Higher Hemoglobin Levels Research Articles

Is preoperative S-albumin associated to postoperative complications and readmission in patients with adult spinal deformity: a prospective analysis of 128 patients using the Spine AdVerse Event Severity (SAVES) system.

To assess the association between preoperative S-albumin and postoperative outcome following adult spinal deformity (ASD) surgery. All patients undergoing ASD surgery from February 1, 2017 and January 31, 2018 at a single quaternary referral center were prospectively included. Adverse events (AE) during admission were assessed using the Spine AdVerse Events Severity (SAVES) system. Based on preoperative S-albumin, patients were categorized as "normal" or "abnormal" and compared regarding postoperative outcome, adverse events (AEs), 30- and 90-day readmission, revision surgery, and mortality. A total of 128 patients aged ≥ 18years were included, and S-albumin was available in 88%. Of these, 73% (n = 93) were classified as "normal", 16% (n = 20) as "abnormal", and 12% (n = 15) as "missing". The "normal" albumin group had less comorbidity burden [ASA score 2 (2, 3) vs 3 (2, 3), p = 0.011], higher hemoglobin levels (8.4 (± 0.9) mmol/L vs 7.4 (± 1.1) mmol/L, p < 0.001), and higher S-albumin (38.9 (± 2.7) g/L vs 31.9 (± 4.4) g/L, < 0.001). The rate of 90-day readmission was significantly increased in the "abnormal" group (65% vs 36%), corresponding to a relative risk increase of 1.25 (95% CI 1.02-1.52, p = 0.029). Similar increased risks were found in subsequent logistic regression analyses, although results were not significant in multivariable analysis (p = 0.102). Comparing remaining outcome parameters, point estimates revealed increased AEs, 30-day readmission, and revision in the "abnormal" albumin group, although effects did not reach statistical significance. In a prospective, consecutive, single-center cohort of 128 patients undergoing ASD surgery, we found a significant association between "abnormal" preoperative S-albumin and increased 90-day readmission. Furthermore, although the findings were not statistically significant, we did find that AEs, 30-day readmission, and revision were numerically more frequent in the "abnormal" group, suggesting an expected tendency that should be further investigated. We conclude that nutritional status prior to ASD surgery could be important to consider and suggest validation in larger prospective cohorts. Prognostic II.

High haemoglobin levels and mortality in males with intracerebral haemorrhage: a retrospective cohort study

ObjectivesTo examine the association between high haemoglobin levels and outcomes in intracerebral haemorrhage (ICH) in a multicentre cohort study.DesignProspective multicentre cohort study.Settings21 tertiary hospitals across mainland China.ParticipantsA total of 5318...

The Spectrum of Kidney Disease in Type Two Diabetic Patients: A Single-Center Study

Background: Diabetic nephropathy (DN) is the dominant reason for end-stage kidney disease linked with a rise in cardiovascular mortality rate. However, besides DN, type 2 diabetic patients may also suffer from various non-diabetic renal diseases (NDRD). Aim: The objective of the current research was to assess the occurrence and type of NDRD diagnosed by kidney biopsy in type 2 diabetic subjects, evaluate the association of various clinical and laboratory characteristics with histopathology findings, and identify essential predictors of NDRD. Methods: Retrospective analysis has been performed through medical record revision of 101 patients with type 2 diabetes undergoing percutaneous renal biopsy at Qilu Hospital of Shandong University (Jinan, China) between January 2015 and December 2020. Results: Renal biopsy results showed that NDRD was found in 59 patients (58.42%), while DN existed in 32 patients (31.68%) and 10 patients (9.90%) showed DN complicated with NDRD. Membranous nephropathy was prevailing NDRD (42%), followed by focal segmental glomerulosclerosis (11.6%) and IgA nephropathy (10.1%). In univariate analysis, patients with NDRD had older age (p < 0.018), a short duration of diabetes (p < 0.000), lower proteinuria (p < 0.030), and had higher hemoglobin levels (p < 0.006) compared to non-NDRD patients. In multivariate logistic regression analysis, the short course of diabetes (OR 0.986; 95% CI = 0.978 - 0.993; p = 0.000) and older age (OR 1.080; 95% CI = 1.028 - 1.134; p = 0.002) were significant risk factors for NDRD occurrence. In ROC analysis for NDRD, the duration of diabetes ≤ 78 months (cut-off value (0.725, 0.313)) illustrated the highest AUC. Conclusions: Clinical parameters such as short duration of diabetes, older age, higher hemoglobin level, and lower proteinuria might be associated with NDRD in type 2 diabetic patients. An early diagnosis of NDRD poses a favorable renal prognosis because it requires a different approach than DN, further larger multicenter randomized prospective investigations focused on identifying possible risk markers of NDRD are still in priority.

