Lower Hb Levels Research Articles

Implication of asymptomatic and clinical Plasmodium falciparum infections on biomarkers of iron status among school-aged children in Malawi

BackgroundIron status is considered as a continuum from an iron deficiency with anaemia, without anaemia, varying amounts of stored iron to iron overload. The burden of Plasmodium falciparum infections is typically high among school-aged children (SAC). Nonetheless, SAC are often less likely to be covered by malaria interventions, making them a group with an untreated reservoir of parasite transmission. This study aimed to assess the effects of asymptomatic and clinical malaria infections on biochemical markers of iron status among SAC in Malawi.MethodsData from the 2015–2016 Malawi Micronutrient Survey (MNS) was used and multivariable logistic regression models using a generalized estimating equation to account for the complex cluster survey design were constructed. Blood samples of 684 children aged 5 to 14 years old were evaluated for clinical and asymptomatic malaria infections. Furthermore, blood samples were used to estimate haemoglobin (Hb), serum ferritin (SF) and, soluble transferrin receptors (sTfR) concentrations.ResultsOf the 684 SAC analysed, approximately 42% had asymptomatic malaria, while 41.0% had clinical malaria. Anaemia (low Hb levels), iron deficiency (low SF concentration), and functional iron deficiency (high sTfR levels) were found in 20%, 5%, and 30% of the children, respectively. School-aged children with asymptomatic malaria had increased odds of being anaemic (adjusted odds ratio [aOR]: 3.71, 95% confidence interval [CI]: 2.29–5.99) and increased levels of sTfR (aOR: 3.00, 95% CI 2.01–4.47). Similarly, SAC with clinical malaria had increased odds of being anaemic (aOR: 3.54, 95% CI 2.19–5.72) and increased levels of sTfR (aOR: 3.02, 95% CI 2.02–4.52).ConclusionsBoth asymptomatic and clinical malaria were independent risk factors for anaemia and functional iron deficiency (FID). The notion that asymptomatic and clinical malaria were associated with both anaemia and FID underscores the need for public health programmers to consider adding mass screening and treatment for malaria to existing school-based health programmes.

Parathyroidectomy Improves the Consumption of Erythropoiesis-Stimulating Agents in Hemodialysis Patients.

Secondary hyperparathyroidism (SHPT) is common in end-stage renal disease (ESRD) patients, and it can suppress erythropoiesis. We aimed to investigate the relationship between the consumption of erythropoiesis-stimulating agents (ESAs) and parathyroidectomy (PTX) in ESRD patients with SHPT and to determine the predictors for anemia improvement. The current standard of chronic kidney disease anemia therapy relies on the prescription of iron supplementation, and ESA. We retrospectively analyzed 81 ESRD patients with PTX at Ditmanson Medical Foundation Chiayi Christian Hospital from July 2004 to Dec 2018. The requirement of ESA therapy markedly declined from a dose of 41.6 (interquartile range [IQR], 0–91.2) to 10.3 (IQR, 0–59.5, p = 0.001) unit/kg/week. In addition, 63.7% of patients required iron replacement therapy preoperatively and the proportion reduced to 52.5% after PTX (p < 0.001). The hemoglobin (Hb) level showed an insignificant change from a median value of 10.7 g/dL (9.5–11.6 g/dL) before PTX to 10.5 g/dL (9.6–11.2 g/dL) at 6 months after PTX. A preoperative Hb level ≤ 10 mg/dL (odds ratio [OR], 20.1; 95% confidence interval [CI], 4.71–125, p < 0.001) and transferrin saturation (TSAT) < 25% (OR, 12.8; 95% CI, 2.51–129, p < 0.001) were predictors for anemia improvement. Our study demonstrated that PTX markedly decreased the requirement of ESA. Patients with a low preoperative Hb level or low TSAT showed an increase in the Hb level after PTX. PTX may be considered not only for SHPT with refractory anemia but also for high ESA-dependent patients.

Talaromyces marneffei is the Persistent Overwhelming Bloodstream Infection Pathogen Among HIV Inpatients in Fujian, China

PurposeThis study aimed to investigate the epidemiology and etiological spectrums of BSI in Fujian over the past 6 years in the post antiretroviral treatment (ART) era.MethodsA retrospective, observational study was conducted to include positive BSI inpatients with HIV between September 2015 and August 2021 in Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Fujian, China. Demographic data and laboratory data including gender, age, blood cell counts, biochemistry results, CD4 and CD8 cell counts, HIV-RNA loads, pathogen isolates, procalcitonin (PCT) levels and c-reactive protein (CRP) levels were collected. Continuous variables were expressed as median (range) and Kruskal–Wallis or Mann–Whitney test was used to analyze the differences between groups. Categorical data were expressed as numbers (percentage) and the differences between groups were analyzed by Pearson’s chi-squared test.ResultsIn total, 3681 HIV inpatients with blood culture data were included and 683 strains identified from 646 inpatients were further analyzed. The median age of patients was 38 years and male accounted for 86.84%. The pooled prevalence of BSI was 18.55% (12.01%–22.36% during the six-year period). The overall isolated rate of Talaromyces marneffei (TM) in blood culture was 12.42% (8.3%–15.00% during the study period). TM was the persistent dominant BSI pathogen from 2015 to 2021 (accounting for 63.04% to 71.43%), followed by Cryptococcus neoformans (responsible for 10.00% to 20.83%). Compared to patients with other organisms BSI, those with TM BSI were younger and had lower CD4 counts, WBC counts, HB and CRP level, but higher HIVRNA loads.ConclusionBSI is still a major problem in the post ART era in hospitalized patients with HIV/AIDS in Fujian, China. TM is the predominant pathogen. This underlines the importance of an early diagnosis of opportunistic pathogen to avoid BSI in HIV-infected populations with a low immune status.

