Including Iron Deficiency Anemia Research Articles

Exploring the Impact of Iron Deficiency Anaemia on Glycated Haemoglobin A1c Levels in Pregnant and Non-Pregnant Women: A Systematic Review.

Haemoglobin A1C (HbA1c) is fundamental in monitoring glycaemic control during pregnancy. However, several conditions could affect this test's accuracy, including iron deficiency anaemia (IDA). Hence, this systematic review delves into the underexplored connection between IDA, iron replacement therapy (IRT), and haemoglobin A1C (HbA1c) during pregnancy. An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by six authors. From a comprehensive search strategy, 968 records were obtained. After applying the inclusion and exclusion criteria, seven studies were included, comprising 365 women selected for analysis. Six studies indicated a positive correlation between IDA and HbA1c levels, while one found no correlation. The average HbA1c level of the included studies in pregnant women was 5.64%. In comparison, it was found that non-pregnant women had lower HbA1c levels. Among the included studies, the mean HbA1c levels decreased from 5.1% to 4.89% after treating pregnant women with IRT. The review emphasises the complexity of interpreting HbA1c levels in pregnant women with IDA, highlighting the influence of pregnancy-induced physiological changes. In addition, this suggests that HbA1c should not be the sole criterion for diabetes management in pregnant women with IDA. Future research should focus on alternative glycaemic monitoring methods unaffected by IDA.

РОЛЬ ПЕРИНАТАЛЬНОГО ЦЕНТРА МНОГОПРОФИЛЬНОЙ БОЛЬНИЦЫ В ПРОФИЛАКТИКЕ МАТЕРИНСКОЙ СМЕРТНОСТИ ОТ АКУШЕРСКИХ КРОВОТЕЧЕНИЙ: КАК БЫЛО И КАК СТАЛО

The study aims to evaluate the role of a perinatal center in a multidisciplinary hospital in the prevention of maternal mortality caused by obstetric bleeding. The study used the continuous sampling method to conduct a retrospective analysis of 185 cases of pregnancies and their outcomes in women with obstetric bleeding during pregnancy, labor, and the postpartum period treated at the Perinatal Center in Khanty-Masiysk from 2010 to 2011 and from 2019 to 2020. It was identified that primary risk factors for maternal mortality due to obstetric bleeding include iron deficiency anemia; gestational diabetes mellitus with complications; four or five pregnancies in anamnesis; and one to three scars on a uterus, which are the most significant risk factors for obstetric bleeding. From 2019 to 2020, there was a 1.3-fold increase in cases of premature detachment of normally situated placentas and a 2.5-fold increase in cases of placenta praevia with bleeding and fused placentas in the structure of hemorrhage. Taking into account existing risk factors, identifying a group of near miss cases and timely routing of patients to a level 3 medical facility is a necessary condition for preventing maternal mortality.

Time to Resolution of Iron Deficiency: A 10-Year Single State Retrospective Review