Identifying the Phenotypes of Sepsis that will Benefit from Red Blood Cell Transfusion Using Unsupervised Cluster Analysis.

Sepsis is a heterogeneous syndrome. Previous studies have shown controversial results of the effects of red blood cell transfusion (RBC) on the clinical outcomes of septic patients. This study aimed to identify the phenotypes of sepsis that will benefit from RBC transfusion. Clinical data were extracted from the Medical Information Mart for Intensive Care III database. The study population included adult (age ≥ 18 years) septic patients with moderate non-bleeding anemia (hemoglobin ≤ 10 g/dL) within 24 hours after admission to the intensive care unit (ICU) between 2001 and 2012. After data preprocessing, partitioning around medoids function was used for unsupervised cluster analysis. We used Kaplan-Meier survival analysis and multivariable Cox proportional hazard models to explore the relationship between RBC transfusion and mortality. In total, 6,821 septic patients with moderate non-bleeding anemia within 24 hours after ICU admission, and 3,874 patients (56.8%) received RBC transfusion during their stay in the ICU. Using unsupervised cluster analysis, we identified three phenotypes of septic patients with moderate non-bleeding anemia: cluster A (n = 1,835) was characterized by advanced age and heart issues; cluster B (n = 3,043) was characterized by mild disease and relatively high hemoglobin levels; and cluster C (n = 1,943) was characterized by severe disease, low mean arterial pressure, bloodstream infection, coagulopathy, high lactate levels, and high mortality. Only for patients in cluster C, RBC transfusion exhibited protective effects in terms of the 14-day [hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.41 - 0.61; p < 0.001], 28-day (HR, 0.61; 95% CI, 0.51 - 0.72; p < 0.001), and 90-day (HR, 0.67; 95% CI, 0.58 - 0.78; p < 0.001) mortality after adjusting the confounding variables. Utilizing unsupervised cluster analysis, we identified three phenotypes of septic patients with moderate non-bleeding anemia who had different responses to RBC transfusion. In the future, randomized controlled trials about prognostic outcomes of RBC transfusions can focus on the specific phenotype of sepsis.

Glycemic control and associated factors in patients with type 1 diabetes mellitus in primary care in Southeastern Brazil

Diabetes is a self-managed condition with knowledge, attitudes and practices that can influence the overall treatment and outcomes delay the complications of diabetes. However, the few reported studies published point out that: low education level, poor adherence to pharmacotherapy and diet recommendations, infrequent monitoring of blood glucose, and insulin dosage regimen are associated with higher hemoglobin levels. This study aimed to assess the knowledge, adherence medication, and complexity of pharmacotherapy in T1DM patients in Brazil. A cross-sectional study was conducted involving 156 T1DM patients who were attending in primary care. Logistic regression analyses were conducted to assess the variables associated with glycemic control. The overall assessments of T1DM patients for the glycemic control were bad (121, 77.6%). However, T1DM patients with high MedTake Test (OR=2.4, CI=1.1-5.7) and Morisky-Green Test (OR= 2.5, CI=1.1-6.1), and in the use of dosage insulin (>40 units, OR=0.3, CI=0.1-0.7) and postprandial glucose (100-125mg/dl, OR=3.8, CI=1.1-14.6) had better glycemic control compared to uncontrolled patients. Glycemic control in Brazilians adults with T1DM is low. We suggested the screening patients with low MedTake and Morisky-Green Tests, increasing patient knowledge as part of a complex intervention that may lead to substantially improved treatment outcomes in primary care.

