Hemodialysis Duration with Levels of Hemoglobin, Hematocrit, Serum Iron and Total Iron Binding Capacity on Chronic Kidney Disease

The correlation of the length of time undergoing hemodialysis with the levels of hemoglobin, hematocrit, serum iron and total iron binding capacity in patients with chronic kidney disease at RSUD Prof. Dr. W. Z. Johannes Kupang. People with chronic kidney disease who are performing Hemodialysis suffer from anemia. Blood loss during the hemodialysis process is affected by frequent blood sampling for laboratory tests. To diagnose the occurrence of iron deficiency, anemia laboratory tests such as complete blood, serum iron (SI), TIBC, transferrin saturation, and serum ferritin can be conducted. The objective of this study is to determine the correlation between the length of undergoing Hemodialysis with the levels of Hemoglobin, Hematocrit, Serum Iron, and Total Iron Binding Capacity (TIBC) in patients with chronic kidney disease in RSUD Prof. Dr.W. Z Johannes Kupang. This study employed an anon-reactive research design or unobtrusive research based on secondary data derived from medical record records at RSUD Prof. Dr.W. Johannes in August - September 2019 on 92 hemodialysis patients who met the inclusion criteria. The collected data were calculated with the SPSS application, while the correlation analysis between variables was performed by administering a linear regression analysis test. Ninety-two (92) respondents were obtained by employing the purposive sampling technique. The majority of patients with chronic kidney disease undergoing Hemodialysis were men (57.6%) with ages 39 - 59 years (63.0%), and the majority of patients undergoing Hemodialysis in patients with chronic kidney failure (CKD) were <12 months (41.3%). It was discovered that there was no relationship between the length of Hemodialysis with hemoglobin, hematocrit, serum iron, and total iron-binding capacity levels in patients with chronic kidney disease (CKD).

Decreased Serum Iron Concentration and Total Iron Binding Capacity Are Associated With Serious Crohn’s Disease

Background: This study aimed to investigate whether serum indicators related to iron stores in the body are associated with clinical and endoscopic disease severity.Methods: Eighty-four patients with Crohn’s disease (CD) and twenty-four healthy volunteers were included. The indicators related to iron stores were detected within one week after endoscopic and CT enterography examinations.Results: Patients were divided into three groups according to the CDAI scores. Serum iron levels were decreased in all patient groups (p<0.05), and the values of remission group were higher than those of moderate group (p<0.001). The total iron binding capacity （TIBC） values of the moderate group were lower than those of the controls and the other patient groups (p<0.05). None of the indicators differed significantly among the patients classified by SES-CD (p>0.05). Underweight, decreased serum iron and TIBC were independent risk factors for moderate clinical disease. Combined detection of decreased serum iron and TIBC was helpful in differentiating severe patients. The sensitivity and specificity were 32.7% and 100%, respectively (AUC = 0.812, p<0.01).Conclusions: Decreases in serum iron and TIBC were associated with the clinical activity of CD. Combined detection of the two indicators was conducive to screening patients with serious disease.

Decreased Serum Iron Concentration and Total Iron Binding Capacity Are Associated With Serious Crohn’s Disease

Background This study aimed to investigate whether serum indicators related to iron stores in the body are associated with clinical and endoscopic disease severity. Methods Eighty-four patients with Crohn’s disease (CD) and twenty-four healthy volunteers were included in this retrospective study. Clinical and endoscopic severity of disease was recorded by Crohn’s disease activity index (CDAI) scores and the simple endoscopic score of Crohn’s disease (SES-CD), respectively. The indicators related to iron stores included serum iron (SI), total iron binding capacity (TIBC), ferritin, transferrin (Tf), and transferrin saturation (TSAT%). They were detected within one week after endoscopic and CT enterography examinations. Results Patients were divided into three groups according to the CDAI scores. Serum iron levels were decreased in all patient groups (p < 0.05), and the values of remission group were higher than those of moderate group (p < 0.001). The TIBC values of the moderate group were lower than those of the controls and the other patient groups (p < 0.05). The above two indicators were negatively correlated with CDAI scores (p < 0.05). None of the indicators differed significantly among the patients classified by SES-CD (p > 0.05). Underweight, decreased serum iron and TIBC were independent risk factors for moderate clinical disease. Combined detection of decreased serum iron and TIBC was helpful in differentiating severe patients. The sensitivity and specificity were 32.7% and 100%, respectively (AUC = 0.812, p < 0.01). Conclusions Decreases in serum iron and TIBC were associated with the clinical activity of CD. Combined detection of the two indicators was conducive to screening patients with serious disease.

