Normocytic Anemia in Pregnant Women: A Scoping Review.

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.

Gestational diabetes complicated with preterm birth: a retrospective cohort study.

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.

Dataset of human skin and fingernails images for non-invasive haemoglobin level assessment.

Anaemia, a decrease in total concentration of haemoglobin (Hb) in blood, affects substantial percentage of the population worldwide. Currently, the gold standard for determining the Hb level is the invasive analysis of venous blood. Yet, more and more research groups demonstrate the possibility of non-invasive Hb assessment using white light imaging of tissue sites where Hb is the main chromophore, in particular, fingernails. Despite the promising declarations, non-invasive Hb assessment via RGB-imaging is still poorly used in practice. The main reason is the difficulty in establishing the true accuracy of the methods presented in different works since they are tested on private datasets collected under different experimental conditions. Here we present an open dataset containing RGB images of skin and fingernails for patients with a known level of Hb, thus providing a single benchmark for researchers and engineers in the field, aimed at fostering translation of non-invasive imaging methods to the bedside.

Cardiac Diagnoses in Obstetric Patients: An Observational Trimester-Based Analysis from Patients Undergoing Cardiology Consultations.

OBJECTIVE: The aim of this study is to evaluate the frequency of cardiac complaints and diagnosed cardiovascular diseases across trimesters in pregnant women referred for cardiology consultations. METHODS: This retrospective observational study was conducted at a second-level state hospital. Pregnant women referred to the cardiology clinic between September 2020 and March 2022 were included. Data collected included demographic information, clinical presentations, trimester of pregnancy, blood pressure, heart rate, anemia status, electrocardiography (ECG), and echocardiographic findings. Cardiac diagnoses were based on clinical evaluation, ECG, and echocardiographic findings. RESULTS: A total of 658 pregnant women were included, with a mean age of 28.18 (± 4.28) years. Most consultations occurred in the third trimester (49.1%). Primary reasons for consultation were palpitations (48%), chest pain (21.3%), leg edema (13.1%), and high blood pressure (11.6%). Anemia was present in 28.7% of the women, and 20.2% had hypertension (HT). Significant differences across trimesters included higher rates of chest pain and presyncope/syncope in the first trimester, and higher rates of palpitations and anemia in the second and third trimesters. The most common cardiac diagnoses were arrhythmias (16.6%), high blood pressure (15.2%), and mitral regurgitation (MR) (12.5%). Hypertension was most frequently diagnosed in the second trimester (P = 0.04). Infective endocarditis, myocarditis, and pericarditis were more common in the third trimester. CONCLUSION: Cardiac consultations are most frequent in the third trimester, with palpitations, chest pain, and high blood pressure being the most common complaints. Hypertension and MR are the most common cardiac diagnoses. Early and ongoing cardiologic assessment during pregnancy is crucial for managing cardiovascular risks.

Trends and predictors of severe and moderate anaemia among children aged 6-59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data.

BACKGROUND: Childhood anaemia remains a significant public health problem in India, as it adversely affects child development and overall health outcomes. This study aimed to analyse the prevalence of severe and moderate anaemia among children aged 6-59 months and identify consistent predictors of this condition over the past 15 years. METHODS: Data from the three most recent rounds of the NFHS were used for this analysis. The final weighted sample included 40,331 children from the NFHS-3 (2005-2006), 200,093 from the NFHS-4 (2015-2016), and 178,909 from the NFHS-5 (2019-2021). Descriptive and bivariate analyses were conducted, followed by binary logistic regression to identify factors associated with severe and moderate anaemia in children aged 6-59 months. All statistical analyses were performed using Stata version 14. RESULTS: Over the past 15 years, the prevalence of severe and moderate anaemia among children in India has shown a slight decline. However, the influence of various predictors has changed over time. Young children (aged 6-23 months), those from Scheduled Caste (SC) and Scheduled Tribe (ST) communities, and children born to mothers with high parity and low educational attainment remain particularly vulnerable to anaemia. Additionally, short-term illness significantly increases the risk of anaemia. Furthermore, women's autonomy, indicated by higher education and lower fertility rates, along with maternal nutrition education, have emerged as key factors in reducing anaemia burden in the future. Notably, children whose mothers had no education were 1.4 times more likely to suffer from severe or moderate anaemia. Similarly, children born to mothers with four to five children (OR 1.1, p < 0.05) and those with six or more children (OR 1.2, p < 0.05) had an elevated risk of anaemia. CONCLUSION: The findings highlight three key areas for programmatic focus to accelerate anaemia reduction in India: [1] targeting young children (aged 6-23 months); [2] ensuring the inclusion of SC and ST communities in all relevant interventions; and [3] promoting women's autonomy. These strategies are essential for reducing the burden of anaemia across the country.

