Ischemic Stroke in Patients With Pulmonary Arteriovenous Fistulas

Background and Purpose: Pulmonary arteriovenous fistulas (PAVFs) are a treatable cause of acute ischemic stroke (AIS), not mentioned in current American Heart/Stroke Association guidelines. PAVFs are recognized as an important complication of hereditary hemorrhagic telangiectasia. Methods: The prevalence of PAVF and hereditary hemorrhagic telangiectasia among patients admitted with AIS in the United States (2005–2014) was retrospectively studied, utilizing the Nationwide Inpatient Sample database. Clinical factors, morbidity, mortality, and management were compared in AIS patients with and without PAVF/hereditary hemorrhagic telangiectasia. Results: Of 4 271 910 patients admitted with AIS, 822 (0.02%) were diagnosed with PAVF. Among them, 106 of 822 (12.9%) were diagnosed with hereditary hemorrhagic telangiectasia. The prevalence of PAVF per million AIS admissions rose from 197 in 2005 to 368 in 2014 ( P trend , 0.026). Patients with PAVF were younger than AIS patients without PAVF (median age, 57.5 versus 72.5 years), had lower age-adjusted inpatient morbidity (defined as any discharge other than home; 39.6% versus 46.9%), and had lower in-hospital case fatality rates (1.8% versus 5.1%). Multivariate analyses identified the following as independent risk markers (odds ratio [95% CI]) for AIS in patients with PAVF: hypoxemia (8.4 [6.3–11.2]), pulmonary hemorrhage (7.9 [4.1–15.1]), pulmonary hypertension (4.3 [4.1–15.1]), patent foramen ovale (4.2 [3.5–5.1]), epistaxis (3.7 [2.1–6.8]), venous thrombosis (2.6 [1.9–3.6]), and iron deficiency anemia (2 [1.5–2.7]). Patients with and without PAVF received intravenous thrombolytics at a similar rate (5.9% versus 5.8%), but those with PAVF did not receive mechanical thrombectomy (0% versus 0.7%). Conclusions: Pulmonary arteriovenous fistula–related ischemic stroke represents an important younger demographic with a unique set of stroke risk markers, including treatable conditions such as causal PAVFs and iron deficiency anemia.

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Abstract P612: Iron Deficiency Anemia and Ischemic Stroke in Patients With Pulmonary Arteriovenous Fistulas

Stroke ◽

10.1161/str.52.suppl_1.p612 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Karan Topiwala ◽

Smit Patel ◽

Mubashir Pervez ◽

Claire Shovlin ◽

Mark J Alberts

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Stroke Risk ◽

Paradoxical Embolism ◽

Deficiency Anemia ◽

Risk Markers ◽

Arteriovenous Fistulas ◽

Stroke Risk Factors ◽

Pulmonary Arteriovenous Fistulas

Introduction: Pulmonary-arteriovenous-fistulas (PAVFs) are pathologic right-to-left shunts resulting in paradoxical embolism causing acute-ischemic-stroke (AIS). Recent single-center studies have identified that in patients with AIS associated with PAVF (AIS-P), traditional stroke risk-factors are not prominent and instead stroke-risk is associated with low serum iron. Single-centre studies have the risk of introducing a selection bias, while multicentre trials are challenging since PAVF still remains a rare and under-recognised entity. We thus seek epidemiological validation of such stroke predictors in patients with PAVF. Methods: We conducted a retrospective analysis of all AIS-admissions within the Nationwide-Inpatient-Sample (NIS) database (2005-2014). Baseline characteristics were compared across AIS populations [AIS-P (with PAVF) and R(routine)-AIS (without PAVF)]. We also compared morbidity, mortality and management trends of AIS in patients with and without PAVF. Results: Of 4,271,910 patients admitted with AIS, 822 (0.02%) were diagnosed with a PAVF. Over this decade the prevalence of PAVF per million AIS-admissions, rose from 197 to 368 (P trend =0.026). Patients with PAVF were younger with a median age (IQR) of 57.5 (42.2 -70.4) years vs. 72.5 (60.8-82.1) years (p<0.001); but had comparable age-adjusted inpatient morbidity (χ 2 p=0.71) and all-cause mortality (χ 2 p=0.26). On multivariate analyses, the odds ratios (95% confidence-interval) favouring PAVF as the cause for AIS were 9.0 (6.79-11.94) for hypoxemia, 4.64 (3.84-5.60) for patent-foramen-ovale, 4.52 (3.42-5.97) for pulmonary hypertension, 4.07(2.23-7.44) for epistaxis, and 2.12 (1.60-2.82) for iron deficiency anaemia [all p-values <0.001]. Conclusion: Pulmonary-arteriovenous-fistula related AIS represents a significantly younger demographic, which suffers inpatient morbidity and mortality comparable to routine ischemic-stroke. They carry a unique set of stroke-risk markers, including treatable conditions such as iron deficiency anemia. Further studies are needed to examine a causal role for such markers on ischemic-stroke risk in this cohort.