Introduction: Iron deficiency can have clinical consequences even without anemia, including fatigue, exercise intolerance and mood disorders. The time from laboratory diagnosis to resolution of iron deficiency has not been previously evaluated. Methods: In a retrospective review of electronic medical record (EMR) data from a single state health system, we identified patients meeting laboratory criteria for iron deficiency (defined as a ferritin level < 25 ng/mL). Patients with at least one follow-up ferritin level of any value within 3 years were included in the final cohort. Patients with a follow-up ferritin > 50 ng/mL at any time point within 3 years were classified as having resolved iron deficiency. Diagnoses of interest included iron deficiency anemia (IDA), as well as other conditions where iron deficiency is routinely assessed and treated irrespective of anemia, namely heart failure (HF) and restless leg syndrome (RLS). Descriptive statistics and time to event analyses (via Cox proportional hazards regression) were performed to determine time to resolution of iron deficiency in the cohort and characteristics predictive of achieving resolution. Results: We identified 13,084 patients with iron deficiency detected between 2010 to 2020. The majority of patients were female (86.6%) and White (79.3%); 57.3% had an EMR diagnosis of IDA (Table 1). We found that 5,485 (41.9%) had resolution of iron deficiency within 3 years of diagnosis, while 7,599 (58.1%) had unresolved iron deficiency. Among those with resolved iron deficiency, the median time to resolution was 1.9 years (IQR 0.8, 3.9 years). Factors associated with resolution of iron deficiency included increasing age (aHR 1.42 [95% CI 1.31 - 1.54], p < 0.001 for age > 60), male gender (1.49 [1.39 - 1.59], p < 0.001) and a diagnosis of HF (1.23 [1.11 - 1.36], p < 0.001) (Table 2). Black race (0.75 [0.68 - 0.83], p < 0.001) and absence of an EMR diagnosis of IDA, HF or RLS (0.75 [0.71 - 0.81], p < 0.001) were associated with a lower likelihood of iron deficiency resolution. Conclusion: Prolonged and unresolved iron deficiency were prevalent in this cohort, with young age, female gender and Black race increasing risk of non-resolution. Interventions are needed to raise awareness of the clinical consequences of non-anemic iron deficiency and of diagnostic ferritin thresholds.

Characterizing Outpatient Classical Hematology Referrals at an Academic Healthcare System

BACKGROUND: Healthcare systems and delivery networks are experiencing an overwhelming number of Classical Hematology (CH) referrals. In our network, patients referred for CH consultation are facing increasing wait times and a shortage of available clinicians. In response to these workforce challenges, our institution is collaborating with advanced practice providers (APPs) to evaluate new patients using a tiered system that matches consults with corresponding years of clinical experience. This model is in use at one clinical site but its potential benefit when implemented across the entire network is unknown. To better inform this initiative, we sought to identify the most common diagnoses for outpatient CH referrals, determine the complexity level of these consults, and identify opportunities for alternative patient scheduling workflows. METHODS: A list of all new outpatient CH referrals evaluated in the Yale Smilow Cancer Network in Connecticut from 2019-2021 was compiled. ICD-10 codes assigned from each new patient encounter were combined into general diagnosis categories including iron deficiency anemia, other anemias, and thrombosis. After the 3 most common diagnoses were identified, 30 new patients evaluated in 2021 were randomly selected from each diagnosis group for manual chart review. Manual review focused on the details of each patient case and assigned a diagnosis level (Table 1). Diagnosis levels were matched with APP years of experience, ranging from level 1 (consults that could be evaluated within the first few years of practice) to level 3 (cases requiring more extensive experience or physician evaluation). These levels were predetermined by a committee of senior level CH physicians in the Smilow network. RESULTS: Based on grouped ICD diagnosis codes, the 3 most common CH referrals to our network from 2019-2021 were anemia (excluding iron deficiency, with an average of 22.4% of all new referrals), iron deficiency anemia (21.2%), and thrombosis (13.2%). Combined, these 3 diagnoses accounted for 56.8% of all incoming new referrals. Manual chart review of the anemia group showed that 3 patients had iron deficiency anemia with a diagnosis level of 1. After excluding these 3 patients, 1/27 (3.7%) anemia patients were level 1, 9/27 (33.3%) were level 2, and 17/27 (63.0%) patients were level 3 (Figure 1). In the iron deficiency group, after accounting for the 3 additional patients transferred from the anemia group, 16/33 (48.5%) were level 1, 7/33 (21.2%) were level 2, and 10/33 (30.3%) were level 3. In the thrombosis group, 12/30 (40.0%) patients were level 2, and 18/30 (60.0%) were level 3. 18.9% of all reviewed charts were level 1, 31.1% were level 2, and 50.0% were level 3. CONCLUSIONS: Manual chart review of the most common CH referrals (anemia, iron deficiency anemia, thrombosis) showed heterogeneity in diagnosis level. Thrombosis and anemia (excluding iron deficiency) had a higher proportion of more complex cases. In contrast, iron deficiency anemia contained a substantial number of level 1 cases (approximately 50% of all iron deficiency referrals). At one of our clinical sites, CH trained APPs have been evaluating new consults using the tiered system described within this study. Patients are then seen in follow-up by a collaborating physician. Manual chart review showed that 50% of consults in the 3 most common referral categories were either level 1 or 2, representing a substantial patient population that could be evaluated by an APP for initial consultation. In addition to increasing trainee and physician recruitment, implementing this model on a network-wide scale may be an invaluable strategy to address the current CH workforce shortage. Our study also identified that iron deficiency contained a large proportion of level 1 cases. This may be a consult population that is particularly amenable to non-traditional triage and evaluation algorithms. Strategies to consider include eConsultations to facilitate faster evaluation and iron infusions when indicated, or specialized provider and clinic creation. Our institution is piloting the use of triage algorithms to identify these uncomplicated iron deficiency cases and further optimize consult workflows.

