Normal Hemoglobin Levels Research Articles

Transfusion Requirements in Hospitalized Patients with Sickle Cell Disease Taking Either Voxelotor or Hydroxyurea

Background Sickle Cell Disease is a cause of anemia frequently requiring blood transfusions. Current treatments for Sickle Cell Anemia include Hydroxyurea, or the recently approved medication in 2019, Voxelotor. Although recent research, such as the HOPE study, has shown that Voxelotor increases hemoglobin levels when compared to Hydroxyurea, there is limited data regarding the requirement of blood transfusions in patients with Sickle Cell Disease when comparing the two medications. We conducted a retrospective cohort study to determine the requirement of blood transfusions in hospitalized patients with Sickle Cell Disease who were on either taking Voxelotor or Hydroxyurea. Methods This retrospective cohort study identified 8,815 patients across several facilities diagnosed with Sickle Cell Disease who were taking outpatient Voxelotor or Hydroxyurea. Patients who had CKD Stage 4 or 5, ESRD, pregnancy, major surgery, normal hemoglobin levels, and elevated liver enzymes were excluded with a final sample of 6,240. Patients were stratified into two groups based on the treatment they were on, a group taking Voxelotor (243 patients 3.92%) and a group taking Hydroxyurea (5961 96.08%) outpatient. We assessed patient's characteristics such as age, sex, race, smoking status and events during hospitalization. The primary outcome was the number of blood transfusions required with either treatment. Zero-inflated Poisson regression was used to determine the quantity and prediction of blood transfusions required according to different characteristics. Results Of the 6,240 with Sickle Cell Disease who were either on Voxelotor or Hydroxyurea the mean age was 31.32 years, 58.11% were female and 41.89% were male, 94.63% were African-American and 5.37% were non-African-Americans. The medication group was not significantly associated with the log count of transfusions (ie. increased number of transfusions), when controlling for other variables (χ 2 = 0.81, p = 0.367). The odds ratio is 0.425, indicating that patients on Voxelotor are 0.4247 times as likely to be in the “certain zero” group as those on Hydroxyurea - in other words, patients taking Hydroxyurea are 2.354 (1/0.425) times as likely to be in the “certain zero” group (i.e., patients on Hydroxyurea are 2.354 times as likely to not need a transfusion compared to patients taking Voxelotor). Conclusion Hospitalized patients with Sickle Cell Disease taking Voxelotor or Hydroxyurea outpatient have similar blood transfusions requirements when controlling for other variables. In the case of Voxelotor, it is known to increase hemoglobin levels more than Hydroxyurea in patients with Sickle Cell Disease, but there is limited data regarding the end requirements of blood transfusions when comparing the two medications. Our study is the first to identify that there was no increased requirement in the quantity of blood transfusions (Wald Chi Square 26.36, p<.0001, CI 0.3063~ 0.5890) when comparing each medication group. However, the limitation is having a relatively small sample size, and possible confounders from the patients and the disease itself. Further research is required to investigate this.

Optimizing Preoperative Iron Deficiency Anemia in Patients Undergoing Cardiac Surgery

