Higher Hemoglobin Levels Research Articles

JAK 2 NEGATIVE POLYCYTHEMIA VERA IN A TERTIARY CARE CENTER IN WEST UP POPULATION IN INDIA :A RARE PRESENTATION OF 5 CASES

Introduction: Polycythaemia vera (PV) belongs to the group of myeloproliferative neoplasms with an excessive increase in hemoglobin levels.(1). It has been seen that JAK2 V617F mutation present in 80-90% of MPNs and JAK2 exon12 mutations are seen in 4%-5% cases of MPNs like PV.As per an Indian data the JAK2V617F mutational frequency in Indian population was 81.8% for PV, which was different from that reported in western literature as more than 95% for PV.Activation of JAK2 by either point mutation or fusion protein causes activation of the JAK-STAT pathway. While mutations in JAK2 are reported in numerous MPN phenotypes, exon 12 mutations specifically result in erythrocytosis due to increased EPO signalling. In India, the incidence of JAK2-negative polycythemia is relatively high, reaching up to 18%. (2,3) Case series: Case 1-A 21-year male presented to the hematology OPD with complains of paresthesias and off and on headache for the past 6 months. He was on multiple symptomatic medications but to no relief. On routine investigations it was seen that he had a persistent hemoglobin level fluctuating between 17.5gm/dl and 18.5 gm/dl. He has iron deficiency for which he is on single oral iron tablet. No definite organomegaly was seen. In hematology OPD he was investigated for polycythemia vera keeping in mind the WHO criterias.His Serum EPO levels are within normal range,JAK2 V617F/exon 12mutation analysis is negative.A bone marrow aspiration and biopsy study done shows Hypoplastic marrow for age with erythroid predominance. In view of clinical suspicion of JAK 2 negative PV he is being treated with ecosprin, phlebotomy every 3 months and supplemental iron orally. The patient is clinically relieved of his symptoms of peripheral neuropathy. His last hemoglobin value is stable at 16.5gm/dl.Case 2-A 32 -year male presented to hematology OPD with mild headache and weakness for 6 months. A routine CBC investigation showed a high hemoglobin level of 18.4 gm/dl. Mildly raised RBC count was also seen. A subnormal serum EPO levels of 3.7 mIU/Ml (4.3-29.0 mIU/ML) was seen. JAK 2V617F/exon 12 mutation analysis was negative. The patient has been started on ecosprin and phlebotomy every 3 months and is symptomatically relieved.Case 3- A 29-year male presented to hematology OPD with paresthesias and weakness for 3 months. A routine CBC investigation showed a high hemoglobin level of 19.7 gm/dl. Mildly raised RBC count was also seen. Rest all parameters were within normal limits. On examination no hepatosplenomegaly or lymphadenopathy was seen. A low serum EPO levels of <1 mIU/Ml (4.3-29.0 mIU/ML) was seen. JAK 2V617F/exon12 mutation analysis was negative. The patient has been started on ecosprin and phlebotomy every 3 months and is symptomatically relieved. Case4-33 year male presented to OPD with fatigue and paresthesias.CBC showed increased hemoglobin of 18gm/dl.Patient was a non-smoker.Vitamin B12 was>1000gm/dl.Bone marrow showed mildly predominant myeloid series.JAK2 mutation profile was negative but the patient responded to phlebotomy.Case5:A 28 year female had recurrent headaches however MRI and other investigations were normal. A serum EPO level done on suspicion of PV showed subnormal ranges.Bone marrow was reported as reactive.JAK2 mutation analysis was negative however patient responds to ecosprin and hyroxyurea. Conclusion-All five cases that presented to the department had been undiagnosed before they reached our setup. The unique feature of all these cases was negativity for both JAK2V617F as well as JAK2 exon 12 mutation despite its clinical behaviour being that of PV .These cases are being actively managed as low risk polycythemia vera and since the start of the treatment comprising of phlebotomy once every 3 months their hemoglobin and hematocrit concentrations are maintained.No cytoreductive therapy is being given .Such unique presentations need to be reported and discussed extensively.

