Nutritional Deficiency Anemia Research Articles

Anemia and Its Connections to Inflammation in Older Adults: A Review.

Anemia is a common hematological disorder that affects 12% of the community-dwelling population, 40% of hospitalized patients, and 47% of nursing home residents. Our understanding of the impact of inflammation on iron metabolism and erythropoiesis is still lacking. In older adults, anemia can be divided into nutritional deficiency anemia, bleeding anemia, and unexplained anemia. The last type of anemia might be caused by reduced erythropoietin (EPO) activity, progressive EPO resistance of bone marrow erythroid progenitors, and the chronic subclinical pro-inflammatory state. Overall, one-third of older patients with anemia demonstrate a nutritional deficiency, one-third have a chronic subclinical pro-inflammatory state and chronic kidney disease, and one-third suffer from anemia of unknown etiology. Understanding anemia's pathophysiology in people aged 65 and over is crucial because it contributes to frailty, falls, cognitive decline, decreased functional ability, and higher mortality risk. Inflammation produces adverse effects on the cells of the hematological system. These effects include iron deficiency (hypoferremia), reduced EPO production, and the elevated phagocytosis of erythrocytes by hepatic and splenic macrophages. Additionally, inflammation causes enhanced eryptosis due to oxidative stress in the circulation. Identifying mechanisms behind age-related inflammation is essential for a better understanding and preventing anemia in older adults.

Diagnostic Utility of Reticulocyte Hemoglobin Equivalent Parameter in the Evaluation of Microcytic Hypochromic Anemia – Our Experience from Northeast India

Background: Reticulocytes are red blood cell precursors with an average lifespan of 1–2 days. Reticulocyte hemoglobin equivalent (Ret-He) is an early marker of iron deficiency (ID) erythropoiesis and reflects real-time information regarding the synthesis of young erythrocytes in the bone marrow. The objective of this study is to determine the diagnostic utility of Ret-He in patients having microcytic hypochromic anemia in comparison with serum ferritin and iron studies. Objectives: The objective of this study is to determine the diagnostic utility of the Ret-He parameter in patients having microcytic hypochromic anemia in comparison with the serum ferritin, iron studies and its role in routine hematological screening for nutritional deficiency anemia like ID. Design and Settings: The design involves observational study. Materials and Methods: A hospital-based observational study was carried out in a referral hospital. Hematological parameters were processed using Sysmex XN1000 (Sysmex Corporation, Kobe, Japan) analyzer and were compared with Serum iron studies using biochemistry analyzer (VITROS® 250 Chemistry System) from 201 participants who presented with microcytic hypochromic anemia. Main Outcome and Measures: Relationship of Ret-He parameter and its diagnostic utility for screening of iron-deficient states. Sample Size: The sample size was 201. Results: When serum ferritin is taken as “the gold standard” to detect ID, with Ret-He cutoff of 27.15 pg/cell, we found a statistically significant positive correlation between Ret-He and serum ferritin (P < 0.001). We found a sensitivity of 57.37% and specificity of 75.95% with area under the curve of 0.681, positive predictive value of 100%, negative predictive value of 3.8%, and accuracy of 62.19% for Ret-He in detecting ID anemia (IDA). Also found a statistically significant negative correlation between Ret-He and total iron binding capacity (P < 0.001). There was no statistical correlation between Ret-He and serum iron levels in our study. Conclusions: The present study suggests Ret-He is one of the better and more reliable hematological parameters indicating ID and, when used along with biochemical parameters like serum ferritin, can give valuable inputs in a better screening and diagnosis of IDA; hence proper treatment is possible. Limitations: The multicentric study is required to standardize Ret-He reference values, and follow-up to therapy of the subjects was not done. Additional hemoglobin variant analysis data would have been favorable to the study.

