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(1) Background: Anaemia is a common finding in patients with colon cancer and is commonly corrected by blood transfusion prior to surgery. However, the prognostic role of perioperative transfusions is still debated. The aim of the present study was to investigate the role of preoperative anaemia and preoperative blood transfusion in influencing the prognosis in colon cancer. (2) Patients and Methods: Patients undergoing elective surgery for colon cancer at a tertiary referral university hospital between January 2010 and December 2018 were included in a retrospective review of a prospectively collected database. Univariate and regression analyses were performed to identify the prognostic role of preoperative anaemia and preoperative transfusions in this homogeneous cohort of patients. (3) Results: A total of 780 patients were included in the final analysis. The estimated five-year overall survival rate was significantly worse in the anaemic group (83.8% in non-anaemic patients, 60.6% in mild anaemic patients, 61.3% in moderate anaemic patients and 58.4% in severe anaemic patients, log-rank &lt, 0.001 vs. non-anaemic patients). Anaemic status was found to be an independent adverse prognostic factor (hazard ratio (HR): 1.46, 95% confidence interval (CI): 1.02–2.07) during multivariate analysis. Among moderate to severe anaemic patients, no significant association was found between preoperative transfusions and the risk of mortality or recurrence. (4) Conclusions: Preoperative anaemia, regardless of its severity, and not preoperative blood transfusion, was independently associated with a worse prognosis after surgery in patients with colonic cancer.

Abstract Background Detecting, treating and monitoring anaemia has a functional, social and economic impact on patients’ quality of life and the health system, since inadequate monitoring can lead to more accident & emergency visits and hospitalizations. The aim of this study is to evaluate the impact in the patient clinical outcomes of using haemoglobinometry to early detect anaemia in patients with chronic anaemia in primary care. Methods Randomized controlled trial Capillary haemoglobin will be measured using a haemoglobinometer on a monthly basis in the intervention group. In the control group, the protocol currently in force at the primary care centre will be followed and venous haemoglobin will be measured. Any cases of anaemia detected in either group will be referred to the transfusion circuit of the reference hospital. Discusion The results will shed light on the impact of the intervention on the volume of hospitalizations and accident & emergency (A&E) visits due to anaemia, as well as patients’ quality of life. Chronic and repeated bouts of anaemia are detected late, thus leading to decompensation in chronic diseases and, in turn, more A&E visits and hospitalizations. The intervention should improve these outcomes since treatment could be performed without delay. Improving response times would decrease decompensation in chronic diseases, as well as A&E visits and hospitalizations, and improve quality of life. The primary care nurse case manager will perform the intervention, which should improve existing fragmentation between different care levels. Trial registration NCT04757909. Registered 17 February 2021. Retrospectively registered.

Background: Anaemia is one of the major public health problems worldwide. Commonest nutritional deficiency affecting more than 1.2 billion individuals worldwide 1. Iron deficiency anaemia is associated with a reduction in physical well being and decreased exercise capacity. The prevalence of anaemia is 30% in stable heart failure and 50% in hospitalized heart failure patients, compared with less than 10% in the general population 2.In iron deficiency anaemia, to maintain adequate oxygen delivery, cardiac output can increase by the compensatory increase in blood volume, preload, heart rate, and stroke volume, and decrease in afterload.If severe iron deficiency anaemia left untreated, it could cause secondary organ damage. Chronic severe iron deficiency anaemia causes cardiac remodelling, cardiomegaly, arrhythmia, left ventricular hypertrophy, and heart failure. Aim: To study the left ventricular dysfunction in patients with severe iron deficiency admitted in a tertiary care hospital. Materials and Methods: A Hospital-based Prospective study was conducted in the Department of Medicine, Santhiram medical college & general hospital for a 2 year period. Universal Sampling Technique was used for the selection of study subjects. All the patients coming to the medicine department during the study period with age > 18years with informed written consent taken from the patient,Hemoglobin< 6gm/dl (according to WHO criteria) and Red cell indices suggestive of iron deficiency anaemia The final sample size was 100 subjects. Results: Out of 100 patients, 62% were females, and 38% were males in the study group. The mean age in the study population was 40.68±12.5 years, with the minimum age being 18 years and maximum age is 70 years. The prevalence of LV dysfunction in the study group was 61%.51% of the total population had systolic dysfunction and 10% had diastolic dysfunction.39% of the total population had normal LV function. In patients with systolic dysfunction, 72.5% were females, and 27.5% were males. In diastolic dysfunction, 50% were males, and 50% were females. Conclusion: As iron deficiency anaemia is more prevalent globally, its consequences on the cardiovascular system were studied. Iron deficiency anaemia is a major public health problem in developing countries, and it causes major cardiovascular morbidity and mortality. Severe iron deficiency anaemia causes structural changes in the left ventricle leading to eccentric or concentric hypertrophy, which predisposes the patients to develop left ventricular dysfunction. Hence, early diagnosis and management of iron deficiency anaemia can reverse remodelling and prevent left ventricular dysfunction. Thus, reducing major cardiovascular morbidity and mortality.

Objective: To evaluate different histopathological patterns and correlate them with indications, findings of Esophagogastroduodenoscopy Esophago-gastro-duodenal (EGD) and serological markers in patients presenting of unexplained anemia and chronic diarrhea. Study Design: Cross sectional study. Place and Duration of Study: Departments of Pathology and Gastroenterology, Combined Military Hospital Lahore Pakistan, from Jul to Dec 2020. Methodology: Histopathological patterns of endoscopic duodenal biopsies, submitted for evaluation of unexplained anemia and chronic diarrhea were studied. Hemoglobin and anti-tTG levels were recorded. Adults with history of unexplained diarrhea and anaemia were included. Biopsies with malignant diagnosis or unfit for evaluation were excluded. Histopathological patterns were correlated with indications and findings of Esophagogastroduodenoscopy and serological markers of celiac disease. Results: The most common indication for Esophagogastroduodenoscopy in 145 patients was chronic diarrhea. Upper gastrointestinal endoscopy in 2/3rd of patients revealed no pathology. Histopathological patterns of duodenal biopsies revealed only 15% cases suggestive of celiac disease. Only 12 patients were suggestive of celiac disease both on Esophagogastroduodenoscopy and histopathology combined. Half of patients with anti tTG level >100 u/ml, showed histopathological features of celiac disease on. There was no correlation between histopathological patterns, indications of Esophagogastroduodenoscopy, morphology of Esophagogastroduodenoscopy and serological markers of celiac disease. Conclusion: Indications for Esophagogastroduodenoscopy, Esophagogastroduodenoscopic findings and histopathological patterns cannot diagnose celiac disease alone.

Background Asymptomatic malaria infections largely remain undetected and act as a reservoir for continuous transmission. The study assessed the prevalence of submicroscopic asymptomatic malaria infections and anaemia in two rural low (300 m above sea level) and highland (700 m asl) settings of Korogwe District north-eastern Tanzania. Methods A cross-sectional malariometric survey involving individuals aged 0–19 years was conducted in June 2018 in the two rural villages. Venous blood was collected from eligible study participants for estimation of haemoglobin level, detection of malaria by rapid diagnostic test (RDT), quantification of malaria parasitaemia by microscopy, as well as dried blood spot (DBS) for determining submicroscopic infections by PCR targeting the small subunit of the ribosomal ribonucleic acid (ssrRNA) of human Plasmodium. Results Out of 565 individuals tested, 211 (37.3%) were malaria positive based on RDT, whereas only 81 (14.3%) were positive by microscopy. There was no significant difference in the prevalence between the highland and the lowland village, p = 0.19 and p = 0.78 microscopy and RDT, respectively. Three out of 206 (1.5%) RDT/microscopy negative samples were P. falciparum positive by PCR. Of the 211 RDT and 81 microscopy positive, 130 (61.6%) and 33 (40.7%), respectively, were defined as being asymptomatic. Of the 565 individuals, 135 (23.9%) were anaemic (haemoglobin Conclusions Asymptomatic malaria is associated with an increased risk of having anaemia in the study communities. The findings highlight the need for targeted interventions focusing on asymptomatic infections which is an important risks factor for anaemia in the community and act as a source of continued transmission of malaria in the study area.

