Reduction In Hemoglobin Levels Research Articles

Decline in Hemoglobin during Hospitalization May Be Associated with Poor Outcome in Acute Stroke Patients

Anemia upon hospital admission is a known predictor of poor functional outcomes in patients with acute cerebral infarction. However, it remains unclear whether reductions in hemoglobin levels during hospitalization influence stroke outcomes. We investigated the association between in-hospital decline in hemoglobin and poor outcomes. We retrospectively analyzed data from 480 consecutive patients who had experienced acute cerebral infarction and presented without anemia between January 2012 and March 2015. Decline in hemoglobin was taken as the difference between hemoglobin levels upon admission and nadir hemoglobin. Poor outcome was defined as a modified Rankin Scale score 3-6. A multivariate analysis of the relationship between decline in hemoglobin and poor outcome at discharge was conducted for various patient characteristics. The mean hemoglobin level at admission was 14.3 ± 1.3 g/dL, whereas the mean nadir hemoglobin value was 13.1 ± 1.9 g/dL, with a mean decline in hemoglobin of 1.3 ± 1.5 g/dL. In patients with poor outcomes, mean decline in hemoglobin was significantly reduced to 3.1 g/dL (P < .001). The optimal cutoff decline in hemoglobin required to distinguish a poor outcome was 1.5 g/dL whereas the sensitivity and specificity were 62% and 82.3%, respectively, with an area under the curve of .77 (P < .0001). A decline in hemoglobin below 1.5 g/dL was found to be an independent predictor of poor outcome (odds ratio: 2.10; confidence interval: 1.10-3.99; P = .023). Decline in hemoglobin in patients hospitalized with acute stroke may be associated with poor outcome.

The effect of Plantago oral syrup on hemoglobin and hematocrit levels in women with normal postpartum hemorrhage

Introduction: Postpartum hemorrhage is one of the major causes of maternal mortality, especially in the developing countries. Some studies have shown the positive effects of Plantago on postpartum hemorrhage. We conducted this study to determine the effects of Plantago syrup on postpartum hemoglobin and hematocrit levels in low-risk women in terms of postpartum hemorrhage. Methods: A double-blind, randomized, clinical trial was carried out on all the women who had gone through normal vaginal delivery in Ganjavian Maternity Clinic of Dezful, Iran, in 2017. The participants were randomly assigned to intervention and placebo group (n=50 per group). Immediately after placental expulsion, the intervention group received 100 cc of Plantago extract 20% and infusion of 20 U of oxytocin in 1 L of Ringer’s solution, and the control group was given 100 cc of placebo syrup and infusion of 20 U of oxytocin in 1 L of Ringer’s solution. Hemoglobin and hematocrit levels were measured in all the participants 6 h postpartum. To analyze the data, independent t-test, Fischer’s Exact test, Mann-Whitney U test, Kendall rank correlation coefficient, Chi-squared test, and repeated measures analysis of variance (ANOVA) were run in SPSS, version 17. Results: There was a significant difference between the two groups in terms of hemoglobin and hematocrit reduction. Before the intervention, the mean levels of hemoglobin and hematocrit in the intervention group were 12.60±3.8 g/dl and 36.69±3.3%, respectively, and in the control group, they were 12.25±1.1 g/dl and 38.06±3.4%, respectively (P>0.005). After the intervention, the mean reduction in hemoglobin level in the intervention and control groups was 1.17±0.4 and 2.19±0.6 g/dl, respectively (P=0.001). Conclusion: Oral Plantago syrup played a significant role in lowering the mean reduction in hemoglobin and hematocrit levels after delivery. The use of this syrup could help prevent the complications of postpartum anemia.

Intra-Articular Tranexamic Acid Injection During the Hip Hemi-Arthroplasty in Elderly Patients: A Retrospective Study.

