Decrease In Hemoglobin Concentration Research Articles

P0703 Risk factors and nomogram for massive postoperative gastrointestinal bleeding in patients with Crohn’s disease: a multicenter retrospective study

Abstract Background Crohn’s disease (CD) is a chronic inflammatory disease that is prone to complications such as intestinal obstruction and perforation, which often require surgical treatments. Massive postoperative gastrointestinal bleeding (MPGB) is a severe complication with a high mortality rate, deteriorating postoperative recovery and disease prognosis. However, there are few related studies and it lacks effective prevention measures. Therefore, we conducted a multicenter study to explore the risk factors for MPGB in CD patients. Methods This study was a multicenter retrospective case-control study. Inclusion criteria included: patients diagnosed with CD; aged over 16 years old; underwent gastrointestinal surgery. Exclusion criteria included: patients with massive gastrointestinal bleeding before surgery. Massive gastrointestinal bleeding is defined as: hemodynamic impairment, requiring active fluid resuscitation; decreased hemoglobin concentration, requiring blood transfusion or surgical treatment; with symptoms of gastrointestinal bleeding. The included patients were divided into a case group and a control group. By comparing medical information between two groups, risk factors for MPGB were identified through logistic regression analysis, and a nomogram was constructed. Results From January 2018 to February 2024, a total of 170 CD patients were included, including 34 patients with MPGB and 136 matched controls. Univariate logistic regression analysis showed that for albumin (P=0.001, OR=0.89), nutrition risk screening (NRS2002) scale (P=0.003, OR=1.61), predictive nutritional index (PNI) (P=0.005, OR=0.92), number of previous surgeries (P<0.001, OR=2.39), history of gastrointestinal bleeding (P<0.001, OR=8.75), international normalized ratio (INR) (P=0.004, OR=1.60), and abnormal liver function (P=0.049, OR=6.29) (P＜0.05), the difference between two groups was statistically significant. Multivariate logistic regression analysis further revealed that NRS2002 (P=0.022, OR=1.53), history of gastrointestinal bleeding (P=0.005, OR=5.71), number of previous surgeries (P<0.001, OR=2.43), and INR (P=0.011, OR=1.61) were associated with an increased risk of MPGB. Based on these results, a nomogram was constructed. The training and validation group achieved an area under the curve (AUC) value of 0.87 and 0.73 respectively with well-fitted Hosmer-Lemeshow calibration curves. Conclusion The risk of MPGB in CD patients will be increased with a history of gastrointestinal bleeding, more previous surgeries, a higher NRS2002 score, and a higher INR value. Strengthening the perioperative nutritional status management of CD patients may prevent the MPGB. Besides, we conduct a nomogram model, which can effectively predict the risk of MPGB in CD patients.

Outcome of Ultrasonography-Guided Percutaneous Nephrolithotomy for the Management of Pediatric Urolithiasis.

Objectives: This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. Methods: A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. Results: Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. Conclusions: US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.

A-153 Study of the evaluation of fragment flag and percentage schistocyte count in MINDRAY® BC-6800 PLUS in a public pediatric hospital in Argentina

