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A 12-year-old Hispanic girl presented with fatigue, lightheadedness, and intermittent headaches. She was depressed and appeared pale to her mother. Her examination was unremarkable except for palpebral conjunctival pallor and was otherwise noncontributory. She had a profound hypoproliferative microcytic anemia with low iron level, low transferrin saturation, and a normal ferritin level. The patient experienced improvement in clinical symptoms following transfusion of packed red blood cells and oral iron therapy. At follow-up 2 months later, she presented with similar symptoms and persistent microcytic anemia with low iron levels. Her ferritin level was increased along with markedly elevated C-reactive protein and erythrocyte sedimentation rate. An oral iron challenge demonstrated lack of absorption, and hepcidin level was also significantly elevated. Thorough gastrointestinal and rheumatologic evaluations were performed to search for a source of inflammation. Key components of the patient's social history supplemented by serology, radiographic, and pathologic findings ultimately cinched an unexpected diagnosis.

Phosphorus has an essential role in cellular and extracellular metabolism; maintenance of normal phosphorus homeostasis is critical. Phosphorus homeostasis can be affected by diet and certain medications; some intravenous iron formulations can induce renal phosphate excretion and hypophosphatemia, likely through increasing serum concentrations of intact fibroblast growth factor 23. Case studies provide insights into two types of hypophosphatemia: acute symptomatic and chronic hypophosphatemia, while considering the role of pre-existing conditions and comorbidities, medications, and intravenous iron. This review examines phosphorus homeostasis and hypophosphatemia, with emphasis on effects of iron deficiency and iron replacement using intravenous iron formulations.

Background: World Health Organization recently acknowledged the proportion of anemia attributable to iron deficiency among under-five children could be lower than the previously assumed 50%. Ethiopia reported 8.6% and 12.3% prevalence of iron deficiency anemia by serum ferritin and soluble transferrin receptor respectively. However, evidence generated from large samples on the magnitude of different types of anemias is limited. We aimed to determine the prevalence and morphological types of anemia in relation to age. Methods: A retrospective analysis was conducted using electronic records of hemoglobin and red blood cell indices of 4739 children of 6–59 months of age who visited Hawassa University Comprehensive and Specialized Hospital from May 2017 to May 2019. Microcytic hypochromic morphology combined with high red cell distribution width was used to estimate the prevalence of iron deficiency. Results: About 44.7% of the children were anemic. Anemia affected 6–23 months old children (53.1%) more than 24–59 (37.2%) months (p < 0.001) with no difference among boys and girls. Iron deficiency and iron-deficiency anemia, as explained by microcytic hypochromic morphology with high red cell distribution width combined model, were estimated to be 38.6% and 24.1%, respectively. About 54% of anemic children had iron deficiency which was higher among 6–23 months (63.5%) than 24–59 months (41.8%) (P < 0.001; X2 = 98.883). Regardless of anemia status, iron deficiency was two-fold higher among 6–23 months old children than 24–59 months of age. On the contrary, normocytic normochromic anemia affected significantly 24–59 months old children (23.1%) compared to 6–23 months. Less than 6% of the total anemia was macrocytic showing no significant relation with age. About 96% of macrocytic anemia was coupled with high red cell distribution width, indicating folate and vitamin B12 deficiency. Conclusions: Microcytic hypochromic anemia with high red cell distribution width was the most prevalent type affecting primarily under two children. Normocytic normochromic anemia was significant among 24–59 months while macrocytic anemia had no age-related pattern. An in-depth study of causes of anemia other than iron deficiency particularly among 24–59 months children is essential.

Pregnancy in women with thalassemia minor is considered safe. However, a higher incidence of maternal and neonatal complications in women with the disorder has been reported in the literature. This study aimed to determine whether there is an increased risk of gestational diabetes mellitus (GDM) in pregnant women with beta-thalassemia minor. We conducted a retrospective matched case-control study of 230 pregnant women who delivered at the Department of Obstetrics and Feto-Maternal Medicine at the Medical University of Vienna between the years 2008 and 2020, whereof 115 women had beta-thalassemia minor. We found no significant difference in the occurrence of GDM between the case group and control group of age and BMI-matched healthy women. However, we observed a significantly lower hemoglobin (Hb) and hematocrit (Ht) level during the first, the second, and the third trimesters of pregnancy, and postpartum (all: p < 0.001) among women with beta-thalassemia minor compared to the healthy controls. Neonates of women with beta-thalassemia were more likely to experience post-natal jaundice and excessive weight loss (p < 0.001). We conclude that GDM is not more likely to occur in pregnant women with beta-thalassemia minor. However, clinicians should be made aware of the risk of adverse maternal and neonatal outcomes. Furthermore, women with beta-thalassemia minor should undergo regular laboratory screening and multidisciplinary pregnancy care. [ABSTRACT FROM AUTHOR]

