RESUMO
INTRODUCTION: The iron supplementation program for pregnant women is the main program for tackling anemia in various countries, especially in developing countries in which daily diets may lack sufficient iron intake. In Indonesia, it is recommended that expectant mothers ingest 90 iron tablets during their pregnancy; however, the World Health Organization reports that 37% of pregnant women in the country continue to experience anemia. Iron deficiency anemia consistently emerges as the primary etiology for diagnosing anemia; however, it is important to recognize that anemia can stem from various factors beyond just lack of iron. In addition to iron deficiency, chronic illnesses and infections significantly contribute to the prevalence of anemia worldwide. Consequently, this literature review endeavors to uncover the underlying factors responsible for normocytic anemia among pregnant women, focusing on developing countries. MATERIALS AND METHODS: Eight search engines, specifically Proquest, EbscoHost, Scopus, Cochrane Library, Science Direct, Wiley Online Library, PubMed, Google Scholar, and Garuda, were utilized to identify primary articles. Three independent reviewers assessed abstracts and full articles based on specific inclusion and exclusion criteria. The data collected encompassed information regarding the population under study, research methods employed, and primary findings pertinent to the review's objectives. Fifteen studies, published between 2014 and 2023, that met the eligibility criteria outlined in the PRISMA-ScR. RESULTS: Among the 15 studies on normocytic anemia in pregnant women, malaria and HIV were the highest causes of normocytic anemia, followed by worm/intestinal parasite infections, chronic diseases, and bleeding.. In pregnant women, anemia of chronic disease and infection often coexists with iron deficiency anemia, both show decrease serum iron levels. Hence, other investigations need to be carried out to diagnose with certainty the cause of anemia in pregnant women. CONCLUSION: Anemia is not a standalone disease but rather a symptom of various underlying diseases. Therefore, diagnosing anemia requires identifying the basic disease that causes anemia, rather than simply labeling it as anemia.
Assuntos
Complicações Hematológicas na Gravidez , Humanos , Feminino , Gravidez , Complicações Hematológicas na Gravidez/epidemiologia , Complicações Hematológicas na Gravidez/diagnóstico , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/etiologia , Anemia/etiologia , Anemia/diagnóstico , Anemia/epidemiologia , Ferro/sangueRESUMO
OBJECTIVE: To delineate the clinical characteristics of preterm birth (PTB) in the context of gestational diabetes mellitus (GDM). METHODS: A retrospective cohort study was conducted, including 14,314 pregnant women with GDM who delivered at Fujian Provincial Maternity and Children's Hospital from January 1, 2018, to December 31, 2021. PTB was stratified into late PTB (34-36 weeks of gestation) and early PTB (< 34 weeks) and pregnancy complications were analyzed. RESULTS: Compared to the term birth (TB) cohort, a higher prevalence of premature rupture of membranes, hypertensive diseases of pregnancy (HDP), intrahepatic cholestasis of pregnancy (ICP), anemia and cervical insufficiency was observed in the PTB cohort. Notably, early PTB increased the incidence of HDP, ICP, anemia and cervical insufficiency compared to late PTB. In the early stages of pregnancy, early PTB was characterized by elevated triglyceride (TG) levels and decreased high-density lipoprotein cholesterol (HDL-C) levels compared to late PTB. In the late pregnancy stages, early PTB was associated with increased white blood cell (WBC) and neutrophil counts. No disparities were observed in 75 g oral glucose tolerance test (OGTT) between early and late PTB. CONCLUSION: Enhanced surveillance and management of GDM, particularly in the presence of HDP, ICP and anemia, are imperative to mitigate the risk of PTB. The lipid profile may serve as a predictive tool for early PTB in the early stages of pregnancy, warranting further studies.
