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An infant with craniosynostosis for craniectomy and cranial-vault remodelling was detected to have very low hemoglobin (6.8 gm%) after induction of anesthesia. This posed a dilemma whether to proceed with or abandon the surgical procedure. The case was postponed and was rescheduled for surgery one week later with hope that his hemoglobin would rise during this period. However, even before second anesthesia his hemoglobin level was found to be unchanged. Meticulous anesthesia management resulted in uneventful surgical procedure.

ObjectiveTo discuss a case of a falsely low hemoglobin A1c (HbA1c) in a transplant patient treated with dapsone and its implications. HbA1c is widely used as a measure of glycemic control in diabetic patients. With the increasing transplant population, it is important to be mindful of medications used in this population that can affect HbA1c and to use other measures of glycemic control to guide treatment decisions.MethodsWe present details of the case and review the relevant literature.ResultsA 61-year-old patient received a liver transplant in 2012 and subsequently was noted to have a falling HbA1c despite evidence of hyperglycemia based on fingerstick glucose and fructosamine measurements. Review of the medical records revealed that the discordance between HbA1c and fingerstick glucose levels developed after initiation of dapsone therapy. Dapsone may lead to a falsely low HbA1c via several mechanisms. Upon cessation of dapsone therapy, the patient's HbA1c returned to pre-dapsone levels.ConclusionIt is important to be aware of medications commonly used in transplant patients that may lead to a falsely low HbA1c level so that incorrect treatment decisions are not made. Fructosamine correlates with HbA1c and can be used as a measure of glycemic control in transplant patients when HbA1c cannot be used.

In this study, we proposed a method for computation of heart rate (HR) from digital color video recordings of the human face. In order to extract photoplethysmographic signals, two orthogonal vectors of RGB (Red Green Blue) color space are used. We used a dual tree complex wavelet transform based denoising algorithm to reduce artifacts (e.g. artificial lighting, movement, etc.). Most of the previous work on skin color based HR estimation performed experiments with healthy volunteers and focused to solve motion artifacts. In addition to healthy volunteers we performed experiments with child patients in pediatric intensive care units. In order to investigate the possible factors that affect the non-contact HR monitoring in a clinical environment, we studied the relation between hemoglobin levels and HR estimation errors. Low hemoglobin causes underestimation of HR. Nevertheless, based on our results, it was concluded that our method could provide acceptable accuracy to estimate mean HR of patients in a clinical environment, especially given that the measurements can be performed remotely.

It is common for clinicians to observe how concentrations of hemoglobin (Hb) as low as 4 or even 3 g/dl may be compatible with life and to see patients affected by chronic anemia who may afford some physical practice, with Hb levels just above 5 or 6 g/dl. On the other hand, we observe that not severely anemic patients can undergo serious ischemic complications. These experiences suggest that, depending on interpersonal variability in anemia tolerance, the range of Hb in which appropriateness of transfusion is uncertain is wide and that other indicators are needed to guide clinical decisions about blood transfusion.

Background: The demand for plateletpheresis is increasing day by day due to its many merits over random donor platelets. However, in our country, there is a dearth of apheresis donors due to greater devotion and time required for the procedure and lack of awareness. Aim: The aim of the present study is to analyse the reasons for deferral of apheresis donors at a tertiary care center. Materials and Methods: This retrospective analysis was conducted to study the causes, frequency and the type of plateletpheresis donor deferral at regional blood transfusion center, Lady Hardinge Medical College and associated Shrimati Sucheta Kriplani Hospital and Kalawati Saran Childrens’ Hospital. The study was undertaken over a period of two years (from January 2010 to December 2011. Results: Out of a total of 343 donors screened, 87 donors were deferred, the overall deferral rate being 25.36%. The most frequent cause of deferral was a low platelet count accounting for 43.5% of all the causes followed by a low hemoglobin level (27.05%). Among the donors deferred for anaemia, 15 out of 23 (65.2%) had hemoglobin in the range of 11.5-12.4gm%, representing 17.2% of all deferrals. Conclusion: Based on these findings and the scarcity of apheresis donors in our country, we are of the opinion that the selection criteria for plateletpheresis donors should be revised to accommodate more donors and reduce deferral rate without compromising on the health of the donors.

Intertrochanteric fractures incidence has been increasing over the past few years and therefore so have all the problems associated with it. It is important to search for possible ways to reduce comorbidities as well as postoperative mortality. We decided to assess the impact of some routine pre-operative analytical values on post-operative mortality of patients with inter-trochanteric fractures 65 years or older.From all intertrochanteric fracture admissions between January 2007 and May 2012, 160 patients were included in this study. The variables studied were age, gender, length of hospital stay, and analytical data such as hemoglobin, total leucocyte count, platelets, urea, creatinin and plasma sodium. Follow-up data on mortality were obtained from the civil registry and, considering 6 months as the cut-off point, patients were divided into 2 groups based on their survival. Mann-Whitney and Chi square statistics were used to study the association between our variables and patients survival.Our population showed a median age of 82 years old and a majority of women (79.4%). Within the first 6 months after surgery, 27 patients of the initial 160 (16.1%) died. Mortality was associated with low hemoglobin, high platelets, high creatinin and low plasma sodium.Postoperative mortality of hip surgery is high. Our findings could be used to reduce this rate by correcting some analytical values preoperatively.Introdução: A incidência das fraturas intertrocantéricas tem aumentado ao longo dos últimos anos, bem como todos os problemas a elas associados. É importante pesquisar possíveis formas de reduzir quer co-morbilidades, quer a mortalidade pós-operatória. Decidimos avaliar o impacto de alguns valores analíticos pré-operatórios na mortalidade pós-operatória de doentes com fractura intertrocantérica, com idade igual ou superior a 65 anos.Material e Métodos: De todas as fracturas intertrocantéricas admitidas entre Janeiro de 2007 e Maio 2012, 160 doentes foram incluídos no estudo. As variáveis estudadas foram idade, género, tempo de internamento, e dados analíticos, como hemoglobina, contagem de leucócitos e plaquetas, níveis de ureia e creatinina e concentração de sódio plasmática. Informação relativa à mortalidade foi obtida através do registo civil e, considerando um ponto de corte de seis meses após a cirurgia, os doentes foram divididos em dois grupos de acordo com a sua sobrevida. Os testes de Mann-Whitney e Chi-quadrado foram utilizados para estudar a associação entre as nossas variáveis e a sobrevida dos doentes.Resultados: A nossa população apresentava uma idade mediana de 82 anos de idade e uma maioria de mulheres (79,4%). Nos primeiros 6 meses após a cirurgia, 27 doentes dos iniciais 160 (16,1%) faleceram. A mortalidade estava relacionada com valores baixos de hemoglobina, elevados de plaquetas, elevados de creatinina e baixa concentração de sódio plasmático.Conclusão: A taxa de mortalidade pos-operatória da cirurgia da anca é elevada. Os nossos resultados podem ser utilizados parareduzir esta taxa, corrigindo valores analíticos pré-operatórios.

