Therapy For Anemia Research Articles

Evaluation of the results and cost of drug therapy for anemia in patients with 5th stage of the chronic kidney disease receiving hemodialysis in the real clinical practice in Moscow

Evaluation of the results and cost of drug therapy for anemia in patients with 5th stage of the chronic kidney disease receiving hemodialysis in the real clinical practice in Moscow

Magnetic Therapy of Anemia Caused by Inflammations

Magnetic Therapy of Anemia Caused by Inflammations

Same-day dismissal for endometrial cancer robotic surgery: feasibility factors.

The aim of this study was to investigate the factors in feasibility and safety of same-day dismissal (SDD) of endometrial cancer patients undergoing robotic hysterectomy and staging. A single-institution retrospective chart review of endometrial cancer patients who underwent robotic hysterectomy and staging between 2012 and 2021 was performed. Patient demographics, medical and surgical history, intra- and postoperative events were examined as possible factors related to non-SDD. These factors were analyzed using univariate (chi-square test) and multivariate logistic regression analysis. Of the 292 patients, 117 (40%) had SDD, and 175 (60%) had non-SDD. The SDD rate increased from 13.8% to 88% over the 10-year study period. The factors significantly associated with non-SDD (p < 0.05) were surgery in the first 5years after the introduction of the SDD and ERAS protocols (2012-2016), age > 75years, and comorbidities such as cardiovascular diseases, anemia (Hb < 11g/dl), and anticoagulant therapy. Extensive adhesiolysis, the performance of complete pelvic and/or aortic lymphadenectomy, operating time > 180min, and PACU discharge after 2:00 p.m. were significant factors for non-SDD. Sentinel lymph node sampling was significantly associated with SDD (OR 0.050; CI 0.273-0.934, p = 0.029). We reported no significant difference in the number, setting and timing of any unscheduled postoperative contacts, complications, and readmissions between SDD and non-SDD groups. SDD after robotic hysterectomy and staging for endometrial cancer is feasible and safe. There are patient and surgery factors for the failure of SDD. The sentinel lymph node sampling was significantly associated with achieving SDD. Trial registration: Institutional Review Board approved the study protocol (#: 1764-05).

Efficacy of Oxymetholone in Severe and Nonsevere Acquired Aplastic Anemia: A Propensity Score Matching Analysis.

Bone marrow transplantation, antithymocyte globulin/cyclosporine and eltrombopag are recommended as first-line therapy of severe aplastic anemia (SAA). However, androgens could be considered as front-line treatment among any patients ineligible for better methods although unsatisfactory efficacy is presented. This retrospective study aimed to evaluate response and survival rate of practical-based treatment with oxymetholone. This constituted an analysis of patients receiving a diagnosis of acquired aplastic anemia (AA) at the age of 15 or over and receiving oxymetholone between January 2004 and December 2018. Propensity Score Analysis (PSA) 1:1 matching was performed, according to sex, age and interval from first symptom to treatment. The primary outcome was one-year overall response (OR). Seventy-four patients were successfully matched by PSA. The 1-year OR of oxymetholone in the nonsevere AA (nSAA) and SAA/very severe AA (vSAA) groups was 54.1 and 13.5%, respectively (P <0.001). With median follow-up 2.7 years, the overall survival was 59.5% in nSAA and 37.8% in SAA/vSAA (P = 0.051). Median survival in nSAA and SAA/vSAA were 7.0 years and 1.8 years, respectively (P = 0.045). However, the responders of SAA/vSAA had longer survival than nonresponders of the nSAA group. These results revealed longer survival among the responders of patients with AA, even in the SAA/vSAA group. However, close monitoring of therapeutic responses is still performed. Switching therapy is necessary when remission is undetected after 6 months of oxymetholone treatment.

First Single-Center Experience with Luspatercept Therapy in Low-Risk Myelodysplastic Syndrome (LR-MDS) Patients with Transfusion Dependence Refractory to Erythropoietin Therapy

