Use of Red Cell Distribution Width Index for Screening and Differentiation of Iron Deficiency Anemia and Beta Thalassemia Trait

Background: Iron deficiency anemia (IDA) is one of the common nutritional disorders in the world. In the subcontinent Microcytic hypochromic anemia is usually caused by beta thalassemia trait (BTT) and iron deficiency anemia (IDA). IDA may be confused with BTT. It is important to distinguish between the above conditions to avoid unnecessary iron therapy in thalassemia carriers. Red cell distribution width index (RDWI) are a simple, easy, and cost effective method to get a primary and valuable information regarding the diagnosis of IDA and BTT. Objective: To assess the predictive value of Red cell distribution width index (RDWI)) for differentiation of Iron Deficiency Anaemia and Beta Thalassaemia Trait.Material & Methods:The study was a cross-sectional descriptive study which was conducted in Department of Clinical Pathology, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh. Over a period of April 2019 to September 2020. The newly clinically diagnosed cases of BTT and IDA were selected for this study. The sample size was 110. Among them 46 cases were identified as BTT and 64 were IDA. Data were analysed using a computer programme SPSS 25.0 version.Results:Total 110 respondents were included in the study. Among them 46.4% were female and 53.6% were male. About 72.72 % of respondents were aged 1 to 10 years old, while 10% were aged 11 to 20 years old and 10% were aged 21 to 30 years old. 4.54 % were between the ages of 31 to 40, as well as those over 40. The average age (SD) was 22.0 � 32.52. Mean (盨D) age was 22.0 � 32.52. RDWI had both sensitivity and specificity more than 80% in detection of BTT and IDA. Sensitivity, specificity of RDWI index for detection of BTT was found 81.0%, 83.8%. In case of IDA, sensitivity and specificity was found 83.8% and 81.0% respectively.Conclusions:The current study found that multiple discriminants can be used to differentiate between iron deficiency anemia and the Beta Thalassaemia Trait. RDWI could be a better way to tell the difference between BTT and IDA.

Safety and efficacy of video DLT (VDLT) for lung isolation during the COVID?19 pandemic

One lung ventilation (OLV) with collapse of the ipsilateral lung is a prerequisite for most thoracic surgical procedures. Double?lumen tube (DLT) is still the preferred method to isolate the lungs and fiberoptic bronchoscopy (FOB) is the gold standard for the confirmation of correct placement of the DLT. However, both these procedures are considered as a high?aerosol?generating procedures and are hazardous to the health workers, particularly at this time of the COVID?19 pandemic. We did nine thoracic surgery cases categorized as essential, requiring OLV during the ongoing period of the COVID?19 between April 2020 and May 2020 where we used Full view DLT for lung isolation. We present our case series which shows that the Full view VDLT can minimize or circumvent the use of FOB during OLV, and reduce the time taken to isolate the lungs thus reducing aerosol in the theater. None of the nine patients required FOB for confirmation of initial positioning nor for diagnosis of intraoperative malposition. The time taken to isolate the lungs was significantly less and the surgical positioning was done under real?time monitoring by visualizing the blue cuff distal to carina at all times. The real?time monitoring by the Full view VDLT offers the additional advantage of detecting any malposition even before it results in loss of isolation or desaturation. We conclude that the Full view VDLT is an efficient and safe alternative for lung isolation at this time of the COVID?19 pandemic.

Comparative analysis of constitutes and metabolites for traditional Chinese medicine using IDA and SWATH data acquisition modes on LC-Q-TOF MS / 药物分析学报