Extra ordinary high blood lead levels in Mashhad,Iran: a one-year study in a referral center

Introduction: Lead is a heavy metal with vast usage in the industry. Lead toxicity affects any organ in the body. It causes various clinical presentations, which leads to diagnostic complexity. Regarding recent increased observation of cases with lead toxicity in our center, we aimed to evaluate the frequencies of lead toxicity in patients referred to Imam-Reza Hospital’s laboratory and find a possible relationship between the blood lead level (BLL) and hematological and biochemical tests. Methods: From 2016 to 2017, the patients referred to Imam-Reza hospital’s laboratory to detect BLL enrolled in the study. Among them, 254 adult cases with BLLs≥10 μg/dl were selected. Complete blood counts and peripheral blood smear were done. Other lab data were extracted from hospital files. Results: The mean BLL of 1649 participants was 59.11±116.25 μg/dl, ranging from 0 to 1580. Sixty nine percent of them had lead toxicity. Eighty-one percent (n=1341) of patients were males and 18.7% (n=308) were females. In 254 selected cases, the mean BLL was 138.17±189.98 μg/dl. There were significant inverse correlations between BLL and red blood cell counts, hemoglobin, mean cell hemoglobin, total iron-binding capacity, target shape and basophilic stippling, as well as positive correlations between BLL and white blood cell counts, red cell distribution width, neutrophil counts and iron. Conclusion: Lead toxicity seems to be more frequent than it is expected. Patients with unexplained anemia with increased iron and decreased total iron-binding capacity are better to be evaluated for BLL.

THE MAIN PARAMETERS OF IRON METABOLISM IN PATIENTS WITH UROTELIAL BLADDER CANCER AT DIFFERENT DEVELOPMENT STAGES OF MALIGNANT NEOPLASM ANEMIA

The article presents information about the protein responsible for the iron depot in the body – ferritin. Its physiological role and clinical significance are demonstrated. A batophenanthroline method was used to determine the range of iron in the blood serum and the range of the total iron-binding capacity of the blood serum. The range of unsaturated iron-binding capacity of blood serum was calculated as the difference between total iron-binding capacity in blood serum and the range of iron in blood serum. The transferrin saturation coefficient of iron was defined as the ratio of the content of iron in blood serum to the total iron-binding capacity in blood serum. The range of transferrin was determined by the rate of the total iron-binding capacity in blood serum, and ferritin using the radiometric method. The dynamics of changes in ferritin content in malignant neoplasm anemia in patients with bladder cancer has been demonstrated. The conclusion about the importance of this parameter for laboratory diagnosis of iron deficiency and anemia of malignant neoplasms is made.

Pengaruh Terapi Bekam Basah (Wet Cupping) Terhadap Kadar Hemoglobin, Fe, Dan Kadar TIBC (Total Iron Binding Capacity) Pada Pasien Anemia

Bekam sangat berkhasiat untuk berbagai macam penyakit, bekam juga merupakan preventive medicine dan pengobatan simptomatis. Penelitian ini bertujuan untuk mengetahui pengaruh bekam basah terhadap Kadar Hemoglobin, Fe, dan Kadar TIBC pada pasien Anemia. Penelitian quasi experimental dengan pre dan post test tanpa kelompok kontrol, Sampel ditentukan sebanyak 21 orang dan mendapat terapi bekam basah. Analisis data pada penelitian ini dilakukan dengan uji Wilcoxon Signed Ranks Test dan uji T berpasangan. Terdapat perbedaan yang bermakna secara statistik dimana hasil uji didapatkan p value 0,000 pada masing – masing variabel dengan kadar hemoglobin medapatkan pengaruh tertinggi dengan selisih hasil rata – rata post test sebesar -0,266 (SD = 72), kemudian Fe sebesar -0,105 (SD = -0,048), dan selanjutnya pada kadar TIBC -0,67 (SD = -0,167). Terapi bekam basah berpengaruh terhadap peningkatan kadar Hb, Fe, dan penurunan kadar TIBC pada pasien anemia.

