Incidence Of Anemia In Patients Research Articles

A Multicenter Retrospective Cohort Study Assessing the Incidence of Anemia in Patients Associated With Uterine Fibroids.

Uterine fibroids are benign tumors that develop from the smooth muscle tissue of the uterus, typically during a woman's reproductive years. A substantial proportionof women with uterine fibroids exhibit symptoms, including menorrhagiathat considerably compromise theirquality of life. This study aims to characterizethe fibroid subtype most commonly associated with the incidence ofanemia. This retrospective multi-center cohort study investigated the incidence of anemia in premenopausal women who were diagnosed with uterine fibroids between January 2016 and December 2022. Fibroid position, size, location, and number were assessed by trans-abdominal/vaginal ultrasound and hysteroscopy and correlated to the pre-treatment hemoglobin level. Three-quarters of patients (n=6) with submucosal fibroid presented with any form of anemia followed by 59.3% (n=115) of patients with intramural fibroid and only 36.8% (n=25) of patients with sub serousal fibroid. Interestingly, there was no difference between the groups with regard to the severity of anemia at presentation. Most red blood cells (RBCs) and hemoglobin (Hb) indices were comparable between the groups, except for mean corpuscle volume (MCV) as it was significantly lower in patients with intramural fibroids. Moreover, our investigations showed that the submucosal fibroids tend to present in a higher number as well as the biggest in size. The multivariable logistic regression showed that subserosal fibroids are associated with the lowest risk of developing anemia. In conclusion, our results suggest that the occurrence of anemia should always be considered in women with submucosal fibroids. However, after adjusting for other contributing factors such as menorrhagia, submucosal fibroid did not show an increase in the risk of anemia.

Duration of Zidovudine Consumption Correlates with Anemia in People Living with HIV

Anemia is the most common hematological disorder associated with Human Immunodeficiency Virus (HIV). WHO recommends zidovudine (AZT) as one of the first-line drugs for this infection. It is important to note that the drug has the adverse effect of causing anemia. Therefore, this study correlates AZT consumption duration and the incidence of anemia in HIV-infected individuals. This cross-sectional study was conducted at health service facilities using 213 participants. The data were obtained from medical records, and the assessed parameter was hemoglobin (Hb) level after less or more than a year of zidovudine administration. Furthermore, they were analyzed using a Pearson’s coefficient contingency test (p<0.05) to evaluate the correlation between groups with and without anemia at each period of drug administration. The results showed a significant correlation (p<0.05) between sex and age with anemia incidence in HIV patients administered AZT. The duration of this drug intake in HIV-infected individuals was correlated with anemia (p= 0.024; OR=0.369). This indicates the use of AZT for at least one year may be a protective factor for the incidence of anemia in patients with HIV compared to the group consuming this drug for less than one year.

Clinical and Laboratory Characteristics of Anaemia in Hospitalized Patients with Inflammatory Bowel Disease.

Anaemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Due to its multifactorial etiopathogenesis, the differential diagnosis and treatment of anaemia in IBD is a significant clinical problem. The main aim of our study was to assess the usefulness of laboratory parameters, including hepcidin, in differential diagnoses of anaemia in hospitalized IBD patients. This study also estimated the impact of anaemia on the length of hospitalization and its relationship with clinical data of analyzed patients. The study included 118 adult patients diagnosed with IBD-55 with ulcerative colitis (UC) and 63 with Crohn's disease (CD). Anaemia was significantly more frequent in patients with CD-42 (66.7%)-compared to 31 (56.4%) patients with UC (p = 0.033). The prevalence of anaemia increased significantly with the severity of IBD and the extent of inflammatory changes in the endoscopic examination. Hospitalization time was significantly longer in patients with anaemia, especially in the group with UC. Ferritin concentrations < 30 ng/mL were found only in 15 (20.55%) IBD patients (9 with UC and 6 with CD), and ferritin < 100 ng/mL was observed in 22 (30.14%) patients, equally frequent with UC and CD (p > 0.05). Significantly higher concentrations of transferrin were observed in patients with anaemia in the course of UC compared to CD (2.58 ± 0.90 g/L vs. 2.15 ± 0.82 g/L; p = 0.037). On the other hand, saturation of transferrin < 16% was equally common in UC and CD patients. In our study, hepcidin levels in anaemic UC patients were significantly lower compared to UC without anaemia (p = 0.042), with no similar differences in CD independently of anaemia presence (p = 0.565). To conclude, we observed a high incidence of anaemia in patients with IBD and its significant impact on the length of hospitalization in UC. Routinely determined single laboratory parameters are not sufficient for the differential diagnosis of anaemia, and a complex laboratory assessment, including of hepcidin levels, is necessary for the full picture of anaemia in the course of IBD.

