Hemoglobin Concentration In Patients Research Articles

A retrospective study of ovarian tissue cryopreservation in female patients with hematological diseases for fertility preservation.

To investigate the effect and safety of ovarian tissue cryopreservation (OTC) for fertility preservation in female patients with hematological diseases. We designed a retrospective study. The clinical data of patients with hematological diseases undergoing OTC admitted to Peking University People's Hospital from April 2017 to January 2023 were analyzed and summarized. A total of 24 patients were included in the study, including 19 patients with malignant hematological diseases and 5 patients with non-malignant hematological diseases. The former included 14 patients with acute leukemia, 1 patient with chronic leukemia, and 4 patients with myelodysplastic syndrome, while the latter 5 patients were aplastic anemia (AA). 16 patients had received chemotherapy before OTC. The average age of 24 patients was 22.80 ± 6.81years. The average anti-Mullerian hormone (AMH) was 1.97 ± 2.12ng/mL, and the average follicle-stimulating hormone (FSH) was 7.01 ± 4.24IU/L in examination before OTC. FSH was greater than 10.0IU/L in 4 cases. The pre-OTC laboratory tests showed that the average white blood cell (WBC) count was (3.33 ± 1.35) × 109/L, the average hemoglobin was 91.42 ± 22.84g/L, and the average platelet was (147.38 ± 114.46) × 109/L. After injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF), blood transfusion, and iron supplementation in pre-OTC treatment, the average WBC count was (4.91 ± 3.07) × 109/L, the average hemoglobin was 98.67 ± 15.43g/L, and the average platelet was (156.38 ± 103.22) × 109/L. Of the 24 patients, 22 underwent laparoscopic bilateral partial oophorectomy and oophoroplasty, and 2 underwent laparoscopic unilateral oophorectomy. The average duration of OTC was 59.54 ± 17.58min, and the average blood loss was 32.1 ± 41.6mL. The maximum blood loss was 200mL. There was no significant difference in WBC count and hemoglobin concentration after OTC compared to pre-OTC period. Only the platelet count after OTC surgery was significantly different from that before surgery ([134.54 ± 80.84 vs. 156.38 ± 103.22] × 109/L, p < 0.05). None of the 24 patients had serious complications after OTC. 2 patients had mild infection symptoms, but both recovered well. 23 patients underwent hematopoietic stem cell transplantation (HSCT) after OTC. The median and interquartile range from OTC to the pretreatment of HSCT was 33 (57) days, and the median and interquartile range from OTC to HSCT was 41 (57) days. Seven of them began pretreatment of HSCT within 20days and began HSCT within 30days after OTC. All patients were followed up. Of the 23 patients who underwent HSCT after surgery, 22 presented with amenorrhea and 1 with scanty menstrual episodes. Seven patients underwent hormone replacement therapy (HRT) after HSCT. A patient with AA underwent ovarian tissue transplantation (OTT) 3years after HSCT and resumed regular menstruation 6months after OTT. Ovarian tissue cryopreservation has a promising future in fertility protection in patients with hematological diseases. However, patients with hematological malignancies often have received gonadotoxic therapy before OTC, which may be accompanied by myelosuppression while patients with non-malignant hematological diseases often present with severe hemocytopenia. So perioperative complete blood count of patients should be paid attention to. There was no significant difference in the WBC count and hemoglobin concentration in patients with hematological diseases before and after OTC surgery, and the platelet count decreased slightly within the normal range. Infection is the most common post-OTC complication, and HSCT pretreatment can be accepted as early as the 10th day after OTC. OTC has no adverse effects on patients with hematological diseases and does not delay HSCT treatment. For young patients with hematological diseases, OTC is an effective method of fertility preservation.

Mechanism-Based Modeling of Perioperative Variations in Hemoglobin Concentration in Patients Undergoing Laparoscopic Surgery.

