Lesión pulmonar aguda producida por transfusión (TRALI): Reporte de caso / Transfusion-induced acute lung injury (TRALI): Case report

Introducción: La lesión pulmonar aguda (TRALI) y la sobrecarga circulatoria (TACO) son las principales causas de morbilidad y mortalidad relacionadas con la transfusión. La TRALI se presenta durante o después de las transfusiones de plasma y sus derivados, o por inmunoglobulinas en alta concentración intravenosa; se asocia a procesos sépticos, cirugías y transfusiones masivas. La TACO es la exacerbación de manifestaciones respiratorias en las primeras 6 horas postransfusión. Reporte caso: Paciente de sexo masculino de 38 días de vida, ingresó al servicio de urgencias con un cuadro clínico de 8 días de evolución, caracterizado por dificultad respiratoria dado por retracciones subcostales y aleteo nasal sin otro síntoma asociado, con antecedentes de importancia de prematuridad y bajo peso al nacer. El reporte de hemograma arrojó cifras compatibles con anemia severa, por lo que requirió transfusión de glóbulos rojos empaquetados desleucocitados. El paciente presentó un cuadro respiratorio alterado en un periodo menor a 6 horas, por lo que se descartaron causas infecciosas y finalmente se consideró cuadro compatible con TRALI. Conclusiones: Se debe considerar una lesión pulmonar aguda relacionada con una transfusión de sangre si se produce una insuficiencia respiratoria aguda durante o inmediatamente después de la infusión de hemoderivados que contienen plasma.

Introduction: Acute lung injury (TRALI) and circulatory overload (TACO) are the main causes of transfusion-related morbidity and mortality. TRALI occurs during or after transfusions of plasma or its derivatives, or by immunoglobulins in high intravenous concentration; it is associated with septic processes, surgeries, and massive transfusions. TACO is the exacerbation of respiratory manifestations in the first 6 hours post transfusion. Case report: A 38-day-old male was admitted to the emergency department with clinical symptoms experienced over the course of 8 days and characterized by respiratory distress due to subcostal retractions and nasal flaring with no other associated symptoms. Important antecedents included prematurity and low birth weight. The hemogram report showed figures compatible with anemia, which benefited from transfusion of packed red blood cells without leukocytes. In a period of less than 6 hours, the patient presented altered respiratory symptoms, practitioners ruled out infectious causes and finally considered clinical signs compatible with TRALI. Conclusion: Acute lung injury related to blood transfusion should be considered if acute respiratory failure occurs during or immediately after infusion of plasma-containing blood products.

Risk factors of mortality in hospitalized children with severe acute malnutrition

Background: Severe acute malnutrition (SAM) is a major cause of morbidity and mortality in children around the world. It is critical to identify the factors that contribute to mortality to reduce SAM related mortality. This study aimed to analyze the risk factors of mortality in hospitalized children with SAM. Methods: This case-control study was conducted in the SAM unit, department of pediatrics, institute of child and mother health, Matuail-1362, Dhaka, from January 2021 to December 2021. Data analysis was conducted using SPSS version 22. Univariate analysis was done to determine factors affecting mortality, and multivariate logistic regression was used to determine significant independent risk factors. Results: Mean age of the study subject was 6.38±3.45 months and 10.90±10.00 months in the case and control groups respectively. So, death was more common in younger children. The percentage of death was more (61.5% vs 54.6%) in males. Mortality was more common in family income <10,000 Tk/ month, 53.8% in the case group and 21.9% in the control group. The mean age of the mother was 19.23±0.60 years and 21.78±4.78 years in the death and survived group. Among risk factors of mortality, dermatosis (46.2% vs 4.9%), oral ulcer (46.2% vs 5.5%), hypoglycemia (46.2% vs 3.8%), severe anemia (38.5% vs 2.2%), septicemia (76.9% vs 29.5%) in case and control group respectively. These risk factors were significantly higher in the death group compared to the surviving group. After doing multivariate logistic regression analysis it was observed that hypoglycemia (OR=9.17 with 95% CI 1.44 to 58.29) and severe anemia (OR=13.42 with 95% CI 1.42 to 126.13) were the strongest predictors of mortality among the hospitalized children with SAM. Conclusions: Hypoglycemia and severe anemia were the main contributing factors of mortal among the children with SAM in the hospital.