Abstract Background Schistocytes are fragmented red blood cells (FRCs) that arise from the mechanical destruction of red blood cells (RBCs). They indicate the possible presence of a thrombotic microangiopathy (TMA). TMA includes hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura(TTP). ICSH defined schistocytes as 4 well stablish shapes always smaller than intact RBCs. The gold standard for the identification of schistocytes is microscopic evaluation. A schistocyte count should be considered clinically meaningful if it represent the main morphological RBCs abnormality in the periferic blood smear (PBS). The results should be expressed as a percentage, after counting at least 1000 RBCs in optimal areas of the PBS. The cut off for TMA was previously stablished in above 1% (adult population) and a higher percentaje in pre term newborns (above 5%). Some blood cell count analyzers have a flag for FRC, and some of them also provide methods for an automated FRC count, through the measurement of forward scatter and the intensity of fluorescence or 2-dimensional optical analysis. The Mindray® BC 6800 PLUS provides a flag for fragments and the research FRC% parameter that quantifies fragmented RBCs. When the flag and the FRC% are combined, can bring value to diagnostic TMA. Objetives Evaluate the sensitivity and specificity of the fragment flag to predict schistocyte on the PBS of pediatric samples. Evaluate the utility of FRC% as TMA diagnostic tool and compare with the gold standard. Methods 725 pediatric samples were analyzed (0-18 years).16 of them was patient samples diagnosed with TMA. All blood cell counts were determined using Mindray®BC-6800 PLUS. Cut off 1% was considered for FRC% in TMA. Inclusion criteria for TMA samples include thrombocytopenia, increased lactate dehydrogenase and decreased hemoglobin concentration. Schistocyte counting was carried out from May-Grunwald-Giemsa-stained PBS according to the recommendations proposed by ICSH. Only ICSH established shapes were kept as valid. Results Regarding the sensitivity of the fragment flag, it was 84.62% with a specificity of 91.13% to detect the presence of schistocytes in PBS samples. In the Bland-Altman analysis, the FRC% shows a difference with a tendency to underestimation with respect to the observation on the PBS, which was less at lower percentages of schistocytes. The sensitivity of the FRC% to TMA was 75% while the specificity was 94.36% and a negative predictive value (NPV) of 99.41%. Conclusions Fragments flag represents a potentially powerful tool for screening of squistocytes in pediatric samples. Although sensibility and NPV for FRC% authomatical counts were acceptable, a few false-negative samples were found. Presence of FRC% below a threshold of 1% could exclude TMA.However PBS microscopic observation is still the gold standard to determine squistocytes presence. For the purpose of complete our study and to get further larger scale prospective data, we started collecting all data for all samples entering the laboratory in order to improve an authomatical method that should have a more rapid turn-around time at lower costs.

Asuhan Keperawatan pada An. I dengan Gangguan Sistem Hematologi: Talasemia di Ruang Anggrek 2 RSUD dr. Soeselo Kabupaten Tegal

Non-communicable diseases (NCDs) are diseases that are not caused by infection with microorganisms such as protozoa, bacteria, fungi or viruses. One example of a NCD is thalassaemia, which has strong genetic factors and an increasing incidence. Children who have parents or family members with thalassaemia have a higher risk of developing the disease. To establish basic assessment data, nurses will use the results of interviews, physical examinations, observations, and laboratory tests. Based on the results of the assessment conducted on An.I with thalassemia, three nursing diagnoses were found, namely ineffective peripheral perfusion associated with decreased haemoglobin concentration, fatigue associated with physiological conditions (anaemia), and knowledge deficit associated with lack of exposure to information. After evaluation, the problem of knowledge deficit was successfully resolved on the first day, while on the second day the problems of ineffective peripheral perfusion and fatigue were also resolved.

Evaluation of the International Society on Thrombosis and Haemostasis definition of major bleeding in Arizona rattlesnake bites

Introduction In 2023, a group of experts proposed that a definition of major bleeding in pharmaceutically anticoagulated patients be used in all snakebite trials. This includes bleeding that results in death, is life-threatening, causes chronic sequelae, or consumes major healthcare resources, including bleeding into a major area or hemoglobin concentration decrease ≥20 g/L. We hypothesized that a decline in hemoglobin concentration ≥20 g/L is common but rarely clinically significant in our population of Arizona rattlesnake bite patients. Methods Poison center records of rattlesnake bites in humans from 2018 through 2022 were retrospectively reviewed and assessed for major bleeding by the above criteria. Results Four hundred and eighty-one patients met the inclusion criteria, of whom 265 (55.1%) had a hemoglobin concentration decrease ≥20 g/L. No patients died, and there was no evidence of bleeding into a critical organ. Three patients (1.1%) received blood transfusions. A decrease in hemoglobin concentration ≥20 g/L was 100% sensitive for identifying the major bleeding-associated outcomes; however, specificity was only 45.2%. Measures of healthcare utilization and chronic sequelae were somewhat higher in patients with a decrease in hemoglobin concentration ≥20 g/L. Discussion Laboratory manifestations of hemotoxicity were common in this population, but hemorrhage was rare. While over half of patients met the major bleeding criterion of a decline in hemoglobin concentration ≥20 g/L, only 1.1% had bleeding that was potentially life-threatening as measured by receipt of a red blood cell transfusion. None died or had bleeding into a critical area. While nonspecific for major bleeding, a drop in hemoglobin concentration correlated with worse envenomation severity: these patients received more vials of antivenom, had a higher medical bill, a longer hospital stay, and were less likely to report full recovery at 90 days. Conclusions A decrease in hemoglobin concentration ≥20 g/L should not be used as evidence of major bleeding for Arizona rattlesnake envenomation studies, but it may have a role as an indirect marker of envenomation severity.

