Safety and effectiveness of intravenous iron sucrose versus standard oral iron therapy in pregnant women with moderate anaemia in India

Background: Aim of the study was to diagnose and treat pregnant females with iron deficiency anaemia, to reduce the complications associated with anaemia in pregnancy and to compare the efficacy, safety and side effects of iron sucrose with ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy.Methods: The subjects for study were enrolled on fulfilling the inclusion and exclusion criteria. After detailed history, examination and investigations of patient the dose of intravenous iron sucrose was calculated by using the following formula: dose of iron: 2.4 x Hb deficit (11-patient’s actual Hb) x body weight in kg + 500. The following investigations were done on day 1: (a) complete blood count (CBC)- Hb, MCV, MCH, MCHC and PCV; (b) urine examination. Patients was randomly allocated into two groups. Group-A: oral group- containing 150 pregnant females. Group-B: intravenous group- containing 150 pregnant females.Results: Majority of women (48%) were from lower middle class and lower class (30%). Only 5.3% were from higher socioeconomic class (p value 0.0001). Maximum women (60%) were primigravida and 40% were multigravida. which indicates that most ladies enter pregnancy with poor iron reserves. Improvement in the mean haemoglobin levels after 4 weeks of treatment was statistically significant in both the groups (p value 0.0001). Similarly rise in the mean PCV levels after 4 weeks of the treatment was significantly associated in both the groups (p value 0.0001). There was slight rise in the mean MCV and MCH after 4 weeks. Peripheral blood film had changed from microcytic hypochromic to normocytic normochromic after 4 weeks of the treatment in both the group (p value 0.004). Presence of side effects with the oral and parenteral treatment were 81.3% and 12% respectively (p value 0.0001).Conclusions: From our study, it can be concluded that intravenous iron sucrose has lesser side effects along with better absorption.

Safety and effectiveness of intravenous iron sucrose versus standard oral iron therapy in pregnant women with moderate anaemia in India

Background: Aim of the study was to diagnose and treat pregnant females with iron deficiency anaemia, to reduce the complications associated with anaemia in pregnancy and to compare the efficacy, safety and side effects of iron sucrose with ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy.Methods: The subjects for study were enrolled on fulfilling the inclusion and exclusion criteria. After detailed history, examination and investigations of patient the dose of intravenous iron sucrose was calculated by using the following formula: dose of iron: 2.4 x Hb deficit (11-patient’s actual Hb) x body weight in kg + 500. The following investigations were done on day 1: (a) complete blood count (CBC)- Hb, MCV, MCH, MCHC and PCV; (b) urine examination. Patients was randomly allocated into two groups. Group-A: oral group- containing 150 pregnant females. Group-B: intravenous group- containing 150 pregnant females.Results: Majority of women (48%) were from lower middle class and lower class (30%). Only 5.3% were from higher socioeconomic class (p value 0.0001). Maximum women (60%) were primigravida and 40% were multigravida. which indicates that most ladies enter pregnancy with poor iron reserves. Improvement in the mean haemoglobin levels after 4 weeks of treatment was statistically significant in both the groups (p value 0.0001). Similarly rise in the mean PCV levels after 4 weeks of the treatment was significantly associated in both the groups (p value 0.0001). There was slight rise in the mean MCV and MCH after 4 weeks. Peripheral blood film had changed from microcytic hypochromic to normocytic normochromic after 4 weeks of the treatment in both the group (p value 0.004). Presence of side effects with the oral and parenteral treatment were 81.3% and 12% respectively (p value 0.0001).Conclusions: From our study, it can be concluded that intravenous iron sucrose has lesser side effects along with better absorption.