Aim The aim of this study was to determine the prevalence and correlates of anaemia among postnatal women. Design A cross‐sectional survey was conducted from April–July, 2020, at a healthcare facility in Dodoma City. Methods Haemoglobin concentration was measured by using HemoCue Hb 201+ analyser machine. Anaemia was defined as haemoglobin concentration of

Aims Iron deficiency (ID) is associated with poor prognosis regardless of anaemia. Intravenous iron improves quality of life and outcomes in patients with ID and heart failure (HF) with reduced ejection fraction (HFrEF). In the Swedish HF registry, we assessed (i) frequency and predictors of ID testing; (ii) prevalence and outcomes of ID with/without anaemia; (iii) use of ferric carboxymaltose (FCM) and its predictors in patients with ID. Methods and results We used multivariable logistic regressions to assess patient characteristics independently associated with ID testing/FCM use, and Cox regressions to assess risk of outcomes associated with ID. Of 21 496 patients with HF and any ejection fraction enrolled in 2017-2018, ID testing was performed in 27%. Of these, 49% had ID and more specifically 36% had ID-/anaemia-, 15% ID-/anaemia+, 29% ID+/anaemia-, and 20% ID+/anaemia+ (48%, 39%, 13%, 30% and 18% in HFrEF, respectively). Risk of recurrent all-cause hospitalizations was higher in patients with ID regardless of anaemia. Of 1959 patients with ID, 19% received FCM (24% in HFrEF). Important independent predictors of ID testing and FCM use were anaemia, higher New York Heart Association class, having HFrEF, and referral to HF specialty care. Conclusion In this nationwide HF registry, ID testing occurred in only about a quarter of the patients. Among tested patients, ID was present in one half, but only one in five patients received FCM indicating low adherence to current guidelines on screening and treatment. Funding Agencies|Vifor Pharma

Background There are few effective drugs for treatment of seizures in avian species. Objectives To investigate the pharmacokinetics and safety of zonisamide in chickens. Methods Phase 1: chickens (n = 4) received a single oral dose of zonisamide at 20 mg/kg. Blood samples were collected intermittently for 36 hr after dosing. Phase 2: chickens (n = 8) received zonisamide in a dose escalation protocol (20, 30, 60 and 80 mg/kg orally every 12 hr). The dose was increased weekly, and peak and trough blood samples were collected on Days 1, 3, and 7 each week. Two birds were randomly euthanized at the end of each week. Plasma zonisamide concentrations were analysed using a commercial immunoassay. Drug concentration vs. time data were subjected to non‐compartmental pharmacokinetic analysis. Results For Phase 1, peak plasma zonisamide (Cmax) was 15 ± 3 µg/ml at 2 ± 1 hr (Tmax). The disappearance half‐life was 6.5 ± 1 hr. Mean plasma concentrations remained within the (human) therapeutic range (10–40 µg/ml) for 6 hr. For Phase 2 of the study, plasma concentrations of zonisamide remained within or close to the recommended mammalian therapeutic range for birds in the 20 and 30 mg/kg dose. Area under the curve (AUC) and Cmax were dose dependent. Two birds developed immune‐mediated haemolytic anaemia. Conclusions Zonisamide appears to be a viable drug for use in chickens at a dose of 20 mg/kg orally every 12 hr., The pharmacokinetics and safety of zonisamide were investigated in chickens in single and repeated dose trials. Zonisamide appears to be a viable drug for use in chickens at a dose of 20mg/kg orally every 12 hr.

BackgroundUndernutrition is a serious matter of public health concern in India. Existing studies, policies and programs focus on women and children thereby ignoring men in policymaking. This study examines the socio-economic inequality in anaemia levels among men in India and tries to decompose the factors behind it.MethodsThe fourth round of National Family Health Survey is used to fulfill the study objectives. The outcome variable of the study is men having anaemia or not. The study uses bivariate and multivariate techniques to identify the factors associated with the outcome variable. Further, concentration index and concentration curve are calculated to measure the socio-economic inequality in anaemia among men in India.ResultsThe results indicate that majority of the socio-economic related inequality is explained by wealth quintile followed by geographical regions of India, body mass index and educational attainment. The results also emphasize that older men belong to the high-risk groups. Moreover, the likelihood of anaemia is 40% more likely among men who belonged to East region and 25%, 13% and 7 % less likely among those who belonged to Northeast, West and South region compared to those who belonged in the North region of the country.ConclusionExisting policies on anaemia should include men to achieve an anaemia free India. Individual education and awareness should be encouraged to improve nutritional status.

A 4‐year‐old English setter presented with a 1‐week history of anorexia, lethargy and occasional vomiting. Blood analysis revealed moderate regenerative anaemia, mild monocytosis, thrombocytopaenia, hypoproteinaemia, hypoglobulinaemia, hypocholesterolaemia and increased C‐reactive protein. On ultrasonography, the spleen had multifocal hypoechoic lesions. Fine needle aspirates from the spleen and liver showed marked extramedullary haematopoiesis, an increased number of histiocytes, haemosiderin deposits and erythrophagocytosis. A tentative diagnosis of haemophagocytic histiocytic sarcoma (HHS) was made, and the owners elected euthanasia. On autopsy, the liver and spleen were enlarged. The spleen had an uneven surface and a yellow‐tan spotted appearance. Histologically, the red pulp was highly cellular and dominated by erythroid cells, as well as a population of larger polygonal cells and aggregates of histiocytes. HHS was confirmed by CD11d immunolabelling. This represents the first documented case of HHS in an English setter., A four‐year‐old English setter presented with a one‐week history of anorexia, lethargy and occasional vomiting. Clinical and clinicopathological findings were indicative of hemophagocytic histiocytic sarcoma (HHS) and the dog was euthanized. Autopsy and immunohistochemistry were performed, and the diagnosis of HHS was confirmed.

Background Anaemia is a global health concern and is also a common comorbidity in multiple medical conditions. Very limited research is available examining anaemia among family members in India and across various countries. The present study aimed to examine the co-existence of the triple burden of anaemia among mother-father-child pairs in a family. Methods The data utilized was from the National Family Health Survey conducted in 2015–16. The effective sample size for the study was 26,910 couples, along with children aged 6–59 months. The bivariate and binary logistic regression analysis were applied to assess the factors associated with family-level anaemia. In bivariate analysis, a chi-square test was performed to determine the association of socio-demographic factors with anaemic family. Results More than half of the mothers (57.5%) and their children (58%), along with 10% of fathers, were found to be anaemic; however, the co-existence of triple burden of anaemia among mother-father-child pairs was 4.7% in the study. The likelihood of family-level anaemia was low when both the parents were educated [OR: 0.69, CI: 0.58–0.81], and it was high when both the parents were employed [OR: 1.40 CI: 1.10–1.80]. Families from the Scheduled Tribe had a 62% higher likelihood to suffer from anaemia [OR: 1.62, CI: 1.33–1.97]. Conclusions The suggested interventions include early diagnosis, effective management, and treatment of anaemia. Moreover, adequate complementary feeding practices for children shall also be promoted. Parental education on nutrition is also required, and community interventions are needed to improve parental education on nutrition. At last, there is a need for greater policy and program attention to improving nutritional knowledge among mothers so as to tackle the triple burden of anaemia among mother-father-child pairs.

A significant barrier to implementation of cell-based therapies is providing adequate vascularization to provide oxygen and nutrients. Here we describe an approach for cell transplantation termed the Therapeutic Vascular Conduit (TVC), which uses an acellular vessel as a scaffold for a hydrogel sheath containing cells designed to secrete a therapeutic protein. The TVC can be directly anastomosed as a vascular graft. Modeling supports the concept that the TVC allows oxygenated blood to flow in close proximity to the transplanted cells to prevent hypoxia. As a proof-of-principle study, we used erythropoietin (EPO) as a model therapeutic protein. If implanted as an arteriovenous vascular graft, such a construct could serve a dual role as an EPO delivery platform and hemodialysis access for patients with end-stage renal disease. When implanted into nude rats, TVCs containing EPO-secreting fibroblasts were able to increase serum EPO and hemoglobin levels for up to 4 weeks. However, constitutive EPO expression resulted in macrophage infiltration and luminal obstruction of the TVC, thus limiting longer-term efficacy. Follow-up in vitro studies support the hypothesis that EPO also functions to recruit macrophages. The TVC is a promising approach to cell-based therapeutic delivery that has the potential to overcome the oxygenation barrier to large-scale cellular implantation and could thus be used for a myriad of clinical disorders. However, a complete understanding of the biological effects of the selected therapeutic is absolutely essential.

