Disease-related Anemia Research Articles

Bone marrow disease profile in geriatric patients: An institutional study

For the diagnosis and treatment of numerous hematological and non-hematological disorders in patients of all ages, a bone marrow examination is a crucial investigation. Due to the growing elderly population and the paucity of published studies on bone marrow disorders that only affect the elderly, age-related health conditions are becoming more prevalent. In our study, we enrolled elderly patients >60 years old who had a bone marrow examination at GMC Jammu's pathology department.: To study the profile of various hematological and non-hematological lesions diagnosed on Bone Marrow aspiration and/or Trephine biopsy in Geriatric age group 2. To summarize an approach for evaluation of anemia in elderly patients for better management.: The study was conducted in two parts; a Retrospective study for 4 years and a prospective study of 1 year. It included all the patients >60 years of age who had undergone Bone marrow examination in the hematology section of the Department of Pathology.: 200 bone marrow aspirations and 40 trephine biopsies, as well as peripheral blood smears and biopsy imprint smears, were all examined. Aplastic anemia, Megaloblastic anemia, Iron deficiency anemia, chronic disease-related anemia, and ITP were among the non-malignant hematological disorders that affected 50.5% (n=101) of the patients; various hematological malignancies affected 40.5% (n=81) of the patients; and non-hematological malignancies affected 1% (n=2) of the patients. 1% (n=2) of the cases were insufficient, and 7% (n=14) of the cases in which BMA and/or BMB were used for lymphoma staging and follow-up did not show any signs of marrow infiltration. With the growing elderly population in India, it is important to pay more attention to diagnosing and treating easily treatable conditions like anemia as well as enhancing the general health of geriatric patients the elderly, bone marrow aspiration.

Assessment of the safety of Roxadustat for cardiovascular events in chronic kidney disease-related anemia using meta-analysis and bioinformatics.

This study compares the cardiovascular risk in anemic chronic kidney disease patients treated with Roxadustat versus erythropoietin stimulating agents (ESAs). It also explores the cardiovascular impact of Roxadustat. We searched PubMed, EMBASE, Cochrane, Scopus, and Web of Science databases up to 13 August 2023, using terms such as "ESA," "Roxadustat," "MACE," "stroke," "death," "myocardial infarction," and "heart failure." Two researchers independently selected and extracted data based on predefined criteria. We assessed the risk of bias with the Cochrane tool and analyzed statistical heterogeneity using the Q and I2 tests. We conducted subgroup analyses by geographical region and performed data analysis with Stata 14.0 and RevMan 5.4 software. Data were sourced from the NCBI database by filtering for "Roxadustat" and "human," and differentially expressed genes were identified using R software, setting the significance at p < 0.01 and a 2-fold logFC, followed by GO enrichment analysis, KEGG pathway analysis, and protein interaction network analysis. A total of 15 articles encompassing 1,43,065 patients were analyzed, including 1,38,739 patients treated with ESA and 4,326 patients treated with Roxadustat. In the overall population meta-analysis, the incidences of Major Adverse Cardiovascular Events (MACE), death, and heart failure (HF) were 13%, 8%, and 4% in the Roxadustat group, compared to 17%, 12%, and 6% in the ESA group, respectively, with P-values greater than 0.05. In the subgroup analysis, the incidences were 13%, 11%, and 4% for the Roxadustat group versus 17%, 15%, and 5% for the ESA group, also with p-values greater than 0.05. Bioinformatics analysis identified 59 differentially expressed genes, mainly involved in the inflammatory response. GO enrichment analysis revealed that these genes are primarily related to integrin binding. The main pathways identified were the TNF signaling pathway, NF-κB signaling pathway, and lipid metabolism related to atherosclerosis. The protein interaction network highlighted IL1B, CXCL8, ICAM1, CCL2, and CCL5 as the top five significantly different genes, all involved in the inflammatory response and downregulated by Roxadustat, suggesting a potential role in reducing inflammation. The meta-analysis suggests that the use of Roxadustat and ESA in treating anemia associated with chronic kidney disease does not significantly alter the likelihood of cardiovascular events in the overall and American populations. However, Roxadustat exhibited a safer profile with respect to MACE, death, and heart failure. The bioinformatics findings suggest that Roxadustat may influence integrin adhesion and affect the TNF and NF-κB signaling pathways, along with lipid and atherosclerosis pathways, potentially reducing inflammation.