A study of anemia profile in a research hospital in Telangana, South India

Background: Anemia is widespread public health problem with 1.62 billion people affected globally. In India, Anemia is considered a major health problem. Children, women of child bearing age and pregnant women are more prone to develop anemia. Anemia affects the physical and mental growth of children, associated with increase maternal and fetal mortality, leads to reduced work productivity in adults. The present study was undertaken to determine prevalence and severity of anemia among patients who attended the outpatient clinics of a Unani research hospital in Telangana. Methods: This hospital based retrospective observational study wasconducted from January 2020 to December 2020 to investigate the prevalence, type, and determinants of anemia. The complete haemogram values of all the patients who underwent haemogram investigation were noted, information was compiled, tabulated, and analysed. Descriptive statistics were computed with percentages, mean, standard deviation, and student抯 t-test was used find the significance of study parameters.Results: Prevalence of anemia was 26.2% (872/3326), high prevalence of anemia was observed in females (44.04%) compared to males (5.72%) (p<0.0001). The prevalence was more in reproductive age group (58.6%). Moderate anemia (58.6%) was more prevalent followed by mild anemia (36.6%). Microcytic hypochromic blood picture predominates with the incidence of 53.6% followed by normocytic blood picture 42.2%.Conclusions: Results confirmed high prevalence of anemia in females and moderate anemia being more prevalent followed by mild anemia and majority of anemia cases were microcytic, suggesting iron deficiency as the main cause of anemia.

Correlation of Red Blood Cell Indices and RBC Histogram with Peripheral Blood Smear Findings in Anemia

The advent of automation has made diagnosis of Anemia and to some extent its underlying cause easy. The objective of our study is to correlate RBC indices and RBC Histogram findings with peripheral smear to provide a better approach in accurate diagnosis of Anemia and to analyze their limitations. All cases of Anemia as per WHO reference range of Hemoglobin levels were included in our study. Patients who have received medical treatment for Anemia in past three months, patients having recent history of blood transfusion, patients having Leukemia or Leukemoid reactions were excluded from the study. Venous blood samples collected from these patients were run in SYSMEX automated hematology analyzer and complete blood count, Red Blood Cell (RBC) indices ie, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW) and RBC Histogram were obtained and peripheral smears were examined. Anemia typing was done based on RBC indices and position, shape and skewing of RBC histograms, followed by peripheral smear examination for morphological typing of Anemia. The diagnoses made by peripheral smear versus RBC histogram and indices were compared and analysed

Microcytic to hypochromic ratio as a discriminant index of thalassaemia trait in subjects with hypochromic anaemia

@#Introduction: Differentiating between thalassaemia and iron deficiency anaemia (IDA) in hypochromic anaemia is a challenge to pathologists as it influences the choice of subsequent specialized confirmatory tests. In this study, we aimed to evaluate the performance of microcytic to hypochromic ratio (MicroR/ Hypo-He, M/H ratio) as a discriminant index in hypochromic anaemia. Materials and Methods: A retrospective study was carried out on 318 subjects with hypochromic anaemia, which comprised 162 IDA and 156 thalassaemia trait subjects with α-thalassemia, β-thalassemia and HbE trait. Optimal cut-off value, sensitivity and specificity of M/H ratio for thalassaemia trait discrimination was determined using Receiver Operating Characteristic (ROC) analysis. Results: Subjects with thalassaemia trait showed higher MicroR compared to IDA ( p< 0.001) while subjects with IDA demonstrated higher Hypo-He than thalassaemia trait (p < 0.001). M/H ratio was significantly higher in thalassaemia trait compared to IDA, with medians of 3.77 (interquartile range: 2.57 – 6.52) and 1.73 (interquartile range: 1.27 – 2.38), respectively (p < 0.001). M/H ratio > 2.25 was the optimal cut-off value for discriminating thalassaemia trait from IDA in hypochromic anaemia, with the area under ROC curve (AUC) of 0.83, sensitivity of 80.8% and specificity of 71.6%. Conclusions: M/H ratio is a useful discriminant index to distinguish thalassaemia trait from IDA in hypochromic anaemia prior to diagnostic analysis for thalassaemia confirmation. High M/H ratio is suggestive of thalassaemia trait than of IDA. However, more studies are required to establish the role of M/H ratio as a screening tool for thalassaemia discrimination in hypochromic anaemia.

