Mean Corpuscular Volume Levels Research Articles

A Patient Event Diary Improves Self-Management In Pediatric Sickle Cell Disease Patients

IntroductionPromotion of chronic illness self-management is crucial to improve outcomes of children with sickle cell disease (SCD). Improvements in patient outcomes and quality of life as well as enhancement in health literacy and patient agency are also imperative. Through an event diary developed by the Bronx Lebanon Hospital Sickle Cell Program, our pediatric SCD patients are better able to track significant health events and health care appointments. This study seeks to validate the effectiveness of the patient event diary as a tool for improvement in self management, allowing for improvement in medication and clinic visit compliance, as well as in a reduction in number of emergency room visits. Additionally, the education section at the beginning of the diary has become an integral teaching tool and reference for patients and their families. It is our hypothesis that the event diary as an educational tool, a self management tool, and a tool for providers, will lead to better management of chronic illness and improved patient outcomes. MethodsWe utilized laboratory and demographic data from the Bronx Lebanon Hospital Center patient electronic medical record between July 2011 and July 2013. Our sample included a population of 50 sickle cell disease patients aged 0 to 21, median age being 7 years. Sickle cell disease types included SS (64%), SC (32%), Sβ+ thalassemia and Sβ0thalassemia (4%). We used a paired, two tailed t-test to assess patients' medication compliance on vitamin D (22 patients) and hydroxyurea (14 patients) through 25-hydroxyvitamin D (25-OHD) and MCV (mean corpuscular volume) levels, respectively. Increased MCV was used as a proxy to indicate improved medication compliance in patients on hydroxyurea. We compared patients on hydroxyurea and vitamin D six months before receiving the event diary and six months after.Additionally, we compared compliance with hematology clinic visits one year before and one year after receiving the event diary. We also compared the number emergency room visits during the year before and the year after patients received the event diary. Results25-OHD data from six months after receiving the event diary showed significantly improved compliance with vitamin D treatment (M = 47, SD = 20) as compared to six months before receiving the event diary (M = 26, SD = 15), t(20) = 2.1, p < 0.05. Additionally, there was a statistically significant improvement in MCV levels six months after receiving the event diary (M=101.6, SD=9.6), as opposed to six months before receiving it (M=97.7, SD=5.6), t(12)=2.2, p<0.05. When looking at patient hematology clinic appointment compliance, there was an improvement, however not statistically significant, in compliance with appointments between one year before (M=33.3%, SD=41.7%) and one year after patients received the event diary (M= 27.2%, SD=30.3%), t(17)=2.1, p=0.2. Emergency department visits did decrease, however not significantly, one year before receiving the event diary (M=1.8, SD=2.5) to one year after receiving the event diary (M= 1.3, SD=1.9), t(47)=2.0, p=0.17. ConclusionsThese data suggest the patient event diary has significantly improved patient self-management. We believe this effect is due to enhanced understanding of disease processes and increased confidence and skills in self-management of the disease. There is improved compliance with hydroxyurea and vitamin D, as well as a trend toward improvement in clinic visit compliance and decreased emergency room visits. The patient event diary is crucial to improved patient outcomes in the pediatric SCD population, and may be useful for other pediatric populations with chronic illness. It is a significant part of our current practice and our ability to teach and empower patients and their families to manage sickle cell disease while at home. Additionally, this tool allows for better management of patients by providers. The event diary helps to elucidate difficulties in patient self-management and gives better insight into complications patients are experiencing at home. In the future, we hope to see that with improved patient knowledge of sickle cell disease and self-management facilitated by use of the event diary, there will be significantly fewer emergency room visits, fewer hospital admissions, and most important, quality of life. Disclosures:Moulton:HRSA: Research Funding; New York State Grant: Research Funding.

