An extra-erythrocyte role of haemoglobin body in chondrocyte hypoxia adaption.

Although haemoglobin is a known carrier of oxygen in erythrocytes that functions to transport oxygen over a long range, its physiological roles outside erythrocytes are largely elusive1,2. Here we found that chondrocytes produced massive amounts of haemoglobin to form eosin-positive bodies in their cytoplasm. The haemoglobin body (Hedy) is a membraneless condensate characterized by phase separation. Production of haemoglobin in chondrocytes is controlled by hypoxia and is dependent on KLF1 rather than the HIF1/2α pathway. Deletion of haemoglobin in chondrocytes leads to Hedy loss along with severe hypoxia, enhanced glycolysis and extensive cell death in the centre of cartilaginous tissue, which is attributed to the loss of the Hedy-controlled oxygen supply under hypoxic conditions. These results demonstrate an extra-erythrocyte role of haemoglobin in chondrocytes, and uncover a heretofore unrecognized mechanism in which chondrocytes survive a hypoxic environment through Hedy.

The prevalence and risk factors associated with preoperative deep venous thrombosis in lung cancer surgery.

PURPOSE: Few studies have so far focused on the preoperative presence of venous thromboembolism (VTE) in lung cancer patients undergoing surgery. In this study, we investigated the prevalence and risk factors for preoperative deep venous thrombosis (DVT) in patients scheduled to undergo lung cancer surgery. METHODS: Between June 2013 and December 2018, 948 consecutive patients underwent lung cancer surgery in Kindai University Hospital. Four patients did not undergo screening for DVT; thus, 944 patients were enrolled in this study. Preoperatively, venous ultrasonography of the lower extremities was performed in patients deemed at risk for DVT, and the prevalence and risk factors for preoperative DVT were examined. RESULTS: Ninety-one patients (9.6%) were diagnosed with preoperative DVT, and postoperative symptomatic pulmonary thromboembolism occurred in one patient (0.11%). A multivariable logistic regression analysis demonstrated that female sex, age ≥ 72 years, history of VTE, a Wells score ≥ 2 points, chronic obstructive pulmonary disease (COPD), and lower hemoglobin levels were significantly associated with preoperative DVT. CONCLUSION: Female sex, age ≥ 72 years, history of VTE, Wells score ≥ 2 points, COPD, and lower hemoglobin levels were identified to be independent risk factors for preoperative DVT. Monitoring for these risk factors and management considering them should help improve the outcomes after lung cancer surgery.

Prevalence and risk factors of high echocardiographic probability of pulmonary hypertension in myeloproliferative neoplasms patients.

Pulmonary hypertension (PH) is emerging as a complication of myeloproliferative neoplasms (MPNs). This was a prospective study conducted at Chiang Mai University Hospital. The primary objective was to determine the prevalence of high echocardiographic probability of PH in MPNs patients. The secondary objectives were to determine risk factors of PH and the correlation between risk factors and peak tricuspid regurgitation velocity (TRVmax). All MPNs patients aged over 18 years, including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), were enrolled. All eligible patients underwent echocardiography for evaluation of the probability of PH in line with the 2015 European Society of Cardiology (ESC) and the European Respiratory Society (ERS) Guidelines. Sixty-six patients with a median age of 59 years were enrolled. There were 35 PV, 25 ET, and 6 PMF patients included. The prevalence of high echocardiographic probability of PH was 4.55% (2 ET and 1 PMF). Risk factors associated with high echocardiographic probability of PHT were not analyzed. There were three risk factors associated with increased TRVmax, specifically lower hemoglobin, older age, and the presence of JAK2V617F mutation. The prevalence of high echocardiographic probability of PH in MPNs patients was 4.55%.

Depression, antidepressants and low hemoglobin level in the Paris Prospective Study III: A cross-sectional analysis.