Comparison of Automated Analyzer Generated Red Blood Cell Parameters and Histogram with Peripheral Smear in the Diagnosis of Anaemia

Introduction: Red blood cell (RBC) indices and histogramobtained from automated analyzer give an idea aboutmorphological changes in anaemia. Along with the peripheralsmear, they can be used to interpret the cause of anaemia.The aim of the present study was to correlate typing ofanaemia based on RBC indices and histograms obtained fromautomated analyzer with peripheral smear examination and togive a better approach in the diagnosis of anaemia and analysetheir limitations.Material and methods: Blood samples collected from1575 anaemic patients, over a period of one year, in theHematology laboratory, were typed for anaemia, first byparameters obtained by haematology analyzer (RBC indiceswith red cell distribution width) and then by peripheral bloodsmear findings. The correlation between the diagnosis madeby peripheral smear versus RBC indices and histogram wereanalysed to find out the significance of the mean difference invarious parameters.Results: Microcytic hypochromic anaemia (50.86%) wasthe most common followed by normocytic normochromic(25.14%), macrocytic (2.29%), dimorphic (15.43%) andhaemolytic anaemia (6.29%) as diagnosed on peripheralsmear examination. Analysis by RBC indices showed 59.43%,32%, 3.43%, 2.86% and 2.29% of microcytic hypochromic,normocytic normochromic, macrocytic, dimorphic andhaemolytic anaemia respectively. Out of 801 (50.86%) casesof microcytic hypochromic anaemia on smear, 513(32.5%)revealed left shift while 288 (18.3%) showed broad-basedcurve on the histogram. In normocytic normochromic anaemia,anormal bell-shaped curve was seen in 378 cases (25%)while 18 cases (1.1%) showed the broad curve. Histogramsin macrocytic anaemia show a right shift in 27 cases (1.7%)while 9 cases (0.6%) showed left shift. In dimorphic anaemia,the histogram was bimodal only in 2.9% of cases whereas amajority (11.4%) showed broad-base histogram.Conclusion: Histogram and RBC indices give valuableinformation, but peripheral smear examination remains theimportant diagnostic tool in haematological disorders.

Segurança do paciente: alterações da hemoglobina e ferro sérico após lipoaspiração e/ou abdominoplastia / Patient safety: changes in hemoglobin and serum iron after liposuction and/or abdominoplasty

Introdução: A lipoaspiração é o sendo segundo procedimento mais realizado no Brasil. Com os avanços da técnica, melhores equipamentos e aumento da segurança no ambiente cirúrgico, passaram-se a ser lipoaspiradas grandes áreas. Contudo, existe uma preocupação com a segurança do paciente. Comitês de segurança têm feito recomendações sobre a infiltração, anestesia, seleção do paciente, volume aspirado, entre outros. A Sociedade Brasileira de Cirurgia Plástica e o Conselho Federal de Medicina também determinaram parâmetros de volumes de segurança do aspirado e superfície corporal aspirada. Ainda assim, a literatura de apoio para as recomendações é escassa. O objetivo é avaliar as alterações dos níveis de hemoglobina, ferro sérico e proteínas totais no pré e pós-operatório mediato (7-10 dias), assim como seus reflexos nos pacientes. Métodos: Realizamos um estudo prospectivo, com pacientes submetidos à lipoaspiração isolada e associada à dermolipectomia abdominal, por indicações estéticas. Avaliamos 30 pacientes, sendo coletados dados demográficos, peso, Índice de Massa Corporal, níveis de hemoglobina, ferro sérico e proteínas totais, no pré-operatório, e entre 7 a 10 dias de pós-operatório. Resultados: A queda da hemoglobina foi entre 2-6g/dl, com média de 3,1g/dl aos 7-10 dia de PO. Tivemos como valor mínimo de hemoglobina 7,8g/dl no pós-operatório com 7-10 dias, enquanto o ferro sérico apresentou redução média de 44,87g/dl. Conclusão: A redução no nível da hemoblogina foi responsável pela sintomatolgia clinica apresentada. A reposição de ferro se mostrou necessária no pós-operatório imediato.