Inflammatory diets are associated with lower total iron binding capacity in sera of young adults

Chronic, systemic inflammation, which is associated with obesity and numerous other diseases, impairs iron status by increasing hepcidin concentration. Inflammation also decreases the concentration of transferrin, the main iron transport protein and a negative acute phase protein, which is indirectly assessed by measuring total iron binding capacity (TIBC). However, the contribution of diet-induced inflammation has not been studied. Data from two studies, namely Diet and Inflammation and Selenium and Inflammation Studies (total n=98) were used to assess the associations among Dietary Inflammatory Index (DII®) scores derived from three-day dietary records, body mass index (BMI=weight[kg]/height[m]2), inflammatory and hematological markers among young adults with normal-weight, overweight or obesity. Subjects’ diets were also categorized as less inflammatory diets (LID) and inflammatory diets (ID) using cluster analysis. Independent t-test and regression analyses were used to assess associations in the data. Intakes of iron, proteins, fat, fiber, and calories were higher in the LID group compared to the ID group (p<0.05). Demographic characteristics and concentrations of C-reactive protein (CRP) and iron status biomarkers did not differ significantly between the two groups (p>0.05). Higher DII score was associated with increasing CRP (β+SE=0.23+0.07, p=0.002) and lower TIBC (β+SE=−8.46+3.44, p=0.02), independent of BMI category. The LID diet was associated with higher TIBC (β+SE=29.87+10.75, p=0.007) compared to the ID diet. In conclusion, inflammatory diets may impair iron status by reducing the iron binding capacity of transferrin.

The identification of ketotifen as a novel cardioprotective agent in patients undergoing anthracyclines chemotherapy

Objective: The present study aimed to investigate the possible cardioprotective effects of ketotifen and to assess its activity as an iron-chelating agent in patients receiving anthracyclines for the treatment of breast cancer. Patients & Methods: This was a randomized, prospective, controlled clinical trial. One hundred eleven eligible patients with breast cancer (age range, 30-60 years) were scheduled to receive anthracyclines chemotherapy. The patients were divided into two groups: Patients (n = 56) assigned to the ketotifen group received ketotifen 1 mg three times daily for six consecutive cycles of treatment, and patients assigned to the control group (n = 55) without ketotifen treatment. The echocardiogram for each patient was recorded two times at baseline and the end of the study. As well, blood samples were collected from all patients. Results: The findings showed a statistically significant reduction in the mean serum levels of common cardiotoxicity accompanied biomarkers in the ketotifen group compared with the control group (P ≤ 0.05). The mean serum levels of total iron-binding capacity were significantly elevated in the ketotifen group (P ≤ 0.001). There was a direct correlation between the mean serum levels of iron and that of lactate dehydrogenase (LDH) (r = + 0.79). On the other hand, there were indirect correlations between mean serum levels of LDH and both the percentage of ejection fraction and the total iron-binding capacity (r = - 0.69 and -0.697, respectively). Conclusion: Oral administration of ketotifen appears to be efficient and safe as a novel cardioprotective agent for the prevention of anthracyclines induced cardiotoxicity. Additionally, ketotifen suggested a beneficial effect in iron overload inducing diseases such as COVID-19.

Gagal Ginjal Kronik Hemodialisis dengan Kadar Eritropoietin dan Hemoglobin Normal: Laporan Kasus

