Evaluation Of Iron Deficiency Research Articles

Evaluation of iron deficiency in heart failure patients by two methods for determining TIBC

Evaluation of iron deficiency in heart failure patients by two methods for determining TIBC

Iron Deficiency: A Silent Threat in Patients With Heart Failure With Reduced Ejection Fraction.

Background Iron deficiency is a prevalent and clinically significant comorbidity in patients with heart failure with reduced ejection fraction (HFrEF). Despite its high prevalence, its impact on clinical outcomes, mortality, and various physiological parameters remains a subject of ongoing investigation. The findings of this study are anticipated to contribute valuable insights into the management and prognosis of patients with HFrEF, potentially informing future interventions and improving patient outcomes. This study aimed to assess the clinical profile of iron deficiency and its implications on morbidity and mortality in patients with HFrEF. Methodology A prospective cohort study was conducted at King Edward Memorial Hospital, India, involving 371 patients with HFrEF. Participants underwent comprehensive clinical and laboratory assessments, evaluating iron deficiency with signs, symptoms, comorbidities, dyspnea, elevated jugular venous pressure (JVP), past medical history, and various hematological and biochemical parameters. Results Overall, 50% of HFrEF participants were iron deficient (n = 185), of whom 80% (n = 148) had anemia against 43% (n = 81) anemics in iron repletes (n = 186). Of the 185 iron-deficient patients, 44 (11.86%) had absolute iron deficiency and 141 (38%)had functional iron deficiency. Iron deficiency significantly correlated with increased mortality in HFrEF patients (χ2 (1, N = 371) = 3.88, p = 0.048). A large positive correlation was observed between absolute iron deficiency and dyspnea severity (r2 = 0.949, p = 0.026).Statistically significant differences were found in hemoglobin (anemia), serum iron, serum ferritin, total iron-binding capacity, and transferrin saturation between iron-deficient and iron-replete patients (p < 0.05). However, no statistically significant difference in left ventricular ejection fraction between iron-deficient and replete patients was noted. Conclusions Iron deficiency emerges as more than a mere comorbidity in heart failure, becoming a prognostic factor with multifaceted outcomes. Its impact extends beyond cardiovascular consequences, encompassing adverse manifestations such as anemia, ascites, edema, dyspnea, elevated JVP, and a heightened risk of mortality. This intricate interplay positions iron deficiency as a critical determinant, significantly influencing the clinical trajectory and outcomes for patients with HFrEF.

Prevalence and clinical correlates of restless legs syndrome in psychiatric patients: A cross-sectional study from North India.

Restless legs syndrome (RLS) is a neuro-sensorimotor disorder which is scarcely researched and is commonly missed in routine psychiatry practice. To evaluate the prevalence of RLS and its correlates in patients with anxiety, depression, and somatoform disorders. A cross-sectional single-center study was undertaken in patients aged 18-65 years suffering from ICD-10 (International Statistical Classification of Diseases-10th edition) diagnosis of anxiety, depressive, and somatoform disorders. RLS was evaluated by using diagnostic criteria of International Restless Legs Syndrome Study Group (IRLSSG) and severity measured on IRLSSG scale. Depression and anxiety were rated on Hamilton Depression and Anxiety Rating Scales respectively, insomnia severity measured by Insomnia Severity Index (ISI), and quality of life measured by WHO Quality of Life-Brief version (WHO-QOL BREF) scale. Serum ferritin levels were measured for evaluating iron deficiency. The rate of RLS was 66.7%, 50%, and 48% in patients with depressive, anxiety, and somatoform disorders, respectively, with no significant inter-group difference. Nearly one-third of patients suffered from severe to very severe symptoms of RLS, and quality of life was poorest in those with depressive disorders. RLS was significantly higher in females (P = 0.019), who were married (P = 0.040), diagnosed with severe depression (P = 0.029), and abused benzodiazepines (P = 0.045). On binary logistic regression, female gender and presence of clinical insomnia predicted occurrence of RLS. The prevalence of RLS is very high in patients with common psychiatric disorders which is often missed. Clinical enquiry and examination for reversible causes such as iron deficiency may assist in its diagnosis and improve clinical outcome.

