Mean Hematocrit Research Articles

Rusfertide, a Hepcidin Mimetic, for Control of Erythrocytosis in Polycythemia Vera

BackgroundPolycythemia vera is a chronic myeloproliferative neoplasm characterized by erythrocytosis. Rusfertide, an injectable peptide mimetic of the master iron regulatory hormone hepcidin, restricts the availability of iron for erythropoiesis. The safety and efficacy of rusfertide in patients with phlebotomy-dependent polycythemia vera are unknown.MethodsIn part 1 of the international, phase 2 REVIVE trial, we enrolled patients in a 28-week dose-finding assessment of rusfertide. Part 2 was a double-blind, randomized withdrawal period in which we assigned patients, in a 1:1 ratio, to receive rusfertide or placebo for 12 weeks. The primary efficacy end point was a response, defined by hematocrit control, absence of phlebotomy, and completion of the trial regimen during part 2. Patient-reported outcomes were assessed by means of the modified Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) patient diary (scores range from 0 to 10, with higher scores indicating greater severity of symptoms).ResultsSeventy patients were enrolled in part 1 of the trial, and 59 were assigned to receive rusfertide (30 patients) or placebo (29 patients) in part 2. The estimated mean (±SD) number of phlebotomies per year was 8.7±2.9 during the 28 weeks before the first dose of rusfertide and 0.6±1.0 during part 1 (estimated difference, 8.1 phlebotomies per year). The mean maximum hematocrit was 44.5±2.2% during part 1 as compared with 50.0±5.8% during the 28 weeks before the first dose of rusfertide. During part 2, a response was observed in 60% of the patients who received rusfertide as compared with 17% of those who received placebo (P=0.002). Between baseline and the end of part 1, rusfertide treatment was associated with a decrease in individual symptom scores on the MPN-SAF in patients with moderate or severe symptoms at baseline. During parts 1 and 2, grade 3 adverse events occurred in 13% of the patients, and none of the patients had a grade 4 or 5 event. Injection-site reactions of grade 1 or 2 in severity were common.ConclusionsIn patients with polycythemia vera, rusfertide treatment was associated with a mean hematocrit of less than 45% during the 28-week dose-finding period, and the percentage of patients with a response during the 12-week randomized withdrawal period was greater with rusfertide than with placebo. (Funded by Protagonist Therapeutics; REVIVE ClinicalTrials.gov number, NCT04057040.)

Effects of Gender on Hematologic Parameters in Kangal Shepherd Dogs

Kangal Shepherd Dogs are highly valuable working dogs unique to Turkey, known for their robustness in withstanding harsh climatic conditions and possessing advanced herd protection and management abilities due to their genetic characteristics. Haematological values serve as crucial indicators of the physiological and physiopathological parameters in animals. A complete blood cell count (CBC) emerges as a powerful diagnostic tool when appropriately assessed. Given the establishment of pure breeds, it is essential to acknowledge that breedspecific hematologic values may exhibit variations influenced by factors such as gender, lifestyle, age, and geographical location. Therefore, understanding the physiological distinctions between genders becomes paramount. This study aims to assess the impact of gender on the complete blood count in Kangal Shepherd Dogs. Upon comparing hematologic parameters between female and male Kangal Shepherd Dogs, a statistically significant difference was observed in the mean platelet volume (MPV) value, which was higher in females than males (p < 0.05). While the mean red blood cell (RBC), haemoglobin (HGB), and haematocrit (HCT) values were higher in males, no statistically significant results were found (p > 0.05)

Oral Water Hydration May Impact Hematocrit and Blood Sugar Levels in Patients with Diabetes Mellitus

Introduction: Patients of diabetes repeatedly need blood glucose measurement, which may be falsely high due to less water intake and poor hydration of the patients. Aims & Objectives: To determine the effect of water intake or hydration on hematocrit and blood sugar levels in patients with diabetes mellitus. Place and Duration of Study: Pathology Department and Diabetic Center of Sheikh Zayed Hospital, Rahim Yar Khan from January 2023 to July 2023. Material & Methods: It was a cross sectional study conducted in total 75 Type-1 & Type-2 diabetes patients using convenient sampling technique. 5 ml blood samples were drawn before and 20 minutes after oral hydration with 500 ml of oral water in all these patients to determine the effect on hematocrit and blood sugar levels. The data was entered and analyzed on SPSS version 23. Pre and post observations were compared using paired t-test. p-value<0.05 was taken as statistically significant. Results: The mean value for age and BSR (before and after) of study subjects was 46±11 years, 200±97 mg/dl, and 199±94 mg/dl (p=0.8) respectively. While mean value of HCT before hydration was 39±5.8% and after hydration was 38±6.4% (p=0.006). Conclusion: Oral water hydration impacted mean hematocrit values in diabetic patients, significantly lowering them whereas their mean BSR values remained unaffected.

