Repeated Blood Transfusions Research Articles

Relationships between plasma zinc and ferritin with nutritional status in thalassemic children

Background Repeated blood transfusions in thalassemic chil-dren can lead to iron overload in the body. High ferritin level leadsto low plasma zinc status because of their competitive inhibition.Previous study found that there was a correlation between plasmazinc level and nutritional status.Objective To obtain plasma zinc level, to investigate the correla-tion between plasma zinc and ferritin, and the impact of plasmazinc on nutritional status in children with thallasemia.Methods A cross sectional study was conducted on 67 thalas-semic children. This study was performed at Thalassemia Center,Cipto Mangunkusumo Hospital, Jakarta, from 1 st until 31 st of March2005. The age of the patients ranged from 4 to 18 years, with fer-ritin levels more than 2000 ng/ml during the last 6 months or totaltransfusion more than 5 liters. The subjects were divided into 2groups, i.e. group 1 (4-10 years) and group 2 (>10-18 years). Di-etary intake was assessed by 3 day-dietary recall. The nutritionalstatus were judged by mid upper arm circumference (MUAC) forage and height for age (H/A). Venous blood was obtained to mea-sure plasma zinc and ferritin levels. Statistical analysis was doneby Student’s t-test (2-tailed) and linear regression analysis.Results We found that 42% subjects were well-nourished, 51%were undernourished, and 7% were severely malnourished. All sub-jects had low plasma zinc status 31.9 (SD 16.9) μg/dl. There was aweak negative correlation between plasma zinc and ferritin level (r= -0.282, P=0.021). Lower zinc intake was detected in 65 out of 67subjects.Conclusion All thalassemic children in our hospital had low plasmazinc level. There was a weak negative correlation between plasmazinc level and ferritin level. There was no significant correlationbetween plasma zinc status and nutritional status

PAI-1 Study in Thalassemia Major Patients Receiving Multiple Blood Transfusion.

Thalassemia is a congenital hemolytic disease which is treated by repeated blood transfusion. Chronic iron overload is currently considered to be the primary cause of mortality in β-thalassemia, mainly due to the induction of left-sided cardiac failure. Iron overload results from a number of mechanisms associated with the disease itself. In addition to chronic iron overload thalassemic patients are more prone for procoagulant status which in turn lead to clinical thrombotic events. The hypercoagulable state in thalassemia is due to multiple elements, a combination of which is often the drive behind a clinical thromboembolic events. PAI-1 study was done in thalassemia major patients receiving multiple blood transfusion as a marker for procoagulant status. Total of 30 thalassemic patients on repeated blood transfusion was included in the study and total of 30 healthy age and sex matched controls were included in the study. It was also found that there was significant differences between cases and controls. The mean level of PAI 1 in controls was 3047±414pg/ml, the value in cases was 3683±358pg/ml. The level was significantly increased (p<0.05) in the cases compared to controls. PAI-1 levels were also compared with the total number of blood transfusion which correlates well.

Profile of alanine aminotransferase and hepatic iron accumulation in thalassemic patients with or without anti-hepatitis C virus

Background Repeated blood transfusions in thalassemic patientscause iron accumulation in tissues and might impair organ func-tion. Other peril of blood transfusion is hepatitis C virus infection.Objectives This study aimed to find out the proportion of increasedalanine aminotransferase (ALT), increased transferrin saturation(TS), and positive anti hepatitis C virus (anti-HCV) among thalas-semic patients and to get the profile of ALT among thalassemicpatients who have increased TS and positive anti-HCV.Methods This cross-sectional descriptive study was conductedon β- and β-HbE-thalassemic patients at the Thalassemia Outpa-tient Clinic, Department of Child Health, Medical School, Univer-sity of Indonesia–Cipto Mangunkusumo Hospital in May 2002.Results Subjects were 57 homozygous β-thalassemic and 33 β-HbE-thalassemic patients. No one had regular desferoxamine orhistory of splenectomy. Proportions of increased ALT, TS, and posi-tive anti-HCV were 76%, 78%, and 6%, respectively. Duration ofillness, total volume of packed red cell (PRC) transfusions, TS level,and positive anti-HCV seemed to have role in the increased pro-portion of subjects with increased ALT, whereas duration of illnessand total volume of PRC seemed to have role in the increased TS.Conclusion Factors that seem to have a role in the increasedproportion of subjects who had increased ALT and TS were (1)duration of illness, total volume of PRC transfusion, TS, and posi-tive anti-HCV; 2) duration of illness and total volume of PRC trans-fusion, respectively