Introduction: Liposuction is the second commonest procedure performed in Brazil. The scope for liposuction has broadened with advances in the technique, with better equipment, and increased safety in the surgical environment. However, there are concerns about patient safety. Safety committees have made recommendations on various aspects of the procedure including infiltration, anesthesia, patient selection, and aspirated volume. The Brazilian Society of Plastic Surgery and the Federal Council of Medicine have also determined the parameters for aspiration safety volumes, and for the aspiration of body surface. However, supporting literature for the recommendations is scarce. The objective is to evaluate changes in hemoglobin, serum iron, and total protein levels in the peri-operative days (between 7 and 10 days), in addition to its impact in patients. Methods: We performed a prospective study, with patients submitted to either liposuction alone, or in conjunction with abdominal dermolipectomy for esthetic indications. We evaluated 30 patients, collecting their demographic data, weight, body mass index, hemoglobin, serum iron, and total protein levels in both, the pre-operative period, and between 7 and 10 post-operative days. Results: The fall in hemoglobin levels were between 2 and 6 g /dL, with an average of 3.1 g /dL between 7 and 10 post-operative days . A minimum hemoglobin value of 7.8 g/dL was noted between 7 and 10 days after surgery, while the mean reduction of serum iron was found to be 44.87 g/dL. Conclusion: The reduction in hemoglobin levels was responsible for the clinical symptoms. Iron supplementation was required in the immediate post-operative period.

Prevalence of anemia in schools of the metropolitan region of Curitiba, Brazil

ABSTRACT Background: Anemia during childhood is one of the biggest public health problems worldwide, including Brazil. Insufficient or abnormal production of hemoglobin, loss of iron and excessive destruction of red blood cells are the most common causes of anemia. Among the reasons of anemia, iron deficiency accounts for 50% of anemia cases in developing countries. Affected individuals present a wide range of clinical problems, including delayed neuropsychomotor progression, impaired cellular immunity and reduction of intellectual capacity. This study aimed to evaluate the prevalence of anemia in children attending public schools in the metropolitan region of Curitiba, Paraná, Brazil. Method: A retrospective study was conducted of 409 children aged 8-12 years old included in an extension project of the Universidade Federal do Paraná. The results of complete blood count and hemoglobin electrophoresis of all children were evaluated. Anemia was considered when the hemoglobin levels were <11.5 g/dL. Results: The prevalence of anemia was found to be 2.2% of the population studied, with hypochromic microcytic anemia being the most common type. Seven children had sickle cell trait and one had β-thalassemia. Conclusion: The prevalence of anemia in this study was considered normal according the World Health Organization classification, which is different from the data found in other Brazilian regions.

Serum Ferritin and Severity Scores in Sickle Cell Disease Patients in Nnewi (South East Nigeria).

Background: Sickle cell disease (SCD) patients have mechanisms that are thought to protect them more than apparently normal individuals from iron deficiency. However, evidence exists that in SCD, hypoferritinaemia may be more prevalent than hyperferitinaemia, especially in developing countries. Methods: Serum ferritin (SF) levels were measured - using an ELISA based kit (Biocheck, USA), and disease severity calculated in fifty- two asymptomatic steady state (ASS) SCD patients; who were iron chelation naive and both parameters correlated. Erythrocyte morphology and malaria parasitaemia were assessed, patients with parasitaemia were excluded. 64 apparently normal individuals in the same environment and socioeconomic group were also assessed as above and served as controls. Statistical analysis was done using SPSS version 20. Results were expressed as means and standard error of mean. Level of significance was set at p= 0.05. Results: 30.7% and 7.6% of the test subjects had hypoferritinaemia and hyperferritinaemia respectively compared to controls, where 56% had hypoferritinaemia and none had hyperferritinaemia. Erythrocyte morphology showed hypochromia and microcytosis to different degrees in all test subjects assessed: 1+ (10.5%), 2+ (63.2%) and 3+ (26.3%), while only 5% of controls had hypochromia and microcytosis. Blood transfusion and age did not seem to significantly affect SF levels (p= 0.65 and 0.93) respectively. SF levels increased progressively with disease severity but didn’t reach statistical significance (p=0.29). Conclusion: The results suggest that hypoferritinaemia is more prevalent than hyperferitinaemia, and that SF levels may be a useful index for computing an objective severity score in SCD management. Anaemia of chronic inflammation may cause a significant part of the anaemia in SCD.