Reticulocyte hemoglobin content associated with the risk of iron deficiency anemia

Background/ObjectiveReticulocyte hemoglobin content (MCHr) was recognized as a rapid and reliable marker for investigating iron deficiency (ID). We hypothesized that MCHr was associated with the risk of iron deficiency anemia in adults. MethodsThis is a dual-center case-control study. A total of 806 patients and healthy individuals were recruited from Ruijin Hospital and Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2021 and December 2021. The participants were categorized into iron deficiency anemia (IDA) group (n = 302), non-IDA group (n = 366), and healthy control group (n = 138). According to the MCHr level, the participants were divided into two groups, i.e. normal MCHr (≥25 pg) and decreased MCHr (<25 pg) group. Multivariate logistic regression analysis and adjusted subgroup analysis were conducted to estimate the relative risk between MCHr and IDA, with confounding factors including age, sex, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), Hematocrit (HCT), serum iron (Fe), ferritin (Ferrit), and total iron binding capacity (TIBC). ResultsCompared with the non-IDA, the MCHr level with IDA decreased significantly. ROC curve analysis showed that MCHr had the largest area under the AUC curve. After comprehensive adjustment for confounding factors, individuals with normal level of MCHr exhibited a decreased risk of IDA (OR = 0.68 [0.60, 0.77], P < 0.01), while the risk of IDA was up to 5 times higher for those with decreased MCHr. ConclusionOur findings supported the hypothesis that MCHr was associated with the risk of IDA in adults and could serve as an indicator of IDA severity. MCHr holds clinical value as an auxiliary diagnostic indicator, providing valuable insights into whether invasive examinations are warranted in the assessment of IDA.

Intravenous versus intramuscular oxytocin injection for preventing uterine atonic primary postpartum haemorrhage in third stage of labour: A double-blind randomised controlled trial.

To compare the efficacy and safety of intravenous and intramuscular oxytocin in preventing atonic primary postpartum haemorrhage in the third stage of labour. A double-blind randomised clinical study on consenting women without risk factors for primary postpartum haemorrhage in labour at term. Two hundred and thirty-two women were randomly allotted into intravenous (n = 115) and intramuscular (n = 117) oxytocin groups in the active management of the third stage of labour. All participants received 10 IU of oxytocin, either IV or IM, and 1 ml of water for injection as a placebo via a route alternate to that of administration of oxytocin within 1 min of the baby's delivery. The primary outcome measures were mean postpartum blood loss and haematocrit change. Trial Registration No.: PACTR201902721929705. The baseline socio-demographic and clinical characteristics were similar between the two groups (p > 0.05). There was no statistically significant difference between the two groups with regards to the mean postpartum blood loss (254.17 ± 34.85 ml versus 249.4 ± 39.88 ml; p = 0.210), haematocrit change (2.4 (0.8%) versus 2.1 (0.6%); p = 0.412) or adverse effects (p > 0.05). However, the use of additional uterotonics was significantly higher in the intravenous group (25 (21.73%) versus 17 (14.53%); p = 0.032). Although oxytocin in both study groups showed similar efficacy in terms of preventing atonic primary postpartum haemorrhage, participants who received intravenous oxytocin were more likely to require additional uterotonics to reduce their likelihood of having an atonic primary postpartum haemorrhage. However, both routes have similar side effect profiles.

Assessing the Role of MAPH Score in Predicting Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Incorporating the concepts of hyperviscosity, platelet hyperactivity, and age-related risk of Acute Coronary Syndrome (ACS), a new score has been put forward-the Mean platelet volume-Age-total Protein-Haematocrit (MAPH) score, which can determine the increased thrombotic tendency associated with ST-Segment Elevation Myocardial Infarction (STEMI). The MAPH score includes parameters such as Mean Platelet Volume (MPV), age, total protein, and haematocrit. Researchers have found that a high MAPH score is associated with a high thrombus burden in cases with STEMI and Non ST-Elevation Myocardial Infarction (NSTEMI). However, the association between MAPH score and ACS is undefined. Aim: To assess the role of MAPH score in predicting ACS. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, Srinivas Institute of Medical Sciences and Research Centre Mangalore, Karnataka, India for six months. The study included 100 clinically diagnosed cases of ACS and 100 healthy controls. The demographic data, MPV, total protein, and haematocrit values of all cases and controls were collected and tabulated, and statistical analysis was performed. Receiver Operating Characteristic (ROC) curve analysis was performed on each MAPH score parameter, and cutoff values for each parameter were obtained based on the Youden index. After calculating the MAPH score of cases and controls, multivariate logistic regression analysis was performed to evaluate the role of the MAPH score as an independent predictor of ACS. Results: A statistically significant increase in MPV (p-value =0.017) and total protein (p-value&lt;0.001) was noted among the cases. The calculated cut-off values for MPV, age, total protein, and haematocrit were 8.4 fL, 54 years, 6.8 g/dL, and 49.1%, respectively. A statistically significant increase in the MAPH score was noted among the cases compared to the controls. Finally, multivariate logistic regression analysis identified the MAPH score as an independent predictor of ACS. Conclusion: This was the first study investigating the association between MAPH scores in patients with ACS. The MAPH score was identified as an independent predictor of ACS and can be used as a screening tool to predict and diagnose the condition in primary healthcare settings. This helps to ensure early coronary revascularisation and reduce Coronary Artery Disease (CAD)- related mortality and morbidity to a greater extent.

