Normal Hb Levels Research Articles

Pretreatment hemoglobin level as a predictor to evaluate the efficacy of immune checkpoint inhibitors in patients with advanced non-small cell lung cancer.

Background:Targeting immune checkpoints represents an immense breakthrough in cancer therapeutics. The prognostic value of hemoglobin (Hb) has been investigated in many malignancies including non-small cell lung cancer (NSCLC). However, the prognostic impact of pretreatment Hb count for immune checkpoint inhibitors (ICIs) in advanced NSCLC patients remains unclear.Methods:A total of 310 late-stage NSCLC patients who received ICI therapies between January 2015 and March 2019 were prospectively enrolled. We used a propensity score-matched cohort analysis for this study. Patients’ clinicopathological characteristics and pretreatment Hb concentration were assessed against the progression-free survival (PFS) and overall survival (OS) using the Kaplan–Meier method and Cox proportional hazards regression.Results:A propensity score (PS)-matched cohort analysis was applied to adjust for potential bias and to create two comparable groups according to patients’ clinicopathological characteristics. The patients with normal baseline Hb levels (⩾110 g/L) had significantly longer PFS [median: 10.0 versus 4.0 months, hazard ratio (HR): 0.63, 95% confidence interval (CI): 0.46−0.86; p = 0.001] and OS [median: 17.6 versus 10.5 months, HR (95% CI): 0.56 (0.40−0.79); p < 0.001] than those with decreased Hb count (<110 g/L) in a PS-matched cohort (n = 255). For patients with normal pretreatment Hb levels, ICI combination therapy was significantly associated with better PFS [median: 11.1 versus 8.0 months, HR (95% CI): 0.74 (0.50−1.06); p = 0.09] and OS [median: 26.0 versus 12.9 months, HR (95% CI): 0.56 (0.37−0.86); p = 0.008] than monotherapy, but there was no such trend for patients with decreased baseline Hb levels.Conclusion:Our findings showed that normal pretreatment Hb count served as a favorable prognostic marker in advanced NSCLC patients treated with ICIs, representing an economical biomarker with readily measuring performance among all reported ones.

Increase in Haemoglobin A2 Window among Healthy Children in Najran Area, Saudi Arabia

INTRODUCTION: A minor increase in hemoglobin (Hb) A2 is common in B thalassemia trait in which Hb A2 usually exceeds 3.5%. Other inherited and acquired disorders result in minor increases that do not often exceed 8%. The remarkable increase (>20%) in Hb A2 may refer to other structural variants that also migrate in the Hb A2 window. The aim of this study was to assess the increased Hb A2 levels and their incidence among schoolchildren in Najran city. AIMS: The aim of this study was to assess the increased Hb A2 levels and their incidence among schoolchildren in Najran city. SUBJECTS AND METHODS: This study was conducted on 665 male students of Najran primary schools. All students were subjected to a full history taking and laboratory investigations including a complete blood count, peripheral blood smear examination, measurement of serum iron and ferritin levels, reticulocyte count, and alkaline Hb gel electrophoresis. RESULTS: Four (0.60%) students had highly significant (P = 0.000) increased Hb A2 levels above 20%. Three of them descend to the same tribe. Two cases had mild anemia and the other two cases had normal Hb levels. All cases showed microcytosis and hypochromia with normal serum iron and ferritin levels. CONCLUSION: Alkaline Hb electrophoresis showed highly significant increased Hb A2 levels among school children with microcytosis and hypochromia. Further investigations are required to ensure whether this is an increase of Hb A2 or from other Hb variants that take the same window of Hb A2.

Prognostic Value of Hemoglobin in Metastatic Hormone-sensitive Prostate Cancer: A Systematic Review and Meta-analysis.

The purpose of this study was to assess the prognostic value of hemoglobin (Hb) in patients with metastatic hormone-sensitive prostate cancer (HSPC). The PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in December 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared patients with HSPC with normal and low Hb levels to determine their ability to predict overall survival, cancer-specific survival, progression-free survival, and castration-resistant prostate cancer-free survival. Formal meta-analyses were performed for these outcomes. The systematic review identified 25 studies including 6614 patients; 21 studies comprising 5782 patients were eligible for meta-analysis. Low Hb levels were associated with worse overall survival (pooled hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.15-1.29), cancer-specific survival (pooled HR, 1.46; 95% CI, 1.24-1.72), progression-free survival (pooled HR, 1.21; 95% CI, 1.14-1.28), and castration-resistant prostate cancer-free survival (pooled HR, 1.37; 95% CI: 1.18-1.57). Subgroup analyses revealed that low Hb levels were also associated with poor overall survival in patients with both "high-volume" (pooled HR, 1.49; 95% CI, 1.29-1.72) and "low-volume" HSPC (pooled HR, 1.40; 95% CI, 1.13-1.73). This meta-analysis revealed that low Hb serum levels in patients with metastatic HSPC were associated with increased risks of overall mortality, cancer-specific mortality, disease progression, and biochemical recurrence. Furthermore, Hb levels were independently associated with overall survival in the "high-volume" and "low-volume" HSPC subgroups. Therefore, it might be useful to incorporate Hb testing into prognostic tools for metastatic HSPC.

