Hgb Values Research Articles

Abstract 379: Implementation of a Multi-Disciplinary Intervention to Reduce Phlebotomy Volumes in Patients Hospitalized With Acute Myocardial Infarction or Heart Failure

Background: Hospital acquired anemia (HAA) is associated with increased mortality and worse health status in AMI patients, and frequently persists after discharge. Studies have identified diagnostic blood loss from phlebotomy as a risk factor for HAA. We studied the feasibility of implementing a phlebotomy reduction initiative, and its impact on standard vs. low volume phlebotomy tube use, phlebotomy volumes and in-hospital hemoglobin (Hgb) values among patients hospitalized with AMI or heart failure. Methods: We conducted a pre-post design, single-center study of a comprehensive diagnostic phlebotomy reduction program. On target hospital units, processes of care were implemented to ensure the use of low volume phlebotomy tubes unless standard blood samples were required for specific tests, use of stored blood for all appropriate lab tests, batching of blood draws for non-stat tests, and use of reinfusion kits to minimize blood loss from central line draws. To ensure comparability of the pre- and post-populations, patients were propensity matched using a multivariable model including demographic, clinical, comorbidity, treatment and procedural variables. After matching, conditional logistic regression was used to compare use of standard vs. low volume, total phlebotomy volume, Hgb at discharge and HAA between the two study phases. Results: There were 442 consecutive patients in the pre-intervention and 465 consecutive patients in the post-intervention cohort. At baseline, use of standard and low volume phlebotomy tubes was similar (median [IQR] 5.0 ml [3.0, 9.0] and 6.0 ml [4.0, 10.0], respectively). Use of larger volume tubes declined and use of low volume tubes increased comparing pre- and post-intervention phases (standard volume: median [IQR] 5.0 ml [3.0,9.0] vs. 3.0 ml [1.0, 6.0], p<0.001; low volume: 6.0 ml [4.0, 10.0] vs. 7.0 ml [5.0, 13.0], respectively, p=0.01). Total phlebotomy volume was numerically lower in the post-intervention phase (mean [SD] 44.8 ml [32.4-74.7] vs. 42.6 ml [27.8-75.2], p=0.09), but there were no differences in discharge Hgb (mean [SD] 12.0±2.0 vs. 12.0±2.1 ml, p=0.66) or HAA rates (42.7% vs. 41.6%, p=0.81). In propensity matched analyses, only a decline in standard volume phlebotomy tube use comparing pre- and post-phases was statistically significant. Conclusions: Implementation of a comprehensive phlebotomy reduction program is feasible in the process of routine AMI and heart failure care. Although we found a reduction in use of larger tubes after the intervention, high baseline rates of low volume blood tube use, reinfusion kits and use of stored serum specimens at our hospital likely limited the impact of the intervention on other outcomes. Further studies at hospitals with low baseline use of phlebotomy reduction strategies are needed to assess the clinical impact of interventions to limit phlebotomy with the goal of preventing HAA.

229

Introduction: US military critical care air transport teams (CCATT), made up of a critical care physician, nurse, and respiratory technician, have reduced mortality of combat casualties by rapidly transporting critically ill patients with severe burns out of theater. Blood transfusion may incur adverse effects and civilian studies report a lower hemoglobin (Hgb) value may be safe for critically ill patients. There are no studies evaluating the optimal Hgb value for critically ill burn patients prior to CCATT evacuation. Methods: We conducted an IRB approved, retrospective cohort study involving critically ill burn casualties transported via CCATT between January 2007 and December 2011. Data was extracted from CCATT medical records and the Department of Defense Trauma Registry (DoDTR). Data was entered into standardized electronic database and validated for errors. Missing data was reconciled. We separated our study population into two cohorts based on Hgb levels at the time of theater evacuation: HgbLo (<=10g/dL), or HgbHi (>10g/dL). We compared demographics, injury description (% total body surface area burned [TBSA] and injury severity scores [ISS]), physiologic parameters, and clinical outcomes. To accurately evaluate the effect of a Hgb≤10g/dL on outcomes in comparison to a Hgb>10g/dL, we propensity score matched groups using injury description (TBSA and ISS). Results: Of the 204 subjects enrolled, 29 were HgbLo, and 111 were HgbHi. Both groups were similar in age and % TBSA burned. HgbLo had a higher ISS (34 ± 19.8 vs 25 ± 16.9, p=0.02) and were more likely to have additional blunt or penetrating trauma (25% vs 50%, p=0.04). Due to injury disparities, propensity matching was performed. After propensity matching to adjust for injuries (n=27 per group) there was no mortality difference (15% HgbHi vs 22% HgbLo, p=0.48). Additionally, groups had similar number of hospital and ICU days, sepsis rates, ARDS, VAP, and renal failure rates. Conclusions: CCATT transport of critically ill burn patients out of combat theater, with a Hgb<10g/dl, had similar complications and mortality as patients with a Hgb≥10g/dL. In this study, lower hemoglobin levels did not confer greater risk for worse outcomes.