Predictors of Renal Recovery among Patients of Obstructive Urolithiasis with Renal FailureA Prospective Observational Study

Introduction: Timely intervention in patients of obstructive uropathy secondary to renal and /or ureteric stones can reduce the morbidity and mortality in such patients. Aim: To determine the factors predicting recovery in patients of urinary stones and obstructive uropathy. Materials and Methods: This prospective observational study was conducted at Shri Mahant Inderesh Hospital, Dehradun, Uttrakhand, India, between December 2018 and June 2020. All patients with renal failure (serum creatinine &gt;1.5 mg/dL) secondary to urinary stones presenting to the Emergency Department were included in the study. Baseline demographic data, clinical, haematological, biochemical and microbiological parameters were recorded at presentation and after Double J Stent (DJS) insertion at postintervention day 1, 3 and 7. Total 40 patients were divided into two groups i.e, recovered (n=25) and non recovered (n=15) groups. Receiver Operating Characteristic (ROC) curves was used to obtain optimal threshold duration of illness, the values of serum creatinine, serum urea, haemoglobin and serum potassium, and time to nadir creatinine for predicting renal recovery. The graphs were made using both Microsoft excel and SPSS software. Results: Out of total 40 pateints, 29 were males and 11 were females. The mean duration of symptoms in the recovered and non recovered groups was 4.64 and 15.53 days, respectively (p-value=0.001). Thirteen out of 15 patients (86.6%) in the non recovered group and 10 out of 25 (40%) in the recovered group had pre-existing co-morbidities (p-value=0.004). Postobstructive diuresis was present in 84% patients in the recovered and 46.6% in the non recovered group (p-value=0.016). The nadir serum creatinine level was 1.26 mg/dL in recovered as compared to 6.08 mg/dL in the non recovered patients (p-value=0.001). The ROC curves were plotted for various parameters in order to find the prognostic accuracy in predicting recovery. The best criteria were symptom duration ≤6 days, serum creatinine at presentation ≤6.2 mg/dL, serum potassium ≤5.5 mg/dL, and haemoglobin level &gt;9.4 gm/dL. Conclusion: Short duration of symptoms (≤6 days), lower serum creatinine levels (≤6.2 mg/dL), lower serum potassium levels (≤5.5 mg/dL), and higher haemoglobin level (&gt;9.4 gm/dL) were found to predict a greater chance of recovery. These factors can help in formulating treatment protocols for early intervention leading to a better prognosis in this subgroup of patients.

Clinical parameters in different stages, zones, and remission/progression statuses of retinopathy of prematurity.

Background:Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in premature infants that causes lifetime visual impairment and blindness in the early ages. In this study, we investigated the differences in the values of clinical laboratory parameters between different ROP and its remission/progression statuses regarding stages and zones.Methods:This historical cohort study includes 828 infants divided into two groups after the first examination containing ROP infants and controls. The biochemical and hematological parameters of the two groups have been collected from the patient’s history.Results:In infants with ROP, the hematopoiesis-related parameters, including the mean level of hemoglobin, total bilirubin, potassium, calcium were significantly less than controls (P=0.039, P=0.001, P=0.001, and P=0.046, respectively). The percentages of reticulocyte and the levels of BUN in ROP patients were significantly higher than in normal infants (P=0.015 and p <0.001, respectively). Moreover, the levels of hemoglobin and BUN were significantly different in the different zones of ROP (P=0.017 and P=0.001, respectively). Also, higher hemoglobin levels, total bilirubin, and CRP were observed in the reduced stages of ROP (P=0.041, P=0.045, and P=0.039, respectively).Conclusion:Laboratory parameters are different in different stages, zones and remission/ progression ROP infants.

Calorimetric Characterisation of the Binding Reaction Between Human Ferric Haemoglobins and Haptoglobin to Develop a Drug for Removal of Cell-Free Haemoglobin.

High levels of cell-free haemoglobin (Hb) may occur in plasma as a consequence of e.g., pathological haemolysis or blood transfusion. These Hb molecules can be removed from blood circulation by forming a complex with the acute-phase protein haptoglobin (Hp) and thereby can also the intrinsic toxicity of free Hb be limited. In this study it is shown that ferric HbA, HbF, HbE and HbS, respectively, all bind firmly to Hp at 25°C. By using isothermal titration calorimetry (ITC), it is demonstrated that ferric HbF has higher affinity to Hp (Ka=2.79±0.29 ×109 M-1) compared with HbA and HbS (1.91±0.24 ×109 M-1) and 1.41±0.34 ×109M-1 for HbA and HbS, respectively. In addition, the affinity constant for HbE is slightly lower than the other haemoglobins (0.47±0.40 ×109M-1). Since Hp shows a general and high affinity to all Hb variants tested, it can be concluded that Hp may be useful as a therapeutic agent for several different haemolytic conditions by intravenous injection.