High level of hemoglobin during the first trimester of pregnancy associated with the risk of gestational diabetes mellitus

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.

TO TRACK ADVERSE REACTIONS, EVENTS AND INCIDENCE ASSOCIATED WITH BLOOD AND BLOOD PRODUCT TRANSFUSION

Haemovigilance is defined as a set of surveillance procedures covering whole transfusion chain from the collection of blood and its components to the follow up of its recipients, intended to collect and assess the information. The major aim of this study is to track adverse reactions/ events and incidence associated with blood and blood product transfusion unexpected or undesirable effects resulting from therapeutic of liable blood products. To identify hazards , risks and to provide information as to where the system is breaking down. To analyze any incidents and errors that may impact on the safety of blood products. To promote, enable and maintain a high level of ethical medical and scientific standards in blood transfusion science and medicine. which shows that the transfusion was majorly done in patients between the age group of 20-30 (29.00%) followed by 30-40 years (22.00%). The age group with the least blood transfusion was found as 40-50years (15.00%), 10-20 years (6.00%) and 0-9 years (8.00%). In our study it was observed that the PRBC administration for the patients with normal Hb levels were due to dialysis and anemic conditions. PRBC are administered in surgery cases even if they have Hb levels greater than 10 gm/dl. Pharmacist should involve in the development of local educational and training materials which is required by staff involved in transfusion procedures. Staff training should be maintained and updated with evidence of training and competency documented assessment of training should be undertaken in accordance with local and national guidelies.

The Relationship Of Drinking Tea Behavior With Levels Of Hemoglobin in STIKes Guna Bangsa Yogyakarta Students

Iron has an important role in the body that functions to transport oxygen from the lungs to all body tissues through hemoglobin in the blood. Iron deficiency is one of the factors causing anemia. Anemia can be diagnosed from a level of hemoglobin. If a person's has Hb level is low, it can be said that the person is suffering from anemia. The low Hb level can be influenced by several factors, one of which is the consumption of tea. The content of tannins in tea can reduce iron absorption by the body. This study aims to analyze the relationship between drinking of tea behavior in STIKES Guna Bangsa Yogyakarta students with level of hemoglobin. The method is carried out by direct interviews with 55 samples of female students and level of henoglobin were checked using the Hb meter automatic. The results obtained were that 71% of the samples consumed tea and 29% did not consume tea. 53.85% of the sample who consumed tea had a low Hb level whereas 68.75% of the samples that did not consume tea had normal Hb levels. Data from the results of chi-square analysis obtained a value of p = 0.001 &lt;0.05, which means that there is a relationship between the behavior of tea drinking with hemoglobin levels in STIKES students for Yogyakarta