Ferritin Reference Ranges in an Adult Population of Working-Age Adults without Anemia

Introduction Considerable controversy has surrounded the creation of reference intervals for ferritin within tested populations. This is particularly true for women and has been attributed to a high prevalence of nonanemic iron deficiency due to physiologic blood loss during menses and physiologic iron transfer during pregnancy. The Quest Blueprint for Wellness (BFW) program is an annual health screening that provides a range of testing to Quest employees and families. Using deidentified data on 24,812 individuals (55% female; age range 18-80 years old) collected as part of this program, we studied the relationship between serum ferritin and characteristics of the study population, red blood cell parameters, and iron saturation in order to better define normal reference ranges for serum ferritin. Methods Test results of participants in the annual BFW screening program conducted between January 2022 and May 2023 were identified (26,535 [53% female]); tests included hematocrit, hemoglobin, RBC indices (including RDW), total serum iron and total iron binding capacity and CRP. Individuals with abnormalities of hemoglobin, hematocrit or RBC indices (including RDW); serum iron or serum TIBC; or elevated CRP were successively excluded, leaving 24,812 participants (55% female). None of these remaining individuals had a personal history of anemia or an identified ICD-10 code associated with anemia or other RBC disorder. This study population was used in subsequent analyses. Multimodal decomposition (MMD) in R (version 4.2.2) was used to calculate reference intervals based on the distribution of results associated with the healthy study subpopulation that was defined. To address the possibility that the TIBC saturation initially employed (20%) was too low, reference intervals were also determined when varying TIBC saturations from 20%-25%. Results As shown in Table 1, the lower limits of the ranges identified did not vary significantly as the TIBC saturation percent was increased from 20% to 25%. The lower limit for women below 50 years of age ranged from 11-13 ng/mL, which was substantially lower than the lower limits for men of the same age. Over the age of 50, the lower limit of the ferritin reference ranges for women increased, approaching but not equaling or exceeding the values observed for men until ages greater than 70. This may reflect the end of menses and the gradual repletion of iron stores. In contrast, the lower limits of the reference ranges for serum ferritin for men increased at ages 30-40 and then declined and fell below that of women in the eighth decade. Conclusions Comparing the lower range of ferritin values between men and women, these data suggest that iron deficiency may be present in a large proportion of working age women in the absence of anemia or abnormal RBC indices. These data also suggest that normal ferritin values are age dependent for both men and women. These conclusions are tempered by the unavailability of a physiologic reference standard able to demonstrate that iron deficiency is in fact present. The lower limit of the ferritin range for women under the age of 60 and for men over the age of 70 approximates the ferritin values associated with the absence of stainable bone marrow iron. While this test is the traditional “gold standard” it is rarely performed for the evaluation of iron status. The evaluation of iron deficiency at present lacks a physiologic indicator, analogous to the relationship between parathyroid hormone and calcium levels which permitted the definition of blood levels of 25 hydroxyvitamin D that represented sufficiency, or methylmalonic acid concentration in B12 deficiency. The broader availability of measures to assess the functional status of reticuloendothelial iron stores available to support erythropoiesis, such as measurements of hepcidin, would facilitate such an assessment.

S757 Yield of Terminal Ileal Intubation in Evaluating Iron Deficiency Anemia

S757 Yield of Terminal Ileal Intubation in Evaluating Iron Deficiency Anemia

Restless Sleep Disorder and the Role of Iron in Other Sleep-Related Movement Disorders and ADHD

In the last few years, restless sleep has been described as the key element of many clinical issues in childhood, leading to the recognition of “restless sleep disorder” (RSD) as a new proposed diagnostic category. The essential aid of video-polysomnographic recordings enables detection and quantification of the “large muscle group movements” (such as limb movements and repositioning) frequently described by parents of children with RSD. Strong evidence links iron deficiency to the pathophysiology of sleep-related movement disorders such as RSD, restless legs syndrome, periodic limb movement disorder, and attention deficit hyperactivity disorder (ADHD) due to the important role played by the brain dopamine production system. Serum ferritin is the main parameter used to evaluate iron deficiency in patients with sleep-related movement disorders. Iron supplementation is recommended when the serum ferritin level is &lt;50 ng/mL, since the literature emphasizes the correlation between lower levels of serum ferritin, serum iron, and cerebrospinal fluid ferritin, and increased symptom severity. Moreover, several studies report an improvement in symptoms when ferritin levels are kept above 50 ng/mL. In this narrative review, we discuss the role of iron in sleep-related movement disorders, as well as ADHD, highlighting not only the connection between these two conditions, but also the relevance of iron supplementation for symptom improvement.