Assuntos
Diabetes Gestacional , Nascimento Prematuro , Humanos , Feminino , Diabetes Gestacional/epidemiologia , Gravidez , Estudos Retrospectivos , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Adulto , China/epidemiologia , Fatores de Risco , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/sangue , Recém-Nascido , Colestase Intra-Hepática/epidemiologia , Colestase Intra-Hepática/sangue , Colestase Intra-Hepática/complicações , Idade Gestacional , Anemia/epidemiologia , Anemia/etiologia , Anemia/sangue , Ruptura Prematura de Membranas Fetais/epidemiologia , Estudos de Coortes , PrevalênciaRESUMO
BACKGROUND: This study aims to review the clinical characteristics, therapeutic response and outcome of idiopathic pulmonary hemosiderosis (IPH), and discover the risk factors for recurrence in children with IPH, which will be helpful for the early diagnosis and reasonable treatment of this disease. METHODS: Children with a diagnosis of IPH were enrolled in the study. Clinical data of the children were collected and analysed. RESULTS: A total of 32 patients with regular follow-up after diagnosis were included in this study. Anaemia, cough and haemoptysis constituted the most common initial symptoms of the disease, and the incidences were 90.6%, 75% and 56.2%, respectively. The mean gap between the onset of symptoms and diagnosis was 5 (0.25-36) months. Most of the children experienced remission (complete and partial remission) over the course of 6 months of treatment, but 19 of the children experienced relapse. The causes of disease recurrence included respiratory tract infection (37.5%), corticosteroid (CS) reduction (18.8%), and irregular medication (6.3%). Interestingly, we found that children with history of allergy (HR 4.255, 1.107-16.356) tended to experience disease recurrence (p = 0.01). CONCLUSIONS: Cough and anaemia are the most common symptoms in children with IPH. The recurrence rate of this disease is high, and respiratory tract infection is the most common cause of its recurrence. High-dose CS impluse therapy cannot reduce the recurrence rate of the disease. Allergic history was an import factor associated with disease recurrence. TRIAL REGISTRATION: This study is a retrospective and observational study, which does not involve human specimens or clinical intervention. Therefore, clinical trial registration is not required, and there is no clinical trial number. However, the study was approved by the Institutional Review Board/Ethics Committee affiliated with West China Second University Hospital, Sichuan University (Ethics review number 2022074).
Assuntos
Tosse , Hemossiderose Pulmonar , Hemossiderose , Pneumopatias , Recidiva , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Corticosteroides/uso terapêutico , Anemia/etiologia , China/epidemiologia , Tosse/etiologia , Hemoptise/etiologia , Hemossiderose/complicações , Infecções Respiratórias/complicações , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Sodium-glucose cotransporter-2 (SGLT-2) is expressed in the kidney and may contribute to anaemia and cardiovascular diseases. The effect of SGLT-2 inhibition on anaemia and vascular endpoints in sickle cell disease (SCD) is unknown. A murine model of SCD was studied to determine the effects of the SGLT-2 inhibitor, empagliflozin, on anaemia and stroke size. The University of Michigan's Precision Health Database was used to evaluate the effect of SGLT-2 inhibitors on anaemia in humans with SCD. SCD mice treated with daily empagliflozin for 8 weeks demonstrated increases in haemoglobin, haematocrit, erythrocyte counts, reticulocyte percentage and erythropoietin compared to vehicle-treated mice. Following photochemical-induced thrombosis of the middle cerebral artery, mice treated with empagliflozin demonstrated reduced stroke size compared to vehicle treated mice. In the electronic health records analysis, haemoglobin, haematocrit and erythrocyte counts increased in human SCD subjects treated with an SGLT-2 inhibitor. SGLT-2 inhibitor treatment of humans and mice with SCD is associated with improvement in anaemic parameters. Empagliflozin treatment is also associated with reduced stroke size in SCD mice suggesting SGLT-2 inhibitor treatment may be beneficial with regard to both anaemia and vascular complications in SCD patients.