Preoperative Anemia as a Negative Risk Factor for Coronary Artery Bypass Grafting Surgery: A Retrospective Study

OBJECTIVES The objective of this study is to check the effects of Anemia on mortality and morbidity in patients having ischemic heart disease and undergoing coronary artery bypass graft surgery (CABG). METHODOLOGY The study involved all the patients who underwent isolated coronary artery bypass graft surgery from July 2019 to December 2022. The clinical data of patients was retrospectively collected from the departmental data pool and was then analyzed using the chi-square test and t-test. A p-value of less than 0.05 was considered significant. RESULTSThe study included 2570 patients who underwent isolated CABG; 78.2% of patients were males with a mean age of 57.87±9.20. Hypertension was the most common comorbidity (68.9%), followed by dyslipidemia (53.7%) &amp; Diabetes mellitus (49.9%). The preoperative mean hematocrit was 30.05±17.85. Of these 2570 patients, 52.37% were anaemic with a mean age of 58.69±9.05. Anemic patients had a significantly higher rate of IABP insertion (P 0.02) and intra-operative blood product transfusion (P &lt;0.001). Anemic patients had a significantly higher incidence of in-hospital mortality (P 0.04) and a higher rate of postoperative blood product transfusion (P &lt;0.001). There is no significant difference in terms of prolonged ventilation, reintubation, or readmission to ICU; however, nonanemic patients have a significantly higher rate of re-opening for bleeding/ tamponade (P 0.01). CONCLUSION Preoperative anaemia increases the mortality and morbidity in ischemic heart disease patients undergoing coronary artery bypass grafting. To improve the outcomes in CABG surgery, preoperative anaemia should be thoroughly investigated and treated to improve the outcomes of surgery.

The effect of neutrophil lymphocyte ratio and other biochemical parameters on mortality in cancer patients admitted to the emergency department

Aims: To investigate the effectiveness of the neutrophil/lymphocyte ratio and other biochemical parameters in predicting mortality in oncology patients with cancer admitted to the emergency department. Methods: This was a retrospective, observational, single-center study. The study period included a two-year period from January 2014 to December 2015. Demographic data, cancer history and blood tests, emergency department diagnoses, blood parameters evaluated in the emergency department, discharge, and mortality status of the patients were recorded in the data form. The APACHE 2 and SOFA scores of all patients were also calculated. Patients whose data could not be reached were excluded from the study. p&lt;0.05 was considered statistically significant. Results: A total of 180 patients were included in the study. The mean age of the survivor group was 66.4±10.752 years, while the mean age of the non-survivor group was 65.18±13 years. The mean neutrophil/lymphocyte (NLR) ratio of the non-survivor group was 1.0288±11.3, while the NLR of the survivor group was 4.400±3.563. (p&lt;0.05) The mean lactate ratio of the non-survivor group was 2.60±3.384, while the mean lactate ratio of the survivor group was 1.36±1. 090. (p&lt;0.05) When survivor and non-survivor patient groups were compared, a statistically significant difference was observed in mean white blood cell count, neutrophil count, hemoglobin, hematocrit, and blood urea nitrogen (BUN) values. (p&lt;0.05) Conclusion: According to the results of this study, NLR, elevated white blood cell and neutrophil values, decreased hemoglobin and hematocrit, and elevated BUN and lactate levels seem to be predictors of mortality during emergency admissions in cancer patients.

Sub-lethal impacts of lead poisoning on blood biochemistry, immune function and delta-aminolevulinic acid dehydratase (δ-ALAD) activity in Cape (Gyps coprotheres) and white-backed (G. africanus) Vulture chicks

