Low Mean Cell Volume Research Articles

Hematological Characteristics of a Sample of Iraqi Patients with Sickle Cell Anemia and Their Correlation with Age and Gender

Background: Characterization of hematological parameters in patients with sickle cell anemia can direct treatment goals toward strategies reducing morbidity and mortality rate.Objective: To evaluate the hematological parameters in a subset of Iraqi patients with sickle cell anemia in relation to age and gender. Patients and Methods: This cross-sectional study was included 30 patients with sickle cell anemia who were known to be at a steady clinical state with no vaso-occlusive crises. About 5 ml of venous blood was collected in EDTA tube from each participant. The complete blood count was conducted according to standard protocol. Results: The mean age was 7.93 ±2.43 years and the age range was 4 to 12 years. The study included 17 males and 13 females. 29 (96.7 %) were anemic and there was no significant difference in mean hemoglobin levels between males and females (p = 0.838). Males demonstrated higher frequency of low mean cell volume (MCV) and mean cell hemoglobin (MCH) (64.7% and 58.8%, respectively) than females (7.7% and 7.7%, respectively) with highly significant differences. Conclusion: Some hematological parameters in patients with sickle disease are affected by gender but show no significant correlation to age. Keywords: Hematological characteristics, Sickle cell anemia, Iraq

Increased Mean Cell Hemoglobin Concentration.

A 44-year-old man with a history of Grave disease presented with tachycardia, weight loss, and dysphagia. He was diagnosed with severe hyperthyroidism, diabetic ketoacidosis, and hyponatremia (Table 1). A complete blood count was performed and the hemoglobin, mean cell hemoglobin (MCH), and MCH concentration (MCHC) were flagged for review due to MCHC >37.5 g/dL. Smear review was normal, and the sample was prewarmed at 37°C with similar results. ... What are potential causes of an increased MCHC? Why does a markedly increased MCHC result serve as a flag for automated hematology analyzers? What is the most likely cause of the increased MCHC in this patient? The answers are below. Causes of high MCHC include red blood cell agglutination, hemolysis, lipemia, icterus, leukocytosis, spherocytosis, and electrolyte abnormalities (1). The high MCHC flag serves to detect interference in hemoglobin, hematocrit, mean cell volume, MCH, and MCHC. Hyponatremia can cause an artificially high MCHC and this was suspected in this patient. Hyponatremia can cause in vitro shrinking of the red blood cells due to osmolality differences between patient plasma and reagent diluent, leading to a falsely low hematocrit, low mean cell volume, and high MCHC (2–4).

Background: Iron Deficiency Anemia (IDA) and beta-thalassemia trait (β-TT) are the two most prevalent causes of microcytic hypochromic anemia. The current study aimed to assess the accuracy of the various indices to distinguish these two conditions. Material & Methods: A total of 40 patients were studied retrospectively by calculating six discrimination indices. The patients were assessed according to the Mentzer,

Background Iron Deficiency Anemia IDA and beta-thalassemia trait beta-TT are the two most prevalent causes of microcytic hypochromic anemia. The current study aimed to assess the accuracy of the various indices to distinguish these two conditions.Material amp Methods A total of 40 patients were studied retrospectively by calculating six discrimination indices. The patients were assessed according to the Mentzer Shine amp Lal England amp Fraser Green amp King Red Cell Distribution Width Index RDWI and Srivastava indices. The study included 19 beta-TT cases based on low Hb and mean cell volume MCV levels normal serum iron and raised levels of HbA2 gt3.5 and 21 IDA cases with low hemoglobin low serum iron low ferritin high total iron-binding capacity and normal electrophoresis. The accurately diagnosed cases were identified and their sensitivity specificity positive and negative predictive value and Youdenrsquos index of the indices were calculated.Results None of the indices showed a sensitivity and specificity of 100. The percentage correctly diagnosed was highest for RDWI 97.5 followed by Green and King 95. Youdenrsquos index was also highest for RDWI 95 followed by Green and King 90 and Mentzer 84.7.Conclusion RDWI Green amp King and Mentzer are readily available and the most stable indices in differentiating between IDA and beta-TT.

High Risk Janus Kinase 2 V617F Allele Burden in a Seven-Year Cohort of Patients with Myeloproliferative Neoplasms.