Introduction:The objective was to evaluate the safety and efficacy of intra-articular injection of tranexamic acid (TXA) in patients between 80 and 100 years of age with femoral neck fracture undergoing hip hemi-arthroplasty (HA).Material and Methods:We conducted a retrospective review to assess perioperative blood loss and transfusion rate after intra-articular injection of TXA during HA. This was a single-center, retrospective, single-surgeon, and standard care cohort study covering the period between January and December 2016. One hundred three consecutive patients undergoing HA under spinal or general anesthesia were included. Fifty-four and 49 patients received and did not receive intra-articular injection of TXA during the HA, respectively. After closing the capsule, 50 mL of a TXA solution at a concentration of 1 g/100 mL of saline was injected into joint capsule. We compared the following outcomes: preoperative hemoglobin (HB) level, postoperative day 1 HB level, postoperative day 3 HB level, the net reduction of HB level by postoperative day 3, transfusion rate, and 30- and 90-day postoperative mortality rates. In addition, we use logistic regression to analyze the factors affecting the transfusion rate.Result:Day 3 postoperative HB level and the net reduction in HB level within 3 days following surgery were 93.22 ± 11.70 g/L and 25.98 ± 6.29 g/L in TXA group, respectively, while were 87.10 ± 10.52 g/L and 35.44±8.61 g/L in no-TXA group. Transfusion rate was 9% (5/54) in TXA group and 24% (12/49) in no-TXA group, respectively. The differences were statistically significant between the both groups. Logistic regression indicated that the topical administration of TXA would reduce the risk for transfusion, while in male diabetes mellitus would increase the risk. There were no significant differences in the deep venous thrombosis, pulmonary embolism, and mortality rates of 30 and 90 days postoperatively (P > .05).Discussion:Because of lower systemic absorption and a higher concentration in the wound, topical use of TXA is safer for elderly patients who may have renal or liver dysfunction. TXA at therapeutic concentration does not affect platelet count, platelet aggregation, or coagulation parameters, and is of value in elderly patients who take antiplatelet drug for secondary prevention of cardiovascular diseases.Conclusion:For patients between 80 and 100 years of age with femoral neck fracture undergoing HA, intra-articular injection of TXA may reduce the perioperative blood loss and transfusion rate without increasing risk of thrombosis.

Simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy.

ABSTRACTObjective:To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients.Patients and Methods:We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization.Results:There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stone-free and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases.Conclusion:With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi.

Miniaturized percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones with a diameter

Aim:The aim of this study is to compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in management of renal stones with a diameter <15 mm.Materials and Methods:This was an open-label prospective study that included a total of 80 cases underwent mini-perc (n = 40) and RIRS (n = 40) between July 2014 and August 2017. The primary outcome objective was stone-free rate, retreatment rate, complications, hospital stay, operative time, and reduction in hemoglobin level. Data were analyzed using SPSS version 16.0 Software.Results:Overall, 80 patients were enrolled in this study. The mean age was 40.12 and 38.20 years, and the mean stone size was 1.15 and 1.30 cm in mini-perc and RIRS group, respectively. Majority of the study participants were males. Overall, mini-perc and RIRS had stone clearance rates of 100% and 95.4%, respectively. Two patients required retreatment in RIRS group. The duration of hospital stay and the rate of complication was similar in both the groups. Operative duration was more in RIRS group. Decrease in hemoglobin level was more in mini-perc group.Conclusions:Results demonstrated that both modalities were associated with high stone clearance rates with minimal complications. RIRS was associated with less reduction in hemoglobin and could be used as standard treatment modality for small renal calculi.

Tranexamic Acid for Lower GI Hemorrhage: A Randomized Placebo-Controlled Clinical Trial.

