Low Hemoglobin Concentration Research Articles

Evaluation of CD4 Count, Haemoglobin, and Intestinal Parasites Status of Cancer Patients Receiving Oncology Therapy in Calabar, Nigeria

Cancer is a human cellular error with a high mortality rate, especially in developing regions. Resolving this error with therapy may render patients immunologically depressed and susceptible to opportunistic infections including parasitic. The gut parasites, Cluster of Differentiation four (CD4) cells and haemoglobin (Hb) levels of cancer patients on oncology therapy in Calabar, Nigeria were studied. Stool and blood samples were collected from 317 (186 cancer and 131 apparently healthy) subjects. Parasites were identified using direct smear and formol ether concentration techniques while CD4 and Hb estimation were done using BD-fascount and fluorescent flow cytometric techniques, respectively. Data were analysed using chi-square and independent sample t-test. Overall parasitosis prevalence in this study was (27.44%) with cancer showing an association with intestinal parasitosis (P=0.001) and CD4 level (P=0.002), respectively but none with Hb level. Parasiteinfected cancer subjects had significantly lower mean haemoglobin concentration than their non-infected counterpart (t = - 4.869, P<0.001). Generally, cancer subjects on cancer treatment had an insignificantly lower parasite and significantly lower CD4 levels compared to their non-treated counterpart (P = 0.829) and (P<0.001), respectively but their mean haemoglobin levels were similar (P=0.701). Cancer subjects on chemotherapy alone had significantly higher parasite prevalence, 50.00% compared to 28.95% for those on combined (surgery and chemotherapy) treatment (P=0.014), whereas the type of treatment showed no significant effect on CD4 and Hb levels. Parasite occurrence was only pronounced (71.43%) among subjects with >12 months of treatment duration (P=0.1038). There was a correlation between duration of treatment and CD4 levels (r = - 0.231, P<0.05) but none with haemoglobin levels (r = 0.024, P>0.05) of cancer subjects. In conclusion, although this study has shown that cancer as a condition increases parasite prevalence and reduces mean CD4 counts in subjects, their haemoglobin levels were not significantly affected, except for subjects with intestinal parasite infections. Treatment with cancer therapy did not also affect the haemoglobin concentration, but significantly reduced the CD4 cell number of subjects. Subjects who had majorly, chemotherapy were mostly infected with the parasite but with no noticeable effect on their CD4 and haemoglobin levels. A prolonged duration of treatment increased parasitosis and reduced the CD4 level of subjects but did not affect haemoglobin levels. Apart from the oncological treatments given to cancer subjects, management of cancer subjects should include parasitological examination and treatment, periodic monitoring of their hematologic profile and regular immune revitalization procedures, especially for those placed on prolonged therapy.

5613357 ULTRASONOGRAPHIC SPLENIC INDICES AND AGE-RELATED CLINICAL AND LABORATORY PARAMETERS IN PATIENTS WITH SICKLE CELL DISEASE IN NORTH-EASTERN NIGERIA