The occurrence of pulmonary hypertension in patients with thalassemia major

Background The life of patients with thalassemia major dependson blood transfusions, while repeated blood transfusions may causeadverse effects such as iron deposition in various organs, includ-ing heart and lungs, which eventually increases the pulmonaryarterial pressure.Objective This study was proposed to know the occurrence ofpulmonary hypertension in patients with thalassemia major, mea-sured by echocardiography in the Thalassemia Clinic, Departmentof Child Health, Medical School, Padjadjaran University/HasanSadikin Hospital, Bandung.Methods A descriptive cross-sectional study was carried outon 30 patients with thalassemia major, aged 10-14 year-old whoreceived repeated blood transfusions. The study was conductedfrom April to May 2002. Subjects were examined right after ablood transfusion completed and the pulmonary arterial pres-sure was assessed using Doppler–echocardiography and 2-Dechocardiography.Results Twenty two out of 30 subjects showed pulmonary hyper-tension, with pulmonary arterial pressure ranged between 32.3 to46.2 mmHg. According to the age group, pulmonary hypertensionwas found in 12 out of 17 subjects aged 10-12 years old and 10out of 13 subjects aged 13-14 years old.Conclusion The occurrence of pulmonary hypertension in patientswith thalassemia major at Hasan Sadikin Hospital was 22/30 andseemed to increase with the age of the patients

Study of Male Sex Hormone Levels in Male Egyptian Children with Beta-Thalassemia: Correlation with Iron load

Beta thalassemia is an inherited hemoglobin disorder resulting in chronic hemolytic anemia. RBCs hemolysis and repeated blood transfusions are the major causes of secondary iron overload which leads to deposition of iron in different endocrine glands. Delayed puberty and hypogonadism are the most obvious clinical consequences of iron overload. The aim of this study was to evaluate male sex hormone levels in male children with β- thalassemia major in correlation with iron overload. The present study was conducted on 60 male children with β- thalassemia major with serum ferritin of more than 1000 ng/ml with their age ranging from 11-18 years and mean age value of 14.16±2.48 (Group I) and 60 male children with β- thalassemia major of matched age with no iron overload (Group II). For all children in both groups the following were done: Complete blood count, Hb electrophoresis, serum ferritin, serum iron, TIBC, serum testosterone levels and assessment of testicular volume by ultrasound and Orchidometer. Serum iron and ferritin were significantly higher while TIBC, serum testosterone levels and testicular volume were significantly lower in Group I than Group II (Mean serum iron was 221.70 ± 46.76 in group I versus 122.45 ± 14.32 in group II with p value of 0.001, mean serum ferritin was 2595.06 ± 903.43 in group I versus 373.75 ± 6.82 in group II with p value of 0.001, mean serum TIBC was 210.93 ± 18.17 in group I versus 311.40 ± 13.57 in group II with p value of 0.001, mean serum testosterone was 1.01±1.61 in group I versus 2.73±2.66 in group II with p value of 0.006, mean testicular volume was 4.45± 4.92 in group I versus 8.66±7.08 in group II with p value of 0.016). There was significant negative correlation between serum ferritin and serum testosterone and between serum ferritin and testicular volume in studied patients in group I (r = -0.457 and p value = 0.011 for correlation between ferritin and testosterone and r = -0.908 and p value = 0.001 for correlation between ferritin and testicular volume). Male sex hormone and testicular volume were significantly lower in thalassemic patients with iron overload, significant negative correlation and serum ferritin. Regular follow up for thalassemia patients for early detection of iron overload with regular assessment of puberty as thalassemic patients are vulnerable to develop hypogonadism and may require sex hormone replacement therapy.

