Fall In Hemoglobin Level Research Articles

Chloroquine treatment for uncomplicated childhood malaria in an area with drug resistance: early treatment failure aggravates anaemia

Childhood anaemia is a major public health problem in malaria holoendemic areas. We assessed the effects of antimalarial treatment in an area with drug-resistant falciparum malaria on haemoglobin levels in small children by applying the 1996 World Health Organization in vivo method for the evaluation of standard chloroquine treatment at the community level. In Fukayosi village, coastal Tanzania, 117 children aged 5–36 months with clinical malaria episodes were treated with chloroquine syrup (25 mg/kg). Early treatment failure (ETF) occurred in 20% and late treatment failure (LTF) in 22% of cases. Age >1 year and malnutrition were protective factors against ETF. The evidence that chloroquine treatment could not prevent an exacerbation of anaemia was (i) the fact that the fall in haemoglobin level after 72 h was significantly greater in ETF than in children with LTF and an adequate clinical response, and (ii) the absence of any haematological improvement at follow-up in children receiving chloroquine alone, even in true treatment successes. In contrast, pyrimethamine/sulfadoxine administered to treatment failures improved the haemoglobin level significantly >21 d after treatment started (mean difference 14 g/L, 95% confidence interval 2·1–27). We conclude that, when chloroquine treatment of childhood malaria is associated with a 20% ETF rate, the haemoglobin response is unsatisfactory and there is a need to change the recommended first-line treatment.

The use of adrenaline in reduction mammaplasty

The results of a prospective, randomised and controlled trial on the use of adrenaline as a vasoconstrictive agent to reduce blood loss in reduction mammaplasty are presented. Thirty-five patients were entered into the trial and randomised to receive either infiltration with adrenaline (16 patients) or normal saline (19 patients). Highly significant reductions in per-operative blood loss and in total blood loss, as measured by the fall in haemoglobin level at 48 h, were noted. There was no difference in the amount of post-operative drainage between the two groups. No systemic or local adverse effects from the infiltration were observed.

Toxicity studies in mice of common spices, Cinnamomum zeylanicum bark and Piper longum fruits.

Acute (24 hours) and chronic (90 days) oral toxicity studies on the ethanolic extracts of common spices Cinnamomum zeylanicum Nees bark and Piper longum L. fruits were carried out in mice. Acute dosages were 0.5, 1.0 and 3 g/kg while the chronic dosage was 100 mg/kg/day. All external morphological, hematological and spermatogenic changes, in addition to body weight and vital organ weights, were recorded. The extracts of both the plants caused no significant acute or chronic mortality compared to the control during this study. During chronic treatment there was no significant change in the pre- and post treatment body weight of the test animals while the weight gain in the control group was significant. C. zeylanicum treatment caused reduction in liver weight while P. longum caused a significant increase in the weight of the lungs and spleen of the treated animals compared to the control. Hematological studies revealed a significant fall in hemoglobin level of C. zeylanicum treated animals. Both of the extracts induced a significant increase in reproductive organ weights, sperm motility, sperm count and failed to illicit any spermatotoxic effect.

Effects of acute iron overload on Atlantic salmon (Salmo salar) and rainbow trout (Oncorhynchus mykiss).

Distribution of radioiron to various tissues after intraperitoneal injections was examined in Atlantic salmon and rainbow trout. Liver and spleen were found to be the major iron storage tissues. Injections of 1 or 5 mg iron as ferric ammonium citrate led to a fall in hemoglobin levels in both species after 2 d. Hemoglobin levels returned to normal levels in rainbow trout after 8 d, but Atlantic salmon had not recovered, and Hb levels fell below 3 g/100 mL. In both species, the fall in Hb was associated with a raise in iron levels in spleen and liver, suggesting damage to erythrocytes. Atlantic salmon liver ferritin showed a two- to threefold increase, while rainbow trout showed a sixfold increase, and a more rapid response. The toxic effect of iron in fish appears to be different from the effect in other vertebrates.

Carboplatin as radiosensitizer in non-small cell lung cancer after cisplatin containing chemotherapy.: A Phase I study of a groupe francais de pneumo-cancerologie (G.F.P.C.)