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Anemia Falciforme , Anemia , Compostos Benzidrílicos , Modelos Animais de Doenças , Glucosídeos , Inibidores do Transportador 2 de Sódio-Glicose , Acidente Vascular Cerebral , Animais , Anemia Falciforme/complicações , Anemia Falciforme/tratamento farmacológico , Anemia Falciforme/sangue , Anemia Falciforme/patologia , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Humanos , Camundongos , Compostos Benzidrílicos/farmacologia , Glucosídeos/farmacologia , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/patologia , Masculino , Anemia/tratamento farmacológico , Anemia/etiologia , Feminino , Transportador 2 de Glucose-Sódio/metabolismo , Camundongos Endogâmicos C57BLRESUMO
BACKGROUND: Infective endocarditis (IE) in children with pre-existing heart conditions is a life-threatening disease entity associated with significant morbidity and mortality. In our cardiac setting, the management outcomes of children with IE are not well documented. We therefore aimed to document the clinical profile and treatment outcomes of children with IE attended at the Jakaya Kikwete Cardiac Institute (JKCI). METHODS: This was a hospital-based cross-sectional study with longitudinal follow-up conducted among children with IE diagnosed by Modified Duke's Criteria at the JKCI from November 2021 to November 2023. A structured questionnaire was used to collect patients' socio-demographic and clinical data. RESULTS: During the study period, 1,546 children were admitted to the JKCI. A total of 30 children with IE were enrolled, of these half (n = 16, 53%) were aged 10 to 18 years, with a median of 10 yrs (Inter quartile range, IQR: 6.5-12.2 yrs). Twelve children (40%) and nearly half (n = 14, 47%) had fever and used antibiotic therapy respectively. Majority of participants had anaemia (n = 26, 87%) and heart failure (n = 21, 70%). Nine children (30%) had positive blood cultures and S. aureus was the most frequently isolated organism (n = 7). Ten patients (33%) developed acute kidney injury (AKI), and eleven (37%) children died during the hospital stay. CONCLUSION: In our setting, in-hospital mortality due to IE among children with heart diseases is high. Heart failure and anaemia were the common presentations of IE. Furthermore, AKI was observed to be the leading in-hospital non-cardiac complication.
Assuntos
Antibacterianos , Humanos , Estudos Transversais , Tanzânia/epidemiologia , Criança , Feminino , Masculino , Adolescente , Pré-Escolar , Antibacterianos/uso terapêutico , Endocardite/epidemiologia , Endocardite/mortalidade , Endocardite/complicações , Endocardite/diagnóstico , Cardiopatias/complicações , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/diagnóstico , Seguimentos , Estudos Longitudinais , Anemia/etiologia , LactenteRESUMO
Cancer-related anemia (CRA) is a common comorbidity in cancer patients, and it can lead to a worse prognosis. The aim of this cross-sectional study is to investigate the clinical value of the red cell size factor (Rsf) in the early diagnosis of nondigestive tract CRA. A total of 231 patients with nondigestive tract solid cancer were included, and they were divided into anemic and nonanemic subjects according to the hemoglobin (Hb) levels. A BC-7500 blood analyzer was used to detect the indices of red blood cell and reticulocyte, and the mean corpuscular volume (MCV), mean reticulocyte volume (MRV), reticulocyte hemoglobin (RHE) content, and reticulocyte production index were observed. Subsequently, the Rsf was calculated. Receiver operating characteristic curve analysis was used to evaluate the identifying power of Rsf for anemia diagnosed by the combination of RHE and reticulocyte production index. The adjusted-multivariate analysis and quartiles were used to assess the relation of reduced Rsf level with the risk and incidence of anemia diagnosed by combining the MCV, MCH, and mean corpuscular hemoglobin concentration (MCHC), respectively. Rsf levels showed no statistical differences between anemia and nonanemia subjects grouped by Hb (Pâ >â .05). Rsf has a high correlation with the RHE level (Râ >â 0.900, Pâ <â .001), or MCV, mean corpuscular hemoglobin (MCH), and MCHC in anemia patients (r: 0.435-0.802, Pâ <â .001). Receiver operating characteristic curves showed that Rsf had the highest overall area under curve of 0.886 (95% confidence interval: 0.845-0.927) in identifying anemia of cancer patients (Pâ <â .001). When the optimal cutoff values of Rsf were set at 97.05 fl in males and 94.95 fl in females, the sensitivity and specificity were 0.94 and 0.76, and 0.98 and 0.75, respectively. Being treated as a categorical variable, Rsf had a highest odds ratio value of 30.626 (12.552-74.726; Pâ <â .001) for the risk of anemia. The increment of Rsf quartiles was highly associated with the decreased incidence of overall anemia (P trendâ <â 0.001). The study suggests that decreased Rsf level is a potentially powerful predictor of overt anemia in nondigestive tract cancer, and it can be used as a convenient, practical, cost-free, and sensitive index in early diagnosis of nondigestive tract CRA.
