Non-anemic Group Research Articles

Pre-treatment nutrition-related indicators and the prognosis of patients with newly diagnosed epithelial ovarian cancer: an ambispective cohort study

BackgroundFew studies have explored the link between nutritional status and prognosis in patients with epithelial ovarian cancer (EOC), and existing findings are controversial. Thus, this study aimed to explore the effects of pre-treatment nutrition-related indicators on the prognosis of patients with newly diagnosed EOC.MethodsIn this ambispective cohort study, 1,020 patients with EOC diagnosed by pathology examination were enrolled and followed-up until December 31, 2023. Univariate and multivariable analyses were conducted on nutrition-related indicators, including body mass index (BMI), albumin (ALB), hemoglobin (Hb), diabetes mellitus (DM), and hyperlipidemia, along with clinicopathological characteristics that might affect patients’ first-line chemotherapy response, progression-free survival (PFS), and overall survival (OS). Survival curves were created using the Kaplan–Meier method. A Cox proportional hazards model was established to obtain hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsThe median follow-up duration was 48 months. Compared with patients having normal nutritional indicators, those with hypoalbuminemia had poorer first-line chemotherapy responses. The proportions of those with complete response (CR), partial response (PR), and stable disease or progressive disease (SD/PD) for the ≤30 g/L, 30 < ALB<35 g/L and normal ALB groups were 57.2, 20.6, and 22.2% vs. 62.0, 22.5, and 15.5% vs.79.5, 13.6, and 6.9%. Patients with hypoalbuminemia had shorter median PFS (mPFS): 15 vs. 19 vs. 57 months in the three groups, respectively; and shorter median OS (mOS): 36 vs. 51 vs. 124 months. Patients with hyperlipidemia also exhibited poorer first-line chemotherapy responses; CR, PR, and SD/PD rates for the hyperlipidemia and non-hyperlipidemia groups were 68.9, 19.5, and 11.6% vs. 76.4, 14.7, and 8.9%, respectively, and shorter mPFS (17 vs. 57 months) and mOS (40 vs. 119 months). Patients with anemia had poorer first-line chemotherapy responses; CR, PR, and SD/PD rates for the anemia and non-anemia groups were 68.4, 19.7, and 11.9% vs. 76.2, 14.9, and 8.9%, respectively. All differences were statistically significant (p < 0.05). Multivariable analysis identified hyperlipidemia as an independent risk factor for PFS (hazard ratio [HR] = 2.083; 95% CI:1.726–2.514; p < 0.001) and OS (HR = 2.158; 95% CI:1.746–2.666; p < 0.001), whereas hypoalbuminemia and anemia were not confirmed as independent prognostic factors. This study found no effect of BMI or DM on patient prognosis.ConclusionPre-treatment hypoalbuminemia, hyperlipidemia, and anemia negatively affected the prognosis of patients with newly diagnosed EOC, with hyperlipidemia being an independent risk factor for shorter survival.

Accuracy of noninvasive total haemoglobin measurement for detecting anaemia in infants: a cross-sectional study in a well-child care clinic, Khon Kaen, Thailand

ObjectiveInfants are at a high risk of developing anaemia, which can arise from various causes, including inappropriate feeding practices. However, few infants attend anaemia screening programmes due to poor cooperation...

Prenatal Hemoglobin Concentration and Long-Term Child Neurocognitive Development.

Anemia in pregnancy, defined by a hemoglobin level (Hb) of less than 110 g/L, contributes to infant mortality and morbidity in sub-Saharan Africa. Maternal Hb changes physiologically and pathologically during pregnancy. However, the impact of these changes on long-term child neurocognitive function is unknown. This study therefore investigates the association between Hb at specific antenatal care visits and prenatal Hb trajectories during pregnancy and long-term child neurocognitive function. We analyzed data from a prospective cohort study that included 6-year-old singleton children born to women enrolled before 29 weeks of gestation into an antimalarial drug clinical trial. Hemoglobin level was analyzed from venous blood collected at least twice during pregnancy and at delivery. We used group-based trajectory modeling to identify distinct prenatal Hb trajectories. In total, 478 children (75.1% of eligible children) had assessment of cognitive and motor functions at 6 years of age. Three distinct Hb trajectories were identified: persistently anemic (Hb <110 g/L throughout the second and third trimesters), anemic to nonanemic (Hb <110 g/L at second trimester with increasing Hb toward the third trimester to Hb ≥110 g/L), and persistently nonanemic (Hb ≥110 g/L throughout the second and third trimesters). Children of women in the persistently anemic and anemic-to-nonanemic groups had significantly lower neurocognitive scores than children of women in the persistently nonanemic group (β = -6.8, 95% CI: -11.7 to -1.8; and β = -6.3, 95% CI: -10.4 to -2.2, respectively). The study shows that maintaining an elevation of Hb at or above 110 g/L from the second to third trimester of pregnancy may be associated with optimal long-term child neurocognitive function.

Effect of Hemoglobin and Blood Glucose Levels on CT Perfusion Ischemic Core Estimation: A Post Hoc Analysis of the ESCAPE-NA1 Trial.

