Management Of Anemia Research Articles

#1275 Post-transplant renal anaemia: a call to action from a national study in routine clinical practice

Abstract Background and Aims Post-transplant anaemia (PTA) is common, frequently unnoticed and carries associated risks. Current guidelines consider the same treatment recommendations and goals for these patients as for chronic kidney disease-non dialysis (CKD-NDD). Previous reports demonstrated low awareness and management that could improve. Aims: To describe current anaemia management, goals, and adherence to guidelines in a representative sample of kidney transplant (KT) recipients. Method Retrospective nationwide multicentre study including patients from 8 KT hospitals. Nephrologists collected demographics, comorbidities, KT data and immunosuppressive therapy and data related to anaemia management (laboratory values, previously prescribed treatments, and subsequent adjustments) from electronic medical records. We classified as early anaemia that within the first 6 months. The European statement on KDIGO guidelines was the reference for definitions, drug prescriptions and targets. Results We included 297 recipients with PTA aged 62.8 y (SD 13.6) and 60% male. They had received a graft from donors after cardiac death or brain death) (61.6%. 31.1% respectively) a median of 2.5 years [0.5-8.7] before. A total of 158 patients were on treatment with erythropoietin stimulating agents (ESAs) and the distribution of haemoglobin (Hb) and iron are summarized in Table 1. Among 110 patients on ESA treatment but without iron prescription, 44 had an indication to receive iron and 30 of them had absolute iron deficiency (ID). Only 39/158 patients exceeded the ESA resistance index (ERI) limit, and this condition was more frequent in early PTA (26.1 vs 9.2%). Absolute or functional ID accounted for the majority of ESA resistance (28.2 vs 17.1; p < 0.001). Conclusion Hemoglobin levels in these patients are within the upper KDIGO. Iron therapy continues to be underused (especially intravenous), while iron deficiency and prior events explain most of ESA hyporesponsiveness. We identify missed opportunities for accurate prescription targeting and adherence to guidelines.

#1122 Anaemia in CKD and cardiovascular risk; all cut from the same cloth?

Abstract Background and Aims Anaemia in chronic kidney disease (CKD) has been repeatedly associated with increased cardiovascular morbidity and mortality, but most studies have not investigated its longitudinal association by sex and age. Our aim was to study the association between haemoglobin (Hb) current value and the hazard of major adverse cardiovascular event (MACE) in specific subgroups of CKD patients defined by age and sex. Because erythropoiesis-stimulating agents (ESA) are incriminated to modify the effect of Hb level on the hazard of event for high level of Hb, we have here only focused in non-ESA users CKD patients. Method We used data from the CKD-REIN cohort, which included 3033 patients with moderate to severe CKD from 40 nationally representative nephrology clinics in France between 2013 and 2016. We included patients with at least one Hb, estimated glomerular filtration rate (eGFR), transferrin saturation (TSAT) or ferritin measurement. We studied all Hb measurements available until a first MACE defined as the first event among cardio-vascular death, myocardial infarction, stroke or hospitalization for acute heart failure; initiation of kidney replacement therapy; death from other causes; or initiation of ESA therapy, whichever came first. First, we estimated the individual trajectories of Hb, eGFR, TSAT, ferritin using multivariate share random effect joint model. Then, we estimated the association between Hb current value and MACE using a cause specific multivariate Cox model in 4 specific subgroups separately: women ≤ and >70 years, men ≤ and >70 years. All models were adjusted on current value of eGFR, TSAT, Ferritin, and baseline value of albumin-to-creatinine ratio, age, CKD aetiology, heart failure past history, alcohol consumption, iron treatment, antithrombotic and anticoagulant. When appropriate, spline functions were used for continuous variables to account for potential non-linear effects. Reference value of Hb for computing hazard ratio was 12 g/dL in women, and 13 in men according to current definition of anaemia. Results A total of 2742 patients were included in the analysis (median eGFR 33 ml/min/1.73 m2, median age at inclusion 69 years) together with 28423 Hb measurements (median of 13 per patient) collected during a median follow-up of 5.0 years. There were 551 women ≤70 (median Hb 12.4 g/dL, 34 (6.2%) MACE), 349 women > 70 (12.2 g/dL, 61 (17.5%) MACE), 1009 men ≤ 70 (13.4 g/dL, 104 (10.3%) MACE) and 833 men > 70 (13.0 g/dL, 163 (19.6%) MACE). No statistical significant association was found in males whatever their age (Hazard ratio of MACE for each 1 g/dL increase in Hb 1.0 (95% CI 0.9-1.1) in men < 70 and 0.9 (95% CI 0.8-1.1) in men > 70). For women, the hazard of MACE raised as the Hb values decreased, with a more pronounced increase in women > 70 (Fig. 1). For example, the hazard ratio for a Hb value of 10 g/dL compared to the reference was 2.0 (95% CI 0.9-4.7) in women < 70 and 3.3 (95% CI 1.5-7.2) in women > 70. Conclusion In non-ESA users CKD patients, anaemia is associated with the occurrence of MACE in females, especially those older than 70 years. These results raise question about a one-size-fits-all approach in the interpretation of low values of haemoglobin and anaemia management. It also suggests to evaluate the effect of anaemia therapies in men and women separately.

