Improvement In Hemoglobin Levels Research Articles

Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia: Long-term results of endoscopic treatment.

Background and study aims This longitudinal prospective study evaluated the long-term outcome of endoscopic treatment of gastrointestinal bleeding in hereditary hemorrhagic telangiectases (HHT), its safety and outcome predictors. Patients and methods Consecutive patients with HHT and either anemia disproportionate to epistaxis or overt gastrointestinal bleeding received endoscopic treatment of gastrointestinal telangiectases with argon plasma coagulation (APC). Hemoglobin levels and transfusion requirements were evaluated before and after treatment. Treatment effectiveness was classified as: 1) complete: hemoglobin level during the follow-up ≥9 g/dL; 2) complete with recurrence: hemoglobin ≥9 g/dL for at least 12 months with subsequent drop to <9 g/dL; or 3) absent: no improvement of hemoglobin level. Adverse events (AEs) were classified as mild, moderate, severe or fatal. Correlations were searched between treatment outcome and demographic/genetic characteristics, number, size and site of telangiectases, and hepatic arterio-venous malformations grade. Results Forty-seven patients with HHT were enrolled. At median follow-up of 134 months (range 20-243 months), 41 of 47 patients showed treatment response (complete or with recurrence) after one (14/47) or more (27/47) endoscopic treatments. Median hemoglobin levels were 7.0 g/dL and 11.9 g/dL at baseline and at the end of follow-up, respectively. Transfusion requirement decreased from 22.8 to 7.3 red cell unit/year. A higher baseline number of telangiectases was associated with a lower chance of response ( P =0.008). Only one severe AE (0.4%, jejunal perforation) was recorded. Conclusions Endoscopic treatment of gastrointestinal teleangiectases for gastrointestinal bleeding in patients with HHT is effective in the long term and safe.

Real-World Patient Characteristics, Treatment Patterns, and Outcomes in Patients with Lower-Risk Myelodysplastic Syndromes Who Have Been Treated with Luspatercept

Background: Myelodysplastic syndromes (MDS) are a group of rare, clonal bone marrow malignancies characterized by ineffective erythropoiesis. Erythropoiesis-stimulating agents (ESAs) are a treatment option for anemia in patients with lower-risk MDS (LR-MDS); however as only one in three patients respond to ESAs, there is a need for additional treatment options. In April 2020, luspatercept was approved for the treatment of anemia in adult patients with LR-MDS who failed to respond to ESAs. The aim of this study was to investigate real-world treatment patterns and early clinical outcomes in adult patients in the United States with LR-MDS receiving luspatercept. Methods: This was a retrospective observational cohort study of adult patients (aged ≥ 18 years at initial MDS diagnosis) with an International Prognostic Scoring System/Revised IPSS (IPSS-R/IPSS) classification of Very Low-, Low-, or Intermediate-risk MDS on or before the initial MDS diagnosis date +30 days, who were actively treated with a therapy of interest (including ESAs, hypomethylating agents [HMAs], erythroid maturation agents [EMAs], iron chelation therapy [ICT], white blood cells [WBCs], growth factors, chemotherapy, immunomodulating drugs [IMiDs], and platelet growth factors), and who received at least one dose of luspatercept between initial MDS diagnosis and November 1, 2022 in the COTA Vantage database which contains longitudinal, HIPAA-compliant data pertaining to the diagnosis, clinical management, and outcomes of patients with cancer from a mix of academic and community settings. The index date was the date of luspatercept initiation. Patients were required to have at least 2 months of medical data post-index unless they died during this period. All analyses were descriptive. Results: A total of 86 patients who were treated with luspatercept (median age 78.0 years, 79.1% White, 52.3% male, 80.2% ECOG 0-1) were included. Median baseline hemoglobin level was 7.8 g/dL (range: 5.3-11.4 g/dL). Median time from MDS diagnosis to luspatercept initiation was 35.4 months and the median follow-up time was 13.4 months. The majority of patients (89.5%) were previously treated with ESAs for a median duration of 9.0 months. The two most used ESAs were darbepoetin alfa (54.5%) and epoetin alfa (44.2%). In addition, 40.7% of patients had previously received a non-ESA treatment, most commonly azacitidine (62.9%) or lenalidomide (31.4%). The median duration of treatment (DoT) with luspatercept was 9.9 months. Around a quarter of patients who received luspatercept (25.6%, n = 22) received a further treatment, such as an ESA or an HMA for a median of 2.8 months. Overall, 51/76 (67.1%) patients with a baseline hemoglobin test who received luspatercept had an increase in hemoglobin of ≥1 g/dL compared with baseline (i.e. the closest hemoglobin test within 6 months prior to index date). Of these, 56.9% maintained the ≥1 g/dL hemoglobin level for ≥8 weeks and 45.1% maintained it for ≥16 weeks. Further, 44/76 (57.9%) patients with a baseline hemoglobin test who received luspatercept had an increase in hemoglobin ≥1.5 g/dL compared with baseline. Of these, 50.0% maintained the ≥1.5 g/dL hemoglobin level for ≥8 weeks and 25.0% maintained it for ≥16 weeks. Conclusion: This real-world study described treatment patterns and outcomes in patients with LR-MDS receiving luspatercept. An improvement in hemoglobin levels was observed in more than half of patients. In a quarter of patients who had a ≥1.5 g/dL increase compared to baseline, these improvements were maintained for ≥16 weeks. As this was a relatively small and descriptive study, future analyses are required to further elucidate these findings.

