Severe Iron Deficiency Anemia Research Articles

Severe Unexplained Iron Deficiency Anemia in Children: High Yield of Upper Gastrointestinal Endoscopy Regardless of Gastrointestinal Symptoms.

In this retrospective study spanning 2016 to 2022, we aimed to evaluate the diagnostic utility of upper gastrointestinal endoscopy (UGE) in children under 18 years presenting with severe unexplained iron deficiency anemia (IDA), defined as microcytic anemia of hemoglobin ≤7g/dL with low ferritin levels. Out of 106 children hospitalized for severe anemia, 29 had unexplained IDA (mean hemoglobin level of 6.2 [3.2 to 6.9] gr/dL), and 25 of them underwent UGE. The mean age was 10.7 ± 3.9 years, with 76% being female. Ten children (40%) had gastrointestinal (GI) symptoms at presentation. The cause of IDA was found in 18 (72%) of 25 children who underwent UGE, of whom 12 were without GI symptoms. Gastric nodularity, erosions, or polyps were observed in 68%, and gastritis was evident in 72% based on histopathology. Helicobacter pylori was found in 50% of those with gastritis. Follow-up showed normalized hemoglobin levels in 92% of cases, with only 2 children requiring repeat iron therapy. Our findings underscore the importance of incorporating UGE into the diagnostic investigation of severe unexplained IDA in children, irrespective of the presence of GI symptoms.

Hereditary hemorrhagic telangiectasia may be the most morbid inherited bleeding disorder in women

AbstractHereditary hemorrhagic telangiectasia (HHT) is the second-most common inherited bleeding disorder (BD) worldwide and remains without approved therapies. HHT causes serious mucosal bleeding resulting in severe iron-deficiency anemia, major psychosocial complications, and visceral arteriovenous malformations in the brain, lung, and liver, which can cause life-threatening hemorrhagic complications. No study has examined the relative morbidity of HHT and von Willebrand disease (VWD), which is the most common inherited BD in women. We performed an observational cohort study of women with HHT or VWD, comparing a representative sample of 100 randomly selected women with HHT to 100 randomly selected age-matched women with VWD. In HHT vs VWD, recurrent epistaxis and gastrointestinal bleeding were more likely (odds ratio [OR], 32.73 [95% confidence interval, 13.81-71.80]; P < .0001 and 5.69 [2.59-12.89]; P < .0001) and heavy menstrual bleeding was less likely (OR, 0.32 [0.18-0.57]; P < .0001). Iron-deficiency anemia was significantly more likely, and the lowest hemoglobin was significantly lower in HHT than in VWD. The odds of iron infusion dependence, requirement for red cell transfusion, and hemostatic surgical procedures were significantly higher—17-fold, threefold, and eightfold higher, respectively—and hospital admissions to manage disease complications were both ∼14 times more frequent in women with HHT vs those with VWD. In conclusion, much higher disease-related morbidity, mortality, and health care use were observed in women with HHT vs VWD, providing evidence that HHT may be the most clinically significant inherited BD in women. Given the vast gap in research funding for HHT compared with both hemophilia (a disease primarily of men) and VWD, these findings have significant implications for gender equity in hematology.

Cerebral Ischemic Stroke Associated with Severe Iron Deficiency Anemia and Thrombocytosis (P11-5.028)

Cerebral Ischemic Stroke Associated with Severe Iron Deficiency Anemia and Thrombocytosis (P11-5.028)

Effectiveness of antianemic therapy for patients with severe iron deficiency anemia

Aim. To assess the effectiveness of antianemic therapy in patients with severe iron deficiency anemia.Material and Methods. For inpatient treatment, 30 patients with severe iron deficiency anemia, who exhibited significant cardiovascular system disturbances in the form of developed cardiomyopathy of anemic origin, were selected.Results and discussion. Therefore, the therapy conducted on average contributes to an increase in hemoglobin level by 5.0-6.0 g/l, serum iron by 1.25 µmol/l, and erythrocytes up to 4.0±0.03. In addition to the pronounced clinical effect, patients showed an increase in hemoglobin levels from 75.0±4.5 g/l to 95.0±5.0 g/l. The content of total lipids did not change significantly.Conclusion. The treatment course conducted in patients with severe forms of anemia was found to contribute to an increase in the number of erythrocytes, and levels of hemoglobin, hematocrit, serum iron, and ferritin. This suggests its effectiveness and safety as a treatment method for patients with iron deficiency anemia in the context of developed cardiomyopathy of anemic origin.