HSD72 Improving Patient Care for Chronic Kidney Disease-Related Anemia in Italy: A Survey to Evaluate the Nephrological Card As a Tool for Optimizing Treatment Pathway

HSD72 Improving Patient Care for Chronic Kidney Disease-Related Anemia in Italy: A Survey to Evaluate the Nephrological Card As a Tool for Optimizing Treatment Pathway

Restless legs syndrome in chronic renal failure patients on dialysis.

Restless legs syndrome (RLS) occurs in patients with chronic renal failure (CRF). To determine the prevalence and morbidity of RLS in CRF patients on dialysis. This cross-sectional questionnaire-based study included 100 dialysis patients (50 on haemodialysis [HD]; 50 on peritoneal dialysis [PD]). A focused lower limb examination was done. Patients were classified with RLS when reporting uncomfortable feelings in their legs that improved with movement and worsened when resting and at night. Gender distribution was equal. The median age was 43 (19-67) years. Six patients (HD and PD n=3 each) had international criteria-confirmed RLS. Twenty-four patients reported symptoms suggestive of RLS. Fourteen and 16 patients with RLS symptoms were on HD and PD, respectively. Sleep disturbances occurred in 43.3% (n=13) of patients with RLS symptoms, compared to 20.0% (n=20) of the large cohort. Sleep disturbances, peripheral sensory loss, chronic disease-related anaemia, increased urea and decreased albumin levels were more common among patients with RLS symptoms. RLS symptoms occurred in 30.0% of the entire cohort, although only 6.0% met the international criteria. The type of dialysis had no impact on the incidence of symptoms. Identifying RLS in patients with CRF on dialysis will allow for early intervention.

A retrospective database analysis of erythropoiesis-stimulating agent treatment patterns and associated healthcare resource use in patients with non-dialysis-dependent chronic kidney disease-related anaemia in Japan.

This study was conducted to evaluate clinical characteristics, treatment patterns, and healthcare resource use (HCRU) for patients in Japan with non-dialysis-dependent chronic kidney disease (CKD) and anaemia. This retrospective, longitudinal, epidemiological database extraction study used the JMDC Claims Database, comprising ~9.4 million unique beneficiaries. The observation period for anaemia and erythropoiesis-stimulating agent (ESA)/iron treatment was 1 January 2015 to 31 December 2018, and for HCRU and costs was 1 April 2016 to 31 March 2018. The non-dialysis-dependent CKD anaemia population, and the ESA treatment, iron treatment, and no-treatment cohorts were evaluated. Patient characteristics, treatment patterns, and outcomes were summarised descriptively. The non-dialysis-dependent CKD anaemia population included 5908 patients (7.9%), with 464 patients in the ESA treatment cohort, 809 patients (13.7%) in the iron treatment cohort (13.7%), and 4405 (74.6%) patients in the no-treatment cohort. The prevalence of patients prescribed an antihypertensive, antidiabetic, and/or antihyperlipidaemic medication generally increased with increasing baseline CKD stage. Proportions of no treatment for anaemia decreased while ESA treatment increased with increasing CKD stage; ESA treatment increased with decreasing baseline haemoglobin levels. Patients in the ESA treatment cohort generally had more frequent events associated with HCRU and higher costs from HCRU-associated activities (e.g., inpatient and outpatient care, pharmacy). As CKD severity increased, anaemia management changed from iron use or no treatment to ESA use; however, anaemia may be undertreated across all CKD stages. ESA-treated patients incurred greater HCRU-associated costs relative to other patients with non-dialysis-dependent CKD anaemia in Japan.

Correlation between blood concentration of roxadustat and clinical efficacy in patients with anemia of chronic kidney disease.

