Significant Increase In Hemoglobin Levels Research Articles

Prevalence and Treatment of Iron Deficiency Anemia in Patients with Chronic Heart Failure

Objective: Approximately 30% of patients with Chronic Heart Failure (CHF) develop anemia. Previous studies showed the beneficial effect of treating the underlying anemia in CHF patients but controversy on the subject remains. We studied the prevalence and treatment of underlying anemia in patients with CHF. Methods and Results: Patients were categorized into three groups: normal hemoglobin levels, anemia of chronic disease; and iron deficiency anemia (IDA). All patients were treated for heart failure. Patients with IDA were treated with iron sulfate. We compared the ejection fractions (EF) and functional capacities both before and after treatment. The prevalence of IDA in our patients was 10.7% and 25.7% of patients had anemia of chronic disease. The mortality rate in the anemic group was 4.9 times higher than the mortality rate in the normal hemoglobin group. Following treatment, there was a significant increase in hemoglobin levels that was more prominent in the IDA group. EF increased in all groups following treatment, but the increase was greatest in the IDA group. Conclusions: Our results demonstrate the improved quality of life that results from treating IDA as part of CHF patient management. Early diagnosis and treatment of anemia can improve EF in patients with CHF.

Effectiveness of Fortification of Drinking Water with Iron and Vitamin C in the Reduction of Anemia and Improvement of Nutritional Status in Children Attending Day-Care Centers in Belo Horizonte, Brazil

Because of the high prevalence of iron-deficiency anemia in Brazil, individual control measures tend to be ineffective, and fortification of foods with iron is considered the most effective method to fight anemia. To evaluate the effectiveness of fortification of drinking water with iron and vitamin C in the reduction of anemia in children in day-care centers in Belo Horizonte, Brazil. This before-and-after study evaluated 318 children aged 6 to 74 months. Identification data and data on socioeconomic variables were collected; anthropometric and biochemical measurements were performed before and after 5 months of fortification of water with 5 mg of elemental iron and 50 mg of ascorbic acid per liter. The fortified water was used for drinking and cooking at the day-care center. Wilcoxon's nonparametric test was used to evaluate the differences in continuous variables, and McNemar's test was used to compare the prevalence rates of anemia. The prevalence of anemia decreased significantly from 29.3% before fortification to 7.9% at the end of the study, with a significant increase in hemoglobin levels. Reductions in the prevalence rates of stunting and underweight were observed. Fortification of water with iron and vitamin C significantly reduced the prevalence of anemia and improved nutritional status among children attending day-care centers.

Optimizing Hydroxyurea Use in Children with Sickle Cell Disease: Least Tolerated Dose Is Effective

Abstract 4851 Background:Hydroxyurea (HU) is an antimetabolite that effectively ameliorates the course of sickle cell disease (SCD). Starting dose is usually 20 mg/kg/day and the dose is escalated up to 35 mg/kg/day in most of the centers. In Oman, due to high level of consanguinity, ethnic neutropenia affects around 10% of population rendering higher doses difficult to maintain in most of the patients. Materials and Methods:161 patients (age 2–16 years, 61% male and 39% female) with SCD at Sultan Qaboos University Hospital, Muscat, Oman, were started on HU for clinically severe course (defined as: annual vaso occlusive crisis admissions more than 3, and/or occurrence of acute chest syndrome) with starting dose of 15 mg/kg and a mean dose of 18 mg/kg/day. All patients were included in the study except for 19 patients who were excluded for various reasons (8 lost follow up, 6 stopped HU by parents, and 5 stopped due to side effects: dizziness, abdominal pain, and myelosuppression). Remaining 142 patients were followed up for median treatment duration of 4 years (range, 1.5–10 years). Patients were assessed for clinical and laboratory response to HU. Results:There was significant reduction in the annual number of admissions due to vaso occlusive crisis (P <0.001, Wilcoxon Signed Ranks Test) with a mean of 4.7 and 1.5 before and after HU use respectively.There was also observed clinical improvement regarding the incidence of acute chest syndrome. Only 12 out of 39 patients initiated on HU for acute chest syndrome had a recurrent attack during a follow up period of 3–7 years.The laboratory parameters were consistent with previous reports: significant increase in hemoglobin level, fetal hemoglobin (HbF) level, Mean Corpuscular Volume, whereas significant decrease in platelet, absolute neutrophil, and absolute reticulocytic counts.All 142 patients tolerated the treatment well. Observed side effects included abdominal pain, dizziness, rash, tremor in one patient each. Of note, 21 patients (11.1%) developed neutropenia (ANC<1000 × 10^9/l) while 7 patients (3.7%) had thrombocytopenia (<100 × 10^9/l) which interrupted the treatment for period ranging from 3 weeks to 3 months only. Conclusion:In SCD patients with background of ethnic neutropenia, lower starting dose and limited range of dose escalation of HU ensured safety and yet did not affect efficacy. Disclosures:No relevant conflicts of interest to declare.