PB2413 HAEMOGLOBIN AGHIA SOPHIA (HBA1:C.187_189DELGTG) IN NORTHERN GREECE. IMPLICATIONS IN CLINICAL PHENOTYPE OF HBH

Background: Alpha-thalassaemia is inherited as an autosomal recessive disorder characterised by a microcytic hypochromic anaemia, and the clinical phenotype varies from almost asymptomatic to a lethal haemolytic anaemia. It is probably the most common monogenic gene disorder in the world. Several mutations have been described that can affect globin gene expression in any step and many of those mutations are rare causes of alpha thalassaemia. Aims: 28 patients have been diagnosed with Hb H disease (14 males and 14 females) from 1986 to 2019 at the regions of Central and Western Macedonia in Northern Greece with a population of around 2.5 million. The most prevalent genotype was the -α 3.7/—med, (5 cases), 2 cases of –α 3,7/-α5,2, 1 case of –med/αPoly A, 1 case of –α 3,7/Hb Adana and 1 case of Hb Aghia Sophia/--med. The phenotype suggests that HbH disease in Greece has in general a moderate presentation. The molecular characterization of the patients with Hb H disease is useful for the prediction of the clinical outcome and the genetic counselling of the couples at risk. Methods: Hb Aghia Sophia carriers are asymptomatic with normal or nearly normal Hb levels and red cell indices similar to α+ thalassaemia carrier as it was shown in 2 members of a family that this mutation was also detected in our region. Haemoglobin (Hb) Aghia Sophia in interaction with deletional α-thalassaemia mutations leads to HbH. We report a case of Hb Aghia Sophia with co-inheritance with the a-thalassaemia – med deletion, a rare double heterozygosity case. Results: The case presented, concerns a 40 year old woman followed in our Thalassemia Clinic who was diagnosed at the age of 8 with Hb H. At diagnosis, totally incidental findings were compatible with a typical phenotype of Hb H, anaemia being mild and growth not having been impaired. As a girl, she retained a mild hypochromic microcytic anaemia until the age of 10 that a splenectomy was decided due to marked splenomegaly and anemia. During the following years her hemoglobin was maintained around 8gr/dl and she had normal growth. At the age of 35 she had an abortion. She was transfused each month during the next two pregnancies. Lately she was complaining for fatigue and her hemoglobin value was 7gr/dl. The investigation of hemoglobin deterioration did not reveal any significant cause. Bone marrow aspiration showed increased erythroid hyperplasia. Molecular examination revealed Aghia Sophia with co-inheritance with the a-thalassaemia – med deletion. As she denied transfusion, erythropoietin therapy was started with good results maintaining Hb level to 9gr/dl. Additionally, she receives deferasirox due to iron overload. Summary/Conclusion: The co-inheritance of Hb Aghia Sophia with –med, is extremely rare and the severity is due to the interaction of a hyper unstable mutant of the a1 gene with an α0-thal determinant. Hb Aghia Sophia causes instability to the polypeptide chain and is rapidly catabolized. Long follow-up of such rare cases is necessary in order to gain as much information as possible, so as to offer the best management to the patients and the most accurate counseling to their families.

Effect of emodilutional anemia on postoperative cognitive function in patients undergoing cardiopulmonary bypass

Objective To evaluate the effects of hemoglobin(Hb) concentrations during cardiopulmonary bypass (CPB) on postoperative cognitive dysfunction (POCD) in patients. Methods One hundred and eight patients underwent cardiopulmonary bypass were enrolled in this study. According to their Hb concentrations, patients were divided into 3 groups. Patients with normal levels of Hb, 90-110, 60-90 g/L Hb were respectively assigned into groupⅠ, group Ⅱ and group Ⅲ. The patients′ Hb concentration 1 day before the surgery, during cardiopulmonary bypass, 1, 2, 3, 4 and 7 days after the surgery were measured. The cerebral oxygen saturation (rSO2) was also assayed during CPB. The score of the neuropsychological test on the day before surgery and the seventh day after surgery were recorded. Whether Hb concentration and rSO2 levels affect the incidence of postoperative cognitive function was analyzed. Results Among three groups, no significant difference was found in basic and operative information, and the score of the neuropsychological test on one day before surgery(P>0.05). The neuropsychological scores at the seventh day after surgery were lower in group Ⅲ compared with group Ⅰ(P<0.05). The incidence of POCD was higher in group Ⅱ and group Ⅲ than that in group Ⅰ (P<0.05). Compared with group Ⅰ, the rSO2 mean and rSO2 min were lower in group Ⅱ and Ⅲ on the seventh day after surgery(P<0.05). Conclusions Patients with anemia are susceptible to POCD, which might be related to decreased cerebral oxygen saturation. Hb concentration may be an independent risk factor for POCD. Key words: Cerebral oxygen saturation; Hemoglobin; Anemia; Postoperative cognitive dysfunction

Self-assessment

A newborn male baby born at 38 weeks of gestation with a birth weight of 2.80 kg was started on breastfeeds from the first day of life and was discharged home. The antenatal period had been uneventful. The baby had been feeding well but the parents were concerned that he was crying and irritable after the first week. On day 8, he developed seizures and was brought to A&E by ambulance. On examination in the A&E department he had ceased seizing, however he was lethargic, noted to be considerably icteric and had marked abdominal distension. He weighed 2.52 kg at admission. A liver was palpable 5 cm below right costal margin. On initial examination, the paediatrician was unclear if the baby had red reflex in both eyes and had suggested re-checking. Serum sodium was 138 mmol/l, S. Calcium was 2.2 mmol/l, blood glucose was 2.0 mmol/l and ALT was 254 IU/l. Renal functions, blood lipid and urate levels, urine microscopy were all reported normal. Blood gas analysis showed pH: 7.36, PCO2: 5.1 kPa, PO2: 11.0 kPa, HCO3: 21 mmol/l and lactate: 1.9 mmol/l. Full blood count revealed neutrophilic leucocytosis with normal Hb and platelet levels. The baby was commenced on nasogastric feeding and broad spectrum antibiotics. An initial blood culture was reported to have grown Gram negative rods. Lumbar puncture could not be performed but CT head was reported normal.