JAK 2 NEGATIVE POLYCYTHEMIA VERA IN A TERTIARY CARE CENTER IN WEST UP POPULATION IN INDIA :A RARE PRESENTATION OF 5 CASES

Introduction: Polycythaemia vera (PV) belongs to the group of myeloproliferative neoplasms with an excessive increase in hemoglobin levels.(1). It has been seen that JAK2 V617F mutation present in 80-90% of MPNs and JAK2 exon12 mutations are seen in 4%-5% cases of MPNs like PV.As per an Indian data the JAK2V617F mutational frequency in Indian population was 81.8% for PV, which was different from that reported in western literature as more than 95% for PV.Activation of JAK2 by either point mutation or fusion protein causes activation of the JAK-STAT pathway. While mutations in JAK2 are reported in numerous MPN phenotypes, exon 12 mutations specifically result in erythrocytosis due to increased EPO signalling. In India, the incidence of JAK2-negative polycythemia is relatively high, reaching up to 18%. (2,3) Case series: Case 1-A 21-year male presented to the hematology OPD with complains of paresthesias and off and on headache for the past 6 months. He was on multiple symptomatic medications but to no relief. On routine investigations it was seen that he had a persistent hemoglobin level fluctuating between 17.5gm/dl and 18.5 gm/dl. He has iron deficiency for which he is on single oral iron tablet. No definite organomegaly was seen. In hematology OPD he was investigated for polycythemia vera keeping in mind the WHO criterias.His Serum EPO levels are within normal range,JAK2 V617F/exon 12mutation analysis is negative.A bone marrow aspiration and biopsy study done shows Hypoplastic marrow for age with erythroid predominance. In view of clinical suspicion of JAK 2 negative PV he is being treated with ecosprin, phlebotomy every 3 months and supplemental iron orally. The patient is clinically relieved of his symptoms of peripheral neuropathy. His last hemoglobin value is stable at 16.5gm/dl.Case 2-A 32 -year male presented to hematology OPD with mild headache and weakness for 6 months. A routine CBC investigation showed a high hemoglobin level of 18.4 gm/dl. Mildly raised RBC count was also seen. A subnormal serum EPO levels of 3.7 mIU/Ml (4.3-29.0 mIU/ML) was seen. JAK 2V617F/exon 12 mutation analysis was negative. The patient has been started on ecosprin and phlebotomy every 3 months and is symptomatically relieved.Case 3- A 29-year male presented to hematology OPD with paresthesias and weakness for 3 months. A routine CBC investigation showed a high hemoglobin level of 19.7 gm/dl. Mildly raised RBC count was also seen. Rest all parameters were within normal limits. On examination no hepatosplenomegaly or lymphadenopathy was seen. A low serum EPO levels of <1 mIU/Ml (4.3-29.0 mIU/ML) was seen. JAK 2V617F/exon12 mutation analysis was negative. The patient has been started on ecosprin and phlebotomy every 3 months and is symptomatically relieved. Case4-33 year male presented to OPD with fatigue and paresthesias.CBC showed increased hemoglobin of 18gm/dl.Patient was a non-smoker.Vitamin B12 was>1000gm/dl.Bone marrow showed mildly predominant myeloid series.JAK2 mutation profile was negative but the patient responded to phlebotomy.Case5:A 28 year female had recurrent headaches however MRI and other investigations were normal. A serum EPO level done on suspicion of PV showed subnormal ranges.Bone marrow was reported as reactive.JAK2 mutation analysis was negative however patient responds to ecosprin and hyroxyurea. Conclusion-All five cases that presented to the department had been undiagnosed before they reached our setup. The unique feature of all these cases was negativity for both JAK2V617F as well as JAK2 exon 12 mutation despite its clinical behaviour being that of PV .These cases are being actively managed as low risk polycythemia vera and since the start of the treatment comprising of phlebotomy once every 3 months their hemoglobin and hematocrit concentrations are maintained.No cytoreductive therapy is being given .Such unique presentations need to be reported and discussed extensively.

Influence of chronic obstructive pulmonary disease on long-term hospitalization and mortality in patients with heart failure with reduced ejection fraction

BackgroundHeart failure with reduced ejection fraction (HFrEF) can coexist with chronic obstructive pulmonary disease (COPD), which complicates the clinical situation and worsens quality of life. The study used standard diagnostic criteria for detecting COPD in hospitalized HFrEF patients and to survey the influence of other comorbidities and medications on the long-term outcomes of HFrEF + COPD patients.MethodsWe retrospectively recruited patients hospitalized due to HFrEF in a tertiary medical center and examined and followed up clinical outcomes, including length of hospital stay, mortality, and readmission episodes, for a 5-year period. Risk factors for mortality were analyzed using multivariate analysis.ResultsOf the 118 hospitalized HFrEF study participants, 68 had concurrent COPD whereas 50 did not. There was a significant increase in the male predominance, smoking history, higher hemoglobin level and increased length of hospital stay in the HF + COPD group than in the HF-only group. Lower left ventricular ejection fraction was found in the HF and COPD comorbidity group. In multivariate analysis, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use independently associated with a beneficial effect on survival in HF patients with COPD. Oral corticosteroid uses and stroke as a comorbidity were independently associated with a shorter time to the first readmission episode.ConclusionIn HFrEF patients, COPD was associated with a prolonged length of hospital stay. ACEI/ARB use might relate to a beneficial effect on survival in HF patients with COPD. The use of maintenance oral corticosteroid in patients with both HF and COPD should be crucially evaluated to determine the clinical benefit and disadvantages.