Introduction Postoperative anaemia can affect more than 90% of patients undergoing major surgeries. Patients develop an absolute iron deficiency in the face of significant blood loss or preoperative anaemia and major surgery. Studies have shown the negative impact of these factors on transfusion requirements, infections, increased hospitalisation and long-term morbidities. Aim of the study The research was performed to determine the correlation between intravenous iron administration in the postoperative period and improved haemoglobin correction trend. Material and methods A prospective study was conducted to screen and treat iron deficiency in patients undergoing major surgery associated with significant bleeding. For iron deficiency anaemia screening, in the postoperative period, the following bioumoral parameters were assessed: haemoglobin, serum iron, transferrin saturation (TSAT), and ferritin, direct serum total iron-binding capacity (dTIBC), mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH). In addition, serum glucose, fibrinogen, urea, creatinine and lactate values were also collected. Results Twenty-one patients undergoing major surgeries (52,38% were emergency and 47,61% elective interventions) were included in the study. Iron deficiency, as defined by ferritin 100-300 μg/L along with transferrin saturation (TSAT) < 20 %, mean corpuscular volume (MVC) < 92 fL, mean corpuscular haemoglobin (MCH) < 33 g/dL, serum iron < 10 μmol/L and direct serum total iron-binding capacity (dTIBC) > 36 μmol/L, was identified in all cases. To correct the deficit and optimise the haematological status, all patients received intravenous ferric carboxymaltose (500-1000 mg, single dose). Using Quadratic statistical analysis, the trend of haemoglobin correction was found to be a favourable one. Conclusion The administration of intravenous ferric carboxymaltose in the postoperative period showed the beneficial effect of this type of intervention on the haemoglobin correction trend in these groups of patients.

Introduction An appropriate management of anaemia laboratory tests is crucial for a correct diagnosis and treatment. A non-sequential "shotgun" approach (where every anaemia related test is ordered) causes workload and cost increases and could be potentially harmful. We have implemented a Decision Support System through our laboratory information system (LIMS) based on reflexive algorithms and automatic generation of interpretative reports specifically in diagnosis of anaemia for primary care patients. Materials and methods When a request contained an "Anaemia Suspicion Study" profile, more than twenty automatic reflexive rules were activated in our LIMS based upon laboratory results. These rules normally involved the addition of reflexive tests. A final report was automatically generated for each interpretation which was always reviewed for their validity by two staff pathologists. We measured the impact of this system in the ordering of most common anaemia related tests and if a proper treatment was established based on the interpretive report. Results From all the studies performed, only 12% were positive being "iron deficiency" and "anaemia of chronic disease" the most frequent causes, 62% and 17%, respectively. Proper treatment was established in 88% of these anaemic patients. Total iron, transferrin, ferritin, folate and vitamin B12 demand decreased substantially after implementation representing a cost reduction of 40% only for these five tests. Conclusions Our system has easily improved patient outcomes, advising on individual clinical cases. We have also noticeably reduced the number of over-requested tests and laboratory costs.

Khansaa Albaroodi Pharmacy Department, Al Zahrawi University College, Karbala, IraqCorrespondence: Khansaa AlbaroodiPharmacy Department, Al Zahrawi University College, Karbala Al-Najaf Highway, Karbala, 56001, IraqTel +9647727009050Email khansaa.albaroodi@hotmail.comIntroduction: The World Health Organization (WHO) reported a moderate incidence of anaemia among pregnant and nonpregnant women and among children younger than 59 months in 2011.Purpose: The aim of this study was to investigate anaemia among children younger than 14 years submitted to haematological exams at the Children’s Teaching Hospital in Karbala, Iraq.Patients and Methods: This was a cross-sectional study carried out in the Children’s Teaching Hospital Laboratory Department in Karbala, Iraq, from 1 July 2019 until 1 September 2019.Results: The prevalence of anaemia among children aged 0– 14 years in Karbala was 9.9%. There was no significant relationship between the type of anaemia diagnosed and age or sex. However, there was a significantly positive relationship between the type of anaemia diagnosed and each ferritin level, mean corpuscular volume, and mean corpuscular haemoglobin (p< 0.0001). The study participant skull diameter and length in relation to sex were compared to the WHO reference values for child growth standards, and the study values were less than the normal range for children below 5 years of age.Conclusion: A high prevalence of anaemia among children was reported with its apparent consequence on their health. This study highlights the prevalence of anaemia among children up to 14 years of age in Karbala, and future research is encouraged.Keywords: anaemia, children with anaemia, prevalence, thalassemia

Background School-aged children (SAC) are a high-risk demographic group for infectious diseases and malnutrition. The objective of this study was to assess the burden and the effect of Plasmodium falciparum and Schistosoma haematobium infections on the haematological indices in SAC and the confounding influence of malnutrition on the outcomes. Methods This cross-sectional study was conducted in SAC 4–14 years old living in Ikata, Bafia and Mile 14-Likoko in Muyuka, Cameroon. Anthropometric measures of malnutrition were obtained and blood samples collected were used for detection of malaria parasites by Giemsa-stained blood films using light microscopy and complete blood count analysis using an automated haematology analyser. Urine samples collected were used to detect micro haematuria with the aid of reagent strips and the eggs of S. haematobium by urine filtration technique. Multiple linear regression model was used to examine influence of independent variables on haematological parameters. Results Out of the 606 SAC examined, the prevalence of single infections with Plasmodium or S. haematobium and co-infection with both parasites was 16.2, 16.3 and 8.3%, respectively. Overall, malaria parasite (MP), urogenital schistosomiasis, malnutrition, anaemia, haematuria, microcytosis and thrombocytopenia was prevalent in 24.4, 24.6, 25.9, 74.4, 12.2, 45.4 and 11.1% of SAC, respectively. A significant linear decline (P = 0.023) in prevalence of P. falciparum infection with the severity of stunting was observed. Factors that significantly influenced haematological parameters included haemoglobin: age, stunting and MP; haematocrit: age and MP; white blood cell count: age; red blood cell count; age and MP; lymphocyte counts: stunting; mean cell volume: age; mean cell haemoglobin: age and stunting; mean cell haemoglobin concentration: sex, stunting and red cell distribution width-coefficient of variation: sex, age and stunting. Conclusions Malnutrition, Plasmodium and S. haematobium infections are common while anaemia is a severe public health problem in Muyuka, Cameroon. The interaction between haematological parameters with malaria parasites as well as linear growth index was negative and other interactions indicate systemic inflammation. While findings provide contextual intervention targets to ensure the judicious use of the limited resources, there is need for regular monitoring and proper treatment to improve the health of the underserved population.

In this study, we focused on the influencing factors of renal anaemia in patients with IgA nephropathy and constructed a nomogram model. We divided 462 patients with IgA nephropathy diagnosed by renal biopsy into anaemic and non-anaemic groups. Then, the influencing factors of renal anaemia in patients with IgA nephropathy were analysed by least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression, and a nomogram model for predicting renal anaemia was established. Eventually, nine variables were obtained, which are easy to apply clinically. The areas under the receiver operating characteristic (ROC) curve and precision-recall (PR) curve reached 0.835 and 0.676, respectively, and the C-index reached 0.848. The calibration plot showed that the model had good discrimination, accuracy, and diagnostic efficacy. In addition, the C-index of the model following internal validation reached 0.823. Decision curve analysis suggested that the model had a certain degree of clinical significance. This new nomogram model of renal anaemia combines the basic information, laboratory findings, and renal biopsy results of patients with IgA nephropathy, providing important guidance for predicting and clinically intervening in renal anaemia.

