Immediate haemoglobin testing in association with a dedicated anaemia clinic: Effectiveness for primary total knee replacement patients

Introduction Preoperative anaemia is associated with higher transfusion rates, increased hospital stays and poorer outcomes. Addressing preoperative anaemia is a crucial pillar of Patient Blood Management. Conventionally, patients are listed for surgery and then screened for anaemia in the pre-assessment clinic, followed by referral to their general practitioner. This process involves substantial delays, and poorly treated anaemia often results in perioperative transfusions. We assessed our pathway of immediate haemoglobin testing at the time of listing in conjunction with a dedicated preoperative anaemia clinic for detecting and treating anaemia in primary total knee replacement patients. Materials and methods We compared transfusion rates between anaemic patients undergoing a primary total knee replacement who were treated in this pathway with those who were not. We reviewed the preoperative haemoglobin levels, transfusion rates and treatment for all primary total knee arthroplasty patients over three years amounting to 2296. Results Transfusion rates were significantly lower in the group treated in this pathway compared to those who were not. The treated group also had significantly higher preoperative haemoglobin levels. Discussion and conclusion: Immediate haemoglobin testing in association with a dedicated preoperative anaemia clinic is effective at detecting and treating anaemia in primary total knee replacement patients and reduces transfusion requirements.

The burden of anemia in pregnancy among women attending antenatal clinic in Mkuranga district, Tanzania

Background: The burden of anemia in pregnancy is of global health importance. Tanzania is no exception. It varies from one region to another owing to the differences in causes, but overall causing a significant burden of maternal mortality. This study sought to assess the prevalence and factors associated with anemia among pregnant women attending antenatal clinic (ANC) at Mkuranga district in Pwani region of TanzaniaMethods: This cross-sectional study design was conducted among 418 pregnant women aged 15-49 years attending the Mkuranga district hospital and Kilimahewa health centre. The outcome variable of interest was anemia in pregnancy defined as haemoglobin concentration of 13g/dl. Data was collected using face to face interviews with a standardized pretested questionnaire, and through blood samples collected for haemoglobin testing. Descriptive analysis was used to determine the prevalence of anemia while multiple logistic regression was used to determine factors associated with anemia in pregnancy. Results: Anemia was prevalent among 83.5% of pregnant women attending the two major antenatal clinics in Mkuranga district were anemic. Of them, 29% presented with mild anemia, while 62% had moderate anemia, and 0.09% succumbed to severe anemia. Factors associated with anemia included being in the third trimester [AOR=2.87, p=0.026]; not consuming vegetables (AOR=2.62, p=0.008), meat (AOR=2.71, p=0.003), eggs (AOR=2.98, p=0.002), and fish (AOR=2.38, p=0.005). Conclusion: More than eight in ten pregnant women attending ANC in Mkuranga districts were anemic. Such unprecedented burden of anemia is associated with a number of factors including feeding practices such as not consuming iron-rich foods like vegetables, meat, eggs, and fish. Women in their third trimester were also more likely to suffer from anemia. This unprecedented burden of anemia in pregnancy can be addressed if efforts to improve feeding practices and early monitoring at the antenatal clinics are sustained.

Identifying Factors Associated with the Level of Child Malnutrition in India: Observations from the Comprehensive National Nutrition Survey

