Differences In Hb Levels Research Articles

Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews.

Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews.

Evaluation on the Influence of the Timing of Twin Pregnancy Termination on the Outcome of Mother and Infants

Objective: To observe the maternal and infant outcomes of pregnant women with twins terminating their pregnancy at different timings. Methods: Among the twin pregnant women admitted to our hospital from August 2019 to August 2020, 50 primiparous women who opted to terminate their pregnancies at 5 different timings of “34——34+6 weeks”, “35——35+6 weeks”, “36——36+6 weeks”, “37——37+6 weeks”, “38——38+6 weeks” were selected as the research subjects. According to the timing of pregnancy termination, they were divided into 5 groups, each with 10 cases of pregnant women, and the impact of the timing of pregnancy termination on the outcome of the mothers and infants were compared. Results: The “37——37+6 weeks” group had the largest amount of postpartum hemorrhage, and the difference in Hb level before and after delivery was the largest. With the increase in gestational week, the weight of both large and small fetuses increased. In terms of neonatal diseases, the comparison between “34——34+6 weeks”, “35——35+6 weeks”, “36——36+6 weeks” and “37——37+6 weeks”, “38——38+6 weeks”, P＜0.05, the comparison between “37——37+6 weeks” and “38——38+6 weeks”, P>0.05. Conclusion: The extension of the gestational week of twin pregnancies has no effect on postpartum hemorrhage, but it can improve the outcome of infants.

Safety of Venous Thromboprophylaxis With Low-molecular-weight Heparin in Children With Ulcerative Colitis.

To evaluate for increased rectal bleeding following enoxaparin thromboprophylaxis in children hospitalized for ulcerative colitis (UC). Retrospective cohort study (2007--2016) of 218 inpatients with active UC. Patients receiving enoxaparin were compared with a nonenoxaparin-treated patient group. Severity of UC was determined using the Pediatric Ulcerative Colitis Activity Index (PUCAI). Hemoglobin (Hb) values and packed red blood cell (pRBC) transfusions were reviewed for a 7-day period following hospital admission. A linear mixed effect model was used to compare change in Hb values between the groups. Risk of pRBC transfusion was compared using a log-rank test and Cox proportional hazard regression. A sub-analysis was also conducted restricting to patients with severe UC to provide more generalizable insight into safety profile of enoxaparin. Children hospitalized for UC and receiving enoxaparin were more likely to have severe disease, received infliximab therapy and be admitted after 2010. Use of enoxaparin showed there was not a difference (P = 0.60) in the fall of Hb detected among those with acute severe colitis (initial PUCAI ≥65) during the week following admission. Moreover, there was no difference in the risk of requiring a pRBC transfusion with enoxaparin use (log-rank test all patients: P = 0.80; severe UC: P = 0.88; Cox proportional hazard regression all patients: P = 0.72; severe UC: 0.85). There was no difference in Hb levels or need for blood transfusions in children hospitalized for severe UC (PUCAI ≥65) whether or not they received enoxaparin for thromboembolism prophylaxis.

Stop Frightening and Start Donating

Background and Objectives: One of the observed fears that keep people hesitant to donate blood is anemia. We conducted this study to investigate the hemoglobin (Hb) level post donation in first-time donors and compared it with healthy nondonor group. Methods: An analytical cross-sectional study was conducted from February 2018 to December 2018 after approval from the institutional ethics committee. There were two study groups: Group 1 which included donors who donated blood as per the National Blood Donor Policy. Group 2 comprised gender matched healthy participants. Laboratory investigations included complete blood counts. Informed consent was taken from participants of both the groups. Anemia was defined as Hb of <14 g/dl in males and <12 g/dl in females. SPSS version 23.0 was used for inferential statistics. Results: A total of 928 donations were included, with 9 (1%) females and 919 (99%) males. Out of 919 male donors, 601 (65%) were donating blood for the first time. Out of 601 first-time donors, 175 (29%) participants were recruited for analysis. An equal number of gender-matched healthy nondonor participants were included in the analysis. The age range was 18–55 years in both the groups. Independent t-test was applied, and the mean difference in Hb level in both the groups was found statistically nonsignificant (P = 0.713). Conclusion: Our study revealed a similar mean Hb level in both the groups. Some other factors we encountered were scarcity of voluntary and female participation in blood donation.