Anemia is known to be associated with depression both in community and clinical populations. However, it is still unknown if this association depends or not on antidepressant intake. We investigated the respective association of depression and antidepressant intake with low hemoglobin level in a large community-based cohort. In 8640 volunteers aged 50 to 75 recruited between June 2008 and June 2012 in Paris (France), we assessed hemoglobin levels (g/dl), depressive symptoms and antidepressant intake. We examined the association of both depression and antidepressant intake with hemoglobin level, adjusting for numerous socio-demographic and health variables. We also assessed the association with specific antidepressant classes. Depression and antidepressant intake were independently associated with lower hemoglobin level (ß = -0.074; p = .05 and ß = -0.100; p = .02 respectively in the fully-adjusted model). Regarding antidepressant classes, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) intake were associated with lower hemoglobin level (ß = -0.11; p = .01). To conclude, both depression and antidepressant intake were associated with lower hemoglobin level. In particular, as SSRI or SNRIs intake was also related to lower hemoglobin level, these classes should be used with caution in depressed individuals at risk for anemia.

Prevalence of anemia in pregnant Iraqi women

Bachkgrond: Anemia is a very important nutritional disorder in the world, it has multiple etiologies and pregnancy is associated with a deficit in the intake of iron and physiological changes of pregnancy. Aim of the study: To assess the prevalence of anemia in pregnant Iraqi women. Patients and method: A cross-sectional study carried at Al-Elwyia maternity teaching hospital in the period from the 1st of Jan. 2018 to the end of October 2018, in which 1000 pregnant women were enrolled in the study and divided into 2 groups: case group (n=652) and control group (n=348) according to the level of Hb. Results: The mean age of the case group was (27.8±7.1) years old and (26.1±2.3) years for the control group. The anemia was found in (6521000) patients and Iron deficiency anemia is the main type of anemia (80.2%) while (19.8%) was another type of anemia. Poor diet (65%) is the common cause of anemia were found commonly in the 3rd trimester (50.2%). Conclusion: The prevalence of anemia was 65.2% in the current study (AU)

Eculizumab in paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome: 10-year pharmacovigilance analysis.

Eculizumab is the first and only medication approved for paroxysmal nocturnal haemoglobinuria (PNH) and atypical haemolytic uraemic syndrome (aHUS) treatment. However, eculizumab safety based on long-term pharmacovigilance is unknown. This analysis summarises safety data collected from spontaneous and solicited sources from 16 March 2007 through 1 October 2016. Cumulative exposure to eculizumab was 28 518 patient-years (PY) (PNH, 21 016 PY; aHUS, 7502 PY). Seventy-six cases of meningococcal infection were reported (0·25/100 PY), including eight fatal PNH cases (0·03/100 PY). Susceptibility to meningococcal infections remained the key risk in patients receiving eculizumab. The meningococcal infection rate decreased over time; related mortality remained steady. The most commonly reported serious nonmeningococcal infections were pneumonia (11·8%); bacteraemia, sepsis and septic shock (11·1%); urinary tract infection (4·1%); staphylococcal infection (2·6%); and viral infection (2·5%). There were 434 reported cases of eculizumab exposure in pregnant women; of 260 cases with known outcomes, 70% resulted in live births. Reporting rates for solid tumours (≈0·6/100 PY) and haematological malignancies (≈0·74/100 PY) remained stable over time. No new safety signals affecting the eculizumab benefit-risk profile were identified. Continued awareness and implementation of risk mitigation protocols are essential to minimise risk of meningococcal and other Neisseria infections in patients receiving eculizumab.

Micronutrient deficiencies following bariatric surgery: a comparative analysis between sleeve gastrectomy and Roux-en-Y gastric bypass. / Deficiências de micronutrientes após cirurgia bariátrica: análise comparativa entre gastrectomia vertical e derivação gástrica em Y de Roux.

OBJECTIVE: to compare the prevalence of micronutrient deficiencies in patients submitted to sleeve gastrectomy (SG) and Roux- en-Y gastric bypass (RYGB). METHODS: this is a comparative study of 576 patients submitted to bariatric surgery, 338 to SG and 238 to RYGB, and evaluated for hemoglobin, iron, ferritin, zinc and vitamin B12 serum levels. We performed these dosages in the preoperative period and at three, six, 12 and 24 months after surgery, for analysis and comparison of micronutrient deficiencies among the techniques. RESULTS: the SG group consisted of 48 men and 290 women, with a mean BMI of 39.4±2.6kg/m2, and a mean of age of 37.2±11 years; the group RYGB consisted of 77 men and 161 women, with mean BMI 42.7±5.9kg/m2, and a mean age of 41.9±11.1 years. After 24 months, hemoglobin deficiency was present in 24.4% of the patients submitted to SG and in 40% of the RYGB individuals (p=0.054); iron deficiency was present in 6,6% of SG patients and in 15% of RYGB ones (p=0.127); ferritin deficiency occurred in 17.8% of the SG group and in 23.7% of RYGB one (p=0.399); the Zinc deficiency incidence was 6.6% in SG and 30% in RYGB (p=0.002); and B12 deficiency took place in 6.6% the SG patients and in 8.7% of RYGB ones (p=0.844). CONCLUSION: patients undergoing SG had serum levels of iron and zinc superior to the ones undergoing RYGB, the prevalence of the latter micronutrient deficit being significantly higher in the RYGB group.