Lower GI hemorrhage is a common source of morbidity and mortality. Tranexamic acid is an antifibrinolytic that has been shown to reduce blood loss in a variety of clinical conditions. Information regarding the use of tranexamic acid in treating lower GI hemorrhage is lacking. The aim of this trial was to determine the clinical efficacy of tranexamic acid when used for lower GI hemorrhage. This was a prospective, double-blind, placebo-controlled, randomized clinical trial. The study was conducted at a tertiary referral university hospital in Australia. Consecutive patients aged >18 years with lower GI hemorrhage requiring hospital admission from November 2011 to January 2014 were screened for trial eligibility (N = 265). A total of 100 patients were recruited after exclusions and were randomly assigned 1:1 to either tranexamic acid or placebo. The primary outcome was blood loss as determined by reduction in hemoglobin levels. The secondary outcomes were transfusion rates, transfusion volume, intervention rates for bleeding, length of hospital stay, readmission, and complication rates. There was no difference between groups with respect to hemoglobin drop (11 g/L of tranexamic acid vs 13 g/L of placebo; p = 0.9445). There was no difference with respect to transfusion rates (14/49 tranexamic acid vs 16/47 placebo; p = 0.661), mean transfusion volume (1.27 vs 1.93 units; p = 0.355), intervention rates (7/49 vs 13/47; p = 0.134), length of hospital stay (4.67 vs 4.74 d; p = 0.934), readmission, or complication rates. No complications occurred as a direct result of tranexamic acid use. A larger multicenter trial may be required to determine whether there are more subtle advantages with tranexamic acid use in some of the secondary outcomes. Tranexamic acid does not appear to decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage in the context of this trial. see Video Abstract at http://links.lww.com/DCR/A453.

Outcome of Cesarean Myomectomy: Is it a Safe Procedure?

Objective Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy. Method A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant. Results While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05). Conclusion This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.

The Possibility of Forecast an Expressed Intraoperative Bleeding During Transurethral Resection of the Prostate using Preoperative Transrectal Ultrasound

There is no doubt about the prevalence rate of benign prostate hyperplasia. Currently, transurethral prostate resection (TUR) is the main method of surgical treatment. To clarify the degree of possible intraoperative bleeding, we assume the application of pre-hospital transrectal ultrasonic prostate examination (TRU) with vascular Doppler and 2D Shear Wave elastography.The aim: to evaluate the possibilities of preoperative complex TRU prostate examination in forecasting of the expressed intraoperative bleeding.Materials and methods. The study included the results of a survey of 242 patients in the urological Department of the road clinical hospital of Rostov-on-don in the period from 2016 to 2017, which had undergone TUR of the prostate. All patients before the operation was performed prostate transrectal ultrasonography (TRU) with Doppler and 2D Shear Wave Elastography (2DSWE). Depending on the amount of blood loss determined after surgery, all patients were divided into three statistically (p &lt; 0.001) significant groups (р &lt; 0.001). All TRU examinations were made with ultrasound system Aixplorer (France). During Doppler sonography, maximal linear blood flow velocity (Vmax) in capsular arteries (CA), in “surgical capsule” arteries (SCA) and in the paraurethral artery (PuA) was measured. During 2D Sheare Wave elastography (2D SWE) stiffness of tissues was measured (in kPa) in symmetric areas of both lobes of peripheral zone (PPZ), central zone (CZ), and transitory zone (TZ) of prostateResults. Significant (p &lt; 0.001) correlation of blood loss with reduction of hemoglobin level, as well as with Vmax CA, Vmax PuA, tissue stiffness TZ and areas on the border with the surgical capsule revealed. The ROC analysis showed, that sensitivity and specificity of predictions of severe intraoperative blood loss, when using a cut-off for the Vmax of the blood flow in CA more 18.7 cm/s, was respectively 87.2% and 94.4 per cent; when using a cut-off for the Vmax of the blood flow in the basin PUA over 24.2 cm/s – respectively of 76.6% and 78.5%; when using a cut-off of stiffness of the tissues TZ less of 39.8 kPa – respectively 100% and 95.4%: when using a cut-off of stiffness of the tissues at the border of the “surgical capsule” less than the 38.1 kPa – respectively 89,4% and 90,8%.Conclusion.The use of cut-off Vmax values for the blood flow in the paraurethral and capsular arteries, as well as the use of cut-off values for tissue stiffness in the prostate transitory zone of prostate and in the surgical capsule area, may be an effective means of forecasting of expressed intraoperative bleeding. The data presented is recommended to take into account the operating surgeon during the selection of patients for operative benefits.

Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities

BackgroundResistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission.MethodsP. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery.ResultsP. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (–1.17 g/dL, 95% CI –2.09 to –0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (–1.66 g/dL, 95% CI –2.68 to –0.64) and Gabonese (–0.91 g/dL, 95% CI –1.79 to –0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (–0.16 g/dL, 95% CI –0.29 to –0.02) and increases in the drop of haemoglobin levels (–0.29 g/dL, 95% CI –0.44 to –0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P < 0.001). No difference was found in the proportion of submicroscopic infections nor in the adverse impact of P. falciparum infections in HIV-infected women from Kenya (P. falciparum prevalence by qPCR: 9%, 32/351) and Mozambique (4%, 15/417).ConclusionsThe lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of P. falciparum infections. Exposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. Distinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease.Trial registrationClinicalTrials.gov NCT00811421. Registered 18 December 2008.

Hepcidin plasma levels are not associated with changes in haemoglobin in early rheumatoid arthritis patients

Objective: A reduction in haemoglobin level is a frequent complication among rheumatoid arthritis (RA) patients. Hepcidin has been linked to disturbed erythropoiesis. The objective of this study was to investigate the longitudinal changes in hepcidin in patients with early RA.Method: Hepcidin plasma concentrations were measured by enzyme-linked immunosorbent assay in patients with early RA (n = 80) and healthy volunteers (HV, n = 40). Haemoglobin and other iron-related proteins were also measured. At baseline, all patients had active disease and were treatment naïve. Patients were treated with disease-modifying anti-rheumatic drugs (DMARDs) and with additional adalimumab (ADA, n = 42) or placebo (PLA, n = 38) during 52 weeks, using a treat-to-target strategy, aiming for a 28-joint Disease Activity Score (DAS28) < 3.2.Results: At baseline, hepcidin levels [median (interquartile range)] were 9.7 ng/mL (5.2–19.4 ng/mL) in DMARD + ADA and 11.3 ng/mL (5.9–19.1 ng/mL) in DMARD + PLA. Both were significantly higher than seen in HV (6.0 ng/mL (3.3–9.3 ng/mL) (p < 0.001). After 12 months, both treatment regimens resulted in normalization of hepcidin. DAS28 correlated with hepcidin at baseline (r = 0.48, p < 0.001). No correlation was observed between levels of haemoglobin and hepcidin at baseline or during the 52 week follow-up. No change in haemoglobin levels was seen as a function of hepcidin changes. In a mixed statistical model, no single factor was connected with the regulation of haemoglobin in early RA.Conclusion: The changes in hepcidin were not associated with changes in haemoglobin levels. Thus, hepcidin could not be used as a prognostic marker in patients with early RA.

Autologous Blood Donation Before Hepatectomy in Patients With Chronic Kidney Disease

Autologous blood is sometimes collected before hepatectomy. The usefulness of autologous blood donation (ABD) has been reported in several studies. However, the relationship between ABD and CKD has never been studied. The aim of this study was to clarify the relationship between preoperative autologous blood donation (ABD) and chronic kidney disease (CKD) in anemia. Between January 2006 and December 2012, 70 patients made 2 ABDs ≥ 600 mL before hepatectomy. CKD stages were based on estimated glomerular filtration rates. Univariate analyses were performed using the Mann–Whitney U test for continuous variables and the chi-square test for nominal variables. Patients at CKD stages &amp;lt; G3b (n = 60) and ≥ G3b (n = 10) were compared. There were no significant differences in hemoglobin level at the initial hospital visit or total volume of ABD between the 2 groups. However, hemoglobin levels just before the first ABD, the second ABD, and resection, and just after resection were significantly lower in the CKD ≥ G3b group than those in the &amp;lt; G3b group (P &amp;lt; 0.05). CKD stage contributes to reductions in hemoglobin levels after ABD. We recommend the use of erythropoietin in CKD ≥ G3b cases that include ABDs.