Gonadal Hormones in Adolescent Females with β-Thalassemia in Relation to Iron Load.

Beta-thalassemia is 'a hereditary blood disorder characterized by reduced or absent beta globin chain synthesis, resulting in reduced hemoglobin in red blood cells, decreased RBCs production and anemia'. Patients with thalassemia major require repeated blood transfusions which 'lead to accumulation of iron in different tissues, including tissues of endocrine glands'. This study aims to evaluate serum gonadal hormones levels in adolescent females with β-thalassemia in relation to iron overload. This study was conducted on 80 adolescent females with β-thalassemia having serum ferritin over 1000 ng/ml with range of their ages between 11 -15 years and mean age of 12. 42 ± 1.12 years (Group I) and 80 females with β-thalassemia of matched age having serum ferritin less than 500 ng/ml (Group II). For all patients the following were done: Complete blood count, hemoglobin electrophoresis, serum iron status including 'serum ferritin, serum iron and total iron binding capacity and' gonadal hormones including LH, FSH, and serum Estrogen. 'There were significantly higher serum ferritin and serum iron and significantly lower TIBC', Follicular Stimulating Hormone, Luteinizing Hormone and Estrogen levels in Group I compared with Group II (Mean serum ferritin was 1839.5 ± 258.2 ng/ml in group I versus 336.2 ± 33.5 ng/ml in group II with p value of 0.001, mean serum iron was 201.3 ± 38.43 ug/dl in group I versus 124.47 ± 12.23 ug/dl in group II with p value of 0.001, mean serum total iron binding capacity was 252.56 ± 23.21 ug/dl in group I versus 353.6 ± 31.79 ug/dl in group II with p value of 0.001, mean FSH level was 1.17 ± 0.67 mIU/ml in group I versus 2.55 ± 1.92 mIU/ml group II with p value of 0.029, mean LH level was 0.98 ± 0.25 mIU/ml in group I versus 1.91 ± 0. 42 mIU /ml in group II with p value of 0.016, mean Estrogen level was 22.46 ± 6.36 pg/ml in group I versus 35 .63 ± 8.63 pg/ml in group II with p value of 0.010). There were significant negative correlations between gonadal hormones including serum Follicle-Stimulating Hormone, Luteinizing Hormone, Estrogen and serum ferritin (r = - 0. 835 and p value of 0.01 for FSH and serum ferritin, r = -0. 949 and p value of 0.01 for LH and serum ferritin and r= - 0. 900 and p value of p 0.01 for Estrogen and serum ferritin. Female patients with β-thalassemia with iron overload may have gonadal hormones deficiency with significant negative correlation between gonadal hormones and serum ferritin. Regular iron chelation to prevent iron overload with subsequent irreversible damage of the ovaries and also regular follow up for females with β-thalassemia with assessment of puberty as they are more vulnerable to develop hypogonadism and may require hormonal replacement therapy.

Non-mutagenic Suppression of Enterocyte Ferroportin 1 by Chemical Ribosomal Inactivation via p38 Mitogen-activated Protein Kinase (MAPK)-mediated Regulation: EVIDENCE FOR ENVIRONMENTAL HEMOCHROMATOSIS

Iron transfer across the basolateral membrane of an enterocyte into the circulation is the rate-limiting step in iron absorption and is regulated by various pathophysiological factors. Ferroportin (FPN), the only known mammalian iron exporter, transports iron from the basolateral surface of enterocytes, macrophages, and hepatocytes into the blood. Patients with genetic mutations in FPN or repeated blood transfusion develop hemochromatosis. In this study, non-mutagenic ribosomal inactivation was assessed as an etiological factor of FPN-associated hemochromatosis in enterocytes. Non-mutagenic chemical ribosomal inactivation disrupted iron homeostasis by regulating expression of the iron exporter FPN-1, leading to intracellular accumulation in enterocytes. Mechanistically, a xenobiotic insult stimulated the intracellular sentinel p38 MAPK signaling pathway, which was positively involved in FPN-1 suppression by ribosomal dysfunction. Moreover, ribosomal inactivation-induced iron accumulation in Caenorhabditis elegans as a simplified in vivo model for gut nutrition uptake was dependent on SEK-1, a p38 kinase activator, leading to suppression of FPN-1.1 expression and iron accumulation. In terms of gene regulation, ribosomal stress-activated p38 signaling down-regulated NRF2 and NF-κB, both of which were positive transcriptional regulators of FPN-1 transcription. This study provides molecular evidence for the modulation of iron bioavailability by ribosomal dysfunction as a potent etiological factor of non-mutagenic environmental hemochromatosis in the gut-to-blood axis.