OBJETIVO: comparar a prevalência das deficiências de micronutrientes nos pacientes submetidos à gastrectomia vertical (GV) e à derivação gástrica em Y de Roux (DGYR). MÉTODOS: estudo comparativo de 576 pacientes submetidos à cirurgia bariátrica, 338 através de GV e 238 de DGYR e avaliados quanto às dosagens séricas de hemoglobina, ferro, ferritina, zinco e vitamina B12. Estas dosagens foram realizadas nos períodos pré-operatório e três, seis, 12 e 24 meses após a cirurgia, para análise e comparação das deficiências de micronutrientes entre as técnicas. RESULTADOS: o grupo submetido à GV foi composto por 48 homens e 290 mulheres, com IMC médio de 39,4±2,6Kg/m2 e média de idade de 37,2±11 anos; o grupo submetido à DGYR foi composto por 77 homens e 161 mulheres, com IMC médio de 42,7±5,9Kg/m2 e média de idade de 41,9±11,1 anos. Após 24 meses, déficit de hemoglobina se fez presente em 24,4% dos pacientes submetidos à GV e 40% da DGYR (p=0,054); deficiência de ferro em 6,6% da GV e 15% da DGYR (p=0,127); déficit de ferritina em 17,8% da GV e 23,7% da DGYR (p=0,399); deficiência de zinco em 6,6% da GV e 30% da DGYR (p=0,002) e deficiência de B12 em 6,6% da GV e 8,7% da DGYR (p=0,844). CONCLUSÃO: pacientes submetidos à GV apresentaram níveis séricos de ferro e zinco superiores aos pacientes submetidos à DGYR, e a prevalência de déficit deste último micronutriente foi significativamente maior no grupo da DGYR.

Depletion of haptoglobin and hemopexin promote hemoglobin-mediated lipoprotein oxidation in sickle cell disease.

Intravascular sickling and lysis of red blood cells, a hallmark feature of sickle cell disease (SCD), releases hemoglobin (Hb) into the circulation. Increased cell-free Hb has been linked to vasculopathy and in vitro lipid oxidation. Scavenger plasma proteins haptoglobin (Hp) and hemopexin (Hpx) can attenuate cell-free Hb and total plasma heme lipid-oxidative capacity but are depleted in SCD. Here, we isolated lipids from BERK-SS mice, guinea pigs (GP) infused with heme-albumin, and patients with SCD undergoing regular exchange transfusion therapy and evaluated the level of lipid oxidation. Malondialdehyde formation, an end product of lipid peroxidation, was increased in BERK-SS mice, purified lipid fractions of the heme-albumin infused GP, and patients with SCD compared with controls. In humans, the extent of lipid oxidation was associated with the absence of Hp as well as decreased Hpx in plasma samples. Postmortem pulmonary tissue obtained from patients with SCD demonstrated oxidized LDL deposition in the pulmonary artery. The relationship between no Hp and low Hpx levels with greater LDL and HDL oxidation demonstrates the loss of protection against cell-free Hb and total plasma heme-mediated lipid oxidation and tissue injury in SCD. Strategies to protect against plasma lipid oxidation by cell-free Hb and total plasma heme (e.g., therapeutic Hp and Hpx replacement) may diminish the deleterious effects of cell-free Hb and total plasma heme toward the vascular system in SCD.

Impact of anaemia on outcome in burn patients.