A Unique Interaction of IVS-I-1 (G>A) (HBA2: c.95+1G>A) with Hb Adana (HBA2: c.179G>A) Presenting as Transfusion-Dependent α-Thalassemia

Nondeletional α-globin mutations are known to cause more serious clinical effects than deletional ones. A rare IVS-I-1 (G>A) (HBA2: c.95+1G>A) donor splice site mutation interferes with normal splicing of pre mRNA and results in activation of a cryptic splice site as well as a frameshift mutation. Hb Adana [HBA2: c.179G>A (or HBA1)] is a highly unstable variant hemoglobin (Hb) resulting from a mutation at codon 59 on the HBA2 or HBA1 gene, recognized to cause severe α-thalassemia (α-thal) syndromes. We report a unique case of compound heterozygosity for these two mutations in a 9-year-old boy who presented with a Hb level of 5.3 g/dL and hepatomegaly at the age of 15 months. He required regular blood transfusions in view of a Hb level of <7.0 g/dL and failure to thrive. He had thalassemic red cell indices and peripheral blood film. The Hb electrophoresis only showed a raised Hb F level (3.3%) and a pre run peak but the Hb H inclusion test was negative. His father had thalassemic red cell indices but a normal Hb level. His mother had almost normal Hb levels and red cell indices. Hb Adana involving the HBA2 gene was detected by mutiplex amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) in the proband and his father. DNA sequencing of the HBA2 gene confirmed the IVS-I-1 mutation in the proband and his mother. This case highlighted the unique interaction of the IVS-I-1 mutation with Hb Adana in a young Malay boy presenting with transfusion-dependent α-thal.

Micronutrient Fortification at Child-Care Centers Reduces Anemia in Young Children

ABSTRACTThe aim of this study was to evaluate the effectiveness of NutriSUS micronutrient fortification, in infants aged 12–36 months, for the prophylaxis and treatment of iron deficiency anemia. In this cluster-randomized clinical trial study, we evaluated infants aged 12–36 months. Length of intervention was 12 weeks. Children were cluster randomized to either NutriSUS micronutrient fortification (Group A) or control (Group B). Primary outcome variables were change in hemoglobin concentration and anemia prevalence. Two biochemical evaluations were performed to determine hemoglobin concentrations: before and after intervention. This study was conducted in eight child-care centers located within the urban perimeter of the municipality of Sobral, Ceará, in the northeast of Brazil. For Group A, baseline mean hemoglobin concentration was 11.4 ± 1.01 g/dL; after intervention it was 11.9 ± 0.90 g/dL (p = .006); 15 of 20 participants who were anemic at baseline had normal Hb levels after intervention. Number needed to treat = 2. In group B, mean baseline hemoglobin was 11.9 ± 0.89 g/dL; after intervention it was 12.2 ± 0.92 g/dL (p = .58); 4 of 5 participants who were anemic at baseline remained anemic after intervention. In our study, NutriSUS micronutrient fortification provided a beneficial effect on Hb values, reducing the prevalence of anemia. However, further studies are necessary to confirm the effectiveness of this intervention in populations on a larger scale.

Analysis of hematological parameters as prognostic markers for toxicity and survival of 223Radium treatment.

223Radium (223Ra) has emerged as treatment prolonging survival in patients with metastatic castration-resistant prostate cancer (CRPC). As 223Ra can cause hematotoxicity (HT), pre-existing hematopoiesis might influence the efficacy of 223Ra and the rate of hematotoxicity, but as to our knowledge such data has not been published yet, we retrospectively conducted an analysis on patients receiving 223Ra.54 patients treated with 223Ra had a median survival of 67 weeks, which was significantly reduced in patients with pre-existing Hb toxicity (Tox) grade 2 (48 weeks P = 0.008) as compared to grade 1 (67 weeks) and normal levels of Hb (not reached); survival in patients with Plt Tox grade 1 was significantly reduced (44 weeks) as compared to normal Plt counts (71 weeks, P = 0.033). Patients with impaired hematopoiesis regarding Hb and Plts developed significantly more grade 3 and 4 HT (Hb < 10 g/dl: 42.9% [3/7] vs 10.6% [5/47], P < 0.001; Plt < 150 G/L: 28.6% [2/7] vs 6.4% [3/47], P = 0.002) and received significantly fewer treatment cycles (Hb <10 g/dl: 5.1 vs 5.8, P = 0.04; Plt < 150 G/L: 3.4 vs 5.6, P < 0.001). These results imply that pre-existing impaired hematopoiesis, in particular thrombocytopenia and anemia, before 223Ra therapy, is an important risk factor for worse outcome of treatment with 223Ra.

Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard-dose, to anemic pregnant women in rural Northern India.