Successful non-operative management of cauda equina syndrome in a case of thalassemia major

Thalassemia is associated with several challenging comorbidities. Here we report a 20 year old thalassemic who presented with cauda equina syndrome due to paraspinal extra medullary hematopoiesis (EMH) and was treated with hydroxyurea, repeated blood transfusions, and radiotherapy. Thus compressive myelopathy due to EMH was successfully managed conservatively.

Prevalence of occult hepatitis C virus infection in Iranian patients with beta thalassemia major.

Occult hepatitis C virus infection (OCI) is a new pathological form of chronic hepatitis virus (HCV) infection characterized by the presence of HCV RNA in liver biopsy and/or peripheral blood mononuclear cell (PBMC) specimens and the absence of HCV RNA and anti-HCV antibodies (Abs) in plasma samples. β-thalassemia major is a hereditary recessive blood disease with deficiency in the hemoglobin beta chain. Thalassemic patients need blood transfusion therapy; repeated blood transfusion increases the risk of viral blood-borne infection. The aim of this study was to determine the prevalence of OCI in Iranian patients with β-thalassemia major. From February 2015 to November 2015, a total of 147 Iranian patients with β-thalassemia major were enrolled in this cross-sectional study. After extraction of viral RNA from the plasma and PBMC samples, HCV genomic RNA in the specimens was amplified by RT-nested PCR using primers from the 5'-UTR. The HCV genotypes of the positive specimens were tested using the RFLP assay. To confirm the HCV genotypes, the 5'-UTR fragment was amplified and cloned into the pJET1.2/blunt cloning vector and then sequenced. Out of 147 patients, 106 (72.1%) were negative for anti-HCV Abs and HCV RNA. HCV RNA was found in PBMC specimens of six (5.7%) patients, from a total of 106 patients with undetectable plasma HCV RNA and anti-HCV Abs. Therefore, six out of 106 patients had OCI. HCV genotyping revealed that three patients were infected with HCV subtype 1b, two patients were infected with HCV subtype 3a, and one patient was infected with HCV subtype 1a. These results revealed that Iranian patients with beta-thalassemia major might have OCI. Therefore, it seems that the design of a study to identify this infection in patients with β-thalassemia major would provide valuable information.

English

Blood transfusion is an important therapeutic intervention in sickle cell anaemia (SCA). Persons with SCA requiring repeated blood transfusions are at risk of contracting transfusion transmissible infections (TTIs) such as human immunodeficiency virus (HIV). Blood meant for transfusion is usually screened for TTIs to ascertain its safety before transfusion. The study investigated the role of blood transfusion in the spread of HIV among patients with sickle cell anaemia and effectiveness of the screening methods used to prevent HIV acquisition through blood transfusion in Jos. Consenting consecutive patients with sickle cell anaemia attending the Haematology clinic of Jos University Teaching Hospital between November, 2013 and July, 2014 had their blood samples screened for human immunodeficiency virus (HIV) after completing a questionnaire. One hundred and eleven (111) SCA patients aged between 17 and 52 years participated. Seventy six (68.5%) had history of blood transfusion while thirty five (31.5%) had no previous blood transfusion. Nine (8.1%) of them were positive for HIV, which comprised of 3 (8.6%) of the non-transfused and 6 (7.9%) of the transfused (p = 0.911). Blood transfusion though an important risk factor for acquisition of HIV infection, did not play a significant role in this study. Current pre transfusion HIV screening techniques were effective but further improvement in the safety of blood supply can be assured through the use of highly sensitive HIV screening methods and newer technologies. Key words: Sickle cell anaemia, HIV, blood transfusion.