Risk factors of mortality in hospitalized children with severe acute malnutrition

Background: Severe acute malnutrition (SAM) is a major cause of morbidity and mortality in children around the world. It is critical to identify the factors that contribute to mortality to reduce SAM related mortality. This study aimed to analyze the risk factors of mortality in hospitalized children with SAM. Methods: This case-control study was conducted in the SAM unit, department of pediatrics, institute of child and mother health, Matuail-1362, Dhaka, from January 2021 to December 2021. Data analysis was conducted using SPSS version 22. Univariate analysis was done to determine factors affecting mortality, and multivariate logistic regression was used to determine significant independent risk factors. Results: Mean age of the study subject was 6.38±3.45 months and 10.90±10.00 months in the case and control groups respectively. So, death was more common in younger children. The percentage of death was more (61.5% vs 54.6%) in males. Mortality was more common in family income <10,000 Tk/ month, 53.8% in the case group and 21.9% in the control group. The mean age of the mother was 19.23±0.60 years and 21.78±4.78 years in the death and survived group. Among risk factors of mortality, dermatosis (46.2% vs 4.9%), oral ulcer (46.2% vs 5.5%), hypoglycemia (46.2% vs 3.8%), severe anemia (38.5% vs 2.2%), septicemia (76.9% vs 29.5%) in case and control group respectively. These risk factors were significantly higher in the death group compared to the surviving group. After doing multivariate logistic regression analysis it was observed that hypoglycemia (OR=9.17 with 95% CI 1.44 to 58.29) and severe anemia (OR=13.42 with 95% CI 1.42 to 126.13) were the strongest predictors of mortality among the hospitalized children with SAM. Conclusions: Hypoglycemia and severe anemia were the main contributing factors of mortal among the children with SAM in the hospital.

Retrospective study on prevalence of severe anemia in pregnant women and its outcome

Background: Anemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries. Anemia during pregnancy is commonly associated with poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus. The study aimed at analyse the maternal and perinatal outcome of pregnant women with severe anemia (Hb <7 gm%) in pregnancy. Aim and objective were to study the prevalence of anemia among pregnant women and to determine its association with maternal and fetal outcomes.Methods: A hospital-based retrospective study on the prevalence of anemia among the antenatal women for 6 months duration from February 2022 to July 2022 in department of obstetrics and gynecology Cheluvamba hospital, Mysore Medical College and Research Institute, Mysore.Results: Out of 4291 deliveries during the study period 76 (1.7%) patients were severely anaemic. There were 55 (72.3%) multigravida. Maternal complications were preterm labour 15 (16.8%), pre-eclampsia and eclampsia 10(13.1%), abortions 22 (28%). Neonatal outcome was analysed in terms of prematurity (16.8%), LBW (22.4%), NICU admission (17.9%), still birth (0.03%), neonatal deaths (0.05%).Conclusions: Severe anemia during pregnancy is associated with adverse maternal and perinatal outcome. It is one of the preventable indirect causes of maternal mortality. Education to adolescents, regular antenatal check-ups, early diagnosis and treatment, prevention of too late too early too frequent too many pregnancies. Educating the women regarding safe abortion services available thus avoiding unwanted pregnancies. Promotion of good nutrition practices thus reaching optimum haemoglobin before conception. Along with these active participation of health workers at grass-root level might help in bringing down the prevalence.

Non-nutritional causes of severe anemia in Kashmiri children

Background: Anemia is one of the leading causes of mortality and morbidity in children. The etiology of anemia is multifactorial including nutritional anemia, hemolytic anemia, aplastic anemia, storage disorders, hematological malignancies, anemia secondary to some chronic diseases. Methods: The study is an observational study. Physical signs of severe anemia were looked in patients attending outpatient department or admitted in hospital. Children with hemoglobin levels <7 g/dl and in the age group 6 months to 6 years were recruited in study. The aim is to look for non-nutritional etiology of severe anemia in children in Kashmir. Results: Out of 192 children, 97 (50.52%) females and 95 (49.48%) males, with a male, female ratio of around 1:1. A total of 147 (76.56%) children in our study were having nutritional and 45 (23.44%) were having non nutritional causes. Among non-nutritional anemia 30 cases were hemolytic anemia, 11 hypoplastic anemia, 3 leukemia and 1 patient were diagnosed as Osteopetrosis. Conclusions: Though nutritional deficiency anemias are predominant; it may not always be the case. Hemolytic anemia and leukemias should be ruled out while evaluating a patient of severe anemia and pancytopenia. Bone marrow failure syndrome, storage disorders should be ruled out in patients with skeletal anomalies.

