Prediction of anemia at delivery.

We aimed to assess risk factors for anemia at delivery by conducting a secondary analysis of a prospective cohort study database including 1527 women who delivered vaginally ≥ 36 gestational weeks. Anemia (Hemoglobin (Hb) < 10.5 g/dL) was assessed at delivery. A complete blood count results during pregnancy as well as maternal and obstetrical characteristics were collected. The primary endpoint was to determine the Hb cutoff between 24 and 30 gestational weeks that is predictive of anemia at delivery by using the area under the curve (AUC) of the receiver operating characteristic curve. Independent risk factors for anemia at delivery were assessed using stepwise multivariable logistic regression. Hb and infrequent iron supplement treatment were independent risk factors for anemia at delivery (OR 0.3 95%CI [0.2-0.4] and OR 2.4 95%CI [1.2-4.8], respectively; C statistics 83%). Hb 10.6 g/dL was an accurate cutoff to predict anemia at delivery (AUC 80% 95%CI 75-84%; sensitivity 75% and specificity 74%). Iron supplement was beneficial to prevent anemia regardless of Hb value. Altogether, Hb should be routinely tested between 24 and 30 gestational weeks to screen for anemia. A flow chart for anemia screening and treatment during pregnancy is proposed in the manuscript.Trial registration: ClinicalTrials.gov Identifier: NCT02434653.

Reticulocyte Hemoglobin Content Helps Avoid Iron Overload in Hemodialysis Patients: A Retrospective Observational Study.

BACKGROUND/AIM: Anemia in patients suffering from end-stage renal failure is currently treated with Erythropoiesis-Stimulating Agents (ESA). This treatment needs sufficient iron supplementation to avoid an inadequate dosage of ESA. Nowadays modern analytical instruments allow to accurately calculate the content of Hemoglobin (Hb) in reticulocytes (CHr), that can be used as a guide for prescribing patients with the appropriate amount of iron. PATIENTS AND METHODS: Patients, undergoing hemodialysis, were retrospectively selected from the database and were divided in two groups: group A received intravenous (IV) iron and subcutaneously ESA, and their dosages were adjusted on the basis of the following parameters: Hb, Mean corpuscular haemoglobin (MCH), CHr with consequent MCH/CHr ratio and reticulocyte count determined by the ADVIA 120 Hematology System of Siemens; group B patients were administered IV iron and ESA monitoring iron storage, Hb and ferritin. The aforementioned parameters and the administered amount of iron and ESA were monitored at baseline, four and eight months from the begining of the study. RESULTS: For ESA supplementation, no difference was observed between the groups at the various observed times. Despite similar Hb levels, the patients of group A needed significant lower doses of IV iron (-57.8%) avoiding risks of organ toxicity and obtaining consequent cost saving of nearly 1 €/patient/month. CONCLUSION: The use of CHr and its related parameters allows the avoidance of overdosage of IV iron, which can potentially damage organs, and the reduction of health care direct and indirect costs.

Ceramic membranes for separation of proteins and DNA through in situ growth of alumina nanofibres inside porous substrates.

Ceramic membranes were fabricated by in situ synthesis of alumina nanofibres in the pores of an alumina support as a separation layer, and exhibited a high permeation selectivity for bovine serum albumin relative to bovine hemoglobin (over 60 times) and can effectively retain DNA molecules at high fluxes.

An improved blood substitute. In vivo evaluation of its renal effects.

Nephrotoxicity of free hemoglobin (Hb) based blood substitutes still awaits full elucidation. Previous reports attributed Hb passage through the renal glomeruli to a tendency of the Hb tetramer to dissociate into dimers. Now it has become more evident that the Hb tetramer is able to extravasate. It appears that the electrical charge of proteins plays an important role, with electronegativity and a low isoelectric point favoring intravascular persistence. This effect was utilized in the development of an improved blood substitute, comprising Hb reacted with o-ATP and o-adenosine, to form an intra- and intermolecularly cross linked product, which is reduced with glutathione. The modification reagents possess the desired pharmacologic activities and produce an increase in the electronegative charges on the Hb surface. All Hb polymers and chemically modified tetramers present in this solution have a uniform electronegative charge, with a pl of 6.1-6.2. In this present study, unmodified bovine Hb and an improved blood substitute were used for the replacement of 40% of the total blood volume in rats. The nephrotoxic effect was investigated by the determination of urinary output, glomerular filtration rate (GFR), fractional excretion of sodium (FENa), potassium (FEK), and chloride (FECl), urine/plasma osmolality ratio, and urine N-acetyl-beta-D-glucosaminidase (NAG) level. The free Hb and non heme protein contents in the urine were analyzed by using isoelectric focusing and size exclusion liquid chromatography methods. The results indicate that unmodified Hb is nephrotoxic. An initially elevated urinary output was followed by a significant oliguria associated with decreased GFR, FEK, and FECl and elevated FENa and NAG. Severe hemoglobinuria was associated with proteinuria. Analysis of urine from unmodified Hb treated rats revealed the presence of Hb tetramers. Histopathological examination of the kidneys showed cytoplasmic vacuolization of proximal tubular epithelium. On the contrary, an improved blood substitute did not produce any nephrotoxic reactions. It was found that this Hb solution did not pass through the renal glomerular barrier and was not present in urine samples. In conclusion, such a chemical and pharmacological alteration of Hb molecules reduced their interaction with renal glomeruli and suspended nephrotoxicity.