A Phase I trial of carboplatin therapy was performed on patients with locally advanced non-small cell lung cancer who had been previously treated with cisplatin, mitomycin and a vinca alkaloı̈d. This was administered as a daily bolus infusion or as a continuous infusion for 6 weeks with concurrent daily thoracic radiation. All patients had to be objective responders or to show no change after chemotherapy. The carboplatin was started at 10 mg/m2 per day, and increased to 15 mg/m2 per day and 20 mg/m2 per day, if treatment was feasible in successive cohorts of at least six patients. The radiation therapy consisted of 62–66 Gray on the tumor and the ipsilateral mediastinal nodes, 50 Gray on the mediastinum and 40–45 Gray on the supraclavicular lymph nodes. Twenty-nine patients took part in this study. Thrombocytopenia was the principal dose-limiting toxicity, with 15 mg/m2 per day of bolus or continuous infusion. Other toxicities included a fall in haemoglobin level, a fall in white-blood cell count, nausea and vomiting. The median survival time is 12 months, but the response rate cannot be determined among patients selected on the basis of response to chemotherapy. The recommended Phase II dose for patients previously treated with cisplatin containing chemotherapy, is 10 mg/m2 per day of either a bolus or continuous infusion.

254 Carboplatin as radiosensitizer in non-small cell lung cancer after a cisplatin containing chemotherapy. A phase I study of a groupe francais de pneumo-cancerologie (G.F.P.C.)

A Phase I trial of carboplatin therapy was performed on patients with locally advanced non-small cell lung cancer who had been previously treated with cisplatin, mitomycin and a vinca aklaloïd. This was administered as a daily bolus infusion or as a continuous infusion for 6 weeks with concurrent daily thoracic radiation. All patients had to be objective responders or to show no change after chemotherapy. The carboplatin was started at 10 mg/m2 per day, and increased to 15 mg/m2 per day and 20 mg/m2 per day, if treatment was feasible in successive cohorts of at least six patients. The radiation therapy consisted of 62-66 Gray on the tumor and the ipsilateral mediastinal nodes, 50 Gray on the mediastinum and 40-45 Gray on the supraclavicular lymph nodes. Twenty-nine patients took part in this study. Thrombocytopenia was the principal dose-limiting toxicity, with 15 mg/m2 per day of bolus or continuous infusion. Other toxicities included a fall in haemoglobin level, a fall in white-blood cell count, nausea and vomiting. The median survival time was 12 months, but the response rate cannot be determined among patients selected on the basis of response to chemotherapy. The recommended Phase II dose for patients previously treated with cisplatin containing chemotherapy, is 10 mg/m2 per day of either a bolus or continuous infusion.

Hemolysis following coil embolization of a patent ductus arteriosus

We describe the development of hemolysis from moderate residual shunting across a patent ductus arteriosus following coil embolization. The fall in hemoglobin levels from 11.6 to 6.0 gm/dl necessitated a second coil procedure which resulted in complete closure of the residual shunting and resolution of hemolysis. Therefore, appearance of anemia following coil embolization of patent ductus arteriosus should be monitored closely; however, repeat coil embolization with elimination of residual shunt will lead to prompt recovery of normal hemoglobin levels.

Acute multiorgan failure syndrome: A potentially catastrophic complication of severe sickle cell pain episodes

The purpose of this report is to characterize the acute multiorgan failure syndrome that complicates some episodes of sickle pain. A retrospective chart review was used to identify episodes of sickle pain complicated by the acute failure of at least two of three organs: lung, liver, or kidney. The defining criteria of organ failure were established, and the clinical characteristics, laboratory values, treatment methods, and outcomes were noted in episodes that met the criteria. Seventeen episodes of acute multiorgan failure were identified in 14 patients, 10 with sickle cell anemia and 4 with hemoglobin SC disease. Most episodes occurred during a pain event that was unusually severe for the patient. The onset of organ failure was associated with fever, rapid fall in hemoglobin level and platelet count, nonfocal encephalopathy, and rhabdomyolysis. Bacterial cultures were negative in all but four episodes. Aggressive transfusion therapy was associated with survival and with rapid recovery of organ function in all but one episode. The syndrome developed in patients who had previously exhibited relatively mild disease with little evidence of chronic organ damage and relatively high hemoglobin values in steady state. Acute multiorgan failure syndrome is a severe, life-threatening complication of pain episodes in patients with otherwise mild sickle cell disease. The syndrome appears to be reversed with prompt, aggressive transfusion therapy. High baseline hemoglobin levels may represent a predisposing factor.

Effects of Low Intensity Antithrombotic Regimes on the Haemoglobin Level

The effects on the haemoglobin level of low dose aspirin and of low intensity oral anticoagulation with warfarin separately and in combination have been established in men aged between 45 and 69 at high risk of ischaemic heart disease. The findings confirm that combined treatment with warfarin and aspirin (WA) leads to a clear excess of minor bleeding episodes over warfarin alone (W) or aspirin alone (A). Each separate treatment on its own (either W or A) leads to an increase in these episodes compared with those on placebo (P) treatment. However, neither combined treatment (WA) nor the separate treatments (W or A) cause a fall in haemoglobin levels over a period of up to two years.