OXYGEN HOMEOSTASIS FROM SEA LEVEL TO HIGH ALTITUDES

In the beginning there was no oxygen (O2) on planet Earth, today the atmosphere hosts 21%, after considerable oscillations of it through millions of years. Over time, living organisms evolved by mounting mechanisms to detect and respond to fluctuations in O2 concentration in their internal environment. Oxygen sensors in the carotid body, and the HIF system in all cells, play a crucial role in maintaining O2 homeostasis at the organism and cellular level. Therefore, in normoxia, HIFs are rapidly synthesized and destroyed, but in hypoxia, their degradation is inhibited. HIFs, regulate protein expression to compensate for hypoxia, increasing O2 delivery to tissues, and reducing O2 consumption. Millions of people live at high altitudes, such as in the Andean and Tibetan plateaus. Newborns in these regions weigh less than those in the lowlands, but this difference in Tibetans is smaller than in the Andeans. There is a greater increase in utero­placental blood flow in Andean and Tibetan women compared to pregnancies in Europeans, at the same altitude. These increases are due to synthesis in NO and PGI2, generated by HIFs. The Andean populations display Chronic Mountain Sickness (CMS), characterized by increase in hemoglobin concentration, diminution of PO2 and pulmonary hypertension. In contrast, the Tibetans do not have these conditions due to polymorphisms of two genes, the EPAS-1 that encodes for HIF-2a, expressing polymorphisms with loss-of-function and the EGLN-1 gene that encodes for prolyl hydroxylase-2, with gain-of-function polymorphisms, thus reducing HIFs tasks, decreasing hemoglobin concentration and pulmonary arterial hypertension.

Molecular Epidemiology of Coronavirus Disease and its Effect on the Hematological Profile in District Kech, Balochistan

The coronavirus disease (COVID-19) is a respiratory disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study aimed to investigate the occurrence of COVID-19 in district Kech, associated risk factors, clinical presentation, and its effect on blood cells. A structured questionnaire was designed to collect the data and the samples were investigated by RT-PCR. In total, 575 suspects were screened, among which 64 (11.16%) had COVID-19 infection, 40.6% were males, and 59.4% were females. An increased positivity of 53.12% was measured in the younger age group (15-30 years) and the lowest (18.75%) was noticed in elders > 50 years. 95.3% of the patients were newly infected, and 7.7% had a contact history with COVID-19-infected patients. The clinical symptoms, such as fever, cough, nausea, vomiting, and diarrhea, were identified in 89.1%, 67.2%, 51.6%, 46.9%, and 12.5%, respectively. The prominent clinical features, like fever, cough, nausea, diarrhea, chest distress, chest pain, and psychological stress were observed. Noticeably, 10.9% of obesity and 7.8% of asthma patients were co-infected with COVID-19 disease including 39.1% of cases showed psychological trauma. Leucocytosis and a decrease in hemoglobin concentration and platelets were determined in COVID-19-infected patients. A significant effect was observed on the hematological profile, however, the effect was severe in the older age group (>50 years). The results suggest that the large population of the study area is infected by SARS-CoV-2, appealing to the need for surveillance on a large scale and the implementation of preventive measures to control further dissemination of the disease.

