Initial Hemoglobin Concentration Research Articles

Haematological and Biochemical Indices of Growing Lambs Fed Fore-Stomach Digesta and Poultry Litter Waste

Haematological values and blood urea nitrogen levels of growing Uda lambs fed forestomach digesta (FSD) and poultry litter waste (PLW) were studied. The experimental animals were randomly allotted (n=4/treatments) to diets A (20% FSD), B (20% PLW), C (10% each of FSD and PLW), D (6.67% FSD and 13.33% PLW) and E (13.33% FSD and 6.67% PLW). The experiment lasted for 84 days. Blood samples were collected prior to and after the feeding trial for haematological and blood urea nitrogen determination. Initial packed cell volume and final red blood cell counts were not significantly different between treatments (P>0.05). Initial haemoglobin concentration (HB) was similar (P>0.05) to those on treatments A, C, D, and E while final HB concentration was similar (P>0.05) for those on treatments B, C, and E. Initial and final values of neutrophil and lymphocyte counts were not significantly different (P>0.05) for all treatments. There were no traces of eosinophils at the end of the feeding trial while monocyte counts were not significantly different (P>0.05) at the beginning and end of the feeding trial. Total protein showed no significant difference in all the treatments at initial and final collections of blood. Similar results were observed for albumin and globulin concentrations. Haematological values and blood urea nitrogen were within normal values; indicating that there was no toxicity associated with the feeding of FSD and PLW alone or in mixtures to growing lambs. It was concluded that the test diets were not toxic to animals based on the haematological indices and blood biochemical parameters which were within recommended values. Key Words: Lambs, Fore-Stomach Digesta, Poultry Litter Waste

The Effects of Preoperative Autologous Donations on Perioperative Blood Levels

The purpose of this study was to evaluate the blood levels of patients preparing for total knee arthroplasty (TKA) who were enrolled in a preoperative autologous donation program. The charts and hospital records of 70 consecutive patients who underwent primary unilateral TKA between 2000 and 2002 were retrospectively reviewed. Study participants were instructed to donate one unit of blood approximately 4 weeks prior to surgery. Predonation and preoperative hemoglobin levels were assessed throughout the study and transfusion requirements were recorded. Transfusions were administered only when warranted by clinical symptoms. The mean initial (predonation) hemoglobin concentration was 14.1 g/dL. The mean number of days donations were made prior to surgery was 13 +/- 3.3 days. Prior to surgery, the average hemoglobin concentration dropped to 12.8 g/dL. Fifty (71%) patients had a hemoglobin value > 13.0 g/dL prior to their autologous donation, but only 30 (43%) patients had blood levels > or = 13.0 g/dL following blood donation. Postoperatively, the mean hemoglobin concentration in the recovery room was 11.6 g/dL and dropped to a nadir of 10.8 g/dL on postoperative day 3. Overall, 91% of patients required autologous blood transfusion following TKA but no patients required allogeneic blood transfusions. Preoperative autologous donation was associated with a decrease in preoperative hemoglobin levels and with a high rate of autologous transfusion based on clinical symptoms of postoperative anemia.

Meeting New Challenges in the Management of Anemia of Chronic Kidney Disease Through Collaborative Care with Pharmacists