Long-Term Outcomes of Iron Deficiency Before and After Bariatric Surgery: a Systematic Review and Meta-analysis.

This study reviews the prevalence of iron deficiency (ID) in bariatric surgery candidates and the long-term outcomes of the prevalence of ID after bariatric surgery. A systematic literature search and meta-analysis were performed in PubMed for articles published by August 31, 2022, including these search terms: bariatric surgery, metabolic surgery, weight loss surgery, obesity surgery, sleeve gastrectomy, gastric banding, gastric bypass, duodenal switch, duodenojejunal bypass, iron, iron deficiency, sideropenia, and hypoferritinemia. Fifty-seven studies examining a total of 26,328 patients with morbidly obese were included in this meta-analysis finally. The results showed a prevalence of 17% of ID in bariatric surgery candidates and a prevalence of 14%, 17%, 26%, 34%, 23%, 38%, and 23% of ID at 1-, 2-, 3-, 4-, 5-, 8-, and 10-year follow-up after bariatric surgery, respectively. Additionally, the results showed a prevalence of 15%, 19%, 35%, 38%, 29%, 30%, and 23% of ID at 1-, 2-, 3-, 4-, 5-, 8-, and 10-year follow-up after Roux-en-Y gastric bypass, respectively; a prevalence of 12%, 12%, 15%, 31%, and 17% of ID at 1-, 2-, 3-, 4-, and 5-year follow-up after sleeve gastrectomy, respectively; and a prevalence of 19% of ID at 1-year follow-up after anastomosis gastric bypass. As a result, preoperative evaluation and correction of ID may lead to better outcomes for bariatric surgery candidates. ID is also common in patients after bariatric procedures, especially RYGB. Long-term, even lifelong, medical and nutritional monitoring and tailored interventions are critical.

Iron deficiency as risk factor for febrile convulsion and the association of iron deficiency anemia and febrile convulsion

Background: Febrile seizure occurs in 2–5% of neurologically healthy infants and children. The recurrence of febrile seizures is 30% after single episode, 50% after 2 or more episodes, and 50% when febrile seizures occur in infants. Their incidence of febrile seizures in India is 10–17% which is higher than in developed countries (2–7%). Aims and Objectives: The purpose of this study was to evaluate iron deficiency (ID) as a risk factor for febrile convulsion and the association of ID anemia with febrile convulsions. Materials and Methods: This was an observational case–control study conducted in tertiary care center in central India between December 2019 and June 2021. All patients with febrile seizures taken as cases and control from similar age group with febrile illness. Body temperature of children in both the groups was measured and recorded. The blood tests of complete blood count, serum iron, and TIBC were performed. Results: In the present study, mean age was 2.33 years in case and mean age was 2.204 years in control. The mean hemoglobin levels were 8.25±1 g/dL in the febrile seizure case group and 9.86±1.49 g/dL in the control group; and their statistical difference was significant. Serum ferritin values was significantly lower among cases group than the control group. The average of MCV, MCH, and MCHC for the case group was less than that of the control group. The present study also demonstrates an association between ID and febrile seizures. Thus, ID is one of the possible risk factors for febrile seizures. Conclusion: The present study showed that hemoglobin, MCV, serum ferritin, and serum iron levels are significantly lower in children suffering from febrile seizures, suggesting that a low iron status has an important role in children with febrile seizures. Thus, ID is predictor for febrile convulsion.

Comparison of Erythrocyte and Reticulocyte Indices for Evaluation of Iron Deficiency by Two Automated Hematologic Analyzers.

The reticulocyte hemoglobin content and hypochromic erythrocyte percentage offer advantages in evaluation of iron deficiency, especially in inflammatory conditions. The aim of this study was to evaluate the correlation of reticulocyte hemoglobin content (CHr, Ret-He) and hypochromic erythrocyte percentage (%HYPO, Hypo-He) between two automated hematologic analyzers. The CHr and %HYPO values were determined using the Advia 2021i (Siemens), while the Ret-He and Hypo-He levels were assessed using the XN-3000 (Sysmex). Data from a total of 971 cases and 834 patients were collected. For reticulocyte hemoglobin content, there was a good linear correlation between CHr and Ret-He (r = 0.857, p < 0.001). For percentage of hypochromic erythrocytes, there was a better correlation between the two measures when using a second-degree polynomial equation (Hypo-He* = 0.4818 - 0.0218 x %HYPO + 0.0069 x %HYPO2) (r = 0.786, p < 0.001).