Modèle explicatif et interprétatif de l'anémie sévère (« Gbébile ¼) chez les sénoufo de Korhogo (Côte d'Ivoire) / NA

L'objectif de cette recherche était d'examiner le modèle explicatif et interprétatif de l'anémie sévère chez le peuple Sénoufo. Elle a permis de comprendre que l'anémie n'est pas seulement la souffrance physique. Elle est aussi un vécu, et comme tel, elle est socialisée et socialement pensée par la culture. Pour y parvenir, la démarche méthodologique suivie s'articule autour de la recherche documentaire et les travaux de terrain. En ce qui concerne les travaux de terrain, un échantillon de 79 personnes composé d'un médecin, de 14 tradipraticiens ou guérisseurs et de 64 parents et grands-parents d'adolescents. A partir d'une approche qualitative centrée sur des entretiens libres et l'observation directe,les résultats fondamentaux montrent quel'anémie sévère est culturellement pensée comme une transgression d'interdits alimentaires ou le meurtre du margouillatdont le nom de la maladie «Gbébile¼.Les agitations convulsives de la peau, l'amaigrissement, la pâleur palmoplantaire sont les symptômes retenus. Le parcours de soins part des centres de santé modernes aux tradipraticiens et/ou guérisseurs qui pour le traitement font usage de scarifications et de décoctions alimentaires.Pour cela,les logiques préventives des Sénoufo s'apparentent à des idéologies secrétées, par les générations précédentes, afin d'éloigner les cadettes et les adolescents de la consommation excessive des aliments indexés et autres considérations culturelles.

The aim of this research was to examine the explanatory and interpretative model of severe anemia among the Sénoufo people. It enabled us to understand that anemia is not just physical suffering. It is also a lived experience, and as such, it is socializedand socially thought through by culture. To achieve this, the methodological approach followed was based on documentary research and fieldwork. The fieldwork involved a sample of 79 people: one doctor, 14 traditional healers and 64 parents and grandparents of adolescents. Based on a qualitative approach centred on free interviews and direct observation, the fundamental results show that severe anaemia is culturally thought of as a transgression of dietary prohibitions or the killing of the lizard whose name "Gbébile" gives the disease its name. The symptoms include convulsive skin movements, weight loss and palmar-plantar pallor. The course of treatment ranges from modern health centres to traditionaltraditional practitioners and/or healers who use scarification and food decoctions for treatment. For this reason, the Senufo's preventive logics are similar to ideologies secreted by previous generations, to keep younger children and adolescents away from excessive consumption of index foods.

Leiomioma uterino gigante en adolescente mexicana de 14 años, un caso raro de sangrado uterino anormal. Reporte de caso / Giant uterine leiomyoma in a 14-year-old Mexican adolescent, a rare case of abnormal uterine bleeding. Case Report

Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.

Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.

Prevalencia y evolución de la anemia en embarazadas del Hospital Central de las Fuerzas Armadas / Prevalence and evolution of anemia in pregnant women at the Central Hospital of the Armed Forces / Prevalência e evolução da anemia em mulheres grávidas no Hospital Central das Forças Armadas

Introducción: de acuerdo a los datos de la Organización Mundial de la Salud la prevalencia de anemia ferropénica en el embarazo oscila entre el 20 y el 39% de los mismos en Latinoamérica, siendo asociada con resultados adversos para la salud. Materiales y métodos: se realizó un estudio observacional, descriptivo, de corte transversal, donde fue estudiada la frecuencia de la anemia en las embarazadas usuarias del Hospital Central de las Fuerzas Armadas, y su evolución posterior luego del embarazo. Resultados: se observó que el 15,7% de las pacientes presentaba anemia en el embarazo, con un buen porcentaje de pacientes que cumplían el tratamiento con hierro indicado, y que sólo un bajo porcentaje realizaba un control de la anemia luego del embarazo. Discusión: el porcentaje de pacientes con anemia en el embarazo en este centro asistencial se encuentra por debajo de los porcentajes establecidos en la literatura internacional, se analizan las causas y se verifica que existe una dificultad en el seguimiento de estas pacientes luego del embarazo.

Introduction: according to World Health Organization data, the prevalence of iron deficiency anemia in pregnancy ranges between 20 and 39% of pregnancies in Latin America, being associated with adverse health outcomes. Materials and Methods: an observational, descriptive, cross-sectional, descriptive study was carried out to study the frequency of anemia in pregnant women users of the Central Hospital of the Armed Forces of Montevideo, and its subsequent evolution after pregnancy. Results: it was observed that 15.7% of the patients had anemia during pregnancy, with a good percentage of patients who complied with the indicated iron treatment, and only a small number of patients underwent anemia control after pregnancy. Discussion: the percentage of patients with anemia in pregnancy in this health care center is below the percentages established in the international literature, the causes are analyzed and it is verified that there is a difficulty in the follow-up of these patients after pregnancy.