[Pulsed Doppler ultrasonography to measure the vasoactive effects of hemoglobin-dextran 10-benzene-tetracarboxylate, a potential erythrocyte substitute]. / Mesure par ultrasonographie Doppler pulsé, des effets vasoactifs de l'hémoglobine-dextrane 10-benzène-tétracarboxylate, substitut èrythrocytaire potentiel.

The effects of Dextran-Benzene-Tetracarboxylate-Hemoglobin (Dex-BTC-Hb), a chemically-modified hemoglobin-based oxygen carrier, on the vascular tone were compared to those of standard solutions, i.e. the animal's own blood and a 50 milligrams albumin solution, by measuring the carotid blood flow velocity, the mean arterial pressure, the heart rate and respiratory frequency, in anesthetized Hartley guinea pigs after a hemorragic shock. Stroma-free hemoglobin induced 40% hypertension and a 110% rise in blood flow velocity immediately after injection. The velocity was still increased 38%, 3 hours after injection. The calculations of the vascular resistances showed an increase in carotid vascular tone. Dex-BTC-Hb brought about 35% hypertension for two hours with no significant modifications of the vascular tone. These effects are similar to those of the albumin solution. These results indicate that, unlike stroma-free hemoglobin, Dex-BTC-Hb does not significantly affect the vascular tone, probably because of its slight interaction with the factors that regulate vascular tone.

Preparation and characterization of diaspirin cross-linked hemoglobin solutions for preclinical studies.

During 1990 and 1991 the capability for repetitive, consecutive production of DCLHb solution to meet a rigorous and complete set of product criteria was demonstrated. In addition, through periodic monitoring of product stored under controlled conditions, the stability of all lots of DCLHb solution during frozen storage was demonstrated for more than a year. In this way, assurance was provided that the DCLHb solution used in preclinical testing met all product criteria throughout the biological testing period.

[The quality of washed autotransfused erythrocytes. The elimination of plasma hemoglobin, osmotic fragility and survival rate of retransfused erythrocytes]. / Die Qualität gewaschener autotransfundierter Erythrozyten. Untersuchungen zur Elimination von Plasmahämoglobin, osmotischen Resistenz und Uberlebensrate retransfundierter Erythrozyten.

Intraoperative transfusion has until recently been understood to mean full retransfusion of the blood removed by a suction pump without significant changes due to external influences, which considerably limited its utilization. Intraoperative transfusion can only be performed without decisive disadvantages when the blood can be suctionally removed in large amounts and immediately retransfused. In recent years, the Cell Saver has provided a system which can also prepare soiled blood for retransfusion. Extensive orthopedic surgery entails large blood losses due to oozing from expanded wound areas; only rarely does acute bleeding occur. Because of intensive tissue contact, the suctioned blood has been soiled with activated clotting factors, lytic enzymes, free haemoglobin from damaged red cells, cleaning solutions, and other undesired elements. With the Cell Saver system, it is possible to remove the plasma and recover 70-80% of the intact red cells sufficiently freed from stroma and free haemoglobin. The osmotic fragility of these cells served as a measure of integrity and membrane stability. They were compared to red cells withdrawn preoperatively and showed an identical osmotic relationship. Determining the survival rate of the retransfused cells in vivo shows that they provide a high-quality and in most cases, a sufficient replacement of blood loss. Even after 6 days, over 70% were found in the circulating blood. Premature, disproportionate elimination, which could be dangerous for the patient, does not occur.