Nonanemic Patients Research Articles

Frequency of anemia in individuals with beta-thalassemia trait.

Objective: To determine the frequency of anemia in carriers of Beta thalassemia Study Design: Retrospective Observational study. Setting: PAEC General Hospital, Islamabad, Pakistan. Period: 1st January 2022 to 30th June 2022. Methods: In this descriptive study, 131 carriers of Beta-thalassemia trait, diagnosed by hemoglobin electrophoresis on cellulose acetate membrane at alkaline pH, of any age and both genders were included. Complete blood counts were performed by hematology analyzer of Sysmex XN-1000 to determine hemoglobin level and red blood cell indices i.e. mean corpuscular volume. The studied parameters included hemoglobin and mean corpuscular volume as quantitative variables. Severity and type of anemia were the qualitative variables of this study and were expressed in terms of frequency and percentages. SPSS 19 version software was used for data analysis. Results: 131 carriers of Beta-thalassemia traits were included in study. 58 (44.27%) were males while 73 (55.73%) were females, male to female ratio being 1: 1.3. Of 131 beta thalassemia traits 67 (51.15%) were found to be anemic while 64 (48.85%) had normal hemoglobin for given age and gender. The mean corpuscular volume of anemic and non-anemics was 59.54+5.82 fl and 63.70+6.95 fl respectively. Mean hemoglobin level of anemic Beta-thalassemia traits was 9.42+1.05 g/dl while non-anemic patients was 12.12+1.39 g/dl. Conclusion: Burden of anemia among carriers of Beta-thalassemia traits is high. Understanding the prevalence of anemia in individuals with the trait is crucial for optimizing healthcare interventions and improving the quality of life for affected individuals.

Pre-operative Anemia as a Risk Factor of Morbidity and Mortality in Valvular Surgeries

Pre-operative anemia can be a hindrance to speedy recovery and will increase blood transfusion intraoperative and post operatively. Objective: To find a correlation between preoperative anemia and the subsequent morbidity and mortality rates in patients undergoing valvular surgeries. Methods: A retrospective observational study, involving 493 valvular surgeries’ patients. All patients had the same anesthetic and surgical techniques. According to the WHO, anemia is a hemoglobin level < 13 g/dl for men and <12 g/dl for women. Clinical variables were compared using chi-square and independent t-test. Results: The patients received cardiac surgery for valvular heart disorders and had an average age of 42.2±14.1 years, with 60.9% being male. Most patients exhibited NYHA III (48.9%) and CCS III (36.5%) functional class symptoms. Highest comorbidity was hypertension (35.1%), followed by diabetes (14.4%) and dyslipidemia (6.5%). 43.2% were anemic and older than non-anemic individuals (P=0.02). Anemic people had a significantly greater incidence of HTN (P 0.02) and DM (P < 0.001). Both groups exhibited identical perfusion and cross-clamp periods (P=0.4 vs. P=0.3). Though not statistically significant (P=0.08), non-anemic patients needed more intraoperative blood or blood product transfusions. Patients with anemia have worse outcomes, including increased rates of in-hospital mortality (P=0.03), extended artificial breathing (P=0.04), and postoperative blood/product transfusion (P<0.001). 44.8% of anemic individuals needed RCC, 41.9% FFP, and 41.4% platelets. Conclusions: anemia is associated with the poorest post-operative results. There is conflicting information about the impact of preoperative anemia, particularly iron deficiency anemia, on valvular surgery.

The effect of the four pharmacological pillars of heart failure on haemoglobin level.

Anaemia, a condition characterized by low levels of haemoglobin, is frequently observed in patients with heart failure (HF). Guideline-directed medical therapy improves HF outcomes by using medications like beta blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers, along with mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors. In this study, we aimed to review the pathophysiology of anaemia in patients with HF and present the current evidence regarding the relationship between the main recommended medications for these patients and haemoglobin levels. The authors conducted a comprehensive search in the medical literature for relevant original clinical articles in which the four pharmacological pillars of HF were given to the patients; we, then, assessed whether the association of use of these medications and haemoglobin level or development of anaemia was provided. These common medications have been shown in the literature that may exacerbate or ameliorate anaemia. Besides, it has been shown that even in the case that they result in the development of anaemia, their use is associated with positive effects that outweigh this potential harm. The literature also suggests that among patients receiving medications with negative effects on the level of haemoglobin, there was no difference in the rate of mortality between anaemic and non-anaemic patients when both were on treatment for anaemia; this point highlights the importance of the detection and treatment of anaemia in these patients. Further research is needed to explore these relationships and identify additional strategies to mitigate the risk of anaemia in this population.

Prevalence of iron deficiency in patients admitted to a geriatric unit: a multicenter cross-sectional study

BackgroundIron deficiency (ID) is often associated with other comorbidities in older patients and is a factor of morbimortality. However, the prevalence of ID remains poorly documented in this population.MethodsThe CARENFER PA study was a French multicenter cross-sectional study whose objective was to evaluate ID in patients (> 75 years) admitted to a geriatric unit. The primary endpoint was the ID prevalence defined as: serum ferritin < 100 µg/L and/or transferrin saturation coefficient (TSAT) < 20%. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death).ResultsA total of 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were included from October 2022 to December 2022. The prevalence of ID was 57.6% (95% CI, 54.3–60.9) in the cohort of older patients (62.6% in anemic and 53.3% in non-anemic patients; p = 0.0062). ID prevalence increased significantly with the presence of more than three comorbidities (65.6% vs. 55.9%; p = 0.0274), CRP ≥ 12 mg/L (73.0% vs. 49.3%; p < 0.001) and treatment that may influence ID/anemia (60.5% vs. 49.6%; p = 0.0042). In multivariate analysis, only CRP ≥ 12 mg/L was an independent predictive factor of ID (odds ratio, 2.78; 95% CI, 1.92–4.08; p < 0.001). SPPB scores were low (0–6) in 60.5% of patients with ID versus 48.6% of patients without ID (p = 0.0076).ConclusionMore than half of older patients had ID, including non-anemic patients. ID was associated with the presence of inflammation and a low SPPB score.Trial registrationNCT05514951.