Introduction: In the treatment of low-risk myelodysplastic syndromes (MDS) patients, anemia is the predominant problem. A recent breakthrough in the therapy of anemia in low-risk MDS patients are drugs involved in TGFβ pathway blockade. Luspatercept is a recombinant fusion protein derived from human activin receptor type IIB. It binds TGFβ superfamily ligands and inhibits the SMAD2/3 pathway leading to potentiation of red cell line differentiation and proliferation. Luspatercept was approved last year by the FDA and EMEA in the treatment of anemic low-risk MDS patients with ring sideroblasts (MDS-RS-MLD, MDS-RS-SLD) and/or SF3B1 mutated patients who are not eligible for erythropoiesis-stimulating agents (ESA) or for patients who failed on this therapy. Luspatercept showed high clinical activity for the treatment of anemia in the phase 2 trial (PACE-MDS) and subsequently in the phase 3 trial (MEDALIST). It has led to transfusion independence (TI) in about 40 % of patients. Methods: From January 2021 to July 2022, 27 patients were treated with luspatercept at the hematology department of Charles University Hospital in Prague, Czech Republic. The median age of the patients was 77 years (range 57-89) with a male to female ratio 17:10. WHO 2016 diagnosis were: MDS-RS-MLD (N = 23) and MDS/MPN-RS-T (N = 4). Median of IPSS-R was 2.5 (range 1-4). Median of IPSS-R cytogenetic score scaled from 0-2 with the median of 1. Median follow-up was 7.8 months (range 1-38). Luspatercept was administered in subcutaneous injections once every 3 weeks with an initial dose of 1 mg/kg. Dose escalation was done according to the level of response to 1.33 and 1.75 mg/kg. The median number of cycles administered was 7 (2-17). Transfusion dependency before luspatercept initiation ranged from 2 transfusion units (TU)/8 weeks to 12 TU/8 weeks, 11 patients had low transfusion burden (LTB), 16 high transfusion burden (HTB). Baseline erythropoietin (EPO) level was 374 IU/l in average (range 150-770) and ferritin level was 1307 μg/l in average (range 234-3832). 9 patients received chelation therapy. 22 patients were tested for SF3B1 mutation with 21 positive results (95.5 %) using Sanger sequencing (N = 3) or NGS approach (N = 18). Isolated mutation of SF3B1 was present in 8 patients (44 %). The most frequent mutations besides SF3B1 were TET2 (N = 8; 44 %), ASXL1 (N = 3; 17 %), DNMT3A and RUNX1 (N = 2; 11 %). Average mutations count per one patient was 1.7 (range 0-5). We did not observe any TP53 mutation. Results: There were 24 evaluable patients in terms of response. Thus far 11 (45 %) patients have responded by achieving TI, 5 (20 %) patients have had a reduction in transfusion dependence (HI, according to IWG criteria 2006), 8 (33 %) patients have not responded. One patient progressed to the higher risk MDS, and one transformed to acute myeloid leukemia. Median duration of response was 7.4 months (range: 0.7-31.8). Median number of cycles to achieve response was 4. Eleven patients responded to the basic dose 1 mg/kg, 2 additional patients on the dose 1.33 mg/kg and 2 more on the dose 1.75 mg/kg. There were differences in response according to transfusion burden, in LTB group achieved TI 8 patients and HI 1 patient, in HTB group we observed TI in 3 patients and HI in 4 patients. In 9 patients, we added ESA to luspatercept therapy, as they act both at different levels of erythropoiesis, which led to the improvement of response in 5 cases. In general, patients with lower initial baseline EPO level were better responders. We did not observe decrease in ferritin level during therapy. There was no significant effect of mutation burden on patient's OS, although patients with single mutated SF3B1 achieved better ORR (75 %), than patients bearing mutations in multiple genes (ORR = 40 %). There were no adverse effects of Grade II or more. Conclusion: In conclusion, luspatercept is certainly the next major step in the treatment of anemia in MDS patients. The advantage of the drug is very good tolerance and easy administration. We observed better responses in patients bearing single mutation in SF3B1, patients with LTB and lower initial baseline EPO levels. The higher response rate in our follow-up may be influenced by the combination with ESA and rapid dose escalation. This work was supported by the following grants: grant AZV 2021-2024 NU21-08-00312, Grant AZV 2019-2023 NV19-08-00144, UNCE/MED/016

JAK 1/2 Inhibition Preserves Hematopoietic Progenitor and Stem Cells, Prevents Aplasia, Inhibits Pro-Inflammatory Cytokines, and Prolongs Survival in Murine Immune Bone Marrow Failure