Biology of Anemia: A Public Health Perspective

Our goal is to present recent progress in understanding the biological mechanisms underlying anemia from a public health perspective. We describe important advances in understanding common causes of anemia and their interactions, including iron deficiency (ID), lack of other micronutrients, infection, inflammation, and genetic conditions. ID develops if the iron circulating in the blood cannot provide the amounts required for red blood cell production and tissue needs. ID anemia develops as iron-limited red blood cell production fails to maintain the hemoglobin concentration above the threshold used to define anemia. Globally, absolute ID (absent or reduced body iron stores that do not meet the need for iron of an individual but may respond to iron supplementation) contributes to only a limited proportion of anemia. Functional ID (adequate or increased iron stores that cannot meet the need for iron because of the effects of infection or inflammation and does not respond to iron supplementation) is frequently responsible for anemia in low- and middle-income countries. Absolute and functional ID may coexist. We highlight continued improvement in understanding the roles of infections and inflammation in causing a large proportion of anemia. Deficiencies of nutrients other than iron are less common but important in some settings. The importance of genetic conditions as causes of anemia depends upon the specific inherited red blood cell abnormalities and their prevalence in the settings examined. From a public health perspective, each setting has a distinctive composition of components underlying the common causes of anemia. We emphasize the coincidence between regions with a high prevalence of anemia attributed to ID (both absolute and functional), those with endemic infections, and those with widespread genetic conditions affecting red blood cells, especially in sub-Saharan Africa and regions in Asia and Oceania.

Laparoscopic hiatal hernia repair for treating patients with massive hiatal hernia and iron-deficiency anaemia

BackgroundMassive hiatal hernias may result in extraoesophageal symptoms, including iron-deficiency anaemia. However, the role played by hiatal hernias in iron-deficiency anaemia is not clearly understood. We examined the prevalence of anaemia in patients with massive hiatal hernias and the frequency of anaemia resolution after laparoscopic hiatal hernia repair at long term follow-up.MethodsPatients who underwent laparoscopic hiatal hernia repair from June 2008 to June 2019 were enrolled in this study. We collected the patients’ demographic and clinical data from their medical records, and compared the pre-surgical and post-surgical findings (at 1 week and 3 months post-surgery). All patients with adequate documentation underwent post-surgical follow-up to evaluate improvements in clinical symptoms and signs.ResultsA total of 126 patients with massive hiatal hernias underwent laparoscopic hiatal hernia repair. Of these, 35 (27.8%) had iron-deficiency anaemia. Anaemia was resolution in all the patients and they had significantly reduced GERD-Q scores at 3 months postoperatively (P<0.01) .The mean follow-up period was 60 months. Iron-deficiency anaemia resolution after hiatal hernia repair was achieved in 93.9% of the patients.ConclusionAnaemia is common in patients with massive hiatal hernias, and most of our patients were symptomatic because of their anaemia. Moreover, in patients with massive hiatal hernias, iron-deficiency anaemia resolution is likely after laparoscopic hiatal hernia repair.

Iron supplements in pregnant women with normal iron status: A systematic review and meta-analysis.