Generally, chronic kidney disease (CKD) is associated with anemia due to decrease of erythropoietin that plays an important role in erythropoiesis. We reported a patient, 61-year-old male, suffered from chronic hemodialysis kidney disease with coinfection of viral hepatitis C, albeit, had normal hemoglobin and erythropoietin levels. The patient was diagnosed as CKD in March 2014 with laboratory results, as follows: hemoglobin (Hb) 9.9 g/dl; ureum 223 mg/dl; creatinine 7.5 mg/dl, and was confirmed with ultrasonography. The patient underwent hemodialysis and was treated with erythropoiesis stimulating agent (ESA) for the first time in April 2014. The last ESA was given in June 2015 and the laboratory results were serum iron 61 µg/dl, total iron binding capacity (TIBC) 173 µg/dl, ferritin 1431 ng/ml, and the qualitative anti HCV test was reactive. Afterwards, the patient was not treated with ESA anymore since his Hb level was normal without ESA or blood transfusion. Moreover, the erythropoietin (EPO) level was tested in December 2018 resulted within normal level. Until now, the patient is still undergoing hemodialysis without ESA or transfusion. This is a rare condition, and there is still no certain pathophysiology to explain. It is assumed that the mechanism is related to hepatitis C infection that stimulates the hepatocyte regeneration, therefore, the cells produce endogen erythropoietin resulting in increased Hb level.Keywords: chronic kidney disease (CKD), erythropoietin and hemoglobin level Abstrak: Umumnya penyakit ginjal kronik (PGK) disertai dengan anemia akibat penurunan eritropoietin yang berperan penting dalam proses eritropoiesis. Kami melaporkan kasus seorang laki-laki 61 tahun dengan PGK hemodialisis disertai ko-infeksi hepatitis C namun dengan kadar hemoglobin dan eritropoietin normal. Pasien dinyatakan PGK sejak Maret 2014 dengan kadar hemoglobin (Hb) 9,9 g/dL; ureum 223 mg/dl; kreatinin 7,5 mg/dl, dan didukung oleh hasil ultrasonografi. Pasien diberikan hemodialisis dan terapi ESA pertama kali pada bulan April 2014. Terapi ESA terakhir diberikan pada bulan Juni 2015 dengan hasil serum iron 61 µg/dl, total iron binding capacity (TIBC) 173 µg/dl, feritin 1431 ng/ml, dan anti HCV kualitatif reaktif, Setelah itu pasien tidak mendapat terapi ESA lagi karena pada pemeriksaan laboratorium ditemukan kadar hemoglobin normal tanpa terapi ESA atau transfusi darah. Pemeriksaan kadar eritropoietin (EPO) pada bulan Desember 2018 mendapatkan hasil 16 mIU/ml (nilai normal 2,6-18,5 mIU/ml). Hingga saat ini pasien masih rutin menjalani hemodialisis dan tidak pernah mendapat terapi ESA atau transfusi darah. Keadaan tersebut jarang ditemukan, dan tidak ada patofisologi yang pasti untuk menjelaskan penyebab keadaan tersebut. Mekanisme keadaan ini dikaitkan dengan infeksi hepatitis C yang merangsang regenerasi hepatosit, sehingga sel-sel tersebut menghasilkan hormon ertiropoietin endogen, dengan hasil akhir ialah peningkatan hemoglobin.Kata kunci: penyakit ginjal kronik (PGK), kadar eritropoietin dan hemoglobin

Novel use of Ketotifen as a cardio-protective agent in patients undergoing anthracycline chemotherapy

Objective: The present study aimed to investigate the possible cardioprotective effects of ketotifen and to assess its activity as an iron-chelating agent in patients receiving anthracyclines for the treatment of breast cancer. Patients & Methods: This was a randomized, prospective, controlled clinical trial. 111 eligible patients with breast cancer (age range, 30-60 year) were scheduled to receive anthracycline chemotherapy. The patients divided into two groups: Patients (n=56) assigned to The ketotifen group received ketotifen 1 mg three times daily for six consecutive cycles of treatment, and patients assigned to The control group (n= 55) without ketotifen treatment. The echocardiogram for each patient was recorded two times at baseline and at the end of the study. As well, blood samples were collected from all patients. Results: The findings showed a statistically significant reduction in the mean serum levels of common cardiotoxicity accompanied biomarkers in The ketotifen group compared with The control group (P ≤ 0.05). The mean serum levels of total iron-binding capacity was significantly elevated in The ketotifen group (P ≤ 0.001). There was a direct correlation between the mean serum levels of iron and that of lactate dehydrogenase (LDH) (r = + 0.79). On the other hand, there were indirect correlations between mean serum levels of LDH and both the percentage of ejection fraction and the total iron-binding capacity (r = - 0.69 and -0.697, respectively). Conclusion: Oral administration of ketotifen appears to be efficient and safe as a novel cardioprotective agent for the prevention of anthracyclines induced cardiotoxicity. Additionally, ketotifen suggested a beneficial effect in iron overload inducing diseases such as COVID-19.