Normal Hemoglobin Research Articles

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).

Photonic spin Hall effect-based ultra-sensitive refractive index sensor for haemoglobin sensing applications

A highly sensitive Photonic Spin Hall Effect (PSHE)-based layered sensor is proposed which detects changes in refractive index of biological sample. A simple and elegant design measures haemoglobin concentrations using Surface Plasmon Resonance (SPR) effect. It consists of a BK7 prism, a thin gold layer, an analyte layer of haemoglobin and BK7 glass as the substrate. The average angle sensitivity (SR) has been calculated and found to be 191°/RIU, 208°/RIU and 171°/RIU respectively for low, normal and high haemoglobin concentrations. The Figure of Merit (FOM) for the proposed structure is found to be 896RIU-1, 812RIU-1 and 3166RIU-1 respectively for low, normal and high concentrations of oxygenated haemoglobin.

FRI244 Autoimmune Polyglandular Syndrome Type 2 And Peripartum Cardiomyopathy: A Case Report

Abstract Disclosure: A.G. Jimenez: None. J.D. Christensen: None. P. Surampudi: None. S. Phatak: None. J. Yoon: None. Background: Peripartum cardiomyopathy (PPCM) is a diagnosis of exclusion with evolving understanding of pathophysiology. There is limited consideration of the autoimmune processes contributing to PPCM. Case Presentation: A 20-year-old female had a recent delivery complicated by placenta previa, hemorrhage requiring transfusion, and pelvic infection. She presented 2 weeks postpartum with altered mental status and abdominal pain, found to be in septic shock, acute respiratory failure, acute liver injury initially thought to be secondary to retained products of conception. Subsequently, she was diagnosed with moderate-to-severe PPCM as she developed signs of heart failure, low ejection fraction <35%, mild ventricular dilatation, cardiogenic shock, hemorrhagic pericardial effusion with tamponade. She had no other prior cardiovascular history. She was briefly started on bromocriptine for treatment of suspected prolactin-mediated PPCM, in addition to digoxin, as her blood pressure was unable to sustain other treatments for PPCM. However, she hemodynamically decompensated and required persistent pressor support, leading to evaluation for other causes. Due to her prior history of hypothyroidism, an adrenal evaluation with a cosyntropin stimulation test was done. It demonstrated an undetectable cortisol at 0, 30, 60 minutes, with an elevated ACTH (1256, n=7-63 ng/dL), consistent with primary adrenal insufficiency (PAI). Workup for PAI did not reveal any infectious, infiltrative, vascular, pharmacological, or neoplastic etiology. Lab workup for concomitant hypophysitis was significant for low IGF-1 (Z-score -5.8, n= -2.0 to +2.0), but otherwise had expected elevated prolactin (121 ng/mL, n=5.2-26.5 ng/mL), suppressed LH (0.3 mIU/mL) and FSH (2.4 mIU/mL), and normal TSH (3.87 mIU/mL, n=0.27-4.20 mIU/mL) on levothyroxine 100 mcg. She had normal parathyroid hormone and hemoglobin A1c levels with no history of chronic candidiasis. Further workup showed positive antibodies to adrenal 21-hydroxylase enzyme, thyroid peroxidase, and glutamic acid decarboxylase 65, suggestive of autoimmune polyglandular syndrome (APS) type 2. She was started on glucocorticoids and mineralocorticoids for adrenal insufficiency resulting in a significant clinical improvement. She was subsequently discharged in stable condition. Conclusion: Due to increased rates of mortality in PPCM (4-11%), thought should be given to nontraditional etiologies of cardiac failure. Although rare, adrenal insufficiency must be considered in those with moderate-to-severe PPCM who continue to decompensate despite treatments. Untreated adrenal insufficiency can result in fatal consequences if not immediately treated. APS type 2 should be considered even in those without any confirmed family history of autoimmune disease. Those with autoimmune tendencies may be at higher risk of PPCM. Presentation: Friday, June 16, 2023

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

Velaglucerase alfa for treatment in children with Gaucher disease type 1: the Russian experience