Assuntos
Anemia , Índices de Eritrócitos , Humanos , Masculino , Feminino , Anemia/diagnóstico , Anemia/sangue , Anemia/etiologia , Anemia/epidemiologia , Pessoa de Meia-Idade , Estudos Transversais , Idoso , Curva ROC , Hemoglobinas/análise , Reticulócitos/metabolismo , Diagnóstico Precoce , Detecção Precoce de Câncer/métodos , AdultoRESUMO
We present the case of a 32-year-old pregnant woman in the 32 + 3 weeks of pregnancy who presented to the hospital with an exacerbation of pain in the right flank. The diagnostic evaluation revealed the presence of severe anemia and a spontaneous adrenal hemorrhage (SAH) in the right adrenal gland. The patient was transferred to the Perinatology, Obstetrics and Gynecology Clinic with the intention of undergoing preterm childbirth. However, the doctors made a risky decision to wait until week 37 and to terminate the pregnancy at that point. The decision was right, as a cesarean section was performed without complications, and the patient gave birth to a healthy child. Spontaneous adrenal hemorrhage (SAH) is a rare condition, defined as spontaneous hemorrhage without trauma or anticoagulant therapy. Due to bleeding and damage to the adrenal cortex, SAH can lead to adrenal insufficiency. Because of its non-specific symptoms and potentially fatal outcomes for the patient and fetus, it should be considered during diagnostics.
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Anemia , Hemorragia , Terceiro Trimestre da Gravidez , Humanos , Feminino , Gravidez , Adulto , Anemia/etiologia , Hemorragia/etiologia , Hemorragia/terapia , Doenças das Glândulas Suprarrenais/complicações , Tratamento Conservador/métodos , Cesárea , Glândulas Suprarrenais/irrigação sanguínea , Glândulas Suprarrenais/diagnóstico por imagem , Complicações Hematológicas na Gravidez/terapia , Complicações na GravidezAssuntos
Diarreia , Humanos , Recém-Nascido , Diarreia/etiologia , Diarreia/diagnóstico , Anemia/diagnóstico , Anemia/etiologia , Masculino , FemininoRESUMO
Peri-operative anemia is a common condition encountered in adult surgical patients. It is increasingly recognized as a predictor of post-operative morbidity and mortality. Evaluation and treatment of anemia pre-operatively can reduce transfusion needs and potentially improve outcomes in surgical patients. This article discusses anemia optimization strategies in peri-operative setting with special focus on use of intravenous iron therapy. Additionally, the authors describe the role of transfusion medicine and best practices around red blood cell, platelet, and plasma transfusions.
Assuntos
Anemia , Transfusão de Sangue , Humanos , Anemia/terapia , Anemia/etiologia , Transfusão de Sangue/métodos , Ferro/uso terapêutico , Ferro/administração & dosagem , Medicina Transfusional/métodos , Transfusão de Eritrócitos , Assistência Perioperatória/métodos , Hematínicos/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapiaRESUMO
Ghosal hematodiaphyseal dysplasia (GHDD) is an autosomal recessive disorder characterized by diaphyseal dysplasia of long bones, bone marrow fibrosis, and steroid-responsive anemia. Patients with this disease have a mutation in the thromboxane-AS1 (TBXAS1) gene located on chromosome 7q33.34. They present with short stature, varying grades of myelofibrosis, and, hence cytopenias. Patients with the above presentation were evaluated through clinical presentation, X-ray of long bones, bone marrow examinations, and confirmed by genetic testing. In this article, we present two cases: The first case is a 3-year-old boy who presented with progressive pallor and ecchymotic patches for a year. On investigation, he had bicytopenia and bone marrow fibrosis. His anemia was steroid responsive and was finally diagnosed as GHDD. The second case is a 20-month-old girl who presented with blood in stools, developmental delay, anemia, and increased intensity of long bones on X-ray. Since other investigations were normal, suspicion of GHDD was raised, and a genetic workup was conducted which suggested mutation in TBXAS1 gene, confirming the diagnosis of GHDD. Children with refractory anemia and cortical thickening on skeletogram should always be evaluated for dysplasias. Timely treatment with steroids reduces transfusion requirements and halts bone damage, thus leading to better growth and improved quality of life.