#2243 The experience from the use of citric acid blood purification solution (CD) with l-ascorbic acid (Vitamin-C) in patients under HD

Abstract Background and Aims The use of CD offers anticoagulation with a reduced dose of heparin while the use of L-Ascorbic acid offers better management of the patients' anemia. The purpose of the study is to record the experience of using CD solution with Vitamin-C in patients with ESRD under HD Method 45 patients with ESRD under HD (40 new recruits) with an average weight of 75 kgrs received CD solution with vitamin-C (2 g/lt) for a period of 12 months. All changes in heparin dose as well as patients' anemia profile (Hb, Hct, ferritin, TSAT, rhEPO dose) were recorded. Results The initial cumulative heparin dose of 1818 ± 659.28 iu (24 iu/kgrBW) was progressively increased to 2677.41 ± 1053.15 iu (36 iu/kgrBW) at 6 months and to 3323.52 ± 1467.79 iu (44 iu /kgr/GB) at 12 months. With no observed thrombotic events or bleeding tendency, the dose of heparin used was significantly lower than the recommended doses with the classical solution (loading dose 30-50 IU/kgBW and then 10 IU/kgBW/hour). Patients' Hb and Hct progressively increased significantly (10.63 ± 1.55 start-11.79 ± 0.91 end, p < 0.05, 32.25 ± 4.45 start-36.5 ± 2, 92 end, p < 0.05) with constant weekly erythropoietin dose (14000 ± 9500 iu start-14000 ± 10000 iu end, p = NS) and stable ferritin levels (526.73 ± 498.72 iu start-690.44 ± 470.32 iu end, p = NS). The above observation was combined with a significant reduction in monthly iron administration (from 700 mg monthly initially to 200 mg monthly after one year). Conclusion Our findings suggest that the use of CD solution and vitamin C compared to the classic one offers anticoagulation with a significant reduction in the dose of heparin used, while simultaneously increasing hemoglobin with a fixed dose of erythropoietin and reduced iron administration.

#2742 Artificial intelligence accurately approximates MGPE dose response relationship in a North American Dialysis Population

Abstract Background and Aims The Anemia Control Model (ACM) is a certified medical device aimed at optimizing the management of CKD-related anemia among patients on dialysis. ACM is based on an artificial neural network (ANN) trained on over 900’000 patients treated in the European Nephrocare Network. Over the years, ACM has offered physicians hundreds of thousands of erythropoietin stimulating agent (ESA) and intravenous iron dosing suggestions and ensured high hemoglobin target achievement rate while minimizing drug use. However, evidence concerning its validity in non-European samples is still limited. Apollo Dial DB is the largest, fully anonymized, collaborative, international database of dialysis patients. The database includes detailed clinical information of more than 500,000 patients over millions of patient-months of observation with an extensive representation over geographies as well as ethnic groups. Given its detailed medical information and size, the database may offer unprecedented opportunities to develop and test equitable and fair decision support systems based on artificial intelligence. In this study we sought to re-train and validate and assess the accuracy of the ACM in an ethnically diverse sample of North American dialysis patients in Apollo Dial DB. Method We constructed the cohort for training and validation of this new ACM version by including a random sample of patients treated in the North American Fresenius Medical Care Dialysis Network. The sample accounted for 20% of the entire North American Section of the Apollo Dial DB dataset. Each patient history has been segmented in a collection of patient-months, which was the unit of analysis. The initial cohort was split in 3 datasets for training (70%), validation (20%) and test (10%). The input variables included laboratory test results, body weight, treatment data, age, sex, and previous ESA and iron prescription. The outcome of interest was the variation in serum hemoglobin concentration over 1 month of follow up. We compared the accuracy of the original ACM based on ANN (baseline model) with a newly trained algorithm based on high-performance light GBM. Results We included 44,220 patients followed by 2,277,276 patient-months overall. The mean age=60.9 ± 13.4, 59.2% were male, 56.4% were Caucasians, 32.2% African American, 3.2% Asians and 8.2% were others. At baseline, mean Hb= 10.9 ± 1.2. The original EMEA version of the Anemia Control Model (ACM) was still accurate in North American patients (mean absolute error, MAE = 0.65 g/dL). The fine-tuned light GBM model achieved a 16% reduction in error rate (MAE = 0.55 g/dL; Fig. 1). No difference in MAE was observed across sex and ethnic groups. Conclusion This study demonstrates the excellent predictive performance of the original ANN-based ACM in the North American dialysis population. Fine tuning by re-training ACM on the dataset further improved the accuracy of the model with substantial equivalence in performance across different demographics, thus ensuring algorithmic fairness. ACM is a promising tool for anemia management in ethnically diverse dialysis population and different healthcare settings.