Hemoglobin concentration ([Hb]) in the perioperative setting should be interpreted in the context of the variables and processes that may affect it to differentiate the dilution effects caused by changes in intravascular volume. However, it is unclear what variables and processes affect [Hb]. Here, we modeled the perioperative variations in [Hb] to identify the variables and processes that govern [Hb] and to describe their effects. We first constructed a mechanistic framework based on the main variables and processes related to the perioperative [Hb] variations. We then prospectively studied patients undergoing laparoscopic surgery, divided into 2 consecutive cohorts for the development and validation of the model. The study protocol consisted of serial measurements of [Hb] along with recordings of hemoglobin mass loss, blood volume loss, fluid infusion, urine volume, and inflammatory biomarkers measurements, up to 96 hours postoperatively. Mathematical fitting was performed using nonlinear mixed-effects. Additionally, we performed simulations to explore the effects of blood loss and fluid therapy protocols on [Hb]. We studied 154 patients: 118 enrolled in the development group and 36 in the validation group. We characterized the perioperative course of [Hb] using a mass balance model that accounted for hemoglobin losses during surgery, and a 2-compartment model that estimated fluid kinetics and intravascular volume changes. During model development, we found that urinary fluid elimination represented only 24% of the total fluid elimination, and that total fluid elimination was inhibited after surgery in a time-dependent manner and influenced by age. Also, covariate evaluation showed a significant association between the type of surgery and proportion of fluid eliminated via urine. In contrast, neither the type of infused solution, blood volume loss nor inflammatory biomarkers were found to correlate with model parameters. In the validation analysis, the model demonstrated a considerable predictive capacity, with 95% of the predicted [Hb] within -4.4 and +5.5 g/L. Simulations demonstrated that hemoglobin mass loss determined most of the postoperative changes in [Hb], while intravascular volume changes due to fluid infusion, distribution, and elimination induced smaller but clinically relevant variations. Simulated patients receiving standard fluid therapy protocols exhibited a hemodilution effect that resulted in a [Hb] decrease between 7 and 15 g/L at the end of surgery, and which was responsible for the lowest [Hb] value during the perioperative period. Our model provides a mechanistic and quantitative understanding of the causes underlying the perioperative [Hb] variations.

The Clinical Usefulness of Mean Corpuscular Hemoglobin Concentration in Patients with Pneumoconiosis.

We investigated the clinical usefulness of mean corpuscular hemoglobin concentration (MCHC) in patients with pneumoconiosis. We retrospectively investigated the medical records from 52 patients with pneumoconiosis, and erythrocyte parameters were analyzed in pneumoconiosis patients with different stages. Here, we found that the values of MCHC were significantly lower in III stage pneumoconiosis than those with I/II stage (p = 0.024), and there was no significantly difference in MCHC between smoking pneumoconiosis patients and non-smoking pneumoconiosis patients. A negatively correlation between MCHC and disease stage was observed in patients with pneumoconiosis (r = -0.298, p = 0.032). In multiple linear regression analysis, the MCHC was found to be independently associated with advanced pneumoconiosis in patients with pneumoconiosis (p=0.011). The results of logistic regression analysis indicated that decreased MCHC was an independent risk factor of advanced pneumoconiosis in patients with pneumoconiosis (OR: 0.936, CI95%: 0.877-0.999, p = 0.046). Receiver operating characteristic curve analysis showed that the optimal cutoff value of MCHC was 330 g/L to identify advanced pneumoconiosis with the area under the curve of 0.694 (CI95%:0.550-0.839, p = 0.018). The decreased MCHC is associated with advanced pneumoconiosis, and MCHC may be used as a monitoring marker for follow-up of pneumoconiosis patients.

Evaluation of clinical use of intravenous iron: Utilization, efficacy, and safety in the management of cancer and chemotherapy-induced anemia in GI oncology.

359 Background: National Comprehensive Cancer Network recommends intravenous (IV) iron therapy for management of cancer and chemotherapy induced anemia without mentioning agent preference. Currently at Dana-Farber Cancer Institute (DFCI), all IV iron formulations can be utilized in management of iron deficiency anemia. This study was performed to evaluate the utilization, efficacy, and safety of IV iron formulations in management of cancer and chemotherapy induced iron deficiency anemia in patients with gastrointestinal (GI) cancer. Methods: Retrospective chart review was performed on DFCI patients with GI cancer undergoing palliative or adjuvant chemotherapy who received ferric gluconate, ferumoxytol, or iron sucrose between January 2021 and January 2022. Patients were identified using electronic medical record reports. Data was collected on cancer diagnosis, chemotherapy regimen, total IV iron dose and frequency, infusion reactions, laboratory values including hemoglobin, mean corpuscular volume (MCV), and iron status parameters (serum iron, ferritin, transferrin, iron-binding capacity, transferrin saturation) at baseline and 4-6 weeks after the last dose. The primary outcome was to assess the utilization of different IV iron formulations. Secondary outcomes were efficacy defined as mean absolute change from baseline in Hemoglobin levels and safety defined as incidence of hypersensitivity reactions. Results: 102 patients were evaluated of which 61 received ferumoxytol, 36 ferric gluconate and 5 iron sucrose. All patients had baseline hemoglobin (≤11 g/dL) and MCV collected. 89 patients had baseline iron status parameters (serum iron, ferritin, transferrin, iron-binding capacity, transferrin saturation). Most patients (N = 70) had diagnosis of colorectal cancer and received chemotherapy every 2 weeks. All patients received recommend total dose of IV iron on days of chemotherapy which was outside the recommended schedule of the IV iron formulations. A gradual increase in Hemoglobin concentrations in patients treated with IV iron was observed. Conclusions: Ferumoxytol and Ferric Gluconate were the most utilized IV iron formulation at DFCI GI oncology patients. All patients received recommended IV iron dosing but did not follow the recommended schedule. All patients had hemoglobin and MCV checked before each IV iron therapy. IV iron therapy was well tolerated and effective in treatment of iron-deficiency anemia in patients with gastrointestinal cancer undergoing chemotherapy.[Table: see text]

