Severe Anemia Research Articles

Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials

Tranexamic acid is a recommended treatment for women with a clinical diagnosis of postpartum haemorrhage, but whether it can prevent bleeding is unclear. We conducted a systematic review and individual patient data (IPD) meta-analysis of randomised controlled trials to assess the effects of tranexamic acid in women giving birth. In this systematic review and IPD meta-analysis, we searched the WHO International Clinical Trials Registry Platform from database inception to Aug 4, 2024 for randomised trials that assessed the effects of tranexamic acid in women giving birth. Trials were eligible if they were prospectively registered, placebo-controlled, included more than 500 women, and had a low risk of bias for random sequence generation and allocation concealment. IPD were requested from the trial investigators. The primary outcomes were the numbers of women with life-threatening bleeding and thromboembolic events. We used a one-stage model to analyse the data and explored whether the effect of tranexamic acid varied by the underlying risk of life-threatening bleeding, type of birth, presence of moderate or severe anaemia, or timing of administration (before or after a diagnosis of postpartum haemorrhage). This study is registered with PROSPERO, CRD42022345775. We analysed data on 54 404 women from five trials. We obtained IPD for 43 409 women from four trials and aggregate data on 10 995 women from one trial. All trials had a low risk of bias. Life-threatening bleeding occurred in 178 (0·65%) of 27 300 women in the tranexamic acid group versus 230 (0·85%) of 27 093 women in the placebo group (pooled odds ratio [OR] 0·77 [95% CI 0·63-0·93]; p=0·008). There was no evidence that the effect of tranexamic acid varied by the underlying risk of life-threatening bleeding, type of birth, presence of moderate or severe anaemia or timing of administration. No significant difference was identified between tranexamic acid and placebo groups with regard to thromboembolic events: 50 (0·2%) of 26 571 women in the tranexamic acid group had fatal or non-fatal thromboembolic events versus 52 (0·2%) of 26 373 women in the placebo group (pooled OR 0·96 [0·65-1·41]; p=0·82) with no significant heterogeneity identified in the subgroup analyses. Tranexamic acid reduces the risk of life-threatening postpartum bleeding. We found no evidence that tranexamic acid increases the risk of thrombosis. Although we do not recommend the use of tranexamic acid in all women giving birth, consideration should be given to its use before a diagnosis of postpartum haemorrhage in women at high risk of death. The Bill & Melinda Gates Foundation.

Sickle Cell Anemia and Pregnancy Hemolysis: Clinical Considerations

Sickle cell anemia (SCA) is a hereditary blood disorder characterized by abnormal hemoglobin production, leading to chronic hemolysis and episodic vaso-occlusive crises (VOCs). Pregnancy in women with SCA poses significant clinical challenges due to the increased physiological demands, which exacerbate hemolysis and increase maternal and fetal risks. This review explores the pathophysiology of hemolysis in SCA during pregnancy, its clinical implications, and management strategies aimed at improving maternal and fetal outcomes. Hemolysis can result in severe anemia, acute chest syndrome, increased risk of infections, and adverse fetal outcomes, such as intrauterine growth restriction and preterm delivery. Management strategies for hemolysis in pregnancy include blood transfusions, pharmacological therapies, nutritional supplementation, and emerging treatments like gene therapy. Blood transfusions are widely used to mitigate anemia and reduce the number of circulating sickled cells, while pharmacological agents such as L-glutamine help address oxidative stress. Nutritional support, particularly with folic acid and antioxidants, is essential in promoting healthy red blood cell production and mitigating oxidative damage. Emerging therapies like gene editing offer promising future directions for more effective management of SCA and pregnancy-related hemolysis.

Determining diagnostic sensitivity loss limits for sample pooling in duplex rtPCR surveillance testing: Theileria orientalis and Anaplasma marginale.

To expand surveillance testing capacity through sample pooling, a thorough understanding is needed of how sample dilution through pooling affects the sensitivity of candidate assays. We validated a robust and representative framework for assessing the dilution effect of sample pooling using duplex rtPCR surveillance of Theileria orientalis and Anaplasma marginale, both of which are causative agents of severe anemia in cattle and a serious threat to the cattle industry in Virginia and many other states. We used 200 known-positive samples with Ct values representative of typical surveillance results in a series of pools in which we re-tested each sample individually, followed by each sample diluted in equal volumes with negative samples to make pools of 2, 4, 6, 8, and 10 total samples. We compared the Ct values of the individual positives with the Ct values of each pool size to determine if Ct values increase past the limit of detection in the 45-cycle assay. We observed a maximum of 2% sensitivity loss (no more than 2 of 100 samples returned a false-negative result) for both T. orientalis and A. marginale during the pooling series, with lower-than-expected average Ct increase and sensitivity loss. We conclude that pooling up to 10 samples would be acceptable for regional surveillance of T. orientalis and A. marginale using our rtPCR assay. The described strategy is applicable to validate pooling for a wide range of single and duplex rtPCR assays, which could expand efficient disease surveillance.