Hereditary hemorrhagic telangiectasia with splenic abscess: a case report

Hereditary hemorrhagic telangiectasia (HHT) is a rare disorder. Although it commonly causes recurrent bleeding manifestations and severe iron deficiency anaemia, they may be overlooked. Splenic abscess is rarely seen in clinical practice in patients with HHT. This case report describes a patient who presented with epistaxis and severe anaemic symptoms and found to have a splenic abscess with underlying HHT.

Prevalence of and risk factors for iron deficiency among pregnant women with moderate or severe anaemia in Nigeria: a cross-sectional study

BackgroundAnaemia during pregnancy causes adverse outcomes to the woman and the foetus, including anaemic heart failure, prematurity, and intrauterine growth restriction. Iron deficiency anaemia (IDA) is the leading cause of anaemia and oral iron supplementation during pregnancy is widely recommended. However, little focus is directed to dietary intake. This study estimates the contribution of IDA among pregnant women and examines its risk factors (including dietary) in those with moderate or severe IDA in Lagos and Kano states, Nigeria.MethodsIn this cross-sectional study, 11,582 women were screened for anaemia at 20-32 weeks gestation. The 872 who had moderate or severe anaemia (haemoglobin concentration < 10 g/dL) were included in this study. Iron deficiency was defined as serum ferritin level < 30 ng/mL. We described the sociodemographic and obstetric characteristics of the sample and their self-report of consumption of common food items. We conducted bivariate and multivariable logistic regression analysis to identify risk factors associated with IDA.ResultsIron deficiency was observed among 41% (95%CI: 38 – 45) of women with moderate or severe anaemia and the prevalence increased with gestational age. The odds for IDA reduces from aOR: 0.36 (95%CI: 0.13 – 0.98) among pregnant women who consume green leafy vegetables every 2-3 weeks, to 0.26 (95%CI: 0.09 – 0.73) among daily consumers, compared to those who do not eat it.Daily consumption of edible kaolin clay was associated with increased odds of having IDA compared to non-consumption, aOR 9.13 (95%CI: 3.27 – 25.48). Consumption of soybeans three to four times a week was associated with higher odds of IDA compared to non-consumption, aOR: 1.78 (95%CI: 1.12 – 2.82).ConclusionAbout 4 in 10 women with moderate or severe anaemia during pregnancy had IDA. Our study provides evidence for the protective effect of green leafy vegetables against IDA while self-reported consumption of edible kaolin clay and soybeans appeared to increase the odds of having IDA during pregnancy. Health education on diet during pregnancy needs to be strengthened since this could potentially increase awareness and change behaviours that could reduce IDA among pregnant women with moderate or severe anaemia in Nigeria and other countries.

Effectiveness of Lesser Known Homoeopathic Medicines in the Treatment of Iron Deficiency Anaemia

Anaemia is a major public health problem in India as it is estimated that most of the non-pregnant women of reproductive age group are anaemic. It occurs when there is decreased level of haemoglobin in red blood cells. The primary cause of anaemia is iron deficiency. Iron deficiency anaemia (IDA) may be present with other systemic diseases. People with mild and moderate iron deficiency anaemia may not have any sign and symptom. But more severe iron deficiency anaemia may cause fatigue, tiredness, shortness of breath or chest pain. Although Homoeopathy gives importance to the individualisation of the patients, for remedy selection, still then, some medicines are prescribed based on disease diagnostic features. Such medicines are not well proved, so they are known as rare/lesser-known medicines. Of course, their role in the management of certain diseases cannot be ignored. This article aims at showing the effectiveness of some lesser-known medicines in the treatment of iron deficiency anaemia.

A Case of Multiple Cerebral Infarcts Due to Severe Anemia Preceded by Migraine-like Headache with Aura.

