Treatment Of Anemia Research Articles

Intravenous Iron Versus Oral Iron Administration for the Treatment of Iron Deficiency Anemia: A Patient-Preference Study.

Intravenous iron supplementation has been reported to provide a superior safety profile and effectiveness in the treatment of iron deficiency anemia(IDA) compared to traditional oral iron supplements. To assess preference for intravenous iron versus oral iron among patients with IDA at King Abdulaziz University Hospital,Jeddah, Saudi Arabia. This observational cross-sectional study included 267 adults diagnosed with IDA or on treatment for IDA at King Abdulaziz University Hospital between February 2023 and March 2024. A specially modified questionnaire was used for the collection of data, which included demographic and treatment-related data. The values of the variables are presented as mean and standard deviation or median and interquartile range. Differences with an asymptotic two-tailed P-value of less than 0.05 were considered to be statistically significant. The majority of the included patients were women (95.5%), Saudi nationals (90.6%), and from the Western region (98.1%). About half of the included patients were receiving intravenous iron supplementation (51.7%), and the other half were receiving oral iron supplements (48.3%). However, the majority of the patients (74.9%) reported that they preferred intravenous iron treatment. With regard to factors that affected their preference, education level (P = 0.044), employment status (P = 0.009), and income level (P = 0.007) were identified as significant predictors. Among the patients who preferred oral iron therapy, the reason cited by the majority, that is, 79.1%, was that tablets were easier to adhere to than needles, while 50.7% stated that tablets had fewer side effects than needles and 64.2% reported a fear of needles. Among the patients who preferred intravenous iron therapy, the majority, that is, 82.4%, stated that intravenous administration was easier for them. Further, 73.5% were of the opinion that intravenous iron therapy had fewer side effects (73.5%), 27.7% reported that they were unable to swallow iron tablets, and 52.5% reported that they had difficulty remembering to take iron tablets. About a third of patients discontinued oral iron therapy due to changes in bowel habits (35%). Although 18.7% of the patients reported feeling pain with intravenous iron therapy, the majority were satisfied (79.4%) and recommended intravenous iron treatment for anemia to friends and family members (84.6%). In contrast, more than half of the patients on oral therapy were uncomfortable (56.2%) with the treatment. Further, 37.1% were not satisfied with their iron tablets, and 25.1% of patients stated that they would not recommend iron tablets for anemia treatment to their friends or family members. The majority of the patients preferred intravenous iron therapy to correct IDA because oral therapy was associated with difficulties related to swallowing iron tablets and remembering to take the tablets. Although the results indicate that both therapies have similar effectiveness, patients receiving intravenous treatment appeared to be more satisfied with the treatment and recommended it to friends and family.

Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia.

Iron is an essential nutrient and a constituent of ferroproteins and enzymes crucial for human life. Generally, nonmenstruating individuals preserve iron very efficiently, losing less than 0.1% of their body iron content each day, an amount that is replaced through dietary iron absorption. Most of the iron is in the hemoglobin (Hb) of red blood cells (RBCs); thus, blood loss is the most common cause of acute iron depletion and anemia worldwide, and reduced hemoglobin synthesis and anemia are the most common consequences of low plasma iron concentrations. The term iron deficiency (ID) refers to the reduction of total body iron stores due to impaired nutrition, reduced absorption secondary to gastrointestinal conditions, increased blood loss, and increased needs as in pregnancy. Iron deficiency anemia (IDA) is defined as low Hb or hematocrit associated with microcytic and hypochromic erythrocytes and low RBC count due to iron deficiency. IDA most commonly affects women of reproductive age, the developing fetus, children, patients with chronic and inflammatory diseases, and the elderly. IDA is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39% and 48.1% in developing countries). The diagnosis, management, and treatment of patients with ID and IDA change depending on age and gender and during pregnancy. We herein summarize what is known about the diagnosis, treatment, and prevention of ID and IDA and formulate a specific set of recommendations on this topic.

Short-term effect of low-dose roxadustat combined with erythropoiesis-stimulating agent treatment for erythropoietin-resistant anemia in patients undergoing maintenance hemodialysis.