Evaluating the levels of vitamins E, C, Malondialdehyde and some hematological parameters and gamma glutamyl transferase in patients with leukemia

Leukemia is one of the most common cancer prevalent worldwide in both gender, and all races regardless of the level of living. It affects blood-forming tissues especially the bone marrow. Due to the importance of this disease and its risks, the study was carried out to evaluate the oxidative stress status and detect the effect of leukemia on some hematological parameters. Estimate gamma glutamyle transferase (GGT). A study was conducted between August 2016 till February 2017 in the center for Hematology/ Yarmouk Hospital. The blood samples were collected from 70 Iraqi patients with leukemia and 37 normal persons as control group, their ages ranged from (6-68 years). The statistical analysis of malondialdehyde (MDA) showed significant increase (P≤ 0.05) in patients with leukemia in compared to healthy. While there was significant decrease in Vitamin C and E concentration in patients (7.10 ± 0.49; 8.75 ± 0.65 µmol/L respectively) in compared with healthy group (18.83 ± 0.67; 25.83 ± 0.88 µmol/L respectively). The results of gamma glutamyle transferase (GGT) showed significant increase (P≤ 0.05) in patients with leukemia compared to healthy group. The results of hematological parameters showed significant decrease (P≤ 0.05) in each of packed cell volume (PCV) in patients with leukemia compared to healthy group, and hemoglobin concentration in patients compared to healthy group, while there was a significant increase (P≤ 0.05) in total leukocytes count in patients with leukemia when compared to healthy group. The results of the study showed a positive correlation between GGT and WBC.

A Case Report of Using Korean Medicine for the Treatment of Anemia of Chronic Disease (ACD) in a Patient with Dizziness, Anorexia, and General Weakness

The purpose of this study was to report the clinical effect of Korean medicine in a patient with anemia of chronic disease (ACD). The patient was treated with herbal medicine, acupuncture, and moxibustion in combination with Western medicine for around 4 weeks. Although the patient's hemoglobin concentration was maintained at a similar level, the other clinical symptoms of ACD (anorexia, xerostomia, dizziness, and general weakness) were improved after the treatment with Korean medicine. Therefore, Korean medicine treatment may be effective for improving the clinical symptoms of ACD.

Factors Affecting Doses of Roxadustat Versus Darbepoetin Alfa for Anemia in Nondialysis Patients

Introduction: Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor for treating anemia of chronic kidney disease (CKD). This post hoc analysis of a Japanese, open-label, partially randomized, phase 3 study in nondialysis-dependent (NDD) CKD patients treated with traditional erythropoiesis-stimulating agents (ESAs) evaluated dosing trends of roxadustat and darbepoetin alfa (DA) required to maintain target hemoglobin concentrations in patients with risk factors associated with ESA hyporesponsiveness. Methods: Patients enrolled in the 1517-CL-0310 study (NCT02988973) that demonstrated noninferiority of roxadustat to DA for change in average hemoglobin levels of week 18–24 from baseline who had used human recombinant erythropoietin or DA before conversion and who were randomized to either roxadustat or DA were included. The endpoints were the average allocated dose of roxadustat and DA per administration in the last 6 weeks (AAD/6W), assessed by subgroups known to be associated with ESA hyporesponsiveness. The analysis of variance was performed by the treatment group to test the influence of subgroup factors on the AAD/6W of study drug. The ratios between the mean AAD/6W in each subgroup category and the within-arm mean AAD/6W were calculated. Results: Two hundred and sixty-two patients were randomized to either the roxadustat or DA comparative group and received treatment (roxadustat, n = 131; DA, n = 131). Higher mean (standard deviation) doses of both roxadustat (63.15 [24.84] mg) and DA (47.33 [29.79] μg) were required in the highest ESA resistance index (≥6.8) quartile (p = 0.003 and p < 0.001, respectively). Patients with adequate iron repletion had the lowest doses for both roxadustat (45.54 [18.01] mg) and DA (28.13 [20.98] μg). High-sensitivity C-reactive protein ≥28.57 nmol/L and the estimated glomerular filtration rate <15 mL/min/1.73 m² were associated with requiring higher DA but not roxadustat doses. Discussion/Conclusion: The roxadustat dose required to maintain target hemoglobin in NDD patients in Japan with anemia of CKD relative to DA dose may not be impacted by low-grade inflammation. Roxadustat may be beneficial for ESA-hyporesponsive NDD CKD patients.