#2895 Erythropoietin Resistance Index (ERI) between mortality and metabolic changes in a cohort of hemodialysis patients. What acts below the surface?

Abstract Background and Aims The management of anemia in hemodialysis patients (HD-ps) is influenced by many factors, including inflammation, martial balance (MB) and mineral metabolism (MM). Recent data would identify the Erythropoietin Resistance Index (ERI) as an indicator of mortality risk in HD-ps. The objective of the present study was to evaluate the relationship of ERI with inflammation, MB and MM, as well as all-cause mortality in a cohort of HD-ps. Method An observational-retrospective study was performed on 100 HD-ps, excluding those with acute or chronic infections (3 months), neoplasia, or immunosuppressive therapy. Mortality was considered primary outcome along a 2-year follow-up (FU). Results HD-ps, predominantly males, had advanced mean age, good Hb values and fair biochemical control. ERI showed significant correlations with some elements of inflammation, MM and BM (Table 1), including c-terminal fragment of Fibroblast Growth Factor 23 (cFGF23). At multivariate, ERI remained influenced by cFGF23 (p = 0.009), iron (p = 0.002) and transferrin (p = 0.007). Furthermore, after 2 years of FU, 42% of HD-ps died. As shown in Table 2, HD-ps that faced the primary outcome (death) were older, had lower levels of albumin, hemoglobin and transferrin, and higher levels of IL6, parathormone (PTH), reactive C protein (PCR), and ERI (p < 0.035). In multivariate, ERI (p = 0.011), age (p = 0.001) and albumin (p = 0.010) remained significant for the outcome studied. Conclusion Our data, albeit on few HD-ps, show a possible association between ERI and mortality. ERI was found to be related to several factors, including cFGF23, itself a factor implicated in maintaining a baseline inflammatory state. The results suggest the possible presence of some pathological mechanisms that can act silently with a negative impact on survival. Certainly, increased numbers and a prospective design could better clarify the explored relationships in the future.

#1174 Prevalence and factors contributing to erythropoietin hyporesponsiveness in CKD patients on hemodialysis: a single center, cross sectional study

Abstract Background and Aims Anemia, one of the most frequent early complications of CKD is associated with a reduced QOL, cardiovascular morbidity, accelerated CKD progression, and it is an independent predictor of mortality. The successful management of anemia is a vital part of patient care, that improves clinical outcomes. According to the literature, 90% of renal anemia patients responded in a dose-dependent manner to rHu EPO, whereas the remaining 5–10% of patients had either a blunted or absent response to this agent, despite high-dose therapy. Erythropoietin hyporesponsiveness is a strong, independent predictor of mortality risk. Various factors have been associated with ESA hypo responsiveness in different studies. Both the inability to achieve a target hemoglobin and administration of high dose epoetin -alpha are associated with increased risk of CVD complications. AIMS AND OBJECTIVES Method STUDY PERIOD: December 2021 to DECEMBER 2022 STUDY DESIGN: Observational cross sectional study. SAMPLE SIZE: N = 144: Patients older than 18 years old undergoing hemodialysis for at least 3 months before the study were enrolled. History of inpatient treatment, infection, bleeding or transfusion within the last month, hematologic disorders sickle cell disease, MDS and active malignancies were excluded. Required parameters were recorded on every month follow up;Demographic data, Cause of ESRD, Dialysis vintage, ESAs dose (Unit/week), type, Medications history; Dose (mg/week) of iron preparation & use of medication like ACEi, ARBs, dialysis adequacy(Kt/V), haemogram, Liver function test, Kidney function test Iron profile, Serum parathyroid hormone, Serum calcium & phosphorus, CRP, Anti EPO antibodies(if required). We used the European Best Practice Guideline (EBPG) II definition to define ESA hyporesponsiveness for our study purpose(Increase in erythropoietin dose ≥25% to maintain the same Hgb level or < 1 mg/dL gain in Hgb after 4 weeks. EHRI was calculated by dividing weekly ESA dose per kilogram of body weight (IU/Kg/W) by hemoglobin level (g/dL). Based on EHRI, patients were assigned or divided into 2 groups. Group I (EHRI<16) and Group II (EHRI ≥ 16). Patients in the Group II were labeled as erythropoietin hyporesponsive patients and they were compared with others in order to identify the impact of different factors on ESA. Results Among 144 patients, 80 were male and 64 females and 28.4% were diabetic. Mean EHRI were calculated for all patients and based on EHRI pts were divided into two study groups, Gr-I (EHRI<16) & Gr-II(EHRI ≥16). EHRI ≥16 group was considered as ESA hyporesponsive groups. The study parameters were compared between the groups and its statistical significance measured. The overall prevalence of ESA hyporesponsive in our study was 26.3%. Conclusion The overall prevalence of ESA hyporesponsive in our study was 26.3%. Iron deficiency anemia, inadequate dialysis, chronic inflammation, malnutrition, secondary hyperparathyroidism and increased dialysis vintage were the factors associated with ESA hyporesponsiveness.