Relationship between iron metabolism and gestational diabetes mellitus: A systemic review and meta analysis.

To investigate the relationship between serum iron metabolism indexes and gestational diabetes mellitus (GDM) using a meta-analysis. Databases including PubMed, Web of Science, Embase, and Cochrane Library were searched. Prospective cohort or case-control studies evaluating the relationships between serum iron metabolism indexes and GDM were retrieved from these data-bases. The outcome indicators, such as mean ± standard deviation, relative risk (RR), or odds ratio (OR) were extracted. The RR or OR, standard mean difference (SMD), and 95% confidence interval (CI) were used to calculate the combined effect sizes. A total of 32 studies on the relationships between serum iron metabolic indexes and GDM were included. The serum iron [SMD=0.40 mg/dL, 95% CI (0.16, 0.64), p=0.001], ferritin [SMD=0.58 ng/mL, 95% CI (0.35, 0.81), p˂0.001], hemoglobin [SMD=0.48 g/dL, 95% CI (0.28, 0.67), p˂0.001], transferrin saturation [SMD=0.83%, 95% CI (0.15, 1.52), p=0.000], and hepcidin [SMD=0.63 ng/mL, 95% CI (0.09, 1.18), p=0.023] levels were higher in the GDM group than in the non-GDM group, whereas total iron binding ability [SMD = -0.53 μg/dL, 95% CI (-1.05, -0.02), p=0.001] was lower in the GDM group than in the non-GDM group. High serum ferritin [OR=1.92, 95% CI (1.59, 2.32), p˂0.001] and hemoglobin levels [OR=1.30, 95% CI (1.04,1.63), p=0.023] were associated with GDM risk. Serum iron, ferritin, transferrin saturation, hepcidin, and hemoglobin levels were higher and total iron binding ability was lower in GDM patients than in those without GDM. High serum ferritin and hemoglobin levels were associated with GDM risk.

Clinical features and outcomes of JAK2 V617F-positive polycythemia vera and essential thrombocythemia according to the JAK2 V617F allele burden.

BackgroundJAK2 mutation status is a well-known risk factor for thrombosis in patients with myeloproliferative neoplasms. However, the clinical usefulness of JAK2 V617F allele burden is under investigation.MethodsWe retrospectively evaluated the impact of the JAK2 V617F allele burden on clinical characteristics and outcomes of JAK2 V617F-positive polycythemia vera (PV) and essential thrombocythemia (ET). The JAK2 V617F allele burden was measured using sequencing.ResultsAltogether, 127 patients with JAK2 V617F mutation (PV, N=61; ET, N=66) were included in this study. JAK2 V617F allele burdens were positively correlated with white blood cell counts, hemoglobin values, lactate dehydrogenase levels, and platelet counts. The median values of JAK2 V617F allele burden in patients with PV and ET were 58% and 30%, respectively. A JAK2 V617F allele burden of ≥30%, older age, and a higher hemoglobin level were risk factors for thrombotic events in ET. In patients with PV, older age was the only thrombotic risk factor. The 8-year probabilities of overall survival (OS) were 82.9% in all patients. A high JAK2 V617F allele burden (≥58%) was associated with poor OS in patients with PV. For the patients with ET, the difference in 8-year OS based on the JAK2 V617F allele burden was not significant.ConclusionThe JAK2 V617F allele burden was correlated with hematologic parameters and clinical outcomes. Assessing the JAK2 V617F allele burden can be helpful in predicting the thrombotic risk and disease course in patients with JAK2 V617F-positive PV and ET.