A Proposed Prognostic Model For Overall Survival In The Oldest Old (>80 Years Old) Follicular Lymphoma Patients

BackgroundDisease characteristics, treatment patterns, and outcomes of follicular lymphoma (FL) patients (pts) aged >80 years (yrs) are infrequently reported. Further, the original Follicular Lymphoma International Prognostic Index (FLIPI) has not been formally studied in pts aged >80 yrs. Also, whether FLIPI is associated with overall survival (OS) in pts aged >80 yrs is unknown. Patients/MethodsWe used the National LymphoCare Study—a Genentech-sponsored, prospective, multicenter registry of FL pts across the United States without study-specific treatment—to comprehensively analyze FL pts aged >80 yrs. Using Pearson chi-squared tests, associations of age groups with disease characteristics and overall response rate (ORR) were examined. Median progression-free survival (PFS) and OS by treatment regimen were estimated using the Kaplan-Meier method. Cox proportional hazards regression that were adjusted for baseline disease factors were used to assess treatment differences in PFS, lymphoma-related mortality (LRM, which includes both disease and treatment-related deaths), and OS, as well as the significance of age by treatment interactions. FLIPI and a prognostic model that was constructed based on the findings were used to predict outcomes. ResultsOf 2649 evaluable pts, 209 (8%) were aged >80 yrs. Compared with pts aged ≤60, pts aged >80 yrs were more likely to be Caucasian, to have worse performance status, to have lower hemoglobin (Hgb) value (<12 g/dL), to have less advanced stage, and were less likely to be treated at academic institutions. When treated, pts aged >80 yrs had lower ORR compared with younger pts and were less likely to receive rituximab + chemotherapy (P <.001) or anthracyclines (P <.001). Use of maintenance rituximab was not significantly different between pt groups when rituximab induction was given (61% for pts aged ≤60, 38% for pts aged >80, P=.11), but it was more frequent in pts aged >80 yrs when rituximab + chemotherapy induction was administered (44% for pts aged ≤60, 59% for pts aged >80, P=.04). After adjusting for maintenance use, sex, and baseline factors, age significantly differentiated PFS impact of observation, rituximab monotherapy, and rituximab + chemotherapy (P=.01). No treatment regimen provided superior PFS or OS in pts aged >80 yrs. With a median follow-up of 6.5 yrs for all pts (4.3 yrs for pts aged >80 yrs), 5-year OS was 59% and 92%for patients aged >80 and ≤60 yrs, respectively. OS in pts aged >80 yrs varied based on FLIPI score (log-rank test, P=.01; Figure 1). Interestingly, the percentage of deaths that were disease-related was 40% in pts aged >80 yrs, which was comparable to the percentage in pts aged ≤60 yrs of 48%. Cox modeling showed that lower Hgb, B symptoms, and male sex predicted worse OS (P<.01) but not PFS in pts aged >80 yrs. Recognizing that males have inferior OS compared with females in the general population, we constructed a prognostic model composed only of B symptoms and Hgb level <12 (low risk=no factors; high risk=1 or more factors; P<.0001; Figure 2). FLIPI and the proposed prognostic model significantly differentiated both OS and LRM (Table 1). [Display omitted] [Display omitted] ConclusionsIn the largest, prospectively published study of FL pts aged >80 yrs, OS, PFS, ORR, and treatment selection varied compared with younger pts. Surprisingly, the proportion of deaths attributed to lymphoma in these older FL pts was 40%. FLIPI was associated with outcome in pts aged >80 yrs and so was a proposed prognostic model comprising lower Hgb and B symptoms. Independent validation of this model is required, and additional prospective studies that are designed for the oldest old are warranted. Disclosures:Nabhan:Genentech Inc.: Advisory Board Other, Honoraria. Byrtek:Genentech, a member of the Roche group: Employment, Equity Ownership; Roche: Equity Ownership, stock options, stock options Other. Dawson:Genentech: Employment; Roche: Equity Ownership. Link:Genentech: Consultancy; Millenium: Consultancy; Pharmacyclics: Consultancy; Spectrum: Consultancy; Genentech: Research Funding; Millenium: Research Funding; Pharacyclics: Research Funding. Zelenetz:GSK: Consultancy; Celgene: Consultancy; Cephalon: Consultancy; Gilead: Consultancy; Seattle Genetics: Consultancy; Sanofi-Aventis: Consultancy; Genentech: Research Funding; GSK: Research Funding; Roche: Research Funding; Cancer Genetics: Scientific Advisor Other. Cerhan:Genentech: Scientific Advisory Board of the National LymphoCare Study Other. Flowers:Abbott, Celgene, Millennium/Takeda, Sanofi, Spectrum, Janssen: Research Funding; Celgene, Genentech Bio-oncology: Consultancy.