Introdução: de acordo com dados da Organização Mundial da Saúde, a prevalência de anemia por deficiência de ferro na gravidez varia entre 20 e 39% das gestações na América Latina, e está associada a resultados de saúde adversos. Materiais e Métodos: foi realizado um estudo observacional, descritivo, transversal e descritivo para estudar a freqüência da anemia em gestantes usuárias do Hospital Central das Forças Armadas, e sua posterior evolução após a gravidez. Resultados: observou-se que 15,7% das pacientes tiveram anemia durante a gravidez, com uma boa porcentagem de pacientes que cumpriram o tratamento com ferro indicado, e apenas uma baixa porcentagem teve controle da anemia após a gravidez. Discussão: a porcentagem de pacientes com anemia na gravidez em nosso centro de atendimento está abaixo das porcentagens estabelecidas na literatura internacional, analisamos as causas e verificamos que existe uma dificuldade em monitorar essas pacientes após a gravidez.

Aplasia medular congénita de serie roja: Anemia de DiamondBlackfan. A propósito de un caso / Marrow aplasia congenital red series: Diamond BlackfanAnemia. About a case

La Aplasia Medular pura de Células Rojas es un trastorno que se caracteriza por anemia con ausencia casi completa de precursores de células rojas en la médula ósea, con contaje de leucocitos y plaquetas normales. La anemia de Diamond-Blackfan es un síndrome de insuficiencia de la médula ósea caracterizada por anemia, reticulocitopenia y disminución de precursores eritroides en la médula ósea. Se presenta el caso de un lactante menor masculino de 2 meses de edad, sin antecedentes familiares ni perinatales de importancia, cuya madre evidencia palidez cutáneo mucosa progresiva asociado a hiporexia; acude a centro de salud donde realizan paraclínicos que reportan hemoglobina en 1,7g/dL. Se realiza frotis de sangre periférica donde se muestra serie eritroide francamente afectada con contaje granulocítico y megacariocítico normales; se realiza biopsia y aspirado de médula ósea concluyéndose aplasia medular de serie roja y en vista de otros hallazgos clínicos, se plantea posible anemia de Diamond-lackfan. Se indica tratamiento con glucocorticoides, sin embargo por respuesta insuficiente, se inicia eritropoyetina aumentando dosis de forma progresiva, a pesar de la administración de la misma, amerita transfusiones sanguíneas de forma regular; se realizan estudios de compatibilidad con familiares de primer grado resultando positivos, actualmente es candidato a trasplante alogénico de médula ósea. Se concluye que a pesar de corresponder a un síndrome poco frecuente, debe sospecharse ante la presencia de anemia severa, sin pérdida sanguínea aguda y descarte previo de otras etiologías, además se plantea que el inicio oportuno del tratamiento es fundamental para la supervivencia de estos pacientes(AU)

Pure red cell aplasia medullary is a disorder characterized by anemia with almost complete absence of red cell precursors in the bone marrow, with leukocyte count and platelets. e Diamond-Blackfan anemia is a failure syndrome characterized by bone marrow anemia, reticulocytopenia and decreased erythroid precursors in the bone marrow. the case of an infant under 2 months of age presented no family or perinatal history major, whose mother progressive skin pallor evidence mucosa associated with hyporexia; go to health center where they perform paraclinical reporting hemoglobin 1.7 g /dL. peripheral blood smear where erythroid frankly affected with normal megakaryocytic granulocytic count shown is made; It biopsied and bone marrow aspirate concluding marrow red cell aplasia; possible anemia Diamond-Blackfan in light of other clinical findings arises. It stays with glucocorticoid treatment, however insufficient response, begins erythropoietin dose progressively increasing, despite it, warrants blood transfusions on a regular basis; compatibility studies performed with firstdegree resulting positive, currently a candidate for allogeneic bone marrow transplantation. It is concluded that despite being a rare syndrome should be suspected in severe anemia where there is acute blood loss, ruling out other etiologies; also timely initiation of treatment is critical to the survival of these patients(AU)

Diagnosis and genetic analysis of severe neonatal anemia caused by α-Thalassemla combined with cold IgG anti-M / 中国输血杂志