Globally, hemoglobin (Hb) E β thalassemia accounts for approximately half the severe forms of β thalassemia. Because of its wide clinical diversity and the ability of patients with this condition to adapt unusually well to low hemoglobin levels, the management of Hb E β thalassemia, particularly the decision to instigate regular blood transfusion, is particularly difficult. Here, we present a summary of our work in patients with this condition, which attempts to define clinical, adaptive, and genetic factors of possible value in determining the early management of this condition.

Twenty-six anesthetic procedures involving 24 free-living mountain gorillas (Gorilla gorilla beringei) from Rwanda or the Democratic Republic of Congo were performed between February 1987 and October 1997. Sixteen procedures were performed to remove snares or to treat snare-related wounds, and four of the animals died without recovering consciousness because of their severe medical conditions. Ketamine was used for induction 19 times, tiletamine/zolazepam was used five times, and the agent was not recorded for two procedures. The mean (+/- SD) ketamine dosage for four animals of known weight was 7.1 +/- 0.9 mg/kg. All induction agents were delivered i.m. by remote injection, and mean induction times for ketamine and tiletamine/zolazepam were 5.5 +/- 2.6 min (n = 12) and 5.4 +/- 3.7 min (n = 5), respectively. Mean recovery times were significantly shorter with ketamine compared with tiletamine/zolazepam (42.0 +/- 24.9 min, n = 9 vs. 75.25 +/- 22.1 min, n = 4). Low hemoglobin oxygen saturation (mean = 86.7%) was recorded in three cases under ketamine anesthesia, and oxygen insufflation is therefore recommended to prevent hypoxemia. Gorillas induced with tiletamine/zolazepam had significantly higher respiratory rates compared with animals given ketamine. Successful anesthesia and recovery, in particular, depended on the assistance of local personnel.

Malnutrition - as a fundamental aspect both in genesis as in healing of pressure ulcers - is the object of this update paper. Countless studies point out that malnutrition, immune function alterations, hypoalbuminemia, low hemoglobin levels, as well as low diet intake, as responsible for an increase in the risk of developing these lesions. Therefore, it is essential to include the assessment of the nutrition status - monitoring of the calorie-protein intake and the difficulties to use the nutrients - in the prevention and treatment protocols of this type of chronic wound.

Many patients either do not receive these drugs or have low hemoglobin levels despite treatment. Thus, there are opportunities for better management.

The transfusion records of 341 orthopedic patients who donated blood preoperative^ in the years 1992 and 1993 were audited to review the transfusion practices associated with the surgical procedures. The study sample underwent 182 total knee (TKA), 123 total hip (THA) arthroplasties, and 33 laminectomies with fusion (IAM) and 3 without. Data used were age, gender, predonation hemoglobin concentration (Hbd), initial (Hb1) and final (Hbf) hemoglobin concentration, surgical procedure, surgical blood order (SBO), and estimated blood loss (EBL). We analyzed for means and associations and differences between covariates. The means of EBL (mL), transfused units, donated units, Hb, (g/dL), Hbd, and Hbf (g/dL) for the most common procedures were: TKA- 272, 1.1, 2.1, 10.4, 13.9, and 10.1; THA951, 2.3, 2.4, 9.4, 13.8, and 9.9; and LAM- 589, 1.5, 2.2, 12.0, 14.6, and 1 1 .2. Phlebotomies for procedures with minimal blood loss, as for total knee arthroplasties, result in wastage. Autodonation under such circumstances takes patients to an unnecessary low hemoglobin concentration prior to either retransfusing the blood taken or discarding part of it. The number of preoperative autologous units donated can be reduced if predonation hemoglobin concentration is >15 g/dL and expected blood loss is not >2 g.

Background. Because traumatic aortic transection is associated with high mortality rates, great debate exists about the appropriate operative technique for treatment of patients who have acute traumatic aortic transection. Methods. To determine the safety and efficacy of the "clamp-sew" method, we retrospectively reviewed our 8-year experience treating 75 patients who had aortic injuries secondary to blunt trauma. Seventy-one of these patients were treated surgically. The clamp-sew method was used in all of these operations. Results. Aortic cross-clamp time averaged 24 minutes (range, 14 to 36 minutes), with 4/71 having times in excess of 30 minutes. One patient (clamp time, 28 minutes) became paraplegic. Significant associated injuries were seen in 51/75 patients (48/71 patients with operation), including intrathoracic (35 patients), orthopedic (28 patients), intraabdominal (24 patients), and central nervous system (17 patients) damage. No patient died within 24 hours of operation. Overall 30-day mortality was 12% (9/75), with 7/9 having two or more aforementioned associated injuries. Of these 7, 5 had central nervous system injuries. Two of 9 died within 30 days without two or more associated injuries: 1 Jehovah's Witness of low hemoglobin, and 1 patient of sepsis. Conclusions. Although any of several maneuvers may be appropriate in managing traumatic aortic injuries, the simple "clamp-sew" technique is a safe and effective method for the treatment of traumatic aortic transections.