Association between vitamin D levels and left ventricular function and NT-proBNP levels among thalassemia major children with iron overload.

Background:Heart disease is the major cause of death in thalassemia patients. Repeated blood transfusions and hemolysis cause iron overload and also disrupts the hydroxylation and synthesis of vitamin D, causing vitamin D deficiency. Vitamin D deficiency is associated with cardiac dysfunction.Objective:The purpose of this study was to determine the association between vitamin D levels and left ventricular function and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in thalassemia major children with iron overload.Patients and Methods:A cross-sectional study was conducted in March-April 2015 in the thalassemia clinic, Department of Child Health, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Thirty-four children with thalassemia were enrolled consecutively. Serum vitamin D and NT-proBNP levels were measured with electrochemiluminescence (ECLIA) method and echocardiography was performed to assess ventricular function.Results:Significant correlations were found between vitamin D levels and left ventricular ejection fraction (LVEF) (r = 0.399, P = 0.019) and fractional shortening (FS) (r = 0.394, P = 0.021). There was also significant correlation between vitamin D and NT-proBNP levels (r = -0.444, P = 0.008). Chi-square analysis also showed a relationship between vitamin D and NT-proBNP (P = 0.019) levels. There was a difference in NT-proBNP levels among thalassemia major children with iron overload (P = 0.020). Post hoc analysis showed that there was a significant difference in NT-proBNP levels between those with vitamin D deficiency and those with normal vitamin D levels (P = 0.012).Conclusion:There is an association between vitamin D and left ventricular function and NT-proBNP levels in children with thalassemia major and iron overload. Vitamin D can be considered in patients with thalassemia having vitamin D deficiency.

An Unexpected Transformation

In this study, a middle aged woman, diagnosed with decompensated cirrhosis presented with complaints of malaise and exertional dyspnea since 3 months, with history of repeated blood transfusions. On evaluation, she was pale and icetric with grade II ascites. Further work up was revealed severe iron deficiency anemia. An upper digestive tract endoscopy (UGIE) revealed presence of small low risk esophageal varices and actively oozing gastric antral vascular ectasia

TREATMENT OF RECTAL AND RECTOSIGMOID CANCER COMPLICATED BY TUMOR BLEEDING USING THE METHOD OF X-RAY-ENDOVASCULAR HEMOSTASIS

Short-term treatment outcomes of X-ray endovascular hemostasis in patients with rectosigmoid and rectal cancer complicated by bleeding were presented. Patients were divided into two groups. Group I (study group) consisted of 16 patients who underwent x-ray-endovascular hemostasis. Group II (control group) included 17 patients who received conservative methods of hemostasis. After hemostasis, patients with rectal cancer from both groups received preoperative radiotherapy followed by radical surgery. Patients with rectosigmoid cancer underwent surgery alone. The components derived from donated blood were used in a significantly larger volume in patients from the control group than in patients from the study group (p<0.01), with the same median estimated blood loss. Recurrence of bleeding was observed on 13.3 ± 1.6 days in 100 % of control group patients. There was no evidence of bleeding recurrence in the study group patients. The relative risk reduction of bleeding was 100 % in Group I patients. Thus, the method of X-ray-endovascular hemostasis allows intraluminal tumor bleeding completely to be stopped avoiding repeated blood transfusions.

Post Transfusion Purpura With Immune Haemolytic Anemia-a Rare Presentation.

A 26 years old female , was referred to us with history of mild gum bleeding and rash over the extrimities 2 days after a blood transfusion she had received in another hospital for her anemia. There was no history of bleeding from any other sites, heavy menses, drug intake, malena, bone pains. There was no history of any chronic illness or repeated blood transfusions in past.