To evaluate chronic kidney disease (CKD)-associated anemia management challenges and limitations and discuss strategies to improve treatment rates and patient response to therapy, monitoring of patient response to therapy, and education of prescribing providers and patients. Multiple MEDLINE searches were performed using a comprehensive search term list to identify studies for inclusion, including, but not limited to, anemia, erythropoiesis-stimulating agent (ESA), epoetin, darbepoetin, CERA, hemoglobin, CKD, dialysis, end-stage renal disease, quality of life, and pharmacist. Annual data reports and clinical practice guidelines published by the National Kidney Foundation and US Renal Data System were included. Information provided within product package inserts for recombinant human erythropoietin (epoetin alfa; Epogen, Procrit) and darbepoetin alfa (Aranesp) were also included. Only articles that were published in English and were relevant for this review were included. Anemia is a common complication of CKD, with significant impact on patients' quality of life. Anemia of CKD represents a significant burden on the healthcare system, with ESA use resulting in substantial financial costs. As new therapies, formularies, and dosing regimens evolve, the collaborative role of the clinical pharmacist is integral to a multidisciplinary treatment strategy, both in the inpatient and outpatient settings, such as hospitals or dialysis centers, respectively. This review focuses on initial and target hemoglobin (Hb) concentrations, as well as patient characteristics, treatment preferences, and dosing schedules, which are important considerations in managing CKD-associated anemia. To ensure effective therapeutic strategies, a patient-centered approach is required. Pharmacists are ideally positioned to help select ESA therapy, influence formulary use, educate healthcare professionals and patients, develop and implement dosing and monitoring protocols, and possibly promote quality improvement. An approach to CKD-associated anemia management that involves collaboration with pharmacists is essential to achieve patient-specific, cost-effective ESA therapy.

Cálculo do volume de sangue necessário para a correção da anemia fetal em gestantes isoimunizadas

to obtain an equation to estimate the volume of red blood cells concentrate to be infused to correct anemia in fetuses of pregnant women with Rh factor isoimmunization, based in parameters obtained along the cordocentesis previous to intrauterine transfusion. a transversal study analyzing 89 intrauterine transfusions to correct anemia in 48 fetuses followed-up in the Centro de Medicina Fetal do Hospital das Clínicas da Universidade de Minas Gerais. The median gestational age at the cordocentesis was 29 weeks and the average number of procedures was 2.1. Fetal hemoglobin was assayed before and after cordocentesis, leading to the volume of transfused red blood cells concentrate. The determination of an equation to estimate the blood volume necessary to correct the fetal anemia was based in the blood volume necessary to raise the fetal hemoglobin in 1 g% (the difference between the final and the initial hemoglobin concentration divided by the transfused volume) and in the volume of the amount necessary to reach 14 g%, in the multiple regression analysis. the concentration of pre-transfusion hemoglobin varied between 2.3 and 15.7 g%. The prevalence of fetal anemia (Hb<10 g%) was 52%. The regression equation obtained in the determination of blood volume necessary to reach the concentration of 14 g% of Hb was: transfusion volume (mL)=18.2 - 13.4 x pre- intrauterine transfusion hemoglobin + 6.0 x gestational age in weeks. This equation was statistically significant (p<0.0001). the study has shown that it is possible to estimate the transfusion volume necessary to correct fetal anemia, based on easily obtainable parameters: gestational age and level of pre-transfusion hemoglobin.

Quality of Life Improvements in Dialysis Patients Receiving Darbepoetin Alfa

Short-acting hematopoietic agents can improve the quality of life (QOL) of hemodialysis patients, but questions remain regarding the domains of QOL affected, the relative importance of initial and final hemoglobin (Hb) concentrations, and the use of long-acting hematopoietic agents. We measured Hb concentrations and QOL in 487 hemodialysis patients who were switched from treatment with recombinant human erythropoietin to treatment with darbepoetin alfa. QOL was measured with the Japanese-language version of the SF-36, at the start of therapy with darbepoetin alfa and again 7-14 weeks later. We examined changes in QOL over time in the group as a whole, and in subgroups stratified by the change in Hb concentration. We also studied relationships between the final Hb concentration achieved and the magnitude of change in QOL. QOL scores increased significantly in all SF-36 domains except Social Functioning. The greatest increases were in vitality and in the two role-functioning domains. The magnitude of the increase in Hb concentration was related to the magnitude of the increase in QOL for only one subscale: Vitality. Patients with higher final Hb concentrations also had greater increases in Vitality scores. Hematopoiesis induced by darbepoetin alfa is associated with increased vitality and may also be associated with improved role functioning. Vitality increased significantly only in those patients with the greatest increases in Hb concentration and in those with higher final Hb concentrations.