#2652 Hemoglobin excursion outside of the target range and their associations with all-cause mortality in hemodialysis patients

Abstract Background and Aims Based on earlier analyses (Mermelstein et al., ASN Renal Week 2023), where we found an improved survival with hemoglobin levels above the currently targeted range of 10 to 11 g/dL quantified as an area under the excursion curve, we hypothesized an independent association between all-cause mortality hazard ratio and a) the number of excursions, and b) the number of days outside of the target range. Method We explored this relationship in a retrospective cohort study of incident hemodialysis patients receiving erythropoietin stimulating agent (ESA) commencing treatment Fresenius Kidney Care clinics in the US. We included patients who were given a long-acting erythropoietin stimulating agent within 90 days of dialysis initiation, considered the first six months as baseline and the following 18 months as the follow-up period. Only patients with at least 5 hemoglobin values over the first 75 days were included. We calculated the ‘area under the curve’ (AUC) above and below the target hemoglobin range of 10-11 g/dL for each patient during the baseline period, as well as days below and above range, and number of excursions below and above range. Cox proportional hazard models additionally adjusted for age, race, sex, diabetes, serum albumin, and phosphate were developed, and the hazard ratio estimates depicted in a forest plot. Results We studied 62,181 patients (57% male, 39% diabetic, mean baseline hgb 10.42 ± 0.72 g/dL, baseline AUC above target 44.36 ± 49.44 g/dL * days and 78.06 ± 86.26 g/dL * days below target). Forest plot of the HR estimates showed an increased risk of death with AUC below the lower limit of the target range (i.e. 10 g/dL), which also held true both for number of excursions and days exposed to lower hgb levels). Conversely, AUC, conversions and days spent at hgb levels higher than the upper limit of the target range (i.e. 11 g/dL), associated with a significant survival advantage. Conclusion In an effort to validate the robustness of our previously shown association between higher hgb levels and survival advantage, and to corroborate the accuracy of the utilized AUC quantification method, we separated both components of the AUC, namely into time and magnitude and quantified the independent associations with the risk of death. This allowed to discern between the associations of both to the risk of death. Consistent with the earlier results, avoiding levels below 10 g/dL and aiming for levels above the upper limit of 11 g/dL, seems to be beneficial for the anemia management of incident hemodialysis patients treated with a long-acting ESA.

Management of iron deficiency anemia in pregnancy in India: A review of current practices and challenges

Iron deficiency anaemia (IDA) is a major global health concern that can lead to difficulties for both the mother and the foetus, especially in pregnant women. The physiological demand of iron during pregnancy increases threefold to support fetoplacental development and maternal adaptation to pregnancy. This study aimed to identify gaps in current IDA management, limitations of conventional oral iron therapy, and the need for effective and well-tolerated treatments.The objective of this study was to understand the gap of current treatment options in IDA management, its limitations, and possible effective strategies for better management.A questionnaire-based opinion survey involving top gynecologists across India was conducted. The survey aimed to gather data on the challenges faced with conventional oral iron therapy, the desire for a change in oral iron salts, and the preference for novel oral iron prescriptions for their patients.Data obtained from the survey showed that 82% of gynecologists and obstetricians noticed challenges with conventional oral iron therapy. 86% wanted to change the oral iron salts, and 70% would like to prescribe novel oral iron for their patients. Ferric maltol, a novel form of chelated oral iron, was introduced as a potential solution for IDA management. It has been studied in various clinical indications, such as IDA associated with inflammatory bowel disease, chronic kidney disease, and pulmonary hypertension, showing significant improvements in hemoglobin and iron indices with good tolerability throughout treatment duration.The study results demonstrate that ferric maltol is a suitable and convenient treatment option for individuals seeking long-term, convenient, and well-tolerated management of IDA.