Historically, the needs of those wounded in war have led to many major advances in blood transfusion. The most important of these is probably the ability to draw blood in one location and transfuse it, at a later time, in a distant location. Another important lesson is the need for meticulous planning. Every hospital and blood center should have a disaster plan consisting of five components. What fluids to use, from where are they to be obtained, to what degree are they to be tested, how will they be transported to the disaster scene, and, once there, how will they be stored. Once drawn up, this plan must be regularly exercised and periodically revised. This will ensure rapid and efficient implementation when an emergency arises. Triage is vital in mass casualty situations, ensuring that scarce resources are used for those with the best chance of recovery. Although patients survive with low hemoglobin levels for considerable periods, speedy treatment of hypovolemia is imperative. When perflourochemicals and hemoglobin solutions are available for general clinical use, they will have a major role to play in disasters. Similarly, a simple method for the cryopreservation of red cells will allow stockpiles to be established. Unfortunately, none of these are presently available, although some are undergoing clinical trials.

Various laboratory and patient-related factors can affect the measurement of hemoglobin A1c (HbA1c). We herein present the case of a diabetic patient with spuriously low HbA1c values on ion-exchange high-performance liquid chromatography (HPLC). Further investigations revealed that the patient was heterozygous for a rare Hb variant, namely Hb Iraq-Halabja (β10 Ala→Val). This is the second report of this variant published in the literature. Clinicians should be aware of the limitations of HbA1c assays because inaccurate values may lead to the inappropriate management of diabetes. Unusual or discrepant HbA1c test results should prompt further investigations for potentially interfering factors, including rare Hb variants.

We regard a 34-year-old female patient, BMI 45 kg/m2, with a history of hypertension and dyslipidemia, and scheduled for a laparoscopic gastric bypass. Twenty-four hours following the operation, the patient developed hematemesis, tachycardia, mild hypotension and a low hemoglobin.

Analysis of blood substances such as hemoglobin, glucose, protein, cholesterol, etc. are important parameters for health condition monitoring. Traditionally, blood sample is taken using a needle. Some chemical process such as enzyme reaction is required before the final value for concentration is read. Reagents involved in such processes are expensive for both the hospital and patient. Non-invasive measurement is much more attractive by its evident advantages such as real time monitoring and infection free operation. The Hemoglobin (Hb) in human blood is measured and analyzed using Advanced RISC (Reduced Instruction Set Computing) machine processor non-invasively. This investigation helps in ruling out the diseases like anemia (a low hemoglobin level) and polycythemia vera (a high hemoglobin level). At present, the procedures used to measure the Hb concentration in blood are invasive. For this purpose blood is taken and analyzed. The hindrance of this method is the delay between the blood collection and its analysis. The portable smart non-invasive measurement system, discussed in this paper, gives a detailed idea about the hemoglobin concentration in the blood.

Avaliou-se o impacto de fatores socioeconômicos, maternos, frequência ao tratamento e frequência de infecções, parasitoses e anemia no incremento de estatura para idade (E/I) em crianças (< 5 anos) submetidas a tratamento em hospital-dia no Centro de Recuperação e Educação Nutricional (n = 57). Doenças respiratórias superiores foram as mais frequentes com associação positiva com a gravidade da subnutrição (p = 0,035) e a idade na admissão (p = 0,001). Em análise de regressão múltipla a gravidade da subnutrição, o baixo nível de hemoglobina, menor renda familiar e frequência no serviço foram fatores preditivos (p < 0,05) para maior incremento de E/I. Os achados mostram a importância do tratamento em hospital-dia para o tratamento de crianças subnutridas. We evaluated the impact of socioeconomic and maternal conditions, treatment frequency and frequency of infections, parasites and anemia in the increment of height for age (H/A) in children (< 5 years) undergoing treatment at day-hospital at a Center for Recovery and Nutritional Education (n = 57). Upper respiratory infections were the most frequent disease with positive association with the severity of undernutrition (p = 0.035) and age at admission (p = 0.001). In multiple regression analysis, the severity of undernutrition, low hemoglobin level, family income and the low frequency at the service were predictors of increment in stature (p < 0.05). The findings show the importance of treatment in day hospitals for undernourished children. UNIFESP Centro de Recuperação e Educação Nutricional UNIFESP Instituto de Saúde e Sociedade Departamento de Ciências do Movimento Humano UNIFESP, Centro de Recuperação e Educação Nutricional UNIFESP, Instituto de Saúde e Sociedade Depto. de Ciências do Movimento Humano SciELO

Anemia can be defined as a reduction in the hemoglobin concentration and red blood cell mass compared with age-matched normal values. Anemia is caused by poor production of red blood cells, destruction of red blood cells, or loss of red blood cells. Pediatric nurse practitioners will encounter patients in their practice who have anemia resulting from each of these causes. Common clinical presentations include the child who is feeling well but is found to have a low hemoglobin concentration on a routine screening test, the child who is "tired" and does not eat well, the infant or child who is being evaluated for other chronic problems and is found to have a low hemoglobin concentration, and last, the child who is obviously pale, lethargic, and requires immediate assessment and evaluation.

Background Anemia in pregnancy is common in Tanzania. Previous information on distribu-ton of hemoglobin concentration in total populations is scarce.Methods Standard measurement of hemoglobin concentration in consecutive first visit at-tenders at the antenatal care clinic in Moshi, 1991-1994, for a total of 1800, divided into three series of 600 each.Results Hemoglobin concentrations ranged from 41 to 146 g/1, mean 96.9 and s.d. 16.3. For international comparison, 74.5% were below 110 g/1 and 7.0% below 70 g/1. The median was 97.0; other percentiles were 10th: 75.0, 90th: 116.0. The distribution did not change with mother's age, but in the years 1991 and 1994 there were more low hemoglobin values than in the intervening years.Conclusions Low hemoglobin concentrations are prevalent among pregnant women in Moshi, Tanzania. Seven percent were found to have severe anemia, defined as a hemoglobin concentration below 70 g/1.

An 83-year-old woman presented to the emergency room from her nursing home with bright-red blood per rectum. Her vital signs were stable and she had a low hemoglobin level of 8 g/100 mL. A radionuclide bleeding scan demonstrated pooling of labeled red blood cells within focally dilated postc

This study was designed to explore whether blood O2 affinity and hypoxic ventilation (HV) behave as independent physiological variables. The experimental model was applied using phytic acid, known to decrease blood oxygen affinity, in rats (low Hb-O2 affinity) and guinea pigs (high Hb-O2 affinity). Baseline P50 and ventilation were significantly lower in guinea pigs than in rats. After administration of phytic acid for 3 weeks, P50 increased significantly more in guinea pigs than in rats. As previously shown, HV was substantially lower in control guinea pigs than in control rats. Guinea pigs with low Hb-O2 affinity induced by phytic acid did not modify their HV significantly. The percent change of ventilation was not significantly different in guinea pigs as compared with rats. At the same level of acute hypoxia, HV was significantly lower in treated guinea pigs than in rats. When the baseline P50 was relatively high (rats), the administration of this pharmacologic agent changed P50, but to a lesser degree than when baseline values were relatively low (guinea pigs). HV and P50 seem to behave as rather independent biological parameters, at least under experimental conditions.