Background: The spleen is one of the organs affected by sickle cell disease (SCD) early in life (1-3); repeated episodes of vaso-occlusion and infarction result in a reduction in both the spleen’s structure and function (4). The rate of progression of this process varies markedly among individuals with SCD. The aim of the current study was to evaluate spleen sizes using abdominal ultrasound in children and adults with SCD in an African setting and to explore baseline clinical and laboratory variables associated with the presence or absence of the spleen. This information could be used for early monitoring and aid management among these patients. Methods: Two hundred and four sickle cell disease patients (SCD) (101 males and 103 females; age range, 1.1 to 45 years) underwent abdominal ultrasound scans at the University of Maiduguri Teaching Hospital, Nigeria between October 2020 to November 2021. One hundred and eleven age-matched healthy persons were enrolled as controls (69 males and 42 females: age range 1.5 years to 34 years). Imaging was performed by a single radiologist who assessed and measured the spleen length, depth, and width, and calculated the volume. Results: The spleen was visualized in 107 SCD patients (52.4%; 95% CI, 46% - 59%; SE 0.035) on ultrasound and was absent in 97 patients. There was a progressive increase in spleen absence with increasing age; while the spleen was present in all the under-fives, it was present in less than 24% (n = 20/85) of those 15 years and above (Fig.1). The pattern of spleen size growth with age among the SCD patients is shown in Fig.2; the median spleen length remained relatively stable at 6.5cm throughout early childhood, increasing only slightly to 7.0 cm in the 10 -14 years before reaching the adulthood size of 8.8cm from 15 years and above. Factors that were significantly associated with the presence of the spleen on the univariate analysis included high HbF and haemoglobin, low levels of platelets, HbA2, red cells indices (MCH, MCHC), positive malaria parasitemia, and history of intake of hydroxyurea. Multivariable logistic regression analysis showed only high HbF (12.2% vs 7.5%; OR, 1.17; 95% CI, 1.05 -1.29. P = 0.003) and low mean corpuscular haemoglobin concentration (MCHC) (34.1pg vs 35.1pg; OR, 0.69; 95% CI, 0.47 – 0.99. P = 0.049) were significantly associated with persistence of the spleen among SCD patients (Table 1). Only 32 (15%) patients were on regular hydroxyurea therapy, however, the HbF% level was significantly higher among patients on hydroxyurea (median 12.7; IQR 9.4) compared to their counterparts not on hydroxyurea (median 7.4; IQR 8.0) (P = 0.000). Sex and clinical parameters including frequencies of hospitalization, painful crises, febrile episodes, and total lifetime transfusion had no association with the presence of spleen on ultrasound Conclusion: In patients with SCD, the spleen persisted up to five years before any evidence of autosplenectomy occurred. Patients with persistent spleens had a higher level of HbF compared to those with absent spleens. Early determination of HbF may be of value in identifying patients who will benefit from HbF-inducing therapy such as hydroxyurea. Table 1 - Adjusted odd ratios for associations with spleen present or absent on ultrasound Parameter OR (95% Confidence interval) P value Hb, g/dl 1.07 (0.78 - 1.46) 0.675 MCH, g/dl 0.86 (0.72 - 1.02) 0.077 MCHC, pg 0.69 (0.47 - 0.99) 0.049* Platelets, ×106/µL 0.99 (0.99 -1.00) 0.274 HbF, % 1.17 (1.05 -1.29) 0.003* HbA2, % 0.75 (0.35 - 1.58) 0.447 Malaria parasite positive 2.55 (0.96 - 6.75) 0.060 Regular intake of hydroxyurea 1.84 (0.42 - 7.99) 0.418 Hb haemoglobin; MCH mean corpuscular haemoglobin; MCHC mean corpuscular haemoglobin concentration; SD standard deviation. CI con

EVALUATION OF OXIDATIVE STRESS MARKERS IN ANTENATAL WOMEN RECEIVING ROUTINE IRON

Background: Anaemia is low haemoglobin concentration affecting 47.74% of pregnant women globally.9 WHO recommends routine supplementation of iron to all antenatal mothers irrespective of the haemoglobin status. The aim of this study was to evaluate the levels of oxidative stress markers in antenatal women receiving routine iron supplementation and correlate their maternal and fetal outcomes. A prospective observational study of 100 pregnant wome Methods: n was conducted over 1.5 years at St. John's Medical College Hospital. On screening for inclusion criteria, at baseline, information on maternal socio-demography, anthropometry, dietary intake and clinical examination was collected. A venous blood sample at baseline and 3rd trimester of pregnancy and at delivery was collected for estimation of oxidative stress markers i.e., catalase and lipid peroxidase and results were correlated with pregnancy and birth outcomes. Results: The levels of oxidative stress markers were found to decrease from rst to third trimester in a subset of 30 patients participating in the study. There was a greater incidence of preeclampsia in women with Hb > 13 g/dl receiving routine iron supplementation (37.5%). Also, there was increased risk of GDM, PROM and febrile morbidity although not statistically signicant. Our study suggests t Conclusion: hat there is a trend towards increase in oxidative stress and incidence of pre-eclampsia when excess iron is supplemented to pregnant women with normal haemoglobin. Assessment of other oxidative stress markers in a larger study may be helpful in deciding the need for iron supplementation and its dosage.

A cross-sectional analysis of ambient fine particulate matter (PM2.5) exposure and haemoglobin levels in children aged under 5 years living in 36 countries