Efficacy of IV Iron Compared to Oral Iron for Increment of Haemoglobin Level in Anemic Chronic Kidney Disease Patients

Introduction: Anemia is the most common finding in chronic kidney disease patients. Iron supplements are commonly prescribed for these patients with or without erythropoietin therapy by means of oral and intravenous iron. Both oral and intravenous irons have their own advantage and disadvantage, and the efficacy is also different. The objective of the study is to analyze the efficacy of oral and intravenous iron in chronic kidney disease patients on erythropoietin therapy, an erythropoiesis stimulating agents for increment of haemoglobin.&#x0D; Methods: This is a prospective study comparing intravenous iron to oral iron in chronic kidney disease patients who underwent maintenance hemodialysis at different centers and visited Kathmandu Medical College Teaching Hospital from April 2010 to April 2011. Patients having a haemoglobin level of &lt; 11 g/dl, transferrin saturation (TSAT) &lt; 25%, ferritin &lt; 300ng/ml and who were on erythropoietin therapy were allocated alternately into two groups to receive oral iron (iron fumarate) or IV iron (iv sucrose). Haemoglobin was measured after 30 days of therapy.&#x0D; Results: A significant increase in haemoglobin levels was observed in both groups. But the mean haemoglobin increment was more in the IV iron group than in the oral iron group. Sixty percent 60% of patients in the IV iron group had an increase in the haemoglobin level of more than 1gm/dl while only 20% of the oral iron group had this increase.&#x0D; Conclusions: Intravenous iron therapy is more effective in raising the hemoglobin level in hemodialysis dependent chronic kidney disease patients.&#x0D; Keywords: anemia; chronic kidney disease; iron.

Uso de talidomida en sangrado recurrente por angiodisplasias gastrointestinales: Caso clínico

Chronic hemodialysis patients may have recurrent bleeding from gastrointestinal angiodysplasia, that often is diffusely located in the digestive tract or in places difficult to reach with traditional endoscopes. Therefore, they cannot be locally treated or removed. We report a 70 years old man on chronic hemodialysis, with severe and persistent anemia due to bleeding from angiodysplasia of the small bowel. Despite administration of high doses of erythropoiesis stimulating agents, intravenous iron, folate, B6 and B12 vitamins, his hemoglobin levels were < 6.5 g/dL, becoming totally dependent on transfusions of red blood cells (up to 46 units per year). Recurrent bleeding was refractory to conventional management and we decided to use thalidomide at doses of 50-100 mg/day achieving rapid control of gastrointestinal bleeding and significant increase of hemoglobin levels, not requiring further transfusions.