Randomized, Double-Blind Trial of Ferumoxytol Compared to Ferric Carboxymaltose for Treatment of Iron Deficiency Anemia: Safety and Efficacy

Background: Intravenous (IV) iron is often used to treat iron deficiency anemia (IDA) in patients unresponsive to, or intolerant of, oral iron. IV iron has been associated with rare, but potentially serious acute hypersensitivity reactions (HSRs). The few randomized trials which assessed comparative risks of adverse events (AEs) with IV iron formulations are limited by small numbers and lack statistical power to identify differences in low frequency AEs such as HSRs. We have attempted to correct this deficit in the literature, by conducting a randomized double-blind clinical trial comparing two IV iron preparations.Aims: To evaluate the comparative safety and efficacy of standard courses of two IV iron preparations, ferumoxytol and ferric carboxymaltose (FCM), with the primary endpoint being the combined incidence of moderate to severe HSRs, including anaphylaxis, or moderate to severe hypotension. A secondary safety endpoint was the composite incidence of moderate to severe HSRs, including anaphylaxis, serious cardiovascular events, or death. Efficacy endpoints included change from baseline in hemoglobin (Hb) and change in Hb per gram of iron administered.Methods: This randomized, double-blind, international, multicenter, trial (NCT02694978) included adults with IDA of any etiology excluding dialysis-dependent CKD (Hb <12.0 g/dL for females; <14.0 g/dL for males and transferrin saturation ≤20% or ferritin ≤100 ng/mL within 60 days of dosing) and a history of unsatisfactory response to or intolerance of oral iron. Randomization was 1:1 to ferumoxytol, administered as two 510 mg doses, or FCM, administered as two 750 mg doses both delivered as an IV infusion over at least 15 minutes on days 1 and 8. Patients were observed for at least 1 hour following the infusions. Follow-up visits were conducted at weeks 2 and 5. All events suggesting possible hypersensitivity or hypotension were reviewed and adjudicated by an expert, independent, blinded Clinical Events Committee (CEC) utilizing pre-specified criteria per protocol. All participants provided written informed consent before enrollment.Results: 2014 patients were randomized at 129 sites in North America (US and Canada) and Eastern Europe (Latvia, Lithuania, Poland, and Hungary). The safety population included the 1997 randomized patients who received any amount of study drug (mean age 55.2 ±17.2 years, 76.1% female, mean baseline values: Hb 10.4 g/dL, transferrin saturation 13.9%, serum ferritin 57.4 ng/mL). The most common underlying causes of IDA included: chronic kidney disease (27%), abnormal uterine bleeding (25%) and gastrointestinal disorders (29%). Ferumoxytol demonstrated non-inferiority (NI) to FCM with respect to both the primary (ferumoxytol rate: 0.6%; FCM rate: 0.7%; treatment difference: -0.1% ; 95% confidence interval: -0.80% to +0.61%) and secondary safety endpoints (ferumoxytol rate: 1.3%; FCM rate: 2.0%; treatment difference: -0.7% ; 95% confidence interval: -1.81% to +0.42%) [TABLE]. Ferumoxytol demonstrated non-inferiority to FCM for both secondary efficacy endpoints (mean change in Hb from Baseline to Week 5, and mean change in Hb from Baseline to Week 5 per gram of iron administered), while additionally demonstrating a significantly greater increase in Hb per gram of iron administered [FIGURE]. Median increase from Baseline to Week 5 in serum ferritin was 182.2 ng/mL for ferumoxytol and 320.5 ng/mL for FCM.Conclusion: While there is little debate as to the efficacy of IV irons on increasing hemoglobin concentrations in patients with IDA, the occurrence of rare but potentially serious acute HSRs continues to be a focus of concern. Very few well conducted trials have compared two or more IV iron formulations by evaluating HSR and hypotension as primary endpoints. In this study there was no significant difference between FCM and ferumoxytol in the composite endpoints of moderate to severe HSR, including anaphylaxis, or moderate to severe hypotension, serious cardiovascular events or all-cause mortality. [Display omitted] DisclosuresAuerbach:AMAG Pharma, Pharmacosmos, Luitpold: Consultancy; AMAG Pharma, Pharmacosmos: Research Funding. Strauss:AMAG pharmaceuticals: Employment, Equity Ownership. Macdougall:AMAG: Consultancy, Honoraria, Research Funding; Pharmacosmos: Honoraria; Vifor Pharma: Consultancy, Honoraria, Research Funding, Speakers Bureau; Akebia: Consultancy; GlaxoSmithKline: Consultancy; Astellas: Honoraria, Research Funding; FibroGen: Consultancy, Speakers Bureau. Bernard:AMAG: Employment. Kaper:AMAG Pharmaceuticals, Inc.: Employment. Chertow:AMAG: Consultancy; Akebia: Consultancy; Amgen: Consultancy, Research Funding; Keryx: Consultancy. Li:AMAG Pharmaceuticals: Employment, Equity Ownership. Trochanov:AMAG Pharmaceutical,Inc: Employment, Other: Company stock. Dahl:AMAG Pharmaceuticals. Inc.: Employment, Equity Ownership. Krop:AMAG Pharmaceuticals: Employment, Other: Stock in company.

Erythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery.

Erythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery.

Vitamin D status is associated with hepcidin and hemoglobin concentrations in patients with severe traumatic injury.

Severe traumatic injury leads to persistent injury-associated anemia that is associated with hypercatecholaminemia, systemic inflammation, increased hepcidin, and a functional iron deficiency. Vitamin D has been shown to reduce proinflammatory cytokines and hepcidin concentrations. This study aimed to investigate the association of vitamin D status with inflammation, iron biomarkers, and anemia following blunt trauma. A prospective observational cohort study comparing blunt trauma patients (n = 45) with elective hip replacement patients (n = 22) and healthy controls (n = 8) was performed. Bone marrow ferroportin, transferrin receptor, and erythroferrone expression was measured using quantitative polymerase chain reaction (qPCR). Plasma was assessed for systemic inflammation, erythropoietin (EPO), iron regulation, and vitamin D (25-OH) concentrations using enzyme-linked immunosorbent assay. Hemoglobin was measured on the day of discharge. Compared with hip replacement, trauma patients had higher plasma interleukin-6 (90.1 vs. 3.8 pg/mL), C-reactive protein (6,223 vs. 2,612 ng/mL), and hepcidin (79.3 vs. 21.2 ng/mL) concentrations. Trauma patients had lower vitamin D (25-OH) (12.8 vs. 18.1 ng/mL) and iron (23.5 vs. 59.9 μg/mL) levels compared with hip replacement patients. Despite the higher hepcidin EPO levels, bone marrow erythroferrone expression was increased 69% following trauma. Following elective hip replacement, patients did have anemia and impaired iron homeostasis without a significant change in inflammatory biomarkers, EPO, and vitamin D status. Vitamin D status did correlate with systemic inflammation, iron dysfunction, and persistent injury-associated anemia following severe blunt trauma. Further research is needed to determine whether supplementation with vitamin D in the trauma population could improve the persistent injury-associated anemia. Prospective study, prognostic, level III.

Interdialytic Weight Gain Effects on Hemoglobin Concentration and Cardiovascular Events

IntroductionAlthough predialysis hemoglobin concentration is affected by interdialytic weight gain (IDWG), the interaction between these parameters is not well understood.MethodsUsing data from the Japanese Dialysis Outcomes and Practice Pattern Study phases 1–5, we analyzed patients who underwent maintenance hemodialysis. The exposure variable was hemoglobin concentration, and the effect modifier was IDWG at baseline. These 2 categorical variables were then combined and analyzed. The primary outcome was major adverse cardiovascular events (MACEs). Hazard ratios were estimated using a Cox model for the association between exposure and MACEs after adjusting for potential confounders. We examined additive interactions between hemoglobin concentration and IDWG by calculating the relative excess risk due to interaction, which is defined as a departure from the additivity of effects.ResultsA total of 8234 patients were enrolled. During a median follow-up of 2.1 years, 1062 (12.9%) patients developed MACEs. In IDWG categories of <6%, adjusted hazard ratios for MACEs tended to be lower as hemoglobin concentration increased. In IDWG categories of ≥6%, point estimation of MACEs with hemoglobin concentration of ≥11.0 g/dl–<12.0 g/dl was higher than that with hemoglobin concentration of ≥10.0 g/dl–<11.0 g/dl. The relative excess risk due to interaction was 0.22 (95% confidence interval 0.02–0.42) between IDWG category of ≥6% and hemoglobin categories of ≥11.0 g/dl–<12.0 g/dl, indicating a synergistic interaction.ConclusionsThe association between hemoglobin concentration and MACEs differed across IDWG. Consideration should be given to the upper limit of hemoglobin concentration in patients with high IDWG.