Disclosure of Physician-Specific Behavior Improves Blood Utilization Protocol Adherence in Cardiac Surgery

Evidence indicates that a transfusion (Tx) trigger hemoglobin (Hgb) value of 8 gm/dL may be safer than a more liberal Tx trigger in cardiac surgery (CS) patients. We hypothesized that weekly physician feedback would improve adherence to such a protocol, but that the public identification of individual physician behavior would have an additive effect. We concurrently reviewed all adult CS patients at our institution from December 1, 2010 to May 27, 2011. We matched any cardiac surgery intensive care unit Tx event (red blood cells) with the Hgb value immediately before Tx. Patients requiring massive transfusions (>10 units/24 hours) were excluded. After all providers agreed upon a Hgb of 8 as the Tx trigger, we studied 3 consecutive time periods: no feedback, weekly feedback of group Tx behavior, and weekly feedback with identification of individual surgeon Tx behavior. Of the 512 patients who underwent cardiac operations, 144 patients underwent 510 Tx events. Compared with period 1, the unadjusted odds of receiving a Tx above 8 gm/dL decreased by 48% in study period 2(odds ratio: 0.52, p < 0.01), and 63% in study period 3(odds ratio: 0.37, p <0.001). Single unit transfusion rates increased from 77% to greater than 90% (p < 0.001). In-hospital mortality also fell from period 1 to period 3 (7.0% to 1.5%, p= 0.02) with the observed to expected mortality ratio decreasing from 2.19 to 0.51. Blood transfusion protocol adherence improves when weekly feedback is provided. Identifying individual surgeon behavior improves adherence to a greater degree. Routine presentation of quality metrics with identification of individual physician-specific behavior may bethe most effective way to accomplish performance improvement.

GW24-e0452 BMI, PTH, and ambulatory SBP are related to LVH in CKD Patients

ObjectivesTo explore the incidence and affecting factors of LVH in CKD3-5 patients.Methods270 CKD3-5 patients were enrolled from Departmnt of nephrology, 3rd hospital of Sun yat-sen University in this study from...

Hospital-acquired anemia: prevalence, outcomes, and healthcare implications.

Evidence suggests that patients with normal hemoglobin (Hgb) levels on hospital admission who subsequently develop hospital-acquired anemia (HAA) may be at risk for adverse outcomes. Our objectives were to (1) determine the prevalence of HAA and (2) examine whether HAA is associated with increased mortality, length of stay (LOS), and total hospital charges. The population consisted of 417,301 adult hospitalizations from January 1, 2009 to August 31, 2011, in an academic medical center and 9 community hospitals. Patients with anemia on admission, and hospitals in the health system without available laboratory data were excluded; 188,447 hospitalizations were included in the analysis. Demographics, comorbidities, and outcomes were retrieved from administrative data; Hgb values were taken from the electronic medical record. Regression modeling was used to examine the association between demographics, comorbidity, hospitalization type, and HAA variables (mild: Hgb >11 and <12 g/dL for women, and >11 and <13 g/dL for men; moderate: Hgb 9.1 to ≤ 11.0 g/dL; severe: Hgb ≤ 9.0 g/dL) on mortality, LOS, and hospital charges. Among 188,447 hospitalizations, 139,807 patients (74%) developed HAA: mild, 40,828 (29%); moderate, 57,184 (41%); and severe, 41,795 (30%). Risk-adjusted odds ratios and 95% confidence intervals for in-hospital mortality with HAA were: mild, 1.0 (0.88-1.17; P = 0.8); moderate, 1.51 (1.33-1.71, P < 0.001); and severe, 3.28 (2.90-3.72, P < 0.001). Risk-adjusted relative mean LOS and hospital charges relative to no HAA were higher with HAA: LOS: mild, 1.08 (1.08-1.10, P < 0.001); moderate, 1.28 (1.26-1.29, P < 0.001); severe, 1.88 (1.86-1.89, P < 0.001). Hospital charges: mild, 1.06 (1.06-1.07, P < 0.001); moderate, 1.18 (1.17-1.19, P < 0.001); severe, 1.80 (1.79-1.82, P < 0.001). HAA is common and associated with increased mortality and resource utilization. Factors related to its development necessitate further study.

Managing severe anemia when the patient is a Jehovahʼs Witness: Explaining to patients who cannot accept major blood fractions how available therapies are produced can help them decide which therapies do not violate their religious beliefs.