Roxadustat has been associated with the efficacy and safety in patients with chronic kidney disease-related anemia. However, the relationship between roxadustat blood concentration and clinical efficacy is lacking. To explore of the correlation between clinical efficacy and blood concentration of roxadustat in patients with renal anemia of chronic kidney diseases, so as to provide reference for rational clinical drug use. A total of 46 patients were selected with a diagnosis of renal anemia who were prescribed roxadustat at the department of nephrology of the First Hospital of Hebei Medical University from December 2019 to March 2020. The roxadustat blood concentration was determined at 12 weeks of treatment, according to the cumulative response rate, patients were divided into the response group and the nonresponse group, and the relationship between roxadustat blood concentration and treatment effect was analyzed. We also explored the correlation between various factors and the blood concentration. The patients in the response group had higher roxadustat blood concentrations than the nonresponse group (P < .05), and there was no correlation between blood concentration and clinical characteristics such as age, gender, and dosage (P > .05). The blood concentration of roxadustat was correlated with clinical efficacy. The higher the blood concentration, the better the clinical efficacy, meaning it might be a predictor of efficacy.

A Case-Control Study of the Factors Associated with Anemia in Chinese Children Aged 3-7 years Old.

Anemia in children is still an important public problem in China and can have a profound impact on the physical and mental health of children. The purpose of this study was to explore the risk factors for anemia among Chinese children aged 3-7 years old and to provide some basis for the prevention and control of anemia. A matched case-control study was conducted and 1104 children (552 cases and 552 controls) were recruited in this study. Cases were children who were diagnosed with anemia by the doctor of physical examination and checked by one deputy chief physician of pediatrics, and controls were healthy children without anemia. Data were collected using a self-designed structured questionnaire. Univariable and multivariable analyses were used to identify independent determinants of anemia. P values less than 0.05 were used to declare statistical significance. In the multivariable analyses, maternal anemia before or during pregnancy and lactation (OR = 2.14, 95% CI: 1.10∼4.15; OR = 2.86, 95% CI: 1.66∼4.94; OR = 2.51, 95% CI: 1.13∼5.60), gestational weeks (OR = 0.72, 95% CI: 0.53∼0.96), having G6PD deficiency or thalassemia (OR = 8.12, 95% CI: 2.00∼33.04; OR = 36.25, 95% CI: 10.40∼126.43), having cold and cough in previous two weeks (OR = 1.56, 95% CI: 1.04∼2.34), family income (OR = 0.80, 95% CI: 0.65∼0.97), and being a picky eater (OR = 1.80, 95% CI: 1.20∼2.71) were determinants of anemia in children aged 3-7 years old. Some of the identified factors are modifiable and could be targeted to reduce childhood anemia. More emphasis should be given by the concerned bodies to intervene in the anemia problem by improving the maternal health education, screening for disease-related anemia, requesting medical services in a timely manner, improving the economic status of households, promoting dietary habits, and improving sanitation and hygiene practices.

The effect of HIF on metabolism and immunity.

Cellular hypoxia occurs when the demand for sufficient molecular oxygen needed to produce the levels of ATP required to perform physiological functions exceeds the vascular supply, thereby leading to a state of oxygen depletion with the associated risk of bioenergetic crisis. To protect against the threat of hypoxia, eukaryotic cells have evolved the capacity to elicit oxygen-sensitive adaptive transcriptional responses driven primarily (although not exclusively) by the hypoxia-inducible factor (HIF) pathway. In addition to the canonical regulation of HIF by oxygen-dependent hydroxylases, multiple other input signals, including gasotransmitters, non-coding RNAs, histone modifiers and post-translational modifications, modulate the nature of the HIF response in discreet cell types and contexts. Activation of HIF induces various effector pathways that mitigate the effects of hypoxia, including metabolic reprogramming and the production of erythropoietin. Drugs that target the HIF pathway to induce erythropoietin production are now approved for the treatment of chronic kidney disease-related anaemia. However, HIF-dependent changes in cell metabolism also have profound implications for functional responses in innate and adaptive immune cells, and thereby heavily influence immunity and the inflammatory response. Preclinical studies indicate a potential use of HIF therapeutics to treat inflammatory diseases, such as inflammatory bowel disease. Understanding the links between HIF, cellular metabolism and immunity is key to unlocking the full therapeutic potential of drugs that target the HIF pathway.

Momelotinib for the treatment of myelofibrosis with anemia.