Elevated levels of PDGF-BB and VEGF are associated with a decreased risk of readmission or death in children with severe malarial anemia.

Children with severe malarial anemia (SMA) typically have low in-hospital mortality but have a high risk of post-discharge readmission or death. We hypothesized that the dysregulation of hematopoiesis, vascular growth factors, and endothelial function that occurs in SMA might affect risk of readmission or death. Plasma was obtained from children 18 months to 12 years old with SMA (N=145) in Kampala, Uganda on admission, and outcomes were assessed over 12-month follow-up. Admission plasma levels of ten biomarkers of vascular growth, hematopoiesis, and endothelial function were compared to risk of readmission or death over 12-month follow-up. Over 12-month follow-up, 19 of 145 children with SMA were either readmitted or died: 15 children were readmitted (13 with malaria) and 4 children died. In multivariable analyses adjusted for age and sex, elevated plasma levels of platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF) on admission were independently associated with a decreased risk of all-cause readmission or death (adjusted hazard ratios [95% confidence intervals], 0.28 [0.16-0.51] and 0.19 [0.08-0.48], respectively) and a decreased risk of readmission due to severe malaria (0.27 [0.15, 0.51] and 0.16 [0.05, 0.47]) but not with risk of uncomplicated malaria (1.01 [0.53, 1.95] and 2.07 [0.93-4.64]). In children with severe malarial anemia, elevated plasma levels of PDGF-BB and VEGF, two factors that promote angiogenesis, are associated with a decreased risk of readmission or death in the year following admission, primarily driven by a decrease in the risk of recurrent severe malaria.

A novel pathogenic variant in ALAS2 gene in young Indian male with X-linked sideroblastic anemia: a case report

BackgroundCongenital sideroblastic anemias are heterogenous disorders with variable phenotypic expression. The most common form is X-linked and is caused by pathogenic variants of the 5-aminolevulinate synthase 2 (ALAS2) enzyme of heme biosynthesis.Case presentationA 19 year old Indian young male presented with severe microcytic anemia. Bone marrow examination revealed ring sideroblasts. Using second generation sequencing, a novel pathogenic variant (Arg204Leu) was found in exon 5 of the ALAS2 gene, establishing the diagnosis of X-linked sideroblastic anemia. On treatment with oral pyridoxine supplement the patient’s hemoglobin level returned to normal.ConclusionsMore than 100 pathogenic variants in the ALAS2 gene have been reported to date. The Arg204Leu variant in our case adds to the XLSA pathogenic variant data base. The associated anemia is fully responsive to pyridoxine supplementation.

Case report: exome sequencing identified mutations in the LRP5 and LGR4 genes in a case of osteoporosis with recurrent fractures and extraskeletal manifestations

BackgroundGenetic mutations have been reported in a number of bone disorders with or without extra-skeletal manifestations. The purpose of the present study was to investigate the genetic cause in a middle-aged woman with osteoporosis, recurrent fractures and extraskeletal manifestations.MethodsA 56-year-old Indian woman presented to the clinic with complaints of difficulty in walking, recurrent fractures, limb bending, progressive skeletal deformities, and poor overall health. At the age of 37, she had experienced severe anemia with diarrhea, significant weight loss, knuckle pigmentation, and a significant loss of scalp hair. She had received multiple blood transfusions and parenteral iron supplementation with normalization of hemoglobin. Subsequently, she had premature menopause at the age of 37. She died at the age of 61 due to liver failure. Exome sequencing followed by Sanger sequencing were undertaken to identify the potential pathogenic mutations.ResultsGenetic investigation identified likely pathogenic mutations in the LRP5 and LGR4 genes. Out of the two mutations, the heterozygous mutation (c.1199C>T) in the LRP5 gene resulted in a non-synonymous substitution of alanine with valine at the 400th position, and the second mutation (c.1403A>C) in the LGR4 gene led to a non-synonymous substitution of tyrosine with serine at the 468th residue of the protein. The minor allele frequencies of the c.1199C>T (LRP5) substitution in the 1000 genomes and IndiGenomes databases are 0.0003 and 0.001, while the c.1403A>C (LGR4) substitution has not been reported in these databases. Various in silico prediction tools suggested LGR4 mutation to be pathogenic and LRP5 mutation to be likely pathogenic.ConclusionHeterozygous mutations in the LRP5 and LGR4 genes had additive deteriorative effects on BMD, resulting in recurrent fractures and bone deformities, and extended the effect to extraskeletal sites, contributing to the poor overall health in this patient.