Endoscopic manifestation of intestinal transplant-associated microangiopathy after stem cell transplantation

BackgroundEndoscopic features of intestinal transplant-associated microangiopathy (iTAM) have not been comprehensively investigated. This study aimed to examine the endoscopic characteristics of patients diagnosed with iTAM.MethodsThis retrospective analysis included 14 patients pathologically diagnosed with iTAM after stem cell transplantation for hematolymphoid neoplasms (n = 13) or thalassemia (n = 1). The sex, age at diagnosis, endoscopic features, and prognosis of each patient were assessed. Serological markers for diagnosing transplant-associated thrombotic microangiopathy were also evaluated.ResultsThe mean age at the time of iTAM diagnosis was 40.2 years. Patients diagnosed based on the pathognomonic pathological changes of iTAM presented with diverse symptoms at the times of endoscopic examinations, including diarrhea (n = 10), abdominal pain (n = 5), nausea (n = 4), appetite loss (n = 2), bloody stools (n = 2), abdominal discomfort (n = 1), and vomiting (n = 1). At the final follow-up, six patients survived, while eight patients succumbed, with a median time of 100.5 days (range: 52–247) post-diagnosis. Endoscopic manifestations included erythematous mucosa (n = 14), erosions (n = 13), ulcers (n = 9), mucosal edema (n = 9), granular mucosa (n = 9), and villous atrophy (n = 4). Erosions and/or ulcers were primarily observed in the colon (10/14, 71%), followed by the ileum (9/13, 69%), stomach (4/10, 40%), cecum (5/14, 36%), duodenum (3/10, 30%), rectum (4/14, 29%), and esophagus (1/10, 10%). Cytomegalovirus infection (n = 4) and graft-versus-host disease (n = 2) coexisted within the gastrointestinal tract. Patients had de novo prolonged or progressive thrombocytopenia (6/14, 43%), decreased hemoglobin concentration (4/14, 29%), reduced serum haptoglobin level (3/14, 21%), and a sudden and persistent increase in lactate dehydrogenase level (2/14, 14%). Peripheral blood samples from 12 patients were evaluated for schistocytes, with none exceeding 4%.ConclusionsThis study provides a comprehensive exploration of the endoscopic characteristics of iTAM. Notably, all patients exhibited erythematous mucosa throughout the gastrointestinal tract, accompanied by prevalent manifestations, such as erosions (93%), ulcers (64%), mucosal edema (64%), granular mucosa (64%), and villous atrophy (29%). Because of the low positivity for serological markers of transplant-associated thrombotic microangiopathy in patients with iTAM, endoscopic evaluation and biopsy of these lesions are crucial, even in the absence of these serological features.

Association of ambient air pollution with hemoglobin levels and anemia in the general population of Korean adults

BackgroundEmerging evidence has suggested significant associations between ambient air pollution and changes in hemoglobin levels or anemia in specific vulnerable groups, but few studies have assessed this relationship in the general population. This study aimed to evaluate the association between long-term exposure to air pollution and hemoglobin concentrations or anemia in general adults in South Korea.MethodsA total of 69,830 Korean adults from a large-scale nationwide survey were selected for our final analysis. Air pollutants included particulate matter with an aerodynamic diameter less than or equal to 10 micrometers (PM10), particulate matter with an aerodynamic diameter less than or equal to 2.5 micrometers, nitrogen dioxide, sulfur dioxide (SO2), and carbon monoxide (CO). We measured the serum hemoglobin concentration to assess anemia for each participant.ResultsIn the fully adjusted model, exposure levels to PM10, SO2, and CO for one and two years were significantly associated with decreased hemoglobin concentrations (all p < 0.05), with effects ranging from 0.15 to 0.62% per increase in interquartile range (IQR) for each air pollutant. We also showed a significant association of annual exposure to PM10 with anemia (p = 0.0426); the odds ratio (OR) [95% confidence interval (CI)] for anemia per each increase in IQR in PM10 was estimated to be 1.039 (1.001–1.079). This association was also found in the 2-year duration of exposure (OR = 1.046; 95% CI = 1.009–1.083; adjusted Model 2). In addition, CO exposure during two years was closely related to anemia (OR = 1.046; 95% CI = 1.004–1.091; adjusted Model 2).ConclusionsThis study provides the first evidence that long-term exposure to air pollution, especially PM10, is significantly associated with reduced hemoglobin levels and anemia in the general adult population.