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.

Anemia in patients undergoing chronic therapeutic plasma exchange

Therapeutic plasma exchange is known to be an extracorporeal treatment procedure with few adverse effects. Anemia in chronically exchanged patients is not a well-recognized adverse effect. Our aim is to find if adult patients develop anemia while undergoing prolonged TPE treatments and to determine the time of onset of anemia. We retrospectively reviewed all outpatients that have undergone TPE at least once a week from July 2017 to March 2020. Kaplan-Meier time-to-event analysis was employed to calculate the time taken for development of anemia and time to reduction of hemoglobin by 1 g/dL from baseline in uncensored patients. A total of 14 patients met inclusion criteria receiving chronic TPE for neurological disorders including myasthenia gravis (MG). Eleven patients had once a week procedure. Study patients underwent a total of 113 (IQR, 84–227) TPE procedures and the duration of TPE was 4 (IQR, 2–6.5) years. Anemia was prevalent in 29% of this patient cohort before the initiation of TPE with a median hemoglobin of 9.4 (IQR, 8.1–11.0) g/dL. All patients regardless of hemoglobin levels prior to therapy had a decrease of 1 g/dL in hemoglobin in 6 (IQR, 3–8) weeks after initiation of chronic TPE. Anemia occurred in all non-anemic patients who underwent chronic TPE within a short period of ten weeks. Patients who were moderately anemic prior to initiation of TPE progressed to severe anemia within six weeks of TPE. Our results suggest that anemia is a consequence of chronic TPE. Baseline and follow-up laboratory studies are vital for early diagnosis.

Decrease in hemoglobin following colorectal surgery - A cohort study with focus on iron deficiency

BackgroundOccurrence of anemia following colorectal cancer surgery is common and has been associated with decreased overall survival. We examine the perioperative hemoglobin change following minimally invasive colorectal cancer surgery. The aim is to assess if an association between decreasing hemoglobin and the existence of preoperative iron deficiency exists. MethodsRegistry based single center cohort study. Surgical colorectal cancer patients (2013–2019) being non-anemic prior to surgery and who underwent intended laparoscopic and curatively planned surgery were included. Hemoglobin change from pre-surgery to discharge was compared between patients with and without preoperative iron deficiency. Analysis was done using multivariate linear regression analysis. Changes in hydration status and inflammation were also accessed and compared to the change in hemoglobin. ResultsOut of a consecutive cohort of 1228 patients, 353 fulfilled the eligibility criteria and were available for analysis. The mean change in hemoglobin-concentration for all patients was -2.02 g/dl (SD +- 1.28) and an intraindividual decrease occurred in 95 % of the patients. Preoperative iron deficiency was not associated with the decrease in hemoglobin (correlation =-0.13, 95 % CI -0.43 – 0.18, p = 0.41). There was a statistically significant association between decreasing albumin levels and decreasing hemoglobin levels. ConclusionsFollowing minimally invasive laparoscopic surgery, 95 % of non-anemic surgical colorectal cancer patients experienced a decreasing hemoglobin level. The median hemoglobin decrease was 2 g/dl during hospitalization. Preoperative iron deficiency was not associated with the decrease in hemoglobin levels.

Effect of New or Worsening Anemia on Clinical Outcomes in 2233 Patients with Myelofibrosis Treated with Ruxolitinib in the Expanded-Access Jump Study