Maternal Hemoglobin and Its Relationship With fetal birth weight

Background: The needs of iron for mother and fetus considerably increase during pregnancy. Its deficiency can be harmful to the mother’s health and the fetal in terms of birth weight. Aim: To examine the relationship between hemoglobin level and fetal birth weight. Methods: This was an observational study, conducted in Govt. Hospital Samanabad, Lahore between April 2021 and April 2022. A total of 106 pregnant women through non probability convenience sampling were recruited in our study. The patients were divided into two groups according to low and normal hemoglobin level. The hemoglobin&lt;11 g/dl was considered low and the hemoglobin ≥11 g/dl was considered normal. Variables like age, Gravida, gestational age at the time of deliveryand fetal birth weight were recorded. The hemoglobin during first trimester of pregnancy was also recorded from medical records of patients. Results: The prevalence of low hemoglobin in our study population was73.6%. The mean age of the women was 25.09±4.74years. The average gestational age at the time of delivery was 271.15±5.61 days. The participants with primigravida were in majority 54.7% as compared to the multigravida 45.3%. Pregnant females with the low Hb level were more likely to have a baby with the birth weight of less than 2500 grams. Hence there was a strong association between birth weight and Hb level (p-value= 0.038). Hemoglobin level was positively correlatedwith the fetal birth weight(r= 0.631, p-value=0.0001). Conclusion: Maternal hemoglobin should be paid more attention even from the first trimester of the pregnancy in order to avoidhigher risk oflow birth weight fetal. Keywords: Fetal birth weight, Hemoglobin, Pregnancy, Anemia, Gravida

Kindergarten indoor dust metal(loid) exposure associates with elevated risk of anemia in children

Exposure to metals and metalloids in indoor dust is associated with adverse health effects in young children, but there is limited evidence for an association with anemia, which is at high risk in children. The aim of this study was to investigate the association between exposure to multiple metal(loid)s in indoor dust in kindergartens and the risk of anemia in children. In 2021, 2165 children from 25 kindergartens in eastern China were included in the study and had their hemoglobin (Hb) measured. Indoor dust samples were collected from the children's kindergartens, and the concentrations of 11 metals and metalloids in the samples were measured using inductively coupled plasma mass spectrometry (ICP-MS). The daily exposure dose (DED) of dust was used to assess the risk of metal(loid) exposure in the children. The results showed that of the 2165 children with available data, 351 (16.2 %) met the WHO definition of anemia. In multiple linear regression and logistic regression analyses, we found that for each quartile of DED increase in Cd inhalation, child Hb levels decreased by 2.703 g/L (95 % CI: −4.055, −1.351), and the risk of anemia increased 1.602-fold (95 % CI: 1.087, 2.360). Mn ingestion was associated with increased odds of anemia [odds ratio (OR) = 1.760 (95 % CI: 1.217, 2.544)]. Interaction analysis indicated that metal(loid)s exposure effects were modified by child sex, age, and body mass index (BMI). Cluster analysis found that children at high risk of metal(loid) exposure in the school environment tended to have lower Hb levels and higher prevalence of anemia compared with those at low risk, although this was not statistically significant. These findings suggest that child school exposure to metal(loid)s in indoor dust is associated with an increased risk of developing anemia in children, modified by child sex, age, and BMI.

Prevalence of anaemia and associated factors among infants under 6 months in rural China.

To examine Hb level and anaemia status among infants under 6 months of age in rural China. A cross-sectional survey collected data among infants under 6 months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4-5 months). Eighty townships were selected in Sichuan, China from November to December 2019. Nine hundred and forty-two infants under 6 months, while Hb level was tested for 577 infants. The overall mean (±sd) Hb level was 106·03 (± 12·04) g/l. About 62·6 % (95 % CI 58·5, 66·6) of sample infants were anaemic using the WHO threshold, and 20·5 % (95 % CI 17·3, 24·1) were anaemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower Hb levels were significantly associated with lower birth weight (<4 months: β = 4·14, 95 % CI 0·19, 8·08; 4-5 months: β = 6·60, 95 % CI 2·94, 10·27) and delivery by caesarean section (<4 months: β = -4·64, 95 % CI -7·79, -1·49; 4-5 months: β = -4·58, 95 % CI -7·45, -1·71). A large share of infants under 6 months in rural western China are anaemic. Infants with low birth weight and caesarean delivered should be prioritised for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between caesarean section and anaemia to promote health and development in infancy.