Efficacy of majun e khabsul hadeed in iron deficiency anemia in reproductive age group: A randomised control study

Background and Objectives: Iron deficiency is a condition in which blood lacks adequate healthy red blood cells. Women of child bearing age are at high risk. In India incidence is 74% and prevalence is 30%. The goals of treatment are to restore changes in hemoglobin levels, red cell indices and peripheral smear. Aim of the study is to evaluate the effect of majune khabsul hadeed in iron deficiency anemia in women of reproductive age group. Methods: A randomised standard controlled study, 60 patients were randomly allocated to test and control groups. Majune khabsul hadeed 5grams in test group and capsule fefol 1 in control group were given once daily for 3months. Subjective parameters viz. pallor, loss of appetite, reduced exercise capacity and fatigue were assessed at every follow up. Red cell indices, as objective parameters were assessed before and after treatment. Results: Significant changes were observed in subjective parameters with p<0.001 at each assessment in both groups. On intergroup comparison there were no significant difference with p>0.05 except for reduced exercise capacity and fatigue. Objective parameters significantly improved in both groups after treatment with p<0.001. Five (16.7%) and 4(13.3%) patients were among responders, 10(33.3%) and 14(46.7%) partial responders and 13(43.3%) and 12(36.7%) non responders to treatment in test and control groups respectively. On intergroup comparison, there was no significant difference with p >0.05 suggesting that both groups had similar effect. Conclusion: Majune khabsul hadeed is as effective as capsule fefol in the management of iron deficiency anemia in women of reproductive age group. Keywords: Iron deficiency anemia; majune khabsul hadeed; women of reproductive age; RBC indices.

Comparative evaluation of different oral iron salts in the management of iron deficiency anemia.

Anemia affects one-fourth of the world's population and is caused mostly by iron deficiency. Iron supplementation is the most essential strategy for preventing iron deficiency anemia. Conventional oral iron salts have many drawbacks such as poor absorption & bioavailability, and poor tolerability resulting in poor clinical outcomes. To compare the effectiveness and safety of ferrous ascorbate, ferrous fumarate, ferrous bis-glycinate, and Sucrosomial iron in the management of iron deficiency anemia. The study is a retrospective observational clinical study comprising 260 subjects with hemoglobin between 7-10g/dl. The patients were divided into four groups I, II, III, and IV, and received ferrous fumarate, ferrous ascorbate, ferrous bis-glycinate, and Sucrosomial iron respectively. Hematological profile and iron store indices were measured at baseline and month 3. One-way ANOVA followed by Tukey multiple comparison test was used to assess statistical significance (P < 0.05) using GraphPad Prism V.9.3.1 software. The observational study showed that hemoglobin levels were significantly increased in the ferrous ascorbate group (11.86 ± 0.09; P < 0.0001), ferrous fumarate group (11.72 ± 0.08; P < 0.0001), ferrous bis-glycinate group (11.69 ± 0.11; P = 0.0003) and Sucrosomial iron group (12.20 ± 0.1; P < 0.0001) compared to the baseline. The Sucrosomial iron-supplemented group showed significantly higher improvement in hemoglobin levels and serum ferritin levels compared to conventional oral iron salts (P < 0.05) with a better safety profile. The Sucrosomial iron showed significantly higher improvement in hemoglobin levels and higher improvement in iron store indices parameters along with a good tolerability profile compared to other conventional oral iron salts.

Modern approaches to the treatment of anemia of malignant neoplasms

Anemia in patients with cancer is a common concomitant condition. The development of anemia in cancer has a multifactorial pathogenesis, including inflammation, metastasis of solid tumors to the bone marrow and displacement of normal hematopoiesis sprouts in the bone marrow by tumor cells in hemoblastosis, myelosuppression against the background of chemo/radiation therapy, nutritional insufficiency due to anorexia, etc. Anemia in cancer patients reduces the quality of life, the response to antitumor therapy, increases the risk of tumor progression and is an independent factor negatively affecting survival. The article discusses the tactics of managing patients with anemia in accordance with the Clinical recommendations of the Ministry of Health of the Russian Federation “Anemia in malignant neoplasms” and “Management of CancerAssociated Anemia With Erythropoiesis-Stimulating Agents: ASCO/ASH Clinical Practice Guideline Update”. The results of clinical studies are presented, which indicate the effectiveness of the use of erythropoiesis-stimulating drugs (including epoetin alpha) in oncological practice, which reduce the need for hemotransfusions and increase hemoglobin levels in patients with anemia against the background of antitumor chemotherapy.