BACKGROUND: Currently, most critical care physicians maintain a patient's haemoglobin levels at 7 to 8 g dL-1. However, little data have been available on haemoglobin-related outcomes in burn patients. The purpose of this study was to evaluate inpatients with greater than 20% total body surface area burns and the effects of haemoglobin below 8 g dL-1 on clinical outcomes. METHODS: This study included 70 patients with burns amounting to greater than 20% of total body surface area. Data were retrospectively evaluated and included age, gender, adult respiratory distress syndrome presence, length of intensive care unit stay, length of mechanical ventilation, days requiring vasopressors, renal insufficiency, positive cultures/infections, cardiovascular complications, number of operations, inhalation injury, and mortality. Logistic regression analyses that were adjusted for age, sex, and percent total body surface area were used to assess the relationships between haemoglobin and multiple clinical outcomes. Odds ratios (OR) were estimated with 99% confidence intervals (99% CI). RESULTS: Haemoglobin below 8 g dL-1 was associated with a need for vasopressors (OR = 2.17; 99% CI = 1.03-8.22). Furthermore, haemoglobin below 8 g dL-1 was associated with higher positive wound (OR = 2.86; 99% CI = 1.00-34.40), urine (OR = 4.63; 99% CI = 1.15-67.00), and lung cultures (OR = 2.24; 99% CI = 1.06-5.47). These associations largely remained after controlling for blood transfusions. CONCLUSIONS: Contrary to most other patient groups, burn patients with burns amounting to greater than 20% of total body surface area and low haemoglobin levels were more likely to develop positive cultures in urine, wounds, and the lung and require vasopressor treatment.

Hemoglobin, iron, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia in Behcet's disease patients with atrophic glossitis.

BACKGROUND/PURPOSE: Behcet's disease (BD) patients should have recurrent aphthous stomatitis (RAS) but they may or may not have atrophic glossitis (AG). This study mainly assessed whether 30 AG-positive RAS/BD (AG+RAS/BD) patients had significantly higher frequencies of hemoglobin, iron, vitamin B12, and folic acid deficiencies and of hyperhomocysteinemia than 33 AG-negative RAS/BD (AGÖ¾RAS/BD) patients or 126 age- and sex-matched healthy control subjects. METHODS: The blood hemoglobin, iron, vitamin B12, folic acid, and homocysteine concentrations were measured and compared among 30 AG+RAS/BD patients, 33 AGÖ¾RAS/BD patients, and 126 healthy control subjects. RESULTS: We found that 43.3%, 33.3%, 13.3%, 6.7%, and 20.0% of 30 AG+RAS/BD patients and 18.2%, 36.4%, 0%, 6.1%, and 9.1% of 33 AGÖ¾RAS/BD patients had hemoglobin, iron, vitamin B12, and folic acid deficiencies and hyperhomocysteinemia, respectively. Moreover, 30 AG+RAS/BD patients had significantly higher frequencies of hemoglobin, iron, vitamin B12, and folic acid deficiencies and of hyperhomocysteinemia than healthy control subjects (all P-values < 0.05), and had a higher frequency of hemoglobin deficiency (P = 0.058, marginal significance) and a significantly higher frequency of vitamin B12 deficiency (P = 0.046) than 33 AGÖ¾RAS/BD patients. In addition, the 33 AGÖ¾RAS/BD patients had significantly higher frequencies of hemoglobin and iron deficiencies than healthy control subjects (both P-values < 0.001). CONCLUSION: We conclude that AG+RAS/BD patients do have significantly higher frequencies of hemoglobin, iron, vitamin B12, and folic acid deficiencies and of hyperhomocysteinemia than healthy control subjects and have significantly higher frequencies of hemoglobin and vitamin B12 deficiencies than AGÖ¾RAS/BD patients.

Deficiências de micronutrientes após cirurgia bariátrica: análise comparativa entre gastrectomia vertical e derivação gástrica em Y de Roux / Micronutrient deficiencies following bariatric surgery: a comparative analysis between sleeve gastrectomy and Roux-en-Y gastric bypass