Magnitude of anemia and associated factors among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest Ethiopia, 2023

BackgroundAnemia is a common complication of HIV infected children and it is enabling HIV disease progression, and decreasing survival. In Ethiopia, there is limited evidence on the prevalence of anemia and its associated factors among HIV infected children particularly in the Awi Zone. Therefore, this study aimed to assess the magnitude and associated factors of anemia among HIV infected children on ART aged from 6 months to 15 year-old in ART Clinic, Awi-Zone, Ethiopia.ObjectiveTo assess the magnitude and associated factors of anemia among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest, Ethiopia, 2022.MethodsA facility based cross-sectional study design was conducted from October to December 2022. A simple random sampling method was used to select the study participants. Descriptive statistics, including frequencies and proportions was used to summarize the study variables and data had been entered in to Epi data 4.2 and exported to SPSS version 25. Bivariable logistic regression followed by multivariable logistic regression was performed. Degree of association between dependent and independent variables had been assessed using adjusted odds ratio with 95% CI at p value of ≤ 0.05.ResultFrom 346 participants in the selected sample 339 (97.9%) of them responded. Prevalence of anemia was 13.3% (n = 45) among which, majority (44.4%) of them had mild anemia, while about (42.2%,) had moderate anemia and around 13.3%, of them were severely anemic. Baseline CD4 count (AOR = 6.58, 95% CI: 2.85–15.22), WHO clinical stage III or IV (AOR = 8.42, 95% CI = 3.47, 20.45), hookworm infection (AOR = 5.06, 95% CI = 2.04, 12) and malaria infection (AOR = 4.92, 95% CI (2.19–11.02) were significantly associated with anemia among children on HAART.ConclusionThe prevalence of anemia among participants was relatively low in this study. However, a considerable proportion of participants had moderate to severe anemia. Lower CD4 count at enrolment, advanced HIV clinical stage, malaria and hookworm infection were significantly linked with anemia. Thus, it requires regular monitoring of anemia status in these patients for better clinical outcomes and quality of life improvements.

An innovative surgical approach for solid pseudopapillary neoplasm with duodenal invasion in a pediatric patient: a case report

BackgroundPediatric pancreatic tumors, especially with duodenal invasion, are exceptionally rare and a strategy for their treatment has not been established. A pancreaticoduodenectomy is often the desired treatment, but may be over-invasive for solid pseudopapillary neoplasm (SPN). This study reports an innovative surgical approach for SPN with duodenal invasion using pancreatic enucleation and endoscopically guided partial duodenectomy.Case presentationAn 11-year-old girl complained of malaise and presented with severe anemia; imaging revealed a tumor of undetermined origin, involving the pancreatic head and descending duodenum. Intraoperative findings showed tumor adherence to the pancreatic head and endoscopy revealed invasion of the duodenum. The tumor was enucleated from the pancreatic head, and partial duodenectomy was performed under endoscopically guided direct visualization. Pathology confirmed SPN with duodenal invasion, and no residual tumor. Although a Grade B pancreatic fistula occurred postoperatively, it was managed conservatively. At the 15-month follow-up, no signs of tumor recurrence, duodenal stenosis, or pancreatic dysfunction were evident.ConclusionsGiven the good prognosis of SPN, we believe that enucleation from the pancreatic head combined with an endoscopically guided partial duodenectomy could be a useful and less invasive alternative to pancreaticoduodenectomy for cases with duodenal invasion.

Patients treated with vitamin K oral anticoagulants in family practice: a new approach to bleeding risk assessment. An ancillary study by the CACAO prospective general practice cohort.