Dietary effect of folate-rich fermented milk produced by Streptococcus thermophilus strains on hemoglobin level

ObjectiveFolate, a water-soluble vitamin, functions as a carbon carrier in the formation of heme, the iron-containing non-protein portion of hemoglobin. Therefore, its deficiency leads to anemia. The objective of this study was to determine the dietary effects of folate-rich fermented milk produced by high-folate–producing Streptococcus thermophilus strains (RD 102 and RD 104) on hemoglobin level using a murine model. MethodsThirty-two albino mice 30 ± 10 d old were assigned to ingest a basal diet (i.e., a synthetic anemic diet, n = 8, group I, control 1), a basal diet with skim milk (n = 8, group II, control 2), a basal diet with fermented skim milk produced by folate plus RD 102 (n = 8, group III, test 1), and a basal diet with fermented skim milk produced by folate plus RD 104 (n = 8, group IV, test 2) in a 6-wk, double-blind, placebo-controlled study. Hemoglobin concentrations were estimated by the Drabkin–Austin cyanmethemoglobin method during the prefeeding (10 d), feeding (20 d), and postfeeding (10 d) trials, respectively. ResultsThe results showed that the test groups (III and IV) receiving folate-rich fermented milks prepared using high-folate producing S. thermophilus strains showed a significant increase in hemoglobin level compared with the control groups (I and II). ConclusionFolate-rich fermented milks have the potential to significantly increase the hemoglobin level of blood. Hence, high-folate–producing S. thermophilus strains offer a novel natural approach to fortify dairy products with folate.

Iron chelation therapy associated with improvement of hematopoiesis in transfusion‐dependent patients

It is well known that iron overload may cause multiple organ failure. In chronically transfused patients, optimal iron chelation therapy is associated with reduced morbidity and mortality. Furthermore, chelation therapy has been associated with erythroid responses. Among chronically transfused adults affected by myeloproliferative neoplasms and treated with iron chelators, two case reports are described. A male adult patient with myelodysplastic syndrome (MDS) and a female adult with aplastic anemia (AA), both transfusion-dependent, were treated with deferasirox, an oral iron chelator. A significant reduction in transfusion requirement was observed and was dependent on chelation therapy. The patient affected by AA also experienced a significant increase in hemoglobin levels. Minimal doses of deferasirox maintained the erythroid responses. Many mechanisms of action of the drug on erythropoiesis have been postulated. The early erythroid response seems to be independent of the removal of iron from deposits, per se, since the reduction of ferritin levels (a surrogate marker of iron deposits) below threshold levels occurs as a later event. Although there are few reports on erythroid responses in patients undergoing iron chelation therapy, they may give new insights in the pathogenesis of MDS and other myeloproliferative neoplasms. AA may benefit in terms of erythroid response. The findings in these cases underline the clinical importance of treating patients with iron overload. A survival benefit of chelation in patients with myeloproliferative neoplasms is still to be confirmed.

Guidelines for Epo use in children with cancer

Guidelines for Epo use in children with cancer

Utilidad de la administración de hierro sacarosa intravenoso para la corrección de la anemia preoperatoria en pacientes programados para cirugía mayor

There is a high incidence of perioperative anemia among surgical patients (20%-70%). Preoperative anemia has been linked to an increased postoperative morbidity and mortality, as well as a decreased quality of life of surgical patients. In addition, a low preoperative hemoglobin constitutes an important predictive factor of allogeneic blood transfusion in major surgery. We evaluated the efficacy of intravenous iron sucrose (IVIS) administration for correction of anemia in these patient populations.Data from 84 patients with anemia who were scheduled for major elective surgery (30 colon cancer resections, 33 abdominal hysterectomies, 21 lower limb arthroplasties) and who received preoperative IVIS during 3-5 weeks were propectively collected.Administration of IVIS -mean dose (standard deviation): 1000 (440)mg- caused a significant increase of hemoglobin levels -2.0 (1.6)g/dl (p<0.001)- and anemia was resolved in 58% of patients. No life-threatening adverse effect was witnessed.Because of the low incidence of side effects and the rapid increase of hemoglobin levels, IVIS emerges as a safe, effective drug for treating preoperative anemia in these patient populations.