Low haemoglobin (Hb) concentrations and anaemia in children have adverse effects on development and functioning, some of which may have consequences in later life. Exposure to ambient air pollution is reported to be associated with anaemia, but there is little evidence specific to low- and middle-income countries (LMICs), where childhood anaemia prevalence is greatest. We aimed to determine if long-term ambient fine particulate matter (≤2.5 μm in aerodynamic diameter [PM2.5]) exposure was associated with Hb levels and the prevalence of anaemia in children aged <5 years living in 36 LMICs. We used Demographic and Health Survey data, collected between 2010 and 2019, which included blood Hb measurements. Satellite-derived estimates of annual average PM2.5 was the main exposure variable, which was linked to children's area of residence. Anaemia was defined according to standard World Health Organization guidelines (Hb < 11 g/dL). The association of PM2.5 with Hb levels and anaemia prevalence was examined using multivariable linear and logistic regression models, respectively. We examined whether the effects of ambient PM2.5 were modified by a child's sex and age, household wealth index, and urban/rural place of residence. Models were adjusted for relevant covariates, including other outdoor pollutants and household cooking fuel. The study included 154,443 children, of which 89,904 (58.2%) were anaemic. The country-level prevalence of anaemia ranged from 15.8% to 87.9%. Mean PM2.5 exposure was 33.0 (±21.6) μg/m3. The adjusted model showed that a 10 μg/m3 increase in annual PM2.5 concentration was associated with greater odds of anaemia (OR = 1.098 95% CI: 1.087, 1.109). The same increase in PM2.5 was associated with a decrease in average Hb levels of 0.075 g/dL (95% CI: 0.081, 0.068). There was evidence of effect modification by household wealth index and place of residence, with greater adverse effects in children from lower wealth quintiles and children in rural areas. Exposure to annual PM2.5 was cross-sectionally associated with decreased blood Hb levels, and greater risk of anaemia, in children aged <5 years living in 36 LMICs.

High-performance surface plasmon resonance fiber sensor based on cylindrical vector modes

Cylindrical vector modes with azimuthal polarization and low transmission loss are proposed for the first time to be utilized in a novel design of a surface plasmon resonance (SPR) sensor based on a circular photonic crystal fiber (C-PCF). A C-PCF with a ring of air holes in the cladding is designed where a gold layer with a thickness of 44 nm is coated on the outer cladding surface. The optimal geometric parameters are determined using the finite-element method (FEM) for a high-quality TE01 mode and high sensitivity of the sensor. The proposed SPR sensor shows high sensitivity for analyte refractive index (RI) ranging from na = 1.29 to 1.34 over the wavelength range of 1400–2000 nm. It is expected that the proposed sensor can sense low concentrations of hemoglobin, lymphocytes and monocytes of red and white blood cells which are effective in diagnosing the progress of cancer tumors. The maximum sensitivity of 13,800 nm/RIU is obtained in the refractive index environment of 1.33–1.34. The sensor resolution is of the order of 10−6 and the amplitude sensitivity reaches its maximum of 2380 RIU−1 at na = 1.30 which is the highest value ever reported. Our proposed sensor shows high sensitivity and simultaneously simple design with high performance.

Relative contributions of anaemia and hypotension to myocardial infarction and renal injury: Post hoc analysis of the POISE-2 trial.

Hypotension and postoperative anaemia are associated with myocardial and renal injury after noncardiac surgery, but the interaction between them remains unknown. To test the hypothesis that a double-hit of postoperative anaemia and hypotension synergistically worsens a 30-day composite of myocardial infarction (MI) and mortality and acute kidney injury (AKI). Characterising the interaction when hypotension and anaemia occur at same time on myocardial infarction and acute kidney injury. Post hoc analysis of the POISE-2 trial. Patients were enrolled between July 2010 and December 2013 at 135 hospitals in 23 countries. Adults at least 45 years old with known or suspected cardiovascular disease. We excluded patients without available postoperative haemoglobin measurements or hypotension duration records. Exposures were the lowest haemoglobin concentration and the average daily duration of SBP less than 90 mmHg within the first four postoperative days. The primary outcome was a collapsed composite of nonfatal MI and all-cause mortality during the initial 30 postoperative days; our secondary outcome was AKI. We included 7940 patients. The mean ± SD lowest postoperative haemoglobin was 10 ± 2 g dl -1 , and 24% of the patients had SBP less than 90 mmHg with daily duration ranging from 0 to 15 h. Four hundred and nine (5.2%) patients had an infarction or died within 30 postoperative days, and 417 (6.4%) patients developed AKI. Lowest haemoglobin concentrations less than 11 g dl -1 , and duration of SBP less than 90 mmHg was associated with greater hazard of composite outcome of nonfatal MI and all-cause mortality, as well as with AKI. However, we did not find significant multiplicative interactions between haemoglobin splines and hypotension duration on the primary composite or on AKI. Postoperative anaemia and hypotension were meaningfully associated with both our primary composite and AKI. However, lack of significant interaction suggests that the effects of hypotension and anaemia are additive rather than multiplicative. Clinicaltrials.gov: NCT01082874.

Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure

The prognostic impact of peak workload-to-weight ratio (PWR) during cardiopulmonary exercise testing (CPET) and its determinants in patients with chronic heart failure (CHF) are not well understood. Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013 and 2018 were identified. The primary outcome was a composite of hospitalization because of worsening heart failure and death. PWR was calculated as peak workload normalized to body weight (W/kg) by CPET. Patients with low PWR (cut-off median 1.38 [W/kg], n=257) were older and more anemic than those with high PWR (n=257). In CPET, patients with low PWR displayed reduced peak oxygen consumption and impaired ventilatory efficiency compared with those with high PWR, whereas the peak respiratory exchange ratio was not significantly different between the 2 groups. There were 89 patients with events over a median follow-up period of 3.3 (interquartile range 0.8 to 5.5) years. The incidence of composite events was significantly higher in patients with low PWR than in those with high PWR (log-rank p <0.0001). In the multivariable Cox regression, lower PWR was associated with adverse events (hazard ratio 0.31, 95% confidence interval 0.13 to 0.73, p=0.008). Low hemoglobin concentration was strongly related to impaired PWR (βcoefficient=0.43, per 1g/100ml increased, p <0.0001). In conclusion, PWR was associated with worse clinical outcomes, where blood hemoglobin was strongly related to PWR. Further study is required to identify therapies targeting peak workload achievements in exercise stress tests to improve the outcome in patients with CHF.

Psychiatric symptoms in a female with subacute combined degeneration of the spinal cord (SCD): a case report

BackgroundSubacute combined degeneration of the spinal cord (SCD) is mainly caused by deficiency of Vitamin B12 and characterized by deep hypoesthesia, sensory ataxia and spasmodic paralysis of lower limbs. SCD often accompanies with megaloblastic anemia. Psychiatric symptoms could be the initial manifestations of SCD by lack of Vitamin B12, but are rarely considered secondary to physical discomfort and psychological factors in SCD. Additionally, treatment experience for psychiatric symptoms in SCD remains little reported.Case reportWe presented a case of a 37-year-old female who complained of being persecuted and controlled for one week and thus was admitted to the psychiatry department. Before that, she had went through persistent paresthesia and numbness of her lower extremities for two-month. Low Vitamin B12 level and hemoglobin concentration, neurologic symptoms and bone marrow smear results supported the clinical diagnosis of SCD and megaloblastic anemia. With supplementation of Vitamin B12 and blood transfusion and short-term prescription of antipsychotics and antidepressants, physical symptoms were improved and psychological symptoms disappeared within 2 weeks.ConclusionsPsychiatric symptoms of SCD could be generated from lack of Vitamin B12, anemia and neurologic symptoms, where short-term use of antipsychotics and antidepressants may be effective.

Does Low Mean Corpuscular Hemoglobin Concentration Really Predict Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

Background and Aim:&#x0D; Several studies have shown associations of low mean corpuscular hemoglobin concentration (MCHC) with mortality and poor clinical course in conditions associated with chronic inflammation such as cardiac failure and COPD. Thus, in this study we aimed to determine the link between MCHC and readmission mortality in a large patient population with minimum 1 year of follow-up. &#x0D; Methods:&#x0D; Clinical data at admission, laboratory data, number of admissions to emergency room due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) following the discharge of the last patient recruited, number of admissions to pulmonology unit, and number of intensive care unit admissions between 2018 and 2019 were recorded. The follow-up duration ranged between 12 and 36 months. &#x0D; Results:&#x0D; A total of 339 patients were included. Based on a ROC analysis, the cut-off value for MCHC was 32.35 g/dl. Comparison of clinical data according to this cut-off value showed an increase in the incidence of pneumonia during admission, hypercapnic respiratory failure, need for non-invasive mechanical ventilation (NIV), and number of intensive care unit admissions within a 1 year period, as well as reduced survival in non-anemic subjects with MCHC ≤ 32.35 g/dL. In multivariate cox-regression analysis MCHC was not an independent predictor of mortality risk. &#x0D; Conclusion: We recommend careful monitoring and assessment of comorbidities in AECOPD patients with low MCHC but without anemia. MCHC was not found to be an independent predictor of mortality but there was a significant correlation between MCHC and survival in patients without anemia.