Pregnancy After Roux en Y Gastric Bypass: Nutritional and Biochemical Aspects.

Although pregnancy after bariatric surgery is related to risk reduction, nutritional complications may occur. This study aimed to evaluate nutritional and biochemical indicators of women who became pregnant after Roux en Y gastric bypass (RYGB). We carried out a retrospective study with women who became pregnant after RYGB. We evaluated anthropometric, biochemical, and dietary intake indicators in the preoperative period and before, during, and after pregnancy by analysis of medical records. Shapiro-Wilk test and ANOVA for repeated measures were performed (p<0.05). The study included 25 patients (35.7±3.8years), who became pregnant 31.3±21.7months after RYGB. Weight loss until the beginning of pregnancy was 32.4%, and the gestational weight gain was 3.8±12kg. There was a higher frequency of patients with hypertension in the preoperative time when compared to that during the pregnancy period. Total cholesterol (180.9±24.8 versus 148.5±30.4mg/dL), LDL-cholesterol (103.5±19.2 versus 85.8±23.1mg/dL), HDL-cholesterol (56.4±8 versus 46.9±8.7mg/dL), and latent iron-binding capacity (337.6±95.8 versus 277.8±65μg/dL) were higher during the pregnancy compared to that before the pregnancy, while hemoglobin values (11.2±1 versus 12.3±1.2g/dL) and sodium (138.8±2.9 versus 141±3mmol/L) were lower. No differences of food intake were found among times. There is no difference on gestational weight gain between women who became pregnant before or after the first year. During pregnancy, there was an expected weight gain and maintenance of the lipid profile within the normal range; however, there was a reduction of hemoglobin levels. These findings show the need for individualized follow-up with adequate nutritional intervention in the event of deficiencies.

A non-randomized prospective study of the blood sparing effect of tranexamic acid in total knee replacement

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Several techniques are available to minimize the likelihood of blood transfusion following total knee arthroplasty. Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip and total knee arthroplasties with or without cement. The objective of this study was to assess the efficacy of antifibrinolytic treatment along with other measures like saline adrenaline infusion, no drain, no tourniquet and hypotensive anaesthesia in reducing perioperative blood loss during total knee replacement&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Between January 2011 to January 2016, seventy five consecutive patients who had given written informed consent, undergoing a TKR received tranexamic acid 15 mg/kg body weight intravenous 5 minutes before the skin incision and two doses afterwards (3 and 6 hours after the first dose respectively). TKR was performed in a routine fashion without tourniquet. The saline adrenaline (1:200000) was infiltrated into the skin subcutaneous tissue and capsule before skin incision. A routine closure was carried out without drain. Total blood loss including the hidden blood loss was calculated. All patients were monitored for anemia and postoperative thromboembolic complications.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average total blood loss in study group is 433 ± 148 ml. This is much lesser than what other studies have reported. Mean reduction in hemoglobin levels (gm/dl) between preoperative and postoperative readings is 1.6 gm/dl. One patient had a postoperative DVT which was treated with rivaroxaban 20 mg OD for 6 weeks (oral anticoagulant)&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Antifibrinolytic agents like tranexamic acid used along with other measures reported in this study produces a significant decrease in blood loss in patients undergoing total knee replacement&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Plasmodium falciparum Infection Status among Children with Schistosoma in Sub-Saharan Africa: A Systematic Review and Meta-analysis.