JAK2 V617F is the most common somatic mutation associated with the classical Philadelphia (Ph) chromosome negative myeloproliferative neoplasms (MPNs), which include essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). JAK2 V617F allele burden may be used for establishing the diagnosis, determining prognosis, and monitoring progression in these diseases. Limited data is available regarding the epidemiology of MPNs in Africa, and there is paucity of data on demographic, laboratory, and clinical features of MPNs in South Africa. This study determined the JAK2 V617F allele burden in a seven-year retrospective cohort of patients diagnosed with MPNs and described the characteristics of these diseases in a South African setting. A laboratory database search was performed to identify patients diagnosed with ET, PV or PMF and a positive JAK2 V617F mutation, diagnosed qualitatively on Fluorescence Resonance Energy Transfer (FRET) real-time PCR and melting curve analysis. The allele burden for these patients was measured on archived residual DNA samples using a quantitative allele specific amplification (QUASA) assay. Demographic data and relevant laboratory results at presentation were analyzed. The search identified 87 patients who tested positive for JAK2 V617F mutation and fulfilled the diagnostic criteria for ET, PV or PMF from 2012 to 2018. Median age at diagnosis was 64 years with a male: female ratio of 1.2:1. ET, PV and PMF accounted for 11.5%, 44.8%, and 43.7% of the MPNs, respectively. Median allele burden for ET, PV, and PMF was 24.9%, 71.1%, and 55.8%, respectively. Allele burden was significantly lower in ET compared to PV (p = 0.0003) and PMF (p = 0.0023) and correlated with leukocytosis, neutrophilia, eosinophilia, and low erythrocyte mean cell volume (p < 0.05). JAK2 V617F-positive MPNs occurred predominantly in older patients with approximately equal gender ratio. ET was the least common MPN and there was a higher proportion of PMF cases than described in studies in Europe and America. Allele burden was also relatively high for all three subtypes of MPNs when compared to other published data, which may predispose to poorer prognosis.

Prevalence of Anemia Among Jazan University Students.

PurposeAnemia is one of the most common disorders affecting the population in both low-income and developing countries. This study aimed to determine the prevalence of anemia and iron deficiency in apparently normal male and female students of Jazan University, Saudi Arabia.Material and MethodsThis cross-sectional study was conducted at the Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia. One hundred thirty-four (85 males and 49 females) healthy students with no outward signs of illness were recruited. A specific questionnaire related to sociodemographic and health characteristics was designed and validated. The collected samples were analyzed for complete blood count, serum iron, and serum ferritin.ResultsIn the male group, 81 participants (95.3%) were nonanemic with normal hemoglobin (14.99 ± 1.11g/dl), whereas only 4 males were anemic (hemoglobin <13.0 g/dl). On the other hand, anemia was more prevalent in female students, as 67.35% had hemoglobin values less than 12.0 g/dl. In addition, 26.54% of the anemic females had low serum iron and serum ferritin, indicating iron-deficiency anemia. Although the majority of male participants had normal hemoglobin levels, 37.6% of them had low mean cell volume (MCV), low mean cell hemoglobin (MCH), low mean cell hemoglobin concentration (MCHC), and high red blood cell (RBC) counts, suggesting thalassemia.ConclusionAnemia, in particular iron-deficiency anemia, was found to be highly prevalent in females, whereas more than one-third of the male participants might be carriers of alpha or beta thalassemia. Additionally, low dietary iron intake and irregular meal consumption could be two of the possible causes of anemia in the study population. Conducting this study on a large scale of male and female students from different faculties of Jazan University will provide in-depth details about the prevalence and types of anemia among them.