Impact of left atrial appendage closure in patients on anticoagulation for atrial fibrillation and recurrent or chronic gastrointestinal bleeding

BackgroundOral anticoagulation in non-valvular atrial fibrillation is associated with an increased risk of bleeding, particularly gastrointestinal bleeding, leading to treatment withdrawal in up to 50% of patients and putting them at risk of embolic events. Left atrial appendage closure (LAAC) can be an alternative to chronic anticoagulation. We aim to describe the impact of LAAC in patients with gastrointestinal bleeding (GIB) or chronic iron deficiency anaemia (CIDA) on healthcare resources consumption. MethodsObservational retrospective study of patients who underwent LAAC for GIB or CIDA at a single centre. ResultsNineteen patients with a median age of 74 years and a median Charlson score of six points were included in the study. Angiodysplasias were the most frequent cause of GIB or CIDA. The procedural success rate of LAAC was 100% with a median anticoagulant and antiplatelet treatment duration of 92 days. One year after the LAAC, we found a significant improvement in the lowest haemoglobin concentration and a reduction in the number of red blood cells transfusion, hospital admissions due to GIB and CIDA and the number of endoscopic examinations. One patient died due to a pulmonary thromboembolism. No deaths related to GIB were observed. ConclusionsLAAC seems to be a safe and effective alternative to anticoagulation in patients with GIB or CIDA.

Effects of roxadustat on anemia, iron metabolism, and lipid metabolism in patients with non-dialysis chronic kidney disease.

We determined the effects of roxadustat on the values of anemia, iron metabolism, renal function, proteinuria, and lipid metabolism and identified the associated factors of the change in hemoglobin levels after roxadustat administration in non-dialysis chronic kidney disease (CKD) patients who were receiving an erythropoietin-stimulating agent (ESA). We conducted retrospective analysis of the changes in hemoglobin, serum ferritin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels; transferrin saturation; the estimated glomerular filtration rate; and the urinary protein/creatinine ratio over 24 weeks after the change from an ESA to roxadustat in 50 patients with non-dialysis CKD and anemia (roxadustat group). Seventy-two patients with non-dialysis CKD and anemia who proceeded ESA therapy were used as the control (ESA) group. We observed no significant between-group differences in clinical parameters at baseline except for the significantly lower hemoglobin concentration and lower proportion of diabetes mellitus in the roxadustat group. The hemoglobin concentration was significantly higher in the roxadustat group after 24 weeks (11.3 ± 1.2 versus 10.3 ± 1.0 g/dL; value of p < 0.05), whereas the transferrin saturation, ferritin concentration, estimated glomerular filtration rate, and urinary protein/creatinine ratio were not different between the two groups. TC (135.9 ± 40.0 versus 165.3 ± 38.4 mg/dL; value of p < 0.05), LDL-C (69.1 ± 28.3 versus 87.2 ± 31.5 mg/dL; value of p < 0.05), HDL-C (41.4 ± 13.5 versus 47.2 ± 15.3 mg/dL; value of p < 0.05), and triglyceride concentrations (101.5 ± 52.7 versus 141.6 ± 91.4 mg/dL, value of p < 0.05) were significantly lower in the roxadustat group compared with the ESA group at 24 weeks. Multiple linear regression analysis showed that the roxadustat dose at baseline (standard coefficient [β] = 0.280, value of p = 0.043) was correlated with the change in the hemoglobin levels during the first 4 weeks of roxadustat treatment, whereas age (β = 0.319, value of p = 0.017) and the roxadustat dose at 24 weeks (β = -0.347, value of p = 0.010) were correlated with the hemoglobin concentration after 24 weeks of roxadustat administration. Roxadustat can improve anemia and reduce serum cholesterol and triglyceride levels in non-dialysis CKD patients after the patients' treatment was switched from an ESA without affecting renal function or proteinuria. These results indicate that roxadustat has superior effects to ESAs regarding anemia and lipid metabolism at the dose selected for the comparison in patients with non-dialysis CKD.

Increased reliance on coronary perfusion for cardiorespiratory performance in seawater-acclimated rainbow trout.

Salmonid ventricles are composed of spongy and compact myocardium, the latter being perfused via a coronary circulation. Rainbow trout (Oncorhynchus mykiss) acclimated to sea water have higher proportions of compact myocardium and display stroke volume-mediated elevations in resting cardiac output relative to freshwater-acclimated trout, probably to meet the higher metabolic needs of osmoregulatory functions. Here, we tested the hypothesis that cardiorespiratory performance of rainbow trout in sea water is more dependent on coronary perfusion by assessing the effects of coronary ligation on cardiorespiratory function in resting and exhaustively exercised trout acclimated to fresh water or sea water. While ligation only had minor effects on resting cardiorespiratory function across salinities, cardiac function after chasing to exhaustion was impaired, presumably as a consequence of atrioventricular block. Ligation reduced maximum O2 consumption rate by 33% and 17% in fish acclimated to sea water and fresh water, respectively, which caused corresponding 41% and 17% reductions in aerobic scope. This was partly explained by different effects on cardiac performance, as maximum stroke volume was only significantly impaired by ligation in sea water, resulting in 38% lower maximum cardiac output in seawater compared with 28% in fresh water. The more pronounced effect on respiratory performance in sea water was presumably also explained by lower blood O2 carrying capacity, with ligated seawater-acclimated trout having 16% and 17% lower haemoglobin concentration and haematocrit, respectively, relative to ligated freshwater trout. In conclusion, we show that the coronary circulation allows seawater-acclimated trout to maintain aerobic scope at a level comparable to that in fresh water.