Managing severe anemia when the patient is a Jehovahʼs Witness: Explaining to patients who cannot accept major blood fractions how available therapies are produced can help them decide which therapies do not violate their religious beliefs.

Effect of chronic alcohol consumption on the red blood cell count and RBC indices in the HIV infected patients on d4T/3TC/NVP drug regimen in Uganda

Alcohol consumption is common problem in Uganda. Among the types of alcohols consumed include beers, spirits, liqueurs, wines and traditional brew. These alcohols are easily accessible and consumed by many people including the HIV infected patients who are on the d4T/3TC/NVP regimen. The aim of this study was to determine the effect of chronic alcohol intake on the red blood cell count (RBC) and the RBC indices in the HIV-infected patients on d4T/3TC/NVP regimen. It was a case control study that used a repeated measures design model where serial measurements of the red blood cell count (RBC) and RBC indices were determined at 3 month interval for 9 months. A total of 41 HIV infected patients were recruited and grouped into two arms; the control group had 21 patients and the chronic alcohol group had 20 patients. The RBC and RBC indices of the whole blood were determined using automated hematological Coulter CBC-5 Hematology Analyzer system using standard procedures. The data was sorted into alcohol-use self reporting by WHO AUDIT tool and alcohol-use biomarkers groups. It was analysed using the SAS 2003 version 9.1 statistical package with the repeated measures fixed model. The means were compared using the student t-test. The mean MCV and MCH values in the chronic alcohol use group were higher than in the control group and there was a significant difference between the 2 groups (p&lt;0.05) for both the WHO AUDIT tool group and chronic alcohol use biomarkers group. The mean RBC count, Hct, HGB and MCHC values in both the control and chronic alcohol use groups were within the normal reference ranges for both groups though the trend was lower in alcohol group. Chronic alcohol use affects the RBC and RBC indices in the HIV infected patients on d4T/3TC/NVP treatment regimen.

Guidelines-based treatment of anaemic STEMI patients: practice patterns and effects on in-hospital mortality: a retrospective analysis from the NCDR.

Anaemia is associated with an increased risk for morbidity and mortality in ST-elevation myocardial infarction (STEMI) patients. While several physiological mechanisms have been proposed to explain this association, decreased receipt of guidelines-based care may also contribute. We examined the relationship between admission haemoglobin (Hgb) level, receipt of ACC/AHA guidelines-based treatments, and in-hospital outcomes among STEMI patients. We also evaluated whether administration of these treatments modified the association between anaemia and in-hospital mortality in this group. We analysed data from 92,686 patients diagnosed with STEMI included in the NCDR ACTION Registry-GWTG database from January 2007 to March 2011. Patients were stratified by initial Hgb value: 83.1% (n=77,035) were classified as non-anaemic (Hgb >13.0 g/dl for men, >12.0 g/dl for women), 11.6% (n=10,710) as mildly anaemic (11.1-13.0 g/dl for men, 11.1-12.0 g/dl for women), 4.4% (n=4059) as moderately anaemic (9.1-11.0 g/dl), and 1.0% (n=882) as severely anaemic (<9.0 g/dl). Anaemia was associated with a significantly increased prevalence of other baseline comorbidities and decreased odds of receiving several class I recommended pharmacological treatments (heparin, beta-blockers, and angiotensin-converting enzyme inhibitors, p<0.01). The overall use of reperfusion therapy (fibrinolytic therapy and/or percutaneous coronary intervention) was also lower in anaemic vs. non-anaemic patients (p<0.01). Anaemia was associated higher in-hospital mortality risk, which remained significant after adjustment for use of guidelines-recommended therapies and interventions (p<0.01). In a national sample of STEMI patients, anaemia on presentation was associated with decreased receipt of ACC/AHA guidelines-based care and higher in-hospital mortality. However, the higher mortality rates could not be fully explained by differences in in-hospital treatment.

Hematology and Clinical Chemistry in Amiata Donkey Foals from Birth to 2 Months of Age

The aim of the present study was to fill the void in data related to hematological and biochemical parameters of donkey foals. Whole-blood and plasma samples were obtained from 16 Amiata donkey foals at birth, at 24 and 48 hours, and at 1, 2, 3, 4, 6, and 8 weeks of age. RBC, WBC, hemoglobin concentration (Hgb), mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, platelet count, glucose, creatinine, blood urea, triglycerides, total cholesterol, total bilirubin, aspartate aminotransferase, γ-glutamyl transferase, creatine-phosphokinase, alkaline phosphatase, total calcium, potassium, sodium, phosphorus, and albumin were measured. Similar to equine foals, values of RBC, Hgb, and Hct decreased significantly after the first 48 hours of life in Amiata donkey foals, reaching values similar to adult donkeys. No changes were found for mean corpuscular volume and mean corpuscular hemoglobin concentration during the study period. The WBC was low at birth when compared with subsequent measurements, but significantly increased in the subsequent surveys. Platelet count was lower in the first week, with a secondary peak 2 weeks later, and then a decline again up to the eighth week. In agreement with equine foals, electrolyte concentrations, triglycerides, and total cholesterol did not show significant differences. Creatinine, total bilirubin, and blood urea showed a trend similar to RBC, Hgb, and Hct. For the first time, data of hematological and biochemical parameters in Amiata donkey foals are provided.