Comparison between two different hemichromes of hemoglobins (HbA and HbS) induced by n-dodecyl trimethylammonium bromide: Chemometric study

The interaction of n-dodecyl trimethylammonium bromide (DTAB) with oxyhemoglobin A and oxyhemoglobin S is investigated using UV–visible absorption spectra and chemometric resolution techniques. Oxyhemoglobins (A and S) induced to partial oxidized form (ferrihemoglobin) by DTAB and finally transform to fully oxidized hemichrome. Hemichrome mole fractions of HbS are more than HbA because of more hydrophobic interaction of DTAB–HbS in second set of binding site relative to DTAB–HbA. The visible spectra between 500 and 650 nm are used for identifying the present components in solution because each species of hemoglobin has a specific spectrum in this region. The number of components and mole fraction of mentioned species were determined by employing chemometric resolution techniques. Subspace comparison was used for determination of the number of components in each concentration of hemoglobin and DTAB. After the determination of components, multivariate curve resolution-alternating least square (MCR-ALS) by initial estimates of spectral profiles and proper constraints, was used to resolve the data matrix into pure concentration and spectral profiles. The results show that both number and mole fraction of components which were formed during hemoglobin (HbA and HbS) oxidation by DTAB were initial hemoglobin concentrations independent. Furthermore, in average the mole fraction of hemichrome of HbS is 14.4% more than HbA. On the other hand, the mole fraction of HbA ferrihemoglobin is 15.6% higher than HbS averagely.

Red Maple (Acer rubrum) Leaf Toxicosis in Horses: A Retrospective Study of 32 Cases

Background:Ingestion of wilted red maple leaves by horses can result in severe hemolytic anemia and methemoglobinemia. Little is known about what factors influence the outcome of red maple leaf toxicosis in horses.Hypothesis:Our hypothesis was that physical examination findings, clinicopathologic variables or therapeutic modalities may predict outcome in horses with red maple leaf toxicity.Animals:Horses with red maple leaf toxicosis presented to referral hospitals in the southeast region of the United States.Methods:A multi‐institutional retrospective study was designed to identify factors that predict mortality in horses with red maple toxicosis.Results:Thirty‐two horses with red maple toxicosis were identified, 19 of which died. Twenty‐nine horses presented with anemia and 24 had clinicopathologic evidence of systemic inflammation. Renal insufficiency was identified in 12/30 (41%) horses. Laminitis (9/28) and colic (13/30) also were identified in horses with red maple toxicosis, but development of these 2 conditions did not have a negative effect on short‐term survival. Horses with red maple toxicosis that survived to discharge were likely to have developed pyrexia during hospitalization (P= .030). Horses that were treated with a corticosteroid had a significantly increased likelihood of death (P= .045). There was no significant relationship between initial serum hemoglobin concentration, methemoglobin concentration, or percentage methemoglobin and mortality in this horse series.Conclusions and Clinical Importance: This study suggests that information obtained on initial examination cannot be used to accurately predict survival in horses with red maple toxicosis, but horses that receive corticosteroids are unlikely to survive.

Red Maple (Acer rubrum) Leaf Toxicosis in Horses: A Retrospective Study of 32 Cases

Ingestion of wilted red maple leaves by horses can result in severe hemolytic anemia and methemoglobinemia. Little is known about what factors influence the outcome of red maple leaf toxicosis in horses. Our hypothesis was that physical examination findings, clinicopathologic variables or therapeutic modalities may predict outcome in horses with red maple leaf toxicity. Horses with red maple leaf toxicosis presented to referral hospitals in the southeast region of the United States. A multi-institutional retrospective study was designed to identify factors that predict mortality in horses with red maple toxicosis. Thirty-two horses with red maple toxicosis were identified, 19 of which died. Twenty-nine horses presented with anemia and 24 had clinicopathologic evidence of systemic inflammation. Renal insufficiency was identified in 12/30 (41%) horses. Laminitis (9/28) and colic (13/30) also were identified in horses with red maple toxicosis, but development of these 2 conditions did not have a negative effect on short-term survival. Horses with red maple toxicosis that survived to discharge were likely to have developed pyrexia during hospitalization (P = .030). Horses that were treated with a corticosteroid had a significantly increased likelihood of death (P = .045). There was no significant relationship between initial serum hemoglobin concentration, methemoglobin concentration, or percentage methemoglobin and mortality in this horse series. This study suggests that information obtained on initial examination cannot be used to accurately predict survival in horses with red maple toxicosis, but horses that receive corticosteroids are unlikely to survive.

