Clinical study on combined "lanzhou prescription" for the treatment of "syndrome of heat-toxin congestion and excessiveness" in children with acute aplastic anemias.

Purpose: The clinical efficacy of "Lanzhou prescription" plus or minus combined with western medicine in the treatment of children with acute aplastic anemia, 'excessive accumulation of heat toxin', was comprehensively and objectively evaluated. Methods: Sixty children diagnosed with acute aplastic anemia, 'excessive accumulation of heat toxin' were divided into observation group (lanzhou prescription plus or minus combined with immunosuppressive therapy) and control group (immunosuppressive therapy alone). The relief degree of clinical symptoms and signs and the change of laboratory indicators were taken as the evaluation criteria. Results: (1) After treatment, the results of remission rate of two groups treated by western medicine shows that the remission rate of the observation group was significantly higher than the control group (P< 0.05). (2) the 'cure rate' of the observation group treated for 6 months was significantly higher than treated for 3 months (P<0.05). (3) After treated for 6 months, the indexes of CD34+ cells and FOXP3+ regulatory cells in bone marrow of observation group increased, while the CD8+ cells and B cells decreased significantly, and the indexes of CD3+ cells, CD4+ cells and NK cells decreased somewhat(P<0.05). Conclusion: Compared with immunosuppressive therapy, lanzhou prescription plus or minus combined with immunosuppressive therapy can alleviate the clinical symptoms and signs of children more effectively, obviously improve the Traditional Chinese Medicine symptoms of children, and help bone marrow hematopoietic stem cells gradually restore hematopoietic function.

Prevalence of anemia in pediatric patients of traumatic brain injury and problems associated with management in a developing country: Unfolding of an underrated comorbidity.

BACKGROUND: Pediatric anemia has a high prevalence in developing countries such as Pakistan. It is common knowledge among hospital specialties but little is done to manage this condition by hospitalists. The issue is compounded with a poor primary care infrastructure nationally. The aim of this study is to bring to light the high prevalence of anemic children in neurosurgery and to describe the difficulties in managing their anemia in a tertiary hospital setting. A literature review is presented highlighting the socioeconomic difficulties that contribute to this widespread comorbidity and the difficulty in managing it from a hospital specialty point of view. METHODS: A prospective descriptive case series was carried out between March 2020 and September 2020. All patients under the age of 13 who presented to our department for traumatic brain injury (TBI) meeting our inclusion and exclusion criteria were enrolled and assessed for the presence and severity of anemia. Demographic data were collected. Following discharge, patients were referred to our hospital's pediatrics' anemia clinic which was before their first neurosurgery follow-up 2 weeks following discharge and attendance to follow up was documented. RESULTS: The prevalence of anemia was 78.9%. Over 95% of patients attended their neurosurgery follow-up but only 28% of patients attended their referral to the anemia clinic. CONCLUSION: Anemia is highly prevalent in children presenting to neurosurgery for TBI and its longitudinal management has difficulties with lost to follow up in a tertiary hospital setting. There is a need for national initiatives to reduce the prevalence of anemia but concurrently better strategies need to be devised to manage anemic children in a hospital setting.

How Effective Is Iron Supplementation During Pregnancy and Childhood in Reducing Anemia Among 6-59 Months Old Children in India?

Objectives: The study sought to identify whether iron and folic acid supplementation of pregnant women and preschool children is associated with child's anemia status and the predictors of anemia among children in India. Design: Secondary data analysis was performed using the National Family Health Survey 4 data. Multivariable logistic regression was used to identify the adjusted associations between child's anemia status and iron supplementation, both during pregnancy and childhood. Also, a model of significant predictors of anemia among children was fitted. Setting: India. Participants: Youngest children (6-59 months) in families. Results: The adjusted association between supplementation during pregnancy and child's anemia status was significant (p = 0.010), whereas the adjusted association between supplementation during childhood and child's anemia status was insignificant (p = 0.16). The variables independently associated with anemia status of the child included younger age (95% CI 2.67-2.86), child's recent diarrhea (95% CI 1.02-1.14), low birth weight (95% CI 1.17-1.27), current underweight (95% CI 1.14-1.28), diet diversity score (95% CI 0.96-0.98), higher birth order (95% CI 1.01-1.05), mother's current anemia (95% CI 1.68-1.81), months of breastfeeding (95% CI 0.99-1.00), no/primary education (95% CI 1.23-1.35), family's low wealth index (95% CI 1.11-1.23), and backward caste (95% CI 1.04-1.14). Conclusions: The National Iron Plus Initiative strategy of child's iron supplementation should be evaluated to identify the reasons of its ineffectiveness in anemia reduction. In addition, vulnerable groups of children, i.e., children from poor and less educated families and those with low birth weight, higher birth order, and poor nutritional status, should be targeted first with anemia reduction interventions.