Epidemiology of malaria and anemia in high and low malaria-endemic North-Eastern districts of India.

Anemia and malaria are the two major public health problems that lead to substantial morbidity and mortality. Malaria infection destroys erythrocytes, resulting in low hemoglobin (Hb) levels known as anemia. Here we report the determinants of anemia in high and low malaria-endemic areas that would help understand which parasite densities, age, and gender-associated low Hb levels. Therefore, a cross-sectional mass survey (n = 8,233) was conducted to screen anemia and malaria in high and low malaria-endemic districts (HMED and LMED) of North-East India. Axillary body temperature was measured using a digital thermometer. The prevalence of anemia was found to be 55.3% (4,547/8,233), of which 45.1% had mild (2,049/4,547), 52.1% moderate (2,367/4,547) and 2.9% had severe anemia (131/4,547). Among anemic, 70.8% (3,219/4,547) resided in LMED and the rest in HMED. The median age of the anemic population was 12 years (IQR: 7–30). Overall, malaria positivity was 8.9% (734/8,233), of which HMED shared 79.6% (584/734) and LMED 20.4% (150/734) malaria burden. The village-wise malaria frequency was concordant to asymptomatic malaria (10–20%), which showed that apparently all of the malaria cases were asymptomatic in HMED. LMED population had significantly lower Hb than HMED [standardized beta (β) = −0.067, p < 0.0001] and low-density Plasmodium infections had higher Hb levels than high-density infections (β = 0.113; p = 0.031). Women of reproductive age had higher odds for malaria (OR: 1.42; 95% CI: 1.00–2.05; p = 0.04). Females (β = −0.193; p < 0.0001) and febrile individuals (β = −0.029; p = 0.008) have shown lower Hb levels, but malaria positivity did not show any effect on Hb. Young children and women of reproductive age are prone to anemia and malaria. Although there was no relation between malaria with the occurrence of anemia, we found low-density Plasmodium infections, female gender, and LMED were potential determinants of Hb.

Predictive factors for massive hemorrhage in women with retained products of conception: a prospective study

Retained products of conception (RPOC) is a common cause of postpartum bleeding, which may be life-threatening; however, no evidence-based guidelines exist to assist in evaluating the risk of massive hemorrhage in women with RPOC. In this prospective study, we aimed to evaluate the predictive factors for massive hemorrhage in women with RPOC. The primary and secondary endpoints were to validate the usefulness of power Doppler color scoring (PDCS) in evaluating hypervascularity and to identify other predictive factors (such as maximum RPOC diameter and serum βhCG and Hb level at first visit), respectively. Among the 51 women with RPOC included in this study, 16 (31.5%) experienced massive hemorrhage during follow-up. None of the women with PDCS 1 or 2 (18) experienced massive hemorrhage, whereas 16 (48.5%) women with PDCS 3 or 4 (33) did. Multiple logistic regression analysis showed that the odds ratio [95% confidence interval] (P value) for PDCS, assisted reproductive technology (ART), and low serum hemoglobin (Hb) levels were 22.39 [2.25 − 3087.92] (P = 0.004), 5.72 [1.28 − 33.29] (P = 0.022), and 4.24 [0.97 − 22.99] (P = 0.056), respectively. Further, the decision tree method identified PDCS, ART, and low serum Hb levels as potential predictive factors for massive hemorrhage. This study identified PDCS as useful predictor of massive hemorrhage in women with RPOC. With additional inclusion of factors such as ART and low serum Hb levels, the risk of massive hemorrhage may be effectively evaluated, leading to better management of women of reproductive age.

Dynamic hip screw versus intramedullary nailing for the treatment of A1 intertrochanteric fractures: A retrospective, comparative study and cost analysis.

Objectives This study aims to compare sliding hip screw and intramedullary nail perioperative results and costs in two-part femoral fractures.Patients and methods Between January 2015 and December 2019, a total of 85 patients (70 males, 15 females; mean age: 85.6±9.5 years; range, 33 to 99 years) who were treated for intertrochanteric two-part femoral fractures were retrospectively analyzed. The patients were stratified and divided into two groups according to type of implant used for surgical fixation: one group treated with intramedullary proximal femoral nail (EBA) and the other with sliding hip screw (DHS). Comorbidity, hemoglobin level (Hb), hematocrit (hct) level, number of transfusions, and days of hospitalization details were evaluated. Postoperative X-rays were analyzed to assess the quality of reduction and to identify non-union, malunion, mechanical failures, and heterotopic ossifications. The modified Harris Hip Score, fracture mobility score, and Parker Mobility Score were calculated. Cost analysis considered the orthopedic device, operating room, transfusion, and hospital costs for the primary hospital stay.Results Of the patients, 44 were treated with DHS and 41 were treated with EBA nail by a single surgeon. No significant differences were found in the baseline demographic data. There was a significant increased operative time (p<0.001) and decreased fluoroscopy X-ray exposure time (p=0.031) in the subgroup of patients who underwent DHS fixation. The patients who underwent EBA nail fixation had a significantly higher transfusion rate during hospitalization (p=0.001) and a significantly lower Hb level and hct level on postoperative Day 1 and Day 3 (p<0.05). There were no significant differences in the clinical and functional scores, radiographic outcomes and mortality (p>0.05). The patients who underwent intramedullary nail fixation had higher costs.Conclusion Sliding hip screws showed decreased postoperative anemization, lower transfusion rates, and similar clinical outcomes compared to the intramedullary nail for two-part femoral fractures. Sliding hip screws should be preferred for A1 intertrochanteric fractures.