Distinct Roles For Hepcidin and Interleukin 6 In The Recovery From Anemia Following Administration Of Heat-Killed Brucella Abortus

Anemia of inflammation (AI) is a complex condition commonly observed in chronic inflammatory states and associated with poor health outcomes and low quality of life. Increased hepcidin (Hamp) expression triggered by interleukin-6 (IL6) is a hallmark of AI and is responsible for iron-restricted erythropoiesis and anemia. Several translational studies have been aimed at neutralizing Hamp overexpression as a therapeutic strategy against AI. However, additional Hamp-independent mechanisms contribute to AI, which are likely mediated by a direct effect of inflammatory cytokines on erythropoiesis.In our study, we investigated the distinct roles of iron metabolism and inflammation triggered by Hamp and IL6 in AI. We utilized Hamp-knockout (Hamp-KO), IL6-KO, and wild-type (WT) mice in which we induced inflammation with an intraperitoneal injection of heat-killed Brucella abortus (HKBA). In these mice, we characterized erythropoiesis with weekly CBC, FACS, and red blood cell (RBC) lifespan analysis. In addition, we measured cytokine expression, iron and transferrin (Tf) saturation in sera as indicators of inflammation and iron availability reflecting of iron stores.CBC analysis showed that hemoglobin (Hb) reached a nadir 2 weeks after HKBA injection in WT mice (6.0±1.1 g/dl), and 1 week after HKBA injection in IL6-KO (8.8±1.8 g/dl), and Hamp-KO mice (11.3±1.0 g/dl) (N=10/group), demonstrating that knockout mice were partially protected against HKBA-induced anemia. Additionally, knockout mice fully recovered within 3-4 weeks, whereas WT mice required more than 6 weeks. Mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), and reticulocyte hemoglobin content (CHr) were decreased in both WT and IL6-KO mice after HKBA, although values were higher in the latter. Interestingly, Hamp-KO mice showed the highest levels of serum iron, Tf-saturation, MCH, MCV and CHr, indicating that the mild anemia induced by HKBA in these mice was a consequence of superior hemoglobinization of their reticulocytes and RBCs. Iron-depleted Hamp-KO mice were still less sensitive to HKBA administration, suggesting that lack of Hamp expression was contributing to protect these mice from anemia, rather than merely iron overload.FACS analysis performed 3 days after HKBA injection showed that BM erythropoiesis was disrupted in all treated mice. After 1 week, only IL6-KO mice were recovering, although their marrow erythroid progenitors were still reduced compared to PBS-treated mice. The faster recovery in IL6-KO mice was supported by the increased production of reticulocytes compared to Hamp-KO and WT mice. After 1 week, we observed stress erythropoiesis in the spleen of all mice, which was most significant in Hamp-KO, who also showed the highest levels of erythropoiesis in the spleen at steady state. Further investigation of stress erythropoiesis in phlebotomized WT mice injected with HKBA demonstrated that spleen erythropoiesis was partially spared from the inflammatory insult.We showed that a shortened RBC lifespan was contributing to anemia in HKBA-treated mice, and that impaired production of RBCs was accompanied by an increased rate of elimination. In fact, by FACS analysis we characterized macrophages (Gr1-/CD115-/SSClow/F4/80hi) engulfing erythroid cells (Ter119+) by discriminating multiplets vs. single cells (SSC-H vs. SSC-A), and observed that hemophagocytosis was occurring in HKBA-treated mice.Finally, we analyzed 58 inflammatory cytokines (RodentMap, Myriad RBM) from mouse sera and showed that HKBA administration changed the level of expression of inflammatory molecules more substantially in Hamp-KO than in IL6-KO compared to WT mice (26 cytokines changed in Hamp-KO mice, with fold change > or <1.5 vs. 1 changed in IL6-KO mice; P<.001). This indicated that lack of Hamp influences cytokine expression more significantly than lack of IL6 after HKBA injection. Further analyses are in progress to define the function and pathways that correlate the different cytokines.In conclusion, we showed that both IL6 and Hamp ablation offered protection against AI and that IL6-KO and Hamp-KO mice exhibited different patterns in the development and resolution of anemia. We believe that our data support the notion that not only IL6 and Hamp play distinct roles in modulating erythropoiesis in AI, but also that cytokines could be targeted as a therapeutic approach to improve marrow erythropoiesis in AI.</abstract> Disclosures:Sasu:Amgen Inc.: Employment. Cooke:Amgen Inc.: Employment. Rivella:Novartis: Consultancy; Bayer: Consultancy; Isis: Consultancy, Research Funding; Merganser: Equity Ownership, Research Funding; Biomarin: Consultancy; Alexion: Consultancy; Imago: Consultancy.