Introduction:To combat anemia among pregnant women, in Haryana, Northern India, administration of intravenous iron sucrose (IVIS) was initiated in 2014 as a public-health measure. We assessed the effect of IVIS on hemoglobin (Hb) levels among the pregnant anemic women.Methods:Pregnant women identified as moderately or severely anemic (Hb <10.0 g/dL) in the second or third trimester during routine antenatal care were prescribed IVIS in a standard-dose of 400 mg given as 100 mg on alternate days. Neither dose calculation, nor allowance for iron-store, was included in this study. We analyzed the data collected between June 2014 and December 2015, at the two primary-health-centers, on Hb level (by HemoCue method) before start of the therapy (baseline), and 4-week or more after the last infusion (endline).Results:A total of 990 women received IVIS. Both baseline and endline Hg-levels were available for 763 (77%), who were included in the analysis. At baseline, the proportion of moderate and severe anemia was 87.94% and 12.06%, respectively. Mean (standard deviation)-Hb increased from 7.85 g/dL (0.80) at baseline, to 9.62 g/dL (1.30) at endline, with a mean increase of 1.76 g/dL (95% confidence interval 1.67, 1.85). The mean increase in Hb-level for pregnant women who had severe and moderate anemia at baseline was 2.54 g/dL and 1.65 g/dL, respectively. Overall, 15.33% of women achieved normal Hb-level by the time of endline measurement. No serious adverse reactions were reported during the observation period.Conclusion:Mean increase in Hb-level was 1.76 mg/dL. Severely anemic pregnant women had larger increase in Hb-level when compared with pregnant women with moderate anemia.

Impact of Knowledge, Attitude and Practice on Iron Deficiency Anaemia Status Among Females of Reproductive Age Group (20-21-year-old) Studying in Government Home Economics College Lahore, Pakistan

Background: Iron deficiency anemia has emerged as a major public health issue in developed and developing countries. According to WHO 29% of all women of reproductive age group are diagnosed to have anemia. Objectives:1) to determine Hemoglobin (Hb) levels among girls 20-21-year-old by Sahli’s method 2) to identify correlation between Hb levels and KAP scores among girls 20-21-year-old. Methods cross sectional study design applied with convenient sampling technique; and sample of 150 girls 20-21 year old was taken. Standardized KAP questionnaire was developed from FAO Guidelines upon iron deficiency anemia, and administered. Hb levels were determined in laboratory by Sahli’s method and classification of anemia was made according to WHO guidelines 2011. Frequency trend of anemia was noted, and Pearson product correlation was applied to Hb levels and KAP scores for risk analysis. Results19.3% had mild, 51.3% had moderate, and 13.3% had severe anemia. Only 16% girls had normal Hb levels. 54% had good knowledge about anemia with Pearson correlation (r) = 0.092, P=0.263. 79% had positive attitude towards self-awareness of anemia as a disease but correlation (r) was found to be in inverse relation (-0.005), P= 0.95. Highly significant positive correlation was found between dietary practices and Hb levels; where 53% had shown desired dietary practices with r= 0.174, P= 0.033. Conclusions: increasing trend of iron deficiency anemia among young girls of reproductive age group was seen; mostly related to life style and behavior towards importance of taking balanced diet. Representative sample study is strongly suggested.

Can Rituximab be Useful for Treating SLE-Associated Immune Cytopenias ? Results from a Retrospective Multicentre Study on 62 Patients

Introduction: Autoimmune cytopenias and mostly immune thrombocytopenia (ITP) are common manifestations of systemic lupus erythematosus (SLE). Rituximab (RTX) is used off-label in many countries for treating primary ITP and warm autoimmune hemolytic anemia (AIHA). In SLE, the place of RTX is controversial and the aim of this study was to assess the efficacy and safety of RTX for treating SLE-associated immune cytopenias.Materials and methods: A multicentre retrospective study was performed throughout the French network of adult’ immune cytopenias. Patients aged >18 years, with a definite diagnosis of SLE according to the usual criteria, treated by RTX from 2005 to 2015 specifically for a SLE-associated immune cytopenia could be included. SLE-associated ITP was defined as platelet count ≤ 50 x 109L after exclusion of any other cause of thrombocytopenia. AIHA was defined by a hemoglobin level (Hb) ≤100 g/l with markers of hemolysis and a positive direct antiglobulin test. To assess treatment efficacy, the following criteria were used: for ITP, complete response (CR) and response (R) were defined according to the consensus international criteria. For AIHA, a CR was defined by a normal Hb level in the absence of recent transfusion and without ongoing haemolysis, and a response (R) by a Hb level ≥100 g/l with an increase of at least 20 g/l from baseline. CR and PR could be retained only for patients who were treated with corticosteroids and/or other immunosuppressive agents at a stable or decreasing dose.Results: Sixty-two patients, 55 women (88.7%), with a median age of 36 years [range 31-49] were included. The median duration of SLE at time of first RTX administration was 6.7 years [3.4-11.4] and the reason for using RTX was ITP in 40 cases (64.5%), AIHA in 15 cases (24.2%) and Evan’s syndrome in 6 cases (9.7%). One patient was treated for a SLE-associated pure red cell aplasia. Other SLE-related manifestations were: articular (54.8%), cutaneous (49.2%), serositis (14.5%), renal (11.1%) and/or neurological (14.5%). Patients had received an average of 3.1 ± 1.3 treatments prior to RTX including steroids (100%), and hydroxychloroquine (90.3%). The overall initial response rate to RTX was 82% (87% for ITP, 86% for AIHA, and 50% for Evan’s syndrome) including 59% CR. Median follow-up after the first injection of RTX was 24.6 months [12.6-61.2]. Twenty-one (41%) of the initial responders relapsed and re-treatment with RTX was successful in 94%. Severe infections occurred after rituximab in three adults with no fatal outcome. No cases of of opportunistic infections of RTX-induced neutropenia were observed.Discussion: RTX appears to be an effective and relatively safe option for the treatment of SLE-associated immune cytopenias. DisclosuresMichel:Roche: Research Funding.