Introduction: Transient dose-dependent anemia is a known consequence of ruxolitinib treatment and can influence decisions regarding initiation, dosing, and discontinuation of therapy. Whether new or worsening anemia following ruxolitinib initiation has an impact on efficacy is unknown. A recent analysis of pooled COMFORT-I/II data indicated that new or worsening anemia did not impact the clinical outcomes of spleen volume response or symptom control (Al-Ali et al., Abstract PB2185, Presented at EHA 2023). The analysis presented here sought to validate this result using data from JUMP, the largest trial of ruxolitinib in patients with myelofibrosis (MF) to date. Methods: JUMP was a large (N=2233) single-arm, phase 3b, expanded-access trial that enrolled and provided ruxolitinib treatment for patients with MF in a setting similar to routine clinical practice. The study evaluated the safety and efficacy of ruxolitinib in patients aged ≥18 years with diagnosed primary or secondary intermediate (Int)-1, Int-2, or high-risk MF (International Prognostic Scoring System criteria) with baseline platelets ≥50×10 9 /L. All patients received ruxolitinib twice daily at a starting dose of 5-20 mg based on baseline platelet count. In this post hoc analysis, patients were stratified at baseline based on anemia due to MF (anemia defined as hemoglobin [Hb] &amp;lt;100 g/L) and transfusion status among patients with anemia (transfusion-requiring anemia [TRA; received ≥2 units of red blood cells over 8 weeks before first ruxolitinib dose] or non-transfusion-requiring anemia [NTRA]). Outcomes were stratified by presence or absence of new or worsening anemia following ruxolitinib initiation (defined as a decrease in Hb of ≥15 g/L or new transfusion requirement at Week 4, 8, or 12). Outcomes evaluated included spleen length response (SLR; defined as ≥50% reduction at Week 24 or 48 from baseline assessed with manual palpation), ≥6.5-point increase in Functional Assessment of Cancer Therapy-Lymphoma total score (FACT-Lym TS response) from baseline at Weeks 24 and 48, and overall survival (OS) measured by Kaplan-Meier method. Results: 2233 patients were included (baseline status: nonanemic, n=1386 [62.1%]; NTRA, n=521 [23.3]; TRA, n=326 [14.6]). Median (range) age of all patients was 67.0 (18-89) years, and 54.5% were men. Baseline characteristics were comparable between patients with vs without new or worsening anemia. Rates of SLR at Week 24 among patients with vs without new or worsening anemia were 31.5% vs 31.2%, respectively, (nonanemic; P=0.93), 24.4% vs 27.9% (NTRA; P=0.49), and 25.0% vs 29.8% (TRA; P=0.48; Table). FACT-Lym TS response at Week 24 for patients with vs without new or worsening anemia was 34.5% vs 34.0% (nonanemic; P=0.86), 32.7% vs 29.6% (NTRA; P=0.52), and 41.7% vs 32.1% (TRA; P=0.13). Similar trends were observed at Week 48 among patients with vs without new or worsening anemia for both SLR (35.6% vs 26.1%; P=0.02 [nonanemic], 29.6% vs 27.2%; P=0.71 [NTRA], and 19.0% vs 33.3%; P=0.10 [TRA]) and FACT-Lym (30.4% vs 23.3%; P=0.02 [nonanemic], 26.4% vs 27.6%; P=0.84 [NTRA], and 34.2% vs 33.3%; P=0.91 [TRA]). For nonanemic patients at baseline, time to median OS was not reached in either cohort; however, better OS was seen in those without vs with new/worsening anemia (hazard ratio: 0.559, [95% CI: 0.357-0.876]; P=0.01; Figure). For patients with baseline anemia (NTRA and TRA), no difference in OS was observed in those with or without new/worsening anemia ( P=0.24) Conclusions: Analysis of 2233 patients in the JUMP trial indicates that onset of new or worsening anemia following ruxolitinib initiation did not diminish clinical benefit of treatment. Ruxolitinib was associated with improvements in spleen size and symptom burden irrespective of baseline anemia and transfusion status. These results are consistent with a recent analysis of pooled COMFORT-I/II data (n=277), which reported similar findings for spleen volume and symptom responses. In contrast to the controlled clinical trial setting of COMFORT-I/II, JUMP reflects a real-world setting and enrolled a broader MF population, including those with platelet count &amp;lt;100×10 9/L and lower-risk MF. Taken together, these results support real-world use of ruxolitinib in patients with MF, regardless of baseline anemia or development of treatment-related anemia.

Soluble transferrin receptor as a marker of tissue iron deficiency: impact on cardiac, systemic, hematinic and neurohormonal biomarkers in patients with heart failure without systemic iron deficiency

Abstract Background Soluble receptor of transferrin (sTfR) is a marker of tissue iron status and may help to inform on subtle iron depletion and increased iron demand at tissular level even in the absence of overt systemic iron deficiency or anaemia. In this regard, the impact of raised sTfR levels as a marker of subtle tissue iron deficiency (ID) on serum biomarkers in non-anaemic HF patients with otherwise normal systemic iron status has not been evaluated. Purpose The aim of our study was to describe the association between sTfR as a marker of increased iron demand and tissue iron deficiency on cardiac, systemic, neurohormonal and hematinic biomarkers in non-anaemic patients with HF and normal systemic iron status. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF regardless the level of LVEF (DAMOCLES study). Patients were included if they had normal haemoglobin levels (≥12 g/dL), normal systemic iron status (serum iron &amp;gt;33 µg/dL, ferritin &amp;gt;100ng/mL and % transferrin saturation &amp;gt;20%) and available biomarker data. sTfR was measured with the Beckman Coulter enzyme immunoassay (higher levels indicate increased iron demand). The primary objective was to explore the association between sTfR and NT-proBNP levels. Secondary objectives were to explore the association between sTfR, and a wide array of serum biomarkers. Pearson’s correlation coefficient (r) was used to estimate correlations in bivariate analyses. The sex-and-age adjusted associations between sTfR, and the biomarkers were explored using General Additive Models (GAM) and linear regression models. Results The final study cohort consisted in 215 patients. Mean age was 70±12 years, mean LVEF was 43±15% and 62 (29%) were women. Mean sTfR values were 1.42±0.66 mg/L. In the whole cohort, median [Q1-Q3] NT-proBNP (pg/mL) was 1,125[587-2,668]. Log-transformed sTfR (log[sTfR]) showed significant correlations with log[NT-proBNP] (r=0.230; p-value=0.001), log[cTnT] (r=0.197; p-value=0.028), log[albumin](r=-0.221; p-value=0.001), C-reactive protein (r=0.215; p-value=0.002), serum erythropoietin levels, MCH (r=-0.247; p-value&amp;lt;0.001) and MCHC (r=-0.209; p-value&amp;lt;0.001). As shown in Table 1, these findings were confirmed in multivariate age-and-sex adjusted linear regression models. In age-and-sex adjusted Generalized Additive Models (GAM) (Figure 1), we confirmed that higher levels of sTfR were associated with increased levels of biomarkers indicating cardiac damage (cTnT, NT-proBNP), active inflammatory status (C-reactive protein) and increased cellular stimulation in response to tissue hypoxia (endogenous erythropoietin). Conclusions In a cohort of HF patients without iron deficiency or anaemia, higher levels of sTfR indicating increased iron demand and tissue ID were associated with a worse biomarker profile indicating early subclinical cardiac and/or systemic damage even in the absence of overt systemic iron deficiency or anaemia.

