Anemia The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Attitudes toward Management of Sickle Cell Disease and Its Complications: A National Survey of Academic Family Physicians Sun, 22 Feb 2015 13:32:44 +0000 Objective. Sickle cell disease (SCD) is a disease that requires a significant degree of medical intervention, and family physicians are one potential provider of care for patients who do not have access to specialists. The extent to which family physicians are comfortable with the treatment of and concerned about potential complications of SCD among their patients is unclear. Our purpose was to examine family physician’s attitudes toward SCD management. Methods. Data was collected as part of the Council of Academic Family Medicine Educational Research Alliance (CERA) survey in the United States and Canada that targeted family physicians who were members of CERA-affiliated organizations. We examined attitudes regarding management of SCD. Results. Overall, 20.4% of respondents felt comfortable with treatment of SCD. There were significant differences in comfort level for treatment of SCD patients depending on whether or not physicians had patients who had SCD, as well as physicians who had more than 10% African American patients. Physicians also felt that clinical decision support (CDS) tools would be useful for treatment (69.4%) and avoiding complications (72.6%) in managing SCD patients. Conclusions. Family physicians are generally uncomfortable with managing SCD patients and recognize the utility of CDS tools in managing patients. Arch G. Mainous III, Rebecca J. Tanner, Christopher A. Harle, Richard Baker, Navkiran K. Shokar, and Mary M. Hulihan Copyright © 2015 Arch G. Mainous III et al. All rights reserved. Effect of Maternal Iron Deficiency Anemia on the Iron Store of Newborns in Ethiopia Wed, 04 Feb 2015 08:17:09 +0000 Iron deficiency anemia among pregnant women is a widespread problem in developing countries including Ethiopia, though its influence on neonatal iron status was inconsistently reported in literature. This cross-sectional study was conducted to compare hematologic profiles and iron status of newborns from mothers with different anemia status and determine correlation between maternal and neonatal hematologic profiles and iron status in Ethiopian context. We included 89 mothers and their respective newborns and performed complete blood count and assessed serum ferritin and C-reactive protein levels from blood samples collected from study participants. Maternal median hemoglobin and serum ferritin levels were 12.2 g/dL and 47.0 ng/mL, respectively. The median hemoglobin and serum ferritin levels for the newborns were 16.2 g/dL and 187.6 ng/mL, respectively. The mothers were classified into two groups based on hemoglobin and serum ferritin levels as iron deficient anemic (IDA) and nonanemic (NA) and newborns of IDA mothers had significantly lower levels of serum ferritin () and hemoglobin concentration (). Besides, newborns’ ferritin and hemoglobin levels showed significant correlation with maternal hemoglobin (; ) and ferritin (; ) levels. We concluded that maternal IDA may have an effect on the iron stores of newborns. Betelihem Terefe, Asaye Birhanu, Paulos Nigussie, and Aster Tsegaye Copyright © 2015 Betelihem Terefe et al. All rights reserved. Management of Sickle Cell Disease: A Review for Physician Education in Nigeria (Sub-Saharan Africa) Sun, 18 Jan 2015 07:20:27 +0000 Sickle cell disease (SCD) predominates in sub-Saharan Africa, East Mediterranean areas, Middle East, and India. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades have witnessed remarkable scientific progress in the understanding of the complex pathophysiology of the disease. Improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic blood transfusions, hydroxyurea therapy, and haemopoietic stem cell transplantation. Coupled with parallel improvements in general supportive, symptomatic, and preventive measures, current evidence reveals remarkable appreciation in quality of life among affected individuals in developed nations. Currently, in Nigeria and other West African states, treatment and control of SCD are largely suboptimal. Improved knowledge regarding SCD phenotypes and its comprehensive care among Nigerian physicians will enhance quality of care for affected persons. This paper therefore provides a review on the aetiopathogenesis, clinical manifestations, and management of SCD in Nigeria, with a focus on its local patterns and peculiarities. Established treatment guidelines as appropriate in the Nigerian setting are proffered, as well as recommendations for improving care of affected persons. Ademola Samson Adewoyin Copyright © 2015 Ademola Samson Adewoyin. All rights reserved. A Retrospective Study Investigating the Incidence and Predisposing Factors of Hospital-Acquired Anemia Sun, 21 Dec 2014 11:18:31 +0000 Hospitalized patients frequently have considerable volumes of blood removed for diagnostic testing which could lead to the development of hospital-acquired anemia. Low hemoglobin levels during hospitalization may result in significant morbidity for patients with underlying cardiorespiratory and other illnesses. We performed a retrospective study and data was collected using a chart review facilitated through an electronic medical record. A total of 479 patients who were not anemic during admission were included in analysis. In our study, we investigated the incidence of HAA and found that, between admission and discharge, 65% of patients dropped their hemoglobin by 1.0 g/dL or more, and 49% of patients developed anemia. We also found that the decrease in hemoglobin between admission and discharge did not differ significantly with smaller phlebotomy tubes. In multivariate analysis, we found that patients with longer hospitalization and those with