The presence of anemia in patients with leg ulcer: laboratory test

ABSTRACT Objective: To evaluate the presence of anemia in patients with chronic lower limb ulcers based on profile and hematometric indices. Method: This is a cross-sectional study carried out in a university hospital in Rio de Janeiro. The sample was composed of 64 participants with lower limb ulcers and evolution time greater than 12 weeks. Data was collected between May/2016 and December/2017 from hematological analyses, records from medical records, and wound assessment form. Results: 36 (56.2%) were male; 38 (59.4%) between 60 and 80 years old; 56 (87.5%) with chronic diseases and 52 (81.2%) with venous ulcers. 6 years mean of active ulceration. Anemia was detected in 36 (56.2%), 27 (75%) of which were normochromic and normocytic; 14 (38.8%) had deficiency anemia recorded in their medical chart. Conclusion: The low hemoglobin concentration is recurrent among the participants characterizing an anemia condition, whose profile reveals congruence to the anemia of chronic disease.

Evaluation of anemia frequency and etiologies in hospitalized patients in a tertiary pediatrics clinic

Objective: Anemia, which is a public health problem on a global scale, continues to maintain its importance in pediatric patients. There are few studies on the prevalence of anemia in hospitalized children. This study was conducted to evaluate the prevalence and etiologies of anemia in hospitalized pediatric patients. Material and Method: This is a cross-sectional epidemiological study. The study group consists of 1000 patients between the ages of 6 months and 18 years who were hospitalized in the Department of Pediatrics of Prof. Dr. Cemil Tascioglu City Hospital. The data of the patients were reviewed retrospectively. The SPSS 22.0 program was used for statistical analyzes and calculations and p< 0.05 was accepted for significance. Results: Of the patients included in the study, 569 (56.9%) were male, and 431 (43.1%) were female. In the study, the number of patients with anemia was 276 (27.6%), and among those 151 (26.5%) were male and 125 (29.0%) were female. The highest rate of anemia in different age groups was in infancy, with 32.3%. The number of patients with iron deficiency anemia was 121 (43.8%), anemia of chronic disease was 42 (15.2%), anemia of acute inflammation was 41 (14.9%), and anemia due to B12 deficiency was 31 (11.2%). It was determined that patients with anemia had a longer hospital stay than those without anemia. Moreover, the hospitalization period of patients with anemia of chronic disease was longer than those with iron deficiency anemia. Conclusion: Anemia is an important problem in hospitalized children as well as in the general population. Iron deficiency is the most common etiology of anemia in hospitalized patients in the pediatric clinic similar to the general population. The hospitalization period was found to be significantly longer in anemic patients than in non-anemic patients. During hospitalization, children should be monitored for anemia and this duration of stay should be regarded as an opportunity to combat anemia or to provide necessary micronutrient or nutritional support to socioeconomically disadvantaged groups.

A Case Report of Using Korean Medicine for the Treatment of Anemia of Chronic Disease (ACD) in a Patient with Dizziness, Anorexia, and General Weakness

The purpose of this study was to report the clinical effect of Korean medicine in a patient with anemia of chronic disease (ACD). The patient was treated with herbal medicine, acupuncture, and moxibustion in combination with Western medicine for around 4 weeks. Although the patient's hemoglobin concentration was maintained at a similar level, the other clinical symptoms of ACD (anorexia, xerostomia, dizziness, and general weakness) were improved after the treatment with Korean medicine. Therefore, Korean medicine treatment may be effective for improving the clinical symptoms of ACD.

Diagnosing a Patient with Erdheim-Chester Disease during the COVID-19 Pandemic

Background: Erdheim-Chester disease (ECD) is a rare hematopoietic neoplasm of histiocytic origin characterized by an insidious course. The coronavirus disease 2019 (COVID-19) pandemic has put an enormous strain on healthcare systems worldwide both directly and indirectly, resulting in the disruption of healthcare services to prevent, diagnose and manage non-COVID-19 disease. Case Presentation: We describe the case of a 58-year-old male patient with sporadic episodes of self-resolving mild fever and anemia of chronic disease with onset two years before the current presentation. Positron emission/computed tomography scan revealed the presence of moderately hypermetabolic perirenal tissue masses. In order to achieve diagnosis, repeated perirenal tissue biopsies were performed, and the diagnostic evaluation was complicated by the strain put on the healthcare system by the COVID-19 pandemic. The patient contracted SARS-CoV-2 and required hospitalization, but recovered fully. No further ECD target organ involvement was documented. Treatment options were presented, but the patient chose to defer treatment for ECD. Conclusion: A high index of suspicion and multidisciplinary team collaboration is paramount to achieve diagnosis in rare conditions such as ECD. Disruptions in healthcare services in the pandemic milieu may disproportionately affect people with rare diseases and further study and effort is required to better meet their needs in the pandemic setting.