185: Recurrent Hemoglobin H hydrops Caused by a Compound Heterozygosity of HBA2: c.* 93_* 94delAA and ɑ0- thalassemia (-- SEA)

We report Hb H hydrops fetalis resulting from non-deletional ɑ-thalassemia mutations, a polyadenylation (polyA) mutation (AATAAA → AATA--) of the ɑ2 globin gene (HBA2: c.*93_*94delAA), and ɑ0-thalassemia (--SEA) in 2 subsequent pregnancies from a Thai family living in Nakhon Pathom. Case Report In the first pregnancy, a 20 years old woman, GA 28+4 weeks, was referred to our hospital due to fetal cardiomegaly, marked anemia and pericardial effusion. She was ɑ0-thalassemia carrier (--SEA/ɑɑ), but her husband who had low mean cell volume (MCV) of 74 fL was negative for common ɑ-thalassemia mutation test. Therefore, they were not identified as a couple at risk for Hb Bart’s hydrops fetalis (--/--). Intrauterine transfusion (IUT), Hb typing, and complete ɑ-globin gene analysis were performed. The results showed that this fetus carried this rare ɑ globin genotype (--SEA/ɑPAɑ). The baby boy was born at 34+6 weeks, and subsequently died at 2 days of life owing to severe hydropic features and multiple organ failure. In the second pregnancy, the mother was detected with fetal cardiomegaly, pericardial effusion and marked fetal anemia at 30+1 weeks. We performed a fetal blood sampling and demonstrated a high level of Hb Bart (70.6%) and confirmed the same ɑ globin genotype again. Due to the grave prognosis of this genetic interaction, the couple decided for a termination of pregnancy rather than IUT, and our postmortem study revealed a full-blown hydrops fetalis in this female stillborn baby. Although recent publications have revealed a variety of clinical severity associated with this polyA mutation, varying from mild non-transfusion dependent to transfusion dependent, to the best of our knowledge, this is for the first time that this polyA mutation is associated with Hb H hydrops. Our probands were far more severe than those reported earlier even though they all had identical genotype, suggesting that there would be additional genetic and/or epigenetic determinants that might supersede or further deteriorating the clinical severity leading to hydropic development.

JAK2V617F Variant Allele Frequency Identifies Patients with Polycythemia Vera (PV) at High Risk for Venous Thrombosis