We herein report a 47-year-old woman who developed migraine-like headache with aura and subsequent multiple cerebral infarcts, likely due to severe iron deficiency anemia (IDA) from menorrhagia. The progression from IDA to ischemic stroke involves several pathophysiological mechanisms, including reduction of erythrocyte deformability, reactive thrombocytosis, and anemic hypoxia. We speculate that a microembolus first caused cortical spreading depression without infarcts and that a larger thromboembolus then caused multiple infarcts. This case highlights the transition from migraine-like headache to ischemic stroke. New-onset migraine-like headache is a warning of impending ischemic stroke, and IDA may be a potential underlying cause.

Koilonychia in a Patient with Severe Iron Deficiency Anemia

Koilonychia is a known sequela of chronic and severe iron deficiency anemia. The pathogenesis is not well understood, but is postulated to be attributed to weakening of the underlying nail connective tissue secondary to poor oxygenation of the distal extremities. Because of the lower prevalence of koilonychia in developed nations, its clinical presentation in the U.S. is of particular significance. In the following case, a female patient presented with angina and heart palpitations of four month duration as well as severe anemia of unknown origin. Physical exam was notable for koilonychia, most prominent in the 1st - 4th digits of the right hand as well as the 1st and 2nd digits of the right foot.

Prevalence of Iron Deficiency Anemia among Infants Consuming Cow's Milk

Iron Deficiency Anemia (IDA) in children is a public health issue affecting child morbidity, mortality, and cognitive development. Infants fed cow's milk are at a higher risk of severe IDA due to calcium and iron absorption competition. Objective: To determine the frequency of Iron deficiency anemia among Cow Milk Fed Infants. Methods: This cross-sectional study was conducted at Peadiatric wards of Liaquat University Hospital Hyderabad and Jamshoro from November 2020 to April 2021. All the full-term infants with age of up to 6 months either gender and having history of cow’s milk consumption and clinically diagnosed to have anemia were included. Infants had 3ml intravenous blood samples taken to get a complete blood picture and ferritin level. All the mothers were interviewed regarding duration of cow’s milk consumption. Data were collected via a predesigned proforma. Results: Total 323 infants were studied to assess the frequency of iron deficiency anemia among cow’s milk infants up to 6 months and the mean age of infants was 4.11 ± 1.31 months. Females were 56.3% and males were 43.7%. Overall average of hemoglobin was 8.92 ± 1.09 g/dl, and overall mean of ferritin level was 90.16 ± 17.71 ng/ml. Frequency of iron deficiency anemia was found to be 18.6%. Conclusions: As per study conclusion overall frequency of iron deficiency anemia was observed to be 18.6% and cow’s milk consumption has been observed as a risk factor of infant’s anemia.

Ectoparasitosis induced severe anemia: a rare cause of severe iron deficiency anemia

Abstract Introduction/Objective Ectoparasites generally infest human’s head and body. It is primarily asymptomatic, however, it can cause iron deficiency anemia on rare occasions, even in developed countries. Bird mites can feed on the blood of people who live near infested pigeons or other infested animals. Methods/Case Report We present a 53 years old homeless male who lives in the New York City’s streets. He was brought to the emergency department by EMS due to ataxia and not being able to stand. Upon arrival, he was covered with countless small ectoparasites later identified as bird mites according to an exterminator. Decontamination and stabilization of patient was begun. No active bleeding or sign of trauma was identified. Complete blood count (CBC) was performed and hemoglobin (Hb) of 2.2 g/dL with Hematocrit of 9.2 % was confirmed after repeat on a second sample. Mean corpuscular volume (MCV), red blood cell (RBC) count, reticulocyte percent and red cell distribution width (RDW) was 73.3 fl, 1.26 M/uL, 3.3 % and 19.9 % respectively. Iron study was not performed initially. White blood cell and Platelets count were normal. Hemoglobin electrophoresis was negative for hemoglobinopathies. After initial transfusion of 2 packs of RBC, the Hb was 3.4 g/dL. He started to have seizures and was intubated. He was transferred to ICU. Ferritin level was checked after transfusion and was still markedly decreased (10.9 ng/mL). He received 6 packs of RBC in total (within 10 hours) and Hb reached 8.7 g/dL, and 48 hours after intubation he was extubated. The patient discharged himself against medical advice the next day. Results (if a Case Study enter NA) NA Conclusion With increasing homelessness, physicians should be aware that ectoparasitosis: 1) is a rare cause of iron deficiency anemia, and 2) because of the gradual onset of the anemia, rapid correction with a massive transfusion is neither warranted nor advised.