Safety and Efficacy of FCM in the Management of Iron Deficiency Anaemia: a Multi-centre Cohort-based Study

This study investigated the efficacy and safety of ferric carboxymaltose (FCM) in the treatment of iron deficiency anaemia (IDA) in a cohort of 100 patients across four locations in West Bengal, India. The results demonstrated significant improvements in various hematological parameters, including a substantial increase in haemoglobin levels, following FCM administration. The study also highlighted the absence of adverse events, showcasing a favorable safety profile of FCM in this population. The use of FCM, a third-generation parenteral iron formulation, proved effective in addressing moderate-to-severe IDA, aligning with existing evidence supporting its efficacy and safety. The rapid and substantial improvement in haemoglobin levels observed within four weeks of FCM administration emphasizes its efficiency in iron repletion, particularly in cases where oral preparations may be insufficient. The absence of adverse effects further supports the tolerability of FCM, a crucial factor in its consideration for widespread use. The study contributes valuable real-world data, especially in the context of the high prevalence of anaemia in India. The findings underscore the potential of FCM as a cornerstone in the treatment of severe anaemia, advocating for its inclusion in targeted interventions and public health initiatives. Overall, this study adds to the growing body of evidence supporting FCM as a promising option in the management of iron deficiency anaemia.

Effects of IL-1β inhibition on anemia and clonal hematopoiesis in the randomized CANTOS trial

AbstractCanakinumab, a monoclonal antibody targeting proinflammatory cytokine interleukin-1β (IL-1β), improved hemoglobin levels while preventing recurrent cardiovascular events in the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS). This cardiovascular (CV) preventive effect was greater in patients with TET2 mutations associated with clonal hematopoiesis (CH). The current proteogenomic analysis aimed to understand the clinical response to canakinumab and underlying proteomic profiles in the context of CH and anemia. The analysis included 4595 patients from the CANTOS study who received either canakinumab or placebo and evaluated multiplexed proteomics (4785 proteins) using SomaScan and targeted deep sequencing for CH mutations. Incident anemia was more common in the presence of CH mutations but reduced by canakinumab treatment. Canakinumab treatment was significantly associated with higher hemoglobin increment in patients with concurrent CH mutations and anemia than patients with CH mutations without anemia or without CH mutations. Compared with those without CH mutations, the presence of CH mutations was associated with proteomic signatures of inflammation and defense response to infection, as well as markers of high-risk CV disease which was further enhanced by the presence of anemia. Canakinumab suppressed hepcidin, proinflammatory cytokines, myeloid activation, and complement pathways, and reversed pathologically deregulated pathways to a greater extent in patients with CH mutations and anemia. These molecular findings provide evidence of the clinical use of IL-1β blockade and support further study of canakinumab for patients with concurrent anemia and CH mutations. This study was registered at www.clinicaltrials.gov as #NCT01327846.