The Impact of Anemia on Long-Term Mortality in Hospitalized Patients with Exacerbation of Chronic Obstructive Pulmonary Disease.

Purpose: Anemia is a risk factor for mortality within the general population and is notably prevalent among individuals with chronic obstructive pulmonary disease (COPD). Our objective was to investigate the impact of anemia on the long-term mortality risk of hospitalized COPD patients. Additionally, we aimed to identify the cause of mortality to assess whether it was different in relation to the presence of anemia. Patients and Methods: This was an observational retrospective analysis of prospectively collected data of consecutive patients admitted because of COPD exacerbation. Clinical characteristics, the presence of anemia, months of survival and cause of death if occurred, were recorded. Patients were categorized into two groups: anemic (for women hemoglobin level < 12 g/dL and for men hemoglobin level < 13 g/dL) and non-anemic. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazard regression analysis. Results: A total of 125 patients (20% women) were included in the study. Among them, 31 (25%) were identified as anemic, By the conclusion of the study, 59 patients (47%) had died: 27 out of 31 anemic patients (87%) and 32 out of 94 non-anemic patients (34%) (p<0.001). Anemia was a robust predictor of mortality one year after admission (adjusted hazard ratio HR; 5.20 [1.86-14.55]); three years after admission (HR 4.30 [2.03-9.10]), and at the study's termination (with a follow-up period ranging from a minimum of 38 months to a maximum of 56 months) (HR; 3.80 [1.96-7.38]). Mortality in the group of patients with anemia was of 27 individuals (87%) and 32 (34%) in patients without anemia (p<0.001). The causes of mortality in patients with or without anemia were similar. Conclusion: The detection of anemia upon admission for COPD exacerbation serves as a robust predictor of mortality in the subsequent years.

Prevalence of anemia and related factors among Tabari cohort population: a cross-sectional study.

BACKGROUND: Anemia presents a considerable public health challenge, standing as a leading contributor to elevated rates of mortality and morbidity. Therefore, this study aimed to investigate the prevalence of anemia and related factors among Tabari cohort population. METHODS: This study involved a cross-sectional investigation carried out during the enrollment phase of the Tabari cohort. The Tabari cohort is a subset of the larger nationwide cohort study known as the "Prospective Epidemiological Research Studies in IrAN" (PERSIAN) cohort. The collected data included general information, anthropometric measurements, medical history and blood samples. Anemia was defined as a hemoglobin level less than 13 mg/dL for men and less than 12 mg/dL for women. Data were analyzed using SPSS V.16. RESULTS: Out of the 10,073 participants included in the analysis, 1,352 individuals (13.4%) were diagnosed with anemia. In the multiple regression analysis, the odds of anemia were significantly 2.31 times in females compared to males, 3.69 times in urban residents compared to rural residents, 1.41 times in social economic categories of IV and 1.35 in social economic categories of V compared to social economic categories of I, 1.70 times in drug abuse compared to non-drug abuse, 0.71 times in body mass index (BMI) categories of 25-29.9 kg/m² and 0.70 in BMI ≥ 30 kg/m² compared to BMI < 25, 0.77 times for triglycerides(TG) > 150 compared to below 150, 0.76 times for total cholesterol(TC) > 200 compared to below 200, 0.83 times for high waist-to-hip ratio (WHR) compared to low WHR, 1.33 times in low High-density Lipoprotein (HDL) compared to high HDL, 1.18 times in diabetics (DM) compared to non-DM, and 1.37 times in individuals with coronary heart diseases (CHD) compared to healthy individuals. CONCLUSION: Anemia was a prevalent condition among Tabari cohort population. Several conditions including female gender, urban residence, Social economic level of IV and V, drug abuse, low HDL, high WHR, DM, and CHD conditions were significantly associated with increased odds of anemia. Furthermore, BMI categories of 25-29.9 kg/m² and ≥ 30 kg/m², high TC and high TG were significantly associated with decreased odds of anemia among this population.

Transfusion burden and willingness to pay for temporary alleviation of anemia status in transfusion-dependent beta-thalassemia patients in China.