CT perfusion (CTP) maps can estimate the ischemic core in acute ischemic stroke based on distinctive cerebral blood flow thresholds. However, metabolic factors beyond perfusion influence the tissue tolerance to ischemia and the infarct growth rate. Underestimating the ischemic core volume (ICV) might result in overestimating the salvageable cerebral tissue and, consequently, overestimating the potential clinical benefits of reperfusion therapies. We aim to evaluate whether baseline hemoglobin and blood glucose levels influence the accuracy of baseline CTP ICV estimations. Large vessel occlusion stroke patients investigated with baseline CTP undergoing thrombectomy with near-complete reperfusion and without parenchymal hemorrhage from the ESCAPE-NA1 trial were included. Patients were subdivided into anemic (hemoglobin <130 g/L for men and <120 g/L for women) and nonanemic groups, and hyperglycemic (blood glucose level >7 mmol/L) and normoglycemic groups. Ischemic core underestimated volume (ICuV) was calculated: final infarct volume minus CTP-based ICV. The primary outcome was the presence of "perfusion scotoma" defined as ICuV ≥10 mL. Presence of "perfusion scotoma" and median ICuV were compared between anemic vs nonanemic and hyperglycemic vs normoglycemic patients using nonparametric tests and multivariable binary logistic regression with adjustment for baseline variables. One hundred sixty-two of 1,105 (15%) patients were included (median age 70.5 [interquartile range (IQR) 61-80.4], 50.6% women). The median ICuV was 7.26 mL (IQR 0-25.63). Seventy-eight (48%) patients demonstrated perfusion scotoma. Forty-two (25.7%) patients were anemic, and 65 (40.1%) were hyperglycemic. In univariable analysis, the hyperglycemic group had a higher prevalence of perfusion scotoma (65% [n = 40] vs 39% [n = 38], p = 0.006) and larger ICuV (17.79 mL [IQR 1.57-42.75] vs 6 mL [-0.31 to 12.51], p = 0.003) compared to normoglycemic patients. No significant ICuV differences between patients with and without anemia were seen. Multivariable regression analysis revealed an association between perfusion scotoma and hyperglycemia, adjusted odds ratio (OR) 2.48 (95% CI 1.25-4.92), and between perfusion scotoma and blood glucose levels, adjusted OR 1.19 (95% CI 1.03-1.39) per 1 mmol/L increase. In our study, CTP-based ischemic core underestimation was common and associated with higher baseline blood glucose levels. Individual metabolic factors beyond perfusion that critically influence the infarct growth rate should be considered when interpreting baseline CTP estimations of ischemic core.

Effects of Preoperative Hemoglobin on Microsurgical Reconstruction and Perioperative Blood Transfusion Requirement: A Meta‐Analysis and Systematic Review of the Literature

ABSTRACTPurposeAlthough blood loss in microsurgical reconstruction is rarely large enough to be life‐threatening, preoperative anemia can be a particular issue in terms of postoperative morbidity, impaired wound healing, and compromised tissue viability. We seek to review the effect of preoperative hemoglobin (Hgb) levels on perioperative blood transfusion (PBT) requirements and complications to guide management of patients with preexisting anemia undergoing reconstruction.MethodsPubMed, Embase, and Scopus were queried for relevant articles. Inclusion criteria were as follows: original studies investigating outcomes and PBT requirements in flap‐based reconstruction based on preoperative Hgb levels. Patient and study characteristics were analyzed using descriptive statistics. A meta‐analysis was conducted to assess transfusion requirements across the included studies using Stata (version 18.0 Stata Corp, College Station, Texas, USA). The Fisher method was used to aggregate individual study p values into a single combined value to statistically assess the combined findings, where a p value of &lt; 0.05 was set as statistically significant.ResultsOne thousand three hundred and eighty‐nine studies were screened for title and abstract relevance, 14 of which met the inclusion criteria, including a total of 61,116 patients. Meta‐analysis of the studies revealed a PBT requirement of 36.2% for anemic individuals, significantly higher than the 20.0% for those with normal preoperative Hgb levels (p &lt; 0.001), with an average 4.9 versus 2.4 units of packed red blood cells being transfused (p &lt; 0.001). The majority of studies concluded that preoperative anemia was associated with medical complications, such as myocardial infarction, stroke, and infection (p &lt; 0.001). While six studies reported a significant relationship between low preoperative Hgb and flap morbidity (flap loss and partial flap necrosis), two studies found no correlation. The overall postoperative complication rate across the studies was 42.2% among patients with low preoperative Hgb levels, whereas the nonanemic group demonstrated a markedly lower rate of 13.9% (p &lt; 0.001).ConclusionThe existing evidence is strongly suggestive of increased PBT requirement in patients with anemia, highlighting the necessity for preoperative optimization of Hgb levels and intraoperative monitoring. While preliminary evidence demonstrates a relationship between anemia and medical complications, more research is warranted to characterize the specific association between preoperative Hgb levels and flap morbidity.