Background. Cardiovascular (CV) events are leading cause of morbidity and mortality in PV. Current risk stratification is based on variables predicting thrombotic risk, ie age >60y and history of thrombosis. Recent studies focused on additional thrombotic risk factors in PV, including generic CV factors and leukocytosis. PV patients (pts) are JAK2V617F mutated, and present wide heterogeneity in variant allele frequency (VAF); it was shown that a VAF >75% was associated with higher number of thrombotic events after diagnosis (Vannucchi AM, Leukemia 2007), but the prognostic role of JAK2 VAF is still debated.Aim. The aim of the study was to evaluate the impact of JAK2V617F VAF on rate of thrombosis in WHO-2016 defined PV pts.Patients and Method. In the CRIMM (Florence) database, a total of 577 pts with a JAK2VF VAF determined within 3 years from diagnosis, who met the 2016 WHO criteria for PV, were identified. All pts had information regarding thromboembolic events, including history of thrombosis, occurrence, type and date of thrombosis in the follow-up (FU) and presence of CV risk factors (smoking, hypertension, and diabetes mellitus). Thrombosis‐free survival (TFS) was determined from the time of diagnosis to the time the first thrombotic event occurred. Pts in whom thrombosis did not occur were censored at the time of last FU. Pre-receiver operating characteristic (ROC) plots were used to determine cutoff levels for continuous variables of interest. Differences in the distribution of continuous variables between categories were analyzed by Mann-Whitney or Kruskal-Wallis test. Pts' groups with nominal variables were compared by χ2 test. TFS was estimated by Kaplan Meier analysis; log rank test was used to compare TFS difference between groups. Cox proportional hazards regression was used for multivariable analysis. A two tailed P ≤ 0.05 was considered statistically significant.Results. The median age of pts at diagnosis was 61y, 308 (53.4%) were above 60y; 57.2% were males. All pts were mutated for JAK2V617F with a median VAF 43% (range 1-100%), 62% had at least one CV risk factor; 83 (14.4%) pts suffered from an episode of thrombosis within 3 yr from, or coincident with, diagnosis. The median FU was 7.3y (0.6-35.9y) during which 87 pts (15.1%) developed thrombosis. (50 arterial and 45 venous thrombosis). During the FU, 110 pts (19.1%) died.A JAK2VAF of ≥60% cutoff level, as determined by ROC analysis, correlated with measurements of stimulated erythropoiesis (higher hematocrit, lower mean cell volume and serum ferritin; all P<.01), leukocytosis (P<.0001), lower platelets count (P=.02) and elevated serum lactate dehydrogenase (LDH) (P<.03). Pts with ≥60% JAK2V617F VAF were at higher relative risk (RR) of having splenomegaly (RR 3.1; P<0.001), suffering from pruritus (RR 2.5; P<0.001) or constitutional symptoms (RR 1.9; P=0.01), harboring a BM fibrosis grade-1 (RR 3.1; P<0.001). Additionally, pts with a VAF>60% had greater risk to progress to PPV-MF (RR 8.5, P<.0001) and acute leukemia (RR 4.4, P=0.04) or to die (RR 3.8, P<0.0001). The JAK2VF VAF (continuous or ≥60%) did not correlate with occurrence of thrombosis at diagnosis, while the rate of thrombosis during FU was significantly increased in pts with VAF ≥60% (23.4% vs 11.0%, RR 2.4, 95%CI = 1.4-4.0; P<0.0001), more marked for venous (RR 3.7, 95%CI = 2.0-6.8; P<0.0001) than arterial (RR 1.8, 95%CI = 0.9-3.3; P=0.05) thrombosis. The impact of VAF on thrombosis during FU was then estimated according to the conventional risk category. In low risk pts (LR) (n=236), factors significantly associated with occurrence of FU thrombosis were CV risk factors (dyslipidemia (RR 3.3, P = 0.02) and hypertension (RR 1.8, P=0.048)), a G1 BM fibrosis (RR 5.3, P=0.006), presence of splenomegaly (RR, 3.2, P=0.001) or constitutional symptoms (RR 3.3, P=0.003) and a VAF ≥60% (RR 2.2, P = 0.024). In high risk pts (HR) (n=341), factors significant for FU thrombosis were splenomegaly (RR 2.0, P=0.03), elevated LDH (RR 4.0, P=0.009) and a VAF ≥60% (RR 2.3, P = 0.012). A VAF ≥60% was correlated with shortened venous TFS after diagnosis in HR (P = 0.01, HR = 3.2, 95%CI = 1.2−8.3; fig.) but not in LR pts (P = 0.20, HR = 1.1, 95%CI = 0.5−2.9).Conclusions. This study indicates that conventionally-defined high-risk PV pts with a JAK2V617F VAF ≥60% suffer from increased rate of venous events and might be worthwhile of more intensive antithrombotic prophylaxis. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Clinical features of bowel disease in patients aged

BackgroundIncidences of colorectal cancer (CRC) and inflammatory bowel disease (IBD) are increasing in those aged <50 years.AimTo identify and quantify clinical features in primary care of CRC/IBD in those aged <50 years. This study considered the two conditions together and aimed to determine which younger patients, presenting in primary care with symptoms, would benefit from investigation for potentially serious colorectal disease.Design and settingMatched case-control study using primary care records from the Clinical Practice Research Datalink, UK.MethodIncident cases (aged <50 years) of CRC (n = 1661) and IBD (n = 9578) diagnosed between 2000 and 2013 were each matched with up to three controls (n = 3979 CRC; n = 22 947 IBD). Odds ratios (OR) and positive predictive values (PPV) were estimated for features of CRC/IBD in the year before diagnosis.ResultsTen features were independently associated with CRC/IBD (all P<0.001): rectal bleeding, change in bowel habit, diarrhoea, raised inflammatory markers, thrombocytosis, abdominal pain, low mean cell volume (MCV), low haemoglobin, raised white cell count, and raised hepatic enzymes. PPVs were >3% for rectal bleeding with diarrhoea, thrombocytosis, low MCV, low haemoglobin or raised inflammatory markers; for change in bowel habit with low MCV, thrombocytosis or low haemoglobin; and for diarrhoea with thrombocytosis.ConclusionThis study quantified the risk of serious bowel disease in symptomatic patients aged <50 years in primary care. Rectal bleeding and change in bowel habit are strongly predictive of CRC/IBD when combined with abnormal haematology. The present findings help prioritise patients for colonoscopy where the diagnosis is not immediately apparent.

Haematological Profile and Intensity of Urogenital Schistosomiasis in Ghanaian Children.