Soluble transferrin receptor as a marker of tissue iron deficiency: impact on exercise capacity and functional class in patients with heart failure without systemic iron deficiency or anaemia

Abstract Background Soluble receptor of transferrin (sTfR) is a marker of tissue iron status and may help to inform on subtle iron depletion and increased iron demand at tissular level even in the absence of overt systemic iron deficiency or anaemia. In this regard, the impact of raised sTfR levels as a marker of subtle tissue ID on functional limitation and submaximal exercise capacity in non-anaemic HF patients with normal systemic iron status has not been evaluated. Purpose To describe the association between sTfR as a marker of increased iron demand and tissue iron deficiency on submaximal exercise capacity, estimated with the distance walked in the 6-minutes walking test (6MWT), and symptoms of functional limitation (evaluated with the NYHA functional class) in non-anaemic patients with HF and normal systemic iron status. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF regardless the level of LVEF (DAMOCLES study). Patients included had a normal haemoglobin levels (≥12 g/dL), a normal systemic iron status (serum iron &amp;gt;33 µg/dL, ferritin &amp;gt;100ng/mL and % transferrin saturation &amp;gt;20%) and an available 6-minute walking test data. Tissue ID was defined as levels of sTfR &amp;gt;75th percentile (1.63mg/L). The primary endpoint was the distance walked in the 6MWT at inclusion in the study. The unadjusted associations between sTfR and the distance walked in the 6MWT were explored using General Additive Models (GAM), uni/multivariate linear regression models and also uni/multivariate binary regression models. All models were adjusted by age, sex, and prognostic factors such as LVEF, NYHA, NT-proBNP levels and iron status parameters among other well-known determinants of HF severity. Results The final study cohort consisted in 202 patients from the DAMOCLES study. Mean age was 70±12 years, mean LVEF was 43±15% and 57 (28%) were women. Mean sTfR values were 1.42±0.66 mg/L. Tissue ID was present in 54 patients (25%). In the whole cohort, mean 6MWT distance was 287±168 m. 6MWT distance was significantly worse in patients with tissue ID compared to patients without tissue ID (206±179m vs. 314±155, p-value&amp;lt;0.0001, respectively). Likewise, impaired submaximal exercise capacity was more common in patients with tissue ID (32, 64%) compared to patients without tissue ID (59, 39%, p-value=0.003). In unadjusted GAM models (Figure 1) we observed a significant association between increased iron demand (higher levels of sTfR) and lower distance achieved in the 6MWT. As shown in Table 1, higher sTfR levels were associated with lower distance in the 6MWT in unadjusted linear regression and binary logistic regression models. Conclusions In a cohort of HF patients without iron deficiency or anaemia, higher levels of sTfR indicating increased iron demand and tissue ID were associated with worse submaximal exercise capacity and tended to experience more functional limitations according to NYHA functional class.

Soluble transferrin receptor as a marker of tissue iron deficiency: impact on clinical outcomes in patients with heart failure without systemic iron deficiency or anaemia

Abstract Background Soluble receptor of transferrin (sTfR) is a marker of tissue iron status and may help to inform on subtle iron depletion and increased iron demand of functional proteins at tissular level even in the absence of overt systemic iron deficiency or anaemia. Raised sTfR levels have been associated with increased risk of all-cause mortality in general population and in patients with heart failure (HF). However, the prognostic significance of raised sTfR levels in non-anaemic HF patients with otherwise normal systemic iron status has not been evaluated. Purpose The aim of our study was to describe the association between sTfR as a marker of increased iron demand and tissue iron deficiency on outcomes in non-anaemic patients with HF and normal systemic iron status. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF (DAMOCLES study). For the current sub-study, we selected all patients form the DAMOCLES cohort that had a complete iron status evaluation including sTfR, normal haemoglobin levels and normal systemic iron status. Tissue ID was defined as levels of sTfR&amp;gt; 75th percentile (1.63mg/L). The primary and secondary endpoints were all-cause mortality and HF hospitalization respectively. Multivariate Cox proportional hazards models were constructed to explore the associations between tissue ID and the studied outcomes. In addition, the multivariate parametric and non-parametric associations between sTfR and the β estimated risk of the occurrence of the primary and secondary endpoints were explored using General Additive Models (GAM). All models were adjusted by age, sex, and prognostic factors such as LVEF, NYHA, NT-proBNP levels and iron status parameters among other well-known determinants of HF severity. Results The final study cohort consisted in 215 patients from the DAMOCLES study. Mean age was 70±12 years, mean LVEF was 43±15% and 62 (29%) were women. Mean sTfR values were 1.42±0.66 mg/L. Tissue ID was present in 54 patients (25%). Hospital readmission occurred in 55 patients (25.6%) and death occurred in 60 (27.9%). In multivariate Cox proportional hazards models (table 1) higher levels of sTfR and Tissue ID were significantly associated with the risk all-cause death. This association was not observed for HF readmission. As shown in figure 1 panel A, adjusted GAM showed there was a significant linear association between higher levels of sTfR and the mortality risk. Moreover, the adjusted cumulative risk of all-cause death (Figure 1 panel B) confirmed higher risk of death among patients with tissue ID compared to patients’ levels of sTfR≤ the 75th percentile with early divergence of the curves during follow-up. Conclusions In a cohort of HF patients without iron deficiency or anaemia, higher levels of sTfR indicating tissue ID were associated with increased risk of mortality. This association was linear and was not observed for HF readmission.

