Low MCH Research Articles

Anemia among Medical Students from Jakarta: Indonesia-Iron Deficiency or Carrier Thalassemia?

Anemia, a global health concern, affects one-fourth of the global population, particularly women. In Indonesia, its prevalence is 23.7%, with 32.0% among 15-24 year-olds. Factors include poor nutrition, infectious diseases, chronic diseases, inherited disorders, and inadequate healthcare access. This study aimed to investigate anemia prevalence and its etiology among medical students from Jakarta. This study was a descriptive research with a cross-sectional approach. Undergraduate students aged 18-23 years old were selected and consented to participate by a consecutive nonrandom sampling methods. Laboratory blood data were evaluated (including Hb, MCV, MCH, HbA2, and ferritin levels) and DNA was isolated to confirm the type of thalassemia carrier. In total, 140 medical students, mainly female, were recruited. Anemia was found in 13.6% (11.4% had low MCV and/or MCH), and 16.5% had low MCV and/or MCH without anemia. Hb electrophoresis revealed high HbA2 values, suggesting the HbE variant (2.1%), and β-thalassemia carrier (0.7%). DNA analysis confirmed the cd26 mutation and heterozygous IVS1nt5. Among those without anemia, 5% had α-deletion, while in the group with anemia, 1.4% had α-deletion (with coexistent IDA), 3.6% had α-deletion, and 0.7% had β-mutation. DNA analysis can identify specific mutations associated with alpha-thalassemia, distinguishing between iron deficiency anemia and the alpha-thalassemia trait. Thalassemia screening should involve low MCV and/or MCH values as the first step (stage 1), followed by Hb analysis (stage 2) and DNA analysis (stage 3). In common areas, a combination of Hb and DNA testing is best. However, healthcare professionals must diagnose and treat thalassemia, as proper management relies on accurately identifying the underlying condition.

Nutritional status in patients with tuberculosis and diabetes mellitus: A comparative observational study

BackgroundIndia has been estimated to have 14 % of malnourished population and a high TB incidence burden with a 26.9 lakh cases. Malnutrition and diabetes mellitus are major risk factors for tuberculosis infection. Malnutrition in patients with both tuberculosis and diabetes (TB-DM) population worsens the disease severity, treatment outcomes and increases morbidity and mortality risk. ObjectiveTo assess the nutritional status in patients with TB-DM compared with patients with TB and DM alone. MethodRecords from January 2016 to November 2020 for patients admitted to Kasturba Hospital, Manipal were assessed. Data pertaining to glycemic parameters, nutritional parameters, and other relevant laboratory parameters were extracted for assessment. The study population were divided into three groups i.e. patients with TB-DM, TB and DM. The statistical association was carried out with one-way ANOVA method, considering p < 0.05 as statistically significant. ResultsA total of 291 patients were included, with 97 patients in each group; among those, male and female were 86.27 % and 13.73 % respectively. Cardiovascular co-morbidity was predominant in the DM (68.04 %) and TB-DM (26.8 %) group. The mean value of HbA1c (10.47 %) was found to be highest for the TB-DM group. Low levels of albumin were reported by 71.91 % of patients of the TB group, whereas 73.68 % patients in TB-DM group had vitamin D deficiency. Moreover, higher prevalence of low MCV and MCH in the TB-DM group suggest an increased risk of iron-deficiency anemia. ConclusionThe findings of our study reflect the need for implementation of nutritional support in patients with TB-DM.

Evaluation of Impact of Low Hb, MCV, MCHC and MCH on Cognitive Ability of Undergraduated Medical Students