Background: Preoperative anemia is common in patients undergoing cardiac surgery, with iron deficiency being the most common cause of anemia in these patients. Patients who are anemic in the preoperative setting have worse perioperative outcomes than patients with normal hemoglobin levels including higher rates of red cell transfusions, acute kidney injury, increased length of stay, and increased mortality. At the University of Virginia (UVA) Medical Center, there was no institutional process in place to identify and treat iron deficiency anemia in patients planned to undergo cardiac surgery. Objective: The UVA Perioperative Blood Management Committee is a newly-formed multidisciplinary group consisting of members from the departments of Hematology, Anesthesiology, Thoracic and Cardiovascular Surgery, Perfusion, and Blood Bank who work together to improve perioperative patient outcomes and blood product utilization. We set out to implement a testing algorithm with the purpose of improving the proportion of anemic patients undergoing cardiac surgery who have iron studies performed in the outpatient setting, thereby improving the percentage of patients receiving intravenous (IV) iron preoperatively. Methods: We adapted two published perioperative treatment algorithms (Lin, Hematology Am Soc Hematol Educ Program 2019; Munting and Klein, Anaesthesia 2019) which recommend iron therapy in patients with hemoglobin < 13 g/dL, ferritin < 100 µg/L, and/or transferrin saturation < 20% for our cardiac surgery preoperative clinic. In November 2022, we implemented a reflex test within Epic electronic medical record that automatically sent ferritin, iron, and transferrin for patients with hemoglobin < 13 g/dL to evaluate for iron deficiency. Patients meeting parameters for iron deficiency (ferritin < 30 ng/mL and/or transferrin saturation < 20%) were then scheduled for iron infusions. We compared the percentage of patients undergoing testing for iron deficiency, as well as the percentage of anemic patients receiving iron infusion preoperatively, to those from a six month period prior to our start date. Results: Between May 31, 2022 and October 31, 2022, 19% of cardiac surgery patients at UVA with hemoglobin values < 13 g/dL had iron studies drawn in the three months prior to surgery. After implementing outpatient reflex iron testing, that number increased to 42% between November 2022 and May 2023 (p < 0.001). In the six months prior to implementation, four iron deficient cardiac surgery patients received preoperative IV iron an average of one day prior to surgery. Between November 1, 2022 and May 29, 2023, fifteen patients received IV iron an average of 5.7 days prior to surgery. The patients who received IV iron had lower rates of blood transfusions than anemic patients who did not receive IV iron (53% vs. 65%) and fewer units of blood transfused per patient who received blood (3.1 vs. 5.7). Conclusions: Results from the first seven months of this project suggest that using a standardized testing methodology in the outpatient setting can increase the uptake of iron testing and thereby treatment of iron deficiency anemia in the preoperative setting. Patients who received IV iron had lower rates of blood transfusions and received fewer units of blood on average than anemic patients who did not receive IV iron. We next plan to implement an iron testing strategy in cardiac surgery inpatients to further improve rates of iron testing and iron infusions in this population. We have created an IRB-approved database to study more patient-centered outcomes such as acute kidney injury, stroke, length of stay, readmissions, and mortality to determine if we can detect a measurable impact from IV iron administration in our patient population.

EFEKTIVITAS BUAH KURMA (PHOENIX DACTYLIFERA) DENGAN KADAR HEMOGLOBIN PADA IBU HAMIL TRIMESTER 2

Anemia is the main cause of maternal death. Pregnant women who suffer from anemia will experience postpartum bleeding, as a result of this bleeding the mother will experience prolonged health problems and even result in death The purpose of this study was to determine the effectiveness of giving dates to increase Hb levels in pregnant women. This research design uses a Pre-experimental design research method (One-Group Pretest-Posttest Design), namely by means of a nonrandomized control group pretest-posttest design comparing two groups, namely the experimental class and the control class. The sample in this study were all pregnant women who experienced anemia as many as 30 respondents. The results of the analysis showed that the average hemoglobin level of anemic pregnant women who were given blood-boosting tablets was 10.4 gr/dl. Hemoglobin levels of anemic pregnant women before being given dates averaged 9.0 gr/dl and after being given dates averaged 10.0 gr/dl and above. In raising Hb levels in pregnant women who experience anemia, date fruit is more effectively consumed with Fe tablets compared to consuming Fe tablets alone with a value of p = 0.045 (p <0.05) that there is an effectiveness of giving date fruit with an increase in Hb levels in pregnant women in PMB “F” in 2022 with a value of p = 0.045 (p <0.05). From the study it was found that date juice increased HB levels in second trimester pregnant women with an average increase per week of 0.2-1.4 per week.

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> 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<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.

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 >33 µg/dL, ferritin >100ng/mL and % transferrin saturation >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<0.001) and MCHC (r=-0.209; p-value<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 >33 µg/dL, ferritin >100ng/mL and % transferrin saturation >20%) and an available 6-minute walking test data. Tissue ID was defined as levels of sTfR >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<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> 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.

A Retrospective Study Evaluating the Association of Qualitative and Quantitative Aspects of Vaso-Occlusive Crises (VOC) with Length of Hospital Stay in Children with Sickle Cell Disease Hospitalized for a VOC