【Objective】 To investigate the family inheritance of α-Thalassemla gene and the risk of severe anemia in neonates caused by cold IgG anti-M. 【Methods】 ABO, Rh, MN blood groups and the specificity of unexpected antibody were identified by blood group serology. The IgG subtype and antibody titer of anti-M antibody were detected. The etiology of neonatal hemolytic disease was identified by three tests and α-Thalassemla gene diagnosis. 【Results】 Family investigation showed that father was B, CCDee, MN with no α-Thalassemla gene detected; Mother B, CcDee, NN, carrying α-Thalassemla gene; both the proband and his brother were B, CCDee, MN, carrying α-Thalassemla gene. Cold IgG anti-M was present in plasma of both the mother and the proband. The titer of the mother was 128 and that of the proband was 64. The subtype of IgG anti-M was IgG1 and IgG3. The direct anti-globulin test, release test and free test of the proband and his brother were negative, and the diagnosis was severe anemia and hemolysis caused by α-Thalassemla combined with cold IgG anti-M. 【Conclusion】 The direct antiglobulin test of neonatal hemolytic disease caused by IgG anti-M can be negative or weakly positive, and α-Thalassemla gene could be hereditary in families. The presence of α-Thalassemla gene can cause anemia, hemolysis and splenomegalysis in neonates, which could be aggravated when accompanied by cold-type IgG anti-M. In the presence of high-valency IgG antibody in plasma, blood exchange combined with transfusion can improve the curative effect.

Haematological profile and its outcome in different species of malaria: a two year study

Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh, which is also one of the endemic areas for malaria. Several factors have been attributed to increased morbidity and mortality in malaria especially with altered hematological and coagulation parameters playing an important role. The aim of present study was to study the hematological and coagulation abnormalities that correspond to severity and the final outcome.Methods: The present study was carried out on 100 patients admitted during the period of November 2016 to October 2018 at Narayana Medical College and hospital, Nellore. All of these patients were confirmed by Peripheral Smear or MPQBC or Antigen Assay followed by detailed clinical history, physical examination and investigated with hematological and coagulation parameters. Then subsequently required routine and special investigation which was followed by monitoring the outcome of the patients with respect to morbidity and mortality.Results: Out of 100 patients 20 patients had severe anemia (Hb% <7 gm%) and most of them patients were falciparum and mixed infection cases. Thrombocytopenia was observed in 63% of the patients and severe thrombocytopenia (<50,000 mm3) was seen in 12% of the patients. PT and APTT were increased in 18% and 13% of the cases respectively. BT was increased in 5% of the cases. None of the patients expired in this study.Conclusions: severe anemia is a poor prognostic factor and has adverse outcome. Thrombocytopenia, increased PT, APTT does not have any correlation to mortality.

Comportamiento clínico y epidemiológico de malaria en pediatría. IVSS Hospital Uyapar. Puerto Ordaz, Estado Bolívar

Introducción: Malaria constituye un problema de salud pública mundial, representa millones de muertes al año en América Latina y Venezuela. Objetivo: Determinar el comportamiento clínico y laboratorio de malaria. Metodología: Estudio de tipo descriptivo y retrospectivo. La muestra la conformaron pacientes pediátricos, de ambos sexos, hospitalizados en el Hospital Uyapar, Puerto Ordaz Estado Bolívar. Resultados: De 856 historias clínicas archivadas en el Departamento de Registro y Estadística, 150 fueron malaria por P. falciparum, promedio de 15 casos por año (±6,96, rango 9 a 29 casos). El año con mayor numero fue 2009, con 19,3 % (n=29), grupo de edad predominante: 30 a 35 años 30 % (n=45) casos, 77,34 % (n=116) del género masculino, 89,3 % (n=134) procedían del estado Bolívar, el tratamiento antimalárico fue quinina, 16,83 % (n=51) casos. 28,05 % (n=85) artesunato y 25,75 % (n=78) mefloquina, la estancia hospitalaria predominante fue 6 a 10 días 55,3 % (n=83), las complicaciones frecuentes: deshidratación 94,7 % (n=142), trombocitopenia 85,3 % (n=128); con el tratamiento de artesunato/mefloquina fue mejor la resolución clínica precoz 85,88 % (n=73), y quinina 31,37 % (n=16). El laboratorio de ingreso: hemoglobina 8,7 g/dl (±2,23), hematocrito 30,81 % (±6,94). leucocitos 5 430,28 células/mm3 (±3 870,15), plaquetas 110 631,74/mm3 (±94341,41), índice de parasitemia en 74 pacientes entre 0,00 a 3,00. Conclusiones: 134 casos (89,3 %) eran del estado Bolívar, los síntomas y signos: fiebre, escalofríos, cefalea y palidez, complicaciones frecuentes: trombocitopenia grave, deshidratación, hipertransaminasemia y anemia grave, el mejor tratamiento fue Artesunato/mefloquina.