The ability of bleeding risk scores to predict major bleeding (MB) or clinically relevant nonmajor bleeding (CRNMB) remains a topic of contention, particularly in nonselected patients in family practice. In addition, the capacity to predict bleeding risk using simple variables has yet to be established. The main objective was to confirm that severe anemia was the most predictive factor for the estimation of bleeding risk in patients treated with vitamin K antagonists (VKAs). Secondary objectives were to test the capacity of different bleeding scores to detect high-risk patients. Subsequently, the impact of functional decline on bleeding incidence was explored. The CACAO study was a multicenter prospective cohort study of patients who, due to nonvalvular atrial fibrillation (NVAF) and/or venous thromboembolism (VTE), had been prescribed an oral anticoagulant by their general practitioner (GP) as a prophylactic measure. Patient characteristics were collected at the time of inclusion by GPs, who then monitored them in accordance with standard practice for one year. MB and CRNMB were the main outcomes for one year. By applying this approach, a total of 13 scores were analyzed. Aaemia was found to be strongly associated with MB (HR: 2.77, 95% CI: 1.2-6.36), with a particularly pronounced association observed in cases of severe anemia (HR: 12.9, 95% CI: 2.76-60.35). Twelve out of 27 MB cases were not identified by at least half of the scores. By contrast, functional decline was identified as a novel factor associated with MB (HR: 2.45, 95% CI: 1.13-5.31). Preexisting anemia is a major prognostic factor associated with the occurrence of bleeding. It seems relevant to suggest that functional decline should be considered by GPs when assessing bleeding risk.

46 Micronutrient deficiencies in children and youth with autism spectrum disorder: Findings from a national surveillance study

Abstract Background Children and youth with autism spectrum disorder (ASD) may be at risk of micronutrient deficiencies secondary to feeding problems such as limited dietary repertoire and high-frequency single food intake. The epidemiology of micronutrient deficiencies in the paediatric ASD population has not been studied. Objectives To determine minimum incidence, clinical characteristics, and health care utilization for four micronutrient deficiencies in children and youth with ASD in Canada: (1) vitamin A deficiency/xerophthalmia, (2) scurvy, (3) severe, symptomatic vitamin D deficiency, and (4) severe iron-deficiency anemia. Design/Methods We conducted a study via the Canadian Paediatric Surveillance Program, an active, population-based surveillance platform, between January 2020 and December 2022. More than 2,500 paediatricians and paediatric subspecialists were asked, monthly, to report cases of children and youth <18 years of age with ASD and one or more of the micronutrient deficiencies under surveillance. Case information was obtained via a detailed clinical questionnaire. Descriptive statistics were used to summarize the data. For average yearly minimum incidence estimates, we used case counts over the 3 year surveillance period, 2021 census data and recent ASD prevalence estimates (2% of children/youth aged 1 to 17 years living in private dwellings in Canada). Results Twenty-seven children and youth met the case definition (most male; median age 7.7 years, range 1.8–14.9 years). Multiple deficiencies were diagnosed concurrently in 9/27 (33%). Minimum incidence, per 100,000 children and youth with ASD per year, was 5.1 for scurvy (17 diagnoses); 3.0 for severe iron deficiency anemia (10 diagnoses); 2.1 for severe, symptomatic vitamin D deficiency (7 diagnoses); and <1 for vitamin A deficiency/xerophthalmia (<5 diagnoses). Restricted diet/limited food repertoire, attributed to the patient, was universal (27/27). Number of different foods in the patient’s diet was <10 in nearly all (20/23, 87%). Most patients were non-verbal (19/27, 70%) and of normal weight (18/26, 69%). Two-thirds (18/27, 67%) were admitted to hospital (median duration 8 days, range 3–32 days). One-third (9/27, 33%) underwent an invasive procedure as part of their diagnostic workup. Conclusion This surveillance study represents the first population-level examination of the epidemiology of micronutrient deficiencies in children and youth with ASD. Results suggest that micronutrient deficiencies in ASD are rare but clinically important, leading not infrequently to hospital admission and invasive investigations. Clinical characteristics of cases should inform anticipatory guidance and prevention efforts tailored to the paediatric ASD population.

Severe anemia in preterm infants associated with increased bacterial virulence potential and metabolic disequilibrium.

Anemia in preterm infants is associated with gut dysbiosis and necrotizing enterocolitis. Our study aimed to identify the bacterial functions and metabolites that can explain the underlying mechanisms of anemia associated disease conditions. We conducted a case control study in preterm infants with cases having a hematocrit 25%. The control infants were matched by birth gestational age and weight. Fecal samples were collected before, at the onset, and after the onset of anemia in cases and with matched postnatal age in controls for metagenomics and metabolomics analyzes. 18 anemic and 20 control infants with fecal samples collected at 17 days, 5 weeks, and 7 weeks postnatal age were included. Virulence factor potential, decrease in beta diversity evolution, and larger changes in metabolome were associated with severe anemia. Metabolite abundances of N-acetylneuraminate and butyrobetaine were associated with virulence factor potential. Anemic group had decreased prostaglandin and lactic acid levels. Fecal omics data showed that severe anemia is associated with a pro-inflammatory gut microbiota with more virulent and less commensal anaerobic bacterial activities. Future studies can examine the link between anemia-associated dysbiosis and clinical outcomes and predict an infant-specific hematocrit threshold that negatively affects clinical outcomes. Severe anemia in preterm infants contributes to a pro-inflammatory gut with greater bacterial virulence and less commensal bacterial activities. The multiomics approach using non-invasive fecal biospecimens identified functional and metabolic changes in the gut microbiota and these mechanistic changes are plausible explanations for anemia-associated disease conditions in preterm infants. Our findings identified biological changes of the gut environment in severely anemic preterm infants that can offer guidance for clinical management.

