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1.
Anaesthesia ; 75(8): 1105-1113, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32339260

RESUMO

As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Doadores de Sangue/provisão & distribução , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anemia/complicações , Anemia/diagnóstico , Anemia/terapia , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Procedimentos Cirúrgicos Eletivos , Emergências , Humanos , Recuperação de Sangue Operatório , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Cuidados Pré-Operatórios/métodos
2.
J Med Virol ; 92(7): 915-918, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32270515

RESUMO

An 80-year-old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O2 saturation and definitive chest computerized tomography scan findings in favor of COVID-19 and positive PCR results in 48 hours. He received antiviral treatment plus recombinant human erythropoietin (rhEPO) due to his severe anemia. After 7 days of treatment, he was discharged with miraculous improvement in his symptoms and hemoglobin level. We concluded that rhEPO could attenuate respiratory distress syndrome and confront the severe acute respiratory syndrome coronavirus 2 virus through multiple mechanisms including cytokine modulation, antiapoptotic effects, leukocyte release from bone marrow, and iron redistribution away from the intracellular virus.


Assuntos
Anemia/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Eritropoetina/uso terapêutico , Febre/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Taquicardia/tratamento farmacológico , Taquipneia/tratamento farmacológico , Idoso de 80 Anos ou mais , Anemia/complicações , Anemia/diagnóstico , Anemia/virologia , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Técnicas de Laboratório Clínico/métodos , Convalescença , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Estado Terminal , Febre/complicações , Febre/diagnóstico , Febre/virologia , Humanos , Irã (Geográfico) , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral/sangue , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Taquicardia/complicações , Taquicardia/diagnóstico , Taquicardia/virologia , Taquipneia/complicações , Taquipneia/diagnóstico , Taquipneia/virologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
PLoS One ; 15(3): e0230333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163502

RESUMO

In low- and middle-income countries, many women experience anemia during pregnancy due to insufficient dietary intake of key micronutrients, parasitic infections, hemoglobinopathies, and chronic infections. Maternal anemia increases perinatal risks for both mothers and infants, and slow progress to reduce the prevalence may be due in part to the lack of affordable tools to quantify hemoglobin levels in antenatal care (ANC) clinics. A simple, inexpensive, accurate, and robust diagnostic is needed to measure hemoglobin in ANC. This study evaluated the performance and usability of the TrueHb Hemometer. A cross-sectional diagnostic accuracy study was conducted to compare the accuracy of the TrueHb and the HemoCue® 201+ using capillary samples. Next, analytical performance (precision, coefficient of variation, R2) of the TrueHb was evaluated in varying environmental conditions using linearity panels with serial dilutions of venous blood samples. Lastly, the usability of the TrueHb Hemometer was assessed across three domains (effectiveness, efficiency, and satisfaction) by 20 ANC providers in Ghana. Capillary blood test results were not well correlated (R2 = 0.35) between the TrueHB and HemoCue201+, but 80% of TrueHb measurements were within +/-1.0 g/dl of the HemoCue® 201+ hemoglobin values. Precision tests indicated similar mean values across the three environmental conditions (CV<6%). At 21°C, the TrueHb follows a linear relationship (R2≥0.96) but does not generate accurate readings below 4.0 g/dl. At 30°C and 37°C, the TrueHb follows a linear relationship (R2 > 0.90) but begins to underestimate the hemoglobin concentration below 7.0 g/dl. The usability study identified potential failure modes due to inadequate instructions and device feedback. With some modifications, both to the product and to the instructions for use, the TrueHb may be suitable for use in ANC settings to help fill the diagnostic gap for anemia screening during pregnancy. Further testing is required with anemic populations in LMIC settings.


Assuntos
Anemia/diagnóstico , Hemoglobinometria/instrumentação , Hemoglobinas/análise , Complicações Hematológicas na Gravidez/diagnóstico , Adulto , Estudos Transversais , Feminino , Gana , Voluntários Saudáveis , Humanos , Programas de Rastreamento , Gravidez , Cuidado Pré-Natal , Prevalência
4.
Klin Lab Diagn ; 65(3): 169-173, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32163691

RESUMO

A study of the main indicators of red blood (RBC, HGB, HCT, MCV, MCH) and the concentration of EPO, sTfR in 9 cancer patients with anemic syndrome (AS) against sepsis was carried out. Among them, patients with chronic disease anemia (ACh), with normocytic, normochromic characteristics of red blood cells and low hematocrit predominated. In 2 patients, microcytosis and erythrocyte hypochromia were noted, the concentration of sTfR was significantly higher than normal (0.9 ± 0.07 µg / ml), amounted to 2.7 µg / ml in one of them and 1.9 µg / ml in the other, which testified to t iron deficiency erythropoiesis (IDE) on the background of the ACh,. In 7 patients with ACh without IDE, sTfR values were within the normal range (0.1-1.2) µg / ml, the median was 0.5 µg/ml. In all patients with sepsis, the production of EPO was inadequate for the severity of the AS, to a lesser extent in patients with IDE. The average EPO production in the group was 19.4 ± 5.1 (7.7-52.8) mU / ml, median = 12.1 mE / ml. Further studies of EPO, sTfR are planned in order to determine their role in therapeutic tactics in the correction of AS in cancer patients with sepsis.