The current gold standard for the treatment of Gaucher disease type 1 in children is enzyme replacement therapy. The efficacy and safety of treatment with velaglucerase alfa have been assessed in only a few large studies involving pediatric patients as subjects of research. In the Russian literature, there are no data available on the use of velaglucerase alfa in drug-naïve patients with Gaucher disease type 1. The aim of our study was to assess the efficacy and safety of treatment with velaglucerase alfa in children with Gaucher disease type 1. The study was approved by the Independent Ethics Committee and the Scientific Council of the National Medical Research Center for Children's Health of Ministry of Healthcare of the Russian Federation. All patients and/or their legal representatives gave their informed consent to the study. The efficacy of treatment with velaglucerase alfa in children with Gaucher disease type 1 was assessed by analyzing monitoring data of 15 patients aged 2 to 15 years who had been registered in the Russian Pediatric Gaucher Registry established at National Medical Research Center for Children's Health of Ministry of Healthcare of Russia over the period from 2015 to 2023. None of the patients had ever undergone enzyme replacement therapy before they were included in this study. The median age at the start of treatment was 6.5 years. We analyzed the patients' anthropometric, laboratory and instrumental data at 0, 6, 12, 24 and 36 months. The initial dose of enzyme replacement therapy ranged from 30 to 60 units/kg (with the median of 43 units/kg per infusion) once every 2 weeks based on disease severity. In as little as 6 months after the initiation of therapy with velaglucerase alfa, patients with Gaucher disease type 1 showed a statistically significant improvement in all measured parameters (p < 0.001): normalization of the median hemoglobin concentration and platelet count (from 113 to 125 g/L and from 111 to 163 × 109/L, respectively); a reduction in degree of liver and spleen enlargement (in terms of volume, from 45.1 to 17.9% and from 39.4 to 15.5%, respectively); a reduction in degree of the right liver lobe enlargement (in terms of linear measurements, from 27.2 to 11.1%); a reduction in degree of spleen enlargement (in terms of its length and width, from 73.4 to 37.8% and from 60.3 to 17.5%, respectively). Our patients had a remarkable decrease in biomarker activity after 3 years of therapy: chitotriosidase activity decreased from 2699 to 227 nmol/mL/h and glucosylsphingosine level was reduced from 204.0 to 35.3 ng/mL (р < 0.001). There were no adverse events during the course of treatment. After 6 months and 1 year of regular enzyme replacement therapy with appropriate doses of velaglucerase alfa initiated in a timely manner, children with Gaucher disease type 1 achieve normal hemoglobin concentrations and platelet counts, a reduction in biomarker activity, and a decrease in liver and spleen volumes. After 3 years of enzyme replacement therapy, patients achieve their main therapeutic goals such as the resolution of anemia and thrombocytopenia, an almost complete regression of hepatosplenomegaly and the normalization of bone mineral density and height adjusted for age.

A quantum chemistry background of sickle cell anemia and gaps in antisickling drug development

Sickle cell anemia disease has been a great challenge for the world in the present situation. It occurs only due to the polymerization of sickle hemoglobin (HbS) having Pro-Val-Glu (PVG) typed mutation, while the polymerization does not occur in normal hemoglobin (HbA) having Pro-Glu-Glu (PGG) residues. According to data from the literature, Val-beta6 of Pro-Val-Glu is hydrophobic in nature, which appears to fit into a hydrophobic pocket in the adjacent HbS. After the insertion of Pro-Val-Glu into a hydrophobic pocket on the adjacent HbS, the polymerization is started. This is a questionable point on how the replacement of glutamic acid with valine in HbS makes it more reactive to fit into a hydrophobic pocket on adjacent HbS for polymerization. No data from the literature on the reactivity of HbS for polymerization was found yet. This is the first time that the theoretical calculation was done in both HbA and HbS where they were structurally different. After that, a comparative study between PVG and PGG was done at quantum level for the evaluation of the reactivity to fit into a hydrophobic pocket on adjacent HbS. At a quantum level, it was found that the HOMO-LUMO gap of Pro-Val-Glu was lower than that of Pro-Glu-Glu. According to the data from the literature, the lesser HOMO-LUMO gap promotes the initiation of the polymerization reaction. On the basis of the results, it was also shown how the mutation point (Pro-Val-Glu) in HbS becomes more reactive to polymerization, whereas Pro-Glu-Glu in HbA does not. The computational method developed for the first time will be very helpful not only for molecular biologists but also for computational and medicinal chemists. Additionally, the required modifications based on gaps in anti-sickling drug development are also suggested in the presented article.