The Effectiveness Biscuits In Increasing Hemoglobin Levels In Pregnant Women

Anemia of pregnancy is still a significant health problem in Indonesia. Various efforts have been made to overcome this problem. Moringa biscuits (Bikelor) processed from Moringa leaves with high iron content are an alternative to increasing hemoglobin levels in pregnant women with anemia. The purpose of this research is to analyze the effectiveness of giving Bikelor to increase Hb in pregnant women with anemia. This research was approved by the health research ethics committee of the Faculty of Medicine, Nusa Cendana University, Kupang. The study used the One Group Pre Test and Post Test Design, conducted from May to October 2020 in the working area of the Waigete and Beru Public Health Centers in Sikka Regency on 20 pregnant women. The research was conducted through 4 stages, namely the stage of making Bikelor, the location of organoleptic testing (testability) for pregnant women to Bikelor, testing of nutrient content, and intervention. The intervention phase was carried out for 14 days in October 2020. The intervention data were analyzed using paired t-test analysis to see the difference in Hb levels before and after giving Bikelor. The results of the study showed that there was a significant difference in the Hb levels of pregnant women before and after being given Bikelor with a p-value of 0.000 (α<0.05). Changes in Hb levels before and after giving Bikelor were 0.8-1.4gr/dl. It showed that Bikelor was one of the food products that can effectively increase Hb levels in pregnant women with anemia. Consumption of Bikelor can increase the Hb level of pregnant women. Pregnant women were expected to continue to consume the iron tablets given or can replace them by consuming Bikelor as a daily snack as much as 4-5 pieces per day

An Estimation of Haemoglobin Levels in Children with Early Childhood Caries- A Retrospective Study

Aim: This study aimed to evaluate Haemoglobin (Hb) levels in children with Early Childhood Caries(ECC) and to find out whether there is any variation from normal values in Hb level in children with earlychildhood caries.Materials & Methods: In this retrospective study the Hb levels and dmft status of 281 children with ECCin the age group of 0 to 6 years were evaluated. The mean Hb values calculated were compared with thesuggested normal levels by the World Health Organisation for the particular age group. Kruskal Wallis testand post hoc test comparisons were done to compare differences in Hb levels in 4 different groups based ondmft values in children with ECC.Results: Overall mean value of Hb in children with ECC was 10.93 ± 1.73 g/dl and mean dmft was 7.19 ±4.3. Group 1 with less than 5 dmft value showed significant difference in Hb values compared to children ingroups with higher dmft values (p?0.05).Conclusions: Half of the study population had low haemoglobin levels i.e. below that of WHO criteria.Children with more than 5 dmft score had significantly lower Hb levels compared to children with less dmftvalues (p?0.05). There was no significant difference noticed in the Hb levels in between boys and girls withECC. This descriptive study results point that ECC can result in low Hb levels in children, however authorssuggest that an analytical study with a control group should be done to test the hypothesis.

The differences in hemoglobin levels before and after consuming ambon bananas in students

The purpose of this study is to determine whether there are differences in hemoglobin levels before and after consuming ambon bananas in students of Prodi Kebidanan Metro. The specific purpose of this study was to determine hemoglobin levels before consuming ambon bananas, hemoglobin levels after consuming ambon bananas and the differences in hemoglobin levels before and after consuming ambon bananas in female students at Prodi Kebidanan Metro. This research is an intervention research with quasi experiment design with The One Group Pretest - posttest design. The population in this study were students in the first and second grade in Prodi Kebidanan Metro who lived in the dormitory as many as 149 female students. A sample of 49 people will take a portion of the population using simple random sampling technique. Data analysis used dependent sample t tests to test the mean increase in Hb levels before and after consuming ambon bananas. The results showed an average Hb level before consuming bananas at 12.51g/dl and an the average hb level after consuming bananas was 12.89g/dl, so the average increase in Hb levels was 0.39g/dl. The results of the analysis using the t-test dependent test obtained p value=0.000, which means that there are significant differences in Hb levels of students before and after consuming ambon banana.