Hematological alterations in lepromatous leprosy: A cross-sectional observational study

BackgroundDapsone has been the mainstay for the treatment of leprosy since its discovery in the 1940s. However, hematological disturbances are not uncommon in leprosy patients on daily dapsone therapy. Hence, the present study was conducted to document the hematologic alterations observed in lepromatous leprosy patients treated with Dapsone 100 mg daily. MethodologyA cross-sectional observational study was conducted amongst 32 lepromatous leprosy patients treated with Dapsone 100 mg daily. A complete hemogram was conducted for all the study recruits. The test results were compared against the standard average values for adults for the given variables. The one sample t-test was employed to compare the difference between the study values and the standard normal values for adults. The statistical significance was considered at p < 0.05. ResultsThe study reveals a marked decrease in hemoglobin concentration in patients on dapsone, 100 mg daily. Other hematological alterations found were reduced platelet count, reduced mean platelet volume, reduced Hematocrit, reduced Mean Corpuscular hemoglobin, reduced Mean Corpuscular hemoglobin concentration. (p < 0.05). ConclusionTreatment of lepromatous leprosy with 100 mg daily Dapsone therapy may lead to hematological alterations. These findings are suggestive of dapsone-induced hemolysis.

Circulating endothelial cells in severe Plasmodium falciparum infection

Plasmodium falciparum infection is associated with diffuse vascular dys-regulation. Levels of blood circulating endothelial cells (CECs; CD146+CD45−) are a marker of vascular injury. This study aimed to measure blood CECs by flow cytometery in patients with acute malaria infection before and after treatment and to evaluate the prognostic value of that measurement for that disease. The subjects were allocated into: Group I: uncomplicated malaria (UM, n = 32), Group II: severe malaria (SM, n = 12), Group III: the treated UM (TUM, n = 32), Group IV: the treated SM (TSM, n = 12) and Group V: healthy controls (HC, n = 25). Before treatment, SM patients showed the highest mean number of CECs (30,658.3 ± 2658.2/5 × 106 peripheral blood mononuclear cells (PBMCs)), followed by UM patients (19,481.56 ± 866.83/5x106PBMCs) and both groups were significantly higher than HC (2034 ± 300.59/5x106PBMCs, P < .001). The level of CECs decreased significantly in both infected groups after treatment; in TUM it became 5602.18 ± 509.72/5 × 106PBMCs and in TSM it reached 8457.5 ± 452.4/5 × 106 PBMCs (both values P < .001 in comparison with SM). By receiver operating characteristic curve analysis, the best cut-off count for CECs which enables prediction of the occurrence of severe malaria infection was 27,150/5 × 106 PBMCs or more, with 100% sensitivity, 100% specificity, and 100% accuracy. CECs had a significant positive correlation with parasitemia index and serum creatinine and a significant negative correlation with hemoglobin concentration in patients with acute malaria. In conclusion, the level of CECs could be used as a biomarker denoting endothelium damage during acute P. falciparum infection, and it correlated with infection severity and predicted its prognosis.

Hemoglobin Concentration in Patients With an Acute Respiratory Distress Syndrome

Hemoglobin Concentration in Patients With an Acute Respiratory Distress Syndrome

Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre

ObjectiveTo determine whether not waiting for the elimination of direct oral anticoagulants (DOACs) has an effect on the amount of perioperative bleeding in patients who undergo operative treatment of a...

Comparison of Dosage Requirement of Erythropoietin Stimulating Agent (ESA) in Maintenance of Hemoglobin Concentration in patients undergoing twice weekly versus thrice weekly Hemodialysis in Pakistani Population