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Association of Iron Deficiency Anemia with Stroke Severity in patients with Acute Ischemic Stroke

10.53350/pjmhs2115113004 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3004-3006

Author(s):

Rabia Rathore ◽

Nasir Farooq Butt ◽

Adil Iqbal ◽

Hina Latif ◽

Mariam Azeem ◽

...

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Descriptive Study ◽

World Health ◽

Deficiency Anemia ◽

P Value ◽

Stroke Severity ◽

Cross Sectional

Aim: To study the relationship of Iron Deficiency anemia (IDA) with severity of acute ischemic stroke. Study Design: A cross-sectional descriptive study. Place & Duration of Study: Department of Medicine, Mayo Hospital, Lahore from March 2020 to February 2021 Methods: A descriptive study of cross-sectional type was done on 200 individuals who had acute ischemic stroke (AIS) and were hospitalized at Mayo Hospital Lahore. Consecutive non-probability convenience sampling method was used to gather the data. Severity of stroke was assessed at the time of admission using the National Institute of Health Stroke Scale, (NIHSS) at the same time blood complete examination along with peripheral blood film was done to diagnose anemia in these patients. Iron studies were done to diagnose iron deficiency anemia (IDA). P-value less than 0.05 was taken as significant. Results: About 200individuals presenting with AIS were enrolled in the research work. Anemia according to World Health Organization was seen in 80(40%) and was not present in 120(60%) patients. Among the subjects who had anemia, 16(20%) had a minor AIS, 23(28.75%) had a moderately severe AIS, and 41(51.25%) reported with a severe AIS, according to NIHSS criteria. A notable relationship was found to exist between anemia and stroke severity, (P-value 0.000). Conclusion: Anemia was a commonly found in individuals with acute stroke due to ischemia and had direct relation with severity of stroke. Keywords: Iron deficiency Anemia, severity, ischemic stroke.

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Iron Deficiency Anemia Related to Hereditary Hemorrhagic Telangiectasia: Response to Treatment With Bevacizumab

The American Journal of the Medical Sciences ◽

10.1097/maj.0b013e3182429866 ◽

2012 ◽

Vol 343 (3) ◽

pp. 249-251 ◽

Cited By ~ 14

Author(s):

Jessica M. Fleagle ◽

Ravi K. Bobba ◽

Carl G. Kardinal ◽

Carl E. Freter

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Hereditary Hemorrhagic Telangiectasia ◽

Response To Treatment ◽

Deficiency Anemia

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Socio-economic status, iron deficiency anemia and COVID-19 disease burden – an appraisal

European Journal of Clinical and Experimental Medicine ◽

10.15584/ejcem.2021.1.8 ◽

2021 ◽

Vol 19 (1) ◽

pp. 52-58

Author(s):

Kusum Ghosh ◽

◽

Diptendu Chatterjee ◽

Abhisikta Ghosh Roy ◽

Arup Ratan Bandyopadhyay ◽

...

Keyword(s):