Background Urogenital schistosomiasis is a widely contracted parasitic helminth infection often associated with haematological abnormalities. Aim We investigated the relationship between the haematological profile and the intensity of schistosomiasis among children in the Yeji district. Materials and Methods A total of 100 participants comprising 50 Schistosoma haematobium (S. haematobium) infected and 50 noninfected controls aged 6–17 years matched for age and sex were recruited into the study. Blood and urine samples were collected and haematological profile and presence of S. haematobium eggs were assessed using standard protocols. Results Haemoglobin (HGB) (P < 0.0001), haematocrit (HCT) (P < 0.0001), mean cell volume (MCV) (P = 0.0053), mean cell haemoglobin (MCH) (P < 0.0001), and mean cell haemoglobin concentration (MCHC) (P = 0.005) levels were reduced in cases compared to controls. Mixed cell percentage (MXD) (P = 0.018) and red blood cell distribution width (RDW-CV) (P = 0.012) were significantly elevated among cases as compared to controls. Haematuria was a clinical characteristic of heavy infection. Conclusion S. haematobium infection creates an imbalance in the haematological profile. We found low HGB, HCT, MCV, MCH, and MCHC levels coupled with increased % MXD count and RDW-CV. Also, low MCV, MCH, and MCHC and high % MXD count are independently associated with S. haematobium infection among our study participants.

Comparison of serum biochemistry and haematology values in captive and free-ranging wild boar (Sus scrofa)

The purpose of this study was to compare haematology and biochemistry data for captive and free-ranging wild boar in the UK and to evaluate whether significant differences were present between these two boar populations. The samples from the captive wild boar comprised 18 adult females housed in three interconnected outdoor paddocks, whilst the samples from free-ranging wild boar comprised 19 adult females living in unrestricted woodland. Samples were obtained under general anaesthesia during health checks. Free-ranging wild boar had significantly lower serum concentrations of total protein, globulin, ionised calcium, urea, creatinine and gamma-glutamyl transferase (GGT) activity and significantly higher serum concentrations of phosphate, bile acids and alkaline phosphatase (ALP) activity compared with captive wild boar. Haematological values for free-ranging wild boar showed significantly higher red blood cell counts (RBC), white blood cell counts (WBC) and neutrophil counts and significantly lower mean cell volume (MCV) and mean corpuscular haemoglobin (MCH). These results provide evidence that significant differences in serum biochemistry and haematology values may exist between captive and free-ranging populations of the same native species. Such differences may need to be considered when studies are undertaken or reported from wild animal populations in semi-natural husbandry situations. Potential sources of these differences may include nutritional state, level of activity and environmental stress.

Ascertainment of iron deficiency and depletion in blood donors through screening questions for pica and restless legs syndrome

Pica and restless legs syndrome (RLS) are associated with iron depletion and deficiency. The presence of pica and RLS was prospectively assessed in blood donors. During a 39-month period, 1236 donors deferred for fingerstick hemoglobin (Hb) level of less than 12.5 g/dL and 400 nondeferred "control" donors underwent health screening and laboratory testing (complete blood count, ferritin, iron, transferrin). Pica and RLS were assessed by direct questioning. Deferred donors and iron-deficient control donors were given 325 mg of ferrous sulfate daily for 60 days. Reassessments were performed and additional iron tablets dispensed at subsequent visits. Pica was reported in 11% of donors with iron depletion or deficiency, compared with 4% of iron-replete donors (p < 0.0001). Pagophagia (ice pica) was most common and often of extraordinary intensity. Female sex, younger age, and lower mean cell volume and transferrin saturation values were strongly associated with pica. Donors with pica given iron reported a marked reduction in the desire to consume the nonnutritive substance by Days 5 to 8 of therapy, with disappearance of symptoms by Days 10 to 14. RLS was reported in 16% of subjects with iron depletion or deficiency compared with 11% of iron-replete donors (p = 0.012). Iron replacement generally resulted in improvement of RLS symptoms; however, at least 4 to 6 weeks of iron therapy was necessary. The presence of pica is associated with a high probability of iron depletion or deficiency in blood donors; however, RLS lacks a strong correlation in this population. Screening questions for pagophagia may be useful in the ascertainment of iron deficiency in donors and may identify those who would benefit from oral iron.

