Utility of reticulocyte hemoglobin in diagnosing latent iron deficiency and iron deficiency anemia

Background: Iron deficiency is the most common cause of anemia and studies have shown poor cognition, psychomotor and social/emotional development in children who are deficient in iron, even with normal hemoglobin levels, the so-called Latent phase of Iron deficiency. It is therefore crucial to identify LID, as well as IDA at the earliest stage, in order to initiate treatment.' Many tests like serum ferritin and soluble transferring receptor(sTfR) have been described collectively as a panel to detect iron deficiency; however no single test is specific enough to be used independently. Also during treatment it takes weeks to observe changes in Hb, hematocrit or RBC indices, hence the need for a more sensitive and reliable test. Objective was to evaluate effectiveness of CHr in diagnosing LID and IDA.Methods: Samples were collected from 180 children, clinically suspected to be anemic. Complete hemogram and Iron profile were measured. Three groups were defined, LID (Tfsat <20%, Hb >11g/dL; n=52), IDA (Tfsat <20%, Hb <11g/dL; (n=84) and controls (Tfsat >20%, Hb >11g/dL; n=44). The mean values of RBC indices, Iron profile and CHr was compared across the groups. A cut off value of <26 pg CHr was taken to represent Iron deficiency state.Results: Comparison between anemic group and control found that all RBC indices were found to be significantly lower including Reticulocyte hemoglobin. All of the variables in anemic group were lower compared to latent iron deficient group except MCHC and reticulocyte count. CHr was found to be statistically lower in LID and IDA group in comparison to control group.Conclusions: CHr can be used as a valuable indicator in diagnosis as well as follow-up of LID and IDA, which is easily available and inexpensive.

Association of Early-Onset Sepsis and Vitamin D Deficiency in Term Neonates

Objective: To determine if vitamin D status is affected in term neonates with early onsetsepsis and its association with outcome. Methods: Study was done at a level 3 neonatal uniton 140 neonates. Term neonates with early onset sepsis (study group, 70 patients) andwithout sepsis (control group, 70 patients) were enrolled. Results: Mean neonatal vitaminD level in the study group was 16.00 (10.49) ng/mL and in the control group, was29.07(8.36) ng/mL (P =0.061). In the study group 80% (n=56) babies had low vitamin Dlevels (<32 ng/mL) among whom 51.7% (n=29) had severe vitamin D deficiency (<11ng/mL).In the control group, 58.5% (n=41) had low vitamin D levels of whom, 9.8% (n=4) hadsevere vitamin D deficiency (P<0.001 and P<0.001, respectively). Mortality and highlyprobable sepsis were more common with vitamin D levels <11ng/mL in the study group(P= 0.005 and P=0.006, respectively). Conclusion: Vitamin D is deficient in neonates withearly onset sepsis and is associated with increased sepsis severity and mortality.

Clinical Experience of Hochu-ekki-to for Symptoms Indicating a State of Ki-deficiency and Low Body Temperature / 日本東洋医学雑誌

Hochu-ekki-to is one type of medicine that improves a Ki-deficiency. We therefore investigated the effects of Hochu-ekki-to on symptoms indicating a state of Ki-deficiency. In addition, we studied the effects of Hochu-ekki-to on blood pressure or body temperature. We studied 14 adult male patients with symptoms of general fatigue, lack of will power and appetite loss. We orally administered 7.5g of Hochu-ekki-to extract fine granules (EK-41) (Kanebo Pharm. Co, Tokyo, Japan) per day for four weeks. Before the oral administration of EK-41, and again four weeks later, we investigated any improvement of symptoms, and changes in the blood pressure or body temperature. After the oral administration of EK-41 for four weeks the general fatigue or lack of will power improved significantly (p<0.05), and we observed a significant increase in body temperature (p<0.05). The over all rate of “improvement” was 57.1%, and the rate for “slight improvement or more” was 71.4%. The oral administration of Hochu-ekki-to not only improved the symptoms of general fatigue and lack of will power but also raised the body temperature. This leads us to suspect that Hochu-ekki-to increased the metabolic function. We therefore consider the oral administration of Hochu-ekkito to be useful for the treatment of Ki-deficiency state patients with the symptoms of general fatigue and lack of will power.