Hemoglobin Response to Zinc Supplementation in Patients with Zinc Deficiency and Chronic Anemia

Background: Zinc is a necessary micronutrient used as a catalyst, structural element, and regulatory ion in many metabolic processes including erythropoiesis. Chronic anemia has an estimated prevalence of 5.6% within the US according to NHANES. Iron deficiency is considered the most common nutritional deficiency leading to anemia, but other nutritional deficiencies have been implicated in anemia including deficiencies of Vitamin A, B12, B6, C, D, and E, folate, Riboflavin, Copper, and Zinc. While zinc fortification has been studied in developing countries and has been associated with a decrease in the overall prevalence of anemia within the pediatric and maternal populations, there have been no studies in adults with chronic anemic in the developed world. The mechanism of Zinc in erythropoiesis is likely multifactorial with zinc acting as a catalyst in alpha-aminolevulinic acid dehydratase enzyme in iron metabolism and heme synthesis. Zinc's incorporation in the structure of the growth factor independent 1B (Gfi-1B) Zinc finger protein and GATA-1 Zinc finger transcription factor, which functions as a regulator in erythroid cell growth by modulating gene expression specific to erythroid series including the SMAD pathways and TGF-β signaling. Zinc's interaction in signaling cascades such as the growth hormone and insulin-like growth factor-1 pathways also result in increased erythropoietin transcription and therefore increased erythropoiesis. In addition, zinc is regarded as an important erythroid differentiation factor. This descriptive, retrospective study describes zinc deficient patients with chronic anemia, who underwent zinc supplementation, and their changes in hemoglobin (HGB) over a 12-month period in an academic outpatient hematology center in California, United States of America. Objectives: Primary endpoints: determine the rate of anemia resolution over 12 months following supplementation of zinc in patients with zinc deficiency and chronic anemia. Secondary endpoints: determine if zinc supplementation in zinc deficient patients with chronic anemia will improve HGB by at least 1.0 g.dL by 1, 3, 6, and 12 month time points. Methods: Ninety Three patients with chronic anemia (HGB &amp;lt;12 for women, HGB &amp;lt;13 for men for &amp;gt;3 months) over the age of 18 were identified to have zinc deficiency (plasma zinc concentration &amp;lt;65 ug/dL) in an academic outpatient hematology center in California. Patients did not start new treatment for their anemia, including initiating new treatments for malignancy 3 months preceding, and within the data collection period. Patients were supplemented with Zinc Sulfate 50 mg daily and their HGB was followed over 12 months. A retrospective analysis was completed for prior medical history, lab data, and HGB was tabulated at the time markers of 1, 3, 6, and 12 months following initiation of zinc supplementation. ANOVA, Wilcoxon rank-sum, and unpaired Students and t tests were performed to determine significant differences where p &amp;lt;0.05 is considered statistically significant. Results Prior to supplementation, average HGB among patients was 9.83 g/dL, WBC was 6.8 g/dL, MCV was 89 fl, PLTS were 211 g/dL. Following 1 month of supplementation average HGB was 10.46 g/dL (p = 0.015, n = 82), at 3 months average HGB was 10.75 g/dL (p = 0.0002, n = 83), at 6 months average HGB was 11.34 g/dL (p= 0.000000004, n = 74), and at 12 months average HGB was 11.48 g/dL (p = 0.00000002, n= 57). Primary endpoint of anemia resolution was found in 39 of 93 patients (42%). Secondary endpoint of HGB improvement by at least 1.0 g/dL was reached in 31% of patients at 1 month, 36% of patients at 3 months, 58% of patients at 6 months and 68% of patients at 12 months. Conclusions: Zinc supplementation significantly improved HGB levels in patients with zinc deficiency and chronic anemia, with resolution of anemia in 42% of patients. There was statistically significant improvement from baseline HGB at the1, 3, 6, and 12 month time markers. Further study is warranted to determine the specific mechanism of zinc deficiency in anemia, as well as clinical studies determining zinc supplementation doses, monitoring, and toxicity.

Comparative analysis of roxadustat efficacy between maintenance hemodialysis and peritoneal dialysis patients.

This study evaluated the comparative efficacy of roxadustat for renal anemia between patients on maintenance hemodialysis (HD) and peritoneal dialysis (PD). 93 maintenance dialysis patients who regularly followed up from August 2015 to June 2021 were enrolled. Despite receiving a therapeutic dose ≥ 12,000 U/week of erythropoiesis-stimulating agents (E+SA) in the past 12 weeks, this had not worked very well. Subjects were assigned to the HD group (n = 60) or the PD group (n = 33) based on their dialysis treatment modality. All patients received oral roxadustat and were followed up for 24 weeks, after which their hemoglobin, serum iron, transferrin saturation, and ferritin were tested. We observed that the hemoglobin level of PD patients was significantly increased from 76.1 ± 15.7 g/L to 106 ± 23.8 g/L (p < 0 .001), while it significantly increased from 73.8 ± 12.9 g/L to 100.7 ± 20.2 g/L (p < 0.001) in the HD patients. After 1 and 3 months of roxadustat treatment, the hemoglobin level and its change in the PD group was significantly higher compared to that in the HD group despite the higher dose of roxadustat in the latter group. In addition, roxadustat was noted to reduce cholesterol levels and stabilize serum iron levels in parallel with improving hemoglobin levels. Roxadustat can effectively increase the hemoglobin level of maintenance dialysis patients, even in those with low erythropoietin response or erythropoietin resistance, and, more importantly, its efficacy in PD patients was more significant.