Introduction: Low-energy helium-neon (He-Ne) laser beam lightis used in combination with sodium hypochlorite (Na2HOCl3) for clinical purposes. Regarding this, the present study aimed to investigate the effect of He-Ne laser (632.8 nm) and sodium hypochlorite on the calf thymus double-stranded deoxyribonucleic acid (ctdsDNA) molecule. Materials and Methods: For the purpose of the study, ctdsDNA solutions (30µg/ml) were exposed to He-Ne laser (632.8 nm) light in the absence and presence of different concentrations of sodium hypochlorite for up to 60 sec. The levels of nucleic acids released as uncontaminated and contaminated proteins were considered as the markers of DNA damage in terms of hypochromasia (i.e., DNA strand breakage) and hyperchromasia (i.e., of DNA strands separation). Results: The mean concentration of nucleic acids insignificantly (P > 0.05) decreased after exposure to laser light irradiation (hypochromic effect). Furthermore, laser irradiation insignificantly and inconsistency protected the ctdsDNA molecules from the effect of sodium hypochlorite. Sodium hypochlorite at concentrations of 1 and 3 mmol reduced the levels of the nucleic acids released from contaminated protein by 29.2% and 78.3% of the pre-incubated levels (hyporchromasia effect). The He-Ne laser (632.8 nm) irradiation induced hypochromic effect on the uncontaminated and contaminated proteins, while sodium hypochlorite induced a remarkable hyperchromic effect at higher concentrations. Conclusion: As the finding indicated, a short time He-Ne laser light (632.8 nm) irradiation exerted minor significant effect on the ctdsDNA molecule. This laser light did not interact with sodium hypochlorite as a synergistic combination against the ctdsDNA molecule.

Anemia is considered a condition, not a disease in which numbers of red blood cells (RBCs) are insufficient to meet the body’s metabolical and physiological needs for oxygen. Anemia may also develop due to nutritional deficiencies such as iron, vitamin B12, folic acid, and vitamin A; moderate and severe inflammation; parasitic infestation; and acquired or inherited disorders that affect hemoglobin synthesis, red blood cell development or red blood cell endurance. This proposed work depicts the distribution of different morphological types of anemia on people of Gurugram, Haryana. All the samples were analyzed for CBC and peripheral blood smear by using Sysmax (three parts) hematology analyzer and microscopy. In the present study, 300 patients in 6 months study period were included to diagnose anemia. Only 166 cases were positive. Out of 166 cases, 85 (51.2%) were female and 81 (48.8%) were male. The highest number of participants showed RBCs count in the range of 4.5-5.5 million/mm³, 24 (14.5%) with P value 0.000. Most of the cases that we revealed were having hypochromic red cells along with morphological variation in RBCs which may be due to iron deficiency. The further confirmatory analysis may be required in order to know the detail classification of anemia. [ABSTRACT FROM AUTHOR]

Introduction: Thalassemia is a group of heterogeneous genetic disorders caused by a decreased rate of synthesis of α or β chains. In thalassemia, one or more globin chains are lacking in production. Hence, there is an excess of globin chains because there are no partners in the process of hemoglobin formation. This condition causes erythropoiesis to be ineffective and erythrocyte gives a picture of hypochromic anemia and because of decreased hemoglobin, erythrocytes become hypochromic and microcytic and many target cells are present. The purpose of this study was to determine the morphological description of erythrocytes in thalassemia patients who are members of the TPPAI branch in Kediri. Methods: Purposive Sampling was done in 20 respondents. Results: From this study the results obtained 100% microcytic anemia, 100% hypochromic, Poikilocytosis dominated target cells 100%, and basophil stippling was found to be 85%. Conclusion: of this study shows that the blood smear of patients with thalassemia is hypochromic microcytic anisopoikilocytosis that is dominated by target cells and the discovery basophil stippling. [ABSTRACT FROM AUTHOR]