Increased Risk of Anemia in Patients with Asthma.

Asthma can cause a systemic inflammatory response, and anemia of chronic disease (ACD) is known to be caused by other disorders with a chronic inflammatory state. However, it is unclear whether the incidence of anemia is increased in patients with asthma. The objective of this study was to compare the incidence of anemia in patients with asthma and healthy adults. This retrospective cohort study included patients newly diagnosed with asthma at Seoul National University Hospital from 2010 to 2017. Patients with comorbidities before the first visit (index date) that may increase anemia risk were excluded. Cox regression models adjusting for patient age, sex, and obesity were used to compare anemia hazard ratios (HRs) between asthma patients (n=1354) and healthy adults (n=1731). This study included 3085 patients. During 5-y follow-up, anemia occurred in 203 (15.0%) patients with asthma and 79 (4.6%) healthy adults. Compared with healthy adults, the HR for anemia after adjusting for age, sex, and obesity was 4.06 (95% CI: 2.70-6.09) in patients with asthma. In patients aged 18-64.9 y, the adjusted HR of anemia was 3.27 (95% CI: 2.12-5.04) in patients with asthma, compared to healthy patients. In patients >65 y, this adjusted HR was 5.56 (95% CI: 1.31-23.67). The risk of anemia was increased in patients with asthma after adjusting for sex, age, and obesity and excluding comorbidities that can cause anemia. These results suggest the need for regular monitoring for anemia in patients with asthma.

Impact and Association of Anaemia Severity and Its Treatment With Quality of Life of Breast Cancer Patients in Malaysia

Anaemia is a crucial issue among cancer patients and need to be treated properly. High incidence of anaemia in patients with cancer have been associated with several physiological manifestations, leading to decreased quality of life (QOL). The current study aimed to assess the severity of anaemia, evaluate the current treatment guideline of anaemia, and to determine the association between the level of anaemia and its treatment on quality of life of breast cancer patients in Malaysia. This prospective study conducted among breast cancer patients in multicancer centers in Malaysia including three follow ups after receiving their chemotherapy. Clinical data were collected from their medical records and at each follow up, they asked to fill up a functional assessment chronic therapy (FACT-An) questionnaire. Descriptive and inferential statistical analysis were done using SPSS. The mean age of participants was 52 ± 11 years old, and out of 120 participants, 32% received anti-anaemic treatments including 87% of them were prescribed with iron supplementation and only 13% received combination of blood transfusion and iron therapy. Surprisingly, none of the participants received erythropoietin stimulating agents (ESAs). Statistical tests also indicated a significant association between anti-anaemic treatments with haemoglobin level and QOL scores. However, this association was insufficient to significantly improve QOL or palliate anaemia severity among participants. This study showed a great evidence that, the current practice of anaemia treatment (iron therapy) among breast cancer patients in Malaysia’s healthcare setting, was not sufficient to palliate anaemia severity or to improve patients’ QOL. There is still a lot of gaps to improve in the management of anaemia among breast cancer patients to show a significant improvement in haemoglobin level. Therefore, respective organisations and oncologists are required to raise awareness about the optimal treatment of anaemia among breast cancer patients, as a result, improve their general wellbeing