Diagnostic Utility of Bone Marrow Aspiration Cytology- A Hospital Based Prospective Study at Nepalgunj Medical College

Introduction: Hematological disorders are common in all age groups and are worldwide in distribution. At times, routine hematological tests are not sufficient to diagnose blood disorders. Bone marrow examination serves as an important diagnostic aid to evaluate various neoplastic and non-neoplastic hematological diseases.
 Aims: To study role of Bone Marrow Aspiration Cytology in diagnosing hematological disorders. 
 Methods: This is a one-year hospital based prospective study done at Department of Pathology, NGMC, Kohalpur. It included 34 cases subjected to Bone marrow aspiration cytology. Correlation with Peripheral Blood Smear, Reticulocyte count, pearls iron stain and other parameters were done before giving the final diagnosis.
 Results: Age of patients ranged from 10-82 years with equal gender distribution. Common indications for Bone marrow examination were pancytopenia (50%), followed by Anemia and Thrombocytopenia. Megaloblastic Anemia (n=10,29%) was the commonest Anemia followed by mixed nutritional deficiency and Iron Deficiency Anemia. Hematological Malignancy accounted for six cases, of which Acute Myeloid Leukemia was diagnosed in two cases. Infectious causes comprised of two cases of Visceral Leishmaniasis and one case of Bone Marrow Tuberculosis.
 Conclusion: Bone marrow aspiration cytology serves as an important adjunct in diagnosing hematological disorders. More reproducible results are obtained if bone marrow biopsy is done in conjucntion with aspiration cytology.

A Study to assess the effectiveness of Iron supplementary ball on Haemoglobin level among adolescent girls with Nutritional deficiency Anemia at selected Nursing Colleges, Thanjavur district

A study was conducted to assess the effectiveness of Iron supplementary ball on haemoglobin level among adolescent girls with nutritional deficiency anemia at selected Nursing colleges, Thanjavur. An experimental research design was used for this study. Samples were selected by using simple random (lottery method) sampling technique. The investigator assessed the haemoglobin level by using Sahli’s method in both experimental and control group. Then from day 2 to day 31 Iron supplementary ball intervention was given to the experimental group sample after breakfast under the supervision of the researcher for a period of 30 days. After 30 days the investigator assessed the posttest level of haemoglobin in both groups. The mean value 10.27 with standard deviation 1.91 in experimental group was higher than the mean value 9.49 with standard deviation 1.38 in control group. The ‘t’ test calculated Value 10.933 was higher than the Table Value 2.05 (CV> TV) which is significant at 0.05 level. The statistical analysis reveals that there was a significant differences in posttest levels of haemoglobin among adolescent in experimental group in comparison with control group. So the given Iron supplementary ball was effective in proving haemoglobin level among the adolescent girls.

Nutritional deficiency anemia and post-acute sequelae in patients with severe acute respiratory syndrome coronavirus 2 infection: A six-month retrospective cohort analysis of 30 892 patients.

The effect of anemia on the post-acute outcome of patients with severe acute respiratory syndrome coronavirus 2 infection was unclear. This study aimed to investigate the potential association between nutritional deficiency anemia (NDA) status and post-acute sequelae of patients with SARS-CoV-2 infection. This retrospective cohort study included patients with coronavirus disease (COVID-19) from January 1, 2022to November 30, 2022 using the TriNetX research network. The patients were grouped into the NDA group comprising patients diagnosed with NDA and the control group comprising patients without NDA, and propensity score matching (PSM) was performed to balance the two groups. The primary outcome was a composite of post-COVID-19 condition, all-cause hospitalization, and all-cause death. The secondary outcomes were any individual outcomes of the primary composite. The follow-up period was set at 90-180 days after COVID-19 diagnosis. Two cohorts comprising 15 446 nonhospitalized patients with COVID-19 in each group with balanced baseline characteristics were created using PSM. During the follow-up period, the NDA group demonstrated a higher risk of the composite primary outcome, including post-COVID-19 condition, all-cause hospitalization, or all-cause death (hazard ratio [HR], 1.896; 95% confidence interval [CI] = 1.757-2.045). Regarding secondary outcomes, the NDA group was associated with worse outcomes, including post-COVID-19 condition (HR, 1.992; 95% CI = 1.403-2.828), all-cause hospitalization (HR, 1.856; 95% CI = 1.714-2.009), and all-cause death (HR, 3.922; 95% CI = 2.910-5.285) compared to the control group. Among nonhospitalized patients with COVID-19, NDA was associated with a higher risk of post-COVID-19 condition, all-cause hospitalization, and all-cause death during the 90-180-day follow-up period.

