Normal Hematocrit Research Articles

Association between Hematocrit and Acute Kidney Injury in Patients with Acute Myocardial Infarction.

Hematocrit is found an independent risk factor for acute kidney injury (AKI) in certain patients, but this effect in patients with acute myocardial infarction (AMI) is unclear. We aim to identify the relationship between hematocrit and AKI in patients with AMI. The patient data for the discovery and validation cohorts were extracted from the electronic Intensive Care Unit database and the Medical Information Mart for Intensive Care III database, respectively, to identify the relationship between hematocrit and AKI. With normal hematocrit as the reference, patients were divided into five groups based on the initial hematocrit value. The primary outcome was AKI during hospitalization. A multivariable logistic regression and a marginal effect analysis were used to evaluate the relationship between hematocrit and AKI. In this study, a total of 9692 patients diagnosed with AMI were included, with 7712 patients in the discovery cohort and 1980 patients in the validation cohort. In the discovery cohort, hematocrit in 30-33%, 27-30% or 27% were independent risk factors for AKI in the multivariate logistic analysis, with odds ratio (OR) of 1.774 (95% confidence interval [CI]: 1.203-2.617, p = 0.004), 1.834 (95% CI: 1.136-2.961, p = 0.013) and 2.577 (95% CI: 1.510-4.397, p 0.001), respectively. Additionally, in the validation cohort, low hematocrit levels independently contributed to an increased risk of AKI among patients with AMI. During the analysis of marginal effects, a significant negative linear relationship between hematocrit levels and AKI was observed. Decreased hematocrit was an independent risk factor for AKI in patients with AMI. The relationship between hematocrit and AKI was negative linear.

The Effect of Repeated Blood Harvesting from Pregnant Mares on Haematological Variables.

Studies have been carried out on the effect of large-volume blood harvesting from horses, but they were performed on nonpregnant horses of various breeds other than Icelandic horses. This study aimed to investigate the effect on the haematological variables indicating erythropoiesis of repeated blood harvesting from pregnant mares. To account for regional variation, two herds of mares were chosen, both kept under free-range conditions. Sequential EDTA blood samples were collected weekly from 160 mares and analysed for haematological variables in an automated analyser. Serum samples from 115 mares were analysed for total protein. In both herds, after three harvests, mares began to measure below the minimum value for erythrocyte numbers, and mild anaemia was present in up to 37% at one time. Mares in only one herd had moderate or marked anaemia, 14.3% of the herd. Both herds showed evidence of increased erythropoiesis, but there was a difference between the herds in the intensity of the response. In both herds, however, all mares had reached the minimum normal haematocrit value three weeks after the last harvest. It is important to investigate the causes for the differences between these herds, which might be addressed to reduce the risk of anaemia.

Magnitude of meconium stained amniotic fluid and associated factors among women who gave birth in North Shoa Zone hospitals, Amhara Region, Ethiopia 2022.

The presence of meconium-stained amniotic fluid is one of the causes for birth asphyxia. Each year, over five million neonatal deaths occur worldwide because of meconium-stained amniotic fluid and other causes, of which 90% are due to birth asphyxia. The aim of this study was to assess the magnitude of meconium-stained amniotic fluid and associated factors among women who gave birth in North Shoa Zone Hospitals, Amhara Region, Ethiopia, 2022. An institutional-based cross-sectional study was employed. We used 610 women who gave birth at North Shoa Zone Hospitals, Amhara region, Ethiopia. The study was conducted from June 8 to August 8, 2022. Recruitment for the study was made using a multistage sampling procedure. Fifty percent of the study hospitals were randomly selected, and proportional allocation was done. Participants were selected from the sampling frame, labour and delivery register book, using a systematic random sampling approach. The first person was selected at random, while the remaining individuals were selected at every two "K" intervals across all hospitals. An interview-administered structured questionnaire and chart review checklist were used to gather the data that were entered into Epi-Data Version 4.6 and exported to SPSS. Logistics regression was employed, and a p-value <0.05 was considered statistically significant. The magnitude of meconium-stained amniotic fluid was 30.3%. Women with a normal hematocrit level were 83% less likely to develop meconium-stained amniotic fluid. Women whose mid-upper arm circumference value was less than 22.9cm (AOR = 1.9; 95% CI: 1.18-3.20), obstructed labour (AOR = 3.6; 95% CI: 1.48-8.83), prolonged labour ≥ 15 hr (AOR = 7.5; 95% CI: 7.68-13.3), premature rapture of membrane (AOR = 1.7; 95% CI: 3.22-7.40), foetal tachycardia (AOR = 6.2; 95% CI: 2.41-16.3), and Bradycardia (AOR = 3.1; 95% CI: 1.93-5.28) showed a significant association with meconium-stained amniotic fluid. The present study revealed that the magnitude of meconium-stained amniotic fluid in North Shoa Zone is nearly one-third. A normal hematocrit level is a preventive factor for meconium-stained amniotic fluid, and a MUAC value <22.9 cm, obstructed and prolonged labour, PROM, bradycardia, and tachycardia are factors associated with meconium-stained amniotic fluid.