Alterations in red blood cell rheological properties in healthy people living at low and mid‐altitudes

People with existing health problems or reduced fitness may feel effects at a much lower altitudes than those who are more physically able. On the other hand living at higher altitudes is different than visiting. A number of studies describe many hematologic changes at extremely high altitudes. However, little information is known about the effect of long‐term living at mid‐altitude on hemorheologic parameters. In this study, the changes of hemorheological properties were investigated on 2 groups of healthy people aged 18–46, who have been living at low (1300m) and mid (2300m) altitude at Erciyes Mountain in Kayseri. Blood samples were taken from the antecubital vein using EDTA as the anticoagulant. An aliquot of the whole blood was used to analyse routine hematological parameters. RBC, HGB and PCV values were higher at mid altitudes than those at low altitudes. However, there were no significant differences in MCV, MCH and MCHC as red cell indices between two groups. As rheological parameters, erythrocyte deformability and osmotic fragility values were lower for people who lived at mid altitude compared to low altitude but an increase was observed in RBC aggregation index. It is known that the hemorheological properties of red blood cell membrane may be changed under hypoxic conditions depend on different altitudes. As a result, these results contribute to the knowledge of the pathogenesis of high altitude disease and stress the significance of altered hemorheology as one of the mechanisms possibly involved in the vascular events observed high altitude conditions. Supported by ERU. The Scientific Research Coordination Unit (BAP). Project No: TOA‐11‐3320

The effect of humic-fatty acid preparation on selected haematological and biochemical serum parameters of growing rabbits

In this study, we assessed the effect of a humic-fatty acid preparation (HFA) used in rabbit feed on certain haematological and biochemical serum parameters (the lipid profile and the Ca, P and Fe contents). A higher RBC, HGB and HCT values were observed in the groups that were given HFA. An increase in Fe concentrations were also noted. The total and LDL cholesterol were lower in the groups which received HFA than in the control group.

Effect of Darbepoetin Alfa on Renal Anemia in Japanese Hemodialysis Patients

A long-acting erythropoiesis-stimulating agent named "darbepoetin alfa" (CAS 11096-26-7) was recently developed. Though it is already in use worldwide, especially in western countries, its efficacy and safety for Asian patients have not been well evaluated yet. The purpose of this study was to evaluate the efficacy and safety of short-term darbepoetin alfa administration for Japanese hemodialysis patients. Patients who had undergone maintenance hemodialysis were enrolled in this study. The erythropoiesis-stimulating agent was switched from epoetin alfa (CAS 113427-24-0) to darbepoetin alfa so as to control the hemoglobin (Hgb) value between 10 and 12 g/dl. The initial conversion ratio was made according to the manufacturer's recommendations. The factors relevant to the responsiveness to erythropoiesis were analyzed. One hundred and fifty-nine patients with a mean age of 67.6 years were enrolled. Two months after switching to darbepoetin alfa, the Hgb value had increased significantly (10.3 +/- 1.2 to 10.6 +/- 1.4 g/dl). Only iron supplementation correlated positively with the change of Hgb. In addition, 14.3% of patients had excess Hgb (Hgb > 12 g/dl) at the end of the study period, but only 5.6% patients at the run-in. Serious cardiovascular disease did not occur during the study period; however, the mean systolic blood pressure at the start of hemodialysis increased significantly and there was no correlation between the change of Hgb value and blood pressure. Darbepoetin alfa increases the Hgb value effectively in Japanese hemodialysis patients. Although no serious adverse events were apparent in our short-term analysis, the incidence of hypertension and excessive increase of the Hgb value must be noted.