Distribution and clinical features of lymphomas involving skin in Taiwan.

A wide variety of primary and secondary lymphoma types involves the skin. However, reports with comparisons between both groups are limited in Taiwan. We retrospectively enrolled all cutaneous lymphomas and evaluated their clinicopathologic features. There were 221 cases of lymphoma: 182 (82.3%) primary and 39 (17.7%) secondary. Mycosis fungoides was the most common primary T-cell lymphoma, 92 (41.7%) cases, followed by CD30-positive T-cell lymphoproliferative disorders including lymphomatoid papulosis (n=33, 14.9%) and cutaneous anaplastic large cell lymphoma (n=12, 5.4%). The most frequent primary B-cell lymphomas were marginal zone lymphoma (n=8, 3.6%) and diffuse large B-cell lymphoma (DLBCL), leg type (n=8, 3.6%). DLBCL including variants was the most common secondary lymphoma involving skin. Most primary lymphomas presented at low-stage (T-cell, 86%; B-cell, 75%), whereas the majority of secondary lymphomas presented at high-stage (T-cell, 94%; B-cell, 100%). Patients with secondary lymphomas had an older mean age, more frequent B symptoms, lower serum albumin and hemoglobin, and a higher frequency of atypical lymphocytes in blood than those with primary lymphomas. In primary lymphomas, older age, lymphoma types, decreased lymphocyte counts and atypical lymphocytes in blood were poorer prognostic factors. In secondary lymphoma patients, lymphoma types, high serum lactate dehydrogenase and low hemoglobin levels predicted poorer survival. We found that the distribution of primary cutaneous lymphomas in Taiwan mirrors that of other Asian countries but shows some differences as compared with Western countries. Primary cutaneous lymphomas have a better prognosis than secondary lymphomas. Histologic classification of lymphomas highly correlated with disease presentation and prognosis.

The potential role of vitamin E in patients with glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis.

As an antioxidant, vitamin E (VitE) may benefit the erythrocytes by protecting glutathione from oxidation by free radicals and peroxide-generating processes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines when reporting this systematic review. We searched 6 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) until May 8, 2022. We included all relevant studies. According to the study design, the Cochrane assessment tool (Risk of Bias 2), Risk Of Bias In Non-randomized Studies - of Interventions checklists, and National Institutes of Health tools were used to assess the risk of bias.Continuous data were pooled as a mean difference (MD) with a relative 95% confidence interval. The protocol was registered on PROSPERO (CRD42022333848). Six studies were included in the meta-analysis with a total of 181 patients. Compared with the control group, VitE significantly improved the hemoglobin level for chronic hemolysis (MD = 2.72 g/dL, P < .0001) and for acute hemolysis (MD = 1.18 g/dL, P < .0001). It also decreased the reticulocyte level for chronic hemolysis (MD = -1.39 P < .0001) and for acute hemolysis (MD = -1.42%, P < .0001). For before and after studies, the use of VitE significantly improved the level of packed cell volume (MD = 0.56%, P < .00001), red blood cell half-life (MD = 2.19 days, P < .0001), and decreased the reticulocytes level (MD = -1.41%, P < .00001). Among patients with glucose-6-phosphate dehydrogenase deficiency, VitE might provide benefits such as increasing the hemoglobin, packed cell volume levels, red blood cell half-life, and decreasing the reticulocyte level, so reducing hemolysis. Further high-quality, well-designed randomized controlled trials are recommended.

A rare presentation of sickle cell disease diagnosed for the first time in a 60-year-old female: A misdiagnosis or missed diagnosis

Sickle cell disease (SCD) mainly manifests in early childhood. During the first 6 months of life, infants are largely protected by high levels of hemoglobin F; soon thereafter, the disease becomes evident in form of various crises such as vaso-occlusive crisis, hemolytic crisis, and acute chest syndrome, and in rare instances aplastic crisis. Therefore, the majority of patients with SCD are diagnosed in childhood or adulthood, whereas those with sickle cell trait usually remain asymptomatic. However, here, we are presenting a rare case in which a patient has been diagnosed to have SCD for the 1st time at the age of 60 years while being treated for dengue and severe anemia. Our case is one of the rare presentations of SCD, as she never required any blood transfusions even during childbirth and without any sickle crises; therefore, she might not be diagnosed with SCD till her presentation to our hospital. This indicates that advanced age should not be considered as an exclusion criterion for the suspecting and diagnosis of SCD. This case outlines the need for awareness and incorporation of screening for sickle cell anemia in childhood or adulthood as same thalassemia screening programs. The early diagnosis by screening programs will ensure appropriate treatment and therefore improve the quality of life in such patients.