Nutritional status, anemia status and application of the Mentzer index on complete blood examination results of students

Thalassemia is a disease that attacks the hemoglobin gene, causing disturbances in erythropoiesis. Anemia is a condition in which the hemoglobin (Hb) concentration and the number of erythrocytes are below normal limits. The high number of anemia and thalassemia causes the need for early detection in order to prevent adverse effects in the future. Research objectives: to determine nutritional status, anemia status, and application of the Mentzer Index for SMK Muhammadiyah II Moyudan students. Methods: This study is a descriptive study with a cross-sectional design. The research subjects were first graders at SMK Muhammadiyah 2 Moyudan. Venous blood samples were examined at the Clinical Pathology Laboratory of FK-KMK UGM using the Sysmex XN-1000 tool on November 25, 2021. Data analysis used IBM SPSS Version 26 and Microsoft Office 365. Results: A total of 53 subjects participated in this study. A total of 47 (89%) respondents had normal hemoglobin values, and 6 (11%) respondents suffered from anemia. 31 (58.5%) respondents have normal nutrition, 15 (28%) respondents have less nutrition, 7 (13%) have excess nutrition, and 29 (54.7%) respondents have normal status. A total of 2 (3.8%) respondents showed Thalassemia. Conclusion: There are two students of SMK Muhammadiyah 2 Moyudan diagnosed with thalassemia and five students diagnosed with anemia. No statistically significant difference exists between Anemia Status in Adolescents at SMK Muhammadiyah 2 Moyudan and Nutritional Status. Further study is needed in wider and more diverse populations to analyze the influence of nutritional conditions on anemia in adolescents.

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

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

Pharmacokinetics of single low dose primaquine in Ugandan and Congolese children with falciparum malaria

There are no pharmacokinetic data of single low dose primaquine (SLDPQ) as transmission blocking in African children with acute Plasmodium falciparum and glucose-6-phosphate dehydrogenase deficiency (G6PDd). Primaquine pharmacokinetics of age-dosed SLDPQ (shown previously to be gametocytocidal with similar tolerability as placebo) were characterised in falciparum-infected Ugandan and Congolese children aged 6 months to 11 years, treated on admission with standard 3-day dihydroartemisinin-piperaquine or artemether-lumefantrine plus SLDPQ: 6m-<1y: 1.25mg, 1-5y: 2.5mg, 6-9y: 5mg, 10-11y: 7.5mg. LC-MS/MS-measured plasma primaquine and carboxyprimaquine (baseline, 1, 1.5, 2, 4, 8, 12, 24h) were analysed by noncompartmental analysis. Multivariable linear regression modelled associations between covariates, including cytochrome-P450 2D6 metaboliser status, and outcomes. 258 children (median age 5 [interquartile range (IQR) 3-7]) were sampled; 8 (3.1%) with early vomiting were excluded. Primaquine doses of 0.10-0.40 (median 0.21, IQR 0.16-0.25) mg base/kg resulted in primaquine maximum plasma concentrations (Cmax) of 2.3-447 (median 103.0, IQR 72.1-140.0) ng/mL between 1.0 and 8.0 (median 2) hours (Tmax) and median areas under the drug concentration curves (AUC0-last) 730.2 (6m-<1y, n=12), 582.8 (1-5y, n=126), 871.1 (6-9y, n=80), and 931.0 (10-11y, n=32) ng∗h/mL. Median elimination half-live (T½) was 4.7 (IQR 3.8-5.6) hours. Primaquine clearance/kg peaked at 18 months, plateauing at 4y. Increasing CYP2D6 metaboliser activity score [poor (3/250), intermediate (52/250), normal (150/250), ultrarapid (5/250), indeterminate (40/250)] and baseline haemoglobin were significantly associated with a lower primaquine AUC0-last,which increased with increasing mg/kg dose and age but was independent of the artemisinin treatment used. Age-dosed SLDPQ resulted in variable primaquine exposure that depended on bodyweight-adjusted dose, age, baseline haemoglobin and CYP2D6 metaboliser status, but not on dihydroartemisinin-piperaquine or artemether-lumefantrine. These data support age-dosed SLDPQ for transmission blocking in sub-Saharan Africa. This work was cofunded by the UK Medical Research Council, Wellcome Trust, and UK Aid through the Global Health Trials (grant reference MR/P006973/1). The funders had no role in the study design, execution, and analysis and decisions regarding publication.