Effect of Iron Deficiency Anemia on HbA1c Levels in a cohort of patients with Type 2 diabetes mellitus in a tertiary care hospital

Introduction: Studies have reported that HbA1c levels can be changed by iron deficiency (ID) which is the commonest nutritional anaemia globally. This study was aimed at determining the effect of iron deficiency anaemia (IDA) on HbA1c levels in a cohort of type 2 diabetes mellitus (T2DM) attending a tertiary care hospital in Sri Lanka. Methods: A retrospective analytical study was performed for a period of six months from January 2021. Laboratory records of 281 adult T2DM patients both, anaemic (n=135) with Hb &lt;12g/dL in females and &lt;13g/dL males and transferrin saturation &lt;16%, and nonanaemic (n=146) with Hb &gt;12g/dL in females and &gt;13g/dL in males were analyzed. Data were analyzed using (SPSS) version 20, descriptive statistical methods, Pearson’s Correlation test, independent sample t-test, one-way analysis of variance (ANOVA) and Chi-Square test were used. P&lt;0.05 was considered significant. Results: Out of the total 281 patients diagnosed with T2DM, 150 were female, and 131 were male, spanning an age range of 22 to 96 years. The mean ± standard deviation (SD) values for HbA1c in both anaemic and non-anemic groups were 7.4±2.2% g/dL and 7.3±2.36% g/dL, respectively. Importantly, no statistically significant relationship was observed between the two groups (p=0.889). Furthermore, there was no significant correlation between HbA1c levels with serum iron (p=0.617), total Iron Binding Capacity (TIBC) (p=0.340), and transferrin saturation (p=0.168). Conclusion: The study reveals, HbA1c in T2DM patients with and without IDA show no significant difference. Therefore, HbA1c could be reliably used in monitoring patients with T2DM and IDA. Keywords: T2DM, HbA1c, iron deficiency anaemia, red blood cell indices

Prognostic value of reticulocyte production ability in patients with chronic heart failure

Abstract Background Anaemia is frequently observed in patients with chronic heart failure (CHF), and many studies have elucidated the association between anaemia and mortality in patients with CHF. The quality of erythropoiesis is an intrinsic aspect of pathophysiology of anaemia, and the ability of reticulocyte production would be one of the pivotal factors in the quality of erythropoiesis. Purpose We sought to investigate whether the reticulocyte production ability is associated with clinical outcomes, and clarify the pathophysiology of reticulocyte production in patients with CHF. Methods We prospectively examined 1,328 symptomatic CHF patients (median age 71 [IQR 65-82] years, mean left ventricular ejection fraction 50 ± 16%, median NT-proBNP 743 [IQR 360–1710] pg/mL) in a multicentre registry with 27 Japanese sites between January 2020 and October 2023. The reticulocyte production ability was evaluated by calculating the reticulocyte production index (RPI) using reticulocyte counts and serum haematocrits. Patients were divided into four groups according to the presence or absence of WHO defined anaemia and the median value of RPI. The primary outcome was a composite of all-cause death and hospitalisation for worsening HF. Results During a median follow-up period of 551 (IQR 321–712) days, the primary outcome occurred in 219 (17%) patients. The group with anaemia and high RPI (≥0.978, the median) showed the highest incidence of the primary outcome among the groups (P &amp;lt; 0.001) (Figure 1). Multivariable regressions showed that higher RPI was independently associated with the higher risk of the primary outcome, even after adjustment for NT-proBNP, sodium, haemoglobin, serum iron, erythropoietin, and MAGGIC risk score (HR 1.41, 95% CI 1.09–1.82). Erythrocyte counts were significantly increased in patients with higher RPI compared to those with lower RPI in the groups without anaemia (P &amp;lt; 0.001)whereas there were no significant differences on erythrocyte counts between the groups with anaemia (P = 0.90) (Figure 2A). Patients with higher RPI had higher log erythropoietin levels compared to those with lower RPI in either anaemic or non-anaemic group (Figure 2B). In addition, serum iron levels and transferrin saturation did not significantly differ between the RPI groups in either anaemic or non-anaemic group (Figures 2C and D). Furthermore, in patients without anaemia, erythrocyte counts positively correlated with RPI (R = 0.27, P &amp;lt; 0.001) whereas there was very weak correlation between erythrocyte counts and RPI in those with anaemia (R = 0.07, P = 0.045). Conclusions Higher RPI was independently associated with worse clinical outcomes, suggesting RPI could be a surrogate marker for risk stratification in patients with CHF, especially in anaemic population. Higher reticulocyte production ability might reflect the impaired maturation of reticulocytes to erythrocytes independent of iron parameters.