We examined the blood of four dasyurid marsupials, all small, active insectivores and/or carnivores, to establish if there were any specializations in oxygen transport. All four species had hemoglobins with a low affinity for oxygen. This was demonstrated by high $P_{50}$'s (the partialpressure of oxygen [PO₂] at which the hemoglobin is half-saturated with oxygen) of the whole blood (means of 38.3-59.8 mmHg) and of red cells suspended in a physiological buffer (means of 41.6-49.0 mmHg) at a CO₂ tension of 43 mmHg. There was a strong correlation betuween increase in body mass over three orders of magnitude and increase in the oxygen affinity of the whole blood. The effects of changing CO₂ tensions on the oxygen affinity of whole blood were measured as △log $P_{50}/{\Delta}log$ PCO₂; mean values ranged from 0.25 to 0.373. Values for △log $P_{50}/{\Delta}pH$ wuere measured for red-cell suspensions; means values ranged from -0.40 to -0.481. The introduction of 2,3-diphosphoglycerate significantly decreased th...

Anemia has been associated with elevated cerebral blood flow (CBF) in animal models and certain clinical conditions (eg, renal disease), but whether hemoglobin level variations across a relatively normal range are associated with local or diffuse CBF changes is unclear. We investigated whether lower hemoglobin is associated with regional increases in relative CBF in older individuals, and if these increases occur in watershed regions.Seventy-four older nondemented adults underwent serial (15)O water positron emission tomography scans. Voxel-based analysis was used to investigate regional relative CBF patterns in association with hemoglobin level and in individuals with and without anemia. Analyses of cross-sectional relations between regional CBF and anemia were performed separately at two time points, 2 years apart, to identify replicable patterns of associations.Restricting results to associations replicated across two cross-sectional analyses, lower hemoglobin was associated with higher relative CBF within the middle/inferior frontal, occipital, precuneus, and cerebellar regions. In addition, individuals with anemia (n = 15) showed higher relative CBF in superior frontal, middle temporal, hippocampal, and gyrus rectus regions than those without anemia. In some regions (right superior temporal gyrus, left inferior frontal gyrus, midline cuneus, and right precuneus); however, lower hemoglobin was associated with lower relative CBF.In nondemented individuals, lower hemoglobin is associated with elevated relative CBF in specific cortical areas but reduced CBF in other areas. Whether this association between anemia and CBF in the absence of chronic diseases and in a normal physiologic range is related to clinical endpoints warrants further study.

Objective: To describe a case of artifactually decreased hemoglobin A1c (HbA1c) attributable to use of dapsone. Methods: We present a detailed case report and results of a related literature search. In addition, potential causes of artifactually lowered HbA1c values are discussed. Results: A 35-year-old patient with type 1 diabetes had high home-monitored blood glucose values, high clinic plasma glucose determinations, increased fructosamine levels, and low HbA1c values. The lowering of the HbA1c level was associated with use of dapsone, and the decrease in HbA1c value was proportional to the dose of dapsone. A literature search revealed one previous report of artifactual lowering of the HbA1c value, in which high methemoglobin levels were found and thought to be the cause of the artifactually decreased HbA1c. Conclusion: By increasing methemoglobin levels and decreasing erythrocyte survival, dapsone can artifactually lower HbA1c. Clinicians should be aware of this potential side effect of dapsone. (Endoc...

To assess long-term developmental outcome in children who received iron-fortified or low-iron formula.Follow-up at 10 years of a randomized controlled trial (1991-1994) of 2 levels of formula iron. Examiners were masked to group assignment.Urban areas around Santiago, Chile.The original study enrolled healthy, full-term infants in community clinics; 835 completed the trial. At 10 years, 473 were assessed (56.6%).Iron-fortified (mean, 12.7 mg/L) or low-iron (mean, 2.3 mg/L) formula from 6 to 12 months.We measured IQ, spatial memory, arithmetic achievement, visual-motor integration, visual perception, and motor functioning. We used covaried regression to compare iron-fortified and low-iron groups and considered hemoglobin level before randomization and sensitivity analyses to identify 6-month hemoglobin levels at which groups diverged in outcome.Compared with the low-iron group, the iron-fortified group scored lower on every 10-year outcome (significant for spatial memory and visual-motor integration; suggestive for IQ, arithmetic achievement, visual perception, and motor coordination; 1.4-4.6 points lower; effect sizes, 0.13-0.21). Children with high 6-month hemoglobin levels (12.8 g/dL [to convert to grams per liter, multiply by 10]) showed poorer outcome on these measures if they received iron-fortified formula (10.7-19.3 points lower; large effect sizes, 0.85-1.36); those with low hemoglobin levels (10.5 g/dL) showed better outcome (2.6-4.5 points higher; small but significant effects, 0.22-0.36). High hemoglobin levels represented 5.5% of the sample (n = 26) and low hemoglobin levels represented 18.4% (n = 87).Long-term development may be adversely affected in infants with high hemoglobin levels who receive 12.7 mg/L of iron-fortified formula. Optimal amounts of iron in infant formula warrant further study.

A Jehovah Witness patient with renal failure on dialysis, with low hemoglobin, underwent urgent off-pump coronary artery bypass grafting without systemic heparinization. The pros, cons, and details of the technique used are discussed. (J Card Surg 2011;26:282-283)

Iron deficiency anemia is a nutritional and medical risk factor that has been implicated in lowered developmental scores, as well as increased irritability and solemnity of infants. The present research examined possible further risk correlates of iron deficiency anemia (IDA) in the medical dossiers of 9 to 12 month old infants (M= 10 months) comprising three low‐socioeconomic culture groups, French, African, and North African Muslim, in a Bilan de Sante health clinic in Paris, France. Using a strict dual criteria on measure of IDA: low hemoglobin (Hg ≤ 10.5) and low mean corpuscular volume levels, MCV ≤ 73), a trend was found for increased respiratory disease, such as otitis media and bronchitis, in infants with iron deficiency anemia. Medical monitoring and nutritional informational efforts with families can help prevent iron deficiency anemia and its risk sequelae for infants.