Assuntos
Anemia , Humanos , Masculino , Pré-Escolar , Feminino , Anemia/etiologia , Anemia/tratamento farmacológico , Mutação , Lactente , Osteocondrodisplasias/genética , Osteocondrodisplasias/complicações , Osteocondrodisplasias/diagnóstico , Resultado do Tratamento , Radiografia , Esteroides/uso terapêutico , Anemia RefratáriaRESUMO
Many large-scale studies revealed that exogenous erythropoietin, erythropoiesis-stimulating agents, have no renoprotective effects. We reported the renoprotective effects of endogenous erythropoietin production on renal function in ischemic reperfusion injury (IRI) of the kidney using the prolyl hydroxylase domain (PHD) inhibitor, Roxadustat. The purpose of this study was to investigate the effects of daprodustat on the progression of chronic renal failure. We retrospectively investigated the effects of daprodustat on the progression of chronic renal failure and renal anemia in patients with stages 3a-5 chronic kidney diseases (estimated glomerular filtration rate, eGFR < 60 mL/min/1.73 m2). The results show that daprodustat largely slowed the reduction in eGFR. The recovery of renal function was observed in some patients. Daprodustat is useful not only for renal anemia but also for the preservation of renal function. The renoprotective effect of daprodustat was small in patients with serum creatinine larger than 3-4 mg/dL because of low residual renal function. The appearance of renal anemia would be a sign of the time to start using daprodustat.
Assuntos
Anemia , Taxa de Filtração Glomerular , Glicina , Insuficiência Renal Crônica , Humanos , Masculino , Anemia/tratamento farmacológico , Anemia/etiologia , Feminino , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Glicina/análogos & derivados , Glicina/uso terapêutico , Glicina/farmacologia , Pessoa de Meia-Idade , Idoso , Taxa de Filtração Glomerular/efeitos dos fármacos , Estudos Retrospectivos , Barbitúricos/uso terapêutico , Rim/efeitos dos fármacos , Rim/fisiopatologia , Rim/metabolismo , Idoso de 80 Anos ou maisRESUMO
Phosphorus is a macroelement found in the body, mostly in the bones as crystals of hydroxyapatite. Higher levels are found in patients affected by chronic kidney disease (CKD). Since the early stage of CKD phosphorous excretion is impaired, but the increase of PTH and FGF23 maintains its level in the normal range. In the last decades, the role of FGF23 in erythropoiesis was studied, and now it is well known for its role in anemia genesis in patients affected by conservative CKD. Both Hyperphosphatemia and anemia are two manifestations of CKD, but many studies showed a direct association between serum phosphorous and anemia. Phosphorus can be considered as the common point of more pathogenetic ways, independent of renal function: the overproduction of FGF23, the worsening of vascular disease, and the toxic impairment of erythropoiesis, including the induction of hemolysis.
Assuntos
Anemia , Fator de Crescimento de Fibroblastos 23 , Hemoglobinas , Fósforo , Insuficiência Renal Crônica , Humanos , Fósforo/sangue , Hemoglobinas/metabolismo , Anemia/etiologia , Anemia/sangue , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Fatores de Crescimento de Fibroblastos/sangue , Hiperfosfatemia/etiologia , Hiperfosfatemia/sangue , EritropoeseAssuntos
Anemia , Epoetina alfa , Glicina , Isoquinolinas , Diálise Renal , Humanos , Anemia/tratamento farmacológico , Anemia/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Epoetina alfa/uso terapêutico , Idoso , Isoquinolinas/uso terapêutico , Glicina/análogos & derivados , Glicina/uso terapêutico , Hematínicos/uso terapêutico , Quimioterapia Combinada , Adulto , Resultado do TratamentoRESUMO
BACKGROUND: Patients with advanced ovarian cancer (AOC) undergoing surgery are often subjected to red blood cell (RBC) transfusions. Both anemia and RBC transfusion are associated with increased morbidity. The aim was to evaluate patient recovery after the implementation of patient blood management (PBM) strategies. METHODS: This retrospective cohort study included 354 patients with AOC undergoing surgery at Skane University Hospital Lund, Sweden, between January 2016 and December 2021. The gradual implementation of PBM strategies included restrictive RBC transfusion, tranexamic acid as standard medication before laparotomies and intravenous iron administered to patients with iron deficiency. Severe complications were defined as Clavien-Dindo (CD) grade ≥ 3a. Logistic and linear regression analyses were used to evaluate the differences between three consecutive periods. RESULTS: After the implementation of new strategies, 52% of the patients had at least one transfusion compared to 83% at baseline (p < 0.001). There was no difference in the rate of severe complications (CD ≥ 3a) between the groups, adjusted odds ratio 0.55 (95% CI 0.26-1.17). The mean difference in hemoglobin before chemotherapy was -1.32 g/L (95% CI -3.04 to -0.22) when adjusted for blood loss and days from surgery to chemotherapy. The length of stay (LOS) decreased from 8.5 days to 7.5 days (p 0.002). INTERPRETATION: The number of patients transfused were reduced by 31%. Despite a slight increase in anemia rate, severe complications (CD ≥ 3a) remained stable. The LOS was reduced, and chemotherapy was given without delay, indicating that PBM is feasible and without causing major severe effects on short-term recovery.
