Intensity Of Anemia Research Articles

ALTERAÇÕES CLÍNICAS E LABORATORIAIS COMO INDICADORES PARA O TRATAMENTO ANTI-HELMÍNTICO EM OVINOS EXPERIMENTALMENTE INFECTADOS COM Haemonchus contortus

Resumo A intensidade da anemia e hipoproteinemia são indicadores da gravidade da hemoncose. Este estudo objetivou verificar as alterações de peso, hematócrito e proteína plasmática, bem como a carga parasitária que indiquem a necessidade de intervenção anti-helmíntica em ovinos experimentalmente infectados com Haemonchus contortus. Foram utilizados 14 ovinos machos mestiços Santa Inês, 42,5 (±7,5) Kg, livres de nematoides, divididos em dois grupos contendo sete animais cada. Os animais do grupo infectado receberam 10.000 larvas de H. contortus cada. Todos os animais foram acompanhados aos 21, 28, 35, 42, 49, 56, 63 e 70 dias pós-infecção e avaliados segundo os parâmetros: OPG, Famacha©, peso, proteínas plasmáticas totais e hematócrito. No grupo infectado, o OPG variou e atingiu seu ápice aos 42 dias de acompanhamento, o hematócrito foi significativamente menor a partir da infecção experimental, o escore Famacha© variou de 1 a 2 e significativamente maior aos 21, 28, 35 e 42 dias, não houve alteração no nível de proteína plasmática nem no peso corpóreo em relação ao grupo controle. A infecção com até 10.000 larvas de H. contortus e OPG até 2500 não afeta significativamente o peso, hematócrito e proteína plasmática de ovinos mestiços Santa Inês, não havendo necessidade de intervenção anti-helmíntica.

Leukocyte Telomere Length Correlates with Disease Severity and Inflammation in Sickle Cell Disease

Telomeres are specialized nucleoprotein structures that protect chromosome ends. The loss of telomeric structure permits DNA-damage and results in cellular senescence and apoptosis. Short telomeres may be due to either impaired telomere elongation due to telomerase defect as observed in dyskeratosis congenita, aplastic anemia, and pulmonary fibrosis or caused by "stress" hematopoiesis and increased cell proliferation due to chronic inflammation and oxidative stress. As bone marrow demand and inflammation are characteristics of sickle cell disease (SCD), we sought to evaluate telomere length in SCD patients. Mean telomere length was measured in peripheral blood leukocytes by quantitative polymerase chain reaction (qPCR), as we have previously described (Gutierrez-Rodrigues, PLoS ONE 2014; 9(11):e113747). The telomere length for each sample was determined using the telomere to single copy gene ratio (T/S ratio) with the calculation of the DCt [Ct(telomere)/Ct(single gene) ]. To validate the qPCR results, we performed terminal restriction fragment (TRF) analysis for 17 samples with long and short telomeres, according to the manufacturer's instructions (TeloTAGGG Telomere Length Assay - Roche Applied Science, Mannheim, Germany). Tumor necrosis factor-alpha (TNF-α) and interleukin 8 (IL-8) were assessed as pro-inflammatory markers, measured in serum samples, in duplicate, using ultra sensitive ELISA kits. Spearman's rank correlation coefficient was used to analyze bivariate associations between telomere lengths, hemolysis markers and inflammation markers. We compared telomere length according to the diagnosis, use of hydroxyurea and gender using Wilcoxon rank sum test. All p values ≤0.5 were considered significant. In all of the analysis we used age-ajusted T/S ratios. A total of 91 adult SCD patients were included in the study, 51 with HbSS, 38 with HbSC and 2 with HbSβ. Fifty-one were off hydroxyurea and 40 were taking the drug, with a median dose of 1g/day (range 500-1750mg/day). We compared age-adjusted T/S ratio of SCD patients to 261 healthy controls and found significantly shorter telomeres in SCD patients (p<0.0001). When we compared HbSS patients to HbSC and HbSβ patients HbSS patients had significantly shorter telomeres (p<0.0001). Telomere length also was shorter in patients on hydroxyurea when compared to those off the drug (P =0.02). We found no difference in T/S ratio according to gender or age in the SCD cohort. To evaluate whether inflammation or hemolysis were associated with telomere attrition in SCD patients, we analyzed the associations between T/S ratios and hemolysis (hemoglobin, hematocrit, lactate dehydrogenase, indirect bilirubin, reticulocyte counts) and inflammation markers (IL-8, TNF-α, total leucocyte, neutrophil, lymphocyte and monocyte counts). We found a significant positive correlation between hemoglobin level and T/S ratio (r=0.29; P =0.004), and a negative correlation between lymphocyte counts and telomere length (r=-0.29; P =0.005), and between IL-8 serum levels and telomere length (r=-0.4; P =0.02). SCD patients presented shorter telomeres in comparison to age-matched health controls. Telomere erosion in SCD appeared to correlate with disease severity and to treatment with hydroxyurea. Our results also indicate that telomere attrition correlated with the intensity of anemia and inflammatory markers. DisclosuresNo relevant conflicts of interest to declare.

TREATMENT OF ANEMIA AND IMPROVEMENT OF QUALITY OF LIFE AMONG PATIENTS WITH CROHN'S DISEASE: experience using ferric carboxymaltose.