The Relationship Between Adequacy of Hemodialysis and Anemia in Chronic Kidney Diseases (Ckd) Patients Undergoing Hemodialysis in Dialysis Unit, Fatmawati Hospital

Background: Anemia is a common problem that often occurs in patients with CKD undergoing hemodialysis. 56.5% of hemodialysis patients were still have anemia, while on the other hand, the achievement of hemodialysis. adequacy only reached 52.7%. Disparity that data is the basis for this research. The aim of this study is to analysis the relationship between the achievement of hemodialysis adequacy with the incidence of anemia in patients with CKD undergoing hemodialysis.Methods: This study uses a descriptive correlation with a cross sectional approach to the analysis of the independent variable (HD Adequacy) and the dependent variable (Anemia). The relationship between these variables was tested using the Chi Square test.Result: The study was conducted on 134 hemodialysis patients aged 13-86 years, the most common vascular access was AV fistula (68.7%), and women were the most respondents (55.2%). The Kt / V value in this study was 1.67 (1.03-2.75) and an adequate one was 54.5%. Adequate URR reached 80.6% with a mean of 75.13 ± 6.38. The incidence of anemia reached 53.7% with the Hb value at 8.93 ± 2.82 mg / dl. The results of the Chi Square test showed that HD adequacy (Kt / V and URR) with the incidence of anemia had P values of 0.670 and 0.217.Conclusion: There is no significant relationship between HD adequacy and the incidence of anemia

Anemia and Idiopathic Intracranial Hypertension: A Systematic Review and Meta-analysis.

Idiopathic intracranial hypertension (IIH) is a condition typically affecting young, obese women. Although anemia is recognized as a risk factor of IIH from case reports, their relationship remains controversial as several comparative studies showed no significant association. This study aimed to examine the relationship between anemia and IIH. MEDLINE, Embase, Cochrane Library, and grey literature were searched to September 2020. Primary studies on patients with diagnoses of anemia of any kind and IIH were included. Primary outcomes included the total number of cases of anemia and IIH. A meta-analysis on the prevalence of anemia in IIH compared with control patients was conducted. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to rate the quality of evidence. Overall, 62 cases and 5 observational or case-control studies were included. Pooled incidence of anemia in patients with IIH was 195/1,073 (18.2%). Patients with IIH (n = 774) had a significantly higher prevalence of anemia compared with controls (n = 230,981) (RR 1.44 [95% confidence interval 1.08-1.92]). Patients were 67.7% females and had a mean age of 22.4 years. The mean opening pressure was 37.9 cmH2O. Anemia was most commonly caused by iron deficiency (51.6%) and aplastic anemia (19.4%). Most patients (59.7%) showed improvement or resolution with anemia treatment only without intracranial pressure-lowering therapy. Evidence was limited because of high risk of reporting bias from the large number of case reports and case-control studies. Anemia is significantly more common in IIH compared with control patients, and case reports suggest a direct relationship. Complete blood counts should be considered in all patients with papilledema, particularly in atypical presentations (male, nonobese, nonperipapillary retinal hemorrhages, prominent risk factor for anemia) or in treatment-refractory IIH.

Incidence and predictors of iron deficiency anaemia in parturients undergoing elective caesarean section at a tertiary hospital in New Zealand: a retrospective, observational cohort study