Assessment of peripheral nerve conduction in iron deficiency anemia patients in Indian rural adult population attending a tertiary care hospital

Background: Iron deficiency anemia (IDA) is the most common nutritional deficiency anemia in India. Peripheral neuropathy can result due to iron deficiency as it disrupts myelination and neuronal energetics in neuronal functioning. Nerve conduction studies (NCS) can quantitatively detect peripheral nerve dysfunction. This study was conducted to observe effect of IDA on peripheral nerve conduction velocity in adults using neuroelectrophysiological techniques with the aim to recommend Complete Blood Count for serologic evaluation of patients with peripheral neuropathy in Indian population. Objectives: This study aims to compare motor and sensory nerve conduction study parameters between controls and IDA patients and evaluate the effect of various grades of IDA on motor and sensory nerves. Methodology: 30 newly diagnosed patients of IDA in age group of 20-45 yrs and 30 healthy controls in same age group were recruited in this study. NCS was conducted on bilateral motor and sensory median and ulnar nerves in Neurophysiology laboratory using Neurosoft machine. Neuroelectrophysiological data of both the groups was evaluated and analysed using Student’s unpaired t test. Also, patients were categorised as mild, moderate and severe anemia cases and one way ANOVA was used for comparison among patients with various grades of anemia. Results: CMAP (compound muscle action potential), SNAP (sensory nerve action potential) and nerve conduction velocity (NCV) of bilateral median and ulnar nerves was reduced and DL (distal latency) was increased in bilateral median and ulnar nerves in patients with IDA compared to controls. The results were statistically significant (p=0.001). A highly significant difference between motor and sensory nerve conduction values between mild, moderate and severe IDA patients was also observed (p=0.001). Conclusion: The results of the study confirmed peripheral nerves involvement in IDA patients. As severity of anemia increases, peripheral neuropathy worsens. These results can be extrapolated for screening patients with peripheral neuropathy for iron deficiency as a routine part of diagnostic approach for peripheral neuropathy.

Iron Deficiency Anemia in Pregnancy: An Overview

The most common and also the most overlooked dietary deficiency in the world is iron deficiency anaemia. It is not only a problem in developing countries or in countries with few resources, but it is also a problem in industrialised ones. The main goal of this article is to raise awareness about the prevalence of anaemia in pregnancy, the aetiology of anaemia in pregnancy (not just during pregnancy but throughout adolescence) and the prevention of anaemia in pregnancy by extending the vision to the adolescent age group in order to reduce the risk of nutritional deficiency anaemia during pregnancy. Because of their increased iron requirements for rapid growth and menstrual blood loss, adolescent girls are particularly sensitive to this illness. Poor nutrition is the most common cause of anaemia, which is caused not only by socioeconomic reasons but also by cultural and other conditioning factors such as viral infections, which promote malnutrition in teenagers. Malaria, intestinal parasites, diarrhoea, and tuberculosis are among diseases that cause malnutrition. Anemia’s severity and length are crucial during pregnancy since it increases the risk of preterm delivery, low birth weight, maternal mortality, and other complications. Anemia is a worldwide health issue that affects about one-third of the world’s population and is one of the primary causes of disability. Anemia in pregnancy is associated with a high rate of morbidity and death due to a woman’s inability to respond to postpartum blood loss, which can have life-threatening effects. Iron deficiency anaemia has a direct link to hunger; according to the WHO, iron deficiency anaemia occurs in 50-80% of areas with chronic malnutrition. However, iron insufficiency is becoming more widespread in wealthy countries, with an increase of 20%. Iron insufficiency is quite common in women of reproductive age, with roughly 30% of them suffering from it.