Soluble transferrin receptor as a marker of tissue iron deficiency: impact on health-related quality of life in patients with heart failure without systemic iron deficiency or anaemia

Abstract Background Soluble receptor of transferrin (sTfR) is a marker of tissue iron status and may help to inform on subtle iron depletion and increased iron demand of functional proteins at tissular level even in the absence of systemic iron deficiency or anaemia. Raised sTfR levels have been associated with of all-cause mortality and impaired exercise capacity in patients with heart failure (HF). However, the impact quality of life (QoL) has not been evaluated. Purpose The aim of our study was to describe the association between sTfR as a marker of increased iron demand and tissue iron deficiency and QoL in non-anaemic patients with HF and normal systemic iron status. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF (DAMOCLES study). For the current sub-study, we selected all patients form the DAMOCLES cohort that had normal haemoglobin levels and normal systemic iron and available QoL data. Tissue ID was defined as levels of sTfR&amp;gt; 75th percentile (1.63mg/L). To assess QoL, we used the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The primary endpoint was the overall summary score (OSS) of the MLHFQ instrument self-administered at inclusion in the study. The unadjusted parametric and non-parametric associations between sTfR and the MLHFQ OSS scores were explored using General Additive Models (GAM). Univariate and multivariate linear regression models were constructed to explore the associations between sTfR levels and tissue ID and the QoL scores. All models were adjusted by age, sex, and prognostic factors such as LVEF, NYHA, NT-proBNP levels and iron status parameters among other well-known determinants of HF severity. Results The final study cohort consisted in 206 patients. Mean age was 70±12 years, mean LVEF was 43±15% and 61 (30%) were women. Mean sTfR values were 1.42±0.66 mg/L. Tissue ID was present in 54 patients (26%). Mean MLHFQ OSS were 42±26. Global QoL was significantly worse in patients with tissue ID compared to patients without tissue ID (51±27 vs. 39±20, p-value=0.006, respectively). In unadjusted GAM models (Figure 1) showed a direct and significant association between increased iron demand and worse global QoL with a linear p-value&amp;lt;0.0001. As shown in Table 1, higher sTfR were associated with higher MLHFQ OSS scores in unadjusted models. These findings were confirmed in forward stepwise multivariate linear regression models (Table 1). Conclusions In a cohort of HF patients without iron deficiency or anaemia, higher levels of sTfR indicating increased iron demand and tissue ID were associated with worse QoL.

Impact of anaemia and iron deficiency on long-term outcomes following transcatheter edge-to-edge repair in degenerative vs. secondary mitral regurgitation: results from a large single-center study

Abstract Background Transcatheter mitral valve edge-to-edge repair (TEER) is an established therapeutic option for significant mitral regurgitation (MR), as an alternative for patients at high risk for open heart surgery. While mitral valve reconstruction is the guideline-recommended treatment modality for degenerative mitral regurgitation (DMR), secondary mitral regurgitation (SMR) is more complex and requires a multifaceted approach. Anaemia and iron deficiency (ID) are both associated with unfavourable outcomes in patients with cardiovascular diseases, particularly in those with heart failure. In patients undergoing TEER, the prevalence of ID and anaemia is exceptionally high. However, data regarding the impact of anaemia and ID on outcomes are limited to short- and mid-term follow-up periods. Purpose This retrospective single center study, aimed to investigate effects of anaemia and ID on long-term outcomes following TEER for relevant MR, as well as to relate it to the underlying MR aetiology. Methods A total of 833 patients (mean age 76.1 ± 8.4 years, 40.7% female, 63.3% secondary MR) were treated by TEER between September 2008 and July 2019. Patients were stratified based on their anaemia status (anaemia was defined as hemoglobin &amp;lt;12 g/dL in females and &amp;lt;13 g/dL in males) or ID (defined according to current HF guidelines as a serum ferritin concentration of &amp;lt;100 ng/mL or 100–299 ng/mL and a transferrin saturation &amp;lt;20%). Clinical follow-up was conducted primarily through in-person visits or by structured telephone interviews at 6 and 12 months after intervention and annually thereafter. The median follow-up time was 5.5 years, with a maximum follow-up of 12.3 years. Results Anaemia and ID were prevalent among patients with 61.6% and 68.1%, respectively. Among all anaemic patients, 73.5% also had ID. Anaemic patients had a lower functional status at baseline and were less likely to show improvement after TEER. Additionally, anaemia was significantly associated with all-cause mortality (hazard ratio [HR]=1.68, 95%-confidence interval [CI]: 1.36-2.07, p&amp;lt;0.001) and the composite endpoint of death or heart failure rehospitalization (HR=1.30, 95%-CI: 1.10-1.54, p=0.002). Moreover, anaemia was found to be an independent predictor for all-cause mortality in patients with secondary MR, with a 5-year mortality rate of 69.9% in anaemic patients compared to 47.8% in non-anaemic patients (p&amp;lt;0.001). However, ID was not associated with an increased risk of all-cause mortality or the composite endpoint of death or heart failure rehospitalization for either degenerative or secondary MR. Conclusion The high prevalence of anaemia and ID in patients undergoing TEER is noteworthy. Anaemia was associated with poorer functional baseline status and less post-interventional improvement. Furthermore, and in contrast to ID, anaemia was linked to higher mortality rates and more heart failure rehospitalizations, particularly in patients with secondary MR.Kaplan Meier survival analysisPredictors for all-cause mortality