The connection between anemia and limitations in daily activities among older males: the critical role of dynapenia

AimThe aim of the present study was to examine the relationship between anemia and basic and instrumental activities of daily living in older male patients.MethodsA total of 223 older males attending one geriatric outpatient clinic were included in this cross-sectional study. Anemia was defined as a hemoglobin level below 13 g/dL. Patients’ demographic characteristics, comorbidities, and comprehensive geriatric assessment parameters were also recorded. Handgrip strength of < 27 kg for males was accepted as dynapenia. Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functional capacity.ResultsThe mean age (standard deviation) of the participants was 80.17 (7.69) years. The prevalence of patients with anemia was 43.9%. There was differences between anemic and non-anemic groups in terms of presence of diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD), malnutrition, dynapenia, geriatric depression, BADL and IADL scores (all p < 0.05). In multivariate analysis, after adjusting for all confounding variables except for dynapenia, patients with anemia were associated with reduced BADL and IADL (all p < 0.05). After adjusting for all confounding variables including dynapenia, deterioration in total BADL and IADL scores did not remain significant in the anemic group compared to the non-anemic group (p > 0.05).ConclusionClose to one in two older outpatient men had anemia. Anemic men had a higher incidence of DM, CHF, CKD, malnutrition, geriatric depression and dynapenia. Anemia was associated with dependence in both BADL and IADL in older men. However, comorbidities, nutritional status, depressive mood and, specifically muscle strength, were important contributors to this association.

Levels of Tumor Necrosis Factor Alfa and Iron Status in Pediatric Patients with Newly Diagnosed Solid Tumors

Abstract Background Tumor necrosis factor alfa (TNF-α) plays a crucial role in the etiopathogenesis of cancer related anemia. Aim: To assess the levels of TNF-α, erythropoietin (EPO), and iron status in relation to anemia in children with newly diagnosed solid tumors. Methods we measured serum levels of TNF-α, EPO and assessed iron status using enzyme linked immunosorbent assay in 42 patients (20 non-anemia and 22 anemic) with newly diagnosed solid malignancies and compared them to 25 age- and sex-matched healthy controls. Results Among the 42 patients enrolled, 14 (33.3%) patients had brain tumors, seven (16.6%) were diagnosed with neuroblastoma, and four (9.5%) with Wilms tumor. The mean hemoglobin levels were 12.39±0.8 g/dl and 9.57±1.3 g/dl in non-anemic and anemic patients respectively. We found significantly higher levels of serum TNF-α and lower EPO levels among patients when compared to the control group (p &amp;lt; 0.001). A post hoc analysis showed a significantly higher TNF-α and lower EPO levels among anemic versus controls (p &amp;lt; 0.001) and non-anemic versus control (p &amp;lt; 0.001). A significant positive correlation was found between both EPO and TNF-α in both anemic and non-anemic group (r = 0.48, p = 0.024) and (r = 0.44, p = 0.021) respectively. However, the median (IQR) levels of both TNF- α and EPO were comparable between both anemic and non-anemic patients (306 (237.5) pg/ml versus 353 (156.2) pg/ml, p = 0.47) and (93 (46) mIU/ml versus 87 (51) mIU/ml, p = 0.48) respectively. The median (IQR) levels of serum ferritin and transferrin saturation index (TSI), as well as; serum TNF-α did not correlate with any of the red cell indices yet; directly correlated with platelet counts (r = 0.491, p = 0.02). Conclusion Children with solid malignancies have significantly higher levels of TNF-α and impaired EPO responses than normal children, however, no significant effect was observed for either on hemoglobin and red cell indices. Whether the positive relationship between TNF- α and EPO suggest other mechanisms of TNF- α related anemia needs further studies.

Characteristics of Gut Microbiota and Fecal Metabolites in Patients with Colorectal Cancer-Associated Iron Deficiency Anemia.

Patients with colorectal cancer (CRC) have a high prevalence of iron deficiency anemia (IDA), and the gut microbiota is closely related to iron metabolism. We performed metagenomic and metabolomic analyses of stool samples from 558 eligible samples, including IDA CRC patients (IDA, n = 69), non-anemia CRC patients (Non-Anemia, n = 245), and healthy controls (CTRL, n = 244), to explore the dynamically altered gut microbes and their metabolites. Compared with the CTRL group, fecal bacteria in both the IDA group and the Non-Anemia group showed a decrease in alpha diversity and changes in microbial communities. Flavonifractor plautii (F. plautii) increases progressively from CTRL to Non-Anemia to IDA, accompanied by decreased trimethoxyflavanone and a downregulated KO gene, megDIII. In the Non-Anemia group, Parabacteroides showed a specifically elevated abundance positively correlated with enriched 1,25-dihydroxyvitamin D3. The intricate correlations among gut microbiota, metabolites, and KO genes were uncovered and highlighted, implicating an aberrant iron metabolism vulnerable to chronic inflammation during the deterioration of the anemic condition. Furthermore, the amount of F. plautii in feces achieved independent and effective prediction performance for the poor outcome of CRC. Perturbed host-microbe interplays represent a novel prospect for explaining the pathogenesis of CRC-associated IDA. The fecal microbial features also reflect the associations between IDA and elevated CRC recurrence risk.