Coexistence of Two β-Globin Gene Deletions in a Chinese Girl with β-Thalassemia Minor

This study reports a rare case of β41/42,Cap/βA genotype in a girl with β-thalassemia (β-thal) minor. The 13-month-old Chinese proband suffered anemia, diarrhea, stunted growth and emaciation. The routine polymerase chain reaction-reverse dot-blot (PCR-RDB) test result for β-thal mutations indicated that she was a compound heterozygote for β41/42 and βCap. However, the complete blood cell (CBC) test gave the following results: mean corpuscular volume (MCV) 79.8 fL, mean corpuscular hemoglobin (MCH) 19.9 pg, with a Hb A2 value of 5.66%, suggesting that the proband also was β-thal minor. The proband’s father showed typical microcytic hypochromic anemia characteristics with a decreased MCV and MCH (63.1 fL and 20.9 pg, respectively) and an increased level of Hb A2 (5.60%), while the proband’s mother had normal levels of MCV, MCH and Hb A2. The PCR-RDB test result showed her father was also a compound heterozygote for the β41/42 (HBB: c.126_129delCTTT) and βCap (HBB: c.-11_-8delAAAC) mutations and her mother was normal. Finally, DNA sequencing identified that the β41/42 and βCap mutations of the proband were inherited from her father and located on one β-globin gene, suggesting that the proband’s genotype is β41/42,Cap/βA.

Red Cell Distribution Width Identifies Cerebral Venous Sinus Thrombosis in Patients With Headache

Diagnosing cerebral venous sinus thrombosis (CVST) in patients referring to emergency service or neurology outpatient unit with complaints of headache is a challenging task. Magnetic resonance (MR) venography is the gold standard, but there are limitations regarding its use. To evaluate the validity of red cell distribution width (RDW) in CVST diagnosis in patients presenting with headache. A total of 138 patients comprising 37 patients with CVST and 101 control primer headache cases were included in this retrospective cross-sectional study. Control group consists of hospitalized patients with primary headache. Venous blood hemoglobin (Hb), platelet, mean corpuscular volume (MCV), RDW, fibrinogen, and vitamin B12 levels of the patients were recorded at the first referral. Diagnosis of CVST was established by MR venography. The RDW ratio of patients with a diagnosis of CVST was significantly higher than that in patients with primary headache (15.3 ± 1.4 vs 13.3 ± 0.5; P <.0001). Fibrinogen and vitamin B12 levels were not significantly different between the 2 groups. In a total of 11 patients, there was more than 1 thrombosis. In 21 of the patients with CVST, gene mutation was detected. There was no significant difference between the patients with and without mutations regarding RDW values. Diagnostic validity of RDW was found to be excellent in differentiating patients with CVST and primary headache (area under the curve = 0.996; 95% CI: 0.990-1.000). Optimum RDW cutoff value was determined as 14.1% (sensitivity: 91.9%, specificity: 99%, positive predictive value: 92.8, negative predictive value: 0.082). We suppose that among patients presenting with the complaint of headache, RDW value may lead to diagnose CVST.

Mean Corpuscular Volume (MCV) Values Reflect Therapeutic Effectiveness in Zidovudine‐Receiving HIV Patients

An increase of the mean corpuscular volume (MCV) of erythrocytes and alterations in the lipid profiles have been described in HIV-infected patients under combination of anti-retroviral treatment (cART), particularly zidovudine (AZT). In 687 sera from 179 HIV-positive patients, MCV levels were correlated with the clinical outcome or therapeutic effectiveness. The sera were classified into three groups according to AZT treatment; cART with AZT (n = 317), cART without AZT (n = 262), and no anti-retroviral therapy (n = 108). The MCV and lipid profile values were increased after cART. The AZT-based cART group had higher MCV levels (111.6 ± 7.0 vs. 97.8 ± 7.0 fl, P < 0.001) and a higher incidence of macrocytosis (>99 fl; 95.3% vs. 38.2%, P < 0.001) than the non-AZT-based cART group. The receiver operating characteristic curve analysis showed that the area under the curve was 0.835 and the cut-off of MCV (>102 fl) had a sensitivity of 96.1% and specificity of 66.7% for detecting HIV-RNA (-) sera in AZT-based cART group. In the multivariate regression analysis, HIV-viral load and HDL-cholesterol were the only significant correlates to the MCV values in the AZT-base cART group (P < 0.05). The MCV values could be used as a surrogate marker to monitor the clinical outcome of HIV-infected patients receiving AZT-based cART.