Aims The aims of the current study were to evaluate the association between anaemia and all‐cause mortality according to chronic kidney disease (CKD) status and to explore at what level of haemoglobin concentration would the all‐cause mortality risk increase prominently among CKD and non‐CKD patients, respectively. Methods and results This is a prospective cohort study, and 1559 patients with ischaemic heart failure (IHF) were included (mean age of 63.5 ± 11.0 years, 85.8% men) from December 2015 to June 2019. Patients were divided into the CKD (n = 481) and non‐CKD (n = 1078) groups based on the estimated glomerular filtration rate of 60 mL/min/1.73 m2. In the CKD group, the incidence rate of all‐cause mortality in anaemic and non‐anaemic patients was 15.4 per 100 person‐years and 10.8 per 100 person‐years, respectively, with an incidence rate ratio of 1.42 (95% confidence interval: 1.00–2.02; P‐value = 0.05). In the non‐CKD group, the incidence rate of all‐cause mortality in anaemic and non‐anaemic patients was 9.8 per 100 person‐years and 5.5 per 100 person‐years, respectively, with an incidence rate ratio of 1.78 (95% confidence interval: 1.20–2.59; P‐value = 0.005). After a median follow‐up of 2.1 years, the cumulative incidence rate of all‐cause mortality in anaemic and non‐anaemic patients was 41.5% and 44.1% (P‐value = 0.05) in the CKD group, and 30.9% and 18.1% (P‐value

BACKGROUND Microcytic hypochromic anaemia is commonly due to iron deficiency, anaemia of chronic disorder [ACD] and thalassaemic syndromes. Reticulocyte count reflects the erythropoietic activity of bone marrow and is thus useful in both diagnosing anaemias and monitoring bone marrow response to therapy METHODS All samples were selected from routine blood counts, and sent for investigation of anaemia, over a period of two years. These samples were run on the DxH800 (Beckman Coulter). 385 cases were selected for the study. Blood analysis for all these cases had been requested by general practitioners to investigate anaemia. These blood samples had been collected in ethylenediaminetetraacetic acid (EDTA) anticoagulant vacutainers and processed within 2 hours of collection. Determination of red cell and reticulocyte parameters in all blood samples, was performed using the Beckman Coulter 7-part analyser [Unicell DxH 800]. RESULTS Of the 156 cases of microcytic hypochromic anaemia studied, iron deficiency anaemia (IDA) was present in 91 cases, anaemia of chronic disorder (ACD) in 50 cases, beta thalassemia trait (BTT) in 15 cases. Of the 50 ACD cases, 37 were associated with IDA. The control group comprised of 229 adult medical students (143 women and 103 men) with a median age of 18.84 ± 0.98 years. We also had 4 cases of other haemoglobinopathies, which were microcytic hypochromic, but were not included in our study as the number of cases was too less to be analysed. CONCLUSIONS New reticulocyte parameters are useful for evaluation of iron status and diagnosing iron deficiency anaemias. They also are reliable parameters for recognising subsets of anaemic patients thereby improving the management of anaemia. KEYWORDS Reticulocyte, Microcytic, Hypochromic, Anaemia, Beckman Coulter

BACKGROUND Intestinal helminthic infections are endemic worldwide. In developing countries like India these contribute to a major morbidity among children. Factors like poverty, lack of proper sanitation, hygiene, illiteracy, hot and humid tropical climate play a role in the transmission of these infections. Under RMNCH + A (child health) school children were receiving biannual albendazole in the months of February and August. We wanted to assess the prevalence of soil transmitted helminthic infections (STHI) among adolescent school children in a residential welfare school. METHODS A cross-sectional study was conducted in the month of October 2018 in rural field practice area of the Department of Community Medicine, Andhra Medical College, Visakhapatnam. The study was done in a residential welfare school for girls in peri urban areas of Visakhapatnam. The study was done among 96 girls who were present in the school during the days of survey by using systematic random sampling after obtaining informed consent. A pretested interview schedule was used to collect data. Microscopic stool examination for ova / cyst and haemoglobin estimation was done for all the study subjects. Data was entered in Microsoft Excel and analysis was done by Statistical Package for Social Sciences (SPSS version 21). RESULTS The mean age of the subjects was 13.41 ± 1.07 years, with age ranging from 12 to 15 years. About 19 % (19.8 %) of the study subjects were found to have STHI on microscopic stool examination. Among them about 68 % of the study subjects were found to have Ascaris lumbricoides followed by Trichuris trichiura (32 %). Mean haemoglobin level was 9.73 + 1.06 (g / dl). On statistical analysis, no significant difference was found between presence of infection and variables like anaemia (P = 1), open air defecation (P = 0.51), nail biting (P = 1), presence of symptoms (P = 1) and pica (P = 0.75). CONCLUSIONS Helminthic infections burden is still high in the school children KEYWORDS Adolescent School Girls, Anaemia, Soil Transmitted Helminthic Infections (STHI’s), Residential School, Visakhapatnam

Background Anaemia is prevalent in children. Therefore, this study examined the association between dietary patterns and anaemia among children in central South China. Methods Cross-sectional studies were conducted in Mayang, central South China, in 2015 and 2018. Diet data were collected using a questionnaire, and dietary patterns were identified via exploratory factor analysis. Haemoglobin was measured to assess anaemia status. Associations between dietary patterns and anaemia were assessed using a logistic regression model. Results The mean age of the infants surveyed was 14.06 months in 2015 and 16.58 months in 2018. Four dietary patterns were identified among infants aged 6–23 months: a diversified diet consisting mainly of tubers, dairy products, beans and bean products; a traditional diet consisting mainly of cereals, water, soup, vegetables and fruit; mainly breast milk, with a little powdered formula; or mainly multi-nutrient powders. The prevalence of anaemia in infants decreased from 29.49% in 2015 to 20.26% in 2018.In infants fed a diversified diet or multi-nutrient powders with top-quartile (Q4) scores, the risk of anaemia was reduced by 45%(adjusted odds ratio [AOR] = 0.55, 95%CI0.30–0.99, P = 0.047) or 59% (AOR = 0.41, 95% CI0.22–0.78, P = 0.006), respectively, compared to infants in the lowest quartile (Q1). Infants fed mainly breast milk had a 3.26-fold greater risk of anaemia compared to those with Q1 scores (AOR = 3.26, 95% CI 1.83–5.81, P Conclusions Four dietary patterns were identified among infants aged 6–23 months in central South China. Infants should be fed a variety of food groups to improve their anaemia status.

Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

India retains the world’s largest burden of anemia despite decades of economic growth and anemia prevention programming. Accurate screening and estimates of anemia prevalence are critical for successful anemia control. Evidence is mixed on the performance of HemoCue, a point-of-care testing device most widely used for large-scale surveys. The use of dried blood spots (DBS) to assess hemoglobin (Hb) concentration is a potential alternative, particularly in field settings. The objective of this study is to assess Hb measurement agreement between capillary HemoCue and DBS among two age groups, children 6–59 months and females age 12–40 years. We analyzed data from the baseline round of a cluster randomized rice fortification intervention in Cuddalore district of Tamil Nadu, India. Capillary blood was collected from a subset of participants for Hb assessment by HemoCue 301 and DBS methods. We calculated Lin’s concordance correlation coefficient, and tested bias by conducting paired t-tests of Hb concentration. Independence of the bias and Hb magnitude was examined visually using Bland–Altman plots and statistically tested by Pearson’s correlation. We assessed differences in anemia classification using McNemar’s test of marginal homogeneity. Concordance between HemoCue and DBS Hb measures was moderate for both children 6–59 months (ρc = 0.67; 95% CI 0.65, 0.71) and females 12–40 years (ρc = 0.67: 95% CI 0.64, 0.69). HemoCue measures were on average 0.06 g/dL higher than DBS for children (95% CI 0.002, 0.12; p = 0.043) and 0.29 g/dL lower than DBS for females (95% CI − 0.34, − 0.23; p

Chunlan Zhang,1 Xi Chen,1 Jingping Li,2 Zhenqi Liu,3 Wei Liu,2 Jingjing Zhang,1 Zhiguang Zhou1 1National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People’s Republic of China; 2Department of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China; 3Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USACorrespondence: Jingjing ZhangNational Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People’s Republic of ChinaTel +86 731-85292154Email doctorzhangjj@csu.edu.cnWei LiuDepartment of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, People’s Republic of ChinaTel +86 731-85292154Email liuweixy@csu.edu.cnBackground: Laparoscopic sleeve gastrectomy (LSG) has become a predominant bariatric procedure at present. However, data are scarce regarding the nutritional impact of this procedure on Chinese patients. This study aimed to evaluate the prevalence of nutritional deficiency after LSG in Chinese patients.Methods: Eighty-two patients with obesity were recruited from the Second Xiangya Hospital of Central South University, and all patients underwent LSG and completed the visit.Results: Compared with the baseline, the serum albumin levels increased significantly at 1– 12 months (P< 0.001) after surgery, and the hypoalbuminemia rate decreased from 8.5% to 0% throughout the study (P=0.063). Anaemia was present in 7.3% of all patients before surgery, and its prevalence increased to 11.0% at 12 months post-operation (P=0.109). The anaemia rate of fertile females was higher than that of males (21.4% vs 2.3%, P=0.036). No significant changes were found in vitamin B12 deficiency throughout the study (0% vs 3.8%, P=1.0). The increases in the folate deficiency were only discovered in the female group (3.7% vs 20%, P=0.031) and the obese without type 2 diabetes (T2D) group after LSG (27.3% vs 47.1%, P=0.031). A decrease in the ferritin levels and an increase in iron deficiency at 12 months post-surgery were found among all patients.Conclusion: Based on 12 months of follow-up, LSG is effective in controlling metabolic syndrome and has a modest effect on nutritional deficiencies, which suggests that LSG is an effective and comparably safe procedure for Chinese patients considering nutritional deficiencies at 12 months post-surgery.Keywords: anaemia, laparoscopic sleeve gastrectomy, nutrition, obesity