Anemia in patients with hidradenitis suppurativa : A systematic review with meta-analysis.

Hidradenitis suppurativa (HS) is associated with a number of physical and psychological comorbidities. Studies have suggested an association between HS and anemia; however, this association is not widely understood and may result in delayed diagnosis and treatment and possible increase in morbidity and mortality. To systematically review and perform a meta-analysis regarding the association between HS and anemia, and to characterize the subtypes of anemia associated with HS. A search of the EMBASE, Medline, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases from the time of database inception to September 25, 2022, yielded 313 unique articles. All observational studies and randomized controlled trials published in English that examined the odds ratio (OR) of anemia in patients with HS were screened by 2 independent reviewers. Case reports were excluded. Among 313 unique articles, 7 were deemed eligible. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines facilitated data extraction. The Newcastle-Ottawa Scale (NOS) was used to analyze risk of bias of included studies. In addition to OR and 95% confidence intervals, relevant data on patient demographics and anemia subtypes were also extracted. The primary outcome was the OR of anemia in HS patients. This study also attempted to characterize anemia subtypes associated with HS. In total, 2 case-control and 5 cross-sectional studies featured a total of 11,693 patients. Among the studies, 4 of 7 demonstrated a statistically significant positive association between anemia and HS (ORs, 2.20 [1.42-3.41], 2.33 [1.99-2.73], 1.87 [1.02-3.44], and 1.50 [1.43-1.57]), with macrocytic and microcytic subtypes being most common. After adjusting for publication bias, meta-analysis with random effects revealed HS to be associated with increased odds of anemia compared to non-HS groups (OR 1.59 [1.19, 2.11]). There is a statistically significant positive association between HS and anemia, particularly for the aforementioned subtypes. Patients with HS should be screened for anemia. In case of lower hemoglobin concentration, the anemia of HS patients should be subdivided according to mean corpuscular volume of the red blood cells and further investigated depending on subtype.

Risk of mortality in COVID-19 patients: a meta- and network analysis

Understanding the most relevant hematological/biochemical characteristics, pre-existing health conditions and complications in survivors and non-survivor will aid in predicting COVID-19 patient mortality, as well as intensive care unit (ICU) referral and death. A literature review was conducted for COVID-19 mortality in PubMed, Scopus, and various preprint servers (bioRxiv, medRxiv and SSRN), with 97 observational studies and preprints, consisting of survivor and non-survivor sub-populations. This meta/network analysis comprised 19,014 COVID-19 patients, consisting of 14,359 survivors and 4655 non-survivors. Meta and network analyses were performed using META-MAR V2.7.0 and PAST software. The study revealed that non-survivors of COVID-19 had elevated levels of gamma-glutamyl transferase and creatinine, as well as a higher number of neutrophils. Non-survivors had fewer lymphocytes and platelets, as well as lower hemoglobin and albumin concentrations. Age, hypertension, and cerebrovascular disease were shown to be the most influential risk factors among non-survivors. The most common complication among non-survivors was heart failure, followed by septic shock and respiratory failure. Platelet counts, creatinine, aspartate aminotransferase, albumin, and blood urea nitrogen levels were all linked to ICU admission. Hemoglobin levels preferred non-ICU patients. Lower levels of hemoglobin, lymphocytes, and albumin were associated with increased mortality in ICU patients. This meta-analysis showed that inexpensive and fast biochemical and hematological tests, as well as pre-existing conditions and complications, can be used to estimate the risk of mortality in COVID-19 patients.