Anemia in Patients with Coinherited Thalassemia and Glucose-6-Phosphate Dehydrogenase Deficiency

Thalassemia and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency are genetic disorders that cause hemolytic anemia. In areas with high frequencies of both hematological disorders, coinheritance of G-6-PD deficiency with thalassemia can be found. Whether G-6-PD deficiency, coinherited with thalassemia, enhances severe anemia is still unclear. Hematological parameters between thalassemia carriers with G-6-PD deficiency and those without G-6-PD deficiency were compared. The G-6-PD deficiency was diagnosed in 410 blood samples from thalassemia patients using a fluorescent spot test. The levels of hemoglobin (Hb), packed cell volume (PCV), mean corpuscular volume (MCV) and Hb A2/Hb E [β26(B8)Glu→Lys; HBB: c.79G>A] were measured using an automated blood counter and high performance liquid chromatography (HPLC), respectively. The G-6-PD deficiency was found in 37 samples (9.02%). Mean levels of Hb, PCV, MCV and Hb A2/E were similar between the two groups. Thus, G-6-PD deficiency did not enhance red blood cell pathology or induce more anemic severity in thalassemia patients.

Alcohol Consumption in Patients with Psoriasis and its Relationship to Disease Severity

Moderate to severe psoriasis is associated with increased alcohol intake and excessive mortality from alcohol-related causes. Alcohol biomarkers are those providing an objective measurement of its consumption. The objective of this study is to assess alcohol consumption in a cohort of patients with psoriasis and to investigate the influence of alcohol intake on disease severity. Patients with psoriasis hospitalized at the Clinic of Dermatology, in Mother Teresa University Hospital were recruited in this cross- sectional study. Alcohol consumption was assessed via CAGE questionnaire and the self- reported amount of alcohol consumed, whereas disease severity was evaluated via PASI scoring system. Blood specimens were taken at admission and levels of gamma glutamyltransferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and mean corpuscular volume of erythrocytes (MCV) were measured. Statistical analysis was performed using SPSS 20.0 statistical package. A total of 62 in- patients completed the study. Significant correlations were observed between GGT and AST values with raki and beer consumption, ALT value with raki, beer and wine consumption and MCV value with raki consumption. Disease severity did not correlate significantly with raki and beer consumption (p&gt; 0.05). Logistic regression analysis between Psoriasis Area and Severity Index (PASI) score and raki consumption in male patients with psoriasis duration of more than 3 years resulted in statistical significance (b= 23.5, p&lt; 0.05). Combination of parameters related to chronic alcohol consumption offers advantage over every isolated test. Measurement of simple laboratory parameters combined with self- report methods of consumption allows identification of users.

Alteration of haematolocial parameters of "zeol fish"- Clarias batrachus exposed to malathion

Clarias batrachus, locally called zeol fish, reared in fresh water on protein diet were exposed to 5% (8.77 mg/l active ingredient) and 10% (17.74 mg/l active ingredient) concentrations of malathion at 24 h intervals, for three weeks in cement tanks containing 580 liters of water with a constant flow (1.5/1 min) of aerated dechlorinated tap water with no recirculation under natural light. Weekly two cc venous blood was drawn from each sample to determine the haematolocial parameters using EDTA (ethylenediamine tetraacetic acid) as an anticoagulant. The findings of this study showed that malathion in different concentrations have some diverse effects on the haematological parameters of Clarias batrachus. Exposer to 10% concentration of malathion was found to have a lethal effect on RBC, thrombocyte, neutrophil and Hb concentration which caused death of the fish with the sign of hypochromic microcytic anemia. Exposer to 5% concentration, on the other hand, showed leucopoenia due to decreased leucocyte counts. Haemoglobin (Hb) concentrations and values of mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), mean corpuscular volume (MCV) and differential count of WBC levels showed decreased values at 5% concentration of malathion. Significant decrease (P&lt;0.05) in Hb and concentration and MCH were observed during the exposer to the pesticide malathion. No significant difference (P&gt;0.05) was observed in the levels of RBC, MCHC, PCV, MCV and WBC. DOI: http://dx.doi.org/10.3329/bjz.v40i2.14311 Bangladesh J. Zool. 40(2): 183-188, 2012