Optimizing the initial tacrolimus dosage in Chinese children with lung transplantation within normal hematocrit levels.

The appropriate initial dosage of tacrolimus is undefined in Chinese pediatric lung transplant patients with normal hematocrit values. The purpose of this study is to optimize the initial dose of tacrolimus in Chinese children who are undergoing lung transplantation and have normal hematocrit levels. The present study is based on a published population pharmacokinetic model of tacrolimus in lung transplant patients and uses the Monte Carlo simulation to optimize the initial tacrolimus dosage in Chinese children with lung transplantation within normal hematocrit levels. Within normal hematocrit levels, for children with lung transplantation who do not carry the CYP3A5*1 gene and have no coadministration with voriconazole, it is recommended to administer tacrolimus at a dosage of 0.02 mg/kg/day, divided into two doses, for children weighing 10-32 kg, and a dosage of 0.03 mg/kg/day, also divided into two doses, for children weighing 32-40 kg. For children with lung transplantation who carry the CYP3A5*1 gene and have no coadministration with voriconazole, tacrolimus dosages of 0.02, 0.03, and 0.04 mg/kg/day split into two doses are recommended for children weighing 10-15, 15-32, and 32-40 kg, respectively. For children with lung transplantation who do not carry the CYP3A5*1 gene and have coadministration with voriconazole, tacrolimus dosages of 0.01 and 0.02 mg/kg/day split into two doses are recommended for children weighing 10-17 and 17-40 kg, respectively. For children with lung transplantation who carry the CYP3A5*1 gene and have coadministration with voriconazole, a tacrolimus dosage of 0.02 mg/kg/day split into two doses is recommended for children weighing 10-40 kg. It is the first time to optimize the initial dosage of tacrolimus in Chinese children undergoing lung transplantation within normal hematocrit.

Effect of Beta Thalassemia Trait in Pregnancy

A cross-sectional, observational study was conducted to determine the effects of beta thalassemia trait in pregnancy. A total of 150 pregnant women diagnosed with beta thalassemia trait in Bangladesh Navy Ship (BNS) Patenga Hospital, at Chattogram, Bangladesh, having regular antenatal care and delivery, between January and December of 2022, were included in the study. Thalassemia status was diagnosed by Hb-electrophoresis. Most of the patients belonged to the age group 19-35 years. 30.46% of women had normal hematocrit level. During pregnancy women suffered from severe anemia (14%) and mild anemia (55.33%) (P&lt;0.001). Blood transfusion needed during 1st trimester (1.3%), 2nd trimester (4.6%), 3rd trimester (8%) and at postpartum period (9.3%) (P&gt;0.05). Most of the women (76.66%) delivered babies at her 36-39 weeks of gestational age,18.67% delivered at or after 40 weeks of gestation and 4.67% delivered baby before 36 weeks (P&lt;0.05). 66.67% had normal vaginal delivery, while 33.33% underwent Caesarean section operation due to several complications. Observed obstetric complications were: pregnancy induced hypertension (6.6%), gestational diabetes (4%), oligohydramnios (11.33%, premature rupture membrane (3.3%), preterm labor (8.66%), and placental abruption (1.33%). Adverse fetal outcomes observed were: prematurity (4.6%), intrauterine growth retardation (5.33%), still birth (0.6%), and fetal asphyxia (3.33%). Neonatal admission at NICU was needed in 2(1.33%) cases. CBMJ 2024 January: vol. 13 no. 01 P: 77-82

Organogermanium, Ge-132, promotes the clearance of senescent red blood cells via macrophage-mediated phagocyte activation

Red blood cells (RBCs) are renewed in a cyclic manner. Aging RBCs are captured and degraded by phagocytic cells, and heme metabolic pigments are subsequently excreted in feces. We evaluated the effect of an organogermanium compound on RBC metabolism and found that the phagocytosis of RAW264.7 macrophage-like cells was increased by treatment with 3-(trihydroxygermyl)propanoic acid (THGP). Additionally, consumption of Ge-132 (a dehydrate polymer of THGP) changed the fecal color to bright yellow and increased the erythrocyte metabolic pigment levels and antioxidant activity in feces. These data suggest that Ge-132 may activate macrophages in the body and promote the degradation of aged RBCs. Furthermore, Ge-132 intake promoted not only increases in RBC degradation but also the induction of erythroblast differentiation in bone marrow cells. The normal hematocrit levels were maintained due to the maintenance of homeostasis, even though Ge-132 ingestion increased erythrocyte degradation. Therefore, Ge-132 enhances the degradation of senescent RBCs by macrophages. In turn, RBC production is increased to compensate for the amount of degradation, and RBC metabolism is increased.