Background: Immune aplastic anemia (AA) is clinically characterized by marked pancytopenia due to cytotoxic T-lymphocyte mediated hematopoietic stem and progenitor cell (HSPC) destruction. Though hematopoietic stem cell transplant and immunosuppressive therapies are effective, both are onerous to administer and a fully oral regimen is desirable. Ruxolitinib (RUX) is a Janus Kinase (JAK) 1/2 inhibitor which suppresses cytotoxic T cell activation and inhibits production of inflammatory cytokines; RUX is FDA-approved for myeloproliferative neoplasms and graft versus host disease. Methods: RUX was administered as a previously validated food additive (Rux-chow) in an immune bone marrow failure (BMF) murine model (major histocompatibility complex mismatched C57BL/6 (B6)ÞCByB6F1 lymph node (LN) cell infusion following sublethal total body irradiation (TBI)). Animals were fed Rux-chow starting at two, four, and six days after BMF induction (D+2, D+4, D+6) until day 28; a control group ate chow without RUX for the duration. Survival was assessed for 56 (D+2) or 70 (D+4, D+6) days. Blood counts, T-cells, apoptosis, and gene expression were assessed from peripheral blood, spleen or bone marrow (BM). Inflammatory cytokines implicated in AA including IFN-g, TNF-a, IL-5, IL-1a, CCL2, FasL, CCL5, and IL-10 in the plasma were measured by Luminex. Colony-forming unit (CFU) assays were performed on BM mononuclear cells mixed in semisolid methylcellulose media containing interleukin (IL)-3, IL-6, stem cell factor and erythropoietin with colonies counted at day 10; results were compared with both untreated BMF and TBI controls. Results: All RUX-treated BMF mice (days +2, +4, and +6) achieved long term survival and all untreated BMF mice died (Figure 1A). RUX rescued blood counts in BMF mice, even with delayed treatment, that were sustained with drug discontinuation. Improvement in bodyweight (BW) was seen in Rux-fed mice. Infiltration and activation of BM T-cells were suppressed with a reduction in CD4+ and CD8+ T cells, decrease in CD25+ T-cells, and an increase in splenic FOXP3+ Tregs. Gene expression in RUX treated mice showed downregulation of immune pathways including cytokine signaling in the immune system, the JAK/STAT signaling pathway, and the IFN-g pathway, indicating inhibition of T cell function. RUX therapy preserved HSPCs phenotypically and functionally: hematopoietic progenitors were significantly greater among BM cells from BMF+RUX mice, at 2 weeks and at 8 weeks following BM failure induction, compared to both untreated BMF mice and TBI controls (Figure 1B). Inflammatory cytokines IFN-g, TNF-a, IL-5, CCL-2, CCL-5, FasL, and IL-10 were suppressed on RUX at two weeks but gradually increased when drug was discontinued (except IFN-g which remained at low levels long term). Conclusion: RUX resulted in prolonged overall survival achieved by rescue of BMF as demonstrated by a sustained improvement in peripheral blood counts; this occurred even with delayed administration up to 6 days after BMF induction. RUX alleviated T-cell mediated immune destruction by suppression of T cell infiltration and activation, expansion of Tregs, as well as functional preservation of HSPCs. RUX, an orally administered medication with a favorable toxicity profile, is a potential new therapy for aplastic anemia and related syndromes. A clinical trial using RUX in patients with immune BMF is currently under development. Figures:1A: Survival with delayed RUX therapy. 1B: CFU assays in RUX treated mice, TBI controls, and BMF controls Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Anti-Human T Lymphocyte Porcine Immunoglobulin Combined with Cyclosporine As First-Line Immunosuppressive Therapy for Severe Aplastic Anemia in China: A Large Single-Center, 10-Year Retrospective Study

Immunosuppressive therapy (IST) based on antithymoglobin (ATG) and cyclosporin (CsA) is the first-line treatment for severe aplastic anemia (SAA) patients who are ineligible for transplantation. Horse ATG is recommended as the standard preparation for first-line immune suppression in SAA, but it has been unavailable in China since the year 2000. The anti-human T lymphocyte porcine immunoglobulin (p-ATG, provided by Yujin Bio-Pharma Wuhan CNBG Co., Ltd., Wuhan, China) was made available in 1983 and approved for the treatment of aplastic anemia by the Sino Food and Drug Administration in 2004. It is a commonly used ATG preparation in IST for SAA in China since 2009. To date, only a few small retrospective cohort studies reported that p-ATG combined with cyclosporine (CsA) is a useful immunosuppressive regimen for SAA in China. This study retrospectively analyzed the data of 1023 consecutive patients diagnosed with SAA that aimed to evaluate the early hematologic response and long-term outcomes of this large cohort of patients with SAA who received p-ATG plus CsA as first-line therapy from 2010 to 2019. Patients received p-ATG for 5 consecutive days (day 1-5), at a dose of 20 mg/kg/day. And CsA was administered orally from day 1 of p-ATG treatment at two separate doses starting from 3 to 5 mg/kg/day and adjusted to maintain the trough concentration at 150-250 ng/ml and the peak concentration at 800-1000 ng/ml. One thousand twenty-three aplastic anemia were included in this study, with a median age of 24 (4-75) years, with 500 males and 473 females. The median follow-up was 57.2 months (3 days-137.5 months). Twenty-nine patients died within 3 months after IST, with an early death rate of 2.8% (29/1023); the median death time was 0.9 (0.1-2.9) months. The overall hematologic response rate (ORR) was 40.6% (415/1023) at 3 months, including 5.9% (60/1023) of patients with CR. The ORR was 53.2% (544/1023) at 6 months, including 13.5% with CR. Of the 395 patients who did not respond at 6 months, 26.1% (103/395) had an overall response at 12 months without any rescue treatment (10 had a CR, 93 had a PR). By the last follow-up, 9.2% (64/697) of the patients had experienced a relapse. The 5-year cumulative incidence of relapse was 9.0% [95% confidence interval (CI), 4.2 to 16.0%]. The 5-year cumulative incidence of clonal evolution was 4.5% (95% CI, 1.4 to 10.6%). The 5-year cumulative incidence of hPNH was 4.7% (95% CI, 1.2 to 12.4%). In patients with PNH clones at diagnosis, the 5-year cumulative incidence of hPNH was 22.5% (95% CI, 10.1 to 37.8%). The 5-year OS rate was 83.7% (95% CI, 81.1 to 86.0%). The 5-year event-free survival rate was 50.4% (95% CI, 47.1 to 53.5%). In conclusion, p-ATG combined with CsA for the treatment of AA is effective and safe, and p-ATG can be used as an alternative ATG preparation for the standard IST regimen in areas where h-ATG is not available.