Sclerosing angiomatoid nodular transformation of the spleen in a child with anemia: a case report and review of the literature

BackgroundSclerosing angiomatoid nodular transformation of the spleen is a relatively rare benign vascular lesion in both adult and pediatric age groups with unclear etiopathogenesis and variable clinical presentations. Many benign and also malignant splenic masses could mimic sclerosing angiomatoid nodular transformation, both clinically and radiologically. Herein, we report our experience with a case of sclerosing angiomatoid nodular transformation in a 3-year-old girl.Case reportA 3-year-old Iranian girl presented with abdominal pain, back pain, and constipation for 2 weeks. She was being followed up by a pediatrician due to her short stature and persistent anemia. Physical examination showed stable vital signs, short stature, pallor, and a puffy face. Laboratory evaluation showed normochromic normocytic anemia with a normal reticulocyte count, ferritin, and hemoglobin electrophoresis. Radiologic assessments revealed a hypoechoic lesion in the spleen with high vascularity, clinically suspected to be lymphoma. She was operated on, and after partial splenectomy, pathologic evaluation of the spleen showed a solitary, well-demarcated, and unencapsulated dark mass. Microscopic examination revealed micronodular appearance composed of irregular-shaped vascular spaces lined by plump endothelial cells and surrounded by concentric collagen fibers, features in keeping with sclerosing angiomatoid nodular transformation. The patient’s anemia was resolved after surgery, and no clinical or radiologic deficits were noted during the 10-month follow-up visits.ConclusionAlthough sclerosing angiomatoid nodular transformation is exceedingly rare in children, it should be considered a differential diagnosis in pediatric splenic neoplasms with concurrent hematologic manifestations, such as anemia.

Association between hemoglobin concentration and hypertension risk in native Tibetans at high altitude.

Previous studies examining the association between hemoglobin concentration and hypertension have yielded inconsistent results. There is still a lack of evidence regarding the association between hemoglobin concentration and hypertension risk in native Tibetans at high altitude. We performed this cross-sectional study in Luhuo County of Ganzi Tibetan Autonomous Prefecture (average altitude of 3500m). In this study, we enrolled 1547 native Tibetans. The association between hemoglobin concentration and hypertension risk was examined by multivariate binary logistic regression and smooth curve fitting. Native Tibetans with hypertension had significantly higher hemoglobin concentrations than those without hypertension (165.9±21.5g/L vs. 157.7±19.2g/L, P<0.001). An increase in hemoglobin concentration of 1g/L was associated with hypertension (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.02) after confounder adjustment. The highest hemoglobin concentration group (exceeding 173g/L) was associated with an increased hypertension risk compared with the bottom quartile of hemoglobin concentration (OR 2.39, 95% CI 1.48-3.85). Hemoglobin concentration (per 1g/L change) exceeding 176g/L was significantly associated with an increased hypertension risk (OR 1.04, 95% CI 1.03-1.06). Additionally, high-altitude polycythemia significantly increased the hypertension risk compared with a normal hemoglobin concentration (OR 2.92, 95% CI 1.25-6.86). A similar result was observed for mild polycythemia (OR 1.74, 95% CI 1.29-2.34). In conclusion, hemoglobin concentration was associated with hypertension risk in native Tibetans. When the hemoglobin concentration exceeded a certain value (approximately 176g/L), the risk of hypertension was significantly increased.

