% CI 0.60-0.74] and TBL 0.70 [95% CI 0.63-0.77], P=0.13. All techniques had low sensitivity and high specificity for women with PPH and decrease in Hgb >3 g/dL. CONCLUSION: Blood loss at time of cesarean, measured by EBL, QBL or TBL, is a poor predictor for a decrease in Hgb by >3 g/dL.

DİRENÇ EGZERSİZLERİ SIRASINDA SU ALIMININ HEMOGRAM ÜZERİNDEKİ AKUT ETKİSİ

The aim of this study is to determine the effects of exercises done by drinking water and not drinking water during resistance training on hemogram (leukocyte, erythrocyte, and thrombocyte). 10 male university students aged between 20 and 23 participated in the study. The participants did five different resistance exercises (3 sets 8 RM) previously determined. During the training program, they did resistance exercises by not consuming water in the first week and consuming water in the second week. (Pre-exercise and exercise days routine food and fluid intake was maintained, fluid intake restriction was applied only during exercise) The participants’ Hemogram (Erythrocyte, Leukocyte and Thrombocyte) measurements were made before and after the exercise. The obtained data were tested at p<0.05 significance level. A significant decrease in Lymph% and a significant decrease in p<0.02 in Gran% were found among exercise pre-test post-test values by taking water from sub leukocyte subgroups. A significant decrease in RBC p<0.01 and a significant decrease in HGB and HCT values of p<0.02 were observed between exercise pre-test post-test values without water intake and water intake of erythrocyte subgroups of the same resistance exercise. A significant decrease in p <0.00 was also found between the exercise pre-test post-test values of the same subgroups (RBC, HGB, HCT). A significant reduction in PDW% value of p<0.04 was observed between the exercise pre-test post-test values of the same resistance exercise without water intake and without taking water from platelet subgroups of the same resistance exercise. No statistically significant change was detected in the parameter values in the other subgroups. The exercise done without water intake; a significant difference was found in the parameters of Thrombocyte and Erythrocyte. However, no statistically significant difference was found in the parameters of Leukocyte. The exercise done with water intake; a significant difference was found in the parameters of Leukocyte and Erythrocyte. However, no statistically significant difference was found in the parameters of Thrombocyte.

Intestinal Spirochetosis: An Obscure Cause of Lower Gastrointestinal Bleeding

Intestinal Spirochetosis is a condition marked by anaerobic spirochetes adherence and colonization of the luminal surface of colonic epithelium with occasional penetration into the epithelium. Most cases are found incidentally on pathological evaluation of colonic biopsies taken during diagnostic or therapeutic colonoscopies. However, whether the colonization of the intestinal mucosa can be attributed to clinical symptoms is a matter of debate. Here we present a case of intermittent hematochezia due to invasion of the colonic mucosa by intestinal spirochetes. A 27 year old male with no medical history presented with four days of atypical chest pain and syncope the day prior to presentation. He also reported watery diarrhea and intermittent hematochezia for the past two weeks. A complete cardiovascular and neurologic workup was unremarkable. After a spontaneous episode of painless hematochezia he was found to have a decrease in Hgb from 14 g/dl to 10 g/dl. CRP was 6.5 and ESR was 60. All stool studies, including Clostridium difficile toxin were negative. Coagulation studies were within normal limits. Physical exam was unremarkable except for guaiac positive stool. Colonoscopy was performed, revealing mild erythematous mucosa of the terminal ileum, and a localized area of severely congested, erythematous and inflamed mucosa in the rectum. Random biopsies were taken. Intestinal spirochetes were found in biopsies of the ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and cecum. Terminal ileum and rectum biopsies showed nonspecific inflammatory changes. The overwhelming spirochete invasion suggested these changes were secondary to the infectious process. Screening for all sexually transmitted diseases was negative. He was treated with metronidazole and improvement in symptoms was reported. This case demonstrates that invasive IS may develop in healthy individuals. Although many cases of asymptomatic IS have been described, cases leading to severe gastrointestinal symptoms are rare. No current methods exist to prove a direct relationship between histologic findings of IS and active disease thus leaving IS as the diagnosis of exclusion. Diagnosis requires random colonic biopsies followed by direct visualization via histologic staining, and may be confirmed by fluorescence in situ hybridization. Treatment of IS is controversial and ultimately should be dictated by the presence of symptoms, after all other etiologies have been ruled out.Figure: Erythematous Colonic Mucosa.Figure: False Brush Border Intestinal Colonization of Spirochetes along the colonic epithelium.