Relationship between the Hematological Indices and COVID-19

Background: Recently, the novel coronavirus disease-2019 (COVID-19) has a wide spread around the world. Clinically, it was responsible for respiratory illness ranged from mild to life-threatening infection. The study aimed to investigate the link of gender, age, ABO blood groups, and hematological indices with COVID-19 infection. Methods: One hindered COVID-19 cases, as confirmed using reverse transcription–polymerase chain reaction test, were checked for some sociodemographic features, blood group, and hematology parameters. A blood sample was collected from each person in an EDTA container and immediately tested for blood group using commercial antisera, in addition to complete blood count parameters using of a semiautomated hematology analyzer (Mindray BC-3200). Results: Of 100 COVID-19 patients, 52% were male and 48% were female. About 33% and 31% of the study participants were of age group 15–31 and 32–49 years, respectively. The majority (37%) of COVID-19 patients carried blood group O+ve, followed by A+ve (24%). A+ve blood group was significantly more reported in males (32.7%) than females (14.6%). Notably, 61% of participants showed low Hb level. Erythropenia was detected in 41% of the participants, while thrombocytopenia was observed only in 19% of the patients. Moreover, lymphocytopenia was detected in 82%, low packed cell volume in 66%, decreased mean corpuscular volume in 20%, and declined mean corpuscular hemoglobin concentration in 8% of the participants. In contrast, leukocytosis and neutrophilia were found in 69% and 73% of the participants, respectively. Conclusion: Taken together, the study findings highlighted the link of COVID-19 with age, gender, blood groups, and hematology parameters, which is important in diagnosis, prognosis, and management of illness.

The Significance of Crescents on the Clinical Features and Outcomes of Primary Immunoglobin A Nephropathy

BackgroundIt is still controversial whether the proportion of crescents below 50% can be an independent predictive risk factor for poor prognosis in IgAN patients. We reported the significance of different proportions of crescents on the clinical features and the cut-off value of crescents in predicting the occurrence of end-stage kidney disease (ESKD) in patients with IgAN.MethodsWe retrospectively analyzed biopsy-proven primary IgAN patients in Sichuan Provincial People’s Hospital from 2007 to 2019. The patients were divided into 5 groups on the basis of crescent proportion as follows: 0 (n = 647), < 10% (n = 221), 10 to 24% (n = 272), 25 to 49% (n = 80), and ≥50% (n = 22). The primary endpoint was defined as ESKD, and the secondary endpoint was the combined renal endpoint (≥50% reduction in eGFR or ESKD). A validation cohort of 346 patients were enrolled from Affiliated Hospital of Southwest Medical University. Cox regression model and Kaplan-Meier survival analysis were performed.ResultsA total of 1242 eligible patients with biopsy-proven IgAN were recorded in the database, compared with the non-crescent group, patients in the crescent group had lower levels of hemoglobin (Hb) and albumin (Alb), higher levels of blood urea nitrogen (BUN), 24h urinary protein and hematuria, a higher proportion of mesangial hypercellularity (M1), endocapillary hypercellularity (E1), segmental glomerulosclerosis (S1), and tubular atrophy/interstitial fibrosis (T1/T2) (p < 0.05). A higher crescent proportion was associated with lower levels of Hb, ALB, eGFR and serum IgG (p < 0.05), higher levels of SCr, BUN, increasing amounts of 24 h urinary protein, increasing proportion of M1 and E1, and increasing severity of interstitial inflammatory infiltration. During the median follow-up of 43 months (range 6-151), 63 individuals (7.0%) reached the primary outcome of ESKD and 99 patients (11.1%) reached the combined renal endpoint. 34(7.5%), 21 (13.3%), 24(12.2%), 14(21.5%) and 6(31.6%) patients reached the combined renal endpoint in the above five groups in crescents 0, <10%, 10∼24%, 25∼49% and ≥50%, respectively. A total of 274(62.6%) cases in the crescent group and 254 (55.7%) cases in the non-crescent group received immunosuppressive therapy. Multivariate Cox regression showed that crescents ≥50% was an independent risk factor for the progression of ESKD (p = 0.003) and crescents ≥25% was an independent risk factor for the combined renal endpoint(p < 0.001). The receiver operating characteristic curve showed that IgAN patients with crescents ≥43.7% had a higher risk of ESKD, even with immunosuppressants (Sensitivity = 75.7%,specificity = 89.6%,p < 0.001). This discovery cohort and the validation cohort further confirmed that patients with crescents <43.7% had better renal prognosis than those with crescents ≥43.7% in the whole group and those with immunosuppressants (p < 0.001).ConclusionIgAN patients with crescents had more severe clinicopathological features and poorer prognosis. Crescents ≥50% was an independent risk factor for the progression of ESKD and crescents ≥25% was an independent risk factor for ≥50% reduction in eGFR or ESKD in treated and untreated IgAN patients. Crescents ≥43.7% was an independent risk factor for ESKD in those with immunosuppressants.