High prepregnancy BMI increases the risk of postpartum anemia.

To assess the independent effect of prepregnancy BMI on the risk of postpartum anemia. Pregnant women from North Carolina who enrolled in the Iron Supplementation Study at their first prenatal visit at <20 weeks gestation and who delivered a live infant were followed to the postpartum visit (n = 439). BMI had a curvilinear relation in the logit of postpartum anemia; therefore, a restricted quadratic spline with three knots at the inflection points was used to specify BMI. Multiple log binomial regression was used to quantify the relation between prepregnancy BMI and postpartum anemia after adjusting for maternal ethnicity/race, education, smoking, initial hemoglobin concentration, and prenatal iron supplementation. Prevalence of postpartum anemia was 19.1%. After adjusting for confounders, we found that risk of postpartum anemia was similar for women with BMI values from 17 to 24 compared with women with a BMI of 20. Adjusted relative risk increased as BMI increased from 24 to 38. Women with a BMI of 28 had approximately 1.8 times the postpartum anemia risk of a woman with a BMI of 20 (95% confidence interval 1.3, 2.5), and obese women with a BMI of 36 had approximately 2.8 times the risk (95% confidence interval 1.7, 4.7). These data suggest that high prepregnancy BMI substantially increases the risk of postpartum anemia. Postpartum anemia screening and iron supplementation of overweight and obese women may be warranted.

Retinal hemorrhage asymmetry in inflicted head injury: a clue to pathogenesis?

ObjectiveTo determine whether regional cerebral parenchymal injury patterns correlate with the distribution of retinal hemorrhages after inflicted head injury. Study designRetrospective case series of funduscopic photographs and serial computerized tomographic imaging of 14 children with confirmed inflicted head injury. Main outcome measures: Retinal Hemorrhage Score per eye and per subject, visual field examination, regional patterns of parenchymal injury on computerized tomographic scans and necropsy, and retinal/optic nerve sheath hemorrhage distribution at necropsy. ResultsTen of 14 children had retinal hemorrhages (71%); 90% were asymmetric (mean retinal score, 4.89 vs 2.56; P=.006). Retinal hemorrhages were maximal on the side of greatest cerebral injury in seven of 10 children initially. Subsequent imaging asymmetry predicted retinal hemorrhage distribution in all eight survivors. Children's Coma Scores, apnea or cardiorespiratory arrest, initial hemoglobin, and plasma glucose concentration did not predict laterality. Asymmetry was greatest if dilated ophthalmoscopy was performed during the first 24 hours (P=.03). Visual outcome was poor; three had homonymous hemianopia and four had cortical visual loss, all correlating with parenchymal atrophy patterns. ConclusionThe distribution of retinal hemorrhages after inflicted head injury correlates with acute and evolving regional cerebral parenchymal injury patterns.