Erythropoietin resistance is present in some patients with chronic kidney disease, especially in those undergoing hemodialysis, and is often treated using roxadustat rather than iron supplements and erythropoiesis-stimulating agents (ESAs). However, some patients cannot afford full doses of roxadustat. This retrospective study investigated the efficacy of low-dose roxadustat combined with recombinant human erythropoietin (rhuEPO) therapy in 39 patients with erythropoietin-resistant renal anemia undergoing maintenance hemodialysis (3-4 sessions/week). The ability of the combination of low-dose roxadustat and rhuEPO to increase the hemoglobin concentration over 12 weeks was assessed. Markers of iron metabolism were evaluated. Eligible adults received 50-60% of the recommended dose of roxadustat and higher doses of rhuEPO. The mean hemoglobin level increased from 77.67 ± 11.18 g/dL to 92.0 ± 8.35 g/dL after treatment, and the hemoglobin response rate increased to 72%. The mean hematocrit level significantly increased from 24.26 ± 3.99% to 30.04 ± 3.69%. The soluble transferrin receptor level increased (27.29 ± 13.60 mg/L to 38.09 ± 12.78 mg/L), while the total iron binding capacity (49.22 ± 11.29 mg/L to 43.91 ± 12.88 mg/L) and ferritin level (171.05 ± 54.75 ng/mL to 140.83 ± 42.03 ng/mL) decreased. Therefore, in patients with ESA-resistant anemia who are undergoing hemodialysis, the combination of low-dose roxadustat and rhuEPO effectively improves renal anemia and iron metabolism.

Data integrity of 14 randomised controlled trials

BackgroundA review of the literature on iron treatments for iron-deficient anaemia in pregnancy indicated duplication of baseline and outcome tables in two separate randomised controlled trials (RCTs) that share only a single author. AimTo assess the integrity of randomised clinical trials from Dr A.M. Darwish, Assiut University, Egypt. DesignAssessment of Research Integrity. MethodsWe tabulated the characteristics of studies, compared baseline and outcome tables between articles and looked for implausible findings. We used the distribution of baseline p-values to assess whether the summary statistics of baseline characteristics were consistent with properly conducted randomisation. ResultsWe identified 14 RCTs (1,405 participants) published between October 2004 and September 2019. Two pairs of studies showed considerable similarities in baseline characteristics, while another pair of studies was plagiarized. The analysis of baseline p-values indicated a low probability that all the studies featured randomised treatment allocation. ConclusionOur analysis of the RCTs of Dr Darwish suggests possible integrity problems. We recommend a critical investigation of the studies that have not been retracted. Until that has been completed, these studies should not be used to inform clinical practice.

Evaluation of Erythropoietin Stimulating Agent’s Responsiveness and Associated Factors in Hemodialysis Patients with Anemia

Abstract Background: Chronic kidney disease (CKD) patients often develop erythropoietin-deficient anemia. Erythropoietin stimulating agents (ESAs) are the conventional treatment for CKD anemia, but patient responses vary. About 10%–15% of erythropoietin-treated patients may not respond, thus identifying hyporesponsiveness causes may help overcome resistance. Objective: This study is designed to evaluate ESA therapy’s responsiveness and to identify possible contributing factors for ESA resistance. Materials and Methods: This observational cross-sectional study was conducted between September 2022 and February 2023 comprised 150 CKD and patients with anemia in a multicenter dialysis unit. Demographic, clinical, and laboratory data were obtained. The weekly body-weight-adjusted ESA dose divided by hemoglobin concentration is calculated as the erythropoietin resistance index (ERI). ERI values of 5 (responsive), 5–15 (hyporesponsive), and >15 (resistant). Results: A total of 150 patients were enrolled among whom 86 (57.3%) were males with a mean age 51.6 ± 14.9 years. Regarding responses of the patients to ESA, 81 patients (54%) were hyporesponsive, 66 patients (44%) were resistanct and 3 patients (2%) were responsive. There was a significant difference in response according to age, body mass index (BMI), and the presence of co-existing diseases among study groups. Phosphate level was directly associated with the presence of resistance. ERI was positively correlated with dialysis frequency, ESA dose, serum iron, and transferrin saturation. Conclusion: According to the findings of this study, many factors can influence response levels in patients with CKD undergoing hemodialysis based on ERI (age, BMI, presence of co-existing diseases, serum phosphorus, serum iron, and transferrin saturation).

Physician and Patient Preferences for Treatment of Anemia Associated with Chronic Kidney Disease in Japan: A Survey Including Best-Worst Scaling.