Hereditary Hemorrhagic Telangiectasia May be the Most Clinically Significant and Morbid Inherited Bleeding Disorder of Women

Background Hereditary hemorrhagic telangiectasia (HHT) is the second most common inherited bleeding disorder (1 in 5000 people) behind von Willebrand disease (VWD) and has no FDA- or EMA-approved therapies. HHT causes serious bleeding resulting in severe iron deficiency anemia, major psychosocial complications, and visceral arteriovenous malformations in brain, lung, and liver that can cause life-threatening hemorrhage, stroke, and other morbid complications. While HHT prevalence is equal in men and women, manifestations may be worse in women (as evidenced by a female predominance in HHT clinical trials). Due to the focus on hemophilia (an X-linked disease nearly exclusive to men) in the hemostasis research community, no study has examined the relative morbidity of the most common inherited bleeding disorders in women: HHT and VWD. Methods We performed an observational cohort study of women with HHT or VWD cared for at our institutional Comprehensive Hemophilia and Von Willebrand Disease Treatment Center or HHT Center of Excellence. Using an electronic patient data registry, a representative sample of 100 randomly selected women with HHT were age-matched to 100 randomly selected women with VWD for analysis. All data was extracted and confirmed using manual chart review; we quantified and compared bleeding and healthcare utilization outcomes. Results Patient Population. The mean (range) age in both groups was 49 (14-87) years. Mean BMI was 27 in both groups, and racial/ethnic breakdown was similar in both groups. Mean follow-up durations were 9.07 years (HHT) and 14.83 years (VWD) per patient. The VWD group included 86 patients with type 1 VWD and 14 with type 2 VWD. Bleeding Outcomes. Bleeding outcomes are detailed in TABLE 1. In women with HHT compared with VWD, recurrent epistaxis and GI bleeding were more likely (odds ratio [OR] [95% CI] = 32.73 [13.81-71.80], P&amp;lt;0.0001 and 5.69 [2.59-12.89], P&amp;lt;0.0001, respectively), and heavy menstrual bleeding was less likely (OR 0.32 [0.18-0.57], P&amp;lt;0.0001). Iron deficiency anemia was significantly more likely, and lowest hemoglobin significantly lower, in HHT versus VWD. Requirements for IV iron and RBC transfusion were significantly more likely in HHT versus VWD. Women with HHT had 17-fold higher odds of iron infusion dependence and 8-fold higher odds of requiring hemostatic surgical procedures than women with VWD. Healthcare Utilization for HHT or VWD Management. Healthcare utilization is detailed in TABLE 2. In women with HHT compared with VWD, emergency department (ED) visits and hospital admissions specifically to manage disease complications were significantly more likely (OR [95% CI] = 3.83 [1.67-8.48], P=0.001 and 7.33 [3.57-14.73], P&amp;lt;0.0001, respectively). Rates of ED visitation, admission, and outpatient encounters specifically for HHT or VWD management were significantly higher in women with HHT vs. women with VWD: ED visits, 10.3 per 100 patient-years (pt-yrs) vs. 0.74 per 100 pt-yrs, P=0.001; admissions, 14.4 per 100 pt-yrs vs. 1.0 per 100 pt-yrs, P&amp;lt;0.0001; outpatient encounters, 386.5 per 100 pt-yrs vs. 43.7 per 100 pt-yrs, P&amp;lt;0.0001. Adjusting these rates for the prevalence of HHT (1 in 5000) and VWD (1 in 1000) at the population level, all rates were still higher in the HHT group. Infusion visits, radiology encounters, and nearly all subspecialty provider visit types were much higher in women with HHT ( TABLE 2). Conclusions Analyzing matched populations of women at a health system that serves as a tertiary referral center for both diseases, HHT, a historically neglected bleeding disorder, was responsible for much higher morbidity and healthcare utilization in women than VWD, certainly at the individual patient level and possibly at the population level (prevalence-adjusted). Overall incidence of disease complications in each group was consistent with the published literature for both HHT and VWD, supporting the generalizability of our findings. These findings are critically important in achieving gender equity in the hemostasis field, given that both government and industry funding for VWD research is many times greater than for HHT research and such funding for hemophilia research, a disease of men, is at least 10-fold greater than for HHT research. Continued neglect of funding for clinical care and research of HHT within the hemostasis academic community and industry will only sustain and exacerbate gender inequities in hematology.