Retrospective Assessment of Total Cost of Care in Non-Dialysis Dependent Chronic Kidney Disease Patients Receiving Parenteral Iron Therapy for Iron Deficiency Anemia

Introduction Iron deficiency anemia (IDA) is a common comorbidity among patients with chronic kidney disease. Iron deficiency occurs in 15% to 48% of non-dialysis dependent chronic kidney disease (ND-CKD) patients with anemia. Parenteral iron therapy is often required in ND-CKD patients with IDA who cannot tolerate or are nonresponsive to oral iron. Available IV iron treatments vary in the amount of iron dose per administration, the number of infusions required to achieve complete iron repletion and drug acquisition cost. The objective of this study was to compare healthcare costs between ferric carboxymaltose (FCM) and low dose IV iron (LDI) for the treatment of IDA in ND-CKD patients. Methods Medical and pharmacy claims from IQVIA PharMetrics® Plus data were analyzed. Adult patients who received first (index) dose of FCM or LDI (i.e., iron sucrose, iron dextran, sodium ferric gluconate complex in sucrose) from 2017 to 2019 were included. Eligible patients were required to be continuously eligible 6 months before (baseline) and 12 months after index IV iron infusion and had medical claims associated with diagnosis of chronic kidney disease (ICD-10: N18.1 to N18.5) and IDA (ICD-10: D50.x) anytime during the 18-month study observation period. In addition, eligible FCM patients were required to receive a second dose of FCM within 21 days of index date. Patients who had claims associated with end stage renal disease (ICD-10: N18.5 and N18.6) or dialysis (HCPCS CPT code: 90935-90999) and patients who had received other IV iron products in the 6-month baseline period were excluded. Unadjusted mean number of IV iron infusions, outpatient visits and hospital admissions in the 6 months before and 12 months following index IV iron dose were summarized on a per-patient-per-month basis. Post-index monthly inpatient, outpatient, and total healthcare costs for FCM and LDI were compared using generalized linear model with gamma log-link adjusting for pre-index monthly cost, age, gender, year of index treatment and the Charlson Comorbidity Index (CCI). Sensitivity analyses comparing FCM versus iron sucrose were performed. Results Data from 3,727 FCM patients [mean (SD) age= 67.9 (13.8) years, 61% females, CCI (SD)=1.9 (2.5)] and 5,068 LDI patients [mean (SD) age=64.8 (15.0) years, 60% females, CCI (SD)=1.6 (2.4)] were analyzed. Within the LDI cohort, 3,489 patients received index iron sucrose treatment [mean (SD) age=64.6 (15.1) years, 60% females, CCI (SD)=1.5(2.4)]. Mean (SD) number of IV iron infusions was 0.24 (0.26) for FCM, 0.43 (0.52) for LDI and 0.46 (0.52) for iron sucrose during the post-index period. During the post-index period, FCM has a smaller increase in the number of outpatient visits (mean change from baseline=0.13) than LDI (mean change from baseline=0.64) and iron sucrose (mean change from baseline=0.70). The number of hospital admissions in the post-index period were numerically lower for FCM (mean change from baseline=-0.05) but numerically higher for LDI (mean change from baseline=0.04) and iron sucrose (mean change from baseline=0.05). Mean total health care cost increased during the 12-month period after IV iron treatment compared to baseline in all treatment groups. After adjusting for pre-index cost and other covariates, FCM treatment was associated with significantly lower post-index inpatient costs [adjusted cost ratio (ACR)= 0.73, p<0.0001], ER costs (ACR=0.76, p<0.0001), outpatient costs (ACR=0.73, p<0.0001) and total costs (including IV iron) (ACR = 0.81, p<0.0001) than LDI. Similar results were observed in the comparisons between FCM and iron sucrose. Conclusion Higher drug acquisition cost of FCM compared to LDI was primarily offset by lower inpatient and outpatient costs during the 12 months after FCM treatment for IDA in ND-CKD patients than LDI, resulting in significantly lower overall total health care cost for FCM compared to LDI. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Avatrombopag Added to Standard Immunosuppressive Therapy for Severe Aplastic Anemia