The Comparison of the Efficiency of Once, Twice or Three Times Daily Oral Doses of Ferrous Sulphate in the Treatment of Iron Deficiency Anemia Among Children

Objective: We aimed to compare the effectiveness of once, twice or three times daily oral 6 mg/kg ferrous sulphate treatment in three months period in children below 6 years of age with iron deficiency anemia. Methods: One hundred and fifty six children with iron deficiency anemia were randomized to three age, and sex- matched groups consequetively. Hematologic parameters at admission, first, and third months of treatment were studied. For statistical analysis X2 test, one way analysis of variance and repeated measures analysis of variance were used. Results: Ninety of 156 subjects completed the trial. There was a significant rise in mean hemoglobin, mean corpuscular volume, serum iron and ferritin levels and decrease in red cell distribution width and total iron binding capacity in all three groups when values were compared at admission, 1st and 3rd months of treatment but there was not a statistical difference between groups. Mild gastrointestinal side effects of iron treatment were observed in all three groups and there was no statistically significant difference between the groups with respect to side effects. Conclusion: In treated cases, single dose iron treatment was as effective as twice or three times daily iron treatment and there was no difference between side effects of iron treatmemt. In this way, single dose daily iron regimen could improve the compliance with treatment of iron deficiency anemia in children.

Iron deficiency in chronic heart failure: An international pooled analysis

Iron deficiency (ID) is an emerging problem in patients with chronic heart failure (HF) and can be a potential therapeutic target. However, not much is known about the prevalence, predictors, and prognosis of ID in patients with chronic HF. In an international pooled cohort comprising 1,506 patients with chronic HF, we studied the clinical associates of ID and its prognostic consequences. Iron deficiency (defined as a ferritin level <100 μg/L or ferritin 100-299 μg/L with a transferrin saturation <20%) was present in 753 patients (50%). Anemic patients were more often iron deficient than nonanemic patients (61.2% vs 45.6%, P < .001). Other independent predictors of ID were higher New York Heart Association class, higher N-terminal pro-brain-type natriuretic peptide levels, lower mean corpuscular volume levels, and female sex (all P < .05). During follow-up (median 1.92 years, interquartile range 1.18-3.26 years), 440 patients died (29.2%). Kaplan-Meier survival analysis revealed ID as a strong predictor for mortality (log rank χ(2) 10.2, P = .001). In multivariable hazard models, ID (but not anemia) remained a strong and independent predictor of mortality (hazard ratio 1.42, 95% confidence interval 1.14-1.77, P = .002). Finally, the presence of ID significantly enhanced risk classification and integrated discrimination improvement when added to a prediction model with established risk factors. Iron deficiency is common in patients with chronic HF, relates to disease severity, and is a strong and independent predictor of outcome. In this study, ID appears to have greater predictive power than anemia.

Identification of a Novel Quantitative Trait Nucleotype Related to Iron Status in a Calcium Channel Gene

Several iron-related parameters have been reported to show significant heritability, and thus, seemed to be genetically regulated. A genome wide family-based study revealed two regions that showed a linkage signal with transferrin receptor levels. The aim of the study was to identify genetic markers associated with iron status biomarkers. Ten SNPs selected from the literature were tested, and parameters related to iron metabolism were analysed, in a group (n=284) of Spanish women. Data were analyzed using Bayesian Model Averaging (BMA) test and decision trees. The rs1375515, located in an intronic region of the calcium channel geneCACNA2D3, showed strong associations with levels of mean corpuscular volume according to BMA test, and with levels of haemoglobin and ferritin according to decision trees. The allele G was associated to low levels of these parameters which suggests higher iron deficiency anaemia risk. This SNP along with the C282Y mutation explained significant differences in the distribution of individuals in three iron-related clinical phenotypes (normal, iron deficient and iron deficiency anaemic). In conclusion, the rs1375515, or other genetic polymorphisms in linkage, may play important roles in iron status, probably by affecting the function of a calcium channel. These findings may be useful for further investigation in the etiology of iron diseases.