Although the prevalence of lead poisoning in southern Africa's Gyps vultures is now well-established, its finer physiological effects on these endangered species remain poorly characterised. We evaluated the sub-lethal impact of acute lead exposure on Cape and White-backed Vulture chicks from two breeding colonies in South Africa, by analysing its possible effects on key blood biochemistry parameters, immune function, packed cell volume and δ-aminolevulinic acid dehydratase (δ-ALAD) activity. All 37 White-backed Vulture nestlings sampled displayed elevated lead levels (>10 μg/dL), and seven had blood [Pb] >100 μg/dL. Eight of 28 Cape Vulture nestlings sampled had blood [Pb] exceeding background exposure, with one showing blood [Pb] >100 μg/dL. Delta-aminolevulinic acid dehydratase (δ-ALAD) activity was significantly and negatively related to blood [Pb] in nestlings from both species, with 50% inhibition of the enzyme predicted to occur at blood [Pb] = 52.8 μg/dL (White-backed Vulture) and 18.8 μg/dL (Cape Vulture). Although no significant relationship was found between % packed cell volume (PCV) and blood [Pb], the relatively lower mean PCV of 32.9% in White-backed Vulture chicks, combined with normal serum protein values, is likely indicative of depression or haemolytic anaemia. The leukogram was consistent in both species, although the presence of immature heterophils suggested an inflammatory response in White-backed Vulture chicks with blood [Pb] >100 μg/dL. Values for cholesterol, triglycerides, total serum protein, albumin, globulin, albumin/globulin ratio, alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) were consistent with values previously reported. Calcium and phosphorus concentrations suggested no adverse effects on bone metabolism. A significant decrease in urea: uric acid (U:UA) ratio at blood [Pb] >100 μg/dL in White-backed Vulture chicks, brought about by a decrease in urea production, raises the possibility of hepatic abnormality. These results suggest that δ-ALAD activity may serve as a sensitive biomarker of lead toxicity in both species, while highlighting the need to better understand the significant variability in sensitivity that is observed, even between closely related members of the same genus.

Chronic exposure to high altitude and the presence of coronary ectasia in patients with ST elevation myocardial infarction.

To evaluate the association between chronic exposure to high altitude and the presence of coronary ectasia (CE) in patients with ST-segment elevation myocardial infarction (STEMI) treated in a highly specialized cardiovascular reference hospital in Peru. Retrospective matched case-control study. The cases were patients with CE and controls without CE. The relationship between CE and chronic exposure to high altitude was evaluated considering intervening variables such as arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and hematocrit values. Patients with chronic inflammatory pathologies, chronic obstructive pulmonary disease, and previous revascularization were excluded. Multivariate logistic regression was applied to obtain the OR value and their respective confidence intervals. Eighteen cases and 18 controls were studied, most of them were men with an average age of 65 years. Thirty-six percent of the population came from high altitude; in this group 76.9% had coronary ectasia of the infarct-related artery. The mean hematocrit value was slightly higher in the high-altitude native (46 ± 7% versus 42 ± 5%, p=0.094). Multivariate conditional logistic regression did not find a significant relationship between exposure to high altitude and the risk of presenting CE (OR:6.03, IC95%: 0.30-118, p=0.236). In patients with STEMI, we found no association between chronic exposure to high altitude and coronary ectasia.

Hematological profile of healthy Thoroughbred foals from birth to one month of age in Trinidad, West Indies.

This study aimed to develop a sound database for the hematological reference intervals of thoroughbred foals in Trinidad, West Indies from birth to 1 month of age. 89 foals. Whole blood samples were taken from 89 foals throughout Trinidad at approximately 1 day, 1 week, and 1 month of age. These foals were examined to be classified as healthy or free from disease. Complete blood count (CBC), microscopic analysis of blood smears, and conventional PCR for Theileria equi and Babesia caballi were performed. Of the 89 foals, 67 were deemed healthy and suitable for establishing reference intervals. Foals in this study had lower mean hemoglobin and hematocrit values for all 3 times of sampling when compared to their North American counterparts. Age had a significant effect on hemoglobin, hematocrit, white blood cell (WBC), neutrophil, and platelet counts of the foals from birth to 1 month of age. Variations in reference intervals can occur due to differences in demographic, physiological, and environmental factors such as age, gender, breed, and geographical location. Given the changes in the hematological values over time, this study provides clinicians with valuable information that can be used to monitor the health status of newborn foals and detect disease conditions.