Background: Malnutrition is a complex phenomenon that has become a universal problem inhibiting human development. India is home of disproportionate height and weight of children including anemia are sign of malnutrition. This study aimed to examine child malnutrition by considering three parameters—stunting (short), underweight (thin), and/or anaemia—among children aged 1–9 years. Methods: This study used nationally representative data from the Comprehensive National Nutrition Survey (CNNS). The analytic sample was restricted to 25,885 children aged 1–9 years for whom data on height, weight, and haemoglobin level was available. This analytic sample was not significantly different from the total sample of 69,413. Based on World Health Organisation’s (WHO) cut-off for child growth standards, child malnutrition is defined as ‘severe’ if a child has suffered all 3 parameters—stunting, underweight, and anaemia, ‘mild/moderate’ if a child has suffered 1 or 2 parameters and ‘none’ if a child has not suffered from any of the 3 parameters. Univariate and bivariate analysis were used for descriptive associations and marginal effects probabilities were calculated using the ordinal logit regression model to identify the correlates of severe malnutrition. Results: Nine percent of children aged 1-9 years were severely malnourished in the country. The prevalence of malnutrition declined considerably with increasing age of children—13% in children aged 1–4 years to 6% in children aged 5–9 years. Severe malnutrition was significantly higher among higher birth order children, children born to illiterate mothers, children belonging to Scheduled Tribes and poor families, children living in rural areas and the eastern region of the country. Zinc deficiency was found more (22%, 95% CI:18.2–26.0) among severely malnourished children as compared to normal children (16%, 95% CI:13.9–17.3). Conclusions: Malnutrition is widely prevalent in children belonging to illiterate mothers, Scheduled Tribes, poor families, rural areas, and eastern region of the country. Frontline workers should identify such vulnerable children through regular monitoring of height, weight, and haemoglobin testing in their coverage areas.

HbE Variants: An Experience from Tertiary Care Centre of Eastern India

Background- HbE is the second most common structural haemoglobin disorder after sickle cell haemoglobin (HbS). Haemoglobin E (HbE) is variant haemoglobin with a mutation in the globin gene causing substitution of glutamic acid for lysine at position 26 of the globin chain. Aims & Objectives- 1) To Know demographical parameters of HbE variants and 2) To know the Hematological parameters of HbE variants. Materials & Methods- The present single-centre, retrospective, cross-sectional study was carried out on consecutive 2035 Hb-E variants who were screened by CE-HPLC for hemoglobinopathies in the Thalassemia control unit (TCU) in our tertiary care referral centre after obtaining the proper approval from ethical committee of the institution and informed consent from the patients. The evaluation was done in Bio-Rad Variant Haemoglobin Testing System (Hercules, California, USA) using variant b-thalassemia short program pack. All the analyses were done using IBM SPSS statistics software, version 19 and MedCalc software, version 12.3.0.0. Result- Among 2035 subjects’ majority (80%) were diagnosed as HbE carrier. Age ranged from 1 year to 75 years with mean of 19.1±13.2 years. Study population mostly comprised of antenatal mothers (23.2 %) followed by premarital (20.2%), children (18.1 %), post marital (17.4%), %), family member of affected person (16.6%), suspected patient (3.5 %) family member of carrier (0.2%) and others (0.8%). Conclusion: HbE disorders are paradox: its behaviour ranges from good, bad to ugly and the value of HbE does not correlate with the severity of the diseases.

Life-course social class is associated with later-life diabetes prevalence in women: evidence from the Irish Longitudinal Study on Ageing

This study aimed to investigate the independent and synergistic effects of childhood and adult social class, as well as the effect of social mobility, on type 2 diabetes (T2D) risk in later life. Cross-sectional data from The Irish Longitudinal Study of Ageing (TILDA) (n = 4,998), a nationally representative probability sample of adults aged 50 and older, were analysed. Prevalent diabetes was defined using subjective (self-reported doctor’s diagnosis) and objective data (medications usage and glycated haemoglobin testing). Social class was classified as a three-level variable based on fathers’ occupation in childhood and respondents’ primary occupation in adulthood. A five-level social mobility variable was created from cross-classification of childhood and adulthood social class. Logistic regression was employed to assess the relationship between social class variables and T2D. Mean (SD) age of the sample was 63.8y (9.9) and 46.4% were male. Incidence of T2D was 11.6% of men and 7.7% of women. Some 57.4% of the sample were classified as Manual social class in childhood. Compared to those in Professional/Managerial occupations, belonging to the Manual social class in childhood was associated with an increased risk of T2D in men (Odds Ratio (OR): 1.36, 95% CI: 0.88, 2.10) and women (OR: 2.16, 95% CI: 1.21, 3.85). This association was attenuated in women when controlled for adulthood social class (OR: 1.84, 95% CI: 1.00–3.37), suggesting that the effect of childhood social class may be modified by improving social circumstance over the life course.