RESUMO Objetivo: comparar a prevalência das deficiências de micronutrientes nos pacientes submetidos à gastrectomia vertical (GV) e à derivação gástrica em Y de Roux (DGYR). Métodos: estudo comparativo de 576 pacientes submetidos à cirurgia bariátrica, 338 através de GV e 238 de DGYR e avaliados quanto às dosagens séricas de hemoglobina, ferro, ferritina, zinco e vitamina B12. Estas dosagens foram realizadas nos períodos pré-operatório e três, seis, 12 e 24 meses após a cirurgia, para análise e comparação das deficiências de micronutrientes entre as técnicas. Resultados: o grupo submetido à GV foi composto por 48 homens e 290 mulheres, com IMC médio de 39,4±2,6Kg/m2 e média de idade de 37,2±11 anos; o grupo submetido à DGYR foi composto por 77 homens e 161 mulheres, com IMC médio de 42,7±5,9Kg/m2 e média de idade de 41,9±11,1 anos. Após 24 meses, déficit de hemoglobina se fez presente em 24,4% dos pacientes submetidos à GV e 40% da DGYR (p=0,054); deficiência de ferro em 6,6% da GV e 15% da DGYR (p=0,127); déficit de ferritina em 17,8% da GV e 23,7% da DGYR (p=0,399); deficiência de zinco em 6,6% da GV e 30% da DGYR (p=0,002) e deficiência de B12 em 6,6% da GV e 8,7% da DGYR (p=0,844). Conclusão: pacientes submetidos à GV apresentaram níveis séricos de ferro e zinco superiores aos pacientes submetidos à DGYR, e a prevalência de déficit deste último micronutriente foi significativamente maior no grupo da DGYR.

ABSTRACT Objective: to compare the prevalence of micronutrient deficiencies in patients submitted to sleeve gastrectomy (SG) and Roux- en-Y gastric bypass (RYGB). Methods: this is a comparative study of 576 patients submitted to bariatric surgery, 338 to SG and 238 to RYGB, and evaluated for hemoglobin, iron, ferritin, zinc and vitamin B12 serum levels. We performed these dosages in the preoperative period and at three, six, 12 and 24 months after surgery, for analysis and comparison of micronutrient deficiencies among the techniques. Results: the SG group consisted of 48 men and 290 women, with a mean BMI of 39.4±2.6kg/m2, and a mean of age of 37.2±11 years; the group RYGB consisted of 77 men and 161 women, with mean BMI 42.7±5.9kg/m2, and a mean age of 41.9±11.1 years. After 24 months, hemoglobin deficiency was present in 24.4% of the patients submitted to SG and in 40% of the RYGB individuals (p=0.054); iron deficiency was present in 6,6% of SG patients and in 15% of RYGB ones (p=0.127); ferritin deficiency occurred in 17.8% of the SG group and in 23.7% of RYGB one (p=0.399); the Zinc deficiency incidence was 6.6% in SG and 30% in RYGB (p=0.002); and B12 deficiency took place in 6.6% the SG patients and in 8.7% of RYGB ones (p=0.844). Conclusion: patients undergoing SG had serum levels of iron and zinc superior to the ones undergoing RYGB, the prevalence of the latter micronutrient deficit being significantly higher in the RYGB group.

Anemia e insegurança alimentar em crianças em idade pré-escolar / Anemia and food insecurity in preschool children

Introdução: No Brasil, a anemia por deficiência de ferro permanece como problema de saúde pública relevante, especialmente para mulheres e crianças. Nessa questão, a situação de insegurança alimentar (IA) pode vir a ser associada a diversos aspectos de desigualdades estruturais e em saúde, visto que seu conceito permite abordar diversos tipos de iniquidades nutricionais. Objetivos: Avaliar a anemia e a insegurança alimentar e nutricional de famílias de crianças em idade pré-escolar: analisar a influência da vulnerabilidade socioeconômica sobre a prevalência da anemia; identificar os padrões alimentares e sua relação com segurança alimentar e estado nutricional; e investigar a relação entre insegurança alimentar e concentração de hemoglobina de pré-escolares. Métodos: A pesquisa foi do tipo transversal. A população investigada foi de pré-escolares inscritos em creches públicas de Taubaté (SP), em 2014, distribuídas em dois grupos diferenciados pelas características socioeconômicas da região onde estão localizadas: região vulnerável e região abastada. O tamanho da amostra foi calculado partindo do pressuposto que a diferença na concentração de hemoglobina (Hb) entre crianças da região vulnerável e abastada fosse equivalente a 1/3 de desvio padrão da média de Hb da população saudável. As variáveis socioeconômicas e demográficas foram coletadas por questionário semi-estruturado. A concentração de Hb foi obtida por meio de punção digital, considerando anemia Hb