Effects of daily iron supplementation in iron replete pregnancy are unclear. This systematic review aimed to assess benefits and harms of oral iron supplements in pregnant women without anemia and iron deficiency. We predefined and registered a protocol in PROSPERO (CRD42020186210) and performed the review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched for randomized clinical trials (RCTs) and observational studies comparing daily oral iron supplementation with no iron supplements in non-anemic iron replete pregnant women. Searches were conducted in MEDLINE (by PubMed), EMBASE (by OVID), Cochrane Library, and ClinicalTrials.gov from inception to September 2022 without language restrictions. Two authors independently screened records, extracted data, and assessed risk of bias using the revised Cochrane risk of bias tool (RoB2). One author read full-texts, assessed certainty of evidence by GRADE and conducted meta-analyses using a random-effects model. Primary outcomes included iron deficiency anemia, iron deficiency, hemoglobin >130 g/L, elevated iron status, small for gestational age newborns, low birthweight newborns, preterm birth, and congenital anomalies. Eight RCTs (2822 women) but no observational studies were eligible for inclusion. Daily oral iron supplementation in pregnancy probably reduces iron deficiency anemia at term (risk ratio [RR]: 0.51, 95% confidence interval [CI]: 0.38-0.70; 4 RCTs, 1670 women; I2 = 13%; moderate-certainty evidence) and the incidence of low birthweight babies (RR: 0.30, 95% CI: 0.13-0.68; 2 RCTs, 361 infants; I2 = 0%; moderate-certainty evidence). In addition, it may reduce iron deficiency at term (RR: 0.74, 95% CI: 0.60-0.92; 4 RCTs, 1663 women; I2 = 58%; low-certainty evidence) and the incidence of small for gestational age babies (RR: 0.39, 95% CI: 0.17-0.86; 1 RCT, 213 infants; I2 not estimable; low-certainty evidence). Daily iron supplementation in iron replete non-anemic pregnant women probably reduces the risk of maternal iron deficiency anemia at term and low birthweight.

Previously Undiagnosed Anemia and Iron Deficiency Anemia among Preschool Children at Taif City

Introduction: In the Arab Gulf countries, anemia, including iron deficiency anemia )IDA(, considered one of the main public health problems. Although, the World Health Organization reported that IDA as the most common type of anemia, which made up half of all anemic cases all over the world, there were limited research performed among preschool children about anemia in Saudi Arabia. Thus, the aim of this study was to investigate the prevalence of previously undiagnosed anemia and IDA among children between 2 to 6 years old. In this study, several risk factors that might contribute to the high prevalence of anemia were assessed. Methods: The study was carried out in Taif city during the period from January 2023 to April 2023. Blood samples were collected from 200 preschool children and analyzed for hematological parameters as well as related biochemistry tests to investigate the prevalence of previously undiagnosed anemia and IDA. Results: The majority of the study participants were Saudi 99% and aged 4 to 6 years 72.5%. Most of children participants, 92.5% had normal haemoglobin (Hb) concentration and normal levels of red blood cells (RBCs) and normal hematocrit indicating their non-anemia health status. In this study, previously undiagnosed anemia were reported within 6% of children indicated by low Hb concentration, low RBC count and abnormal low hematocrit level. Out of these undiagnosed anemic children, there were 25% diagnosed with IDA. Conclusions: Since, anemia and IDA are still a public health problem among preschool children in Saudi Arabia this study suggested that the hematological blood examination should be done to students as a requirement before school which may reveal the presence of previously undiagnosed anemia and might associated with low mantle and functional performance among children. Moreover, further studies are recommended at all regions of the Kingdome to investigate the underlying related risk factors, which will provide more insight ....

Paleoepidemiology of cribra orbitalia: Insights from early seventh millennium BP Con Co Ngua, Vietnam.