Effects of whole brain radiation on blood counts

Background: Whole brain radiation therapy is commonly used in the treatment of patients with CNS metastatic disease. Radiation to other areas of the body is associated with decrease in bone marrow proliferation. It is unclear what the effects ofWBRT have on blood counts. Methods: Retrospective chart review of patients with brain metastases treated with WBRT with recorded hematologic valuesbefore and after treatment. Univariate analysis was performed to identify statistical differences in outcome via paired t -testing. Results: Forty-nine patients were analyzed. Median age was 61 and 36 subjects were female. Analysis revealed significantly amedian decrease of 0.87 g/dL in hemoglobin values ( p .05). Conclusion: WBRT leads to a decrease in Hgb and platelets but does not appear to affect WBC counts. Physicians and patientsshould be aware of this side effect of WBRT.KeyWords: Whole brain radiotherapy, Anemia, Metastatic brain cancer

Effect of HIV Infection on Some Haematological Parameters and Immunoglobulin Levels in HIV Patients in Benin City, Southern Nigeria

This research is aimed at determining the effect of HIV infections on some haematological and immunological parameters. One hundred and fifty subjects were recruited for the studies (50 HIV seropositive subjects not on ART, 50 HIV seropositive subjects on ART and 50 HIV seronegative controls). Informed consent was obtained from all subjects. Ethical approval was obtained from the Ethics Committee of the Faculty of Health Sciences and Technology, Nnamdi Azikiwe University. Five millilitre of blood was collected from each subject for HIV test by ELISA, CD4 count by Cyflow technique, immunoglobulin test by immunoturbidimetric method, estimation of FBC by automated analyzer and ESR by Westergren method. Statistical package for social science (version 20) was used for the data analysis. Results shows that the mean ± SD of WBC was significantly higher in control than HIV subjects on ART (p<0.05). IgG and ESR was significantly increased in HIV positive subjects on ART and non-ART than control (p<0.05), while HGB and HCT was significantly lower in HIV positive subjects on ART and HIV subjects not on ART than control (p<0.05). However there was a nonsignificant increase in CD4 count and IgA in control compared to HIV subjects on ART and those not on ART, while there was a non-significant decrease in IgM in control compared to HIV subjects on ART and those not on ART (P>0.05). IgG was significantly higher in female HIV subjects on ART compared to the males while IgM was significantly higher in male HIV subjects not on ART than the females (P<0.05). There is an elevation of ESR and IgG levels in HIV infected subjects with a decrease in HGB and HCT value. The elevated IgG could be attributed to infection requiring IgG response, while elevated ESR could be an indicator of inflammatory response. Immunoglobulin could be used as a predictive marker for monitoring HIV, alongside haematological parameters.

Chronic restraint stress after injury and shock is associated with persistent anemia despite prolonged elevation in erythropoietin levels

Following severe traumatic injury, critically ill patients have a prolonged hypercatacholamine state that is associated with bone marrow (BM) dysfunction and persistent anemia. However, current animal models of injury and shock result in a transient anemia. Daily restraint stress (chronic stress [CS]) has been shown to increase catecholamines. We hypothesize that adding CS following injury or injury and shock in rats will prolong the hypercatecholaminemia and prolong the initial anemia, despite elevated erythropoietin (EPO) levels. Male Sprague-Dawley rats (n = 6-8 per group) underwent lung contusion (LC) or combined LC/hemorrhagic shock (LCHS) followed by 6 days of CS. CS consisted of a 2-hour restraint period interrupted with repositioning and alarms every 30 minutes. At 7 days, urine was assessed for norepinephrine (NE) levels, blood for EPO and hemoglobin (Hgb), and BM for erythroid progenitor growth. Animals undergoing LC or combined LCHS predictably recovered by Day 7; urine NE, EPO, and Hgb levels were normal. The addition of CS to LC and LCHS models was associated with a significant elevation in NE on Day 6. The addition of CS to LC led to a persistent 20% to 25% decrease in the growth of BM hematopoietic progenitor cells. These findings were further exaggerated when CS was added following LCHS, resulting in a 20%q to 40% reduction in BM erythroid progenitor colony growth and a 20% decrease in Hgb when compared with LCHS alone. Exposing injured animals to CS results in prolonged elevation of NE and EPO, which is associated with worsening BM erythroid function and persistent anemia. Chronic restraint stress following injury and shock provides a clinically relevant model to further evaluate persistent injury-associated anemia seen in critically ill trauma patients. Furthermore, alleviating CS after severe injury is a potential therapeutic target to improve BM dysfunction and anemia.

Impact of Switching From Darbepoetin Alfa to Epoetin Beta Pegol on Iron Utilization and Blood Pressure in Peritoneal Dialysis Patients.