Baseline Hemoglobin Levels Associated with One-Year Mortality in ST-Segment Elevation Myocardial Infarction Patients.

The association between hemoglobin (Hb) levels and mortality in patients with ST-segment elevation myocardial infarction (STEMI) remains controversial. The purpose of this study was to examine the mortality among STEMI patients with anemia or erythrocytosis, and further establish the relationship between mortality and the increment of Hb level. Between 2006 and 2012, 951 consecutive patients with STEMI undergoing primary percutaneous coronary intervention in a medical center in Northern Taiwan were enrolled in our study, including 535 patients with normal Hb level, 148 with anemia (male Hb ≤ 13 g/dl, female ≤ 12) and 268 with erythrocytosis (male Hb ≥ 16, female ≥ 15). Patients in the anemia group were the oldest, and had higher morbidity than the normal Hb group, followed by the erythrocytosis group. In regression analyses, neither anemia nor erythrocytosis was associated with 30-day and 1-year mortality. Each 1-g/dl increment of Hb level was not associated with 30-day mortality both in patients with anemia or erythrocytosis. However, it was associated with a decreased risk of 1-year mortality in anemic patients [hazard ratio (HR): 0.756, 95% confidence interval (CI): 0.608-0.938, p = 0.011] and an increased risk of 1-year mortality in those with erythrocytosis (HR: 2.086, 95%CI: 1.106-3.937, p = 0.023). In multivariate analysis, each 1-g/dl increment of Hb level was associated with 1-year mortality both in anemic patients and those with erythrocytosis (HR: 0.788, 95%CI: 0.621-0.999, p = 0.049; HR: 2.302, 95%CI: 1.051-5.04, p = 0.037). Higher hemoglobin levels in STEMI patients with anemia were associated with decreased risks of 1-year mortality, whereas higher hemoglobin levels in those with erythrocytosis were associated with increased risks of one-year mortality.

Usefulness of Relative Hypochromia in Risk Stratification for Nonanemic Patients With Chronic Heart Failure

The purpose of this study is to investigate the impact of a reduction of hemoglobin (Hb) content in the erythrocytes as estimated by mean corpuscular hemoglobin concentration (MCHC) on long-term clinical outcomes in nonanemic patients with heart failure (HF). We prospectively enrolled 1,579 subjects with HF who underwent coronary angiography enrolled in the GeneBank study with 5-year follow-up of all-cause mortality. Levels of Hb and MCHC were assessed at enrollment and after 6months of follow-up. Anemia was defined as Hb levels <13g/dl in men and <12g/dl in women. In our nonanemic cohort (n=785, 49.7%), mean Hb and median MCHC were 13.8 ± 1.1g/dl and 34.3 g/dL (interquartile range 33.6 to 35), respectively. Nonanemic patients with heart failure with lower MCHC had higher mortality risk (quartiles 1 vs 4, hazard ratio= 2.1, 95% confidence interval 1.4 to 3.3, p= 0.001). In a subset of nonanemic patients with persistent normal Hb on follow-up (n= 206), the mean time between baseline and follow-up MCHC levels was 169.3 ± 41.6days. In comparison with patients with levels of MCHC more than the first quartile (≥33.6g/dl) on baseline and follow-up, patients with persistently low MCHC (<33.6g/dl) had a significantly increased mortality risk (log rank <0.001). All models remained significant even after adjusting for traditional cardiac risk factors, left ventricular ejection fraction, baseline Hb levels, and mean corpuscular volume. In conclusion, relative hypochromia is an independent predictor of increased mortality risk in patients with HF, even in the setting of normal Hb levels.