Introduction: Low concentrations of hemoglobin or anemia can contribute chronic brain hypoxia and reduced aerobic capacity, thus increasing the risk of dementia or cognitive decline. From the clinical point of view, brain ischemia is a known risk factor of cognitive dysfunction and dementia. We investigated correlation and impact of low Hb, MCV, MCHC and MCH on cognitive abilities from 386 participants on 59 top 10 undergraduate medical students. Objective: This study aimed to determine and evaluate the correlation and impact of low Hb, MCV, MCHC and MCH on cognitive abilities of 59 top 10 undergraduated medical students in Ahmad Shah Abdali Higher Education Institute of Khost province of Afghanistan. Method and Materials: It is prospective descriptive cross sectional study, on 59 top 10 undergraduated medical students in Ahmad Shah Abdali Higher Education Institute of Khost province from 2023/ Oct / 12 to 2023/ Nov / 02. The including parameters were Hb, MCV, MCHC and MCH of all 386 participants under study that recorded in computer special format. Hb, MCV, MCHC and MCH are done by special regents and micro lab. Recorded findings processing, comparison and evaluation results have been identified by IBM SPSS-23 version. Results: The study was conducted during (20) days on 386 undergraduated medical students in Ahmad shah Abdali Higher Education Institute of Khost province. Initially we described all male participants according to age. At the current study all male participants were with (mean age: 23.14 ± 3.68; range: 20-45 years). All participants of this study were from all (1st, 2nd, 3rd, 4th, 5th and 6th) classes. Statistic description of all participants, according to Hb, MCV, MCHC and MCH shows that normal range of Hb level for male (14-16.6g/dl) was more prevalent 301(77.97). Low level of Hb for male (Low ˂ 13.5g/dl) was 19(4.92) and high level of Hb for male (High &gt; 16.6g/dl) was 66(17.09).The normal range of MCV (80-95%) was 327(84.71), low range (Low ˂80) was 54(13.98) and high range (High&gt;95%) was 5(1.29).The normal range of MCHC (32-36%) was 370(95.85), low range (Low ˂ 32) was 15(3.88) and high range (High&gt;36%) was 1(0.25).The normal range of MCH (23-31%) was 322(83.41), low range (Low ˂ 23) was 19(4.92) and high range (High&gt;31%) was 5(11.65). In the second part of this study we described all above parameters in the group of all 59 top 10 participants students for comparative outcomes. Statistic description of 59 top 10 participants, according to Age, Hb, MCV, MCHC and MCH shows that at the current study top 10 participants were with (mean age 23.40± 2.78; range: 18-32 years). Normal range of Hb level for male (14-16.6g/dl) was 43(72.88). Low level of Hb for male (Low ˂ 13.5g/dl) was 2(3.38) and high level of Hb for male (High &gt; 16.6g/dl) was 14(23.72). The normal range of MCV (80-95%) was 51(86.44), low range (Low ˂80) was 8(13.55) and high range (High&gt;95%) was 0(0). The normal range of MCHC (32-36%) was 57(96.61), low range (Low ˂ 32) was 2(3.38) and high range (High&gt;36%) was 0(0).The normal range of MCH (23-31%) was 50(84.74), low range (Low ˂ 23) was 2(3.38) and high range (High&gt;31%) was 7(11.86).Pearson correlation between Hb and MCV is at the 0.01 level significant, (P&lt;0.00). Conclusion: Overall, findings of our study indicated that, low Hb, MCV, MCHC and MCH have significant correlation with cognitive ability of undergraduated students. However, this issue needs to further investigations to confirm these findings.

A 38 Week and 2 Day G1P0A0 Primigravida in the First Stage of Labor with Thalassemia: A Case Report

Thalassemia is one of the most prevalent inherited blood disorders worldwide. We reported a case of 20-year-old G1P0A0 pregnant woman diagnosed with thalassemia intermedia since childhood based on chronic anemia, facies Cooley, and family history. She had 6 times red blood cell transfusion throughout current pregnancy. On 38 week 2 day gestation, she was admitted with chief complaint of painful regular uterine contractions and bloody show. Physical and laboratory findings were low hemoglobin, hematocrit, MCV, and MCH. Thalassemia can be alpha or beta type, depending on the affected globin chain. Clinical severity varies. The main therapies are repeated blood transfusions and iron chelation. During pregnancy, optimal evaluation and management are crucial to prevent maternal and fetal complications. This patient will undergo cesarean section and needs thorough high-risk antenatal care.

Serum ferritin level in children with normal hemoglobin and low MCV and MCH in a hospital in Iraq

Background: Iron deficiency is common around the world, particularly in young people because of their elevated need for iron to grow and develop. Iron deficiency is demonstrated by low levels of serum ferritin. This research will investigate the level of serum ferritin in children with normal hemoglobin but low MCV and MCH, the purpose of this is to determine the degree to which subclinical iron deficiency is present and distinguish it from other causes of microcytosis. Method: 150 children with typical hemoglobin but low MCV and MCH were recruited recognizing subordinate iron deficiency. Blood samples and demographic information regarding sociological aspects were collected and assessed. A computerized hematology analyzer and an ELISA were both used to assess the level of haemoglobin in the blood and the serum level of ferritin. Results: Children with normal hemoglobin but low MCV and MCH had a mean hemoglobin level of 12.7±0.6 mg/ dl and a serum ferritin level of 86.5±7 ng/ ml, according to the study. The levels of serum ferritin and hemoglobin changed significantly, depending on the sociodemographic variables. Among the pediatric population, the levels of serum ferritin and hemoglobin were significantly higher (P-value 0.002). Conclusion: In children with typical hemoglobin, but low MCV and MCH, the sociodemographic factors are strongly associated with the hemoglobin and serum ferritin levels. Gender, birth order, and family size—children under the age of 10 years— had an effect on the serum level of ferritin. The age, birthdate, and the time of supplemental food consumption also had an effect on hemoglobin levels. These findings demonstrate the necessity of recognizing and treating iron deficiency early on in life.