Atg4a Promotes Mitochondrial Quality Control and Hemoglobin Production In Vivo

Mitochondrial quality control is essential for maintaining cellular homeostasis and contributes to the regenerative capacity of hematopoietic stem cells and the differentiation of lineage-committed progeny. During red blood cell (RBC) production, mitochondria contribute to the production of hemoglobin and are the site for heme synthesis. Mitochondrial dysfunction is found in patients with mtDNA mutations, sickle cell disease, and myelodysplastic syndromes; therefore, it is critical to delineate the molecular mediators of mitochondrial quality control during erythropoiesis. While it is established that autophagy contributes to mitochondrial clearance during reticulocyte maturation, less is known about the regulation of mitochondrial quality control in erythroid progenitors. Our previous study identified an erythroid-specific role for the autophagy-related protease ATG4A in human erythropoiesis (Stolla MC et al., Blood Advances, 2022). To better understand the contribution of Atg4a-dependent autophagy to erythropoiesis in vivo, we have developed a new genetically modified mouse model . To evaluate the role of Atg4a in vivo, we disrupted the expression of Atg4a by targeting exons 5/6 using CRISPR/Cas9 in C57/BL6 embryos. Analysis of the peripheral blood of adult Atg4a-/- (KO) and Atg4a+/+ (WT) mice revealed a normal hematocrit (47.5% WT vs. 47% KO), but elevated numbers of red blood cells (10.7 M/μL WT vs. 11.2 M/μL KO, p=0.012) and a compensatory 5.8 % decrease in RBC volume (MCV: 44.3 fl WT vs. 41.7 fl KO, p=0.0004). Consistent with a reduction in RBC size, we observed a modest reduction in total hemoglobin (16.8 g/dl WT vs. 16.0 g/dl KO, p=0.054) and a profound decrease in the mean corpuscular hemoglobin concentration (MCHC: 35.39 g/dl WT vs. 34.17 g/dl KO, p=0.038) in Atg4a -/- (KO) mice. To determine if Atg4a-/- mice are iron deficient, we evaluated iron parameters in peripheral blood. While Atg4a-/- mice had slightly lower values of serum iron (152 μg/dl WT vs. 128.7 μg/dl KO, p=0.21) and total-iron binding capacity (511 μg/dl WT vs. 456 μg/dl KO, p=0.04) they had comparable levels of transferrin saturation (29.9% WT vs. 28.1% KO, p=0.65). Furthermore, we found similar amounts of EPO in the serum of Atg4a-/- and Atg4a+/+ mice (314 pg/ml WT vs. 345 pg/ml KO, p=0.78). Thus, loss of Atg4a leads to a reduction in hemoglobin production and RBC size without overt iron deficiency. To determine if alterations in erythroid maturation contributed to the decrease in MCV and MCHC, we used flow cytometry to quantify bone marrow erythroid progenitors (I), basophilic erythroblasts (II), polychromatic and orthochromatic erythroblasts (III), and reticulocytes (IV) using CD44, Ter119, CD71, and lineage markers (CD11b, B220, Gr-1) in Atg4a-/- mice. Similar numbers of erythroid populations (I-IV) were observed in the bone marrow and spleen of Atg4a-/- and Atg4a+/+ mice suggesting that erythroid maturation was not significantly altered in vivo. Since Atg4a is known to facilitate mitochondrial clearance during human erythropoiesis, we next evaluated mitochondrial dynamics in murine erythroid populations I-IV using dyes for active (TMRM) and total mitochondria (Mitotracker Green, MTG). Compared to Atg4a+/+ mice, Atg4a-/- mice had increased MTG fluorescence in erythroid populations I and II and a 25% decrease in TMRM fluorescence. Therefore, loss of Atg4a significantly reduces the ratio of active-to-total mitochondria in erythroid progenitors and basophilic erythroblasts, indicating that elimination of inactive mitochondria promotes mitochondrial function early in erythropoiesis. Since mitochondria are the site for heme synthesis, we sorted erythroid populations from Atg4a-/- and Atg4a+/+ mice and measured total heme content. While in Atg4a +/+ mice heme content increased by 3-fold between erythroid populations III and IV, heme content did not increase between erythroid populations III and IV from Atg4a-/- mice resulting in significantly reduced heme content in reticulocytes. Our study highlights an important protective role for autophagy in erythropoiesis where it mediates the elimination of dysfunctional mitochondria. Loss of mitochondrial quality control restricts heme production reducing the hemoglobin concentration of circulating RBCs. Further investigation will determine if the absence of Atg4a compromises the response to stress erythropoiesis.