Myelofibrosis is a myeloproliferative neoplasm characterized by splenomegaly, debilitating constitutional symptomsand bone marrow failure. Disease-related anemia is common and associated with an inferior quality of life and survival. Unfortunately, few therapies exist to improve hemoglobin in myelofibrosis patients. Momelotinib is a JAK1/JAK2 inhibitor that also antagonizes ACVR1, leading to downregulation of hepcidin expression and increased availability of iron for erythropoiesis. In clinical testing, momelotinib has demonstrated a unique ability to improve hemoglobin and reduce transfusion burden in myelofibrosis patients with baseline anemia, while producing reductions in spleen size and symptom burden. This review explores the preclinical rationale, clinical trial dataand future role of momelotinib in the evolving therapeutic landscape of myelofibrosis.

Non-nutritional and disease-related anemia in Indone-sia: A systematic review.

Non-nutritional anemia, the second most common type of anemia worldwide after nutritional anemia, includes the anemia of inflammation (AI) and that due to helminthiasis. In this review, we examine the contribution that non-nutritional anemia makes to incidence in Indonesia. Anemia due to helminthiasis is a common problem in Indonesia and contributes to prevalence, particularly in children under 5 years. We conducted a systematic literature review based on Google Scholar and Pubmed for non-nutritional anemia. We supplemented this with hemoglobin and chronic disease data in Makassar where prevalence and type of anemia were available. To effectively reduce anemia prevalence in Indonesia, interventions should address both nutritional and non-nutritional contributing factors, in-cluding infection and genetic predisposition.

Non-nutritional and disease-related anemia in Indone-sia: A systematic review.

Non-nutritional anemia, the second most common type of anemia worldwide after nutritional anemia, includes the anemia of inflammation (AI) and that due to helminthiasis. In this review, we examine the contribution that non-nutritional anemia makes to incidence in Indonesia. Anemia due to helminthiasis is a common problem in Indonesia and contributes to prevalence, particularly in children under 5 years. We conducted a systematic literature review based on Google Scholar and Pubmed for non-nutritional anemia. We supplemented this with hemoglobin and chronic disease data in Makassar where prevalence and type of anemia were available. To effectively reduce anemia prevalence in Indonesia, interventions should address both nutritional and non-nutritional contributing factors, in-cluding infection and genetic predisposition.

Erythropoiesis and chronic kidney disease-related anemia: From physiology to new therapeutic advancements.

Erythropoiesis is triggered by hypoxia and is strictly regulated by hormones, growth factors, cytokines, and vitamins to ensure an adequate oxygen delivery to all body cells. Abnormalities in one or more of these factors may induce different kinds of anemia requiring different treatments. A key player in red blood cell production is erythropoietin. It is a glycoprotein hormone, mainly produced by the kidneys, that promotes erythroid progenitor cell survival and differentiation in the bone marrow and regulates iron metabolism. A deficit in erythropoietin synthesis is the main cause of the normochromic normocytic anemia frequently observed in patients with progressive chronic kidney disease. The present review summarizes the most recent findings about each step of the erythropoietic process, going from the renal oxygen sensing system to the cascade of events induced by erythropoietin through its own receptor in the bone marrow. The paper also describes the new class of drugs designed to stabilize the hypoxia-inducible factor by inhibiting prolyl hydroxylase, with a discussion about their metabolism, disposition, efficacy, and safety. According to many trials, these drugs seem able to simulate tissue hypoxia and then stimulate erythropoiesis in patients affected by renal impairment. In conclusion, the in-depth investigation of all events involved in erythropoiesis is crucial to understand anemia pathophysiology and to identify new therapeutic strategies, in an attempt to overcome the potential side effects of the commonly used erythropoiesis-stimulating agents.

The hypoxia inducible factor/erythropoietin (EPO)/EPO receptor pathway is disturbed in a rat model of chronic kidney disease related anemia.