High-Altitude Hypoxia Is Common in Adults with Sickle Cell Disease

BACKGROUND In Sickle Cell Disease (SCD), hypoxia favors deoxy-HbS formation, sickle hemoglobin (Hb) polymerization, and red blood cell (RBC) sickling. The hypobaric hypoxia of high altitude (such as plane flights and high-altitude vacation destinations) may uncover occult hypoxia in people with SCD, trigger vaso-occlusive episodes, and/or exacerbate cardiopulmonary complications. There are few published data on high-altitude hypoxia in people with SCD. High altitude simulation testing (HAST) recapitulates the hypoxia of high altitude and can be used to assess the need for prophylactic supplemental oxygen prior to trips. At our institution, due to anecdotal reports of symptom exacerbation following air travel, we complete pretravel HAST for people with sickle cell disease, and then prescribe portable oxygen therapy. OBJECTIVE This retrospective cross-sectional study aimed to assess the prevalence of high-altitude hypoxia in those adults with SCD who underwent pretravel evaluation from 2019 to 2023. Additionally, we examined the clinical characteristics of those people found to have high-altitude hypoxia. METHODS After getting IRB approval, we retrospectively reviewed the medical records of patients with SCD who had undergone HAST as part of pretravel evaluation in 2019 through 2023. HAST was performed with the use of a Hans Rudolph two-way non-rebreathing valve system, and oxygen saturation was monitored with a forehead oximeter. Compressed Air (10 liters per minute) and Nitrogen (8 liters per minute) were blended to an oxygen level of 15%, simulating an altitude of 8,000 feet for 20 minutes. High-altitude hypoxia is defined as persistent SpO 2 ≤88% at 15%FiO 2, requiring supplemental oxygen. Demographics, SCD-related medical history, clinical labs and imaging were collected near the time of testing. We assessed the prevalence of high-altitude hypoxia in our patient population over the time period. We described the characteristics of those tested. Using parametric and non-parametric statistical tests, we evaluated associations between time to hypoxia (in minutes). RESULTS 22 adult patients underwent HAST, and 13 (59%) were positive for high-altitude hypoxia (Figure 1). The time to hypoxia ranged from 1-17 minutes with a mean of 5.3 minutes with a minimum SpO 2, in those that tested positive, ranging from 86-89%. However, hypoxic patients were immediately treated with supplemental oxygen during testing, so a true nadir cannot be determined. Compared to those who tested negative, the participants that tested positive had lower BMI and lower mean Hb and hematocrit levels. Their mean absolute reticulocyte counts (ARC) and mean total bilirubin were higher than those who tested negative, and their mean white blood counts (WBC) trended higher. We did not observe significant difference in HAST results by SCD genotype, hydroxyurea use and opioid use. Other patient characteristics are described (Figure 2). We found the strongest inverse correlations between time to hypoxia and WBC (r= -0.73, p= 0.004) and ARC (r= -0.69, p=0.010). CONCLUSIONS Adults with sickle cell disease are at risk for occult hypoxia during travel due to hypobaric hypoxia associated with altitude. In our experience, screening patients with SCD prior to travel, we found HAST-positive hypoxia in 59%, for whom we prescribed supplemental oxygen during travel. Our observations suggested that people with more ‘active’ SCD (lower Hgb and higher ARC) were more likely to have high-altitude hypoxia and tended to declare their hypoxia earlier in the testing period. Our study is limited by sample size, retrospective design, and a lack of patient reported outcomes about altitude associated symptoms or complications. Additionally, there may be a selection bias towards healthier people with SCD, i.e., those who are well enough to travel. However, given the pathophysiology of SCD, our results suggest that providers should be proactive in inquiring about travel plans and assessing the risk for hypoxia. Furthermore, the development of a brief screening tool in this setting may be warranted.

Erythrocytosis Is Rare With Exogenous Testosterone in Gender-Affirming Hormone Therapy.

Studies have found a variable incidence of erythrocytosis among people using testosterone as part of gender-affirming hormone therapy (GAHT). To examine the effect of using exogenous testosterone as GAHT on hematocrit in a large North American cohort. We conducted a cross-sectional analysis of testosterone and hematocrit laboratory values in 6670 patients who were prescribed testosterone through Plume, a national provider of GAHT. The prevalence of erythrocytosis, the mean hematocrit at predetermined testosterone thresholds and with varying routes of testosterone administration were assessed. Among 6670 individuals, 560 (8.4%) had a hematocrit ≥50%, 182 ≥ 52% (2.7%), and 60 ≥ 54% (0.9%). There was significant variation (P < .001) in hematocrit between different clinically relevant testosterone thresholds (T < 50 vs T 50-299 vs T 300-999 vs T ≥ 1000 ng/dL) and when comparing serum testosterone in increments of 50 ng/dL within the target range for males (300-1000 ng/dL) (P < .001). Mean hematocrit ranged from 41.84% (T < 50 ng/dL) to 45.68% (T 900-949 ng/dL). Patients on intramuscular testosterone had a higher mean hematocrit than those on transdermal testosterone (44.96% vs 43.41%, P < .001). Both route of administration (P < .001) and testosterone level (P < .001) had statistically significant associations with hematocrit when controlling for each other. While the magnitude of change in hematocrit with serum level and route of administration of testosterone was statistically significant, the absolute levels were within the normal range, unlikely to be clinically meaningful. These findings, along with the low prevalence of erythrocytosis, should help allay concerns about the use of testosterone as GAHT.

Aorta Dilatation in Unrepaired Tetralogy of Fallot.

Background Aortic root dilation is an increasingly recognized feature in repaired tetralogy of Fallot (TOF) patients. However, the dilation at the aortic root and ascending aorta in unrepaired TOF is rarely studied. This study aims to confirmwhether aortic dilation is a common feature in unrepaired TOF andinvestigate the factors attributed to aortic dilation. Methodology Patients with an echocardiographic diagnosis of TOF undergoing computed tomography angiography were retrospectively studied. Diameters and z scores of aortic annular (Ao1), aortic sinotubular junction (Ao2), ascending aorta (Ao3), and distal transverse aortic arch (Ao4) were measured. Preoperative body surface area (BSA), hemoglobin (Hb), hematocrit (HCT), arterial oxygen saturation (SaO2), and platelet (PLT)count were recorded. Results A total of 101 TOF patients aged 6.8 ± 9.5 years were included in this study, whose mean BSA (m2), Hb (g/L), HCT, SaO2(%), and PLT (109/L)were 0.7 ± 0.4, 162.1 ± 3.8, 0.5± 0.1, 85.1 ± 9.3, and 238.1 ± 101.1, respectively. The mean z score of Ao1, Ao2, Ao3, and Ao4 were 10.3 ± 3.5, 4.7 ± 2.9, 4.0 ± 2.7, and 4.1 ± 2.4, respectively. Age and BSA were positively correlated with the z scores of Ao1 and Ao2. Preoperative Hb and HCT were positively correlated with the z scores of Ao1, Ao2, Ao3, and Ao4. Preoperative SaO2and PLT were negatively correlated with the z scores of Ao1, Ao2, Ao3, and Ao4. Conclusions Aortic dilation is common in unrepaired TOF patients.The dilation of different levels of the aorta was correlated with age, BSA, preoperative Hb, HCT, SaO2,and PLT.