Iron-deficiency anemia in children: from diagnosis to treatment

Iron-deficiency anemia (IDA) is the most frequent hematologic and nutritional disorder in children. The risk factors associated with IDA in children are rapid growth with inadequate dietary iron, low birth weight, premature birth, perinatal bleeding, early cow's milk intake, and breastfeeding beyond 6 months without iron supplementation. Blood loss is also an important cause of IDA. Most children with IDA are asymptomatic and may go undiagnosed. The diagnosis of IDA is confirmed by microcytic hypochromic anemia and a low level of serum ferritin. Monitoring the response to iron supplementation is a reasonable intervention for a clinically stable child with mild anemia and inadequate iron intake. IDA must be differentiated from the anemia that arises from chronic disease and thalassemia. Oral iron is usually recommended as first-line therapy. Parenteral iron is indicated in cases of poor compliance or failure of oral iron, intestinal malabsorption, or chronic bleeding.

Microcytic hypochromic anemia: Should high performance liquid chromatography be used routinely for screening anemic and antenatal patients.

Background: Hemoglobinopathies are the most common inherited red cell disorders worldwide. Identification of these disorders is immensely important epidemiologically and for improved management protocols. Aim and Objectives: Our aim was to determine the prevalence of hemoglobinopathies in patients with microcytic hypochromic anemia and to assess the suitability of using high performance liquid chromatography (HPLC) routinely for screening antenatal cases and patients with anemia. Materials and Methods: A total of 4335 cases received from Mar 2007 to Nov 2011 were studied for various hemoglobinopathies and variants on BIO RAD ‘VARIANT’ analyzer. Results: Of the 4335 cases studied, 2119 were antenatal cases, 1710 patients with other disorders and 506 family studies. Of these, 688 cases displayed abnormal hemoglobin fractions on HPLC of which 140 were antenatal women. There were 455 cases of  thalassemia trait, 24 thalassemia major, 20 thalassemia inter-media, 54 sickle cell trait, fi vesickle cell disease, 21 double heterozygous  thalassemia–sickle cell trait, nineand 4 Hb D- Punjab heterozygous and homozygous respectively, three Hb D  Thalassemia trait, 20 and 37 Hb E homozygous and heterozygous respectively, three Hb E  Thalassemia trait and four cases of Hb Q India. Twenty nine adults had isolated HbF elevation. Conclusion: Our study found a high prevalence (15.8%) of hemoglobinopathies amongst microcytic hypochromic anemia and antenatal cases. An accurate diagnosis helps in preventing unnecessary iron loading. Screening all antenatal cases with anemia helps in timely antenatal counseling, thus preventing the psychological trauma of bearing a transfusion dependent child for life.

A Case of Waardenburg Syndrome Type 4

PURPOSE: To report the first case of Waardenburg syndrome type 4 in Korea. CASE SUMMARY: A 3-year-old boy visited our clinic to have his abnormal right eye iris color checked. The patient had a previous operation Hirschsprung's disease. In addition, his older sister and aunt showed similar ocular findings. A general physical examination, hearing test, and fundus examination were performed. On examination, hypochromic heterochromic iridum, albinism of the posterior pole upon ipsilateral fundus, and dystopia canthorum were found. There was no abnormal finding in the hearing test. CONCLUSIONS: The patient showed hypochromic heterochromic iridum, dystopia canthorum, and albinism of ipsilateral fundus. He also had a family history of Waardenburg syndrome and had surgery associated with congenital megacolon. The patient was diagnosed with Waardenburg syndrome type 4.