Prevalence trends of anemia impairment in adolescents and young adults with HIV/AIDS

BackgroundAnemia is a common complication of HIV/AIDS, particularly in adolescents and young adults across various countries and regions. However, little is known about the changing prevalence trends of anemia impairment in this population over time.MethodsData on anemia in adolescents and young adults with HIV/AIDS from 1990 to 2019 were collected from the Global Burden of Disease. Prevalence was calculated by gender, region, and country for individuals aged 10–24, and trends were measured using estimating annual percentage changes (EAPC).ResultsGlobally, the prevalence of adolescents and young adults with HIV/AIDS increased from 103.95 per 100,000 population in 1990 to 203.78 in 2019. However, anemia impairment has decreased over the past three decades, with a global percentage decreasing from 70.6% in 1990 to 34.7% in 2019, mainly presenting as mild to moderate anemia and significantly higher in females than males. The largest decreases were observed in Central Sub-Saharan Africa, North America, and Eastern Sub-Saharan Africa, with EAPCs of -2.8, -2.34, and -2.17, respectively. Tajikistan (78.76%) and Madagascar (74.65%) had the highest anemia impairment percentage in 2019, while China (16.61%) and Iceland (13.73%) had the lowest. Anemia impairment was closely related to sociodemographic index (SDI) levels, with a high proportion of impairment in low SDI regions but a stable decreasing trend (EAPC = -0.37).ConclusionContinued anemia monitoring and management are crucial for patients with HIV, especially in high-prevalence regions and among females. Public health policies and interventions can improve the quality of life and reduce morbidity and mortality.

Challenges in the diagnosis and management of autoimmune hemolytic anemia: A case-based approach. Experience from a tertiary care hospital in the Haryana region.

Autoimmune hemolytic anemia (AIHA) is a rare immune disorder which occurs when antibodies are directed against self red blood cells (RBCs) leading to hemolysis. AIHA is widely classified as warm autoimmune hemolytic anemia, cold agglutinin syndrome, mixed AIHA, paroxysmal cold hemoglobinuria and rarely drug induced AIHA. The pathogenesis of AIHA is complex interplay between genetic predisposition, immune dysregulation and enviornmental triggers. A direct antiglobulin test can be used to assess the immunological origin of the hemolysis in order to diagnose AIHA after identifying laboratory and clinical symptoms of hemolysis. The objective is to understand underlying mechanism in AIHAs, and usage of targeted therapies to modulate specific components of the immune response. We are hereby presenting a case series of 11 clinically suspected cases of AIHA in collaboration with their clinical features, immuno-hematological and other laboratory parameters, Flow cytometric analysis of lymphocyte subset in relevant cases, underlying etiology as well as serological subtype are also included. Majority of the patients were categorized as secondary AIHA (7/11, 63.63%). Out of 11 cases 7 were serologically subtyped as warm AIHA (7/11, 63.63%) ,2 cases were DaaT negative AIHA (2/11;18.18%), 2 cases were characterized as mixed AIHA subtype (2/11, 18.18%). Accurate subtyping of AIHA requires a systematic immunohematological approach coupled with comprehensive evaluations of clinical, hematological, and biochemical parameters.

Pharmacological action of epoetin beta in the treatment of anemia in patients with kidney diseases

Chronic kidney disease is becoming one of the leading causes of death globally. Anemia, a common complication in chronic kidney disease, not only diminishes patients’ life quality but also increases the risk of heart-related problems. The use of recombinant human erythropoietin has revolutionized the treatment of anemia in chronic kidney disease patients. By reaching the desired levels of hemoglobin with recombinant human erythropoietin, patients experience significant improvements in life quality and a decrease in death rates. Epoetin beta is among the various erythropoiesis stimulating agents available in the market. Research indicates that weekly doses of epoetin beta are as effective as three weekly doses of epoietin alpha for reaching hemoglobin goals in patients undergoing renal replacement therapy. This not only enhances patients’ adherence to the treatment but also cuts down on the time and costs associated with managing renal anemia, thus allowing for a therapy that is more tailored to patient needs. On the one hand, this improves patients’ adherence to the treatment. On the other hand, the time and cost burden in the management of renal anemia is decreased due to reduction in recombinant human erythropoietin prescribing rates, which eventually makes it possible to better tailor therapy to the patients’ needs. The proven efficacy and safety profile of epoetin beta combined with the increased convenience of less frequent dosing, make epoetin beta a safe and effective treatment option that can help more patients with chronic kidney disease to reach their target hemoglobin levels.