Clinical case analysis of 32 children aged 0-6 years with lead poisoning in Nanning, China.

Lead is one of the heavy metals that is toxic and widely distributed in the environment, and children are more sensitive to the toxic effects of lead because the blood-brain barrier and immune system are not yet well developed. The objective of the study was to investigate the clinical characteristics of lead poisoning in children aged 0∼6 years in a hospital in Guangxi, and to provide scientific basis for the prevention and treatment of lead poisoning. We collected and analyzed the clinical data of 32 children with lead poisoning admitted to a hospital in Guangxi from 2010 to 2018. The results showed that most of the 32 cases presented with hyperactivity, irritability, poor appetite, abdominal pain, diarrhea, or constipation. The hemoglobin (HGB), mean corpusular volume (MCV), mean corpuscular hemoglobin (MCH), and hematocrit (HCT) of the lead-poisoned children were all decreased to different degrees and were below normal acceptable levels. Urinary β2-microglobulin was increased. Blood lead levels (BLL) decreased significantly after intravenous injection of the lead chelator, calcium disodium edetate (CaNa2-EDTA). In addition, HGB returned to normal levels, while MCV, MCH, and HCT increased but remained below normal levels. Urinary β2-microglobulin was reduced to normal levels. Therefore, in this cohort of children, the high-risk factors for lead poisoning are mainly Chinese medicines, such as baby powder. In conclusion, lead poisoning caused neurological damage and behavioral changes in children and decreased erythrocyte parameters, leading to digestive symptoms and renal impairment, which can be attenuated by CaNa2-EDTA treatment.

Inhibition of PAK1 generates an ameliorative effect on MPLW515L mouse model of myeloproliferative neoplasms by regulating the differentiation and survival of megakaryocytes

Most thrombopoietin receptor (MPL) mutations result in abnormal megakaryocyte expansion in the spleen or bone marrow (BM), leading to progressive fibrosis. It has been reported that p21 (RAC1)-activated kinase 1 (PAK1) participates in the proliferation and differentiation of megakaryoblast, PAK1 phosphorylation was found to be increased in patients with myeloproliferative neoplasm (MPNs) and murine MPN cells with the MPLW515L mutant gene in the present study; however, the function of the over activated PAK1 in MPN cells remains unclear. We found that inhibition of PAK1 caused significant changes in the biological behaviors of MPLW515L mutant cells in vitro, including arrested growth or reduced clonality as well as increased polyploid DNA and cells apoptosis due to upregulated cleaved caspase 3. In vivo, PAK1 inhibitor treatment caused a slow elevation of leukocytosis and hematocrit (HCT) and reduction in hepatosplenomegaly in 6133/MPLW515L transplanted mice, along with reduced tumor cell infiltration and prolonged survival. Further deletion of PAK1 sustained a relatively normal HCT and platelet count at the beginning of disease but did not completely alleviate the splenomegaly of MPLW515L mutant mice. Notably, PAK1 knockout attenuated the destruction of splenic structure, and reduced the megakaryocyte burden within the BM. These results suggest that the inhibition of PAK1 may be a considerable method treatingMPLW515L mutant MPN by intervening megakaryocytes.

Contemporary Practice of Anemia Treatment Among Dialysis Patients in the United States