ObjectivesAnemia is a known driver for hypoxia inducible factor (HIF) which leads to increased renal erythropoietin (EPO) synthesis. Bone marrow (BM) EPO receptor (EPOR) signals are transduced through a JAK2-STAT5 pathway. The origins of anemia of chronic kidney disease (CKD) are multifactorial, including impairment of both renal EPO synthesis as well as intestinal iron absorption. We investigated the HIF- EPO- EPOR axis in kidney, BM and proximal tibia in anemic juvenile CKD rats.MethodsCKD was induced by 5/6 nephrectomy in young (20 days old) male Sprague-Dawley rats while C group was sham operated. Rats were sacrificed 4 weeks after CKD induction and 5 minutes after a single bolus of IV recombinant human EPO. An additional control anemic (C-A) group was daily bled for 7 days.ResultsHemoglobin levels were similarly reduced in CKD and C-A (11.4 ± 0.3 and 10.8±0.2 Vs 13.5±0.3 g/dL in C, p<0.0001). Liver hepcidin mRNA was decreased in CA but increased in CKD. Serum iron was unchanged while transferrin levels were mildly decreased in CKD. Kidney HIF2α protein was elevated in C-A but unchanged in CKD. Kidney EPO protein and mRNA levels were unchanged between groups. However, BM EPO protein (which reflects circulating EPO) was increased in C-A but remained unchanged in CKD. BM and proximal tibia EPOR were unchanged in C-A but decreased in CKD. Proximal tibial phospho-STAT5 increased after the EPO bolus in C but not in CKD.ConclusionsCompared to blood loss, anemia in young CKD rats is associated with inappropriate responses in the HIF-EPO-EPO-R axis: kidney HIF2α and renal EPO are not increased, BM and bone EPOR levels, as well as bone pSTAT5 response to EPO are reduced. Thus, anemia of CKD may be treated with additional therapeutic avenues beyond iron and EPO supplementation.

Role of anuria in the relationship between indoxyl sulfate and anemia in peritoneal dialysis patients.

BackgroundExperimental evidence suggests that indoxyl sulfate (IS) is associated with chronic kidney disease-related anemia. However, clinical studies are limited, and few have explored the potential confounding effect of anuria. This study, thus, evaluated the association between IS and anemia in both non-anuric and anuric peritoneal dialysis (PD) patients.MethodsThis cross-sectional and observational study included 165 chronic PD patients aged 19–84 years. Their serum IS levels in total and free forms were measured by ultra performance liquid chromatography. Correlations between serum IS and hemoglobin (Hb) were performed in both non-anuric and anuric groups.ResultsAmong the study subjects, 90 were non-anuric and 75 were anuric. As a whole, there was no correlation between IS and Hb. Nonetheless, subsequent analysis of the non-anuric patients showed that Hb is negatively correlated with IS levels (rs=−0.405, P<0.001 for total form and rs=−0.296, P=0.005 for free form). Factors that significantly affected Hb levels in the stepwise multiple regression analysis include total IS and iron saturation. In contrast for anuric patients, serum ferritin, albumin, iron saturation, use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, but not serum IS, were predictors for anemia in the multiple regression model.ConclusionsSerum IS is associated with an increased severity of anemia in non-anuric PD patients and not in anuric ones, indicating anuria could be a confounding factor in such association.

The Impact of Anemia on Overall Survival in Patients with Myelofibrosis Treated with Ruxolitinib: An Exploratory Analysis of the Comfort Studies