A feeding trial was conducted to estimate the optimum vitamin D requirement in the diet for juvenile hybrid tilapia Oreochromis niloticus×0. aureus. Eight vitamin D levels, ranging from 0 to 2, 100IU/kg diet at a 300IU increment were fed for 16 weeks to triplicate groups of tilapia weighing 0.78g in a recirculated double filtered rearing system. Results indicated that fish fed with diets lacking supplementary vitamin D had poor growth and feed conversion ratio (FCR), and low hemoglobin, hepatosomatic index values, and plasma alkaline phosphatase activity. Plasma calcium and phosphorus concentration were similar in all the dietary groups. Weight gain analyzed by broken line regression indicated the vitamin D requirement for maximum growth in tilapia to be 374.8IU/kg.

OBJECTIVES To assess the prevalence, associated risk factors and outcome of post partum hemorrhage (PPH) among women delivering at the hospital setting. DESIGN Descriptive retrospective hospital based cross-section study RESULTS The targeted respondents were 344 pregnant women. Prevalence of PPH was 11.9% with re-admission rate of 41.5% and 12.2% deaths secondary to PPH where most of the women (35.2%) were given blood transfusion after re-admission and surgery as an immediate measure taken. Also it has been found that increase in blood loss is statistically associated with delivery by LSCS. (P=0.02) Risk factors for PPH found in this study are low hemoglobin (HB), pregnancy induced hypertension (PIH), trauma after delivery, history of birth before arrival (BBA), advanced age group (>32years old) and multiparity (> 3 parity). CONCLUSION Although the prevalence seems to be low as compared to overall for Africa (33.4%), still PPH is associated with high mortality (12.2%) and morbidity where majority of risk factors found in this study are preventable.

BACKGROUND Anemia is associated with worse long term outcomes in heart failure. However, there is little evidence on the effect of low hemoglobin level to the left ventricular (LV) structure and diastolic function in hypertensive patients. This study assessed the relationship of hemoglobin level to LV filling pressure in elderly hypertensive patients. METHODS From January 2005 to January 2009, 200 newly diagnosed hypertensive patients over 50 years old (mean age 60 ± 6 years, 116 women) were analyzed. The clinical parameters and comprehensive echocardiographic data were obtained. The patients with and without anemia were compared. RESULTS There were significant differences between the anemic and non-anemic groups in the LV mass index (115.27 ± 34.95 vs. 103.75 ± 28.21 g/m(2)), left atrial (LA) volume index (29.31 ± 10.74 vs. 24.99 ± 7.43 mL/m(2)), and E/E' (11.92 ± 4.34 vs. 9.37 ± 2.51). Chronic renal failure was more prevalent in anemic group. On multivariate logistic analysis, anemia was significantly correlated with high LV filling pressure, reflected by E/E', even after controlling for LV mass index and LA volume index. Furthermore, E/E' was significantly correlated with the hemoglobin level (R(2) = 0.093, p < 0.001). CONCLUSION In newly-diagnosed hypertensive patients over 50 years old, the presence of anemia was significantly associated with elevated LV filling pressure and LV structural changes. And the hemoglobin level was negatively correlated with noninvasively estimated LV filling pressure.

Peoples living in high altitudes have adapted to their situation (see the Perspective by Storz). To identify gene regions that might have contributed to high-altitude adaptation in Tibetans, Simonson et al. conducted a genome scan of nucleotide polymorphism comparing Tibetans, Han Chinese, and Japanese, while Yi et al. performed comparable analyses on the coding regions of all genes—their exomes. Both studies converged on a gene, endothelial PAS domain protein 1 (also known as hypoxia-inducible factor 2α), which has been linked to the regulation of red blood cell production. Other genes identified that were potentially under selection included adult and fetal hemoglobin and two functional candidate loci that were correlated with low hemoglobin concentration in Tibetans. Future detailed functional studies will now be required to examine the mechanistic underpinnings of physiological adaptation to high altitudes. T. S. Simonson, Y. Yang, C. D. Huff, H. Yun, G. Qin, D. J. Witherspoon, Z. Bai, F. R. Lorenzo, J. Xing, L. B. Jorde, J. T. Prchal, R. Ge, Genetic evidence for high-altitude adaptation in Tibet. Science 329 , 72–75 (2010). [Abstract][Full Text] X. Yi, Y. Liang, E. Huerta-Sanchez, X. Jin, Z. X. P. Cuo, J. E. Pool, X. Xu, H. Jiang, N. Vinckenbosch, T. S. Korneliussen, H. Zheng, T. Liu, W. He, K. Li, R. Luo, X. Nie, H. Wu, M. Zhao, H. Cao, J. Zou, Y. Shan, S. Li, Q. Yang, Asan, P. Ni, G. Tian, J. Xu, X. Liu, T. Jiang, R. Wu, G. Zhou, M. Tang, J. Qin, T. Wang, S. Feng, G. Li, Huasang, J. Luosang, W. Wang, F. Chen, Y. Wang, X. Zheng, Z. Li, Z. Bianba, G. Yang, X. Wang, S. Tang, G. Gao, Y. Chen, Z. Luo, L. Gusang, Z. Cao, Q. Zhang, W. Ouyang, X. Ren, H. Liang, H. Zheng, Y. Huang, J. Li, L. Bolund, K. Kristiansen, Y. Li, Y. Zhang, X. Zhang, R. Li, S. Li, H. Yang, R. Nielsen, J. Wang, J. Wang, Sequencing of 50 human exomes reveals adaptation to high altitude. Science 329 , 75–78 (2010). [Abstract][Full Text] J. F. Storz, Genes for high altitudes. Science 329 , 40–41 (2010). [Abstract][Full Text]