Unlocking the mystery of the role of Vitamin D in iron deficiency anemia in antenatal women: a case control study in a tertiary care hospital in New Delhi

BackgroundVitamin D deficiency and anemia are clinical conditions that coexist during pregnancy. A high prevalence of Vitamin D deficiency ranging from 50 to 94% is seen throughout the country. The aim of the study was to discover the association between Vitamin D status and iron deficiency anemia during pregnancy. Improving the vitamin D status of pregnant women is crucial to prevent iron deficiency anemia and can improve maternal and fetal outcomes.MethodsA case–control study including 94 primigravida women of age within the age group 18 to 30 years, divided into two groups: a Case Group of 48 patients with already diagnosed iron deficiency anemia (mild to moderate) and a Control Group of 46 antenatal women with normal hemoglobin levels. Data on sociodemographic, clinical characteristics, and the levels of 25(OH) Vitamin D was estimated in both the groups. The association of 25(OH)D levels and anemia was then determined using suitable statistical analysis.ResultsAmong pregnant women affected with anemia, 75% of women had serum Vitamin D concentrations < 20 ng/ml compared to 52.2% of women in the controls. Maternal serum vitamin D level was significantly lower in pregnant women affected with anemia (19.61 ± 13.12) as compared to control (29.43 ± 24.05); (p = 0.024). A positive correlation was found between hemoglobin and vitamin D levels in pregnant women (Pearson’s r = 0.200, p = 0.05).ConclusionsThese findings provide evidence suggesting that Vitamin D deficiency or insufficiency during pregnancy may be a risk factor for anemia and correction of Vitamin D levels can improve hemoglobin levels. Educational efforts should be made to include safe vitamin D intake in antenatal care.

Effectiveness of Lactoferrin in the Treatment of Anemia in Chronic Kidney Disease: A Single-Center Pilot Study.

Anemia occurs in majority of patients with chronic kidney disease despite adequate dialysis and iron replete status. This study was done to evaluate the effects of lactoferrin with or without iron supplementation for the treatment of anemia in patients with chronic kidney disease (CKD). In this prospective, observational, single-center, single-arm pilot study, adult patients aged >18 years, having stage 5 CKD (estimated glomerular filtration rate [eGFR] <15 ml/min/1.73 m2), and who had anemia (hemoglobin [Hb] <10 g/dl; transferrin saturation [Tsat] >20%) were included. Patients were treated with 100 mg of oral lactoferrin twice a day for one month with or without iron supplementation. Patients had been on stable erythropoietin doses for ≥1 month prior to inclusion in the study. We report on the improvement in Hb levels and effect on inflammatory markers from baseline at four weeks. A total of 46 CKD patients having anemia were included. Patients had a mean age of 39.3 years, and a majority were men (69.6%). Improvement in the mean (SD) Hb level (g/dl) was observed from baseline (8.18 [1.19]) to Week 2 (8.54 [1.57]), which attained significance at Week 4 (8.96 [1.93]; P < 0.001; mean difference: -0.76; 95% confidence interval [CI]: -1.291 to - 0.2383). The improvement in Hb was higher in women than in men (P = 0.48) and in patients receiving lactoferrin with iron supplementation than in those receiving lactoferrin alone (P = 0.14). There was a non-significant decrease in the erythrocyte sedimentation rate (P = 0.14) and a non-significant increase in C-reactive protein (P = 0.54) level. Oral lactoferrin therapy was effective in improving hemoglobin levels in patients with advanced CKD and anemia. The effects of lactoferrin therapy on inflammatory markers remain uncertain.

