Anemia among Pregnant Women at Nepalgunj Medical College

Introduction: Anemia in pregnancy is major health issue of developing countries responsible for adverse maternal and fetal outcome. According to World health organization pregnant women with hemoglobin level less than 11 gm/dl in first trimester and less than 10.5gm/dl in second and third trimester are considered to be anemic. Iron deficiency anemia is common during pregnancy followed by megaloblastic anemia. Aims: To find out the prevalence of anemia during pregnancy. To correlate the maternal and fetal complications associated with anemia during pregnancy. Methods: This is a prospective hospital based study done at department of obstetrics and gynecology Nepalgunj Medical College from July 2020 to January 2021. All pregnant women with hemoglobin level <11 gm/dl were enrolled in the study. Data were collected from antenatal clinic and biochemistry laboratory. Results: In this study maximum participants were of age group 20-25 consisting of 38.5%. Anemia was more common in multiparous i.e. 60% as compared to primipara i.e. 40%. In this study maximum participant had vaginal delivery (57%) followed by LSCS (29%) then instrumental delivery (14%). These ladies had complications like postpartum hemorrhage (27.7%), preterm labor (16.9%), pregnancy induced hypertension (9.2%). similarly 10.8% had sepsis and 20% had no complications. About 23.1% babies delivered by anemic ladies required neonatal intensive care. Intrauterine growth restriction was seen in 12.3%, preterm birth in 10.3% and 53.8% babies had no complications. Conclusion: The prevalence of anemia during pregnancy is high leading to adverse maternal and fetal outcome.

Reducing infantile anemia: insight on patterns of process and outcome indicators by ethnicity and socioeconomic class during a 10-year intervention program and 5 years after

Background In 2005, Clalit Health Services (CHS), the largest health maintenance organization in Israel, initiated an intervention program aimed at reducing the prevalence rate of infantile anemia (IA). This study evaluated the progress made during the intervention (2005–2014) and its yield 5 years after it ended (2019). Methods The CHS database was retrospectively reviewed twice yearly from 2005 to 2014 for repetitive samples of children aged 9 to 18 months regarding the previous half-year interval, and a single sample in 2019. Data were collected on gender, ethnicity (Jewish/non-Jewish), socioeconomic class (SEC; low/intermediate/high), hemoglobin testing (yes/no), and hemoglobin level (if tested). Excluded were infants with documented or suspected hemoglobinopathy. Results At study initiation, the rate of performance of hemoglobin testing was 54.7%, and the IA prevalence rate was 7.8%. The performance rate was lower in the Jewish than the non-Jewish subpopulation. The low-SEC subpopulation had a similar hemoglobin testing rate to the high-SEC subpopulation but double the IA prevalence rate. Overall, by the end of the intervention (2014), the performance rate increased to 87.5%, and the AI prevalence rate decreased to 3.4%. In 2019, there was little change in the performance rate from the end of the intervention (88%) and the IA prevalence was further reduced to 2.7%. The non-Jewish and low-SEC subpopulations showed the most improvement which was maintained and even bettered 5 years after the intervention ended. Conclusions The 10-year IA intervention program introduced by CHS in 2005 led to a reduction in IA prevalence rate to about 3.5% in all sub-populations evaluated. By program end, the results in the weaker subpopulations, which had the highest prevalence of IA at baseline, were not inferior to those in the stronger subpopulations. We recommended to the Israel Ministry of Health to adopt the intervention countrywide, and we challenge other countries to consider similar interventions.

Edukasi Anemia Defisiensi Besi dan Pemeriksaan Hemoglobin sebagai Deteksi Dini Resiko pada Ibu Hamil di Desa Matang Seulimeng Kecamatan Langsa Barat Kota Langsa