Reticulocyte hemoglobin content (CHr) and percentage of hypochromic cells (%Hypo) are restricted to the Siemens analysers. The aims of the study were to investigate the correlation of Red cells size factor (RSf) and low Hemoglobin density (LHD%), reported by Beckman-Coulter analysers, with CHr and %Hypo in the assessment of iron status in the presence of inflammation. 381 samples were run on both LH 750 (Beckman-Coulter) and Advia 2120 (Siemens) analysers. Correlation between parameters were calculated and the diagnostic performance of the new parameters was assessed. Results. Correlation between RSf and CHr, 𝑟 = 0 . 8 5 . ROC curve analysis for RSf in the diagnosis of iron restricted erythropoiesis defined as CH r 2 8 pg: AUC 0.983; Cutoff 91.1%; Sensitivity 98.8%; Specificity 89.6% Correlation between LHD% and %Hypo, 𝑟 = 0 . 8 6 9 . ROC curve analysis for LHD% in the diagnosis of iron deficiency defined by %Hypo > 5 %: AUC 0.954; Cut off 6.0%; Sensitivity 96.6%; Specificity 83.2% Conclusions. RSf and LHD% could be reliable parameters for the study of iron metabolism status.

Responses to the 1990 American Association of Blood Banks (AABB) Institutional Membership Questionnaire were submitted by 2126 regional blood centers, hospital-based blood banks, and transfusion facilities. Data from 2117 of these facilities were considered to be valid. The questionnaire included information on blood donor demographics, number of units collected, and collection procedures; services performed; usage of blood components; and transfusion-transmitted diseases reported during 1989. Institutional members collected 7.4 million whole blood units, of which 90.8 percent were donated for allogeneic use, 6.0 percent were donated for autologous use, and 3.2 percent were donated for directed use. Approximately 630,546 allogeneic and directed-use blood donors were deferred, most often for low hemoglobin or hematocrit values. Approximately 225,205 full allogeneic and directed-donor units were discarded, primarily for elevated alanine aminotransferase levels or the presence of hepatitis B core antibody. The 14.3 million transfused components included 56.7 percent red cell-containing components, 27.4 percent platelets, 11 percent fresh-frozen plasma, and 4.8 percent cryoprecipitate. Institutional members reported 1397 cases of transfusion-associated hepatitis. In this group, 921 patients were tested for hepatitis B surface antigen after the transfusion; 339 (36.8%) were found to be hepatitis B surface antigen positive. The AABB Institutional Questionnaire results provide recent data on blood donor and transfusion-related activities that are vital to the evaluation of current transfusion medicine practices.

The impact of low hemoglobin levels on the work performance of 74 rural Nepali villagers was examined with a 3 minute exercise step test. Work output was standardized at 75 watts for men and 55 watts for women. Hemoglobin values ranged from 4.2-15.7 g/dl, and averaged 12.0 ± 2.7 g/dl for 35 men and 10.9 ± 1.72 g/dl for 39 women. Low hemoglobin levels significantly elevated the heart rates and recovery times of the men, but not of the women. A positive relationship with oxygen uptake and a negative one with net mechanical efficiency was found for men but not for women (anemic men appeared more efficient as they used up marginally less oxygen during exercise). Values are in good agreement with those recently published for Gurkha soldiers, but are at variance with those examining the step test performance of Nepali women. In the light of behavioral data on work patterns, mild anemia may have little impact on the performance of moderate self-paced physical activity. Nepali villagers pause frequently during the course of subsistence activities, a behavior which allows time for recovery from an elevated pulse rate. © 1992 Wiley-Liss, Inc.

BACKGROUND: Presenting blood donors are screened to ensure both their safety and that of the recipients of blood products. Donors with identified risks are deferred from donating blood either temporarily or permanently. Minorities are underrepresented as donors in the United States and this may in part be a result of increased donor deferral rates in minorities compared to white individuals. STUDY DESIGN AND METHODS: Data consisted of deferred and successful blood donor presentations to the American Red Cross Southern Region in the metropolitan Atlanta area in 2004 to 2008. Bivariate and multivariate analyses were conducted by race/ethnicity, age group, and sex. RESULTS: A total of 586,159 voluntary donor presentations occurred in 2004 to 2008, of which 79,214 (15.6%) resulted in deferral. In the age 16 to 69 years subset (98.3% of the presentations), deferred presentations were mostly women (78.2%). The most common reason for donor deferral was low hemoglobin (62.6%). The donor deferral rate varied by race/ethnicity, age, and sex: whites (11.1%), Hispanics (14.1%), and African Americans (17.9%); 16- to 19-year-olds (17.0%) and 50- to 59-year-olds (11.7%); and females (20.0%) and males (6.2%). Compared to whites and Hispanics, African American females had the highest deferral rate in each age group. CONCLUSIONS: Minorities are disproportionately impacted by blood donor deferrals. Methods to decrease blood donor deferral rates among African Americans are needed.

Introduction: The impact of anemia on functional outcome and mortality in patients suffering from non-traumatic intracerebral hemorrhage (ICH) has not been investigated. Here, we assessed the relationship between hemoglobin (HB) levels and clinical outcome after ICH. Methods: One hundred and ninety six patients suffering from supratentorial, non-traumatic ICH were extracted from our local stroke database (June 2004 to June 2006). Clinical and radiologic computed tomography data, HB levels on admission, mean HB values and nadir during hospital stay were recorded. Outcome was assessed at discharge and 3 months using the modified Rankin score (mRS). Results: Forty six (23.5%) patients achieved a favorable functional outcome (mRS ≤ 3) and 150 (76.5%) had poor outcome (mRS 4 - 6) at discharge. Patients with poor functional outcome had a lower mean HB (12.3 versus 13.7 g/dl, P < 0.001) and nadir HB (11.5 versus 13.0 g/dl, P < 0.001). Ten patients (5.1%) received red blood cell (RBC) transfusions. In a multivariate logistic regression model, the mean HB was an independent predictor for poor functional outcome at three months (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P = 0.007), along with National Institute of Health Stroke Scale (NIHSS) at admission (OR 1.17, 95% CI 1.11 - 1.24, P < 0.001), and age (OR 1.08, 95% CI 1.04 - 1.12, P < 0.001). Conclusions: We report an association between low HB and poor outcome in patients with non-traumatic, supratentorial ICH. While a causal relationship could not be proven, previous experimental studies and studies in brain injured patients provide evidence for detrimental effects of anemia on brain metabolism. However, the potential risk of anemia must be balanced against the risk of harm from red blood cell infusion.