Background: Children with sickle cell disease (SCD) are at risk for developing a vaso-occlusive pain crisis (VOC) due to sickled red blood cells causing turbulent blood flow and obstruction within the vasculature, leading to local tissue infarcts and subsequently pain. A VOC can often be managed with analgesics and supportive care either at home or in the emergency room. However, sometimes the pain is not adequately controlled in those settings, so children require hospitalization for further management of their VOC. There exists a high degree of variability in length of hospital stay (LOS) among children who are admitted for VOCs. The purpose of this study is to determine which factors are associated with decreased or increased length of hospital stay (LOS). By identifying these factors, it will allow for a more targeted approach to VOC management with the goal of improving overall pain and reducing LOS. Methods: This 3 year (2019 - 2022) retrospective cohort study includes 88 patients (5 years to 27 years of age) with sickle cell disease (HbSS, HbSB0, HbSB+, HbSC) who were hospitalized for VOC management. Several variables were analyzed to determine if they correlated with LOS. These variables included SCD genotype, age, sex, pain scores, average hemoglobin and reticulocyte levels during hospitalization, pain medication dosage and frequency, blood transfusions and complications during hospitalization. The statistical analysis of these variables was conducted across all VOCs of all patients. Results: There were 289 hospital admissions for VOCs with a mean of 3.55 hospital admissions per patient among the 88 patients with SCD during study duration. LOS for these VOC hospital admissions ranged from 1 day to 10 days with an overall mean of 3.81 days per hospital admission. LOS was independently highest in females (mean LOS = 4.123 days, F (1, 287) = 6.415, p = .012) and patients who developed acute chest syndrome (mean LOS = 6.333 days, F (9, 277) = 4.771, p < .001). LOS positively correlated with pain scores (r 2 = .272, p = .002), number of blood transfusions (r 2 = .229, p < .001) and total units of blood transfused during admission (r 2 = .230, p < .001) and negatively correlated with morphine frequency (r 2 = -.125, p = .042) and average hemoglobin during admission (r 2 = -.142, p = .016). SCD genotype, age, reticulocyte levels and medication dosage were not found to have a statistically significant association with LOS. Conclusion: Our study showed that factors such as higher average pain scores, number of blood transfusions, total units of blood transfused, females and acute chest syndrome were associated with longer LOS. Other factors such as more frequent morphine administration and higher average hemoglobin levels were associated with shorter LOS. While this study provides initial insight into some of the factors that are associated with LOS in children with SCD admitted for a VOC, further studies are warranted to determine if these factors can be used to risk stratify patients in terms of severity of VOC and thereby better optimize and individualize their pain management.

Poor School Performance As an Indicator of Severity of Sickle Cell Disease

Purpose: Patients with sickle cell anemia can have long term neurocognitive deficits throughout their lifespan. The purpose of this study is to conduct neuropsychiatric evaluations and brain imaging to determine if individuals who have higher risk of falling behind in education can be identified, emphasize the importance of addressing educational needs of these patients, and identify patients who are at risk of developing further complications. Methods: IRB approved retrospective study of patients with Hemoglobin SS disease, who underwent Stanford-Binet Intelligence testing and Woodcock Johnson Achievement. All patients who underwent cognitive testing and also received a transcranial doppler ultrasound or magnetic resonance imaging between were included. All patients were referred to neuropsychiatric testing due to poor school performance. Results: 33 patients were included who underwent neuropsychiatric testing. These students were referred due to poor school performance. Of those, 15 patients had additional imaging studies. All patients were identified with hemoglobin SS disease. All patients were African American. The median age was 9 with an age range of 6 to 16 with a median grade was 4. This sample included 12 females and 3 males. 73% (11 of 15 individuals) were identified with below average full scale intelligence quotient. Of these, 46% (6 of 11) had measurable changes in MRI or transcranial doppler results. 5 of them had measurable changes in transcranial doppler and changes in their MRI, while 1 patient had a normal transcranial doppler, but showed changes in their MRI. On average, the maximum mean velocity was 164 cm/s and was higher than the patients with normal intelligence quotient scores at 148cm/s. The remaining 5 individuals also had below average full scale intelligence quotient without any findings on imaging. All 11 individuals also had below average scores in academic application, academic fluency, and academic skills. On average these patients were 3 years behind on reading, 2 years behind on math, and 2 years behind writing. Only one of these patients had an individualized education plan with extra assistance for education. 7 of the 11 patients with below average full scale intelligence quotients were on hydroxyurea and 2 of the 4 patients with average scores used hydroxyurea. The average hemoglobin level in the group that performed below average was 9.5 and 8.9 in the group that performed average. While, all patients who had average scores on the stanford-binet test did not have any abnormal transcranial dopplers and they all had delays in math, reading, and writing. Conclusion: Below average intelligence and delays in academic performance may be an indicator of patients at risk of developing further complications such as stroke.The full extent to this relationship is unclear. Further research is needed to determine the relationship between intelligence, academic performance and changes in imaging. Earlier detection of these patients can prevent further complications, develop individual treatment plans, and target closer monitoring. A multidisciplinary approach to treating patients with sickle cell disease should include neuropsychiatric evaluations, an assessment of academic achievement, and the opportunity for additional support in school to fully address the needs of this population.