Anaemia is defined by the presence of haemoglobin (Hb) levels

In this large single-centre study, we report high prevalence (25%) of, small (p = 0.04). PNH clone, irrespective of size, was a good predictor of response to immunosuppressive therapy (IST) and to stem cell transplant (HSCT) (in MDS: 84% if PNH+ vs. 44.7% if PNH−, p = 0.01 for IST, and 71% if PNH+ vs. 56.6% if PNH− for HSCT; in AA: 78 vs. 50% for IST, p p = 0.01 for HSCT). PNH positivity had a favorable impact on disease progression (0.6% vs. 4.9% IPSS-progression in MDS, p p = 0.01), leukemic evolution (6.8 vs. 12.7%, p = 0.01 in MDS), and overall survival [73% (95% CI 68–77) vs. 51% (48–54), p p

Inflammation in chronic kidney disease (CKD) is mostly due to activation of the innate immune system, in which Interleukin-1 (IL-1) is a key player. Anemia of CKD may also be due to erythropoietin (EPO) resistance, clinically associated with inflammation. IL-1 receptor antagonist knockout (RaKO) mice show arthritis and excessive inflammation. Inhibition of IL-1 was shown to be beneficial in many inflammatory conditions, but its role in CKD and anemia is unknown. Here, we report that enhanced inflammation in RaKO mice with CKD provoked both higher degrees of renal insufficiency and anemia in comparison to wild-type CKD, in association with a downregulation of renal hypoxia inducible factor-2 (HIF2) as well as decreased bone marrow EPO-receptor (EPOR) and transferrin receptor (TFR). In contrast, administration of P2D7KK, an anti-IL1b monoclonal antibody, to CKD mice results in a lower grade of systemic inflammation, better renal function and blunted anemia. The latter was associated with upregulation of renal HIF-2α, bone marrow EPO-R and TFR. Altogether, this supports the key role of inflammation, and IL-1 particularly, in CKD progression and anemia. Novel treatments to reduce inflammation through this and other pathways, may improve renal function, attenuate the anemic state or increase the response to exogenous EPO.

Hepatic veno-occlusive disease or sinusoidal obstruction syndrome (VOD/SOS) is a potentially life-threatening complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). In the present prospective study, we aimed to investigate the incidence, management, and outcome of VOD/SOS in patients with thalassemia major (TM) who received allo-HSCT. VOD/SOS was diagnosed and classified based on the modified Seattle criteria. The prophylactic regimen for VOD/SOS was a combination treatment of dalteparin and lipo-PGE1. VOD/SOS was managed through an approach consisting of adequate supportive measures, short-term withdrawal of calcineurin inhibitors (CNIs), and the use of methylprednisolone and basiliximab for graft-versus-host disease prophylaxis. VOD/SOS was found in 54 of 521 patients (10.4%) at a median time of 12 days after allo-HSCT. The cumulative incidence of all-grade and moderate VOD/SOS was 10.4% and 4.2%, respectively. Among the 54 VOD/SOS patients, no patient developed severe grade and died from VOD/SOS. Besides, the cumulative incidence of transplant-related mortality on day 100 for patients with or without VOD/SOS was 0% vs. 4.0% (P = 0.187), respectively, and the 3-year overall survival rates were 94.3% vs. 93.2% (P = 0.707), respectively. Collectively, we concluded that appropriate symptomatic therapy and short-term withdrawal of CNIs safely mitigated the mortality of VOD/SOS in TM patients who underwent allo-HSCT.

Background This study aimed to determine the prognostic value of preoperative blood parameters in renal cell carcinoma (RCC) and tumour thrombus (TT) patients that were surgically treated. Method We retrospectively analysed clinicopathological data and blood parameters of 146 RCC and TT patients that were surgically treated. Univariate or multivariate Cox regression analyses were performed to determine the risk factors associated with progression-free survival (PFS) and overall survival (OS). Kaplan-Meier analysis and logistic regression were performed to study the risk factors. Receiver operating characteristic curves were applied to test improvements in the predictive accuracy of the established prognosis score. Results On univariate and multivariate analysis, anaemia (HR 2.873, P = 0.008) and lymph node metastasis (HR 4.811, P = 0.015) were independent prognostic factors linked to OS. Besides, thrombocytosis (HR 2.324, P = 0.011), histologic subtype (HR 2.835, P = 0.004), nuclear grade (HR 2.069, P = 0.033), and lymph node metastasis (HR 5.739, P = 0.001) were independent prognostic factors associated with PFS. Kaplan–Meier curves revealed that patients with anaemia exhibited worse OS than those without it (P = 0.0033). Likewise, patients with thrombocytosis showed worse PFS than those without it (P Conclusions Preoperative anaemia and thrombocytosis were adverse prognostic factors in non-metastatic RCC patients with TT. Also, both preoperative anaemia and thrombocytosis can be clinically used for risk stratification of non-metastatic RCC and TT patients.

Aims There have been no investigations of the prevalence and clinical implications of coexistence of anaemia and frailty in older patients hospitalized with heart failure (HF) despite their association with adverse health outcomes. The present study was performed to determine the prevalence and prognostic value of the coexistence of anaemia and frailty in hospitalized older patients with HF. Methods and results We performed post hoc analysis of consecutive hospitalized HF patients ≥65 years old enrolled in the FRAGILE‐HF, which was the prospective, multicentre, observational study. Anaemia was defined as haemoglobin

Iron deficiency is a common cause of morbidity and can arise as a consequence or complication from many diseases. The use of intravenous iron has increased significantly in the last decade, but concerns remain about indications and administration. Modern intravenous iron preparations can facilitate rapid iron repletion in one or two doses, both for absolute iron deficiency and, in the presence of inflammation, functional iron deficiency, where oral iron therapy is ineffective or has not worked. A multidisciplinary team of experts experienced in iron deficiency undertook a consensus review to support healthcare professionals with practical advice on managing iron deficiency in gastrointestinal, renal and cardiac disease, as well as; pregnancy, heavy menstrual bleeding, and surgery. We explain how intravenous iron may work where oral iron has not. We provide context on how and when intravenous iron should be administered, and informed opinion on potential benefits balanced with potential side-effects. We propose how intravenous iron side-effects can be anticipated in terms of what they may be and when they may occur. The aim of this consensus is to provide a practical basis for educating and preparing staff and patients on when and how iron infusions can be administered safely and efficiently.Key messagesIron deficiency treatment selection is driven by several factors, including the presence of inflammation, the time available for iron replenishment, and the anticipated risk of side-effects or intolerance.Intravenous iron preparations are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used, and therefore have applicability in a wide range of clinical contexts, including chronic inflammatory conditions, perioperative settings, and disorders associated with chronic blood loss.Adverse events occurring with intravenous iron can be anticipated according to when they typically occur, which provides a basis for educating and preparing staff and patients on how iron infusions can be administered safely and efficiently.

Objective: The aim of the study was to evaluate sociodemographic factors and outcome asassociated with anemia and its mode of correction. Materials and methods: A hospital-based cross sectional study of 200 anemic women of all age group was conducted in the department of obstetrics and gynecologyof FAAMCH Barpeta from June 2019 to August 2019. Cases were selected consecutively and data were collected employing the interviewer-administered questionnaire after obtaining consent from participants. The result was analysed and presented using tables. Descriptive statistics were computed with percentages and proportions, chi square test. Variables with p value < 0.05 were considered statistically significant. Results: A total of 200 anemic women were included in the study. 70% were antenatal cases, 30% non antenatal. Majority of the cases were less than 20 yrs of age. More than 80 cases were married at early age and had 1 child before 20 years of age. Using multivariate analysis, the sociodemographic factors like age, age at marriage, age at first child birth (p

Background: Thyroid disorders and iron deficiency (ID) are associated with obstetrical and fetal complications. Iron is essential for the normal functioning of thyroid peroxidase (TPO-abs) and ID is frequent during pregnancy. Objective: The present study was undertaken to see the relationship between iron deficiency anaemia and thyroid disorder in antenatal cases. Methods: A total of 100 cases attending the outpatient department of Obstetrics and Gynecology in their 1st trimester (from LMP to 12 weeks) were studied at Naval Hospital Powai during a period from Jan 2016 to Dec 2017. A detailed clinical and obstetric history was taken and patients were subjected to routine antenatal investigations along with thyroid profile. Results: Among 100 cases, 21 antenatal cases had increased TSH. Out of which 4 cases had overt hypothyroidism and 17 cases had subclinical hypothyroidism. 2 cases had decreased thyroid stimulating hormone in early trimester out of which only 1 had overt hyperthyroidism. In the same study 23 cases had mild iron deficiency anaemia and 4 had moderate anaemia. It was later correlated that out of 27 cases with anaemia 14 had hypothyroidism. 51% of the cases with anaemia had hypothyroidism and 60% of the hypothyroid cases had iron deficiency anaemia. Applying regression analysis between TSH and Hb level, there was a positive correlation between these two factors in cases. r2 value was found to be 0.2871. This was statistically significant with a P value of less than 0.005. Conclusion: It is concluded that there is increased prevalence of thyroid disorders and iron deficiency anaemia in antenatal cases and there is relationship between iron deficiency anaemia and hypothyroid cases.