Prevalence and contributing factors of anemia in patients with gynecological cancer: a retrospective cohort study

This retrospective cohort study aimed to determine the prevalence of anemia among patients with gynecological cancer prior to any treatment and to identify contributing factors associated with anemia in this group. We retrospectively analyzed data from female patients aged 18 and above, diagnosed with various forms of gynecological cancer at The Affiliated Hospital of Southwest Medical University between February 2016 and March 2021. Anemia was assessed based on the most recent CBC results before any cancer treatment. Eligibility was based on a definitive histopathological diagnosis. Key variables included demographic details, clinical characteristics, and blood counts, focusing on hemoglobin levels. Statistical analysis was conducted using logistic regression models, and anemia was defined as hemoglobin levels below 12 g/dL for women, according to WHO criteria. Of the 320 participants, a significant prevalence of anemia was found. Correlations between anemia and factors like age, educational level, and biological markers (iron, folic acid, and vitamin B12 levels) were identified. In our study, we found that the prevalence of anemia among patients with gynecological cancer prior to any treatment was 59.06%, indicating a significant health concern within this population. The study highlights a significant prevalence of anemia in patients with gynecological cancer, emphasizing the need for regular hemoglobin screening and individualized management. These findings suggest the importance of considering various characteristics and clinical variables in anemia management among this patient group. Further studies are needed to explore the long-term effects of these factors on patient outcomes and to develop targeted interventions.

Current approach to the management of preoperative iron deficiency anemia in colorectal cancer patients: a review of literature.

&lt;b&gt;Introduction:&lt;/b&gt; The prevalence of preoperative anemia is the highest in the group of colorectal cancer (CRC) patients and may reach over 75%. The prevalence of anemia in CRC patients increases even further following surgery. Approximately 75-80% of anemic CRC patients present with absolute or functional iron deficiency (ID). Preoperative anemia constitutes an independent risk factor for allogeneic blood transfusion (ABT), postoperative complications, prolonged length of hospital stay, and increased mortality. ABT is itself associated with increased morbidity and mortality.&lt;b&gt;Aim:&lt;/b&gt; The aim of this review article was to present the pathophysiology and the current approach to the diagnostics and treatment of preoperative iron deficiency anemia (IDA) in CRC patients.&lt;b&gt;Material and methods:&lt;/b&gt; Extensive search of medical literature databases was performed (Pubmed, Embase). The key words that were used were as follows: CRC, colorectal surgery, ID, IDA, intravenous iron, Patient Blood Management (PBM).&lt;b&gt;Results:&lt;/b&gt; There are several laboratory parameters that can be used for IDA diagnosis, however, the simplest and most cost- -effective is reticulocyte hemoglobin equivalent (RET-He). Pathophysiologic features of IDA in CRC patients favor treatment with intravenous, as opposed to oral, iron formulations. Applying PBM strategies minimizes the exposure to ABT.&lt;b&gt;Conclusions:&lt;/b&gt; Preoperative IDA is highly prevalent among CRC patients. Preoperative anemia is an independent risk factor for ABT, increased morbidity and mortality, as well as prolonged hospital length of stay. The same negative consequences are associated with ABT. Therefore, preoperative IDA in CRC patients needs to be screened for, diagnosed, and treated before surgery. Effective treatment of preoperative IDA in CRC patients is with intravenous iron formulations. ABT should be the treatment of last resort due to the risk of negative clinical consequences, including an increased rate of cancer recurrence.

Short versus long-acting erythropoiesis-stimulating agents for anemia management in Egyptian hemodialysis patients.

Chronic kidney disease (CKD) often results in renal anemia, impacting the well-being of patients and causing various negative consequences. Erythropoiesis-stimulating agents (ESAs) offer promising solutions for managing anemia in CKD. This study aimed to evaluate and compare the effectiveness, safety profile, and cost-effectiveness of short-acting (Eprex®) and long-acting (Aranesp®) ESAs. This comparative prospective cohort cost-effectiveness study was carried out over 6 months among adult Egyptian hemodialysis patients of either gender. Participants were categorized into two groups based on the type of ESA administered: the Eprex group, receiving epoetin alfa, and the Aranesp group, receiving darbepoetin alfa. These two treatment groups' efficacy, safety, and cost were analyzed and compared. Of 127 hemodialysis patients, 60 (47.2%) received Eprex, while 67 (52.8%) were treated with Aranesp. Target hemoglobin (Hb) was achieved by 50.6% of patients in the Eprex group versus 63.4% in the Aranesp group, with a significant difference (P < 0.001). Both treatment groups exhibited a similar safety profile, while Aranesp® was considered the cost-saving protocol. In hemodialysis Egyptian patients, Aranesp with extended dosing intervals proved to be more effective in achieving target Hb with comparable adverse effect profiles, a substantial cost-saving strategy, and offered time-saving advantages for medical staff workload compared to Eprex. The Clinicaltrial.gov registration ID is NCT05699109 (26/01/2023).