Several treatment options are available for anemia associated with chronic kidney disease (CKD); however, there remains a lack of awareness of physician and patient preferences regarding these treatments. We aimed to explore physicians' and patients' perceptions and preferences regarding the management of anemia of CKD in Japan. A web-based survey, including best-worst scaling (BWS), was conducted with physicians who had treated ≥1 patient with anemia of CKD in the preceding year, and with patients with CKD who self-reported a clinical diagnosis of anemia of CKD or low hemoglobin levels. A three-step approach was used comprising cognitive interviews, a pilot survey, and a main survey. The BWS survey results were analyzed using multinomial logit and hierarchical Bayesian models. The survey was completed by 906 participants: 103 patients (average age 60.6 years; 77.7% male) and 803 physicians (166 nephrologists, 214 cardiologists, 137 diabetologists, and 286 general internists). Almost all (96.0%) physicians surveyed considered anemia of CKD to be an important condition to treat. Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors had the highest treatment satisfaction among physicians, whereas patients had the highest satisfaction with both erythropoietin-stimulating agent therapy and HIF-PH inhibitors. Approximately one-third (35.9%) of patients surveyed indicated that they were receiving treatment. When comparing the relative importance of attributes and levels, physicians favored efficacy (particularly improvement in hemoglobin levels), whereas patients favored safety (particularly a lower rate of severe adverse events). Although a majority of physicians consider treatment of CKD-related anemia important, differences in the perceptions and usage of medications exist between medical specialties. Preferences for the management of anemia of CKD vary between physicians and patients; therefore, patient involvement in treatment decisions may help optimize outcomes.

Pengaruh Anemia dan Preeklampsia terhadap Kejadian Bayi Berat Lahir Rendah (BBLR)

Anemia and preeclampsia during pregnancy contribute significantly to the risk of low birth weight (LBW) in neonates. Anemia, characterized by hemoglobin levels below 11 g/dL in the first and third trimesters, and below 10 g/dL in the second trimester, and preeclampsia, which involves hypertension and organ dysfunction after 20 weeks of pregnancy, can interfere with the supply of oxygen and nutrients to the fetus, causing LBW. The study conducted a Literature Review of 840 articles, and found that anemia increased the risk of LBW by about 1.49 times, while preeclampsia also had a significant association with LBW. These findings suggest the importance of early detection and treatment of anemia and preeclampsia to improve neonatal health outcomes. Further research is needed to develop more effective interventions to address these conditions.

HIF-ɑ: New Target For Treatment of Renal Anemia. Molecular Aspects and Activation of Pathway HREs

Roxadustat, recently approved, is a hypoxia-inducible factor prolyl hydroxylase inhibitor that has demonstrated favorable safety and efficacy in the treatment of renal anemia. This article reviews main features and possible effects by activation of pathway sequences HREs.

The effect of late presentation on HIV related mortality among adolescents in public hospitals of north showa zone Oromiya, Ethiopia; 2022: a retrospective cohort study

BackgroundLate human immunodeficiency virus (HIV) diagnosis is the most prominent cause of HIV/AIDS-related mortality and also increases the risk of transmission and spread of the disease in society. Adolescents are the most vulnerable population’s age group for HIV infection in several settings, but expanding access to early HIV testing remains a challenge. Consequently, a significant proportion of adolescents are still dying of HIV-related causes, and the current study aimed at assessing the effect of late presentation on HIV-related mortality among adolescents living with HIV.MethodsAn institutional-based retrospective cohort study was conducted from August 21–November 21, 2022, at selected public hospitals in the North Showa Zone of Oromiya, Ethiopia. All adolescents living with HIV who had received no ART and presented for ART follow-up at public hospitals from September 1, 2012, to August 31, 2021, were included in the study. Data entry was done by Epi-data version 3.1.1 software and exported to Stata version 16 for further analysis. Both bi-variable and multivariable analyses were performed using the Cox proportional hazard model to compare the HIV-related mortality of early and late-presented adolescents using an adjusted hazard ratio at a 95% confidence interval (CI).ResultsA total of 341 medical records of adolescents were included in the study, contributing an overall incidence rate of 3.15 (95% CI: 2.21–4.26) deaths per 100 person-years of observation throughout the total follow-up period of 1173.98 person-years. Adolescents with late presentation for HIV care had three times the higher hazard of mortality (adjusted hazard ratio (aHR) = 3.00; 95% CI: 1.22–7.37) as compared to those with early presentation for HIV/AIDS care. Adolescents within the age range of 15–19 years old (aHR = 3.56; 95% CI: 1.44–8.77), rural residence (aHR = 2.81; 95% CI: 1.39–5.68), poor adherence to ART (aHR = 3.17; 95% CI: 1.49–6.76), and being anemic (aHR = 3.09; 95% CI: 1.52–6.29) were other independent predictors of HIV-related mortality.ConclusionThe study found a substantial link between HIV late presentation to care and mortality among adolescents. Residence, age, antiretroviral therapy (ART) medication adherence, and anemia status were also found to be other independent predictors of HIV-related mortality. To achieve the ultimate aim of lowering mortality among adolescents living with HIV, rigorous emphasis must be placed on early presentation for HIV/AIDS care. In addition, counseling on adherence and prompt diagnosis and treatment of anemia are highly recommended to reduce mortality.