Assuntos
Anemia/diagnóstico , Neoplasias/complicações , Sepse/complicações , Anemia/complicações , Eritropoese , Hematócrito , Humanos
5.
PLoS Med ; 17(3): e1003055, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32203504

RESUMO

BACKGROUND: Housing is essential to human well-being but neglected in global health. Today, housing in Africa is rapidly improving alongside economic development, creating an urgent need to understand how these changes can benefit health. We hypothesised that improved housing is associated with better health in children living in sub-Saharan Africa (SSA). We conducted a cross-sectional analysis of housing conditions relative to a range of child health outcomes in SSA. METHODS AND FINDINGS: Cross-sectional data were analysed for 824,694 children surveyed in 54 Demographic and Health Surveys, 21 Malaria Indicator Surveys, and two AIDS Indicator Surveys conducted in 33 countries between 2001 and 2017 that measured malaria infection by microscopy or rapid diagnostic test (RDT), diarrhoea, acute respiratory infections (ARIs), stunting, wasting, underweight, or anaemia in children aged 0-5 years. The mean age of children was 2.5 years, and 49.7% were female. Housing was categorised into a binary variable based on a United Nations definition comparing improved housing (with improved drinking water, improved sanitation, sufficient living area, and finished building materials) versus unimproved housing (all other houses). Associations between house type and child health outcomes were determined using conditional logistic regression within surveys, adjusting for prespecified covariables including age, sex, household wealth, insecticide-treated bed net use, and vaccination status. Individual survey odds ratios (ORs) were pooled using random-effects meta-analysis. Across surveys, improved housing was associated with 8%-18% lower odds of all outcomes except ARI (malaria infection by microscopy: adjusted OR [aOR] 0.88, 95% confidence intervals [CIs] 0.80-0.97, p = 0.01; malaria infection by RDT: aOR 0.82, 95% CI 0.77-0.88, p < 0.001; diarrhoea: aOR 0.92, 95% CI 0.88-0.97, p = 0.001; ARI: aOR 0.96, 95% CI 0.87-1.07, p = 0.49; stunting: aOR 0.83, 95% CI 0.77-0.88, p < 0.001; wasting: aOR 0.90, 95% CI 0.83-0.99, p = 0.03; underweight: aOR 0.85, 95% CI 0.80-0.90, p < 0.001; any anaemia: aOR 0.87, 95% CI 0.82-0.92, p < 0.001; severe anaemia: aOR 0.89, 95% CI 0.84-0.95, p < 0.001). In comparison, insecticide-treated net use was associated with 16%-17% lower odds of malaria infection (microscopy: aOR 0.83, 95% CI 0.78-0.88, p < 0.001; RDT: aOR 0.84, 95% CI 0.79-0.88, p < 0.001). Drinking water source and sanitation facility alone were not associated with diarrhoea. The main study limitations are the use of self-reported diarrhoea and ARI, as well as potential residual confounding by socioeconomic position, despite adjustments for household wealth and education. CONCLUSIONS: In this study, we observed that poor housing, which includes inadequate drinking water and sanitation facility, is associated with health outcomes known to increase child mortality in SSA. Improvements to housing may be protective against a number of important childhood infectious diseases as well as poor growth outcomes, with major potential to improve children's health and survival across SSA.


Assuntos
Anemia/epidemiologia , Saúde da Criança , Transtornos da Nutrição Infantil/epidemiologia , Diarreia/epidemiologia , Habitação , Malária/epidemiologia , Determinantes Sociais da Saúde , África ao Sul do Saara/epidemiologia , Fatores Etários , Anemia/diagnóstico , Anemia/mortalidade , Anemia/prevenção & controle , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Estudos Transversais , Diarreia/diagnóstico , Diarreia/mortalidade , Diarreia/prevenção & controle , Água Potável , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Mosquiteiros Tratados com Inseticida , Malária/diagnóstico , Malária/mortalidade , Malária/prevenção & controle , Masculino , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Saneamento
6.
Cardiovasc Ther ; 2020: 8647837, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32190122

RESUMO

Background: Anemia following acute myocardial infarction (AMI) is associated with poor outcomes. While previous studies in patients with AMI have focused on anemia at admission, we hypothesized that hemoglobin (Hb) decline during hospitalization and lower discharge Hb would be associated with greater long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: We analyzed records of 983 STEMI patients who were treated with primary PCI. The primary end point was all-cause mortality at 1 year and 2 years. The relationship between discharge Hb levels, decline in Hb levels, bleeding event classification, and all-cause mortality was determined. Results: Overall, 16.4% of patients had bleeding events, which were classified by the Thrombolysis in Myocardial Infarction (TIMI) score as 7% minimal, 8.6% minor, and 0.9% major. No significant gastrointestinal bleed and cerebral hemorrhage occurred in hospitals among these patients. The incidence rate of the 2-year all-cause mortality increased with severity of the bleeding event score (8.78% for no bleeding vs. 11.59% for minimal bleeding vs. 20.24% for minor bleeding vs. 55.56% for major bleeding, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006-1.034, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006-1.034, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006-1.034. Conclusions: In this population of patients hospitalized for STEMI, all-cause mortality increased with lower discharge Hb, and discharge Hb was a significant predictor of mortality risk.