Establishing pregnancy-specific haematological reference intervals in Ghana; a three-center cross-sectional study.

Abnormal intra-pregnancy haematological variables are associated with adverse feto-maternal outcomes. However, the reference intervals (RIs) employed in sub-Saharan Africa to inform clinical decisions are generally imported. Since RIs are influenced by age, geographical location, and race, we hypothesized that context specific RIs should be established in Ghana to contextualize intra-pregnancy decision making. This cross-sectional study retrospectively retrieved data of 333 pregnant women with no known clinically determined intra-pregnancy complications; 22 participants in their first trimester (T1; 1-13 weeks), 177 in their T2 (14-27 weeks), and 132 in T3 (28-41 weeks). RIs for haematological parameters were non-parametrically determined at 2.5th and 97.5th percentiles in accordance with CLSI guidance document EP28-A3c. Two-sample comparisons were undertaken using Wilcoxon rank-sum tests whereas more than two-sample comparisons were undertaken using Kruskal-Wallis test. Statistical significance was set at p <0.05 under the two-tailed assumptions. In accordance with WHO trimester-specific haemoglobin cutoffs, anaemia prevalence was a moderate (T1: 36.4%; 8/22 & T2: 31.6%; 56/177) to severe (T3:68.0%; 90/132) public health problem. Additionally, 9.3% (31/333) individuals had high gestational haemoglobin levels (Hb >13.0 g/dL). Moreover, haemoglobin (T2: 8.6-14.3 vs T3: 7.5-13.6 g/dL), MCH (T2: 22.5-69.8 vs T3: 21.6-31.9 pg), MCHC (T2: 30.2-51.8 g/L vs T3: 30.5-37.9 g/L), TWBC (T2: 4.0-13.4 vs T3: 4.1-13.0 x 109/L) required trimester specific RIs, compared to RBC (2.8-5.1 x 1012/L), MCV (66.2-100.2 fL), and platelet counts (106.3-388.3 x 109/L) that each required combined reference intervals. The intra-pregnancy haematological RIs determined have appreciable lower limits; there is the need to determine context-specific thresholds for haematological variables predictive of positive and/or adverse maternal and infant health outcomes.

Abstract TMP8: Admission Hemoglobin Concentration And Outcome After Endovascular Thrombectomy In Large Vessel Occlusion Stroke

Background: After ischemic stroke, low and high hemoglobin levels have been shown to be detrimental in large epidemiologic studies. It is unclear whether admission hemoglobin levels have prognostic value in patients treated with endovascular thrombectomy (EVT). Methods: Consecutive anterior and posterior circulation stroke patients who presented for EVT were included in this retrospective analysis. Admission hemoglobin levels were divided into quintiles (Q1-Q5). Outcome measures included early neurologic deterioration (END), defined as an NIHSS increase of ≥ 4 points from admission to 24 hours, 90-day functional dependence (modified Rankin score &gt;2) and 90-day mortality. Results: 970 EVT patients (554 male, mean ± SD age of 67 ± 15, mean ± SD admission hemoglobin level of 138 ± 18) were included. In binary logistic regression adjusting for potential confounders, low admission hemoglobin predicted functional dependence at day 90 (Q1 vs Q3 OR 1.63; 95% CI 1.01 - 2.62, p=0.04) but did not predict END or death at day 90. High admission hemoglobin levels predicted END (Q5 vs Q3 OR 2.54 95%CI 1.20- 5.37, p= 0.01), death at day 90 (Q5 vs Q3 OR 3.11 95% CI 1.50 - 6.41, p=0.002) as well as a trend towards increased functional dependence at day 90 (Q5 vs Q3 OR 1.51 95% CI 0.93- 2.44, p=0.10). The increased mortality with elevated hemoglobin was apparent within the first week after stroke. Conclusion: In stroke patients treated with EVT, both low and high admission hemoglobin levels are associated with worse patient outcomes. Optimizing hemoglobin levels may be a therapeutic target in large vessel occlusion stroke.

Iron supplementation improves skeletal muscle contractile properties in mice with chronic kidney disease.