Patient Experience Interviews with a Novel Treatment Iptacopan for Paroxysmal Nocturnal Hemoglobinuria

Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal and complex disorder characterized by hemolytic anemia, thrombosis, smooth muscle dystonia, hemoglobinuria, and chronic kidney disease. Individuals with PNH experience severe and chronic fatigue, which can significantly impact their quality of life. While two anti-C5 antibody therapies have been approved for treating PNH (eculizumab and ravulizumab), the majority of patients who use these therapies still do not achieve normal hemoglobin levels. Iptacopan, the first oral proximal complement inhibitor developed to fill this critical need, has shown in two Phase III trials (APPLY-PNH [NCT04558918] and APPOINT PNH [NCT04820530]) to achieve a comprehensive control of hemolysis. As part of the trials, patient experience interviews were conducted with patients entering an iptacopan extension study (CLNP023C12001B) to explore their experience with the treatment. Objectives: To conduct patient experience interviews across 5 countries to understand and document how patients' PNH disease experience changed in response to treatment, the meaningfulness of any reported changes, patients' experience receiving the iptacopan treatment, patients' preference for iptacopan compared to other PNH treatments, and their satisfaction with treatment. Methodology: Patients were recruited by clinical sites in the United States, United Kingdom, France, Italy, and Germany enrolled in the iptacopan extension study. Patients enrolled in the iptacopan extension study were eligible to consent to and participate in an optional 30-minute qualitative interview. Interviews were conducted by independent, trained interviewers in the patient's local language. A semi-structured interview guide was used to ask patients open-ended questions to elicit spontaneous descriptions of their disease, and treatment experience, including satisfaction and preferences. Interviews were audio-recorded, transcribed verbatim, translated into English (if applicable), anonymized, coded, and then analyzed using qualitative data analytic methods. Results: Interviews were completed with 22 patients diagnosed with PNH across 5 countries. Following treatment with iptacopan, patients reported improvements in their PNH-related signs, symptoms, and impacts that they experienced before treatment. The most common symptoms that patients reported improvements in were fatigue (n=13/13, 100.0%), tiredness (n=11/12, 91.7%), and low energy (n=10/10, 100.0%). Patients most commonly reported their ability to work (n=5/8, 62.5%), ability to walk (n=4/8, 50.0%), and feelings of unhappiness (n=7/8, 87.5%) improved with treatment. Patients commented that these improvements in PNH-related signs, symptoms, and impacts were meaningful to them. When discussing their treatment experience with iptacopan, patients reported that they liked the convenience of the oral treatment (n=18, 81.8%), treatment efficacy (n=13, 59.1%), and reduced medical appointments (n=8, 36.4%). Additionally, patients described the oral administration as convenient (n=18, 81.8%) and the treatment schedule easy to follow (n=17, 77.3%). Some patients disliked the frequent treatment schedule in the trial (n=7, 31.8%). Of the 18 patients who were asked, all (n=18/18, 100.0%) reported they preferred iptacopan over previous PNH treatments overall, including eculizumab and ravulizumab (Table 1). Compared to previous anti-C5 PNH treatments, most patients preferred the iptacopan treatment administration (n=20/20, 100.0%) and treatment schedule (n=16/20, 80.0%). Overall, patients reported being very satisfied (n=14, 63.6%) or satisfied (n=8, 36.3%) with their iptacopan treatment experience (Table 2). Conclusion: These qualitative interviews provide evidence that patients were satisfied with their iptacopan treatment experience, and prefer iptacopan over other PNH treatments. Patients preferred iptacopan for the convenience of treatment administration and treatment schedule, the ease of following the treatment regimen, and liked the treatment for the oral administration, treatment efficacy, and reduced medical appointments. Additionally, this data demonstrates significant and meaningful improvement in patients' PNH-related signs, symptoms, and impacts with iptacopan.

Risk Factors for Abnormal Hemoglobin Levels in Online Motorcycle Taxi Drivers in the Tanjung Mas Industrial Area, Semarang City