Introduction: Anemia is a sign of disease progression and a key prognostic factor in myelofibrosis (MF). In the phase 3 COMFORT studies, ruxolitinib, a Janus kinase (JAK) 1/JAK2 inhibitor, demonstrated improved overall survival compared with placebo and best available therapy in patients with intermediate 2 or high-risk MF (per the International Prognostic Scoring System [IPSS]). Ruxolitinib treatment was associated with dose-dependent increases in cytopenias that occurred mostly in the first 12 weeks of therapy and were manageable with dose adjustments and red blood cell (RBC) transfusions. The objective of this analysis was to evaluate the differential impact of disease-related anemia (anemia at baseline) and anemia occurring after initiation of ruxolitinib therapy on overall survival (OS) in patients with MF.Methods: Data from the COMFORT-I and COMFORT-II 3-year data cuts were pooled for this exploratory analysis for patients who survived at least 12 weeks after day 1. Baseline anemia was defined as hemoglobin (Hgb) < 10 g/dL at baseline or receipt of RBC transfusions within 12 weeks prior to day 1. Postbaseline anemia was defined as new or worsening anemia within the first 12 weeks after initiation of ruxolitinib therapy that was grade ≥ 2 (per Common Terminology Criteria for Adverse Events v3.0) and a higher grade than at baseline; this time frame captures 85% of these events during ruxolitinib treatment. Patients were assessed for OS using a cox model stratified by study and baseline anemia status to evaluate the impact of anemia occurring after ruxolitinib initiation on OS.Results: Among patients treated with ruxolitinib (n = 296), 162 patients were not anemic at baseline and 134 patients were anemic at baseline. Of the 162 patients who were not anemic at baseline, 99 had postbaseline anemia; of the 134 with anemia at baseline, 93 also had postbaseline anemia. Consistent with published prognostic models, anemia at study baseline was prognostic of decreased survival in this study (Figure 1). A higher proportion of those who were anemic at baseline had PMF (58% vs 40%) and high-risk disease per the IPSS (69% vs 40%) vs those who were not anemic at baseline. As expected, mean platelet count (308.3 × 109/L vs 280.5 × 109/L), Hgb (12.2g/dL vs 9.1 g/dL), and leukocyte count (24.2 × 109/L vs 17.0 × 109/L) were higher among patients who were not anemic at baseline vs those who were. Within the subgroups of patients with and without baseline anemia, postbaseline anemia did not impact OS during ruxolitinib therapy (Figure 1) (overall hazard ratio for no postbaseline anemia vs postbaseline anemia = 1.030; 95% CI: 0.615-1.725). Patients treated with ruxolitinib had improved OS compared to control patients, both among those with anemia and without anemia at baseline (Figure 1) (overall hazard ratio for ruxolitinib vs control = 0.644; 95% CI: 0.459-0.903; P = .0102). OS probability at 3 years for ruxolitinib vs control was 0.66 vs 0.57 among patients with anemia at baseline, and 0.87 vs 0.66 among patients without anemia at baseline.Conclusions: Consistent with validated prognostic models, baseline anemia was associated with decreased OS in the COMFORT studies. Treatment with ruxolitinib improved OS as compared with the control arm regardless of baseline anemia status. Notably, postbaseline anemia that occurred on ruxolitinib therapy did not impact OS and was manageable with dose adjustments and RBC transfusions. We conclude that early onset ruxolitinib-related anemia does not have the same deleterious effect as disease-related anemia. [Display omitted] DisclosuresGupta:Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Incyte: Honoraria, Research Funding. Harrison:Gilead: Honoraria; Shire: Speakers Bureau; Sanofi: Honoraria, Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau; CTI Biopharma: Consultancy, Honoraria, Speakers Bureau. Al-Ali:Celgene: Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Foltz:Promedior: Research Funding; Novartis: Honoraria, Research Funding; Gilead: Research Funding. Montgomery:Incyte: Employment. Peng:Incyte Corporation: Employment, Equity Ownership. Gopalakrishna:Novartis Pharma AG: Employment. Verstovsek:Incyte Corporation: Research Funding; Astrazeneca: Research Funding; Lilly Oncology: Research Funding; Roche: Research Funding; Geron: Research Funding; NS Pharma: Research Funding; Bristol Myers Squibb: Research Funding; Gilead: Research Funding; Celgene: Research Funding; Seattle Genetics: Research Funding; Promedior: Research Funding; CTI BioPharma Corp.(formerly Cell Therapeutics, Inc.): Research Funding; Galena BioPharma: Research Funding; Pfizer: Research Funding.

Ambulatory Management of Anemia: A Retrospective View from an Italian Multidisciplinary Team