Iron Deficiency ◽

Infectious Diseases ◽

Iron Deficiency Anemia ◽

Economic Status ◽

Case Fatality ◽

Therapeutic Interventions ◽

Deficiency Anemia ◽

Iron Stores ◽

Socio Economic Status ◽

Mild Anemia

Introduction. Severe Acute Respiratory Syndrome-2, possesses varying degrees of susceptibility and lethality worldwide and WHO declared this as a pandemic of this century. Aim. In this background, the aim of this present narrative is to provide a complementary overview of how low iron stores and mild anemia offers protection from infectious diseases like COVID-19 by restricting the viral replication and also to suggest some potential adjuvant therapeutic interventions. Material and methods. Therefore, we performed a literature search reviewing pertinent articles and documents. PubMed, Google Scholar, Chemrxiv, MedRxiv, BioRxiv, Preprints and ResearchGate were investigated. Analysis of the literature. Recent studies reported drastic systemic events taking place that contribute to the severe clinical outcomes such as decreased hemoglobin indicating anemia, hypoxia, altered iron metabolism, hypercoagulability, oxidative stress, cytokine storm, hyper-ferritinemia and thus Multi Organ Failure, reportedly hailed as the hallmark of the COVID-19 hyper- inflammatory state. Interestingly it is globally observed that, countries with higher Socio-economic status (SES) have considerably lower prevalence of Iron Deficiency Anemia (IDA) but higher Case Fatality Rate (CFR) rate due to COVID-19 while, low SES countries characterized by the higher prevalence of IDA, are less affected to COVID-19 infection and found to have less CFR, which is almost half to that of the higher SES counterpart. Conclusion. Present review presumed that,low iron stores and mild anemia may play a beneficial role in some cases by offering protection from infectious diseases as low iron restricts the viral replication.Thus, suggested iron chelation or iron sequestration as an alternative beneficial adjuvant in treating COVID-19 infection.

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A Case of Acute Ischemic Stroke Associated with Hookworm Anemia.

10.21203/rs.3.rs-198581/v1 ◽

2021 ◽

Author(s):

Jiang-qiong Ke ◽

Huicong Huang ◽

Guangyao Zhou ◽

Yan Li ◽

Shengmin Shao ◽

...

Keyword(s):

Bone Marrow ◽

Ischemic Stroke ◽

Iron Deficiency ◽

Cerebral Infarction ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Deficiency Anemia ◽

Cerebral Stroke ◽

Parasitic Diseases ◽

Normal Brain

Abstract Background: Hookworm disease discovered in a patient presenting with cerebral infarction due to severe iron-deficiency anemia and confirmed by gastroduodenoscopy has not been reported especially with negative stool routine. Case presentation: We report a male patient who presented himself to us with acute cerebral stroke verified as hookworm disease. Routine laboratory tests revealed low Hemoglobin (Hb) concentration but stool routine and occult blood test were normal. Brain magnetic resonance imaging (MRI) showed left-sided parietal-occipital lobe and centrum semiovale (“watershed”) infarction verified the diagnosis of acute ischemic stroke. Bone marrow aspiration showed proliferative bone marrow image with obvious red system hyperplasia. Gastroduodenoscopy discovered adult hematophagic hookworms in the bulb and descending part of duodenum of the patient. A series of conservative drug treatment was initiated and the patient was subsequently treated with albendazole after the gastroduodenoscopy. Twenty-five days later, the patient's physical function improved gradually and he was discharged without neurological deficit. Conclusion: Hookworm disease could be manifest in acute ischemic stroke. It was concluded that patients with severe iron-deficiency anemia should also be examined for rare intestinal parasitic diseases. Screening for these intestinal parasitic diseases in patients presenting with cerebral infarction and anemia could effectively avoid misdiagnosis and make increase the efficacy of treatment.

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Incidence of Thromboembolic Disease in Hereditary Hemorrhagic Telangiectasia (Osler Weber Rendu Syndrome)

Blood ◽

10.1182/blood-2018-99-112945 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4967-4967

Author(s):

Marcelo Martin Serra ◽

Cristina Maria Elizondo ◽

Marina Alonso ◽

Veronica Peuchot ◽

Fernando Javier Vazquez

Keyword(s):