Evaluation of Prevalence and Severity of Anemia among Non-pregnant women of Reproductive Age in Garmian Province, Iraqi Kurdistan Region

Anemia is a major significant public health issue that affects both pregnant and non-pregnant women throughout the world. This study aimed to determine the prevalence and severity of anemia, as well as its classification, based on MCV values in non-pregnant women residing in the Garmian province in the east of Iraq. Blood samples were collected from non-pregnant women between the ages of 16 and 49 years. Anemia is classified as mild, moderate and severe, and as microcytic, normocytic and macrocytic depending on the level of Hb or mean corpuscular volume (MCV) respectively. In this study sociodemographic and hematological characteristics were also evaluated. The results showed that 56% of the study samples were anemic, and of the total anemic patients, 54 (35%), 86 (55%) and 16 (10%) had mild, moderate, and severe anemia respectively. Also, of the total anemic patients, 102 (65%) had microcytic type of anemia, 51 (33%) had normocytic anemia and only 3 (2%) had macrocytic anemia. The majority of anemic women (77.6%) had normal RBC counts but low Hct, MCH and MCHC values of 76.3%, 79.5% and 81.4%, respectively. The results showed also that there was no significant difference between the severity of anemia and age groups, occupation, blood pressure, bleeding, and haemorrhoids. However, diabetics showed a significant difference in anemia severity with &lt;0.0004 P-value. The results showed that anemia had become a major public health issue in the study area.

The identification of blood pattern for gastric cancer from routine blood tests in a territory-wide big clinical database.

e13584 Background: Development of non-invasive means for early detection is key to reduce gastric cancer mortality. Artificial intelligence (AI) has to potential to accurately identify gastric malignancy related physiological processes including subclinical bleeding, systemic inflammation and coagulation disorder, through machine learning of pattern of change in routine blood profile panel, which constitute a blood signature for cancer. The pattern of laboratory values of various components in the blood panels between diseased and non-diseased were not systematically reported in the Big Clinical population cohort. Methods: This is a territory-wide healthcare database study using data from Hong Kong Hospital Authority data collaboration laboratory. All patient prescribed with medications for dyspepsia from year of 2004-2009, 2011-2014 were retrieved. Disease status (patients with gastric cancer and no cancer diagnosis) and blood test results (Blood tests within 3 months closest to the date of diagnosis of gastric cancer and any blood tests for negative controls) were retrieved. Blood tests retrieved included CBC, LFT, RFT and clotting function. The laboratory values were normalized according to normal limits. Components with low record counts were excluded. The differences in median values across groups were tested with Mann-Whitney U test. Results: 7,734 patients with gastric cancer diagnosis and 603,484 non-diseased patients were included. The record counts for basophil and eosinophil counts are low and were excluded. In the group of diseased patients, only median of Hb level, RBC count, RDW, hematocrit, albumin, ALT and AST were out of normal range. The pattern for laboratory values in pts with gastric cancer is distinct, which shows lower RBC, hemoglobin, hematocrit, lower MCH, lower MCHC, lower MCV, higher RDW which could suggest occult bleeding; higher platelet, higher neutrophil and lower lymphocyte inclining systemic inflammation; lower protein, albumin and creatinine, inclining impaired nutritional status; shorter APTT and PT inclining clotting disorders; and higher ALT and AST level suggesting liver irritation, which may be related to systemic inflammation and metastases. All of the above differences were statistically significant (p &lt; 0.05, Mann-Whitney U test). Conclusions: This is the first population-based description of the pattern of routine blood test results between patients with and without gastric cancer. Statistical analysis showed that the variations in blood components of subjects with gastric cancer is distinct and separable from the variations of non-diseases patients. The finding opens the opportunity for discovery and identification of a spectral signature for gastric cancer in the Big Clinical population cohort using AI. The classification outcome using Big Clinical Data and AI are reported in companion abstract.

Predictive value of complete hemogram in comparison to serum ferritin in the diagnosis of iron deficiency anaemia among paediatric population with congenital heart defect: A cross- sectional study

: Iron deficiency anaemia (IDA) is often associated with congenital heart defect (CHD) in children, especially in developing world. Often it remains undiagnosed due to the unaffordability to do costly tests like serum ferritin. We have done this study to know whether simple test like complete hemogram is sufficient to diagnose IDA in a child with CHD. This hospital based observational study was done for a period of one and half year in paediatric ward of a district medical college of eastern India in children up to the age of 12 years with echocardiography confirmed CHD. Blood sample were tested for serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin and hemoglobin concentration (MCH,MCHC) and red cell distribution width (RDW) to diagnose IDA.: We found IDA in 46 children out of total 100 CHD cases based on serum ferritin level. Out of 46 IDA children, 40 children (87%) had low MCV, 39 children(84.8%) had low MCH, 33 children (71.7%) had low MCHC, 41 children (89.1%) had high RDW and 37children(80.4%) having microcytic hypochromic picture. In logistic regression analysis we found RDW as the independent predictor of IDA. : IDA is fairly common among children with CHD. Simple blood tests of complete hemogram including MCV, MCH, MCHC and RDW can diagnose it effectively where RDW shows the most predictive value in our study. So in resource limited developing countries we may not depend on costly gold standard tests like serum ferritin to diagnose IDA.