Usefulness of Reticulocyte Haemoglobin Equivalent in the Evaluation of Iron Deficiency Status: A Cross-sectional Study

Introduction: Iron deficiency is the most frequent cause of nutritional anaemia. Evaluation of parameters like serum ferritin and iron is critically important for evaluation of the iron status of patients and diagnosis of Iron Deficiency Anaemia (IDA). But in inflammatory disorders, ferritin concentration may be normal or increased due to the acute phase response, resulting in inaccurate interpretation of the iron status. Similarly, the serum Iron levels may be high in cases of thalassaemia with combined iron deficiency. Reticulocyte Haemoglobin equivalent (RET-He) which correlates to the iron content in reticulocytes is effective, convenient and provides useful information for the immediate diagnosis and treatment of iron deficient states. Aim: The aim of this study was to evaluate the diagnostic performance of RET-He level by comparing it with the iron status of the patients. Materials and Methods: This cross-sectional study was done in Department of Pathology at Tagore Medical College and Hospital, Chennai, Tamil Nadu, India, from December 2020 to November 2021. The complete blood count, RET-He, serum iron and serum ferritin levels of 406 patients with microcytic hypochromic anaemia and dimorphic anaemia were reviewed and RET-He levels were compared with the serum iron and ferritin levels. The p-value was calculated using Statistical Package for Social Sciences (SPSS) IBM software version 28.0. The sensitivity of RET-He and serum ferritin levels in evaluating iron deficiency were calculated. Results: Low RET-He was observed in 394 cases, low serum iron in 401 cases and reduced serum ferritin in 376 cases. Twenty one of 34 cases of IDA with concomitant inflammation showed low RET-He and serum iron, despite normal to high serum ferritin levels. Five cases of iron deficiency with concomitant Haemoglobin defect also showed low RET-He levels and serum ferritin, whereas the serum iron was raised. Low RET-He was observed in 17 cases of dual deficiency anaemia i.e., iron deficiency along with vitamin B12/folate deficiency. Conclusion: It was concluded that measurement of the reticulocyte haemoglobin content provides useful information for the diagnosis, treatment and monitoring of iron deficient states.

Incidence of iron deficiency anemia among the children with febrile seizures.

Objective: To determine frequency of iron deficiency anemia among the children having febrile seizures. Study Design: Descriptive Cross Sectional study. Setting: Pediatric Unit Allama Iqbal Memorial Teaching Hospital Sialkot. Period: September 2020 to February 2021. Material &amp; Methods: Total 70 children were studied with age six months to 10 years with either gender presenting with febrile seizures. All data of the patients was documented including demographic data like age, gender, residential area, educational status, socioeconomic status and clinical findings at the time of presentation like fever, fits and duration of symptoms etc. Blood hemoglobin and ferritin level were tested of each patient to evaluate iron deficiency anemia. Results: There were 65.7% male and 34.3% female cases in this study. Age range of the patients was 6 months to 10 years with mean age of 4.36 ± 2.71 years. Most of the children (60%) were below three years of age. Mostly children belonged to low and middle socioeconomic status with the frequency of 42.8% and 45.7% respectively. Iron deficiency anemia was found in 38.6% cases. Majority of the mothers were illiterate (65%). There were 44.3% cases from rural areas and 55.7% from urban area. Conclusion: Iron deficiency anemia is a common problem among children with febrile seizures, younger than 03 years and belonging to rural areas. Illiterate mothers, is an important risk factor of iron deficiency anemia in their children.

The Evaluation of Iron Deficiency and Iron Overload

In the western world, 10-15% of women of child-bearing age suffer from iron-deficiency anemia. Iron overload due to chronic treatment with blood transfusions or hereditary hemochromatosis is much rarer. This review is based on pertinent publications retrieved by a selective search on the pathophysiology, clinical features, and diagnostic evaluation of iron deficiency and iron overload. The main causes of iron deficiency are malnutrition and blood loss. Its differential diagnosis includes iron-refractory iron deficiency anemia (IRIDA), a rare congenital disease in which the hepcidin level is pathologically elevated, as well as the more common anemia of chronic disease (anemia of chronic inflammation), in which increased amounts of hepcidin are formed under the influence of interleukin-6 and enteric iron uptake is blocked as a result. Iron overload comes about through long-term transfusion treatment or a congenital disturbance of iron metabolism (hemochromatosis). Its diagnostic evaluation is based on clinical and laboratory findings, imaging studies, and specific mutation analyses. Our improving understanding of the molecular pathophysiology of iron metabolism aids in the evaluation of iron deficiency and iron overload and may in future enable treatment not just with iron supplementation or iron chelation, but also with targeted pharmacological modulation of the hepcidin regulatory system.