UPAYA PENINGKATAN KADAR HEMOGLOBIN REMAJA PUTRI SMK WIDYA PRAJA UNGARAN PADA PEMBERIAN KUDAPAN BERBASIS TEPUNG TEMPE

Background : Anemia is a nutritional problem in Indonesia which was characterized by a condition where the red blood cells or hemoglobin levels is lower than the normal value. Nutritional anemia is caused by deficiency nutrients that play a role in the formation of hemoglobin, due to inadequate consumption or absorption disorders. These nutrients are iron, protein, vitamin B12 which act as catalysts in hem synthesis in hemoglobin molecules, vitamin C, zinc which affect iron absorption and vitamin E which affect the stability of the red blood cell membrane. Most of these are iron nutrient anemia. Females adolescent are more susceptible to anemia compared than men. The minimum of hemoglobin levels in females adolescent to diagnose as anemia is when hemoglobin levels are less than 12 g / dl.Objective : To increase hemoglobin levels of females adolescents by providing tempeh flour-based snacksMethod : In this study, an attempt had made to create tempe-based formula in the form of pizza which was high in iron and protein, the availability of tempe flour was great because the absorption disturbing agent was damaged by the fermentation process. The analysis was carried out to observe the difference in Hb levels in the treatment group (given tempe flour pizza) and control (given a regular pizza) and the relationship between BMI, nutrients-intake and consumption compliance with Hb levels.Result : The results showed there was an increase in Hb levels of 1.21 g% in the treatment group (61.54%). Nevertheless, the increase did not statistically significant. There was no relationship between BMI, nutrients intake and compliance with pizza consumption to increase Hb levels.Conclussion : Administration of tempeh fluor-based pizza for a month could increase Hb levels by 1.21 g/dl in most study participant, but it did not statistically significant.

Postoperative Intravenous Iron Supplementation Does Not Improve Hemoglobin Level and Transfusion Rate Following Staged Bilateral Total Knee Arthroplasty

BackgroundWe determined whether postoperative intravenous (IV) iron supplementation could reduce transfusion rate in patients undergoing staged bilateral total knee arthroplasty (TKA). Furthermore, we examined whether hemoglobin (Hb) levels and iron profile differed between patients with and without postoperative IV iron supplementation. MethodsThis retrospective, comparative cohort study included 126 patients who underwent primary staged bilateral TKA during a single hospitalization. The second TKA was performed at a week’s interval. Group iron (n = 65) received IV iron immediately after each surgery, while patients in group no-iron (n = 61) received no iron after surgery. Transfusion rate, change in Hb levels, and iron profile including serum iron, ferritin, total iron binding capacity, and transferrin saturation were evaluated preoperatively; on postoperative days 1, 2, and 4 after the first TKA; and postoperative days 1, 2, 4, and 7, 6 weeks, and 3 months after the second TKA. ResultsThere were no significant differences in Hb levels and transfusion rate following staged bilateral TKA between patients with and without postoperative IV iron supplementation although serum iron profiles were improved in patients with IV iron supplementation. ConclusionPostoperative IV iron supplementation immediately after acute blood loss caused by TKA was not effective in improving the transfusion rate. Therefore, surgeons should use protocols other than postoperative IV iron supplementation for reducing the transfusion rate in patients undergoing staged bilateral TKA in a single hospitalization. Level of EvidenceIII.

Efektifitas Pemberian Jus Jambi Terhadap Kadar Hemoglobin Ibu Hamil Trisemester II dengan Anemia

Ibu hamil yang menderita anemia berisiko mengalami keguguran, bayi lahir sebelum waktunya, bayi berat lahir rendah, serta perdarahan sebelum dan setelah melahirkan. Penanganan anemia pada ibu hamil ada 2 cara yang dilakukan yaitu farmakologi dan non farmakologi. cara non farmakologis anemia dan pencegahan dengan cara mengkonsumsi buah bit, jambu biji, dan jus bayam. Penelitian bertujuan mengetahui efektifitas pemberian jus jambu buji, buah bit dan jus bayam terhadap kadar hemoglobin ibu hamil trimester II dengan anemia. Metode penelitian menggunakan The One Group Pretest Posttest Design. Populasi adalah ibu hamil trimester II dengan anemia di RS Aura Syifa Kediri. Jumlah sampel 30 orang ibu hamil trimester II dengan anemia dengan metode pengambilan purposive sampling. Teknik analisis bivariat menggunakan paired t test dan analisis multivariat menggunakan Oneway Anova, p sama dengan 5 persen. Instrumen yang digunakan adalah Easy Touch Blood Hemoglobin. Pemberian jus jambu biji, p value lebih kecil dari 0,001, p value lebih kecil dari, jus buah bit, p value lebih kecil dari 0,001, p value lebih kecil dari, dan jus bayam, p value lebih kecil dari 0,001, p value lebih kecil dari efektif dalam meningkatkan kadar Hb ibu hamil trimester II dengan anemia. Analisis Oneway Anova menunjukkan selisih rerata kadar Hb jus bayam 2,50 gr per dl, jus buah bit 2,15 gr per dl, dan jus jambu biji 1,82 gr per dl. Artinya penggunaan jus bayam lebih tinggi dalam menaikkan kadar Hb dibanding jus buah bit dan jus jambu biji. Diharapkan pemberian jus bayam, jambu biji dan buah bit dapat menjadi salah satu alternatif dalam mencegah dan menangani anemia ibu hamil.