lower BMI are at higher risk of developing HAA. In conclusion, our study confirms that hospital-acquired anemia is common. More aggressive strategies such as reducing the frequency of blood draws and expanding the use of smaller volume tubes for other laboratory panels may be helpful in reducing the incidence of HAA during hospitalization. Peter C. Kurniali, Stephanie Curry, Keith W. Brennan, Kim Velletri, Mohammed Shaik, Kenneth A. Schwartz, and Elise McCormack Copyright © 2014 Peter C. Kurniali et al. All rights reserved. Prevalence and Severity of Anaemia Stratified by Age and Gender in Rural India Thu, 04 Dec 2014 12:26:03 +0000 Anaemia is a major public health problem in India. Although nearly three quarters of the Indian population live in rural areas, the epidemiology of anaemia in rural settings is not well known. We performed a retrospective observational study using routine clinical data from patients attending the out-patient clinics of a rural hospital in India from June 2011 to August 2014. The study included 73,795 determinations of haemoglobin. 49.5% of patients were female. The median haemoglobin concentration was 11.3 g/dL (interquartile range (IQR), 9.8–12.4) in females and 12.5 g/dL (IQR, 10.6–14.2) in males. Anaemia was present in the majority of children <10 years, women after puberty, and older adults. Children <5 years had the highest prevalence of anaemia, especially children aged 1-2 years. The high proportion of microcytic anaemia and the fact that gender differences were only seen after the menarche period in women suggest that iron deficiency was the main cause of anaemia. However, the prevalence of normocytic anaemia increased with age. The results of this study can be used by public health programmes to design target interventions aimed at reducing the huge burden of anaemia in India. Further studies are needed to clarify the aetiology of anaemia among older adults. Gerardo Alvarez-Uria, Praveen K. Naik, Manoranjan Midde, Pradeep S. Yalla, and Raghavakalyan Pakam Copyright © 2014 Gerardo Alvarez-Uria et al. All rights reserved. Correlation between Plasma Interleukin-3, the α/β Globin Ratio, and Globin mRNA Stability Tue, 18 Nov 2014 06:24:31 +0000 Background. Globin chain synthesis (GCS) analysis is used in the diagnosis of thalassemia. However, the wide reference range limits its use as a decisive diagnostic tool. It has been shown that α and β  globin mRNA increase through stimulation of cells by interleukin-3 (IL-3). Therefore, this study investigates the relationship between plasma IL-3 and the β/α  globin ratio. Methods. Blood samples were collected from 32 healthy participants on two occasions one month apart. GCS analysis, real-time PCR, and ELISA tests were conducted to determine the β/α  globin ratio, globin mRNA expression and stability rate, and IL-3 levels. Results. On the basis of IL-3 levels, the participants were divided in two groups. One group included participants who showed a significant increase in IL-3 as indicated by a significant rise in mean values of α, β, and γ  globin mRNA, α and β  globin, RBC, and hemoglobin. The other group included participants who showed no difference in IL-3 levels with no significant variations in the above-mentioned parameters. Conclusion. The results of this study indicate that IL-3 has an equivalent positive effect on α and β  globin chain synthesis. Therefore, IL-3 levels do not explain the wide reference range of the α/β  globin ratio. S. Rouhi Dehnabeh, R. Mahdian, S. Ajdary, E. Mostafavi, and S. Khatami Copyright © 2014 S. Rouhi Dehnabeh et al. All rights reserved. Validity of Palmar Pallor for Diagnosis of Anemia among Children Aged 6–59 Months in North India Sun, 09 Nov 2014 11:21:08 +0000 Introduction. The Integrated Management of Childhood and Neonatal Illness (IMNCI) recommends the use palmar pallor to diagnose anaemia. Earlier studies to validate palmar pallor as clinical sign for anaemia were largely done in African context. There was a need to test validity of palmar pallor to detect anemia in different settings. Objective. To study the validity and interobserver agreement of palmar pallor examination to diagnose anemia in children under 5 years of age in India. Methods. In a village in Northern India, hemoglobin estimation was done for 80 children using cyanomethemoglobin method. Two examiners, a physician and a health worker, trained in IMNCI evaluated children for palmar pallor. Sensitivity and specificity and Kappa statistics were calculated. Results. Health worker diagnosed palmar pallor with sensitivity of 30.8–42.8% and specificity of 70–89%. Similar figures for doctor were 40–47% and 60–66%, respectively. Kappa agreement between a health worker and a physician was 0.48 (95% CI = 0.298–0.666) and then increased to 0.51 when categories of severe pallor and mild pallor were merged. Conclusion. While using palmar pallor as clinical sign for anaemia, children with no pallor should also be followed up closely for possible detection of missed cases during follow-up. Arun Kumar Aggarwal, Jaya Prasad Tripathy, Deepak Sharma, and Ajith Prabhu Copyright © 2014 Arun Kumar Aggarwal et al. All rights reserved. Study of Hematological Parameters in Children Suffering from Iron Deficiency Anaemia in Chattagram Maa-o-Shishu General Hospital, Chittagong, Bangladesh Tue, 21 Oct 2014 08:45:29 +0000 A total of 150 (30.61%) anemic patients out of 490 patients diagnosed to have iron deficiency anemia (IDA) have been selected for the first time in Bangladesh. For detailed study, blood samples from 150 anemic patients along with 25 controls were analyzed. Analysis of variance showed significant value between mean platelet volume (MPV) in females (8.08 μm3) and males (7.59 μm3) () in iron deficiency anemia patients. Besides, the value of white blood cells (WBC) in males (10946.08/cmm) was