Iron Deficiency ◽

General Population ◽

Iron Deficiency Anemia ◽

Hereditary Hemorrhagic Telangiectasia ◽

Anticoagulation Therapy ◽

Thromboembolic Disease ◽

Deficiency Anemia ◽

Thromboembolic Events ◽

Number Of Patients ◽

Venous Thromboembolic Events

Abstract The Hereditary Hemorrhagic Telangiectasia (HHT) is a rare autosomal dominant vascular dysplasia that affects 1-5000 individuals worldwide. Is characterized by fragile mucocutaneous telangiectasia and vascular malformations in organs such as brain, lungs, liver and the gastrointestinal tract. Nose and gastrointestinal bleeding are remarkable, leading to frequent iron deficiency anemia (IDA) or life threatening bleeding episodes. Venous thromboembolic events (VTE) in HHT are probably more frequent than general population due to high plasmatic levels of FVIII specially in clinical conditions like long time immobilization due to brain abscesses or severe anemia. Additionally, in those patients with pulmonary fistula, the thromboembolic events can produce paradoxal strokes. On the other hand, almost all HHT medical treatments usually used to treat HHT related bleeding could produce thromboembolic disease. Anticoagulation (ACO) in this bleeding condition is a challenge, nevertheless, almost 50% can tolerate it well. Objective: To report the incidence of VTE in the HHT population. Methods: Ambispective cohort of adult based on the Institutional Registry of HHT. VTE was defined as the first episode of pulmonary embolism (PE), deep venous thrombosis (VTE) or thrombosis in the fistula sac or the progression of a prior event after its first 48 hs despite anticoagulation. Result: Over 524 patients 394 adults with HHT confirmed by Curazao criteria or positive genetic test and complete data were included. There were 18 VTE events 4.6% (CI95% 2.7-6.8%), 9 DVT (2.3% IC95% 1.2-4.4%) and 3 PE (0.7% IC95% 0.13-2%). The female gender represents 72%. The median age at the event was 67 years (IIQ 25-75% 56-73). Five patients (27%) were on ACO prior to the event, mainly for atrial fibrillation, and 3(18%) suffered a previous VTE. The most frequent risk factors were recent hospitalization (44%) and iron deficiency anemia (44%), immobility (33%), recent surgery (18%), as well as cancer (5%) and recent travel (5%) patient each.Fifteen (83%) patients received ACO, 10(55%) received LMH followed by acenocumarol, 3(30%) of which had to be stopped due to nose or gastrointestinal bleeding.In 5 (27%) a cava vein filter were inserted, of which 3 are under anticoagulation therapy. Conclusion: VTE incidence in our study was significantly higher than reported in general population at similar age. However, the inclusion of more symptomatic and serious HHT patients could be selection bias. The low number of patients, may influence the results. IDA and hospitalization were the most important associated conditions. Most patients tolerated well the anticoagulation therapy. Disclosures No relevant conflicts of interest to declare.

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655: A CASE OF ACUTE ISCHEMIC STROKE IN A TODDLER WITH SEVERE IRON DEFICIENCY ANEMIA

Critical Care Medicine ◽

10.1097/01.ccm.0000808944.11216.91 ◽

2021 ◽

Vol 50 (1) ◽

pp. 320-320

Author(s):

Yezan Abderrahman ◽

Niranjan Vijayakumar ◽

Aditya Badheka ◽

Madhuradhar Chegondi

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Deficiency Anemia

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Caso clínico: Acidente Vascular Cerebral Isquêmico em lobo frontal à esquerda associado a anemia ferropriva idiopática / Clinical case: Ischemic Stroke in The Left frontal lobe associated with idiopathic iron deficiency anemia

Brazilian Journal of Development ◽

10.34117/bjdv7n12-523 ◽

2021 ◽

Vol 7 (12) ◽

pp. 118067-118071

Author(s):

Gabriela Roriz De Deus ◽

Flávia Borges Carapina Santos ◽

Carla Soares Alves ◽

Claudia Soares Alves ◽

Jordanna de Paula Felipe Mendes ◽

...

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Frontal Lobe ◽

Iron Deficiency Anemia ◽

Clinical Case ◽

Deficiency Anemia ◽

Left Frontal Lobe

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Hypersensitivity reactions to intravenous ferric carboxymaltose in a patient with iron deficiency anemia: a rare case report

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20181657 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1036

Author(s):

Shadma H. Quazi ◽

Sushil K. Varma ◽

Sharjeel H. Khan ◽

Sonali S. Kirde ◽

Harshada Arun Bhoware

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Poor Response ◽

The United States ◽

Deficiency Anemia ◽

Ferric Carboxymaltose ◽

Hypersensitivity Reactions ◽

Rare Case Report

Ferric carboxymaltose (FCM) is a non-dextran iron preparation recently approved in the United States for intravenous treatment of iron deficiency anemia (IDA) in adult patients with intolerance or poor response to oral iron therapy. Acute hypersensitivity reactions (HSRs) during iron infusions are very rare but can be life-threatening. Adverse events, including immune system disorders (0% in FCM) and skin disorders (7.3% in FCM), are less frequently observed with FCM. On treatment with FCM, the change in hemoglobin from baseline to the highest observed level is about 2.8g/dL. Treatment of IDA with FCM resulted in fewer hypersensitivity reactions. Here, authors report a case of a 23 years old female diagnosed for IDA presented with the picture of adverse drug reaction due to injection FCM given by the physician. The patient was managed with Antibiotics, Corticosteroids and Intravenous fluids and recovered well within 12 hours of admission from this adverse drug reaction. Since such cases have been rarely reported, authors are intended to notify about this potentially dangerous drug reaction due to FCM which is used extensively in the treatment of IDA. Hence management of iron infusions requires very careful and precise observation, and, in the event of an adverse reaction, prompt recognition and severity-related interventions by well-trained medical and nursing staff.

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