BackgroundWorldwide, iron deficiency anaemia in pregnancy is a significant problem which can be especially problematic when delivery is by caesarean section, a procedure associated with significant blood loss. Optimising iron stores pre-delivery remains an overarching goal. We aim to measure the incidence of iron deficiency anaemia in patients undergoing elective caesarean section at our institution and determine any associated predictors, as well as adverse outcomes.MethodsA retrospective, observational cohort study of patients presenting for elective caesarean section over a two-year period. Patient data was collected from hospital electronic records. Iron deficiency anaemia was defined a haemoglobin < 110 g/L and a ferritin < 30 μg/L in the three-month period prior to delivery. The primary aim was to establish the incidence of iron deficiency anaemia at the time of delivery and any associated predictors. Secondary outcomes included any association between the primary outcome and complications defined by the hospital discharge complication coding system, as well as an evaluation of the number of blood tests carried out antenatally per trimester.ResultsOne thousand and ninety-three women underwent caesarean section over the study period and 16.2% had iron deficiency anaemia. Patients with iron deficiency anaemia were more likely to be of Māori and Pacific Island ethnicity, have a greater booking body mass index, be younger and have a greater parity. Pre-operative anaemia was associated with a greater likelihood of post-operative blood transfusion.ConclusionsThere remains potential for optimisation of iron deficiency anaemia in our local population undergoing elective caesarean section.

The Presence of Anemia in Children with Abusive Head Trauma

To evaluate the incidence of anemia in patients with abusive head trauma (AHT), noninflicted traumatic brain injury (TBI), and physical abuse without AHT and the effect of anemia on outcome. In a retrospective, single-center cohort study, we included children under the age of 3 years diagnosed with either AHT (n=75), noninflicted TBI (n=77), or physical abuse without AHT (n=60) between January 1, 2014, and December 31, 2016. Neuroimaging was prospectively analyzed by pediatric neuroradiologists. Primary outcome was anemia at hospital presentation. Secondary outcomes included unfavorable outcome at hospital discharge, defined as a Glasgow Outcome Scale between 1 and 3, and intracranial hemorrhage (ICH) volume. Patients with AHT had a higher rate of anemia on presentation (47.3%) vs noninflicted TBI (15.6%) and physical abuse without AHT (10%) (P<.001). Patients with AHT had larger ICH volumes (33.3mL [10.1-76.4mL] vs 1.5mL [0.6-5.2mL] ; P<.001) and greater ICH/total brain volume percentages than patients with noninflicted TBI (4.6% [1.4-8.2 %] vs 0.2% [0.1-0.7%]; P<.001). Anemia was associated with AHT (OR, 4.7; 95% CI, 2.2-10.2) and larger ICH/total brain volume percentage (OR, 1.1; 95% CI, 1.1-1.2) in univariate analysis. Unfavorable outcome at hospital discharge was associated with anemia (OR, 4.4; 95% CI, 1.6-12.6) in univariate analysis, but not after controlling for covariates. Patients with AHT were more likely to present to the hospital with anemia and increased traumatic ICH volume than patients with noninflicted TBI or physical abuse without AHT. Children with anemia and AHT may be at increased risk for an unfavorable outcome.

INCIDENCE OF ANEMIA IN PATIENT WITH NASOPHARYNGEAL CARCINOMA AT ENT-HNS DEPARTMENT WEST NUSA TENGGARA

Introduction&#x0D; Nasopharyngeal carcinoma is common in China and Southeast Asia, includingIndonesia. The cases are often diagnosed in an advanced stage with a poor prognosis.&#x0D; Objective&#x0D; The purpose of this study was to determine the incidence of anemia in nasopharyngeal carcinoma patients in the ENT-HNS Department West Nusa Tenggara Hospital.&#x0D; Methods&#x0D; The methods of this research are a descriptive study that used data from the medical record of West Nusa Tenggara Hospital. The data were obtained between April 2017 to September 2017.&#x0D; Result&#x0D; During the study periods, we obtained 32 cases. 75% of patients were male and 25% female, with ratio 3: 1. According to the age, patients were distributed from 28 to 69 years old with peak incidence at 41-60 years old. Most patients were stage IV (68.75%). There was 87.51% patient with anemia in this research. However,the highest number was found mild anemia 59.38% and the most types of anemia were hypochromic microcytic.&#x0D; Conclusion&#x0D; The incidence of anemia in a patient with nasopharyngeal cancer in West Nusa Tenggara Hospital is 87.51%. Most of them were mild grade and hypochromic microcytic type