Haematinic Pill Chart Partner – An Innovative Production for the Management of Anaemia in Pregnancy in Perak, Malaysia

Anaemia is one of the most prevalent health problems in the world, affecting almost half a billion women of reproductive age.1 Major recognised contributing factor of anaemia in pregnancy is iron and folate deficiency. Many antenatal patients are not adherent to the iron supplementations prescribed. The objectives of this innovation, Haematinic Pill Chart Partner (HPCP), was to improve compliance of iron supplementation by antenatal anaemic patients, to achieve Hb &lt; 11 gm% at 36 weeks of pregnancy, to provide comprehensive and effective health education to all antenatal patients, to reduce time of consultation as well as to produce a pill chart in a cost effective manner. Time taken for initial doctor’s consultation pre and post HPCP was analysed from the clinic’s antenatal record book. 10 patients in January 2018 (pre-intervention) and 12 patients in January 2019 (post-intervention) were compared. Mean time taken and cost for production of one pill chart were calculated. There was marked reduction in the percentage of antenatal patients with Hb &lt; 11gm% at 36 weeks of pregnancy by 6.9%; from 8.3% in 2018 to only 1.4%. HPCP proved to be comprehensive and effective. 20 patients (100%) were satisfied (Patient’s Satisfaction Survey) and 5 doctors (100%) were satisfied (Doctor’s Satisfaction Survey) using HPCP. There was marked reduction in time taken (26 minutes) for doctor’s consultation. Cost of production of one HPCP was only RM 8.00. HPCP was found to be a very useful, user-friendly, and effective in the management of anaemia in pregnancy in Buntong Health Clinic.

Correlates for Transfusion at Delivery Among Latinx Birthing Patients at a Tertiary Care Center [ID 2683569

INTRODUCTION: We observed a higher transfusion rate among Latinx compared to non-Latinx individuals. We sought to determine whether this disparity resulted from preexisting anemia or acute blood loss at delivery, to devise targeted prevention strategies. METHODS: We conducted a retrospective cohort study of 1,960 births between April 1, 2021, and March 31, 2022. Demographic and obstetric factors, hematocrit (Hct), pregnancy outcomes, and anemia treatment were abstracted. Anemia was defined as Hct less than 33%. Statistical differences between groups were evaluated by chi-squared or independent-sample t-tests. Odds ratios (ORs) and 95% CIs were calculated by logistic regression, adjusting for confounders. RESULTS: Transfusion at delivery occurred among 21 (8.0%) Latinx and 77 (4.5%) non-Latinx patients (OR 1.84; 95% CI, 1.12–3.04; P=.015). Latinx patients were younger (mean 30 versus 32 years; P&lt;.001), more likely to receive Medicaid (85% versus 80%; P=.05), not speak English (21% versus 6%; P&lt;.001), deliver preterm less than 37 weeks (33% versus 19%; P&lt;.001), and have complex cesarean delivery (CD) (5.7% versus 3.2%; P=.049). Preexisting anemia was statistically associated with transfusion (P&lt;.001) but not with Latinx ethnicity. Oral and intravenous iron did not differ between groups. After adjustment for anemia and CD, Latinx ethnicity remained significantly associated with transfusion (adjusted OR 1.73; 95% CI, 1.18–2.28; P=.04). CONCLUSION: Latinx patients were more likely to require complex CD; with preexisting anemia, this likely increased the risk for transfusion. Recognition of risk factors for complex CD in addition to prompt diagnosis and management of anemia are key for preventing transfusions.

Anemia Status Changes Among Patients With Obesity Following Bariatric Surgery.

Objective This study aims to investigate trends in anemia severity among patients with pre-existing anemia who underwent bariatric surgery due to obesity. It also examines how different bariatric surgery techniques impact anemia outcomes. Methods This prospective study included 280 patients aged 18 to 65 with obesity who underwent bariatric surgery. The patients were categorized into three groups based on the type of surgery: sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass. Anemia severity was evaluated over a 12-month follow-up period. Chi-square tests were used to assess the homogeneity of baseline factors among the groups, and McNemar tests along with generalized estimating equations were used to compare anemia outcomes. Results Before surgery, the rates of moderate anemia across the three surgical groups ranged from 18.2% to 22.4%, with no cases of severe anemia observed. There was no significant difference among the groups (p=0.949). During the 12-month follow-up, the odds ratio for reducing anemia severity in the sleeve gastrectomy and Roux-en-Y gastric bypass groups were 2.13 and 1.91, respectively, compared to the one-anastomosis gastric bypass group. Additionally, the odds ratio for reducing anemia severity in patients with hypothyroidism was 1.84 compared to those without hypothyroidism. Conclusion The choice of bariatric surgery technique significantly affects anemia outcomes, with sleeve gastrectomy showing a higher success rate in reducing anemia severity. The role of hypothyroidism in anemia management also appears to be significant.