Status Epilepticus in Children at a Tertiary Care Center in India: Etiology, Preventable Risk Factors, and Short-Term Outcome

Abstract Introduction Status epilepticus (SE) is a common neurological emergency in children. Recent guidelines suggest initiating treatment after 5 minutes of seizure activity. Objective This study analyzes the clinical, laboratory parameters, and treatment outcomes of children with SE to identify preventable risk factors. Materials and Methods Prospective observational study of 150 children. They were evaluated for relevant history, clinical features, laboratory investigations, treatment, course, and outcome. Results The risk factors that had an impact on outcome in children with SE were identified as red flag signs on initial pediatric advanced life support (PALS) assessment, malnutrition, abnormal head circumference and number of seizures before child presented to hospital. The strongest predictor of outcome was stable status of children on initial PALS assessment (odds ratio = 20.174 [1.117, 364.393], p = 0.042). Presence of abnormal head size was 86% less likely to have favorable outcome and if the child had lesser number of seizures before child presented to hospital (single), it was 3.7 times likely that it would yield a favorable outcome. Conclusion Aggressive treatment of seizures, identification of red flag signs on initial PALS assessment, identification and treatment of malnutrition, anemia, hypocalcemia, and sodium derangements, strengthening vaccination to prevent central nervous system infections, and early intervention for developmental delay, can all help to combat morbidity and mortality in children with SE.

Pharmacokinetics, Pharmacodynamics, and Safety of Vadadustat in Healthy Volunteers and Patients with Chronic Kidney Disease.

Vadadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor for treating anemia in chronic kidney disease (CKD). Single ascending dose (SAD) and multiple ascending dose (MAD) studies assessed pharmacokinetics (PK), pharmacodynamics (PD), and safety of vadadustat in healthy volunteers. A single-dose, open-label study was conducted in patients with CKD stages 3 and 4 not on dialysis. In the SAD study, 48 healthy adult men (n = 8/cohort) received single doses of vadadustat (80-1,200 mg) or placebo. In the MAD study, 34 healthy adult men (n = 8-9/cohort) received daily vadadustat (500-900 mg) or placebo for 10 days. In the single-dose CKD study, 22 male and female patients with CKD (stage 3: n = 10; stage 4: n = 12) received single doses of vadadustat (500 mg). PK parameters included plasma vadadustat; PD biomarkers were measured, including erythropoietin (EPO) levels, reticulocytes, and others. Plasma vadadustat peaked 3-4 hours after single or multiple dosing in healthy volunteers, with a mean t 1/2 of approximately 4.5 hours. In patients with CKD, plasma vadadustat peaked at 5-6 hours, with a mean t 1/2 of 7.2 (stage 3) and 8.5 (stage 4) hours. Vadadustat AUC∞ and C max increased dose proportionally in SAD and MAD trials. In all trials, EPO concentrations increased in a dose-related manner and returned approximately to baseline by 24 hours. Adverse events were mild and considered not study drug related. The PK and PD results of these studies were utilized for further clinical development of vadadustat for treatment of anemia in CKD patients.

Exploiting multivariate network meta-analysis: A calibrated Bayesian composite likelihood inference.

Multivariate network meta-analysis has emerged as a powerful tool in evidence synthesis by incorporating multiple outcomes and treatments. Despite its advantages, this method comes with methodological challenges, such as the issue of unreported within-study correlations among treatments and outcomes, which potentially lead to misleading conclusions. In this paper, we proposed a calibrated Bayesian composite likelihood approach to overcome this limitation. The proposed method eliminated the need to specify a full likelihood function while allowing for the unavailability of within-study correlations among treatments and outcomes. Additionally, we developed a hybrid Gibbs sampler algorithm along with the Open-Faced Sandwich post-sampling adjustment to enable robust posterior inference. Through comprehensive simulation studies, we demonstrated that the proposed approach yielded unbiased estimates while maintaining coverage probabilities close to the nominal level. Furthermore, we implemented the proposed method on two real-world network meta-analysis datasets; one comparing treatment procedures for the root coverage and another comparing treatments for anaemia in chronic kidney disease patients.