Background: Microcytic hypochromic anemia is a distinct morphologic subtype of anemia with well- de ned etiology and treatment. The objective of this study was to determine the etiology and frequency of microcytic hypochromic anemia. Materials and Methods: This cross-sectional observational study was conducted at Kathmandu Medical College Teaching Hospital. One hundred cases of microcytic hypochromic anemia were included. Relevant clinical history, hemogram, reticulocyte count, iron pro les were documented in a proforma. Bone marrow aspiration and hemoglobin electrophoresis was conducted when required. Data was analysed by Microsoft SPSS 16 windows. Result: Iron de ciency was the commonest etiology (49%). Dysfunctional uterine bleeding (20.8%) was the commonest cause of iron de ciency, malignancy (24.3%) was the commonest cause of anemia of chronic disease. Mean value of Mean Corpuscular Volume was lowest in hemolytic anemia (71.0 ). Mean Red cell Distribution Width was normal (14.0%) in hemolytic anemia but was raised in other types. Mean serum iron was reduced in iron de ciency anemia (32.2μg/dl) and chronic disease (34.8μg/dl), normal in hemolytic anemia (83μg/dl) and raised in sideroblastic anemia (295μg/dl). Mean serum ferritin was reduced in iron de ciency anemia (7.6ng/ml), raised in chronic disease (158.6ng/ml) and normal in hemolytic anemia (99.2ng/ml). Serum ferritin was normal in sideroblastic anemia (93ng/ml). Mean Total Iron Binding Capacity was raised in iron de ciency anemia (458μg/dl) and normal in other microcytic hypochromic anemias. Conclusion: Diagnosis of microcytic hypochromic anemia requires a standardized approach which includes clinical details, hemogram, peripheral blood smear, reticulocyte count, iron pro le, hemoglobin electrophoresis and bone marrow examination.

Introduction: Low-energy helium-neon (He-Ne) laser beam light is used in combination with sodium hypochlorite (Na2HOCl3) for clinical purposes. Regarding this, the present study aimed to investigate the effect of He-Ne laser (632.8 nm) and sodium hypochlorite on the calf thymus double-stranded deoxyribonucleic acid (ctdsDNA) molecule. Materials and Methods: For the purpose of the study, ctdsDNA solutions (30μg/ml) were exposed to He-Ne laser (632.8 nm) light in the absence and presence of different concentrations of sodium hypochlorite for up to 60 sec. The levels of nucleic acids released as uncontaminated and contaminated proteins were considered as the markers of DNA damage in terms of hypochromasia (i.e., DNA strand breakage) and hyperchromasia (i.e., of DNA strands separation). Results: The mean concentration of nucleic acids insignificantly (P > 0.05) decreased after exposure to laser light irradiation (hypochromic effect). Furthermore, laser irradiation insignificantly and inconsistency protected the ctdsDNA molecules from the effect of sodium hypochlorite. Sodium hypochlorite at concentrations of 1 and 3 mmol reduced the levels of the nucleic acids released from contaminated protein by 29.2% and 78.3% of the pre-incubated levels (hyporchromasia effect). The He-Ne laser (632.8 nm) irradiation induced hypochromic effect on the uncontaminated and contaminated proteins, while sodium hypochlorite induced a remarkable hyperchromic effect at higher concentrations. Conclusion: As the finding indicated, a short time He-Ne laser light (632.8 nm) irradiation exerted minor significant effect on the ctdsDNA molecule. This laser light did not interact with sodium hypochlorite as a synergistic combination against the ctdsDNA molecule. [ABSTRACT FROM AUTHOR]

Manganese is an essential trace elenent. There is a little evidence for deficiency of manganese in human , while as its toxicity has been reported in several cases. Manganese toxicity occurrs in humans exposed to high enviromental concentrations (for example workers in the dry battery production) and may be particularly important in the neonatal period. The chemical similarities between manganese and iron and their binding to apo-transferrin (apo-tf) may lead to the disturbances of iron metabolism. In the present project the interrelationship of anemia and manganese toxicity by techniques such as Affinity chromatography ; Equilibrium dialysis ; Urea polyacrylamide gel electrophoresis ; Spectrophotometric titration was investigated. The charactristics of Mn and Fe binding to apo-tf have been investigated and compared in this article . Using Equilibrium dialysis technique the binding of Fe and Mn to apo-tf was also studied. The binding constant of Mn to apo-tf was calculated using scatchared plot analysis. Addition of Mn (1.5 mg/ml) to reaction mixture containing Fe and apo-tf reduced Fe binding to apo-transferrin in comparison to control. Using Urea polyacrylamide gel electrophoresis (Urea-PAGE) technique conforming the binding of Mn to apo-tf. The data that has been presented in this article elucidated the probable mechanism by which Mn interference with Fe metabolism; which result in the apperance of anemia.