Iron deficiency anemia and associated factors among pregnant women in a tertiary care hospital, in Sargodha District, Pakistan

Purpose: To evaluate iron deficiency anemia and other concomitant risk factors among pregnant women in a tertiary care hospital in Sargodha District of Pakistan.&#x0D; Methods: An observational cross-sectional study on pregnant women over a six-month period from December 2016, was conducted in the gynaecology and obstetrics department of the District Headquarters Hospital, Sargodha, Pakistan. All women with renal failure, heart disease and surgical history were excluded from the study, while all pregnant women visiting the out-patient department (OPD) were included in the investigation. Blood sampling and analysis were performed, following standard laboratory operating procedures to determine the haemoglobin (Hb) levels of the patients.&#x0D; Results: Fifty pregnant women were enrolled in this study. They had a mean age of 27.85 ± 4.99 years with a range of 20 – 46 years. Almost half, i.e., 26 (52 %), were aged 20 – 30 years; 18 (36 %) 31 – 40 years and six (12 %) &gt; 40 years of age. Regarding occupational status, 45 (90 %) of the respondents were housewives. In total, 86 % of the women were anemic, while the remaining 14 % were non-anemic and had an Hb level slightly &gt; 11 g/dL. Among the anemic women, 13 (26 %) had mild anemia, 33 (66 %) moderate anemia, and 4 (8 %) were severely anemic.&#x0D; Conclusion: Iron deficiency and anemia have major health impacts on pregnant women. Steps should be taken during ante-natal care to monitor Hb levels in pregnant women and apply appropriate remedy where necessary. Other biomarkers and related risk factors such as total iron binding capacity (TIBC) and total blood count (TBC) have previously been found to be linked to anemia

Anemia, iron deficiency, and cobalamin deficiency in cats with chronic gastrointestinal disease.

BackgroundIron deficiency and cobalamin deficiency, as sequelae to chronic gastrointestinal (GI) disease, could result in anemia and increased morbidity in cats with chronic enteropathies.ObjectiveTo evaluate iron deficiency in cats with chronic GI disease and its relationship with hypocobalaminemia, anemia, and disease severity.AnimalsTwenty client‐owned cats with primary GI disease.MethodsProspective, cross‐sectional study. Cats were enrolled at the time of evaluation for chronic GI disease, after exclusion of comorbidities. CBC with reticulocyte indices, iron metabolism (serum iron and ferritin concentrations, total iron binding capacity [TIBC]), serum methylmalonic acid (MMA), cobalamin, and folate concentrations, pancreatic lipase and trypsin‐like immunoreactivity, and disease severity were evaluated.ResultsAnemia (hematocrit <30%), iron deficiency, and cobalamin deficiency were diagnosed in 4/20, 7/20, and 8/20 cats, respectively. Hematocrit (r s = −.45; P < .05) and body condition score (r s = −.60; P < .01) negatively correlated with MMA. Median TIBC was lower in cats with increased vs normal MMA (218 μg/mL; range, 120‐466 μg/mL vs 288 μg/mL; range, 195‐369 μg/mL; P = .02). Hematocrit (r s = .51; P = .02), reticulocyte MCV (r s = .52; P = .02), reticulocyte hemoglobin content (r s = .71; P < .001), and percent transferrin saturation (r s = .79; P < .0001) positively correlated with serum iron concentration.Conclusions and Clinical ImportanceFunctional iron deficiency was common in cats with chronic GI disease. Associations between hypocobalaminemia, iron parameters, and hematologic parameters warrant further investigation on the impact of iron deficiency on chronic GI disease morbidity in cats.