Extrauterine Placental Perfusion and Oxygenation in Infants With Very Low Birth Weight

An extrauterine placental perfusion (EPP) approach for physiological-based cord clamping (PBCC) may support infants with very low birth weight (VLBW) during transition without delaying measures of support. To test whether EPP in resuscitation of infants with VLBW results in higher hematocrit levels, better oxygenation, or improved infant outcomes compared with delayed cord clamping (DCC). This nonblinded, single-center randomized clinical trial was conducted at a tertiary care neonatal intensive care unit. Infants with a gestational age greater than 23 weeks and birth weight less than 1500 g born by cesarean delivery between May 2019 and June 2021 were included. Data were analyzed from October through December 2021. Prior to cesarean delivery, participants were allocated to receive EPP or DCC. In the EPP group, infant and placenta, connected by an intact umbilical cord, were detached from the uterus and transferred to the resuscitation unit. Respiratory support was initiated while holding the placenta over the infant. The umbilical cord was clamped when infants showed regular spontaneous breathing, stable heart rates greater than 100 beats/min, and adequate oxygen saturations. In the DCC group, cords were clamped 30 to 60 seconds after birth before infants were transferred to the resuscitation unit, where respiratory support was started. The primary outcome was the mean hematocrit level in the first 24 hours after birth. Secondary prespecified outcome parameters comprised oxygenation during transition and short-term neonatal outcome. Among 60 infants randomized and included, 1 infant was excluded after randomization; there were 29 infants in the EPP group (mean [SD] gestational age, 27 weeks 6 days [15.0 days]; 14 females [48.3%]) and 30 infants in the DCC group (mean [SD] gestational age, 28 weeks 1 day [17.1 days]; 17 females [56.7%]). The mean (SD) birth weight was 982.8 (276.6) g and 970.2 (323.0) g in the EPP and DCC group, respectively. Intention-to-treat analysis revealed no significant difference in mean hematocrit level (mean difference [MD], 2.1 percentage points; [95% CI, -2.2 to 6.4 percentage points]). During transition, infants in the EPP group had significantly higher peripheral oxygen saturation as measured by pulse oximetry (adjusted MD at 5 minutes, 15.3 percentage points [95% CI, 2.0 to 28.6 percentage points]) and regional cerebral oxygen saturation (adjusted MD at 5 minutes, 11.3 percentage points [95% CI, 2.0 to 20.6 percentage points]). Neonatal outcome parameters were similar in the 2 groups. This study found that EPP resulted in similar hematocrit levels as DCC, with improved cerebral and peripheral oxygenation during transition. These findings suggest that EPP may be an alternative procedure for PBCC in infants with VLBW. ClinicalTrials.gov Identifier: NCT03916159.

Rusfertide Improves Markers of Iron Deficiency in Patients with Polycythemia Vera