Recurrent and de-novo autoimmune hemolytic anemia in patients treated with immunotherapy for advanced cancer.

e14170 Background: Immunotherapy (IO) has brought dramatic clinical benefit to cancer patients. Serious immune-related adverse events (irAE) have been reported, however, hematological toxicities such as autoimmune hemolytic anemia (AIHA) remains poorly characterized. Here we performed a single institution retrospective study to determine the incidence and risk factors for AIHA and if prior positive direct anti-globulin test (DAT) or anti-RBC alloantibodies (alloAb) on type and screen predicts subsequent AIHA in patients treated with IO. Methods: This is a retrospective review of patients treated with IO between November 2012 and February 2017 at the Ohio State University. Patients who received IO either on clinical trial or as standard of care were included. The electronic medical records were reviewed for patients who developed AIHA. Overall survival (OS) was calculated from the date of initiation of IO to death from any cause or date or last follow-up. Medians and 95% CIs were estimated using Kaplan-Meier method and differences compared using the Log-Rank test. The association between irAE and DAT or alloAb testing was studied using Fisher’s exact test. Results: In 1,097 patients treated with IO, we identified 179 (16.6%) patients who had a DAT or alloAb testing at any time, 126 (11.5%) had this done prior to receiving IO. Of the 179 tested 10 (5.6%) had positive alloAb and 7 (3.9%) had a positive DAT. During treatment, two patients with prior history of AIHA experienced recurrence of AIHA during treatment. Three patients had positive DAT after IO, one was diagnosed as a delayed hemolytic transfusion reaction, and the patient required transfusion every 2 weeks since DAT positivity. The other two with positive DAT were not diagnosed with AIHA and did not require intervention. Patients with positive baseline alloAb (n = 6) had higher rate of irAE than patients without (n = 120) (13.3% vs 2.1%, p = 0.03), including 2 thyroid dysfunction, 2 skin rash, 2 myalgia, 2 hemolytic anemia. Patients with a positive DAT at baseline did not have a higher rate of irAEs (p = 0.09). Median OS for the entire cohort was 7.6 (5.8-9.9) months. No association was found between baseline positive DAT or alloAb and OS (p = 0.1748 and p = 0.3164 respectively). Conclusions: The incidence of hemolytic anemia in patients treated with IO was low. Presence of alloAb at baseline may predict irAE during IO treatment as patients with positive alloAb at baseline had a higher rate of irAE than those without.

Clinical Significance of Detecting the Erythrocyte Life Expectancy in Patients with Malignant Lymphoma Complicated with Anemia

To investigate the clinical value of erythrocyte life span in the diagnosis and treatment of lymphoma patients with anemia. The clinical data of 45 patients with lymphoma diagnosed by Department of Hematology in Beijing Union Hospital from January 2017 to June 2017 were collected. The life of erythrocytes was detected by alveolar gas CO test. The incidence of anemia in patients with malignant lymphoma was 46.7%, 40.0% of patients displayed the shorting of blood cell life and the hemolytic status existed in 15.56% of patients. The incidence of anemia was 47.1% in patients with DLBCL. Patients with B symptoms, bone marrow involvement, splenomegaly or LDH increase often accompanied with anemia, but only the splenomegaly and LDH level were significantly negatively correlated with red blood cell life; there was a significant difference in the effects of CHOP ± R regimen and other chemotherapy regimens (R+MINE/FC/SMILE/GDP) on patients with anemia and erythrocyte life span. The incidence of anemia in patients with lymphoma is high, red cell damage or shortened life may be involved in the mechanism of anemia, the use of a strong chemotherapy regimen can significantly shorten the red blood cell life of patients and aggravates anemia.

Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair.