Anemia is one of the major complications of patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and is associated with left ventricular hypertrophy and also increases morbidity and mortality. Anemia in patients with CKD can be due to two major reasons; iron deficiency or erythropoietin insufficiency. Erythropoietin Stimulating Agent (ESAs) administration is the mainstay in treating anemia if the patient is iron sufficient. However, higher doses of ESAs have been associated with increased cerebrovascular and cardiovascular events. We conducted this study to see how much erythropoietin is required in our setting in iron sufficient patients to maintain hemoglobin(Hb) level and the effect of dialysis frequency on ESA doses. &#x0D; Methods and Findings:&#x0D; A cross-sectional study was conducted at the Department of Nephrology at Ziauddin University Hospital. Patients’ charts were reviewed for Hb levels and doses of ESA to maintain Hb between 10-12 mg/dl. Patients were excluded if they had iron deficiency, malignancy, were on immunosuppressive agents, had renal transplant, and with Hb &gt;12 mg/dl or &lt;10 mg/dl and their ferritin levels, transferrin saturation, hemoglobin concentration, frequency of hemodialysis and ESA dosage were monitored. We also compared these variables between patients undergoing hemodialysis thrice weekly with those undergoing hemodialysis twice a week.&#x0D; A total of 105 patients were analyzed. 24 were excluded as they did not match the inclusion criteria. 81 patients were included in the study. 36 (44.4%) were males and 45 (55.6%) were females. Mean age of the patient was 56.47 ± 11.72 years. The average dose of ESA was 106.91 ± 61.47 for patients undergoing hemodialysis thrice weekly and 183.94 ± 116.71 for patients undergoing hemodialysis twice a week. Significant difference was found to exist between dosage of patients undergoing thrice weekly dialysis versus twice weekly dialysis(p=&lt;0.001).&#x0D; Our study has limitations. First our study only looked at Hb levels, iron stores and dosages of ESA, while other factors like Parathyroid Hormone(PTH) levels and Vitamin B12 were not considered that may have a role in anemia of chronic renal disease. In addition, it was a study limited to one center only and a multicenter trial should be taken to validate the results. We have reported one aspect of dialysis vintage i.e. high ESA dosage requirement&#x0D; Conclusion:&#x0D; We found that patients undergoing hemodialysis three times a week require recommended dosage of ESA; however those undergoing hemodialysis less than three times a week require higher dosage of ESA to maintain Hb level. Here we report significant effect of hemodialysis on ESA dosage to maintain same level of Hb.

SERUM IRON AND FREE HEMOGLOBIN CONCENTRATIONS IN PATIENTS WITH ACUTE ISCHEMIC STROKE

A number of evidences suggest that during ischemic stroke, serum iron and hemoglobin (Hb) levels are changed. Yet, there are few reports in the literature related to this issue and resolution of this mechanism requires further experiments. The aim of the present study was to investigate the potential role of serum iron and hemoglobin levels as a biomarker in diagnosis of acute ischemic stroke. The sample size was 60 ischemic stroke patients who were admitted to the Rouhhani hospital in Babol, with 60 healthy volunteers selected as control group. Clinical evaluation consisted of complete medical history and physical examination and neuro-imaging's studies. Sampling strategy was based on clinical characteristics, including age, gender, and history of diseases. Laboratory measurements were performed in the department of clinical biochemistry. Serum iron and plasma hemoglobin levels were measured by standard kit of iron and hemoglobin ELISA Kit, as of the manufactures' manual. Data were analyzed through statistical software SPSS version 22. The mean level of serum iron and hemoglobin in patients with acute ischemic stroke were higher than those in control group (P 0.05). Our results reinforce the possibility of serum iron and hemoglobin as biomarker in diagnosis of ischemic stroke patients.

Optimal hemoglobin concentration in patients with aneurysmal subarachnoid hemorrhage after surgical treatment to prevent symptomatic cerebral vasospasm.

Medical complications occur frequently after aneurismal subarachnoid hemorrhage (aSAH), such as cerebral vasospasm (CVS), anemia, etc. The relationship between hemoglobin (Hgb) concentration and the occurrence of CVS after aSAH remains largely elusive. A total of 218 patients with postoperative aSAH were recruited. Symptomatic cerebral vasospasm (SCVS) was initially diagnosed on the basis of their clinical signs and symptoms, and confirmed by imaging tests. The patients were then divided into four groups on the basis of the postoperative mean Hgb concentration (<11, 11-12, 12-13, and >13 g/dl). The possible influential factors that were statistically significant in the initial univariate analysis were subjected to a multivariable logistic regression analysis. Univariate analysis showed that Hunt and Hess neurological grade on admission, intraoperative aneurysm rupture, CT Fisher grade, and postoperative mean Hgb were associated significantly with SCVS in aSAH patients after surgical treatment (P<0.05). Subsequent multivariable analysis showed that postoperative mean Hgb remained significant after adjustment for Hunt and Hess neurological grade on admission and CT fisher grade. The incidence of SCVS in the group with an Hgb concentration 11-12 g/dl was found to be the lowest among all groups [odds ratio (OR), 3.29, 95% confidence interval (CI), 1.43-7.58, P=0.005; OR, 3.63, 95% CI, 1.41-9.34, P=0.007; OR, 5.34, 95% CI, 1.85-15.43, P=0.002]. Postoperative Hgb concentration is an independent risk factor for SCVS in aSAH patients following surgery, and maintaining the concentration at 11-12 g/dl may reduce the incidence of SCVS.