P1488: ASSOCIATION BETWEEN HEMOGLOBIN LEVELS AND END-ORGAN DAMAGE IN SICKLE CELL DISEASE: A RETROSPECTIVE LINKED PRIMARY AND SECONDARY CARE DATABASE ANALYSIS IN ENGLAND

Background: Sickle cell disease (SCD) is a chronic, multifaceted blood disorder that affects the oxygen-carrying protein hemoglobin (Hb). Along with chronic hemolysis and vaso-occlusion that often accompanies SCD, low Hb levels may contribute to downstream end-organ damage (EOD). Emerging evidence suggests an association between chronic hemolytic anemia in SCD and both short-term and long-term adverse outcomes, including EOD. Therefore, treatments that directly increase Hb may improve patients’ acute symptoms while reducing the risk for long-term disease-related effects known to contribute to morbidity and mortality. Aims: This study aims to ascertain the association between Hb level variation and EOD and clinical conditions typically associated with SCD (stroke, pulmonary hypertension, chronic kidney disease [CKD], end-stage renal disease [ESRD], leg ulcers, and pneumonia) in a real-world data set. Methods: The Clinical Practice Research Datalink (CPRD) and the Hospital Episode Statistics (HES) databases in England were used to retrospectively identify linked Hb data among patients with SCD (1 April 2007 to 31 March 2019). Recurring results in any 90-day period were averaged. Logistic regression adjusted with demographic and clinical variables was used to determine odds ratios (ORs) of developing each EOD outcome or clinical complication. ORs, P values, 95% confidence intervals (CIs), and areas under the receiver operating curve (AUC-ROCs) and corresponding 95% CIs were reported. Results: Of 11,936 patients identified, 5379 (45%) had Hb results recorded in the CPRD. The logistic model for risk assessment of all outcomes studied indicated that an increase in Hb among patients with SCD was associated with a statistically significant (P<0.001) decrease in adjusted ORs per 1 g/dL increase in Hb (Table). Except for ESRD, leg ulcers, and pneumonia, the adjusted models showed statistically significant increases in AUC-ROC compared with the unadjusted models, signifying that the adjusted models were more robust and further verified a statistical OR after adjustment. Increased Hb was associated with decreased risk of respiratory-related events. Pulmonary hypertension had the strongest effect with the most robust model (ORadjusted of 0.66). For pneumonia, ORadjusted was 0.77. For renal insufficiency, ORs for developing CKD or ESRD were significantly lower than 1 (ORadjusted=0.73 and ORadjusted=0.75, respectively). After adjusting for clinical and demographic factors, the model predicted a lower risk for stroke (ORadjusted=0.89). The estimated AUC-ROCs suggest that the adjusted model is more robust in stroke, hypertension, and CKD. These findings did not change when testing for other covariates such as deep vein thrombosis. Image:Summary/Conclusion: Among patients with SCD, an increase in Hb of 1 g/dL was associated with a statistically significant reduction in risk for 6 common EOD outcomes and clinical conditions. The results were more pronounced after adjusting for demographic and clinical covariates (based on clinical opinion and literature review) and further assessed with a bivariate analysis. The results were obtained from a representative real-world evidence dataset analyzed over a 12-year period, which was sufficient to observe EOD events, and are generalizable to the UK and similar populations. Our findings support the use of therapeutics that increase Hb in patients with SCD to protect against deleterious organ damage.

P1523: DEMOGRAPHICS, CLINICAL CHARACTERISTICS, AND REAL-WORLD TREATMENT PATTERNS AMONG PATIENTS WITH BETA-THALASSEMIA: A RETROSPECTIVE MEDICAL RECORD ABSTRACTION STUDY