The prognostic role of pre-cystectomy hemoglobin levels in patients with invasive bladder cancer.

To determine whether pre-treatment hemoglobin (Hb) levels in patients with bladder cancer impact on oncological outcomes after radical cystectomy (RC). A consecutive, contemporary series of 246 patients undergoing RC and pelvic lymph node dissection for bladder cancer. Decreased Hb level was defined as ≤12g/dL. The Kaplan-Meier method was used to estimate recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). The Fisher exact/Chi-square test was used to investigate differences between both groups. Uni- and multivariable Cox regression analysis addressed risk factors for recurrence, cancer-specific death and overall death. The median follow-up was 30months (2-116). Of the 246 patients, 182 (74%) had normal (>12g/dL) and 64 decreased (≤12g/dL) preoperative Hb (26%). In univariable analysis, decreased Hb was associated with increased age, extravesical disease, hydronephrosis (all p<0.001), node-positive disease and positive resection margins (both p=0.01). Subanalyzed for patients with organ-confined disease (defined as ≤pT2bN0R0; N=109), the 3-year RFS, CSS and OS was significantly lower in patients with decreased (34.9, 35.5 and 19.8%) compared to normal Hb level (69.7, 86.3 and 77.6%; p=0.01/p=0.002/p<0.001). In multivariable analysis, RFS, CSS and OS were significantly lower in patients with decreased Hb (p=0.007, p=0.001 and p=0.002), pathologically locally advanced tumor (≥pT3a; p=0.023, p=0.036 and p=0.065) and nodal stage (p<0.001, p=0.006 and p=0.001) and positive soft tissue surgical margins (p=0.040, p=0.004 and 0.012). Pre-cystectomy Hb levels are associated with adverse histopathologic characteristics and provide additional prognostic information especially for patients with pathologically localized bladder cancer.

24 Anaemia in heart failure unit St. Michaels hospital dun laoghaire

Background Iron deficiency anaemia is a frequent finding in adults with heart failure (HF). The prevalence varying depending upon the population studied. 1,2 The recent FAIR-HF trial, demonstrates the importance of iron metabolism in patients with HF. 3 Moreover, that a work-up evaluation for absolute or functional iron deficiency should be considered, and implementation of IV iron replacement for symptomatic improvement. In this audit we wish to evaluate the prevalence of anaemia and iron deficiency in our unit Method This was a prospective single centre audit between 21 October and 18 November 2014. The cycle was repeated between 26 March and 26 April 2015. The audit standard was the WHO definition of anaemia. Results Part 1: Demographics During cycle 1 Population: 86 patients were worked up for anaemia and iron deficiency. The average follow up time in Heart Failure Unit was 19.6 months There were more males than females in our population. Only one female patient is still menstruating. 74% of our population are HfREF (n = 64) versus 26% HfPEF (n = 22). During cycle 2 Population: 56 patients were worked up for anaemia and iron deficiency. The average follow up time in Heart Failure Unit was 20.4 months. There were more males than females in our population. 57% of our population are HfREF (n = 31) versus 43% HfPEF (n = 23). Part 2: Prevalence and incidence The prevalence of anaemia in our cohort was 48% during cycle 1 and 64.8% during cycle 2. Previous studies have found that the incidence of anaemia appears to increase with worsening functional class (from 9% for NYHA class I to 79% for class IV in one report). 4,5 We found no association between the incidence of anaemia for NYHA, BNP or EF in our cohort. Part 3: Haematinic Screen Haematinic screens were not routinely ordered on all anaemic patients during cycle 1. No haematinic screen was found for 15 anaemic patients, an incomplete screen was carried out on 9 anaemic patients and a complete anaemic screen on 17 patient. A complete haematinic screen was carried out on 8 patients with normal Hb levels. Iron deficency was detected in 17 patients. Five patient with iron deficency were noted to have a normal Hb level. During cycle 2 and implementation of a routine strategy of a haematinic screening at initial programme visit or at annual review, if no such screen were on record, all patients had a haematinic screen. Summary Iron deficiency management is not incorporated in the current ESC HF guidelines. 6 However, recent studies have raised interest in the importance in symptomatic and QUAL in of HfREF patients, and experts anticipate it’s inclusion in future guidelines. Further given that there are few treatment strategies for HfPEF patients, management of iron deficiency in this cohort would be an area of interest to access any symptomatic and other clinical benefit. In this audit we successfully implemented a strategy of routine screening for iron deficiency, to capture all patients in both HfREF and HfPEF patients. Importantly, at present our cohort our stable from a heart failure perspective. In future direction and management of these patients we aim to implement a strategy of IV iron replacement based on recent FAIR-HF and CONFIRM-HF studies. 3,7 References De Silva R, Rigby AS, Witte KK, et al . Anemia, renal dysfunction, and their interaction in patients with chronic heart failure. Am J Cardiol. 2006; 98 :391–398 Westenbrink BD, Visser FW, Voors AA, et al . Anaemia in chronic heart failure is not only related to impaired renal perfusion and blunted erythropoietin production, but to fluid retention as well. Eur Heart J. 2007; 28 :166–171 Anker SD, Comin Colet J, Filippatos G, et al . Rationale and design of Ferinject assessment in patients with iron deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia. Eur J Heart Fail . 2009; 11 :1084–1091 Silverberg DS, Wexler D, Sheps D, et al . The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study. J Am Coll Cardiol . 2001; 37 :1775–1780 Van der Meer P, Groenveld HF, Januzzi JL Jr, et al . Erythropoietin treatment in patients with chronic heart failure: a meta-analysis. Heart 2009; 95 :1309–1314 McMurray J, Adamopoulos S, Anker S, et al . ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J . 2012; 33 :1787–1847 Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al . Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J . 2015; 36 (11):657–68