Correlation of tuberculosis-related anemia severity with tuberculosis-induced inflammation in children: a six-year retrospective study

BackgroundAnemia is a common complication of tuberculosis (TB), and there is evidence that its prevalence is higher in patients with TB. Although TB is very important in epidemiology, careful investigation of TB-related anemia in children has not been carried out systematically. This study aimed to describe the details of anemia in children with TB and its association with clinical characteristics and the severity of inflammation.MethodsIn this retrospective study, we explored Hb levels in 103 children with pulmonary TB (PTB) and they were divided into anemic or non-anemic groups. Logistics regression analysis was used to study the associations between anemia and demographic characteristics. Spearman correlations analysis was performed to analyse the associations between the biochemical parameters and hemoglobin levels in blood.ResultsThe prevalence of anemia in children with TB was 37.9% (48.7% showed microcytic hypochromic anemia, and 5.1% showed normal cell anemia). Compared with the anemia (n = 39) group, the non-anemic group (n = 64) had longer fever duration and increased respiratory rate (P < 0.05). In logistic regression analysis, anemia was associated with lower levels of Alb and higher levels of WBC, CRP, LDH, and ESR (P < 0.05). Spearman correlations analysis showed a significant negative correlation between hemoglobin (Hb) levels and inflammatory markers. After one month of antitubercular therapy (ATT), the Hb levels of 76.9% children returned to normal.ConclusionsAnemia is common among children with TB at diagnosis. The majority of children with TB-related anemia are mild to moderate microcytic hypochromic anemia. There is a strong correlation between the severity of anemia and the inflammation induced by TB. This suggests that anemia is a biomarker of the severity of TB in clinical practice among children.

Prevalence and associated Factors of Anemia in Diabetic Patients

Introduction: Diabetes presents a significant global health challenge due to its association with a range of pathological changes, such as metabolic, cellular, and blood disturbances, that lead to long-term microvascular and macrovascular complications. Healthcare providers often underestimate anemia as a co-morbidity in diabetes, despite the wide range of prevalence estimates reported in the literature. Addressing anemia in diabetes patients early can reduce the incidence of these complications, as has been demonstrated. Aim of the study: The study aimed to estimate the prevalence of anemia and its associated factors among patients with type 2 diabetes mellitus (T2DM). Methods: This is a cross-sectional prospective study with a retrospective review of diabetic patient medical records attending family medicine clinics at four military hospitals (King Hussien Medical Center, Prince Rashed Military Hospital, Queen Aliah Military Hospital, and Prince Hashem Military Hospital) at Royal Medical Services. Adult patients over the age of 18 diagnosed with type 2 diabetes mellitus for more than one year will be included in the study. However, those patients with diseases (such as thalassemia and leukemia) or other systemic disorders (such as infectious diseases) that could result in anemia, those with acute conditions such as acute hemorrhage, those who received blood transfusions in the last three months, pregnant women, or type 1 diabetes will be excluded. Anemia will be defined as hemoglobin level &lt; 13 g/dl in men and 12g/dl in females (Harrison TR, 2011). Type 2 DM will be defined glycated hemoglobin (HbA1c &gt; 6.5%), fasting blood glucose (FBG &gt; 126 mg/dl), random blood glucose (RBG &gt; 200 mg/dl) (American Diabetes Association, 2012). Patients’ medical records will be reviewed for patient medications, duration of diabetes, diabetic complications, and glycemic control. Furthermore, to exclude any patients who have one or more of the aforementioned conditions reported in the exclusion criteria. Meanwhile, researcher will collect the following data in the clinic after patients’ agreement to participate in the study which include: age, sex, marital status, smoking status, comorbidities, anthropometric measurements including weight, height and body mass index (BMI). Moreover, patient will ask to withdraw complete blood count (CBC) blood sample which include hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) for diagnosing anemia if its present. Patients will be divided into two groups based on the presence of anemia; anemic group and non-anemic group. Regarding study variables. Glycemic control will be classified into two categories based on HbA1c result (controlled diabetic group comprised those whose HbA1c level was equal to or &lt;7.5% and poorly controlled diabetic group comprised those whose HbA1c level was &gt;7.5%). Body mass index will classify according to Center of Disease Control (CDC) as follow: BMI score &lt; 18.5 Kg/m2 is underweight, 18.5–24.9 Kg/m2 is normal, 25–29.9 Kg/m2 is overweight and BMI ≥ 30 Kg/m2 is obese. The sample size will be calculated based on Cohran’s sample size formula as: n=Z2 pq /e2. Here, p will be the anticipation of anemia prevalence in the diabetic population, q=1 - p; e is an acceptable error (5%); and Z= 1.96. A simple random sampling (systematic procedure) will be used to choose patients with type 2 diabetes in order to reduce the possibility of selection bias. With this technique, we randomly choose the first subject and then select the next subjects in a periodic manner according to K (interval). K will be determined based on the sampling frame prepared by researchers divided by n. Descriptive analysis will be used with the mean (standard deviation) for normally distributed variables and the median (inter-quartile range) for highly skewed distributions. The t-test and the Mann-Whitney test will be used to compare the baseline characteristics of quantitative variables between anemic and non-anemic groups for variables with a normal and highly skewed distribution, respectively. Categorical variables will be compared between the groups using the chi-square test. Logistic regression analyses will be employed to find out how these variables are associated with anemia. The results will be given as odds ratios (ORs) with a 95% confidence interval (CI). We will select only covariates with a p-value &lt;0.20 in the univariate analysis to enter the logistic analysis.