Acquired aplastic anemia is immune-mediated bone marrow failure disease. Antithymocyte globulin (ATG) and cyclosporine based immunosuppressive therapy (IST) is effective for severe aplastic anemia (SAA), but only 12-17% of patients achieve complete response at 6 months. Complete hematologic response predicts better survival of patients, so clinicians have been trying to further improve the complete response rate. Addition of eltrombopag improves both the overall response rate and complete response rate of SAA patients, but its hepatotoxicity is still worrying. Avatrombopag is a novel, oral, small-molecule thrombopoietin receptor agonist being developed to provide a predictable increase in platelet counts in immune thrombocytopenia and thrombocytopenia in patients with chronic liver disease. To date, there is no report on the effectiveness of avatrombopag in treating aplastic anemia. Here we enrolled 32 severe and very severe aplastic anemia (SAA/VSAA) patients who received ATG, cyclosporine and avatrombopag as first-line treatment between June 2021 and March 2022. Thirty-one patient received porcine ATG (20mg/kg.d for 5 consecutive days) and one patient received rabbit ATG (3mg/kg.d for 5 consecutive days). Avatrombopag was added within 3 months after ATG initiation at dose of 40-60mg per day and administered for at least 3 months. Cyclosporine was given orally at dose of 3.5-5mg/kg.d. There were 17 SAA patients and 15 VSAA patients. The median neutrophil count was 0.31 (range 0.01-1.01) ×109/L, median reticulocyte count was 8 (range 2-54) ×109/L, and median platelet count was 5 (range 1-16) ×109/L. All patients achieved the end-point of 3 months and 23 patients achieved end-point of 6 months. One patient with VSAA died at 1 month due to infections and was counted as no response at 3 months and 6 months. The rate of complete response was 15.6% and rate of overall response was 46.9% at 3 months. The rate of complete response at 6 months was 30.4% and rate of overall response was 65.2%. The complete response rate at 3 months and 6 months were both higher than historical results of standard IST (ATG and cyclosporine, 5.2% at 3 months and 14.6% at 6 months). Avatrombopag was safe, and there was no drug-related liver dysfunction. No patient discontinued avatrombopag due to adverse events. In conclusion, the addition of avatrombopag to IST was safe and associated with higher complete response rate among patients with SAA/VSAA.

Perioperative Outcomes of Patients Treated in an Anemia Clinic before Spine Surgery

BACKGROUND: Patients with preoperative anemia are at increased risk of postoperative blood transfusion, as well as other adverse outcomes, including infection, prolonged length of stay (LOS), and death. Requirement of intraoperative transfusions may be an independent risk factor for mortality among patients undergoing noncardiac surgery. As such, efforts have emerged internationally to establish clinical decision support tools, dedicated preoperative anemia clinics, and clinical trials studying the effects of preoperative treatment of patients to improve outcomes after surgery. While studies to date have shown mixed results, some suggest that treatment with intravenous (IV) iron improves anemia and decreases transfusion requirements. Treatment with erythropoietin-stimulating agents (ESA) has also been associated with fewer transfusions in patients undergoing orthopedic surgery. METHODS: We established a preoperative clinic in 2019 with a pilot for patients undergoing spine surgery. Patients who were found to have a hemoglobin (Hgb) < 13.0 g/dL on preadmission testing were automatically referred, and when possible, had iron studies reflexively added on to their samples. Patients were offered an appointment with a nurse practitioner or physician in Hematology and treated with IV iron or a combination of IV iron and ESA at the discretion of the provider. Importantly, if time did not allow for a visit or the patient declined an appointment or preoperative treatment, surgeries were not cancelled or delayed. This retrospective study included patients undergoing elective spine surgeries between August 1, 2019 and June 1, 2021 at Thomas Jefferson University Hospital and Jefferson Hospital for Neuroscience. Patients were eligible if they were automatically referred to the preoperative anemia clinic based on preadmission testing results. The primary outcome was postoperative allogeneic red blood cell (RBC) transfusion during the index admission. Secondary outcomes included decrease in Hgb postoperatively, LOS, and 30-day readmission rate. RESULTS: The study included 108 patients (53.7% female) who underwent a total of 112 distinct elective spine surgeries. The median age at the time of surgery was 65 years. The most common surgery was decompression and fusion (73.2%), followed by decompression (17.0%) and fusion (9.8%). 16.1% of surgeries were revisions of a prior surgery. The median preoperative Hgb was 11.6 g/dL. Prior to the 112 surgeries, 45 (40.2%) patients were seen by a Hematology provider and 37 (33.0%) received preoperative treatment for anemia, including 28 (25.0%) who got IV iron plus ESA, 8 (7.1%) IV iron alone, and 1 (0.9%) ESA alone. The final treatment was given a median of 5 days before surgery (IQR 3-9.5 days). There was a nonsignificant trend toward lower mean preoperative Hgb in patients who were treated before surgery and those who were not (mean 11.2 vs 11.6 g/dL, p=.162) and greater mean estimated blood loss during surgery when reported (392 vs 315 mL, p=.462). Compared to untreated patients, those who were treated before surgery were significantly more likely to be iron deficient (ferritin < 30 ng/mL or iron saturation < 15%) (45.9% vs 26.7%, p=.041). The primary outcome of allogeneic RBC transfusion occurred in 18.9% of patients who received pre-treatment and 9.3% of those who did not (p=.149). The degree of initial Hgb drop postoperatively from last pre-op value was significantly lesser in pre-treated patients (-0.93 vs -1.56 g/dL, p=.015), and a nonsignificant improvement was observed in the change from baseline to nadir Hgb during the index admission (-1.54 vs -2.15 g/dL, p=.074). A trend toward shorter LOS was observed in pre-treated patients (3.30 vs 3.47 days, p=.739), though that group also experienced more 30-day inpatient readmissions (18.9 vs 12.0%, p=.325). No deaths were observed during the study period. CONCLUSION: In this preoperative anemia clinic pilot, treatment with IV iron and/or ESA before major spine surgery was not associated with a reduction in allogeneic RBC transfusions or hospital readmission. However, those who received pre-treatment had significantly lesser declines in Hgb after surgery and a trend toward shorter LOS. Patients who received treatment were significantly more likely to be iron deficient before surgery and had lower mean Hgb levels, which confounds the results. Larger prospective studies of preoperative anemia therapy are needed. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Evaluation of the prescription pattern of ferrous sulfate as a therapy for preventing iron deficiency anemia in infants.