The Prevalence of anemia in adolescents and non-pregnant women of reproductive age, referring to City Medical Complex in 2022

Introduction: Anemia is a prevalent illness of the hematopoietic system that generally occurs in both developed and developing countries. Anemia is rampant among children and reproductive women. The present study was conducted to investigate the prevalence of anemia in adolescent girls and non-pregnant women of reproductive age, referring to City Medical Complex in 2022 Material and methods: A total of 671 adolescents and healthy, non-pregnant women of reproductive age (aged 10 to 49 years old) take part in the study. Informed consent was taken from the subjects, and hemoglobin concentration was measured. Statistical analysis was performed using SPSS version 24 software. Results: Of the 671, 131 (or 19.5%) had mild anemia, 136 (or 20.3%) had moderate anemia, 23 (or 3.4%) had severe anemia, and 381 (or 56.8%) had normal hemoglobin. Disscusion: Our findings show that the prevalence of anemia and a low body mass index (BMI) in adult women is higher than that in adolescent girls living in Kabul in 2022.

Variations in complete blood counts and cellular morphological alterations in blood smear of COVID-19 patients from a tertiary care center

Corona viruses are a large family of viruses of which Corona virus disease 19 (COVID 19) infection evokes a hyperinflammatory response and severe acute respiratory distress syndrome in human beings. Complete blood count evaluation and peripheral smear examination is an essential tool for early diagnosis and management of COVID-19 positive patients. This study was aimed to evaluate the variations in complete blood counts (CBC) and changes in the cellular morphology in the blood smear in patients affected with COVID-19. This was an observational study, undertaken in a tertiary care center. The study included baseline blood samples from 96 proven COVID-19 positive cases. The samples were subjected for automated complete blood count analysis and peripheral smear examination.Thequantitative data were expressed by mean and Standard deviation. Qualitative categorical variables were expressed as numbers and percentages. Out of the total 96 cases, the most common quantitative finding was neutrophilic leukocytosis with relative lymphopenia. Five cases of absolute lymphopenia was observed. Majority of the cases had normal hemoglobin values and normal platelet counts. The characteristic morphological changes were seen in neutrophils and lymphocytes. The neutrophils showed presence of toxic granules, cytoplasmic vacuolations and hypolobation.The morphological alteration in lymphocytes included reactive lymphocytes with plasmacytoid and monocytoid morphology, large granular lymphocytes and Turk cells. Infrequent finding of leukoerythroblastic reaction was also observed in our study.To summarize, hematological investigation of COVID 19 cases may show several abnormal findings. Quantitative findings like Neutrophilia and lymphopenia were characteristic, whereas, the most common morphological alteration observed was atypical lymphocytes. Quantitative and qualitative alterations of hematological parameters are one of the investigations which would aid timely diagnosis of the disease. Toxic granules and cytoplasmic vacuolations in neutrophils may indicate ongoing sepsis in COVID 19 patients which in turn aids in efficient management of the patients to reduce the mortality rate.

Hospital-Acquired Anemia in Patients with Acute Coronary Syndrome: Epidemiology and Potential Impact on Long-Term Outcome