Opportunistic Infections among People Living with HIV in the Infectious Disease Department, the University Hospital of Fann in Dakar, Senegal

Aim: The aim of this study was to identify the main infections and opportunistic infections in hospitalized patients living with HIV and to determine the hospital lethality rate. Patients and Methods: This was a retrospective, descriptive study of patients hospitalized in the infectious diseases department of the University Hospital of Fann over a 02-year period from 1 January 2021 to 31 December 2022. Results: We recorded 308 cases, 296 of which were patients living with HIV, out of a total of 1208 patients admitted to the department, a hospital prevalence rate of 24.5%. The average age of the patients was 43.3 ± 13.3 years, with a sex ratio of 0.7. One hundred and thirty-one patients (44.26%) were married. 22.97% had no occupation and 35.5% of patients came from home. The average diagnostic period was 3.9 days ± 4.78 days. Two hundred and five patients (69.26%) were at WHO stage 4. Tuberculosis was the most common bacterial infection, with 114 cases (38.5%), followed by common bacterial pneumonia (7.77%) and septicemia (4.72%). With regard to viral infections, the prevalence of viral hepatitis B was 6.76%, followed by herpes (1.68%). Among parasitic infections, toxoplasmosis was noted in 6.41% and cryptosporidiosis in 2.02%. Candidiasis was the most common fungal opportunistic infection, affecting forty-three patients (14.52%), followed by pneumocystis (7.09%) and cryptococcosis (2.36%). More than a third of our patients (37.84%) had severe anaemia, with haemoglobin levels below 8g/dl. Nearly a quarter of patients (21.28%) had impaired kidney function. Conclusion: HIV infection occurs in young adults at a late stage. Mortality remains high due to opportunistic infection. It is essential to carry out early screening, but above all to make available diagnostic tools and certain molecules for treatment of opportunistic infections.

Selective Extrauterine Placental Perfusion in Monochorionic Twins Is Feasible-A Case Series.

Monochorionic (MC) twins are at risk for severe twin-to-twin transfusion syndrome (TTTS) or twin anemia-polycythemia sequence (TAPS). In the case of preterm delivery, cesarean section (CS) with immediate umbilical cord clamping (ICC) of both twins is usually performed. While the recipient is at risk for polycythemia and may benefit from ICC, this procedure may result in aggravation of anemia with increased morbidity in the anemic donor. The purpose of this study was to demonstrate that the novel approach of selective extrauterine placental perfusion (EPP) with delayed umbilical cord clamping (DCC) in the donor infant is feasible in neonatal resuscitation of MC twins and may prevent severe anemia in donor and polycythemia in the recipient. Preterm MC twins with antenatal suspected severe anemia of the donor as measured by Doppler ultrasound, born with birthweights < 1500 g by CS, were transferred to the neonatal resuscitation unit with placenta and intact umbilical cords. In the donor, the umbilical cord was left intact to provide DCC with parallel respiratory support (EPP approach), while the cord of the recipient was clamped immediately after identification. Selective EPP was performed in three cases of MC twins with TAPS and acute peripartum TTTS. All donor twins had initial hemoglobin levels ≥ 13.0 g/dL, and none of them required red blood cell transfusion on the first day after birth. Selective EPP may be a feasible strategy for neonatal resuscitation of MC preterm twins with high stage TAPS and TTTS to prevent anemia-related morbidities and may improve infant outcome.