The treatment of anemia is a major activity in the care of patients undergoing maintenance hemodialysis (HD). The comparative effectiveness of new pharmacologic treatments, relative to erythropoiesis-stimulating agents (ESAs), should be anticipated on the bases of controlled trials and current practice. We describe the contemporary practice of anemia treatment in a national cohort of patients undergoing maintenance HD. We analyzed the United States Renal Data System (USRDS) data to identify adult patients undergoing in-facility HD in 2016 to 2019. Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb) dataset, we identified hemoglobin and ESA utilization (agent and cumulative dose) during each patient-month, as well as intravenous (IV) iron utilization, ferritin, and transferrin saturation. We compared ESA dosing during the study era to dosing in the Normal Hematocrit Cardiac Trial (NHCT), conducted in the 1990s. We assessed ESA hyporesponsiveness by estimating the prevalence of the following: (i) high erythropoietin resistance index (ERI) and (ii) either 3 or 6 consecutive months with hemoglobin<10 g/dl. Nearly two-thirds of patient-months had hemoglobin of 10.0 to 11.9 g/dl. Mean ESA utilization was 76.7% per month, with increasing use of pegylated epoetin beta. ESA dosing was stable; epoetin alfa dosing was slightly lower than in the low-target arm of the NHCT. The prevalence of ESA hyporesponsiveness was 22.2% if defined by high ERI, but only 2.1% to 6.0% if defined by 3 to 6 consecutive months with hemoglobin<10 g/dl. Median transferrin saturation was 22.3% with high ERI and persistently low hemoglobin. Hemoglobin and ESA dosing distributions are stable, with epoetin alfa dosing below the low-target arm of the NHCT. Persistently low hemoglobin occurs infrequently and may reflect iron depletion.

Clinical findings, treatment and outcome in cats diagnosed with precursor-targeted immune-mediated anaemia in a referral hospital in the UK: 30 cases (2010-2021).

This retrospective study aimed to report clinical findings, treatment response and survival in cats diagnosed with precursor-targeted immune-mediated anaemia (PIMA) in a referral hospital in the UK. Feline cases diagnosed with presumed PIMA between January 2010 and February 2021 were retrospectively recruited. Signalment, clinical signs, diagnostic tests, treatment and outcome were recorded. Descriptive analytics were performed. Outcomes were documented according to survival to discharge, 30-day survival, total survival time, response to immunosuppressive treatment and frequency of relapses. Thirty cats met the inclusion criteria. A higher prevalence of females (19/30) was identified (p = 0.001). Most cats (25/30) presented with haematocrit below 0.15 L/L. Concurrent cytopenias occurred in 18 of 30 cats. Bone marrow diagnosis was erythroid hyperplasia in 24 of 30 cases. Survival to discharge was documented in 26 of 30 cats, of which 23 survived more than 30 days since diagnosis. Initial treatment included blood products (26/30) and prednisolone (26/30) or prednisolone with ciclosporin (3/30); 18 of 30 cats responded to treatment, with a normal haematocrit at a mean of 28 days. The initial haematocrit and the presence of concurrent cytopenia were not statistically different between responders and non-responders. The median survival time was 140 days (range 1-3930 days). The treatment response rate of feline PIMA was high (60%), with a mortality rate of 23% over the 30 days following diagnosis. Relapses occur frequently (77%) but the response rate after treatment modification was high (76%) and therefore ongoing treatment may be justified at that point. Long survival times (up to 3930 days) can be achieved.

Clinical analyzes and theoretical calculations of the characteristics of blood cells in patients with lymphoblastic leukemia

Lymphoblastic leukemia is one of the serious diseases of the hematopoietic system, which requires long-term treatment, but despite this, it often leads to disability and mortal-ity. In this regard, all the still unexplored relationships between blood elements and their motor ability, which can be described by the rheological properties of blood, are of inter-est. For a better understanding of the relationship between morphometric features and the rheological properties of blood, we compiled a research algorithm, the purpose of which was to study the rheological parameters of the blood system using clinical tests and in silico calculations against the background of the clinical picture of the number and size of formed elements, lymphocytic formula of patients with lymphoblastic leuke-mia. In the group of patients with leukoblastic leukemia, the number of neutrophils was reduced by 38% compared with the control. Other types did not change significantly. Thrombocytopenia, a decrease in hemoglobin concentration and hematocrit were ob-served, however, the number of erythrocytes corresponded to the values in the control. The dynamics of the size of erythrocytes is an indicator of the lability of the blood sys-tem. Under conditions of development of leukemic processes, the proportion of young erythroid forms is negligible. The development of lymphoblastic leukemia was accompa-nied by thrombocytopenia, a decrease in hemoglobin concentration and hematocrit, however, the number of erythrocytes corresponded to the values in the control. Studies have revealed changes in the geometric characteristics of erythrocytes in patients with leukemia. The increase in overall dimensions (diameter and height) of erythrocytes in patients with patients with leukoblastic leukemia varied by 15–20 % compared with the control. The rheological parameters were changed significantly. According to our data, the violation of blood flow occurs due to changes in erythrocyte aggregation, deformabil-ity of the erythrocyte membrane, plasma viscosity with an unchanged number of erythro-cytes, i.e. with normal hematocrit. These data are especially interesting from the point of view of rheology and clinic of leukemias.