Is the prevalence of anemia in children living at high altitudes real? An observational study in Peru.

Anemia diagnosis in populations residing at high altitude (HA) involves an adjustment of hemoglobin (Hb) values owing to the increase in its concentration with altitude. The suitability of the adjustment has been questioned since Hb concentrations depend on how adapted a population is to HA. In Peru, anemia in preschool children (PSC) is a matter of severe public concern for its high rates; in the city of Puno (∼3800 MASL), for example, 67.7% of children under 3 years are diagnosed with anemia. Here, we conducted an observational study in PSC living at different altitudes in Puno to assess Hb, iron status, and the suitability of altitude-adjusted Hb values in defining iron deficiency anemia. After adjusting Hb, 65.66% of the population had anemia, while only 4.8% of PSC had anemia when using unadjusted Hb. Receiver-operating characteristic curves using total body iron (TBI) as a marker of iron status are presented. In the 36- to 59-month age group, unadjusted Hb performed better than altitude-adjusted Hb. In the 6- to 35-month age group, anemia (adjusted or unadjusted) was not associated with TBI. We conclude that Hb adjustment by altitude is not appropriate. Anemia at an early age is not entirely attributable to iron deficiency.

Efficacy and Safety of Jianpi Shengxue Granule Alone or Combined with Iron Supplement versus Iron Supplement Alone in the Treatment of Iron Deficiency Anemia in Children ：A Meta-analysis / 中国药房

OBJECTIVE： To systematically review the efficacy and safety of Jianpi shengxue granule alone or combined with iron supplement versus iron supplement alone in the treatment of iron deficiency anemia in children， and to provide evidence-based reference for iron deficiency anemia in children. METHODS： Retrieved from PubMed， Embase， Medline， Scifinder， Cochrane library， CJFD， VIP and Wanfang database during database establishment to Nov. 2018， RCT about efficacy and safety of Jianpi shengxue granule alone or combined with iron supplement （trial group） versus iron supplement alone （control group） in the treatment of iron deficiency anemia in children were collected. After the data were extracted from clinical studies that met the inclusion criteria， and the quality was evaluated with Cochrane System Evaluator Manual 5.1.0， Meta-analysis was conducted by using Rev Man 5.3 statistical software for total response rate， cure rate， the levels of hemoglobin （HB）， mean corpuscular volume （MCV）， mean corpuscular hemoglobin （MCH）， serum iron （SI）， serum ferritin （SF） elevation， the incidence of ADR. RESULTS： Totally 19 RCTs were enrolled， involving 2 259 patients. Results of Meta-analysis showed that total response rate [OR＝6.73， 95％CI （4.68， 9.68）， P＜0.001]， cure rate [OR＝2.51， 95％CI （2.06，3.06）， P＜0.001]， HB increased levels [MD＝8.91， 95％CI （6.13，11.68）， P＜0.001]， MCV increased levels [MD＝9.13， 95％CI （5.32，12.95）， P＜0.001]， MCH increased levels [MD＝2.95， 95％CI （1.75，4.15）， P＜0.001]， SI increased levels [MD＝3.66， 95％CI （2.77， 4.55）， P＜0.001]， SF increased levels [MD＝10.82， 95％CI （9.18，12.45）， P＜0.001] and the incidence of ADR [OR＝0.49， 95％CI （0.33，0.71）， P＝0.000 2] in trial group were all better than control group， with statistical significance. CONCLUSIONS： Jianpi shengxue granule alone or combined with iron supplement versus iron supplement alone can improve total response rate， cure rate， the levels of HB， MCV， MCH， SI and SF in children with iron deficiency anemia， and also decrease the incidence of ADR.