A case report of acute myocardial infarction with hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by epistaxis, gastrointestinal bleeding, iron deficiency anemia, and arteriovenous malformations (AVMs) affecting the lungs, liver, and brain. Owing to its rarity and diagnostic challenges, early identification is often elusive. Underdiagnosis and prolonged diagnostic delays are prevalent. Here, we present the case of a 63-year-old male who presented with chest pain and was diagnosed with an ST-elevation myocardial infarction (STEMI). Subsequently, he underwent placement of a drug-eluting stent in the right coronary artery (RCA). However, recurrent postoperative epistaxis resulted in severe anemia, prompting further investigation leading to the diagnosis of hereditary hemorrhagic telangiectasia through comprehensive medical history and genetic testing. Future studies are warranted to evaluate reperfusion strategies in HHT patients presenting with myocardial infarction.

Assessment of fetal cardiac function in pregnant women with anemia: prospective case-control study.

To compare fetal cardiac function in pregnant women with iron deficiency anemia (IDA) vs healthy pregnant controls. This was a single-center, prospective, case-control study conducted in a tertiary hospital between November 2022 and September 2023. Women diagnosed with IDA who attended as outpatients at the pregnancy follow-up clinic at 30-34 weeks' gestation or who were hospitalized for intravenous iron treatment owing to profound anemia were included. The control group consisted of randomly selected gestational-age-matched pregnant women with no obstetric complications or comorbidities and who did not have anemia. Patients underwent two-dimensional imaging, followed by pulsed-wave Doppler and M-mode and tissue Doppler imaging (TDI) to evaluate fetal cardiac function. A fetal cardiac score was calculated using systolic, diastolic and global hemodynamic function parameters, and was compared between patients with IDA and those without. The fetal cardiac score was also assessed according to the severity of anemia in the IDA group. A total of 150 patients, comprising 50 patients with IDA and 100 healthy pregnant women at 30-34 weeks' gestation, were included in the study. Of the patients with IDA, 20 had mild, 18 had moderate and 12 had severe anemia. The fetal myocardial performance index and isovolumetric relaxation time were significantly higher in the IDA group compared with the control group (P < 0.0001 for both), while isovolumetric contraction time was similar. Among the fetal tricuspid and mitral valve diastolic parameters, the E, A and E/A values were significantly lower in the IDA group (P < 0.05 for all). Mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursions were significantly lower in the IDA group (P < 0.05 for both). The IDA group also had significantly lower values for the TDI parameters mitral and tricuspid E', A', S' and E'/A' ratio and a significantly higher E/E' ratio (P < 0.05 for all). Among the IDA subgroups, a significant decrease was observed in the tricuspid and mitral A, E and E/A ratio in fetuses whose mothers had severe anemia (P = 0.001). M-mode Doppler analysis revealed significantly lower fetal TAPSE and MAPSE in the patient group with severe maternal anemia (P = 0.001 for both). According to the subgroup comparison of TDI findings, the fetuses of mothers with severe anemia had significantly lower tricuspid and mitral E', A', S' and E'/A' ratio values and a significantly higher E/E' ratio (P < 0.05 for all). The fetal cardiac score was significantly higher in the maternal IDA group compared with the control group (P < 0.001). A significant negative correlation was found between maternal hemoglobin level and fetal cardiac score (P < 0.001). We observed differences in fetal systolic and diastolic cardiac function in pregnancies with maternal IDA. Fetal cardiac function was affected more among patients with severe anemia. This study found an increased E/E' ratio in the fetuses of pregnant women with IDA, suggesting decreased fetal heart maturation. Prenatal fetal cardiac evaluation, especially in women with severe anemia, can facilitate a more seamless transition to the postnatal period for these newborns. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Global burden of anemia and cause among children under five years 1990-2019: findings from the global burden of disease study 2019.