significantly higher than in females (9470.833/cmm) (). The significant correlation was observed among hemoglobin levels with hematocrits, hemoglobin with RBC, RBC with hematocrits, and MCV with MCH as well as MCH with MCHC. However, the negative correlation was observed between the hematological variables neutrophils and lymphocytes (). The common complaints we have found in the survey were weight loss 73.33%, attention problem 68%, dyspepsia 65%, decrease of appetite 72%, weakness 68%, diarrhea 65%, and headache 55% among IDA patients. ANOVA showed significant statistical difference in all the hematological and biochemical parameters. Analysis of variance test between anemias with only one of three biochemical parameters decreased and control showed that this group does not have iron deficiency. Abu Syed Mohammed Mujib, Abu Sayeed Mohammad Mahmud, Milton Halder, and Chowdhury Mohammad Monirul Hasan Copyright © 2014 Abu Syed Mohammed Mujib et al. All rights reserved. Anaemia among Female Undergraduates Residing in the Hostels of University of Sri Jayewardenepura, Sri Lanka Mon, 22 Sep 2014 06:01:55 +0000 Anaemia is a major public health problem that has affected around 25% of the world’s population. An analytical cross-sectional study was performed on 313 female undergraduates residing in hostels of University of Sri Jayewardenepura, Sri Lanka, during year 2011. Objective of this study was to determine prevalence and contributing factors to anaemia among the study population. Haemoglobin concentration was assayed using cyanomethaemoglobin method. A pretested self-administered questionnaire was used to retrieve information regarding dietary habits and personal factors of participants. Descriptive statistical methods, chi-square test, and independent sample t-test were used to analyze data. Of the 302 females, 17.5% () had mild anaemia and 7.9% () had moderate anaemia. Severely anaemic individuals were not observed. Participants’ dietary habits and personal factors were not significantly associated with prevalence of anaemia (whether a participant is a vegetarian or not (), drinking tea within one hour of a meal (), frequency of consumption of red meat, fish, and eggs (), antihelminthic treatment within past year (), and menorrhagia ()). Anaemia in the study population is below the average for Sri Lankan data. Diet and selected medical conditions were not a causative factor for anaemia in this population. Gayashan Chathuranga, Thushara Balasuriya, and Rasika Perera Copyright © 2014 Gayashan Chathuranga et al. All rights reserved. Determinants of Anemia among Children Aged 6–59 Months Living in Kilte Awulaelo Woreda, Northern Ethiopia Mon, 15 Sep 2014 00:00:00 +0000 Introduction. The aim of this study was to determine the prevalence of anemia and determinant factors among children aged 6–59 months living in Kilte Awulaelo Woreda, eastern zone. Method. A community based cross-sectional study was conducted during February 2013 among 6 tabias of Kilte Awulaelo Woreda, northern Ethiopia. A total of 568 children were selected by systematic random sampling method. Anthropometric data and blood sample were collected. Bivariate and multivariate logistic regression analyses were performed to identify factors related to anemia. Result. The mean hemoglobin level was 11.48 g/dl and about 37.3% of children were anemic. Children who were aged 6–23 months [AOR = 1.89: 95% CI (1.3, 2.8)], underweight [AOR = 2.05: 95% CI (1.3, 3.3)], having MUAC less than 12 cm [AOR = 3.35: 95% CI (2.1, 5.3)], and from households with annual income below 10,000 Ethiopian birr [AOR = 4.86: 95% CI (3.2, 7.3)] were more likely to become anemic. Conclusion. The prevalence of anemia among the children is found to be high. It was associated with annual household income, age, and nutritional status of the child. So, improving family income and increasing awareness of the mother/caregiver were important intervention. Gebremedhin Gebreegziabiher, Belachew Etana, and Daniel Niggusie Copyright © 2014 Gebremedhin Gebreegziabiher et al. All rights reserved. Prevalence of Anemia and Associated Factors among Pregnant Women in an Urban Area of Eastern Ethiopia Mon, 25 Aug 2014 11:06:13 +0000 This research work presents the magnitude of anemia and its determinant factors among pregnant women. As far as this research is done in the eastern part of Ethiopia, where there is a different cultural issue related to pregnancy and dietary habit, it will help the researchers to know the problem in different parts of the country. Kefyalew Addis Alene and Abdulahi Mohamed Dohe Copyright © 2014 Kefyalew Addis Alene and Abdulahi Mohamed Dohe. All rights reserved. Assessment of Serum Zinc Levels of Patients with Thalassemia Compared to Their Siblings Thu, 14 Aug 2014 11:06:48 +0000 Zinc (Zn) is essential for appropriate growth and proper immune function, both of which may be impaired in thalassemia children. Factors that can affect serum Zn levels in these patients may be related to their disease or treatment or nutritional causes. We assessed the serum Zn levels of children with thalassemia paired with a sibling. Zn levels were obtained from 30 children in Islamabad, Pakistan. Serum Zn levels and anthropometric data measures were compared among siblings. Thalassemia patients’ median age was 4.5 years (range 1–10.6 years) and siblings was 7.8 years (range 1.1–17 years). The median serum Zn levels for both groups were within normal range: 100 μg/dL (10 μg/dL–297 μg/dL) for patients and 92 μg/dL (13 μg/dL–212 μg/dL) for siblings. There was no significant difference between the two groups. Patients’ serum Zn values correlated positively with their corresponding siblings (, ). There were no correlations between patients’ Zn levels, height for age Z-scores, serum ferritin levels, chelation, or blood counts (including both total leukocyte and