Identification of components and metabolites of traditional Chinese medicines (TCMs) employing liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-Q-TOF MS) techniques with information-dependent acquisition (IDA) approaches is increasingly frequent. A current drawback of IDA-MS is that the complexity of a sample might prevent important compounds from being triggered in IDA settings. Sequential window acquisition of all theoretical fragment-ion spectra (SWATH) is a data-independent acquisition (DIA) method where the instrument deterministically fragments all precursor ions within the predefined m/z range in a systematic and unbiased fashion. Herein, the superiority of SWATH on the detection of TCMs' components was firstly investigated by comparing the detection ef-ficiency of SWATH-MS and IDA-MS data acquisition modes, and sanguisorbin extract was used as a mode TCM. After optimizing the setting parameters of SWATH, rolling collision energy (CE) and variable Q1 isolation windows were found to be more efficient for sanguisorbin identification than the fixed CE and fixed Q1 isolation window. More importantly, the qualitative efficiency of SWATH-MS on sanguisorbins was found significantly higher than that of IDA-MS data acquisition. In IDA mode, 18 kinds of sangui-sorbins were detected in sanguisorbin extract. A total of 47 sanguisorbins were detected when SWATH-MS was used under rolling CE and flexible Q1 isolation window modes. Besides, 26 metabolites of sangui-sorbins were identified in rat plasma, and their metabolic pathways could be deduced as decarbonylation, oxidization, reduction, methylation, and glucuronidation according to their fragmental ions acquired in SWATH-MS mode. Thus, SWATH-MS data acquisition could provide more comprehensive information for the component and metabolite identification for TCMs than IDA-MS.

Assessment of Reticulocyte-haemoglobin Equivalent (Ret-He) as a Diagnostic Indicator for Iron Deficiency Anaemia

@#Introduction: Iron deficiency anaemia (IDA) is the most common cause of anaemia. The diagnosis of IDA, however, remains a challenge and is a problem worldwide. Serum iron study is commonly used for IDA diagnosis but there are some limitations. This study was conducted to evaluate reticulocyte-haemoglobin equivalent (Ret-He) as a screening tool for IDA diagnosis in adults. Method: This is a comparative case control study conducted in Hospital Tengku Ampuan Afzan, Kuantan consisting of adult patients with iron deficiency anaemia and a healthy control group. Haematological parameters (Hb, RBC count, MCV, MCH, RDW) inclusive of Ret-He and serum iron parameters (serum iron, transferrin saturation and serum ferritin) were measured. Correlation between Ret-He with other haematological and serum iron parameters were analysed. Results: There were 103 IDA adult patients with majority of them being female (85.4%) with median age of 36 years old. Malay ethnicity (79.6%) contributed to the larger proportion of adult IDA patients. The Ret-He value for patient and control groups were 16.50 ± 4.90 pg and 34.80 ± 1.97 pg, respectively. Ret-He was 89.32% sensitive and 100% specific with 100% positive predictive value (PPV) and 73.11% negative predictive value (NPV) when compared to transferrin saturation. There was significant correlation between Hb, MCH, MCV, RDW and serum iron, transferrin saturation and serum ferritin parameters with Ret-He. Conclusion: Ret-He together with a complete blood count, may serve as an alternative to the serum iron parameters for screening of IDA in adults.

A study on influence of iron deficiency anaemia over HbA1c levels

Background: Haemoglobin A1c (HbA1c) is a glycated form of haemoglobin reflects average plasma glucose over the previous 8 to 12 weeks. HbA1c can be affected by multiple non-glycaemic parameters. Iron deficiency anaemia (IDA) is one among them which is the most common type of anaemia in India. However, reports on the effects of iron deficiency anaemia on HbA1c levels are inconsistent. Hence we conducted a study to find out the influence of iron deficiency anaemia over HbA1c levels. Methods: 120 patients confirmed to have iron deficiency anaemia were enrolled in this study. HbA1c levels were measured at baseline and 3 months after treatment, and these values were compared with those in the control population.Results: The mean baseline HbA1c level in anaemic patients (4.62%) was significantly lower than that in the control group (5.45%, P<0.001). A significant increase was observed in the patients HbA1c levels at 3 months after treatment (5.82%, P<0.001). There was a significant correlation observed between haemoglobin and HbA1c level (Coefficient of correlation=0.26, P<0.01) in the study group before correction.Conclusions: In contrast to the observations of previous studies, ours showed that HbA1c levels increased with treatment of iron deficiency anaemia. This could be attributable to nutritional deficiency, racial-ethnic variations and/or certain unknown variables. Further studies are warranted.