Identification of a novel quantitative trait nucleotype related to iron status in a calcium channel gene.

Several iron-related parameters have been reported to show significant heritability, and thus, seemed to be genetically regulated. A genome wide family-based study revealed two regions that showed a linkage signal with transferrin receptor levels. The aim of the study was to identify genetic markers associated with iron status biomarkers. Ten SNPs selected from the literature were tested, and parameters related to iron metabolism were analysed, in a group (n=284) of Spanish women. Data were analyzed using Bayesian Model Averaging (BMA) test and decision trees. The rs1375515, located in an intronic region of the calcium channel gene CACNA2D3, showed strong associations with levels of mean corpuscular volume according to BMA test, and with levels of haemoglobin and ferritin according to decision trees. The allele G was associated to low levels of these parameters which suggests higher iron deficiency anaemia risk. This SNP along with the C282Y mutation explained significant differences in the distribution of individuals in three iron-related clinical phenotypes (normal, iron deficient and iron deficiency anaemic). In conclusion, the rs1375515, or other genetic polymorphisms in linkage, may play important roles in iron status, probably by affecting the function of a calcium channel. These findings may be useful for further investigation in the etiology of iron diseases.

Relationship Between Mean Corpuscular Volume and Cognitive Performance in Older Adults

To examine the relationship between erythrocyte mean corpuscular volume (MCV) and cognitive performance over time. Longitudinal. Sample from the Baltimore Longitudinal Study of Aging (BLSA). Eight hundred twenty-seven participants from the BLSA (mean age 67, range 50-96). Mean corpuscular volume and several other blood indices were measured, including hemoglobin, iron, ferritin, vitamin B12, folate, white blood cell count, albumin, and erythrocyte sedimentation rate. Cognitive performance was examined using neuropsychological measures of visual memory, verbal memory, language, attention, executive function, and global mental status. High MCV levels were significantly associated with lower global mental status even after adjusting for potential confounders. High MCV levels were also significantly associated with high rates of decline on tasks of global mental status, long delay memory, and attention, even after adjusting for potential confounders. The findings confirm a previous observation that larger erythrocytes in older adults are associated with poorer cognitive function. Anemia and inflammation do not appear to explain the relationship between MCV and cognition. Further research is needed to clarify the mechanisms behind this association.

Detection of β-Thalassemia/Hemoglobin E Disease in Samples which Initially were Diagnosed as Homozygous Hemoglobin E

Differentiation of beta-thalassemia/HbE disease from homozygous HbE in samples containing HbA2/E > 75% and HbF < 15% is difficult. The aim of this study is to observe the possibility of using Hb typing and hematological parameters to identify both disorders. Multiplex amplification refractory mutation system (MARMS)-PCR for beta-thalassemia codons 17 (A > T), 41/42 (-TCTT), 71/72 (+A), and IVSI-ntl (G > T) mutations and ARMS-PCR for HbE were performed in 67 samples that contained HbA2/E > 75% and HbF < 15%. Beta-thalassemia/HbE disease was identified in 10 of 67 (14.93%) samples. Levels of hemoglobin, hematocrit, and mean corpuscular volume (MCV) of beta-thalassemia/HbE disease were significantly lower than those of homozygous HbE whereas, levels of HbF were significantly higher. In places where the molecular analysis is not available, HbF > 5% in combination with MCV < 55 fL, hemoglobin < 100 g/L, and hematocrit < 0.30 L/L could be used for screening of beta-thalassemia/HbE disease.