Effect of periodontal therapy on hemoglobin and erythrocyte levels in chronic generalized periodontitis patients: An interventional study

Aims and Objectives:Anemia of chronic disease (ACD) is one of the most common forms of anemia. It is defined as anemia occurring in chronic infections, inflammatory conditions or neoplastic disorders which are not due to marrow deficiencies or other diseases, and occurring despite the presence of adequate iron stores and vitamins. Periodontitis is one of the most prevalent chronic inflammatory diseases in humans. This study aimed at finding out if periodontitis, like other inflammatory conditions, could lead to anemia.Materials and Methods:Thirty chronic generalized periodontitis male patients with hemoglobin levels below 15 mg/dl and serum ferritin values above 30 ng/ml were selected. The various blood parameters recorded at baseline were hemoglobin levels(Hb), erythrocyte count (RBC), erythrocyte sedimentation rate (ESR), mean corpuscular volume(MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC).Periodontal parameters recorded at baseline included: plaque index, gingival index, probing pocket depth, clinical attachment level. Periodontal treatment including surgery if required was carried out in all the patients. Periodontal status of patients was monitored by repeating evaluation of periodontal indices at three months and at the end of one year. The hematological values were again measured at the end of one year.Results:The results showed that correction of periodontal inflammation resulted in a significant increase in hemoglobin levels and erythrocyte counts. The erythrocyte sedimentation rate showed a reduction indicating resolution of periodontal inflammation. There was a significant, but much lesser, improvement in MCV, MCH and MCHC values.Conclusion:The results of this study showed that treatment of periodontitis leads to an improvement in hematocrit and other related blood parameters in chronic generalized periodontitis patients with anemia. This provides evidence that periodontitis like other chronic diseases may also cause anemia.

Valoración de la respuesta endoscópica al tratamiento con argón plasma en la rectitis actínica crónica

To evaluate endoscopic improvement after argon plasma coagulation (APC) in symptomatic patients with chronic radiation proctopathy. A prospective study of 38 patients with radiation proctitis (26 males and 12 females, mean age 70.9 +/- 7.38 yrs), and with rectal bleeding and or anemia. We performed monthly interviews, blood tests, and APC sessions until rectal bleeding had ceased and hemoglobin and ferritin levels were improved, with a follow-up of 24 months. We used blood testing, bleeding scores (Chutckhan's index), and endoscopic scores to evaluate improvement. Mean time between inclusion and follow-up completion was 28.5 +/- 3.9 months. Mean number of sessions per patient was 3.6 +/- 2.7. There was a significant decrease (2.29 +/- 1.8 vs. 0.59 +/- 1.12, p < 0.05) in rectal bleeding (Chutckan score) from baseline after APC. There was a significant increase in hemoglobin levels (11.3 +/- 3.05 vs. 14.014 +/- 1.29, p < 0.001) and ferritin levels (31.15 +/- 66.45 vs. 80.60 +/- 55.6, p < 0.05) from baseline after APC. Also, there was improvement in the endoscopic index at the end of treatment, as well as in friability (p < 0.0001) and involved surface area (p < 0.0001). Argon plasma coagulation is an effective technique, and the endoscopic index is a useful tool to evaluate endoscopic improvement.

Effect of intravenous iron administration frequency on AOPP and inflammatory biomarkers in chronic hemodialysis patients: A pilot study