Role of serum ferritin in differential diagnosis of anaemia along with various indices of anaemia and their haematological profile in geriatric population

Anaemia is one of the commonest hematological disorders prevalent in elderly population of either sex. WHO suggested any condition with decline of haemoglobin is considered as anaemia. Ferritin an iron storage compound is considered as a well known marker of iron storage. Therefore the present study was designed to evaluate the role of serum ferritin in differential diagnosis of anaemia along with various indices of anaemia and their haematological profile in geriatric population. Methods: Complete blood count included the following: Hb level; and white cell indices such as total leucocyte count (TLC) and differential leucocyte count, as well as corrected TLC. All investigations were carried out on an automated cell counter. Serum ferritin was estimated by automated analyser. Results: The nutrition deficiency anaemia (47.5%) was most common type of anaemia among elderly population. Further, anaemia due to chronic disease (20.2%), Marrow infiltration (8.3%) and multiple myeloma (7.1%) were recorded in the elderly population. serum ferritin level was significantly low in iron deficiency anaemia (151±88 ng/ml) compare to other types of anaemia dual defficency anaemia (157±98 ng/ml). However, ferritin was significantly high in megaloblastic anaemia (210±101 ng/ml) and anaemia of chronic diseases (204±102 ng/ml). Conclusion: Findings of the current study revealed that ferritin can be an important marker for the differential diagnosis of anaemia in elderly population. Moreover, the diagnostic accuracy may be enhanced when PBF and bone marrow findings are combined with clinical examination and other relevant investigations. Biochemical investigation of serum ferritin along with other findings might be helpful in early diagnosis along with accurate aetiology of anaemia in elderly population.

The Prevalence and Risk Factors of Iron Deficiency Anemia among Rural School children in Kudat, Sabah

Abstract@#Introduction: Iron deficiency anaemia (IDA) is the most common nutritional anaemia in the world that affects individuals in both developed and developing countries including Malaysia. The prevalence of IDA among schoolchildren is crucial to know as IDA may contribute to poor mental and school academic performance. Hence, the objective of the study was to diagnose the present prevalence of IDA and to analyse the association with probable risk factors. Methods: This cross-sectional study was carried out from August 2017 to February 2018 among 261 school children, who aged between 8 to 10 years in Kudat, Sabah, were selected through simple random sampling. After getting informed consent from the parents or guardians of the participants self-administered validated questionnaire was used to gather information regarding socio-demographic data, knowledge, attitude and practice towards iron deficiency anaemia and Food Frequency Questionnaires. The blood sample was collected for confirmation of anaemia through serum haemoglobin (Hb) concentration and determination of iron status through serum ferritin, serum iron and serum TIBC and stool samples were collected for children identified with anaemia for soil-transmitted helminths analysis. Results: Out of 82 anaemic students, 36 were suffering from iron deficiency anaemia. The BMI status, the presence of soil-transmitted helminths and level of knowledge regarding IDA had highly significant (p<0.001) association with prevalence of IDA. Conclusion: By improving the household economy, education, sanitation, and personal hygiene status and promoting consistent nutritional education among the population may help to reduce the prevalence of IDA.

Qualitative characterization of flavonoids in Scutellariae Radix by using PREC-IDA-EPI / 中国中药杂志

Flavonoids are the most abundant constituents and induce these the rapeutic effects against inflammation, gastrointestinal infections, cardiovascular diseases, and respiratory. Most of these flavonoids have low content in Scutellarie Radix. It was difficult to detect some minor compounds by using LC-MS method with full scan. Based on the review of flavonoids that had been extracted from Scutellariae Radix, a method with PREC-IDA-EPI technique was developed and applied to Scutellariae Radix by using UPLC-MS/MS. A total of 97 flavonoids were identified, including 29 aglycones and 68 -glycosides. This study laid the foundation for pharmacodynamicss of Scutellariae Radix.It is believed that an individual detection scheme based on the PREC-IDA-EPI technique could be used to identify unknown compounds.