ABSTRAK Anemia merupakan masalah global terutama bagi ibu hamil. Penyebab utama anemia pada kehamilan adalah defisiensi besi kemudian diikuti oleh defisiensi folat. WHO memperkirakan angka kejadian anemia sekitar 42 % terjadi pada ibu hamil dengan kondisi ekonomi menengah kebawah. Tujuan Pengabdian ini adalah untuk meningkatkan pengetahuan ibu hamil. tentang anemia defisensi besi dan pemeriksaan kadar hemoglobin sebagai deteksi dini mandiri di Desa Matang Seulimeng wilayah kerja Puskesmas Langsa Barat Kota Langsa. Bentuk kegiatan pengabdian masyarakat adalah dengan metode penyuluhan dengan ceramah dan tanya jawab. Sedangkan deteksi dini resiko tinggi dilakukan dengan pemeriksaan kadar hemoglobin dan setelah 2 minggu intervensi dilakukan evaluasi ibu hamil anemia dengan pemeriksaan kadar Hemoglobin. Terjadi perubahan peningkatan pengetahuan baik sebesar 85 % dan hasil pemeriksaan hemoglobin dari 18 ibu hamil anemia setelah evaluasi menjadi 67,8 % tidak anemia .Penilaian mengenai pemahaman ibu hamil tentang edukasi anemia Defisiensi besi dan pemeriksaan Hemoglobin sebagai deteksi dini resiko pada ibu hamil adalah 3 (tiga) tahap (tahap pretest, tahap penyuluhan, dan tahap posttest serta evaluasi ibu hamil anemia). Adanya peningkatan pengetahuan setelah diberikan edukasi anemia defisiensi pada ibu hamil, dan mampu melakukan deteksi dini mandiri tanda gejala anemia sehingga mendapat penanganan sesegera mungkin. Kata Kunci : anemia defisiensi zat besi, kadar hemoglobin, deteksi dini, ibu hamil ABSTRACT Anemia is a global problem, especially for pregnant women. The main cause of anemia in pregnancy is iron deficiency followed by folate deficiency. WHO estimates that the incidence of anemia is around 42% in pregnant women with middle to lower economic conditions. The purpose of this service is to increase the knowledge of pregnant women. regarding iron deficiency anemia and hemoglobin level examination as an independent early detection in Matang Seulimeng Village, the working area of Langsa Barat Health Center, Langsa City. The form of community service activities is the extension method with lectures and questions and answers. Meanwhile, early detection of high risk is carried out by examining hemoglobin levels and after 2 weeks of intervention, pregnant women with anemia are evaluated by examining hemoglobin levels. There was an increase in knowledge of both 85% and the results of hemoglobin examination from 18 anemic pregnant women after the evaluation became 67.8% not anemic. An assessment of the understanding of pregnant women about iron deficiency anemia education and hemoglobin examination as early detection of risk in pregnant women is 3 (three) stages (pretest stage, counseling stage, and posttest stage and evaluation of anemic pregnant women). There is an increase in knowledge after being given education on deficiency anemia in pregnant women, and being able to independently detect early signs of anemia so that they get treatment as soon as possible. Keywords: iron deficiency anemia, hemoglobin levels, early detection, pregnant women

Factors Contributing to Red Blood Cells Crossmatch and Transfusion among Obstetrics Patients in a Single Tertiary Hospital

INTRODUCTION: Transfusion of blood and blood components among obstetrics patients is a common practice but they are not without risks. This study aims to determine crossmatch to transfusion ratio (C:T ratio) and to assess the factors that influence red blood cells (RBC) transfusion among obstetrics patients in a single tertiary hospital. MATERIAL AND METHODS: This was a retrospective cohort study of RBC crossmatch requests with data collected from 350 obstetrics patients. The patients were grouped into either received RBC transfusion or did not receive transfusion. Demographics and clinical characteristics were analyzed using descriptive and multivariate analysis. RESULTS: The mean C:T ratio was 3.1. Of 350 patients, 149 (42.6%) patients did receive RBC transfusion. Patients with underlying hemoglobinopathy (75.9%), history of postpartum hemorrhage (63.6%), underwent instrumental assisted delivery (64.3%), and with hemoglobin level of < 70 g/L upon crossmatch requests (90.5%) did receive RBC transfusion. Cesarean section (p=0.011), hemoglobin level < 99 g/L (p<0.001), estimated blood loss > 1000 mL (p<0.001), and symptomatic anemia (p=0.029) were the significant factors associated with RBC transfusion. CONCLUSION: The mean C:T ratio in our study was high. Identifying the factors contributing to RBC transfusion among obstetrics patients are important to reduce unnecessary crossmatch and subsequently improve blood inventory management, and thus further reduce the risks associated with allogeneic transfusion.