Anemia represents a significant global health issue affecting numerous children and women, characterized by diminished hemoglobin levels that may impede cognitive and developmental progress. Although commonly attributed to iron deficiency, the etiology of anemia in this demographic is multifaceted, encompassing nutritional, genetic, and infectious contributors. Nonetheless, there is a lack of high-quality data on anemia prevalence and causes analysis among children under 5 years. The aim of this study was to provide a comprehensive global assessment of the burden of anemia and its causes among children under 5 years, using data from the Global Burden of Disease Study 2019. This investigation utilized data from the Global Burden of Disease Study (GBD) 2019 to assess the prevalence and years lived with disability (YLD) attributable to anemia in children under five from 1990 to 2019. Analyses were conducted to delineate age-specific YLD, prevalence rates, and etiological factors, with stratification by gender and Socio-Demographic Index (SDI). In 2019, anemia imposed a substantial global burden on children under five, with a reported YLD of 1,252.88 (95% UI: 831.62-1,831.34) per 100,000 population. The prevalence of moderate anemia was highest at 985.46 (95% UI: 646.24-1,450.49) per 100,000, surpassing both severe anemia at 197.82 (95% UI: 132.53-277.80) per 100,000 and mild anemia at 69.59 (95% UI: 24.62-152.53) per 100,000. Globally, the total prevalence was 39,517.75 (95% UI: 38,784.81 - 40,239.62) cases per 100,000 population. Notably, disparities were evident between genders, with males demonstrating higher YLD and prevalence rates than females. Iron deficiency emerged as the leading cause globally, with significant contributions from hemoglobinopathies and other nutritional deficiencies. Regions with a low Socio-Demographic Index, particularly sub-Saharan Africa and South Asia, exhibited the most pronounced burdens. Despite a declining trend over three decades, persistent regional and gender-based disparities highlight the necessity for continuous and focused public health interventions. The burden of anemia among children under five continues to be considerable, marked by stark regional and socioeconomic disparities. These findings underscore the urgent need for advanced nutritional and healthcare strategies tailored to alleviate anemia in this vulnerable population, with a particular emphasis on regions exhibiting low SDIs. The sustained prevalence of high anemia rates in these areas underscores the imperative for persistent, localized intervention efforts.

Nonimmune Hemolytic Anemia in Myelodysplastic Neoplasms (MDS) with U2AF1 Gene Mutation at S34 Hotspot: A Rare and Challenging Case Presentation

Abstract Introduction/Objective Hemolysis is recognized but not well understood in a subset of patients with myelodysplastic Neoplasms (MDS), largely through non-immune-mediated mechanisms. Lower survival rates are observed in MDS patients experiencing hemolysis. It is important to investigate the underlying mechanism including the molecular features of these cases. We hereby present a rare and challenging case of nonimmune hemolytic anemia in MDS with U2AF1 gene mutation at S34 hotspot. Methods/Case Report The patient is a 75-year-old male with past medical history of hypertension that presented with two weeks of 20 pounds weight loss, dyspnea on exertion and a syncopal event complicated with a parietal subarachnoid hemorrhage. Patient was found to have pancytopenia with severe anemia (hemoglobin 3.6 g/dl), reticulocytosis (reticulocyte 13.29%), decreased haptoglobin, while increased indirect bilirubin and lactate dehydrogenase. Spherocytes were detected in peripheral blood smear. With Coombs test being negative, all above are consistent with nonimmune hemolytic anemia. There is no evidence of paroxysmal nocturnal hemoglobinuria. Bone marrow biopsy revealed trilineage hematopoiesis, many hypo-or mono-lobated dysplastic megakaryocytes and less than 5% blasts. Cytogenetics/FISH unveiled 5q deletion, 20q deletion and trisomy 8. Mutation in the U2AF1 gene at S34 hotpot is detected by next-generation sequencing. The overall findings are consistent with MDS with nonimmune mediated hemolysis. Results (if a Case Study enter NA) NA Conclusion Hemolysis, although uncommon in MDS, has a substantial impact on prognosis, treatment approaches and response. U2AF1 gene mutation is associated with poor outcomes in MDS patients. U2AF1 gene mutation at S34 hotpot is observed in 30% MDS patients with hemolysis in one recent report. Responses to erythropoiesis-stimulating agents and hypomethylating agents vary depending on different mutations, including U2AF1, SF3B1 and EZH2, with discrepancies across studies. Further investigation is warranted to elucidate the relationship between the molecular abnormalities and treatment response as well as prognosis in MDS patients with hemolysis.

Single-Center Observational Study of Anaemia in Adolescents, Pregnant, and Lactating Women

The aim of this study was to evaluate the prevalence of anaemia among a target population comprising adolescent girls,pregnant women, and lactating women, by assessing their concentrations. The study also sought to identify the major sociobiologicaldeterminants that burden the healthcare system. Each group, the adolescent group and the pregnant/lactating group,consisted of 149 individuals. The study was conducted during a medical check-up oneday camp organized by the DharmaramAssociation for Social Service in CSA LR Nagar slum, Bengaluru, India, between November 22, 2023, Subsequently, the data wascollected, scored, and analyzed using statistical procedures, specifically calculating the mean and correlation.The findings of thestudy indicated that among the adolescent girls, 40% (N=40) exhibited low levels of anaemia, 31.4% (N=32) had moderate anaemia,and 27.5% (N=28) had severe anaemia based on their haemoglobin levels. Regarding pregnant and lactating women, the studyrevealed a prevalence of anaemia at a rate of 70% (N=28/48).