Air pollution can affect health conditions, CO and Pb are one of the compositions of vehicle exhaust gases that are dangerous. Online motorcycle taxi drivers have a high risk of exposure to pollutants. This research aims to determine the risk factors that affect hemoglobin levels in online motorcycle taxi drivers in the Tanjung Emas Area of Semarang City. The method used observational analytics with a cross-sectional approach. The total population in this study was 55 respondents and the number of respondents was determined using total sampling. Based on the results of examining hemoglobin levels using a hematology analyzer, of 55 respondents, 47 respondents had normal hemoglobin levels and 8 respondents had abnormal hemoglobin levels. The results of the Chi square test on smoking status have a significant relationship (p=0.04) to the blood hemoglobin level of online motorcycle taxis in the Tanjung Emas Area of Semarang city while in the status of Education, length of work, and knowledge there is no significant relationship (0.05) to the hemoglobin level of online motorcycle taxi drivers in the Tanjung Emas Area of Semarang City. The conclusion of this study is that there is a significant relationship between smoking status and hemoglobin levels of online motorcycle taxi drivers in the Tanjung Emas Area of Semarang City and there is no significant relationship between education factors, length of work time, and knowledge of hemoglobin levels of online motorcycle taxis in the Tanjung Emas Area of Semarang City.

Effect of Hemoglobin Levels on the Process of Healing Post Sectio Caesarea Wounds

The long healing of post sectio caesarea wounds has an impact on patients and their families.In addition to the additional burdensome costs, patients can experience trauma due to the wound healing process that lasts a long time.Hemoglobin is the main component that transports oxygen and nutrients needed for the wound healing process. This study aims to analyze the effect of hemoglobin levels on the healing process of post sectio caesarea wounds at Aminah Hospital Blitar.The research design uses a case control approach samples were taken using consecutive sampling techniques with research inclusion criteria of 89 respondents.Data on hemoglobin levels were taken from secondary data on preoperative hemoglobin levels of patients in medical record documents and data on the process of wound healing seen from the results of one-time observation when the patient controls the obstetric polyclinic between day 7 to day 10 post sectio caesarea.Data were analyzed using a simple linear regression test. The results showed that 62.9% of respondents had normal hemoglobin levels and 79.77% of respondents showed good wound healing processes.The results of the statistical test analysis showed a p value of 0.000 which was smaller than α of 0.05 with an R-square of 0.196.This means that there is an effect of hemoglobin levels on the wound healing process post sectio caesarea.So it is expected that pregnant women and their families pay attention to the value of hemoglobin levels during pregnancy and after delivery to ensure health and wound healing post sectio caesarea.Keywords:hemoglobin,wound,post sectio caesarea

Effect of Hemoglobin Levels on the Process of Healing Post Sectio Caesarea Wounds

The long healing of post sectio caesarea wounds has an impact on patients and their families.In addition to the additional burdensome costs, patients can experience trauma due to the wound healing process that lasts a long time.Hemoglobin is the main component that transports oxygen and nutrients needed for the wound healing process. This study aims to analyze the effect of hemoglobin levels on the healing process of post sectio caesarea wounds at Aminah Hospital Blitar.The research design uses a case control approach samples were taken using consecutive sampling techniques with research inclusion criteria of 89 respondents.Data on hemoglobin levels were taken from secondary data on preoperative hemoglobin levels of patients in medical record documents and data on the process of wound healing seen from the results of one-time observation when the patient controls the obstetric polyclinic between day 7 to day 10 post sectio caesarea.Data were analyzed using a simple linear regression test. The results showed that 62.9% of respondents had normal hemoglobin levels and 79.77% of respondents showed good wound healing processes.The results of the statistical test analysis showed a p value of 0.000 which was smaller than α of 0.05 with an R-square of 0.196.This means that there is an effect of hemoglobin levels on the wound healing process post sectio caesarea.So it is expected that pregnant women and their families pay attention to the value of hemoglobin levels during pregnancy and after delivery to ensure health and wound healing post sectio caesarea.Keywords:hemoglobin,wound,post sectio caesarea

Unlocking the mystery of the role of Vitamin D in iron deficiency anemia in antenatal women: a case control study in a tertiary care hospital in New Delhi

BackgroundVitamin D deficiency and anemia are clinical conditions that coexist during pregnancy. A high prevalence of Vitamin D deficiency ranging from 50 to 94% is seen throughout the country. The aim of the study was to discover the association between Vitamin D status and iron deficiency anemia during pregnancy. Improving the vitamin D status of pregnant women is crucial to prevent iron deficiency anemia and can improve maternal and fetal outcomes.MethodsA case–control study including 94 primigravida women of age within the age group 18 to 30 years, divided into two groups: a Case Group of 48 patients with already diagnosed iron deficiency anemia (mild to moderate) and a Control Group of 46 antenatal women with normal hemoglobin levels. Data on sociodemographic, clinical characteristics, and the levels of 25(OH) Vitamin D was estimated in both the groups. The association of 25(OH)D levels and anemia was then determined using suitable statistical analysis.ResultsAmong pregnant women affected with anemia, 75% of women had serum Vitamin D concentrations < 20 ng/ml compared to 52.2% of women in the controls. Maternal serum vitamin D level was significantly lower in pregnant women affected with anemia (19.61 ± 13.12) as compared to control (29.43 ± 24.05); (p = 0.024). A positive correlation was found between hemoglobin and vitamin D levels in pregnant women (Pearson’s r = 0.200, p = 0.05).ConclusionsThese findings provide evidence suggesting that Vitamin D deficiency or insufficiency during pregnancy may be a risk factor for anemia and correction of Vitamin D levels can improve hemoglobin levels. Educational efforts should be made to include safe vitamin D intake in antenatal care.