Red cell distribution width is an independent predictor of mortality in hip fracture

the red cell distribution width (RDW), an automated measure of variability in the red blood cell size on full blood count (FBC) is an independent predictor of mortality in several disease states and in healthy older people. we wanted to determine the prognostic value of RDW in patients following a hip fracture-a condition associated with high mortality. we examined the relationship between admission RDW and mortality in 698 consecutive patients admitted with hip fracture. regression analysis was used to examine admission RDW and subsequent mortality, adjusting for admission haemoglobin, mean corpuscular volume, age, gender, pre-morbid residence and independence level, Charlson co-morbidity index and post-operative complications. the mean age was 78 ± 13 years. Unadjusted 1-year mortality was 12, 15, 29 and 36% across quartiles of increasing RDW. Along with age and post-operative complications, RDW remained significantly associated with in-hospital, 120-day and 1-year mortality [adjusted hazard ratios: HR: 1.119, 95% CI: (1.000-1.253), P = 0.05, 1.134 (1.047-1.227), P = 0.004 and 1.131 (1.067-1.199), P < 0.001, respectively]. These relationships remained significant at all three time points on repeat analysis in non-anaemic patients (n = 548). RDW, a widely available parameter on FBC, is independently associated with an increased risk of short- and long-term mortality following hip fracture.

Is analysis of the reticulocyte haemoglobin equivalent a useful test for the diagnosis of iron deficiency anaemia in geriatric patients?

BackgroundIron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are common in elderly patients but there are no standard diagnostic criteria. The reticulocyte haemoglobin equivalent (Ret-He) is routinely measured by modern automated blood analysers and is an early indicator of iron deficiency. The aim of this study was to investigate whether the Ret-He level as calculated by the Sysmex XE-5000 automated blood analyser is a useful parameter for the diagnosis of IDA in a geriatric hospitalized population. MethodsIn a prospective study, blood samples were collected in 26 geriatric patients with IDA and 111 patients with ACD diagnosed according to generally accepted laboratory and clinical criteria. A blood count including Ret-He, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and standard iron parameters was performed in each patient. ResultsHaemoglobin, Ret-He, MCV, MCH and MCHC levels were all significantly lower in IDA as compared to ACD patients. However, the area under the curve (AUC) was greater for MCH (0.87, 95% CI 0.78–0.95) and MCHC (0.86, 95% CI 0.76–0.96) then for Ret-He (0.828, 95% CI 0.73–0.93) and MCV (0.80, 95% CI 0.68–0.91). A Ret-He cut-off value of 26pg had a sensitivity and specificity based on its optimal combination of 85% and 69% respectively. ConclusionAnalysis of Ret-He does not perform better than the classical red cell indices such as MCH and MCHC in differentiating IDA and ACD in geriatric patients.

Relationship between carbohydrate‐deficient transferrin, gamma‐glutamyl transferase, and mean corpuscular volume levels and alcohol‐related brain volume decreases in male drinkers

We investigated the association between mean corpuscular volume (MCV), carbohydrate-deficient transferrin (CDT), and gamma-glutamyl transferase (GGT) levels and gray and white brain matter in male drinkers to find out which if any of these biomarkers of alcohol consumption is indicative for alcohol-related differences in brain volume. Plasma levels of CDT, GGT, and MCV and magnetic resonance imaging-determined brain gray and white matter volumes were assessed in 55 male drinkers. Current alcohol intake and lifetime alcohol intake were determined by self-report measures. The relationship between MCV, CDT, and GGT and brain volumes was explored using multiple linear regression analyses. There was a significant negative relationship between plasma GGT and MCV levels and gray matter volumes. Middle-aged male drinkers with highly elevated GGT and MCV levels (twice the standard deviation above the mean) have 4-12% less parietal and occipital gray matter than males with average GGT and MCV levels. There was no association between CDT levels and brain gray or white matter. Elevated GGT and MCV levels may be indicative of alcohol-related gray-matter decline in male drinkers. The link with GGT may reflect that elevated GGT levels are a sign of increased oxidative stress. The link with MCV levels may reflect a decreased oxygen transport to the brain.