Effect of α+ Thalassemia on the Severity of Plasmodium falciparum Malaria in Different Sickle Cell Genotypes in Indian Adults: A Hospital-Based Study

There is a paucity of literature on the association of α+-thalassemia, sickle-cell hemoglobin disorders, and malaria in India. This study aimed to understand the effect of α+-thalassemia on the severity of Plasmodium falciparum malaria in adults with respect to sickle-cell genotypes. The study subjects were categorized into ‘severe-malaria’ and ‘uncomplicated-malaria’ and age-gender matched ‘control’ groups. Sickle-cell and α+-thalassemia were investigated in all the recruited subjects. The effect of α+-thalassemia on the severity of malaria was analyzed in HbAA and sickle-cell genotypes (HbAS and HbSS) separately. The prevalence of α+-thalassemia in various groups ranged from 41.5% to 81.8%. The prevalence of α+-thalassemia was lower (OR = 1.64; p = 0.0013) in severe malaria (41.5%) as compared to healthy controls (53.8%) with HbAA genotype. In contrast, in HbAS genotype, the prevalence of α+-thalassemia was higher (OR = 4.11; p = 0.0002) in severe malaria (81.8%) compared to controls (52.2%). In severe malaria with HbAA genotype, there was a significantly higher hemoglobin level and low MCV and MCH level in patients with α+-thalassemia compared to the normal α-globin genotype. Further, the incidence of cerebral malaria, hepatopathy, and mortality was lower in patients (HbAA) with α+-thalassemia as compared to normal α-globin genotype (HbAA). In severe malaria with either HbAS or HbSS genotype, only a few parameters showed statistical differences with respect to α+-thalassemia. Low prevalence of α+-thalassemia in severe malaria with HbAA genotype compared to healthy controls with HbAA genotype indicates the protective effect of α+-thalassemia against severe malaria. However, the high prevalence of α+-thalassemia in patients with HbAS genotype depicts its interference in the protective effect of sickle-cell against severe malaria.

Hematological profile of children under five years with typhoid fever at Idaman Banjarbaru Hospital, Indonesia

Introduction: Typhoid fever is a disease caused by Salmonella typhi, Salmonella paratyphi A, B, C. An estimated 200,000 people die each year from about 21.6 million people infected with typhoid fever. This study aims to determine the hematological profile in typhoid fever cases in children under five at Idaman Banjarbaru Hospital. Methods: The research was carried out with a retrospective descriptive approach with a consecutive sampling technique. The research subjects were children under five diagnosed with typhoid fever recorded in the Idaman Banjarbaru Hospital's medical records for July 2018 to January 2019. Results: The sample consisted of 58 patients, 32 boys, and 26 girls. Most patients were found in 12 - &lt;36 months, namely 28 (48.28%) children. Thirty-eight (65.52%) children have a normal weight. The hematological profile showed that 46.55% of the patients had iron deficiency anemia (IDA). Hematocrit levels decreased in 51.72% of patients. Erythrocyte levels in 86.21% of patients were normal. Low MCV, low MCH, IDA were found in 46.55%, 36.21%, 46.55% of patients. Leukopenia was present in 17.24% of children. All patients had normal basophil values. Eosinopenia, band neutropenia, segmented neutropenia, lymphocytosis, monocytosis were found in 69.09%, 90.90%, 56.37%, 58.18%, 58.18% of children, respectively. Thrombocytopenia and thrombocytosis were found in the same percentage, 13.80%. Conclusion: The haematological profile of typhoid fever patients in children under five can have different results depending on each child's body's response to S. typhi and S. paratyphi that enter the body.

Concordance Test of Various Erythrocyte Indices for Screening of Beta Thalassemia Carrier

Carrier screening for early detection of thalassemia in the general population needs a careful approach, especially in areas with limited health services. Various erythrocyte indices have been introduced as options for the first stage; however, the low-reliability value of these erythrocyte indices remains the problem. This study aimed to determine the most reliable index for screening beta-thalassemia carriers and distinguish it from iron deficiency anemia. A cross-sectional study was designed to explore thalassemia carrier status among medical students. Inter-rater reliability value of various indices was compared to Shine and Lal index. The Cohen's Kappa coefficient was calculated using SPSS v. 25.0. Among 320 respondents, 295 subjects were non-anemic and 25 were anemic subjects, whereas 105 subjects had low MCV and/or MCH values. Cohen's Kappa value showed moderate reliability results compared to Shine and Lal index for example Mentzer index (0.58), Ehsani index (0.57), Srivastava index (0.53), and Bordbar index (0.41), but showed very low-reliability results with Green and King index (0.04). New cut-off indices based on Kumar et al. were also compared, resulting in moderate reliability results. Since there was no Hb-electrophoresis test, the sensitivities and specificities of those indices could not be calculated. For this reason, a complete blood count can only be used for the early stages of screening for beta-thalassemia carriers, whereas Hb-electrophoresis and DNA tests were considered necessary to perform to confirm a diagnosis.