Transfusion-Associated Reversible Cerebral Vasoconstriction Syndrome in Pediatrics: A Case Report and Review of Literature

Background Reversible cerebral vasoconstriction syndrome (RCVS) is a rare complication of packed red blood cell (pRBC) transfusion primarily reported in adults with severe chronic anemia due to menorrhagia. It is characterized by a triad of rapidly changing and reversible segmental cerebral artery narrowing and dilatation, thunderclap headache, and benign cerebrospinal fluid findings. 1,2 More than 50% of patients experience blurring of vision or cortical vision loss, and a subset of patients develop hemiparesis or aphasia. 1 There are emerging case reports of RCVS in pediatric patients, however the literature examining this transfusion complication in children is limited. The rarity and potential severity of RCVS warrants better understanding by pediatric hematology and transfusion providers. Results We describe a previously healthy 4 year-old male who presented with pallor and laboratory parameters consistent with severe iron deficiency anemia. Chest x-ray showed cardiomegaly, and echocardiogram demonstrated pericardial effusion, moderate left ventricular dilation, and moderate coronary artery dilatation. His history was notable for an extremely selective diet and at least 50 ounces of cow's milk daily. The patient was admitted, and over the course of 3 days, he received a total of 43 mL/kg of pRBCs (602 mL total) in 8 aliquots, and his hemoglobin (Hgb) increased from 1.4 g/dL to 11.4 g/dL (Fig. 1). He then re-presented 5 days after discharge with altered mental status and malignant hypertension. Brain MRI/MRA was consistent with RCVS, with luminal irregularities in multiple anterior and posterior circulation intracranial arteries creating a beaded appearance. He was treated supportively with aggressive blood pressure control and made a complete neurologic recovery 8 days after presentation. At hematology clinic follow-up 2 months post-discharge, he remained at his typical neurologic baseline. Conclusions The connection between blood transfusion and RCVS is postulated to be due to a rapid increase in hematocrit and blood viscosity, which alters cerebral autoregulation and leads to hypertensive encephalopathy despite systemic normotension. 3 The increased viscosity may also lead to vasospasm. 3 When a patient with severe chronic anemia receives a pRBC transfusion, there is increased cerebral blood flow and viscosity, resulting in decreased vasodilation, increased vascular resistance, and cerebral vessel constriction. However, these are hypothesized mechanisms with little supportive experimental data. Vasculopathies and vasoconstrictive medications 2 are also risk factors for RCVS. There are 4 previous reported cases of pediatric RCVS associated with pRBC transfusion. 2 patients were acutely ill with complications of sickle cell anemia. 7,9 Another case occurred in a patient with systemic lupus erythematosus 8, and the fourth occurred in the setting of severe iron deficiency anemia. 5 Several features of our patient's clinical course are similar to the reported cases of transfusion-related RCVS 5 and warrant highlighting: 1) severe chronic anemia with cardiac dysfunction and 2) the large volume of transfused pRBCs over a short period resulting in a significant increase in Hgb. However, our patient developed symptoms of RCVS sooner than other published cases and did not have seizure or stroke. Pediatric guidelines recommend pRBC transfusion for Hgb levels between 5-10 g/dL, depending on the clinical scenario. 4 There are few data to guide Hgb targets for pediatric patients presenting with severe anemia. Over-transfusion does not offer physiological benefit and poses risk of transfusion-related adverse events. A case report from Dou et al 6 proposed that a &amp;gt;5 g/dL Hgb increase was associated with a greater likelihood of developing RCVS. For this patient with cardiac dysfunction and social concerns including lack of primary care, the potential benefits of achieving a higher Hgb with pRBC transfusions were prioritized. RCVS should be considered in pediatric and adult patients recently transfused for chronic severe anemia presenting with headaches or other neurological symptoms. Prompt recognition of RCVS may prevent unnecessary treatment and potentially limit risk of neurologic compromise. The role of the volume and rapidity of the pRBC transfusions in the development of RCVS warrants further study. Fig 1. Timeline of initial presentation, detailing blood transfusions