ANALYSIS OF FASTING ON BLOOD TESTS

As a procedure to obtain information with bodily fluid samples, a laboratory test is complementary to a diagnostic assessment. One parameter of laboratory tests is hematology, for which a blood profile is used to evaluate clinical conditions and provide diagnostic information about hematological abnormalities, prognosis, and response treatment. Nowadays, accessibility to laboratory tests has been made easier with medical checkups integrated into the Occupational Health and Safety program, which a company is obliged to have to check on its employees’ health status. Our study analyzed the results of fasting blood tests on the employees of The College of Health Sciences of Al-Irsyad Al-Islamiyyah Cilacap. This College is known for the practice of Islamic and religious values, including fasting, among its employees. Taking the employees as a population and samples, the research included variables of levels of erythrocytes, leukocytes, hemoglobin, and hematocrit in the descriptive analysis method. We gained eleven respondents, 8 males, and 3 females, and used a cluster sampling method with appropriate criteria. The data of obtained samples were analyzed and processed based on the interpretation of the results. The results of routine blood examinations on fasting showed 90.90% normal hemoglobin levels and 72.70% normal hematocrit levels. Conclusively, our results of the blood profile examination on hemoglobin and hematocrit in fasting people showed that fasting is metabolically healthy and produces no indication of anemia.

Previously Undiagnosed Anemia and Iron Deficiency Anemia among Preschool Children at Taif City

Introduction: In the Arab Gulf countries, anemia, including iron deficiency anemia )IDA(, considered one of the main public health problems. Although, the World Health Organization reported that IDA as the most common type of anemia, which made up half of all anemic cases all over the world, there were limited research performed among preschool children about anemia in Saudi Arabia. Thus, the aim of this study was to investigate the prevalence of previously undiagnosed anemia and IDA among children between 2 to 6 years old. In this study, several risk factors that might contribute to the high prevalence of anemia were assessed. Methods: The study was carried out in Taif city during the period from January 2023 to April 2023. Blood samples were collected from 200 preschool children and analyzed for hematological parameters as well as related biochemistry tests to investigate the prevalence of previously undiagnosed anemia and IDA. Results: The majority of the study participants were Saudi 99% and aged 4 to 6 years 72.5%. Most of children participants, 92.5% had normal haemoglobin (Hb) concentration and normal levels of red blood cells (RBCs) and normal hematocrit indicating their non-anemia health status. In this study, previously undiagnosed anemia were reported within 6% of children indicated by low Hb concentration, low RBC count and abnormal low hematocrit level. Out of these undiagnosed anemic children, there were 25% diagnosed with IDA. Conclusions: Since, anemia and IDA are still a public health problem among preschool children in Saudi Arabia this study suggested that the hematological blood examination should be done to students as a requirement before school which may reveal the presence of previously undiagnosed anemia and might associated with low mantle and functional performance among children. Moreover, further studies are recommended at all regions of the Kingdome to investigate the underlying related risk factors, which will provide more insight ....

Physiological Responses of Anemic Women to Exercise under Hypoxic Conditions

When combining two conditions of reduced oxygen availability, anemia and hypoxia, human physiological responses are highly challenged to maintain arterial oxygen delivery, especially during whole-body exercise. The aim of this study was to compare the cardiorespiratory responses of mildly anemic women with those of healthy controls, while cycling in normobaric hypoxia. Two groups of young females were matched for age, weight, height, and involvement in physical activity, one with normal hemoglobin, hematocrit, and ferritin levels and another suffering from mild iron deficiency anemia (10 &lt; (Hb) &lt; 12 g/dL, 34 &lt; Hct &lt; 37%, ferritin &lt; 15 μg/L). They cycled to exhaustion under normoxia and hypoxia (FIO2 0.21 and 0.14), and their physiological responses were compared at 40, 80, and 100% VO2max of the specific condition. The two groups differed (p &lt; 0.05) mainly at the higher exercise intensities; the anemic participants exhibited similar heart rate but lower oxygen pulse than their control counterparts, as well as a larger drop in maximal oxygen uptake. However, they sustained maximal effort by employing the anaerobic metabolism to a larger extent, which stimulated a greater ventilatory response. It appears that iron deficiency anemia of mild severity, which is commonly observed in young athletic females, impacts physiological responses during whole-body exercise in the presence of moderate hypoxia.