Positive Outcome in a Pregnancy with Anti-kell Alloimmunization Treated with Intravenous Immunglobulin and Therapeutic Plasma Exchange Despite Persistence of High Titre Antibody: A Case Report

Background: Few reports have been published about the current clinical management of anti-Kell alloimmunization in pregnancy; its low frequency of occurrence means that the few long series published have covered an extensive time period in which different treatment approaches have overlapped. The objective of the present paper is to present our experience in the clinical management of a pregnant woman who was positive for the anti-Kell antibody. Materials and Methods: The laboratory follow-up included the weekly measurement of the antibody titre, and identification of the paternal and fetal genotype. The clinical management included TPE and IVIG administration. Obstetric monitoring included ultrasonographic monitoring of the fetus. Case Description: We report a case of anti-Kell alloimmunization with high antibody titre at first observation. Testing for fetal DNA circulating in maternal blood confirmed positivity for KEL1 gene. The patient underwent fifteen sessions of TPE after 18 weeks of gestational age, followed by weekly IVIG infusion, which continued until 27 weeks of pregnancy. Anti-Kell titres were measured before and after each TPE session. The patient had no need for IUBT and delivered by cesarean section at 34 weeks of gestational age. Pregnancy resulted in a live birth with mild HDFN. Discussion: HDFN is a potentially lethal complication of alloimmunization, and IUBT is the standard treatment for severe fetal anemia. TPE and IVIG are two alternative treatment modalities described in the literature to avoid or postpone the need for IUBT transfusion. In the case reported, despite any substantial change in antibody titre, pregnancy resulted in a live birth. This result suggests that the use of TPE and IVIG in alloimmunization during pregnancy could be an effective treatment strategy.

Assessment of essential and toxic trace element levels in erythrocytes of hemodialysis patients with end-stage renal disease

BackgroundChronic kidney disease (CKD) is a global public health problem, resulting in end-stage kidney disease, cardiovascular disease, and premature death. AimThe aim of the study was to determine the profile of essential and toxic trace elements in erythrocytes of patients with end-stage renal disease (ESRD) and their relationship with selected anthropometric and biochemical parameters. MethodsThe present study compared the profiles of trace elements, including toxic sub-stances, in the erythrocytes of 80 hemodialysis patients with CKD with 40 healthy subjects. All patients had stage 5 CKD. The levels of Cd and Pb were determined by graphite furnace atomic absorption spectrometry and levels of Fe, Mn, Zn, Cu Cr, Ni, and Li by inductively coupled plasma atomic emission spectrometry. ResultsThe ESRD patients demonstrated significantly lower Fe and Zn concentrations and significantly higher Mn and Li and toxic Pb and Cd concentrations in erythrocytes compared to those of the healthy controls. Negative correlations were observed, among others, between the concentrations of Cu, Li, and creatinine; Cu and phosphates; Mn, Pb, and transferrin saturation while positive correlations were noted between Cu, Cr, and transferrin and Pb, Cr, and the normalized protein catabolism rate. ConclusionsThe higher concentrations of toxic elements present in the erythrocytes of CKD patients might have resulted from the reduced ability of the kidneys to excrete them. Moreover, differences in the concentrations of essential elements (Fe, Mn, Zn) between the two groups indicated that their resorption in the kidneys of CKD patients was impaired. Patients with CKD might benefit from interventions intended to reduce high, toxic concentrations of Pb and Cd and Li and Mn as an alternative supportive treatment. Iron and zinc supplementation should be a component for the treatment of anemia in CKD patients.