Iron deficiency prevalence in infants is high. Therefore, iron supplementation has been recommended and specified as a program. This study aimed to determine the characteristics of the prescription of ferrous sulfate as a preventive therapy for iron deficiency anemia in young infants. We conducted a descriptive cross-sectional study of clinical records of young infants with eight visits per year. We analyzed a total of 287 records. The prescription characteristics included five criteria prescription indication, age at prescription, dosage, periodicity, and time. These characteristics were scored as follows 1 point when it was considered adequate and 0 when it was considered inadequate; the minimum possible score was 0, and the maximum possible score was 5 points. Statistical analysis included percentages and 95% confidence intervals (CI). The prescription pattern of ferrous sulfate as preventive therapy in infants under one year of age was indicated in 100% of the records reviewed. All five criteria were met in 18.1% of the reviewed records (95%CI 13.6-22.6). The lowest compliance corresponded to adequate dosage (29.2%; 95%CI 23.9-34.5). Age at prescription was correct in 75.9% (95%CI 70.9-80.9); duration of prescription was correct in 44.2% (95%CI 38.4-50.0), and periodicity was proper in 31.1% (95%CI 25.9-36.7) of the files reviewed. Compliance with the prescription of ferrous sulfate as a preventive measure for anemia in infants was not as expected; interventions are needed to reverse this behavior.

Blood management in patients with uterine myoma and anemia in the perioperative period

Introduction. In the structure of gynecological diseases, uterine myoma occupies one of the leading places and is accompanied by abnormal uterine bleeding, anemia, hemodynamic and hemostasiological disorders. Purpose. To optimize the management of the perioperative period in patients with uterine myoma and iron deficiency anemia (IDA) using methods of patient blood management (PBM). Materials and methods. The study group consisted of 94 patients with uterine myoma and IDA, who were examined and treated at the Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology. Of these, 74 patients made up the first, prospective group, who received IDA treatment with intravenous administration of ferric carboxymaltose during the perioperative period and during surgical treatment (laparoscopy / laparotomy and myomectomy), they underwent intraoperative autologous blood transfusion (IABT) using the cell salvage with Cell Saver 5+ apparatus. 20 women with myoma uterine and IDA constituted a comparison group (retrospective) who did not receive intravenous iron therapy in the perioperative period and did not undergo IABT. During surgical intervention (laparoscopy / laparotomy and myomectomy) or in the postoperative period, they received transfusion of donor erythrocyte-containing blood components according to indications. Results. All patients underwent surgical treatment in the amount of laparoscopy / laparotomy and myomectomy. During the operation, 74 patients of the main group underwent IABT in an average volume of 467.4 ± 327.8 ml. In the postoperative period, the patients of the main group continued to receive anemia therapy with intravenous administration of ferric carboxymaltose. And blood transfusions were not required in any patient of the main group. In patients of the second group, two (10 %) patients received donor erythrocyte suspension in an average volume of 358.2 ± 85.8 ml. Infectious and inflammatory complications: fever, inflammation of the postoperative suture, parametritis occurred in 6.8 % of women in the main group; in the comparison group – in 15 % of patients. Conclusions. Introduction into clinical practice of modern methods of blood management in patients with uterine myoma and IDA: the Infusion of intravenous high-dose ferric preparationsin the perioperative period, the use of Cell Saver devices for intra-operative autologous blood transfusion, helps to reduce the time of therapy, minimize transfusions of donor erythrocytes, reducing the frequency of infectious and inflammatory complications.

Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric Hematology-Oncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics

Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.

The Influence of Iron-Deficiency Anaemia (IDA) Therapy on Clinical Outcomes and Healthcare Resource Consumptions in Chronic Kidney Disease Patients Affected by IDA: A Real-Word Evidence Study among the Italian Population.

Anaemia is a uraemia-related complication frequently found in non-dialysis-dependent chronic kidney disease (ND-CKD) patients, with iron-deficiency anaemia (IDA) as the main underlying mechanism. Given the suboptimal anaemia management in ND-CKD patients with a co-diagnosis of IDA, this study evaluated the role of IDA therapy on clinical outcomes and healthcare resource consumptions in an Italian clinical setting. A retrospective observational real-world analysis was performed on administrative databases of healthcare entities, covering around 6.9 million health-assisted individuals. From January 2010 to March 2019, ND-CKD patients were included and diagnosed with IDA in the presence of two low-haemoglobin (Hb) measurements. Patients were divided into IDA-treated and untreated, based on the prescription of iron [Anatomical-Therapeutic Chemical (ATC) code B03A] or anti-anaemia preparations (ATC code B03X), and evaluated during a 6-month follow-up from the index date [first low haemoglobin (Hb) detection]. IDA treatment resulted in significantly decreased incidence of all cause-related, cardiovascular-related, and IDA-related hospitalizations (treated vs. untreated: 44.5% vs. 81.8%, 12.3% vs. 25.3%, and 16.2% vs. 26.2%, respectively, p < 0.001). A healthcare direct cost estimation showed that overall mean expenditure per patient reduced by 47% with IDA treatment (5245€ vs. 9918€, p < 0.001), mainly attributable to hospitalizations (3767€ vs. 8486€, p < 0.001). This real-life analysis on Italian ND-CKD-IDA patients indicates that IDA therapy administration provides significant benefits in terms of patients’ clinical outcomes and healthcare cost savings.

