Influence of anaemia in severely injured patients on mortality, transfusion and length of stay: An analysis of the TraumaRegister DGU®

Purpose Anaemia is one of the leading causes of death among severely injured patients. Anaemia is known to increase the risk of death and prolong the length of hospital stay in various surgical groups. The main objective of this study is to analyse the anaemia rate on admission to the emergency department and the impact of anaemia on in-hospital mortality. Methods Data from the TraumaRegister DGU® (TR-DGU) between 2015 and 2019 was analysed. Inclusion criteria were age >= 16 years and worst Abbreviated Injury Scale (AIS) score ≥ 3. Patients were divided into three anaemia subgroups: no or mild anaemia (NA), moderate anaemia (MA) and severe anaemia (SA). Pre-hospital data, patient characteristics, treatment in the ER, outcomes, and differences between trauma centres were analysed. Results Of 67,595 patients analysed, 94.9% (n=64,153) exhibited no or mild anaemia (Hb ≥ 9 g/dl), 3.7% (n=2,478) displayed moderate anaemia (Hb 7–8 g/dl) and 1.4% (n=964) presented with severe anaemia (Hb < 7 g/dl). Haemoglobin (Hb) values ranged from 3 g/dl to 18 g/dl with a mean Hb value of 12.7 g/dl. In surviving patients, anaemia was associated with prolonged length of stay (LOS). Multivariate logistic regression analyses revealed moderate (p<0.001 OR 1.88 (1.66-2.13)) and severe anaemia (p<0.001 OR 4.21 (3.46-5.12)) to be an independent predictor for mortality. Further significant predictors are ISS score per point (OR 1.0), age 70-79 (OR 4.8), age >80 (OR 12.0), severe pre-existing conditions (ASA 3/4) (OR 2.26), severe head injury (AIS 5/6) (OR 4.8), penetrating trauma (OR 1.8), unconsciousness (OR 4.8), shock (OR 2.2) and prehospital intubation (OR 1.6). Conclusion The majority of severely injured patients are admitted without anaemia to the ER. Injury-associated moderate and severe anaemia is an independent predictor of mortality in severely injured patients.

Prevalence and factors associated with severe anaemia post-caesarean section at a tertiary Hospital in Southwestern Uganda

Background Severe anaemia after caesarean section adversely affects the woman and the new-born. While prenatal anaemia is extensively studied, the literature on post-caesarean section anaemia is limited and characteristics of women at the highest risk of developing severe anaemia after caesarean section are unknown. This study aimed to determine the prevalence and factors associated with severe anaemia on day three post caesarean section. Methods On the third day after caesarean section, women were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital (MRRH). Women who got transfused peripartum were excluded. For every woman, we measured haemoglobin (Hb) concentration and collected data on sociodemographic, obstetric, and medical characteristics. The primary outcome was severe anaemia after caesarean section, defined as Hb < 7 g/dl. We used logistic regression analysis to determine factors associated with severe anaemia after caesarean section. P-value < 0.05 was considered statistically significant. Results From December 2019 to March 2020, 427 of 431 screened women were enrolled in the study. Their mean age was 26.05 (SD ± 5.84) years. Three hundred thirteen (73.3%) had attended at least four antenatal care visits. The prevalence of severe anaemia post-caesarean section was 6.79%. Foetus with macrosomia (aOR 7.9 95%CI: 2.18–28.85, p < 0.01) and having mild or moderate anaemia pre-caesarean section (aOR:9.6, 95%CI: 3.91–23.77, p < 0.01) were the factors associated with severe anaemia after caesarean section. Conclusion Severe anaemia in women post-caesarean section is relatively uncommon at our institution. It is associated with preoperative anaemia and macrosomic birth. Women with a low preoperative Hb concentration and those whose foetus have macrosomia could be targeted for haemoglobin optimisation before and during caesarean section.

Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: a prospective cohort study

ObjectivesTo investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7–9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth.DesignA prospective cohort study of pregnant women recruited in the third trimester and followed-up after childbirth.SettingTen hospitals across four states in India.Participants1342 pregnant women.InterventionNot applicable.MethodsHb and coagulation parameters: fibrinogen, D-dimer, D-dimer/fibrinogen ratio, platelets and international normalised ratio (INR) were measured at baseline. Participants were followed-up to measure blood loss within 2 hours after childbirth and PPH was defined based on blood loss and clinical assessment. Associations between coagulation parameters, Hb, anaemia and PPH were examined using multivariable logistic regression models.Outcomes measuresAdjusted OR with 95% CI.ResultsIn women with severe anaemia during the third trimester, the D-dimer was 27% higher, mean fibrinogen 117 mg/dL lower, D-dimer/fibrinogen ratio 69% higher and INR 12% higher compared with women with no/mild anaemia. Mean platelets in severe anaemia was 37.8×109/L lower compared with women with moderate anaemia. Similar relationships with smaller effect sizes were identified for women with moderate anaemia compared with women with no/mild anaemia. Low Hb and high INR at third trimester of pregnancy independently increased the odds of PPH at childbirth, but the other coagulation parameters were not found to be significantly associated with PPH.ConclusionAltered blood coagulation profile in pregnant women with severe anaemia could be a risk factor for PPH and requires further evaluation.

CHANGING PATTERN OF HAEMOGLOBIN LEVEL FOLLOWING ANTI-MALARIAL TREATMENT AMONG MALARIA CASES ATTENDING A TERTIARY CARE HOSPITAL IN KOLKATA

Anaemia is one of the major causes of severe and complicated malaria. Malaria associated anaemia are due to decreased production of RBCs and lysis of infected and uninfected erythrocytes. The role of anti-malarial treatment in correcting anaemia are not studied extensively. The present work was undertaken to study the changing pattern of haemoglobin level following anti-malarial therapy. A total of 201 microscopically positive mono-infected with P. vivax (103) and P falciparum (98) patients were recruited and treated with antimalarial drugs and followed up on day 3, 14, and 28 to study the changing pattern of haemoglobin level. Among the P. falciparum positive patients mean haemoglobin level on Day 0 and day 28 was 13.17 g/dl and 13.31 g/dl whereas among P. vivax cases mean haemoglobin level was 13.28 g/dl and 13.29g/dl, respectively. Among the P. falciparum cases (n = 98), 4.08%, 16.33% and 79.59% was classied as moderate anaemia, mild anaemia and normal, respectively. Similarly, among the P. vivax cases (n = 103), 1.94%, 17.47% and 80.58% had moderate anaemia, mild anaemia and normal, respectively. Mean haemoglobin level was declined on day 3 which gradually increased to its initial level by day 28 among both P. falciparum and P. vivax cases. Similar study in other malaria endemic areas will be helpful for better understanding the changing pattern of haemoglobin level among malaria patients.

Clinical & Laboratory Profile of Possible Sickle Delta Beta Thalassemia in Telangana State