New erythropoiesis-stimulating agents with a longer half-life have been developed for the treatment of anemia in patients with end-stage renal disease. This study evaluated the efficacy of darbepoetin alfa (DA) and long-acting epoetin beta pegol (continuous erythropoietin receptor activator, CERA) in patients on peritoneal dialysis (PD). Twenty-nine patients who had undergone PD for at least 6 months and were iron replacement-naïve and negative for inflammatory parameters were enrolled. Hemoglobin (Hgb) levels and blood pressure were evaluated before and after switching from DA to CERA. Percent transferrin saturation (TSAT), serum ferritin levels and blood pressure were also assessed. Twenty-eight patients were subject to the analysis, excluding one patient with a decrease in Hgb by ≥10%. Switching from DA to CERA did not alter Hgb levels. The doses of DA and CERA after 12 month treatment of each agent were 118.48 ± 79.63 and 89.88 ± 47.50 μg/4 weeks, respectively (conversion ratio, 1:0.76). The CERA dose administered during the final 6 months was abated, compared with that given during the initial 6 months (P = 0.035). The frequency of CERA injection over a 12-month period was less than that of DA (10.0 ± 3.0 vs. 16.4 ± 5.0, P < 0.01). The conversion from DA to CERA did not alter TSAT, but decreased serum ferritin levels (from 202.69 ± 132.57 to 150.15 ± 110.07 ng/mL, P = 0.012) and systolic blood pressure (from 133.8 ± 17.3 to 129.5 ± 11.3 mm Hg, P = 0.024). In PD patients, lower doses and less frequent injection of CERA are sufficient to maintain Hgb at levels similar to those achieved by DA therapy, with improved iron utilization and reduced blood pressure.

Abstract 16202: Changes in Hemoglobin After Pulmonary Artery Catheterization: Results From the ESCAPE Trial

Introduction: We sought to investigate the association between hemoglobin (Hgb) changes in patients with ADHF (with and without PACs) to mortality and clinical outcomes. Methods: We examined 433 patients enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Change of Hgb (g/dL) was defined as at least 1 (g/dL) drop by hospital discharge. Quartiles of % change of Hgb (g/dL) were calculated. We used multivariable Cox regression analysis to evaluate the effect Hgb change on mortality and composite end points of death, cardiac re-hospitalization, or cardiac transplant. Results: Of the 433 patients, 324 (75%) had baseline and discharge Hgb available for analysis. Of those, 64 (20%) had at least 1 (g/dL) drop of Hgb by time of discharge. Patients in the Hgb drop group were older than those without Hgb changes (59 vs. 55, p = 0.011). There were no baseline differences in gender, race, and etiology of HF between groups. Compared to patients without Hgb changes, patients with Hgb drop had lower systolic BP (99 vs. 106, p = 0.017), lower sodium (136 vs. 137, p =0.025), higher BUN (37 vs. 26, p &lt;0.001), and higher Creatinine (1.6 vs. 1.3, p &lt;0.001), respectively. Higher Hgb drop was observed in the PACs (vs. no PACs) randomized arm of the trial (2 g/dL: PACs 10% versus 3%, p =0.010; 3 g/dL: PACs 5% versus 0%, p =0.005). After adjustments, higher in-hospital Hgb was associated with lower mortality (HR 0.79, p =0.003). In addition, patients in the Hgb drop group had increased risk of mortality (Adjusted HR 2.38, p =0.003) and composite endpoints (Adjusted HR 1.43, p =0.055). PACs insertion was not associated with adverse clinical outcomes by quartiles of % change of hemoglobin (Mortality: Q1: HR 0.80, p 0.601, Q2 HR 0.79, p = 0.706, Q3 HR 0.34, p =0.101, Q4 HR 2.23, p =0.357). Conclusion: In-hospital decrease in Hgb is independently associated with increased long-term mortality and adverse cardiovascular events in severe HF. The ideal Hgb levels in ADHF patients should be investigated and the insertion of PACs to direct therapy should be weighed against bleeding risks.

Prevention of acute radiation-associated toxicity by traditional Chinese medicine Tianwang buxin mini-pills in patients with head and neck cancer

Background: Anemia and oral mucositis are main side effects of radiotherapy (RT) and are important factors affecting the quality of life (QOL) in head and neck cancer (HNC) patients treated with RT. This study aimed to explore the safety and therapeutic efficacy of Tianwang Buxin Mini-pills (＂TWBXM＂) for the prevention of acute RT toxicity in HNC patients by using a randomized, double-blind and placebo-controlled study design. Patients and Methods: Seventy-three HNC patients participated the study. They were randomized into a treatment group (n = 38) and a control group (n = 35). All patients received daily either ＂TWBXM＂ treatment or placebo starting from the initiation of RT until 1-month follow-up after RT completion. All patients were evaluated for QOL, acute RT toxicities and laboratory data (hemoglobin [Hgb], white blood cell and platelet) at 3 time points: Pre-RT, upon RT completion and at ＂TWBXM＂ completion. Results: The ＂TWBXM＂ group maintained normal levels of Hgb during the duration of the study while the placebo group showed a decrease in Hgb (P = 0.035). Conclusions: This study demonstrated the safety and efficacy of ＂TWBXM＂ applied in the HNC patients receiving RT. It prevented the decrease of Hgb in HNC patients undergoing RT treatment as well 1-month-post-RT treatment. Further studies are needed to assess the effects of ＂TWBXM＂ for the prevention of other RT toxicities.