BackgroundImerslund-Gräsbeck syndrome is a rare genetic disease characterised by vitamin B12deficiency and proteinuria.Case presentationA 4-year old Sri Lankan boy presented with gradually worsening difficulty in walking for two weeks duration. He was previously diagnosed and managed as having non-transfusion-dependent α-thalassaemia based on the presence of hypochromic microcytic anaemia, haemoglobin H inclusion bodies in the blood film and compound heterozygous α-thalassaemia genotype with a gene deletion. However, his transfusion requirement increased over the past three months and he gradually lost his motor developmental milestones during two weeks before admission. The neurological examination revealed generalised hypotonia, exaggerated knee jerks and extensor plantar response. His complete blood count showed pancytopenia, and bone marrow biopsy revealed megaloblastic changes. Serum vitamin B12and red blood cell folate levels were low. MRI revealed sub-acute combined degeneration of the spinal cord with characteristic ‘inverted V sign’. Urine analysis showed non-nephrotic range proteinuria. The diagnosis of Imerslund-Gräsbeck syndrome was made due to the presence of non-nutritional vitamin B12deficiency and asymptomatic proteinuria. He showed a rapid haematological and neurological improvement to intramuscular hydroxocobalamin.ConclusionsThis case report presents a rare occurrence of severe vitamin B12deficiency due to Imerslund-Gräsbeck syndrome masked by co-existent α-thalassaemia, resulting in serious consequences. It highlights the need for a high index of suspicion in evaluating children with severe anaemia, especially in the presence of mixed pathologies.

Renal anaemia is a common and important complication in patients with chronic kidney disease (CKD). The current standard‐of‐care treatment for renal anaemia in CKD patients involves ensuring adequate iron stores and administration of erythropoietin stimulating agents (ESA). Hypoxia inducible factor (HIF) is a key transcription factor primarily involved in the cellular regulation and efficiency of oxygen delivery. Manipulation of the HIF pathway by the use of HIF‐prolyl hydroxylase inhibitors (HIF‐PHI) has emerged as a novel approach for renal anaemia management. Despite it being approved for clinical use in various Asia‐Pacific countries, its novelty mandates the need for nephrologists and clinicians generally in the region to well understand potential benefits and harms when prescribing this class of drug. The Asian Pacific society of nephrology HIF‐PHI Recommendation Committee, formed by a panel of 11 nephrologists from the Asia‐Pacific region who have clinical experience or have been investigators in HIF‐PHI studies, reviewed and deliberated on the clinical and preclinical data concerning HIF‐PHI. This recommendation summarizes the consensus views of the committee regarding the use of HIF‐PHI, taking into account both available data and expert opinion in areas where evidence remains scarce., SUMMARY AT A GLANCE The Asian Pacific society of nephrology HIF‐PHI Recommendation Committee summarizes the consensus views of the committee regarding the use of HIF‐PHI, taking into account both available data and expert opinion in areas where evidence remains scarce.

A 24-year-old horse was presented with a clinical history of anaemia, large intestine impaction and hind limb weakness. Loss of body weight was also reported. Hematocrit and hemoglobin levels were low and piroplasmosis test was negative. Nasogastric intubation with laxative agents was performed and 50 ml of a red blood-cell-supplement was given daily during a month. An assessment following Traditional Chinese Veterinary Medicine (TCVM) principles was performed after the last episode of large intestine impaction. A swollen, pale and wet tongue was observed. A superficial, weak pulse combined punctually with a slippery pulse was detected on the right side. The pulse on the left side was very thin. BL18, BL20 and BL23 were the most sensitive acupoints on the right side. BL18 and BL23 were the most sensitive on the left. TCVM diagnosis was Qi/Yang Kidney Deficiency, Spleen Qi Deficiency with Stagnation and Blood Deficiency. It received acupuncture at Bai-Hui, KI3, KI7, KI10, BL23, GB39, ST36, BL17 and acupressure at SP10. The client reported a significant improvement after treatment and hematocrit and hemoglobin levels were normal. KI3, ST36, BL39 acupoints were treated 14 days later. The outcome was favourable and one acupuncture session per month was recommended. No previous case reports in equines have been documented with a combination of blood, gastrointestinal and musculoskeletal problems in the same episode. This case is an example of an integrative approach to investigate the origin and the interdependent relation between body systems.

Cardiovascular and non-cardiovascular comorbidities are frequently observed in heart failure patients, complicating the therapeutic management and leading to poor prognosis. The prompt recognition of associated comorbid conditions is of great importance to optimize the clinical management, the follow-up, and the treatment of patients affected by chronic heart failure. Anaemia and iron deficiency are commonly reported in all heart failure forms, have a multifactorial aetiology and are responsible for reduced exercise tolerance, impaired quality of life, and poor long-term prognosis. Diabetes mellitus is highly prevalent in heart failure and a poor glycaemic control is associated with worst outcome. Two specific heart failure forms are usually observed in diabetic patients: an ischaemic cardiomyopathy or a typical diabetic cardiomyopathy. The implementation of use of sodium-glucose cotransporter-2 inhibitors will much improve in the near future the long-term prognosis of patients affected by heart failure and diabetes. Among cardiovascular comorbidities, atrial fibrillation is the most common arrhythmic disease of heart failure patients and it is still not clear whether its presence should be considered as a prognostic indicator or as a marker of advanced disease. The aim of the present review was to explore the clinical and prognostic impact of anaemia and iron deficiency, diabetes mellitus, and atrial fibrillation in patients affected by chronic heart failure.

The fourteenth annual ASCAT conference was held 21–23 October 2019. The theme of the conference was ‘Sickle Cell and Thalassaemia disorders new treatment horizon; while ensuring patient safety and delivering excellence in routine patient care.’ Over the three-day conference, topics on current and novel models of care, advances in bone marrow transplant and gene therapy, as well as the psychosocial aspects of mind, body and health related quality of life were discussed. In addition, blood transfusion, apheresis, iron chelation therapy and acute haemolytic complications were presented. Quality standards in the diagnosis and treatment of sickle cell and thalassaemia were reviewed. Experts from Europe, the United Kingdom, the Middle East, the United States and Africa reported up-to-date scientific data, guides to comprehensive care, and current research into developing cures and advancing current therapy were described. In addition, oral and poster presentations on novel research from all over the world were shown during the conference.

Aims Hypophosphataemia is an increasingly recognized side-effect of ferric carboxymaltose (FCM) and possibly iron isomaltoside/ferric derisomaltose (IIM), which are used to treat iron deficiency. The aim of this study was to determine frequency, severity, duration and risk factors of incident hypophosphataemia after treatment with FCM and IIM. Methods A systematic literature search for articles indexed in EMBASE, PubMed and Web of Science in years 2005-2020 was carried out using the search terms 'ferric carboxymaltose' OR 'iron isomaltoside'. Prospective clinical trials reporting outcomes on hypophosphataemia rate, mean nadir serum phosphate and/or change in mean serum phosphate from baseline were selected. Hypophosphataemia rate and severity were compared for studies on IIM vs. FCM after stratification for chronic kidney disease. Meta-regression analysis was used to investigate risk factors for hypophosphataemia. Results Across the 42 clinical trials included in the meta-analysis, FCM induced a significantly higher incidence of hypophosphataemia than IIM (47%, 95% CI 36-58% vs. 4%, 95% CI 2-5%), and significantly greater mean decreases in serum phosphate (0.40 vs. 0.06 mmol/L). Hypophosphataemia persisted at the end of the study periods (maximum 3 months) in up to 45% of patients treated with FCM. Meta-regression analysis identified low baseline serum ferritin and transferrin saturation, and normal kidney function as significant predictors of hypophosphataemia. Conclusion FCM is associated with a high risk of hypophosphataemia, which does not resolve for at least 3 months in a large proportion of affected patients. More severe iron deficiency and normal kidney function are risk factors for hypophosphataemia.