Appropriateness of anemia management in hemodialysis patients

The anemia of end stage renal disease (ESRD) is common and often severe complication that can be managed successfully by erythropoiesis-stimulating agents (ESA) administration. Aims To investigate current practice of anemia management in hemodialysis patients and to assess the appropriateness of anemia management by comparing observed practice to the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline recommendations. Settings and design The study was conducted at two hemodialysis centers in Riyadh, Saudi Arabia. Data on anemia parameters, comorbidities, ESA dosing and iron supplementation were collected. The data were collected for 7 months retrospectively from April to the end of May 2008 and prospectively from June to October 2008. Patients who were over 18 years of age with ESRD undergoing hemodialysis were included. Patients were excluded if they have cancer or receiving chemotherapy or radiotherapy. Results Data were collected from 87 patients. Mean Hgb value for those patients was 11.16 ± 0.97 g/dL. Thirty-nine patients (45%) had mean Hgb values between 11.0 and 12.0 g/dL the target range recommended by KDOQI guideline. The mean weekly prescribed dose of erythropoietin was 8099 ± 5946 IU/Week (135 ± 99 IU/kg/Week). Information on ferritin concentrations was available for 48 (55%) patients. The mean serum ferritin concentration for those patients was 693 ± 420.5 ng/mL. Fifty-two patients had transferrin saturation (TSAT) values recorded. The mean TSAT value was 38.5 ± 19.7%. Conclusions: There is an opportunity to improve anemia management in hemodialysis patients particularly thorough evaluation of causes of inadequate response rate and better monitoring and management of iron status.

Relationship between delayed menarche and bone density in patients affected by juvenile

Puberty is an essential step in bone mass accrual. Growth failure and impairment of sexual maturation are frequent manifestations of chronic illnesses in the paediatric population, and chronic rheumatologic disorders such as juvenile idiopathic arthritis (JIA) are no exception to this. The aim of our study was to prospectively evaluate bone density in adolescent females with JIA, and to correlate the results with clinical variables, in particular with age at menarche. Lumbar spine (L2-L4) area bone mineral density (aBMD) (assessed by Dual X-ray Absorbiometry, DXA) was monitored every 6-12 months in a group of 38 girls with JIA. The evaluated bone density accrual during the peripubertal time as well as absolute and relative (Z-score) aBMD in relationship with age at menarche, JIA subset, disease activity (as evaluated by ESR and Hgb), corticosteroid and methotrexate treatment (mean pro kg daily dose, cumulative dose) was assessed. Height, body mass index (BMI), bone mass content (BMC) values were also collected. Volumetric BMD (vBMD) evaluated with a geometric correction formula has been calculated and compared to aBMD. Patients were divided into two groups: - group I included girls with menarche age within normal limits for Italian standards; - group II included girls with delayed menarche. The BMD values and Z scores in group I were not significantly different to normal population. The BMD values and Z scores in group II were significantly decreased when compared to the normal population (p<0.001). With a multivariate analysis only age at menarche seemed independently related to peripubertal mineralization (p=0.025, r between -0.65 and -0.75). With a binary logistic analysis only disease activity (ESR and Hgb values) seems independently related to a menarche delay (1.24+/-0.4 for each mm/h). Our data show a critical role for disease activity in determination of a regular pubertal onset and an optimal bone density achievement.

The Effect of &lt;i&gt;Clerodendrum Myricoides&lt;/i&gt; Aqueous Extract on Blood, Liver and Kidney Tissues of Mice

Clerodendrum myricoides is a plant traditionally used for its medicinal value in many parts of the world including Ethiopia. Several human defects are treated in different regions of Ethiopia using the roots, leaves, twigs, fruits and root barks of Clerodendrum myricoides species. The objective of the present study is to investigate the effect of the aqueous extract of Clerodendrum myricoides root on different tissue of mice in chronic administration. The root of the plant were collected in Bale area, Ethiopia dried and crushed into powder and soaked in water to yield aqueous extract. The extract was then administered to mice at doses of 100 and 400mg/kg bw/day for six weeks and 1134mg/kg bw/day (LD50) once. The 400mg/kg bw/day and LD50 treated mice showed hypoactivity (abnormally diminished activity), grooming, prostration (submissively prone position), piloroerection (elevation of hairs) and irritation, while 100mg/kg bw/day treated mice showed no behavioral changes. The dose of 100mg/kg bw/day produced significant weight gain, while 400mg/kg bw/day produced significant weight lost in chronic administration. The extract increased only urea at the dose of 100mg/kg bw/day, whereas it increases most hematological and biochemical parameters at 400mg/kg bw/day. The extract, however did not show significant change in platelet, HGB and MCHC value at both doses. Several histopathological changes in liver and kidney were also observed at both doses of the extract. There were inflammation and hydropic degeneration of hepatocytes at both doses. The LD50 of the extract produced hemorrhages and congestion in the glomeruli of the kidney.