Assuntos
Anemia/sangue , Hemoglobinas/metabolismo , Hemorragia/sangue , Alta do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Anemia/diagnóstico , Anemia/mortalidade , Biomarcadores/sangue , Causas de Morte , Feminino , Hemorragia/diagnóstico , Hemorragia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Resultado do Tratamento
7.
Anesth Analg ; 130(5): 1364-1380, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32167979

RESUMO

Anemia is common in the perioperative period and is associated with poor patient outcomes. Remarkably, anemia is frequently ignored until hemoglobin levels drop low enough to warrant a red blood cell transfusion. This simplified transfusion-based approach has unfortunately shifted clinical focus away from strategies to adequately prevent, diagnose, and treat anemia through direct management of the underlying cause(s). While recommendations have been published for the treatment of anemia before elective surgery, information regarding the design and implementation of evidence-based anemia management strategies is sparse. Moreover, anemia is not solely a concern of the preoperative encounter. Rather, anemia must be actively addressed throughout the perioperative spectrum of patient care. This article provides practical information regarding the implementation of anemia management strategies in surgical patients throughout the perioperative period. This includes evidence-based recommendations for the prevention, diagnosis, and treatment of anemia, including the utility of iron supplementation and erythropoiesis-stimulating agents (ESAs).


Assuntos
Anemia/diagnóstico , Anemia/prevenção & controle , Gerenciamento Clínico , Assistência Perioperatória/métodos , Anemia/sangue , Transfusão de Eritrócitos/métodos , Hematínicos/administração & dosagem , Humanos , Ferro/administração & dosagem , Ferro/sangue
8.
Zhonghua Er Ke Za Zhi ; 58(3): 201-205, 2020 Mar 02.
Artigo em Chinês | MEDLINE | ID: mdl-32135591

RESUMO

Objective: To explore the predictive values of routine blood test results for iron deficiency (ID) screening in children. Methods: Routine blood test results and serum ferritin (SF) levels from 1 443 healthy children (862 boys, 581 girls) aged 6 months to 18 years, who were seen for well-child visits between June 2017 and May 2019 in Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. ID was defined as SF<20 µg/L, iron deficiency anemia (IDA) as ID with anemia (hemoglobin(Hb)<110 g/L at 6 months-5 years of age, Hb<120 g/L at 6-18 years of age), non-anemia ID as ID without anemia, non-ID anemia as SF≥20 µg/L with anemia, and healthy control subjects as those with SF≥20 µg/L but without anemia. The blood test results including Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), and the percentage of low hemoglobin density (LHD) of healthy control, non-anemia ID, non-ID anemia, and IDA groups were compared by analysis of variance (ANOVA) or non-parametric test, quantitative data were described as x±s or M(interquartile range), and receiver operating characteristic curve (ROC) analysis was applied to assess predictive values of routine blood test results and LHD for detecting IDA and ID. Results: Among 1 443 children with median age of 2.1(3.3) years, 1 061 children were in healthy control group, 292 in non-anemia ID group, 43 in non-ID anemia group and 47 in IDA group. The prevalence of ID was much higher than that of anemia (23.5% (339/1 443) vs. 6.2% (90/1 443) , χ(2)=169.76, P<0.01). Compared with control group, non-anemia ID group showed higher LHD (0.088 (0.093) vs.0.073 (0.068), P<0.01) and RDW (0.131±0.013 vs. 0.126±0.008, P<0.01), lower MCV ((80±4) vs. (83±4) fl, P<0.01) and MCHC values ((326±9) vs. (329±8) g/L, P<0.01). IDA group showed higher LHD (0.322(0.544)) and RDW (0.151±0.018), lower MCV ((73±6) fl) and MCHC values((309±14) g/L) than non-anemia ID group (all P<0.01). The area under curve (AUC) values of MCHC, LHD, RDW and MCV for detecting ID were 0.63 (95%CI: 0.60-0.67), 0.63 (95%CI:0.60-0.67), 0.67 (95%CI: 0.63-0.70) and 0.73 (95%CI: 0.69-0.76) respectively. With cutoff limits (MCV<80.2 fl, RDW>0.131 or MCHC<322 g/L), MCV, RDW and MCHC showed higher sensitivity for screening ID than hemoglobin (0.540, 0.469 and 0.336 vs. 0.139, χ(2)=121.70, 87.47, 35.56, all P<0.01). Conclusion: MCV, RDW and MCHC can be used to screen ID in primary health care settings.