Cerebral venous thrombosis and B12 deficiency

Infants with prematurity and necrotizing enterocolitis (NEC) are at increased risk for short bowel syndrome and subsequent nutritional deficiencies. In particular, ileal resection is associated with vitamin B12 malabsorption, which interferes with normal myelination and homocysteine metabolism.1, 2 Vitamin B12 deficiency is associated with neurodevelopmental delay as well as hyperhomocysteinemia, which increases the risk for venous thrombosis.2, 3 This eight-year-old boy presented with severe headache, dehydration, and lethargy. He developed acute onset severe frontal headache followed by decreased oral intake, decreased urine output, and recurrent vomiting. The headache was dull and radiating to the back of his head. At the same time, he appeared to be sleepy and less active. These symptoms lasted for two to three days before he was brought to the primary doctor's office and then referred to the emergency department. On assessment, he was tired-looking and exhibited mild microcephaly, but his neurological examination was normal, as was an examination by an ophthalmologist. He experienced mild global developmental delay. He was born at 25 weeks gestational age and had a prolonged stay in the neonatal intensive care unit, complicated by NEC and a hemicolectomy with ileostomy and removal of ileocecal valve. He had low normal levels of B12 for several years prior to presentation and was not treated (151 pg/ml after surgery [normal 160-950]). Brain magnetic resonance imaging and magnetic resonance venography (MRV) showed filling defects in the inferior sagittal, straight, torcula, and proximal transverse sinuses consistent with cerebral venous sinus thrombosis (CVST) with no evidence of acute infarction (Figure 1). Dehydration was initially considered to be the cause. Enoxaparin sodium was started at 1 mg/kg every 12 h with the goal of anti-Xa level between 0.5 and 1.0 U/ml. The hypercoagulation evaluation was normal. The B12 level was 86 pg/ml. His hematocrit was 33.3, and his mean corpuscular volume (MCV) was 87.4. He was not treated at that time. He was discharged within a week after the repeat imaging remained stable with the goal to continue enoxaparin sodium for three months. After three months, he again developed headache and lethargy, and MRV showed a new thrombus. Enoxaparin was switched to warfarin. After a year of warfarin, the clot resolved but he still had headaches. Two B12 levels were obtained, both below 200. His anemia worsened (hematocrit 24.7) and his MCV increased to 96.9. The homocysteine level was 184 μmol/L (normal <11.4). At this point, he began B12 injections (1000 mcg daily for one week followed by monthly and then quarterly injections thereafter). His B12 levels normalized and remained normal throughout his course. The warfarin was discontinued and thrombus has not recurred. Our patient had a difficult-to-treat CVST secondary to a condition predisposing to nutritional deficiency. His chronic B12 deficiency was overlooked by his treating physicians until he presented with a profound deficiency with megaloblastic anemia. The association between B12 deficiency and CVST has been described in children with nutritional deficiency and megaloblastic anemia.4 Previous authors suggested that testing for hyperhomocysteinemia and with B12 supplementation should be considered in pediatric patients with CVST.5 The diagnosis becomes even more crucial in patients with conditions known that promote nutritional deficiencies, such as a history of NEC and ileal surgery. In such children, early recognition of vitamin B12 deficiency and timely vitamin supplementation may prevent the occurrence of CVST as well as other manifestations of B12 deficiency, such as developmental delay.6, 7 In this patient, the B12 deficiency was chronic. While it is difficult to prove that the deficiency caused the CVST, it likley played a substantial role. Hyperhomocysteinemia can damage the vascular endothelium, predisposing to thrombus formation.8, 9 Consequently, vitamin B12 deficiency is a potential risk factor in children with CVST. Fatemeh Mohammadpour Touserkani: Conceptualization; supervision; writing – original draft; writing – review and editing. Theodora Andriotis: Conceptualization; investigation; writing – original draft; writing – review and editing. Yaoping Zhang: Conceptualization; supervision; writing – original draft; writing – review and editing. Steven Pavlakis: Conceptualization; supervision; writing – original draft; writing – review and editing. We would like to thank the patient's parents for their consent for this publication. The authors declare no conflict of interest.

Effect of nutritional-deficiency anemia on peripapillary retinal nerve fiber layer: A North Indian study.

The purpose of this study was to evaluate the effect of nutritional-deficiency anemia (NDA) on peripapillary retinal nerve fiber layer thickness (PPRNFLT) using spectral-domain optical coherence tomography and to determine any correlation arising thereof. This was a single-center, cross-sectional, observational study. A total 115 eyes of 115 NDA patients (50 of each with iron-deficiency anemia [IDA] and Vitamin B12-deficiency anemia [BDA], and 15 with folic acid-deficiency anemia [FDA]) aged 18-65 years were compared with a total 100 eyes of 50 age- and sex-matched healthy controls. All subjects underwent comprehensive clinical, ophthalmic, and hematological evaluation, followed by PPRNFLT assessment for the mean total, superior, inferior, nasal, and temporal quadrants. PPRNFLT for the mean total and all four quadrants in IDA patients, for the mean total, inferior, nasal, and temporal quadrants in BDA patients, and for the mean total, inferior, and nasal quadrants, in FDA patients, was significantly lower as compared to the controls (P < 0.05). The mean total PPRNFLT of all NDA patients correlated significantly (P < 0.05) with their relevant hematological parameters with Pearson's coefficient (r) value of 0.613, 0.610, 0.336, 0.295, 0.337, 0.374, and - 0.509, respectively, for serum haemoglobin (Hb), iron, ferritin, mean corpuscular volume (MCV), mean cell hemoglobin, mean corpuscular hemoglobin concentration, and total iron binding capacity in IDA; 0.310, 0.435, and - 0.386, respectively, for serum Hb%, Vitamin B12, and MCV in BDA; and 0.557, 0.358, and - 0.294 for Hb%, folate, and MCV, respectively, in FDA cases. Mean total retinal nerve fiber layer thinning of all NDA patients showed progression with the increasing severity grades of anemia, except in very severe BDA where an inverse relationship was documented. Our study revealed that PPRNFLT is significantly thinner in all NDA patients (total and all four quadrants in IDA; total, inferior, nasal, and temporal in BDA; and total, inferior, and nasal in FDA) correlating well with their relevant hematological parameters. Early detection of this may be crucial in preventing potential blinding sequelae and differentiating glaucomatous and other neuro-ophthalmic disorders.