absolute lymphocyte counts). Patients’ serum Zn values correlated with their siblings’ values. In this study, patients with thalassemia do not seem to have disease-related Zn deficiency. Mohamed El Missiry, Mohamed Hamed Hussein, Sadaf Khalid, Naila Yaqub, Sarah Khan, Fatima Itrat, Cornelio Uderzo, and Lawrence Faulkner Copyright © 2014 Mohamed El Missiry et al. All rights reserved. Presence and Characterisation of Anaemia in Diabetic Foot Ulceration Wed, 23 Jul 2014 09:32:04 +0000 Introduction. Diabetic foot ulceration (DFU) is the commonest cause of severe limb ischaemia in the western world. In diabetes mellitus, anaemia is frequently unrecognized, yet studies have shown that it is twice as common in diabetics compared with nondiabetics. We aimed to assess the incidence of anaemia and further classify the iron deficiency seen in a high-risk DFU patient group. Methods. An observational study was undertaken in a multidisciplinary diabetic foot clinic setting. All patients with DFU attending over a four-month period were included. Anaemia was defined as haemoglobin (Hb) levels <12 g/dL. Iron deficiency was classified according to definitions of AID (absolute iron deficiency) and FID (functional iron deficiency). Results. 27 patients had DFU; 14 (51.9%) were anaemic; two (7.41%) had severe anaemia (Hb < 10 g/dL). No patient had B12 or Folate deficiency. In patients with anaemia, there was significant spread of indices. Only one patient had “textbook” absolute iron deficiency (AID) defined as low Hb, MCV, MCH, and ferritin. Functional iron deficiency (FID) was seen in a further seven patients (25.5%). Conclusion. Anaemia and iron deficiency are a common problem in patients with DFU. With current clinical markers, it is incredibly difficult to determine causal relationships and further in-depth scientific study is required. J. A. Wright, M. J. Oddy, and T. Richards Copyright © 2014 J. A. Wright et al. All rights reserved. Extent of Anaemia among Preschool Children in EAG States, India: A Challenge to Policy Makers Wed, 23 Jul 2014 00:00:00 +0000 Background. India is the highest contributor to child anemia. About 89 million children in India are anemic. The study determines the factors that contributed to child anemia and examines the role of the existing programs in reducing the prevalence of child anemia particularly in the EAG states. Methods. The data from the latest round of the National Family Health Survey (NFHS-3) is used. Simple bivariate and multinomial logistics regression analyses are used. Results. About 70% children are anemic in all the EAG states. The prevalence of severe anemia is the highest (6.7%) in Rajasthan followed by Uttar Pradesh (3.6%) and Madhya Pradesh (3.4%). Children aged 12 to 17 months are significantly seven times (, ) more likely to be severely anemic compared to children of 36 to 59 months. Children of severely anemic mothers are also found to be more severely anemic (, ) than the children of not anemic mothers. Conclusions. The study reveals that the existing government program fails to control anemia among preschool children in the backward states of India. Therefore, there is an urgent need for monitoring of program in regular interval, particularly for EAG states to reduce the prevalence of anemia among preschool children. Rakesh Kumar Singh and Shraboni Patra Copyright © 2014 Rakesh Kumar Singh and Shraboni Patra. All rights reserved. Cormic Index Profile of Children with Sickle Cell Anaemia in Lagos, Nigeria Thu, 17 Apr 2014 11:43:37 +0000 Background. Sickle cell disorders are known to have a negative effect on linear growth. This could potentially affect proportional growth and, hence, Cormic Index. Objective. To determine the Cormic Index in the sickle cell anaemia population in Lagos. Methodology. A consecutive sample of 100 children with haemoglobin genotype SS, aged eight months to 15 years, and 100 age and sex matched controls (haemoglobin genotype AA) was studied. Sitting height (upper segment) and full length or height were measured. Sitting height was then expressed as a percentage of full length/height (Cormic Index). Results. The mean Cormic Index decreased with age among primary subjects (SS) and AA controls. The overall mean Cormic Index among primary subjects was comparable to that of controls (% versus %; % versus %) in boys and girls, respectively. In comparison with AA controls, female children with sickle cell anaemia who were older than 10 years had a significantly lower mean Cormic Index. Conclusion. There was a significant negative relationship between Cormic Index and height in subjects and controls irrespective of gender. Similarly, a significant negative correlation existed between age, sitting height, subischial leg length, weight, and Cormic Index in both subjects and controls. Samuel Olufemi Akodu, Olisamedua Fidelis Njokanma, and Omolara Adeolu Kehinde Copyright © 2014 Samuel Olufemi Akodu et al. All rights reserved. Validation of the WHO Hemoglobin Color Scale Method Tue, 15 Apr 2014 14:06:42 +0000 This study was carried out to evaluate the diagnostic accuracy of WHO color scale in screening anemia during blood donor selection in Sri Lanka. A comparative cross-sectional study was conducted by the Medical Laboratory Sciences Unit of University of Sri Jayewardenepura in collaboration with National Blood Transfusion Centre, Sri Lanka. A total of 100 subjects participated in this study. Hemoglobin value of each participant was analyzed by both WHO color scale method and cyanmethemoglobin method. Bland-Altman plot was used to determine the agreement between the two methods. Sensitivity, specificity, predictive values, false positive, and negative rates were calculated. The sensitivity of the WHO color scale was very low. The highest sensitivity observed was 55.55% in hemoglobin concentrations >13.1 g/dL and the