MARKERS OF COMPLICATIONS AFTER LAPAROSCOPIC GASTRIC BYPASS IN PATIENTS WITH OBESITY

Introduction. Bariatric surgery is one of the most effective methods of treating morbid obesity, which allows for a long-lasting result. Along with the increase in the number of operative methods of obesity treatment, the relevance of issues related to postoperative complications is increasing. In recent years, the issue of using special checklists after surgery has been actively investigated. This will help optimize the process of monitoring patients' condition in the postoperative period.&#x0D; The aim of the study: to develop a check-list model to prevent the detection of complications after laparoscopic gastric bypass in obese patients.&#x0D; Materials and methods. On the basis of the developed checklist, a study of the condition of obese patients, who underwent laparoscopic gastric bypass during 2019-2023, was conducted on the basis of the Department of General Surgery No. 2 of the Bogomolets National Medical University. The checklist included the following criteria: the level of pain on the VAS scale, the level of nausea, eating, mobility, whether there is a desire to be discharged home, abdominal muscle tension, pain in the calf muscles, heart rate, oxygen saturation in the blood, the number drainage discharge within 24 hours, temperature, systolic blood pressure, central venous pressure, laboratory diagnosis, decrease in hemoglobin concentration, leukocyte level after surgery, C-reactive protein level after surgery, blood procalcitonin level, erythrocyte sedimentation rate level, the presence of a shift in the leukocyte formula to the left. The presence of complications was assessed, the parameters of the checklist were analyzed using univariate logistic regression and ROC analysis for early detection of complications and determination of the chance of complications in the future.&#x0D; Results. Complications occurred in 18/218 (8.2%). The most frequent complication was bleeding in 6/18 (33.3%). Reoperation was performed in 12 cases of 12/18 (66.6%), endoscopic treatment was performed in 1 case, and conservative methods were used in 5 cases. According to the checklist, 31.81% had a positive predictive value (PPV) and 99.56% had a negative predictive value (NPV). The optimal cut-off point of the total score of the checklist was 6. Patients with a positive prognosis of the checklist have a higher chance of developing complications of VSH – 4.5 (95% CI 1.8-9.72), p &lt;0.001.&#x0D; Conclusions. The complication rate was 18/218 (8.2%). According to the checklist, heart rate, systolic blood pressure and mobility are very good predictors of postoperative complications. The checklist is the best option for determining the readiness of patients to be discharged from the hospital due to a high prognostic negative result. Due to the low prognostic positive result, the evaluated checklist needs additional modification and optimization taking into account the results already obtained.

The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis.

The aim of this study was to analyze the development of albumin administration in patients admitted to the adult ICU. In addition, we assessed the impact of albumin administration on serum hemoglobin concentration. We conducted a retrospective single-center study including all patients who were admitted to the ICU from January 2013 to December 2021 and stayed at least 24 hours. The study was conducted in an academic hospital (University Hospital Basel, Switzerland). A total of 20,927 admissions were included, of which 3748 received albumin at least once during their ICU stay. To analyze volume expansion, 2006 admissions met the inclusion criteria, namely at least two hemoglobin measurements within 12 hours, one albumin delivery, and experienced no bleeding, dialysis, or transfusions during this period. None. We examined the hemoglobin levels before and after albumin administration and compared them with a matched control group to assess the amount and duration of volume expansion. From 2013 to 2021 the proportion of critically ill patients treated with albumin rose from 5.0% to 32.5%. An overproportioned increase in albumin use could be seen in surgical patients (4.7-47.2%) and in those receiving RBC transfusion (13.7-72.6%). In those patients receiving albumin, a significant drop in hemoglobin of around 5 g/L on average could be observed following treatment with albumin. Hemodilution was observable for at least 12 hours after albumin administration and may have caused a decrease in hemoglobin concentration of greater than 8 g/L when isooncotic albumin solution (5%, 25 g in 500 mL) was administered. This makes albumin, especially in its isooncotic form, an ideal colloid to achieve long-lasting volume expansion. However, RBC transfusions may increase under albumin therapy, as transfusion thresholds may be undershot after albumin administration.