Impact of Ayurvedic Interventions to improve the Nutritional Status among Adolescent Girls and Children under-five years in Devbhumi Dwarka district of Gujarat

Introduction: Anaemia is the global public health crisis, so also in India. The most direct connection between Pandu Roga and nutritional deficiency anaemia can be found in Ayurveda. Ayurvedic remedy was put through a clinical study on anaemic adolescent girls because anaemia is commonly prevalent that affects the society and the side effects of oral allopathic iron preparations are highly common. The present study assesses the impact of ayurvedic medicines in improving the nutritional status among anemic adolescent girls and severely underweight children under five years of age in Devbhumi Dwarka district of Gujarat. Method: The pre-post study was registered with Clinical Trial Registry of India conducted at Devbhumi Dwarka district of Gujarat. A total of 450 anaemic adolescent girls and 179 severely underweight children were screened respectively. Adolescent girls were provided with Faltrikadhi Kavath, Purnanavardi Mandur, and Amalaki Rasayan. Under-five children was given Shishubhaishaj granules in powder form. The study was conducted in three phases (Baseline, Intervention and Endline Assessment). Results: A total of 219 adolescent girls and 120 under-five children was evaluated during endline assessment. The mean improvement in Hb was +0.36 gm/dL for 219 subjects, however subjects (n=99) with better compliance shows significant improvement (+1.07 gm/dL, P=0.005). Under five children shows improvement in their anthropometric measurements (WAZ). Conclusion: The present study revealed that Ayurvedic intervention can improve Hb status of adolescent girls only with better compliance. The study also reports the reason of non-compliance and ways to address it.

Workplace-based Nutrition Intervention towards Nutrition for All

Workplace-based Nutrition Intervention towards Nutrition for All

Utility of Bone Marrow Examination in Pediatric Age Group: Experience of a Tertiary Healthcare Centre in India.

IntroductionBone marrow is involved in various haematological and non-haematological conditions in the paediatric age group. To understand and analyse the underlying etiology, bone marrow examination, including both bone marrow aspiration and trephine biopsy, forms an important diagnostic tool. It helps to differentiate proliferative disorders of the myeloid and lymphoid series, find out their prognosis based on severity, and assess their status before therapy is started. It also aids in staging and in the detection of infiltration of the marrow by foreign cells. The spectrum of disorders affecting the marrow in children ranges from common disorders like nutritional deficiency anaemia to serious conditions like leukaemia. Their line of management, severity, and prognosis differ from the bone marrow lesions found in adults. The present study was done to demonstrate the utility of bone marrow examination in the paediatric age group, to demonstrate its contribution to the final diagnosis of the patient, and to list and study the various lesions encountered in this age group in a tertiary care teaching hospital and for better understanding of clinicopathological features and microscopy, suggesting variation with or convergence with literature.Material and methodsThis was an observational study with a combination of retrospective and prospective studies, carried out over a period of six years, from January 2014 to December 2019. All bone marrow aspiration and biopsy samples received in the surgical pathology department of our tertiary healthcare centre during the study period of patients between zero and 18 years of age were included. Samples obtained at autopsy and samples where the tissue was diluted or the marrow was inadequate were excluded from the study. Detailed histomorphology was studied in all cases, and the data obtained was recorded in an excel sheet. The descriptive statistics were expressed in terms of numbers and percentages. The study was ethically approved by the Ethics and Research Committee of our hospital before the commencement of the study.ResultsThe maximum number of marrows were performed in the age group of 12-18 years, followed by six to 12 years. The most common indication for performing bone marrow examination was ‘evaluation of cytopenias’, followed by ‘suspected/to rule out haematological malignancy’. A male predominance was found. Overall and amongst neoplastic lesions, acute leukaemia was the commonest diagnosis in the bone marrow. Infections were the second most common lesion overall and the commonest non-neoplastic lesion encountered.ConclusionThe spectrum of lesions requiring bone marrow examination in the paediatric age group is of varied etiologies. Bone marrow examination in children is useful in understanding the pathogenesis, establishing a tissue diagnosis, ruling out haematological malignancies and other causes of cytopenias, planning further lines of investigations and management, and knowing the response to therapy and prognosis.