The Effectiveness of Homemade Soymilk in Increasing Haemoglobin (Hb) Levels in Pregnant Women

The high prevalence of anaemia in pregnant women in West Aceh Regency (40.5%), which is indicated by the haemoglobin (Hb) levels of below 11 g%, should receive special attention because anaemia will have an impact on maternal and infant mortality. Soy milk is one processed beverage that contains iron, high protein, essential fatty acids, fibre, vitamins and minerals. Nutrients contained in soy can produce energy, maintain optimal body functions, and meet the needs of iron in pregnant women. Soybean is a type of food which is ranked third to have the richest iron (8.8 mg%) after meat and cereals. The purpose of this study was to examine the effectiveness of homemade soy milk in increasing Hb levels in pregnant women. The study design was an experiment on pregnant women. The object of this study was pregnant women in their first and second trimester of pregnancy. The intervention was giving homemade soy milk by adding 10 ml of honey, as a substitute for sugar, to 1 cup of homemade soy milk (250 ml), from a basic intake of 4 mg of iron per day for pregnant women. This intervention resulted in a significant increase in Hb levels in pregnant women (P < 0.005). The provision of homemade soy milk can significantly increase the mean of Hb levels in pregnant women with an average increase of 2.99 mg% ± 1.422. Furthermore, the p-value obtained was = 0.000, indicating that there was a significant difference in Hb levels between measurement I (before being given homemade soy milk) and after being given homemade soy milk for 3 months. Homemade soy milk is an effective drink in increasing Hb levels in pregnant women.

Comparison of hemoglobin and hematocrit levels at 1, 4 and 24 h after red blood cell transfusion

Previous studies have shown that equilibration following a red cell transfusion had occurred by 24 h. A shorter time to follow the hemoglobin (Hb) and hematocrit (Hct) after transfusion may help physicians to provide earlier and more pertinent treatment. This was a prospective study conducted from December 2014 to August 2015. This research aimed to determine the equilibration time point of the level of Hb and Hct after one unit red blood cell (RBC) transfusion. Patients were randomized into three groups and Hb level and Hct were assessed at one, four or 24 h after transfusion. The mean differences in Hb level and Hct before and after transfusion were compared between each group. Sixty patients were eligible for enrollment onto this study; 20 patients were therefore allocated to each group. The median age was 51 years old, male predominating (83.33%). The most common indication for transfusion was post-operative anemia (88.33%). There were no significant differences between the baseline characteristics baseline Hb, Hct and volume of RBC transfusion in each group. The mean differences in Hb (g/dl)/Hct (%) level at the different time points of one, four and 24 h were 1.21/3.62, 1.19/3.63, and 0.95/3.09 respectively (P = 0.109 and P = 0.398, respectively). The equilibration of Hb and Hct did not differ between one, four and 24 h after a RBC transfusion. The target Hb and Hct can be determined at one hour after transfusion.

The association of the difference in hemoglobin levels before and after hemodialysis with the risk of 1-year mortality in patients undergoing hemodialysis. Results from a nationwide cohort study of the Japanese Renal Data Registry.

BackgroundFew clinical studies have directly examined the associations of hemoglobin (Hb) levels after hemodialysis (HD) and of the difference in Hb levels before and after HD (ΔHb) with patient outcomes. The present study aimed to determine ΔHb and post-HD Hb levels with nationwide data and to examine their associations with all-cause mortality in patients undergoing HD.MethodsThis study is based on data from 2008 and 2009 recorded in the Japanese Renal Data Registry. Study endpoints were all-cause mortality within 1-year. The ΔHb and post-HD Hb level as categorical variables using Cox regression for 1-year mortality, adjusting for potential confounders.ResultsThe median ΔHb was 1.0 g/dl, and the post-HD Hb level was 11.3 g/d. The median pre-HD Hb level was 10.4 g/dl. The risk of mortality was lower with a ΔHb of 0 to 1.0 g/dl (adjusted hazard ratio [aHR], 0.90; 95% confidence interval [CI], 0.70–1.01) or > 1.0 g/dl (aHR, 0.73; 95% CI, 0.64–0.84) than with a ΔHb < 0 g/dl. The risk for mortality was also lower with a post-HD Hb of 10 to 11 g/dl (aHR, 0.82; 95% CI, 0.73–0.92), 11 to 12 g/dl (aHR, 0.77; 95% CI, 0.68–0.87), or > 12 g/dl (aHR, 0.77; 95% CI, 0.68–0.87) than with a post-HD Hb < 10 g/dl.ConclusionsBoth a low ΔHb and a low post-HD Hb level were associated with a higher risk of 1-year mortality.