Association of Periprocedural Haemoglobin Reduction and Myocardial Injury in Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention

Background: Patients undergoing percutaneous coronary intervention are at risk of different complications such as periprocedural bleeding and acute hemoglobin reduction that can lead to myocardial injury. Blood loss through the catheter during the procedure and through puncture site haematoma causes periprocedural acute haemoglobin drop. Objectives: To find out the association between acute haemoglobin reduction and myocardial injury after PCI in patients with unstable angina. Methods: This prospective observational study was conducted at the National Institute of Cardiovascular Diseases (NICVD) for one year of time. A total of 130 patients were enrolled based on inclusion and exclusion criteria during the study period. Haemoglobin and troponin-I were measured before and after PCI within 24 to 48 hours of the procedure. On the basis of post-procedural acute haemoglobin level, the study population was categorized into two groups: Group I patients with normal haemoglobin levels and Group II patients with significant acute haemoglobin reduction (≥ 1 gm/dl). Results: A total of 24 patients developed a periprocedural myocardial injury, among them 17 (70.8%) were in the reduced haemoglobin group and 7 (29.2%) in the normal haemoglobin group. Elevation of troponin I after PCI was higher in group II than in group I patients with a statistically significant difference. Multivariate logistic regression analysis showed that haemoglobin reduction was an independent predictor of PMI (OR 1.94; 95% CI, 1.241-8.684; p = 0.01). Conclusion: Periprocedural haemoglobin reduction in patients with unstable angina was associated with myocardial injury after percutaneous coronary intervention (PCI).

Replenishment of iron deficiency in women before the use of assisted reproductive technologies

Introduction. Anemia is a major health problem worldwide, increasing the risks of low birth weight, preterm birth, perinatal mortality, stillbirth, postpartum hemorrhage, and maternal mortality. Replenishing iron deficiency at the stage of preconceptional preparation reduces the incidence of IDA and can reduce the incidence of pregnancy complications and improve perinatal outcomes.Aim. To evaluate the effectiveness of ferrous sulfate 80 mg and its potential to replenish iron deficiency in women with infertility before using assisted reproductive technologies (ART).Materials and methods. A prospective clinical longitudinal study was conducted from May to September 2023 at LLC Health Clinic, Moscow. The study included women (n = 34) at the stage of pregnancy planning by IVF with a diagnosed iron deficiency. Iron deficiency was established in accordance with the following criteria: decrease in serum ferritin level less than 30 μg/l, serum iron level less than 15 μmol/l.Results. After 12 weeks of taking ferrous sulfate, the average hemoglobin level increased from 112.3 ± 6.5 (101–119) g/l to 118.5 ± 6.5 (110–133) g/l (W-Wilcoxon 9300 test, p = 0.003), mean serum iron level from 15.4 ± 4.0 (5.7–22.5) μmol/l to 34.8 ± 7.1 (20.1–46.7) μmol/l (Wilcoxon W test 602.0, p &lt; 0.001), mean ferritin level from 8.2 ± 3.1 (4.5–17.0) μg/ml to 37.6 ± 6.7 (30.6–52.6) μg/ml (Wilcoxon W test 595.0, p &lt; 0.001).Conclusions. Timely examination of patients for iron deficiency and iron deficiency anemia at the stage of preconceptional preparation makes it possible to prescribe an effective correction, thereby helping to reduce the risks of complications of pregnancy and childbirth.

Cerebral hemodynamics and oxygenation in adult patients with sickle cell disease after stem cell transplantation.