We test the hypothesis that the condition(s) leading to the development of cribra orbitalia at Con Co Ngua, an early seventh millennium sedentary foraging community in Vietnam, effectively reduced the resilience of the population to subsequent health/disease impacts. An assessment of both the implications and potential etiology of cribra orbitalia in this specific population is carried out. The effective sample included 141 adults aged ≥15 years (53 females, 71 males, and 17 unknown sex) and 15 pre-adults aged ≤14 years. Cribra orbitalia was identified by way of cortical bone porosity of the orbital roof initiated within the diplöic space, rather than initiated subperiosteally. The approach is also robust to the misidentification of various pseudo-lesions. Resultant data was analyzed using Kaplan-Meier survival analysis. Median survival is higher in adults aged ≥15 years without cribra orbitalia than those with this lesion. For the pre-adult cohort, the opposite pattern is seen where median survival is higher in those with cribra orbitalia than those without. Adults displayed increased frailty and pre-adults increased resilience with respect to cribra orbitalia. The differential diagnosis for a survival analysis of adults and pre-adults with and without cribra orbitalia included iron deficiency anemia and B12/folate deficiency, parasitism (including hydatid disease and malaria) in addition to thalassemia. The most parsimonious explanation for observed results is for both thalassemia and malaria being the chief etiological agents, while appreciating these conditions interact with, and can cause, other forms such as hematinic deficiency anemias.

Определение риска осложнений беременности и родов у женщин с исходно нормальной массой тела в зависимости от прибавки массы в процессе гестационного периода

Aim. To study the results of the course and outcomes of pregnancy in women depending on weight gain and to determine the risk of complications of the gestational period. Using the continuous sampling method, we conducted a retrospective study of the outcomes of pregnancy and childbirth in 1080 women with initially normal body weight. The initial body mass index in pregnant women of the survey group was in the parameters of 18.5–24.9. Depending on the recommended (11.5–16.0 kg) weight gain, pregnant women were divided by us into 3 subgroups: MG; GS1; GS2. The MG (363 people) included pregnant women whose total body weight gain during the entire pregnancy corresponded to the recommended weight gain parameters (11.5–16.0 kg). GS1 (543 people) included pregnant women whose total body weight gain was below the reference values (11.5 kg). GS2 (174 people) included women whose weight gain during pregnancy exceeded the reference values (16.0 kg).was carried out using the polymerase chain reaction method (Kvant-21 test). Results. With an excess of the recommended weight gain in women, parameters in which the relative risk index was more than 2 were found to be 3.5 times more than in women with a deficiency in body weight gain. These include iron deficiency anemia (8.57); gestational arterial hypertension (2.59); pregnancy-induced edema (3.2); pathology of the urinary system of inflammatory origin (3.4); ZRP (2.63); the birth of infants with a body weight of 2000 to 2499 g (2.76) and a body weight of 4500–4999g (2.77). Conclusion. Our results suggest that excess weight gain during pregnancy, even against the background of normal initial body weight, is a risk factor that has a negative impact on the condition of women and infants, to a greater extent than lack of weight gain. However, it should be noted that at present there is a certain trend towards an increase in the number of pregnant women with a lack of weight gain, which also carries certain risks for their health, although to a lesser extent than excess weight gain.