Perioperative hemodilution

Acute normovolemic hemodilution (ANH) entails the removal of blood from a patient either immediately before or shortly after induction of anesthesia and the simultaneous replacement with cell-free fluid, preferably synthetic colloids with a predictable volume effect (6% dextran 60/70, 6% hydroxyethyl starch 200,000 and 130.000, respectively). Hemodilution is part of the concept for avoiding or limiting the use of allogeneic blood and should be considered for patients undergoing elective surgery free of contraindications and presenting with an initial hemoglobin concentration ⩾12 g/dl and an anticipated blood loss of ⩾1500 ml. The efficacy of ANH, judged by the necessity to transfuse homologous blood, depends on the preoperative (initial) hematocrit, the target hematocrit (to which hemodilution is performed), and the preset intra- and postoperative transfusion trigger. In the past data from clinical trials have shown that in healthy subjects a target hematocrit of 20–25% (7.0–8.0 g/dl hemoglobin concentration) is feasible and safe for the patient. The lower the target hemoglobin concentration, the more extensive monitoring is required: intraoperative target hemoglobin concentrations of 5.0 g/dl and less have been tolerated by young surgical patients without adverse effects. The safety as well as efficacy of acute normovolemic hemodilution in terms of reducing homologous blood transfusion requirements have been demonstrated in various clinical studies. ANH therefore is regarded an integral part of programs aimed at reducing the need for homologous blood, and can thus be successfully combined with preoperative autologous blood deposition, intraoperative blood salvage and carefully adjusted surgical techniques.

Maternal hemoglobin and risk of gestational diabetes mellitus in Chinese women

OBJECTIVE: To examine the relationship between high maternal hemoglobin concentration at the initial antenatal visit and occurrence of gestational diabetes mellitus (GDM) in the third trimester in nonanemic women. METHODS: In a prospective observational study, 762 nondiabetic Chinese women with singleton pregnancies, whose initial visit hemoglobin concentration and mean cell volume were 10 g/dL or more and 80 fL or more, respectively, recruited at 28–30 weeks, had blood drawn for repeat measurement of hemoglobin concentration and iron parameters. These women were categorized by their initial visit hemoglobin concentration into quartiles, and the incidence of GDM was analyzed together with the maternal characteristics and iron status. RESULTS: The final study sample comprised 730 women. Compared with the rest, the group in the highest hemoglobin quartile (more than 13 g/dL) had a significantly higher incidence of GDM (18.7% versus 10.9%, P = .007), as well as greater age, weight, and serum ferritin and iron concentrations. Logistic regression was used to examine the effects of high body mass index (more than 25 kg/m 2), advanced age (older than 34 years), parity of 1 or more, and hemoglobin in the highest quartile, on the incidence of GDM. Only advanced age (odds ratio 3.79, 95% confidence interval 2.33, 6.17) and hemoglobin in the highest quartile (odds ratio 1.73, 95% confidence interval 1.08, 2.78) emerged to be significant factors. CONCLUSION: A high maternal hemoglobin (more than 13 g/dL) at the initial prenatal visit in Chinese women is an independent risk factor for GDM. This may reflect a better nutritional status in these women, as suggested by the increased iron status.

Plasma β-carotene and retinol concentrations of children increase after a 30-d supplementation with the fruit Momordica cochinchinensis (gac)

In rural Vietnam, vitamin A deficiency is a concern. Among the indigenous fruit and vegetables, Momordica cochinchinensis (gac) fruit has been identified as having the highest beta-carotene concentration. Locally, it is mixed with rice in a preparation called xoi gac. The purpose of this study was to assess this beta-carotene- rich rice preparation as a source of provitamin A for children in rural Vietnam. Preschoolers (n = 185) participated in a 30-d controlled supplementation trial. Children with low hemoglobin concentrations were assigned to 1 of 3 groups: a fruit group, who received xoi gac that contained 3.5 mg beta-carotene per serving; a powder group, who received rice mixed with 5.0 mg synthetic beta-carotene powder; and a control group, who received rice without fortification. The mean increase in plasma beta-carotene concentrations in the fruit and powder groups was significantly greater than that in the control group (P < 0.0001). After supplementation, the mean plasma retinol concentration in the fruit group was significantly higher than that in the control (P = 0.006) and powder (P = 0.0053) groups. Among the children with initial hemoglobin concentrations <or=110 g/L, the mean increase in hemoglobin concentrations in the fruit group was marginally higher than that in the control group (P = 0.017) but was not significantly different from that in the powder group. beta-Carotene from xoi gac is a good source of provitamin A carotenoids. Severely anemic children might particularly benefit from routine xoi gac consumption