BackgroundIt has been suggested that Schistosoma infection may be associated with Plasmodium falciparum infection or related reduction in haemoglobin level, but the nature of this interaction remains unclear. This systematic review synthesized evidence on the relationship of S. haematobium or S. mansoni infection with the occurrence of P. falciparum malaria, Plasmodium density and related reduction in haemoglobin level among children in sub-Saharan Africa (SSA).Methodology/Principal findingsA systematic review in according with PRISMA guidelines was conducted. All published articles available in PubMed, Embase, Cochrane library and CINAHL databases before May 20, 2015 were searched without any limits. Two reviewers independently screened, reviewed and assessed all the studies. Cochrane Q and Moran’s I2 were used to assess heterogeneity and the Egger test was used to examine publication bias. The summary odds ratio (OR), summary regression co-efficient (β) and 95% confidence intervals (CI) were estimated using a random-effects model. Out of 2,920 citations screened, 12 articles (five cross-sectional, seven prospective cohort) were eligible to be included in the systematic review and 11 in the meta-analysis. The 12 studies involved 9,337 children in eight SSA countries. Eight studies compared the odds of asymptomatic/uncomplicated P. falciparum infection, two studies compared the incidence of uncomplicated P. falciparum infection, six studies compared P. falciparum density and four studies compared mean haemoglobin level between children infected and uninfected with S. haematobium or S. mansoni. Summary estimates of the eight studies based on 6,018 children showed a higher odds of asymptomatic/uncomplicated P. falciparum infection in children infected with S. mansoni or S. haematobium compared to those uninfected with Schistosoma (summary OR: 1.82; 95%CI: 1.41, 2.35; I2: 52.3%). The increase in odds of asymptomatic/uncomplicated P. falciparum infection among children infected with Schistosoma remained significant when subgroup analysis was conducted for S. haematobium (summary OR: 1.68; 95%CI: 1.18, 2.41; I2: 53.2%) and S. mansoni (summary OR: 2.15; 95%CI: 1.89, 2.46: I2: 0.0%) infection. However, the density of P. falciparum infection was lower in children co-infected with S. haematobium compared to those uninfected with Schistosoma (summary-β: -0.14; 95% CI: -0.24, -0.01; I2: 39.7%). The mean haemoglobin level was higher among children co-infected with S. haematobium and P. falciparum than those infected with only P. falciparum (summary-mean haemoglobin difference: 0.49; 95% CI: 0.04, 0.95; I2: 66.4%)Conclusions/SignificanceThe current review suggests S. mansoni or S. haematobium co-infection may be associated with increased prevalence of asymptomatic/uncomplicated P. falciparum infection in children, but may protect against high density P. falciparum infection and related reduction in haemoglobin level.

Injectable mineral supplementation to transition period dairy cows and its effects on animal health

The dairy cattle production rises worldwide, with genetically selected animals. Consequently, they present high nutritional requirements, especially during the transition period. The aim of this study was to evaluate the effects of parenteral supplementation of a mineral blend composed by selenium, copper, magnesium, phosphorus, and potassium on hematological, biochemical, immunological, and antioxidant status in transition period dairy cows and newborn calves. The Holstein cows were divided into the control group (A, n = 3) and treated group (B, n = 4), which were supplemented twice with an intramuscularly dose of 10 mL/animal, at approximately 20 days prior to the parturition, and a subsequent dose at the parturition. Total blood was collected from cows on days 20 and 5 antepartum, and 2 and 7 postpartum, and from calves, at the birth. We observed a decreased in concentrations of thiobarbituric acid reactive substances (TBARSs) for cows fed mineral blend during the transition period (P < 0.05), as well as a greater number of total leukocyte, total protein and globulin levels, and reduction of hemoglobin levels (P < 0.05). The catalase activity was increased in supplemented cows and in its calves (P < 0.05). Therefore, based on these evidences, the parenteral supplementation with mineral provides beneficial effects in pregnant cows and during the transition period, as well as in their calves.

ITPA polymorphism effects on decrease of hemoglobin during sofosbuvir and ribavirin combination treatment for chronic hepatitis C.