Anemia is the most common hematological alteration in patients with Crohn's disease, and is frequently related to intestinal inflammatory activity. Its cause is multifactorial and mostly associated with absolute iron deficiency (iron deficiency anemia) and/or functional iron deficiency (inflammation anemia or anemia of chronic disease). It may also be identified through other causes, such as folic acid or vitamin B12 deficiency and secondary to adverse effects from medications (salicylic derivatives and immunosuppressive drugs). In the present study, patients with active Crohn's disease and anemia were evaluated and treated with intravenous ferric carboxymaltose. We discuss the therapeutic schemes (doses), safety, results and improvement of quality of life. In the present prospective study, 10 consecutive patients with Crohn's disease, with moderate to severe activity, with anemia (Hb: 6.7 to 10 g/dL), who were attended between March 2014 and March 2015, were evaluated. Six (60%) were men and four were women, all with moderate or severe anemia (hemoglobin <10 g/dL). They were treated with a maximum of three intravenous infusions of 1000 mg of ferric carboxymaltose, of at least 15 minutes in duration. It was also sought to correlate the inflammatory Crohn's disease activity degree (measured using the Crohn's Disease Activity Index, CDAI) and C-reactive protein level with the severity of anemia. The primary outcome was an increase in Hb of ≥2 g/dL and the secondary outcome was the normalization of anemia (Hb ≥12 g/dL for women and ≥13 g/dL for men) and the improvement in quality of life seen 12 weeks after the last application of carboxymaltose. Among the 10 patients studied, parenteral iron supplementation was administered in three cases during hospitalization and the others received this on an outpatient basis. The total iron dose ranged from 1,000 to 2,000 mg, with an average of 1,650 mg. Crohn's disease activity measured using CDAI and C-reactive protein correlated with the intensity of anemia. An increase of 2 g/dL occurred in eight (80%) patients after 12 weeks and normalization of anemia was found in seven (70%) patients. Improvements in quality-of-life scores were found for all (100%) patients after 12 weeks. Carboxymaltose was well tolerated. Three patients presented adverse reactions (two with nausea and one with headache) of mild intensity. Anemia is a frequent complication for Crohn's disease patients. Intravenous iron therapy has been recommended for Crohn's disease patients, because for these patients, oral iron absorption is very limited. This is because of the inflammatory state and "blocking" of iron entry into enterocytes through hepcidin action on ferroportin, along with the elevated rates of gastrointestinal adverse events that compromise adherence to treatment and possibly aggravate the intestinal inflammatory state. The degree of Crohn's disease activity, as measured using CDAI and C-reactive protein, correlates with the severity of anemia. Carboxymaltose is a safe drug, which can be administrated in high doses (up to 1,000 mg per application per week) and corrects anemia and iron stocks over a short period of time, with consequent improvement in quality of life.

Viusid, a nutritional supplement, in combination with interferon α‐2b and ribavirin in patients with chronic hepatitis C

The pathogenesis of chronic hepatitis C (CHC) is associated to severe oxidative stress that leads to necro-inflammation and progression of fibrosis. Previous trials suggested that antioxidative therapy may have a beneficial effect. We evaluated the efficacy and safety of Viusid in combination with interferon alpha-2b (IFN alpha-2b) and ribavirin in patients with CHC. We randomly assigned 100 patients, between October 2002 and December 2004, in two arms: IFN alpha-2b (5 MU on alternate days), ribavirin at a dose of 13 mg/kg daily and Viusid (three sachets daily) vs. IFN alpha-2b (5 MU on alternate days) and ribavirin at a dose of 13 mg/kg daily. Subjects were treated for 48 weeks and then followed for an additional 24 weeks. The primary end point was the histologic response (reduction of at least two points without fibrosis worsening in the total score on the Histological Activity Index). A significantly high proportion of patients who received combined therapy plus Viusid had a histologic response better than those patients who received IFN alpha-2b and ribavirin (57% vs. 37%, P=0.03). The patients with virologic response achieved the highest percentages of histologic response, irrespective of assigned treatment. Among non-responders, the highest reduction in the mean change from baseline score for necro-inflammatory activity (NA) and fibrosis (F) was reported in patients treated with Viusid [NA, -1.50 (Viusid), -1.20 (without Viusid); F, -0.31 (Viusid), 0.00 (without Viusid)]. Sustained normalization of serum alanine aminotransferase concentration was highest in the Viusid group compared with standard therapy (67% vs. 41%, P=0.009). The overall safety profile was similar in both groups, but interestingly, the anemia was less intense in the group with Viusid (P=0.04). Our results suggest that triple therapy with Viusid, IFN alpha-2b and ribavirin was well tolerated and may have a beneficial effect on histologic and biochemical variables. The intensity of anemia is reduced in patients treated with Viusid.

Bedside method for judging anemia.

Anemia is a frequently missed clinical diagnosis; its severity too often is assumed to be a matter of conjecture. Nevertheless, the presence and intensity of anemia often can be suspected with fair accuracy by careful examination of the patient without recourse to complicated laboratory methods. In evaluating anemia at the bedside, the clinician examines particularly the skin, mucous membranes, conjunctiva, and fingernails. It is the purpose of this communication to direct attention to study of the creases of the palm as a simple clinical method for estimating the degree of pallor. The hand as a source of clinical information is so obvious that it may be neglected. 1 The hand is richly endowed with blood vessels through which an enormous amount of blood flows. From time immemorial, the color of the palms and fingernail beds, has been utilized for evaluating anemia. According to Wintrobe, 2 the palms are more reliable