Background and Objectives While iron deficiency (ID) is the most common cause of anaemia, little is known about the prevalence and type of ID in preoperative surgical patients. The aims of the present study were to investigate the prevalence and types of ID in a large cohort of surgical patients, and how these are related to perioperative blood use after correction for confounders such as haemoglobin level.Materials and MethodsData were retrospectively extracted from electronic case records of all patients who underwent elective surgery between September 2016 and November 2017 (n = 2711). Iron parameters, haemoglobin and details of perioperative red cell transfusions were collected.ResultsOf 2711 patients, 618 (22.8%) were iron deficient (= transferrin saturation [TSAT] < 16%) preoperatively, 173 (6.4% of the cohort) had an absolute iron deficiency (AID; TSAT < 16% and ferritin < 30 mu g/L) and 445 (16.4%) had functional/mixed ID (TSAT < 16% and ferritin >= 30 mu g/L). Corrected for Hb level, iron-deficient patients received significantly more red cell units than patients without ID (p = 0.026). AID was not associated with a significantly higher incidence of transfusions (7.5% of patients transfused; p = 0.12 after correction for Hb) than patients without ID, whereas patients with functional/mixed deficiency did receive significantly more transfusions (6.1%; p = 0.021) as compared to patients without ID (1.7%).ConclusionPreoperative ID, in particular the functional/mixed type, was associated with a higher risk of receiving perioperative red cell transfusions as compared to patients without ID. Adequately treating ID might, therefore, reduce the need for perioperative red cell transfusions.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. Introduction: Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. Methods: Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. Results: Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother–child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3–30.2) and 6.9% (95% CI: 6.1–7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85–1.30). The sample did not have moderate or severe malnutrition. Conclusions: There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done. Revisión por pares

BACKGROUND Malnourishment is a major public health challenge in India. The prevalence of thyroid disorders is about 15 – 25 % in different parts of the country. As Thyroid hormone is essential for normal erythropoiesis, anaemia often accompanies thyroid disorders. It is also observed that iron deficiency anaemia state negatively influences the thyroid hormone function. So, the relationship between anaemia and thyroid disorders is complex and both have to be addressed. Keeping this in view, we tried to study the haematological parameters of inpatients with thyroid disorders in our hospital. METHODS A retrospective hospital based observational study was conducted in Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam. All adults (> 18 yrs. of age), non-pregnant patients admitted during the period November 2017 to November 2018 with a diagnosis of thyroid disorder at discharge were included in the study. Fasting thyroid profile (using Siemens advanced fully automated analyser) and haematological parameters (using automated haematology analyser - LABLIFE NOBLE III) were obtained. Data analysis was done using Microsoft Excel 2013 and SPSS version 26. RESULTS 107 patients were included in the study. Mean age of the patients was 33.20 (± 12.45) years with majority being female (91.6 %) and of the age group 18 – 40 years (80.3 %). Hypothyroidism (73.83 %) was the most common thyroid disorder observed followed by subclinical hypothyroidism (19.63 %) & hyperthyroidism (6.54 %). About 79.6 % of female patients and all male patients had anaemia of varying degree. Majority of the patients had moderate degree of anaemia [haemoglobin of 8 - 11.9 gm / dL (females) / 8 - 12.9 gm / dL (males)]. Both microcytic hypochromic anaemia (53.8 %) and normocytic normochromic anaemia (46.2 %) were almost equally prevalent in female patients. Statistically significant positive correlation was observed between TSH (Thyroid Stimulating Hormone) and mean corpuscular volume. (Pearson’s correlation = 0.324, significant correlation at the level 0.01.). CONCLUSIONS Our study highlighted the association between anaemia and thyroid dysfunction. As anaemia is common in our country and the occurrence of hypothyroidism and other thyroid disorders is on the rise, it is essential for clinicians to understand the interrelation between both the disorders and make appropriate therapeutic decisions for simultaneous treatment of anaemia as well as thyroid dysfunction as one may be the cause of the other. KEYWORDS Anaemia, Thyroid Dysfunction, Hypothyroidism

Background and objective:Anaemia commonly aggravates the severity of respiratory diseases, whereas thus far, no study has elucidated the impact of anaemiaonCorona Virus Disease 2019(COVID-19). The aim of this study was to evaluate the clinical characteristics of patients with anaemia, and to further explore the relationship between anaemiaand the severity of COVID-19.METHODS:In this single-center, retrospective, observational study, a total of 222 patients were recruited, including 79 patients with anaemia and 143 patients without anaemia. Clinical characteristics, laboratory findings, disease progression and prognosis were collected and analyzed. Risk factors associated with the severe illness in COVID-19were established by univariable and multivariable logistic regression models.Result：In our cohort, compared to patients without anaemia, patients with anaemia were more likely to experience one or more comorbidities and severe COVID-19 illness, as well as higher mortality. More patients demonstrated elevated levels of C-reactive protein (CRP), procalcitonin(PCT) and creatinine in anaemia group. Levels of erythrocyte sedimentation rate(ESR), D-dimer, myoglobin, T-pro brain natriuretic peptide(T-pro-BNP) and urea nitrogen(BUN)in patients with anaemia were significantly higher than those without. In addition,the proportion of patients with dyspnoea，elevated CRP and PCT was positively associated with the severity of anaemia. The Odd Ratio (OR) of anaemia related to the severe condition of COVID-19 was 5.07 (95% CI:1.82-14.18, P=0.002) and 3.47 (95% CI:1.02-11.75, P=0.046) after adjustment for baseline date and laboratory indices, respectively.Conclusion:Anaemia is an independent risk factor associated with the severe illness of COVID-19, and healthcare professionals should be more sensitive to the haemoglobin levels of COVID-19 patients on admission. To avoid rapid deterioration, more intensive care should be given to patients with anaemia.Trial registration: Ethics committee of Wuhan University People's Hospital (wdry2020-k064)

Background Incidence of malaria and anaemia are of public health importance especially in pregnant women in endemic regions, due to the negative health consequences to the mother and fetus. This study aimed to assess the pattern of falciparum malaria infection and anaemia, based on malaria prevention methods practiced by participants. Methods A semi-structured tool was used to capture information on demographic, socio-economic and malaria prevention practices from 113 pregnant women attending antenatal clinics in 2 peri-urban health facilities in Lagos, southwest Nigeria. Malaria microscopy was conducted and haematocrit was measured. Logistic regression analysis was performed on the data collated from the survey. Results The prevalence of anaemia among pregnant women was 87.2%. The mean (± sd) packed cell volume (PCV) (%) of the 22 (19.5%) infected subjects (26.8 ± 6.6), was significantly lower (t = −2.60, P value = 0.007) than that of the 91 (80.5%) uninfected subjects (30.8 ± 6.0). The prevalence of infection was highest in the 3rd trimester (n = 40, 35.4%) at 27.5% (11/40) and among those in their first pregnancy (n = 32, 28.3%) at 25.0% (8/32). There was a significant difference (t = −2.23, P-value = 0.01) in the mean PCV % of pregnant women who consumed herbal teas in pregnancy (28.2 ± 5.2) compared to those who did not (30.8 ± 6.6). Regression analysis showed that first pregnancy, anti-malarial use and insecticide-treated nets use the night before study had increased odds of malaria infection in participants (OR = 1.35, P = 0.006, 95% CI 0.52−2.49; OR = 2.3, P = 0.005, 95% CI 0.14−0.41; OR = 1.92, P = 0.001, 95% CI 0.62−5.98) while intermittent preventive treatment (IPT) participation and formal education were strongly and significantly associated with lower risk of parasitaemia (OR = 0.95, P = 0.025, 95% CI 0.41−2.26; OR = 0.44, P = 0.005, 95% CI 0.34−10.50). Conclusion Interventions that will reduce malaria and moderate to severe anaemia, especially in a first pregnancy, should include education on the correct use of long-lasting insecticide-treated bed nets (LLIN), IPT and the dangers of herbal teas in pregnancy.