EVALUATION OF THE VALIDITY OF HEMOCUE HB 201+ FOR PREDONATION ASSESSMENT OF LOW AND HIGH HAEMOGLOBIN LEVELS IN BLOOD DONORS: ONE YEAR PROSPECTIVE STUDY IN BLOOD BANK OF GMC DODA

Introduction: Predonation assessment of haemoglobin in blood donors is important to avoid unnecessary rejection of potential blood donors. Compared to the conventional screening methods for haemoglobin assessment the method to be used in blood banks needs to be rapid, sensitive and accurate for both low and high haemoglobin values. Materials and methods: This was a prospective study conducted in blood bank of GMC Doda w.e.f 1st April 2020 to 31st March 2021. Finger prick samples were taken from 1214 potential blood donors and hemoglobin was estimated using HemoCue Hb 201+. Also venous samples of potential blood donors were obtained and run on automated haematologyanalysers. The values were compared. Male donors with haemoglobin in the range of 12.5g/dl -18.5g/dl and females with hemoglobin in the range of 12.5g/dl -16.5g/dl were considered fit for donation. Results: We analyzed that haemoglobin levels measured by HemoCue Hb 201+ were higher than those measured by automated haematologyanalyser. We found a significant correlation between the standard method and HemoCue Hb 201+ for haemoglobin levels less than 12.5 g/dL. However the correlation was found to be less for high haemoglobin levels &gt;18.5g/dl. Sixty percent of donors, who had haemoglobin levels higher than upper limit were unnecessarily rejected accounting for high deferral rate. Conclusion: We concluded that HemoCue Hb 201+ was suitable for screening for low haemoglobin in blood donors. Male predominance among blood donors and topography of this particular area accounts for donors with haemoglobin values near upper limit which were falsely deferred on the basis of HemoCue Hb 201+. Also testing with this method was found to be expensive, so it was recommended that qualitative methods should be used for primary screening among blood donors and accurate quantitative methods to be used only when qualitative methods fail.

Erythrocytosis associated with IgA nephropathy.

SummaryBackgroundErythrocytosis is a hematological disorder usually related to hematopoietic stem cell somatic mutations. However, unexplained erythrocytosis remains frequent. In this study, we evaluated the involvement of IgA1, a regulator of erythropoiesis also implicated in IgA nephropathy (IgAN) pathophysiology, in unexplained polycythemia/erythrocytosis (PE) of IgAN patients.MethodsIgAN-PE patients’ serum was collected, analyzed and used to study IgA1 effect on proliferation and differentiation of erythroid progenitors. Hematological parameters of transgenic mice for human alpha1 heavy chain were studied. Multicentric observational cohorts of chronic kidney disease (CKD) patients, including both native kidney diseases and renal transplants, were studied to analyze patient hemoglobin levels.FindingsWe retrospectively identified 6 patients with IgAN and unexplained PE. In large CKD cohorts, IgAN was associated with PE in 3.5% of patients (p<0.001 compared to other nephropathies). IgAN was an independent factor associated with higher hemoglobin levels (13.1g/dL vs 12.2 g/dL, p=0.01). During post-transplant anemia, anemia recovery was faster in IgAN patients. Elevated polymeric/monomeric IgA1 ratio as well as high Gd-IgA1 rate were observed in circulating IgA1 of the 6 IgAN-PE patients as compared with control or IgAN patients without PE. IgA1 from these patients increased the sensitivity of erythroid progenitors to Epo. In mice, we also observed an elevation of hematocrit in alpha1 knock-in mice compared to wild type controls.InterpretationThese data identify a new etiology of erythrocytosis and demonstrate the role of pIgA1 in human erythropoiesis. This syndrome of IgA-related erythrocytosis should be investigated in case of unexplained erythrocytosis and renal disease.FundingThis work was supported by INSERM (French national institute for health and medical research), Labex GRex and Imagine Institute (Paris, France)

Covert Brain Infarcts in Patients with Philadelphia Chromosome-Negative Myeloproliferative Disorders.