Introduction: In Brazil, iron deficiency anemia remains a relevant public health problem, specially for women and children. In this respect, the situation of food insecurity (FI) may prove to be associated with various aspects of structural inequalities and health, as its concept allows addressing various types of nutritional inequities. Objective: Evaluate anemia, food and nutrition insecurity of families of children in preschool age; analyze the influence of socioeconomic vulnerability on the prevalence of anemia; identify dietary patterns and their relation to food security and nutritional status; and investigate the relationship between food insecurity and concentration of preschool hemoglobin. Methods: The study was crosssectional. The investigated population was enrolled preschool children in public day care centers in Taubaté (SP) in 2014, divided into two different groups by socioeconomic characteristics of the region where they are located: vulnerable region and wealthy region. The sample size was calculated on the assumption that the difference in hemoglobin (Hb) between children of vulnerable and wealthy region was equivalent to 1/3 of Hb mean standard deviation of the healthy population. Socioeconomic and demographic variables were collected by semi-structured questionnaire. The Hb concentration was obtained by finger prick, considering anemia Hb

Common Bean Leaves as a Source of Dietary Iron: Functional Test in an Iron-Deficient Rat Model.

Recent findings made by our group indicate that the iron content in Phaseolus vulgaris leaves is at least four times greater than in grains therefore, we evaluated the effect of supplementation with bean leaf (iron content of 275 mg/kg on a dry basis) in iron-deficient rats. Anemia was induced by feeding rats with an iron-deficient diet (IDD) for 11 days and iron-recovery diets were subsequently tested for 14 days using a normal diet, a 10 % bean leaf-supplemented IDD (BLSD) or a ferrous sulfate-supplemented IDD. Decreased levels of leukocytes (64 %), erythrocytes (30 %), lymphocytes (62 %), granulocytes (72 %), hematocrit (34 %), hemoglobin (35 %), and ferritin (34 %) were observed in the iron-deficient rats compared to the control rats. BLSD supplementation showed the highest recovery values relative to those recorded for control rats: leukocytes (40 %), erythrocytes (24 %), lymphocytes (33 %), granulocytes (88 %), hematocrit (17 %), and hemoglobin (18 %), suggesting that common bean leaves could be a good source of bioavailable iron with possible immunomodulatory effects.

Anemia en el embarazo y el posparto inmediato. Prevalencia y factores de riesgo / Anaemia in pregnancy and in the immediate postpartum period. Prevalence and risk factors in pregnancy and childbirth

Introducción y objetivo: El objetivo del estudio fue evaluar la prevalencia de la anemia en el posparto inmediato (48-72 h), determinar los factores de riesgo y el valor óptimo de la hemoglobina antes del parto para reducir la anemia. Material y métodos: Estudio prospectivo, observacional y longitudinal que incluyó a 1.426 mujeres de forma consecutiva que accedieron a participar en el estudio. Se estudiaron diferentes variables, analíticas, epidemiológicas y clínicas tanto fetales como maternas. Resultados: La prevalencia de anemia en el posparto inmediato fue del 49,7%. Los factores de riesgo más importantes fueron la anemia preparto y el tipo de parto. Con el fórceps hubo un 82,3% de anemia posparto, con el vacuum un 67%, con la cesárea un 58,2% y con el parto eutócico un 37,2%. En el estudio multivariado se encontraron como factores de riesgo independientes más importantes: la hemoglobina el día del parto (OR: 6,16; IC: 3,73-10,15) y el parto instrumentado (OR: 4,61; IC: 3,44-6,19). Otros factores de riesgo independientes fueron la hemoglobina del tercer trimestre, la episiotomía y los desgarros perineales, la etnia, el peso del neonato, la paridad y las complicaciones intra- y/o posparto. Conclusiones: La anemia en el posparto es un problema frecuente. Los factores que más se asociaron fueron el parto instrumentado y la anemia preparto. Si las pacientes llegaran al día del parto con hemoglobina ≥ 12,6 g/dl y optimizáramos la tasa de partos instrumentados y cesáreas, restringiendo las episiotomías sin aumentar los desgarros perineales de alto grado podríamos conseguir una disminución muy significativa de la anemia en el posparto inmediato (AU)