lowest was 28.57% in hemoglobin concentrations between 7.1 and 9.0 g/dL. The mean difference between the WHO color scale and the cyanmethemoglobin method was 0.2 g/dL (95% confidence interval; 3.2 g/dL above and 2.8 g/dL below). Even though the WHO color scale is an inexpensive and portable method for field studies, from the overall results in this study it is concluded that WHO color scale is an inaccurate method to screen anemia during blood donations. Leeniyagala Gamaralalage Thamal Darshana and Deepthi Inoka Uluwaduge Copyright © 2014 Leeniyagala Gamaralalage Thamal Darshana and Deepthi Inoka Uluwaduge. All rights reserved. Hematological Indices for Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia Thu, 10 Apr 2014 09:08:25 +0000 Background. The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and β-TT in the same patient groups. Methods. A total of 290 carefully selected children aged 1.1–16 years were evaluated. We calculated 12 discrimination indices in all patients with hemoglobin (Hb) values of 8.7–11.4 g/dL. None of the subjects had a combined case of IDA and β-TT. All children with IDA received oral iron for 16 weeks, and HbA2 screening was performed after iron therapy. The patient groups were evaluated according to red blood cell (RBC) count; red blood distribution width index; the Mentzer, Shine and Lal, England and Fraser, Srivastava and Bevington, Green and King, Ricerca, Sirdah, and Ehsani indices; mean density of hemoglobin/liter of blood; and mean cell density of hemoglobin. Results. The Mentzer index was the most reliable index, as it had the highest sensitivity (98.7%), specificity (82.3%), and Youden’s index (81%) for detecting β-TT; this was followed by the Ehsani index (94.8%, 73.5%, and 68.3%, resp.) and RBC count (94.8%, 70.5%, and 65.3%). Conclusion. The Mentzer index provided the highest reliabilities for differentiating β-TT from IDA. Aysel Vehapoglu, Gamze Ozgurhan, Ayşegul Dogan Demir, Selcuk Uzuner, Mustafa Atilla Nursoy, Serdar Turkmen, and Arzu Kacan Copyright © 2014 Aysel Vehapoglu et al. All rights reserved. Trace Element Status (Iron, Zinc, Copper, Chromium, Cobalt, and Nickel) in Iron-Deficiency Anaemia of Children under 3 Years Wed, 26 Feb 2014 12:27:47 +0000 Aim. To determine trace element status and aetiologic factors for development of trace elements deficiencies in children with iron-deficiency anaemia (IDA) aged 0 to 3 years. Contingent and Methods. 30 patients of the University Hospital, Pleven, Bulgaria—I group; 48 patients of the Sumy Regional Child’s Clinical Hospital, Sumy, Ukraine—II group; 25 healthy controls were investigated. Serum concentrations of iron, zinc, copper, chromium, cobalt, and nickel were determined spectrophotometrically and by atomic absorption spectrophotometry. Results. Because the obtained serum levels of zinc, copper, and chromium were near the lower reference limits, I group was divided into IA and IB. In IA group, serum concentrations were lower than the reference values for 47%, 57%, and 73% of patients, respectively. In IB group, these were within the reference values. In II group, results for zinc, cobalt, and nickel were significantly lower (), and results for copper were significantly higher in comparison to controls. Conclusion. Low serum concentrations of zinc, copper, cobalt, and nickel were mainly due to inadequate dietary intake, malabsorption, and micronutrient interactions in both studied groups. Increased serum copper in II group was probably due to metabolic changes resulting from adaptations in IDA. Data can be used for developing a diagnostic algorithm for IDA. Maria Georgieva Angelova, Tsvetelina Valentinova Petkova-Marinova, Maksym Vladimirovich Pogorielov, Andrii Nikolaevich Loboda, Vania Nedkova Nedkova-Kolarova, and Atanaska Naumova Bozhinova Copyright © 2014 Maria Georgieva Angelova et al. All rights reserved. An Etiologic Profile of Anemia in 405 Geriatric Patients Sun, 23 Feb 2014 09:24:01 +0000 Background. Anemia is a common condition in the elderly and a significant risk factor for increased morbidity and mortality, reducing not only functional capacity and mobility but also quality of life. Currently, few data are available regarding anemia in hospitalized geriatric patients. Our retrospective study investigated epidemiology and causes of anemia in 405 hospitalized geriatric patients. Methods. Data analysis was performed using laboratory parameters determined during routine hospital admission procedures (hemoglobin, ferritin, transferrin saturation, C-reactive protein, vitamin B12, folic acid, and creatinine) in addition to medical history and demographics. Results. Anemia affected approximately two-thirds of subjects. Of 386 patients with recorded hemoglobin values, 66.3% were anemic according to WHO criteria, mostly (85.1%) in a mild form. Anemia was primarily due to iron deficiency (65%), frequently due to underlying chronic infection (62.1%), or of mixed etiology involving a combination of chronic disease and iron deficiency, with absolute iron deficiency playing a comparatively minor role. Conclusion. Greater awareness of anemia in the elderly is warranted due to its high prevalence and negative effect on outcomes, hospitalization duration, and mortality. Geriatric patients should be routinely screened for anemia and etiological causes of anemia individually assessed to allow timely initiation of appropriate therapy. Tabea Geisel, Julia Martin, Bettina Schulze, Roland Schaefer, Matthias Bach, Garth Virgin, and Jürgen Stein Copyright © 2014 Tabea Geisel et al. All rights reserved. Prevalence and Predictors of Maternal Anemia during Pregnancy in Gondar, Northwest Ethiopia: An Institutional Based Cross-Sectional Study Mon, 20 Jan 2014 14:20:09 +0000 Background. Anaemia is a global public health problem which has an eminence impact on pregnant mother. The aim of