Asuhan Kebidanan pada Ibu Hamil Trimester III dengan Anemia

Anemia is a condition where the level of hemoglobin in the blood is less than the normal limit (<12 g%) caused by a lack of iron in the body due to malnutrition. While anemia in pregnancy is a condition where the hemoglobin level in pregnant women is <11gr% or <10.5gr% in third trimester pregnant women which generally occurs due to the hemodilution process. The purpose of this case to find out the cause of anemia in late pregnancy and the treatment that can be done to prevent complications that occur with care to routinely consume blood-added tablets (Fe) and recommend foods high in iron. This care design used a comprehensive care method for pregnant women in the third trimester who experience mild anemia (haemoglobin <10,5gr%) in Kalimade Village, Kesesi District, Pekalongan Regency. The results of this care showed an increase in hemoglobin levels in the mother. The conclusion of this case study shows that regularly consuming Fe tablets can increase hemoglobin levels in the blood so that it can prevent and treat anemia. For this reason, pregnant women are expected to routinely consume Fe tablets during pregnancy and midwives are expected to provide education about the benefits of Fe tablets to pregnant women to prevent anemia.Keywords: Haemoglobin; Anemia; Pregnancy AbstrakAnemia merupakan suatu kondisi dimana kadar haemoglobin dalam darah kurang dari batas normal (<12 gr%) yang disebabkan karena kurangnya zat besi didalam tubuh akibat kurang gizi. Sedangkan anemia pada kehamilan adalah kondisi dimana kadar haemoglobin pada ibu hamil <11gr% atau <10,5gr% pada ibu hamil trimester III yang umumnya terjadi karena adanya proses hemodilusi. Tujuan dari kasus ini yaitu untuk mengetahui penyebab terjadinya anemia pada kehamilan lanjut serta penanganan yang dapat dilakukan guna mencegah terjadinya komplikasi yang mungki terjadi dengan asuhan untuk rutin mengkonsumsi tablet tambah darah (Fe) serta anjuran mengkonsumsi makanan tinggi zat besi. Rancangan Asuhan ini menggunakan metode asuhan komprehensif pada ibu hamil trimester III yang mengalami anemia ringan (Haemoglobin <10,5gr%) di Desa Kalimade Kecamatan Kesesi Kabupaten Pekalongan. Hasil asuhan ini menunjukan adanya peningkatan kadar haemoglobin pada ibu. Simpulan studi kasus ini menunjukan bahwa dengan rutin mengkonsumsi tablet Fe dapat meningkatkan kadar Haemoglobin dalam darah sehingga dapat mencegah serta mengobati anemia. Untuk itu ibu hamil diharapkan agar rutin mengkonsumsi tablet Fe selama kehamilan. Bidan diharapkan agar bisa memberikan edukasi tentang manfaat tablet Fe pada ibu hamil guna mencegah terjadinya anemia.Kata kunci: Haemoglobin; Anemia; Kehamilan

A COMPARATIVE STUDY OF INTRAVENOUS IRON SUCROSE VERSUS ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA DURING POSTPARTUM PERIOD

Introduction: Anemia is the commonest major contributing factor in maternal mortality and morbidity in developing countries and according to World Health Organization (WHO) criteria, it contributes to 20% of maternal deaths. Anemia in pregnancy defined as hemoglobin level <11 gm/dl (7.45 mmol/L) and hematocrit less than 33% (WHO). Aim: To compare the efficacy of oral iron ferrous sulphate therapy with intravenous iron sucrose therapy in the treatment of iron deficiency anemia during postpartum period. Material & Methods: This was a prospective randomized comparative clinical trial single center study conducted on 200 postpartum women aged >18 years (after normal delivery or LSCS) within 10 days of delivery with Hb level more or equal to 6 gm/dl but less than 10 gm/dl were included in the study. This was a one year study conducted during 1st December 2018 to 30th November 2019. Results : There was a significant increase in the hemoglobin level in both the groups i.e. in IV iron group, from 8.26 ±1.03gm/dl on day 1 to 11.62±0.94gm/dl on day 45 as compared to oral iron group, from 8.24±1.09gm/dl on day 1 to 11.07±1.14gm/dl on day 45; and serum ferritin level from 41.69±40.45ng/ml on day 1 to 77.34±41.60ng/ml on day 45 in IV iron group as compared to the oral iron group from 22.20±8.82ng/ml on day 1 to 31.72±9.72 ng/ml on day 45. So, there was a rapid increase in both hemoglobin and serum ferritin levels in IV iron group as compared to the oral iron group. Conclusion: Intravenous iron sucrose administration increases the hemoglobin level and serum ferritin more rapidly in compare to the oral intake of ferrous sulphate in women with iron deficiency anemia in postpartum women in our study. Keywords: Iron deficiency anemia, Intravenous iron sucrose, Serum ferritin, Maternal mortality.

Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman’s correlation coefficient −0.4, p = 0.02), percentage of CD19+ cells (r = −0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.

Prevalence of Anemia and Its Association with Handgrip Strength in Indonesian Elderly Population: A Cross-Sectional Study Using Indonesian Family Life Survey Data Year 2014-2015

Aim This study aimed to elucidate the prevalence of anemia in Indonesian elderly population aged ≥60 years old and to analyze its association with handgrip strength in the elderly. Method This was a cross-sectional study using data from Indonesian Family Life Survey-5 (IFLS-5). All participants aged ≥60 years old were included in this study. Exclusion criteria were: (1) respondents who refused to take health measurements (hemoglobin level, handgrip strength, weight, stature, and waist circumference); (2) respondents with incomplete or missing data; (3) respondents with history of stroke; and (4) respondents with history of pain, swelling, inflammation, injury, and surgery on one or both hands within the last 6 months. The dependent variable for this study was handgrip strength. The independent variables were hemoglobin level, gender, age, body mass index (BMI), waist circumference, smoking history, comorbidities, and current use of drug therapies. Statistical analyses included correlation, bivariable, and multivariable analyses. Result A total of 3192 individuals were selected for analysis. Overall, 38.8% of participants aged ≥60 years had anemia based on definition of anemia by WHO. There was a positive correlation between hemoglobin level and handgrip strength in Indonesian elderly population (r: 0.349; p value: 0.000). Multivariable analysis showed that anemia was significantly associated with weak handgrip strength (OR: 1.557; 95% CI: 1.314-1.846; p value: 0.000). This association was stronger for males and elderly aged ≥80 years old. Conclusion Based on the results, anemia was associated with weak handgrip strength in Indonesian elderly population and it is more pronounced in males and elderly aged ≥80 years old.

Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?

Background In severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L−1, but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L−1 or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h. Methods Prospective analysis of retrospectively collected data from a trauma registry (01/2011–12/2019). MFD-C was defined by a fibrinogenemia 1.51–1.99 g L−1 or the corresponding FIBTEM-A5 values (MFD-A5) that were determined from linear regression and ROC curve analysis. Administration of fibrinogen were described according to the following admission parameters: shock index (SI) > 1, hemoglobin level < 110 g L−1 (HemoCue®), and base deficit > 5 mEq L−1. Data are expressed as count (%), median [IQR]. Results 1076 patients were included in the study and 266 (27%) had MFD-C, among them, 122/266 (46%) received fibrinogen. Patients with MFD-C who received fibrinogen were more severely injured (ISS: 27 [19–36] vs. 24 [17–29]) and had more impaired vital signs (base deficit: 5.4 [3.6–7.8] vs. 3.8 [2.0–6.0]). Linear regression analysis found a positive correlation between fibrinogen level and FIBTEM-A5 (r: 0.805). For a fibrinogen level < 1.5 g L−1 and < 2.0 g L−1, FIBTEM-A5 thresholds were 6 mm (sensitivity 85%, specificity 83%, AUC: 0.934) and 9 mm (sensitivity 84%, specificity 69%, AUC: 0.874), respectively. MFD-A5 values (185 (27%) patients) were defined as a FIBTEM-A5 between 7 and 9 mm. More than 50% of MFD-C patients presenting a SI > 1, a hemoglobin level < 110 g L−1, or a base deficit > 5.0 mEq L−1 received fibrinogen. The relative risk [95% CI] for fibrinogen administration (SI > 1) were 1.39 [1.06–1.82] for MFD-C, and 2.17 [1.48–3.19] for MFD-A5. Results were not modified after adjustment on the ISS. Conclusions We have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients with MFD.