Iron Deficiency Anemia in Pregnancy after Bariatric Surgery: Etiology, Risk Factors, and How to Manage It

Abstract Objective Pregnancy after bariatric surgery is a reality of the 21st century and therefore is essential that all obstetricians know how to manage it. The most prevalent nutritional deficiency is iron deficiency and, consequently, anemia. Although bariatric surgery and pregnancy are already risk factors for anemia, we evaluated in our study if there were any other risk factors and actions to improve hemoglobin levels in this population. Methods We performed a retrospective cohort study, and performed frequency measurements and analyzes of odds ratio, X2 and Fisher exact test to evaluate the risk factors. Results We evaluated 44 pregnancies after bariatric surgery, with an incidence of anemia of 62%, and the only identifiable risk factor for anemia was being black. As for the treatment, the iron salt used for oral supplementation did not associate with anemia risk, and in 27% of the patients, the adjustment of the oral dosage was enough for improvement in hemoglobin levels, but in 36% supplementation with intravenous iron was necessary. Conclusion Being black is a risk factor for anemia. The type of iron salt does not correlate with the incidence of anemia, and for the treatment and improvement of iron dosages, it seems an effective increase in iron intake.

Cava Smoothie As An Adjuvant in Iron Supplementation Can Increase Hemoglobin Levels and Erythrocyte Indices in Anemic Adolescent Girls

Uncontrolled anemia leads to a decline in hemoglobin levels and erythrocyte blood indices, posing various health risks. To address this, a study aimed to assess the effectiveness of cava smoothies and iron supplementation in boosting hemoglobin levels and erythrocyte indices among anemic adolescent girls. The study involved 87 adolescent girls with moderate anemia, divided into three groups. The control group (C) received weekly iron tablets (60 mg), while two intervention groups (I1 and I2) were given the same iron tablets along with cava smoothies in increasing doses over 28 days. The results revealed significant improvements in hemoglobin levels. Group C showed an increase of 0.27 g/dL, while I1 and I2 demonstrated remarkable gains of 1.46 g/dL and 2.54 g/dL, respectively. Furthermore, erythrocyte indices (MCV, MCH, MCHC) exhibited positive changes. Group C saw increases of 0.35 fl, 0.34 pg, and 0.27 g/dL, I1 showed improvements of 0.69 fl, 0.61 pg, and 0.64 g/dL, and I2 experienced substantial enhancements of 1.97 fl, 1.61 pg, and 1.60 g/dL. In conclusion, the study confirmed that cava smoothies and iron supplementation effectively raise hemoglobin levels and improve erythrocyte indices in anemic adolescent girls, highlighting the potential benefits of this intervention for combating anemia.

Nutrition Education and Assistance Based on Behavior Change in Adolescent Girls to Improve Nutritional Status and Hemoglobin Levels

Inappropriate nutritional behavior is a common cause of nutritional issues among adolescents, often leading to conditions like underweight and anemia. This study aimed to assess the impact of nutrition education and behavioral change-based support on the nutritional status and hemoglobin levels of adolescent girls. The study included 75 adolescent girls aged 16-18 years from Singosari Village, Gresik District, chosen through purposive sampling. Over a 30-day period, intensive nutrition education and assistance were provided, utilizing various methods such as lectures, discussions, role play, and practical exercises. The results revealed significant improvements in various aspects. Participants exhibited increased nutrition knowledge, energy and protein intake, body weight, nutritional status, and hemoglobin levels after the intervention (p &lt; 0.05). The rise in knowledge was linked to higher protein intake (p=0.009), while adequate protein intake was associated with weight gain (p=0.025). Weight gain, in turn, correlated significantly with improved nutritional status based on BMI/U (p = 0.041). Hemoglobin levels also significantly increased, shifting from 11.6 + 0.2 mg/dl (low) to 13.4 + 0.1 mg/dl (normal) after the intervention. This improvement in hemoglobin levels was linked to increased energy intake (p = 0.012) and a change in the practice of consuming iron supplementation, shifting from no usage to weekly consumption. In conclusion, nutrition education and behavioral change-based support can effectively enhance energy, protein, and iron intake, leading to improved nutritional status and hemoglobin levels among adolescent girls.