Silver Nanoparticles in Biomedical Applications: Insights from In Vitro and In Vivo Studies

This work provides a thorough examination of the biological impacts of silver nanoparticles (AgNPs) via in vitro and in vivo investigations. In vitro tests demonstrated a concentration- dependent reduction in cell viability, decreasing from 90% at 5 µg/mL to 50% at 25 µg/mL, with a substantial rise in reactive oxygen species (ROS) from 20% to 80%. The data indicate that AgNPs may possess cytotoxic effects. Moreover, apoptosis rates escalated from 5% to 18% with increasing doses of AgNP. In vivo investigations revealed significant alterations in hematological parameters, including a decrease in hemoglobin concentrations (from 15 g/dL to 11 g/dL), an elevation in white blood cell counts (from 8 x10³/µL to 12 x10³/µL), and a drop in platelet counts (from 250 x10³/µL to 200 x10³/µL) corresponding to escalating AgNP dosages. Histological studies demonstrated dose-dependent changes in organ tissues, especially the liver, with scores escalating from two to six. Tumor size reductions of 20%, 40%, and 60% were seen with low, medium, and high dosages of AgNPs, respectively. These results underscore the promise of AgNPs for biological applications, especially in tumor therapy. Nonetheless, comprehensive safety evaluations and accurate dosage optimization are required prior to their clinical use. This work highlights the potential biological uses of AgNPs while stressing the need of meticulous evaluation to guarantee their safe and effective incorporation into medical procedures.

Anemia in Pregnancy: Cause and Effect

One of the most common complications associated with pregnancy is anemia. Severe anemia that occurs during pregnancy has adverse effects on both the mother and the fetus. This literature review aims to provide related information related to how anemia can occur in pregnancy, what are the risk factors and causes of anemia in pregnancy, and the impact of anemia on pregnant women and their fetuses. We searched from online databases and used review articles, research, guidelines from professional organizations, such as World Health Organization and Ministry of Health Republic of Indonesia. Result: In general, pregnant women will experience a decrease in hemoglobin concentration due to the physiological role of hemodelution during pregnancy. However, this condition will be worsened and make pregnant women fall into anemia when accompanied by other factors such as iron deficiency, folic acid deficiency, infection, non ideal BMI (Body Mass Index), and congenital blood diseases. As a result, severe anemia that occurs during pregnancy has adverse effects on both the mother and the fetus. Conclusion: It is important to understand the factors that cause anemia in pregnancy to avoid adverse effects on pregnant women and their fetuses or children.

CBFA2T3 affects red blood phenotype in the blood clam Tegillarca granosa by regulating hemocyte proliferation

The red blood phenotype of blood clam Tegillarca granosa, is tightly linked to its health conditions and nutritional benefits, making it an economically important trait. Despite its significance, the molecular regulatory mechanisms responsible for red blood phenotype variation in blood clams still poorly understood. Our previous study shows that hemocyte proliferation may affect hemoglobin concentration (HGC) and cause the red blood phenotype variation in T. granosa. Thus, we defined total hemocyte counts (THC) and HGC as red blood-related traits. In this research, we discovered that blood clams with higher THC exhibited elevated HGC and a darker blood color. To gain insights into the genes associated with THC in T. granosa, we conducted RNA-Seq analysis. Our transcriptome analysis identified 682 genes exclusively highly expressed in high THC clams (HTHC:THC ≥ 15.5 × 104 cells/mL), and 709 genes highly expressed in low THC clams (LTHC:THC ≤ 6.5 × 104 cells/mL). Furthermore, the weighted gene co-expression network analysis (WGCNA) revealed that the grey60 module exhibited significant positive correlations with THC and HGC, implying an association of this module with the red-blood phenotype. Subsequently, the red blood-related module exhibited a significant positive correlation with gill tissue, providing an alternative perspective to support the hypothesis that gills serve as the primary hematopoietic organ in T. granosa. By employing differential expression analysis and WGCNA, CBFA2T3, TAL1, and FLI1 are potentially key genes involved in the regulation of hemocyte proliferation and differentiation. RNA interference of CBFA2T3 gene led to a remarkable decrease in HGC and THC in T. granosa, resulting in a lighter blood color. EdU staining further confirmed the decrease of cell proliferation activity in the gills of T. granosa after knockdown of CBFA2T3. This study enhances our apprehending of the molecular mechanisms in red blood phenotype variation in T. granosa, and potential contributes to the selection breeding of high THC blood clams.