Anemia is one of the most prevalent clinic condition leading to a specialist medical consult. In 2014 our Internal Medicine unit started a Multidisciplinary Anemia Ambulatory (Internist, Immune-Hematologist, Hematologist) with the purpose to rapidly manage, diagnosis and treatment of anemic patients, giving a direct connection between general practitioners and hospital services. We treated and collected data on patients come to our attention in a tertiary care hospital in Genoa (Liguria), an area characterized by elderly population, which often carries more than one comorbidity with the purpose of better define the epidemiology of such a prevalent but underestimated issue. From January 1st 2014 a total of 212 patients came to our attention for internist consult due to anemia: 165 female and 47 male, medium age 63,23 years (F 58,86, M 78,57, range 19-100). A precise classification of anemia was determined for 187 patients: 130 had iron deficiency anemia (IDA, 61,32%), 17 multifactorial anemia (inflammatory disorders, chronic kidney disease and combined deficiency, 8,02%), 16 combined deficiency anemia (iron and vitamins, 7,55%), 9 chronic kidney disease related anemia (4,25%), 7 anemia secondary to inflammatory chronic disorder (3,30%), 5 B12 deficiency (2,36%), 2 both folate and B12 deficiency (0,94%), 1 folate deficiency (0,47%). Twenty-five patients were not classified due to lack of data. Severity of anemia was defined according to WHO criteria: 53 patients (25%) presented mild anemia (Hb 129 - 110 g/L), 123 (58%) moderate anemia (Hb 109 - 80 g/L), 33 (15,6%) severe anemia (Hb < 80 g/L). Three patients were not anemic at the baseline evaluation. We considered comorbidities of internistic relevance, which could be worsened by anemia: cardiovascular (coronary heart disease, arrhythmias, heart failure), 30 patients; neurologic (ischemic and degenerative diseases), 19 patients; respiratory disease (COPD and asthma), 11 patients. Eleven patients had 2 comorbidities (cardiovascular and respiratory or neurological) and 3 patients had all three comorbidities. Patients were treated according to clinical practice in relation to type, severity and clinical manifestation of anemia. One hundred and thirty patients needed more than one access to ambulatory to correct anemia; data from the second access were: patient responders (normalization of Hb levels or improvement of at least 20 g/L): 78 patients; partial responders (improvement of Hb levels from 5 to 20 g/L): 34 patients; non responders: 18 patients. Fourteen patients needed at least 1 blood red cells transfusion, 12 with severe anemia and 2 with moderate anemia. A total of 93 patients needed deep diagnostic insight through specialist pathways, such as hematologic (4 patients), gastroenterologic (39 patients), gynecologic (37 patients), both gastroenterologic and gynecologic (13 patients). All patients were managed as outpatients, except for 8 patients which required hospitalization due to severity of clinical findings: 4 patients were hospitalized in Internal Medicine ward, 1 patients in Gynecology and 3 patients needed access through Emergency Care Unit. Among IDA patients, 92 were treated with intravenous iron supplement: 32 with sodium ferric gluconate (SFG) (medium 16,68 vials, range 8-43) and 50 with ferric carboxymaltose (FC) (medium 1,04 vials). Nine patients treated with SFG experienced allergic reaction, so they were switched to FC. Patients treated with SFG were successfully treated for 69,56% and 26,08% responded partially. One patient treated with FC experienced allergic reaction, so he was switched to oral therapy. FC patients fully responded in 76% and 22% were partial responders. These preliminary data shows that Multidisciplinary Anemia Ambulatory and its diagnostic-therapeutic path, with the involvement of different Specialists and Operative Unit, resulted in an improvement of the coordination and continuity of care, reducing sanitary cost in terms of hospitalization, drugs rationalization and quality of life for patients. More data will derive from the newborn Anemia Regional Register, which will lead to a better comprehension of the real size of anemia in our local epidemiology, in which health derived costs are rising together with ageing of the comorbid population which often needs longitudinal assistance, coordination and continuity of care. DisclosuresNo relevant conflicts of interest to declare.

CAUSES OF CANINE ANEMIA IN TAIWAN: A FIVE-YEAR RETROSPECTIVE SURVEY

Anemia is a common hematologic disorder in dogs, however, few data are available regarding epidemiology and causes in Taiwan. To investigate the causes of anemia, 3174 anemic cases (hematocrit &lt; 37%) collected between January 2008 and December 2012 at National Taiwan University Veterinary Hospital (NTUVH) were analyzed. Most dogs (48.5%, n = 1540) presented with a mild form (30% ≤ hematocrit &lt; 37%), which was followed by a moderate form (20% ≤ hematocrit &lt; 30%; 36.4%, n = 1155), a severe form (13% ≤ hematocrit &lt; 20%; 10.5%, n = 332) and a very severe form (hematocrit &lt; 13%; 4.6%, n = 147). Among the 2037 dogs with identifiable causes, 70.4% (1435 dogs) were induced by single cause, whereas 29.6% (602 dogs) by multiple causes. Cancer-related anemia (CRA, n = 460), infectious pathogens-related anemia (n = 287), renal disease-related anemia (n = 251) and post-surgery/trauma-related anemia (n = 182) account for 32.1%, 20.0%, 17.6% and 12.7% of single-cause cases, respectively. Furthermore, 255 of the total (17.8.0%) presented with severe and very severe anemia. 72 dogs with very severe anemia primarily resulted from infectious disease-related anemia (59.7%), followed by immune-mediated hemolytic anemia (13.9%), and other disease-related anemia (9.7%). Of the 43 infectious disease-related very severe anemic dogs, the most commonly diagnosed pathogen was Babesia gibsoni (83.7%, n = 36), followed by Ehrlichia canis (11.6%, n = 5), Babesia canis (2.3%, n = 1) and Leptospira spp. (2.3%, n = 1). Taken together, cancer, infectious diseases, and renal failure are the most frequent causes of canine anemia in Taiwan, and B. gibsoni appeared to be the most important infectious pathogen causing very severe anemia.