The effect of different types of anemia on HbA1c levels in non-diabetics

BackgroundDiabetes mellitus is one of the most common diseases worldwide with significant morbidity and mortality. HbA1c remains one of the most important methods for diagnosis and monitoring of the disease. Since HbA1c is a reflection of the glucose attached to red blood cells, factors affecting hemoglobin and red blood cells’ half-life can influence HbA1c measurements.ObjectiveThis study aims to evaluate the effect of different types of anemia including iron deficiency anemia, sickle cell anemia, β -thalassemia trait, and megaloblastic anemia on HbA1c levels in a tertiary hospital over the past 6 years (2016–2022).MethodThis is a retrospective chart review study of 324 patients including those with one of the four types of anemia mentioned above and a control group. The control group were healthy adults with normal HbA1c and hemoglobin, who were not known to have diabetes or anemia. Patients with diabetes or prediabetes based on self-reporting or elevated fasting, random blood sugar, or 2 hours post-prandial blood glucose were excluded.ResultsThe mean HbA1c levels were significantly higher in sickle cell anemia at 5.83% (95% CI = 5.39–6.28) and in iron deficiency anemia at 5.75% (95% CI = 5.68–5.82) when compared to the control group at 5.32% (95% CI = 5.22–5.41). However, the mean HbA1c levels in megaloblastic anemia were 5.38% (95% CI = 5.26–5.5) and 5.45% (95% CI = 5.21–5.69) in beta thalassemia trait, which were not significantly different when compared to the control group. HbA1c significantly decreased from 5.75 to 5.44% after treatment in the iron-deficient group with a p-value of < 0.001. Moreover, lower hemoglobin and higher red cell distribution width correlated with higher HbA1c levels in patients with sickle cell anemia.ConclusionThis study found a significant increase in HbA1c levels in iron deficiency anemia and sickle cell disease in patients not known to have diabetes. However, there was no significant effect in those patients with β-thalassemia trait and megaloblastic anemia. Treatment of iron deficiency anemia significantly decreased the HbA1c level, bringing it back to normal.

Risk factors for the development of a peri-prosthetic joint infection up to 2 Years following primary reverse shoulder arthroplasty

BackgroundReverse shoulder arthroplasty (RSA) has become commonly used to treat glenohumeral osteoarthritis (GHOA), of which complications such as peri-prosthetic joint infections (PJIs) may develop. The objective of this study was to compare patient demographics of those who did and did not develop PJIs within 2 years after primary RSA for GHOA and identify risk factors for this sequela. MethodsA nationwide database was queried from 2005 to 2014 for Medicare patients treated with primary RSA (International Classification of Disease (ICD-9) procedural code 81.88) for GHOA. Patients who developed PJIs within 2-years of primary RSA defined the study group, whereas those who were devoid of infections represented the comparison group. Our study consisted of 51,824 patients, of which 879 (1.69%) developed a PJI. Patient demographics comprising the Elixhauser comorbidity index (ECI) were compared using Chi-Square analyses. Multivariable logistic regression models were used to compute the odds-ratios (OR) of patient-specific factors associated with acquiring a PJI within 2 years after RSA. P values less than 0.002 were significant. ResultsPatients developing a PJI had higher mean ECI (8 vs. 6; p < 0.0001). The greatest risk factors for developing PJIs within 2-years following RSA were male sex (OR: 2.10, 95%CI: 1.81–2.43, p < 0.0001), pathologic weight loss (OR: 1.78, 95%CI: 1.45–2.17, p < 0.0001), iron deficiency anemia (OR: 1.75, 95%CI: 1.49–2.06, p < 0.0001), morbid obesity (OR: 1.52, 95%CI: 1.21–1.88, p = 0.0001), rheumatoid arthritis (OR: 1.32, 95%CI: 1.13–1.54, p = 0.0003), arrhythmias (OR: 1.26, 95%CI 1.09–1.46, p = 0.001), and depressive disorders (OR: 1.23, 95%CI 1.06–1.43, p = 0.001). ConclusionsThe greatest risk factors for PJIs within 2 years of primary RSA included male sex; additional modifiable risk factors included iron deficiency anemia, pathologic weight loss, and obesity. Preoperative screening can help to identify modifiable risk factors and alter management for high-risk patients to potentially minimize PJIs.