Effects of Aloe Vera Gel on Red Blood Cell-parameters in Phenylhydrazine-induced Anaemic Wistar albino Rats

Background & objective: Anaemia is the most significant disorder of the blood. Many researchers have developed the concept of using medicinal plants as an alternative source of treatment for anaemia with fewer side effects. Aloe vera, being a medicinal plant, is popularly used as a natural drug in haematological disorders. The present study was intended to observe the effects of Aloe vera gel on red blood cell parameters in phenylhydrazine (PHZ)-induced anaemic Wistar albino rats. Methods: This Experimental study was conducted in Dhaka Medical College, Dhaka from July 2021 to June 2022. A total of 24 healthy Wistar albino rats were selected for the study. After procurement, the rats were initially kept in a standard laboratory condition on a 12/12-hour light/dark cycle for 14 days of acclimatization before 21 days of the experiment. All the rats had free access to basal diet and normal saline during the period of acclimatization and experiment. After acclimatization for 14 days, the rats were divided into three groups-Group A (baseline control group, n = 8), Group B (PHZ-treated group, n = 8), and Group C, the Experimental Group (PHZ-induced and Aloe vera gel treated group, n = 8). To induce anaemia, Group B and Group C received intraperitoneal injection of PHZ at a dose of 0.5 ml/100 g body weight on days 1, 3, 5 and day 7. Moreover, the experimental group (Group C) received Aloe vera gel orally at a dose of 0.6 ml/kg body weight from Day 8 to Day 21. On day 22, rats were sacrificed to test their blood samples for haematologic variables (RBC count, Hb conc., and PCV) and haematological indices (MCV, MCH and MCHC). Result: All the haematological parameters and indices were almost similar among the study groups at baseline (on Day 1). On Day 8, rats of groups B and C demonstrated a drastically reduced count of RBC (2.66 ± 0.53 and 2.69 ± 0.52 million/μl respectively) compared to the rats of group A (8.16 ± 0.76 million/μl). On Day 22, the RBC count in rats of Group C staggeringly increased to 7.63 ± 0.64 million/μl; however, the RBC count in rats of Group B remained almost the same as was found on Day 8. A significant decrease in Hb conc. and PCV in PHZ-induced control on Day 8 compared to that on Day 1 was also observed. The mean MCV in all the study groups on Day 1 was around 50 fl, which abnormally increased to 85 and 87 fl in Groups B and C respectively on Day 8. On Day 22, Group B further exhibited an increase in MCV to > 87 fl. Meanwhile, the MCV in Group C (Aloe vera-treated group) favourably decreased to 55 fl. On the 8th Day of intervention, the MCH level significantly decreased in Groups B and C. Although no significant change in MCH was observed in Group B from Day 8 to Day 22, group C demonstrated a significant increase in the mean MCH to nearly 18 pg during the same period. The mean MCHC significantly dropped to < 23% in Groups B and C on Day 8 from the baseline figure of 34%. While no significant change in MCHC was evident in Group B from Day 8 to Day 22, it significantly improved to about 28% in Group C during the same period. Conclusion: From the study, it can be concluded that Aloe vera has significant erythropoietic potentials which result in the improvement of red blood cell parameters (RBC count, Hb conc., PCV, MCV, MCH and MCHC) in PHZ-induced anaemic rats. Ibrahim Card Med J 2023; 13 (1&2): 40-46

Green Synthesis of Phyllanthus Niruri Nanoparticles for the Treatment of Sickle Cell Anemia

Nanotechnology is currently the most active research area in modern materials science. While numerous chemical and physical methods exist for the synthesis of nanomaterials, the green synthesis approach is increasingly prominent. Plant-mediated synthesis of nanoparticles is a green chemical technique that integrates nanotechnology with botany. This novel method of synthesis ideally occurs at ambient temperatures, neutral pH, and is cost-effective and environmentally friendly. Given this goal, various routes have been explored for synthesizing nanomaterials. The present study aims to formulate and evaluate herbal nanoparticles derived from Phyllanthus niruri for the natural treatment of sickle cell anemia. Sickle cell anemia is characterized by the presence of sickle-shaped erythrocytes caused by abnormal hemoglobin production. This condition leads to clogging of capillaries and obstructs blood flow in the vessels, resulting in severe complications such as ischemia, hypoxia, and organ failure. While some drugs, such as hydroxyurea, are available for treating sickle cell anemia, they are often associated with severe adverse effects, limiting their frequent use. Therefore, this study focuses on designing herbal nanoparticles as an alternative treatment for sickle cell anemia. The plant material for this study was sourced from an authorized market, dried, and powdered for further processing.

ATP-Binding Cassette Transporter of Clinical Significance: Sideroblastic Anemia.