Serum erythropoietin level in anemia of chronic kidney disease - experience of a Romanian medical centre / Nivelul eritropoietinei serice în anemia din boala renală cronică - experiența unui centru medical românesc

AbstractIn this study, different aspects of anemia in chronic kidney disease have been observed, starting from the fact that the severity of anemia is associated with the degree of kidney dysfunction, the main cause being the erythropoietin deficiency, which is synthesized mostly by the kidneys. 58 persons were included in this study, 19 patients with non-dialysis-dependent chronic kidney disease, 18 patients with chronic kidney disease who received kidney transplantation and 21 apparently healthy persons. We evaluated the serum level of erythropoietin, serum creatinine, proteinuria, the glomerular filtration rate, the erythrocyte parameters and the correlations between them. The prevalence of anemia in patients with chronic kidney disease was of 51.35%. The hemoglobin concentration in patients with kidney transplantation (12.4 ± 2.7 g/dL) and in non-dialysis-dependent patients (11.7 ± 1.4 g/dL) is significantly different compared to the apparently healthy persons (14.6 ± 0.8 g/dL) (p&lt;0.05). In the case of the non-dialysis-dependent patients who were not treated with erythropoiesis- stimulating agents we found positive associations between the glomerular filtration rate and the number of erythocytes (r = 0.71), hemoglobin (r = 0.65) and hematocrit (r = 0.73), as well as negative associations between creatinine and the number of erythrocytes (r = -0.72), hemoglobin (r = -0.86) and hematocrit (r = -0.88). In patients with kidney transplantation and anemia we observed positive correlations between erythropoietin and the number of erythrocytes (r = 0.69), between the glomerular filtration rate and the number of erythrocytes (r = 0.78) and erythropoietin (r = 0.97), as well as negative correlations between proteinuria and the number of erythrocytes (r= -0.89), hemoglobin (r= -0.72), hematocrit (r = -0.72), and erythropoietin (r = -0.67), and between creatinine and the number of erythrocytes (r = -0.75) and erythropoietin (r = -0.86).

Parathyroid hormone may be an early predictor of low serum hemoglobin concentration in patients with not advanced stages of chronic kidney disease.

BackgroundParathyroid hormone (PTH) has been associated with anemia only in dialysis patients with severe hyperparathyroidism. Whether an association between PTH and hemoglobin also exists in patients with chronic kidney disease not on dialysis (CKD-patients) is still unclear. In this study we evaluated the association between PTH and hemoglobin in CKD-patients without severe secondary hyperparathyroidism.MethodsHospitalized patients and outpatients (N = 979) were retrospectively evaluated and categorized according to PTH quartile and serum hemoglobin (<12.0, <11.0, <10.0 g/dl). Gender, diabetes, glomerular filtration rate (GFR), hemoglobin, PTH, markers of mineral metabolism, inflammation, iron status and nutrition were variables of adjustment in univariate and multivariate analysis.ResultsAn inverse association (p = 0.001) was observed between PTH and hemoglobin in patients as a whole, in diabetics, and in patients with GFR ≤60 ml/min. PTH was the single predictor of low hemoglobin in patients as a whole (unstandardized beta −2.12; p = 0.005), in diabetics (unstandardized beta −8.86; p = 0.007) and in patients with GFR ≤60 ml/min (unstandardized beta −2.52; p = 0.006). For each increase of quartile of PTH the risk of having hemoglobin level <10.0 mg/dl was more than doubled [hazard ratio (HR) 2.79, 95 % confidence interval (CI) 2.00–3.88; p = 0.001]. The receiver operating characteristic curve showed that PTH ≥122 pg/ml had 67 % sensitivity and 75 % specificity in predicting hemoglobin level <10.0 g/dl with area under the curve of 0.758 (95 % CI 0.73–0.78).ConclusionsThis study shows a significant inverse association between PTH and hemoglobin levels across the whole spectrum of non-dialysis CKD and a doubled risk of having serum hemoglobin <10.0 mg/dl in the absence of severely deranged PTH concentration. These findings may have clinical relevance in ascertaining the cause of unexplained low hemoglobin levels in CKD-patients.