S2480 Black Speckled Villi

Introduction: Pseudomelanosis duodeni (PD) is a rare incidental finding characterized by brownish black pigmentation seen primarily in the first and second portions of the duodenum. The exact cause is unknown but it is associated with certain medications and chronic medical conditions. Here we present a case to help gastroenterologists recognize this rare endoscopic finding. Case Description/Methods: A 49-year-old man with a past medical history of GERD, obesity, obstructive sleep apnea, type 2 diabetes and atrial fibrillation was referred for evaluation of rectal bleeding and iron deficiency anemia. His medications included iron supplementation, amlodipine, aspirin, atorvastatin, carvedilol, furosemide, and hydralazine. The cause of the patients rectal bleeding was determined to be from hemorrhoids found during colonoscopy. Esophagogastroduodenoscopy demonstrated diffuse mucosal changes characterized by speckled black pigmentation extending along the villi (Figure). Biopsies were taken and showed benign black pigmented macrophages in the lamina propria. Discussion: Pseudomelanosis duodeni is a rare finding of unknown etiology. It is associated with chronic medical conditions including iron deficiency anemia, hypertension, diabetes, chronic kidney disease and common medications such as ferrous sulfate, hydralazine, propranolol, hydrochlorothiazide and furosemide. Despite the association with these common conditions and medications, PD remains a rare endoscopic finding. Why certain patients develop this finding is unknown. Interestingly, there is no association with anthraquinones as seen in pseudomelanosis coli. Histology typically shows black granular pigment inside macrophages within the tips of the villi. Although the endoscopic findings are striking, the condition has no clinical consequence and requires no treatment.Figure 1.: Pseudomelanosis duodeni.

39-Year-Old Woman With Severe Weakness

39-Year-Old Woman With Severe Weakness

TU2.9 Under-investigation of iron deficiency anaemia in QFIT-negative suspected colorectal cancer patients

Abstract Introduction QFIT (Quantitative faecal immunochemical testing) has become the first-line screening tool for suspected colorectal cancer due to a lower risk profile, higher sensitivity and specificity than routine colonoscopy and faecal occult blood testing. Patients with QFIT measurements &amp;lt;10micrograms/ml are considered unlikely to have colorectal cancer and may be discharged from the 2-week wait (2WW) pathway without further investigations, in the absence of other concerning features including iron deficiency anaemia (IDA). We present our findings on the under-investigation of IDA in a cohort of QFIT-negative patients. Method We collected data on 100 patients in a district general hospital, referred via the 2WW suspected colorectal cancer pathway with QFIT measured as &amp;lt;10 micrograms/ml, over a 2-month period. Our data-points included whether iron, ferritin and haemoglobin were measured in the 6months preceding QFIT measurement. Results Our patients included 67 females and 33 males, with a median age of 67.5. 32 out of 100 patients underwent neither iron nor ferritin blood tests; 21 of which did not have their haemoglobin measured either. 25 out of 100 patients underwent iron, ferritin and haemoglobin blood tests in the specified time period. Discussion Failure to investigate IDA in QFIT-negative suspected colorectal cancer patients increases the risk of missed pathology. Studies have found patients with right sided colon cancer sometimes have false negative QFIT results but often present with IDA. We propose that mandatory investigation of IDA is incorporated into existing 2WW suspected colorectal cancer pathways, alongside QFIT measurement, to mitigate this risk.

Identification of Serum Ferritin-Specific Nanobodies and Development towards a Diagnostic Immunoassay.

Serum ferritin (SF) is an iron-rich protein tightly connected with iron homeostasis, and the variations are frequently observed in diseased states, including iron-deficiency anemia, inflammation, liver disease, and tumors, which renders SF level an indicator of potential malignancies in clinical practice. Nanobodies (Nbs) have been widely explored and developed into theranostic reagents. Surprisingly, no reports stated the identification of anti-SF Nbs, nor the potential of such Nbs as a diagnostic tool. In this study, we generated SF-specific Nbs and provided novel clinical diagnostic approaches to develop an immunoassay. An immune library was constructed after immunizing an alpaca with SF, and five Nbs specifically targeting human SF were retrieved. The obtained Nbs exhibited robust properties including high stability, affinity, and specificity. Then, an ELISA-based test using a heterologous Nb-pair was developed. The calibration curve demonstrated a linear range of SF between 9.0 to 1100 ng/mL, and a limit of detection (LOD) of 1.01 ng/mL. The detecting recovery and coefficient variation (CV) were determined by spiking different concentrations of SF into the serum sample, to verify the successful application of our selected Nbs for SF monitoring. In general, this study generated SF-specific Nbs and demonstrated their potential as diagnostic immunoassay tools.