Molecular Characterization of Alpha and Beta Thalassemia in Yemeni Sickle Cell Disease Children

There are no previous reports about the molecular defects of alpha and beta thalassemia in Yemeni sickle cell disease (SCD) patients, except one report about alpha thalassemia in Yemeni SCD children living in Riyadh Saudi Arabia. The aim of this clinical cross-sectional study was directed to determine the genetic defects of α and β- thalassemia in Yemeni sickle cell disease children and to determine their prevalence in Taiz governorate Yemen where the prevalence of sickle-cell trait HbAS is about 8.2%. Blood samples were collected from 145 SCD children to determine the complete blood count, sickling tests and hemoglobin fraction analysis by high pressure liquid chromatography (HPLC) method. Serum ferritin was determined in serum of those patients who had low mean cell volume (MCV) and low mean cell hemoglobin (MCH) to exclude presence of iron deficiency anemia. The DNA was analyzed in 30 patients with thalassemia indices after exclusion of iron deficiency anemia using polymerase chain reaction (PCR) based techniques namely (The β- Globin and α-globin test Strips assay and Gap PCR). This study showed that in Taiz governorate the overall prevalence of SCD with thalassemia was (27.5%) and according to DNA analysis the prevalence of ( HbSS+α-thalassemia) and (HbS/β0- thalassemia) were 18.5% and 5.9%, respectively. For first time in Taiz and Yemen the present study confirms presence of different combination between sickle cell gene, β0- Thalassemia and α-Thalassemia genes which means presence of these genetic diseases in Yemeni population. There were 8 patients (26.6%) with (βS/ β0) - thalassemia and 22 (73.3%) with (HbSS/ α�thalassemia). There were three β thalassemia mutations detected the most common mutation was the ( IVS II-1 A>T ) type with frequency of (75%), and the α-thalassemia deletion found in Yemeni SCD children was of right ward deletion (-3.7 kb), and 17 patients (68%) had one gene deletion and 8 patients (32%) two gene deletions.

Screening of β-thalassaemia trait by means of red cell indices and derived formulae

Context: Thalassaemias are a group of genetic disorders with tremendous morbidity and mortality that are present widely across the globe. Aim of the Study: To evaluate the usefulness of automated haematology analyser-based red cell indices and formulae derived from these indices in β-thalassaemia trait (BTT) detection. Settings and Design: Prospective study conducted over a period of 1 year. Materials and Methods: The study included 301 cases with mild-to-moderate reduction in haemoglobin (Hb) with a lower cut-off value of 8 g/dl. Automated haematology analysis was done by using an Arcus Diatron (2000) for all these cases. A cut-off value of mean cell volume (MCV) 3.5%). Indices like RDW, RDW with low MCV, MCH, RDWI and DS were found to have a better discriminating function (higher Youden's index) compared with RBCC, MDHL and MI. Conclusion: Automated haematology analyser-based red cell indices and certain formulae derived from these indices have a high predictive value in screening BTT.

Analysis Of δ-Globin Gene Mutations in the Chinese Population

Although δ-globin gene (HBD MIM#142000) mutations have no immediate physical consequence, it can interfere with the diagnosis of β-thalassemia (β-thal), which can be severe. In the present study, of 40,863 samples referred for thalassemia trait screening, 167 samples with lower than expected Hb A2 levels, in the presence or absence of a second Hb A2 fraction, were selected for our analysis and 152 samples (0.4%) were positive for δ-globin gene mutations. Twenty-one different mutations were detected, and of these 12 have not been previously described. We found that −77 (T>C) was the most common mutation in Chinese followed by −30 (T>C), together accounting for almost 82.3% of the total number of δ-globin gene defects. Since compound heterozygotes for β-thal and a δ-globin gene mutation may have low mean cell volume (MCV) and normal Hb A2 levels, and therefore be overlooked as β-thal heterozygotes, a detailed molecular analysis for both α- and β-thal is necessary, especially when one partner has been identified to have β-thal trait.