ObjectivesIntravenous iron administration (IVIR) is effective for correcting anemia in hemodialysis (HD) patients, but it also enhances the generation of hydroxyl radicals. Previously we demonstrated that IVIR increases oxidized serum albumin levels in HD patients. However, the effect of IVIR frequencies on the oxidative stress has never been studied before. Therefore, we compared the two IVIR schedules recommended by the Japanese Society for Dialysis Therapy guideline 2004 by measuring oxidized albumin in chronic HD patients. Design and methodsTwenty-two HD patients were divided into two IVIR protocol groups (group I: 40 mg of iron 3 times a week for 4 weeks, group II: 40 mg of iron once a week for 3 months). These protocols differ in IVIR frequency, but receive the same amount of iron (total 520 mg). We compared these two regimens by determining the levels of hemoglobin, serum ferritin, advanced oxidation protein products (AOPP), and oxidized albumin at 0, 4, 8, 12, 16, and 20 weeks. ResultsBoth patient groups resulted in a similar and significant increase in hemoglobin levels, whereas group I markedly induced AOPP and oxidation of serum albumin than group II at 4 weeks (P<0.05). AOPP and oxidation of serum albumin was also gradually declined by 20 weeks, while the oxidized albumin and AOPP in group II was not significantly changed during the entire experimental period. Transferrin saturation and serum ferritin levels were also increased in group I compared with group II at 4 weeks (P<0.001). In addition, we found a strong positive correlation between oxidized albumin and serum ferritin levels (r=0.615, P<0.05), suggesting the possibility that the accumulation of iron stores has a causative role in the progression of oxidative stress in HD patients treated with IVIR. ConclusionsThe results of this study indicate that lower frequency IVIR protocol is recommended to reduce IVIR-induced oxidative stress in HD patients.

Better Mycophenolic Acid 12-Hour Trough Level After Enteric-Coated Mycophenolate Sodium in Patients With Gastrointestinal Intolerance to Mycophenolate Mofetil

Introduction Enteric-coated mycophenolate sodium (EC-MPS) is the enteric-coated salt form of mycophenolic acid (MPA), the active component of the prodrug mycophenolate mofetil. EC-MPS was developed to reduce the upper-gastrointestinal (GI) effects of mycophenolate mofetil. There are no studies available comparing trough plasma levels in patients with GI intolerance to MMF when they are converted to EC-MPS. Aim To compare the GI tolerance and the MPA levels in patients previously treated with MMF in whom this drug was replaced by EC-MPS. Materials and methods A prospective study was conducted in 133 renal transplant patients after conversion from MMF to EC-MPS (median time posttransplant 42 months, range 1 to 240 months). The causes for EC-MPS switching were GI intolerance to MMF (51.9%; group A), low trough plasma levels with MMF (29.3%; group B), and others (18.8%; group C). These patients were converted to equipotent doses of EC-MPS. Results The trough plasma MPA levels increased from 1.5 ± 1.1 μg/mL at baseline to 2.5 ± 2.0 μg/mL at 1 month postconversion despite the equipotent EC-MPS doses not being increased. These higher plasma levels were maintained throughout the study. In group A, this increase was from 1.8 ± 1.0 to 2.7 ± 2.1 μg/mL ( P = .01) and in group B from 0.8 ± 0.4 to 2.4 ± 1.4 μg/mL ( P < .001). The doses and levels of calcineurin inhibitor decreased from baseline. Creatinine clearance improved from 56.5 ± 24.7 mg/dL at baseline to 61.9 ± 28.6 at 6 months postconversion ( P = .02). There was a statistically significant increase in hemoglobin levels. In group A, the GI tolerance improved in 78% of the patients. Conclusions At equipotent doses, patients converted to EC-MPS have higher and more adequate levels of MPA. At 6 months postconversion, we observed an improvement of the renal function, probably due to a reduction of calcineurin inhibitor drugs. However, the possibility that a better immunosuppressive efficacy as demonstrated by more suitable trough plasma levels may have been a contributing factor cannot be discarded.