Analysis of the efficacy and safety of erythropoietin for anemia in patients with chronic heart failure / 中国基层医药

ObjectiveTo analyze the efficacy and safety of erythropoietin for anemia in patients with chronic heart failure.Methods66 cases with chronic heart failure were randomly divided into the observation group and the control group.The control group was treated with conventional anti-anemia iron treatment,and the observation group was taken erythropoietin therapy treatment on the basis of the control group.Both of the two groups were treated for 8 weeks continuously.ResultsThere were statistically significant differences between the two groups of patients after 8 weeks of treatment,cardiac function had improvement after treatment than before treatment (P ＜ 0.05 ).The observation group was significantly superior than the control group.The blood data in the two groups were compared,the Hb,RBC of the observation group were significantly increased compared with before treatment,the difference was significant (P ＜ 0.05).The RBC level did not change significantly in the control group before and after treatment.The electronic patient data in the two groups were compared,the LVEF,FS in the observation group and control group improved significantly compared with before treatment,but improvement of the observation group was significantly better than control group.The degree of improvement in the two groups were compared,the difference was significant( P ＜0.05).The SV,CO in the two groups were compared,it increasedsignificantly than before treatment,the difference was significant(P ＜ 0.05).The SV,CO before and after treatment in the control group didn't improve significantly.The E/A before and after treatment didn't improve significantly.The incidence of adverse drug reactions in the two groups showed no significant difference.ConclusionThe level of anemia had a direct impact on the degree of heart function classification.Following the usual treatment of heart failure,taking erythropoietin for anemia in patients with chronic heart treatment could significantly improve the treatment of patients with curative effect,with the advantages of safe,widely used for clinical application.

Nutritional anemia and its epidemiological correlates among women of reproductive age in an urban slum of Bhubaneswar, Orissa.

The present cross-sectional study involving 240 women of reproductive age as the study population was carried out in the beneficiary slum area, the field practice area of Community Medicine department to find out the burden of nutritional anemia and study its epidemiological correlates. The prevalence of anemia was found to be 60.8%, of which 39.6, 20.0 and 1.2% women had mild, moderate and severe anemia, respectively. Almost 63, 21.2 and 15.7% of the study subjects had microcytic hypochromic picture, indicative of iron deficiency anemia, normocytic hypochromic picture suggestive of early stage of iron deficiency anemia and dimorphic/ macrocytic hypochromic anemia implying iron deficiency anemia and or folate/vitamin B12 deficiency respectively. Statistical analyses have shown that epidemiological factors like age, education of respondents, socioeconomic status, history of excessive menstrual bleeding and inadequate intake of green leafy vegetables and pulses were found to be significantly associated with anemia.

Reticulocyte Indices for the Differential Diagnosis of Anemia of Chronic Disease and Iron Deficiency Anemia in Adult Women with Microcytic Hypochromic Anemia

BACKGROUND: Iron deficiency anemia (IDA) is the most common anemia followed by anemia of chronic disease (ACD). Reticulocyte indices have been shown to be helpful indicators for detecting IDA. We investigated whether RBC and reticulocyte indices can be used to differentiate ACD from IDA. METHODS: A total of 85 women showing microcytic hypochromic anemia (38 IDA and 47 ACD cases) were enrolled. IDA was defined as those with ferritin level of 450 microg/dL. ACD was defined as ferritin level of > or =6 microg/dL, TIBC of or =24.6 pg could be used to differentiate ACD from IDA with 85.1% sensitivity and 81.6% specificity. CONCLUSIONS: The reticulocyte indices, especially CHr, are useful for the differential diagnosis of microcytic hypochromic anemias, ACD and IDA.