Peripheral neuropathy in severe iron deficiency anemia: A case report

Anemia is a global health problem that need medical attention. Iron deficiency anemia (IDA), in particular is the most common nutritional deficiency anemia prevalent in India. Iron essential for effective myelination of peripheral nervous system.1 Nerve conduction studies are one of the neurophysiological investigations that can quantitatively detect peripheral nerve dysfunction.2 In this case report, we present findings of nerve conduction studies performed on a case of severe iron deficiency anemia and the associated peripheral neurodeficit observed in the case study. Nerve conduction study (NCS) was performed in bilateral median and ulnar motor and sensory nerves. CMAP (compound muscle action potential) and SNAP(sensory nerve action potential) and motor and sensory NCV (nerve conduction velocity) was decreased and the distal latency was prolonged in both ulnar and median nerves. These observations indicate a sensorimotor demyelinating and axonal peripheral neuropathy in the patient due to iron deficiency.

Characterization of novel papillomavirus from free-ranging Antillean manatee Trichechus manatus manatus with genital papillomatosis.

The Antillean manatee Trichechus manatus manatus is an Endangered species living along the Atlantic coasts of the Americas from Florida (USA), throughout the Caribbean, to Brazil. In July 2020, a manatee with multiple wounds due to boat-inflicted trauma was rescued from the coast east of Cayo Mata, Salinas, Puerto Rico. This manatee had neutropenia, leukopenia, and monocytosis associated with immunosuppression and nutritional deficiency anemia, as well as bacteria and fungi within the lesions. The manatee had genital lesions which included papules and linear plaques, microscopically characterized by mucosal hyperplasia with cytopathic changes typical of papillomavirus infection. Superficial epithelial cells had strong nuclear immunolabeling when examined using a monoclonal antibody specific to papillomavirus. The sequencing data of PCR products with papillomavirus-specific degenerative primers indicated that these lesions contained a novel manatee papillomavirus (Trichechus manatus papillomavirus, TmPV). The genomic DNA was amplified using a rolling circle amplification, and fully sequenced to be 7586 bp (GenBank accession no. OK073977). Other TmPVs were previously isolated from Florida manatees T. manatus latirostris. This novel virus was designated TmPV type 5 (TmPV5) based on its genomic characterization and sequence comparison. The TmPV5 genome shared 50.7, 48.9, 69.4, and 62.1% similarities with TmPV1, TmPV2, TmPV3, and TmPV4, respectively. TmPV5 is classified in the genus Rhopapillomavirus together with other manatee papillomaviruses. After 2.5 mo of veterinary treatment and rehabilitation, the manatee recovered and was released. This is the first report of papillomatosis in a free-ranging Antillean manatee.

Impact of Correcting Nutritional Deficiency Anemias in the Elderly on Hospitalizations, Falls, and Mortalities.