Assuntos
Anemia Ferropriva/diagnóstico , Anemia/diagnóstico , Adolescente , Anemia/epidemiologia , Anemia Ferropriva/sangue , Anemia Ferropriva/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Índices de Eritrócitos , Eritrócitos/química , Feminino , Hemoglobinas/química , Humanos , Lactente , Ferro/sangue , Ferro/deficiência , Masculino , Estudos Retrospectivos
10.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32079720

RESUMO

This is the case of a previously healthy 15-month-old girl who initially presented to her primary pediatrician with a 2-week history of intermittent periorbital edema. The edema had improved by the time of the visit, and a urine specimen was unable to be obtained in the clinic. A routine fingerstick demonstrated anemia to 8.8 mg/dL, so the patient was started on ferrous sulfate. She then returned to the emergency department 1 month later with severe periorbital edema and pallor but no other significant symptoms. On physical examination, she was tachycardic with striking periorbital edema and an otherwise normal physical examination. She was noted to have a severe microcytic anemia (hemoglobin of 3.9 mg/dL and mean corpuscular volume of 53.1 fL) and hypoalbuminemia (albumin of 1.9 g/dL and total protein of 3.3 g/dL). The remainder of her electrolytes and liver function test results were within normal limits. A urinalysis was sent, which was negative for protein. Our panel of experts reviews her case to determine a unifying diagnosis for both her severe anemia and her hypoalbuminemia.


Assuntos
Anemia/diagnóstico , Anemia/complicações , Edema/etiologia , Feminino , Humanos , Lactente , Doenças Orbitárias/etiologia , Índice de Gravidade de Doença
11.
Am J Physiol Renal Physiol ; 318(4): F861-F869, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32003597

RESUMO

Serum soluble Fas (sFas) levels are associated with erythropoietin (Epo) hyporesponsiveness in patients with chronic kidney disease (CKD). Whether sFas could predict the need for erythropoiesis-stimulating agent (ESA) usage and its influence in erythropoiesis remain unclear. We evaluated the relation between sFas and ESA therapy in patients with CKD with anemia and its effect on erythropoiesis in vitro. First, we performed a retrospective cohort study with 77 anemic patients with nondialysis CKD. We performed in vitro experiments to investigate whether sFas could interfere with the behavior of hematopoietic stem cells (HSCs). HSCs were isolated from umbilical cord blood and incubated with recombinant sFas protein in a dose-dependent manner. Serum sFas positively correlated with Epo levels (r = 0.30, P = 0.001) but negatively with hemoglobin (r = -0.55, P < 0.001) and glomerular filtration rate (r = -0.58, P < 0.001) in patients with CKD at baseline. Elevated sFas serum levels (4,316 ± 897 vs. 2,776 ± 749, P < 0.001) with lower estimated glomerular filtration rate (26.2 ± 10.1 vs. 33.5 ± 14.3, P = 0.01) and reduced hemoglobin concentration (11.1 ± 0.9 vs. 12.5 ± 1.2, P < 0.001) were identified in patients who required ESA therapy compared with patients with non-ESA. Afterward, we detected that the sFas level was slight correlated with a necessity of ESA therapy in patients with nondialysis CKD and anemia. In vitro assays demonstrated that the erythroid progenitor cell frequency negatively correlated with sFas concentration (r = -0.72, P < 0.001). There was decreased erythroid colony formation in vitro when CD34+ HSCs were incubated with a higher concentration of sFas protein (1.56 ± 0.29, 4.33 ± 0.53, P < 0.001). Our findings suggest that sFas is a potential predictor for ESA therapy in patients with nondialysis CKD and that elevated sFas could affect erythropoiesis in vitro.


Assuntos
Anemia/sangue , Eritropoese , Células-Tronco Hematopoéticas/metabolismo , Células-Tronco Multipotentes/metabolismo , Insuficiência Renal Crônica/complicações , Receptor fas/sangue , Adulto , Idoso , Anemia/diagnóstico , Anemia/tratamento farmacológico , Anemia/etiologia , Biomarcadores/sangue , Brasil , Células Cultivadas , Tomada de Decisão Clínica , Bases de Dados Factuais , Eritropoese/efeitos dos fármacos , Eritropoetina/sangue , Feminino , Hematínicos/uso terapêutico , Células-Tronco Hematopoéticas/efeitos dos fármacos , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Células-Tronco Multipotentes/efeitos dos fármacos , North Carolina , Seleção de Pacientes , Valor Preditivo dos Testes , Proteínas Recombinantes/farmacologia , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos
12.
PLoS One ; 15(2): e0228330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027674