Deficiência de ferro em obesos acompanhados ambulatorialmente no pré-operatório de cirurgia bariátrica

Introduction: Obesity is an internationally health crisis. The bariatric surgery offers treatment to reduce body weight, induce remission of obesity-related diseases and improve quality of life. Nutritional deficiencies may have been installed even before surgery, and preoperative anemia is an independent risk factor. Thus, the present study aims to evaluate iron deficiency in obese candidates for bariatric surgery, attending a nutrition ambulatory of a university hospital in Recife/Brazil. Methods: Cross-sectional, descriptive study. The patients were evaluated according to sex, age, weight, body mass index (BMI), iron and ferritin levels. Iron deficiency was classified by levels &lt;50 Ug/dl and &lt;65 Ug/dl for women and men, respectively. The ferritin levels classified as deficient were those below 15 ng/ml for both sexes. Data collection was performed from May 2017 to June 2018, using data from nutrition setting’s monitoring forms. Data were tabulated and analyzed using Microsoft Excel software version 10. Results: 75 patients were included, with prevalence of women (85.3%), mean BMI of 47.99 ± 7.56 kg/m2. The means of serum iron (n = 70) and ferritin (n = 60) were 76.33 ± 37.06 Ug/dl and 160.82 ± 159.43 ng/ml, respectively. There was a high prevalence of serum iron deficiency (62.9%); however, ferritin was deficient in only 1.7% of the study population. Conclusion: This study observed an important presence of iron deficiency in the group of obese patients evaluated, with the greatest sensitivity being detected by means of serum iron. The biochemical evaluation of the patient who will be submitted to the bariatric procedure is important, in order to avoid health issues and postoperative complications, thus helping in their recovery.

Study of hematological profile in patients with chronic kidney disease

Background: Chronic Kidney Disease (CKD) with its high prevalence, morbidity and mortality, has become an important public health problem. The incidence and prevalence of CKD is increasing worldwide, including India. CKD is associated with a variety of hematological abnormalities, include anaemia, infections and bleeding diathesis. Anaemia is the most consistent hematological abnormality and is associated with poor quality of life and poor cardiovascular outcomes.Methods: A hospital based cross-sectional observational study was done to detect the prevalence of haematological abnormalities, correlation of anaemia with CKD stage and evaluation of iron deficiency. Newly diagnosed CKD (stages 3 to 5) patients were included in this study. Presence of anaemia (Hb%, haematocrit, MCV, peripheral smear), iron deficiency (TSAT, serum ferritin), thrombocytopenia, leucocyte count and coagulation abnormalities (PT, APTT) in different stages of CKD were studied.Results: All the subjects in study group had anaemia which was normocytic and normochromic and of moderate degree in most patients. The severity of anaemia progressed with stage of the disease. Iron deficiency was significantly prevalent (52% in the study population, with transferrin saturation (TSAT) &lt;20%). WBC count was not significantly altered. There was mild thrombocytopenia in a few patients. Bleeding time or other in vitro tests of platelet function were not measured. The coagulation parameters, PT and APTT, were not significantly altered.Conclusions: All CKD patients should be screened for iron deficiency anaemia for its early treatment and to decrease morbidity.

The Long Life of a Clip

Hemoclips are a very common and effective intervention used during colonoscopies to stop immediate bleeding. A recent survey of VA gastroenterologists reported that when hemostatic treatment was applied, 76% of physicians preferred a hemoclip.1 Although hemoclips are very common, there are no clear established guidelines for their use. Hemoclips typically fall off on their own within 1-2 weeks. However, there have been an increased number of cases where clips have been found as long as 2 years later.6,7 Here we describe a case of retained hemoclip for over one year and discuss the possible implications of such clips<./p> A 67 year old African American man with a history of multiple GI bleeds, iron deficiency anemia, CAD, paroxysmal Afib, and CVAs presented to the GI endoscopy suite for colonoscopy to evaluate iron deficiency anemia. One 10mm TA was removed by cold snare polypectomy in the cecum. Two TA in the ascending colon were also removed. No hemoclips were placed. Several days later, patient had significant GI bleed while on dual antiplatelet therapy after recent NSTEMI. EGD was normal. On colonoscopy, post-polypectomy sites seen in the cecum and ascending colon showed evidence of bleeding stigmata. 3 hemoclips were placed in the cecum and 1 was placed in ascending colon achieving hemostasis. Numerous hyperplastic polyps were also seen in the rectosigmoid colon with the plan to remove them in one year once off anti-platelets. On repeat colonoscopy 1 year later, 3 flat hyperplastic polyps were removed. Interestingly, a clip was also seen in the cecum at the site of the prior post polypectomy bleed. The case presented here is another example of hemoclips staying in place much longer than expected. While hemoclips can be excellent tools to achieve hemostasis, they are not completely benign. They are contraindications to MRI, and two years after endoscopy hemoclips would likely not have been considered. Abdominal radiographs have been suggested as a possible way to screen for retained clips prior to MRI.7 There has also been a case report of a GI bleed resulting from focal ulceration at the base of a retained clip, therefore these retained clips may pose as a risk factor for future bleeding.8 In scenarios where large polyps are removed, persistence of clips could interfere with detecting and treating any residual polyps<.sup>9 Therefore, it is important for physicians to consider these possible complications prior to placing hemoclips<./p>2933_A Figure 1. Hemoclip placed in cecum to achieve hemostatis after GI bleed.2933_B Figure 2. Retained hemoclip on colonoscopy over one year later.