BackgroundAnemia (either pre-existing or hospital-acquired) is considered an independent predictor of mortality in acute coronary syndromes. However, it is still not clear whether anemia should be considered as a marker of worse health status or a therapeutic target. We sought to investigate the relationship between hospital-acquired anemia and clinical and laboratory findings and to assess the association with mortality and major cardiovascular events at long-term follow-up. MethodsPatients consecutively admitted at Niguarda Hospital between February 2014 and November 2020 for an acute coronary syndrome were included in this cohort analysis and classified as anemic at admission (group A), with normal hemoglobin at admission but developing anemia during hospitalization (hospital-acquired anemia) (group B); and with normal hemoglobin levels throughout admission (group C). ResultsAmong 1294 patients included, group A included 353 (27%) patients, group B 468 (36%), and group C 473 patients (37%). In terms of cardiovascular burden and incidence of death, major cardiovascular events and bleeding at 4.9-year median follow-up, group B had an intermediate risk profile as compared with A and C. Baseline anemia was an independent predictor of death (hazard ratio 1.51; 95% confidence interval, 1.02-2.25; P = .04) along with frailty, Charlson comorbidity Index, estimated glomerular filtration rate, previous myocardial infarction, and left ventricular ejection fraction. Conversely, hospital-acquired anemia was not associated with increased mortality (hazard ratio 1.18; 95% confidence interval, 0.8-1.75; P = .4). ConclusionsHospital-acquired anemia affects one-third of patients hospitalized for acute coronary syndrome and is associated with age, frailty, and comorbidity burden, but was not found to be an independent predictor of long-term mortality.

Comparative sonographic assessment of the spleen in individuals with and without sickle cell anaemia in Abakaliki, Nigeria

Background: Sickle cell anaemia (HbSS) is a major public health problem in Sub-Saharan Africa and commonly affects the spleen, with associated increased morbidity and mortality. This study aimed to evaluate the ultrasonographic findings of the spleen in patients with HbSS in steady state and to compare findings with those of individuals with normal adult haemoglobin (HbAA).&#x0D; Methods: This was a cross-sectional comparative study. Haemoglobin phenotypes were determined using haemoglobin electrophoresis. The spleen was scanned using transabdominal ultrasonography. Splenic size and parenchymal echotexture were assessed. Data was analysed with SPSS software, version 20.&#x0D; Results: One-hundred-and-twenty participants were recruited for the study, made up of 60 patients with HbSS and 60 age-and-sex-matched individuals with HbAA. They were made up of 54 (45%) males and 66 (55%) females, aged 2 to 32years, with mean age of 15.78 ±7.2 years for HbSS and 15.80 ±7.5years for HbAA participants. Thirteen (21.7%) patients with HbSS had autosplenectomy, 7 (11.7%) had splenomegaly, 6 (10%) had shrunken spleens, while 34 (56.7%) had normal sized spleens. All the participants with HbAA had normal splenic size with age. Of the 47 patients with HbSS whose spleen were visualized, 20 (42.6%) had abnormal splenic echotexture, whereas all the 60 (100%) participants with HbAA, had normal echotexture. There was significant difference in splenic echotexture in patients with HbSS compared to those with HbAA (p &lt;0.05). &#x0D; Conclusion: A number of patients with HbSS have abnormal splenic size and echotexture compared to those with HbAA. There should be adequate follow up of patients with HbSS to prevent possible resultant splenic complications.

Outcome of Second Primary Malignancies Developing in Multiple Myeloma Patients.

There is an increased risk of second primary malignancies (SMPs) in patients with multiple myeloma (MM). This multinational 'real-world' retrospective study analyzed the characteristics and outcomes of MM patients that developed SPMs. 165 patients were analyzed: 62.4% males; 8.5% with a prior cancer; 113 with solid SPMs, mainly ≥stage 2; and 52 with hematological SPM (hemato-SPM), mainly MDS/AML. Patients with hemato-SPM were younger (p = 0.05) and more frequently had a prior AutoHCT (p = 0.012). The time to SPM was shorter in the older (>65 years) and more heavily pretreated patients. One hundred patients were actively treated at the time of SPM detection. Treatment was discontinued in 52, substituted with another anti-MM therapy in 15, and continued in 33 patients. Treatment discontinuation was predominant in the patients diagnosed with hemato-SPM (76%). The median OS following SPM detection was 8.5 months, and the main cause of death was SPM. A poor ECOG status predicted a shorter OS (PS 3 vs. 0, HR = 5.74, 2.32-14.21, p < 0.001), whereas a normal hemoglobin level (HR = 0.43, 0.19-0.95, p = 0.037) predicted longer OS. With the continuing improvement in OS, a higher proportion of MM patients might develop SPM. The OS following SPM diagnosis is poor; hence, frequent surveillance and early detection are imperative to improve outcomes.