Background: Anemia is a medical condition in which the red blood cells (RBCs) count and hemoglobin (Hb) are less than the normal range. The main causes of anemia are a decrease in RBCs, their destruction and decrease of Hb synthesis. A useful method for diagnosis and classification of anemias is based on the morphological appearance of RBCs on an ideal stained blood smear. The main terms used in such classification are normocytic normochromic, microcytic hypochromic and macrocytic anemia. Aim: The aim of this study is to determine the most common morphological pattern of anemia in Saudi anemic patients who were admitted at King Abdul-aziz Medical City-Riyadh. Materials and Methods: Retrospectively we evaluated the results of complete blood count (CBC) and peripheral blood picture (PBP) of all anemic patients attending during the year 2013 (from 1st January to 31st December). Results: Participants in this study included 150 patients (13 infants, 27 children, 12 youths, 52 adults and 46 old). The gender distribution showed 70 males and 80 females. The results of CBC and PBP showed that 113 (75.3%), 36 (24%) and 1 (0.7%) of the patients had normocytic normochromic, microcytic hypochromic and macrocytic pattern of anemia respectively. Conclusion: The normocytic normochromic pattern of anemia is highly frequent among this sample of Saudi patients while the macrocytic pattern of anemia is the lowest. According to gender groups microcytic hypochromic pattern of anemia is more common among females; malnutrition, increase of blood loss due to pregnancy or menstruation, and lack of iron absorption are the main causes, while the normocytic normochromic is highly frequent among males, which are mainly due to blood loss or chronic diseases. [ABSTRACT FROM AUTHOR]

Introduction Various indices derived from red blood cell ( RBC) parameters have been described for distinguishing thalassemia and iron deficiency. We studied the microcytic to hypochromic RBC ratio as a discriminant index in microcytic anemia and compared it to traditional indices in a learning set and confirmed our findings in a validation set. Methods The learning set comprised samples from 371 patients with microcytic anemia mean cell volume (MCV < 80 fL), which were measured on a CELL-DYN Sapphire analyzer and various discriminant functions calculated. Optimal cutoff values were established using ROC analysis. These values were used in the validation set of 338 patients. Results In the learning set, a microcytic to hypochromic RBC ratio >6.4 was strongly indicative of thalassemia (area under the curve 0.948). Green-King and England-Fraser indices showed comparable area under the ROC curve. However, the microcytic to hypochromic ratio had the highest sensitivity (0.964). In the validation set, 91.1% of microcytic patients were correctly classified using the M/H ratio. Conclusions Overall, the microcytic to hypochromic ratio as measured in CELL- DYN Sapphire performed equally well as the Green-King index in identifying thalassemia carriers, but with higher sensitivity, making it a quick and inexpensive screening tool. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we aimed to determine the incidence of anemia in children between the ages of 1-15. Materials and Methods: A total of 14449 patients admitted to pediatric outpatient clinic between 01.01.2012 and 31.12.2012 were retrospectively reviewed from hospital records. Patients between the ages of 1-15 without chronic disease were included into the study in order to evaluate the prevalence of anemia. Results: Of patients admitted to hospital, 8747 were male (60.5%) and 5707 were female (39.5%). Patients were divided into five groups according to age groups including, 2531 patients in 1-3 age group (17.5%), 2872 patients in 4-6 age group (19.9%), 2735 patients in 7-9 age group (18.9%), 2637 patiens in 10-12 age group (18.3%) and 3674 patients in 13-15 age group (25.4%). Anemia was detected in 853 (5.9%) patients, and 465 of them were male (54.5%) and 388 of them were female (45.5%). The distrubition of anemia according to age group was as follows: 205 patients in 1-3 age group (8.1%), 97 in 4-6 age group (3.4%), 98 in 7-9 age group (3.6%), 128 in 10-12 age group (4.9%) and 325 in 13-15 age group (8.9%). The distribution of low MCV values according to age groups was as follows: 1-3 age group; 9.4% (237), 4-6 age group; 5.3% (151), 7-9 age group; 3.8% (104), 10-12 age group; 4.5% (119), 13-15 age group; 8.0% (294). Conclusions: Anemia is one of the most common diseases in the pediatric age group. Anemia continues to be a major health problem in childhood in spite of the policies of the health in our country. Diagnosis and treatment is easy. Physicians should be alert to anemia in childhood and families should be informed about this topic. Also all society must work to improve this situation which affects the health and mental development. [ABSTRACT FROM AUTHOR]