Introduction and objective: The objective of the study was to assess the prevalence of anaemia in the immediate postpartum period (48-72 hours), determine the risk factors and the value of haemoglobin before birth to reduce postpartum anaemia. Material and methods: A prospective, observational and longitudinal study that included 1,426 women who delivered consecutively and agreed to participate in the study. Different variables, analytical, epidemiological, foetal and maternal symptoms were studied. Results: The prevalence of anaemia in the postpartum period was 49.7%. The most important risk factors were antepartum anaemia and type of delivery. The types of delivery most influencing postpartum anaemia were, forceps (82.3%), the ventouse 67%, cesarean section (58,2%) and vaginal delivery (37.2%). In the multivariate study was found as the most important independent risk factors, the haemoglobin in the delivery day (OR 6.16, CI: 3.73 to 10.15) and instrumental delivery (OR: 4.61, CI: 3.44 to 6, 19). Other independent risk factors were haemoglobin in the third trimester, episiotomy and perineal tears, ethnicity, birth weight, parity and intra/postpartum complications. Conclusions: Anaemia in the immediate postpartum is a prevalent problem. The factors most associated postpartum anaemia were antepartum anaemia and instrumental delivery. If patients arrive at the day of delivery with haemoglobins ≥ 12,6 g/dl and were restricted to necessary instrumented deliveries and cesarean sections, episiotomies and we could avoid perineal tears we can decrease anaemia in the immediate postpartum period very significantly (AU)

Análise da anemia por deficiência relativa de ferro e eritropoietina de pacientes com insuficiênciarenal crônica em tratamento hemodialítico / Analysis of anemia relative deficiency of iron and erythropoietin in patients with chronic renal failure in hemodialysis

Introdução: A anemia ferropriva é uma importante complicação da insuficiência renal crônica, apresentando como causa mais comum, a deficiência de eritropoetina. Objetivo: Analisar a anemia por deficiência relativa de ferro e eritropoietina de pacientes com insuficiência renal crônica em tratamento hemodialítico. Métodos: Trata-se de estudo descritivo, transversal, documental, com abordagem quantitativa realizada em uma clí- nica especializada em tratamento renal na qual a amostra foi constituída por 72 pacientes com doença renal crônica. O estudo foi realizado durante o período de janeiro a dezembro de 2013. Foi utilizado um questionário semiestruturado pró- prio. O tratamento dos dados se deu por epidemiologia descritiva. O projeto foi aprovado pelo Comitê de Ética em Pesquisa, protocolo nº 705677. Foi analisado, através da análise dos prontuários, o registro laboratorial mensal dos ní- veis de hemoglobina, hematócrito, índice de saturação de transferrina e ferritina, no período de um ano. As estatísticas descritivas foram apresentadas em percentuais. As médias anuais da variação dos níveis laboratoriais de cada paciente foram classificadas de acordo com os valores de referência utilizados: em baixa, alvo ou alta. Resultados: A média de idade dos 72 pacientes foi de 44 ± 14, sendo 79% do sexo masculino e 21% feminino. Hemoglobina menor que 11g/dL foi verificada em 25% dos pacientes. Deficiência de ferro (%SAT <20%) foi diagnosticada em 7%. Observou-se que 8% apresentaram níveis de ferritina abaixo do esperado(<200ng/dL). Do total de pacientes com (%SAT< 20%), 4,2% apresentavam ferritina dentro dos parâ- metros normais, um paciente apresentou níveis de ferritina aumentados e um outro paciente mostrou-se com valores de ferritina diminuídos. Dos pacientes considerados anêmicos, 18,05% apresentavam %SAT normal e ferritina elevados. Conclusões: A variabilidade de hemoglobina ocorreu mais comumente para níveis mais elevados do que para valores mais baixos. Torna-se necessária a realização de outros estudos a fim de se obter maiores embasamentos para a correção da anemia em portadores de DRC