Long-term Preventive Mass Prescription of Weekly Doses of Iron Sulfate May be Highly Effective to Reduce Endemic Child Anemia

Iron-deficiency anemia in children remains one of the most important nutritional problems faced by developing countries. Well-controlled efficacy studies show that intermittent iron supplementation can improve children's iron status as well as the traditional daily schedule. This gives new impetus to controlling child anemia by weekly preventive iron supplementation. The objective of this study was to evaluate, in a child population in which anemia is highly prevalent, the effectiveness of long-term preventive provision of weekly doses of iron sulfate to all children from 6 to 59 months of age. Children from both the intervention and the control groups were selected from a random cross-sectional sample of the child population of the city of São Paulo, Brazil. Parents in the intervention group were visited in their homes and received nutrition education plus a solution of iron sulfate with the request to give it to their children once a week until a follow-up visit occurred in approximately six months. Parents in the control group received only nutrition education. The effect of the intervention was judged by changes in hemoglobin concentration and the prevalence of anemia. Comparisons between the two groups were made based on an intention-to-treat approach, and all estimates were adjusted for initial hemoglobin concentration, initial age, total duration of follow-up, and family income. The average hemoglobin gain due to the intervention was 4.0 g/L, with a fall of more than 50% in the prevalence of anemia among the children. The intervention was particularly effective in preventing declines in hemoglobin concentration during the first two years of life. This study demonstrates that long-term preventive weekly iron supplementation of preschool children significantly reduces the risk of anemia under conditions similar to those possible through routine public health programs.

Hematologic changes associated with the appearance of eccentrocytes after intragastric administration of garlic extract to dogs.

To determine whether dogs given garlic extract developed hemolytic anemia and to establish the hematologic characteristics induced experimentally by intragastric administration of garlic extract. 8 healthy adult mixed-breed dogs. 4 dogs were given 1.25 ml of garlic extract/kg of body weight (5 g of whole garlic/kg) intragastrically once a day for 7 days. The remaining 4 control dogs received water instead of garlic extract. Complete blood counts were performed, and methemoglobin and erythrocyte-reduced glutathione concentrations, percentage of erythrocytes with Heinz bodies, and percentage of eccentrocytes were determined before and for 30 days after administration of the first dose of garlic extract. Ultrastructural analysis of eccentrocytes was performed. Compared with initial values, erythrocyte count, Hct, and hemoglobin concentration decreased to a minimum value on days 9 to 11 in dogs given garlic extract. Heinz body formation, an increase in erythrocyte-reduced glutathione concentration, and eccentrocytes were also detected in these dogs. However, no dog developed hemolytic anemia. The constituents of garlic have the potential to oxidize erythrocyte membranes and hemoglobin, inducing hemolysis associated with the appearance of eccentrocytes in dogs. Thus, foods containing garlic should not be fed to dogs. Eccentrocytosis appears to be a major diagnostic feature of garlic-induced hemolysis in dogs.

Changes in iron status during pregnancy in Peruvian women receiving prenatal iron and folic acid supplements with or without zinc

Iron deficiency anemia is the most prevalent nutrient deficiency during pregnancy, yet there are few data on the effect of prenatal iron supplementation in women in developing countries. Our objective was to describe the effect of iron supplementation on hematologic changes during pregnancy, and the effect on those changes of adding zinc to the supplements. Pregnant women were enrolled in a randomized, double-masked study conducted at a hospital in a shantytown in Lima, Peru. Women were supplemented daily from 10-24 wk gestation to 4 wk postpartum with 60 mg Fe and 250 microg folic acid with or without 15 mg Zn. Hemoglobin and ferritin concentrations were measured in 645 and 613 women, respectively, at enrollment, at 28-30 and 37-38 wk gestation, and in the cord blood of 545 neonates. No differences in iron status were detected by supplement type, but hematologic changes were related to initial hemoglobin status. Women with anemia (hemoglobin <110 g/L) showed steady increases in hemoglobin concentration throughout pregnancy whereas women with relatively higher initial hemoglobin concentrations had declining values during mid pregnancy, then rising values by 37-38 wk gestation. Women with an initial hemoglobin concentration >95 g/L showed increases in serum ferritin by the end of the pregnancy. Despite supplementation, women with poorer hematologic status; who were younger, single, and multiparous; and who consumed fewer supplements were more likely to have anemia at the end of pregnancy. These hematologic changes are congruent with the effects of iron supplementation reported in placebo-controlled trials and the addition of zinc did not significantly affect them.