Association of Anemia with Cerebral Venous Thrombosis in Puerperium and its Pattern of Recovery

Background: Anemia is often considered to be a risk factor for cerebral venous thrombosis (CVT). We investigated the association between anemia and CVT. Methods:  42 postpartum /puerperal females were studied retrospectively for various factors like anemia, conscious level at admission, place of delivery (home or hospital) and their neurological sequel was measured at the time of discharge. Platelets counts were also noted (to rule out thrombocytosis). Anemia was defined according to World Health Organization criteria: non- pregnant women hemoglobin < 7.5 gm/dl, pregnant women < 6.9gm/dl. Modified Rankin Score (mRS) was taken as a scale for recovery. Results: Patients with CVT were younger (mean age 28). Anemia was more frequent in 32.7%. Hemoglobin as a continuous variable was inversely associated with CVT. Platelets counts, BT CT were normal hence no thrombocytosis was seen. No gross increase in WBC count was noted indicating absence of sepsis (puerperal). Outcome was favorable in 83% patients. N=4 (7%) patients died. Conclusions: We concluded that there is a positive correlation with increased levels of HbA1c and FBS (p˂0.001) in diabetic postmenopausal women and knee osteoarthritis. we found a significant association of severe anemia and CVT in patients of CVT of non-infectious origin, although the exact mechanism leading to hypercoagulability remains unclear and had poor prognosis.

Síndrome de Cornelia. Presentación de caso de enfermería vinculado a la teoría de Ida Orlando / Cornelia de Lange syndrome. Presentation of a case of nursery related with Ida Orlando theory

En 1933, una pediatra holandesa, la Dra. Cornelia de Lange, describía dos niños con rasgos similares, hoy en día es ella a quien se le reconoce el haber descrito los síntomas que abarcan el síndrome que lleva su nombre. Es un trastorno malformativo múltiple congénito, se determina por sus características faciales en asociación con retraso del crecimiento pre y postnatal, retraso mental de nivel variable, en algunos casos, anomalías de las partes superiores, muchos de los síntomas se pueden mostrar en el nacimiento y a muy temprana edad. El proceso de atención de enfermería, es el método científico de actuación de los profesionales de Enfermería, vinculado a una base teórica que desarrollan habilidades analíticas que aplicadas en la práctica, repercuten en la mejoría de los pacientes. Se realizó este trabajo con el objetivo de presentar un caso poco frecuente del síndrome de Cornelia de Lange, ejecutando el proceso de atención de Enfermería vinculado al modelo teórico de Ida Orlando. Se trató de una paciente de 10 meses de edad, sexo femenino, raza blanca, que ingresó a los dos meses de nacida en la sala de terapia intensiva del Hospital Pediátrico Provincial Eliseo Noel Caamaño, de Matanzas. La vinculación de la teoría de Ida Orlando a este proceso de atención de Enfermería permitió una atención integral al individuo enfermo, y desarrolló las habilidades prácticas de la asistencia de Enfermería, además de fomentar el razonamiento critico en aras de brindar cuidados con calidad y enfoque científico.

In 1933, a Dutch pediatrician, PhD Cornelia de Lange described two children with similar characteristics. Nowadays she is recognized as the one who described the symptoms encompassing the syndrome named after her. It is a congenital multiple malformative disorder, determined by its facial characteristics associated to pre and postnatal grow retardation, mental retardation of variable level, and, in some cases, anomalies of the upper parts. Many of the symptoms appear at birth and at early ages. The process of nursery care is the scientific method ruling Nursery professionals’ performance, related to a theoretical basis and developing analytical skills that, practically applied, strike on patients’ improvement. This work was carried out with the aim of presenting a few frequent case of Cornelia de Lange Syndrome, performing the Nursery care process according to Ida Orlando theoretical model. It deals with female, white, 10-months patient who entered the Intensive Care Service of the Provincial Pediatric Hospital “Eliseo Noel Caamaño”, of Matanzas when she was two months. Relating Ida Rolando’s theory to this Nursery care process allowed the patient’s integral care, and developed the practical skills of Nursery care, besides promoting the critical reasoning for the sake giving a quality and scientifically focused care.

Prevalence of Iron Deficiency Anemia among Chronic Kidney Disease Patients in Kaveri Delta Region, Tamilnadu, India.