Operative Repair of Type A Aortic Dissection in Jehovah’s Witnesses: Insights From a Case Series

BackgroundJehovah’s Witnesses are known to refuse allogeneic blood products. Consequently, many surgeons will decline to perform aortic surgery on this patient group, given their higher risk. We present here a case series describing operative repair of type A aortic dissection without the use of allogeneic blood products. MethodsFrom 2018 to 2021, 6 Jehovah’s Witness patients underwent open repair of type A aortic dissection. We reviewed preoperative characteristics, diagnostic workup, operative technique, and postoperative outcomes. We also looked specifically at use of autologous whole blood, Cell Saver (Haemonetics) transfusion, synthetic clotting factors (recombinant factor VIIa), and albumin and prothrombin complex concentrate when allowed. ResultsModified hemiarch replacement was performed with the branched single-anastomosis frozen elephant trunk repair (B-SAFER) technique in 4 patients; 2 patients received a standard hemiarch replacement. Aortic valve replacement was performed in 2 patients; root replacement was performed in 1 patient. There were no immediate postoperative coronary complications, strokes, or instances of renal failure. Average decrease in hemoglobin concentration after surgery was 2.3 ± 1.5 g/dL (mean ± SD). Thirty-day mortality was 0. Five of 6 patients survived to discharge, and all survivors to discharge were still alive at the time of submission. ConclusionsBloodless aortic dissection repair in these rare patients can be performed safely in specialized centers using the techniques described. Furthermore, we believe that these techniques can be applied to the general population of patients undergoing emergent cardiac operation to avoid allogeneic transfusions.

The outcome of central nervous system hemangioblastomas in Von Hippel-Lindau (VHL) disease treated with belzutifan: a single-institution retrospective experience.

Belzutifan is a Hypoxia Inducible Factor 2-alpha inhibitor approved in 2021 by the FDA for the treatment of renal cell carcinoma (RCC) in patients with Von-Hippel Landau (VHL) disease. These patients can also present with central nervous system (CNS) hemangioblastomas (HBs). We aim to study the effectiveness and adverse effects of belzutifan for CNS HBs, by reporting our preliminary institutional experience. We present a series of VHL patients with CNS HBs undergoing treatment with belzutifan for RCC. All the included patients met the RECIST inclusion criteria. The clinical and radiological outcome measures included: Objective response rate (ORR), time-to-response (TTR), adverse events (AE), and patient response. Patient response was classified as partial response (PR), complete response (CR), progressive disease (PD), or stable disease (SD). Seven patients with 25 HBs were included in our study. A belzutifan dose of 120mg/day PO was administered for a median of 13 months (range 10-17). Median follow up time was 15 months (range 10-24). An ORR of 71% was observed. The median TTR was 5 months (range: 1-10). None of the patients showed CR, while 5 patients (71.4%) showed PR and 2 (28.5%) showed SD. Among patients with SD the maximum tumor response was 20% [increase/decrease] of the lesion diameter. All the patients experienced decreased hemoglobin concentration, fatigue, and dizziness. None of the patients experienced severe anemia (grade 3-4 CTCAE). Belzutifan appears to be an effective and safe treatment for CNS hemangioblastoma in VHL patients. Further clinical trials to assess the long-term effectiveness of the medication are required.