A Feasibility Study Evaluating Von Willebrand Factor in Patients with Gastrointestinal Angiodysplasia

Background: Abnormalities of von Willebrand Factor (VWF), such as those found in von Willebrand Disease (VWD) are associated with the development of abnormal blood vessels known as angiodysplasia. Angiodysplasia occurs primarily in the gastrointestinal (GI) tract, particularly the small bowel. Among patients with VWD, angiodysplasia is significantly overrepresented as a cause of GI bleeding and occurs in all VWD subtypes although it is reported more frequently in those with loss of the high molecular weight multimer of VWF. Recent studies have demonstrated more than a third of patients with VWD and GI bleeding have angiodysplasia when systematically assessed with Video Capsule Endoscopy (VCE) to examine the small bowel. Given the relationship between angiodysplasia and VWD our objective was to assess the feasibility of evaluating patients with GI angiodysplasia for abnormalities of VWF. Methods: We undertook a prospective single center pilot study to assess patients over the age of 18 with GI angiodysplasia for underlying abnormalities of VWF. Patients were identified based on angiodysplasia being present on a VCE study. Patients who consented to enrollment completed a self-administered bleeding assessment tool (BAT) as well as baseline demographic data. VWF testing included VWF antigen (VWF:Ag), VWF functional assay (VWF:GPIbM), Factor VIII coagulant activity (FVIII:C), and VWF pro-peptide (VWFpp) levels. Results: After reviewing 190 consecutive VCE studies performed at our institution between April 2021 and April 2023, we identified 50 patients who had capsule endoscopies demonstrating angiodysplasia of the GI tract. Thirteen of these patients consented to enrollment in the study. The bleeding histories of included patients are detailed in Table 1 along with their baseline clinical, laboratory, and demographic data. Two patients endorsed lifelong bleeding symptoms and three reported a significant family history of bleeding - all in a female relative. ISTH-BAT scores ranged from 0 to 18 with a median score of 2. Since our population is older than other studies that report on bleeding scores, we considered an abnormal bleeding score to be &amp;gt;6 as recent evidence indicates normal BAT scores increase over time. Five patients (38.6%) in our study had an ISTH-BAT abnormal bleeding score. VWF levels were assessed (Table 1) and one patient aged 88 years old with a significant family and lifelong history of bleeding received a new diagnosis of Type 2A VWD. Severe iron deficiency anemia requiring ongoing IV iron was diagnosed in two patients. Conclusion: In our feasibility study, we demonstrated a feasible protocol for recruitment of patients with GI angiodysplasia for clinical and laboratory testing of VWF. A significant proportion of our patients (38.6%) had abnormal bleeding scores and one patient had an underlying Type 2A VWD diagnosis.

Intravenous Iron Therapy in Severe Anemia at 28-34 Weeks of Gestation and it’s Feto-Maternal Outcome- A Prospective Study from A Developing Country