Cerebral Venous Sinus Density on Noncontrast CT Correlates with Hematocrit

A positive correlation between HCT and CT attenuation of intravascular blood has long been assumed but has never been established by using substantial patient numbers and modern CT equipment. The purpose of this study was to determine whether apparent increased attenuation on CT in cerebral venous sinuses can be attributed to hemoconcentration alone and to assess whether sinus thrombosis can be differentiated from hemoconcentrated blood based on attenuation values alone. We measured HUs in a region of interest within the confluence of dural venous sinuses in 166 unenhanced head CTs and correlated these data with HCT and HGB values in male and female patients aged 2 to 100 years. We then compared these data with similar measurements in 8 patients with recent venous sinus thrombosis. Two-tailed t test and linear regression analyses were performed to evaluate HGB and HCT between groups and with measured CT attenuation of intravascular blood, respectively. A statistically significant relationship was noted between both HCT and HGB with CT attenuation. Seven of 8 patients with sinus thrombosis had attenuation values >70, but none of the normal subjects had HUs >70. Hemoconcentration correlates with CT attenuation in cerebral venous sinuses. Our findings suggest that comparing the ratio of HUs to HCT may be useful in gauging concern for sinus thrombosis.

Index of Suspicion * Case 1: Abdominal Pain and Coffee Ground Emesis in a 9-year-old Boy * Case 2: Vomiting, Headache, and Seizures in a 7-year-old Boy * Case 3: Primary Amenorrhea in a 15-year-old Girl

* ALT: : alanine aminotransferase AST: : aspartate aminotransferase BUN: : blood urea nitrogen CBC: : complete blood count CNS: : central nervous system CSF: : cerebrospinal fluid CT: : computed tomography ECG: : electrocardiography ED: : emergency department EEG: : electroencephalography ESR: : erythrocyte sedimentation rate GI: : gastrointestinal GU: : genitourinary Hct: : hematocrit Hgb: : hemoglobin MRI: : magnetic resonance imaging WBC: : white blood cell A 9-year-old boy presents to the ED with severe abdominal pain and vomiting. He has no history of diarrhea, fever, chills, rash, trauma, arthralgia, or headache. He has no prior history of gastrointestinal complaints or other chronic illnesses. He cannot tolerate clear liquids and is admitted for observation. He vomits coffee ground material and then blood. On physical examination, his temperature is 38.5°C, heart rate is 140 beats/min, blood pressure is 123/83 mm Hg, and respiratory rate is 24 breaths/min. He is uncomfortable and diaphoretic. He has tachycardia, but his cardiopulmonary examination results are normal otherwise. He has generalized abdominal tenderness, with guarding and rebound tenderness most pronounced in the periumbilical region and extending to the right lower quadrant. Hip abduction elicits pain. CBC documents a normal Hgb value and platelet and leukocyte counts, with a left shift and 78% neutrophils. Urinalysis shows moderate blood and trace proteinuria, with 2 RBCs per high-power field. The chest radiograph appears normal. The abdominal radiograph shows a few mildly distended small bowel loops but no radiographic evidence of obstruction. CT scan of the abdomen leads to exploratory laparoscopy and the correct diagnosis. A 7-year-old developmentally appropriate boy presents to the ED with a 3-day history of forceful vomiting, headache, and reduced oral intake. Several times after vomiting, he had complained of numbness in his hands and feet that lasted several seconds. Two hours after receiving a dose of promethazine prescribed by his pediatrician, he could not be aroused by his parents. On arrival at the ED by ambulance, he is initially sleepy and confused. He is afebrile. His blood pressure is 99/74 mm Hg, heart rate is 89 beats/min, and oxygen saturation is 98% in room air. He has no dysmorphic features and no skin findings. His funduscopic findings and extraocular movements are …

Blood Loss Related to Participation in Pharmacokinetic Study in Preterm Neonates

Background: The amount of blood that can be safely drawn from a preterm neonate for scientific purposes is poorly established. Objectives: To provide scientific evidence on the amount of blood that can be drawn from very low birth weight (VLBW) neonates for study purposes. Methods: We performed a post-hoc analysis of a pharmacokinetic (PK) study of penicillin-G, enrolling 18 neonates with a birth weight of <1,200 g, gestational age of <28 weeks and postnatal age of <5 days, with a risk of early onset sepsis. A median of 2.3 ml/kg of blood was collected from each neonate for the PK analysis. Hemoglobin (Hgb), hematocrit (Ht), basic hemodynamic parameters, total fluid intake, number of blood component transfusions and number of blood analysis for clinical indications were recorded. The control group consisted of 35 gestational age-, postnatal age- and birth weight-matched neonates who had not participated in a PK study. Results: We did not observe significant differences in any studied safety parameter, including Hgb and Ht values, between the two groups. Median number of blood component transfusions (n = 2 in both groups), median volume of transfused red blood cells (22 vs. 24 ml/kg in study vs. control group) and total daily fluid requirement were similar. The median calculated blood loss on clinical indications was 1.9 ml/24 h in the control group and 1.66 ml/24 h in the study group. Conclusions: In VLBW neonates, up to 2.3 ml/kg of blood (corresponding to 2.4% of calculated circulating blood volume) can be drawn for scientific purposes without compromising basic hemodynamic parameters, Hgb and Ht values, blood component transfusions or fluid requirements.