Association of blood pressure parameters post mechanical thrombectomy in anemic versus non-anemic patients and clinical outcomes

IntroductionHigher blood pressure (BP) is considered to be detrimental in patients who undergo mechanical thrombectomy (MT), however, the impact of BP post-MT based on comorbidities like anemia has not been well studied. We aim to determine the association of 24-h post-MT BP parameters with clinical outcomes depending on their anemia status. MethodsWe conducted a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 1/2015 to 12/2020. Patients were dichotomized into anemic and non-anemic groups based on the World Health Organization’s definition of anemia [hemoglobin < 12.0 g/dL in women and < 13.0 g/dL in men]. We performed a multivariable analysis with binary logistic regression with the 24-h post-MT BP parameters as predictors. The outcomes were functional dependence (3-month mRS 3–6), mortality, and an early neurological improvement. Results220 patients met the inclusion criteria. 158 (71.82 %) patients had functional dependence at 3-months. In the multivariable analysis, the parameters of a higher mean SBP (132.9 ± 11.94 vs.126.52 ± 13.3; OR, 1.05; 95 % CI, 1.02–1.09; P 0.011), a higher mean MAP (93.35 ± 8.44 vs.89.69 ± 10.03; OR,1.06; 95 % CI, 1.01–1.11; P 0.029) and a higher maximum MAP (115.26 ± 11.73 vs.109.37 ± 12.51; OR,1.05; 95 % CI, 1.01–1.08; P 0.023)were significantly associated with functional dependence in non-anemic patients, while a lower mean DBP (65.53 ± 9.73 vs. 71.94 ± 10.16; OR, 0.92; 95 % CI, 0.86–0.98; P 0.007), lower mean MAP (85.7 ± 8.65 vs. 91.38 ± 10; OR, 0.93; 95 % CI, 0.86–0.99; P 0.02), a lower minimum DBP (49.27 ± 10.51 vs. 55.1 ± 11.23; OR, 0.93; 95 % CI, 0.88–0.99; P 0.019), a lower minimum MAP (68.96 ± 9.54 vs. 74.73 ± 10.47; OR, 0.93; 95 % CI, 0.87–0.99; P 0.023) were significantly associated with mortality in patients with anemia, and a lower minimum DBP (54.75 ± 10.42 vs. 59.69 ± 8.87; OR, 0.95; 95 % CI, 0.91–0.99; P 0.012) and a lower minimum MAP (71.92 ± 14.7 vs.75.67 ± 14.17; OR, 0.97; 95 % CI, 0.94–0.99; P 0.047) were significantly associated with an early neurological improvement in non-anemic patients. For patients with anemia, there was no association between 24-hour BP Parameters post-MT and functional dependence and early neurological improvement, and between 24-hour BP Parameters post-MT and mortality in non-anemic patients. ConclusionIn our study, higher BP parameters were associated with worse outcomes in patients without anemia, however, this effect was not found in patients with anemia. Certain lower BP parameters were associated with higher 3-month mortality in anemic patients; however, this effect was not found in non-anemic patients. Higher BP post-MT can potentially promote perfusion and thus is not associated with worse outcomes in anemic patients post-MT, whereas in non-anemic patients it may potentially lead to reperfusion injury While our study is limited because of size and its retrospective nature, the findings suggest that an individualized approach to tailor the target BP post-MT to a patient's risk factor profile and associated co-morbid conditions to achieve optimization of medical care post-MT and associated co-morbid conditions to achieve optimization of medical care post-MT.

Preoperative Anemia Is Associated With Worse Postoperative Outcomes After Open Reduction Internal Fixation of Distal Radius Fractures.

Preoperative anemia has been shown to be associated with complications after numerous orthopedic procedures. No studies to our knowledge have examined its impact on outcomes after open reduction internal fixation (ORIF) of distal radius fracture (DRF). We hypothesized that patients with preoperative anemia would have increased likelihood of adverse outcomes, and likelihood would increase with severity of anemia. A total of 14 136 patients underwent ORIF for DRF over 2012-2021, identified in the National Surgical Quality Improvement Program database. Patients were classified by World Health Organization criteria as nonanemic (hematocrit >36% for women, >39% for men), mildly anemic (hematocrit 33%-36% for women, 33%-39% for men), or moderately to severely anemic (hematocrit <33% for women or men). Multivariable regressions adjusted for age, sex, race, and comorbidities statistically different between anemic and nonanemic patients were used to examine the effect of anemia on postoperative outcomes. Mildly anemic patients had significantly longer length of stay and were significantly more likely to experience readmission and sepsis (P < .05 all). Moderately to severely anemic patients had significantly longer length of stay and were significantly more likely to experience readmission, postoperative transfusion, septic shock, and any adverse event (P < .05 all). Preoperative anemia is associated with increased likelihood of adverse outcomes after ORIF for DRF, and likelihood increases with severity of anemia. Surgeons should monitor patients for preoperative anemia and endeavor to identify the source of and, if safe and possible, correct the anemia preoperatively or manage and educate patients postoperatively.