Introduction: Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy. Anemia results in poor pregnancy outcome and also affects fetal outcome. This study was undertaken to evaluate the response of intravenous iron given to pregnant women with severe IDA and their feto-maternal outcome.&#x0D; Methodology: A prospective study was conducted in the department of Obstetrics &amp; Gynaecology, at a tertiary care centre of Northern India. Fifty-two pregnant women with haemoglobin between 5-7 g% with diagnosed iron deficiency attending antenatal clinic were given intravenous iron complex Follow-up after 4 weeks was done and IDA specific blood profile was done at baseline and at follow-up. Feto-maternal outcomes were seen at delivery.&#x0D; Results: The mean age of study population was 25.5 ± 3.96 yrs. Improvement at 4 week follow-up from baseline in hemoglobin (p value-0.001) and iron profiles (S. Iron, Total Iron Binding Capacity (TIBC), S. Ferritin) (p value -0.0001) were highly significant. On comparing the Hb levels at delivery after intravenous infusion at 28-34 weeks gestation, 17 patients were still below 8 gm%, whereas 35 were above 8 gm%. Distribution of IUGR, preterm labor and blood transfusion in postpartum period were statistically significant amongst both group (p value&lt;0.05). Fetal outcomes were also evaluated amongst the 2 groups. Distribution of Preterm birth, birth weight and NICU admission was also statistically significant (p value&lt;0.05).&#x0D; Conclusion: The intravascular iron therapy definitely has a rapid increase in haemoglobin which can prevent the complications due to severe anaemia in pregnancy and blood transfusion can also be prevented, but iron stores are not replenished to the optimum level, so there is a need to give replacement therapy (by oral route) post transfusion for long term benefits. The rise of hemoglobin affects feto-maternal outcomes even in the last trimester.contrast agents. This is a first case report of AHCM portrayed by this ingenious technology.&#x0D; Keywords: AMCH, IUGR, TIBC

Associated factors in pediatric patients admitted with severe iron-deficiency anemia in the last seven years - the experience of a single pediatric unit.

To study the causes of iron deficiency, laboratory findings and clinical manifestation of infants aged 6-12 months and children aged 1-3 years diagnosed with severe iron-deficiency anemia. We conducted an observational, retrospective single tertiary center study between January 2015 and April 2022, which included 142 children. The control group (patients with no diagnosis of severe iron-deficiency anemia) included 71 patients and the study group (patients diagnosed with severe iron-deficiency anemia) included also 71 patients. Clinical data were retrospectively collected from hospital medical records. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) 25.0 software. Seventy-one children had hemoglobin <7 g∕dL and low values of ferritin/serum iron (22 infants aged 6-12 months and 49 children aged 1-3 years). In both the study and control groups, the male gender was slightly more prevalent. Mother's age at birth and living standard is significantly lower in the study group. We note a higher frequency of premature births (14.08%) in children identified with anemia compared to control group (8.45%). We found a statistically significant distribution of cow's milk consumption among the two groups (p<0.001). Pearson's correlation test revealed a significant positive correlation, indicating that anemia is directly proportional to cow's milk consumption. The most frequent cause of iron-deficiency anemia in infants and children 1-3 years old was the consumption of cow's milk following incorrect diversification and incomplete prophylaxis of iron-deficiency anemia.

Modern possibilities for correcting of severe iron deficiency anemia during pregnancy

An analytical review of literature data on modern methods of treatment of pregnant patients with severe iron deficiency anemia (IDA) was carried out. The authors present their own data on the results of treatment of severe IDA in two pregnant patients who were in the Department of Pregnancy Pathology of the Gomel City Clinical Hospital №3 in October – November 2022. Literature data on the high effectiveness of treatment of pregnant patients with severe IDA by intravenous infusion of iron carboxymaltosate in a dose of 1000 mg . The absence of immediate adverse side effects and complications of pregnancy makes it reasonable to use this drug in the 2nd and 3rd trimesters in the complex treatment of IDA.