Hematological Profile of Sickle Cell Disease from South Gujarat, India

The aim of this study was to determine hematological profile of sickle cell disease (SCD) from Surat, South Gujarat, India. This prospective cross-sectional study was conducted in the Department of Pediatrics and Sickle Cell Anemia Laboratory, Faculty of Pathology, Government Medical College, Surat, India, between July 2009 and December 2010. Patients included in this study were in their steady state for a long period of time without any symptoms related to SCD or other diseases which could affect the hematological parameters. Venous blood of all patients was collected in ethylenediaminetetraacetic acid and hematological indices were measured. Thirty-three subjects homozygous in all were studied for their hematological parameters for sickle cell anemia. Moderate to severe anemia, low mean cell volume and high foetal hemoglobin dominate the hematological profile of SCD children.

Prevalence of haemoglobinopathy in sportsmen in qatar

BackgroundHaemoglobinopathy are the most common genetically inherited disease in many parts of the world. Both health and athletic performance may be affected in athletes training at high intensity and in...

Circulating unmetabolized folic acid and 5-methyltetrahydrofolate in relation to anemia, macrocytosis, and cognitive test performance in American seniors

Folate deficiency has serious consequences for the fetus. Folic acid fortification of food addresses this problem. However, clinical consequences of vitamin B-12 deficiency may be worsened by high folic acid intakes, perhaps as a direct result of unmetabolized folic acid, which does not occur naturally in body tissues. We attempted to attribute associations that we previously found between higher folate status and anemia and cognitive test performance to circulating unmetabolized folic acid or 5-methyltetrahydrofolate (5MeTHF). The subjects (n = 1858) were senior participants in the US National Health and Nutrition Examination Survey (1999-2002) who had normal renal function and reported no history of stroke, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries. Subjects had undergone a phlebotomy, a complete blood count, and cognitive and dietary assessments. Circulating unmetabolized folic acid was detected in approximately 33% of the subjects and was related to an increased odds of anemia in alcohol users. In seniors with a serum vitamin B-12 concentration <148 pmol/L or a plasma methylmalonic acid concentration > or =210 nmol/L, the presence compared with the absence of detectable circulating unmetabolized folic acid was related to lower cognitive test scores and lower mean cell volume. In the same subgroup, higher serum 5MeTHF was related to an increased odds of anemia and a marginally significantly decreased odds of macrocytosis. In seniors with a normal vitamin B-12 status, a higher serum 5MeTHF concentration was related to higher cognitive test scores. Results of this epidemiologic study were somewhat consistent with reports on the folic acid treatment of patients with pernicious anemia, but some findings were unexpected.

Screening Tests for Latent Anemia in Hospitalized Adults Over the Age of 65

Objective: Anemia is an independent risk factor for morbidity and mortality in an array of disorders common to seniors including cancer, renal disease, and heart disease. The aim of this study was to identify the frequency of RBC abnormalities and the utility of laboratory tests for the detection of anemia and its cause in the hospitalized elderly. Methods: A prospective analysis was performed on 140 consecutive adults over 65 who had chronic diseases (mean age 72, range 65–80). Laboratory tests included hemoglobin (HGB), hematocrit (HCT), red cell indices, mean cell volume (MCV), mean cellular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), reticulocyte count (RET), serum iron, total iron binding capacity, and index saturation transferrin (IST). Results: Only a minority of patients, 33 (23.58%), had normal results for all hematological tests. An additional 16 patients (11.4%) had normal HGB and HCT but low MCV or MCH. Conclusion: Anemia is common in older, chronically ill adults. Routine anemia screening should be recommended in hospitalized chronically ill adults over 65 years of age, and the World Health Organization (WHO) must redefine anemia by these common parameters.