Cost Effectiveness Analysis (CEA) Strategi Terapi Anemia pada Pasien Penyakit Ginjal Kronis

Chronic kidney disease (CKD) is a condition in which the kidneys are unable to maintain a fluid balance of metabolic waste that is progressive, irreversible, and takes place slowly. Anemia is a complication of CKD that contributes to morbidity, mortality, and quality of life of patients, as well as greater costs of care. This study aims to evaluate the differences in the effectiveness and cost of anemia therapy with epoetin in patients with chronic kidney disease. The study was conducted in an analytical-observational manner with a retrospective cohort design from the provider's perspective. The sample used was CKD patients with anemia who met the inclusion criteria for the period January - December 2020, data were taken from medical records and patient financial recapitulation. Statistical analysis was carried out on the effectiveness of anemia therapy with epoetin based on the achievement of clinical outcomes of increasing Hb values within 3 months and financing calculated based on direct medical costs. A total of 113 patients met the inclusion criteria, consisting of 96 patients in the epoetin alpha group and 17 patients in the epoetin beta group. The percentage of achieving therapeutic targets in the epoetin beta group was higher (11.76%) than in the epoetin alfa group (10.42%). The average increase in Hb in the EPO beta group was higher than in the EPO alpha group. The cost of epoetin for anemia treatment in the beta epoetin group (Rp 1,005,365) was lower than the epoetin alfa group (Rp 1,017,188). The ICER value obtained was IDR -125,966, indicating a cost savings of IDR 125,966 to increase 1% of the achievement of therapeutic targets for Hb values &gt;10 g/dl. The cost of therapy with EPO beta is lower than EPO alpha and the achievement of Hb therapy targets is better in EPO beta than EPO alpha.

Recommendations From the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS).

Perioperative anemia has been associated with increased risk of red blood cell transfusion and increased morbidity and mortality after surgery. The optimal approach to the diagnosis and management of perioperative anemia is not fully established. To develop consensus recommendations for anemia management in surgical patients. An international expert panel reviewed the current evidence and developed recommendations using modified RAND Delphi methodology. The panel recommends that all patients except those undergoing minor procedures be screened for anemia before surgery. Appropriate therapy for anemia should be guided by an accurate diagnosis of the etiology. The need to proceed with surgery in some patients with anemia is expected to persist. However, early identification and effective treatment of anemia has the potential to reduce the risks associated with surgery and improve clinical outcomes. As with preoperative anemia, postoperative anemia should be treated in the perioperative period. Early identification and effective treatment of anemia has the potential to improve clinical outcomes in surgical patients.

The Use of Folic Acid in Chronic Kidney Disease Patients With Anemia

Chronic kidney disease (CKD) is defined as decreasing kidney function (GFR &lt; 60 ml/minute/1.73 m2 ) for more than 3 months. Anemia is a common complication of CKD due to a decrease in the hormone erythropoietin related to hemoglobin levels. One of the anemia therapies involves using folic acid. Folic acid helps the process of nucleoprotein synthesis and erythropoiesis maintenance. The objective of this study was to determine the pattern of folic acid applied to CKD patients with anemia at University of Muhammadiyah Malang General Hospital. Observational, descriptive, and retrospective data collection methods were used. The results showed that there were 17 patients (47%) with a single use of folic acid (3x1 mg, oral); the most common pattern of the two-combination was folic acid (3x1 mg, oral) and PRC (250 ml, intravenous [iv]), which was given to 11 patients (65%); and the most common pattern of threecombination was folic acid (3x1 mg, oral), Promavit® (3x1 tab, oral), and PRC (250 ml, iv), which was given to 2 patients or 100%. Of the 16 switch patterns, the most of common combination was a single pattern of folic acid (3x1 mg, oral) and a combination of folic acid (3x1 mg, oral) and PRC (250 ml, iv), given to 7 patients (44%).&#x0D; Keywords: folic acid, anemia, chronic kidney disease

Parathyroidectomy Improves the Consumption of Erythropoiesis-Stimulating Agents in Hemodialysis Patients.