Acute Chest Syndrome in Children with Sickle Cell Anemia

Vaso-occlusive crisis is the most common cause of morbidity in patients with sickle cell anemia (SCA). Those patients are frequently admitted with chest signs and symptoms suggesting an infective process. The term acute chest syndrome (ACS) is used to describe those chest episodes in SCA patients, and it is postulated that a primary bone vaso-occlusive crisis may be the cause of the acute chest syndrome in SCA patients. In this study we report 52 episodes of ACS in a group of 22 children with SCA. Chest pain, fever, and leukocytosis were a constant clinical finding. The hematological, radiological, and bacteriological studies are reported. There is a constant and significant fall in hemoglobin levels from 88 +/- 10 g/L (8.8 +/- 1.0 g/dl) to 68 +/- 15 g/L (6.8 +/- 5 g/dl). Unilateral or bilateral pulmonary basal infiltrations were found in 50 episodes. Pleural effusion was noticed in 60 episodes, and it was bilateral in three. No significant bacteriological findings were present.

Intrapulmonary haematoma complicating mechanical ventilation in patients with chronic obstructive pulmonary disease

Intrapulmonary haematomas occurred during mechanical ventilation of two patients with advanced chronic obstructive pulmonary disease and bullous dystrophy. In both cases, the haematomas were revealed by blood-stained aspirates, a fall in haemoglobin level, and the appearance of radiological opacities. Haematoma occurrence in the area of a bulla which recently has rapidly increased in size, suggests that the haematoma is due to the rupture of stretched vessels embedded in the wall of the bulla.

The preoperative bleeding time as a predictor of postoperative hemorrhage after cardiopulmonary bypass

To determine whether the preoperative bleeding time, the most reliable indicator of in vivo platelet dysfunction, can prognosticate excessive postoperative hemorrhage and, hence, the need for infusion of platelet concentrations, we studied blood loss versus bleeding time in 43 patients undergoing coronary bypass grafting. There was no correlation between bleeding time and either fall in hemoglobin level (r = 0.04) or chest tube drainage (r = 0.004). In addition, bleeding time did not correlate with the number of units of platelet concentrate (r = 0.12) or packed red cells (r = 0.2) infused. The bleeding time, which has been recommended as an essential screening test before all cardiopulmonary bypass procedures, need not be performed as a preoperative screen in otherwise healthy patients with no history of bleeding abnormalities and a normal coagulation profile.

Phase 1 study of carboplatin in patients with advanced cancer, intermittent intravenous bolus, and 24-hour infusion.

We undertook a phase 1 study of Carboplatin (CBDCA) on an intermittent single intravenous (IV) bolus (schedule A) and a 24-hour continuous infusion schedule (schedule B). Hydration and forced diuresis were not performed. Patients were not premedicated for anticipated vomiting. Thirty-eight adult patients with solid tumors received a total of 71 courses. In schedule A, doses were escalated from 20 to 600 mg/m2. The dose-limiting toxicity was myelosuppression. At doses of 270 mg/m2 and higher, leukopenia and thrombocytopenia were reproducibly seen. The dose of 600 mg/m2 was the maximally tolerated dose, producing severe thrombocytopenia (platelet counts less than 30,000/microL). Other toxicities included a fall in hemoglobin levels and tolerable nausea and vomiting. Schedule B produced comparable hematologic and emetogenic toxicities to those in schedule A. In three patients audiograms became abnormal with high-frequency hearing loss without overt deafness. Two patients developed hypomagnesemia without irreversible renal dysfunction. Patients with poor performance status, preexisting renal dysfunction, a third fluid space, or bone metastases seemed to develop increased hematologic toxicity. The recommended phase 2 dose for good risk patients is 400 mg/m2 IV bolus and for poor risk patients 270 mg/m2 IV bolus. Responses were seen in one patient each with head and neck carcinoma (partial response), small cell lung cancer (minor response), and breast cancer (minor response).

Long-term effects of hydroxyurea in psoriases.