� Objective:�To describe very low hemoglobin A 1c levels in a patient with type 2 diabetes mellitus and an unusual presentation of b-thalassemia minor. � Methods: We present the clinical and laboratory findings of the study patient. � Results: A 64-year-old African American man with type 2 diabetes mellitus was referred to the endocrinology clinic with a hemoglobin A 1c level of 1.6% despite elevated blood glucose concentrations. A red blood cell survival study with chromium-51 revealed that he had a reduced erythrocyte life span less than 25% of normal. He also had a markedly elevated reticulocyte count ranging from 236 to 534 × 10 3 /mL (reference range, 25-75 × 10 3 /mL). The laboratory findings, which are not characteristic of b-thalassemia minor, could be the cause of the markedly low hemoglobin A 1c in this patient. � Conclusions: Although rare, when associated with marked erythrocyte turnover, b-thalassemia minor can lead to a severe reduction in HbA 1c levels. In this scenario, glycemic control is best assessed by measuring fructosamine. (Endocr Pract. 2010;16:89-92)

The haemoglobin status of children with malaria and/ urinary schistosomiasis was studied over a period of six months (from August 2006-January 2007) at Odau in Abua Odual Local Government Area Rivers State, Nigeria. Two hundred (200) children aged between six months and fourteen (0-14) years were randomly selected for the study, out of which one-hundred and eight-seven (187; 93.5%) were infected with either or both diseases. The overall rate of mixed- infection was 75.0%, a bit lower than the rates of the single infections. Age prevalence for all the infection categories peaked in the five to nine (5-9)years old age category and there-after declined. Majority of the children with mixed infection of malaria and urinary schistosomiasis especially those in the zero to four (0-4) years age group, were found to have very low haemoglobin concentration relative to those with single infections and the uninfected ones. A negative linear relationship (r = 0.01; p = 0.99) was found between low haemoglobin concentration and prevalence of mixed-infection. The occurrence of low concentrations of haemoglobin (less than 11.0mg/dl) was highest in children with mixed infection (59.9%) while it was less for the malaria (39.6%) and the schistosomiasis (32.6%) groups. The rate of low haemoglobin was higher in children with malaria than in those with urinary schistosomiasis although the later had higher prevalence of infection. The age related prevalence of low hemoglobin concentration rose to a peak in the ten to fourteen (10-14) years old Improved economic and health conditions of the children and the entire community will help reduce the pathology of these endemic infections especially, in the most vulnerable individuals. Keywords : low haemoglobin concentration, children, malaria, urinary schistosomiasis Journal of Agriculture and Social Research Vol. 7 (1) 2007: pp. 56-62

Background: Recent studies, in which the cardiovascular risk and mortality associated with high and low hemoglobin target values, respectively, have been investigated, challenged the concept that hemoglobin normalization improves prognosis. Methods: The results of these studies are reviewed with respect to differences in study populations, study design and methodological limitations to provide guidance for their interpretation and relevance for clinical practice. Results: There are important differences with respect to enrolled populations, design and conduct of the studies. Each study has its specific, inherent methodological limitations. Importantly, there is no statistically significant and consistent pattern of negative results for cardiovascular and mortality outcomes, although in general outcomes are not in favor of hemoglobin normalization. On the other hand, the reported data on quality of life are consistently and significantly better with higher hemoglobin values. Conclusions: Recent evidence from large outcome studies suggested an increased risk associated with hemoglobin normalization. On the other side, several study-inherent and methodological limitations must be considered before simply extrapolating the negative findings of these studies into clinical practice. However, until new evidence becomes available from ongoing and future clinical studies, an upper Hb limit of 12 g/dl should not be exceeded.

A retrospective evaluation of simultaneous tests of oximeters of various manufacturers in volunteer subjects disclosed greater errors at low saturations in subjects with low hemoglobin (Hb) concentrations. Forty-three pulse oximeters of 12 manufacturers studied over a period of 10 months showed that, at a mean arterial oxygen saturation (SaO2) level of 54.5%, as Hb concentration fell, average pulse oximeter (SpO2) bias increased approximately linearly from 0 at Hb greater than 14 g/dl to about -14% at 8 less than Hb less than 9 g/dl. At SaO2 = 53.6%, the mean bias (SaO2--SpO2) of 13 oximeters of 5 manufacturers averaged -15.0% (n = 43) in a subject with Hb = 8 g/dl, but -6.4% (n = 390) in nonanemic subjects. The additional bias in the anemic subject increased with desaturation. It was 0.13% at SaO2 = 98.5% (n = 13), -1.31% at 87.5% (n = 38), -2.71% at 75.1% (n = 38), -5.18% at 61.3% (n = 26), and -9.95% at 53.6% (n = 41); n is the product of the number of oximeters and number of tests in each saturation range. The instruments that showed the greatest errors at low saturations in nonanemic subjects also showed the greatest additional errors associated with anemia (the range between manufacturers of anemic incremental error at about 53% being from -3.2 to -14.5%) and conformed well to the relationship bias (anemic) = 1.35 x bias (normal) -8.18% (r = 0.94; Sy.x = 3.3%). The error due to anemia was zero at 97% SaO2 and became evident when SaO2 fell below 75%.

National and international authorities recommend exclusive breastfeeding for an infant's first 6 months. Effects of these recommendations on iron status of U.S. children are unknown.To ascertain if full breastfeeding for 6 months versus 4 months places U.S. children at greater risk for iron deficiency.Data regarding 2268 children ages 6 to24 months from NHANES III, a nationally representative cross-sectional survey conducted from 1988-1994, were analyzed. Similar analyses were conducted for 526 children ages 12 to24 months from NHANES 1999-2002. Anemia (low hemoglobin or history of anemia) and iron status (serum ferritin) were compared for five groups: formula fed only (n = 1142), or full breastfeeding for: 1 month "FullBF1" (n = 425), 1 to4 months "FullBF1-3+" (n = 343), 4 to6 months "FullBF4-5+" (n = 222), andor= 6 months "FullBF6" (n = 136). Laboratory data were available for children 12 to 24 months (n = 745). SUDAAN software was used to account for the complex sampling design. Logistic regression adjusted for confounding factors.In unadjusted analyses (NHANES III), 10.0% of "FullBF6+" versus 2.3% of "FullBF4-5+" had a history of anemia (p = 0.007) but unadjusted between group serum ferritin and hemoglobin differences were insignificant in both surveys. Adjusting for birth weight and demography revealed persistently lower risk of history of anemia (NHANES III, odds ratio [OR] 0.20, confidence interval [CI] 0.06, 0.63) and low serum ferritin (NHANES 1999-2002, OR 0.19, CI 0.06, 0.57) but not low hemoglobin at time of survey "FullBF4-5+" versus "FullBF6."Young children in the United States fully breastfed for 6 months may be at increased risk of iron deficiency. Adequate iron may not be provided by typical complementary infant foods. Healthcare providers should be vigilant to prevent iron deficiency in this group of infants.