BACKGROUND: Transfusion-dependent ß-thalassemia (TDT) is one of the global public health concerns highlighted by the World Health Organization. Patients with TDT require regular blood transfusion to survive. However, the availability of blood resources is extremely limited. The purpose of this study was to investigate transfusion burden and willingness to pay (WTP) for temporary remission of anemia status among patients with TDT and to explore the associated factors. METHODS: Adult patients with TDT were recruited through cluster sampling across several high-incidence provinces in China. Consenting patients completed online questionnaires on demographic information, transfusion burden and WTP with real-time WeChat communication assistance from researchers. The guiding techniques of double-bounded dichotomous choices and open-ended questions in the contingent valuation method (CVM) were used to obtain participants' WTP for 1 unit of leukocyte-depleted red blood cells. WTP calculations were performed using maximum likelihood estimation, with further insights gained through subgroup analysis based on gender, family monthly income level and convenience of blood transfusion. RESULTS: The analysis included 149 TDT patients from five high-incidence provinces, with an average monthly income of $198.5. Patients received an average of 3.7 units per transfusion, 15.4 times annually, with an average WTP of $70.4 per unit (95% CI [62.0, 78.9]). Estimated WTP for temporary anemia alleviation per transfusion totaled $260.6, exceeding monthly income by 1.32 times. Higher WTP was observed among males, higher-income households, and those with at least junior education. Lower WTP was noted among patients with lower transfusion volumes and those needing to travel for transfusion or during hospitalization for blood transfusion. CONCLUSION: High WTP indicated a strong desire for temporary anemia relief. Most TDT patients faced significant economic and transfusion burden. The evident gap in meeting clinical needed underscores the urgent demand for innovative treatments to reduce transfusion dependency, potentially transforming TDT care and improving socioeconomic well-being and clinical outcomes. These findings supported evidence-based decision-making for TDT pharmacoeconomics and efficient healthcare resource allocation in China.

Prevalence of Anemia and its associated factors among 6-59 months age children visiting public hospitals at Afar Region, Northeast Ethiopia: a hospital-based cross-sectional study.

BACKGROUND: Anemia is a significant global public health issue among children aged 6 to 59 months, particularly in low-income countries like Ethiopia. Studies focusing on pastoral communities, especially in the Afar Region, often underestimate the prevalence of anemia in these children. To address this information gap, this study aimed to determine the prevalence of anemia and its associated factors among children aged 6 to 59 months in public hospitals in the Afar Region of northeastern Ethiopia. METHOD: A hospital-based cross-sectional study was conducted among children aged 6 to 59 months, using systematic random sampling, at public hospitals in the Afar Region from February 28 to April 30, 2023.The data collection tool was adapted from the Ethiopian National Food Consumption Survey and the World Health Organization Infant and Young Child Feeding guidelines. Data entry was performed using EpiData version 4.2 and Anthroplus software for anthropometric measurements. Data analysis was conducted using SPSS version 26. Binary logistic regression models were applied to identify predictors of anemia, with a p-value of ≤ 0.05 considered statistically significant. RESULT: Among the 306 children aged 6 to 59 months, the overall prevalence of anemia was 46.41 (95 CI: 43.8-48.9 ). Of the 142 anemic children aged 6 to 59 months, 62 (43.66 ) had mild anemia, 60 (42.25 ) had moderate anemia, and 20 (14.08 ) had severe anemia. Key factors associated with anemia included mothers with no formal education, the lowest family monthly income, a family size greater than five, and rural residence. Additionally, a previous diagnosis of parasitic infection, children aged 24-35 months, early weaning, a malaria diagnosis within the past three months, and diarrhea in the last two weeks were significant predictors of anemia in children aged 6 to 59 months. CONCLUSION: In the current study, anemia in children aged 6 to 59 months was classified as severe and is regarded as a critical public health issue. This suggests that more efforts should be made to significantly decrease anemia by actively involving rural mothers with no formal education and low income who have children aged 6-59 months, focusing on the prevention and management of malaria, diarrhea, and parasitic infections.

Safe to save blood in ovarian cancer surgery - time to change transfusion habits.

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.

Red cell size factor is a sensitive index in the early diagnosis of nondigestive tract cancer-related anemia: An observational study.

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 (P > .05). Rsf has a high correlation with the RHE level (R > 0.900, P < .001), or MCV, mean corpuscular hemoglobin (MCH), and MCHC in anemia patients (r: 0.435-0.802, P < .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 (P < .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; P < .001) for the risk of anemia. The increment of Rsf quartiles was highly associated with the decreased incidence of overall anemia (P trend < 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.

Infective endocarditis in children with heart diseases at Jakaya Kikwete Cardiac Institute, Tanzania: a cross-sectional study.

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.

Prevalence of schistosomiasis and its association with anemia in Ethiopia, 2024: a systematic review and meta­analysis.