Iron and Vitamin C Supplements for Young Women with Anemia at Islamic Boarding School Addanuriyah Semarang

Young women are at risk of having anemia higher than young men because every month they had menstruation. The purpose of this study was to determine the effectiveness of giving iron and vitamin C supplements to adolescent girls.This is a quantitative research with true experiment design. Research samples were young women who experienced mild-moderate anemia. The study begins with initial screening by measuring Hb levels. The selected samples were given iron supplements in the control group and given iron supplements plus vitamin C in the treatment group. In weeks I and II Fe tablets and vitamin C were given 1 tablet each. Week III, during menstruation the sample is given 1 tablet of Fe and vitamin C every day during menstruation. In week IV given 1 tablet of Fe and vitamin C.The results showed that there were differences in Hb levels in the groups given Fe and Fe tablets plus vitamin C with significance values α = 0.000 and α = 0.000. The average increase Hb in the group with Fe was 1.2 g / dL and in the group given Fe plus vitamin C it was 1.7 g / dL. The group that received Fe and vitamin C tablets was more effective than the group with Fe tablets only. Vitamin C can increase iron absorption when given during menstruation, so it can reduce anemia in young women Keywords: Iron supplements, Vitamin C, Anemia, Young women

Time influence of umbilical cord clashing on hemoglobin level in newborn baby

Clamping and cutting the umbilical cord is the standard procedure that is always done when the baby is born. The right time to clamp the umbilical cord is still widely debated by experts. The purpose of this research is to know the influence of delay time penglleman umbilical to hemoglobin level in newborn. This type of research is an experimental study with posttest control group design design. The location of the research was conducted at the Bidan Practice Mandiri Setia of Kamonji Puskesmas in Palu in September-October 2017. The population of this study were all newborns in BPM Setia Kota Palu. The samples were 40 newborns consisting of 2 groups of samples, 18 controls infants (2-minute umbilical cord clamp time) and 22 experimental group babies (3-minute cord clamping time). Sampling is done by purposive sampling. Blood collection after umbilical cord clamped and cut from the umbilical vein as much as 2 cc and done in laboratory examination using the tool Hematology Autoanalyzer. Data analysis was done by using average test using independent T-test. The results of the average value of hemoglobin group of 2 minutes amounted to 14.5 g / dl and group 3 minutes of 15.9 gr / dl. Means there is a difference in Hb levels between the time 3 minutes higher than 2 minutes. From the results of independent T-test obtained p value = 0,000, then the value p = 0,000 &lt;α = 0.05. It was concluded that the delay time of umbilical cord clashing effect on hemoglobin level in newborn. The research suggestion the need for health workers to evaluate the delay time of umbilical cord clamping used in APN to increase hemoglobin levels in newborns.

Interleukin-6 gene polymorphisms and serum erythropoietin and hemoglobin in hemodialysis Iraqi patients.

Chronic kidney disease (CKD) is characterized by elevated levels of pro-inflammatory cytokines. Interleukin-6 (IL-6) is a pleiotropic and pro-inflammatory cytokine involved in different biological activities such as hematopoiesis, inflammation, and acute-phase response. The rate of IL-6 synthesis and degradation is affected by single nucleotide polymorphisms. This study aimed to evaluate the frequencies of 174G/C IL-6 gene promoter polymorphism in Iraqi hemodialysis (HD) patient and to examine the association between the allelic variations and serum erythropoietin (EPO) and hemoglobin (Hb) levels. The frequencies of IL-6 gene polymorphism were studied in 70 chronic renal failure patients on maintenance HD (patients group) and in 20 healthy participants (control group). Genotyping of IL-6 gene was performed by conventional polymerase chain reaction-restriction fragment length polymorphism. The distribution of IL-6 genotypes between groups was similar, and GG genotype is the most frequent followed by CG and CC genotypes. Control group had a nonsignificant difference in serum EPO levels among different IL-6 genotypes, while patients with GG genotype displayed significant elevation in serum EPO with time, followed by CG and CC genotypes. No significant differences in Hb levels were observed in patients and control groups. A significant positive correlation was observed between serum EPO and Hb in control group with different IL-6 genotypes, while a nonsignificant negative correlation was observed in patients group throughout the study. CKD did not significantly alter IL-6 genotypes, and IL-6 gene polymorphism had a significant effect on serum EPO levels and a nonsignificant effect on Hb levels.