Backgrounds and Purpose. Philadelphia chromosome-negative myeloproliferative disorders (Ph-negative MPD) are a rare group of hematological diseases, including three distinct pathologies: essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). They most often manifest with thrombotic complications, including cerebrovascular events. Covert brain infarcts (CBIs) are defin ed as predominantly small ischemic cerebral lesions that are detected using magnetic resonance imaging (MRI) in the absence of clinical stroke events. The relationship between MPD and CBIs remains unclear. Methods. Included in the study were 103 patients with the diagnosis of Ph-MPD (according to WHO 2016 criteria) (median age—47 (35; 54) years; 67% female). In total, 38 patients had ET, 42 had PV, and 23 had PMF. They underwent clinical examination, routine laboratory analyses (complete blood count), brain MRI, ultrasound carotid artery, flow-mediated dilatation (as a measure of endothelial dysfunction—FMD). Results. Overall, 23 patients experienced an ischemic stroke (as per MRI and/or clinical history), of which 16 (15.5%) could be classified as CBIs. The rate of CBIs per MPD subtype was statistically non-significant between groups (p = 0.35): ET–13.2%, PV–21.4%, and PMF–8.7%. The major vascular risk factors, including arterial hypertension, carotid atherosclerosis, and prior venous thrombosis, were not associated with CBIs (p > 0.05). Age was significantly higher in patients with CBIs compared to patients without MRI ischemic lesions: 50 (43; 57) years vs. 36 (29; 48) (p = 0.002). The frequency of headaches was comparable between the two groups. CBIs were associated with endothelial dysfunction (OR - 0.71 (95% CI: 0.49–0.90; p = 0.02)) and higher hemoglobin levels (OR—1.21 (95% CI: 1.06–1.55); p =0.03). Conclusions. CBIs are common in patients with Ph-negative MPD. Arterial hypertension and carotid atherosclerosis were not associated with CBIs in this group of patients. The most significant factors in the development of CBIs were endothelial dysfunction (as measured by FMD) and high hemoglobin levels. Patients with Ph-negative MPD and CBIs were older and had more prevalent endothelial dysfunction.

Clinical Profile of End Stage Renal Disease Patients Undergoing Hemodialysis in Chitwan, Nepal.

There are very few researches from Nepal that have evaluated clinical profile of end stage renal disease patients. Our main objective was to study the clinical profile of end stage renal disease patients, who were under maintenance hemodialysis for at least three months duration in two dialysis centers located in Chitwan Nepal. This was a descriptive, cross-sectional study conducted among 138 end stage renal disease patients, who were undergoing maintenance hemodialysis at two government centers located in Chitwan, Nepal. Among 138 patients in our study, 42 (30.4%) patients had diabetic nephropathy and 11 (8%) patients had hypertensive nephropathy as the leading causes of end stage renal disease; however the cause could not be ascertained in 63 (45.7%) patients. 47 (34.1%) patients had started hemodialysis within one month of diagnosis of their kidney disease. Fatigue and musculoskeletal pain were the commonest symptoms found in 78 (56.6%) patients, whereas hypotension and fever were the two most common intra-dialytic complications found in 73 (52.9%) and 61 (44.2%) patients respectively. Anemia was present in 127 (92%) patients, 41 (29.7%) had hyperkalemia, 54 (39.1%) had hypocalcemia, 116 (84.1%) had hyperphosphatemia and 43 (31.2%) had hyperuricemia. Regular use of erythropoietin analogs was significantly associated with higher hemoglobin levels (p value- 0.000) and lesser frequency of blood transfusions (p value- 0.000) in our study. Diabetic nephropathy was the leading cause of end stage renal disease in our study. Cause of ESRD could not be ascertained in nearly half of the total patients.

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Background: The goal of this research was to assess the effectiveness and safety of intra-articular tranexamic acid (TA) with intravenous (IV) TA in reducing perioperative blood loss, the severity of early postoperative problems, and venous thromboembolism in patients who have had a primary unilateral cemented total knee replacement.&#x0D; Patients and methods: This comparative study was undertaken using a non-probability purposive sampling technique at the Department of Orthopedic Surgery, King Edward Medical University / Mayo Hospital, Lahore, from July 1st, 2018 to October 30th, 2019. A total of number 71 patients, aged 35 to 75 years, who underwent unilateral cemented total knee replacement for advanced knee osteoarthritis were included in the study. Patients who had known allergic reactions to tranexamic acid, risk factors of thromboembolism, severe kidney and heart diseases, and blood clotting disorders were excluded. The patients were divided into two groups, A and B. Pre-operatively, patients in Group A were given intraarticular tranexamic acid (3000mg). In Group B, intravenous tranexamic acid (10mg/kg) was given pre-operatively. Outcome parameters studied were drained blood (DB), level of hemoglobin (Hb), blood transfusion (BT), and hematocrit (Hct) after 48 hours of surgery and compared with the preoperative value. Data was entered and analyzed using SPSS version 21.0. Independent sample T-test was applied to compare the hematocrit and hemoglobin difference in the two groups, and the P-value was taken less than 0.05 as significant.&#x0D; Results: Out of the total 36 patients in Group A, there were 20 (55.5%) males and 16 (44.4%) females, while amongst 35 patients in Group B, there were 21 (60%) males and 14 (40%) females. The mean preoperative Haemoglobin (Hb) in Group A was 13.9+1.2 and 13.8+0.9 in Group B (p = 0.44). The mean postoperative Hb in Group A was 12.11±2.47 and 11.24 ± 3.52 in Group B (p = 0.002). The mean variation of Hct in Group A was 4.49 and 6.82 in Group B (p = 0.001).&#x0D; Conclusion: Intra-articular tranexamic acid during total knee joint replacement is a viable alternative to the established intravenous tranexamic acid with statistically significant high postoperative hemoglobin and hematocrit levels.