BACKGROUND: Schistosomiasis is a neglected tropical disease that affects over 250 million people, predominantly in impoverished communities, including those in Ethiopia. However, there is currently no available national data regarding its prevalence in Ethiopia or its potential association with anemia. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-2020) guideline was followed in our study. A comprehensive search strategy was conducted using international databases (PUB Med, Embase, Scopus, and Science Direct) and websites (Google Scholar and Google) from their date of inception to April 22, 2024. The quality of the retrieved studies was assessed using an adapted version of the Newcastle-Ottawa Scale. Publication bias and statistical heterogeneity were statistically assessed. A random effects model was applied, and all analysis was performed with STATA 17 statistical software. RESULT: The prevalence of schistosomiasis was assessed in twelve studies with 5747 participants. S. mansoni was studied in 11 research papers, while S. hematobium was assessed in one study. Using a random effect model due to high heterogeneity (I2 = 98.46%; P < 0.001), the overall pooled prevalence of schistosomiasis in Ethiopia was 22% (95% CI: 14.3, 29.6). The prevalence of schistosomiasis was about two and a half times higher in rural settings (23%) (95% CI: 15, 31) than in urban areas (10%) (95% CI: 3, 17). The burden of schistosomiasis was 23% between 2020 and 2024, compared to 16% from 2015-2019, with a higher prevalence among pediatric age groups (22%) versus 14% in mixed pediatric and adult age groups. The magnitude of schistosomiasis for good and very good-quality papers was 22% and 17%, respectively. In all the subgroup analyses, there was considerable statistically significant heterogeneity. No study was found to evaluate the association of schistosomiasis with anemia. CONCLUSION: The study reveals Ethiopia's higher schistosomiasis prevalence. Rural areas have a high burden of schistosomiasis. No eligible study was found to evaluate the association of schistosomiasis with anemia. Therefore, prevention and control measures should focus on rural settings. TRIAL REGISTRATION: The registration number at PROSPERO is CRD42024538522.

Steroid-responsive anemia with bony dysplasias: What lurks behind!

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.

Does tea intake increase the risk of anemia? Evidence from a large prospective cohort and Mendelian randomization study.

Tea consumption is avoided by some due to concerns about its potential to cause anemia. To clarify this impact, we assessed the association between tea intake and anemia in a Chinese prospective cohort study and by Mendelian randomization (MR). We analyzed associations of tea intake with anemia using data from the baseline (N = 30 085) and three subsequent follow-ups (the first: N = 17 898; the second: N = 10 435; the third: N = 5311) in the Guangzhou Biobank Cohort Study (GBCS). We also assessed the causal effect of tea intake on anemia, hemoglobin (Hgb) and hematocrit (Hct) using two-sample MR with summary statistics from relevant genome-wide association studies and the UK Biobank (N = 447 485). At the baseline, compared with never-drinkers, regular tea drinkers had higher levels of Hgb and Hct and a lower risk of anemia after adjustment for confounders (all P < 0.05; all P for trend ≤0.006). Prospectively, compared with never-drinkers, regular tea drinkers had higher Hgb (g L-1) (ß = 0.69; 95% CI, 0.28 to 1.10; P for trend <0.001) and Hct (%) (ß = 0.30; 95% CI, 0.19 to 0.41; P for trend <0.001), but no significant difference in anemia risk (OR = 0.91; 95% CI, 0.82 to 1.02; P for trend = 0.071). MR analyses showed no association between tea intake and anemia, Hgb and Hct. Through triangulation of evidence using a Chinese cohort and genetics, tea consumption appears unlikely to impact anemia risk.

The accuracy and precision of plain CT chest for diagnosis of anaemia.

OBJECTIVE: To determine the accuracy and precision of anaemia diagnosis with plain computed tomography of chest by keeping complete blood count as the gold standard. METHODS: The cohort study was conducted from January 1 to December 31, 2020, at Dow University of Health Sciences, Karachi, and comprised patients attending the hospital regardless of gender or age. The subjects underwent complete blood count and high-resolution computed tomography scan of chest with 7-day interval. On the basis of haematology, the subjects were divided into anaemic group A and control group B. Blood attenuation measurements and visual perception of the inter-ventricular septum was done blinded to haemoglobin values. Region of interest attenuation cursor was placed within the right ventricular chamber and left ventricular chamber. Quantitative diagnosis of anaemia on computed tomography was done with Hounsfield unit <35 in a chamber. Qualitative computed tomography diagnosis of anaemia was equivalent to inter-ventricular septum visualisation. Accuracy and precision was calculated. Data was analysed using SPSS 17. RESULTS: Of the 124 subjects, 62(50%) were males and 62(50%) were females. The overall mean age was 51.45±17.3 years (range: 8-96 years). On the basis of haematology, 74(59.6%) subjects were in group A and 50(40.3%) were in group B. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of chest computed tomography for quantitative diagnosis of anaemia were 48.6%, 76.5%, 76.5%, 50.6% and 60.5% respectively. The corresponding values for qualitative diagnosis of anaemia were 55.4%, 88.0%, 87.2%, 57.1%, and 68.5%. CONCLUSIONS: There was a high positive predictive value for quantitative diagnosis of anaemia on chest computed tomography with low diagnostic accuracy and moderate reliability.