Adult chronic kidney disease (CKD) patients commonly display decreased physical function, leading to increased mortality, which is exacerbated with iron deficiency and anemia. Interventions to mitigate CKD myopathy are scarce, potentially because the underlying contractile deficits have not been fully investigated. We examined single fiber force production, myosin-actin interactions and myofilament properties in soleus and extensor digitorum longus muscles of 16-week-old CKD mice without (CKD, N=12) and with iron supplementation (CKDFE, N=6, weekly injections of 0.2 mg/kg iron dextran) and controls (N=10). Late-stage CKD was induced by 0.2% adenine diet for 8 weeks. CKD with iron supplementation (CKDFE) improved anemia status compared to CKD, but not back to control levels. Maximally activated (pCa 4.5, 25°C) specific tension (maximal isometric force divided by cross-sectional area) was reduced 36-51% with CKD due, in a large part, to a reduction in strongly-bound myosin-actin cross-bridges in all myosin heavy chain (MHC) I, IIA, and IIB fibers. Iron supplementation improved specific tension and number of strongly-bound cross-bridges in MHC IIA and IIB fibers. Myosin-actin cross-bridge kinetics were slower with CKD in MHC I and IIA fibers, with iron supplementation restoring kinetics closer to control values in MHC IIA fibers. Higher hemoglobin levels were correlated to improvements in specific tension and strongly-bound cross-bridges in MHC IIA and IIB fibers, and with faster cross-bridge kinetics in MHC IIA fibers. However, CKD induced decreases in myofilament lattice stiffness for MHC IIA and IIB fibers were not improved with iron supplementation. Our findings show that iron supplementation improved various aspects of the cellular and molecular CKD-induced myopathy in fast-contracting fiber types. Thus, correction of iron imbalance and/or anemia may be an effective countermeasure to reduce contractile deficits and improve quality of life in late-stage CKD patients.

Health Equity in Sickle Cell Research and Access to Therapy

Health Equity in Sickle Cell Research and Access to Therapy

A pilot study to evaluate clinical factors associated with iron and ferritin elevations during pediatric extracorporeal membrane oxygenation.

Introduction: Elevations in serum ferritin and serum iron occur during pediatric extracorporeal membrane oxygenation (ECMO). Previous reports attribute the elevation to frequent red blood cell transfusions and/or hemolysis. Chronic transfusion can cause iron deposition in tissues leading to multisystem organ dysfunction. This study aims identify clinical factors associated with elevated ferritin and iron in pediatric ECMO patients, along with post-decannulation magnetic resonance imaging (MRI) assessment of iron deposition in liver and brain.Methods: Prospective, pilot study, using descriptive statistics to investigate potential associations between patient characteristics, serum ferritin and iron levels, and post-decannulation hepatic and basal ganglia iron deposition.Results: In this study, nine patients (100%) had elevated serum ferritin levels during ECMO. High ferritin levels were more common with veno-arterial than with veno-venous cannulation (p = 0.026) and were also associated with high plasma free hemoglobin levels (p < 0.001). Five patients presented with elevated serum iron levels. High serum iron levels were associated with higher daily (p = 0.016) and cumulative transfusion volumes (p = 0.013) as well ECMO duration beyond 7days. MRI scans were performed on three patients with no evidence of abnormal iron deposition detected in the liver or brain.Conclusions: This pilot study shows that during pediatric ECMO, elevations in serum ferritin and serum iron occur and those elevations may be related to the cannulation modality, ECMO duration, amount of hemolysis, and volume of red blood cell transfusions. Further investigation is warranted to fully understand the implications of elevated serum iron and ferritin in pediatric ECMO.

Effect of Training Method and Hemoglobin Level on Cardovascular Endurance of Siliwangi University Football Players

The purpose of this study was to analyze the influence of exercise methods, namely HIIT 10 minutes cardio workout and HIIT walk and run, on the cardiovascular endurance ability of football players, to analyze the effect of normal high and normal low haemoglobin levels on capacity cardiovascular endurance of football players, and to analyze the interaction of HIIT 10 minutes cardio workout and HIIT walk and run exercise methods and haemoglobin levels to cardiovascular endurance ability in unsil football players in 2022. This study used an experimental method with a 2x2 factorial design, a data analysis technique using Analysis Of Variance (ANOVA) at the signification level (α: 0.05). Results of this study: This is a HIIT 10 minutes cardio workout exercise method with an average VO2Max increase of 1.44, while the HIIT walk and run exercise method have an average of 1.35. Unsil United football SME players In 2022 who have high normal haemoglobin have an average increase in cardiovascular endurance ability greater than players who have low normal haemoglobin. Still, the results of cardiovascular endurance ability in unsil united football SMEs in 2022 showed no interaction because players with low haemoglobin levels get good VO2Max results. Of course, with high haemoglobin, there are also fewer VO2Max results because both methods of HIIT 10 minutes cardio workout and HIIT walk and run exercise with the same intensity and administration, so there is no interaction.