The investigation of resveratrol and analogs as potential inducers of fetal hemoglobin

Βeta-thalassemia, is a hemoglobinopathy characterized by reduced beta-globin chain synthesis, leading to imbalanced globin chain production, ineffective erythropoiesis and anemia. Increasing gamma-globin gene expression is a promising therapeutic approach as it reduces this imbalance by combining with the excess alpha globin chains and producing fetal hemoglobin (HbF). Furthermore, increased iron absorption and repeated blood transfusions lead to iron overload and tissue damage secondary to reactive oxygen species. Compounds exhibiting both antioxidant and HbF inducing activities are, therefore, highly desirable therapeutic agents. Resveratrol, a natural phytoalexin, combines these two activities but is also cytotoxic. Nine hydroxystilbenic resveratrol derivatives were synthesized in an attempt to identify compounds that retain the HbF-inducing and antioxidant activities of resveratrol but exhibit reduced cytotoxicity. Three derivatives (P1, P4 and P11) exhibited similar hemoglobin-inducing properties to resveratrol in K562 cells, however, only P11 showed reduced cytotoxicity. All three derivatives demonstrated variable HbF-inducing activity in primary erythroid progenitor cells from healthy donors. Resveratrol and P11 increased HbF induction significantly, with P11 having the highest activity. Additionally, P4 significantly increased progenitor numbers. A combinatorial treatment in K562 cells using resveratrol and decitabine resulted in a statistically significant increase in hemoglobin-inducing activity only above the level shown by resveratrol alone.

Assessment of Visual Problems on Patients with Thalassemia (Major) and it impact on their Quality of Life: Case control study

Background: Major thalassemia is the most inherited hemoglobinopathy that caused severe and progressive anemia. Iron overload due to repeated blood transfusion cause organ damage such as heart, liver, endocrine gland and skeletal system. Desferal, as an iron chelator is used to eliminate iron in the blood that despite its side effects is few, visual problems due to it is exactly known. Objectives: 1-Assessment of visual problems among thalassemia major patients 2- To find out the impact of the visual problems on patients quality of life 3- To compare between thalassemic major patients quality of life for case and control study. Methodology: A descriptive design study was carried out in Ibn-Al-baldi hospital and AL-Karama hospital, starting in 1th November 2013 to the 1st Jun 2014. A non- probability (purposive) sample of 70 adults thalassemia major patients who have visual complication (Case) were attending to the hospitals, and 70 thalassemia major patients not have visual complication as a control study sample. The study instrument was composed of three parts and page of patents agreement to participate in the present study, which as socio- demographic information was included; age group, gender, marital status, level of education, occupational, economic, part two consist of medical information was comprised of (15 ) items, which deals(The past and present medical history), and the Indian Vision Function questionnaire. (IND -VFQ) which consist of (33-items) to measures the quality of life. The researchers used the appropriate statistical methods for data analysis which include the descriptive data analysis, and inferential data analysis, by using the SPSS version 19. Results: the results of present study revealed that 47.1% of the study sample have visual problems since 5-20 years, 45.9%, 23% of these problems was cataract and myopia respectively, and the quality of life for control group batter than quality of life for case groups. Conclusion: High percent of the study sample have visual complication for 5-20 years ago, most of them have cataract, most of the study sample have defect in both eyes, and there were significant relationship was appear between eye problems and patients wear class, and there were highly significant between patients feel batter after operation and their problems in both eyes at p-0.05 value. Recommendation: the researchers recommends to all thalassemic patients should be screened for such complications. However, the results were not conclusive on whether these complications are attributable to the anemia, the iron overload, or a side effect of the iron chelating agents, and works to rehabilitation of patients with visual problems to cope with the situation by training patients to daily life activities.

Therapeutic value of combined therapy with deferiprone and silymarin as iron chelators in Egyptian children with beta thalassemia major.