BACKGROUND Sickle delta beta thalassemia is a rare genetic disorder, with varied symptoms, signs, requiring careful monitoring for potential complications. It is due to sickle mutation and thalassemia mutation occurring together, with sparse data available worldwide. The purpose of this study was to assess the clinical and laboratory profile of possible sickle delta beta thalassemia. METHODS The study design is retrospective analysis of clinical information of those selected patients done in our multi-specialty tertiary care referral hospital situated in Telangana state in south India. The case material was collected from December 2017 to December 2019 (2 years duration). All haemoglobin electrophoresis reports were collected with no prior blood transfusions in preceding 4 months. The information collected was analysed and presented. RESULTS Total 9 patients were diagnosed as possible sickle delta beta thalassemia, with male to female ratio of 5 : 4 and age ranging from 12 years to 45 years of age. The commonest symptoms were joint pain and jaundice in 5 patients and sign was splenomegaly in 2 patients. Ultrasonogram of abdomen showed that 3 patients had gall stones, 1 patient had gall bladder sludge, 1 patient had autosplenectomy and 3 patients had splenomegaly. Mild to moderate anaemia was seen with reticulocytosis, sickling test positive in all patients, with haemoglobin in the range of 5.5 g/dl to 12.7 g/dl. 3 patients had iron over load, 2 patients had hepatopathy, 5 patients had unconjugated hyperbilirubinemia, Acute chest syndrome, hepatic necrosis, and nephropathy was seen in 1 patient each. Haemoglobin electrophoresis showed Hb S was from 46.1 % to 76.4, Hb A from 5.3 % to 34.7 %, Hb F from 4.8 % to 22.7 %, Hb A2 from 1.5 % to 3.3 %. 2 patients were treated with hydroxyurea. 2 patients had mutation analysis elsewhere that was reported as compound heterozygous for β-globulin gene for Hb S (GAG-GTG) and IVS 1 - 5 (G-C). CONCLUSIONS Sickle delta beta thalassemia presents as mild to moderate anaemia haemolysis, splenomegaly with vaso-occlusive crises. Hydroxyurea may help in the treatment. Genetic analysis helps in diagnosis and future therapies. KEYWORDS Haemoglobin S, Haemoglobin A2, Haemoglobin A, Haemoglobin F

Anemia in Pregnancy as a Predisposing Factor of Severe Preeclampsia

Objective: This case may partly explain that anaemia can be a predisposing factor for the development of many women with preeclampsia were have a low level of haemoglobin during their pregnancy.Methods: A case reportCase: We present a case 23-year-old pregnant woman who has had moderate anaemia with severe preeclampsia at 38-week pregnant. As the evidence, there were elevated blood pressure, decreasing haemoglobin obtained by routine blood analysis, and presence of urine protein by urinalysis examination.Conclusion: In terms of anaemia as one of a predisposing factor of preeclampsia it is important to care provider, pregnant women, and families to prevent anaemia in pregnancy through routine ANC.Keywords: anaemia, pregnancy, severe preeclampsia. Abstrak Tujuan: Kasus ini sebagian dapat menjelaskan bahwa anemia dapat menjadi faktor predisposisi bagi perkembangan banyak perempuan dengan preeklamsia yang memiliki kadar hemoglobin yang rendah selama masa kehamilan mereka.Metode: Laporan kasus.Kasus : Kami melaporan kasus ibu hamil berusia 23 tahun yang mengalami anemia sedang dengan preeklamsia berat di usia 38 minggu, dibuktikan dari peningkatan tekanan darah, penurunan hemoglobin, serta protein uria pada pemeriksaan urinalisis.Kesimpulan : Berkaitan antara anemia sebagai predisposisi preekalmsia, penting bagi petugas kesehatan dan ibu hamil serta keluarga untuk mencegah anemia dalam kehamilan melalui ANC yang rutin.Kata kunci : anemia, kehamilan, preeklamsia berat.

A Comparative Study on Prevalence of Anaemia among Rural & Urban Pregnant Women in a Selected Hospital of Kashmir with a View to Prepare Information Module on Prevention of Anaemia

Anaemia in pregnancy exists worldwide. In Jammu and Kashmir 58.7% of women are anemic compared to national average of 51.8%. 17.6% suffer from moderate anaemia compared to national average of 14.8%. The present study was aimed to compare the prevalence of anaemia among rural (50) and urban (50) pregnant subjects using descriptive comparative survey design. Purposive sampling technique was used for data collection. The study found mild anaemia (98%) among rural and (100%) among urban subjects. Moderate anaemia was found (2%) only among rural subjects. Both urban and rural pregnant subjects had significant association of nutritional status with socioeconomic status.