Anemia severa secundaria a excesiva extracción sanguínea en recién nacidos: un llamado de atención a los neonatólogos / Severe severe anemia to excessive blood extraction in recent Born: a call for attention to neonatologists

Contexto: Los exámenes de laboratorio son un complemento de interés como ayuda diagnóstica, tienen gran valor en las unidades de cuidados intensivos, especialmente en el área neonatal en donde los recién nacidos carecen de síntomas específicos para valorar determinadas patologías, el problema radica en que esta práctica se ha hecho rutinaria y excesiva teniendo como principal complicación la anemia. Propósito: Este estudio tiene como objetivo principal evaluar las complicaciones que se presentan debido a las repetidas extracciones sanguíneas a las que son sometidos los neonatos durante su estancia hospitalaria. Métodos: Se trata de un estudio observacional, analítico, descriptivo, prospectivo de corte longitudinal, se utilizó un formato de recolección de datos previamente validado, en donde se registraron a 220 neonatos hospitalizados en el área de neonatología del Hospital Luz Elena Arismendi que cumplían con los criterios de inclusión. Resultados: Se analizaron los datos de 220 recién nacidos, de los cuales 50% fueron a término y el otro 50% pretérmino, de ellos el 65,83% correspondió al sexo masculino y 34,17% al femenino, la principal complicación de las extracciones múltiples fue la anemia, que estuvo presente en el 46,36% de la población.Para el volumen de sangre extraída se observó que a los 5 días de vida el promedio de sangre extraído fue de 12,60 ml, volumen excesivo si se toma en cuenta la volemia aproximada de un recién nacido. Conclusiones: En el 46,36% de los neonatos se extrajo más del 10% de la volemia a los 5 días de vida, lo que aumento en 21,71 veces la probabilidad de presentar anemia iatrogénica, causando transfusiones en el 69,61% de estos pacientes de los cuales el 58,23% tenían menos de 10 días de vida al momento de la transfusión, además el 77,3% de los recién nacidos hospitalizados por más de 15 días presentaron 24,22 veces más probabilidad de desarrollar este tipo de anemia.

Context: Laboratory tests are a complement of interest as a diagnostic aid, they have great value in intensive care units, especially in the neonatal area where newborns lack specific symptoms to assess certain pathologies, the problem is that this practice has become a routine and excessive, with anemia as the main complication. Purpose: The main objective of this study is to evaluate the complications that occur due to the repeated blood extractions to which neonates are subjected during their hospital stay. Methods: This was an observational, analytical, descriptive, prospective, longitudinal study. A previously validated data collection format was used, where 220 neonates hospitalized in the neonatal area of the Luz Elena Arismendi Hospital were registered according to the inclusion criteria. Results: Data from 220 newborns were analyzed, of which 50% were full-term and the other 50% were preterm, 65.83% were male and 34.17% were female, the main complication of the multiple extractions was anemia, which was present in 46.36% of the population. Was observed that at 5 days of life the averages of blood extracted was 12.60 ml. Conclusions: In 46.36% of the neonates, more than 10% of the blood volume was extracted at 5 days of age, which increased the probability of presenting iatrogenic anemia by 21.71 times, causing transfusions in 69.61% of these patients of whom 58.23% had less than 10 days of life at the time of transfusion, in addition 77.3% of newborns hospitalized for more than 15 days were 24.22 times more likely to develop this type of anemia.

Study of the anemia status and genotype of thalassemia in preschool children in Shenzhen / 实用医学杂志

Objective To study the anemia status and genotype of thalassemia in preschool children in Shenzhen. Methods 658 preschool with anemia hospitalized in Shenzhen Longgang Maternal and Child Health Hospital from October 2012 to September 2015 were screened by complete blood analysis . The most common mutations of thalassemia genotype (17 β thalassemia genotype mutation,3 α thalassemia genotype mutation and 3α thalassemia genotype absence change) in Chinese population were detected. Results All cases have microcytic hypochromic anemia. 426 cases were identified to be thalassemia (64.7%). 23 genotypes and 13 gene mutation type were detected. The most common genotype type were SEA/αα(46%),β654/βN(15%),β41?42/βN(12.7%). And the most common allele gene mutation type were SEA (49.1%),IVS?Ⅱ?654( C→T)(14.4%),CD41?42(?TTCT)(12.4%) re?spectively. MCV and MCH of thalassemia children was significantly lower than that of children diagnosed as without thalassemia. The differences of RBC,Hb,MCV,MCH,MCHC,RBC?SD between the two groups were statistical?ly significant. Conclusion The proportion of thalassemia among preschool anemia children in Shenzhen area was high,and it is necessary to strengthen the local thalassemia prevention and decrease anemia effect on preschool children′s health.

Acquired aplastic anemia in children.

This article provides a practice-based and concise review of the etiology, diagnosis, and management of acquired aplastic anemia in children. Bone marrow transplantation, immunosuppressive therapy, and supportive care are discussed in detail. The aim is to provide the clinician with a better understanding of the disease and to offer guidelines for the management of children with this uncommon yet serious disorder.