Efficacy of different doses of mifepristone in the management of uterine leiomyoma in a tertiary care centre

Leiomyoma or uterine fibroid are benign tumours that arise from the smooth muscles of the uterus. The leiomyomas are common gynaecological problem encountered among reproductive age group women. Mifepristone is the commonly used drug in the management of uterine leiomyoma. The objective of the study were to study the efficacy and safety of 10mg and 25mg of Mifepristone in the management of uterine fibroid. This is a randomized controlled Trial conducted in tertiary care centre. Hundred women with the diagnosis of uterine fibroid were taken up for the study. Group-A (n=50) were given Mifepristone 10mg and Group-B (n=50) were given Mifepristone 25mg daily for a period of 3 months. Reduction in the size of fibroid were assessed at the end of 3 months. At the end of 3months there was a significant reduction in both menstrual blood loss and fibroid volume in both the groups (p&amp;#60;0.001). There was a also significant improvement in haemoglobin levels in both the groups. When compared to Group –A (10mg Mifepristone) more side effects were noted in Group-B (25mg Mifepristone). Nausea and vomiting developed in 90% and 60% of patients in group A and B.Gastrointestinal discomfort developed in 80% and 50% of patients in group A and B. Both Mifepristone 10mg and 25mg had similar clinical outcomes but 10mg had better compliance and lower side effects. Hence, 10mg can be preferred over 25mg in order to bring about effective management of uterine fibroid.

Washed microbiota transplantation improves haemoglobin levels in anaemia of chronic disease.

Anaemia of chronic disease (ACD) is the second most common type of anaemia and lacks an effective treatment. Patients with anaemia are reported to have altered gut microbial profiles, which may affect erythropoiesis. Here, we investigated the gut microbial features of patients with ACD and determined whether regulating gut microbiota using washed microbiota transplantation (WMT) was effective in treating ACD. We compared the gut microbiota profile of patients with ACD and healthy controls, evaluated the efficacy of WMT on haematological parameters in the patients, and analysed the alterations in gut microbiota after WMT treatment. Patients with ACD had lower gut microbial richness, and differences in microbial composition and function, relative to healthy controls. Additionally, the relative abundances of two butyrate-producing genera Lachnospiraceae NK4A136 group and Butyricicoccus, were positively correlated with the haemoglobin (HGB) level and lower in patients with ACD than controls. WMT significantly increased HGB levels in patients with ACD. After the first, second and third WMT rounds, normal HGB levels were restored in 27.02%, 27.78% and 36.37% (all p < .05) of patients with ACD, respectively. Moreover, WMT significantly increased the abundance of butyrate-producing genera and downregulated gut microbial functions that were upregulated in patients with ACD. Patients with ACD exhibited differences in gut microbial composition and function relative to healthy controls. WMT is an effective treatment for ACD that reshapes gut microbial composition, restores butyrate-producing bacteria and regulates the functions of gut microbiota.

Post-partum iron deficiency anemia: Prevalence and impact of moringa oleifera leaves powder on hemoglobin levels in postpartum period

Iron deficiency anemia is a cause of concern for pregnant and lactating mother globally. As per NFHS 5 Data, 52.2% pregnant women (Both Urban and Rural) are anemic in India. Iron Deficiency Anemia is associated with maternal and neonates’ mortality, restricted cognition development, low birth weight babies, Premature babies and majorly stunting which affects the nutritional status throughout the vicious cycle. Postpartum anemia is associated with an impaired quality of life, reduced cognitive abilities, emotional instability, and depression and constitutes a significant health problem in women of reproductive age. Multipronged strategies are required to curtail maternal anemia. Food based approach to prevent anemia is the most sustainable strategy. To investigate the impact of moringa oleifera leaves powder capsules on haemoglobin levels of postpartum mothers. The study was conducted in one of the govt. hospitals of Vadodara District of Gujarat, India and was a part of larger study carried on M Oleifera effects on prolactin levels. An interventional study was carried out amongst 106 postpartum mothers. Fifty-six mothers constituted the interventional group of which 45 mothers did complete compliance and 50 mothers constituted the control group of which 37 mothers did complete compliance of capsules for 30 days. Hemoglobin levels were analysed on day 0 (Baseline) and on day 7 (Endline) post-partum. Data was analysed using independent t test and appropriate statistical analysis.Findings revealed the prevalence of iron deficiency anemia to be 59%in postpartum mothers post-delivery. Mean baseline hemoglobin values for experimental and control group was 10.9 ± 1.4 g/dl and 10.3 ± 1.5 g/dl respectively on day 0 post-partum. The mean end line hemoglobin values for experimental and control group were 12.3 ± 1.5 g/dl and 11.6 ± 1.6 g/dl respectively on day 7 post-partum. The mean rise in haemoglobin levels of experimental group was 1.4g/dl and that of control group was 0.8g/dl which was significant (p=0.00001).Postpartum anemia is a cause of concern.There was a significant impact of Moringa Oleifera Leaves on hemoglobin levels of enrolled lactating mothers. Thus, it can be suggested that Moringa oleifera can be supplemented to lactating mothers’ post-partum to aid curtailing iron deficiency anemia. Improved haemoglobin levels in post-partum mothers may facilitate Exclusive Breastfeeding practices.