Background: Polycythemia vera (PV) is a chronic myeloproliferative neoplasm characterized by erythrocytosis defined by an acquired increase in hemoglobin (Hb)/hematocrit (HCT). Disease complications are associated with increased blood viscosity, cardiovascular/thrombotic events and iron deficiency (Marchioli et al. N Engl J Med. 2013;368:22-33). Most patients with PV are iron deficient and therapeutic phlebotomy may exacerbate iron deficiency (Ginzburg et al. Leukemia. 2018;32:2105-16). Methods:PTG-300-08 (clinicaltrials.gov NCT04767802, PACIFIC study) is an open-label, 52-week, phase 2 study that investigated the efficacy and safety of rusfertide in Asian patients with poor hematocrit (HCT) control as noted by HCT &amp;gt;48%. Treatment was initiated with 40 mg rusfertide subcutaneously (SC) twice a week. Once HCT was &amp;lt;45%, the treatment was changed to 40 mg once a week with subsequent dose adjustments allowed to maintain HCT &amp;lt;45%. In addition to HCT and erythrocyte morphology (mean corpuscular volume, or MCV), biomarkers reflective of iron biology, such as hepcidin, erythroferrone (ERFE), erythropoietin (EPO), and soluble transferrin receptor (sTfR) were measured at baseline, Week 4, 16, and 32 following initiation of rusfertide treatment. To examine the effect of rusfertide on serum iron, patients were stratified by baseline ferritin levels to examine patients who were iron deficient (ferritin ≤20 µg/L) compared to patients who had normal iron (ferritin &amp;gt;20 µg/L). Results: Twenty patients (15 males, 5 females), average age 56.7 (SD, 9.12) years and average weight 65 (10.9) kg were enrolled. Thirteen patients (65%) were low risk and 7 (35%) were high risk, all based on age. No patients had a prior history of thromboembolic events. Mean duration since PV diagnosis was 4.2 (3.83) years. Rusfertide rapidly and robustly reduced mean HCT and sustained HCT &amp;lt;45% for the duration of treatment, and ferritin, TSAT and MCV increased (Table 1). At baseline, 30% of subjects had serum ferritin levels below 20 µg/L, with all subjects achieving and sustaining ferritin levels above 20 µg/L by Week 4 following initiation of rusfertide treatment. Table 1 also summarizes the biomarkers related to iron indices. Median hepcidin concentrations increased, median EPO concentration was below and remained below the limit of detection, and ERFE concentration decreased modestly with rusfertide dosing consistent with reduced erythropoietic drive. Among patients with evidence of baseline iron deficiency (ferritin &amp;lt;20 µg/L), rusfertide normalized iron levels while iron levels remained stable in rusfertide patients with normal iron levels at baseline (Figure 1). Similarly, patients with iron deficiency had low MCV at baseline (Figure 1) which increased following initiation of rusfertide treatment. In patients with normal iron levels, MCV remained stable in the normal range (&amp;gt;80 fl). Conclusions: Treatment with rusfertide resulted in rapid, robust, and sustained reduction in HCT levels in PV patients with elevated HCT levels at baseline. Treatment resulted in normalization of iron parameters as noted by increases in ferritin, and normalization of serum iron and MCV in patients who were iron deficient at baseline. Improvements in iron deficiency following rusfertide are suggestive of clinical benefits and merit further investigation. This analysis confirms the general understanding that managing iron deficiency in PV remains an unmet need.

Prehospital Critical Care Blood Product Administration: Quantifying Clinical Benefit.

Prehospital blood transfusion has been widely practiced in the military and is drawing renewed scrutiny after many years of civilian use. The objective of this article is to quantify the benefit derived from prehospital transfusion of blood products. Deidentified data were extracted retrospectively from the flight records of a critical care transportation program between April 2018 and January 2020. Patients who were transported before a prehospital blood transfusion protocol were compared with patients after initiation of the blood transfusion protocol. Demographic data, vital signs, laboratory analytics, and other outcome measures were analyzed. Nine scene transport patients who met the transfusion criteria before a blood transfusion protocol were compared with 11 patients transported after initiation of the protocol. Identical outcome measures were analyzed. Patients who received prehospital blood transfusions had a statistically significantly longer hospital length of stay (16.5 vs 3.7 days, P = .03) and were more often taken directly to the operating room (80% vs 28%, P = .04). No statistically significant difference was identified when comparing mean arterial pressure, heart rate, respiratory rate, hemoglobin, hematocrit, or survival to hospital discharge. Trauma patients who received prehospital blood transfusion had a longer hospital length of stay and were more often taken directly to the operating room, but without improvement in survival.

The combined use of erythropoietin and iron preparations for the management of postpartum anemia: a systematic review and meta-analysis

INTRODUCTION: There are limited data on the effectiveness of erythropoietin in combination with oral ferrotherapy for the management of postpartum anemia. OBJECTIVE: To evaluate the efficacy of erythropoietin in combination with oral iron compared with oral ferrotherapy in puerperas with postpartum haemorrhage. MATERIALS AND METHODS: MEDLINE, Scopus, EBSCOhost and 5 other databases (January 1980 to February 2023) were searched for articles on the use of oral iron in combination with and without erythropoietin for the treatment of post-hemorrhagic anemia in puerperas. Primary outcomes: hemoglobin level, hemoglobin increase, hematocrit, number of blood transfusions, secondary outcomes: ferritin level, serum iron, lactation capacity. The analysis was carried out in accordance with the PRISMA guidelines, 2020. RESULTS: 4 studies were analyzed, 198 women were included. When using erythropoietin in combination with oral ferrotherapy, the cumulative value of the increase in hemoglobin concentration after 5 days, 2 weeks of treatment was significantly higher compared with the control group (mean difference [MD]: 11.83 g/L, 95% CI 4.43–19.23; р = 0.002, MD 10.13 g/L, 95% CI 4.97–15.29; р = 0.0001), respectively. The cumulative mean hemoglobin concentration after 40 days of treatment was significantly higher in the erythropoietin group (MD 11.00 g/L, 95% CI 1.70–20.30; р = 0.02). The cumulative mean hematocrit after 2 weeks of treatment was significantly higher in the erythropoietin group (MD 3.35 %, 95% CI 0.31–6.39; р = 0.03). The use of erythropoietin in combination with oral iron reduces the likelihood of blood transfusion (relative risk 0.12, 95% CI 0.02–0.95; р = 0.04). CONCLUSIONS: A faster hematological response was shown with the combined use of erythropoietin with oral ferrotherapy compared with monotherapy with iron preparations in the management of postpartum anemia. Further studies with sufficient sample sizes are required.