Teaching Video NeuroImages: A treatable rare cause of chorea

A 72-year-old woman developed progressive choreic movements involving the right hemibody and the orofacial muscles (video 1). Her examination was otherwise unremarkable, without ataxia. Brain MRI, blood glucose, thyroid function, and rheumatologic panel were unremarkable. Genetic testing for Huntington disease and C9orf72 expansions were negative. Initial hematocrit and hemoglobin levels were normal, but increased to abnormal values (56% and 18.5 g/dL) 1 year after chorea onset. The JAK2V617F mutation was positive, suggesting a diagnosis of chorea due to polycythemia vera. Chorea disappeared with phlebotomy and hydroxyurea. Neurologists should suspect this rare treatable entity in elderly patients with chorea even with initially normal hematocrit levels.1

Preoperative frailty to predict short-term outcomes in patients with cancer.

810 Background: Frailty is associated with increased postoperative complications. Despite multiple evidence-based modalities to assess frailty, surgeons often make subjective assessments of patients’ ability to tolerate surgery. Identification of those at risk of poor outcomes is particularly important in Surgical Oncology, as major resections may worsen debility and functional status, limiting the patients' ability to receive further therapy. The Risk Analysis Index (RAI-C) is a validated tool to assess frailty in surgical patients. It assigns points for any cancer diagnosis, potentially overestimating frailty in Surgical Oncology patients, and has not been validated in this subgroup. Methods: We performed a prospective, surgeon-blinded study to correlate results of a preoperatively administered frailty survey to predict short- and long-term outcomes in patients with histologically proven malignancy who underwent surgery. The RAI-C, Patient Health Questionnaire (PHQ9), and General Anxiety Disorder (GAD) surveys were administered to assess for frailty, depression, and anxiety, respectively; C-reactive protein (CRP), pre-albumin, albumin, and hematocrit were obtained. Outcomes, including readmission, major complications, ICU admission, disposition (home vs rehabilitation/nursing facility), and 1-year survival were compared between the different groups as defined by survey and lab results. Results: One hundred ninety-one patients were included, of which 135 patients were considered frail based on the predefined value (RAI-C ≥21). Frail patients were more likely to be readmitted within 30 days (14% vs 2%, P=0.01). No difference was found in length of stay, 90-day readmission, ICU admission, major complications, or disposition. Only 15.8% of patients met criteria for anxiety and 11% met criteria for depression. Measured outcomes were similar in patients defined as anxious or depressed. Patients with abnormal pre-albumin levels were more likely to require ICU admissions (31% vs 8%, P &lt;0.005), postoperative intubation (12% vs 0.02%, P=0.02), and to be discharged to a facility other than home (19% vs 10%, P=0.01). Similar trends were noted for patients with abnormal albumin levels who also had longer lengths of stay (mean 9.32 vs 7.88 days, P=0.007). There was an association of improved 1-year survival in patients with normal CRP, pre-albumin, albumin, and hematocrit levels. Frailty as determined by RAI-C survey was not associated with decreased 1-year survival. Conclusions: The RAI-C is a validated tool that can be used for prescreening of Surgical Oncology patients at risk of postoperative readmission, however the score did not correlate with other important outcomes including major morbidity, discharge disposition, and 1-year survival. Results from the survey, as well as preoperative laboratory results can be used in screening patients who may benefit from preoperative optimization and increased follow-up.

A Retrospective Study on Factors Associated with Severe Childhood Community-Acquired Pneumonia

Background and Aim: Globally, community-acquired pneumonia (CAP) is the most common source of mortality among children. Early diagnosis and effective management need the identification of risk factors. The purpose of this study was to characterize the clinical symptoms and investigation of various risk factors for severe CAP in children. Patients and Methods: A retrospective study was conducted on 186 children in the Pediatric Department of Niazi Welfare Teaching Hospital, Sargodha from March 2022 to November 2022. Children with pneumonia who had radiological confirmation were included. Community-acquired pneumonia cases were categorized into two groups: Group-I composed of severe CAP cases whereas Group-II non-severe CAP cases. Baseline characteristics such as age, nutritional status, and gender were collected. Vital signs, fever, duration of symptoms, and physical findings such as chest retraction, cyanosis, wheezing, and nasal faring were clinical data recorded. Laboratory findings such as serum electrolyte, full blood count, and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded. SPSS version 27 was used for data analysis. Results: Of the total 186 children, there were 74 (39.8%) females and 112 (60.2%) male. Age-wise distribution of patients were as follows: 146 (78.5%) in 0-5 years, 26 (14%) in 6-10 years, and 14 (7.5%) in 11-15 years. Out of 186 children, the incidence of severe and non-severe CAP was 58 (31.2%) and 130 (68.8%) respectively. The most common clinical signs in both categories are fever and cough, followed by reduced appetite, vomiting, and shortness of breath. A seizure is present in 14 (24.1%) severe CAP cases. Based on physical examination, Rhonchi is found in 94 (72.3%) non-severe and 46 (79.3%) severe CAP patients. Among patients with severe pneumonia, over half have chest retractions, but only 22% have non-severe pneumonia. Tachypnea was experienced by approximately 33% of severe pneumonia patients against 14% of individuals with non-severe pneumonia. As inflammatory indicators, ESR and CRP are high in all groups. Conclusion: The present study concluded that a fever persisting for &gt;7 days and an elevation in RR are risk factors for severe pneumonia. Severe pneumonia is also prevented by a normal hematocrit level and BMI. There was a higher rate of severe pneumonia in CAP hospitalizations in children who had fevers lasting longer than seven days as well as tachypnea. According to these findings, RR should be utilized to determine both the severity of pneumonia and the identification of pneumonia. Keywords: Sever community-acquired pneumonia, Risk factors, Childhood pneumonia