Sodium-glucose cotransporter 2 inhibitors and anemia among diabetes patients in real clinical practice.

Aims/IntroductionSodium–glucose cotransporter 2 inhibitors (SGLT2i) were reported to increase hemoglobin levels in short‐term clinical trials. Whether it is also true in real clinical practice is unknown.Materials and MethodsThis is a retrospective cohort study. Inclusion criterion was diabetes patients who visited our outpatient clinic from January 2019 to August 2020. Exposure of interest was the use of SGLT2i. Outcomes were hemoglobin levels. For the cross‐sectional analyses, non‐linear regression models were fitted with restricted cubic splines to investigate the association between hemoglobin levels and estimated glomerular filtration rate (eGFR) for users and non‐users of SGLT2i. For the case–control study, cases (anemia defined as hemoglobin <120 g/L for men, <110 g/L for women or the use of erythropoiesis stimulating agents) and controls were matched by age, sex and eGFR.ResultsAmong 2,063 diabetes patients, 723 were taking SGLT2i. In the cross‐sectional analyses, hemoglobin levels were higher among SGLT2i users compared with non‐users at eGFR >15 mL/min/1.73 m2. For the case–control study, 197 cases and controls were matched. Conditional logistic regression showed that the use of SGLT2i was associated with significantly lower prevalence of anemia (odd ratio 0.35, 95% confidence interval 0.21–0.58). Adjusted mean differences in hemoglobin levels between users and propensity score‐matched non‐users of SGLT2i were 7.0 g/L (95% confidence interval 3.0–10.0 g/L) at 6 months. Among SGLT2i users, the odds of an increase in 6‐month hemoglobin were similar across eGFR categories, except for eGFR <15 mL/min/1.73 m2.ConclusionsThe use of SGLT2i was associated with higher hemoglobin levels and lower prevalence of anemia in real clinical practice.

Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients.

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman’s correlation coefficient −0.4, p = 0.02), percentage of CD19+ cells (r = −0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.

Clinical characteristics and risk factors of recurrent Kawasaki disease

Objective: To summarize the clinical characteristics and explore the risk factors of recurrent Kawasaki disease. Methods: In this retrospective study, reviewed 41 cases with recurrent Kawasaki disease in Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University from January 2013 to January 2021. And another 123 children with Kawasaki disease who had no recurrence during at least 6 years of follow-up were assigned into control group. Furthermore, the risk factors of recurrence were derived by comparing the clinical characteristics of recurrent cases at their initial episodes with those of control cases by Chi-square test and the Mann-Whitney U test, followed by Logistic regression and receiver operating characteristic analysis. Results: There were 29 males and 12 females in 41 children with recurrent Kawasaki disease, 33 children (80%) suffered a recurrence within 2 years after the first episode and 8 children (20%) developed a recurrence after 2 years. Compared with the first episode, the second episode had lower white blood cell count (15.2 (12.8-18.8)×109 vs. 18.0 (14.9-23.4)×109/L, Z=-2.462, P=0.014) and rate of edema in extremities (54% (22/41) vs. 76% (31/41), χ2=4.321, P=0.038), shorter fever durations before intravenous immunoglobulin treatment (5.0 (5.0-6.0) vs. 6.0 (5.0-7.5) d, Z=-3.329, P=0.001) and higher levels of hemoglobin ((116±8) vs. (107±12)g/L, t=-4.124, P<0.05) and albumin((39±5) vs. (36±6) g/L, t=-3.009, P=0.004). Multivariate Logistic regression analysis showed that C-reaction protein>97.5 mg/L (OR=3.014, 95%CI 1.350-6.730, P=0.007), platelet >276 × 109/L (OR=4.099, 95%CI 1.309-12.838, P=0.015), intravenous immunoglobulin resistance (OR=9.239, 95%CI 1.178-72.477, P=0.034), Mycoplasma pneumoniae infection (OR=2.585, 95%CI 1.129-5.922, P=0.025) were independent risk factors for recurrent Kawasaki disease recurrence.The predictive model then was generated using these four risk factors. The receiver operating characteristic analysis showed that the area under curve was 0.732 (95%CI 0.647-0.817). When the cut-off was 0.241, the sensitivity and specificity were 63.4% and 70.7%, respectively. Conclusions: Children with Kawasaki disease should be followed up for at least 2 years after the first episode and should pay more attention to C-reactive protein. Children with Mycoplasma pneumoniae infection, intravenous immunoglobulin resistance, higher C-reactive protein and platelet at the first onset have a higher risk of recurrent Kawasaki disease.