Hemostatic effects of a dextran-based priming solution for cardiopulmonary bypass: A secondary analysis of a randomized clinical trial

IntroductionIntravascular fluids administered to patients may influence hemostasis. In patients undergoing cardiac surgery with cardiopulmonary bypass, the heart-lung machine is primed with 1300 ml of fluid. We assessed postoperative coagulation and platelet function in patients randomized to two different priming solutions, one colloid-based (dextran 40) and one crystalloid-based. Materials and methodsEighty-four elective cardiac surgery patients were randomized to either a dextran-based prime or Ringer's acetate with added mannitol. Blood samples were collected before, and 2 and 24 h after cardiopulmonary bypass. Coagulation was assessed by standard coagulation tests and rotational thromboelastometry. Platelet function was assessed with impedance aggregometry. Bleeding volumes and transfusion requirements were recorded. ResultsComparing the groups 2 h after bypass, the dextran group showed lower hemoglobin concentration, hematocrit, platelet count, and fibrinogen concentration, and higher INR and aPTT, as well as longer clot formation time (+41 ± 21 % vs. +8 ± 18 %, p < 0.001) and a larger reduction in fibrinogen-dependent clot strength (−37 ± 12 % vs. -7 ± 20 %, p < 0.001). Adenosine diphosphate-dependent platelet activation was reduced in the dextran group but not in the crystalloid group 2 h after bypass (−14 ± 29 % vs. -1 ± 41 %, p = 0.041). No significant between-group differences in hemostatic variables remained after 24 h, and no significant differences in perioperative bleeding volumes, re-explorations for bleeding, or transfusion rates were observed. ConclusionsCompared to a crystalloid solution, a dextran-based prime had measurable negative impact on hemostatic variables but no detectable increase in bleeding volume or transfusion requirements in cardiac surgery patients.

Dietary intakes of iron, folate, and vitamin B12 during pregnancy and correlation with maternal hemoglobin and fetal growth: findings from the ROLO longitudinal birth cohort study

PurposeDietary micronutrient intakes of iron, folate and vitamin B12 are known to influence hemoglobin. Low maternal hemoglobin (maternal anemia) has been linked to low birthweight and other adverse health outcomes in the fetus and infant. Our primary aim was to explore relationships between maternal dietary micronutrient intakes, maternal full blood count (FBC) parameters and fetal abdominal circumference (AC) and estimated fetal weight (EFW) growth trajectories. Secondarily, we aimed to assess relationships between maternal dietary micronutrient intakes, maternal hemoglobin values and placental weight and birthweight.MethodsMother–child pairs (n = 759) recruited for the ROLO study were included in this analysis. Maternal dietary micronutrient intakes were calculated from food diaries completed during each trimester of pregnancy. FBC samples were collected at 13- and 28-weeks’ gestation. Fetal ultrasound measurements were recorded at 20- and 34-weeks’ gestation. Growth trajectories for AC and EFW were estimated using latent class trajectory mixture models.ResultsDietary intakes of iron and folate were deficient for all trimesters. Mean maternal hemoglobin levels were replete at 13- and 28-weeks’ gestation. Dietary iron, folate and vitamin B12 intakes showed no associations with fetal growth trajectories, placental weight or birthweight. Lower maternal hemoglobin concentrations at 28 weeks’ gestation were associated with faster rates of fetal growth and larger placental weights and birthweights.ConclusionThe negative association between maternal hemoglobin at 28 weeks’ gestation and accelerated fetal and placental growth may be due to greater consumption of maternal iron and hemoglobin by fetuses’ on faster growth trajectories in addition to placental biochemical responses to lower oxygen states.

Factores asociados a los niveles de hemoglobina en niños menores de 6 meses de edad hospitalizados en un centro pediátrico de Perú

Introduction: Anemia is a condition in which there is a low concentration of hemoglobin (Hb) levels. Although many causes of anemia have been identified, there are few studies in which they are related to epidemiological factors in the first months of life. Objective of the study: To determine the factors associated with hemoglobin levels in children under 6 months of age hospitalized in a specialized pediatric center in Peru. Material and methods: Cross-sectional study in children under 6 months of age hospitalized in the medical services of a pediatric center during the year 2017, 267 medical records were reviewed, emphasizing clinical and epidemiological characteristics. Results: 61.4% of the infants were female, and only 6.7% of the proportion of the population studied were less than 1 month old. 6.7% had low birth weight, and 53.2% had a normal delivery. The level of anemia in hospitalized children under 6 months of age is 66.7%. Conclusions: According to the bivariate analysis, a significant association was found between hemoglobin levels with the variables age, nutritional status of weight for length and hospital causes. Regarding the multivariate analysis, only an association was found between age and the median Hb present in boys and girls aged 0 to 5 months hospitalized in a pediatric center in Peru.

Predictors and clinical complications associated with antiphospholipid antibodies in sickle cell disease.