Polymorphisms in the inosine triphosphatase (ITPA) gene is associated with anemia induced by peg-interferon (PEG-IFN) plus ribavirin (RBV) treatment for patients with chronic hepatitis C virus (HCV) infection. However, the effect of ITPA polymorphism on sofosbuvir plus RBV treatment is unknown. Two hundred and forty-four patients with chronic HCV genotype 2 infection without decompensated liver cirrhosis were treated with sofosbuvir plus RBV for 12weeks. The effects of ITPA polymorphism on hemoglobin levels and RBV dose reduction and treatment response were analyzed. ITPA (rs1127354) was genotyped using the Invader assay. Multivariate regression analysis was performed to identify factors associated with sustained virological response (SVR). Overall, SVR12 was achieved in 231 (94.7%) patients, based on intention to treat analysis. During the therapy, reduction of hemoglobin levels was significantly greater in ITPA genotype CC patients than CA/AA patients. Therefore, the cumulative proportion of patients with RBV dose reduction was significantly higher and total dose of RBV was significantly lower in patients with CC genotype compared to CA/AA genotypes. SVR12 rates were similar between ITPA genotypes CC and CA/AA (94.7 and 94.4%, respectively, P=0.933). Multivariate logistic regression analysis identified FIB4 index <3.25 (odds ratio [OR], 9.388 for ≥3.25; P=0.005) and low body weight (OR, 1.059, for high body weight; P=0.017) as independent predictors for SVR12. ITPA polymorphism influences hemoglobin levels and incidence of RBV dose reduction during sofosbuvir plus RBV therapy. However, ITPA genotype CC patients can expect a curative effect equivalent to CA/AA patients for chronic HCV genotype 2 infection.

Analysis of haematological changes in tofacitinib-treated patients with rheumatoid arthritis across phase 3 and long-term extension studies.

Tofacitinib is an oral Janus kinase inhibitor for the treatment of RA. The aim of this analysis was to characterize changes in haematological parameters following tofacitinib treatment, and to compare changes in haemoglobin with markers of disease activity, fatigue and vitality. Changes in neutrophil counts, lymphocyte counts and haemoglobin levels were analysed in patients with RA from six phase 3 randomized controlled trials (n = 4271) of tofacitinib 5 or 10 mg bd, placebo or active comparators of up to 24 months' duration, and two long-term extension (LTE) studies (n = 4858) of tofacitinib of up to 84 months' duration. Disease activity markers included CRP and ESR. Fatigue and vitality were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and Short Form Health Survey-36 vitality domain scores. In phase 3 studies, mean neutrophil and lymphocyte counts decreased and mean haemoglobin levels increased in all tofacitinib treatment groups. Haemoglobin levels and neutrophil counts stabilized in the LTE studies, while lymphocyte count decreases stabilized at approximately month 48. Increased haemoglobin was associated with decreased ESR and CRP levels. Clinically meaningful reductions in haemoglobin levels (⩾3 g/dl from baseline or haemoglobin ⩽7 g/dl) occurred in <1.0% of patients in all treatment groups. FACIT-F and Short Form Health Survey-36 vitality scores were weakly correlated with haemoglobin levels. Small changes in haematological parameters were seen with tofacitinib treatment, which stabilized over time in the LTE studies. Changes in haemoglobin levels, although associated with changes in ESR and CRP, were not associated with fatigue or vitality.

Hemoglobin levels and blood transfusion in patients with sepsis in Internal Medicine Departments.

BackgroundAcute reduction in hemoglobin levels is frequently seen during sepsis. Previous studies have focused on the management of anemia in patients with septic shock admitted to intensive care units (ICU’s), including aggressive blood transfusion aiming to enhance tissue oxygenation.AimTo study the changes in hemoglobin concentrations during the first week of sepsis in the setting of Internal Medicine (IM) units, and their correlation to survival.DesignObservational prospective study.MethodsWe recorded hemoglobin values upon admission and throughout the first week of hospital stay in a consecutive cohort of septic patients admitted to IM units at a community hospital, the patients were enrolled into a prospective registry.Data on blood transfusions was also collected, we examined the correlation between hemoglobin concentrations during the first week of sepsis and survival, the effect of blood transfusion was also assessed.ResultsEight hundred and fifteen patients (815) with sepsis were enrolled between February 2008 to January 2009. More than 20 % of them had hemoglobin levels less than 10g/dL on admission, a rate that was doubled during the first week of sepsis. Overall, 68 (8.3 %) received blood transfusions, 14 of them (20.6 %) due to bleeding. Typically, blood transfusion was given to older patients with a higher rate of malignancy and lower hemoglobin levels. While hemoglobin concentration on admission had strong correlation with in-hospital mortality (O.R-0.83 [95 % C.I. 0.74–0.92], blood transfusion was not found to be an independent predicting factor for mortality.ConclusionAnemia is very common in sepsis. While hemoglobin level on admission exhibit independent correlation with survival, blood transfusion do not.