The Role of Interleukin-6 and Bone-Marrow Derived Cell Production of Hepcidin In Anemia of Inflammation

AbstractAbstract 167Anemia of inflammation is the second most common form of anemia in the general population, and its impact on patient well-being is largely underestimated. Anemia cause by inflammation is multi-factorial and includes hepcidin-induced iron restricted erythropoiesis as well as direct cytokine effects on the bone marrow, erythropoietin production and efficacy, and on the lifespan of red cells. Many murine models of anemia of inflammation are unreliable or cumbersome, but a new model introduced by Sasu et al (Blood, 2010) using a single intraperitoneal injection of heat-killed brucella abortus antigen (HKBA) has proven reproducible and robust. We have used this model to explore the role of interleukin-6 and bone marrow derived cell production of hepcidin in anemia of inflammation (AI). First, we sought to explore the effect this model of AI in wild type mice, iterleukin-6 knockout mice (IL6-KO) and hepcidin knockout mice (Hamp-KO) (n≥15 for each group). We followed these mice for 7 weeks with weekly CBC's to observe the severity and time to recovery from anemia. Wild type mice were most affected 2 weeks after injection and slowly recovered over 7 weeks (HgB at 2 week = 6.4g/dl ± 1.2). IL6-KO mice were equally affected initially, with similar hemoglobin values at 2 weeks (6.9g/dl ± 1.3) and recovered by 6 weeks. Hamp-KO mice were less affected throughout the course of anemia, with hemoglobin values of 10.8g/dl ± 0.7 at 2 weeks with resolution by week 4. IL6-KO mice began to recover more quickly than wild type mice by week three, with hemoglobin values of 10.9g/dl ± 1.5 at that time, compared to wild type mice at 3 weeks with hemoglobin values of 7.4g/dl ± 0.7 (p= 0.0001). We believe that this demonstrates that interleukin-6 and hepcidin do coordinate to contribute to anemia of inflammation, but that there may be independent effects or additional factors. To address these questions, we are currently evaluating iron-related gene expression in these groups of mice as well as evaluating iron stores at multiple time points. We also evaluated serum cytokine levels in each of these groups of mice. We found similar elevations TNF-alpha and interferon gamma in all three groups at 6 and 24 hours. We found similar elevations of IL-6 in wild type and Hamp-KO mice at 6 and 24 hours. Bone marrows and spleens form each group of mice were evaluated at 2 weeks by flow cytometry using ter119 and CD44 to evaluate specific effects on erythroid maturation. This evaluation demonstrated a a profound inhibitory effect on erythropoiesis and, in particular, on the production of erythroid progenitor cells, showing a similar profile by flow cytometry between the three groups. In vitro studies have suggested that macrophage production of hepcidin is important in the development of AI (Theurl et al 2008). We evaluated the importance of bone marrow derived cell production of hepcidin on the development of AI using bone marrow chimeras. Using 600cGy × 2 as a preparative regimen, we transplanted wild type mice with bone marrow from Hamp-KO mice. We also irradiated Hamp-KO mice and transplanted them with wild type marrow. We injected these two groups of mice as well as wild type and Hamp-KO controls, we followed them for a period of 4 weeks with weekly CBC's to evaluate the degree of anemia. Hemoglobin values of wild type mice transplanted with Hamp-KO marrow were statistically indistinguishable from those of non-transplanted wild type mice during the follow-up period (HgB values at 1 week = 6.8g ± 0.7 vs 7.29g ± 1.1; at 2 weeks = 7.3 ± 0.6 vs 6.4 ± 1.2; at 3 weeks = 8.5 ± 1.8 vs 7.4 ± 0.5; at 4 weeks = 9.1 v 1.9 vs 8.6 ± 0.5; p<0.02 for all time points). Hamp-KO mice with wild-type bone marrow were statistically indistinguishable from non-transplanted Hamp-KO mice (Hgb values at 1 week = 9.9 ± 2.4 vs 10.8 ± 0.7; at 2 weeks = 10.6 ± 1.5 vs 10.3 ± 1.0; at 3 weeks = 12.8 ± 1.2 10.8 ± 0.7; at 4 weeks 12.6 ± 1.2 vs. 13.6 ± 1.0; p<0.02 for all time points). This suggests that the production of hepcidin by bone marrow derived cells dose not play a physiologically important role in the development of anemia of inflammation. Disclosures:No relevant conflicts of interest to declare.