Background: Iron deficiency anemia (IDA) is the most common type of anemia. But the incidence of iron deficiency anemia in chronic kidney disease (CKD) has not been well established in Kaveri Delta Region, Tamilnadu, India. Hence, the present study has been undertaken to evaluate the prevalence of iron deficiency anemia in chronic kidney disease patients of Kaveri Delta Region, Tamilnadu, India. Materials and Methods: The present study enrolled 221 chronic kidney disease patients from a private nephrology outpatient clinic, Tiruchirappalli. All biochemical tests were done including serum ferritin. Patients were categorized into two groups based on ferritin levels. Group 1 (N: 87) considered as case and the group 2 (N: 134) patients considered as control. These two groups were compared each other respective with gender and age groups with all parameters. Results: Out of these patients, 87 belonged to iron deficiency anemia patients. Group 1 patients (Total Number of Patients: 87 Male: 29 Female: 58) showing significantly lower serum ferritin levels (15.04±12.48) than group 2 patients (88.98±47.39) (P<0.0001). Within group 1, females had lower ferritin levels (12.98±8.84) than males (17.11±10.78) in the age group of 31-40 years (P <0.0001). Conclusion: The prevalence of iron deficiency anemia among chronic kidney disease in Kaveri Delta Region was found to be 39%.

Evaluation of effectiveness of intravenous iron sucrose in antenatal patients of iron deficiency anemia.

Background: Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy. Prophylactic oral iron is recommended during pregnancy to meet the increased requirement of iron. In India, more than 50% women become pregnant with low baseline haemoglobin level resulting in high incidence of moderate to severe anaemia in pregnancy where oral iron therapy cannot meet the requirement. This study was undertaken for critical evaluation of iron sucrose in terms of efficacy, safety, and feasibility along with any reduction in blood transfusion rate. Aims & Objective: To evaluate the efficacy of intravenous Iron sucrose in antenatal patients with Iron deficiency anaemia and to study the side effects of intra venous Iron sucrose. Material and Methods: This prospective study was conducted from Nov 2012 to June 2013 at VS General Hospital, Ahmedabad. 60 antenatal patients found to have anaemia having Hb level < 9 gm% were admitted and given intravenous iron sucrose therapy 100mg alternate day after calculating the dose of the iron requirement. Results: In patients having moderate anaemia (Hb 7-9 gm%), the rise in Hb found to be 2.17 ± 0.45 gm% from pre-treatment Hb of 7.88 ± 0.58 gm% to 9.9 ± 0.53 gm%. In patients with severe anaemia (Hb < 7 gm%), the rise in Hb was observed up to 2.73 ± 0.51 (SD) gm% after 1 month of iron sucrose treatment. No major side effects or anaphylactic reactions were noted during the study period. Conclusion: Parenterally administered iron sucrose elevates Hb and restores iron stores earlier and also that intravenous iron administration has led to the reduction in the rate of blood transfusion rate.

Study of biochemical markers in iron deficiency anemia.

Background: The present study was aimed to study alterations in levels of oxidants and antioxidants in iron deficiency anemia (IDA). Methods: 30 patients of IDA in age group of 20-50 and 30 healthy subjects were included for study. Serum Iron, TIBC & Hb% were estimated to diagnose IDA. Serum Malondialdehyde (MDA), Nitric oxide (NO) as an oxidants & Superoxide dismutase (SOD), vitamin E, vitamin C, Zinc (Zn) levels as antioxidants were estimated. Results: Significant decreased levels of Hb%, serum iron, SOD, Vitamin C, vitamin E, Zn were found. TIBC, MDA, NO were significantly increased as compared to controls. Conclusion: The normal adult erythrocytes can resist oxidative stress by several antioxidant defense systems. In IDA, oxidative stress causes lipid peroxidation and membrane damage. So antioxidants can be used as a marker for prevention of membrane damage due to oxidative stress.

Cerebral Infarction Caused by Mild Head Injury in a Child with Iron Deficiency Anemia from Prolonged Breast Feeding: Case Report

A child who had iron deficiency anemia(IDA) resulted from the prolonged breast feeding presented with left side hemiparesis following mild head injury. The serial computed tomography and magnetic resonance imaging showed right internal carotid artery territory infarction. It has been generally accepted that prolonged breast feeding causes IDA. A few cases of infarction caused by IDA have been reported. A few cases of cerebral infarction caused by mild head injury have been also reported. However, few have been reported nonhemorrhagic cerebral infarction caused by mild head injury associated with IDA from prolonged breast feeding. We reviewed the literature that prolonged breast feeding causes IDA and in this case, mild head injury could cause the cerebral infarction. We think that it is important to have clinical suspicion of cerebral infarction in a child with IDA from prolonged breast feeding who has mild head injury because early diagnosis is difficult.