Screening for thyroid disease in patients with type 2 diabetes mellitus: An evaluation of current practice

Background United Kingdom national guidelines do not recommend routine testing for thyroid disease in people with type 2 diabetes mellitus (T2DM). However, some studies suggest an increased risk of thyroid dysfunction in T2DM. The aim of this study was to evaluate the current practice of screening for thyroid disease in patients with T2DM. Methods Patients with pre-existing T2DM ( n = 339) were selected from records for routine glycated haemoglobin testing performed in December 2008. Using routinely collected primary/secondary care data from 2009 to 2017, we examined longitudinal thyroid-stimulating hormone and free thyroxine requests to determine the overall proportion of patients screened for thyroid dysfunction and the time interval between thyroid tests requested. Results Thirty-three patients (9.7%) had pre-existing thyroid disease. Of the remaining 306 patients, 96.4% had at least one thyroid test during the follow-up period. When the time interval between tests was evaluated in these patients, there was a discrete peak in thyroid function test requests at 12 months, consistent with routine annual testing. Most requests (77%) originated from a general practice setting. Conclusions Contrary to current guidelines, we have provided evidence suggestive of regular screening for thyroid dysfunction in patients with T2DM, particularly in general practice. The appropriateness of this practice remains unclear, but may warrant further examination to assess the clinical benefits of screening, balanced against cost.

Toxic inhalational injury

A middle-aged patient presented with toxic inhalational injury, and was resuscitated prehospitally and treated in the emergency department for smoke inhalation, carbon monoxide (CO) exposure and cyanide poisoning with the use of antidotes. Due to the CO effects on spectrophotometry, an anaemia initially identified on blood gas analysis was thought to be artefactual, but was later confirmed by laboratory testing to be accurate. In addition, cyanide can confound haemoglobin testing due to its use in the analytical process and non-cyanide analysis is required when there is suspected exposure. Although no consensus exists on a first-line cyanide antidote choice, hydroxocobalamin is the only antidote without a serious side effect profile and/or deleterious cardiovascular effects. We propose prehospital enhanced care teams consider carrying hydroxocobalamin for early administration in toxic inhalational injury.

Glycaemic control, antidiabetic medications and influenza vaccination coverage among patients with diabetes in Udine, Italy

ObjectiveThe objectives of this study were to estimate influenza vaccination coverage among patients with diabetes mellitus in an Italian 250 000-inhabitant area in the 2017–2018 season and to assess whether glycaemic control and pharmacological treatment were associated with the likelihood of being vaccinated.DesignIn this cross-sectional study, we analysed anonymous health administrative databases, linked with each other at the individual patient level through a stochastic key: diabetes mellitus registry, vaccinations, drug prescriptions and laboratory database.SettingThe study was conducted in the catchment area of the University Hospital of Udine (‘the Udine area’), a 250 000-inhabitant area in the northeast of Italy.ParticipantsThe study included all subjects included in the regional registry of patients with diabetes mellitus, living in the Udine area as of 1 October 2017.Main outcome measuresVaccination coverage in the 2017–2018 influenza season was calculated. The association between patients’ characteristics and the likelihood of being vaccinated was assessed through multivariate log binomial regression.Result53.0% of 15 900 patients with diabetes living in the area were vaccinated. Coverage increased with age, approaching 75% at ≥85 years. Patients lacking recent glycated haemoglobin testing were less likely to be vaccinated (43.4% vaccination coverage), as were those not treated pharmacologically (44.4% vaccination coverage). Patients treated with both insulin, metformin and other antidiabetic medications were more likely to be vaccinated than those treated with metformin alone (58.1% vaccination coverage; adjusted relative risk=1.07, 95% CI 1.01 to 1.14).ConclusionInfluenza vaccination coverage was suboptimal in this Italian population of patients with diabetes. Strategies to improve diabetes management could in turn positively affect influenza coverage.