Diagnóstico laboratorial da deficiência de ferro: [revisão] / Laboratory diagnosis of iron deficiency anemia: [review]

A deficiência de ferro é a causa mais comum de anemia e, em geral, o diagnóstico laboratorial é feito sem grandes dificuldades, usando-se testes simples e rotineiramente disponíveis pelos laboratórios em geral. A interpretação dos resultados, no entanto, deve ser feita cuidadosamente, tendo em mente as limitações e interferentes de cada reação. Nessa revisão serão apresentados os testes que auxiliam na investigação da deprivação de ferro, com algumas noções técnicas e comentários sobre a interpretação dos mesmos.

Iron deficiency is the most common cause of anemia and, in general, the diagnosis is easily established by simple tests that are routinely available in general laboratories. The interpretation of results, however, must be carefully carried out keeping in mind the limitations and interference in each reaction. This review presents the tests that assist in the investigation of iron deficiency, with some technical aspects and comments on their interpretation.

A Case of Severe Anemia by Necator americanus Infection in Korea

This report describes clinical and parasitological findings of an 82-yr-old female patient who lived in a local rural village and suffered from severe chronic anemia for several years. She was transferred to the National Police Hospital in Seoul for management of severe dyspnea and dizziness. At admission, she showed symptoms or signs of severe anemia. Gastroduodenoscopy observed hyperemic mucosa of the duodenum and discovered numerous moving roundworms on the mucosa. Endoscopy isolated seven of them, which were identified as Necator americanus by characteristic morphology of cutting plates in the buccal cavity. The patient was treated with albendazole and supportive measures for anemia, and her physical condition much improved. This case suggests the possibility that hookworm N. americanus is still transmitted in a remote local mountainous area in Korea.

O papel do RDW, da morfologia eritrocitária e de parâmetros plaquetários na diferenciação entre anemias microcíticas e hipocrômicas / The role of RDW, erythrocyte morphology and platelet parameters in the differentiation between microcytic and hypochromic anemias

As anemias microcíticas e hipocrômicas atingem grande parcela da população mundial. Entre estas, significativa porcentagem de casos se deve à deficiência do ferro, enquanto em algumas regiões a frequência de talassemia menor se torna importante. Por outro lado, a anemia de doença crônica é a causa mais comum de anemia em pacientes hospitalizados. O diagnóstico diferencial destas doenças é clinicamente importante, e é atualmente realizado através dos exames padrão ouro envolvendo a avaliação do metabolismo do ferro e dosagem de HbA2. Embora dotados de grande utilidade, estes testes podem apresentar uma metodologia mais demorada e onerosa que, em casos de concomitância de doenças, comuns na prática clínica, não conseguem proporcionar um correto diagnóstico. Na tentativa de otimizar e direcionar o diagnóstico destas anemias, o uso de alguns parâmetros derivados dos modernos contadores automáticos tem sido sugerido. Neste estudo, o papel do RDW, parâmetros plaquetários (número de plaquetas, PDW, VPM) e morfologia eritrocitária como parâmetros diferenciadores, foi avaliado em um grupo de 159 pacientes portadores de anemia microcítica e hipocrômica devido à deficiência do ferro, anemia de doença crônica e talassemia beta menor, comprovado pelos exames padrão ouro. Foi possível observar que o RDW não se mostrou um bom discriminante, enquanto o índice plaquetário PDW pode ser um parâmetro auxiliar no diagnóstico diferencial das anemias microcíticas e hipocrômicas. Com relação às alterações morfológicas dos eritrócitos, o pontilhado basófilo foi um achado bastante comum apenas em pacientes portadores de talassemia beta menor, com indícios de potencial utilidade na elucidação de casos de microcitose.