Secondary hyperparathyroidism (SHPT) is common in end-stage renal disease (ESRD) patients, and it can suppress erythropoiesis. We aimed to investigate the relationship between the consumption of erythropoiesis-stimulating agents (ESAs) and parathyroidectomy (PTX) in ESRD patients with SHPT and to determine the predictors for anemia improvement. The current standard of chronic kidney disease anemia therapy relies on the prescription of iron supplementation, and ESA. We retrospectively analyzed 81 ESRD patients with PTX at Ditmanson Medical Foundation Chiayi Christian Hospital from July 2004 to Dec 2018. The requirement of ESA therapy markedly declined from a dose of 41.6 (interquartile range [IQR], 0–91.2) to 10.3 (IQR, 0–59.5, p = 0.001) unit/kg/week. In addition, 63.7% of patients required iron replacement therapy preoperatively and the proportion reduced to 52.5% after PTX (p < 0.001). The hemoglobin (Hb) level showed an insignificant change from a median value of 10.7 g/dL (9.5–11.6 g/dL) before PTX to 10.5 g/dL (9.6–11.2 g/dL) at 6 months after PTX. A preoperative Hb level ≤ 10 mg/dL (odds ratio [OR], 20.1; 95% confidence interval [CI], 4.71–125, p < 0.001) and transferrin saturation (TSAT) < 25% (OR, 12.8; 95% CI, 2.51–129, p < 0.001) were predictors for anemia improvement. Our study demonstrated that PTX markedly decreased the requirement of ESA. Patients with a low preoperative Hb level or low TSAT showed an increase in the Hb level after PTX. PTX may be considered not only for SHPT with refractory anemia but also for high ESA-dependent patients.

Role of sclrostin (SOST) to predisposing for osteoporosis in β- thalassemia major patients

Sclrostin is a biomarker interrupted in bone resorption process by binding to LRP5 and/or LRP6 family, and prevent Wingless-type signaling (Wnt) which is important to both bone development and the maintain of bone mass. Sixty (60) patients with thalassemia major were enrolled from the period 2/5/2021 to 1/9/2021 in summer to assessment role of sclrostin to predisposing for osteoporosis in β-thalassemia major patients (β-TM). Patients ages were from (2-40 year) males and females they divided to children and adults had osteoporosis and/or osteopenia."All patients diagnosed by Hb electrophoresis and were receiving regular blood transfusions for anemia and chelation therapy for prevention of iron overload related complications. Detailed history and examination including height and weight were recorded on pre-designed questionnaire and blood samples were taken for measurement of serum"sclrostin level. The results showed non-significant differences (P˃0.05) of serum sclerostin (SOST) concentration between osteoporosis of beta thalassemia patients (β-TM) and osteopenia of beta thalassemia patients for both gender, but appeared increased significant (P˃0.05) in male adults of osteopenia with progressive aged.

1593P Real-world data on anemia management in patients with solid tumors and malignant lymphoma in Germany

Anemia is a frequent complication in patients with breast cancer (BC), gastrointestinal tumors (GC), lung cancer (LC) and malignant lymphomas (ML). Guidelines (GL) on anemia management (ESMO, DGHO) provide dedicated algorithms for diagnosis and treatment of anemia. GL adherence (GLAD) was analyzed. This was a retrospective sample analysis representative for practices and hospitals in Germany. Data on tumor treatments and anemia management was collected from records of cancer patients (pts) with grade ≥ 2 anemia diagnosed between January and June 2021. Definition of diagnosis GLAD score (GLAD-D): 2 points (pt) for full adherence, 1 pt for a lack in differential diagnosis on iron metabolism. 0 pt if differential diagnosis is missing. Treatment GLAD score (GLAD-T): 2 pt for full adherence to GL recommendation in relation to diagnosis. 1 pt for indicated red blood cells (RBC) as only anemia therapy or no therapy in pts with Hb ≥8g/dl. 0 pt for RBC without indication, p.o. iron substitution under inflammatory conditions (CRP>5mg/l) or vitamin B12 or folate deficiency without substitution. Data from 1046 pts (311 BC, 371 GC, 260 LC, 104 ML) were collected from 143 centers. Hb-values at diagnosis of anemia were 8-10 g/dl in 899 (85.9%) pts, 6-8g/dl in 135 (12.9%) and <6g/dl (1.2%) in 12 pts. 456 pts were treated with RBC (43.6%), 198 (18.9%) with iron substitution, 106 (10.1%) with ESA and 60 (5.7%) with vitamin B12. 60.6% of the pts with iron substitution were treated i.v. and 39.4% p.o. 37.5% of pts with RBC had no indication in the sense of the restrictive RBC policy recommended by the GLs. GLAD was poor in diagnosis and treatment: GLAD-D was 2 pt in 310 pts (29.6%) of pts, 1 pt at 168 (16.1%) and 0 pt in 568 (54.3%) pts. GLAD-T was 2 pt in 270 pts (25.8%), 1 pt in 310 (29.6%) and 0 pt in 466 (44.6%). Higher GLAD-D correlated significantly to a higher GLAD-T (τB 0.262, p<0.001). Full GLAD-T (2 pt) was significantly associated with a greater Hb increase (p<0.001) at 28 days (10.2 vs. 9.7 g/dl) and at 2 months (10.4 vs 9.9 g/dl). GLAD is insufficient in Germany, especially concerning liberal transfusion policy and the lack of differential diagnostics of iron metabolism. Pts with anemia management as per GL had a significantly greater Hb-increase.