The increased incidence of anemia in patients with hiatal hernias (HH) and resolution of anemia after HH repair (HHR) have been clearly demonstrated. However, the implications of preoperative anemia on postoperative outcomes have not been well described. In this study, we aimed to identify the incidence of preoperative anemia in patients undergoing primary HHR at our institution and sought to determine whether preoperative anemia had an impact on postoperative outcomes. Using our IRB-approved institutional HH database, we retrospectively identified patients undergoing primary HHR between January 2011 and April 2017at our institution. We identified patients with anemia, defined as serum hemoglobin levels less than 13mg/dL in men and 12mg/dL in women, measured within two weeks prior to surgery, and compared this group to a cohort of patients with normal preoperative hemoglobin. Perioperative outcomes analyzed included estimated blood loss (EBL), operative time, perioperative blood transfusions, failed postoperative extubation, intensive care unit (ICU) admission, postoperative complications, length of stay (LOS), and 30-day readmission. Outcomes were compared by univariable and multivariable analyses, with significance set at p < 0.05. We identified 263 patients undergoing HHR. The median age was 66years and most patients were female (78%, n = 206). Seventy patients (27%) were anemic. In unadjusted analyses, anemia was significantly associated with failed postoperative extubation (7 vs. 2%, p = 0.03), ICU admission (13 vs. 5%, p = 0.03), postoperative blood transfusions (9 vs. 0%, p < 0.01), and postoperative complications (41 vs. 18%, p < 0.01). On adjusted multivariable analysis, anemia was associated with 2.6-fold greater odds of postoperative complications (OR 2.57; 95% CI 1.36-4.86; p < 0.01). In this study, anemia had a prevalence of 27% in patients undergoing primary HHR. Anemic patients had 2.6-fold greater odds of developing postoperative complications. Anemia is common in patients undergoing primary HHR and warrants consideration for treatment prior to elective repair.

Prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure.

Anemia is a frequent comorbidity in patients with heart failure. However, the incidence of anemia in patients with heart failure varies widely, and there is limited evidence on the association between anemia and rehospitalization and on the health consequences of anemia in patients with heart failure. We aimed to identify the prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. This cross-sectional study included 284 patients with heart failure diagnosed at outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained socio-demographic and clinical information, including frequency of readmissions and emergency department visits, using face-to-face interviews and medical record reviews. The prevalence of anemia, defined based on World Health Organization guidelines, was 39.1% among patients with heart failure. Anemia was significantly more prevalent among patients with one or more re-admissions or emergency department visits compared with patients with no history of hospital re-admissions or emergency department visits (42.7% vs. 13.9% ( p = 0.001) and 55.1% vs. 34% ( p = 0.002) respectively). Anemia increased the risk of hospital readmission (odds ratio =8.04, 95% confidence interval, 2.19-29.54) and emergency department visit (odds ratio=2.37, 95% confidence interval, 1.22-4.60) in patients with heart failure. It is imperative that patients with heart failure presenting with anemia undergo appropriate nursing assessment and intervention. Future prospective studies targeting interventions to improve anemia are required to determine whether anemia influences readmission rates and emergency department visits.

55: EVALUATING THE PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS IN PATIENTS WITH ULCERATIVE COLITIS

Background and aims:IBD includes Crohn's disease and ulcerative colitis is 2 inflammations. Symptoms of IBD include abdominal pain, diarrhea and fever, but symptoms of the intestinal tract or other organ...

Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.

PurposeThe purpose of this study was to evaluate and characterize the risk of anemia during the course of chemotherapy among patients with five common types of solid tumors.Patients and methodsPatients diagnosed with incident cancers of breast, lung, colon/rectum, stomach, and ovary who received chemotherapy were identified from Kaiser Permanente Southern California Health Plan (2010–2012). All clinical data were collected from the health plan’s electronic medical records. Incidence proportions of patients developing anemia and 95% confidence intervals were calculated overall and by anemia severity and type, as well as by stage at cancer diagnosis, and by chemotherapy regimen and cycle.ResultsA total of 4,426 patients who received chemotherapy were included. Across cancers, 3,962 (89.5%) patients developed anemia during the course of chemotherapy (normocytic 85%, macrocytic 10%, microcytic 5%; normochromic 47%, hyperchromic 44%, hypochromic 9%). The anemia grades were distributed as follows: 58% were grade 1, 34% grade 2, 8% grade 3, and <1% grade 4. The incidence of grade 2+ anemia ranged from 26.3% in colorectal cancer patients to 59.2% in ovarian cancer patients. Incidence of grade 2+ anemia increased from 29% in stage I to 49% in stage IV. Incidence of grade 2+ anemia varied from 18.2% in breast cancer patients treated with cyclophosphamide + docetaxel regimen to 59.7% in patients with ovarian cancer receiving carboplatin + paclitaxel regimen.ConclusionThe incidence of moderate-to-severe anemia (hemoglobin <10 g/dL) remained considerably high in patients with solid tumors receiving chemotherapy. The risk of anemia was greater in patients with distant metastasis.