Efforts To Prevent Adolescent Anemia Through Giving Soy Milk And Dates

Anemia is a decrease in the capacity of the blood to carry oxygen due to a less than normal number of red blood cells or a decrease in hemoglobin concentration which can be caused by a decrease in the production of red blood cells or a lot of blood loss. Anemia in Indonesia is generally caused by iron deficiency, so it is more often called iron deficiency anemia. Anemia is a condition in which a person has a hemoglobin (Hb) level of &lt;13g/dL for males or &lt;12g/dL for females. This disease is the highest cause of disability in the world. The aim of this activity is to prevent anemia through giving soy milk and dates to anemic young women at Baitul Hikmah Tempurejo Vocational School, Jember. The method of delivering health education is carried out by means of a question and answer discussion to all respondents. The results of community service activities have provided education to young women through lectures, checking Hb levels, discussing the importance of preventing anemia. The responses generated by the respondents were enthusiastic enough to be understood by teenagers. This is evidenced by the questions and answers from the respondents. A screening test for hemoglobin (Hb) levels was carried out. From the results of the examination, not all adolescents with normal Hb levels, some were in the anemia category, the hemoglobin level was checked using an electric detection device. Treatment has been given by giving date soy milk to adolescents with anemia, then re-evaluation was carried out and the results showed an increase in Hb levels.

Carbetocin versus Oxytocin with or without Tranexamic Acid for Prophylactic Prevention of Postpartum Hemorrhage after a Vaginal Delivery: A Randomized Clinical Trial

Objective: Our study’s primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including carbetocin only, oxytocin only, and a combination of carbetocin or oxytocin with tranexamic acid. Design: A multicentric randomized controlled trial. Participants/Materials, Setting, and Methods: This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient’s bed within 2 h after delivery. Group I: carbetocin 100 μg/mL (n = 75), group II: oxytocin 5 IU/mL (n = 75), group III: carbetocin and tranexamic acid 50 mg/mL (n = 75), group IV: oxytocin and tranexamic acid (n = 75). Results: The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; p < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; p = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; p = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; p < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; p < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; p = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; p = 0.6). Limitations: The most important limitation of the study is a relatively small number of participants. Conclusion: In conclusion, our findings suggest that carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery.

Giant thoracic hematoma post-transradial coronary angiography: a case report and review of the literature

BackgroundAlthough there are cardiac interventional procedures, certain transradial access complications might be life-threatening.Case presentationA 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period.ConclusionsVascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.

Clinical analyzes and theoretical calculations of the characteristics of blood cells in patients with lymphoblastic leukemia

Lymphoblastic leukemia is one of the serious diseases of the hematopoietic system, which requires long-term treatment, but despite this, it often leads to disability and mortal-ity. In this regard, all the still unexplored relationships between blood elements and their motor ability, which can be described by the rheological properties of blood, are of inter-est. For a better understanding of the relationship between morphometric features and the rheological properties of blood, we compiled a research algorithm, the purpose of which was to study the rheological parameters of the blood system using clinical tests and in silico calculations against the background of the clinical picture of the number and size of formed elements, lymphocytic formula of patients with lymphoblastic leuke-mia. In the group of patients with leukoblastic leukemia, the number of neutrophils was reduced by 38% compared with the control. Other types did not change significantly. Thrombocytopenia, a decrease in hemoglobin concentration and hematocrit were ob-served, however, the number of erythrocytes corresponded to the values in the control. The dynamics of the size of erythrocytes is an indicator of the lability of the blood sys-tem. Under conditions of development of leukemic processes, the proportion of young erythroid forms is negligible. The development of lymphoblastic leukemia was accompa-nied by thrombocytopenia, a decrease in hemoglobin concentration and hematocrit, however, the number of erythrocytes corresponded to the values in the control. Studies have revealed changes in the geometric characteristics of erythrocytes in patients with leukemia. The increase in overall dimensions (diameter and height) of erythrocytes in patients with patients with leukoblastic leukemia varied by 15–20 % compared with the control. The rheological parameters were changed significantly. According to our data, the violation of blood flow occurs due to changes in erythrocyte aggregation, deformabil-ity of the erythrocyte membrane, plasma viscosity with an unchanged number of erythro-cytes, i.e. with normal hematocrit. These data are especially interesting from the point of view of rheology and clinic of leukemias.