Does Physical Exercise Ameliorate Chronic Kidney Disease-Related Complications? The Case of Anaemia and Chronic Kidney Disease-Mineral Bone Disorder.

BACKGROUND: Physical exercise (PE) can regulate inflammation, cardiovascular health, sarcopenia, anaemia, and bone health in the chronic kidney disease (CKD) population. Experimental and clinical studies both help us better understand the mechanisms that underlie the beneficial effects of the exercise, especially in renal anaemia and CKD-mineral bone disorders (CKD-MBDs). Here, we summarize this evidence, exploring the biological pathways involved, locally released substances, and crosstalk between tissues, but also the shortcomings of current knowledge. SUMMARY: Anaemia: Both in healthy and CKD subjects, PE may mimic hypoxia, inhibiting PHDs; so hydroxylate HIF-α subunits may be translocated into the nucleus, resulting in dimerization of HIF-1α and HIF-1ß, recruitment of p300 and CBP, and ultimately, binding to HREs at target genes to cause activation. However, in CKD subjects acute PE causes higher levels of lactate, leading to iron restriction by upregulating hepatic hepcidin expression, while chronic PE allows an increased lactate clearance and HIF-α and VEGFα levels, stimulating both erythropoiesis and angiogenesis. CKD-MBD: PE may improve bone health decreasing bone resorption and increasing bone formation throughout at least three main pathways: (a) increasing osteoprotegerin and decreasing RANKL system; (b) decreasing cytokine levels; and (c) stimulating production of myokines and adipokines. KEY MESSAGES: Future research needs to be defined to develop evidence-based exercise guidance to provide optimal benefit for CKD using exercise interventions as adjuvant therapy for CKD-related complications such as anaemia and CKD-MBD.

Integrated Population Pharmacokinetics of Daprodustat in Patients with Chronic Kidney Disease with Anemia.

BACKGROUND AND OBJECTIVE: Daprodustat is a first-in-class hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) approved in the USA for treatment of anemia owing to chronic kidney disease (CKD) in dialysis-dependent adults and in Japan for treatment of CKD in dialysis- and non-dialysis dependent adults. This analysis characterized the population pharmacokinetics (PopPK) of daprodustat in adults with CKD and evaluated the influence of intrinsic and extrinsic factors. METHODS: This PopPK analysis included data from one phase 2B and four phase 3 studies comprising 707 CKD subjects dose titrated to prespecified target hemoglobin levels with daprodustat doses ranging from 1 to 24 mg once daily and 2 to 48 mg given three times a week (TIW). Model development leveraged a previous phase 1/2 PopPK model. Stepwise covariate analysis included 20 extrinsic and intrinsic factors. Model evaluation used standard goodness-of-fit and visual predictive checks. RESULTS: Daprodustat PopPK was adequately characterized using a three-compartment distribution model with first-order elimination. The absorption phase was described using five transit compartments. Oral clearance and volume of distribution was 24.6 L/h and 26.9 L, respectively. Body weight dependence (with fixed allometric coefficients) of clearance and volume terms was a statistically significant covariate. Concomitant use of clopidogrel (moderate CYP2C8 inhibitor) decreased oral clearance, resulting in higher area under the plasma concentration-time curve (AUC) ratio of 1.59 (90% CI: 1.39-1.82), subjects' dialysis status (non-dialysis versus dialysis) had an effect on absorption, with Cmax ratio of 1.19 (90% CI: 1.09-1.30). None of the other investigated intrinsic or extrinsic covariates, including concomitant administration with phosphate binders, oral iron and acid reducing agents resulted in a significant change in daprodustat systemic exposure. CONCLUSION: The PopPK of daprodustat in the CKD population with anemia was adequately characterized. Allometrically-scaled body weight on clearance and volume, dialysis status on absorption and clopidogrel on clearance were statistically significant covariates.