Treatment with IDA-FLAG (idarubicin, fludarabine, cytarabine, G-CSF) Regimen in Children with Myelodysplastic Syndrome and Relapsed/Refractory Acute Myelogenous Leukemia / 대한소아혈액종양학회지

PURPOSE: The prognosis of refractory or relapsed acute myelogenous leukemia (AML) is poor and effective reinduction regimens are rare. Myelodysplastic syndrome (MDS) is a heterogenous group of clonal disorders of hematopoiesis and the outcome for children with MDS is poor, and the optimal treatment of MDS has not been defined. This study was undertaken to investigate the therapeutic results of IDA-FLAG (idarubicin, fludarabine, cytarabine, G-CSF) in children with MDS and relapsed or refractory AML. METHODS: Eleven children with refractory or relapsed AML and ten with MDS were treated with the IDA-FLAG regimen, a combination therapy of idaraubicin (day 1~3, 12 mg/m2/day), fludarabine (day 1~5, 30 mg/m2/day), cytarabine (day 1~5, 2 g/m2/day) and G-CSF (day 0~5, 400 g/m2/day & day 12 up to ANC > 1,000/L, 5 g/kg/day). RESULTS: In AML group, they received a total 15 courses of IDA-FLAG. Complete remission (CR) was achieved in 4/11 (36.4%) with median remission duration of 3 (2~6) months. In MDS group, they received 13 courses of IDA-FLAG and 8 courses of FLAG (IDA-FLAG without idarubicin). CR was achieved in 6/8 (75.0%) with median remission duration of 4 (2~13) months. All the patients experienced grade 4 hematologic toxicities. The median duration of neutropenia (<500/ mm3) and thrombocytopenia (<30,000/mm3) was 23 days (20~46 days) and 23.5 days (16~44 days) in AML, meanwhile those were 18 days (14~30 days) and 16 days (13~32 days) in MDS, respectively. Infectious complications were the main non-hematological toxicity. Two patients died of sepsis and intracerebral hemorrhage on day 7 and 27, respectively. CONCLUSION: IDA-FLAG may be an efficient reinduction therapy for resistant and intensively pretreated AML and an effective regimen for poor prognostic MDS with acceptable toxicity, even though remission duration seems to be relatively short. Therefore, an intensified post-remission therapy seems necessary.

Study on Preparation and Identification of Immobilized Metal Ion Affinity Adsorption Gel / 生物化学与生物物理进展

Sepharose 6B was activated by epichlorohydrin in the strong base condition, and then reacted with solution of iminodiacetic sodium. The arms of IDA were conjuncted to the activated Sepharose 6B. Then the products were reacted with the solution of NiSO4. The arms of IDA were chelated with Ni2+,and the chelating resin―Ni2+-IDA could be prepared. The physicochemical indexes and performance in purifying protein of the expressing product were assayed with atomic absorption method and purifying aimed protein-human B lymphocyte stimulator(hBLyS) from the expressing products in E.coli. The results indicated that the performance of made gel is very good, and its price is less than 1/10 of that of commodity gel.

Comparison of Hemoglobin Levels between Iron-Supplemented Group and Non-Iron-Supplemented Group in Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Anemia associated with pregnancy is keen of interest to both the mother and the obstetrician and oral iron supplementation for iron deficiency anemia(IDA) during pregnancy is commonpiece. The purpose of this study is to compare the changes in hematologic parameters between iron supplemented and non-iron supplemented women just prior to and 24 hours after delivery. METHODS: A comparative study was conducted concerning the difference in hematologic changes between 30 iron-supplemented and non-iron-supplemented women, who have delivered at Yonsei University Medical School Yongdong Severance Hospital from 1999. 11. 1 from 2000. 1. 18. RESULTS: Between the iron-supplemented and the non-iron-supplemented group, no statistically significant difference was observed for the duration of gestation, neonatal birth weight and maternal age. However, the mean hemoglobin levels were 11.78mg% and 10.34mg% prior to delivery(p<0.001) and 10.52mg% and 9.59mg% 24 hours after delivery, respectively, thus showing a statistically significant decrease in the non-iron-supplemented group(p<0.001). CONCLUSION: Adequate iron supplementation during the antenatal period significantly improves the hematologic status of the mother.