Sickle cell disease (SCD) is characterized by chronic hemolytic anemia associated with impaired cerebral hemodynamics and oxygen metabolism. Hematopoietic stem cell transplantation (HSCT) is currently the only curative treatment for patients with SCD. Whereas normalization of hemoglobin levels and hemolysis markers has been reported after HSCT, its effects on cerebral perfusion and oxygenation in adult SCD patients remain largely unexplored. This study investigated the effects of HSCT on cerebral blood flow (CBF), oxygen delivery, cerebrovascular reserve (CVR), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2 ) in 17 adult SCD patients (mean age: 25.0 ± 8.0, 6 females) before and after HSCT and 10 healthy ethnicity-matched controls (mean age: 28.0 ± 8.8, 6 females) using MRI. For the CVR assessment, perfusion scans were performed before and after acetazolamide as a vasodilatory stimulus. Following HSCT, gray and white matter (GM and WM) CBF decreased (p < .01), while GM and WM CVR increased (p < .01) compared with the baseline measures. OEF and CMRO2 also increased towards levels in healthy controls (p < .01). The normalization of cerebral perfusion and oxygen metabolism corresponded with a significant increase in hemoglobin levels and decreases in reticulocytes, total bilirubin, and LDH as markers of hemolysis (p < .01). This study shows that HSCT results in the normalization of cerebral perfusion and oxygen metabolism, even in adult patients with SCD. Future follow-up MRI scans will determine whether the observed normalization of cerebral hemodynamics and oxygen metabolism prevents new silent cerebral infarcts.

Nutrition Education Using E-Booklet Against Hemoglobin Levels of Young Women

Anemia in adolescent girls is characterized by Hb levels &lt; 12 g / dl. Anemia is influenced by various factors including nutritional intake, and knowledge. Anemia results in learning concentration, fatigue, to decreased learning achievement. One of them overcomes this problem by giving Fe supplements and nutrition education. The purpose of this study was to determine the relationship between nutrition education using e-booklets on hemoglobin levels in adolescent girls. The design of this study was a Quasi-Experiment with a comparison group. The study was divided into the treatment group and the comparison group. Providing nutrition education using e-booklets and Fe supplements for 3 weeks in the treatment group. The number of respondents was 36 in the treatment group and the comparison in the comparison group. The results of the t-dependent test showed an average difference in the two groups with a p-value of  0.05. The average hemoglobin level of the treatment group was 0.411 g / dl and the comparison group was 0.2 g / dl. The results of the t-independent test showed no difference in the average hemoglobin levels of the treatment group with a comparison group with a p-value of  0.05. The average difference in hemoglobin levels in the treatment group with the comparison group was 0.211 g / dl. Fe supplements and nutrition education with e-booklets can increase Hb levels.

THU601 Massive Pericardial Effusion As Sole Symptom For Uncontrolled Hypothyroidism.

Abstract Disclosure: D.A. Lopez: None. M. Caban: None. C. Camacho: None. Y. Fuentes: None. M. Sanchez: None. K. Velez: None. Hypothyroidism is a common endocrine disorder with worldwide prevalence resulting from deficiency of thyroid hormone that can affect multiple organs. It can be asymptomatic and subclinical or symptomatic with fatal complications. Hypothyroidism can present with symptoms such as fatigue, slow movement and slow speech, cold intolerance, constipation, weight gain, and bradycardia. Hypothyroidism can be the cause of pericardial effusion due to increase membrane permeability. Massive pericardial effusion or pericardial tamponade is rare. Pericardial effusion can also be caused by autoimmune conditions, infections, uremia, medications, iatrogenic, and trauma. This is a case of 68-year-old Hispanic female with past medical history of hypothyroidism that was admitted to the hospital due to large pericardial effusion. These findings were found incidentally by her primary care physician during a preoperative evaluation for cataract surgery. Chest X-ray showed massive enlargement of the cardiac silhouette. Echocardiogram was ordered presenting large circumferential pericardial effusion with moderate diastolic right atrial collapse reason why patient was sent to the hospital. Physical examination showed distant heart sounds but absent jugular venous distention. Vital signs were within normal limits. Beck's triad was absent. Electrocardiogram showed a sinus rhythm with low QRS voltage. Patient denied any recent procedure, trauma, myocardial infarction, malignancy, or fever. Complete blood count was without leukocytosis, normal hemoglobin levels and platelet count. Basic metabolic panel presented without electrolyte disturbances and preserved renal function. Evaluation for causes of pericardial effusion was made including autoimmune conditions. Results showed negative ANA, Rheumatoid factor, Anti-dsDNA antibody, Anti-Scl-70 antibody, anti-U1-ribonucleoprotein, anti-Ro, and anti-La. Inflammatory markers were within normal limits. TSH level were in 22.5μIU/mL (0.03-5.0μIU/mL) with undetectable Free T4 pointing towards uncontrolled hypothyroidism as the cause of her large pericardial effusion. Patient denied other symptoms of hypothyroidism. She agreed not being compliant with levothyroxine. Pericardiocentesis was done and 750ml of pericardial fluid was removed. A catheter was placed and 200ml of fluid was drained on the second day. Catheter was removed and Echocardiogram showed immediate resolution of the diastolic right atrial collapse. She was sent home with adequate medical therapy and intense education of hypothyroidism. As a take home message, this unique case presents the importance of being compliant to medical therapy since the initial presentation of uncontrolled hypothyroidism could be a fatal complication as pericardial effusion. This could’ve been prevented if compliance with medications was encourage since the beginning of this disorder. Presentation: Thursday, June 15, 2023