Role of erythropoietin in anemia after heart transplantation

Background Anemia after heart transplantation is common; however, there are scant data on etiology and treatment. This study evaluates type of anemia and the effects of erythropoietin therapy. Methods In 37 anemic heart transplant recipients (31 male/59.1 ± 10.3 years/hemoglobin < 12.0g/dl), complete anemia work-up was performed including erythropoietin determination. For three months, 12 anemic patients with renal failure (9 male/64.1 ± 13.6 years) were treated with 1–3 × 4000 IU of epoietin beta/week; treatment endpoints were hemoglobin levels and quality of life as determined by questionnaire. Results In 31 patients no other cause of anemia than renal insufficiency (mean creatinine 1.9 ± 0.9 mg/dl, mean calculated GFR 50.8 ± 21.5 ml/min, no hemodialysis) was found; in 93.5% of these patients with renal insufficiency, measured erythropoietin levels were markedly lower than predicted [Beguin Y, Clemons GK, Pootrakul P, Fillet G. Quantitative assessment of erythropoiesis and functional classification of anemia based on measurements of serum transferrin receptor and erythropoietin. Blood 1993; 81(4):1067-1076.]. There was an inverse correlation of hemoglobin levels with serum creatinine/creatinine clearance and a strong trend for inverse correlation of erythropoietin levels. All 12 patients treated with erythropoietin showed a significant increase in hemoglobin levels after three months returning to pre-treatment values within 3 months of cessation of therapy (before study 10.8 ± 1.1 g/dl, end of study 14.1 ± 1.7 g/dl, three months after end of study 11.6 ± 2.1 g/dl; p < 0.005). Quality of life was significantly improved in eight patients (75%). Conclusions Anemia after heart transplantation is associated with moderate renal failure and low erythropoietin levels in most patients. Erythropoietin therapy resulted in increased hemoglobin levels in all and improved quality of life in 75% of patients. Erythropoietin may be a superior marker of functional renal impairment after heart transplantation; its therapeutic substitution allows effective anemia management and improves quality of life.

EVALUATION OF BLOOD TRANSFUSION EFFECTS ON MIXED VENOUS OXYGEN SATURATION AND LACTATE LEVELS IN PATIENTS WITH SIRS/SEPSIS

To evaluate the effects of red blood cell transfusion in patients with SIRS/sepsis who presented hemoglobin levels under 9.0 g/dL at intensive care unit admission, using two parameters of organ perfusion: mixed venous oxygen saturation and serum lactate levels. All patients admitted to the intensive care unit with SIRS/sepsis, as defined by Consensus Conference in 1992, and hemoglobin levels under 9.0 g/dL were included. Hemoglobin levels, mixed venous oxygen saturation, and lactate levels were collected before red blood cell transfusion (pre-T) and up to 1 hour after transfusion (post-T). These variables were analyzed through a paired t test, and results were considered significant if P < .05. Twenty-nine patients (17 male, 12 female) with ages of 61.9 +/- 15.1 (mean +/- SD) years (range, 21-85 years) and a mean APACHE II score of 12.5 +/- 3.75 (7-21) were transfused with a mean of 1.41 packed red cell units. A significant increase in hemoglobin levels was reached by blood transfusion, from 8.14 +/- 0.64 g/dL (pre-T) to 9.4 +/- 0.33 g/dL (post-T), with P <.001. However, this was not accompanied by a significant change in lactate levels, from 1.87 +/- 1.22 mmol/l (pre-T) to 1.56 +/- 0.28 mmol/l (post-T), with P =.28, or in mixed venous oxygen saturation, from 64.3 +/- 8.52% (pre-T) to 67.4 +/- 6.74% (post-T), with P = .13. The results were similar even in patients with hemoglobin levels under 8.0 g/dL (n = 9). These results suggest that red blood cell transfusions, in spite of leading to a significant increase in hemoglobin levels, are not associated with an improvement in tissue oxygenation in patients with SIRS/sepsis and hemoglobin levels < 9 g/dL.

Patterns of resistance and DHFR/DHPS genotypes of Plasmodium falciparum in rural Tanzania prior to the adoption of sulfadoxine–pyrimethamine as first-line treatment