The Relationship between Protein Intake and Hemoglobin Levels in Women of Reproductive Age at Inche Abdoel Moeis Hospital Samarinda

The prevalence of anemia in Indonesia among women of childbearing age in 2018 was 28.7%. Less protein intake will inhibit the formation of hemoglobin levels. The purpose of this study was to determine the relationship between protein intake and hemoglobin levels in inpatients of women of childbearing age. The population is 87 and the sample is 38 subjects. Samples were taken by purposive sampling using inclusion and exclusion criteria. The statistical test uses the Spearman test. The results show that protein intake and hemoglobin levels have a value of r = 0.81+, p = 0.00 meaning that there is a significant relationship between protein intake and hemoglobin levels with a very strong relationship strength. Inpatients, especially women of childbearing age, are expected to increase protein intake according with the need for both animal and plant origin to maintain normal hemoglobin levels.

The Prevalence of Anemia in Working Women.

Anemia can be defined as a reduction in the amount of hemoglobin (Hb) in red blood cells (RBCs). It is becoming a growing socioeconomic issue. It is important to identify the causes of anemia and educate people about its symptoms. This can aid in the early identification and diagnosis of anemia, thereby preventing the disease's complications. The complications of anemia include the risk of low birth weight, prematurity, prenatal and neonatal mortality, and maternal mortality. The objective of the study is to investigate the factors contributing to anemia among working-class women employed in government or private sectors located in Karachi, Pakistan. By identifying the causes and risk factors of anemia, participants can be counseled to adopt a healthier lifestyle, a well-balanced diet, and activities that may eliminate the causes of anemia, further preventing the incidence of anemia. The objectives of the study are specific, measurable, achievable, realistic, and time-bound (SMART). The study was conducted from November 2019 to August 2021 despite facing COVID-19-related restrictions. The sample size fit the inclusion criteria, and the objectives were accomplished successfully with adequate resources. The cross-sectional study was conducted after receiving clearance from institutions and consent from participants. A total of 180 participants provided consent after receiving a thorough explanation of the study, and they had the right to refuse to participate. In respect of confidentiality, the participants were not required to provide their names, as they were not included in our data analysis. The inclusion criteria included women of the working class, aged 18-45 years, working a minimum of four to five hours per week, and employed in government or private sectors located in Karachi, Pakistan. The exclusion criteria included women with bleeding or hematological disorders, a history of surgery in the last 12 months, pregnancy, or systemic disease. Data collection was divided into two sections: section one (questionnaire) and section two (investigations). The questionnaire was given to each participant via Google Forms and was filled out before section two of data collection, which included blood tests via a finger prick to measure hemoglobin with a Veri-Q Multi Meter hemoglobin monitoring system (manufactured by Q-line BIOTECH, New Delhi, India). The mean Hb was 11.15 ± 1.29 mg/dl (n = 180). The study revealed that 58.3% of the participants had a normal hemoglobin concentration according to the WHO anemia classification, while 41.7% were anemic. Overall, the prevalence of anemia was 41.7%, and the majority (56%) of the participants had mild anemia. The majority of the participants had mild anemia. Education on anemia and its symptoms, eating habits, occupational status, and stress-related factors can affect the hemoglobin concentration in RBCs. A diet low in meat, leafy vegetables, and fruit leads to anemia. Despite knowledge of anemia and its symptoms, non-medical professionals, especially young adults, had a higher prevalence of anemia than medical professionals, although the difference was minor.

Soluble Transferrin Receptor as Iron Deficiency Biomarker: Impact on Exercise Capacity in Heart Failure Patients.