Ascending aorta replacement for acute aortic dissection repair was carried out in a 29-year-old man without the use of blood or blood products. Intraoperative blood loss was minimized with the use of biological glues and red cell salvage. Erythropoietic agents were started before surgery and continued during and after operative repair. Postoperatively, oxygen balance was maintained despite very low hemoglobin levels by increasing the cardiac output to compensate for the low oxygen-carrying capacity, thus maximizing oxygen delivery. Only essential laboratory determinations were carried out, which reduced additional blood loss. Repair was successful, and the patient was discharged from the hospital despite a delay in diagnosis and definitive surgical repair.

Introduction. 20–30% of the world population suffers from iron deficiency anemia. Despite the availability of diagnostic and therapeutic options, the real medical practice in relation to iron deficiency anemia remains on a suboptimal level. As a result, over the past 20 years there is no significant improvement in the iron deficiency anemia frequency in young children. Objective. To analyze the existing care tactic for toddlers with iron deficiency anemia in a primary care setting and to identify the possible ferrotherapy mistakes. Methods. A retrospective study of 135 3-year-old children with anemia in primary health care. The inclusion criteria was: documented low hemoglobin level as recommended by WHO in at least two sequential complete blood tests. Results. Control complete blood count (CBC) was performed within 6 months of anemia detection in 70.4% cases. However, this control was performed during the optimal time only in 15.6% of cases. In 56.3% of cases the fact of ferrotherapy wasn’t documented. The onset of ferrotherapy after the first episode of low hemoglobin detection was in 19.3% of children. 29.6% of children received treatment with iron supplements in an adequate dose. Only in 11.9% of cases the dose of iron was lower than recommended. 30.4% of children had a relapse of iron deficiency anemia and up to 6% had multiple relapses. The average duration of iron deficiency anemia in children during the first three years of life was 6.4 months. Conclusion. In the majority of cases the therapy of the majority of iron deficiency anemia in toddlers was delayed. The biggest problem is the lack of adequate hemoglobin levels monitoring.

PREVIEWEarly initiation of therapy to decelerate the decline in beta cell function and achieve low hemoglobin A1c levels is advantageous in patients with type 2 diabetes. In this first of two articles on treatment of type 2 diabetes, the authors share their experience in optimizing therapy and advocate fixed-dose oral combinations because of lower cost, improved efficacy, better compliance, and fewer side effects. The second article (on page 15) looks at the use of injection therapy when oral therapy is not enough.

Background: Province of Yogyakarta Special Territory is a province of “elderly” structure population, as viewed from the number of elderly which is 15% of total population. Anemia is one of nutrition problems of elderly which reaches as high as 50%. This is caused by low intake of iron and other substances related to iron metabolism process in forming hemoglobin. Low hemoglobin concentration can be one of causes of elderly declining physical fitness. Efforts to overcome anemic problems can be done through the supply of iron and zinc for the elderly twice a week. Objective: To know effect of iron and zinc supply to hemoglobin concentration and physical fitness for anemic elderly at Bantul District, Province of Yogyakarta Special Territory. Methods: The study was a randomized double blind controlled trial design. Subject of the study were anemic elderly that fulfilled inclusion criteria. The supply of iron, combination of iron and zinc to trial group was given twice a week on different days, supply of iron was given on Monday and Thursday, while supply of zinc was given on Tuesday and Saturday. Laboratory and physical fitness examination to both group were done prior and after treatment. Nutrition intake data were achieved through food record. Next, to know effect of iron, iron and zinc supply to elderly hemoglobin concentration and physical fitness, covariant analysis was done. Results: The result of the study showed that after 3 months’ treatment, there was significant difference of hemoglobin concentration caused by different treatment of group with iron supply, iron and zinc combination supply and control group (p=0.012) although iron and combined iron and zinc supply had equal effectiveness in increasing hemoglobin concentration (p=0.404). There was no significant relationship between elderly hemoglobin concentration and physical fitness (p=0.448). This showed that treatment given affected increase of hemoglobin concentration but the supply and increase of hemoglobin concentration did not affect increase of elderly physical fitness. Conclusion: The supply of iron and combined iron and zinc increase hemoglobin concentration, but the supply and in- crease of hemoglobin concentration did not increase the elderly physical fitness.

Although the association between low hemoglobin levels and poorer outcomes in radiation oncology has long been recognized, anemia is often overlooked and untreated. However, a growing body of clinical evidence now indicates that low hemoglobin levels during radiation treatment are associated with decreased response and survival following radiotherapy. For example, a large Canadian retrospective study in patients receiving radical radiotherapy for cervical cancer showed that the 5-year survival rate was 19% higher in those whose hemoglobin during radiation treatment was =12 g/dl compared to those with levels

A study was performed to evaluate blood from young lambs using the Technicon H*1 hematology analyzer, with emphasis on RBC parameters, comparison of tripotassium EDTA and heparin, and the effects of storage on heparinized blood. Blood samples from lambs 2 days to 18 weeks of age were analyzed within 6 hours, revealing a high precision, except for WBC counts in heparinized blood. The HCT values estimated by the H*1 correlated well (r(2)=.90) with those obtained by the microhemotocrit method. Mean hematologic values obtained for heparinized blood differed by up to 4% from values obtained from blood collected into EDTA. WBC counts decreased 8.5% in heparinized blood stored at 4 degrees C for 1 day, but differences observed in RBC counts were