A study was carried out to assess the patterns of resistance and occurrence of DHFR/DHPS genotypes of Plasmodium falciparum prior to the adoption of sulfadoxine–pyrimethamine (SP) as first-line treatment for uncomplicated malaria in Tanzania. Children under five years ( n=117) with clinical, uncomplicated malaria were randomly allocated to standard treatments of either chloroquine (CQ) (25 mg/kg) or SP (25 mg sulfadoxine and 1.25 mg pyrimethamine/kg). Patients were monitored for 28 days. Clinical recovery was achieved in 98% ( n=58) and 90% ( n=59) of the patients in the SP and CQ groups, respectively. Parasitologically, 14% of the patients in the SP group and 51% in the CQ group exhibited RII/RIII resistance. When relating pre-treatment blood drug levels to treatment outcome and the degree of parasite resistance to the number of mutations, no relationships could be detected. There was an overall significant increase in haemoglobin levels from day 0 to day 28 in both patient groups. Sulfadoxine–pyrimethamine produced an acceptable clinical response but the high degree of parasitological resistance (RII/RIII) observed two years prior to the introduction of the drug as first-line treatment is of concern, especially considering the long half-lives of sulfadoxine and pyrimethamine.

Management of anemia with quotidian hemodialysis

Background: Most patients with end-stage renal disease have chronic anemia caused by inadequate erythropoietin (EPO) synthesis and require therapy with exogenous EPO to maintain recommended hematocrit and hemoglobin levels. Methods: The London Daily/Nocturnal Hemodialysis Study compared anemia control among patients on either short daily, long nocturnal, or conventional thrice-weekly hemodialysis (HD) therapy. Patients were administered iron, either orally (900 mg/d) or intravenously (50 to 125 mg every 1 to 4 weeks), to maintain serum ferritin levels at greater than 45 ng/mL (100 μg/L) or transferrin saturations greater than 20%. EPO was administered by subcutaneous injection at frequencies ranging from twice weekly to once every second week to maintain hemoglobin levels within the target range of 11 to 12 g/dL (110 to 120 g/L). Results: Both the daily HD and nocturnal HD study groups showed increased hemoglobin levels at later times compared with baseline levels, although only nocturnal HD patients had a statistically significant increase in hemoglobin levels at 18 months (11.94 g/dL [119.4 g/L] versus 10.95 g/dL [109.5 g/L] at baseline; P = 0.047). Both the daily HD and control groups showed a trend for decreased EPO dose requirements at later times compared with baseline, although these decreases were not statistically significant. The nocturnal HD group showed increased EPO dose requirements, although not statistically significant. Conclusion: Quotidian HD is associated with an increased quantity of blood loss that can account for some of the increased requirements in EPO dose. Additional studies with larger numbers of patients are needed to fully elucidate the effects of quotidian HD on anemia.

Randomized, crossover study of the effect of vitamin C on EPO response in hemodialysis patients

Background:Vitamin C has been reported to be an effective adjuvant agent in the treatment of anemia in iron-overloaded hemodialysis patients. We aim to evaluate its effect on erythropoietin (EPO) response in a prospective, randomized, double-blind, crossover study. Methods:Sixty-three patients were randomly divided into two groups. Group 1 was treated with intravenous vitamin C, 500 mg, three times a week, and group 2, with placebo for 6 months. During the second 6-month period, group 1 was treated with placebo, and group 2, with the same dose of vitamin C. Thirty patients in group 1 and 28 patients in group 2 completed the study. Hemoglobin levels, weekly EPO dose, and ratio of EPO to hemoglobin as an index of EPO need were determined at both baseline and the end of the two periods, together with other parameters known to be associated with EPO response. Results:Twenty patients in group 1 (66.7%) and 18 patients in group 2 (64.3%) were responsive to vitamin C. In both groups, vitamin C resulted in a significant increase in hemoglobin levels (P < 0.0001 for both) and a significant decrease in EPO-hemoglobin ratio (P < 0.0001, P = 0.019). Transferrin saturation also increased with vitamin C treatment in both groups (P = 0.009, P = 0.005). All these parameters remained stable with placebo in both groups. Other parameters did not change throughout the study. Conclusion:Vitamin C can be used as an effective adjuvant therapy to EPO in hemodialysis patients. Further studies are needed to determine possible predictors of hematologic response to vitamin C.