A call for improved anemia treatments in myelofibrosis: A single-center retrospective study.

e18531 Background: Anemia in myelofibrosis (MF) is associated with poor prognosis and decreased quality of life. Effective treatments are limited, posing a significant challenge in clinical management. This study aims to provide insights into the treatment of anemia in MF patients from an underserved urban tertiary care center. Methods: We retrospectively reviewed 88 MF patients referred to our center in the Bronx, NY between 2000 and 2023. Demographic data, presence of anemia (hemoglobin ≦10 g/dl) at time of diagnosis or referral (TODR), transfusion dependence ( ≥ 2 units on ≥2 occasions within 8 weeks), anemia treatments, disease modifying treatment, and anemia response to treatments (as defined by the IWG-MRT and ELN consensus report) were assessed via non-parametric tests and univariate cox regression. Events were defined as death from any cause or development of anemia. Patients with missing data were excluded. Results: Among 88 patients analyzed, 77 (87.5%) experienced anemia during the study period. Overall survival (OS) for anemic patients was 7.7 years with 31 deaths, versus only 1 death in the non-anemic group. 51 (60%) of patients were anemic at TODR. For patients not anemic at TODR, median time to anemia (TTA) was 31 months. Patients with HMR (n=24) had faster median TTA than those without (22 vs. 49 months, p = 0.1). All triple-negative (TN) patients (n=8) were anemic at TODR and had statistically lower initial hemoglobin compared to patients with driver mutations (7.4 g/dl vs. 9.9 g/dl, p = 0.0023). Among anemic patients (n=77), age &gt; 65 was associated with poorer OS (HR 2.293, CI 1.076 - 4.887, p=.0315), while transfusion dependency (HR 2.093, CI 0.4777 - 0.9422, p=0.0697) and Ruxolitinib use (HR 2.843, CI 0.9912 - 8.155, HR 0.052) approached significance. Secondary anemia treatments did not impact OS (HR 0.9346, CI 0.4537 - 1.925, p=.854) and are summarized in the table. Most patients received Ruxolitinib (68.8%) and hydroxyurea (35.06%), while fewer received Momelotinib (N = 4), Pacritinib (N = 6), or Fedratinib (N = 4). Conclusions: Our findings highlight the limited effectiveness of current treatments in reducing transfusion burden and anemia in MF, and that patients of higher genetic risk may be more susceptible to developing anemia. Transfusion dependency and treatment non-response are marginally associated with poorer outcomes, emphasizing the need for newer therapies. [Table: see text]

Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Anemia.

Anemia is associated with worse clinical outcomes in cardiac patients. We aim to investigate the clinical outcomes and readmission rates in anemic patients undergoing transcatheter edge-to-edge repair (TEER) for severe mitral valve regurgitation (MR). The National Readmissions Database (NRD) from 2015 to 2018 was queried using the ICD-10 codes to identify patients admitted for TEER. Patients were divided into anemic and non-anemic sub-groups. Univariate and multivariate analyses were performed. Cardiovascular outcomes were assessed between cohorts at index admission and readmissions at 30, 90, and 180 days. STATA v.17 was used for analysis (StataCorp LLC, Texas, USA). Our final cohort included 28,995 patients who had undergone TEER in the United States between 2016 and 2019. About 1,434 (4.9%) had a diagnosis of anemia. The mean age of patients who had TEER with anemia and TEER without anemia was 76.9 ± 10.8 vs. 77.7 ± 10.2, respectively. In the adjusted model, anemic patients had higher odds of acute kidney injury (AKI) (aOR 2.21; 95% [CI 1.81-2.6; p<0.001]), HF (aOR 1.75; 95% [CI 1.28-2.3; p<0.001]), myocardial infarction (MI) (aOR 1.54; 95% [CI 1.01-2.33; p<0.041]), major adverse cardiac and cerebrovascular events (MACCE) (aOR 1.72; 95% [CI 1.2-9-2.3; p<0.001]), and net adverse event (aOR 1.85; 95% [CI 1.32-2.59; p<0.001]). The anemic group's readmission rate was overall higher at 30, 90, and 180 days from 2016 to 2019. Anemia was associated with increased adverse clinical outcomes and more extended hospital stays in patients with anemia who had undergone TEER procedures compared to the non-anemic group.

A Comprehensive Assessment of Prescription Patterns for Anemia Management in Pregnant Women: A Study From Anand District, India.