Tissue Clearing and Its Application in the Musculoskeletal System.

The musculoskeletal system is an integral part of the human body. Currently, most skeletal muscle research is conducted through conventional histological sections due to technological limitations and the structure of skeletal muscles. For studying and observing bones and muscles, there is an urgent need for three-dimensional, objective imaging technologies. Optical tissue-clearing technologies seem to offer a novel and accessible approach to research of the musculoskeletal system. Using this approach, the components which cause refraction or prevent light from penetrating into the tissue are physically and chemically eliminated; then the liquid in the tissue is replaced with high-refractive-index chemicals. This innovative method, which allows three-dimensional reconstruction at the cellular and subcellular scale, significantly improves imaging depth and resolution. Nonetheless, this technology was not originally developed to image bones or muscles. When compared with brain and nerve organs which have attracted considerable attention in this field, the musculoskeletal system contains fewer lipids and has high levels of hemoglobin, collagen fibers, and inorganic hydroxyapatite crystals. Currently, three-dimensional imaging methods are widely used in the diagnosis and treatment of skeletal and muscular illnesses. In this regard, it is vitally important to review and evaluate the optical tissue-clearing technologies currently employed in the musculoskeletal system, so that researchers may make an informed decision. In the meantime, this study offers guidelines and recommendations for expanding the use of this technology in the musculoskeletal system.

Ecological and physiological parameters of Myotis dasycneme (Mammalia: Chiroptera: Vespertilionidae) in the Urals

Understanding the evolution of bat homeostasis and the formation of an adaptive strategy of animals to climatic fluctuations and pathogens determine the need for further laboratory and modelling studies devoted to the ecology and physiology of bats. This study was aimed to assess the hematological and biochemical parameters of homeostasis of Myotis dasycneme, a protected endemic bat species of the Urals. Animals (n = 65) were caught in the zone of mass habitation of bats in the Southern Urals (Chelyabinsk Region) and the Middle Urals (Sverdlovsk Region). We used samples from M. dasycneme populations in the Ilmensky State Nature Reserve (Russia). Multivariate non-parametric analysis of variance has shown no significant sex differences in red blood parameters in bats (p &gt; 0.05). The blood of bats was characterised by high levels of hemoglobin (167.9–187.2 g/L), hematocrit (47.2–51.5%), erythrocytes (9.6–11.5 × 1012/L), platelets (136.8–271.3 × 109/L). In the autumn-winter period of hibernation, under hypoxic load on the body and prolonged exposure to low positive and near-zero temperatures, an increased content of agranulocytes (50.6–53.6%) was noted in the blood of females and males. The spring process of awakening and exit from deep hypothermia is accompanied by the reactivity of the innate immune system in males and females (granulocytes: 53.2–54.2%). During the winter period of hypobiosis in bats, the basal metabolism increases and the concentration of glucose in the blood increases to 4.7 ± 0.5 mmol/L (p &lt; 0.05). The absence of statistically significant sex differences in the content of glucose and triglycerides (p &gt; 0.05) in the blood plasma of animals has been noted. This ensures metabolic processes (carbohydrate and lipid metabolism) in all seasonal periods of their annual life cycle. The amino acid fund of blood plasma of bats is represented by 22 amino acids. In the blood plasma of males and females, the fund of free amino acids decreases during the year in the following direction: summer ≥ autumn ≥ winter &gt; spring (p &lt; 0.05). There were no sex differences (p &gt; 0.05) in the content of amino acid metabolic groups, namely glycogenic (GGAA), non-essential (NEAA), branched carbon chain (BCCA). A significant accumulation of metabolically active glucoplastic alanine in autumn (3.1 times) and winter (2.3 times) in the blood of females, and in autumn and winter (2.0 and 1.9 times) in males indicates its role as a low-temperature adaptogen. Under conditions of low positive temperatures, in the blood plasma of M. dasycneme, the disappearance of the essential amino acid tryptophan was observed (p &lt; 0.05). This suggests a high demand for serotonin synthesis as one of triggers actively involved in maintaining hypothermia and hypometabolism in bats. Thus, the biochemical and immunohematological parameters, obtained in the course of the study, make it possible to expand and systematise the available information on the mechanisms of participation of the blood system in the regulatory processes in bats. They can be used for long-term monitoring in solving problems of conservation and abundance of healthy populations of bats that adapt both to seasonal modulations and biotic factors, and to stressors of zoonotic significance.