this study was to assess the prevalence and predictors of maternal anemia. Method. A cross-sectional study was conducted from March 1 to April 30, 2012, on 302 pregnant women who attended antenatal care at Gondar University Hospital. Interview-based questionnaire, clinical history, and laboratory tests were used to obtain data. Bivariate and multivariate logistic regression was used to identify predictors. Result. The prevalence of anemia was 16.6%. Majority were mild type (64%) and morphologically normocytic normochromic (76%) anemia. Anemia was high at third trimester (18.9%). Low family income (AOR [95% CI] = 3.1 [1.19, 8.33]), large family size (AOR [95% CI] = 4.14 [4.13, 10.52]), hookworm infection (AOR [95% CI] = 2.72 [1.04, 7.25]), and HIV infection (AOR [95% CI] = 5.75 [2.40, 13.69]) were independent predictors of anemia. Conclusion. The prevalence of anemia was high; mild type and normocytic normochromic anemia was dominant. Low income, large family size, hookworm infection, and HIV infection were associated with anemia. Hence, efforts should be made for early diagnosis and management of HIV and hookworm infection with special emphasis on those having low income and large family size. Mulugeta Melku, Zelalem Addis, Meseret Alem, and Bamlaku Enawgaw Copyright © 2014 Mulugeta Melku et al. All rights reserved. Iron Deficiency Anemia among Hospitalized Children in Konya, Turkey Wed, 18 Dec 2013 16:34:05 +0000 The aim of this study was to investigate the characteristics of our hospitalized patients with the diagnosis of iron deficiency anemia (IDA) and effects of the IDA prevention project of the Turkish Ministry of Health which was started in 2004. The recommended dose of prophylactic iron supplementation was 1-2 mg/kg/day. The files of 1519 patients who were hospitalized to Konya Education and Research Hospital Pediatrics Clinic were reviewed. A total of 50 patients consisting of 35 boys and 15 girls with the mean age of 16,59 ± 1,68 months were included into the study. The prevalence of IDA was 3.29% (boys: 4.23%, girls: 2.1%). Hgb and Hct of the patients >24 months were significantly higher than those of the patients with the age of 6–12 months. Iron supplementation receiving rates were very low. Of the 28 patients older than 12 months, only 44% of them had received a full course of iron supplementation for 8 months. In conclusion, although prophylactic iron supplementation lowered the prevalences of IDA, receiving rates of iron supplementation were not adequate. While IDA is still a public health problem, prophylactic approaches should be carried out more effectively. Fatih Akin, Ece Selma Solak, Cengizhan Kilicaslan, Saltuk Bugra Boke, and Sukru Arslan Copyright © 2013 Fatih Akin et al. All rights reserved. Beta-Thalassemia Major and Female Fertility: The Role of Iron and Iron-Induced Oxidative Stress Mon, 16 Dec 2013 09:12:28 +0000 Endocrine complications due to haemosiderosis are present in a significant number of patients with beta-thalassemia major (BTM) worldwide and often become barriers in their desire for parenthood. Thus, although spontaneous fertility can occur, the majority of females with BTM is infertile due to hypogonadotropic hypogonadism (HH) and need assisted reproductive techniques. Infertility in these women seems to be attributed to iron deposition and iron-induced oxidative stress (OS) in various endocrine organs, such as hypothalamus, pituitary, and female reproductive system, but also through the iron effect on other organs, such as liver and pancreas, contributing to the impaired metabolism of hormones and serum antioxidants. Nevertheless, the gonadal function of these patients is usually intact and fertility is usually retrievable. Meanwhile, a significant prooxidants/antioxidants imbalance with subsequent increased (OS) exists in patients with BTM, which is mainly caused by tissue injury due to overproduction of free radicals by secondary iron overload, but also due to alteration in serum trace elements and antioxidant enzymes. Not only using the appropriate antioxidants, essential trace elements, and minerals, but also regulating the advanced glycation end products, could probably reduce the extent of oxidative damage and related complications and retrieve BTM women’s infertility. Paraskevi Roussou, Nikolaos J. Tsagarakis, Dimitrios Kountouras, Sarantis Livadas, and Evanthia Diamanti-Kandarakis Copyright © 2013 Paraskevi Roussou et al. All rights reserved. Effects of Iron Deficiency on Cognitive Function in School Going Adolescent Females in Rural Area of Central India Tue, 10 Dec 2013 13:29:46 +0000 Iron deficiency anemia is most common nutritional deficiency disorder in India and remains a formidable health challenge. Girls in the period of later school age and early adolescence are prone to develop iron deficiency. Iron deficiency leads to many non-hematological disturbances which include growth and development, depressed immune function in infants; reduces physical work capacity; decreases the cognitive function in both infants and adolescents. Present study was done to know the prevalence of iron deficiency in both the anemic and non anemic school going adolescent girls, to assess the effect of iron deficiency on cognitive functions in anemic iron deficient and non-anemic iron deficient school girls in a village school situated in central India. Methods. A secondary school having girl students in the age group of 12–15 years studying in sixth to ninth standard was selected. Serum ferritin concentration was estimated by ELISA. For assessing the cognitive function mathematics score, one multi-component test for memory, attention and verbal learning and Intelligent Quotient scores of the students were used. Results. Scholastic Performance, IQ and Scores of Mental balance, Attention & Concentration, Verbal Memory and Recognition were