Distribution of hemoglobin and prevalence of anemia in 10 ethnic minorities in China: A population-based, cross-sectional study.

Racial differences have been reported in hemoglobin (Hb). However, distributions of Hb and anemia rate in ethnic minorities were rarely reported.We aimed to observe whether there are ethnic differences in Hb distributions and prevalence of anemia.The data included 480,699 women 20 to 49 years’ old from 10 ethnic minorities in China in 2014. Analyses of variance were used to examine the differences of Hb distribution among the 10 ethnic groups, as well as the differences in Hb level between different ages, education levels, occupations, and non- or ethnic enclaves in each ethnic group. χ2-test was adopted to analyze the differences in anemia rate among the 10 ethnic groups and between different ages and nonethnic or ethnic enclaves in each ethnic group.The ethnic differences of the Hb distribution and anemia prevalence were observed in the 10 ethnic groups. The lowest mean Hb concentration was shown in Chuang (126.8 g/L), and the highest mean Hb concentration was in Tibetan (138.5 g/L). According to the World Health Organization criteria to define anemia, the highest prevalence was in Tibetan (46.9%) after the adjustment of Hb concentration for altitude, and the lowest prevalence was in Yi (10.6%). Furthermore, there were differences on mean Hb concentration or anemia rate in participants between ethnic enclaves and non-ethnic enclaves in most ethnic groups.The ethnic differences of the Hb distribution and anemia prevalence were observed in the 10 ethnic groups, which might be associated with geographic conditions, genetic background, and eating habits.

Anemia and pregnancy outcomes: a longitudinal study

Objectives: To determine the prevalence of anemia at the first antenatal visit and at 32–34 weeks gestational age, and to evaluate perinatal and maternal outcomes.Methods: Venous blood samples were obtained for complete blood counts at both study visits. Maternal and perinatal morbidity and mortality were also recorded. The data were analyzed using SPSS (version 23).Results: Two thousand pregnant women were recruited. The prevalence of anemia was 42.7% (n = 854/2000) at the first antenatal visit. Thirty-five percent had mild anemia and 68.9% had normocytic normochromic anemia. The prevalence of anemia in HIV infected women was higher than that in the noninfected group and 47.2% of the study population (n = 2000) was HIV infected. At the 32–34 weeks visit, hemoglobin (Hb) levels were available for 1433/2000 (71.7%) of the participants. The prevalence of anemia was 28.1% (n = 403/1433); 19.3% had mild anemia and 65.3% had normocytic normochromic anemia. There was a significant difference in Hb levels between that of the first visit and that at 32–34 weeks (42.7% vs. 28.1%; p = .001; 95% CI: 0.11–0.18). There were significant differences in prematurity, birth weight and hypertensive disorders of pregnancy between the anemic and nonanemic groups.Conclusion: The prevalence of anemia decreased from 42.7% (booking) to 28.1% (32 − 34 weeks). Normocytic normochromic anemia was the commonest type of anemia. Attention needs to be focused on detailed investigations to establish the exact cause of anemia.

Short-acting erythropoiesis-stimulating agents for anaemia in predialysis patients.