A tertiary care study to assess the effectiveness of 'Supplement adherence kit' on intake of nutritional supplements among pregnant women.

An antenatal mother undergoes significant changes throughout pregnancy and most of which occur during the second trimester. Supplements are important for normal growth and development of fetus, Deficiency of supplements during pregnancy leads to anemia and can have a negative impact on perinatal and maternal outcomes. These complications can be prevented by supplementing needed vitamins and minerals. A Quasi-experimental study was conducted on 137 subjects visiting gynecology OPD enrolled by total enumerative sampling technique. Hemoglobin level and the adherence of supplements were assessed during the second trimester of antenatal mothers in both the groups. Adherence of supplements has increased significantly (p value = 0.005, 0.004, and 0.040 for iron, folic acid, and calcium, respectively) among subjects in the experimental group. Results of SMAQ shows that there is increase in adherent mothers from 33.3% to 71.2% experimental group. Supplement adherence kit was effective in increasing supplement adherence level along with an improvement in hemoglobin levels among antenatal mothers in the Experimental group.

Comparative study of Ulipristal and Ormeloxifene in treatment of uterine fibroids

Aim: This study was conducted among reproductive age women between 30-50 yrs diagnosed with uterine fibroids to compare the efficacy and safety of Ormeloxifene and Ulipristal in treatment of uterine fibroids.Methodology: Prospective interventional study was conducted from May 2021 to September 2022 among 40 patients diagnosed with uterine fibroids who were randomly divided into two groups, 20 patients in each group, Group 1 were given Ormeloxifene and group 2 were given UlipristalResults: Mean fibroids size reduced in patients who took Ulipristal than in Ormeloxifene group which was statistically significant. Mean HB CONC increased in Ulipristal group than in Ormeloxifene group which was statistically insignificant.Conclusion: Ulipristal is better as compared to ormeloxifene in reduction of fibroid size. Ulipristal also reduced menstrual blood loss and improved hemoglobin levels when compared to Ormeloxifene.

Abstract CT243: Clinical trial simulation to inform dose selection of zilurgisertib, an ALK2 inhibitor, in patients with anemia due to myelofibrosis (MF)

Abstract Disease-associated anemia is reported in over one-third of patients at MF diagnosis and can be exacerbated by currently available MF therapies. Further, anemia is associated with poor prognosis in MF. Activation of activin receptor-like kinase (ALK)-2 (also known as ACVR1) may contribute to MF-associated anemia via up-regulated levels of hepcidin. Zilurgisertib (INCB000928) is a potent and selective ALK2 inhibitor that has demonstrated dose-dependent improvement in hemoglobin levels in a cancer-induced anemia mouse model, in which maximum hemoglobin increase was observed when zilurgisertib trough concentration covered pSMAD IC50 for at least half of the dosing interval. Zilurgisertib is being evaluated as monotherapy or in combination with ruxolitinib in a phase 1/2 dose-escalation and -expansion study in patients with anemia due to MF (NCT04455841). The objective of the current study is to use modeling and simulation, which integrate both preclinical and clinical data, to inform dose finding for the ongoing phase 1/2 trial in MF patients. Population (Pop) PK analyses were conducted using a total of 3089 zilurgisertib plasma concentrations from 161 healthy subjects in 3 completed phase 1 studies: a single ascending dose study (64 subjects, 10-500 mg), a multiple ascending dose study (59 subjects, 50-400 mg QD and 300 mg BID), and a drug-drug interaction study (38 subjects, 100 mg single dose of zilurgisertib alone). A nonlinear mixed-effects modeling approach in Monolix software was used for the analyses. Zilurgisertib PK were well-characterized by a 3-compartment model with nonlinear clearance and inter-occasion variability on absorption rate constant and bioavailability. The diagnostic plots and visual predictive check demonstrated that the model appropriately characterized the zilurgisertib plasma concentrations. Because zilurgisertib PK are similar between MF patients and healthy subjects, as suggested by available PK data in MF patients receiving doses up to 200 mg, the pop PK model developed with data from healthy subjects was used to simulate steady-state exposures in MF patients receiving 200 to 600 mg daily dose. Simulation results showed that daily doses of ≥600 mg would result in &amp;gt;90% of patients achieving exposure similar to the observed exposure associated with maximum efficacy in the mouse model. The conclusions from this clinical trial simulation support the decision to continue dose escalation in MF patients receiving zilurgisertib monotherapy. Citation Format: Yan-ou Yang, Hong Yang, Betty Lamothe, Matthew Stubbs, Amanda McBride, Francis Seguy, Kevin Rockich, Jay Getsy, Phillip Wang, Xiang Liu, Jeff Jackson, Ekaterine Asatiani, Xuejun Chen. Clinical trial simulation to inform dose selection of zilurgisertib, an ALK2 inhibitor, in patients with anemia due to myelofibrosis (MF) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT243.