Household and individual risk factors of anaemia among under-5 children in Lesotho

Background: Anaemia among under-5 children is a major public health issue worldwide. Some countries with a high prev- alence of anaemia also have high prevalence of malaria. Even though Lesotho does not have a high prevalence of malaria, its prevalence rate of anaemia is as high. According to the 2014 Lesotho Demographic and Health Survey (DHS), the prevalence of anaemia among children under-5 was 51%. Other factors could be influencing the prevalence of anaemia in Lesotho. Objectives: This study examined the household and individual risk factors of anaemia among children under-5 in Lesotho. Methods: Data from the 2014 Lesotho DHS which included 924 children under-5 years were analysed. Descriptive statistics, chi-square cross-tabulations and ordered logistic regression models were run using Stata v15. Results: Twenty-one percent (21%) of children under-5 had mild anaemia while 7% had severe-moderate anaemia. Children residing in households cooking with biogas (aOR=4.88, CI: 1.28-18.58) and those living in households that cook with bio- mass (aOR=4.22, CI: 1.40-12.67) had higher odds of severe-moderate anaemia. Conclusion: Using solid fuels for cooking increases the vulnerability of children under-5 developing anaemia. Therefore, knowledge of renewable energy resources should be increased. This will help reduce levels of anaemia among under-5 chil- dren in Lesotho. Keywords: Household and individual risk factors; anaemia; under-5 children; Lesotho.

Evaluating the potential of using urine and saliva specimens for malaria diagnosis in suspected patients in Ghana

Background This study aimed at detecting PfHRP2 and pLDH malaria antigens in urine and salivary specimens of suspected malaria patients using RDT kits, and identifying factors influencing the detection of these antigens. Methods Malaria rapid test kit (SD Bioline RDT kit) was used to detect malaria antigens, PfHRP2 and pLDH, in blood, urine and saliva samples received from patients suspected of malaria. Subsequently, malaria parasitaemia was determined. From the same patients, body temperature readings and haemoglobin concentrations were recorded. Also, micro-haematuria and saliva occult blood were determined. Relative to blood, the sensitivities and the performance of urine and saliva as alternative samples were evaluated. Results A total of 706 suspected malaria patients provided all three specimens. Prevalence of malaria by microscopy and RDT was 44.2% and 53.9%, respectively. Compared to blood, the sensitivities of urine and saliva were 35.2% and 57.0% respectively. Haemoglobin concentration < 9.9 g/dL, body temperature > 38.7 °C and occult blood influenced the detection of malaria antigens in both urine and saliva. Furthermore, the antigens were not detected in urine and saliva when parasitaemia was < 60,000 parasites/µL and < 40,000 parasites/µL, respectively. Conclusion Saliva, with or without blood contamination, was found to be more efficient that urine samples. Therefore these non-blood specimens have the potential to be used as non-invasive samples for malaria diagnosis. However, this approach is useful in severe to moderate anaemia, hyperthermia, parasitaemia > 60,000 parasites/µL and samples contaminated with blood.

The Burden of Anaemia Among Women in Jordan

Background: Anaemia is a leading haematological disorder and one of the most common health problems worldwide affecting over a billion people. Anaemia leads to the lowered ability of the blood to carry oxygen. In this study, we focused particularly on the prevalence of anaemia in students currently enrolled at the Hashemite University/Jordan, shining light on the overall prevalence in this age group elsewhere. These individuals are at an increased risk of developing anaemia and are a nutritionally susceptible part of the population. Methods: Complete blood counts were determined for a total of two hundred students. Questionnaires were also completed by students regarding their life-style and dietary habits. Results: A significant 27% of female students were found to be anaemic. 17% of females had mild type of anaemia, whereas 10% of females tested suffered from moderate anaemia. The percentage of anaemia among males was also determined and found to be insignificant with only 2% of male students affected. A direct link was found between anaemia and a lack of consumption of foods rich in iron and/or over-consumption of foods that inhibit iron absorption. An inverse correlation was also observed with body mass index (BMI). Conclusion: Prevention of anaemia is particularly relevant in females and may be implemented by different but complementary means such as education workshops, iron fortification of foods and the adaption of lifestyle habits.