Delayed cord clamping for prevention of iron deficiency anemia in term infants

Background Iron deficiency childhood is a concern due to its potentially detrimental effectson development, some of which may be irreversible even after irontreatment. Delayed cord clamping may prevent IDA by increasingan infant's iron reserve at birth.Objective We aimed to evaluate the effect of delayed umbilicalcord clamping at birth on the iron status in newborns at age 24hours of life.Methods This randomized, single􀁒blind study was conducted fromMarch to May 2009, at two general hospitals in Medan, NorthSumatera Province. Eligible newborn infants were randomlyassigned to one of two groups: early cord clamping (Eee)performed 15 seconds after delivery or delayed cord clamping(DeC) performed 2 minutes after delivery. Infants were placed ontheir mothers' abdomens before the umbilical cords were clamped.Hematologic status was determined from umbilical cord blood.Results Sixty􀁒three subjects were included in our study, consistingof31 infants in the Eee group and 32 infants in the Dec group.We found that mean neonatal hemoglobin level was higher inthe Dec group than in the Eee group ( 18.4 g% and 16.2 g%,respectively, P=O.OOOl). Also, mean ferritin level was higher inthe Dec group than in the Eee group (556 mg/dL and 329 mg/dL, respectively, p=o.o 15). Other hematological status indicators,including mean hematocrit and mean corpuscular volume (MeV)level, were also higher in the Dec group. However, mean redblood cell levels were not significantly groups. Nor was there a significant level between the Dec and Eee groups.Concl usion Dela y ed cord c l a m p i n g m a y improve ironstatus and prevent IDA in term infants. [Paediatr Indones.2012;52:223-8].

Is Iron Insufficiency Associated With Febrile Seizure? Experience in an Iranian Hospital

Background: Febrile seizures (FS) are the most common type of convulsion in young children. The predisposing factors are still under investigation; however, iron insufficiency might play a role in this regard. Objectives: Our objective was to determine the association between iron status and febrile seizure. Patients and Methods: This prospective case-control study was conducted among 109 children aged 6 months to 6 years and hospitalized for the first episode of FS. The case group was compared to a group of 70 age- and sex-matched controls admitted to the same ward with the same diagnosis of infection. The control and case groups were matched based on family history of FS, age, sex, temperature, cause of illness, erythrocyte sedimentation rate (ESR), white blood cells (WBC), and platelets. Venous blood samples were examined for complete blood count (CBC), serum iron, serum ferritin, and total iron-binding capacity. The CBC included measurements of red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), WBC, and platelets. Results: There were no significant differences between the study groups in terms of temperature, ESR, WBC, and platelets. The mean Hb, HCT, ferritin, iron, and MCH were significantly lower in the case group than in the control group. The mean level of MCV in the FS group was lower than the mean level of MCV in the control group, but the difference was not significant. Conclusions: Low levels of serum ferritin and iron might play a role in the pathogenesis of simple febrile seizure. Further longitudinal studies are clearly needed to confirm our findings.

Is Iron Insufficiency Associated With Febrile Seizure? Experience in an Iranian Hospital

Background: Febrile seizures (FS) are the most common type of convulsion in young children. The predisposing factors are still under investigation; however, iron insufficiency might play a role in this regard. Objectives: Our objective was to determine the association between iron status and febrile seizure. Patients and Methods: This prospective case-control study was conducted among 109 children aged 6 months to 6 years and hospitalized for the first episode of FS. The case group was compared to a group of 70 age- and sex-matched controls admitted to the same ward with the same diagnosis of infection. The control and case groups were matched based on family history of FS, age, sex, temperature, cause of illness, erythrocyte sedimentation rate (ESR), white blood cells (WBC), and platelets. Venous blood samples were examined for complete blood count (CBC), serum iron, serum ferritin, and total iron-binding capacity. The CBC included measurements of red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), WBC, and platelets. Results: There were no significant differences between the study groups in terms of temperature, ESR, WBC, and platelets. The mean Hb, HCT, ferritin, iron, and MCH were significantly lower in the case group than in the control group. The mean level of MCV in the FS group was lower than the mean level of MCV in the control group, but the difference was not significant. Conclusions: Low levels of serum ferritin and iron might play a role in the pathogenesis of simple febrile seizure. Further longitudinal studies are clearly needed to confirm our findings.