Objective:The current study explored changes in trend of anaemia and BMI among currently pregnant nullipara adolescent women against socio-economic determinants in India from 2005 through 2015. The association between anaemia in currently pregnant nullipara adolescent women v. currently pregnant nullipara older women of reproductive age was also explored.Design:We used the 2005 and the 2015 nationally representative Indian Demographic and Health Surveys (DHS). The outcomes of interest, anaemia and BMI, were measured based on the DHS methodology following WHO standards and indicators. Place of residence, educational attainment and wealth quintiles were used as determinants in the analysis.Setting:India.Participants:In total, 696 adolescent girls from the India 2005 DHS and 3041 adolescent girls from the India 2015 DHS.Results:The 10-year transition from 2005 to 2015 showed differences between the least and most wealthy sections of society, with heaviest gains in anaemia reduction over time among the latter (from 50·0 to < 40·0 %). The odds of anaemia were significantly higher among the adolescent population when compared with adult women both in 2005 and in 2015 (OR = 1·2).Conclusions:Despite an overall improvement in the prevalence of both BMI < 18·5 and anaemia among adolescents nullipara in India, the adjusted risk of anaemia in the latter category was still significantly higher as compared with their adult counterparts. Since the inequalities evidenced during the first round of DHS remained unchanged in 2015, more investments in universal health care are needed in India.

BACKGROUND Haemolytic Disease of Fetus and Newborn (HDFN) is characterised by lysis of red blood cells resulting in anaemia and its hypoxic effects thereafter. Following anaemia, the production of fetal red blood cells is drastically increased. This is followed by extramedullary haematopoiesis in a widespread manner and erythroblastosis characterized by nucleated red cells in the circulation. Since this is an illness affecting many a newborn, assessing the patterns of anaemia in both ABO and Rh-D HDFN may help in effective planning and implementation of better management protocols. METHODS This is a cross sectional study with comparative analysis. The study was performed among 154 neonates who were diagnosed to have HDFN. Setting for this study was Department of Transfusion Medicine and Pediatrics of Government Medical College, Trivandrum. During the time of delivery, 5 mL umbilical cord blood was collected. That sample was used for analyzing haemoglobin levels of the neonate. Duration of treatment of the neonate was noted down during follow up. Statistical analysis was done using SPSS software version 16. RESULTS The mean cord blood haemoglobin value in ABO haemolytic disease was 17.1 ± 2.7 g %. The mean cord blood haemoglobin value in Rh-D haemolytic disease was 14.5 ± 1.9 g %. In infants with ABO haemolytic disease, 53 (48.2 %) had undergone no treatment in ICU. Remaining 51.8 % had undergone 3 - 10 days of treatment in neonatal ICU. Infants with Rh-D HDFN 20 (45.5 %), had undergone no treatment in ICU. Remaining 54.5 % has got 3 - 9 days of treatment in neonatal ICU. Mean treatment duration in infants with ABO haemolytic disease was 3.1 ± 3.3 days. Mean treatment duration in infants with Rh-D haemolytic disease was 2.9 ± 2.9 days. A comparison of mean values of cord blood haemoglobin in neonates with both categories of haemolytic disease was performed. The p value was 0.00 and it was significant. Mean values of duration of treatment of neonates with ABO and Rh-D haemolytic anaemias were compared statistically. No significant difference was observed. CONCLUSIONS Mean haemoglobin levels in Rh-D HDFN showed a significant decrease as compared to ABO-HDFN. Duration of treatment in ABO HDFN and Rh-D HDFN presented no significant difference. KEYWORDS Haemolytic Disease of Fetus and Newborn, Umbilical Cord Haemoglobin, Anaemia, ICU Stay, ABO HDFN, Rh-D HDFN

Background: Anaemia among under-5 children is a major public health issue worldwide. Some countries with a high prev- alence of anaemia also have high prevalence of malaria. Even though Lesotho does not have a high prevalence of malaria, its prevalence rate of anaemia is as high. According to the 2014 Lesotho Demographic and Health Survey (DHS), the prevalence of anaemia among children under-5 was 51%. Other factors could be influencing the prevalence of anaemia in Lesotho. Objectives: This study examined the household and individual risk factors of anaemia among children under-5 in Lesotho. Methods: Data from the 2014 Lesotho DHS which included 924 children under-5 years were analysed. Descriptive statistics, chi-square cross-tabulations and ordered logistic regression models were run using Stata v15. Results: Twenty-one percent (21%) of children under-5 had mild anaemia while 7% had severe-moderate anaemia. Children residing in households cooking with biogas (aOR=4.88, CI: 1.28-18.58) and those living in households that cook with bio- mass (aOR=4.22, CI: 1.40-12.67) had higher odds of severe-moderate anaemia. Conclusion: Using solid fuels for cooking increases the vulnerability of children under-5 developing anaemia. Therefore, knowledge of renewable energy resources should be increased. This will help reduce levels of anaemia among under-5 chil- dren in Lesotho. Keywords: Household and individual risk factors; anaemia; under-5 children; Lesotho.

Acaeruloplasminemia is a rare autosomal recessive condition caused by inactivating mutations of the CP gene encoding caeruloplasmin (ferroxidase). Caeruloplasmin is a copper‐containing plasma ferroxidase enzyme with a key role in facilitating cellular iron efflux. We describe a case of a patient with acaeruloplasminemia, confirmed by genetic analysis, treated with combination therapy of monthly fresh‐frozen plasma (FFP) or Octaplas and iron chelation over a 3‐year period. This 19‐year‐old male was diagnosed at the age of 14 after developing issues with social interaction at school prompting investigation. Prior to this, he had been well with a normal childhood. He was found to have an iron deficient picture with a paradoxically high ferritin, with low serum copper and undetectable caeruloplasmin. Genetic testing identified a homozygous splicing mutation, c.(1713 + delG);(c.1713 + delG), in intron 9 of the caeruloplasmin gene. Ferriscan showed a high liver iron concentration of 5.3 mg/g dry tissue (0.17‐1.8). Brain and cardiac T2‐weighted magnetic resonance (MR) imaging did not detect iron deposition of the brain or heart respectively. Treatment with monthly Octaplas infusion was commenced alongside deferasirox (540 mg o.d.) in an attempt to increase caeruloplasmin levels and reduce iron overload, respectively. After 3 years of treatment, there was biochemical improvement with a reduction in ferritin from 1084 (12‐250) to 457 μg/L, ALT from 87 (

Background Malaria during pregnancy may result in unfavourable outcomes in both mothers and their foetuses. This study sought to document the current burden and factors associated with malaria and anaemia among pregnant women attending their first antenatal clinic visit in an area of Ghana with perennial malaria transmission. Methods A total of 1655 pregnant women aged 18 years and above with a gestational age of 13–22 weeks, who attended an antenatal care (ANC) clinic for the first time, were consented and enrolled into the study. A structured questionnaire was used to collect socio-demographic and obstetric data and information on use of malaria preventive measures. Venous blood (2 mL) was collected before sulfadoxine-pyrimethamine administration. Malaria parasitaemia and haemoglobin concentration were determined using microscopy and an automated haematology analyser, respectively. Data analysis was carried out using Stata 14. Results Mean age (SD) and gestational age (SD) of women at enrolment were 27.4 (6.2) years and 16.7 (4.3) weeks, respectively. Overall malaria parasite prevalence was 20.4% (95% CI 18.5–22.4%). Geometric mean parasite density was 442 parasites/µL (95% CI 380–515). Among women with parasitaemia, the proportion of very low (1–199 parasites/µL), low (200–999 parasites/µL), medium (1000–9999 parasites/µL) and high (≥ 10,000 parasites/µL) parasite density were 31.1, 47.0, 18.9, and 3.0%, respectively. Age ≥ 25 years (OR 0.57, 95% CI 0.41–0.79), multigravid (OR 0.50, 95% CI 0.33–0.74), educated to high school level or above (OR 0.53, 95% CI 0.33–0.83) and in household with higher socio-economic status (OR 0.34, 95% CI 0.21–0.54) were associated with a lower risk of malaria parasitaemia. The prevalence of anaemia ( Conclusion One out of five pregnant women attending their first ANC clinic visit in an area of perennial malaria transmission in the middle belt of Ghana had Plasmodium falciparum infection. Majority of the infections were below 1000 parasites/µL and with associated anaemia. There is a need to strengthen existing malaria prevention strategies to prevent unfavourable maternal and fetal birth outcomes in this population.