BackgroundThe incidence and prevalence of anemia increase with age, particularly in adults older than 65 years, and it is associated with a number of adverse health outcomes (AHO), particularly hospitalizations, falls and mortalities. Given that approximately one-third of these anemias are due to reversible causes, we studied whether the treatment of nutritional deficiency anemia (NDA), namely iron deficiency anemia (IDA), cobalamin deficiency anemia (CDA), and folate deficiency anemia (FDA), improves AHO; and explored whether each NDA had different AHO.MethodsWe reviewed electronic medical records of our internal medicine office patients aged 65 years or older, who had a diagnosis of anemia in a non-acute setting.ResultsTotal 600 patients were included. Mean age was 75.2 years. Thirty-one point three percent had NDA (CDA 15.3%, IDA 12.3%, FDA 3.7%); and 68.7% had other anemias whom we categorized as non-nutritional deficiency anemias (NNDA), which included anemia of chronic disease (11.2%), myelodysplastic syndrome (6.2%), renal insufficiency anemia (5.7%) and unexplained anemia (45.6%). Even after adequate treatment, IDA group had significantly more hospitalizations (median, 25th - 75th: 2 (0 - 4) vs. 0 (0 - 1), P < 0.001), falls (median, 25th - 75th: 1 (0 - 3) vs. 0 (0 - 1), P < 0.001) and mortalities (10.8% vs. 3.4%, P = 0.011); CDA group had significantly more hospitalizations (median, 25th - 75th: 1 (0 - 2) vs. 0 (0 - 1), P = 0.007), but no difference in falls (median, 25th - 75th: 0 (0 - 1) vs. 0 (0 - 1), P = 0.171) and mortalities (7.6% vs. 3.4%, P = 0.083); and FDA group had significantly more hospitalizations (median, 25th - 75th: 1 (0 - 2) vs. 0 (0 - 1), P = 0.001), but no difference in falls (median, 25th - 75th: 0 (0 - 1) vs. 0 (0 - 1), P = 0.615) and mortalities (4.5% vs. 3.4%, P = 0.550), compared to the NNDA group. Age, Black race, higher number of comorbidities, presence of malignancy and use of direct oral anticoagulants were associated with increased odds of AHO in patients with NDA.ConclusionsCompared to the patients with NNDA, patients with IDA had more hospitalizations, falls and mortalities even after adequate treatment; while patients with CDA and FDA had only more hospitalizations. Adequate treatment mitigated falls and mortalities in elderly patients with CDA and FDA.

Nutritional anaemia in children in post supplementation era: A cross sectional study

Background: Nutritional anemia is still the primary cause of anemia despite of various nutritional programmes in developing countries.&#x0D; Aims and Objective: The present study was planned to asses Iron, Folate, and Vitamin B12 deficiency anaemia in developing countries.&#x0D; Materials and Methods: This cross-sectional study was conducted at a tertiary care centre in Agra in collaboration with Institute of Genomics and Integrative Biology, New Delhi. Admitted children of age 6 months to 14 years having signs and symptoms of anaemia were included in the study. Sample size calculated was 157. All the cases were subjected to CBC, GBP, serum iron, ferritin, folate and vitamin B12 level estimation.&#x0D; Results: Out of 672 children, 157 children with clinical feature of anaemia were enrolled in the study. Among these 157 children, 52.87% were male. Percent proportion of anaemia was highest among toddlers (27.39%) and lowest in adolescent (10.83%). The maximum cases were of urban area (65.6%) and middle socioeconomic status (47.13%). Most of the children were undernourished/underweight (60.4%). Mean iron level was significantly low in female children, children of rural areas, low socioeconomic status and malnutrition/underweight. Mixed iron, folate and B12 deficiency was found in 48.41%, 30.57% and 22.93% cases respectively. In 24.20% cases no deficiencies were found and were classified as anaemia due to some unspecified causes.&#x0D; Conclusion: Nutritional deficiency anaemia is contributing to a large proportion of anaemic patients. More intensified programmes are needed especially for female children, children of rural areas, low socioeconomic status and malnutrition/underweight.

Project nEU-Med. The Contribution of Isotopic Analysis in the Differential Diagnosis of Anemia, the Case of the Medieval Cemetery of Vetricella (Scarlino, GR) in Tuscany

ABSTRACT Pathological conditions in skeletal remains, such as cribra orbitalia and porotic hyperostosis, can be caused by etiologically different forms of anemia: hereditary hemolytic anemias, iron deficiency anemias, megaloblastic anemias, etc. Though not always simple to apply, differential diagnosis of cases of anemia found in the archaeological record is essential to correlate the pathology with the wider environmental and socio-cultural context. Anthropological analysis of the skeletal sample from the archaeological site of Vetricella showed a very high prevalence of cribra orbitalia and porotic hyperostosis. The differential diagnosis between acquired and congenital anemia is essential in the study of this condition, especially considering the presence of Plasmodium falciparum in this area and its role in the possible subsequent spread of the thalassaemia gene, which was widespread until a few decades ago. Carbon and nitrogen stable isotope analysis was carried out on a large subset of the skeletal sample, including both anemic and non-anemic individuals, to investigate the nutritional patterns of the Vetricella population in order to verify whether the widespread traces of anemia might be of dietary origin. Isotope results allowed for the exclusion of the hypothesis of nutritional-deficiency anemia and supported the hypothesis of congenital anemia.