RESUMO

Inter-pregnancy interval is an important determinant of both maternal and child health. Suboptimal inter-pregnancy interval has been associated with adverse maternal outcomes -including postpartum hemorrhage and hypertensive disorders, direct causes of maternal mortality. Both overall maternal mortality and the contribution of postpartum hemorrhage on maternal mortality have increased in Tanzania. If we are to achieve sustainable development goal (SDG) number 3.1 to reduce the global maternal mortality ration to less than 70 per 100,000 live births by 2030, it is highly important that such contributors are dealt with. This study aimed to determine the distribution and trends of inter-pregnancy interval and to deduce its association with adverse maternal outcomes among women who delivered at Kilimanjaro Christian Medical Centre (2000-2015).A retrospective cohort study was designed using Kilimanjaro Christian Medical Centre medical birth registry data for women who delivered from 2000 to 2015. Women with at least two births recorded in the registry were included. A total of 7,995 births from 6,612 mothers were analyzed. Anemia during pregnancy, post-partum hemorrhage and pre-eclampsia were adverse maternal outcomes of interest. Data analysis was performed using multivariable logistic regression models allowing for robust standard errors. Crude and adjusted odds ratio with their respective 95% confidence intervals were estimated. More than half (51.7%) of non-first births were born within sub-optimal IPI. The median IPI was 34 months (IQR: 33.5 months). The median IPI increased from 11 months in 2002 to 35 months in 2006 and plateaued until 2014, but it rose to 41.6 months in 2015. Median IPI was shorter in young women <20 years and in birth order seven and above (16 vs. 27 months, respectively). Short IPI was associated with lower risk of pre-eclampsia [aOR: 0.71, 95%CI: 0.52, 0.97] while long IPI was associated with lower risk of post-partum hemorrhage [aOR: 0.70, 95%CI: 0.52, 0.94]. This study found an association between long and short IPI with adverse maternal outcomes. Even though these results should be interpreted with caution based on the fact that the data was sampled from a referral hospital and hence there could be overrepresentation of women with maternal complications, our findings still warrant the importance of supporting modern family planning methods as a measure to improve IPI and thereby improve maternal outcomes as well.


Assuntos
Anemia/diagnóstico , Intervalo entre Nascimentos/estatística & dados numéricos , Hemorragia Pós-Parto/diagnóstico , Pré-Eclâmpsia/diagnóstico , Adulto , Fatores Etários , Feminino , Humanos , Modelos Logísticos , Mortalidade Materna , Razão de Chances , Gravidez , Sistema de Registros , Estudos Retrospectivos , Tanzânia , Adulto Jovem
13.
Curr Opin Anaesthesiol ; 33(2): 220-226, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32004168

RESUMO

PURPOSE OF REVIEW: Red cell transfusions are commonly used in management of hemorrhage in trauma patients. The appropriate indications and criteria for transfusion are still debated. Here, we summarize the recent findings on the use of red cell transfusion in trauma setting. RECENT FINDINGS: Recent evidence continues to support the long-established link between allogeneic transfusion and worse clinical outcomes, reinstating the importance of more judicious use of allogeneic blood and careful consideration of benefits versus risks when making transfusion decisions. Studies support restrictive transfusion strategies (often based on hemoglobin thresholds of 7-8 g/dl) in most patient populations, although some argue more caution in specific populations (e.g. patients with traumatic brain injury) and more studies are needed to determine if these patients benefit from less restrictive transfusion strategies. It should be remembered that anemia remains an independent risk factor for worse outcomes and red cell transfusion does not constitute a lasting treatment. Anemia should be properly assessed and managed based on the cause and using hematinic medications as indicated. SUMMARY: Although the debate on hemoglobin thresholds for transfusion continues, clinicians should not overlook proper management of the underlying issue (anemia).


Assuntos
Transfusão de Eritrócitos , Hemorragia/terapia , Ferimentos e Lesões/terapia , Anemia/diagnóstico , Anemia/terapia , Hemoglobinas/análise , Humanos
14.
Knee ; 27(1): 249-256, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31911082

RESUMO

OBJECTIVES: To study the significance of checking post-operative hemoglobin and hematocrit following unicompartmental knee arthroplasty (UKA). SETTING: Single center. Multiple surgeons. DESIGN: Retrospective case series. Level of evidence IV. MATERIALS AND METHODS: Following institutional approval, a retrospective analysis of all patients undergoing UKA at our level one academic university hospital was conducted. Operative records of all patients undergoing primary UKA were reviewed between March 2016 and March 2019. Patients' pre-operative hemoglobin and hematocrit, BMI, co-morbidities, application of tourniquet, tourniquet time, administration of tranexamic acid, need for post-operative blood transfusion, hospital length of stay, complications, and re-admission were all recorded. Blood loss was estimated using the post-operative hematocrit. RESULTS: A total number of 155 patients were included. There were 70 females (45%) and 85 males (55%). The mean age was 66 ±â€¯10 years. Median pre-op blood volume was 4700 mLs (interquartile range (IQR); 4200-5100). Median blood loss was 600 mLs (IQR; 400-830). Mean pre-op hemoglobin was 135 ±â€¯14 g/L and mean post-op hemoglobin was 122 ±â€¯13 g/L. No patient had a post-op hemoglobin under 80 g/L (range 93-154). No patients in our study needed transfusion. CONCLUSION: The results of our study indicated that post-operative hemoglobin and hematocrit check proved unnecessary in all of our patients and could have been omitted from post-operative routines. We conclude that routine post UKA check of hemoglobin and hematocrit can be avoided and be saved for special circumstances depending on patient's physiology.