Introduction: Malaria is a global public health problem, representing millions of deaths per year in Latin America and Venezuela. Objective: To determine the clinical and laboratory behavior of malaria. Methodology: Descriptive and retrospective study. The sample consisted of pediatric patients, of both sexes, hospitalized in the Uyapar Hospital, Puerto Ordaz state Bolivar. Results: 856 medical records filed in the Registry and Statistics Department, 150 cases of malaria were diagnosed by P. falciparum, average of 15 cases per year (±6,96, range 9-29 cases). The year where more cases was 2009, with 19.30 % (n = 29), the most frequent age group was 30 to 35 years, 30.00 % (n = 45) cases. 77.34 % (n = 116) were male gender, the state of origin 89.30 % (n = 134) from Bolivar state. The treatment received, a total of 28.05 % (n = 85) artesunate and 25.75 % (n = 78) received mefloquine, the most frequent long of stay was 6 to 10 days 55,30 % (n = 83), the most frequent complications were: dehydration 94.70.% (n = 142), thrombocytopenia 85,30 % (n = 128), among others, the relationship between the treatment of artesunate / mefloquine was better in early clinical resolution of 85.88 % of patients (n = 73) compared with quinine 31.37 % (n = 16). Laboratory parameters averages to income level hematology patients admitted values of 8.70 g / dl of hemoglobin (±2,23). Hematocrit was 30.81 % (±6,94). Leukocytes was 5,430.28 cells / mm3 (±3 870,15). A level of platelets, were 110,631.74 / mm3 (±94341,41). Parasitemia index was obtained in 74 patients, and values ranged from 0.00 to 3.00. Conclusions: The most common source was Bolivar state, the common signs and symptoms were fever, chills, headache, pallor, the most frequent complications were severe thrombocytopenia, hypertransaminasemia, dehydration, and severe anemia, the treatment with better results Artesunate/ Mefloquine.

Pregnant women with severe anemia reporting in labor: prevalence, socio-demographic and obstetric determinants

Background: Severely anemic women reporting in labor remains one of the most important challenging situation for the obstetrician as well as for the mother and her family due to its adverse feto-maternal outcome. Various socio-demographic and obstetric conditions need to be explored which are important to tackle them, for primary prevention of anemia. The aim and objectives of the study were to estimate prevalence of severe anemia in pregnant women reporting in labor in a tertiary hospital of Delhi and to evaluate various socio-economic and associated obstetric factors associated.Methods: This is a hospital based, prospective, case contol study. Hemoglobin was estimated at the time of labor room admission. Fifty consecutive antenatal women with severe anemia (Group A) and 50 non-anemic women (Group B) were enrolled in early labor. Socio-demographic and obstetric factors, were recorded and analyzed.Results: Prevalence of severe anemia was estimated to be 2.23%. Determinants of severe anemia were found to be socio-economic status (p value 0.001), education (p value 0.001), rural living (p value 0.016), calorie intake (p value 0.001), BMI (p value 0.046), booking status of pregnancy (p value 0.001), gravida (p value 0.024), inter-conception interval (p value 0.002) and regular iron-folic acid intake (p value 0.001).Conclusions: Primary prevention of anemia by targeting these factors at the community/state/ national level, by the policy makers is important. Early booking and screening for anemia in antenatal clinics, providing iron supplements to anemic women for secondary prevention of severe anemia is recommended so that no woman reports with severe anemia in labor.