Abstract 14006: Cardiovascular Health Benefits of Theobromine in Cacao and Chocolate

Introduction: Theobromine is a naturally occurring substance found in cocoa products. Theobromine may have beneficial cardiovascular effects through various mechanisms. We used the NHANES database to analyze associations between theobromine consumption and cardiovascular health outcomes. Methods: The NHANES database represents a nationally representative population which was used to construct the study population from 1996-2016. We assessed multiple demographic factors and compared differences amongst those who consumed various amounts of theobromine to those who did not. The primary outcome measures were hypertension and lipid profiles. Results: Among 42,038 NHANES survey participants, 37569 and 4469 of the participants reported never consuming theobromine and consuming theobromine, respectively. Table 1 demonstrates baseline characteristics of those reporting no theobromine consumption in comparison to the theobromine consuming participants (100-400md/g and 400-850mg/d). Moderate to high amounts of theobromine consumption was observed in participants who were older with higher BMI and more education and were more likely to be tobacco users in comparison to those with no theobromine consumption (all p-values &lt;0.05). Moderate to high theobromine consumption was also observed to be associated with a higher hemoglobin level, higher LDL cholesterol, lower HDL cholesterol, and prevalence of hypertension (all p-values &lt;0.05). Conclusions: We observed that individuals who consumed moderate to high amounts of theobromine had associated improvements in lipid profile parameters as well as reduced blood pressure. Theobromine may represent a complementary non-pharmacologic supplementation to typical lifestyle modifications to improve cardiovascular outcomes. Further prospective studies are needed to better clarify this potential association.

Aberrant expression of SPAG6 may affect the disease phenotype and serve as a tumor biomarker in BCR/ABL1-negative myeloproliferative neoplasms.

Sperm-associated antigen 6 (SPAG6) is a newly identified cancer-testis antigen that has been revealed to contribute to the occurrence and development of various types of human cancer, such as ovarian, bladder, breast and lung cancer. However, to the best of our knowledge, the expression levels of SPAG6 in breakpoint cluster region (BCR)/ABL1-negative myeloproliferative neoplasms (MPNs) have not been investigated previously. Using reverse transcription-quantitative PCR and different tissue staining techniques, the present study revealed that SPAG6 was expressed by MPN cells, both at the mRNA and protein levels, and that nucleated erythroid precursors and megakaryocytes expressed the highest levels of SPAG6. In addition, SPAG6, which is known as a microtubule-associated protein, was found to exhibit nucleic, cytoplasmic or both cytoplasmic and nucleic subcellular localization patterns within the same patient or cell type; however, it did not always co-localize with β-tubulin. Furthermore, SPAG6 expression was revealed to be associated with fewer splenomegaly [P=0.015 for polycythemia vera (PV) and essential thrombocythemia (ET); and P=0.012 for primary myelofibrosis (PMF)] and myelofibrosis events (P=0.014 for PV and ET; and P=0.004 for PMF). In patients with PMF, upregulated expression levels of SPAG6 were also found to be associated with lower white blood cell counts (P=0.042) and lactate dehydrogenase levels (P=0.012), and higher hemoglobin levels (P=0.031) and platelet counts (P=0.025). In addition, the receiver operating characteristic curve analysis indicated that SPAG6 may be a potential biomarker for distinguishing MPN cases from healthy individuals. In conclusion, to the best of our knowledge, the present study is the first to report that aberrant SPAG6 expression may affect the disease phenotype and serve as a tumor biomarker in BCR/ABL1-negative MPNs.