Peculiarities of progression of chronic glomerulonephritis associated with anemia

To study the influence of renal anemia on the clinical course of chronic kidney disease in patients with chronic glomerulonephritis (CGN) at the early stage of the disease. This prospective 12 month study included evaluation of clinical and laboratory characteristics of 149 patients aged 17-66 (mean 37,6±12,6) years at the pre-dialysis stage of CGN (92 men (37,04±13,4 yr) and 57 women (38,2±11,2 yr). By the end of prospective observation, patients of group 1 (CGN without anemia) showed a decrease of the hemoglobin level accompanied by the impairment of nitrogen releasing function with the glomerular filtration rate of 70,1 (43,1-111) ml/min compared with 87 (61,3-115,3) at the onset of observations (p<0,05). In group 2 (CGN with anemia), dynamics of the nitrogen-releasing function was similar but even more pronounced with the glomerular filtration rate reduced to 47,4 (32,2-91,8) ml/min compared with 80,7 (39,8-107,9) at the onset of observations (p<0,05) and the serum creatinine level increased to157 (92-242) mcmol/l compared with 123 (86-171) (p<0,05). Reduction of hemoglobin level in patients with CGN is apparent at the early stages of the disease in association with impairment of glomerular filtration. The data obtained indicate that anemia can be a laboratory predictor of deteriorated nitrogen-releasing function.

The relationship between helminth infections and low haemoglobin levels in Ethiopian children with blood type A.

The current study was conducted to evaluate the nature of association of ABO blood type with helminth infection and related reduction in haemoglobin concentration. Stool samples were collected from 403 school-age children attending Tikur Wuha Elementary School from February to April 2011. Helminth infection was examined using formol-ether concentration and thick Kato-Katz (two slides per stool specimen) techniques. Haemoglobin level was determined using a HemoCue machine and ABO blood type was determined using the antisera haemagglutination test. Nutritional status was assessed using height and weight measurements. Out of 403 children examined, 169, 120, 96 and 18 had blood type O, A, B and AB, respectively. The prevalences of helminth infections were 46.9% for hookworm, 24.6% for Schistosoma mansoni, 4.2% for Ascaris lumbricoides, 1.7% for Trichuris trichiura and 58.3% for any helminth species. The relative odds of infection with at least one helminth species was significantly higher among children with blood type A (adjusted odds ratio (AOR), 2.10; 95% confidence interval (CI), 1.28-3.45) or blood type B (AOR, 2.08; 95% CI, 1.22-3.56) as compared to children with blood type O. Among children infected with helminths, mean haemoglobin concentration was lower in those with blood type A than those with blood type O (β, -0.36; 95% CI, -0.72 to -0.01). The relative odds of hookworm infection (AOR, 1.78; 95% CI, 1.08-2.92) and related reduction in haemogobin levels (β, -0.45; 95% CI, -0.84 to -0.04) was higher among children with blood type A as compared to those with blood type O. Although the difference was not significant, the relative odds of S. mansoni or A. lumbricoides infections and related reduction in haemoglobin levels was also higher in children with blood type A or B as compared to children with blood type O. In conclusion, children with blood type A are associated with an increased risk of helminth, particularly hookworm, infection and related reduction in haemoglobin level. The mechanisms by which blood type A makes children susceptible to helminth infection and a related reduction in haemoglobin level ought to be investigated.