ROLE OF IRON SUCROSE INFUSION IN THE IMPROVEMENT OF HAEMOGLOBIN LEVEL IN PREGNANT WOMEN IN A RURALAREA OF CHENGALPATTU DISTRICT-TAMILNADU.

Introduction: Anaemia is a serious public health problem which is prevalent among young children and pregnant women. WHO denes anaemia as haemoglobin (Hb) &lt;11 g %1 In India, the ICMR classication of iron deciency anaemia is: 8-11 g% as mild, 5-8 g % as moderate and &lt;5 g% as severe anaemia. This study is mainly to assess the effect of Iron sucrose infusion in the improvement of hemoglobin level in pregnant women in a eld practice area of rural Block PHC- Chunampet, Tamilnadu.Methodology: Government Block Rural PHC-Chunampet is the only Government health facility in that area, surrounding 15 km. In Government Block Rural PHC-Chunampet, they are regularly monitoring haemoglobin level to rule out anaemia and providing iron sucrose infusion depending upon the hemoglobin level for improvement of anaemia. We have reviewed the data from January-2021 to December-2021. All Pregnant women who visited Government Block Rural PHC-Chunampet during the study period, (from January-2021 to December-2021) were included in the study. We entered the data in excel sheet and analyzed using SPSS version 21.0. Results: Among the 143 study participants, 67 (47.9%) participants belonged to the age group 21-25 years and 52 participants (36.4%) belonged to the age group 26 - 30 years Before Iron sucrose Intervention, the mean Hb level was 9.023 (+ 0.77). After Iron sucrose Intervention, the mean Hb level was 9.755 (+ 0.79). Conclusion: The study has shown that iron sucrose injection has been effective in increasing the Hb levels in all gestational ages of pregnancy. The intervention proved to be most effective in primi gravida women, reducing the number of women with Hb less than 10g/dl by 37.1% from 96.6% to 58.6% after administration of iron sucrose.

Improving Hemoglobin Level with Increasing Copper, Cobalamin, and Iron Intake of Pregnant Women

Over the past five years, there has been a dramatic increase in anemia problems among pregnant women in Indonesia. Almost half (48.9%) of pregnant women in Indonesia have anemia. Further research is needed to explore the role of additional nutritional deficiencies that cause anemia in Indonesia, apart from iron deficiency. The aim of this research was to determine the characteristics and nutrient intakes affecting pregnant women’s hemoglobin levels. A cross-sectional study was carried out from May to October 2019 on 60 pregnant women at Public Health Center Kebon Jeruk, Jakarta. The independent variables were pregnant women’s characteristics, intake of energy, protein, folate, vitamin B6, B12 (cobalamin), C, E, iron, copper, and calcium. The dependent variable was hemoglobin level. Multiple regression using dummy variables was used for multivariate analysis. The average age is 28.3+5.5 years old, with no mothers being of risky age. The average hemoglobin (Hb) level is 11.5+1.4 g/dL. The majority of women are in their third trimester (42%). The variables that significantly affect hemoglobin levels are the intake of iron, vitamin B12, and copper. Increasing the intake of iron, vitamin B12, and copper effectively improves hemoglobin levels among pregnant women. It is recommended to provide iron tablets in multi-nutrient form, and further research is needed for its effectiveness.

Improving Hemoglobin Level with Increasing Copper, Cobalamin, and Iron Intake of Pregnant Women

Improving Hemoglobin Level with Increasing Copper, Cobalamin, and Iron Intake of Pregnant Women