PREVALENCE OF NUTRITIONAL ANEMIA IN MUMBAI, 3- YEAR STUDY DONE IN INDIAN REFERENCE LABORATORY

Introduction: - Anemia is major health problem which affects children, women of reproductive age groups to a signicant extent. This study was done to study prevalence of anemia in Mumbai across different age groups. Aims And Objectives: - To study prevalence of nutritional anemia in Mumbai with respect to age group &amp; gender To compare prevalence of vitamin B12 deciency anemia with iron deciency anemia To establish correlation between RBC indices with serum Iron &amp; Serum B12 levels Method: - We did a retrospective analysis of serum iron prole, CBC, Vitamin B12, Folic acid data obtained in referral laboratory in Mumbai over a span of 3 years (2019-2021). Population studied belonged to Mumbai metropolitan region. CBC was analyzed on DXH Coulter. Serum Iron, serum ferritin, TIBC, Vitamin B12 &amp;serum folic acid were analyzed on Cobas analyzers. We compared &amp; correlated results according to gender &amp; age Results: - Prevalence of low serum Iron &amp; serum ferritin was seen in females as compared to males (P&lt; 0.001). However low levels of vitamin B12 was signicantly seen in males as compared to females (P&lt;0.001). Low serum iron, Ferritin, MCH, MCV and high TIBC were signicantly associated with low Hemoglobin (P&lt;0.001)

STUDY OF ANAEMIA & IRON PROFILE IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS ON MAINTENANCE DIALYSIS AND ITS CORRELATION WITH DIABETES MELLITUS

Most patients with chronic kidney disease (CKD) have anaemia, the cause of which is erythropoietin and iron deciency. Anaemia in patients on haemodialysis is associated with poor patient outcomes. Diabetes remains one of the predominant aetiologies of CKD all over the world. The study was undertaken to study the iron prole in haemodialyzed patients and its corelation with diabetes mellitus. Sixty-six patients were enrolled in the study with the aim to study the prevalence of anaemia and diabetes in haemodialyzed patients as well as the iron prole in these patients. Patients were studied as a single group as well as divided into two groups, a non-diabetic group comprising of 36 patients and a diabetic group comprising of 30 patients. Anaemia was found to be prevalent in 56(84.84%) patients out of which 28(50%) were diabetics. Also, diabetics comprised of 45.45% of the study group. Various parameters like haemoglobin with blood indices and iron prole was studied and compared in both groups. There was no signicant difference in the various parameters in both groups except a signicantly low MCH and MCHC and signicantly high ferritin levels in the diabetic group. We concluded that the low MCH and MCHC might be suggestive of an increased cardiovascular risk in diabetic patients while higher levels of serum ferritin may suggest sub-clinical inammation rather than iron overload. In conclusion diabetes remains to be the single most important aetiology for the causation of end stage renal disease and appropriate management of anaemia in terms of EPO and iron therapy remains the mainstay of therapy in haemodialyzed patients.

Antidiabetic, hypolipidemic, antioxidant and anti-inflammatory effects of Momordica charantia L. foliage extract

Context: Momordica charantia (Cucurbitaceae) is extensively distributed in tropical areas, and it is traditionally used as antidiabetic. Nevertheless, few studies supporting the metabolic effects of its foliage extracts have been reported elsewhere. Aims: To evaluate the effects of M. charantia foliage extract (MCh) on blood glucose and lipids levels in animal models of hyperglycemia. The anti-inflammatory and antioxidant properties together with the acute toxicity and genotoxic effects were also assessed. Methods: An MCh powder was obtained by spray-drying techniques. The anti-hyperglycemic and hypolipidemic effects of MCh were evaluated in the glucose tolerance test and the alloxan-induced diabetes, respectively. The in vitro and ex vivo MCh antioxidant effects were assessed against the 2,2´-azinobis3-ethylbenzothiazoline-6-sulfonic acid (ABTS), peroxyl, and superoxide anion radicals. The MCh anti-inflammatory effects were also assessed together with its toxicological profile by means of the Acute Toxic Class Method, and the chromosome aberration assay. Results: MCh administered orally diminished the glucose and lipids levels in normoglycemic healthy rats and alloxan-induced hyperglycemic mice. Strong in vitro free radical scavenging effects was demonstrated by MCh against ABTS, peroxyl, and superoxide anion radicals. The extract also improved the free radical scavenging ability of diabetic mice serum. Moreover, MCh reduced the weight of cotton-induced granulomas in mice, the exudate volume, and its leukocyte counts in carrageenan-induced pleurisy in rats. Very low MCh toxicity was also verified. Conclusions: The hypoglycemic, hypolipidemic, anti-inflammatory, and antioxidant activities here observed make the spray-drayed powder from M. charantia foliage extract an interesting alternative for the correction of diabetes and its complications.