Background: Beta-thalassemias (BTs) are genetic disorders of hemoglobin (Hb) synthesis defined by deficient or absent synthesis of the beta-globin subunit. As a result, patients with BT experience hypochromic anemia and excess alpha-globin chain, causing ineffective erythropoiesis and low-grade hemolysis; however, patient characteristics and treatment patterns are not well understood. Aims: This retrospective medical record abstraction study evaluated patients prior to introduction of luspatercept with transfusion-dependent (TD) and non-transfusion-dependent (NTD) BT for demographics, clinical characteristics, and treatment patterns. Methods: Medical records of adults with TD or NTD BT in the United Kingdom (UK), France, Germany, Spain, and Canada with ≥5 years of visit history within the practice were evaluated. The target sample size was 50 patients in all countries (except Canada: N=20 patients), with an even distribution of patients with TD and NTD BT. Information on demographics, clinical characteristics, and treatment patterns was abstracted from the medical records. Results: In total, 118 patients with TD and 96 patients with NTD BT were identified. Among patients with TD BT, mean (standard deviation [SD]) patient age was 36.1 (11.9) years, and 28.8% were female; among patients with NTD BT, mean (SD) patient age was 36.6 (9.8) years, and 38.5% were female (Table). Table shows characteristics and results per country. Among patients with TD BT, 90/118 (76.3%) were receiving transfusions at least once every 4 weeks, with 5.1% receiving transfusions weekly, 16.1% every 2 weeks, 28.8% every 3 weeks, 26.3% every 4 weeks, 3.4% every 5 weeks, 17.8% every 6 weeks, and 2.5% other or unknown. Patients with TD BT had an average (SD) of 2.4 (0.6) units of blood transfused per session (range, 1.9 in Spain to 2.7 in UK), with an average (SD) Hb level before the transfusion of 6.9 (1.3) g/dL (range, 5.9 in Canada to 7.3 in Germany). Patients with TD BT had been on the transfusion regimen for an average of 72.6 months (range, 45.2 in Canada to 104.9 in UK) during the observation period. All patients with NTD BT had previously had ≥1 transfusion at any point in time that the physician was aware of, with an average (SD) of 2.9 (0.9) transfusions per patient (range, 2.6 in Canada to 3.1 in Germany). Among patients with NTD BT with detailed transfusion data available post-index date (N=81; 84.4%), the mean (SD) number of units of blood per transfusion was 2.2 (0.6) (range, 1.9 in Spain to 2.7 in France), and the mean (SD) Hb level before transfusion was 7.4 (1.2) g/dL (range, 6.2 in Canada to 8.2 in Spain). Iron chelation therapy was received in 70.3% of TD patients (range, 44.4% in the UK and 92.6% in Germany) and in 45.8% of NTD patients (range, 37.0% in France to 80.0% in Canada). The percentages of patients with hepatitis B, C, and D were low (ie, all <2%) for both the TD and NTD cohorts, as were the percentages of patients with cerebrovascular disease (2.5% for TD and 1.0% for NTD) and congestive heart failure (5.1% for TD and 2.1% for NTD). Image:Summary/Conclusion: Real-world data on clinical practice and outcomes in patients with BT are lacking. This study found that NTD and TD patients with BT have similarly low pre-transfusion Hb levels. A high number of patients, especially TD patients, are not treated according to the current recommendations, highlighting the importance of national reference centers to improve outcomes and quality of life in these patients.

Significantly lower mean serum vitamin B12 and folic acid levels and a significantly higher frequency of serum iron deficiency in younger than in older atrophic glossitis patients

Background/purpose: Our previous study found that 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 atrophic glossitis (AG) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. This study mainly evaluated the anemia, hematinic deficiencies, and hyperhomocysteinemia in 224 younger (≤50 years old) and 840 older (>50 years old) AG patients. Materials and methodsThe blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, and homocysteine levels in 224 younger and 840 older AG patients were measured and compared with the corresponding levels in 112 younger (≤50 years old) and 420 older (>50 years old) healthy control subjects (HCSs), respectively. ResultsWe found that 224 younger AG patients had significantly lower mean blood Hb and serum iron levels than 112 younger HCSs. Moreover, 840 older AG patients had significantly lower mean blood Hb and serum iron levels and a significantly higher mean serum homocysteine level than 420 older HCSs. In addition, 224 younger AG patients had significantly lower mean serum vitamin B12 and folic acid levels, a lower mean serum homocysteine level (marginal significance, P = 0.056), a significantly higher frequency of serum iron deficiency, and a significantly lower frequency of hyperhomocysteinemia than 840 older AG patients. ConclusionThe younger AG patients do have significantly lower mean serum vitamin B12 and folic acid levels, a significantly higher frequency of serum iron deficiency, and a significantly lower frequency of hyperhomocysteinemia than the older AG patients.

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation.

IntroductionThe loss of blood is a significant problem in Total Knee Arthroplasty (TKA). Anemia often occurs after such surgeries, leading to serious consequences, such as higher postoperative infection rates and longer hospital stays. Tools for predicting possible anemia can provide additional guidance in realizing better blood management of patients.Methods2,165 patients who underwent TKA from 2015 to 2019 in the same medical center were divided into training and validation cohorts. Both univariate and multivariate logistic regression analyses were performed to identify independent preoperative risk factors for anemia. Based on these predictors, a nomogram was established using the area under the curve (AUC), calibration curve (AUC), and the area under the curve (AUC). The model was then applied to the validation cohort, and decision curve analyses (DCA) were also plotted.ResultsThrough analysis of both univariate and multivariate logistic regression, five independent predictors were found in the training cohort: female, relatively low BMI, low levels of preoperative hemoglobin, abnormally high levels of ESR, and simultaneously two sides of TKA in the same surgery. The AUCs of the nomogram were 74.6% (95% CI, 71.35%–77.89%) and 68.8% (95% CI, 63.37%–74.14%) of training and the validation cohorts separately. Furthermore, the calibration curves of both cohorts illustrated the consistency of the nomogram with the actual condition of anemia of patients after TKA. The DCA curve was higher for both treat-none and treat-all, further indicating the relatively high practicality of the model.ConclusionFemale, lower BMI, lower levels of preoperative Hb, simultaneous bilateral TKA, and high levels of preoperative ESR were figured out as five independent risk factors for postoperative anemia (<9.0 g/dL) in patients undergoing TKA. Based on the findings, a practical nomogram was constructed to predict risk of postoperative anemia. The evidence level should be level 4 according to guideline.