Development and Evaluation of Nutritious Supplementary Food Product in Phenyl Hydrazine Induced Anaemia in Wistar Rats

Objective- Nutritional deficiency anemia mainly results from a lack of iron, but it also associated due to lack of folate/vitamin B12 and low vitamin C intake. From various studies this is found anemia in people is due to poor eating habits, such as not eating enough fruits and legumes such as beans and peas. Proper nutritional supplementation may be useful in such condition. The aim of the present work was to select a suitable iron rich food material, and prepared a suitable dosage form for management of anaemic condition and to evaluate anti-anaemic potential of nutritious supplementary food. Method- Anemia was induced by phenyl-hydrazine. Animals were treated with nutritious supplementary food throughout the study for 30 days. The haemoglobin concentration was determined after 30 days. Results- Nutritious supplementary food was found to be rich in folic acid, ascorbic acid, and iron. Following the induction of anaemia, the haemoglobin concentration decreased by 30%. Administration of standard hematinic preparation and nutritious supplementary food 2gm/day in divided dose resulted in significant increase (P ≤ 0.05) in haemoglobin concentration when compared to the untreated phenyl hydrazine-induced anaemic rats. Conclusion- Nutritious supplementary food effectively raised the level of haemoglobin. Vitamin and minerals found in nutritious supplementary food are most likely active ingredients responsible for its hematinic effects.&#x0D; Keywords- Anaemia, nutrition, nutritional anaemia, iron, phenyl hydrazine

A Study of Socioeconomic Determinants of Anemia among Expecting Mothers in Khyber Pakhtunkhwa Pakistan

One of the instrumental factors contributing towards the GDP of any country is human capital and for a progressive human capital, the main resource is physical and mental health. Females constitute approximately 48% of population of Pakistan, out of which a great number suffer from nutritional deficiency anemia at their reproductive age, which results in an unhealthy child. This study is designed to find the socioeconomic factors that lead to anemia among expecting women. The research design for this study is case control where data was collected from two groups; control group (non-anemic pregnant women) and case group (anemic pregnant women) registered in the Basic Health Unit (BHU) from different areas of Peshawar. Collected data was analyzed using binary logistic regression. Findings revealed that monthly income of household, independent members or number of employed members of the family, gap between children, non-staple food consumption and supplements continuity have significant inverse relationship with anemia, indicating that increase in mentioned variables will decrease the prevalence of anemia in pregnant women of rural areas. The study concluded that anemia being a common grievance amongst pregnant women is mostly caused by low level of monthly income, family size with lower number of employed members, low frequency of non-staple food consumption per week, lack of continuity of iron supplements and poor health seeking behavior. Awareness regarding attainment of education irrespective of gender, government focus on health promotion interventions and more job opportunities can improve health conditions and socioeconomic status of women in Khyber Pakhtunkhwa.

Evaluating the Effectiveness of an Educational Intervention for Care of Anemic Patients in a Long-Term Care Geropsychiatric Unit: A Pilot Study.

Anemia is one of the most common age-related health conditions. When concurrently present with psychiatric conditions, the problem is confounded. The primary objective of the current research was to evaluate the effectiveness of an educational intervention for geropsychiatric nurses about nutritional deficiency anemia, anemia of chronic disease, and unexplained anemia in older adults. Fifty nurses employed by an inpatient psychiatric facility participated in the pilot study. A 10-item knowledge evaluation questionnaire was administered prior to and following a 45-minute educational intervention. Analysis of a paired samples t test indicated a significant difference between pretest scores (mean = 36.8, SD = 16.3) and posttest scores (mean = 90.8, SD = 10.66) (p < 0.001). Despite initial knowledge gaps, significant improvement in nursing knowledge was noted following the intervention. As a result of improved knowledge, RNs may be better able to recognize and respond to signs and symptoms that commonly go unnoticed in geropsychiatric patients with anemia. [Journal of Gerontological Nursing, 46(8), 12-16.].