Background: World Health Organization recently acknowledged the proportion of anemia attributable to iron deficiency among under-five children could be lower than the previously assumed 50%. Ethiopia reported 8.6% and 12.3% prevalence of iron deficiency anemia by serum ferritin and soluble transferrin receptor respectively. However, evidence generated from large samples on the magnitude of different types of anemias is limited. We aimed to determine the prevalence and morphological types of anemia in relation to age., Methods: A retrospective analysis was conducted using electronic records of hemoglobin and red blood cell indices of 4739 children of 6-59 months of age who visited Hawassa University Comprehensive and Specialized Hospital from May 2017 to May 2019. Microcytic hypochromic morphology combined with high red cell distribution width was used to estimate the prevalence of iron deficiency., Results: About 44.7% of the children were anemic. Anemia affected 6-23 months old children (53.1%) more than 24-59 (37.2%) months (p < 0.001) with no difference among boys and girls. Iron deficiency and iron-deficiency anemia, as explained by microcytic hypochromic morphology with high red cell distribution width combined model, were estimated to be 38.6% and 24.1%, respectively. About 54% of anemic children had iron deficiency which was higher among 6-23 months (63.5%) than 24-59 months (41.8%) ( P < 0.001 ; X 2 = 98.883). Regardless of anemia status, iron deficiency was two-fold higher among 6-23 months old children than 24-59 months of age. On the contrary, normocytic normochromic anemia affected significantly 24-59 months old children (23.1%) compared to 6-23 months. Less than 6% of the total anemia was macrocytic showing no significant relation with age. About 96% of macrocytic anemia was coupled with high red cell distribution width, indicating folate and vitamin B 12 deficiency., Conclusions: Microcytic hypochromic anemia with high red cell distribution width was the most prevalent type affecting primarily under two children. Normocytic normochromic anemia was significant among 24-59 months while macrocytic anemia had no age-related pattern. An in-depth study of causes of anemia other than iron deficiency particularly among 24-59 months children is essential., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Background: Pityriasis versicolor is a superficial mycosis caused by lipophilic yeasts of the genus Malassezia. Clinical features are manifested by hypochromic to hyperchromic patches; some cases show an achromians variety. Objectives: To determine the frequency of dyschromic changes associated with pityriasis versicolor and to establish gender and age group affected. Patients and method: We performed a retrospective study of 194 cases at Dermatology and Skin Surgery Institute Prof. Dr. Fernando A Cordero C, in Guatemala city. Results: Hypochromic dyschromia was the most frequent clinical manifestation (79.%); males were more commonly affected (53.5%) and the highest incidence was in the age range from 11 to 20 years (40.7%). Conclusions: According to our data, pityriasis versicolor in Guatemala is mainly hypochromic and males are the most affected. [ABSTRACT FROM AUTHOR]

Objectives: Iron deficiency anemia (IDA) and beta-thalassemia trait (B-TT) are the most common causes of hypochromic microcytic anemias. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood count analyzers. The purpose of the study was to evaluate the predictive value of these indices in differential diagnosis of IDA and B-TT in adult cases. Methods: This study consists of 45 IDA cases, 36 women and nine men, whose mean age is 33.87 ± 11.59 (mean ± SD) (range 17–57 yr) and 66 B-TT cases, 41 women and 25 men, whose mean age is 33.26 ± 13.36 (mean ± SD) (range 14–74 yr). IDA cases with Hb value <8.7 g/dL have been excluded because these cases are not confused with B-TT cases in practice. Patient groups have been evaluated according to red blood cell (RBC), red blood cell distribution width (RDW), Mentzer index, Shine and Lal indices, England and Fraser indices, Srivastava index, Green and King indices, RDW index and Ricerca index. Sensitivity, specificity, positive and negative predictive values and Youden’s index have been calculated. Results: Finally, none of these different formulations are superior to RBC value obtained from automated analyzers in adult cases with IDA and B-TT. Conclusions: Total body iron status and hemoglobin A2 level should be obtained for accurate differential diagnosis of IDA and B-TT until more efficient tools develop. [ABSTRACT FROM AUTHOR]