The ATP-binding cassette (ABC) transporters are a vast group of 48 membrane proteins, some of which are of notable physiological and clinical importance. Some ABC transporters are involved in functions such as the transport of chloride ions, bilirubin, reproductive hormones, cholesterol, and iron. Consequently, genetic or physiological disruption in these functions is manifested in various disease processes like cystic fibrosis, Tangier disease, and sideroblastic anemia. Among other etiologies, primary sideroblastic anemia results from a genetic mutation in the ATP-binding cassette-7 (ABCB7), a member of the ABC transporter family. There are not many articles specifically tackling the disease processes caused by ABC transporters in detail. Some testing methodologies previously reported in the available literature for investigating sideroblastic anemia need updating. Here, we expound on the relevance of ABCB7 as a clinically important ABC transporter and a rare participant in the disease process of Sideroblastic anemia. The other genetic and secondary etiologies of sideroblastic anemia, which do not involve mutations in the ABCB7 protein, are also described. We review the pathophysiology, clinical course, symptoms, diagnosis, and treatment of sideroblastic anemia with a focus on modern technologies for laboratory testing.

Non-invasive hemoglobin screening device: a promising digital method for reducing anemia prevalence through routine screening and timely intervention

ABSTRACT Background Several non-invasive technologies are nowadays available in the market which claim to determine the hemoglobin levels instantly without the requirement of the blood sample. But no study has shown the significance of such non-invasive devices on a routine basis for determining their impact on anemia reduction programs. This study is conducted to determine the impact of regular hemoglobin screening on the women population to determine its potential in reducing anemia, using a digitalized non-invasive device. Method A cross-sectional study was conducted on 203 women of reproductive age group, residing in the Moradabad district. Repetitive readings were taken after a time interval of a minimum of 1 month for determining the impact of regular screening. The entire data collection process was carried out using the EzeCheck mobile app. Results It was observed that the prevalence of anemia was reduced upon the second time screening and was accepted by the women population. Repetitive testing has a significant impact on reducing anemia prevalence. Also, the simplified non-invasive technology for estimating the hemoglobin values, makes the user more comfortable to take the test. Conclusion Non-invasive devices should be used regularly to keep track of hemoglobin levels which will help in the effective treatment of anemia. The mobile app-based testing could help to easily evaluate the reports of the patients from any remote location with instant result interpretation and health assistance.

Iron-deficiency Anemia Treatment with Ferric Carboxymaltose: A Real-world Quasi-experimental Study from Bangladesh.

Miah MMZ, Pramanik MEA, Rafi A, et al. Iron-deficiency Anemia Treatment with Ferric Carboxymaltose: A Real-world Quasi-experimental Study from Bangladesh. Euroasian J Hepato-Gastroenterol 2024;14(1):12-15.

Effects of Individualized Anemia Therapy on Hemoglobin Stability: A Randomized Controlled Pilot Trial in Patients on Hemodialysis.

Anemia is common among hemodialysis patients. Maintaining stable hemoglobin levels within predefined target levels can be challenging, particularly in patients with frequent hemoglobin fluctuations both above and below the desired targets. We conducted a multi-center, randomized, controlled trial comparing our anemia therapy assistance software against a standard population-based anemia treatment protocol. We hypothesized that personalized dosing of erythropoiesis stimulating agents (ESA) improves hemoglobin target attainment. Ninety-six patients undergoing hemodialysis and receiving methoxy polyethylene glycol-epoetin beta were randomized 1:1 to the intervention group (personalized ESA dose recommendations computed by the software) or the standard of care group for twenty-six weeks. The therapy assistance software combined a physiology-based mathematical model and a model predictive controller designed to stabilize hemoglobin levels within a tight target range (10 to 11 g/dl). The primary outcome measure was the percentage of hemoglobin measurements within the target. Secondary outcome measures included measures of hemoglobin variability and ESA utilization. The intervention group showed an improved median percentage of hemoglobin measurements within target at 47% (IQR 39 to 58), with a 10 percentage points median difference between the two groups (95% CI: 3 to 16; P=0.008). The odds ratio of being within the hemoglobin target in the standard of care group compared to the group receiving the personalized ESA recommendations was 0.68 (95% CI: 0.51 to 0.92). The variability of hemoglobin levels decreased in the intervention group, with the percentage of patients experiencing fluctuating hemoglobin levels being 45% vs 82% in the standard of care group. ESA usage was reduced by about 25% in the intervention group. Our results demonstrated an improved hemoglobin target attainment and variability by employing personalized ESA recommendations using the physiology-based anemia therapy assistance software.