Assuntos
Anemia/diagnóstico , Artroplastia do Joelho/efeitos adversos , Transfusão de Sangue , Hemoglobinas/análise , Idoso , Anemia/sangue , Anemia/etiologia , Anemia/terapia , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica , Testes Diagnósticos de Rotina , Feminino , Hematócrito , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Período Pós-Operatório , Estudos Retrospectivos , Torniquetes
15.
Am J Obstet Gynecol ; 222(1): 81.e1-81.e13, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31306649

RESUMO

BACKGROUND: Doppler ultrasound measurements of the peak systolic velocity of the middle cerebral artery can be used to noninvasively diagnose fetal anemia but are less precise following fetal blood transfusion and in late gestation. We have previously demonstrated the feasibility of estimating fetal hematocrit in vitro using magnetic resonance imaging relaxation times. Here we report the use of magnetic resonance imaging as a noninvasive tool to accurately detect fetal anemia in vivo. OBJECTIVES: This study has 2 objectives: (1) to determine the feasibility and accuracy of magnetic resonance imaging in estimating hematocrit in anemic fetuses and (2) to compare magnetic resonance imaging and middle cerebral artery Doppler in detecting moderate to severe fetal anemia. STUDY DESIGN: Fetuses undergoing fetal blood sampling or transfusion underwent magnetic resonance imaging examinations prior to and following their procedures at 1.5 Tesla (Siemens Avanto). A modified Look-Locker inversion pulse sequence and T2 preparation sequence were applied for T1 and T2 mapping of the intrahepatic umbilical vein. Estimated fetal hematocrit was calculated using a combination of T1 and T2 values and compared with conventional hematocrit obtained from fetal blood samples and middle cerebral artery Doppler measurements. RESULTS: Twenty-three fetuses were assessed during 33 magnetic resonance imaging scans. The mean absolute difference between the laboratory and magnetic resonance imaging-estimated hematocrit was 0.06 ± 0.05 with a correlation of 0.77 (P < .001) determined by a multilevel, mixed-effects model adjusting for the repeated measurements from the same participants, multiple gestation pregnancies, and the scan type (ie, before or after transfusion scan). Bland-Altman analysis revealed a systematic bias of -0.03 between the magnetic resonance imaging and fetal blood sampling measurements. Magnetic resonance imaging and middle cerebral artery Doppler had similar sensitivities of approximately 90% to detect moderate to severe anemia. However, magnetic resonance imaging had a higher specificity (93% [13/14], 95% confidence interval, 66-100%) than Doppler (71% [10/14], 95% confidence interval, 42-92%). CONCLUSION: Moderate to severe fetal anemia can be detected noninvasively by magnetic resonance imaging with high sensitivity and specificity. Our results suggest an adjunct role for magnetic resonance imaging in fetuses with suspected anemia, particularly following previous transfusion and in late gestation.


Assuntos
Anemia/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Hematócrito , Artéria Cerebral Média/diagnóstico por imagem , Anemia/diagnóstico , Anemia/terapia , Velocidade do Fluxo Sanguíneo , Incompatibilidade de Grupos Sanguíneos/complicações , Transfusão de Sangue Intrauterina , Estudos Transversais , Feminino , Sangue Fetal/metabolismo , Doenças Fetais/diagnóstico , Doenças Fetais/terapia , Transfusão Feto-Fetal/complicações , Transfusão Feto-Fetal/terapia , Humanos , Imagem por Ressonância Magnética , Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Ultrassonografia Doppler
16.
Int J Gynaecol Obstet ; 148(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31556455

RESUMO

OBJECTIVE: To clarify the association between postpartum depression (PPD) and anemia in each stage of pregnancy as well as in the postpartum period. METHODS: A prospective cohort study was conducted between May 2010 and November 2013 at a tertiary hospital in Japan. In total, 1128 women were assessed using the Edinburgh Postpartum Depression Scale (EPDS) at postpartum week 4 and a blood test was performed in the second trimester (24-28 weeks of gestation), third trimester (35-36 weeks of gestation), and postpartum week 1. The primary outcome was PPD, defined as an EPDS score of 9 or higher. Multivariate logistic regression analysis was used to elucidate the association between anemia and PPD for each period. Additionally, trend analysis was conducted to determine if there was a linear association between maternal hemoglobin concentration and PPD. RESULTS: Postpartum anemia was significantly associated with increased PPD risk (adjusted odds ratio 1.63, 95% confidence interval 1.17-2.26) whereas anemia in the second and third trimesters was not. Similarly, a significant inverse association was observed between the quintiles of maternal hemoglobin levels in the puerperium and the PPD risk (P value for trend 0.004). CONCLUSION: Postpartum anemia was associated with an increased risk of PPD.