Assuntos
Neoplasias Ovarianas , Humanos , Feminino , Estudos Retrospectivos , Neoplasias Ovarianas/cirurgia , Pessoa de Meia-Idade , Idoso , Transfusão de Eritrócitos/estatística & dados numéricos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Perda Sanguínea Cirúrgica/prevenção & controle , Suécia/epidemiologia , Anemia/etiologia , Ácido Tranexâmico/uso terapêutico , Ácido Tranexâmico/administração & dosagem , Transfusão de Sangue/estatística & dados numéricosRESUMO
PURPOSE: To explore the potential of testosterone therapy in managing cytopenias in myelodysplastic neoplasm and investigate the link between hypogonadism and hematologic malignancies. METHODS: A case of a patient with intermediate-risk myelodysplastic neoplasm and hypogonadism treated with testosterone replacement therapy is presented. Testosterone, prostate specific antigen, and erythropoietin levels were checked prior to therapy initiation and 3 months after. Blood counts were monitored over time. This is followed by a literature review of testosterone use in myelodysplastic neoplasm and the prevalence of hypogonadism in hematologic malignancies. RESULTS: The patient showed sustained improvement in anemia with testosterone therapy and reported subjective improvement in his weakness and fatigue. This improvement occurred even in the setting of an undetectable follow up erythropoietin level. His repeat prostate specific antigen levels remained low, while testosterone levels showed marked improvement. The literature review demonstrated positive response rates for testosterone in treating myelodysplastic neoplasm-related cytopenias, and showed a higher incidence of hypogonadism in hematologic malignancies. CONCLUSION: Our review suggests that the use of testosterone in low and intermediate-risk myelodysplastic neoplasm is underexplored and poses to have significant potential as a future therapeutic agent, after careful consideration of risks and benefits. In addition, the incidence of hypogonadism in myelodysplastic neoplasm and its potential impact on exacerbating cytopenias in myelodysplastic neoplasm warrants further investigation.