The Blood Profile of Indonesian Native Chickens that Reared in Semi-Intensive System

The objective of the study was to evaluate the blood profile of Indonesian native chickens reared in a semi-intensive raised system. A total number of 68 chickens from four strains (Red Lurik, Wareng, Ranupane, and Putih) were used as samples. Chickens were challenged for 14 d in a semi-intensive raised system. Blood sampling was obtained from the pectoralis vein of the wing. The ANOVA and Duncant’s test were applied for data analysis. The observed variables consist of hemoglobin, erythrocytes, hematocrit, total blood plasma protein, leukocytes, and leukocyte differentiation. The results showed that chicken strains had a very significant difference (P &lt; 0.01) in blood protein and hematocrit variables, a significant effect (P &lt; 0.05) on hemoglobin levels, and no difference (P &gt; 0.05) on the number of erythrocytes, leukocytes, and leukocyte. The highest hemoglobin level was found in the Ranupane strain (13.48 g dL-1). The highest blood protein and hematocrit values were found in the Putih strain at 7.60 g 100 mL-1 and 42.45 %, respectively. In conclusion that chicken strains of Lurik, Wareng, Ranupane, and Putih have different blood profiles (hemoglobin, blood protein, hematocrit, erythrocytes, leukocytes, and leukocyte differentiation). Consequently, the native chicken strain was normal even in a reared semi-intensive system.

Clinical Profile of Nonproteinuric Kidney Disease in Type 2 Diabetic Patients in India.

Diabetic kidney disease (DKD) is the commonest cause of end-stage renal disease (ESRD) across the world. Development of microalbuminuria is the earliest marker of DKD and predicts progressive decline in estimated glomerular filtration rate (eGFR). However, recent evidence has suggested that a significant proportion of type 2 diabetic patients have chronic kidney disease (CKD) without proteinuria. In this single-center, prospective observational study, 400 consecutive type 2 diabetic patients with either overt proteinuria (>500 mg/day) and/or renal dysfunction eGFR <60 ml/min/1.73 m2) were recruited. Baseline demographic and clinical data were recorded. eGFR and proteinuria were recorded at 6 months and 1 year. Patients with proteinuric (proteinuria >0.5 g/day) and nonproteinuric phenotypes were compared for progression of renal dysfunction in terms of doubling of serum creatinine and need for dialysis. In our study cohort, 106 (26.5%) were nonproteinuric. Both the groups were similar in terms of gender, duration of diabetes, comorbidities, body mass index (BMI), blood pressure control, and glycemic control. The nonproteinuric group was older (56.5 ± 2.1 vs. 54.7 ± 11.6 years, P = 0.012), had lesser prevalence of diabetic retinopathy (49 [46.2%] vs. 218 [74.1%], P < 0.001), higher hemoglobin levels (11.3 ± 1.7 vs. 10.5 ± 2.0 g/dl, P < 0.001), and higher cholesterol levels (169.3 ± 43.3 vs 157.1 ± 58.1 mg/dl, P = 0.025). The nonproteinuric phenotype had higher eGFR at baseline, 6 months, and 1 year. However, doubling of serum creatinine (10 [9.4%] vs. 48 [16.3%]) and progression to ESRD (5 [4.7%] vs. 19 [6.5%], P = 0.159) were not different between the two phenotypes. Nonproteinuric DKD is common. Patients with nonproteinuric DKD tend to be older with a slower decline in eGFR.

Prevalence of Anaemia and its Association with Severity of COVID-19 among Hospitalised Patients: A Cross-sectional Study

Introduction: Coronavirus Disease-2019 (COVID-19) emerged as a global pandemic and was associated with various haematologic abnormalities. There are very few studies from India regarding the association between anaemia and disease severity of COVID-19. Aim: To check the prevalence of anaemia and its association with severity of disease among hospitalised COVID-19 patients. Materials and Methods: This was a cross-sectional study involving 203 patients admitted in general ward and Intensive Care Unit (ICU) of a tertiary care hospital in eastern India. Complete blood count at admission along with other relevant clinical and laboratory parameters was noted. Haematological parameters of the patients were described and then correlated with disease severity and death. Spearman’s correlation and Chi-square test were used to determine the associations. Results: Out of 203 patients with COVID-19,145 (71.4%) had anaemia. The study included 107 males (52.7%) and 96 females (47.3%), of which 77 (80%) females had anaemia compared to 68 (63.5%) males. Co-morbidities were present in 73 patients. Haemoglobin levels were significantly negatively correlated with disease severity (p&lt;0.001). This was even true for patients without any other co-morbidities (p&lt;0.05). Haemoglobin was also negatively correlated with deaths in this study (p&lt;0.05). Conclusion: The prevalence of anaemia in admitted patients of COVID-19 was very high and low haemoglobin levels were associated with more severe disease and death. So, low haemoglobin levels in COVID-19 may be considered as a risk factor for more severe disease and death.