The Incidence of Anemia in Patients with Rheumatoid Arthritis

The Incidence of Anemia in Patients with Rheumatoid Arthritis

Protease inhibitors-based therapy induces acquired spherocytic-like anaemia and ineffective erythropoiesis in chronic hepatitis C virus patients.

The addition of protease inhibitors, boceprevir (BOC) or telaprevir (TRV), to peg-interferon and ribavirin (PR) increases the incidence of anaemia in patients with chronic hepatitis C virus (HCV) infection. Although genetic variants in inosine triphosphatase (ITPA) gene have been linked to the haemolytic anaemia induced by PR, the mechanism sustaining severe anaemia during triple therapy is still unknown. This study aims to elucidate the molecular mechanisms underlying anaemia in chronic HCV patients with combined therapy. We studied 59 patients with chronic HCV genotype-1: 29 treated with TRV/PR and 30 with BOC/PR. We evaluated biochemical and haematological parameters, red cell index at baseline, 4, 12, 16 and 24 weeks of treatment; in a subgroup, we performed functional studies: osmotic fragility, red cell membrane protein separation, mass spectrometry analysis, quantification of erythroid microparticles release. IL28B and ITPA polymorphisms were also evaluated. We found early acute normochromic normocytic haemolytic anaemia (4-8 weeks) followed by a late macrocytic hypo-regenerative anaemia with inappropriate low reticulocyte count (12-24 weeks). Studies on red cells revealed: (i) presence of spherocytes; (ii) increased osmotic fragility; (iii) abnormalities in red cell membrane protein composition; (iv) reduced membrane-cytoskeleton stability; (v) increased release of erythroid microparticles. ITPA polymorphisms impacted only the early phase of anaemia. The bimodal pattern of anaemia in chronic HCV patients on triple therapy might be because of acquired spherocytic-like anaemia in the early phase, followed by hyporegenerative anaemia, most likely related to the combined effects of PR and TRV or BOC on erythropoiesis.