Assuntos
Hipogonadismo , Síndromes Mielodisplásicas , Testosterona , Humanos , Testosterona/uso terapêutico , Masculino , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/complicações , Hipogonadismo/tratamento farmacológico , Terapia de Reposição Hormonal/métodos , Anemia/tratamento farmacológico , Anemia/etiologia , Idoso , Pessoa de Meia-Idade , CitopeniaRESUMO
OBJECTIVE: Chronic kidney disease (CKD)-associated anaemia has substantial biopsychosocial impacts. This study explores the impact of CKD-associated anaemia and treatment preferences from the patient perspective. DESIGN: Cross-sectional survey. SETTING: Anonymised online survey implemented by Ipsos UK on behalf of the National Kidney Federation and GSK from October 2022 to January 2023. PARTICIPANTS: Data were collected from UK adults living with CKD (self-reported). PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome measures were exploratory and not predefined. The cross-sectional survey was designed to explore the biopsychosocial impact of living with anaemia on individuals with CKD; their unmet needs; the treatment strategies typically implemented and the associated barriers/facilitators to adherence; the healthcare professional-patient relationship with regard to anaemia diagnosis and management. RESULTS: Of 101 participants, 90 (89%) were patients with CKD and 11 (11%) were informal carers. 96 (95%) participants reported symptom(s) relevant to their experience of CKD. 88 (87%) participants reported symptom(s) associated with anaemia and 61 (64%) expressed an impact on daily life including 18 (19%) unable to perform daily activities, 13 (14%) unable to go to work and 9 (9%) reporting poor social life/interactions. 85 (84%) participants reported they have received treatment for anaemia: intravenous iron (n=55, 54%), iron tablets (n=29, 29%), erythropoietin-stimulating agents (ESAs) via an autoinjector (n=28, 28%), ESA injections via a syringe (n=24, 24%), ESA injections via a dialysis machine (n=17, 17%), folic acid (n=22, 22%) and blood transfusion (n=17, 17%). Six of seven (86%) participants who received their ESA from a healthcare professional at home preferred injections whereas 13/27 (48%) participants who injected themselves at home preferred oral tablets. CONCLUSIONS: There is not a 'one-size-fits-all' approach to the management of CKD-associated anaemia. A personalised approach incorporating the treatment preferences of the individual should be explored when discussing treatment options.
Assuntos
Anemia , Cuidadores , Insuficiência Renal Crônica , Humanos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Anemia/etiologia , Anemia/terapia , Estudos Transversais , Masculino , Feminino , Reino Unido , Cuidadores/psicologia , Pessoa de Meia-Idade , Idoso , Adulto , Inquéritos e Questionários , Idoso de 80 Anos ou mais , Hematínicos/uso terapêutico , Atividades CotidianasRESUMO
BACKGROUND: This case describes chronic anemia of a late preterm infant secondary to maternal-fetal hemorrhage and subsequent findings of maternal choriocarcinoma. CLINICAL FINDINGS: This infant was born at 35 6/7 weeks gestational age via cesarean section for non-reassuring fetal heart tones. The mother presented with decreased fetal movement and the biophysical profile was 4/8. Following delivery, the infant did not require respiratory support, was vigorous with extreme pallor, and had a hemoglobin of less than 5 on cord gas. PRIMARY DIAGNOSIS: Chronic anemia secondary to fetomaternal hemorrhage. INTERVENTIONS: The infant's initial hemoglobin was 2.4 and hematocrit was 8.1. The mother's Kleihauer-Betke test was elevated at 7%. The infant required a partial exchange transfusion following admission to the neonatal intensive care unit. Following the partial exchange transfusion, the infant began to experience increasing respiratory distress and required respiratory support. An echocardiogram showed severe persistent pulmonary hypertension of the neonate. The mother was subsequently diagnosed with choriocarcinoma. OUTCOMES: The infant fully recovered from chronic anemia and persistent pulmonary hypertension of the neonate and was discharged home with the mother. The infant required follow-up testing for choriocarcinoma outpatient. PRACTICE RECOMMENDATIONS: Newborns diagnosed with early chronic anemia should be evaluated, the cause investigated, and appropriate treatment considered. If the cause of blood loss is unknown, a maternal Kleihauer-Betke test should be considered. In this case, a partial exchange transfusion was performed to avoid cardiovascular volume overload, but another course of treatment could include small aliquots of packed red blood cell transfusions.