Hydroxyurea is an effective treatment for psoriasis but consistently produces macrocytosis in peripheral blood with a fall in haemoglobin levels and white cell counts. In this long-term study of 16 patients anaemia and leukopenia have proved frequent and troublesome side effects requiring discontinuance of treatment in many cases. In view of these findings hydroxyurea cannot be recommended as the drug of first choice even for treating severe and intractable psoriasis, and it is our opinion that methotrexate is safer and at least as effective in these circumstances. The clearest indications for the use of hydroxyurea appear to be in life-ruining psoriasis when methotrexate treatment has either failed or is contraindicated because of liver damage. A great deal more investigative work is required before these indications can be generally extended.

The effects of repeated doses of bacterial endotoxin on erythropoiesis in the normal and splenectomized mouse.

Summary: A study has been made of the effects of repeated doses of bacterial endotoxin on erythropoiesis in the mouse. It was found that, in the intact mouse, 10 μg/day of Lipopolysaccharide B from S. abortus equi caused a fall in haemoglobin level, reticulocytosis, a severe reduction in bone‐marrow erythropoiesis, and an increase in splenic erythropoiesis. In the splenectomized mouse a fall in haemoglobin occurred but it was not accompanied by reticulocytosis, and the reduction in bone‐marrow erythropoiesis was much less marked.There was no great increase in red‐cell production over a. period of 20 days in the intact mouse and a raised percentage of 59Fe into circulating blood at 10 days was due mainly to a raised percentage of iron‐incorporating cells in peripheral blood rather than a change in production rate. Random destruction of circulating red cells was not significantly increased in endotoxin‐treated animals.Bone‐marrow erythropoiesis remained depressed throughout 20 days of endotoxin administration. Possible mechanisms for such a shift of erythropoiesis, maintained over a considerable period, are discussed.

Red cell production in the continuously irradiated mouse.

Abstract A study has been made of changes in red cell production in the mouse undergoing continuous irradiation at 40 rads/day. There is an early rapid fall in haemoglobin level followed by a continuing gradual fall. The initial decrease in the incorporation of 59Fe into circulating red blood cells is shown to be due to a low reticulocyte count and not to any reduction in red cell production. The repopulating ability of femoral bone marrow falls drastically and reaches 5 per cent of normal after three weeks of irradiation, by eight weeks, the rate of red cell production has risen to above normal levels, due to a large increase in splenic erythropoiesis which is additional to the normal level of erythropoiesis in the bone marrow. Continuous irradiation increases considerably the random rate of destruction of mature red blood cells. These results are compared with the response of rats to continuous irradiation at various doserates.

Haemolytic disease of the newborn piglet.

Four litters of newborn piglets suffering from haemolytic disease of four different grades of severity, were observed clinically. Pallor and mild jaundice were evident in some cases, but the activity of the piglets was not reduced except in the terminal stages of fatal cases. Malnutrition affected a number of piglets sometimes from fortuitous factors. In mild cases there were no clinical symptoms, and the disease could be detected only by demonstrating a fall in haemoglobin level or sensitization of the red cells.Several blood group systems were concerned in the genesis of the disease in these piglets and both agglutinating and incomplete antibodies were shown to be present in the piglets' circulations; in one case antibody was found in the piglet's circulation only 3½ hr. after suckling started, and by 4 hr. the titre of free antibody was 256. The antibodies did not pass the placenta.In severe cases a rapid fall in haemoglobin, interrupted by a sharp, transient rise, and accompanied by reticulocytosis and erythroblastaemia, was characteristic of the first 24 hr.; this was followed in some cases by a prolonged low level of haemoglobin before recovery started.In some of the animals that died, severe and widespread focal necrosis of the liver, together with degeneration and necrosis in the kidney, were marked. Pigment deposits and erythrophagocytosis were common in nearly all organs but abnormal extramedullary erythropoiesis was not observed.A number of haematological, serological and biochemical findings are recorded.

The Fecal Excretion of Urobilinogen of Normal and Lead Poisoned Guinea Pigs

Abstract 1. The method of Watson for the estimation of fecal urobilinogen has been modified for use in guinea pigs. 2. Estimations on three or four day fecal collections give less variable results than estimations on single day collections. Loss of urobilinogen consequent upon storage to the third or fourth day is small. 3. For normal guinea pigs a mean daily excretion of 0.23 mg. with a standard deviation of 0.10 was found. 4. Serial estimations were carried out of the urobilinogen excretion of guinea pigs before and during experimental poisoning with lead nitrate. During lead poisoning there developed a statistically significant increased excretion of urobilinogen. This increased excretion was shown, moreover, to be correlated with the fall in hemoglobin levels which occurred in the poisoned animals. 5. It is concluded that these results provide confirmatory evidence for the view that hemolysis plays an important part in the anemia of chronic lead poisoning.