Intratumoral pO 2-measurements as predictive assay in the treatment of carcinoma of the uterine cervix

Background: Several studies have shown that pretreatment oxygenation status of cervical tumors measured with a polarographic oxygen electrode could be a predictive factor for radiation response and survival. The purpose of this study was to evaluate the impact of intratumoral pO 2 levels and hypoxic fractions on local control and disease free survival employing a standardized measuring procedure under routine conditions. Materials and methods: Between April 1994 and December 1997 pO 2 measurements were performed prior to radiotherapy with an Eppendorf histograph in 51 evaluable patients with primary cervical carcinoma. All patients were treated with curative intent by combined external beam therapy (median total dose 49.6 Gy) and 3–6 applications of high dose rate- (7 Gy/fr. at point ‘A’) or pulse dose rate brachytherapy (20–25 h pulses, 1 Gy/pulse at point ‘A’). Oxygenation data are given as median pO 2 of pooled readings and percentage of readings below 5 mm Hg (HF 5). Results: Median pO 2 values ranged from 0 to 60 mm Hg (median 10). HF5 ranged from 0 to 95% (median 22%). Median follow-up was 26 months (range 9–54 months). Actuarial overall and disease-free survival rates (OS/DFS) at 3 years were 53%/50%. Comparing patients with median pO 2 ≤10 mm Hg ( n=26) to patients with higher median pO 2 levels ( n=25) calculated DFS was 34 and 69%, respectively ( P<0.02). Corresponding data for local control were 47 and 84% ( P=0.053). Comparing patients with HF5 below and above the median calculated DFS was 36 and 66%, respectively ( P<0.02). Patients who had median pO 2 <10 mm Hg and HF5 >20% had the worst prognosis (3-year DFS: 28%). Besides oxygenation status, stage and initial hemoglobin concentration were statistically significant for treatment outcome. Conclusions: This study confirms earlier data that the presence of hypoxia is associated with poor local control and survival in patients with carcinoma of the uterine cervix. Polarographic pO 2 measurements are feasible under routine conditions and can be regarded as a reproducible predictive assay.

Änderungen der Hämoglobinkonzentration bei kombinierter Radio- und Chemotherapie lokal fortgeschrittener HNO-Tumoren

Despite multimodality treatment strategies of locally advanced head and neck cancers long-term results leave much to be desired. There is evidence that oxygenation status of head and neck tumors is directly influenced by the hemoglobin concentration. The aim of this study was to verify changes in the hemoglobin level during combined radio-chemotherapy of locally advanced head and neck tumors. Sixty-eight patients with locally advanced head and neck cancer had primary or adjuvant radiotherapy with doses of 60 to 74 Gy in combination with cisplatin- (+/- 5-FU) or carboplatin chemotherapy in the first and fifth week of treatment. Hemoglobin levels were analyzed before and at the end of radiotherapy. In 41% of all patients the initial hemoglobin concentration was below normal levels. The mean hemoglobin values in all patients dropped significantly from 12.9 +/- 1.7 g/dl before to 11.6 +/- 1.6 g/dl at the end of treatment. In 12 cases (18%) allogeneic erythrocytes had to be transfused during treatment. At the end of treatment 76% of all patients had anemic hemoglobin levels. In the groups of patients with cisplatin and carboplatin chemotherapy a significant decrease in hemoglobin levels was seen without meaningful statistical difference between these 2 groups. In patients with locally advanced head and neck cancer a high initial rate of anemia was registered (41%): This rate was nearly doubled during chemoradiation (76%). Since several studies have shown a correlation between hemoglobin levels and local tumor control, there is evidence, that this group might benefit from correcting anemia before combined radio-chemotherapy.