The soluble transferrin receptor (sTfR) is a marker of tissue iron status, which could indicate an increased iron demand at the tissue level. The impact of sTfR levels on functional capacity and quality of life (QoL) in non-anemic heart failure (HF) patients with otherwise normal systemic iron status has not been evaluated. We conducted an observational, prospective, cohort study of 1236 patients with chronic HF. We selected patients with normal hemoglobin levels and normal systemic iron status. Tissue iron deficiency (ID) was defined as levels of sTfR > 75th percentile (1.63 mg per L). The primary endpoints were the distance walked in the 6 min walking test (6MWT) and the overall summary score (OSS) of the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The final study cohort consisted of 215 patients. Overall QoL was significantly worse (51 ± 27 vs. 39 ± 20, p-value = 0.006, respectively), and the 6 MWT distance was significantly worse in patients with tissue ID when compared to patients without tissue ID (206 ± 179 m vs. 314 ± 155, p-value < 0.0001, respectively). Higher sTfR levels, indicating increased iron demand, were associated with a shorter distance in the 6 MWT (standardized β = -0.249, p < 0.001) and a higher MLHFQ OSS (standardized β = 0.183, p-value = 0.008). In this study, we show that in patients with normal systemic iron parameters, higher levels of sTfR are strongly associated with an impaired submaximal exercise capacity and with worse QoL.

Anemia and idiopathic intracranial hypertension: a prospective study

ContexteOn a établi un lien temporel entre l'anémie et l'hypertension intracrânienne idiopathique (HII), mais le lien est incertain en raison de l'absence d’études prospectives, sans compter que l'HII et l'anémie sont toutes 2 fréquentes chez la jeune femme obèse. Plan et méthodesIl s'agit d'une étude prospective portant sur des patients consécutifs qui présentaient une HII et qui ont été adressés à l'une de 3 cliniques de neuro-ophtalmologie entre mars 2021 et septembre 2022. On disposait des résultats de l'hémogramme réalisé dans les 6 mois précédant la visite à la clinique pour chacun des patients. L'anémie se définissait comme suit : légère (110–120 g/L), modérée (80–109 g/L) ou grave (< 80 g/L). RésultatsSur les 143 patients, 113 avaient un taux d'hémoglobine normal (groupe 1) et 30 étaient anémiques (groupe 2). Dans le groupe 2, l'anémie était légère (15 patients sur 30; 50,0 %), modérée (11 patients sur 30; 36,7 %) ou grave (4 patients sur 30; 13,3 %). On n'a observé aucune différence en lien avec le sexe féminin (105 patientes sur 113 vs 29 sur 30; p = 0,453), l’âge (31,5 ± 9,2 ans vs 28,5 ± 10,3 ans; p = 0,144) et l'indice de masse corporelle (35,2 ± 6,9 kg/m2 vs 38,0 ± 8,1 kg/m2; p = 0,111). Les patients des groupes 1 et 2 présentaient des caractéristiques semblables quant à l'acuité visuelle (0,04 ± 0,09 logMAR vs 0,07 ± 0,14 logMAR; p = 0,377), à l’épaisseur de la couche de fibres nerveuses rétiniennes (174,5 ± 68,4 μm vs 206,5 ± 97,0 μm; p = 0,098), à la déviation moyenne (–3,2 ± 3,1 dB vs –3,9 ± 3,4 dB; p = 0,180) et au besoin de recevoir un traitement médicamenteux (34 patients sur 113 vs 8 sur 30; p = 0,715) ou un traitement chirurgical (3 patients sur 113 vs 3 sur 30; p = 0,074). Les patients dont l'anémie était modérée ou grave étaient plus susceptibles de devoir recevoir un traitement chirurgical (2 patients sur 15 vs 3 sur 113; p = 0,045). ConclusionEnviron 1 patient sur 5 présente à la fois une HII et de l'anémie, et cette dernière est grave dans > 10 % des cas. Les patients dont l'anémie est modérée ou grave peuvent avoir besoin d'un traitement chirurgical plus effractif. Compte tenu de l'incidence élevée d'anémie et de la possibilité de réaliser un hémogramme, nous recommandons ce test pour tous les patients chez lesquels on soupçonne la présence d'une HII.