Benefits and Risks Associated with Meat Consumption during Key Life Processes and in Relation to the Risk of Chronic Diseases.

Red meat has been an important part of the diet throughout human evolution. Overall, when included as part of a healthy and varied diet, red meat can provide a rich source of bioavailable essential nutrients and high biological value protein. The present paper discusses the dietary role/impact of red and processed meat, with some reference to the relative effect of white meat, in a range of chronic conditions including iron-deficiency anaemia, cardiovascular diseases (CVD), cancer and dementia. The role of red meat in relation to key physiological conditions such as maintaining skeletal muscle and bone health and during pregnancy is also discussed. The inclusion of lean red meat in a healthy, varied diet may be beneficial during these critical conditions. There is however increasing evidence that red meat and especially processed meat are associated with increased risks of CVD, cancer and dementia whereas white meat is neutral or associated with a lower risk. There now seems little doubt that processed and unprocessed meat should have separate public dietary guidance.

In Plain Sight: An Inconspicuous Case of a Giant Cell Tumor

A 37-year-old Jamaican man presented to the Emergency Department for 2 months of increasing fatigue, left thigh pain, and difficulty ambulating. He had been living in the United States for the past 2 years. His medical history included iron deficiency anemia diagnosed in 2008 during a work health examination. He was placed on ferrous sulfate tablets without any additional work-up performed. At that time, he had been living in Jamaica and worked as a cruise ship chef. A year prior to presentation, he had undergone a single blood transfusion, which he attributed to his iron deficiency anemia.

Flour enrichment and iron-deficiency anemia in the Kyrgyz Republic

Introduction. Poor nutrition is the main cause of nutrition-associated diseases, including iron-deficiency anemia (IDA). An enrichment of basic foods is the one of the most effective preventive measures among the population, especially women and children. Materials and methods. A survey of 2,218 respondents was conducted to identify public awareness and consumption of enriched flour, of which 1,442 (65%) were women and 776 (35%) were men. The enrichment quality of 408 flour samples was determined according to GOST 26928-86. An epidemiological analysis of the long-term follow up on the prevalence and incidence rates was carried out for the period 2009-2019. Results. According to the results of the survey, 5.7% of respondents did not know what the term “enriched flour” means, 68.3% consider it “safe flour enriched with vitamins and minerals”. The media were the main sources of information on enriched flour. The majority (30.9%) of the respondents noted the improvement of physical and mental development among the beneficial properties of enriched flour. According to the results of the analysis, 77.4% of Orion brand flour were found to have an underestimated iron content compared with the requirements of the Technical Regulation of the Kyrgyz Republic “On the safety of fortified flour”, 54.8% of Rola flour, 44.7% of Aliya flour. A retrospective analysis of the long-term trend in IDA for the period from 2010 to 2018 revealed a significant decline in the trend by 44.8% (in 2010 - 2373.3 per 100 thousand people, in 2018 - 1311.0 per 100 thousand people) among adults and adolescents, and among children from 0 to 14 years of age by 18.4%. Limitations. The study has potential limitations due to the lack of a comparative analysis of the incidence of iron-deficiency anemia in the population using enriched flour and without, and that not all brands of flour produced domestically and imported were subjected to a full study. Conclusion. The enrichment of flour with micro-elements is one of the ways to provide functional nutrition. Flour fortification can contribute to strengthening the health of the nation by providing essential vitamins and minerals that are lacking in daily nutrition.

Clinical management of autoimmune gastritis

Autoimmune gastritis (AIG) is a chronic immune-mediated inflammation of the gastric corpus/fundus mucosa leading to progressive atrophy of the oxyntic gastric glands (AOM) and their consecutive loss of function. Possible clinical consequences of AIG include iron deficiency anemia, pernicious anemia, gastric neuroendocrine tumors (gNET), and gastric adenocarcinoma. This article provides a review of interdisciplinary aspects of the diagnosis and treatment of AIG.