decreased in iron deficient girls, both anemic and non anemic as compared to the non iron deficient girls. Sarika More, V. B. Shivkumar, Nitin Gangane, and Sumeet Shende Copyright © 2013 Sarika More et al. All rights reserved. Diagnosis of Severe Fetal Anemia Based on Perinatal Outcomes: A Comparative Analysis of the Current Reference Values Wed, 20 Nov 2013 18:55:55 +0000 Objectives. To compare current criteria for severe fetal anemia diagnosis. Methodology. A cohort study analyzed 105 alloimmunized fetuses that underwent cordocentesis due to risk of anemia. Concordance among the diagnostic criteria for severe fetal anemia, hemoglobin deficit >7 g/dL, hemoglobin deficit ≥5 g/dL, and hemoglobin concentration <0.55 MoM, was analyzed using Cohen’s Kappa index. Perinatal mortality, fetal hydrops, and fetal acidosis were used to discuss discordances. Results. There was fair concordance among the three criteria analyzed: 0.80 (Kappa index, IC 95%: 0.67 to 0.93) when comparing hemoglobin deficit >7.0 g/dL and hemoglobin concentration <0.55 MoM criteria, 0.63 (Kappa index, IC 95%: 0.47 to 0.69) when comparing hemoglobin deficit ≥5.0 g/dL and hemoglobin deficit >7.0 g/dL reference, and 0.77 (Kappa index, IC 95%: 0.64 to 0.90) when comparing hemoglobin deficit≥5.0 g/dL and hemoglobin concentration <0.55 MoM standards. Eighteen cases were classified differently depending on the criteria used. The cut-off point of hemoglobin deficit ≥5 g/dL was the best criterion to discriminate fetuses with poor perinatal outcome in our study. Conclusions. Relevant discordances in classification of severe fetal anemia were pointed out. Some criteria may underestimate the real gravity of fetal anemia. Zilma Silveira Nogueira Reis, Gabriel Costa Osanan, Tiago Lanfernini Ricardo Coelho, Cezar Alencar De Lima Rezende, Henrique Vitor Leite, and Antônio Carlos Vieira Cabral Copyright © 2013 Zilma Silveira Nogueira Reis et al. All rights reserved. Chelation Therapy with Oral Solution of Deferiprone in Transfusional Iron-Overloaded Children with Hemoglobinopathies Mon, 04 Nov 2013 16:19:56 +0000 Iron overload in hemoglobinopathies is secondary to blood transfusions, chronic hemolysis, and increased iron absorption and leads to tissue injury requiring the early use of chelating agents. The available agents are parenteral deferoxamine and oral deferiprone and deferasirox. There are limited data on the safety and efficacy of deferiprone at a very young age. The aim of our study was the presentation of data regarding the use of oral solution of deferiprone in 9 children (mean age 6.5, range 2–10) with transfusion dependent hemoglobinopathies (6 beta thalassemia major, 1 thalassemia intermedia, and 2 sickle cell beta thalassemia). The mean duration of treatment was 21.5 months (range 15–31). All children received the oral solution without any problems of compliance. Adverse reactions were temporary abdominal discomfort and diarrhea (1 child), mild neutropenia (1 child) that resolved with no need of discontinuation of treatment, and transient arthralgia (1 child) that resolved spontaneously. The mean ferritin levels were significantly reduced at the end of 12 months (initial 2440 versus final 1420 μg/L, ). This small study shows that oral solution of deferiprone was well tolerated by young children and its use was not associated with major safety concerns. Furthermore, it was effective in decreasing serum ferritin. Alexandros Makis, Nikolaos Chaliasos, Sapfo Alfantaki, Paraskevi Karagouni, and Antigone Siamopoulou Copyright © 2013 Alexandros Makis et al. All rights reserved. Serum Iron Status of Under-Five Children with Sickle Cell Anaemia in Lagos, Nigeria Thu, 31 Oct 2013 08:49:32 +0000 Background. Iron status in patients with sickle cell anaemia is a matter of continuing investigation. Objective. This paper aims to determine the serum iron status of under-five, sickle cell anaemia patients. Methods. The study spanned from December 2009 to February 2010 at the Consultant Outpatient Clinics involving 97 HbSS subjects and 97 age- and sex-matched HbAA controls. Biochemical iron status was assayed in subjects and controls. Results. Age range of the children was seven months to five years, with a mean of 30.6 (±15.97) months. Irrespective of gender, mean serum iron values were higher in HbAA controls than their HbSS counterparts but the observed difference was not significant ( and 0.111, resp.). The mean total iron binding capacity values of males and females were also not significantly different for sickle cell anaemia subjects and controls (). Males and females with HbAA had significantly lower serum ferritin when compared with their HbSS counterparts. Irrespective of gender, mean transferrin saturation was lower in HbSS subjects but the difference was not statistically significant (). Conclusion. Children with sickle cell anaemia have higher serum ferritin than controls, implying relatively higher iron content in the reticuloendothelial cells. S. O. Akodu, I. N. Diaku-Akinwumi, O. A. Kehinde, and O. F. Njokanma Copyright © 2013 S. O. Akodu et al. All rights reserved. Multivariable Discriminant Analysis for the Differential Diagnosis of Microcytic Anemia Wed, 04 Sep 2013 15:20:56 +0000 Introduction. Iron deficiency anemia and thalassemia are the most common causes of microcytic anemia. Powerful statistical computer programming enables sensitive discriminant analyses to aid in the diagnosis. We aimed at investigating the performance of the multiple discriminant analysis (MDA) to the differential diagnosis of microcytic anemia. Methods. The training group was composed of 200 β-thalassemia carriers, 65 α-thalassemia carriers, 170 iron deficiency anemia (IDA), and 45 mixed cases of thalassemia and acute phase response or iron deficiency. A set of potential predictor parameters that could detect differences among