Assuntos
Anemia/etiologia , Depressão Pós-Parto/complicações , Doenças do Recém-Nascido/etiologia , Adulto , Anemia/diagnóstico , Depressão Pós-Parto/diagnóstico , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Japão , Razão de Chances , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Adulto Jovem
17.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 378-384, jan.-dez. 2020. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1052935

RESUMO

Objetivo: Comparar características sociodemográficas, comportamentais, condições de saúde e parâmetros laboratoriais entre idosos anêmicos e não anêmicos. Métodos: Estudo epidemiológico transversal realizado com 257 idosos. Para realizar as comparações utilizou-se o teste t para amostras independentes e o teste não paramétrico U de Mann-Whitney. Resultados: Encontrou-se maior proporção de anemia em idosos com idade acima de 80 anos (p=0,026), e maior proporção de dependência para atividades básicas (p=0,018) e instrumentais (p=0,010) da vida diária em idosos com anemia. Identificou-se diferença na distribuição da dosagem dos parâmetros laboratoriais, sendo as concentrações médias de ureia e creatinina maiores nos idosos anêmicos, e esses tiveram menores concentrações de glicemia, albumina, ALT/TGP, cálcio sérico e T3 total. Conclusão: A anemia não está relacionada exclusivamente ao processo de envelhecimento, mas sim resultado de múltiplos fatores como as condições sociodemográficas, de saúde, alimentares e de vida dos idosos


Objective: To compare sociodemographic, behavioral characteristics, health conditions and laboratory parameters among anemic and non - anemic elderly. Methods: Cross-sectional epidemiological study with 257 elderly subjects. To perform comparisons, the t-test for independent samples and the non-parametric Mann-Whitney U test were used. Results: There was a higher proportion of anemia in the elderly over 80 years (p = 0.026), and a higher proportion of dependence on basic activities (p = 0.018) and instrumental (p = 0.010) daily activities in elderly patients with anemia. Differences were observed in the distribution of laboratory parameters, with mean values of urea and creatinine being higher in anemic elderly, with lower concentrations of glycemia, albumin, ALT / TGP, serum calcium and total T3. Conclusion: Anemia is not exclusively related to the aging process, but is a result of multiple factors such as sociodemographic, health, food and life conditions of the elderly


Objetivo: Comparar características sociodemográficas, comportamentales, condiciones de salud y parámetros de laboratorio entre ancianos anémicos y no anémicos. Metodo: Estudio epidemiológico transversal realizado con 257 ancianos. Para realizar las comparaciones se utilizó la prueba t para muestras independientes y la prueba no paramétrica U de Mann-Whitney. Resultados: Se encontró mayor proporción de anemia en ancianos con edad superior a 80 años (p = 0,026), y mayor proporción de dependencia para actividades básicas (p = 0,018) e instrumentales (p = 0,010) de la vida diaria en ancianos con anemia. Se identificó diferencia en la distribución de la dosificación de los parámetros de laboratorio, siendo las concentraciones medias de urea y creatinina mayores en los ancianos anêmicos. Conclusión: La anemia no está relacionada exclusivamente con el proceso de envejecimiento, sino el resultado de múltiples factores como las condiciones sociodemográficas, de salud, alimentos y de vida de los ancianos


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Idoso/estatística & dados numéricos , Anemia/diagnóstico , Anemia/etiologia , Fatores Socioeconômicos , Saúde do Idoso , Estudos Transversais , Nutrição do Idoso
18.
Ann Vasc Surg ; 62: 295-303, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449946

RESUMO

BACKGROUND: The vast majority of patients undergoing hemodialysis (HD) are anemic. The severity of anemia in these patients may influence the postoperative outcomes and the durability of vascular access. Thus, the purpose of this study is to assess the association between anemia and adverse outcomes in patients undergoing HD access placement (arteriovenous grafts and fistula). METHODS: Patients with chronic kidney disease stages IV and V recorded in the Vascular Quality Initiative Hemodialysis database between 2011 and 2017 were included. Patients were divided into 3 study groups based on preoperative hemoglobin (Hgb) levels: normal/mild anemia (Hgb: females ≥10 g/dL, males ≥12 g/dL), moderate anemia (Hgb: females: 7-9.9 g/dL, males: 9-11.9 g/dL), and severe anemia (Hgb: females<7 g/dL, males<9 g/dL). Multivariable logistic and Cox regression analyses were implemented to evaluate the association between anemia and 30-day mortality and primary patency (PP) at 1 year. RESULTS: A total of 28,000 patients undergoing HD access surgery were identified (normal/mild [42%], moderate [49%], and severe [9%] anemia). Postoperative bleeding (2.1% vs. 2.2% vs. 2.2%) and 30-day outcomes including swelling (0.4% vs. 0.5% vs. 0.7%) and wound infection (0.4% vs. 0.3% vs. 0.1%) were similar in mild/normal, moderate, and severe anemia groups, respectively (All P > 0.05). However, 30-day mortality was significantly higher in patients with severe anemia compared with normal/mild and moderate anemia (2.1% vs. 1.1% and 1.1%, P < 0.001). After adjusting for potential confounders, severe anemia was associated with 90% higher risk of 30-day mortality (odds ratio [95% confidence interval]: 1.90 [1.20-3.00], P = 0.006) and 17% increase in PP loss at 1 year (adjusted hazard ratio [95% confidence interval]: 1.17 [1.02-1.35], P = 0.01) compared with the normal/mild anemia group. However, no significant difference was seen between normal/mild and moderate anemia. CONCLUSIONS: In this large study of patients undergoing HD access placement, severe anemia was associated with 90% increased risk of 30-day mortality and 17% increased risk of loss of PP compared with those with normal/mild anemia. Management of severe anemia before surgery might be indicated to reduce operative mortality and improve the durability of HD access.