PTH-011 Missing colorectal cancer: the muddle of haemoglobin, ferritin and mcv

<h3>Introduction</h3> The development of iron deficiency anaemia is well recognised as an early presentation of colorectal cancer. The World Health Organisation defines anaemia as a haemoglobin of &lt;13 g/dl in men and 12 g/dl in women. The presence of a low ferritin is the most powerful test for iron deficiency with a ferritin of &lt;50 μg/l consistent with this diagnosis. Recent literature suggests that a lower limit of 100 μg/l is more sensitive when considering a diagnosis of colorectal cancer. In iron deficiency anaemia, red cells classically have a low mean cell volume (MCV). The aims of this study are fourfold: To evaluate the change in haemoglobin in the 2 years prior to colorectal cancer diagnosis To gauge the adequacy of investigation of anaemia To assess the correlation between ferritin and colorectal cancer in anaemic patients To explore the relationship between MCV and low ferritin <h3>Methods</h3> The records of 194 patients diagnosed with colorectal cancer between April 2007 and September 2009 were reviewed retrospectively. Haemoglobin, ferritin and MCV within the previous 2 years were recorded. <h3>Results</h3> 186 patients had a previous haemoglobin available. 76 patients (41%) were anaemic prior to diagnosis and a further 25 (13%) had a 10% drop in haemoglobin from baseline. 18% of these patients had a low MCV. No patients had an elevated MCV. Of the 101 patients with anaemia or a 10% haemoglobin drop, 37 (37%) had iron studies performed. Ferritin was &lt;50 μg/l in 73% of cases and &lt;100 μg/l in 97%. A normal MCV was found in 64% of patients with a ferritin of &lt;100 μg/l. The median time from presentation of anaemia to diagnosis of colorectal cancer was 3 months but 24 patients had a delay of between 12 and 24 months. The median time to diagnosis was the same for patients with a low ferritin or a 10% drop in haemoglobin. <h3>Conclusion</h3> In the 2 years preceding colorectal cancer diagnosis, 41% of patients develop anaemia and a further 13% have a 10% drop in haemoglobin. This remains poorly investigated. A normal MCV is falsely reassuring and patients meeting developing anaemia or a 10% drop in haemoglobin should have iron studies performed. This study confirms recent findings that a lower limit for ferritin of 100 mcg/l is more sensitive when considering colorectal cancer. 24% of patients wait 12–24 months between the development of anaemia or a 10% drop in haemoglobin and a diagnosis of colorectal cancer. This percentage could be significantly reduced by the timely investigation of these patients with iron studies. Referral for urgent GI investigations should be made for patients with a ferritin &lt;100 μg/l and no overt blood loss from another source.

Iron deficiency and sleep-related breathing disorders in children with epilepsy

<h3>Introduction</h3> Iron plays an important role in the developing brain (including myelination, synaptogenesis and neurotransmission) and deficiency has been linked to difficulties in behaviour, cognitive ability and paediatric sleep disturbances. Iron also has a key role in immunity and deficiency is linked to adenotonsillar hypertrophy and obstructive sleep apnoea (OSA, measurable as Δ 12 index on pulse oximetry), which may in turn affect seizure control in epileptic children, although there are few studies investigating the possibility of a link. <h3>Methods</h3> An audit was undertaken of laboratory results of 38 tertiary centre children with epilepsy, 30 of whom had overnight pulse oximetry because of symptoms of sleep-related breathing disorder. Full blood counts were retrieved from the hospital electronic system, and the red cell indices were correlated with the average and minimum haemoglobin oxygen saturation (SpO₂), the total number of desaturations and, where available, the Δ 12 Index. <h3>Results</h3> Twenty-two (58%) of the 38 children had low haemoglobin for age, 28 (74%) had low haematocrit, 6 (16%) had low mean cell haemoglobin (MCH) and 5 (13%) had low mean cell volume. In the 30 children with pulse oximetry (12 boys, median age 7.3 (range 3.0–16.6) years), there were correlations between number of desaturations and MCH (r=−0.391; p=0.04), haematocrit (r=−0.393, p=0.04) and haemoglobin (r=−0.428, p=0.02), but there was no relationship between average or minimum overnight SpO₂ and the red cell indices. In the 16 children for whom Δ 12 index and red cell indices were available, there were correlations with haematocrit (r=−0.556, p=0.03) and haemoglobin (r=−0.571, p=0.02). <h3>Discussion</h3> Epilepsy, iron deficiency and sleep-related breathing disorders are all common paediatric problems. Indices suggesting iron deficiency appear to be common in children with epilepsy and to be associated with the number of desaturations overnight and with an index of OSA. Further research is needed to see if these children are actually iron deficient and if restoring iron stores improves the sleep disturbance. As treatment of OSA has been shown to improve seizure control in adults, the possibility that restoration of iron stores reduces seizure frequency in this subgroup of patients should be explored.