Anemia of Chronic Disease in Patients With Cardiovascular Disease

Objective: Anemia is often found in patients with coronary artery disease (CAD) or acute coronary syndrome (ACS) and related to disease severity. Our study investigated the relationship between anemia, iron homeostasis and inflammation in CAD and examined their influence on the outcome of patients.Patients and Methods: Markers of immune activation (neopterin, interleukin [IL]-12, IL-6, high sensitive C-reactive protein (hsCRP), fibrinogen, serum amyloid A [SAA]) and iron metabolism (ferritin, transferrin saturation, hemoglobin) were determined in 2,082 patients (68.7 % men, median age 63 years) from the Ludwigshafen Risk and cardiovascular Health (LURIC) cohort. Patients were followed-up for a median of 9.81 years.Results: 960 patients (46.1 %) presented with chronic CAD, 645 patients (31.0 %) had an ACS, and 477 patients (22.9 %) presented with no CAD in coronary angiography (CAG). Anemia (n = 357, 17.1 %) was associated with disease severity (reflected by more progressed stenosis in CAG, CCS, and NYHA classes, and a lower LV-EF), a higher cardio-cerebrovascular event rate and higher levels of inflammatory markers. Interestingly, anemia was only predictive for an adverse outcome in patients with elevated inflammatory markers. Accordingly, anemia of chronic disease (ACD) was associated with a higher cardio-cerebrovascular event-rate in the subsequent 2 years as compared to patients with other types of anemia or without anemia (14.3 vs. 6.1 vs. 4.0%, p &lt; 0.001).Conclusions: This study confirms that anemia and immune activation are strongly related to cardiovascular disease progression and an adverse outcome. Our data suggest that the association of anemia with disease severity and outcome might mainly be due to underlying inflammation.

Genetically Determined Chronic Low-Grade Inflammation and Hundreds of Health Outcomes in the UK Biobank and the FinnGen Population: A Phenome-Wide Mendelian Randomization Study

BackgroundC-reactive protein (CRP) has been used as a biomarker of chronic low-grade inflammation in observational studies. We aimed to determine whether genetically determined CRP was associated with hundreds of human phenotypes to guide anti-inflammatory interventions.MethodsWe used individual data from the UK Biobank to perform a phenome-wide two-stage least squares (2SLS) Mendelian randomization (MR) analysis for CRP with 879 diseases. Summary-level data from the FinnGen consortium were utilized to perform phenome-wide two-sample MR analysis on 821 phenotypes. Systematic two-sample MR methods included MR-IVW, MR-WME, MR-Mod, and MR-PRESSO as sensitivity analyses combined with multivariable MR to identify robust associations. Genetic correlation analysis was applied to identify shared genetic risks.ResultsWe found genetically determined CRP was robustly associated with 15 diseases in the UK Biobank and 11 diseases in the FinnGen population (P &lt; 0.05 for all MR analyses). CRP was positively associated with tongue cancer, bronchitis, hydronephrosis, and acute pancreatitis and negatively associated with colorectal cancer, colon cancer, cerebral ischemia, electrolyte imbalance, Parkinson’s disease, epilepsy, anemia of chronic disease, encephalitis, psychophysical visual disturbances, and aseptic necrosis of bone in the UK Biobank. There were positive associations with impetigo, vascular dementia, bipolar disorders, hypercholesterolemia, vertigo, and neurological diseases, and negative correlations with degenerative macular diseases, metatarsalgia, interstitial lung disease, and idiopathic pulmonary fibrosis, and others. in the FinnGen population. The electrolyte imbalance and anemia of chronic disease in UK Biobank and hypercholesterolemia and neurological diseases in FinnGen pass the FDR corrections. Neurological diseases and bipolar disorders also presented positive genetic correlations with CRP. We found no overlapping causal associations between the populations. Previous causal evidence also failed to support these associations (except for bipolar disorders).ConclusionsGenetically determined CRP was robustly associated with several diseases in the UK Biobank and the FinnGen population, but could not be replicated, suggesting heterogeneous and non-repeatable effects of CRP across populations. This implies that interventions at CRP are unlikely to result in decreased risk for most human diseases in the general population but may benefit specific high-risk populations. The limited causal evidence and potential double-sided effects remind us to be cautious about CRP interventions.