Relationship of differences in immunoglobulin heavy/light chain pairs (Hevylite), selected laboratory parameters and stratification systems in different immunochemical types of multiple myeloma.

Advances in the diagnosis and treatment of multiple myeloma (MM), place increasing demands on accurate stratification of patients as the starting point for optimal individualized therapy. The present study focused on assessing the association between HLC levels and the HLC-r to parameters of MM activity, prognosis and tumor mass volume.The objective was to assess the correlation of immunoglobulin (Ig), heavy/light chain (HLC) pairs (IgG-κ and-λ, IgA-κ and -λ HLC) and the ratio of monoclonal involved-HLC (i-HLC) to polyclonal uninvolved (u-HLC) Ig concentrations assessed by the Hevylite(TM) method with the free light chain κ/λ ratio (FLC-r), selected prognostic laboratory parameters i.e. Hb, platelets, albumin, β2-microglobulin (β2-M), Ca, lactate dehydrogenase (LDH), creatinine and the Durie-Salmon (D-S) and International Staging System (ISS), stages (1-3) for MM. Hevylite assays were done on the sera of 132 MM patients at the time of diagnosis (IgG 94, IgA 38). HLC-r was calculated in the case of i-HLC-κ from the i-HLC-κ/u-HLC-λ ratio and for i-HLC-λ from the i-HLC-λ/u-HLC-κ ratio. D-S and ISS stages were evenly distributed. Md IgG-κ HLC-r was 64.8 (2.7-2222) and of IgG-λ HLC-r 49.6 (0.7-465.1), in the case of IgA-κ, Md HLC-r was 408.9 (3.4-3966) and for IgA-λ HLC-r the Md was 180.0 (0.1-3110). Normal levels of HLC pairs and HLC-r did not always rule out the diagnosis of MM. HLC-r correlated with FLC-r in IgG (r = 0.244, P = 0.018), but not in the IgA type. For IgG, HLC-r values were significantly different in patients with abnormal vs normal levels of Hb (P < 0.0001), albumin (P < 0.043), β2-M (P < 0.0001) and creatinine (P = 0.034) but not thrombocyte count, Ca or LDH. For the IgA isotype, we found a significant difference in HLC-r values only for thrombocyte count (P = 0.026) and β2-M (P = 0.016) but not for Hb, albumin, Ca, LDH or creatinine. For the IgG isotype there was a significant relationship of HLC-r index to stages 1-3 (P = 0.038) and substage A vs B (P = 0.048) according to D-S, and with high significance to stages 1-3 according to ISS (P = 0.005) and between stages 1 vs 3 (P = 0.001). For the IgA isotype, we found significant differences in HLC-r only between stages 1-3 (P = 0.025) according to D-S but not in the case of ISS. There were no significant correlations between i-HLC Ig levels and D-S or ISS stages in both IgG-κ and λ and IgA-κ and λ. Exceptions were significant differences for stages 1 vs 3 (P = 0.012) and 2 vs 3 (P = 0.017) for the IgG-λ isotype. There were no correlations of the HLC-r and u-HLC levels for either D-S or ISS stratifications in all HLC isotypes. We found a significant positive contribution of HLC-r using the i-HLC/u-HLC ratio even in the case of i-HLC-λ i.e. i-HLC-λ/u-HLC-κ. Variable results for the relationship of important laboratory parameters and D-S and ISS stratifications (stage 1-3) to HLC-r values in IgG and IgA isotypes make separate interpretation of the Hevylite method results necessary in clinical practice.