A hospital-based study of severe anemia in adults in Eastern India

Background: Anemia remains a crucial health problem in developing countries. Cardiac compromise and fatal complications usually occur at Hb of <5g/dL. The aim of the study was to determine possible etiologic and clinical profile in adult patients with very severe anemia (Hb of <5g/dL).Methods: A prospective observational study was conducted in a teaching hospital of Odisha over a period of 12months. A total of 70 patients of both men and non-pregnant women admitted to the medicine wards were included after exclusion. Detailed history, clinical examination and investigation findings were recorded. Independent ‘t’ test, Wilcoxon rank sum test, Pearson chi-square test and Fisher exact test were used as applicable, to compare the variables.Results: The mean Hb (g/dL) was 3.73 ±0.85 and the mean age of the study group was 53.34±17.75years. No significant difference was observed in the severity of anemia between the female (mean Hb of 3.56±0.93) and male patients (mean Hb of 3.87±0.77) (p=0.130). The most frequent etiology found was absolute iron deficiency (44.3%, n=31) and mostly (41.9%) found in the age group of ≥65years (p<0.001). Congestive cardiac failure was found in 20% (n=14) of patients and majority of patients (64.2%, n=9) were males (p<0.001).Conclusions: Iron deficiency is the principal cause of very severe anemia in adults rather than malignancy or anemia of chronic disease and only about one fourth of patients develop heart failure even with very severe anemia.

Severe anemia, malnutrition, hypotonia and aggravation of the conscious disturbance, methyl malonic acidemia or propionic acidemia? / 中华实用儿科临床杂志

The patient was a 21 days-old baby girl,admitted to Guangdong Women and Children Hospital because of "poor intake,seldom crying and no activity in 1 day".The major clinical manifestations included hypotonia,aggravation of the conscious disturbance,pancytopenia,intractable acidosis and hyperammonemia,so,inherited metabolic disorders should be considered.Screening of inherited metabolic diseases with blood and urine samples,genetic test and active treatments were carried out.After targeted next-generation sequencing,a novel homozygotic frame shift mutation in PCCB gene:c.838_839insC (L280Pfs * 11) was identified,which was validated by Sanger sequencing.This mutation had not been reported in the mutation database,and bioinformatic analysis of this mutation indicated disease-causing.So,the diagnosis of propionic acidemia was identified.The baby was in a critical condition,and despite active treatment,her conscious disturbance was aggravated,and the spontaneous breathing disappeared.Subsequently,the baby died of pneumonia.Propionic acidemia is a relatively common genetic metabolic disease in newborns.The severity and the clinical phenotypes of propionic acidemia varied,which often made the diagnosis difficult.When the baby is presented with developmental delay,hypotonia,recurrent convulsion and vomiting,etc,which can't be explained by common diseases of children,propionic acidemia may be considered.Next generation sequencing analysis of the complicated cases can easily to pinpoint a disease-causing gene,which lays a solid foundation for accurate diagnosis and treatment of the patients.

Study on reducing red blood cell transfusion mechanism of Traditional Chinese Medicine / 中国医学装备

Objective:To explore the Chinese medicine to reduce red blood cell transfusion mechanism, anemia treatment and provide a theoretical basis for patients with severe hypoxic ischemic symptoms.Methods: in our hospital from 2012 May to 2013 May in our hospital were severe anemia in 96 cases, according to the order of admission, were randomly divided into study group(48 cases) and control group(48 cases), study group was treated with Chinese medicine Yiqi Buxue cream treatment, the control group using sugar iron injection treatment, treatment effects were compared between the two groups.Results: the treatment group the total effective rate was 97.9% in treatment group, the total effective rate was 87.5%, and there was significant difference between two groups(P<0.05). Study group Hb after treatment was (106.43±13.08) g/L, the control group after treatment Hb(98.69±14.25)g/L, there was significant difference between two groups(t=13.26,P<0.05). After treatment, study group MCV, MCH, MCHC improvement, compared with the control group with statistical significance; the two groups in the improvement of red blood cell morphology were obvious effect, and the study group was better than control group. Statistical significance of group SF after treatment and the control group at the same time difference(t=11.28,P<0.05). The control group had 10 cases of gastrointestinal discomfort, study group 1 cases of no adverse reaction.Conclusion: TCM symptoms of Chinese medicine Yiqi Buxue cream treatment can significantly improve the syndrome of blood deficiency of iron deficiency anemia, reduce the number and the number of red blood cell transfusion, clinical curative effect, less adverse reaction.

Ulcerative colitis in 17 yr old girl masquerading as severe anemia: A case report.

Ulcerative colitis is a chronic inflammatory disease of unknown etiology. It is localized to the colon and spares the upper gastrointestinal tract. Ulcerative colitis can occur at any age, the peak incidence is among the age group 15-25 years and in 55-65 years. The first pediatric case was reported by Helmholz. The purpose of reporting this case of 17 year old girl with ulcerative colitis who presented with severe anemia is, to not only create awareness of ulcerative colitis among pediatric age group but also to discuss the challenges facing the diagnosis and management of the disease in a developing country like India.

Association of ABO groups in malaria infection of variable severity.