Quantifying the Pathophysiology of Beta-Thalassemia Using a Novel in-Silico Model of Red Blood Cell Production and Lifespan

Background: From a qualitative perspective the pathophysiology of beta-thalassemia (BT) is generally well understood. Reduction in hemoglobin (Hb) beta-chain synthesis relative to the normal rate of alpha-chain synthesis causes a free alpha-chain excess (ACE) that is toxic to the RBC and its precursors. Circulating RBCs are hemolyzed in the spleen, shortening their lifespan from the normal value of 120 days. RBC precursors in the bone marrow undergo early apoptosis leading to reduced RBC production relative to other anemic states (so called “ineffective erythropoiesis”). Together with low MCH levels these mechanisms lead to Hb levels ranging from 10 - 12 g/dL in BT trait, 7 - 10 g/dL in non-transfusion dependent (NTD) BT, below 7 g/dL in transfusion-dependent (TD) BT at baseline and above 9 - 10.5 g/dL in TD patients receiving regular transfusions administered every 2 to 5 weeks. To quantify the mechanisms responsible for the different BT phenotypes and the response to transfusion in TD patients, we have developed an in-silico model of RBC production and lifespan.Methods: The theoretical amount of ACE per cell was estimated by assuming that the alpha-chain level corresponds to an MCH of 30 pg and the non-alpha chain level (beta, gamma and delta chains) corresponds to the MCH of the BT phenotype, which varies from ~12 to 20 pg in TD BT to ~16 to 23 pg in NTD BT and ~18 to 24 pg in BT trait. The in-silico model consists of a bone marrow module - representing the production and aging of reticulocytes, Hb synthesis and entry to the bloodstream (equivalent to the RBC production rate, PRBC); a circulation module - representing the total blood volume (TBV), conversion of reticulocytes to mature RBCs, attainment of the final MCH, normal aging of RBCs, and a hemolytic process in BT (with rate constant kH that depends on the ACE level); and a transfusion module - representing the volume of transfused blood (VTF) with hematocrit H, a normal RBC age-distribution, and a separate hemolytic process (with rate constant kH_Tf). Reticulocyte lifespans in the bone marrow and circulation were set to ~3 days and ~1 day, respectively, but can vary oppositely at high PRBC (stress erythropoiesis). A key assumption of the model is that PRBC is down-regulated by the Hb level according to a sigmoidal Hill function, which was calibrated using PRBC data from normal subjects and patients with sickle cell disease, and was assumed to have a maximum value 10-fold the normal PRBC rate. In BT the PRBC function is also modulated by a factor FBT, dependent on the ACE level. Additional data from BT patients were used to derive the kH and FBT values. The model was expressed in ordinary differential equations using the Berkeley Madonna platform (Version 8.3.18).Results: To simulate the spectrum of BT phenotypes, MCH levels were varied from 15 pg to the normal value of 30 pg and the ACE levels, kH and FBT values were computed from the model. The simulated steady-state dependences of Hb vs. MCH (Figure 1A) and Reticulocyte count vs. Hb level (Figure 1B) are in good agreement with published literature data. For virtual patients (VPs) with MCH levels of 23, 21 and 18 pg, typical of BT trait, NTD and TD phenotypes, respectively, the estimated ACE levels were 0.22, 0.28 and 0.38 fmole/cell; kH values were 0.01, 0.019 and 0.037 day-1 and values of FBT were 0.65, 0.6 and 0.55. The effective RBC lifespans for these VPs were 68, 47 and 23 days, respectively. Regular transfusions (VTF = 15 mL/kg; H = 0.6) were simulated over 24 weeks for a TD VP (MCH = 18 pg; baseline Hb = 6.61 g/dL) to maintain the Hb level above 9 g/dL. In Figure 2A, where kH_Tf = 0 (no hemolysis of transfused blood), the transfusion interval stabilizes at 3.71 weeks. In Figure 2B, where kH_Tf = 0.0165 day-1(an effective RBC lifespan of 50.7 days), the transfusion interval stabilizes at 2 weeks. Reticulocyte counts decrease markedly in both cases. To achieve a ~3 g/dL increment in the Hb level, TBV must equal 100 mL/kg (~40% greater than normal).Conclusions: Our in-silico model explains the phenotypic variation of Hb levels and reticulocyte counts in BT in terms of the effects of ACE on the hemolysis rate constant (kH) and the fractional reduction in RBC production (FBT). The 2-week transfusion interval required in some patients to maintain Hb above 9 g/dL is explained by a shortened lifespan of the transfused blood. More clinical data would be helpful to confirm and refine these observations to better understand the key drivers of disease pathology in BT. [Display omitted] DisclosuresMazer:Roche: Employment, Equity Ownership. Hermosilla:Roche: Employment. Koerner:Roche: Employment.