124 Investigating the Role of Soybean Meal and its Innate Bioactive Compounds on Nursery Pig Systemic Health, Inflammatory Markers, and Gastrointestinal Physiology

Abstract Soybean meal (SBM) inclusion is reduced in young pig diets due to antinutritional factors that may negatively impact performance and gut function. However, when SBM is fed to grower pigs under disease or environmental stress, health may improve through modulation of immunity. Presently it is unknown if a parallel effect will be realized in nursery pigs. Therefore, the experimental objective was to examine the role of SBM and its bioactive compounds on nursery pig gastrointestinal physiology, systemic health, and inflammatory markers. Two replications of 18 barrows (8.12 ± 0.80 kg BW; PIC800×Camborough), were randomly assigned to 1 of 6 dietary treatments: a high SBM positive control (SBMC; 28.6%), a negative control void of SBM (SP), but included soy protein isolate and concentrate to provide amino acids equivalent to SBM in SBMC; SP formulated to similar contribution and composition of isoflavones as SBMC (SP+ISO; 528 mg/kg of soy-isoflavones); SP diet fortified with soybean lecithin and phytosterols at similar concentrations to SBMC (SP+LIP; 2.85 g/kg of functional lipids); SP formulated to an equivalent ratio of insoluble to soluble fiber as SBM in SBMC (SP+FIB; 30 g/kg of soy fiber); or SP diet fortified with lunasin-peptide at 3.81 g/kg (SP+LUN). Pigs were individually housed, and limit-fed 2.5 times maintenance for a metabolism study consisting of a 6-d adaptation period, followed by 72-h of urine and fecal collections, and a 12-h lactulose:mannitol test. On d 11, whole blood and serum were collected before feeding, and at 2, 5, and 24 h post-feeding via jugular-venipuncture. Serum was analyzed for total antioxidant capacity (TAC) and malondialdehyde (MDA). Hematology was measured on whole blood. On d 12, pigs were necropsied for intestinal tissues collection. Data were analyzed as a linear mixed model with treatment as a fixed effect, replicate as a random effect, and initial BW as a covariate where appropriate. A dependent covariance structure was used for repeated measurements (Table 1). Pigs fed either SBMC or SP+LIP had greater mean corpuscular volume and hematocrit % (P = 0.027). Relative to the SP diet, pigs fed SP+LIP tended to have 11.4% greater hemoglobin concentrations (P=0.086). Circulating total white blood cells (WBC) were 21.2% and 22.6% less in pigs fed SBMC and SP+ISO diet, respectively, relative to SP (P = 0.002). Similarly, SBMC and SP+ISO had reduced neutrophil counts (P = 0.043). Relative to SP, SBMC, SP+ISO, and SP+FIB tended to have increased systemic TAC (P=0.086). Pigs fed either SBMC or SPC+ISO had over a 2-fold increase in the TAC of the jejunum, relative to SP (P = 0.039), but those fed SPC+FIB had increased TAC in the ileum and reduced MDA (P &amp;lt; 0.05). In conclusion, SBM and its isoflavones altered WBC concentrations. Whereas, SBM functional lipids may alter red blood cells, and SBM fiber modulated oxidative status.

Study of Haematocrit Level in Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome can lead to oxyhaemoglobin desaturation and has the possibility of stimulating erythropoiesis, leading to an increased haematocrit. The aim of this study is to identify the level of haematocrit in obstructive sleep apnea syndrome (OSAS) patients and to determine the correlation between haematocrit levels and the severity of obstructive sleep apnea syndrome (OSAS). This is a descriptive cross-sectional study at Hospital Universiti Sains Malaysia. All consented patients were interviewed and underwent a polysomnography (PSG) study. The severity of OSAS was based on the apnea–hypopnea index (AHI) and average oxygen desaturation. The blood haematocrit level was also obtained. Thirty-six OSAS patients were in the study group, and 17 patients were in the control group. The mean haematocrit level in the control group was 41.6 (2.5 SD), whereas in the study group the mean haematocrit level was 44.0 (3.27 SD). Pearson correlation analysis showed there was no significant correlation between AHI and haematocrit level (p-value: 0.392), however, there is a significant correlation between haematocrit levels and average oxygen saturation level (P-value: 0.022). The independent t-test between mean haematocrit level between OSAS group and control group showed that there was a significant difference between the mean haematocrit level among the control and OSAS groups. The increased level of haematocrit is significantly correlated with average oxygen desaturation but not with AHI in OSAS patient. Average oxygen desaturation can be considered as a parameter to assess severity and hypoxic stress in OSA patients.