How Important Impact of Low Level of Hematocrit Can Be on Outcome in Patients Undergoing Off Pump Coronary Artery Bypass Surgery?

Cardiosurgical patients can be often anemic, and preoperative anaemia is associated with increased postoperative complications, as well as morbidity and mortality. The present study was conducted aiming to determine the influence of lower preoperative hematocrit values on the early postoperative recovery of patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). Our retrospective study included 150 patients who underwent elective OPCABG surgery from September 2021 to December 2022 at the Clinic for Cardiovascular Surgery University of Sarajevo. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin level <130g/l males and <120g/l females. Study observed comorbidities and early postoperative data. Overall prevalence of anemia in OPCABG patients was 36,6%, more frequent among older patients. Comorbidities as chronic obstructive pulmonary disease, hypertension, ejection fraction was quite similar in both groups, but body mass index was significantly higher in the group of patients with anemia (29.9% vs 28.4%). In early recovery period, vasopressors were more used in patients with anemia (63.6% vs 42.1%) and their doses were higher. Total drainage was higher in patients with anemia (744.45±45.72 ml vs 681.58±349.06 ml). Number of transfusions was higher in the group of patients with anemia: red blood cells (0.89±1.29 vs 0.29±0.84; p<0,05), fresh frozen plasma (0.65±1.13 vs 0.41±1.15; p<0,05) and platelets (0.11±0.57 vs 0,07±0.42; p>0,05). Duration of mechanical ventilation was longer in patients with anemia compared to non-anemic patients (623-91±259.83 minutes vs 469±191.13 minutes). Atrial fibrillation occurred more often in patients with anemia (12.7 vs 7.4%). Length of stay in the intensive care unit was without significant difference. Based on our findings, patients who underwent elective OPCABG with lower than normal hematocrit, needed more blood and blood products, more vasopressor drugs in higher doses, longer mechanical ventilation, all which can prolong the patient's recovery and increase the cost of treatment.

Noninvasive polarization-based technique for hematocrit monitoring

Subject of study. Polarization images corresponding to the 2D distributions of polarization state parameters for light scattered by biological specimens with different hematocrit levels were obtained by shining laser light in a given polarization state of blood-containing tissue through the nail bed of the left fifth finger. Aim of work. The aim of this work is to determine whether active video polarimetry is suitable for noninvasive real-time monitoring of blood hematocrit and to develop data-based criteria to identify hematocrit levels corresponding to various body states of human test subjects. Method. Physical models of changes in the parameters of polarized radiation during interaction with a biological specimen are used. A prototype optical design was developed for a Stokes video polarimeter capable of recording the irradiance distribution within a single analysis field on the sensitive area of a photodetector array. The digital images were processed using the Stokes–Mueller matrix formalism. A comparative statistical analysis of the 3D distributions for various parameters describing the polarization state (degree of polarization and the azimuth and ellipticity of the polarization ellipse) was performed to determine whether it is possible to detect differences in the hematocrit levels of human blood. Main results. A new approach to noninvasive hematocrit monitoring based on optical polarization is proposed. We obtained 3D distributions and histograms of light polarization state parameters for two human test subjects known to have different hematocrits. Statistical analysis revealed that significant differences in the second–fourth order statistical moments of the light polarization parameters are the most relevant diagnostic indicators for comparative analysis of biological tissues having different blood hematocrit levels. Practical significance. With further development, the proposed method can be applied to both medical diagnosis and emergency treatment. Timely detection of significant deviations from the normal hematocrit based on automated calculation and analysis of the data parameters identified will enable continuous hematocrit monitoring during surgical operations and effective real-time adjustment of blood viscosity.