Background & objectives: Literature reports several studies on ABO groups and malaria but a study with an adequate sample size and controls is not available. ABO groups are genetically controlled, hence, large sample size and comparison with population frequency is essential. To determine whether malaria infection with variable severity has correlation with ABO groups. Study design & Methods: Blood samples of non-transfused malaria cases were obtained from pathology laboratories and transfused malaria patients’ from Blood Bank. The malaria parasites were identified by examination of thick and thin smears. Control (normal population) included 11,303 students. Results: The ABO group frequency of normal population was ‘O’ 32.3%, ‘A’ 22.2%, ‘B’ 36.7% and ‘AB’ 8.8%. The overall ABO group distribution in 8028 malaria cases was ‘O’ 30%, ‘A’ 24.6%, ‘B’ 35.5% and ‘AB’ 8.9%. ‘A’ group incidence was significantly higher than normal (‘A’ vs non-‘A’ 2 = 15, df=1, p <0.001). ABO group frequencies were comparable within Plasmodium falciparum and P. vivax malaria. There was no significant difference in ABO group distribution in malaria patients having severe anemia or among transfused and nontransfused malaria cases. About 32% of P. falciparum cerebral malaria cases and 36% DIC cases were of ‘A’ group. Compared to 22.2% ‘A’ group in the population, malaria cases showed preponderance of ‘A’ group. Because of the small numbers statistical evaluation was not done. Conclusion: ‘A’ blood group is more susceptible to have malaria infection and risk of cerebral malaria and DIC in malaria is also more in ‘A’ group individuals.

Anemia severa en pacientes adultos hospitalizados VIH seropositivos en el Jackson Memorial Hospital de la ciudad de Miami / Severe anemia in hospitalized HIV positive adults in the Jackson Memorial Hospital of Miami City

Introducción: anemia es una complicación común y seria de la infección por el VIH y de su tratamiento. Anemia severa es una condición potencialmente fatal, sus causas en estos pacientes son múltiples, pero su frecuencia no es conocida. Objetivo: evaluar la frecuencia de las causas de anemia severa en pacientes infectados por el VIH al momento de su admisión al Hospital Jackson Memorial (JMH) en Miami, U.S. Materiales y métodos: se revisó las historias clínicas de los pacientes con anemia severa (definida aquí como hematocrito menor de 20%) infectados por el VIH admitidos al JMH durante un año (5/96 - 5/97). Resultados: Se encontraron 53 pacientes, (27 hombres y 26 mujeres). El promedio de CD4 fué de 47 células/mm3, y 67% de los pacientes tuvieron un CD4 de menos de 50 células/mm3. Sesenta y cuatro por ciento de los pacientes recibían terapia antiretroviral, que incluyó AZT (94%) e inhibidores de proteasa (29%).El hematocrito promedio al momento de admisión fue de 16%, y el número promedio de unidades de sangre transfundidas fue de 4. La causa más común de anemia severa en pacientes con CD4 < 50 células/mm3 se debió a infecciones oportunistas, y con CD4 50 células/mm3 a toxicidad de medicamentos. Conclusión: Las causas de anemia severa en pacientes infectados por el VIH son múltiples y varían según el CD4. A medida que baja el CD4 la anemia de enfermedad crónica es menos frecuente y las enfermedades infecciosas oportunistas son más frecuentes.

Introduction: anemia is a common and serious complication of both HIV infection and its treatment. Severe anemia is a life-threatening condition and its causes in these patients are multiple but their frequency is unknown. Objective: of the study was to evaluate the causes of severe anemia in HIV infected adults at the time of admission to Jackson Memorial Hospital (JMH) in Miami. Materials and Methods: we reviewed the cases of severe anemia (hematocrit < 20% on admission) in HIV seropositive adults admitted to JMH between 5/96 to 5/97. Results: there were 53 patients, (27 men, 26 women). The mean CD4 cell count was 47cells/mm3 and 67% of the patients had a CD4 cell count less than 50 cells/mm3. Sixty-four percent of the patients were on antiretroviral therapy, including AZT (94%) and protease inhibitors (29%). The mean hematocrit on admission was 16% and the mean number of units of blood transfused was 4. The most common cause of severe anemia in patients with a CD4 < 50 cells/mm3 was opportunistic infections and with CD 50 cells/mm3 was medication toxicity. Conclusion: causes of severe anemia in HIV positive patients are multiple and varies with the level of CD4. With a lower CD4 anemia of chronic disease becomes less frequent and opportunistic infections are more common.