Assessing the occurrence and severity of pre- and postendodontic pain in anemic and healthy female patients.

The objective of this current survey was to assess both the occurrence and severity of pre- and post-endodontic pain among female individuals, distinguishing between those with anemia and those without. In the current study, we included a total of 60 women with anemia (hemoglobin < 11) and those without anemia (hemoglobin > 13). We recorded the occurrence and severity of pain before and at 24, 48, and 72 h following root canal treatment using a visual analog scale (VAS)ranging from 0 to 10. Additionally, we collected data on patient age, tooth type, as well as pulpal and periapical conditions. Statistical analysis was carried out using two-way ANOVA, pairedt-tests, and Pearson correlation coefficient. The significance level for statistical tests was set at p ≤ .05. The incidence of preoperative pain in both anemic and non-anemic patients was 80%. The total incidence of post-operative pain was recorded as 71.7% (82.2% in anemic and 61.1% in non-anemic women). Compared with the pretreatment pain incidence and intensity, the values increased in 24 h but declined in 48 hand 72 h after treatment. Considering the posttreatment pain intensity, the mean values were higher in the three time intervals (24, 48, and 72 h) in anemic patients. Pulpal and periapical status, in contrast to age and tooth type, significantly contributed to the intensity of posttreatment pain. Regarding the importance of pain phenomenon in human life, it is recommended to consider anemia as an important risk factor for post-endodontic pain. Early diagnosis and analgesic treatment interventions in anemic females, alongside the pain control during root canal treatment, could promote the patient's satisfaction and quality of care.

What we should consider to facilitate recovery of the hematological profile in all patients after pancreaticoduodenectomy: the role of preoperative intravenous iron treatment

BackgroundIn pancreaticoduodenectomy (PD), the duodenum and upper jejunum responsible for iron absorption are removed, which can lead to massive hemorrhage during surgery and cause iron deficiency anemia after PD. The aim of this study was to evaluate overall changes in hematologic profiles of patients who underwent pancreaticoduodenectomy. Effect of preoperative intravenous iron treatment on recovery of anemia after surgery was also investigated.MethodsFrom March 2021 to December 2021, patients who underwent curative PD at our institution due to periampullary lesions were enrolled. They were divided into two groups according to whether or not iron was administered before surgery. In the IV iron group, all patients had been routinely administered with 1000 mg of ferric carboxymaltose intravenously once about 3–7 days before the operation day. Contrarily, patients in the control group did not receive intravenous iron before PD. Changes in hematological profile were measured preoperatively and at 5, 14, and 30 days postoperatively. Clinical results of the two groups were compared and analyzed. Additionally, a subgroup analysis was performed for selected non-anemic patients who had preoperative hemoglobin level of 12.0 g/dl or higher to compare changes in hematologic profiles between the two groups.ResultsThirty patients of the IV iron group and 34 patients of the control group were analyzed. Although no difference was observed in postoperative complications or mortality, hemoglobin and iron levels were recovered significantly faster at two weeks postoperatively in the IV iron group than in the control group. Iron levels were significantly higher in the IV iron group throughout the postoperative period. In subgroup analysis conducted for non-anemic patients, hemoglobin levels were recovered significantly faster and maintained higher in the IV iron group throughout the postoperative period, although baseline levels of hemoglobin were similar between the two groups. In addition, the length of intensive care unit stay was significantly shorter in the IV iron group than in the control group.ConclusionsPreoperative intravenous iron treatment might be effective in facilitating recovery of hematologic profiles of patients during the recovery period after PD regardless of the presence of preoperative anemia, thus preventing postoperative iron deficiency anemia.

Prevalence of, association with, severity of, and prognostic role of serum hemoglobin level in acutely decompensated heart failure patients

BackgroundThe role of hemoglobin (Hb) level in the short-term prognosis of patients with acute decompensated heart failure (ADHF) remains a matter of debate. We aimed to declare the prevalence of, association with, severity of, and prognostic role of SHL with ADHF.MethodsUsing the data from the Persian Registry Of Cardiovascular Disease/ Heart Failure (PROVE-HF) study, we assessed the association between anemia and polycythemia (Hb < 13 g/dLit, > 16.5 g/dLit in males and < 12 g/dLit, and > 16 g/dLit in females, respectively) and short-term mortality using Cox proportional hazard modeling, with adjustment of clinically relevant variables.ResultsOf 3652 ADHF patients, anemia was seen in 1673 patients (48.40%). The prevalence of mild, moderate, and severe anemia was 42.33% (n = 1546), 3.23% (n = 118), and 0.24% (n = 9), respectively. Also, 422 patients (11.55%) had polycythemia. Compared to non-anemic patients, anemic patients were mainly male, older, and were more likely to have diabetes mellitus (DM), renal dysfunction, hypertension (HTN), and thyroid disease. Significant predictors of short-term mortality were lower systolic and diastolic blood pressure, lower Hb level, and higher blood urea nitrogen (BUN). Anemic patients had higher all-cause mortality [adjusted hazard ratio (aHR) 1.213, 95% confidence interval [CI] 1.054–1.396]. Moderate anemia increased mortality by approximately 80% in males (aHR 1.793, 95% CI 1.308–2.458) and females (aHR 1.790, 95% CI 1.312–2.442), respectively. Polycythemia had no association with short-term mortality in both genders (P-value > 0.05).ConclusionsThis study revealed that anemia is an adverse prognostic factor for short-term mortality in ADHF patients, with higher mortality in moderately anemic patients.