Beta Thalassemia is inherited anemia characterized by absent or reduced synthesis of β-globin chains of hemoglobin, caused by β-globin gene mutations resulting in chronic hemolytic anemia that requires 'repeated blood transfusion with resulting iron overload'. Silymarin has iron chelating activity in thalassemic patients with iron overload. was to study the therapeutic value of combined therapy of Deferiprone and silymarin as iron chelators in Egyptian children with beta thalassemia with iron overload'. 'This study was conducted on 80 beta thalassemic children with their serum ferritin more than 1000 ng/ml who were divided into two groups'. Group I included 40 patients who were treated with oral Deferiprone and silymarin for 9 months. Group II included 40 patients who were treated with oral Deferiprone and placebo for 9 months. 'There were no significant differences in serum ferritin, iron and TIBC between group I and group II before the study but after regular chelation therapy, serum ferritin and iron were significantly lower in group I than group II. No statistically significant differences in serum creatinine, blood urea, ALT, AST and bilirubin levels between Group I and Group II before and after chelation therapy were observed'. Deferiprone in combination with silymarin are better iron chelators than Deferiprone and placebo. 'Extensive multicenter studies in large number of patients with longer follow up period and more advanced methods of assessment of iron status to clarify the exact role of silymarin in reduction of iron over load in thalassemic children'.

Reassessing the value of MRI T2∗ in evaluation of hepatic and myocardial iron concentration: An institutional study

Patients with chronic hemolytic anemia like thalassemia and sickle cell anemia need repeated blood transfusions which lead to iron overload and cellular damage especially in the heart and liver. Classically, serum ferritin and liver biopsy have been used to monitor patient response to chelation therapy. Magnetic resonance imaging (MRI) has been proved effective in detecting and quantifying iron in the heart and liver. ObjectiveTo assess the accuracy of MRI T2∗ procedure in assessment of hepatic (LIC) and myocardial iron concentration (MIC). MethodsIn 70 cases of monthly transfused patients, hepatic and myocardial iron overload was measured by multibreath holds MRI T2∗ and compared to serum ferritin (a traditional marker of iron overload). ResultsNo significant correlation was observed between serum ferritin level and cardiac T2∗ MRI (p=0.528, r=−0.077). However, a significant correlation was observed between serum ferritin and liver T2∗ MRI (p=0.007, r=−0.318). ConclusionRoutine evaluation of liver and heart iron content using MRI T2∗ is suggested to better evaluate the hemosiderosis status in thalassemic and sickle cell patients.

Ligadura de las arterias hipogástricas en el cáncer de cuello uterino

Existen en la práctica obstétrica y ginecológica, diversas condiciones patológicas que determinan copiosas hemorragias cérvico-vaginales o corporales; que son muy difíciles de controlar por los métodos convencionales de: taponamiento útero-vaginal, sutura cérvico-vaginal, uso de coagulantes, transfusiones sanguíneas repetidas, etc., y que ponene en peligro la vida de estas pacientes. En el caso particular del cáncer de cuello uterino, estas hemorragias son frecuentes severas y persistentes y, condicionan situaciones desesperantes para estas ya delicadas enfermas debido a que la conducta terapéutica rutinaria siempre fracasa. Como son numerosos los casos con cáncer de cuello uterino, que no obstante el tratamiento con radiaciones, continúan perdiendo sangre, hemos meditado en varios aspectos del problema.

ROS-mediated iron overload injures the hematopoiesis of bone marrow by damaging hematopoietic stem/progenitor cells in mice.

Iron overload, caused by hereditary hemochromatosis or repeated blood transfusions in some diseases, such as beta thalassemia, bone marrow failure and myelodysplastic syndrome, can significantly induce injured bone marrow (BM) function as well as parenchyma organ dysfunctions. However, the effect of iron overload and its mechanism remain elusive. In this study, we investigated the effects of iron overload on the hematopoietic stem and progenitor cells (HSPCs) from a mouse model. Our results showed that iron overload markedly decreased the ratio and clonogenic function of murine HSPCs by the elevation of reactive oxygen species (ROS). This finding is supported by the results of NAC or DFX treatment, which reduced ROS level by inhibiting NOX4 and p38MAPK and improved the long-term and multi-lineage engrafment of iron overload HSCs after transplantation. Therefore, all of these data demonstrate that iron overload injures the hematopoiesis of BM by enhancing ROS through NOX4 and p38MAPK. This will be helpful for the treatment of iron overload in patients with hematopoietic dysfunction.