Assuntos
Coriocarcinoma , Transfusão Feto-Materna , Humanos , Transfusão Feto-Materna/diagnóstico , Transfusão Feto-Materna/terapia , Transfusão Feto-Materna/complicações , Feminino , Recém-Nascido , Gravidez , Coriocarcinoma/complicações , Coriocarcinoma/diagnóstico , Coriocarcinoma/terapia , Transfusão Total/métodos , Neoplasias Uterinas/complicações , Neoplasias Uterinas/terapia , Neoplasias Uterinas/diagnóstico , Recém-Nascido Prematuro , Cesárea , Anemia/etiologia , Anemia/terapia , AdultoRESUMO
BACKGROUND: Plasmodium falciparum infection is associated with the human ABO blood group. However, there is a paucity of data on the role that ABO and Rhesus blood groups play in malaria clinical presentations. Therefore, the objective of this study was to assess the association of human ABO blood groups and the Rhesus blood (Rh) types with the severity of malaria. METHODS: This cross-sectional study was carried out at the Suhum Government Hospital in the Eastern region of Ghana. Conveniently, study participants with malaria, diagnosed by microscopy, were selected into the study. Subsequently, their ABO and Rh blood groups were determined (Accucare ABO/Rh monoclonal antibodies, Chennai, India). Malaria severity was assessed using the criteria for assessing severe malarial anaemia published by the World Health Organization. According to the criteria, severe malarial anaemia was classified as having haemoglobin (Hb) < 5 g/dL for children < 12 years and in patients ≥ 12 years, Hb level < 7 g/dL, with parasitaemia > 10,000/µL in both cases. Severe malarial anaemia was also classified as having plasma bilirubin > 50 µmol/L with parasitaemia ≥ 100,000/µL, for all ages. Chi square statistical analysis was used to test the association between the blood groups and the clinical or laboratory findings, while multivariate analysis was performed to identify which blood groups were more vulnerable to develop severe malarial anaemia. RESULTS: Of the total number of the study participants (n = 328), most of the patients had blood group O Rh positive (35.7%) while few of them had blood group AB Rh negative (2.1%). The types of Rhesus did not associate with malaria. However, compared to blood group O, the odds of developing severe malarial anaemia, in children < 12 years and in patients ≥ 12 years, were 16 times and 17.8 times higher among patients with blood group A, respectively. Furthermore, the odds of having bilirubin level > 50 µmol/L with parasitaemia ≥ 100,000 /µL was 10 times higher among patients with blood groups A and 2.6 times higher in patients with blood group B, compared to blood group O. Finally, in patients with blood group A majority (71.6%) of them developed high temperature (> 37.5 °C) while 43.3% of them vomited and had diarrhoea. However, pallor (group B = 46.2% vs group A = 37.3%), fever (group B = 84.6% vs group A = 79.1%) and nausea (group B = 46.2% vs group A = 25.4%) were more frequent in patients with blood group B than A. CONCLUSIONS: This study found that people with blood groups A and B were severely affected by malaria, with group A being the most vulnerable. It is recommended that blood group assessment be performed for all patients with malaria. Patients found to have blood group A or B must be promptly and efficiently managed to avoid the development of severe malaria anaemia.
Assuntos
Sistema ABO de Grupos Sanguíneos , Anemia , Malária Falciparum , Sistema do Grupo Sanguíneo Rh-Hr , Humanos , Estudos Transversais , Masculino , Feminino , Pré-Escolar , Criança , Gana/epidemiologia , Adulto , Malária Falciparum/complicações , Malária Falciparum/epidemiologia , Malária Falciparum/sangue , Anemia/etiologia , Anemia/sangue , Anemia/epidemiologia , Adolescente , Adulto Jovem , Lactente , Pessoa de Meia-Idade , IdosoRESUMO
We aimed to compare the clinical efficacy and safety of roxadustat with erythropoiesis-stimulating agents, particularly erythropoietin (EPO), in the treatment of maintenance hemodialysis patients with renal anemia. A prospective cohort study was carried out at the Nephrology Department of the Nantong First People's Hospital and Nantong University Affiliated Hospital from December 2020 to December 2021. We compared hemoglobin (Hb) levels, serum ferritin (SF) levels, and adverse cardiovascular events between the roxadustat and EPO groups at 1, 3, and 6 months into the treatment. A total of 209 patients participated in the study, with 112 in the roxadustat group and 97 in the EPO group. At baseline, no statistically significant differences were observed between the 2 groups in terms of age, gender, weight, dialysis modality and duration, previous EPO dosage, Hb levels, SF levels, transferrin saturation, heart function classification, and blood pressure levels (Pâ >â .05). After 1 month, Hb levels in the roxadustat group were significantly higher than those in the EPO group (Pâ <â .05). However, no statistically significant differences were found between the 2 groups at 3 and 6 months (Pâ >â .05). Additionally, there were no significant differences in SF levels and the occurrence of adverse cardiovascular events between the 2 groups after treatment (Pâ >â .05). Roxadustat was superior to EPO in the initial treatment phase, while its cardiovascular safety was comparable to that of EPO.