82 Management of Very Severe Iron Deficiency Anemia: Is Transfusion Always Necessary?

Abstract Background Paediatric iron deficiency anemia (IDA) is a common condition in Canadian children; however, little is known about the natural history of extreme cases. This deficit makes it challenging to determine how to approach management when these patients present acutely to the emergency department (ED). Objectives To describe the clinical features and management of children presenting to the ED with very severe IDA with hemoglobin &amp;lt; 40 g/L. Design/Methods Retrospective chart reviews were performed for paediatric patients with IDA and hemoglobin &amp;lt; 40 g/L over a 5-year period (June 2017 – June 2022) at a Canadian tertiary care children’s hospital. Results Chart reviews were completed for 19 patients. The mean case rate was 3.1 patients annually (SD 2.14) with 11(58%) presenting in 2021–2022. Patients were young (median age 24 months; IQR 18–32) and predominantly female (79%). Nutritional deficiencies were the most common etiology (n=16, 84%). Median presenting hemoglobin was 25 g/L (IQR 22–36 g/L). The most common clinical features documented at presentation were pallor (n=19, 100%), tachycardia (n=17, 89%), and systolic ejection murmur (n=14, 74%). Thirteen (68%) patients had a ferritin measured in ED, 11(58%) had a chest x-ray, four (21%) had a lactate measured. One (5%) patient had an echocardiogram, and four (21%) had bedside cardiac ultrasounds documented. Eight (42%) patients with median hemoglobin 35 g/L (IQR 25–36 g/L) were managed without blood transfusion (PO iron only: n=3, 16%; IV iron only: n=5, 26%). Of the 11 (63%) patients who received blood, 2 (18%) had transfusion-related adverse events, with one patient undergoing intubation for transfusion-associated circulatory overload while admitted. All patients (100%) were initiated on oral iron supplementation. Ten patients (53%) received intravenous (IV) iron (dose 5–7 mg/kg) with one experiencing a mild reaction. Fifteen patients (79%) were hospitalized, with two (10%) admitted directly to the Paediatric Intensive Care Unit. Median duration of hospitalization was 5 days (IQR 2–9 days). Patients followed after transfusion-free management (n=5) demonstrated median hemoglobin increase of 21 g/L (IQR 20–32 g/L) within 12 days. No patient returned to the ED for anemia within 30 days. Conclusion Paediatric patients with very severe IDA do not always require transfusion. Some patients were effectively managed with IV iron alone. Investigation and management of these patients appears heterogenous. Given the risks of blood transfusion and the increased availability of IV iron, guidelines outlining evidence-based management of severe IDA are needed. These guidelines should promote optimization of iron therapy and guide judicious administration of blood transfusion.

Anti-Glomerular Basement Membrane Disease in a Six-year-old Child: A Rare Presentation

Antiglomerular basement membrane (anti-GBM) disease is a rare small vessel vasculitis caused by auto-antibodies targeting auto-antigen expressed in basement membranes of capillary beds in lungs and kidneys. A six-year-old male presented with fever, cough, and generalized weakness for three days with respiratory distress for one day. The child had three prior admissions with similar complaints and was treated as a case of lower respiratory tract infection with severe iron deficiency anemia in the past. Multiple packed red cell transfusions were required in these past admissions. In this current admission, he had tachycardia, tachypnea, severe pallor, right-sided lung crepitations &amp; bronchial breath sounds. The hemogram showed severe anemia and leukocytosis. Urine examination showed mild proteinuria and microscopic hematuria. Chest X-ray (current admission) showed right middle and lower zone consolidation. HRCT of the chest revealed an interstitial pattern. A lung biopsy showed pulmonary hemorrhage and positive Prussian blue staining. Raised anti-GBM titers confirmed diagnosis of anti-GBM disease. Renal biopsy revealed normal glomerular morphology on histopathology; with immune fluorescence showing linear positivity for IgG (3+), Kappa (3+), and Lambda (3+). Electron microscopy reported mild effacement of visceral epithelial foot processes and subepithelial/intramembranous electron-dense deposits. He was treated with intravenous methylprednisone for 5 days followed by oral prednisolone for one month, which was thereafter tapered to a lower maintenance dose for 18 months. The child received six cycles of intravenous cyclophosphamide along with a daily low dose of steroids. Currently, the child is asymptomatic after one year of follow-up with seroconversion (antiGBM titers decreased) and normalization of the chest radiograph.

A Case of Hookworm Infection in a Child Causing Severe Anemia Diagnosed by Endoscopy: A Neglected Tropical Disease

Hookworm (Necator americanus, Ancylostoma duodenale) infection are common in tropical and subtropical countries. These are still an neglected tropical disease in rural areas,leading to severe iron deficiency anemia and even mortality. Here we present a case from a tertiary care center in northern India of a 3 year old child with progressive complaint of pallor and generalised body swelling. On upper gastrointestinal gastroscopy hookworms were visualised and recovered. Patients stool sample was sent to lab in which egg of hookworm was also seen on microscopy. The child was treated with albendazole and anemia was also cured