Racial differences in red blood cell transfusion in hospitalized patients with anemia.

BackgroundGuidelines recommend transfusion of red blood cells (RBC's) when a hospitalized patient's hemoglobin (Hb) drops below a restrictive transfusion threshold, either at 7 or 8 g. Hospitals have implemented transfusion policies to encourage compliance with guidelines and reduce variation in transfusion practice. However, variation in transfusion practice remains. The purpose of this study was to examine whether there is variation in the receipt of transfusion by patient race.MethodsHospitalized general medicine patients with anemia (Hb < 10 g/dL) were eligible. Chi‐squared tests were used to compare the percent of patients receiving a transfusion by race overall and within strata of their nadir Hb. Linear regression was used to test the association between a patient's race, their nadir Hb, receipt of an RBC transfusion, and the number of units transfused.ResultsFour thousand nine hundred and fifty‐one patients consented, including 1363 (28%) who received a transfusion. 71% of patients were African American, 25% were White, and 4% were Other Race. Overall African Americans were less likely to be transfused compared to Whites (25% vs. 30%, p < .01), and within Hb strata below a Nadir Hb of 9 g/dL (Hb 8.0–8.9 g/dL 1% vs. 7%, p < .01; 7.0–7.9 g/dL 15% vs. 28%, p < .01; <7 g/dL 80% vs. 86%, p < .01). African Americans also received fewer units of RBC's (β = −.17, p < .01) overall and at lower Hb levels (β = .14, p < .01) compared to Whites.DiscussionThe Hb level at which patients are transfused at and the total number of RBC units received during hospitalization differ by patient race.

Significantly higher frequencies of macrocytosis, anemia, serum vitamin B12 and folic acid deficiencies, and hyperhomocysteinemia in male than in female atrophic glossitis patients

Background/purposeOur previous study found that 19.0%, 16.9%, 5.3%, 2.3%, 11.9%, and 26.7% of 1064 atrophic glossitis (AG) patients have anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity, respectively. This study evaluated the anemia, hematinic deficiencies, and hyperhomocysteinemia in 150 male and 914 female AG patients. Materials and methodsThe blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, GPCA levels in 150 male and 914 female AG patients were measured and compared with the corresponding levels in 75 male and 457 female healthy control subjects (HCSs), respectively. ResultsWe found that 150 male AG patients had significantly lower mean blood Hb, serum iron, vitamin B12, and folic acid levels, and significantly higher mean serum homocysteine levels than 75 male HCSs. Moreover, 914 female AG patients had significantly lower mean blood Hb and serum iron levels and significantly higher mean serum homocysteine level than 457 female HCSs. In addition, 150 male AG patients had significantly higher mean blood Hb and serum homocysteine levels, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of Hb, vitamin B12, and folic acid deficiency and hyperhomocysteinemia than 914 female AG patients. ConclusionThe male AG patients do have significantly higher mean blood Hb and serum homocysteine levels, significantly lower mean serum vitamin B12 and folic acid levels, and significantly higher frequencies of Hb, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia than the female AG patients.

Determining the Maternal Risk Factors Contributing to the Birth of Low Birth Weight Newborn: A Case-Control Study

Aim:To determine the maternal risk factors contributing to the birth of low birth weight newborn Study design: A case-control study Place and Duration:This study was conducted at ChildLife Foundation (CLF), Paediatric Emergency NICH Karachi Pakistan from August 2021 to January 2022. Methodology:A total of 920 mothers were included in the study that delivered the baby during the mentioned time frame, out of which 460 were cases and 460 controlled mothers for the comparative analysis of risk factors. All the newborns weighing less than 2500 grams of weight were considered as respective cases for the study. Newborns that weight more than 2500 grams were included in the control groups Results:The mean weight of newborn cases was 2.07 ± 0.45 kilograms and 3.14 ± 0.36 kilograms in the newborn control group. However, the mean gestational age of the cases was 37.2 ± 1.48, and the control was 38.3 ± 1.23 weeks. Whereas mothers of 37.2% of cases and 38.7% of control had no education background, 76% of cases had low HB levels, and 68.7% of cases had less than 24 months of the birth interval were relatedto low birth weight. There was no direct associationbetweenmaternal hypertension and low birth weight among newborns observed in the present study. Conclusion:The present study concluded that maternal low HB levels, poor socioeconomic status, low BMI, poor educational background and close birth spacing have a strong association with LBW among newborns. The country's child and maternal health care services should be prioritized to address these issues. Keywords: Childbirth, Infant mortality, Low birth weight, Neonatal mortality, Parental risk factors.