Intravenous Iron Therapy in Pregnancy Anemia: Hematological Response in Relation to Gestational Age

This study was undertaken to evaluate the response to parenteral administration of iron in 62 pregnant patients with asiderotic anemia and mean initial hemoglobin (Hb) concentrations (Hb1) of 9.91 ± (SD) 1.13 g/dl. Iron (742 ± 366 mg) was administered intravenously, and the response to treatment was classified according to the rise in Hb (VarHb; 0.97 ± 0.77 g/dl) and evaluated after 19.5 ± 14.6 (range 4–57) days. It was found that the VarHb was inversely correlated with the Hb1 value (r = –0.46; p <0.001) and only weakly correlated with the number of vials administered. In addition, two-cluster analysis of patients on the basis of VarHb and gestational age resulted in two significantly different groups (p <0.001): >28 weeks of pregnancy (n = 39, group 1: 1.27 ± 0.66, range 0.1–3.3 g/dl) and ≤28 weeks of pregnancy (n = 23, group 2: 0.45 ± 0.69, range 0.4–2.3 g/dl). No difference was found between groups 1 and 2 in relation to Hb1, iron dose, and therapy duration. The number of patients with VarHb >0.8 g/dl was found to be higher in group 2 than in group 1: 31/39 versus 8/23 (p <0.001). These results indicate that the response to intravenous iron therapy in pregnancy anemia is related to Hb1 level and gestational age at the onset of treatment and probably depends on the erythropoietin response to anemia.

Association of Erythropoiesis during Autologous Blood Donation with Initial Hemoglobin Concentration and Length of Donation Period

Objective: Assessment of factors that influence erythropoiesis during autologous blood donation. Design:Retrospective study. Setting:Autologous blood donation program at the central laboratory of a teaching hospital. Patients:All consecutive patients with initial hemoglobin concentrations of at least 11.5 g/dl and without acute cardiovascular or infectious diseases who planned to donate autologous blood prior to hip replacement surgery. Interventions: a) Between 1992 and 1997, up to 4 units of 500 ml blood each were withdrawn at weekly intervals within a 21-day period. Starting in January 1996, female patients were offered a more flexible donation scheme extended by 1 week, allowing to omit at least one of the 5 appointments depending on hemoglobin concentrations. b) Iron was substituted by oral (March 1992 to January 1995 and November 1995 to April 1997 2 ×?100 mg elemental iron/day) or intravenous routes (January 1995 to June 1995 200 mg elemental iron, April 1995 to September 1995 125 mg elemental iron, September 1995 to November 1995 62.5 mg elemental iron; each dose in an infusion of 500 ml 0.9% NaCl solution after blood donation). c) Based on hemoglobin measurements and body weight, the volumes of donated and regenerated packed red blood cells (RBCs) were calculated for each donor and statistically related to possible factors of influence. Results:In 215 women and 138 men, the mean total volumes of packed RBCs increased by 390 ml and 500 ml, respectively. Higher initial hemoglobin concentrations were significantly associated with the regeneration of greater RBC volumes. Because of a longer donation period, regenerated RBC volumes were higher in 79 women with 5 than in 80 women with 4 appointments (425 ± 173 ml vs. 350 ± 145 ml). In women only, younger age supported a faster RBC regeneration. Associations between erythropoietic regeneration and the form or dose of iron supplementation, reticulocyte counts as well as ferritin and erythropoietin levels were statistically not significant. Conclusions:Initial hemoglobin concentrations and the length of time from withdrawal of the first blood unit till surgery independently correlated with the volume of regenerated RBCs during autologous blood donation. In order to optimize the process of autologous blood donation and facilitate RBC regeneration, a suitable number of blood units should be donated before surgery as early as possible, but a minimum hemoglobin level during the preoperative period must be maintained. Other factors did not significantly correlate with RBC regeneration.