Introduction Pregnancy induces various physiological changes, often leading to complications. Physiological anemia of pregnancy, resulting from increased plasma volume and erythropoietin levels, poses significant health risks.Adverse outcomes associated with anemia during pregnancy include maternal and perinatal mortality, premature delivery, and low birth weight. Drug utilization research aims to promote rational drug use for improving health outcomes. The Food and Drug Administration (FDA) categorizes drugs based on teratogenic risk, providing guidance for clinicians. This study aims to analyze prescription trends and FDA risk categories for anemia in pregnant women in the Anand district. Materials and methods The study received institutional ethics approval and involved 816 pregnant women attending antenatal clinics from December 2021 to March 2023. Participants provided informed consent, and data collection included hemoglobin (Hb) levels at each trimester, categorizing participants into anemic (Hb < 11 gm/dL) and non-anemic groups. Prescribed drugs were recorded, and their essentiality was assessed using the WHO Essential Medicines List (WHO-EML) and the National List of Essential Medicines-2022 (NLEM-2022). FDA drug risk categories were utilized for assessing drug safety. Descriptive and statistical analyses were performed. Results Anemia prevalence across trimesters ranged from 62.50% to 65.93%, with an overall average of 64.42%. Iron and folic acid supplementation were significant across trimesters, with varying rates of prescription. Calcium supplementation showed fluctuations, with 100% prescription rates in later trimesters. Ascorbic acid was significantly prescribed in anemic pregnant women throughout pregnancy. Multivitamins were consistently prescribed, emphasizing their importance. The WHO-EML and NLEM-2022 highlighted essential micronutrients, while FDA categories indicated drug safety. Conclusion Anemia prevalence remained high throughout pregnancy, emphasizing the need for consistent supplementation. Prescription patterns aligned with evidence-based guidelines, focusing on iron and folic acid supplementation. Variations in calcium prescription suggest trimester-specific considerations. Prescription trends reflect a responsible approach to managing anemia during pregnancy, emphasizing prophylactic iron and folic acid therapy. The absence of high-risk medications underscores cautious prescribing practices. This study contributes valuable insights into evidence-based pharmacotherapy and maternal health care.

Tuberculosis Co-infection among HIV/AIDS Cases Attending an Anti-retroviral Therapy Center: A Retrospective Cohort Study from Pakistan

Objective: The co-occurrence of tuberculosis (TB) and human immunodeficiency virus (HIV) results in heightened morbidity and mortality, placing an increased burden on healthcare systems. This study aims to assess the incidence and identify associated risk factors for TB/HIV co-infection, with the objective of enhancing the survival rates of co-infected patients in Pakistan. Methods: This retrospective cohort investigation took place at the Anti-Retroviral Treatment Center in Islamabad, Pakistan. Data spanning a decade (January 2006 to December 2016) were extracted from 2,542 people living with HIV using a pre-tested data extraction tool. Results: Following the exclusion of 156 ineligible participants, records of 2,386 individuals were analyzed over 4,433 person-years. The cumulative incidence and incidence rate of TB among HIV/AIDS patients were 446 (18.7%) and 0.001 cases/10,000 person-years, respectively. The majority (81%) of incident TB cases occurred within one year, predominantly manifesting as pulmonary TB. Of the TB-infected individuals, 98.6% received TB medication, with 0.7% prescribed Isoniazid prophylaxis. Significant associations with TB were identified in relation to work abroad history, patient age, and current HIV stage (P&lt;0.05). Binary logistic regression indicated a 3.1 times higher likelihood of TB infection in the anemic group compared to the non-anemic group. HIV/AIDS infection emerged as a consistent TB risk factor irrespective of CD4 count and WHO HIV staging. Conclusion: This study highlights a substantial incidence of TB co-infection among HIV patients in Pakistan, emphasizing the need for comprehensive efforts by the National AIDS Control and National TB Control Programs to effectively manage co-infection.

Factors associated with increased risk of postoperative blood transfusion in patients undergoing total hip arthroplasty at an Irish University Hospital

IntroductionApproximately 7000 total hip arthroplasty (THA) surgeries occur in Ireland each year. A number of preoperative factors have been identified that increase the risk of postoperative blood transfusion after THA, including anaemia. The ability to identify patients at risk may allow preoperative management strategies to reduce blood transfusions. Data from Irish orthopaedic patients is currently lacking.AimTo investigate if preoperative anaemia and other factors are associated with postoperative blood transfusions in patients who undergo THA.MethodsA retrospective cohort study of all patients who underwent THA in 2019 in SIVUH, Cork, using medical chart review.ResultsIn total, 350 charts met the inclusion criteria, with 291 charts reviewed. 8.9% of the patients who underwent THA had preoperative anaemia. Among these, 19.2% had a postoperative blood transfusion, compared to 1.5% of patients who were not anaemic preoperatively. The odds of receiving a blood transfusion was 15.5 times greater in the preoperative anaemia group compared to the non-anaemic group. Increasing age and higher ASA scores were associated with preoperative anaemia and postoperative blood transfusions. Length of stay was increased by 2.2 days (p < 0.00016) if blood transfusion was required.ConclusionPreoperative anaemia was common in an Irish orthopaedic population undergoing THA. Preoperative anaemia predisposes patients to the greatest increased risk of postoperative blood transfusions. The other factors associated with the need for postoperative transfusion were ASA grade 3 or more and age greater than 65 years. Patients who received postoperative blood transfusions had a significantly increased length of hospital stay.