Microcytic and hypochromic anemias affect many people worldwide. A significant percentage of cases are due to iron deficiency, while in certain regions the frequency of thalassemia minor is important. On the other hand, anemia of chronic disease is the most common cause of anemia in hospitalized patients. Differential diagnosis between these anemias, currently established by using gold standard tests involving evaluation of iron metabolism and measurement of HbA2, is of clinical importance. Although very useful, these tests are time consuming and onerous. In cases of concomitant diseases, a common finding in the clinical practice, these tests are unable to provide a correct diagnosis. In an attempt to optimize diagnosis of these anemias, the use of some parameters derived from modern automated blood count analyzers has been suggested. In this study, the role of RDW, platelet parameters (platelet number, PDW, MPV) and erythrocyte morphology as differentiating parameters were evaluated in a group of 159 patients diagnosed as carriers of microcytic or hypochromic anemias due to iron deficiency, anemia of chronic disease and â-thalassemia minor, as confirmed by gold standard tests. The RDW did not prove to be a good discriminator, while the platelet index, PDW, may be helpful in the differential diagnosis of microcytic and hypochromic anemias. Regarding the red cell morphologic alterations, basophilic stippling was a quite common finding just in patients with â-thalassemia minor, suggesting it to be a potential marker for elucidating cases of microcytosis.

Type 3 Waardenburg Syndrome

PURPOSE: We report a case of Type 3 Waardenburg syndrome accompanied by intermittent exotropia, which had not previously been encountered in Korea along with the literature study. METHODS: A 5-year-old boy visited as a result of hypochromic heterochromic iridum in the right eye. Suspecting Type 3 Waardenburg syndrome, plain radiography, a hearing test, an alternate prism cover test and fundus examinations were performed and the presence of lateral displacement of the lacrimal puntum was evaluated. RESULTS: The presence of hypochromic heterochromic iridum, dysplasia of the left thumb, sensorineural deafness, dystopia canthorum along with a lateral displacement of the lacrimal puntum, albinism of the posterior pole upon a fundus examination, and intermittent exotropia with a 20 prism diopters of deviation were found. CONCLUSIONS: This patient showed the 4 criteria for a diagnosis of Type 3 Waardenburg syndrome including hypochromic heterochromic iridum, dystopia canthorum along with lateral displacement of the lacrimal puntum, sensorineural deafness, and a muscular system abnormality, i.e., dysplasia of the left thumb. He also showed intermittent exotropia.

Hematologic Characteristics and Hemoglobin Fraction Analysis by High Performance Liquid Chromatogaphy in Patients with Hypochromic Microcytosis: Trials for Detection of beta-thalassemia / 대한진단검사의학회지

BACKGROUND: In Korea, more than 20 cases of beta-thalassemia have been reported up to date. To detect -thalassemia. Hemoglobin (Hb) fractions were measured in patients with hypochromic microcytosis, and we analyzed the hematological characteristics of these patients. METHODS: Among 359, 369 CBCs performed at Asan Medical Center, 229 patients (0.064%) showed hypochromic microcytosis with less than 75 fL of mean corpuscular volume (MCV), less than 24 pg of mean corpuscular hemoglobin (MCH), and less than 18% of red cell distribution width (RDW). We analysed Hb fractions using high performance liquid chromatography (VARIANT(TM) Hemoglobin Testing System). Iron, total iron binding capacity (TIBC), ferritin, and reticulocyte counts were measured and medical history was searched on cases with Hb A2 and F fractions more than 3.5% and 2.0%, respectively. RESULTS: Among the 229 patients with hypochromic microcysis, 44 (19.2%) showed an increased level of Hb A2 and/or F fractions. With the exclusion of 28 patients (23 children <2 years old and 5 pregnant women), 16 (7.0%) showed a significantly increased level of Hb A2 and/or F. However, all 16 patients were diagnosed as having iron deficiency anemia based on their iron status and clinical findings. Three patients who had an increased level of Hb F at more than 5% needed a further study and follow-up to rule out the diagnosis of the hereditary persistence of the fetal hemoglobin. CONCLUSIONS: No thalassemia cases were found in the study. Incidence of beta-thalassemia should be very low, less than 1/359, 369 (0.00027%), in South Korea; a larger population should be screened to detect beta-thalassemia.