CKD-related anaemia: challenges and precautions using intravenous iron

Intravenous iron is essential in the ongoing management of chronic kidney disease related anaemia and is increasingly being administered to patients in community settings. In this article, Samantha Timmins explains how the renal anaemia service at the Royal Devon and Exeter NHS Foundation Trust has overcome barriers to provide an efficient intravenous iron service for outpatients.

A systematic analysis of global anemia burden from 1990 to 2010.

Previous studies of anemia epidemiology have been geographically limited with little detail about severity or etiology. Using publicly available data, we estimated mild, moderate, and severe anemia from 1990 to 2010 for 187 countries, both sexes, and 20 age groups. We then performed cause-specific attribution to 17 conditions using data from the Global Burden of Diseases, Injuries and Risk Factors (GBD) 2010 Study. Global anemia prevalence in 2010 was 32.9%, causing 68.36 (95% uncertainty interval [UI], 40.98 to 107.54) million years lived with disability (8.8% of total for all conditions [95% UI, 6.3% to 11.7%]). Prevalence dropped for both sexes from 1990 to 2010, although more for males. Prevalence in females was higher in most regions and age groups. South Asia and Central, West, and East sub-Saharan Africa had the highest burden, while East, Southeast, and South Asia saw the greatest reductions. Iron-deficiency anemia was the top cause globally, although 10 different conditions were among the top 3 in regional rankings. Malaria, schistosomiasis, and chronic kidney disease-related anemia were the only conditions to increase in prevalence. Hemoglobinopathies made significant contributions in most populations. Burden was highest in children under age 5, the only age groups with negative trends from 1990 to 2010.

A systematic analysis of global anaemia burden between 1990 and 2010

BackgroundAnaemia is associated with increased maternal and neonatal mortality, with young children most at risk of developing long-term ramifications. Most previous studies have been geographically limited with little detail about severity or aetiology. In this analysis, we completed the most comprehensive survey of anaemia burden to date. MethodsUsing publicly available data, we estimated mild, moderate, and severe anaemia in 1990 and 2010 for 187 countries, both sexes, and 20 age groups. We then performed cause-specific attribution to 17 conditions using data and resources of the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2010. FindingsGlobal anaemia prevalence in 2010 was 32·9%, causing 68·36 million years lived with disability (95% CI 40·98–107·54 million; 8·8% of the total for all conditions, 95% CI 6·3–11·7). Prevalence dropped for both sexes from 1990 to 2010, though more so for males. Females' prevalence was higher in most regions and age groups. South Asia and central, west, and east sub-Saharan Africa had the highest burden, while east, southeast, and south Asia saw the greatest reductions. Ten different conditions were among the top three in prevalence, depending on the region. Malaria, schistosomiasis, and chronic kidney disease-related anaemia were the only conditions to increase in prevalence. Haemoglobinopathies made significant contributions to the anaemia burden in both sexes, most regions, and all time periods. Burden was highest in children under 5 years old, the only age groups with negative trends from 1990 to 2010. InterpretationAnaemia is a heterogeneous and complex condition. Despite significant progress, many challenges remain. Regional differences remain stark, some conditions are growing as a proportion of overall anaemia, the gender gap is widening, and the total disease burden remains high. Worryingly, young children, the most vulnerable group, appear to be doing worse over the past 20 years. Targeted surveillance and intervention in high-risk populations should be a greater priority. FundingFunding for GBD 2010 was provided by the Bill & Melinda Gates Foundation.