Although a higher prevalence of antiphospholipid autoantibodies (aPL) has been observed in some cohorts of sickle cell disease (SCD) patients, the clinical risk factors for the development of aPL and its associated complications remain unclear. In a retrospective study of 63 SCD patients, a lower hemoglobin concentration and higher white blood cell count were independently associated with an elevated aPL. SCD patients with elevated aPL had increased pregnancy complications (≥3 miscarriages, preterm delivery, pre-eclampsia) and venous thrombotic events. Our findings suggest that SCD may predispose to the generation of aPL and that aPL itself may contribute to the vasculopathy of SCD. Prospective testing for aPL is warranted in patients with SCD.

Lower haemoglobin concentrations are associated with impaired cognition in patients with carotid artery occlusion

BackgroundPatients with carotid artery occlusion (CAO) are vulnerable to cognitive impairment (CI). Anaemia is associated with CI in the general population. We hypothesized that lower haemoglobin is associated with cognitive impairment (CI) in patients with CAO and that this association is accentuated by cerebral blood flow (CBF). Methods104 patients (mean age 66±8 years, 77% men) with complete CAO from the Heart-Brain Connection study were included. Anaemia was defined as haemoglobin < 12 g/dL for women and < 13 g/dL for men. Cognitive test results were standardized into z-scores (using a reference group) in four cognitive domains. Patients were classified as cognitively impaired when ≥ one domain was impaired. The association between lower haemoglobin and both cognitive domain z-scores and the presence of CI was assessed with adjusted (age, sex, education and ischaemic stroke) regression models. Total CBF (measured with phase contrast MRI) and the interaction term haemoglobin*CBF were additionally added to the analyses. ResultsAnaemia was present in 6 (6%) patients and was associated with CI (RR 2.54, 95% CI 1.36; 4.76). Lower haemoglobin was associated with the presence of CI (RR per minus 1 g/dL haemoglobin 1.15, 95% CI 1.02; 1.30). This association was strongest for the attention-psychomotor speed domain (RR for impaired attention-psychomotor speed functioning per minus 1 g/dL haemoglobin 1.27, 95% CI 1.09;1.47) and ß for attention-psychomotor speed z-scores per minus 1 g/dL haemoglobin -0.19, 95% CI -0.33; -0.05). Adjustment for CBF did not affect these results and we found no interaction between haemoglobin and CBF in relation to cognition. ConclusionLower haemoglobin concentrations are associated with CI in patients with complete CAO, particularly in the domain attention-psychomotor speed. CBF did not accentuate this association. If validated in longitudinal studies, haemoglobin might be a viable target to prevent cognitive deterioration in patients with CAO.

Biomarker Phenotypes in Heart Failure with Preserved Ejection Fraction Using Hierarchical Clustering: A Pilot Study

Objectives: We hypothesized the existence of distinct phenotype-based groups within the very heterogeneous population of patients of heart failure with preserved ejection fraction (HFpEF) and using an unsupervised hierarchical clustering applied to plasma concentration of various biomarkers. We sought to characterize them as “biomarker phenotypes” and to conclude differences in their overall characteristics. Subjects and Methods: A cross-sectional study was conducted on 75 patients with HFpEF. An agglomerative hierarchical clustering was performed using the concentrations of cardiac remodeling biomarkers, BNP, and cystatin C. Results: According to the obtained heat map of this analysis, we concluded two distinctive biomarker phenotypes within the HFpEF. The “remodeled phenotype” presented with significantly higher concentrations of cardiac remodeling biomarkers and cystatin C (p < 0.001), higher prevalence of myocardial infarction (p = 0.047), STEMI (p = 0.045), atrial fibrillation (p = 0.047), and anemia: lower erythrocytes count (p = 0.037), hemoglobin concentration (p = 0.034), and hematocrit (p = 0.046), compared to “non-remodeled phenotype.” Echocardiography showed that patients within “remodeled phenotype” had significantly increased parameters of left ventricular remodeling: left ventricular mass index (p < 0.001), left ventricular mass (p = 0.001), diameters of the interventricular septum (p = 0.027), posterior wall (p = 0.003), and function alterations, intermediate pauses duration >2.0 s (p < 0.006). Conclusion: Unsupervised hierarchical clustering applied to plasma concentration of various biomarkers in patients with HFpEF enables the identification of two biomarker phenotypes, significantly different in clinical characteristics and cardiac structure and function, whereas one phenotype particularly relates to patients with reduced ejection fraction. These findings imply distinct underlying pathophysiology within a unique cohort of HFpEF.