groups were selected: Red Blood Cells (RBC), hemoglobin (Hb), mean cell volume (MCV), mean cell hemoglobin (MCH), and RBC distribution width (RDW). The functions obtained with MDA analysis were applied to a set of 628 consecutive patients with microcytic anemia. Results. For classifying patients into two groups (genetic anemia and acquired anemia), only one function was needed; 87.9% β-thalassemia carriers, and 83.3% α-thalassemia carriers, and 72.1% in the mixed group were correctly classified. Conclusion. Linear discriminant functions based on hemogram data can aid in differentiating between IDA and thalassemia, so samples can be efficiently selected for further analysis to confirm the presence of genetic anemia. Eloísa Urrechaga, Urko Aguirre, and Silvia Izquierdo Copyright © 2013 Eloísa Urrechaga et al. All rights reserved. Direct Comparison of the Safety and Efficacy of Ferric Carboxymaltose versus Iron Dextran in Patients with Iron Deficiency Anemia Thu, 29 Aug 2013 14:09:52 +0000 Several intravenous iron complexes are available for the treatment of iron deficiency anemia (IDA). Iron dextran (DEX) is associated with an elevated risk of potentially serious anaphylactic reactions, whereas others must be administered in several small infusions to avoid labile iron reactions. Ferric carboxymaltose (FCM) is a nondextran intravenous iron which can be administered in high single doses. A randomized, open label, and multicenter comparison of FCM to DEX in adults with IDA and baseline hemoglobin of ≤11.0 g/dL was conducted. A total of 160 patients were in the safety population (FCM ; DEX ). Adverse events, including immune system disorders (0% in FCM versus 10.3% in DEX, ) and skin disorders (7.3% in FCM versus 24.4% in DEX, ), were less frequently observed in the FCM group. A greater portion of patients in the FCM group experienced a transient, asymptomatic decrease in phosphate compared to patients in the DEX group (8.5% in FCM versus 0% in DEX, ). In the FCM arm, the change in hemoglobin from baseline to the highest observed level was 2.8 g/dL, whereas the DEX arm displayed a change of 2.4 g/dL (). Treatment of IDA with FCM resulted in fewer hypersensitivity-related reactions than DEX. Iftikhar Hussain, Jessica Bhoyroo, Angelia Butcher, Todd A. Koch, Andy He, and David B. Bregman Copyright © 2013 Iftikhar Hussain et al. All rights reserved. Rapid Assessment for Coexistence of Vitamin B12 and Iron Deficiency Anemia among Adolescent Males and Females in Northern Himalayan State of India Mon, 22 Jul 2013 13:31:42 +0000 Coexistence of folic acid and vitamin B12 deficiency has been observed among adolescents with iron deficiency anemia, but limited evidence is available from India. So, a rapid assessment was done to study the prevalence of iron, folic acid, and vitamin B12 deficiency among adolescent males and females in northern Himalayan state in India. Methods. Total 885 (female: 60.9%) adolescents (11 to 19 completed years) were surveyed from 30-cluster village from two community development blocks of Himachal Pradesh. Serum ferritin, folic acid, and vitamin B12 were estimated among randomly selected 100 male and 100 female adolescents. Results. Under-nutrition (BMI < 18.5 kg/m2) was observed among 68.9% of adolescents (male: 67.1%; female: 70.7; ). Anemia was observed to be prevalent among 87.2% males and 96.7% females (). Mild form of anemia was observed to be the most common (53.9%) form followed by moderate (29.7%) anemia. Strikingly, it was found that all the adolescents were deficient in vitamin B12 and none of the adolescents was observed to be deficient in folic acid. Conclusion. Among both male and female adolescents anemia with vitamin B12 deficiency was observed to be a significant public health problem. Folic acid deficiency was not observed as a problem among surveyed adolescents. Ashok Bhardwaj, Dinesh Kumar, Sunil Kumar Raina, Pardeep Bansal, Satya Bhushan, and Vishav Chander Copyright © 2013 Ashok Bhardwaj et al. All rights reserved. Preoperative Hematocrit Concentration and the Risk of Stroke in Patients Undergoing Isolated Coronary-Artery Bypass Grafting Tue, 30 Apr 2013 15:29:14 +0000 Background. Identification and management of risk factors for stroke following isolated coronary artery bypass grafting (CABG) could potentially lower the risk of such serious morbidity. Methods. We retrieved data for 30-day stroke incidence and perioperative variables for patients undergoing isolated CABG and used multivariate logistic regression to assess the adjusted effect of preoperative hematocrit concentration on stroke incidence. Results. In 2,313 patients (mean age 65.9 years, 73.6% men), 43 (1.9%, 95% CI: 1.4–2.5) developed stroke within 30 days following CABG (74.4% within 6 days). After adjustment for a priori defined potential confounders, each 1% drop in preoperative hematocrit concentration was associated with 1.07 (95% CI: 1.01–1.13) increased odds for stroke (men, OR: 1.08, 95% CI: 1.01–1.16; women, OR: 1.02, 95% CI: 0.91–1.16). The predicted probability of stroke for descending preoperative hematocrit concentration exceeded 2% for values <37% (<37% for men (adjusted OR: 2.39, 95% CI: 1.08–5.26) and <38% for women (adjusted OR: 2.52, 95% CI: 0.53–11.98), with a steeper probability increase noted in men). The association between lower preoperative hematocrit concentration and stroke was evident irrespective of intraoperative transfusion use. Conclusion. Screening and management of patients with low preoperative hematocrit concentration may alter postoperative stroke risk in patients undergoing isolated CABG. Khaled M. Musallam, Faek R. Jamali, Frits R. Rosendaal, Toby Richards, Donat R. Spahn, Kaivan Khavandi, Iskandar Barakat, Benjamin Demoss, Luca A. Lotta, Flora Peyvandi, and Pier M. Sfeir Copyright © 2013 Khaled M. Musallam et al. All rights reserved.