Effects of varying group sizes on performance, body defects, and productivity in broiler chickens

This study aimed to determine the changes in the performance, welfare, and productivity level of broiler chickens reared at various group sizes (GS3000, GS4000, GS6000, and GS20 000) under intensive field conditions. The study was carried out according to a randomized block design with four different group sizes (GS) in three trials. Weekly body weights (BWs) were determined randomly in 150 individuals from each GS group. Feed intake (FI), feed conversion ratio (FCR), and European production efficiency factor (EPEF) were determined for each GS treatment. Body defects (footpad dermatitis, FPD, hock burn, HB, and the breast burn, BB) were measured randomly in 150 chickens (75 male and 75 female) from each group using a visual scoring system with a 0–3 scale. At 1 and 2 weeks of age, GS3000 broilers had similar BW to GS6000 and higher than GS4000 and GS20 000. However, this situation changed at 6 weeks of age and the male chickens in GS6000 became heavier than in GS3000, GS4000 and GS20 000 ( 0.007). No differences in mean values of temperature, humidity, air velocity and litter moisture levels were observed among GS treatments. GS3000 and GS4000 chickens had significantly lower levels of FPD, HB, and BB than chickens reared in GS6000 and GS20 000 ( 0.001). The EPEF values from highest to lowest were 425.8, 404.5, 358.8, and 354.0 in the GS6000 GS3000, GS4000, and GS20 000 groups, respectively. In conclusion, our study results showed that rearing in groups of 6000 broilers had both better performance and higher overall productivity than other groups but tended to show more severe body defects.

MO790: Arteriovenous Fistula Calcifications—Risk Factors and Impact on Arteriovenous Fistula Functionality

Abstract BACKGROUND AND AIMS Vascular calcifications have been recognized as frequent findings in patients with end-stage renal disease (ESRD) and have intricate mechanisms, including chronic kidney disease—mineral and bone disorders (CKD-MBD), inflammation and advanced atherosclerosis. The pathogenesis of arteriovenous fistula (AVF) calcifications is not fully understood, since it involves many other factors related to haemodialysis (HD) such as haemodynamic variables or vessel wall shear stress. The current study aims to assess the risk factors related to AVF calcifications and the impact on AVF functionality. METHOD The study included 174 chronic HD patients, mean age 58 ± 12 years, 35% female, median AVF duration 44 ± 52 months, with 35.9% radio-cephalic AVF, 12.1% brachio-basilic AVF, 52% brachio-cephalic AVF. The same nephrologist performed Doppler and B-mode AVF US scans in order to record AVF calcifications (defined as areas of hyperechogenicity with or without posterior shadowing within the arterial wall), as well as other complications (stenosis, partial thrombosis, aneurysms). In the same month of the AVF ultrasound assessment, cardiac echocardiography was performed in order to assess valvular calcifications. Laboratory parameters were analysed in the same month (Hb, calcium, phosphorus, serum bicarbonate, iPTH, albumin, ferritin, CRP). Dialysis efficiency (mean eKt/V in the month of ultrasound assessment) was recorded. The AVF survival was followed for 1 year after the initial evaluation, or up to the patient's death/transplantation. Statistical analysis was performed using MedCalc 14.8.1.0. RESULTS In our group, we found that the prevalence of AVF calcifications was 38% (66/174). Significantly more radiocephalic AVFs (47%) had calcifications than brachio-cephalic (38%) or brachio-basilic AVFs (15%), P = 0.04. The presence of calcifications was associated with longer AVF duration (P &amp;lt; .001), the presence of concomitant AVF stenosis (P = .04) and lower Hb levels (P = .02). The presence of AVF calcifications was not significantly associated with age, cardiac calcifications, or the presence of diabetes mellitus. Moreover, there was no statistically significant difference between the eKT/v values obtained in the group with AVF calcifications versus without AVF calcifications. We used the Cox proportional hazards model adjusted for standardized predicted values to determine whether patients with AVF calcifications had an increased risk of AVF failure. We found that after 1 year, 18,1% AVFs with calcifications had failed (12/66) while only 4.6% AVFs without calcifications had failed (5/108) [P = 0.02, hazard ratio (HR) 3.5, 95% confidence interval (95% CI) 1–11.3]. CONCLUSION The prevalence of AVF calcifications was 38% and affects radio-cephalic AVFs the most. AVF calcifications detected through ultrasound represent a risk factor for AVF failure, but the mechanism might be different from the pathways engaged in other vascular calcifications associated with CKD. We found no correlation with concomitant cardiac calcifications or CKD-MBD related biochemical changes. We found that AVF calcifications rather associate with HD-related factors (longer AVF duration and the presence of AVF stenosis). We suggest that periodic screening via ultrasound may be an easy method to diagnose AVF calcifications.