Laboratory, clinical, neurological and neuropsychological features of the course of post-COVID syndrome in patients with cerebrovascular disease

A review of the literature reveals a wide range of terms for conditions after coronavirus disease (COVID-19): post-­COVID syndrome, post-acute COVID syndrome, chronic COVID-19, long-term complications of COVID-19, long COVID-19, and post-acute sequelae of severe acute respiratory syndrome coronavirus 2 infection. All these terms and others indicate that after ­COVID-19, a person does not return to his/her usual state of health. Many scientists are researching and looking for the causes of these symptoms, why and when they occur, and how to diagnose and treat them. Therefore, the aim of the study was to improve the diagnosis of post-COVID syndrome in patients with cerebrovascular disease (CVD) by studying clinical, neurological, laboratory and neuropsychological markers. Materials and methods. The study uses psychometric methods — Beck Anxiety Inventory, Hamilton Depression Rating Scale, Fatigue Assessment Scale; neuropsychological — Montreal Cognitive Assessment; clinical — neurological status; laboratory — hemoglobin, C-reactive protein, fibrinogen, albumin, ferritin, lactate dehydrogenase. All patients were divided into four groups: the first group included 20 people with post-­COVID syndrome and CVD, the second — 15 individuals with post-COVID syndrome without CVD, the third — 15 patients without post-COVID syndrome with CVD, and the fourth — 15 people without post-COVID syndrome and without CVD. Results. In the group of patients with post-COVID syndrome with cerebrovascular disease (n1 = 20), the average level of hemoglobin (M = 115.15 ± 4.93) and albumin (M = 32.15 ± 1.53) was below the normal range; the content of fibrinogen (M = 6.04 ± 0.82), C-reactive protein (M = 5.50 ± 0.68) was above normal. Data of the Hamilton Depression Rating Scale indicate that patients with post-COVID syndrome and cerebrovascular disease Data of the Hamilton Depression Rating Scale indicate that patients with post-COVID syndrome and cerebrovascular disease (n1 = 20) had a mild depression (M = 6.75 ± 3.90; M = 8.60 ± ± 3.06). Correlation analysis revealed a direct relationship between cognitive functions and hemoglobin (r = 0.455, p ≤ 0.01), albumin (r = 0.571, p ≤ 0.01) and an inverse relationship between cognitive functions and fibrinogen (r = –0.605, p ≤ 0.01), C-reactive protein (r = –0.547, p ≤ 0.01), ferritin (r = 0.408, p ≤ 0.01). There was an inverse correlation between anxiety and hemoglobin (r = –0.619, p ≤ 0.01) and albumin (r = –0.567, p ≤ 0.01) and a direct relationship between anxiety and fibrinogen (r = 0.550, p ≤ 0.01) and C-reactive protein (r = 0.537, p ≤ 0.01). The depression scale negatively correlates with the level of hemoglobin (r = –0.597, p ≤ 0.01), albumin (r = –0.543, p ≤ 0.01) and directly with the content of fibrinogen (r = 0.433, p ≤ 0.01), C-reactive protein (r = 0.383, p ≤ 0.01) and lactate dehydrogenase (r = 0.276, p ≤ 0.05). The indicators of fibrinogen, C-reactive protein, and ferritin were the highest in the group of patients with post-COVID syndrome and cerebrovascular disease. According to the obtained data, there are statistically significant differences between four groups in cognitive functions (χ2 = 36.419, p ≤ 0.01), fatigue (χ2 = 37.251, p ≤ 0.01), anxiety (χ2 = 37.981, p ≤ 0.01) and depression (χ2 = 37.171, p ≤ 0.01). The highest rate of fatigue, anxiety, and depression was found in patients with post-COVID syndrome and cerebrovascular disease.