Studi Indeks Eritrosit Pada Pasien Diagnosis Positif Malaria

Malaria is a contagious disease caused by parasites (protozoa) of the genus Plasmodium, which can be transmitted through the bite of a female Anopheles mosquito. There are 4 species of Plasmodium that cause malaria in humans, namely Plasmodium Vivax, Plasmodium Falciparum, Plasmodium Malariae and Plasmodium Ovale. Malaria is an infectious disease that is found in many tropical and sub-tropical countries. This study aims to determine the description of the erythrocyte index in patients diagnosed with malaria positive at the Kotaratu Public Health Center, Ende Utara District. Erythrocyte index examination functions in determining the type of anemia. This research method is laboratory observation with a descriptive approach. The research sample was 20 patients with positive diagnosis of malaria in Kotaratu Public Health Center, Ende Utara District. The results of this study were 20 samples, for normal MCV values 10 samples (50%), 10 samples (50%) less than normal and 0 samples (0%) more than normal. The MCH value was less than normal for 7 samples (35%), 13 samples (65%) normal and 100% normal MCHC value. The conclusion is that in malaria parasite infection there is a low MCV is 50% and 50% normal, low MCH is 35%, and normal is 65, while normal MCHC is 100%. Keywords: Erythrocyte Index (MCV, MCH, MCHC), Malaria

Reconciling markedly discordant values of serum ferritin versus reticulocyte hemoglobin content.

To determine why serum ferritin and reticulocyte hemoglobin (RET-He), drawn to assess neonatal iron sufficiency, sometimes have markedly discordant results. Retrospective records review of five NICUs over 28 months, identifying all patients with a ferritin and RET-He within 48 h. We examined records of all who had marked discordance (one value >95th % reference interval, the other <5th %). Of 190 paired ferritin and RET-He measurements, 16 (8%) were markedly discordant. Fifteen of the 16 discordant samples involved a high ferritin and a low RET-He. In these, low MCV and high %Micro-R, and low MCH and high %HYPO-He were present. In total, 8 of the 15 had laboratory or clinical evidence of an inflammatory process and five had suspicion of infection documented. When ferritin and RET-He were discordant, erythrocyte microcytosis and hypochromasia suggested that the RET-He gave the more accurate interpretation; that iron deficiency was likely present.

Non-anaemic iron deficiency should be investigated with the same priority as iron deficiency anaemia in fast track colorectal clinics-retrospective cohort study.

Since year 2000 the diagnostic criterion for fast track (FT) referrals for patients with suspected colorectal cancer (CRC) is used in the UK. Iron deficiency anaemia (IDA) is one of the diagnostic criteria. There is a strong evidence in the literature which suggests that Iron deficiency (ID) alone has a strong relationship with CRC. Non-anaemic Iron deficiency (NAID) and all other types of anaemia are investigated outside the scope of FT clinics. We postulated that patients with ID regardless of degree of anaemia have an increased risk of CRC. By confirming this hypothesis, we can broaden the scope of the diagnostic criterion for referral that can help to increase diagnostic yield of FT CRC services. A retrospective observational cohort study was conducted from a dedicated data for FT clinics from 2016-2018. Association between CRC and different forms of anaemia, Iron deficiency alone and bowel symptoms was determined. Patients with iron deficiency (low MCV, MCH and ferritin) regardless of degree of anaemia were found more likely to have CRC. Factors like age, gender, family history and bowel symptoms (except abdominal mass) showed a very weak association with CRC in patients with ID. ID without anaemia has a strong relationship with CRC and should be investigated with the same priority as IDA is investigated.

P1163IMPACTS OF IRON-BASED PHOSPHATE BINDER ON ANEMIA AND IRON METABOLISM IN PERITONEAL DIALYSIS PATIENTS: A CROSS-SECTIONAL, LONGITUDINAL MULTICENTER STUDY IN KANAGAWA, JAPAN