Role of Hepcidin in Anemia of Chronic Disease in Rheumatoid Arthritis

Objective: Anemia of chronic disease is a frequent consequence in rheumatoid arthritis and is associated with major clinical and patient outcomes. The present cross-sectional study explored the role of hepcidin (HEP) in anemia of chronic disease in rheumatoid arthritis by studying its relationships with markers of anemia, iron metabolism, inflammation, and erythropoiesis. Methods: Blood samples from anemic (n = 43) and nonanemic (n = 43) rheumatoid arthritis patients were analyzed for markers of anemia (hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cells distribution width, and reticulocyte hemoglobin), iron metabolism (iron, total iron binding capacity, ferritin, transferrin saturation, soluble transferrin receptor), inflammation (erythrocyte sedimentation rate, C-reactive protein, and interleukin 6), and erythropoiesis (erythropoietin and HEP). Correlation analysis was used to identify relationships between HEP and all other variables. Principal component analysis was used to identify common underlying dimensions representing linear combinations of all variables. Results: HEP had statistically significant mostly moderate-to-large correlations with markers of anemia (0.30–0.70, all p < 0.01), small correlation with markers of iron metabolism and markers of inflammation (r = 0.20–0.40, all p < 0.01), and moderate correlations with markers of erythropoiesis. Principal component analysis revealed two underlying components (factors) capturing approximately 50% of total variability. Factor 1 comprised mainly of markers of anemia, iron metabolism, and erythropoiesis and was related to “erythrocyte health status,” while factor 2 comprised mainly markers of inflammation and iron metabolism and was related to “acute phase reactants.” HEP was the only variable demonstrating substantial loadings on both factors. Conclusions: HEP is related to markers of anemia, iron metabolism, inflammation, and erythropoiesis. In addition, when all variables are “reduced” to a minimum number of two “latent” factors, HEP is loaded on both, thus underlying its pivotal role in the complex interaction of the erythropoietic response in inflammation-induced anemia and/or functional iron deficiency.

STUDY OF CLINICALAND HAEMATOLOGICAL PROFILE OF ANEMIA IN GERIATRIC PATIENTS AT A TERTIARY LEVEL CENTRE IN HARYANA

Background: The demographic transition with ageing of population is a global phenomenon and in recent years there has been an increasing international awareness of health issues relating to aging population. Anemia represents an emerging global health problem producing a negative impact in the quality of life among the elderly and requiring greater allocation of health resources. Aims: To identify elderly patients with anemia and study the etiology, clinical parameters, laboratory parameters in these patients. Methods: A total of 100 patients were enrolled in this study. The entire medical history were obtained from each of the cases including previous medical reports and imaging studies. Complete blood counts , RBC indices,total WBC count, differential count, platelet count, haematocrit, ESR, peripheral smears ,reticulocyte count, ferritin, iron and TIBC were recorded for each patient. The data was compiled and analyzed using Statistical Package for social services (SPSS vs 20). Results: Among the etiologies, iron deciency anemia was seen in 43% of patients, anemia of chronic disease in 32%, anemia of chronic kidney disease and unexplained anemia in 11 % patients. Among clinical features the commonest symptom was easy fatiguability and commonest sign was pallor. Peripheral smear study showed that normocytic normochromic anemia was commonest type. Conclusion: This study showed that the commonest cause for anemia among elderly patients is iron deciency anemia followed by anemia due to chronic disease. Geriatric anemia is a disease that often goes unreported hence every effort should be made to identify the disease and evaluate the cause.

Impact and predictors of readmission in hypercalcemia of malignancy: Findings of a nationwide analysis.

e18809 Background: Hypercalcemia of malignancy (HCM) is common in cancer. It is a sign of advanced malignancy and associated with poor outcomes. Although a well-known phenomenon, treatment options are limited and recurrence leading to readmissions is common, increasing morbidity and mortality. We attempt to explore the mortality, healthcare resource utilization, 30-day readmission rate and independent predictors of readmission for HCM. Methods: We queried the 2017 National Readmission Database (NRD) of adults readmitted within 30 days after index admission for HCM with a concomitant diagnosis of solid tumors. T test was used for continuous variables and chi square test was used for categorical variables. Multivariate regression was used to identify predictors for unplanned readmissions. Results: A total of 14,323 patients with solid tumors were admitted with HCM. The 30-day readmission rate was 24.9%. Common causes for readmission were sepsis, respiratory failure, hypercalcemia, distant metastases and AKI. At 30 days, readmitted patients were less likely to be discharged compared to patients admitted initially due to hypercalcemia (27.4 vs 30.8%; P<0.01). Readmitted patients had a higher in-hospital mortality at 30 days (1.5 vs. 0.1%; P<0.01), more incidence of chemotherapy induced pancytopenia (3.8 vs 2.5%; P<0.01), mechanical ventilation (5.8 vs 4.7%; P=0.05) and venous thromboembolism (8.3 vs 5.9%; P<0.01). Total economic burden of readmission was $251 million in total charges and $62.6 million in total costs. Adjusting for age and comorbidities, independent predictors of readmission were anemia of chronic disease, iron deficiency anemia and obesity. Conversely, predictors for lower odds of readmission were disposition to skilled facility and discharge with home health care services (Table). Conclusions: Nationally, HCM has a high rate of readmissions with increased morbidity and mortality making it a consequential healthcare burden. Among causes of readmission, potentially targetable include AKI and sepsis while among readmission predictors, iron deficiency anemia and anemia of chronic disease warrant further attention. Similarly, negative predictors highlight the importance of proper disposition planning and supportive care in malignancy.[Table: see text]