Fetal Hemoglobin Altering Effects of KLF1, BCL11A rs11886868 and XmnI-HBG2 on Transfusion Dependent Beta Thalassemia Patients: Preeliminary Study

Aim: High fetal hemoglobin value is one of the quantitative trait in beta thalassemia and may effect transfusion dependency status of beta thalassemic cases. There are population-based differences about known genetic modifiers of different fetal hemoglobin values. We aimed to find if high fetal hemoglobin value are caused by XmnI-HBG2 polymorphism, rs11886868 of BCL11A or KLF1 whole gene mutations. Material and Methods: Genotyping procedure of thirty well re-defined and characterized transfusion dependent beta thalassemia patients was conducted via either sanger sequencing or and PCR-RFLP. Statistic analysis of groups and multiple logistic regression analysis of related genotypes were performed. Results: We found strong correlations between transfusion dependency and fetal hemoglobin levels (P&lt;0.05). IVS.I.110 (G&gt;A) homozygous mutation was found to be predominant in HBB gene. Lower fetal hemoglobin levels were seen in IVS.I.110 (G&gt;A) homozygous group (P&lt;0.05). Total count of variations among the three modifier genes BCL11A polymorphism was leading first. We did not observe any statistically significant relationship in patients with beta thalassemia major patients who have high fetal hemoglobin values between three modifiers group (P&gt;0.05). Conclusion: This is the first research report from Turkey in terms of 3 different modifiers were analysed and evaluated. Since some cases have more than one variations in these three modifiers, involving higher sample size may overcome this challenge. Other genomic alterations rather than XmnI-HBG2, variations of BCL11A rs11886868 and mutation profile of KLF1 gene, which could decrease or abolish the effect of gamma globin repressors, may have more direct role with high fetal hemoglobin levels in patients with transfusion dependent beta thalassemia in Turkey.

Diving efficiency at depth and pre-breeding foraging effort increase with haemoglobin levels in gentoo penguins

Individual differences in oxygen storage and carrying capacity have been associated with fitness-related traits and, for air-breathing aquatic animals, to diving ability and foraging success. In winter, many seabirds must replenish the energy reserves they have depleted during the breeding period. Thus, winter foraging efficiency can influence their upcoming breeding behaviour. Using gentoo penguinsPygoscelis papuaas a study species, we investigated (1) if inter-individual variation in diving efficiency (proportion of time spent at the bottom) is associated with indices of oxygen storage and carrying capacity (haemoglobin, haematocrit, body mass), and (2) if measures of pre-breeding foraging effort (mean trip duration, total time at sea, and vertical distance travelled) are associated with these oxygen indices and breeding status. Haemoglobin was positively correlated with diving efficiency, particularly for deeper dives, and only penguins with high haemoglobin levels frequently dove to depths ≥140 m. Such differences could affect resource access. However, because reaching deep offshore waters likely requires travelling more than foraging nearshore, vertical distance travelled during pre-breeding increased with haemoglobin levels. The relationship with haematocrit was non-linear, suggesting that commonly used analyses may be inappropriate for this index. We found that early-laying penguins spent less time at sea prior to nesting than non-breeding penguins, suggesting that more efficient foragers lay earlier. Given that diving efficiency at depth is linked to aerobic capacity, anthropogenic activities taking place in either nearshore or offshore waters (e.g. shallow-water fisheries, offshore oil rigs) may have differing impacts on individuals. Further understanding these links could help the conservation of diving species.

Factors Affecting Ischemic Stroke Short-Term Outcome According to Hemoglobin Level

Background and aims There seems to be a U-shaped relation between hemoglobin level and ischemic stroke severity. We aimed to explore possible causes of this relation. Methods All patients with ischemic stroke between 2006 and 2016 admitted within 3 hours of onset were included. Hemoglobin and NIHSS score were obtained on admission. Modified Rankin Scale (mRS) score was obtained day 7. Locally weighted scatterplot smoothing (lowess smoother) curves displaying the frequencies of M1 occlusion and complications according hemoglobin level on admission and lowess smoother curves displaying mRS day 7 in patients with and without middle cerebral artery (M1) occlusion according to hemoglobin level on admission were obtained. Results This study includes 905 ischemic stroke patients. Low hemoglobin was associated with pneumonia and urinary tract infection. Neurological worsening was not associated with hemoglobin level. Increasing mRS day 7 was strongly associated with increasing high hemoglobin in patients with M1 occlusion (correlation factor=.61, P=.02). Conclusions Poor outcome in ischemic stroke patients with low hemoglobin is associated with complications during the hospital stay whereas poor outcome in ischemic stroke patients with increasing high hemoglobin levels is associated with occlusion of the middle cerebral artery.