Abstract Background and Aims Iron-based phosphate binder (IPB) is a noncalcium phosphate binder that demonstrated sustained serum phosphorus control, good tolerability and lower pill burden compared with sevelamer carbonate in a Phase 3 study conducted in dialysis patients. These efficacy of IPB has been demonstrated for hemodialysis (HD) patients, but few studies have focused on patients undergoing peritoneal dialysis (PD). We evaluated efficacy of IPB and focused on effects for anemia and iron metabolism in patients on PD. Method This study was a cross-sectional, longitudinal multicenter study conducted by PD OASIS, organized committee in Kanagawa Japan. We analyzed the effects of IPB during a 6 months observation period in chronic kidney disease patients on PD who had administrated IPB, Ferric citrate hydrate and Sucroferric oxyhydroxide, between 2017 and 2019. The primary endpoint was the changes of phosphate, and several secondary endpoints were assessed: calcium, intact PTH, RBC, hemoglobin, MCH, RDW-VC, Fe, TSAT, Ferritin, albumin, CRP, monthly dosage of Erythropoietin stimulating agents (ESA) and ESA resistance index (ERI). In addition, we assessed the association between these markers and iron metabolism utilizing multivariate logistic regression analysis. Results A total of 102 patients were registered in the study who had received IPB. The initial doses of Ferric citrate hydrate and Sucroferric oxyhydroxide were 1010.9 ±400.9 mg and 941.7 ±502.9 mg daily, finally increased to 1213.6 ±559.9 mg and 1310.0 ±521.8 mg respectively at the end of the observation. We observed a significant reduction of serum phosphate to 5.27 ± 0.98 mg/dL from 6.56 ± 1.52 mg/dL with follow-up of six months (p &amp;lt; 0.01). At the end of the study, 76.4% of participants had achieved the target of less than 6 mg/dL. The hemoglobin, TSAT and Ferritin increased significantly from 10.47 ±1.26 g/dl, 27.95 ±11.05 % and 139.0 ±147.6 ng/mL to 11.17 ±1.16 g/dl, 40.46 ±15.00 % and 305.9 ±232.0 ng/mL respectively in six months (p &amp;lt; 0.01). No significant changes of serum calcium, intact parathyroid hormone (PTH) and CRP occurred over the study period. The monthly dosage of ESA was significantly decreased after administration with IPB and ERI significantly improved to 0.11±0.12 (μg/month/kg/g Hb) from 0.21±0.16 (μg/month/kg/g Hb) (p&amp;lt;0.01). Hemoglobin overshoot, an increase of more than 12 g/dl, was observed in 27.5% patients. This related low MCH and high RDW-VC at baseline which was proven by multivariate logistic regression. Additionally, we assessed the factors of ferritin increase because it was remarkable in follow-up six months compared to HD patients. In multivariate analysis, phosphate (Odds ratio 5.85, 95%CI 1.18-91.77, p=0.027), intact PTH (0.99, 0.97-1.15, p=0.015), hemoglobin (Odds ratio 0.10, 95%CI 0.05-0.59, p=0.025), RBC (Odds ratio 1.16, 95%CI 1.04-1.41, p=0.003), and RDW-CV (Odds ratio 0.44, 95%CI 0.10-0.99, p=0.046) were significantly associated with ferritin increase more than 300 ng/ml ,after adjusted. Conclusion This study confirmed the efficacy of Iron-based phosphate binder, Ferric citrate hydrate and Sucroferric oxyhydroxide, in the treatment of hyperphosphatemia in PD patients. In addition, IBP caused secondary effects of anemia improvement and ESA dosage reduction resulting in ERI improvement. However, in this study, the increase in ferritin levels was remarkable. It may be because PD does not lose iron by treatment compared to HD. Therefore, we should check iron metabolism more frequently for PD patients taking IPB than HD patients. It is necessary to further investigate the effects of IPB on anemia and iron metabolism in PD patients.

Kualitas diet, kurang energi kronis (KEK), dan anemia pada pengantin wanita di Kabupaten Semarang

Introduction: Pre-conception women are potential mothers or vulnerable groups who need special attention. The less of nutrients Intake than necessary can lead to nutritional problems such as Chronic Energy Deficiencyand nutritional anemia that have an impact on the next phase of life such as the risk of giving birth to babies with low birth weight (LBW), babies stunting, and growth disruption and development of the fetus / baby during pregnancy or after that. Objective: To analyze the relationship between diet quality, chronic energy malnutrition status with anemia in the bride.Methods: A cross-sectional study with 70 subjects who were brides aged 16-30 years. Selection of subjects with consecutive sampling method. Dietary quality data was measured through the Semi Quantitative Food Frequency Questionnaire (SQ-FFQ) and Diet Quality Index - International (DQI-I) forms, SEZ status assessed from body mass index (BMI) and upper arm circumference (LiLA). Anemia status was measured from hemoglobin levels, MCV, MCH, and MCHC. To examine the relationship between diet quality, chronic energy malnutrition, and anemia using a linear regression test.Results: The subject aged 16-30 years, and 41.4% are still &lt;20 years old. A total of 10 subjects (14.3%) belonged to Chronic Energy Deficiency. Haemoglobin level measurements showed there were 8 subjects (11.4%) who had low Hb levels, and 4 of them had anemia with microcytic hypychromic type which was characterized by low MCV, MCH and MCHC values. Based on the calculation of intake was known that 55 subjects (78.6%) had a low quality diet. This study showed no relationship between diet quality and anemia, but the sub-components of diet quality were adequacy of protein intake (p = 0.007), iron intake (p = 0.009) and upper arm circumference (p = 0.018) indicating a significant relationship with anemia (hemoglobin level) in the bride. Conclusion: the less protein and iron intake and lower upper arm circumference associated with a decrease in the bride's hemoglobin level