Trends and predictors of severe and moderate anaemia among children aged 6–59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data

BackgroundChildhood anaemia remains a significant public health problem in India, as it adversely affects child development and overall health outcomes. This study aimed to analyse the prevalence of severe and moderate anaemia among children aged 6–59 months and identify consistent predictors of this condition over the past 15 years.MethodsData from the three most recent rounds of the NFHS were used for this analysis. The final weighted sample included 40,331 children from the NFHS-3 (2005–2006), 200,093 from the NFHS-4 (2015–2016), and 178,909 from the NFHS-5 (2019–2021). Descriptive and bivariate analyses were conducted, followed by binary logistic regression to identify factors associated with severe and moderate anaemia in children aged 6–59 months. All statistical analyses were performed using Stata version 14.ResultsOver the past 15 years, the prevalence of severe and moderate anaemia among children in India has shown a slight decline. However, the influence of various predictors has changed over time. Young children (aged 6–23 months), those from Scheduled Caste (SC) and Scheduled Tribe (ST) communities, and children born to mothers with high parity and low educational attainment remain particularly vulnerable to anaemia. Additionally, short-term illness significantly increases the risk of anaemia. Furthermore, women’s autonomy, indicated by higher education and lower fertility rates, along with maternal nutrition education, have emerged as key factors in reducing anaemia burden in the future. Notably, children whose mothers had no education were 1.4 times more likely to suffer from severe or moderate anaemia. Similarly, children born to mothers with four to five children (OR 1.1, p < 0.05) and those with six or more children (OR 1.2, p < 0.05) had an elevated risk of anaemia.ConclusionThe findings highlight three key areas for programmatic focus to accelerate anaemia reduction in India: [1] targeting young children (aged 6–23 months); [2] ensuring the inclusion of SC and ST communities in all relevant interventions; and [3] promoting women’s autonomy. These strategies are essential for reducing the burden of anaemia across the country.

A Study of Clinical, Hematological and Biochemical Profiles of Patients with Pancytopenia

This study aimed to investigate patients’ clinical, hematologic, and biochemical profiles with pancytopenia. This prospective observational study was conducted at a tertiary care hospital from January 2019 to June 2020 on 80 patients, 39 (48.7%) were males and 41 (51.2%) were females, over the age of 18 presenting with pancytopenia. All the patients were subjected to thorough clinical and physical examinations. A complete blood count (CBC), peripheral smear examination, bone marrow aspiration, and reticulocyte count were performed. The data was analyzed using the IBM SPSS 20.0 software. Most of the cases had moderate (Hb&lt;7-9.9g/dl) anemia (63.7%, 51/80 cases), while severe anemia (&lt;7g/dl) was seen in 31.2% (25/80) cases, and 5% (04/80) cases showed mild anemia (Hb&lt;10-11.9g/dl). Most patients with severe anemia had vitamin B12 deficiency anemia (12/80), that is, 15%. Macrocytic anemia was noted in preponderance (50% cases, 40/80), whereas microcytic hypochromic and normocytic hypochromic anemia constituted 21.3% (17/80), and dimorphic anemia was seen in 7.5% (06/80) cases. Based on WBC counts, 56.3% of cases (45/80) showed counts between 2000 and 4000 cells/cu.mm, while counts between 1000 and 2000 cells/cu.mm were seen in 31.3% of cases (25/80), and 12.5% of cases (10/80) had counts of &lt;1000 cells/cu.mm. The study highlighted that 28.8% (23/80) had a platelet count between 50,000 and 1 lakh/cu.mm (mild thrombocytopenia), 36.3% (29/80) cases had a platelet count between 20,000 and 50,000/cu.mm (moderate thrombocytopenia), and 35% (28/80) cases had a platelet count less than 20,000/cu.mm (severe thrombocytopenia). The most common diagnosis of bone marrow aspiration was megaloblastic anemia, seen in 50.0% (6/12) cases. Megaloblasts were seen in 50.0% (6/12) cases of megaloblast anemia. The bone marrow aspirate of a patient with dengue fever and malaria showed macrophages containing engulfed red blood cells, lymphocytes, and platelets. Myeloblasts (&gt;20%) were seen in 1 (8.3%) case of AML, and decreased myelopoiesis was seen in 25% of cases (two cases of aplastic anemia and one case of MDS). This study concludes that vitamin B12 deficiency is the most common cause, which is more common in people who are strict vegetarians, with a predominance in the younger age group. The study also emphasized the vitality of the physical findings, detailed primary hematologic and biochemical investigations, and peripheral blood pictures, all of which provide precious information in the work-up of pancytopenia patients.