Study of the association between anemia and prognosis of moderate-to-severe traumatic brain injury

Objective: To investigate the impact of admission anemia on the prognosis of patients with moderate- to-severe traumatic brain injury (TBI). Methods: The clinical data of patients with moderate-to-severe TBI treated in the Department of Intensive Care Unit in our hospital from January 2020 to September 2022 were retrospectively analyzed. The patients were divided into admission non-anemia group (Hb ≥ 100 g/L) and admission anemia group (Hb&lt;100 g/L) based on hemoglobin (Hb) levels. The Glasgow Coma Scale (GCS) score, first blood analysis, arterial blood gas, blood pressure, injury mechanism, pupillary reflex at admission and others were compared, multivariate logistic was used to analyse independent risk factors for patient death. Results: One hundred and nine patients were included in the study, of which 17 died in the hospital and 52 had anemia at admission. Compared with patients in the admission non-anemia group, patients in the admission anemia group were younger, had lower admission GCS and trauma score (PTS) scores, higher mortality rates, and longer hospital stay (all P&lt;0.05).Univariate analysis showed that moderate-to-severe TBI patients with admission anemia, admission hyperglycemia, GCS&lt;8, PTS&lt;8, abnormal pupillary reflex, and other organ injuries had higher mortality rates (all P&lt;0.05) .Multivariate logistic regression analysis showed that admission anemia (OR=9.383, 95% CI=1.086~81.094, P=0.042), admission pupillary reflex abnormalities (OR=23.121,95% CI=3.680~145.270,P=0.001), and admission hyperglycemia (OR=15.181, 95% CI=2.019~114.160, P=0.008) are independent risk factors for death of Moderate-to-severe TBI patients. Conclusions: Admission anemia is an independent risk factor for death of moderate-to-severe TBI patients, and it can prolong the length of hospital stay for such patients.

The mean reticulocyte volume is a valuable index in early diagnosis of cancer-related anemia.

Cancer-related anemia (CRA) is a functional iron deficient anemia, and the early diagnosis will improve the prognosis of the patients. This prospective study aimed to investigate the utility of mean reticulocyte volume (MRV) in the early diagnosis of CRA. A total of 284 first-diagnosed cancer patients were enrolled, and the subjects were assigned anemia and non-anemia groups by hemoglobin (Hb) concentrations. The mature RBC and reticulocyte indices were detected with BC-7500 blood analyzer, and the MRV, reticulocyte hemoglobin (RHE) content, and reticulocyte production index (RPI) were obtained. ROC curves were constructed in identifying anemia diagnosed by the combination of RHE and RPI. An adjusted multivariate analyse and quartiles were used to assess the associations of MRV with early CRA diagnosed by combining RBC indices (MCV, MCH and MCHC), respectively. No statistical differences were observed in MCV, RHE and MRV levels between anemia and non-anemia subjects (p>0.05). MRV exhibited a complete or high correlation with the RHE levels (r=1.000, p<0.001), or MCV, MCH, and MCHC in anemia patients (R: 0.575-0.820, p<0.001). ROC curves analyse indicated a highest area under curve of 0.829 (95% CI [0.762-0.895]) and 0.884 (95% CI [0.831-0.936]) for MRV in identifying anemia in male and female patients, respectively (p<0.001). When the optimal cutoff values of MRV were set at 100.95 fl in males and 98.35 fl in females, the sensitivity and specificity were 1.00 and 0.68, and 1.00 and 0.73, respectively. The regression analyse showed that, when being as a categorical variable, MRV showed an odds ratio of 19.111 (95% CI [6.985-52.288]; p<0.001) for the incidence of CRA. The incidence of overall anemia demonstrated a more significant decrease trend along with the increase of MRV quartiles (p-trend < 0.001). This study revealed that the MRV can be used as a convenient and sensitive index in early diagnosis of cancer-related anemia, and decreased MRV level may be the powerful predictor of overt anemia in cancer patients.

Association of Gestational Iron-deficiency Anemia with Antenatal Depression among Pregnant Women: A Case-control Study from Tertiary Care Hospitals, Lahore.

The goal of this study is to investigate the potential association between gestational anemia and antenatal depression in pregnant women. It is a case-control study consisting of 684 pregnant women under 18 years recruited in different tertiary care hospitals, in Lahore, between June 2023 and December 2023. Utilizing an online questionnaire, data collection encompassed demographics, dietary habits, and the Edinburgh Postnatal Depression Scale (EPDS). Pregnant women with antenatal hemoglobin (Hb) levels above and below 11.0 g/dL were categorized as a nonanemic and anemic group. Statistical analysis involved Chi-square tests to explore the relationships between gestational parameters and maternal factors. The depression scores of anemic and nonanemic pregnant women compare two groups of pregnant women based on their Hb levels: those with Hb <110 g/l during pregnancy (anemic) and those with Hb ≥110 g/l (nonanemic). The anemic group had higher depression scores than the nonanemic group, both for those with EPDS <12 points and those with EPDS ≥12 points. However, P = 0.077 indicates that this difference was not statistically significant at a typical alpha level of 0.05. No significant association was found between gestational anemia and antenatal depression in pregnant women. These findings prompt further research to unravel the intricacies of the association between gestational anemia and depression. The outcomes thus urge the researchers and health-care professionals to consider the diverse factors that may contribute to mental health outcomes during pregnancy and refine strategies for maternal care.