The benefits of erythropoiesis-stimulating agents (ESA) for chronic kidney disease (CKD) patients have been previously demonstrated. However, the efficacy and safety of short-acting epoetins administered at larger doses and reduced frequency as well as of new epoetins and biosimilars remains uncertain. This review aimed to evaluate the benefits and harms of different routes, frequencies and doses of epoetins (epoetin alpha, epoetin beta and other short-acting epoetins) for anaemia in adults and children with CKD not receiving dialysis. We searched the Cochrane Kidney and Transplant Specialised Register to 12 September 2016 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. We included randomised control trials (RCTs) comparing different frequencies, routes, doses and types of short-acting ESAs in CKD patients. Two authors independently assessed study eligibility and four authors assessed risk of bias and extracted data. Results were expressed as risk ratio (RR) or risk differences (RD) with 95% confidence intervals (CI) for dichotomous outcomes. For continuous outcomes the mean difference (MD) with 95% confidence intervals (CI) was used. Statistical analyses were performed using the random-effects model. We identified 14 RCTs (2616 participants); nine studies were multi-centre and two studies involved children. The risk of bias was high in most studies; only three studies demonstrated adequate random sequence generation and only two studies were at low risk of bias for allocation concealment. Blinding of participants and personnel was at low risk of bias in one study. Blinding of outcome assessment was judged at low risk in 13 studies as the outcome measures were reported as laboratory results and therefore unlikely to be influenced by blinding. Attrition bias was at low risk of bias in eight studies while selective reporting was at low risk in six included studies.Four interventions were compared: epoetin alpha or beta at different frequencies using the same total dose (six studies); epoetin alpha at the same frequency and different total doses (two studies); epoetin alpha administered intravenously versus subcutaneous administration (one study); epoetin alpha or beta versus other epoetins or biosimilars (five studies). One study compared both different frequencies of epoetin alpha at the same total dose and at the same frequency using different total doses.Data from only 7/14 studies could be included in our meta-analyses. There were no significant differences in final haemoglobin (Hb) levels when dosing every two weeks was compared with weekly dosing (4 studies, 785 participants: MD -0.20 g/dL, 95% CI -0.33 to -0.07), when four weekly dosing was compared with two weekly dosing (three studies, 671 participants: MD -0.16 g/dL, 95% CI -0.43 to 0.10) or when different total doses were administered at the same frequency (four weekly administration: one study, 144 participants: MD 0.17 g/dL 95% CI -0.19 to 0.53).Five studies evaluated different interventions. One study compared epoetin theta with epoetin alpha and found no significant differences in Hb levels (288 participants: MD -0.02 g/dL, 95% CI -0.25 to 0.21). One study found significantly higher pain scores with subcutaneous epoetin alpha compared with epoetin beta. Two studies (165 participants) compared epoetin delta with epoetin alpha, with no results available since the pharmaceutical company withdrew epoetin delta for commercial reasons. The fifth study comparing the biosimilar HX575 with epoetin alpha was stopped after patients receiving HX575 subcutaneously developed anti-epoetin antibodies and no results were available.Adverse events were poorly reported in all studies and did not differ significantly within comparisons. Mortality was only detailed adequately in four studies and only one study included quality of life data. Epoetin alpha given at higher doses for extended intervals (two or four weekly) is non-inferior to more frequent dosing intervals in maintaining final Hb levels with no significant differences in adverse effects in non-dialysed CKD patients. However the data are of low methodological quality so that differences in efficacy and safety cannot be excluded. Further large, well designed, RCTs with patient-centred outcomes are required to assess the safety and efficacy of large doses of the shorter acting ESAs, including biosimilars of epoetin alpha, administered less frequently compared with more frequent administration of smaller doses in children and adults with CKD not on dialysis.

Impact of body mass index, waist circumference and Pfannenstiel sitetissue thickness, and elastosonography on operative parameters

Background/aim: This study aimed to evaluate the impact of body fat distribution measured by body mass index (BMI), waist circumference (WC) and Pfannenstiel incision site tissue thickness, and elastosonography on bleeding and operation time during cesarean delivery.Materials and methods: A prospective study was made of 52 healthy, term pregnant women with prior cesarean deliveries. The impact of BMI, WC, incision site thickness, and elastosonography on preoperative and postoperative differences in hemoglobin (Hb) and hematocrit (Htc) levels and operation times was evaluated.Results: A moderate negative relationship was found between Htc levels and WC. Htc levels were found to decrease by 0.148 units for each 1-cm increase in WC. Skin-to-fascia time was found to increase by 0.697 s with each 1-unit increase in BMI, whereas fascia-to-uterus time was found to increase by 1.117 s with each 1-cm increase in Pfannenstiel site tissue thickness. None of the elastosonographies or differences in Hb levels were found to be significant for any parameter.Conclusion: Each of the evaluated parameters was found to have an impact on different factors: WC on Htc levels, BMI on skin-to-fascia time, and Pfannenstiel tissue thickness on fascia-to-uterus time.