Anemia of chronic disease in rheumatoid arthritis is associated with increased apoptosis of bone marrow erythroid cells: improvement following anti–tumor necrosis factor-α antibody therapy

AbstractCircumstantial evidence has implicated tumor necrosis factor α (TNF-α) in the pathogenesis of anemia of chronic disease (ACD) in rheumatoid arthritis (RA). We investigated the role of TNF-α in erythropoiesis of patients with active RA (n = 40) and the effect of anti–TNF-α antibody administration (cA2). Patients with RA had lower numbers of CD34+/CD71+ and CD36−/glycophorin A+ (glycoA+) bone marrow (BM) cells and increased proportions of apoptotic cells within the CD34+/CD71+ and CD36+/glycoA+ cell compartments, compared to healthy controls (n = 24). Erythroid burst-forming units (BFU-Es) obtained by BM mononuclear or purified CD34+ cells were significantly lower in RA patients compared to controls. These abnormalities were more pronounced among patients with ACD. Increased TNF-α levels in patient long-term BM culture supernatants inversely correlated with BFU-Es and hemoglobin levels and positively with the percentage of apoptotic CD34+/CD71+ and CD36+/glycoA+ cells. Following cA2 therapy, a normalization was documented in the number of CD34+/CD71+ and CD36−/glycoA+ cells, the number of BFU-Es, and the proportion of apoptotic CD34+/CD71+ and CD36+/glycoA+ cells, which was associated with a significant increase in hemoglobin levels compared to baseline. Recovery from anemia was more prominent in patients with ACD. The exogenous addition of an anti–TNF-α antibody in the cultures increased BFU-E number in patients prior to cA2 treatment but not after treatment, further substantiating the inhibitory role of TNF-α on patients' erythropoiesis. We conclude that TNF-α–mediated apoptotic depletion of BM erythroid cells may account for ACD in RA and that cA2 administration may ameliorate ACD in these patients by down-regulating the apoptotic mechanisms involved in erythropoiesis.

The effect of different anthelmintic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial

A randomized controlled trial in KwaZulu-Natal (South Africa) of 428 primary-school pupils (stratified into 6 groups by age, sex and intervention) measured the effect of different anthelmintic treatments and iron supplementation regimens provided twice at 6-monthly intervals for 1 year (1996/97). Half the pupils received iron supplementation (ferrous fumarate 200 mg weekly for 10 weeks). Pupils received 2 anthelmintic regimens, either (i) albendazole 400 mg plus praziquantel 40 mg/kg or (ii) albendazole 400 mg on 3 consecutive days plus praziquantel 40 mg/kg or (iii) placebo. Baseline prevalences of Ascaris 55·9%, Trichuris 83·6%, hookworm spp. 59·4%, were reduced after 12 months for single-dose albendazole treatment to Ascaris 17·4% ( P < 0·005), Trichuris 61·5% (NS), hookworm spp. 0% ( P < 0·005), and for triple-dose albendazole treatment to Ascaris 14.8% ( P < 0·005), Trichuris 25·0% ( P < 0·01), hookworm 0% ( P < 0·005). Schistosoma haematobium 43·4% was reduced among treated groups to 8·3% ( P < 0·005). There were no significant changes in the anthropometry of the different treatment groups at either 6 or 12 months post treatment. Twelve months after treatment there was a significant increase in haemoglobin levels ( P = 0·02) among pupils receiving triple-dose albendazole, praziquantel and ferrous fumarate; pupils receiving no anthelmintic treatment showed a significant decrease as did pupils who received triple-dose albendazole and praziquantel but no iron. Regular 6-monthly anthelmintic treatment significantly reduced the prevalence of Ascaris, hookworm spp. and S. haematobium infections ( P < 0·05). Triple-dose treatment for Trichuris was significantly more effective than a single dose of albendazole 400 mg ( P = 0·002). In areas with schistosomiasis, hookworm infection and high prevalence of Trichuris infection, combination treatment with praziquantel, triple-dose albendazole, plus iron supplementation, is likely to improve pupils' health and haemoglobin levels.