Anaemia is a predictor of mortality in patients undergoing aortic valve surgery

We read the article ‘Preoperative anaemia is a risk factor for mortality and morbidity following aortic valve surgery (AVS)’ by Elmistekawy et al. [1] with interest. They aimed to investigate the incidence of preoperative anaemia in patients undergoing nonemergency AVS and its association with postoperative outcomes. They concluded that preoperative anaemia is a common finding in patients undergoing AVS and is an important and potentially modifiable risk factor for postoperative morbidity and mortality. We believe that these findings will pave the way for further studies about the relationships between preoperative anaemia and AVS. Thanks to the authors for their contribution. It is actually believed that patients undergoing heart surgery have a lower margin of safety for tolerance of low haemoglobin (Hg) levels. A significant association between anaemia with adverse outcomes (death, stroke and renal impairment) in patients undergoing cardiac and non-cardiac surgery has been demonstrated in previous studies [2]. Blood transfusion is dangerous with regard to in-hospital mortality, morbidity and long-term survival. Blood transfusion is frequently used as a volume expander while simultaneously increasing the haematocrit. Transfusions have been independently associated with increased mortality after cardiac surgery. Transfusion is also dose-dependent risk factor for early mortality after revascularization. Blood transfusions have been linked to postoperative renal dysfunction, pneumonia, wound infections, severe sepsis and hospital mortality [3]. Based on this point of view, because anaemia and need for blood transfusions lead to very significant adverse effects after cardiopulmonary bypass surgery, it is necessary to research the effective methods of anaemia correction to reduce the need for blood transfusions. Nowadays, although anaemia is a predictor of postoperative complications and is a risk factor for mortality in patients after cardiac surgery treatment, red distribution width (RDW) is known as an independent early marker of Hg evolution and independently identified risk of new onset anaemia, providing predictive information for haematological abnormalities beyond Hg concentrations and other known risk factors. RDW has recently been identified as an independent predictor of all-cause long-term mortality in patients with coronary artery disease [4]. So, if the authors had mentioned RDW, the results of the study might be different. Reduced glomerular filtration rate (GFR) may also be associated with adverse outcomes in patients with cardiovascular disease. In previous study, preoperative GFR was predictive of all-cause mortality, cardiovascular mortality and combined cardiovascular mortality and morbidity. GFR may be useful to identify those patients undergoing cardiovascular surgery with subclinical chronic kidney disease [5]. For this reason, it would be better, if the authors mentioned any of these possible conditions. Finally, it would be better if the authors might define how much time they specified on measuring Hg levels, because it can be associated with haemodilutional anaemia [6]. Following cardiac surgery, some factors including longer hospital stays, increased risk of infection, higher rate of pulmonary complications, prolonged ventilation, stroke, renal failure, atrial fibrillation, myocardial infarction, pneumonia, prolonged ventilation and operation time are associated with increased morbidity and mortality rates in patients undergoing AVS [3]. So, the further studies should evaluated these factors in patients with AVS.

Descriptive study of incidence of side effects of Pegylated interferon alpha therapy and their relation to age, gender, duration of treatment and type of hepatitis in 50 Iraqi patients.

Background: Hepatitis C and B is common disease all over the world and their chronicity is a social and medical problem so medical treatment by alpha interferon can change the mortality and morbidity.Object: Identify the incidence of the side effects of pegylated interferon alpha in a sample of Iraqi patients with chronic hepatitis B&amp;C and their relation to age, gender, duration of treatment and type of hepatitis comparing them with the literatures from other countries.Patients and methods:A descriptive case series study was conducted on 50 patients, 24 male and 26 female, with established diagnosis of hepatitis B(20 patients)and C(30 patients) who attend Baghdad Teaching hospital and Gastroenterology and Hepatology centre in Baghdad between the period of January 2009 and October 2010 with follow up over at least 3 months.A direct interview with detailed history and thorough clinical examination with some simple laboratory investigation were done to determine any of the documented side effects of alpha interferon therapy or discover new side effects not elicited in the studies done on other populations.Results: Flu-like illness is the most common side effect (84%), followed by fatigue, anorexia, local reaction and neuropsychiatric side effects while Neutropenia, lymphopenia and thyroiditis are rare.There is no significant difference in the incidence of side effects between age groups with the exception of constipation which occurs more in younger age group. Arthralgia, palpitation, eczema, itching and rash increase in incidence with prolonged duration of treatment.There is no significant difference in incidence of side effects between both genders apart from hypertension (more in female) and dizziness (more in male).There is no significant difference in incidence of side effects between patients with hepatitis B&amp;C but anemia occurs more in patients with hepatitis C and tremor reported more in patients with hepatitis B.Conclusion: Almost all patients on treatment with interferon-based regimen will experience adverse events that can threaten good adherence. Flu-like illness is the most common side effect (84%), followed by fatigue, anorexia, local reaction and neuropsychiatric side effects (depression, nervousness, insomnia).The higher incidence of anemia in patients with hepatitis C is mostly due to concomitant ribavirin therapy.Age, gender, type of hepatitis and duration of treatment can affect the incidence of interferon therapy.