Serum erythropoietin level in anemic and non-anemic patients with chronic leukemia

Abstract Background: Anemia is a common issue in chronic leukemia, which results in a worse outcome and shorter survival. Inadequate production of erythropoietin (EPO) as compared to the severity of anemia may play a major role in ACD for patients with hematological malignancies. Clarifying the role of EPO may provide a better understanding of its pathogenesis, and proper management of patients. Objectives: To determine serum EPO levels and look for any potential link between EPO and the cause of anemia in anemic patients with chronic leukemia in a sample of Iraqi patients in the middle euphrates region. Materials and Methods: This is a case control study included 38 patients (19 chronic myeloid leukemia [CML], 19 chronic lymphocytic leukemia [CLL]) who were attending the outpatient clinic of hematology in Baghdad Teaching Hospital, Marjan Teaching Hospital from September 2022 to March 2023, together with 30 adult participants without disease as a control group. All patients involved were diagnosed as having a disease based on a specialist’s physical examination, morphological evaluation of peripheral blood films and bone marrow, and flow cytometric immune-phenotypic profile. Blood samples were collected from each subject, and the following investigations were done: CBC, RFT, blood film examination, and ELISA assay for serum EPO. Results: The mean age of CML patients was (50.1 ± 12.85) range from 24 to 72, CLL patients (58.2 ± 10.4) range from 38 to 75. The majority of patients were men (N = 23, 60.5%). The participants in the patient group were subdivided into 18 (47.4%) patients with anemia and 20 (52.6%) patients without anemia. The mean differences of EPO concentration (U/L) between study groups demonstrated significant higher level among patient group (49.53 ± 56.82) than control group (12.73 ± 4.72) with P value &lt; 0.0001. The level of serum EPO in anemic patients (89.28 ± 61.95) has been found to be higher than non-anemic patients (13.82 ± 4.43) and it was statistically significant (P &lt; 0.0001). Endogenous EPO production was found to be defective in 10% of CML patients, 50% of CLL patients were judged by a value for the ratio of observed-to-predicted serum EPO levels (observed/predicted ratio) of ≤0.9. Conclusion: These findings indicate that anemia associated with hematologic malignancy may result from an inappropriately low EPO response. EPO treatment should benefit in this group of patients.

Effect of Anemia on Tumor Response to Preoperative Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

Preoperative neoadjuvant chemoradiotherapy (nCRT) and total rectal mesenteric resection (TME) are the primary treatment options for locally advanced rectal cancer (LARC), but their efficacy varies. This study aimed to investigate the impact of anemia on the tumor response of patients with LARC receiving preoperative neoadjuvant chemoradiotherapy. This study was a retrospective analysis of clinical and pathological data from patients with LARC who underwent nCRT and TME from January 2019 to May 2022 at a single institution. The tumor response was evaluated based on the tumor regression grade (TRG) and T-stage change of the primary tumor. Hemoglobin concentration was measured and graded to determine the presence of anemia. Anemia was categorized into four groups based on the hemoglobin levels: mild anemia (90-120 g/L), moderate anemia (60-90 g/L), severe anemia (30-60 g/L), and extreme anemia (less than 30 g/L). Finally, tumor response was quantified histologically using the AJCC 8th edition tumor regression grading system for rectal cancer and pre- and post-treatment T-grading. A total of 88 patients with LARC who received nCRT and TME were included in the study, with 17 females and 71 males. Of these patients, 9 were moderately anemic and 37 were mildly anemic. The radiation therapy regimen was administered at a dose of 1.8-2 Gy per fraction, five times a week, for a total dose of 45-50.4 Gy. Capecitabine chemotherapy was also administered orally (825 mg/m2, twice a day) on the days of radiation therapy. Other chemotherapy regimens included XELOX and mFOLFOX6. The TRG was significantly different in anemic patients compared to non-anemic patients (P = 0.039). Only 2 out of 46 anemic patients (4%) showed an excellent response (TRG0), while 8 out of 42 non-anemic patients (19%) showed an excellent response (p = 0.043). There was also a significant difference in the incidence of anemia between cT3 and cT4 stages (p = 0.048), with 44% of cT3 patients and 67% of cT4 patients being anemic. The number of patients with poor response (TRG2-3) decreased as the degree of anemia decreased, but no significant difference was found. The incidence of TRG3 was 11% in patients with moderate anemia and 7% in non-anemic patients (P = 0.863). There was no significant difference in postoperative pathological T-stage between anemic and non-anemic patients. 89% of anemic patients had a pathological stage of ypT3 or less after chemoradiotherapy, while 95% of non-anemic patients did (P = 0.167). The pre- and post-treatment pathological staging did not significantly differ between anemic and non-anemic patients. 67% of anemic patients had descending tumors, while 59.5% of non-anemic patients had descending tumors (p = 0.509). Patients with LARC who have normal hemoglobin concentrations during nCRT have better tumor regression compared to patients with anemia. Additionally, the incidence of anemia was higher among patients with advanced T-stage prior to treatment.