Assuntos
Anemia/sangue , Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular , Hemoglobinas/metabolismo , Diálise Renal , Insuficiência Renal Crônica/terapia , Idoso , Anemia/diagnóstico , Anemia/mortalidade , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/mortalidade , Biomarcadores/sangue , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Grau de Desobstrução Vascular
19.
Support Care Cancer ; 28(1): 155-161, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30993448

RESUMO

PURPOSE: Chemotherapy-induced anemia is a frequent complication of systemic chemotherapy and is associated with decreased functional capacity and quality of life. The objective of this study was to identify the candidate variables most likely to be associated with chemotherapy-induced severe anemia (hemoglobin < 8 g/dL) in patients treated with cytotoxic chemotherapy. METHODS: A total of 14 clinical and laboratory covariates were prospectively evaluated at baseline in a cohort of consecutive cancer patients receiving cytotoxic chemotherapy. The anemia risk category for each chemotherapy regimen used was determined based on pivotal trials published in the literature. All regimens were classified to three categories (high risk, intermediate risk, and low risk). Logistic regression analysis adjusted for the regimen risk was used to determine the candidate risk factors associated with chemotherapy-induced anemia. RESULTS: A total of 305 patients were included in the study. Administration of high-risk regimens (i.e., regimens with ≥ 20% risk of anemia in a pivotal trial) was demonstrated to be a novel independent predictive factor for severe anemia (odds ratio 3.33, p = 0.005). Considering regimen risk as an adjustment factor, 5 readily available predictors including low hemoglobin, body mass index (BMI) less than 23 kg/m2, low hematocrit, high haptoglobin, and high ferritin were associated with the outcome. CONCLUSIONS: The application of these candidate predictors would be helpful in classifying patients at risk for severe anemia, who might be appropriate candidates for prophylactic erythropoietin. Multivariable models including such promising candidate predictors need to be developed.


Assuntos
Anemia/induzido quimicamente , Anemia/diagnóstico , Antineoplásicos/efeitos adversos , Neoplasias/tratamento farmacológico , Adulto , Idoso , Anemia/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
20.
PLoS One ; 14(12): e0225731, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31794569

RESUMO

BACKGROUND: Anemia is a major cause of global morbidity and mortality, particularly among children. Management of anemia depends on causes and severity of anemia. However blood transfusion is a lifesaving intervention in severe and life-threatening anemia. There are no published data on blood transfusion for anemia in Sudan. METHODS: A descriptive study was conducted in Gadarif Hospital in eastern Sudan during 1 August, 2017 to 31 March, 2018. Consecutive children who presented at the emergency room with an indication for blood transfusion were enrolled in the study. A detailed history was gathered from all patients. Physical examinations, including vital signs, were performed. The World Health Organization guidelines for blood transfusion were followed. RESULTS: During the study period, a total of 1800 children were admitted to the emergency pediatric ward in Gadarif Hospital and were assessed for anemia, 513 (28.5%) were anemic and 141 (7.8%) had severe anemia. Three hundred anemic children received blood transfusion. The median (interquartile) of the age of the 300 children who received blood transfusion was 4.2 4.2(2.0-9.0) years. A total of 148 (49.3%) of the children were boys and 151 (50.3%) were younger than 5 years. The diagnoses associated with the order for blood transfusion were sickle cell disease (129, 43.0%), active bleeding (58, 19.3%), malaria (50, 16.7%), visceral leishmaniasis (25, 8.3%), severe acute malnutrition (16, 5.30%), snake bite (11, 3.7%), sepsis (5, 1.7%), and others. Two hundred eighty-five (95.0%) children improved, nine children were discharged against medical advice, and six (2.0%) children died. CONCLUSION: There is a high burden of anemia in eastern Sudan. Sickle cell disease, malaria, and visceral leishmaniasis are the main causes of anemia in this region. Further research on blood transfusion is needed.


Assuntos
Anemia/terapia , Transfusão de Sangue , Serviço Hospitalar de Emergência , Anemia/diagnóstico , Criança , Pré-Escolar , Feminino , Hemoglobinas/metabolismo , Humanos , Masculino , Sudão , Resultado do Tratamento
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