Background: Iron deficiency anemia is a major complication of chronic renal failure, with as most common cause, erythropoietin deficiency. Objective: Analyze the relative deficiency anemia iron and erythropoietin in patients with chronic renal failure undergoing hemodialysis. Methods: This is a descriptive study, cross, document, with a quantitative approach carried out in a clinic specializing in kidney treatment in which the sample consisted of 72 patients with chronic kidney disease. The study was conducted during the period January to December 2013. A semistructured questionnaire itself was used. The processing of data was by descriptive epidemiology. The project was approved by the Research Ethics Committee, protocol number 705677. Was analyzed by analysis of the records, the monthly record of laboratory hemoglobin, hematocrit, transferrin saturation and ferritin index, within one year. Descriptive statistics were presented in percentages. The average annual variation of laboratory levels of each patient were classified according to the reference values used: low, high or target. Results: The average age of the 72 patients was 44 ± 14, 79% male and 21% female. Hemoglobin less than 11g / dl was found in 25% of patients. Iron deficiency (SAT%<20%) was diagnosed in 7%. It was observed that 8% had ferritin levels lower than expected (<200ng/dL). Of all patients with (SATA%<20%), 4.2% had ferritin within normal parameters, one patient had increased ferritin levels, and another patient showed up with decreased ferritin values. Of patients considered anemic, 18.05% had% Normal SAT and high ferritin. Conclusions: The hemoglobin variability occurs most commonly at higher levels than at lower values. It is necessary to carry out further studies in order to obtain larger emplacements for the correction of anemia in patients with CKD

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Sequência anemia-policitemia em gêmeos: definição, classificação e tratamento / Twin anemia-polycythemia sequence: definition, classification and treatment

A presença de anastomoses vasculares placentárias nas gestações gemelares monocoriônicas favorece o surgimento de complicações graves como a Síndrome de Transfusão Feto-Fetal (STFF) e a Sequência Anemia-Policitemia em Gêmeos (TAPS). STFF e TAPS são ambas formas crônicas de transfusão feto-fetal. TAPS, descrita em 2007, é caracterizada por anemia crônica no gêmeo doador e policitemia no gêmeo receptor, na ausência de discordância no volume de líquido amniótico, característica da STFF clássica. O diagnóstico pode ser feito pré- e pós-natal. O critério diagnóstico pré-natal é baseado na discordância intergemelar da medida do Doppler do pico de velocidade sistólica da artéria cerebral média (PSV-ACM). O diagnóstico pós-natal é baseado na grande diferença da hemoglobina intergemelar, ao nascimento, e reticulocitose no gêmeo doador.(AU)

The presence of placental vascular anastomoses in monochorionic twins favors the development of several complications like Twin-Twin Transfusion Syndrome (TTTS) and Twin Anemia-Polycythemia Sequence (TAPS). TTTS and TAPS are both chronic forms of fetofetal transfusion. TAPS, described on 2007, is characterized by chronic anemia in the donor twin and polycythemia in the recipient twin, in the absence of amniotic fluid volume discordances, characteristic of classical TTTS. The diagnostic can be made pree posnatally. The prenatal diagnostic criteria is based on the inter-twin discordance in Doppler measurement of peak systolic velocity in the middle cerebral artery (MCA-PSV). The postnatal diagnosis is based on large intertwin hemoglobin difference at birth and retoculocytosis in the donor twin.(AU)

Impact of haematologic deficiencies on recurrent aphthous ulceration: a meta-analysis.

BACKGROUND: Recurrent aphthous ulceration (RAU) is one of the most common oral mucosal diseases, some of which may be secondary to haematologic deficiencies. This meta-analysis aims to evaluate the association between haematologic deficiencies and RAU. MATERIALS AND METHODS: Case control studies were identified using a predefined search strategy that compared the difference in haematologic deficiencies between a RAU group and a control group. A meta-analysis was performed to estimate the combined odds ratios (ORs) and 95% confidence intervals (95% CIs) in a fixed-effects model and a random-effects model, as appropriate. RESULTS: In this meta-analysis, nine case control studies, including total 710 cases in RAU groups and 602 cases in control groups, were considered eligible for inclusion. Overall, the combined results based on all studies showed that the rate of haematinic deficiencies was significantly high in the RAU group (vitamin B12: OR=3.75, 95% CI: 2.38-5.94; folic acid: OR=7.55, 95% CI: 3.91-14.60; ferritin: OR=2.62, 95% CI: 1.69-4.06; and haemoglobin: OR=1.77, 95% CI: 1.12-2.80). CONCLUSION: This meta-analysis suggests that haematologic deficiencies could be a significant risk factor for RAU. Thus, screening and treating any haematologic deficiencies may play an important role in preventing the occurrence of RAU.