Rationale and Design of a Prospective, Multicenter, Observational Study Evaluating Iron Deficiency in Patients Hospitalized for Heart Failure (FERIC-RO)

Abstract Introduction: Several landmark studies, which enrolled heart failure (HF) patients who were ambulatory at the time of inclusion, identified iron deficiency (ID) as an important therapeutic target: intravenous iron administration with ferric carboxymaltose (FCM) improves morbidity, exercise capacity, and quality of life in patients with HF and reduced EF (HFrEF). However, there is still limited knowledge about ID prevalence during hospitalization for Worsening Chronic HF (WCHF) and about the relationship between ID during hospitalization and post-discharge outcomes. Although previous studies documented ID as an independent risk factor for poor outcomes in HFrEF, its prognostic significance in HF patients with EF&gt;40% remains unclear. Method and Results: The FERIC-RO study is a prospective, multicenter, observational study with longitudinal follow up, conducted in 9 Romanian hospitals that will include 200 consecutive patients admitted for worsening HF. A comprehensive description of the Iron metabolism biomarkers will be performed on discharge and 1-month follow up. The primary endpoint is defined as the prevalence of ID on discharge and 1-month post-discharge, and the secondary endpoints include: all-cause re-hospitalization and all-cause-mortality at 1 and 3 months follow up, and quality of life on discharge and 1-month. Conclusions: FERIC-RO will provide new evidence about the prevalence and the predictors of ID in patients hospitalized for WCHF regardless of LVEF. Furthermore, the study will explore the relationship between in-hospital ID and post-discharge outcomes. The results of FERIC-RO will thus be highly relevant to the management of patients hospitalized for AHF.

Iron deficiency anaemia and its association with febrile seizures

Background: As reported by World Health Organization of total world’s population about 500 million to 2 billion people are deficient in iron. Iron deficiency is the most common hematological disease found in age group 6 months to 5 years. This age group generally coincides with the age group of occurrences of febrile seizures. Aim of this study was to study the role of iron deficiency in febrile seizures.Methods: This cross sectional, observational study done in the Pediatrics department of D. Y. Patil Hospital and Research Centre. 170 children of age group between 6months to 5 years will be included in the study over a period of 24 months from May 2015 to May 2017, Presenting with simple and complex febrile seizures to the emergency department and Pediatrics ward of hospital.Results: In the study the mean age of onset of febrile seizures is 21 months. Severity of anemia doesn’t have any correlation with occurrence of febrile seizures. Iron deficient in terms of low HB, low MCH, low MCV, high RDW, low serum Iron, high TIBC and low serum iron and TIBC ratio.Conclusions: From the current hospital based observational study we have concluded that, iron deficiency anemia was more frequent among children with febrile seizures. The result suggests that iron deficiency anemia may be a risk factor for febrile seizures screening for IDA should be considered in children with febrile seizures. All the investigations (Sr Iron, TIBC) carried out to evaluate iron deficiency anemia were significantly lower. This suggests that iron deficient children are more prone for febrile seizures.

Disseminated histoplasmosis diagnosed on routine outpatient endoscopy in a renal transplant patient

A 58-year-old female with prior renal transplant on immunosuppression underwent upper endoscopy and colonoscopy to evaluate iron deficiency anemia. Her upper endoscopy appeared normal and her colonoscopy showed mild colitis in her transverse colon. Biopsies of her duodenum, taken to evaluate for celiac disease, as well as biopsies of the colitis showed intracellular yeast within histiocytes in the lamina propria consistent with disseminated histoplasmosis. This case describes a renal transplant patient with disseminated gastrointestinal histoplasmosis (GIH), which is rarely diagnosed on routine outpatient endoscopy.